Third Generation Ventricular Assist Device: Mid‐Term Outcomes of the HeartWare HVAD in Pediatric Patients

The HeartWare HVAD is a small, third generation continuous flow pump that is intracorporeally placed for support of a failing ventricle in adult patients. This device is small in size when compared to other left ventricular assist devices and can therefore be used in smaller sized pediatric patients. We present our initial experience using the HVAD as a bridge to heart transplantation in the pediatric population. We performed a retrospective, single center, nonrandomized review of 17 pediatric patients who underwent HVAD implantation between June 2013 and March 2016. The primary endpoints evaluated in this study were overall survival to heart transplantation, ongoing device support, or death. In this patient cohort, nine (53%) of 17 patients were male. The median age of the patients was 13.4 ± 3.8 (range 5–17) years. The median body surface area was 1.4 ± 0.4(0.7–2) m². Etiologies of heart failure requiring HVAD support were dilated cardiomyopathy (n = 8), myocarditis (n = 5) and noncompaction cardiomyopathy (n = 4). The overall mean length of HVAD support was 254 ± 298 (range 2–804) days. A successful outcome (bridge to transplant and ongoing mechanical support) was achieved in 13 patients (76.5%). Of the 13 patients, nine (69.2%) were bridged to heart transplantation and four continue to receive support (30.7%) and are eligible for transplantation. Post‐transplant survival has been 100%, with a mean follow‐up of 296 ± 264.5 (range 18–785) days. The most common complication was pump thrombosis (23.5%) in follow‐up. Four patients (23.5%) experienced no complications. The HVAD continuous flow ventricular assist device can be safely used to bridge pediatric patients to cardiac transplantation. Favorable outcomes of this device are comparable to the adult population. This analysis demonstrated safe and effective implantation of the HVAD System in a child with a BSA of 0.7 m².     

Leptin: does it have any role in childhood asthma?

BACKGROUND: Although there is evidence of a positive association between asthma and obesity in adults and children, very little is known about the role of leptin in asthmatic children. OBJECTIVES: The aims of this study were to evaluate the relation between leptin and parameters of atopy and asthma in children. METHODS: Body mass index (BMI) and serum leptin levels were measured in 102 (37 female, 65 male; mean age, 5.9 +/- 3.4 years) asthmatic and 33 (14 female, 19 male; mean age, 6.1 +/- 3.4 years) healthy children. Skin prick tests, total serum IgE, and pulmonary function tests were performed and were completed. RESULTS: A significant difference was observed in serum leptin levels between asthmatic and healthy children. Median (interquartile range) levels were 3.53 (2.06-7.24) ng/mL and 2.26 (1.26-4.71) ng/mL, respectively (P=.008). Subgroup analysis revealed that this difference in leptin levels was confined entirely to boys: 3.09 (1.99-7.51) ng/mL in boys with asthma versus 1.52 (1.06-3.17) ng/mL in boys without asthma (P=.003). By logistic regression analysis, we found that leptin was a predictive factor for having asthma (odds ratio, 1.98; CI, 1.10-3.55; P=.021), whereas sex, age, or BMI were not. In a stepwise multiple regression analysis including sex (P=.001), age (P=.016), BMI (P <.001), and asthma (P=.022), all of these variables were found to affect log leptin levels (R2=0.404). There was no significant sex difference in serum leptin levels among asthmatic children, whereas healthy boys had significantly lower leptin levels than healthy girls (P=.019). Atopic asthmatic subjects had significantly higher leptin levels than nonatopic asthmatic subjects (P=.038) with similar BMI. A significant, but weak, correlation was observed between leptin levels and IgE in the overall group of asthmatic children (r=0.231; P=.019). Again, this correlation was confined entirely to boys (r=0.319; P=.010). There was no relation between leptin levels and skin prick tests, pulmonary function tests, passive smoking, birth weight, and duration of breast-feeding. CONCLUSION: Our findings suggest that leptin may play a role in atopic asthma. High serum leptin levels in asthmatic boys may partly explain the higher prevalence of childhood asthma in male sex.     

Body image among Turkish women during the first year postpartum

In this study, we investigated the body image of Turkish women in their first year postpartum. We recruited 440 postpartum women who had applied to the outpatient clinics of the Maternity and Children's Hospital in the city of Ordu, Turkey. The mean of the women's body image scores was over the "middle level." The women's body image scale (BIS) score showed a significant negative relation with age, number of births, weight before pregnancy, weight gain, during pregnancy, weight soon after childbirth, present weight, postpartum weight gain, and postpartum body mass index (BMI).     

Ocular findings in posterior microphthalmos

Aim

To report a critical case series of six patients with posterior microphthalmos (PM).

Relationship between arm span and height in postmenopausal osteoporotic women

Osteoporosis is a progressive systemic skeletal disease characterized by low bone density and microarchitectural deterioration of the bone. A minimum 3-cm difference between arm span and height makes up one of the criteria for suspecting osteoporosis. Therefore, it is easy to determine osteoporotic women by measuring the proportion of height to the arm span. The purposes of this study are to assess the relationship between arm span and height and to compare them in postmenopausal and young healthy women. This was a randomized-controlled, prospective study. There were two groups in this study. Group I included 70 postmenopausal osteoporotic women and group II had 70 healthy young women. Height, weight and arm span of the individuals were measured in all subjects. Bone mineral density and radiological examination of spine were also evaluated. Mean age of postmenopausal women was 64.4 ± 8.6 years and it was 27.3 ± 3.5 years in young healthy women. Mean height was 152 ± 5.1 and 161.5 ± 5.9 cm in group I and II, respectively. Mean arm span length was 159.6 ± 6.3 cm in postmenopausal women and 163.5 ± 6 cm in young healthy women. Mean arm span-height difference was significantly higher in postmenopausal women when compared to healthy young women (7.7 ± 3.6 and 2 ± 2.9 cm, respectively, P < 0.001). We suggest that arm span measurements can be used in the estimation of youth height and age-related loss in stature in postmenopausal women.     

The evaluation of DLCO changes in patients with relatively higher lung shunt fractions receiving TARE

Annals of Nuclear Medicine - Transarterial radioembolization (TARE) with Yttrium-90 (90Y) labeled microspheres is an effective locoregional treatment option for patients with primary and metastatic...