Patients with BP are more likely to have various neurological diseases, schizophrenia and psoriasis prior to the diagnosis of BP, supporting associations found in other studies. Further research is required to elucidate the tentative causal association with BP.

Left untreated nonalcoholic fatty liver disease (NAFLD) can progress to nonalcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma. The observed failure of clinical trials in NASH may suggest that current model systems do not fully recapitulate human disease, and/or hallmark pathological features of NASH may not be driven by the same pathway in every animal model let alone in each patient. Identification of a model-agnostic disease-associated node can spur the development of effective drugs for the treatment of liver disease. Glycerol-3-phosphate acyltransferase1 (GPAT1) plays a pivotal role in lipid accumulation by shunting fats away from oxidation. In the present study, hepatic GPAT 1 expression was evaluated in three etiologically different models of NAFLD. Compared to the sham cohort, hepatic GPAT 1 mRNA levels were elevated by ∼5-fold in steatosis and NASH with fibrosis with immunofluorescent staining revealing increased GPAT1 in the fatty liver. A significant and direct correlation ( r = 0.88) was observed between hepatic GPAT 1 mRNA expression and severity of the liver disease. Picrosirius red staining revealed a logarithmic relation between hepatic GPAT 1 mRNA expression and scar. These data suggest that hepatic GPAT1 is an early disease-associated model-agnostic node in NAFLD and form the basis for the development of a potentially successful therapeutic against NASH.

As part of the safety net, free clinics (FCs) increase access to preventive and primary care for the uninsured. This study compared a group of uninsured FC users and a group of uninsured non-FC users to explore the impact of FC enrollment on the pattern of ED visits, as characterized by (1) level of complexity of care received at the ED, and (2) avoidable vs. unavoidable as classified by an existing clinical algorithm. Emergency department visits by FC users were less likely to be low-level-of-care than visits by non-FC users (OR 0.89, 95% CI 0.84-0.93). Free clinic enrollment was not a statistically significant predictor of avoidable visits (p=.6465). We found that the group of individuals who had access to primary care at the local FCs were significantly less likely than the group of uninsured individuals who were not enrolled in a FC to use the ED for care with lower levels of clinical complexity. Thus, the cost of increasing the primary care workforce as the Medicaid population expands may be worth it in the long run. Further exploration into what characterizes an effective FC is needed.

Changes in renal dimensions, including total kidney volume, not only inform ongoing renal disease but also disease progression. Determination of renal dimensions can inform drug efficacy, is important for matching recipients with potential donors, and to inform debulking of renal tumors. Imaging of kidney and application of the ellipse-based formula has become standard for estimating renal dimensions. Nevertheless, the existing ellipse-based formula underestimates renal dimensions including total kidney volume, regardless of the imaging modality used. Based on a model of murine kidney disease, this laboratory has previously proposed a modification to this formula which exhibits better estimation of renal dimensions. The present study sought to determine whether this modified formula is applicable to additional models of kidney disease. Kidneys were sourced from etiologically distinct murine and rat models of renal scarring. In each case, renal dimensions calculated using the existing ellipse-based formula was significantly lesser than the measured dimensions. By contrast, there was no difference between the measured dimensions and those calculated using the modified formula. In a model of polycystic kidney disease, total kidney volume calculated using the existing formula significantly underestimated measured kidney volume whereas use of the modified formula yielded a calculated kidney volume in excellent agreement with the measured volume. Use of this modified formula provides a better estimate of renal dimensions across a number of disease models.

background The Affordable Care Act gives states the option to expand state Medicaid programs to cover many who are currently uninsured. The potential financial impact has not been thoroughly examined. We characterized the health risk of uninsured adults in Buncombe County, North Carolina, relative to that of local Medicaid recipients, to estimate the cost of expanding Medicaid coverage to include the uninsured. methods We obtained de-identified patient enrollment and claims data for 2008 from the Division of Medical Assistance, North Carolina Department of Health and Human Services and from the 3 safety-net providers who care for most of the county's low-income uninsured adults. We used the Chronic Illness and Disability Payment System (CDPS) risk-adjustment tool to measure the relative health risk of the two populations. Based on actual spending in the Medicaid group and its health risk relative to that of the uninsured, we then projected how much it would have cost to provide Medicaid coverage for these uninsured in 2008. results We estimated, based on CDPS adjustment for demographics and diagnoses, that these uninsured adults would have incurred costs 13% greater than those of the actual nondisabled adult Medicaid population. The projected cost of providing Medicaid coverage to these uninsured would have been $4,320 per person. Limitations Data were drawn from only the 3 major safety-net organizations and therefore excluded care obtained from other safety-net providers. Also, this sample of uninsured people included some who are ineligible for Medicaid because of their citizenship status. Furthermore, Medicaid enrollment might lead to increased utilization, revealing a greater burden of illness than we detected. conclusion In Buncombe County, uninsured adults who enroll in expanded Medicaid are likely to have somewhat more costly health problems than do currently enrolled nondisabled adults.