Citations

Background: There are few studies evaluating regional disparities in the care of acute myocardial infarction-cardiogenic shock (AMI-CS). Methods and Results: Using the National Inpatient Sample from 2000 to 2016, we identified adults with a primary diagnosis of AMI and concomitant CS admitted to the United States census regions of Northeast, Midwest, South, and West. Interhospital transfers were excluded. End points of interest included in-hospital mortality, use of coronary angiography, percutaneous coronary intervention, mechanical circulatory support, hospitalization costs, length of stay, and discharge disposition. Multivariable regression was used to adjust for potential confounding. Of the 402 825 AMI-CS admissions, 16.8%, 22.5%, 39.3%, and 21.4% were admitted to the Northeast, Midwest, South, and West, respectively. Higher rates of ST-elevation AMI-CS were noted in the Midwest and West. Admissions to the Northeast were on average characterized by a higher frequency of whites, Medicare beneficiaries, and lower rates of cardiac arrest. Admissions to the Northeast were less likely to receive coronary angiography, percutaneous coronary intervention, and mechanical circulatory support, despite the highest rates of extracorporeal membrane oxygenation use. Compared with the Northeast, in-hospital mortality was lower in the Midwest (adjusted odds ratio [aOR], 0.96 [95% CI, 0.93–0.98]; P <0.001) and West (aOR, 0.96 [95% CI, 0.94–0.98]; P =0.001) but higher in the South (aOR, 1.04 [95% CI, 1.01–1.06]; P =0.002). The Midwest (aOR, 1.68 [95% CI, 1.62–1.74]; P <0.001), South (aOR, 1.86 [95% CI, 1.80–1.92]; P <0.001), and West (aOR, 1.93 [95% CI, 1.86–2.00]; P <0.001) had higher discharges to home. Conclusions: There remain significant regional disparities in the management and outcomes of AMI-CS.

Background: Goodpasture’s syndrome is a rare, life-threatening, small vessel vasculitis. Given its rarity, data on its inpatient burden and resource utilization are lacking. We conducted this study aiming to assess inpatient prevalence, mortality, and resource utilization of Goodpasture’s syndrome in the United States. Methods: The 2003–2014 National Inpatient Sample was used to identify patients with a principal diagnosis of Goodpasture’s syndrome. The inpatient prevalence, clinical characteristics, in-hospital treatment, end-organ failure, mortality, length of hospital stay, and hospitalization cost were studied. Multivariable logistic regression was performed to identify independent factors associated with in-hospital mortality. Results: A total of 964 patients were admitted in hospital with Goodpasture’s syndrome as the principal diagnosis, accounting for an overall inpatient prevalence of Goodpasture’s syndrome among hospitalized patients in the United States of 10.3 cases per 1,000,000 admissions. The mean age of patients was 54 ± 21 years, and 47% were female; 52% required renal replacement therapy, whereas 39% received plasmapheresis during hospitalization. Furthermore, 78% had end-organ failure, with renal failure and respiratory failure being the two most common end-organ failures. The in-hospital mortality rate was 7.7 per 100 admissions. The factors associated with increased in-hospital mortality were age older than 70 years, sepsis, the development of respiratory failure, circulatory failure, renal failure, and liver failure, whereas the factors associated with decreased in-hospital mortality were more recent year of hospitalization and the use of therapeutic plasmapheresis. The median length of hospital stay was 10 days. The median hospitalization cost was $75,831. Conclusion: The inpatient prevalence of Goodpasture’s syndrome in the United States is 10.3 cases per 1,000,000 admissions. Hospitalization of patients with Goodpasture’s syndrome was associated with high hospital inpatient utilization and costs.

Abstract 1. The concentration of hyaluronic acid in synovial fluid was determined by a modification of the Dische carbazole method for the determination of uronic acids. 2. The results of this determination in 80 specimens of normal and abnormal synovial fluid confirmed values reported by other methods. 3. An inverse relationship between the hyaluronic acid in the synovial fluid and the degree of synovitis was suggested.

Abstract Our experiences with the automatic titration method of quantitating serum calcium and magnesium are presented. In addition, modifications of the original procedure to allow determination of intraerythrocyte concentrations of magnesium are described. It appears that adoption of a separate magnesium standard in addition to the calcium standard, plus certain other minor modifications designed to minimize the variables inherent in the procedure, provides a significant increase in accuracy and reproducibility of results. Values for intraerythrocyte magnesium concentration in 9 normal dogs were found to range from 4.69 to 5.77 mg./100 ml. Values for 4 dogs that received long-term administration of chlorothiazide also fell within this normal range.

Abstract A semiautomatic procedure for the direct estimation of both serum calcium and magnesium is described. The indicator used, Eriochrome blue SE (EBSE), has the advantage of stability and freedom from interference by naturally occurring substances. The procedure requires 3-5 min. per sample and is very reproducible. The values obtained agree with those obtained by back-titration of excess chelator and are consistently 0.3 mg./100 ml. less than those obtained by a standard oxalate precipitation method.

Abstract Modification of the Köiw and Grönwall procedure for the staining of glycoproteins separated by paper electrophoresis has adapted this method to papers of the Whatman 3MM class, with achievement of results comparable to those reported by direct chemical determination of hexose in the individual protein fractions. Preliminary concentration of specimen fluids was achieved by ultrafiltration through collodion sacks. A preliminary wash of the oven-dried paper strips with 95 per cent ethanol was found essential to clear the paper of buffer salts and insure that the pH in the oxidation procedure remained in the 3.0-3.5 range. Close control of the reagent composition and timing of each step were found necessary. Inclusion of 40 per cent ethanol in the oxidation bath and immersion of dry strips were required to insure rapid penetration of the periodic acid. Control of the oxidation procedure at 20 ± 0.5° for 12 minutes was of prime necessity to maintain a low background color. Also, the concentrations of hydrochloric acid in the dye bath and in the wash solutions were found to affect the quality of the final stain. The ethanol wash served to remove residual sulfite and hydrochloric acid and stabilize the color. The new method has been applied to the analysis of several body fluids of normal persons and patients with certain disease entities, and satisfactory glycoprotein distribution patterns have been obtained.

Abstract The glycoprotein hexose in the sera of patients having an electrophoretically homogeneous globulin fraction was studied by paper electrophoresis. The largest diagnostic category was multiple myeloma, but also included were cases of macroglobulinemia, primary systemic amyloidosis, lymphoma, collagen vascular disease, liver disease, and other conditions. The hexose contents of the pathologic globulin fractions were compared; only in the macroglobulins was this value of diagnostic significance, consistently averaging more than 3 times that in normal gamma globulin. In myeloma globulins there was a relationship between the hexose content and the electrophoretic mobility, with only an occasional value approaching the macroglobulin range in the faster electrophoretic mobilities. It is shown that paper electrophoresis and the PAS staining technic, in conjunction with protein staining on a duplicate sample of serum, constitute a useful screening test for detection of increased concentration of macroglobulin in serum in a large percentage of cases of "hypergammaglobulinemia." Gel electrophoresis, immunologic typing, and ultracentrifugation studies then can be used for further elucidation of the type of abnormality present.

Abstract Background The proportion of tumors of various histologies that may respond to drugs targeted to molecular alterations is unknown. NCI-MATCH, a collaboration between ECOG-ACRIN Cancer Research Group and the National Cancer Institute, was initiated to find efficacy signals by matching patients with refractory malignancies to treatment targeted to potential tumor molecular drivers regardless of cancer histology. Methods Trial development required assumptions about molecular target prevalence, accrual rates, treatment eligibility, and enrollment rates as well as consideration of logistical requirements. Central tumor profiling was performed with an investigational next-generation DNA–targeted sequencing assay of alterations in 143 genes, and protein expression of protein expression of phosphatase and tensin homolog, mutL homolog 1, mutS homolog 2, and RB transcriptional corepressor 1. Treatments were allocated with a validated computational platform (MATCHBOX). A preplanned interim analysis evaluated assumptions and feasibility in this novel trial. Results At interim analysis, accrual was robust, tumor biopsies were safe (&lt;1% severe events), and profiling success was 87.3%. Actionable molecular alteration frequency met expectations, but assignment and enrollment lagged due to histology exclusions and mismatch of resources to demand. To address this lag, we revised estimates of mutation frequencies, increased screening sample size, added treatments, and improved assay throughput and efficiency (93.9% completion and 14-day turnaround). Conclusions The experiences in the design and implementation of the NCI-MATCH trial suggest that profiling from fresh tumor biopsies and assigning treatment can be performed efficiently in a large national network trial. The success of such trials necessitates a broad screening approach and many treatment options easily accessible to patients.

Anomalous coronary artery is an uncommon congenital cardiac anomaly that is often detected incidentally on coronary angiography. It has rarely been reported in the donor heart of patients who have undergone cardiac transplantation. Here, we report a case of a 72-year-old patient who received a second heart transplant and has been identified to have an anomalous left main coronary artery originating from the right coronary sinus on postoperative coronary angiography.