Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?

Objective

Thoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown—this is important because in proximal (Stanford type A) aortic dissections, 10% to 30% are not accepted for surgery and 30% to 50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated by using TEVAR.

TAp63 regulates oncogenic miR-155 to mediate migration and tumour growth

miR-155 is an oncogenic microRNA which is upregulated in many solid cancers. The targets of miR-155 are well established, with over 100 confirmed mRNA targets. However, the regulation of miR-155 and the basis of its upregulation in cancer is not well understood. We have previously shown that miR-155 is regulated by p63, and here we investigate the role of the major p63 isoforms TAp63 and ΔNp63 in this regulation. When the TAp63 isoform was knocked down, or exogenously overexpressed, miR-155 levels were elevated in response to TAp63 knockdown or reduced in response to TAp63 overexpression. The ΔNp63 isoform is shown to directly bind to the p63 response element on the miR-155 host gene, and this binding is enriched when TAp63 is knocked down. This could indicate that TAp63 prevents ΔNp63 from binding to the miR-155 host gene. The knockdown of TAp63, and the subsequent elevation of miR-155, enhances migration and tumour growth similar to that seen when directly overexpressing miR-155. The migratory phenotype is abrogated when miR-155 is inhibited, indicating that miR-155 is responsible for the phenotypic effect of TAp63 knockdown.     

The Association Between Acculturation and Health Insurance Coverage for Immigrant Children from Socioeconomically Disadvantaged Regions of Origin

Among immigrant children whose parents have historically had lower education, the study explored which immigrant children were most likely to have coverage based on maternal region of origin. The direct and indirect relationship of acculturation on immigrant children’s coverage was also assessed. A subsample of US-born children with foreign-born mothers from the Early Childhood Longitudinal Survey-Kindergarten Cohort was analyzed using multinomial logistic regressions (n = 1,686). Children whose mothers emigrated from the Caribbean or Indochina had greater odds of being insured compared to children whose mothers emigrated from Mexico. Moreover, Latin American children did not statistically differ from Mexican children in being uninsured. Maternal citizenship was positively associated with children’s coverage; while living in a household with a mother who migrated as a child was negatively associated with private insurance. To increase immigrant children’s coverage, Latin American and Mexican families may benefit from additional financial assistance, rather than cultural assistance.     

Deprescribing interventions in primary health care mapped to the Behaviour Change Wheel: A scoping review

BackgroundPolypharmacy and inappropriate medication use are an increasing concern. Deprescribing may improve medication use through planned and supervised dose reduction or stopping of medications. As most medication management occurs in primary health care, which is generally described as the first point of access for day-to-day care, deprescribing in primary health care is the focus on this review.ObjectiveThis scoping review aimed to identify and characterize strategies for deprescribing in primary health care and map the strategies to the Behaviour Change Wheel (BCW).MethodsA scoping review was conducted that involved searches of six databases (2002–2018) and reference lists of relevant systematic reviews and included studies. Studies that described and evaluated deprescribing strategies in primary health care were eligible. Two independent reviewers screened articles and completed data charting with charting verified by a third. Deprescribing strategies were mapped to the intervention functions of the BCW and linked to specific Behaviour Change Techniques (BCT).ResultsSearches yielded 6871 citations of which 43 were included. Nineteen studies were randomized, 24 were non-randomized. Studies evaluated deprescribing in terms of medication changes, feasibility, and prescriber/patient perspectives. Deprescribing strategies involved various professionals (physicians, pharmacists, nurses), as well as patients and were generally multifaceted. A wide range of intervention functions were identified, with 41 BCTs mapped to Environmental restructuring, 38 BCTs mapped to Enablement, and 34 BCTs mapped to Persuasion.ConclusionsDeprescribing strategies in primary health care have used a variety of BCTs to address individual professionals (e.g. education) as well as strategies that addressed the practice setting, including support from additional team members (e.g. pharmacists, nurses and patients). Further research is warranted to determine comparative effectiveness of different BCTs, which can help facilitate implementation of deprescribing strategies, thereby reducing polypharmacy, in primary health care.