Research Spotlight

Trindade, A.J., Copland, A., Bhatt, A., Bucobo, J.C., Chandrasekhara, V., Krishnan, K., Parsi, M.A., Kumta, N., Law, R., Pannala, R., Rahimi, E.F., Saumoy, M., Trikudanathan, G., Yang, J. and Lichtenstein, D.R. (2021). “Single-use duodenoscopes and duodenoscopes with disposable end caps.” Gastrointest Endosc Mar 9;S0016-5107(20)35112-9. [Epub ahead of print].

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BACKGROUND AND AIMS: Multidrug-resistant infectious outbreaks associated with duodenoscopes have been documented internationally. Single-use duodenoscopes, disposable distal ends, or distal end cap sealants could eliminate or reduce exogenous patient-to-patient infection associated with ERCP. METHODS: This document reviews technologies that have been developed to help reduce or eliminate exogenous infections because of duodenoscopes. RESULTS: Four duodenoscopes with disposable end caps, 1 end sheath, and 2 disposable duodenoscopes are reviewed in this document. The evidence regarding their efficacy in procedural success rates, reduction of duodenoscope bacterial contamination, clinical outcomes associated with these devices, safety, and the financial considerations are discussed. CONCLUSIONS: Several technologies discussed in this document are anticipated to eliminate or reduce exogenous infections during endoscopy requiring a duodenoscope. Although disposable duodenoscopes can eliminate exogenous ERCP-related risk of infection, data regarding effectiveness are needed outside of expert centers. Additionally, with more widespread adoption of these new technologies, more data regarding functionality, medical economics, and environmental impact will accrue. Disposable distal end caps facilitate duodenoscope reprocessing; postmarketing surveillance culture studies and real-life patient infection analyses are important areas of future research.

Steiger, D., Siddiqi, M.F., Yip, R., Yankelevitz, D.F., Henschke, C.I. and I-ELCAP investigators (2021). “The importance of low-dose CT screening to identify emphysema in asymptomatic participants with and without a prior diagnosis of COPD.” Clin Imaging 78: 136-141.

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PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD. METHODS: We reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program. RESULTS: Of 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p < 0.0001), younger age (OR(age10) = 0.72, p < 0.0001), lower pack-years of smoking (OR(10pack-years) = 0.90, p < 0.0001), completed college or higher (OR = 1.54, p < 0.0001), no family history of lung cancer (OR = 1.12, p = 0.04), no self-reported cardiac disease (OR = 0.76, p = 0.0003) or hypertension (OR = 0.74, p < 0.0001). The severity of emphysema was significantly lower among the 9595 participants with no prior COPD diagnosis, the OR for moderate emphysema was OR(moderate) = 0.58(p = 0.0007) and for severe emphysema, it was OR(severe) = 0.23(p < 0.0001). CONCLUSION: Emphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation.

Kastelz, A., Fernhall, B., Wang, E., Tzvetanov, I., Spaggiari, M., Shetty, A., Gallon, L., Hachaj, G., Kaplan, B. and Benedetti, E. (2021). “Personalized physical rehabilitation program and employment in kidney transplant recipients: A randomized trial.” Transpl Int Mar 18. [Epub ahead of print].

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INTRODUCTION: Kidney transplantation is the preferred treatment for kidney failure however after transplant, reduced physical function, poor self-perceptions and unemployment are common concerns that remain. METHODS: This randomized controlled trial compared the effects of a 12 month exercise rehabilitation program (intervention) to standard care alone (control) in kidney transplant recipients. The exercise intervention consisted of a 2 day/week, 60 minute personalized, one-on-one, resistance based exercise trainings. RESULTS: Eighty participants completed the study (52 intervention vs. 28 control). For individuals unemployed at baseline there was a 52.3% increase in employment compared to 13.3 % increase in the control group after 12 months (p=<0.0001). For those already employed at baseline, 100% of individuals maintained employment in both groups after 12 months (p=0.4742). For all comers, there was a positive trend for Global Physical Health (p=0.0034), Global Mental Health (p=0.0064), and Physical Function (p=0.0075), with the intervention group showing greater improvements. DISCUSSION/CONCLUSION: These findings suggest the implementation of an exercise rehabilitation program post kidney transplant can be beneficial to increase employment for individuals previously unemployed, improve self-perceived health, physical function, and mental health, overall contributing to better health outcomes in kidney transplant recipients. (Clinicaltrials.gov number: NCT02409901 ).

Shahim, B., Malaisrie, S.C., George, I., Thourani, V.H., Biviano, A.B., Russo, M.J., Brown, D.L., Babaliaros, V., Guyton, R.A., Kodali, S.K., Nazif, T.M., McCabe, J.M., Williams, M.R., Généreux, P., Lu, M., Yu, X., Alu, M.C., Webb, J.G., Mack, M.J., Leon, M.B. and Kosmidou, I. (2021). “Atrial Fibrillation and Outcomes After Transcatheter or Surgical Aortic Valve Replacement (from the PARTNER 3 Trial).” Am J Cardiol Mar 7;S0002-9149(21)00215-0. [Epub ahead of print].

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The prognostic impact of preexisting atrial fibrillation or flutter (AF) in low-risk patients with severe aortic stenosis treated with transcatheter (TAVR) or surgical aortic valve replacement (SAVR) remains unknown. In this sub-analysis of the PARTNER 3 trial of patients with severe aortic stenosis at low surgical risk randomized 1:1 to TAVR versus SAVR, clinical outcomes were analyzed at 2 years according to AF status. Among 948 patients included in the analysis (452 [47.7%] in the SAVR vs 496 [52.3%] in the TAVR arm), 168 (17.6%) patients had AF [88/452 (19.5%) and 80/496 (16.1%) treated with SAVR and TAVR, respectively]. At 2 years, patients with AF had higher unadjusted rates of the composite outcome of death, stroke or rehospitalization (21.2% vs 12.9%, p = 0.007) and rehospitalization alone (15.3% vs 9.4%, p = 0.03) but not all cause death (3.8% vs 2.6%, p = 0.45) or stroke (4.8% vs 2.6%, p = 0.12). In adjusted analyses, patients with AF had a higher risk for the composite outcome of death, stroke or rehospitalization (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.20-2.71, p = 0.0046) and rehospitalization alone (HR 1.8, 95% CI 0.12-2.9, p = 0.015), but not death or stroke. There was no interaction between treatment modality and AF on the composite outcome (Pinter = 0.83). In conclusion, preexisting AF in patients with severe AS at low surgical risk was associated with increased risk of the composite outcome of death, stroke or rehospitalization at 2 years, irrespective of treatment modality.

Shah, R.A., Powell, P.R. and Parekh, P.K. (2021). “What lies beneath: Cutaneous involvement of mantle cell lymphoma underlying an insect-bite-like reaction.” J Cutan Pathol 48(4): 563-566.

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Mantle cell lymphoma (MCL) is an uncommon subtype of mature B-cell non-Hodgkin lymphoma characterized by specific morphologic, immunophenotypic, and genetic characteristics, namely the t(11;14)(q13;q32) chromosomal translocation with resultant cyclin D1 overexpression. MCL has a generally aggressive course and is often widely disseminated at the time of diagnosis. Skin involvement is exceedingly rare and is seldom the first manifestation of MCL. We present a case of MCL in an 84-year-old man with cutaneous involvement as the first manifestation, discovered incidentally after biopsy of a persistent nodule believed to be an insect bite. This case not only serves to raise awareness of the possibility of MCL presenting in the skin but also to point out that MCL can have lesions with both an insect-bite-like reaction and a deeper dermal MCL infiltrate.