Outcomes of Adult Patients with Small Body Size Supported with a Continuous-Flow Left Ventricular Assist Device

There is insufficient data on patients with small body size to determine if this should be considered a risk factor for continuous-flow left ventricular assist device (CF-LVAD) support. We sought to evaluate survival outcomes, adverse events, and functional status of CF-LVAD patients with body surface area (BSA) <1.5 m2 in a large national registry. Adults with BSA < 1.5 m2 (n = 128) implanted with a HeartMate II (HMII)-LVAD from the Interagency Registry for Mechanically Assisted Circulatory Support registry from April 2008 to December 2012 formed this cohort. Outcomes were compared with HMII bridge to transplant (BTT) and destination therapy (DT) post approval studies. The majority of patients were female (n = 106, 83%). A total of 64% (n = 82) were implanted for BTT and 36% (n = 46) for DT. The median BSA (range) was 1.44 (1.19–1.49) and 1.45 (1.25–1.49) m2 for BTT and DT, respectively. Overall survival 1 year post implant was 81% ± 5% for BTT and 84% ± 6% for DT. The most common adverse events for BTT and DT patients were bleeding (0.91, 0.88 events/patient year) and driveline infection (16%, 0.28 events/patient year). Six months post implantation, 87% of BTT and 77% of DT patients were New York Heart Association functional class I or II. Post implant survival, functional status improvement, and adverse event profile for adult BTT and DT HMII patients with BSA < 1.5 m2 are favorable and comparable with outcomes published in the overall patient population

Improving Aviation Safety through Modeling Accident Risk Assessment of Runway

The exponential increase in aviation activity and air traffic in recent decades has raised several public health issues. One of the critical public health concerns is runway safety and the increasing demand for airports without accidents. In addition to threatening human lives, runway accidents are often associated with severe environmental and pollution consequences. In this study, a three-step approach is used for runway risk assessment considering probability, location, and consequences of accidents through advanced statistical methods. This study proposes novel models for the implementation of these three steps in Iran. Data on runway excursion accidents were collected from several countries with similar air accident rates. The proposed models empower engineers to advance an accurate assessment of the accident probability and safety assessment of airports. For in-service airports, it is possible to assess existing runways to remove obstacles close to runways if necessary. Also, the proposed models can be used for preliminary evaluations of developing existing airports and the construction of new runways. Document type: Articl

Predictors of right ventricular failure after left ventricular assist device implantation

Number of left ventricular assist device (LVAD) implantations increases every year, particularly LVADs for destination therapy (DT). Right ventricular failure (RVF) has been recognized as a serious complication of LVAD implantation. Reported incidence of RVF after LVAD ranges from 6% to 44%, varying mostly due to differences in RVF definition, different types of LVADs, and differences in patient populations included in studies. RVF complicating LVAD implantation is associated with worse postoperative mortality and morbidity including worse end-organ function, longer hospital length of stay, and lower success of bridge to transplant (BTT) therapy. Importance of RVF and its predictors in a setting of LVAD implantation has been recognized early, as evidenced by abundant number of attempts to identify independent risk factors and develop RVF predictor scores with a common purpose to improve patient selection and outcomes by recognizing potential need for biventricular assist device (BiVAD) at the time of LVAD implantation. The aim of this article is to review and summarize current body of knowledge on risk factors and prediction scores of RVF after LVAD implantation. Despite abundance of studies and proposed risk scores for RVF following LVAD, certain common limitations make their implementation and clinical usefulness questionable. Regardless, value of these studies lies in providing information on potential key predictors for RVF that can be taken into account in clinical decision making. Further investigation of current predictors and existing scores as well as new studies involving larger patient populations and more sophisticated statistical prediction models are necessary. Additionally, a short description of our empirical institutional approach to management of RVF following LVAD implantation is provide

Comparative evaluation of LAMP and Nested-PCR for the diagnosis of bovine paratuberculosis

AbstractIntroductionMycobacterium avium subsp. paratuberculosis causes paratuberculosis (Johne’s disease), a systemic infection and chronic inflammation of the intestine that affects many species, including bovine. Infection is widespread in livestock, and human populations are exposed. A possible association between MAP infection and Crohn’s disease in humans has been also described. Effective control of paratuberculosis has hampered due to lake of rapid and accurate diagnostic test. Range of diagnostic tests is available, but all have inborn limitations. The present study was designed to develop a loop-mediated isothermal amplification (LAMP) assay for the rapid and simple detection of Mycobacterium avium subsp. paratuberculosis (MAP).Materials and methodsSix primers were specially designed for recognizing eight distinct sequence of insertion sequence 900 (IS900). To determine the sensitivity of the LAMP assay, 10-fold serial dilutions were made from 431ng/μl MAP stock solution and compared with Nested-PCR results obtained using similar templates at identical concentrations. Detection limit of the LAMP was defined as the last positive dilution and the reactions were performed four times to examine the reproducibility of the test. The specificity of the assays were evaluated by testing three Gram-positive bacteria including Mycobacterium bovis AN5, Mycobacterium tuberculosis DT and Mycobacterium avium avium.ResultsSensitivity of this assay for detection of DNA of MAP was 4fg/μl and the specificity was 100%. This assay successfully detected MAP not only in the bacterial cultures but also in clinical fecal samples and the specificity of both PCR was 100%. This LAMP method is performed under isothermal conditions and no special apparatus is needed. In addition, its reactivity is directly observed with the naked eye without electrophoresis either as turbidity or in the form of a color change when SYBR Green 1, a fluorescent dsDNA intercalating dye, is employed.ConclusionsThis assay is rapid which requires nearly 1h for detection of MAP, low in cost and simple to perform, sensitive and practical tool for the detection of MAP and will be useful in facilitating the early diagnosis of paratuberculosis (Johne’s disease) caused by the organism

Improving Aviation Safety through Modeling Accident Risk Assessment of Runway

The exponential increase in aviation activity and air traffic in recent decades has raised several public health issues. One of the critical public health concerns is runway safety and the increasing demand for airports without accidents. In addition to threatening human lives, runway accidents are often associated with severe environmental and pollution consequences. In this study, a three-step approach is used for runway risk assessment considering probability, location, and consequences of accidents through advanced statistical methods. This study proposes novel models for the implementation of these three steps in Iran. Data on runway excursion accidents were collected from several countries with similar air accident rates. The proposed models empower engineers to advance an accurate assessment of the accident probability and safety assessment of airports. For in-service airports, it is possible to assess existing runways to remove obstacles close to runways if necessary. Also, the proposed models can be used for preliminary evaluations of developing existing airports and the construction of new runways