Independent predictors of mortality and 5-year trends in mortality and resource utilization in hospitalized patients with diffuse large B cell lymphoma.

Background: This retrospective study analyzed factors influencing all-cause inpatient mortality in 80,930 adult patients (2016-2020) with diffuse large B cell lymphoma using the National Inpatient Sample database. Methods: Utilizing ICD-10 codes, patients were identified, and statistical analysis was conducted using STATA. Fisher's exact and Student's t tests compared proportions and variables, multivariate logistic regression examined mortality predictors, and a 5-year longitudinal analysis identified mortality and resource utilization trends. Results: The inpatient mortality rate was found to be 6.56% with a mean age of 67.99 years. Several hospital- and patient-level factors including specific comorbidities such as congestive heart failure, atrial fibrillation, acute kidney injury, chronic obstructive pulmonary disease, liver failure, pancytopenia, tumor lysis syndrome, and severe protein-calorie malnutrition were independently associated with inpatient mortality. Hospitalization costs showed an increasing trend, impacting the overall population and survivors. Conclusion: These insights may refine risk assessment, treatment selection, and interventions.

Age - a significant independent factor of A1C levels. Evidence from the National Health and Nutrition Examination Survey 1999-2014.

AIM: The aim of our study is to examine the association between age and A1C levels in nondiabetic subjects and develop the age-adjusted A1C levels for screening and diagnosis of prediabetes and diabetes. METHODS: Participants from National Health and Nutrition Examination Survey (NHANES) -1999-2014 with age over 12 years were examined. Individuals with previous diagnosed diabetes, baseline anemia, established hemoglobinopathies, known liver or chronic kidney disease, and abnormal liver function tests or creatinine levels were excluded. Total 16949 subjects consisting of 8651 female subjects and 8298 male subjects were included in the analyses. Linear regression and multivariate regression analyses were performed to assess the relationship between A1C levels and age. Age adjusted A1C levels were determined. RESULTS: Significant positive correlation between A1C and age was found in both female and male subjects in the fasting plasma glucose (FPG) interval between 4.4-7mmol/L (80-126mg/dL) (P<0.0001). There was a linear correlation between A1C levels and age. Linear regression analysis suggested A1C levels rose by 0.009% (about 0.09mmol/mol) in female and by 0.008% (about 0.08mmol/mol) in male per year in subjects without abnormality in glucose homeostasis (p<0.0001). CONCLUSIONS: Our study concluded that age is a significant independent factor of A1C levels.

Sinoatrial Arrest Caused by Ticagrelor after Angioplasty in a 62-Year-Old Woman with Acute Coronary Syndrome.

The platelet aggregation inhibitor ticagrelor, a P2Y12 receptor antagonist, is widely used after angioplasty in patients with acute coronary syndrome. Clinical trial data have shown that it is well tolerated by most patients. We present the case of a 62-year-old woman whose ticagrelor-related asymptomatic and persistent sinus pauses after angioplasty resolved when ticagrelor was replaced with prasugrel.

Multivariate analysis of hypertension in general US adults based on the 2017 ACC/AHA guideline: data from the national health and nutrition examination survey 1999 to 2016.

PURPOSE: Since the publication of the 2017 ACC/AHA hypertension guideline, few studies have analyzed the epidemiology and management of hypertension across many heterogeneous subgroups in the US. MATERIALS AND METHODS: We analyzed the data collected by the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016. Participants greater than 20 years of age, who had valid blood pressure measurements, were included in the study. A comprehensive analysis of 14 population subgroups was done to systematically examine how hypertension awareness, treatment, and control varied by subpopulations. RESULTS: Our study included 45,557 participants with a mean age of 47.1 years, 48.3% were male and 51.7% were female. 47.8% participants had hypertension, of which 59.9% were aware of their diagnosis. Among the participants who were aware of their hypertension, 90.3% were prescribed medication(s) to lower blood pressure, of which 39.2% had achieved control. Multivariate analysis showed age, gender, Race/ethnicity, annual family income, education level, BMI, waist to height ratio, diabetes, and previous cardiovascular events to be independent risk factors for hypertension. Lower likelihoods of awareness and treatment were associated with male sex, younger age, Mexican ethnicity, participants without health insurance, absence of previous cardiovascular events, diabetes, obesity, or smoking. Overall, hypertension control rate was suboptimal across most of subgroups (<40%). CONCLUSION: Based on the 2017 ACC/AHA guideline, almost half of the US adult population has hypertension. The suboptimal number of people with controlled blood pressure is pervasive in all subgroups and warrants greater efforts in prevention, as well as more effective treatment.

Giant Left Ventricular Thrombus in a Patient with Acute Ischemic Stroke: A Case Report and Minireview.

A 56-year-old healthy male with no obvious risk factors or significant past medical history was admitted to the emergency room with acute ischemic stroke. On his transthoracic echocardiography (TTE), an extremely large thrombus was detected at the apex involving the distal anterior wall. The thrombus was predominantly adherent but with a mobile tip. The patient was subsequently managed with dual antiplatelet therapy. In this report, we present an interesting case of an acute ischemic stroke secondary to a giant left ventricular thrombus in a patient with no past significant cardiac or neurologic medical history.

Race and ethnicity have significant influence on fractional exhaled nitric oxide.

BACKGROUND: Race and ethnicity have been shown to influence fractional exhaled nitric oxide (FeNO). There is a need to investigate cutoff points for different races and ethnicities to improve clinical application. OBJECTIVE: To investigate cutoff points for different races and ethnicities by analyzing the FeNO data collected by the National Health and Nutrition Examination Survey from 2007 to 2012. METHODS: This study included 23,433 participants. After excluding participants with confounding factors, 11,084 participants were eligible for data analysis. Based on age and the probability of having allergic airway inflammation, participants were divided into 4 groups. The geometric mean and 5th, 50th, and 95th percentiles of FeNO in Hispanic, white, black, and other races were analyzed in all groups. RESULTS: Compared with white participants, the geometric mean for FeNO in black participants was 36% to 41% higher in children and 5% to 8% higher in adults. Hispanic children had significantly higher FeNO values (14% to 19%) compared with non-Hispanic white children; however, those differences were not significant in adults. Other races had significantly higher FeNO values in children (24-54%) and adults (9-29%) compared with white participants. Further, for normal healthy black children, the 95th percentile was 40.2 parts per billion (ppb), which is significantly higher than the cutoff point recommended by current guidelines. CONCLUSION: Although there are significant differences in FeNO values among races and ethnicities, the current cutoff point at 50 ppb is sufficient to separate healthy from asthmatic populations in adults. However, for black children, we suggest increasing the cutoff point from 35 to 40 ppb to avoid unnecessary diagnosis and treatment.

Thromboembolic complications following a first isolated episode of superficial vein thrombosis: a cross-sectional retrospective study.

Superficial vein thrombosis (SVT) may be associated with complications such as venous thromboembolism (VTE) and recurrent SVT. The purpose of this study was to explore risk factors among patients with a first isolated episode of SVT (index SVT) involving upper and lower extremities and to estimate the prevalence of VTE complications within 1 year of index SVT. Retrospective chart review of electronic records at Marshfield Clinic in Wisconsin identified 381 subjects with a first isolated SVT diagnosis (male/female: 170/211; median age 59.4 years). Patients were stratified based on whether they did (n = 44; 11.5 %) or did not (n = 337; 88.5 %) experience VTE complications and whether they did (n = 25; 6.6 %) or did not (n = 356; 93.4 %) experience pulmonary embolism (PE) and/or deep vein thrombosis (DVT) within 1 year of index SVT. There were 49 complications among 44 patients; these included DVT (n = 18, 36.7 %), propagation of SVT (n = 18, 36.7 %), PE (n = 9, 18.4 %), new SVT at different location (n = 3, 6.1 %), and recurrent SVT (n = 1, 2.0 %). Univariate analysis of all VTE complications identified seven potential risk factors and similar analysis of PE/DVT complications identified eight potential risk factors, with six common risk factors identified in both analyses. Multivariate analysis identified indwelling venous catheter 30 days prior to SVT (p = 0.044), cancer history with treatment in the previous year (p = 0.001), and non-surgical trauma 7 days prior to SVT (p < 0.001) as independent risk factors for PE/DVT complications. Independent risk factors identified in the current study may convey greater risk for VTE complications, especially PE/DVT, following an initial isolated SVT episode.

Methane storage in dry water gas hydrates.

Dry water stores 175 v(STP)/v methane at 2.7 MPa and 273.2 K in a hydrate form which is close to the Department of Energy volumetric target for methane storage. Dry water is a silica-stabilized free-flowing powder (95% wt water), and fast methane uptakes were observed (90% saturation uptake in 160 min with no mixing) as a result of the relatively large surface-to-volume ratio of this material.

Rapid and reversible hydrogen storage in clathrate hydrates using emulsion-templated polymers.

A method for greatly accelerating the storage of gases such as hydrogen in clathrates by supporting the clathrate phase on a highly macroporous emulsion-templated polymer is presented. The gravimetric penalty is low due to the low bulk density of the support, no mechanical mixing is required, and the system is fully recyclable over multiple charge/ discharge cycles.

Methylphenidate does not improve cognitive function in healthy sleep-deprived young adults.

BACKGROUND: Abuse of methylphenidate, a treatment of attention-deficit/hyperactivity disorder, is reported to be increasing among students for the purpose of improving cognition. METHODS: A single capsule, containing methylphenidate (20 mg) or placebo, was administered to healthy young adults orally following 24 hours of sleep deprivation. Measurements included percent change in score from sleep-deprived baseline on four standardized tests of cognitive function: Hopkins Verbal Learning, Digit Span, Modified Stroop, and Trail Making tests. Measurements also included percent changes in blood pressure and heart rate from sleep-deprived baseline and plasma methylphenidate concentration. RESULTS: Differences in cognitive test performance were not observed between intervention groups. In subjects receiving methylphenidate, mean percent changes from baseline for systolic blood pressure and heart rate were increased relative to placebo between 90 and 210 minutes following capsule administration (maximum increases of 9.45% and 11.03%, respectively). The timing of peak differences in physiologic measures did not correlate with peak serum methylphenidate concentrations. Exit questionnaire ratings of "capsule effect" and perceived performance on the postcapsule administration of the most challenging cognitive test were both higher (p = .044 and p = .009, respectively) for the methylphenidate group than for the placebo group. CONCLUSIONS: Cognitive improvement among sleep-deprived young adults was not observed following methylphenidate administration. Benefits perceived by abusers may relate to increased confidence and sense of well-being, as well as to sympathetic nervous system stimulation. Moreover, methylphenidate administration results in physiologic effects that could be harmful to certain individuals.