In addition, the expression level of gicerin/CD146 RNA in neonatal rats was upregulated after birth. Therefore, it is suggested that gicerin/CD146 might participate in the increase of myocardial cell volume both in the pathway of cardiac hypertrophy and in the developmental growth of heart.Cytochrome P450 2C9 (CYP2C9) is involved in the metabolism of cancer drugs and exogenous carcinogens. In our study, CYP2C9 was downregulated in multiple cohorts of human esophageal squamous cell carcinoma (ESCC). Until now, its role and epigenetic regulation of CYP2C9 repression in ESCC remain poorly understood. CYP2C9 repression in collected ESCC patient tumor tissues was demonstrated by RT-qPCR and Western blot. The histone acetylation level was carried out by the treatment of histone deacetylase inhibitor TSA and RNA interference. Epigenetic analysis revealed that the increased expression of CYP2C9 in KYSE-150 and TE1 cells was characterized by inhibition of HDAC8 and HDAC1, respectively. TSA decreased the levels of HDAC occupancy around CYP2C9 promoter region greatly. Overexpression of CYP2C9 reduced the invasion and migration of ESCC cells.

With mounting pressure to reduce opioid use, concerns exist about abrupt withdrawal of treatment for the millions of Americans using long-term opioid therapy (LTOT). However, little is known about how patients are tapered from LTOT nationally.

Measure national patterns of LTOT discontinuation and adherence to recommended tapering speed.

Observational study of Medicare Part D from 2012 to 2017.

Using claims for a 20% sample of Medicare beneficiaries, we included patients on LTOT for 1year or more, defined as those with ≥ 4 consecutive quarters with > 60days of opioids supplied in each quarter.

Our primary outcome was discontinuation of LTOT, defined as at least 60 consecutive days without opioids supplied. We additionally examined whether discontinuation of LTOT was „tapered” or „abrupt” by comparing LTOT users’ daily MME dose in the last month of therapy to their average daily dose in a baseline period of 7 to 12months before discontinuation. By the last month of therapy, patients with „abrupt” d users, even those on high doses, had less than 50% reduction in dose, which is inconsistent with existing guidelines.

Accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and the meaningful use of electronic health records (EHRs) generated particular attention during the last decade. Translating these reforms into meaningful increases in population health depends on improving the quality and clinical integration of primary care providers (PCPs). However, if these innovations spread more quickly among PCPs in urban and wealthier areas, then they could potentially worsen existing geographic disparities in health outcomes.

To determine the market penetration of Medicare Shared Savings Program (MSSP) ACOs, PCMHs, and the meaningful use of EHRs among PCPs across urban and rural counties in Ohio.

Retrospective, observational study of the percent of PCPs in a county who are affiliated with PCMH, ACO, and meaningful use (MU) of EHR.

PCPs in all of Ohio’s 88 counties from 2011 to 2015.

Primary care market penetration of ACO, PCMH, and meaningful use of EHR KEY RESULTS In 2015, the Ohio primary caretion were less effective among the rural population in Ohio, federal programs to accelerate adoption of EHRs were overwhelmingly successful in rural areas.

Alcohol use disorder (AUD) imposes a high mortality and economic burden. Effective treatment is available, though underutilized.

Describe trends in AUD pharmacotherapy, variation in prescribing, and associated patient factors.

Retrospective cohort using electronic health records from 2010 to 2019.

Primary care patients from 39 clinics in Ohio and Florida with diagnostic codes for alcohol dependence or abuse plus social history indicating alcohol use. PCPs in family or internal medicine with at least 20 AUD patients.

Pharmacotherapy for AUD (naltrexone, acamprosate, and disulfiram), abstinence from alcohol, patient demographics, and comorbidities. Generalized linear mixed models were used to identify patient factors associated with prescriptions and the association of pharmacotherapy with abstinence.

We identified 13,250 patients; average age was 54 years, 66.9% were male, 75.0% were White, and median household income was $51,776 per year. Over 10 years, the prescription rate rose from 4.4 to 5.6%.riation among PCPs. Increasing the use of pharmacotherapy by non-prescribers may increase abstinence from alcohol.

People who are homeless have a higher burden of illness and higher rates of hospital admission and readmission compared to the general population. Identifying the factors associated with hospital readmission could help healthcare providers and policymakers improve post-discharge care for homeless patients.

To identify factors associated with hospital readmission within 90 days of discharge from a general internal medicine unit among patients experiencing homelessness.

This prospective observational study was conducted at an urban academic teaching hospital in Toronto, Canada. Interviewer-administered questionnaires and chart reviews were completed to assess medical, social, processes of care, and hospitalization data. Multivariable logistic regression with backward selection was used to identify factors associated with a subsequent readmission and estimate odds ratios and 95% confidence intervals.

Adults (N = 129) who were admitted to the general internal medicine service between November 2017 and Nov should evaluate tailored discharge planning and dedicated resources to support implementation of these plans in the community.Cannabidiol, a non-intoxicating phytocannabinoid, has potential therapeutic effects over a broad range of disorders. Recently, there has been increased interest in CBD, as several studies showed promising anticonvulsant efficacy with few side effects. In 2018, a CBD-based oral solution, Epidiolex®, was approved by the FDA to treat two severe forms of pediatric epilepsy, Dravet syndrome, and Lennox-Gastaut syndrome. Although only these two syndromes are recognized indications for CBD, it has been consumed in an unregulated fashion for a variety of indications including chronic pain, muscle stiffness, inflammation, anxiety, smoking cessation, and even cancer. While CBD legislation in the USA is confusing due to the differences in state and federal laws, CBD has proliferated in the US market in several forms such as CBD oil or capsules, hemp oil/extract, and also as an ingredient in several dietary supplements, syrups, teas, and creams. With the ever-increasing use of CBD and its widespread availability to the general public, it is important to examine and report on possible drug-drug interactions between CBD and other therapeutic agents as well as addictive substances such as alcohol and tobacco. A detailed literature search for CBD’s possible interactions was conducted using online databases. As expected, CBD has been reported to interact with anti-epileptic drugs, antidepressants, opioid analgesics, and THC, but surprisingly, it interacts with several other common medications, e.g. acetaminophen, and substances including alcohol. This review provides a comprehensive list of interacting drugs. The possible mechanisms for these drug-drug interactions are presented in table format. Given the growing popularity of CBD as a medication and the dearth of available information on CBD drug-drug interactions, it is critical to be aware of current drug-drug interactions and it will be important to investigate the impact of CBD upon concomitant medication use in future randomized, controlled trials.

There is growing interest in financing housing and supportive services for homeless individuals through Medicaid. Permanent Supportive Housing (PSH), which integrates non-time-limited housing with supportive services for people who are disabled and chronically homeless, has seen rapid growth in the last decade, but clear evidence on the long-term impacts of PSH, needed to guide state efforts to finance some PSH services through Medicaid, is lacking.

Assess changes in Medicaid expenditures and utilization associated with receiving PSH.

Cohort study using a difference-in-differences approach.

A total of 1226 PA Medicaid enrollees who entered PSH 2011-2016 and remained in PSH for 180 days or more, and a matched comparison cohort of 970 enrollees experiencing housing instability who did not receive PSH.

Medicaid spending in aggregate, and on behavioral and physical health services; emergency department (ED) visits and inpatient hospital stays.

Three years after PSH entry, spending decreased by an avercare settings.

The use of professional interpretation is associated with improvements in overall healthcare of patients with limited English proficiency (LEP). For these patients, it is important to understand whether quality of professional interpretation in-person is preserved using remote interpretation modalities (video-conferencing, telephone).

To compare patient perceptions of professional interpretation quality delivered in-person, via video-conferencing, or via telephone during in-person primary care clinical visits.

Secondary analysis of a telephone survey conducted within 1 week after a primary care visit PARTICIPANTS The 326 Chinese and Latino survey participants with LEP who reported using a professional interpreter-in-person, video medical conferencing (VMI), or telephone-during their visit MAIN MEASURES Six items about the quality of interpretation five detailed items scored as a scale, and a sixth overall quality item (range 1 = poor to 5 = excellent) KEY RESULTS While there was a range for all modalitints who used any type of professional interpretation was positive, and that the quality found with in-person interpretation is preserved for remote modalities. Health systems should consider a multimodality approach to interpreter service provision including options for accessing professional interpreters via all three modalities based on communication and access needs.

Medication adherence (MA) is critical to successful chronic disease management. It is not clear how social determinants of health (SDH) impact MA. We conducted a systematic review and meta-analysis to summarize the evidence on the relationship between SDH and MA.

We conducted a systematic review of the literature using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) format. A literature search was performed using three databases PubMed, Scopus, and Cochrane Clinical Trials Register in December of 2018. Included studies were completed in the USA, included adults aged 18 years and older, measured at least one social determinant of health, and medication adherence was the primary outcome measure. Data from included full texts were independently extracted using a standardized data extraction form. We then conducted a meta-analysis and pooled the odds ratios from the included studies for each social determinant as well as for all SDH factors collectively.

A total of 3137 unduplierogenous and varied widely in SDH and MA measurements, adverse social determinants overall were significantly associated with lower MA. The relationship between SDH and MA warrants more attention and research by health care providers and policymakers.