Search

Cannabis (Cannabis sativa) is a widely used drug in the United States and the frequency of cannabis use is particularly high among people living with HIV (PLWH). One key component of cannabis, the non-psychotropic (−)-cannabidiol (CBD) exerts a wide variety of biological actions, including anticonvulsive, analgesic, and anti-inflammatory effects. However, the exact mechanism of action through which CBD affects the immune cell signaling remains poorly understood. Here we report that CBD modulates type I interferon responses in human macrophages. Transcriptomics analysis shows that CBD treatment significantly attenuates cGAS-STING-mediated activation of type I Interferon response genes (ISGs) in monocytic THP-1 cells. We further showed that CBD treatment effectively attenuates 2’3-cGAMP stimulation of ISGs in both THP-1 cells and primary human macrophages. Interestingly, CBD significantly upregulates expression of autophagy receptor p62/SQSTM1. p62 is critical for autophagy-mediated degradation of stimulated STING. We observed that CBD treated THP-1 cells have elevated autophagy activity. Upon 2’3’-cGAMP stimulation, CBD treated cells have rapid downregulation of phosphorylated-STING, leading to attenuated expression of ISGs. The CBD attenuation of ISGs is reduced in autophagy deficient THP-1 cells, suggesting that the effects of CBD on ISGs is partially mediated by autophagy induction. Lastly, CBD decreases ISGs expression upon HIV infection in THP-1 cells and human primary macrophages, leading to increased HIV RNA expression 24 hours after infection. However, long term culture with CBD in infected primary macrophages reduced HIV viral spread, suggesting potential dichotomous roles of CBD in HIV replication. Our study highlights the immune modulatory effects of CBD and the needs for additional studies on its effect on viral infection and inflammation. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to describe and analyze the research outputs on enteral nutrition, which is the administration of food through the gastrointestinal tract for nutrition maintenance.Methods and Study Design: We searched the Web of Science Core Collection database for original publications on enteral nutrition research from 2010 to 2019. HistCite and VOSviewer software were used for analysis and visualization of the publication outputs, journals, institutions, keywords, cocitations, and collaborations among authors in different countries or regions.Results: A total of 963 relevant articles were included. The number of publications in 2010 and 2019 were 68 and 139, respectively. Nutrition in Clinical Practice and the Journal of Parenteral and Enteral Nutrition had the highest number of publications and cocitations (76, 7.89%; 2058), respectively. The United States and China were the top contributors, accounting for 24.1% and 22.3% of the total articles, respectively. Andrew S. Day and Stephen A. McClave were core researchers in this field. Primary authors collaborated closely. Enteral nutrition, parenteral nutrition, and support were the three most common keywords. The top 10 cocited references concerned administering early enteral nutrition therapy in acutely ill patients and patients with acute Crohn's disease. Crohn's disease, acute pancreatitis, upper gastrointestinal malignancy, and other surgical diseases were among the research hotspots.Conclusions: Our findings can help researchers identify notable research trends and clinically relevant articles. New catheterization technologies are a future research direction. [ABSTRACT FROM AUTHOR]

Four species of Haploporus, H. angustisporus, H. crassus, H. gilbertsonii and H. microsporus are described as new and H. pirongia is proposed as a new combination, based on morphological characteristics and molecular phylogenetic analyses inferred from internal transcribed spacer (ITS) and large subunit nuclear ribosomal RNA gene (nLSU) sequences. Haploporus angustisporus, H. crassus and H. microsporus occur in China, H. gilbertsonii occurs in the USA, and the distribution of H. pirongia is extended from New Zealand to Australia. Haploporus angustisporus is characterized by the distinct narrow oblong basidiospores measuring 10.5-13.5 x 3.9-5 µm. Haploporus crassus is characterized by the presence of ventricose cystidioles occasionally with a simple septum, dissepimental hyphae usually with a simple septum, unique thick-walled basidia and distinctly wide oblong basidiospores measuring 13.5-16.5 x 7.5-9.5 µm. Haploporus gilbertsonii is characterized by its large pores (2-3 per mm), a dimitic hyphal structure with non-dextrinoid skeletal hyphae and wide oblong basidiospores measuring 12-15 x 6-8 µm. Haploporus microsporus is characterized by distinctly small pores (7-9 per mm), the presence of dendrohyphidia, and distinctly small ellipsoid basidiospores measuring 5.3-6.7 x 3-4.1 µm. Haploporus pirongia is proposed as a new combination. Haploporus amarus is shown to be a synonym of H. odorus and Pachykytospora wasseri is considered a synonym of H. subtrameteus. [ABSTRACT FROM AUTHOR]

Context: Thyroid cancer, the most common endocrine cancer, is on the rise. It is less common in the African American (AA) population in the United States. Few studies have looked at outcome disparities for different patient populations, particularly those involving race. Objective: Using data from the SEER registry, we sought to determine whether five-year survival differed significantly between AA and White patients and, whether differences were due to patient or disease characteristics. Design: Retrospective cohort analysis. Univariate comparisons were made using Student-t-tests for continuous variables, chi-square tests for categorical variables. Survivor functions were estimated using Kaplan-Meier curves, and comparisons were made by log rank tests. Setting and Patients: 26,902 patients (25,210 White and 1,692 AA) were diagnosed with thyroid cancer between 1992 and 2006. Main Outcome Measure(s): Five-year survival defined as time from diagnosis to death from cancer within five years. Results: AA had a significantly lower rate of five-year survival compared to Whites (96.5% vs 97.4%, P=.006). AA patients were 2.3 times more likely to be diagnosed with anaplastic disease (Risk ratio [RR] = 2.33 (95% Ch 1.52-3.58), P .0001), and were also nearly 80% more likely to be diagnosed with follicular disease (RR-1.78 [95% CI: 1.59-1.99], P<.0001). They were nearly twice as likely to have larger tumors (≤ 4 cm) than White patients (RR = 1.94 [95% CI: 1.78-2.121, P<.0001). Conclusions: AA had poorer survival from thyroid cancer relative to White patients; this difference may be explained by differences in disease characteristics such as a relatively higher rate of anaplastic thyroid cancer, follicular cancer and larger tumors at presentation. (Ethn Dis. 2011 ;21 (2):210-215) [ABSTRACT FROM AUTHOR]

AbstractBackground:Venous thromboembolism (VTE) occurs most often during hospitalization for major surgery or trauma but may also occur up to several months after surgery. Since the potential for VTE exists in a range of clinical settings, an assessment of its impact on overall outcomes and costs to the patient and to the healthcare system is warranted.Objective:To evaluate the effects of VTE (deep vein thrombosis, pulmonary embolism, or both) occurring within the first 30 days of hospital discharge for total hip replacement (THR) or total knee replacement (TKR) surgery on inpatient costs, mortality, rehospitalization, and major bleeding within 1 year after initial hospitalization for THR or TKR surgery.Methods:The Medicare Provider Analysis and Review (MEDPAR) file for calendar years 2005–2007 provided hospital discharge abstracts for the fee-for-service, acute-care hospitalizations of all Medicare recipients. All patients included in the analysis underwent THR (n  51,108) or TKR (n  115,627). VTE events were diagnosed within the first 30 days and within 1 year post discharge. Propensity score matching was used to control for differences in baseline characteristics in patients with and without VTE events. Total cost was measured as Medicare cost plus beneficiary out-of-pocket cost.Results:VTE occurred in 0.74 of patients undergoing THR. For patients with VTE versus no VTE, mortality was higher (2.9 vs 0.4, P < 0.001) and rehospitalization within 1 year was more frequent (51.9 vs 22.4, P < 0.001), as were complications such as bleeding (11.2 vs 2.7, P < 0.001). Risk-adjusted Medicare cost and total healthcare cost, including beneficiary cost share in 1 year, were significantly higher for VTE patients versus patients with no VTE (18,929 vs 3763, P < 0.001). VTE occurred in 0.70 of patients undergoing TKR. For patients with VTE versus no VTE, mortality was higher (2.5 vs 0.15, P < 0.001), and rehospitalization within 1 year was more frequent (48.7 vs 20.7, P < 0.001), as were complications such as bleeding (13.7 vs 2.1, P < 0.001). For TKR surgery, risk-adjusted total healthcare cost, including beneficiary cost share in 1 year, was significantly different for VTE versus no VTE (17,996 vs 4358, P < 0.001).Limitations:Study limitations include a reliance on ICD-9-CM codes, which could be inaccurate, and the inability (1) to control for unmeasured confounders, such as surgeons’ skills; (2) to include outpatient medical care costs; and (3) to ensure that all patients were enrolled continuously throughout the study period.Conclusions:VTE after THR or TKR is associated with higher mortality, rehospitalization, and bleeding within 1 year, compared with no VTE. Risk-adjusted total, Medicare, and beneficiary healthcare costs were significantly higher for both THR and TKR patients with VTE (P < 0.001). [ABSTRACT FROM AUTHOR]

The article presents a study which examines the trends in health care expenditures in children with autism spectrum disorders (ASDs) in Medicaid in the U.S. The study compared inflation-adjusted expenditures and Medicaid reimbursements from inpatient, outpatient, long-term care, and prescription drugs in 42 states from 2000 to 2003. Results show slight growth of per patient expenditures and large increase in treated prevalence due to the rise of total ASD-associated health care expenditures.

Objective: The Department of Veterans Affairs funded assisted living, adult family home, and adult residential care for the first time in the Assisted Living Pilot Program (ALPP). This article compares the use and cost for individuals that entered ALPP and a comparison group. Method: This was a nonrandomized study. The comparison group consisted of VA patients who were eligible but did not enter an ALPP facility. The ALPP (n = 393) and comparison (n = 259) groups were followed for 12 months to assess ALPP facility, case management, and health care costs. Results: ALPP facility and ALPP case management costs were respectively $5,560 and $2,830 per individual. Total health care costs, including ALPP costs, were $11,533 higher for the ALPP group compared to the comparison group after adjusting for baseline differences. Discussion: Although ALPP successfully helped individuals transition to longer term care in these facilities, it was more costly than the comparison group. [ABSTRACT FROM AUTHOR]

Objectives: The Department of Veterans Affairs (VA) funded assisted living (AL), adult family home (AFH), and residential care for the first time in the Assisted Living Pilot Program (ALPP). This article describes the background and methods of the ALPP evaluation and the characteristics and experiences of the facilities. Method: Facility data were collected from the contracting/inspection process and a survey of ALPP facilities and those contacted but not participating in ALPP. Results: Data on 131 participating facilities are presented: 41 AFHs, 47 assisted living facilities ALFs), and 43 residential care facilities (RCFs). The average facility had 33 beds (about one quarter Medicaid beds), for-profit ownership, and private rooms for ALPP residents, and about half had private baths. About two thirds of ALPP AFH providers spoke a primary language other than English. Discussion: Findings indicate that a wide range of community facilities were willing to provide care to residents with heterogeneous needs on VA funding. [ABSTRACT FROM AUTHOR]

Background: Severe mental illness (SMI) has been associated with more medical co-morbidity and less cardiovascular procedure use for older patients with myocardial infarction. However, it is unknown whether SMI is associated with increased long term mortality risk among patients presenting with acute coronary syndromes (ACS). We tested the hypothesis that SMI is associated with higher one-year mortality following ACS hospitalization. Methods: All ACS patients (n = 14,194) presenting to Veterans Health Administration (VHA) hospitals between October 2003 and September 2005 were included. Survival analysis evaluated the association between SMI and one-year all-cause mortality, adjusting for demographics, comorbidities, in-hospital treatment, and discharge medications. Results: Overall, 18.4 % of ACS patients had SMI. Patients with SMI were more likely female, younger, Caucasian race, have a history of alcohol abuse, liver disease, dementia, hypertension and more likely to be a current smoker; however, prior cardiac history was similar between the 2 groups. There were no significant differences in cardiac procedure use, including coronary angiogram (38.7% vs. 40.3%, p = 0.14) or coronary revascularization (31.0% vs. 32.3%, p = 0.19), and discharge medications between those with and without SMI. One-year mortality was lower for patients with SMI (15.8% vs. 19.1%, p < 0.001). However, in multivariable analysis, there were no significant differences in mortality (HR 0.91; 95% CI 0.81-1.02) between patients with and without SMI. Conclusion: Among ACS patients in the VHA, SMI is prevalent, affecting almost 1 in 5 patients. However, patients with SMI were as likely to undergo coronary revascularization and be prescribed evidence-based medications at hospital discharge, and were not at elevated risk of adverse 1-year outcomes compared to patients without SMI. [ABSTRACT FROM AUTHOR]

Background: Alzheimer disease is an increasingly common con-dition in older people. Knowledge of life expectancy after the diagnosis of Alzheimer disease and of associations of patient characteristics with survival may help planning for future care. Objective: To investigate the course of Alzheimer disease after initial diagnosis and examine associations hypothesized to corre-late with survival among community-dwelling patients with Alz-heimer disease. Design: Prospective observational study. Setting: An Alzheimer disease patient registry from a base pop-ulation of 23 000 persons age 60 years and older in the Group Health Cooperative, Seattle, Washington. Patients: 521 newly recognized persons with Alzheimer disease enrolled from 1987 to 1996 in an Alzheimer disease patient reg-istry. Measurements: Baseline measurements included patient demo-graphic features, Mini-Mental State Examination score, Blessed Dementia Rating Scale score, duration since reported onset of symptoms, associated symptoms, comorbid conditions, and selected signs. Survival was the outcome of interest. Results: The median survival from initial diagnosis was 4.2 years for men and 5.7 years for women with Alzheimer disease. Men had poorer survival across all age groups compared with females. Survival was decreased in all age groups compared with the life expectancy of the U.S. population. Predictors of mortality based on proportional hazards models included a baseline Mini-Mental State Examination score of 17 or less, baseline Blessed Dementia Rating Scale score of 5.0 or greater, presence of frontal lobe release signs, presence of extrapyramidal signs, gait disturbance, history of falls, congestive heart failure, ischemic heart disease, and diabetes at baseline. Limitations: The base population, although typical of the sur-rounding Seattle community, may not be representative of other, more diverse populations. Conclusions: In this sample of community-dwelling... [ABSTRACT FROM AUTHOR]

Presents a study which introduced a generalized autoregressive conditional heteroskedastic (GARCH) model with a flexible parametric error distribution based on the exponential generalized beta (EGB) family of distributions. Description of the GARCH-EGB2 model; Application of the GARCH-EGB2 model to United States dollar exchange rate data; Empirical results.

The article presents the study that investigates the precancerous lesions on the ovarian cancer.

The emotional reactivity hypothesis holds that, over the course of phylogeny, the selection of animals with less reactive temperaments supported the development of sophisticated social-cognitive skills in several species, including humans (Hare, 2007). In the ontogenetic human case, an emotional reactivity hypothesis predicts that children with less reactive temperaments will reach certain milestones in theory-of-mind (ToM) development more quickly. We examined relations between temperament and false-belief understanding in 102 preschool-age children from China and the United States. Temperament was measured via parental ratings of behavior as well as with physiological measures of children's reactivity (hypothalamic-pituitary-adrenocortical axis reactivity gauged via salivary cortisol). In accord with an emotional reactivity hypothesis, children with certain reactive temperaments-specifically, those who were more aggressive and those who were both socially withdrawn and physiologically reactive- evidenced poorer social-cognition. However, our findings also force amendment to the ontogenetic emotional reactivity hypothesis. For the majority of children in both countries, physiological reactivity predicted more advanced ToM, perhaps by facilitating social engagement and attention to social stimuli. Moreover, children who were withdrawn from social interaction yet nonreactive, especially Chinese children of this temperament, evidenced advanced ToM. Thus, some forms of social disengagement may foster social-cognitive development in certain sociocultural contexts. [ABSTRACT FROM AUTHOR]

Hurricane Katrina produced a surge of patient referrals to our facility for cardiac surgery. We sought to determine the impact of this abrupt volume change on operative outcomes. Using our cardiac surgery database, which is part of the Department of Veterans Affairs' Continuous Improvement in Cardiac Surgery Program, we compared procedural outcomes for all cardiac operations that were performed in the year before the hurricane (Year A, 29 August 2004-28 August 2005) and the year after (Year B, 30 August 2005-29 August 2006). Mortality was examined as unadjusted rates and as risk-adjusted observed-to-expected ratios. We identified 433 cardiac surgery cases: 143 (33%) from Year A and 290 (67%) from Year B. The operative mortality rate was 2.8% during Year A (observed-to-expected ratio, 0.4) and 2.8% during Year B (observed-to-expected ratio, 0.6) (P=0.9). We identified several factors that enabled our institution to accommodate the increase in surgical volume during the study period. We conclude that, although Hurricane Katrina caused a sudden, dramatic increase in the number of cardiac operations that were performed at our facility, good surgical outcomes were maintained. [ABSTRACT FROM AUTHOR]

Background: The age of onset of hypertension (HTN) is decreasing, and obesity is a significant risk factor. The prevalence and racial disparities in pediatric HTN and the association between body composition and blood pressure are insufficiently studied. This study aimed to evaluate the prevalence of HTN in Chinese and American children and adolescents and to assess the relationship between various body composition indices and HTN., Methods: Seven thousand, five hundred and seventy-three Chinese and 6239 American children and adolescents aged 8-18 years from the 2013-2015 China Child and Adolescent Cardiovascular Health study and the 2011-2018 National Health and Nutrition Examination Surveys were analyzed. Blood pressure and body composition (fat and muscle) were measured by trained staff. The crude prevalence and age-standardized prevalence rate (ASPR) of primary HTN and its subtypes [isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH)] were calculated based on 2017 American Academy of Pediatrics guidelines. Multivariable-adjusted linear regression coefficients and odds ratios (ORs) were calculated to assess the associations of body composition indicators with HTN, ISH and IDH., Results: The ASPR of HTN was 18.5% in China (CN) and 4.6% in the United States (US), whereas the obesity prevalence was 7.4% and 18.6%, and the population attributable risk of HTN caused by overweight and obesity was higher in the US than in CN. Increased fat mass, muscle mass and body fat percentage mass were associated with a higher risk of HTN in both countries. The percent of muscle body mass had a protective effect on HTN and ISH in both countries [HTN (CN: OR = 0.83, 95% CI = 0.78-0.88; US: OR = 0.72, 95% CI = 0.64-0.81); ISH (CN: OR = 0.87, 95% CI = 0.80-0.94; US: OR = 0.71, 95% CI = 0.62-0.81)], and the protective effect was more common among children and adolescents with high levels of physical activity., Conclusions: The burden of HTN in Chinese children and adolescents was substantial and much greater than that in the US, and the contribution of obesity to HTN was higher in the US than in CN. Augmenting the proportion of muscle mass in body composition has a protective effect against HTN in both populations. Optimizing body composition positively influences blood pressure in children and adolescents, particularly those with high-level physical activity. Video abstract (MP4 149982 KB)., (© 2023. Children's Hospital, Zhejiang University School of Medicine.)

Background/purpose: Extreme events such as hurricanes adversely impact healthcare systems and the communities they serve. The degree to which hurricanes affect healthcare use among high need groups such as older adults with chronic conditions has not been well examined, nor has the impact of hurricane severity on health outcomes. We characterized hospitalizations among older adults by chronic condition after eight large-scale hurricanes in the United States., Methods: Using a combination of administrative healthcare data and the Federal Emergency Management Agency's Disaster Declaration database we conducted a self-controlled case series analysis. We identified Medicare beneficiaries who were exposed to one of eight hurricanes and compared hospitalizations in the 30-days after a hurricane to hospitalizations in the rest of the calendar year of the hurricane. We examined hospitalizations (1) in total, (2) separately for diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) admissions, and (3) by hurricane damage category., Results: Among all older adults exposed, hospitalizations in the 30-day period after each disaster increased for all three chronic conditions; diabetes (incidence rate ratio [IRR] = 1.06, 95% confidence interval [CI] 1.03, 1.10), COPD (IRR = 1.06, 95% CI 1.04, 1.08), and CHF (IRR = 1.19, 95% CI 1.17, 1.21. In the 30-to-60-day period hospitalizations also increased for each chronic condition; diabetes (IRR = 1.06, 95% CI 1.03, 1.10), COPD (IRR = 1.12, 95% CI 1.10, 1.15), and CHF (IRR = 1.32, 95% CI 1.30, 1.34). Substantial differences in hospitalizations were observed according to individual hurricane and by the chronic disease examined., Conclusion: Exposure to hurricanes is associated with an increase in hospitalizations for chronic conditions across all hurricane damage categories. As disasters are expected to increase in strength and frequency, our results underscore the need for response strategies and health policy planning for healthcare systems designed to address the health needs of older Americans with chronic conditions., (© 2022 The American Geriatrics Society.)

Background: Population-based estimates of the incidence and prognosis of brain metastases at diagnosis of hepatocellular carcinoma (HCC) are lacking. The aim of this study was to characterize the incidence proportion and survival of newly diagnosed hepatocellular carcinoma with brain metastases (HCCBM)., Materials and Methods: Data from Surveillance, Epidemiology, and End Results (SEER) program between 2010 and 2014 was evaluated. Patients with HCCBM were included. Multivariable logistic and Cox regression were performed to identify predictors of the presence of brain metastases at diagnosis and prognostic factors of overall survival (OS). We also built a nomogram based on Cox model to predict prognosis for HCCBM patients., Results: We identified 97 patients with brain metastases at the time of diagnosis of HCC, representing 0.33% of the entire cohort. Logistic regression showed patients with bone or lung metastases had greater odds of having brain metastases at diagnosis. Median OS for HCCBM was 2.40 months. Cox regression revealed unmarried and bone metastases patients suffered significantly shorter survival time. A nomogram was developed with internal validation concordance index of 0.639., Conclusions: This study provided population-based estimates of the incidence and prognosis for HCCBM patients. The nomogram could be a convenient individualized predictive tool for prognosis., Competing Interests: The authors have declared that no competing interests exist.