Heart failure (HF) is a chronic disease that develops over months to years. In HF, ventricular repolarization is prolonged. We tested the hypothesis that I KCa modulates repolarization only when ventricular repolarization reserve is reduced as occurs in chronic HF, but not short term HF. Methods: A tachypacing - induced HF canine model was used, and LV midwall myocytes were isolated from 1 and 4 month HF groups, and compared to normal controls. Action potential duration at 50 (APD50) and 90% (APD90) repolarization was measured before and after the application of 100nM apamin (I KCa blocker, n=5-9 per group). Adjacent tissue (n=4 per group) was collected to measure the proteins encoding cardiac I KCa (SK2 and SK3). Results: One and 4 month HF had similar severity of HF (LVFS: 19.00 ± 1.36 vs. 15.9 ± 2.45, respectively P=NS). APD50 or APD90 in 1 month HF was no different from controls. 4 Mo HF resulted in a significant (P<0.05) APD90 prolongation compared to both control and 1 Mo HF groups, consistent with reduced repolarization reserve. Apamin significantly increased (P<0.05) APD50 and APD90 only in the 4 Mo HF group. Similarly proarrhythmic repolarization instability (beat-to-beat variability) was evident after apamin in the 4 month, but not the 1 month HF group (p<0.05). SK2 expression was unchanged between groups; SK3 was increased ~ 4 fold in both 1 month and 4 month HF group (P<0.05 vs control). Conclusions: Changes in SK protein expression do not fully explain I KCa -induced repolarization modulation. Rather, I KCa inhibition prolongs repolarization only when repolarization reserve is decreased, as occurs in chronic HF. The safety of targeting I KCa in chronic HF needs to be carefully evaluated as I KCa inhibition may increase susceptibility to ventricular arrhythmias.
e24041 Background: Integrative oncology (IO) is PROACTIVE and combines complementary with conventional care. The VA's comprehensive collection of integrative services is already in place. However, providers are often unaware of these, therefore veteran cancer patients don’t benefit from them. Prostate cancer is the most common cancer within the VA (31.8%), Aside from radiation/chemotherapy side effects (dry mouth, stomatitis, fatigue, neuropathy, gastrointestinal ) prostate cancer patients also have hormonal issues (hot flashes, low bone density, sexual dysfunction). Conventional treatments focus on symptoms (REACTIVE). Complementary and IO approaches are evidence-based toward specific treatment-related side effects. By educating and offering integrative approaches, we empower veterans to take charge of their health and well-being. Shifting our focus from treating only the disease to treating the entire patient, will improve health outcomes. Methods: Recruit 40 prostate cancer patients with fatigue, radiation-induced diarrhea, neuropathy, nausea, vomiting, anorexia, constipation, sexual dysfunction, and emotional issues(depression, anxiety, poor sleep, lack of energy). Identify/train providers to focus on concerning areas. Develop VA Personal Health Plans (PHP) to identify patients mission, aspiration, and purpose (MAP). Offer acupuncture, yoga, Reiki, TaiChi, meditation, biofeedback for headaches - Video Support group. Assessment tools. In late 2022, we reached our goal of 40 prostate cancer patients and opened clinic enrollment to patients of all cancer types. Results: The pilot IO clinic began in 2020, with 40 patients. In 2022, we expanded services to patients with other cancer types. Integrative options improved surgical outcomes, minimize chemotherapy /radiation side effects, boost morale, and optimize clinical outcomes. There is a high-interest level among oncology staff and patients. Resources are abundant but need organization and refinement to effectively present IO to our patients. Conclusions: There is huge potential for integrative oncology to improve the clinical, laboratory, and quality-of-life outcomes of cancer patients. We were able to construct a program within the Veteran Affairs, using existing integrative resources with high patient engagement. Currently, we plan to expand services to other VA sites nationwide.
In this position paper-one of six care practice papers published by Lamaze International and reprinted here with permission-the benefit of continuous labor support is discussed and presented as an evidence-based practice that helps promote, protect, and support normal birth. The paper is written for childbearing women and their families. Women with continuous support are less likely to have a cesarean, an instrument delivery, and regional anesthesia. They are also less likely to report dissatisfaction with or negatively rate their childbirth experience. The value of the doula for both the laboring woman and her labor partner is discussed. The accompanying commentary-written by a leading proponent of maternity care practices-supports evidence that promotes continuous labor support. Lamaze International encourages women to plan for a supportive birth environment that includes continuous support.
6546 Background: The VA Pittsburgh Healthcare System (VAPHS) Virtual Cancer Care Network was launched in January 2018 after we had established an electronic consult service where 555 hematology electronic consults were completed at VAPHS in FY17. The clinical video telehealth (CVT) clinic allows veterans from central Pennsylvania to receive their anticancer therapy at the VA in Altoona, Pennsylvania where the oncology pharmacy, nursing, telehealth, and supportive oncology staff are on site. Patients follow regularly and remotely during treatment via CVT visits with their oncologist located 93 miles away at the VA in Pittsburgh. Methods: A chemotherapy pharmacy and nursing infusion clinic were created at the VA in Altoona. CVT visits started in January 2018. Data including treatment, adverse events defined through CTCAE v5.0, gender, age, zip code, and other details were examined retrospectively. Results: 279 CVT visits for 89 patients were completed January 2018 through Sept 2018. 87 were male, 2 were female. Average age was 70 (range 45-90). Most common primary disease sites were prostate (19.1%), colorectal (13.4%), and lung (9%). 61.8% of patients were on treatment. Non-treatment visits were for surveillance and survivorship. Treatment administered included platinum doublets, fluorouracil doublets, immunotherapy, and oral anticancer therapy. 5.4% of patients had Grade 3-4 events due to febrile neutropenia, increased liver enzymes, and hemolytic anemia. 41.7% had grade 1-2 events due to peripheral neuropathy, neutropenia, anemia, thrombocytopenia, and infusion-related reactions. Using an average commuting speed of 60 mph and a travel cost of $ 0.56 per mile, the total commute distance averted was 49,579 miles. Mean distance averted per patient was 557 miles. Total commute time saved for veterans was 826 hours. Total mileage costs saved for veterans was $27,764. Conclusions: The Virtual Cancer Care Network reduced the travel time and costs for veterans who previously would have travelled from central Pennsylvania to VAPHS for their oncology treatment. Adverse events were tolerable and managed by the VA in Altoona. Integration of CVT secures safe access to cancer care and maintains patients’ primary relationships with their oncologists.
Introduction: A gender gap exists in stroke, with increased morbidity and mortality in women. The underlying mechanisms remain unknown, although differences in platelet biology may play a role. Inhibition of the interaction between VWF and GP 1B-IX-V has demonstrated thrombolytic efficacy. Hypothesis: We hypothesized that sex differences in reperfusion after stroke were attributable to the VWF-GP IB-IX-V axis, and inhibition of this interaction would yield clear discrepancies. Methods: Adult wild-type (C57BL/6J) mice were anesthetized, the right carotid artery exposed and baseline carotid flow obtained by Doppler. Thrombosis was induced with a FeCl 3 patch. After 20-minute stabilization, mice were intravenously administered vehicle (n, male=12, female=8) or VWF aptamer. Aptamer (0.5 mg/kg) administration was assessed using a bolus (5 min; n, male=5, female=8) method. Given the minimal observed thrombolytic effect in females, a continuous infusion (45 min; n, female=5) was also attempted. Next, blood from male (n=8) and female (n=8) adult wild-type beagles was mixed with VWF aptamer (control, 6.25 nM, 12.5 nM, 25 nM, and 100 nM), and platelet reactivity was assessed (Platelet Function Analyser-100). Statistical analysis was performed using a two-way ANOVA with multiple comparisons. Results: Bolus VWF aptamer restored carotid blood flow in male mice (Figure 1), compared to females (p<0.001) and vehicle (p<0.01). With continuous infusion, reperfusion in female mice was significantly higher than vehicle (p<0.01). Male canines (264.3 ± 70.3 s) demonstrated significantly more platelet inhibition (p<0.01) than females (175.3 ± 83.2 s) at the 12.5 nM VWF aptamer concentration. Conclusions: Following VWF inhibition, in vivo thrombolytic efficacy in mice is gender dependent, while ex vivo platelet activity varies in canines. The mechanisms underlying these differences in platelet biology are unclear, but this indicates that the VWF-GP IB-IX-V axis plays a role.
