New insights into the mechanism of nickel superoxide degradation from studies of model peptides.

A series of small, catalytically active metallopeptides, which were derived from the nickel superoxide dismutase (NiSOD) active site were employed to study the mechanism of superoxide degradation especially focusing on the role of the axial imidazole ligand. In the literature, there are contradicting propositions about the catalytic importance of the N-terminal histidine. Therefore, we studied the stability and activity of a set of eight NiSOD model peptides, which represent the major model systems discussed in the literature to date, yet differing in their length and their Ni-coordination.

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).

C-reactive protein as a predictor of chorioamnionitis.

Context: Chorioamnionitis (CAM) affects many pregnancies complicated by preterm premature rupture of membranes (PPROM). Finding a serum factor that could accurately predict the presence of CAM could potentially lead to more efficient management of PPROM and improved neonatal outcomes.

Objective: To determine if C-reactive protein (CRP) is an effective early marker of CAM in patients with PPROM.

Risk factors for failed closed reduction of pediatric supracondylar humerus fractures.

The purpose of this retrospective study was to examine pediatric supracondylar humerus fractures at a Level I trauma center. Data were analyzed to identify risk factors associated with closed reduction failure. Closed pediatric supracondylar humerus fractures that were treated at the authors' trauma center between October 1997 and January 2009 were reviewed.

Increased complication rate in obese patients undergoing laparoscopic adrenalectomy.

Objectives: Laparoscopic adrenalectomy has become the standard of care for resection of adrenal masses, with extremely low morbidity and mortality. This study investigates the difference in outcomes in patients who underwent laparoscopic adrenalectomy, comparing obese with healthy weight patients.

Methods: A retrospective chart review was performed on patients undergoing laparoscopic adrenalectomy between January 2000 and February 2010.

The New York PTSD risk score for assessment of psychological trauma: male and female versions.

We previously developed a new posttraumatic stress disorder (PTSD) screening instrument-the New York PTSD Risk Score (NYPRS). Since research suggests different PTSD risk factors and outcomes for men and women, in the current study we assessed the suitability of male and female versions of this screening instrument among 3298 adults exposed to traumatic events. Using diagnostic test methods, including receiver operating characteristic (ROC) curve and bootstrap techniques, we examined different prediction domains, including core PTSD symptoms, trauma exposures, sleep disturbances, depression symptoms, and other measures to assess PTSD prediction models for men and women.

Middle-of-the-night PCI does not affect subsequent day PCI success and complication rates by the same operator.

Objective: To determine the impact of percutaneous coronary interventions (PCI) performed during late-night hours on next day PCI performance by the same interventional cardiologist.

Background: There is little data regarding the effects of sleep deprivation on interventional cardiologists performing PCIs.

Methods: All primary PCIs from January 1, 2005 to December 31, 2009 between 11 PM and 7 AM were identified.

Tumor necrosis factor-α inhibitor use is not associated with lipid changes in rheumatoid arthritis.

Objective: To determine the association of use of tumor necrosis factor-α (TNF-α) inhibitors with differences in lipid levels in patients with rheumatoid arthritis (RA).

Methods: We studied 807 patients with incident RA to compare differences in lipid levels in TNF-α inhibitor users versus nonusers, with adjustment for relevant covariables.

Results: TNF-α inhibitor use was not associated with differences in levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), triglycerides, LDL:HDL, or TC:HDL compared to nonusers.

Overactive bladder and hyperlipidemia: is there an association?

Objectives: : To determine the relationship between overactive bladder (OAB), with or without urinary incontinence (UI), and hyperlipidemia.

Methods: : A random sample of 8077 primary care patients were recruited for the General Longitudinal Overactive Bladder Evaluation. This was a prospective population-based survey to determine severity and occurrence of urgency, frequency, nocturia, and UI.

Predicting Future PTSD using a Modified New York Risk Score: Implications for Patient Screening and Management.

AIM: We previously developed a posttraumatic stress disorder (PTSD) screening instrument - the New York PTSD Risk Score - that was effective in predicting PTSD. In the present study, we assessed a 12-month prospective version of this risk score, which is important for patient management, follow-up, and for emergency medicine. METHODS: Using data collected in a study of New York City adults after the World Trade Center Disaster (WTCD), we developed a new PTSD prediction tool.

Bisphosphonate therapy, death, and cardiovascular events among female patients with CKD: a retrospective cohort study.

Background: Accelerated vascular calcification contributes to cardiovascular disease burden in patients with chronic kidney disease (CKD). We hypothesized that bisphosphonate therapy would reduce the risk of mortality and cardiovascular events in this population.

Study Design: Retrospective cohort study.

Anthropometric measurements: effect of CT depth of pretracheal soft tissue on tracheotomy tube selection.

Background And Purpose: Tracheotomy is a commonly performed procedure; however, in the obese, it can be associated with a high morbidity and mortality, partially due to accidental decannulation. We hypothesize that a simple and rapid measurement of the DPST on CT will accurately predict those patients in need of an extended-length tracheotomy tube.

Materials And Methods: A retrospective review of the electronic health record and available CT imaging of the neck was performed for all patients who underwent tracheotomy at a tertiary care center.

Diabetes mellitus risk in rheumatoid arthritis: reduced incidence with anti-tumor necrosis factor α therapy.

Objective: To examine the association of tumor necrosis factor α (TNFα) inhibitor use and the risk of developing diabetes mellitus in a rheumatoid arthritis (RA) inception cohort.

Methods: Adults diagnosed with RA between January 1, 2001, and December 31, 2009, were identified (n = 1,881). Prevalent cases of diabetes mellitus (n = 294) were excluded.

PTSD and alcohol use after the World Trade Center attacks: a longitudinal study.

Research suggests that posttraumatic stress disorder (PTSD) is associated with increased alcohol use, but the findings have not been consistent. We assessed alcohol use, binge drinking, and psychotropic medication use longitudinally in 1,681 New York City adults, representative of the 2000 census, 2 years after the World Trade Center attacks. We found that, with the exception of a modified CAGE Questionnaire index for alcohol, alcohol use showed a modest increase over time and was related to PTSD symptoms, with an increase of about 1 more drink per month for those with PTSD, even though overall levels appeared to be within the National Institute on Alcohol Abuse and Alcoholism's safe range.

Hydroxychloroquine use associated with improvement in lipid profiles in rheumatoid arthritis patients.

Objective: Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Disease-modifying therapies that improve risk factors for CVD, such as dyslipidemia, are desired. This study used an electronic health record to determine if hydroxychloroquine (HCQ) use was associated with an improvement in lipid levels in an inception RA cohort.

Hydroxychloroquine use and decreased risk of diabetes in rheumatoid arthritis patients.

Background/objectives: Several studies have associated hydroxychloroquine use with decreased risk of diabetes mellitus (diabetes) or improved glycemic control in rheumatoid arthritis patients, but the studies were small or used data from self-report. The present study sought to replicate this protective relationship in a health system using electronic health records with laboratory data and physician diagnoses.

Methods: This study is a retrospective cohort of 1127 adults with newly diagnosed rheumatoid arthritis and no diabetes within the Geisinger Health System between January 1, 2003, and March 31, 2008.

Childhood dysfunctional voiding is differentially associated with urinary incontinence subtypes in women.

Purpose: To estimate the relationship between the history of childhood dysfunctional voiding and urinary incontinence (UI) in adult women with and without clinical UI and to estimate its relationship with stress, urge, and mixed UI.

Materials And Methods: Using a case-control study, we surveyed adult women with or without UI using a validated dysfunctional voiding questionnaire. Cases were clinically classified as stress, urge, or mixed UI.

Implementation of a stroke alert protocol in the emergency department: a pilot study.

Context: Although tissue plasminogen activator (tPA) is an effective treatment for stroke patients, it typically must be administered within 3 hours of symptom onset to substantially reduce morbidity and mortality. Because of this limited treatment window, it is essential for healthcare professionals to properly identify and quickly triage stroke patients.

Objective: To determine if implementation of a stroke alert protocol coupled with a limited education program will reduce arrival time to computed tomography scan time and treatment time for stroke patients in the emergency department (ED).

Door-to-balloon times under 90 min can be routinely achieved for patients transferred for ST-segment elevation myocardial infarction percutaneous coronary intervention in a rural setting.

Objectives: The purpose of this study was to demonstrate the feasibility of routine transfer of ST-segment elevation myocardial infarction (STEMI) patients to achieve percutaneous coronary intervention (PCI) in less than 90 min from presentation.

Background: Many PCI hospitals have achieved routine door-to-balloon times under 90 min for patients with STEMI presenting directly to the hospital. However, few patients transferred from a non-PCI center undergo PCI within 90 min of presentation.

A survey of clinicians addressing the approach to the management of severe sepsis and septic shock in the United States.

Purpose: Mortality in severe sepsis and septic shock (SS/SS) remains high. Surviving Sepsis Campaign (SSC) guidelines were published in 2004 with the goal of improving outcomes in SS/SS. We tested the hypothesis that adherence to SSC guidelines and management of patients with SS/SS were influenced by physician specialty.

Parity is not associated with urgency with or without urinary incontinence.

Introduction And Hypothesis: Evidence varies on the relation between parity and urgency or urge incontinence (UUI). We used data from the General Longitudinal Overactive Bladder Evaluation to determine whether differences in case definitions could account for variation in findings.

Methods: We simulated case criteria to correspond to studies of urgency, UUI, and parity using data from 1,880 patients.

Improved influenza and pneumococcal vaccination in rheumatology patients taking immunosuppressants using an electronic health record best practice alert.

Objective: To examine whether an electronic health record (EHR) best practice alert (BPA), a clinical reminder to help guideline adherence, improved vaccination rates in rheumatology patients receiving immunosuppressants. Guidelines recommend yearly influenza and pneumococcal vaccination with revaccination for patients age >65 years who are taking immunosuppressive medications.

Methods: A vaccination BPA was developed based on immunosuppressant treatment, age, and prior vaccinations.

ST-elevation myocardial infarction patients can be enrolled in randomized trials before emergent coronary intervention without sacrificing door-to-balloon time.

Background: Multicenter trials are necessary to compare the effectiveness of new drugs and devices for patients with ST-elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI). However, enrollment of STEMI patients in clinical trials could be detrimental to patients if it significantly delayed reperfusion therapy. We sought to determine whether STEMI patients treated with PCI could be enrolled in clinical trials without prolonging door-to-balloon times.