HBV Reactivation After Bariatric Surgery for HBV-Infected Obese Patients

Obesity Surgery - The association between non-alcoholic fatty liver disease and hepatitis B virus (HBV) infection is inconclusive. The aim of this study was to investigate the viral dynamic of HBV...     

Functionally significant insulin-like growth factor I receptor mutations in centenarians

Rather than being a passive, haphazard process of wear and tear, lifespan can be modulated actively by components of the insulin/insulin-like growth factor I (IGFI) pathway in laboratory animals. Complete or partial loss-of-function mutations in genes encoding components of the insulin/IGFI pathway result in extension of life span in yeasts, worms, flies, and mice. This remarkable conservation throughout evolution suggests that altered signaling in this pathway may also influence human lifespan. On the other hand, evolutionary tradeoffs predict that the laboratory findings may not be relevant to human populations, because of the high fitness cost during early life. Here, we studied the biochemical, phenotypic, and genetic variations in a cohort of Ashkenazi Jewish centenarians, their offspring, and offspring-matched controls and demonstrated a gender-specific increase in serum IGFI associated with a smaller stature in female offspring of centenarians. Sequence analysis of the IGF1 and IGF1 receptor (IGF1R) genes of female centenarians showed overrepresentation of heterozygous mutations in the IGF1R gene among centenarians relative to controls that are associated with high serum IGFI levels and reduced activity of the IGFIR as measured in transformed lymphocytes. Thus, genetic alterations in the human IGF1R that result in altered IGF signaling pathway confer an increase in susceptibility to human longevity, suggesting a role of this pathway in modulation of human lifespan.     

Sonographic Differentiation of Thyroid Nodules With Eggshell Calcifications

Objective. The purpose of this study was to assess the role of known suspicious sonographic findings and to find other additional sonographic findings to differentiate benign and malignant thyroid nodules with “eggshell” calcifications. Methods. Our Institutional Review Board approved this retrospective study, and informed consent was not required. We reviewed sonographic findings of thyroid nodules in 795 patients who underwent thyroid surgery in our institution between August 2006 and February 2007. Ninety‐three thyroid nodules with eggshell calcifications in 92 patients were included in this study. Each lesion was evaluated for known suspicious sonographic criteria, including marked hypoechogenicity, irregular or microlobulated margins, and a taller‐than‐wide shape, as well as 2 additional sonographic findings: a hypoechoic halo and disruption of eggshell calcifications (halo and disrupted calcification rim). The sensitivity and specificity based on the sonographic criteria were calculated and compared among the 2 types of criteria. Results. Among the 93 thyroid nodules, 59 were malignant and 34 were benign. The halo and disrupted calcification rim showed higher sensitivity (62.7% and 76.3%, respectively) than any of the known suspicious sonographic criteria (40.7%, 35.6%, and 55.9%). The combination of both the halo and the disrupted calcification rim showed significantly higher sensitivity (93.2%) than the combination of the known suspicious sonographic criteria (78%; P < .05), although both had the same specificity (64.7%). Conclusions. In thyroid nodules with eggshell calcifications but no other calcifications, the findings of a peripheral halo and disruption of the eggshell calcifications may be more useful sonographic predictors of malignancy than hypoechogenicity, microlobulated margins, and a taller‐than‐wide shape.     

Comorbidity and outcomes of coronary artery bypass graft surgery at cardiac specialty hospitals versus general hospitals

BACKGROUND: Cardiac specialty hospitals assert better patient outcomes and efficiency, whereas general hospitals contend they attract healthier patients. OBJECTIVES: To ascertain whether increased cardiac specialization of a hospital's services is associated with improved outcomes for coronary artery bypass graft (CABG) surgery and whether patients with and without comorbid disease have equivalent outcomes to their counterparts at general hospitals. METHODS: We conducted a retrospective cohort study of a 5% sample of Medicare beneficiaries undergoing CABG procedures from 2001 to 2003. Using multivariate analyses, we assessed the hospital degree of cardiac specialization on mortality, length of stay, hospital readmissions, and emergency room visits leading to rehospitalization for all patients and those with more comorbidities. RESULTS: Patients at cardiac specialty hospitals had less comorbid disease (29.7% with Charlson scores > or =2) than those at moderately (37.2%) and least specialized hospitals (36.6%, P = 0.001). Overall, CABG outcomes in all 3 groups were similar for inpatient mortality (P = 0.78), 30-day postdischarge mortality (P = 0.69), emergency room visit leading to rehospitalization (P = 0.35), and hospital readmission within 30 days postdischarge (P = 0.70). However, for patients with greater comorbidity, 30-day postdischarge mortality was worse at cardiac specialty hospitals compared with least specialized hospitals from across the United States (adjusted odds ratio, 1.71; 95% confidence interval, 1.26-2.32; P = 0.001). Results were robust when hospitals were compared within metropolitan statistical areas. CONCLUSIONS: Favorable patient selection may occur at cardiac specialty hospitals. Although healthier patients fare comparably across types of hospitals, patients with greater comorbid disease seem to experience worse 30-day postdischarge mortality at specialty hospitals.