The long-term prognostic significance of 6-minute walk test distance in patients with chronic heart failure

Background. The 6-minute walk test (6-MWT) is used to assess patients with chronic heart failure (CHF). The prognostic significance of the 6-MWT distance during long-term followup ( > 5 years) is unclear. Methods. 1,667 patients (median [inter-quartile range, IQR]) (age 72 [65-77] ; 75% males) with heart failure due to left ventricular systolic impairment undertook a 6-MWT as part of their baseline assessment and were followed up for 5 years. Results. At 5 years' followup, those patients who died (n = 959) were older at baseline and had a higher log NT pro-BNP than those who survived to 5 years (n = 708). 6-MWT distance was lower in those who died [163 (153) m versus 269 (160) m; P 360 m. 6-MWT distance was a predictor of all-cause mortality (HR 0.97; 95% CI 0.96-0.97; Chi-square = 184.1; P < 0.0001). Independent predictors of all-cause mortality were decreasing 6-MWT distance, increasing age, increasing NYHA classification, increasing log NT pro-BNP, decreasing diastolic blood pressure, decreasing sodium, and increasing urea. Conclusion. The 6-MWT is an important independent predictor of all-cause mortality following long-term followup in patients with CHF. © 2014 Lee Ingle et al

Long-term culture of intestinal cell progenitors: an overview of their development, application, and associated technologies

Purpose of Review Long-term culture of adult progenitor cells in 3D is a recently emerging technology that inhabits the space between 2D cell lines and organ slice culture. Recent Findings Adaptations to defined media components in the wake of advances in ES and iPS cell culture has led to the identification of conditions that maintained intestinal cell progenitors in culture. These conditions retain cellular heterogeneity of the normal or tumour tissue, and the cultures have been shown to be genetically stable, such that substantial biobanks are being created from patient derived material. This coupled with advances in analytical tools has generated a field, characterized by the term “organoid culture”, that has huge potential for advancing drug discovery, regenerative medicine, and furthering the understanding of fundamental intestinal biology. Summary In this review, we describe the approaches available for the long-term culture of intestinal cells from normal and diseased tissue, the current challenges, and how the technology is likely to develop further

Separating true range measurements from multi-path and scattering interference in commercial range cameras

Time-of-flight range cameras acquire a three-dimensional image of a scene simultaneously for all pixels from a single viewing location. Attempts to use range cameras for metrology applications have been hampered by the multi-path problem, which causes range distortions when stray light interferes with the range measurement in a given pixel. Correcting multi-path distortions by post-processing the three-dimensional measurement data has been investigated, but enjoys limited success because the interference is highly scene dependent. An alternative approach based on separating the strongest and weaker sources of light returned to each pixel, prior to range decoding, is more successful, but has only been demonstrated on custom built range cameras, and has not been suitable for general metrology applications. In this paper we demonstrate an algorithm applied to both the Mesa Imaging SR-4000 and Canesta Inc. XZ-422 Demonstrator unmodified off-the-shelf range cameras. Additional raw images are acquired and processed using an optimization approach, rather than relying on the processing provided by the manufacturer, to determine the individual component returns in each pixel. Substantial improvements in accuracy are observed, especially in the darker regions of the scene

Improving Agricultural Irrigation on the Balkhab River, Afghanistan

In Afghanistan, where 80% of the population is rural, irrigated agriculture is important for satisfying subsistence needs. While most of the irrigated agriculture is fed by diversion canal systems which tap surface flows, legal and physical water infrastructure in the region is generally poor. A math programming model is used to optimize irrigation strategies under different water-availability and policy scenarios. It is found that the construction of a reservoir could increase net revenues to a representative farming community by up to 30%. However, even greater benefits may result from increasing distribution efficiencies, depending on the initial level of conveyance losses. Further, property rights schemes may be implemented to distribute wealth more evenly through various zones at minimal cost to the agricultural community as a whole. These results may prove useful to policymakers or water authorities in reestablishing water rights.linear programming, irrigation, Afghanistan, Agricultural and Food Policy, Community/Rural/Urban Development, International Development,

Development of a composite model derived from cardiopulmonary exercise tests to predict mortality risk in patients with mild-to-moderate heart failure

Objective: Cardiopulmonary exercise testing (CPET) is used to predict outcome in patients with mild-to-moderate heart failure (HF). Single CPET-derived variables are often used, but we wanted to see if a composite score achieved better predictive power. Methods: Retrospective analysis of patient records at the Department of Cardiology, Castle Hill Hospital, Kingston-upon-Hull. 387 patients [median (25th-75th percentile)] [age 65 (56-72) years; 79% males; LVEF 34 (31-37) %] were included. Patients underwent a symptomlimited, maximal CPET on a treadmill. During a median follow up of 8.6 ± 2.1 years in survivors, 107 patients died. Survival models were built and validated using a hybrid approach between the bootstrap and Cox regression. Nine CPET-derived variables were included. Z-score defined each variable's predictive strength. Model coefficients were converted to a risk score. Results: Four CPET-related variables were independent predictors of all-cause mortality in the survival model: the presence of exertional oscillatory ventilation (EOV), increasing slope of the relation between ventilation and carbon dioxide production (VE/VCO2 slope), decreasing oxygen uptake efficiency slope (OUES), and an increase in the lowest ventilatory equivalent for carbon dioxide (VEqCO2 nadir). Individual predictors of mortality ranged from 0.60 to 0.71 using Harrell’s C-statistic, but the optimal combination of EOV + VE/VCO2 slope + OUES + VEqCO2 nadir reached 0.75. The Hull CPET risk score had a significantly higher area under the curve (0.78) when compared to the Heart Failure Survival Score (AUC=0.70;

Cardiorespiratory requirements of the 6-min walk test in patients with left ventricular systolic disfunction and no major structural heart disease

The six-minute walk test (6-MWT) is widely used to assess functional status in patients with chronic heart failure (CHF). The aims of the present study were: (1) to compare metabolic gas exchange during the 6-MWT in older patients with left ventricular systolic dysfunction (LVSD) and in breathless patients with no major structural heart disease (MSHD); (2) to determine the exercise intensity of the 6-MWT relative to peak oxygen uptake; (3) to establish the accuracy and reproducibility of the Metamax 3B ergospirometer during an incremental workload. Twenty four older patients with LVSD (19 male; age 76 ± 5 years; BMI 27 ± 4), and 18 patients with no MSHD (12 male; age 75 ± 8 years; BMI 27 ± 4) attended on consecutive days at the same time. Patients completed a 6-MWT with metabolic gas exchange measurements using the Metamax 3B portable ergospirometer, and an incremental cycle ergometry test using both the Metamax 3B and Oxycon Pro metabolic cart. Patients returned and performed a second 6-MWT and an incremental treadmill test, metabolic gas exchange was measured with the Metamax 3B. In patients with LVSD, the 6-MWT was performed at a higher fraction of maximal exercise capacity (p = 0.02). The 6-MWT was performed below the anaerobic threshold in patients with LVSD (83 %) and in patients with no MSHD (61 %). The Metamax 3B showed satisfactory to high accuracy at 10 W and 20 W in patients with LVSD (r = 0.77 - 0.97, p < 0.05), and no MSHD (r = 0.76 - 0.94, p < 0.05). Metabolic gas exchange variables measured during the 6-MWT showed satisfactory to high day-to-day reproducibility in patients with LVSD (ICC = 0.75 - 0.98), but a higher variability was evident in participants with no MSHD (ICC = 0.62 - 0.97). The Metamax 3B portable ergospirometer is an accurate and reproducible device during submaximal, fixed rate exercise in older patients with LVSD and no MSHD. In elderly patients with LVSD and no MSHD, the 6-MWT should not be considered a maximal test of exercise capacity but rather a test of submaximal exercise performance. Our study demonstrates that the 6-MWT takes place at a higher proportion of peak oxygen uptake in patients with LVSD compared to those with no MSHD, and may be one reason why fatigue is a more prominent symptom in these patients

Nasal septal perforation repair with an inferior turbinate flap and acellular dermal matrix

Nasal septal perforation is an uncommon disorder that can cause disturbance of nasal physiology. The perforations can vary widely in size, location, and symptomatology. Many different closure techniques have been described in the literature; however, no gold standard has been recognized. The choice of surgical technique usually depends on the characteristics of the perforation and surgeon experience. Due to the goal of perforation repair being restoration of normal nasal physiology, techniques with the best outcomes have been those resurfacing the septum with nasal respiratory mucosa. Here we present our novel surgical method for large (\u3e 2 cm) septal perforation closure using a modification of the inferior turbinate flap repair using a polydioxanone plate and the acellular dermal matrix allograft (Alloderm, Allergan Inc.)