Spontaneous Resolution of Parastomal Gallbladder Herniation After Attempted Surgical Intervention: A Case Report and Review of the Literature

Cholecystic parastomal herniation is a rare condition that has only been documented 16 times in the literature. We present a case report and literature review of cholecystic parastomal herniation managed with diagnostic laparoscopy without cholecystectomy or hernia repair. Furthermore, we assess the demographics, presentation, stoma types, and management of cholecystic parastomal hernias across all documented cases.

Evaluation of Access Disparities to Biologic Disease-Modifying Antirheumatic Drugs in Rural and Urban Communities

The American College of Rheumatology guidelines provides a strong recommendation for the use of biologic disease-modifying antirheumatic drugs (bDMARDs) when conventional rheumatoid arthritis treatments fail to meet treatment targets. Although bDMARDs are an effective and important treatment component, access inequalities remain a challenge in many communities worldwide. The purpose of this analysis is to assess nationwide trends in bDMARD access in the United States, with a specific focus on rural and urban access gaps. This study combined multiple county-level databases to assess bDMARD prescriptions from 2015 to 2019. Using geospatial analysis and the Moran’s I statistic, counties were classified according to prescription levels to assess for hotspots and coldspots. Analysis of variance (ANOVA) was used to compare significant counties across 49 socioeconomic variables of interest. The analysis identified statistically significant hotspot and coldspot prescription clusters within the United States. Coldspot (Low-Low) clusters with low access to bDMARDs are located predominantly in the rural west North Central region, extending down to Oklahoma and Arkansas. Hotspot (High-High) clusters are seen in urban and metro areas of Wisconsin, Minnesota, Pennsylvania, North Carolina, Georgia, Oregon, and the southern tip of Texas. Comparing coldspot to hotspot areas of bDMARD access revealed that the Medicare populations were older, more rural, less educated, less impoverished, and less likely to get their bDMARDs from a rheumatologist.

Demographic and Geospatial Analysis of Buprenorphine and Methadone Prescription Rates

Background

The medical community continues to seek to understand both the causes and consequences of opioid use disorder (OUD). The recent 2019 public release of the Automation of Reports and Consolidated Orders System (ARCOS) database from the years 2006 to 2012 provides a unique opportunity to analyze a critical period of the opioid epidemic with unprecedented data granularity.

Objectives

This study aims to use the ARCOS dataset to (1) determine significant contributory variables to opioid overdose death rates, (2) determine significant contributory variables to the relative prescription of buprenorphine and methadone, and (3) evaluate the existence of statistically significant geospatial clusters in buprenorphine and methadone prescription rates.

Methods

This study utilizes multiple databases, including the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER), the Drug Enforcement Administration (DEA) prescription drug data, and the United States (US) Census demographics, to examine the relationship between the different treatments of OUD. Linear regressions are used to determine significant contributory factors in overdose rate and the buprenorphine-to-methadone ratio. Geospatial analysis is used to identify geographic clusters in opioid overdoses and treatment patterns.

Results

Methadone prescriptions, racial demographics, and poverty were found to significantly correspond to opioid overdose death rates (p < 0.05). Buprenorphine prescriptions were not found to be significant (p = 0.20). Opioid overdoses, metro character, racial categorization, and education were found to significantly correspond to the ratio of buprenorphine to methadone prescribed (p < 0.05). Cluster analysis demonstrated different geospatial distributions in the prescriptions of buprenorphine and methadone (p < 0.05).

Conclusion

Historically, methadone prescriptions have been higher in areas with high overdose rates. Buprenorphine and methadone prescribing patterns have historically demonstrated different geographic trends.

Cellular molecular and proteomic profiling deciphers the SIRT1 controlled cell death pathways in esophageal adenocarcinoma cells

Worldwide prevalence of esophageal adenocarcinomas with high rates of mortality coupled with increased mutations in esophageal cells warrants investigation to understand deregulation of cell signaling pathways leading to cancer. To this end, the current study was undertaken to unravel the cell death signatures using the model human esophageal adenocarcinoma cell line-OE33. The strategy involved targeting the key epigenetic modulator SIRT1, a histone deacetylase by a small molecule inhibitor - sirtinol. Sirtinol induced a dose-dependent inhibition of cell viability under both normoxic and hypoxic conditions with long term impact on proliferation as shown by clonogenic assays. Signature apoptotic signaling pathways including caspase activation and decreased Bcl-2 were observed. Proteomic analysis highlighted an array of entities affected including molecules involved in replication, transcription, protein synthesis, cell division control, stress-related proteins, spliceosome components, protein processing and cell detoxification/degradation systems. Importantly, the stoichiometry of the fold changes of the affected proteins per se could govern the cell death phenotype by sirtinol. Sirtinol could also potentially curb resistant and recurrent tumors that reside in hypoxic environments. Overall, in addition to unraveling the cellular, molecular and proteomics basis of SIRT1 inhibition, the findings open up avenues for designing novel strategies against esophageal adenocarcinoma.

Non-animal collagens as new options for cosmetic formulation

OBJECTIVE

To examine the potential of non-animal collagens as a new option for cosmetic applications.

METHODS

Non-animal collagens from three species, Streptococcus pyogenes, Solibacter usitatus and Methylobacterium sp 4-46, have been expressed as recombinant proteins in Escherichia coli using a cold-shock, pCold, expression system. The proteins were purified using either metal affinity chromatography or a simple process based on precipitation and proteolytic digestion of impurities, which is suitable for large-scale production. Samples were examined using a range of analytical procedures.

RESULTS

Analyses by gel electrophoresis and mass spectrometry were used to examine the purity and integrity of the products. Circular dichroism spectroscopy showed stabilities around 38°C, and calculated pI values were from 5.4 to 8.6. UV-visible light spectroscopy showed the clarity of collagen solutions. The collagens were soluble at low ionic strength between pH 5 and pH 8, but were less soluble under more acidic conditions. At lower pH, the insoluble material was well dispersed and did not form the fibrous associations and aggregates found with animal collagens. The materials were shown to be non-cytotoxic to cells in culture.

CONCLUSIONS

These novel, non-animal collagens may be potential alternatives to animal collagens for inclusion in cosmetic formulations.

Impact of heparan sulfate chains and sulfur-mediated bonds on the mechanical properties of bovine lens capsule

We assessed the importance of glycosaminoglycans and sulfur-mediated bonds for the mechanical properties of lens capsules by comparing the stress-strain responses from control and treated pairs of bovine source. No significant change in mechanical properties was observed upon reduction of disulfide bonds. However, removal of glycosaminoglycan chains resulted in a significantly stiffer lens capsule, whereas high concentrations of reducing agent, which is expected to reduce the recently reported sulfilimine bond of collagen IV, resulted in a significantly less stiff lens capsule. A comparison of the diffraction patterns of the control and strongly reduced lens capsules indicated structural rearrangements on a nanometer scale.