1,150 research outputs found
The Impact of Chronic Liver Diseases on the Level of Heart-Type Fatty Acid-Binding Protein (H-FABP) Concentrations
Objectives: Heart-type fatty acid binding-protein (H-FABP) has been reported to be a potential novel biochemical marker for the early diagnosis of acute myocardial infarction (AMI). The presence of H-FABP in the liver has not been reported. The aim of this study was to compare the effect of chronic liver diseases on the level of H-FABP concentrations. Methods: The effects of chronic liver diseases including infective hepatitis and cirrhosis on the concentration of H-FABP was studied in a small group of patients (n=10, mean age ±SD = 58.33 ± 7.19 years). The serum concentrations of the following markers were measured: H-FABP, alanine aminotransferase (ALT) and bilirubin and compared with a reference control group (20 healthy blood donors, mean age ±SD = 63.8 ±8.01). Results: The serum concentrations of these markers in the control group as compared to patients with chronic liver disease were as follows (mean ± SD): H-FABP = 6.86 ±2.21 µg/L versus 6.44 ±3.06 µg/L (p = NS); ALT = 29.8 ±14.7 U/L versus ALT = 198.67 ±122.89 U/L (p < 0.0005) and bilirubin = 9.6 ±4.0 µmol/L versus bilirubin = 100.89 ±87.85 µmol/L (p < 0.0001). Conclusion: These data illustrate clearly that there is no significant interference with the normal concentration of H-FABP in the presence of liver diseases, despite the significant elevation of liver enzymes and proteins. These data may support a useful role of H-FABP for the diagnosis of myocardial injury in patients with liver diseases
An introduction to the Global Registry of Acute Coronary Events: GRACE
The Global Registry of Acute Coronary Events (GRACE) study is a multinational, prospective, observational study of clinical management practices and patient outcomes across the full spectrum of Acute Coronary Syndrome (ACS). By describing treatment practices and providing data to cardiologists, GRACE aims to enhance understanding of patient management and outcomes, both on an individual hospital level and from a global perspective
Acute systemic inflammation enhances tissue plasminogen activator release in man
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Data for Users of Handheld Ion Mobility Spectrometers
Chemical detection technology end-user surveys conducted by Idaho National Laboratory (INL) in 2005 and 2007 indicated that first responders believed manufacturers’ claims for instruments sometimes were not supported in field applications, and instruments sometimes did not meet their actual needs. Based on these findings, the Department of Homeland Security (DHS) asked INL to conduct a similar survey for handheld ion mobility spectrometers (IMS), which are used by a broad community of first responders as well as for other applications. To better access this broad community, the INL used the Center for Technology Commercialization, Inc. (CTC), Public Safety Technology Center (PSTC) to set up an online framework to gather information from users of handheld IMS units. This framework (Survey Monkey) was then used to perform an online Internet survey, augmented by e-mail prompts, to get information from first responders and personnel from various agencies about their direct experience with handheld IMS units. Overall, 478 individuals responded to the survey. Of these, 174 respondents actually owned a handheld IMS. Performance and satisfaction data from these 174 respondents are captured in this report. The survey identified the following observations: • The most common IMS unit used by respondents was the Advanced Portable Detector (APD 2000), followed by ChemRae, Sabre 4000, Sabre 2000, Draeger Multi IMS, Chemical Agent Monitor-2, Chemical Agent Monitor, Vapor Tracer, and Vapor Tracer 2. • The primary owners were HazMat teams (20%), fire services (14%), local police (12%), and sheriffs’ departments (9%). • IMS units are seldom used as part of an integrated system for detecting and identifying chemicals but instead are used independently. • Respondents are generally confused about the capabilities of their IMS unit. This is probably a result of lack of training. • Respondents who had no training or fewer than 8 hours were not satisfied with the overall operation of the handheld IMS unit. • IMS units were used for detecting a range of analytes. The most common use was for detection of hazardous chemicals, followed by detection of explosives, illicit drugs, chemical warfare, nerve agents, and radiation. One IMS unit had dual capability as a radiation detector. • Respondents who did not own an IMS listed prohibitive cost of equipment as the main factor for not having one. • Respondents who were highly satisfied with the overall operation of the handheld IMS obtained the IMS through a direct purchase. In comparison, the respondents who were not satisfied had obtained the handheld IMS through a DHS grant
Identifying Acute Coronary Syndrome Patients Approaching End-of-Life
Background: Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL. Methods and Findings: 172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23%) patients suitable for EoL care while GRACE identified 32 (19%) patients with $10 % risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006), had more comorbidities (1.660.7 vs. 1.260.9, p = 0.007), more frequent hospitalisations before (p = 0.001) and after (0.0001) their index admission, and were more likely to die during follow-up (GSF+ 20 % vs GSF- 7%, p = 0.03). GRACE score was predictive of 12-month mortality (C-statistic 0.75) and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88). Conclusions: This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission
10-Year Mortality Outcome of a Routine Invasive Strategy Versus a Selective Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial.
BACKGROUND: The RITA-3 (Third Randomised Intervention Treatment of Angina) trial compared outcomes of a routine early invasive strategy (coronary arteriography and myocardial revascularization, as clinically indicated) to those of a selective invasive strategy (coronary arteriography for recurrent ischemia only) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). At a median of 5 years' follow-up, the routine invasive strategy was associated with a 24% reduction in the odds of all-cause mortality. OBJECTIVES: This study reports 10-year follow-up outcomes of the randomized cohort to determine the impact of a routine invasive strategy on longer-term mortality. METHODS: We randomized 1,810 patients with NSTEACS to receive routine invasive or selective invasive strategies. All randomized patients had annual follow-up visits up to 5 years, and mortality was documented thereafter using data from the Office of National Statistics. RESULTS: Over 10 years, there were no differences in mortality between the 2 groups (all-cause deaths in 225 [25.1%] vs. 232 patients [25.4%]: p = 0.94; and cardiovascular deaths in 135 [15.1%] vs. 147 patients [16.1%]: p = 0.65 in the routine invasive and selective invasive groups, respectively). Multivariate analysis identified several independent predictors of 10-year mortality: age, previous myocardial infarction, heart failure, smoking status, diabetes, heart rate, and ST-segment depression. A modified post-discharge Global Registry of Acute Coronary Events (GRACE) score was used to calculate an individual risk score for each patient and to form low-risk, medium-risk, and high-risk groups. Risk of death within 10 years varied markedly from 14.4 % in the low-risk group to 56.2% in the high-risk group. This mortality trend did not depend on the assigned treatment strategy. CONCLUSIONS: The advantage of reduced mortality of routine early invasive strategy seen at 5 years was attenuated during later follow-up, with no evidence of a difference in outcome at 10 years. Further trials of contemporary intervention strategies in patients with NSTEACS are warranted. (Third Randomised Intervention Treatment of Angina trial [RITA-3]; ISRCTN07752711)
Nowhere to Run; Nowhere to Hide: The Reality of Being a Law Library Director in Times of Great Opportunity and Significant Challenges
This is an edited version of remarks presented at \u27Nowhere to Run, Nowhere to Hide\u27: The Reality of Being a Law Library Director in Times of Great Opportunity and Significant Challenges, January 5, 2015, at the Association of American Law Schools Annual Meeting, Washington, D.C
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