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Balloon valvuloplasty and surgical aortic valvotomy have been the treatment mainstays for congenital aortic stenosis in children. Choice of intervention often differs depending upon centre bias with limited relevant, comparative literature.
This study aims to provide an unbiased, contemporary matched comparison of these balloon and surgical approaches.
Retrospective analysis of patients with congenital aortic valve stenosis who underwent balloon valvuloplasty (Queensland Children’s Hospital, Brisbane) or surgical valvotomy (Royal Children’s Hospital, Melbourne) between 2005 and 2016. Patients were excluded if pre-intervention assessment indicated ineligibility to either group. Propensity score matching was performed based on age, weight, and valve morphology.
Sixty-five balloon patients and seventy-seven surgical patients were included. Overall, the groups were well matched with 18 neonates/25 infants in the balloon group and 17 neonates/28 infants in the surgical group. Median age at balloon was 92 days (range 2 days – 18.8 years) compared to 167 days (range 0 days – 18.1 years) for surgery (rank-sum p = 0.08). Mean follow-up was 5.3 years. There was one late balloon death and two early surgical deaths due to left ventricular failure. There was no significant difference in freedom from reintervention at latest follow-up (69% in the balloon group and 70% in the surgical group, p = 1.0).
Contemporary analysis of balloon aortic valvuloplasty and surgical aortic valvotomy shows no difference in overall reintervention rates in the medium term. Balloon valvuloplasty performs well across all age groups, achieving delay or avoidance of surgical intervention.
Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.
Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals
Patients ≤18 years old ventilated for ≥1 day
We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.
In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.
We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes.
The histories of chronicles composed in England during the fourteenth and fifteenth centuries and onwards, with a focus on texts belonging to or engaging with the Prose Brut tradition, are thefocus of this volume. The contributors examine the composition, dissemination and reception of historical texts written in Anglo-Norman, Latin and English, including the Prose Brut chronicle (c. 1300 and later), Castleford's Chronicle (c. 1327), and Nicholas Trevet's Les Cronicles (c. 1334), looking at questions of the processes of writing, rewriting, printing and editing history. They cross traditional boundaries of subject and period, taking multi-disciplinary approaches to their studies in order to underscore the (shifting) historical, social and political contexts inwhich medieval English chronicles were used and read from the fourteenth century through to the present day. As such, the volume honours the pioneering work of the late Professor Lister M. Matheson, whose research in this area demonstrated that a full understanding of medieval historical literature demands attention to both the content of the works in question and to the material circumstances of producing those works.
Jaclyn Rajsic is a Lecturer in Medieval Literature in the School of English and Drama at Queen Mary University of London; Erik Kooper taught Old and Middle English at Utrecht University; until his retirement in 2007; Dominique Hoche is an Associate Professor at West Liberty University in West Virginia.
Contributors: Elizabeth J. Bryan, Caroline D. Eckhardt, A.S.G. Edwards, Dan Embree, Alexander L. Kaufman, Edward Donald Kennedy, Erik Kooper, Julia Marvin, William Marx, Krista A. Murchison, Heather Pagan, Jaclyn Rajsic, Christine M. Rose, NeilWeijer