Hepatitis C Infection Patterns at a Tertiary Care Center in New York: A Cross-Sectional Study.

Introduction In the United States, 2.7 to 3.9 million patients are infected with the hepatitis C virus (HCV) with 3,500 new cases reported yearly. According to the Centers for Disease Control and Prevention, HCV was the underlying or contributing cause of death of 19,659 patients in 2014. These facts underscore the need for a better understanding of the scope of this disease. Our epidemiologic study aimed at analyzing the pattern of occurrence of HCV infection at Staten Island University Hospital (SIUH) by evaluating the characteristics of newly infected patients with hepatitis C in 2014. The identified features served to better distinguish the targets for preventive health care in our particular population. Methodology A cross-sectional study of all newly diagnosed patients with HCV infections in the year 2014 presenting to SIUH was conducted using International Classification of Disease-9 codes (ICD-9) for hepatitis C. We included all patients with a positive HCV antibody confirmed by polymerase chain reaction testing. Patients were divided into groups according to age to simulate the age groups in the 2013 - 2014 Hepatitis B and C Annual Report of the New York City (NYC) Department of Health and Mental Hygiene published in 2016 (abbreviated to 2014 NYCDOH Report, hereafter). Gender and HCV genotypes were also collected. We compared disease frequency between age groups, gender, and genotype with the results of the 2014 NYCDOH Report. Results A total of 378 newly diagnosed HCV cases were identified; 60.05% were men, and 39.95% were women. The rate of infection with genotype 1a was the highest (36. 5%) followed by 1b (25.9%). In women, genotype 1b was predominant (13.76%) versus genotype 1a as the most common in men. The mean age was 54 years for men and 57 years for women. Most cases fell into the 60 to 69-year age group (32.28%), followed by the 50 to 59-year age group (31.48%). More so, all patients 80 years and older were exclusively women. Conclusions We found most new HCV infections at SIUH were diagnosed in patients aged 60 to 69 years, and the 2014 NYC DOH Report indicates most new HCV infections occur in patients aged 40 to 59 years. Also, all HCV infections detected in patients older than 80 years of age were found in women. These findings provide a better understanding of the patient demographics for appropriate HCV screening policies. Increased awareness and strict adherence to screening policies in baby boomers and high-risk populations are paramount in order to diagnose HCV infection early, offer therapy, and prevent HCV-related mortality and morbidity

Analysis of residual acrylamide in field crops

Polyacrylamide (PAM) is a widely used product for a large number of applications. Many of the emerging applications are in the area of agriculture. PAM is blended with pesticides as a thickening agent, added to irrigation water to minimize soil erosion, and used as a medium for hydroponically grown crops. Although PAM is stable and considered to be safe, residual acrylamide (AMD) monomer is a neurotoxin and animal carcinogen. In this work, residual AMD is analyzed in a variety of crops that were grown under PAM treatment to stabilize soil erosion. Corn, potatoes, sugar beets, and beans are analyzed for AMD. A sample of the crop is homogenized with water, and the water layer is filtered and derivatized with bromine to form 2,3-dibromopropionamide. The derivative is then extracted with ethyl acetate and converted to the more stable 2-propenamide prior to gas chromatographic analysis using an electron capture detector. Capillary Carbowax columns were used. All tested crops show < 10 ppb AMD. Furthermore, it seems that AMD is not stable when it comes in contact with the crop tissues. In the presence of plant tissues, AMD will disappear as a function of time. Beans blended with 100 ppb AMD for 10 min yield a recovery of only 22%. For a bean sample that was soaked with 500 ppb AMD solution for 18 h, the recovery is 7%. Other crops show different AMD recoveries

Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience.

Background and aims  Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America. Methods  This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre- and post-ESD histology, and factors associated with failed resection. Results  In total, 171 patients (median age 63 years; 56 % men) underwent rectal ESD (median size 43 mm). En bloc resection was achieved in 141 cases (82.5 %; 95 %CI 76.8-88.2), including 24 of 27 (88.9 %) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9 % (95 %CI 68.4-81.4). Post-ESD bleeding and perforation occurred in 4 (2.3 %) and 7 (4.1 %), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6 % of post-ESD specimens. There was one case (1/120; 0.8 %) of recurrence at a median follow-up of 31 weeks; IQR: 19-76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fibrosis was associated with a higher likelihood of both failed en bloc and R0 resection. Conclusion  Rectal ESD in North America is safe and is associated with high en bloc and R0 resection rates. The presence of submucosal fibrosis was the main predictor of failed en bloc and R0 resection. ESD can be considered for select rectal lesions, and serves not only to establish a definitive tissue diagnosis but also to provide curative resection for lesions with covert advanced disease

Comparing the probability of stroke by the Framingham risk score in hypertensive Korean patients visiting private clinics and tertiary hospitals

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to investigate the pattern of distribution of risk factors for stroke and the 10-year probability of stroke by the Framingham risk score in hypertensive patients visiting private clinics vs. tertiary hospitals.</p> <p>Methods</p> <p>A total of 2,490 hypertensive patients who attended 61 private clinics (1088 patients) and 37 tertiary hospitals (1402 patients) were enrolled. The risk factors for stroke were evaluated using a series of laboratory tests and physical examinations, and the 10-year probability of stroke was determined by applying the Framingham stroke risk equation.</p> <p>Results</p> <p>The proportion of patients who had uncontrolled hypertension despite the use of antihypertensive agents was 49% (66 and 36% of patients cared for at private clinics and tertiary hospitals, respectively; p < 0.001). The average 10-year probability of stroke by the Framingham risk score in hypertensive patients was 21% (approximately 2.2 times higher than of the risk of stroke in the Korean Cancer Prevention Study [KCPS] cohort) and was higher in patients attending tertiary hospitals compared to private clinics (16 and 24% of patients attending private clinics and tertiary hospitals, respectively; p < 0.001).</p> <p>Conclusions</p> <p>Since the 10-year probability of stroke by the Framingham risk score in hypertensive patients attending tertiary hospitals was higher than the risk for patients attending private clinics. We suggest that the more aggressive interventions are needed to prevent and early detect an attack of stroke in hypertensive patients attending tertiary hospitals.</p

Null convention logic circuits using balanced ternary on SOI

We propose and analyze novel Ternary logic circuits targeting an asynchronous Null Convention Logic (NCL) pipeline where the Null value (i.e. Data not valid) is used to make the pipeline self-synchronizing and delay insensitive. A balanced Ternary logic system is used, in which the logic set {High Data, Null, Low Data} maps to voltage levels {+V DD, 0V, -V DD}. Low power circuits such as Ternary to Binary converter, DATA/NULL Detector and Ternary Register are described based a 45nm SOI process technology that offers multiple simultaneous transistor thresholds

Ternary Circuits for Null Convention Logic

Null Convention Logic (NCL) adds a control value (NULL i.e., DATA not valid) to its Boolean set to create a symbolically complete logic system that is inherently self determined, locally autonomous, self synchronizing and delay insensitive. NCL circuits typically employ a dual-rail binary scheme to represent these three levels. In this paper, we propose using an offset ternary logic system where the logic set {t, N, O} maps to voltage levels {+V DO&#039; V 00/2, OV}. Low-power circuits for basic components such as DATAINULL Detector circuit and a Ternary Register are described based on the characteristics of a commercial silicon-on-sapphire MOS process that offers multiple simultaneous transistor thresholds