Two-Year Outcomes of Prostatic Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: An International, Multicenter, Prospective Study.

PURPOSE: To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE). MATERIALS AND METHODS: This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics. RESULTS: Four hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p < 0.001); QoL at baseline was 4.7 and decreased to 2.0, 2.1, and 2.3 at 3, 12, and 24 months, respectively (all p < 0.001). The mean SHIM score at baseline and 12 months following PAE was 13.8 and 13.9, respectively. Of the 73 patients treated for AUR, 48 (65.8%) had their indwelling catheter removed within 3 months of PAE and remained catheter free at 24 months. Fifty-five patients (11.5%) experienced ≥ 1 AE and 10 (2.1%) experienced a serious AE. CONCLUSION: PAE is a safe and effective treatment for symptomatic BPH and LUTS. Level of Evidence Level 3 Trial registration ClinicalTrials.gov NCT03527589.

Rapid Determination of Procyanidins Using MALDI-ToF/ToF Mass Spectrometry.

Although procyanidins constitute a unique class of polymeric plant secondary metabolites with a variety of biological properties including potent antioxidant activity, structure determination has been challenging, and structures of many complex procyanidins remain uncertain. To expedite the characterization of procyanidins, negative ion matrix-assisted laser desorption ionization high-energy collision-induced dissociation tandem time-of-flight (MALDI-ToF/ToF) mass spectra of 20 isolated procyanidins containing catechin and epicatechin subunits with degrees of polymerization up to five were obtained and evaluated. Structurally significant fragmentation pathways of singly charged, deprotonated molecules were identified representing quinone methide, heterocyclic ring fission, and retro-Diels-Alder fragmentation. The interpretation of the tandem mass spectra for sequencing A-type, B-type, mixed-type, linear, and branched procyanidins is explained using specific examples of each.

Therapeutic Alternatives in the Management of Late Complications of Surgery for Isolated Coarctation of the Aorta.

Despite initial technical success in the treatment of coarctation of aorta, late recurrence and/or development of aneurysms and pseudoaneurysms frequently prompt reintervention. The authors hereby present such a patient whose management required more than a single intervention to treat his complex anatomy, and they discuss the therapeutic alternatives under similar circumstances.

Procyanidins: a comprehensive review encompassing structure elucidation via mass spectrometry.

Procyanidins are polyphenols abundant in dietary fruits, vegetables, nuts, legumes, and grains with a variety of chemopreventive biological effects. Rapid structure determination of these compounds is needed, notably for the more complex polymeric procyanidins. We review the recent developments in the structure elucidation of procyanidins with a focus on mass spectrometric approaches, especially liquid chromatography-tandem mass spectrometry (LC-MS/MS) and matrix-assisted laser desorption ionization (MALDI) MS/MS.

Role of ammonium in the ionization of phosphatidylcholines during electrospray mass spectrometry.

RATIONALE: Electrospray mass spectrometry methods for the analysis of phosphatidylcholines (PCs) routinely include ammonium acetate or ammonium formate in the mobile phase. In an effort to justify and optimize the use of these additives, we investigated possible functions of ammonium compounds in the ionization of PCs. METHODS: Because PCs contain a quaternary amine, the role of ammonium in neutralizing the negatively charged phosphate group was investigated by using deuterated ammonium acetate, adjusting the pH, varying the organic solvent composition, and by comparing the additives ammonium acetate, ammonium formate and ammonium bicarbonate. Seven PC standards were measured ranging from lyso 1-palmitoyl-sn-glycero-3-phosphocholine to 1,2-dieicosapentaenoyl-sn-glycero-3-phosphocholine as well as a mixture of PCs in a krill oil dietary supplement. RESULTS: Under all conditions tested, aqueous acetonitrile provided more abundant formation of protonated PCs than did aqueous methanol. Regardless of the mobile phase composition and electrospray ion source parameters, no [M + NH4 ]+ ions were detected. Adding deuterated ammonium acetate to the mobile phase failed to form deuterated PCs, indicating that ammonium is not the source of the proton that neutralizes the phosphate negative charge. Instead, water was the source of the proton as deuterated water resulted in the formation of [M + D]+ ions. Addition of organic acids, ammonium formate, ammonium acetate, or ammonium bicarbonate to the mobile phase did not enhance and in most cases suppressed PC ionization. CONCLUSIONS: Ammonium compounds and organic acids can suppress ionization of PCs when using an aqueous acetonitrile mobile phase during electrospray. Copyright © 2016 John Wiley & Sons, Ltd.

Development of a Magnetic Microbead Affinity Selection Screen (MagMASS) Using Mass Spectrometry for Ligands to the Retinoid X Receptor-α.

To overcome limiting factors in mass spectrometry-based screening methods such as automation while still facilitating the screening of complex mixtures such as botanical extracts, magnetic microbead affinity selection screening (MagMASS) was developed. The screening process involves immobilization of a target protein on a magnetic microbead using a variety of possible chemistries, incubation with mixtures of molecules containing possible ligands, a washing step that removes non-bound compounds while a magnetic field retains the beads in the microtiter well, and an organic solvent release step followed by LC-MS analysis. Using retinoid X receptor-α (RXRα) as an example, which is a nuclear receptor and target for anti-inflammation therapy as well as cancer treatment and prevention, a MagMASS assay was developed and compared with an existing screening assay, pulsed ultrafiltration (PUF)-MS. Optimization of MagMASS involved evaluation of multiple protein constructs and several magnetic bead immobilization chemistries. The full-length RXRα construct immobilized with amylose beads provided optimum results. Additional enhancements of MagMASS were the application of 96-well plates to enable automation, use of UHPLC instead of HPLC for faster MS analyses, and application of metabolomics software for faster, automated data analysis. Performance of MagMASS was demonstrated using mixtures of synthetic compounds and known ligands spiked into botanical extracts. Graphical Abstract ᅟ.

Magnetic Microbead Affinity Selection Screening (MagMASS) of Botanical Extracts for Inhibitors of 15-Lipoxygenase.

To expedite the identification of active natural products in complex mixtures such as botanical extracts, a magnetic microbead affinity selection screening (MagMASS) procedure was developed. This technique utilizes target proteins immobilized on magnetic beads for rapid bioaffinity isolation of ligands from complex mixtures. A MagMASS method was developed and validated for 15-lipoxygenase. As a proof of concept, several North American prairie plants used medicinally by Native Americans were extracted with MeOH and screened. A hit from an extract of Proserpinaca palustris, also known as mermaid weed, was flagged for further characterization using high-resolution tandem mass spectrometry, dereplication, and identification using XCMS online. Through the application of high-resolution product ion tandem mass spectrometry, comparison with natural product databases, and confirmation using standards, the hit was identified as quercitrin, which is a known inhibitor of 15-lipoxygenase. The overall workflow of MagMASS is faster and more amendable to automation than alternative methods designed for screening botanical extracts or complex mixtures of combinatorial libraries.

Impact of a 12-week, pharmacist-directed walking program in an established employee preventive care clinic.

PURPOSE: The impact on physical activity and health of a 12-week, pharmacist-directed walking program incorporated into an employee health and wellness clinic was evaluated. METHODS: Clinic participants were eligible for study inclusion if they or their spouse was a current or retired employee of Ohio Northern University. Participants received a pedometer, a calendar with specific daily walking goals for the 12-week period, and maps with walking routes. Participants also met with a pharmacist and a student pharmacist for point-of-care tests measuring lipid and fasting glucose concentrations and blood pressure. Participants reported to weekly pedometer checks where steps were recorded and medications were reassessed by the pharmacist or student pharmacist. As an incentive to meet the walking goals, the participants received a raffle ticket each week their goal had been achieved. After 12 weeks, participants reported for a final appointment when all baseline variables were reassessed by a team of health care professionals. RESULTS: A total of 144 participants were screened at baseline and included in the study, 65 of whom completed the program. At baseline, there were 240 abnormal laboratory test values found in participants with no prior history of dyslipidemia, hyperglycemia, or hypertension. After 12 weeks, significant changes in high-density-lipoprotein (HDL) cholesterol concentrations (p = 0.0012), fasting blood glucose concentrations (p = 0.0017), and blood pressure (p = 0.021) were noted. CONCLUSION: A pharmacist-directed walking program that included clinical assessments, walking goals, and weekly pedometer checks was an effective approach to increase employee activity levels, identify previously unknown health conditions, lower blood glucose concentrations and blood pressure values, and increase HDL cholesterol concentrations.

Heparin-bonded, expanded polytetrafluoroethylene-lined stent graft in the treatment of femoropopliteal artery disease: 1-year results of the VIPER (Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease) trial.

PURPOSE: To evaluate the performance of a heparin-bonded, expanded polytetrafluoroethylene (ePTFE)-lined nitinol endoprosthesis in the treatment of long-segment occlusive disease of the femoropopliteal artery (FPA) and to identify factors associated with loss of patency. MATERIALS AND METHODS: In a single-arm, prospective, 11-center study (VIPER [Gore Viabahn Endoprosthesis with Heparin Bioactive Surface in the Treatment of Superficial Femoral Artery Obstructive Disease] trial), 119 limbs (113 patients; 69 men; mean age, 67 y), including 88 with Rutherford category 3-5 disease and 72 with Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) C or D lesions of the FPA, underwent stent graft implantation. The mean lesion length was 19 cm; 56% of lesions were occlusions. Follow-up evaluations included color duplex ultrasonography in all patients, with patency defined as a peak systolic velocity ratio< 2.5. RESULTS: At 12 months, Rutherford category and ankle-brachial index (ABI) were significantly improved (mean category improvement, 2.4; ABI increased from 0.6±0.2 to 0.9±0.19; P<.0001). Primary and secondary patency rates were 73% and 92%. The primary patency for devices oversized<20% at the proximal landing zone was 88%, whereas the primary patency for devices oversized by>20% was 70% (P = .047). Primary patency was not significantly affected by device diameter (5 vs 6 vs 7 mm) or lesion length (≤20 cm vs>20 cm). The 30-day major adverse event rate was 0.8%. CONCLUSIONS: The heparin-bonded, ePTFE/nitinol stent graft provided clinical improvement and a primary patency rate of 73% at 1 year in the treatment of long-segment FPA disease. Careful sizing of the device relative to vessel landing zones is essential for achieving optimal outcomes.

Design and implementation of a pharmacist-directed preventive care program.

PURPOSE: The design and implementation of pharmacist-directed preventive care services within a university-based, employee health and wellness clinic are described. SUMMARY: Ohio Northern University (ONU) HealthWise is a multidisciplinary employee health and wellness clinic located on the campus of ONU that offers medication therapy management, disease management, nutrition counseling, and physical wellness coaching services. A pharmacist-directed preventive care program based on recommendations from the U.S. Preventive Services Task Force (USPSTF) was designed for incorporation into the clinic. Using an electronic search tool provided by USPSTF, pharmacists are able to provide a review of recommended preventive services that are appropriate for each individual patient. Whenever possible, pharmacists within the clinic perform the screenings and other interventions that are recommended by USP-STF; when necessary, patients are referred to other health care providers to receive recommended interventions. To date, nine patients have participated in the preventive care program. For these nine patients 112 recommendations have been reviewed by pharmacists in the clinic. Of these, 16 were found to be inappropriate after further discussion with the patients and 36 were verified as already completed by the patient, resulting in a total of 60 unmet recommendations. Of these 60, 52 recommendations were met through interventions by the pharmacist in the clinic, while 5 possible screenings were declined by patients and 3 unmet recommendations required referral to a provider outside of the clinic. CONCLUSION: A pharmacist-directed preventive care service offered within an employee health clinic helped ensure that employees receive appropriate screenings and preventive care according to current guidelines.

Employee attitudes toward participation in a work site-based health and wellness clinic.

PURPOSE: To conduct a needs assessment to determine employee attitudes and barriers toward participation in a multidisciplinary work site-based health and wellness clinic. METHODS: A 21-question survey was developed and sent electronically to all available (n = 874) employees of a self-insured employer. RESULTS: Of the 303 survey respondents (34.7% response rate), 67.3% (n = 204) individuals indicated a desire to meet with a pharmacist regarding medication information. Medication therapy management (MTM) services most often selected by survey respondents included basic education about each medication and its intended purpose (33%, n = 100); education on self-care (30%, n = 91); and information on generic or less expensive alternative medications and strategies for cost savings (25.1%, n = 76). Eighty-eight (29%) respondents indicated a desire for preventive care counseling to receive guidance on recommended disease screenings, immunizations, and other recommended services. Additional interest was observed in nutrition coaching (n = 131, 43.2%) and exercise programming (n = 272, 89.4%). CONCLUSIONS: The majority of respondents indicated a desire to participate in a work site-based health and wellness clinic, regardless of baseline health status or medication use. These data provide insight into the needs and preferences of participants in work site wellness programs and shows the value of a needs assessment.

An evaluation of ureteral flow after doppler-guided uterine artery occlusion device placement during organ-preserving gynecologic procedures.

We studied the use of color Doppler ultrasonography for ureteral patency after placement of a transvaginal Doppler-guided uterine artery occlusion device before organ-preserving surgery for leiomyomata uteri. Our case series involved 7 patients in whom ureteral flow was assessed using color Doppler sonography before and after placement of a Doppler-guided uterine artery occlusion device. Bilateral ureteral flow was assessed at the trigone using a grading system. Furosemide and additional intravenous hydration were administered if no flow was observed. Color Doppler ultrasonography can quantify ureteral flow before and after Doppler-guided uterine artery occlusion device placement during organ-preserving gynecologic procedures, facilitating safe placement and repositioning of the transvaginal device when necessary.