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Background: Increased mortality risk is associated with short-term temperature variability. However, to our knowledge, there has been no comprehensive assessment of the temperature variability-related mortality burden worldwide. In this study, using data from the MCC Collaborative Research Network, we first explored the association between temperature variability and mortality across 43 countries or regions. Then, to provide a more comprehensive picture of the global burden of mortality associated with temperature variability, global gridded temperature data with a resolution of 0·5° × 0·5° were used to assess the temperature variability-related mortality burden at the global, regional, and national levels. Furthermore, temporal trends in temperature variability-related mortality burden were also explored from 2000–19. Methods: In this modelling study, we applied a three-stage meta-analytical approach to assess the global temperature variability-related mortality burden at a spatial resolution of 0·5° × 0·5° from 2000–19. Temperature variability was calculated as the SD of the average of the same and previous days’ minimum and maximum temperatures. We first obtained location-specific temperature variability related-mortality associations based on a daily time series of 750 locations from the Multi-country Multi-city Collaborative Research Network. We subsequently constructed a multivariable meta-regression model with five predictors to estimate grid-specific temperature variability related-mortality associations across the globe. Finally, percentage excess in mortality and excess mortality rate were calculated to quantify the temperature variability-related mortality burden and to further explore its temporal trend over two decades. Findings: An increasing trend in temperature variability was identified at the global level from 2000 to 2019. Globally, 1 753 392 deaths (95% CI 1 159 901–2 357 718) were associated with temperature variability per year, accounting for 3·4% (2·2–4·6) of all deaths. Most of Asia, Australia, and New Zealand were observed to have a higher percentage excess in mortality than the global mean. Globally, the percentage excess in mortality increased by about 4·6% (3·7–5·3) per decade. The largest increase occurred in Australia and New Zealand (7·3%, 95% CI 4·3–10·4), followed by Europe (4·4%, 2·2–5·6) and Africa (3·3, 1·9–4·6). Interpretation: Globally, a substantial mortality burden was associated with temperature variability, showing geographical heterogeneity and a slightly increasing temporal trend. Our findings could assist in raising public awareness and improving the understanding of the health impacts of temperature variability. Funding: Australian Research Council, Australian National Health & Medical Research Council. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Studies have investigated the effects of heat and temperature variability (TV) on mortality. However, few assessed whether TV modifies the heat-mortality association. Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries. TV was calculated as the standard deviation of the average of the same and previous days’ minimum and maximum temperatures. We used location-specific quasi-Poisson regression models with an interaction term between the cross-basis term for mean temperature and quartiles of TV to obtain heat-mortality associations under each quartile of TV, and then pooled estimates at the country, regional, and global levels. Results show the increased risk in heat-related mortality with increments in TV, accounting for 0.70% (95% confidence interval [CI]: −0.33 to 1.69), 1.34% (95% CI: −0.14 to 2.73), 1.99% (95% CI: 0.29–3.57), and 2.73% (95% CI: 0.76–4.50) of total deaths for Q1–Q4 (first quartile–fourth quartile) of TV. The modification effects of TV varied geographically. Central Europe had the highest attributable fractions (AFs), corresponding to 7.68% (95% CI: 5.25–9.89) of total deaths for Q4 of TV, while the lowest AFs were observed in North America, with the values for Q4 of 1.74% (95% CI: −0.09 to 3.39). TV had a significant modification effect on the heat-mortality association, causing a higher heat-related mortality burden with increments of TV. Implementing targeted strategies against heat exposure and fluctuant temperatures simultaneously would benefit public health. © 2022 The Author(s)

BACKGROUND: Many regions of the world are now facing more frequent and unprecedentedly large wildfires. However, the association between wildfire-related PM2·5 and mortality has not been well characterised. We aimed to comprehensively assess the association between short-term exposure to wildfire-related PM2·5 and mortality across various regions of the world. METHODS: For this time series study, data on daily counts of deaths for all causes, cardiovascular causes, and respiratory causes were collected from 749 cities in 43 countries and regions during 2000-16. Daily concentrations of wildfire-related PM2·5 were estimated using the three-dimensional chemical transport model GEOS-Chem at a 0·25° × 0·25° resolution. The association between wildfire-related PM2·5 exposure and mortality was examined using a quasi-Poisson time series model in each city considering both the current-day and lag effects, and the effect estimates were then pooled using a random-effects meta-analysis. Based on these pooled effect estimates, the population attributable fraction and relative risk (RR) of annual mortality due to acute wildfire-related PM2·5 exposure was calculated. FINDINGS: 65·6 million all-cause deaths, 15·1 million cardiovascular deaths, and 6·8 million respiratory deaths were included in our analyses. The pooled RRs of mortality associated with each 10 μg/m3 increase in the 3-day moving average (lag 0-2 days) of wildfire-related PM2·5 exposure were 1·019 (95% CI 1·016-1·022) for all-cause mortality, 1·017 (1·012-1·021) for cardiovascular mortality, and 1·019 (1·013-1·025) for respiratory mortality. Overall, 0·62% (95% CI 0·48-0·75) of all-cause deaths, 0·55% (0·43-0·67) of cardiovascular deaths, and 0·64% (0·50-0·78) of respiratory deaths were annually attributable to the acute impacts of wildfire-related PM2·5 exposure during the study period. INTERPRETATION: Short-term exposure to wildfire-related PM2·5 was associated with increased risk of mortality. Urgent action is needed to reduce health risks from the increasing wildfires. FUNDING: Australian Research Council, Australian National Health & Medical Research Council. Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Background: Exposure to cold or hot temperatures is associated with premature deaths. We aimed to evaluate the global, regional, and national mortality burden associated with non-optimal ambient temperatures. Methods: In this modelling study, we collected time-series data on mortality and ambient temperatures from 750 locations in 43 countries and five meta-predictors at a grid size of 0·5° × 0·5° across the globe. A three-stage analysis strategy was used. First, the temperature–mortality association was fitted for each location by use of a time-series regression. Second, a multivariate meta-regression model was built between location-specific estimates and meta-predictors. Finally, the grid-specific temperature–mortality association between 2000 and 2019 was predicted by use of the fitted meta-regression and the grid-specific meta-predictors. Excess deaths due to non-optimal temperatures, the ratio between annual excess deaths and all deaths of a year (the excess death ratio), and the death rate per 100 000 residents were then calculated for each grid across the world. Grids were divided according to regional groupings of the UN Statistics Division. Findings: Globally, 5 083 173 deaths (95% empirical CI [eCI] 4 087 967–5 965 520) were associated with non-optimal temperatures per year, accounting for 9·43% (95% eCI 7·58–11·07) of all deaths (8·52% [6·19–10·47] were cold-related and 0·91% [0·56–1·36] were heat-related). There were 74 temperature-related excess deaths per 100 000 residents (95% eCI 60–87). The mortality burden varied geographically. Of all excess deaths, 2 617 322 (51·49%) occurred in Asia. Eastern Europe had the highest heat-related excess death rate and Sub-Saharan Africa had the highest cold-related excess death rate. From 2000–03 to 2016–19, the global cold-related excess death ratio changed by −0·51 percentage points (95% eCI −0·61 to −0·42) and the global heat-related excess death ratio increased by 0·21 percentage points (0·13–0·31), leading to a net reduction in the overall ratio. The largest decline in overall excess death ratio occurred in South-eastern Asia, whereas excess death ratio fluctuated in Southern Asia and Europe. Interpretation: Non-optimal temperatures are associated with a substantial mortality burden, which varies spatiotemporally. Our findings will benefit international, national, and local communities in developing preparedness and prevention strategies to reduce weather-related impacts immediately and under climate change scenarios. Funding: Australian Research Council and the Australian National Health and Medical Research Council. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Background In the Stockholm region, a regional political assembly is responsible for health care services for a population of 2.3 million. In November 2017, the political leadership decided on a programme to project health and healthcare developments in the Stockholm region until 2040 as a basis for a longterm health plan. This presentation aims to describe the methodology used, share some results and raise some questions for further work. Through the presentation we also seek collaboration with European partners involved in similar health planning work. Methodology Six perspectives for analysis were defined and under each a set of areas for deeper analysis identified. It was agreed that the planning should be fact-driven. Under the constraint of availability, data covering the period 2000 to 2017 was collected for around 90 variables. Data was gathered from various publicly available databases and was analysed in Microsoft Excel. Results Stockholm’s population increased continuously since the millennial shift and could increase by another 28% until 2040. Since 2000, life expectancy increased by 2 years for women and 3 years for men. More than 85% of the burden of disease is caused by chronic diseases. However, the overall disease burden per 100 000 population has been decreasing over the years. In 2017, more than 21 million outpatient care visits were done. Extrapolations of these trends show that the disease burden per capita will continue to decrease, but the total burden of disease as well as demand for health care will continue to increase. Discussion A fact-based analysis of future health and healthcare proved to be an efficient base for planning and discussions of future health care services. Results confirmed some well-established perceptions of developments but also pointed to some misconceptions and established “facts” that proved to be false. New digital services make prediction of the future health service mix dynamic and challenging. Key messages To meet future health care needs, future health and health care trends should be planned for and considered in decision making processes. Forecasts and health care planning should be fact-based to have an as accurate picture of future health and health care trends as possible.

Background: Although studies have provided estimates of premature deaths attributable to either heat or cold in selected countries, none has so far offered a systematic assessment across the whole temperature range in populations exposed to different climates. We aimed to quantify the total mortality burden attributable to non-optimum ambient temperature, and the relative contributions from heat and cold and from moderate and extreme temperatures. Methods: We collected data for 384 locations in Australia, Brazil, Canada, China, Italy, Japan, South Korea, Spain, Sweden, Taiwan, Thailand, UK, and USA. We fitted a standard time-series Poisson model for each location, controlling for trends and day of the week. We estimated temperature-mortality associations with a distributed lag non-linear model with 21 days of lag, and then pooled them in a multivariate metaregression that included country indicators and temperature average and range. We calculated attributable deaths for heat and cold, defined as temperatures above and below the optimum temperature, which corresponded to the point of minimum mortality, and for moderate and extreme temperatures, defined using cutoffs at the 2・5th and 97・5th temperature percentiles. Findings: We analysed 74 225 200 deaths in various periods between 1985 and 2012. In total, 7・71% (95% empirical CI 7・43-7・91) of mortality was attributable to non-optimum temperature in the selected countries within the study period, with substantial differences between countries, ranging from 3・37% (3・06 to 3・63) in Thailand to 11・00% (9・29 to 12・47) in China. The temperature percentile of minimum mortality varied from roughly the 60th percentile in tropical areas to about the 80-90th percentile in temperate regions. More temperature-attributable deaths were caused by cold (7・29%, 7・02-7・49) than by heat (0・42%, 0・39-0・44). Extreme cold and hot temperatures were responsible for 0・86% (0・84-0・87) of total mortality. Interpretation: Most of the temperature-related mortality burden was attributable to the contribution of cold. The effect of days of extreme temperature was substantially less than that attributable to milder but non-optimum weather. This evidence has important implications for the planning of public-health interventions to minimise the health consequences of adverse temperatures, and for predictions of future effect in climate-change scenarios. Funding: UK Medical Research Council., The Lancet, 386(9991), pp.369-375; 2015

Purpose Single lung transplantation is an acceptable therapeutic option. Here we use our single lung porcine allograft as a vehicle for stem cell transfer. We present our protocol for perfusion of porcine lungs with human stem cells using our ex-vivo machine. Methods Adult pigs underwent unilateral left pneumonectomy . The explanted lungs were removed from surgical field and connected to ex-vivo circuit. Porcine lungs were perfused with human albumin after explanation. Lungs were ventilated during perfusion. Total ex vivo perfusion In group 1 CD133+ cells were only passed through the needle. In group2, MSCs were perfused into the pulmonary artery using the ex vivo machine Results 1. Human male somatic CD133+ Cells were passed through a Microlance needle (BD Gr.20, ∅ 0,8 × 40 mm, 26 Gauge)without injection into the lung. 750,000 human CD133+ cells (mobilized peripheral blood), purity (92.4-99.4%), frozen sample were used and different verification runs pump/syringe (n=10, flow rate up to 4mL/min, 30sec), viability was not unchanged (Table 1). 2. 100,000,000 human BMCs were perfused using the ex-vivo machine. The viability of the cells before and after lung perfusion did not show any significant in regard to viability rate, FACS and histological characteristics. Conclusion Both methods showed safe application route for pulmonary stem cell transfer. The viability of CD105+/45- cells is not as affected during ex vivo perfusion as rest of the cells. The Ex-Vivo mediated transfer is more practical for lung treatment. More histologic and cell culture studies are needed to confirm the feasibility.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most prevalent drugs inducing hypersensitivity reactions. The aim of this analysis was to estimate the prevalence of NSAID-induced respiratory symptoms in population across Europe and to assess its association with upper and lower respiratory tract disorders.The GAThe mean prevalence of NSAID-induced dyspnea was 1.9% and was highest in the three Polish centers [Katowice (4.9%), Krakow (4.8%), and Lodz (4.4%)] and lowest in Skopje, (0.9%), Amsterdam (1.1%), and Umea (1.2%). In multivariate analysis, the prevalence of respiratory reactions to NSAIDs was higher in participants with chronic rhinosinusitis symptoms (Odds Ratio 2.12; 95%CI 1.78-2.74), asthma symptoms in last 12 months (2.7; 2.18-3.35), hospitalization due to asthma (1.53; 1.22-1.99), and adults vs children (1.53; 1.24-1.89), but was not associated with allergic rhinitis.Our study documented significant variation between European countries in the prevalence of NSAID-induced respiratory hypersensitivity reactions, and association with chronic airway diseases, but also with environmental factors.

OBJECTIVE: To investigate the prevalence and incidence rate of chronic bronchitis (CB) in relation to smoking habits and exposure to welding fumes in a general population sample.METHODS: Subjects from Northern Europe born between 1945 and 1971 who participated in Stage 1 (1989-1994) of the European Community Respiratory Health Survey were mailed a respiratory questionnaire in 1999-2001 (the RHINE study); 15 909 answered the questionnaire and gave complete data on smoking. CB was defined as chronic productive cough of at least 3 months a year for 2 consecutive years. The questionnaire comprised an item about age when CB started and items about exposure to welding fumes. The incidence of CB was retrospectively assessed for the observation period 1980-2001.RESULTS: CB had a prevalence of 5.4%, and was associated with current smoking and welding exposure. The incidence rate of CB was 1.9 per 1000 person-years, and was increased in relation to welding exposure (low exposure HR 1.4, 95%CI 1.1-1.8; high exposure HR 2.0, 95%CI 1.6-2.7) and in relation to smoking (HR 2.1, 95%CI 1.8-2.5).CONCLUSION: Smoking and occupational exposure to welding fumes are both associated with an increased risk of CB.

To cite this article: Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, Gjomarkaj M, Forsberg B, Gunnbjornsdottir M, Minov J, Brozek G, Dahlen SE, Toskala E, Kowalski ML, Olze H, Howarth P, Krämer U, Baelum J, Loureiro C, Kasper L, Bousquet PJ, Bousquet J, Bachert C, Fokkens W, Burney P. Asthma in adults and its association with chronic rhinosinusitis: The GA(2) LEN survey in Europe. Allergy 2011; DOI: 10.1111/j.1398-9995.2011.02709.x ABSTRACT: Background: The prevalence of asthma and its association with chronic rhinosinusitis (CRS) have not been widely studied in population-based epidemiological surveys. Methods: The Global Allergy and Asthma Network of Excellence (GA(2) LEN) conducted a postal questionnaire in representative samples of adults living in Europe to assess the presence of asthma and CRS defined by the European Position Paper on Rhinosinusitis and Nasal Polyps. The prevalence of self-reported current asthma by age group was determined. The association of asthma with CRS in each participating centre was assessed using logistic regression analyses, controlling for age, sex and smoking, and the effect estimates were combined using standard methods of meta-analysis. Results: Over 52 000 adults aged 18-75 years and living in 19 centres in 12 countries took part. In most centres, and overall, the reported prevalence of asthma was lower in older adults (adjusted OR for 65-74 years compared with 15-24 years: 0.72; 95% CI: 0.63-0.81). In all centres, there was a strong association of asthma with CRS (adjusted OR: 3.47; 95% CI: 3.20-3.76) at all ages. The association with asthma was stronger in those reporting both CRS and allergic rhinitis (adjusted OR: 11.85; 95% CI: 10.57-13.17). CRS in the absence of nasal allergies was positively associated with late-onset asthma. Conclusion: Geographical variation in the prevalence of self-reported asthma was observed across Europe, but overall, self-reported asthma was more common in young adults, women and smokers. In all age groups, men and women, and irrespective of smoking behaviour, asthma was also associated with CRS.

We wanted to assess relations between the daily occurrence of asthma symptoms and fluctuations of air pollution concentrations and meteorological conditions. In a panel of 31 asthmatic patients residing in the town of Pitea in northern Sweden, severe symptoms of shortness of breath, wheeze, cough and phlegm were recorded in an asthma diary together with suspected causes. Sulphur dioxide, nitrogen dioxide, black smoke, relative humidity and temperature were used to evaluate the relationship to the environment. By using multivariate analyses, we found that daily variations in the particulate pollution levels, indicated by black smoke levels below the criteria limits, had significant effects on the risk of developing severe symptoms of shortness of breath. This association was stronger among 10 subjects, who had at least five incident days with severe shortness of breath. Meteorological conditions were not significant in the multivariate models. Cough and phlegm did not show significant relationships to any environmental condition that was evaluated. Only one-third of the subjects reported, at least once during the study, symptoms believed to be related to air pollutants, although we found significant correlations between the pollution levels and the frequency of pollution-related symptoms. We conclude that an association has been established for black smoke as pollutant and shortness of breath as respiratory symptom, and that in certain asthmatics, effects were occurring at lower particulate levels than suggested previously.

Studies conducted by Petrobras (the Brazilian national oil company) in Western Amazonia indicate a high demand for petroleum in the region. This fact encouraged Petrobras to build a pipeline that transports 60 thousand barrels of oil per day from the Urucu oil and gas province to the Solimoes terminal north of the city of Coari. This oil is then shipped to another terminal in Manaus. The water level changes between dry and wet seasons attain a difference up to 14 meters in the surroundings of Coari city. The strong seasonal character of the Amazonian climate gives rise to four distinct scenarios in the annual hydrological cycle: low water, high water, receding water, and rising water. These scenarios constitute the main reference for the definition of oil spill response planning by Petrobras. The systematic coverage of JERS-1 SAR images obtained in Western and Central Amazonia between October 1995 and November 1996 allowed the construction of mosaics contemplating these four seasonal scenarios, and therefore improving information about oil spill environmental sensitivity. Twenty-two (22) images per seasonal scenario were used to build the mosaics, which were then classified using the unsupervised semivariogram textural classifier (USTC). Cover types identified using USTC included flooded forest, upland forest and water. These four seasonal mosaics were manipulated using GIS technology to: (1) serve as a spatial framework to environmental studies, such as genetics and distribution offish species, malaria, social-economics, macrophyte distribution, water chemistry, among others; (2) design Petrobras' contingency plans and guide simulated oil spill exercises in the fluvial environment; (3) model water hydrodynamics over the flooded forest; (4) define the route of the Coari-Manaus pipeline avoiding oil sensitive and environmentally protected areas. The information derived from JERS-1 SAR data is straightforward to interpret and constitutes an operational representation in the cartographic space of oil spill sensitivity classes conceived by Petrobras.

Several studies have identified obesity as a risk factor for asthma in both children and adults. An increased prevalence of asthma in subjects with gastro-oesophageal reflux (GOR) and obstructive sleep apnoea syndrome has also been reported. The aim of this investigation was to study obesity, nocturnal GOR and snoring as independent risk factors for onset of asthma and respiratory symptoms in a Nordic population. In a 5-10 yr follow-up study of the European Community Respiratory Health Survey in Iceland, Norway, Denmark, Sweden and Estonia, a postal questionnaire was sent to previous respondents. A total of 16,191 participants responded to the questionnaire. Reported onset of asthma, wheeze and night-time symptoms as well as nocturnal GOR and habitual snoring increased in prevalence along with the increase in body mass index (BMI). After adjusting for nocturnal GOR, habitual snoring and other confounders, obesity (BMI >30) remained significantly related to the onset of asthma, wheeze and night-time symptoms. Nocturnal GOR was independently related to the onset of asthma and in addition, both nocturnal GOR and habitual snoring were independently related to onset of wheeze and night-time symptoms. This study adds evidence to an independent relationship between obesity, nocturnal gastro-oesophageal reflux and habitual snoring and the onset of asthma and respiratory symptoms in adults.

We describe a method for assessing tissue-specific plasma free fatty acid (FFA) utilization in vivo using a non-beta-oxidizable FFA analog, [9,10-3H]-(R)-2-bromopalmitate (3H-R-BrP). Ideally 3H-R-BrP would be transported in plasma, taken up by tissues and activated by the enzyme acyl-CoA synthetase (ACS) like native FFA, but then 3H-labeled metabolites would be trapped. In vitro we found that 2-bromopalmitate and palmitate compete equivalently for the same ligand binding sites on albumin and intestinal fatty acid binding protein, and activation by ACS was stereoselective for the R-isomer. In vivo, oxidative and non-oxidative FFA metabolism was assessed in anesthetized Wistar rats by infusing, over 4 min, a mixture of 3H-R-BrP and [U-14C] palmitate (14C-palmitate). Indices of total FFA utilization (R*f) and incorporation into storage products (Rfs') were defined, based on tissue concentrations of 3H and 14C, respectively, 16 min after the start of tracer infusion. R*f, but not Rfs', was substantially increased in contracting (sciatic nerve stimulated) hindlimb muscles compared with contralateral non-contracting muscles. The contraction-induced increases in R*f were completely prevented by blockade of beta-oxidation with etomoxir. These results verify that 3H-R-BrP traces local total FFA utilization, including oxidative and non-oxidative metabolism. Separate estimates of the rates of loss of 3H activity indicated effective 3H metabolite retention in most tissues over a 16-min period, but appeared less effective in liver and heart. In conclusion, simultaneous use of 3H-R-BrP and [14C]palmitate tracers provides a new useful tool for in vivo studies of tissue-specific FFA transport, utilization and metabolic fate, especially in skeletal muscle and adipose tissue.

Most models of lipoprotein oxidation by free radicals have excluded macromolecular plasma components from the system. This limits their biological significance because oxidation of lipoproteins appears to occur in the intima in the presence of a plasma ultrafiltrate. Hemin, a product of in vivo hemoglobin degradation, binds and oxidizes purified lipoproteins. However, it is not known whether this occurs in the presence of plasma components that may sequester hemin. We found that hemin in serum diluted to protein levels of the extracellular fluid (10-30%) binds to low and high density lipoproteins (LDL, HDL) with association constants in the nmol/L range. In the presence of H2O2, hemin oxidizes both lipoproteins in diluted serum with formation of conjugated dienes, thiobarbituric acid reacting substances, and F2-isoprostanes. This appeared to be caused by the high affinity of hemin with LDL and by the Fe3+ liberated that remains associated with the particles after hemin is degraded. Spectrophotometric and fluorescence experiments and electrophoresis of porphyrins complex with LDL indicated that the heme ring is buried in the lipoprotein surface-monolayer with the carboxylic groups in contact with positive regions of the protein and the solvent. Human macrophages associated and degraded 3- to 4-times more hemin-oxidized LDL in diluted serum than native LDL. It is possible then that at sites of LDL, accumulation in the extracellular intima, hemin and H2O2 production could cause oxidation with potential atherogenic consequences for cellular lipoprotein processing. This may occur even when other macromolecules of the extracellular fluid are present.

Methods The database of the International Children’s Heart Foundation was searched for all patients receiving surgery in Iraq. The sites of assistance were Sulimaniyah, Nasiriyah, Najaf and Basra in the order in which assistance was started. Two week mission trips were performed in all sites, but a program of near continuous presence was instituted in Nasiriyah in July 2012. Total and specific institutional analysis was performed. The RACHS-1 model of risk classification was employed for analysis. Results Total mission trips were 14 (Nasiriyah 6, Najaf 5, Sulimaniyah 2, Basra 1) and beginning in August 2012 until May 31, 2012 we have spent 33 weeks in-country. The total number of patients undergoing primary operations was 425. The distribution of cases and mortality by RACHS-1 was; 1- 51/425 (14%) and 1.9% (1/51); 2- 179/425 (48%) and 3.4% (6/179); 3- 122/425 (33%) and 16% (20/122); 4- 17/425 (6%) and 59% (10/17); there was only one RACHS 6 operation. There were 49/425 adults and 6/425 non-classifiable pediatric cases. Mortality and total case volume improved over time p < 0.05 mortality and p < 0.01 for case volume. Neonates comprised 4% of the total cases with mortality of 18.7%. Conclusions Pediatric cardiac surgery in Iraq has increased over time with our assistance. Neonatal cardiac surgery is now offered for the first time in Iraq.

Background The American Society of Extracorporeal Technology (AmSECT) has distributed a recommendation standard of practice and essential guidelines based on clinical evidence and currently accepted perfusion practice worldwide. These are integrated as learning objectives for clinical perfusion education. OnCloud©, an informatics and quality management program has been developed to collect and quantify procedural data to accurately produce quality control reports of perfusion practice incorporating these standards of practice.

Background: There is an increasing interest in the development of rapid and reliable techniques for platelet alloantigen typing. Study Design and Methods: By use of standardized flow cytometry and a specific human alloantiserum, 236 Swedish blood donors were immunophenotyped for the platelet-specific alloantigen, PI A1 (HPA-1a). Results: Ten individuals (4.2%) had low fluorescence intensities and were considered PI A1 -negative (HPA-1a-negative); all of them also demonstrated a PI A2 /PI A2 (HPA-1b/1b) genotype in a polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) assay of the underlying DNA polymorphism. The remaining population had clear positive fluorescence and was regarded as PI A1 -positive (HPA-1a-positive). The fluorescence distribution histogram among PI A1 -positive (HPA-1a-positive) individuals was dome-shaped, and those individuals who were homozygous for PI A1 (HPA-1a) could not be distinguished from those who were heterozygous. This finding was further substantiated by PCR-RFLP analysis of the PI A1 /PI A2 (HPA-1a/1b) genotype; a heterozygous genotype was found among those having a medium fluorescence intensity as well as among those having a strong fluorescence intensity. Conclusion: Flow cytometry is a valuable tool for large-scale detection of PI A1 (HPA-1a). However, flow cytometry based on only one antiserum cannot distinguish between homozygous and heterozygous carriers of PI A1 (HPA-1a). For zygosity testing and when platelets are difficult to obtain, the PCR-RFLP technique is the assay of choice

Cross-sectional epidemiological study based on a representative sample of the general population in northern Sweden.To assess the prevalence of respiratory symptoms, the role of respiratory symptoms as indicators of impairment of lung function, and to define risk factors for respiratory symptoms and lung function impairment.The 1340 subjects of 6610 who reported respiratory symptoms suggestive of asthma or chronic bronchitis in a postal questionnaire study were invited to a structured interview and lung function tests. A control group of 315 subjects was also invited. Risk factors were assessed from the postal questionnaire.400 subjects in the symptomatic group had attacks of breathlessness and wheezing, while none in the control group had them, corresponding to 7% of the original study population. Chronic productive cough was present in 537 subjects, of whom 13 were from the control group, suggesting that 12% of the original study population had this symptom. Persistent wheeze was the symptom that predicted the greatest proportion of cases of impaired lung function. Attacks of breathlessness, wheezing, long-standing cough and sputum production were all related to age, smoking and a family history of asthma. Both chronic productive cough and impaired lung function correlated strongly with smoking and age, and their prevalences differed in different socio-economic groups.Impaired lung function can be predicted from respiratory symptoms. Data collected in postal questionnaires suffice for the identification of risk factors. Combinations of symptoms gave greater odds ratios than individual symptoms.

Until recently the prevalence of asthma in Sweden was assessed to be 2-3 per cent. An increase in the prevalence of asthma and allergic rhinitis was noted among new conscripts undergoing health work-ups prior to military service with the most marked increase in northern Sweden, were 5 per cent of conscripts were reported to have asthma. In southern Sweden the prevalence remained about 2 per cent. More recent questionnaire studies in mid- and southern Sweden have reported similar rates of respiratory symptoms and use of anti-asthmatic drugs as in northern Sweden, suggesting that there may be no difference in asthma prevalence between the north and the south of the country. The exact prevalence of allergic diseases among Swedish adults is still not clear, but 40 per cent of adults in northern Sweden report that they often have wheezing in the chest, attacks of breathlessness, longstanding cough or sputum production. In questionnaire studies among children about 40 per cent of respondents have reported that they had asthma, allergic rhinitis or other type of hypersensitivity. The absence of generally accepted diagnostic criteria for asthma and allergic disorders in epidemiological studies makes comparison of prevalence difficult. It is thus not possible to be sure that the prevalence of asthma and allergic disorders in Sweden has recently increased. Risk factors for the development of asthma and allergic disorders are under study in Sweden. Several studies report an association in children between urban living and allergic disorders.

The dose distribution obtained with two different techniques for external irradiation of cervical carcinoma is described. The dose to the central area is somewhat higher with the multiple beam technique compared with the newly introduced shielding block technique. The difference between the calculated CRE values for the two techniques is small. When the shielding block is not placed over the area corresponding to the position of the applicators from the previous intracavitary treatment the considerable difference in absorbed dose between the two techniques does not correspond to the difference in the calculated CRE values. A comparison of the relative distributions laterally, in total dose and CRE, shows that for central volumes the relative CRE is much higher than the relative dose, when the normalization is made at the pelvic wall.

In this investigation, variance measurements of the secondary electron emission current from an evacuated chamber have been performed and a formula to calculate y/sup -/ /SUB D/ in these experiments has been derived. The value obtained for y/sup -/ /SUB D/ is within 50% of y/sup -/ /SUB D/ obtained with a gas detector and a factor of 2 greater than calculated values. The mean track length and the V /SUB track/ term were also calculated for this irradiation geometry, V /SUB track/ being of the same order of magnitude as V /SUB track/ for a sphere.

The temperature of the blood returning from an extracorporeal circuit may influence the vascular stability. Mean arterial blood pressure, heart rate and the temperature in the in-and outlet lines for blood and dialysis fluid of the dialyzer (TBa, TBv, TDi and TDo) were continuously measured in 8 patients suffering from vascular instability during standard dialysis. The TBv was adjusted to 37, 36 and 35 degrees C at the start of dialysis by manipulating TDi. The patients were studied two times at each temperature level during a 4-hour dialysis. At the start of dialysis TBa was 35.7 +/- 0.3 degrees C. The patient's mean arterial blood pressure and heart rate decreased and increased, respectively, continuously during TBv 37 and 36 degrees C experiments, but were fairly stable at an TBv of 35 degrees C. The standard TDi of 37 degrees C should be abandoned for a temperature which is similar to TBa (35.7 degrees C) to avoid the vascular effects of heating or cooling the blood in the extracorporeal system.

The frequency of the HLA B 40 antigen was significantly higher among renal transplanted patients with herpes zoster infection than in controls. The presence of HLA B 40 may be related to impaired immune response in transplanted and immunosuppressed carriers.

Plasma exchange was performed weekly during 6 months in two patients with symptomatic primary biliary cirrhosis. At the end of the treatment period improvement of liver demethylating capacity was noted, along with reduced C3 activation and a decrease in serum concentrations of IgM and procollagen III aminopeptide. Serum concentrations of aminotransferases, alkaline phosphatases, and anti-mitochondrial antibodies were not affected. These data suggest that long-term plasma exchange may improve liver function and possibly retard the progression of fibrosis in primary biliary cirrhosis.

Arteriovenous fistula in the forearm has been the established technique for vascular access in haemodialysis treatment for the last 15 years. The fistula is usually constructed between the radial artery and the cephalic vein if these vessels are available. The anastomosis may be performed side-to-side as was originally described by Cimino, Brescia and others in 1966. It can also be performed side-to-end or end-to-end, and each anastomosis technique has its advantages and disadvantages. To compare the usefulness of various anastomosis techniques we started a randomized study in 27 uremic patients who were prepared for haemodialysis treatment.

Reactive oxygen-derived free radicals form excessively during irradiation of biological structures, but also normally in many cellular oxidative processes, albeit in small amounts. Unless scavenged by protective mechanisms, such radicals may induce peroxidation of polyunsaturated fatty acids resulting in membrane damage. The process may be catalysed to a considerable extent by transitional metals with the capacity to form redox systems, such as Fe3+ in equilibrium Fe2+. In the present study, it is shown that radiation by X-rays and/or exposure to ionic iron (Fe3+) causes decreased survival in parallel with lysosomal labilization of cultured mouse peritoneal macrophages (MPMs). The latter event was demonstrated as a reduced capacity of lysosomes in living MPMs to retain acridine orange during photo-oxidative stress caused by continuous exposure to blue light of short wavelength. The effects of X-irradiation, and/or lysosomal iron-loading, could be counteracted by the addition of the .OH-scavenging drug dimethylsulfoxide (DMSO) to the cell culture medium. The findings suggest that X-irradiation may damage certain sensitive G0 cells, such as Kupffer cells, serous cells of salivary glands and old macrophages, which normally have substantial concentrations of metals within their vacuolar apparatus, possibly by lysosomal damage involving .OH-mediated lipid peroxidation.

Microdosimetry measurements give information about the energy imparted to a volume of given size. With the most frequent method only data for object sizes above 0.2 micrograms are obtainable. Although restricted to the dose mean values, the variance technique can, however, be applied to objects sizes an order of magnitude less. In this report some limiting parameters for this technique are discussed and results down to about 20 nm in a 60Co gamma-ray beam are reported. the resulting data exceed earlier reported values at objects size below 0.1 microgram, but are in good agreement for larger object sizes.