Exercise stress testing (EST) identifies functional abnormalities that may manifest only during physiologic stress to the heart. This may have significant prognostic value in identifying latent conduction abnormalities in asymptomatic patients with myotonic dystrophy type 1 (MD1), who may benefit from prophylactic permanent pacemaker (PPM) implantation.

We report the case of a patient with MD1 with a 5-month history of atypical left-sided chest pain. Her baseline electrocardiogram (ECG) showed sinus rhythm and variable PR interval prolongation (206-220 ms) without symptoms of cardiac conduction disease. Routine blood tests and cardiac investigations including a 24-h ECG monitoring, echocardiogram, and a cardiac magnetic resonance imaging scan, revealed no abnormalities. To investigate her chest pain and to determine the need for prophylactic PPM implantation, EST and an electrophysiological study were performed. Exercise testing revealed minimal PR shortening (PR = 200 ms) at peak exercise and paradoxicalonduction abnormalities in MD1 patients without any specific symptoms of bradycardia, which warrant further invasive electrophysiological studies (EPS).

The patient is a 15-year-old male with situs inversus, dextrocardia, bilateral superior caval veins, atrioventricular discordance with a single outlet, large perimembranous ventricular septal defect, aortic override, pulmonary atresia, and right aortic arch. The complex anatomy with a Ventricular Septal Defect (VSD) distant from the aorta (unsuitable for baffling to the aorta) meant he was unsuitable for biventricular repair and proceeded down a univentricular palliation pathway.

Post-total cavopulmonary connection his clinical course was uneventful until the age of 5 when he developed fatigability with desaturation. An accessory hepatic vein was surgically banded with improved saturations and exercise tolerance. At the age of 15, cardiovascular magnetic resonance (CMR) was performed to investigate borderline saturations and as workup for transition to adult services. Cardiovascular magnetic resonance and cardiac computed tomography (CT) imaging demonstrated an eccentric thrombus causing stenosis of the extracardiac conduit and a thrombus outside of the lumen contained by the thin outer membrane of the Gore-Tex conduit. Collateralization suggested this was longstanding. Cardiac catheterization demonstrated a 4 mm × 6 mm stenosis at the junction of the conduit with the pulmonary arteries. The region was successfully balloon dilated and stented with a 34 mm-long Cheatham Platinum stent, with no complications.

To date, this is the first documented case of a dissecting thrombus of a Gore-Tex graft in the literature. This case emphasizes the need for anticoagulation and serial cross-sectional imaging (CT or CMR) in Fontan patients with prosthetic grafts throughout a patients’ lifetime.

To date, this is the first documented case of a dissecting thrombus of a Gore-Tex graft in the literature. This case emphasizes the need for anticoagulation and serial cross-sectional imaging (CT or CMR) in Fontan patients with prosthetic grafts throughout a patients’ lifetime.

At present, understanding the synergies between the Surface Urban Heat Island (SUHI) phenomenon and extreme climatic events entailing high mortality, i.e., heat waves, is a great challenge that must be faced to improve the quality of life in urban zones. The implementation of new mitigation and resilience measures in cities would serve to lessen the effects of heat waves and the economic cost they entail. In this research, the Land Surface Temperature (LST) and the SUHI were determined through Sentinel-3A and 3B images of the eight capitals of Andalusia (southern Spain) during the months of July and August of years 2019 and 2020. The objective was to determine possible synergies or interaction between the LST and SUHI, as well as between SUHI and heat waves, in a region classified as highly vulnerable to the effects of climate change. For each Andalusian city, the atmospheric variables of ambient temperature, solar radiation, wind speed and direction were obtained from stations of the Spanish State Meteorol available at 10.1007/s41748-021-00268-9.

The online version contains supplementary material available at 10.1007/s41748-021-00268-9.This paper explores the relationship between the industry collaborations of grant applicant teams and the outcomes of a multistage grant evaluation process. We studied this relationship by focusing on two possible channels of impact of industry engagement-team diversity (or the diversity effect) and prior collaboration experience (or the experience effect)-and examined their influence on the evaluators’ decision by using the proxies of direct industry engagement (i.e., the involvement of a company-affiliated researcher in the grant applicant team) and indirect industry engagement (i.e., joint publications with a company-affiliated researcher prior to the grant application), respectively. We analyzed data extracted from the application and reviewed materials of a multidisciplinary, pan-European research funding scheme-European Collaborative Research (EUROCORES)-for the period 2002-2010 and conducted an empirical investigation of its three consecutive grant evaluation stages at the team level. We found that teams presenting an indirect engagement were more likely to pass the first stage of selection, whereas no significant relationships were found at any of the three evaluation stages for teams presenting a direct engagement. Our findings point to the heterogeneity of the decision-making process within a multistage grant evaluation scheme and suggest that the policy objective of fostering university-industry collaboration does not significantly impact the funding process.The cultivars of the common lilac (Syringa vulgaris) grown in the south of the Russian Far East are not always winter-hardy and are often damaged by fungal diseases due to a very humid climate. A promising trend in the selective breeding of lilacs in Russia is the creation of new breeding material based on the gene pool of the broadleaf lilac (S. oblata) and its hybrids in order to introduce valuable adaptive traits into cultivars. The present work aimed to identify the traits of leaf anatomy in species and cultivars of Syringa resistant and susceptible to Pseudocercospora lilacis, the causative agent of brown leaf spot disease. The study was carried out on the living collection of the Botanical Garden-Institute, Far Eastern Branch, Russian Academy of Sciences (Vladivostok). The leaf anatomical structure of two Syringa species showing different degrees of resistance to P. lilacis in the monsoon climate of the Far East (resistant S. oblata and weakly resistant S. vulgaris, and also their hybrid cultivars) has ernal plant.The purpose of the present study was to estimate the effect of preoperative fracture tilt and to scrutinize the effect of anterior tilt on the risk of treatment failure in patients with Garden Type-I and II femoral neck fractures that are treated with internal fixation.

A retrospective multicenter study was performed on a consecutive series of patients ≥60 years of age who had undergone primary internal fixation for the treatment of Garden Type-I and II femoral neck fractures. The study included 1,505 patients with a minimum follow-up of 2 years. Radiographic assessments encompassed preoperative and postoperative tilt, implant inclination, and treatment failure. Data on reoperation and mortality were collected. The risk of treatment failure was assessed with use of Cox proportional hazard regression analysis.

The study comprised 1,505 patients (71% female) with a median age of 81 years (range, 60 to 108 years). Overall, 234 patients (16%) were classified as having a treatment failure and 251 patients (17%) underwent reoperation. A preoperative anterior tilt of >10° and a posterior tilt of >20° were predictors of treatment failure and reoperation, respectively. Treatment failure occurred in 74 (25%) of 301 patients with a posterior tilt of >20° and in 17 (43%) of 40 patients with an anterior tilt of >10°.

This multicenter cohort study identified a subgroup of patients with Garden Type-I and II femoral neck fractures with an anterior tilt of >10° as having high treatment failure rates and major reoperation rates comparable with those associated with displaced femoral neck fractures. A preoperative posterior tilt of >20° increases the risk of treatment failure, and the potential benefit of arthroplasty in this subgroup of patients remains to be further investigated.

Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.

Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.In this observational study, we describe the medium-term outcomes of total joint arthroplasty (TJA) in human immunodeficiency virus (HIV)-positive patients in Malawi, a low-income country. With a high prevalence of HIV and increasing arthroplasty rates in low and middle-income countries, understanding the outcomes of TJA in this unique cohort of patients is essential to ensure that surgical practice is evidence-based.

Data for all HIV-positive patients who had TJA from January 2005 to March 2020 were extracted from the National Arthroplasty Registry of the Malawi Orthopaedic Association (NARMOA). From January 2005 to March 2020, a total of 102 total hip arthroplasties (THAs) and 20 total knee arthroplasties (TKAs) were performed in 97 patients who were HIV-positive and without hemophilia or a history of intravenous drug use. The mean length of follow-up was 4 years and 3 months (range, 6 weeks to 15 years) in the THA group and 4 years and 9 months (range, 6 weeks to 12 years) in the TKA group. The mean patieut hemophilia or a history of intravenous drug use, who have had TJA in a low-income country. This study demonstrated good medium-term results among HIV-positive patients undergoing TJA, low complication rates, and improvements in patient-reported outcome measures.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.The COVID-19 pandemic created an unprecedented challenge for orthopaedic surgery residency applicants when away rotations were canceled and interviews were held virtually. The authors hypothesized that (1) Instagram would have more total social media accounts compared with Twitter or Facebook, (2) most social media accounts on all platforms would be created during 2020, and (3) the average number of Instagram followers would be higher among highly ranked programs.

A list of Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs (n = 202) that were ranked by reputation was acquired from Doximity. Public Instagram, Facebook, and Twitter profiles of orthopaedic surgery residency programs were identified through a manual search. Variables assessed on each social media platform were all available summary statistics provided by the social media platform. Instagram accounts were categorized into 5 tiers based on numeric reputation ranking, with 40 programs in each tier (except tier 5 with 42 programs).