IMPORTANCE Guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) recommend intensive statin therapy and adding nonstatin therapy if low-density lipoprotein cholesterol (LDL-C) levels are 70 mg/dL or more. Compliance with guidelines is often low.OBJECTIVE To track LDL-C treatment patterns in the US over 2 years. DESIGN, SETTING, AND PARTICIPANTS GOULD is a prospective observational registry study involving multiple centers. Patients with ASCVD receiving any lipid-lowering therapy (LLT) were eligible. Between December 2016 and July 2018, patients were enrolled in 1 of 3 cohorts: (1) those currently receiving proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) and 2 groups not receiving PCSK9i drugs, with (2) LDL-C levels of 100 mg/dL or more or (3) LDL-C levels of 70 to 99 mg/dL. Patients had medical record reviews and telephone interviews every 6 months. Analysis was done on data collected as of October 5, 2020. MAIN OUTCOMES AND MEASURESThe primary outcome was the change in LLT use in 2 years. Secondary outcomes included the number of LDL-C measurements, LDL-C levels, and responses to structured physician and patient questionnaires over 2 years.RESULTS A total of 5006 patients were enrolled (mean [SD] age, 67.8 [9.9] years; 1985 women [39.7%]; 4312 White individuals [86.1%]). At 2 years, 885 (17.1%) had LLT intensification. In the cohorts with LDL-C levels of 100 mg/dL or more and 70 to 99 mg/dL, LLT intensification occurred in 403 (22.4%) and 383 (14.4%), respectively; statins were intensified in 115 (6.4%) and 168 (6.3%), ezetimibe added in 123 (6.8%) and 118 (4.5%), and PCSK9i added in 114 (6.3%) and 58 (2.2%), respectively. In the PCSK9i cohort, 508 of 554 (91.7%) were still taking PCSK9i at 2 years. Lipid panels were measured at least once over 2 years in 3768 patients (88.5%; PCSK9i cohort, 492 [96.1%]; LDL-C levels Ն100 mg/dL or more, 1294 [85.9%]; 70-99 mg/dL, 1982 [88.6%]). Levels of LDL-C fell from medians (interquartile ranges) of 120 (108-141) mg/dL to 95 (73-118) mg/dL in the cohort with LDL-C levels of 100 mg/dL or more, 82 (75-89) to 77 (65-90) mg/dL in the cohort with LDL-C levels of 70 to 99 mg/dL, and 67 (42-104) mg/dL to 67 (42-96) mg/dL in the PCSK9i cohort. Levels of LDL-C less than 70 mg/dL at 2 years were achieved by 308 patients (21.0%) and 758 patients (33.9%) in the cohorts with LDL-C levels of 100 mg/dL or more and 70 to 99 mg/dL, respectively, and 272 patients (52.4%) in the PCSK9i cohort. At 2 years, practice characteristics were associated with more LLT intensification (teaching vs nonteaching hospitals, 148 of 589 [25.1%] vs 600 of 3607 [16.6%]; lipid protocols or none, 359 of 1612 [22.3%] vs 389 of 2584 [15.1%]; cardiology, 452 of 2087 [21.7%] vs internal or family medicine, 204 of 1745 [11.7%] and other, 92 of 364 [25.3%]; all P < .001) and achievement of LDL-C less than 70 mg/dL (teaching vs nonteaching hospitals, 173 of 488 [35.5%] vs 823 of 2986 [27.6%]; lipid protocols vs none, 451 of 1411 [32.0%] vs 545 of 2063 [26.4%]; both P < .001; cardi...

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Abstract.-Commercially obtained phytohemagglutinin (PHAP) derived from Phaseolus vulgaris contains 17 different protein bands when analyzed by acrylamide gel electrophoresis. When it is subjected to CM-Sephadex chromatography followed by molecular sieving on Sephadex G150, several species of potent mitogenic proteins, which differ greatly in their hemagglutinating capacity, are obtained. A low hemagglutinating mitogen (L-PHAP), homogeneous by several different criteria, is the most potent mitogen isolated, and also possesses potent leukoagglutinating activity. It is a glycoprotein with a molecular weight of 115,000, containing glucosamine, mannose, xylose, and fucose or arabinose. Also isolated is a mixture of at least two closely related proteins possessing high hemagglutinating capacity, with hemagglutination titers 250 times more potent than L-PHAP. This material is a slightly less potent mitogen than L-PHAP and also possesses leukoagglutinating capacity, although of a lower order of magnitude. Its amino acid and carbohydrate composition are similar to L-PHAP, but it contains approximately twice as much carbohydrate and is slightly larger as determined by molecular sieving.In order to study in detail the mechanism whereby phytohemagglutinin, a protein derived from the kidney bean Phaseolus vulgaris, causes lymphocyte transformation, it was deemed necessary to obtain a highly purified transforming factor. The present report describes procedures by which such a factor may be isolated from commercially available starting materials, characterizes the fractions obtained, and clarifies the relationship between the serologic and mitogenic properties of several closely related protein species encountered.Materials and Methods. -Bacto-phytohemagglutin P (PHAP) was obtained from Difco Laboratories (Detroit, Michigan; cat. #3110-57). Four different batches of starting material prepared by the method of Rigas and Osgood' were used, and no significant differences were encountered. The contents of 1-3 vials (41-125 mg) of PHAP were dissolved in 5-10 ml of 0.15 M NaCl and dialyzed for 6 hours at 4VC against several liters of 0.01 M phosphate buffer, pH 5.5. A precipitate that constituted 5-10% of the original material was spun down and discarded. The supernatant solution was applied to a 1 X 25 cm column of CM-Sephadex C-50 (Pharmacia Fine Chemicals Inc., capacity 4.5 i 0.5 meq/gm, particle size 40-120 /u) previously equilibrated with 0.01 M phosphate, pH 5.5, and eluted with the same buffer at a flow rate of 24 ml/hour in 8-ml aliquots. After elution of the initial peak, stepwise elution was carried out with 0.0167 M phosphate, pH 6.6, followed by 0.03 M phosphate, pH 8.1. Finally, a linear gradient was developed using 250 ml 0.03 M phosphate, pH 8.1, containing 0.5 M NaCl and an equivalent volume of 0.03 M phosphate, pH 8.1. In other experiments the gradient was developed, using 0.2 M NaCl in 0.03 M P04, pH 8.1, as the limit buffer. The resultant fractions were monitored for protein content (OD 280 mu), hemagglutination t...

In 6 of 29 (20.7%) patients surgically staged for Hodgkin's disease, vascular invasion was demonstrated in either sections of the diagnostic lymph node biopsy or spleen removed at the time of laparotomy. Surgical staging showed that patients with this histologic feature had either Stage III or IV disease; only 43.5% of those in whom vascular invasion was not seen had such extensive disease. In addition, involvement of either the liver, lung, or bone marrow was found in 5 of 6 patients with vascular invasion while only one patient without this feature showed visceral involvement. These findings suggest that vascular invasion is a histopathologic feature of important prognostic value, since it may indicate that hematogenous dissemination has occurred. The association of vascular invasion of the spleen with unequivocal liver involvement in 2 of 3 cases suggests that hematogenous dissemination of Hodgkin's disease via the portal system may be a pathway for the spread of the disease to the liver.