Results of Fontan in Patients with Apicocaval Juxtaposition or/and Separated Hepatic Venous Drainage

Objective:Modifications of the Fontan operation,which are also known as total cavopulmonary connection(TCPC),are widely applied for patients with functionally univentricular hearts(FUH).Herein,we summed up the different surgical pathways and clinical outcomes in FUH patients with apicocaval juxtaposition(ACJ)or/and separated hepatic venous(SHV)drainage.Methods:Between January 2009 and December 2019,123 patients who undergone TCPC in our institute were included in this retrospective study.We have included 70 patients with ACJ(Group 1)and 53 patients with SHV(Group 2).Moreover,Group 2 included 17 cases combing with ACJ(32.1%).In Group 1,three different TCPC methods were conducted.While 45 cases were conducted with the extracardiac conduit-TCPC(EC-TCPC)method,24 cases used the intracardiac conduit-TCPC(IC-TCPC)method,and only one case used the lateral tunnel-TCPC(LT-TCPC).In Group 2,four TCPC methods were conducted on patients.Forty cases used the EC-TCPC-common open technique,6 cases with IC-TCPC technique,4 cases with LT-TCPC,and 3 cases with intra-extracardiac conduit-TCPC(IEC-TCPC).Results:There were 7 patients in Group 1 and 14 patients in Group 2 who required early re-operation during hospitalization(p<0.05).Postoperative mean pulmonary artery pressure(mPAP)greater than 15 mmHg emerged as a predictor for early re-operation(p<0.01)and early death(p<0.001)in univariate analysis.Conclusions:TCPC can be performed in these patients and shows beneficial results.Under the Fontan principle of connecting systemic venous to the pulmonary vasculature unimpededly,surgeons should carefully evaluate three components when choosing for the surgical technique:The distance between inferior vena cava(IVC)and the apex;the site of the vertebrae relative to the ACJ;the distance between ACJ and SHV if coexisting.However,the technique should be altered when the postoperative mPAP was greater than 15 mmHg.

Geographically evaluating urban-wildland juxtapositions across 36 urban areas in the United States

As human populations become concentrated in larger,more intensely urbanized areas connected through glob-alization,the relationships of cities to their surrounding landscapes are open to social,ecological,and economic reinterpretation.In particular,the value of access to nature in the form of nearby undeveloped wildland to ur-ban populations implies a relatively novel type of synergistic city-region relationship.We develop a robust and replicable metric-the urban-wildland juxtaposition(UWJ)-that quantifies critical dimensions of the juxtapo-sition of the urbanicity of cities with the quantity of nearby unbuilt wildlands,based on the spatial proximity and relative intensities of these two contrasting system types.Using a distance-decay gravity model,this analysis provides documentation on the calculation of the UWJ and its component metrics,urbanicity(U)and wildland(W)and then presents U,W,and UWJ metrics for 36 urbanized areas representing all regions of the U.S.,pro-viding the basis for comparisons and analysis.We explore the potential of the metric by testing correlations with“creative class”employment and public health measures.The UWJ has implications and potential applications for demographic,economic,social,and quality-of-life trends across the U.S.and internationally.

Tectonic juxtaposition of crust and continental growth during orogenesis: Example from the Rengali Province, eastern India

The southern houndary of the Singhbhum Craton witnessed multiple orogenies that juxtaposed thin slice of granulite suite of the Rengali Province against the low-grade granite-greenstone belt of the craton along the E-W trending Sukinda Thrust. The strong southerly dipping mylonitic foliation within the granulites along with the pronlinent down-dip mineral lineation, suggest a northerly-verging thrusting. Mylonitized charnockite at the contact zone contains enclaves of mafic and ultranlafic granulite, whereas granitoid gneiss contains enclaves of pelitic granulite. Mafic granulite enclaves preserve an early （SiM） foliation that formed during DiM deformation. This rock, along with the host charnockite, were intensely deformed by the D2M thrusting event and resulting S2M foliation development in both rock suites. Geothermobaronietric and pseudosection analyses show that the garnet-clinopyroxene-plagioclase- orthopyroxene-ihllenite-quartz assemblage in mafic granulite was stabilized at high-pressure and temperature conditions （10 12 kbar, 860 C） and was overprinted by a fine-grained assemblage of cli- nopyroxene-plagioclase J hornblende that developed during deconlpression （down to 5.5-7.5 I〈bar）. Matrix hornblende shows incipient breakdown to garnet-clinopyroxene-quartz intergrowth due to a granulite facies reworking. A contrasting P-T history is preserved in the pelitic granulite. The peak assemblage garnet-orthopyroxene-cordierite-quartz-rutile was stabilized at -6.0 kbar, 730 C which resulted flom heating of the mid crust magma during the D2M thrusting. The contrasting P-T histories could result flonl the tectonic juxtaposition of lowerand mid-crustal section during the D2M event. Evidences of an early orogenic imprint within the mafic granulite imply involvement of deep continental crust during southward growth of the Singhbhum Craton.

Literary Impressionism in Willa Cather's Novels

In her writing,Willa Cather absorbed the techniques of the impressionist painters,striving to present human perception and fo-cus their individual impression on a fleeting moment to provide the fragments of impression upon which the whole can be constructed.

Literary Techniques Employed to Develop Celie's Character in The Color Purple

In 1982,Alice Walker’s The Color Purple,was published and became one of the best sellers.As the novel progressed,Celie's acquiescent behavior transformed into one of resilience and dignity.By incorporating the literary techniques of tone,symbolism,and juxtaposition into her novel,Alice Walker was able to develop Celie's character,emphasizing her progression from subservience to independence.

Disharmonious Ventricular Relationship and Topology for the Given Atrioventricular Connections.Contemporary Diagnostic Approach Using 3D Modeling and Printing

In the last issue,two case reports separately present examples of the extremely rare and complex congenital heart diseases that show concordant atrioventricular connections to the L-looped ventricles in the presence of situs solitus.Both cases highlight that the relationship between the two ventricles within the ventricular mass is not always harmonious with the given atrioventricular connection.Such disharmony between the connections and relationships requires careful assessment of the three basic facets of cardiac building blocks,namely their morphology,the relationship of their component parts,and their connections with the adjacent segments.3D imaging and printing can now facilitate an otherwise difficult diagnosis in such complex situations.Rotation of either the 3D images or the models permit accurate assessment of the ventricular topologic pattern by creating the right ventricular en-face septal view,thus facilitating placement of the observer’s hands.As we now emphasize,an alternative approach,which might prove more attractive to imagers,is to rotate the ventricular mass to provide the ventricular apical view,thus permitting determination of the ventricular relationship without using the hands.

2q37.3 Deletion with Complex Heart Defects Suggesting Interruption of Early Ventricular Looping

A maternally inherited 828 kb microdeletion of 2q37.3 manifested in a 3-week-old premature boy as left juxtaposition of the atrial appendages associated with tricuspid atresia,double outlet infundibulum,subvalvar pulmonary atresia,large secundum atrial septal defect,and right aortic arch with mirror-image branching,consistent with developmental arrest early in heart looping.To the best of our knowledge,no previous 2q37 deletion syndrome has been reported with such a severe cardiac dysmorphology.Hence,this case adds to the cardiac phenotypes identified in 2q37 deletion syndrome.

On the Expressionist Techniques in Death of a Salesman

Miller’s highly expressionist narrative technique and style,say,detailed stage directions,stage lighting and juxtaposition of protagonist’s reality with memories and hallucinations,plays a significant role in Death of A Salesman.This paper discusses how such narrative techniques managed to provide the audience with a unique experience:observe and experience the death of the protagonist.