Merrilldowns4503

Rheumatoid arthritis is a common autoimmune disease that requires new therapeutic agents. Cyclin-dependent kinase 4/6 inhibitors have recently been approved for metastatic breast cancer patients and have also been reported to improve the arthritis score in collagen-induced arthritis mouse models. We report a 56-year-old woman who had previously been diagnosed with rheumatoid arthritis and treated with methotrexate. At age 40, she underwent surgery with curative intent for breast cancer but subsequently developed lung metastases. Palbociclib, a cyclin-dependent kinase 4/6 inhibitor, was administered in combination with fulvestrant (anti-oestrogen drug) for metastatic breast cancer. One month later, serum matrix metalloproteinase-3 and C-reactive protein levels were markedly decreased, and her rheumatoid arthritis symptoms, which had worsened just prior to the detection of metastatic lung disease, showed amelioration. Methotrexate, which had been used to treat her rheumatoid arthritis, could subsequently be administered in a reduced dose. The cyclin-dependent kinase 4/6 inhibitor was also effective for the metastatic breast cancer, and, to date, the patient's disease has remained stable for more than one year. Based on the results of basic research, cyclin-dependent kinase 4/6 inhibitors are promising new therapeutic agents for rheumatoid arthritis patients, although these drugs have not, as yet, been used in a clinical setting. To the best of our knowledge, this is the first report to describe a patient whose rheumatoid arthritis responded to a cyclin-dependent kinase 4/6 inhibitor administered for metastatic breast cancer.A key obstacle to advocacy efforts to promote legal and policy reforms that ensure women's and girls' access to comprehensive abortion care (CAC) is the lack of relevant and timely evidence. This commentary outlines a research agenda-setting initiative that identified research priorities to support evidence-informed policy and advocacy for CAC access in sub-Saharan Africa (SSA). NSC697923 molecular weight It involved three phases 1) a landscape analysis; 2) research agenda co-creation with stakeholders, and 3) a validation exercise on research priorities. Overall, the priority evidence needs included 1) estimating the incidence and magnitude of unsafe abortion and related costs; 2) examining the role of abortion laws and policies in facilitating or inhibiting access to CAC; 3) developing and documenting successful approaches for addressing societal barriers to the provision of CAC, and fostering a more inclusive and liberal abortion environment, and 4) documenting practice-based evidence on the provision of legal abortion services as well as for advocating for CAC. Various stakeholders, including researchers, policymakers, civil society organizations, and funding agencies, will find the agenda useful as they engage, at different levels, for the full domestication and implementation of forward-looking commitments on access to CAC in SSA.In HIV-infected patients, antiretroviral therapy (ART) is associated to adipose tissue redistribution known as lipodystrophy (LD). This study aimed at verifying the association between the polymorphism of the MMP1 gene (rs1799750) (1G/2G) and the serum levels of matrix metalloproteinase 1 (MMP-1) with LD and its subtypes in people living with HIV on ART. This is a cross-secional study. LD was self-reported. The determination of the MMP1 rs1799750 gene polymorphism was performed by real-time PCR, and the serum concentrations of MMP-1 were quantified by the enzyme-linked immunosorbent assay (ELISA) method. Of 404 participants, 204 (51%) were diagnosed with LD, of whom 89 (43%) had mixed lipodystrophy (ML), 72 (35%) had lipohypertrophy (LH), and 43 (22%) had lipoatrophy (LA). There was an association between the genotypes 1G/1G+1G/2G and higher serum levels of MMP-1 (p = .025). There was no association of MMP1 (1G/2G) with LD. Other factors associated with LD were current CD4 ≤ 350 [odds ratio (OR) = 4.85, confidence interval (CI) = 1.78-47.99, p = .0033] and serum MMP-1 levels >6.81 (OR = 2.67, CI = 1.21-6.08, p = .0165). Factors associated with ML current CD4 ≤ 350 (OR = 5.59, CI = 1.69-20.39, p = .006); with LH number of antiretroviral regimens used 2 (OR = 2.06, CI = 1.01-4.20, p = .0460) and 3+ (OR = 2.09, CI = 1.00-4.35, p = .0477), and current CD4 ≤ 350 (OR = 2.08, CI = 1.00-4.24, p = .0461); and with LA current viral load >40 (OR = 2.52, CI = 1.03-5.91, p = .0372) and current use of zidovudine (OR = 2.97, CI = 1.32-6.54, p = .0074). Higher levels of MMP-1 were associated with genotypes 1G/2G+1G/1G and with LD. Other individual risk factors were independently associated with LD, and its subtypes, suggesting that the pathogenesis itself is differently manifested for each type of LD.Background Medications for Opioid Use Disorder (MOUD) are recognized as successful treatments for Opioid Use Disorder (OUD). The Emergency Department is well situated to initiate MOUD and begin the referral process. Unfortunately, uptake of this practice among Emergency Medicine (EM) physicians has been slow. EM physicians may feel inadequately prepared to provide MOUD and addiction referral services due to lack of previous training and experience. The goal of this pilot study was to create, implement, and evaluate an OUD management curriculum for EM residents and measure impact on knowledge, practice, and empathy. Methods A 4.5-hour curriculum was developed, incorporating the Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment mission statement as well as the Accreditation Council for Graduate Medical Education and the American Board of Emergency Medicine resident physician milestones. The curriculum was inserted into an existing EM residency didactic block at an urban, tertiary care, residency program. Surveys were obtained pre- and post-intervention. Results Post curriculum surveys demonstrated improved knowledge of buprenorphine/naloxone including indications, clinical effects and side-effects (p  less then  0.05). Surveys also noted increased comfort prescribing buprenorphine/naloxone for opioid withdrawal and misuse and instructing patients on home induction (p  less then  0.05). Additionally, residents responded positively regarding the impact of the curriculum on their understanding of the topic and their subsequent confidence in managing patients with OUD in the ED setting. Conclusion A dedicated brief MOUD and referral curriculum can be effectively integrated into EM resident education to provide valuable clinical knowledge that may affect clinical practice.

Coronary ectasia (CE) is defined as dilation of the coronary artery, 1.5 times that of the surrounding vessel. Outcomes of percutaneous intervention (PCI) in patients with CE presenting as ST-elevated myocardial infarction (STEMI) remain a topic of debate.

Studies comparing outcomes of PCI in CE versus no-ectasia (NE) STEMI patients were identified. Baseline angiographic characteristics include thrombolysis in myocardial infarction (TIMI) 0-1 flow, right coronary artery (RCA) involvement, and primary outcomes including thrombus aspiration, no-reflow, mortality, and TIMI-3 post-PCI. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

Six studies (n = 5746, CE-340 and NE-5406) qualified for the analysis. RCA involvement was more common in CE than NE, OR-1.39 (95%CI1.06-1.82, p-0.02). Pre-procedure TIMI-0-1 was of comparable results between the groups (p-1.13). Higher thrombus aspiration for CE (OR 2.18, 95%CI1.44-3.32;p-<0.001). CE had higher incidence of no-reflow (OR 4.07, 95%CI2.42-6.84;p-<0.001). TIMI-3 flow post-PCI was achieved less commonly in the CE group (OR-0.64, 95%CI-0.48-0.86;p-<0.001). Mortality on follow-up was comparable (0.83, 95%CI0.39-1.78;p-0.63). Metaregression analysis did not show confounding effects from comorbidities.

Coronary ectasia patients with STEMI had higher rates of PCI failure and no-reflow than NE; however, mortality during follow-up was comparable.

Coronary ectasia patients with STEMI had higher rates of PCI failure and no-reflow than NE; however, mortality during follow-up was comparable.Barriers to effective interprofessional collaboration may include insufficient knowledge of other professional roles and inexperience using effective communication skills. Improving self-efficacy for interprofessional collaboration may enhance the ability to practice expertly within the interprofessional environment of healthcare. This article examines the results of a multiple methods pretest/posttest study that used the Self-Efficacy for Interprofessional Experiential Learning (SEIEL) scale to determine self-reported perceptions of self-efficacy development following participation in a trauma simulation. Participants included 74 undergraduate nursing students and nine undergraduate social work students. Findings included a significant increase in perceived self-efficacy from pretest to posttest for both groups. Nursing majors and participants who reported previous interaction with a member of another profession scored significantly higher on the posttest. Qualitative data were analyzed through thematic content analysis which produced three themes an improved understanding of the importance of communication and the interconnection of interprofessional roles; a realistic simulation which challenged the students; and an increased appreciation for teamwork. These findings suggest that challenging simulations with pre-licensure students can increase undergraduate students' perceived self-efficacy for interprofessional collaboration and contribute to an improved understanding of interprofessional team roles and communication.

Prior research has individually linked rumination, anxiety, and emotion dysregulation to alcohol misuse, but limited research has examined a comprehensive model linking these variables together. The present study tested a moderated-mediation model to examine whether emotion dysregulation moderated the indirect association of anxiety symptoms on alcohol-related problems

ruminative thinking styles.

Participants were 448 college students who consumed alcohol in the previous month. A plurality of participants identified as being White, non-Hispanic (40.6%), female (68.6%), and reported a mean age of 22.75 (Median = 20.00;

 = 6.84) years.

Brooding and reflection subtypes of ruminative thinking mediated the association between anxiety symptoms and alcohol-related problems with higher rates of anxiety symptoms associated with higher ruminative thinking, which in turn was associated with more alcohol-related problems. Further, the indirect effect of anxiety symptoms on alcohol-related problems through ruoms relate to problematic alcohol use, especially among individuals with high emotion dysregulation. Additional work is needed to test whether decoupling the associations between negative emotional states and ruminative thinking among college students with high emotion dysregulation is a viable intervention target to reduce problematic alcohol use.