Mark M. Melendez

Influence of Age on the Association of Retinol-binding Protein 4 With Metabolic Syndrome

Objective: The relationships of retinol‐binding protein 4 (RBP4) with insulin sensitivity and body fat distribution have been investigated in a few recent studies with conflicting results. This may have been due to differences in ages of the subjects in the different studies. The aim of this study was to investigate whether the association of RBP4 and insulin sensitivity and percent trunk fat are influenced by age.

Endothelial Adhesion Molecules Are Associated with Inflammation in Subjects with HIV Disease

BACKGROUND The presence of the adhesion molecules intercellular adhesion molecule-1 (ICAM-1) and soluble vascular cell adhesion molecule-1 (VCAM-1) is associated with elevated risk of cardiovascular disease. Subjects with human immunodeficiency virus (HIV) disease have multiple risk factors for cardiovascular disease, including elevated serum lipid levels, insulin resistance, and elevated levels of ICAM-1 and VCAM-1. This study assessed the variables associated with elevated adhesion molecule levels in this patient population. METHODS Serum levels of ICAM-1 and VCAM-1 were assessed in 31 subjects without HIV disease and 52 subjects with HIV disease. Pearson correlation indicated a significant relationship between ICAM concentration and other variables, including CD4+ cell count, HIV viral burden, insulin sensitivity, and serum lipid level. Multiple regression modeling was used to determine the strengths of association among the variables. RESULTS Subjects with HIV disease had elevated levels of ICAM-1 and VCAM-1. Pearson correlation analysis revealed significant associations between ICAM-1 and VCAM-1 level and insulin sensitivity, plasma lipid level, and presence of type 2 soluble receptor for tumor necrosis factor-alpha (sTNFR2). With multiple regression modeling to control for interdependence, only sTNFR2, a marker of inflammation, was an independent predictor of ICAM-1 and VCAM-1 levels. CONCLUSIONS The study suggests that many of the variables associated with ICAM-1 and VCAM-1 levels can be related to their impact on inflammation.

Novel Macromolecular Crosslinking Hydrogel to Reduce Intra-Abdominal Adhesions

BACKGROUND The aim of this study was to compare the anti-adhesion efficacy of a biodegradable, in situ, macromolecular cross-linking hydrogel made from oxidized dextran/N-carboxyethyl chitosan (Odex/CEC) with a commercially available carboxymethylcellulose/modified hyaluronan barrier film (Seprafilm; Genzyme Corporation, Cambridge, MA) in a rat cecum abrasion model. METHODS The rat model utilized a cecal abrasion and abdominal wall insult surgical protocol. The 2% Odex/CEC hydrogel treatment was applied by syringe to coat both the cecal and the abdominal wall insults, while other animals were treated with Seprafilm applied to the cecal injury only. Control animals did not receive any treatment. Animals were sacrificed after post operative day 21 and adhesion severity was quantitatively graded using a whole number scale from 0 - 3. Histological analysis was also performed for animals receiving Odex/CEC hydrogel treatment and no treatment (control). RESULTS Mean adhesion score was 2.09+/-1.22 for control animals, 1.00+/-1.00 for 2% Odex/CEC hydrogel animals, and 1.25+/-1.22 for Seprafilm animals. Hydrogel treated animals showed significantly lower adhesion scores than control animals (P<0.05), while Seprafilm demonstrated a marginally lower adhesion score (P<0.1) compared with the controls. Histological analysis of an Odex/CEC treated rat showed tissue repair and small fragments of hydrogel inside both healed abdominal and cecal surfaces. CONCLUSIONS Both Seprafilm and the 2% Odex/CEC hydrogel showed a significantly decreased adhesion score compared with the control. However, the hydrogel, compared with Seprafilm, offers ease of application and ability to conform to complex tissue geometries that could provide surgeons with another prophylactic treatment to prevent abdominal adhesions.

The importance of basic science and clinical research as a selection criterion for general surgery residency programs.

OBJECTIVE The selection criteria for surgical residents applying for residency differ among programs nationwide. Factors influencing this selection process have not been well defined, and research in particular has not been evaluated fully. This study aimed to evaluate the relative importance of basic science and clinical research in the selection criteria used by program directors (PDs). DESIGN A web-based survey consisting of 11 questions was sent to PDs using the list server of the Association of Program Directors in Surgery. Respondents were asked to rank selection factors using a 1-to-5 scoring system, with 5 as most important. Their responses were recorded and tabulated. SETTING University-based teaching hospital. PARTICIPANTS The survey went to 251 accredited general surgery residency programs in the United States. RESULTS Overall, 134 (53.3%) of the surveys were returned, representing 61 university-based programs, 57 community-based programs with university affiliation, and 16 community-based programs without university affiliation. In total, 120 PDs (89.5%) considered basic or clinical research almost always or all the time when evaluating applicants to their general surgery program. Another 73 PDs (54.5%) gave basic science and clinical research equal importance. Another 40 PDs (29.9%) rarely or never credited research unless it had been published as an abstract or paper. In ranking research, 11 (8.2%) respondents gave it the 5 score. Most respondents (n = 93; 69.4%) gave it the 3 score. An applicants interview and interest in surgery were the factors considered most important by 93 (69.4%) and 78 (58.2%), respectively, of the PDs. CONCLUSIONS Basic science and clinical research constituted an important but secondary criterion for resident selection by PDs into general surgery residency programs. PDs perceived the primary factors for residency selection to be the interview, demonstrated interest in surgery, AOA membership, letters of recommendation, and USMLE Step I scores.

Plasma Retinol-Binding Protein-4 Concentrations Are Elevated in Human Subjects With Impaired Glucose Tolerance and Type 2 Diabetes Response to Cho et al.

In their recent study, Cho et al. (1) demonstrated higher levels of retinol-binding protein-4 (RBP4) in in-dividuals with impaired glucose tolerance and type 2 diabetes. Additionally, higher waist circumferences increased with plasma RBP4 quartiles. This was also demonstrated by Graham et al. (2). Cho et al. suggested that visceral fat may be more important than total body fat in determining circulating RBP4 levels. In our study (3), we investigated whether visceral …

Rosiglitazone-Mediated Effects on Skeletal Muscle Gene Expression Correlate with Improvements in Insulin Sensitivity in Individuals with HIV-Insulin Resistance

Rosiglitazone, an agonist of peroxisome proliferator activated receptor (PPARγ), improves insulin sensitivity by increasing insulin-stimulated glucose uptake into muscle tissue. This study was undertaken to assess changes in expression of PPAR-regulated genes in muscle tissue following treatment of HIV-associated insulin resistance with rosiglitazone. Muscle gene expression was assessed in twenty-two seronegative HIV subjects (control), 21 HIV-infected individuals with normal insulin sensitivity (HIV-IS) and 19 HIV-infected individuals with insulin resistance (HIV-IR). A subset of the HIV-IR group (N = 10) were re-evaluated 12 weeks after treatment with 8 mg/d of rosiglitazone. The HIV-IR groups rosiglitazone-mediated improvement in insulin sensitivity was highly correlated with increased expression of PPARγ and carnitine palmitoyl transferase-1 (CPT-1), (r = 0.87, P < .001) and (r = 0.95, P < .001), respectively. The changes in PPARγ expression were also correlated with the changes in CPT1 expression (r = 0.75, P = .009). The results suggest that rosiglitazone; may have a direct effect on muscle tissue to improve insulin sensitivity.

Billing for Bedside Procedures

In the USA, in the year 2000, critical care medicine accounted for 14.4% of inpatient days and 0.56%, or

Retinol-Binding Protein 4 Is Associated with Insulin Resistance and Body Fat Distribution in Nonobese Subjects without Type 2 Diabetes

55.5 billion, of the gross domestic product.1 The act of billing for these services has become an art with all the rules and regulations that must be adhered to in order to get compensated for the work that one does. To have a clear understanding of the billing process, this chapter begins with an introduction into the US billing and reimbursement program and then progresses to the process of cognitive and procedural reimbursement.