The Importance of Lead Positioning to Improve Clinical Outcomes in Cardiac Resynchronization Therapy

Left ventricular (LV) lead positioning is one of the main contributors to the cardiac resynchronization therapy (CRT) response. Conventional left ventricular (LV) lead implantation faces several difficulties, which may ultimately affect lead stability and performance. Several imaging techniques have been proposed to overcome all these obstacles including multimodality cardiac imaging to help in preprocedural or intraprocedural identification of the latest activated areas of the LV. Emerging pacing strategies like LV multisite and multipoint pacing may help deliver an enhanced response to CRT, but prospective trials are warranted to confirm the superiority of this approach

Cardiac rehabilitation after catheter ablation of atrial fibrilation

Atrial fibrillation is the most common arrhythmia worldwide. Besides antiarrhythmic drugs and electrical cardioversion, atrial fibrillation can be treated with a newer technique called catheter ablation. Patients suffering a catheter ablation can benefit from an integrated rehabilitation programme like all other patients suffering a cardiac surgery. Physical training and psycho-educative consultations are specific after catheter ablation and integrated rehabilitation can improve mental health, physical capacity and permits return to sports activities

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

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Introduction and objective: This study correlates the Singing Voice Handicap Index (SVHI) scores with videostrobolaryngoscopy and acoustic analysis in healthy professional singers, as a measure of self-perceived vocal health, versus actual pathology diagnosed during examination by stroboscopy, or by modification at the acoustic voice evaluation. The objectives of the study were to measure the strength of self-assessment among professional singers and to determine whether there is a benefit of combining SVHI, acoustic analysis and videostrobolaryngoscopy for the routine assessment of singers who have no obvious singing voice problem. Method: Prospective cross-sectional study. The voice quality of 40 students of the Music Academy, Cluj-Napoca, was assessed by means of a multidimensional test battery containing a singing voice handicap index (SVHI), as well as SVHI-10, videolaryngostroboscopy, maximum phonation time on vowel /a/, S/Z ratio, Jitter, Shimmer and NHR (Harmonic Noise Ratio, at lowest, highest and conversational frequency). Additionally, in a questionnaire on daily habits has been recorded for the participants, covering the prevalence of smoking, eating habits, and vocal abuse. The correlation between SVHI scores, acoustic analysis and pathologic findings seen on videostrobolaryngoscopy was analyzed using linear regression and serial t tests to draw the conclusions of this study. Results: Both SVHI and SVHI-10 scores showed, as previously expected, normal values for healthy singers (SVHI-10 being the singers preferred metric). However, although all participants self-identified as healthy, laryngeal abnormalities were relatively common. Acoustic analysis of students voices identified relative instability of pitches, problems with F0 variation, TMF (Maximum Phonation Time) and S/Z ratio. No Significant correlation (P = 0.9501) between SVHI scores, acoustic analysis and videostrobolaryngoscopy findings were shown by the linear regression analysis. Conclusions: Multidimensional assessment of voice quality for the routine evaluation of singers without obvious singing voice problems is an important tool for the early detection of voice problems, despite appearances of a healthy voice. A trained singer has the possibility to compensate minor laryngeal modifications using singing techniques and, thus, is at risk of overlooking or ignoring an existing pathology. In conclusion, acoustic evaluation of the performers’ voices through the methods outlined above could assist in early detection and treatment of vocal pathology.Introducción y objetivo: Este estudio correlaciona el índice de deficiencia de voz de canto (SVHI) con videolaringoestroboscopia y análisis acústico en cantantes profesionales sanos, como una medida de la salud vocal subjetiva, contra la patología actual diagnosticada durante el examen por estroboscopia, o por la modificación en la evaluación acústica de la voz. Los objetivos del estudio eran medir la fuerza de autovaloración entre cantantes profesionales y determinar si hay una ventaja de combinar SVHI, el análisis acústico y videolaringoestroboscopia para la evaluación rutinaria de cantantes que no tienen ningún problema de voz de canto evidente. Método: Estudio prospectivo. La calidad de voz de 40 estudiantes de la Academia de Música Cluj-Napoca, fue evaluada mediante una batería multidimensional de pruebas que contiene un índice de deficiencia de voz de canto (SVHI), así como SVHI-10, videolaringoestroboscopia, tiempo de fonación máximo en vocal /a/, proporción de S/Z, Jitter, Shimmer y NHR (Harmonic Noise Ratio, en la frecuencia más baja, más alta y conversacional). Además, los participantes anotaron en un custionario sus hábitos diarios, como hábito tabáquico, hábitos de comida y abuso vocal. La correlación entre os datos de SVHI, análisis acústico y halllazgos patológicos en videolaringoestroboscopia fue analizada usando la regresión lineal y t-test. Resultados: Tanto el SVHI como los datos de SVHI-10 mostraron valores de referencia para cantantes sanos (SVHI-10 fue la evaluación preferida). Sin embargo, aunque todos los participantes se identificaron como sanos, las anomalías laríngeas fueron relativamente comunes. El análisis acústico de las voces de los estudiantes identificó inestabilidad relativa de entonación, problemas con la variación F0, el TMF (Tiempo de Fonación Máximo) y la proporción S/Z. No se halló correlación significativa en el análisis de regresión lineal entre las medidas de SVHI, análisis acústico y los hallazgos de la videolaringoestroboscopia (p= 0,9501). Conclusiones: la evaluación multidimensional de la calidad de voz para la evaluación rutinaria de cantantes sin problemas de voz de canto obvios es un instrumento importante para el descubrimiento temprano de problemas de voz, a pesar de tener una voz aparentemente sana. Un cantante entrenado tiene la posibilidad de compensar una patología laríngea menor mediante técnicas de canto con el peligro de pasar por alto o no detectar una patología existente. Para concluir, la evaluación acústica de la voz puede descubrir patología de voz precozmente y permitir el tratamiento de la patología vocal

Thermogravitational Convection of Hybrid Nanofluid in a Porous Chamber with a Central Heat-Conducting Body

A problem with the thermogravitational energy transference of a hybrid nanofluid (Al2O3-SiO2/H2O) in a porous space with a central heat-conducting body has been presented and numerical analysis has been performed. Governing equations, transformed in terms of non-dimensional parameters, have been solved by a developed numerical algorithm based on the finite difference technique. The behavior of streamlines and isotherms was investigated, and the impact of various important characteristics is discussed. The variation in the average and local Nusselt numbers was studied; by selecting various appropriate nano-sized particle combinations in hybrid nanosuspension, the desired energy transport strength could be obtained. The results were compared and successfully validated with previous reported numerical and experimental data from the literature