Objective To estimate the impact of the insurance expansion in 2006 on use of knee and hip replacement procedures by race/ethnicity, area income, and the use of hospitals that predominantly serve poor people ("safety net hospitals").

In selected patients with RSVA, PC using modified double-disc occluders may become a valuable alternative to surgery with encouraging immediate outcomes and midterm results.

Hispanics and blacks face higher barriers to outpatient care access; the higher barriers among Hispanics (but not blacks) seem mediated by SES, lack of insurance, cost barriers, and limited provider availability.

Context Evidence on variability in emergency medical services (EMS) use is limited. Objective To obtain national evidence on geographic variation in the use of ambulance transport to the emergency department (ED) among Medicare enrollees, and assess the role of health status, socioeconomic status (SES) and provider availability. Design, Setting, and Participants We used 2010 Medicare claims data for a random sample of 999,999 enrollees aged 66 and older, and identified ambulance transport and ED use. Main Outcomes Measures Number of ambulance transports to ED per 100 person-years (ambulance transport rate) and proportion (%) of ED visits by ambulance transport by hospital referral regions (HRR). Results The national ambulance transport rate was 22.2 and the overall proportion of ED visits by ambulance was 36.7%. Relative to HRRs in the lowest rate quartile, HRRs in the highest quartile had a 75% higher ambulance transport rate (incidence rate ratio (IRR), 1.75; 95% confidence interval (CI) = [1.69, 1.81]) and a 15.5% higher proportion of ED visits by ambulance (IRR, 1.155; 95% CI = [1.146, 1.164]). Adjusting for health status, SES, and provider availability reduced quartile 1 vs. quartile 4 difference in ambulance transport rate by 43% (IRR, 1.43; 95% CI = [1.38, 1.48]) and proportion of ED visits by ambulance by 7% (IRR, 1.145; 95% CI = [1.135, 1.155]). Among the three covariate domains, health status was associated with the largest variability in ambulance transport rate (30.1%), followed by SES (12.8%) and provider availability (2.9%). Conclusion Geographic variability in ambulance use is large, and associated with variation in patient health status and SES.

Molecular mechanisms underlying myocardial ischemia/reperfusion (MI/R) injury and effective strategies to treat MI/R injury are both in shortage. Although pyroptosis of cardiomyocytes and the protective role of cardiac fibroblasts (CFs) have been well recognized as targets to reduce MI/R injury and sudden cardiac death (SCD), the connection has not yet been established. Here, we showed that CFs protected cardiomyocytes against MI/R-induced injury through suppression of pyroptosis. A novel molecular mechanism underpinning this effect was further identified. Under hypoxia/reoxygenation condition, CFs were found to secrete exosomes, which contain increased level of microRNA-133a (miR-133a). These exosomes then delivered miR-133a into cardiomyocytes to target ELAVL1 and repressed cardiomyocyte pyroptosis. Based on this finding, we successfully developed a new strategy that used exosomes derived from CFs with overexpressed miR-133a to enhance the therapeutic outcomes for the MI/R injury. Overall, our results provide a novel molecular basis for understanding and treating MI/R injury, and our study also provides novel insight for the postmortem diagnosis of MI/R injury induced SCD by using exosome biomarker in forensic.