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Dual-graft (DG) adult living donor liver transplantation (ALDLT) with ABO-incompatible (ABOi) and ABO-compatible (ABOc) graft combination is associated with high rates of graft survival, with no significant difference for ABOi and ABOc grafts, according to research published online July 31 in the American Journal of Transplantation. Jae Hyun Kwon, M.D., from the University of Ulsan College of Medicine in Seoul, South Korea, and colleagues conducted a retrospective review of medical records of patients who underwent ABOi DG ALDLT between 2008 and 2014. The authors also assessed the graft regeneration rate using computed tomography volumetric analysis. During a mean follow-up of 57.0 ± 22.4 months, the researchers found that the one-, three-, and five-year patient survival rate was 96.4 percent. The rate of graft survival at one-, three-, and five-years was 96.4, 94.2, and 92.0 percent, respectively; ABOc and ABOi grafts did not differ significantly (P = 0.145). No significant differences were seen between ABOc and ABOi grafts in the biliary complication rate (P = 0.195). There was no significant difference in regeneration rates for ABOi and ABOc grafts. "DG ALDLT with ABOi and ABOc graft combination seems to be a feasible option for expanding the donor pool without additional donor risks," the authors write.

For patients with stage 4 or 5 chronic kidney disease and hepatitis C virus (HCV) infection, 12 weeks of treatment with glecaprevir and pibrentasvir results in a high rate of sustained virologic response, according to a study published online Oct. 11 in the New England Journal of Medicine. Edward Gane, M.D., from Auckland City Hospital in New Zealand, and colleagues conducted a multicenter trial to examine the efficacy and safety of combination treatment with the NS3/4A protease inhibitor glecaprevir and the NS5A inhibitor pibrentasvir for 12 weeks in adults with HCV infection and compensated liver disease with severe renal impairment, dependence on dialysis, or both. Participants had stage 4 or 5 chronic kidney disease. One hundred four patients were enrolled in the trial. The researchers found that the sustained virologic response rate was 98 percent. During treatment, none of the patients had virologic failure, and none had a virologic relapse after the end of treatment. Pruritus, fatigue, and nausea were reported in at least 10 percent of the patients. Twenty-four percent of the patients reported serious adverse events. Because of adverse events, four patients discontinued the trial treatment prematurely; three of these had sustained virologic response

Ropinirole, bromocriptine, and piribedil are associated with the highest incidence rates of adverse effects in Parkinson's disease, according to a review published online Sept. 4 in CNS Neuroscience & Therapeutics. Bao-Dong Li, from the Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine in China, and colleagues conducted a systematic review to compare the adverse effects of 11 drugs used to treat Parkinson's disease. Data were included from 24 randomized controlled trials. The researchers found that, compared with placebo, the incidence of adverse reactions of ropinirole, rotigotine, entacapone, and sumanirole were higher in terms of nausea. The incidence rates of dyskinesia side effects were highest with ropinirole, while in terms of patients' hallucination, pramipexole was significantly higher. The surface under the cumulative ranking curve values of all drugs showed that the incidence of adverse reaction of pergolide was relatively high (nausea, 83.5 percent; hallucination, 79.8 percent); the incidence of dyskinesia and somnolence was higher with ropinirole (80.5 and 69.4 percent); in terms of dizziness, the incidence of adverse reaction of piribedil was higher (67.0 percent), and in terms of constipation, the incidence of bromocriptine was relatively high (62.3 percent). "In addition to current forms of treatment, we hope that our results can produce useful information for further development of new drugs to treat Parkinson's disease based on the natures of each drug," the authors write.

A new screening tool can adequately detect risk of diabetic retinopathy in adults with diabetes in low-income communities in Mexico, according to a study published in the October issue of Preventing Chronic Disease. Kenny Mendoza-Herrera, from the National Institute of Public Health in Mexico, and colleagues analyzed biochemical, clinical, anthropometric, and sociodemographic information from 1,000 adults with diabetes in low-income communities in Mexico in order to develop a screening tool based on a predictive model for early detection of diabetic retinopathy. Time since diabetes diagnosis, high blood glucose levels, systolic hypertension, and physical inactivity were risk factors included in the screening tool. The researchers found that the model had a mean area under the receiver operating characteristic curve (AUC ROC) of 0.78 in the validation data set. Using the optimized cut point that best represented the study population, the model had a sensitivity of 82.9 percent and a specificity of 61.9 percent. "We developed a low-cost and easy-to-apply screening tool to detect people at high risk of diabetic retinopathy in Mexico," the authors write. "Although classification performance of our tool was acceptable (AUC ROC > 0.75), error rates (precision) depend on false-negative and false-positive rates. Therefore, confirmatory assessment of all cases in mandatory."

For young patients with type 1 diabetes, insulin pump therapy is associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and better glycemic control than insulin injection therapy, according to a study published online Oct. 10 in the Journal of the American Medical Association. Beate Karges, M.D., from RWTH Aachen University in Germany, and colleagues conducted a population-based cohort study in 446 diabetes centers. They identified patients with type 1 diabetes who were younger than 20 years and had diabetes duration of more than one year. The researchers found that 14,119 patients used pump therapy and 16,460 used insulin injections. A total of 9,814 patients using pump therapy were matched with 9,814 using injection therapy. Compared with injection therapy, pump therapy was correlated with lower rates of severe hypoglycemia (9.55 versus 13.97 per 100 patient-years) and diabetic ketoacidosis (3.64 versus 4.26 per 100 patient-years). Lower levels of glycated hemoglobin were seen with pump versus injection therapy (8.04 versus 8.22 percent). Compared with injection therapy, pump therapy was associated with lower total daily insulin doses (0.84 versus 0.98 U/kg). No significant difference in body mass index was seen between the treatment regimens

For patients with unruptured intracranial aneurysms (UIAs) that are 3 mm or smaller, no preventive treatment or imaging follow-up is the most effective management strategy, according to a study published online Nov. 20 in JAMA Neurology. Ajay Malhotra, M.D., from the Yale School of Medicine in New Haven, Conn., and colleagues used inputs from the medical literature to conduct a decision-analytic model-based comparative effectiveness analysis. Five management strategies were assessed: annual magnetic resonance angiography (MRA) screening, biennial MRA screening, MRA screening every five years, aneurysm coiling and follow-up, and no treatment or preventive follow-up. In an analysis of 10,000 iterations simulating adult patients, the researchers found that the highest health benefit was seen for the management strategy of no treatment or preventive follow-up (mean quality-adjusted life-years, 19.40). MRA every five years was the best of the management strategies that incorporate follow-up imaging, with the next highest effectiveness (mean quality-adjusted life-years, 18.05). When the annual growth rate and risk of rupture of growing aneurysms are varied, no routine follow-up remains the optimal strategy. No follow-up is the optimal strategy when the annual risk of rupture of nongrowing UIAs is less than 1.7 percent; coiling should be performed directly if the annual risk of rupture is >1.7 percent.

The incidence of lower urinary tract injuries is 0.33 percent for patients undergoing gynecologic laparoscopy for benign indications, according to a review published online Dec. 4 in Obstetrics & Gynecology. Jacqueline M.K. Wong, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a systematic review of studies to examine the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. Ninety studies met the inclusion criteria, representing 140,444 surgeries. The researchers identified 458 lower urinary tract injuries with an incidence of 0.33 percent. Bladder injury occurred three times more often than ureteral injury (0.24 versus 0.08 percent). The highest rates of injury were seen for laparoscopic hysterectomy not otherwise specified and laparoscopically assisted vaginal hysterectomy (1.8 and 1.0 percent, respectively). Most ureteral and bladder injuries resulted from electrosurgery (33.3 percent) and lysis of adhesions (23.3 percent), respectively. Ureteral injuries were most often recognized postoperatively (60 percent) and repaired by open ureteral anastomosis (47.4 percent), while most bladder injuries were recognized intraoperatively (85 percent) and repaired by laparoscopic suturing (34.9 percent).

During cardiopulmonary resuscitation (CPR) performed by males, self-adjusted and nearest kneeling postures are more effective for chest compression, with lower perceived exertion, according to a study published online Oct. 5 in the Journal of Clinical Nursing. S.H. Ho, from The Hong Kong Polytechnic University and Daniel H.K. Chow, Ph.D., from The Education University of Hong Kong, applied a self-controlled repeated-measures design to examine the impact of kneeling posture on chest compression during CPR in males. The authors recruited 18 participants with a qualified first-aid certificate. Each participant performed three sessions of CPR on a mannequin using one of three kneeling postures (farthest, self-adjusted, and nearest) in each. Each session comprised five CPR cycles (30 strokes of chest compression within 18 seconds) in each kneeling posture and lasted two minutes. The researchers found that the efficacy of chest compression was significantly better in the self-adjusted and nearest kneeling postures than in the farthest posture. Similar effect was seen for the self-adjusted and nearest postures, while because of the lower rate of perceived exertion, most participants preferred self-adjusted kneeling posture.

For patients with acute coronary syndromes (ACS), diabetes mellitus (DM), but not pre-DM, is associated with an increased risk of major adverse cardiac events (MACE), according to a study published online Oct. 18 in the Journal of the American College of Cardiology. Serdar Farhan, M.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues examined the impact of pre-DM on coronary plaque characteristics and ischemic outcome in patients with ACS. Participants underwent quantitative coronary angiography, grayscale intravascular ultrasound (IVUS), and radiofrequency IVUS after successful percutaneous coronary intervention. Patients were categorized based on their glucometabolic status as normal glucose metabolism (NGM; 162 patients), pre-DM (202 patients), and DM (183 patients). The researchers found that there were no significant between-group differences with respect to IVUS findings indicative of vulnerable plaques. Compared to patients with pre-DM or NGM, patients with DM had a higher crude rate of MACE (25.9 versus 16.3 and 16.1 percent; P = 0.03 and 0.02, respectively). Using NGM as the reference group, DM, but not pre-DM, was correlated with increased risk of MACE in an adjusted model (hazard ratios, 2.2 [95 percent confidence interval, 1.25 to 3.86; P = 0.006] and 1.29 [95 percent confidence interval, 0.71 to 2.33; P = 0.41]).

Internal medicine patients are frequently prescribed potentially inappropriate medications (PIMs), but screening tools can detect clinically relevant PIMs, according to a study published online Oct. 8 in the Journal of Clinical Pharmacy and Therapeutics. Anne-Laure Blanc, Pharm.D., Ph.D., from Geneva University Hospitals in Switzerland, and colleagues compared two PIM-screening tools -- STOPP/START and PIM-Check -- in a general internal medicine ward. They also analyzed a random sample of 50 patients hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and 50 sex-and age-matched patients who were not readmitted. The researchers found that across the whole ward population, PIM-Check and STOPP/START detected 1,348 and 537 PIMs, respectively, which was the equivalent of 13.5 and 5.4 PIMs per patient. PIM-Check had a substantially shorter screening time versus STOPP/START (four versus 10 minutes). Of the PIMs detected using PIM-Check and STOPP/START, the clinical pharmacist found 45 percent and 42 percent, respectively, to be clinically relevant to individual patients' cases. There were no significant differences in the rates of detected and clinically relevant PIMs between readmitted and nonreadmitted patients.