Approximately one third of physicians treating cancer patients are not aware of what decision aids are, and only 24% are currently using decision aids in clinical practice. Strategies to increase physician awareness about decision aids and to implement these tools into clinical practice are important.
Fecal microbiota transplantation (FMT) is a promising therapy for Clostridium difficile infection (CDI). However, questions remain regarding efficacy and safety in inflammatory bowel disease (IBD) patients, as well as longitudinal stability of donor stool composition. This report describes an IBD patient with two CDIs 18 months apart, each successfully treated with FMT with no IBD flares or complications. Microbiome composition analysis of patient samples during each infection revealed low-diversity microbiota patterns similar to those previously described in non-IBD patients with CDI and active IBD alone. Samples taken after each transplant demonstrated quick remodeling towards the donor's sample composition coinciding with symptom resolution. Of note, samples taken from the same donor 18 months apart reflected marked differences in microbiota abundances, suggesting that the use of single donors in FMT programs offers little benefit in ensuring predictability of donor stool composition over time. This report describes similar microbial composition patterns during CDI in IBD patients to those described previously in non-IBD patients, and supports FMT as safe and effective treatment for recurring CDI in this patient population.
Objective: To systematically review and perform a meta-analysis of the risk of ectopic pregnancy in endometriosis. Data Sources: MEDLINE (OVID), Embase (OVID), CINAHL (EBSCO), and Cochrane Library to April 1, 2019. Inclusion criteria were cohort or case-control studies from 1990 onward. Exclusion criteria were cohort studies without controls, case reports or series, or no English full-text. Methods of Study Selection: A total of 1361 titles/abstracts were screened after removal of duplicates, 39 full-texts were requested, and, after 24 studies were excluded, there were 15 studies in the meta-analysis. Tabulation, Integration, and Results: Data were extracted using standardized spreadsheets with 2 independent reviewers, and conflicts were resolved by a third reviewer. We performed random effects calculation of weighted estimated average odds ratio (OR). Heterogeneity and publication bias were assessed with the I 2 metric and funnel plots/Egger's test, respectively. The Ottawa-Newcastle Quality Assessment Scale was used with a cutoff of ≥7 for higher quality. There were 10 case-control studies (17 972 ectopic pregnancy cases and 485 266 nonectopic pregnancy controls) and 5 cohort studies (30 609 women with endometriosis and 107 321 women without endometriosis). For case-control studies, endometriosis was associated with increased risk of ectopic pregnancy with an OR of 2.66 (95% confidence interval [CI] = 1.14−6.21, p = .02). For cohort studies, the OR was 0.95 (95% CI = 0.29−3.11, p = .94), but after post hoc analysis of the studies with a Ottawa-Newcastle score ≥7, the OR was 2.16 (95% CI = 1.67−2.79, p <.001). For both case-control and cohort studies, there was high heterogeneity among studies (I 2 = 93.9% and I 2 = 96.6%, Q test p <.001) but no obvious evidence of systematic bias in the funnel plot, and Egger's test results were not significant (p = .35, p = .70), suggesting no strong publication bias. There were insufficient data to make any conclusions with respect to anatomic characteristics of endometriosis (e.g., stage) or mode of conception (e.g., assisted reproductive technology vs spontaneous). Conclusion: Possible evidence of an association between endometriosis and ectopic pregnancy was observed (OR = 2.16−2.66). However, these results should be considered with caution, owing to high heterogeneity among studies. Continued research is needed to delineate the pregnancy implications of endometriosis.
SUMMARY The peak acid output of the stomach in a group of 71 mothers of spina bifida children and in 71 matched controls was estimated indirectly by the serum level of group I pepsinogens. The mean levels did not differ significantly, suggesting that the conjectured teratogen is not specially acid-labile. The variance was significantly higher in index subjects than in controls, but the interpretation of this finding is not clear. The latter is the subject of the present report. Our interest in the possible detoxification of a conjectural teratogen by gastric acid was aroused by the work of Keeler (1969Keeler ( , 1971Keeler ( , 1973 and his associates. They showed that the teratogen, cyclopamine (11-deoxojervine), was converted into the inactive compound veratramine, at pH < 3 0. They also showed that the teratogenicity of cyclopamine, readily demonstrable in rats, could usually be shown in rabbits only by the concomitant administration of an antacid such as calcium carbonate, which presumably prevented the inactivation of the compound by acid in the rabbit's stomach. The nature of the teratogen(s) producing spina bifida in man is not known but, from more recent work ofthe same group (Keeler et al., 1976a,b), one possible teratogen might be a potato-associated alkaloid having a structure related to that ofcyclopamine. We, therefore, decided to look for a possible relation between spina bifida and the ability of the mother's stomach to secrete hydrochloric acid, in the knowledge that this ability is very restricted in some people (Segal and Miller, 1955).Received for publication 24 March 1977 The study was designed to narrow the search for a specific teratogen by testing whether or not it is acid-labile. If it is acid-labile and if it is critically involved in most spina bifida occurrences (say 66 % or more in the London area), poor producers of acid should be considerably overrepresented among the mothers of spina bifida children. This overrepresentation should be detectable by a lower mean serum level of group I pepsinogens. MethodsGastric acidity is most repeatably measured by the peak acid output. Of the numerous indirect ways of assessing peak acid output, the serum level of group I pepsinogens was considered to be the most appropriate for our purpose. When it was assayed on non-ulcer patients in a hospital population in the fasting state, the correlation coefficient was 0-82 between this level and the peak acid output in response to betazole hydrochloride, 1-5 mg per kg (Samloff et al., 1975b).Of the methods rejected, the direct assay of peak acid output itself was considered expensive and largely impracticable in the homes of volunteers, and telemetering was also rejected a fortiori for the same reasons. The level of autoantibody to oxyntic (parietal) cells and the rate of excretion of dye after ingestion of dye-resin complex (the Diagnex Blue method) both probably have somewhat lower correlations with peak acid output than does the serum level of group I pepsinogens. 332 on 27 April 2019 by guest. Prote...
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