Research Spotlight

Flannery, B., C. Smith, R. J. Garten, M. Z. Levine, J. R. Chung, M. L. Jackson, L. A. Jackson, A. S. Monto, E. T. Martin, E. A. Belongia, H. Q. McLean, M. Gaglani, K. Murthy, R. Zimmerman, M. P. Nowalk, M. R. Griffin, H. Keipp Talbot, J. J. Treanor, D. E. Wentworth and A. M. Fry (2018). “Influence of Birth Cohort on Effectiveness of 2015-2016 Influenza Vaccine Against Medically Attended Illness Due to 2009 Pandemic Influenza A(H1N1) Virus in the United States.” J Infect Dis 218(2): 189-196.

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Background: The effectiveness of influenza vaccine during 2015-2016 was reduced in some age groups as compared to that in previous 2009 pandemic influenza A(H1N1) virus (A[H1N1]pdm09 virus)-predominant seasons. We hypothesized that the age at first exposure to specific influenza A(H1N1) viruses could influence vaccine effectiveness (VE). Methods: We estimated the effectiveness of influenza vaccine against polymerase chain reaction-confirmed influenza A(H1N1)pdm09-associated medically attended illness from the 2010-2011 season through the 2015-2016 season, according to patient birth cohort using data from the Influenza Vaccine Effectiveness Network. Birth cohorts were defined a priori on the basis of likely immunologic priming with groups of influenza A(H1N1) viruses that circulated during 1918-2015. VE was calculated as 100 x [1 – adjusted odds ratio] from logistic regression models comparing the odds of vaccination among influenza virus-positive versus influenza test-negative patients. Results: A total of 2115 A(H1N1)pdm09 virus-positive and 14 696 influenza virus-negative patients aged >/=6 months were included. VE was 61% (95% confidence interval [CI], 56%-66%) against A(H1N1)pdm09-associated illness during the 2010-2011 through 2013-2014 seasons, compared with 47% (95% CI, 36%-56%) during 2015-2016. During 2015-2016, A(H1N1)pdm09-specific VE was 22% (95% CI, -7%-43%) among adults born during 1958-1979 versus 61% (95% CI, 54%-66%) for all other birth cohorts combined. Conclusion: Findings suggest an association between reduced VE against influenza A(H1N1)pdm09-related illness during 2015-2016 and early exposure to specific influenza A(H1N1) viruses.

Dehorney, I. and P. F. Ashcraft (2018). “Effect of Joint Camp on Patient Outcomes Following Total Joint Replacement.” J Nurs Care Qual 33(3): 279-284.

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Two major cost concerns related to joint replacement surgery are patient length of stay (LOS) and 30-day hospital readmission rates. A quality improvement project was implemented to evaluate the impact of a joint replacement program on patient readmissions and hospital LOS. A total of 1425 patients older than 50 years participated. At the end of the project period, readmission rates decreased from 6.19% to 2.8% and average LOS decreased from 5.87 days to 2.7 days.

Bresalier, R. S. and R. F. Souza (2018). “A Goblet (Cell) Half Full: What Do We Really Know About Barrett’s Esophagus-A Tribute to Emmet Keeffe.” Dig Dis Sci Jun 9. [Epub ahead of print].

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It is our pleasure to introduce this fourth annual special supplement to Digestive Diseases and Sciences (DDS) dedicated to its former Editor-in-Chief, the late, great Emmet B. Keeffe. Through our many interactions with Emmet, either as Associate Editor (RSB) or as President of the Gastroenterology Research Group (RFS), which named Digestive Diseases and Sciences its official journal (a relationship enthusiastically encouraged and promoted by Emmet), we witnessed first-hand Emmet’s tireless efforts to create a journal relevant to both clinicians and scientists. In 2007 Emmet called me (RSB) to ask if I might serve as an Associate Editor for DDS as he had been recently tasked to “reinvent” the journal. His idea was that while other excellent gastroenterology-based journals existed, DDS could fill a niche as a truly translational journal with appeal to a broad audience. I had known Emmet for many years and knew him to be a true Renaissance man, clinician, scientist, and consummate educator and communicator. Needless to say I jumped at the chance to work with him on this exciting project. Under his leadership and that of the current Editor-in-Chief, Jonathan Kaunitz, articles received per year have doubled to over 2000, usage increased greater than 4.5-fold (617,734 in 2017), page count increased 1.5-fold, editorials published increased 15-fold, and impact factor doubled, while time to first decision was reduced from 67 to 23 days. We are honored to Guest Edit this Special Issue devoted to Barrett’s esophagus. We recruited authors who are not only experts in the field, but who also have active research endeavors in the areas of pathology, endoscopy, epidemiology, and molecular biology of Barrett’s esophagus. The emphasis is not only on the state of the art of what we know, but how ideas are evolving to answer the many gaps in our knowledge [hence a goblet (cell) half full]. We are confident that Emmet would be pleased with the quality, scope, and utility of this Special Issue, and we hope that our readers will be as well. (Excerpt from text of this Editor’s Introduction to a special issue of Digestive Diseases and Sciences; no abstract available.)

Bhojani, N., J. E. Paonessa, M. M. El Tayeb, J. C. Williams, Jr., T. A. Hameed and J. E. Lingeman (2018). “Sensitivity of Noncontrast Computed Tomography for Small Renal Calculi With Endoscopy as the Gold Standard.” Urology 117: 36-40.

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OBJECTIVE: To compare the sensitivity of noncontrast computed tomography (CT) with endoscopy for detection of renal calculi. Imaging modalities for detection of nephrolithiasis have centered on abdominal x-ray, ultrasound, and noncontrast CT. Sensitivities of 58%-62% (abdominal x-ray), 45% (ultrasound), and 95%-100% (CT) have been previously reported. However, these results have never been correlated with endoscopic findings. METHODS: Idiopathic calcium oxalate stone formers with symptomatic calculi requiring ureteroscopy were studied. At the time of surgery, the number and the location of all calculi within the kidney were recorded followed by basket retrieval. Each calculus was measured and sent for micro-CT and infrared spectrophotometry. All CT scans were reviewed by the same genitourinary radiologist who was blinded to the endoscopic findings. The radiologist reported on the number, location, and size of each calculus. RESULTS: Eighteen renal units were studied in 11 patients. Average time from CT scan to ureteroscopy was 28.6 days. The mean number of calculi identified per kidney was 9.2 +/- 6.1 for endoscopy and 5.9 +/- 4.1 for CT (P <.004). The mean size of total renal calculi (sum of the longest stone diameters) per kidney was 22.4 +/- 17.1 mm and 18.2 +/- 13.2 mm for endoscopy and CT, respectively (P = .06). CONCLUSION: CT scan underreports the number of renal calculi, probably missing some small stones and being unable to distinguish those lying in close proximity to one another. However, the total stone burden seen by CT is, on average, accurate when compared with that found on endoscopic examination.

Asrani, S. K., G. Saracino, J. G. O’Leary, S. Gonzales, P. T. Kim, G. J. McKenna, G. Klintmalm and J. Trotter (2018). “Recipient characteristics and morbidity and mortality after liver transplantation.” J Hepatol 69(1): 43-50.

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BACKGROUND AND AIMS: Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple co-morbidities has increased in the United States. We sought to identify an easily applicable set of recipient factors among HCV negative adult transplant recipients associated with significant morbidity and mortality within five years after liver transplantation. METHODS: We collected national (n=31,829, 2002-2015) and center-specific data. Coefficients of relevant recipient factors were converted to weighted points and scaled from 0-5. Recipient factors associated with graft failure included: ventilator support (five patients; hazard ratio [HR] 1.59; 95% CI 1.48-1.72); recipient age >60years (three patients; HR 1.29; 95% CI 1.23-1.36); hemodialysis (three patients; HR 1.26; 95% CI 1.16-1.37); diabetes (two patients; HR 1.20; 95% CI 1.14-1.27); or serum creatinine >/=1.5mg/dl without hemodialysis (two patients; HR 1.15; 95% CI 1.09-1.22). RESULTS: Graft survival within five years based on points (any combination) was 77.2% (0-4), 69.1% (5-8) and 57.9% (>8). In recipients with >8points, graft survival was 42% (model for end-stage liver disease [MELD] score <25) and 50% (MELD score 25-35) in recipients receiving grafts from donors with a donor risk index >1.7. In center-specific data within the first year, subjects with >/=5points (vs. 0-4) had longer hospitalization (11 vs. 8days, p<0.01), higher admissions for rehabilitation (12.3% vs. 2.7%, p<0.01), and higher incidence of cardiac disease (14.2% vs. 5.3%, p<0.01) and stage 3 chronic kidney disease (78.6% vs. 39.5%, p=0.03) within five years. CONCLUSION: The impact of co-morbidities in an MELD-based organ allocation system need to be reassessed. The proposed clinical tool may be helpful for center-specific assessment of risk of graft failure in non-HCV patients and for discussion regarding relevant morbidity in selected subsets. LAY SUMMARY: Over the last decade, liver transplantation of sicker, older patient with multiple co-morbidities has increased. In this study, we show that a set of recipient factors (recipient age >60years, ventilator status, diabetes, hemodialysis and creatinine >1.5mg/dl) can help identify patients that may not do well after transplant. Transplanting sicker organs in patients with certain combinations of these characteristics leads to lower survival.