Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion

BACKGROUND Colorectal cancer(CRC)remains a relevant public health problem.Current research suggests that racial,economic and geographic disparities impact access.Despite the expansion of Medicaid eligibility as a key component of the Affordable Care Act(ACA),there is a dearth of information on the utilization of newly gained access to CRC screening by low-income individuals.This study investigates the impact of the ACA’s Medicaid expansion on utilization of the various CRC screening modalities by low-income participants.Our working hypothesis is that Medicaid expansion will increase access and utilization of CRC screening by low-income participants.AIM To investigate the impact of the Affordable Care Act and in particular the effect of Medicaid expansion on access and utilization of CRC screening modalities by Medicaid state expansion status across the United States.METHODS This was a quasi-experimental study design using data from the Behavioral Risk Factor Surveillance System,a large health system survey for participants across the United States and with over 2.8 million responses.The period of the study was from 2011 to 2016 which was dichotomized as pre-ACA Medicaid expansion(2011-2013)and post-ACA Medicaid expansion(2014-2016).The change in utilization of access to CRC screening strategies between the expansion periods were analyzed as the dependent variables.Secondary analyses included stratification of the access by ethnicity/race,income,and education status.RESULTS A greater increase in utilization of access to CRC screening was observed in Medicaid expansion states than in nonexpansion states[+2.9%;95%confidence interval(95%CI):2.12,3.69].Low-income participants showed a+4.02%(95%CI:2.96,5.07)change between the expansion periods compared with higher income groups+3.19%(1.70,4.67).Non-Hispanic Whites and Hispanics[+3.01%(95%CI:2.16,3.85)vs+5.51%(95%CI:2.81,8.20)]showed a statistically significant increase in utilization of access but not in Non-Hispanic Blacks,or Multiracial.There was an increase in utilization across all educational levels.This was significant among those who reported having a high school graduate degree or more+4.26%(95%CI:3.16,5.35)compared to some high school or less+1.59%(95%CI:-1.37,4.55).CONCLUSION Medicaid expansion under the Affordable Care Act led to an overall increase in self-reported use of CRC screening tests by adults aged 50-64 years in the United States.This finding was consistent across all low-income populations,but not all races or levels of education.

Impact of erythropoietin therapy on cardiorenal syndrome:A systematic review with meta-analysis

BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ systems.Cardiorenal syndrome(CRS)results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice versa.AIM To evaluate the use of erythropoietin(EPO)in patients with CRS and its effects on hemoglobin(Hb),major cardiovascular(CV)events,and hospitalization rates.METHODS On February 24,2022,searches were conducted using PubMed,MEDLINE,and EMBASE,and 148 articles were identified.A total of nine studies were considered in this systematic review.We assessed the included articles based on the National Heart,Lung,and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional studies.An assessment of bias risk was conducted on the chosen studies,and data relevant to our review was extracted.RESULTS The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV mortality.In addition,the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is unknown.Future studies,such as randomized controlled clinical trials and prospective cohort studies,should be conducted to enhance the literature on the potential of EPO therapy in patients with CRS.CONCLUSION Our systematic review suggests that EPO therapy may have a significant role in managing CRS.The review highlights the potential benefits of EPO in improving baseline Hb levels,reducing the risk of major CV events,improving cardiac remodeling,myocardial function,New York Heart Association class,and B-type natriuretic peptide levels.However,the effect of EPO treatment on hospitalization remains unclear and needs further exploration.

Emerging therapeutic options for non-alcoholic fatty liver disease:A systematic review

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)has become a prevalent cause of chronic liver disease and ranks third among the causes of transplantation.In the United States alone,annual medical costs are approximately 100 billion dollars.Unfortunately,there is no Federal Drug Administration(FDA)-approved medication for its treatment.However,various clinical trials are investigating several therapeutic classes that could potentially treat NAFLD.It is valuable to have a compilation of the data available on their efficacy.AIM To assess the efficacy of cyclophilin inhibitors,fibroblast growth factor 21 analogs(FGF21),and dual and pan peroxisome proliferator-activated receptor(PPAR)agonists for treating NAFLD.METHODS A comprehensive literature search using keywords including cyclophilin inhibitor,FGF agonist,pan-PPAR agonists,dual-PPAR agonist,NAFLD,nonalcoholic steatohepatitis,and fatty liver was conducted on October 29,2022,in PubMed,EMBASE,Cochrane Library,Scopus and Web of Science.Animal and human research,case reports,and published articles in English from all countries with patients aged 18 and above were included.Only articles with a National Institutes of Health(NIH)Quality Assessment score of five or higher out of eight points were included.Articles that were narrative or systematic reviews,abstracts,not in English,focused on patients under 18 years old,did not measure outcomes of interest,were inaccessible,or had a low NIH Quality Assessment score were excluded.Each article was screened by two independent researchers evaluating relevance and quality.Resources were scored based on the NIH Quality Assessment Score;then,pertinent data was extracted in a spreadsheet and descriptively analyzed.RESULTS Of the 681 records screened,29 met the necessary criteria and were included in this review.These records included 12 human studies and 17 animal studies.Specifically,there were four studies on cyclophilin inhibitors,four on FGF agonists/analogs,eleven on pan-PPAR agonists,and ten on dual-PPAR agonists.Different investigational products were assessed:The most common cyclophilin inhibitor was NV556;FGF agonists and analogs was Efruxifermin;pan-PPAR agonists was Lanifibranor;and dual-PPAR agonists was Saroglitazar.All classes were found to be statistically efficacious for the treatment of NAFLD,with animal studies demonstrating improvement in steatosis and/or fibrosis on biopsy and human studies evidencing improvement in different metabolic parameters and/or steatosis and fibrosis on FibroScan(P<0.05).CONCLUSION The data analyzed in this review showed clinically significant improvement in individual histological features of NAFLD in both animal and human trials for all four classes,as well as good safety profiles(P<0.05).We believe this compilation of information will have positive clinical implications in obtaining an FDA-approved therapy for NAFLD.

Confounders in Adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer

Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there in increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods: A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results: Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance was associated with adenoma detection. Conclusion: In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.

Current systematic reviews and meta-analyses of COVID-19

BACKGROUND Coronavirus disease 2019(COVID-19)has left a significant impact on the world's health,economic and political systems;as of November 20,2020,more than 57 million people have been infected worldwide,with over 1.3 million deaths.While the global spotlight is currently focused on combating this pandemic through means ranging from finding a treatment among existing therapeutic agents to inventing a vaccine that can aid in halting the further loss of life.AIM To collect all systematic reviews and meta-analyses published related to COVID-19 to better identify available evidence,highlight gaps in knowledge,and elucidate further meta-analyses and umbrella reviews that are yet to be performed.METHODS We explored studies based on systematic reviews and meta-analyses with the keyterms,including severe acute respiratory syndrome(SARS),SARS virus,coronavirus disease,COVID-19,and SARS coronavirus-2.The included studies were extracted from Embase,Medline,and Cochrane databases.The publication timeframe of included studies ranged between January 01,2020,to October 30,2020.Studies that were published in languages other than English were not considered for this systematic review.The finalized full-text articles are freely accessible in the public domain.RESULTS Searching Embase,Medline,and Cochrane databases resulted in 1906,669,and 19 results,respectively,that comprised 2594 studies.515 duplicates were subsequently removed,leaving 2079 studies.The inclusion criteria were systematic reviews or meta-analyses.860 results were excluded for being a review article,scope review,rapid review,panel review,or guideline that produced a total of 1219 studies.After screening articles were categorized,the included articles were put into main groups of clinical presentation,epi-demiology,screening and diagnosis,severity assessment,special populations,and treatment.Subsequently,there was a second subclassification into the following groups:gastrointestinal,cardiovascular,neurological,stroke,thrombosis,anosmia and dysgeusia,ocular manifestations,nephrology,cutaneous manifestations,D-dimer,lymphocyte,anticoagulation,antivirals,convalescent plasma,immunosuppressants,corticosteroids,hydroxychloroquine,renin-angiotensin-aldosterone system,technology,diabetes mellitus,obesity,pregnancy,children,mental health,smoking,cancer,and transplant.CONCLUSION Among the included articles,it is clear that further research is needed regarding treatment options and vaccines.With more studies,data will be less heterogeneous,and statistical analysis can be better applied to provide more robust clinical evidence.This study was not designed to give recommendations regarding the management of COVID-19.

Characterization of gut microbiome and metabolome in Helicobacter pylori patients in an underprivileged community in the United States

BACKGROUND Helicobacter pylori(H.pylori),a bacterium that infects approximately half of the world’s population,is associated with various gastrointestinal diseases,including peptic ulcers,non-ulcer dyspepsia,gastric adenocarcinoma,and gastric lymphoma.As the burden of antibiotic resistance increases,the need for new adjunct therapies designed to facilitate H.pylori eradication and reduce negative distal outcomes associated with infection has become more pressing.Characterization of the interactions between H.pylori,the fecal microbiome,and fecal fatty acid metabolism,as well as the mechanisms underlying these interactions,may offer new therapeutic approaches.AIM To characterize the gut microbiome and metabolome in H.pylori patients in a socioeconomically challenged and underprivileged inner-city community.METHODS Stool samples from 19 H.pylori patients and 16 control subjects were analyzed.16S rRNA gene sequencing was performed on normalized pooled amplicons using the Illumina MiSeq System using a MiSeq reagent kit v2.Alpha and beta diversity analyses were performed in QIIME 2.Non-targeted fatty acid analysis of the samples was carried out using gas chromatography-mass spectrometry,which measures the total content of 30 fatty acids in stool after conversion into their corresponding fatty acid methyl esters.Multi-dimensional scaling(MDS)was performed on Bray-Curtis distance matrices created from both the metabolomics and microbiome datasets and a Procrustes test was performed on the metabolomics and microbiome MDS coordinates.RESULTS Fecal microbiome analysis showed that alpha diversity was lowest in H.pylori patients over 40 years of age compared to control subjects of similar age group.Beta diversity analysis of the samples revealed significant differences in microbial community structure between H.pylori patients and control subjects across all ages.Thirty-eight and six taxa had lower and higher relative abundance in H.pylori patients,respectively.Taxa that were enriched in H.pylori patients included Atopobium,Gemellaceae,Micrococcaceae,Gemellales and Rothia(R.mucilaginosa).Notably,relative abundance of the phylum Verrucomicrobia was decreased in H.pylori patients compared to control subjects.Procrustes analysis showed a significant relationship between the microbiome and metabolome datasets.Stool samples from H.pylori patients showed increases in several fatty acids including the polyunsaturated fatty acids(PUFAs)22:4n6,22:5n3,20:3n6 and 22:2n6,while decreases were noted in other fatty acids including the PUFA 18:3n6.The pattern of changes in fatty acid concentration correlated to the Bacteroidetes:Firmicutes ratio determined by 16S rRNA gene analysis.CONCLUSION This exploratory study demonstrates H.pylori-associated changes to the fecal microbiome and fecal fatty acid metabolism.Such changes may have implications for improving eradication rates and minimizing associated negative distal outcomes.

Mortality rate of COVID-19 infection in end stage kidney disease patients on maintenance hemodialysis:A systematic review and meta-analysis

BACKGROUND Coronavirus disease 2019(COVID-19)has been the most talked-about disease of the past few years.Patients with significant comorbidities have been at particular risk of adverse outcomes.This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease,a group of patients known to be particularly susceptible to infectious complications.AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.METHODS We searched PubMed/MEDLINE,EMBASE,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Web of Science databases for relevant terms and imported the results into the Covidence platform.From there,studies were assessed in two stages for relevance and quality,and data from studies that satisfied all the requirements were extracted into a spreadsheet.The data was then analyzed descriptively and statistically.RESULTS Of the 920 studies identified through the initial database search,only 17 were included in the final analysis.The studies included in the analysis were mostly carried out during the first wave.We found that COVID-19 incidence among patients on hemodialysis was significant,over 10%in some studies.Those who developed COVID-19 infection were most likely going to be hospitalized,and over 1 in 5 died from the infection.Intensive care unit admission rate was lower than the infection lethality rate.Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections,and a significant proportion was infected during the first wave.Their prognosis is overall much worse than in the general population,and every effort needs to be made to decrease their exposure.

Adverse Effects of Sedentary Lifestyles: Inflammation, and High-Glucose Induced Oxidative Stress—A Double Blind Randomized Clinical Trial on Diabetic and Prediabetic Patients

Sedentary lifestyles promote adipose tissue accumulation that generates systemic inflammation and oxidative damage. Physical activity induces cardiovascular fitness, increases muscle mass, and healthy blood glucose regulation, while reducing visceral fat, triglycerides and low-density lipoproteins. It is theoretically possible to develop a long-term multi-exercise regimen for health management and enhancement. Pragmatically, time and career restraints, individual choices, genetic factors, or demoralization due to the draconian commitment involved in weight loss, have rendered over a billion of individuals obese, or overweight, burdened by excess lipids, insulin resistance, elevated glucose levels, and inflammation, that foster a number of medical conditions including diabetes. Strenuous overtraining has ensued adverse effects, including an upsurge of proinflammatory cytokines, and hyperglycemia. We implemented an one-month long innovative method with 20 diabetic and prediabetic patients. Results demonstrated a statistically significant reduction of both fasting and PP blood glucose. Fasting and PP insulin reached optimal levels. There was a substantial decline in dyslipidemia, reflecting a reverse relationship of elevated HDL versus triglycerides descending towards the normal range. The notable visceral fat reduction was validated by sonography reports that indicated no evidence of fatty liver in seven patients previously diagnosed with hepatic steatosis. These findings have important implications in improving the health status of obese diabetic and prediabetic individuals, by helping them jumpstart an active lifestyle, or by serving as an exercise alternative to reduce lipids, blood glucose levels and insulin resistance.

ABO incompatibility in renal transplantation

ABO blood group incompatibility(ABO-I)was historically considered an absolute contraindication to kidney transplantation due to the significant risk of acute antibody-mediated rejection and early graft loss.Nevertheless,the urge to minimize the gap between the candidates’number on the waitlist for kidney transplants and the available kidney donors encourage investigation into finding ways to use organs from ABO-I kidney donors,especially in the era of using more potent immunosuppression therapies.This review aims to discuss a general overview of ABO-I kidney transplantation and the different protocols adopted by some transplant centers to meaningfully overcome this barrier.

Liver transplantation during global COVID-19 pandemic

The coronavirus disease 2019(COVID-19)caused by severe acute respiratory disease respiratory syndrome coronavirus-2 has significantly impacted the health care systems globally.Liver transplantation(LT)has faced an unequivocal challenge during this unprecedented time.This targeted review aims to cover most of the clinical issues,challenges and concerns about LT during the COVID-19 pandemic and discuss the most updated literature on this rapidly emerging subject.

Dynamic Optimization of Caregiver Schedules Based on Vital Sign Streams

Hospital facilities use a collection of heterogeneous devices, produced by many different vendors, to monitor the state of patient vital signs. The limited interoperability of current devices makes it difficult to synthesize multivariate monitoring data into a unified array of real-time information regarding the patients state. Without an infrastructure for the integrated evaluation, display, and storage of vital sign data, one cannot adequately ensure that the assignment of caregivers to patients reflects the relative urgency of patient needs. This is an especially serious issue in critical care units (CCUs). We present a formal mathematical model of an operational critical care unit, together with metrics for evaluating the systematic impact of caregiver scheduling decisions on patient care. The model is rich enough to capture the essential features of device and patient diversity, and so enables us to test the hypothesis that integration of vital sign data could realistically yield a significant positive impact on the efficacy of critical care delivery outcome. To test the hypothesis, we employ the model within a computer simulation. The simulation enables us to compare the current scheduling processes in widespread use within CCUs, against a new scheduling algorithm that makes use of an integrated array of patient information collected by an (anticipated) vital sign data integration infrastructure. The simulation study provides clear evidence that such an infrastructure reduces risk to patients and lowers operational costs, and in so doing reveals the inherent costs of medical device non-interoperability.

Coronavirus disease 2019 and renal transplantation

Ever since the severe acute respiratory syndrome virus causing coronavirus disease 2019(COVID-19)struck the world,global health strategies have changed significantly.According to the Centers for Disease Control and Prevention,kidney transplant recipients are stratified as being high risk of developing fatal illness from COVID-19 infection.Kidney transplant is the gold-standard treatment for end-stage kidney disease subjects.During the pandemic,significant concerns have emerged regarding continuation of kidney transplant surgeries and management of kidney transplant recipients post-transplant.The added risk of immunosuppression in this cohort was and remains a theoretical concern,posing a potential risk of transplantation rather than benefit.This comprehensive review aims to cover most of the faced challenges in kidney transplantation in different stages of the pandemic.In addition,it will elucidate the epidemiology,nature,course of the disease,surgical consideration in donors and recipients as well as role of immunosuppression and management of COVID-19 infected kidney transplant recipients during these extraordinary circumstances.

Genetic Diversity and DNA Barcoding of Yam Accessions from Southern Nigeria

Knowledge of genetic diversity and barcoding of yam is lacking in Enugu and Ebonyi States of southern Nigeria. Therefore, DNA barcoding was used to facilitate identification and biodiversity studies of yam species from Southern Nigeria. Seventy five yam accessions were collected from Enugu and Ebonyi States, including International Institute of Tropical Agriculture for DNA extraction and amplification using a chloroplast DNA (cpDNA) ribulose-1,5-bisphosphate carboxylase (rbcL) marker. There was high level of similarity among the accessions and presence of 534 conserved and 7 variable sites. A transversional mutation of G/T at a consensus position of 335 was identified followed by transitions at 362 (A/G), 368 (A/G), 371 (C/T) and 391 (C/T) within the accessions. Phylogeny resolved the yam accessions into ten major groups with their bootstrap values ranging from 0 - 100. Phylogenetic diversity was highest in group X, followed by VII, VI and IX. The inter-group genetic distance based on Kimura 2-parameter model ranged from 0.5000 ± 0.4770 - 5.0560 ± 2.5760, while the intra-group had 0.5250 ± 0.5000 - 2.0103 ± 1.2579. The mean genetic diversity within the entire population was 0.7970 ± 0.06910. BLAST analysis of total bit score, query coverage, and percentage identity were in the ranges of 411 - 1011, 99% - 100% and 97% - 100%, respectively. However, the rbcL could not resolve the yam accessions well following the comparative assessment of some discrepancies in the detected number of species from phylogenetic groupings, genetic diversity indices and NCBI BLAST hits, thereby, exposing the inefficiency of this marker in discriminating the yam accessions. It was demonstrated that rbcL is not an effective marker;therefore, it should not be recommended as a standard-alone marker of choice for DNA barcoding of yam accessions, especially, when accurate identification, discrimination and estimation of genetic diversity of this vital crop are of paramount importance for crop improvement and germplasm conservation.

An Observation Data Driven Simulation and Analysis Framework for Early Stage <i>C. elegans</i>Embryogenesis

Recent developments in cutting-edge live microscopy and image analysis provide a unique opportunity to systematically investigate individual cell’s dynamics as well as simulation-based hypothesis testing. After a summary of data generation and analysis in the observation and modeling efforts related to C. elegans embryogenesis, we develop a systematic approach to model the basic behaviors of individual cells. Next, we present our ideas to model cell fate, division, and movement using 3D time-lapse images within an agent-based modeling framework. Then, we summarize preliminary result and discuss efforts in cell fate, division, and movement modeling. Finally, we discuss the ongoing efforts and future directions for C. elegans embryo modeling, including an inferred developmental landscape for cell fate, a quasi-equilibrium model for cell division, and multi-agent, deep reinforcement learning for cell movement.

Impact of type 2 diabetes on adenoma detection in screening colonoscopies performed in disparate populations

BACKGROUND The Black/African Ancestry(AA)population has a higher prevalence of type 2 diabetes mellitus(T2DM)and a higher incidence and mortality rate for colorectal cancer(CRC)than all other races in the United States.T2DM has been shown to increase adenoma risk in predominantly white/European ancestry(EA)populations,but the effect of T2DM on adenoma risk in Black/AA individuals is less clear.We hypothesize that T2DM has a significant effect on adenoma risk in a predominantly Black/AA population.AIM To investigate the effect of T2DM and race on the adenoma detection rate(ADR)in screening colonoscopies in two disparate populations.METHODS A retrospective cohort study was conducted on ADR during index screening colonoscopies(age 45-75)performed at an urban public hospital serving a predominantly Black/AA population(92%)(2017-2018,n=1606).Clinical metadata collected included basic demographics,insurance,body mass index(BMI),family history of CRC,smoking,diabetes diagnosis,and aspirin use.This dataset was combined with a recently reported parallel retrospective cohort data set collected at a suburban university hospital serving a predominantly White/EA population(87%)(2012-2015,n=2882).RESULTS The ADR was higher in T2DM patients than in patients without T2DM or prediabetes(35.2%vs 27.9%,P=0.0166,n=981)at the urban public hospital.Multivariable analysis of the combined datasets showed that T2DM[odds ratio(OR)=1.29,95%confidence interval(CI):1.08-1.55,P=0.0049],smoking(current vs never OR=1.47,95%CI:1.18-1.82,current vs past OR=1.32,95%CI:1.02-1.70,P=0.0026),older age(OR=1.05 per year,95%CI:1.04-1.06,P<0.0001),higher BMI(OR=1.02 per unit,95%CI:1.01-1.03,P=0.0003),and male sex(OR=1.87,95%CI:1.62-2.15,P<0.0001)were associated with increased ADR in the combined datasets,but race,aspirin use and insurance were not.CONCLUSION T2DM,but not race,is significantly associated with increased ADR on index screening colonoscopy while controlling for other factors.

Liver kidney crosstalk:Hepatorenal syndrome

The dying liver causes the suffocation of the kidneys,which is a simplified way of describing the pathophysiology of hepatorenal syndrome(HRS).HRS is characterized by reversible functional renal impairment due to reduced blood supply and glomerular filtration rate,secondary to increased vasodilators.Over the years,HRS has gained much attention and focus among hepatologists and nephrologists.HRS is a diagnosis of exclusion,and in some cases,it carries a poor prognosis.Different classifications have emerged to better understand,diagnose,and promptly treat this condition.This targeted review aims to provide substantial insight into the epidemiology,pathophysiology,diagnosis,and management of HRS,shed light on the various milestones of this condition,and add to our current understanding.

一株多种耐药结核菌在纽约全市的暴发流行

背景:1992年纽约市医院耐两种或更多种药物的活动性结核病情况。目的:检查纽约市1992年结核发病高峰期间,经鉴定命名为公共卫生研究所(PHRI)W株的具有高度耐药且有17条IS6110印迹带的结核菌在全市的分布情况。同时还将此W株与其它纽约市常见菌株加以比较。设计:应用双盲回归法对保存的结核菌培养物进行限定性片段长度多态性(RFLP)DNA指纹分析。结果:1992年中,我们在21所医院的住院病人中共分离112株W印迹株和8个变株。几乎所有的分离株均对四种一线药物和卡那霉素(KAN)耐药。1992年此单一菌株至少占纽约市多种耐药(MDR)结核病的22％,远高于其它任何一株。几乎所有的W株病例均是AIDS患者。该菌群为纽约市耐药程度最高且迄今为止与其它地区比较所鉴定出的最大的具有IS6110指纹相似性的菌群。结论:由于推荐的四药化疗方案对此高度耐药的菌群不能有效杀灭,因此90年代初在纽约AIDS患者中发生因W株感染而引起的结核暴发流行。其它常见菌株并非呈现高度耐药,甚至于令人惊奇的是表现为全敏感。单一多种耐药菌株能够在AIDS和结核均常见的地区引起广泛的播散。

New onset hypertension after transplantation

It has been reported that up to 90%of organ transplant recipients have suboptimal blood pressure control.Uncontrolled hypertension is a well-known culprit of cardiovascular and overall morbidity and mortality.In addition,rigorous control of hypertension after organ transplantation is a crucial factor in prolonging graft survival.Nevertheless,hypertension after organ transplantation encompasses a broader range of causes than those identified in non-organ transplant patients.Hence,specific management awareness of those factors is mandated.An in-depth understanding of hypertension after organ transplantation remains a debatable issue that necessitates further clarification.This article provides a comprehensive review of the prevalence,risk factors,etiology,complications,prevention,and management of hypertension after organ transplantation.

Assessment of the Visual Analogue Score in the Evaluation of the Pruritus of Cholestasis

Background and Aims:A visual analogue score (VAS),based on application of a visual analogue scale,has been widely used to assess pruritus in clinical studies of patients with cholestatic liver disease.A VAS is a numerical score of the severity of the perception of pruritus,and,hence,is inherently subjective.The objective of this study was to assessthe reliability of a VAS as an index of pruritus in cholestatic patients.Methods:In 8 patients with chronic pruritus due to primary biliary cholangitis,values for a VAS of pruritus were compared with corresponding measurements of scratching activity,which were generated by a monitoring system specifically designed to quantitate this activity.The relationship between individual values for the VAS and corresponding values for scratching activity during a specific interval immediately preceding the recording of the VAS was examined by determining the Spearman's rank correlation coefficient.Results:The mean Spearman's rank correlation coefficient between individual values for the VAS and corresponding mean values for scratching activity was 0.072;the range of these coefficients was-0.04 to 0.26.A VAS of pruritus is an unreliable index of scratching activity,and,hence,of the pathophysiological process responsible for the pruritus of cholestasis.Conclusion:It is concluded that the use of a VAS as a primary quantitative endpoint in trials of the efficacy of potential therapies for the pruritus of cholestasis may be inappropriate.