A better integration of health and economic impact assessments of climate change.

Climate change could lead to high economic burden for individuals (i.e. low income and high prices). While economic conditions are important determinants of climate change vulnerability, environmental epidemiological studies focus primarily on the direct impact of temperature on morbidity and mortality without accounting for climate-induced impacts on the economy. More integrated approaches are needed to provide comprehensive assessments of climate-induced direct and indirect impacts on health. This paper provides some perspectives on how epidemiological and economic impact assessments could be better integrated. We argue that accounting for the economic repercussions of climate change on people's health and, vice versa, the consequences of health effects on the economy could provide more realistic scenario projections and could be more useful for adaptation policy.

Neglected implications of land-use and land-cover changes on the climate-health nexus.

Climate change can substantially affect temperature-related mortality and morbidity, especially under high green-house gas emission pathways. Achieving the Paris Agreement goals require not only drastic reductions in fossil fuel-based emissions but also land-use and land-cover changes (LULCC), such as reforestation and afforestation. LULCC has been mainly analysed in the context of land-based mitigation and food security. However, growing scientific evidence shows that LULCC can also substantially alter climate through biogeophysical effects. Little is known about the consequential impacts on human health. LULCC-related impact research should broaden its scope by including the human health impacts. LULCC are relevant to several global agendas (i.e. Sustainable Development Goals). Thus, collaboration across research communities and stronger stakeholder engagement are required to address this knowledge gap.

Overcoming global inequality is critical for land-based mitigation in line with the Paris Agreement.

Transformation pathways for the land sector in line with the Paris Agreement depend on the assumption of globally implemented greenhouse gas (GHG) emission pricing, and in some cases also on inclusive socio-economic development and sustainable land-use practices. In such pathways, the majority of GHG emission reductions in the land system is expected to come from low- and middle-income countries, which currently account for a large share of emissions from agriculture, forestry and other land use (AFOLU). However, in low- and middle-income countries the economic, financial and institutional barriers for such transformative changes are high. Here, we show that if sustainable development in the land sector remained highly unequal and limited to high-income countries only, global AFOLU emissions would remain substantial throughout the 21st century. Our model-based projections highlight that overcoming global inequality is critical for land-based mitigation in line with the Paris Agreement. While also a scenario purely based on either global GHG emission pricing or on inclusive socio-economic development would achieve the stringent emissions reductions required, only the latter ensures major co-benefits for other Sustainable Development Goals, especially in low- and middle-income regions.

Propensity-matched analysis does not support angiosome-guided revascularization of multilevel peripheral artery disease (PAD).

BACKGROUND: This retrospective comparative cohort study evaluated the clinical outcome of angiosome-guided endovascular arterial reconstructions in chronic limb-threatening ischemia (CLTI) due to multilevel peripheral artery disease (PAD). METHODS: Patients treated in an endovascular fashion for CLTI with tissue loss due to multilevel PAD were analyzed. Limbs were classified as having undergone either angiosome-guided (direct) revascularization (DR) or nonangiosomic (indirect) revascularization (IR). DR was defined as uninterrupted in-line flow to the affected angiosome, revascularization through the pedal arch was also considered direct. Groups were adjusted with propensity score (PS) matching and compared for amputation-free survival (AFS), freedom from major adverse limb events (MALE), and healing rate at 12 months. RESULTS: A total of 174 patients (81 men, mean age 70.0 ± 10.4 y) were included. PS matching produced two groups of 55 patients each: DR (24 men, mean age 71.7 ± 10.7 y) and IR (26 men, mean age 72.0 ± 9.4 y). The matched groups had no significant differences in baseline variables. At 12 months there were no significant differences in AFS (73.2% vs 71.6%; p = 0.841), freedom from MALE (71.7% vs 66.1%; p = 0.617), and healing rate (72.7% vs 72.0%; p = 1.000) between DR and IR, respectively. CONCLUSION: This study failed to support the use of angiosome concept in CLTI due to multilevel disease.

Popliteal Artery Angioplasty for Chronic Total Occlusions with versus without the Distal Landing Zone.

BACKGROUND: The purpose of this study was to evaluate the outcome of percutaneous transluminal angioplasty in patients with critical limb ischemia due to popliteal artery (PA) chronic total occlusions depending on the presence of a patent portion of the PA distal to the occlusive lesion-the distal landing zone (DLZ). MATERIALS AND METHODS: We retrospectively analyzed 80 patients with critical limb ischemia (all Rutherford class 5-6), who underwent percutaneous transluminal angioplasty with or without stenting for PA chronic total occlusions with no inflow disease. Baseline demographic and clinical variables, periprocedural outcome, 12-month overall survival, limb salvage, primary patency, freedom from target lesion revascularization (TLR), amputation-free survival, and freedom from major adverse limb events in DLZ versus no-DLZ lesions were assessed. RESULTS: Of all patients (43 men; mean age 70.2 y), 40 (50%) had DLZ in the PA, whereas another 40 (50%) did not (no-DLZ). Diabetes was significantly more common among DLZ patients and was found to be a risk factor for DLZ compared with no-DLZ lesions (HR 2.58; 95% CI 1.03-6.46; P = 0.04). Other demographic and clinical variables were similar between the groups. The stenting rate was 45.0% versus 42.5% in DLZ versus no-DLZ (P = 1.0). At 12 months, there was no significant difference in primary patency (64.7% vs. 51.6%; P = 0.156), overall survival (73.4% vs. 84.0%; P = 0.283), amputation-free survival (60.0% vs. 68.8%; P = 0.432), and limb salvage rate (93.6% vs. 82.2%; P = 0.126) between DLZ and no-DLZ groups, respectively. However, freedom from TLR (92.1% vs. 67.7%; P = 0.03) and major adverse limb events (80.1% vs. 41.8%; P = 0.003) was significantly higher in DLZ compared with no-DLZ lesions (92.1% vs. 67.7%; P = 0.03). CONCLUSIONS: Diabetes was found to be a significant risk factor for DLZ compared to no-DLZ lesions. Technical success and stenting rates were similar in DLZ versus no-DLZ patients. At 12 months, there was no significant difference in limb salvage, primary patency, and overall survival between the study groups. The DLZ lesions were associated with a significantly higher freedom from TLR than no-DLZ lesions.

Study of immunogenicity of recombinant proteins based on hemagglutinin and neuraminidase conservative epitopes of influenza A virus.

BACKGROUND: Recombinant hemagglutinin (rHA) and neurominidase (rNA) developed in our investigation are amino acid sequence consensus variants of H1N1 2009 subtype influenza virus strain, also including immunogenic epitopes typical for other influenza virus subtypes (H3N1 and H5N1). Substitutions were made: typical for Russian virus isolates (in HA - S220T, NA - D248N) and in active centers of molecules - R118L, R293L, R368L; C92S, C417S to increase recombinant proteins stability in E. coli. The aim of the present work was to study immunogenicity of the obtained rHA and rNA. MATERIAL AND METHODS: Fragments aa 83-469 of NA and aa 61-287 of HA were chosen because they include the main B-cell epitopes and are the minimal structures for correct folding of target proteins. The designed nucleotide sequences were synthesized and purified and the expression of rNA and rNA were analyzed. For immunization and virus challenge we used influenza viruses A/California/04/2009 (H1N1), A/PR/8/34 (H1N1), A/Perth/16/2009 (H3N2), A/Chicken/Kurgan/05/2005 R.G. (H5N1), and B/Florida/04/2006. Specific IgG levels were determined by ELISA in 96-well ELISA plates. Significant differences of survival in mouse groups were analyzed by Mantel-Cox (log-rank) and Gehan-Breslow-Wilcoxon tests. RESULTS: The obtained results demonstrate the high immunogenicity and ability of indicated proteins mixture to provide similar cross-protection against influenza viruses of the H1N1 subtype. CONCLUSIONS: The data obtained suggest efficient pluripotent vaccine creation based on HA and NA conservative regions.