Abstract Background We examined prescription adherence rates by contraceptive method among women who used oral contraceptive pills (OCP), transdermal patch or vaginal ring. Study Design Women in the ...St. Louis area were provided their choice of OCP, patch or ring at no cost and followed for 18 months. Time between monthly refills was obtained from pharmacy data and analyzed as a marker of adherence. Risk factors for initial nonadherence were estimated using Cox proportional hazards; predictors for repeated nonadherence were analyzed using Poisson regression with robust error variance. Results Overall, 619 participants filled 6435 contraceptive prescriptions with a median of 10 refills per participant. Only 30% of women ( n =187) obtained all refills on time. In the time-to-failure analysis, use of vaginal ring and increased parity were predictors of early nonadherence (p<.05). In the multivariable analysis, use of the vaginal ring and history of abortion were risk factors for repeated nonadherence (p<.01). Conclusions Even with financial barriers removed, pharmacy data show that many women inconsistently refill their contraception and may be at risk for unintended pregnancy.
Although the pancreas is affected by only a small fraction of known inherited disorders, several of these syndromes predispose patients to pancreatic adenocarcinoma, a cancer that has a consistently ...dismal prognosis. Still other syndromes are associated with neuroendocrine tumors, benign cysts, or recurrent pancreatitis. Because of the variability of pancreatic manifestations and outcomes, it is important for clinicians to be familiar with several well-described genetic disorders to ensure that patients are followed appropriately. The purpose of this review was to briefly describe the hereditary syndromes that are associated with pancreatic disorders and neoplasia.
Abstract Myxoid change is a nonspecific finding in soft tissue tumours and can be encountered in sarcomas, benign soft tissue neoplasms, and even reactive lesions. For this reason, tumours that are ...intrinsically myxoid often present a diagnostic dilemma, especially if limited material is available for study. Here we provide a detailed description of four commonly encountered myxoid neoplasms: myxoma, myxoid liposarcoma, myxofibrosarcoma, and low grade fibromyxoid sarcoma. The accompanying differential diagnosis for each will aid the pathologist in the correct classification of myxoid soft tissue tumours.
Despite the recommendation of expert gastrointestinal pathologists, private and academic centers (including our own) have continued to use ancillary stains for identification of Helicobacter pylori . ...For a one month period, gastric biopsies were prospectively evaluated for H. pylori using routine hematoxylin and eosin (H&E) and a reflex Diff-Quik stain. During this time 379 gastric biopsies were collected on 326 patients. H. pylori organisms were prospectively identified in 23 patients (7%), all of whom had superficial dense lymphoplasmacytic inflammation expanding the lamina propria. An additional two patients with neutrophilic inflammation were found to have H. pylori by immunohistochemical (IHC) staining. One patient diagnosed with normal gastric mucosa was retrospectively found to have inflammation with rare H. pylori organisms originally overlooked on both H&E and Diff Quik but later identified on immunostain (0.5%). No patients with chemical gastritis (16%) or chronic inflammation (27%) were found to have H. pylori . During the study month, 9 immunostains for H. pylori were performed in addition to the 379 Diff-Quik. After discontinuation of reflex Diff-Quik, approximately 20 immunostains are performed for H. pylori each month, which decreases technical time spent processing gastric biopsies and reduces cost to the healthcare system. In our population with a low prevalence of H. pylori, reflex staining for organisms is not cost-effective. The organisms can be seen on routine H&E; when suspicious superficial or active inflammation is present without visible organisms, IHC will confirm presence or absence within a day. Discontinuation of up-front ancillary studies is cost-effective without compromising patient care.
Advanced non-alcoholic fatty liver disease (NAFLD) is a rapidly emerging global health problem associated with pre-disposing genetic polymorphisms, most strikingly an isoleucine to methionine ...substitution in patatin-like phospholipase domain-containing protein 3 (PNPLA3-I148M). Here, we study how human hepatocytes with PNPLA3 148I and 148M variants engrafted in the livers of broadly immunodeficient chimeric mice respond to hypercaloric diets. As early as four weeks, mice developed dyslipidemia, impaired glucose tolerance, and steatosis with ballooning degeneration selectively in the human graft, followed by pericellular fibrosis after eight weeks of hypercaloric feeding. Hepatocytes with the PNPLA3-148M variant, either from a homozygous 148M donor or overexpressed in a 148I donor background, developed microvesicular and severe steatosis with frequent ballooning degeneration, resulting in more active steatohepatitis than 148I hepatocytes. We conclude that PNPLA3-148M in human hepatocytes exacerbates NAFLD. These models will facilitate mechanistic studies into human genetic variant contributions to advanced fatty liver diseases.
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•Steatosis in human hepatocyte graft starts as early as 4 weeks on hypercaloric diets•Liver chimeras develop ballooning degeneration and fibrosis despite immunodeficiency•PNPLA3-148M in human hepatocytes exacerbates steatosis and steatohepatitis activity•PNPLA3-148M-overexpressing 148I hepatocytes phenocopy homozygous 148M hepatocytes
A genetic variant in PNPLA3 has been associated with non-alcoholic fatty liver disease progression. Kabbani et al. show that the presence of this variant in human hepatocytes results in more severe steatosis and active steatohepatitis in liver chimeric mice fed hypercaloric diets.
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