Leadership for coordinated care: role of a project manager

The use of clinical pathways as a method to improve outcomes for specific populations within health care organizations has become widely adopted. This article focuses on the role of a project manager in facilitating a wide range of outcomes. Through a quality improvement framework, interdisciplinary collaboration, and data-driven decision making, organizational performance can be enhanced. An advanced practice nurse is well suited to lead organizational improvement efforts aimed at optimizing the care delivery system to effectively meet expectations of all constituents.     

Alterations in intestinal structure, fat absorption and body weight after intestinal bypass for morbid obesity

Eleven patients underwent jejunoileal bypass for morbid obesity. Serial intestinal biopsies were obtained prior to, and at timed intervals following, operation in both fasted and fat-fed states. Villus height increased asymptotically, reaching a plateau one year after operation, with an increase of 80 per cent in mean villus length. The postbypass body weight reached a plateau at 63.9 per cent of initial body weight and correlated linearly with villus height following an asymptotic curvilinear course. The time required to attain 90 per cent of total body weight loss was 15.9 months. A study of intestinal fat absorption at both the light microscopic and ultrastructural levels showed that the enlarged villi are lined along the entire villus by functionally mature epithelium capable of transporting lipid. Villus hypertrophy is an important mechanism in the plateauing of weight loss after jejunoileal bypass for morbid obesity.     

Antigen-specific adherence of antibody-producing hybridoma cells: application to neural and nonneural antigens

Antibody-producing hybridoma cells specifically bind to microgram quantities of antigen molecules adsorbed onto the surface of plastic microtiter plates. The binding of hybridoma cells to nonantigen is optimally below 5%, similar binding of non-antibody-producing cells is 4-7%, compared to the binding of the hybridomas to their antigen. There is a difference in the kinetics of binding hybridomas to antigen compared to nonantigen. The number of bound cells depends on the amount, i.e., the surface density, of the antigen molecules and shows typical saturation effects. Preincubation of hybridomas with excess free antigen and saturation of the antibody binding site on the surface with the hybridoma-produced antibody reduces binding of the hybridoma cells to the antigen. Treatment of cells with trypsin reduces binding to antigen-coated plastic surfaces. Drugs such as sodium azide, cytochalasin B, colchicine, vinpocetine, and vincristine sulfate reduce binding to the antigen. Hybridoma cells adhering to the antigen produce more antibody than nonadhering cells. The results reported in this paper show that antigen molecules adsorbed to include a plastic surface and hybridoma cells interact specifically. This system forms a suitable model to study the interaction of antigen with antigen-specific cells and may be useful as a separation method for specific antibody-producing cells.     

IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin

Hypoferremia is a common response to systemic infections or generalized inflammatory disorders. In mouse models, the development of hypoferremia during inflammation requires hepcidin, an iron regulatory peptide hormone produced in the liver, but the inflammatory signals that regulate hepcidin are largely unknown. Our studies in human liver cell cultures, mice, and human volunteers indicate that IL-6 is the necessary and sufficient cytokine for the induction of hepcidin during inflammation and that the IL-6-hepcidin axis is responsible for the hypoferremia of inflammation.     

Anti-inflammatory Effects of Novel P2X4 Receptor Antagonists,NC-2600 and NP-1815-PX,in a Murine Model of Colitis

Inflammation - The pharmacological blockade of P2X4 receptors has shown potential benefits in the management of several immune/inflammatory diseases. However, data regarding the involvement of P2X4...     

Migraine Patients Show Increased Platelet Vasopressin Receptors

This study was designed to investigate vasopressin receptor status (B_max and K_d) on platelets, vasopressin plasma levels, and vasopressin-induced platelet aggregation in migraine patients (21 females and 6 males) during a headache-free interval and in a matched control group. In the migraine group, B max was significantly higher ( P = 0.02) at 53.9 ± 20.6 fmol/mg than in the control group (36.8 + 21.0 fmol/mg). A correlation between B_max and high or low sensitivity to vasopressin as an aggregator was evident in the control group, but not in the migraine group. No differences in K_d or in plasma levels of vasopressin between the migraine and control group were apparent. Men in both groups were much less sensitive to vasopressin as a platelet aggregator than were women ( P < 0.01). Whether the higher B_max in the migraine group is a reflection of temporarily higher vasopressin levels during headache or reflects a primary increase in sensitivity to vasopressin, remains to be clarified. The higher sensitivity of platelets (as a model for vessel wall receptors) from women may indicate why many more women than men suffer from migraine. Since the B_max of the vasopressin receptor on platelets from migraine patients is increased compared to controls, treating migraine headache with vasopressin may deserve more attention.