Latest Evaluation Research Articles

Module and system test development for the Phase-2 ATLAS ITk Pixel upgrade

In the high-luminosity era of the Large Hadron Collider, the instantaneous luminosity is expected to reach unprecedented values, resulting in about 200 proton–proton interactions in a typical bunch crossing. To cope with the resulting increase in occupancy, bandwidth and radiation damage, the ATLAS Inner Detector will be replaced by an all-silicon system, the Inner Tracker (ITk). The innermost part of ITk will consist of a pixel detector, with an active area of about 14 m2. In order to cope with the changing requirements in terms of radiation hardness, power dissipation and production yield, several different silicon sensor technologies will be employed in the five barrel and end-cap layers. With the arrival of the first readout chip prototype, the RD53A chip, the development of hybrid detector modules is starting to address numerous production issues, understanding of which will be crucial for the final design and production of the ITk pixel detector modules. In addition, the new powering scheme is serial which introduces further challenges. A large prototyping program on system test level is ongoing. Components for larger structures with multiple modules, based on the FE-I4 front-end chip, which is currently used in the Pixel detector, were produced and are in assembly and evaluation. The paper will present the latest results from the assembly and characterization of prototype modules as well as the latest evaluation and results of thermo-mechanical prototypes and fully electrical prototypes.

Results of prototyping for the Phase-II upgrade of the pixel detector of the ATLAS experiment

The current inner tracker of the ATLAS experiment is foreseen to be replaced for the High-Luminosity era of the LHC to cope with the increase in occupancy, bandwidth and radiation damage. The new tracker consists of an all-silicon system, the Inner Tracker (ITk). It is built of both silicon pixel and silicon strip sub-systems aiming to provide tracking coverage up to |η|=4. For a high tracking performance, radiation hard and high-rate capable silicon sensors and readout electronics are important. Moreover, services and stable, low mass mechanical structures are essential and present challenges for the system design. Currently, a large prototyping programme is ongoing within the ITk pixel detector community. Components for larger structures with multiple modules based on the FE-I4 readout chips were produced and are in assembly and evaluation. This way the system integration and design is prototyped and validated. In the report, the latest evaluation and results of thermo-mechanical prototypes and fully electrical prototypes are presented. Important system relevant aspects and their application will be discussed.

Treatment of pathologic fractures of the proximal femur

BackgroundMetastatic lesions to the proximal femur occur frequently and require special consideration due to the high risk of pathologic fractures. Type of surgery might influence patient survival considering the growing concept of oligometastases. In fact, the use of modular tumor megaprosthesis is increasing in the last decades compared to intramedullary nailing. Aim of this study was to evaluate oncological and functional results of treatment in patients with pathologic or impending fracture of the proximal femur, with patient survival being the primary, complications the secondary, and functional results the tertiary endpoint. MethodsBetween 2016 and 2017, 40 patients with pathologic fracture (29 cases) or impending fracture according to the Mirels score (11 cases) of the proximal femur, were treated in our Institute and prospectively collected. There were 29 females (72.5%) and 11 males (27.5%), with a mean age at diagnosis of the metastasis of 63.6 years (range 35 to 92 years). Patients were treated due to bone metastases (commonly develop from breast cancer) or hematologic malignancies. Considering number of lesions, 17 patients had less than three bone metastases. Surgical procedures included intramedullary nailing (7 patients), conventional endoprosthesis (4 patients) and modular endoprosthetic replacement (29 patients). Adjuvant treatments included chemotherapy (13 cases), radiation therapy (8 cases) or both (15 cases), and selective arterial embolization (6 pre-op). Oncological results were evaluated considering the survival of patients. Functional results were assessed as pain intensity in VAS score and MSTS score. ResultsThe mean follow-up of patients was 10.2 months (range 6–26.3 years). At the latest evaluation, 23 patients were alive with disease, 3 patients were alive without evidence of disease and 14 patients were dead with disease. There was a significant better survival in patients treated with PFR compared to IMN and EPR groups (p = 0.0080). No differences in term of survival were found comparing impending vs actual pathological fracture and oligo vs multiple metastases. After surgery, all patients experienced improvement in quality of life resulting from reduction in pain. Mean MSTS score was 22.4. The overall complications rate was 22.5%. The most frequent complication was dislocation followed by wound dehiscence and deep infections. ConclusionModular tumour prosthesis for proximal femur replacement provides good functional outcome, relative low incidence of complications and higher life quality in the medium term. Oncologic results were influenced by type of surgery, biased by the correct indications for resection and nailing. Preoperative general health condition, life expectancy and ambulatory capacity may influence treatment strategy. With the numbers available, the patients with actual pathologic or impending fracture of the proximal femur treated with resection had a significantly higher survival, especially those with metastases from renal carcinoma or multiple myeloma.

Long-term outcomes of proximal row carpectomy: A series of 62 cases

The aim of this study was to determine and analyze the functional and radiographic outcomes after proximal row carpectomy (PRC). We hypothesized that this surgery could restore wrist mobility and function in case of radiocarpal osteoarthritis or severe carpal trauma. Sixty-two patients who had undergone PRC were included in this study: 44 patients with wrist osteoarthritis (11 SNAC, 24 SLAC, 3 Kienböck's disease, 6 other) and 18 patients with severe carpal trauma. Each patient underwent clinical (pain, range of motion, grip strength, functional scores) and radiographic evaluations. At the latest evaluation after a mean of 11.8 years, 15 patients (24.2%) required revision total wrist arthrodesis surgery in a median of 22 months (range, 6–179) because of disabling pain and lack of strength. The failure was statistically correlated with being young and a manual laborer. The range of motion and strength of the operated wrist were 61.5% and 70%, respectively, compared to the contralateral side. PRC remains a reliable procedure for treating wrist arthritis and severe carpal trauma. However, manual activity and being under 50years of age can lead to an early salvage procedure such as total arthrodesis of the wrist. In this subset of the population, another alternative must be considered.

OP24 A Framework For Improved Systems Of Care In Myocardial Infarction

INTRODUCTION:In the past decade numerous efforts have been made to enhance quality of care in the province of Québec for patients with ST-elevation myocardial infarction (STEMI). Despite two prior field evaluations and diffusion of a systematic review as well as recommendations, a third audit revealed persistent gaps in care, specifically excessive treatment delays. Our cardiovascular evaluation unit thus aimed to develop a more comprehensive quality improvement framework that further engaged healthcare professionals.METHODS:A literature update identified best practices and ways to reduce treatment delays and improve outcomes. This review, combined with the latest evaluation results, was used to establish structural and process quality standards adapted to the Québec context, via a consensus process with a panel of clinical experts. The standards identified quality-of-care targets and key elements of a governance structure to guide the improvement process. Quality indicators to monitor change were also developed. An implementation plan was then created, likewise based on literature and evaluation results.RESULTS:For the first time, the unit publicly disseminated the results of the third evaluation according to region, in addition to standard individual hospital “report cards”. A summit conference was held during which the standards and indicators were presented to clinicians and other stakeholders, in collaboration with the health ministry and a panel of cardiovascular experts. Site visits are planned to facilitate change and establishment of local improvement plans and committees. A “tool kit” was developed containing a treatment algorithm, a drug protocol, five quality indicators each for processes and care networks, and measurement tools for indicators. A 75 percent minimal achievement target was set for treatment times.CONCLUSIONS:A comprehensive framework aimed at improving quality of care for STEMI patients and monitoring change was created by combining evidence from the literature and “real world” data and mobilizing key stakeholders.

Decays of the Three Top Contributors to the Reactor ν[over ¯]_{e} High-Energy Spectrum, ^{92}Rb, ^{96gs}Y, and ^{142}Cs, Studied with Total Absorption Spectroscopy.

We report total absorption spectroscopy measurements of ^{92}Rb, ^{96gs}Y, and ^{142}Cs β decays, which are the most important contributors to the high energy ν[over ¯]_{e} spectral shape in nuclear reactors. These three β decays contribute 43% of the ν[over ¯]_{e} flux near 5.5MeV emitted by nuclear reactors. This ν[over ¯]_{e} energy is particularly interesting due to spectral features recently observed in several experiments including the Daya Bay, Double Chooz, and RENO Collaborations. Measurements were conducted at Oak Ridge National Laboratory by means of proton-induced fission of ^{238}U with on-line mass separation of fission fragments and the Modular Total Absorption Spectrometer. We observe a β-decay pattern that is similar to recent measurements of ^{92}Rb, with a ground-state to ground-state β feeding of 91(3)%. We verify the ^{96gs}Y ground-state to ground-state β feeding of 95.5(20)%. Our measurements substantially modify the β-decay feedings of ^{142}Cs, reducing the β feeding to ^{142}Ba states below 2MeV by 32% when compared with the latest evaluations. Our results increase the discrepancy between the observed and the expected reactor ν[over ¯]_{e} flux between 5 and 7MeV, the maximum excess increases from ∼10% to ∼12%.

Posterior dynamic stabilization in the lumbar spine – 24 months results of a prospective clinical and radiological study with an interspinous distraction device

BackgroundInterspinous distraction devices (IDD) are due to maintain or restore intersegmental range of motion (iROM) in a controlled fashion with the aim of stabilization the affected level dynamically. The following study is the first to present clinical and radiological data with the Wallis® spacer during a follow-up of 24 months.MethodsTen patients underwent posterior dynamic stabilization (PDS) of the lumbar spine with an IDD (Wallis® spacer) and were controlled clinically and radiologically after 3, 6, 12, and 24 months in a prospective study design. Pain intensity, functional disability and life quality were assessed by use of subjective scores. Motion analyses were performed with the help of lateral functional x-rays to determine the iROM of the operated segments and total ROM (tROM) of the lumbar spine. In addition, roentgen stereophotogrammetric analysis (RSA) was used to measure the iROM of the treated levels.ResultsDuring the postoperative course pain and disability most clinical scores were significantly improved. After 24 months we observed statistically significant reduction in back pain intensity with a mean value of 6.0 on visual analog scale (VAS) before surgery and of 2.7 at the latest evaluation. The leg pain was also decreased without statistical significance from 4.7 preoperatively to 2.1 at final follow-up. The functional disability according to Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RM) was decreased both with statistical significance at all examination dates with a mean value in ODI of 40.0 % before operation and of 17.3 % after 2 years and an initial mean value in RM of 55.2 and of 23.5 % after latest follow-up. After 24 months, the results of the health related quality of life score also showed much better values with only two exceptions. The iROM of the treated levels was reduced during each follow-up examination with preserved residual mobility. Directly postoperatively and after 3 and 12 months intersegmental mobility was statistically significantly decreased with an average iROM of 6.62° before operation and of 2.69° few days after surgery, of 3.79° and 3.16° 3 and 12 months later. At 6 (4.37°) and 24 (4.01°) months follow-up iROM was also but not statistically significantly reduced. The mean tROM did not change significantly during all postoperative controls.ConclusionsThe radiological findings support the thesis of posterior dynamic stabilization by the used implant. The positive clinical findings should be interpreted with caution because of the limited number of patients and the missing control group.

Cognitive and neuropsychological evolution in children with anti-NMDAR encephalitis.

We describe neurological and cognitive/neuropsychological changes from symptom onset in 13 consecutive children (8 females and 5 males; median age 11 years, range 3-17) with anti-NMDAR-encephalitis. We assessed neurological status using the modified Rankin Scale for children and cognitive/neuropsychological status using a standardized battery that was administered serially in 10 prospective patients, and at latest follow-up in three retrospective patients diagnosed before study initiation. Symptom onset was marked by neurological or psychiatric/behavioural manifestations, which became severe but regressed at variable rates after starting immunotherapy. The 10 prospective patients were able to undergo first standardized cognitive/neuropsychological assessment a median of 3 months (range 1-12) after symptom onset: they had extensive deficits, although severity varied. Subsequent assessment showed marked improvements although the timescale varied. At latest evaluation (median 31 months, range 3-112, after symptom onset), seven patients had no neurological disability, five had improved substantially, and one had persistent behavioural problems. Latest cognitive/neuropsychological assessment in 11 patients with at least a year of follow-up showed normal general intellectual abilities, but over half had residual deficits indicating frontal lobe dysfunction. All patients had resumed normal activities. Our findings suggest that early installation of immunotherapy results in good long-term recovery in most paediatric patients with anti-NMDAR-encephalitis, however, recovery is incomplete and the disease leaves subtle lasting defects that impact quality of life, social relationships, and academic achievement.

Excision of anomalous muscle bundles as an important addition to extended septal myectomy for treatment of left ventricular outflow tract obstruction

ObjectiveThis study aims to report our preliminary experience and anatomic findings in the surgical treatment and postoperative management of hypertrophic obstructive cardiomyopathy. MethodsThis study included 277 patients with hypertrophic obstructive cardiomyopathy (168 [60.65%] were male), with a median age of 47 years (interquartile range, 35-54 years), who underwent surgical myectomy performed by 1 surgeon in Fuwai Hospital between May 2010 and April 2015. The median follow-up was 14 months (interquartile range, 7-24 months). ResultsA total of 127 patients (45.85%) underwent concomitant procedures, and 2 patients (0.72%) died in the early perioperative days. The left ventricular outflow gradient decreased from 78 mm Hg (interquartile range, 61-100 mm Hg) to 11 mm Hg (interquartile range, 8-15 mm Hg) when discharged (P < .001). Of the 228 patients with well-documented anatomic description, more than 80% had various intraventricular anomalies. The cumulative survival was 99.28% (95% confidence interval, 97.15-99.82) at 1 year and 96.98% (95% confidence interval, 92.56-98.79) at 5 years. Of the surviving 272 patients, 268 (98.53%) were categorized with functional class I and II of the New York Heart Association classification at the latest evaluation. ConclusionsAnomalous muscle bundles are common in hypertrophic obstructive cardiomyopathy, and they may lead to middle-apical obstruction. Surgical myectomy provides excellent clinical outcomes with low risk for sufficient relief of obstruction and radical correction of intraventricular anomalies in patients with hypertrophic obstructive cardiomyopathy.

Peer coaching for nurse managers.

Peer coaching for nurse managers.

The split anterior tibialis tendon transfer procedure for spastic equinovarus foot in children with cerebral palsy: results and factors associated with a failed outcome.

The aims of the study were to evaluate the outcomes and predictive factors of the split anterior tibialis tendon transfer (SPLATT) procedure for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). Forty-five ambulatory CCP with 68 equinovarus feet, positive for the flexor withdrawal reflex test, aged 8.1 ± 2.5 (range four to 15) years were enrolled. All feet underwent a soft tissue release procedure combined with the SPLATT procedure and were followed for at least 12 months after surgery. The functional outcome was rated using the criteria of Kling and co-workers. Pre-treatment gross motor functional classification system (GMFCS) levels were compared to the patients' latest evaluations. Factors associated with outcomes and success rate were assessed. At an average follow-up of 5.5 ± 3.3 (range 1.1-16) years, feet were rated as excellent in 48 cases (70 %), good in ten (15 %) and poor in ten (15 %), respectively. Thirty-four CCP showed an improvement for the GMFCS level, P < 0.001. The factor that could predict a poor outcome was the pre-treatment GMFCS levels 3-4 with an odds ratio (95 % CI) of 4.92 (0.96-25.2), P = 0.03. The ten years success rate of the SPLATT procedure between CCP with GMFCS levels 1-2 and levels 3-4 were not different with a mean ± SD (95 % CI) of 0.85 ± 0.1 (0.5-0.96) versus 0.6 ± 0.1 (0.3-0.8), P = 0.08, respectively. The SPLATT procedure provides a balanced function of the foot, thus improving the ambulatory ability in CCP and should be integrated into the surgical plan. Pre-treatment GMFCS levels 3-4 predicted unfavourable outcomes and should be addressed during pre-operative parental counselling.

Natural Evolution of Syrinx in Patients Undergoing Posterior Correction for Scoliosis Secondary to Syringomyelia

Introduction While correction surgery for syringomyelia-associated scoliosis frequently results in an elongation of the spine and may potentially influence the natural history of syringomyelia, a paucity of data exists regarding the syrinx behavior in the postoperative course. This study aims to investigate the natural evolution of syrinx in patients undergoing one-stage posterior instrumented spinal fusion for treatment of scoliosis secondary to idiopathic syringomyelia (IS). Materials and Methods Twenty-two patients with IS-associated scoliosis treated with one-stage posterior correction and fusion were evaluated at a minimum of 12-month follow-up (mean, 28.5 months; range, 12–57 months). Standing anteroposterior and lateral radiographs were examined for curve pattern, primary curve magnitude, thoracic kyphosis, and postoperative correction. Preoperatively and at follow-up, T2-weighted MR images, location, configuration, and size of the syrinx cavity were systematically assessed, and significant syrinx resolution was defined as more than 20% decrease in length or maximal syrinx/cord ratio. Results The series consisted of 15 male and 7 female patients with a mean age of 19.0 years (range, 12–35 years). Postoperative percent correction of the primary curve averaged to 64.0 ± 15.7% and was well maintained (58.5 ± 11.5%) at latest evaluation. Regarding syrinx size, the maximal syrinx/cord ratio improved from 0.44 to 0.41, with an average change rate of 3.5%. Overall, 10 (45.5%) and 11 (50.0%) patients met the criteria for syrinx improvement and stabilization, and syrinx deterioration was observed only in 1 case (4.5%). Age, gender, preoperative syrinx length, and number of fused vertebra were not associated with the prognosis of syringomyelia ( p &gt; 0.05), whereas a significantly greater coronal correction was found in patients harboring a collapsed syrinx than in those with syrinx deterioration or stabilization (73.9 vs. 54.6%, p = 0.001). Using Spearman correlation test, improvement rate of the maximal syrinx/cord ratio was found to be strongly related to the coronal percent correction of the primary curve (r = − 0.547, p = 0.008). There were no neurological or other major complications related to the surgery. Conclusion For treatment of scoliosis secondary to IS in the setting of minimal neurological deficits, one-stage spinal fusion with lengthening of the vertebral column provides an effective coronal and sagittal correction without neurological complications. Following surgery, the vast majority (95.5%) of syringes shrank or remained stable, indicating that deformity correction did not exert a deleterious effect on the natural evolution of syringomyelia.

A genealogical and clinical study of the phenotypical variation within the Swedish transthyretin His88Arg (p. His108Arg) amyloidosis family

In 2005 we reported the first case of transthyretin His88Arg (p. His108Arg) amyloidosis, a mutation characterised by cardiomyopathy. Six additional gene carriers of whom five have clinical symptoms of disease have now been identified in Sweden, and we have been able to identify a possible founder and to characterise the Swedish phenotype of the transthyretin (TTR) His88Arg mutation. Genealogical studies of church records were used to identify the individuals with the disease and their families. Routine clinical investigations of neurological and heart manifestation of the disease were utilised. We found that genealogically all seven individuals were related and originated from the same region in Sweden. Amyloid deposits were demonstrated in biopsies and the TTR His88Arg mutation was identified in all patients. Patients had a late onset disease (≥50 years of age) and all exhibited a severe amyloid cardiomyopathy. A pronounced peripheral axonal neuropathy was with certainty demonstrated in one patient only, who also was operated for a magnetic resonance confirmed spinal stenosis, however, without any effect on his neurological symptoms. Five of the patients had carpal tunnel syndrome. The first reported case is now deceased from cardiac failure. One patient has had a sequential heart and liver transplantation. One gene carrier had no symptoms or findings of disease on latest evaluation at the age of 44. In conclusion: the Swedish TTRHis88Arg patients all have a common Swedish founder. Cardiomyopathy with heart failure, as well as carpal tunnel syndrome and spinal stenosis were early signs of disease; but peripheral neuropathy was present in one patient before symptoms of cardiomyopathy so the phenotypical presentation of this mutation is variable.

Application of pulsed electromagnetic fields after microfractures to the knee: a mid-term study.

Pulsed electromagnetic fields (PEMFs) may improve clinical outcomes following microfractures and prevent their decline over time. Sixty-eight patients who underwent partial medial meniscectomy and microfractures to the medial femoral condyle for management of grade III-IV cartilage lesions were randomly divided into two groups using a block randomization procedure. After surgery, 34 patients underwent PEMFs application in the I-ONE group; 34 patients underwent placebo treatment in the placebo group. All patients had the same postoperative rehabilitation protocol. Sixty patients (28 in the I-ONE group, 32 in the placebo group) were assessed at an intermediate follow-up of two years and a minimum follow-up of five years after surgery. The two groups were homogeneous. There was a significant improvement from baseline to the last minimum follow up of two years. At two years, IKDC and Lysholm and Constant scores were significantly improved compared to baseline in both groups with no significant inter-group differences. At the last follow up (minimum five years), clinical and functional outcomes were decreased in both the groups, with significant better outcomes in the I-ONE group. At five years, the percentage of patients still active at the same level they were pre-operatively was greater in the I-ONE group (82% vs 68%, P = 0.28). At radiographic assessment, at the latest evaluation, six patients (21.4%) in the I-ONE group and nine (28.1%) in the placebo group demonstrated grade I-II degenerative changes according to Fairbank grading system (Χ = 0.36, P = 0.55). PEMFs application can improve the effectiveness of microfracture in the long term.

0528: Long term follow-up and prognosis of abnomalous origin of left coronary from pulmonary artery

The aim of the study was to assess the long term outcome of patients with ALCAPA Retrospective single-center analysis of patients who underwent surgery for ALCAPA from 1980 to 2012. Surgical techniques, demographics, echocardiographic parameters and outcomes were collected. Patients were divided into group I <2 years at diagnosis, group II: >2 years). 48 patients (28 females) were included, median age 6 months (min 4 mos, max 65y), median weight 6kg (min 1.9kg): 36 in group I and 12 in II. HF was patent in 39 patients (mean age 4y), 9 were asymptomatic (mean age 10y), Qwave on ECG was present in 87% of cases. Mean LVSF= 24.2% (group I= 26.6% vs II= 37.7%, and 16.6% in patients <6mos of age), LVEDD and LVESD Z-scores were respectively +2 and +5 in groups I and II; 73% had MR: severe in 6%, moderate in 46%, mild in 21%. Left coronary artery ostium located in the left posterior sinus in 31 cases, right posterior sinus in 12 and in right pulmonary branch in 4. Direct coronary artery reimplantation was performed in 71%, Takeuchi technique in 6%, Meyer technique in 20% and LCA ligation in 3%. Mean age at surgery was 29mos, mean weight 9kg. Postoperative mechanical circulatory support was required in 3 cases, who had more severe HF, lower LVSF and longer bypass duration. Mean FU was 81mos (6 to 312mos). Freedom from reoperation was 100% at 1y, 91% at 10y and 88% at 20y. LVSF increased by 20% in the early postoperative course and 36% at late FU. MR improved significantly in most of the cases. Overall mortality was 33% (15 in group I died before Day-30, none in group II), decreasing over time from 55% to 11%, and was lower in patients who had direct reimplantation. Q wave disappeared in 82% of the cases; 93% of survivors were asymptomatic at latest evaluation. ALCAPA patients have good long-term survival and outcome. Age >2y at diagnosis and direct implantation are factors of favourable prognosis.

0533: Sildenafil in the postoperative course after surgery in children with congenital heart disease

Pulmonary hypertension (PHT) is one main cause of postoperative morbidity and mortality after repair of CHD. Although efficacy of iNO is wellestablished, the utilization of sildenafil is not yet clearly defined. The aim of this study was to assess efficacy of sildenafil after CHD repair in children. Retrospective analysis of patients who received sildenafil in postoperative course after CHD repair, from 2005 to 2012. Duration of mechanical ventilation, CICU and in-hospital stay, pulmonary pressure and overall outcome were assessed. Patients were divided into group I (sildenafil onset <H24) and II (> H24). 50 patients were included: 30 in I and 20 in II. Mean age was 11.5mos, (med3.7mos), mean weight 4.4 kg. CHD included 20VSD, 2VSD+coarctation, 9AVSD, 3 truncus arteriosus, 2TGV, 3TOF, 9 abnormal pulmonary venous return, 3 miscellaneous. Mechanical ventilation duration was 8.4d, CICU stay 12.9d, hospital stay 21.6d. Bypass time was 100.8± 45 mn, aortic clamp time 60.2±22 mn. InhaledNO was administered within 5 mn post-bypass, at 11.3±5.5 ppm and duration of 4±3 days. Sildenafil dose was 0.25-2 mg/ kg/4h, 1st dose was 0.67 mg/ kg/4h. Mean sildenafil dose was 1.16 mg/kg/4h at time of iNO withdrawal. Duration of sildenafil was 22.4±14.6 days. Preoperative systolic pulmonary pressure (PAPs) /systolic aortic pressure (PAs) was 0.94±0.1. Preoperative PAPs decreased from 72 to 36.5 mmhg at iNO cessation, PAPs/PAs from 0.94 to 0.43 and PAPmean/ PAmean from 0.8 to 0.46. PaO2/FiO2 increased from 121.4 at end-bypass to 269 at iNO cessation. Duration of ventilation was 6.2d vs 11.6d (p= 0.04), CICU stay 9.4d vs 18d (p= 0.005), in-hospital stay 16d vs 30d (p= 0.001), in groups I and II. Duration of iNO was shorter in I (3.3d) than II (5d), p=0.05. Preoperative PAPs did not differ between the 2 groups. No significant side effect occurred. Overall mortality was 4%; 4 patients needed long term sildenafil therapy. At latest evaluation, 38% were in NYHA class I, 40% NYHA II and 22 NYHA III. Sildenafil is safe and reliable in postoperative course after surgery for CHD in children and efficacy is optimal if administered < H24 after bypass.

Evolution of syrinx in patients undergoing posterior correction for scoliosis associated with syringomyelia.

While correction surgery for syringomyelia-associated scoliosis frequently results in an elongation of the spine and may potentially influence the natural history of syringomyelia, a paucity of data exists regarding the syrinx behavior in the postoperative course. This study aimed to investigate the natural evolution of syrinx in patients undergoing one-stage posterior instrumented spinal fusion for treatment of scoliosis associated with idiopathic syringomyelia (IS). Twenty-two patients with IS-associated scoliosis treated with one-stage posterior correction and fusion were evaluated at a minimum of 12-month clinical and MRI follow-up (mean 29.6 months; range 12-57 months). All syringes were located within the cervical or cervicothoracic region. Standing anteroposterior radiographs were examined for primary curve magnitude and postoperative correction. On preoperative and follow-up T2-weighted MR images, location, configuration and size of the syrinx cavity were systematically assessed, and significant syrinx resolution was defined as any more than 20% decrease in length or maximal syrinx/cord ratio. Postoperative percent correction of the primary curve averaged 64.0 ± 15.7% and was well maintained (58.5 ± 11.5%) at latest evaluation. Regarding syrinx size, although paired t test revealed no statistically significant difference between pre- and postoperative maximal syrinx/cord ratios (0.44 versus 0.41; P > 0.05), 10 of 22 (45.5%) patients were found to meet the criteria for significant syrinx resolution. Additionally, 11 (50.0%) patients had syrinx stabilization, whereas syrinx deterioration was observed only in 1 case (4.5%) at final follow-up. Using Spearman correlation test, improvement rate of the maximal syrinx/cord ratio was found to be strongly related to the coronal percent correction of the primary curve (r = -0.547, P = 0.008). There were no neurologic or other major complications related to the surgery. For treatment of scoliosis associated with IS in the setting of minimal neurological deficits, one-stage spinal fusion with a lengthening of the vertebral column provides an effective coronal and sagittal correction without neurologic complications. Following surgery, the vast majority (95.5%) of syringes shrank or remained stable, indicating that deformity correction did not exert a deleterious effect on the natural evolution of syringomyelia.

Assessment about Development Level of Low-Carbon Economy in Resource-Based City

In recent years, the phenomenon that global is becoming warmer, natural disasters occur frequently, natural resources and energy are decreasing more and more seriously affects the survival of mankind and the normal production and other activities. In this context, the concepts of “low-carbon economy”, “low-carbon city”, and “low-carbon technology” come into world attention, and low-carbon economy become the main direction of transformation of the resource-based city gradually. Therefore, studying problems about developmental level evaluation and strategies of low-carbon economy for the resource-based city has become an important research topic of scholars both at home and abroad.Facing the low-carbon economic development model, under the background of fully understanding the research status of the resource-based cities at home and abroad and low-carbon economy, the author sum up some problems which the resource-based cities need facing in sustainable development, and put forward concrete solving countermeasures. In order to guarantee the low-carbon economy developing better, the author found a low-carbon economy evaluation index system which suit for the resource-based city, on the base of following the principle of low-carbon economy evaluation index system setting up and the latest evaluation standard. Then taking Daqing city as an example, the author analyses the status of economic industry development in Daqing city and the obstacles existing in the low-carbon economy development of Daqing. At last, it screens 34 secondary indexes, and applies FAHP and DEA method to evaluation. The model gives full play to the features that FAHP can effectively reduce the index weight of subjectivity and DEA is easy to operate and can adjust to the original inputs, and provides theoretical guidance for resource-based cities develop low-carbon economy. Finally, the author submits specific promoting strategies for the resource-based city develop low-carbon economy, which can offer references for the sustainable development of the resource-based city.

ALCAPA long-term follow-up and prognosis

The aim of the study was to assess the long-term outcome of patients with ALCAPA. Retrospective single-center analysis of patients who underwent surgery for ALCAPA from 1980 to 2012. Surgical techniques, demographics, echocardiographic parameters and outcomes were collected. Patients were divided into group I < 2years at diagnosis, group II: > 2years). Forty-eight patients (28 females) were included, median age 6 months (min 4 months, max 65 years), median weight 6 kg (min 1.9 kg): 36 in group I and 12 in II. HF was patent in 39 patients (mean age 4 years), 9 were asymptomatic (mean age 10 years), Qwave on ECG was present in 87% of cases. Mean LVSF = 24.2% (group I = 26.6% vs II = 37.7%, and 16.6% in patients < 6 months of age), LVEDD and LVESD Z-scores were respectively +2 and +5 in groups I and II; 73% had MR: severe in 6%, moderate in 46%, mild in 21%. Left coronary artery ostium located in the left posterior sinus in 31cases, right posterior sinus in 12 and in right pulmonary branch in 4. Direct coronary artery reimplantation was performed in 71%, Takeuchi technique in 6%, Meyer technique in 20% and LCA ligation in 3%. Mean age at surgery was 29 months, mean weight 9 kg. Postoperative mechanical circulatory support was required in 3 cases, who had more severe HF, lower LVSF and longer bypass duration. Mean FU was 81 months (6 to 312 months). Freedom from reoperation was 100% at 1 year, 91% at 10 years and 88% at 20 years. LVSF increased by 20% in the early postoperative course and 36% at late FU. MR improved significantly in most of the cases. Overall mortality was 33% (15 in group I died before day 30, none in group II), decreasing over time from 55% to 11%, and was lower in patients who had direct reimplantation. Q wave disappeared in 82% of the cases; 93% of survivors were asymptomatic at latest evaluation. ALCAPA patients have good long-term survival and outcome. Age > 2 years at diagnosis and direct implantation are factors of favorable prognosis.

Reconsideration of the temporary ADI and refined exposure assessment for Sunset Yellow FCF (E 110)

The Panel on Food Additives and Nutrient Sources added to Food (ANS Panel) has previously provided a scientific opinion re-evaluating the safety of Sunset Yellow FCF (E 110) as a food additive in the EU and establishing a temporary acceptable daily intake (ADI) of 1 mg/kg bw/day (EFSA ANS Panel, 2009). Following a request by the European Commission, the ANS Panel was asked to assess newly submitted data from a study conducted as a result of the recommendations contained in the 2009 opinion. In addition, EFSA was requested to carry out the refined exposure assessment of Sunset Yellow FCF. The new information assessed comprised an evaluation of the 28-day study report, the data considered by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) in its latest evaluation from 2011, and any additional toxicological information that had become available since the completion of the previous evaluation by the ANS Panel. The ANS Panel has considered that the newly submitted data from the 28-day study and the overall available toxicological database on Sunset Yellow FCF provides a basis to revise the established temporary ADI and concluded that, based on the NOAEL of 375 mg/kg bw/day from the long-term feeding study in rats and an uncertainty factor of 100, a new ADI for Sunset Yellow FCF of 4 mg/kg bw/day can be established, in agreement with the latest evaluation by JECFA. Exposure estimates for Sunset Yellow FCF based both on the currently authorised MPLs and reported use levels provided are well below the new ADI of 4 mg/kg bw/day for all population groups. Overall, the Panel concluded that, using data provided by the food industry and Member States, the reported uses and use levels of Sunset Yellow FCF (E 110) would not be of safety concern