Ivan Magallanes Marrufo

Background: Each year, thousands of patients are diagnosed with gastrointestinal (GI) bleeding. Many of these patients undergo colonoscopy and are subsequently diagnosed with benign or malignant colorectal neoplasms. The aim of this study is to evaluate whether patients with cardiovascular comorbidities, many of whom are on anti-platelet or anticoagulation therapy, are more likely to be diagnosed with new benign or malignant colorectal neoplasms than patients without cardiovascular comorbidities. Methods: From the 2007–2011 NIS, 802,080 primary lower GI bleed admissions (ICD-9) were identified; 283,925 had cardiovascular comorbidities. We compared patients with vs without these comorbidities for the primary outcome of new benign or malignant colorectal neoplasms. Weighted analyses accounting for the complex survey design were performed in SAS 9.4, with trends assessed using Cochran–Armitage tests and linear regression and associations with colorectal cancer stage evaluated by multinomial logistic regression (p ≤ 0.05). Results: Between 2007–2011, the odds of malignant colorectal neoplasms increased between 49.9% and 65.3% for patients without cardiovascular comorbidities when presenting with a lower GI bleed, compared to those with cardiovascular comorbidities. Between 2007 and 2011, the most notable and statistically significant difference was observed in 2010, when patients with cardiovascular comorbidities had 10.5% higher odds of being diagnosed with benign colorectal neoplasms than those without cardiovascular comorbidities. Conclusion: Patients presenting with a lower gastrointestinal bleed without cardiovascular comorbidities were significantly more likely to be diagnosed with malignant colorectal neoplasms than those with cardiovascular comorbidities.

Bedside screening tools can be used to distinguish delirium from other causes of altered mental status, enabling timely care and reducing costs.

Background: The systemic immune responses associated with persistent respiratory symptoms (PRS) after exposure to airborne environmental pollutants remain poorly understood. Objective: To identify immune disturbances associated with PRS, defined as persistent wheeze, cough, or breathlessness, we examined systemic immune responses and airway function in a cross-sectional cohort with detailed histories of airborne pollutant exposure. Methods: Never-smoking post-deployment Veterans with PRS (n=16) or without PRS (n=24) underwent chest computed tomography, pulmonary function testing, and oscillometry to assess structural and functional airway abnormalities. Peripheral blood mononuclear cells (PBMCs) were stimulated with anti-CD3/CD28 antibodies, lipopolysaccharide, or β-glucan, and cytokine production was measured. Correlation analyses evaluated associations between cytokine responses and physiological measures of airway function. Results: Oscillometry, but not conventional pulmonary function testing or chest computed tomography, detected small-airway abnormalities in participants with PRS, including significantly greater frequency dependence of resistance and higher resonant frequency. Baseline PBMC cytokine concentrations were similar between groups. After stimulation, however, PBMCs from participants with PRS showed increased IL-17A production consistent with a type 17 (T17) response; innate stimulation also increased the type 2 (T2) cytokines IL-33 and IL-4. T2/T17 cytokine responses correlated positively with oscillometric measures of small-airway dysfunction. Conclusion: Individuals with PRS exhibited a stimulus-dependent systemic T2/T17 immune signature that was associated with early small-airway dysfunction. Clinical Implication: Stimulus-dependent systemic immune profiling, combined with oscillometry, may help identify early respiratory abnormalities in pollutant-exposed individuals whose conventional pulmonary tests remain normal. KEY MESSAGES: Oscillometry detected early small-airway dysfunction in pollutant-exposed individuals with persistent respiratory symptoms, whereas conventional pulmonary function tests and chest CT did not distinguish the groups. Immune stimulation revealed a mixed T2/T17 systemic signature in participants with persistent respiratory symptoms, including increased IL-17A and stimulus-dependent increases in IL-4 and IL-33. T2/T17 cytokine responses correlated with oscillometric abnormalities, linking systemic immune dysregulation to small-airway dysfunction and suggesting a potential approach for identifying early pollutant-associated respiratory disease. CAPSULE SUMMARY: A stimulus-dependent systemic T2/T17 immune signature correlated with oscillometric evidence of small-airway dysfunction, identifying a potential early respiratory phenotype in pollutant-exposed individuals with persistent respiratory symptoms.

PURPOSE: To compare cancer survival in the United States during the past half century in adolescent and young adult (AYA) patients of age 15-39 years with younger and older patients. METHODS: Annual survival data were obtained from 8 US SEER regions during 1975-2017 for AYAs, younger (age 0-14 years), and older (age 40-59 and ≥65 years) populations. The average annual percent change (AAPC) in 5-year relative survival was determined with and without deaths from HIV/AID-associated malignancies that compromised overall cancer survival in males during the HIV/AIDS epidemic of 1981-1998. Joinpoint analysis identified time trends and statistical significances. RESULTS: During 1975-1997, the AAPC in 5-year relative survival in AYAs was 0.66 (95% CI, 0.63 to 0.69), which was less than that in both younger, age <15 years, 0.93 (95% CI, 0.82 to 1.05) and older, age 40-64 years, 1.12 (95% CI, 0.10 to 1.14) patients. Subsequently, the 2000-2017 AAPC in AYAs was 0.47 (95% CI, 0.45 to 0.49), which was greater than that in both younger, age <15 years, 0.40 (95% CI, 0.34 to 0.45) and older, age 40-64 years, 0.43 (95% CI, 0.42 to 0.44) patients. In males, whose overall cancer survival was seriously compromised by the HIV epidemic in the 1980s and 1990s, much of the overall progress occurred as a result of the epidemic's cessation. Excluding HIV-associated cancers, however, showed even greater progress than the results for males and females considered together. CONCLUSION: While compared with younger and older patients with cancer, American AYAs had the slowest improvement in 5-year relative survival before 1998, they since have had a greater improvement rate. Much of this progress can be attributed to national efforts led by NCI-funded cooperative groups to focus on AYA oncology.

Background: Each year, thousands of patients are diagnosed with gastrointestinal (GI) bleeding. Many of these patients undergo colonoscopy and are subsequently diagnosed with benign or malignant colorectal neoplasms. The aim of this study is to evaluate whether patients with cardiovascular comorbidities, many of whom are on anti-platelet or anticoagulation therapy, are more likely to be diagnosed with new benign or malignant colorectal neoplasms than patients without cardiovascular comorbidities. Methods: From the 2007–2011 NIS, 802,080 primary lower GI bleed admissions (ICD-9) were identified; 283,925 had cardiovascular comorbidities. We compared patients with vs without these comorbidities for the primary outcome of new benign or malignant colorectal neoplasms. Weighted analyses accounting for the complex survey design were performed in SAS 9.4, with trends assessed using Cochran–Armitage tests and linear regression and associations with colorectal cancer stage evaluated by multinomial logistic regression (p ≤ 0.05). Results: Between 2007-2011, the odds of malignant colorectal neoplasms increased between 49.9% and 65.3% for patients without cardiovascular comorbidities when presenting with a lower GI bleed, compared to those with cardiovascular comorbidities. Between 2007 and 2011, the most notable and statistically significant difference was observed in 2010, when patients with cardiovascular comorbidities had 10.5% higher odds of being diagnosed with benign colorectal neoplasms than those without cardiovascular comorbidities. Conclusion: Patients presenting with a lower gastrointestinal bleed without cardiovascular comorbidities were significantly more likely to be diagnosed with malignant colorectal neoplasms than those with cardiovascular comorbidities.

Trochanteric bursitis is a common cause of lateral hip pain, particularly among elderly and postmenopausal females, but abscess formation within the trochanteric bursa is exceedingly rare. We report an unusual extra-acetabular trochanteric abscess identified during cadaveric dissection of an elderly female, characterized by irregular fibrotic and proteinaceous tissue with multiple inclusion bodies but no evidence of malignancy or granulomatous inflammation. Although limited by an absent clinical history, the gross and histopathologic findings suggest a chronic inflammatory or degenerative process consistent with synovial osteochondromatosis of the trochanteric bursa.