Somatostatin inhibits multireceptor stimulation of cyclic AMP formation and corticotropin secretion in mouse pituitary tumor cells.

The AtT-20/D16-16 mouse pituitary tumor cell secretes corticotropin (ACTH) in response to corticotropin-releasing factor (CRF), (-)-isoproterenol, and vasoactive intestinal peptide (VIP). These responses are associated with a rapid increase in cyclic AMP formation. Somatostatin (SRIF) markedly decreases the stimulatory effect of CRF, (-)-isoproterenol, and VIP on both cyclic AMP formation and immunoreactive ACTH secretion. Forskolin and cholera toxin, adenylate cyclase activators, also stimulate cyclic AMP formation and ACTH secretion in AtT-20 cells and these responses are all inhibited by SRIF. The ACTH secretory responses to melittin and to the calcium ionophore A23187, neither of which increases cyclic AMP in AtT-20 cells, were not inhibited by SRIF. SRIF did not affect the binding of a tritiated beta-adrenergic receptor antagonist to AtT-20 membranes nor did it decrease basal cyclic AMP formation even in the presence of excess phosphodiesterase inhibitor, indicating that the reduction of cyclic AMP levels by SRIF did not involve either an interference with beta-adrenergic agonist binding to receptors or stimulation of cyclic AMP degradation. These results indicate that the inhibition of CRF-, (-)-isoproterenol-, and VIP-stimulated ACTH secretion by SRIF may be regulated by its inhibitory action on adenylate cyclase.     

Intravenous unfractionated heparin dosing in obese patients using anti-Xa levels

There is limited guidance on intravenous dosing of unfractionated heparin in obese patients. The purpose of this study was to determine the efficacy and safety of a standard unfractionated heparin (UFH) protocol in obese patients based on total body weight (TBW) or adjusted body weight (ABW) to reach two consecutive therapeutic anti-Xa levels. This was a retrospective observational cohort study conducted in a large academic medical center. Adults received a standard UFH protocol between January 1, 2013 to December 31, 2015. Inclusion criteria included age ≥ 18 years of age, weight ≥ 100 kg with a BMI ≥ 30 kg/m², and received intravenous UFH. Patients were excluded if they received an alternative UFH protocol, received?<?24 h of the standard UFH protocol, or had inadequate compliance to protocol. Out of the 131 patients included, 109 patients reached two consecutive therapeutic UFH levels within 96 h. The average time to two consecutive therapeutic UFH levels was 29.4 h and 27.6 h in patients dosed by TBW and ABW, respectively (95% CI ??4.63 to 8.11; P?=?0.93). Safety outcomes included major bleeding, overt bleeding, or death events between patients dosed by TBW compared to ABW, (p?=?0.61, p?=?1.0, p?=?1.0, respectively). Dosing intravenous UFH based on TBW or ABW resulted in similar times to therapeutic anti-Xa levels and safety outcomes. The data provided suggests using either TBW or ABW in obese patients is as effective and safe to use.

     

Concurrent validity of the MAE visual naming test.

Deficient confrontation naming has been observed in a number of neurological illnesses, as well as in aphasia and normal aging. The Visual Naming Test (VNT) of the Multilingual Aphasia Examination (MAE) is a standardized measure of confrontation naming. One hundred patients, consecutively referred for neuropsychological evaluation, were administered the VNT, Boston Naming Test (BNT), and WAIS-R. Concurrent validity of the two confrontation naming measures was demonstrated by their high intertest agreement. Performance on the VNT was found to be related to a unique ability separate from general intellectual functioning. Suggestions regarding the clinical use of the VNT are discussed.     

Modeling the economic benefit of targeted mild hypothermia in deceased donor kidney transplantation

Delayed graft function (DGF) in kidney transplant significantly increases inpatient and outpatient cost. Targeted, mild hypothermia in organ donors after neurologic determination of death significantly reduced the rate of DGF in a recent randomized controlled clinical trial. To assess the potential economic benefit of national implementation of donor hypothermia, rates of reduction DGF were combined with estimates of the impact of DGF on hospital cost and total health expenditure for standard and extended criteria donor organs (SCD and ECD). DGF increases the cost of the transplant episode by $9487 for ECD transplant and $10 342 for SCD transplant. Medicare recipients with DGF incur an additional $18 513 spending for ECD and $14 948 in SCD transplants over the first year. An absolute reduction in DGF rate after kidney transplantation consistent with trial results (ECD 25%, SCD 7%) has the potential to lower annual hospital cost for kidney transplant by $13 178 746 and annual Medicare spending by $20 970 706 compared to standard donor management practice using static cold storage. Targeted mild hypothermia improves care of renal transplant patients by safely reducing DGF rates in both ECD and SCD transplant. Broader application of this safe, effective, and low‐cost intervention could reduce healthcare expenditures for providers and insurers.     

Prorating Wechsler Adult Intelligence Scale-III summary scores

The application of the nine-subtest prorated version of the Wechsler Adult Intelligence Scale-III (WAIS-III) in estimating Verbal, Performance, and Full-Scale IQ scores was evaluated in a sample of 278 mixed clinical patients from two Department of Veterans Affairs Medical Centers. The composite reliabilities of the three prorated summary scores, which excluded Comprehension and Picture Arrangement, did not differ from reliabilities from the full WAIS-III. All three prorated IQ summary scores demonstrated good alternate forms reliability with the standard WAIS-III summary scores. Verbal Performance discrepancy scores were accurate for 86% of the cases. The results of this study appear to support the regular use of prorated WAIS-III summary scores in estimating full WAIS-III summary scores. The benefit of this system is that by giving all of the subtests required for the index scores, not only are the index scores derived, but a very close estimation of the summary scores are generated.     

Ductal carcinoma <Emphasis Type="Italic">in situ</Emphasis> of the breast (DCIS) with heterogeneity of nuclear grade: prognostic effects of quantitative nuclear assessment

Background  

Previously, 50% of patients with breast ductal carcinoma in situ ( DCIS) had more than one nuclear grade, and neither worst nor predominant nuclear grade was significantly associated with development of invasive carcinoma. Here, we used image analysis in addition to histologic evaluation to determine if quantification of nuclear features could provide additional prognostic information and hence impact prognostic assessments.