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Primary amyloidosis is a disease with a complex and not fully understood pathogenesis, which is characterized by a wide range of clinical manifestations. Light chain amyloidosis is the most common form of systemic amyloidosis. At this, the heart is the dominant target organ in systemic amyloidosis. Cardiac amyloidosis (amyloid cardiomyopathy) is most often manifested by diastolic heart failure resulting from restrictive cardiomyopathy. Therapy of amyloid cardiopathy includes optimal treatment of heart failure and chemotherapy. To reduce the symptoms of heart failure, diuretics are the main means, since other pathogenetic agents cannot be used due to hypotension and a possible decrease in cardiac output. With the introduction of new medicinal products into clinical practice, such as the proteosome inhibitor Bortezomib, the prognosis for patients has improved. However, amyloidosis remains a difficult disease to diagnose and treat.

In mammals, de novo methylation of cytosines in DNA CpG sites is performed by DNA methyltransferase Dnmt3a. Changes in the methylation status of CpG islands are critical for gene regulation and for the progression of some cancers. Recently, the potential involvement of DNA G-quadruplexes (G4s) in methylation control has been found. Here, we provide evidence for a link between G4 formation and the function of murine DNA methyltransferase Dnmt3a and its individual domains. As DNA models, we used (i) an isolated G4 formed by oligonucleotide capable of folding into parallel quadruplex and (ii) the same G4 inserted into a double-stranded DNA bearing several CpG sites. Using electrophoretic mobility shift and fluorescence polarization assays, we showed that the Dnmt3a catalytic domain (Dnmt3a-CD), in contrast to regulatory PWWP domain, effectively binds the G4 structure formed in both DNA models. The G4-forming oligonucleotide displaced the DNA substrate from its complex with Dnmt3a-CD, resulting in a dramatic suppression of the enzyme activity. In addition, a direct impact of G4 inserted into the DNA duplex on the methylation of a specific CpG site was revealed. Possible mechanisms of G4-mediated epigenetic regulation may include Dnmt3a sequestration at G4 and/or disruption of Dnmt3a oligomerization on the DNA surface.

ObjectivesSchool-age children with and without parent-reported listening difficulties (LiD) were compared on auditory processing, language, memory, and attention abilities. The objective was to extend what is known so far in the literature about children with LiD by using multiple measures and selective novel measures across the above areas.DesignTwenty-six children who were reported by their parents as having LiD and 26 age-matched typically developing children completed clinical tests of auditory processing and multiple measures of language, attention, and memory. All children had normal-range pure-tone hearing thresholds bilaterally. Group differences were examined.ResultsIn addition to significantly poorer speech-perception-in-noise scores, children with LiD had reduced speed and accuracy of word retrieval from long-term memory, poorer short-term memory, sentence recall, and inferencing ability. Statistically significant group differences were of moderate effect size; however, standard test scores of children with LiD were not clinically poor. No statistically significant group differences were observed in attention, working memory capacity, vocabulary, and nonverbal IQ.ConclusionsMild signal-to-noise ratio loss, as reflected by the group mean of children with LiD, supported the children's functional listening problems. In addition, children's relative weakness in select areas of language performance, short-term memory, and long-term memory lexical retrieval speed and accuracy added to previous research on evidence-based areas that need to be evaluated in children with LiD who almost always have heterogenous profiles. Importantly, the functional difficulties faced by children with LiD in relation to their test results indicated, to some extent, that commonly used assessments may not be adequately capturing the children's listening challenges.Supplemental Materialhttps://doi.org/10.23641/asha.12808607

Steganography is the science of hiding information in various types of data. Some of the most popular formats for Microsoft Office electronic documents are docx, xlsx, and pptx. The paper analyzes the structure of documents according to the OOXML standard. Algorithms for embedding data in electronic documents such as docx, xlsx and pptx, using the functionality of Microsoft office, as well as corresponding to a zip archive, are considered. There are six types of data attachments: zip comments, restricted zip fields, file embedding, additional Xml fields, hidden text, and tracking text. The stability of the data algorithm and the main advantages and disadvantages are assessed.

A key component of population health status is premature mortality, defined as a death occurring before the age of 75 years...

The article discusses the specifics of hollow tracts and the features of their monitoring.

Background: Premature mortality under the age of 75 years exacerbates the burden of coronary artery disease (CAD) as the leading cause of death in the nation, with particular concerns being raised about its disproportionate effect on the vulnerable population of the Appalachian region compared to other regions of the United States. It is unknown whether the problem of premature CAD mortality in the Appalachian residents is further aggravated by disparities across various population groups within the Appalachian region itself. We hypothesized that within-region socioeconomic and geographic (rural-urban) disparities, independently of each other, aggravate the premature CAD mortality problem in the Appalachian population. Methods: A population-based study of age-adjusted premature CAD mortality among 25-74 year old residents of the Appalachian region was conducted (n=63,630,221). Counties’ rurality status was defined using the U.S. Department of Agriculture Economic Research Service’s (USDA ERS) Rural-Urban Continuum Codes: of 420 Appalachian counties, 217 were classifies as rural and 203 - as urban. To adjust for multiple covariates, general linear modeling (GLM) analysis was conducted (SAS, ver. 9.4). Results: Age-adjusted premature CAD mortality rates were higher in rural than urban Appalachian counties: 99.0 + 40.2 vs. 78.8 + 26.4 per 100,000 (p+ 7.3% vs. 24.4 + 5.7%, p+ 2.0% vs. 6.7 + 1.2%, p+ 3.5% vs. 16.0 + 3.6%, p+ 3.8% vs. 20.2 + 2.9%, p+ 3.8% vs. 32.0 + 3.5%, p+ 4.5% vs. 29.6 + 4.7%, pbeta 3.322, pbeta 0.947, pbeta -0.532, pbeta 2.761, pbeta 0.652, p Conclusions: Premature CAD mortality in rural Appalachian counties is statistically significantly higher than in urban Appalachian counties. Socioeconomic disparities and modifiable CAD risk factors further aggravate the problem.

In this article, we will explore methods of using data hiding in a pdf document. The widespread use of PDF files can make its use for this purpose an interesting and practical solution. We was explore of algorithms of steganography algorithms from open sources and based on the analysis, an algorithm for detecting steganography proposed. We explore the methods to use a hide data in structure of the pdf document format, the basic strategies for hiding data, the statistical characteristics of PDF operators, we analysis the detection of changes after applying the algorithm for hiding data.

Notwithstanding the popularity of multimedia files for steganography purposes, other files, whether binary data files, executables or text based files, can also be used to hide information. The widespread use of PDF files can make its use for this purpose an interesting and practical solution. In the article, an analysis was made of the structures of PDF documents, the use of steganography capabilities and their detection. A study of steganography algorithms from open sources was conducted and based on the analysis, an algorithm for detecting steganography was proposed. For this purpose, an integrated approach was developed.

Human papillomavirus (HPV) is the main causative agent of cervical cancer. This cross-sectional survey examined differences in HPV status and risky sexual behaviors between food-secure and ...

Purpose With Aim 1, we compared the comprehension of and sensitivity to canonical and noncanonical word order structures in school-age children with specific language impairment (SLI) and same-age typically developing (TD) children. Aim 2 centered on the developmental improvement of sentence comprehension in the groups. With Aim 3, we compared the comprehension error patterns of the groups. Method Using a “Whatdunit” agent selection task, 117 children with SLI and 117 TD children (ages 7:0–11:11, years:months) propensity matched on age, gender, mother's education, and family income pointed to the picture that best represented the agent in semantically implausible canonical structures (subject–verb–object, subject relative) and noncanonical structures (passive, object relative). Results The SLI group performed worse than the TD group across sentence types. TD children demonstrated developmental improvement across each sentence type, but children with SLI showed improvement only for canonical sentences. Both groups chose the object noun as agent significantly more often than the noun appearing in a prepositional phrase. Conclusions In the absence of semantic–pragmatic cues, comprehension of canonical and noncanonical sentences by children with SLI is limited, with noncanonical sentence comprehension being disproportionately limited. The children's ability to make proper semantic role assignments to the noun arguments in sentences, especially noncanonical, is significantly hindered.

Background: Previously conducted studies have demonstrated that diabetes mellitus (DM) and end-stage renal disease (ESRD) can worsen survival prognosis in coronary artery disease (CAD) patients. It remains unclear whether racial and socio-economic disparities can affect the outcomes of coronary revascularization procedures in CAD patients with DM (CAD-DM), in particular in relation to the presence of ESRD. Study Objective: To investigate racial and socio-economic disparities in the in-hospital mortality outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in CAD-DM patients with and without ESRD. Methods: We conducted a retrospective cohort study of in-hospital mortality in 353,711 CAD-DM patients [mean±SD age: 66.1±11.1 years; 65.2% (230,617 of 353,711) males] after CABG and PCI during 2007-2011. Median household income state quartile was used as a measure of patients’ socio-economic status (SES). Race was defined as white, black, Asian, or Native American. In-hospital patient death was a dichotomous outcome of interest. Adjusted odds ratios were obtained from multivariable logistic regression, adjusted for the type of coronary revascularization procedure and known clinical, demographic, and socio-economic covariates. Results: In the covariate-adjusted multivariable logistic regression analysis, post-procedure mortality in CAD-DM patients with ESRD was significantly higher than in their counterparts without ESRD (adjusted OR = 1.70, 95% CI: 1.56-1.87, p Conclusions: Results suggest existence of SES and racial disparities in in-hospital post-coronary revascularization mortality in CAD-DM patients independently of the type of procedure, presence of ESRD, comorbidities and demographic covariates. Further studies investigating the responsible mechanisms for these outcome disparities – possibly, disparities in the realized access to primary care – are warranted.

Aim 1 of this study was to examine the developmental changes in typically developing English-speaking children's syntactically based sentence interpretation abilities and sensitivity to word order. Aim 2 was to determine the psychometric standing of the novel sentence interpretation task developed for this study, because we wish to use it later with children with specific language impairment. Children listened to semantically implausible sentences in which noun animacy and the natural affordance between the nouns were removed, thus controlling for event probability. Using this novel “whatdunit?” agent selection task, 256 children 7–11 years old listened to two structures with canonical word order and two with noncanonical word order. After each sentence, children selected as quickly as possible the picture of the noun they believed was “doing the action.” Children interpreted sentences with canonical word order with greater accuracy and speed than those with noncanonical word order. Older children (mean age = 10 years, 8 months) were more accurate and faster than younger children (mean age = 8 years, 1 month) across all sentence forms. Both older and younger children demonstrated similar error patterns across sentence type. The “whatdunit?” task also proved to have strong validity and reliability, making it suitable for studies with children with specific language impairment.

Pneumoconiosis (PNC) is a major occupational disease that develops as a result of occupational exposure to dust via inhalation. In addition to its harmful effects on the respiratory system, PNC can increase vulnerability to coronary heart disease (CHD)—the leading cause of death in the United States and in the world. Currently, two types of cardiovascular intervention procedures for CHD treatment are percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The objective of this study was to investigate comparative effectiveness of the two major cardiovascular intervention procedures—PCI and CABG—in PNC patients with CHD. Data from 1094 hospitalizations of adult patients with PNC and CHD (CHD-PNC patients) and 534,120 hospi-talizations of CHD patients without PNC (CHD-nonPNC) were investigated. Adjusted odds ratios for in-hospital death in relation to the type of procedure, adjusted for patient socio-demographic and clinical characteristics and hospital characteristics, were calculated using multivariable logistic regression. Men constituted 97.8% of CHD-PNC patients and 68.6% of CHD-nonPNC patients. Within the CHD-PNC group, crude (unadjusted) in-hospital mortality after CABG and PCI did not differ significantly (1.35% vs. 2.00%, p = 0.425) and remained insignificant in the multivariable analysis, adjusted for patient and hospital characteristics (adjusted OR = 0.714, 95% CI 0.220 - 2.323, p = 0.576). But in the CHD-nonPNC group, in-hospital mortality after CABG was significantly higher than after PCI both in crude analysis (2.83% vs. 1.28%, p

The incorporation of chemotherapeutic agent 6-thioguanine (SG) into DNA is a prerequisite for its cytotoxic action. This modification of DNA impedes the activity of enzymes involved in DNA repair and replication. Here, using hemimethylated DNA substrates we demonstrated that DNA methylation by Dnmt3a-CD is reduced if DNA is damaged by the incorporation of SG into one or two CpG sites separated by nine base pairs. An increase in the number of SG substitutions did not enhance the effect. Dnmt3a-CD binding to either of SG-containing DNA substrates was not distorted. Our results suggest that SG incorporation into DNA may influence epigenetic regulation via DNA methylation.

Background: Racial disparities in coronary artery disease (CAD) can worsen patient outcomes. While a number of studies have investigated racial disparities in CAD risk factors, the underlying mechanisms of racial disparities in the treatment outcomes in hospitalized CAD patients remain unclear. Hypothesis: We hypothesized that racial disparities in in-hospital CAD mortality are, at least partially, attributed to non-hospital factors that are external to quality of in-hospital care. Methods: We conducted a retrospective cohort study of in-hospital mortality in 9,128,116 hospitalized CAD patients (mean±SD age 72.4±13.0 years; 56.7% males) over a five-year time period. Multivariable logistic regression was used to obtain adjusted odds ratios (aOR) for in-hospital death in relation to patients’ race, adjusting for major clinical and demographic covariates. Results: A total of 349,688 deaths occurred among 9,128,116 hospitalized CAD cases (3.8% mortality). Mortality in patients admitted through the emergency department was higher than in non-emergency admissions (4.3% vs. 2.8%, p Conclusion: Racial disparities in in-hospital mortality for CAD patients do exist. These disparities are attributed to several factors, including the non-hospital factors external to quality of in-hospital care, such as lack of access to a high-quality primary care resulting in emergency admissions with more severe forms of CAD and severe comorbidities.

Background: Coronary artery disease (CAD) is the leading cause of death among patients with end-stage renal disease (ESRD). ESRD patients are at a higher risk of coronary artery bypass grafting (CABG) perioperative mortality than their non-ESRD counterparts. The extent and the mechanisms of racial disparities in post-CABG outcomes among ESRD patients remain unclear. Hypothesis: We hypothesized that post-CABG in-hospital mortality in ESRD patients is affected by patients’ race. Methods: We conducted a retrospective cohort study of post-CABG in-hospital mortality among 6,590 CAD patients with ESRD during the period of 2007-2011 [mean±SD age: 64.8±11.13 years; 67.8% (4,468 of 6,590) males]. Most of the patients were white (66.0%; 4,347 of 6,590), 21.7% (1,432 of 6,590) were black, 11.0% (725 of 6,590) were Asian, and 1.3% (86 of 6,590) were American Indian. In-hospital death was defined as a binary outcome (discharged alive or deceased) due to a relatively short length of stay. Adjusted odds ratios (OR) for in-hospital death after CABG in relation to patients’ race, adjusting for major clinical and demographic covariates, were obtained with multivariable logistic regression. Results: Unadjusted (crude) post-CABG in-hospital mortality rate in ESRD patients was 8.8% (579 of 6,590). Mortality rate was higher among patients admitted through emergency department (ED) than non-ED admitted patients: mortality rates 10.2% (221 of 2,169 ED admitted) and 8.1% (358 of 4,421 non-ED admitted), respectively ( P =0.0048). Deceased patients had more severe comorbidities and higher Elixhauser-Walraven comorbidity scores (12.6±6.7 points among deceased and 9.2±6.0 points among discharged alive; P P =0.0169). However, neither white patients (adjusted OR, 1.35; 95% CI, 0.96-1.89; P =0.0860) nor American Indian patients (adjusted OR, 2.16; 95% CI, 0.95-4.94; P =0.0676) had a statistically significantly higher risk of post-CABG death compared to Asian patients. Conclusions: Our findings indicate that racial disparities affect post-CABG in-hospital mortality rates in CAD patients with ESRD. Post-CABG mortality rate disparities may be attributed, at least partially, to racial disparities in severity of comorbidity and the type of admittance. Further studies investigating more detailed mechanisms responsible for these disparities are warranted.

Clinical measurement, technical note.To describe a technique to measure interspinous process distance using ultrasound (US) imaging, to assess the reliability of the technique, and to compare the US imaging measurements to magnetic resonance imaging (MRI) measurements in 3 different positions of the lumbar spine.Segmental spinal motion has been assessed using various imaging techniques, as well as surgically inserted pins. However, some imaging techniques are costly (MRI) and some require ionizing radiation (radiographs and fluoroscopy), and surgical procedures have limited use because of the invasive nature of the technique. Therefore, it is important to have an easily accessible and inexpensive technique for measuring lumbar segmental motion to more fully understand spine motion in vivo, to evaluate the changes that occur with various interventions, and to be able to accurately relate the changes in symptoms to changes in motion of individual vertebral segments.Six asymptomatic subjects participated. The distance between spinous processes at each lumbar segment (L1-2, L2-3, L3-4, L4-5) was measured digitally using MRI and US imaging. The interspinous distance was measured with subjects supine and the lumbar spine in 3 different positions (resting, lumbar flexion, and lumbar extension) for both MRI and US imaging. The differences in distance from neutral to extension, neutral to flexion, and extension to flexion were calculated.The measurement methods had excellent reliability for US imaging (intraclass correlation coefficient [ICC3,3] = 0.94; 95% confidence interval: 0.85, 0.97) and MRI (ICC3,3 = 0.98; 95% confidence interval: 0.95, 0.99). The distance measured was similar between US imaging and MRI (P.05), except at L3-4 flexion-extension (P = .003). On average, the MRI measurements were 1.3 mm greater than the US imaging measurements.This study describes a new method for the measurement of lumbar spine segmental flexion and extension motion using US imaging. The US method may offer an alternative to other imaging techniques to monitor clinical outcomes because of its ease of use and the consistency of measurements compared to MRI.

Evidence from cell studies indicates that persistent organic pollutants (POP) can induce insulin resistance, an essential component of the metabolic syndrome (MetS). We hypothesized that residential proximity to environmental sources of POP would be associated with the MetS in the population. The present study examined the association between residency in a zip code containing or abutting environmental sources of POP and MetS-related hospitalization rates. Hospitalization data were obtained from the New York Statewide Planning and Research Cooperative System. Relative risks (RR) were calculated as hospitalization rate ratios. Adjusted RR and their 95% confidence intervals (CI) were estimated by multivariable Poisson regression. A higher proportion of African Americans resided in POP zip codes compared to Caucasians (25.9% and 24.3%, respectively, p < 0.01). Residence in POP zip codes was associated with a statistically significant 39.2% increase in MetS-related hospitalization rates, adjusted for race, gender, and age (adjusted RR = 1.392, 95% CI: 1.032–1.879, p = 0.030). Increase in age was independently associated with higher MetS-related hospitalization rates (p for trend < 0.001). Our findings contribute to the body of evidence supporting the hypothesis of POP constituting an environmental risk factor for the MetS. Further studies investigating exposure to POP and insulin resistance are warranted.

Recent evidence indicates that exposure to persistent organic pollutants (POPs) is emerging as an important risk factor for atherosclerosis-related diseases, including stroke. Hypertension (HTN) is a major risk factor for stroke, and some studies suggest that exposure to POPs is also a risk factor for HTN. We hypothesized that POPs increase the environmental burden of stroke with comorbid HTN.A population-based study of hospitalization rates for stroke with comorbid HTN in populations presumably exposed to POPs, based on the zip code of residence, was conducted. Data on hospitalizations for stroke with comorbid HTN were obtained from the New York Statewide Planning and Research Cooperative System for 1993-2004. Relative risks, with 95% confidence intervals (RR, 95% CI), of hospitalization were estimated by multiple Poisson regression analysis.RR of hospitalization for stroke with comorbid HTN was 13.4% higher in populations residing in zip codes containing or abutting environmental sources of POPs (RR = 1.134; 95% CI, 1.036-1.241; p = 0.006). Also, hospitalization rates were significantly higher in males than in females (RR = 1.397; 95% CI, 1.357-1.437; p 0.001), in African Americans than in Caucasians (RR = 3.902; 95% CI, 3.617-4.208; p 0.001), and in older age groups (p for trend 0.001). These statistically significant findings of the effect of demographic factors are highly consistent with the current knowledge of stroke and serve as indirect quality indicators for our model.Results of our study support the hypothesis that exposure to POPs increases the environmental burden of both stroke and HTN.

Problem Whole-body vibration (WBV) is an occupational issue of concern due to adverse health effects or simple discomfort and annoyance. Unlike in Europe, WBV is an emerging topic in the U.S. safety and health (S&H) professional community. We hypothesized that at least one-half of the U.S. occupational S&H professionals knew little or nothing about WBV. Method We conducted a cross-sectional study (survey) of WBV knowledge among members of the American Society of Safety Engineers. A Likert scale (1-none to 5-expert) was used to determine WBV topic knowledge levels (KL1-5). Results Analysis of 2,764 responses revealed that 69.5% of the participants self-reported a less than basic WBV understanding. The WBV KL1-5 mean for all participants was 1.94 ± 1.00, corresponding to an awareness of WBV without a depth of understanding. Summary Many at-risk U.S. workers may not be supported by occupational S&H professionals with adequate WBV knowledge. Impact on Industry A significant number of U.S. workers may be exposed to unhealthy levels of whole-body vibration. However, the U.S. occupational safety and health community is generally unprepared to anticipate, monitor, and control the whole-body vibration hazard.

Background: End-stage renal disease (ESRD) increases risk of coronary artery disease (CAD) and also worsens prognosis in CAD patients. Percutaneous coronary intervention (PCI) with stenting is an effective treatment procedure for certain categories of CAD patients. It remains unclear whether post-procedure mortality in ESRD patients is associated with patients’ race and a type of stent [[Unable to Display Character: –]] a drug-eluting stent (DES) or a bare-metal stent (BMS). Hypothesis: We hypothesized that disparities in utilization of DES and BMS stents and post-procedure mortality would exist in CAD patients with ESRD (CAD-ESRD). Methods: We conducted a retrospective cohort study of in-hospital mortality in 12,289 CAD-ESRD patients [mean + SD age: 65.4 + 11.9 years; 60.3% (7,414 of 12,289) males] after PCI with DES and BMS during 2007-2011. Patients’ race was defined as white, black, or other (Asian, Pacific Islander, Native American). Due to short length of stay, in-hospital death was defined as a binary variable (discharged alive or deceased). Multivariable logistic regression was used to obtain adjusted odds ratios (OR) for in-hospital death after DES and BMS PCI in relation to patients’ race, adjusting for clinical and demographic characteristics, including age, gender, number of stents inserted, number of vessels treated, socio-economic status, emergency department (ED) admission, rural/urban area status. Results: Crude (unadjusted) post-PCI mortality was 4.4%, with crude post-DES mortality being 3.4% and post-BMS mortality being 6.7% ( P P P =0.046), while in white and other patients the risk of post-procedure death was similar (adjusted OR, 0.70; 95% CI, 0.48-1.03; P =0.072). Conclusions: Our results are indicative of the persistence of racial differences in post-PCI mortality in CAD-ESRD patients still exist, regardless of the improvements in the technique. Further studies investigating the mechanisms responsible for these disparities are warranted.

Background Low household food security (HFS) and high cervical cancer rates have been reported in Appalachian Ohio. High antioxidant intake may reduce the risk of human papillomavirus (HPV) infection and progression to cervical cancer. Study Objective To examine interrelationship of HFS, produce intake/ behaviors, and cervical health in adult women living in rural Appalachia. Method Survey of females 蠅 21 years [USDA HFS module, produce intake and behavior-related instrument, and Risky Sexual Behavior (RSB) Index questionnaire]. Clinical HPV results were obtained. Results Participants (n=153) [HPV-negative, n=139 (91.4%); HPV-positive, n=13 (8.6%)] were 29.4±7.8 years. For HFS, 113 (75.3%) had high and 37 (24.7%) had marginal, low, or very low HFS. Statistically significant test results showed food insecure group had a higher RSB scores compared to their counterparts (p

Background: Besides being a major risk factor for coronary artery disease (CAD), diabetes mellitus (DM) also worsens CAD patients’ prognosis. Percutaneous coronary intervention (PCI) with stenting is an effective treatment procedure for certain categories of CAD patients with DM (CAD-DM). Newer drug-eluting stents (DES) were developed to minimize the occurrence of restenosis known to hinder PCI with older non-drug-eluting stents (non-DES). We hypothesized that disparities in DES utilization and post-procedure mortality would exist in CAD-DM patients. Methods: We conducted a retrospective cohort study of in-hospital mortality in 132,934 CAD-DM patients [mean+SD age: 65.3+11.4 years; 62.7% (83,409 of 132,934) males] after PCI with DES and non-DES in the years 2007,2009. Patient race was classified as white, black, or other Asian, Pacific Islander, Native American). Due to short length of stay, in-hospital death was defined as a binary variable (discharged alive vs. deceased). Multivariable logistic regression was used to obtain adjusted odds ratios (ORs) for in-hospital death after DES and non-DES PCI in relation to patients’ race, adjusting for confounders: age, gender, comorbidities, number of stents inserted, number of vessels treated, socio-economic status, emergency department (ED) admission, rural/urban area status. Results: Blacks were less likely to receive newer DES stent than any other racial group: 75.7% blacks, 76.9% whites, 79.0% other (p Conclusions: Racial disparities exist in DES utilization by CAD-DM patients and in post-PCI in-hospital mortality: blacks are least likely to receive DES, but patients of other racial groups are more likely to die after PCI. Further studies investigating the mechanisms responsible for these disparities are warranted.

Background: The two major intervention treatment procedures for coronary artery disease (CAD) are coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with. Besides being a major risk factor for CAD, diabetes mellitus (DM) also impacts unfavorably CAD patients’ prognosis. We hypothesized that racial and socio-economic disparities are associated with post-procedure mortality in CAD patients with DM. Methods: A retrospective cohort study of post-procedure mortality after CABG and PCI in 188,851 CAD patients with DM (mean age 65.5∓11.3 years, 35.3% women) was conducted. In-hospital patient death was a binary outcome of interest. Adjusted odds ratios (OR) were obtained from multivariable logistic regression, adjusted for a number of demographic, socio-economic and clinical confounders, including the severity of comorbid conditions (other than DM) measured by Elixhauser Comorbidity Index, Walraven modification. All results were analyzed with SAS version 9.2. Results: Post-CABG in-hospital mortality was higher than post-PCI (adjusted OR 1.89, 95% CI: 1.72-2.08, p Conclusion: Racial and socio-economic disparities are associated with in-hospital mortality after coronary intervention procedures. Further investigation of mortality disparities in CAD patients with DM is warranted.

BACKGROUND: Racial disparities in treatment procedure mortality contribute to long-term mortality disparities. Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI; coronary angioplasty) are two common revascularization procedures for coronary heart disease (CHD) interventional therapy. In-hospital post-coronary revascularization procedure mortality contributes to long-term, overall CHD mortality. While racial disparities in long-term CHD mortality have been reported, existence of racial disparities in post-procedure mortality remains an open question of important implications. HYPOTHESIS: We hypothesized that racial disparities in post-CABG and post-PCI mortality would exist. METHODS: We conducted a study of in-hospital mortality in 427,864 patients [mean+SD age: 66.1+11.8 years; 68.5% (292,955 of 427,864) males] after CABG and PCI during the years 2007,2009. Patient race was classified as white, black, or other (Asian, Pacific Islander, Native American). Because post-procedure length of stay in the hospital is relatively short (days, not months), post-procedure in-hospital death was defined as a binary variable (discharged alive vs. deceased). Multivariable logistic regression models were used to obtain adjusted odds ratios (OR) for in-hospital death after CABG and PCI in relation to race, adjusting for confounding factors - patient and hospital characteristics (age, gender, socio-economic status, Elixhauser comorbidity measures, emergency department admission, rural/urban area status). RESULTS: Significantly higher percentage of black patients were admitted via emergency department (44.8%) as compared to other (37.8%) and white (36.2%) patients (p CONCLUSIONS: Our findings are indicative of two distinctive patterns of racial disparities in post-coronary revascularization procedure mortality. Blacks have a higher post-CABG mortality and lower post-PCI mortality than whites. Other patients have a higher post-PCI mortality than whites, but similar post-CABG mortality. Further studies of the mechanisms responsible for these racial disparity patterns are needed.

BACKGROUND: Pre-gestational hypertension (HTN) remains a compelling problem, both cardiological and obstetrical. It can increase risk of unfavorable maternal and neonatal outcomes, especially in patients without adequate prenatal care. Little is known about factors associated with inadequate prenatal care in women with pre-gestational HTN, beyond racial and ethnic disparities. HYPOTHESIS: We hypothesized that social factors are associated with inadequate prenatal care in pre-gestational HTN women, beyond race/ethnicity-related disparities. METHODS: A case-control study of adequacy of prenatal care was conducted in 1,635 women with pre-gestational HTN who were living and gave birth in the State of Ohio in 2010. The comprehensive births data for the year 2010 were obtained from the Ohio Department of Health. Cases were identified as those with inadequate prenatal care; controls were identified as those with adequate-plus, adequate, or intermediate care, as defined by the Adequacy of Prenatal Care Utilization Index (the Kotelchuk Index). Adjusted odds ratios for inadequate care in pre-gestational HTN women in relation to their demographic and socio-economic characteristics were obtained using multivariable logistic regression (SAS software). RESULTS: A total of 14.4% (235 of 1,635) pre-gestational HTN women received inadequate prenatal care. In pre-gestational HTN women, adequacy of prenatal care was statistically significantly associated with their level of educational attainment and marital status, even after adjustment for race and ethnicity. Compared to pre-gestational HTN women with a higher educational level (at least some college or higher), pre-gestational HTN women with a lower educational level (high school or below) were 1.69 times more likely to receive inadequate prenatal care as measured by the Kotelchuk Index (began prenatal care late and/or completed less than 50% of the recommended visits) (OR 1.69, 95% CI 1.20-2.38, p CONCLUSIONS: Although white women with pre-gestational HTN are at lowest risk of receiving inadequate prenatal care, these disparities cannot be attributed to race and ethnicity only. Pre-gestational HTN women with lower educational attainment and unmarried women are at higher risk of receiving inadequate prenatal care. Pre-gestational risk stratification and management of HTN in women during pregnancy by the cardiologist are warranted.

Stroke disparities in relation to the Stroke Belt have been studied extensively, but little is known about stroke mortality disparities outside the Stroke Belt. We examined the hypothesis that racial and rural-urban stroke disparities exist outside the Stroke Belt.A county-based population study of stroke mortality in adults, aged -25 years, for a seven-year period (2000-2006) was conducted in the non-Stroke Belt states. Data on stroke deaths were obtained from the Centers for Disease Control and Prevention, National Center for Health Statistics. Relative risks (RR) were estimated by multivariable Poisson regression, adjusting for known confounders.Stroke death rates.In the non-Stroke Belt states, African Americans had 1.44 times higher stroke death rates than Caucasians, 2.14 times higher than Asians/Pacific Islanders, and 1.56 times higher than American Indians (adjusted RR=1.44, P.001; adjusted RR=2.14, P.001; and, adjusted RR=1.56, P.001, respectively). After adjusting for race, sex, and age, residents of rural counties outside the Stroke Belt still had a statistically significant 12% increase in stroke mortality compared to urban counties (adjusted RR=1.12, P.001). Female sex and older age were also associated with higher stroke mortality.The present study revealed that racial and rural-urban disparities in stroke mortality exist in populations residing outside the Stroke Belt. Stroke mortality in the non-Stroke Belt states is disproportionately higher in African Americans and in rural area residents. African Americans are the only racial group in which urban residency is not associated with a decrease in stroke mortality.

Studies suggest that environmental exposure to persistent organic pollutants (POPs) may be an emerging risk factor for ischemic heart disease, including acute myocardial infarction (AMI). However, some studies indicate that exposure to POPs may also be a risk factor for hypertension, a well-established risk factor for AMI. To investigate effect of POPs on the environmental burden of cardiovascular disease, a study of AMI with comorbid hypertension in populations environmentally exposed to persistent organic pollutants, based on the zip code of residence, was conducted. Data on hospital discharges for AMI with comorbid hypertension were obtained from the New York Statewide Planning and Research Cooperative System for 1993–2004. Patients residing in zip codes containing or abutting POPs contaminated sites were considered environmentally exposed. Relative risks (RR) — with corresponding 95% confidence intervals (95% CI) — of hospitalization for AMI with comorbid hypertension were estimated by Poisson regression, adjusting for known confounders. Adjusted hospitalization rates for AMI with comorbid hypertension were 12.4% higher in populations residing in proximity to a POPs site (adjusted RR = 1.124, 95% CI 1.025–1.233, p < 0.05), compared to not in proximity to a POPs site. Also, hos- pitalization rates for AMI with comorbid hypertension were higher in males than in females (adjusted RR = 2.157, 95% CI 2.100–2.215, p < 0.05), in African Americans than in Caucasians (adjusted RR = 1.631, 95% CI 1.483–1.794, p < 0.05), and in older age groups (p for trend < 0.05). These findings are consistent with the established effects of non-modifiable risk factors and serve as indirect quality indicators for our model. In conclusion, our results support the hypothesis that environmental exposure to POPs increases the burden of cardiovascular disease in exposed populations.

Background: Evidence is emerging that exposure to persistent organic pollutants (POP) is a risk factor for atherosclerosis-related diseases and for diabetes mellitus (DM). We hypothesized that residential proximity to sources of POP will be associated with an increase in hospitalization rates for ischemic stroke (IS) with comorbid DM (IS-DM). Methods: We examined IS-DM hospitalization rates in the New York State (exclusive of New York City) during a 12-year period. POP exposure status was assessed based on residency in a zip code containing or abutting environmental sources of POP. Adjusted relative risks (RR) of IS-DM hospitalization were estimated by multivariate Poisson regression. Results: A statistically significant 10% increase in IS-DM hospitalization rates was observed in populations environmentally exposed to POP (adjusted RR 1.10, 95% confidence interval, CI, 1.01–1.20; p = 0.031). IS-DM hospitalization rates were also higher in males (adjusted RR 1.34, 95% CI 1.30–1.39; p < 0.001), in blacks (adjusted RR 4.54, 95% CI 4.16–4.94; p < 0.001) and in older age groups (p for trend Conclusions: Residential proximity to sources of POP is associated with an increase in RR of IS-DM hospitalization. Our findings support the hypothesis of POP being a risk factor for IS. Further studies are warranted.

Objectives: Environmental exposure to persistent organic pollutants (POPs) has been associated with an increased risk of both acute myocardial infarction (AMI) and diabetes mellitus (DM). A study of first-time hospitalizations for AMI with DM as a comorbidity in populations presumed to be exposed or not exposed on the basis of residence near POPs sites was conducted to investigate whether exposure to POPs increases the environmental burden of disease. Materials and Methods: We examined the association between residential proximity to environmental sources of POPs and hospitalization rates for first-time AMI with comorbid DM in 31 428 patients aged 25–74 years, using the New York Statewide Planning and Research Cooperative System data for a 12-year period (1993–2004). Environmental exposure status was assessed based on the zip code of residence. Adjusted relative risks (RR) of AMI hospitalization were estimated by multivariate Poisson regression. Results: Hospitalization rates for first-time AMI with comorbid DM were significantly greater in populations living near POPs sites (adjusted RR = 1.169, 95% CI: 1.014–1.347, p < 0.05). These rates were also significantly higher in African Americans than in Caucasians (adjusted RR = 1.902, 95% CI: 1.659–2.180, p < 0.001), in males (adjusted RR = 1.767, 95% CI: 1.695–1.843, p < 0.001), and for older ages (p for trend < 0.001). These findings, consistent with established non-modifiable risk factors, support the plausibility of our model. Conclusions: Residential proximity to environmental sources of POPs is associated with a significant increase in hospitalization rates for first-time AMI with comorbid DM, compared to respective rates in populations not exposed to POPs.

In this work analysis of immunomodulating properties of retinoids and carotinoids, mainly beta-carotene is presented. The main attention is concentrated on the latest investigations of the role of retinoid receptors in realization of retinoid influence on differentiation of hematopoietic elements and the apoptosis induction. The conclusion concerning the principal advantages of beta-carotene as immunomodulator comparing to other existing immunomodulating agents has been made.