Sweet potato revisited

In Britain, the sweet potato is a new and exotic addition to the variety of vegetables on offer in retail outlets. However, elsewhere, especially in tropical developing countries, it has been a safeguard against hunger for centuries. The good nutritional qualities and range of sensory characteristics of the sweet potato are now being re-explored on an international level with a view to development and promotion of the crop and its processed food products in both developed and developing countries.     

Human enolase isozymes: electrophoretic and biochemical evidence for three loci

1. Four major enolase isozymes have been identified in human tissues and are referred to as L, M, 'intermediate' and 'fast'. The M isozyme is the major form found in skeletal muscle and heart extracts and the L isozyme the major form found in extracts of liver and most other tissues. The 'intermediate' and 'fast' isozymes are most active in brain but are observed as weak components in most other tissues including heart but are not seen in skeletal muscle. It was observed that during fetal development of heart and skeletal muscle the L form declines in activity while the M form increases in activity. 2. The kinetic properties, heat stabilities and molecular sizes of the main enolase isozymes have been compared. Although the isozymes share many features in common, the 'fast' isozyme is more stable when subjected to heat treatment than either the L or M isozymes. Further, the 'fast' isozyme retains its dimeric structure and activity in the absence of magnesium ions while the L and M isozymes dissociate and lose activity. The 'intermediate' isozyme has properties which are intermediate to those of the L and 'fast' isozymes. 3. The 'intermediate' isozyme can be partially dissociated to equal quantities of L and 'fast' isozymes by storage at room temperature or by freezing and thawing in the presence of 2 M-NaCl. Conversely, mixtures of L with 'fast' and M with 'fast' give rise to an 'intermediate' isozyme after freezing and thawing. 4. Evidence derived from this study has led to the suggestion that three separate gene loci are involved in the determination of human enolase. It is proposed that one of these, ENO1, determines the L isozyme which is the homodimer alphaalpha; another locus, ENO2, determines the 'fast' isozyme which is the homodiner betabeta; and the third locus, ENO3, determines the M isozyme which is the homodimer gammagamma. The 'intermediate' isozyme seen as a strong component in brain and as a weak component in most other tissues is thought to be the heterodimer alphabeta. In heart however it is probably mainly betagamma.     

PATTERNS OF DISABILITY RELATED TO JOINT INVOLVEMENT IN RHEUMATOID ARTHRITIS

The relationship between particular disabilities and specificimpairments of which these disabilities could be the consequencehas been explored. Assessments of performance of activitiesof daily living (ADL) have been simplified by factor analysis,and the resultant factors have been related to the sites ofjoint involvement in patients with rheumatoid arthritis. Ourpreliminary findings on the grouping together of various ADLactivities are meaningful in terms of underlying impairments,and at the same time indicate an approach for simplificationof ADL assessments so as to enhance their value for researchand the evaluation of outcome. The results are entirely consistentwith a comprehensive model of disablement. ^*Based on a paper presented to the inaugural meeting of theSociety for Research in Rehabilitation, June 1978     

Warfarin Is Not Needed in Low-Risk Patients Following Atrial Fibrillation Ablation Procedures

Background: The recently published HRS/EHRA/ECAS AF Ablation Consensus Statement recommended that warfarin should be used for at least 2 months following an AF ablation in all patients regardless of stroke risk factors. The objective of the study was to assess outcomes based upon anticoagulation practice after atrial fibrillation (AF) ablation to determine relative risk of a strategy of aspirin only in low-risk patients.
Methods: A total of 630 consecutive patients who underwent 934 ablation procedures using an open irrigated tip catheter for symptomatic AF were evaluated. Outcomes were compared between patients treated with warfarin (goal INR: 2–3) versus aspirin only (325 mg/day) in CHADS2 0–1 patients after ablation.
Results: Of the 690 patients, 123 (20%) were treated with aspirin and 507 (80%) with warfarin. Prevalences of the CHADS2 scores of patients on aspirin were (0: 40.7%, 1: 59.3%) and on warfarin (0: 13.6%, 1: 31.6%, ≥2: 54.8%), P < 0.0001. Patients in the warfarin group were older, had on average a lower ejection fraction, and had higher rates persistent/permanent AF, repeat ablations, hypertension, prior stroke/TIA, and diabetes. The 1-year survival free of AF for the total study population was 71.6%. There were no strokes/TIA in the aspirin group and 4 events (4 strokes, 0 TIAs) in the warfarin group. Two patients in the warfarin group died of fatal hemorrhage (1 intracranial, 1 gastrointestinal).
Conclusion: Select low-risk patients with a low CHADS2 (0–1) score who undergo left atrial ablation with an aggressive anticoagulation strategy with heparin and use of an open irrigated tip catheter with low CHADS2 scores can safely be discharged following their procedure on aspirin alone.     

Frequency of Coronary Angiography and Revascularization among Men and Women with Myocardial Infarction and Their Relationship to Mortality at One Year: An Analysis of the Geisinger Myocardial Infarction Cohort

Objectives

To determine sex bias in the selection of strategies to evaluate patients with acute myocardial infarction (AMI), and determine if the choice of strategy influences survival.

Background

Controversy exists regarding the role of female sex in the use of invasive evaluation for AMI and its possible effect on adverse outcomes.

Methods

Electronic health record data from the Geisinger Acute Myocardial Infarction Cohort (GAMIC) was analyzed which included 1,968 men and 1,047 women admitted to the Geisinger Medical Center between January 2001 and December 2006 with acute myocardial infarction (AMI).Multivariate logistic regression analyses were used to determine independent correlates of an invasive evaluation. Multivariate logistic regression modeling stratified on sex was used to determine when invasive evaluation was done and whether there was a correlation with mortality.

Results

In unadjusted analyses, male sex was a significant predictor for the use of invasive evaluation (odds ratio = 1.71, 95% CI = [1.46, 2.00]). Adjusted for baseline differences (like age, renal function, co‐morbid conditions) multivariate analyses found no significant relationship between male sex and invasive evaluation (OR = 1.02, 95% CI = [0.82, 1.23]). Females in the STEMI group were found to be less revascularized. No difference was observed in the one‐year mortality between women and men regardless of invasive evaluation or revascularization.

Conclusions

Sex was not independently associated with the occurrence of an invasive evaluation of a MI. Females in the STEMI group were less revascularized. There was no strong gender effect on survival irrespective of the performance on an invasive evaluation or revascularization. (J Interven Cardiol 2013;26:14–21)

     

GuideLiner Mother‐and‐Child Guide Catheter Extension: A Simple Adjunctive Tool in PCI for Balloon Uncrossable Chronic Total Occlusions

Objectives

To investigate the use of the GuideLiner “mother‐and‐child” guide catheter extension system as a simple solution to facilitate initial device delivery in balloon uncrossable chronic total occlusions (CTOs) undergoing percutaneous coronary intervention (PCI).

Background

During PCIs for CTO lesions, an important reason for procedural failure is the inability to deliver a balloon or microcatheter across the lesion.

Methods

We retrospectively accessed our interventional registry for 07/01/2010 to 03/21/2012 and extracted data on all CTO lesions involving GuideLiner catheter use. Cine review was performed to identify cases where a guidewire had crossed the CTO and the use of a GuideLiner catheter facilitated initial device delivery.

Results

We identified 28 patients that underwent PCI for CTO with a GuideLiner catheter used to assist initial balloon or microcatheter advancement across the culprit lesion. Mean overall CTO length was 26.3 ± 18.1 mm. The GuideLiner catheter was successful in delivering a small balloon to the CTO lesion in 85.7% of cases (24/28). A single CTO PCI resulted in a distal guidewire perforation, but there was no hemodynamic compromise or pericardial effusion and the patient was discharged the next day. Overall procedural success in these selected cases (where a guidewire had already crossed the CTO) was 89.3% (25/28).

Conclusions

The GuideLiner mother‐and‐child catheter is a simple, safe and efficacious adjunctive device for difficult CTO PCIs where despite standard measures it is not possible to deliver an initial balloon or microcatheter across the occluded segment.

     

Spinal cord injuries in young children: a review of children injured at 5 years of age and younger

Aim To determine the epidemiology and complications of spinal cord injuries (SCIs) in children injured at 5 years of age and younger who were seen between 1981 and 2008 at a children’s hospital in the USA. Method Complications studied were scoliosis, hip dysplasia, latex allergies, autonomic dysreflexia, pressure ulcers, spasticity, deep venous thrombosis, and kidney stones. Demographic and injury‐related factors included age at injury, etiology, level of injury, American Spinal Injury Association Impairment Scale (AIS), and SCIs without radiological abnormalities (SCIWORA). Results Of the 159 individuals seen (92 males, 67 females) median age at injury was 2 years (range 0y–5y 11mo). Forty‐nine percent were injured in vehicular accidents, 60% had complete injuries, 66% had paraplegia, and 72% had SCIWORA. Ninety‐six percent developed scoliosis, 57% had hip dysplasia, and 7% had latex allergy. Thirty‐four percent with injuries at or above T6 experienced autonomic dysreflexia, 41% developed pressure ulcers, and 61% experienced spasticity. Of those without bowel or bladder control, 82% were on intermittent catheterization and 69% were on a bowel program. Median age of initiating wheelchair use was 3 years 4 months (range 1y 2mo–12y 5mo). Twenty‐four were community ambulators, and they were more likely to have AIS D lesions (half the key muscle functions below the level of injury have a muscle grade 3 or greater) and less likely to have skeletal complications. Interpretation The epidemiology, complications, and manifestations of SCIs in children injured at a young age are unique and differ distinctively from adolescent and adult‐onset SCIs.     

US State Polarization,Policymaking Power,and Population Health

Policy Points

• Explanations for the troubling trend in US life expectancy since the 1980s should be grounded in the dynamic changes in policies and political landscapes. Efforts to reverse this trend and put US life expectancy on par with other high‐income countries must address those factors.
• Of prime importance are the shifts in the balance of policymaking power in the United States, the polarization of state policy contexts, and the forces behind those changes.

The troubling trend in us life expectancy and the widening disparities in life expectancy across the United States have deep roots. This article posits that both trends are grounded in the dynamic changes in the policy and political landscapes since the 1980s. It first briefly describes the trends and the importance of excavating their structural roots. It then builds the case that changes in state policies and politics, as well as the forces behind those changes, are key explanations for both trends.     

The Role of Value-Based Payment in Promoting Innovation to Address Social Risks: A Cross-Sectional Study of Social Risk Screening by US Physicians

Policy Points

• One of the most important possibilities of value‐based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. Screening patients for social risks such as housing instability and food insecurity represents an early step physician practices can take to address social needs.
• At present, adoption of social risk screening by physician practices is linked with having high innovation capacity and focusing on low‐income populations, but not exposure to value‐based payment.
• Expanding social risk screening by physician practices may require standardization and technical assistance for practices that have less innovative capacity.

ContextOne of the most important possibilities of value‐based payment is its potential to spur innovation in upstream prevention, such as attention to social needs that lead to poor health. However, there is uncertainty about the conditions under which value‐based payment will encourage health care providers to innovate to address upstream social risks.MethodsWe used the 2017‐2018 National Survey of Healthcare Organizations and Systems (NSHOS), a nationally representative survey of physician practices (n = 2,178), to ascertain (1) the number of social risks for which practices systematically screen patients; (2) the extent of practices’ participation in value‐based payment models; and (3) measures of practices’ capacity for innovation. We used multivariate regression models to examine predictors of social risk screening.FindingsOn average, physician practices systematically screened for 2.4 out of 7 (34%) social risks assessed by the survey. In the fully adjusted model, implementing social risk screening was not associated with the practices’ overall exposure to value‐based payment. Being in the top quartile on any of three innovation capacity scales, however, was associated with screening for 0.95 to 1.00 additional social risk (p < 0.001 for all three results) relative to the bottom quartile. In subanalysis examining specific payment models, participating in a Medicaid accountable care organization was associated with screening for 0.37 more social risks (p = 0.015). Expecting more exposure to accountable care in the future was associated with greater social risk screening, but the effect size was small compared with practices’ capacity for innovation.ConclusionsOur results indicate that implementation of social risk screening—an initial step in enhancing awareness of social needs in health care—is not associated with overall exposure to value‐based payment for physician practices. Expanding social risk screening by physician practices may require standardized approaches and implementation assistance to reduce the level of innovative capacity required.     

Cardiovascular recovery from stress and hypertension risk factors: A meta-analytic review

Recent research has suggested that cardiovascular recovery from stress can play a potential role in hypertension pathogenesis. Sixty nine studies were included in meta analytic review to evaluate the effect of various hypertension risk factors (e.g., race, lack of exercise) on cardiovascular recovery from stress. Small mean effect sized were observed for studies examining hypertension status and race as risk factors associated with delayed diastolic blood pressure recovery. Lack of fitness was also associated with delayed heart rate recovery. These results revealed that, for the specified risk factors and cardiovascular variables, high risk individuals exhibited delayed cardiovascular recovery as compared with low risk individuals. Further, the relationships between hypertension status, race and cardiovascular recovery were typically associated with the use of “ctive” laboratory stressors. The relationship between lack of fitness and cardiovascular recovery was also associated with the use of “active” and exercise laboratory stressors.