The effects of monensin on plasma concentrations and changes in plasma concentrations of energy metabolites and minerals over time were investigated using 24 multiparous Holstein cows. Cows were paired according to farm, predicted date of calving, and body condition score and were randomly allocated to two groups. Treated cows were given a ruminal bolus containing 32 g of monensin at 50 +/- 7 d before predicted calving. Treated cows had lower plasma concentrations of glucose, free fatty acid (FFA), and beta-hydroxybutyrate (BHBA) than did control cows before calving, indicating that monensin influenced energy metabolism. However, no significant differences in plasma concentrations of glucose, FFA, and BHBA were found between groups after calving. Plasma BHBA concentrations increased more before calving in control cows, and plasma FFA and urea concentrations increased significantly before calving in all cows. No significant differences in body weight, plasma concentrations of urea, or whole blood concentrations of glutathione peroxidase were detected between groups before or after calving. Plasma ceruloplasmin activity did not differ between groups before calving, but was significantly higher in treated cows after calving. Plasma concentrations of Ca did not significantly differ between groups before or after calving. Monensin altered both energy and mineral metabolism and has the potential to improve the health and production of dairy cows.

Non-alcoholic fatty liver disease (NAFLD) is a disease of increasing interest as its prevalence is on the rise. NAFLD has been linked to metabolic syndrome, which is becoming more common due to the Western diet. Since NAFLD can lead to cirrhosis and related complications including hepatocellular carcinoma, the increasing prevalence is concerning and medical therapy aimed at treating NAFLD is of great interest. Researchers studying the effects of medical therapy on NAFLD use dietary mouse models. The two main types of mouse model diets are the methionine- and choline-deficient (MCD) diet and Western-like Diet (WD). Although both induce NAFLD, the mechanisms are very different. We reviewed several studies conducted within the last 5 years that use MCD diet or WD mouse models in order to mimic this disease in a way most similar to humans. The MCD diet inconsistently induces NAFLD and fibrosis and doesn’t completely induce metabolic syndrome. Thus, the clinical significance of the MCD diet is questionable. In contrast, WD mouse models consisting of high fat, cholesterol, and a combination of high fructose corn syrup, sucrose, fructose or glucose not only lead to metabolic syndrome but also induce NAFLD with fibrosis making these choices most suitable for research.

The depth of our knowledge regarding mast cells has widened exponentially in the last 20 years. Once thought to be only important for allergy-mediated events, mast cells are now recognized to be important regulators of a number of pathological processes. The revelation that mast cells can influence organs, tissues, and cells has increased interest in mast cell research during liver disease. The purpose of this review is to refresh the reader's knowledge of the development, type, and location of mast cells and to review recent work that demonstrates the role of hepatic mast cells during diseased states. This review focuses primarily on liver diseases and mast cells during autoimmune disease, hepatitis, fatty liver disease, liver cancer, and aging in the liver. Overall, these studies demonstrate the potential role of mast cells in disease progression.

568 Background: Published rates of colorectal cancer (CRC) screening with diagnostic colonoscopy after abnormal fecal immunochemical test (FIT) findings have varied substantially from 42% to 83% and median days to follow up colonoscopy have ranged from 41 to 184 days. Although data for lack of follow up exists for urban safety-net hospital systems, Veteran’s Affairs systems, and healthcare systems not located in the southern US to our knowledge no data exists for the Baylor Scott & White Health System (BSWH) which is the largest not-for-profit healthcare system in Texas. Methods: The initial retrospective chart review searched BSWH’s Central Texas division for whom a FIT was ordered during the following dates: June 1, 2014 to June 1, 2016. Eligible patients were between and including 50 and 75 years of age. The search results were manually screened by two resident Internal Medicine physicians. Results: The initial screen produced 232 patients with a positive FIT test. After excluding for testing reasons other than CRC screening, 94 patients were included in the final analysis. Most of those (70/94, 74.47%) received a gastroenterology clinic visit within one year, and most (62/94, 65.96%) received or were offered a colonoscopy. The most common reasons for not completing colonoscopy were patient no-show (14/32, 43.75%) and no documented reason (12/32, 37.5%). Of those receiving a colonoscopy at our institution, median time from positive FIT to colonoscopy was 64 days, a quarter (11/43, 25.58%) waited longer than 6 months, and 22/43 (51.16%) had an abnormal finding. The abnormal findings on colonoscopy included: 3/22 (13.64%) were dysplastic polyps, 13/22 (59.10%) were adenomatous polyps and 6/19 (31.58%) were hyperplastic polyps. Conclusions: Colonoscopy following an abnormal FIT is an important part of preventing and diagnosing CRC. Although fecal based screening tests are more convenient and affordable, it appears that poor follow up is not limited to government and indigent health systems. As one of the largest not-for-profit health systems in the nation, a 65.96% follow up colonoscopy rate after abnormal FIT testing leaves much room for improvement.

Cannabis is the most commonly consumed recreational drug in the world. As more states legalize cannabis use in some form, the incidence of cannabinoid hyperemesis syndrome (CHS) is expected to rise. CHS is a constellation of symptoms including severe cyclical nausea and vomiting and epigastric or periumbilical abdominal pain as a result of long-term cannabis use. Recognizing the diagnosis and educating patients on the benefits of cessation is essential, as these patients often undergo extensive and repeated evaluations in the clinic, emergency department, and inpatient setting that could be avoided with extensive history taking and early recognition of the syndrome. In this study, we compared costs incurred by patients in various settings to determine if there is a difference between patients with and without CHS. Although there were not statistically significant cost differences between groups for all cost categories, it is clear that patients with CHS consume considerably more health care dollars than patients who deny cannabis use, and obtaining a detailed social history is imperative to prevent unnecessary workups and increased financial burden on the health care industry.

Cholestatic liver injury is characterized by damage induced on the biliary tree and cholangiocytes, the cells lining the biliary tree, thus they are termed “cholangiopathies”. Cholangiopathies include diseases such as Primary Biliary Cholangitis, Primary Sclerosing Cholangitis, Biliary Atresia and Cholangiocarcinoma. These pathologies lack viable therapies and most patients are diagnosed during late stage disease progression (with the exception of Biliary Atresia, which is found shortly after birth). The lack of therapies for these diseases has put a significant burden on the need for liver transplantation as this is the only indicative “cure” for cholangiopathies. The molecular mechanisms for cholangiopathies have been extensively studied; however, and unfortunately, the lack of effective biomarkers and therapeutics remains. In this review article we highlight the latest studies to investigate the molecular mechanisms regulating cholangiopathies and the potential therapeutics that might be discovered.

The objective of this study was to assess adherence and costs-benefits of colorectal cancer (CRC) screenings from an accountable care organization/population health perspective. We performed a retrospective review of 94 patients (50-75 years of age) in an integrated safety net system for whom fecal CRC screening was abnormal for the period of June 1, 2014, to June 1, 2016. A cost-benefit model was constructed using Medicare payment rates and a sensitivity analysis. Most patients included in the study (64/94, 68%) received or were offered a colonoscopy. Of those receiving a colonoscopy, 24 of 45 (53%) had an abnormal finding. Total direct medical costs avoided by screening the patient panel was $32,926 but could have exceeded $63,237 had more patients received follow-up colonoscopies. A sensitivity analysis with 1000 patients demonstrated total monetary benefits between $2.2 million and $8.16 million when follow-up and colonoscopy rates were allowed to vary. Although the resulting rates of follow-up were within the range reported in the literature, there is room for improvement, especially considering the monetary benefit that could be used on other diseases. Health systems and payers should work cooperatively to structure payment models to better incentivize CRC screenings. KEYWORDS Colorectal cancer screening; cost-benefit model; preventive careA n estimated 95,520 cases of colorectal cancer (CRC) occur annually in the USA. CRC is the second leading cause of cancer deaths, with an estimated 50,260 per year, and is one of the most costly types of cancer, with nearly $14 billion spent on direct medical care in 2010. [1][2][3][4] Costs of CRC the first year after diagnosis are estimated to range from $12,757 to $58,704 depending on comorbidities, stage, location, and other factors. [4][5][6][7][8][9] Evidence suggests that screening-invasive exams, like colonoscopy, and noninvasive stool tests, like fecal immunochemical test (FIT)-reduces CRC incidence and mortality and is cost effective. 2,[10][11][12][13][14][15] Patients are more likely to complete screening when FIT is recommended or when given a choice between fecal methods and colonoscopy, but the rate of diagnostic colonoscopy after an abnormal fecal test result ranges from 42% to 83%. Improving followup after abnormal FIT represents a significant population

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