Sex and Race Differences in Electrocardiogram Use (The National Hospital Ambulatory Medical Care Survey)

There are sex and race differences in many aspects of health care delivery. For example, blacks and women are less likely to receive aspirin and thrombolytic drugs. Blacks and women presenting with chest pain are less likely to be referred for cardiac catheterization. Blacks and women diagnosed with acute myocardial infarction (AMI) are also less likely to undergo cardiac catheterization. The gender differences in diagnostic evaluation after AMI appear more pronounced among younger women. The American College of Cardiology and the American Heart Association joint electrocardiography guidelines state that all patients presenting to the emergency department (ED) with chest pain should undergo electrocardiography (ECG) to rule out acute ischemia or infarction, regardless of sex or age. It is possible that sex and race differences exist in the administration of this important screening tool among patients with chest pain, possibly reflecting a lower suspicion of coronary heart disease in women (especially young women) and blacks. These management differences may result in failure to diagnose coronary heart disease and may explain why these subgroups are referred less often for cardiac catheterization. Therefore, the purpose of this study was to examine whether this basic guideline is being implemented uniformly in a national sample of patients presenting to the ED with chest pain. Specifically, we hypothesized that young women and blacks presenting with chest pain would be significantly less likely to undergo ECG relative to their white male counterparts

Crushing of a bridging stent during follow-up of endovascular branched aortic arch repair:A novel mode of failure

A 68-year-old man developed aneurysmal degeneration of the aortic arch and proximal descending aorta after an open ascending graft for a type A aortic dissection. A three-branched endovascular aortic arch repair was performed with patency of all branches despite some degree of initial misalignment of the branches in relation to the target vessels. At 6 months postoperatively, an asymptomatic partial crushing of the left common carotid bridging grafts was observed on computed tomography angiography. This was treated by reinforcing the branch with a balloon-expandable endograft. The postoperative course was uneventful but a computed tomography angiography after 1 month showed recurrent asymptomatic compression. A left carotid-subclavian bypass was eventually performed. We have reported a new failure mode of an inner branch arch repair of residual type A chronic dissection. (J Vasc Surg Cases Innov Tech 2022;8:646-50.

Outcomes in heart failure patients with preserved ejection fraction Mortality, readmission, and functional decline

AbstractObjectivesWe evaluated the six-month clinical trajectory of patients hospitalized for heart failure (HF) with preserved ejection fraction (EF), as the natural history of this condition has not been well established. We compared mortality, hospital readmission, and changes in functional status in patients with preserved versus depressed EF.BackgroundAlthough the poor prognosis of HF with depressed EF has been extensively documented, there are only limited and conflicting data concerning clinical outcomes for patients with preserved EF.MethodsWe prospectively evaluated 413 patients hospitalized for HF to determine whether EF ≥40% was an independent predictor of mortality, readmission, and the combined outcome of functional decline or death.ResultsAfter six months, 13% of patients with preserved EF died, compared with 21% of patients with depressed EF (p = 0.02). However, the rates of functional decline were similar among those with preserved and depressed EF (30% vs. 23%, respectively; p = 0.14). After adjusting for demographic and clinical covariates, preserved EF was associated with a lower risk of death (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.26 to 0.90; p = 0.02), but there was no difference in the risk of readmission (HR 1.01, 95% CI 0.72 to 1.43; p = 0.96) or the odds of functional decline or death (OR 1.01, 95% CI 0.59 to 1.72; p = 0.97).ConclusionsHeart failure with preserved EF confers a considerable burden on patients, with the risk of readmission, disability, and symptoms subsequent to hospital discharge, comparable to that of HF patients with depressed EF

The Use of Iliac Branched Devices in the Acute Endovascular Repair of Ruptured Aortoiliac AneurysmsThe Use of Iliac Branched Devices in the Acute Endovascular Repair of Ruptured Aortoiliac Aneurysms

BACKGROUND: The objective of this study was to evaluate the feasibility and midterm outcomes of iliac branch devices (IBDs) to preserve the internal iliac artery perfusion in emergent endovascular repair of ruptured aorto-iliac aneurysms.METHODS: Between December 2012 and July 2017, a total of 8 IBDs were implanted in 6 patients (the median age 65 years; all men) in a single tertiary referral center. The indication for IBD implantation was a ruptured abdominal aortic aneurysm with a concomitant common iliac artery aneurysm (n = 4) or isolated CIA aneurysms (n = 2). The main outcome measures were technical and clinical success. The secondary outcomes were primary and primary assisted patency, the occurrence of type I/III endoleaks, and reinterventions.RESULTS: All patients were hemodynamically stable during the procedures, which were performed under local anesthesia. Technical success was achieved in all cases (the median total procedure time of 188 min and the median IBD procedure time of 28 min). The median follow-up was 34 months (interquartile range 19-78). There were no deaths during the follow-up and no major complications unrelated to the IBD. Two (25%) secondary interventions were performed for IBD occlusion in patients with bilateral IBDs. The other reintervention was a type II endoleak embolization in 1 of these 2 patients. The freedom from reintervention estimate was 75% through 2 years. The overall primary assisted patency was 100% through 3 years.CONCLUSIONS: The use of IBDs in the acute setting is feasible to exclude ruptured aortoiliac aneurysms while maintaining pelvic circulation. The secondary intervention rate is considerable; however, the midterm assisted primary patency rates are promising. Further studies are needed to guide patient selection and to evaluate longer term outcomes

A unified framework for Simplicial Kuramoto models

Simplicial Kuramoto models have emerged as a diverse and intriguing class of models describing oscillators on simplices rather than nodes. In this paper, we present a unified framework to describe different variants of these models, categorized into three main groups: "simple" models, "Hodge-coupled" models, and "order-coupled" (Dirac) models. Our framework is based on topology, discrete differential geometry as well as gradient flows and frustrations, and permits a systematic analysis of their properties. We establish an equivalence between the simple simplicial Kuramoto model and the standard Kuramoto model on pairwise networks under the condition of manifoldness of the simplicial complex. Then, starting from simple models, we describe the notion of simplicial synchronization and derive bounds on the coupling strength necessary or sufficient for achieving it. For some variants, we generalize these results and provide new ones, such as the controllability of equilibrium solutions. Finally, we explore a potential application in the reconstruction of brain functional connectivity from structural connectomes and find that simple edge-based Kuramoto models perform competitively or even outperform complex extensions of node-based models.Comment: 36 pages, 11 figure

Pathological implications of Th1/Th2 cytokine genetic variants in Beh\ue7et's disease: Data from a pilot study in a Sicilian population

Cytokines act as pleiotropic polypeptides able to regulate inflammatory/immune responses and to provide important signals in physiological and pathological processes. Several cytokines (Th1, Th2, and Th17) seem to be involved in the pathophysiology of Beh\ue7et's disease, a chronic immune-mediated disease characterized by oral and genital lesions and ocular inflammation. Its individual susceptibility seems to be modulated by genetic variants in genes codifying these cytokines. Th1 and Th17 seem to be involved in the disease's active phases, and Th2 seems to affect the development or severity of the disease; however, contrasting data are reported. In this study, some genetic variants of the Th1/Th2 cytokine genes were investigated in Sicilian patients and age- and gender-matched controls. Three very significant associations with Beh\ue7et's disease were detected, and combined genotypes associated with increased disease risk were identified. Results obtained point to the key role of Th1/Th2 cytokine genetic variants in disease susceptibility

Decrease in excitatory neurons, astrocytes and proliferating progenitors in the cerebral cortex of mice lacking exon 3 from the Fgf2 gene

<p>Abstract</p> <p>Background</p> <p>The <it>Fgf2 </it>gene is expressed in the brain neuroepithelium during embryonic development and in astroglial cells throughout life. Previous knockout studies suggested that FGF2 plays a role in the proliferation of neural progenitors in the embryonic cerebral cortex. These studies exclusively used knockout alleles lacking the <it>Fgf2 </it>exon 1. However, the description of putative alternative exons located downstream from the canonical exon 1 raised the possibility that alternatively spliced transcripts may compensate for the lack of the canonical exon 1 in the <it>Fgf2 </it>-/- mice.</p> <p>Results</p> <p>We generated and characterized a new line of Fgf2 knockout mice lacking the expression of exon 3, which is conserved in all <it>Fgf2 </it>transcripts and contains essential heparin and receptor binding interfaces. The expression of <it>Fgf2 </it>exon 3 was prevented by inserting a transcriptional STOP cassette in the <it>Fgf2 </it>genomic locus. These mice demonstrate a phenotype in the adult neocortex characterized by decreased density and number of cortical excitatory neurons and astrocytes, which is virtually identical to that of the <it>Fgf2 </it>-/- mice lacking exon 1. In addition, we also show that the <it>Fgf2 </it>exon 3 knockout mice have decreased proliferation of precursors in the adult cerebral cortex, which had not been previously investigated in the other mutant lines.</p> <p>Conclusion</p> <p>The results demonstrate that the phenotype of two completely different <it>Fgf2 </it>KO mouse lines, lacking exon 1 or exon 3, is remarkably similar. The combined results from these KO models clearly indicate that FGF2 plays a role in cortical cell genesis during embryonic development as well as in adulthood. Thus, FGF2 may be required for the maintenance of the pool of adult cortical progenitor cells.</p

Hadron Mass Predictions of the Valence Approximation to Lattice QCD

We evaluate the infinite volume, continuum limits of eight hadron mass ratios predicted by lattice QCD with Wilson quarks in the valence (quenched) approximation. Each predicted ratio differs from the corresponding observed value by less than 6\%.Comment: 13 pages of Latex + 2 PostScript files attached, IBM/HET 92-

Glueball production in radiative J/psi, Upsilon decays

Using a bound-state model of weakly bound gluons for glueballs made of two gluons and a natural generalization of the perturbative QCD formalism for exclusive hadronic processes, we present results for glueball production in radiative J/psi, Upsilon decays into several possible glueball states, including L \not= 0 ones. We perform a detailed phenomenological analysis, presenting results for the more favored experimental candidates and for decay angular distributions.Comment: RevTeX4, 26 pages, 11 eps figure