Charlie Norwood VA Medical Center

About: Charlie Norwood VA Medical Center is a healthcare organization based out in Augusta, Georgia, United States. It is known for research contribution in the topics: Autophagy & Kidney. The organization has 349 authors who have published 490 publications receiving 16360 citations. The organization is also known as: Augusta VA Medical Center.

Analysis of Apoptosis: Basic Principles and Protocols

Abstract: Apoptosis is a distinct form of cell demise. Originally defined by cellular morphology, apoptosis can now be characterized at the molecular, biochemical, and cellular levels. The detection of apoptosis has become more important, not only in the interests of scientific investigation, but also because of its significance in clinical practice. For example, since apoptosis has been implicated in a variety of devastating diseases such as cancer, therapies targeting apoptosis are being developed. To evaluate the effectiveness of the treatment, one would have to assess the apoptotic response before, during, and after the therapy. For the typical apoptosis, a set of characteristics in cell structure and biochemistry has been well defined. In combination, these provide the basis for apoptosis detection in a given setting. The methodology for analyzing these characteristics is as diverse as the research subjects. Several books devoted to the methodology of apoptosis analysis have recently been published (1–3). Readers may find detailed experimental protocols in these books. This chapter provides an overview of the basic approaches used in analyzing apoptosis, the principle and the basic methodology, in order to provide a quick guide for readers to use when deciding which methods are available and appropriate for their own study. We start with the determination of cell viability and the morphology of dying cells. We then discuss approaches for examining apoptotic changes on the cell membrane, in the cytosol, and in the nucleus. We also summarize some of the common sources of reagents for apoptosis research.

Cancer incidence and risk factors in dialysis patients with human immunodeficiency virus: a cohort study.

Abstract: Background Patients with human immunodeficiency virus (HIV) or end-stage renal disease receiving dialysis have an increased risk of developing malignancies, but few data are available on cancer in patients with both conditions. Thus, the objective of this study was to determine the incidence of selected malignancies and identify their potential risk factors in HIV-infected dialysis patients. Methods This study was a nationwide cohort analysis using the US Renal Data System. Participants included all HIV-infected patients starting dialysis from 2005 to 2011. HIV status, comorbidities and malignancies were identified using International Classification of Diseases, Ninth Revision codes. Descriptive statistics and generalized linear models quantifying risk factors were performed for the overall cohort and the three most common malignancies. Results Overall, 6641 HIV-infected dialysis patients were identified, with 543 (8.2%) carrying a malignancy diagnosis. The most common malignancies were non-Hodgkin's lymphoma (NHL, 25%), Kaposi sarcoma (KS, 16%) and colorectal cancer (13%). Factors increasing the risk of any malignancy diagnosis included: history of cancer [adjusted relative risk (aRR) = 5.37], two or more acquired immunodeficiency syndrome-defining opportunistic infections (ADOIs) (aRR = 3.11), one ADOI (aRR = 2.23), cirrhosis (aRR = 2.20), male sex (aRR = 1.54) and hepatitis B (aRR = 1.52). For NHL and colorectal cancer, history of cancer (aRR = 7.05 and 9.80, respectively) was the most significant risk factor. For KS, two or more ADOIs (aRR = 6.78) was the largest risk factor. Conclusions Over 8% of HIV-infected dialysis patients developed a malignancy. History of cancer and ADOIs were major risk factors, underscoring the significance of immune dysregulation in malignancy development.

Septic arthritis in the end-stage renal disease population.

Abstract: Septic arthritis is important to consider in any patient who presents with joint pain because it is a medical emergency with an 11% fatality rate. Diagnosis and treatment may improve prognosis; however, many patients do not regain full joint function. In patients with end-stage renal disease (ESRD), immune dysfunction due to uremia and chronic vascular access leads to increased risk of infection. We examined the incidence, risk factors and sequelae of septic arthritis in a cohort of hemodialysis patients. The US Renal Data System was queried for diagnoses of septic arthritis and selected sequelae using International Statistical Classification of Diseases and Related Health Problems-9 and Current Procedural Terminology-4 codes in patients who initiated hemodialysis between 2005 and 2010. Multivariable logistic regression was used to determine potential risk factors for septic arthritis and its sequelae. 7009 cases of septic arthritis were identified, an incidence of 514.8 per 100,000 persons per year. Of these patients, 2179 were diagnosed with a documented organism within 30 days prior to or 14 days after the septic arthritis diagnosis, with methicillin-resistant Staphylococcus aureus infections (57.4%) being the most common. Significant risk factors for septic arthritis included history of joint disease, immune compromise (diabetes, HIV, cirrhosis), bacteremia and urinary tract infection. One of the four sequelae examined (joint replacement, amputation, osteomyelitis, Clostridioides difficile infection) occurred in 25% of septic arthritis cases. The high incidence of septic arthritis and the potential for serious sequelae in patients with ESRD suggest that physicians treating individuals with ESRD and joint pain/inflammation should maintain a high clinical suspicion for septic arthritis.

Esophageal Rupture Presenting with ST Segment Elevation and Junctional Rhythm Mimicking Acute Myocardial Infarction.

Abstract: Esophageal rupture is a rare but potentially fatal cause of chest pain. The presentation is variable and can mimic other conditions such as aortic dissection, pulmonary embolism, and myocardial infarction (MI). A 71-year-old male with a history of coronary artery disease presented to the ED with complaints of acute chest pain and respiratory distress. Over the next 48 hours, the patient developed dynamic ST segment changes on surface electrocardiogram mimicking an inferolateral ST segment elevation MI accompanied by a junctional rhythm. Curiously, his cardiac enzymes remained negative during this time, but his clinical status continued to deteriorate. A subsequent CT scan demonstrated a lower esophageal rupture, and the patient underwent successful endoscopic stenting. While rare, prompt recognition of esophageal rupture is imperative to improving morbidity and mortality. While esophageal rupture has been noted to cause ST segment elevation before, this appears to be the first case associated with a junctional rhythm.