The effect of mailed outreach on FIT completion among patients aged 45-50 in a safety net healthcare system.

Purpose: Colorectal cancer screening is recommended starting at age 45, but there has been little research on strategies to promote screening in patients younger than 50.

Methods: An outreach program quasi-randomly assigned patients aged 45-50 without recent fecal immunochemical test (FIT), colonoscopy or contraindications to screening to two intervention arms: electronic outreach with email and text (electronic outreach only) versus electronic outreach plus mailed outreach with FIT, an instructional letter and a prepaid return envelope (mailed + electronic outreach). In response to known disparities in screening uptake, all Black patients were assigned to receive mailed + electronic outreach.

Do Women with Skin of Color Think They Are Well Represented in Skin Aging Prevention Information?

Objective: There are clinical differences in healthy skin requirements and skin-aging features by race and ethnicity. However, individuals of color are underrepresented in dermatology-related medical information. We sought to gather information from women of color regarding their attitudes about the importance of the prevention of skin aging, available information, and perception of representation in skin-aging prevention information.

Secondary hemophagocytic lymphohistiocytosis associated with Rocky Mountain spotted fever in a toddler: A case report.

A three-year-old boy presented with fever, maculopapular rash involving palms and soles, and hyponatremia two weeks following a tick bite. Empiric doxycycline that he was on was discontinued following negative initial rickettsial serology based on the non-endemicity of Rocky Mountain spotted fever (RMSF) in Northeast Ohio. He demonstrated high inflammatory markers and met the criteria for hemophagocytic lymphohistiocytosis (HLH).

Ribonuclease recruitment using a small molecule reduced c9ALS/FTD r(GC) repeat expansion in vitro and in vivo ALS models.

The most common cause of amyotrophic lateral sclerosis and frontotemporal dementia (c9ALS/FTD) is an expanded GC RNA repeat [r(GC)] in chromosome 9 open reading frame 72 (), which elicits pathology through several mechanisms. Here, we developed and characterized a small molecule for targeted degradation of r(GC). The compound was able to selectively bind r(GC)’s structure and to assemble an endogenous nuclease onto the target, provoking removal of the transcript by native RNA quality control mechanisms.

A Novel approach to catheterizing the Left Gastric Artery for bariatric embolization.

We present the case of a 45 Y/o morbidly obese male who - unable to lose weight despite extensive lifestyle interventions, presented to us for an experimental procedure known as bariatric embolization. This arterial embolization procedure was performed targeting the left gastric artery with aims to restrict blood flow to the gastric fundus, and lowering serum ghrelin levels. In this case the left gastric artery arose cephalad from the celiac, earlier than where it normally branches; a variation known as a "false tripod", causing some initial difficulty with selection.

The current and potential uses of Electronic Medical Record (EMR) data for primary health care performance measurement in the Canadian context: a qualitative analysis.

Background: Electronic Medical Records (EMRs) are a rich data source to measure and improve quality of care. As Canadian primary health care (PHC) EMRs mature, there is increasing potential use of EMR data for performance measurement. This study identifies and describes current uses of EMR data for performance measurement and considerations to further its potential in the Canadian context.

Illustrating the patient journey through the care continuum: Leveraging structured primary care electronic medical record (EMR) data in Ontario, Canada using chronic obstructive pulmonary disease as a case study.

Background: Although barriers exist to secondary use of primary care electronic medical record (EMR) data, the Alliance for Healthier Communities (the Alliance) in Ontario, Canada has successfully created one of the largest structured primary care EMR datasets in Canada. In 2018, the Alliance and the Canadian Institute for Health Information (CIHI), an organization that provides comparable and actionable data to accelerate improvements in health across Canada, entered into a partnership to share EMR data. In this paper, we describe (i) the processes that enabled the collection of structured EMR data by the Alliance; (ii) how CIHI connected with the Alliance to share data and assess its quality; and, (iii) demonstrate the value of linking structured EMR data to administrative acute care data in illustrating the patient journey through the care continuum, using COPD as a case study.

Small-molecule targeted recruitment of a nuclease to cleave an oncogenic RNA in a mouse model of metastatic cancer.

As the area of small molecules interacting with RNA advances, general routes to provide bioactive compounds are needed as ligands can bind RNA avidly to sites that will not affect function. Small-molecule targeted RNA degradation will thus provide a general route to affect RNA biology. A non-oligonucleotide-containing compound was designed from sequence to target the precursor to oncogenic microRNA-21 (pre-miR-21) for enzymatic destruction with selectivity that can exceed that for protein-targeted medicines.

Measuring the frequency and variation of unnecessary care across Canada.

Background: Through the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm.

A Randomized Controlled Trial of Opt-in Versus Opt-Out Colorectal Cancer Screening Outreach.

Objectives: METHODS:: RESULTS:: Patients randomized to opt-in agreed to participate 23.1% of the time, and only 2.5% of those in opt-out chose not to participate.

Symptomless Multi-Variable Apnea Prediction Index Assesses Obstructive Sleep Apnea Risk and Adverse Outcomes in Elective Surgery.

Study Objective: To validate that the symptomless Multi-Variable Apnea Prediction index (sMVAP) is associated with Obstructive Sleep Apnea (OSA) diagnosis and assess the relationship between sMVAP and adverse outcomes in patients having elective surgery. We also compare associations between Bariatric surgery, where preoperative screening for OSA risk is mandatory, and non-Bariatric surgery groups who are not screened routinely for OSA.

Methods: Using data from 40 432 elective inpatient surgeries, we used logistic regression to determine the relationship between sMVAP and previous OSA, current hypertension, and postoperative complications: extended length of stay (ELOS), intensive-care-unit-stay (ICU-stay), and respiratory complications (pulmonary embolism, acute respiratory distress syndrome, and/or aspiration pneumonia).

Sensitivity of primary fibroblasts in culture to atmospheric oxygen does not correlate with species lifespan.

Differences in the way human and mouse fibroblasts experience senescence in culture had long puzzled researchers. While senescence of human cells is mediated by telomere shortening, Parrinello et al. demonstrated that senescence of mouse cells is caused by extreme oxygen sensitivity.

Facial Filler Complications.

The use of facial fillers has greatly expanded over the past several years. Along with increased use comes a rise in documented complications, ranging from poor cosmetic result to nodules, granulomas, necrosis, and blindness. Awareness of the potential types of complications and options for management, in addition to the underlying facial anatomy, are imperative to delivering the best patient care.

Pharmacological repression of PPARγ promotes osteogenesis.

The nuclear receptor peroxisome proliferator-activated receptor gamma (PPARγ) is the master regulator of adipogenesis and the pharmacological target of the thiazolidinedione (TZD) class of insulin sensitizers. Activation of PPARγ by TZDs promotes adipogenesis at the expense of osteoblast formation, contributing to their associated adverse effects on bone. Recently, we reported the development of PPARγ antagonist SR1664, designed to block the obesity-induced phosphorylation of serine 273 (S273) in the absence of classical agonism, to derive insulin-sensitizing efficacy with improved therapeutic index.

Antiobesity Effect of a Small Molecule Repressor of RORγ.

The orphan nuclear receptor RORγ is a key regulator for T helper 17 (TH17) cell differentiation, which regulates metabolic and circadian rhythm genes in peripheral tissues. Previously, it was shown that the small molecule inverse agonist of RORγ SR1555 [1-(4-((4'-(1,1,1,3,3,3-hexafluoro-2-hydroxypropan-2-yl)-[1,1'-biphenyl]-4-yl)methyl)piperazin-1-yl) ethanone] suppressed TH17 differentiation and stimulated induced T regulatory (iTreg) cells. Here, we show that treatment of cultured pre-adipocyctes with SR1555 represses the expression of RORγ while leading to increased expression of FGF21 and adipoQ.

Antiproliferation activity of a small molecule repressor of liver receptor homolog 1.

The orphan nuclear receptor liver receptor homolog 1 (LRH-1; NR5A2) is a potent regulator of cholesterol metabolism and bile acid homeostasis. Recently, LRH-1 has been shown to play an important role in intestinal inflammation and in the progression of estrogen receptor positive and negative breast cancers and pancreatic cancer. Structural studies have revealed that LRH-1 can bind phospholipids and the dietary phospholipid dilauroylphosphatidylcholine activates LRH-1 activity in rodents.

Conjunctival Pigmentation Following Minocycline Therapy.

Minocycline is a tetracycline antibiotic commonly used to treat acne and rosacea. Although pigmentation of the skin, nails, teeth, oral mucosa, and sclera is a well-recognized adverse outcome associated with minocycline, ocular pigmentation may be missed on routine examination. The authors present a case of a 43-year-old white woman who demonstrated bilateral pigmented palpebral conjunctival cysts after 12 months of minocycline therapy for cystic acne.

Facial dystonias and rosacea: is there an association?

Purpose: Benign essential blepharospasm (BEB) and hemifacial spasm (HFS) belong to a spectrum of focal movement disorders that cause involuntary, spasmodic contractions of the eyelid and facial muscles. In our clinical experience, we have observed an increased prevalence of rosacea in patients who present with BEB and HFS. We investigate our clinical findings with a review of disease pathophysiology and treatment.

Orbital varix thrombosis following surgical prone positioning for spinal decompression.

Orbital varix is a rare venous malformation within the orbit that is especially susceptible to thrombosis and hemorrhage. We report a unique case of vision-threatening orbital varix thrombosis resulting from prolonged prone positioning during an orthopedic spine procedure.

Lacrimal gland sparing IgG4-related disease in the orbit.

Purpose: We report an unusual case of orbital IgG4-related disease and discuss the distinguishing characteristics of the ophthalmic disease subtype.

Design: Case report.

Methods: Literature review and case description.

Facial blanching due to neurotoxins: proposed mechanisms.

Background: The effect of perceived facial blanching with neurotoxin therapy has been described in the literature and has been used to treat the undesirable facial flushing of Frey's syndrome. Patients rarely report it as a complication after cosmetic injection, but it can be distressing.

Objectives: To elucidate the proposed mechanism(s) of this unusual vasculocutaneous phenomenon, we reviewed normal physiologic responses to heat stress and the role of cholinergic neurotransmission in modulating cutaneous vascular tone in the context of the literature.