Soluble urokinase plasminogen activator receptor and functionally relevant coronary artery disease: a prospective cohort study.

BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) is an emerging biomarker associated with anatomical CAD burden and cardiovascular outcomes including myocardial infarction (MI) and death. We aimed to validate previous findings of the prognostic value of suPAR and to evaluate its diagnostic potential for functional relevant CAD (fCAD). METHODS: Consecutive patients with suspected fCAD were enrolled. Adjudication of fCAD was performed blinded to suPAR concentrations by myocardial perfusion single-photon emission tomography (MPI-SPECT) and coronary angiography. Prognostic outcome measures included all-cause death, cardiovascular death, and incident MI during 2-year follow-up. RESULTS: Among consecutive 968 patients, suPAR concentrations were higher in patients with fCAD compared to those without (3.45 vs. 3.20 ng/mL, p = 0.007), but did not provide acceptable diagnostic accuracy (area under the curve [AUC]: 0.56, 95%CI 0.52-0.60). SuPAR correlated with high-sensitivity cardiac-troponin T (Spearman's rho (ρ) 0.393, p < 0.001), NT-proBNP (ρ = 0.327, p < 0.001), age (ρ = 0.364, p < 0.001) and very weakly with coronary atherosclerosis (ρ = 0.123, p < 0.001). Prognostic discrimination of suPAR was moderate for cardiovascular death (AUC = 0.72, 95%CI 0.62-0.81) and all-cause death (AUC = 0.72, 95%CI 0.65-0.79) at 2-years. SuPAR remained a significant predictor for all-cause death in multivariable Cox regression (HR = 1.96, p = 0.001). CONCLUSIONS: SuPAR was an independent predictor of all-cause death, without diagnostic utility for fCAD. CLINICAL TRIAL REGISTRATION: NCT01838148.

Medical Students' Knowledge and Attitudes Regarding Justice-Involved Health.

Despite the demonstrated need for sustainable and effective carceral health care, justice-involved medical education curricula are limited, and it's unclear if informal clinical education is sufficient. Investigators aimed to quantify medical student involvement with carceral populations and explore how students' knowledge of and attitudes towards justice-involved patients changed over the course of their training. A survey was designed by the investigators and sent to all current medical students at a single United States medical school. Stata 14.0 was used to compare results between the years of medical school. Differences between groups were tested using linear regression. Most 4th year students reported working in a carceral health setting. An increase in overall knowledge of justice-involved patients was observed as carceral medicine education (ptrend = 0.02), hours worked in a jail (ptrend < 0.01), and substance abuse training (ptrend < 0.01) increased. Overall attitude score increased with the students' reported number of hours working in a jail (ptrend < 0.01) and the amount of substance abuse training (ptrend < 0.01). Finally, we found a trend of increasing knowledge and attitude scores as the year of standing increased (ptrend < 0.01). Our data suggest that most USC medical students work in a carceral setting during medical school. Didactic and experiential learning opportunities correlated with improved knowledge of and attitude toward justice-involved patients, with increases in both metrics increasing as the year in medical school increased. However, senior medical students still scored poorly. These findings underscore the need for a formal curriculum to train our healthcare workforce in health equity for carceral populations.

The assessment of sarcopenia using psoas muscle thickness per height is not predictive of post-operative complications in IBD.

BACKGROUND: Sarcopenia is associated with postoperative complications in inflammatory bowel disease. It has most commonly been defined using the skeletal muscle index, computed after analysis of cross-sectional muscle area at L3. Psoas muscle thickness normalized to height (PMTH), which is easier to derive, is a potential surrogate of SMI and sarcopenia in patients with cirrhosis and chronic pancreatitis. We investigate whether sarcopenia defined by PMTH has utility in predicting post-operative outcomes in patients with inflammatory bowel disease. METHODS: We performed a retrospective study of adults undergoing IBD-related surgery from 2009 to 2019 at two hospitals. Sarcopenia was defined by sex-specific PMTH at the umbilicus on cross-sectional imaging using a 50th percentile median cutoff. Predictive models were created using variables (BMI, age, sex, smoking status, albumin, INR, platelets, hemoglobin, hypertension, diabetes, CAD, medications) that may be associated with complications (mortality, reoperation, readmission, transfusions, ICU admission, infection, DVT/PE), and sarcopenia for comparison. RESULTS: 85 patients with IBD were included. Lower albumin level (OR = 0.52, p = 0.039) and biologic use (OR = 5.92, p = 0.006) were associated with postoperative complications. There was no significant difference using PMTH compared to a model incorporating hypoalbuminemia and biologic use in predicting complications. Sarcopenia on univariate analysis was associated with a lower 30 day rate of reoperation (p = 0.04). CONCLUSIONS: A low status of PMTH was not associated with increased postoperative complications, however hypoalbuminemia and biologic use were. PMTH as a surrogate for sarcopenia requires further study, ideally with prospective studies comparing PMTH with accepted radiographic surrogates for sarcopenia, to determine its role in clinical decision making.

The role of antiseptic agents in atopic dermatitis

The skin of individuals with atopic dermatitis has a susceptibility to be colonized with Staphylococcus aureus. This has been associated with increased frequency and severity of exacerbations of atopic dermatitis. Therefore, there is a growing interest in the use of antiseptic agents to target primary bacterial colonization and infection. Antiseptic agents have been found to be better tolerated and less likely to induce bacterial resistance as compared to antibiotics. There is also a wide variety of antiseptic agents available. The efficacy of antiseptic agents has yet to be established as the studies reviewed previously have been small and of suboptimal quality. This review discusses the rationale behind targeting S. aureus with antiseptic agents and presents findings from a review of studies assessing the efficacy of antiseptics in atopic dermatitis in the last five years. Four studies were found, including a bleach bath study which has already been reviewed elsewhere. The remaining 3 studies assessed the efficacy of sodium hypochlorite containing cleansing body wash, sodium hypochlorite baths and 1% triclosan in leave on emollient. These studies suggested some benefit for the inclusion of antiseptic use with the mainstay management of atopic dermatitis, including a potential steroid sparring effect. However, there are many limitations to these studies which therefore warrant further investigation on the impact of antiseptic use in atopic dermatitis.

Dependence of collision-induced dissociation energy on molecular degrees of freedom as a means to assess relative binding affinity in multivalent complexes.

In collision-induced dissociation mass spectrometry experiments, the collision energy required for dissociation linearly depends on the degrees of freedom in the precursor ion. The magnitude of the slope of this relationship previously has been shown to qualitatively correlate to the relative binding strength of a noncovalently bound, monovalent complex. The goal of the work presented here is to determine if a similar methodology can be applied for assessing relative binding strengths in multivalent species. We have tested the method on complexes formed from 18-crown-6 and a variety of protonated, primary alkylamines, [C(n)H(2n+1)NH(3)](+) (n=9, 12, 14, 16 and 18) and alkyldiamines, [H(3)NC(n)H(2n)NH(3)](2+) (n=3, 5, 6, 9 and 12), and compared our results with dissociation energies calculated using density functional theory at the B3LYP/6-31G* level. We found that the method correctly assessed the stronger crown ether/headgroup interaction in the two divalent species (1:1 and 2:1 complexes formed from the diaminoalkanes) compared with the weaker interaction in the monovalent species (1:1 complexes formed from mono-aminoalkanes). However, the experimental method could not distinguish between the binding strengths of the two divalent complexes, perhaps because their calculated dissociation energies were quite similar. Our preliminary results suggest that this method could potentially be used for a quick and simple analysis of binding strengths in multivalent species if the binding strengths of the species are significantly different from one another.

Measuring children's health-related quality of life after trauma.

Consideration of children's health-related quality of life (HRQOL) after injury is a critical aspect of outcome in assessing the effectiveness of trauma care. Numerous instruments are available today for measuring the HRQOL of injured children. HRQOL instruments reflect the subjective perspective of the impact an injury or disease has on a child's physical, emotional, and social well being. Most studies to date have examined children's HRQOL during the first year postinjury, relatively little is known about children's long-term HRQOL after trauma. Most trauma outcome studies have included children with heterogeneous injuries so the impact of specific injuries on HRQOL outcomes has not been well established. The majority of outcome studies have focused on injured children who have been hospitalized, however the research should be extended to the emergency department because a large proportion of injured children are treated and released from there. In addition to documenting recovery, investigators should use HRQOL instruments to evaluate the quality of care we offer injured children and their families. Rigorously conducted HRQOL assessment will provide valuable information that we can use to successfully optimize children's recovery after trauma.

Risk of posthospitalization mortality among persons with traumatic brain injury, South Carolina 1999-2001.

Traumatic brain injury (TBI) negatively impacts long-term survival. However, little is known about the likelihood of death within the first year following hospital discharge. This study examined mortality among a representative sample of 3679 persons within 1 year of being discharged from any of 62 acute care hospitals in South Carolina following TBI and identified the factors associated with early death using a multivariable Cox proportional hazards model. The mortality experience of the cohort was also compared with that of the general population by using standardized mortality ratios for selected causes of death by age, adjusted for race and sex.

Comparison of Maryland hospital discharge and trauma registry data.

BACKGROUND: This study aimed to examine the validity of using Maryland hospital discharge data to characterize injuries sustained by trauma patients. METHODS: Maryland hospital discharge and Maryland trauma registry data for 1999 were merged, and the extent of agreement regarding the presence and severity of injuries sustained was evaluated. RESULTS: The mean Injury Severity Score was 8.4 according to the Maryland hospital discharge data and 10 according to the Maryland trauma registry data (p < 0.0001). The Maryland hospital discharge data identified 95% or more of all moderate to severe injuries (Abbreviated Injury Score, > or =2) for all body regions except the head. There was substantial agreement between the two data sets for mechanism of injury (weighted kappa, 0.62), the number of preexisting conditions present (weighted kappa, 0.45) and final disposition (weighted kappa, 0.78). CONCLUSIONS: The Maryland hospital discharge data are a valid source for documenting the nature and severity of injuries sustained by trauma patients, except for those with a relatively minor head injury.

The influence of insurance, race, and gender on emergency department disposition.

OBJECTIVES: To examine the influence of insurance, race, and gender on the likelihood of hospitalization among trauma patients. METHODS: Statewide hospital discharge and emergency department (ED) visit data collected between 1996 and 2000 were merged to examine factors that influence hospitalization among patients who sustained an injury. Multivariate logistic regression was used to model the likelihood of hospitalization as a function of patient, injury, and hospital characteristics. RESULTS: Of 1,512,611 patients who presented to an ED in South Carolina for treatment of a traumatic injury during the five-year study period, 8% were hospitalized and 92% were treated and released. One fourth (26%) of the study population was uninsured. Insurance, race, and gender were significant predictors of hospitalization despite controlling for injury severity, comorbidities, age, trauma center level, place of residence, and year of injury. Regardless of injury severity, uninsured patients were significantly less likely to be hospitalized compared with privately insured patients (odds ratio [OR] 0.63, 99% CI = 0.62 to 0.65). Among those mildly to moderately injured, patients covered by Medicare or other government insurance policies were significantly more likely to be admitted compared with those with private coverage (OR 1.46, 99% CI = 1.41 to 1.52; OR 1.56, 99% CI = 1.36 to 1.78). Finally, among those mildly injured, African American females were significantly less likely to be admitted compared with white females (OR 0.63, 99% CI = 0.61 to 0.65). CONCLUSIONS: These results suggest that the disposition of trauma patients from the ED may be influenced by insurance and demographic characteristics in addition to the patient's clinical condition.