Contrast medium-induced adverse reactions: economic outcome

Because the cost of managing an expected greater number of adverse reactions when high-osmolality contrast media (HOM) are used could offset the higher material cost of low-osmolality contrast media (LOM), a prospective study was done of 795 inpatients undergoing any of four procedures involving intravascular injection of HOM: cardiac catheterization, peripheral angiography, head computed tomography (CT), or body CT. The resources used in managing HOM-induced adverse reactions were measured, and the costs of these resources were estimated. Four hundred five patients (51%) had adverse reactions. Reactions were grouped into three classes according to their severity. Class 1 (mild) reactions occurred in 358 patients (45%), class 2 (moderate) reactions occurred in 44 patients (6%), and class 3 (severe) reactions occurred in three patients (0.4%). Ninety-nine patients (12%) consumed resources as a result of an adverse reaction. The average cost of these resources per patient undergoing examination was $1.07 to the radiology department, $5.83 to the hospital, and $12.93 to a charge-paying insurer. Mean (+/- standard deviation) cost to the hospital for managing class 1, class 2, and class 3 reactions were $2.52 +/- $5.33, $24 +/- $54, and $910 +/- $749, respectively. By comparison, the difference in material cost of HOM versus LOM ranged from $93 for body CT to $179 for cardiac catheterization. Even if LOM were to induce no adverse reactions, the increased material cost associated with universal substitution of LOM for HOM would be greater than the expected cost of managing adverse reactions when HOM are used.     

Stenoses in dialysis fistulas: treatment with percutaneous angioplasty

Percutaneous transluminal angioplasty (PTA) was performed on 30 stenotic lesions in 25 dialysis access fistulas. The fistulas were in 23 patients with a mean age of 53 years. Lesions were detected with angiography within a few days after poor flow or increased venous pressure was documented during dialysis. Twenty-two lesions were in patients with polytetrafluoroethylene graft fistulas, five were in patients with bovine carotid fistulas, and three were in patients with endogenous arteriovenous fistulas. There were 28 venous stenoses (20 at the anastomotic site and eight more proximally) and two arterial stenoses. The overall success rate was 80%, with a 6-month patency of 76% and a mean patency after PTA of 9.4 months. Among the venous lesions, the success was 100% for proximal lesions and 71% for anastomotic lesions. There were two technical failures, which required surgery for revision of the fistulas, and four self-limited hematomas. PTA is a safe and effective treatment for stenoses in dialysis fistulas, particularly for lesions remote from the anastomotic sites.     

Establishing Yourself as an Expert in Nutrition Science: Advice for Young Professionals

In today’s world in which there is a surplus of both scientists and online nutrition “experts,” how do young professionals establish themselves? Becoming established as an expert requires selling yourself and your ideas to your colleagues and the general public by using effective communication skills. Helping young professionals develop these skills was the goal of a panel held at the ASN Scientific Sessions and Annual Meeting at Experimental Biology 2015. This panel featured a set of distinguished speakers who discussed techniques and strategies to enhance professional reputations centered around effectively leveraging communication platforms and opportunities to engage with colleagues. Early-career nutrition scientists can use the guidance provided by the panelists to improve their visibility and be a champion for themselves in order to establish themselves as experts in the field.     

The development of difference turbidimetric analysis for monoclonal antibodies to human IgG

Individual monoclonal antibodies to human IgG have been shown to form immune complexes of defined stoichimetry. These complexes are non-precipitating and do not exhibit turbidity. Combinations of two monoclonal antibodies directed against spatially distinct antigenic determinants produce complexes exhibiting marked turbidity. Such combined monoclonal antibody ‘cocktails’ may be applied to quantitative techniques.     

Quality assessment of randomized controlled trials of contrast media

Numerous randomized controlled trials (RCTs) have been conducted to define the relative benefits of low-osmolality contrast media (LOM) and high-osmolality contrast media (HOM). Because of the clinical and economic significance of the conclusions drawn from these RCTs, the authors used a standardized instrument to evaluate the quality of study design and data analysis of 100 RCTs published between 1982 and 1987 that compared LOM and HOM. The mean quality score (+/- standard deviation) was 39 +/- 12 (maximum possible score, 100). The largest number of patients studied in any RCT was 435; the smallest was five. A majority of the RCTs received high scores on three attributes of quality, intermediate scores on seven, and low scores on nine. These results underscore the difficulty of designing, performing, analyzing, and reporting high-quality RCTs. Nevertheless, limitations in study design and data analysis need to be considered when interpreting results of these RCTs. Future RCTs comparing LOM and HOM should be performed with greater attention to basic elements of good study design and data analysis.     

Missense mutation clustering in the survival motor neuron gene: a role for a conserved tyrosine and glycine rich region of the protein in RNA metabolism?

The Survival Motor Neuron (SMN) gene shows deletions in the majority of patients with Spinal Muscular Atrophy (SMA), a disease of motor neuron degeneration. To date only two missense mutations have been reported in SMN in patients with SMA. The fact that no SMN-homologues have been forthcoming from data-base searching has resulted in a lack of hypotheses concerning the structural and functional consequences of these mutations. Recently SMN has been shown to interact with heterogeneous nuclear ribonucleoproteins (hnRNPs) suggesting a role in mRNA metabolism. We describe a novel missense mutation and the subsequent identification of a triplicated tyrosine-glycine (Y-G) peptide sequence at the C-terminal of SMN which encompasses each of the three predicted amino acid sequence substitutions. We have identified apparent orthologues of SMN in Caenorhabditis elegans and Schizosaccharomyces pombe. These sequences retain the highly conserved Y-G motif and provide additional support for a role of SMN in mRNA metabolism.