Angiopoietin-1 protects 3T3-L1 preadipocytes from saturated fatty acid-induced cell death.

Cross talk between endothelial cells and adipocytes is vital to adipocyte functions, but little is known about the mechanisms or factors controlling the process. Angiogenesis is a critical component linking the endothelium to healthy adipogenesis, yet it is not known if or how it is involved in adipocyte physiology. Therefore, the purpose of this study was to determine the effect of angiopoietin-1 (Ang-1) and -2 (Ang-2) as well as their receptor, Tie-2, on adipocyte physiology. 3T3-L1 pre- and mature adipocytes were found to express Ang-1, Ang-2, and Tie-2, which decrease upon polyunsaturated fatty acid treatment. Furthermore, 3T3-L1 cells treated with recombinant Ang-1 or Ang-2 increased expression of the antiapoptotic gene Bcl-x and decreased expression of the proapoptotic gene Casp-8. Next, preadipocytes were treated with saturated fatty acids (SFAs) to induce cell stress. SFA-mediated splicing of X-box-binding protein-1 was reduced by co-treatment with Ang-1, and cell viability was improved in the presence of SFAs + Ang-1. Taken together, these results indicate that Ang-1 may protect preadipocytes from SFA-induced apoptosis and endoplasmic reticulum stress.

Delivery and Measurement of High-Value Care in Standardized Patient Encounters.

BACKGROUND: Residencies have incorporated high-value care (HVC) training to contain health care expenditures. Assessment methods of HVC curricula are limited. OBJECTIVE: In our clinical skills laboratory, we evaluated the effectiveness of HVC curricula using standardized patients (SPs) to determine if there is a correlation with performance in counseling, history and physical, HVC knowledge, and demographics. METHODS: Through ambulatory cases, SPs evaluated postgraduate year 2 (PGY-2) residents using checklists to determine if they obtained the chief complaint, medical and social history, focused physical examination, and conveyed information regarding patient management. Investigators scored knowledge-based questions on the need for imaging in low back pain, annual stress testing in coronary artery disease, and chest x-ray for gastroesophageal reflux disease. Univariate analysis was used to calculate percentage distribution of residents' ordering of inappropriate tests. RESULTS: All 56 PGY-2 residents participated in the study and completed at least 2 of 3 HVC cases. Analysis showed that 48% (27 of 56) ordered at least 1 inappropriate test. Residents who ordered unnecessary testing had similar performance in history and physical as well as knowledge of HVC. Inappropriate ordering was significantly associated with poorer performance in counseling (mean percentage counseling score of 68% versus 56% for those who ordered inappropriately, P < .001) and communication skills (mean percentage communication score of 74% versus 71% for those who ordered inappropriately, P < .003). There were no patterns for ordering by demographics. CONCLUSIONS: Our evaluation of residents during SP encounters found a correlation between the use of inappropriate testing and lower counseling and communication skills.

Treating Dyspnea: Is Oxygen Therapy the Best Option for All Patients?

The high prevalence of dyspnea at the end of life carries with it significant health and economic burden. Given the complex mechanism of dyspnea, management should be tailored to the individual patient experience and the underlying disease process. No clear role for supplemental oxygen has been established in the treatment of dyspnea in patients without no hypoxemia, and providers should consider the negative effects of oxygen supplementation. Symptom control with medications, exercise, behavioral therapy, treatment of associated anxiety, and the use of fans may be more effective and less costly than oxygen therapy. Further research is needed in the assessment and treatment of this symptom to more effectively treat patients.

Adolescent religiosity as a mediator of the relationship between parental religiosity and adolescent health outcomes.

Studies have demonstrated the positive impacts of both parent and adolescent religiosity on adolescent outcomes; however, the relationships among these variable have not been studied. Our study was conducted to assess whether adolescent religiosity mediates the relationship between parent religiosity and adolescent emotional and behavioral health outcomes. A sample of 491 late adolescents ages 18-22 completed surveys that assessed their parents' religious practices, their own religious practices, deviant behaviors, and internalizing behaviors. Findings suggest that adolescent religiosity mediates the relationship between parents' religiosity and adolescent health outcomes such as drug and alcohol use and depression.