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The objective of this research was to analyze the synergy between ecosystem services and beef production through scientific investigations. Therefore, a systematic review of the literature was made from the scientific publications on this subject. The results obtained demonstrate the emergence and exponential growth of this theme in the last decade. In addition, beef production was associated with ecosystem services through four main areas, namely: environmental impacts, land use changes, landscape aspects and institutional environment. In this perspective, it should be noted that the area of environmental impacts is being most explored in the scientific environment, in addition to having a direct influence on the institutional environment through the formation of regulations and indicators that help in the process of evaluating economic and ecological benefits. Thus, the investigations denote the efforts made by the researchers, in order to modify and implement restrictions so that the ecosystem resources are used rationally in the production of cattle. [ABSTRACT FROM AUTHOR]

Classical trajectories have beenintegrated to study the O + ClOreaction, both reactive and vibrational energy transfer processes,for the range of temperatures 100 ≤ T/K ≤500 using momentum Gaussian binning. The employed potential energysurface is the recently proposed single-sheeted double many-body expansionpotential energy surface for the 2A″ ground-stateof ClO2based on multireference ab initio data. A capture-typeregime with a room-temperature rate constant of (17.8 ± 0.5)× 10–12cm3s–1and temperature dependence of k(T/K)/cm3s–1= 22.4 × 10–12× T–0.81exp(−39.2/T) has been found. Although the value reported here is halfof the experimental and recommended one, tentative explanations aregiven. Other dynamical attributes are also examined for the titlereaction, with state-to-all and state-to-state vibrational relaxationand excitation rate constants reported for temperatures of relevancein stratospheric chemistry. [ABSTRACT FROM AUTHOR]

A global single-sheeted double many-bodyexpansion potential energysurface is reported for the ground electronic state of ClO2. The potential energy surface is obtained by fitting 3200 energypoints that map all atom–diatom dissociation channels as wellas all relevant stationary points, including the well-known OClO andClOO structures. The ab initio calculations are obtained at the multireferenceconfiguration interaction level of theory, employing the cc-pVXZ (X= D, T) Dunning basis sets, and then extrapolated to the complete basisset limit with the generalized uniform singlet- and triplet-pair protocol.The topographical features of the novel global potential energy surfaceare examined in detail. [ABSTRACT FROM AUTHOR]

The ClO3 many-body expansion potential energy surface of Farantos and Murrell (Int J Quantum Chem 1978, 14, 659) has been modified along the minimum energy path for the reaction O + OClO → ClO + O2 such as to conform with the available kinetics data. The dynamics of the title reaction is also studied for temperatures of relevance in stratospheric chemistry. Two mechanisms for ClO + O2 formation are identified: (i) direct abstraction of a terminal oxygen atom from the OClO reactant and (ii) formation of an intermediate ClO3 complex followed by dissociation. The novel potential energy surface gives also a good description of the kinetics of the reaction Cl + O3 → ClO + O2. © 2007 Wiley Periodicals, Inc. Int J Chem Kinet 39: 422–430, 2007 [ABSTRACT FROM AUTHOR]

The ClO3 many-body expansion potential energy surface of Farantos and Murrell (Int J Quantum Chem 1978, 14, 659) has been modified along the minimum energy path for the reaction O + OClO → ClO + O2 such as to conform with the available kinetics data. The dynamics of the title reaction is also studied for temperatures of relevance in stratospheric chemistry. Two mechanisms for ClO + O2 formation are identified: (i) direct abstraction of a terminal oxygen atom from the OClO reactant and (ii) formation of an intermediate ClO3 complex followed by dissociation. The novel potential energy surface gives also a good description of the kinetics of the reaction Cl + O3 → ClO + O2. © 2007 Wiley Periodicals, Inc. Int J Chem Kinet 39: 422–430, 2007 [ABSTRACT FROM AUTHOR]

In 68 patients with anorectal malformations cardiovascular anomalies (CVA) were seen in 15 and genitourinary (GU) anomalies in 30. CVA were more frequent (33%) whenever there was a GU anomaly. Ventricular septal defect was the most frequent lesion. All but 1 CVA occurred with type III anorectal malformation. The complexity of the cardiac lesion did not parallel that of the GU anomaly. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a leading cause of death worldwide. TB represents a serious public health threat, and it is characterized by high transmission rates, prevalence in impoverished regions, and high co-infection rates with HIV. Moreover, the serious side effects of long-term treatment that decrease patient adherence, and the emergence of multi-resistant strains of Mycobacterium tuberculosis, the causing agent of TBs, pose several challenges for its eradication. The search for a new TB treatment is necessary and urgent. Dihydroorotate dehydrogenase (DHODH) is responsible for the stereospecific oxidation of (S)-dihydroorotate (DHO) to orotate during the fourth and only redox step of the de novo pyrimidine nucleotide biosynthetic pathway. DHODH has been considered an attractive target against infectious diseases. As a first step towards exploiting DHODH as a drug target against TB, we performed a full kinetic characterization of both bacterial MtDHODH and its human ortholog (HsDHDOH) using both substrates coenzyme Q0 (Q0) and vitamin K3 (K3). MtDHODH follows a ping-pong mechanism of catalysis and shares similar catalytic parameters with the human enzyme. Serendipitously, Q0 was found to inhibit MtDHODH (K I (Q0) = 138 ± 31 μM). To the best of our knowledge, Q0 is the first non-orotate like dihydroorotate-competitive inhibitor for class 2 DHODHs ever described. Molecular dynamics simulations along with in silico solvent mapping allowed us to successfully probe protein flexibility and correlate it with the druggability of binding sites. Together, our results provide the starting point for the design of a new generation of potent and selective inhibitors against MtDHODH., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Dammed rivers lose its natural characteristics of the flow cycle and becomes controlled by the energy demands of the hydroelectric plants. With the connection of the energy-producing plants to a central station in Brazil the situation is aggravated since demands in different regions of the country affect the water flow. Using downstream flow data from the Tucuruí dam over a 50-year period, we tested whether the variation in water flow has changed. We observed an increase of the annual variation of the water flow and the extreme events of flooding at downstream of the dam, indicating the operation of the dam intensified the control of water passage. The study reveals an increase in the variation of water flow in the dam's downstream section following the interconnection of the Tucurui dam with the Central System in 1997. Management strategies for the dam should be considered integrated with the national electricity demand, since distant demands may affect the local environment in question., (© 2023 The Authors.)

The current COVID-19 pandemic demands massive testing by Real-time RT-PCR (Reverse Transcription Polymerase Chain Reaction), which is considered the gold standard diagnostic test for the detection of the SARS-CoV-2 virus. However, the virus continues to evolve with mutations that lead to phenotypic alterations as higher transmissibility, pathogenicity or vaccine evasion. Another big issue are mutations in the annealing sites of primers and probes of RT-PCR diagnostic kits leading to false-negative results. Therefore, here we identify mutations in the N (Nucleocapsid) gene that affects the use of the GeneFinder COVID-19 Plus RealAmp Kit. We sequenced SARS-CoV-2 genomes from 17 positive samples with no N gene detection but with RDRP (RNA-dependent RNA polymerase) and E (Envelope) genes detection, and observed a set of three different mutations affecting the N detection: a deletion of 18 nucleotides (Del28877-28894), a substitution of GGG to AAC (28881-28883) and a frameshift mutation caused by deletion (Del28877-28878). The last one cause a deletion of six AAs (amino acids) located in the central intrinsic disorder region at protein level. We also found this mutation in 99 of the 14,346 sequenced samples by the Sao Paulo state Network for Pandemic Alert of Emerging SARS-CoV-2 variants, demonstrating the circulation of the mutation in Sao Paulo, Brazil. Continuous monitoring and characterization of mutations affecting the annealing sites of primers and probes by genomic surveillance programs are necessary to maintain the effectiveness of the diagnosis of COVID-19.

Neospora caninum causes heavy losses related to abortions in bovine cattle. This parasite developed a complex defense redox system, composed of enzymes as glutathione reductase (GR). Methylene blue (MB) impairs the activity of recombinant form of Plasmodium GR and inhibits the parasite proliferation in vivo and in vitro. Likewise, MB and its derivatives inhibits Neospora caninum proliferation, however, whether the MB mechanism of action is correlated to GR function remains unclear. Therefore, here, N. caninum GR (NcGR) was characterized and its potential inhibitors were determined. NcGR was found in the tachyzoite cytosol and has a similar structure and sequence compared to its homologs. We verified the in vitro activity of rNcGR (875 nM) following NADPH absorbance at 340 nM (100 mM KH 2 PO 4 , pH 7.5, 1 mM EDTA, ionic strength: 600 mM, 25 °C). rNcGR exhibited a Michaelian behavior (K m(GSSG) :0.10 ± 0.02 mM; k cat(GSSG) :0.076 ± 0.003 s -1 ; K m(NADPH) :0.006 ± 0.001 mM; k cat(NADPH) : 0.080 ± 0.003 s -1 ). The IC 50 of MB,1,9-dimethyl methylene blue, new methylene blue, and toluidine blue O on rNcGR activity were 2.1 ± 0.2 μM, 11 ± 2 μM, 0.7 ± 0.1 μM, and 0.9 ± 0.2 μM, respectively. Our results suggest the importance of NcGR in N. caninum biology and antioxidant mechanisms. Moreover, data presented here strongly suggest that NcGR is an important target of phenothiazinium dyes in N. caninum proliferation inhibition., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The interruption of the maternal-filial bond in young calves can alter the physiological responses due to increased stress at this moment. Therefore, we aimed to analyze the association between age at weaning and the immune responses of 64 beef calves weaned abruptly. The animals were distributed in three weaning (W) treatments: hyper-early (W30), early (W75) and conventional (W180). The treatments agree with the weaning ages used in cow-calf systems in South America. Blood samples were collected of all experimental animals on the day of weaning and days 1, 2 and 7 post-weaning day of the three treatments. Blood samples were used to analyze hematological variables, total plasma proteins (TPP), fibrinogen, serum amyloid A protein (SAA) and cortisol. The variables analyzed were influenced by the sampling day (P < 0.001) and the calf gender (P < 0.05), and an interaction between treatment x sampling day was observed. Over the study period, high serum cortisol levels were observed for W30 calves. The serum amyloid A protein was significantly influenced by sampling day. When compared to W180 calves, W30 and W75 animals showed prolonged concentrations in plasma fibrinogen. In addition, they presented neutrophilia and lymphopenia during the 180-187 days period, which resulted in a greater neutrophil:lymphocyte ratio (N:L ratio). Calf gender resulted in changes in the number of blood leukocytes (P < 0.05). This result provides an alert for weaning at an early age, indicating that different management strategies must be tested to minimize physiological instabilities in critical periods of the life of animals., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Assessment of target druggability guided by search and characterization of hot spots is a pivotal step in early stages of drug-discovery. The raw output of FTMap provides the data to perform this task, but it relies on manual intervention to properly combine different sets of consensus sites, therefore allowing identification of hot spots and evaluation of strength, shape and distance among them. Thus, the user's previous experience on the target and the software has a direct impact on how data generated by FTMap server can be explored. DRUGpy plugin was developed to overcome this limitation. By automatically assembling and scoring all possible combinations of consensus sites, DRUGpy plugin provides FTMap users a straight-forward method to identify and characterize hot spots in protein targets. DRUGpy is available in all operating systems that support PyMOL software. DRUGpy promptly identifies and characterizes pockets that are predicted by FTMap to bind druglike molecules with high-affinity (druggable sites) or low-affinity (borderline sites) and reveals how protein conformational flexibility impacts on the target's druggability. The use of DRUGpy on the analysis of trypanothione reductases (TR), a validated drug target against trypanosomatids, showcases the usefulness of the plugin, and led to the identification of a druggable pocket in the conserved dimer interface present in this class of proteins, opening new perspectives to the design of selective inhibitors., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Cellular agriculture has been considered a mechanism to enable the generation of animal protein in the laboratory. Notwithstanding, this emerging technology, still on an experimental scale, is imbued with speculations, paradoxes, and ambiguities. So, the objective of this research was to analyze how synthetic meat is considered in the scientific context from the perspective of cellular agriculture considering its trajectory and its approaches. For this, we used a systematic review of the literature with detailed analysis of 109 manuscripts and application of network analysis of co-citations and predominance. This paper has constructed a historical overview of the conceptual evolution of science concerning synthetic meat from its emergence to the present day. We also verified and categorized the research about synthetic meat into three distinct approaches: (1) environmental and health; (2) technical and economic feasibility of the production process; and (3) social and market. This research maximizes the understanding of synthetic meat and its stage of technological and economic development to make commercial production feasible. Aside from that, it has brought insights about synthetic meat and this knowledge can be used by the conventional meat industries., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Food Scientists & Technologists (India) 2019.)

A 36-year-old woman was seen with complaints of exertional chest pain and shortness of breath. Her medical history included atrial fibrillation and diabetes. Physical examination was unremarkable except for an irregular cardiac rhythm. Myocardial perfusion imaging revealed the presence of a large area of infarction involving the entire anterior and apical walls and part of the anteroseptal wall with minimal periinfarct ischemia. Computed tomography coronary angiogram revealed an anomalous left main coronary artery arising from the main pulmonary artery. Right and left heart catheterizations demonstrated moderate pulmonary hypertension with a slight step-up in oxygen saturation between the right ventricle and main pulmonary artery. Coronary angiography showed a large tortuous right coronary artery with collaterals to the left anterior descending artery that drained into the main pulmonary artery. She was referred for surgery. This case demonstrates a rare coronary artery anomaly in an adult where survival is dependent on collateral circulation., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aims: Metabolic syndrome (MetS) is often accompanied by pro-oxidative and pro-inflammatory processes. Lifestyle modification (LiSM) may act as primary treatment for these processes. This study aimed to elucidate influencing factors on changes of malondialdehyde (MDA) and C-reactive protein (CRP) concentrations after a LiSM intervention., Methods: Sixty subjects (53 yrs, 84% women) clinically approved to attend a 20 weeks LiSM-program were submitted to weekly nutritional counseling and physical activities combining aerobic (3 times/week) and resistance (2 times/week) exercises. Before and after intervention they were assessed for anthropometric, clinical, cardiorespiratory fitness test (CRF) and laboratory markers. Statistical analyses performed were multiple regression analysis and backward stepwise with p<0.05 and R(2) as influence index., Results: LiSM was responsible for elevations in CRF, healthy eating index (HEI), total plasma antioxidant capacity (TAP) and HDL-C along with reductions in waist circumference measures and MetS (47-40%) prevalence. MDA and CRP did not change after LiSM, however, we observed that MDA concentrations were positively influenced (R(2)=0.35) by fasting blood glucose (β=0.64) and HOMA-IR (β=0.58) whereas CRP concentrations were by plasma gamma-glutamyltransferase activity (β=0.54; R(2)=0.29)., Conclusions: Pro-oxidant and pro-inflammatory states of MetS can be attenuated after lifestyle modification if glucose metabolism homeostasis were recovered and if liver inflammation were reduced, respectively., (Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Low-grade chronic systemic inflammation is often associated with chronic non-communicable diseases, and its most frequently used marker, the C-reactive protein (CRP), has become an identifier of such diseases as well as an independent predictor for cardiovascular disorders and mortality. CRP is produced in response to pro-inflammatory signaling and to individual and behavioral factors, leading to pathological states. The aim of this study was to rank the predicting factors of high CRP concentrations in free-living adults from a community-based sample. We evaluated 522 adults (40-84 years old; 381 women) for anthropometric characteristics, dietary intake, clinical and physical tests, and blood analysis. Subjects were assigned to groups, according to CRP concentrations, as normal CRP (G1; <3.0 mg/L; n = 269), high CRP (G2; 3.0-6.0 mg/L; n = 139), and very high CRP (G3; >6.0 mg/dL; n = 116). Statistical comparison between groups used one-way ANOVA or Kruskal-Wallis tests, and prediction of altered values in increasing CRP was evaluated by proportional hazard models (odds ratio). CRP distribution was influenced by gender, body mass index, body and abdominal fatness, blood leukocytes, and neutrophil counts. The higher CRP group was discriminated by the above variables in addition to lower VO(2max), serum metabolic syndrome components (triglycerides, glucose, and HDL cholesterol), higher insulin, homeostasis assessment of insulin resistance, uric acid, gamma-GT, and homocysteine. After adjustments, only fatness, blood leukocytes, and hyperglycemia remained as independent predictors for increased serum CRP concentrations. Intervention procedures to treat low-grade chronic inflammation in overweight women would mainly focus on restoring muscle mass and functions in addition to an antioxidant-rich diet.

Objective. To compare values from predictive equations of resting energy expenditure (REE) with indirect calorimetry (IC) in overweight and obese adults. Methods. Eighty-two participants aged 30 to 60 years old were retrospectively analyzed. The persons had a body mass index ≥25 kg/m(2). REE was estimated by IC and other five equations of the literature (Harris and Benedict, WHO1, WHO2, Owen, Mifflin). Results. All equations had different values when compared to those of IC. The best values were found by Harris and Benedict, WHO1, and WHO2, with high values of intraclass correlation coefficient and low values of mean difference. Furthermore, WHO1 and WHO2 showed lower systematic error and random. Conclusion. No predictive equations had the same values of REE as compared to those of indirect calorimetry, and those which least underestimated REE were the equations of WHO1, WHO2, and Harris and Benedict. The next step would be to validate the new equation proposed.

Background: Brain hypoperfusion during neurocardiogenic syncope develops as a consequence of hypotension and bradycardia. Transcranial Doppler indicates that an increase in cerebral vascular resistance occurs before or during the loss of consciousness., Objective: Cerebral blood flow velocity was studied during tilt table testing in pediatric patients with neurocardiogenic syncope. We assessed whether a critical reduction in flow velocity (>40%) was predictive of the presyncopal manifestations during the test., Methods: A 2-MHz transcranial Doppler measured blood flow velocity in the right middle cerebral artery in 27 pediatric patients (ages, 8 to 18 years) during a three-stage 80 degrees tilt table test protocol. A positive test required development of syncope or presyncope with at least 30% decrease in systolic blood pressure and/or heart rate relative to preceding values. Patients were divided into: group I (isoproterenol-induced positive tests), group II (positive without isoproterenol), and group III (negative tests)., Results: Within the first 3 minutes of the upright position mean cerebral blood flow velocity in groups I, II, and III decreased by 18%, 29%, and 17%, respectively, as the systolic and diastolic blood pressures showed only minimal changes. A decreased mean blood flow velocity of 48% and 45% and an increase in resistance index of 42% and 26% from supine values in the absence of hypotension, were detected in groups I and II at 46 seconds (range, 30-120 seconds) and 50 seconds (range, 0-300 seconds) before any clinical symptom (presyncope latency). Mean blood flow velocity during presyncope decreased by 58% and 59%, whereas resistance index was double. A significant correlation (rho = -0.62) was found between presyncope latency and the decreased mean cerebral blood flow velocity. Similar blood flow velocity changes were not detected in group III., Conclusion: A sustained reduction >40% in mean cerebral blood flow velocity in the absence of hypotension always resulted in presyncopal or syncopal manifestations. It seems that once this critical threshold is identified during the tilt table testing, supine position may be resumed several seconds before the clinical manifestations of syncope.

Transcranial Doppler (TCD) was used to evaluate brain circulation during cardiac catheterizations in 32 children requiring pulmonary (n=10) or aortic balloon dilatations (n=2), ductus arteriosus coil insertions (n=5), or angiography (n=15). Cerebral blood flow velocity (CBFV) in the middle cerebral artery was measured before (baseline), during, and after each procedure (mean+/-95%ci). High-intensity transient signals (HITS) were also detected during these maneuvers. Balloon angioplasty decreased CBFV by 63+/-11% from baseline (P < 0.01). Shorter durations of the inflation cycle resulted in earlier CBFV recovery (r=0.78). During angiography, CBFV increased by 11+/-4% (P < 0.01) in all except one case that showed retrograde diastolic flow. Mean total HITS count was 44 (95%ci.limits: 27,74). These signals were more frequently found in septal defects or systemic arterial manipulations. Pediatric cardiac catheterization may impose transient fluctuations in brain perfusion as indicated by TCD, but their clinical implications are uncertain. CBFV changes during balloon angioplasty emphasize the importance of rapid inflation/deflation cycles. TCD can monitor such changes and evaluate preventive measures.

Radiofrequency (RF) catheter ablation has been widely used in the treatment of cardiac arrhythmias. In atrioventricular nodal reentrant tachycardia (AVNRT), the experience has been predominantly in adults. The cardiac electrophysiological records of 18 consecutive children undergoing RF catheter AV node modification for AVNRT were reviewed. The patients (10 females, 8 males) were 8.2-17.9 years of age (mean 13.6 +/- 3.0), weight 15.2-88.1 kg (mean 52.2 +/- 20.8), and height 103-190 cm (mean 157.1 +/- 21.7). Thirteen were on antiarrhythmic medications (1-3, average 1.5 drugs/day). All drugs were discontinued 48 hours prior to the ablations. The procedures were performed under sedation and local anesthesia. Pre- and post-AV node modification electrophysiological studies were performed in all procedures. The 18 patients underwent a total of 25 procedures (1.39 +/- 0.61 per patient): the anterior approach aimed at the antegrade fast pathway in the first four patients and the posterior approach aimed at the slow pathway in the remainder. The number of energy applications was 8-54 (19.8 +/- 10.7) per procedure. The maximum energy used in each procedure was 30-50 watts (33.8 +/- 8.4). The average energy was 24-50 watts (33.0 +/- 6.8). The fluoroscopy time was 7.1-73.4 minutes (29.9 +/- 20.0) per procedure, for a total catheterization time of 228-480 minutes (300.3 +/- 59.1). Preablation spontaneous or induced AVNRT (cycle length 310.4 +/- 55.0 msec) was seen in all except one who had the arrhythmia (cycle length 270 msec) on surface ECG.(ABSTRACT TRUNCATED AT 250 WORDS)

Neonatal orthotopic heart transplantation is an attractive primary surgical therapy for severe uncorrectable congenital heart defects such as variants of the hypoplastic left heart syndrome. Aortic arch reconstruction is frequently required to repair the hypoplastic aortic arch and the coarctation at the time of graft implantation. Residual coarctation of the aorta after neonatal heart transplantation for such a condition has satisfactorily been treated with percutaneous balloon dilatation. We describe the successful surgical repair of a recurrent coarctation of the aorta via a sternotomy in a 2-year-old patient who had previously undergone neonatal orthotopic heart transplantation. Postoperative periodic investigations have not shown any evidence of obstruction across the site of the primary end-to-end anastomosis.

Two patients presenting with pulmonary venous baffle obstruction following Mustard or Senning repair of transposition of the great arteries were successfully treated with percutaneous balloon dilatation. At the time of baffle dilatation, a significant systemic to pulmonary venous Mustard baffle leak was successfully closed with a Rashkind ductal occluder device. Specific features pertaining to the morphology of the baffle defect that allowed successful catheter occlusion are discussed and compared to that found in a Senning patient. The important adjunctive role of transoesophageal echocardiography within the catheterization laboratory is emphasized.

Heart murmurs, most of them innocent, are the most common reason for referrals to a pediatric cardiologist. In the evaluation of murmurs, the electrocardiogram and echocardiogram are often included. The purpose of this study was to determine the utility of these examinations in the initial assessment of heart murmurs in children and adolescents. In a prospective series of 161 patients, the clinical diagnosis of heart murmurs by a pediatric cardiologist was compared with that obtained after electrocardiogram and echocardiogram (two-dimensional, M-mode, Doppler, and color-Doppler). On the basis of the clinical diagnosis the patients were classified as having "innocent murmur," "pathologic murmur," or "possible pathologic murmur." A total of 161 patients (51% males), aged 1 month to 17 years (median 3.2 years), were studied. After electrocardiogram, no diagnosis was changed. After echocardiogram, the clinical diagnosis of innocent murmur in 109 patients changed in 2 to pathologic (small ventricular septal defect 1, small atrial septal defect 1); pathologic murmur in 46 changed to innocent in 3 and possible pathologic in 2; and possible pathologic in 6 changed to innocent in 3 and to pathologic in 2. The clinical examination by an experienced pediatric cardiologist is an accurate means of assessing newly referred patients with murmurs. The clinical examination had a sensitivity of 96%, specificity of 95%, positive predictive value of 88%, and negative predictive value of 98%. The electrocardiogram, unlikely to disclose any unsuspected heart disease, may assist in reaching the lesion-specific diagnosis when there is underlying pathology. Echocardiography, although diagnostic when heart disease is suspected, is unnecessary in pediatric patients with clinically diagnosed innocent heart murmurs.

A 14-year-old male presented with a one week history of weakness, lightheadedness and vomiting. Bilateral pleural effusions were evident on chest radiography; electrocardiogram revealed decreased voltages. Echocardiogram, abdominal ultrasound and magnetic resonance imaging revealed a mass in an hepatic vein and the inferior vena cava extending up to and filling the right atrium. Under deep hypothermia and extracorporeal circulation the mass was removed en bloc. It originated from the hepatic vein. Pathology revealed a smooth muscle tumour intermediate between benign and malignant (atypical leiomyoma). This is the first reported pediatric primary leiomyoma of the hepatic vein. It caused the Budd-Chiari syndrome, a rare pediatric entity.

We collected data on 930 neonates with structural congenital heart disease seen during 1975-1977 at the existing pediatric cardiac referral and treatment centers in Ontario. Estimates were made of unmet need for pediatric cardiology services in Ontario. The data showed that a number of counties had significantly low referral rates and that at least 25% of the newborns with severe structural heart disease (that is, 75 newborns each year) were not seen by pediatric cardiologists, although the children would benefit from prompt assessment and rapid treatment under specialist supervision.