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In the United States, approximately 2 million people live with limb loss and that number is expected to double by 2050. Although this is a significant figure, it still does not represent a substantial market size for the private sector to develop prosthetics for this population. Mobility is highly crucial for long-term health , , , , and prosthetic limbs are vital in restoring mobility. Undoubtedly, people with limb loss are among the most vulnerable segments of society. Therefore, we contend that their safety and care should be a high priority for the government. In this article, we recap the public policy landscape surrounding prosthetic limbs in the United States before proposing ways to increase access and adoption of prosthetic limbs. [ABSTRACT FROM AUTHOR]

The centralization of cancer treatment centers in large cities results in transportation-related barriers to accessing high-quality cancer care. Although evidence suggests limited access and long-distance treatments negatively affect cancer outcomes, the literature remains uncertain about the effect of built environment attributes on treatment consequences. This study examines the effects of geographical accessibility and built environment attributes on improved cancer outcomes. A cross-sectional survey of cancer patients in the United States (2019) was conducted to collect data related to those patients who received radiotherapy and chemotherapy treatments, including their travel-related patterns to health care providers. We employed geographic information systems (GIS) to geocode patients' home and healthcare provider locations to identify travel distance to care providers. In addition, the residential built environment attributes, including density, diversity, distance to transit, and street design, have been measured. To explore the research assumptions, we employed structural equation models (SEMs) and tested the effects from key variables on cancer outcomes as well as interaction effects among the posited variables. Results from the SEM indicate that patients living in neighborhoods with long distances to transit and the long distance to the closest hospital are more likely to have longer travel distances to radiotherapy providers as well. Moreover, as the travel distance to radiotherapy providers increases, the frequency of radiotherapy trips reduces. However, long travel distance to radiotherapy providers is positively associated with greater tumor-free years. For chemotherapy, travel distance to the closest large hospital increases travel distance to the chemotherapy provider, however, neither built environmental measures nor travel distance significantly affects tumor-free years. Only travel frequency to chemotherapy providers slightly increases the tumor-free years for cancer. Thus, traveling the remoter distance to radio providers may enhance the opportunity of access to higher volume hospitals with advanced treatment quality and surpass the potential downsides of longer travel distance. The results have great potential to help policymakers and urban planners make informed decisions on how designing-built environment to enhance equity access to cancer treatments and improve patients' health outcomes. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, restrictive non-pharmaceutical policy interventions (NPIs), with the goals of reducing interactions and travel for people in different households, were introduced. In the U.S., each state had jurisdiction over the NPI policy imposed, resulting in myriad policy decisions. The aggregate impacts of these decisions are known; however, the individual impacts are not fully understood. We disaggregated the NPIs imposed during the first three months of the epidemic (1 March and 7 June 2020) using panel data regression analysis. Vehicular travel reduction as a proxy for NPI impacts on traffic was regressed against stay-at-home orders, business closures, school closures, and gathering bans. The results show that school closures and full closures of non-essential businesses were correlated with the largest impacts in reducing vehicle trips compared to when they are not in place. Stay-at-home orders had about half the impact of school closures compared to when they were not in place. Gathering bans had the least impact. In the U.S., decisions that target businesses were the most effective in reducing vehicle traffic. There was heterogeneity in how people responded to these restrictions. This study can be used in epidemiology models and inform decision-makers on policies that work best. [ABSTRACT FROM AUTHOR]

Heart failure is a leading cause of readmissions in the United States, although treatment has come along away, palliative care is often not appropriately offered in advanced heart failure. The purpose of this study was to use a large database of national in-patient sample to find out the use of palliative care in acute heart failure admissions. Data from 2002 to 2017 was used for analysis. Simple linear regression was used for trend analysis over the years. Variables that were statistically significant in univariate analysis were used in single-step (entry method) multiple logistic analysis. The use of palliative care was found to be low at 4.1%, although recent trends have shown an increase (from 0.4% in 2002 to 6.2% in 2017). Women (0.3% in 2002 to 6.5% in 2017) and Caucasians (0.6% in 2002 to 6.9% in 2017) had a higher proportion of PC encounters as compared to men (0.5% in 2002 to 5.9% in 2017) and other racial minorities, increasing age (OR, 1.04[CI; 1.03-1.04], p < 0.01), female gender (OR, 1.03[CI; 1.02-1.03], p < 0.01), do not resuscitate status (OR, 10.62[CI; 10.53-10.70], p < 0.01), diabetes mellitus (OR, 1.10[CI; 1.01-1.11], p < 0.01), liver disease (OR, 1.63[CI; 1.60-1.66], p < 0.01), renal failure (OR, 1.40[CI; 1.39-1.41], p < 0.01), acute myocardial infarction (OR, 1.28[CI; 1.27-1.30], p < 0.01), and cardiogenic shock (OR, 2.89[CI; 2.84-2.93], p < 0.01) were associated with higher odds of having PC encounter. In conclusion, the use of palliative care has increased in the United States over the years, however, it is still low as compared to other high-income countries. [ABSTRACT FROM AUTHOR]

Background: Liver disease is a risk factor for development of atrial fibrillation (AF). We aim to study inpatient mortality and resource utilization of end-stage liver disease (ESLD) patients with AF from a nationally representative United States population sample. Methods: For the purpose of our study, we utilized data from National Inpatient Sample for calendar years 2005-2015. Patients with ESLD and AF were identified using relevant International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Key outcomes of inpatient mortality and resource utilization were assessed. We also constructed a multiple logistic regression model to determine predictors of mortality in ESLD patients. Propensity matching was also done to balance confounding variables. Results: A total of 309,959 ESLD patients were included in final analysis. Out of these, about 32,858 (10.6%) patients have concomitant AF. ESLD patients with AF were older and had higher burden of key co-morbidities such as heart failure, diabetes and hypertension. Mortality was significantly higher in both unmatched (12.3% vs. 9.2%, p < 0.01) and matched cohorts (12.2% vs. 10.8%, p < 0.01). Additionally, ESLD patients with AF have longer length of stay, increased facility discharge and cost of hospitalization compared to ESLD patients without AF. In multivariate analysis, AF is an independent predictor of mortality in ESLD patients. Conclusion: AF portends worse outcomes in patients with ESLD. Strong index of suspicion is warranted to timely identify AF in this patient population. [ABSTRACT FROM AUTHOR]

Aims: The primary objective of this systematic review was to estimate the prevalence and temporal changes in chronic comorbid conditions reported in heart failure (HF) clinical trials.Methods and Results: We searched MEDLINE for HF trials enrolling more than 400 patients published between 2001 and 2016.Trials were divided into HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), or trials enrolling regardless of ejection fraction. The prevalence of baseline chronic comorbid conditions was categorized according to the algorithm proposed by the Chronic Conditions Data Warehouse, which is used to analyse Medicare data. To test for a trend in the prevalence of comorbid conditions, linear regression models were used to evaluate temporal trends in prevalence of comorbidities. Overall, 118 clinical trials enrolling a cumulative total of 215 508 patients were included. Across all comorbidities examined, data were reported in a mean of 35% of trials, without significant improvement during the study period. Reporting of comorbidities was more common in HFrEF trials (51%) compared with HFpEF trials (27%). Among trials reporting data, hypertension (63%), ischaemic heart disease (44%), hyperlipidaemia (48%), diabetes (33%), chronic kidney disease (25%) and atrial fibrillation (25%) were the major comorbidities. The prevalence of comorbidities including hypertension, atrial fibrillation and chronic kidney disease increased over time while the prevalence of smoking decreased in HFrEF trials.Conclusion: Many HF trials do not report baseline comorbidities. A more rigorous, systematic, and standardized framework needs to be adopted for future clinical trials to ensure adequate comorbidity reporting and improve recruitment of multi-morbid HF patients. [ABSTRACT FROM AUTHOR]

Background: Role of statins in prevention of contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography remains controversial. We studied the use of statins in decreasing CI-AKI following coronary angiography.Methods: We reviewed all patients who underwent coronary angiography with or without PCI and had a follow-up creatinine from January 2012 to December 2016 at a single tertiary care center in the United States. CI-AKI was defined as 0.3 mg/dL absolute rise in creatinine. Patients who were on moderate to high-intensity statins or received moderate to high-intensity statins prior to coronary angiography were included in the statin group. Crude and adjusted odds ratios (AOR) were calculated using univariate multiple logistic regression analysis.Results: Out of 2055 patients (females = 30.7%, mean age 58.0 ± 12.5 years, statin group = 886, non-statin group = 1169), 293 (14.3%) developed CI-AKI. Mean estimated glomerular filtration rate (eGFR) was not significantly different between the statin and the non-statin group (86.5 mL/min/1.73 m2 vs 87.1 mL/min/1.73 m2, p = 0.65). There was no significant difference in the incidence of CI-AKI between statin and non-statin group (14.4% vs 14.1%, p = 0.83). When adjusted for other risk factors, statin use was not significantly associated with decreased risk of CI-AKI (AOR) = 0.8, [95% confidence interval (CI) = 0.6-1.1, p = 0.19]. Results remained statistically non-significant on subgroup analysis of patients with acute coronary syndrome (ACS) (OR = 0.8, 95% CI = 0.6-1.2, p = 0.27), patients who had percutaneous coronary intervention (PCI) (OR = 1.1, 95% CI = 0.6-1.7, p = 0.81) and patients with eGFR < 60 mL/min/1.73 m2 (OR = 0.9, 95% CI = 0.6-1.5, p = 0.9).Conclusion: Statin use prior to coronary angiography is not associated with decreased incidence of CI-AKI. [ABSTRACT FROM AUTHOR]

A 65-year-old man with a medical history of anxiety and depression came to the ED with concerns of coughing blood-tinged phlegm for the past 3 days. Four days before the presentation, the patient had a motor vehicle accident as a restrained driver with airbag deployment. The patient struck his chest against the steering wheel. He was evaluated at a level 1 trauma center and underwent a whole-body scan, including a CT scan of the chest, which showed no acute abnormalities. Apart from mild-to-moderate bruising and tenderness on the right side of his face, nose, and anterior chest, the patient was stable and was discharged the next day. After returning home, the patient started coughing blood-tinged phlegm, which became progressively bloodier for the next 3 days, achieving individual posttussive volumes of 1 T of frank blood. In the ED, the patient denied any similar symptoms in the past. He denied any recent or distant known history of malignancy, infections, or travel outside the United States. He lives by himself and previously worked various jobs. He endorsed active tobacco use and smoking 3 to 6 cigarettes per day for the past 20 years with 5 pack-year history. Patient reported consuming one to two alcohol drinks per month. [ABSTRACT FROM AUTHOR]

Following four years of relative stability at around $106 per barrel (bbl), oil prices have declined sharply since June 2014 and are expected to remain low for a considerable period of time. There are multiple factors which are being considered behind the plunge in the price of oil since June 2014. Most observers have conjectured that domestic oil boom in the United States and Iraq is the major cause for the falling oil prices. Some have suggested that a major shock to oil price expectations occurred after the November 2014 meeting of OPEC, when they did not cut production despite the steady increase in non-OPEC oil production. In this paper, first we analyzed the effect of various factors on the oil prices and then we studied impacts of the falling oil prices on non-hydro renewable energy. We compare the recent decline in oil prices with previous episodes up to 1996. We show that the demand and supply formula cannot be implemented to the current oil plunge. The study shows that so far the recent plunge in oil prices has produced no major impact on renewable energy sector. We found that renewable energies, such as solar and wind, are increasingly becoming cost competitive with fossil fuel energy. However the oil price crash could hurt the short-term outlook for certain specific clean energy technologies such as bio-fuel and electric vehicles that do compete with oil-based transportation. While long term low oil prices may threaten renewable energies, climate policies have the potential to act as a counterweight, encouraging long-term, low carbon, investment. [ABSTRACT FROM AUTHOR]

Background Recent improvement in the care of patients with myocardial infarction should lead to better outcome. The goal of this study was to evaluate the incidence of all cause cardiogenic shock (CS) and CS occurring in the setting of ST elevation myocardial infarction (STEMI) in the United States. Method The Nationwide Inpatient Sample (NIS) database was utilized to calculate the age-adjusted incident rate of CS from 1996 to 2006 based on ICD-9 coding in the setting of STEMI. Furthermore, we evaluated this trend based on race and gender. Results A total population of 52,784,917 patients was available between 1996 and 2006. We found that the incidence of all cause CS has not changed over time. However, in the setting of STEMI, CS has been declining slowly over the last 10 years. The age-adjusted rate for CS was 4.3 per 100,000 in 1996 which remained steady with an incidence of 3.1 per 100.000 in 2006 (p < 0.01). This decline was persistent across different race or gender. However, African Americans and female gender had persistently lower rate of CS. Conclusion Advancement in the treatment of acute STEMI has led to gradual reduction in the incidence of STEMI related cardiogenic shock irrespective of ethnicities or gender suggesting improving outcome of patients presenting with STEMI in recent years. [ABSTRACT FROM AUTHOR]

Hospital readmissions following an acute myocardial infarction (MI) are associated with increased mortality and morbidity. The aim of this study was to investigate if there is a significant association between specific mental health disorders (MHD) and risk of hospital readmission after an index hospitalization for acute MI. We analyzed the U.S. National Readmission Database for adult acute MI hospitalizations from 2016 to 2017. Co-morbid diagnoses of MHD were obtained using appropriate ICD-10-CM diagnostic codes. The primary outcome of interest was 30-day all-cause unplanned readmission. Cox-regression analysis was used to identify the association of various MHD and risk of 30-day readmission adjusted for demographics, medical and cardiac comorbidities, and coronary revascularization. We identified a total of 1,045,752 hospitalizations for acute MI; patients had mean age of 67 ± 13 years with 37.6% female. The prevalence of any MHD was 15.0 ± 0.9%. After adjusting for potential confounders, comorbid diagnosis of major depression [HR 1.11 (95% CI 1.07–1.15)], bipolar disorders [1.32 (1.19–1.45)], anxiety disorders [1.09 (1.05–1.13)] and schizophrenia/other psychotic disorders [1.56 (1.43–1.69)] were independently associated with higher risk of 30-day readmission compared to those with no comorbid MHD. We conclude that MHD are significantly associated with a higher independent risk of 30-day all-cause hospital readmissions among acute MI hospitalizations. [ABSTRACT FROM AUTHOR]

Background: Acute pericarditis is a frequent cause of hospitalization in the United States. Although recurrence of this condition is common, few studies have investigated hospital readmissions in this patient population.Methods: We queried the National Readmission Database for the years 2016 and 2017 to identify adult admissions for acute pericarditis, and analyzed the data for 30-day readmission. Using multivariate Cox regression analysis, we identified clinical characteristics that were independently predictive of hospital readmission within 30 days.Results: A total of 21,335 patients (mean age 52.5 ± 0.2 years; 38.3% women) who were discharged following hospitalization for acute pericarditis were included. The rate of 30-day readmission was 12.9% (n = 2740). Increasing age (adjusted hazard ratio [HR] 1.05 per 5-year increase; 95% confidence interval [CI], 1.02-1.09; P < 0.001), female sex (adjusted HR 1.33; 95% CI, 1.18-1.49; P < 0.001), dialysis dependence (adjusted HR 1.70; 95% CI, 1.30-2.22; P < 0.001), chronic obstructive pulmonary disease (adjusted HR 1.27; 95% CI, 1.11-1.45; P < 0.001), and presence of pericardial effusion (adjusted HR 1.24; 95% CI, 1.04-1.49; P = 0.02) were independently associated with a higher risk of readmission. In-hospital mortality was significantly higher after readmission than for the index hospitalization (3.4% vs 1.0%, P < 0.001).Conclusion: After hospitalization for acute pericarditis, readmission within 30 days is common and is associated with increased mortality. Identification of characteristics associated with a higher risk of readmission may lead to focused interventions to improve outcomes. [ABSTRACT FROM AUTHOR]

Since the introduction of the measure of economic policy uncertainty, businesses, policymakers, and academic scholars closely monitor its momentum due to expected economic implications. The US is the world's top-ranked equity market by size, and prior literature on policy uncertainty and stock prices for the US is conflicting. In this study, we reexamine the policy uncertainty and stock price nexus from the US perspective, using a novel dynamically simulated autoregressive distributed lag setting introduced in 2018, which appears superior to traditional models. The empirical findings document a negative response of stock prices to 10% positive/negative shock in policy uncertainty in the short-run, while in the long-run, an increase in policy uncertainty by 10% reduces the stock prices, which increases in response to a decrease with the same magnitude. Moreover, we empirically identified two significant thresholds: (1) policy score of 4.89 (original score 132.39), which negatively explain stock prices with high magnitude, and (2) policy score 4.48 (original score 87.98), which explains stock prices negatively with a relatively low magnitude, and interestingly, policy changes below the second threshold become irrelevant to explain stock prices in the United States. It is worth noting that all indices are not equally exposed to unfavorable policy changes. The overall findings are robust to the alternative measures of policy uncertainty and stock prices and offer useful policy input. The limitations of the study and future line of research are also highlighted. All in all, the policy uncertainty is an indicator that shall remain ever-important due to its nature and implication on the various sectors of the economy (the equity market in particular). [ABSTRACT FROM AUTHOR]

• In comparison with influenza, COVID-19 infection in renal transplant recipients is associated with greater morbidity, the need for mechanical ventilation and vasopressor support, and higher rates of acute kidney injury requiring hemodialysis. • Renal transplant recipients with COVID-19 had a tenfold in-hospital mortality rate compared to those with influenza infection (14.09% vs 2.61%, OR 9.73 [95% CI (5.74-16.52)], P <.001). • COVID-19 is associated with a significantly longer length of hospital stay compared to influenza (7.6 days vs 4.9 days, adjusted length of stay 3.4 days high, P <.001). • Mean hospitalization charges are significantly higher in patients with COVID-19 than in those with influenza (90,674 USD vs 52,501 USD, adjusted total charge 49,806 USD higher, P <.001). COVID-19 infection has worse outcomes in immunocompromised individuals. This includes those with diabetes mellitus, cancer, chronic autoimmune diseases requiring immunomodulatory therapy, and solid-organ transplant recipients on chronic immunosuppression. Using the National Inpatient Sample Database, this study retrospectively compared 14,915 renal transplant recipients who were hospitalized with either COVID-19 or Influenza virus infection in the US at any point between 1st January 2020 and 31st December 2020. We found that compared to renal transplant recipients with influenza infection, recipients with COVID-19 infection were more likely to require mechanical ventilation and vasopressor support and develop acute kidney injury requiring hemodialysis. COVID-19 patients also had significantly longer length of hospital stay. Renal transplant recipients with COVID-19 had significantly higher in-hospital mortality compared to recipients with influenza infection (14.09% vs 2.61%, adjusted odds ratio [aOR] 9.73 [95% CI (5.74-16.52)], P <.001). Our study clearly demonstrates the severe outcomes of high mortality and morbidity in renal transplant recipients with COVID-19. Further research should be undertaken to focus on the key areas noted to reduce morbidity and mortality in this population. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal membrane oxygenation (ECMO) is associated with gastrointestinal haemorrhage (GIH), which may result from coagulopathy, systemic inflammation, reduced gastric perfusion, and arteriovenous malformation from non-pulsatile blood flow. Data are limited regarding the burden of this complication in the United States. Material and methods: We analysed the National Inpatient Sample (NIS) database for the years 2007 to 2011 to identify hospitalisations in which an ECMO procedure was performed. Hospitalizations complicated by GIH in this cohort were then identified by relevant codes. Results: Between 2007 and 2011, ECMO hospitalisations increased from 1869 to 3799 (p < 0.01). The proportion of hospitalisations complicated by GIH increased from 2.12% in 2007 to 7.46% in 2011 (p < 0.01). Gastrointestinal haemorrhage was more common in men (56.7%) and in Caucasians (57.4%). Common comorbidities in this population were renal failure (71%), anaemia (55%), and hypertension (26%). All-cause inpatient mortality showed a numerical but nonsignificant increase from 56.7% to 61.9% (p = 0.49). The average cost of care per hospitalisation with GIH associated with ECMO use increased from $132,420 in 2007 to $215,673 in 2011 (p < 0.01). Conclusions: Gastrointestinal haemorrhage during ECMO hospitalisations occurred in small but significantly increasing proportions. The inpatient mortality rate and costs associated with GIH were substantial and increased significantly during the study period. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) and end‐stage renal disease are considered independent risk factors for developing atrial fibrillation (AF). Percutaneous occlusion of left atrial appendage (LAAC) using WATCHMAN device is a widely accepted alternative to anticoagulation therapy to prevent ischemic stroke in AF in patients who are not candidates for anticoagulation. There is limited data regarding the utilization and periprocedural safety of this intervention in patients with CKD/ESRD. Methods: We retrospectively reviewed all hospitalizations from 2016 to 2017 with (ICD‐10) procedure diagnosis code of LAA closure using WATCHMAN procedure with and without a secondary diagnosis of CKD/ESRD in acute‐care hospitals across the United States using the national inpatient sample. Demographic variables (gender, race, income, hospital characteristics, medical comorbidities) were collected and compared. The primary outcomes were inpatient mortality, hospital length, and cost of stay. Results: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Sixteen thousand five hundred five hospitalizations were for adult patients with a procedure code for LAA closure via watchman procedure. Of 16,505 patients, 3245 (19.66%) had CKD and ESRD. There was no statistically significant difference in mortality, length, and cost of stay in patients with and without CKD/ESRD. There were no statistically significant differences in periprocedural cerebrovascular accidents in both groups. Conclusion: Patients with and without ESRD/CKD who undergo LAA occlusion with Watchman have similar procedure related, in‐hospital mortality, and complications. [ABSTRACT FROM AUTHOR]

Prostate cancer (PCa) is the most common cancer in men, accounting for approximately 10% of all new cases in the United States. Plant-derived bioactive compounds, such as pentacyclic triterpenoids (PTs), have the ability to inhibit PCa cell proliferation. We isolated and characterized nummularic acid (NA), a potent PT, as a major chemical constituent of Ipomoea batatas, a medicinal food plant used in ethnomedicine for centuries. In the current study, in vitro antiproliferative potential against PCa cells (DU145 and PC3) via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay; Western blot protein expression analysis; absorption, distribution, metabolism, excretion (ADME); pharmacokinetic prediction studies; and bisphenol A (BPA)-induced prostate inhibition in Sprague Dawley rats were conducted to gauge the anti-cancer ability of NA. Significant (p < 0.05 and p < 0.01) time- and dose-dependent reductions in proliferation of PCa cells, reduced migration, invasion, and increased apoptotic cell population were recorded after NA treatment (3–50 µM). After 72 h of treatment, NA displayed significant IC50 of 21.18 ± 3.43 µM against DU145 and 24.21 ± 3.38 µM against PC3 cells in comparison to the controls cabazitaxel (9.56 ± 1.45 µM and 12.78 ± 2.67 µM) and doxorubicin (10.98 ± 2.71 µM and 15.97 ± 2.77 µM). Further deep mechanistic studies reveal that NA treatment considerably increased the cleavage of caspases and downstream PARP, upregulated BAX and P53, and downregulated BCL-2 and NF-κB, inducing apoptosis in PCa cells. Pharmacokinetic and ADME characterization indicate that NA has a favorable physicochemical nature, with high gastrointestinal absorption, low blood–brain barrier permeability, no hepatotoxicity, and cytochrome inhibition. BPA-induced perturbations of prostate glands in Sprague Dawley rats show a potential increase (0.478 ± 0.28 g) in prostate weight compared to the control (0.385 ± 0.13 g). Multi-dose treatment with NA (10 mg/kg) significantly reduced the prostate size (0.409 ± 0.21 g) in comparison to the control. NA-treated groups exhibited substantial restoration of hematological and histological parameters, reinstatement of serum hormones, and suppression of inflammatory markers. This multifaceted analysis suggests that NA, as a novel small molecule with a strong pharmacokinetic and pharmacological profile, has the potential to induce apoptosis and death in PCa cells. [ABSTRACT FROM AUTHOR]

Background: Pacemaker implantation in the U.S. is rising due to an aging population. The aim of this analysis was to identify risk factors associated with increased mortality and complications in hospitalized patients requiring pacemaker implantation. Methods: We performed a retrospective analysis using the National Inpatient Sample database, identifying hospitalized patients who underwent pacemaker implantation using International Classification of Disease, Tenth Revision, Clinical Modification codes. Independent predictors of inpatient mortality were identified using multivariate logistic regression analysis. Results: There were 242,980 hospitalizations with pacemaker implantation during 2016 and 2017. The most frequently encountered indications for hospitalizations involving pacemaker insertion included sick sinus syndrome (SSS) (27.60%), complete atrioventricular (AV) block (21.57%), and second‐degree AV block (7.83%). Chronic liver disease was associated with the highest adjusted odds of inpatient mortality (aOR = 5.76, 95% CI: 4.46 to 7.44, p <.001). Comorbid anemia had the highest statistically significant adjusted odds ratio (aOR) for predictors of post‐procedural cardiac complications (aOR = 3.17, 95% CI: 2.81 to 3.58, p <.001). Mortality in hospitalized patients needing pacemaker implantation was 1.05%. About 3.36% of hospitalizations developed post procedural circulatory complications (PPCC), 2.45% developed sepsis, and 1.84% developed mechanical complications of cardiac electronic devices. Conclusions: We identified several predictors of inpatient mortality in hospitalized patients undergoing pacemaker implantation, including chronic liver disease, protein‐calorie malnutrition, chronic heart failure, anemia, and history of malignancy. Anemia, chronic liver disease, and congestive heart failure were independent predictors of adverse outcomes in such patients. [ABSTRACT FROM AUTHOR]

The regulatory landscape for device-based heart failure (HF) therapies has seen a major shift in the last 7 years. In 2013, the U.S. Food and Drug Administration released guidance for early feasibility and first-in-human studies, thereby encouraging device innovation, and in 2016 the U.S. Congress authorized the Breakthrough Devices Program to expedite access for Americans to innovative devices indicated for diagnosis and treatment of serious illnesses, such as HF. Since December 2016, there has been an increase in the number of HF devices for which manufacturers are seeking approval through the breakthrough designation pathway. This has led to a rapid uptake in the development and evaluation of device-based HF therapies. This article reviews the current and future landscape of device therapies for chronic HF and associated comorbidities and the regulatory environment that is driving current and future innovation. [ABSTRACT FROM AUTHOR]

Introduction: Angiodysplasia is the most common vascular lesion of the gastrointestinal (GI) tract. However, limited epidemiological data exists on hospitalizations related to angiodysplasia of the intestine (ADOI) in the United States (U.S.). The aim of this study is to analyze inpatient trends and outcomes in hospitalizations with ADOI. Methods: We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of angiodysplasia of the intestine with or without hemorrhage (ICD-9 code 569.85 and 569.84 respectively) as principal and/or secondary diagnosis during the period from 2001 to 2011. Results: In 2001, there were 39,244 admissions with discharge diagnosis of ADOI as compared to 41,214 in 2011 (p <0.0001). Women (58.0%) were more commonly affected than men (42.0%) (p < 0.0001). Overall in-hospital mortality rate was 2.2% for patients with ADOI with hemorrhage and 1.6% for patients with ADOI without hemorrhage (p <0.0001). Mean cost of hospitalization increased from $10,701 in 2001 to $12,478 in 2011 (16.6% increase, p < 0.0001). Conclusion: The total number of hospitalizations with ADOI increased significantly with women having significantly higher hospitalization rates. Mortality rate was higher in hospitalizations with ADOI with hemorrhage than those without hemorrhage. There was a notable increase in the average cost of hospitalization. [ABSTRACT FROM AUTHOR]

Objective Familial aggregation of fibromyalgia has been increasingly recognized. The goal of this study was to conduct a genome-wide linkage scan to identify susceptibility loci for fibromyalgia. Methods We genotyped members of 116 families from the Fibromyalgia Family Study and performed a model-free genome-wide linkage analysis of fibromyalgia with 341 microsatellite markers, using the Haseman-Elston regression approach. Results The estimated sibling recurrence risk ratio (λs) for fibromyalgia was 13.6 (95% confidence interval 10.0-18.5), based on a reported population prevalence of 2%. Genome-wide suggestive evidence of linkage was observed at markers D17S2196 (empirical P [ Pe] = 0.00030) and D17S1294 ( Pe = 0.00035) on chromosome 17p11.2-q11.2. Conclusion The estimated sibling recurrence risk ratio (λs) observed in this study suggests a strong genetic component of fibromyalgia. This is the first report of genome-wide suggestive linkage of fibromyalgia to the chromosome 17p11.2-q11.2 region. Further investigation of these multicase families from the Fibromyalgia Family Study is warranted to identify potential causal risk variants for fibromyalgia. [ABSTRACT FROM AUTHOR]

Nonalcoholic fatty liver disease (NAFLD) develops when the liver is unable to oxidize or export excess free fatty acids generated by adipose tissue lipolysis, de novo lipogenesis, or dietary intake. Although treatment has generally been centered on reversing metabolic risk factors that increase the likelihood of NAFLD by influencing lifestyle modifications, therapeutic modalities are being studied at the cellular and molecular level. The endocannabinoid system has been of recent focus. The agonism and antagonism of cannabinoid receptors play roles in biochemical mechanisms involved in the development or regression of NAFLD. Exocannabinoids and endocannabinoids, the ligands which bind cannabinoid receptors, have been studied in this regard. Exocannabinoids found in cannabis (marijuana) may have a therapeutic benefit. Our recent study demonstrated an inverse association between marijuana use and NAFLD among adults in the United States. This commentary combines knowledge on the role of the endocannabinoid system in the setting of NAFLD with the findings in our article to hypothesize different potential mechanisms that may influence the inverse relationship between cannabis and NAFLD. [ABSTRACT FROM AUTHOR]