Appropriateness of Diagnostic Coronary Angiography as a Measure of Cardiac Ischemia Testing in Non-Emergency Patients – A Retrospective Cross-Sectional Analysis

BackgroundAdequate application of guidelines concerning non-invasive ischemia testing (NIIT) could avoid inappropriate invasive testing in non-emergency situations. Hardly any data exists regarding frequency and appropriateness of diagnostic coronary angiography (CA). The aim of this study was to evaluate the proportion and predictors of patients without NIIT prior to elective purely diagnostic CA without therapeutic intervention.MethodsRetrospective cross-sectional analysis of insurance claims data from 2012 and 2013. Patients <18 years, acute cardiac ischemia and emergency procedures and patients insured in a managed care model were excluded from analysis. The proportion of patients with NIIT procedures (stress-ECG, transthoracic echocardiography, stress echocardiography, scintigraphy, computer tomography, heart MRI) undertaken within two months before diagnostic CA was assessed. Multiple logistic regression analysis was applied to investigate independent determinants for receiving NIIT.Findings2714 patients were included for analysis. 37.5% (1018) did not receive any NIIT before CA. When high risk patients (patients having received therapeutic cardiac intervention within one month after or 18 months prior to diagnostic CA, n = 766) were excluded 34.3% (669) did not receive NIIT before CA. High risk status as well as >6 chronic comorbidities were independently associated with a lower proportion of NIIT (p<0.0001, OR 0.607 and p = 0.0041, OR 0.648), when additionally controlled for age, sex, language area, insurance coverage, inpatient treatment, cardiovascular medication and lower number of chronic comorbidities. Age (p<0.05, OR 1.009) and intake of oral antiplatelet therapy (p<0.0001, OR 1.914) were independently associated with a higher proportion of NIIT when controlled for the mentioned cofactors.ConclusionsOur data show that despite the existence of guidelines a substantial overuse of a potentially harmful and inappropriate diagnostic intervention is performed suggesting the need for improvement of diagnostic pathways prior to invasive testing.     

Progress and promise in understanding the genetic basis of common diseases

Susceptibility to common human diseases is influenced by both genetic and environmental factors. The explosive growth of genetic data, and the knowledge that it is generating, are transforming our biological understanding of these diseases. In this review, we describe the technological and analytical advances that have enabled genome-wide association studies to be successful in identifying a large number of genetic variants robustly associated with common disease. We examine the biological insights that these genetic associations are beginning to produce, from functional mechanisms involving individual genes to biological pathways linking associated genes, and the identification of functional annotations, some of which are cell-type-specific, enriched in disease associations. Although most efforts have focused on identifying and interpreting genetic variants that are irrefutably associated with disease, it is increasingly clear that—even at large sample sizes—these represent only the tip of the iceberg of genetic signal, motivating polygenic analyses that consider the effects of genetic variants throughout the genome, including modest effects that are not individually statistically significant. As data from an increasingly large number of diseases and traits are analysed, pleiotropic effects (defined as genetic loci affecting multiple phenotypes) can help integrate our biological understanding. Looking forward, the next generation of population-scale data resources, linking genomic information with health outcomes, will lead to another step-change in our ability to understand, and treat, common diseases.     

Interim Responses of Floodplain Wetland Vegetation to Phase I of the Kissimmee River Restoration Project: Comparisons of Vegetation Maps from Five Periods in the River's History

Phase I of the Kissimmee River Restoration Project (KRRP) reestablished intermittent inundation of the river's floodplain by backfilling 12 km of the C‐38 flood control canal in 2001. We compared floodplain vegetation maps based on 2003 and 2008 aerial imagery (2 and 7 years following completion of Phase I, respectively) to vegetation maps from 1954 (pre‐channelization), 1974 (3 years after channelization), and 1996 (25 years after channelization) to evaluate broad‐scale vegetation responses to Phase I restoration. Results indicate that the extent of wetland plant communities expanded rapidly, more than doubling in area within 2 years after completion of Phase I, and that by 2008 wetlands had nearly recovered to pre‐channelization levels. However, full reestablishment of the pre‐channelization wetland mosaic has not yet occurred. Prior to channelization, much of the floodplain was dominated by a broadleaf marsh (BLM) community associated with extended, deep annual flooding, while shorter‐hydroperiod communities dominated the floodplain in 2003 and 2008. Prior to restoration construction, the reestablishment of BLM was predicted to be slow because suitable hydrology is dependent on project components that will not be in place until all restoration components are completed (projected for 2019). Hydrologic data indicate that the duration and variability of floodplain inundation have not yet achieved restoration targets over the entire Phase I study area. Other factors affecting vegetation responses are likely involved, including the age and viability of soil seed banks, the rarity of relict propagule sources following the channelized period, and competition from an invasive wetland shrub species.     

Plant species dominance shifts across erosion edge–meadow transects in the Swiss Alps

While exerting no obvious function under “average” environmental conditions, the presence of certain plant specialists becomes crucial in the event of a complete failure of a community due to severe disturbance such as landslides. Plants capable of growing at erosion edges may act as potential edge-engineers by coping with unstable ground and stabilizing the soil with their roots. We hypothesized that life conditions at erosion edges select for a particular set of specialists or species with specific traits, the identification of which was the aim of the study. Across 17 small-scale transects (0.40 × 1.60 m) from intact meadows to landslide edges (Ursern Valley, Swiss Alps, c. 1,600 m a.s.l.), we quantified plant species abundance by the point intercept method and characterized growth conditions based on Landolt’s indicator values, leaf δ¹³C, and volumetric soil moisture in the uppermost soil layers. We observed a clear change of plant species composition and relative abundance from the meadow to the edge, presumably induced by the 25 % lower soil moisture and microclimatic exposure. Species richness at the edge was two-thirds of that in the meadow, but was positively correlated with species richness of the adjacent meadow. Species with “edge-preference” had either (1) rolled or festucoid leaves like Festuca spp., Avenella flexuosa and Nardus stricta, or (2) small, scleromorphic leaves like Vaccinium vitis-idaea, Calluna vulgaris and Thymus ssp. Graminoids with rolled/festucoid leaves were found to be the most dominant edge-specialists. The grass Festuca valesiaca s.l. emerged as the most dominant plant species at the edge, having an 11-times higher cover at the edge than in the meadow. In this montane grassland, a single species contributes to the stabilization of erosion edges and may be regarded as a potential keystone species for slope stability and regeneration after landslides even its role has not so far been established.     

Localisation of the gene coding for the haemopoietic stem cell antigen CD34 to chromosome 1q32

Summary Using in situ hybridisation, we have localised the CD34 gene to chromosome 1 in the region q32.