Background Nonadherence to cardiovascular medications is a significant public health problem. This randomized study evaluated the effect on medication adherence of linking hospital and community ...pharmacists. Methods Hospitalized patients with coronary artery disease discharged on aspirin, β-blocker, and statin who used a participating pharmacy were randomized to usual care or intervention. The usual care group received discharge counseling and a letter to the community physician; the intervention group received enhanced in-hospital counseling, attention to adherence barriers, communication of discharge medications to community pharmacists and physicians, and ongoing assessment of adherence by community pharmacists. The primary end point was self-reported use of aspirin, β-blocker, and statin at 6 months postdischarge; the secondary end point was a ≥75% proportion of days covered (PDC) for β-blocker and statin through 6 months postdischarge. Results Of 143 enrolled patients, 108 (76%) completed 6-month follow-up, and 115 (80%) had 6-month refill records. There was no difference between intervention and control groups in self-reported adherence (91% vs 94%, respectively, P = .50). Using the PDC to determine adherence to β-blockers and statins, there was better adherence in the intervention versus control arm, but the difference was not statistically significant (53% vs 38%, respectively, P = .11). Adherence to β-blockers was statistically significantly better in intervention versus control (71% vs 49%, respectively, P = .03). Of 85 patients who self-reported adherence and had refill records, only 42 (49%) were also adherent by PDC. Conclusions The trend toward better adherence by refill records with the intervention should encourage further investigation of engaging pharmacists to improve continuity of care.
Optical and scanning electron microscopy were used to examine the changes in the surface morphology of optical fibers as a result of acid etching. The resulting surface modifications are modeled and ...the resulting structures are considered as alternatives to conventional fibers for chemical sensor development. Hydrofluoric acid (HF) etching has been performed on the tips of flat-end graded index fibers, and spherical-end graded and step index fibers. The acid treatment caused the formation of a cone-shaped hollow in the center of graded index fiber tips. This structure provides a surface area enhancement of up to 5.3-fold over untreated fibers. In addition, this cone-shaped cavity provides a sub-nanoliter reservoir in which reagent can be held at the sensing tip of the fiber. Spherical-end fibers provide surface area increases of up to 35-fold compared to flat-end fibers. With spherical-end step index fibers, HF etches the cladding, but not the core, thereby providing an even greater surface area for reagent immobilization. The potential utility of these acid etched fibers for the development of fiber-optic chemical sensors (FOCS) is discussed.
Objectives The goal of this study was to characterize nonsystem reasons for delay in door-to-balloon time (D2BT) and the impact on in-hospital mortality. Background Studies have evaluated predictors ...of delay in D2BT, highlighting system-related issues and patient demographic characteristics. Limited data exist, however, for nonsystem reasons for delay in D2BT. Methods We analyzed nonsystem reasons for delay in D2BT among 82,678 ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention within 24 h of symptom onset in the CathPCI Registry from January 1, 2009, to June 30, 2011. Results Nonsystem delays occurred in 14.7% of patients (n = 12,146). Patients with nonsystem delays were more likely to be older, female, African American, and have greater comorbidities. The in-hospital mortality for patients treated without delay was 2.5% versus 15.1% for those with delay (p < 0.01). Nonsystem delay reasons included delays in providing consent (4.4%), difficult vascular access (8.4%), difficulty crossing the lesion (18.8%), “other” (31%), and cardiac arrest/intubation (37.4%). Cardiac arrest/intubation delays had the highest in-hospital mortality (29.9%) despite the shortest time delay (median D2BT: 84 min; 25th to 75th percentile: 64 to 108 min); delays in providing consent had a relatively lower in-hospital mortality rate (9.4%) despite the longest time delay (median D2BT: 100 min; 25th to 75th percentile: 80 to 131 min). Mortality for delays due to difficult vascular access, difficulty crossing a lesion, and other was also higher (8.0%, 5.6%, and 5.9%, respectively) compared with nondelayed patients (p < 0.0001). After adjustment for baseline characteristics, in-hospital mortality remained higher for patients with nonsystem delays. Conclusions Nonsystem reasons for delay in D2BT in ST-segment elevation myocardial infarction patients presenting for primary percutaneous coronary intervention are common and associated with high in-hospital mortality.
The expression of Pap pili alternates between ON $\rm (pili\sp+)$ and OFF $\rm (pili\sp-)$ states, a process called phase variation. Pap phase variation is controlled by Leucine responsive regulatory ...protein (Lrp), PapI, and Deoxyadenosine methylase (Dam). Methylation patterns of two GATC sites in the pap regulatory region are established by competition between Dam methylation and Lrp binding. In the phase OFF state, Lrp binds cooperatively to promoter proximal binding sites (1,2,3) and protects GATC-II from methylation whereas GATC-I is methylated. In the phase ON state Lrp binds to distal binding sites (4,5) protecting GATC-I from methylation whereas GATC-II is methylated. Lrp binding to GATC-I required PapI, suggesting that PapI is required for switching to the phase ON state. PapI bound specifically to Lrp-pap DNA complexes, but not Lrp-ilvIH, Lrp in solution or pap DNA. PapI reduced the affinity of Lrp for sites (1,2,3) and increased the affinity for sites (4,5) resulting in translocation of Lrp from the pap GATC-II region to the pap GATC-I region. These observations suggested that Lrp and PapI may directly interact in switching to phase ON. To identify PapI-Lrp binding sites, mutagenesis of papI and lrp was performed. Mutagenesis of papI yielded mutations that resulted in unstable proteins. A novel two color genetic screen was performed to identify pap-specific mutations in lrp. papBA-phoA (blue indicator) and ilvIH-lacZYA (red indicator) fusions generated purple colonies in the presence of wild type lrp. Red colonies were chosen because they contained lrp mutations that could activate ilvIH but not papBA transcription. One mutant, designated $\rm Lrp\sp{E133G}$ failed to translocate to GATC-I but was competent for pap and ilvIH DNA binding and PapI-pap DNA binding. Another pap-specific mutation, $\rm Lrp\sp{Y115C}$ may be defective in PapI binding. Furthermore, radiolabeled PapI bound to an Lrp peptide spanning amino acids 105-118. Together, these data indicate that Lrp contains a PapI binding site and a region required for translocation to GATC-I. A model for PapI mediated translocation of Lrp in the phase OFF to phase ON switch is presented.
BACKGROUND: Thiazolidinediones as PPARγ agonists and fibrates as PPARα agonists improve insulin sensitivity in insulin-responsive tissues. Recent data show an induction of adiponectin receptor 2 ...(AdipoR2) by PPARα and PPARγ agonists in human macrophages. OBJECTIVE: In this study, we examined the effects of thiazolidinediones and fibrates on the expression of adiponectin receptors in human skeletal muscle cells, an important cell type in the context of insulin resistance. RESULTS AND METHODS: In vitro differentiated human myotubes treated with troglitazone or rosiglitazone (20 h) showed no significant changes in AdipoR1 and AdipoR2 mRNA expression. PPARγ activation was controlled by determination of PPARγ mRNA induction. Likewise, differentiated myotubes treated with Wy-14,643 or fenofibrate (20 h) revealed no significant regulation of AdipoR1 and AdipoR2 mRNA. PPARα activation was assessed by measuring PDHK4 mRNA expression. CONCLUSION: Induction of AdipoR gene expression in human skeletal muscle cells is not involved in the insulin-sensitizing effects of thiazolidinediones or fibrates.
Background and Aims Endoscopic treatment of anorectal bleeding can be challenging. We report use of the endoscopic over-the-scope clip (OTSC) to treat massive bleeding from the transitional zone of ...the anorectum. The aim of this retrospective study was to assess the clinical outcome and efficacy of the OTSC and to describe the technique of its use in acute severe bleeding occurring at the transitional zone of the anorectum. Methods We treated 5 consecutive patients (age range, 36-79 years, 5 men) with severe bleeding from the transitional zone of the anorectum caused by hemorrhoid therapy, digital trauma, and a Dieulafoy lesion. We analyzed the efficacy, safety, and outcome of endoscopic treatment using the OTSC. Results Primary hemostasis was successfully achieved in all the patients using a single OTSC. The OTSC deployment technique was adapted from the endoscopic band ligation of hemorrhoids. There was no immediate or late rebleeding. We observed that there were no adverse events from OTSC placement in the anorectum. Conclusions This case series provides evidence that OTSCs may be effective in controlling bleeding from the transitional zone of the anorectum. Although use of OTSCs for bleeding elsewhere in the GI tract has been described, this case series is the first to show its application in the transitional zone of the anorectum.
Advanced endoscopic resection of colorectal lesions Sanchez-Yague, Andres; Kaltenbach, Tonya; Raju, Gottumukkala ...
Gastroenterology clinics of North America,
09/2013, Letnik:
42, Številka:
3
Journal Article
Recenzirano
Advanced endoscopic resection techniques allow curative treatment of difficult colonic lesions and avoid the need for surgery in certain cases. If endoscopic resection is indicated, the choice of the ...most appropriate resection technique depends on lesion characteristics and endoscopist expertise.
Limited data are available on the use of coronary computed tomographic angiography (CCTA) in patients who have received percutaneous coronary intervention (PCI). To evaluate patterns of cardiac ...testing including CCTA after PCI, we created a retrospective observational dataset linking National Cardiovascular Data Registry CathPCI Registry baseline data with longitudinal inpatient and outpatient Medicare claims data for patients who received coronary stenting from November 1, 2005 through December 31, 2007. In 192,009 patients with PCI (median age 74 years), the first test after coronary stenting was CCTA for 553 (0.3%), stress testing for 89,900 (46.8%), and coronary angiography for 22,308 (11.6%); 79,248 (41.3%) had no further testing. Patients referred to CCTA first generally had similar or lower baseline risk than those referred for stress testing or catheterization first. Compared to patients with stress testing first after PCI, patients who underwent CCTA first had higher unadjusted rates of subsequent noninvasive testing (10% vs 3%), catheterization (26% vs 15%), and revascularization (13% vs 8%) within 90 days of initial testing after PCI (p <0.0001 for all comparisons). In conclusion, despite similar or lesser-risk profiles, patients initially evaluated with CCTA after PCI had more downstream testing and revascularization than patients initially evaluated with stress testing. It is unclear whether these differences derive from patient selection, performance of CCTA compared to other testing strategies, or the association of early adoption of CCTA with distinct patterns of care.
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