Association of Socioeconomic Status with One-Year Readmission and Mortality among Patients with Acute Myocardial Infarction

Background: Mortality and morbidity are known to be negatively associated with socioeconomic status (SES). This research aims to investigate the magnitude of this association at the individual level: household income (a proxy for the SES) and cardiovascular disease (CVD). CVD accounts for almost one-third of deaths in the world and one-fourth of deaths in the United States. Given the size of CVD incidence and its severity, we examined how it occurs across various levels of SES. Methods: The zip-code based median household income data in the U.S. Census Bureau were matched to CVD patients from the Myocardial Infarction Data Acquisition System (MIDAS), a rich database that comprises cardiovascular admissions to acute care hospitals in New Jersey. Logistic Regression and Cox Proportional Hazards models were applied to study the relationship between income and three cardiovascular clinical outcomes: readmission for acute myocardial infarction (AMI readmission), cardiovascular death (CV death), and all-cause death among patients with a first admission for AMI, while controlling for covariates available in the database, including demographic factors, insurance types, and comorbidities. Results: The main results indicate that patients at the lowest income level had higher risk for AMI readmission and CV death, but not for all-cause death. Ceteris paribus, the chance of one-year AMI readmission increases with lower income levels according to the Logistic Regression outcomes. Conclusions: Our findings may help better allocate limited resources to where they are in greater need, so the costly and deadly incidence of heart disease can be reduced

Primary vs Revisional Gastric Bypass for Weight Loss and Improvements in Comorbidities: Comparisons at Mid-term Follow-up

Background: Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared to R-RYGB (e.g., post sleeve gastrectomy or gastric banding) are controversial. Methods: Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011 - June 2015) at our center. One hundred and twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension and dyslipidemia in terms of remission, improvement, persistence, relapse and de novo. The current study also assessed mortality and complications rates. Results: There were no significant differences in the baseline characteristics of patients who received P-RYGB with those who received R-RYGB in terms of age, gender and preoperative BMI. However, at 18 months: a) Patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P <0.001), reflected by a higher mean delta BMI (P = 0.02), TWL%(P <0.0001) and EWL%(P < 0.0001); b) No differences were observed between the two patients groups in terms of glycemic parameters, lipid profiles, and control of T2DM, hypertension, and dyslipidemia; and, c) No deaths were reported among both patients groups, and complication rates were comparable. Conclusion: Although R-RYGB effectively addressed inadequate weight loss, weight regain and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared to P-RYGB. There were no significant differences between the two procedures in terms of their clinical control of T2DM, hypertension and dyslipidemia. Both procedures exhibited comparable complication rates. - 2019, The Author(s).Scopu

Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

Background Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. Methods Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011–June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. Results A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients’ age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P= 0.001) and BMI (P Conclusions Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.Other Information Published in: Obesity Surgery License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s11695-019-04280-x</p

Safety and efficacy of antiplatelet regimens after percutaneous coronary intervention using drug eluting stents: A network meta-analysis of randomized controlled trials

Aims: We aimed to determine the efficacy and safety of different anti-platelet regimens after percutaneous coronary intervention (PCI) with drug eluting stent (DES) implantation using a network meta-analysis of randomized controlled trials (RCTs). Methods: RCTs comparing shorter duration (= 12 months) DAFT (1-DAFT) after PCI were searched in the MEDLINE, EMBASE and COCHRANE databases. End-points of interest were all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stent thrombosis (ST), major bleeding and major or minor bleeding. Network meta-analyses were performed using frequentist approach. Results: Eighteen RCTs with total of 57,942 patients met the indusion and exclusion criteria. This included 14 RCTs (N - 28,853) of S-DAPT with ASA monotherapy and 4 RCTs (N = 29,089) with P2Y12 inhibitor monotherapy. Compared with 1-DAFT, the odds of MI were higher with S-DAPT with ASA monotherapy [OR 1.23; 95% CI 1.01-1.48], but not with P2Y12 inhibitor monotherapy [0.98; 0.85-1.14]. Both S-DAFT regimens lowered rates of major bleeding when compared with 1-DAFT; ASA monotherapy [0.70; 0.49-1.001 and P2Y12 monotherapy [0.67; 0.45-0.98]. There were no differences in risks of all-cause or CV death between either regimen of S-DAPT and L-DAFT'. However, in the acute coronary syndrome subgroup. ASA monotherapy was associated with increased risk of ST [1.55; 1.021-2.36] but P2Y12 monotherapy was not [0.93; 0.58-1.48]. Conclusion: Amongst patients undergoing DES implantation. S-DAPT with P2Y12 inhibitor monotherapy reduces bleeding without increased risk of MI or ST compared with 1-DAFT. Prospective trials are needed to evaluate if S-DAPT with P2Y12 monotherapy is superior to S-DAPT with ASA monotherapy for ischemic protection. (C) 2020 Elsevier Inc. All rights reserved

Epigenetic alterations in TRAMP mice: epigenome DNA methylation profiling using MeDIP-seq

Abstract Purpose We investigated the genomic DNA methylation profile of prostate cancer in transgenic adenocarcinoma of the mouse prostate (TRAMP) cancer model and to analyze the crosstalk among targeted genes and the related functional pathways. Methods Prostate DNA samples from 24-week-old TRAMP and C57BL/6 male mice were isolated. The DNA methylation profiles were analyzed by methylated DNA immunoprecipitation (MeDIP) followed by next-generation sequencing (MeDIP-seq). Canonical pathways, diseases and function and network analyses of the different samples were then performed using the Ingenuity® Pathway Analysis (IPA) software. Some target genes with significant difference in methylation were selected for validation using methylation specific primers (MSP) and qPCR. Results TRAMP mice undergo extensive aberrant CpG hyper- and hypo-methylation. There were 2147 genes with a significant (log2-change ≥ 2) change in CpG methylation between the two groups, as mapped by the IPA software. Among these genes, the methylation of 1105 and 1042 genes was significantly decreased and increased, respectively, in TRAMP prostate tumors. The top associated disease identified by IPA was adenocarcinoma; however, the cAMP response element-binding protein (CREB)-, histone deacetylase 2 (HDAC2)-, glutathione S-transferase pi (GSTP1)- and polyubiquitin-C (UBC)-related pathways showed significantly altered methylation profiles based on the canonical pathway and network analyses. MSP and qPCR results of genes of interests corroborated with MeDIP-seq findings. Conclusions This is the first MeDIP-seq with IPA analysis of the TRAMP model to provide novel insight into the genome-wide methylation profile of prostate cancer. Studies on epigenetics, such as DNA methylation, will potentially provide novel avenues and strategies for further development of biomarkers targeted for treatment and prevention approaches for prostate cancer

Denosumab treatment for progressive skull base giant cell tumor of bone in a 14 year old female – a case report and literature review

Abstract Background Giant cell tumor of bone (GCT) is a rare primary bone tumor, which can metastasize and undergo malignant transformation. The standard treatment of GCT is surgery. In patients with unresectable or metastatic disease, additional therapeutic options are available. These include blocking of the receptor activator of NF-kappa B ligand (RANKL) signaling pathway, which plays a role in the pathogenesis of GCT of bone, via the anti-RANKL monoclonal antibody denosumab. Case Presentation Herein we report on a female teenager who presented in a very poor clinical condition (cachexia, diplopia, strabismus, dysphonia with palsy of cranial nerves V, VI, VIII, IX, X, XI and XII) due to progressive disease, after incomplete resection and adjuvant radiotherapy, of a GCT which affected the cervical spine (C1 and C2) as well as the skull base; and who had an impressive clinical response to denosumab therapy. To the best of our knowledge, this is the youngest patient ever reported with a skull base tumor treated with denosumab. Conclusion In situations when surgery can be postponed and local aggressiveness of the tumor does not urge for acute surgical intervention, upfront use of denosumab in order to reduce the tumor size might be considered. Principally, the goal of denosumab therapy is to reduce tumor size as much as possible, with the ultimate goal to make local surgery (or as in our case re-surgery) amenable. However, improvement in quality of life, as demonstrated in our patient, is also an important aspect of such targeted therapies

Immune cell pathology in rabbit hemorrhagic disease

Aim: The aim of this research was to study the effect of rabbit hemorrhagic disease virus (RHDV) on the host immune response by examining the cellular composition/pathology of lymphoid organs and serum levels of tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ). Materials and Methods: Nine adult rabbits were inoculated with 1 ml of 10% infected liver homogenate, and three rabbits served as controls. The rabbit hemorrhagic disease (RHD)-induced animals were studied on 3 consecutive days post-infection. Diagnosis of RHD was made through routine hemagglutination tests and the polymerase chain reaction. Blood smears and tissue samples from bone marrow (BM), spleen, lymph nodes, and liver were analyzed for cell composition and cytopathology. Serum levels of TNF-α and IFN-γ were measured by enzyme-linked immunosorbent assay. Results: RHD showed a decreased absolute cell count of blood as well as lymph nodes, spleen, and BM cell populations with marked left shift. This was seen as a progressive rise in immature and blast cells. Quantitative cellular changes were accompanied by an increase in specific inflammatory cytokines. Immunocytopathological alterations were evidenced by: Vacuolized, hyperactivated tissue macrophages, finding of Dohle bodies in neutrophils, and activated lymphocytes with increased nuclear-cytoplasmic ratio. Cytoplasmic eosinophilic viral inclusions found in tissue (liver, spleen, and BM) macrophages were shown for the 1st time in RHD. Megakaryocytic emperipolesis was a common feature of RHD. Conclusion: These studies suggest that RHDV induces pathology in leukocytes due to hyperactivation with left shift (toward immature stages of the different cell lineages). Macrophages are increased in number and show an expressed cytopathic effect often accompanied by viral eosinophilic cytoplasmic inclusions. They also developed a secretory activation (increased levels of pro-inflammatory cytokines)