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Mental and physical symptoms associated with lower social support for patients with hepatitis C

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World Journal of Gastroenterology 2006年第29期12卷 4665-4672页

作者： Julie A Blasiole Laura Shinkunas Douglas R LaBrecque Robert M Arnold Susan L Zickmund va Pittsburgh healthcare system Center for health Equity Research and Promotion PittsburghPAUnited States Department of Epidemiology University of Iowa School of Public health Iowa CityIAUnited States Department of Internal Medicine University of Iowa Hospitals and Clinics Iowa CityIAUnited States Department of Medicine University of Pittsburgh School of Medicine PittsburghPAUnited States Department of Medicine University of Pittsburgh School of Medicine VA Pittsburgh Healthcare SystemCenter for Health Equity Research and PromotionPittsburghPAUnited States

AIM: To systematically examine the impact of the hepatitis C virus (HCV) diagnosis on patients' level of social support in a large-scale study. METHODS: Patients evaluated and treated for HCV in a tertiary referral center were enrolled in a cross-sectional study. Demographic data, functional and emotional status as measured by the Hospital Anxiety and Depression Scale (HAD) and the Sickness Impact Profile (SIP), severity of liver disease, mode of acquisition, and physical and psychiatric comorbidities were collected from patients or abstracted from the medical record. All participants completed a semi-structured interview, addressing questions of social support. RESULTS: A total of 342 patients (mean age 45.2 years; 37% women) were enrolled. Ninety-two (27%) patients described lower levels of support by family and friends. Nearly half of the participants (45%) noted the loss of at least one relationship due to the disease. Fears related to transmitting the disease (25%) were common and often associated with ignorance or even discrimination by others (19%). Nearly one fifth of the patients did not share information about their disease with others to avoid being stigmatized. Lower levels of social support were significantly associated with living alone, being unemployed, being excluded from antiviral therapy, having psychiatric comorbidities, contracting HCV through intravenous drug use, having high levels of anxiety and depression as measured by the HAD and negative mood state as measured by the SIP. Patients reporting lower levels of social support also noted more physical symptoms as measured by the SIP. CONCLUSION: Patients with hepatitis C often face significant social problems, ranging from social isolation to familial stress. The most common concerns reflect a limited insight of patients and their relatives and friends about the disease, the risk factors for its spread, and about potential consequences. Our data suggest that educational interventions targeting

关键词： Hepatitis C Social support Depression Anxiety Quality of life Stigmatization

Lineage structure of the human antibody repertoire in response to influenza vaccination

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医用生物力学 2013年第S1期28卷 36-37页

作者： Ning Jiang Jiankui He Joshua A.Weinstein Lolita Penland Sanae Sasaki Xiao-Song He Patrick C.Wilson Harry B.Greenberg Mark M.Davis Daniel S.Fisher Stephen R.Quake Department of Biomedical Engineering the University of Texas at AustinAustinTXUSA Department of Bioengineering Stanford University School of MedicineStanfordCaliforniaUSA Biophysics Graduate Program Stanford UniversityStanfordCaliforniaUSA Department of Immunology and Microbiology Stanford University School of MedicineStanfordCaliforniaUSA va palo alto health care system Palo AltoCaliforniaUSA Department of Medicine Stanford University School of MedicineStanfordCaliforniaUSA Department of Medicine University of Chicago Pritzker School of MedicineChicagoIllinoisUSA Howard Hughes Medical Institute Department of Applied Physics Stanford UniversityStanfordCaliforniaUSA Department of Biology Stanford UniversityStanfordCaliforniaUSA

The adaptive immune system produces a large and diverse set of antibodies,each with an individual evolutionary and clonal *** so called"antibody repertoire"protects each individual against insults such as infection and cancer,and responds to vaccination with B cell proliferation in response to the antigenic *** and antigen-specific FACSbased analysis have given us much insight on how the immune system generates the complex and diverse immune response required to protect the body from the wide variety of potential ***,these methods have not been sufficient to make global and unbiased characterizations of the clonal structure of the immune system of a particular individual。

关键词： vaccination clonal antigenic diverse insight stimulation evolutionary immunized protect vaccine

Advancing Pediatric Hemodialysis care through the Novel Intervention in Children’s healthcare (NICH) Program

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Open Journal of Nephrology 2024年第3期14卷 295-301页

作者： Jessica Williams Natalia Garban Cynthia Wong Elizabeth Talley Department of Pediatric Nephrology Lucille Packard Childrens Hospital Stanford Palo Alto USA NICH Program care Team Lucille Packard Childrens Hospital Stanford Palo Alto USA

Racial, ethnic, and socioeconomic disparities present daunting hurdles that prevent equitable health outcomes for patients with end-stage kidney disease (ESKD) on hemodialysis. Additional resources, such as the Novel Intervention in Children’s health (NICH) at Lucille Packard Children’s Hospital Stanford, provide individualized support to best assist families by assessing barriers to care with the goal of improving health outcomes. In this retrospective cohort study, we reviewed patients with ESKD on hemodialysis involved in NICH to explore if NICH serves as a liaison between the patients and multidisciplinary medical team and to explore if NICH helps patients better manage the challenges of end-stage kidney disease. Through the electronic medical record system, EPIC, we reviewed the patients’ surveys to identify barriers to care, which included school and life engagement difficulty, lack of mental health resources, food and transportation insecurity, and cultural/language barriers. We also tracked the number of hospitalizations and ED visits before and during the patients’ enrollment in NICH. We discovered that through NICH, the aforementioned barriers to care were eliminated, the number of hospitalizations and emergency department visits was reduced, and all patients transitioned from inactive to active on the transplant list. NICH successfully improved the health outcomes of these patients and empowered patients to be more engaged in their care.

关键词： Pediatric Hemodialysis ESKD NICH healthcare Disparities

Liver cancer understaging in liver transplantation in the current era of radiologic imaging and newer generation locoregional therapies

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Hepatoma Research 2022年第1期8卷 233-247页

作者： Hannah M.Lee Donna McClish Binu V.John Sarah Winks Ryan Clayton Somaya Albhaisi Allawy Allawy Samarth Patel Emma C.Fields Scott Matherly Brian Strife Chandra Bhati Amit Sharma Richard K.Sterling Division of Gastroenterology Hepatologyand NutritionDepartment of MedicineVirginia Commonwealth UniversityRichmondVA 23298USA Department of Biostatistics Virginia Commonwealth UniversityRichmondVA 23298USA Division of Digestive health and Liver Disease University of Miamiand Division of Gastroenterology and HepatologyMiami VA Health SystemMiamiFL 33125USA Department of Radiology Virginia Commonwealth UniversityRichmondVA 23298USA Department of Internal Medicine Virginia Commonwealth UniversityRichmondVA 23298USA Central Virginia Veterans health care system RichmondVA 23249USA Department of Radiation Oncology Virginia Commonwealth UniversityRichmondVA 23298USA Division of Interventional Radiology Department of RadiologyVirginia Commonwealth UniversityRichmondVA 23298USA Hume-Lee Transplant Center Virginia Commonwealth UniversityRichmondVA 23298USA

Background:Discordance in hepatocellular carcinoma(HCC)staging between pre-transplant imaging and explant pathology is associated with an increased risk of recurrence and *** aim was to evaluate variables that predicted concordance/discordance in the era of new generation locoregional therapies(LRT)and improved radiologic technology in ***:A single-center retrospective study was performed on patients who received a liver transplant for HCC between ***-and post-LT variables,including type of LRT,downstaging(DS),transplant time period,and radiologic response to LRT,were analyzed for concordance/***-Meier analysis was used to assess post-LT ***:Of 146 patients transplanted within Milan Criteria(MC),discordance rates(understaged)were 45%.Discordance was associated with≥3 HCC lesions at diagnosis but not newer generation LRT(transarterial radioembolization/stereotactic body radiation therapy),traditional LRT or *** differences in discordance were seen between transplant periods(2008-2013 vs.2014-2019),but those within MC in the earlier period had higher concordance rates.A trend was observed between DS and ***:HCC stage discordance remains common and poorly *** was associated with three or more HCC lesions at the time of *** within MC transplanted between 2008-2013 was associated with concordance,while a trend was noted between DS and *** other pre-or post-LT variables predicted discordance/*** was associated with decreased survival.

关键词： Hepatocellular carcinoma understaging liver transplant radioembolization stereotactic body radiation therapy(SBRT)

Gene therapy for neurodegenerative disorders:advances, insights and prospects

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Acta Pharmaceutica Sinica B 2020年第8期10卷 1347-1359页

作者： Wei Chen Yang Hu Dianwen Ju Department of Biological Medicines Fudan University School of Pharmacy Shanghai 201203 China Department of Ophthalmology Stanford University School of Medicine Palo Alto CA 94304 USA

Gene therapy is rapidly emerging as a powerful therapeutic strategy for a wide range of neurodegenerative disorders, including Alzheimer’s disease(AD), Parkinson’s disease(PD) and Huntington’s disease(HD). Some early clinical trials have failed to achieve satisfactory therapeutic effects. Efforts to enhance effectiveness are now concentrating on three major fields: identification of new vectors,novel therapeutic targets, and reliable of delivery routes for transgenes. These approaches are being assessed closely in preclinical and clinical trials, which may ultimately provide powerful treatments for patients. Here, we discuss advances and challenges of gene therapy for neurodegenerative disorders,highlighting promising technologies, targets, and future prospects.

关键词： disorders degenerative Huntington

Bile acid interactions with cholangiocytes

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World Journal of Gastroenterology 2006年第22期12卷 3553-3563页

作者： Xuefeng Xia Heather Francis Shannon Glaser Gianfranco Alpini Gene LeSage University of Texas at Houston Medical School Houston TX United States Division of Research and Education Scott & White Hospital and The Texas A&M University System Health Science Center College of Medicine Temple TX United States Department of Medicine Division of Research and Education Scott & White Hospital and The Texas A&M University System Health Science Center College of MedicineTemple TX United States Central Texas Vctcrans health care system and Department of Medicine and Systems Biology and Translational Medicine United States

Cholangiocytes are exposed to high concentrations of bile acids at their apical membrane. A selective transporter for bile acids, the Apical Sodium Bile Acid Cotransporter （ASBT）（also referred to as Ibat; gene name Slc10a2） is localized on the cholangiocyte apical membrane. On the basolateral membrane, four transport systems have been identified （t-ASBT, multidrug resistance （MDR）3, an unidentified anion exchanger system and organic solute transporter （Ost） heteromeric transporter, Ostα- Ostβ. Together, these transporters unidirectionally move bile acids from ductal bile to the circulation. Bile acids absorbed by cholangiocytes recycle via the peribiliary plexus back to hepatocytes for re-secretion into bile. This recycling of bile acids between hepatocytes and cholangiocytes is referred to as the cholehepatic shunt pathway. Recent studies suggest that the cholehepatic shunt pathway may contribute in overall hepatobiliary transport of bile acids and to the adaptation to chronic cholestasis due to extrahepatic obstruction. ASBT is acutely regulated by an adenosine 3＇, 5＇monophosphate （cAMP）-dependent translocation to the apical membrane and by phosphorylation-dependent ubiquitination and proteasome degradation. ASBT is chronically regulated by changes in gene expression in response to biliary bile acid concentration and inflammatory cytokines. Another potential function of cholangiocyte ASBT is to allow cholangiocytes to sample biliary bile acids in order to activate intracellular signaling pathways. Bile acids trigger changes in intracellular calcium, protein kinase C （PKC）, phosphoinositide 3-kinase （PI3K）, mitogenactivated protein （MAP） kinase and extracellular signalregulated protein kinase （ERK） intracellular signals. Bile acids significantly alter cholangiocyte secretion,proliferation and survival. Different bile acids have differential effects on cholangiocyte intracellular signals,and in some instances trigger opposing effects on cholangiocyte secretion, pro

关键词： Cholangiocytes Bile acid Liver

HSV gene transfer in the treatment of chronic pain

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生理学报 2008年第5期60卷 610-616页

作者： David J. Fink Marina Mata University of Michigan and va Ann Arbor healthcare system Ann Arbor Michigan 48109 USA

It has proven difficult to use systemic administration of small molecules to selectively modulate *** the past decade,we and others have developed non-replicating herpes simplex virus(HSV)-based vectors to treat chronic *** inoculation of an HSV vector effectively transduces sensory neurons in the dorsal root ganglion;release of transgene-coded inhibitory neurotransmitters or anti-inflammatory peptides reduces pain-related behaviors in rodent models of chronic inflammatory and neuropathic pain.A phase 1 trial of this therapy in patients is set to begin soon.

关键词： HSV 基因慢性疼痛临床分析病症

Medical decision making for older adults： an international perspective comparing the United States and India

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Journal of Geriatric Cardiology 2015年第4期12卷 329-334页

作者： Ankur Kalra Daniel E Forman Sarah J Goodlin Division of lnterventional Cardiology Beth lsrael Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA Division of Cardiology Department of Medicine Kalra Hospital SRCNC Pvt. Ltd. New Delhi India Section of Geriatric Cardiology University of Pittsburgh Medical Center Pittsburgh PA USA Geriatrics Research Education and Clinicai Center VA Pittsburgh Healthcare System Pittsburgh PA USA Department of Medicine-Geriatrics Oregon Health & Sciences University and Veterans Affairs Portland Health Care System Portland Oregon USA

There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advan- tages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac dis- ease with comparisons of West to East, focusing particularly on the United States versus India.

关键词： Advance care planning Advance directive End-of-life India Surrogate decision-making

MultiSciView: Multivariate Scientific X-ray Image Visual Exploration with Cross-Data Space Views

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Visual Informatics 2018年第1期2卷 14-25页

作者： Wen Zhong Wei Xu Kevin G.Yager Gregory S.Doerk Jian Zhao Yunke Tian Sungsoo Ha Cong Xie Yuan Zhong Klaus Mueller Kerstin Kleese van Dam Brookhaven National Laboratory UptonNew YorkUnited States Stony Brook University Stony BrookNew YorkUnited States FX palo alto Laboratory Palo AltoCaliforniaUnited States Facebook Inc. Menlo ParkCaliforniaUnited States Midea Emerging Technology Center San JoseCaliforniaUnited States

X-ray images obtained from synchrotron beamlines are large-scale,high-resolution and high-dynamic-range grayscale data encoding multiple complex properties of the measured *** are typically associated with a variety of metadata which increases their inherent *** is a wealth of information embedded in these data but so far scientists lack modem exploration tools to unlock these hidden *** bridge this gap,we propose MultiSciView,a multivariate scientific x-ray image visualization and exploration system for beamline-generated x-ray scattering *** system is composed of three complementary and coordinated interactive visualizations to enable a coordinated exploration across the images and their associated attribute and feature *** first visualization features a multi-level scatterplot visualization dedicated for image exploration in attribute,image,and pixel *** second visualization is a histogram-based attribute cross filter by which users can extract desired subset patterns from *** third one is an attribute projection visualization designed for capturing global attribute *** demonstrate our framework by ways of a case study involving a real-world material scattering *** show that our system can efficiently explore large-scale x-ray images,accurately identify preferred image patterns,anomalous images and erroneous experimental settings,and effectively advance the comprehension of material nanostructure properties.

关键词： Scientific x-ray image visualization Multi-level scatterplot Crossdata space exploration