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Intracardiac teratomas are rare primary tumours. We report the case of an infant prenatally diagnosed with an isolated multi-cystic mass developed in the right ventricle causing neonatal refractory ventricular arrhythmia. Despite rescue extracorporeal support and partial surgical resection, he died as almost all the previous reported perinatal intracardiac teratomas whatever the prenatal tolerance and the size of the tumour. The common poor outcome of fetal intracardiac teratomas should be known when counselling parents during pregnancy.
We consider a lifting of Joseph ideals for the minimal nilpotent orbit closure to the setting of affine Kac–Moody algebras and find new examples of affine vertex algebras whose associated varieties are minimal nilpotent orbit closures. As an application we obtain a new family of lisse (
$C_{2}$
-cofinite)
$W$
-algebras that are not coming from admissible representations of affine Kac–Moody algebras.
For an arbitrary connected reductive group
$G$
, we consider the motivic integral over the arc space of an arbitrary
$ \mathbb{Q} $
-Gorenstein horospherical
$G$
-variety
${X}_{\Sigma } $
associated with a colored fan
$\Sigma $
and prove a formula for the stringy
$E$
-function of
${X}_{\Sigma } $
which generalizes the one for toric varieties. We remark that, in contrast to toric varieties, the stringy
$E$
-function of a Gorenstein horospherical variety
${X}_{\Sigma } $
may be not a polynomial if some cones in
$\Sigma $
have nonempty sets of colors. Using the stringy
$E$
-function, we can formulate and prove a new smoothness criterion for locally factorial horospherical varieties. We expect that this smoothness criterion holds for arbitrary spherical varieties.
To establish whether continuous subglottic suctioning (CSS) could be cost-effective.
Design.
Cost-benefit analysis, based on a hypothetical replacement of conventional ventilation (CV) with CSS.
Setting.
A surgical intensive care unit (SICU) of a tertiary care university hospital in France.
Patients.
All consecutive patients receiving ventilation in the SICU in 2006.
Methods.
Efficacy data for CSS were obtained from the literature and applied to the SICU of our hospital. Costs for CV and CSS were provided by the hospital pharmacy; costs for ventilator-associated pneumonia (VAP) were obtained from the literature. The cost per averted VAP episode was calculated, and a sensitivity analysis was performed on VAP incidence and on the number of tubes required for each patient.
Results.
At our SICU in 2006, 416 patients received mechanical ventilation for 3,487 ventilation-days, and 32 VAP episodes were observed (7.9 episodes per 100 ventilated patients; incidence density, 9.2 episodes per 10,000 ventilation-days). Based on the hypothesis of a 29% reduction in the risk of VAP with CSS than CV, 9 VAP episodes could have been averted. The additional cost of CSS for 2006 was estimated to be €10,585.34. The cost per averted VAP episode was €1,176.15. Assuming a VAP cost of €4,387, a total of 3 averted VAP episodes would neutralize the additional cost. For a low VAP incidence of 6.6%, the cost per averted VAP would be €1,323. If each patient required 2 tubes during ventilation, the cost would be €1,383.69 per averted VAP episode.
Conclusion.
Replacement of CV with CSS was cost-effective even when assuming the most pessimistic scenario of VAP incidence and costs.
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