Heart disease mortality during the early pandemic period in the United States.

ImportanceThe coronavirus disease 2019 (COVID-19) outbreak has been associated with decreases in acute myocardial infarction diagnoses (AMI) and admissions in the United States. Whether this affected heart disease deaths is unknown. ObjectiveTo determine whether changes in heart disease deaths occurred during the early pandemic period in the US, we analyzed areas without large COVID-19 outbreaks. This isolated the effect of decreased healthcare-seeking behavior during the early outbreak. Design, Setting, and ParticipantsWe performed an observational study of heart disease-specific mortality using National Center for Health Statistics data (NCHS). Weekly provisional counts were disaggregated by jurisdiction of occurrence during 2019 and 2020 for all-cause deaths, COVID-19 deaths, and heart disease deaths. For the primary analysis, jurisdictions were included if; 1) There was no all-cause excess mortality during the early pandemic period (weeks 14-17, 2020); 2) The completeness of that data was estimated by NCHS to be >97% as of July 22, 2020, and; 3) Decreases in emergency department (ED) visits occurred during the study period. We compared heart disease death rates during the early pandemic period with corresponding weeks in 2019 and a pre-pandemic control period of 2020 as a sensitivity analysis. Incident rate and rate ratios were calculated. ExposureThe US COVID-19 outbreak. Main Outcomes and MeasuresIncidence of heart disease deaths. ResultsTwelve states met the primary inclusion criteria, capturing 747,375,188 person-weeks for the early pandemic period and 740,987,984 person-weeks for the 2019 control period. The mean incidence rate (per 100,000 person-weeks) for heart disease in states without excess deaths during the early pandemic period was 3.95 (95% CI 3.83 to 4.06) versus 4.19 (95% CI 4.14 to 4.23) during the corresponding period in 2019. The incident rate ratio (2020/2019) was 0.91 (95% CI 0.87 to 0.97). No state recorded an increase from either the corresponding period in 2019 or the 2020 prepandemic control period. Two states recorded fewer heart disease deaths. Conclusions and RelevanceThis observational study found a decrease in heart disease deaths during the early US outbreak in regions without significant COVID-19 burdens, despite decreases in ED utilization. Long term follow-up data are needed.

The 2018 AACC/SYCL PhD Clinical Chemist Compensation Survey.

BACKGROUND: Doctoral level board-certified clinical chemists play an invaluable role in many facets of laboratory medicine and healthcare. However, information concerning their total compensation is sparse. CONTENT: A confidential self-reported compensation survey was conducted by the American Association for Clinical Chemistry's Society for Young Clinical Laboratorians (AACC SYCL) Core Committee from April 1 to April 17, 2018. Respondents provided information on geographic location, employment sector, gender, and years of experience to account for the influence of these variables on compensation. There were 199 respondents in total from the United States and Canada, however, only respondents employed in the United States with an earned doctoral degree and certification by the American Board of Clinical Chemistry (n = 133), were included in the full analysis. In comparison to compensation reported in AACC SYCL salary surveys conducted in 2010 and 2013, early career median salaries are trending upwards after correction for inflation. SUMMARY: This survey is the first to collect the gender of respondents, and identify a pay gap for some geographic groups. However, this gap could be due in part to a difference in the years of experience, since males were highly represented in the group with >20 years of experience (25 out of 35, 71%). Future studies on compensation trends within clinical chemistry that do not rely on self-report are needed to ensure accuracy and completeness of the dataset.

Highly Efficient Dual-Color Electrochemiluminescence from BODIPY-Capped PbS Nanocrystals.

Electrochemiluminescence (ECL) of a hybrid system consisting of PbS nanocrystals (NCs) and a BODIPY dye (BDY) capping ligand was discovered to produce highly efficient dual emissions with tri-n-propylamine as a coreactant. By means of spooling ECL spectroscopy, the strong dual ECL emission peaks of 984 and 680 nm were attributed to the PbS and BDY moieties, respectively, and found to be simultaneous during the light evolution and devolution. The ECL of the PbS was enhanced via NC collisions with the electrode and reached an efficiency of 96% relative to that of Ru(bpy)3(2+), which is the highest among the semiconductor NCs.

Enhanced Electrochemiluminescence from a Stoichiometric Ruthenium(II)-Iridium(III) Complex Soft Salt.

Electrochemiluminescence (ECL) and electrochemistry are reported for a heterometallic soft salt, [Ru(dtbubpy)3 ][Ir(ppy)2 (CN)2 ]2 ([Ir][Ru][Ir]), consisting of a 2:1 ratio of complementary charged Ru and Ir complexes possessing two different emission colors. The [Ru](2+) and [Ir](-) moieties in the [Ir][Ru][Ir] greatly reduce the energy required to produce ECL. Though ECL intensity in the annihilation path was enhanced 18× relative to that of [Ru(bpy)3 ](2+) , ECL in the co-reactant path with tri-n-propylamine was enhanced a further 4×. Spooling spectroscopy gives insight into ECL mechanisms: the unique light emission at 634 nm is due to the [Ru](2+) * excited state and no [Ir](-) * was generated in either route. Overall, the soft salt system is anticipated to be attractive and suitable for the development of efficient and low-energy-cost ECL detection systems.

Human chorionic gonadotropin discriminatory zone in ectopic pregnancy: does assay harmonization matter?

OBJECTIVE: To determine the effect that lack of hCG assay harmonization has on the interpretation of a serum hCG concentration with regards to the hCG discriminatory zone. DESIGN: A multisite method comparison study. SETTING: Clinical laboratories. PATIENT(S): Eighty serum samples containing various concentrations of hCG. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Concentrations of hCG obtained from seven hCG reagent platforms. RESULT(S): The hCG concentrations were significantly different across hCG reagent platforms. Seventy-one percent of assay pairs showed significant differences with samples selected based on hCG concentrations between 1,500 and 3,500 IU/L as determined by a comparative method. Relative to the comparative method, the calculated hCG discriminatory zones for five assays were within 9%, and one assay was within 40% of the target concentrations of 1,500 and 3,500 IU/L. CONCLUSION(S): Despite significant differences in hCG concentrations across hCG immunoassays, an hCG concentration within a discriminatory zone of 1,500-3,500 IU/L can be used for all but one commonly used hCG reagent platform.

Relationship between blood alcohol concentration and observable symptoms of intoxication in patients presenting to an emergency department.

AIMS: Clinical and medico-legal decisions often require knowledge of alcohol impairment that is not necessarily revealed by an individual's appearance, and in turn, may not necessarily reflect level of blood alcohol. This study compares clinical signs and symptoms with measured and estimated blood alcohol concentrations (BACs). METHOD: Individuals (n = 384) perceived to be under the influence of alcohol at presentation to an emergency department were assessed by physicians and nurses for clinical features of alcohol intoxication (alcohol symptom checklist, ASC), who were asked to estimate the patient's BAC. Relation to measured BACs was assessed by correlation. RESULTS: BACs ranged from 0 to 418 mg/100 ml. The correlation between the estimated BAC and measured BAC was r = 0.513. Measured BAC correlated with ASC r = 0.250. In subjects without a history of chronic drinking (n = 134) there was a better (P < 0.05) correlation with the ASC score (r = 0.363) versus measured BAC compared with that for chronic drinkers (r = 0.154). The positive predictive value of estimating BAC at or above a particular BAC cut-off decreased from 93.2% at 100 mg/100 ml to 37.7% at 300 mg/100 ml (P < 0.05). CONCLUSIONS: Measured BAC does not correlate well with the outward physical signs of intoxication, especially for chronic drinkers. There is a need for further education on how tolerance masks clinical signs of intoxication for the chronic drinker. BACs should be measured especially in the obtunded where no history (symptoms) can be given by the patient.

Superiority of postmortem liver fentanyl concentrations over peripheral blood influenced by postmortem interval for determination of fentanyl toxicity.

OBJECTIVE: The current study was undertaken to determine the relationship between postmortem (PM) peripheral blood (PB) and liver fentanyl concentrations and the role of measuring liver fentanyl concentrations in cause of death investigations in medical examiner cases in which fentanyl was identified. DESIGN AND METHODS: FB and liver tissue were routinely collected at autopsy from 4 Minnesota medical examiners' offices in 2010-2011. Samples were analyzed by gas chromatography-mass spectrometry (GC-MS). RESULTS: PB fentanyl ranged from <2-15µg/L in non-drug related deaths (n=5), <2-22µg/L from mixed drug toxicity (n=26) and 3.7-56µg/L from fentanyl toxicity (n=33). Liver fentanyl ranged from 11 to 104µg/kg, 6 to 235µg/kg, and 18 to 365µg/kg, respectively. PB and liver fentanyl showed a modest correlation (r=0.67). PM interval to the liver/blood ratio showed a decreasing ratio over increasing PM interval in cases from fentanyl and mixed drug toxicity. Liver fentanyl concentrations best define therapeutic use at <23µg/kg and fatal toxicity at >56µg/kg, without substantial overlap as found in blood fentanyl concentrations. CONCLUSION: Discriminatory liver fentanyl concentrations suggestive of therapeutic or toxic drug levels may better assist cause of death determination in cases of suspected fentanyl toxicity than postmortem PB concentrations. Peripheral blood fentanyl concentrations appear to undergo postmortem redistribution, associated with an increasing PM interval.

Self-enhanced electrochemiluminescence of an iridium(III) complex: mechanistic insight.

Improved luminophore: The electrochemiluminescence (ECL) of an iridium complex self-enhanced up to 16 times is reported. Three excited states were observed in the emission spectra (see picture). The ECL efficiency of this complex is the highest reported for an iridium complex.

Interrogating near-infrared electrogenerated chemiluminescence of Au25(SC2H4Ph)18(+) clusters.

The electrochemistry, near-infrared photoluminescence (NIR-PL) spectroscopy, and electrogenerated chemiluminescence (ECL) of Au(25)(SC(2)H(4)Ph)(18)(+)C(6)F(5)CO(2)(-) (Au(25)(+)) clusters were investigated. For the first time, NIR-ECL emission was observed in both annihilation and coreactant paths. Our newly developed spooling spectroscopy was employed during the ECL evolution and devolution processes along with explicit NIR-PL spectroscopy to elucidate light generation mechanisms. It was discovered that the electronic relaxation of the Au(25)(-) excited state to the ground state plays a key role in giving off ECL at 893 nm, while intermediate, strong, and weak NIR-PL emissions at 719/820, 857, and 1080 nm can be attributed to the excited states higher than the HOMO-LUMO gap, across the HOMO-LUMO gap, and of semi-rings, respectively.

Synthesis, structure, electrochemistry, and electrochemiluminescence of thienyltriazoles.

Four blue-emitting thienyltriazoles with desired N and O coordination atoms were prepared in high yield via click chemistry for potential incorporation into metal complexes. Three of their crystal structures were determined by X-ray crystallography. The electrochemical properties, electronic structures of these thienyltriazoles, 1-4, and their correlations were studied using cyclic voltammetry and differential pulse voltammetry techniques along with density function theory (DFT) calculations. All of the compounds underwent irreversible redox reactions, leading to unstable electrogenerated radical cations and anions. Electrochemical gaps determined from the differences between first formal reduction and oxidation reactions were correlated to HOMO-LUMO energy gaps obtained from UV-vis spectroscopy and the DFT calculations as well as energies of excited states measured from photoluminescence spectroscopy. We observed weak electrochemiluminescence (ECL) from annihilation of these thienyltriazole radicals in acetonitrile containing 0.1 M tetra-n-butylammonium perchlorate as electrolyte. An enhancement in ECL efficiency ranging from 0.16 to 0.50% was observed upon addition of benzoyl peroxide as a coreactant in the above electrolyte solutions. The generation of excimers in solutions of 1-4 was observed as seen by the red-shift in ECL maxima relative to their corresponding photoluminescence peak wavelengths. Our work is of importance for the development of efficient blue-emitting fluorophores via click chemistry that could be potential luminophores in metal complexes.

Bright electrochemiluminescence of iridium(III) complexes.

Electrochemiluminescence (ECL) of four bright iridium(III) complexes containing aryltriazole cyclometallated ligands is reported. The ECL mechanisms, spectra and high efficiencies via annihilation and coreactant paths have been investigated.

Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T.

OBJECTIVES: The purpose of this study was to determine whether there is immunoreactive cardiac troponin T (cTnT) expression in diseased skeletal muscle that might cause possible false-positive increases in cTnT. BACKGROUND: Cardiac troponin (I or T) is the biomarker of choice for the diagnosis of cardiac injury. Recently, we were presented with a case that challenged the specificity of cTnT. METHODS: Patients with myopathies seen in the Neuromuscular Clinic at the Mayo Clinic were screened for increases in cTnT. If present, an assay for cTnI was performed. If normal, skeletal biopsy tissue was obtained for Western blot analysis using the capture and detection antibodies from both the fourth-generation and high-sensitivity cTnT assays. Results were compared with findings in normal cardiac tissue. RESULTS: Sixteen patients had increases in cTnT but not cTnI. All had a myopathy by clinical evaluation, clinical testing, and biopsy. Four residual biopsy samples were obtained. All 3 antibodies used in the cTnT (M11.7, M7) and high-sensitivity cTnT (5D8, M7) assays were immunoreactive with a 37- to 39-kDa protein in all 4 diseased skeletal muscle biopsy specimens and in cardiac tissue. A second immunoreactive isoform (34 to 36 kDa) was also found in 1 patient. None of the noncardiac control tissues expressed immunoreactive protein. CONCLUSIONS: These results document that there are forms in diseased skeletal muscle that could cause increases in circulating levels of cTnT. These increases could reflect re-expressed isoforms. Clinicians need to be aware of the possibility that noncardiac increases in cTnT may occur and lead to a possible false-positive diagnosis of cardiac injury when skeletal muscle pathology is present.

Electrogenerated chemiluminescence of triazole-modified deoxycytidine analogues in N,N-dimethylformamide.

Triazole-modified deoxycytidines have been prepared for incorporation into single-stranded deoxyribonucleic acid (ssDNA). Electrochemical responses and electrogenerated chemiluminescence (ECL) of these deoxycytidine (dC) analogues, 1-4, were investigated as the monomers. Cyclic voltammetry and differential pulse voltammetry techniques were used to determine the oxidation and reduction potentials of 1-4, along with the reversibility of their electrochemical reactions. The dC analogues, in N,N-dimethylformamide containing 0.1 M tetra-n-butylammonium perchlorate as electrolyte, exhibited weak relative ECL efficiencies following the annihilation mechanism, while these efficiencies were enhanced with the use of benzoyl peroxide following the coreactant mechanism. It was shown that these nucleosides could generate excited monomers, and excimers as seen by the red-shifted ECL maxima relative to their corresponding photoluminescence peak wavelengths.

A multi-channel sensor based on 8-hydroxyquinoline ferrocenoate for probing Hg(II) ion.

A new sensing molecule 8-hydroxyquinoline ferrocenoate (Fc-Q) which combines ferrocene and 8-hydroxyquinoline moieties was synthesized and applied as a multi-channel sensor for the detection of Hg(2+) ion. Fc-Q can coordinate with Hg(2+) to give colorimetric, fluorescent and electrochemical responses. Upon complexation with Hg(2+) ion, the characteristic absorption peak is red-shifted (Δλ=45 nm), the fluorescent intensity is quenched at 303 nm, and the oxidation peak is cathodic shifted (ΔE(1/2)=-149 mV). Quantitatively analyzed Hg(2+) ions at the range of ppb level could be achieved by electrochemical response. For the practical application of sensing Hg(2+) in real world water, Fc-Q modified screen-printed carbon electrodes were obtained for facile, sensitive, and on-site analysis of Hg(2+).

Postmortem redistribution of fentanyl in blood.

Fentanyl concentrations were measured in postmortem specimens collected in 20 medical examiner cases from femoral blood (FB), heart blood (HB), heart tissue, liver tissue, and skeletal muscle. Unique was a subset of 7 cases in which FB was obtained at 2 postmortem intervals, shortly after death (FB1) and at autopsy (FB2). The mean collection times of FB1 and FB2 after death were 4.0 and 21.6 hours, respectively. Fentanyl concentrations for FB1 and FB2 ranged from undetectable to 14.6 microg/L (mean, 4.6 microg/L) and 2.0 to 52.5 microg/L (mean, 17.3 microg/L), respectively. Corresponding mean HB, liver tissue, and heart tissue fentanyl concentrations were 29.8 microg/L, 109.7 mg/kg, and 103.4 mg/kg, respectively. The fentanyl HB/FB1 ratio (mean, 8.39) was higher compared with the corresponding HB/FB2 ratio (mean, 3.48). These results suggest that postmortem redistribution of fentanyl can occur in FB.

Blue fluorescent deoxycytidine analogues: convergent synthesis, solid-state and electronic structure, and solvatochromism.

We report the synthesis and photospectroscopic characterisation of intrinsically fluorescent triazole-appended cytidines. Fluorescence was found to be highly dependent on solvent conditions. X-Ray crystallographic data show the proton of the exocyclic amine of the nucleobase and the triazole N(3) engaged in a H-bond.

Treatment of severe haemoptysis by embolisation of the bronchial artery. A case report.

A case report is presented of a 50-year-old man with severe haemoptysis. The exact source of the bleeding was not known and medical treatment had no effect. Selective angiography of the bronchial arteries showed extravasation of the contrast medium into a bronchus. Embolisation of the bleeding bronchial artery caused the haemoptysis to stop immediately.