Worldwide Experience with the Robotic Navigation System in Catheter Ablation of Atrial Fibrillation: Methodology, Efficacy and Safety

Worldwide Survey on Robotic AF Ablation . Introduction: The Hansen Robotic system has been utilized in ablation procedures for atrial fibrillation (AF). However, because of the lack of tactile feedback and the rigidity of the robotic sheath, this approach could result in higher risk of complications. This worldwide survey reports a multicenter experience on the methodology, efficacy, and safety of the Hansen system in AF ablations. Methods and Results: A questionnaire addressing questions on patient's demographics, procedural parameters, ablation success rate and safety information was sent to all centers where more than 50 robotic AF ablation cases have been performed. From June 2007 to December 2009, 1,728 procedures were performed at 12 centers utilizing the Hansen robotic navigation technology. The overall complication rate was 4.7% and the success rate was 67.1% after 18 ± 4 months of follow‐up. In 5 low volume centers there appeared to be a learning curve of about 50 cases (complication rate 11.2% for the first 50 cases vs 3.7% for the 51–100 cases; P = 0.044) and a trend showing a decrease of complication rate with increasing case volume. However, in the remaining 7 centers no learning curve was present and the complication rate was stable over time (3.7% for the first 50 cases vs 3.6% for the 51st case thereafter; P = 0.942). Conclusion: The Hansen robotic system can be used for AF ablation safely. In low volume centers, there appeared to be a learning curve of the first 50 cases after which the complication rate decreased. With a higher case volume, the success rate increased. (J Cardiovasc Electrophysiol, Vol. 23, pp. 820‐826, August 2012)     

Endothelin in coronary artery disease

Abstract

Objectives. The aim of the present study was to compare changes in circulating levels of proopiomelanocortin (POMC) derivates and lactate after remote ischemic preconditioning (IPC) and physical exercise. Introduction. Remote IPC (rIPC) is cardioprotective following acute myocardial infarction and major cardiac surgery. A blood-borne, transferable factor, released following not only rIPC but also vigorous exercise, mediates protection that is abolished by naloxone suggesting involvement of an opioid-receptor-dependent pathway. Design. Eight healthy volunteers underwent rIPC by four cycles of 5-min inflation of a pneumatic tourniquet to 200 mmHg interrupted by 5 min of deflation. Subsequently, circulating plasma levels of POMC derivates, cortisol, and lactate were measured. After 3 days, the volunteers completed a vigorous exercise program, after which the same compounds were measured. Results. While rIPC was not associated with any significant increase in circulating POMC derivates or lactate, exercise induced significant elevation of both compared with baseline. Conclusions. We were not able to demonstrate a detectable increase in circulating POMC derivates by a standard rIPC stimulus, suggesting that rIPC effect is not mediated by local or detectable central release of these derivates.     

Rural and remote health research: Does the investment match the need?

Objective

To determine the percentage of research projects funded by the National Health and Medical Research Council in the period 2000–2014 that aimed specifically to deliver health benefits to Australians living in rural and remote areas and to estimate the proportion of total funding this represented in 2005–2014.

Design

This is a retrospective analysis of publicly available datasets.

Setting

National Health and Medical Research Council Rural and Remote Health Research 2000–2014.

Outcome measures

‘Australian Rural Health Research’ was defined as: research that focussed on rural or remote Australia; that related to the National Health and Medical Research Council's research categories other than Basic Science; and aimed specifically to improve the health of Australians living in rural and remote areas. Grants meeting the inclusion criteria were grouped according to the National Health and Medical Research Council's categories and potential benefit. Funding totals were aggregated and compared to the total funding and Indigenous funding for the period 2005–2014.

Results

Of the 16 651 National Health and Medical Research Council‐funded projects, 185 (1.1%) that commenced funding during the period 2000–2014 were defined as ‘Australian Rural Health Research’. The funding for Australian Rural Health Research increased from 1.0% of the total in 2005 to 2.4% in 2014. A summary of the funding according to the National Health and Medical Research Council's research categories and potential benefit is presented.

Conclusion

Addressing the health inequality experienced by rural and remote Australians is a stated aim of the Australian Government. While National Health and Medical Research Council funding for rural health research has increased over the past decade, at 2.4% by value, it appears very low given the extent of the health status and health service deficits faced by the 30% who live in rural Australia.     

The extent of soil loss across the US Corn Belt

Soil erosion in agricultural landscapes reduces crop yields, leads to loss of ecosystem services, and influences the global carbon cycle. Despite decades of soil erosion research, the magnitude of historical soil loss remains poorly quantified across large agricultural regions because preagricultural soil data are rare, and it is challenging to extrapolate local-scale erosion observations across time and space. Here we focus on the Corn Belt of the midwestern United States and use a remote-sensing method to map areas in agricultural fields that have no remaining organic carbon-rich A-horizon. We use satellite and LiDAR data to develop a relationship between A-horizon loss and topographic curvature and then use topographic data to scale-up soil loss predictions across 3.9 × 10⁵ km² of the Corn Belt. Our results indicate that 35 ± 11% of the cultivated area has lost A-horizon soil and that prior estimates of soil degradation from soil survey-based methods have significantly underestimated A-horizon soil loss. Convex hilltops throughout the region are often completely denuded of A-horizon soil. The association between soil loss and convex topography indicates that tillage-induced erosion is an important driver of soil loss, yet tillage erosion is not simulated in models used to assess nationwide soil loss trends in the United States. We estimate that A-horizon loss decreases crop yields by 6 ± 2%, causing $2.8 ± $0.9 billion in annual economic losses. Regionally, we estimate 1.4 ± 0.5 Pg of carbon have been removed from hillslopes by erosion of the A-horizon, much of which likely remains buried in depositional areas within the fields.

Productive agricultural soils are vital for producing food for a growing global population (1–3). However, degradation of soil quality by erosion reduces crop yields, which can result in food insecurity, conflict (3), and the decline of civilizations (4). Degradation of soils leads not only to economic losses for farmers but also a loss in ecosystem services (5), which alters the ability of soils to regulate hydrologic and biogeochemical cycles. Widespread use of synthetic fertilizers to enhance the function of degraded soils increases food production costs (6) and impairs water resources (7), which negatively impacts human health (8) and aquatic ecosystems (9).Globally, the reservoir of carbon stored in soils is three times that in the atmosphere (10) and given the extent of agricultural land use (11), understanding soil carbon dynamics in agricultural systems is critical to understanding the carbon cycle (12). Whether soil erosion constitutes a net carbon sink or source depends on both the depositional fate of the eroded carbon and the ability to replace carbon in degraded soils (13–15). If biological productivity replaces eroded carbon, and decomposition of carbon stored in sedimentary deposits is halted or slowed, then soil erosion is a net sink of atmospheric carbon (14–17). However, if eroded carbon rapidly decomposes and is not replaced in eroded soil horizons, then soil erosion constitutes a carbon source. Restoring carbon to degraded soils therefore has potential to both reestablish soil function and sequester atmospheric CO₂ (10). However, quantifying the impacts of soil degradation on agricultural productivity and the carbon cycle first requires robust estimates of the magnitude of agriculturally induced soil loss (14, 16).Although thousands of soil erosion measurements have been made globally (18), the lack of a robust and scalable method for estimating the magnitude of erosion in agricultural landscapes remains a major gap in soil erosion research (19). Large-scale assessments of soil erosion are often based on model predictions (20–22) or qualitative information from soil surveys regarding the degree of soil degradation (23). In the United States, for example, nationwide soil loss trends (24) are simulated using water and wind erosion models that have been calibrated with erosion measurements made on small plots over a period of decades (21, 25). It has been debated whether upscaling such predictions to regional or national scales results in an accurate assessment of the current magnitude of soil loss in the United States (26, 27). Whereas such models are useful for assessing relative rates of erosion for soil conservation planning, the soil loss predictions do not provide information regarding the cumulative soil loss that has occurred since the initiation of cultivation, and hence the overall magnitude of agricultural soil degradation.To assess the degree of cumulative soil degradation, soil surveys conducted by the US Department of Agriculture have assigned erosion classes to soils based on the percentage of the original A horizon that has been eroded (28). Because the A horizon has the largest fraction of soil organic carbon within the soil profile, it is a key component of water and nutrient retention and soil productivity (29). Soils where 100% of the A-horizon thickness has been removed are designated as Class 4 eroded soils, and other classes represent lesser reductions in A-horizon thickness (<25%, 25 to 75%, and >75% for Classes 1, 2, and 3, respectively). A major disadvantage of the use of erosion classes is that properly assigning classes based on the percentage of A-horizon loss requires accurate determination of the original A-horizon thickness on all topographic positions (30). Hence, although soil erosion classes indicate soil degradation is widespread (23) we do not have a robust, quantitative understanding of how much soil has already been lost.Here we present results from a remote sensing method used to estimate the spatial extent of agriculturally induced loss of A-horizon soil for a major global agricultural region, the Corn Belt of the midwestern United States. Rather than simulate or measure short-term soil loss rates, we combine measurements of soil-surface reflectance in the visible spectrum (soil color) with high-resolution satellite imagery to directly measure the proportion of the agriculturally cultivated landscape that has completely lost its original A horizon. Combining our spectral analysis with relationships between A-horizon soil loss and topography derived from high-resolution LiDAR topographic data allows us to predict A-horizon soil loss in areas where images are not available. We find that historical soil erosion has completely removed A-horizon soil from approximately one-third of the Corn Belt. The spatial patterns of soil loss suggest that key erosion mechanisms are not simulated in nationwide assessments of soil erosion trends in the United States and that soil survey data greatly underestimate the extent of A-horizon loss.     

Using Remote Communication Technology in Insulin Pump Training: A Feasibility Study

Purpose:

This feasibility study was designed to examine if remote communication technology can be used in the technical training of an insulin pump in adults with diabetes who were familiar with insulin pump therapy.

Methods:

Surveys were emailed to 69 individuals who purchased an insulin pump and had been trained by the manufacturer’s diabetes educators. In consultation with providers, participants were given the choice of receiving training in a face-to-face meeting or via remote communication technology. The survey consisted of 27 questions asking participants’ characteristics, device proficiency, confidence, and their satisfaction with the insulin pump and the training method. Differences between the 2 groups were examined using bivariate analyses.

Results:

There were 17 participants in the remote group and 20 participants in the face-to-face group. Participants had a mean age of 40.9 ± 14.3 years, had diabetes for 24.3 ± 13.8 years, and used an insulin pump for 9.8 ± 4.9 years. The participants in both groups were not statistically different in age, diabetes history, years on insulin pump, device proficiency, confidence, or satisfaction with the training method. The remote group reported less graduate-level education (P < .05) and higher satisfaction scores with the insulin pump training (P < .05).

Conclusion:

Although this study has limitations associated with the small sample size and self-selection bias, the results suggest that remote communication technology may be an effective tool to provide technical training to adults who are familiar with insulin pump therapy. Additional research is required to determine the effectiveness of the remote insulin pump training.     

医用中心供氧远程抄表管理系统的设计与应用

目的：研发一套可用于计量医院各病区氧气流量的远程自动抄表管理系统。方法：采用气体质量流量计作为计量装置,运用串口通信技术实现远程抄表,通过后台管理软件实现临床科室用氧管理及数据分析。结果：系统实现了远程自动抄表、流量实时监测、管道泄漏或流量计失常报警、打印报表等功能。结论：该系统实现了远程集中周期自动抄表,能够实时流量监测,及时掌握医院用氧动态,判断泄漏情况或流量计失常报警,提高用氧安全性。     

Delayed remote preconditioning induces cardioprotection: role of heme oxygenase-1

Background

The role of heme oxygenase-1 (HO-1) in the cardioprotection induced by delayed remote ischemic preconditioning (DRIPC) has not been investigated. Therefore, this study was designed to investigate whether HO-1 is involved in DRIPC-mediated cardioprotection in an isolated perfused rat heart model.

Materials and methods

Isolated rat hearts were subjected to 30 min ischemia followed by 60 min reperfusion. DRIPC (four cycles 5-min occlusion and 5-min reflow at the unilateral hind limb once per day for 1, 2, or 3 d before heart isolation, abbreviated as D1RIPC, D2RIPC, or D3RIPC respectively). Infarct size, myocardial troponin levels, and heart function were measured. The protein and messenger RNA levels of HO-1 were determined.

Results

DRIPC facilitated postischemic cardiac functional recovery and decreased cardiac enzyme release. The infarct size-limiting effect of DRIPC was more pronounced in the D3RIPC group (10.22 ± 2.57%) than the D1RIPC group (22.34 ± 4.02%, P < 0.001) or the D2RIPC group (14.60 ± 3.13%, P = 0.034). These effects in the D1RIPC group could be blocked by Zinc Protoporphyrin IX (ZnPP) (an HO-1 specific inhibitor). DRIPC-mediated cardioprotection was associated with enhanced HO-1 protein expression (D1RIPC, 0.11 ± 0.03; versus 0.15 ± 0.06 in the D2RIPC group, P = 0.06; versus 0.20 ± 0.04 in the D3RIPC group, P = 0.04) and messenger RNA levels of HO-1 expression.

Conclusions

Our findings suggest that HO-1 is involved in the cardioprotection induced by DRIPC, and that increase in the number of preconditioning stimuli may enhance cardioprotective effects accompanied with increased HO-1 level.