Infants with complex cyanotic CHD can become symptomatic from insufficient pulmonary blood supply following either ductal closure or due to outflow tract obstruction. Blalock–Taussig shunt mortality remains significant and recent studies have highlighted the advantages of using transcatheter alternatives. We present here our experience in changing our primary choice of palliation from the Blalock–Taussig shunt to transcatheter palliation with either a ductal stent or, if antegrade flow is present, a right ventricular outflow tract stent.

This is a retrospective, single-unit cohort study. Eighty-seven infants underwent palliation for insufficient pulmonary blood flow at under 3 months of age between 2012 and 2019. On an intention-to-treat basis, 29 underwent insertion of a Blalock–Taussig shunt, 36 duct stents, and 22 right ventricular outflow tract stents at median ages of 15, 9, and 32 days, respectively, and median weights of 3.3, 3.1, and 3.1 kg, respectively. No primary Blalock–Taussig shunts have been performed in our institution since 2017.

At 30-days there had been one death in each group (univariable p = 0.93) and deaths prior to repair totalled three in the shunt group, four in the ductal stent group, and two in the right ventricular outflow tract stent group (univariable p = 0.93). Reintervention on the pulmonary circuit prior to next stage of surgery was more frequent in those undergoing transcatheter intervention, reaching statistical significance by logrank (p = 0.012).

In conclusion, within this work we provide further evidence of the safety and efficacy of transition from a primary surgical to primary transcatheter palliation pathway in infants with insufficient pulmonary blood supply.

Integrated weed management practices, such as crop rotation and increased seeding rates, potentially improve weed management. Yet, few studies compare competitive interactions of weeds with different crops. This research quantified the impact of Persian darnel on spring wheat, canola, and sunflower yield across different seeding rates. Increasing crop density increased yield when Persian darnel affected crop yield early in physiological development. Crop yield loss was estimated to reach 83, 70, and 57% for spring wheat, canola, and sunflower, respectively, at high Persian darnel densities. Persian darnel reduced spring wheat yield by limiting the number of tillers per plant and seed per tiller; reduced canola yield by limiting the number of branches per plant, pods per branch, and seed per pod; and reduced sunflower yield by limiting the number of seed per plant. Persian darnel affected crop growth early in physiological development, indicating that interspecific interference occurred early in the growing season. Cultural and resource management aimed at reducing Persian darnel impact on resource availability and crop yield components will reduce Persian darnel impact on crop yield.

Persian darnel control options are limited and unmanaged populations can cause substantial crop yield loss. Integrating crop diversification and higher crop seeding rates into a cropping system might improve Persian darnel management. Field experiments were conducted to determine the effect of different crops and increased crop seeding rates on Persian darnel fecundity. Persian darnel produced up to 2,800 seeds per plant and 53,000 seeds/m2 when grown without competition. Increasing crop density reduced Persian darnel tillers per plant, seed weight, and fecundity. Increasing crop density reduced Persian darnel fecundity 0.4 to 0.2% per spring wheat plant, 0.6 to 0.1% per canola plant, and 16 to 8% per sunflower plant. Persian darnel fecundity was impacted the greatest by reduced weed seedling establishment, which was caused by crop competition and seeding sunflower late in the spring preceded by a nonselective herbicide application. Results indicated delaying the seeding of spring crops or including a late-seeded warm season crop, like sunflower or safflower, in the cropping system is an effective weed management tool for reducing Persian darnel fecundity.

Whole farm simulation analysis and econometric techniques are employed in an analysis of crop rotations and tenure arrangement strategies. The FLIPSIM model is used to analyze a representative Texas Upper Gulf Coast rice and soybean farm. Probit analysis is then used to determine the impact of net cash farm income, land tenure, and crop rotation on probability of survival. Results suggest that, although the simulation model is useful in providing information on the effect at the farm level of following the different strategies, probit results provide greater understanding into the returns and risk inherent to each strategy.

Background: Seizures associated with intracranial neoplasms are occasionally refractory to conventional anti-epileptic drugs. Gabapentin (GBP) is one of several novel anti-epileptic drugs effective as an add-on therapy for intractable seizures but has not been studied in patients with cerebral tumours. Patients and Methods: We used GBP in a open-label add-on fashion to treat 14 patients with intractable seizures associated with intracranial tumours including four glioblastomas, four metastases, three recurrent glioblastomas, and one each of anaplastic and low grade astrocytoma and meningioma. GBP was added if optimization of pre-existing therapy failed and was titrated until seizures were controlled. Results: One patient experienced adverse drowsiness. Follow-up ranged from 3–24 weeks during which time 7 patients died from disease progression. Concurrent therapy included dexamethasone in eight, cranial irradiation in four, and radiosurgery in one. Responder rate (number with at least 50% fewer seizures) was. 100% and persisted throughout follow-up. Complete resolution of seizures occurred in 8/14 patients. Conclusions: GBP was well tolerated in patients with brain tumours. Seizure frequency was reduced in all patients and efficacy persisted over time; however, the mechanism of this improvement is unclear. Concurrent therapy, regression of frequency to the mean, and the lack of controls may account for apparent benefit. In addition, because GBP may interact with a leucine-related neuronal binding site we also speculate that this novel mechanism of action may have been enhanced in our patients due to the abnormal blood-brain barrier associated with cerebral tumours. Further investigation and a controlled trial are warranted.

We compare complications from 66 sural nerve biopsies in 41 patients with diabetic peripheral neuropathy to 40 patients with neuropathy from other causes, using a retrospective telephone survey. Diabetic patients were followed for a mean of 6.8 years and non-diabetics for 5.6 years. Mild long-term pain was described by 18.9% of patients overall with no difference between groups. Mild persistent sensory symptoms, insufficient to interfere with daily activity or warrant medical therapy, were reported by 63.6% of diabetic and 27.5% of non-diabetic patients (p < 0.006). Wound infection and severe pain were uncommon in both groups and no different in diabetics. Significant complications of sural nerve biopsy occurred no more frequently in diabetic than in non-diabetic patients. While sural nerve biopsy plays no role in the routine evaluation of diabetic peripheral neuropathy, it may be performed without increased risk when indicated in these patients to exclude other causes of neuropathy and in the context of research trials.

We report a 77-year-old woman who presented with partial seizures and was found to have an enhancing dural-based parietal convexity mass. The lesion enlarged on serial examination by computed tomography (CT) over a one year period. The clinical features and radiologic appearance were compatible with a pre-operative diagnosis of meningioma; however, pathologic findings were typical of a dural cavernous hemangioma. Accumulating evidence suggests that these lesions are an uncommon but distinct type of vascular malformation most often arising from the cavernous sinus, tentorium, or cerebello-pontine angle. With CT, magnetic resonance imaging and angiography, these lesions can closely resemble meningioma in terms of signal characteristics, enhancement pattern, and location. This is of importance both in the practical management of meningiomas where the diagnosis is often based on radiologic studies alone, and in clinical trials where incorrect entry diagnosis should be avoided.

Background: Thirty-one gliosarcomas (25 nonirradiated and 6 postirradiated tumors) were selected based on the presence of two distinctive areas: a malignant gliomatous and a sarcomatous component. In all cases, the sarcomatous component appears like fibrosarcoma or malignant fibrous histiocytoma. Two tumors showed additional areas consisting of osteochondroid differentiation. Methods: All tumors were examined using antibodies against Ulex europaeus agglutinin I (UEA), glial fibrillary acidic protein (GFAP), vimentin (VM), epithelial membrane antigen (EMA), desmin, collagen IV, alpha-1-antitrypsin (a-l-AT) and smooth muscle actin (SMA). Results: While the VM highlighted the sarcomatous areas of all tumors there were only scattered spindle cells that were GFAP-positive in the same areas. The a-l-AT was diffusely reactive in the sarcomatous areas in 20 cases. Focal immunoreactivity was seen with SMA (20 tumors), UEA (8 tumors), EMA (5 tumors), collagen IV (5 tumors) and desmin (4 tumors) in the nonvascular sarcomatous cells. Conclusions: The range of immunophenotypical expression is likely to be a reflection of the capacity of a multipotential progenitor to undergo divergent differentiation. There is very little morphological difference between the postirradiated and nonirradiated tumors except that a higher proportion of postirradiated tumors are immunoreactive to SMA and desmin.

The potential of bio-dielectrics for thin film transistor applications was explored via the incorporation of titanium dioxide (TiO2) nanoparticles, rutile form, a high dielectric constant (ε) ceramic, in the deoxyribonucleic acid (DNA) bio-polymer. The DNA-ceramic hybrid films were fabricated from stable suspensions of the TiO2 nanoparticles in viscous, aqueous DNA solutions. Dielectric characterization revealed that the incorporation of TiO2 in DNA resulted in enhanced dielectric constant (14.3 at 1 kHz for 40 wt % TiO2) relative to that of DNA in the entire frequency range of 1 kHz-1 MHz. Variable temperature dielectric measurements, in the 20-80°C range, of the DNA-TiO2 films revealed that the ceramic additive stabilizes DNA against large temperature dependent variations in both ε and the dielectric loss factor tan δ. The bulk resistivity of the DNA-TiO2 hybrid films was measured to be two to three orders of magnitude higher than that of the control DNA films, indicating their potential for utilization as insulating dielectrics in transistor and capacitor applications.