Assessing for Cardiotoxicity from Metal-on-Metal Hip Implants with Advanced Multimodality Imaging Techniques.

BACKGROUND: High failure rates of metal-on-metal (MoM) hip implants prompted regulatory authorities to issue worldwide safety alerts. Circulating cobalt from these implants causes rare but fatal autopsy-diagnosed cardiotoxicity. There is concern that milder cardiotoxicity may be common and underrecognized. Although blood metal ion levels are easily measured and can be used to track local toxicity, there are no noninvasive tests for organ deposition. We sought to detect correlation between blood metal ions and a comprehensive panel of established markers of early cardiotoxicity. METHODS: Ninety patients were recruited into this prospective single-center blinded study. Patients were divided into 3 age and sex-matched groups according to implant type and whole-blood metal ion levels. Group-A patients had a ceramic-on-ceramic [CoC] bearing; Group B, an MoM bearing and low blood metal ion levels; and Group C, an MoM bearing and high blood metal-ion levels. All patients underwent detailed cardiovascular phenotyping using cardiac magnetic resonance imaging (CMR) with T2*, T1, and extracellular volume mapping; echocardiography; and cardiac blood biomarker sampling. T2* is a novel CMR biomarker of tissue metal loading. RESULTS: Blood cobalt levels differed significantly among groups A, B, and C (mean and standard deviation [SD], 0.17 ± 0.08, 2.47 ± 1.81, and 30.0 ± 29.1 ppb, respectively) and between group A and groups B and C combined. No significant between-group differences were found in the left atrial or ventricle size, ejection fraction (on CMR or echocardiography), T1 or T2* values, extracellular volume, B-type natriuretic peptide level, or troponin level, and all values were within normal ranges. There was no relationship between cobalt levels and ejection fraction (R = 0.022, 95% confidence interval [CI] = -0.185 to 0.229) or T2* values (R = 0.108, 95% CI = -0.105 to 0.312). CONCLUSIONS: Using the best available technologies, we did not find that high (but not extreme) blood cobalt and chromium levels had any significant cardiotoxic effect on patients with an MoM hip implant. There were negligible-to-weak correlations between elevated blood metal ion levels and ejection fraction even at the extremes of the 95% CI, which excludes any clinically important association. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence

Socio-Technical Innovation Bundles for Agri-Food Systems Transformation

This open access book is the result of an expert panel convened by the Cornell Atkinson Center for Sustainability and Nature Sustainability. The panel tackled the seventeen UN Sustainable Development Goals (SDGs) for 2030 head-on, with respect to the global systems that produce and distribute food. The panel’s rigorous synthesis and analysis of existing research leads compellingly to multiple actionable recommendations that, if adopted, would simultaneously lead to healthy and nutritious diets, equitable and inclusive value chains, resilience to shocks and stressors, and climate and environmental sustainability

Socio-Technical Innovation Bundles for Agri-Food Systems Transformation

This open access book is the result of an expert panel convened by the Cornell Atkinson Center for Sustainability and Nature Sustainability. The panel tackled the seventeen UN Sustainable Development Goals (SDGs) for 2030 head-on, with respect to the global systems that produce and distribute food. The panel’s rigorous synthesis and analysis of existing research leads compellingly to multiple actionable recommendations that, if adopted, would simultaneously lead to healthy and nutritious diets, equitable and inclusive value chains, resilience to shocks and stressors, and climate and environmental sustainability

Socio-Technical Innovation Bundles for Agri-Food Systems Transformation

Technological and institutional innovations in agri-food systems (AFSs) over the past century have brought dramatic advances in human well-being worldwide. Yet these gains increasingly appear unsustainable due to massive, adverse spillover effects on climate, natural environment, public health and nutrition, and social justice. How can humanity innovate further to bring about AFS transformations that can sustain and expand past progress, while making them healthier for all people and for the planet that must sustain current and future generations? This report was commissioned by the Cornell Atkinson Center for Sustainability in response to an invitation from the journal Nature Sustainability, which—in collaboration with its new sister journal, Nature Food—wanted to devote its 2020 expert panel to this topic. The panel brought together experts who come from many different continents and who span a wide range of disciplines and organizations—from industry and universities to social movements, governments, philanthropies, institutional and venture capital investors, and multilateral agencies. The panel synthesized the best current science to describe the present state of the world’s AFSs and key external drivers of AFS changes over the next 25–50 years, as well as tease out key lessons from the COVID-19 pandemic experience this year. As is increasingly widely recognized, the costs that farmers and downstream value chain actors incur and the prices consumers pay understate foods’ true costs to society once one accounts for adverse environmental, health, and social spillover effects. Inevitable demographic, economic, and climate change in the coming decades will catastrophically aggravate these problems under business-as-usual scenarios. Innovations will be needed to facilitate concerted, coordinated efforts to transition to more healthy, equitable, resilient, and sustainable AFSs

Socio-technical Innovation Bundles for Agri-food Systems Transformation

ISSN:2398-962