Consulting Program by and for Older Detroiters.

This article profiles a program in Detroit, MI, funded by the National Institute on Aging, called the Michigan Center for African American Aging Research and its key offshoot the Healthier Black Elders Center (HBEC). Board members of its Community Advisory Board weigh in on key programming and offer perspectives and recommendations on health and social issues. The HBEC Consulting Program is a blend of formal volunteering and paid work through consulting fees. The article also outlines next steps for HBEC.

African American health disparities in lung cancer.

Lung cancer is a leading cause of cancer-related deaths in the United States and globally. African Americans experience significant differences in lung cancer incidence and mortality. Smoking is the single greatest risk for lung cancer, making smoking cessation programs a potentially fruitful approach for reducing the risk of lung cancer. Despite clinical practice guidelines that prompt nurses to advise patients to quit smoking, only a small percentage of nurses do so. Minority patients are less likely than Whites to receive smoking cessation advice. This article discusses recent findings on the pathophysiology and risks for lung cancer. The literature on smoking cessation research is examined to determine the features of successful cessation interventions. Recommendations are offered for enhancing tobacco cessation efforts in nursing practice, education, and research.

Hyperlipidemia-associated pancreatitis in pregnancy managed with fenofibrate.

BACKGROUND: Pancreatitis is a concerning clinical event during pregnancy, with high morbidity and mortality rates for mother and fetus. Hypertriglyceridemia is considered a rare cause of pancreatitis in pregnancy, with the majority of reported cases being associated with the lipid metabolism disorders. CASE: We report on a case of hypertriglyceridemia-induced pancreatitis in a woman presenting at 32 weeks of gestational age. Her dyslipidemia was not controlled with diet alone, necessitating medical intervention. Fenofibrate was used successfully. Recurrence of pancreatitis during the pregnancy was avoided, and a healthy neonate was delivered at 35 weeks of gestation. CONCLUSION: Fenofibrate was used safely and successfully during pregnancy in this case of hypertriglyceridemia-associated pancreatitis refractory to conservative measures.

Clinical course of symptomatic spontaneous pneumothorax in term and late preterm newborns: report from a large cohort.

The purpose of this observational study was to characterize the clinical course of newborn infants with spontaneous pneumothorax and to identify those infants who eventually required further interventions. We performed a retrospective review of newborns with symptomatic spontaneous pneumothorax, born between January 2002 and December 2007. Seventy-six infants ≥36 weeks' gestation were identified with symptomatic spontaneous pneumothorax. Twenty-two (29%) of the 76 infants with spontaneous pneumothorax required either thoracentesis or/and thoracostomy drainage, and 54 (71%) were managed without such intervention. In all, 18 (24%) infants received mechanical ventilation and 12 (16%) infants developed persistent pulmonary hypertension (PPHN) during the course of illness. Ten of the 22 infants requiring thoracentesis and/or thoracostomy for progressively worsening respiratory distress developed PPHN. Seven of these 10 infants with PPHN received inhaled nitric oxide, and four infants subsequently required extracorporeal membrane oxygenation. In contrast, the majority of the infants (50 of 54, 93%) not requiring thoracentesis or/and thoracostomy could be managed simply with supplemental oxygen or close observation. Progressively worsening respiratory distress prompting intervention in infants with spontaneous pneumothorax may indicate presence of PPHN that needs prompt recognition and referral to tertiary-level neonatal units for escalating respiratory support.

Recombinase mediated cassette exchange into genomic targets using an adenovirus vector.

Recombinase mediated cassette exchange (RMCE) is a process in which site-specific recombinases exchange one gene cassette flanked by a pair of incompatible target sites for another cassette flanked by an identical pair of sites. Typically one cassette is present in the host genome, whereas the other gene cassette is introduced into the host cell by chemical or biological means. We show here that the frequency of cassette exchange is dependent on the relative and absolute quantities of the transgene cassette and the recombinase. We were able to successfully modify genomic targets not only by electroporation or chemically mediated gene transfer but also by using an adenovirus vector carrying both the transgene cassette to be inserted and the recombinase coding region. RMCE proceeds efficiently in cells in which the adenovirus vector is able to replicate. In contrast, insufficient quantities of the transgene cassette are produced in cells in which the virus cannot replicate. Additional transfection of the transgene cassette significantly enhances the RMCE frequency. This demonstrates that an RMCE system in the context of a viral vector allows the site directed insertion of a transgene into a defined genomic site.

Gold nanoparticles for the improved anticancer drug delivery of the active component of oxaliplatin.

The platinum-based anticancer drugs cisplatin, carboplatin, and oxaliplatin are an important component of chemotherapy but are limited by severe dose-limiting side effects and the ability of tumors to develop resistance rapidly. These drugs can be improved through the use of drug-delivery vehicles that are able to target cancers passively or actively. In this study, we have tethered the active component of the anticancer drug oxaliplatin to a gold nanoparticle for improved drug delivery. Naked gold nanoparticles were functionalized with a thiolated poly(ethylene glycol) (PEG) monolayer capped with a carboxylate group. [Pt(1R,2R-diaminocyclohexane)(H(2)O)(2)]2NO(3) was added to the PEG surface to yield a supramolecular complex with 280 (+/-20) drug molecules per nanoparticle. The platinum-tethered nanoparticles were examined for cytotoxicity, drug uptake, and localization in the A549 lung epithelial cancer cell line and the colon cancer cell lines HCT116, HCT15, HT29, and RKO. The platinum-tethered nanoparticles demonstrated as good as, or significantly better, cytotoxicity than oxaliplatin alone in all of the cell lines and an unusual ability to penetrate the nucleus in the lung cancer cells.

Indwelling catheter management: from habit-based to evidence-based practice.

Indwelling urinary catheters are used in the care of more than five million patients per year. Prevalence rates range from 4% in home care to 25% in acute care. Catheter-associated urinary tract infections account for more than 40% of all nosocomial infections and can be associated with significant complications. Clinical practices in catheter management vary widely and frequently are not evidence-based. Effective nursing measures include: identifying patients who no longer need indwelling catheters, discussing appropriate catheter alternatives, and providing patient and caregiver education. Many catheter-associated problems can be avoided by selecting a closed catheter system with a small size catheter (14 to 18 French with a 5-cc balloon), following manufacturer's recommendations for inflation/deflation, maintaining a closed system, securing the catheter, and properly positioning the drainage bag. Practices such as routine catheter irrigation should be avoided. Current recommendations related to the management of encrustation and blockage also are discussed. Providing evidence-based catheter management strategies may reduce the rate of catheter-associated urinary tract infection, catheter encrustation, and leakage as well as the discomfort and costs associated with these complications.