Does oral radiocontrast affect image quality of abdominal sonography?

OBJECTIVE: Emergency Department patients with abdominal pain may require both an ultrasound (US) and computed tomography (CT) for an accurate diagnosis. Patients are often asked to drink oral radiocontrast while awaiting ultrasound, in order to better expedite a CT in the case of a non-diagnostic US. The impact of oral radiocontrast on US image quality has not been studied. We compared the quality of US images obtained before and after the ingestion of oral radiocontrast in healthy adult volunteers. METHODS: This was a prospective study in which adult volunteer subjects underwent sonographic studies of the aorta, the right upper quadrant, the right lower quadrant, and the Focused Assessment with Sonography in Trauma (FAST) examination. Initial studies were performed prior to ingestion of oral radiocontrast, with subsequent imaging occurring at 1 and 2hour post-ingestion. All of the images from the sonographic exams were randomized and subsequently scored for quality by two emergency ultrasound fellowship trained emergency physicians with extensive experience in performing and interpreting US. RESULTS: 638 images from 240 exams were obtained from 20 subjects at three time points. Six exams were not scored due to inadequate images. There were no significant differences in image quality for any of the US exam types after the ingestion of oral radiocontrast at 1 and 2h. CONCLUSION: Ingestion of oral radiocontrast did not affect image quality of four common abdominal ultrasound examinations.

Pharmacy waste, fraud, and abuse in health care reform.

OBJECTIVE: To describe the new Medicare and Medicaid waste, fraud, and abuse provisions of the Affordable Care Act (H. R. 3590) and Health Care and Education Affordability Reconciliation Act of 2010 (H. R. 4872), the preexisting law modified by H. R. 3590 and H. R. 4872, and applicable existing and proposed regulations. SUMMARY: Waste, fraud, and abuse are substantial threats to the efficiency of the health care system. To combat these activities, the Department of Health and Human Services and Centers for Medicare & Medicaid Services promulgate and enforce guidelines governing the proper assessment and billing for Medicare and Medicaid services. These guidelines have a number of provisions that can catch even well-intentioned providers off guard, resulting in substantial fines. H. R. 3590 and H. R. 4872 augment preexisting waste, fraud, and abuse laws and regulations. This article reviews the new waste, fraud, and abuse laws and regulations to apprise pharmacists of the substantial changes affecting their practice. CONCLUSION: H. R. 3590 and H. R. 4872 modify screening requirements for providers; modify liability and penalties for the antikickback statute, federal False Claims Act, remuneration, and Stark Law; and create or extend auditing and management programs. Properly navigating these changes will be important in keeping pharmacies in compliance.

Gleevec suppresses p63 expression in head and neck squamous cell carcinoma despite p63 activation by DNA-damaging agents.

OBJECTIVES: The objectives of this study were to determine the effects of Gleevec on p63 expression in head and neck squamous cell carcinoma (HNSCC) cell lines and to investigate the role of Gleevec in regulating p63 stabilization under DNA-damaging conditions. METHODS: Immunohistochemical staining was performed to determine p63 expression in HNSCC tissue. Annexin V staining was used to assess the effects of p63 on early apoptosis. Immunoblotting was used to examine the effects of Gleevec on p63 protein levels in HNSCC cell lines in response to DNA damage. Immunofluorescence staining was performed to study the expression pattern of p63 and c-Abl. RESULTS: In HNSCC, p63 protein levels are induced by DNA-damaging agents, including ionizing radiation, doxorubicin, and ultraviolet light. We demonstrate that Gleevec reduces p63/DeltaNp63 expression in a dose-dependent manner in HNSCC and overrides the protein induction by DNA-damaging agents. Overexpression of c-Abl in the absence of Gleevec results in higher levels of p63 than those treated with Gleevec, implicating c-Abl kinase activity as a regulator of p63 protein stability. CONCLUSIONS: Gleevec downregulates p63/DeltaNp63 levels in HNSCC in a dose-dependent manner under both normal and DNA-damaging conditions. This downregulation can be explained by Gleevec's inhibition of c-Abl, which destabilizes p63. Based on our data, treating cancers with high expression of TAp63 with Gleevec may result in the unfavorable inhibition of a tumor suppressor, whereas downregulation of DeltaNp63 would be advantageous. Further development of antibodies that can discriminate between TAp63 and DeltaNp63 will be needed to determine the specific effects of Gleevec on p63 in HNSCC.