Prevalence of the cagA Virulence Factor Varies by Race among H. pylori-infected Patients Undergoing Upper Endoscopy.

INTRODUCTION: We designed a race-conscious study to assess the presence of Helicobacter pylori (Hp) virulence factor cagA in a retrospective cohort of patients with active Hp infection. METHODS: We compared cagA status by race in gastric tissue samples from 473 patients diagnosed with active Hp infection from 2015-2019. RESULTS: Hp+ Black patients were two times more likely to be cagA+ than Hp+ White patients (82% vs. 36%, P < .0001). DISCUSSION: Presence of cagA is common among endoscopy patients with active Hp infection; appropriate testing and treatment of Hp can both reduce gastric cancer risk and address health disparities.

A viral histone-like protein exploits antagonism between linker histones and HMGB proteins to obstruct the cell cycle.

Virus infection necessarily requires redirecting cellular resources toward viral progeny production. Adenovirus encodes the histone-like protein VII, which causes catastrophic global reorganization of host chromatin to promote virus infection. Protein VII recruits the family of high mobility group box (HMGB) proteins to chromatin along with the histone chaperone SET. As a consequence of this recruitment, we find that protein VII causes chromatin depletion of several linker histone H1 isoforms. The relationship between linker histone H1 and the functionally opposite HMGB proteins is critical for higher-order chromatin structure. However, the physiological consequences of perturbing this relationship are largely unknown. Here, we employ complementary systems in Saccharomyces cerevisiae and human cells to demonstrate that adenovirus protein VII disrupts the H1-HMGB balance to obstruct the cell cycle. We find that protein VII causes an accumulation of G2/M cells both in yeast and human systems, underscoring the high conservation of this chromatin vulnerability. In contrast, adenovirus E1A and E1B proteins are well established to override cell cycle regulation and promote transformation of human cells. Strikingly, we find that protein VII obstructs the cell cycle, even in the presence of E1A and E1B. We further show that, in a protein-VII-deleted infection, several cell cycle markers are regulated differently compared to wild-type infection, supporting our model that protein VII plays an integral role in hijacking cell cycle regulation during infection. Together, our results demonstrate that protein VII targets H1-HMGB1 antagonism to obstruct cell cycle progression, revealing an unexpected chromatin vulnerability exploited for viral benefit.

Utilization of a reminder mailing to improve blood glucose log reporting in an outpatient diabetes clinic.

Self-monitored blood glucose (SMBG) offers a strategy used to achieve glycemic control in diabetic patients. However, if SMBG readings are unavailable to clinicians, this strategy will have a limited effect. This study assessed the impact of a reminder mailing on response rates to requests for SMBG logs. Patients were asked to mail completed SMBG logs to the clinic in 2 weeks. For the intervention, a reminder mailing was sent to each patient 1 week before SMBG logs were to be returned. Compliance rates pre and postinterventions were compared. The primary outcome was the percentage of all SMBG logs returned on time. Secondary outcomes included the percentage of SMBG logs returned, percentage fulfilled, percentage of clinic appointments kept, percentage of SMBG logs brought to follow-up appointments, and number of interventions made to antidiabetic therapy. Twenty SMBG requests were made in the preintervention cohort versus 19 in postintervention cohort. A trend toward more on time and fulfilled SMBG requests was observed post vs. preintervention. Overall return rates were similar between groups. A nonsignificant increase in clinic appointments kept and a nonsignificant decrease in interventions made were observed postintervention. Receipt of a reminder mail was not a significant predictor of patients bringing an SMBG log to follow-up appointments. In conclusion, the use of a reminder mail was not associated with an increase in the return rate of SMBG logs, although there were nonsignificant trends toward more on time and fulfilled SMBG logs received during the postintervention period.

Cinacalcet for the treatment of primary hyperparathyroidism.

The objective of this article is to review the literature regarding the treatment of primary hyperparathyroidism (PHPT) with a focus on cinacalcet. A MEDLINE (1965-June 2009) and bibliographic search of the English-language literature was conducted using the search terms cinacalcet, calcimimetics, primary hyperparathyroidism, and treatment. All articles identified in the search were included. Parathyroidectomy is curative for patients with PHPT; however, there are few options for patients who are not surgical candidates, who refuse surgery, or those with refractory PHPT after parathyroidectomy. Possible treatment options include estrogens, raloxifene, bisphosphonates, calcitonin, and cinacalcet. Cinacalcet has been shown to decrease serum calcium and parathyroid hormone serum levels in patients with PHPT. These trials, however, have not studied the effect of cinacalcet on patient-oriented outcomes such as bone mineral density, nephrolithiasis, or other complications of PHPT. Cinacalcet may be considered to reduce serum calcium and parathyroid hormone serum levels in patients with PHPT who cannot or will not undergo surgery and those with refractory PHPT after parathyroidectomy. Because the effects of cinacalcet on bone mineral density are uncertain, more frequent monitoring of bone mineral density may be required along with a medication proven to improve bone mineral density. Future studies should evaluate the effect of cinacalcet on complications of PHPT.