The global campaign to eliminate HBV and HCV infection: International Viral Hepatitis Elimination Meeting and core indicators for development towards the 2030 elimination goals

Hepatitis B virus (HBV) and hepatitis C virus (HCV) affect more than 320 million people worldwide, which is more than HIV, tuberculosis (TB) and malaria combined. Elimination of HBV and HCV will, therefore, produce substantial public health and economic benefits and, most importantly, the prevention of 1.2 million deaths per year. In 2016, member states of the World Health Assembly unanimously adopted a resolution declaring that viral hepatitis should be eliminated by 2030. Currently, few countries have elimination programmes in place and even though the tools to achieve elimination are available, the right resources, commitments and allocations are lacking. During the fifth International Viral Hepatitis Elimination Meeting (IVHEM), 7–8 December 2018, Amsterdam, the Netherlands, an expert panel of clinicians, virologists and public health specialists discussed the current status of viral hepatitis elimination programmes across multiple countries, challenges in achieving elimination and the core indicators for monitoring progress, approaches that have failed and successful elimination plans

ФАКТОРЫ РИСКА ВОЗВРАТА ПРЕДСЕРДНЫХ ТАХИАРИТМИЙ У ПАЦИЕНТОВ С НЕПАРОКСИЗМАЛЬНЫМИ ФОРМАМИ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ ПОСЛЕ ТОРАКОСКОПИЧЕСКОЙ АБЛАЦИИ BOX LESION SET

Highlights Identification of risk factors impacting the effectiveness of thoracoscopic ablation according to the box session set scheme will allow us to formulate criteria for the selection of patients with non-paroxysmal atrial fibrillation for epicardial ablation of the left atrium.Duration of atrial fibrillation for more than 7.5 years and the volume of the left atrium indexed to the body surface area of more than 47 mL/m2 statistically significantly reduce the effectiveness of thoracoscopic ablation of stable atrial fibrillation by 34.2 and 55.8% during the three-year follow-up period, respectively.The need to assess the function of left atrium using modern two-dimensional speckle-tracking echocardiography technology should be considered to determine the criteria for the successful ablation of non-paroxysmal atrial fibrillation. The aim. To study risk factors for atrial tachyarrhythmias recurrence after thoracoscopic ablation (TSA) of non-paroxysmal atrial fibrillation (AF) in the long-term follow-up period.Methods.  The retrospective study included a series of 100 patients with non-paroxysmal AF undergoing “Box lesion set” TSA with one-stage exclusion of the left atrial (LA) appendage. The efficacy of TSA in the long-term follow-up period was evaluated using 24-h HM ECG results. A retrospective analysis of risk factors for atrial tachyarrhythmias recurrence after TSA was performed. The analysis included the main clinical characteristics of patients in the preoperative period, as well as data of transthoracic echocardiography with inclusion of left atrial strain in the reservoir and conduit phases.Results. In the presented study, the main risk factors for atrial tachyarrhythmias recurrence after TSA were: duration of AF more than 7.5 years and LAVI more than 47 mL/m2. However, univariate analysis showed that for every 1-year increase in the duration of AF, the risk of arrhythmia recurrence after TSA increased 1.07-fold [95% CI: 1.01; 1.17, p = 0.0374], and for every 10 mL/m2 increase in LAVI, the risk of atrial tachyarrhythmia recurrence increased 1.95-fold [95% CI: 1.49; 2.56, p<0.001]. According to the data of two-dimensional speckle-tracking echocardiography there was a tendency towards the decrease of the parameters of left atrial strain in the reservoir phase mainly in patients with AF, which requires further more detailed study on a larger cohort of patients.Conclusion. It is necessary to consider not only the assessment of the anatomy of the left atrium, but its function with the use of modern methods of radial imaging at the preoperative stage in order to improve the effectiveness of TSA “Box lesion set” for non-paroxysmal AF in the long-term follow-up period.Основные положенияОпределение факторов риска, влияющих на эффективность торакоскопической аблации по схеме box lesion set, позволит сформулировать критерии отбора пациентов с непароксизмальной фибрилляцией предсердий для эпикардиальной аблации левого предсердия.Анамнез фибрилляции предсердий более 7,5 года и объем левого предсердия, индексируемый к площади поверхности тела, более 47 мл/м2 статистически значимо снижают эффективность торакоскопической аблации устойчивых форм фибрилляции предсердий на 34,2 и 55,8% в течение трехлетнего периода наблюдения, соответственно.Следует рассмотреть необходимость оценки функционального состояния левого предсердия с использованием современной технологии двухмерной speckle-tracking эхокардиографии для поиска критериев успеха аблации непароксизмальной фибрилляции предсердий. Цель. Ретроспективный поиск факторов риска возврата предсердных тахиаритмий после торакоскопической аблации непароксизмальной фибрилляции предсердий (ФП) в отдаленном периоде наблюдения.Материал и методы. В исследование включили 100 пациентов с непароксизмальной ФП, которым выполнили торакоскопическую аблацию по схеме box lesion set с одномоментной ампутацией ушка левого предсердия. Оценили эффективность торакоскопической аблации ФП в отдаленном периоде наблюдения по результатам суточного холтеровского мониторирования электрокардиограммы. Провели ретроспективный анализ факторов риска возврата предсердных тахиаритмий после торакоскопической аблации. В анализ включили основные клинические характеристики пациентов в предоперационном периоде, а также данные трансторакальной эхокардиографии с показателями деформации левого предсердия в резервуарную и кондуитную фазы.Результаты. Основные факторы риска возврата предсердных тахиаритмий после торакоскопической аблации ФП – анамнез ФП более 7,5 года и объем левого предсердия, индексируемый к площади поверхности тела, более 47 мл/м2. Согласно однофакторному анализу, при увеличении длительности анамнеза ФП на 1 год риск рецидива аритмии после торакоскопической аблации повышается в 1,07 раза (95% доверительный интервал 1,01–­1,17, p = 0,0374), а при увеличении объема левого предсердия, индексируемого к площади поверхности тела, на 10 мл/м2 риск возврата предсердной тахиаритмии повышается в 1,95 раза (95% доверительный интервал 1,49–2,56, p < 0,001). Согласно данным двухмерной speckle-tracking эхокардиографии, снижались показатели деформации левого предсердия в резервуарную фазу преимущественно у пациентов с ФП, что требует детального изучения на большей когорте пациентов.Заключение. На предоперационном этапе следует оценивать не только анатомическое состояние левого предсердия, но и функциональное с применением современных методов лучевой визуализации с целью повышения эффективности торакоскопической аблации по схеме box lesion set непароксизмальной ФП в отдаленном периоде наблюдения

ЭВОЛЮЦИЯ ТОРАКОСКОПИЧЕСКОГО ЛЕЧЕНИЯ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ: ОТ СТАНОВЛЕНИЯ ДО СОВРЕМЕННОГО ЭТАПА

HighlightsThe development and implementation of video-assisted thoracoscopic atrial fibrillation ablation since 2005 by R. Wolf and colleagues have undergone a number of modifications for improvement and simplification. A study of the evolutionary development of thoracoscopic ablation of atrial fibrillation is necessary to optimize ablation recruitment and surgical technique for different forms of atrial fibrillation. AbstractThere is a variety of treatments for atrial fibrillation (AF): therapeutic, interventional and surgical. The effectiveness of these methods varies significantly depending on the form of AF. For a long time, surgery was considered the only highly effective treatment for AF. In modern arrhythmology, «Maze IV» and its modifications are considered only as a simultaneous procedure in cardiac surgery. The work of M. Haïssaguerre et al. has established that the main focus of catheter ablation (CA) in AF should be the pulmonary veins, but their isolation in non-paroxysmal AF is questionable. This discovery has stimulated the development of alternative treatment modalities for resistant AF. Recently, video-assisted thoracoscopic epicardial ablation (TSA), which does not require sternotomy, cardiopulmonary bypass and cardioplegia, has been increasingly preferred. TSA of AF is an alternative surgical treatment for isolated forms of AF on the working heart. This procedure may include: pulmonary vein ablation, posterior left atrial wall and pulmonary vein ablation and left atrial appendage exclusion, but its effectiveness varies considerably due to the heterogeneity of patients, surgical technique and follow-up period. The aim of this review is to provide data on the evolutionary development of thoracoscopic ablation of AF depending on the choice of surgical access, ablation line set and ablation device.Основные положенияВидеоассистированная торакоскопическая аблация фибрилляции предсердий, разработанная и внедренная с 2005 г. R. Wolf и коллегами, претерпела ряд модификаций, связанных с ее улучшением и упрощением. Изучение эволюционного становления торакоскопической аблации необходимо для оптимизации набора аблаций и техники операции при различных формах фибрилляции предсердий. РезюмеВ настоящее время существует широкий спектр методов лечения фибрилляции предсердий (ФП): терапевтических, интервенционных и хирургических. Эффективность вышеописанных методов существенно варьирует в зависимости от формы ФП. Длительное время единственным высокоэффективным методом лечения ФП считался хирургический. В современной аритмологии операцию Maze IV и ее модификации рассматривают исключительно в качестве симультанной процедуры при кардиохирургических вмешательствах. Благодаря работе M. Haïssaguerre и соавт. установлено, что основной мишенью катетерных аблаций при ФП следует считать легочные вены, но их изолированная изоляция при непароксизмальных формах ФП сомнительна. Все это послужило стимулом для создания альтернативных методов лечения устойчивых форм ФП. Последние десятилетия все большее предпочтение отдается видеоассистированным торакоскопическим эпикардиальным аблациям (ТА), не требующим стернотомии, искусственного кровообращения и кардиоплегии. ТА является альтернативным хирургическим методом лечения изолированных форм ФП на работающем сердце. Данная процедура может включать изоляцию устьев легочных вен, изоляцию задней стенки левого предсердия и устьев легочных вен, ампутацию ушка левого предсердия. Показатели эффективности ТА существенно варьируют из-за разнородности пациентов, техники операции и периода наблюдения. Цель данного обзора – представить данные эволюционного становления торакоскопической аблации ФП в зависимости от выбора хирургического доступа, набора линий аблации и используемого аблационного устройства

Interaction between the microbiome and TP53 in human lung cancer.

BACKGROUND: Lung cancer is the leading cancer diagnosis worldwide and the number one cause of cancer deaths. Exposure to cigarette smoke, the primary risk factor in lung cancer, reduces epithelial barrier integrity and increases susceptibility to infections. Herein, we hypothesize that somatic mutations together with cigarette smoke generate a dysbiotic microbiota that is associated with lung carcinogenesis. Using lung tissue from 33 controls and 143 cancer cases, we conduct 16S ribosomal RNA (rRNA) bacterial gene sequencing, with RNA-sequencing data from lung cancer cases in The Cancer Genome Atlas serving as the validation cohort. RESULTS: Overall, we demonstrate a lower alpha diversity in normal lung as compared to non-tumor adjacent or tumor tissue. In squamous cell carcinoma specifically, a separate group of taxa are identified, in which Acidovorax is enriched in smokers. Acidovorax temporans is identified within tumor sections by fluorescent in situ hybridization and confirmed by two separate 16S rRNA strategies. Further, these taxa, including Acidovorax, exhibit higher abundance among the subset of squamous cell carcinoma cases with TP53 mutations, an association not seen in adenocarcinomas. CONCLUSIONS: The results of this comprehensive study show both microbiome-gene and microbiome-exposure interactions in squamous cell carcinoma lung cancer tissue. Specifically, tumors harboring TP53 mutations, which can impair epithelial function, have a unique bacterial consortium that is higher in relative abundance in smoking-associated tumors of this type. Given the significant need for clinical diagnostic tools in lung cancer, this study may provide novel biomarkers for early detection

Paleoseismic History of the Dead Sea Fault Zone

International audienceThe aim of this entry is to describe the DSF as a transform plate boundary pointing out the rate of activedeformation, fault segmentation, and geometrical complexities as a control of earthquake ruptures. Thedistribution of large historical earthquakes from a revisited seismicity catalogue using detailedmacroseismic maps allows the correlation between the location of past earthquakes and fault segments.The recent results of paleoearthquake investigations (paleoseismic and archeoseismic) with a recurrenceinterval of large events and long-term slip rate are presented and discussed along with the identification ofseismic gaps along the fault. Finally, the implications for the seismic hazard assessment are also discussed

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma a

ARIA 2016 : Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.Peer reviewe

Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. METHODS: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets. FINDINGS: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. INTERPRETATION: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. FUNDING: Bill & Melinda Gates Foundation