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Miguel Urencio,1 Chris Greenleaf,1 Jorge D Salazar,2 Ali Dodge-Khatami2 1Division of Cardiothoracic Surgery, 2Children’s Heart Center, University of Mississippi Medical Center, Jackson, MS, USA Abstract: Hypoplastic left heart syndrome (HLHS) was a uniformly fatal diagnosis before 1983, when surgical treatment was first undertaken with the Norwood I operation as the first of 3-staged operations. Since then, operative survival rate of stage I has risen from 53% to over 90% in the current era, not only thanks to technical advances in surgery but also through prenatal diagnosis and imaging, enhanced cardiopulmonary bypass technology, better perioperative intensive care, and closer interstage monitoring. The improvements in patient outcomes achieved through rigorous multidisciplinary teamwork have come at a tremendous cost in manpower and resources, making HLHS still a challenge to all congenital heart programs, established or emerging. We review the various surgical steps to treat HLHS and their current expected outcomes, and put into perspective cost considerations compared to other more “simple” congenital heart defects. Keywords: hypoplastic left heart syndrome, Norwood, congenital heart disease

Dana K Voelker,1 Justine J Reel,2 Christy Greenleaf3 1West Virginia University, College of Physical Activity and Sport Sciences, Morgantown, WV, 2University of North Carolina Wilmington, College of Health and Human Services, Wilmington, NC, 3University of Wisconsin–Milwaukee, College of Health Sciences, Milwaukee, WI, USA Abstract: Adolescence represents a pivotal stage in the development of positive or negative body image. Many influences exist during the teen years including transitions (eg, puberty) that affect one’s body shape, weight status, and appearance. Weight status exists along a spectrum between being obese (ie, where one’s body weight is in the 95th percentile for age and gender) to being underweight. Salient influences on body image include the media, which can target adolescents, and peers who help shape beliefs about the perceived body ideal. Internalization of and pressures to conform to these socially prescribed body ideals help to explain associations between weight status and body image. The concepts of fat talk and weight-related bullying during adolescence greatly contribute to an overemphasis on body weight and appearance as well as the development of negative body perceptions and dissatisfaction surrounding specific body parts. This article provides an overview of the significance of adolescent development in shaping body image, the relationship between body image and adolescent weight status, and the consequences of having a negative body image during adolescence (ie, disordered eating, eating disorders, and dysfunctional exercise). Practical implications for promoting a healthy weight status and positive body image among adolescents will be discussed. Keywords: adolescence, eating disorders, obesity, bullying, puberty, physical activity

Introduction: As international guidelines suggest keeping the platelet count between 50 and 100 × 10 9 cells/L in children on extracorporeal membrane oxygenation (ECMO), platelet transfusions are administered to two-thirds of ECMO days, and up to 70% of these patients still bleed. We aim to describe outcomes in critically ill children who develop severe thrombocytopenia on ECMO., Methods: Single-center retrospective study, enrolling critically ill children on ECMO admitted at Children's Memorial Hermann, TX, between 1/2018 and 12/2022, with at least one platelet count below 50 × 10 9 cells/L (severe thrombocytopenia). Platelet counts were measured four times a day. We report platelet transfusion, bleeding, hemolysis, and clotting events within 6 h after transfusion, as well as ECMO duration and mortality., Results: We enrolled 54 patients representing 337 ECMO days and 1190 platelet counts. Median weight was 3.7 kg and 54% were male. Severe thrombocytopenia was observed in 56% of platelet counts. Severe thrombocytopenia was not associated with bleeding in the subsequent 6 h (18% vs 20%, p = .95), but was associated with more frequent platelet transfusions (18% vs 11%, p = .001). There was no correlation between time spent with severe thrombocytopenia and the duration of ECMO (R 2 = 0.03). While the time spent with severe thrombocytopenia was not associated with on-ECMO mortality rate ( p = .36), there was an association with in-hospital mortality rate ( p = .003)., Conclusions: Our results indicate a restrictive platelet transfusion strategy is not associated with higher proportions of subsequent bleeding, duration of ECMO, or on-ECMO mortality rate. Multicenter studies are needed to evaluate further the appropriateness of this strategy., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A 47-year-old with repaired ventricular septal defect and pulmonary valve stenosis as a child presents with chronic intermittent chest pain. CT evaluation for transcatheter pulmonary valve replacement revealed right coronary artery compression between a sternal wire and dilated right ventricle. Removal of the sternal wire resulted in improved symptoms.

Aortic arch obstruction is often present with complex concomitant congenital heart defects (CHDs). The use of nonvalved femoral vein homograft (FVH) to reconstruct the aortic arch has distinct surgical advantages, including simplified reconstruction. We present an intraoperative video of a Yasui procedure utilizing FVH for aortic reconstruction in a 12-day-old (2.2 kg) neonate with right ventricular outflow tract obstruction, malalignment ventricular septal defect, aortic valve atresia, aortic arch hypoplasia, atrial septal defect, and ductal dependent systemic circulation. Further, we report outcomes for a series of three additional neonatal patients with complex CHD and aortic arch obstruction who underwent FVH arch reconstruction., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study aimed to assess the internalization of sociocultural attitudes and appearance comparison among U.S. athletes with physical disabilities. Female (n = 19) and male (n = 25) athletes between the ages of 18 and 73 years completed a quantitative survey along with two exploratory open-ended questions related to body appearance and influencers. Results showed significant correlations between internalization of the thin and low-body-fat ideal and appearance comparison (r = .55, p < .05) and internalization of the muscular ideal and appearance comparison (r = .76, p < .05) among women. For men, results showed a significant association between internalization of the muscular ideal and appearance comparison (r = .52, p < .05). The findings prompt further investigation of whether appearance comparison and internalization influence body dissatisfaction and disordered eating among athletes with physical disabilities.

Background: Borderline small ventricular size or technical issues precluding the use of both ventricles may lead to single ventricle palliation. Fontan complications have led some centers to look for alternatives to the traditional pathway. The objective of this study is to evaluate the essential philosophy and outcomes of a new biventricular (BiV) conversion program., Methods: The prospectively collected Children's Memorial Hermann Heart Institute Society of Thoracic Surgeon's Database was retrospectively reviewed between July 2017 and July 2020., Results: Thirteen patients met inclusion criteria and underwent BiV conversion during that time. The most frequent diagnosis was malposed great arteries and a ventricular septal defect (VSD) in 4 (31%) patients. Seven (54%) patients were in the first interstage, and 1 (8%) patient had already undergone a Fontan operation before their BiV conversion operation. One or more risk factors for single ventricle palliation (genetic syndrome ≥ moderate atrioventricular valve regurgitation ≥ moderate ventricular dysfunction, presence of signs of Fontan failure) were present in 3 (23%) patients. The median left ventricular end diastolic pressure increased from 5.5 mmHg (4-10 mmHg) to 10 mmHg (6-20 mmHg) postoperatively (p < .05). The right ventricular pressure (RVP) was estimated as less than half systemic in all six patients who were able to be estimated. At a median follow-up of 22.6 months (0.3-36.4 months), 12 (92%) patients are alive., Conclusions: BiV conversion is feasible with reasonable short-term clinical outcomes. Mortality risk is low, but as seen in other studies, the risk of reintervention is high., (© 2021 Wiley Periodicals LLC.)

The current coronavirus disease 2019 pandemic has been particularly challenging for the clinician because of the unclear nature of the underlying disease mechanisms. One of the hallmarks of the disease involves an increased risk of thrombosis and hypercoagulable state. Here, we describe 2 cases of patients admitted with submassive pulmonary embolism in the setting of positive tests for severe acute respiratory syndrome coronavirus 2., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The study explored reasons for exercise as possible mediators of the relationship between body appreciation and exercise avoidance motivation and between body surveillance and exercise avoidance motivation. Using a cross-sectional design, 131 women with a body mass index (BMI) of 25 or higher completed measures of body surveillance, body appreciation, reasons for exercise, and exercise avoidance motivation. Mediation analyses indicated that appearance-oriented reasons for exercise partially mediated the body surveillance-exercise avoidance motivation relationship. Health and fitness professionals, organizations, and environments should avoid reinforcing appearance-oriented reasons for exercise. Rather, empowering exercise experiences and environments should be created as they seem to benefit women regardless of reasons for exercise.

Despite significant health benefits of regular physical activity, over 60 percent of college women do not meet recommended physical activity guidelines to promote their health and health-related quality of life (HRQoL), a comprehensive construct including physical and psychosocial health functioning. The major purpose of this study was to examine the influences of individual (e.g., self-efficacy, enjoyment), social (e.g., family and friend support), and physical environmental factors (e.g., crime safety) on college women's physical activity and HRQoL. Participants were 235 (Mean age = 21.0 years) college women from a public research university located in the southwest region of the United States. They completed validated surveys assessing their perceptions of physical activity, HRQoL, and social ecological factors during the spring semester of 2012. The findings of three multiple linear regressions, entering individual factors first, followed by social and physical environmental factors, revealed that self-efficacy and crime safety were significantly related to physical activity. For HRQoL-physical functioning, significant factors were self-efficacy, enjoyment, and crime safety. Enjoyment was the only factor related to HRQoL-psychosocial functioning. These findings indicated that physical activity professionals need to foster safe environments, enhance self-efficacy, and provide enjoyable activities to promote college women's physical activity and HRQoL.

Background: Adolescence is a critical time for the development of psychological well-being. Weight gain and the emergence of body image concerns during this period can lead to the development of negative psychological states. To explore this issue, we examined the relationship between weight control behavior (WCB; ie, trying to lose, gain, stay the same, or do nothing about weight) and levels of depression and self-esteem., Methods: Adolescents (508 boys, 502 girls; Mage  = 12.32 ± .88 years) completed a survey that assessed WCB, depression, and self-esteem. Descriptive discriminant analysis was used to analyze WCB group differences on psychological well-being. Multivariate post hoc analysis further examined group differences. Structure coefficients indicated the relative importance of each dependent variable in boys and girls., Results: Results indicated that, among both sexes, WCB was significantly related to depression and self-esteem. Individuals trying to lose weight had lower levels of psychological well-being than the other groups., Conclusions: Adolescents trying to lose weight reported the lowest psychological well-being scores whereas those not doing anything to control weight reported the highest levels of psychological well-being. These findings have important implications for screening and education programs designed to monitor and support adolescent psychological well-being., (© 2016, American School Health Association.)

Up to 80% of individuals with eating disorders engage in dysfunctional exercise, which is characterized by exercising in excessive quantities often past the point of pain as well as compulsive feelings and negative affect when exercise is disrupted (Cook, Hausenblas, Crosby, Cao, & Wonderlich, 2015). Intuitive exercise involves an awareness of the senses while moving and attending to one's bodily cues for when to start and stop exercise, rather than feeling compelled to adhere to a rigid program (Reel, 2015). The purpose of this study was to design a measurement tool to evaluate the construct of intuitive exercise in research, treatment, and prevention settings. The 14-item Intuitive Exercise Scale (IEXS) was developed and validated in the current study with completed surveys from 518 female and male adult participants. Exploratory factor analysis was used to identify four latent constructs, including emotional exercise, exercise rigidity, body trust, and mindful exercise, which were supported via confirmatory factor analysis (CFI=0.96; SRMR=0.06). The IEXS demonstrated configural, metric, and scalar invariance across women and men. Correlations with measures of intuitive eating, exercise dependence, and exercise motivation supported convergent and discriminant validity., (Published by Elsevier Ltd.)

The purpose of the present study was to investigate particular psychosocial predictors of obesity bias in prehealth professionals, which include the internalization of athletic and general body ideals, perceived media pressure and information, and achievement goal orientations. Exercise science undergraduate students (n= 242) filled out a survey containing questions of demographic characteristics, achievement goals, social-cultural attitudes toward appearance (using Sociocultural Attitudes Towards Appearance Questionnaire-3), and obesity bias measurements (using the antifat attitudes test and fat phobia scale). The results indicated that students were explicitly biased toward overweight and obese individuals, held had high task and ego goals, and had high internalization of an athletic body type ideal, as determined by mean scores being above the median values for each scale. Internalization of the athletic body type predicted obesity bias for fat phobia, weight control blame, and physical/romantic attractiveness. In conclusion, exercise science students may enter programs socialized from society and sport, and, potentially, these psychosocial attitudes and beliefs may have implications to working with future clients, especially for those of the general population and those whose body shape and size are different than themselves., (Copyright © 2016 The American Physiological Society.)

Adolescent girls commonly engage in weight management and dietary restriction with the hopes of changing their bodies to more closely approximate social body ideals. The purpose of this study was to examine biopsychosocial factors that predict dietary restraint. Participants (n=774, Mage=12.38) completed measures of dietary intent, pubertal status, sociocultural pressures, body comparison, internalization, body dissatisfaction, social support, and general self-esteem. Height, weight, and cardiorespiratory fitness were objectively measured. Pressures to lose weight and gain muscle mass, internalization of social body ideals, and friend support predicted higher levels of dietary intent; cardiorespiratory fitness predicted lower levels of dietary intent. Girls who experience pressure, adopt social body ideals as their own, and experience social support from friends may be at increased risk for disturbed eating attitudes and behaviors. Fitness may offer a protective effect against psychological and social risk factors. Additional research is needed to establish the causal nature of these relationships and determine effective methods for reducing disordered eating risk among adolescent girls., (Copyright © 2015 Elsevier Ltd. All rights reserved.)