Slicing through silos: Development and evaluation of a hospital-based telehealth hepatitis C virus treatment program

BACKGROUND

There exist many barriers to hepatitis C virus (HCV) treatment for those with substance use disorder (SUD) or who lack access to routine medical care. A hospital-based telehealth program was developed to provide treatment opportunities for hospitalized patients living with HCV.

METHODS

This single site prospective cohort study conducted from July 2022 to March 2023 aimed to measure linkage to care with an HCV clinician and initiation of HCV treatment in hospitalized patients. Patients were assessed in-person by a social worker then seen via telehealth by a clinician who prescribed either glecaprevir/pibrentasvir or sofosbuvir/velpatasvir. Treatment was initiated with pharmacist assistance. The team conducted in-person and/or telephonic outreach during and after hospitalization. Cure was confirmed by sustained virologic response at 12 weeks (SVR12) post-treatment.

RESULTS

A total of 25 patients were enrolled and completed telehealth visits. All patients had a history of SUD and 18 (72 %) were unstably housed. Nineteen patients (76 %) initiated treatment, and 14 (56 %) successfully completed treatment. Twelve patients (48 %) completed post-treatment labs, including two who prematurely discontinued treatment. Eleven patients (44 %) achieved confirmed cure with SVR12.

CONCLUSION

A hospital-based, multidisciplinary telehealth program can be an innovative care model to successfully treat HCV in a difficult-to-treat patient populations.

Neuronal cell adhesion molecule deletion induces a cognitive and behavioral phenotype reflective of impulsivity

Cell adhesion molecules, such as neuronal cell adhesion molecule (Nr-CAM), mediate cell-cell interactions in both the developing and mature nervous system. Neuronal cell adhesion molecule is believed to play a critical role in cell adhesion and migration, axonal growth, guidance, target recognition and synapse formation. Here, wild-type, heterozygous and Nr-CAM null mice were assessed on a battery of five learning tasks (Lashley maze, odor discrimination, passive avoidance, spatial water maze and fear conditioning) previously developed to characterize the general learning abilities of laboratory mice. Additionally, all animals were tested on 10 measures of sensory/motor function, emotionality and stress reactivity. We report that the Nr-CAM deletion had no impact on four of the learning tasks (fear conditioning, spatial water maze, Lashley maze and odor discrimination). However, Nr-CAM null mice exhibited impaired performance on a task that required animals to suppress movement (passive avoidance). Although Nr-CAM mutants expressed normal levels of general activity and body weights, they did exhibit an increased propensity to enter stressful areas of novel environments (the center of an open field and the lighted side of a dark/light box), exhibited higher sensitivity to pain (hot plate) and were more sensitive to the aversive effects of foot shock (shock-induced freezing). This behavioral phenotype suggests that Nr-CAM does not play a central role in the regulation of general cognitive abilities but may have a critical function in regulating impulsivity and possibly an animal's susceptibility to drug abuse and addiction.

Overlapping functions of the cell adhesion molecules Nr-CAM and L1 in cerebellar granule cell development

The structurally related cell adhesion molecules L1 and Nr-CAM have overlapping expression patterns in cerebellar granule cells. Here we analyzed their involvement in granule cell development using mutant mice. Nr-CAM-deficient cerebellar granule cells failed to extend neurites in vitro on contactin, a known ligand for Nr-CAM expressed in the cerebellum, confirming that these mice are functionally null for Nr-CAM. In vivo, Nr-CAM-null cerebella did not exhibit obvious histological defects, although a mild size reduction of several lobes was observed, most notably lobes IV and V in the vermis. Mice deficient for both L1 and Nr-CAM exhibited severe cerebellar folial defects and a reduction in the thickness of the inner granule cell layer. Additionally, anti-L1 antibodies specifically disrupted survival and maintenance of Nr-CAM-deficient granule cells in cerebellar cultures treated with antibodies. The combined results indicate that Nr-CAM and L1 play a role in cerebellar granule cell development, and suggest that closely related molecules in the L1 family have overlapping functions.

Collagen changes in rat cervix in pregnancy--polarized light microscopic and electron microscopic studies

The structural arrangement of collagen fibers in cervical ripening was studied in normal pregnant rats by picrosirius red staining and polarized light microscopy. The macromolecular arrangement of collagen fibers in the cervices of nonpregnant controls and in firm and rigid cervices of rats in early pregnancy (1-10 days of gestation) were optically anisotropic and had birefringence and a positive sign of elongation when examined by polarized light microscopy. The findings indicated that the structure of these collagen fibers was assembled from well-packed parallel collagen molecules. The direction of fibrous formation was arranged with regularity. In contrast, most of the collagen fibers in the soft cervices were optically isotropic. The fibers were fragmented and had a structure with discontinuous birefringence. Disarray and disorientation of the collagen fibers was found in the soft cervices. These collagen fibers changed their direction of formation. The disorganization of these collagen fibers might have a major impact on weakening the tensile strength of the cervix. Thus, we conclude that the processes of rearrangement of collagen fibers might be an important process in the cervical ripening. Electron microscopic studies suggest that in the focal hydrolytic processes of collagen and other matrix components degradation by lysosomal and phagosomal vesicles were associated with atrophic smooth muscle cells and fibroblasts of the cervices. Hydrolases released from lysosomes from these apoptotic cells may presumably be one of the processes in the remodeling of collagen structure.

Comparison of DNA content in primary and lymph node metastases in prostate adenocarcinoma

There is increasing evidence that nuclear DNA content has significant prognostic value for adenocarcinoma of the prostate. There also appear to be considerable differences in cellular DNA content between patient cohorts when primary tumor or pelvic lymph node metastases are measured. In addition, prostate adenocarcinoma is heterogeneous in DNA measurements; that adds confusion to studies incorporating fine needle aspiration biopsy samples. We compared cellular DNA content in 34 patients with available needle biopsies and pelvic lymph node metastases. Four groups of patients were identified: diploid-range primaries and metastases (8 patients), diploid-range primaries and aneuploid metastases (13), aneuploid primaries and metastases (10), and aneuploid primaries and diploid-range metastases (2). Patients with diploid-range primary tumors had a longer interval to progression and death than did patients with aneuploid primary tumors, although neither was significant in this small series. Patients with diploid-range lymph node metastasis had a longer interval to progression (P = .04) and survival (P = .09) than did individuals with aneuploid metastases. We conclude that the cellular DNA content of prostate cancer metastases in this series of stage D1 patients was more powerful in predicting time to progression and ultimate survival than evaluation of needle biopsy specimens of the primary cancer.

Renal malignancy in peritoneal dialysis patients with acquired cystic kidney disease

A known complication of long-term hemodialysis, acquired cystic kidney disease (ACKD) has been reported infrequently in association with chronic ambulatory peritoneal dialysis (CAPD). The duration of end stage renal failure (ESRF) is thought to correlate with the development of ACKD. Renal cell carcinoma has been reported in 4-10% of patients with ACKD. Two patients on CAPD for more than 6 years without prior hemodialysis treatment developed renal malignancy in the setting of ACKD. Flank and abdominal pain was the presenting symptom in both patients neither of whom had hematuria. Renal ultrasound detected cystic lesions consistent with ACKD; malignant masses were ultimately identified by CT scan. Both patients underwent flank radical nephrectomy, resumed CAPD early in the postoperative period and continue on CAPD 9 and 4 months after surgery. One patient has since developed hepatic metastasis. ACKD is an important risk factor for the development of renal cell carcinoma not only in maintenance hemodialysis patients but also in the CAPD population. A high index of suspicion and serial ultrasound screening for ACKD is warranted in patients with long-term dialysis-dependence.

Giant Aplysia neuron R2 has distal dendrites: evidence for protein sorting and a second spike initiation site

Because of its anatomy, the neuron R2 of Aplysia has been used to study how proteins are distributed to their appropriate destinations within the cell. The R2 cell body resides in the abdominal ganglion, while its axons terminate on glands in the skin. Using intracellular injection of HRP and intraxonal recordings, we found that R2 has a dendritic (receptive) arborization in the pleural ganglion. The structure of these dendrites was examined after injecting the soma with 3H-L-fucose, thereby labeling glycoproteins that are transported to all regions of the cell. Light- and electron-microscope autoradiography show that the openings to the dendrites are not on the periphery, but are suspended inside the axon by glial cell infoldings. All of the organelles seen in the axon are found in the dendrites, including 2 types of vesicles. Neither the axon nor the dendrites contain ribosomes. Thus, R2 has 3 functionally distinct regions--cell body, dendrites, presynaptic terminals--that are separated from each other by at least 4 cm. This implies that pre- and postsynaptic proteins made in the cell body are transported along the axon to the pleural ganglion, where they are sorted. To investigate this idea, we exposed the abdominal ganglion to 35S-methionine to label R2's proteins. Analyses by SDS-PAGE of the rapidly transported labeled proteins from R2 consistently showed a 78 kDa band that accumulated in the pleural ganglion and did not move into the peripheral nerves. This then is a putative dendritic constituent.

Identified cholinergic neurons R2 and LPl1 control mucus release in Aplysia

1. R2 and LPl1 are homologous giant cholinergic neurons in the nervous system of Aplysia with overlapping and almost symmetrical axonal trees extending over most of the body wall. In spite of much experimental study, the behavioral role of the cells has remained unknown. 2. After intrasomatic injection of R2 and LPl1 with horseradish peroxidase (HRP), the giant cell axons were traced to the periphery and found to contact subepidermal glands in the body wall exclusively. 3. The axons penetrated the glandular basal lamina, indenting the gland cell cytoplasm, and expanded into varicosities containing putative cholinergic transmissive sites. 4. Histochemical characterization of the contents of the glands showed that they contain mucus, suggesting that the giant cells control mucus release from the body wall. 5. Stimulation of R2 or LPl1 resulted in glandular discharge, as measured both by an increase in the appearance of protein and of mucus on the body wall. 6. R2 and LPl1 control mucus release from the body wall, thus providing a new system for investigations of neuroglandular control as well as a behavioral context for cellular studies using these two neurons.

Sizing of phosphatidylcholine vesicles by transmission electron microscopy

Coating of support films for transmission electron microscopy with silica by evaporation of "silicon monoxide" provides a surface which is easily wetted by aqueous systems. Dispersed colloidal particles spread on this surface without the use of added soluble wetting agents. Such coated supports are found to be particularly useful for the quantitative characterization of the size distribution of vesicles prepared from saturated phosphatidylcholine. The weight average vesicle sizes determined for several samples from measurements of negatively stained electron micrographs are in good agreement with values measured by light scattering and ultracentrifugation.