Better survival after transcatheter aortic valve replacement by process improvements

ObjectiveThe aim of this study is to assess the effects on procedural, 30-day, and 1‑year all-cause mortality by a newly introduced quality improvement strategy in patients after transcatheter aortic valve replacement (TAVR).MethodsIn October 2015, a coherent set of quality improving interventions with respect to patient geriatric screening, general diagnostic examination and safety of the procedure was implemented at a single centre in the Netherlands. Patients undergoing TAVR in 2013–2018 were included for retrospective analysis. Mortality was assessed in the pre-quality improvement strategy cohort (January 2013 to October 2015; cohort A) and in the post-quality improvement strategy cohort (November 2015 to December 2018; cohort B). Logistic regression analysis was used to estimate the influence of patient and procedural characteristics on the results of the quality improvement strategy in terms of procedural, 30-day, and 1‑year all-cause mortality.ResultsIn total, 806 patients were analysed with 274 patients in cohort A and 532 patients in cohort B. After introduction of the quality improvement strategy, procedural (4.4% to 1.3%, p < 0.01), 30-day (8.4% to 2.7%, p < 0.01) and 1‑year (16.4% to 8.5%, p < 0.01) all-cause mortality significantly decreased. Multivariate regression analysis showed that the quality improvement strategy also significantly reduced 30-day (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.09–0.42) and 1‑year (OR 0.38, 95% CI 0.24–0.61) all-cause mortality if corrected for patient characteristics.ConclusionStructural meetings on evaluation of outcomes highlight potential areas for improvement and subsequent outcome-based quality improvement initiatives can result in lower procedural, 30-day, and 1‑year all-cause mortality.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01526-7) contains supplementary material, which is available to authorized users.     

Noncommunicable disease outcomes and the effects of vertical and horizontal health aid

Foreign health aid forms a substantial portion of health spending in many low- and middle-income countries (LMICs). It can be either vertical (funds earmarked for specific diseases) or horizontal (funds used for broad health sector strengthening). Historically, most health aid has been disbursed vertically toward key infectious diseases, with minimal allocations to noncommunicable diseases (NCDs). High NCD burden in LMICs underscores a need for increased assistance toward NCD objectives, but evidence on the outcomes of health aid for NCDs is sparse. We obtained annual data on cause-specific deaths and disability-adjusted life years (DALYs) for four leading NCDs across 116 countries, 2000–2016, and evaluated the relationship between these indicators and vertical and horizontal health aid using country fixed-effects models with 1-to-5-year lagged effects. After adjusting for fixed and time-variant country heterogeneity, vertical assistance for NCDs was significantly associated with subsequent reductions in NCD morbidity and mortality, particularly for persons under age 70 and for cardiovascular and chronic respiratory diseases. An additional dollar in per-capita NCD vertical assistance corresponded to reductions in the average annual NCD burden of 7,459 DALYs/281 deaths after one year, 7,728 DALYs/319 deaths after two years, and 8,957 DALYs/346 deaths after three years. The findings suggest that vertical assistance for NCD programs may be an appropriate mechanism for addressing short-term NCD needs in LMICs, where it may help to fill health sector gaps in NCD care, but longer-term evaluation is needed for assessing the role of horizontal assistance.     

Envenomation and the bite rate by venomous snakes in the kingdom of Saudi Arabia over the period (2015–2018)

Snakebite being medical emergency and known cause for increased mortality needs assessment and treatment on high-priority bases, even in patients of snakebite who appear fine initially. The current retrospective study presents the snake bites in Saudi Arabia from 2015 to 2018 reported by General Administration of Statistics and Information, Ministry of Health, Kingdom of Saudi Arabia. The data presented in the current study, was extracted, analyzed, and reported after getting ethical approval from institutional committee. Totally, 14,679 cases of snakebites were reported during the four-year study period, with a higher prevalence in males (80%) in their productive age. Most patients were within the age group between 25 and 44 followed by 44 to 64 years. The majority of snakebite affected inhabitants were reported from farms of the rural areas, commonly during night hours of spring and summer seasons when snakes are very active. Only 36 (0.24%) patients out of 14,679 were reported dead and 14,643 (99.63%) were discharged after the treatment. Awareness among the general public should be encouraged and early diagnosis and usage of proper snake antivenoms could be life-saving. The delay in appropriate treatment can lead to significant morbidity and mortality.     

The MnSOD Ala16Val SNP: Relevance to human diseases and interaction with environmental factors

Abstract

The relevance of reactive oxygen species (ROS) production relies on the dual role shown by these molecules in aerobes. ROS are known to modulate several physiological phenomena, such as immune response and cell growth and differentiation; on the other hand, uncontrolled ROS production may cause important tissue and cell damage, such as deoxyribonucleic acid oxidation, lipid peroxidation, and protein carbonylation. The manganese superoxide dismutase (MnSOD) antioxidant enzyme affords the major defense against ROS within the mitochondria, which is considered the main ROS production locus in aerobes. Structural and/or functional single nucleotide polymorphisms (SNP) within the MnSOD encoding gene may be relevant for ROS detoxification. Specifically, the MnSOD Ala16Val SNP has been shown to alter the enzyme localization and mitochondrial transportation, affecting the redox status balance. Oxidative stress may contribute to the development of type 2 diabetes, cardiovascular diseases, various inflammatory conditions, or cancer. The Ala16Val MnSOD SNP has been associated with these and other chronic diseases; however, inconsistent findings between studies have made difficult drawing definitive conclusions. Environmental factors, such as dietary antioxidant intake and exercise have been shown to affect ROS metabolism through antioxidant enzyme regulation and may contribute to explain inconsistencies in the literature. Nevertheless, whether environmental factors may be associated to the Ala16Val genotypes in human diseases still needs to be clarified.     

Bioaccumulation of Key Metals and Other Contaminants by Seaweeds from the Egyptian Mediterranean Sea Coast in Relation to Human Health Risk

This study examined the bioaccumulation of key metals and other contaminants (SO₄, F, Na, K, Ca, Mg, P, Si, Fe, Mn, Zn, Ni, Co, Cu, and Cd) by seaweeds from the Egyptian Mediterranean Sea coast and their risk to human health. Bioaccumulation factor calculations indicated that S, F, Na, K, Zn, Cu, and Cd had high seaweed uptake and this referred to the potential pollution of the coastal area. Multivariate analysis of the studied contaminants confirmed the bioaccumulation factor results as well as the physiological processes in seaweeds. Human health risk assessment of F, Mn, Zn, Ni, Cu, and Cd was conducted using hazard quotient (HQ) and incremental lifetime cancer risk (ILCR) analyses. The carcinogenic assessment of sediments and ingestion of seaweeds using ILCR calculations revealed that Mn, Ni, and Cd in sediments and F and Zn in seaweeds require remedial action in order to reduce their human health risks. Additionally, HQ calculations for the contaminants in seaweeds and reference to toxicological references values from different agencies revealed that F and Co present high human health risk effects. Consequently, the potential public health risks from dietary exposure to hazardous contaminants in seaweeds must be continually subjected to research, regulation, and debate.     

Oocyte markets: women's reproductive work in embryonic stem cell research

Somatic cell nuclear transfer (SCNT) research, otherwise known as therapeutic cloning, requires large numbers of research oocytes, placing pressure on an already limited supply. In the UK, Canada, Australia, Singapore and most of Western Europe, oocytes are made available through modestly reimbursed donation, and, owing to the onerous nature of donation, the existing demand for reproductive oocytes far outstrips availability. SCNT research will place this system under even greater pressure. This paper investigates the growth in a global market for oocytes, where transnational IVF clinics broker sales between generally poor, female vendors and wealthy purchasers, beyond the borders of national regulation, and with little in the way of clinical or bioethical scrutiny. It considers the possible impact that SCNT research will have on this global market. It argues that oocyte vending could be understood as a kind of reproductive labor in the bioeconomy, and suggests some ways to improve the protection, security and power of vendors.     

Force Measurement During Contraction to Assess Muscle Function in Zebrafish Larvae

Zebrafish larvae provide models of muscle development, muscle disease and muscle-related chemical toxicity, but related studies often lack functional measures of muscle health. In this video article, we demonstrate a method to measure force generation during contraction of zebrafish larval trunk muscle. Force measurements are accomplished by placing an anesthetized larva into a chamber filled with a salt solution. The anterior end of the larva is tied to a force transducer and the posterior end of the larva is tied to a length controller. An isometric twitch contraction is elicited by electric field stimulation and the force response is recorded for analysis. Force generation during contraction provides a measure of overall muscle health and specifically provides a measure of muscle function. Although we describe this technique for use with wild-type larvae, this method can be used with genetically modified larvae or with larvae treated with drugs or toxicants, to characterize muscle disease models and evaluate treatments, or to study muscle development, injury, or chemical toxicity.     

财经类院校贫困生心理健康状况及述情障碍

目的：评估财经类院校贫困生心理状况,探讨财经类院校贫困生的心理状况与述情障碍的关系,为更好解决贫困生的心理问题提供依据。方法：对298名贫困学生进行症状自评量表（SymptomChecklist-90,SCL-90）多伦多述情障碍量表（Twenty-ItemTorontoAlexithymiaScale,TAS．20）的测量并与320名非贫困生对照组的结果进行比较。结果：①贫困生组的抑郁、焦虑、人际关系敏感、精神病性、偏执因子分及SCL．90总分因子高于对照组,贫困生组的F1因子明显高于对照组;②述情障碍组SCL-90总分和各因子得分明显高于非述情组;③述情量表总分及各因子分与症状自评量表总分及各因子分显著相关（P〈0．01或P〈0．05）。结论：①与非贫困学生相比,贫困生具有较多的心身症状,主要表现在抑郁、焦虑、人际关系敏感、精神病性、偏执。②述情障碍与心理健康密切相关,述情障碍个体倾向于更容易出现心身症状。③F1（缺乏识别情感的能力）是一个较其它因子更敏感的述情障碍的鉴定指标。     

Desarrollo global del niño: más allá de la suplementación farmacológica con yodo

Iodine deficiency is a factor that may compromise child development, but is not the only one. Other health determinants, some of them outside the healthcare system, are able to influence development. Fighting iodine deficiency may be a pragmatic and useful strategy if it is found to be not maleficent, beneficial to health, and cost-effective, and does not make us lose the notion that child development goes beyond psychomotor or cognitive performance. This article analyzes such constraints from a critical point of view.