North American Experience Research Articles

First North American experience with the Berlin Heart EXCOR Active driver

For smaller pediatric patients on ventricular assist devices (VADs), the Berlin Heart EXCOR® remains the main form of durable support. It requires a connection to the external IKUS which has limited portability and battery life. The new EXCOR® Active mobile driving unit has battery life up to 13 hours. We describe the first North American experience with the EXCOR® Active in pediatric patients with a Berlin Heart device. Retrospective chart review was undertaken. Between Oct/2022 to Mar/2024, seven patients were on a Berlin Heart and supported with the EXCOR® Active. All patients were initially supported with the IKUS with a median time to transition to the EXCOR® Active of 12.0 days (IQR 9.5, 18.5) and a median time of support with the EXCOR® Active of 65.0 days (IQR, 32.0, 81.0). The EXCOR® Active posed no significant safety issues and minimal operating issues were noted. Following transition from IKUS to the EXCOR® Active there was increased patient and caregiver mobility throughout the hospital. Use of the EXCOR® Active has the potential to improve quality of life in pediatric patients waiting for heart transplantation.

ANALYSIS OF THE DEVELOPMENT OF GONDOLA CAR BODY STRUCTURES

The article is devoted to the analysis of promising directions for the development of gondola car body structures. It considers the history of the emergence of gondola cars as a separate type of railway rolling stock. The authors systemise the design of gondola cars and discuss the advantages and disadvantages of various designs. The study has shown that the manufacture of the two-axle gondola cars began in the second half of the 19th century. They were designed mainly for transporting coal and iron ore, with their bodies made of wood. Further design improvement led to the appearance of four-axle gondola cars with increased load capacity. Rolled metal began to be used in body structures to improve strength. Particular attention in the article goes to analysing the results of innovative design and technological solutions intended to enhance the efficiency and reliability of body structures. The research indicates that attempts to replace steel with aluminium alloys in manufacturing bodies did not yield results. The reason is the high cost of aluminium and the labour-intensive manufacturing. A promising direction is the use of low-alloy steels 10KhSND and 10KhNDP. For many years, there has been a trend in the railcar-building industry toward producing higher-load gondola cars. It requires increasing the axle load to 25 tons. However, implementing such cars necessitates a substantial restructuring of the railway infrastructure. We consider the design features of innovative domestic gondola cars in detail. The latest technical solutions for the body frame, efficient materials, and components with improved performance have doubled the overhaul mileage. The article analyses the North American experience of gondola car construction and operation. It shows that some models of American gondola cars use longitudinal cylindrical boxes to increase the body volume and reduce the car’s centre of mass. They are on both sides of the girder beam and occupy the space between the carts. Aluminium alloys are also widely used: the frame and lower part of the body are steel, and the side and end walls are aluminium alloy. Keywords: gondola car, body, girder beam, pivot beam, side walls, hatch cover, reliability.

Ripples Over the Rim: Narrating Dispossession through Asian Diasporic Formations in Ruth Ozeki's A Tale for the Time Being

Abstract: This article examines the condition of dispossession as a multi-scalar phenomenon by tracing historical continuities between different forms of transpacific displacement to contemplate how Asian American critique can offer the tools to render deterritorialized identities legible as political entities. Using Ruth Ozeki's A Tale for The Time Being , the article illustrates how Asian North American exclusions serve as a heuristic to interpret environmental displacements post-Fukushima as imperial dispossessions that are related and complementary. In showing how Ozeki expends the category of dispossession by politicizing the spaces of alterity, her text reveals the radical promises of planetary interconnectedness. Reading the rōnin , the unwelcome and ostracized subject of modernity, as the emblematic figure of the outsider allows me to present their social alienation alongside Asian North American experiences of dispossessions. In narrating experiences of social and political dispossession alongside environmental displacements, Ozeki expands the category of the rōnin from one of social to ecological dispossession. As such, the figure of rōnin foregrounds the ways in which these experiences of dispossession are interrelated, interlinked, and interwoven. This inextricability in turn allows for a different articulation of dispossession, one not grounded in a singular place but distributed across a series of sites and scales. I name this methodology of tracing Asian dispossessions across planetary geographies as "trash-nationalism."

Radiofrequency ablation of benign thyroid nodules: A prospective, multi-institutional North American experience

Radiofrequency ablation of benign thyroid nodules: A prospective, multi-institutional North American experience

(1365) - First North American Experience with The Berlin Heart Active Driver

(1365) - First North American Experience with The Berlin Heart Active Driver

Subtalar extra-articular screw arthroereisis: Early North American experience in a novel minimally invasive treatment for pediatric pes planovalgus

Subtalar extra-articular screw arthroereisis: Early North American experience in a novel minimally invasive treatment for pediatric pes planovalgus

Commentary on JPOSNA® paper, “Subtalar extra-articular screw arthroereisis: Early North American experience in a novel minimally invasive treatment for pediatric pes planovalgus”

Commentary on JPOSNA® paper, “Subtalar extra-articular screw arthroereisis: Early North American experience in a novel minimally invasive treatment for pediatric pes planovalgus”

Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience.

Rapid adoption of sleeve gastrectomy (SG) in the last decade aptly reflects the desire of patients and surgeons for alternatives to RYGB and DS. While SG provides good outcomes, other options that address specific patient needs are warranted. Recently approved by ASMBS, SADI, and OAGB have garnered increasing interest due to their single anastomosis technique. Using the Metabolic and Bariatric Surgery Quality Improvement Program database, we examined laparoscopic and robotic cases from 2018 to 2021 to understand the percentage of primary bariatric surgery cases that are SADI and OAGB. We used coarsened exact matching to match patients who underwent SADI or OAGB to patients who underwent Roux-en-Y gastric bypass (RYGB). We examined outcomes of matched patients using logistic regression. Of the 667,979 patients that underwent bariatric-metabolic surgery, 1326 (0.2%) underwent SADI, and 2541 (0.4%) underwent OAGB. SADI was not identified in the database until 2020. In 2020, there were 487 SADI procedures compared to 839 in 2021. From 2018 to 2021, OAGBs went from 149 to 940. Compared with RYGB, SADI was associated with higher rates of anastomotic or staple line leak (OR 2.21 (95% CI 1.08-4.53)) and sepsis (OR 3.62 (95% CI 1.62-8.12)). Compared with RYGB, OAGB was associated with lower rates of gastrointestinal bleeding (OR 0.29 (95% CI 0.12-0.71)) and bowel obstruction (OR 0.10 (95% CI 0.02-0.39)). Of note, there were no differences between these procedures and RYGB for 30-day mortality. More SADIs and OAGBs are being performed. However, there were higher complication rates associated with the SADI procedure. Further studies will be needed to better understand the key drivers for these outcomes.

Rereading Afropean Identities through Espérance Hakuzwimana’s Tutta intera

This article investigates the term Afropean through an analysis of Espérance Hakuzwimana’s debut novel Tutta intera (2022). It aims to show how the novel, far from losing sight of the national context as the term Afropean implies, effectively mediates issues related to specific localities and temporalities (racist and racial configurations in Italy in the 2010s) and transnational influences (the European and North American experiences of colonialism and slavery). By exploring the intersection of Afropean and Afroitalian, the novel aims to decentre the notion of (white) Europeanness and Italianness while highlighting global articulations of Blackness. Space, language, and class will be key elements to demonstrate how the novel expands the boundaries of Afropean/Afropeanness beyond race to promote a more inclusive and intersectional understanding of the term.

Radiofrequency ablation of benign thyroid nodules: A prospective, multi-institutional North American experience

BackgroundRadiofrequency ablation for benign thyroid nodules aims to achieve a volume reduction rate of ≥50%. However, factors that predict treatment success have not been defined in a large-scale study. MethodsA prospective cohort study of biopsy-proven benign thyroid nodules treated with radiofrequency ablation at 3 institutions was performed. Patient demographics, nodule sonographic features, procedural data, and nodule volume reduction were evaluated. Binary logistic regression analysis was performed to identify features associated with treatment response. ResultsA total of 620 nodules were analyzed. The pooled median volume reduction rate at 12 months was 70.9% (interquartile range 52.9–86.6). At 1 year follow-up, 78.4% of nodules reached treatment success with a volume reduction rate ≥50%. The overall complication rate was 3.2% and included temporary voice changes (n = 14), vasovagal episodes (n = 5), nodule rupture (n = 3), and lightheadedness (n = 2). No permanent voice changes occurred. Four patients developed postprocedural hypothyroidism. Large baseline nodule volume (>20 mL) was associated with a lower rate of successful volume reduction (odds ratio 0.60 [0.37–0.976]). Large nodules achieved treatment success by 12-month follow-up at a rate of 64.5%, compared with 81.4% for small nodules and 87.2% for medium nodules. ConclusionTo our knowledge, this is the largest North American cohort of patients with benign thyroid nodules treated with radiofrequency ablation. Overall, radiofrequency ablation was an effective treatment option with a low risk of procedural complications. Large volume nodules (>20 mL) may be associated with a lower rate of successful reduction with radiofrequency ablation treatment.

Examining the Safety Impacts of High-Occupancy Vehicle Lanes: International Experience and an Evaluation of First Operation in Israel

Current transport policies promote better use of existing roadways by using traffic management strategies such as high-occupancy vehicle (HOV) lanes. International experience showed positive mobility impacts of HOV lanes, while research evidence on their safety implications is limited. In Israel, the first HOV lanes were introduced in 2019. This study examined the impacts of HOV lanes on road safety based on a detailed review of international research and accident analyses, which evaluated the safety effects of HOV lanes in Israel. The literature survey applied a systematic screening of research studies from the past two decades and found that HOV lanes were frequently associated with an adverse effect on road safety. Yet, findings were limited to the North American experience, with mostly left-side HOV lanes in use, while in Israel, right-side HOV lanes were introduced. In Israeli evaluations, before-after comparisons of accident changes with comparison groups were applied, with regression models fitted to monthly time series of 17 accident types. Results showed that HOV lanes’ operation led to increasing accident trends, particularly in interchange areas and in the daytime. In injury accidents on road sections, an average increase of 31–41% was found (yet non-significant), while at interchange areas, an increase was even higher and sometimes significant. Thus, adverse safety effects should be expected and accounted for in future planning of HOV lanes. Further research should explore the design features of HOV lanes to reduce their negative safety implications.

Post-operative outcomes in Indigenous patients in North America and Oceania: A systematic review and meta-analysis.

Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10-1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12-1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02-1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations.

Cystic fibrosis survival outcomes following second lung transplant: The north American experience.

Re-transplant is an option for those who develop end-stage lung disease due to rejection; however, little data exist following re-transplantation in cystic fibrosis (CF). Data from the Canadian CF Registry and US CF Foundation Patient Registry supplemented with data from United Network for Organ Sharing were used. Individuals who underwent a 2nd lung transplant between 2005 and 2019 were included. The Kaplan-Meier method was used to estimate the probability of survival post-second transplant at 1, 3, and 5-years. Of those people who were waitlisted for a second transplant (N=818), a total of 254 (31%) died waiting, 395 (48%) were transplanted and 169 (21%) people were alive on the waitlist. Median survival time after 2nd lung transplant was 3.3 years (95% CI: 2.8-4.1). The 1-, 3- and 5-year survival rates were 77.4% (95% CI: 73.1-82%), 52% (95% CI: 46.7-58%) and 39.4% (95% CI: 34.1-45.6%). Survival following second lung transplant in CF patients is lower than estimates following the first transplant. Over half of subjects who are potentially eligible for a second transplant die without receiving a second organ. This warrants further investigation.

WEB (Woven EndoBridge) device for intracranial aneurysm treatment: technical, radiological, and clinical findings in a consecutive North American cohort.

Utilization of Woven EndoBridge (WEB) for treatment of intracranial aneurysms has increased due to increasing operator experience. We aimed to report our contemporary series of a North American center with the WEB, examining factors associated with occlusion rates. Consecutive patients (2019-2022) with intracranial aneurysms treated with WEB device were included. Through a univariate and multivariate analysis, independent predictors of adequate occlusion (RR1/RR2) were examined. Procedural and clinical results were reported. A total of 104 consecutive aneurysms/patients (25 men/79 women; median age, 63years, IQR: 55-71) were treated with single-layer WEB-SL in our institution. Seventeen patients (16%) had a ruptured aneurysm. The median aneurysm dome size was 5.5mm (IQR = 4.5-6.5), and the most common locations were AcomA (36/104 = 34.6%), MCA bifurcation (29/104 = 27.9%), and BT (22/104 = 21.2%). The rate of technical failure was 0.9%. The median intervention time was 32min (IQR = 25-43). Overall, 8 (7.6%) cases needed additional interventions: 4 (3.8%) additional stenting, 3 cases (3.8%) of intravenous tirofiban infusion (because of the excessive WEB protrusion), and one case (0.9%) of additional coiling (need to complete the neck occlusion). At 12-month follow-up, 67 patients were available showing 59/67 (88%) and 6/67 (9%) of complete occlusion and neck remnant, respectively on dual-energy CTA. There were no cases necessitating retreatment. Ruptured presentation (OR = 0.09, 95% CI = 0.008-0.9, p = .024), undersized WEB (OR = 15, 95% CI = 1.2-50, p = .006), WEB shape change (OR = 0.07, 95% CI = 0.001-0.6, p = .05), aneurysm neck diameter (OR = 0.4, 95% CI = 0.2-0.9, p = .05), and angle between the parent artery and the aneurysm dome (OR = 0.2, 95% CI = 0.01-0.8, p = .008) were significantly associated with occlusion status (RR1-2) at follow-up. However, in the multivariate logistic regression, these factors did not reach the statistical significance. The overall rate of morbidity was 0.9%. Our contemporary North American experience on consecutive intracranial aneurysms treated with WEB confirms the medium-term efficacy of this strategy, with low procedural time and morbidity. Further research is needed to demonstrate long-term occlusion rates.

Transcatheter Treatment of Native Aortic Valve Regurgitation: The North American Experience With a Novel Device

BackgroundTranscatheter treatment of patients with native aortic valve regurgitation (AR) has been limited by anatomical factors. No transcatheter device has received U.S. regulatory approval for the treatment of patients with AR. ObjectivesThe aim of this study was to describe the compassionate-use experience in North America with a dedicated transcatheter device (J-Valve). MethodsA multicenter, observational registry was assembled of compassionate-use cases of J-Valve implantation for the treatment of patients with severe symptomatic AR and elevated surgical risk in North America. The J-Valve consists of a self-expanding Nitinol frame, bovine pericardial leaflets, and a valve-locating feature. The available size matrix (5 sizes) can treat a wide range of anatomies (minimum and maximum annular perimeters 57-104 mm). ResultsA total of 27 patients (median age 81 years [IQR: 72-85 years], 81% at high surgical risk, 96% in NYHA functional class III or IV) with native valve AR were treated with the J-Valve during the study period (2018-2022). Procedural success (J-Valve delivered to the intended location without the need for surgical conversion or a second transcatheter heart valve) was 81% (22 of 27 cases) in the overall experience and 100% in the last 15 cases. Two cases required conversion to surgery in the early experience, leading to changes in valve design. At 30 days, there was 1 death, 1 stroke, and 3 new pacemakers (13%), and 88% of patients were in NYHA functional class I or II. No patient had residual AR of moderate or greater degree at 30 days. ConclusionsThe J-Valve appears to provide a safe and effective alternative to surgery in patients with pure AR and elevated or prohibitive surgical risk.

MP34-07 MV140 SUBLINGUAL VACCINE REDUCES RISK OF RECURRENT URINARY TRACT INFECTION (RUTI) IN NORTH AMERICAN WOMEN: RESULTS FROM THE FIRST NORTH AMERICAN CLINICAL EXPERIENCE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP34-07 MV140 SUBLINGUAL VACCINE REDUCES RISK OF RECURRENT URINARY TRACT INFECTION (RUTI) IN NORTH AMERICAN WOMEN: RESULTS FROM THE FIRST NORTH AMERICAN CLINICAL EXPERIENCE STUDY J. Curtis Nickel, Dean Elterman, Kerri-Lynn Kelly, Ashley Griffin, and R. Christopher Doiron J. Curtis NickelJ. Curtis Nickel More articles by this author , Dean EltermanDean Elterman More articles by this author , Kerri-Lynn KellyKerri-Lynn Kelly More articles by this author , Ashley GriffinAshley Griffin More articles by this author , and R. Christopher DoironR. Christopher Doiron More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003268.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent UTI in women is associated with widespread morbidity, massive antibiotic use, increasing antibiotic resistance, and significant costs. This is the first North American real-world, clinical experience evaluation of MV140, a novel bacterial sublingual vaccine for prevention of rUTI. METHODS: Females with ≥3 UTI/yr underwent 3-month (mo) vaccination treatment, 9-mo efficacy and subsequent 3-mo follow-up (total 15-mo) periods. Primary outcome was no clinically diagnosed UTI (symptoms requiring antibiotics) following vaccination. Secondary outcomes included reduction in UTI compared to pre-vaccination, quality of life (QoL), global response assessment (GRA), microbiology and safety. RESULTS: 67 subjects (mean age 55.6 yr; range 18-80) were enrolled; 64 completed 3-mo vaccination period and at least one post-vaccination assessment. Prior to vaccination, subjects reported 6.8±4.6 UTI/yr with E. coli (59%), Klebsiella (18%) and Enterococcus (15%) being the predominant causative bacterial species. The UTI free rate for the 9-mo post-vaccination efficacy period was 40.6%. Compared to the UTI rate in the year prior to vaccination (0.56 UTI/subject/mo), the reduction in UTI rate was 74.8% for the 9-mo efficacy period (0.14 UTI/subject/mo) post-vaccination. Total number of UTI and patients reporting UTI decreased substantially for each 3-mo follow-up period while the percentage of UTI free subjects increased following vaccination (Table 1). The predominant bacterial strains post-vaccination remained E. coli (60%), Klebsiella (14%) and Enterococcus (11%). At the 12-mo efficacy visit, 82% reported (GRA) that they were moderately/markedly improved; 59% were mostly satisfied, pleased or delighted while mean SF-12 improved by 1.5 points on QoL assessment. 11 adverse events (A/Es) in 9 subjects were potentially related to vaccine; all mild and resolved by 3 mo. None of the 13 Serious AEs were related to vaccine. CONCLUSIONS: This first Health Canada-approved North American experience with the sublingual vaccine, MV140, demonstrates its safety and potential effectiveness in real world clinical practice in reducing UTI risk and rendering a significant number of women suffering from rUTI completely UTI-free. Source of Funding: Inmunotek supplied MV140 vaccine © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e461 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information J. Curtis Nickel More articles by this author Dean Elterman More articles by this author Kerri-Lynn Kelly More articles by this author Ashley Griffin More articles by this author R. Christopher Doiron More articles by this author Expand All Advertisement PDF downloadLoading ...

Multicenter review of a tadalafil suspension formulation for infants and children with pulmonary hypertension: A North American experience.

Phosphodiesterase type 5 (PDE5) inhibitors, with sildenafil the earliest among them, are widely used in the management of pediatric pulmonary arterial hypertension (PAH). Tadalafil is a PDE5 inhibitor with a long half life (16 h), stable pharmacokinetics and pharmacodynamics, and minimal adverse effects. However, the utility of tadalafil suspensions in this setting has not been widely explored due to a lack of clinical experience. We present a multicenter experience that details the safety and tolerability of a tadalafil suspension, either alone or in combination with another vasodilator, for the management of pediatric pulmonary hypertension (PH). This is a retrospective chart review of infants and children at Children's Wisconsin and the Stollery Children's Hospital enrolled in pediatric PH programs between December 2013 and April 2022 managed with a tadalafil suspension. Patients aged six years of age and under who were treated with a tadalafil suspension were included. Demographics, clinical information, echocardiographic and hemodynamic measurements, and laboratory data were collected before and six months after tadalafil initiation. Over the study period, 154 children with a median age of 1.0 (range 0.0-6.9) years were treated with tadalafil therapy. Of these, 39 (25.3%) were in group 1 (PAH), 79 (51.3%) were in group 3 (lung disease), and 33 (21.4%) were in group 5 (pulmonary hypertensive vascular disease). The median initial dose of tadalafil was 1.0 mg/kg once daily. Eleven (7.1%) patients in the cohort were established on tadalafil therapy de novo. The suspension formulation was necessary for 103 (66.9%) patients due to an inability to take enteral tablets and for 49 (31.8%) due to a need for feeding via gastric or jejunal tubes. We observed a statistically significant increase in tricuspid annular plane systolic excursion as well as significant decreases in right-ventricular systolic pressure and NT-proBNP. Tadalafil therapy was well tolerated over the six-month period: at six months, no adverse effects were reported aside from gastrointestinal disturbances by 2 (1.3%) patients. Tadalafil, a long-acting PDE5 inhibitor, when administered in a suspension formulation, has a safe and tolerable adverse effect profile. Following six months of therapy, our cohort showed improvements in clinical parameters, echocardiographic measurements, and laboratory results. Patient compliance was good and adverse effects were rare, minor, and manageable with nonpharmacological means.

Multicenter review of a tadalafil suspension formulation in infants and children with pulmonary hypertension: a north american experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary arterial hypertension (PAH) is a disease characterised by an increase in pulmonary vascular resistance and pulmonary artery pressure. Phosphodiesterase type 5 (PDE5) inhibitors, with sildenafil the earliest among them, are widely used in the management of pediatric PAH. There has more recently been a transition to once-daily tadalafil suspensions. Herein, we present a multicenter experience detailing safety, tolerability and haemodynamic data utilizing tadalafil suspension alone or in combination for the management of pediatric PAH. Methods and materials We performed a retrospective review of all infants and children at two North American paediatric PH centres between December 2013 and April 2022. We included all patients less than 9 years of age who were treated with a tadalafil suspension after an initial treatment with sildenafil. Demographic, clinical, imaging, and laboratory data were collected. Results Over the study period, 158 children were treated with tadalafil therapy: 41 (25.9%) had group 1 PAH, 81 (51.3%) had group 3 PH, and 33 (20.9%) had group 5 PH. The median initial dose of tadalafil was 1.0 mg/kg once daily with a median time to maximum dose of 1 day. The majority of patients required the suspension formulation due to an inability to take oral tablets or the need for nasogastric or nasojejunal feeding. We observed improvements in median echocardiographic parameters in the six months following initiation, namely, in RVFAC from 34.7% (Q1 = 31.0%, Q3 = 42.0%) to 37.0% (Q1 = 31.0%, Q3 = 44.0%) and in TAPSE from 1.0 (Q1 = 0.8, Q3 = 1.7) cm to 1.3 (Q1 = 1.0, Q3 = 1.7) cm. We observed median decreases in RVSp from 51.0 (Q1 = 35.0, Q3 = 69.0) mmHg to 37.0 (Q1 = 30.0, Q3 = 50.0) mmHg and in NT pro BNP levels from 439.0 (Q1 = 217.0, Q3 = 2051.0) ng/L to 313.0 (Q1 = 193.0, Q3 = 1110.0) ng/L. Tadalafil therapy was well tolerated over the six-month period: at baseline, only four patients (2.5%) reported gastrointestinal side effects, two (1.3%) reported adverse skin adverse effects (i.e., rash and flushing), and one (0.6%) reported adverse neurological effects. At six months, 150 patients (94.9%) reported no adverse effects. Conclusion Tadalafil, a long-acting PDE5 inhibitor, when administered in a suspension formulation, has a safe and tolerable adverse effect profile once patients are established on sildenafil therapy. Following 6 months of once daily tadalafil suspension, alone or in combination, showed a trend towards improvement in clinical parameters, echocardiographic measurements, and laboratory results for pediatric PAH. All patient adverse effects were managed with non pharmacological measures and there was good patient compliance.

Aloisio Magalhães and the North American experience: design in practice and theory

This article seeks to present the North American scenario found by Aloisio Magalhães at the end of the 1950s, when he began a process of turning off painting for entry into the field of design. In the pragmatic action of American artists and immigrants welcomed in the country, Aloisio recognizes the possibility of a design built in the practical exercise but also in teaching and critical theory, seeing in that system the mode of production compatible with contemporaneity.

Outcomes of lung transplantation from organ donation after medical assistance in dying: First North American experience

Over 2.5% of deaths in Canada occur as a result from medical assisting in dying (MAID), and a subset of these deaths result in organ donation. However, detailed outcomes of lung transplant recipients using these donors is lacking. This is a retrospective single center cohort study comparing lung transplantation outcomes after donation using MAID donors compared to neurologically determined death and controlled donation after circulatory death (NDD/cDCD) donors from February 2018 to July 2021. Thirty-three patients received lungs from MAID donors, and 560 patients received lungs from NDD/cDCD donors. The donor diagnoses leading to MAID provision were degenerative neurological diseases (n=33) and end stage organ failure (n=5). MAID donors were significantly older than NDD/cDCD donors (56 [IQR 49-64] years vs. 48 [32-59]; p=.0009). Median ventilation period and 30day mortality were not significantly different between MAID and NDD/cDCD lungs recipients (ventilation: 1day [1-3] vs 2days [1-3]; p=.37, deaths 0% [0/33] vs. 2% [11/560], p=.99 respectively). Intermediate-term outcomes were also similar. In summary, for lung transplantation using donors after MAID, recipient outcomes were excellent. Therefore, where this practice is permitted, donation after MAID should be strongly considered for lung transplantation as a way to respect donor wishes while substantially improving outcomes for recipients with end-stage lung disease.