The role of early management and hormone replacement therapy in potential heart and lung donors

Heart and lung transplantation activity is frustrated by the lack of availability of donor organs. The haemodynamic, hormonal and inflammatory changes that follow brain stem death leads to donor organ injury. Appropriate donor management is essential to avoid further damage to already injured donor heart and lungs. Hormone replacement therapy with tri-iodothyronine and methylprednisolone in organ donors has been reported to increase the retrieval rate of heart and lungs with improved function. In a prospective, randomised, double blind, controlled trial the role of hormone replacement therapy and early donor management on the donor heart and lung function and their retrieval rate was studied. Heart donor Outcome Early donor management was associated with significant improvement in donor heart function. It may also increase the retrieval rate of hearts for transplantation. However, administration of hormones neither influenced the donor heart function nor the heart retrieval rate. Serial echocardiography guides in identifying suitable donor hearts for transplantation during intensive management. Lung donor outcomes Early donor management was associated with significant increase in lung retrieval rate for transplantation. Despite management donor lung function deteriorated following brain stem death. Hormone replacement therapy did not increase the lung retrieval rate or affect the donor lung function. However, methylprednisolone administration leads to significant reduction in progressive donor lung water accumulation. Measurement of thermodilution lung water index predicted ultimate lung suitability for transplantation and recipient outcome. Conclusion Early donor management is the cornerstone to improve the donor heart function and to increase the lung retrieval rate. It may also increase the heart retrieval rate. Serial transthoracic echocardiography may guide in identifying suitable hearts that respond to donor management

Measurement of psi (2S) production cross-sections in proton-proton collisions at v s=7 and 13 TeV

The cross-sections of \u3c8(2 S) meson production in proton-proton collisions at s=13TeV are measured with a data sample collected by the LHCb detector corresponding to an integrated luminosity of 275pb-1. The production cross-sections for prompt \u3c8(2 S) mesons and those for \u3c8(2 S) mesons from b-hadron decays (\u3c8(2S)-from-b) are determined as functions of the transverse momentum, pT, and the rapidity, y, of the \u3c8(2 S) meson in the kinematic range 2<20GeV/c and 2.0 < y< 4.5. The production cross-sections integrated over this kinematic region are \u3c3(prompt\u3c8(2S),13TeV)=1.430\ub10.005(stat)\ub10.099(syst)\u3bcb,\u3c3(\u3c8(2S)-from-b,13TeV)=0.426\ub10.002(stat)\ub10.030(syst)\u3bcb.A new measurement of \u3c8(2 S) production cross-sections in pp collisions at s=7TeV is also performed using data collected in 2011, corresponding to an integrated luminosity of 614pb-1. The integrated production cross-sections in the kinematic range 3.5<14GeV/c and 2.0 < y< 4.5 are \u3c3(prompt\u3c8(2S),7TeV)=0.471\ub10.001(stat)\ub10.025(syst)\u3bcb,\u3c3(\u3c8(2S)-from-b,7TeV)=0.126\ub10.001(stat)\ub10.008(syst)\u3bcb.All results show reasonable agreement with theoretical calculations

Measurement of the eta(c)(1S) production cross-section in p p collisions at root s=13TeV

Using a data sample corresponding to an integrated luminosity of 2.0 fb-1, collected by the LHCb experiment, the production of the \u3b7c(1 S) state in proton\u2013proton collisions at a centre-of-mass energy of s=13TeV is studied in the rapidity range 2.0 < y< 4.5 and in the transverse momentum range 6.5<14.0GeV. The cross-section for prompt production of \u3b7c(1 S) mesons relative to that of the J/ \u3c8 meson is measured using the pp\uaf decay mode and is found to be \u3c3\u3b7c(1S)/\u3c3J/\u3c8=1.69\ub10.15\ub10.10\ub10.18. The quoted uncertainties are, in order, statistical, systematic and due to uncertainties on the branching fractions of the J/\u3c8\u2192pp\uaf and \u3b7c\u2192pp\uaf decays. The prompt \u3b7c(1 S) production cross-section is determined to be \u3c3\u3b7c(1S)=1.26\ub10.11\ub10.08\ub10.14\u3bcb, where the last uncertainty includes that on the J/ \u3c8 meson cross-section. The ratio of the branching fractions of b-hadron decays to the \u3b7c(1 S) and J/ \u3c8 states is measured to be Bb\u2192\u3b7cX/Bb\u2192J/\u3c8X=0.48\ub10.03\ub10.03\ub10.05, where the last uncertainty is due to those on the branching fractions of the J/\u3c8\u2192pp\uaf and \u3b7c\u2192pp\uaf decays. The difference between the J/ \u3c8 and \u3b7c(1 S) masses is also determined to be 113.0\ub10.7\ub10.1MeV, which is the most precise single measurement of this quantity to date

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk- outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))

Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license