Intravital Multiphoton Microscopy with Fluorescent Bile Salts in Rats as an In Vivo Biomarker for Hepatobiliary Transport Inhibition

The bile salt export pump (BSEP) is expressed at the canalicular domain of hepatocytes, where it mediates the elimination of monovalent bile salts into the bile. Inhibition of BSEP is considered a susceptibility factor for drug-induced liver injury that often goes undetected during nonclinical testing. Although in vitro assays exist for screening BSEP inhibition, a reliable and specific method for confirming Bsep inhibition in vivo would be a valuable follow up to a BSEP screening strategy, helping to put a translatable context around in vitro inhibition data, incorporating processes such as metabolism, protein binding, and other exposure properties that are lacking in most in vitro BSEP models. Here, we describe studies in which methods of quantitative intravital microscopy were used to identify dose-dependent effects of two known BSEP/Bsep inhibitors, 2-[4-[4-(butylcarbamoyl)-2-[(2,4-dichlorophenyl)sulfonylamino]phenoxy]-3-methoxyphenyl]acetic acid (AMG-009) and bosentan, on hepatocellular transport of the fluorescent bile salts cholylglycyl amidofluorescein and cholyl-lysyl-fluorescein in rats. Results of these studies demonstrate that the intravital microscopy approach is capable of detecting Bsep inhibition at drug doses well below those found to increase serum bile acid levels, and also indicate that basolateral efflux transporters play a significant role in preventing cytosolic accumulation of bile acids under conditions of Bsep inhibition in rats. Studies of this kind can both improve our understanding of exposures needed to inhibit Bsep in vivo and provide unique insights into drug effects in ways that can improve our ability interpret animal studies for the prediction of human drug hepatotoxicity

FINANCIAL PROSPECTS, BUSINESS ORGANIZATION, AND MANAGEMENT: FARM BUSINESS CHALLENGES

Farm Management,

Can analyses of electronic patient records be independently and externally validated? The effect of statins on the mortality of patients with ischaemic heart disease: a cohort study with nested case-control analysis

Objective To conduct a fully independent and external validation of a research study based on one electronic health record database, using a different electronic database sampling the same population. Design Using the Clinical Practice Research Datalink (CPRD), we replicated a published investigation into the effects of statins in patients with ischaemic heart disease (IHD) by a different research team using QResearch. We replicated the original methods and analysed all-cause mortality using: (1) a cohort analysis and (2) a case-control analysis nested within the full cohort. Setting Electronic health record databases containing longitudinal patient consultation data from large numbers of general practices distributed throughout the UK. Participants CPRD data for 34 925 patients with IHD from 224 general practices, compared to previously published results from QResearch for 13 029 patients from 89 general practices. The study period was from January 1996 to December 2003. Results We successfully replicated the methods of the original study very closely. In a cohort analysis, risk of death was lower by 55% for patients on statins, compared with 53% for QResearch (adjusted HR 0.45, 95% CI 0.40 to 0.50; vs 0.47, 95% CI 0.41 to 0.53). In case-control analyses, patients on statins had a 31% lower odds of death, compared with 39% for QResearch (adjusted OR 0.69, 95% CI 0.63 to 0.75; vs OR 0.61, 95% CI 0.52 to 0.72). Results were also close for individual statins. Conclusions Database differences in population characteristics and in data definitions, recording, quality and completeness had a minimal impact on key statistical outputs. The results uphold the validity of research using CPRD and QResearch by providing independent evidence that both datasets produce very similar estimates of treatment effect, leading to the same clinical and policy decisions. Together with other non-independent replication studies, there is a nascent body of evidence for wider validity

Cost-effectiveness of the Manchester approach to identifying Lynch syndrome in women with endometrial cancer

This is the final version. Available on open access from MDPI via the DOI in this recordLynch syndrome (LS) is a hereditary cancer syndrome responsible for 3% of all endometrial cancer and 5% in those aged under 70 years. It is unclear whether universal testing for LS in endometrial cancer patients would be cost-effective. The Manchester approach to identifying LS in endometrial cancer patients uses immunohistochemistry (IHC) to detect mismatch repair (MMR) deficiency, incorporates testing for MLH1 promoter hypermethylation, and genetic testing for pathogenic MMR variants. We aimed to assess the cost-effectiveness of the Manchester approach based on primary research data from clinical practice in Manchester. The PETALS study informed estimates of diagnostic performances for a number of different strategies. A recent microcosting study was adapted and used to estimate diagnostic costs. A Markov model was used to predict long-term costs and health outcomes (measured in quality-adjusted life years, QALYs) for individuals and their relatives. Bootstrapping and probabilistic sensitivity analysis were used to estimate the uncertainty in cost-effectiveness. The Manchester approach dominated other reflex testing strategies when considering diagnostic costs and Lynch syndrome cases identified. When considering long-term costs and QALYs the Manchester approach was the optimal strategy, costing £5459 per QALY gained (compared to thresholds of £20,000 to £30,000 per QALY commonly used in the NHS). Cost-effectiveness is not an argument for restricting testing to younger patients or those with a strong family history. Universal testing for Lynch syndrome in endometrial cancer patients is expected to be cost-effective in the UK NHS, and the Manchester approach is expected to be the optimal testing strategy.Medical Research Council (MRC)National Institute for Health Research (NIHR

Is Fractional Reserve Banking Necessarily Immoral?

When Deposits are made to a bank, the bank can loan out most of it, while claiming they have the money to pay you back. When you deposit money in a bank, only a fraction of it stays on deposit; the rest is loaned out. When the person receives the loan spends it, money goes to another bank, repeating the process. Ultimately, if the central bank puts $100 of reserves into the FRB system,$1000 of money could enter the economy

Matching Variables with the Appropriate Statistical Tests in Counseling Research

Quantitative research literacy, including matching variables with the appropriate statistical tests, is a key element in counselor education and preparation. Counselor educators are tasked with teaching quantitative research and statistics, which counselors-in-training tend to find anxiety-producing. Authors aimed to provide a succinct overview of matching variables with appropriate statistical tests and provide strategies counselor educators can use to enhance their pedagogy

Pulpits and Platforms: The Role of the Church in Determining Protest among Black Americans

This article further specifies the relationship between church-based resources, group identification and political activism among black Americans. Previous research indicates that political communication within churches and activism within the church serve to motivate political participation. Our research suggests that, net of relevant controls, activism within the church does not significantly increase protest politics. A key determinant of protest participation is attending a church that exhibits a politicized church culture, and this effect is contingent upon educational attainment and membership in secular organizations.Hence, the church serves as a crucial context for the dissemination of political messages and exposure to opportunities for protest only for those black Americans with relatively low educational achievement and organizational involvement. Group identification has no effect on protest participation