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The real-world effectiveness and safety of a 0/1-hour accelerated protocol using high-sensitivity cardiac troponin (hs-cTn) to exclude myocardial infarction (MI) compared to routine care in the United States is uncertain. The objective was to compare a 0/1-hour accelerated protocol for evaluation of MI to a 0/3-hour standard care protocol.

We sought to determine whether cardiac rehabilitation (CR) improves cardiorespiratory fitness and markers of chemotherapy-related cardiotoxicity. Patients with cancer and evidence of cardiotoxicity were randomized to CR or usual care. Peak oxygen uptake improved with CR. No changes in cardiac markers were observed. This study supports CR for patients undergoing cardiotoxic chemotherapy.

Prostate cancer is recognized as the second-most common cause of cancer and the sixth-leading cause of cancer mortality among men worldwide. According to the American Cancer Society, there were an [...]

With over 20 years of the opioid crisis, our collective response has evolved to address the ongoing needs related to the management of opioid use and opioid use disorder. There has been an increasing recognition of the need for standardized metrics to evaluate organizational management and stewardship. The clinical laboratory, with a wealth of objective and quantitative health information, is uniquely poised to support opioid stewardship and drive valuable metrics for opioid prescribing practices and opioid use disorder (OUD) management.To identify laboratory-related insights that support these patient populations, a collection of 5 independent institutions, under the umbrella of the Clinical Laboratory 2.0 movement, developed and prioritized metrics. Using a structured expert panel review, laboratory experts from 5 institutions assessed possible metrics as to their relative importance, usability, feasibility, and scientific acceptability based on the National Quality Forum criteria.A total of 37 metrics spanning the topics of pain and substance use disorder (SUD) management were developed with consideration of how laboratory insights can impact clinical care. Monitoring these metrics, in the form of summative reports, dashboards, or embedded in laboratory reports themselves may support the clinical care teams and health systems in addressing the opioid crisis. The clinical insights and standardized metrics derived from the clinical laboratory during the opioid crisis exemplifies the value proposition of clinical laboratories shifting into a more active role in the healthcare system. This increased participation by the clinical laboratories may improve patient safety and reduce healthcare costs related to OUD and pain management.

According to the New England Journal of Medicine, an estimated one billion people worldwide are vitamin D deficient or insufficient. (1) Experts believe at least half of adults over the [...]

* Objectives To evaluate the seriousness and frequency of violence and the degree of associated injury depicted in the 100 top-grossing American films of 1994. * Methods Each scene in each film was examined for the presentation of violent actions on persons and coded by a systematic context-sensitive analytic scheme. Specific degrees of violence and indices of injury severity were abstracted. Only actually depicted, not implied, actions were coded, although both explicit and implied consequences were examined. * Results The median number of violent actions per film was 16 (range, 0-110). Intentional violence outnumbered unintentional violence by a factor of 10. Almost 90% of violent actions showed no consequences to the recipient's body, although more than 80% of the violent actions were executed with lethal or moderate force. Fewer than 1% of violent actions were accompanied by injuries that were then medically attended. * Conclusions Violent force in American films of 1994 was overwhelmingly intentional and in 4 of 5 cases was executed at levels likely to cause significant bodily injury. Not only action films but movies of all genres contained scenes in which the intensity of the action was not matched by correspondingly severe injury consequences. Many American films, regardless of genre, tend to minimize the consequences of violence to human beings., Violence in popular entertainment media has recently moved onto the public health agenda as the causes, consequences, and prevention of violence have become the subject of urgent social debate. These [...]

A sensitive assay has been developed to quantitate fibrinogen in plasma or in other aqueous solutions. Microscopic latex particles, modified with a mixed monomolecular film of lecithin and fibrinogen, are used as a solid-phase reagent. These lecithin/fibrinogen-coated beads aggregate when stirred in the presence of thrombin and, when solution-phase fibrinogen is added, the increased rate of aggregation is proportional to the concentration of soluble fibrinogen. Using a sample volume of 200 μl, as little as 15 nM (∼5 μg ml−1) fibrinogen can be measured. Fibrinogen determinations using the bead assay compared favorably with those derived from a standard clinical assay, with a correlation coefficient (r2) of 0.9710 over a range of 2.5 to 28.0 μM. Analytic precision was comparable to available assays, with typical coefficients of variation of 12.7 and 7.1% for fibrinogen concentrations of 30 nM and 15.0 μM, respectively. The method has a dynamic range of 15 nM to over 3.0 μM and offers the advantage of being sensitive to 20-fold lower concentrations of fibrinogen compared to routine clot-based methods. Unlike immunological assays, e.g., ELISA, it measures only the functional protein. This bead method should prove to be of greatest use to investigators measuring low levels of functional fibrin(ogen).

We assessed the processivity of fibrin(ogen) adsorbed to unmodified, and to lecithin-coated (160 Å2· molecule -1), polystyrene-divinylbenzene beads. At saturation, lecithin-coated beads bind ∼22% less fibrinogen than do unmodified beads, a consequence of the protein being excluded from the area occupied by the hydrophilic head group of the lipid on the lecithin-coated surface. Despite this reduced capacity, lecithin-coated beads saturated with fibrinogen aggregate in the presence of thrombin at a rate and to an extent both greater than those of saturated unmodified beads. These differences cannot be due to inhibition of thrombin activity by the unmodified beads since liberation of fibrinopeptides A and B from both beads is quantitative. Whereas the action of thrombin on bound fibrinogen is indifferent to the lipid film, fibrinogenolysis is much more rapid and complete when fibrinogen is bound to the lecithin-coated surface than when it is bound to unmodified polystyrene-divinylbenzene. We attribute this to greater accessibility of plasmin-labile sites when the fibrinogen is coadsorbed with the phospholipid. Based on several results and observations, including thrombin-initiated aggregation of heads, and patterns of fibrinogenolysis and transamidation of adsorbed fibrin, we hypothesize that flexible, elongate fibrin(ogen) molecules bind to the hydrophobic regions of these surfaces in near end-on fashion, an orientation that appears to be preserved by lecithin. We propose further that the study of fibrin(ogen) on surfaces, lipid surfaces in particular, should provide information relevant to a host of physiologic/pathophysiologic processes where fibrin(ogen) deposition on surfaces occurs.

Using microscopic, polystyrene-divinylbenzene beads, and an aqueous solution of sodium dodecyl sulfate and 2-mercaptoethanol, we demonstrate that fibrinogen bound to amphiphilic or hydrophobic surfaces exists as two distinct species. One species, which constitutes a small but significant percentage, ~10-15%, of the molecules in densely packed, adsorbed films of the protein, is not functional in the classic sense of fibrin gelation and resists detergent-facilitated elution; the other species, which constitutes the bulk of the molecules of adsorbed, saturated films of fibrinogen, is functional and elutes rapidly according to a first order process with a half-life of several minutes. A plot of the surface concentration of nondesorbable fibrinogen versus the initial surface concentration of the protein is linear with a slope near unity for low initial surface concentrations but curves and becomes constant when the initial concentrations are high. Such a profile indicates that: (1) when the area available to each fibrinogen is great, all of the bound protein takes on the form of the nondesorbable species, (2) conversion to the nondesorbable species occurs at a rate that is on the time scale of adsorption, and (3) there is a limit to the capacity of the surface for the nondesorbable species. The similarity of the molecular area of the nondesorbable species on beads, ~26 Ų per amino acid residue, and that of fibrinogen in stable, insoluble monolayers at the air-water interface, ~23 Ų per amino acid residue, supports the proposal that functional, desorbable fibrinogen adsorbs to the surface even as the surface is being "conditioned" by the nondesorbable species. Thus, the nondesorbable species renders hydrophilic the surface for the adsorption of the functional species, and this rendering precludes denaturation of functional molecules. We propose that amphiphilic secondary structural features of fibrinogen confer stability to the nondesorbable species, a species likely operative in the biology of fibrinogen at interfaces. Copyright 1994, 1999 Academic Press

Protocols utilizing high-sensitivity cardiac troponin (hs-cTn) assays for the evaluation of suspected acute coronary syndrome (ACS) in the emergency department (ED) have been gaining popularity across the US and the world. These protocols more rapidly rule-out ACS and more accurately identify the presence of acute myocardial injury. At this time, few randomized trials have evaluated the safety and operational impact of these assays, resulting in limited evidence to guide the use and implementation of hs-cTn in the ED.

The principles, technology, and prospects for coupling capillary supercritical fluid chromatography (SFC) to Fourier transform infrared spectroscopy (FTIR) are described. The information available from reconstructed chromatograms, in both universal and selective detection modes, in addition to the IR spectrum itself, makes SFC-FTIR a powerful hyphenated technique. Flow cell and solvent elimination interfaces are compared, and the restrictions imposed by the compromise between chromatographic and spectroscopic requirements, especially in flow cell design, and by the choice of mobile phase are discussed. Illustrative examples of SFC-FTIR applications are presented, and some likely future trends are projected.