Echocardiography reporting of pulmonary hypertension and subsequent referral to a specialty clinic.

INTRODUCTION: Echocardiography is commonly performed in the evaluation of patients with pulmonary hypertension (PH). The report summary often serves to guide the future evaluation of these patients. Our aim was to explore the relationship between the echocardiography reports of patients with PH and referral to a PH specialty clinic. METHODS: A random sample of 500 echocardiographic reports of patients with an estimated right ventricular systolic pressure (RVSP) greater than 40 mm Hg between 2006 and 2014 was selected from the institutional database of a single academic center. Referral to the PH clinic was determined by evaluating the electronic medical record. Univariate and multivariate logistic regression analyses were performed to identify characteristics associated with referral. RESULTS: Pulmonary hypertension was mentioned in 31% of the report summaries, and only 4.6% were referred to the PH clinic. Variables associated with referral were younger age, indication for echocardiography, higher right atrial and ventricular (RV) systolic pressures, RV dilatation, mention of PH in the summary, and higher left ventricular ejection fraction. Mention of PH in the summary was the variable most strongly associated with referral (adjusted odds ratio 4.6, 95% CI 1.5-14.2). CONCLUSION: Pulmonary hypertension was infrequently mentioned in the summary of echocardiography reports of patients with RVSP >40 mm Hg. Referral to the PH clinic was rare but occurred more often following the mention of PH in the summary. Explicit mention of the presence of PH in the echocardiography report summary may facilitate referral to a specialty clinic and allow more comprehensive evaluation of PH.

Relation of Venous Thromboembolism Risk to Ischemic Stroke Risk in Hospitalized Patients with Cancer.

Patients with cancer are at increased risk for venous thromboembolism (VTE). However, the relationship of cancer type to the risk of arterial thrombosis in patients with high VTE risk has not been described. The goal of this study is to determine the rate of arterial thrombosis in patients with different types of solid tumors stratified by VTE risk. Using the 2012 National Inpatient Sample, we identified 373,789 hospitalizations involving patients ≥18 years associated with solid tumors, stratified by type. Data were collected on clinical characteristics, VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]), and arterial thrombosis (primary diagnosis of myocardial infarction [MI] and ischemic stroke). Subjects with solid tumors (stages I to IV) were stratified by VTE risk - high versus low. Certain solid tumor types (esophageal, lung, melanoma, ovarian, pancreatic, stomach, and uterine) were found to be associated with a higher rate of VTE compared with other cancer types (6.8% vs 3.9%, p < 0.001). Multivariate analysis applied to the high VTE risk group showed no increased risk for MI (odds ratio [OR] 0.93, p = 0.74), however, the rate of ischemic stroke was increased (OR 1.22, p < 0.001). Those in the high VTE risk group who had metastatic disease were at higher risk for arterial thrombosis (MI OR 1.35, p < 0.001, ischemic stroke OR 2.43, p < 0.001). In conclusion, different cancer types are associated with increased risk of both venous and arterial thrombosis and the risk is further increased by the presence of metastatic disease.

Development of associations between microalgae and denitrifying bacteria in streams of contrasting anthropogenic influence.

We compared the development of microalgal and bacterial-denitrifier communities within biofilms over 28 days in a restored-prairie stream (RP) and a stream receiving treated wastewater effluent (DER). Inorganic nutrient concentrations were an order of magnitude greater in DER, and stream waters differed in the quality of dissolved organics (characterized via pyrolysis-GC/MS). Biofilm biomass and the densities of algae and bacteria increased over time in both systems; however, algal and denitrifier community composition and the patterns of development differed between systems. Specifically, algal and denitrifier taxonomic composition stabilized more quickly in DER than RP, whereas the rates of algal and denitrifier succession were more closely coupled in RP than DER. We hypothesize that, under unenriched conditions, successional changes in algal assemblages influence bacterial denitrifiers due to their dependence on algal exudates, while under enriched conditions, this relationship is decoupled. Between-system differences in organic signatures supported this, as RP biofilms contained more labile, aliphatic compounds than DER. In addition, potential denitrification rates (DNP) were negatively correlated with the percentage of aromatic compounds within the biofilm organic signatures, suggesting a significant relationship between algal exudate composition and denitrification. These results are significant because anthropogenic factors that affect biofilm community composition may alter their capacity to perform critical ecosystem services.