Search Results (124)

Background and Objectives: Despite advances in the surgical management of patients with Fontan circulation, their exercise capacity and quality of life remain significantly impaired. Exercise-based cardiac rehabilitation (CR) offers promising improvements in these areas, but the implementation and adherence to these programmes are often inconsistent. This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and optimal exercise modalities for Fontan patients. Materials and Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted on 24 August 2023. Studies were screened and assessed for quality using the Cochrane RoB Tool 2 and STROBE checklist. Meta-analysis was performed using a continuous random-effects model to determine the effectiveness of various CR interventions, including aerobic exercise training (AET), resistance training, and inspiratory muscle training (IMT). Results: A total of 26 studies (7 RCTs, 19 cohorts) comprising 22 distinct cohorts were included, with a total sample size of 428 Fontan patients. The interventions ranged from 4 weeks to 24 months and included AET (18 studies), resistance training (11 studies), and IMT (6 studies). The meta-analysis revealed significant improvements in exercise capacity, with a pooled mean difference in peak VO₂ of 1.947 (95% CI: 1.491 to 2.402, p < 0.001). Subgroup analyses showed that combined AET and resistance training had the most robust effect, with a mean difference of 2.11 (95% CI: 1.57 to 2.65, p < 0.001). Home-based interventions showed significant benefits, while supervised and hybrid interventions did not show statistically significant differences. Publication bias was identified, particularly in home-based interventions, where smaller studies demonstrated larger effect sizes, as confirmed by Egger’s test (Intercept = 2.417, 95% CI: 1.498 to 3.337, p = 0.001). However, no significant bias was detected in supervised or hybrid interventions, which displayed symmetrical distributions in funnel plots and non-significant Egger’s test results. Conclusions: CR appears to be an effective intervention for improving exercise capacity in Fontan patients, particularly when combining AET with resistance training. Home-based programmes offer promising results, though the potential for publication bias, especially in smaller studies, warrants cautious interpretation of these findings. Further research is needed to refine protocols, explore long-term outcomes, and determine the underlying mechanisms, particularly for patients with more severe clinical presentations. The low incidence of adverse events across the studies reinforces the safety of these interventions. Full article

The rise of antibiotic-resistant bacteria in clinical settings has become a significant global concern. Among these bacteria, Acinetobacter baumannii stands out due to its remarkable ability to acquire resistance genes and persist in hospital environments, leading to some of the most challenging infections. Horizontal gene transfer (HGT) plays a crucial role in the evolution of this pathogen. The A. baumannii AMA205 strain, belonging to sequence type ST79, was isolated from a COVID-19 patient in Argentina in 2021. This strain’s antimicrobial resistance profile is notable as it harbors multiple resistance genes, some of which had not been previously described in this species. The AmpC family β-lactamase bla_CMY-6, commonly found in Enterobacterales, had never been detected in A. baumannii before. Furthermore, this is the first ST79 strain known to carry the carbapenemase bla_NDM-1 gene. Other acquired resistance genes include the carbapenemase bla_OXA-23, further complicating treatment. Susceptibility testing revealed high resistance to most antibiotic families, including cefiderocol, with significant contributions from bla_CMY-6 and bla_NDM-1 genes to the cephalosporin and carbapenem resistance profiles. The A. baumannii AMA205 genome also contains genetic traits coding for 111 potential virulence factors, such as the iron-uptake system and biofilm-associated proteins. This study underscores A. baumannii’s ability to acquire multiple resistance genes and highlights the need for alternative therapies and effective antimicrobial stewardship to control the spread of these highly resistant strains. Full article

Potato is the third most important food crop in the world in terms of adaptability, yield potential, and nutritional advantages. This study aimed to conduct potato breeding work for cultivation in Kazakhstan; potato breeding for further processing into chips with cultivation in the northern regions; and the selection of potatoes for processing into frozen French fries with cultivation in the southern and south-eastern regions. Potato varieties (Fontane, Santana, and Punchy) were used as reference varieties to check molecular markers linked to maturity, tuber shape, and flesh color. A total of 42 potato breeding lines crossed from Yagodnyi 19 and CIP clone 397079-6 were used in this study to identify prospective breeding lines. The research was carried out between 2023 and 2024 and under greenhouse conditions. According to the results of molecular analysis and phenotypic data, 21 breeding lines were identified as prospective potato breeding lines. The majority of these potato breeding lines had a round tuber shape and were recommended for chip processing. Three breeding lines had a long oval tuber shape, making them suitable for French fries. Six breeding lines with short-oval and oval tuber shapes were found for consumer potato processing. It is recommended that the breeding process and studies of biochemical properties are continued in all of these identified potato breeding lines. Full article

Background and Objectives: The Fontan procedure, a palliative surgery for univentricular heart physiology, often reduces exercise capacity and quality of life. This study aimed to evaluate the impact of cardiac rehabilitation (CR) on improving outcomes in Fontan patients to inform evidence-based care. Materials and Methods: Fontan patients aged 8–30 participated in a structured CR program for at least three months. The program included weekly aerobic and resistance training sessions with educational and nutritional guidance. Baseline and post-CR assessments included cardiac function, fitness, daily activity, and health-related quality of life (HRQOL). Results: The cohort included ten Fontan patients, of whom six had a right systemic ventricle. CR significantly improved cardiorespiratory fitness, as seen in VO2 max (from 27.92 ± 5.15 to 34.69 ± 1.14 mL/kg/min, p = 0.0089) and percent predicted VO2 (from 0.67 ± 0.18 to 0.90 ± 0.02, p = 0.005). VCO2 increased by +8.68 ± 8.59 mL/kg/min but did not reach statistical significance (p = 0.05). Most haemodynamic and ventilatory parameters showed no significant improvement. All the SF-36 questionnaire domains showed significant HRQOL gains (p < 0.001). High adherence (85–93%), no adverse events, and reduced NT-proBNP levels supported the program’s safety. Conclusions: This study’s findings have important implications for the care of Fontan patients. CR significantly improved exercise capacity and HRQOL in Fontan patients across various anatomies, particularly in the right systemic ventricle. Integrating physical conditioning into standard care could reduce long-term morbidity and mortality; however, further research is needed to refine the protocols and confirm sustained benefits. Full article

Objectives: Pregnancies in women with Fontan circulation are on the rise, and they are known to imply high maternal and fetal complication rates. The altered hemodynamic profile of univentricular circulation affects placental development and function. This study describes placental sonomorphologic appearance and Doppler examinations and correlates these to histopathologic findings and pregnancy outcomes in women with Fontan circulation. Methods: A single-center retrospective analysis of pregnancies in women with Fontan circulation was conducted between 2018 and 2023. Maternal characteristics and obstetric and neonatal outcomes were recorded. Serial ultrasound examinations including placental sonomorphologic appearance and Doppler studies were assessed. Macroscopic and histopathologic findings of the placentas were reviewed. Results: Six live births from six women with Fontan physiology were available for analysis. Prematurity occurred in 83% (5/6 cases) and fetal growth restriction and bleeding events in 66% (4/6 cases) each. All but one placenta showed similar sonomorphologic abnormalities starting during the late second trimester, such as thickened globular shape, inhomogeneous echotexture, and hypoechoic lakes, resulting in a jelly-like appearance. Uteroplacental blood flow indices were within normal range in all women. The corresponding histopathologic findings were non-specific and consisted of intervillous and subchorionic fibrin deposition, villous atrophy, hypoplasia, or fibrosis. Conclusions: Obstetric and perinatal complication rates in pregnancies of women with Fontan circulation are high. Thus, predictors are urgently needed. Our results suggest that serial ultrasound examinations with increased awareness of the placental appearance and its development, linked to the Doppler sonographic results of the uteroplacental and fetomaternal circulation, may be suitable for the early identification of cases prone to complications. Full article

Phosphorus is a key element for identifying past human activity. Recently, phosphorus analyses have been extended to archaeological objects, aiming at distinguishing how depositional contexts contribute to its enrichment. In archaeological pottery, phosphorus might depend on several manufacturing and postdepositional processes (i.e., addition of organic temper, pigments, diagenetic incorporation). We analyzed by XRD, XRF, and mid-infrared (FTIR-ATR) spectroscopy 178 pots from eight NW Spain archaeological sites. These sites encompass different chronologies, contexts, and local geology. The phosphorus content was highly variable (224–27,722 mg kg⁻¹) overall but also between archeological sites (1644 ± 487 to 13,635 ± 6623 mg kg⁻¹) and within archaeological sites (4–36, max/min ratio). No phosphate minerals were identified by XRD nor FTIR-ATR, but correlations between phosphorus content and MIR absorbances showed maxima at 1515 and 980 cm⁻¹, suggesting the presence of two sources: one organic (i.e., phosphorylated aromatic compounds) and another inorganic (i.e., albite and K-feldspar). Phosphorylated aromatics were most likely formed during pottery firing and were preserved due to their high resistance to temperature and oxidation. Meanwhile, albite and K-feldspar are among the P-bearing minerals with higher P concentrations. Our results suggest that P content is related to intentional and non-intentional actions taken in the pottery production process. Full article

As an anti-staling agent in bread, the desorption isotherm of polydextrose has not been studied due to a very long equilibrium time. The adsorption and desorption isotherms of five Chinese polydextrose products were measured in the range of 0.1–0.9 a_w and 20–35 °C by a dynamic moisture sorption analyzer. The results show that the shape of adsorption and desorption isotherms was similar to that of amorphous lactose. In the range of 0.1–0.8 a_w, the hysteresis between desorption and adsorption of polydextrose was significant. The sorption isotherms of polydextrose can be fitted by seven commonly used models, and our developed seven-parameter polynomial, the adsorption equations of generalized D’Arcy and Watt (GDW) and Ferro-Fontan, and desorption equations of polynomial and Peleg, performed well in the range of 0.1–0.9 a_w. The hysteresis curves of polydextrose at four temperatures quickly decreased with a_w increase at a_w ˂ 0.5, andthereafter slowly decreased when a_w ≥ 0.5. The polynomial fitting hysteresis curves of polydextrose were divided into three regions: ˂0.2, 0.2–0.7, and 0.71–0.9 a_w. The addition of 0–10% polydextrose to rice starch decreased the surface adsorption and bulk absorption during the adsorption and desorption of rice starch, while it increased the water adsorption value at a_w ≥ 0.7 due to polydextrose dissolution. DSC analysis showed that polydextrose as a gelling agent inhibited the retrogradation of rice starch, which could be used to maintain the quality of cooked rice. Full article

Over the past five decades, the Fontan procedure has been developed to improve the life expectancy of patients with congenital heart defects characterized by a functionally single ventricle. The Fontan circulation aims at redirecting systemic venous return to the pulmonary circulation in the absence of an impelling subpulmonary ventricle, which makes this physiology quite fragile and leads to several long-term complications. Despite the importance of hemodynamic assessment through cardiac catheterization in the management and follow-up of these patients, a thorough understanding of the ultimate functioning of this type of circulation is lacking, and the interpretation of the hemodynamic data is often complex. In recent years, new tools such as combined catheterization with cardiopulmonary exercise testing have been incorporated to improve the understanding of the hemodynamic profile of these patients. Furthermore, extensive percutaneous treatment options have been developed, addressing issues ranging from obstructive problems in Fontan pathway and acquired shunts through compensatory collaterals to the percutaneous treatment of lymphatic circulation disorders and transcatheter edge-to-edge repair of atrioventricular valves. The aim of this review is to detail the various tools used in cardiac catheterization for patients with Fontan circulation, analyze different percutaneous treatment strategies, and discuss the latest advancements in this field. Full article

Background: Patient reported outcomes (PROs) are important measures in acquired heart disease but have not been well defined in Adult Congenital Heart Disease (ACHD). Our aim was to explore the discriminatory capacity of PRO survey tools in Fontan circulatory failure (FCF). Methods: Consecutive adults were enrolled from our ambulatory clinics. Inclusion criteria were age ≥18 years, a Fontan circulation or a hemodynamically insignificant shunt lesion, and sufficient cognitive/language abilities to complete PROs. A comprehensive package of PRO measures, designed to assess perceived health-related quality of life (HRQOL) was administered (including the Kansas City Cardiomyopathy Questionnaire [KCCQ-12], EuroQol-5-dimension [EQ5D], Short Form Health Status Survey [SF-12], self-reported New York Heart Association [NYHA] Functional Class, and Specific Activity Scale [SAS]). Results: We compared 54 Fontan patients (35 ± 10 years) to 25 simple shunt lesion patients (34 ± 11 years). The KCCQ-12 score was lower in Fontan versus shunt lesion patients (87 [IQR 79, 95] versus 100 [IQR 97, 100], p-value < 0.001). The FCF subgroup was associated with lower KCCQ-12 scores as compared with the non-FCF subgroup (82 [IQR 56, 89] versus 93 [IQR 81, 98], p-value = 0.002). Although the KCCQ-12 had the best discriminatory capacity for determination of FCF of all PRO tools studied (c-statistic 0.75 [CI 0.62, 0.88]), superior FCF discrimination was achieved when the KCCQ-12 was combined with all PRO tools (c-statistic 0.82 [CI 0.71, 0.93]). Conclusions: The KCCQ-12 questionnaire demonstrated good discriminatory capacity for the identification of FCF, which was further improved through the addition of complementary PRO tools. Further research will establish the value of PRO tools to guide management strategies in ACHD. Full article

Background: Stent implantation has become the preferred method of treatment for treating vessel stenosis in congenital heart diseases. The availability of covered stents may decrease complications and have an important role in the management of patients with complex anatomy. Aim: This study aims to evaluate the feasibility and safety of the pre-mounted cobalt–chromium stent-graft-covered ePTFE Aortic BeGraft in a broad spectrum of vascular lesions. Methods: This is a multicenter retrospective results analysis of 107 implanted BeGraft stents between 2016 and 2022 in six different European centers. Results: One hundred and four patients with a mean age of thirteen years (range 1–70 years) and with the body weight of 56.5 kg (range 11–115 kg) underwent the BeGraft stent implantation. Stents were implanted in the following conditions: aortic coarctation (74 patients), RVOT dysfunction (12 patients), Fontan circulation (7 patients), and miscellaneous (11 subjects with complex CHD). All the stents were implanted successfully. The median stent diameter was 16 mm (range 7–24 mm), and the median length was 39 mm (range 19–49 mm). Major complications occurred in five subjects (4.7%). During a median follow-up of fourteen (1–70) months, stents’ re-dilatation was performed in five patients. Conclusions: The BeGraft stent can be used safely and effectively in a wide spectrum of congenital heart diseases. Whether these good results will be stable in the longer term still needs to be investigated in a follow-up given its recent introduction into clinical practice, in particular regarding stent fracture or neointimal proliferation. Full article

Right-sided mechanical support of the Fontan circulation by existing devices has been compounded by the cross-sectional design of vena cava anastomosis to both pulmonary arteries. Our purpose was to investigate whether increasing inferior vena cava (IVC) flow with a rotary blood pump in the IVC only in an ovine animal model of Fontan would lead to acceptable superior vena cava (SVC) pressure. To achieve this, a Fontan circulation was established in four female sheep by anastomosing the SVC to the main pulmonary artery (MPA) and by interposing a Dacron graft between the IVC and the MPA. A rotary blood pump was then introduced in the graft, and the effect of incremental flows was observed at increasing flow regimen. Additionally, to stimulate increased pulmonary resistance, the experience was repeated in each animal with the placement of a restrictive band on the MPA distally to the SVC and Dacron graft anastomosis. Circulatory support of IVC flow alone increased the systemic cardiac output significantly, both with and without banding, indicating the feasibility of mechanical support of the Fontan circulation by increasing the flow only in the inferior vena cava. The increase in SVC pressure remained within acceptable limits, indicating the potential effectiveness of this mode of support. The findings suggest that increasing the flow only in the inferior vena cava is a feasible method for mechanical support of the Fontan circulation, potentially leading to an increase in cardiac output with acceptable increases in superior vena cava pressure. Full article

High-mountain lakes are freshwater ecosystems situated above the tree line which are known for their remote locations and limited accessibility. These ecosystems host simplified biotic communities primarily concentrated in the littoral zone and dominated by benthic macroinvertebrates that serve as bioindicators of environmental pressures. A two-year monitoring investigation was performed in July 2022 and July 2023 at Nero Lake (Cesana Torinese, Northwest Italy). Five sites along the lakeshore were selected for sampling physicochemical water parameters and macrobenthos. All collected data were analysed to compare trends across years and within specific sites. The results revealed that Nero Lake exhibited consistent macrobenthic communities across the two years studied, but significant differences were observed in its microhabitats. This suggests that substrate type and physicochemical water parameters strongly influence community composition. Chironomidae larvae and Mollusca were the dominant species, showing distinct associations with different substrates and environmental factors from one year to another. These findings contribute to our understanding of the intricate relationships between benthic macroinvertebrates and their environments, highlighting the necessity of detailed, small-scale assessments to comprehend ecosystem dynamics and develop effective conservation strategies. Full article

The increasing relevance of remote sensing and artificial intelligence (AI) for archaeological research and cultural heritage management is undeniable. However, there is a critical gap in this field. Many studies conclude with identifying hundreds or even thousands of potential sites, but very few follow through with crucial fieldwork validation to confirm their existence. This research addresses this gap by proposing and implementing a fieldwork validation pipeline. In northern Portugal’s Alto Minho region, we employed this pipeline to verify 237 potential burial mounds identified by an AI-powered algorithm. Fieldwork provided valuable information on the optimal conditions for burial mounds and the specific factors that led the algorithm to err. Based on these insights, we implemented two key improvements to the algorithm. First, we incorporated a slope map derived from LiDAR-generated terrain models to eliminate potential burial mound inferences in areas with high slopes. Second, we trained a Vision Transformer model using digital orthophotos of both confirmed burial mounds and previously identified False Positives. This further refines the algorithm’s ability to distinguish genuine sites. The improved algorithm was then tested in two areas: the original Alto Minho validation region and the Barbanza region in Spain, where the location of burial mounds was well established through prior field work. Full article

Adult patients with congenital heart disease have now surpassed the pediatric population due to advances in surgery and improved survival. One such complex congenital heart disease seen in adult patients is the Fontan circulation. These patients have complex physiology and are at risk for several complications, including thrombosis of the Fontan pathway, pulmonary vascular disease, heart failure, atrial arrhythmias, atrioventricular valve regurgitation, and protein-losing enteropathy. This review discusses the commonly encountered phenotypes of Fontan circulatory failure and their contemporary management. Full article

Objectives: Fontan circulation presents significant challenges for patients with congenital heart disease, often necessitating heart transplantation (HTX) due to deteriorating functionality across multiple organ systems. However, the impact of prior Fontan palliation on HTX outcomes remains poorly understood, with early mortality rates suggesting a heightened risk. The aim of our study is to evaluate the long-term results after heart transplantation in patients with univentricular congenital heart disease previously palliated with Fontan circulation. Methods: A retrospective analysis was conducted on patients who underwent HTX for congenital heart disease. Patients were categorized into two groups based on the pre-HTX circulation pathway: the Failing Fontan Group (FFG) and the Biventricular Congenital Group (BCG). Data were collected from patients between 1987 and 2018. Early and late outcomes, including survival rates, were assessed and critically analyzed. Results: Of the 66 patients, 29 (43%) had a failing Fontan palliation (FFG), and 37 had biventricular congenital diseases (BCG) before heart transplantation. Early mortality (30-day) was not statistically different between the two group. The overall survival rate was 82.6 ± 13.9% at 1 year, 79.0 ± 14.9% at 5 years, 67.2 ± 17.6% at 10 years and 63.2 ± 18.2 ± at 15 years for the FFG, and 86.1 ±11.4% at 1 year, 79.5 ± 13.7% at 5 years, 75.7 ± 14.9% at 10 years, 75.7 ± 14.9% at 15 years for the BCG, with no statistically significant difference (Mantel Cox p value: 0.69, 0.89, 0.52 and 0.39, respectively). Regarding Cox-regression analysis, the long-term survival rate was not affected either by previous Fontan surgery or by the era of heart transplantation (before vs. after the year 2000). Conclusions: Although heart transplantation after Fontan palliation showed a higher risk in the early post-operative period, the medium- and long-term survival rates are comparable with biventricular circulation patients. Despite the failing Fontan patients being a challenging set of candidates for transplantation, it is a reasonable option in their treatment. Full article