Society Consensus Research Articles

Intraindividual variability in lipoprotein(a): the value of a repeat measure for reclassifying individuals at intermediate-risk

Abstract Background Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease and outcomes. Levels are predominantly genetically determined and repeat measurements are traditionally considered unlikely to be useful. However, the temporal variation of Lp(a) is not well characterized and it is unclear whether a single measure of Lp(a) is sufficient to assess cardiovascular risk in all individuals. Purpose To determine the intraindividual variability of Lp(a) and whether a repeated measure reclassified Lp(a)-specific cardiovascular risk using the European Atherosclerosis Society (EAS) consensus statement risk categories. Methods This retrospective cohort study analyzed initial and repeated Lp(a) measures obtained using the same laboratory assay from 609 individuals in the Nashville Biosciences database accessed through the American Heart Association Precision Medicine Platform. Categorical variables are presented as counts (%) and compared using Fisher’s exact test. Continuous variables are presented as mean ± standard deviation or median (Q1-Q3), tested for normality using the Shapiro-Wilk test, and compared using parametric and nonparametric tests where appropriate. The Spearman’s Rank correlation coefficient was used to assess the relationship between two variables. The significance level was set at p<0.05. Results Median age was 52.5 (37.1-62.8) years, 45% were women, 80.3% were White patients, 13.3% were Black patients, 1.6% were Asian patients, and 4.8% were other/unknown patients. In terms of relevant comorbidities, 41% had ischemic heart disease, 24.1% had chronic kidney disease, and 13.5% had liver disease. The median time between the two Lp(a) measures was 1.07 (0.5-2.1) years. Our analysis shows a significant difference between the paired Lp(a) values (p<0.05), with 38.1% [95% CI 34.2%-42%] changing by ≥10mg/dL, and 40.5% [95%CI 36.6%-44.3%] changing by >25%. There was a positive correlation between the baseline Lp(a) levels and the absolute changes in Lp(a), (r=0.59, p<0.01). The proportions of individuals with variability are similar in those who were never on the potentially Lp(a)-altering agents (statin, niacin, or PCSK9 inhibitor drugs) (n=91), with 32% [95%CI 22.4%-41.6%] changing by ≥10mg/dL, and 34% [95%CI 24.3%-43.7%] changing by >25%. While over 90% of those whose values were initially in the EAS low-risk and high-risk categories remained in those categories, 53% of those in the intermediate "grey-zone" category transitioned to either the low (20%)- or the high (33%)- risk category (Figure). Conclusion(s) Temporal-related changes in Lp(a) variability were present in many individuals and should be included in calculating the expected effect sizes in future studies targeting Lp(a). A repeat Lp(a) measure may allow more precise Lp(a)-specific cardiovascular risk prediction for individuals whose initial value is in the EAS-defined intermediate "grey-zone" category.

Lomitapide for the treatment of paediatric patients with homozygous familial hypercholesterolaemia (APH-19): results from the efficacy phase of an open-label, multicentre, phase 3 study

Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited disorder characterised by extremely high concentrations of LDL cholesterol, leading to early-onset atherosclerosis. Lomitapide is an orally administered microsomal triglyceride transfer protein (MTP) inhibitor that effectively lowers LDL cholesterol and is approved for adults with HoFH. We aimed to investigate the efficacy and safety of lomitapide in paediatric patients with HoFH receiving standard-of-care lipid-lowering therapy. APH-19 is an open-label, single-arm, phase 3 trial performed at 12 study centres in Germany, Israel, Italy, Saudi Arabia, Spain, and Tunisia. A 6-week run-in period was followed by a 24-week efficacy phase and an 80-week safety phase. Patients aged 5-17 years, on stable lipid-lowering therapy, with HoFH diagnosed using the criteria from the 2014 European Atherosclerosis Society Consensus Panel on HoFH were titrated to maximum tolerated doses of oral lomitapide, starting at 2 mg (patients aged 5-15 years) or 5 mg (patients aged 16-17 years). The primary endpoint was the percentage change from baseline to week 24 in LDL cholesterol, which was assessed in patients who had received at least one dose of lomitapide, and who had a baseline and at least one post-baseline measurement. The secondary outcomes were the percentage change from baseline at week 24 in total cholesterol, non-HDL cholesterol, VLDL cholesterol, apolipoprotein B, triglycerides, and lipoprotein(a). Safety was assessed in patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, NCT04681170. Between Dec 20, 2020, and Oct 16, 2022, 43 patients were included and treated (24 [56%] were female and 19 [44%] were male, and median age was 10·7 years [7·0-14·0]). Mean change from baseline in LDL cholesterol at week 24 was -53·5% (95% CI -61·6 to -45·4, p<0·0001). Mean percentage reductions were observed at week 24 for non-HDL cholesterol (-53·9%, 95% CI -61·7 to -46·1, p<0·0001), total cholesterol (-50·0%, 95% CI -57·6 to -42·4, p<0·0001), VLDL cholesterol (-50·2%, -59·1 to -41·2, p<0·0001), apolipoprotein B (-52·4%, -60·3 to -44·5, p<0·0001), triglycerides was -49·9% (-58·8 to -41·0, p<0·0001), and lipoprotein(a) (-11·3%, -32·9 to 10·3 [in 21 patients with measurements in mg/dL]; -23·6%, -38·2 to -9·0 [in 22 patients with measurements in nmol/L]; p=0·0070 combined). Adverse events were mostly mild, and gastrointestinal and hepatic in nature. Adverse events of special interest were reported for five (12%) patients (gastrointestinal in two patients and hepatic in three). One serious treatment-emergent adverse event was reported (also classed as an adverse event of special interest): an increase in hepatic enzymes, resulting in two dose interruptions, two dose reductions, and a repeated dose escalation. Lomitapide provided a significant, clinically meaningful LDL cholesterol reduction and has the potential to be an efficient, LDL receptor-independent option for paediatric patients with HoFH. Amryt Pharmaceuticals.

External factors in democratic transition in Pakistan in 2008: an analysis of the US supporting role

The political history of Pakistan has seen ephemeral intervals of democratic rule while protracted periods of military rule. A landmark development happened when a peaceful democratic transition from the authoritarian rule of General Musharraf was held in 2008. The internal factors for this transition were an independent judiciary, vibrant media, civil society, and political consensus between major political parties. This article meticulously investigates the significant role of the US as an external factor in supporting the democratic transition in Pakistan in 2008. Data is collected from secondary sources like newspapers, journal articles, books, and websites. The US supported General Musharraf's regime as part of its war on terror strategy but also urged him publicly to restore democracy. The Bush administration encouraged negotiation between Benazir Bhutto and General Musharraf and supported a political reconciliation between them, which shaped the politics of Pakistan in a new direction. When General Musharraf adopted authoritarian means, the US pressured him to democratise by different means to reinforce its interest in counterterrorism. Under heavy pressure, General Musharraf resigned as army chief and lifted the state of emergency. Later, he resigned from the presidency to escape the humiliation of impeachment, and democracy was restored in Pakistan.

Effective Connection between Criminal Law and Administrative Law Protection in Environmental Crimes

With the increasing emphasis on ecological environment protection, it has become a consensus of the whole society to use the strictest system and the most rigorous rule of law to protect the ecological environment. Due to its unique severity and deterrence, criminal law is becoming a trend to construct and improve protection for environmental crimes through criminal law. Many countries in the world have environmental crimes in their criminal codes or subsidiary criminal laws, and China is no exception. However, criminal law always relies on administrative law in regulating environmental crimes, and seeking a balance between the application of criminal law and administrative law in order to maximize the environmental protection and punishment functions of criminal law is an urgent problem that needs to be solved. The article analyzes and studies the basic theory of environmental crime and its administrative attributes, pointing out the appropriate mechanism for criminal law intervention in environmental protection, in order to achieve effective connection between administrative law and criminal law in environmental protection issues.

Hemoglobin A1c levels are related to patency and adverse limb events in diabetics after revascularization

ObjectivePoor glycemic control in the perioperative period has been reported to be associated with early and late major adverse limb events (MALEs). However, these studies were mostly from large databases or lacked long-term outcomes. We examined the long-term effects of high hemoglobin A1c (HbA1c) level on patency, MALE, limb salvage (LS) and survival after lower extremity revascularization procedures in patients with diabetes. MethodsPatients with diabetes who underwent revascularization for Rutherford class 3 to 6 ischemia between May 2002 and December 2018 were identified. Patients with an HbA1c of ≤7% were compared with those with an HbA1c of >7% for patency, MALE, survival, LS, and amputation-free survival. ResultsOf 706 patients, 699 had HbA1c data (775 limbs), with 311 (357 limbs) in the HbA1c ≤7% and 388 (418 limbs) in the HbA1c >7% groups. Patients with an HbA1c of >7% were younger (69.9 ± 10.2 years vs 71.7 ± 9.5 years; P = .011), had higher lipid levels, insulin use (70% vs 49%; P < .01), American Society of Anesthesiologists classification of 4, and had a lower prevalence of chronic kidney disease (32% v s41%; P = .023). Patients with an HbA1c of >7% were more likely to present with chronic limb-threatening ischemia (CLTI) (79% vs 72%; P = .019) and undergo infrapopliteal interventions (49% vs 42%; P = .005), with no difference in anatomical complexity (TransAtlantic Inter Society Consensus class C/D, 75% vs 77%; P = .72) or type of revascularization (24% vs 18% open, 66% vs 70% endovascular, 10% vs 12% hybrid; P = .236). Patency and freedom from MALE were significantly lower in patients with an HbA1c of >7% for infrainguinal revascularizations, whereas amputation-free survival and overall survival were similar. In patients with chronic limb-threatening ischemia, LS rates at 5 years were significantly lower in patients undergoing open revascularization (HbA1c > 7%: 64% ± 6% vs HbA1c < 7%:86% ± 5%; P = .020), whereas it was similar after endovascular interventions (HbA1c > 7%:79% ± 4% vs HbA1c < 7%:77% ± 3%; P = .631). Seventy patients with an HbA1c of >7% lost limbs vs 38 patients with an HbA1c of ≤7% (P = .007). In multivariate analysis, HbA1c was associated significantly with primary patency. HbA1c, insulin use, level of intervention, and angiotensin-converting enzyme inhibitor use were associated with MALE. ConclusionsA perioperative HbA1c of >7% is associated with poorer patency rates and increased MALE, especially at the infrainguinal level revascularization in patients with diabetes, with no significant impact on survival. LS is impacted after open, but not after endovascular revascularization.

피해자변호사제도에 대한 소고

The victim protection system appears to be focused only on victim protection in Korea. The victim lawyer system is one representative system that shows the tendency of this victim protection system. This study examined the victim lawyer system, mainly focusing on which victims could get legal assistance, and suggest improvement measures. In an adversarial system, the prosecutor and defendant are central to the procedure, while the victim is totally forgotten. However, the victim should be respected as a human being. As the victim is another stakeholder with the defendant and affected by the consequences of criminal procedure, the victim also shares a great interest in criminal procedure as a way of justice. Not only that, as one of the parties to the accident with the defendant, it would be fair if the victim could get the opportunity to participate in criminal procedure as the defendant has. At this point, the victims' protection and participation should be considered in the criminal system. However, there is a limitation that victims' protection and participation should not infringe on the defendant's rights. Only a few laws, including the Sexual Violence Punishment Act, provide the victim lawyer system. However, the victim lawyer's role should not be restricted to the victim's guardian but should be expanded to assist the victim in participating. Today, many victims want to participate in criminal procedure, and it's gaining remarkable consensus in society. As the law or system should reflect society or culture, the victim lawyer system necessarily expands to help victims' participation generally. Compared to Germany and France, this country introduced victim lawyers to assist victims' participation, and all the victims typically have the right to legal assistance. As ruling the victim lawyer system and nation-appointed lawyer system separate, it could help the victims participate in criminal procedure and protect vulnerable victims. Therefore, a victim lawyer system must be enacted in the Criminal Procedure Act to establish a general rule, and, in particular, some acts should deal with a nation-appointed lawyer system of victims to protect vulnerable victims.

Intra-individual variability in lipoprotein(a): the value of a repeat measure for reclassifying individuals at intermediate risk.

Lipoprotein(a) [Lp(a)] levels are predominantly genetically determined and repeat measurements are generally considered unlikely to be clinically useful. However, the temporal variation of Lp(a) is not well characterized. Our aim was to determine the intra-individual variability of Lp(a) and whether a repeated measure reclassified Lp(a)-specific cardiovascular risk using the European Atherosclerosis Society (EAS) consensus statement risk categories. This retrospective cohort study analysed initial and repeated serum Lp(a) levels measured using the same methodology from 609 individuals in the Nashville Biosciences database, a de-identified electronic medical records database. Baseline and follow-up paired values were significantly different (P < 0.05), with an absolute change of ≥10 mg/dL in 38.1% [95% CI 34.2-42%] and a >25% change in 40.5% [95% CI 36.6-44.3%] of individuals. Although the categories of those whose values were in the EAS low-risk and high-risk categories did not change, 53% of those in the intermediate 'grey-zone' category transitioned to either the low-risk (20%) or high-risk (33%) category. Black individuals exhibited greater variability than White individuals and women exhibited greater variability than men. There was a positive correlation between the baseline Lp(a) levels and the absolute changes in Lp(a), (r = 0.59, P < 0.01). Temporal-related changes in Lp(a) variability were present in many individuals. A repeat Lp(a) measure may allow more precise Lp(a)-specific cardiovascular risk prediction for individuals whose initial value is in the EAS-defined intermediate 'grey-zone' category. Lp(a) variability should be included in calculating the expected effect sizes in future clinical research studies targeting Lp(a).

Preoperative treatment with dopamine agonist therapy influences surgical outcome in prolactinoma: a retrospective single-center on 159 patients

IntroductionProlactinoma account to the most common pituitary adenomas and current therapy regime constitutes of dopamine agonist therapy (DA) and surgery in selected cases [17]. Due to tumor fibrosis induced by previous DA therapy, surgical removal can be challenging though. Therefore, this study investigates how preoperative DA usage influences perioperative treatment and surgical outcome in prolactinoma and aims to ascertain whether a specific subgroup of prolactinoma patients could derive greater benefit from exclusive surgical intervention.MethodsWe retrospectively analyzed n = 159 surgically treated and histologically confirmed prolactinomas in the sella region from 2013–2022 in our institution. Clinical, radiological and surgical features were analyzed. Univariate and multivariate analyses were performed.ResultsOut of total of 159 prolactinoma patients, 83.6% received previous treatment with DA followed by surgery, while only 16.4% received exclusive surgery. Both groups presented similar initial tumor volumes (1.9cm3 vs. 1.5cm3, p = 0.59) and equal preoperative prolactin levels (PRL) (199.7 µg/l vs. 191.0 µg/l, p = 0.44). Surgical procedures took significantly longer when patients received prior DA treatment (79 min. vs. 70 min., p = 0.0479). Six months after surgery, pretreated patients revealed significantly higher PRL compared to non-treated (107 g/l vs. 8.64 µg/, p = 0.0009). Additionally, untreated microprolactinoma presented a remission of 100%, whereas pretreated exhibited a remission rate of 88.75%.ConclusionThe current study demonstrates that prior DA treatment is associated with significantly longer surgeries, higher recurrence rates and lower rates of normalization of PRL levels after surgery, particularly in microprolactinomas and support the latest recommendations of the Pituitary Society's Consensus Statement 2023, which favors the option of surgery alone as first-line therapy for microprolactinomas.

Limits of Viability: Perspectives of Portuguese Neonatologists and Obstetricians.

Advances in neonatal care have improved the prognosis in extremely preterm infants. The gestational age considered for active treatment has decreased globally. Despite implemented guidelines, several studies show variability in practice. The aim of this study was to understand theperspectives of Portuguese neonatologists and obstetricians regarding the management of extremely preterm infants. An online survey was sent through the Portuguese Neonatology Society and the Portuguese Society of Obstetrics and Maternal-Fetal Medicine from August to September 2023. We obtained 117 responses: 53% neonatologists, 18% pediatricians, and 29% obstetricians, with 62% having more than 10 years of experience. The majority (80%) were familiar with the Portuguese Neonatology Society consensus on the limits of viability and 46% used it in practice; 62% were unaware of Portuguese morbidity-mortality statistics associated with extremely preterm infants. Most (91%) informed parents about morbiditymortality concerning the gestational age more frequently upon admission (64%) and considered their opinion in the limit of viability situations (95%). At 22 weeks gestational age, 71% proposed only comfort care, while at 25 and 26 weeks, the majority suggested active care (80% and 96%, respectively). Less consensus was observed at 23 and 24 weeks. At 24 weeks, most obstetricians offered active care with the option of comfort care by parental choice (59%), while the neonatology group provided active care (65%), p < 0.001. Regarding the lower limit of gestational age for in utero transfer, corticosteroid administration, cesarean section for fetal indication, neonatologist presence during delivery, and endotracheal intubation; neonatologists considered a lower gestational age than obstetricians (23 vs 24 weeks; p = 0.036; p < 0.001; p < 0.001; p = 0.021; p < 0.001, respectively). Differences in perspectives between obstetricians and neonatologists in limits of viability situations were identified. Neonatologists considered a lower gestational age in various scenarios and proposed active care earlier. Standardized counseling for extremely preterm infants is crucial to avoid ambiguity, parental confusion, and conflicts in perinatal care.

Venous blood collection systems using evacuated tubes: a systematic review focusing on safety, efficacy and economic implications of integrated vs. combined systems.

Venous blood collection systems (VBCSs) are combinations of in-vitro diagnostics and medical devices, usually available as integrated set. However, purchasing and using a combination of devices from different sets is considered by clinical laboratories as an option to achieve specific sampling tasks or reduce costs. This systematic review aimed to retrieve available evidence regarding safety, efficacy, and economic aspects of VBCSs, focusing on differences between integrated and combined systems. The literature review was carried out in PubMed. Cited documents and resources made available by scientific organisations were also screened. Extracted evidence was clustered according to Quality/Efficacy/Performance, Safety, and Costs/Procurement domains and discussed in the current European regulatory framework. Twenty documents published between 2010 and 2021 were included. There was no evidence to suggest equivalence between combined and integrated VBCSs in terms of safety and efficacy. Scientific society's consensus documents and product standards report that combined VBCS can impact operators' and patients' safety. Analytical performances and overall efficacy of combined VBCSs are not guaranteed without whole system validation and verification. EU regulatory framework clearly allocates responsibilities for the validation and verification of an integrated VBCS, but not for combined VBCSs, lacking information about the management of product nonconformities and post-market surveillance. Laboratory validation of combined VBCS demands risk-benefit and cost-benefit analyses, a non-negligible organisational and economic burden, and investment in knowledge acquisition. Implications in terms of laboratory responsibility and legal liability should be part of a comprehensive assessment of safety, efficacy, and cost carried out during device procurement.

It is Time to Screen for Homozygous Familial Hypercholesterolemia in the United States.

Homozygous familial hypercholesterolemia (HoFH) is an ultra-rare inherited condition that affects approximately one in 300,000 people. The disorder is characterized by extremely high, life-threatening levels of low-density lipoprotein (LDL) cholesterol from birth, leading to significant premature cardiovascular morbidity and mortality, if left untreated. Homozygous familial hypercholesterolemia is severely underdiagnosed and undertreated in the United States (US), despite guidelines recommendations for universal pediatric lipid screening in children aged 9-11. Early diagnosis and adequate treatment are critical in averting premature cardiovascular disease in individuals affected by HoFH. Yet, an unacceptably high number of people living with HoFH remain undiagnosed, misdiagnosed, and/or receive a late diagnosis, often after a major cardiovascular event. The emergence of novel lipid-lowering therapies, along with the realization that diagnosis is too often delayed, have highlighted an urgency to implement policies that ensure timely detection of HoFH in the US. Evidence from around the world suggests that a combination of universal pediatric screening and cascade screening strategies constitutes an effective approach to identifying heterozygous familial hypercholesterolemia (HeFH). Nevertheless, HoFH and its complications manifest much earlier in life compared to HeFH. To date, little focus has been placed on the detection of HoFH in very young children and/or infants. The 2023 Updated European Atherosclerosis Society Consensus Statement on HoFH has recommended, for the first time, broadening pediatric guidelines to include lipid screening of newborn infants. Some unique aspects of HoFH need to be considered before implementing newborn screening. As such, insights from pilot studies conducted in Europe may provide some preliminary guidance. Our paper proposes a set of actionable measures that states can implement to reduce the burden of HoFH. It also outlines key research and policy gaps that need to be addressed in order to pave the way for universal newborn screening of HoFH in the US.

Impact of nomenclature as metabolic associated steatotic liver disease on steatotic liver disease prevalence and screening: a prospective population survey in Asians.

The introduction of the latest nomenclature, metabolic associated steatotic liver disease (MASLD), proposed by the multi-society without Asian society consensus statement, aims to redefine the diagnostic criteria for metabolic associated fatty liver disease (MAFLD). However, its effect on the epidemiology in Asia remains unclear. We conducted a population-based cross-sectional survey on fatty liver disease using multistage stratified random sampling of participants from Guangzhou, a representative area in China (ChiCTR2000033376). Demographic, socioeconomic, lifestyle, and laboratory data were collected. Hepatic steatosis and the severity of fibrosis were assessed using FibroScan. A total of 7388 individuals were recruited, the proportion of which meeting the definitions for nonalcoholic fatty liver disease (NAFLD), MAFLD, and MASLD were 2359 (31.9%), 2666 (36.1%), and 2240 (30.3%), respectively. One hundred and twenty (1.6%) patients had cryptogenic SLD, and 537 (7.3%) patients were diagnosed with MetALD. MASLD did not significantly differ from NAFLD and MAFLD, except that MAFLD patients had a lower proportion of males, hypertension, and diabetes and were less likely to consume tea (P<0.05). Both cryptogenic SLD and MASLD non-MAFLD patients exhibited milder hepatic steatosis and a lower frequency of liver injury than NAFLD, MAFLD, or MASLD patients (all P<0.05). An increased HOMA-IR (adjusted OR: 1.33, 95% CI: 1.10-2.03) was associated with higher risk of moderate-to-severe steatosis for MASLD non-MAFLD patients, while consuming more cups of tea (P for trend=0.015) showed inverse associations. Irrespective of terminology used is that fatty liver disease is highly prevalent in the Han Chinese population. Differences in insulin resistance and lifestyle risk factors are associated with redefinition disparities.

Роль политических институтов в экономическом развитии Юга России в условиях новой реальности

Introduction. Ineffective resolution of economic problems by political institutions can jeopardize a country’s technological sovereignty in the face of existing geopolitical challenges. The purpose of the article is to identify areas for increasing the efficiency of the functioning of political institutions from the point of view of ensuring the economic security of the southern Russian regions, considering the challenges of socio-economic development that exist for them. Methodology and methods. This study centers on the Southern Federal District, which acts as an administrative entity responsible for implementing regional-level economic policies. The research utilized content analysis of scientific publications and comparative analysis of regional socio-economic indicators of economic development as part of implementing economic policy. The method for analyzing the influence of political institutions on economic development was based on the principle of balancing the combination of tactical and strategic decisions in assessing the effectiveness of implemented measures and was based on the basic principles of the theory of factors of production. Analysis. An analysis of the results of the economic policy pursued in the southern Russian regions showed that a relatively high level of resistance to sanctions challenges is ensured mainly by the export capabilities of agricultural products. However, the continued high level of import dependence on production increases the risk of conflict over the use of production factors between exportoriented companies and companies oriented to the domestic market, which creates significant threats to the implementation of national growth models. The turn of state economic policy towards the global East and South poses the tasks of the authorities of the southern Russian regions to develop transport infrastructure, as well as state support for companies participating in the construction of new production and supply chains. At the same time, increasing migration flows from border areas requires solving the problem of ensuring the socio-economic well-being of both the people moving and the host community. Results. It was found that the existing political risks to the economic development of southern Russian regions are associated with a lack of balance between the political decisions made and the strategic objectives of achieving technological sovereignty. It is concluded that the conditions of modern economic reality require economic and political mobilization to achieve value consensus and consolidation in society in order to solve the problems of economic development, implemented through the responsibility and patriotic position of political and economic elites at all levels of government. Authors’ contribution. I.V. Mitrofanova: development and justification of the concept; interpretation and synthesis of research results; O.A. Chernova: formation of methodology; development of research design; content analysis; formulation of conclusions.

Social Technologies for Social Inclusion in Traditional Communities in the Amazon

There is a widely recognized consensus in contemporary society and the academic community that education is crucial for a nation's socioeconomic development. This paper presents the research experience, outreach, and curricular internship of the Grupo de Pesquisa Interação, employing the Interaction Method (Action-Research) approach to train professionals for working with riverside communities in the Amazon region. The research employs a comprehensive set of data collection techniques, such as bibliographic and documentary research, semi-structured surveys, interviews with key informants, and both group and individual dynamics with domestic-family groups to encourage participation from local community members and institutions. The results aim to provide community organizations and domestic-family groups with environmentally sustainable innovations and social technologies. Additionally, they offer qualified support to regional public policy institutions for developing affirmative actions geared towards citizenship and social inclusion.

Arrhythmic manifestations and outcomes of definite and probable cardiac sarcoidosis

BackgroundThe 2014 Heart Rhythm Society consensus statement defines histological (definite) and clinical (probable) diagnostic categories of cardiac sarcoidosis (CS), but few studies have compared their arrhythmic phenotypes and outcomes. ObjectiveThe purpose of this study was to evaluate the electrophysiological/arrhythmic phenotype and outcomes of patients with definite and probable CS. MethodsWe analyzed the arrhythmic/electrophysiological phenotype in a single-center North American cohort of 388 patients (median age 56 years; 39% female, n = 151) diagnosed with definite (n = 58) or probable (n = 330) CS (2000–2022). The primary composite outcome was survival to first ventricular tachycardia/fibrillation (VT/VF) event or sudden cardiac death. Key secondary outcomes were also assessed. ResultsAt index evaluation, in situ cardiac implantable electronic devices and antiarrhythmic drug use were more common in definite CS. At a median follow-up of 3.1 years, the primary outcome occurred in 22 patients with definite CS (38%) and 127 patients with probable CS (38%) (log-rank, P = .55). In multivariable analysis, only a higher ratio of the 18F-fluorodeoxyglucose maximum standardized uptake value of the myocardium to the maximum standardized uptake value of the blood pool (hazard ratio 1.09; 95% confidence interval 1.03–1.15; P = .003, per 1 unit increase) was associated with the primary outcome. During follow-up, patients with definite CS had a higher burden of device-treated VT/VF events (mean 2.86 events per patient-year vs 1.56 events per patient-year) and a higher rate of progression to heart transplant/left ventricular assist device implantation but no difference in all-cause mortality compared with patients with probable CS. ConclusionPatients with definite and probable CS had similarly high risks of first sustained VT/VF/sudden cardiac death and all-cause mortality, though patients with definite CS had a higher overall arrhythmia burden. Both CS diagnostic groups as defined by the 2014 Heart Rhythm Society criteria require an aggressive approach to prevent arrhythmic complications.

Analysis of the socio-economic parameters of farms applying soil restoration strategies in Bulgaria and Austria

This article presents the assessment of the degree of influence of socio-economic parameters of farms applying soil restoration strategies over the supply chain cooperation, public-private partnerships, and landscape alliances in Austria and Bulgaria. The aim of the assessment is to highlight new socio-economic opportunities, which can be a target for the public policies. The study is based on the pilot farms analysis of the TUdi1 project survey results. The analysis of the socio-economic parameters is made with an Analytical Hierarchical Process (AHP). The results are analyzed on both county and soil restoration strategy base. The analysis shows that Fertilization strategies have impact on supply chain cooperation. The goal aims to involve all suppliers and the most important socio-economic opportunities are certainty of demand, access to finance, and uncertainty of income. In terms of fertilization and remediation strategies, the analysis shows that the most important socio-economic opportunities are related to certainty of demand and access to finance. On the other hand, the implementation of Remediation strategy requires higher consensus in the local society and more activities, which explains the stronger interaction of this criteria with the goals public-private partnership and landscape alliances. In this case, the most important socio-economic opportunities are certainty of demand, access to finance, political support, and training and equipment.

Analysis on the Low-carbon Transformation Path of China's Logistics Industry under the Background of Carbon Neutralization

Under the background of “carbon neutrality”, green and low-carbon have gradually become a broad consensus of the whole society. As an important part of social and economic development, the logistics industry consumes a large amount of energy and urgently needs low-carbon transformation.This paper analyzes the problems encountered in the low-carbon transformation development of our country's logistics industry and puts forward the necessary solutions, which will not only promote the development of the low-carbontransformation of our country's logistics industry, but also promote the realization of the goal of "carbon neutrality" as soon as possible. Based on the economic and social development of our country under the "double carbon" policy, facing the dilemma of low-carbon transformation of logistics industry in China, this paper puts forward the general and concrete ideas of low-carbon transformation of logistics industry in our country, and puts forward the specific path and method under the guidance of the thought of low-carbontransformation, hoping to provide some references for the low-carbon transformation of logistics industry in China.

International Anal Neoplasia Society's consensus guidelines for anal cancer screening.

The International Anal Neoplasia Society (IANS) developed consensus guidelines to inform anal cancer screening use among various high-risk groups. Anal cancer incidence estimates by age among risk groups provided the basis to identify risk thresholds to recommend screening. Guided by risk thresholds, screening initiation at age 35 years was recommended for men who have sex with men (MSM) and transgender women (TW) with HIV. For other people with HIV and MSM and TW not with HIV, screening initiation at age 45 years was recommended. For solid organ transplant recipients, screening initiation beginning from 10 years post-transplant was recommended. For persons with a history of vulvar precancer or cancer, screening initiation was recommended starting within 1 year of diagnosis of vulvar precancer or cancer. Persons aged ≥45 years with a history of cervical/vaginal HSIL or cancer, perianal warts, persistent (>1 year) cervical HPV16, or autoimmune conditions could be considered for screening with shared decision-making, provided there is adequate capacity to perform diagnostic procedures (high-resolution anoscopy [HRA]). Anal cytology, high-risk (hr) human papillomavirus (HPV) testing (including genotyping for HPV16), and hrHPV-cytology co-testing are different strategies currently used for anal cancer screening that show acceptable performance. Thresholds for referral for HRA or follow-up screening tests are delineated. These recommendations from IANS provide the basis to inform management of abnormal screening results, considering currently available screening tools. These guidelines provide a pivotal foundation to help generate consensus among providers and inform the introduction and implementation of risk-targeted screening for anal cancer prevention.

Ценообразование как условие формирования рыночной конкуренции

The article examines the limits of the freedom of market pricing and the limits of state interference in the processes of market pricing in the light of conceptual approaches to the organization of society, which can be carried out by: ensuring the social process based on public self-regulation, and ensuring social equilibrium provided by state regulation. These approaches also manifest themselves in the economic sphere, including pricing processes, such as ensuring the market process, including free pricing, and ensuring market equilibrium through state regulation of commodity prices. These principles are not mutually exclusive, however, it is the social process based on self-regulation that is basic. Public self-regulation, including in the economic sphere, including pricing, is a source of legal formation, since it is based on the coordination of the interests of participants in market relations. State regulation of the social process, which has the goal of ensuring social equilibrium, by means of various kinds of incentives, restrictions and prohibitions, is a subsidiary means of regulating social relations, which can contribute both to the achievement of consensus in society, when it is aimed at protecting the rights of the subjects of social relations, and to harm it, when it is aimed at replacing the natural social process with its own normative regulations. Government pricing should be brought within the strict framework of the law and kept to a minimum.

Indian Brachytherapy Society consensus recommendations for brachytherapy in breast cancer.

This consensus statement of Indian Brachytherapy Society (IBS) aims to generate practical and reproducible guidelines allowing for direct implementation in the Indian scenario. IBS board of directors appointed a panel of physicians with expertise in breast cancer and, in particular, breast brachytherapy, to develop a consensus statement. First, a literature review on breast brachytherapy was conducted, focusing on randomized trials, prospective studies, and multi-institutional series. Then, guidelines were drafted based on authors' consensus according to Indian scenario. IBS advocate accelerated partial breast irradiation (APBI) with brachytherapy following breast conservation surgery (BCS) for suitable groups of patients. Also, IBS recommends brachytherapy as the preferred technique for patients requiring tumor bed boost. Multi-catheter interstitial brachytherapy (MIB) is suitable in most situations, except for a large tumor to breast ratio, and type 2 oncoplasty or higher performed. For best cosmesis, IBS recommends a minimum 3-week gap between chemotherapy and APBI. Brachytherapy continues to be an established technique for APBI as well as boost in appropriately selected patients with early breast cancer (EBC). As breast brachytherapy is an underutilized therapy in the Indian context, this article will hopefully encourage the readers to use its clinical potential in the suitable groups of patients.