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The COVID-19 pandemic has influenced organ transplantation decision making. Opinions regarding the utilization of coronavirus disease-2019 (COVID-19) donors are mixed. We hypothesize that COVID-19 infection of deceased solid organ transplant donors does not affect recipient survival. All deceased solid organ transplant donors with COVID-19 testing results from March 15, 2020 to September 30, 2021 were identified in the OPTN database. Donors were matched to recipients and stratified by the COVID-19 test result. Outcomes were assessed between groups. COVID-19 test results were available for 17 694 donors; 150 were positive. A total of 269 organs were transplanted from these donors, including 187 kidneys, 57 livers, 18 hearts, 5 kidney-pancreases, and 2 lungs. The median time from COVID-19 testing to organ recovery was 4 days for positive and 3 days for negative donors. Of these, there were 8 graft failures (3.0%) and 5 deaths (1.9%). Survival of patients receiving grafts from COVID-19-positive donors is equivalent to those receiving grafts from COVID-19-negative donors (30-day patient survival = 99.2% COVID-19 positive; 98.6% COVID-19 negative). Solid organ transplantation using deceased donors with positive COVID-19 results does not negatively affect early patient survival, though little information regarding donor COVID-19 organ involvement is known. While transplantation is feasible, more information regarding COVID-19-positive donor selection is needed.

Introduction: Health-related quality of life in children who have undergone the Ross procedure has not been well characterised. The aim of this study was to characterise health-related quality of life in this cohort and compare to children with other CHD. Method: In this cross sectional, single-centre study, health-related quality of life was assessed in patients who underwent a non-neonatal Ross procedure using the Pediatric Quality of Life Inventory. Ross cohort scores were compared with healthy norms, patients with CHD requiring no surgical intervention or had curative surgery (Severity 2, S2) and patients who were surgically repaired with ≥1 surgical procedure and with significant residual lesion or need for additional surgery (Severity 3, S3). Associations between Pediatric Quality of Life Inventory score and patient factors were also examined. Results: 68 patients completed surveys. Nearly one-sixth of patients had overall scores below the cut-off for at-risk status for impaired health-related quality of life. There was no difference in overall health-related quality of life score between the Ross cohort and healthy children (p = 0.56) and S2 cohort (p = 0.97). Health-related quality of life was significantly higher in the Ross cohort compared to S3 cohort (p = 0.02). This difference was driven by a higher psychosocial health-related quality of life in the Ross cohort as compared to S3 cohort (p = 0.007). Anxiety scores were significantly worse in the Ross cohort compared to both S2 (p = 0.001) and S3 (p = 0.0017), respectively. Conclusion: Children who have undergone a Ross procedure report health-related quality of life equivalent to CHD not requiring therapy and superior to CHD with residual lesions. Despite these reassuring results, providers should be aware of potential anxiety among Ross patients.

Post-transplant lymphoproliferative disorders (PTLD) are heterogenous lymphoproliferative disorders that develop as a consequence of immunosuppression in transplant recipients. We sought to determine if subtypes of PTLD correlated with different outcomes. We performed a retrospective review of PTLD occurring in pediatric heart transplant recipients. A total of 558 children and infants underwent cardiac transplantation at our institution between 1985 and 2019 and were followed until March 2021. Forty-nine of 558 patients developed PTLD (8.8%). As compared to older children (>one year of age), infant recipients (

Introduction: Rejection remains a significant cause of graft loss after heart transplantation. The current prevalence of recurrent rejection and its impact on graft loss after pediatric heart transplantation is unknown. Methods: All pediatric heart transplants between 1/2000-6/2020 in the Pediatric Heart Transplant Society database were included. Rejection was defined as a clinical event determined by biopsy, echocardiogram or clinical findings that resulted in augmentation of immunosuppression. Recurrent rejection was defined as ≥ 2 episodes of rejection after heart transplant. Freedom from recurrent rejection in the early (2000-2009) and current (2010-2020) era were compared. Multiphase parametric hazard modeling was utilized to understand the effects of each additional episode of rejection on graft loss in addition to identifying other risk factors. Results: Of 6342 heart transplants during the study period, 3921 (62%) had 0, 1386 (21%) had 1 and 1035 (17%) had ≥2 rejection episodes. In the current era, recurrent rejection is less frequent [468/4206 (11.1%) vs. 567/2136 (26.5%); p Conclusions: Currently, recurrent rejection is experienced by 1 in 10 pediatric HT recipients. Each additional episode of rejection post-HT confers an increasing risk for graft loss. Identifying risk factors for recurrent rejection is paramount to improving graft longevity.

Background Unlike most virtual reality (VR) training programs that are targeted at homogenous populations, a set of VR games for rehabilitation purposes targeted at a heterogeneous group of users was developed. The VR games covered physical training, cognitive training (classification and reality orientation), community-living skills training, and relaxing scenery experiences. Special considerations for local older adults and people with disabilities were made in terms of hardware choice and software design. Objective This study aimed to evaluate the feasibility, acceptance, and efficacy of VR training among users with varying abilities. Methods A single-arm pretest-posttest evaluation study was conducted. The participants of the evaluation study were encouraged to undergo 30-minute VR training three times a week for 6 weeks. The 30-minute session consisted of 10 minutes of upper-limb motion games, 10 minutes of lower-limb motion games, and 10 minutes of cognitive games/community-living skills training/relaxing scenery experiences, as appropriate. On completion of each session, usage statistics were documented via the built-in VR software, whereas feedback on the experience of the VR games and adverse events was collected via self-reports and staff observations. Feasibility was reflected by usage statistics, and acceptance was reflected by positive feedback. In addition, health outcomes, including upper-limb dexterity, functional mobility, cognitive function, and happiness, were assessed at baseline, as well as 6 weeks and 3 months after baseline. The primary outcomes were upper-limb dexterity and acceptance of playing VR games. Results A total of 135 participants with a mean age of 62.7 years (SD 21.5) were recruited from May 2019 to January 2020, and 124 (91.9%) completed at least one follow-up. Additionally, 76.3% (103/135) of the participants could attend at least 70% of the proposed 18 sessions, and 72.5% (1382/1906) of the sessions had a training time of at least 20 minutes. Linear mixed effect models showed statistically significant effects in terms of upper-limb dexterity (small effect) and cognitive function (moderate effect). Among the 135 participants, 88 provided positive comments. Additionally, 10.4% (14/135) reported mild discomfort, such as dizziness, and none reported severe discomfort. Conclusions A set of VR training games for rehabilitation could be applied to users with heterogeneous abilities. Our VR games were acceptable to local older adults and those with different disabilities. Benefits in upper-limb dexterity and cognitive function were observed despite partial compliance to the training protocol. Service providers could refer to our experiences when developing VR training systems for their clients.

Acute kidney injury following orthotopic heart transplantation in pediatric recipients is often multifactorial, requiring balance of immune suppression, nephrotoxic medication exposure, nutrition, and fluid status. Therapeutic options are often limited by patient size and hemodynamic stability. We describe a four-month, 4.9-kg female bridged by mechanical circulatory support to transplant after failed stage 1 palliation secondary to recurrent aortic stenosis and severe ventricular dysfunction. Posttransplant, kidney injury was managed by transcatheter relief of central obstruction from an anastomotic stricture and continuous renal replacement therapy, allowing uninterrupted immune suppression, medication, and nutrition delivery until sufficient recovery of renal function.

This article examines whether bad upbringing (or what is sometimes called a “rotten social background”) affects just or deserved punishment. There are two possible rationales for this claim. First, it may be argued that an offender’s blameworthiness for his choice to offend is reduced if he had a bad upbringing; second, it may be argued that fairness requires us to impose a less severe punitive burden on an offender with a bad upbringing, even if he is no less blameworthy for his crime. The article rejects both of these rationales.

The benefit-fairness theory of punishment (sometimes referred to simply as the “fairness” theory of punishment), which is one of the most prominent retributive justifications of punishment, appeals to some benefits received by an offender in explaining why it is fair to impose punitive burdens on him. However, many see the two traditional versions of the theory, found in the works by writers such as Herbert Morris, Jeffrie Murphy, and George Sher, as being susceptible to fatal objections. In a recent paper, “Fairness, Political Obligation, and Punishment,” Zachary Hoskins offers a new version of the benefit-fairness theory of punishment. I will highlight his original contribution by showing how his version of the benefit-fairness theory of punishment is different from the traditional versions in such a way that the main objections applying to the traditional versions do not apply to his account. Nonetheless, despite its many virtues, I will argue that Hoskins’s theory fails because it would entail disproportionate punishment.

The utility of hemodynamic ramp studies in single ventricle patients supported by continuous flow left ventricular assist devices (CF-LVADs) is largely unknown. We report the novel use of the hemodynamic ramp test to optimize a 26 year-old Fontan-palliated single-ventricle patient supported with a continuous-flow ventricular assist device (Heartware HVAD). Modest improvements in Fontan hemodynamics resulted in significant and persistent clinical improvement and symptomatic relief.

In this paper, I will critically assess the expressive justification of punishment recently offered by Christopher Bennett in The Apology Ritual and a number of papers. I will first draw a distinction between three conceptions of expression: communicative, motivational, and symbolic. After briefly demonstrating the difficulties of using the first two conceptions of expression to ground punishment and showing that Bennett does not ultimately rely on those two conceptions, I argue that Bennett’s account does not succeed because he fails to establish the following claims: (1) punishment is the only symbolically adequate response to a wrongdoing; and (2) punishment is permissible if it is the only symbolically adequate response to a wrongdoing.

Danon disease (DD) is an X-linked dominant disorder caused by a mutation in the lysosomal-associated membrane protein-2 (LAMP-2) gene coding for the LAMP-2 protein. We report two cases of successful heart transplantation (HT) in adolescent brothers with DD, including one who was bridged to HT for 34 days with a HeartWare left ventricular assist device. In both patients, the post-transplant course was complicated by profound skeletal muscle weakness that resolved with corticosteroid withdrawal. These cases highlight that both HT and ventricular assist device support are feasible in patients with DD. Corticosteroid use may exacerbate skeletal myopathy, and therefore, steroid minimization may be warranted whenever possible.

The case of a 14-year-old female with ectopic atrial tachycardia who had been followed for a history of anxiety and depression is presented. The patient was admitted to the intensive care unit after she attempted suicide, at which point there was electrocardiographic evidence of the atrial arrhythmia. During subsequent invasive electrophysiology study, a focus near the tricuspid annulus was localized and targeted for ablation, followed by resolution of the psychiatric symptoms. The case highlights the overlap between psychiatric complaints and true cardiac arrhythmia. A review of the literature is presented, with a special emphasis on distinguishing these two entities as well as a synopsis of this uncommon arrhythmia in the pediatric population.

Should poverty be a mitigating factor, if it affects neither the strength of temptations to commit a crime an offender faced nor his mental capacity to refrain from committing the crime? I argue that it should, because of distributive justice. I argue for this conclusion in two steps. First, I argue that we can improve distributive justice by mitigating poor offenders. Second, I argue that there are no strong objections against taking into account considerations of distributive justice in the sentencing process. I also compare my argument with an argument made by Jeffrie Murphy and explain how some objections against Murphy’s argument do not apply against my argument.

We investigate finite-volume effects in the hadronic vacuum polarization, with an eye toward the corresponding systematic error in the muon anomalous magnetic moment. We consider both recent lattice data as well as lowest-order, finite-volume chiral perturbation theory, in order to get a quantitative understanding. Even though leading-order chiral perturbation theory does not provide a good description of the hadronic vacuum polarization, it turns out that it gives a good representation of finite-volume effects. We find that finite-volume effects cannot be ignored when the aim is a few percent level accuracy for the leading-order hadronic contribution to the muon anomalous magnetic moment, even when using ensembles with $m_\pi L> 4$ and $m_\pi \sim 200$ MeV., Comment: 17 pages, 5 figures; ChPT result corrected; better agreement between ChPT and lattice data; ref. added

At 2 days of age, a term female newborn infant is evaluated for tachypnea. She was born at 40 weeks’ gestation, with birthweight 4.6 kg, to a 34-year-old G2P2 woman via normal spontaneous vaginal delivery. Maternal history is pertinent for well-controlled gestational diabetes mellitus and hypothyroidism treated with levothyroxine. Prenatal laboratories are significant for group B Streptococcus positivity for which the mother was adequately treated. All other prenatal laboratories are unremarkable. The delivery was complicated by a nuchal cord and apnea requiring positive pressure ventilation for 10 seconds. Apgar scores were 6 at 1 minute and 9 at 5 minutes. A review of her vital signs from the newborn nursery reveal the following: heart rate, 128 beats per minute; respiratory rate, 52 breaths per minute; and oxygen saturation, 89% in room air that had improved without supplemental oxygen. Her respiratory rate is 82 breaths per minute, and pre- and postductal oxygen saturations are 97% in room air. On physical examination, she is consistently tachypneic, as noted by multiple caregivers, with minimal subcostal retractions but without grunting or flaring. The remainder of her examination is within normal limits. Basic metabolic panel, capillary blood gas, and complete blood count are all normal. A chest radiograph is read as unremarkable (Fig 1A). Blood cultures are drawn, but given a low risk for sepsis, antibiotics are not started. A cardiologist is consulted for sustained tachypnea and a new grade I/VI systolic murmur in the left lower sternal border. An echocardiogram …

Several physiologic and pathologic conditions demonstrating extraosseous localization of bone scanning agents have been described, including metastatic calcification of the soft tissues secondary to metabolic disorders, malignancies, and chronic renal failure. However, extraosseous uptake in primary oxalosis has not been documented, although scintigraphic uptake pattern in a patient with primary oxalosis has been described. Oxalosis (Hyperoxaluria) is an autosomal recessive genetic disorder of glyoxylate metabolism. Type 1 (glycolic aciduria) is caused by the deficiency of 2-oxoglutarate; glyoxylate carboligase results in excessive urinary excretion of oxalic, glycolic, and glyoxylic acids

Synovial cell sarcoma, which accounts for much less than 1% of all malignancies, arises from the cells associated with the synovium or the tendon sheath, bursa, or external capsule of the joint. The extremities' periarticular regions are commonly the primary site (94%). Synovial cell sarcoma affects young adults (mean age = 30) and usually spreads by the hematogenous route, while lymphatic spread is uncommon. At the time of initial diagnosis, the vast majority has no detectable distant metastases. However, if metastasis is present, 75% would develop in the lungs, 15% in the regional lymph nodes, 10% in bones. Metastases can appear as calcified nodules in 30–50% of cases. This case presents an unusual appearance of calcification in the right lower abdominal metastatic focus. In addition, calcification of the larger pulmonary metastatic foci were also visualized.

Duff offered an argument for the conclusion that just or legitimate punishment of socially deprived offenders in our unjust society is impossible. One of the claims in his argument is that our courts have the standing to blame an offender only if our polity has the right to do so since our courts are acting as the representatives of, or to use the exact phrases by Duff, “in the name of”, or “on behalf of”, the whole polity. In this paper I will challenge that claim. I will argue that the courts can be seen as acting, not on behalf of the whole polity, but only on behalf of a subset of its citizens, namely, the just citizens (i.e. the citizens who cannot be seen to have wronged the deprived offenders).