Accuracy and Inter-observer Agreement Among Endoscopists for Visual Identification of Colorectal Polyps Using Endoscopy Images.

Background: It is essential to accurately distinguish small benign hyperplastic colon polyps (HP) from sessile serrated lesions (SSL) or adenomatous polyps (TA) based on endoscopic appearances. Our objective was to determine the accuracy and inter-observer agreements for the endoscopic diagnosis of small polyps.

Methods: High-quality endoscopic images of 30 small HPs, SSLs, and TAs were used randomly to create two-timed PowerPoint slide sets-one with and another one without information on polyp size and location.

Effect of Sofosbuvir/Ledipasvir and Glecaprevir/Pibrentasvir on Serum Creatinine.

Background & Objectives: There are reports of worsening renal functions with sofosbuvir, but there are no comparative data of different direct-acting antivirals (DAAs) on serum creatinine. In this retrospective cohort analysis, we examined the treatment effect of two commonly used regimens, sofosbuvir/ledipasvir (SOF/LDV) and glecaprevir/pibrentasvir (GLE/PIB), on serum creatinine.

Methods: We included all patients treated with SOF/LDV (n = 825) and GLE/PIB (n = 116) between December 1, 2014, and December 31, 2018.

Off-Label Use of Multitarget Stool DNA Testing in Primary Care.

Introduction: We evaluated the off-label use of multitarget stool DNA (mt-sDNA) testing in the primary care setting.

Methods: We reviewed all mt-sDNA orders between July 1, 2018, and June 30, 2019, to determine the frequency of off-label mt-sDNA orders.

Results: Nine hundred two patients with mt-sDNA orders were evaluated, of which 160/902 patients (17.

Effectiveness of Buffered Lidocaine for Local Anesthesia During Liver Biopsy.

The aim of this research study was to evaluate the effectiveness of lidocaine versus lidocaine with sodium bicarbonate in reducing anxiety and pain, using visual analog scales, in subjects receiving local anesthetic during liver biopsies. The project included 199 subjects presenting for percutaneous liver biopsy using local anesthesia. Subjects were randomized into 2 groups: the control group, which received lidocaine alone, and the experimental group, which received lidocaine buffered with sodium bicarbonate.

Superiority of Higher-Volume Fresh Feces Compared to Lower-Volume Frozen Feces in Fecal Microbiota Transplantation for Recurrent Clostridioides Difficile Colitis.

Goals: To compare the clinical outcomes of different protocols for fecal microbiota transplantation (FMT) in two community hospitals with similar patient demographics.

Background: FMT is commonly performed for recurrent or refractory Clostridioides difficile infection (rCDI). The clinical efficacy of FMT for this indication has been well established.

Two-Dose Hepatitis B Vaccine (Heplisav-B) Results in Better Seroconversion Than Three-Dose Vaccine (Engerix-B) in Chronic Liver Disease.

Background: The efficacy of the two-dose hepatitis B virus (HBV) vaccine (Heplisav-B) in patients with chronic liver disease (CLD) is unknown.

Aims: To compare the immunogenicity achieved with Heplisav-B and the conventional three-dose vaccine (Engerix-B) in patients with CLD, and to identify factors that predict seroconversion.

Methods: We retrospectively identified all adults who completed Heplisav-B or Engerix-B regimens from August 1, 2015, to January 31, 2019.

How Good Are Controlled Attenuation Parameter Scores from Fibroscan to Assess Steatosis, NASH, and Fibrosis?

Background And Aims: The objective of our study was to determine the concordance rates of steatosis staging by controlled attenuation parameter (CAP) scores from transient elastography (TE) in comparison with liver histology in patients with chronic liver disease and to determine the optimal CAP cutoffs to predict the severity of steatosis and identify those with nonalcoholic steatohepatitis (NASH).

Methods: Patients (n = 217) who had both CAP scores and liver biopsy within a period of 90 days were retrospectively studied. Histology was graded in a blinded fashion by a single pathologist; steatosis was graded on a scale from 0 to 3.

A Combination of N-Acetylcysteine and Prednisone Has No Benefit Over Prednisone Alone in Severe Alcoholic Hepatitis: A Retrospective Analysis.

Introduction: In this study, we assessed whether there were any survival advantages with a combination treatment of intravenous N-acetylcysteine (NAC) and prednisone over prednisone alone in those with severe alcoholic hepatitis [discriminant function (DF) ≥ 32].

Patients And Methods: Between January 1, 2013, and February 28, 2019, we identified 68 patients (mean age 47.2 years ± 10.

Repositioning of an anti-depressant drug, agomelatine as therapy for brain injury induced by craniotomy.

Traumatic brain injury (TBI) leads to the disruption of blood-brain barrier integrity and therefore results in increased brain water content (brain edema). Brain edema is a significant factor for increased intracranial pressure (ICP), which ultimately causes functional disability and death. The decompressive craniotomy (DC) is a surgical procedure widely used for treating increased ICP following TBI.

HCV compliance and treatment success rates are higher with DAAs in structured HCV clinics compared to general hepatology clinics.

The real-world cure rates for hepatitis C (HCV) with direct-acting antivirals (DAAs) based on intention-to-treat (ITT) analysis may be lower than reported in the literature because of non-compliance.To determine whether patients treated in a structured outpatient HCV clinic (SHC) had higher compliance and treatment success rates compared to those treated in general hepatology clinics (GHC).In this study, we compared the treatment and compliance success rates of 488 and 840 patients treated in the SHC and GHC, respectively.

Driving Performance Among Patients with Cirrhosis Who Drove to Their Outpatient Hepatology Clinic Appointments.

Background: Minimal hepatic encephalopathy (MHE) may adversely affect driving skills.

Aims: To compare the driving performance of cirrhotic patients with and without prior HE as well as controls using a driving stimulator and to correlate psychometric testing with driving performance.

Methods: Adult patients with cirrhosis, who drove to the outpatient clinic for their routine appointments underwent a battery of driving and psychometric tests including number connection tests A & B (NCT-A and NCT-B), digit symbol test (DST) and critical flicker and fusion frequency (CFF) testing.

Oncostatin M protects against demyelination by inducing a protective microglial phenotype.

Multiple sclerosis (MS) is a chronic disabling disease of the central nervous system (CNS), in which destruction of myelin sheaths leads to disturbed axonal conduction. Available MS therapies modulate the immune response, but are unable to prevent neurological decline. Therefore, great efforts are made to develop therapies that limit demyelination and axonal degeneration.

Local overexpression of interleukin-11 in the central nervous system limits demyelination and enhances remyelination.

Demyelination is one of the pathological hallmarks of multiple sclerosis (MS). To date, no therapy is available which directly potentiates endogenous remyelination. Interleukin-11 (IL-11), a member of the gp130 family of cytokines, is upregulated in MS lesions.

Outcomes of liver transplantation for glycogen storage disease: a matched-control study and a review of literature.

Background: The clinical characteristics and outcomes of patients with glycogen storage disease (GSD) who undergo liver transplantation (LT) have not been well defined. In this study, our objective was to determine the outcome of LT in patients with GSD and compare it with a comparable group of patients without GSD (matched controls).

Methods: UNOS data from 1986 to 2007 were used for this study.

Protective effect of Etoricoxib against middle cerebral artery occlusion induced transient focal cerebral ischemia in rats.

Stroke is the third leading cause of global death and disability. Cyclooxygenase-2 mRNA has been shown to be up-regulated after stroke and also the time window of its expression extends from 4 to 12 h. The objective of this study was to elucidate the protective effect of Etoricoxib (a selective Cyclooxygenase-2 inhibitor) against transient middle cerebral artery occlusion induced behavioral, biochemical and histological alterations.

Endocrine diseases and the liver.

Liver disease and endocrine disorders, both common in the general population, have a bidirectional and complex relationship. Certain liver diseases are more commonly associated with endocrine disorders, including nonalcoholic fatty liver disease, autoimmune hepatitis, and primary biliary cirrhosis. There may be an association between hepatitis C and type 2 diabetes mellitus as well as thyroid disorders, and sex hormonal preparations may cause specific hepatic lesions.

Endoscopic ultrasound and fine-needle aspiration for the diagnosis of hepatocellular carcinoma.

Hepatocellular cancer (HCC) is the sixth most common cancer in the world with an estimated incidence of more than 650,000 cases per year. The major risk factor associated with the development of HCC is cirrhosis caused by viral hepatitis B or C and chronic alcohol consumption. The overall prognosis of patients with HCC remains poor with 5-year survival estimates that range between 0% and 10%.

Management of acute hepatitis C.

The World Health Organization estimates that about 170 million people are infected with hepatitis C virus (HCV). Blood transfusions from unscreened donors and unsafe therapeutic procedures are the major modes of HCV transmission in the developing world, and injection drug use accounts for most newly diagnosed HCV infections in the developed countries. Acute infection with HCV leads to symptomatic hepatitis in only a minority of patients, and recent studies suggest that spontaneous clearance of virus is higher in symptomatic acute hepatitis C infection.

Insulin resistance and microalbuminuria are associated with microvascular disease in patients with cirrhosis.

Cardiovascular (CV) disease has a significant impact on post-liver transplantation (LT) survival. Finding surrogate markers for occult CV disease would improve CV assessment in the LT evaluation. This study was designed to determine the prevalence of microvascular disease (MVD) and the utility of both microalbuminuria and the homeostatic model for insulin resistance (HOMA-IR) for assessing the presence of MVD in potential LT recipients.

Survival after liver transplantation for hepatocellular carcinoma in the model for end-stage liver disease and pre-model for end-stage liver disease eras and the independent impact of hepatitis C virus.

It has been suggested that hepatitis C virus (HCV) patients with hepatocellular carcinoma (HCC) may have worse outcomes after liver transplantation (LT) because of more aggressive tumor biology. In this study, we determined the post-LT survival of HCC patients with and without HCV using United Network for Organ Sharing data from January 1994 to March 2008. Patients with HCC were stratified into HCV (HCC-HCV) and non-HCV (HCC-non-HCV) groups.

Acute hepatitis C.

Symptomatic acute hepatitis C occurs in only about 15% of patients who are infected with hepatitis C virus (HCV). Acute hepatitis C is most often diagnosed in the setting of post-exposure surveillance, or seroconversion in high-risk individuals (eg, health-care professionals or injecting drug users) previously known to be seronegative. Although transmission via transfusion and injecting drug use has declined in developed countries, unsafe blood products and medical practices continue to increase transmission of HCV in many developing countries.

Biliary complications and outcomes of liver transplantation from donors after cardiac death.

Biliary complications after liver transplantation (LT) using organs retrieved from donors after cardiac death are not well characterized. The aim of this study was to evaluate the severity of biliary complications and outcomes after donation after cardiac death liver transplantation (DCD-LT). A retrospective evaluation of 20 DCD-LTs from 1997-2006 was performed.

Sirolimus monotherapy versus sirolimus in combination with steroids and/or MMF for immunosuppression after liver transplantation.

Calcineurin inhibitor (CI)-associated renal dysfunction has emerged as a major cause of morbidity and mortality after liver transplantation. In this retrospective study, we compared the efficacy, safety, and renal protective effect of sirolimus monotherapy (Group A; n = 26) with sirolimus in combination (Group B; n = 34) with steroids and/or mycophenolate mofetil (MMF) in liver transplant recipients who were switched from CI. Patients were switched abruptly or over a period of 2-4 weeks and followed for 17 +/- 10 months.