RESUMEN
BACKGROUND: We hypothesized that phosphorus has an effect on anemia in both normal kidney function and early chronic kidney disease (CKD). We sought to determine whether higher phosphorus levels are associated with anemia in a large diverse population without CKD and early CKD. METHODS: This study is a historical population-based study within the Kaiser Permanente Southern California health system (1 January 1998 to 31 December 2013) among individuals aged 18 years and older with estimated glomerular filtration rate >30 mL/min/1.73 m(2) and measurements of serum phosphorus, creatinine and hemoglobin. Individuals were excluded if they had secondary causes of anemia. Odds ratio (OR) estimated for moderate anemia defined as hemoglobin <11 g/dL for both sexes. Mild anemia was defined as <12 g/dL (females) and <13 g/dL (males). RESULTS: Among 155 974 individuals, 4.1% had moderate anemia and 12.9% had mild anemia. Serum phosphorus levels ≥3.5 mg/dL were associated with both mild and moderate anemia. Moderate anemia OR (95% confidence interval) was 1.16 (1.04-1.29) for every 0.5 mg/dL phosphorus increase and 1.26 (1.07-1.48) in the highest versus middle phosphorus tertile. Additional independent anemia risk factors, including female sex, Asian race, diabetes, low albumin and low iron saturation, were observed, but did not alter the anemia-phosphorus association. CONCLUSIONS: Higher phosphorus levels were associated with a greater likelihood for anemia in a population with early CKD and normal kidney function. Phosphorus may be a biomarker for anemia and may affect aspects of hematopoiesis.
Asunto(s)
Anemia/diagnóstico , Anemia/etiología , Hemoglobinas/análisis , Fósforo/sangre , Insuficiencia Renal Crónica/complicaciones , Anemia/sangre , California/epidemiología , Estudios de Cohortes , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Insuficiencia Renal Crónica/fisiopatología , Factores de RiesgoRESUMEN
Acute exudative polymorphous vitelli-form maculopathy (AEPVM) is a rare condition of unclear etiology that has been seen in association with respiratory and viral infections. It has also been reported as a paraneoplastic phenomenon in older individuals. The authors report the first case of AEPVM associated with Lyme disease with over 3.5 years of follow-up. Multimodality serial imaging suggested the lesions began as multiple serous detachments followed by accumulation of photoreceptor outer segments in the subretinal space that gradually resolved over time and gave rise to the characteristic fundus findings at various stages.
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Enfermedad de Lyme/complicaciones , Enfermedades de la Retina/etiología , Exudados y Transudados , Femenino , Angiografía con Fluoresceína , Humanos , Tomografía de Coherencia Óptica , Adulto JovenRESUMEN
PURPOSE: To assess the impact of using an advanced electronic health record (EHR) on hospital quality and patient satisfaction. METHOD: This retrospective, cross-sectional analysis was conducted in 2012 to evaluate the association between advanced EHR use (Healthcare Information Management Systems Society [HIMSS] Stage 6 or 7 as of December 2012) and estimated process and experience of care scores for hospitals under the Medicare Hospital Value-Based Purchasing Program, using data from the American Hospital Association for 2008 to 2010. Generalized linear regression models were fit to test the association between advanced EHR use with process of care and experience of care, controlling for hospital characteristics. In a second analysis, the models included variables to account for HIMSS stage of advanced EHR use. RESULTS: The study included 2,988 hospitals, with 248 (8.3%) classified as advanced EHR users (HIMSS Stage 6 or 7). After controlling for hospital characteristics, advanced EHR use was associated with a 4.2-point-higher process of care score (P < .001). Hospitals with Stage 7 EHRs had 11.7 points higher process of care scores, but Stage 6 users had scores that were not substantially different from those of nonadvanced users. There was no significant difference in estimated experience of care scores by level of advanced EHR use. CONCLUSIONS: This study evaluated the effectiveness of the U.S. federal government's investment in hospital information technology infrastructure. Results suggest that the most advanced EHRs have the greatest payoff in improving clinical process of care scores, without detrimentally impacting the patient experience.
Asunto(s)
Registros Electrónicos de Salud , Hospitales , Satisfacción del Paciente , Evaluación de Procesos, Atención de Salud , Calidad de la Atención de Salud , Estudios Transversales , Humanos , Estudios Retrospectivos , Medición de Riesgo , Estados UnidosRESUMEN
Vitamin D signaling in mammary cancer stem cells (MCSCs), which are implicated in the initiation and progression of breast cancer, is poorly understood. In this study, we examined vitamin D signaling in mammospheres which are enriched in MCSCs from established breast cancer cell lines. Breast cancer cells positive for aldehyde dehydrogenase (ALDH(+)) had increased ability to form mammospheres compared to ALDH(-) cells. These mammospheres expressed MCSC-specific markers and generated transplantable xenografts in nude mice. Vitamin D receptor (VDR) was significantly down-regulated in mammospheres, as well as in ALDH(+) breast cancer cells. TN aggressive human breast tumors as well as transplantable xenografts obtained from SKBR3 expressed significantly lower levels of VDR but higher levels of CD44 expression. Snail was up-regulated in mammospheres isolated from breast cancer cells. Inhibition of VDR expression by siRNA led to a significant change in key EMT-specific transcription factors and increased the ability of these cells to form mammospheres. On the other hand, over-expression of VDR led to a down-regulation of Snail but increased expression of E-cad and significantly compromised the ability of cells to form mammospheres. Mammospheres were relatively insensitive to treatment with 1,25-dihydroxyvitamin D (1,25D), the active form of vitamin D, compared to more differentiated cancer cells grown in presence of serum. Treatment of H-Ras transformed HMLE(HRas) cells with DETA NONOate, a nitric oxide (NO)-donor led to induction of MAP-kinase phosphatase -1 (MKP-1) and dephosphorylation of ERK1/2 in the mammospheres. Combined treatment of these cells with 1,25D and a low-concentration of DETA NONOate led to a significant decrease in the overall size of mammospheres and reduced tumor volume in nude mice. Our findings therefore, suggest that combination therapy using 1,25D with drugs specifically targeting key survival pathways in MCSCs warrant testing in prospective clinical trial for treatment of aggressive breast cancer.