US-guided CVC placement in children is associated with decreased number of anatomical sites attempted and decreased number of attempts to gain placement. Time to placement by residents was decreased with US, but not the time to placement by other operators. US guidance increased the use of internal jugular catheter placement and decreased artery punctures. US guidance did not improve success rates.

Background: Hepatitis C virus (HCV) infection causes hepatocellular carcinoma (HCC) and subtypes of non-Hodgkin lymphoma (NHL). Associations with other cancers are not established. We systematically assessed associations between HCV infection and cancers in the US elderly population. Methods: We conducted a registry-based case-control study using the SEER-Medicare data in US adults aged ≥66 years. Cases (n=1,623,538) were people with first cancers identified in SEER registries (1993–2011). Controls (n=200,000) were randomly selected cancer-free individuals frequency-matched to cases on age, sex, race, and calendar year. We determined associations with HCV using logistic regression. Results: HCV prevalence was higher in cases than controls (0.7% vs. 0.5%). HCV was positively associated with cancers of the liver (adjusted odds ratio [aOR]=31.5; 95%CI=29.0–34.3), intrahepatic bile duct (aOR=3.40; 95%CI=2.52–4.58), extrahepatic bile duct (aOR=1.90; 95%CI=1.41–2.57), pancreas (aOR=1.23; 95%CI=1.09–1.40), anus (aOR=1.97; 95%CI=1.42–2.73), and non-melanoma non-epithelial skin cancer (aOR=1.53; 95%CI=1.15–2.04), myelodysplastic syndrome (aOR=1.56; 95%CI=1.33–1.83), and diffuse large B-cell lymphoma (DLBCL) (aOR=1.57; 95%CI=1.34–1.84). Specific skin cancers associated with HCV were Merkel cell carcinoma (aOR=1.92; 95%CI=1.30–2.85) and appendageal skin cancers (aOR, 2.02; 95%CI=1.29–3.16). Inverse associations were observed with uterine cancer (aOR=0.64; 95%CI=0.51–0.80) and prostate cancer (aOR=0.73; 95%CI=0.66–0.82). Associations were maintained in sensitivity analyses conducted among people without documented alcohol abuse, cirrhosis, or hepatitis B or human immunodeficiency virus infections, and after adjustment for socioeconomic status. Associations of HCV with other cancers were not observed. Conclusion(s): HCV is associated with increased risk of cancers other than HCC in the US elderly population, notably bile duct cancers and DLBCL. These results support a possible etiologic role for HCV in an expanded group of cancers.

Background and aim: Chronic hepatitis C virus (HCV) infection is associated with several extrahepatic manifestations (EHMs). Data on the effect of sustained virological response (SVR) on the risk of EHMs are limited. Methods: We conducted a retrospective cohort study using data of patients from the U.S. Veterans Affairs HCV Clinical Case Registry who had a positive HCV RNA test between 10/1999 and 8/2009. Patients receiving interferon-based antiviral therapy (AVT) were identified. SVR was defined as negative HCV RNA at least 12 weeks after end of AVT. Risk of 8 incident EHMs were evaluated in Cox proportional hazards regression models. Results: Of the 160,875 HCV-infected veterans, 31,143 (19.4%) received AVT, of whom 10,575 (33.9%) experienced SVR. EHM risk was reduced in the SVR group compared to untreated patients for mixed cryoglobulinemia (adjusted hazard ratio [aHR]=0.61; 95%CI=0.39–0.94), glomerulonephritis (aHR=0.62; 95%CI=0.48–0.79), porphyria cutanea tarda (PCT) (aHR=0.41; 95%CI=0.20–0.83), non-Hodgkin lymphoma (NHL) (aHR=0.64; 95%CI=0.43–0.95), diabetes (aHR=0.82; 95%CI=0.76–0.88), and stroke (aHR=0.84; 95%CI=0.74–0.94), but not for lichen planus (aHR=1.11; 95%CI=0.78–1.56) or coronary heart disease (aHR=1.12; 95%CI=0.81–1.56). Risk reductions were also observed when patients with SVR were compared to treated patients without SVR for mixed cryoglobulinemia, glomerulonephritis, PCT, and diabetes. Significant reductions in the magnitude of aHRs towards the null with increasing time to initiation of AVT after HCV diagnosis were observed for glomerulonephritis, NHL, and stroke. Conclusions: Risks of several EHMs of HCV infection are reduced after AVT with SVR. However, early initiation of AVT may be required to reduce the risk of glomerulonephritis, NHL, and stroke.

Background & Aims Chronic hepatitis B virus (HBV) infection is an important cause of cirrhosis and hepatocellular carcinoma worldwide; populations that migrate to the US and Canada might be disproportionately affected. The Hepatitis B Research Network (HBRN) is a cooperative network of investigators from the United States and Canada, created to facilitate clinical, therapeutic, and translational research in adults and children with hepatitis B. We describe the structure of the network and baseline characteristics of adults with hepatitis B enrolled in the network. Methods The HBRN collected data on clinical characteristics of 1625 adults with chronic HBV infection who are not receiving antiviral therapy from 21 clinical centers in North America. Results Half of the subjects in the HBRN are male, and the mean age is 42 years; 72% are Asian, 15% are Black, and 11% are White, with 82% born outside of North America. The most common HBV genotype was B (39%); 745 of subjects were negative for the hepatitis B e antigen. The median serum level of HBV DNA when the study began was 3.6 log10 IU/mL; 68% of male subjects and 67% of female subjects had levels of alanine aminotransferase above the normal range. Conclusions The HBRN cohort will be used to address important clinical and therapeutic questions for North Americans infected with chronic HBV and to guide health policies on HBV prevention and management in North America.

In a multinational study of children with acute liver failure, we found that incorporating diagnostic test recommendations into electronic medical record order sets accessed at time of admission reduced the percentage with an indeterminate diagnosis that may have reduced liver transplants without increasing mortality. Widespread use of this approach could significantly enhance care of acute liver failure in children.

Background Several recent reports suggest an increasing incidence of oral squamous cell carcinoma (OSCC) among young persons in many regions of the world-a trend which is particularly concerning given the overall stabilization or even decline in incidence rates for head and neck cancer in general. The aim of this study is to determine whether there has been an increase in the number of cases of OSCC diagnosed in patients \40 years old by our biopsy service from 1971 to 2006. Methods A retrospective review of all OSCC cases diagnosed from 1971 to 2006 by the Emory University Hospital Oral Pathology biopsy service was performed. A comparison of demographic information, frequency, location and histologic grade was made between these cases as a whole and those occurring in a subset of patients \40 years old. Statistical procedures included chi-square analyses. Results From 1971-2006, 1,919 cases of OSCC were diagnosed, and 95 (5.0%) occurred in patients \40 years old.

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INTRODUCTION Alterations in the immune system can result in alanine aminotransferase (ALT) flares either during pregnancy or after delivery in women with chronic hepatitis B virus (HBV) infection. The aim of this study was to prospectively assess changes in serum biochemical and virological markers of HBV infection during and after pregnancy in a large North American cohort of pregnant women with chronic HBV. METHODS Adult pregnant women enrolled in the Hepatitis B Research Network between 2011 and 2016 were included. Serum ALT values and HBV DNA viral levels were obtained at <28 weeks and >28 weeks of gestation and <16 weeks, 16–31 weeks, and 32–48 weeks postpartum. Outcomes of ALT flares included severity, duration, and initiation of antiviral therapy. RESULTS Amongthe 158 pregnant women with chronic HBV, the median age was 33 years, 73% were Asian, and 63% were hepatitis B e antigen (HBeAg) negative. The median HBV DNA level was substantially higher in the HBeAg-positive vs HBeAg-negative women (1.3 × 10 8 vs 343 IU/mL), but serum ALT levels at their first study visit were similar. Among untreated pregnant women, there was a very mild increase in serum ALT postpartum among both HBeAg-positive and HBeAg-negative women (P < 0.001). Serum ALT flares (range 107–513 U/L) developed in 3.4% (5/149) during pregnancy and in 4.3% (4/92) after delivery. Twenty-two percent were initiated on antiviral therapy. After withdrawal of prophylactic anti-HBV therapy, 17.2% (5/29) developed serum ALT flares (range 107–208 U/L)within 14 weeks ofdrug discontinuation, and 3 additional women had flares despite continuous anti-HBV therapy during pregnancy or postpartum. Many ALT flares were not associated with significant changes in HBV DNA levels. No flares were severe with elevations of bilirubin or clinical decompensation. DISCUSSION Spontaneous ALT flares in untreated pregnant women with chronic HBV are infrequent, mild, and self-limited both prepartum and postpartum. Although flares after the withdrawal of antiviral therapy postpartum are more common, they were also mild and self-limited. Further studies of the immunopathogenesis of pregnancy-related flares are needed, as well as effects on long-term outcome of the mother and infant.