Transcriptomic analyses reveal proinflammatory activation of human brain microvascular endothelial cells by aging-associated peptide medin and reversal by nanoliposomes.

Medin is a common vascular amyloidogenic peptide recently implicated in Alzheimer's disease (AD) and vascular dementia and its pathology remains unknown. We aim to identify changes in transcriptomic profiles and pathways in human brain microvascular endothelial cells (HBMVECs) exposed to medin, compare that to exposure to β-amyloid (Aβ) and evaluate protection by monosialoganglioside-containing nanoliposomes (NL). HBMVECs were exposed for 20 h to medin (5 µM) without or with Aβ(1-42) (2 µM) or NL (300 µg/mL), and RNA-seq with signaling pathway analyses were performed.

Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System: Use of Medication Administration Record and Bar Code Scanning Technology.

Objectives: The goal of this project was to evaluate and improve the ordering, administration, documentation, and monitoring of enteral nutrition therapies within the inpatient setting in a Veteran's Health Administration system.

Methods: An interdisciplinary team of clinicians reviewed the literature for best practices and revised the process for enteral nutrition support for hospitalized veterans. Interventions included training staff, revising workflows to include scanning patients and products, including enteral nutrition orders within the medication administration record (MAR), and using the existing bar code medication administration system for administration, documentation, and monitoring.

Histophysiology of Fibrocartilage.

There are 3 types of cartilage found in the human body: hyaline cartilage, elastic cartilage, and fibrocartilage. Fibrocartilage may be found in intervertebral discs, symphysis pubis, tendinous insertions, acetabular labrums, and the temporomandibular joint. Specifically, in the foot and ankle we mainly see fibrocartilage in tendinous insertions and in areas where tendons wrap around boney prominence.

Association of low fasting C-peptide levels with cardiovascular risk, visit-to-visit glucose variation and severe hypoglycemia in the Veterans Affairs Diabetes Trial (VADT).

Aims: Low C-peptide levels, indicating beta-cell dysfunction, are associated with increased within-day glucose variation and hypoglycemia. In advanced type 2 diabetes, severe hypoglycemia and increased glucose variation predict cardiovascular (CVD) risk. The present study examined the association between C-peptide levels and CVD risk and whether it can be explained by visit-to-visit glucose variation and severe hypoglycemia.

Sodium Perturbations After Pituitary Surgery.

Sodium perturbations are a common complication after pituitary surgery, with hyponatremia being the most frequent. Postoperative assessments should be tailored to the early and late periods, and monitoring sodium perturbations is recommended. Cerebral salt wasting is rare after pituitary surgery, and diagnosis and management can be challenging.

Team inclusion and empowerment among nursing staff in long-term care.

Team-based approaches to long-term care are increasingly part of the landscape in residential care facilities to improve staff performance and resident outcomes vis-à-vis empowering direct care staff. This study characterizes licensed and unlicensed nursing staffs' (N = 95) perceptions of inclusion as care team members by co-workers, supervisors and non-nursing clinicians. Further, we explored whether inclusion was correlated with heightened empowerment and its related dimensions using the Perception of Empowerment Instrument.

Strategies for Patient-Centered Communication in the Digital Age.

Recently, the major professional societies in Radiology have embarked upon a campaign to increase the patient-centeredness of Radiology. At the foundation of this initiative is direct communication between radiologist and patient, an area that has long been a deficiency for the field. Historically, there have been a number of barriers to effective radiologist-patient communication including logistical challenges, a negative impact on efficiency, and uncertainty of the role of the radiologist in discussing results with patients.

Group medical visits after heart failure hospitalization: Study protocol for a randomized-controlled trial.

A primary goal of this research project is to better understand how shared medical appointments (SMAs) can improve the health status and decrease hospitalization and death for patients recently discharged with heart failure (HF) by providing education, disease state monitoring, medication titration, and social support to patients and their caregivers. We propose a 3-site randomized-controlled efficacy trial with mixed methods to test a SMA intervention, versus usual care. Patients within 12 weeks of a HF hospitalization will be randomized to receive either HF-SMA (intervention arm) with optional co-participation with their caregivers, versus usual care (control arm).

Review: The relationship of hemoglobin A1c to postoperative surgical risk with an emphasis on joint replacement surgery.

Patients with diabetes mellitus are known to have a high risk of postoperative complications, including infections, impaired wound healing, cardiovascular events, venous thromboembolism, and mortality. Because hyperglycemia has been thought to mediate this risk, there is a clinical propensity for improving glycemic control, as assessed by hemoglobin A1c (HbA1c) level, prior to proceeding with elective surgery, particularly joint replacement surgery. However, it is not established whether chronic poor glycemic control, indicated by elevated HbA1c levels, predicts increased risk of postoperative complications.

Amyloidogenic medin induces endothelial dysfunction and vascular inflammation through the receptor for advanced glycation endproducts.

Aims: Medin is a common amyloidogenic protein in humans that accumulates in arteries with advanced age and has been implicated in vascular degeneration. Medin's effect on endothelial function remains unknown. The aims are to assess medin's effects on human arteriole endothelial function and identify potential mechanisms underlying medin-induced vascular injury.

Cigarette Smoking and Musculoskeletal Pain Severity Among Male and Female Afghanistan/Iraq Era Veterans.

Objective: Cigarette smoking and musculoskeletal pain are prevalent among Department of Veterans Affairs (VA) health care system users. These conditions frequently co-occur; however, there is limited empirical information specific to Afghanistan/Iraq era veterans. The present study sought to examine gender differences in the association between cigarette smoking and moderate to severe musculoskeletal pain in US veterans with Afghanistan/Iraq era service.

Native Valve Endocarditis due to Ralstonia pickettii: A Case Report and Literature Review.

Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals. Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block.

Dietary models of insulin resistance.

Insulin resistance is a significant factor in the development of type 2 diabetes mellitus, however the connection between the Western diet and the development of insulin resistance has not been fully explained. Dietary macronutrient composition has been examined in a number of articles, and diets enriched in saturated fatty acids, and possibly in fructose, appear to be most consistently associated with the development of insulin resistance. However, mechanistic insights into the metabolic effects of such diets are lacking, and merit further study.

Adipose and leptomeningeal arteriole endothelial dysfunction induced by β-amyloid peptide: a practical human model to study Alzheimer's disease vasculopathy.

Background: Evidence point to vascular dysfunction and hypoperfusion as early abnormalities in Alzheimer's disease (AD); probing their mechanistic bases can lead to new therapeutic approaches. We tested the hypotheses that β-amyloid peptide induces endothelial dysfunction and oxidative stress in human microvasculature and that response will be similar between peripheral adipose and brain leptomeningeal arterioles.

New Method: Abdominal subcutaneous arterioles from living human subjects (n=17) and cadaver leptomeningeal arterioles (n=6) from rapid autopsy were exposed to Aβ1-42 (Aβ) for 1-h and dilation response to acetylcholine/papaverine were measured and compared to baseline response.

A randomised controlled trial of kinematically and mechanically aligned total knee replacements: two-year clinical results.

We have previously reported the short-term radiological results of a randomised controlled trial comparing kinematically aligned total knee replacement (TKR) and mechanically aligned TKR, along with early pain and function scores. In this study we report the two-year clinical results from this trial. A total of 88 patients (88 knees) were randomly allocated to undergo either kinematically aligned TKR using patient-specific guides, or mechanically aligned TKR using conventional instruments.

Biologically active insulin-derived peptides.

Insulin has many actions within cells many of which are dependent on the cell type. For example, insulin stimulates glucose uptake in adipose tissue and skeletal muscle but not in liver. In liver glucose influx will increase as insulin stimulates the phosphorylation of glucose and eventual storage in the form of glycogen.

Link between decisions regarding resuscitation and preferences for quality over length of life with heart failure.

Aims: Survival preferences, ascertained from time-trade-off utilities, have not been studied in heart failure patients who designate a 'do not resuscitate' (DNR) status. Therefore, the aim of this study was to determine the association of heart failure patients' resuscitation preferences with survival preferences and mortality in the ESCAPE trial.

Methods And Results: We analysed the association of resuscitation orders at 1 month with time-trade-off utilities and 6-month mortality.

Exenatide suppresses postprandial elevations in lipids and lipoproteins in individuals with impaired glucose tolerance and recent onset type 2 diabetes mellitus.

Objective: Chronic exenatide treatment in type 2 diabetes is associated with improved glucose control and fasting lipid levels, as well as weight loss. Less established is whether exenatide directly reduces postprandial lipid and lipoprotein levels without the reduction in body weight or fasting glucose and triglycerides levels that frequently occur with prolonged therapy. Therefore, the effect of a single injection of exenatide on postprandial lipids, remnant lipoproteins, and apolipoproteins was studied.

Pioglitazone inhibits the expression of inflammatory cytokines from both monocytes and lymphocytes in patients with impaired glucose tolerance.

Objective: The current study determines whether pioglitazone (PIO) therapy reduces both monocyte and lymphocyte inflammatory activity and their ability to induce inflammation in other tissues.

Methods And Results: Monocyte and lymphocyte cytokine gene and protein expression of interleukin (IL)-6 were first shown to be greater in subjects with impaired glucose tolerance (IGT) than in subjects with normal glucose tolerance. Sixty-six IGT subjects were then randomized to 4,5 months of placebo or PIO therapy.

Prevalence of Barrett's esophagus in patients with moderate to severe erosive esophagitis.

Aim: To investigate the proportion of patients with moderate-severe erosive esophagitis (EE) who will have Barrett's esophagus (BE) after healing of inflammation.

Methods: Patients with EE of Los Angeles (LA) class B, C and D who underwent follow-up endoscopy documenting complete mucosal healing.

Results: A total of 86/169 patients were suspected of having BE (38 before healing and 48 after healing of EE) and, 46/86 eventually had the histological confirmation.

Epidemiology of the Charcot foot.

The Charcot foot (osteoarthropathy) is a significant lower extremity complication of diabetes mellitus that can result in significant deformity, ulceration, and subsequent limb loss. A result of even unrecognized trauma to an insensitive foot, continued weight bearing on the injured foot promotes the evolution of the disorder that is often diagnosed only after significant deformity has occurred. Although this entity is considered a rare complication of the diabetic population, it has profound implications for those persons affected.

Regulation of protein degradation by insulin-degrading enzyme: analysis by small interfering RNA-mediated gene silencing.

Proteins are vital to the overall structure of cells and to the function of cells in the form of enzymes. Thus the control of protein metabolism is among the most important aspects of cellular metabolism. Insulin's major effect on protein metabolism in the adult animal is inhibition of protein degradation.

Role of the decrement in intraislet insulin for the glucagon response to hypoglycemia in humans.

Objective: Animal and in vitro studies indicate that a decrease in beta-cell insulin secretion, and thus a decrease in tonic alpha-cell inhibition by intraislet insulin, may be an important factor for the increase in glucagon secretion during hypoglycemia. However, in humans this role of decreased intraislet insulin is still unclear.

Research Design And Methods: We studied glucagon responses to hypoglycemia in 14 nondiabetic subjects on two separate occasions.