Background: Gastric intestinal metaplasia (GIM) is a precancerous condition. Limited data exist on real-world clinical practice relative to guidelines. Aim: The aim of this study was to evaluate ...adherence to GIM risk stratification and identify factors associated with follow-up endoscopy. Materials and Methods: We conducted manual chart review of patients with histologically confirmed GIM at an urban, tertiary medical center were identified retrospectively and details of their demographics, Helicobacter pylori , biopsy protocol, endoscopic/histologic findings, and postendoscopy follow-up were recorded. Multivariable logistic regression was used to identify factors independently associated with follow-up endoscopy. Results: Among 253 patients, 59% were female, 37% non-Hispanic White (NHW), 26% Hispanic, 16% non-Hispanic Black (NHB). The median age at index endoscopy was 63.4 years (IQR: 55.9 to 70.0), with median follow-up of 65.1 months (IQR: 44.0 to 72.3). H. pylori was detected in 21.6% patients at index EGD. GIM extent and subtype data were frequently missing (22.9% and 32.8%, respectively). Based on available data, 26% had corpus-extended GIM and 28% had incomplete/mixed-type GIM. Compared with NHW, Hispanic patients had higher odds of follow-up EGD (OR=2.48, 95% CI: 1.23-5.01), while NHB patients had 59% lower odds of follow-up EGD (OR=0.41, 95% CI: 0.18-0.96). Corpus-extended GIM versus limited GIM (OR=2.27, 95% CI: 1.13-4.59) was associated with follow-up EGD, but GIM subtype and family history of gastric cancer were not. Conclusions: We observed suboptimal risk stratification among patients with GIM and notable race and ethnic disparities with respect to endoscopic surveillance. Targeted interventions are needed to improve practice patterns and mitigate observed disparities.
Purpose:
The Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project examined the impact of financial incentives on Medicaid beneficiaries with diabetes.
Design:
Observational ...pre–post study and randomized controlled trial (RCT).
Setting:
Federally qualified health centers (FQHCs) and Hawaii Kaiser Permanente.
Participants:
The observational study included 2003 Medicaid beneficiaries with diabetes from FQHCs. The RCT included 320 participants from Kaiser Permanente.
Intervention:
Participants could earn up to $320/year of financial incentives for a minimum of 1 year.
Measures:
(1) Clinical outcomes of change in hemoglobin A1c (HbA1c), blood pressure, and cholesterol; (2) compliance with American Diabetes Association (ADA) standards of diabetes care; and (3) cost effectiveness.
Analysis:
Generalized estimating equation models were used to assess differences in clinical outcomes. General linear models were utilized to estimate the medical costs per patient/day.
Results:
Changes in clinical outcomes in the observational study were statistically significant. Mean HbA1c decreased from 8.56% to 8.24% (P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL (P < .0001). No significant differences were found between groups in the RCT. Improved ADA compliance was observed. No reduction in total health cost during the project period was demonstrated.
Conclusion:
The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.
Growth-arrested rat mesangial cells (RMCs) at a G0/G1 interphase stimulated to divide in hyperglycemic medium initiate intracellular hyaluronan synthesis that induces autophagy/cyclin D3-induced ...formation of a monocyte-adhesive extracellular hyaluronan matrix after completing cell division. This study shows that heparin inhibits the intracellular hyaluronan synthesis and autophagy responses, but at the end of cell division it induces synthesis of a much larger extracellular monocyte-adhesive hyaluronan matrix. Heparin bound to RMC surfaces by 1 h, internalizes into the Golgi/endoplasmic reticulum region by 2 h, and was nearly gone by 4 h. Treatment by heparin for only the first 4 h was sufficient for its function. Streptozotocin diabetic rats treated daily with heparin showed similar results. Glomeruli in sections of diabetic kidneys showed extensive accumulation of autophagic RMCs, increased hyaluronan matrix, and influx of macrophages over 6 weeks. Hyaluronan staining in the glomeruli of heparin-treated diabetic rats was very high at week 1 and decreased to near control level by 6 weeks without any RMC autophagy. However, the influx of macrophages by 6 weeks was as pronounced as in diabetic glomeruli. The results are as follows: 1) heparin blocks synthesis of hyaluronan in intracellular compartments, which prevents the autophagy and cyclin D3 responses thereby allowing RMCs to complete cell division and sustain function; 2) interaction of heparin with RMCs in early G1 phase is sufficient to induce signaling pathway(s) for its functions; and 3) influxed macrophages effectively remove the hyaluronan matrix without inducing pro-fibrotic responses that lead to nephropathy and proteinurea in diabetic kidneys.
Background: Hyperglycemic dividing mesangial cells initiate intracellular hyaluronan synthesis, autophagy, and cyclin D3-mediated hyaluronan matrix formation.
Results: Heparin prevents the intracellular responses but induces synthesis of a monocyte-adhesive extracellular hyaluronan matrix after cell division.
Conclusion: Heparin inhibits inflammatory responses in diabetic glomeruli.
Significance: Responses of dividing cells to hyperglycemia contribute to diabetic pathologies.
Human immunodeficiency virus (HIV) is a chronic infectious disease currently requiring lifelong antiretroviral therapy (ART). People living with HIV (PLWH) face an increased risk of comorbidities ...associated with aging, chronic HIV, and the toxicity arising from long-term ART. A literature review was conducted to identify the most recent evidence documenting toxicities associated with long-term ART, particularly among aging PLWH. In general, PLWH are at a greater risk of developing fractures, osteoporosis, renal and metabolic disorders, central nervous system disorders, cardiovascular disease, and liver disease. There remains limited evidence describing the economic burden of long-term ART. Overall, an aging HIV population treated with long-term ART presents a scenario in which the clinical, humanistic, and economic burden for healthcare systems will demand thoughtful policy solutions that preserve access to treatment. Newer treatment regimens with fewer drugs may mitigate some of the cumulative toxicity burden of long-term ART.
Funding
: ViiV Healthcare.
Among Asian Americans, cancer is the leading cause of death and colorectal cancer (CRC) is the second most common cancer.
The uptake of CRC screening influences incidence and mortality trends; ...however, the most recent American Cancer Society CRC statistics reveals ongoing disparities in screening based on race and ethnicity, with people of Asian descent demonstrating the lowest CRC screening rates despite being the fastest growing racial or ethnic group in the United States.
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The chemotherapeutic effect of doxorubicin (Dox) is limited by cumulative dose-dependent cardiotoxicity in cancer survivors. Dexrazoxane (DRZ) is approved to prevent Dox-induced cardiotoxicity. ...Humanin and its synthetic analog HNG have a cytoprotective effect on the heart. To investigate the cardioprotective efficacy of HNG alone or in combination with DRZ against Dox-induced cardiotoxicity, 80 adult male mice were randomly divided into 8 groups to receive the following treatments via intraperitoneal injection: saline dailym HNG (5 mg/kg) daily, DRZ (60 mg/kg) weekly, Dox (3 mg/kg) weekly, DRZ + HNG, Dox + HNG, Dox + DRZ, and Dox + HNG + DRZ. Echocardiograms were performed before and at 4, 8, and 9.5 wk after the beginning of treatment. All mice were euthanized at 10 wk. In the absence of Dox, HNG, DRZ, or DRZ + HNG had no adverse effect on the heart. Dox treatment caused decreases in ejection fraction and cardiac mass and increases in cardiomyocyte apoptosis and intracardiac fibrosis. HNG or DRZ alone blunted the Dox-induced decrease in left ventricle posterior wall thickness and modestly ameliorated the Dox-induced decrease in ejection fraction. HNG + DRZ significantly ameliorated Dox-induced decreases in ejection function, cardiac fibrosis, and cardiac mass. Using a targeted analysis for the mitochondrial gene array and protein expression in heart tissues, we demonstrated that HNG + DRZ reversed DOX-induced altered transcripts that were biomarkers of cardiac damage and uncoupling protein-2. We conclude that HNG enhances the cardiac protective effect of DRZ against Dox-induced cardiotoxicity. HNG + DRZ protects mitochondria from Dox-induced cardiac damage and blunts the onset of cardiac dysfunction. Thus, HNG may be an adjuvant to DRZ in preventing Dox-induced cardiotoxicity. NEW & NOTEWORTHY Doxorubicin (Dox) is commonly used for treating a wide range of human cancers. However, cumulative dosage-dependent carditoxicity often limits its clinical applications. We demonstrated in this study that treating young adult male mice with synthetic humanin analog enhanced the cardiac protective effect of dexrazoxane against chemotherapeutic agent Dox-induced cardiac dysfunction. Thus, humanin analog can potentially serve as an adjuvant to dexrazoxane in more effectively preventing Dox-induced cardiac dysfunction and cardiomyopathy.
The tumor-suppressive role of p53, a transcription factor that regulates the expression of many genes, has been linked to cell cycle arrest, apoptosis, and senescence. The noncanonical function or ...the pathogenic role of p53 has more recently been implicated in pulmonary vascular disease. We previously reported that rapid nuclear accumulation of hypoxia-inducible factor (HIF)-1α in pulmonary arterial smooth muscle cells (PASMCs) upregulates transient receptor potential channels and enhances Ca
entry to increase cytosolic Ca
concentration (Ca
). Also, we observed differences in HIF-1α/2α expression in PASMCs and pulmonary arterial endothelial cells (PAECs). Here we report that p53 is increased in PAECs, but decreased in PASMCs, isolated from mice with hypoxia-induced pulmonary hypertension (PH) and rats with monocrotaline (MCT)-induced PH (MCT-PH). The increased p53 in PAECs from rats with MCT-PH is associated with an increased ratio of Bax/Bcl-2, while the decreased p53 in PASMCs is associated with an increased HIF-1α. Furthermore, p53 is downregulated in PASMCs isolated from patients with idiopathic pulmonary arterial hypertension compared with PASMCs from normal subjects. Overexpression of p53 in normal PASMCs inhibits store-operated Ca
entry (SOCE) induced by passive depletion of intracellularly stored Ca
in the sarcoplasmic reticulum, while downregulation of p53 enhances SOCE. These data indicate that differentially regulated expression of p53 and HIF-1α/2α in PASMCs and PAECs and the cross talk between p53 and HIF-1α/2α in PASMCs and PAECs may play an important role in the development of PH via, at least in part, induction of PAEC apoptosis and PASMC proliferation.
Drawing upon human capital theory, we empirically tested the relationships among human capital management, employees' value and uniqueness, and organizational competitiveness. To do this, we adopted ...a quantitative approach via multiple regression analysis with 183 participants from
Taiwan and Mainland China. Results showed that human capital development and deployment were positively associated with both value and uniqueness of employees in Taiwan and also in Mainland China. This indicated that development and deployment practices, such as training and job design, were
conducive to increasing employees' value and uniqueness. In addition, the positive relationship between human capital and employees' value that was observed in a Mainland Chinese context was not observed in Taiwan, which indicates that contextual differences affected methods of attracting
talented employees. We found it surprising that in neither Taiwan nor Mainland China were organizations capable of retaining unique employees. Practical and theoretical implications of our findings are discussed.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The early Cretaceous Fangcheng basalts were erupted in the peak stage of lithospheric thinning of the North China Craton (NCC). They have olivine phenocrysts with forsterite (Fo) contents ranging ...from 74 to 92, clinopyroxene with high Mg# from 76 to 89, and contain pyroxenite xenoliths. Both the basalts and pyroxenite xenoliths have coexisting high-Ca and low-Al clinopyroxene and high-Mg and low-Ca olivine, indicating that the parental magmas of the basalts have high water contents comparable with arc basalts. They also show similar mineral chemistry and olivine O isotopic compositions (δ18O=5.5–7.2‰), trace element patterns with large ion lithophile elements (LILEs) and light rare earth elements (LREEs) enrichments and high field strength elements (HFSEs) depletions, as well as enriched Sr–Nd–Hf isotopic features. Therefore, the pyroxenite xenoliths are cognate with the basalts. High δ18O values (average~6.5‰) of fresh olivine crystals from the basalts and xenoliths indicate the involvement of 18O-rich crustal materials in the mantle source. Incorporation of 18O-rich crustal materials to the mantle source is consistent with the highly evolved Sr–Nd–Hf isotopic signatures of the basalts and the pyroxenite xenoliths. Modeling results based on the Sr–Nd–O isotopic compositions of the basalts indicate that both upper and lower crustal materials of the Yangtze Block may have been incorporated into the mantle source. Therefore, the 18O-rich crustal materials were likely derived from the subducted Yangtze Block in Triassic time. However, neither the NCC subcontinental lithospheric mantle nor the deeply subducted Yangtze crustal materials can provide sufficient water to produce hydrous basaltic magmas, instead exotic fluids may have been derived from the subducted paleo-Pacific slab. Dehydration of the subducted paleo-Pacific slab may have released enough fluids to trigger extensive hydrous melting of the enriched mantle source beneath the Fangcheng and its surrounding regions.
•The primary mantle-derived magmas for the Fangcheng basalts were rich in water.•Both the Fangcheng basalts and pyroxenite xenoliths are cognate in origin.•18O-rich subducted Yangtze upper crust rocks were incorporated in the mantle source.•Melting of enriched mantle source was triggered by exotic slab-dehydrated fluids.
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