Rebeka Tabbey

Inverse relationship between long-chain n-3 fatty acids and risk of sudden cardiac death in patients starting hemodialysis

Experimental and clinical evidence suggests that long chain n-3 fatty acids may protect against sudden cardiac death, the leading cause of mortality in hemodialysis patients. Here we investigated whether long chain n-3 fatty acids have a protective relationship with sudden cardiac death in 100 patients who died of sudden cardiac death during the first year of starting hemodialysis and 300 patients who survived. Individuals were selected from a nationally representative cohort of over 1000 U.S. hemodialysis units in 2004–2005. The odds of sudden cardiac death were calculated by quartile of long chain n-3 fatty acids levels over the first year. There was a significant inverse relationship between long chain n-3 fatty acids and the risk of sudden cardiac death even after adjusting for relevant co-morbid conditions, biochemical values, and dietary fats. The odds of sudden cardiac death at 1 year for the second, third, and fourth quartile groups of long chain n-3 fatty acids were 0.37, 0.22, and 0.20, respectively, compared to the lowest quartile. This significant inverse relationship was maintained even during the highest-risk first few months on hemodialysis. Thus, long chain n-3 fatty acids are strongly and independently associated with a lower risk of sudden cardiac death in hemodialysis patients throughout the first year of hemodialysis.

Pericyte coverage of differentiated vessels inside tumor vasculature is an independent unfavorable prognostic factor for patients with clear cell renal cell carcinoma

The objective of this study was to evaluate the effect of pericyte coverage (PC) of differentiated tumor microvessels on the prognosis of patients with clear cell renal cell carcinoma (CCRCC).

Low blood levels of long-chain n-3 polyunsaturated fatty acids in US hemodialysis patients: Clinical implications

Background: Cardioprotective and other clinical benefits of long-chain n–3 polyunsaturated fatty acids (PUFA) are inversely related to dietary intake and hence blood content. We therefore investigated, in the first study of its kind, the blood content and distribution of these fatty acids in a large representative population of US hemodialysis patients. Methods: Frozen sera were obtained from 400 individuals who were part of a large, contemporary, representative cohort of US incident hemodialysis patients. Long-chain n–3 PUFA were measured in total serum lipids and in the neutral and polar serum fractions using gas chromatography and solid phase extraction techniques. Mean long-chain n–3 PUFA levels were compared to levels in other dialysis and nondialysis populations from published reports. Results: The study population was qualitatively similar to the overall US hemodialysis population in terms of major clinical characteristics. Long-chain n–3 PUFA were present in the serum polar fraction, with essentially none being detected in the neutral fraction (p < 0.0001 for polar vs. neutral fractions for all three long-chain n–3 PUFA). Mean serum long-chain n–3 PUFA levels (weight percent (±SD): total 1.55 ± 0.95, polar 3.99 ± 1.45) were low compared to nondialysis and most other non-US hemodialysis cohorts. Conclusions: While US hemodialysis patients have a blood distribution of long-chain n–3 PUFA that is similar to that in the general population, blood content is among the lowest recorded in the medical literature. This has implications for renal dietary recommendations and makes US patients an ideal group for testing the clinical effects of long-chain n–3 PUFA supplementation.

Pulmonary diffusing capacity in healthy Caucasian children.

Previous studies of pulmonary diffusing capacity in children differed greatly in methodologies; numbers of subjects evaluated, and were performed prior to the latest ATS/ERS guidelines. The purpose of our study was to establish reference ranges for the diffusing capacity to carbon monoxide (DLCO) and alveolar volume (VA) in healthy Caucasian children using current international guidelines and contemporary equipment.

Atopy, Cytokine Production, and Airway Reactivity as Predictors of Pre-School Asthma and Airway Responsiveness

Childhood asthma is often characterized by recurrent wheezing, airway hyper‐reactivity, atopy, and altered immune characteristics; however, our understanding of the development of these relationships from early in life remains unclear. The aim of our study was to evaluate whether atopy, cytokine production by peripheral blood mononuclear cells (PBMCs), and airway responsiveness, assessed in infants and toddlers, are associated with asthma and airway responsiveness at 4‐years of age.

Sa1841 Targeted Biopsies Using Chromoendoscopy Can Replace Random Biopsies in Patients With IBD at High Risk for Colorectal Neoplasia

try using image processing software. Results To date, 25 subjects have been enrolled, 12 control and 13 cirrhotic patients with documented PHT. Average vessel diameter (AVD) was measured in 249 regions of interest from control vs. 301 regions from subjects with PHT. AVD in controls was 11.4μm (95% CI: 10.5−12.3μm) vs. 17.4μm (95% CI: 15.9−18.9μm) in PHT, p=3.9x10-7. In addition, regression analysis revealed a correlation of r=0.77 (95% CI: 0.54−0.89, p=6.4x10-6) between AVD and the severity of portal gastropathy (none, mild, moderate, severe), and revealed a correlation of r=0.79 (95% CI: 0.58−0.9, p=2.4x10-6) between AVD and variceal grade (0-3). The average columnar cell height (ACCH) within the villus epithelial stripe was measured in 219 control vs. 197 PHT regions. ACCH was 39.4μm (95% CI: 33.9−44.9μm) in controls and 52.8μm (95% CI: 48.6−57μm) in PHT, p=3.5x10-4. ACCH correlated with the severity of portal gastropathy with r=0.66 (95% CI: 0.35−0.84, p=3.6x10-4), and variceal grade with r=0.5 (95% CI: 0.14−0.75, p=0.01). Conclusion: In the duodenal mucosa, PHT appears to be associated with (1) endoscopicallyinapparent microvascular dilatation and (2) altered epithelial cell volume/morphology revealed In Vivo by pCLE. While PHE has been described endoscopically by congestive vascular features, changes in epithelial morphology (swelling) have not been reported quantitatively to our knowledge. Additional studies will define the correlation between microscopic PHE, vascular patterns, epithelial cell volume, and the hepatic venous pressure gradient. Quantitative pCLE may reveal subclinical PHT and serve as a novel and early biomarker of chronic liver disease and its complications.

Risk of Advanced Neoplasia Using the National Cancer Institute's Colorectal Cancer Risk Assessment Tool.

Background: There is no validated, discriminating, and easy-to-apply tool for estimating risk of colorectal neoplasia. We studied whether the National Cancer Institute’s (NCI’s) Colorectal Cancer (CRC) Risk Assessment Tool, which estimates future CRC risk, could estimate current risk for advanced colorectal neoplasia among average-risk persons. Methods: This cross-sectional study involved individuals age 50 to 80 years undergoing first-time screening colonoscopy. We measured medical and family history, lifestyle information, and physical measures and calculated each person’s future CRC risk using the NCI tool’s logistic regression equation. We related quintiles of future CRC risk to the current risk of advanced neoplasia (sessile serrated polyp or tubular adenoma ≥ 1 cm, a polyp with villous histology or high-grade dysplasia, or CRC). All statistical tests were two-sided. Results: For 4457 (98.5%) with complete data (mean age = 57.2 years, SD = 6.6 years, 51.7% women), advanced neoplasia prevalence was 8.26%. Based on quintiles of five-year estimated absolute CRC risk, current risks of advanced neoplasia were 2.1% (95% confidence interval [CI] = 1.3% to 3.3%), 4.8% (95% CI = 3.5% to 6.4%), 6.4% (95% CI = 4.9% to 8.2%), 10.0% (95% CI = 8.1% to 12.1%), and 17.6% (95% CI = 15.5% to 20.6%; P < .001). For quintiles of estimated 10-year CRC risk, corresponding current risks for advanced neoplasia were 2.2% (95% CI = 1.4% to 3.5%), 4.8% (95% CI = 3.5% to 6.4%), 6.5% (95% CI = 5.0% to 8.3%), 9.3% (95% CI = 7.5% to 11.4%), and 18.4% (95% CI = 15.9% to 21.1%; P < .001). Among persons with an estimated five-year CRC risk above the median, current risk for advanced neoplasia was 12.8%, compared with 3.7% among those below the median (relative risk = 3.4, 95 CI = 2.7 to 4.4). Conclusions: The NCI’s Risk Assessment Tool, which estimates future CRC risk, may be used to estimate current risk for advanced neoplasia, making it potentially useful for tailoring and improving CRC screening efficiency among average-risk persons.

790 Can the NCI's Risk Assessment Tool for Future Risk of Colorectal Cancer Be Used to Estimate Current Risk for Advanced Neoplasia?

Background: While evidence exists to guide the timing of the first surveillance colonoscopy, there are few data that quantify the subsequent risk of advanced neoplasia. Objective: Use clinical practice-based data to derive a risk index for finding advanced neoplasia on the second surveillance colonoscopy in patients with previous adenomatous polyps. Methods: In this retrospective cohort study assembled from a single-site community-based gastroenterology practice, we analyzed 965 consecutive subjects with baseline adenomatous polyps, two surveillance colonoscopies, and no reported family history of colorectal cancer. Using demographic data and findings from the index colonoscopy and 1st surveillance colonoscopy, we performed multivariable logistic regression with advanced adenoma (a polyp of size >= 1 cm, villous histology, or high-grade dysplasia) as the dependent (i.e., outcome) variable. Point values were assigned to each independent variable and summed to a score for each subject. The score was then related to the risk for advanced neoplasia on the 2nd surveillance colonoscopy. Results: Mean age of the cohort was 57.8 ± 9.8 years, 62% were men, and 36% had advanced adenoma on index colonoscopy. Median (IQR) intervals between the index and 1st surveillance colonoscopy and between the 1st and 2nd surveillance colonoscopy were 36.3 (IQR, 16.7-40.5) months and 38.5 (IQR, 35.9-60.0) months, respectively (P = 65 years) and prior findings (non-neoplastic, non-advanced, advanced [scored 0, 1, and 2, respectively]) on index colonoscopy and 1st surveillance colonoscopy, with scores potentially ranging from 1-7. The risks of advanced adenoma on the 2nd surveillance colonoscopy with scores 5 were 4.8% (95% CI, 3.5-6.4%) and 14.9% (CI, 7.4-25.7%), respectively, and comprised 93% and 7% of the cohort, respectively. Median (IQR) intervals between the index and 1st surveillance colonoscopies in low-risk and high-risk groups were 36.5 (IQR, 17.7-40.9) and 21.0 (IQR, 14.0-37.7) months, respectively (P=0.0003), while those between the 1st and 2nd surveillance colonoscopies were 39.0 (IQR, 36.1-60.3) and 31.7 (IQR, 23.1-37.4) months (P<0.0001). Conclusion: With a cutpoint of 5, this new risk index stratifies risk for advanced adenoma on the 2nd surveillance colonoscopy. If validated in other settings, it may be useful for tailoring colonoscopic surveillance.