Racial disparities in total ankle arthroplasty utilization and outcomes

IntroductionThe objective of this study was to examine the racial disparities in total ankle arthroplasty (TAA) utilization and outcomes.MethodsWe used the National Inpatient Sample (NIS) to study the time-trends. Race was categorized as White and Black. Utilization rates were calculated for the U.S. general population per 100,000. Hospital length of stay, discharge disposition and mortality after TAA were assessed. We used the Cochran Armitage trend test to assess time-trends from 1998 to 2011 and chi-square test to compare TAA utilization. We used analysis of variance or chi-squared test to compare the characteristics of Whites and Blacks undergoing TAA and logistic regression to compare mortality, length of stay and discharge to home versus medical facility.ResultsThe mean ages for Whites undergoing TAA were 62 years and for Blacks was 52 years. Significant racial disparities were noted in TAA utilization rates (/100,000) in 1998, 0.14 in Whites vs. 0.07 in Blacks (P < 0.0001; 2-fold) and in 2011, 1.17 in Whites vs. 0.33 in Blacks (P < 0.0001; 4-fold). Racial disparities in TAA utilization increased significantly from 1998 to 2011 (P < 0.0001). There was a trend towards statistical significance for the difference in the length of hospital stay in Blacks vs. Whites (52.9% vs. 44.3% with length of hospital stay higher than the median; P = 0.08). Differences in the proportion discharged to an inpatient medical facility after TAA, 16.6% Blacks vs. 13.4% Whites, were not significant (P = 0.36).ConclusionsThis study demonstrated significant racial disparities with lower TAA utilization and suboptimal outcomes in Blacks compared to Whites. Further studies are needed to understand the mediators of these disparities and to assess whether these mediators can be targeted to reduce racial disparities in TAA.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-015-0589-2) contains supplementary material, which is available to authorized users.     

Natural radioactivity in Indian tea

Summary The paper presents the results of measurements on tea samples collected during 1962 and 1973–1983 period for their natural radioactivity content. The radioisotopes studied under this programme are radium-226, thorium-228, and potassium-40. Tea was found to contain higher concentration of these radionuclides compared to other foodstuffs having vegetative origin. Interpretation for higher concentrations in tea compared to other foodstuffs is briefly given on the basis of agroclimatic conditions.     

Confirmation of structure of the flavonol glucoside tambuletin

The structure of tambuletin, present in seeds of Xanthoxylum species has been confirmed as the 8-glucoside of gossypetin 7,4′-dimethyl ether.     

N-terminal groups of buffalo thyroglobulin

N-Terminal analysis of purified buffalo thyroglobulin by the fluorodinitrobenzene method of Sanger yielded about 1.5 moles of DNP-glutamic acid per mole of buffalo thyroglobulin. No water-soluble DNP-amino acid was detectable as N-terminal. The presence of glutamic acid has been confirmed by Edman degradation and characterization of the PTH-amino acid in different solvent systems, and also after regeneration of free amino acid from PTH-amino acid in butanol-acetic acid-water (4:1:5, v/v) system. This is in contrast to the occurrence of aspartic acid or asparagine as N-terminals for several other mammalian thyroglobulins.     

Alternate pleckstrin homology domain orientations regulate dynamin-catalyzed membrane fission

The self-assembling GTPase dynamin catalyzes endocytic vesicle scission via membrane insertion of its pleckstrin homology (PH) domain. However, the molecular mechanisms underlying PH domain–dependent membrane fission remain obscure. Membrane-curvature–sensing and membrane-curvature–generating properties have been attributed, but it remains to be seen whether the PH domain is involved in either process independent of dynamin self-assembly. Here, using multiple fluorescence spectroscopic and microscopic techniques, we demonstrate that the isolated PH domain does not act to bend membranes but instead senses high membrane curvature through hydrophobic insertion into the membrane bilayer. Furthermore, we use a complementary set of short- and long-distance Förster resonance energy transfer approaches to distinguish PH-domain orientation from proximity at the membrane surface in full-length dynamin. We reveal, in addition to the GTP-sensitive “hydrophobic mode,” the presence of an alternate, GTP-insensitive “electrostatic mode” of PH domain–membrane interactions that retains dynamin on the membrane surface during the GTP hydrolysis cycle. Stabilization of this alternate orientation produces dramatic variations in the morphology of membrane-bound dynamin spirals, indicating that the PH domain regulates membrane fission through the control of dynamin polymer dynamics.     

Hypothermia resulting in characteristic ECG changes mimicking an acute myocardial infarction: Osborn waves and atrial fibrillation

Hypothermia can cause several ECG changes which can be mistaken for other cardiac diseases, most importantly acute transmural ischaemia. These ECG changes correlate strongly with the degree of hypothermia and the prognosis of the patient. This brief report presents a 32-year-old male who was seen after a drowning accident. After resuscitation a 12-lead electrocardiogram showed changes typical for hypothermia: atrial fibrillation and Osborn waves. The ECG of the patient normalised after rewarming.