Blastocoel fluid aspiration improves vitrification outcomes and produces similar sexing results of in vitro-produced cattle embryos compared to microblade biopsy.

The potential applications of in vitro-produced (IVP) cattle embryos are significantly enhanced when combined with genotype selection and cryopreservation techniques. While trophectoderm (TE) biopsies are frequently used for genotyping, cell-free DNA (cfDNA) found in blastocoele fluid (BF) arises as a less-invasive method. Moreover, the blastocoel collapse produced by BF aspiration could be beneficial for embryo cryotolerance. This study was conducted to test the BF as a source of cell free-DNA (cfDNA) and to compare the BF to the TE biopsy in terms of sexing efficiency/accuracy, embryo survival and gene expression after vitrification/warming. IVP day 7 expanded blastocysts were artificially collapsed by aspiration of BF (VIT-Collapsed) or biopsied (VIT-Biopsied). After sample collection, embryos were vitrified/warmed by the Cryotop method and individually cultured in vitro. Intact fresh non-vitrified and vitrified/warmed blastocysts served as Fresh Control and VIT-Control, respectively. After sex identification of BF or TE biopsies and the corresponding surviving embryos, amplification efficiency and sexing accuracy were assessed. There were no differences between the BF and TE biopsy samples in terms of sexing accuracy or efficiency. Although all vitrified groups showed lower post-warming re-expansion rates (p < 0.05), the blastocyst re-expansion rates in the VIT-Collapsed group were comparable to those in the Fresh Control group whereas biopsied blastocysts showed the lowest (p < 0.05) re-expansion rates. VIT-Collapsed blastocysts had hatching rates that were comparable to those of Fresh Control blastocysts but significantly higher than those of the other vitrification treatments. Proapoptotic gene BAX was overexpressed in VIT-Biopsied embryos, whereas BCL2 transcripts were more abundant in the VIT-Collapsed group. On the other hand, VIT-Biopsied embryos showed altered ATP1B1- and AQP3-mRNA levels. The analysis of the cfDNA present in the BF is an efficient, minimally invasive approach to sex IVP cattle embryos. Besides, the artificial collapse of blastocoel prior to vitrification resulted in higher re-expansion and hatching ability than when embryos were vitrified after being biopsied.

Inteligencia artificial en medicina y procedimientos quirúrgicos: impacto en la toma de decisiones y la salud / Artificial Intelligence in Medicine and Surgical Procedures: Impact on Decision Making and Health

Introducción: Las revisiones sistemáticas de la literatura constituyen una herramienta metodológica práctica para la búsqueda de información sobre investigaciones clínicas, aplicaciones tecnológicas y la toma de decisiones de impacto en la salud. Objetivo: Describir cómo influye la inteligencia artificial en la toma de decisiones médicas según el grado de concordancia entre estas evidencias y los sistemas expertos aplicados en las especialidades clínicas y quirúrgicas de impacto en la salud, según reportes entre 2010 y 2019. Métodos: Se realizó una revisión sistemática con el uso de un modelo de bases de datos relacional y un modelo de entidad relación para garantizar la entidad referencial de la que hacen parte las bases de datos y los artículos, así como la calidad de cada uno de los artículos mediante clasificación por grados de concordancia entre muy concordante o no concordante con la temática de interés y la toma de decisiones de impacto en la salud. Conclusiones: Las aplicaciones como los sistemas expertos, los aprendizajes de máquinas y la robótica aportan innovación a las instituciones y un cambio revolucionario en lo académico, clínico y epidemiológico(AU)

Introduction: Systematic reviews of the literature constitute a practical methodological tool for the search of information on clinical research, technological applications and health impact decision-making. Objectives: To describe how artificial intelligence influences medical decision-making according to the degree of agreement between this evidence and the expert systems applied in clinical and surgical specialties with an impact on health, according to reports from 2010 to 2019. Methods: A systematic review was conducted with the use of a relational database model and a relationship entity model to guarantee the referential entity of which the databases and articles are part, as well as the quality of each of the articles classified by degrees of agreement between very concordant or not concordant with the topic of interest and the decision making of impact on health. Conclusions: Applications such as expert systems, machine learning and robotics bring innovation to institutions and a revolutionary change in academic, clinical and epidemiological areas(AU)

Occurrence of emerging organic contaminants and endocrine disruptors in different water compartments in Mexico - A review.

This review compiles the studies (2007-2021) regarding the occurrence of emerging organic contaminants (EOCs) and endocrine disruptors (EDs) in wastewater, surface water and groundwater in Mexico. A total of 174 compounds were detected, including pharmaceuticals, hormones, plasticizers, personal care products, sweeteners, drugs, and pesticides considered as EDs. The levels of EOCs and EDs varied from ng/L to 140 mg/L, depending on the compound, location, and compartment. Raw wastewater was the most studied matrix, showing a greater abundance and number of detected compounds. Nevertheless, surface waters showed high concentrations of bisphenol-A, butylbenzil-phthalate, triclosan, pentachlorophenol, and the hormones estrone, 17 α-ethinylestradiol, and 17 ß-estradiol, which exceeded the thresholds set by international guidelines. Concentrations of 17 α-ethinylestradiol and triclosan exceeding the above-mentioned limits were reported in groundwater. Cropland irrigation with raw wastewater was the principal activity introducing EOCs and EDs into groundwater. The groundwater abundance of EOCs was considerably lesser than that of wastewater, highlighting the attenuation capacity of soils/aquifers during wastewater infiltration. However, carbamazepine and N,N-diethyl-meta-toluamide showed higher concentrations in groundwater than those in wastewater, suggesting their accumulation/concentration in soils/pore-waters. Although the contamination of water resources represents one of the most environmental concerns in Mexico, this review brings to light the lack of studies on the occurrence of EOCs in Mexican waters, which is important for public health policies and for developing legislations that incorporates EOCs as priority contaminants in national water quality guidelines. Consequently, the development of legislations will support regulatory compliance for wastewater and drinking water, reducing the human exposure.

3D printed bioresorbable scaffolds for articular cartilage tissue engineering: a comparative study between neat polycaprolactone (PCL) and poly(lactide-b-ethylene glycol) (PLA-PEG) block copolymer.

This work identifies and describes different material-scaffold geometry combinations for cartilage tissue engineering (CTE). Previously reported potentially interesting scaffold geometries were tuned and printed using bioresorbable polycaprolactone and poly(lactide-b-ethylene) block copolymer. Medical grades of both polymers were 3D printed with fused filament fabrication technology within an ISO 7 classified cleanroom. Resulting scaffolds were then optically, mechanically and biologically tested. Results indicated that a few material-scaffold geometry combinations present potential for excellent cell viability as well as for an enhance of the chondrogenic properties of the cells, hence suggesting their suitability for CTE applications.

Características clínico-epidemiológicas de pacientes notificados con infección intrahospitalaria en Unidad de Cuidados Intensivos pediátricos. Cienfuegos, 2015-2019

RESUMEN Fundamento: la tasa de infecciones intrahospitalarias es uno de los indicadores de la calidad de los servicios; adquiere mayor importancia en las unidades de cuidados intensivos pediátricas, por su alta incidencia y gravedad. Objetivo: caracterizar los casos de infección asociada a la asistencia sanitaria en Unidad de Cuidados Intensivos Pediátricos. Métodos: estudio descriptivo retrospectivo de los pacientes ingresados en la Unidad de Cuidados Intensivos Pediátricos del Hospital Pediátrico Universitario Paquito González Cueto, de Cienfuegos, que adquirieron una infección en dicha unidad, en el periodo de 2015 a 2019. Se analizaron las variables: edad al egreso, sexo, localización de la sepsis, proceder de alto riesgo, uso del apoyo microbiológico y positividad del mismo, letalidad. Resultados: la tasa promedio de infección asociada a la atención fue de 3,5 por cada 100 egresos; fueron más afectados los niños menores de un año con un 27,3 %. La infección respiratoria predominó con un 46,8 %. El uso de la canalización venosa se presentó en el 94,8 % de los casos y los antimicrobianos por infecciones previas fueron aplicados al 49,4 %. El apoyo microbiológico se realizó al 77,9 % y fue positivo en 76,7 %. Predominaron los gérmenes Gram negativos. Fallecieron cuatro pacientes. Conclusiones: la tasa de infección nosocomial es comparable con las cifras reportadas internacionalmente. Se infectan más los niños menores de un año, con una letalidad no despreciable, por lo que se deben extremar las medidas de prevención y control dirigidas a los principales factores de riesgo para su aparición.

ABSTRACT Background: the rate of intra-hospital infections is one of the qualities of services' indicators; It acquires greater importance in pediatric intensive care units, due to its high incidence and severity. Objective to characterize the cases of infection associated with health care in the Pediatric Intensive Care Unit. Methods: retrospective descriptive study of patients admitted to the Pediatric Intensive Care Unit at the Paquito González Cueto University Pediatric Hospital, Cienfuegos, who acquired an infection in this unit, in the period from 2015 to 2019. The analyzed variables were: age at discharge, sex, location of sepsis, high-risk procedure, use of microbiological support and its positivity, lethality. Results: the average rate of infection associated with care was 3.5 per 100 discharges; Children under one year of age were more affected with 27.3%. Respiratory infection predominated with 46.8%. The use of venous catheterization occurred in 94.8% of the cases and antimicrobials due to previous infections were applied in 49.4%. Microbiological support was performed in 77.9% and it was positive in 76.7%. Gram negative germs predominated. Four patients died. Conclusions: the nosocomial infection rate is comparable with the numbers reported internationally. Children under one year of age are more infected, with a non-negligible lethality, so prevention and control measures aimed at the main risk factors for their appearance must be taken to extremes.

Microplastics, bisphenols, phthalates and pesticides in odontocete species in the Macaronesian Region (Eastern North Atlantic).

The gastrointestinal contents of twelve individuals from six odontocete species that stranded between 2018 and 2019 in the Macaronesian Region (Eastern North Atlantic) were examined for the presence of marine debris. In addition, concentrations of eleven organic persistent contaminants (nonylphenols, bisphenols, phthalates and pesticides) were analysed in muscle samples by liquid chromatography. No particles larger than 5 mm were found, except for two plastic labels that were found on the same dolphin. On the contrary, all animals contained microplastics of diverse sizes, most of them being fibres (98.06%, n = 708). The predominant detected pollutants were bisphenols (4-984 ng/g) and DEHP (102-1533 ng/g). Also, except for two individuals, all animals had pesticide levels in their tissues. This work has allowed the establishment of a protocol for the study of microplastic ingestion in cetaceans, and tests the potential of microRaman to improve the understanding of microplastic alteration processes.

Caracterización y oportunidad del tratamiento quirúrgico en pacientes con cáncer de esófago / Characterization and Chances for Surgical Treatment in Patients with Esophageal Cancer

Introducción: El cáncer de esófago es una de las neoplasias más agresivas del tracto digestivo, presenta alta morbilidad y mortalidad a nivel mundial. Objetivo: Determinar las características clínico epidemiológicas de los pacientes con cáncer de esófago y su oportunidad del tratamiento. Métodos: Se realizó una investigación básica de tipo descriptiva y retrospectiva en los pacientes con cáncer de esófago hospitalizados en el Instituto Nacional de Oncología y Radiobiología durante el período enero 2016 - enero 2017. Se obtuvieron los datos necesarios de las historias clínicas individuales de los casos que cumplieron los criterios de inclusión. Se aplicaron frecuencias absolutas y porcentajes para permitir los análisis estadísticos de variables seleccionadas. Resultados: El diagnóstico en las edades entre 60 y 69 años fue más frecuente, con el 44,8 por ciento de los casos; el 73,7 por ciento eran hombres y el 52,3 por ciento de la raza negra. En el 71,0 por ciento se encontró antecedentes de esofagitis de reflujo; 78,9 por ciento eran fumadores y 52,6 por ciento bebedores abusivos. La disfagia fue el síntoma más común y el carcinoma epidermoide se presentó con mayor frecuencia alcanzándose el 82,1 por ciento de la muestra estudiada. La mayoría de los casos se diagnosticó en estadio III. Conclusiones: Esta neoplasia constituye un problema de salud en Cuba, se incrementa su incidencia en los últimos años. Se recomienda aplicar el programa de detección y diagnóstico precoz de la enfermedad(AU)

Introduction: Esophageal cancer is one of the most aggressive neoplasms of the digestive tract; it accounts for high morbidity and mortality worldwide. Objective: To determine the clinical-epidemiological characteristics of patients with esophageal cancer and their chances for treatment. Methods: A descriptive and retrospective basic research was carried out, during the period from January 2016 to January 2017, in patients with esophageal cancer hospitalized at the National Institute of Oncology and Radiobiology. The necessary data were obtained from the individual medical records of the cases. that met the inclusion criteria. Absolute frequencies and percentages were applied for the statistical analyses of the selected variables. Results: The diagnosis at ages between 60 and 69 years was more frequent, accounting for 44.8 percent of the cases. 73.7 percent were men and 52.3 percent were of black race. A history of reflux esophagitis was found in 71.0 percent. 78.9 percent were smokers and 52.6 percent were abusive drinkers. Dysphagia was the most common symptom, while squamous cell carcinoma presented more frequently, reaching 82.1 percent of the sample studied. Most of the cases were diagnosed in stage III. Conclusions: This neoplasm is a health concern in Cuba; its incidence has increased in recent years. It is recommended to apply the program of early diagnosis and detection of the disease(AU)

Molecular and Cellular Mechanisms of Delayed Fracture Healing in Mmp10 (Stromelysin 2) Knockout Mice.

The remodeling of the extracellular matrix is a central function in endochondral ossification and bone homeostasis. During secondary fracture healing, vascular invasion and bone growth requires the removal of the cartilage intermediate and the coordinate action of the collagenase matrix metalloproteinase (MMP)-13, produced by hypertrophic chondrocytes, and the gelatinase MMP-9, produced by cells of hematopoietic lineage. Interfering with these MMP activities results in impaired fracture healing characterized by cartilage accumulation and delayed vascularization. MMP-10, Stromelysin 2, a matrix metalloproteinase with high homology to MMP-3 (Stromelysin 1), presents a wide range of putative substrates identified in vitro, but its targets and functions in vivo and especially during fracture healing and bone homeostasis are not well defined. Here, we investigated the role of MMP-10 through bone regeneration in C57BL/6 mice. During secondary fracture healing, MMP-10 is expressed by hematopoietic cells and its maximum expression peak is associated with cartilage resorption at 14 days post fracture (dpf). In accordance with this expression pattern, when Mmp10 is globally silenced, we observed an impaired fracture-healing phenotype at 14 dpf, characterized by delayed cartilage resorption and TRAP-positive cell accumulation. This phenotype can be rescued by a non-competitive transplant of wild-type bone marrow, indicating that MMP-10 functions are required only in cells of hematopoietic linage. In addition, we found that this phenotype is a consequence of reduced gelatinase activity and the lack of proMMP-9 processing in macrophages. Our data provide evidence of the in vivo function of MMP-10 during endochondral ossification and defines the macrophages as the lead cell population in cartilage removal and vascular invasion. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Fatores de Risco Cardiovascular em Cardiologistas Especialistas pela Sociedade Brasileira de Cardiologia / Cardiovascular Risk Factors in Cardiology Specialists from the Brazilian Society of Cardiology

Resumo Fundamento: Principal causa de morte em todo o mundo, as doenças cardiovasculares (DCV) e sua prevalência nos médicos cardiologistas são pouco conhecidas. Objetivos: Descrever os hábitos de vida e os fatores de risco cardiovascular e verificar a prevalência de diagnóstico, conhecimento e controle dos fatores de risco cardiovasculares (FRCV) de médicos cardiologistas associados e especialistas pela Sociedade Brasileira de Cardiologia. Métodos: Estudo multicêntrico nacional transversal que avaliou cardiologistas brasileiros por meio de questionário sobre hábitos de vida, doenças preexistentes, medicações em uso, medidas antropométricas, pressão arterial e dosagens de glicose e lípideos sanguíneos. Resultados: Foram avaliados 555 cardiologistas, 67,9% do sexo masculino, média de idade de 47,2±11,7 anos. A maioria era não tabagista (88,7%), fisicamente ativa (77,1%), consumia bebida alcóolica (78,2%), com circunferência abdominal normal (51,7%) e excesso de peso (56,1%). As prevalências de hipertensão arterial sistêmica (HAS), diabetes mellitus (DM) e dislipidemia (DLP) foram de 32,4%, 5,9% e 49,7%, respectivamente e, destes, apenas 57,2%, 45,5% e 49,6% sabiam ter as doenças. Conclusões: Os cardiologistas brasileiros participantes do estudo apresentaram prevalências significativas de HAS, DM e DLP, mas apenas a metade dos participantes sabia ser portador dessas condições e, entre eles, as taxas de controle eram baixas para HAS e DLP, apesar de os cardiologistas serem profissionais detentores de conhecimento diferenciado sobre esses FRCV. Os achados representam um alerta para a abordagem dos FRCV em cardiologistas brasileiros e estimulam a realização de estudos futuros.

Abstract Background: A major cause of death worldwide, cardiovascular diseases and their prevalence in cardiologists are little known. Objectives: To describe life habits and cardiovascular risk factors (CVRF) and to investigate the prevalence of diagnosis, awareness, and control of these CVRF among cardiologists members affiliated to and specialists from the Brazilian Society of Cardiology. Methods: National multicenter cross-sectional study to assess Brazilian cardiologists using a questionnaire on life habits, preexisting diseases, current medications, anthropometric measurements, blood pressure, and levels of glucose and lipids. Results: A total of 555 cardiologists were evaluated, of which 67.9% were male, with a mean age of 47.2±11.7 years. Most were non-smoker (88.7%) and physically active (77.1%), consumed alcohol (78.2%), had normal weight circumference (51.7%), and were overweight (56.1%). The prevalence of systemic arterial hypertension (SAH), diabetes mellitus (DM), and dyslipidemia (DLP) were 32.4%, 5.9%, and 49.7%, respectively, of which only 57.2%, 45.5%, and 49.6%, respectively, were aware of the diseases. Conclusions: The Brazilian cardiologists participating in the study had a high prevalence of SAH, DM and DLP, but only a half of participants were aware of these conditions and, among these, the rates of controlled disease were low for SAH and DLP, although cardiologists are professionals with great knowledge about these CVRF. These findings represent a warning sign for the approach of CVRF in Brazilian cardiologists and encourage the conduction of future studies.

Glutathione Ethyl Ester Protects In Vitro-Maturing Bovine Oocytes against Oxidative Stress Induced by Subsequent Vitrification/Warming.

This study aimed to examine whether the addition of glutathione ethyl ester (GSH-OEt) to the in vitro maturation (IVM) medium would improve the resilience of bovine oocytes to withstand vitrification. The effects of GSH-OEt on spindle morphology, levels of reactive oxygen species (ROS), mitochondrial activity and distribution, and embryo developmental potential were assessed together with the expression of genes with a role in apoptosis (BAX, BCL2), oxidative-stress pathways (GPX1, SOD1), water channels (AQP3), implantation (IFN-τ) and gap junctions (CX43) in oocytes and their derived blastocysts. Vitrification gave rise to abnormal spindle microtubule configurations and elevated ROS levels. Supplementation of IVM medium with GSH-OEt before vitrification preserved mitochondrial distribution pattern and diminished both cytoplasmic and mitochondrial ROS contents and percentages of embryos developing beyond the 8-cell stage were similar to those recorded in fresh non-vitrified oocytes. Although not significantly different from control vitrified oocytes, vitrified oocytes after GSH-OEt treatment gave rise to similar day 8-blastocyst and hatching rates to fresh non-vitrified oocytes. No effects of GSH-OEt supplementation were noted on the targeted gene expression of oocytes and derived blastocysts, with the exception of GPX1, AQP3 and CX43 in derived blastocysts. The addition of GSH-OEt to the IVM medium before vitrification may be beneficial for embryo development presumably as the consequence of additional anti-oxidant protection during IVM.

In vitro maturation in the presence of Leukemia Inhibitory Factor modulates gene and miRNA expression in bovine oocytes and embryos.

Members of the interleukin-6 (IL-6) family of cytokines are important for reproductive function that are mediated through changes in gene and miRNA expression. Herein, we characterized the expression of miR-21, miR-155, miR-34c and miR-146a in bovine oocytes and cumulus cells during in vitro maturation (IVM) with leukemia inhibitory factor (LIF), IL-6 and IL-11 or unsupplemented controls. LIF-exposed COCs showed higher expression of miR-21 and miR-155 in oocytes, whereas miR-146a expression was increased in oocytes matured with IL-6 and IL-11. In cumulus cells, miR-155 expression was elevated by all treatments while only LIF increased miR-21 expression. Based on these results, we next examined how LIF exposure during IVM affected oocyte competence, through IVF and the expression of specific genes in GV- and MII-oocytes, in 2- and 8-cell embryos, and in Day 8-blastocysts. LIF supplementation did not affect cleavage rate, blastocyst yield or several other developmental parameters, but did increase hatching rate. LIF suppressed DPPA3, ZAR1 and NPM2 expression in 2 cell- and/or 8-cell embryos. LIF increased the expression of KAT2A and HSPA1A in MII-oocytes, and that of HDAC1, KAT2A and HSP90AA1 and the BAX:BCL2L1 ratio in 2-cell embryos. In contrast, HDAC1, KAT2A and HSP90AA1 expression and BAX:BCL2L1 ratio was lower in 8-cell embryos derived from LIF oocytes. IVM with LIF also increased the expression of DNMT3A, HSPA1A and HSP90AA1 in blastocysts. In conclusion, supplementation with LIF during IVM was consistently associated with changes in the relative abundance of transcripts in mature bovine oocytes and in specific embryo developmental stages.

In Vitro Maturation with Leukemia Inhibitory Factor Prior to the Vitrification of Bovine Oocytes Improves Their Embryo Developmental Potential and Gene Expression in Oocytes and Embryos.

Oocyte cryopreservation has a significant impact on subsequent embryonic development. Herein, we investigated whether supplementing in vitro maturation medium with Leukemia Inhibitory Factor (LIF) prior to vitrification affects embryo development and gene expression at different embryo developmental stages. A panel of genes including maternal effect, epigenetics, apoptosis and heat stress was relatively quantified. The results show reduced cleavage rates after vitrification, regardless of the LIF treatment. Although not statistically different from control-vitrified oocytes, oocyte apoptosis and the blastocyst yield of LIF-vitrified oocytes were similar to their non-vitrified counterparts. Vitrification increased oocyte ZAR1, NPM2 and DPPA3 gene expression while its expression decreased in LIF-vitrified oocytes to similar or close levels to those of non-vitrified oocytes. With a few gene-specific exceptions, vitrification significantly increased the expression of DNMT3A, HDAC1, KAT2A, BAX and BCL2L1 in oocytes and most stages of embryo development, while comparable expression patterns for these genes were observed between LIF-vitrified and non-vitrified groups. Vitrification increased HSPA1A expression in oocytes and HSP90AA1 in 2-cell embryos. Our data suggest that vitrification triggers stage-specific changes in gene expression throughout embryonic development. However, the inclusion of LIF in the IVM medium prior to vitrification stimulates blastocyst development and several other developmental parameters and induces oocytes and embryos to demonstrate gene expression patterns similar to those derived from non-vitrified oocytes.

Reducing the Clinical and Public Health Burden of Familial Hypercholesterolemia: A Global Call to Action.

Importance: Familial hypercholesterolemia (FH) is an underdiagnosed and undertreated genetic disorder that leads to premature morbidity and mortality due to atherosclerotic cardiovascular disease. Familial hypercholesterolemia affects 1 in 200 to 250 people around the world of every race and ethnicity. The lack of general awareness of FH among the public and medical community has resulted in only 10% of the FH population being diagnosed and adequately treated. The World Health Organization recognized FH as a public health priority in 1998 during a consultation meeting in Geneva, Switzerland. The World Health Organization report highlighted 11 recommendations to address FH worldwide, from diagnosis and treatment to family screening and education. Research since the 1998 report has increased understanding and awareness of FH, particularly in specialty areas, such as cardiology and lipidology. However, in the past 20 years, there has been little progress in implementing the 11 recommendations to prevent premature atherosclerotic cardiovascular disease in an entire generation of families with FH. Observations: In 2018, the Familial Hypercholesterolemia Foundation and the World Heart Federation convened the international FH community to update the 11 recommendations. Two meetings were held: one at the 2018 FH Foundation Global Summit and the other during the 2018 World Congress of Cardiology and Cardiovascular Health. Each meeting served as a platform for the FH community to examine the original recommendations, assess the gaps, and provide commentary on the revised recommendations. The Global Call to Action on Familial Hypercholesterolemia thus represents individuals with FH, advocacy leaders, scientific experts, policy makers, and the original authors of the 1998 World Health Organization report. Attendees from 40 countries brought perspectives on FH from low-, middle-, and high-income regions. Tables listing country-specific government support for FH care, existing country-specific and international FH scientific statements and guidelines, country-specific and international FH registries, and known FH advocacy organizations around the world were created. Conclusions and Relevance: By adopting the 9 updated public policy recommendations created for this document, covering awareness; advocacy; screening, testing, and diagnosis; treatment; family-based care; registries; research; and cost and value, individual countries have the opportunity to prevent atherosclerotic heart disease in their citizens carrying a gene associated with FH and, likely, all those with severe hypercholesterolemia as well.