Florida-California Cancer Health Equity Center (CaRE2) Community Scientist Research Advocacy Program.

The Community Scientist Program (CSP), a model connecting researchers with community members, is effective to inform and involve the general population in health-related clinical research. Given the existing cancer disparities among Black/African American and Hispanic/Latino/a populations, more models describing how cancer-related CSPs are designed, implemented, and evaluated are needed. The Florida-California Cancer Research, Education and Engagement (CaRE2) Health Equity Center is a tri-institutional, bicoastal center created to eliminate cancer health disparities among Black/African American and Hispanic/Latino/a populations living in California and in Florida. The CaRE2 Center created a Community Scientist Research Advocacy (CSRA) training program for community members to become cancer research advocates. The CSRA program is currently a 13-week program conducted 100% virtually with all materials provided in English and Spanish for participants to learn more about prostate, lung, and pancreas cancers, ongoing research at CaRE2, and ways to share cancer research throughout their communities. Participants attend didactic lectures on cancer research during weeks 1-5. In week 4, participants join CSRA self-selected groups based on cancer-related topics of interest. Each group presents their cancer-related advocacy project developed during weeks 5-12 at the final session. In this paper, we describe the CaRE2 Health Equity Center's CSRA program, share results, and discuss opportunities for improvement in future program evaluation as well as replication of this model in other communities.

Identification of a Potential Inhibitor of the FIV p24 Capsid Protein and Characterization of Its Binding Site.

Feline immunodeficiency virus (FIV) is a veterinary infective agent for which there is currently no efficient drug available. Drugs targeting the lentivirus capsid are currently under development for the treatment of human immunodeficiency virus 1 (HIV-1). Here we describe a lead compound that interacts with the FIV capsid. This compound, 696, modulates the in vitro assembly of and stabilizes the assembled capsid protein. To decipher the mechanism of binding of this compound to the protein, we performed the first nuclear magnetic resonance (NMR) assignment of the FIV p24 capsid protein. Experimental NMR chemical shift perturbations (CSPs) observed after the addition of 696 enabled the characterization of a specific binding site for 696 on p24. This site was further analyzed by molecular modeling of the protein:compound interaction, demonstrating a strong similarity with the binding sites of existing drugs targeting the HIV-1 capsid protein. Taken together, we characterized a promising capsid-interacting compound with a low cost of synthesis, for which derivatives could lead to the development of efficient treatments for FIV infection. More generally, our strategy combining the NMR assignment of FIV p24 with NMR CSPs and molecular modeling will be useful for the analysis of future compounds targeting p24 in the quest to identify an efficient treatment for FIV.

Optic neuritis secondary to syphilis.

Optic neuritis is a rare manifestation of syphilis, and the involvement of the central nervous system should be considered synonymous with neurosyphilis. This infectious disease, well known as the great imitator, can affect any structure and produce multiple clinical symptoms. Here, we report a case of a 62- year-old male patient who presented to our service with decreased vision and myodesopsias in right eye. The posterior segment showed a hyperemic nerve with peripapillary hemorrhages and retinal pigment epithellium hyperplasia. The patient was recently diagnosed with HIV. Serology for syphilis was positive with posterior decreased levels of nontreponemal test following treatment with ceftriaxone. Optic neuritis can occur at any stage of syphilis and must always be considered a differential diagnosis.

Tertiary wastewater treatment combined with high dilution rates fails to eliminate impacts on receiving stream invertebrate assemblages.

The amount of wastewater processed in treatment plants is increasing following more strict environmental regulations. Treatment facilities are implementing upgrades to abate the concentrations of nutrients and contaminants and, thus, reduce their effects on receiving systems. Although many studies characterized the chemical composition and ecotoxicological effects of treated wastewater, its environmental effects are still poorly known, as receiving water bodies are often subjected to other stressors. We performed a field manipulative experiment to measure the response of invertebrate assemblages to one year of tertiary-treated wastewater discharges. We poured treated wastewater from an urban wastewater treatment plant into the lower-most 100-m of a previously unpolluted stream (3.6 % daily flow on average) while using another upstream reach as control. The positive correlation between effect sizes of abundance changes and IBMWP scores suggested assemblage modifications were following taxa tolerance to ecological impairment. The treatment increased the temporal variability of SPEARorganic, EPT relative abundance, and invertebrate functional redundancy. Our results show that even in this best-case scenario of tertiary-treated and highly diluted wastewater, the abundance of the most sensitive taxa in the aquatic assemblages is reduced. Further improvements in wastewater treatments seem necessary to ensure these effluents do not modify receiving water ecosystems.

Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile.

BACKGROUND: MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. OBJECTIVE: To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. METHODS: Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. RESULTS: We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0-34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0-10), and median PI 0.17 (0-4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05). CONCLUSION: MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.

Antibiotic resistance of subgingival species in chronic periodontitis patients.

BACKGROUND AND OBJECTIVE: The increasing rate of resistance of microorganisms to penicillin and other antibiotics has generated concern among health authorities in Latin America. The present investigation determined the in vitro susceptibility of Porphyromonas gingivalis, Fusobacterium nucleatum, black-pigmented Prevotella spp. and Aggregatibacter actinomycetemcomitans to metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin and moxifloxacin in patients with chronic periodontitis. MATERIAL AND METHODS: Subgingival plaque samples from patients with periodontitis were collected and cultured on selective and nonselective culture media. The antimicrobial susceptibility of periodontopathogenic isolates was studied in chronic periodontitis patients in Colombia. Metronidazole, amoxicillin, amoxicillin/clavulanic acid, clindamycin and moxifloxacin were tested on all bacterial isolates and the percentage of resistant strains was calculated. RESULTS: Of the 150 bacteria identified, 51 were P. gingivalis, 45 were black-pigmented Prevotella spp., 36 were F. nucleatum and 18 were A. actinomycetemcomitans. All the isolates were sensitive to amoxicillin/clavulanic acid and to moxifloxacin, but exhibited variable susceptibility patterns to the other antimicrobial agents tested. CONCLUSION: The results of the present study suggest that periodontal microorganisms in patients with chronic periodontitis can be resistant to the antimicrobial agents commonly used in anti-infective periodontal therapy. We suggest that the indiscriminate use of antimicrobials could result in the appearance of more highly antibiotic-resistant strains of bacteria associated with periodontal diseases in our population compared with the populations of other countries.

Drug Targets: Screening for Small Molecules that Inhibit Fasciola hepatica Enzymes.

The in vitro screening of small molecules for enzymatic inhibition provides an efficient means of finding new compounds for developing drug candidates. This strategy has the advantage of being rapid and inexpensive to perform. Enzymes are suitable targets for screening when simple methods to obtain them and measure their activities are available and there is evidence of their essential role in the parasite's life cycle. Here, we describe the screening of small molecules as inhibitors of two Fasciola hepatica enzyme targets (cathepsin L and triose phosphate isomerase), an initial step to find new potential compounds for drug development strategies.

[Infections by OXA-48 carbapenemase-producing Enterobacteriaceae in surgical patients: antibiotic consumption and susceptibility patterns]. / Infecciones asociadas a enterobacterias productoras de carbapenemasas OXA-48 en pacientes quirúrgicos: consumo de antibióticos y evolución de sensibilidades.

OBJECTIVE: To assess antibiotic consumption, susceptibility patterns and targeted treatment for OXA-48 carbapenemase-producing Enterobacteriaceae (CPE) related infections in surgical patients in a General Surgery Department. METHODS: Retrospective review of patients with a positive culture for OXA-48 and associated clinical data of infection, while hospitalized in a General Surgery Department from January 2013 to December 2018. RESULTS: Sixty-five patients with 66 isolations (OXA-48) were included: Klebsiella pneumoniae, 57 (86.5%); Enterobacter cloacae, 5 (7.6%); Escherichia coli, 3 (4.5%); Morganella morganii, 1 (1.5%). The most frequent source was intra-abdominal infection (n=39, 60%), and previous antibiotic consumption was: piperacillin-tazobactam (48%), meropenem (45%), ciprofloxacin (25.5%), ertapenem (16.5%), imipenem (12%), amikacin (12%), tigecycline (12%). Temporal trends (2013/14, 2015/16 and 2017/18) in susceptibility patterns were (percentages): ceftazidime-avibactam X-X-100; amikacin 100- 96-84 (p=0.518); tigecycline 100-92-80 (p=0.437); colistin 100-67-66 (p<0.001); meropenem 37-64-72 (p=0.214); imipenem 51-41-77 (p=0.109); gentamicin 13-19-18 (p=0.879); ertapenem 35-0-0 (p<0.001). Median duration of the targeted antibiotic therapy was 14 [IQR 9-20] days; antibiotics used were: tigecycline (57%); meropenem (40.5%); amikacin (37.5%); ceftazidime-avibactam (9%); imipenem (7.5%); colistin (7.5%). Global mortality rate at 30 days was 12% (8 patients). Targeted treatment was appropriate (antibiogram) in 87.7%, and targeted combination scheme was administered in 76.9%, which included a carbapenem in 49.2%. CONCLUSIONS: OXA-48-related-intra-abdominal infection is significant in surgical patients, with substantial broad-spectrum antibiotic consumption. Useful targeted therapy includes ceftazidime-avibactam, amikacin, tigecycline, meropenem, and imipenem.

Conservative Management of Gallstone Disease in the Elderly Population: Outcomes and Recurrence.

BACKGROUND & AIMS: The prevalence of gallstone disease increases with age, being early cholecystectomy the most accepted treatment in the vast majority of patients in order to prevent complications and recurrence. The aim of this study is to determine the recurrence rate and its possible predictors after initial non-operative management. MATERIALS AND METHODS: We reviewed a consecutive series of patients, older than 65 years, admitted for a gallstone-related disease and treated with a non-operative management between January 2010 and December 2013. We analyzed comorbidities, clinical data, diagnosis, management, recurrence, and its treatment. Median follow-up after the discharge was 2 years. Recurrence was analyzed by a Kaplan-Meier survival curve. Possible recurrence's predictors were analyzed. RESULTS: The study included 226 patients. Mean age was 80.4 ± 7.2 years, 127 (56%) were female. The main causes of index hospitalization were acute cholecystitis (58%) and biliary pancreatitis (18.1%). After 2 years of follow-up, the recurrence rate was 39.8%; mean time to recurrence was 255.2 ± 42.1 days, 81% of patients recurred within 1 year. Bile duct disease implied a higher recurrence rate than the gallbladder disease group (52% vs 33%, p < 0.001). Subjects with two or more diagnoses during index admission presented higher recurrence rate (32% vs 49%, p < 0.001). CONCLUSION: More than a third of elderly patients could present a recurrence within 2 years after initial non-operative management. Early cholecystectomy should be considered at index admission in order to prevent recurrence.

Neuroendocrine tumours within a Meckel's diverticulum.

A Meckel's diverticulum is a common anomaly of the gastrointestinal tract. Although the majority of patients do not have any symptoms, malignancies can develop inside these diverticula, with neuroendocrine tumours being the most common. Diverticulectomy is the best option for complicated diverticula but prophylactic resection of asymptomatic diverticula in adults remains controversial. We present a case series of three patients with a neuroendocrine tumour found in a Meckel's diverticulum. Given the number of asymptomatic diverticula not resected, it seems likely that incidental neuroendocrine tumours are more prevalent than thought previously. With the minimally invasive techniques now available and the low complication rate for incidental diverticulectomy, we believe that the benefits of resection of this high risk area for cancer outweigh the risks of surgery.

[Comparison of the clinical response to the application of Hylan G-F 20 and collagen-PVP in patients with knee osteoarthritis]. / Comparación de la respuesta clínica a la aplicación de hilano G-F 20 y colágeno-PVP en pacientes con artrosis de rodilla.

BACKGROUND: Knee osteoarthritis is a joint disease characterized by degeneration, loss of cartilage and subchondral bone alteration associated with changes in the soft tissues. In a sample of 2,500 individuals, the prevalence of osteoarthritis was found in 2.3% (IC 95% 1.7 a 2.9) in adults; it represents the second cause of consultation in our hospital. MATERIAL AND METHODS: Two groups of patients were studied: the first included 70 patients who received hylan G-F 20 in three infiltrations; the other group, of 40 patients, received collagen-PVP in four applications. A subjective questionnaire based on the WOMAC evaluation was applied, with which we could assess pain, stiffness and functional capacity before and after the application. RESULTS: Both hylan G-F 20 and collagen-PVP improved the quality of life of our patients by reducing symptoms such as pain, stiffness and functional limitation, collagen being more efficient for reducing pain and hylan G-F 20 for reducing stiffness and functional limitation. CONCLUSIONS: Both treatments were safe and effective; they can be used in our institute as a conservative treatment to decrease hospitalizations for pain management.

ANTECEDENTES: La osteoartritis de rodilla es una enfermedad articular caracterizada por degeneración, pérdida del cartílago y alteración del hueso subcondral asociadas a cambios en los tejidos blandos. En una muestra de 2,500 individuos se encontró una prevalencia de artrosis de 2.3% (IC 95% 1.7 a 2.9) en adultos. En nuestro hospital representa la segunda causa de consulta. MATERIAL Y MÉTODOS: Se tomaron dos grupos de pacientes: el primero, de 70 pacientes a los que se les aplicó hilano G-F 20 en tres infiltraciones; al otro grupo, de 40 pacientes, se le aplicó colágeno-PVP en cuatro aplicaciones. Se les realizó un interrogatorio basado en el cuestionario de WOMAC, con el cual pudimos valorar dolor, rigidez y capacidad funcional antes y después de la aplicación de los medicamentos. RESULTADOS: Nuestro estudio presentó que en ambos grupos hubo mejora de la calidad de vida al disminuir los síntomas tales como dolor, rigidez y limitación funcional; el colágeno fue más eficiente para la disminución del dolor y el hialino G-F 20, para la disminución de la rigidez y la limitación funcional. CONCLUSIONES: Ambos tratamientos mostraron seguridad y eficacia. Su uso en nuestro instituto para los pacientes fuera de tratamiento quirúrgico puede disminuir de manera importante los internamientos por dolor, con lo que podemos hacer un uso más eficiente de los recursos con que contamos.

Neuroendocrine tumour arising inside a tailgut cyst.

Tailgut cysts are rare benign retrorectal cysts arising from persistent remnants of an embryonic hindgut. Malignant transformation inside this lesion is very uncommon and occurrence of neuroendocrine tumours in this context is extremely rare. We report the case of a 56-year-old woman who underwent surgical excision of a presacral tailgut cyst, which was found incidentally to include a neuroendocrine tumour.

Fast ring-shape self-assembling in water-based ink-jetted droplets.

We report on a phenomenon of ring pattern formation of nanoparticles in small ink-jetted droplets (30-60 microm diameter) of water-based suspensions on substrate, which occurs in several seconds, unlike 10 min and more in most previous works. The phenomenon may open the way for new applications connected with rapid creation of desired structures. In addition, we report here a method for the study of the relative motion of the solvent and pigments in suspension droplets by coloring the solvent with soluble dye and using spectral imaging techniques.

Propuesta de clasificación tomográfica preoperatoria para el tumor del cuerpo carotideo / Proposal for a preoperative tomographic classification for carotid body tumor

OBJETIVO: proponer una clasificación preoperatoria a los pacientes con tumor de cuerpo Carotídeo y relacionarlos con complicaciones postoperatorias. MATERIAL Y MÉTODOS: todos los pacientes operados con diagnóstico de tumor del cuerpo Carotídeo entre el 2005 al 2014 en el Hospital Obrero N° 1 de la Caja Nacional de Salud en La Paz - Bolivia RESULTADOS: se analizaron y operaron 115 pacientes con un promedio de edad de 52 años (DE±11,725 y una moda de 57 años) de los cuales el 109 (94,80%) correspondieron al género femenino con una razón de 18:1. Todos los pacientes eran originarios y residentes de ciudades ubicadas a más de 2500 m.s.n.m. El promedio de evolución fue de 3 años (DE±2,189), y solo 7 pacientes (6,1%) presentan hábito tabáquico. 83 pacientes (72,2%) de los TCC se localizan en el lado izquierdo En las manifestaciones clínicas, todos los pacientes presentan el tumor localizado en el ángulo mandibular, por delante del musculo esternocleidomastoideo, describiéndose un crecimiento paulatino y permanente en 72 sujetos (62,6%), cefalea en 45 (39,1%), presencia de latido en 30 sujetos (26,1%), disfagia en 9 (7,9%), mareos en 16 (13,9%) y disfonía en 6 (5,2%). Entre los signos más evidentes de TCC, se describe el signo de Fontaine en 114 sujetos (99,2%), adenomegalia en 20 (17,4%) y otros menos frecuentes como soplo, abombamiento parafaringeo y compromiso de pares craneales. Todos los pacientes fueron clasificados en ambos sistemas (Shamblin y la nuestra llamada de los Andes). Se describen 39 pacientes (33,2%) con complicaciones postoperatorias, Grado I: 1 paciente sin complicaciones; Grado II: de 58 sujetos, 4 (3,5%) presentaban parálisis temporal del Hipogloso; en el Grado III: de los 41 sujetos, 24 (20,8%) presentaron ligadura de la arteria carótida externa, parálisis del hipogloso y glosofaringeo, lesión de recurrente y del laríngeo superior. En el grupo IV, de los 15 sujetos operados, 11 presentaron complicaciones (9,6% del total y 73% del grupo) entre las cuales están ligadura de la arteria carótida externa, lesión del hipogloso y un paciente con AVC y hemiparesia. Se describe una reoperación (0,86%) y ninguna mortalidad. CONCLUSIÓN: proponer una clasificación preoperatoria que tenga la posibilidad de asociarse a complicaciones y pronóstico.

OBJECTIVE: to propose a preoperative classification of patients with Carotid Body Tumor and relate them to postoperative complications. MATERIAL AND METHODS: all patients operated with a diagnosis of Carotid Body Tumor between 2005 and 2014 at the Obrero Hospital No. 1 of the National Health Fund in La Paz - Bolivia RESULTS: 115 patients with an average age of 52 years (SD±11.725 and a mode of 57 years) were analyzed and operated on, of which 109 (94.80%) corresponded to the female gender with a ratio of 18: 1. All the patients were from and residents of cities located more than 2,500 meters above sea level. The mean evolution was 3 years (SD±2.189), and only 7 patients (6.1%) had a smoking habit. 83 patients (72.2%) of CBTs are located on the left side In the clinical manifestations, all patients present the tumor located in the mandibular angle, in front of the sternocleidomastoid muscle, describing a gradual and permanent growth in 72 subjects (62.6%), headache in 45 (39.1%), presence of heartbeat in 30 subjects (26.1%), dysphagia in 9 (7.9%), dizziness in 16 (13.9%) and dysphonia in 6 (5.2%). Among the most obvious signs of CBT, the Fontaine sign is described in 114 subjects (99.2%), adenomegaly in 20 (17.4%) and other less frequent signs such as murmur, parapharyngeal bulging and cranial nerve involvement. All patients were classified in both systems (Shamblin and ours called from the Andes). 39 patients (33.2%) with postoperative complications were described, grade I: 1 patient without complications; Grade II: of 58 subjects, 4 (3.5%) had temporary hypoglossal paralysis; in Grade III: of the 41 subjects, 24 (20.8%) presented external carotid artery ligation, hypoglossal and glossopharyngeal paralysis, recurrent lesion and superior larynx. In group IV, of the 15 operated subjects, 11 presented complications (9.6% of the total and 73% of the group), among which are external carotid artery ligation, hypoglossal injury and one patient with stroke and hemiparesis. A reoperation (0.86%) and no mortality are described. CONCLUSION: propose a preoperative classification that has the possibility of being associated with complications and prognosis.

An insight into early reproductive processes through the in vivo model of ovum donation.

To gain insight into early reproductive processes we have prospectively designed ovum donation protocols to elucidate several phenomena relating to embryo implantation and pregnancy sustenance. Artificial endometrial cycles with variable follicular phases were induced in 60 recipients by sequential estrogen and progesterone. A total of 964 oocytes were retrieved throughout 43 ovum donation attempts, for an average of 22.4 (range, 16-41) eggs/retrieval. The overall delivery rate per egg retrieval (donors and recipients combined) was 72.1% (31 of 43). The shortest estrogen stimulation (short follicular phase) resulting in ongoing pregnancies was 5 days in duration, while the longest (long follicular phase) was 35 days in duration before progesterone initiation. Utilization of variable length follicular phases, artificially extended the stage of endometrial receptivity to over 4 weeks. To assess the window of implantation, same age embryos were transferred onto endometrium of different maturational stages. Pregnancies were documented with embryo transfers between luteal day 1 (day 15) to luteal day 6 (day 20), extending the window of implantation in the human to at least 6 consecutive days. To evaluate the relative contribution of oocyte quality and endometrial receptivity to pregnancy outcome, common source ova were transferred onto endometrium with variable hormonal exposure. Despite the drastically different follicular phase estradiol levels and periods of exposure, similar delivery rates were attained in donor cycles (29.4%) and recipient cycles during short follicular phases (29.6%). Slightly higher delivery rates (39.4%) were observed with long follicular phases. The comparable pregnancy rates in donors and recipients are attributed to the common source oocytes regardless of endometrial stimulation.

Small bowel length in hyperlipidemia and massive obesity.

Small bowel length has been measured during intestinal bypass surgery in 272 morbidly obese patients undergoing jejunoileal bypass and 121 nonobese patients undergoing partial ileal bypass for hyperlipidemia. There was no statistically significant difference in small bowel length between the obese and the nonobese patients. Small bowel length was not correlated with the degree of obesity expressed as the percentage of ideal weight. The only statistically significant correlation determined was between sex and bowel length in the obese subjects, where a greater length of small intestine was found in the males.

Increased hepatic cholesterol synthesis in normal rats by cross-circulation with ileal bypassed partners.

Aortic cross-circulation between Holtzman rat littermates was employed to investigate the possible role of a blood-borne factor from the small intestine in the regulation of hepatic cholesterol synthesis. Experimental pairs, consisting of a normal rat and a distal 50% small bowel excluded partner, demonstrated significantly increased combined hepatic cholesterol synthesis when compared to control pairs, consisting of two normal rats, both at 3 and 5 days following parabiosis. This difference was accounted for by increased hepatic cholesterol synthesis in the normal rat in each experimental pair. Neither weight loss nor differences in dietary intake contributed to this effect. Whole blood cholesterol in the common circulation of both experimental and control pairs was lowered; while hepatic cholesterol content was transiently increased, at 3 but not 5 days following parabiosis. Thus, the intestinal bypassed rat stimulates, or releases inhibition of, hepatic cholesterol synthesis in a non-bypassed parabiotic partner. The mechanism for this phenomenon has yet to be defined.