Sweet potato revisited

In Britain, the sweet potato is a new and exotic addition to the variety of vegetables on offer in retail outlets. However, elsewhere, especially in tropical developing countries, it has been a safeguard against hunger for centuries. The good nutritional qualities and range of sensory characteristics of the sweet potato are now being re-explored on an international level with a view to development and promotion of the crop and its processed food products in both developed and developing countries.     

PATTERNS OF DISABILITY RELATED TO JOINT INVOLVEMENT IN RHEUMATOID ARTHRITIS

The relationship between particular disabilities and specificimpairments of which these disabilities could be the consequencehas been explored. Assessments of performance of activitiesof daily living (ADL) have been simplified by factor analysis,and the resultant factors have been related to the sites ofjoint involvement in patients with rheumatoid arthritis. Ourpreliminary findings on the grouping together of various ADLactivities are meaningful in terms of underlying impairments,and at the same time indicate an approach for simplificationof ADL assessments so as to enhance their value for researchand the evaluation of outcome. The results are entirely consistentwith a comprehensive model of disablement. ^*Based on a paper presented to the inaugural meeting of theSociety for Research in Rehabilitation, June 1978     

Spinal cord injuries in young children: a review of children injured at 5 years of age and younger

Aim To determine the epidemiology and complications of spinal cord injuries (SCIs) in children injured at 5 years of age and younger who were seen between 1981 and 2008 at a children’s hospital in the USA. Method Complications studied were scoliosis, hip dysplasia, latex allergies, autonomic dysreflexia, pressure ulcers, spasticity, deep venous thrombosis, and kidney stones. Demographic and injury‐related factors included age at injury, etiology, level of injury, American Spinal Injury Association Impairment Scale (AIS), and SCIs without radiological abnormalities (SCIWORA). Results Of the 159 individuals seen (92 males, 67 females) median age at injury was 2 years (range 0y–5y 11mo). Forty‐nine percent were injured in vehicular accidents, 60% had complete injuries, 66% had paraplegia, and 72% had SCIWORA. Ninety‐six percent developed scoliosis, 57% had hip dysplasia, and 7% had latex allergy. Thirty‐four percent with injuries at or above T6 experienced autonomic dysreflexia, 41% developed pressure ulcers, and 61% experienced spasticity. Of those without bowel or bladder control, 82% were on intermittent catheterization and 69% were on a bowel program. Median age of initiating wheelchair use was 3 years 4 months (range 1y 2mo–12y 5mo). Twenty‐four were community ambulators, and they were more likely to have AIS D lesions (half the key muscle functions below the level of injury have a muscle grade 3 or greater) and less likely to have skeletal complications. Interpretation The epidemiology, complications, and manifestations of SCIs in children injured at a young age are unique and differ distinctively from adolescent and adult‐onset SCIs.     

Safety of Transcatheter Aortic Valve Implantation in a Hospital With Visiting On‐Site Cardiac Surgery

Objectives

To describe the feasibility and safety of transcatheter aortic valve implantation (TAVI) with a visiting on‐site cardiac surgery program for surgical back‐up.

Background

Both European and American guidelines recommend institutional cardiac surgery back‐up for TAVI. However, the conversion to cardiac surgery is very rare, many complications of TAVI can be managed by catheter techniques and a visiting team can also provide surgical stand‐by. Therefore, the need for institutional cardiac surgery (by a surgeon who routinely performs conventional surgical valve replacement at the institution performing TAVI) has been questioned.

Methods

A retrospective review of consecutive TAVI cases with visiting on‐site cardiac surgery was performed. Key demographic, echocardiographic, and procedural data were collected prospectively.

Results

A total of 97 patients (81.9 ± 6.3 years) with high‐risk criteria (log Euroscore 21.6 ± 14.4, chronic renal failure 39.2%, severe systolic dysfunction 24.7%) underwent TAVI with visiting on‐site cardiac surgery at our institution. Local anesthesia with or without conscious sedation was used in 94.8% of patients. Procedural technical success was 100%, with 2 episodes of tamponade (both treated with pericardiocentesis) and a 16.5% vascular complication rate (all treated conservatively or percutaneously). Thirty‐day mortality was 3.1%, with 5.2% rate of stroke and 8.2% rate of major bleeding. There were no conversions to surgery.

Conclusions

TAVI can be done safely in the setting of a hospital with visiting on‐site cardiac surgery. This requires careful patient selection, experienced operators and surgeons in experienced centers with well‐established criteria and processes of care. In this setting, it may be an option for hospitals without institutional cardiac surgery. (J Interven Cardiol 2015;28:76–81)

     

A Gastroesophageal Electrode for Atrial and Ventricular Pacing

Temporary transvenous cardiac pacing requires technical expertise and access to fluoroscopy. We have developed a gastroesophageal electrode capable of atrial and ventricular pacing. The flexible polythene gastroesophageal electrode is passed into the stomach under light sedation. Five ring electrodes, now positioned in the lower esophagus, are used for atrial pacing. A point source (cathode) on the distal tip of the electrode, now positioned in the gastric fundus. is used for ventricular pacing. Two configurations of atrial and ventricular pacing were compared: unipolar and bipolar. During unipolar ventricular pacing the indifferent electrode (anode) was a high impedance chest pad. For bipolar ventricular pacing the indifferent electrode was a ring electrode placed 2 cm proximal to the tip. Unipolar atrial pacing was performed with 1 of 5 proximal ring electrodes acting as cathode ("cathodic") or as anode ("anodic") in conjunction with a chest pad. Bipolar atrial pacing was performed using combinations of 2 of 5 ring electrodes. Atrial capture was obtained in all 55 subjects attempted. When all electrode combinations were compared, atrial capture was significantly more frequent using the bipolar approach (153/210 bipolar, 65/210 unipolar; t = 7.37, P < 0.001). For unipolar atrial pacing, cathodic stimulation (from esophagus) was more successful than anodic stimulation (cathodic 62/105, anodic 20/105; t = 5.81, P < 0.001). In 43 subjects attempted unipolar ventricular pacing resulted in a higher frequency of capture than the bipolar approach (unipolar 41/43 (95.3%), bipolar 19/43 (44.2%); P < 0.001). In conclusion, atrial pacing was optimal using pairs of ring electrodes ("bipolar") while ventricular pacing was optimal using the distal electrode tip (cathode) in conjunction with a chest pad electrode ("unipolar"). This gastroesophageal electrode may be useful in the emergency management of acute bradyarrhythmias and for elective electrophysiological studies.     

US State Polarization,Policymaking Power,and Population Health

Policy Points

• Explanations for the troubling trend in US life expectancy since the 1980s should be grounded in the dynamic changes in policies and political landscapes. Efforts to reverse this trend and put US life expectancy on par with other high‐income countries must address those factors.
• Of prime importance are the shifts in the balance of policymaking power in the United States, the polarization of state policy contexts, and the forces behind those changes.

The troubling trend in us life expectancy and the widening disparities in life expectancy across the United States have deep roots. This article posits that both trends are grounded in the dynamic changes in the policy and political landscapes since the 1980s. It first briefly describes the trends and the importance of excavating their structural roots. It then builds the case that changes in state policies and politics, as well as the forces behind those changes, are key explanations for both trends.     

Cardiovascular recovery from stress and hypertension risk factors: A meta-analytic review

Recent research has suggested that cardiovascular recovery from stress can play a potential role in hypertension pathogenesis. Sixty nine studies were included in meta analytic review to evaluate the effect of various hypertension risk factors (e.g., race, lack of exercise) on cardiovascular recovery from stress. Small mean effect sized were observed for studies examining hypertension status and race as risk factors associated with delayed diastolic blood pressure recovery. Lack of fitness was also associated with delayed heart rate recovery. These results revealed that, for the specified risk factors and cardiovascular variables, high risk individuals exhibited delayed cardiovascular recovery as compared with low risk individuals. Further, the relationships between hypertension status, race and cardiovascular recovery were typically associated with the use of “ctive” laboratory stressors. The relationship between lack of fitness and cardiovascular recovery was also associated with the use of “active” and exercise laboratory stressors.