Search

Congenital hyperinsulinism (CHI) is a heterogeneous genetic disease characterized by increased insulin secretion and causes persistent hypoglycemia in neonates and infants due to dysregulation of insulin secretion by pancreatic β cells. Babies with severe hypoglycemia and for whom medical treatment has been ineffective usually require surgical treatment with near-total pancreatectomy. To evaluate the clinical and surgical aspects affecting survival outcomes in babies diagnosed with CHI in a single tertiary care center.

This study investigates the influence of social capital, market orientation, and technological readiness levels (TRLs) on the intensity of collaboration between researchers from a public research institution in Brazil and companies, and how TRLs moderate this relationship. Using a quantitative approach, we applied structural equation modeling (PLS-SEM) to analyze responses from researchers at this institution. The analysis highlights the critical roles of social capital and market orientation in fostering effective R&D interactions. Social capital enhances collaboration through trust and network strength, while market orientation aligns R&D efforts with market needs, ensuring that innovations are both relevant and timely. Importantly, this study explores how technological readiness levels (TRLs) moderate these relationships, offering insights into the varying impact of social capital and market orientation across different stages of technological development. Findings reveal that participation in projects with TRLs 4 to 6, known as the Valley of Death, significantly moderates the impact of market orientation on researchers' interaction intensity with companies, underscoring the importance of considering technological maturity in R&D collaborations. The study is framed within the open innovation approach, emphasizing the importance of leveraging external knowledge and collaborative networks to enhance innovation outcomes. Theoretically, this research extends the existing models of R&D collaboration by illustrating how TRLs modify the effects of social capital and market orientation. Practically, it offers actionable insights for R&D managers and policymakers on structuring environments that foster robust academic–industry partnerships, facilitating the successful transition of innovations from conceptualization to market readiness.

Hereditary spastic paraplegia (HSP) is a group of genetically heterogenous neurodegenerative disorders characterized by progressive spasticity and weakness of lower limbs. We report a novel splicing variant (c.1617-2A>C) of the SPASTgene in a heterozygous carrier from an Italian family with autosomal dominant HSP. The case study describes a pure form of spastic paraparesis with the cardinal clinical features of SPG4. The novel variant affects a canonical splice site and is likely to disrupt RNA splicing. We conclude that the c.1617-2A>C substitution is a null variant, which could be classified as pathogenic; its penetrance should be further investigated.

This paper seeks to evaluate the professional culture factors that are present in knowledge integration mechanisms in two selected cases. In-depth case studies were conducted in two different expatriate groups, EmbraerBrazilian workers (at Saab in Sweden) and KuhnFrench workers (at Kuhn-MB in Brazil), in order to investigate their collaborative practices and professional cultures while implementing open innovation practices. The research is based on different large-sized firms and, therefore, the findings may not be applied to SMEs. The study identified ten main professional culture factors that were present and influenced open innovation. It provides information and is based on real aspects that involve workers from different cultures in collaborative projects. The factors described in this paper are based on the ongoing collaborative practices at the studied organisations, and results are expected to contribute to the management literature and practitioners.

•Congenital Diaphragmatic Hernia (CDH) is a congenital defect affecting 1 in every 5000 live births.•Sensorineural Hearing Loss (SNHL) is an important prevalent complication in survivors.•Mechanical ventilation and many other CDH therapies have been linked to SNHL.•Cochlear bleeding may be responsible and explain part of SNHL in CDH ventilated patients.

This study examined the influence of networks on the development of technological capabilities of 90 technology-based companies (TBCs) graduated by Brazilian incubators. The relational-based view theoretically supported the study. The data were processed via Structural Equation Modeling (SEM). A model with three hypotheses was tested. Two hypotheses were validated, proving that technological and financial networks built by those firms with external agents explained 70.6% of their capacity to innovate. The insertion into technology networks of licensing, universities, suppliers, and consulting shows that the TBCs are making use of relationships of high technical content, which is expected according to previous literature. As for the financial networks, it was observed that the insertion into networks of venture capital and economic subvention demonstrates that the innovation ecosystem presents advancements in the well-known challenge of financial support for technology-based startups. A third hypothesis was not validated, which provides another important finding: the planning effort presented a negative relationship on the technological capability, but a positive relationship on the insertion into relationship networks. This means that only direct planning is not able to support technological capabilities. In other words, planning is more effective when indirectly applied to relational resources of technical and financial networks, rather than when directly applied to technological capabilities. The insertion into technical and financial networks, in turn, positively affects the TBC’s innovation capability. Results demonstrate that this change in planning focus, from inside to outside of the company, could improve technological capabilities in R&D, patent, people, and products. Future studies could investigate the entrepreneur’s competencies in managing networks and further understanding of how networks could be constructed through formal and informal cooperation.

The development of information technology projects is no longer limited to the domestic sphere. This study identifies the differentiation of risk categories between global and domestic projects through an exploratory research carried out by means of a systematic literature review. 1367 risks were identified in 37 articles and classified within 22 categories. The major concern regarded in domestic project management was the client (external risk) and scope (internal risk) and, in global project management, the psychic distance (external) and coordination and control (internal). The main difference between the risk categories for each project type refers to the psychic distance category, which was identified almost exclusively in global projects, thus making the external risks more relevant than those in domestic projects. On the other hand, it makes risks such as client, supplier and stakeholders be underestimated. The results indicate that project managers should focus on different risks depending on the type of IT project: global or domestic.

Subsidiaries conduct innovation activities in foreign markets either to capture valuable knowledge that is necessary to adapt their products to local markets or to create valuable knowledge for headquarters. For emerging market multinationals, most studies have overlooked the determinants of successful reverse knowledge transfer from subsidiaries located in emerging and developed markets. This paper analyzed the responses of a survey administered to 78 Brazilian multinationals that own subsidiaries in developed and emerging markets. We found that knowledge complexity developed at the subsidiary, its autonomy and embeddedness in the foreign market determine the successful reverse knowledge transfer to headquarters of emerging market multinationals. This paper contributes to previous studies of reverse knowledge transfer by underlying the main drivers for emerging market multinationals.

Neonatal pulmonary hypertension (PH) is a devastating disorder of the pulmonary vasculature characterized by elevated pulmonary vascular resistance (PVR) and mean pulmonary arterial pressure (mPAP). Occurring predominantly because of maldevelopment or maladaptation of the pulmonary vasculature, PH in neonates is associated with suboptimal short- and long-term outcomes because its pathobiology is unclear in most circumstances, and it responds poorly to conventional pulmonary vasodilators. Understanding the pathogenesis and pathophysiology of neonatal PH can lead to novel strategies and precise therapies. The review is designed to achieve this goal by summarizing pulmonary vascular development and the pathogenesis and pathophysiology of PH associated with maladaptation, bronchopulmonary dysplasia, and congenital diaphragmatic hernia based on evidence predominantly from preclinical studies. We also discuss the pros and cons of and provide future directions for preclinical studies in neonatal PH.

•miR-143 is related with more inflammation and edema of intestinal loops of gastroschisis rat model.•Time of exposure of the amniotic fluid increases the intestinal damage.•miR-143 is a possible marker of gut inflammation.

This research paper analyses three concepts that are correlated with the phenomenon of developing project management as a core competence of organizations. Project management competence is the individual's capability to support the organizational stability objective, aligning the mission and vision and optimizing the resource allocation to maintain a sustainable competitive advantage. This study reviews three concepts in relation to their assumptions and possible outputs: project management, competence management and psychological contracts. This discussion paper presents the thesis that these three concepts converge in an approach in which project management is, indeed, a core competence of the organization. To project-management-oriented enterprises, this concept can provide a fundamental research theme for business studies’ evolution. As the results of this reflexive paper, a series of possible research objectives are indicated, such as how the enterprise must stablish a psychological contract with subcontracted parties and employees in general, short-term hired professionals. Another concept concerns how companies should design a project management competence governance structure or system, using a framework of the International Project Management Association(IPMA), and how they can apply the ICB normative guide to develop project management as a core competence of Brazilian organizations.

Necrotizing enterocolitis is a severe multifactorial intestinal disorder that primarily affects preterm newborns, causing 20-40% mortality and morbidity. Intestinal fatty acid-binding protein has been reported to be a biomarker for the detection of intestinal injuries. Our aim was to assess intestinal tissue injury and the molecular expression of intestinal fatty acid-binding protein over time in a necrotizing enterocolitis model.

ABSTRACTVaccines prevent infections in patients with multiple sclerosis (MS). Though recommendations regarding vaccinating patients with MS have been recently published, real-world data regarding vaccines’ planning in patients receiving disease-modifying drugs (DMDs) for MS are missing. Our aim was, therefore, to describe vaccination coverage rates, timing-proposal and safety in real-life vaccinating patients with MS undergoing DMDs before the start of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination campaign. Patients followed at our MS-center were referred to individualized immunization-programs customized to Italian recommendations, patients’ risks, immunity to exanthematic diseases, ongoing DMDs, or therapy-start urgency. Disease-activity stated the need for an essential immunization-cycle, whose core was composed by four vaccines: meningococcal-B, pneumococcal conjugated, Haemophilus influenzae B, and meningococcal-ACWY vaccines. Vaccines were administered prior to the planned DMD-start when possible, inactivated-vaccines >2 weeks and live-vaccines >4 weeks before treatment-start. Patients received a 6-months clinical-/radiological-follow-up after immunization. One-hundred and ninety-five patients were vaccinated between April 2017 and January 2021. 124/195 (63.6%) started a vaccination-program before therapy-start/-switch and 108/124 (87.1%) effectively completed immunization before new therapy-start without any delay. The time needed for immunization-conclusion reached a median of 27 (confidence interval 22) days in 2020. No increase in clinical-/radiological-activity 3-/6-months after immunization was noted. In conclusion, our study confirmed feasibility and safety of a vaccination-protocol in patients with MS whose duration resulted in a median of 27 days.

Congenital diaphragmatic hernia (CDH) is a severe embryological defect that causes pulmonary hypoplasia and hypertension. The prevalence and mortality rate of CDH varies around the world and little information is available about CDH in Latin America. Our aim was to estimate the general prevalence, mortality rate, prevalence of associated anomalies and features related to the outcomes of CDH in newborns from São Paulo state, Brazil.

Progress in the last three decades in prenatal genetic diagnosis and advancement in prenatal imaging and characterization of fetal anomalies have allowed better preparation in family counseling and afforded the opportunity to consider prenatal treatment for congenital defects that would have fatal outcomes, among them the fetal tumors. Advances in fetal therapy and surgical approaches including minimally invasive procedures, have permitted not just the survival of rare tumor cases but improved long-term outcomes. In this review, we described some of the most common fetal tumors and their recommended management with emphasis on in utero treatment options.

Recently, studies have referenced innovation as a key factor affecting the performance of firms. Companies make use of its innovative capacities to achieve sustainable competitive advantage. The objective of this paper is to contribute to innovation planning policies in highly complex environments. Thus, a modelling proposal is presented to assess the impact of technological innovation capacity on the performance of high–tech companies in Brazil. This procedure was prepared according to the following phases: phase 1: determination of the conceptual model; phase 2: verification of the conceptual model. The research was initially conducted based on the specialised literature, which extracted the data regarding the constructs/structure and content in order to build the model. To demonstrate the modelling feasibility, it used a survey of high–tech companies in Brazil. The research involved the intervention of experts knowledgeable on the object studied, selected by technical–scientific criteria. The data were extracted using an assessment matrix. To reduce subjectivity in the results achieved the following methods were used complementarily and in combination: multicriteria analysis, multivariate analysis, psychometric scaling and neurofuzzy technology. The data were extracted using an assessment matrix and the results were satisfactory, validating the modelling approach.

DTC patients having detectable Tg and negative post-therapeutic 131I-WBS have to be investigated by different imaging techniques to detect metastases. Comparison of neck US, CT and [18F]-FDG PET scan. In 49 DTC patients with biochemical disease, neck was examined by US, CT and [18F]-FDG PET. FNA was performed and Tg was determined by FNA-Tg in selected cases of suspicious lymph nodes. Thorax was examined by CT and PET. Serum Tg was measured on LT4 therapy (basal Tg) and after the stimulation with recombinant human TSH (peak Tg). A thyroid remnant was seen by US, CT and PET in eight patients; recurrences were seen by US, CT and PET in six, five and five patients, respectively. Two metastatic nodes were identified by US and CT but not by PET. Lung micronodules were detected by CT in 7/49 (14.3 %) patients and by FDG PET in three of them. Basal Tg ranged from 0.5–1,725 ng/ml while peak Tg ranged from 0.5 to 2,135 ng/ml: the distribution between positive and negative patients was similar. Bone scan was negative in all cases. In DTC patients with detectable Tg and negative I-131 post-therapy WBS, imaging examination revealed remnant or metastases in 43 % of cases. Remnant and recurrences were equally detected by the three techniques; US was better than [18F]-FDG PET for lymph node metastases since this latter method can give false both positive and negative results; chest examination is best made by CT versus FDG PET due to its higher spatial resolution.

The treatment of chronic kidney disease (CKD) consists of pharmacological, nutritional, and psychological-social approaches. The dietary therapy of CKD, namely a low-protein low-phosphorus diet, plays a crucial role in contributing to delay the onset of end-stage renal disease (ESRD) and to protect cardiovascular and nutritional status. The protein-free food products represent a very important tool for the implementation of a low-protein diet to ensure adequate energy supply, reducing the production of nitrogenous waste products.

To evaluate the histological changes of tracheal cartilage and epithelium caused by tracheal occlusion at different gestational ages in a fetal rat model.

This work intends to contribute to the planning guidelines in the field of value chain management (VCM). Thus, it develops a model reference proposal supported by the definition of a highly complex environment of knowledge towards on the innovation value chain performance in the product/technology development process (PDP) applied to technology–based companies under uncertainty and restraint. This stage considers a sequence of systematic procedures in the following phases: 1) determining the information needs in two stages; 2) determination of knowledge objects. The results produced are satisfactory, validating the proposed procedure for VCM.

Gastroschisis is a congenital abdominal wall defect with increasing occurrence worldwide over the past 20–30 years. Our aim was to analyze the morbidity of newborns after gastroschisis closure, with emphasis on metabolic and hydroelectrolyte disturbances in patients at three tertiary university centers.

Cleft lip and palate (CLP) is the most common congenital defect of the face. Many animal models have been utilized to study embryogenesis and pathogenesis of CLP, including the development of secondary anomalies and consequent deformities. However, the ideal gestational age for surgical creation of lip or palate defects in rat models has never been determined. The aim of the present study is to improve the experimental model utilizing rat fetuses, defining the most appropriate timing for creation of the lip defect model. The study was composed of three groups of fetuses undergoing surgical creation of a lip defect at the left side of the superior lip at 17.5, 18.5, and 19.5 days of gestation. Fetuses were harvested at 21.5 days of gestation (term = 22 days) and underwent macroscopic and microscopic analyses. We found that the most appropriate moment for lip defect creation was at 19.5 days, given the presence of lip depression at the site of the defect and asymmetry and retraction associated with interruption of the lip and complete reepithelialization of the borders of the defect.

Correction of gastroschisis can be accomplished by primary or staged closure. There is, however, no consensus regarding the best approach or criteria to favor one method over the other has been established.

Background/Purpose: Babies with congenital duodenal obstruction (CDO) have a high incidence of additional anomalies. Downs syndrome (DS) is the most common associated chromosomal defect, affecting up to 20 of these newborns. Morbidity is expected to be higher in DS patients, since it is a major cause of congenital heart disease, immunodeficiency, and other birth defects. We could find only one report concerning the morbidity in the DS newborn, when associated with CDO. The purpose of this report is to compare the postoperative outcome of two groups of newborns with CDO: group I, patients with associated DS and group II, without DS. Methods: A two-center retrospective review of charts of 46 newborns with CDO admitted to the Hospital of “UNICAMP” and the “Hospital das Clinicas da UFMG”, between 1993 and 2001, was undertaken. Results: Sixteen (34,7) of the 46 babies had DS. The groups were homogeneous concerning gestational age, gender, birth weight and nutritional status. There was a higher incidence of cardiopathy (56 x 20) and sepsis (37 x 16) among patients with DS; however we could find statistic difference only for the incidence of cardiopathy. The survival rate was similar for both groups, reaching 94. Conclusions: Despite the associated anomalies, newborns with DS individuals had a similar postoperative course, when compared with babies without DS after surgical correction of CDO. The earlier diagnosis of CDO and other birth defects, associated with intensive care, appropriate surgical procedure and postoperative support can provide an equivalent morbidity for DS patients.

Background/Purpose: Babies with congenital duodenal obstruction (CDO) have a high incidence of additional anomalies. Down's syndrome (DS) is the most common associated chromosomal defect, affecting up to 20% of these newborns. Morbidity is expected to be higher in DS patients, since it is a major cause of congenital heart disease, immunodeficiency, and other birth defects. We could find only one report concerning the morbidity in the DS newborn, when associated with CDO. The purpose of this report is to compare the postoperative outcome of two groups of newborns with CDO: group I, patients with associated DS and group II, without DS. Methods: A two-center retrospective review of charts of 46 newborns with CDO admitted to the Hospital of “UNICAMP” and the “Hospital das Clinicas da UFMG”, between 1993 and 2001, was undertaken. Results: Sixteen (34,7%) of the 46 babies had DS. The groups were homogeneous concerning gestational age, gender, birth weight and nutritional status. There was a higher incidence of cardiopathy (56% x 20%) and sepsis (37% x 16%) among patients with DS; however we could find statistic difference only for the incidence of cardiopathy. The survival rate was similar for both groups, reaching 94%. Conclusions: Despite the associated anomalies, newborns with DS individuals had a similar postoperative course, when compared with babies without DS after surgical correction of CDO. The earlier diagnosis of CDO and other birth defects, associated with intensive care, appropriate surgical procedure and postoperative support can provide an equivalent morbidity for DS patients.

The beneficial effects of statins in reducing cardiovascular events have been attributed predominantly to their lipid-lowering effects, recent studies suggest that these effects might be due to their anti-inflammatory properties. We here investigate the in vivo and in vitro effects of simvastatin on cytokine production in pre-dialysis chronic renal failure patients.

The lack of power exercised by the European Union (EU) in the international security arena explains its relative invisibility in the US. When Americans do recognise the EU, their interpretations of American history shape their responses to it. Whether puzzled by the loss of sovereignty or by the continuing strength of national identity, the American understanding of European integration cannot be divorced from Americans’ own understanding of the American process of nation-building and the exercise of federal power.

As a result of changing market needs and growth in competition, companies' competitiveness is increasingly being determined by their innovation capacity. This study aims at analyzing the characteristics of technological behavior of the Telecom industry in Brazil, specifically of equipment suppliers, which account for most of the sector's technological innovation. This study encompasses quantitative analysis describing the profile of innovative companies and their Research and Development (R&D) efforts, and the results obtained. In order to complement the analysis, a few cases were studied in order to show, among others, the main areas and/or products having R&D carried out in Brazil, factors attracting R&D activities to the country, cooperation with local universities and difficulties faced by companies when carrying R&D locally. Main conclusions and suggestions for public policies of the telecom industry are finally presented.

SummaryAs a result of changing market needs and growth in competition, companies’ competitiveness is increasingly being determined by their innovation capacity. This study aims at analyzing the characteristics of technological behavior of the Telecom industry in Brazil, specifically of equipment suppliers, which account for most of the sector’s technological innovation. This study encompasses quantitative analysis describing the profile of innovative companies and their Research and Development (R&D) efforts, and the results obtained. In order to complement the analysis, a few cases were studied in order to show, among others, the main areas and/or products having R&D carried out in Brazil, factors attracting R&D activities to the country, cooperation with local universities and difficulties faced by companies when carrying R&D locally. Main conclusions and suggestions for public policies of the telecom industry are finally presented.

Acute myocardial infarction (AMI) is associated with a stimulation of cortisol which lasts 24 hours in patients treated by thrombolysis. Percutaneous transluminal coronary angioplasty (PTCA) is an alternative treatment for AMI which reduces the length of myocardial ischemia. Our objective was the determination of the amplitude and duration of cortisol and other hormones of the hypothalamo-pituitaryadrenal (HPA) axis release in patients undergoing PTCA. These responses were also analyzed in relation with the time of onset of AMI. The effect of coronarography with or without angioplasty in patients without AMI was also studied. Plasma ACTH, cortisol, corticotropin-releasing hormone and arginine vasopressin levels were determined during the first 48 hours in 20 patients with first AMI, treated by PTCA and in 10 patients without AMI undergoing coronarography (and angioplasty in five of them). A strong stimulation of the HPA axis was observed in AMI patients, but the duration of cortisol secretion was significantly reduced (less than 8 hours) as compared with previous studies in patients treated with thrombolysis. A clear-cut ACTH-cortisol dissociation was also observed after the third hour. ACTH and cortisol stimulation was higher in patients admitted between 04:00 h and 16:00 h than in patients admitted between 16:00 h and 04:00 h In patients without AMI, coronarography induced a moderate, but significant short-lasting ACTH and cortisol stimulation. In conclusion, our data suggest that the degree of stimulation of the HPA axis may depend upon the type of treatment and the circadian rhythm of this axis.

Background:Several studies have provided convincing evidence that in apparently healthy subjects elevated serum levels of plasma C-reactive protein (CRP) are associated with an increased risk of experiencing myocardial infarction and sudden cardiac death. It has been claimed that, in dialytic patients, the hepatic synthesis of this ‘acute phase response’ plasma protein is primarily induced by the macrophage-derived interleukin 6 (IL-6). Little information is available, however, regarding CRP and IL-6 plasma levels in pre-dialytic renal failure. Methods:Plasma CRP by a modification of the laser nephelometry technique, IL-6 and serum albumin were determined in 103 chronic pre-dialytic patients (mean age 50 ± 6.3 years; creatinine clearance (Cr.cl.) 36.3 ± 23.1 ml/min). Results:CRP was >5 mg/l (normal upper range) in 42% of the global population. CRP and IL-6 were significantly related (r = 0.35, p < 0.0004). CRP and IL-6 were related to renal function (CRP vs. Cr.cl., r = –0.56, p < 0.0001; IL-6 vs. Cr.cl., r = –0.55, p < 0.0001, Spearman correlation coefficient). When patients were divided in tertiles according to renal function, CRP median value resulted 7.9 mg/l (interquartile interval: 5–12) in the first tertile (Cr.cl. <18.5 ml/min), 4.0 mg/l (3–6) in the second tertile (Cr.cl. 18.5–45 ml/min) and 3.2 mg/l (2.7–4.0) in the last tertile (Cr.cl. >45 ml/min) (p < 0.0001). A negative correlation between CRP and S-albumin was also found (r = –0.52, p < 0.0001, Spearman correlation coefficient). Conclusions:IL-6 and CRP were increased and were inversely related to creatinine clearance in our population of 103 chronic predialytic patients. The possibility of a decreased renal clearance of CRP and/or cytokines as a cause of an activated acute-phase response is discussed. A negative correlation between CRP and S-albumin was found confirming the link between chronic inflammation and malnutrition in chronic renal patients.

We describe four patients with proven sarcoidosis and minor pulmonary involvement according to high-resolution CT (HRCT) findings in whom the recently described sign of decreased attenuation on expiratory HRCT scan appeared associated with the reduction of the single-breath diffusing capacity of the lung for carbon monoxide (Dlco) and the Dlcoadjusted for alveolar volume. These alterations were, in part, reversible under steroid treatment. Major indexes of airway obstruction (FEV1/vital capacity ratio and FEV1) were normal, while the maximum expiratory flow at 25% above the residual volume of FVC was reduced. These observations suggest that an expiratory HRCT mosaic pattern and diffusion impairment may be early findings in pulmonary sarcoidosis and may be useful for its detection and follow-up.

The process of local government borrowing to finance the capital needs of social services has an impact on both central-local relations and the type of service which can be offered to the citizen-consumer. Based on an examination of these relationships in the United States, the United Kingdom, France, and Italy, it is postulated that different types of central-local relations are dependent on the nature of relations between central government and the investment community. Further, through use of material from a case study of public housing politics in Italy, it is shown how the investment criteria of the so-called “private” sector are transferred to the operations of the public sector through the mechanism of local borrowing. This transferal affects the manner in which social services are conceived and delivered.

The article is concerned with the control procedures of a IV generation Uninterruptible Power Supply (U.P.S.) system.

Abstract: Childhood cancer often results in pulmonary metastases, and proper identification and prompt treatment of these lesions increases the survival of these patients. Between 21 May 1995 and 26 June 1996, nine children (five with osteosarcoma, two with Wilms' tumor, and one each with hepatoblastoma and an adrenocortical tumor) underwent median sternotomy at our institution for resection of bilateral pulmonary metastases. These five boys and four girls ranged in age from 2 to 16 years (median, 11 years). Identification and resection of metastases in all lobes of the lungs was greatly facilitated by the median sternotomy approach because both thoracic cavities were fully accessible. In each of five patients, as many as 23 metastases were removed using wedge resection or a stapling device. Multiple biopsies only were obtained from the four remaining patients, whose lesions were too numerous and diffuse for effective resection. All nine patients recovered uneventfully; the median hospitalization was 3 days (range, 2–5 days). We find that median sternotomy is a safe, effective, and relatively simple procedure for resecting bilateral pulmonary metastases in children with cancer.

The matrix structure recommends itself as a convenient framework for implementing cross‐disciplinary projects. However, this structure tends to generate conflict between project and disciplinary managements. In excess, conflict can reduce performance. The aim of the work described in this paper was to see whether conflict could be controlled by better definition of the respective roles of project and functional managers.

Eight patients with chronic thromboembolic pulmonary hypertension (CTPH) that had been demonstrated by perfusion lung scan, pulmonary arteriography, and right heart catheterization had their pulmonary circulation evaluated by CT. Eight subjects without lung pathology were also studied for comparison. High resolution CT from apex to base with 1 cm thick sections after intravenous injection of contrast medium was performed in each individual. Emboli lodged in main pulmonary arteries on arteriography were regularly shown by CT, whereas those in segmental or smaller arteries were not detected. Diameters of the main pulmonary arteries measured on CT correlated with systolic pulmonary artery pressure (p < 0.001). The ratio between diameters of segmental arteries and the corresponding bronchi (A/B ratio) on CT was > 1 in 72 of 144 examined pulmonary segments (18 segments for each patient) in patients with CTPH. The ratio was > 1 in only 10 of 144 examined segments in normal control subjects. Dilatation of bronchial arteries was present in four of eight patients with CTPH. The parenchymal density in patients with CTPH was significantly higher in the axial than in the middle or peripheral lung compartments. In conclusion, CT may help with the diagnosis of CTPH by detecting thrombi of main arteries and by showing characteristic findings; moreover, it is accurate in estimating pulmonary arterial pressure secondary to thromboembolic obstruction.

Administration of extracellular vesicles derived from amniotic fluid stem cells regenerates underdeveloped fetal lungs in rodents.

Embryologically, duodenal atresia results from inadequate recanalization and proliferation of the solid cord in the 8–10th week of gestation, while apple-peel atresia is a consequence of a vascular accident. The presence of both malformations is rather rare. We report a case with both associations; to our knowledge, this is the twelfth such case reported in the English literature.

The article addresses the nine myths regarding the Chinese People's Liberation Army (PLA) and People's Liberation Army Navy (PLAN) that could affect the China-U.S. military relations. It clarifies that China has an army-subordinate navy and two brigades of marines that are subordinate to the South Sea Fleet of the PLAN. According to the authors, PLAN understands the U.S. Navy better than the other way around. They add that the U.S. tends to be more inclined to history than China.

This is the first report of intracardiac thrombi and pulmonary embolism complicating pacemaker leads implanted for cardiac resynchronization therapy. Prompt diagnosis and successful therapy with a thrombolytic agent lead to a favourable outcome. This report suggests that long-term oral anticoagulation should be considered in patients with depressed left ventricular function undergoing cardiac resynchronization therapy in order to prevent this potentially serious complication.