Search Results (31)

The doctrine of deification (or theosis) has seen renewed interest in recent decades within lines of inquiry that extend beyond its traditional association with the Eastern Orthodox tradition. The ascendancy of Tuomo Mannermaa’s Finnish interpretation of Luther—a rereading of the mercurial monk linking his doctrine of justification to deification—was an important catalyst of this turn of events, as it prompted scholars to reexamine the presence of deification–imagery within the intellectual topography of significant Protestant figures. Initially regarded as absent from, alien to, or even contradictory with Western Protestantism, deification is increasingly being recognized as a core feature of biblical soteriology—particularly in relation to articulating the contours of what union with Christ and/or participation in the divine nature (2 Pet 1:4) truly entails. Indeed, several biblical specialists—Michael Gorman, Ben Blackwell, Stephen Finlan, L. Ann Jervis, and others—following the lead of their theologian counterparts, have similarly proposed that deification best characterizes both Pauline and Johannine soteriologies. Although scholars are now exploring how deification operates within the theological frameworks of key Protestants, two significant issues persist within the ever-growing body of literature on the doctrine. The first issue concerns adequately defining deification, as its contours and content differ among individual thinkers and across theological, chronological, and geographic spectrums. Norman Russell aptly recognizes this problem due to his decades-long research tracing the evolution of the concept of deification and notes that the doctrine requires a clear working definition due to entering both mainstream theological traditions—manifesting in diverse forms—and popular spirituality. The lack of a clear definition is directly tied to a second issue—little attention has been given to articulating the doctrine’s practical disciplines and lived experience within theological frameworks external to Eastern Orthodoxy, and more recently, the Western academy. To fill this lacuna in scholarship, we introduce a portrayal of deification advanced by a significant Christian voice from the Global South, Witness Lee (1905–1997), whose theological vision presents a distinctive understanding of the practical experienced of deification called the “God-man living”. Full article

The IPDfromKM method, or Shiny method, is an artificial intelligence tool that enables indirect comparisons between studies by reconstructing individual patient data (IPD) from Kaplan–Meier (KM) curves. The IPDfromKM method is generally used for superiority analyses, but a further application could be represented by non-inferiority analyses. However, there are no studies supporting this methodological hypothesis. The aim of this work was to validate the IPDfromKM method for non-inferiority analyses by “exploiting” the well-described non-inferiority of implantable devices occluding the left atrial appendage compared to oral anticoagulants in patients with atrial fibrillation. We performed a systematic review searching for randomized controlled trials (RCTs) in the PubMed database and found five studies. The R software (version 4.3.3) was used to perform a standard survival analysis comparing Watchman and Amlet devices with warfarin. The hazard ratio (HR), with 95% confidence interval (CI), was the main parameter of our analysis. The results confirmed the non-inferiority of Amlet and Watchman compared to warfarin (HR of Watchman vs. warfarin: 1.23, 95% CI 0.80 to 1.9; HR of Amlet vs. warfarin: 1.05, 95% CI 0.61 to 1.80). Therefore, we proposed a new application of the IPDfromKM method that could be potentially relevant in decision-making for the management of this common cardiac arrhythmia and a wide range of other pathological conditions. Full article

(1) Background: Cerebral magnetic resonance imaging has reported new cerebral ischemic lesions after left atrial appendage (LAA) closure in about one- third of patients. Stroke occurs predominantly periprocedurally. This study evaluated the characteristics of embolized debris captured by the SENTINEL^TM cerebral embolic protection system in patients undergoing LAA closure; (2) Methods: Sixty filters of 30 consecutive patients undergoing LAA closure with the WATCHMAN FLX^TM device were collected and captured debris was analyzed by histopathology and histomorphometry. Clinical outcome measures were disabling and non-disabling stroke within 72 h; (3) Results: In most filters, no material was captured. The predominant captured debris was acute or organized thrombi. The most common pattern was acute fibrin-rich thrombus, which was detected in 11/30 (33.3%) patients. Particles of heart tissue were seen in 6/30 (20%) patients, and foreign material was seen in one (3.3%) patient. The number of particles ranged from 0 to 52 per patient with a maximum of 31 in the distal and 21 in the proximal filter. Particle diameter ranged from 131 to 2614 µm. By logistic regression analysis, only protected time remained a multivariable predictor for larger particles (p = 0.039). There was no disabling or non-disabling stroke. Compared to transfemoral aortic valve replacement, the number of particles is only about 1.5%. (4) Conclusion: LAA occlusion with the WATCHMAN FLX^TM was associated with a very low number of embolized particles captured with the double-filter SENTINEL^TM embolic protection system and no periprocedural stroke. Full article

Suicide is the second leading cause of death for American Indian youth, far surpassing the rates of suicide experienced by other races. The White Mountain Apache Tribe has made significant impacts on suicide risk by implementing a robust suicide prevention program which includes a community-led database and case management follow-ups. Due to the success of the program in preventing suicides, the White Mountain Apache team has worked with other tribal communities to adapt the program. We wanted to understand the factors that are most important to implementing and sustaining this model and how these factors compare with existing implementation science frameworks. We employed an adapted nominal group technique to compile facilitators and barriers to implementation of the suicide prevention model across settings with five partner teams. Two researchers independently coded the resulting list of facilitators and barriers using the Consolidated Framework for Implementation Research (version 1.0) codebook. The final list of cross-site prioritized facilitators and barriers included 41 factors. Some factors did not match easily with the framework’s constructs. The White Mountain Apache suicide prevention team noted that seven of the top prioritized factors are considerations they most try to emphasize to new communities working in suicide prevention. The factors fall into two key themes: staffing and tribal engagement. This finding affirms their focus when they conduct suicide prevention trainings with new communities and provides an opportunity for more structure and in-depth training in those two areas. Several factors could not be easily coded to the framework, especially around the sociocultural characteristics of suicide prevention work in Native communities. This contributes to the larger discussion in implementation science concerning the ways in which Indigenous approaches to public health differ from Western models. Full article

Background: Percutaneous left atrial appendage closure (LAAC) reduces the incidence of stroke/bleeding events in patients with non-valvular atrial fibrillation, high risk of stroke, and contraindication in continuing anticoagulation therapy. Of them, patients with heart failure may remain at high risk of these events after LAAC. Method: Patients who underwent LAAC and were listed for the multi-center, prospectively collected OCEAN-LAAC registry, were eligible. Of them, individuals without baseline plasma B-type natriuretic peptide (BNP) levels and those dependent on hemodialysis were excluded. The prognostic impact of baseline plasma BNP levels on the incidence of death or stroke/bleeding events after LAAC was evaluated. Results: A total of 937 patients (median 78 years, 596 men) were included. The LAAC device was successfully implanted in 934 (98%) patients. Over the 366 (251, 436) days after the LAAC, 148 patients encountered a primary outcome. The common logarithm of baseline plasma BNP was independently associated with the primary outcome with an adjusted hazard ratio of 1.46 (95% confidence interval 1.06–2.18, p = 0.043). A calculated cutoff of 2.12 (equivalent to 133 pg/mL of plasma BNP level) significantly stratified the cumulative incidence of the primary outcome (29% vs. 21% for 2 years, p = 0.004). Conclusions: Using prospectively collected large-scale multi-center Japanese registry data, we demonstrated that a baseline higher plasma BNP level was independently associated with a higher incidence of stroke/bleeding events and mortality after LAAC. Further studies are warranted to understand the optimal therapeutic strategy for LAAC candidates with elevated baseline plasma BNP levels. Full article

Left atrial appendage closure (LAAC) is a crucial intervention for stroke prevention in patients with non-valvular atrial fibrillation who are unsuitable for long-term anticoagulation. Amulet and Watchman are the most implanted devices worldwide for performing LAAC, and the aim of this review is to provide a comprehensive comparison focusing on their efficacy, safety, and short- and long-term outcomes. The Watchman device, the first to gain FDA approval, has been extensively studied and demonstrates significant reductions in stroke and systemic embolism rates. The Amulet device, a newer alternative, promises enhanced design features for more efficient appendage sealing. Current data highlight that both devices offer similar efficacy and safety for LAAC. While the two devices differ in terms of intraprocedural complication rates, they offer similar short- to long-term outcomes in terms of peri-device leaks, device-related thrombosis, and mortality. Both devices are indicated for patients who are unable to tolerate OAC, given their similar risk and safety profiles. Newer clinical studies are directed at establishing the efficacy of both devices as the primary method for stroke prevention in AF as an alternative to OAC. Full article

Background: Percutaneous left-atrial appendage closure (LAAC) is an established method for preventing strokes in patients with atrial fibrillation, offering an alternative to oral anticoagulation. Various occluder devices have been developed to cater to individual anatomical needs and ensure a safe and effective procedure. In this retrospective, monocentric cohort study, we compare different LAAO devices with respect to clinical outcomes, LAA sealing properties, and device-related complications. Methods: We conducted a retrospective analysis of 270 patients who underwent percutaneous LAA closure in our center between 2009 and 2023. Patient data were extracted from medical records, including gender, age at implantation, indication, device type and size, laboratory values, LAA anatomy, periprocedural complications, ECG parameters, transthoracic and transesophageal echocardiography parameters (TTE and TEE), as well as medication at discharge. Moreover, fluoroscopy time and implantation duration, as well as post-implantation clinical events up to 1 year, were collected. Endpoints were bleeding events, recurrent stroke, thrombi on devices, and death. Results: The implanted devices were the Watchman 2.5, Watchman FLX, Amplatzer Cardiac Plug (ACP), and Amulet. The procedural success rate was 95.7% (n = 265), with cactus anatomy posing the most challenges across all devices. The mean patient age was 75.5 ± 7.7 years, with 64.5% being male. The median CHA2DS2-VASc score was 4.8 ± 1.5 and the median HAS-BLED score was 3.8 ± 1.0. Indications for LAA closure included past bleeding events and elevated bleeding risk. Periprocedural complications were most commonly bleeding at the puncture site, particularly after ACP implantation (p = 0.014). Significant peridevice leaks (PDL) were observed in 21.4% of simple sealing mechanism devices versus 0% in double sealing mechanism devices (p = 0.004). Thrombi were detected on devices in six patients, with no subsequent ischemic stroke or thromboembolic event. Comparative analysis revealed no significant differences in the occurrence of stroke, transient ischemic attack (TIA), thromboembolic events, device-related thrombi, or mortality among different device types. A 62.3% relative risk reduction in thromboembolic events and 38.6% in major bleedings could be observed over 568.2 patient years. Conclusions: In summary, our study highlights the efficacy and safety of LAA closure using various occluder devices despite anatomical challenges. Our long-term follow-up findings support LAA closure as a promising option for stroke prevention in selected patient cohorts. Further research is needed to refine patient selection criteria and optimize outcomes in LAA closure procedures. Full article

Watchman Nee’s anthropology has been widely debated and polarized in academic fields. However, Watchman Nee’s concept of human and the problem of ecclesiastical practices have often been overlooked in contemporary Chinese mainland churches. In the first three sections, this paper will start from different Chinese mainland denominations’ interpretation of Nee’s concept of human and their corresponding ecclesiastical practices. On the one hand, through the interpretive attitudes of different denominations toward the “concept of human” and their related ecclesiastical practices, we can see the situation of acceptance of Nee’s anthropology in different contemporary Chinese denominations. On the other hand, we can also provide feedback for the academic research on Nee’s anthropology from the reality of contemporary Chinese mainland churches. Then, this paper will make a comparison of anthropologies between Luther and Watchman Nee, referring to the current study of Martin Luther and the Third Enlightenment in China. The comparative study of these two men will not only open up new avenues for the study of their theologies but will also serve Chinese mainland churches by utilizing the results of the research on Nee’s thoughts and Martin Luther and the Third Enlightenment. Full article

Pentecostalism contributes significantly to Christian revivals as well as to the rise of indigenous churches in the non-Western world. This is due to its proximity to local religious traditions, such as the practices of dream interpretation, healing, and exorcism. However, Pentecostalism as a term also reflects an American-dominated narrative; it has proven incapable of covering the main traits of indigenous Christian movements, either in the Global South or in China. For instance, in the 19th century—far before the birth of Pentecostalism as a modern term—both the Taiping Heavenly Kingdom (1851–1864) and the ministry of the legendary Pastor Hsi (Xi Shengmo 席胜魔, 1835–1896) expressed some Pentecostal characteristics. In the early 20th century, some indigenous churches, like the True Jesus Church and the Jesus Family, had clear connections with Pentecostal missionaries or organizations and showed obvious Pentecostal characteristics. However, leading evangelists such as Watchman Nee (Ni Tuosheng 倪柝声, 1903–1972) agreed with some practices of Pentecostalism and opposed others. Instead of claiming a Pentecostal identity (Ling’en pai 灵恩派), most Chinese Christians preferred to be defined as “spiritual” (Shuling 属灵). With the Spirit (Ling 灵) at the center, Chinese Christians went beyond the narrative of both Pentecostalism and indigenization; their exact aim was to seek the authentic Christianity of the apostolic age. “Spiritual Christian” (Shuling jidutu 属灵基督徒) would thus suggest a re-conception of part of the history of Christianity in China. Full article

Background and Objectives: Percutaneous left-atrial appendage (LAA) occlusion is an important therapeutic option for preventing cardioembolic stroke in patients with non-valvular atrial fibrillation (AF) at high risk of thromboembolic events and with contraindications for oral anticoagulation (OAC). It is usually performed with transesophageal echocardiography (TOE) guidance under general anesthesia (GA). In this retrospective study, we present a multicenter experience of LAA occlusion performed with conscious sedation (CS) without an anesthesiologist on site. Materials and Methods: All the patients on the waiting list for LAA occlusion procedure at Infermi Hospital, Rivoli, and San Luigi Gonzaga University Hospital, Orbassano, from October 2018 to October 2022 were analyzed. All the procedures were performed with a Watchman/FLX LAA closure device under TOE and fluoroscopic guidance without an anesthesiologist on site. CS was performed with a combination of midazolam and fentanyl as needed. Results: One-hundred fifteen patients were included (age 76.4 ± 7.6 years, median CHA2DS2Vasc 4.4 ± 1.4). CS was performed using midazolam (mean dose 5.9 ± 2.1 mg), adding fentanyl for thirty-nine (33.9%) patients in case of poor tolerance for the procedure despite midazolam. The acute procedural success rate was 99.1%. We observed seven acute severe complications. No patients needed anesthesiological assistance during the procedure, and no cases of respiratory failure necessitating ventilation were reported. In a follow-up after 10 ± 9 months, one case of stroke (0.9%) and one case (0.9%) of transient ischemic attack (TIA) occurred. Conclusions: LAA occlusion performed under CS and without the presence of an anesthesiologist on site appears to be safe and effective. It can be an attractive alternative to general anesthesia (GA), as fewer resources are required. Full article

This study aimed to compare the peri-procedural success and complication rate within a large registry of intra-cardiac echocardiography (ICE)- vs. transesophageal echocardiography (TEE)-guided left atrial appendage occlusion (LAAO) procedures with a Watchmann FLX device. Data from 772 LAAO procedures, performed at 26 Italian centers, were reviewed. Technical success was considered as the final implant of a Watchmann FLX device in LAA; the absence of pericardial tamponade, peri-procedural stroke and/or systemic embolism, major bleeding and device embolization during the procedure was defined as a procedural success. One-year stroke and major bleeding rates were evaluated as outcome. ICE-guided LAA occlusion was performed in 149 patients, while TEE was used in 623 patients. Baseline characteristics were similar between the ICE and TEE groups. The technical success was 100% in both groups. Procedural success was also extremely high (98.5%), and was comparable between ICE (98.7%) and TEE (98.5%). ICE was associated with a slightly longer procedural time (73 ± 31 vs. 61.9 ± 36 min, p = 0.042) and shorter hospital stay (5.3 ± 4 vs. 5.8 ± 6 days, p = 0.028) compared to the TEE group. At one year, stroke and major bleeding rates did not differ between the ICE and TEE groups. A Watchmann FLX device showed high technical and procedural success rate, and ICE guidance does not appear inferior to TEE. Full article

Background: Percutaneous left atrial appendage occlusion (LAAO) therapy using the WATCHMAN system has been introduced to prevent thrombosis and minimize the use of anticoagulants in patients with non-valvular atrial fibrillation. Given the high risk of bleeding and stroke in elderly patients, these patients would be good candidates for this therapy. However, the efficacy and feasibility of LAAO therapy in elderly patients remains uncertain. Methods: Consecutive patients who underwent LAAO therapy using the WATCHMAN system in a large academic center between June 2020 and March 2023 were included. The safety and efficacy of LAAO therapy during the 1-year observation period in patients aged ≥85 years old were compared with those in the younger cohort. Results: A total of 188 patients (78.4 ± 6.9 years old, 133 male patients) were included. 34 patients were ≥85 years old, 96 were between 75 and 84 years old, and 58 were <75 years old. The elderly group had a higher CHA₂DS₂-VASc score and were at greater risk of falling-related bleeding compared with the younger cohort. The device implantations were successful in all patients except for one. During the 1-year observation period, one patient had a peri-device leak >5 mm and there were 6 device-related cases of thrombosis, whose incidence was not significantly different between the groups (p = 0.98). The cumulative incidences of bleeding and thrombotic events in the elderly group were as low as in the younger cohort (p > 0.05 for both). Most anticoagulants were terminated regardless of age. Conclusion: The mid-term feasibility and efficacy of percutaneous LAAO therapy using the WATCHMAN system in elderly patients aged ≥85 years were as acceptable as in the younger cohort. Full article

Christian, especially Protestant, identity is often framed through the lens of belief, particularly belief understood as an interior orientation. Through an examination of the non-denominational Protestant group, the ‘Little Flock’, founded by Watchman Nee in the early 20th century, we trace enduring aspects of Little Flock theology in contemporary Chinese Protestant practice. In particular, we attend to conceptions of and debates surrounding belief and how to determine the quality of one’s faith—whether or not one might be considered not just a Christian, but a ‘good’ one. Full article

Watchman Nee (Ni Tuosheng, 1903–1972), one of the most prominent theologians in Republican China (1911–1949), developed a “spiritual theology” that is concentrated on the work of the Holy Spirit. This theological perspective shares parallels with Pentecostal-Charismatic theology. This paper examines Nee’s attitude toward Pentecostalism and the charismatic experience. First, based on his teaching of the three-stage work of the Holy Spirit, Nee argued that the inner guidance of the Holy Spirit was more important than any external manifestation and that the “baptism of the Holy Spirit” in the Pentecostal-Charismatic movement was not a personal experience that Christians should pursue. Second, in terms of subjective experience, Nee’s trichotomous view of human nature as consisting of spirit, soul, and body suggested that many charismatic experiences originate in the soul and need to be overcome. Third, concerning the spiritual world, Nee regarded as the work of evil spirits those charismatic experiences that occur in irrational and unconscious situations. Nee’s negative stance towards Pentecostalism and the charismatic experience serves as a means of distinguishing his spiritual theology from Pentecostalist-Charismatic movements. Both Nee’s theology and his church practices reveal a strong elitist element, in stark contrast to Pentecostalism. Full article

To clarify the factors influencing the green production behavior of peach farmers, this paper uses the survey data of 741 peach farmers in 19 provinces and cities in China, it uses a multiple ordered probit model to empirically analyze the impact of the government regulations on the green production behavior of peach farmers, from the perspective of the market structure. This paper also analyzes its intermediary role in this process, and it analyzes the possible heterogeneity at both the planting scale and the regional level. The results show the following: (1) Government regulation has a positive and significant impact on the green production behavior of peach farmers. Specifically, government supervision and inspection, alongside green subsidies, can positively promote the implementation of green production behavior by peach farmers, but government publicity and training have not played a good role. (2) The market structure plays a partial intermediary role, rather than a complete intermediary role, in the government regulation affecting the green production behavior of peach farmers. (3) The impact of the government regulation on the green production behavior of peach farmers is heterogeneous. Specifically, compared with small farmers, the impact on large-scale farmers is higher; however, the influence of the three methods of government regulation on the green production behavior of peach farmers varies from region to region. Therefore, in order to promote the implementation of green production, the government should introduce appropriate local policies, strongly support new agricultural business entities, draw clear guidelines for the market, and play the role of “night watchman”. Full article