Comparing the outcomes and costs of cardiac monitoring with implantable loop recorders and mobile cardiac outpatient telemetry following stroke using real-world evidence

Aim: Patients with ischemic stroke (IS) commonly undergo monitoring to identify atrial fibrillation with mobile cardiac outpatient telemetry (MCOT) or implantable loop recorders (ILRs). The authors compared readmission, healthcare cost and survival in patients monitored post-stroke with either MCOT or ILR. Materials & methods: The authors used claims data from Optum's de-identified Clinformatics® Data Mart Database to identify patients with IS hospitalized from January 2017 to December 2020 who were prescribed ambulatory cardiac monitoring via MCOT or ILR. They compared the costs associated with the initial inpatient visit as well as the rate and causes of readmission, survival and healthcare costs over the following 18 months. Datasets were balanced using patient baseline and hospitalization characteristics. Multivariable generalized linear gamma regression was used for cost comparisons. Cox proportional hazard regression was used for survival and readmission analysis. Sub-cohorts were analyzed based on the severity of the index IS. Results: In 2244 patients, readmissions were significantly lower in the MCOT monitored group (30.2%) compared with the ILR group (35.4%) (hazard ratio [HR] 1.23; 95% CI: 1.04-1.46). Average cost over 18 months starting with the index IS was $27,429 (USD) lower in the MCOT group (95% CI: $22,353-$32,633). Survival difference bordered on statistical significance and trended to lower mortality in MCOT (8.9%) versus ILR (11.3%) (HR 1.30; 95% CI: 1:00-1.69), led by significance in patients with complications or comorbidities with the index event (MCOT 7.5%, ILR 11.5%; HR 1.62; 95% CI: 1.11-2.36). Conclusion: The use of MCOT versus ILR as the primary monitor following IS was associated with significant decreases in readmission, lower costs for the initial IS and total care over the next 18 months, significantly lower mortality for patients with complications and comorbidities at the index stroke, and a trend toward improved survival across all patients.

Relationships between certain individual characteristics and occupational injuries for various jobs in the construction industry: a case-control study

BACKGROUND

There is little published about the role of individual characteristics in occupational injuries. Construction workers have a high rate of injury; we assessed 11 personal characteristics in this professional sector.

METHODS

A case-control study was conducted on 880 male workers who had had at least one occupational injury during a 2-year period and 880 controls. A questionnaire was administered by an occupational physician. Statistical analysis was made via logistic regression method.

RESULTS

Young age (<30 years), sleep disorders and current smoker influenced all the injuries combined. Sleep disorders and young age were common risk factors for several jobs. Physical disabilities and no sporting activity had a role in masons, and 5 years or less in present job in plumbers and electricians only. Sleep disorders influenced both the injuries with and without hospitalization; young age, current smoker, and physical disability influenced those without hospitalization only.

CONCLUSIONS

Young age, sleep disorders, smoking, disabilities, sporting activity, and experience influenced the occupational injuries. The risk for each worker depended on his job. Occupational physicians could inform the workers of these risks and encourage them to take remedial action.

Relationships of job, age, and life conditions with the causes and severity of occupational injuries in construction workers

OBJECTIVES

To assess the relationships of job, age, and life conditions with the causes and severity of occupational injuries in male construction labourers.

METHODS

The sample included 880 male construction workers having had at least one occupational injury with subsequent sick leave. The survey used a standardised questionnaire, filled in by the occupational physician in the presence of the subject: socio-demographic data, job, safety training, smoking habit, alcohol consumption, sporting activities, physical disabilities, hearing, vision, and sleep disorders. Statistical analysis was via the logistic regression method.

RESULTS

Logistic models showed that falls and injuries from the handling of objects or hand tools was similar for all jobs, while masons, plumbers and electricians had a higher risk of injury from moving objects, and carpenters, roofers and civil-engineering workers were more exposed to injury from construction machinery and devices. Age <30 was related to injury from hand tools [adjusted OR (95%CI) 2.20 (1.28-3.79)]; sleep disorders and hearing disorders to those from moving objects [ORs 2.29 (1.27-4.12) and 1.85 (1.01-3.41) respectively]; no sporting activity to those from the handling of objects [OR 1.54 (1.09-2.17)]; and being overweight to falls on the same level [OR 2.04 (1.30-3.21)] and falls to a lower level [OR 1.55 (1.13-2.13)]. Injuries from the handling of objects were less frequent in overweight workers [OR 0.62 (0.46-0.84)]. Injuries with hospitalisation or sick leave > or =60 days were associated with age > or =30 and hearing disorders.

CONCLUSIONS

The causes of injuries were related to jobs. Prevention through working conditions could be made against the revealed risks. The risks for each worker depended on age, body mass index, hearing disorders, sleep disorders, and sporting activities. The occupational physician could inform the workers of these risks and encourage them to practise sporting activities and reduce their hearing disorders and sleep disorders.

Therapeutic effect of neutralizing endogenous IL-18 activity in the collagen-induced model of arthritis

Two distinct IL-18 neutralizing strategies, i.e. a rabbit polyclonal anti-mouse IL-18 IgG and a recombinant human IL-18 binding protein (rhIL-18BP), were used to treat collagen-induced-arthritic DBA/1 mice after clinical onset of disease. The therapeutic efficacy of neutralizing endogenous IL-18 was assessed using different pathological parameters of disease progression. The clinical severity in mice undergoing collagen-induced arthritis was significantly reduced after treatment with both IL-18 neutralizing agents compared to placebo treated mice. Attenuation of the disease was associated with reduced cartilage erosion evident on histology. The decreased cartilage degradation was further documented by a significant reduction in the levels of circulating cartilage oligomeric matrix protein (an indicator of cartilage turnover). Both strategies efficiently slowed disease progression, but only anti-IL-18 IgG treatment significantly decreased an established synovitis. Serum levels of IL-6 were significantly reduced with both neutralizing strategies. In vitro, neutralizing IL-18 resulted in a significant inhibition of TNF-alpha, IL-6, and IFN-gamma secretion by macrophages. These results demonstrate that neutralizing endogenous IL-18 is therapeutically efficacious in the murine model of collagen-induced arthritis. IL-18 neutralizing antibody or rhIL-18BP could therefore represent new disease-modifying anti-rheumatic drugs that warrant testing in clinical trials in patients with rheumatoid arthritis.

Apraclonidine and anterior segment laser surgery. Comparison of 0.5% versus 1.0% apraclonidine for prevention of postoperative intraocular pressure rise

PURPOSE

To compare the efficacy of 0.5% and 1.0% apraclonidine in preventing laser-induced intraocular pressure (IOP) elevation after trabeculoplasty, neodymium: YAG (Nd: YAG) iridotomy, and capsulotomy.

METHODS

This is a prospective, masked, and randomized study of 83 patients undergoing trabeculoplasty, 62 patients undergoing iridotomy, and 57 patients undergoing capsulotomy. Surgical eyes received one drop of 0.5% or 1.0% apraclonidine immediately after surgery.

RESULTS

Intraocular pressure reduced 2 hours after trabeculoplasty in the 0.5% (P = 0.028) and 1.0% (P = 0.004) groups. Intraocular pressure was higher than baseline in a greater number of eyes treated with 0.5% (12 of 39 eyes, 31%) compared with 1.0% apraclonidine (5 of 44 eyes, 11%) (P = 0.032). Intraocular pressure in eyes with a narrow chamber angle was reduced in 16 (85%) of 19 eyes treated with 0.5% and in 10 (84%) of 12 eyes treated with 1.0% apraclonidine after iridotomy. Of patients with chronic angle-closure glaucoma, IOP was similar to prelaser values in 11 (69%) of 16 eyes treated with 0.5% (P > 0.7) and 12 (80%) of 15 eyes treated with 1.0% apraclonidine (P > 0.3). In patients undergoing capsulotomy, pressure was significantly lowered in the 0.5% group (P = 0.04) but not in the 1.0% apraclonidine group. After capsulotomy, both treatment groups had similar (P > 0.3) numbers of eyes with an IOP less than baseline (83% for 0.5% apraclonidine and 81% for 1.0% apraclonidine).

CONCLUSION

The single postoperative administration of 0.5% apraclonidine is as effective as the 1.0% concentration in preventing IOP elevation immediately after trabeculoplasty, iridotomy, or capsulotomy.

CD23 interacts with a new functional extracytoplasmic domain involving N-linked oligosaccharides on CD21

Human CD21 has been described as a receptor for the C3d,g and iC3b proteins of complement, for the Epstein-Barr virus, and also for IFN-alpha. We reported recently that CD23, a low affinity receptor for IgE (Fc epsilon R2), is a new functional ligand for CD21. To determine the site of interaction of CD23 on CD21, we analyzed the ability of purified recombinant CD23 incorporated into fluorescent liposomes to bind CD21 mutants bearing various deletions of extracytoplasmic short consensus repeats (SCRs). We found that the site of interaction of CD23 on CD21 is on SCRs 5 to 8, with contribution of SCRs 1 and 2. Tunicamycin treatment of CD21-transfected K562 cells strongly inhibited the binding of CD23-liposomes, suggesting that an N-linked sugar, present on SCRs 5 to 8, is involved in the CD23/CD21 interaction. By mutating together or individually, the three asparagines present on SCRs 5 to 8, asparagines (Asn) 370 and 295, but not Asn 492, were shown to be involved critically in the binding of CD23. Furthermore, we mapped the binding sites of a panel of anti-CD21 mAbs and found that at least six epitopes can be detected on CD21. The mAbs that inhibit the most CD23 binding to CD21 map in SCRs 5 to 8. This study indicates that SCRs 5 to 8 represent a novel functional domain on the CD21 molecule, and is the first demonstration of an activity of an extracytoplasmic region of the CD21 outside of SCRs 1 to 4.

CD23 interacts with a new functional extracytoplasmic domain involving N-linked oligosaccharides on CD21

Human CD21 has been described as a receptor for the C3d,g and iC3b proteins of complement, for the Epstein-Barr virus, and also for IFN-alpha. We reported recently that CD23, a low affinity receptor for IgE (Fc epsilon R2), is a new functional ligand for CD21. To determine the site of interaction of CD23 on CD21, we analyzed the ability of purified recombinant CD23 incorporated into fluorescent liposomes to bind CD21 mutants bearing various deletions of extracytoplasmic short consensus repeats (SCRs). We found that the site of interaction of CD23 on CD21 is on SCRs 5 to 8, with contribution of SCRs 1 and 2. Tunicamycin treatment of CD21-transfected K562 cells strongly inhibited the binding of CD23-liposomes, suggesting that an N-linked sugar, present on SCRs 5 to 8, is involved in the CD23/CD21 interaction. By mutating together or individually, the three asparagines present on SCRs 5 to 8, asparagines (Asn) 370 and 295, but not Asn 492, were shown to be involved critically in the binding of CD23. Furthermore, we mapped the binding sites of a panel of anti-CD21 mAbs and found that at least six epitopes can be detected on CD21. The mAbs that inhibit the most CD23 binding to CD21 map in SCRs 5 to 8. This study indicates that SCRs 5 to 8 represent a novel functional domain on the CD21 molecule, and is the first demonstration of an activity of an extracytoplasmic region of the CD21 outside of SCRs 1 to 4.

Cardiopulmonary bypass in the successful resuscitation of a 28-year-old woman with cardiac arrest

This patient remained hospitalized for several weeks, and her stay was relatively uneventful. She extubated herself 2 days after admission, after an operative procedure to remove the cannulas and repair the right femoral cutdown site. A fasciotomy of her right calf was done for compartment syndrome. The patient had minor neurologic deficits of short-term memory loss and spatial depth perception loss. These deficits, attributed to postresuscitative hypoxia, eventually resolved. Extensive cardiac testing performed to pinpoint the underlying cause of her cardiac dysfunction were inconclusive. Because no cause was found, an automatic implantable cardiodefribrillator was recommended to prevent future cardiac events. The patient agreed and the device was implanted before her discharge. With expert occupational therapy, physical rehabilitation, nursing care, and medical treatment the patient regained her previous level of functioning. Her October wedding was postponed to December, but she was able to return to work in November 1990.

Secondary bacterial peritonitis due to Listeria monocytogenes after paracentesis

Although it is a relatively rare cause of peritonitis, Listeria monocytogenes must be considered in cirrhotic patients with ascites and a suggestive clinical presentation. We believe this is the first report of a case of peritonitis due to L monocytogenes in a patient without sepsis, and the sixth reported case of bacterial peritonitis in a patient with cirrhosis.

Metabolism and biological activity of cis- and trans-phylloquinone in the rat

The separation of sufficient cis and trans forms of vitamin K for feeding and metabolic studies was accomplished on silica gel columns eluted with solvent containing n-butyl ether. The lack of biological activity of the cis isomer of phylloquinone was observed. The cis isomer was retained longer in liver, particularly in mitochondria, but had low retention in that portion of the endoplasmic reticulum isolated as the rough membrane fraction. The cis isomer of phylloquinone was a poor substrate for 2,3-epoxidation in vivo and in vitro. These data are consistent with the hypothesis that epoxidation of vitamin K is coupled to the biological activity of the vitamin, and that microsomes are the site of metabolism and function of vitamin K.