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PubMed2003

Topically applied vitamin C and cysteine derivatives protect against UVA-induced photodegradation of suprofen in ex vivo pigskin.

Exposure of the nonsteroidal anti-inflammatory drug suprofen (SUP) to UV-radiation results in the formation of radicals, reactive oxygen species (ROS), photodecarboxylated products and photoadducts with biomacromolecules. Using an ex vivo pigskin explant model, we investigated whether topical coapplication of the water-soluble antioxidants vitamin C (Lascorbic acid, ASC), N-acetyl-L-cysteine (NAC) or L-cysteine ethylester (CYSET) with SUP reduced ultraviolet A (UVA)-induced decomposition of SUP. UVA-induced changes in antioxidant bioavailability in the stratum corneum and epidermis were also studied. Epidermal bioavailability of SUP in sham-irradiated pigskin increased 2.2- to 4.1-fold after the lowest antioxidant doses (P < 0.05). As compared with no applied antioxidant, increasing doses of all tested antioxidants resulted in increased levels of SUP and decreased levels of photoproducts (P < 0.05). A maximal protection against SUP photodegradation of 70% was found after an ASC dose of 1 micromol/cm2; these values were 60% for a NAC dose of 10 micromol/cm2 and 50% for a CYSET dose of 5 micromol/cm2. Skin antioxidant levels increased with increasing applied dose (P < 0.05); the bioavailability of CYSET was approximately three-fold lower than that of ASC and NAC. UVA exposure resulted in 30-50% consumption of the topically applied ASC or NAC in the stratum corneum, whereas CYSET was not consumed. In conclusion, the topically applied water-soluble antioxidants ASC, NAC and CYSET protect against UVA-induced decomposition of SUP by scavenging radicals and ROS. Coapplication of these antioxidants may therefore be an effective way to reduce or prevent the phototoxic effects of SUP in vivo.

Animals↗

PubMed2025

Symptoms of Allodynia and Pain Thresholds Amongst Those with Acute Post-Traumatic Headache Attributed to Mild Traumatic Brain Injury: A Prospective, Longitudinal Study.

BACKGROUND: Post-traumatic headache (PTH) is a common acute and persistent symptom following mild traumatic brain injury (mTBI). Symptoms of cutaneous allodynia and presence of nociceptive sensitization might be associated with acute PTH and its persistence. The objectives of this study were to compare allodynia symptoms and cutaneous heat pain thresholds amongst males and females with acute PTH to healthy controls (HC) and determine if pain thresholds and allodynia symptoms are associated with PTH outcomes. METHODS: This prospective longitudinal study enrolled 139 adults with acute PTH attributed to mTBI as defined by the International Classification of Headache Disorders and 95 HC. All PTH participants completed a baseline research visit near PTH onset and a follow-up visit three to four months later. All PTH participants and a subset of HC completed the Allodynia Symptom Checklist (ASC-12) at each research visit. A different subset of the participants underwent quantitative sensory testing (QST) during baseline, 4-week, and 16-week research visits to quantify cutaneous heat pain thresholds at the forehead and forearms. Data from daily headache diaries were used to determine longitudinal PTH improvement versus non-improvement at three months. ASC-12 score and pain threshold comparisons were made between PTH and HC groups, PTH improved versus non-improved cohorts, and between PTH males and females. RESULTS: Participants with PTH had an average age of 42.6 years and 64.0% were female. HC had an average age of 40.0 years and 65.3% were female. At the first visit, PTH participant ASC-12 scores averaged 3.6 versus 0.1 amongst HC, p < 0.001. 44.8% of PTH participants had headache improvement at 3 months. ASC-12 scores were higher in the PTH non-improved versus improved group at baseline (4.0 versus 2.4, p = 0.038) and 3-month follow-up (3.4 versus 1.9, p = 0.012). ASC-12 scores were higher in females than males at baseline (4.7 versus 1.6, p < 0.001) and 3-months (3.9 versus 1.2, p < 0.001). Cutaneous heat pain thresholds at the forehead and forearm did not differ between any group. CONCLUSIONS: PTH attributed to mTBI is associated with symptoms of cutaneous allodynia. Greater allodynia symptoms are present in females with PTH compared to males and may be associated with PTH non-improvement.

allodynia↗

PubMed1998

Hepatitis C virus 1b(II) infection and development of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma: a case-control study in Japan.

This study was performed to determine the distribution of hepatitis C virus (HCV) genotypes among asymptomatic carriers (ASC) and patients with chronic hepatitis without cirrhosis (NC-CH), liver cirrhosis (LC), and hepatocellular carcinoma (HCC) in the Osaka area, and to assess whether infection with HCV genotype 1b (II) is more likely to develop into hepatocellular carcinoma (HCC) than is that with genotype 2a (III) or genotype 2b (IV). Genotypes of all study subjects were determined by Okamoto's method. HCV genotype 1b was detected in 100 of the 143 ASC (69.9%), 551 of the 726 NC-CH patients (75.9%), 86 of the 103 patients with LC (83.5%), and 153 of the 179 HCC (85.5%) patients. Using unconditional logistic regression analysis, the age- and sex- adjusted odds ratios contrasting NC-CH with ASC, LC with ASC and HCC with ASC were 1.38 [95% confidence interval (CI) = 0.93-2.05], 2.28 (95% CI = 1.12-4.63) and 2.27 (95% CI = 1.02-5.06) respectively. HCV genotype 1b is predominant in both healthy carriers and patients with chronic liver diseases in the Osaka area. The findings from the three case-control studies indicate that type 1b infection is more closely associated with the development of LC and HCC than type 2a or 2b through its role in the progression of chronic liver inflammation to a cirrhotic stage.

Adult↗

PubMed2006

Matrix metalloproteinase inhibitors suppress transforming growth factor-beta-induced subcapsular cataract formation.

The pleotropic morphogen transforming growth factor-beta (TGFbeta) plays an important role in the development of fibrotic pathologies, including anterior subcapsular cataracts (ASCs). ASC formation involves increased proliferation and transition of lens epithelial cells into myofibroblasts, through epithelial-mesenchymal transformation that results in opaque plaques beneath the lens capsule. In this study, we used a previously established TGFbeta-induced rat cataract model to explore the role of matrix metalloproteinases (MMPs) in ASC formation. Treatment of excised rat lenses with TGFbeta resulted in enhanced secretion of MMP-2 and MMP-9. Importantly, co-treatment with two different MMP inhibitors (MMPIs), the broad spectrum inhibitor GM6001 and an MMP-2/9-specific inhibitor, suppressed TGFbeta-induced ASC changes, including the epithelial-mesenchymal transformation of lens epithelial cells. Using an anti-E-cadherin antibody, we revealed that conditioned media from lenses treated with TGFbeta contained a 72-kd E-cadherin fragment, indicative of E-cadherin shedding. This was accompanied by attenuated levels of E-cadherin mRNA. Conditioned media from lenses co-treated with TGFbeta and MMPIs exhibited attenuated levels of the E-cadherin fragment compared with those from TGFbeta-treated lenses. Together, these findings demonstrate that TGFbeta-induced E-cadherin shedding in the lens is mediated by MMPs and that suppression of this phenomenon might explain the mechanism by which MMPIs inhibit ASC plaque formation.

Animals↗

PubMed1993

Compromised antioxidant status associated with ascites in broilers.

Tissue infiltration by white blood cells in poultry with ascites has been reported, which could alter endogenous antioxidant status from oxidant stress. Therefore, the objective of this study was to determine the effect of ascites on ascorbic acid, tocopherol, and glutathione (GSH), which are major intracellular antioxidants. Broiler chicks (1 day) were placed in environmental chambers maintained with normal ventilation (Control) or under low ventilation, which produced a cumulative mortality of 31.3% due to ascites. At 3, 5, and 7 wk, lung and liver tissues were obtained from control birds (n = 5) and from birds in the low ventilation chamber with (ASC, n = 5) or without (NASC, n = 5) overt symptoms of ascites. There were no differences in tissue ascorbate, tocopherol, and GSH between the control and NASC groups with the exception of hepatic tocopherol at 7 wk, which was higher (P < .05) in NASC birds than in ASC and control birds. In general, lung and liver concentrations of all three antioxidants were lower (P < .05) in ASC birds than in NASC and control groups. Uric acid, a product of purine metabolism, was lower (P < .05) in liver and lung in ASC birds at 3 wk compared with control birds. However, uric acid concentrations in ASC birds were higher (P < .05) in the lung and serum at 5 wk, and in the liver at 7 wk compared with NASC and control birds.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2004

Plasmablast and plasma cell production and distribution in trout immune tissues.

These studies describe the in vitro and ex vivo generation of plasmablasts and plasma cells in trout (Oncorhynchus mykiss) peripheral blood and splenic and anterior kidney tissues. Cells were derived either from naive trout and cultured with the polyclonal activator, Escherichia coli LPS, or from trout that had been immunized with trinitrophenyl-keyhole limpet hemocyanin. Hydroxyurea was used to resolve populations of replicating (plasmablast) and nonreplicating (plasma cell) Ab-secreting cells (ASC). Complete inhibition of Ig secretion was only observed within the PBL. Both anterior kidney and splenic lymphocytes possessed a subset of ASCs that were hydroxyurea resistant. Thus, in vitro production of plasma cells appears to be restricted to the latter two tissues, whereas peripheral blood is exclusively restricted to the production of plasmablasts. After immunization with trinitrophenyl-keyhole limpet hemocyanin, specific ASC could be isolated from all immune organs; however, the anterior kidney contained 98% of all ASC. Late in the response (>10 wk), anterior kidney ASC secreted specific Ab for at least 15 days in culture, indicating that they were long-lived plasma cells. Cells from spleen and peripheral blood lost all capacity to secrete specific Ab in the absence of Ag. Late in the Ab response, high serum titer levels are solely the result of Ig secretion from anterior kidney plasma cells.

Animals↗

PubMed1999

Correlation between arthroscopically observed changes and synovial light microscopic findings in osteoarthritic temporomandibular joints.

The aim of this study was to determine the correlation between arthroscopically observed (ASC) changes in the synovial membrane and other joint components and synovial light microscopic (LM) findings in the temporomandibular joint (TMJ). Synovial membrane biopsies were obtained during unilateral arthroscopy in forty patients. Thirty-one patients were diagnosed with TMJ osteoarthritis (OA) and nine patients with non-osteoarthritic conditions of their TMJs. Correlations between ASC and synovial LM findings were analyzed with Cohen's Kappa and Spearman's rank correlation tests. Values for Kappa of 0.6 and higher and values for a correlation coefficient of 0.7 and higher were considered satisfactory. No correlations were found in the retrodiscal tissue biopsies. In the anterodiscal tissue biopsies, ASC hypervascularity correlated with LM intima cell shape and cell density. ASC lowered attachment to the anterior slope of the articular eminence correlated with the LM presence of a fibrous intima matrix. In several TMJs, a high concurrence was observed between ASC and LM pathologic changes. The severity of pathologic changes as observed by LM was, however, often less than was suggested arthroscopically.

Adult↗

PubMed1997

Ambulatory purchasing: harnessing supply costs.

The healthcare system remains in a dynamic state of flux. We have all heard the story: the changing healthcare market brings reduced reimbursement for services, increased competition, and steadily increasing supply, maintenance, and equipment costs. Ambulatory surgery centers (ASCs) must keep in sync with this change or fail to survive the current market forces. However, because they represent a small contract to various vendors, many ASCs pay premium prices for inventory while receiving less from Managed Care Plans (MCPs) and Health Maintenance Organizations (HMOs). This dilemma makes control of supply costs a top priority for ASCs. In reality, purchasing is becoming more strategically connected to the ASC balance sheet than ever before. Apart from personnel costs, supply and pharmaceutical purchasing represents the greatest expense category on our financial statement. Harnessing these costs directly relates to bottom line profitability. In addition, while performing cost savings magic, ASCs must maintain patient and surgeon satisfaction with the superior outcomes and state-of-the-art technology their reputations are based upon. Sound impossible? This article details how Surgery Center Plus, Inc. (SCP) implemented a cost containment project.

Contract Services↗

PubMed1995

Medicare program; additions to and deletions from the current list of covered surgical procedures for ambulatory surgical centers--HCFA. Final notice with comment period.

This final notice with comment period implements section 1833(i)(1) of the Social Security Act, which requires, in part, that the list of covered ambulatory surgical center (ASC) procedures be reviewed and updated at least every 2 years. This notice announces the specific additions to and deletions from the list of surgical procedures for which facility services are covered when the procedures are performed in a Medicare-participating ASC, as well as the assigned payment groups for each addition. The notice also announces a change in our criteria for deleting procedures from the ASC list. This notice also responds to public comments received in response to our proposed notice published December 14, 1993 (58 FR 65357). In that notice, we requested comments on the proposed additions to and deletions from the list of covered surgical procedures for ASCs; the proposed quantitative change in our deletion criteria; the development of alternatives to the proposed quantitative deletion criteria; and the assignment of payment groups for each addition. Finally, this notice solicits public comment on certain additions to and deletions from the ASC list that had not been suggested in our December 1993 proposed notice. It also solicits public comment on the assignment of payment groups for certain new procedure codes.

Medicare↗

PubMed1996

Ambulatory surgery centers: harbinger of managed care shift.

Since the late 1960s, elective surgery in the US has been shifting from traditional hospitals to freestanding, independent, corporate or hospital-owned ambulatory surgery centers (ASCs). At present, over three million surgeries are performed yearly in some 2,100 ASCs across the nation. Many underlying forces have been at work influencing this change in the surgical environment. For example, technological advances in minimally invasive procedures have gained acceptance by physicians and patients alike. And these new surgical developments are used in ASCs. Patients have chosen convenience over the institutional approach. And finally, managed care has demanded the lower overhead costs and the efficiencies that ASCs provide. This article examines the growth of ASCs. It also looks specifically at how Columbia/HCA's 130 ambulatory surgery centers purchase products and services.

Ambulatory Surgical Procedures↗

PubMed1998

Medicare program; update of ratesetting methodology, payment rates, payment policies, and the list of covered surgical procedures for ambulatory surgical centers effective October 1, 1998--HCFA. Proposed rule.

In this rule we propose to--Update the criteria for determining which surgical procedures can be appropriately and safely performed in an ambulatory surgical center (ASC); Make additions to and deletions from the current list of Medicare covered ASC procedures based on the revised criteria; Rebase the ASC payment rates using cost, charge, and utilization data collected by a 1994 survey of ASCs; Refine the ratesetting methodology that was implemented by a final notice published on February 8, 1990 in the Federal Register; Require that ASC payment, coverage, and wage index updates be implemented annually on January 1 rather than having these updates occur randomly throughout the year; Reduce regulatory burden; and Make several technical policy changes. This proposed rule implements requirements of section 1833(i)(1) and (2) of the Social Security Act.

Ambulatory Surgical Procedures↗

PubMed1998

Medicare program; update of ratesetting methodology, payment rates, payment policies, and the list of covered procedures for ambulatory surgical centers effective October 1, 1998; extension of comment period--HCFA. Notice of extension of comment period for proposed rule.

This notice extends the comment period for a proposed rule published in the Federal Register on June 12, 1998 (63 FR 32290). In that rule we proposed to: Update the criteria for determining which surgical procedures can be appropriately and safely performed in an ambulatory surgical center (ASC): Make additions to and deletions from the current list of Medicare covered ASC procedures based on the revised criteria; Rebase the ASC payment rates using cost, charge, and utilization data collected by a 1994 survey of ASCs; Refine the ratesetting methodology that was implemented by a final notice published on February 8, 1990 in the Federal Register; Require that ASC payment, coverage, and wage index updates be implemented annually on January 1 rather than having these updates occur randomly throughout the year; Reduce requlatory burden; and Make several technical policy changes. This proposed rule implements requirements of section 1833(i) (1) and (2) of the Social Security Act. The comment period is extended for 30 days.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed1998

Medicare program; update of ratesetting methodology, payment rates, payment policies, and the list of covered procedures for ambulatory surgical centers effective October 1, 1998; reopening of comment period and delay in adoption of the proposed rule as final--HCFA. Notice of reopening of comment period for proposed rule and delay in adoption of provisions of the proposed rule as final.

This notice reopens the comment period for a proposed rule affecting Medicare payments to ambulatory surgical centers (ASCs) that was originally published in the Federal Register on June 12, 1998 (63 FR 32290). This document gives notice of a delay in the adoption of the provisions of the June 12, 1998 ASC proposed rule as a final rule to be concurrent with the adoption as final of the hospital outpatient prospective payment system (PPS) that is the subject of a proposed rule published in the Federal Register on September 8, 1998 (63 FR 47551). In addition this document confirms that the current ASC payment rates that are effective for services furnished on or after October 1, 1998, will remain in effect until rebased ASC rates and the provisions of the June 12, 1998 ASC proposed rule are adopted as final to be concurrent with the adoption as final of the Medicare hospital PPS.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2000

Pros and cons of practice-owned and office-based ambulatory surgery centers.

A detailed feasibility analysis is imperative to ensure the success of a practice-owned ASC. Analysis of the payer mix and the market relating to surgical volume that can be performed at the ASC is imperative. If overbuilding, overequipping, and overstaffing are avoided and the group has adequate volume that can be managed at the ASC, the facility should be a success. Building a practice-owned ASC without an accurate and detailed financial feasibility and payer study can place the endeavor at risk. A well-planned, economically constructed and properly managed ASC will result in an efficient and successful ancillary service for the orthopedic group practice.

Ambulatory Care Facilities↗

PubMedDate not supplied

Correlation of trauma scoring systems with abdominal septic complications in abdominal trauma.

INTRODUCTION: Anatomical trauma scoring systems can predict the occurrence of postoperative abdominal septic complications (ASC) after major abdominal trauma; however, this has not been validated in any Indian study. We attempted such an evaluation in patients attending a teaching hospital in central India. METHOD: A retrospective analysis of data from 169 patients who had undergone emergency laparotomy for penetrating or blunt abdominal injury between August 1996 and July 2001 was done. Every patient was scored using three trauma severity indices and the occurrence of ASC was identified. RESULTS: Patients who developed ASC had higher trauma severity scores than those who did not. Thirty-eight patients had isolated small bowel injury; trauma scores underestimated the occurrence of ASC in these patients. CONCLUSIONS: Trauma severity indices may serve as useful tools to predict the occurrence of postoperative ASC in patients with abdominal trauma, except in those with isolated small bowel injury. There is thus a need to modify the weight of small bowel injury in these scoring systems.

Abdominal Injuries↗

PubMed2003

Autoimmune liver disease in children.

Autoimmune liver disorders are characterised by an inflammatory liver histology, circulating non-organ specific autoantibodies and increased levels of immunoglobulin G (IgG) in the absence of a known aetiology. They respond to immunosuppressive treatment, which should be instituted as soon as diagnosis is made. Liver disorders with a likely autoimmune pathogenesis include autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC). Two types of AIH are recognised according to seropositivity for smooth muscle and/or antinuclear antibody (SMA/ANA, type 1) or liver kidney microsomal antibody (LKM1, type 2). There is a female predominance in both. LKM1-positive patients tend to present more acutely, at a younger age, and commonly have immunoglobulin A (IgA) deficiency, while duration of symptoms before diagnosis, clinical signs, family history of autoimmunity, presence of associated autoimmune disorders, response to treatment and long-term prognosis are similar in both groups. The most common type of paediatric sclerosing cholangitis is ASC. The clinical, biochemical, immunological and histological presentation of ASC is often indistinguishable from that of AIH. In both, there are high IgG, non-organ specific autoantibodies and interface hepatitis. Diagnosis is made by cholangiography. Children with ASC respond to immunosuppression satisfactorily and similarly to AIH in respect to remission and relapse rates, times to normalisation of biochemical parameters and decreased inflammatory activity on follow-up liver biopsies. However, the cholangiopathy can progress and there may be an evolution from AIH to ASC over the years, despite treatment. Whether the juvenile autoimmune form of sclerosing cholangitis and AIH are 2 distinct entities, or different aspects of the same condition, remains to be elucidated.

Child↗

PubMed2003

Determinants of human papillomavirus load among women with histological cervical intraepithelial neoplasia 3: dominant impact of surrounding low-grade lesions.

Measurement of human papillomavirus (HPV) DNA load has been suggested as a means for improving the positive predictive value of HPV testing for detecting cervical intraepithelial neoplasia 3 and cancer (CIN3+). We hypothesized that lesions surrounding CIN3+ (especially the extent of associated CIN1) are important determinants of load, which limit its clinical use. To test this hypothesis, we reviewed the pathology of women at enrollment in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesion Triage Study who were managed at enrollment with oncogenic HPV testing using Hybrid Capture 2 (Digene Corp., Gaithersburg, MD) or colposcopy. We focused our analysis on 133 cases of CIN3+ that were identified, stratified by the number of HPV types detected using a PCR-based method (62 single, 71 multiple infections). Infection with multiple types (P < 0.01) and identification of CIN1 or CIN2 in tissues surrounding CIN3 (P = 0.01) were each significantly associated with higher load (two-way ANOVA). Higher load was associated with more extensive CIN1 (P < 0.01), especially when associated with multiple HPV types. Intensive partial rescreening of enrollment thin-layer slides obtained from women with histopathological CIN3+ revealed that ASC-US/LSIL cells were more numerous than ASC-H/HSIL cells. ASC-US/LSIL cell counts were significantly correlated with load (r = 0.31; P < 0.01), whereas counts of ASC-H/HSIL cells were uncorrelated. We conclude that the extent of histopathological CIN1, number of HPV types, and the number of ASC-US/LSIL cells in exfoliative cervical samples vary greatly among cases of CIN3+ and strongly affect HPV load. These factors severely limit the clinical use of load measurements irrespective of HPV testing methodology.

Adult↗

PubMed2003

Human papillomavirus triage of patients with atypical squamous cells of undetermined significance on cervical Papanicolaou smear.

INTRODUCTION: The recent development of affordable human papillomavirus (HPV) testing has prompted consideration of its use as adjuvant and primary screening for cervical dysplasia. This review focuses on the use of HPV testing in triage management of atypical squamous cells of undetermined significance (ASC-US) Pap smears. MATERIALS AND METHODS: A Medline search was performed for articles relevant to HPV testing as a triage strategy for ASC-US Paps. Key references from other papers that were not included in the search were also reviewed. Findings from the major randomised trials were then summarised. RESULTS: Reflex HPV testing with hybrid capture is at least as effective and potentially cheaper than repeat cytology for evaluation of an ASC-US Pap. It also avoids 50% of colposcopies that would normally be performed if immediate colposcopy were done for all ASC-US Paps, while retaining excellent negative predictive value. CONCLUSION: Reflex HPV testing using liquid-based cytology is the preferred management strategy for triage of ASC-US Paps.

Adult↗