Notes

Organocatalytic Asymmetric Dearomatization Response for the Synthesis associated with Axial Chiral Allene-Derived Naphthalenones Having Quaternary Stereocenters.
Ventricular arrhythmias are common in the early period after myocardial infarction (MI), with the highest risk occurring in the immediate postinfarct window. The wearable cardioverter-defibrillator (WCD) has been proven to have efficacy in treating sudden cardiac arrest in patients soon after MI. However, data concerning clinical and health economic outcomes of WCD usage among Medicare patients have not been evaluated. The aim of this study was therefore to investigate the clinical and health economic impacts of WCD use among Medicare patients hospitalized for MI. A 5% sample of Medicare's Standard Analytical Files (2010-2012) was used to identify patients. Beneficiaries with an acute inpatient admission for acute MI were stratified by WCD presence and absence, respectively. Baseline clinical history, all-cause mortality, and the total cost of health-care expenditures over one year were collected. In total, 16,935 patients were included in the final analysis; of these, 89 were placed in the WCD group and 16,846 were placed in the non-WCD group. Overall, WCD patients were younger (70 versus 74 years of age; p less then 0.001), more likely to be male (74.2% versus 57.4%; p = 0.002), and more likely to have congestive heart failure and/or ventricular arrhythmias prior to the indexed acute MI. At 30 days, the mortality rate in the WCD group (not reported due to volume less then 11 Medicare beneficiaries) was lower in comparison with the non-WCD group (10.4%; p = 0.18). At one year, the adjusted mortality rates were 11.5% for the WCD group and 19.8% for the non-WCD group (hazard ratio 0.46; p = 0.017). For the WCD group, the one-year incremental cost-effectiveness ratio was $12,373 per life-year gained. Among Medicare beneficiaries, WCD use after an acute MI was associated with better 30-day and one-year survival. Thus, our findings indicate that WCD use was cost-effective in the present sample of Medicare patients.This is a report of a patient with a history of hypertension and myocardial infarction and a left ventricular ejection fraction of 35% who suffered a syncopal event. Her admitting electrocardiogram was compatible with her old myocardial infarction, an anteroseptal left ventricular aneurysm, left ventricular hypertrophy, and short-QT syndrome. The present report discusses how each of these might contribute individually and to some extent synergistically to producing syncope. She was treated with an implantable cardioverter-defibrillator (ICD), though she did not meet strict Multicenter Automatic Defibrillator Implantation Trial (MADIT), MADIT II, and Multicenter Unsustained Tachycardia Trial (MUSTT) patient characteristics. Her implant, however, was consistent with the 2014 Heart Rhythm Society/American College of Cardiology/American Heart Association consensus document regarding patients who do not match clinical trial enrollees but for whom ICD consideration is appropriate.Capture management algorithms in current cardiac implantable electronic devices (CIEDs) can enhance device performance and battery longevity. Although generally safe, these algorithms have on rare occasions been implicated in the onset of significant complications, especially in pacemaker-dependent patients. CIEDs implanted in patients with postoperative congenital heart disease (CHD) often require epicardial pacing leads rather than transvenous leads; unfortunately, epicardial leads can experience higher rates of malfunction. We herein report on a young adult with a status of postoperative CHD and complete atrioventricular block following implantation of a epicardial dual-chamber cardiac resynchronization therapy pacemaker (CRT-P; Consulta®; Medtronic, Minneapolis, MN, USA) who developed frequent periods of asystole after malfunction of one of the ventricular leads. The underlying cause of asystole was found to be due to the atrial capture management (ACM) algorithm of the CRT-P device, temporarily converting biventricular to right ventricular-only pacing as part of the algorithm. This case highlights implications of the ACM algorithm in devices with a similar platform for pacemaker-dependent patients.Atrial fibrillation (AF) is often treated with antiarrhythmic drugs (AADs) or catheter ablation. In a unique subset of patients, AF can convert to atrial flutter (AFL) after the initiation of an AAD. It has previously been shown that, in this subset of patients, cavotricuspid isthmus (CTI) ablation followed by the continuation of the AAD regimen has an unusually high rate of successfully maintaining sinus rhythm. This is an underrecognized approach toward rhythm management in such patients. However, the reason(s) for such a high degree of efficacy with this hybrid therapeutic approach are unclear. We suggest that conversion from AF to AFL selects for a group of patients in whom AF is particularly responsive to the effects of the AAD. Since CTI ablation is essentially curative of AFL, the combination of both techniques results in a high efficacy of sinus rhythm maintenance. Further investigation is required to confirm these hypotheses.Phenome Wide Association Studies (PheWAS) enables phenome-wide scans to discover novel associations between genotype and clinical phenotypes via linking available genomic reports and large-scale Electronic Health Record (EHR). Data heterogeneity from different EHR systems and genetic reports has been a critical challenge that hinders meaningful validation. To address this, we propose an FHIR-based framework to model the PheWAS study in a standard manner. We developed an FHIR-based data model profile to enable the standard representation of data elements from genetic reports and EHR data that are used in the PheWAS study. As a proof-of-concept, we implemented the proposed method using a cohort of 1,595 pan-cancer patients with genetic reports from Foundation Medicine as well as the corresponding lab tests and diagnosis from Mayo EHRs. A PheWAS study is conducted and 81 significant genotype-phenotype associations are identified, in which 36 significant associations for cancers are validated based on a literature review.Non-lattice subgraphs are often indicative of structural anomalies in ontological systems. Visualization of SNOMED CT's non-lattice subgraphs can help make sense of what has been asserted in the hierarchical ("is-a") relation. More importantly, it can demonstrate what has not been asserted, or "is-not-a," using Closed-World Assumption for such subgraphs. A feature-rich web-based interactive graph-visualization engine called WINS is introduced, for supporting non-lattice based analysis of ontological systems such as SNOMED CT. A faceted search interface is designed for querying conjunctively specified non-lattice subgraphs. PD98059 To manage the large number of possible nonlattice subgraphs, MongoDB is used for storing and processing sets of concepts, relationships, and subgraphs, as well as for query optimization. WINS' interactive visualization interface is implemented in the open source package D3.js. 14 versions of SNOMED CT (US editions from March 2012 to September 2018), with about 170,000 subgraphs in each version, were extracted and imported into WINS.
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