INTRODUCTION:
Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease in developed countries with a prevalence of 25%-30%. Independent of cardiovascular and metabolic ...risk factors, NAFLD is associated with the progression of coronary atherosclerosis. The Framingham risk score (FRS) is useful in identifying patients at higher 10-year coronary heart disease risk. We aim to creative a simple, safe, cost-effective and non-invasive method for diagnosing NAFLD and assigning a cardiovascular risk.
METHODS:
In this retrospective analysis, 1038 adult patients who underwent a liver biopsy between the years of 2009 – 2016 were examined. NAFLD was diagnosed on the basis of histology after the exclusion of alcohol, viral, metabolic and autoimmune liver disease by chart review. Clinical and laboratory data was collected from the time of the liver biopsy. The NAFLD Activity Score was used to histologically classify our patients into different degrees of steatohepatitis. From the initial 1038 patients, 276 patients were identified to have steatosis on histology (< 5% steatosis excluded). We calculated the FRS score based on a standard score sheet that is gender specific and includes the following variables: age, blood pressure, total cholesterol, HDL-cholesterol, smoking history and history of diabetes. To conform to the FRS, we included only patients between 30-74 years old. Non-invasive scores for liver fibrosis such as AST platelet ratio index, BARD, Fibrosis-4 index, and NAFLD fibrosis score were calculated for the remaining 50 patients and compared to the liver histology graded by the NAFLD Activity Score and to the FRS.
RESULTS:
Regression of our variables showed a positive association between AST platelet ratio index with the FRS, 2.71 (
P
= 0.0162), and a negative association between the BARD score and FRS 1.38 (
P
= 0.0189). The remaining non-invasive scores (FIB-4, NFS) did not show a statistically significant association with the FRS. Finally, the NAS score did not show a statistically significant association with the FRS score.
CONCLUSION:
The APRI score can accurately predict the degree of liver fibrosis in a patient with NAFLD and the FRS can readily be calculated in NAFLD patients that may be at highest risk of CHD outcomes and could benefit from an intervention. Our study was limited due to a small sample size, which may attribute to the lack of statistical significant association between FIB4, NFS, and the NAS to the FRS and the 10 year risk of coronary heart disease.
Introduction: The Boston Bowel Prep Score (BBPS) is a validated tool to assess the quality of a patients bowel preparation in a standardized fashion. Given its utility and acceptance among ...gastroenterologists, we sought to identify patient factors that could potentially affect BBPS and, by extension, the indication to repeat a colonoscopy. Methods: We identified 1081 patients who had undergone outpatient colonoscopies by 11 gastroenterologists at our institution between 1 July 2017 and 31 December 2017. We analyzed the 388 (35.6%) with documented BBPS and excluded the other 693 (64.4%). BBPS was dichotomized at values greater than 6 (i.e. high) and at those less than or equal to 6 (i.e. low). We used t-tests to look for statistically significant differences in means for numerical variables for each BBPS category (Table 1). We used Fishers exact test to find statistically significant differences in the proportions having high or low BBPS for categorical variables (Table 2). A test level of 0.05 was considered significant. All analyses were conducted in R version 3.4.2 (R Core Team 2017, Vienna, Austria). Results: We found no statistically significant differences between the BBPS groups based on BMI, baseline creatinine or hemoglobin, or last hemoglobin A1c (Table 1). Patients who had previously undergone colonoscopies, who had diabetes, and who took high-volume (4.0L) bowel preparation had lower BBPS compared to those who had none of these (Table 2). We found no statistically significant differences in BBPS based on sex, ethnicity, insurance type, type of polyp found, or history of chronic kidney disease, anemia, or smoking. Conclusion: The BBPS groups had similar BMI, baseline renal function, hemoglobin, and hemoglobin A1c levels. While the high BBPS group was younger, it is unlikely to be clinically significant. There were no statistically significant differences in BBPS based on socioeconomic factors such as sex, ethnicity, or insurance type. Poorer compliance with high-volume (4.0L) bowel preparation may have led to lower BBPS than for low-volume (2.9L). Diabetics were more likely to have lower BBPS, possibly from difficulty complying with dietary restrictions leading up to the procedure along with autonomic dysmotility. Patients with prior colonoscopies had lower BBPS, which may reflect a pattern of poor compliance in the past. All colonoscopies at our institution will eventually incorporate BBPS and this will in turn allow us to further elucidate factors that may affect BBPS.
Introduction: Colonoscopies remain the gold standard in helping identify and remove pre-cancerous and malignant polyps. The adenoma detection rate (ADR) is a recognized quality metric to assess ...screening colonoscopies. Few studies have examined associations between ADR and both bowel prep quality as assessed by the Boston Bowel Prep Score (BBPS) and socioeconomic factors. Methods: We performed a single-center, retrospective study on all outpatient colonoscopies from 1 July 2017 to 31 December 2017 at our institution. We excluded colonoscopies that did not document BBPS. We dichotomized the cohort into those with neoplastic polyps and those with non-neoplastic polyps. We used the t-test to analyze the continuous variables comprising each group (Table 1) and the Fisher's exact test to investigate associations between categorical variables and ADR (Table 2). A test level of 0.05 was considered significant. All analyses were conducted in R version 3.4.2 (R Core Team 2017, Vienna, Austria). Results: We identified 1081 patients who had undergone outpatient colonoscopies by 11 different endoscopists at our institution. Of these, 388 (35.6%) reported a BBPS. Neoplastic polyps were identified in 145/388 patients (60%). Anemia was significantly associated with increased ADR. ADR was higher in men than in women, but this difference was not statistically significant. We found no statistically significant differences in ADR based on sex, ethnicity, insurance type, BBPS, history of diabetes, smoking, or chronic renal disease. We also noted a trend toward significantly higher ADR with low-volume (2.9L) bowel preparation compared to the high-volume (4L) one. Conclusion: Anemia was significantly associated with increased ADR. This is likely due to endoscopists' increased scrutiny in patients with this condition as well as the possibility that the anemia was due to underlying neoplastic lesions. ADR was not associated with either high or low BBPS. This finding is likely due to the limited sample size and it is contrary to what prior studies with similar observational designs have found. Increasing ADR with low-volume bowel preparation may reflect improved compliance with consumption. Prospective randomized studies and additional larger retrospective studies are needed to evaluate these findings.
Cell dose and concentration play crucial roles in phenotypic responses to cell-based therapy for heart failure.
To compare the safety and efficacy of 2 doses of allogeneic bone marrow-derived human ...mesenchymal stem cells identically delivered in patients with ischemic cardiomyopathy.
Thirty patients with ischemic cardiomyopathy received in a blinded manner either 20 million (n=15) or 100 million (n=15) allogeneic human mesenchymal stem cells via transendocardial injection (0.5 cc per injection × 10 injections per patient). Patients were followed for 12 months for safety and efficacy end points. There were no treatment-emergent serious adverse events at 30 days or treatment-related serious adverse events at 12 months. The Major Adverse Cardiac Event rate was 20.0% (95% confidence interval CI, 6.9% to 50.0%) in 20 million and 13.3% (95% CI, 3.5% to 43.6%) in 100 million (
=0.58). Worsening heart failure rehospitalization was 20.0% (95% CI, 6.9% to 50.0%) in 20 million and 7.1% (95% CI, 1.0% to 40.9%) in 100 million (
=0.27). Whereas scar size reduced to a similar degree in both groups: 20 million by -6.4 g (interquartile range, -13.5 to -3.4 g;
=0.001) and 100 million by -6.1 g (interquartile range, -8.1 to -4.6 g;
=0.0002), the ejection fraction improved only with 100 million by 3.7 U (interquartile range, 1.1 to 6.1;
=0.04). New York Heart Association class improved at 12 months in 35.7% (95% CI, 12.7% to 64.9%) in 20 million and 42.9% (95% CI, 17.7% to 71.1%) in 100 million. Importantly, proBNP (pro-brain natriuretic peptide) increased at 12 months in 20 million by 0.32 log pg/mL (95% CI, 0.02 to 0.62;
=0.039), but not in 100 million (-0.07 log pg/mL; 95% CI, -0.36 to 0.23;
=0.65; between group
=0.07).
Although both cell doses reduced scar size, only the 100 million dose increased ejection fraction. This study highlights the crucial role of cell dose in the responses to cell therapy. Determining optimal dose and delivery is essential to advance the field, decipher mechanism(s) of action and enhance planning of pivotal Phase III trials.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02013674.
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