RESUMEN
BACKGROUND: Depression is common among patients with heart failure (HF) and can impact patients' outcomes. In this study, we evaluated the rates of psychotherapy referrals for patients with HF with depression. METHODS AND RESULTS: Using the National Ambulatory Medical Care Survey from 2008 to 2018, we examined visits for patients with depression and concurrent HF or coronary artery disease. We estimated the likelihood of referral for psychotherapy using survey weights to provide nationally representative estimates. Among 1797 visits for patients with HF or coronary artery disease and depression, only 9.4% (95% confidence interval 7.2%-12.2%) were referred for psychotherapy, including mental health counseling and stress management. Rates of referral were lowest among patients with depression and HF at 7.5% (95% confidence interval 4.1%-13.2%). The odds of referral decreased over the years from 2008 to 2018 (odds ratio per additional year 0.87, 95% confidence interval 0.77-0.98, Pâ¯=â¯.022), with referral rates in 2008 of 12.8% compared with 4.8% in 2018. CONCLUSIONS: In this nationally representative study of ambulatory visits, patients with HF and depression were referred for psychotherapy in only 7.5% of visits and referral rates have decreased over the years. Magnifying the value of psychotherapy and increasing referral rates are essential steps to improve care for patients with HF with depression.
RESUMEN
The North American plant Cimicifuga racemosa, also known as black cohosh (BC), is a herb that recently has gained attention for its hormonal effects. As the usage of hormone replacement therapy is declining due to its adverse effects in women with cancer, many are turning to herbal remedies like BC to treat menopausal symptoms. It is crucial to determine whether the effects of BC involve estrogen receptor-alpha (ERα). Previous studies from our laboratory have shown ERα to be a possible molecular target for BC. In this study, we examined the effects of BC (8% triterpene glycosides) alone and in combination with hormones and antihormones on the cellular viability, expression of ERα and progesterone receptor (PR)-A/B, and cytolocalization of ERα in ER (+) and PR-A/B (+) T-47D breast cancer cells. Cells were cultured and proteins were extracted and quantified. Western blot analysis revealed alterations in the expression of ERα and PR after treatment with BC (5-100 µM). BC induced a concentration-dependent decrease in ERα and PR protein levels when compared to the control. Image cytometric analysis with propidium iodide staining was used to enumerate changes in T-47D cell number and viability. A decrease in T-47D cell viability was observed upon treatment with 5-100 µM BC. The ideal concentration of BC (100 µM) was used in combination with hormones and antihormones in an effort to further understand the possible similarities between this compound and other known effectors of ERα and PR. After a 24-hour concomitant treatment with and/or in combination of BC, estradiol, ICI 182, 780, and Tamoxifen, downregulation of ERα and PR protein levels was observed. Delineating the role of BC in the regulation of ERα, PR, as well as its mechanisms of action, may be important in understanding the influence of BC on hormone receptors in breast cancer.
RESUMEN
Resveratrol (RES) is a natural antioxidant found abundantly in grapes, peanuts, and berries, and is known to possess anti-tumorigenic properties. However, there is a noticeable lack of studies on the mechanistic effects of Resveratrol on tumor suppressors. Previous studies from our laboratory have shown the tumor suppressor protein p53 and estrogen receptor-alpha (ERα) to be possible molecular targets for RES. In this study, the anti-estrogenic effects of RES were analyzed on the expression of ERα and p53. The breast cancer cells grown in stripped serum were treated with 60 µM RES, as the optimum concentration based on data obtained from a concentration study using 1-100 µM RES. Our studies indicate that RES caused a decrease in the levels of protein expression of p53 and ERα as compared to the control. Increasing concentrations of RES caused a four-fold decrease in cell number in comparison to estradiol. RES, in conjunction with ICI 182,780 (ICI), caused a down-regulation of both p53 and ERα as compared to the control. These observed effects on cell proliferation and regulation of both p53 and ERα by RES may lead to further understanding of the relationship between tumor suppressor proteins and steroid receptors in breast cancer cells.