Veteran Affairs Medical Center

Durham, NC, United States

Veteran Affairs Medical Center

Durham, NC, United States
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Santos F.L.,Centro Hospitalar Vila Nova Gaia Espinho | Esteves S.S.,Centro Hospitalar do Porto | da Costa Pereira A.,University of Porto | Yancy Jr W.S.,Veteran Affairs Medical Center | And 2 more authors.
Obesity Reviews | Year: 2012

A systematic review and meta-analysis were carried out to study the effects of low-carbohydrate diet (LCD) on weight loss and cardiovascular risk factors (search performed on PubMed, Cochrane Central Register of Controlled Trials and Scopus databases). A total of 23 reports, corresponding to 17 clinical investigations, were identified as meeting the pre-specified criteria. Meta-analysis carried out on data obtained in 1,141 obese patients, showed the LCD to be associated with significant decreases in body weight (-7.04kg [95% CI -7.20/-6.88]), body mass index (-2.09kgm-2[95% CI -2.15/-2.04]), abdominal circumference (-5.74cm [95% CI -6.07/-5.41]), systolic blood pressure (-4.81mmHg [95% CI -5.33/-4.29]), diastolic blood pressure (-3.10mmHg [95% CI -3.45/-2.74]), plasma triglycerides (-29.71mgdL-1[95% CI -31.99/-27.44]), fasting plasma glucose (-1.05mgdL-1[95% CI -1.67/-0.44]), glycated haemoglobin (-0.21% [95% CI -0.24/-0.18]), plasma insulin (-2.24 micro IUmL-1[95% CI -2.65/-1.82]) and plasma C-reactive protein, as well as an increase in high-density lipoprotein cholesterol (1.73mgdL-1[95%CI 1.44/2.01]). Low-density lipoprotein cholesterol and creatinine did not change significantly, whereas limited data exist concerning plasma uric acid. LCD was shown to have favourable effects on body weight and major cardiovascular risk factors; however the effects on long-term health are unknown. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.

Kallini J.R.,Eisenhower Medical Center | Kallini J.R.,Baylor College of Medicine | Hamed N.,Alexandria University | Khachemoune A.,New York University | Khachemoune A.,Veteran Affairs Medical Center
International Journal of Dermatology | Year: 2015

Squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer. It originates from epidermal keratinocytes or adnexal structures (such as eccrine glands or pilosebaceous units). We describe the salient features of cutaneous SCC. We also review novel classification schemes proposed during the last decade which attempt to stratify SCC lesions based on prognosis. Biopsy leads to definitive diagnosis. Treatment includes surgical excision; Mohs micrographic surgery produces excellent cure rates and spares the maximal amount of tissue. Other modalities include electrodessication and curettage, cryosurgery, radiotherapy, topical medications, photodynamic therapy, and systemic therapy. Management and follow-up depend on the risk stratification of individual lesions. © 2014 The International Society of Dermatology.

Robinson E.S.,Veteran Affairs Medical Center | Robinson E.S.,University of Pennsylvania | Werth V.P.,Veteran Affairs Medical Center | Werth V.P.,University of Pennsylvania
Cytokine | Year: 2015

Cutaneous lupus erythematosus (CLE) is an inflammatory disease with a broad range of cutaneous manifestations that may be accompanied by systemic symptoms. The pathogenesis of CLE is complex, multifactorial and incompletely defined. Below we review the current understanding of the cytokines involved in these processes. Ultraviolet (UV) light plays a central role in the pathogenesis of CLE, triggering keratinocyte apoptosis, transport of nucleoprotein autoantigens to the keratinocyte cell surface and the release of inflammatory cytokines (including interferons (IFNs), tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, IL-8, IL-10 and IL-17). Increased IFN, particularly type I IFN, is central to the development of CLE lesions. In CLE, type I IFN is produced in response to nuclear antigens, immune complexes and UV light. Type I IFN increases leukocyte recruitment to the skin via inflammatory cytokines, chemokines, and adhesion molecules, thereby inducing a cycle of cutaneous inflammation. Increased TNFα in CLE may also cause inflammation. However, decreasing TNFα with an anti-TNFα agent can induce CLE-like lesions. TNFα regulates B cells, increases the production of inflammatory molecules and inhibits the production of IFN-α. An increase in the inflammatory cytokines IL-1, IL-6, IL-10, IL-17 and IL-18 and a decrease in the anti-inflammatory cytokine IL-12 also act to amplify inflammation in CLE. Specific gene mutations may increase the levels of these inflammatory cytokines in some CLE patients. New drugs targeting various aspects of these cytokine pathways are being developed to treat CLE and systemic lupus erythematosus (SLE).

Alix J.J.P.,University of Leicester | Alix J.J.P.,University of Sheffield | Zammit C.,University of Malta | Riddle A.,Oregon Health And Science University | And 4 more authors.
Annals of Neurology | Year: 2012

Objective: Developing central white matter is subject to ischemic-type injury during the period that precedes myelination. At this stage in maturation, central axons initiate a program of radial expansion and ion channel redistribution. Here we test the hypothesis that during radial expansion axons display heightened ischemic sensitivity, when clusters of Ca2+ channels decorate future node of Ranvier sites. Methods: Functionality and morphology of central axons and glia were examined during and after a period of modeled ischemia. Pathological changes in axons undergoing radial expansion were probed using electrophysiological, quantitative ultrastructural, and morphometric analysis in neonatal rodent optic nerve and periventricular white matter axons studied under modeled ischemia in vitro or after hypoxia-ischemia in vivo. Results: Acute ischemic injury of central axons undergoing initial radial expansion was mediated by Ca2+ influx through Ca2+ channels expressed in axolemma clusters. This form of injury operated only in this axon population, which was more sensitive to injury than neighboring myelinated axons, smaller axons yet to initiate radial expansion, astrocytes, or oligodendroglia. A pharmacological strategy designed to protect both small and large diameter premyelinated axons proved 100% protective against acute ischemia studied under modeled ischemia in vitro or after hypoxia-ischemia in vivo. Interpretation: Recent clinical data highlight the importance of axon pathology in developing white matter injury. The elevated susceptibility of early maturing axons to ischemic injury described here may significantly contribute to selective white matter pathology and places these axons alongside preoligodendrocytes as a potential primary target of both injury and therapeutics. Copyright © 2012 American Neurological Association.

Jain G.,University of Alabama at Birmingham | Jaimes E.A.,University of Alabama at Birmingham | Jaimes E.A.,Veteran Affairs Medical Center
Biochemical Pharmacology | Year: 2013

The deleterious health effects of cigarette smoking are far reaching, and it remains the most important modifiable risk factor for improving overallmorbidity and mortality. In addition to being a risk factor for cancer, cardiovascular disease and lung disease, there is strong evidence, both from human and animal studies, demonstrating a role for cigarette smoking in the progression of chronic kidney disease (CKD). Clinical studies have shown a strong correlation between cigarette smoking and worsening CKD in patients with diabetes, hypertension, polycystic kidney disease, and post kidney transplant. Nicotine, in addition to its role in the addictive properties of cigarette smoking, has other biological effects via activation of non-neuronal nicotinic acetylcholine receptors (nAChRs). Several nAChR subunits are expressed in the normal kidney and blockade of the α7-nAChR subunit ameliorates the effects of nicotine in animal models of CKD. Nicotine increases the severity of renal injury in animal models including acute kidney injury, diabetes, acute nephritis and subtotal nephrectomy. The renal effects of nicotine are also linked to increased generation of reactive oxygen species and activation of pro-fibrotic pathways. In humans, nicotine induces transitory increases in blood pressure accompanied by reductions in glomerular filtration rate and effective renal plasma flow. In summary, clinical and experimental evidence indicate that nicotine is at least in part responsible for the deleterious effects of cigarette smoking in the progression of CKD. The mechanisms involved are the subject of active investigation and may result in novel strategies to ameliorate the effects of cigarette smoking in CKD. © 2013 Elsevier Inc. All rights reserved.

Cortez K.J.,Veteran Affairs Medical Center | Kottilil S.,U.S. National Institutes of Health
Therapeutic Advances in Chronic Disease | Year: 2015

Hepatitis C virus (HCV) infection results in a chronic carrier state in 80% of individuals infected with the virus and presently affects over 170 million people worldwide. Approximately 20% of those chronically infected will ultimately progress to develop cirrhosis and death due to end-stage liver disease or hepatocellular carcinoma (HCC). Unlike many other chronic viral infections, effective treatments for HCV are available. Cure from the infection is known as a sustained virologic response (SVR). SVR is associated with reversal of the long-term outcomes of chronic liver disease, decrease in incidence of HCC, and decrease HCV attributable mortality. The current FDA approved therapies for hepatitis C virus genotype 1 (GT-1) include pegylated interferon (PEG-IFN) and ribavirin (RBV) in combination with a directly acting antiviral agent (DAA). New therapeutic advances are being made aiming to simplify management, improve the tolerability of treatment, and shorten the duration of therapy. Moreover, treatment regimens that will effectively eradicate hepatitis C without the use of interferon formulations (IFN) are being developed. In this review, we report the transition of HCV therapeutics from an interferon-α based combination therapy to an all-oral, directly acting antiviral therapy. © The Author(s), 2014.

Liu J.,Georgia Institute of Technology | Lau S.K.,Veteran Affairs Medical Center | Varma V.A.,Veteran Affairs Medical Center | Kairdolf B.A.,Georgia Institute of Technology | Nie S.,Georgia Institute of Technology
Analytical Chemistry | Year: 2010

The multicolor and multiplexing capabilities of semiconductor quantum dots (QDs) are most promising for improving the sensitivity and specificity of in vitro molecular and cellular diagnostics. Here, we report the use of multiplexed QDs and wavelength-resolved imaging to detect and characterize a class of low-abundant tumor cells in Hodgkin's lymphoma. Known as the Hodgkin's and Reed-Sternberg (HRS) cells, this class of malignant cells is a pathological hallmark in clinical diagnosis, but it comprises only about 1% of the heterogeneous infiltrating cells in lymph node tissues. To overcome this cellular heterogeneity and rarity problem, we have developed multicolor QD-antibody conjugates to simultaneously detect a panel of four protein biomarkers (CD15, CD30, CD45, and Pax5) directly on human tissue biopsies. This multiplexing approach allows rapid detection and differentiation of rare HRS cells from infiltrating immune cells such as T and B lymphocytes. We have also carried out clinical translation studies involving six confirmed Hodgkin's lymphoma patients, two suspicious lymphoma cases, and two patients with reactive lymph nodes (but not lymphoma). The results indicate that a distinct QD staining pattern (CD15 positive, CD30 positive, CD45 negative, and Pax5 positive) can be used to not only detect Hodgkin's lymphoma but also differentiate it from benign lymphoid hyperplasia. © 2010 American Chemical Society.

News Article | November 28, 2016

MINNEAPOLIS, MN--(Marketwired - November 28, 2016) - The US Department of Veteran Affairs Medical Center (MVAHCS) in Minneapolis released on Monday, November 28 a presolicitation notice for contractual services to provide their medical expertise and services for a 2.0 FTE Audiology Technicians. The contractor shall provide two Audiology Technicians to provide full-time, 80 hours every two-weeks, on-site services. The NAICS code assigned to this procurement will be 621340 with a size standard of $7.5 million. The VA will award a firm, fixed-price, commercial services contract. Contract use will be limited to Minneapolis VA Health Care System only. Interested contractors must be able to accept a 6-month base year contract, and the MVAHCS also retains the right to renew the contract for an additional 6-month period. Service is slated to begin December 12, 2016 and end on May 11, 2017 for the base year. Proposals must be emailed to Contract Specialist Steven Yale at To receive the contract, contractors must be registered with the System for Award Management (SAM) database, and have as part of the Registration all current Representations and Certifications. US Federal Contractor Registration, the world's largest third-party government registration firm, completes the required Registrations on behalf of its clients. It also makes available information about opportunities like this, as well as training on how to locate, research, and respond to opportunities. For more information, to get started with a SAM registration, or to learn more about how US Federal Contractor Registration can help your business succeed, call 877-252-2700, ext. 1.

Florek A.G.,Northwestern University | Dellavalle R.P.,Veteran Affairs Medical Center
Journal of Medical Case Reports | Year: 2016

A case report is a detailed narrative that usually illustrates a diagnostic or therapeutic problem experienced by one or several patients. Case reports commonly serve as the first line of evidence for new interventions or they function as alarms that an issue exists with an already established therapy. Case reports are of minor importance in evidence-based medicine; however, they make meaningful contributions to both the knowledge and education of medical students, residents, and fellows. Case reports are written with the goal of sharing information for medical, scientific, or educational purposes. They often serve as medical or even undergraduate students' first experience with medical writing and they provide a solid foundation for manuscript preparation and publication. In the last few decades, there has been an exponential increase in medical student research, specifically in the number of manuscripts published by medical students. It is important to foster this academic spirit among students by encouraging them to become involved in research. This editorial will focus on the value and educational benefits of writing case reports for medical students, university students, residents, and fellows. © 2016 Florek and Dellavalle.

A 57-year-old Caucasian man with a history of Child's class A hepatitis C, cirrhosis and progressive multifocal hepatocellular carcinoma was treated with sorafenib but progressed after 7 months of stable disease. At progression he was given salvage chemotherapy consisting of 5-fluorouracil and leucovorin and went into complete radiographic remission after 12 cycles of treatment. He did develop a portal vein thrombosis but nevertheless his hepatic lesions continued to resolve. Throughout his therapy α-fetoprotein (AFP) levels decreased only minimally. He did not seek retreatment after 14 cycles of chemotherapy and presented 3 months later with relapsed disease on CT scans with markedly elevated AFP levels. He received one more chemotherapy cycle but was unable to tolerate further treatment, succumbing to his disease 3 months thereafter, and a total of 29 months after he was deemed a sorafenib failure. Copyright 2013 BMJ Publishing Group. All rights reserved.

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