The impact of coronary calcium score as an addition to myocardial perfusion imaging in altering clinical management (ICCAMPA trial).

Introduction: AIM: Myocardial perfusion imaging (MPI) is a key tool for the identification and risk stratification of patients with coronary artery disease. The use of a coronary calcium score further adds to prognostic data above MPI alone. In this study, our aim was to evaluate the extent to which the use of a coronary artery calcium (CAC) score, when co-reported with MPI, impacts changes in clinical management in patients without a history of coronary artery disease (CAD) undergoing functional imaging.

Molecular Outcome, Prediction, and Clinical Consequences of Splice Variants in COL1A1, Which Encodes the proα1(I) Chains of Type I Procollagen.

Approximately 10%-20% of germline pathogenic variants alter mRNA splicing, with phenotypes often dependent on the stability of the mRNA produced by the mutant allele. To better understand the relationships between genotype, mRNA splicing, and phenotype, we examined clinical and molecular data from 243 probands with osteogenesis imperfecta (OI) representing 145 unique splicing variants within the type I procollagen gene, COL1A1. All individuals with IVSX-1G>A mutations had OI type I because the substitution shifted the splice acceptor site 1 nt downstream and destabilized the mRNA.

Gastronomic nostalgia: Salvadoran immigrants' cravings for their ideal meal.

Immigrants typically express cravings for the food of their homeland, but for undocumented and temporarily documented Salvadoran immigrants living in the United States, the hunger for their traditional cuisine is particularly poignant. To cope with a history of food scarcity in El Salvador and their documentation liminality in the United States, Salvadoran immigrants in this study crave symbolically rich foods. Salvadoran women provide these foods by recreating for their families an ideal Salvadoran meal into which they "groom" meanings of an imagined past and a hoped for present and future.

Degradation of a pharmaceutical in HPLC grade methanol containing trace level formaldehyde.

An anomalous peak was observed in the HPLC/UV analysis of a developmental drug product. High resolution LC/MS revealed that the mass of this degradant was 12 Da greater than the drug substance, corresponding to a net gain of a single carbon atom. The degradant was reproduced by incubating the drug substance with formaldehyde, followed by isolation using normal phase chromatography and structure elucidation by NMR.

Critical pathway for an aggressive diagnostic strategy for patients who present with chest pain but a nondiagnostic electrocardiogram to the emergency department.

Background: The prolonged length of stay for patients who seek treatment in the emergency department with chest pain and normal or nondiagnostic electrocardiogram has led to a backlog of patients in the emergency department and the telemetry unit. Correct early management requires risk stratification processes that can effectively separate the majority of these patients into low-risk, low/intermediate-risk, intermediate-risk, and high-risk subsets.

Methods And Results: Patients who seek treatment in the emergency department with chest pain are risk-stratified into low-risk, low/intermediate-risk, and high-risk categories using a Risk Score to determine who would benefit from immediate exercise stress testing.

ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association.

Under the auspices of the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC), an appropriateness review was conducted for radionuclide cardiovascular imaging (RNI), specifically gated single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). The review assessed the risks and benefits of the imaging test for several indications or clinical scenarios and scored them based on a scale of 1 to 9, where the upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The mid range (4 to 6) implies that the test may be generally acceptable and may be a reasonable approach for the indication.

Diagnose chest pain for less with early risk stratification and SPECT imaging protocol.

Why waste time in the diagnosis of chest pain? A diagnostic strategy of SPECT imaging and exercise tolerance testing halves the medical resources required to rule out heart attacks, a small-scale study shows. A key to success is having a clear-cut system for identifying lower-risk patients, the study's lead author says.

An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiograms: Results from a randomized trial.

Study Objective: Conventional emergency department testing strategies for patients with chest pain often do not provide unequivocal diagnosis of acute coronary syndromes. This study was conducted to determine whether the routine use of single photon emission computed tomography (SPECT) imaging at rest and early exercise stress testing to assess intermediate-risk patients with chest pain and no ECG evidence of acute ischemia will lead to earlier discharges, more discriminate use of coronary angiography, and an overall reduction in average costs of care with no adverse clinical outcomes.

Methods: All patients in this study had technetium 99m tetrofosmin SPECT imaging at rest and were randomly assigned to either a conventional (results of the imaging test blinded to the physician) or perfusion imaging-guided (results of the imaging test unblinded to the physician) strategy.

An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiograms: results from a randomized trial.

Study Objective: Conventional emergency department testing strategies for patients with chest pain often do not provide unequivocal diagnosis of acute coronary syndromes. This study was conducted to determine whether the routine use of single photon emission computed tomography (SPECT) imaging at rest and early exercise stress testing to assess intermediate-risk patients with chest pain and no ECG evidence of acute ischemia will lead to earlier discharges, more discriminate use of coronary angiography, and an overall reduction in average costs of care with no adverse clinical outcomes.

Methods: All patients in this study had technetium 99m tetrofosmin SPECT imaging at rest and were randomly assigned to either a conventional (results of the imaging test blinded to the physician) or perfusion imaging-guided (results of the imaging test unblinded to the physician) strategy.

Entoptic foveal avascular zone measurement and diabetic retinopathy.

Background: Entoptic visualization of the foveal avascular zone (FAZ) provides a noninvasive method for measurement of the FAZ. To determine if repeatability of measurement with this technique is good enough to monitor changes in diabetic retinopathy, we quantify (1) the repeatability of entoptic FAZ measurement in healthy subjects and (2) the relationship between measured FAZ diameter and the severity of retinopathy.

Methods: (1) To determine FAZ measurement repeatability, 10 healthy adults entoptically measured their FAZ diameters in 11 separate testing sessions.

Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms.

Objectives: We sought to evaluate the clinical use and cost-analysis of acute rest technetium-99m (Tc-99m) tetrofosmin single-photon emission computed tomographic (SPECT) myocardial perfusion imaging in patients with chest pain and a normal electrocardiogram (ECG).

Background: Current approaches used in emergency departments (EDs) for treating patients presenting with chest pain and a nondiagnostic ECG result in poor resource utilization.

Methods: Three hundred fifty-seven patients presenting to six centers with symptoms suggestive of myocardial ischemia and a nondiagnostic ECG underwent Tc-99m tetrofosmin SPECT during or within 6 h of symptoms.

Potential cost effectiveness of initial myocardial perfusion imaging for assessment of emergency department patients with chest pain.

Previous investigations have confirmed the diagnostic and predictive usefulness of initial single-photon emission computed tomography (SPECT) myocardial perfusion imaging using technetium-99m sestamibi in the evaluation of emergency department patients with chest pain. Patients with a normal SPECT perfusion scan performed during chest pain have an excellent short-term prognosis, and may be candidates for expeditious cardiac evaluation or outpatient management. However, there are limited data regarding the cost effectiveness of this technique.

The early diagnosis and treatment of non-ST-segment elevation acute ischemic syndromes: the need for a new approach.

The diagnosis and treatment of ST-segment elevation myocardial infarction (MI) has been well defined by many multicenter trials. However, the treatment and diagnosis of non-ST-segment elevation MI is much less understood. Single photon emission computerized tomographic perfusion imaging shows great promise in risk-stratifying patients into low-risk and high-risk subsets when 12-lead ECG and initial cardiac enzymes are normal or nondiagnostic.

Ninety-day follow-up of patients in the emergency department with chest pain who undergo initial single-photon emission computed tomographic perfusion scintigraphy with technetium 99m-labeled sestamibi.

Background: Patients in the emergency department with typical chest pain and a normal or nondiagnostic electrocardiogram have a 10% to 20% risk of nonfatal myocardial infarction. These patients can be stratified into groups of very low and very high risk for inpatient adverse cardiac events on the basis of initial 99mTc-labeled sestamibi single-photon emission computed tomographic (SPECT) perfusion imaging performed during symptoms. However, the intermediate or posthospital discharge prognosis of such patients has not been reported.

Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain.

Objectives: The purpose of this investigation was to evaluate the practicality and short-term predictive value of acute myocardial perfusion imaging with technetium-99m sestamibi in emergency room patients with typical angina and a normal or nondiagnostic electrocardiogram (ECG).

Background: Accuracy of emergency room chest pain assessment may be improved when clinical and ECG variables are used in conjunction with acute thallium-201 myocardial perfusion imaging. Technetium-99m sestamibi is a new radioisotope that is taken up by the myocardium in proportion to blood flow, but unlike thallium-201, it redistributes minimally after injection.

Posterior subluxations of the medial and lateral tibiofemoral compartments. An in vitro ligament sectioning study in cadaveric knees.

We report for the first time the abnormal increases in posterior subluxation of the medial and lateral tibial plateaus after sectioning the posterolateral structures and posterior cruciate ligament. We applied specific forces and moments to the knees of seven cadaveric whole lower limbs and measured the position of the tibia at which the ligaments and the geometry of the joint limited motion. Removal of only the posterolateral structures resulted in an average increase in posterior translation of the lateral tibial plateau of 8.

Development of a culturally appropriate food guide for pregnant Caribbean immigrants in the United States.

Communities with large Caribbean immigrant populations in Boston, Mass, have alarmingly high rates of both infant mortality and low-birth-weight infants. Although the federally funded Special Supplemental Food Program for Women, Infants, and Children (WIC) has been shown to increase infant birth weight and reduce fetal mortality, observations made in this study show that pregnant Caribbean immigrants who enrolled in WIC did not receive comprehensive, culturally appropriate nutrition counseling. Public health nutritionists and other health care providers used the Basic Four food group model as the basis for their dietary recommendations.