Transforming growth factor beta 1 levels in the blood of pediatric liver recipients: Clinical and biochemical correlations

TGF‐β1 is a cytokine with profibrogenic and immunosuppressive activities, which suggest the clinical significance of TGF‐β1 for the assessment of graft function after LT. We analyzed the dynamics of TGF‐β1 levels in the blood after LDLT in 135 pediatric liver recipients and examined the relationship between the cytokine levels and the laboratory and clinical variables. We found that TGF‐β1 levels in the blood of patients with ESLD were lower than that in healthy children of the same age, P = .001. Moreover, blood levels of TGF‐β1 were associated with liver disease etiology (r = .23) and hepatic fibrosis severity (r = .33). Before LDLT, TGF‐β1 levels were significantly higher in children with good outcomes than in recipients who developed graft dysfunction early in the post‐transplant period, P = .047. One month after LDLT, TGF‐β1 levels in blood plasma increased in pediatric recipients, P = .002. Cytokine levels were significantly correlated with gender (r = .21) and HLA (r = ?.24) mismatches, as well as with TAC dosage (r = ?.32) later in the post‐transplant period. One year after LDLT, TGF‐β1 plasma levels were higher (P = .01) than those before LDLT and did not correlate with most of the investigated biochemical and clinical variables. Conclusion: Blood levels of TGF‐β1 are associated with hepatic fibrosis severity, graft dysfunction development, and TAC dosage and can be regarded as a potential prognostic biomarker for the assessment of graft function and the optimization of immunosuppressant dosage in pediatric recipients after LDLT.     

Tenofovir-associated renal and bone toxicity

Objectives The aims of the study were to describe the clinical presentation and renal and bone abnormalities in a case series of HIV-infected patients receiving treatment with tenofovir (TDF), and to recommend appropriate screening for toxicity related to TDF.
Methods Patients were identified from referrals to a specialist HIV renal clinic. Patients were included if treatment with TDF was assessed as the primary cause of the renal function impairment and clinical data were available prior to and following discontinuation of TDF treatment. Data were collected from case note review and clinic databases.
Results Twenty-two patients (1.6% of all those who received TDF) were identified with TDF-associated renal toxicity. All had normal serum creatinine prior to TDF therapy. All presented with proteinuria. On stopping TDF, renal function improved. Eight patients had confirmed Fanconi syndrome. Twelve patients presented with bone pain and osteomalacia was confirmed on an isotope bone scan in seven of these patients. The findings (in those patients tested) of tubular proteinuria, reduced tubular transport maximum of phosphate (TmP), and glycosuria were all consistent with the proximal tubule being the site of toxicity.
Conclusion Renal toxicity remains a concern in patients treated with TDF. Clinical presentation may be with renal dysfunction, Fanconi syndrome or osteomalacia. Our investigations suggest proximal tubular toxicity as a common pathogenic mechanism.     

Comparison of scholarly impact among surgical specialties: An examination of 2429 academic surgeons

Objectives/Hypothesis

The h‐index, a bibliometric indicator that objectively characterizes the impact of an author's scholarship, is an effective tool that may be considered by academic departments for decisions related to hiring and faculty advancement. Our objective was to characterize the scholarly productivity of academic surgeons from different specialties relative to otolaryngologists.

Study Design

Analysis of a bibliometric database.

Methods

The h‐indices of 2,429 faculty members within surgical specialties at 20 randomly selected academic institutions were calculated using the Scopus database and were examined to determine relationship with academic rank and comparison among surgical subspecialties.

Results

The h‐index statistically increased with academic rank. Mean h‐indices were as follows: assistant professor, 4.37 (range, 2.73–6.69); associate professor, 8.70 (6.53–11.02); professor, 16.44 (13.39–20.45); and chairperson, 20.79 (14.81–27.89). Mean increase between academic rank was 5.47, with the largest increase between the levels of associate professor and professor. Further examination demonstrated statistically significant increases through all academic ranks for most, but not all, individual specialties. Urologists, general surgeons, and neurosurgeons had the highest mean h‐indices.

Conclusions

h‐indices among the different surgical specialties vary and are potentially impacted by the number of practitioners as well as research emphasis within a field. The mean h‐index of academic otolaryngologists falls in the lower values for academic surgeons. Because this metric varies among different fields, it is most relevant for comparison when examining values within a field. H‐indices reliably increase with increasing academic rank through professor and offer a quantifiable and objective alternative to other metrics when evaluating faculty members for academic advancement.     

Left ventricular function of patients with chronic nonspecific lung diseases

Echocardiographic studies of left ventricular function were carried out in 20 patients with chronic unspecific pulmonary diseases (CUPD). These patients showed no true left ventricular myocardial hypertrophy, while electrocardiographic signs of the latter might be related to the recording of potentials from the hypertrophic ventricular septum produced by positional cardiac changes due to pulmonary emphysema. In addition to septal hypertrophy, end diastolic left ventricular size was shown to be diminished. A hypothesis is proposed for the pathogenesis of left ventricular pumping disorders associated with CUPD.     

Promotion of high school blood donations: testing the efficacy of a videotaped intervention

"Life to Life," an 11-minute videotape based on social learning principles, was used by 10 blood centers in presentations to 4970 high school students one week before school blood drives. At each school, some students saw the videotape and others attended a blood center's customary presentation. Students also completed a brief questionnaire assessing donation attitudes, donation history, and intent to donate. The videotape accounted for a relative increase of 18.7 percent in donations even when other factors were not controlled for. Results were analyzed with logistic models and showed a consistently positive effect over all models used. For students who had never donated, the estimated odds ratio for actual donation (videotape:control) was 1.528. When the model included both type of presentation and ethnicity, the relative increase in donation over that after the blood centers' usual presentation was 69.8 percent for first-time donors. Among previous donors considered alone, the effect on donation was not significant. Whatever their donor history, students who viewed the videotape showed significantly more positive attitudes toward donation and had greater intention to donate than students who saw the blood centers' standard presentations. These results suggest that this videotape is a useful tool for recruitment of high school blood donors.     

The yield of colorectal cancer among fast track patients with normocytic and microcytic anaemia

Introduction

We receive fast track referrals on the basis of iron deficiency anaemia (IDA) for patients with normocytic anaemia or for patients with no iron studies. This study examined the yield of colorectal cancer (CRC) among fast track patients to ascertain whether awaiting confirmation of IDA is necessary prior to performing bowel investigations.

Methods

A review was undertaken of 321 and 930 consecutive fast track referrals from Centre A and Centre B respectively. Contingency tables were analysed using Fisher’s exact test. Logistic regression analyses were performed to investigate significant predictors of CRC.

Results

Overall, 229 patients were included from Centre A and 689 from Centre B. The odds ratio for microcytic anaemia versus normocytic anaemia in the outcome of CRC was 1.3 (95% confidence interval [CI]: 0.5–3.9) for Centre A and 1.6 (95% CI: 0.8–3.3) for Centre B. In a logistic regression analysis (Centre B only), no significant difference in CRC rates was seen between microcytic and normocytic anaemia (adjusted odds ratio: 1.9, 95% CI: 0.9–3.9). There was no statistically significant difference in the yield of CRC between microcytic and normocytic anaemia (p=0.515, Fisher’s exact test) in patients with anaemia only and no colorectal symptoms. Finally, CRC cases were seen in both microcytic and normocytic groups with or without low ferritin.

Conclusions

There is no significant difference in the yield of CRC between fast track patients with microcytic and normocytic anaemia. This study provides insufficient evidence to support awaiting confirmation of IDA in fast track patients with normocytic anaemia prior to requesting bowel investigations.     

Esophageal Perforation and Rupture: a Comprehensive Medicolegal Examination of 59 Jury Verdicts and Settlements

Background

Consequences accompanying esophageal perforation make this complication a prime litigation target. We characterize factors in jury verdicts and settlements regarding esophageal perforation, including operative procedure, patient demographics, alleged cause(s) of malpractice, outcome, and other factors.

Methods

Pertinent court records were examined for the aforementioned factors.

Results

Gastroenterologists, general surgeons, and anesthesiologists were the most commonly named defendants. Two thirds of outcomes were for the defendant, and 11.9 % were settled (median—$650,000); 20.3 % resulted in awarded damages (median—$1.2 M). Esophagogastroduodenoscopy was the most commonly litigated procedure, followed by intubation and Nissen fundoplication. Necessity of repair, delayed diagnosis, death, and inadequate consent were the most frequently cited factors in litigation.

Conclusions

An understanding of the factors important in determining legal responsibility is of great interest for practitioners in multiple specialties. The requirement of surgical repair and a delay in diagnosis are two of the most common factors present in litigated cases resulting in a payment. The importance of explicitly listing esophageal perforation in the informed consent for esophagogastroduodenoscopy, abdominal surgery, and any patients at risk of intubation injury needs to be emphasized.