Impact of sex, race and socioeconomic status on survival after pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.

OBJECTIVES: Pulmonary thromboendarterectomy (PTE) is a definitive treatment for chronic thromboembolic pulmonary hypertension. Demographic-based disparities in PTE outcomes have not been well-studied. METHODS: We reviewed all patients who underwent PTE for chronic thromboembolic pulmonary hypertension between 2009 and 2019 at our institution, tracking demographic information including self-identified race, preoperative characteristics and 2-year survival. Socioeconomic status was assessed using the zip code-linked Distressed Communities Index, a validated holistic measure of community well-being. Survival was estimated using Kaplan-Meier method and factors associated with mortality were estimated using Cox regression. RESULTS: Of 235 PTE patients, 101 (42.9%) were white and 87 (37.0%) were black. White patients had a higher median age at surgery (57 vs 51 years, P = 0.035) and a lower degree of economic distress (33.6 vs 61.2 percentile, P < 0.001). Regarding sex, 106 (45.1%) patients were male and 129 (53.6%) were female. Male patients had a higher median age (59 vs 50 years, P = 0.004), greater rates of dyslipidaemia (34% vs 20.2%, P = 0.025), a lower ejection fraction (55% vs 57%, P = 0.046) and longer cross-clamp (77 vs 67.50 min, P = 0.004) and circulatory arrest times (42 vs 37.50 min, P = 0.007). No difference was observed in unadjusted 2-year survival after PTE between patients stratified by race and sex (P = 0.35). After adjustment for clinically relevant variables, neither socioeconomic status, sex nor race were associated with mortality in Cox proportional hazard analysis. CONCLUSIONS: Sex, socioeconomic status and race were not associated with adverse outcomes after PTE in our single-centre experience.

Feasibility and Preliminary Effectiveness of Varenicline for Treating Co-Occurring Cannabis and Tobacco Use.

Few studies have evaluated treatment for co-occurring cannabis and tobacco use. The objective of this pilot study was to evaluate the feasibility and preliminary effectiveness of varenicline for co-occurring cannabis and tobacco use. Participants who reported cannabis use on ≥5 days per week were recruited from an urban, outpatient opioid treatment program (OTP). Participants were randomized to either four weeks of standard OTP clinical care (SCC; medication-assisted treatment for opioid use disorder and individual behavioral counseling), followed by four weeks of SCC plus varenicline (SCC+VT), or to four weeks of SCC+VT followed by four weeks of SCC. All participants contributed feasibility and outcome data during both study phases. Of 193 persons screened, seven were enrolled. Retention at eight weeks was 100%. No adverse effects prompted varenicline discontinuation. Participants reported lower cannabis craving during the SCC+VT phase compared to baseline, and lower frequencies and quantities of cannabis use compared to both baseline and the SCC alone phase. In the SCC+VT phase, participants also reported fewer cigarettes per day. Among persons with co-occurring cannabis and tobacco use, varenicline is well-tolerated and may reduce cannabis craving, cannabis use, and tobacco use.

Skin permeation profile and anti-inflammatory effect of anemonin extracted from weilingxian.

The aim of this study was to evaluate the skin permeability of anemonin, which was extracted from the Chinese herb weilingxian, and its potency of relieving the inflammation caused by rheumatoid arthritis (RA). To optimize the formulation, the solubility of anemonin in water and selected concentration of ethanol-water vehicles was determined. The effect of ethanol on the permeation of anemonin through human skin was then studied. Additionally, the influences of hydroxypropyl methylcellulose E50 (HPMC) and Carbomer 934 in different concentrations on the permeation of drug were investigated. Finally, the anti-inflammatory effect of the optimized formulation was assessed by murine model of xylene-induced ear edema. The results showed that the solubility and transdermal permeation of anemonin in ethanol-water vehicles linearly depended on the ethanol concentration. The combination of 30% ethanol and 3% Azone had a synergistic enhancement effect and was therefore selected for gel preparation. The 0.14% anemonin gel prepared with 1% HPMC exhibited the highest transdermal flux. The xylene-induced ear edema inhibitory rate of the optimized formulation was 48.85%. The results indicated that transdermal administration of anemonin is a potential modality for combating inflammation caused by RA.

The impact of certified diabetes educators on diabetes performance and variation among primary care sites within an integrated health system.

OBJECTIVES: Primary care networks within integrated health systems can experience significant variation in diabetes care. We studied an established, 20-site network to determine the impact of a quality improvement intervention to add certified diabetes educators (CDEs). We sought to measure whether sites with CDEs had higher quality and whether care improved over time more in sites with CDEs, beyond the existing differences among sites. METHODS: Diabetes quality outcomes were (1) HbA1c ≤8%, (2) low-density lipoprotein (LDL) ≤100 mg/dL, (3) microalbumin checked, (4) blood pressure (BP) ≤130/80 mm Hg (tight control), and (5) BP ≤140/90 mm Hg (lenient control). Baseline differences brought us to divide sites into 3 site types by predominant payer and teaching status (commercial/nonteaching, mixed [mostly government-sponsored]/teaching and mixed/nonteaching). We measured the association between CDEs and each outcome using a 2-level mixed effects logistic regression with site type as a random effect. RESULTS: Our analysis included 13 001 patients with visits and labs pre- and post-CDE implementation. Sites with CDEs improved significantly in 2 of 5 outcomes compared with sites without CDEs. Improvements occurred in microalbumin checks (odds ratio = 2.21, P < .001) and BP <140/90 mm Hg (odds ratio = 1.46, P = .03). There was no improvement in the other measures of diabetes quality. Of note, commercial/nonteaching and mixed/teaching sites also improved significantly in these 2 outcomes compared with mixed/nonteaching sites during that time period. CONCLUSIONS: We found that CDEs are associated with significant improvements in some diabetes outcomes. However, heterogeneity among primary care sites in an integrated network persists and all types of sites might not benefit equally from a quality improvement intervention like CDEs.

[Influence of permeation enhancers on transdermal permeation of anemonin].

OBJECTIVE: To investigate the effect of different permeation enhancer on transdermal permeation of anemonin through human skin. METHOD: The permeation experiments were performed using human skin on modified Franz diffusion cells in vitro. The concentrations of anemonin in receptor compartment at specified time points were determined by HPLC. The steady flux and the cumulative quantity of anemonin through skin were calculated. RESULT: The flux of anemonin permeating through human skin from 30% ethanol, 50% ethanol solution and a combination of 3% laurocapm -5% polysorbate 20 and 30% ethanol -3 % laurocapm -5% polysorbate 20 of anemonin was (9.30 +/- 0.32), (18.56+/-0.58), (7.29+/-0.35), (13.77+/-0. 16) microg x cm(-2) x h(-1) and 7.9, 15.9, 6.2, 11.8 times higher than from saturated water solution respectively. CONCLUSION: Ethanol and laurocapm can remarkably improve the transdermal permeation of anemonin and the anemonin have the potential to be developed to new transdermal preparation.