Materials and

Methods: A systematic search for relevant s

Materials and

Methods: A systematic search for relevant studies was performed of the PubMed/MEDLINE and EMBASE databases. Two reviewers independently assessed the methodologic quality Galardin cell line of each study by using the Quality Assessment of Diagnostic Accuracy Studies tool. The inclusion criteria were met by 50 studies. Heterogeneity was tested, and the presence of publication bias was visually assessed (by using a funnel plot). A meta-analysis of the reported sensitivity and specificity of each study with 95% confidence intervals (CIs) was performed on a per-patient level.

Results: Concerning sensitivity, the selected studies showed moderate heterogeneity. For specificity, low heterogeneity was observed. Moderate-heterogeneity studies that investigated only sensitivity or specificity were excluded from the pooled analyses by using a bivariate random effects model. The majority of the studies (n = 30) used a four-detector row CT scanner. The studies had good methodologic quality. Pooled sensitivity Stattic was 98% (95% CI: 97%, 99%), and pooled specificity was 100% (95% CI: 97%, 100%). Potential sources of variability among the studies were variations in the methodologic features (quality score), CT examination procedure (number of rows on the multidetector

CT scanner), the standard of reference used, and the prevalence of ruptured intracranial aneurysms. There was evidence for publication bias, which may have led to overestimation of the diagnostic accuracy of CT angiography.

Conclusion: Multidetector CT angiography can be used as a primary examination

tool in the diagnostic work-up of patients with SAH. (C) RSNA, 2010″
“Background: Respiratory syncytial virus (RSV) is a common cause of bronchiolitis in infants. In children with congenital heart disease (CHD), it is associated with significant morbidity and mortality. Palivizumab is a monoclonal antibody that reduces the number of RSV-associated hospitalizations in children with CHD. BMS-777607 ic50 We sought to assess cost savings and cost-effectiveness of palivizumab in children < 2 years old with hemodynamically significant CHD in a provincially administered RSV prophylaxis program.

Methods: A cohort of children who received palivizumab (N = 292) from 2003-2007 was compared to a historical cohort of children (N = 412) from 1998-2003 who met the eligibility criteria for palivizumab prior to initiation of the prophylaxis program. Direct and indirect costs and benefits were determined.

Results: The direct and indirect costs in the historical cohort were $838 per patient season compared to $ 9130 per patient season in the palivizumab cohort. Risk of admission was reduced by 42%, and days in hospital were reduced by 83%. The incremental cost of the RSV prophylaxis program was $8292 per patient for 1 RSV season. The incremental cost to prevent 1 day of hospitalization was $15,514. The cost of palivizumab accounted for 87.9% of the cost of prophylaxis.

This procedure allowed the recovery of chromatographically pure a

This procedure allowed the recovery of chromatographically pure antimicrobial peptides with the yields of 19%, 10% and 15% of BAP1, BAP2

and BAP3, respectively. The respective apparent molecular masses as determined by tricine-SDS-polyacrilamide gel electrophoresis were 6365, 3426 and 3496. N-terminal amino acid sequencing of the BAPs and comparison of their sequences with those of international data bases indicated that BAP1 is more likely to be a casein-derived bioactive protein produced upon hydrolysis of the tryptone present in MRS broth by Lb. curvatus CWBI-B28 during active growth. However, the identity of BAP2 and BAP3 could not be determined with certainty; yet, they would be novel bacteriocins PF-6463922 research buy not fitting in any of the known classes of bacteriocins.

Therefore, this strain would have the ability to produce intrinsic antimicrobial Tariquidar datasheet substances and also release bioprotective peptides from milk-proteins upon cultivation in milk or casein-containing food products due to its proteolytic activity. Thus, Lb. curratus CWBI-B28 possesses a good potential to be used in food preservation and safety. (C) 2009 Elsevier Ltd. All rights reserved.”
“Spoligotyping is the most frequently used method for genotyping isolates of Mycobacterium bovis worldwide. In the current work, we compared spoligotypes from 1684 M. bovis isolates

from Argentina (816), Brazil (412), Chile (66), Mexico (274) and Venezuela (116), obtained from cattle, humans, pigs, wild boars, farmed deer, goats, buffaloes, cats, and wild animals. A total of 269 different spoligotypes were found: 142 (8.4%) isolates presented orphan spoligotypes, whereas 1542 (91.6%) formed 113 different clusters. In cattle, SB0140 was the most representative spoligotype with 355 (24.6%) isolates, followed by SB0121 with 149 (10.3%) isolates. Clustering of spoligotypes ranged from 95.2% in Argentina to 85.3% in Mexico. Orphan spoligotypes VE 821 were also variable, ranging from 23.7% in Mexico to 4.1% in Brazil. A large proportion of spoligotypes were common to the neighboring countries Argentina, Brazil and Chile. In conclusion, despite the diversity of spoligotypes found in the five countries studied, there are major patterns that predominate in these neighboring countries. These clusters may reflect a long-lasting active transmission of bovine tuberculosis or common historical origins of infection. (C) 2012 Elsevier Ltd. All rights reserved.”
“In view of the low sensitivity of Sokolow-Lyon voltage criteria in the assessment of electrocardiographic left ventricular hypertrophy (ECG LVH) in overweight subjects, we determined its clinical utility in 1840 lean and 3555 overweight subjects with hypertension.

This evidence may suggest aspects within clinical practice where

This evidence may suggest aspects within clinical practice where modifications may be made in order to optimize patient outcomes.”
“Staphylococcus aureus continues to be a major health problem. This species’ requirement for proline and proline transport from the extracellular environment is not well understood. Here, we identify a S. aureus low-affinity proline transport gene (opuD) with homology to the OpuD protein of Bacillus subtilis. Mutation of the

opuD gene caused a significant decline in proline uptake under low-affinity conditions as compared with wild type, but the opuD mutant strain showed no significant attenuation in a murine abscess model of infection. The S. aureus opuD gene was transcriptionally activated during growth in moderate osmolarity media with high levels of proline or glycine betaine independent of SigB. In murine abscesses, CA3 in vivo the opuD gene was activated at a later time point, Tozasertib manufacturer whereas the opuD expression dropped over the course of an 18-h period within murine urinary tracts. Transcriptional regulation

of opuD in S. aureus appears to be coordinated within this species when grown in moderate to high NaCl environments, but the level of extracellular proline had a marked effect on expression of this proline transport gene. The differential regulation of proline transport genes in S. aureus may be an adaptation for life in a variety of environments, including survival within the human body.”
“Thermal conductivity values of several laser materials were determined by photothermal measurements and compared AZD8055 to predicted values. The effect of the ytterbium doping concentration could be modeled using a simple

cationic mass difference model. For ytterbium content corresponding to an absorption coefficient of 10 cm(-1) (or 85% absorption of the pump power) Yb: GdVO4 (c-axis) and Yb: Gd3Ga5O12 laser materials present the highest measured thermal conductivity values of 8.1 W m(-1) K-1 and 7.7 W m(-1) K-1, respectively. Yb: Y3Al5O12, Yb: Lu3Al5O12, Yb: CaGdAlO4, and Yb: YAlO3 belong to the 6-7 W m(-1) K-1 range while Yb: CaF2 and Yb: Lu2SiO5 are situated in the 5-6 W m(-1) K-1 range. Other matrices such as Yb: SrLaGa3O7, Yb: CaGdAl3O7, Yb: SrGdGa3O7, and Yb: BaLaGa3O7 have thermal conductivity values lower than 5 W m(-1) K-1. With the knowledge of the thermal conductivities and the determination of the thermal expansion coefficients, thermal shock parameters are evaluated for several ytterbium doped laser hosts. (c) 2010 American Institute of Physics. [doi: 10.1063/1.3520216]“
“Neurophysiological deficits could make patients with Ehlers-Danlos syndrome (EDS) type III (hypermobility type) more vulnerable to musculoskeletal problems, particularly to joint instability.

The results also show a good spinnability for the copolymer solut

The results also show a good spinnability for the copolymer solution in a range of voltages from 16 to 24 kV. When the molar ratio of 1,4-cyclohexanedimethanol to 1,4-butanediol was 10 : 90, the electrospun membrane prepared by the corresponding GW786034 mw copolymers had a higher elastic modulus than the commercial TPEE (Hytrel 4056, 4.51 +/- 6 0.35 MPa). Differential scanning calorimetry and X-ray diffraction showed that a crystalline phase existed in the electrospun poly[(butylene terephthalate)-co-(1,4-cyclohexanedimethanol terephthalate)]-b-poly(tetramethylene

glycol) (P(BT-co-CT)-b-PTMG) copolymer fiber membranes. The melting point of the electrospun fibers was approximately

less than that of the corresponding copolymers (C) 2011 Wiley Periodicals, Inc. J Appl Polym GSK621 molecular weight Sci 122: 1698-1706, 2011″
“To investigate the factors that influence treatment satisfaction after high-power potassium-titanyl-phosphate (KTP) laser vaporization of the prostate, we compared the characteristics between patients who were satisfied and those who were not satisfied. In all, 97 patients aged between 53-82 years (median age 67 years) underwent high-power KTP laser vaporization of the prostate for lower urinary tract symptoms due to benign prostatic hyperplasia. At 12 months postoperatively, 60 patients were satisfied with the treatment, whereas 37 were dissatisfied. Although there were no differences in International Prostate Symptom Score (IPSS) values at baseline, the satisfied group scored better in total IPSS at 1, 3, 6, and 12 months postoperatively (P < 0.05). At baseline, the maximum flow rate (Q(max)) was lower in the dissatisfied group and remained low throughout the follow-up period, with the exception of 1 month postoperatively (P < 0.05), compared with the satisfied group. There were no differences in other objective data between the two groups, including post-void residual

NU7026 chemical structure and the number of voids based on the frequency-volume charts. In a multivariate model, a higher bladder contractility index was associated with a greater likelihood of treatment satisfaction 12 months after high-power KTP laser vaporization (odds ratio 1.024, 95% confidence interval 1.001-1.048, P < 0.05). Patients who were not satisfied following the surgery had a smaller improvement in subjective symptoms and Q(max). In addition, our findings suggest that the relative risk of treatment dissatisfaction following high-power KTP laser vaporization was increased in patients with weak detrusor contractility.”
“We study absorption enhancement by light scattering at periodically textured interfaces in thin film silicon solar cells. We show that the periodicity establishes resonant coupling to propagating waveguide modes.

The question addressed was: Is

The question addressed was: Is AZD6244 it worth packing the head with ice in patients undergoing deep hypothermic circulatory arrest (DHCA)? Altogether more than 34 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question, 5 of which were animal studies, 1 was a theoretical laboratory study and 1 study looked at the ability to cool using circulating water ‘jackets’

in humans. There were no available human studies looking at the neurological outcome with or without topical head cooling with ice without further adjunct methods of cerebral protection. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four papers studied animals undergoing DHCA for 45 min-2 h depending on the study design, with or without packing the head with ice. The studies all demonstrated improved cerebral cooling when the head was packed with ice during DHCA. They also illustrated an improved neurological outcome, with better behavioural scores (P < 0.05), and in some, survival, when

compared with animals whose heads were not packed in ice. One study examined selective head cooling with the use of packing the head with ice during rewarming after DHCA. However, they demonstrated worse neurological outcomes in these animals, possibly due to the loss of cerebral vasoregulation and cerebral oedema. One LDN-193189 solubility dmso study involved a laboratory experiment showing improved cooling using circulating cool water in cryotherapy braces than by using packed ice. They extrapolated that newer devices to cool the head may improve cerebral cooling during DHCA. The final study discussed here demonstrated the use of circulating water to the head in humans undergoing pulmonary endarterectomy. They found that tympanic membrane temperatures could be maintained significantly lower than bladder or rectal temperatures when using circulating water to cool the head. We conclude that topical Selleckchem Nutlin3a head cooling with ice is of use during DHCA but not during rewarming following DHCA and that

it may be possible to advance topical head cooling techniques using circulating water rather than packed ice.”
“Studies showed a rise in obesity prevalence in world population and evidences point to a possible association with vitamin A deficiency (VAD). The objective of this study is to assess vitamin A nutritional status through functional [night blindness diagnosis-xerophthalmia (XN)] and biochemical (serum levels and retinol liver store) indicators of class III obesity individuals and its association.

We studied 114 patients of both genders with BMI a parts per thousand yen40 kg/m(2), candidates to bariatric surgery at Clinica CirA(0)rgica Carlos Saboya in Rio de Janeiro, Brazil. XN was diagnosed through a standardized interview (WHO and MacLaren and Frigg), and serum levels and retinol liver store were quantified by HPLC-UV with < 1.

Studies evaluating testosterone treatment of older men with low <

Studies evaluating testosterone treatment of older men with low CA4P in vivo testosterone levels are limited, but they suggest some increase in fat free mass, some decrease in fat mass, and some increase in bone density of the lumbar spine and femoral neck.

Conclusion: The Testosterone

Trial should provide definitive information regarding the potential benefits of TRT in men = 65 years of age. If efficacy is confirmed, we will still need more information regarding the risks of TRT in older men.”
“Contents This study was conducted to explore the influencing factors of ova in vitro fertilization (IVF) and transfer of the fertilized ova into the oviduct of recipient hens. The efficiency of fertilization was compared using three aspects: (i) the different time of ova collection and transfer,

(ii) egg-laying period of recipient hen; and (iii) semen volume. The following results are observed: 72%, 40% and 0% of ova were found in ovarian sac in 30 approximate to 40min, 50 approximate to 60min and more than 90min post-oviposition, respectively; 20%, 18%, 14% and 5.8% of ova were fertilized with 0.1, 0.2, 0.5 and 1.0ml semen, respectively; and 33% and 100% of healthy chickens were hatched from fertile ova with 0.1 and 0.5ml of semen, respectively. All oocytes obtained from ovary and mid-oviduct were unfertilized. Embryos were transferred into recipient hens 30min +/- 10min post-oviposition, and 70% of shelled eggs were produced. There were no eggs produced in this website the other transfer times. This demonstrated that live chicken can be obtained by IVF of ova collected click here shortly after oviposition. It was important that the ovum was transferred into the oviduct infundibulum of recipient hens immediately or shortly after oviposition.”
“Background: Odds ratios (OR) significantly overestimate associations between risk factors and common outcomes. The estimation of relative risks (RR) or prevalence ratios (PR) has represented a statistical challenge in

multivariate analysis and, furthermore, some researchers do not have access to the available methods. Objective: To propose and evaluate a new method for estimating RR and PR by logistic regression.

Methods: A provisional database was designed in which events were duplicated but identified as non-events. After, a logistic regression was performed and effect measures were calculated, which were considered RR estimations. This method was compared with binomial regression, Cox regression with robust variance and ordinary logistic regression in analyses with three outcomes of different frequencies.

Results: ORs estimated by ordinary logistic regression progressively overestimated RRs as the outcome frequency increased. RRs estimated by Cox regression and the method proposed in this article were similar to those estimated by binomial regression for every outcome. However, confidence intervals were wider with the proposed method.

005) in isolated heart The

005) in isolated heart. The GW4869 solubility dmso activity exerted by progesterone-dihydropyridimidine derivative on perfusion pressure [10(-9) to 10(-4) mM] was

blocked in presence of indomethacin [10(-6) mM] and PINANE TXA(2) [10(-6) mM]. These data suggest that activity induced by progesterone-derivative on perfusion pressure and coronary resistance involves the thromboxane A(2) (TXA(2)) synthesis and secretion.”
“Alzheimer’s disease, one of the most common forms of dementia, is a neurodegenerative disorder characterized by progressive cognitive decline and affects as many as 5.3 million people in United States alone. Both Alzheimer’s and dementia have tripled the cost of health care for elderly people, amounting to about $148 billion each year. Although there have been numerous drugs designed check details so far, no ideal or successful drug treatment for Alzheimer’s and dementia has been translated into clinical setups. One of the most widely accepted theories of Alzheimer’s pathology is the aggregation of amyloid-beta (A beta) into extracellular cortical and hippocampal plaques. It has also been postulated that excessive cholesterol build-up in the brain plays an integral

role in A beta aggregation, and using HMG-coA reductase inhibitors may reduce A beta accumulation by lowering brain cholesterol levels. Based on the success of animal studies and phase II clinical trials, HMG-coA reductase inhibitors may provide a viable alternative therapy in AD treatment. This review highlights the results of both pre-clinical and clinical trials on HMG-coA reductase inhibitors in order to give a comprehensive overview of their recent progress in Alzheimer’s disease research.”
“Monte Carlo simulations are carried out for Zn cluster supported on a suspended graphene to estimate the morphological evolution of the following growth of ZnO nanostructure. The metal-metal interactions are modeled with the tight-binding many-body

potential and a Lennard-Jones potential is used to describe the metal-carbon interactions. The dynamic processes of Zn cluster in the temperature field decomposing and drifting effects are visualized through the simulation. Zn atoms make one regular atomic single layer on the graphene sheet at a relatively low temperature, which would act as orderly and high density catalytic nucleation sites. In the relatively high temperature, the Zn atomic single layer falls to pieces, the orderly and low density catalytic nucleation sites are formed. It is expected from these behaviors that the buffer layer of graphene provide a sound explanation for the formation of ordered orientated ZnO nanostructure. (C) 2011 American Institute of Physics. [doi:10.1063/1.3537828]“
“In order to carry out research on the effects of corn peptides on exercise tolerance, free radical metabolism in liver and serum Glutamic-pyruvic transaminase (GPT) activity of mice, sixty Kun-Ming male mice were randomly divided into two experimental groups, that is, Group I (20 mice) and Group II (40 mice).

Seventeen women with SUI were enrolled by urogynecologic and urod

Seventeen women with SUI were enrolled by urogynecologic and urodynamic examination. Each of them underwent EMG of striated urethral sphincter performed by 25-mm concentric needle that was put in as far as 5 mm inside internal urethral sphincter. Amplitude and duration of EMG potentials were measured during

caught, maximal contraction, and at rest. Four months after TOT treatment women underwent EMG.

The mean amplitude of EMG potentials does not show significant statistical differences between pre- and post-TOT (P = NS). The duration of potentials, instead, changed between MRT67307 ic50 pre and posttreatment only during the maximal contraction test (P a parts per thousand currency signaEuro parts per thousand 0.05).

TOT prosthesis surgery, avoiding denervation and devascularization of pelvic structures does not produce damage of the urethral sphincter.”
“A LY2090314 notable success for evolutionary genetics during the past century was to generate a coherent, quantitative explanation for an apparent evolutionary paradox: the tendency for multicellular organisms to show declining fitness with age (senescence, often referred to simply as ‘ageing’). This general theory

is now widely accepted and explains most of the features of senescence that are observed in natural and laboratory populations, but specific instantiations of that theory have been more controversial. To date, most of the empirical tests of these models have relied on data generated from

biometric experiments. Modern population genetics and genomics provide new, and probably more powerful, ways to test ideas that are still controversial more than half a century after the original theory was developed. System-genetic experiments have the potential to address both evolutionary and MK-2206 research buy mechanistic questions about ageing by identifying causal loci and the genetic networks with which they interact. Both the biometrical approaches and the newer approaches are reviewed here, with an emphasis on the challenges and limitations that each method faces.”
“In this work, we study the properties of the Rashba-induced spin accumulation in a quantum wire, by considering an impurity in this system. First, in the zero-impurity case, the dependence of the spin accumulation on the structure parameters is shown, it is consequently found that in addition to the quantum interference, the spin accumulation is determined by the quantum-wire bandwidth and the external bias. Next we, respectively, consider the cases of the impurity in the Rashba region and the normal region to present the effect of the impurity on the spin accumulation. We see that the impurity destroys the spin accumulation in a nontrivial way, and its influence on the spin accumulation is tightly associated with the coupling manners and strengths between the impurity and the quantum wire and the impurity energy.

These conditions are not met in control embryos which form abnorm

These conditions are not met in control embryos which form abnormal SAMs characterized by the presence of intercellular spaces and differentiation of meristematic

cells. Such meristems fail to reactivate at germination find more resulting in embryo abortion. Physiological and molecular studies have further demonstrated that the oxidized glutathione environment induces several responses, including changes in ascorbate metabolism, abscisic acid and ethylene synthesis, as well as alterations in storage product deposition patterns. This review attempts to relate these responses to the improved embryonic performance and proposes improved culture conditions to be applied for those cell lines and species recalcitrant to in

vitro embryogenesis. (C) 2009 Elsevier Masson SAS. All rights reserved.”
“Objective To characterize sleeping respiratory rates (SRRs) and resting respiratory rates (RRRs), collected in the home environment, of dogs with subclinical heart disease that could result in left-sided congestive heart failure.

Design Prospective cross-sectional study.

Animals-190 adult dogs with subclinical left-sided heart disease.

Procedures Most dogs had mitral valve disease or dilated cardiomyopathy of various severities. Clients collected ten 1-minute SRRs or RRRs during a period ranging from 1 week to 6 months. Clinicians provided echocardiographic and medical data on each patient.

Results The within-dog mean SRR (SRRmean,: 16 breaths/min) was significantly Small Molecule Compound Library lower than the within-dog mean RRR (RRRmean; 21 breaths/min). Seven dogs had SRRmean and 33 dogs had RRRmean > 25 breaths/min; 1 dog had SRRmean and 12 dogs had RRRmean PF-04929113 inhibitor > 30 breaths/min; these dogs mostly had a left atrial (LA)-to-aortic ratio > 1.8. Dogs with moderate LA enlargement had a significantly higher SRRmean than did other dogs.

However, median SRRmean for each of 4 levels of LA enlargement was < 20 breaths/min; median RRRmean, for each of 4 levels of LA enlargement was < 25 breaths/min. Both within-dog SRR and RRR remained stable for 10 consecutive measurements. Treatment with cardiac medications or presence of pulmonary hypertension was not associated with SRRmean or RRRmean

Conclusions and Clinical Relevance Results suggested that dogs with confirmed subclinical left-sided heart disease of various seventies generally had SRRmean <25 breaths/min, which was infrequently exceeded at any time, and that SRR and RRR remained stable, regardless of individual within-dog SRRmean or RRRmean.”
“The case report presented here is of a 4-year-old girl with severely decayed maxillary anterior teeth. After root canal treatment, the primary maxillary central and lateral incisors were reinforced using polyethylene fiber-reinforced composite resin short posts and restored using celluloid strip crowns.

“Oral meal consumption increases glucagon-like peptide 1 (

“Oral meal consumption increases glucagon-like peptide 1 (GLP-1) release which maintains euglycemia by increasing insulin Napabucasin JAK/STAT inhibitor secretion. This effect is exaggerated during short-term follow-up of Roux-en-y gastric bypass (RYGB). We examined the durability of this effect in patient with type 2 diabetes (T2DM) > 10 years after RYGB.

GLP-1 response to a mixed meal in the 10-year post-RYGB group (n = 5) was compared to lean (n = 9), obese (n = 6), and type 2 diabetic (n = 10) controls using a cross-sectional study design. Analysis of variance (ANOVA) was used to evaluate GLP-1 response to mixed meal consumption from 0 to 300 min, 0-20 min, 20-60 min, and 60-300 min, respectively. Weight,

insulin resistance, and T2DM were also assessed.

GLP-1 response 0-300 min in the 10-year post-RYGB showed a statistically significant overall difference (p = 0.01) compared to controls. Furthermore, GLP-1 response 0-20 min in the 10-year post-RYGB group showed a very rapid statistically significant rise (p = 0.035) to a peak of 40 pM. GLP-1 response between 20 and 60 min showed a rapid statistically significant (p = 0.041) decline Stem Cell Compound Library in GLP-1 response from

similar to 40 pM to 10 pM. GLP-1 response in the 10-year post-RYGB group from 60 to 300 min showed no statistically significant difference from controls. BMI, HOMA, and fasting serum glucose before and > 10 years after RYGB changed from 59.9 -> aEuro parts per thousand 40.4, 8.7 -> aEuro parts per thousand 0.88, and 155.2 -> aEuro parts per thousand 87.6 mg/dl, respectively, and were statistically significant (p < 0.05).

An exaggerated GLP-1 response was noted 10 years after RYGB, strongly suggesting a durability of this effect. This phenomenon may play a key role in maintaining type 2 diabetes remission and weight loss after RYGB.”
“Rheumatic heart disease (RHD) is a leading cause of cardiac disease among children in developing nations, and in indigenous populations of some industrialized countries. In endemic areas, RHD has long been a target of screening programmes that, historically,

have relied on cardiac auscultation. The evolution click here of portable echocardiographic equipment has changed the face of screening for RHD over the past 5 years, with greatly improved sensitivity. However, concerns have been raised about the specificity of echocardiography, and the interpretation of minor abnormalities poses new challenges. The natural history of RHD in children with subclinical abnormalities detected by echocardiographic screening remains unknown, and long-term follow-up studies are needed to evaluate the significance of detecting these changes at an early stage. For a disease to be deemed suitable for screening from a public health perspective, it needs to fulfil a number of criteria. RHD meets some, but not all, of these criteria.