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Extracranial Carotid Disease and Effect of Intra-arterial Treatment in Patients With Proximal Anterior Circulation Stroke in MR CLEAN.
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Extracranial Carotid Disease and Effect of Intra-arterial Treatment in Patients With Proximal Anterior Circulation Stroke in MR CLEAN.

Ann Intern Med. 2017 May 23;:

Authors: Berkhemer OA, Borst J, Kappelhof M, Yoo AJ, van den Berg LA, Fransen PSS, Beumer D, Schonewille WJ, Nederkoorn PJ, Wermer MJH, Marquering HA, Lingsma HF, Roos YBWEM, van Oostenbrugge RJ, Dippel DWJ, van Zwam WH, Majoie CBLM, Emmer BJ, van der Lugt A, MR CLEAN investigators

Abstract
Background: The presence of extracranial carotid disease (ECD) is associated with less favorable clinical outcomes a in patients with acute ischemic stroke caused by intracranial proximal occlusion. Acute intra-arterial treatment (IAT) in the setting of extracranial and intracranial lesions is considered challenging, and whether it yields improved outcomes remains uncertain.
Objective: To examine whether the presence of ECD modified the effect of IAT for intracranial proximal anterior circulation occlusion.
Design: Prespecified subgroup analysis of a randomized clinical trial of endovascular treatment for acute ischemic stroke in the Netherlands. (Trial registrations: NTR1804 [Netherlands Trial Register] and ISRCTN10888758).
Setting: 16 hospitals in the Netherlands.
Patients: Acute ischemic stroke caused by proximal intracranial arterial occlusion of the anterior circulation. Extracranial carotid disease was defined as cervical internal carotid artery stenosis (>50%) or occlusion.
Intervention: IAT treatment versus no IAT.
Measurements: The primary outcome was functional outcome, as measured by the modified Rankin Scale at 90 days and reported as adjusted common odds ratio (acOR) for a shift in direction of a better outcome. Multivariable ordinal logistic regression analysis with an interaction term was used to estimate treatment effect modification by ECD.
Results: The overall acOR was 1.67 (95% CI, 1.21 to 2.30) in favor of the intervention. The acOR was 3.1 (CI, 1.7 to 5.8) in the prespecified subgroup of patients with ECD versus 1.3 (CI, 0.9 to 1.9) in patients presenting without ECD. Both acORs are in favor of the intervention (P for interaction = 0.07).
Limitation: The study was not powered for subgroup analysis.
Conclusion: Intra-arterial treatment may be at least as effective in patients with ECD as in those without ECD, and it should not be withheld in these complex patients with acute ischemic stroke.
Primary Funding Source: Dutch Heart Foundation, AngioCare BV, Medtronic/Covidien/EV3, MEDAC Gmbh/LAMEPRO, Penumbra Inc., Stryker, and Top Medical/Concentric.

PMID: 28531910 [PubMed - as supplied by publisher]




Racial and Ethnic Disparities in Interval Colorectal Cancer Incidence: A Population-Based Cohort Study.
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Racial and Ethnic Disparities in Interval Colorectal Cancer Incidence: A Population-Based Cohort Study.

Ann Intern Med. 2017 May 23;:

Authors: Fedewa SA, Flanders WD, Ward KC, Lin CC, Jemal A, Sauer AG, Doubeni CA, Goodman M

Abstract
Background: Interval colorectal cancer (CRC) accounts for 3% to 8% of all cases of CRC in the United States. Data on interval CRC by race/ethnicity are scant.
Objective: To examine whether risk for interval CRC among Medicare patients differs by race/ethnicity and whether this potential variation is accounted for by differences in the quality of colonoscopy, as measured by physicians' polyp detection rate (PDR).
Design: Population-based cohort study.
Setting: Medicare program.
Participants: Patients aged 66 to 75 years who received colonoscopy between 2002 and 2011 and were followed through 2013.
Measurements: Kaplan-Meier curves and adjusted Cox models were used to estimate cumulative probabilities and hazard ratios (HRs) of interval CRC, defined as a CRC diagnosis 6 to 59 months after colonoscopy.
Results: There were 2735 cases of interval CRC identified over 235 146 person-years of follow-up. A higher proportion of black persons (52.8%) than white persons (46.2%) received colonoscopy from physicians with a lower PDR. This rate was significantly associated with interval CRC risk. The probability of interval CRC by the end of follow-up was 7.1% in black persons and 5.8% in white persons. Compared with white persons, black persons had significantly higher risk for interval CRC (HR, 1.31 [95% CI, 1.13 to 1.51]); the disparity was more pronounced for cancer of the rectum (HR, 1.70 [CI, 1.25 to 2.31]) and distal colon (HR, 1.45 [CI, 1.00 to 2.11]) than for cancer of the proximal colon (HR, 1.17 [CI, 0.96 to 1.42]). Adjustment for PDR did not alter HRs by race/ethnicity, but differences between black persons and white persons were greater among physicians with higher PDRs.
Limitation: Colonoscopy and polypectomy were identified by using billing codes.
Conclusion: Among elderly Medicare enrollees, the risk for interval CRC was higher in black persons than in white persons; the difference was more pronounced for cancer of the distal colon and rectum and for physicians with higher PDRs.
Primary Funding Source: American Cancer Society.

PMID: 28531909 [PubMed - as supplied by publisher]




Methods and Reporting Studies Assessing Fecal Microbiota Transplantation: A Systematic Review.
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Methods and Reporting Studies Assessing Fecal Microbiota Transplantation: A Systematic Review.

Ann Intern Med. 2017 May 23;:

Authors: Bafeta A, Yavchitz A, Riveros C, Batista R, Ravaud P

Abstract
Background: Fecal microbiota transplantation (FMT) could be a novel treatment option for several chronic diseases associated with altered gut microbiota.
Purpose: To examine the conduct and reporting of studies assessing FMT.
Data Sources: Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Web of Science from inception to 31 January 2017.
Study Selection: Two reviewers independently examined titles and abstracts to identify all English-language reports of human clinical studies assessing the safety or efficacy of FMT.
Data Extraction: Three reviewers independently assessed study types and characteristics and the reporting of important methodological components of the FMT intervention.
Data Synthesis: Most (84%) of the 85 published reports found addressed the use of FMTs for Clostridium difficile infection or inflammatory bowel disease, and most (87%) were non-randomized controlled trials. Important methodological components that were not reported in published studies included the following: eligibility criteria for donors (47%), materials used for collecting stools and the period of collection (96%), methods used for conservation of stools (76%), the amount and type of stools used (for example, fresh or frozen), and duration of stool conservation (67%). Many (58%) did not report an analysis of microbiota composition.
Limitations: Lack of universal consensus regarding the most important methodological components of FMT and inability to assess the actual conduct of studies and whether the publication process affected the completeness of reporting.
Conclusion: Key components of FMT interventions, which are necessary to replicate and understand study findings about efficacy and safety, are poorly reported.
Primary Funding Source: No specific funding.

PMID: 28531908 [PubMed - as supplied by publisher]




High-Risk Pools: An Illusion of Coverage That May Increase Costs for All in the Long Term.
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High-Risk Pools: An Illusion of Coverage That May Increase Costs for All in the Long Term.

Ann Intern Med. 2017 May 23;:

Authors: Hall JP

PMID: 28531907 [PubMed - as supplied by publisher]




Tocilizumab-Induced Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome in Adult-Onset Still Disease: A Case Report.
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Tocilizumab-Induced Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome in Adult-Onset Still Disease: A Case Report.

Ann Intern Med. 2017 May 23;:

Authors: Zuelgaray E, Domont F, Peiffer-Smadja N, Saadoun D, Cacoub P

PMID: 28531906 [PubMed - as supplied by publisher]




Treatment With Fecal Microbiota Transplantation: The Need for Complete Methodological Reporting for Clinical Trials.
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Treatment With Fecal Microbiota Transplantation: The Need for Complete Methodological Reporting for Clinical Trials.

Ann Intern Med. 2017 May 23;:

Authors: Young VB

PMID: 28531905 [PubMed - as supplied by publisher]