These data are discussed in relation to the treatment of patients

These data are discussed in relation to the treatment of patients with suspected ureteral dysfunction using Ca entry blockers.”
“To GSK872 in vitro assess cerebral functional asymmetry for accessing the meaning of emotional words, native English speakers were asked to make lexical decisions to emotional words,

neutral words and nonwords briefly flashed in their left or right visual field, that is, perceived by their right or left visual cortex, respectively. Emotionally negative words had an overall probability of occurrence of 12.5% in each visual field and were expected to elicit a P3b event-related potential modulation indexing shifts of attention. Emotionally negative words elicited a P3b when perceived by the left visual cortex but failed to

trigger such attention-related response when perceived click here by the right hemisphere. The results suggest relative insensitivity on the part of the right hemisphere in registering the negative emotional valence of written words.”
“The ketogenic diet, a high-fat diet, is a therapeutic alternative in the treatment of refractory epilepsy, especially in children. However, there are concerns that a high-fat diet may influence the normal development of the central nervous system and cognition. In this study we investigated the influence of ketogenic diet on adult neurogenesis in the dentate gyrus. Rats were provided with either a high-fat diet (80% fat) or a standard rat diet (5% fat) Exoribonuclease ad libitum for 4 weeks. In both female and male rats, the amounts of bromodeoxyuridine immunoreactive cells in the dentate gyrus were the same in the different groups. Our results suggest that the ketogenic diet does not disturb the neurogenesis in the rat dentate gyrus.”
“Axonal outgrowth is a prerequisite

for the development of the most complex organ, the brain. It depends partially on the attachment of sialic acid on glycans of (sialo)-glycoproteins expressed on the plasma membrane. In our study, we showed that nerve growth factor-induced neurite outgrowth of PCl2-cells enhances the expression of UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine-kinase (GNE), the key enzyme for the biosynthesis of sialic acid. Furthermore, we could show that overexpression of GNE induces neurite outgrowth in PC12 cells. The neurite-outgrowth promoting activity of overexpressed GNE, however, does not lead to an increased biosynthesis of sialic acid. These data suggest a novel role of GNE during neurite outgrowth, which is independent to its specific enzymatic activity.”
“This study aimed to clarify the effects of inescapable and escapable stressors on behavior and interleukin-2 (IL-2) levels in the brain.

This is consistent with the predicted mobility of the amino termi

This is consistent with the predicted mobility of the amino terminus that may bring the amino groups within 19 angstrom of one another in solution. These technical improvements allow this method to be used for investigating protein-protein interactions in complex biological samples.”
“Consolidation and reconsolidation are phases of memory stabilization that diverge slightly. Noradrenaline is known to influence both processes, but the relative contribution of alpha

1- and beta-adrenoceptors is unclear. The present study sought to investigate this matter by comparing their recruitment to consolidate and/or reconsolidate a contextual fear memory trace under enhanced noradrenergic activity induced by yohimbine. We report that this alpha 2-adrenoceptor antagonist was able to potentiate fear memory trace consolidation or reconsolidation when administered this website immediately after acquisition https://www.selleckchem.com/products/VX-809.html or retrieval, respectively, resulting in increased freezing expression. In either case,

generalization of this response to an unpaired context was also seen when it achieved a ceiling level in the paired context. These effects endured for over 7 d and relied on action at central rather than peripheral sites, but were prevented when a memory trace was not acquired, when memory reactivation was omitted, or when administration of yohimbine was delayed until 6 h after acquiring or retrieving the memory trace. The beta-adrenoceptor antagonist propranolol was able to prevent the above-mentioned effects of yohimbine, while pretreatment with the alpha 1-adrenoceptor antagonist prazosin blocked only its facilitating effects on memory reconsolidation. These results

highlight a differential participation of alpha 1- and beta-adrenoceptors in fear memory processing. Moreover, it was shown that the alpha 2-adrenoceptor agonist clonidine, as opposed to yohimbine, mitigates fear expression by weakening memory consolidation or reconsolidation.”
“Purpose: The 20S proteasome is a multicatalytic protein complex, which plays a major role in intracellular protein degradation. In mammalian cells, it consists of 28 subunits arranged in four stacked rings (alpha 1-7 beta 1-7 Acetophenone beta 1-7 alpha 1-7). The aim of this study is to characterize and compare subunit composition and heterogeneity (or subtypes) of the 20S proteasome from four human pancreatic cancer cell lines.

Experimental design: To study subunit compositions and heterogeneity of 20S proteasome from human pancreatic cancer cell lines, in the present study, 20S proteasome from four different pancreatic cancer cell lines (SW1990, a human exocrine adenocarcinoma, derived from spleen metastasis; PANC-1, a human ductal carcinoma in situ; BxPC-3, a human ductal carcinoma in situ; and CFPAC-1, a human ductal adenocarcinoma, derived from liver metastasis) were subjected to a gel-based proteomics analysis, respectively.

75 (95% CI 0 69-0 81) Given the prespecified constraint of achie

75 (95% CI 0.69-0.81). Given the prespecified constraint of achieving at least 85% sensitivity, our model led to the clinical CP-690550 solubility dmso decision rule, for children with a first febrile urinary tract infection cystography should be performed in cases with ureteral

dilatation and serum procalcitonin level 0.17 ng/ml or higher, or without ureteral dilatation (ie ureter not visible) when serum procalcitonin level is 0.63 ng/ml or higher. The rule had 86% sensitivity (95% CI 74-93) with 47% specificity (95% CI 42-51). Internal cross-validation produced 86% sensitivity (95% CI 79-93) and 43% specificity (95% CI 39-47).

Conclusions: A clinical decision rule was derived to enable a selective approach to cystography in children with urinary tract infection. The rule predicts high grade vesicoureteral reflux with approximately 85% sensitivity and avoids half of the cystograms that do not find reflux grade III or higher. Further validation is needed before its widespread use.”
“Although established smokers have a very regular pattern of smoking behavior, converging lines of evidence suggest that the escalation of smoking behavior is a critical Selleckchem TH-302 factor in the development of dependence. However, the neurobiological mechanisms that underlie the escalation

of smoking are unknown, because there is no animal model of the escalation of nicotine intake. On the basis of the pattern of smoking behavior in humans and presence of monoamine oxidase inhibitors in tobacco smoke, we hypothesized that the escalation of nicotine intake may only occur when animals are given extended-access (21 h per day) self-administration sessions after repeated periods of abstinence (24-48 h), and after chronic inhibition of monoamine oxidase using phenelzine sulfate. Intermittent access (every Docetaxel chemical structure 24-48 h) to extended nicotine self-administration produced a robust escalation of nicotine intake, associated with increased responding under fixed- and progressive-ratio schedules of reinforcement, and increased somatic signs of withdrawal. The escalation of nicotine intake

was not observed in rats with intermittent access to limited (1 h per day) nicotine self-administration or daily access to extended (21 h per day) nicotine self-administration. Moreover, inhibition of monoamine oxidase with daily administration of phenelzine increased nicotine intake by similar to 50%. These results demonstrate that the escalation of nicotine intake only occurs in animals given intermittent periods of abstinence with extended access to nicotine, and that inhibition of monoamine oxidase may contribute to the escalation of smoking, thus validating both an animal model of the escalation of smoking behavior and the contribution of monoamine oxidase inhibition to compulsive nicotine-seeking. Neuropsychopharmacology (2012) 37, 2153-2160; doi:10.1038/npp.2012.


“BACKGROUND AND IMPORTANCE: We describe an unusual present


“BACKGROUND AND IMPORTANCE: We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute intracranial hematoma between the dural layers associated with an acute spinal epidural hematoma descending to L1.

CLINICAL PRESENTATION: A 35-year-old woman presented 3 hours

after ictus learn more with a postcoital headache, neck stiffness, and bilateral abducens cranial nerve palsy. No other neurological deficits were present. Clinically, she had a subarachnoid hemorrhage World Federation of Neurosurgical Societies grade 1. CT scan demonstrates an acute subdural hematoma, extending from the right parasellar region, around the clivus, tentorium, and falx. Angio-CT showed a posterior communicating artery aneurysm and an anterior communicating artery aneurysm and an extension of the hematoma to the cervical spine. This justified a spinal and cerebral MRI that confirmed an extension of the hematoma to the epidural CFTRinh-172 chemical structure space

at the cervical, thoracic, and lumbar levels. Three-dimensional digital subtraction angiography confirmed aneurysms on the right posterior communicating artery and on the anterior communicating artery. Both aneurysms were completely occluded by coiling. With reference to the concept of the cranial subdural compartment described in studies conducted using an electron microscope, this group of hematomas was classified as interdural.

CONCLUSION: Ruptured aneurysm of the posterior communicating artery may cause cranial acute interdural hematoma with a typical subarachnoid hemorrhage clinical presentation, and it rarely can extend to spinal epidural space.”
“The genetic elements of herpesvirus origins of lytic replication have been characterized in detail; however, much remains to be elucidated concerning their functional role in replication Methocarbamol initiation. In the case of the Epstein-Barr virus (EBV), we have found that in addition to the two well-defined critical elements required for lytic replication (the upstream and downstream essential

elements, UEE and DEE), the origin of lytic replication (OriLyt) also requires the presence of a GC-rich RNA in cis. The BHLF1 transcript is similar to the essential K5 transcript identified at the Kaposi’s sarcoma-associated herpesvirus OriLyt. We have found that truncation of the BHLF1 transcript or deletion of the TATA box, but not the putative ATG initiation codon, reduce OriLyt function to background levels. By using an antibody specific for RNA-DNA hybrid molecules, we found the BHLF1 RNA stably annealed to its DNA template during the early steps of lytic reactivation. Furthermore, expression of human RNase H1, which degrades RNA in RNA-DNA hybrids, drastically reduces OriLyt-dependent DNA replication as well as recruitment of the viral single-stranded DNA binding protein BALF2 to OriLyt.

Conclusion: LA intake of 4 en% appears to be a recommendable inta

Conclusion: LA intake of 4 en% appears to be a recommendable intake, without signs of stimulated eicosanoid biosynthesis or oxidation. (c) 2008 Elsevier Ltd. Idasanutlin research buy All rights reserved.”
“It is well established that patients with hemispatial neglect present with severe visuospatial impairments, but studies that have investigated visuomotor control directly have revealed diverging results, with some investigations finding impairments mirroring the perceptual difficulties of these patients, while others have shown that

such neglect patients perform relatively better in action tasks.

In this review we attempt to reconcile these diverging findings, addressing differences in the type of visuomotor tasks studied but also highlighting the diverging neuroanatomy that seems to be driving the differences in performance.

We argue that there are different types of actions and that these in turn depend on different cortical networks (Goodale, Westwood, & Milner, 2004; Milner & Goodale, 2006). Patients with visuospatial neglect, in contrast to patients with optic ataxia, are relatively unimpaired at performing target-directed tasks even towards stimuli located in their ‘neglected’ field. We relate these findings to the view that for the on-line guidance of action, spatial information is coded in egocentric coordinates

and depends on the visuomotor networks of the visual dorsal stream. Furthermore, based on recent lesion-symptom LY2228820 datasheet mapping studies, we postulate that deficits in on-line actions that are observed after right-brain damage are associated with damage

to the visuomotor Chlormezanone control network, in particular with damage to the basal ganglia, frontal and parieto-occipital regions. On the other hand, clear neglect-specific deficits emerge when the action is off-line and not directly target-driven, thus requiring relational metrics or scene-based coordinates (as is the case for example in delayed and mirrored (anti-pointing) reaches). We review recent studies that support our argument that such deficits in off-line actions are associated with damage to occipito-temporal and parahippocampal cortex, perhaps as part of the ventral visual stream or areas where information from the two visual streams is combined. Crown Copyright (C) 2011 Published by Elsevier Ltd. All rights reserved.”
“Venezuelan equine encephalitis (VEE) virus is a mosquito-borne alphavirus associated with sporadic outbreaks in human and equid populations in the Western Hemisphere. After the bite of an infected mosquito, the virus initiates a biphasic disease: a peripheral phase with viral replication in lymphoid and myeloid tissues, followed by a neurotropic phase with infection of central nervous system (CNS) neurons, causing neuropathology and in some cases fatal encephalitis.

Finite element models were constructed from in vivo magnetic reso

Finite element models were constructed from in vivo magnetic resonance imaging-based cardiac geometry and postmortem measurement of myofiber helix angles using diffusion tensor magnetic resonance imaging. Material properties were iteratively determined by comparing the finite

element model output with systolic tagged magnetic resonance imaging strain measurements.

Results: At the mid-wall, fiber stress in the border zone decreased by 39% (sham = 32.5 +/- 2.5 kPa, repair = 19.7 +/- 3.6 kPa, P = .001) to the level of remote regions after repair. In the septum, however, border zone fiber stress remained high (sham = 31.3 +/- 5.4 kPa, repair = 23.8 +/- 5.8 kPa, P = .29). Cross-fiber stress at the mid-wall decreased LXH254 ic50 by 41% (sham = 13.0 +/- 1.5 kPa, repair = 7.7 +/- 2.1 kPa, P = .01), but cross-fiber stress in the un-excluded septal infarct was 75% higher in the border zone than RAD001 mouse remote regions (remote = 5.9 +/- 1.9 kPa, border zone = 10.3 +/- 3.6 kPa, P < .01). However, end-diastolic fiber and cross-fiber stress were not reduced in the remote myocardium after plication.

Conclusion: With the exception of the retained septal infarct, end-systolic stress is reduced in all areas of the left ventricle after infarct plication. Consequently, we expect the primary positive effect of infarct plication to be

in the infarct border zone. However, the amount of stress reduction necessary to halt or reverse nonischemic infarct extension in the infarct border zone and eccentric hypertrophy in the remote myocardium is unknown.”
“Background: Epidemiologic studies have shown a relationship between glycated hemoglobin levels and Astemizole cardiovascular events in patients with type 2 diabetes. We investigated whether intensive therapy to target

normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors.

Methods: In this randomized study, 10,251 patients (mean age, 62.2 years) with a median glycated hemoglobin level of 8.1% were assigned to receive intensive therapy (targeting a glycated hemoglobin level below 6.0%) or standard therapy (targeting a level from 7.0 to 7.9%). Of these patients, 38% were women, and 35% had had a previous cardiovascular event. The primary outcome was a composite of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up.

Results: At 1 year, stable median glycated hemoglobin levels of 6.4% and 7.5% were achieved in the intensive-therapy group and the standard-therapy group, respectively. During follow-up, the primary outcome occurred in 352 patients in the intensive-therapy group, as compared with 371 in the standard-therapy group (hazard ratio, 0.90; 95% confidence interval [CI], 0.78 to 1.04; P=0.16).

In this study, SILAC quantitative proteomics

was used to

In this study, SILAC quantitative proteomics

was used to identify differentially externalized proteins in the conditioned media from the mammary fibroblasts Stattic cost with or without intact T beta RII. Over 1000 proteins were identified and their relative differential levels were quantified. Immunoassays were used to further validate identification and quantification of the proteomic results. Differential expression was detected for various extracellular proteins, including proteases and their inhibitors, growth factors, cytokines, and extracellular matrix proteins. CXCL10, a cytokine found to be up-regulated in the T beta RII knockout mammary fibroblasts, is shown to directly stimulate breast tumor cell proliferation and migration Overall, this

study revealed hundreds of specific extracellular protein changes modulated by deletion of T beta RII in mammary fibroblasts, which may play important roles in the tumor microenvironment. These results warrant further investigation into the effects of inhibiting the TGF-beta signaling pathway in fibroblasts because systemic inhibition of TGF-beta signaling pathways is being considered as a potential cancer therapy.”
“Background: Current Canadian and international guidelines suggest patients with transient ischemic attack (TIA) or nondisabling stroke and ipsilateral internal carotid artery stenosis of 50% to 99% should be offered carotid endarterectomy (CEA) <= 2 weeks of the incident TIA or stroke. The objective of the study was to identify whether these goals are being met and the factors that SHP099 manufacturer most influence wait times.

Methods:

Patients who underwent CEA at the Ottawa Hospital for symptomatic carotid artery stenosis from 2008 to 2010 were identified. Time intervals based on the dates of initial symptoms, referral to and visit with a vascular surgeon, the decision to operate, and the date of surgery were recorded for each patient. The influence of various factors on wait times was explored, including age, sex, type of index event, referring physician, PIK-5 distance from the surgical center, degree of stenosis, and surgeon assigned.

Results: Of the 117 patients who underwent CEA, 92 (78.6%) were symptomatic. The median time from onset of symptoms to surgery for all patients was 79 days (interquartile range [IQR], 34-161). The shortest wait times were observed in stroke patients (49 [IQR, 27-81] days) and inpatient referrals (66 [IQR, 25-103] days). Only 7 of the 92 symptomatic patients (8%) received care within the recommended 2 weeks. The median surgical wait time for all patients was 14 days (IQR, 8-25 days). In the multivariable analysis, significant predictors of longer wait times included retinal TIA (P = .003), outpatient referrals (P = .004), and distance from the center (P = .008). Patients who presented to the emergency department had the shortest delays in seeing a vascular surgeon and subsequently undergoing CEA (P < .0001).

After the comparison of the protein profiles from MA(100) fed

After the comparison of the protein profiles from MA(100) fed VX-689 mouse fish and from control, 49 protein spots were found to be altered in abundance (>= 2-fold). Analysis by MALDI-TOF/TOF allowed the unambiguous identification of 29 spots, corresponding to 19 different proteins. These proteins were: phosphoglucomutase, phosphoglucose isomerase, S-adenosyl methionine-dependent methyltransferase class I, aldehyde dehydrogenase, catalase, 6-phosphogluconate dehydrogenase, fumarylacetoacetate hydrolase, 4-hydroxyphenylpyruvic dioxygenase, methylmalonate-semialdehyde dehydrogenase, lysozyme, urate oxidase, elongation factor 2, 60 kDa heat-shock

protein, 58 kDa glucose-regulated protein, cytokeratin E7, type-II keratin, intermediate filament proteins, 17-beta-hydroxysteroid dehydrogenase type 4, and kinase suppressor of Ras1. Western blot analysis of kinase suppressor of Ras1, glucose 6-phosphate dehydrogenase, elongation factor 2, 60 kDa heat-shock protein, and catalase supported the proteome evidence. Based

on the changes found in the protein-expression levels of these proteins, we proposed a cellular-signalling pathway www.selleckchem.com/products/ca-4948.html to explain the hepatic-cell response to the intake of a diet containing MA.”
“Objective: The Hemodialysis Reliable Outflow (HeRO) graft is becoming a recognized alternative to lower extremity arteriovenous grafts (LEAVGs) as an option for patients who have exhausted traditional upper extremity access; however, which should be applied preferentially is unclear.

Methods: A retrospective review of LEAVG

and HeRO implants from January 2004 to August 2010 was performed. Patient demographics, medical history, procedural data, and outcomes were evaluated.

Results: Within the time periods, 60 HeROs were placed in 59 patients and 22 LEAVGs Sitaxentan were placed in 21 patients. Demographics were similar between the two groups for many factors; however, the patients who underwent HeRO placement had significantly higher body mass index compared with the LEAVG group. Mean follow-up was 13.9 months for the HeRO group and 11.9 months for the LEAVG group. The HeRO patients underwent a mean of 6.3 previous tunneled dialysis catheter insertions and 3.1 previous AVG/arteriovenous fistula placements. The LEAVG patients underwent placement of a mean of 4.1 previous tunneled dialysis catheters and 2.6 previous AVG/arteriovenous fistulas. The principal difference was the number of interventions to maintain patency, which was 2.21 per year in the HeRO group and 1.17 per year in the AVG group (P = .003) Secondary patency at 6 months was 77% for the HeRO patients and 83% for the LEAVG patients (P = .14). The HeRO and LEAVG groups had no difference in infection rate per 1000 days (0.61 vs 0.71; P = .77) or mortality rate (22% vs 19% respectively; P = .22) at 6 months.

Conclusions: In access challenged patients, LEAVG and HeRO offer similar rates of secondary patency, infection, and all-cause mortality.

RESULTS: Patients experienced significant improvement in both VAS

RESULTS: Patients experienced significant improvement in both VAS (9.9 vs 2.0, P < .001) and BNI-PS (5.0 vs 1.9, P < .001) after MVD. The area under the receiver-operating characteristic curve was greater for BNI-PS than for VAS for all 3 anchors, indicating that BNI-PS is probably better suited for calculating MCID. The 3 MCID calculation methods generated a range of MCID values for each of the PROs (VAS: 1.40-8.87, BNI-PS: 0.95-3.26).

CONCLUSION: HSP inhibitor MVD-specific

MCID is highly variable based on calculation technique. Some of these calculations appear to either overestimate or underestimate the patients’ preoperative expectations. When the different MCID methods are averaged, the results are clinically appropriate and consistent with preoperative expectations. The average MCID for VAS is 6.25 and for BNI-PS is 2.44.”
“Recent findings indicate that binding and synchronization of distributed activities are crucial for the mechanism of consciousness, and there is increased evidence that disruptions in feature binding produce disintegration of consciousness in schizophrenia. These data suggest that the disrupted binding

and disintegration of consciousness could be related to dissociation, which is historically linked to Bleuler’s concept Birinapant datasheet of splitting in schizophrenia. In the present study we aimed to investigate relations among electroencephalogram (EEG) activities of cortical sites and used psychometric measures of positive and negative schizophrenia symptoms (Positive and Negative Syndrome Scale) and the Dissociative Experiences Scale (DES) in 58 patients with paranoid schizophrenia. SPTLC1 The results show statistically significant Spearman correlations of the DES with cross-correlation function

in nine (of 16) EEG pairs. Positive symptoms display significant Spearman correlation with mean of cross-correlation function in only one EEG pair (F4-C4). Results of the Mann-Whitney test between patients with higher (DES >= 30) and lower dissociation show statistically significant differences between the groups for cross-correlations in nine EEG pairs. The results of this study provide the first supportive evidence for a negative relationship between cross-correlation indices and symptoms of dissociation in schizophrenia. (C) 2009 Elsevier Ireland Ltd. All rights reserved.”
“Hepatitis C virus (HCV) is one of the most common etiologic agents of chronic liver diseases, including liver cirrhosis and hepatocellular carcinoma. In addition, HCV infection is often associated with extrahepatic manifestations (EHM), including mixed cryoglobulinemia and non-Hodgkin’s lymphoma. However, the mechanisms of cell tropism of HCV and HCV-induced EHM remain elusive, because in vitro propagation of HCV has been limited in the combination of cell culture-adapted HCV (HCVcc) and several hepatic cell lines.

Results: Microwave significantly enhanced the coupling efficiency

Results: Microwave significantly enhanced the coupling efficiency of [F-18]-sugar and silylated

uracil by reducing the reaction time to 10 min (6-fold reduction as compared to conventional heating) at 95 degrees C. Base hydrolysis followed by high-performance liquid chromatography purification produced the desired [F-18]-FMAU. The overall radiochemical yield was 20 +/- 4% (decay corrected, n = 3). Radiochemical purity was >99% and specific activity was >400 mCi/mu mol. The alpha/beta anomer ratio was 1:2. The radiosynthesis time was about 90 min from the end of bombardment.

Conclusions: selleck kinase inhibitor A reliable microwave-assisted approach has been developed for routine synthesis learn more of [F-18]-FMAU. The new approach affords a simplified process with shorter synthesis time and higher radiochemical yield as compared to conventional heating. A fully automated microwave-assisted synthesis of [F-18]-FMAU can be readily achieved under new reaction conditions. (c) 2012 Elsevier

Inc. All rights reserved.”
“Objective: We sought to identify predictors of structural valve deterioration after pulmonary valve replacement in patients with tetralogy of Fallot.

Methods: A retrospective review of 227 patients with tetralogy of Fallot who underwent stented bioprosthetic pulmonary valve replacement at Children’s Hospital Boston between 1994 and 2009 was performed. Patient and valve characteristics were assessed as potential predictors of structural valve deterioration by using univariate and multivariable analysis. Freedom from pulmonary valve reintervention and structural valve deterioration were determined by using Kaplan Meier analysis.

Results: Two hundred twenty-nine pulmonary valve replacement operations were performed, with no early GPX6 mortalities. Freedom from reintervention and structural valve deterioration were 94% (95% confidence interval, 87% 100%) and 74%(95% confidence interval, 63% 85%) at 5 years, respectively,

and median time to reintervention was 6.4 years (range, 2 10.1 years). Younger age and higher indexed valve internal diameter were predictors of reduced time to structural valve deterioration. Among patients aged less than 20 years at the time of pulmonary valve replacement, indexed valve internal diameter was a significant predictor of increased risk of structural valve deterioration. Valve manufacturer was not a significant predictor of structural valve deterioration.

\Conclusions: Younger age at the time of pulmonary valve replacement and valve oversizing in patients less than 20 years of age at the time of pulmonary valve replacement were significant predictors of structural valve deterioration and could potentially affect the timing of pulmonary valve replacement and the extent of valve oversizing in small children.