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Allison R Schulman, Walter Chan, Aiofe Devery, Michele B Ryan, Christopher C Thompson
BACKGROUND AND AIMS: Marginal ulceration, or ulceration at the gastrojejunal anastomosis, is a common complication of Roux-en-Y gastric bypass (RYGB). Acidity likely contributes to the pathophysiology, and proton pump inhibitors (PPIs) are frequently prescribed for treatment. However, patients with gastric bypass only have a small gastric pouch and rapid small bowel transit, which limits the opportunity for capsule breakdown and PPI absorption. Soluble PPIs (open capsules, OCs) might be more easily absorbed than intact capsules (IC)...
October 20, 2016: Clinical Gastroenterology and Hepatology
Leo F Buckley, Enrique Seoane-Vazquez, Judy W M Cheng, Ahmed Aldemerdash, Irene M Cooper, Lina Matta, Danika S Medina, Mandeep R Mehra, Kristina Navarro-Velez, Elaine L Shea, Joanne R Weintraub, Lynne W Stevenson, Akshay S Desai
Innovative treatment strategies for decompensated heart failure (HF) are required to achieve cost savings and improvements in outcomes. We developed a decision analytic model from a hospital perspective to compare 2 strategies for the treatment of decompensated HF, ambulatory diuretic infusion therapy, and hospitalization (standard care), with respect to total HF hospitalizations and costs. The ambulatory diuretic therapy strategy included outpatient treatment with high doses of intravenous loop diuretics in a specialized HF unit whereas standard care included hospitalization for intravenous loop diuretic therapy...
November 1, 2016: American Journal of Cardiology
Joshua B Lewis, Dallin C Milner, Adam L Lewis, Todd M Dunaway, Kaleb M Egbert, Scott C Albright, Brigham J Merrell, Troy D Monson, Dallin S Broberg, Jason R Gassman, Daniel B Thomas, Juan A Arroyo, Paul R Reynolds
It has long been understood that increased epithelial permeability contributes to inflammation observed in many respiratory diseases. Recently, evidence has revealed that environmental exposure to noxious material such as cigarette smoke reduces tight junction barrier integrity, thus enhancing inflammatory conditions. Claudin-6 (Cldn6) is a tetraspanin transmembrane protein found within the tight junctional complex and is implicated in maintaining lung epithelial barriers. To test the hypothesis that increased Cldn6 ameliorates inflammation at the respiratory barrier, we utilized the Tet-On inducible transgenic system to conditionally over-express Clnd6 in the distal lung...
October 17, 2016: International Journal of Environmental Research and Public Health
Megan A Rocchio, James W Schurr, Aaron P Hussey, Paul M Szumita
BACKGROUND: In October 2010, a pharmacist-driven stewardship program was implemented at the Brigham and Women's Hospital to ensure continued adherence to the prescribing guideline, focusing on indications for intravenous immune globulin (IVIG) use and dosing per ideal body weight. OBJECTIVE: The primary objective was to describe an IVIG stewardship program at a tertiary academic medical center. METHODS: This was a prospective, observational study from January 2013 through December 2014...
October 6, 2016: Annals of Pharmacotherapy
Brigham J Hartley, Kristen J Brennand
Human induced pluripotent stem cells (hiPSCs) can theoretically yield limitless supplies of cells fated to any cell type that comprise the human organism, making them a new tool by which to potentially overcome caveats in current biomedical research. In vitro derivation of central nervous system (CNS) cell types has the potential to provide material for drug discovery and validation, safety and toxicity assays, cell replacement therapy and the elucidation of previously unknown disease mechanisms. However, current two-dimensional (2D) CNS differentiation protocols do not faithfully recapitulate the spatial organization of heterogeneous tissue, nor the cell-cell interactions, cell-extracellular matrix interactions, or specific physiological functions generated within complex tissue such as the brain...
October 12, 2016: Neurochemistry International
Ibhar Al Mheid, Heval Mohamed Kelli, Yi-An Ko, Muhammad Hammadah, Hina Ahmed, Salim Hayek, Viola Vaccarino, Thomas R Ziegler, Greg Gibson, Michelle Lampl, R Wayne Alexander, Ken Brigham, Greg S Martin, Arshed A Quyyumi
BACKGROUND: Lifestyle modifications are first-line measures for cardiovascular disease prevention. Whether lifestyle intervention also preserves cardiovascular health is less clear. Our study examined the role of a Health Partner-administered lifestyle intervention on metrics of ideal cardiovascular health. METHODS AND RESULTS: A total of 711 university employees (48±11 years; 66% women, 72% Caucasian/22.5% African Americans) enrolled in a program that promoted healthier lifestyles at Emory University (Atlanta, GA)...
October 11, 2016: Journal of the American Heart Association
Harriet Kiwanuka, Mario A Aycart, David F Gitlin, Elaine Devine, Bridget J Perry, Thet-Su Win, Ericka M Bueno, Muayyad Alhefzi, Nicco Krezdorn, Bohdan Pomahac
BACKGROUND: Facial self-inflicted gunshot wounds (SIGSWs) cause a devastating midfacial defect and pose a challenging problem to the reconstructive surgeon. Face transplantation (FT) has the potential for near-normal restoration in otherwise non-reconstructible defects. Two out of 7 FT recipients at Brigham and Women's Hospital (BWH) sustained SIGSWs. In this study, we illustrate the role of FT in the management of SIGSWs through an aesthetic, functional, and psychosocial examination of outcomes...
September 8, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Emily Stamell Ruiz, Pritesh S Karia, Frederick C Morgan, Chrysalyne D Schmults
BACKGROUND: There is limited evidence on the utility of radiologic imaging for prognostic staging of cutaneous squamous cell carcinoma (CSCC). OBJECTIVE: Review utilization of radiologic imaging of high-stage CSCCs to evaluate whether imaging impacted management and outcomes. METHODS: Tumors classified as Brigham and Women's Hospital (BWH) tumor (T) stage T2B or T3 over a 13-year period were reviewed to identify whether imaging was performed and whether results affected treatment...
October 1, 2016: Journal of the American Academy of Dermatology
Edward V Nunes, Joshua D Lee, Dominic Sisti, Andrea Segal, Arthur Caplan, Marc Fishman, Genie Bailey, Gregory Brigham, Patricia Novo, Sarah Farkas, John Rotrosen
We examine ethical challenges encountered in the design of an effectiveness trial (CTN-0051; X:BOT), comparing sublingual buprenorphine-naloxone (BUP-NX), an established treatment for opioid dependence, to the newer extended-release injectable naltrexone (XR-NTX). Ethical issues surrounded: 1) known poor effectiveness of one possible, commonly used treatment as usual control condition-detoxification followed by counseling without medication; 2) the role of patients' preferences for treatments, given that treatments were clinically approved and available to the population; 3) differences between the optimal "usual treatment" clinical settings for different treatments making it challenging to design a fair comparison; 4) vested interest groups favoring different treatments exerting potential influence on the design process; 5) potentially vulnerable populations of substance users and prisoners; 6) potential therapeutic misconception in the implementation of safety procedures; and 7) high cost of a large trial limiting questions that could be addressed...
September 28, 2016: Contemporary Clinical Trials
Elisabeth F Beaber, Anna N A Tosteson, Jennifer S Haas, Tracy Onega, Brian L Sprague, Donald L Weaver, Anne Marie McCarthy, Chyke A Doubeni, Virginia P Quinn, Celette Sugg Skinner, Ann G Zauber, William E Barlow
PURPOSE: Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. METHODS: We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women's Hospital (BWH) during 2011-2013 with no prior breast imaging or breast cancer...
November 2016: Breast Cancer Research and Treatment
Eric B Laxer, Craig D Brigham, Bruce V Darden, P Bradley Segebarth, R Alden Milam, Alfred L Rhyne, Susan M Odum, Leo R Spector
PURPOSE: Many investigators have reported the financial conflicts of interest (COI), which could result in potential bias in the reporting of outcomes for patients undergoing total disc replacement (TDR) rather than anterior cervical discectomy and fusion (ACDF). This bias may be subconsciously introduced by the investigator in a non-blinded radiographic review. The purpose of this study was to determine if bias was present when a group of spine specialists rated adjacent segment degeneration (ASD) following cervical TDR or ACDF...
September 20, 2016: European Spine Journal
Jesmond Dalli, Romain A Colas, Carolina Quintana, Diana Barragan-Bradford, Shelley Hurwitz, Bruce D Levy, Augustine M Choi, Charles N Serhan, Rebecca M Baron
OBJECTIVE: To identify and measure recently described chemical mediators, termed specialized pro-resolving mediators that actively regulate the resolution of acute-inflammation, and correlate measurements with clinical outcomes. DESIGN: Herein, deidentified plasma was collected from sepsis patients (n = 22 subjects) within 48 hours of admission to the ICU and on days 3 and 7 thereafter and subjected to lipid mediator profiling. SETTING: Brigham and Women's Hospital Medical Intensive Care Unit...
September 14, 2016: Critical Care Medicine
M F Vázquez-Alonso, C Abdala-Dergal
The frequent causes of relapsing carpal tunnel syndrome were analyzed. Nine patients were followed-up from January 1st to December 31st, 2011. They underwent a physical exam and imaging tests. Pain was measured in all of them with the VAS, and the Brigham and Womens Hospital questionnaire was used to assess disability. Patients included seven females and two males; mean age was 52 years. Major causes for relapse included postoperative fibrosis with incomplete release in seven patients and incomplete release in two patients in whom minimally invasive approaches were used...
January 2016: Acta Ortopédica Mexicana
Allison A Lambert, Nirupama Putcha, M Bradley Drummond, Aladin M Boriek, Nicola A Hanania, Victor Kim, Gregory L Kinney, Merry-Lynn N McDonald, Emily P Brigham, Robert A Wise, Meredith C McCormack, Nadia N Hansel
BACKGROUND: Obesity is prevalent in the United States; however the impact of obesity upon COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD. METHODS: We examined 3631 participants from the multicenter prospective cohort study COPDGene who had spirometry confirmed COPD, a post-bronchodilator FEV1 <80% predicted and a body mass index (BMI) ≥18.5kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders...
August 25, 2016: Chest
Sara Tejani, Ahmed Sultan, Ivan Stojanov, Sook-Bin Woo
OBJECTIVES: To determine (1) the prevalence of candidal carriage in patients with oral mucosal disease to be treated with topical immunosuppressive therapy, and (2) the incidence of oral candidiasis among carriers and noncarriers after initiation of therapy to assess any correlation between carriage and the development of candidiasis. STUDY DESIGN: Records of patients who underwent swab cultures for Candida between January 2009 and October 2014 at the Brigham and Women's Hospital in Boston, Massachusetts, were retrospectively reviewed...
October 2016: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Zenon J Czenze, R Mark Brigham, Anthony J R Hickey, Stuart Parsons
Seasonal changes in weather and food availability differentially impact energy budgets of small mammals such as bats. While most thermal physiological research has focused on species that experience extreme seasonal temperature variations, knowledge is lacking from less variable temperate to subtropical climates. We quantified ambient temperature (T a) and skin temperature (T sk) responses by individuals from a population of New Zealand lesser short-tailed bats (Mystacina tuberculata) during summer and winter using temperature telemetry...
August 25, 2016: Oecologia
Joshua D Lee, Edward V Nunes, Patricia Novo Mpa, Genie L Bailey, Gregory S Brigham, Allan J Cohen, Marc Fishman, Walter Ling, Robert Lindblad, Dikla Shmueli-Blumberg, Don Stablein, Jeanine May, Dagmar Salazar, David Liu, John Rotrosen
INTRODUCTION: For opioid-dependent patients in the US and elsewhere, detoxification and counseling-only aftercare are treatment mainstays. Long-term abstinence is rarely achieved; many patients relapse and overdose after detoxification. Methadone, buprenorphine-naloxone (BUP-NX) and extended-release naltrexone (XR-NTX) can prevent opioid relapse but are underutilized. This study is intended to develop an evidence-base to help patients and providers make informed choices and to foster wider adoption of relapse-prevention pharmacotherapies...
September 2016: Contemporary Clinical Trials
Kathryn Brigham Egan
This article assesses the reported prevalence and incidence rates for benign prostatic hyperplasia and lower urinary tract symptoms (BPH/LUTS) by age, symptom severity, and race/ethnicity. BPH/LUTS prevalence and incidence rates increase with increasing age and vary by symptom severity. The BPH/LUTS relationship is complex due to several factors. This contributes to the range of reported estimates and difficulties in drawing epidemiologic comparisons. Cultural, psychosocial, economic, and/or disease awareness and diagnosis factors may influence medical care access, symptom reporting and help-seeking behaviors among men with BPH/LUTS...
August 2016: Urologic Clinics of North America
Natasha Kekre, Francisco J Marquez-Malaver, Monica Cabrero, Jl Piñana, Albert Esquirol, Robert J Soiffer, Dolores Caballero, M J Terol, Rodrigo Martino, Joseph H Antin, L Lopez-Corral, Carlos Solano, Philippe Armand, Jose A Pérez-Simon
There is at present little data to guide the choice of conditioning for patients with lymphoma undergoing reduced-intensity conditioning (RIC) allogeneic stem cell transplantation (SCT). In this study, we compared the outcomes of patients undergoing RIC SCT who received fludarabine and melphalan (FluMel), the standard RIC regimen used by the Spanish Group of Transplantation, and fludarabine and busulfan (FluBu), the standard RIC regimen used by the Dana-Farber Cancer Institute/Brigham and Women's Hospital. We analyzed 136 patients undergoing RIC SCT for lymphoma with either FluBu (n = 61) or FluMel (n = 75) conditioning between 2007 and 2014...
October 2016: Biology of Blood and Marrow Transplantation
K E Joung, H H Burris, L J Van Marter, T F McElrath, Z Michael, P Tabatabai, A A Litonjua, S T Weiss, H Christou
OBJECTIVE: Vitamin D deficiency is associated with asthma and reactive airway disease in childhood but its potential contribution to bronchopulmonary dysplasia (BPD) in preterm infants is unknown. Preterm infants have lower levels of 25-hydroxyvitamin D (25(OH)D) at birth and are at risk for nutritional deficiencies after birth. The objective of the study was to evaluate the association of 25(OH)D concentrations at birth and at 36 weeks' corrected gestational age with BPD in preterm infants born before 29 completed weeks of gestation...
October 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
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