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C1QBP Inhibits DUX4-Dependent Gene Activation and Can Be Targeted with 4MU

Tue, 05/16/2017 - 4:45pm

FSHD is linked to the misexpression of the DUX4 gene contained within the D4Z4 repeat array on chromosome 4. The gene encodes the DUX4 protein, a cytotoxic transcription factor that presumably causes the symptoms of the disease. However, individuals have been identified who express DUX4 in their muscle biopsies, but who remain asymptomatic, suggesting that there are other factors that modify FSHD penetrance or severity. We hypothesized that an FSHD-modifying factor would physically interact with DUX4, and we took a proteomic approach to identify DUX4-interacting proteins. We identified the multifunctional C1QBP protein as one such factor. C1QBP is known to regulate several processes that DUX4 affects, including gene expression, oxidative stress, apoptosis, and pre-mRNA splicing. We used siC1QBP knockdown assays to determine if C1QBP affects DUX4 activity. While C1QBP had little effect on DUX4 activity in myotubes, we found that it inhibits the kinetics of DUX4-target gene activation during myogenic differentiation. This identifies C1QBP as a regulator of DUX4 activity and a potential target for FSHD therapeutics. Importantly, C1QBP is regulated by binding to the signaling molecule hyaluronic acid (HA). Decreasing HA by treating cells with 4-methylumbelliferone (4MU), an inhibitor of HA synthesis, resulted in a sharp decline in DUX4 activity and also greatly reduced its cytotoxicity. We have found that DUX4-induced cytotoxicity is associated with severe mislocalizaton of C1QBP, which is prevented by 4MU. This defect is not a downstream result of DUX4-induced oxidative stress, as it could not be prevented by treating cells with an antioxidant, nor could it be recapitulated by exposing cells to oxidants. This identifies C1QBP as a target for the treatment of FSHD, and in particular indicates that 4MU, already an approved drug in Europe and currently under investigation for other indications, may be an effective C1QBP-targeting FSHD therapeutic compound.

Impact of Body Mass Index and Weight Change on Risk of Recurrence in Patients Treated for Endometrial Adenocarcinoma

Tue, 05/16/2017 - 4:45pm

Background: Obesity is a well-documented risk factor for EAC, but the relationship between obesity and disease recurrence is controversial. Additionally, body weight is an inherently dynamic variable and no studies have examined the relationship between interval weight change and risk of EAC recurrence.

Objectives: To identify if there is a relationship between body mass index (BMI) or interval weight change and the risk of disease recurrence among women treated for EAC.

Methods: We conducted a retrospective chart review of 337 women diagnosed and treated surgically for EAC at UMass Memorial Medical Center from 2010 to 2015. The effect of BMI on risk of disease recurrence was assessed by Cox proportional hazards model adjusting for age, FIGO stage, myometrial invasion, lymphovascular space involvement and status of adjuvant therapy. The effect of interval weight change on EAC recurrence was assessed using logistic regression, adjusting for BMI and recurrence free interval.

Results: Among 337 women diagnosed with EAC, mean BMI at diagnosis was 35.9 pounds (SD: 8.9), mean weight at diagnosis was 201.5 pounds (SD: 52.7) and mean interval weight change was -8.1 pounds (SD: 18.8). At time of data extraction there were 19 patients (5.7%) with disease recurrence. The hazard ratio for recurrence in women with BMI >50 was 11.4 [95%CI: 1.54-84.05] times that of women with BMI<30 >(p=0.02). Women who maintained or gained weight following primary surgical resection had no increased risk of recurrence compared to those who lost weight [OR: 1.02, 95%CI: 0.27-3.82] (p=0.97).

Conclusion: Women with extreme obesity at diagnosis are more likely to have disease recurrence following primary surgical treatment for endometrial adenocarcinoma. However, women who lose weight following primary surgical treatment of EAC are just as likely to have disease recurrence as those who maintain or gain weight.

Gastrointestinal Perforations: Examining the Overlooked Unintentional Consequences of Our Nation’s Epidemic of Antibiotic Exposure

Tue, 05/16/2017 - 4:45pm

Objective: More than 266 million courses of antibiotics are dispensed to outpatients annually in the US, with the rising elderly population consuming a substantial number of antibiotics. At least 30% of these antibiotics prescribed are unnecessary. Alterations in gut microbiome are known to cause stomach and small intestine (SSI) perforations. However, the impact of antibiotic exposure outcomes of SSI perforations among the elderly has not been studied. We examined the relationship between antibiotic exposure, as a proxy for microbiome modulation, and SSI perforation outcomes in a nationwide sample of elderly patients.

Methods: A 5% random sample of Medicare beneficiaries (2009-2011) was queried to identify patients with SSI perforations. Previous outpatient antibiotic exposure (0-30, 31-60, 61-90 days prior to admission) was assessed. Clinical characteristics were compared between no previous antibiotic exposure (NPA) and previous antibiotic exposure (PA) patients. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay and 30-day readmission. Univariate and multivariable regression analyses were performed.

Results: Overall, 401 patients ≥ 65 years had SSI perforations (68.3% with NPA and 31.7 % with PA). Mean age (± SD) was 80 years (± 8). Overall in-hospital mortality was 13%. There was a significant difference in the rates of mortality (12% in NPA vs. 18 % in 0-30 days PA, 17% 31-60 days PA, and 8% 61-90 days PA, P= 0.002). After adjustment of other factors, a trend toward increased in-hospital mortality was observed among patients in 0-30 days PA (odds ratio [OR] 2.0, 95% confidence interval [CI] (0.9, 4.7) and was significantly associated with ICU admission (OR 4.3, 95% CI (1.8, 10.2).

Conclusion: Recent antibiotic use increases illness severity and may increase mortality among elderly patients with SSI perforations. Exposure to antibiotics, one of the most modifiable determinants of microbiota, should be minimized in the outpatient setting.

The Effects of Early Adoption of Academic Electronic Health Records System (EHRS) on Patient Outcome in Nursing

Tue, 05/16/2017 - 4:45pm

The wide adoption of EHR systems has led the Institute of Medicine (IOM) to emphasize the use of informatics as a core competency required of all health care professions. However, the nursing profession has been slow to incorporate information technology into formal nurse education and practice. In the massive transformation from disconnected, inefficient, paper-based care delivery to interconnected system driven by EHRs (Electronic Health Records system), little is known about the effect of the early adoption of academic EHRs in nursing education and relationship between effective use of EHRs and patient outcome in nursing.

In this study, a community-academic partnership was driven to have better resources to assess the effect of the early adoption of academic EHRs in Nursing education, using the local hospital’s training set of electronic health records system (EHRs). With this pilot study, a quantitative research design with supportive qualitative research will be used. First a two-group quasi-experimental pre-post design will be used to assess changes in nursing students’ readiness/effectiveness of nursing documentation using academic EHRs. Second, a cross-sectional research design will be used to identify the relationship between effectiveness of nursing documentation by nurses (e.g., time) and patient outcome (e.g., incident rate, healthcare associated infections, falls incidences, pressure ulcer incidences, and patient satisfaction). Student and faculty participants will be recruited from one university in the Eastern United States. Nurse participants will be recruited from one hospital in Eastern United States. Patient outcome information will be retrieved from the electronic health record system.

These findings will be very helpful to prepare students for the future of health information technology. Meaningful adoption of academic electronic health record systems will help in building the undergraduate nursing students’ competence in nursing documentation with electronic health record systems and improve patient care.

Trends in Cause of Death among Puerto Rican and United States Multiple Myeloma Patients

Tue, 05/16/2017 - 4:45pm

Background/Objective: Multiple myeloma (MM) is an incurable, yet treatable, cancer of plasma cells. Due to recent improvements in treatment, people diagnosed with MM have been living longer, and other co-morbid conditions may be of increasing importance. This study examines temporal trends in specific causes of death among MM patients in Puerto Rico (PR) and United States (US).

Methods: We analyzed primary cause of death among all incident MM cancer cases recorded in the Puerto Rico Central Cancer Registry (PRCCR) (n=3,018) and the US Surveillance, Epidemiology, and End Results Program (SEER) (n=67,733) between 1987-2013, overall and by follow-up time, age, and sex. We calculated the cumulative incidence of death due to seven selected causes and analyzed age-adjusted mortality trends by MM and other causes using joinpoint regression.

Results: MM accounted for 71.7% and 71.3% of all reported deaths in PR and US, respectively, among people diagnosed with MM. In PR, the proportion of patients that died from MM decreased with increasing follow-up time since diagnosis (72.3% of deaths with ≤2 years vs 65.6% with >5 years of follow-up) and the proportion of patients who died from circulatory (4.6% vs 9.0%) and respiratory system (3.7% vs 5.0%) diseases increased slightly. A similar trend of decreasing MM deaths with follow-up time was observed in the US (73.2% of deaths with ≤2 years vs 66.5% with >5 years of follow-up). Joinpoint regression showed a decreasing trend in MM mortality in the US (APC1987-2007=-2.8%, and APC2007-2013=-18.4%) and a similar, though somewhat weaker, trend in PR (APC1987-2013=-2.73).

Conclusion: In both PR and the US, people diagnosed with MM are still more likely to die from MM than from another cause. However, a decrease in MM mortality is evident, particularly in more recent years, but this decrease is lower in Puerto Rico.

Geographic Variation in Hospital Costs Associated with Isolated Coronary Artery Bypass Grafting

Tue, 05/16/2017 - 4:45pm

Background: In the past decades, studies have shown geographic variation (GV) in patient risk factors, outcomes, and practice patterns associated with coronary artery bypass grafting (CABG). However, contemporary data related to GV in hospital costs associated with isolated CABG are lacking.

Methods: We used the latest (2014) National Inpatient Sample (NIS) to identify patients aged 18+ who underwent primary isolated CABG. ICD-9 codes were used to derive comorbidities and procedure types. Geographic stratification was based on the Census Division of each hospital. The NIS cost-to-charge ratio based on all-payer inpatient costs and census-region-based medical care consumer price index were used to adjust for hospital costs. Data were analyzed by using weighted analyses of variance for continuous data and the Rao-Scott likelihood ratio Chi-square test for categorical variables. Weighted multivariable regression analysis was used to examine the association between geographic divisions and adjusted costs (log-transformed) by adjusting for patient/procedure characteristics, and comorbidities.

Results: In 2014, 132,270 patients from 1,106 hospitals underwent a primary isolated CABG. The median (Inter Quartile Range [IQR]) of age was 65 (57-72) years (GV: 63-66), and 25% was female (GV: 22%-28%). Overall, 47% were admitted electively (GV: 38%-54%), 28% had a primary diagnosis of acute myocardial infarction (GV: 26%-32%), 84% had hypertension (GV: 80%-86%), 27% had atrial fibrillation (GV: 24%-29%), 12% (GV: 8%-15%) had 4+ coronary arteries bypassed and 1.4% died in-hospital (GV: 0.9%-2.1%). The median (IQR) hospital length of stay was 6.9 (5.0-9.8) days (GV: 6.3-7.2). The median (IQR) adjusted cost was $34,949 ($26,879-$44,725), which was lowest in the East South Central ($28,854 [$23,268-$36,193]) and highest in the East North Central ($41,852 [$32,965-$54,223]) (p

Conclusions: We observed statistically, but not clinically, significant differences in patient baseline characteristics. Geographic variations exist in outcomes and the hospital costs among patients who underwent isolated CABG.

Broad Repertoire of T Cell Autoreactivity Directly from Islets of Donors with Type 1 Diabetes (T1D)

Tue, 05/16/2017 - 4:45pm

Type 1 diabetes (T1D) is an autoimmune disease characterized by the infiltration of lymphocytes into the insulin-producing β-cells in the pancreas. We have isolated live T cells sorted or grown directly from the isolated, handpicked islets of human donors with T1D. We received ~500 islet equivalent EQ of variable purity (10-90%) from 12 donors with T1D (disease duration 0.42-20 years) and from seven control donors and two donors with type 2 diabetes (T2D). A total of 321 T cell lines and clones were derived from the islets of donors with T1D (3 lines from the 9 control donors). These are 131 CD4+ lines and clones, 47 CD8+ lines and 143 lines that contain both CD4+ and CD8+ T cells. From 50 lines and clones examined to date, we have determined the autoreactivity of 19 and have seen a broad repertoire of T cell autoreactivity in the islets, including characterized targets and post-translationally modified targets. Autoreactivity of CD4+ T cell lines was to three different peptides from glutamic acid decarboxylase 65 (GAD; GAD115-127, GAD274-286, GAD555-567), proinsulin76-90, and to chromogranin A or proinsulin expressed by DR4+DQ8+ B cells transduced with lentivirus containing constructs with the open reading frames corresponding to whole autoantigens. Reactivity to modified peptides included the glucose-regulated protein 78 and islet amyloid polypeptide with arginine to citrulline modifications (GRP78292-305(Arg-Cit297) and IAPP65-84(Arg-Cit 73, 81)), deaminations (IA-2545-562(Gln-Glu 548, 551, 556), and to several insulin hybrid peptides. These autoreactive CD4+ T cell lines and clones secreted only pro-inflammatory cytokines (IFN-γ, TNFα) upon peptide stimulation. For CD8+ T cells from islets, from one donor with T1D, we saw binding of a pool of HLA-A2 pentamers loaded with insulin B10-18, IA-2797-805 and insulin specific glucose-6-phosphatase catalytic subunit related protein, IGRP265-273. These results have implications for the development of successful prevention and reversal therapeutic strategies in T1D.

The Effectiveness of Tablet-based Application for Older Adults with Diabetes Mellitus Type II: A Pilot Study

Tue, 05/16/2017 - 4:45pm

Introduction: Advances in technological applications such as tablet-based computers is growing dramatically in the field of healthcare, as there is a considerable eagerness for mobile health interventions. Tablet-based interventions can have positive effects on both health and health service delivery processes (Free et al, 2013). Technological applications have been developed for a wide range of healthcare needs, including patient registration, data management, and self- management applications.

Background: The usefulness of technology and the powerful capabilities of technological applications have led to a significantly increased interest in finding novel approaches to support older adults’ self-management.Self-management technological applications have been used in various contexts, and usability is key in sustainability and adoption of such technologies.

Theoretical Framework: The study will be guided by the self-management model of Maintaining the Balance (Jacelon, 2010).

Design: Quasi-experimental design.

Methods: Quantitative standardized measures will be used in this study. A purposive sample of 24 elderly patients with DMII will be recruited for the study. The descriptive and inferential analysis will be used to analyze the quantitative data.

Results: This is an ongoing project, and the study is currently in the recruitment and data collection phase.The final patient is expected to be enrolled by the end of March 2017. We hope to recruit approximately 24 patients to the study. Analyses will focus on usability attributes (effectiveness, efficacy, errors/simplicity, and overall satisfaction), perceived diabetes self-management and blood glucose level are the main outcomes.

Conclusion: A well-designed application with new features has the ability to provide more promising results regarding improving the quality of life, supporting informed decision making, improving communication with care providers, promoting active collaboration with care teams, encouraging self-care behaviors, problem-solving, improving health status, and improving clinical outcomes.

The BCH-SBPR: A Multi-disciplinary Registry Collecting Longitudinal Data on Patients with Spina Bifida

Tue, 05/16/2017 - 4:45pm

Introduction. In the U.S. alone, approximately 1500 infants are born with SB each year. An estimated 166,000 individuals with SB live in the United States.

Background. The BCH-SBPR was established in August 2015 to help increase knowledge about new procedures, surgeries and treatment options, growing up with Spina Bifida, and to guide healthcare practices by prospectively studying a cohort of children born with this condition.

Objective. The objective of this project is to collect comprehensive longitudinal clinical data (demographics, treatments, and outcomes) from a multi- disciplinary clinic on patients with SB.

Design: Prospective longitudinal design. Data collection will occur every six months.

Methods. Study subjects include children whose ages range from birth to 35 years with one of the following six SB diagnoses: Myelomeningocele, Meningocele, Lipoma of Spinal Cord, Fatty Thickened Filum, Split Cord Malformation, and Terminal Myelocystocele will be eligible to participate.

Results. 653 patients were enrolled in this registry. 635 patients were enrolled in this registry. 66 patients were randomly selected to conduct a descriptive analysis. The mean age was 9.7 (7.63 SD). The majority of the patients' age were between 5 and 13 years old (40 %). The female participants (58.3 % ) were slightly more than male participants (41.7%). The majority was white (56.7%) and None-Hispanic or Latino. 40% of the patient relaid on public insurance. 70% had an MMC and 30 non-MMC diagnoses. The majority of the patients were geographically located in Massachusetts (63.2.%). Therefore, further analysis of descriptive and inferential statistics will be conducted early August 2017.

Conclusion. This Registry will provide valuable longitudinal clinical data from approximately 700 patients with SB conditions. The collected data will be used for quality improvement and research projects.

Poster Session Program: 2017 UMass Center for Clinical and Translational Science Research Retreat

Tue, 05/16/2017 - 4:45pm

Poster Session Program for the 7th annual UMass Center for Clinical and Translational Science Research Retreat, held Tuesday, May 16, 2017 at the University of Massachusetts Medical School, Worcester, MA.

View poster abstracts

An Innovative Nurse-Managed Transition Clinic for Adolescents and Young Adults with Spina Bifida: A Pilot Study

Tue, 05/16/2017 - 4:45pm

Background. Transition from pediatric to adult care for patients with complex illness is challenging. The Spina Bifida Center at Boston Children’s Hospital (SBC) has approximately 650 patients, of which 25% (N=162) are ≥ 18 years of age. The SBC has not had a structured paradigm for successful transition. A first transition clinic with our pediatric and adult care urology partners was initiated in August 2016.

Methods. A 20 question (TRAQ: Transition Readiness Assessment Questionnaire) paper survey was distributed to patients in the first Spina Bifida Transition Clinic at Boston Children's Hospital. TRAQ is a validated, patient-centered questionnaire which providers and families can use to assess youths' readiness to transition to adult care.

Results. Seven young adults participated in the Spina Bifida Transition Readiness Assessment Questionnaire (TRAQ). Of the seven patients who took part in the TRAQ survey, 85.7 % (n=6) were males and 14.3% (n=1) were females. 85.7% were white-non-Hispanic or Latino, and 14.3 % were white-Hispanic or Latino. The participants' mean age was 28.1. Of the patients who completed the questionnaires, 61.4 % reported a positive response ("Yes, I have started doing this," or "Yes, I always do this when I need to.") related to their ability level regarding managing medications, appointment keeping, tracking health issues, talking with providers, and managing daily activities. 16.4% reported a negative response ("No, I do not know how,") related to the domains mentioned above, and 22.1% had a negative response but were either willing to learn or already learning how to manage and develop skills needed for the transition to adult care.

Conclusion. Transition is a multi-step process. We found that successful transition for the patient and family requires investment from pediatric and adult providers, involvement of social work and the support of local spina bifida association.

Association between Psychosocial Factors, Quality of Life and Atrial Fibrillation

Tue, 05/16/2017 - 4:45pm

Background: Atrial fibrillation (AF) is associated with cognitive and psychosocial comorbidities, and poorer quality of life (QOL). In this study, we aimed to study the association between cognition, psychosocial status and QOL at baseline and AF recurrence.

Methods: We enrolled 222 symptomatic AF patients (64±10.0 years, 36% women) treated with a rhythm-control strategy. We performed cognitive, psychosocial, and QOL assessments using Montreal cognitive assessment (MOCA, cognitive impairment

Results: A total of 123 (55%) participants experienced an AF recurrence over the 6-month follow-up period. Participants with an AF recurrence had higher rates of depression (31% vs.14%, p=0.022) and lower QOL (62±24 vs. 72±21, p=0.003) at baseline than did participants free from recurrence. In multivariable logistic regression models, lower baseline QOL, but not depression, anxiety, or cognition, was associated with a significantly higher odds of AF recurrence event (Odds Ratio: 0.98, CI 0.97-0.99).

Conclusion: Lower AF-related QOL is associated with higher odds of AF recurrence over 6 months among symptomatic AF patients treated with rhythm control. Patient-reported variables have not previously been considered as risk factors for disease progression or prognosis. Our data suggests QOL may serve as a useful tool to aid clinicians in the management of AF patients.

Predictors of Cardiac Mortality in the CCU: A Retrospective Study in a Tertiary Center

Tue, 05/16/2017 - 4:45pm

Background: Although prior studies have linked troponin I (TnI) elevation, serum sodium (Na) fluctuation, and reduced ejection fraction (EF) with an increased mortality in the medical/surgical critical care units, this has not been validated in the CCU. We aim to identify clinical and laboratory factors to predict cardiac related length of survival (LOS) in the CCU.

Methods: We retrospectively analyzed 134 consecutive patients who were admitted to the CCU from December 2012 to March 2015, and who died during that admission. We used student T-test, correlation matrices, and Framingham risk factors adjusted multivariable logistic regression models to examine the role of TnI, serum Na, EF and other clinical covariates on LOS in cardiac death (CD) and non- cardiac death (NCD) group.

Results: The average age of the study population was 70.0 ±14.3 (39.0% women). The prevalence of CD and NCD were 63% and 59%. LOS was statistically shorter in the CD vs. NCD group (5.3 days vs. 8.2 days, p=0.012). LOS negatively correlated with initial TnI (p= 0.05). LOS was not statistically affected by EF or Na level. Our regression models identified BMI and diabetes mellitus (DM) as strong predictors of CD (p= 0.04 and p=0.01).

Conclusion: Our results validate prior studies showing that TnI, BMI, and DM are predictors of cardiac related mortality in the CCU. Patients with a cardiac etiology had a higher mortality rate and a shorter LOS. Future studies are needed to develop a scoring system specific for predicting mortality in the CCU.

The "Double Loaded" LV: High Prevalence of Hypertensive LVH Preceding the Development of Severe Aortic Stenosis

Tue, 05/16/2017 - 4:45pm

Background: It is generally assumed that left ventricular hypertrophy (LVH) in aortic stenosis (AS) is a compensatory adaptation to chronic outflow obstruction. However the advent of TAVR has stimulated more focus on AS in older patients, most of whom have antecedent hypertension (HTN). Accordingly our aim was to investigate the interaction between HTN and AS on LV remodeling in contemporary practice.

Methods: We studied 33 consecutive patients with AV peak velocity (PV) >2.5 m/s on their initial echo and a PV of >3.5 m/s on a subsequent study performed at least 5 years later. Patients’ demographics and clinical information were collected. Peak intraventricular pressure (IVP, mmHg) was defined as the sum of systolic arterial pressure and peak intraventricular gradient.Data were analyzed using descriptive statistics, paired- samples T test, and linear correlation.

Results: Of our sample (46% women, mean age of 82±11 y), 29 (88%) had a history of hypertension. The average interval between the two echo studies was 6.2±1 years. As expected, wall thickness, LV Mass, and relative wall thickness increased over time. There was no correlation between change in LV mass index (LVMi, g/m2) and peak IVP, PV or AV MG. However change in LVMi did correlate inversely with baseline LVMi (r= -0.37, p= 0.03).

Conclusion: Most patients seen in our practice with severe AS have antecedent hypertension and LVH. LVH worsens in parallel with worsening severity of AS. Remodeling in these patients features increasing concentric remodeling of the LV, rather than LV dilation. Given these findings, we speculate that regression of LVH to normal will not be effected by AVR because LVH proceeded hemodynamically severe AS. Strict control of blood pressure might be of equal importance in preventing and ameliorating pressure overload in these patients.

Does Pre-Stroke Statin Use Influence Survival and Institionalization after Hospital Discharge?

Tue, 05/16/2017 - 4:45pm

Background: Meta-analytic findings suggest statin exposure at the onset of acute ischemic stroke (AIS) may improve outcomes. Whether this applies to very old, clinically complex patients remains unclear.

Objective: To compare survival and the composite outcome death/institutionalization between statin users and non-users in a national cohort of AIS patients rehabilitated in skilled nursing facilities (SNF).

Methods: From Medicare Part A claims, we identified 18,551 community-dwelling older adults hospitalized for AIS between 04/01/11-09/02/2012 and discharged to a SNF. Pre-stroke statin use and dose intensity were defined using Part D claims (high intensity, low/intermediate intensity, non-user). Patients were followed for 120 days post-discharge to ascertain death and location at day 120 (SNF/nursing home or community). Patients hospitalized at day 120 were assigned to the location preceding admission. Multivariable log-binomial regression models with a log link estimated the covariate-adjusted relative risks (aRR) for the association of statin exposure with death and death/institutionalization.

Results: The median age of the cohort was 84 years and 39.3% used statins before the AIS, of whom 10.8% received a high-intensity dose. Within 120 days of hospital discharge, 19.8% of high intensity statin users, 20.0% of low-intensity statin users, and 21.3% of non-users died (aRR high intensity vs non-users: 1.01, 95% Confidence Interval (CI): 0.87-1.16; aRR low intensity vs non-users: 0.95, 95% CI: 0.89-1.01). At day 120, 44.5% of high intensity statin users, 47.0% of low intensity statin users, and 49.2% of non-users were dead or institutionalized (aRR high intensity vs non-users: 0.92, 95% CI: 0.85-1.00; aRR low intensity vs non-users: 0.95, 95% CI: 0.92-0.98).

Conclusions: In this large cohort of older patients residing in the community prior to AIS, nearly half were dead or institutionalized 120 days after hospital discharge. Statin use prior to AIS did not appear to confer a mortality advantage in this clinically complex population.

The Utilization of Video Capsule Endoscopy in Patients with Peutz-Jeghers Syndrome

Tue, 05/16/2017 - 4:45pm

AIM: Our aim is to demonstrate the utilization of VCE in the patients with Peutz–Jeghers syndrome (PJS) and evaluate the distribution of the polyps in each part of the small intestine and the percentage of patients with PJS who developed complications.

METHODS: Single center, retrospective chart review study of outpatients with PJS who underwent a video capsule endoscopy study between January 2006 and January2016.

RESULTS: A total of 16 patients were identified with PJS; mean age was 40 years. Female gender was predominant with 9 patients. Polyps were found in the duodenum, jejunum and ileum in 33%, 80% and 26 % respectively. Sixty percent of the patients had further evaluation with deep enteroscopy of the small intestine and 88 % of them showed small intestine polyps. Colonoscopy was done in 13 of the patients and polyps were found in 11 patients. 33% of patients had complications with intussusceptions or small bowel obstruction and all of them had jejunal polyps. 100% of females had polyps in the small intestine and 33% of them developed complications. 6 patients had polyps larger than 20 mm in the jejunum and 4 had complications with either intussusceptions or small bowel obstruction.

CONCLUSIONS: VCE has the ability to visualize more polyps compared to current deep enteroscopy devices. There is a direct relationship between the size of the polyp, location and the risk of complication. Polyps of at least 20mm in size, primarily in the jejunum had a high complication rate in this study of 67%. VCE is a valuable tool in evaluating patients with PJS and allows for monitoring of the small bowel and will further help to determine patients at high risk of complications. However, VCE was found in this study to be inferior to upper endoscopy for the detection of gastric polyps.

Frequent Cannabis Users Have Reduced Odds for Non Alcoholic Fatty Liver Disease

Tue, 05/16/2017 - 4:45pm

Background: Cannabis is the world's most widely used illicit drug. Though marijuana use has been revealed to impact the prevalence of diabetes, hypertension, and obesity - established risk factors for Non-Alcoholic Fatty Liver (NAFLD), it's relationship with NAFLD remains unknown.

Aim: We sought to investigate the association between cannabis use and NAFLD.

Methods: From the National Health and Nutrition Examination Survey (NHANES III, 1988–1994) survey data, we retrieved data from individuals aged 20 to 60 years who had an abdominal ultrasound for evaluation for hepatic steatosis (n=10,682). We then identified three cannabis use groups: never used before (never users, 62.22%), no use in the past month (infrequent users, 29.76%), and multiple uses in the past month (frequent users, 7.91%). After eliminating gender-specific severe alcohol consumption to recognize individuals with NAFLD (18.12%), we controlled for age, gender, race, BMI, DM to estimate the adjusted odds ratio (AOR) for having NAFLD on the frequency of cannabis use (SAS 9.4).

Results: When compared to never users of marijuana, unlike infrequent users who had no difference in the odds of NAFLD, frequent cannabis users had a 52% reduced odds for the disease (AOR: 0.95[0.76-1.18] & 0.48[0.35-0.66]). Frequent cannabis users also had a 52% lower odds of NAFLD when compared to infrequent users (AOR: 0.51[0.34-0.75]). Compared to Non-Hispanic Whites, Non-Hispanic Blacks and Hispanics respectively had 35% reduced and 58% increased odds of NAFLD (0.66[0.52-0.83) & 1. 58[1.26-1.99]). Females had a 31% lower odds for NAFLD (0.69[0.58-0.82]). Every percentage unit rise in glycated hemoglobin was associated with a 27% increased odds for NAFLD (1.27[1.17-1.38])

Conclusion: Our findings suggest that frequent cannabis use is associated with a lower odds of NAFLD. More powerful longitudinal studies are required to confirm these novel observations and to provide deeper insight into the modulation of NAFLD by cannabis use.

InVitro-Q: A High-throughput Biosensor Used to Evaluate the Mechanism of Phagocytosis of Macrophages Using Different Particles

Tue, 05/16/2017 - 4:45pm

The method of phagocytosis of a particle can provide information on how macrophages respond to a detected particle. The response elicited varies based on the nature of the particle and in turn changes which receptor-mediated phagocytosis is initiated. We have developed a multi-well cell-based sensor that can monitor real-time biological changes in living cells, such as mass redistribution, and viscoelasticity. This system provides unique kinetic information regarding the phenotypic change in the cells post treatment. As a proof of principle study, we evaluate macrophage phagocytosis using three different particles: latex beads, Zymosan A, and Staphylococcus aureus. These studies show the InVitro-Q’s ability to distinguish and differentiate the unique physiological method of macrophage phagocytosis of an indigestible particle (latex beads), and digestible particles of different origins (Zymosan A (yeast cell wall) and S. aureus (wood bacteria). The real-time data generated illustrates the unique phenotypic signatures of macrophages in response to particle specific phagocytosis. The traces then dictate time points at which visualization will occur, and guides the elucidation of the mechanism of action.

Poster Session Program: 2017 UMass Center for Clinical and Translational Science Research Retreat

Tue, 05/16/2017 - 4:45pm

Poster Session Program for the 7th annual UMass Center for Clinical and Translational Science Research Retreat, held Tuesday, May 16, 2017 at the University of Massachusetts Medical School, Worcester, MA.

View poster abstracts

Caring for Substance Exposed Newborns

Tue, 05/16/2017 - 2:35pm

As part of the mini-symposium entitled "Pregnant and Parenting Mothers with History of Opiate Addiction," this presentation describes innovations in care for substance exposed newborns while highlighting the gaps in services antepartum and post hospital discharge.