Toward proof of concept of a one health approach to disease prediction and control.

A One Health approach considers the role of changing environments with regard to infectious and chronic disease risks affecting humans and nonhuman animals. Recent disease emergence events have lent support to a One Health approach. In 2010, the Stone Mountain Working Group on One Health Proof of Concept assembled and evaluated the evidence regarding proof of concept of the One Health approach to disease prediction and control. Aspects examined included the feasibility of integrating human, animal, and environmental health and whether such integration could improve disease prediction and control efforts. They found evidence to support each of these concepts but also identified the need for greater incorporation of environmental and ecosystem factors into disease assessments and interventions. The findings of the Working Group argue for larger controlled studies to evaluate the comparative effectiveness of the One Health approach.

Imaging the ascending aorta and aortic arch using transesophageal echocardiography: the expanded aortic view.

Transesophageal echocardiography (TEE) imaging of the aorta requires multiple views and is limited by its inability to visualize the distal ascending aorta and proximal aortic arch ("blind spot"). Recent advances in ultrasound technology allow improved imaging of cardiac structures. In this study we describe the ability to image the aortic valve, entire ascending aorta, and aortic arch in one view, the "expanded aortic view" obtained from a novel proximal transgastric window. In 22 patients, an expanded aortic view was acquired with the transducer positioned in a proximal transgastric position using new generation ultrasound system with a TEE probe that incorporates increased range of mobility. Fluoroscopy imaging was performed to confirm the position of transducer in relation to the cardiac anatomy. In 7 of 22 patients, the ability to achieve this view was also tested using an older echocardiography system. The novel proximal transgastric plane allowed reliable images of the aortic valve, ascending aorta including the "blind spot," and aortic arch in a single view-the expanded aortic view.

Incidence of thrombus formation on the CardioSEAL and the Amplatzer interatrial closure devices.

Transcatheter closure for atrial septal defect (ASD) and patent foramen ovale (PFO) is a promising alternative to surgical closure or anticoagulant therapy. A potential complication is thrombus formation on the device after implantation. From February 2001 to June 2003, 66 patients with atrial communication were treated successfully with the Amplatzer device (16 septal and 20 PFO occluders) or the CardioSEAL device (30). Patients were discharged on antiplatelet medication (aspirin and clopidogrel) and/or anticoagulation. Fifty patients (76%) had transesophageal echocardiography (TEE) 1 month after device implantation (28 +/- 10 days). No patient experienced a thromboembolic episode during follow-up. TEE revealed that thrombus formation occurred more frequently on the CardioSEAL device (5 of 23 patients; 22%) than on the Amplatzer device (0 of 27 patients; 0%) (p = 0.02). Although thrombus disappeared or markedly diminished after additional anticoagulation therapy in 3 patients, 1 patient had surgical explantation of the device due to progressive increase in the size of thrombus with hypermobility despite intensive anticoagulation therapy. There was no variable associated with the presence of thrombus formation on the occluder other than the use of the CardioSEAL device. One month after insertion, the CardioSEAL device is more likely to have thrombus present than the Amplatzer device.