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Search Results: 1 - 10 of 3931 matches for " Amy Barton Pai "
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Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status
Natsuki Kubotera,Alexander J. Prokopienko,Adinoyi O. Garba,Amy Barton Pai
International Journal of Nephrology , 2013, DOI: 10.1155/2013/954956
Abstract:
Endotoxin Binding by Sevelamer: Potential Impact on Nutritional Status
Natsuki Kubotera,Alexander J. Prokopienko,Adinoyi O. Garba,Amy Barton Pai
International Journal of Nephrology , 2013, DOI: 10.1155/2013/954956
Abstract: Patients on hemodialysis (HD) have a high burden of chronic inflammation induced associated with multiple comorbidities including poor nutritional status. Endotoxin (ET) is a Gram-negative bacterial cell wall component and a potent stimulus for innate immune system activation leading to the transcription of proinflammatory cytokines (e.g., IL-1, IL-6, and TNFα) that adversely affect protein metabolism and nutrition. Several cross-sectional observational studies have found that elevated serum ET concentrations in hemodialysis patients are associated with lower serum albumin, higher proinflammatory cytokine, and C-reactive protein concentrations. Possible sources of ET in the systemic circulation are bacterial translocation from the gastrointestinal tract and iron supplementation, potentially leading to intestinal bacterial overgrowth. Sevelamer is a nonabsorbable hydrogel approved for use as a phosphate binder in HD patients. Reductions in serum ET concentrations in hemodialysis patients have been observed with sevelamer therapy in observational studies and the few published interventional studies. Reduction of ET concentrations was associated with concomitant reductions in TNFα, IL-6, and CRP and improvement in serum albumin in the majority of these small studies. Additional studies are needed to evaluate the potential effects of sevelamer treatment on nutritional status in chronic kidney disease (CKD) patients with elevated ET. 1. Introduction Proinflammatory cytokines such as IL-1, IL-6, and TNF- and the anti-inflammatory cytokine IL-10 are elevated in hemodialysis (HD) patients [1]. Several factors are linked with the Proinflammatory state in end-stage renal disease (ESRD) patients on dialysis including nutritional status, diabetes, hypertension, sepsis, and biocompatibility with dialysis membranes [1]. Poor nutritional status is a vexing clinical problem that occurs in up to 50% of ESRD patients on hemodialysis and is associated with increased mortality [2]. Documented appetite loss in ESRD patients is associated with higher mortality rates [3]. Albumin is a negative acute phase reactant, and low serum albumin concentrations are associated with elevated markers of inflammation including IL-6, CRP, and TNF- [4–6]. ESRD patients on HD exhibit increased protein catabolism profiles and greater skeletal muscle breakdown that is correlated with reduced serum albumin concentrations [5, 7, 8]. This loss of lean body mass in concert with chronic inflammation has been identified as a major risk factor for cardiac heart failure in ESRD patients [9, 10].
Lipoteichoic Acid from Staphylococcus aureus Induces Lung Endothelial Cell Barrier Dysfunction: Role of Reactive Oxygen and Nitrogen Species
Amy Barton Pai, Heena Patel, Alexander J. Prokopienko, Hiba Alsaffar, Nancy Gertzberg, Paul Neumann, Anjoli Punjabi, Arnold Johnson
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0049209
Abstract: Tunneled central venous catheters (TCVCs) are used for dialysis access in 82% of new hemodialysis patients and are rapidly colonized with Gram-positive organism (e.g. Staphylococcus aureus) biofilm, a source of recurrent infections and chronic inflammation. Lipoteichoic acid (LTA), a cell wall ribitol polymer from Gram-positive organisms, mediates inflammation through the Toll-like receptor 2 (TLR2). The effect of LTA on lung endothelial permeability is not known. We tested the hypothesis that LTA from Staphylococcus aureus induces alterations in the permeability of pulmonary microvessel endothelial monolayers (PMEM) that result from activation of TLR2 and are mediated by reactive oxygen/nitrogen species (RONS). The permeability of PMEM was assessed by the clearance rate of Evans blue-labeled albumin, the activation of the TLR2 pathway was assessed by Western blot, and the generation of RONS was measured by the fluorescence of oxidized dihydroethidium and a dichlorofluorescein derivative. Treatment with LTA or the TLR2 agonist Pam(3)CSK(4) induced significant increases in albumin permeability, IκBα phosphorylation, IRAK1 degradation, RONS generation, and endothelial nitric oxide synthase (eNOS) activation (as measured by the p-eNOSser1177:p-eNOSthr495 ratio). The effects on permeability and RONS were effectively prevented by co-administration of the superoxide scavenger Tiron, the peroxynitrite scavenger Urate, or the eNOS inhibitor L-NAME and these effects as well as eNOS activation were reduced or prevented by pretreatment with an IRAK1/4 inhibitor. The results indicate that the activation of TLR2 and the generation of ROS/RNS mediates LTA-induced barrier dysfunction in PMEM.
The regulation of mobile health applications
Amy J Barton
BMC Medicine , 2012, DOI: 10.1186/1741-7015-10-46
Abstract: Mobile health, or more commonly, mHealth, is 'the use of wireless communication devices to support public health and clinical practice' [1]. Mobile devices are handheld in nature and include mobile phones, personal digital assistants, patient monitoring devices, and other wireless devices. mHealth applications are receiving increased attention largely due to the global penetration of mobile technologies. It is estimated that over 85% of the world's population is now covered by a commercial wireless signal, with over 5 billion mobile phone subscriptions [2]. The availability of mobile technology has advanced infrastructure development in low- and middle-income countries beyond roads and electricity [2]. Mobile medical applications range from communication between individuals and health systems (such as call centers, appointment reminders, treatment compliance) to health monitoring and surveillance (including surveys, patient monitoring devices), and access to information at the point of care (health records, decision support).The Royal Tropical Institute [3] defined eight mHealth application areas. Education and awareness systems are those that provide information about health promotion and disease prevention. Point-of-care support and diagnostics are used to provide the clinician with reference information for clinical care as well as decision support for diagnostics. Patient monitoring provides patients with support for treatment adherence. Disease and epidemic outbreak surveillance provides real-time tracking of infectious diseases. Emergency medical response systems provide alerts for accidents and disasters. Health information systems manage data used in clinical care. mLearning provides mobile platforms for educational support for health professionals. Finally, health financing applications are those that facilitate the use of smart cards or vouchers for mobile payments. The purpose of this article is to explain the context for regulation, identify implications
Ferumoxytol: a silver lining in the treatment of anemia of chronic kidney disease or another dark cloud?
Barton Pai A, Garba AO
Journal of Blood Medicine , 2012, DOI: http://dx.doi.org/10.2147/JBM.S29204
Abstract: umoxytol: a silver lining in the treatment of anemia of chronic kidney disease or another dark cloud? Review (1328) Total Article Views Authors: Barton Pai A, Garba AO Published Date August 2012 Volume 2012:3 Pages 77 - 85 DOI: http://dx.doi.org/10.2147/JBM.S29204 Received: 18 July 2012 Accepted: 09 August 2012 Published: 29 August 2012 Amy Barton Pai, Adinoyi O Garba Albany College of Pharmacy and Health Sciences, Albany, New York, NY, USA Abstract: Intravenous iron therapy is pivotal in the treatment of anemia of chronic kidney disease to optimize the response of hemoglobin to erythropoiesis-stimulating agents. Intravenous iron use in patients with chronic kidney disease is on the rise. Recent clinical trial data prompting safety concerns regarding the use of erythropoiesis-stimulating agents has stimulated new US Food and Drug Administration label changes and restrictions for these agents, and has encouraged more aggressive use of intravenous iron. The currently available intravenous iron products differ with regard to the stability of the iron-carbohydrate complex and potential to induce hypersensitivity reactions. Ferumoxytol is a newer large molecular weight intravenous iron formulation that is a colloidal iron oxide nanoparticle suspension coated with polyglucose sorbitol carboxymethyl ether. Ferumoxytol has robust iron-carbohydrate complex stability with minimal dissociation or appearance of free iron in the serum, allowing the drug to be given in relatively large doses with a rapid rate of administration. Clinical trials have demonstrated the superior efficacy of ferumoxytol versus oral iron with minimal adverse effects. However, recent postmarketing data have demonstrated a risk of hypersensitivity that has prompted new changes to the product information mandated by the Food and Drug Administration. Additionally, the long-term safety of this agent has not been evaluated, and its place in the treatment of anemia of chronic kidney disease has not been fully elucidated.
Ferumoxytol: a silver lining in the treatment of anemia of chronic kidney disease or another dark cloud?
Barton Pai A,Garba AO
Journal of Blood Medicine , 2012,
Abstract: Amy Barton Pai, Adinoyi O GarbaAlbany College of Pharmacy and Health Sciences, Albany, New York, NY, USAAbstract: Intravenous iron therapy is pivotal in the treatment of anemia of chronic kidney disease to optimize the response of hemoglobin to erythropoiesis-stimulating agents. Intravenous iron use in patients with chronic kidney disease is on the rise. Recent clinical trial data prompting safety concerns regarding the use of erythropoiesis-stimulating agents has stimulated new US Food and Drug Administration label changes and restrictions for these agents, and has encouraged more aggressive use of intravenous iron. The currently available intravenous iron products differ with regard to the stability of the iron-carbohydrate complex and potential to induce hypersensitivity reactions. Ferumoxytol is a newer large molecular weight intravenous iron formulation that is a colloidal iron oxide nanoparticle suspension coated with polyglucose sorbitol carboxymethyl ether. Ferumoxytol has robust iron-carbohydrate complex stability with minimal dissociation or appearance of free iron in the serum, allowing the drug to be given in relatively large doses with a rapid rate of administration. Clinical trials have demonstrated the superior efficacy of ferumoxytol versus oral iron with minimal adverse effects. However, recent postmarketing data have demonstrated a risk of hypersensitivity that has prompted new changes to the product information mandated by the Food and Drug Administration. Additionally, the long-term safety of this agent has not been evaluated, and its place in the treatment of anemia of chronic kidney disease has not been fully elucidated.Keywords: iron, ferumoxytol, oxidative stress, safety, kidney disease
Adapting Your Teaching to Accommodate the Net Generation of Learners
Diane J. Skiba,Amy J. Barton
Online Journal of Issues in Nursing , 2006,
Abstract: Educators are faced with the challenge of adapting their teaching styles to accommodate a new generation of learners. The Net Generation or Millennials, who are now entering colleges and universities, have learning expectations, styles, and needs different from past students. This article assists educators in teaching the Net Generation by highlighting the characteristics of the Net Generation and providing examples of how to adapt teaching strategies to accommodate the Net Generation, in light of their preferences for digital literacy, experiential learning, interactivity, and immediacy.
Ancestry reported by white adults with cutaneous melanoma and control subjects in central Alabama
Ronald T Acton, Ellen H Barton, William W Hollowell, Amy L Dreibelbis, Rodney CP Go, James C Barton
BMC Cancer , 2004, DOI: 10.1186/1471-2407-4-47
Abstract: Frequencies of country of ancestry reports were tabulated. The reports were also converted to scores that reflect proportional countries of ancestry in individuals. Using the scores, we computed aggregate country of ancestry indices as estimates of group ancestry composition. HLA-DRB1*04 allele frequencies and relationships to countries of ancestry were compared in probands and controls. Results were compared to those of European populations with HLA-DRB1*04 frequencies.Ninety evaluable adult white cutaneous melanoma probands and 324 adult white controls reported countries of ancestry of their grandparents. The respective frequencies of Ireland, and Scotland and "British Isles" reported countries of ancestry were significantly greater in probands than in controls. The respective frequencies of Wales, France, Italy and Poland were significantly greater in controls. 16.7% of melanoma probands and 23.8% of controls reported "Native American" ancestry; the corresponding "Native American" country of ancestry index was not significantly different in probands and controls. The frequency of HLA-DRB1*04 was significantly greater in probands, but was not significantly associated with individual or aggregate countries of ancestry. The frequency of DRB1*04 observed in Alabama was compared to DRB1*04 frequencies reported from England, Wales, Ireland, Orkney Island, France, Germany, and Australia.White adults with cutaneous melanoma in central Alabama have a predominance of Irish, Scots, and "British Isles" ancestry and HLA-DRB1*04 that likely contributes to their high incidence of cutaneous melanoma.The incidence of cutaneous melanoma in Alabama is high (16.9 and 8.6 per 100,000 men and women, respectively, in 1998) [1]. The average annual incidence rate in Alabama during 1996 was 15.5 per 100,000 for men and 8.8 per 100,000 for women, indicating that the incidence in men is increasing. This is consistent with reports that cutaneous melanoma is one of few cancers the incidence a
Effect of different intravenous iron preparations on lymphocyte intracellular reactive oxygen species generation and subpopulation survival
Ajay Gupta, Jiaying Zhuo, Junli Zha, Srinivasa Reddy, Jonathan Olp, Amy Pai
BMC Nephrology , 2010, DOI: 10.1186/1471-2369-11-16
Abstract: Peripheral blood mononuclear cells (PBMC) were isolated from healthy donor buffy coat. PBMC were cultured and incubated with 100 μg/mL of sodium ferric gluconate (SFG), iron sucrose (IS) or iron dextran (ID) for 24 hours. Cells were then probed for reactive oxygen species (ROS) with dichlorofluorescein-diacetate. In separate studies, isolated PBMCs were incubated with the 25, 50 or 100 μg/mL iron concentrations for 72 hours and then stained with fluorescein conjugated monoclonal antibodies for lymphocyte subpopulation identification. Untreated PBMCs at 24 hours and 72 hours served as controls for each experiment.All three IV iron preparations induced time dependent increases in intracellular ROS with SFG and IS having a greater maximal effect than ID. The CD4+ lymphocytes were most affected by IV iron exposure, with statistically significant reduction in survival after incubation with all three doses (10, 25 and 100 μg/mL) of SFG, IS and ID.These data indicate IV iron products induce differential deleterious effects on CD4+ and CD16+ human lymphocytes cell populations that may be mediated by intracellular reactive oxygen species generation. Further studies are warranted to determine the potential clinical relevance of these findings.Infection is the second leading cause of mortality among hemodialysis (HD) patients. Infections in HD patients are also associated with increased cardiovascular mortality, which may be related to immune system dysfunction resulting in recurrent infections that contribute to chronic inflammation and accelerated atherosclerosis [1]. Cellular dysfunction of both innate (e.g. T cells and macrophages) and adaptive (e.g. B cells) immunity is well described in patients with chronic kidney disease (CKD) and may be attributable to many factors including accumulated uremic toxin burden, bio-incompatible dialysis membranes, anemia, malnutrition and altered iron metabolism [1,2].Transfusional iron overload has long been linked with immune dysfunctio
Dissecting the Within-Africa Ancestry of Populations of African Descent in the Americas
Klara Stefflova,Matthew C. Dulik,Jill S. Barnholtz-Sloan,Athma A. Pai,Amy H. Walker,Timothy R. Rebbeck
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014495
Abstract: The ancestry of African-descended Americans is known to be drawn from three distinct populations: African, European, and Native American. While many studies consider this continental admixture, few account for the genetically distinct sources of ancestry within Africa – the continent with the highest genetic variation. Here, we dissect the within-Africa genetic ancestry of various populations of the Americas self-identified as having primarily African ancestry using uniparentally inherited mitochondrial DNA.
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