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The optimal treatment of submassive pulmonary embolism (PE) remains controversial, despite growing evidence to support a role for catheter-directed therapy in carefully selected patients.

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We conducted 2 feasibility studies to assess the performance and safety of the percutaneous left atrial appendage (LAA) transcatheter occlusion system for the prevention of stroke in high-risk patients with nonrheumatic atrial fibrillation. Results showed that percutaneous LAA occlusion can be performed using the device at acceptable risk. This procedure may be particularly useful for patients at increased risk of ischemic stroke with a contraindication to anticoagulation therapy.

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We assessed the histologic features of 526 carotid plaques from consecutive patients undergoing endarterectomy for symptomatic carotid stenosis and found a high prevalence of coronary-type plaque instability, with strong correlations between macrophage infiltration and both cap rupture and time since stroke. Temporal trends were much weaker after a transient ischemic attack than after a stroke, with a tendency for plaque features to persist for a longer period, suggesting heterogeneity in the underlying pathological mechanisms.

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Hydatid disease of the liver is endemic in some areas of the world but is rarely encountered in the United States. The disease is usually caused by the parasite Echinococcus granulosus. Physicians who work within multicultural communities must be aware of this disease and its treatment. We present the case of a 35-year-old Mexican woman who complained of chronic right upper-quadrant pain. Computed tomography scanning revealed a ring-enhancing lesion within the right lobe of the liver, suggesting the diagnosis of a hydatid cyst. Following a course of antiparasitic therapy, the cyst was surgically removed. Six months later, the patient was pain free.

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One important aspect of medical care for the elderly is enacting strategies to prevent infections before and during hospitalization.

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According to the American Diabetes Association (ADA), 23.6 million children and adults have diabetes (8% of the US population) and another 5.7 million cases remain undiagnosed. Epidemiologists predict that these statistics will double by 2030, further taxing the healthcare system. Medical expenditures are approximately 2.3 times higher for diabetic versus nondiabetic patients, and the annual cost of diabetes is estimated to be $116 billion.

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The vital cell stress protein, heat shock protein (Hsp)60, has recently been found in the circulation of healthy subjects over an extremely large concentration range. We performed an analysis of subjects with diabetes to determine whether Hsp60 is associated with biochemical markers of cardiovascular disease. Results showed that high circulating levels of Hsp60 are associated with clinically manifest cardiovascular disease. Hsp60 has cytokine-like actions, which may be responsible for this association.

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Closing thoughts regarding a discussion on improving the management of patients with treatment-resistant depression using newer treatment approaches in a more standardized fashion.

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Barton-Maxell details the importance of caring for stage A heart failure patients in the primary care setting.

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Techniques to identify and address EHR usability challenges.

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We evaluated the prognostic role of metabolic syndrome after myocardial infarction and found that metabolic syndrome correlated with an increased risk of cardiovascular events and death. The risk of developing diabetes decreased with weight loss in patients with metabolic syndrome. These results indicate that a more aggressive approach to the treatment of patients with metabolic syndrome, particularly with regard to changes in lifestyle, would be beneficial.

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The article by Mant and colleagues concerning the Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study is a welcomed addition to the now vast literature regarding the relative benefits of warfarin anticoagulation in patients with atrial fibrillation.

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The concept of treating malignancies using a regional approach originated in 1950, when Klopp and associates began to infuse nitrogen mustard into the arterial supply of various neoplasms.

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We evaluated a multiethnic cohort of subjects with nonrheumatic atrial fibrillation hospitalized over a 6-year period to determine the racial and ethnic differences in the risk of intracranial hemorrhage (ICH) and the effect of warfarin treatment on ICH risk. Treatment with warfarin was associated with a 2-fold greater risk of ICH in whites, a 4- to 5-fold greater risk in both blacks and Hispanics, and a 15-fold greater risk in Asians. After adjusting for established stroke risk factors and warfarin use, Asians were 4 times as likely as whites to have ICH, whereas blacks and Hispanics were twice as likely.

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We evaluated 100 subjects who underwent multislice computed tomography (MSCT) to assess the presence and severity of coronary artery disease (CAD) and to determine the occurrence of coronary events (including cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) over a follow-up period of 16 months.