Surgical treatment of accessory atrioventricular pathways and symptomatic tachycardia in children and young adults

Twenty-seven patients aged 21 years or younger (mean 15) with symptomatic tachycardia underwent operation for ablation of an accessory atrioventricular pathway. Six patients had associated Ebstein's malformation of the tricuspid valve. Supraventricular tachycardia had been present for a mean of 5 years. At electrophysiologic study, 4 patients were found to have 2 accessory pathways. Left ventricular free wall pathways were found In 14 patients, right ventricular free wall pathways in 10 and septal pathways in 6. Successful initial ablation of all the pathways was achieved in 26 of the 27 patients. No patient died perioperatively and none had persistent complete heart block. During a mean follow-up of 11 months, no patient had recurrence of an arrhythmia related to the accessory pathway. Thus, the surgical treatment of children and young adults with accessory atrioventricular pathways and symptomatic supraventricular tachycardia is safe and effective. For these patients, unless the tachycardia can be easily controlled with a minimal number of drugs and adverse effects, surgical ablation should be considered early in the clinical course.     

Structure,Morphology, Heat Capacity,and Electrical Transport Properties of Ti3(Al,Si)C2 Materials

A study of Ti₃Al_1−xSi_xC₂ (x = 0 to x = 1) MAX-phase alloys is reported. The materials were obtained from mixtures of Ti₃AlC₂ and Ti₃SiC₂ powders with hot pressing sintering technique. They were characterised with X-ray diffraction, heat capacity, electrical resistivity, and magnetoresistance measurements. The results show a good quality crystal structure and metallic properties with high residual resistivity. The resistivity weakly varies with Si doping and shows a small, positive magnetoresistance effect. The magnetoresistance exhibits a quadratic dependence on the magnetic field, which indicates a dominant contribution from open electronic orbits. The Debye temperatures and Sommerfeld coefficient values derived from specific heat data show slight variations with Si content, with decreasing tendency for the former and an increase for the latter. Experimental results were supported by band structure calculations whose results are consistent with the experiment concerning specific heat, resistivity, and magnetoresistance measurements. In particular, they reveal that of the s-electrons at the Fermi level, those of Al and Si have prevailing density of states and, thus predominantly contribute to the metallic conductivity. This also shows that the high residual resistivity of the materials studied is an intrinsic effect, not due to defects of the crystal structure.     

Exploring NANDA's Definition of Nursing Diagnosis: Linking Diagnostic Judgments with the Selection of Outcomes and Interventions

Nursing diagnoses are described by definition as the basis for selection of interventions to achieve health outcomes. Processes used to link diagnostic judgments with desired outcomes and interventions can be holistic or reductionistic. A model of clinical inference is presented to illustrate the interrelated nature of judgments about diagnoses, desired outcomes, and interventions. Implications for development of diagnostic and taxonomic tools to guide holistic judgments are explored.     

Fe2O3 and Gd2O3 nanoparticles loaded in mesoporous silica: insights into influence of NPs concentration and silica dimensionality

Fine Fe₂O₃ and Gd₂O₃ magnetic nanoparticles (NPs) with sizes 7 nm and 10 nm embedded into mesoporous silica have been prepared using a wet-impregnation method. A comparative study of the reactant concentration along with the hosting matrix symmetry on mesostructuring and the magnetic properties of the nanocomposites have been investigated. Reactants with four different concentrations of Fe³⁺ and Gd³⁺ ions and silica matrices with two different kinds of symmetry (hexagonal and cubic) have been utilized for the study. The structural characterization of the samples has been carried out by the N₂ adsorption/desorption method, high-energy X-ray diffraction (HE-XRD), TG/DTA, and high resolution transmission electron microscopy (HRTEM). The magnetic properties of the nanocomposites have been examined by means of SQUID magnetometry. It has been found that a range of different magnetic states (diamagnetic, paramagnetic, ferromagnetic, superparamagnetic) can be induced by the feasible tailoring of the particle concentration, the porous matrix symmetry and the composition. Furthermore, the existence of a “critical concentration limit” for embedding the particles within the body of the matrix has been confirmed. Exceeding the limit results in the expulsion of nanoparticles on the outer surface of the mesoporous matrix. Revelation of the relationships between particle concentration, matrix symmetry and magnetic properties of the particular composite reported in this study may facilitate the design and construction of advanced intelligent nanodevices.

The concentration of nanoparticles inside the pores and the symmetry of the porous matrix significantly affected the magnetic properties.     

Polyclonal nature of diffuse proliferation of interstitial cells of Cajal in patients with familial and multiple gastrointestinal stromal tumours

BACKGROUND: Diffuse proliferation of interstitial cells of Cajal (ICCs) in the myenteric plexus layer of the intestine has been described in patients with familial and multiple gastrointestinal stromal tumours (GISTs). However, it is not fully understood whether proliferation is polyclonal or monoclonal. AIMS: To evaluate the clonal nature of diffuse ICC proliferation in familial and multiple GIST cases, we carried out clonal analysis using inactivation at the human androgen receptor (HUMARA) locus. MATERIALS AND METHODS: Diffuse ICC proliferation tissues from three female patients were microdissected using a laser capture microdissection (LCM) system. Normal intestinal mucosal tissues were also microdissected for polyclonal controls and GIST tissues for monoclonal controls from the same patients, and genomic DNA was extracted. After digestion by restriction enzyme HhaI, the HUMARA locus was amplified by a fluorescent polymerase chain reaction (PCR) procedure and the PCR products were analysed. RESULTS: One case was uninformative because it was homozygous at the HUMARA locus. In the two other cases, PCR products from the diffuse ICC proliferation showed two alleles as well as those from normal intestinal mucosal tissues, indicating that ICC proliferation was polyclonal. In contrast, PCR products from associated GIST tissues showed only one allele, indicating that GISTs were monoclonal. CONCLUSION: The results suggested that diffuse ICC proliferation in familial and multiple GIST cases was non-neoplastic hyperplasia.     

Evolution of Sezary syndrome in the course of hairy cell leukemia

A patient with a history of "leukemia" for 19 yr and documented hairy cell (HC) leukemia for 10 yr developed mycosis fungoides and the Sezary syndrome. The manifestations of both diseases were diagnostic on clinical and pathologic grounds. Ultrastructural, immunohistochemical, and surface marker techniques proved the HC to have phenotypic characteristics of the T-helper subset of lymphocytes to which the Sezary cells (SC) also belonged. Both types of cells contained tartrate- resistant acid phosphatase. HC did not infiltrate the skin. SC did not contain ribosome lamellar complexes. Because of otherwise overlapping morphology and the apparent replacement of HC by SC, it is likely that the Sezary cells constituted a genetic variant of the original neoplastic clone represented by the hairy cells. Since the biologic and therapeutic implications of such clonal evolution may be important, subtle phenotypic changes should be looked for repeatedly in patients with these diseases.