“Heart failure” is a catch-all term used to describe any condition in which the organ doesn’t work as it’s supposed to — but one person’s experience with the disease can be very different from someone else’s.
Researchers from the University College London (UCL) recently used machine learning — a type of artificial intelligence — to pinpoint five distinct types of heart failure, with the goal of predicting the prognosis for the different kinds.
“We sought to improve how we classify heart failure, with the aim of better understanding the likely course of disease and communicating this to patients,” said lead author Professor Amitava Banerjee from UCL in a press release announcing the study.
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“Currently, how the disease progresses is hard to predict for individual patients,” he also said. “Some people will be stable for many years, while others get worse quickly.”
The five types of heart failure identified were early onset, late onset, atrial fibrillation (which causes an irregular heart rhythm), metabolic (linked to obesity but with a low rate of cardiovascular disease) and cardiometabolic (linked to obesity and cardiovascular disease), according to a press release on UCL’s website.
“The five types of heart failure were on the basis of common risk factors, such as age at onset of heart failure, history of cardiac disease, history of cardiac risk factors such as diabetes and obesity, or atrial fibrillation (the commonest heart rhythm problem),” explained Banerjee in a statement to Fox News Digital.
For the study, published in the journal Lancet Digital Health, the researchers analyzed data from more than 300,000 U.K. adults aged 30 and older who had experienced heart failure over a 20-year period.
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“Four methods of machine learning were used to cluster individuals with heart failure in electronic health data by their baseline characteristics,” said Banerjee. “The method and the number of clusters that ‘fit’ best to the data were selected.”
For each type of heart failure, the researchers determined the likelihood of the person dying within a year of diagnosis. The prognosis varied widely for the five subtypes, they found.
The five-year mortality risk was 20% for early onset, 46% for late onset, 61% for atrial fibrillation-related, 11% for metabolic and 37% for cardiometabolic, according to the press release.
For health professionals, Banerjee recommends that they ask their heart failure patients about common risk factors to help them understand the subtype they have.
“Researchers also need to test how usable, generalizable and acceptable these subtypes defined in our study are in clinical practice,” he added.
“They should also consider whether studies such as ours, which use AI, can help inform a better understanding of disease processes and drug discovery.”
The research team also developed an app for physicians that would enable them to determine which subtype of heart failure a patient has — with the goal of better predicting risk and keeping patients informed.
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Dr. Ernst von Schwarz, a triple board-certified clinical and academic cardiologist at UCLA in California, reviewed the results of UCL’s study.
“For clinicians, it is interesting to differentiate heart failure according to prognosis, which usually is not done in the clinical setting,” he told Fox News Digital. “Heart failure is generally seen as an incurable, chronic, progressive disease with poor long-term outcomes.”
“Heart failure is generally seen as an incurable, chronic, progressive disease with poor long-term outcomes.”
“Studies like this might help clinicians make a more appropriate risk assessment according to the etiology of heart failure,” von Schwarz added.
In particular, the very high mortality rate for atrial fibrillation-induced heart failure highlights the importance of aggressively managing this common arrhythmia, he said.
The mortality predictions for the five subtypes are “by far the most interesting part of this data,” according to Dr. Matthew Goldstein, a physician at Cardiology Consultants of Philadelphia, who also reviewed the study findings.
“This may help us guide who is at risk for dying suddenly, and thus, who needs protection with a defibrillator and who does not,” he added.
AI shows promise, but limitations remain
While Goldstein recognizes that AI is becoming more common in general, he believes its application is medicine has shown “somewhat less success.”
He told Fox News Digital, “It is, however, good at looking for patterns that are too complicated for the human mind to see.”
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“Some of the more common utilizations are automatic readings of radiology studies to make sure that nothing is missed and emerging use in EKG interpretation to suggest underlying pathology,” he added.
In terms of using AI to classify heart failure, Goldstein noted that this is only a retrospective study and will need to be proven for future cases in order to be truly useful.
The main limitation of the new study was that the researchers didn’t have access to any imaging data, which is most commonly used to diagnose and predict risk in heart failure.
“However, imaging markers alone do not predict mortality and other outcomes,” Banerjee said.
“The fact that we were able to use routinely collected data without this imaging data to predict subtypes and outcomes relatively well suggests that the imaging biomarkers alone may not be the best way to characterize and study heart failure at population scale.”
The next step, Banerjee said, is to determine whether classifying various heart failures can make a practical difference to patients — “whether it improves predictions of risk and the quality of information clinicians provide, and whether it changes patients’ treatment.”
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Cost-effectiveness is another consideration, he added.
The UCL research team previously used similar methods to identify subtypes in chronic kidney disease.
Looking ahead, Banerjee expects that machine learning will be used to analyze many types of routinely collected medical data and to identify subtypes of different diseases.
Unleashing a New Weapon on the Mosquito: A Mosquito
In a laboratory in downtown Medellín, Colombia, it is lunchtime: A technician in a white coat carries a loaded tray into a steamy nursery. She walks between rows of white mesh cages, each the size of a mini-fridge, and slides a thin tray of blood into every one. In response, her charges, all 100,000 of them, begin to whir and emit an excited hum.
This is a mosquito factory. Each week it churns out more than 30 million adult Aedes aegypti mosquitoes, with their distinctive white polka dots on their wiry black legs. The brood stock of females is fed on discarded blood blank donations, and horse blood. Eventually, some of their progeny will be released into Medellín, Cali and cities and towns in Colombia’s verdant river valleys. Other insects will be chilled into a stupor for a journey up to Honduras.
Inside the World Mosquito Program lab.
The elaborate effort is part of an experiment that is making encouraging progress in the long fight against mosquito-borne disease.
Aedes aegypti spreads arboviruses, including dengue and yellow fever, which can severely sicken or kill people. But these are special Aedes aegyptis: They carry a type of bacteria that can neutralize those deadly viruses.
Five decades ago, entomologists confronting the many kinds of suffering that mosquitoes inflict on humans began to consider a new idea: What if, instead of killing the mosquitoes (a losing proposition in most places), you could disarm them? Even if you couldn’t keep them from biting people, what if you could block them from passing on disease? What if, in fact, you could use one infectious microbe to stop another?
These scientists began to consider a parasitic bacteria called Wolbachia, which lives quietly in all kinds of insect species. A female mosquito with Wolbachia passes it on in her eggs to all of her offspring, who eventually pass it on to the next generation.
But Wolbachia isn’t naturally found in the mosquito species that cause humans the most problems — the Aedes aegypti, the virus carrier, and the Anopheles subspecies, which carry malaria. If it were, it might eventually render those species essentially harmless.
So how do you infect a mosquito with Wolbachia?
Researchers found, after painstaking trial and error, that they could insert the bacteria into mosquito eggs using minute needles. The mosquitoes that grew from those eggs were infected.
How mosquito eggs are injected with Wolbachia
A looping video showing a thin needle injecting fluid into a row of black mosquito eggs. Each egg is oblong and about half a millimeter long.
Source: World Mosquito Program
The Aedes aegypti mosquitoes that hatched and lived with Wolbachia did just fine. And as hoped, the Wolbachia mostly blocked the viruses: The mosquito who bit someone with dengue, and picked up the virus, didn’t pass it on to the next person it bit.
That got the researchers thinking: If they could infect all the mosquitoes in a village or city, they might stop the disease. Unlike truckloads of insecticides, sprayed down every street and running off into water systems, this method would not harm the ecosystem.
But how do you get Wolbachia into all the mosquitoes in a city the size of Medellín?
How Wolbachia spreads among wild mosquitoes
A series of three illustrations showing the outcomes of breeding between wild mosquitoes and mosquitoes infected with Wolbachia. When a Wolbachia-infected male and a wild female mate, no offspring will hatch. When a wild male and a Wolbachia-infected female mate, all offspring will carry Wolbachia. And when two Wolbachia-infected mosquitoes mate, all offspring will also carry Wolbachia.
Source: World Mosquito Program
Once they were confident they could infect generations of mosquitoes in the lab, the scientists needed to know if their theory would work in the wild. The method was first tested in small towns in northern Australia, where females with Wolbachia released in the field mated with wild males and did, indeed, spread Wolbachia through the mosquito population.
A team led by an Australian entomologist named Scott O’Neill next tried some towns in Vietnam, and then a small city in Indonesia. There, after three years, areas where Wolbachia had been released had 77 percent fewer cases of dengue reported, and 86 percent fewer hospitalizations.
Those results were stunning — a delight for a population used to miserable dengue seasons, and a huge relief for the public health system. Dengue causes intense suffering in even “mild” cases — it’s commonly called “breakbone fever” — and 5 percent of cases progress to the hemorrhagic form of the disease, with uncontrolled bleeding. Half of the people who develop hemorrhagic dengue die if they do not have access to treatment to control the bleeding. There are no antiviral drugs to kill the dengue virus, and the search for a safe and effective vaccine has been long and fraught.
Dengue already sickens 400 million people around the world each year, and kills 20,000, and it’s spreading fast. In places such as Indonesia, where the virus is endemic, every outbreak season, dengue overwhelms hospitals the way Covid-19 did in different places during the height of the pandemic.
Because of climate change, aegypti is broadening its range, bringing dengue with it: France had its first endemic dengue outbreak last year. The virus is in Florida and Texas. The worst dengue outbreak ever recorded was last year in Brazil — 2.3 million cases and nearly 1,000 deaths.
The countries and territories reporting dengue as of 2018
A map of the world, showing countries with recent dengue transmission highlighted in orange. About 110 countries or territories are included in this group, including most countries in the Americas and a large portion of African and Southeast Asian countries.
2 U.S. states and
45 countries or territories
2 U.S. states and
45 countries or
2 U.S. states and
Source: Leta et al., International Journal of Infectious Diseases
Note: Data in the United States is shown at the state level. All other areas are shown at the country level. Countries only reporting travel-related dengue infections are not highlighted.
Mosquitoes are increasingly resistant to insecticides. But the Wolbachia trial results in Indonesia suggested that if the Wolbachia-carrying mosquitoes supplanted the local population, then the bacteria might be established for good — and no further mosquito control would be needed.
From Indonesia, Dr. O’Neill’s group took their testing to Brazil. Another group, called WolBloc and run by the University of Glasgow entomologist Steven Sinkins and his colleagues, began a trial in a neighborhood of Kuala Lumpur, the capital of Malaysia, using a different strain of Wolbachia.
And Medellín, population three million, is the biggest test to date.
One of the neighborhoods in Medellín, Colombia.
For a mosquito showdown in a city this size, you need a lot of mosquitoes. Millions and millions of them.
Dr. O’Neill’s group — now calling themselves the World Mosquito Program — set up the production process. It’s tricky work, creating the conditions to maximize mosquito reproduction.
In the factory, females feast from the blood trays at the top of the cages, then fly down to the bottom where they lay eggs on filter paper placed in little cups of water. Technicians pluck out the paper, speckled with hundreds of tiny eggs. Some of those eggs are placed in large tubs of nutrient-enriched water, and after nine or 10 days they hatch into squirming larvae that resemble tiny worms.
From there they become pupae. Hours before they are due to transition to adulthood, they are poured through a strainer that sorts them by sex (females are bigger) and moved into mesh cages.
Mosquito pupae in a tray of water.
Some females are kept to breed — like battery hens — but hundreds of thousands of the adults are boxed up to be sent out into the world. They are released into neighborhoods by program staff members on foot or riding on the backs of motorbikes. In the city of Cali, researchers are using a large blue drone that spits out 150 mosquitoes every 50 meters, skimming over rooftops and between high-rises.
The other group of eggs are packaged into capsules that are only a bit bigger than a vitamin, along with the nutrients they need to mature. These are given out to people in the community, who can drop them in a cup of water and grow dengue-proof mosquitoes on their patios.
The World Mosquito Program released two million Wolbachia-infected mosquitoes over three months in its first target area in Medellín.
Then researchers waited: would they successfully mate with locals? And pass on Wolbachia to their progeny?
After four weeks of releases, the program began to collect mosquitoes in traps through the neighborhood to check. Back in the lab, they ground the insects up and tested for the presence of Wolbachia RNA. Over the ensuing months, more and more of the samples had it.
A drawing of mosquito’s anatomy on a dry erase board inside the lab.
Eventually, the program found Wolbachia in about two-thirds of the mosquitoes — enough that it could consider the bacteria established in the trial neighborhood — so staff members fanned out over the entire city, gradually blanketing it in Wolbachia mosquitoes.
A few years ago the project expanded to Cali, where the rates of dengue and chikungunya were surging. In the neighborhood of Siloé, which climbs over a hill above the city, Marlon Victoria, 33, had a case of chikungunya in 2018. He was feverish and aching, unable to get out of bed. “I couldn’t work for two months, and that had a big effect on our family economically,” he said.
Marlon Victoria and family.
So when the researchers came looking for help, Mr. Victoria signed up. He hung boxes of mosquito eggs in the trees, and he reassured skeptics that this would help with the dengue cases that were sending their kids to the hospital. “We explained to people that we were going to be bringing more mosquitoes, but good ones,” he said.
Did it work? It’s a tricky thing, measuring dengue rates: Outbreaks of the disease typically arrive in cycles of four, five or six years, and the Covid pandemic — during which people stayed away from public transportation, markets and schools, all major transmission sites — also complicates the numbers.
But Colombia’s national dengue monitoring system recorded the lowest dengue rates in Medellín in more than two decades in 2021 — which should have been a peak dengue year.
Dengue infections in Medellín
A graphic showing recurring peaks in dengue infections, and a missing peak in 2021 after mosquito releases began in 2017.
began August 2017
expected to be
a peak year
120 monthly dengue cases
began August 2017
expected to be
a peak year
Source: Medellín Health Secretariat and the World Mosquito Program
Enthusiasts such as Dr. O’Neill say the experience of Colombia, combined with that of Indonesia, should be all the evidence it takes to show that Wolbachia mosquitoes should be released everywhere that has an arbovirus problem. But that is no small proposition.
It’s not cheap to mass produce mosquitoes, and disperse them all over a city or a country. The Colombian program has a bustling technical operation and a vast staff. It took seven years for the mosquito factory there to be able to produce over a million insects a week. Personnel is the main cost; automatization, like using the drone to manage the releases that Mr. Victoria did by hand, helps streamline the process.
A World Mosquito Program drone taking off from an empty parking lot.
The World Mosquito Program estimates it has cost $2 to $3 per person to implement Wolbachia in Medellín. Outside estimates put the cost of a mosquito-control-through-release program at closer to $15 per person. But the program says the project will pay for itself in seven years, in reduced health care costs, in reduced spending on insecticide spraying and other control methods and in regained wages.
Racks of mosquito eggs and a tray of chilled mosquitoes.
Will it work everywhere? That’s not clear. The World Mosquito Program mosquitoes didn’t establish themselves in some areas in which they were released in Vietnam; Dr. O’Neill says they don’t know why. It’s also taken longer to establish the insects in different parts of Medellín than in others. The Wolbachia strain being used in Malaysia seems to do better at higher temperatures and could be better suited for some countries.
Laura Harrington, a professor of entomology at Cornell University who is an expert on mosquito mating (What goes into a successful mosquito hookup?), says her decades of research have found that lab-reared mosquitoes don’t compete as well against wild ones for mates, in any climate zone. “They’re not as sexy,” she says. So while the potential for Wolbachia is exciting, it’s much too soon to put a price tag or a timeline on using it for dengue control, she said, because it’s unclear how many mosquitoes a city program would actually need to release.
Then there is the matter of the evolutionary battle underway inside every infected mosquito: The arboviruses need to spread to survive, so they’re trying to find a way to overcome the ability of Wolbachia to disarm them. Likely, they eventually will, Dr. O’Neill said, but he predicts it won’t be soon.
“It might happen on an evolutionary timescale, maybe decades, maybe more like 10,000 years,” he said. “But I’d be content with a few decades, to allow other technologies to develop, until we have a better tool set.”
If the arboviruses move into other mosquito species, that’s a separate problem. But Wolbachia could move into other species, too: The WolBloc team has had some early success in preventing malaria transmission by mosquitoes infected with Wolbachia. That holds enormous promise for countries such as those in West Africa that have heavy burdens of both arboviruses and malaria.
In Medellin, mosquitoes have shifted from menace to irritant. “You don’t hear people talk much about dengue these days,” Mr. Victoria said. “If people can just forget about it — that would be a tremendous thing.”
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Ask a doc: ‘What should I know before getting a breast lift?’
A growing number of women are opting to reverse gravity by getting a surgical breast-lift procedure.
The prevalence of breast lifts has risen 70% since 2000 — twice the growth of breast implant surgery, according to new statistics from the American Society of Plastic Surgeons.
“A breast lift — or ‘mastopexy’ — is a procedure in which excess skin is removed to tighten the breast envelope,” said New York-based plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen in comments to Fox News Digital.
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“This also repositions the breast tissue and the nipple-areolar complex higher on the chest wall.”
Why do women opt for breast lifts?
All women’s breasts change with time and gravity, Chen noted.
“As women get older, it is typical and natural for the skin to lose elasticity and for the breasts to drop,” she said.
Breastfeeding is the biggest cause of this, she said; but occasionally some women who did not breastfeed may find that their breasts droop over time.
“Menopause is also a factor, because dense, glandular breast tissue is replaced by fat — and fatty tissue is softer and less firm,” Chen said.
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”If a woman is unhappy about sagging breasts, the only way to fix it is surgery,” the doctor said. “A well-fitted bra can provide support for a better look in clothes, but exercises to firm the underlying chest muscles won’t impact the breast tissue itself.”
In most cases, a mastopexy will not change the size of the breasts, even though the result may make the breasts appear fuller and rounder, according to Chen.
“In cases where a woman wants larger or smaller breasts, additional procedures such as augmentation or reduction can be done in conjunction with a breast lift,” she said.
Dr. Brian Reagan of CosmetiCare, who practices in San Diego, California, said many patients come to his practice for lifts after they have children — usually a few months post-breastfeeding.
“The breasts will change for months after breastfeeding, so we want to wait a minimum of three months,” he told Fox News Digital.
Types of breast lifts
There are several different mastopexy procedures depending on the degree of lift needed, Chen advised.
A “crescent lift” is the least invasive procedure. In this case, a crescent of skin at the top of the nipple-areolar complex is removed to improve the position of the nipple, Chen said.
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“The crescent lift is called for when the breasts are basically perky, but the woman wants her nipple-areolar complex adjusted upward slightly,” the doctor noted.
“In cases where a woman also wants bigger breasts, the crescent lift can be performed in conjunction with breast augmentation.”
A “Benelli lift” is also used to provide a small lift for barely drooping breasts.
“Here, a doughnut-shaped incision is made around the nipple-areolar complex, and the skin is tightened,” Chen said. “While this kind of breast lift is less invasive than a full lift, it can have the side effect of flattening the breast. An implant can be used to improve the projection of the breast.”
A “lollipop lift,” or a short-scar vertical mastopexy, is used when the breast tissue itself needs to be positioned higher on the chest wall, the doctor noted.
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“The short-scar vertical mastopexy refers to the limited scars around the nipple-areolar complex and then vertically to the fold below the breast, which looks like a lollipop,” Chen said. “In this procedure, more breast skin is removed, and the underlying breast tissue is repositioned to significantly change the breast shape and lift it up.”
Finally, an “anchor lift” — or the traditional Wise-pattern mastopexy — adds a horizontal scar along the crease below the breast to the same scars of the vertical mastopexy, which allows for reshaping and repositioning of the tissue.
“This is an older procedure used by older surgeons not trained in the vertical mastopexy, who are particularly prone to using it when there is significant sagging in large breasts,” Chen noted.
The vertical and the Wise-pattern mastopexies are both full breast lifts that are equally effective in creating a perkier, more youthful result, according to Chen.
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“The vertical mastopexy is also called the ‘short-scar mastopexy’ because it eliminates the horizontal scar in the inframammary fold,” she said. “It is an improvement on the anchor lift.”
She added, “The full mastopexy is the most commonly performed breast lift, because it is usually the appropriate technique for someone who wants a noticeable change to their breast appearance.”
Risks of breast lifts
Every plastic surgery procedure comes with some degree of risk — and breast lifts are no exception.
Reagan said the main risks associated with breast lifts are a decrease in nipple sensation, potential loss of tissue (including the nipple) and poor scarring.
Due to elevated risk, there are certain groups of people who are not good candidates for the procedure, he said.
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He advises against smokers getting a breast lift, for example.
“Actively smoking can cause delayed healing and possible open wounds,” Reagan said.
He recommends kicking the habit at least six to eight weeks prior to surgery.
People who have existing medical issues, such as high blood pressure or diabetes, are also not good candidates, the doctor warned.
“The ideal candidate is someone who is healthy, has no medical issues and has deflated, droopy breasts,” he said.
For more Health articles, visit www.foxnews.com/health.
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