Utilization of diagnostic resources and costs in patients with suspected cardiac chest pain

Aims Non-acute chest pain is a common complaint and can be caused by various conditions. With the rising healthcare expenditures of today, it is necessary to use our healthcare resources effectively. This study aims to give insight into the diagnostic effort and costs for patients with non-acute chest pain.Methods and results Financial data of patients without a cardiac history from four hospitals (January 2012-October 2018), who were registered with the national diagnostic code 'no cardiac pathology' (ICD-10 Z13.6), 'chest wall syndrome' (ICD-10 R07.4), or 'stable angina pectoris' (ICD-10 I20.9) were extracted. In total, 74 091 patients were included for analysis and divided into the following final diagnosis groups: no cardiac pathology: N=19 688 (age 5318), 46% male; chest wall syndrome: N=40 858 (age 56 +/- 15), 45% male; and stable angina pectoris (AP): N=13 545 (age 67 +/- 11), 61% male. A total of approximately (sic)142.7 million was spent during diagnostic work-up. The total expenditure during diagnostic effort was (sic)1.97, (sic)8.13, and (sic)10.7 million, respectively for no cardiac pathology, chest wall syndrome, and stable AP per year. After 8years of follow-up, >= 95% of the patients diagnosed with no cardiac pathology or chest wall syndrome had an (cardiac) ischaemic-free survival.Conclusion The diagnostic expenditure and clinical effort to ascertain non-cardiac chest pain are high. We should define what we as society find acceptable as 'assurance costs' with an increasing pressure on the healthcare system and costs.Cardiolog

Identification of a Chromogranin A Domain That Mediates Binding to Secretogranin III and Targeting to Secretory Granules in Pituitary Cells and Pancreatic β-Cells

Chromogranin A (CgA) is transported restrictedly to secretory granules in neuroendocrine cells. In addition to pH- and Ca(2+)-dependent aggregation, CgA is known to bind to a number of vesicle matrix proteins. Because the binding-prone property of CgA with secretory proteins may be essential for its targeting to secretory granules, we screened its binding partner proteins using a yeast two-hybrid system. We found that CgA bound to secretogranin III (SgIII) by specific interaction both in vitro and in endocrine cells. Localization analysis showed that CgA and SgIII were coexpressed in pituitary and pancreatic endocrine cell lines, whereas SgIII was not expressed in the adrenal glands and PC12 cells. Immunoelectron microscopy demonstrated that CgA and SgIII were specifically colocalized in large secretory granules in male rat gonadotropes, which possess large-type and small-type granules. An immunocytochemical analysis revealed that deletion of the binding domain (CgA 48–111) for SgIII missorted CgA to the constitutive pathway, whereas deletion of the binding domain (SgIII 214–373) for CgA did not affect the sorting of SgIII to the secretory granules in AtT-20 cells. These findings suggest that CgA localizes with SgIII by specific binding in secretory granules in SgIII-expressing pituitary and pancreatic endocrine cells, whereas other mechanisms are likely to be responsible for CgA localization in secretory granules of SgIII-lacking adrenal chromaffin cells and PC12 cells

Espécies do gênero Munida Leach (Crustacea, Decapoda, Galatheidae), distribuídas na costa do Brasil Species of the genus Munida Leach (Crustacea, Decapoda, Galatheidae) with distribution in the Brazilian coast

<abstract language="eng">The purpose of this work is to analyse the taxonomy and distributional patterns of the species of the genus Munida Leach, 1820 which occur along the Brazilian coast. The species of Munida present some peculiar characteristics, rarely found in any other marine group. They live in groups with great number of individuals (gregariousness) and with several species found together in the same population (sintopy). In addition, they exhibit a great degree of intraspeciftc variation and, paradoxally, a little variability among the species. These factors make a better understanding of the systematics of this group very difficult. In the present study the utilization of non variable characters was emphasized. As a corollary of this study, "species-complexes" were defined including groups of species morphologically very similar but yet well characterized. Sixteen species with distribution along the Brazilian coast were studied. An identification key is provided. A general discussion where the main problems on taxonomy and distributional patterns of species were analysed was done