Assessment of angle velocity in girls with adolescent idiopathic scoliosis

<p>Abstract</p> <p>Background</p> <p>Although it has been demonstrated that the peak height velocity (PHV) is a predictive factor of progression in adolescent idiopathic scoliosis (AIS), little is known about the usefulness of angle progression in clinical practice. The purpose of this study was to establish a relationship between height and angle velocities, as well as to determine if peak angle velocity (PAV) occurs at the same time than PHV.</p> <p>Methods</p> <p>A retrospective study of a cohort of girls with idiopathic scoliotic curves greater than 10°. Data of 132 girls who participated in a previous retrospective study about growth in AIS were used to calculate height and angle velocities. Relationship between height and angle velocities was estimated by the use of a Linear Mixed Model.</p> <p>Results</p> <p>PHV and PAV take place simultaneously 1 year before menarche in progressive curves managed with a brace in AIS. Changes in angle velocity are influenced by changes in height growth velocity, in such a way that as from 6 months post-menarche, height growth velocity in this group of girls estimates curve progression velocity (β-coefficient -0.88, p = 0.04).</p> <p>Conclusion</p> <p>As from 6 months post-menarche, there is an inverse relationship between height velocity and curve progression in the group of AIS girls with progressive curves managed with a brace. Because height velocity is decreasing from 1 year before menarche, this finding corroborates that at the end of puberty, there is still a risk of progression in this group of girls despite bracing. The assessment of both height and angle velocity might be useful in clinical practice at the time of assessing brace effectiveness and how long bracing has to be indicated.</p

Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial

Background Non-alcoholic steatohepatitis (NASH) is a common type of chronic liver disease that can lead to cirrhosis. Obeticholic acid, a farnesoid X receptor agonist, has been shown to improve the histological features of NASH. Here we report results from a planned interim analysis of an ongoing, phase 3 study of obeticholic acid for NASH. Methods In this multicentre, randomised, double-blind, placebo-controlled study, adult patients with definite NASH,non-alcoholic fatty liver disease (NAFLD) activity score of at least 4, and fibrosis stages F2–F3, or F1 with at least oneaccompanying comorbidity, were randomly assigned using an interactive web response system in a 1:1:1 ratio to receive oral placebo, obeticholic acid 10 mg, or obeticholic acid 25 mg daily. Patients were excluded if cirrhosis, other chronic liver disease, elevated alcohol consumption, or confounding conditions were present. The primary endpointsfor the month-18 interim analysis were fibrosis improvement (≥1 stage) with no worsening of NASH, or NASH resolution with no worsening of fibrosis, with the study considered successful if either primary endpoint was met. Primary analyses were done by intention to treat, in patients with fibrosis stage F2–F3 who received at least one dose of treatment and reached, or would have reached, the month 18 visit by the prespecified interim analysis cutoff date. The study also evaluated other histological and biochemical markers of NASH and fibrosis, and safety. This study is ongoing, and registered with ClinicalTrials.gov, NCT02548351, and EudraCT, 20150-025601-6. Findings Between Dec 9, 2015, and Oct 26, 2018, 1968 patients with stage F1–F3 fibrosis were enrolled and received at least one dose of study treatment; 931 patients with stage F2–F3 fibrosis were included in the primary analysis (311 in the placebo group, 312 in the obeticholic acid 10 mg group, and 308 in the obeticholic acid 25 mg group). The fibrosis improvement endpoint was achieved by 37 (12%) patients in the placebo group, 55 (18%) in the obeticholic acid 10 mg group (p=0·045), and 71 (23%) in the obeticholic acid 25 mg group (p=0·0002). The NASH resolution endpoint was not met (25 [8%] patients in the placebo group, 35 [11%] in the obeticholic acid 10 mg group [p=0·18], and 36 [12%] in the obeticholic acid 25 mg group [p=0·13]). In the safety population (1968 patients with fibrosis stages F1–F3), the most common adverse event was pruritus (123 [19%] in the placebo group, 183 [28%] in the obeticholic acid 10 mg group, and 336 [51%] in the obeticholic acid 25 mg group); incidence was generally mild to moderate in severity. The overall safety profile was similar to that in previous studies, and incidence of serious adverse events was similar across treatment groups (75 [11%] patients in the placebo group, 72 [11%] in the obeticholic acid 10 mg group, and 93 [14%] in the obeticholic acid 25 mg group). Interpretation Obeticholic acid 25 mg significantly improved fibrosis and key components of NASH disease activity among patients with NASH. The results from this planned interim analysis show clinically significant histological improvement that is reasonably likely to predict clinical benefit. This study is ongoing to assess clinical outcomes

Isolated hepatic hemangiomatosis in 2 septuagenarians

We report 2 cases of isolated hepatic hemangiomatosis: a 76-year-old woman who is, to our knowledge, the oldest person with this diagnosis, and a 74-year-old woman. Magnetic resonance imaging of the abdomen showed T2 hyper intense lesions throughout the liver, peripheral nodular arterial enhancement, and filling of contrast on the portal venous and delayed phases. Computed tomography showed liver lesions with peripheral nodular enhancement in the early phase and a centripetal pattern or “filling in” during the late phase; the lesions opacified after a delay of 3 or more minutes and remained isodense or hyperdense on delayed scans. Both images were consistent with hepatic hemangiomatosis. These cases help increase awareness about benign and unusual liver lesions with radiologic characteristics similar to those of malignant liver tumors. The authors also present a review of 15 other cases of isolated hepatic hemangiomatosis reported in English literature from 1970 to present. Keywords: Hepatic hemangiomatosi

Immunosuppression in liver transplant

The increasing potency of immunosuppression (IS) agents resulted in significantly decreased rates of steroid resistant rejection and rejection related graft loss in liver transplantation (LT). Currently, more than two thirds of late mortality after LT is unrelated to graft function. However, the increased benefit of more potent IS drugs, coupled with the prolonged survival of transplant recipients led to longer patients exposure to these drugs and their unwanted adverse effects, creating a double-edged sword. In this article the authors describe the mechanism of action and the adverse effects of the most commonly used immunosuppressed drugs, and the most commonly used IS regimens for both induction and maintenance regimens. The balance between the ideal IS regimen to prevent rejection and the need to minimize the dose of IS drugs in order to prevent the adverse effects related to its use requires the knowledge of the science and the experience with the art of medicine. The different protocols aimed at protecting renal function and preventing the development of de novo cancer and metabolic syndrome are discussed here. The main causes of mortality late after liver transplant are associated with prolonged use of IS medications, and clear evidence exists about over-immunosuppression of recipients of liver transplant. The current status of strategies of IS minimization and withdrawal are reviewed in this article, with evaluation of its benefits and pitfalls

TAQIH, a tool for tabular data quality assessment and improvement in the context of health data

Background and objectives: Data curation is a tedious task but of paramount relevance for data analytics and more specially in the health context where data-driven decisions must be extremely accurate. The ambition of TAQIH is to support non-technical users on 1) the exploratory data analysis (EDA) process of tabular health data, and 2) the assessment and improvement of its quality. Methods A web-based tool has been implemented with a simple yet powerful visual interface. First, it provides interfaces to understand the dataset, to gain the understanding of the content, structure and distribution. Then, it provides data visualization and improvement utilities for the data quality dimensions of completeness, accuracy, redundancy and readability. Results It has been applied in two different scenarios. (1) The Northern Ireland General Practitioners (GPs) Prescription Data, an open data set containing drug prescriptions. (2) A glucose monitoring tele health system dataset. Findings on (1) include: Features that had significant amount of missing values (e.g. AMP_NM variable 53.39%); instances that have high percentage of variable values missing (e.g. 0.21% of the instances with > 75% of missing values); highly correlated variables (e.g. Gross and Actual cost almost completely correlated (∼ + 1.0)). Findings on (2) include: Features that had significant amount of missing values (e.g. patient height, weight and body mass index (BMI) (> 70%), date of diagnosis 13%)); highly correlated variables (e.g. height, weight and BMI). Full detail of the testing and insights related to findings are reported. Conclusions TAQIH enables and supports users to carry out EDA on tabular health data and to assess and improve its quality. Having the layout of the application menu arranged sequentially as the conventional EDA pipeline helps following a consistent analysis process. The general description of the dataset and features section is very useful for the first overview of the dataset. The missing value heatmap is also very helpful in visually identifying correlations among missing values. The correlations section has proved to be supportive as a preliminary step before further data analysis pipelines, as well as the outliers section. Finally, the data quality section provides a quantitative value to the dataset improvements. Keywords: Data quality; Exploratory data analysis; Data pre-processin

The role of laparoscopy in the diagnosis of cirrhosis

Background: A definitive diagnosis of cirrhosis is important in the prognosis and management of patients with chronic liver disease. The diagnosis of cirrhosis is made either by histologic examination of a biopsy specimen or upon visualization of a diffusely nodular and firm surface of the liver at laparotomy or laparoscopy. A liver biopsy, however, may not demonstrate the histologic features of cirrhosis in some cirrhotic patients. Our goal in this study was to compare the accuracy of liver descriptions made during laparoscopy with liver histology found by laparoscopic biopsy in patients with chronic liver disease. Methods: A retrospective review of paired laparoscopy and histology reports was performed on 434 consecutive patients who underwent laparoscopy between 1992 and 1994. (M:F ratio, 1.3:1; mean age, 48 ± 14 years). Etiology: 52% hepatitis C, 8% hepatitis B, 8% fatty liver, 4% primary biliary cirrhosis, 3% autoimmune hepatitis, and 25% miscellaneous (cancer patients were excluded). Results: One hundred sixty-nine patients had laparoscopic evidence of cirrhosis; 115 were confirmed by histology, representing a 32% sampling error. Two of 265 patients with histologic evidence of cirrhosis (0.8%) had no macroscopic evidence of cirrhosis at laparoscopy. Conclusions: (1) There was a 32% histologic sampling error among patients documented to have cirrhosis by laparoscopy. (2) Using laparoscopy as a gold standard, the sensitivity of liver biopsy was 68% and the specificity was 99%. (Gastrointest Endosc 1996;43:568-71.