Recent Research Articles from UNTHSC

Recent research articles indexed in PubMed from authors affiliated with the UNT Health Science Center.

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Updated: 1 hour 32 min ago

HIV/neuroAIDS biomarkers.

Tue, 05/15/2018 - 07:46
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HIV/neuroAIDS biomarkers.

Prog Neurobiol. 2017 Oct;157:117-132

Authors: Rahimian P, He JJ

Abstract
HIV infection often causes neurological symptoms including cognitive and motor dysfunction, which have been collectively termed HIV/neuroAIDS. Neuropsychological assessment and clinical symptoms have been the primary diagnostic criteria for HIV/neuroAIDS, even for the mild cognitive and motor disorder, the most prevalent form of HIV/neuroAIDS in the era of combination antiretroviral therapy. Those performance-based assessments and symptoms are generally descriptive and do not have the sensitivity and specificity to monitor the diagnosis, progression, and treatment response of the disease when compared to objective and quantitative laboratory-based biological markers, or biomarkers. In addition, effects of demographics and comorbidities such as substance abuse, psychiatric disease, nutritional deficiencies, and co-infection on HIV/neuroAIDS could be more readily determined using biomarkers than using neuropsychological assessment and clinical symptoms. Thus, there have been great efforts in identification of HIV/neuroAIDS biomarkers over the past two decades. The need for reliable biomarkers of HIV/neuroAIDS is expected to increase as the HIV-infected population ages and their vulnerability to neurodegenerative diseases, particularly Alzheimer's disease increases. Currently, three classes of HIV/neuroAIDS biomarkers are being pursued to establish objective laboratory-based definitions of HIV-associated neurologic injury: cerebrospinal fluid biomarkers, blood biomarkers, and neuroimaging biomarkers. In this review, we will focus on the current knowledge in the field of HIV/neuroAIDS biomarker discovery.

PMID: 27084354 [PubMed - indexed for MEDLINE]

Alternative mitochondrial electron transfer for the treatment of neurodegenerative diseases and cancers: Methylene blue connects the dots.

Tue, 05/15/2018 - 07:46
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Alternative mitochondrial electron transfer for the treatment of neurodegenerative diseases and cancers: Methylene blue connects the dots.

Prog Neurobiol. 2017 Oct;157:273-291

Authors: Yang SH, Li W, Sumien N, Forster M, Simpkins JW, Liu R

Abstract
Brain has exceptional high requirement for energy metabolism with glucose as the exclusive energy source. Decrease of brain energy metabolism and glucose uptake has been found in patients of Alzheimer's, Parkinson's and other neurodegenerative diseases, providing a clear link between neurodegenerative disorders and energy metabolism. On the other hand, cancers, including glioblastoma, have increased glucose uptake and rely on aerobic glycolysis for energy metabolism. The switch of high efficient oxidative phosphorylation to low efficient aerobic glycolysis pathway (Warburg effect) provides macromolecule for biosynthesis and proliferation. Current research indicates that methylene blue, a century old drug, can receive electron from NADH in the presence of complex I and donates it to cytochrome c, providing an alternative electron transfer pathway. Methylene blue increases oxygen consumption, decrease glycolysis, and increases glucose uptake in vitro. Methylene blue enhances glucose uptake and regional cerebral blood flow in rats upon acute treatment. In addition, methylene blue provides protective effect in neuron and astrocyte against various insults in vitro and in rodent models of Alzheimer's, Parkinson's, and Huntington's disease. In glioblastoma cells, methylene blue reverses Warburg effect by enhancing mitochondrial oxidative phosphorylation, arrests glioma cell cycle at s-phase, and inhibits glioma cell proliferation. Accordingly, methylene blue activates AMP-activated protein kinase, inhibits downstream acetyl-coA carboxylase and cyclin-dependent kinases. In summary, there is accumulating evidence providing a proof of concept that enhancement of mitochondrial oxidative phosphorylation via alternative mitochondrial electron transfer may offer protective action against neurodegenerative diseases and inhibit cancers proliferation.

PMID: 26603930 [PubMed - indexed for MEDLINE]

Exploring the relationship between adverse childhood experiences and oral health-related quality of life.

Sun, 05/13/2018 - 07:39
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Exploring the relationship between adverse childhood experiences and oral health-related quality of life.

J Public Health Dent. 2018 May 12;:

Authors: Kabani F, Lykens K, Tak HJ

Abstract
OBJECTIVES: Evidence indicates that adverse childhood experiences (ACEs) have destructive impacts on quality of life, health outcomes, and health-care expenditures. Studies further demonstrate a dose-response relationship between the number of ACEs and risk for experiencing chronic illness, such as oral diseases later in life. Research is scarce on the prioritization of contextualized public health interventions addressing this important threat.
METHODS: Cross-sectional data from 2011 to 2012 National Survey of Children's Health (NSCH) provided a nationally representative sample of children in the United States, ages 1-17 for dentate status (n = 61,530). The dependent variables identified untreated oral health-care needs and preventive dental utilization. The key independent variables included exposure to parental death, parental divorce, parental incarceration, mental health illnesses, domestic violence, neighborhood violence, and racial discrimination. Exogenous variables included age, sex, race/ethnicity, number of children in household, socioeconomic status proxies, health insurance status, and special health needs. The data, when adjusted for complex survey design, proportionately represent children in the United States.
RESULTS: Unadjusted and adjusted logistic regressions revealed varying magnitudes of significance across diverse racial and ethnic profiles. Exposures to parental divorce and parental death particularly exhibited critical magnitudes of influence, compared to all other ACEs.
CONCLUSIONS: In keeping with the Pareto Principle, exposure to certain ACEs, namely parental divorce and parental death, potentially introduces more profound social and health-related consequences later in life. Therefore, contextualized interventions should prioritize public health efforts to address households burdened with exposure to parental divorce and/or parental death.

PMID: 29752809 [PubMed - as supplied by publisher]

Current state-of-art of STR sequencing in forensic genetics.

Sat, 05/12/2018 - 07:33
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Current state-of-art of STR sequencing in forensic genetics.

Electrophoresis. 2018 May 11;:

Authors: Alonso A, Barrio PA, Müller P, Köcher S, Berger B, Martin P, Bodner M, Willuweit S, Parson W, Roewer L, Budowle B

Abstract
The current state of validation and implementation strategies of MPS technology for the analysis of STR markers for forensic genetics use is described, covering the topics of the current catalogue of commercial MPS-STR panels, leading MPS-platforms, and MPS-STR data analysis tools. In addition, the developmental and internal validation studies carried out to date to evaluate reliability, sensitivity, mixture analysis, concordance, and the ability to analyze challenged samples are summarized. The results of various MPS-STR population studies that showed a large number of new STR sequence variants that increase the power of discrimination in several forensically-relevant loci are also presented. Finally, various initiatives developed by several international projects and standardization (or guidelines) groups to facilitate application of MPS technology for STR marker analyses are discussed in regard to promoting a standard STR sequence nomenclature, performing population studies to detect sequence variants, and developing a universal system to translate sequence variants into a simple STR nomenclature (numbers and letters) compatible with national STR databases. This article is protected by copyright. All rights reserved.

PMID: 29750373 [PubMed - as supplied by publisher]

European survey on forensic applications of massively parallel sequencing.

Sat, 05/12/2018 - 07:33
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European survey on forensic applications of massively parallel sequencing.

Forensic Sci Int Genet. 2017 07;29:e23-e25

Authors: Alonso A, Müller P, Roewer L, Willuweit S, Budowle B, Parson W

PMID: 28495357 [PubMed - indexed for MEDLINE]

Interaction between graviception and carotid baroreflex function in humans during parabolic flight-induced microgravity.

Fri, 05/11/2018 - 07:43

Interaction between graviception and carotid baroreflex function in humans during parabolic flight-induced microgravity.

J Appl Physiol (1985). 2018 May 10;:

Authors: Ogoh S, Marais M, Lericollais R, Denise P, Raven PB, Normand H

Abstract
The aim of the present study was to assess carotid baroreflex (CBR) during acute changes in otolithic activity in humans. To address this question, we designed a set of experiments to identify the modulatory effects of microgravity on CBR function at a tilt angle of -2{degree sign}, which was identified to minimize changes in central blood volume during parabolic flight. During parabolic flight at 0g and 1g, CBR function curves were modelled from the heart rate (HR) and mean arterial pressure (MAP) responses to rapid pulse trains of neck pressure (NP) and neck suction (NS) ranging from +40 to -80 Torr; CBR control of HR (carotid-HR) and MAP (carotid-MAP) baroreflex function curves, respectively. The maximal gain (Gmax) of both carotid-HR and carotid-MAP baroreflex function curves were augmented during microgravity compared to 1g (carotid-HR, -0.53 to -0.80 beats/min/mmHg, P<0.05; carotid-MAP, -0.24 to -0.30 mmHg/mmHg, P<0.05). These findings suggest that parabolic flight-induced acute change of otolithic activity may modify CBR function and identifies that the vestibular system contributes to blood pressure regulation under fluctuations in gravitational forces.

PMID: 29745800 [PubMed - as supplied by publisher]

Survival of Mice with Gastrointestinal Acute Radiation Syndrome through Control of Bacterial Translocation.

Fri, 05/11/2018 - 07:43
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Survival of Mice with Gastrointestinal Acute Radiation Syndrome through Control of Bacterial Translocation.

J Immunol. 2018 May 09;:

Authors: Suzuki F, Loucas BD, Ito I, Asai A, Suzuki S, Kobayashi M

Abstract
Macrophages (Mϕ) with the M2b phenotype (Pheno2b-Mϕ) in bacterial translocation sites have been described as cells responsible for the increased susceptibility of mice with gastrointestinal acute radiation syndrome to sepsis caused by gut bacteria. In this study, we tried to reduce the mortality of mice exposed to 7-10 Gy of gamma rays by controlling Pheno2b-Mϕ polarization in bacterial translocation sites. MicroRNA-222 was induced in association with gamma irradiation. Pheno2b-Mϕ polarization was promoted and maintained in gamma-irradiated mice through the reduction of a long noncoding RNA growth arrest-specific transcript 5 (a CCL1 gene silencer) influenced by this microRNA. Therefore, the host resistance of 7-9-Gy gamma-irradiated mice to sepsis caused by bacterial translocation was improved after treatment with CCL1 antisense oligodeoxynucleotide. However, the mortality of 10-Gy gamma-irradiated mice was not alleviated by this treatment. The crypts and villi in the ileum of 10-Gy gamma-irradiated mice were severely damaged, but these were markedly improved after transplantation of intestinal lineage cells differentiated from murine embryonic stem cells. All 10-Gy gamma-irradiated mice given both of the oligodeoxynucleotide and intestinal lineage cells survived, whereas all of the same mice given either of them died. These results indicate that high mortality rates of mice irradiated with 7-10 Gy of gamma rays are reducible by depleting CCL1 in combination with the intestinal lineage cell transplantation. These findings support the novel therapeutic possibility of victims who have gastrointestinal acute radiation syndrome for the reduction of their high mortality rates.

PMID: 29743312 [PubMed - as supplied by publisher]

Strengthening forensic DNA decision making through a better understanding of the influence of cognitive bias.

Fri, 05/11/2018 - 07:43
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Strengthening forensic DNA decision making through a better understanding of the influence of cognitive bias.

Sci Justice. 2017 Nov;57(6):415-420

Authors: Jeanguenat AM, Budowle B, Dror IE

Abstract
Cognitive bias may influence process flows and decision making steps in forensic DNA analyses and interpretation. Currently, seven sources of bias have been identified that may affect forensic decision making with roots in human nature; environment, culture, and experience; and case specific information. Most of the literature and research on cognitive bias in forensic science has focused on patterned evidence; however, forensic DNA testing is not immune to bias, especially when subjective interpretation is involved. DNA testing can be strengthened by recognizing the existence of bias, evaluating where it influences decision making, and, when applicable, implementing practices to reduce or control its effects. Elements that may improve forensic decision making regarding bias include cognitively informed education and training, quality assurance procedures, review processes, analysis and interpretation, and context management of irrelevant information. Although bias exists, reliable results often can be (and have been) produced. However, at times bias can (and has) impacted the interpretation of DNA results negatively. Therefore, being aware of the dangers of bias and implementing measures to control its potential impact should be considered. Measures and procedures that handicap the workings of the crime laboratory or add little value to improving the operation are not advocated, but simple yet effective measures are suggested. This article is meant to raise awareness of cognitive bias contamination in forensic DNA testing and to give laboratories possible pathways to make sound decisions to address its influences.

PMID: 29173454 [PubMed - indexed for MEDLINE]

Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery.

Fri, 05/11/2018 - 07:43
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Discharges with surgical procedures performed less often than once per month per hospital account for two-thirds of hospital costs of inpatient surgery.

J Clin Anesth. 2017 Sep;41:99-103

Authors: O'Neill L, Dexter F, Park SH, Epstein RH

Abstract
STUDY OBJECTIVE: Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital.
DESIGN: Observational study.
SETTING: State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016.
PATIENTS: Inpatients discharged with a major therapeutic ("operative") procedure.
MEASUREMENTS: For each of N=343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month.
MAIN RESULTS: Major procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (P<0.00001). Average percentage differences were insensitive to the endpoint, with similar results for the percentage of patient days and percentage of DRG case-mix weights.
CONCLUSIONS: Approximately 2/3rd (mean 68%) of inpatient costs among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them.

PMID: 28802622 [PubMed - indexed for MEDLINE]

Uncommon combinations of ICD10-PCS or ICD-9-CM operative procedure codes account for most inpatient surgery at half of Texas hospitals.

Fri, 05/11/2018 - 07:43
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Uncommon combinations of ICD10-PCS or ICD-9-CM operative procedure codes account for most inpatient surgery at half of Texas hospitals.

J Clin Anesth. 2017 Sep;41:65-70

Authors: O'Neill L, Dexter F, Park SH, Epstein RH

Abstract
STUDY OBJECTIVE: Recently, there has been interest in activity-based cost accounting for inpatient surgical procedures to facilitate "value based" analyses. Research 10-20years ago, performed using data from 3 large teaching hospitals, found that activity-based cost accounting was practical and useful for modeling surgeons and subspecialties, but inaccurate for individual procedures. We hypothesized that these older results would apply to hundreds of hospitals, currently evaluable using administrative databases.
DESIGN: Observational study.
SETTING: State of Texas hospital discharge abstract data for 1st quarter of 2016, 4th quarter of 2015, 1st quarter of 2015, and 4th quarter of 2014.
PATIENTS: Discharged from an acute care hospital in Texas with at least 1 major therapeutic ("operative") procedure.
MEASUREMENTS: Counts of discharges for each procedure or combination of procedures, classified by ICD-10-PCS or ICD-9-CM.
MAIN RESULTS: At the average hospital, most surgical discharges were for procedures performed at most once a month at the hospital (54%, 95% confidence interval [CI] 51% to 55%). At the average hospital, approximately 90% of procedures were performed at most once a month at the hospital (93%, CI 93% to 94%). The percentages were insensitive to the quarter of the year. The percentages were 3% to 6% greater with ICD-10-PCS than for the superseded ICD 9 CM.
CONCLUSIONS: There are many different procedure codes, and many different combinations of codes, relative to the number of different hospital discharges. Since most procedures at most hospitals are performed no more than once a month, activity-based cost accounting with a sample size sufficient to be useful is impractical for the vast majority of procedures, in contrast to analysis by surgeon and/or subspecialty.

PMID: 28802614 [PubMed - indexed for MEDLINE]

Plasma Pentraxin 3 and Glucose Kinetics to Acute High-Intensity Interval Exercise versus Continuous Moderate-Intensity Exercise in Healthy Men.

Wed, 05/09/2018 - 07:46
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Plasma Pentraxin 3 and Glucose Kinetics to Acute High-Intensity Interval Exercise versus Continuous Moderate-Intensity Exercise in Healthy Men.

Appl Physiol Nutr Metab. 2018 May 08;:

Authors: Slusher AL, Whitehurst M, Maharaj A, Dodge KM, Fico BG, Mock JT, Huang CJ

Abstract
Pentraxin 3 (PTX3) is mainly synthesized and released by neutrophils to help regulate innate immunity. While plasma PTX3 concentrations are associated with improved glucose metabolism and overall metabolic health, evidence has shown that significant elevations in plasma glucose downregulates circulating levels of PTX3. To examine whether or not this relationship would be altered in response to exercise, this study investigated the kinetics of the plasma glucose and PTX3 response following high-intensity interval exercise (HIIE) and continuous moderate-intensity exercise (CMIE). It was hypothesized that the increased concentrations of plasma glucose following HIIE would be associated with the attenuated plasma PTX3 response compared to CMIE. Eight healthy male subjects participated in both HIIE and CMIE protocols administered as a randomized, counterbalanced design. Linear mixed models for repeated measures revealed that the overall plasma glucose response was greater following HIIE compared to CMIE (protocol x time effect: p = 0.037). To the contrary, although the plasma PTX3 response was only higher at 19 minutes during HIIE than CMIE (protocol x time effect: p = 0.013), no relationships were observed between plasma glucose and PTX3 in either baseline or in response to both exercise protocols, as indicated by area under the curve "with respect to increase" analysis. Our results indicate that exercise-mediated plasma PTX3 concentrations are independent of plasma glucose response. In addition, the present study suggests that the neutrophil-mediated innate immune response, as indicated by plasma PTX3 response, may be activated earlier during HIIE compared to CMIE.

PMID: 29738271 [PubMed - as supplied by publisher]

Energetic redistribution in allostery to execute protein function.

Wed, 05/09/2018 - 07:46
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Energetic redistribution in allostery to execute protein function.

Proc Natl Acad Sci U S A. 2017 07 18;114(29):7480-7482

Authors: Liu J, Nussinov R

PMID: 28696318 [PubMed - indexed for MEDLINE]

Artemisinin Prevents Glutamate-Induced Neuronal Cell Death Via Akt Pathway Activation.

Tue, 05/08/2018 - 13:42
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Artemisinin Prevents Glutamate-Induced Neuronal Cell Death Via Akt Pathway Activation.

Front Cell Neurosci. 2018;12:108

Authors: Lin SP, Li W, Winters A, Liu R, Yang SH

Abstract
Artemisinin is an anti-malarial drug that has been in use for almost half century. Recently, novel biological effects of artemisinin on cancer, inflammation-related disorders and cardiovascular disease were reported. However, neuroprotective actions of artemisinin against glutamate-induced oxidative stress have not been investigated. In the current study, we determined the effect of artemisinin against oxidative insult in HT-22 mouse hippocampal cell line. We found that pretreatment of artemisinin declined reactive oxygen species (ROS) production, attenuated the collapse of mitochondrial membrane potential induced by glutamate and rescued HT-22 cells from glutamate-induced cell death. Furthermore, our study demonstrated that artemisinin activated Akt/Bcl-2 signaling and that neuroprotective effect of artemisinin was blocked by Akt-specific inhibitor, MK2206. Taken together, our study indicated that artemisinin prevented neuronal HT-22 cell from glutamate-induced oxidative injury by activation of Akt signaling pathway.

PMID: 29731711 [PubMed]

Insertion within the flanking region of the D10S1237 locus.

Tue, 05/08/2018 - 13:42
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Insertion within the flanking region of the D10S1237 locus.

Forensic Sci Int Genet. 2018 Apr 27;:

Authors: Novroski NMM, Woerner AE, Budowle B

PMID: 29729851 [PubMed - as supplied by publisher]

Duration of isoflurane-based surgical anesthesia determines severity of brain injury and neurological deficits after a transient focal ischemia in young adult rats.

Tue, 05/08/2018 - 13:42
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Duration of isoflurane-based surgical anesthesia determines severity of brain injury and neurological deficits after a transient focal ischemia in young adult rats.

Brain Res Bull. 2017 Sep;134:168-176

Authors: Gaidhani N, Sun F, Schreihofer D, Uteshev VV

Abstract
Tremendous efforts and funds invested in discovery of novel drug treatments for ischemic stroke have so far failed to deliver clinically efficacious therapies. The reasons for these failures are not fully understood. An indiscriminate use of isoflurane-based surgical anesthesia with or without nitrous oxide may act as an unconstrained, untraceable source of data variability, potentially causing false-positive or false-negative results. To test this hypothesis, a common transient suture middle cerebral artery occlusion (tMCAO) model of ischemic stroke in young adult male rats was used to determine the impact of a typical range of anesthesia durations required for this model on data variability (i.e., infarct volume and neurological deficits). The animals were maintained on spontaneous ventilation. The study results indicated that: (1) Variable duration of isoflurane anesthesia prior, during and after tMCAO is a significant source of data variability as evidenced by measurements of infarct volume and neurological deficits; and (2) Severity of brain injury and neurological deficits after tMCAO is inversely related to the duration of isoflurane anesthesia: e.g., in our study, a 90min isoflurane anesthesia nearly completely protected brain tissues from tMCAO-induced injury and thus, would be expected to obscure the effects of stroke treatments in pre-clinical trials. To elevate transparency, rigor and reproducibility of stroke research and minimize undesirable effects of isoflurane on the outcome of novel drug testing, we propose to monitor, minimize and standardize isoflurane anesthesia in experimental surgeries and make anesthesia duration a required reportable parameter in pre-clinical studies. Specifically, we propose to adopt 20-30min as an optimal anesthesia duration that both minimizes neuroprotective effects of isoflurane and permits a successful completion of surgical procedures in a suture tMCAO model of ischemic stroke in rodents. As the mechanisms and neuroprotective, metabolic and immune effects of general anesthesia are not fully understood, the results of this study cannot be blindly generalized to other anesthetics, animal species and experimental models.

PMID: 28755978 [PubMed - indexed for MEDLINE]

Core Entrustable Professional Activities in Clinical Pharmacology for Entering Residency: Value of Interprofessional Health-Care Teams in Medication Prescribing and Medication Error Prevention.

Fri, 05/04/2018 - 07:39

Core Entrustable Professional Activities in Clinical Pharmacology for Entering Residency: Value of Interprofessional Health-Care Teams in Medication Prescribing and Medication Error Prevention.

J Clin Pharmacol. 2018 May 03;:

Authors: Cohen LJ, Donnenberg VS, Wiernik PH, Newman WC, Amankulor N

Abstract
In recent years, health care has been increasingly delivered by interprofessional teams in the inpatient, outpatient, and transition-of-care arenas. For many reasons, effective communication between patient-centered care teams and patients is critically important in order to optimize care, ensure patient safety, and prevent medical and medication misadventures. In rapid-paced, high-stress medical environments, it is especially important to carefully evaluate the causes of all misadventures in a manner that avoids assigning blame and identifies the root causes and, through team activity, leads to development of remedies that reduce the likelihood of future misadventures. Using a series of illustrative cases, this paper seeks to bring attention to these issues and provide insights regarding some tools developed to assist in improving patient safety and effective team communication.

PMID: 29723424 [PubMed - as supplied by publisher]

Glycemic management in the bariatric surgery population: a review of the literature.

Fri, 05/04/2018 - 07:39

Glycemic management in the bariatric surgery population: a review of the literature.

Pharmacotherapy. 2018 May 03;:

Authors: Howard ML, Steuber TD, Nisly SA

Abstract
Obesity is a worldwide epidemic often complicated by multiple comorbidities, including type 2 diabetes mellitus (T2DM). Bariatric surgery is an increasingly common and effective weight loss strategy for obese patients that may result in resolution of metabolic related disease states, such as T2DM. Although bariatric surgery has many positive outcomes for patients, dietary and pathophysiologic changes can create difficult to control blood glucose, especially in the immediate perioperative setting. Depending on oral antidiabetic agent and insulin needs preoperatively, many patients require cessation of oral agents and reduction or cessation of insulin. Unfortunately, despite available perioperative bariatric surgery guidelines, no specific recommendations for perioperative oral antidiabetic agent or insulin management exist. The purpose of this article is to review the current body of evidence for blood glucose management in the setting of bariatric surgery. An English-language PubMed and Medline search was conducted from 1964 through March 2018 using the following search terms alone and in various combinations: bariatric surgery, gastric banding, laparoscopic sleeve gastrectomy (LSG), Roux-en Y gastric bypass (RYGB), glucose management, insulin, and oral antidiabetic agent. Five articles were identified evaluating insulin management in the perioperative bariatric surgery setting, which were separated into 2 categories: immediate perioperative insulin management and long-term postoperative insulin management. Overall, various blood glucose management insulin protocols were evaluated. All studies included some type of insulin reduction in the perioperative setting. No studies identified specifically evaluated down-titration or discontinuation of oral antidiabetic agents. Given lack of specific guideline recommendations, limitations of standardized insulin protocols, and inconsistency of outcomes studied, perioperative insulin at reduced doses compared to previous maintenance doses coupled with frequent blood glucose monitoring is reasonable. An opportunity exists for successful protocols to be addressed in future, larger studies. This article is protected by copyright. All rights reserved.

PMID: 29722910 [PubMed - as supplied by publisher]

Undiagnosed Liver Fibrosis in Patients Undergoing Pancreatoduodenectomy for Pancreatic Adenocarcinoma.

Fri, 05/04/2018 - 07:39
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Undiagnosed Liver Fibrosis in Patients Undergoing Pancreatoduodenectomy for Pancreatic Adenocarcinoma.

World J Surg. 2017 11;41(11):2854-2857

Authors: Gdowski A, Osman H, Butt U, Foster S, Jeyarajah DR

Abstract
BACKGROUND: Chronic obstruction of the biliary system may cause hepatic fibrosis and liver failure. The purpose of this study was to define the incidence of unrecognized liver fibrosis in patients undergoing pancreaticoduodenectomy (PD).
METHODS: Retrospective data were collected on patients undergoing PD during a 21-month period. Each patient had a core needle biopsy at the time of surgery by a hepatobiliary surgeon.
RESULTS: This study identified 36 consecutive patients who were referred to a tertiary center and underwent pancreatoduodenectomy during a period of 21 months. The majority of patients, 32 (88.8%), were diagnosed with pancreatic adenocarcinoma. Liver fibrosis was diagnosed in 23 (63.9%) patients. A total of 25 (69.4%) patients were found to have pathological evidence of cholestasis consistent with bile obstruction. Patients that were found to have evidence of obstruction had significantly increased odds that fibrosis stage 2 would be found on pathological diagnosis (OR 6.75, 95% CI 1.20-38.02, Fisher's exact test P value = 0.0312). There was no significant association in patients who were stented compared to non-stented patients and their diagnosis of high-grade fibrosis stage 2 (OR 1.5238, 95% CI 0.4019-5.7769, Fisher's exact test P value = 0.7360).
CONCLUSIONS: An astonishing 63.9% of patients who underwent PD were diagnosed with stage 1-4 liver fibrosis and half (47.2%) had fibrosis stage of 2 or more. Further, stent status had no significant impact on the degree of liver fibrosis. Liver fibrosis is currently underrecognized in patients undergoing PD, which is important for physicians to be conscious of as it is known that liver fibrosis increases morbidity and mortality.

PMID: 28717906 [PubMed - indexed for MEDLINE]

Effects of Popular Diets without Specific Calorie Targets on Weight Loss Outcomes: Systematic Review of Findings from Clinical Trials.

Wed, 05/02/2018 - 07:38
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Effects of Popular Diets without Specific Calorie Targets on Weight Loss Outcomes: Systematic Review of Findings from Clinical Trials.

Nutrients. 2017 Jul 31;9(8):

Authors: Anton SD, Hida A, Heekin K, Sowalsky K, Karabetian C, Mutchie H, Leeuwenburgh C, Manini TM, Barnett TE

Abstract
The present review examined the evidence base for current popular diets, as listed in the 2016 U.S. News &amp; World Report, on short-term (≤six months) and long-term (≥one year) weight loss outcomes in overweight and obese adults. For the present review, all diets in the 2016 U.S. News &amp; World Report Rankings for "Best Weight-Loss Diets", which did not involve specific calorie targets, meal replacements, supplementation with commercial products, and/or were not categorized as "low-calorie" diets were examined. Of the 38 popular diets listed in the U.S. News &amp; World Report, 20 met our pre-defined criteria. Literature searches were conducted through PubMed, Cochrane Library, and Web of Science using preset key terms to identify all relevant clinical trials for these 20 diets. A total of 16 articles were identified which reported findings of clinical trials for seven of these 20 diets: (1) Atkins; (2) Dietary Approaches to Stop Hypertension (DASH); (3) Glycemic-Index; (4) Mediterranean; (5) Ornish; (6) Paleolithic; and (7) Zone. Of the diets evaluated, the Atkins Diet showed the most evidence in producing clinically meaningful short-term (≤six months) and long-term (≥one-year) weight loss. Other popular diets may be equally or even more effective at producing weight loss, but this is unknown at the present time since there is a paucity of studies on these diets.

PMID: 28758964 [PubMed - indexed for MEDLINE]

Students' versus residency programs' perceptions of a high-quality PGY1 residency applicant.

Tue, 05/01/2018 - 13:36
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Students' versus residency programs' perceptions of a high-quality PGY1 residency applicant.

Curr Pharm Teach Learn. 2018 Feb;10(2):137-145

Authors: Gibson CM, Elrod S

Abstract
INTRODUCTION: Securing a pharmacy residency position is highly competitive, and pharmacy students must work throughout pharmacy school to ensure their applications are as competitive as possible. Several surveys asking residency programs to describe the most crucial qualities of a high-quality residency candidate have been conducted. However, no study has investigated whether congruency exists between pharmacy students' and residency programs' perceptions of these sought-after qualities.
METHODS: We surveyed pharmacy students to compare their perceptions of important qualities of residency candidates for securing an interview and ultimately being ranked by residency programs. The results were compared to results of an identical previously-published survey of residency program directors.
RESULTS: Student and program perceptions of important qualities of residency candidates were mostly in agreement. Students' perceptions of qualities considered for final ranking of candidates are similar among pharmacy students in professional years 1-3 (P1-P3). However, P3 students' perceptions of qualities important for interview invitations are better aligned with residency programs than P1 and P2 students.
DISCUSSION: Students' and programs' perceptions of important qualities for residency candidates were well aligned on most items. However, only students perceived a letter of recommendation from the dean and North American Pharmacist Licensure Examination (NAPLEX) scores as an important factor for residency. As the pharmacy curriculum progresses, students' and residency programs' perceptions of the most important qualities used to ultimately rank candidates appear to converge; however, perceptions of important characteristics for an interview invitation were consistent over time.
CONCLUSIONS: Overall, perceptions of components of a high-quality residency applicant are congruent between residency programs and students.

PMID: 29706267 [PubMed - in process]

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