Aim: Coronary angiography is indicated in many patients with known or suspected angina for the investigation of coronary artery disease (CAD). However, up to half of patients with symptoms of ischaemia have no obstructive coronary arteries (INOCA). This large subgroup includes patients with suspected microvascular angina (MVA) and/or vasospastic angina (VSA). Clinical guidelines relating to the management of patients with INOCA are limited. Uncertainty regarding the diagnosis of patients with INOCA presents a health economic challenge, both in terms of healthcare resource utilisation and of quality-of-life impact on patients. Methods: A cost-effectiveness analysis of the introduction of stratified medicine into the invasive management of INOCA, based on clinical and resource-use data obtained in the CorMicA trial, from a UK NHS perspective. The intervention included an invasive diagnostic procedure (IDP) of coronary vascular function during coronary angiography to define clinical endotypes to target with linked medical therapy. Outcomes of interest were mean total cost and QALY gain between treatment groups, and the incremental cost-effectiveness ratio. We undertook probabilistic sensitivity and scenario analyses. Results: The incremental cost per QALY gained at 12 months was 4500 pound (2937 pound, 33264) pound. Compared with a willingness-to-pay (WTP) threshold of 20,000 pound per QALY, the use of the IDP test is cost-effective. At this WTP threshold there is a 96% probability of the IDP being cost-effective, based on the uncertainty described by bootstrap analysis. Conclusions: The burden of INOCA, particularly in women, is known to be significant. These findings provided new evidence to inform this unmet clinical need. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

METHODS: We created an order set in our electronic medical record that automatically ordered two sputum collections testing for AFB smear, culture, and NAAT using Xpert MTB/RIF 8 hours apart. We analyzed the results of those tests for the two years before and aft er implementation. We calculated the earliest possible time to clearance of AII based on two negative NAAT tests or three negative AFB smears. We measured the accuracy of NAAT compared to AFB smear, the time to obtain results for each component of the order set, length of stay, and time on AII. We used parametric and non-parametric independent sample tests to compare the differences between patients who used the order set versus those who did not.

Chronic kidney disease (CKD) occurs frequently after liver transplantation (LT) and is associated with significant morbidity and mortality. Thus, there is a pressing need to identify characteristics and biomarkers diagnostic of CKD to enable early diagnosis allowing preemptive interventions, as well as mechanistic insights into the progression from kidney injury to irreversible kidney failure. We analyzed 342 patients who had baseline glomerular filteration rate (GFR) >60 at the time of LT and are now >3 years post-LT. Risk factors for post-LT CKD were compared between three different groups defined by current GFR: >90 (n = 40), 60-90 (n = 146) and <60 (n = 156) mL/min. Age, cyclosporine use and pre-LT GFR were independently associated with new onset CKD. A subset (n = 64) without viral/immune disease or graft dysfunction underwent multianalyte plasma proteomic evaluations for correlation with CKD. Plasma proteomic analysis of two independent cohorts, test (n = 22) and validation (n = 42), identified 10 proteins highly associated with new onset CKD. In conclusion, we have identified clinical characteristics and a unique plasma proteomic signature correlating with new onset CKD after LT. These preliminary results are currently being validated in a prospective, multicenter study to determine if this signature precedes the onset of CKD and resolves with early interventions aimed at preserving kidney function.

Luminex Corp. has developed a multiplex assay system (FlowMetrix) that incorporates the most advanced digital signal processing technology into an established assay platform, enhancing its speed, economy, sensitivity, precision, and throughput. Microsphere-based assays are now multiplexed assays, capable of performing up to 64 discrete tests in a single tube from the same sample at the same time. The flow cytometer becomes an absolute measurement instrument, acquiring and analyzing the data generated by thousands of microspheres every second, and reporting the values in real time. With applications in routine immunoassay and advanced molecular diagnostics, this system should provide significant benefit to the clinical laboratory today and in the future.