Congratulations are in Order
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Congratulations to Dr. Hanni Menn-Josephy (Department of Medicine, BUSM/BMC) and colleagues on their publication, “Renal Interstitial Fibrosis: An Imperfect Predictor of Kidney Disease Progression in Some Patient Cohorts,” in the American Journal of the Nephrology. The extent of interstitial fibrosis on kidney biopsy is regarded as a prognostic indicator and guide to treatment. Patients with extensive fibrosis are assigned to supportive treatments with the expectation that they have advanced beyond the point at which immunosuppressive or other disease-modifying therapies would be of benefit. This study highlights some of the limitations of using interstitial fibrosis to predict who will develop end-stage renal disease (ESRD). In the study, analysis of 434 consecutive renal biopsies was performed between 2001 and 2012 at a single center. Assessed was the influence of various clinical factors along with fibrosis as predictors of ESRD and dialysis-free survival in various patient groups. Interstitial fibrosis performed well overall as a predictor of progression to dialysis. On average, patients with >50% fibrosis progressed more rapidly than those with either 25-49 or 0-24% fibrosis with a median time to dialysis of 1.2, 6.5 and >10 years, respectively. In contrast, interstitial fibrosis was of less value as a predictor of disease progression in a subset of cases that included patients over the age of 70 and those with diabetic nephropathy on biopsy. Surprisingly, 13.9% of patients with normal renal function had 25-49% fibrosis and 5% had more than 50% fibrosis on biopsy, and 5 years after undergoing biopsy 21% of patients with >50% fibrosis still remained dialysis free. The study concluded that renal fibrosis is an imperfect prognostic indicator for the development of ESRD and caution should be exercised in applying it too rigidly, especially in elderly or diabetic patients.
Congratulations to Dr. Arthur Baghdanian (Radiology, BUMC/BMC) and colleagues on their publication, “Effect of an Institutional Triaging Algorithm on the Use of Multidetector CT for Patients with Blunt Abdominopelvic Trauma over an 8-year Period,” in the Radiology. The study’s purpose is to evaluate the effect of an institutional clinical triaging algorithm on the rate of multidetector computed tomography (CT) utilization in blunt abdominopelvic trauma (BAPT) over an 8-year period at an urban level 1 trauma center. Adult patients (n = 13 096; mean age, 42 years; age range, 15-95 years) admitted with BAPT from January 1, 2006, to December 31, 2013, were included. Patients with BAPT were divided into two groups: those admitted before (referred to as the prealgorithm group, from January 1, 2006, to June 30, 2010) and after (referred to as the postalgorithm group, from July 1, 2010, to December 31, 2013) the implementation of an institutional clinical triaging algorithm. The following parameters were recorded from abdominopelvic CT study reports for the pre- and postalgorithm groups: number of abdominopelvic CT examinations at admission, number of abdominopelvic CT examinations with positive BAPT-related findings, injury severity score, length of hospital stay, and number of mortalities. The unpaired t test and χ2 analysis were used to determine significant differences. Results The percentage of patients admitted for BAPT who underwent an abdominopelvic CT study was 76.7% (5900 of 7688) in the prealgorithm group and 44.6% (2413 of 5408) in the postalgorithm group, a 32.1% decrease in use of CT (P < .001). The mean injury severity score increased from 10.1 ± 9.1 (standard deviation) to 13.3 ± 11.9 after implementation of the algorithm in patients admitted for BAPT who underwent abdominopelvic CT examination (P < .001). The percentage of abdominopelvic CT examinations with BAPT-related findings increased from 17.1% (1007 of 5900) to 19.8% (479 of 2413) (P = .003). There was a significant difference in average length of stay, from 4.8 days ± 7.0 to 4.2 days ± 6.2 (P < .001). Mortality decreased from 3.1% (242 of 7688) to 2.7% (148 of 5408) after implementation of the algorithm (P = .19). The study concluded that the implementation of a clinical triaging algorithm resulted in decreased use of multidetector CT in patients who presented with BAPT to the emergency department.
Congratulations to Dr. David T. Felson (Clinical Epidemiology Research and Training Unit, BUSM) and colleagues on their publication, “Multiple Nonspecific Sites of Joint Pain Outside the Knees Develop in Persons with Knee Pain,” in the Arthritis & Rheumatology. Many persons with knee pain have joint pain outside the knee but despite the impact and high frequency of this pain, its distribution and causes have not been studied. Those studying gait abnormalities have suggested that knee pain causes pain in adjacent joints but pain adaptation strategies are highly individualized. Studied were persons age 50-79 years with or at high risk of knee osteoarthritis drawn from two community-based cohorts, the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative and were followed for 5-7 years. Excluded were those with knee pain at baseline and compared were those who developed and did not develop knee pain at the first follow-up examination (the index visit). Pain was examined on most days at joint regions outside the knee in examinations after the index visit. Logistic regression analyses examined the risk of joint specific pain adjusted for age, sex, BMI, depression with sensitivity analyses excluding those with widespread pain. In the combined cohorts, there were 693 persons with index visit knee pain vs. 2793 without it. 79.6% of those with bilateral and 63.8% of those with unilateral knee pain had pain during follow-up in a joint region outside the knee vs. 49.9% of those without knee pain. An increased risk of pain was present in most extremity joint sites without a predilection for specific sites. Results were unchanged when those with widespread pain were excluded. The study concluded that persons with chronic knee pain are at increased risk of pain in multiple joints in no specific pattern.
Congratulations to Dr. Timothy Naimi (General Internal Medicine, BUSM/BMC, and Community Health Sciences, BUSPH) and colleagues on their publication, “Amount of Televised Alcohol Advertising Exposure and the Quantity of Alcohol Consumed by Youth,” in the Journal of Studies on Alcohol and Drugs. Although studies demonstrate that exposure to brand-specific alcohol advertising is associated with an increased likelihood of youth consuming particular brands, the relationship between quantity of brand-specific advertising exposure and quantity of brand-specific consumption has not been firmly established. Using the Alcohol Brand Research Among Underage Drinkers (ABRAND) national sample of 1,031 young drinkers (ages 13-20), this study examined the relationship between their aggregated past-year exposure to advertising (in adstock units, a measure based on gross rating points) for 61 alcohol brands that advertised on the 20 most popular nonsports television programs viewed by underage youth and their aggregated total consumption of those same brands during the past 30 days. Predictive models adjusted for other media exposure, predictors of youth's alcohol consumption, and the consumption of brands not advertised on the 20 shows. For the fully adjusted models, each 100 adstock unit increase in exposure (about 1 SD) was associated with an increase of 5.9 drinks (95% CI [0.9, 11.0 drinks]) consumed during the past 30 days among those with less than 300 units of advertising exposure, and an increase of 55.7 drinks (95% CI [13.9, 97.4 drinks]) among those with 300 or more adstock units of exposure. The study concluded that among underage youth, the quantity of brand-specific advertising exposure is positively associated with the total quantity of consumption of those advertised brands, even after controlling for the consumption of non-advertised brands. Future research should examine exposure-consumption relationships longitudinally and in other media.
Congratulations to each of you for your accomplishments!