Current Use of Statins for Primary Prevention of Cardiovascular Disease: Patient-Reported Outcomes and Adherence

Recent updates in atherosclerotic cardiovascular disease (ASCVD) risk assessment and management guidelines have expanded the global number of statin-indicated persons, prompting clinicians to rethink conversations about initiating new statin therapy. The benefits of statins in primary prevention of ASCVD are less convincing than in secondary prevention, although higher ASCVD risk is associated with greater statin benefit. Therefore, clinicians must engage patients in a shared decision about starting new statin therapy, which should involve discussion about the risks and benefits of therapy, patient perceptions, and health status. Research has identified nonadherence to statin therapy as a factor associated with reduced clinical benefits of statin therapy. Clinicians should be aware of patient-specific factors associated with nonadherence and implement strategies to improve adherence as indicated. Data on the impact of adherence improvement strategies and the accuracy of how we currently measure adherence are lacking. Additionally, research focusing on patient preferences and reported outcomes would greatly inform practice and improve clinician–patient relationships.     

Folding and ligand recognition of the TPP riboswitch aptamer at single-molecule resolution

Thiamine pyrophosphate (TPP)-sensitive mRNA domains are the most prevalent riboswitches known. Despite intensive investigation, the complex ligand recognition and concomitant folding processes in the TPP riboswitch that culminate in the regulation of gene expression remain elusive. Here, we used single-molecule fluorescence resonance energy transfer imaging to probe the folding landscape of the TPP aptamer domain in the absence and presence of magnesium and TPP. To do so, distinct labeling patterns were used to sense the dynamics of the switch helix (P1) and the two sensor arms (P2/P3 and P4/P5) of the aptamer domain. The latter structural elements make interdomain tertiary contacts (L5/P3) that span a region immediately adjacent to the ligand-binding site. In each instance, conformational dynamics of the TPP riboswitch were influenced by ligand binding. The P1 switch helix, formed by the 5′ and 3′ ends of the aptamer domain, adopts a predominantly folded structure in the presence of Mg²⁺ alone. However, even at saturating concentrations of Mg²⁺ and TPP, the P1 helix, as well as distal regions surrounding the TPP-binding site, exhibit an unexpected degree of residual dynamics and disperse kinetic behaviors. Such plasticity results in a persistent exchange of the P3/P5 forearms between open and closed configurations that is likely to facilitate entry and exit of the TPP ligand. Correspondingly, we posit that such features of the TPP aptamer domain contribute directly to the mechanism of riboswitch-mediated translational regulation.     

A Simple Technique to Preserve the LSVC during Reoperative Orthotopic Heart Transplant

Abstract Increasingly, patients undergo heart transplant after previous heart surgery. In patients with a persistent left superior vena cava (LSVC), the preferred technique, preservation of drainage via the native coronary sinus, can be difficult in reoperative cases due to adhesions. We report a technique simplifying this operation in such a patient. (J Card Surg 2012;27:767‐768)     

A dynamic two-dimensional phantom for ultrasound hyperthermia controller testing

A new thin layer phantom for testing hyperthermia controllers has been constructed and evaluated using an ultrasound hyperthermia system. The phantom's thermal behaviour agrees with the characteristics of the Pennes' bio-heat transfer equation (BHTE). In particular, the experimental and theoretical results agree in the following ways. First, with respect to the power deposition: for a given power magnitude and scan radius, the shape of the temperature distribution across the phantom corresponds to the shape predicted by the BHTE and the experimental and theoretical temperature values agree closely; when the power magnitude is varied at a fixed scan radius, the average temperature of the phantom varies linearly with the applied power, and as the scan radius is varied at a fixed power magnitude, the average temperature increases with decreasing scan radius size. Secondly, with respect to perfusion: increasing or decreasing the flow rate over the phantom simulates an increase or decrease in the BHTE perfusion term, and the estimated perfusion values are dependent on flow rate only, and are not functions of power or geometry. The combination of these experimental and theoretical results validate the phantom's potential for testing feedback control systems, particularly for future use in the development and verification of modelbased controllers. The use of this phantom should improve and accelerate the testing and evaluation of feedback control systems, and reduce the need for animal and human testing.     

Hypnotic Age Regression and the Importance of Assessing Interpersonally Relevant Affect

The present study was undertaken to replicate an earlier experiment and to clarify which factors in this previous experiment (Nash, Johnson, & Tipton, 1979) were responsible for the obtained child-like behaviors of hypnotically regressed Ss. As in the previous study, 3 characteristics of the transitional object relationship (spontaneity, specificity, and intensity) were used as the primary criteria to investigate the effects of hypnotic age regression when Ss were regressed to age 3 and placed in 3 home situations. While in the previous study E suggested separation anxiety and isolation during the 3 home situations (mother-absent condition), the present study deleted all references to anxiety and isolation, and replaced them with suggestions of security and maternal proximity (mother-present condition). As expected, the mother-present versus mother-absent conditions led to similar hypnotized-simulating differences. In further accord with predictions, hypnotized Ss and simulating Ss requested a transitional object infrequently in the presence of mother. The importance of using dependent measures which index affective processes germane to interpersonal affect-laden experience is discussed.     

Treatment of Prostate Cancer Local Recurrence After Whole-Gland Cryosurgery With Frameless Robotic Stereotactic Body Radiotherapy: Initial Experience

BackgroundThe use of frameless robotic stereotactic body radiotherapy has not been investigated in patients whose primary cryosurgery treatment failed. The aim of this series was to present initial experiences with frameless robotic radiosurgery in the treatment of local prostate recurrence after cryotherapy.MethodsWe reviewed the outcome of frameless robotic radiosurgery in 4 patients for biopsy-proven local recurrent prostate cancer after cryotherapy. The patients underwent stereotactic body radiation therapy (SBRT) at Winthrop University Hospital, Mineola, New York.ResultsThe patients' ages ranged from 66 to 75 years old. The average follow-up was more than 4 months. Presalvage prostate-specific antigen (PSA) levels were 7.3, 11.9, 6.1, and 20.9 ng/mL for the four patients. Presalvage Gleason scores were 7, 7, 9, and 8 respectively. One patient had insufficient follow-up for inclusion. The 3 remaining patients showed reduction of PSA levels after SBRT. Follow-up post-SBRT PSA levels were 2.2, 0.19, and 2.0 ng/mL. The average PSA reduction was 7.0 ng/mL. Morbidity at 3-week follow-up included urinary urgency, dysuria, and constipation. There was no change in international prostate symptom score or The International Consultation on Incontinence Questionnaire-Short Form scores after SBRT. One patient experienced erectile dysfunction from SBRT.ConclusionsInitial results indicate that robotic SBRT is a viable option for patients who have failed initial cryosurgery therapy measures. The patients had minimal morbidity with significant reduction in PSA levels.     

Last Marrow Standing: Bone Marrow Transplantation for Acquired Bone Marrow Failure Conditions

Paroxysmal nocturnal hemoglobinuria, aplastic anemia, and myelodysplastic syndrome are a spectrum of acquired marrow failure, having a common pathologic thread of both immune dysregulation and the development of abnormal hematopoiesis. Allogeneic hematopoietic cell transplantation plays a critical role in the treatment of these disorders and, for many patients, is the only treatment modality with demonstrated curative potential. In recent years, there have been many breakthroughs in the understanding of the pathogenesis of these uncommon disorders. The subsequent advances in non-transplant therapies, along with concurrent improvement in outcomes after hematopoietic cell transplantation, necessitate continual appraisal of the indications, timing, and approaches to transplantation for acquired marrow failure syndromes. We review here contemporary and critical new findings driving current treatment decisions.     

Hazards after the storm: Floodwater drainage pump stations and exposure to hydrogen sulfide

A hurricane can present unique hazards that exist long after the strong winds and heavy rains have subsided. These hazards may not only be physical, but chemical as well. Hydrogen sulfide (H₂S) represents an important and potentially overlooked hazard that can be naturally produced in floodwaters following a hurricane. In August of 2012, in the wake of Hurricane Isaac, Plaquemines Parish, Louisiana was submerged under a blanket of floodwater. To remove floodwaters that had breached the levee system designed to keep water out, temporary drainage pump stations were installed at strategic locations. The transfer of floodwaters at these drainage stations resulted in the generation of elevated concentrations of airborne H₂S at the pumping stations. The generation of H₂S at these pumping stations represented a potential inhalation hazard for workers; thus, awareness for possible H₂S exposure at these installments is crucial.