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To define optimal thromboprophylaxis strategy after stent implantation in superior or total cavopulmonary connections.
Stent thrombosis is a rare complication of intravascular stenting, with a perceived higher risk in single-ventricle patients.
All patients who underwent stent implantation within superior or total cavopulmonary connections (caval vein, innominate vein, Fontan, or branch pulmonary arteries) were included. Cohort was divided into aspirin therapy alone versus advanced anticoagulation, including warfarin, enoxaparin, heparin, or clopidogrel. Primary endpoint was in-stent or downstream thrombus, and secondary endpoints included bleeding complications.
A total of 58 patients with single-ventricle circulation underwent 72 stent implantations. Of them 14 stents (19%) were implanted post-superior cavopulmonary connection and 58 (81%) post-total cavopulmonary connection. Indications for stenting included vessel/conduit stenosis (67%), external compression (18%), and thrombotic occlusion (15%). Advanced anticoagulation was prescribed for 32 (44%) patients and aspirin for 40 (56%) patients. Median follow up was 1.1 (25th–75th percentile, 0.5–2.6) years. Echocardiograms were available in 71 patients (99%), and advanced imaging in 44 patients (61%). Thrombosis was present in two patients on advanced anticoagulation (6.3%) and none noted in patients on aspirin (p = 0.187). Both patients with in-stent thrombus underwent initial stenting due to occlusive left pulmonary artery thrombus acutely post-superior cavopulmonary connection. There were seven (22%) significant bleeding complications for advanced anticoagulation and none for aspirin (p < 0.001).
Antithrombotic strategy does not appear to affect rates of in-stent thrombus in single-ventricle circulations. Aspirin alone may be sufficient for most patients undergoing stent implantation, while pre-existing thrombus may warrant advanced anticoagulation.
Diogenes Laertius has Plato reading the Phaedo and Lysis aloud to his students, but the only true lecture or series of lectures attributed to him by ancient sources was entitled On the Good,
Aristotle's disciple the musical theorist Aristoxenus records that Aristotle attended the Lecture or Lectures (I shall henceforth refer to it in the singular); and Simplicius, writing in the sixth century A.D., notes first that the Lecture was also attended by Speusippus, Xenocrates, and others and later that Hestiaios and Heraclides Ponticus were there too. According to both Aristoxenus and Simplicius, Aristotle maintained the Lecture was delivered relatively late in Plato's career.
We are accustomed to thinking of Marsilio Ficino (1433-1499) as the great Renaissance champion of Plato from a Christian point of view and the leader of those who wished to effect an accommodation between Platonism (or more accurately Neoplatonism) and Christianity, as the most distinguished of Plato's several Medicean apologists. Many texts lend credibility to this interpretation of Ficino's goals, and it is essentially correct. However, it is important that we appreciate just where he traced the boundaries of accommodation between Catholic dogma and what he regarded as authentic Platonism; and in particular that we appreciate the care and circumspection with which he approached the problem of analyzing the relationship between the dogma of the Trinity and the various texts in Plato that lent themselves to a trinitarian interpretation that Plato himself could not have intended or even fully conceived.
Transcatheter right ventricle decompression in neonates with pulmonary atresia and intact ventricular septum is technically challenging, with risk of cardiac perforation and death. Further, despite successful right ventricle decompression, re-intervention on the pulmonary valve is common. The association between technical factors during right ventricle decompression and the risks of complications and re-intervention are not well described.
This is a multicentre retrospective study among the participating centres of the Congenital Catheterization Research Collaborative. Between 2005 and 2015, all neonates with pulmonary atresia and intact ventricular septum and attempted transcatheter right ventricle decompression were included. Technical factors evaluated included the use and characteristics of radiofrequency energy, maximal balloon-to-pulmonary valve annulus ratio, infundibular diameter, and right ventricle systolic pressure pre- and post-valvuloplasty (BPV). The primary end point was cardiac perforation or death; the secondary end point was re-intervention.
A total of 99 neonates underwent transcatheter right ventricle decompression at a median of 3 days (IQR 2–5) of age, including 63 patients by radiofrequency and 32 by wire perforation of the pulmonary valve. There were 32 complications including 10 (10.5%) cardiac perforations, of which two resulted in death. Cardiac perforation was associated with the use of radiofrequency (p=0.047), longer radiofrequency duration (3.5 versus 2.0 seconds, p=0.02), and higher maximal radiofrequency energy (7.5 versus 5.0 J, p<0.01) but not with patient weight (p=0.09), pulmonary valve diameter (p=0.23), or infundibular diameter (p=0.57). Re-intervention was performed in 36 patients and was associated with higher post-intervention right ventricle pressure (median 60 versus 50 mmHg, p=0.041) and residual valve gradient (median 15 versus 10 mmHg, p=0.046), but not with balloon-to-pulmonary valve annulus ratio, atmospheric pressure used during BPV, or the presence of a residual balloon waist during BPV. Re-intervention was not associated with any right ventricle anatomic characteristics, including pulmonary valve diameter.
Technical factors surrounding transcatheter right ventricle decompression in pulmonary atresia and intact ventricular septum influence the risk of procedural complications but not the risk of future re-intervention. Cardiac perforation is associated with the use of radiofrequency energy, as well as radiofrequency application characteristics. Re-intervention after right ventricle decompression for pulmonary atresia and intact ventricular septum is common and relates to haemodynamic measures surrounding initial BPV.
This essay calls into question Zuckert's claim in Postmodern Platos that Strauss provides the best contemporary defense of the superiority of the philosophic life against the claims of Nietzsche and Heidegger that it leads to nihilism and despair. For her, Strauss persuasively draws on Plato, read through Alfarabi and Maimonides, to defend this view by showing that the philosopher understands the true ends of human life as a whole which is part of the whole, and thus provides a vision of the noblest, best, and most beautiful. I argue that this claim is implausible, that Strauss's Platonic vision of the ends of human life is obscure, and that even if correct, it does not offer an answer to the question of the relative value of these heterogenous ends, and thus does not demonstrate that the philosophic life is more worth living than any other form of life.
While a large literature suggests an important role for political parties in development, this article is the first attempt to layout and test a comprehensive theory connecting parties to economic growth. The authors argue that strong parties broaden the constituencies to which policymakers respond and help politicians solve coordination problems. These features help to ensure better economic management, public services, and political stability. And this, in turn, enhances economic growth. Drawing on a novel measure of party strength from the Varieties of Democracy data set, the authors test this theory on data drawn from more than 150 countries observed annually from 1901–2010. They identify a sizeable effect that is robust to various specifications, estimators, and samples. The effect operates in both democracies and autocracies, and is fairly stable across regions and time periods.
Cannabis and its main psychoactive ingredient δ-9-tetrahydrocannibidiol (THC) can induce transient psychotic symptoms in healthy individuals and exacerbate them in those with established psychosis. However, not everyone experience these effects, suggesting that certain individuals are particularly susceptible. The neural basis of this sensitivity to the psychotomimetic effects of THC is unclear.
We investigated whether individuals who are sensitive to the psychotomimetic effects of THC (TP) under experimental conditions would show differential hippocampal activation compared with those who are not (NP). We studied 36 healthy males under identical conditions under the influence of placebo or THC (10 mg) given orally, on two separate occasions, in a pseudo-randomized, double-blind, repeated measures, within-subject, cross-over design, using psychopathological assessments and functional MRI while they performed a verbal learning task. They were classified into those who experienced transient psychotic symptoms (TP; n = 14) following THC administration and those who did not (NP; n = 22).
Under placebo conditions, there was significantly greater engagement of the left hippocampus (p < 0.001) in the TP group compared with the NP group during verbal encoding, which survived leave-one-out analysis. The level of hippocampal activation was directly correlated (Spearman's ρ = 0.44, p = 0.008) with the severity of transient psychotic symptoms induced by THC. This difference was not present when we compared two subgroups from the same sample that were defined by sensitivity to anxiogenic effects of THC.
These results suggest that altered hippocampal activation during verbal encoding may serve as a marker of sensitivity to the acute psychotomimetic effects of THC.