Haaning Olson (actionshame2)

BACKGROUND AND AIMS Because data on metachronous risk for patients with index proximal 5 to 9 mm hyperplastic polyps (HPs) are limited, the clinical significance of these polyps is unclear. Conversely, published data suggest that sessile serrated polyps (SSPs), traditional serrated adenomas (TSAs) and large (>1 cm) hyperplastic polyps (HPs) are high-risk lesions requiring close surveillance. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine the risk of metachronous large serrated polyps (SPs) and advanced adenomas in patients with 5 to 9 mm proximal HPs. METHODS We included adults with at least 1 polyp resected at index colonoscopy and a surveillance examination 12 months or more after index. Outcomes were risk for metachronous large (>1 cm) SPs and advanced adenomas (AA) (>1 cm, villous elements, HGD or CRC). Individuals were hierarchically stratified by the most significant index SP. The risks for adults with proximal 5 to 9 mm HPs at index examination were compared with individualsnovel data suggest that close surveillance intervals may be appropriate for patients with 5 to 9 mm proximal HPs. Although acetaminophen (APAP) is a commonly used analgesic antipyretic drug, hepatotoxicity and nephrotoxicity are common after the overdose. The main mechanism of APAP toxicity is oxidative stress based. Stress may induce the production of heme oxygenase 1 (HO)-1 which is regulated by interleukin (IL)-10 and inhibit the production of tumor necrosis factor-alpha (TNF-α). HO-1 expression is further regulated by nuclear factor erythroid 2-related factor 2 (Nrf2) and the transcription factor BTB and CNC homology 1 (BACH1). Drug-induced toxicity can be relieved by several natural products, which are preferred due to their dietary nature and less adverse reactions. Of these natural products, omega-3 (ω-3) fatty acids are known for anti-inflammatory and antioxidant actions. However, effects of ω-3fatty acids on APAP-induced hepatic and renal toxicity are not well addressed. We designed this study to test the potential protecting actions of ω-3 fatty acids (270 mg/kg Eicosapentaenoic acid and 180 mg/kg docosahexaenonslocation to the nucleus; BACH1 exit from the nucleus and inhibited NF-ĸB nuclear translocation. These findings suggested the protecting actions of ω-3 fatty acids against APAP-induced hepatic and renal toxicity through regulation of antioxidant Nrf2 and inflammatory NF-ĸB pathways. BACKGROUND This study reports a single center experience with thrombolytics for left ventricular assist device (LVAD) pump thrombosis. METHODS Adults undergoing continuous-flow LVAD implantation between 2004-2018 at a single center were reviewed and those with pump thrombosis identified. Primary outcomes included 1-year survival and success rates of thrombolytic therapy. Secondary outcomes included post-treatment adverse events, freedom from major bleeding at 1-year and freedom from stroke at 1-year follow-up. RESULTS 341 patients underwent LVAD implantation and 10.8% (n=37) developed pump thrombosis. Of these 37, 26 (70.2%) received initial thrombolytic therapy, 5 (13.5%) underwent direct pump exchange, and 6 (16.2%) received only intravenous heparin due to presentation with acute stroke or severe multiorgan failure. Successful treatment was achieved in 11.5% (n=3) of patients receiving thrombolytics. Early adverse events following thrombolytic therapy included major bleeding in 11.5% (n=3) and new stroke in 7.7% (n=2). The majority of patients undergoing thrombolytic therapy underwent subsequent device exchange (69.2%; n=18). The overall survival in patients with pump thrombosis following treatment was 96.8% at 30-days, 78.9% at 90-days, and 63.1% at 1-year. The freedom from major bleeding and stroke at 1-year was 74.2% and 87.2%, respectively. CONCLUSIONS In this single center experience of thrombolytics for pump thrombosis in LVAD patients, there was limited efficacy with the majority of patients requir