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Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007
Full text linkObjective To assess the public health consequences of the rise in multiple births with respect to congenital anomalies. Design Descriptive epidemiological analysis of data from population-based congenital anomaly registries. Setting Fourteen European countries. Population A total of 5.4 million births 1984-2007, of which 3% were multiple births. Methods Cases of congenital anomaly included live births, fetal deaths from 20 weeks of gestation and terminations of pregnancy for fetal anomaly. Main outcome measures Prevalence rates per 10 000 births and relative risk of congenital anomaly in multiple versus singleton births (1984-2007); proportion prenatally diagnosed, proportion by pregnancy outcome (2000-07). Proportion of pairs where both co-twins were cases. Results Prevalence of congenital anomalies from multiple births increased from 5.9 (1984-87) to 10.7 per 10 000 births (2004-07). Relative risk of nonchromosomal anomaly in multiple births was 1.35 (95% CI 1.31-1.39), increasing over time, and of chromosomal anomalies was 0.72 (95% CI 0.65-0.80), decreasing over time. In 11.4% of affected twin pairs both babies had congenital anomalies (2000-07). The prenatal diagnosis rate was similar for multiple and singleton pregnancies. Cases from multiple pregnancies were less likely to be terminations of pregnancy for fetal anomaly, odds ratio 0.41 (95% CI 0.35-0.48) and more likely to be stillbirths and neonatal deaths. Conclusions The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has implications for prenatal and postnatal service provision. The contribution of assisted reproductive technologies to the increase in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk counselling
A meta-analysis of mortality data in Italian contaminated site whith industrial waste landfills or illegal dumps
Full text linkObjectives:Adverse effects of waste management represent a public health issue. Mortality meta-analysis in Italian National Priority Contaminated Sites (NPCSs) with industrial waste landfills or illegal dumps is presented. Methods:24 NPCSs include industrial waste landfills or illegal dumps. Class 1 (10 NPCSs with industrial waste landfills) and Class 2 (14 NPCSs with illegal dumps) were categorized. Random-effects model meta-analyses of Standardized Mortality Ratios non-adjusted (SMRs) and adjusted for Deprivation (DI-SMRs) computed for each CS (1995-2002) were performed for overall 24 NPCSs and the two classes. The North-Southern gradient was considered. Result: 24 CSs pooled-SMRs are significantly increased in both genders for cancer of liver (men: SMR = 1.13; women: SMR = 1.18), bladder (men: SMR = 1.06; women:SMR = 1.11), and for cirrhosis (men: SMR = 1.09; women: SMR = 1.13). In Class 2 the increase is confirmed in both genders for liver and bladder cancers and for cirrhosis and in men only for lung cancer. Congenital anomalies and adverse perinatal conditions are not increased. Conclusion: The results are consistent with the hypothesis of adverse health effects of non-adequately managed hazardous waste. Causal interpretation is not allowed, but the meta-analytic approach provides more confidence in the findings.
A modelling tool to study the combined effects of drug administration and LVAD assistance in pathophysiological circulatory conditions.
No full textThe aim of this work is to develop a tool to study the effect of sodium nitroprusside (SNP) on hemodynamics in conjunction with baroreflex and mechanical circulatory assistance. To this aim, a numerical model of the pharmacodynamic effect of SNP was developed and inserted into a cardiovascular circulatory model integrated with baroreflex and LVAD (continuous flow pump with atrio-aortic connection)sub-models. The experiments were carried out in two steps. In the first step the model was verified comparing simulations with experimental data acquired from mongrel dogs on mean arterial pressure (MAP), cardiac output (CO), heart rate (HR), peripheral resistance, and left ventricular properties. In the second step, the combined action of SNP and mechanical circulatory assistance was studied. Data were measured at pump off and at pump on (20000 rpm and 24000 rpm). At pump off, with a 2.5 ?g/kg per min SNP infusion in heart failure condition, the MAP was reduced by approximately 8%, CO and HR increased by about 16% and 18%, respectively. In contrast, during assistance (24000 rpm) the changes in MAP, CO and HR were around -9%, +12%, and +20%, respectively. Furthermore, the effects of the drug on hemodynamic parameters at different heart conditions were significantly different. Thus, the model provides insight into the complex interactions between baroreflex, drug infusion, and LVAD and could be a support for clinical decision-making in cardiovascular pathologies
R wave magnitude analysis during continous-flow LVAD, experimental study.
No full textThe current use of left ventricular assist devices (LVADs) as destination therapy is associated with the clinical need of monitoring patient-pump interaction. To this aim, the present work investigated the possibility of getting useful information about the status of the assisted left ventricle using electrocardiographic (ECG) data. A total of six animals, undergoing Gyro Centrifugal Pump 2 implantation (a new version of Gyro Centrifugal Pump C1E3 [Kyocera Corporation, Kyoto, Japan]) and CircuLite Synergy Micropump (CircuLite, Inc., Saddlebrooke, NJ, USA) in atrio-aortic connection, were analyzed. Data refer to different LVAD speeds with consequently different levels of ventricular unloading. From ECG signal, the R wave peak was individuated together with the corresponding left ventricular volume. Then on both signals, a moving average analysis was performed to reduce the effect of the ventilation. A regression and correlation analysis performed on the two resulting signals evidenced that the R wave peak and the ventricular volume are strictly related. Specifically, any change of LVAD speed, inducing a change in ventricular volume, is associated with a change in R wave peak value. The present work is a first step in investigating the usefulness of the ECG signal during LVAD therapy, for the monitoring of mechanical parameters of the heart such as the ventricular volumes. The correlation found between the ECG and the ventricular volume can be a promising starting point for possible future noninvasive LVAD patient monitoring
European Recommendations for Primary Prevention of Congenital Anomalies: A Joined Effort of EUROCAT and EUROPLAN Projects to Facilitate Inclusion of This Topic in the National Rare Disease Plans
Full text linkCongenital anomalies (CA) are the paradigm example of rare diseases liable to primary prevention actions due to the multifactorial etiology of many of them, involving a number of environmental factors together with genetic predispositions. Yet despite the preventive potential, lack of attention to an integrated preventive strategy has led to the prevalence of CA remaining relatively stable in recent decades. The 2 European projects, EUROCAT and EUROPLAN, have joined efforts to provide the first science-based and comprehensive set of recommendations for the primary prevention of CA in the European Union. The resulting EUROCAT-EUROPLAN \u27Recommendations on Policies to Be Considered for the Primary Prevention of Congenital Anomalies in National Plans and Strategies on Rare Diseases\u27 were issued in 2012 and endorsed by EUCERD (European Union Committee of Experts on Rare Diseases) in 2013. The recommendations exploit interdisciplinary expertise encompassing drugs, diet, lifestyles, maternal health status, and the environment. The recommendations include evidence-based actions aimed at reducing risk factors and at increasing protective factors and behaviors at both individual and population level. Moreover, consideration is given to topics specifically related to CA (e.g. folate status, teratogens) as well as of broad public health impact (e.g. obesity, smoking) which call for specific attention to their relevance in the pre- and periconceptional period. The recommendations, reported entirely in this paper, are a comprehensive tool to implement primary prevention into national policies on rare diseases in Europe
Simulation of apical and atrio-aortic VAD in patients with transposition or congenitally corrected transposition of the great arteries
No full textPurpose: VADs could be used for transportation of the great arteries (TGA) and for congenitally corrected transposition (ccTGA) treatment. A cardiovascular numerical model (NM) may offer a useful clinical support in these complex physiopathologies. This work aims at developing and preliminarily verifying a NM of ccTGA and TGA interacting with VADs. Methods: Hemodynamic data were collected at the baseline (BL) and three months (FUP) after apical (atrio-aortic) VAD implantation in a TGA (ccTGA) patient and used in a lumped parameter NM to simulate the patient\u27s physiopathology. Measured (MS) and simulated (SIM) data were compared. Results: MS and SIM data are in accordance at the BL and at FUP. Cardiac output (l/min): BL_m = 2.9 ? 0.4, BL_s = 3.0 ? 0.3; FUP_m = 4.2 ? 0.2, FUP_s = 4.1 ? 0.1. Right atrial pressure (mmHg): BL_m = 21.4 ? 4.1, BL_s = 18.5 ? 4.5; FUP_m = 13 ? 4, FUP_s = 14.8 ? 3.6. Pulmonary arterial pressure (mmHg): BL_m = 56 ? 6.3,BL_s = 57 ? 2, FUP_m = 37.5 ? 7.5, FUP_s = 35.5 ? 5.9. Systemic arterial pressure (mmHg): BL_m = 71 ? 2, BL_s = 74.6 ? 2.1; FUP_m = 84 ? 9, FUP_s = 81.9 ? 9.8. Conclusions: NM can simulate the effect of a VAD in complex physiopathologies, with the inclusion of changes in circulatory parameters during the acute phase and at FUP. The simulation of differently assisted physiopathologies offers a useful support for clinicians
Policies to clean up toxic industrial contaminated sites of Gela and Priolo: a cost-benefit analysis
Full text linkBackground Cost-benefit analysis is a transparent tool to inform policy makers about the potential effect of regulatory interventions, nevertheless its use to evaluate clean-up interventions in polluted industrial sites is limited. The two industrial areas of Gela and Priolo in Italy were declared "at high risk of environmental crisis" in 1990. Since then little has been done to clean the polluted sites and reduce the health outcomes attributable to pollution exposure. This study, aims to quantify the monetary benefits resulting from clean-up interventions in the contaminated sites of Gela and Priolo. Methods A damage function approach was used to estimate the number of health outcomes attributable to industrial pollution exposure. Extensive one way analyses and probabilistic analyses were conducted to investigate the sensitivity of results to different model assumptions. Results It has been estimated that, on average, 47 cases of premature death, 281 cases of cancer and 2,702 cases of non-cancer hospital admission could be avoided each year by removing environmental exposure in these two areas. Assuming a 20 year cessation lag and a 4% discount rate we calculate that the potential monetary benefit of removing industrial pollution is ?3,592 million in Priolo and ?6,639 million in Gela. Conclusions Given the annual number of health outcomes attributable to pollution exposure the effective clean-up of Gela and Priolo should be prioritised. This study suggests that clean-up policies costing up to ?6,639 million in Gela and ?3,592 million in Priolo would be cost beneficial. These two amounts are notably higher than the funds allocated thus far to clean up the two sites, ?127.4 million in Gela and ?774.5 million in Priolo, implying that further economic investments - even considerable ones - could still prove cost beneficial
Major Congenital Anomalies in Babies Born With Down Syndrome: A EUROCAT Population-Based Registry Study
Full text linkPrevious studies have shown that over 40% of babies with Down syndrome have a major cardiac anomaly and are more likely to have other major congenital anomalies. Since 2000, many countries in Europe have introduced national antenatal screening programs for Down syndrome. This study aimed to determine if the introduction of these screening programs and the subsequent termination of prenatally detected pregnancies were associated with any decline in the prevalence of additional anomalies in babies born with Down syndrome. The study sample consisted of 7,044 live births and fetal deaths with Down syndrome registered in 28 European population-based congenital anomaly registries covering seven million births during 2000-2010. Overall, 43.6% (95% CI: 42.4-44.7%) of births with Down syndrome had a cardiac anomaly and 15.0% (14.2-15.8%) had a non-cardiac anomaly. Female babies with Down syndrome were significantly more likely to have a cardiac anomaly compared to male babies (47.6% compared with 40.4%, P < 0.001) and significantly less likely to have a non-cardiac anomaly (12.9% compared with 16.7%, P < 0.001). The prevalence of cardiac and non-cardiac congenital anomalies in babies with Down syndrome has remained constant, suggesting that population screening for Down syndrome and subsequent terminations has not influenced the prevalence of specific congenital anomalies in these babies.
The role of learning and kinematic features in dexterous manipulation: a comparative study with two robotic hands
Full text linkDexterous movements performed by the human hand are by far more sophisticated than those achieved by current humanoid robotic hands and systems used to control them. This work aims at providing a contribution in order to overcome this gap by proposing a bio-inspired control architecture that captures two key elements underlying human dexterity. The first is the progressive development of skilful control, often starting from - or involving - cyclic movements, based on trial-and-error learning processes and central pattern generators. The second element is the exploitation of a particular kinematic features of the human hand, i.e. the thumb opposition. The architecture is tested with two simulated robotic hands having different kinematic features and engaged in rotating spheres, cylinders, and cubes of different sizes. The results support the feasibility of the proposed approach and show the potential of the model to allow a better understanding of the control mechanisms and kinematic principles underlying human dexterity and make them transferable to anthropomorphic robotic hands