Quality and access outcomes in 2 Veterans Health Administration facilities with fidelity to the comprehensive medication management framework.

Purpose: Utilization of clinical pharmacists providing comprehensive medication management (CMM) has been shown to improve the quadruple aim of healthcare. Lack of fidelity surrounding CMM practice standardization components has led to heterogeneity in interpretation of clinical pharmacist outcomes. We compared 2 Veterans Health Administration (VHA) facilities with the patient-aligned care team (PACT) Platinum Practice designation in terms of clinical pharmacist practitioner (CPP) access and care quality relative to national CPP averages.

A Pathogenic Role of Non-Parenchymal Liver Cells in Alcohol-Associated Liver Disease of Infectious and Non-Infectious Origin.

Now, much is known regarding the impact of chronic and heavy alcohol consumption on the disruption of physiological liver functions and the induction of structural distortions in the hepatic tissues in alcohol-associated liver disease (ALD). This review deliberates the effects of alcohol on the activity and properties of liver non-parenchymal cells (NPCs), which are either residential or infiltrated into the liver from the general circulation. NPCs play a pivotal role in the regulation of organ inflammation and fibrosis, both in the context of hepatotropic infections and in non-infectious settings.

Mechanical Circulatory Support Prior to Heart Transplantation Predicts Early Post-Operative Stroke.

Background: Mechanical circulatory support (MCS) devices are often deployed to treat patients with refractory cardiogenic shock, rapid deterioration of heart failure, and inotrope-dependent patients. Stroke is a common complication of MCS therapy. This study assesses the risk of stroke during the early post-heart transplantation (HT) period (days from successful HT to discharge or death) in patients who received MCS therapy leading to HT.

Twenty-first birthday drinking: Extreme-drinking episodes and white matter microstructural changes in the fornix and corpus callosum.

The 21st birthday celebration is characterized by extreme alcohol consumption. Accumulating evidence suggests that high-dose bingeing is related to structural brain changes and cognitive deficits. This is particularly problematic in the transition from adolescence to adulthood when the brain is still maturing, elevating the brain's sensitivity to the acute effects of alcohol intoxication.

Pore-Forming Proteins as Mediators of Novel Epigenetic Mechanism of Epilepsy.

Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures. In the last two decades, numerous gene defects underlying different forms of epilepsy have been identified with most of these genes encoding ion channel proteins. Despite these developments, the etiology of majority of non-familial epilepsies has no known associated genetic mutations and cannot be explained by defects in identified ion channels alone.

Impact Study: MK-0646 (Dalotuzumab), Insulin Growth Factor 1 Receptor Antibody Combined with Pemetrexed and Cisplatin in Stage IV Metastatic Non-squamous Lung Cancer.

Background: Insulin-like growth factor 1 receptor (IGF-1R) regulates cell growth, proliferation, and apoptosis. Adenocarcinoma and never-smokers have a higher expression of IGF-1R, which is associated with worse overall survival. Dalotuzumab-MK0646 (D) is a humanized monoclonal antibody that targets IGF-1R.

Efficacy of galactose and adalimumab in patients with resistant focal segmental glomerulosclerosis: report of the font clinical trial group.

Background: Patients with resistant focal segmental glomerulosclerosis (FSGS) who are unresponsive to corticosteroids and other immunosuppressive agents are at very high risk of progression to end stage kidney disease. In the absence of curative treatment, current therapy centers on renoprotective interventions that reduce proteinuria and fibrosis. The FONT (Novel Therapies for Resistant FSGS) Phase II clinical trial (NCT00814255, Registration date December 22, 2008) was designed to assess the efficacy of adalimumab and galactose compared to standard medical therapy which was comprised of lisinopril, losartan, and atorvastatin.

Patterns of antiplatelet agent use in the US.

Background: The American Society of Gastrointestinal Endoscopy (ASGE) published updated guidelines in 2009 to help endoscopists manage the treatment of their patients who have been prescribed antiplatelet therapy (APT).

Study Aim: To assess the use of APT among endoscopists, and to identify factors guiding their use of APT while treating their patients.

Method: A survey questionnaire was distributed to endoscopists at two national meetings to assess their usage of APT while treating patients during the peri-endoscopic period.

Safety and feasibility of volumetric laser endomicroscopy in patients with Barrett's esophagus (with videos).

Background: Volumetric laser endomicroscopy (VLE) produces high-resolution, cross-sectional surface, and subsurface images for detecting neoplasia, targeting biopsies, and guiding real-time treatment.

Objective: To evaluate the safety and feasibility of the Nvision VLE system.

Design: Prospective, multicenter study.

A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy.

Objective: To prospectively evaluate the effect of transrectal ultrasonography (TRUS)-guided prostate biopsy on erectile and voiding function at multiple time-points after biopsy.

Patients And Methods: All men who underwent TRUS-guided prostate biopsy completed a five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS) before and at 1, 4 and 12 weeks after TRUS-guided biopsy. Statistical analyses used were a general descriptive analysis, continuous variables using a t-test and categorical data using chi-square analysis.

Handwriting with a preferred retinal locus for AMD with scotomas.

Purpose: Individuals with macular scotomas from age-related macular degeneration frequently have difficulty writing legibly. The purpose of this study was to investigate the causes of this difficulty by documenting the location of the retinal image of the pen used for writing in relation to the scotoma and fixational preferred retinal locus (fPRL).

Methods: Subjects with macular scotomas from age-related macular degeneration and visually normal age-matched controls wrote words while observing their hand, pen, and text in a scanning laser ophthalmoscope.

Permeability factors in nephrotic syndrome and focal segmental glomerulosclerosis.

Circulating permeability factors have been identified in the plasma of patients with focal segmental glomerulosclerosis (FSGS). Post-transplant recurrence of proteinuria, improvement of proteinuria after treatment with plasmapheresis, and induction of proteinuria in experimental animals by plasma fractions each provide evidence for such plasma factors. Advanced proteomic methods have identified candidate molecules in recurrent FSGS.

Impact of patient navigation from diagnosis to treatment in an urban safety net breast cancer population.

Background: Disparities between U.S. population groups in cancer incidence, treatment and outcome have been well documented.

Subclavian-vertebral artery bifurcation stenting using drug-eluting stents: a report of two cases using different techniques.

Endovascular treatment of vertebral artery stenosis and subclavian artery stenosis are low-risk procedures, but there are few reports of the best approach for subclavian-vertebral artery stenoses where there is an ostial stenosis of a vertebral artery that arises from a stenosed segment of the subclavian artery. This is a report of two cases with subclavian-vertebral artery stenosis that were treated with two different techniques. One-year follow up demonstrated widely patent stents.

Kansas City VAMC Optometry Residency Program: a survey of residents since 1975.

Background: The nation's first one-year, Council on Optometric Education accredited hospital-based optometry residency program began at the Kansas City Veterans Affairs Medical Center in 1975. As part of the 25th anniversary review, past residents were surveyed to determine whether the residency had met their goals and influenced their postresidency activities. This is the first in-depth study of a single residency program.

A double-blind, placebo-controlled study of nortriptyline and bromocriptine in male alcoholics subtyped by comorbid psychiatric disorders.

This double-blind, placebo-controlled, 6-month follow-up treatment study investigated the efficacy of bromocriptine and nortriptyline in attenuating drinking behavior and psychiatric symptoms in 216 male alcoholic patients subtyped by comorbid psychiatric disorder(s). Three well-defined subtypes were examined: alcoholism only, alcoholism + affective/anxiety disorder, and alcoholism + antisocial personality disorder. It was hypothesized that both medications would relieve negative affective symptoms associated with alcohol use and would be particularly effective for the affective/anxiety subgroup.

Elevated cerebrospinal fluid protein in men with unipolar or bipolar depression.

We studied a large sample of rigorously diagnosed, generally unmedicated patients with major depressive disorder (n = 179), bipolar affective disorder (n = 102), or schizophrenia (n = 125) to determine if increased cerebrospinal fluid (CSF) protein is associated with a particular diagnosis or gender. Men had a higher mean CSF protein level than women across all diagnoses (p < 0.001).

Behavioral sensitivity of rats to extremely-low-frequency magnetic fields.

Work in our laboratory has revealed autonomic and/or behavioral sensitivity of mice, rats, and a domestic fowl to extremely-low-frequency (ELF) or nominally static magnetic (B) fields at flux densities between 250 and 1700 microT (rms). To extend our work, an automated exposure and data-acquisition system was used with the technique of conditional suppression to assess behavioral sensitivity to time-varying B fields. Each of five rats was exposed aperiodically to a B field during 3 min warning periods that terminated in a brief electric shock.

Airway carcinoembryonic antigen concentrations in patients with central lung cancer or chronic bronchitis.

To determine the clinical utility of airway carcinoembryonic antigen (CEA) concentrations to distinguish malignant from inflammatory airway disease in patients undergoing bronchoscopy, we determined CEA concentrations by enzyme immunoassay in bronchial washings recovered in 48 subjects, including 20 patients with central lung cancer, 18 patients with chronic bronchitis, and ten nonsmoking patients with a diagnosis of pneumonia or peripheral granuloma. Concentrations of CEA in bronchial washings were standardized by using the total protein concentration in recovered fluid (CEA/TP). Concentrations of CEA were significantly increased in bronchial washings recovered from both patients with chronic bronchitis and lung cancer compared with patients with pneumonia or granuloma (252 +/- 47 ng/mg and 199 +/- 64 ng/ml vs 62 +/- 11 ng/mg, SEM, p less than 0.

Effect of corticosteroid treatment on cell recovery by lung lavage in acute radiation-induced lung injury.

The purpose of this study was to quantitate cell populations recovered by lung lavage up to 6 weeks following thoracic irradiation (24 Gy) as an index of the acute inflammatory response within lung structures. Additionally, rats were treated five times weekly with intraperitoneal saline (0.3 cc) or methylprednisolone (7.

Zeroing in on amyloid proteins in Alzheimer disease therapy.

The authors have provided us with a complete review of the approaches to the amyloid proteins of Alzheimer's disease in regards to targets for drug therapy. Sufficient information is now available concerning systemic amyloidogenesis, genes for familial Alzheimer's disease and the beta amyloid precursor protein, as well as the posttranslational processing requirements for amyloidogenesis and its prevention. Recent excitement concerning the roles for serine proteases and their inhibitors, both in the production and prevention of amyloidogenesis, make this review and its publication in the Neurobiology of Aging extremely timely.

Septic arthritis of the knee due to Streptococcus anginosus.

A case of arthritis caused by Streptococcus anginosus was observed in which the only predisposing factor was osteoarthritis of the knee and an acute meniscal tear. We report here the fifth case of septic arthritis due to Streptococcus anginosus.

Alveolar macrophage proliferation in situ after thoracic irradiation of rats.

Saline lavage was performed on rat lungs at weekly intervals for as long as 6 wk after thoracic irradiation (24 Gy). The number of alveolar macrophages recovered by lavage was significantly increased compared with that in control animals beginning at 4 wk after irradiation (p less than 0.05).

Proteoglycan synthesis by primary chick skeletal muscle during in vitro myogenesis.

The proteoglycans synthesized by primary chick skeletal muscle during in vitro myogenesis were compared with those of muscle-specific fibroblasts. Cultures of skeletal muscle cells and muscle fibroblasts were separately labeled using [35S] sulfate as a precursor. The proteoglycans of the cell layer and medium were separately extracted and isolated by ion-exchange chromatography on DEAE-Sephacel followed by gel filtration chromatography on Sepharose CL-2B.