Heartland Research Associates

Critical mitral valve stenosis due to a failed bioprosthetic valve is associated with significant morbidity and mortality, with the transcatheter Valve-in-Valve (ViV) approach becoming a popular treatment option. We present a case of cardiogenic shock secondary to a stenotic mitral bio-prosthetic valve. The Heart team was consulted; the patient was a high-risk surgical candidate for valve replacement. He required venoarterial extracorporeal membrane oxygenation as a bridge to definitive therapy. The patient underwent a successful urgent transcatheter mitral ViV procedure with a trans-septal approach. Follow-up echocardiography showed significant improvement in mitral valve dynamics. Recently emerging transcatheter approaches for mitral ViV implantation after balloon valvuloplasty into a failed mitral valve prosthesis are technically feasible in high-risk patient populations and should be considered over re-operative mitral valve surgery.

Type 1 diabetes (T1D) is an autoimmune disease in which pancreatic islet β-cells are attacked by the immune system, resulting in insulin deficiency and hyperglycemia. One of the top non-synonymous single-nucleotide polymorphisms (SNP) associated with T1D is in the interferon-induced helicase C domain-containing protein 1 ( IFIH1 ), which encodes an anti-viral cytosolic RNA sensor. This SNP results in an alanine to threonine substitution at amino acid 946 (IFIH1 A946T ) and confers an increased risk for several autoimmune diseases, including T1D. We hypothesized that the IFIH1 A946T risk variant, ( IFIH1 R ) would promote T1D pathogenesis by stimulating type I interferon (IFN I) signaling leading to immune cell alterations. To test this, we developed Ifih1 R knock-in mice on the non-obese diabetic (NOD) mouse background, a spontaneous T1D model. Our results revealed a modest increase in diabetes incidence and insulitis in Ifih1 R compared to non-risk Ifih1 ( Ifih1 NR ) mice and a significant acceleration of diabetes onset in Ifih1 R females. Ifih1 R mice exhibited a significantly enhanced interferon stimulated gene (ISG) signature compared to Ifih1 NR , indicative of increased IFN I signaling. Ifih1 R mice exhibited an increased frequency of plasma cells as well as tissue-dependent changes in the frequency and activation of CD8 + T cells. Our results indicate that IFIH1 R may contribute to T1D pathogenesis by altering the frequency and activation of immune cells. These findings advance our knowledge on the connection between the rs1990760 variant and T1D. Further, these data are the first to demonstrate effects of Ifih1 R in NOD mice, which will be important to consider for the development of therapeutics for T1D.

Chest pain is one of the common complaints a patient presents to the healthcare provider. It needs prompt evaluation to determine the cause and origin. Angina occurs when myocardial oxygen demand exceeds oxygen supply; the clinical manifestation is often chest discomfort. Atherosclerotic disease is the major cause of angina. However, several non-atherosclerotic conditions have been studied and reported in the literature that causes angina in rarity. We describe a case of coronary artery fistula (CAF) likely causing angina.

Based on these percentages, approximately 10% of patients present with neurologic symptoms and without chest pain. Neurologic manifestation in aortic dissection included ischemic stroke (16%), ischemic neuropathy (11%), syncope (6%), seizures (3%), hypoxic encephalopathy (2%), and spinal cord ischemia (1%).

Background. Highly pathogenic avian influenza H5N1 viruses remain a threat to human health, with potential to become pandemic agents.Methods. This phase III, placebo-controlled, observer-blinded study evaluated the immunogenicity, cross-reactivity, safety, and lot consistency of 2 doses of oil-in-water (AS03A) adjuvanted H5N1 A/Indonesia/05/2005 (3.75 μg hemagglutinin antigen) prepandemic candidate vaccine in 4561 adults aged 18–91 years.Results. Humoral antibody responses in the H5N1 vaccine groups fulfilled US and European immunogenicity licensure criteria for pandemic vaccines in all age strata 21 days after the second dose. At 6 months after the administration of the primary dose, serum antibody seroconversion rates continued to fulfill licensure criteria. Neutralizing cross-clade immune responses were demonstrated against clade 1 A/Vietnam/1194/2004. Consistency was demonstrated for 3 consecutive H5N1 vaccine lots. Temporary injection-site pain was more frequent with H5N1 vaccine than placebo (89.3% and 70.7% in the 18–64 and ≥65 years strata vs 22.2% and 14.4% in the placebo groups). Unsolicited adverse event frequency, including medically attended and serious events, was similar between groups through day 364.Conclusions. In adults and elderly adults, AS03A-adjuvanted H5N1 candidate vaccine was highly immunogenic for A/Indonesia/05/2005, with cross-reactivity against A/Vietnam/1194/2004. Temporary injection site reactions were more frequent with H5N1 vaccine than placebo, although the H5N1 vaccine was well tolerated overall.Clinical Trials Registration. NCT00616928.

Management strategies for recruiting and retaining personnel in this time of critical workforce crisis must include attractive and equitable rewards and recognition for service and responsibility.A study was performed in 2002 to assess the compensation levels of cytotechnologists of differing:1. years of experience, 2. job title, and 3. gender.The trends found in this survey can also be applied to the general laboratory workforce, including medical technologists, histotechnologists, and others.All clinical laboratory personnel experience similar salary administration policies, even though the actual pay ranges differ.Previous cytotechnologist salary surveys, 1-3 as well as clinical laboratory personnel salary survey results, 4 have been published.However, these surveys have not explored the potential existence of an inequitable compensation system for laboratory personnel, nor discussed its impact. MethodsA national survey of cytotechnologists was distributed by mail to the entire current membership of the American Society for Cytotechnology (ASCT) in July 2002 with the dues renewal statements.The survey consisted of 11 questions asking for demographic, salary, experience, and job vacancy data.Participants mailed or faxed their responses to ASCT Headquarters in Raleigh, NC.Five hundred sixty-three completed surveys were returned by the deadline for an 88% response rate.Responses were entered into a computer spreadsheet file from which calculations were performed.Participants were grouped into 10 regions of the United States to assess possible geographic differences.Salary data was compiled for 8 levels of experience (in years), 3 job titles, and gender.To collect gender data, all 88 male survey participants were blindly matched with females of equal years of experience, job title, geographic location, and employer type.Average salaries of both genders were then independently calculated. ResultsCytotechnologist salary ranges for each of 10 geographic regions of the country and position vacancy data was collected and published in the American Society for Cytotechnology's Journal of Cytotechnology. 5 Greater differences in cytotechnologist salaries are seen between geographic regions than between job title and years of experience.The lowest reported salary for staff cytotechnologists in each of the 10 national regions varies by 34% (from $18.00 to $24.04 per hour).The highest reported staff cytotechnologist salary in each of the 10 regions varies by 64% (from $27.40 to $45.00 per hour).The highest average staff cytotechnologist salary ($34.74 per hour) is seen in the region defined as California/Hawaii.The quantity of experience reported by all survey participants is shown in F1.All levels of experience are represented in this survey.The single greatest group of participants has between 26 and 30 years of experience.Of interest is the fact Cytotechnologist Salary Inequities for Experience, Job Title, and Gender