Search

Background: Atrioventricular valve (AVV) regurgitation is increasingly prevalent in patients with a Fontan circulation.Objectives: We sought to determine the impact of ventricular dominance and AVV operation on outcomes in patients with a Fontan circulation and ≥moderate AVV regurgitation.Methods: We conducted a retrospective study, including propensity score matching analysis, of 1,703 patients who survived Fontan operation in Australia and New Zealand from 1987 to 2021.Results: Patients undergoing AVV operation were more likely to have right ventricular (RV) dominance or an atrioventricular septal defect. In the entire cohort, death or transplantation after Fontan operation was significantly higher in patients who underwent AVV operation before or at Fontan completion compared with those who did not (20 years: 18%; 95% CI: 8%-26% vs 13%; 95% CI: 10%-15%; P = 0.03). After propensity score matching, including for RV dominance, there was no significant difference in death or transplantation between the groups (20 years: 18%; 95% CI: 8%-26% vs 16%; 95% CI: 10%-22%; P = 0.41). Only patients with RV dominance who developed ≥moderate AVV regurgitation after Fontan operation were at increased risk of death or transplantation (HR: 2.8; 95% CI: 1.4-5.3; P < 0.01). In patients with left ventricular dominance, there was no significant difference in death or transplantation between patients with ≥moderate AVV regurgitation compared with those with Conclusions: RV dominance, but not AVV surgery itself, was associated with poor outcomes. Moderate or greater AVV regurgitation after Fontan operation is associated with a significantly increased risk of death or transplantation, only in patients with RV dominance. [ABSTRACT FROM AUTHOR]

Pulmonary complications in CTD are common and can involve the interstitium, airways, pleura and pulmonary vasculature. ILD can occur in all CTD (CTD‐ILD), and may vary from limited, non‐progressive lung involvement, to fulminant, life‐threatening disease. Given the potential for major adverse outcomes in CTD‐ILD, accurate diagnosis, assessment and careful consideration of therapeutic intervention are a priority. Limited data are available to guide management decisions in CTD‐ILD. Autoimmune‐mediated pulmonary inflammation is considered a key pathobiological pathway in these disorders, and immunosuppressive therapy is generally regarded the cornerstone of treatment for severe and/or progressive CTD‐ILD. However, the natural history of CTD‐ILD in individual patients can be difficult to predict, and deciding who to treat, when and with what agent can be challenging. Establishing realistic therapeutic goals from both the patient and clinician perspective requires considerable expertise. The document aims to provide a framework for clinicians to aid in the assessment and management of ILD in the major CTD. A suggested approach to diagnosis and monitoring of CTD‐ILD and, where available, evidence‐based, disease‐specific approaches to treatment have been provided. [ABSTRACT FROM AUTHOR]

The 14 major bird collections in Australia (10) and New Zealand (4) together hold half a million specimens, including 275 000 from Australia and 115 000 from New Zealand. Six large collections in Australia, and two in New Zealand, each hold at least 30 000 birds. The largest single collection (Australian Museum, Sydney) has 78 000 birds. Overall, study-skins are the most common form of preparation (47%), followed by eggs (20%). However, for New Zealand collections alone, fossil bones are the biggest single category (56%) reflecting that country's remarkable Holocene fossil record of birds. Taxonomically, the best-represented group in the Australasian collections is the order Passeriformes, followed by Anseriformes, Procellariiformes, Psittaciformes, Charadriiformes, Columbiformes, Falconiformes, and ratites (Ratitae). Most birds in Australasian collections (81%) are from Australia or New Zealand, followed by 27 000 specimens (6%) from the south-west Pacific (islands of Polynesia and Melanesia, including New Guinea). The Australasian collections are managed by a total staffing complement of about 25 FTE (full-time equivalents), most of whom care for other taxonomic groups besides birds. Nearly all specimen records are now captured electronically, but seven different software systems are used (KE "EMu" and Vernon Systems "Collection" most commonly). The 14 Australasian bird collections together form a nationally and internationally important resource. These collections document the biodiversity of the birds of the Australasian biogeographic region, and allow researchers to study many aspects of avian biology, including speciation, biogeography, moult and plumages, systematics and conservation. [ABSTRACT FROM AUTHOR]