Impact of income and perceived stress on engagement and weight loss outcomes in an online behavioral weight loss program

Journal of Behavioral Medicine - Lower income is associated with greater stress, and stress has been shown to undermine treatment engagement and weight loss outcomes in face-to-face interventions....     

Cangrelor dose titration using platelet function testing during cerebrovascular stent placement

BackgroundOptimal antiplatelet inhibition is vital during cerebrovascular stenting procedures, yet no standardized recommendation exists for antithrombotic therapy in these scenarios. Cangrelor is an intravenous P2Y12 inhibitor with a favorable pharmacokinetic profile for use during neuroendovascular stenting.MethodsA retrospective review of all neuroendovascular patients who underwent stenting between 1 January 2019 and 22 March 2020 and were treated with cangrelor was conducted. Thirty-seven patients met inclusion criteria.ResultsAll patients were administered a bolus of 5 mcg/kg of cangrelor followed by a maintenance infusion. Antiplatelet effects of cangrelor were monitored using platelet reactivity units (PRU). Based on the initial PRU, seven patients’ doses were adjusted with subsequent PRUs in or near the goal range of 50–150. One patient experienced an acute intraprocedural occlusion likely related to a subtherapeutic PRU which subsequently resolved with cangrelor dose adjustment and intra-arterial tirofiban administration, and one patient experienced a post-procedure stent occlusion which required a thrombectomy and intra-arterial tirofiban administration. No hemorrhagic complications occurred.DiscussionCangrelor utilization during neuroendovascular stenting with maintenance doses of <2 mcg/kg/min with dose adjustments based on platelet function testing has not been previously described. Cangrelor presents many advantages compared to standard therapy in patients undergoing stent placement related to its pharmacokinetic profile, rapid onset of action, ease of transition to oral P2Y₁₂ antiplatelet agents, and measurability.ConclusionCangrelor is a promising alternative to currently available therapies, especially in patients with a high hemorrhagic risk.     

X-ray structure of trypanothione reductase from Crithidia fasciculata at 2.4-A resolution.

Trypanosomes and related protozoan parasites lack glutathione reductase and possess instead a closely related enzyme that serves as the reductant of a bis(glutathione)-spermidine conjugate, trypanothione. The human and parasite enzymes have mutually exclusive substrate specificities, providing a route for the design of therapeutic agents by specific inhibition of the parasite enzyme. We report here the three-dimensional structure of trypanothione reductase from Crithidia fasciculata and show that it closely resembles the structure of human glutathione reductase. In particular, the core structure surrounding the catalytic machinery is almost identical in the two enzymes. However, significant differences are found at the substrate binding sites. A cluster of basic residues in glutathione reductase is replaced by neutral, hydrophobic, or acidic residues in trypanothione reductase, consistent with the nature of the spermidine linkage and the change in overall charge of the substrate from -2 to +1, respectively. The binding site is more open in trypanothione reductase due to rotations of about 4 degrees in the domains that form the site, with relative shifts of as much as 2-3 A in residue positions. These results provide a detailed view of the residues that can interact with potential inhibitors and complement previous modeling and mutagenesis studies on the two enzymes.     

Evidence for an involvement of the brain cholecystokinin B receptor in anxiety.

The effect of neuropeptide cholecystokinin (CCK) receptor agonists and antagonists was examined in the rat elevated X-maze model of anxiety. The selective CCK-B receptor antagonists CI-988 (PD 134308) and L-365,260 produced anxiolytic-like effects, whereas MK-329, a CCK-A receptor antagonist, was respectively less potent by factors of 313 and 200. The intracerebroventricular administration of the nonselective CCK receptor agonist caerulein or the selective CCK-B receptor agonist pentagastrin increased dose dependently the level of anxiety. CI-988 dose dependently antagonized the anxiogenic response to pentagastrin but not that induced by pentylenetetrazol. These results strongly suggest that activation of the brain CCK-B receptor induces anxiety and that selective antagonists of this receptor represent a separate class of anxiolytic agents.     

Effects of thyroid-stimulating hormone, carbachol, norepinephrine, and adenosine 3',5'-monophosphate on polyphosphatidylinositol phosphate hydrolysis in dog thyroid slices

TSH (10-250 mU/ml), carbachol (100 nM to 10 microM), and norepinephrine (10-100 microM) stimulated in a dose-dependent manner the accumulation of [3H]glycerophosphoinositol, [3H]inositol monophosphate, [3H]inositol bisphosphate, and [3H]inositol triphosphate in dog thyroid slices prelabeled with myo-[2-3H]inositol. The maximal effect of carbachol was considerably greater than that of TSH and norepinephrine. Carbachol stimulation of [3H]inositol phosphates (InsPs) was present by 5 min of incubation, while that of TSH required at least 30 min. Neither the basal level of [3H]InsPs nor the stimulation by carbachol (1 microM) or norepinephrine (500 microM) was affected by forskolin (10 microM) or cAMP analogs [8-bromo-cAMP or (Bu)2-cAMP; 1 mM]. A maximal amount of TSH (250 mU/ml) had ergistic effects on submaximal carbachol (1 microM)- and additive effects on maximal norepinephrine (500 microM)-induced accumulation of [3H]InsPs. Since not all of the effects of TSH on the thyroid can be explained by activation of the adenylate cyclase system, these data indicate that TSH may also regulate thyroid function through the polyphosphatidylinositol phosphate pathway. In addition, stimulation of the adenylate cyclase-cAMP system does not modify the effects of carbachol or norepinephrine on [3H]InsPs accumulation in dog thyroid slices.     

Mycobacterium avium complex pulmonary disease in patients without HIV infection

Mycobacterium avium complex (MAC) is ubiquitous. It is found in various freshwater and saltwater sources around the world, including hot water pipes. Although the organism was identified in the 1890s, its potential to cause human disease was only recognized 50 years later. Only a minority of people exposed to the organism will acquire MAC lung disease, usually those with underlying lung disease or immunosuppression. MAC may, however, cause progressive parenchymal lung disease and bronchiectasis in patients without underlying lung disease, particularly in middle-aged and elderly women. Preliminary data suggest that the interferon-gamma pathways may be deficient in elderly women with MAC lung disease. Other groups of patients who are more likely to harbor MAC in their lungs include patients with a cystic fibrosis or an abnormal alpha(1)-antiproteinase gene and patients with certain chest wall abnormalities. Treatment results continue to be disappointing, and the mortality of patients with MAC lung disease remains high. A PubMed search identified 38 reports of the treatment of MAC lung disease. Apart from the British Thoracic Society study, the only published controlled investigation, the studies published since 1994 have included a macrolide, either clarithromycin or azithromycin, usually in combination with ethambutol and a rifamycin. If success is defined as eradication of the organism without relapse over a period of several years after treatment has been discontinued, the reported treatment success rate with the macrolide containing regimens is approximately 55%. The prolonged treatment period, side effects, and possibly reinfection rather than relapse are responsible for the high failure rate.