Modified Blalock Taussig shunt: a not-so-simple palliative procedure.

OBJECTIVES: Thirty-two consecutive isolated modified Blalock Taussig (BT) shunts performed in infancy since 2004 were reviewed and analysed to identify the risk factors for shunt intervention and mortality. METHODS: Sternotomy was the only approach used. Median age and weight were 10.5 (range 1-74) days and 2.9 (1.9-4.4) kg, respectively. Shunt palliation was performed for biventricular hearts (Tetralogy of Fallot/double outlet right ventricle/transposition of great arteries_ventricular septal defect_pulmonary stenosis/pulmonary atresia_ventricular septal defect/others) in 21, and univentricular hearts in 11, patients. Hypoplastic left heart syndrome patients were excluded. Two procedures required cardiopulmonary bypass. Median shunt size was 3.5 (3-4) mm and median shunt size/kg body weight was 1.2 (0.9-1.7) mm/kg. Reduction in shunt size was necessary in 5 of 32 (16%) patients. RESULTS: Three of 32 (9%) patients died after 3 (1-15) days due to cardiorespiratory decompensation. Lower body weight (P = 0.04) and bigger shunt size/kg of body weight (P = 0.004) were significant risk factors for mortality. Acute shunt thrombosis was observed in 3 of 32 (9%), none leading to death. Need for cardiac decongestive therapy was associated with univentricular hearts (P < 0.001), bigger shunt size (P = 0.054) and longer hospital stay (P = 0.005). Twenty-eight patients have undergone a successful shunt takedown at a median age of 5.5 (0.5-11.9) months, without late mortality. CONCLUSIONS: Palliation with a modified BT shunt continues to be indicated despite increased thrust on primary corrective surgery. Though seemingly simple, it is associated with significant morbidity and mortality. Effective over-shunting and acute shunt thrombosis are the lingering problems of shunt therapy.

Magnetic field scaling of relaxation curves in small particle systems

We study the effects of the magnetic field on the relaxation of the magnetization of smallmonodomain noninteracting particles with random orientations and distribution of anisotropyconstants. Starting from a master equation, we build up an expression for the time dependence of themagnetization which takes into account thermal activation only over barriers separating energyminima, which, in our model, can be computed exactly from analytical expressions. Numericalcalculations of the relaxation curves for different distribution widths, and under different magneticfields H and temperatures T, have been performed. We show how a T ln(t/t0) scaling of the curves,at different T and for a given H, can be carried out after proper normalization of the data to theequilibrium magnetization. The resulting master curves are shown to be closely related to what wecall effective energy barrier distributions, which, in our model, can be computed exactly fromanalytical expressions. The concept of effective distribution serves us as a basis for finding a scalingvariable to scale relaxation curves at different H and a given T, thus showing that the fielddependence of energy barriers can be also extracted from relaxation measurements.

Growth and Nutrition of Eucalypt Rooted Cuttings Promoted by Ectomycorrhizal Fungi in Commercial Nurseries

ABSTRACT Ectomycorrhizal fungi (EMF) may improve the adaptation of eucalypts saplings to field conditions and allow more efficient fertilizer use. The effectiveness of EMF inoculum application in promoting fungal colonization, plant growth, nutrient uptake, and the quality of rooted cuttings was evaluated forEucalyptus urophylla under commercial nursery conditions. For inoculated treatments, fertilization of the sapling substrate was reduced by 50 %. The experiment was carried out in a completely randomized design in a 4 × 4 factorial arrangement, wherein the factors were inoculum application rates of 0 (control), 5, 10, and 15 gel beads of calcium alginate containing the vegetative mycelium of Amanita muscaria, Elaphomyces antracinus, Pisolithus microcarpus, andScleroderma areolatum, plus a non-inoculated treatment without fertilization reduction in the substrate (commercial). Ectomycorrhizal fungi increased plant growth and fungal colonization as well as N and K uptake evenly. The best plant growth and fungal colonization were observed for the highest application rate. The greatest growth and fungal colonization and contents of P, N, and K were observed at the 10-bead rate. Plant inoculation with Amanita muscaria, Elaphomyces anthracinus, and Scleroderma areolatum increased P concentrations and contents in a differential manner. The Dickson Quality Index was not affected by the type of fungi or by inoculum application rates. Eucalypt rooted cuttings inoculated with ectomycorrhizal fungi and under half the amount of commercial fertilization had P, N, and K concentrations and contents greater than or equal to those of commercial plants and have high enough quality to be transplanted after 90 days.

Preparing Tomorrow's Transportation Workforce: A Midwest Summit, 2010

regional transportation workforce development summits held across the United States in 2009 and 2010 as part of a coordinated initiative to ultimately develop a national strategy to address future transportation workforce issues. The initiative is being led by the U.S. Department of Transportation’s (DOT) Research and Innovative Technology Administration (RITA). This particular summit was hosted by Iowa State University’s Midwest Transportation Consortium (MTC) and Institute for Transportation (InTrans). The purpose of the Midwest summit was to assess the educational and training needs of the future transportation workforce and identify strategies to address those needs across various career paths. It addressed a broad spectrum of topics including strategies to attract women and under-represented minority groups, pre-college opportunities and strategies, post-secondary education, post-college continuing education, professional licensure, and specific industry perspectives. The goals of the summit were (1) to gain an improved understanding of the transportation workforce needs of Iowa and the surrounding states and (2) to identify best practices in addressing the workforce development needs. This event had two tracks: one focused on pre-college education and the other focused primarily on college education and practitioners. Attendees provided a good cross-section of the larger transportation industry. From what was learned at the summit, Iowa State University, like other regional hosts, can develop a “profile of needs” for Iowa including specific job categories over specific time horizons. The summit was also successful in identifying best practices in addressing the workforce needs that can be utilized by us and others as potential tools or in a “national-level list of attributes.” Each regional summit has provided some guidance in developing statewide profiles. The collection of best practices or tools from all the regional summits can be shared and applied to address state (or regional) needs profiles to attract, develop, and retain an effective workforce.

Endocytosis, autophagy and JNK inhibition in neuroprotection against excitotoxicity and neonatal cerebral ischemia

Abstract : Neonatal stroke occurs in 1 out of 4000 live births and usually leads to serious motor and cognitive disabilities. Ischemic brain injury results from a complex of pathophysiological events that evolve over space and time making it difficult to devise successful therapy. To date, there are no effective treatments for perinatal brain damage. Most clinical trials of neuroprotectaot drugs have failed because of their side-effects. For this reason it is important to find ways to target drugs specifically into the stressed cells. In this study we plan to contribute to the development of an efficient neuroprotective strategy against excitotoxic cell death in the neonate. In order to achieve this goal, several strategies were followed. A recently described phenomenon of induced endocytosis associated with excitotoxicity was more deeply investigated. As a simplified model we used dissociated cortical neurons exposed to an excitotoxic dose of NMDA, and we showed that this phenomenon depends on clathrin and dynamin. Using a model of neonatal focal cerebral ischemia, we demonstrated that the excitotoxicity-related endocytosis targets molecules such as TAT peptides into stressed neurons. These appear to be viable, raising the possibility of using this phenomenon as a doorway for neuroprotection. One part of the project was devoted to the study of the TAT-conjugated JNK inhibitory peptide, D-JNKI1. Adose-response study showed strong neuroprotection over a wide dose-range in the case of delayed administration (either intravenous or intraperitoneal). Since D-JNKI1 is aTAT-linked peptide, we investigated the role of its own NMDA-induced endocytosis in its neuroprotective efficacy. Furthermore, we showed that this endocytosis is JNK dependent, and that D-JNKI1 regulates its own uptake. We additionally studied the different types of cell death involved in a model of neonatal focal cerebral ischemia. Necrosis occurred rapidly in the center of the lesion whereas apoptosis and autophagic cell death occurred late at the lesion border. Inhibiting apoptosis was not protective, but use of autophagy inhibitor 3methyladenine provided a strong neuroprotection. Finally, combining two neuroprotectants that target different intracellular pathways was neuroprotective in a severe model of cerebral ischemia where neither of the drugs was efficient when administered individually. Résumé : L'ischémie néonatale connaît une incidence de 1 naissance sur 4000, entraînant généralement de sérieux dysfonctionnements moteurs et cognitifs. L'ischémie cérébrale résulte d'évènements physiopathologiques complexes qui évoluent dans l'espace et le temps rendant difficile la conception de thérapies efficaces. A l'heure actuelle, aucun traitement n'existe pour lutter contre les accidents vasculaires cérébraux qui se produisent autour de la naissance. La plupart des essais cliniques concernant des molécules neuroprotectrices ont échoué du fait de leurs effets secondaires néfastes. Pour cette raison, il est important de trouver des moyens de cibler les drogues dans les cellules stressées spécifiquement. Dans cette étude nous visons à participer au développement d'une stratégie neuroprotectrice efficace contre l'ischémie cérébrale chez le nouveau-né. Dans ce but, plusieurs stratégies ont été poursuivies. Un nouveau phénomène d'endocytose induite par un stimulus excitotoxique a été récemment décrit. Une partie de cette étude va consister à mieux comprendre ce phénomène. Pour céla, nous avons utilisé comme modèle d'étude simplifié des cultures dissociées de neurones corticaux exposées à une dose excitotoxique de NMDA. Nous avons ainsi montré que cette endocytose associée à l'excitotoxicité dépend de la clathrine et de la dynamine. A l'aide d'un modèle d'ischémie cérébrale focale chez le raton de 12 jours, nous avons démontré que cette endocytose induite par l'excitotoxicité permet de cibler des molécules diverses et en particulier les peptides TAT dans les neurones stressés. Ces neurones fortement endocytiques apparaissent comme étant encore viables, ouvrant la possibilité d'utiliser cette endocytose comme moyen d'entrée pour des molécules thérapeutiques. Une partie du projet a été consacrée à l'étude d'un inhibiteur de la voie JNK, couplé au TAT, appelé D-JNKI1. Des études de dose réponse du D-JNKI1 ont été réalisées chez l'animal, testant les effets d'une administration retardée en injection intraveineuse ou intra péritonéale. Ces études démontrent qu'une large gamme de dose permet d'obCenir une réduction de la taille de la lésion. Comme D-JNK11 est couplé au peptide TAT, nous avons étudié la contribution que sa propre endocytose lors de l'excitotoxicité apporte à ses effets protecteurs. Par ailleurs, nous avons montré que cette endocytose induite par l'excitotoxicité dépend de la voie de signalisation JNK et que D-JNK11 est donc capable de réguler sa propre entrée. Nous avons en parallèle étudié les différents types de mort cellulaires impliqués dans le développement de la lésion dans un modèle sévère d'ischémie cérébrale chez le raton nouveau-né. La mort cellulaire par nécrose se développe rapidement dans le centre de la lésion alors que les morts cellulaires par apoptose et autophagique vont apparaître plus tard et au bord de la lésion. Inhiber l'apoptose n'a pas permis de réduire la taille de la lésion alors que l'utilisation d'un inhibiteur d'autophagie, la 3-méthyladénine, procure une forte neuroprotection. Finalement, la combinaison de deux peptides qui ciblent différentes voies de signalisation intracellulaire permet d'obtenir une bonne protection dans le modèle d'ischémie sévère dans lequel aucun des deux peptides administré séparément n'a donné d'effets bénéfiques.

Affective state and voice : cross-cultural assessment of speaking behavior and voice sound characteristics : a normative multicenter study of 577 + 36 healthy subjects

BACKGROUND: Human speech is greatly influenced by the speakers' affective state, such as sadness, happiness, grief, guilt, fear, anger, aggression, faintheartedness, shame, sexual arousal, love, amongst others. Attentive listeners discover a lot about the affective state of their dialog partners with no great effort, and without having to talk about it explicitly during a conversation or on the phone. On the other hand, speech dysfunctions, such as slow, delayed or monotonous speech, are prominent features of affective disorders. METHODS: This project was comprised of four studies with healthy volunteers from Bristol (English: n = 117), Lausanne (French: n = 128), Zurich (German: n = 208), and Valencia (Spanish: n = 124). All samples were stratified according to gender, age, and education. The specific study design with different types of spoken text along with repeated assessments at 14-day intervals allowed us to estimate the 'natural' variation of speech parameters over time, and to analyze the sensitivity of speech parameters with respect to form and content of spoken text. Additionally, our project included a longitudinal self-assessment study with university students from Zurich (n = 18) and unemployed adults from Valencia (n = 18) in order to test the feasibility of the speech analysis method in home environments. RESULTS: The normative data showed that speaking behavior and voice sound characteristics can be quantified in a reproducible and language-independent way. The high resolution of the method was verified by a computerized assignment of speech parameter patterns to languages at a success rate of 90%, while the correct assignment to texts was 70%. In the longitudinal self-assessment study we calculated individual 'baselines' for each test person along with deviations thereof. The significance of such deviations was assessed through the normative reference data. CONCLUSIONS: Our data provided gender-, age-, and language-specific thresholds that allow one to reliably distinguish between 'natural fluctuations' and 'significant changes'. The longitudinal self-assessment study with repeated assessments at 1-day intervals over 14 days demonstrated the feasibility and efficiency of the speech analysis method in home environments, thus clearing the way to a broader range of applications in psychiatry. © 2014 S. Karger AG, Basel.

Origin and expansion of the allotetraploid Aegilops geniculata, a wild relative of wheat.

*This study reconstructs the phylogeography of Aegilops geniculata, an allotetraploid relative of wheat, to discuss the impact of past climate changes and recent human activities (e.g. the early expansion of agriculture) on the genetic diversity of ruderal plant species. *We combined chloroplast DNA (cpDNA) sequencing, analysed using statistical parsimony network, with nonhierarchical K-means clustering of amplified fragment length polymorphism (AFLP) genotyping, to unravel patterns of genetic structure across the native range of Ae. geniculata. The AFLP dataset was further explored by measurement of the regional genetic diversity and the detection of isolation by distance patterns. *Both cpDNA and AFLP suggest an eastern Mediterranean origin of Ae. geniculata. Two lineages have spread independently over northern and southern Mediterranean areas. Northern populations show low genetic diversity but strong phylogeographical structure among the main peninsulas, indicating a major influence of glacial cycles. By contrast, low genetic structuring and a high genetic diversity are detected in southern Mediterranean populations. Finally, we highlight human-mediated dispersal resulting in substantial introgression between resident and migrant populations. *We have shown that the evolutionary trajectories of ruderal plants can be similar to those of wild species, but are interfered by human activities, promoting range expansions through increased long-distance dispersal and the creation of suitable habitats.

Analysis of gene expression patterns in animals

During my PhD, my aim was to provide new tools to increase our capacity to analyse gene expression patterns, and to study on a large-scale basis the evolution of gene expression in animals. Gene expression patterns (when and where a gene is expressed) are a key feature in understanding gene function, notably in development. It appears clear now that the evolution of developmental processes and of phenotypes is shaped both by evolution at the coding sequence level, and at the gene expression level.Studying gene expression evolution in animals, with complex expression patterns over tissues and developmental time, is still challenging. No tools are available to routinely compare expression patterns between different species, with precision, and on a large-scale basis. Studies on gene expression evolution are therefore performed only on small genes datasets, or using imprecise descriptions of expression patterns.The aim of my PhD was thus to develop and use novel bioinformatics resources, to study the evolution of gene expression. To this end, I developed the database Bgee (Base for Gene Expression Evolution). The approach of Bgee is to transform heterogeneous expression data (ESTs, microarrays, and in-situ hybridizations) into present/absent calls, and to annotate them to standard representations of anatomy and development of different species (anatomical ontologies). An extensive mapping between anatomies of species is then developed based on hypothesis of homology. These precise annotations to anatomies, and this extensive mapping between species, are the major assets of Bgee, and have required the involvement of many co-workers over the years. My main personal contribution is the development and the management of both the Bgee database and the web-application.Bgee is now on its ninth release, and includes an important gene expression dataset for 5 species (human, mouse, drosophila, zebrafish, Xenopus), with the most data from mouse, human and zebrafish. Using these three species, I have conducted an analysis of gene expression evolution after duplication in vertebrates.Gene duplication is thought to be a major source of novelty in evolution, and to participate to speciation. It has been suggested that the evolution of gene expression patterns might participate in the retention of duplicate genes. I performed a large-scale comparison of expression patterns of hundreds of duplicated genes to their singleton ortholog in an outgroup, including both small and large-scale duplicates, in three vertebrate species (human, mouse and zebrafish), and using highly accurate descriptions of expression patterns. My results showed unexpectedly high rates of de novo acquisition of expression domains after duplication (neofunctionalization), at least as high or higher than rates of partitioning of expression domains (subfunctionalization). I found differences in the evolution of expression of small- and large-scale duplicates, with small-scale duplicates more prone to neofunctionalization. Duplicates with neofunctionalization seemed to evolve under more relaxed selective pressure on the coding sequence. Finally, even with abundant and precise expression data, the majority fate I recovered was neither neo- nor subfunctionalization of expression domains, suggesting a major role for other mechanisms in duplicate gene retention.

Mineralization of the recalcitrant oxalic and oxamic acids by electrochemical advanced oxidation processes using a boron-doped diamond anode

Oxalic and oxamic acids are the ultimate and more persistent by-products of the degradation of N-aromatics by electrochemical advanced oxidation processes (EAOPs). In this paper, the kinetics and oxidative paths of these acids have been studied for several EAOPs using a boron-doped diamond (BDD) anode and a stainless steel or an air-diffusion cathode. Anodic oxidation (AO-BDD) in the presence of Fe2+ (AO-BDD-Fe2+) and under UVA irradiation (AO-BDD-Fe2+-UVA), along with electro-Fenton (EF-BDD), was tested. The oxidation of both acids and their iron complexes on BDD was clarified by cyclic voltammetry. AO-BDD allowed the overall mineralization of oxalic acid, but oxamic acid was removed much more slowly. Each acid underwent a similar decay in AO-BDD-Fe2+ and EFBDD, as expected if its iron complexes were not attacked by hydroxyl radicals in the bulk. The faster and total mineralization of both acids was achieved in AO-BDD-Fe2+-UVA due to the high photoactivity of their Fe(III) complexes that were continuously regenerated by oxidation of their Fe(II) complexes. Oxamic acid always released a larger proportion of NH4 + than NO3- ion, as well as volatile NOx species. Both acids were independently oxidized at the anode in AO-BDD, but in AO-BDD-Fe2+-UVA oxamic acid was more slowlydegraded as its content decreased, without significant effect on oxalic acid decay. The increase in current density enhanced the oxidation power of the latter method, with loss of efficiency. High Fe2+ contents inhibited the oxidation of Fe(II) complexes by the competitive oxidation of Fe2+ to Fe3+. Low current densities and Fe2+ contents are preferable to remove more efficiently these acids by the most potent AO-BDD-Fe2+-UVA method.

Mixed mating in androdioecious Mercurialis annua inferred using progeny arrays and diploid-acting microsatellite loci in a hexaploid background.

Background and Aims The frequency at which males can be maintained with hermaphrodites in androdioecious populations is predicted to depend on the selfing rate, because self-fertilization by hermaphrodites reduces prospective siring opportunities for males. In particular, high selfing rates by hermaphrodites are expected to exclude males from a population. Here, the first estimates are provided of the mating system from two wild hexaploid populations of the androdioecious European wind-pollinated plant M. annua with contrasting male frequencies.Methods Four diploid microsatellite loci were used to genotype 19-20 progeny arrays from two populations of M. annua, one with males and one without. Mating-system parameters were estimated using the program MLTR.Key Results Both populations had similar, intermediate outcrossing rates (t(m) = 0.64 and 0.52 for the population with and without males, respectively). The population without males showed a lower level of correlated paternity and biparental inbreeding and higher allelic richness and gene diversity than the population with males.Conclusions The results demonstrate the utility of new diploid microsatellite loci for mating system analysis in a hexaploid plant. It would appear that androdioecious M. annua has a mixed-mating system in the wild, an uncommon finding for wind-pollinated species. This study sets a foundation for future research to assess the relative importance of the sexual system, plant-density variation and stochastic processes for the regulation of male frequencies in M. annua over space and time.

Considerations for prenatal counselling of patients with cardiac rhabdomyomas based on their cardiac and neurologic outcomes.

Cardiac rhabdomyomas are benign cardiac tumours with few cardiac complications, but with a known association to tuberous sclerosis that affects the neurologic outcome of the patients. We have analysed the long-term cardiac and neurological outcomes of patients with cardiac rhabdomyomas in order to allow comprehensive prenatal counselling, basing our findings on the records of all patients seen prenatally and postnatally with an echocardiographic diagnosis of cardiac rhabdomyoma encountered from August, 1982, to September, 2007. We analysed factors such as the number and the location of the tumours to establish their association with a diagnosis of tuberous sclerosis, predicting the cardiac and neurologic outcomes for the patients.Cardiac complications include arrhythmias, obstruction of the ventricular outflow tracts, and secondary cardiogenic shock. Arrhythmias were encountered most often during the neonatal period, with supraventricular tachycardia being the commonest rhythm disturbance identified. No specific dimension or location of the cardiac rhabdomyomas predicted the disturbances of rhythm.The importance of the diagnosis of tuberous sclerosis is exemplified by the neurodevelopmental complications, with four-fifths of the patients showing epilepsy, and two-thirds having delayed development. The presence of multiple cardiac tumours suggested a higher risk of being affected by tuberous sclerosis. The tumours generally regress after birth, and cardiac-related problems are rare after the perinatal period. Tuberous sclerosis and the associated neurodevelopmental complications dominate the clinical picture, and should form an important aspect of the prenatal counselling of parents.

Evaluation of Temporary Ramp Metering for Work Zones, 2012

Ramp metering has been successfully implemented in many states to improve traffic operations on freeways. Studies have documented the positive mobility and safety benefits of ramp metering. However, there have been no studies on the use of ramp metering for work zones. This report documents the results from the first deployment of temporary ramp meters in work zones in the United States. Temporary ramp meters were deployed at seven urban short-term work zones in Missouri. Safety measures such as driver compliance, merging behavior, and speed differentials were extracted from video-based field data. Mobility analysis was conducted using a calibrated simulation model and the total delays were obtained for under capacity, at capacity, and over capacity conditions. This evaluation suggests that temporary ramp meters should only be deployed at work zone locations where there is potential for congestion and turned on only during above-capacity conditions. The compliance analysis showed that non-compliance could be a major safety issue in the deployment of temporary ramp meters for under-capacity conditions. The use of a three-section instead of a traditional two-section signal head used for permanent ramp metering produced significantly higher compliance rates. Ramp metering decreased ramp platoons by increasing the percentage of single-vehicle merges to over 70% from under 50%. The accepted-merge-headway results were not statistically significant even though a slight shift towards longer headways was found with the use of ramp meters. Mobility analysis revealed that ramp metering produced delay savings for both mainline and ramp vehicles for work zones operating above capacity. On average a 24% decrease in total delay (mainline plus ramp) at low truck percentage and a 19% decrease in delay at high truck percentage conditions resulted from ramp metering.

The european higher education area at work: Lights and shadows defining continuous assessment

The aim of this paper is to analyse how learning assessment, particularly the Continuous Assessment system, has been defined in the Public Administration and Management Diploma Course of the University of Barcelona (Spain). This course was a pioneering experiment at this university in implementing the guidelines of the European Higher Education Area (EHEA), and thus represents a good case study for verifying whether one of the cornerstones of the EHEA has been accomplished with success. Using data obtained from the Teaching Plans elaborated by the lecturers of each subject, we are able to establish that the CA system has been progressively accepted to such an extent that it is now the assessment formula used by practically all of the lecturers, conforming in this way to the protocols laid down by the Faculty of Law in which this diploma course is taught. Nevertheless, we find that high dispersion exists in how Continuous Assessment is actually defined. Indeed, it seems that there is no unified view of how Continuous Assessment should be performed. This dispersion, however, seems to diminish over time and raises some questions about the advisability of agreement on criteria, considering the potential which CA has as a pedagogical tool. Moreover, we find that the Unique Assessment system, which students may also apply for, is an option chosen only by a minority, with lecturers usually defining it as merely a theoretical and/or practical test, of little innovation in relation to traditional tests.

Selectome update: quality control and computational improvements to a database of positive selection.

Selectome (http://selectome.unil.ch/) is a database of positive selection, based on a branch-site likelihood test. This model estimates the number of nonsynonymous substitutions (dN) and synonymous substitutions (dS) to evaluate the variation in selective pressure (dN/dS ratio) over branches and over sites. Since the original release of Selectome, we have benchmarked and implemented a thorough quality control procedure on multiple sequence alignments, aiming to provide minimum false-positive results. We have also improved the computational efficiency of the branch-site test implementation, allowing larger data sets and more frequent updates. Release 6 of Selectome includes all gene trees from Ensembl for Primates and Glires, as well as a large set of vertebrate gene trees. A total of 6810 gene trees have some evidence of positive selection. Finally, the web interface has been improved to be more responsive and to facilitate searches and browsing.

Considerations for prenatal counselling of patients with cardiac rhabdomyomas based on their cardiac and neurologic outcomes.

Cardiac rhabdomyomas are benign cardiac tumours with few cardiac complications, but with a known association to tuberous sclerosis that affects the neurologic outcome of the patients. We have analysed the long-term cardiac and neurological outcomes of patients with cardiac rhabdomyomas in order to allow comprehensive prenatal counselling, basing our findings on the records of all patients seen prenatally and postnatally with an echocardiographic diagnosis of cardiac rhabdomyoma encountered from August, 1982, to September, 2007. We analysed factors such as the number and the location of the tumours to establish their association with a diagnosis of tuberous sclerosis, predicting the cardiac and neurologic outcomes for the patients.Cardiac complications include arrhythmias, obstruction of the ventricular outflow tracts, and secondary cardiogenic shock. Arrhythmias were encountered most often during the neonatal period, with supraventricular tachycardia being the commonest rhythm disturbance identified. No specific dimension or location of the cardiac rhabdomyomas predicted the disturbances of rhythm.The importance of the diagnosis of tuberous sclerosis is exemplified by the neurodevelopmental complications, with four-fifths of the patients showing epilepsy, and two-thirds having delayed development. The presence of multiple cardiac tumours suggested a higher risk of being affected by tuberous sclerosis. The tumours generally regress after birth, and cardiac-related problems are rare after the perinatal period. Tuberous sclerosis and the associated neurodevelopmental complications dominate the clinical picture, and should form an important aspect of the prenatal counselling of parents.