Hepatitis B and C in Switzerland - healthcare provider initiated testing for chronic hepatitis B and C infection

Hepatitis B and hepatitis C are contagious liver diseases caused by the hepatitis B virus (HBV) and the hepatitis C virus (HCV), respectively. In particular, chronic infection with HBV or HCV is a major public health problem throughout Europe. The majority of persons chronically infected (65%-75%) are not aware of their infection status until symptoms of advanced liver disease appear. In addition, the peak in the number of patients suffering from advanced stages of the disease, such as cirrhosis and hepatocellular carcinoma, has not yet been reached. In order to reduce the current and future morbidity and mortality associated with chronic HBV or HCV infection, the timely detection of chronically infected persons, with follow-up and case management, is crucial. However, the current screening strategies in Europe and Switzerland have to be considered as inadequate to detect the majority of chronically infected persons. Hence, we emphasise the importance of an alternative approach: the healthcare provider initiated identification of HBV or HCV infection in defined risk groups. This entails determining whether a person is not only at risk of being chronically infected, but also at risk of becoming infected with HBV or HCV and, if necessary, testing for HBV or HCV infection.

Incidence and Imaging Outcomes of Acute Scaffold Disruption and Late Structural Discontinuity After Implantation of the Absorb Everolimus-Eluting Fully Bioresorbable Vascular Scaffold: Optical Coherence Tomography Assessment in the ABSORB Cohort B Trial (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions).

OBJECTIVES This study sought to describe the frequency and clinical impact of acute scaffold disruption and late strut discontinuity of the second-generation Absorb bioresorbable polymeric vascular scaffolds (Absorb BVS, Abbott Vascular, Santa Clara, California) in the ABSORB (A Clinical Evaluation of the Bioabsorbable Everolimus Eluting Coronary Stent System in the Treatment of Patients With De Novo Native Coronary Artery Lesions) cohort B study by optical coherence tomography (OCT) post-procedure and at 6, 12, 24, and 36 months. BACKGROUND Fully bioresorbable scaffolds are a novel approach to treatment for coronary narrowing that provides transient vessel support with drug delivery capability without the long-term limitations of metallic drug-eluting stents. However, a potential drawback of the bioresorbable scaffold is the potential for disruption of the strut network when overexpanded. Conversely, the structural discontinuity of the polymeric struts at a late stage is a biologically programmed fate of the scaffold during the course of bioresorption. METHODS The ABSORB cohort B trial is a multicenter single-arm trial assessing the safety and performance of the Absorb BVS in the treatment of 101 patients with de novo native coronary artery lesions. The current analysis included 51 patients with 143 OCT pullbacks who underwent OCT at baseline and follow-up. The presence of acute disruption or late discontinuities was diagnosed by the presence on OCT of stacked, overhung struts or isolated intraluminal struts disconnected from the expected circularity of the device. RESULTS Of 51 patients with OCT imaging post-procedure, acute scaffold disruption was observed in 2 patients (3.9%), which could be related to overexpansion of the scaffold at the time of implantation. One patient had a target lesion revascularization that was presumably related to the disruption. Of 49 patients without acute disruption, late discontinuities were observed in 21 patients. There were no major adverse cardiac events associated with this finding except for 1 patient who had a non-ischemia-driven target lesion revascularization. CONCLUSIONS Acute scaffold disruption is a rare iatrogenic phenomenon that has been anecdotally associated with anginal symptoms, whereas late strut discontinuity is observed in approximately 40% of patients and could be viewed as a serendipitous OCT finding of a normal bioresorption process without clinical implications. (ABSORB Clinical Investigation, Cohort B [ABSORB B]; NCT00856856).

Neodymium isotopes from fossil fish teeth and detrital sediment, and oxygen isotopes from benthic forams from ODP Hole 119-738 B

Ephemeral polar glaciations during the middle-to-late Eocene (48-34 Ma) have been proposed based on far-field ice volume proxy records and near-field glacigenic sediments, although the scale, timing, and duration of these events are poorly constrained. Here we confirm the existence of a transient cool event within a new high-resolution benthic foraminiferal d18O record at Ocean Drilling Program (ODP) Site 738 (Kerguelen Plateau; Southern Ocean). This event, named the Priabonian oxygen isotope maximum (PrOM) Event, lasted ~140 kyr and is tentatively placed within magnetochron C17n.1n (~37.3 Ma) based on the correlation to ODP Site 689 (Maud Rise, Southern Ocean). A contemporaneous change in the provenance of sediments delivered to the Kerguelen Plateau occurs at the study site, determined from the <63 µm fraction of decarbonated and reductively leached sediment samples. Changes in the mixture of bottom waters, based on fossil fish tooth epsilon-Nd, were less pronounced and slower relative to the benthic d18O and terrigenous epsilon-Nd changes. Terrigenous sediment epsilon-Nd values rapidly shifted to less radiogenic signatures at the onset of the PrOM Event, indicating an abrupt change in provenance favoring ancient sources such as the Paleoproterozoic East Antarctic craton. Bottom water epsilon-Nd reached a minimum value during the PrOM Event, although the shift begins much earlier than the terrigenous epsilon-Nd excursion. The origin of the abrupt change in terrigenous sediment provenance is compatible with a change in Antarctic terrigenous sediment flux and/or source as opposed to a reorganization of ocean currents. A change in terrigenous flux and/or source of Antarctic sediments during the oxygen isotope maximum suggests a combination of cooling and ice growth in East Antarctica during the early late Eocene.