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This report describes a single center experience with laser fenestration of the inferior vena cava for the treatment of type 2 endoleak after endovascular abdominal aortic aneurysm repair. Our technique is reviewed, and clinical data after treatment are reported. Twelve patients underwent transcaval embolization via laser fenestration. Technical success was achieved in all cases (100%) with no postoperative complications. At a median follow-up of 12.9 months, no patient demonstrated a persistent endoleak and there were no cases of aortocaval fistula. Transcaval embolization, via laser fenestration, provides an additional strategy for the management of type 2 endoleak after endovascular abdominal aortic aneurysm repair.

Summary: Many US states published crisis standards of care (CSC) guidelines for allocating scarce critical care resources during the COVID-19 pandemic. However, the performance of these guidelines in maximizing their population benefit has not been well tested. In 2,272 adults with COVID-19 requiring mechanical ventilation drawn from the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID) multicenter cohort, we test the following three approaches to CSC algorithms: Sequential Organ Failure Assessment (SOFA) scores grouped into ranges, SOFA score ranges plus comorbidities, and a hypothetical approach using raw SOFA scores not grouped into ranges. We find that area under receiver operating characteristic (AUROC) curves for all three algorithms demonstrate only modest discrimination for 28-day mortality. Adding comorbidity scoring modestly improves algorithm performance over SOFA scores alone. The algorithm incorporating comorbidities has modestly worse predictive performance for Black compared to white patients. CSC algorithms should be empirically examined to refine approaches to the allocation of scarce resources during pandemics and to avoid potential exacerbation of racial inequities.

Summary: Elucidating the mechanism of reprogramming is confounded by heterogeneity due to the low efficiency and differential kinetics of obtaining induced pluripotent stem cells (iPSCs) from somatic cells. Therefore, we increased the efficiency with a combination of epigenomic modifiers and signaling molecules and profiled the transcriptomes of individual reprogramming cells. Contrary to the established temporal order, somatic gene inactivation and upregulation of cell cycle, epithelial, and early pluripotency genes can be triggered independently such that any combination of these events can occur in single cells. Sustained co-expression of Epcam, Nanog, and Sox2 with other genes is required to progress toward iPSCs. Ehf, Phlda2, and translation initiation factor Eif4a1 play functional roles in robust iPSC generation. Using regulatory network analysis, we identify a critical role for signaling inhibition by 2i in repressing somatic expression and synergy between the epigenomic modifiers ascorbic acid and a Dot1L inhibitor for pluripotency gene activation. : Tran et al. combine ascorbic acid, 2i, and Dot1l inhibition to robustly generate induced pluripotent stem cells. With single-cell transcriptomes, they define the transcriptional signature and key regulators of reprogramming cells. Using network analysis, they find 2i suppresses somatic while ascorbic acid and Dot1l inhibitor collaboratively upregulate pluripotency genes.

Tocopherols and tocotrienols are metabolized via hydroxylation and oxidation of their hydrophobic side chain to generate 13′-hydroxychromanols (13′-OHs) and various carboxychromanols, which can be further metabolized by conjugation including sulfation. Recent studies indicate that long-chain carboxychromanols, especially 13′-carboxychromanol (13′-COOH), appear to be more bioactive than tocopherols in anti-inflammatory and anticancer actions. To understand the potential contribution of metabolites to vitamin E-mediated effects, an accurate assay is needed to evaluate bioavailability of these metabolites. Here we describe an LC/MS/MS assay for quantifying vitamin E metabolites using negative polarity ESI. This assay includes a reliable sample extraction procedure with efficacy of ≥ 89% and interday/intraday variation of 3–11% for major metabolites. To ensure accurate quantification, short-chain, long-chain, and sulfated carboxychromanols are included as external/internal standards. Using this assay, we observed that sulfated carboxychromanols are the primary metabolites in the plasma of rodents fed with γ-tocopherol or δ-tocopherol. Although plasma levels of 13′-COOHs and 13′-OHs are low, high concentrations of these compounds are found in feces. Our study demonstrates an LC/MS/MS assay for quantitation of sulfated and unconjugated vitamin E metabolites, and this assay will be useful for evaluating the role of these metabolites in vivo.

Competing Interests: Declaration of Competing Interest No authors declare any competing interests.

Background: Adult cancer survivors (ACS) are at increased risk for developing various comorbid conditions and having poor health-related quality of life (HRQOL) when compared to adults with no history of cancer. The effect of social and emotional support on HRQOL among ACS is not fully elucidated. The purpose of this study was to understand the role of social and emotional support on HRQOL in ACS and to examine if the association between social and emotional support and HRQOL is modified by gender, time since cancer diagnosis, or marital status., Methods: Data for this study were obtained from the 2009 Behavioral Risk Factor Surveillance System. Statistical analysis was based on ACS with complete data (n = 23,939) on all variables considered. Multivariable logistic regression models were used to model the association between social and emotional support and indicators of HRQOL (i.e., general health, physical health, mental health, and activity limitation). To examine if gender, marital status, or the number of years since cancer diagnosis modify the association, separate stratified analyses were conducted., Results: When compared to ACS who reported that they Rarely/Never received social and emotional support, those who reported that they Always received were 32 % less likely to report Fair/Poor General health, 23 % less likely to report frequent unhealthy days of Physical health, 73 % less likely to report frequent unhealthy days of Mental health and 38 % less likely to report frequent unhealthy days of Activity limitation. Social and emotional support was positively associated with all four domains of HRQOL among ACS who were female, unmarried, or greater than 5 years since cancer diagnosis, while this positive association was evident only with one or two domains of HRQOL among their corresponding counterparts (i.e., male, married, less than 5 years since diagnosis)., Conclusions: Social and emotional support is an important factor directly related to a better HRQOL, but it is modified by gender, marital status, and time since diagnosis. Findings from this study should inform health care providers about the importance of a support system for ACS in improving their overall quality of life., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: The first objective was to determine the impact on hospital readmissions at 30- and 90-days after discharge. The second objective was to examine the change in number of medications a patient was taking before enrollment versus after enrollment and potential health care savings., Setting: Independent community pharmacy in the southeastern United States., Practice Description: Blue Ridge Pharmacy, Inc. is composed of 2 long-term care pharmacies, 2 community pharmacies, a compounding pharmacy, and a specialty pharmacy., Practice Innovation: The Access Program is a transitions of care and coordination of care program. Sona Access helps patients who have undergone a transition of care from a skilled nursing facility, health system, physician office, or community partner. Access incorporates social care services and medication services such as free home delivery, home visit, monthly care calls, and adherence packaging., Evaluation: This retrospective study included participants age 18 years and older who enrolled in the program between March 2015 and March 2016 and had at least 3 months of data. Data collected included patient demographics, reason for referral, admissions to hospitals or skilled nursing facilities, number of medications before enrollment, and number of medications three months after enrollment., Results: The mean age (±SD) was 70 ± 13.8 years, and 65% of patients were female. The 123 patient enrollments yielded 113 total hospitalizations, resulting in a mean of 0.92 hospitalizations per patient. Pharmacist consultation and reconciliation decreased the average number of medications from 12 to 10 medications per patient. Within the 113 hospitalizations that occurred after enrollment, 5 occurred within 30 days, 13 occurred within 90 days, and 95 occurred at 91 days or greater., Conclusion: This study suggests that the delivery of coordination of care services through medication reconciliation, medication synchronization, and home visits has a positive effect on health outcomes for patients who have undergone a recent transition of care., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Tocopherols and tocotrienols are metabolized via hydroxylation and oxidation of their hydrophobic side chain to generate 13'-hydroxychromanols (13'-OHs) and various carboxychromanols, which can be further metabolized by conjugation including sulfation. Recent studies indicate that long-chain carboxychromanols, especially 13'-carboxychromanol (13'-COOH), appear to be more bioactive than tocopherols in anti-inflammatory and anticancer actions. To understand the potential contribution of metabolites to vitamin E-mediated effects, an accurate assay is needed to evaluate bioavailability of these metabolites. Here we describe an LC/MS/MS assay for quantifying vitamin E metabolites using negative polarity ESI. This assay includes a reliable sample extraction procedure with efficacy of ≥ 89% and interday/intraday variation of 3-11% for major metabolites. To ensure accurate quantification, short-chain, long-chain, and sulfated carboxychromanols are included as external/internal standards. Using this assay, we observed that sulfated carboxychromanols are the primary metabolites in the plasma of rodents fed with γ-tocopherol or δ-tocopherol. Although plasma levels of 13'-COOHs and 13'-OHs are low, high concentrations of these compounds are found in feces. Our study demonstrates an LC/MS/MS assay for quantitation of sulfated and unconjugated vitamin E metabolites, and this assay will be useful for evaluating the role of these metabolites in vivo., (Copyright © 2015 by the American Society for Biochemistry and Molecular Biology, Inc.)

Objectives: The goal of this study was to assess coronary artery calcification in patients ≥10 years or age with a history of Kawasaki disease (KD)., Background: Patients with a history of KD and coronary artery aneurysms are at risk for late morbidity from coronary artery events. It is unknown whether patients with KD with acutely normal or transiently dilated coronary arteries also have increased risk of late coronary artery complications. Coronary calcium scoring using noncontrast computed tomography is a well-established tool for risk-stratifying patients with atherosclerotic coronary artery disease, but there are limited data on its role in evaluating patients with a history of KD., Methods: We performed coronary artery calcium (CAC) volume scoring using a low radiation dose computed tomography protocol on 70 patients (median age 20.0 years) with a remote history of KD (median interval from acute KD to imaging 14.8 years). Forty-four (63%) patients had no history of coronary dilation, 12 (17%) had a history of transient dilation, and 14 (20%) had coronary aneurysms., Results: All of the patients with normal coronary artery internal diameter during the acute phase of KD and 11 of 12 patients with transient dilation had CAC scores of zero. Coronary calcification was observed in 10 of the 14 patients with coronary aneurysms, with the degree of calcification ranging from mild to severe and occurring years after the patients' acute KD., Conclusions: Coronary calcification was not observed in patients with a history of KD and normal coronary arteries during the acute phase. Therefore, CAC scanning may be a useful tool to screen patients with a remote history of KD or suspected KD and unknown coronary artery status. Coronary calcification, which may be severe, occurs late in patients with coronary aneurysms. The pathophysiology and clinical implications of coronary calcification in patients with aneurysms are currently unknown and warrant further study., (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)