Guidelines for heart transplantation

Based on the changes in the field of heart transplantation and the treatment and prognosis of patients with heart failure, these updated guidelines were composed by a committee under the supervision of both the Netherlands Society of Cardiology and the Netherlands Association for Cardiothoracic surgery (NVVC and NVT). The indication for heart transplantation is defined as: ‘End-stage heart disease not remediable by more conservative measures’. Contraindications are: irreversible pulmonary hypertension/elevated pulmonary vascular resistance; active systemic infection; active malignancy or history of malignancy with probability of recurrence; inability to comply with complex medical regimen; severe peripheral or cerebrovascular disease and irreversible dysfunction of another organ, including diseases that may limit prognosis after heart transplantation. Considering the difficulties in defining end-stage heart failure, estimating prognosis in the individual patient and the continuing evolution of available therapies, the present criteria are broadly defined. The final acceptance is done by the transplant team which has extensive knowledge of the treatment of patients with advanced heart failure on the one hand and thorough experience with heart transplantation and mechanical circulatory support on the other hand. (Neth Heart J 2008;16:79-87.)     

Dynamics of the yeast transcriptome during wine fermentation reveals a novel fermentation stress response

In this study, genome-wide expression analyses were used to study the response of Saccharomyces cerevisiae to stress throughout a 15-day wine fermentation. Forty per cent of the yeast genome significantly changed expression levels to mediate long-term adaptation to fermenting grape must. Among the genes that changed expression levels, a group of 223 genes was identified, which was designated as fermentation stress response (FSR) genes that were dramatically induced at various points during fermentation. FSR genes sustain high levels of induction up to the final time point and exhibited changes in expression levels ranging from four- to 80-fold. The FSR is novel; 62% of the genes involved have not been implicated in global stress responses and 28% of the FSR genes have no functional annotation. Genes involved in respiratory metabolism and gluconeogenesis were expressed during fermentation despite the presence of high concentrations of glucose. Ethanol, rather than nutrient depletion, seems to be responsible for entry of yeast cells into the stationary phase.     

The Ultuna long-term soil organic matter experiment

In 1991, soil samples were taken from the long-term (40 years old) field trial at Ultuna in order to investigate soil P status and the distribution of its various forms. Among the treatments investigated, two were inorganic PK additions only – one to continuous fallow (PK-fallow) and the other to cropped fields (PK). There were also treatments amended with PK in combination with applications of straw, green manure composed of grass (GM), farmyard manure (FYM) or sewage sludge (SS). A total of 720, 720, 883, 1154, 1941 and 6617 kg P h^-1 had been supplied in the PK-fallow, PK, Straw, GM, FYM and SS treatments, respectively up to 1991. The soil P distribution was determined by step-wise fractionation using anion exchange resin (resin-P), sodium bicarbonate (bicarb-P), sodium hydroxide (hyd-P), and HCl (HCl-P). Finally, the soil was digested to obtain residual P (resid-P). The amendments resulted in a significant (p=0.05) enrichment of total P in soils relative to the initial value. A breakdown of the bicarb-P and hyd-P into inorganic P (P_i) and organic P (P_o) was manifested as considerable transformations within these P compartments compared with the initial values. Thus, total P_i (resin-P, bicarb-P_i, hyd-P_i, HC1-P, resid-P)/total P_o (bicarb-P_o, hyd-P_o) ratios markedly decreased in all treatments relative to control. The two P compartments were significantly and negatively (p =0.05) correlated. On average, the total P_o increase was about 380 mg kg^-1 (range 270–715). The results suggested that an equilibrium between P_i immobilization and P_o mineralization was difficult to attain under any of the experimental management regimes used, which exclude inorganic N application. The balance sheet calculations revealed P deficits ranging from about 10 to 60 kg ha^-1, indicating that some P had migrated to the subsoil.     

Listing criteria for heart transplantation in the Netherlands

The updated listing criteria for heart transplantation are presented on behalf of the three heart transplant centres in the Netherlands. Given the shortage of donor hearts, selection of those patients who may expect to have the greatest benefit from a scarce societal resource in terms of life expectancy and quality of life is inevitable. The indication for heart transplantation includes end-stage heart disease not remediable by more conservative measures, accompanied by severe physical limitation while on optimal medical therapy, including ICD/CRT‑D. Assessment of this condition requires cardiopulmonary stress testing, prognostic stratification and invasive haemodynamic measurements. Timely referral to a tertiary centre is essential for an optimal outcome. Chronic mechanical circulatory support is being used more and more as an alternative to heart transplantation and to bridge the progressively longer waiting time for heart transplantation and, thus, has become an important treatment option for patients with advanced heart failure.Supplementary InformationThe online version of this article (10.1007/s12471-021-01627-x) contains supplementary material, which is available to authorized users.     

Human health risks of metals and metalloids in muscle tissue of Synodontis zambezensis Peters, 1852 from Flag Boshielo Dam,South Africa

Muscle tissue from 63 Synodontis zambezensis collected bimonthly in 2013 at Flag Boshielo Dam were analysed for metals and metalloids in a desktop human health risk assessment. The Hazard Quotient, based on a weekly meal of 67 g of fish muscle, exceeded the maximum acceptable level of one for lead, cobalt, cadmium, mercury, arsenic and selenium. The concentrations of these elements were higher in 2013 than those recorded in 2009 and 2012 in other fish species from Flag Boshielo Dam and these may pose a long-term health risk if consumed regularly by impoverished rural communities reliant on fish as a source of protein.