...establishing non-invasive biomarkers to monitor disease status is essential. Since periostin and thymus and activation regulated chemokine (TARC) have been implicated in facilitating eosinophil ...tissue infiltration in allergic esophageal responses, we sought to measure these levels in patients with EoE.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objectives We sought to determine whether skeletal muscle capillary recruitment is impaired in type 2 diabetes mellitus (DM) with and without microvascular complications (MC). Background Insulin and ...exercise each stimulate recruitment of skeletal muscle capillaries. Insulin-mediated recruitment is impaired in insulin-resistant humans and animals, but exercise-mediated recruitment has not been studied. Methods We studied 20 control subjects, 22 patients with DM, and 8 patients with DM + MC. With the patients under fasting conditions, contrast-enhanced ultrasound perfusion imaging of the forearm flexor muscles was performed to evaluate capillary blood flow and blood volume at rest and during low- or high-intensity contractile exercise (25% and 80% maximal handgrip). Rheologic parameters of erythrocyte deformability and plasma viscosity were measured. Results Muscle capillary responses to exercise were similar between the control and DM groups, but were reduced (p < 0.05) in those with DM + MC. The DM + MC group had a ≈50% reduction in capillary recruitment and a ≈60% to 70% reduction in capillary blood flow during both low- and high-intensity exercise compared with the control group. These abnormalities were independent of disease duration. Patients with DM + MC were more insulin resistant than DM patients and had an elevated whole blood viscosity that correlated with plasma glucose (p = 0.001) and C-reactive protein (p = 0.003). Conclusions Capillary recruitment during low- and high-intensity exercise is normal in uncomplicated type 2 DM but is impaired in those with microvascular complications. Abnormalities in capillary recruitment may be related to abnormal hemorheology, although larger trials are needed to establish this relation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The Alliance for Academic Internal Medicine (AAIM) supports the need for a uniform subspecialty fellowship training and advanced residency training start date. At present, training programs and their ...sponsoring institutions vary widely in the timing of institutional orientation and fellowship/advanced residency training start dates. Some institutions conduct orientation programs before the scheduled completion of the initial training program, which leads to conflicts for the resident between current and future obligations. AAIM believes that requiring residents to report for fellowship before completion of residency training is disruptive to medical education, creates unnecessary stress for the residents, and risks, violating federal labor laws and Center for Medicare and Medicaid Services graduate medical education funding rules. Adoption of Jul 1, 2015 as the earliest start date for all training and orientation activities can be endorsed internally by AAIM institutions and would resolve these conflicts. Here, Barrett et al examine AAIM adoption of a uniform subspecialty fellowship and other advanced training.
Limb Stress-Rest Perfusion Imaging With Contrast Ultrasound for the Assessment of Peripheral Arterial Disease Severity Jonathan R. Lindner, Lisa Womack, Eugene J. Barrett, Judy Weltman, Wendy Price, ...Nancy L. Harthun, Sanjiv Kaul, James T. Patrie Noninvasive methods to detect peripheral vascular disease are not yet optimal. A method looking at tissue perfusion would be useful. This study used lower extremity stress-rest perfusion imaging along with contrast-enhanced ultrasound to evaluate calf blood flow/flow reserve in patients with claudication. Calf perfusion during exercise as well as its perfusion reserve correlated with symptoms in peripheral vascular disease and was better than conventional tests in estimating severity of disease. Limb microvascular perfusion imaging during exercise, using contrast-enhanced ultrasound can evaluate muscle blood in patients with peripheral arterial disease. Abnormal perfusion and flow reserve may be useful for estimating the severity of peripheral vascular disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background In Canada, interferon-free, direct-acting antiviral hepatitis C virus (HCV) regimens are costly. This presents challenges for universal drug coverage of the estimated 220 000 people with ...chronic HCV infection nationwide. The study objective was to appraise criteria for reimbursement of 4 HCV direct-acting antivirals in Canada. Methods We reviewed the reimbursement criteria for simeprevir, sofosbuvir, ledipasvir-sofosbuvir and paritaprevir-ritonavir-ombitasvir plus dasabuvir in the 10 provinces and 3 territories. Data were extracted from April 2015 to June 2016. The primary outcomes extracted from health ministerial websites were: 1) minimum fibrosis stage required, 2) drug and alcohol use restrictions, 3) HIV coinfection restrictions and 4) prescriber type restrictions. Results Overall, 85%-92% of provinces/territories limited access to patients with moderate fibrosis (Meta-Analysis of Histologic Data in Viral Hepatitis stage F2 or greater, or equivalent). There were no drug and alcohol use restrictions; however, several criteria (e.g., active injection drug use) were left to the discretion of the physician. Quebec did not reimburse simeprevir and sofosbuvir for people coinfected with HIV; no restrictions were found in the remaining jurisdictions. Prescriber type was restricted to specialists in up to 42% of provinces/territories. Interpretation This review of criteria of reimbursement of HCV direct-acting antivirals in Canada showed substantial interjurisdictional heterogeneity. The findings could inform health policy and support the development and adoption of a national HCV strategy.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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