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Introduction: Disparities in cardiovascular care are well recognized, with socioeconomic status being one of the strongest determinants of cardiovascular disease outcomes. This study evaluates whether these disparities translate to coronary artery calcium (CAC) scan utilization. Specifically, we aim to describe regional variation and socioeconomic variables that impact CAC utilization across the United States relative to the prevalence of coronary artery disease (CAD) and related comorbidities., Methods: This cross-sectional study integrates county-level CAC utilization with CAD prevalence and publicly available socioeconomic variables including self-identified ethnicity, education, and adjusted gross income. CAC utilization rates were sourced from 2022 hospital commercial claims, outpatient Medicare service claims, and independent imaging center claims. Heart disease prevalence and socioeconomic variables were extracted from the Centers for Disease Control and Prevention and the National Center for Chronic Disease Prevention and Health Promotion. Adjusted gross income per capita was gathered from Internal Revenue Service data., Results: CAC utilization was evaluated across 808 counties within the United States, representing 600,379 claims. Median utilization was 1.62 scans per 1,000 persons with a range of 0.03 to 104.39. The West had the highest CAC scan utilization rate (median 3.09 scans per 1,000 persons) with a CAD prevalence of 548 per 100,000 persons. In contrast, the Midwest had the lowest utilization rate (median 1.24 scans per 1,000 persons) with a CAD prevalence of 635 per 100,000 persons. Socioeconomic factors that favor higher CAC utilization include a larger density of White/Caucasian ethnicity (p = 0.007) and a higher adjusted gross income per capita (p = 0.006). Counties with the lowest rates of CAC utilization have a higher population of African Americans (p <0.001) and a higher proportion of females (p <0.001)., Conclusion: This analysis highlights regional and socioeconomic differences in CAC utilization in the United States. Under-represented ethnicities such as African Americans have among the lowest rates of CAC utilization despite having a higher burden and mortality from heart disease. Discordance between CAC utilization, heart disease prevalence and socioeconomic status reveals a need for targeted interventions and policies aimed at mitigating structural barriers that perpetuate health inequities., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

A Multiple patient-specific and provider-perceived factors delay initiation of treatment in patients with hepatitis C. Patient-specific barriers to initiation of treatment for hepatitis C virus (HCV) include age, race, gender, economic status, insurance status, and comorbidities such as HIV coinfection, psychiatric illness, and other psychosocial factors.Provider-perceived patient factors include substance abuse history, older age, psychiatric illness, medical comorbidities, treatment adverse effect risks, and factors that might limit adherence (eg, comprehension level).Study limitations included problems with generalizability of the populations studied and variability in reporting or interpreting data associated with substance or alcohol use disorders (strength of recommendation: B, based on 2 prospective and 5 retrospective cohort studies).

Objective: To determine the effect of transfusion therapy with leukocyte-depleted platelet concentrates in comparison to transfusion support with standard platelet concentrates on the frequency of HLA alloimmunization in hematologic-oncologic patients., Design: Prospective randomized study., Setting: Institute for Transfusion Medicine and Immunohematology at a University Hospital., Patients: 52 hematologic-oncologic patients randomized in 2 groups., Interventions: Exclusive substitution with leukocyte-depleted blood components (platelet concentrates and packed red cells, filter group) or with standard platelet concentrates and leukocyte-depleted packed red cells (control group). Determination of the development of HLA antibodies., Results: 27% of the patients in the control group (4 out of 15) developed HLA antibodies in contrast to zero patients (0 out of 22) in the filter group (p < 0.02)., Conclusions: The results of this comparative clinical study show that the consequent and exclusive support with leukocyte-depleted blood components is an effective approach for prevention of HLA alloimmunization in long-term substituted patients.

Cryoglobulins and cryofibrinogens are special forms of cryopathies. With regard to the clinical findings, determination and analysis of cryoproteins can support the diagnostics. Because cryoproteins occur in patients and healthy persons, occasionally it may be difficult to estimate the clinical significance. We determined and analyzed cryproteins in 47 patients with the following diagnoses: urticaria (8), morbus Raynaud (10), acrocyanosis (7), vasculitis (3), collagenosis (6), lupus erythematosus (2), suspect of cryoproteinemia (9) and of cryofibrinogenemia (2). There were cryoproteins in 42 patients of the following characteristics: immunoglobulins A, G, M (14), fibrinogen (2), immunoglobulins A, G, M together with fibrinogen (26) with a considerable predominance of IgM. There was no correlation between the diagnoses and the cryoprotein types, and therefore it is reasonable to determine cryoproteins in close cooperation with the clinics. Contamination of the cryoprecipitates with hemoglobin from red blood cells can simulate alpha 2-macroglobulin and cause misinterpretations.

The sensitivity, specificity and reproducibility of the solid phase capture-platelet test (CPT) were compared with those of the platelet adhesion immunofluorescence test (PAIFT) and the lymphocytotoxic test (LCT). This study shows that CPT has a higher sensitivity than PAIFT (P < 0.001) and LCT (P < 0.01). The specificity was 86% lower than LCT (100%) (P < 0.01). Both the CPT test and PAIFT were comparable with regard to reproducibility (100%, 92%). The solid phase assay is easier to handle than PAIFT and LCT, allowing identification of HLA as well as of platelet specific antibodies. It is an efficient antibody screening test.

There are three basic forms of the 170-year-old autologous blood transfusion. The intraoperative and perioperative autologous blood transfusion and the preoperative autologous blood donation and retransfusion. The latter is a preferred task of blood transfusion services. Indications and contraindications have to be carefully considered. Each step from the decision for autologous donation to the retransfusion has to be carried out with the same conscientiousness as any other preparation of blood units and performance of hemotherapy. Although the interest in autologous blood deposit has increased in the last 5 years the percentage of autologous blood donation is very small. In order to include all suitable patients in an autologous predeposit programme a close and understanding cooperation between hospitals and transfusion services is necessary. The frequency of autologous blood donations decreases if these requirements are not complied with.

According to the hypothesis of Ceppellini and Morgan the Lewis blood groups are formed by the secondary attachment of the Lewis substances to the red blood cells and this process is genetically controlled by the genes of the ABH und Lewis(a)-substance secretion (SE, se, L and 1). The correctness of this hypothesis is demonstrated by determination of the Lewis blood groups and the ABH and Lewis secretor status with different suitable antisera and by estimation of the gene frequencies Se, se, L and 1 in a sample of 382 blood donors from Schleswig-Holstein and by determination of the same groups in 73 pairs of parents with 156 children. There are no significant differences between observation and expectation in the sample as well as in the family investigation and there are no critical pairs of parents having children with "impossible" Lewis blood group. The results suggest to make more use of the Lewis blood groups.

Studies carried out on the red cells of a patient with autoanti-B agglutinin gave further evidence that it is probably not modified red cell antigens which cause autoantibody formation.

The introduction of a standardized paternity in index (PI) for the statistical evaluation of blood group findings in cases of disputed paternity is proposed and explained. Using the PI X/Y as a parameter, it is not necessary to give the probability of paternity in percent. The PI includes the full information of the blood group findings. In addition to that, using the suggested standardization based on the probabilities of error according to Schulte Mönting and Walter, the test volume is also taken into account. The interpretation of the mathematical result is given by verbal predicates, the limitations of which are dependent on the verbal predicates for the probabilities of error according to Schulte Mönting and Walter, published by us previously. Besides the essential fact that the test volume is taken into account, the most important advantage of this procedure is that the mathematical result is involved in the court decision only by the PI (which is free of any valuation) and its verbal predicate and not by sometimes relatively high percentages, which may be misunderstood by laymen.

An obviously new phosphoglycolate phosphatase (PGP) gene product (PGP Sumatra) was detected by use of horizontal starch gel electrophoresis (SGE). The observed phenotype PGP (1-Sumatra) can be distinguished from any known PGP type.

Erythrocytes of group 0 cde/cde successively treated with bromelin and beta-glucuronidase (DFE) react not only with antibodies (anti-DFE) contained in the IgM-fraction of each human serum but also with Rh-specific antibodies of the IgG-fraction of anti-Rh-sera. This indicates, that the enzyme treatment makes accessible two different possibly crossreacting structures. Since anti-DFE is contained in the IgM-fraction of all human-sera, the antigenic determinant reacting with anti-DFE is considered a polyagglutinogen not identical with the well known polyagglutination-phenomena (T, Tn and Cad) as it is shown by comparative investigations with anti-T and anti-Tn as well as anti-Cad active seed extracts.

The question of how often erythrocytes should be washed in order to obtain a protein-free and therapeutically efficient unit of washed red blood cells is still controversial. To obtain more information regarding this problem, 6 X 15 units of whole blood were washed 1-6 times with a saline solution immediately and after 7, 14, 21, 28 and 35 days of storage. After each washing procedure the content of total protein, of immunglobulins A, G, and M and of complement factor C3 was determined in the supernatants, as well as the osmotic fragility in the corresponding erythrocyte sediments. The statistically analyzed results enabled us to describe the average degree of influences as equations and to recommend a preparation prescription. The results show that the protein levels decrease precipitously after the first and second washing procedures. The following 4 procedures have no significant effect. On the other hand, with increasing time of storage more washing procedures are necessary to reach the same results than with younger units. That is also true for the concentrations of immunoglobulins and complement C3. The osmotic fragility of the erythrocytes increases with each washing procedure as well as each day of storage. According to these results, an optimal, protein-free and effective unit of washed red blood cells is obtained when a 1-2-week-old unit of whole blood is washed 2-3 times.

The introduction of a standardized paternity index (PI) for the statistical evaluation of blood group findings in cases of disputed paternity is proposed and explained. By using the PI X/Y as parameter, it is not necessary to give the information of the probability of paternity in percent. The PI includes the full information of the blood group findings. In addition to that, by using the suggested standardization based on the probabilities of error according to Schulte Mönting and Walter the test volume is also taken into account. The interpretation of the mathematical result is given by verbal predicates, the limitations of which are orientated by the verbal predicates for the probabilities of error according to Schulte Mönting and Walter, published by us elsewhere. Besides the essential fact that the test volume is taken into account, the most important advantage of this procedure is that the mathematical result is involved in the court decision only by the PI (which is free of any valuation) and its verbal predicate and not by sometimes relatively high percentages, which may be misunderstood by laymen.

In order to ensure the economical handling of thrombocyte preparations which cannot be dispensed of and provided in unlimited quantities as well as in the interest of an indulgent behaviour towards donors it is desirable to adjust the platelet content of preparations in such a way that it corresponds to a therapeutically required, but also sufficient concentration. For this purpose, it must be possible to assess the yield of an apheresis in advance. This can be made without any difficulties by applying an equation developed according to a mathematical-statistical analysis by a multiple and partial correlation from 120 cases of apheresis, which shows, however, that the yield does not depend on machine data, but in a decisive manner on the donor's initial platelet number and the separated total blood volume.

The serum of a patient (Mr. Lat) with the regular blood group A1 B contains an anti-B reacting with all cells having a B antigen except Bx and cis AB. The anti-B reacts at 4 degrees C and occasionally at room temperature as shown by agglutination, absorption-eluction and by thermo-dynamic assays. The antibody is regarded as an irregular autoantibody belonging to the group of the so called "suppressed" or "latent" antibodies.

In order to desintegrate the membranes and to isolate Rh antigens erythrocytes with well defined Rh patterns are treated with ultrasonic waves. The results of investigation of the homogenous sonicates allow the following tentative conclusions: The Rh antignes (C and E) are combined obviously with certain functional membrane areas of a given size. After sonication the activity of the sonicate to neutralize specific antibodies is greater than the activity of the same amount of untreated cells. It is supposed that this effect is caused by making accessible hidden antigens that are inaccessible in the intact membrane. Immunization of rabbits with the sonicates does not stimulate Rh-specific antibodies.

Fifty-six patients with unexplained lymphocytosis were investigated with a panel of antibodies to lymphocyte surface antigens. In 23 the distribution of cell surface markers suggested reactive lymphocytosis. The remaining 33 patients showed a distribution of cell surface markers that indicated or suggested a diagnosis of B-cell lymphoproliferative disease. Two illustrative case reports show how such studies performed early in the investigation of unexplained lymphocytosis may permit earlier diagnosis of the underlying mechanism.

A new variant of the PGMa1 erythrocyte enzyme system not identical with the known variants of the system has been detected in the hemolyzed red blood cells of a healthy blood donor by isoelectric focusing. Using this technique the variant is represented by two bands, a strong and slow one more cathodically located than the a3 band and a weak one in the position of the a2 band. Using agarose thin layer or acetate foil electrophoresis the variant is represented only by a minimal cathodic broadening of the PGM1 1 band and therefore it is easily overlooked. Investigation of the propositus' family shows that the variant occurs combined with the common alleles PGMa1(1), PGMa1(2), and PGMa1(3) and that it has an autosomal dominant inheritance. Obviously the variant has a very low frequency.

Homologous blood can be spared by the donation and retransfusion of autologues blood which has to be supervised preferably or--in component therapy and longtime conservation--exclusively by transfusion medicine. In spite of the recently increasing interest in this form of blood substitute, the sparing effect is poor and of little importance, because it can only be applied in case of especially suitable patients and operations and it is more time- and cost-consuming than the homologous transfusion. The sparing effect could be increased if the method would be applied in all suitable patients and interventions. This aim should be strived for in every way because the autologous donation and retransfusion is the most secure form of transfusion.