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African Americans are less likely to receive curative treatment for hepatocellular carcinoma

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World Journal of Hepatology 2018年第11期10卷 849-855页

作者： Lindsay A Sobotka alice hinton Lanla F Conteh Department of Internal Medicine The Ohio State University Wexner Medical Center Division of Biostatistics College of Public Health The Ohio State University Department of Gastroenterology and Hepatology The Ohio State Wexner Medical Center

AIM To determine if racial disparities continue to exist in the treatment of hepatocellular carcinoma(HCC).METHODS A retrospective database analysis using the Nationwide Inpatient Sample was performed including patients with a primary diagnosis of HCC. Univariate and multivariate analyses were utilized to determine racial disparities in liver decompensation, treatment, inpatient mortality, and metastatic *** A total of 62604 patients with HCC were included consisting of 32428 Caucasian, 9726 African-American, 8988 Hispanic, and 11462 patients of other races. Caucasian patients were more likely to undergo curative therapies of liver transplant(OR: 2.66, 95%CI: 1.92-3.68), resection(OR: 1.82, 95%CI: 1.48-2.23), and ablation(OR: 1.77, 95%CI: 1.36-2.30) than African-American patients. Hispanic patients were more likely to undergo transplant(OR: 2.18, 95%CI: 1.40-3.39) and ablation(OR: 1.46, 95%CI:1.05-2.03) than African-American patients. Patients of other races were more likely to receive a liver transplant(OR: 2.41, 95%CI: 1.62-3.61), resection(OR: 1.79 95%CI: 1.39-2.32), and ablation(OR: 2.03, 95%CI: 1.47-2.80) than African-American patients. There are no differences in the rates of transarterial chemoembolization between *** Racial disparities in HCC treatment exist despite emphasis to support equality in healthcare. African-American patients are less likely to undergo curative treatments for HCC.

关键词： Racial disparity Hepatocellular carcinoma Liver transplantation Resection Ablation

Trends and outcomes of transarterial chemoembolization in hepatocellular carcinoma:a national survey

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Hepatobiliary & Pancreatic Diseases International 2017年第6期16卷 624-630页

作者： Khalid Mumtaz Nishi Patel Rohan M Modi Vihang Patel alice hinton James Hanje Sylvester M Black Somashaker Krishna Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical Center Columbus OHUSA Department of Internal Medicine The Ohio State University Wexner Medical Center Columbus OHUSA Department of Surgery The Ohio State University Wexner Medical Center Columbus OHUSA Division of Biostatistics College of Public Health The Ohio State University Columbus OH USA

BACKGROUND:Transarterial chemoembolization(TACE) is a palliative procedure frequently used in patients with advanced hepatocellular carcinoma(HCC). We examined the national inpatient trends of TACE and related outcomes in the United States over the last ***:We utilized the National Inpatient Sample(2002 to 2012) and performed trend analyses of TACE for HCC in all adult patients(age >18 years). Multivariate analyses for the outcomes of in-hospital "procedure-related complications"(PRCs) and "post-procedure complications"(PPCs) were performed. We also compared early(2002 to 2006) and late(2007 to 2012) eras by multivariate analyses to identify predictors of complications, healthcare resource utilization and ***:Overall, 19058 patients underwent TACE for HCC where PRCs and PPCs were seen in 24.2% and 17.6% of patients, respectively. The overall trends in the use of TACE(P<0.001) and associated PRCs(P=0.006) were observed to be increasing. There was less mortality [adjusted Odds ratio(a OR):0.58; 95% CI:0.41, 0.82], reduced length of hospital stay(-1.87 days; 95% CI:-2.77,-0.97) and increased hospital charges($19232; 95% CI:11013, 27451) in the late era. Additionally, there was increased mortality(a OR:4.07; 95% CI:2.96, 5.59), PRCs(a OR:3.21; 95% CI:2.56, 4.02), and PPCs(a OR:2.70; 95% CI:2.11, 3.46) among patients with ***:There is an increasing trend of TACE utilization in HCC. However, the outcomes are worse in patients with coagulopathy. Although PRCs have increased, mortality has decreased in recent years. These findings should be considered during TACE evaluation in patients with HCC.

关键词： transarterial chemoembolization hepatocellular carcinoma procedural complications mortality

Diagnosis of morbid obesity may not impact healthcare utilization for orthotopic liver transplantation:A propensity matched study

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World Journal of Hepatology 2017年第12期9卷 595-602页

作者： Joshua R Peck Nicholas Latchana Anthony Michaels Adam J Hanje alice hinton Elmahdi A Elkhammas Sylvester M Black Khalid Mumtaz Division of Gastroenterology Hepatology and Nutritionthe Ohio State University Wexner Medical Center Department of Surgery the Ohio State University Wexner Medical Center Department of Biostatistics the Ohio State University Wexner Medical Center

AIM To study mortality, length of stay, and total charges in morbidly obese adults during index hospitalization for orthotopic liver *** The Nationwide Inpatient Sample was queried to obtain demographics, healthcare utilization, post orthotopic liver transplantation(OLT) complications, and short term outcomes of OLT performed from 2003 to 2011(n = 46509). We divided patients into those with [body mass index(BMI) ≥ 40] and without(BMI < 40) morbid obesity. Multivariable logistic regression analysis was performedto characterize differences in in-hospital mortality, length of stay(LOS), and charges for OLT between patients with and without morbid obesity after adjusting for significant confounders. Additionally, propensity matching was performed to further validate the *** Of the 46509 patients who underwent OLT during the study period, 818(1.8%) were morbidly obese. Morbidly obese recipients were more likely to be female(46.8% vs 33.4%, P = 0.002), Caucasian(75.2% vs 67.8%, P = 0.002), in the low national income quartile(32.3% vs 22.5%, P = 0.04), and have ≥ 3 comorbidities(modified Elixhauser index; 83.9% vs 45.0%, P < 0.001). Morbidly obese patient also had an increase in procedure related hemorrhage(P = 0.028) and respiratory complications(P = 0.043). Multivariate and propensity matched analysis showed no difference in mortality(OR: 0.70; 95%CI: 0.27-1.84, P = 0.47), LOS(β:-4.44; 95%CI:-9.93, 1.05, P = 0.11) and charges for transplantation(β: $15693; 95%CI:-51622-83008, P = 0.64) between the two groups. Morbidly obese patients were more likely to have transplants on weekdays(81.7%) as compared to those without morbid obesity(75.4%, P = 0.029).CONCLUSION Morbid obesity may not impact in-hospital mortality and health care utilization in OLT recipients. However, morbidly obese patients may be selected after careful assessment of co-morbidities.

关键词： Deceased donors Outcome Complications Economics Selection criteria

Accuracy of virtual chromoendoscopy in differentiating gastric antral vascular ectasia from portal hypertensive gastropathy:A proof of concept study

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World Journal of Hepatology 2021年第12期13卷 2168-2178页

作者： Ahmad M Al-Taee Mark P Cubillan alice hinton Lindsay A Sobotka Alex S Befeler Christine Y Hachem Hisham Hussan Division of Gastroenterology and Hepatology NYU Langone HealthNew YorkNY 10016United States Department of Internal Medicine Saint Louis UniversitySt LouisMO 63110United States Division of Biostatistics The Ohio State UniversityColumbusOH 43210United States Division of Gastroenterology Hepatologyand NutritionThe Ohio State UniversityColumbusOH 43210United States Division of Gastroenterology and Hepatology Saint Louis UniversitySt LouisMO 63110United States

BACKGROUND Accurate detection of gastric antral vascular ectasia(GAVE)is critical for proper management of cirrhosis-related gastrointestinal ***,endoscopic diagnosis of GAVE can be challenging when GAVE overlaps with severe portal hypertensive gastropathy(PHG).AIM To determine the added diagnostic value of virtual chromoendoscopy to high definition white light for real-time endoscopic diagnosis of GAVE and *** We developed an I-scan virtual chromoendoscopy criteria for diagnosis of GAVE and *** tested our criteria in a cross-sectional cohort of cirrhotic adults with GAVE and PHG when high-definition white light endoscopy(HDWLE)diagnosis was in *** then compared the accuracy of I-scan vs HDWLE alone to *** Twenty-three patients were included in this study(65.2%Caucasians and 60.9%males).Chronic hepatitis C was the predominant cause of cirrhosis(43.5%)and seven adults(30.4%)had confirmed GAVE on histology.I-scan had higher sensitivity(100%vs 85.7%)and specificity(75%vs 62.5%)in diagnosing GAVE compared to *** translates into a higher,albeit not statistically significant,accuracy of I-scan in detecting GAVE compared to HDWLE alone(82%vs 70%).I-scan was less likely to lead to an accurate diagnosis of GAVE in patients on dialysis(P<0.05)and in patients with elevated creatinine(P<0.05).Iscan had similar accuracy to HDWLE in detecting *** This pilot work supports that virtual chromoendoscopy may obviate the need for biopsies when the presence of GAVE is in *** studies are needed to assess the impact of virtual chromoendoscopy on success of endoscopic therapy for GAVE.

关键词： Portal hypertensive gastropathy Gastric antral vascular ectasia Virtual chromoendoscopy Endoscopy

Hospital outcomes and early readmission for the most common gastrointestinal and liver diseases in the United States:Implications for healthcare delivery

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World Journal of Gastrointestinal Surgery 2021年第2期13卷 141-152页

作者： Somashekar G Krishna Brandon K Chu Alecia M Blaszczak Gokulakrishnan Balasubramanian Hisham Hussan Peter P Stanich Khalid Mumtaz alice hinton Darwin L Conwell Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Department of Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Biostatistics Ohio State University Wexner Medical CenterColumbusOH 43210United States

BACKGROUND Gastrointestinal(GI)and liver diseases contribute to substantial inpatient morbidity,mortality,and healthcare resource *** ways to reduce the economic burden of healthcare costs and the impact of these diseases is of crucial ***-day readmission rates and related hospital outcomes can serve as objective measures to assess the impact of and provide further insights into the most common GI *** To identify the thirty-day readmission rates with related predictors and outcomes of hospitalization of the most common GI and liver diseases in the United *** A cross-sectional analysis of the 2012 National Inpatient Sample was performed to identify the 13 most common GI *** 2013 Nationwide Readmission Database was then queried with specific International Classification of Diseases,Ninth Revision,Clinical Modification *** outcomes were mortality(index admission,calendar-year),hospitalization costs,and thirty-day readmission and secondary outcomes were predictors of thirty-day *** For the year 2013,the thirteen most common GI diseases contributed to 2.4 million index hospitalizations accounting for about$25 *** thirty-day readmission rates were highest for chronic liver disease(25.4%),Clostridium difficile(***)infection(23.6%),functional/motility disorders(18.5%),inflammatory bowel disease(16.3%),and GI bleeding(15.5%).The highest index and subsequent calendar-year hospitalization mortality rates were chronic liver disease(6.1%and 12.6%),*** infection(2.3%and 6.1%),and GI bleeding(2.2%and 5.0%),***-day readmission correlated with any subsequent admission mortality(r=0.798,P=0.001).Medicare/Medicaid insurances,≥3 Elixhauser comorbidities,and length of stay>3 d were significantly associated with thirty-day readmission for all the thirteen GI *** Preventable and non-chronic GI disease contributed to a significant economic and health

关键词： Gastrointestinal disease Thirty-day readmission Nationwide readmission database Outcomes Mortality Cost

Paracentesis in cirrhotics is associated with increased risk of 30-day readmission

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World Journal of Hepatology 2018年第6期10卷 425-432页

作者： Lindsay A Sobotka Rohan M Modi Akshay Vijayaraman A James Hanje Anthony J Michaels Lanla F Conteh alice hinton Ashraf El-Hinnawi Khalid Mumtaz Department of Internal Medicine the Ohio State University Wexner Medical Center Division of Gastroenterology Hepatology and Nutrition the Ohio State Wexner Medical Center Division of Biostatistics College of Public Health the Ohio State University Department of Surgery the Ohio State Wexner Medical Center

AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and *** A retrospective analysis of the nationwide readmission database(NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites,spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of *** Of the 59597 patients included in this study, 18319(31%) were readmitted within 30 d. Majority(58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832(50%) patients on index admission. Independent predictors of 30-d readmission included age 3 Elixhauser comorbidity(OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis(OR: 1.16; CI: 1.10-1.23), paracentesis on index admission(OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma(OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted(P-value: 0.34); however cost of care was significantly more on 30 d readmission($30959 ± 762) as compared to index admission($12403 ± 378), P-value: < *** Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.

关键词： Cirrhosis Readmission rates Paracentesis Ascites

Appendectomy for Appendicitis Has Worse Hospital Outcomes in Inflammatory Bowel Disease Patients

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Journal of Biosciences and Medicines 2018年第5期6卷 23-35页

作者： Ravi Babu Pavurala Andrea Johnson alice hinton Somashekar G. Krishna Anita Afzali Cheng Zhang Department of Medicine College of Medicine The Ohio State University Columbus OH USA Division of Gastroenterology Hepatology &amp amp Nutrition College of Medicine The Ohio State University Columbus OH USA Division of Biostatistics College of Public Health The Ohio State University Columbus OH USA Department of Gastroenterology MercyCrest Gastroenterology Springfield OH USA

Background and Aims: Appendectomy is the choice of surgery for appendicitis but little is known about its outcomes in patients with Inflammatory Bowel Disease (IBD). We sought to compare hospital outcomes of appendectomy for appendicitis between patients with and without IBD. Methods: This is a cross-sectional study utilizing the Nationwide Inpatient Sample between 2009 and 2013. Patients with appendicitis undergoing appendectomy were identified using appropriate International Classification of Diseases codes. Primary outcomes of interest included length of stay (LOS), hospital costs, and post-surgical complications. Univariate and multivariate analyses were used to compare these outcomes between patients with and without IBD. Results: A total of 849,312 patients with appendicitis undergoing appendectomy were included in this study, of which 4261 patients had IBD. IBD patients had longer LOS and increased hospital costs. Crohn’s disease (CD) patients were more likely to develop post-operative pulmonary embolism (adjusted odds ratio (aOR) 7.06, 95% Confidence Interval (CI) (2.19, 22.79)) and anemia (aOR 2.23, 95% CI (1.21, 4.10)), whereas ulcerative colitis patients were more likely to develop post-operative deep vein thrombosis (aOR 9.79, 95% CI (2.41, 39.75)). CD patients were more likely to have perforated ap-pendicitis (aOR 1.37, 95% CI (1.67, 1.11)) and open appendectomy (aOR 1.56, 95% CI (1.96, 1.27)). Conclusions: Appendectomy for appendicitis in IBD patients is associated with adverse hospital outcomes. Focused attempts are needed to decrease the risk of DVT and PE in these patients. Treating patient’s pre-surgical anemia and proactive venous thromboembolism prophylaxis in IBD patients undergoing appendectomy for appendicitis might improve hos-pital outcomes.

关键词： Ulcerative Colitis Crohn’s Disease Inflammatory Bowel Disease Appendicitis Appendectomy Outcomes

Outcomes of inpatient cholecystectomy among adults with cystic fibrosis in the United States

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World Journal of Gastrointestinal Endoscopy 2021年第9期13卷 371-381页

作者： Mitchell L Ramsey Lindsay A Sobotka Somashekar G Krishna alice hinton Stephen E Kirkby Susan S Li Michael P Meara Darwin L Conwell Peter P Stanich Division of Gastroenterology Hepatology and NutritionThe Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of Biostatistics The Ohio State University College of Public HealthColumbusOH 43210United States Division of Pulmonary and Critical Care Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of General Internal Medicine The Ohio State University Wexner Medical CenterColumbusOH 43210United States Division of General and Gastrointestinal Surgery The Ohio State University Wexner Medical CenterColumbusOH 43210United States

BACKGROUND Symptomatic biliary and gallbladder disorders are common in adults with cystic fibrosis(CF)and the prevalence may rise with increasing CF transmembrane conductance regulator modulator *** may be considered,but the outcomes of cholecystectomy are not well described among modern patients with *** To determine the risk profile of inpatient cholecystectomy in patients with *** The Nationwide Inpatient Sample was queried from 2002 until 2014 to investigate outcomes of cholecystectomy among hospitalized adults with CF compared to controls without CF.A propensity weighted sample was selected that closely matched patient demographics,patient’s individual comorbidities,and hospital *** propensity weighted sample was used to compare outcomes among patients who underwent laparoscopic *** outcomes of open and laparoscopic cholecystectomy were compared among adults with *** A total of 1239 inpatient cholecystectomies were performed in patients with CF,of which 78.6%were performed *** was<0.81%,similar to those without CF(P=0.719).In the propensity weighted analysis of laparoscopic cholecystectomy,there was no difference in mortality,or pulmonary or surgical complications between patients with CF and *** adjusting for significant covariates among patients with CF,open cholecystectomy was independently associated with a 4.8 d longer length of stay(P=0.018)and an$18449 increase in hospital costs(P=0.005)compared to laparoscopic *** Patients with CF have a very low mortality after cholecystectomy that is similar to the general *** patients with CF,laparoscopic approach reduces resource utilization and minimizes post-operative complications.

关键词： Laparoscopic cholecystectomy Nationwide Inpatient Sample Cystic fibrosis Mortality Length of stay Symptomatic biliary disorders

Down in the Dump:The Abject in alice Notley’s Culture of One

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Journal of Foreign Languages and Cultures 2019年第1期3卷 127-137页

作者： Laura hinton The City College of New York

alice Notley’s Culture of On e(2011)is a“poet’s novel”about a woman who lives in the dump of a *** desert *** female character who“inhabits”the dump-and this poet’s novel-is both metonym for and guide into the lost representation of“the abject,”a concept developed by Julia Kristeva as a psychic state of horror and response to that which lies outside culturally“normalized”subjects and objects,and our“desire for meaning.”Utilizing her dump refuse for its materials,the main character,Marie,creates her own“culture of one,”standing as figure for the artist/writer plunging not“meaning”but meaninglessness and its abject association with death,which is prefigured as the unclean,the improper,rejected body parts,deviant“non-existent”personae-and,ultimately,Marie’s figural status as marginal inhabitant/“culture remaker”/older woman/multi-media“poet”*** traditional conventions of novelistic character development,plot,and visual description,Notley’s“poet’s novel”formally engages in what Viktor Shkolvsky,in his well-known essay“Art as Technique,”terms“defamiliarization”or“strangeness”(“ostranenie,”in Russian),including those principles he cites of“deceleration”and“deviation of the norm.”Notley’s work twists the binary logic implied in Shkolvsky’s“deviation”versus“norm”further by revealing abjection’s“strangeness”in the poet’s novel itself as form,”a text that is always becoming its own site of the linguistic abject,never codifying identity,or the interpreted known.

关键词： alice Notley the poet’s novel prose poem the abject Kristevan theory.