bluuebunny/crossref_metadata_2025_split huggingface dataset:
3148 CMV Colitis in a Patient With Diffuse Large B-Cell Lymphoma (DLBCL) and Crohn's Disease
Authors: Atteberry Preston , Buffie Charlie , Wan David 
Published: October 2019

INTRODUCTION:
Cytomegalovirus (CMV) colitis, while uncommon in immunocompetent hosts, can occur relatively frequently in patients with IBD. Here we present the case of a woman with Crohn's disease and DLBCL with biopsy evidence suggesting CMV colitis.

CASE DESCRIPTION/METHODS:
A 59 year-old woman with Crohn's disease and DLBCL (on 12 mg dexamethasone daily) presented with abdominal pain and gastrointestinal bleeding. The patient was having sharp, intermittent, left-sided epigastric pain, similar to her prior Crohn's flares, and 5-6 bloody bowel movements per day, requiring 6 units of packed red blood cell transfusions at an outside hospital. She initially received mesalamine, with some relief of symptoms. On exam, the patient was in mild discomfort and had a soft, non-tender, non-distended abdomen. Initial laboratory testing was notable for a normal WBC count, hemoglobin 9.3, ALP 721, ALT 157, AST 102, ESR 2, CRP 5.2, and CMV viral load of 6,806,760. Abdominal CT and CT angiography showed colonic musical enhancement and mural edema indicative of probable colitis, without evidence of active bleeding. Empiric treatment with ganciclovir was initiated for presumed CMV colitis while the medical team awaited receipt of reports from the outside hospital. The patient had intermittent bleeding for several days that eventually resolved spontaneously. A prior colonoscopy report from the outside hospital ultimately showed colonic ulceration and endoscopic features “highly suggestive of CMV infection.” The immunopathology report of colon tissue biopsies showed ulceration and numerous enlarged cells with intranuclear and intracytoplasmic eosinophilic inclusions, consistent with CMV infection.

DISCUSSION:
This patient's presentation demonstrates the diagnostic challenge that can occur with IBD patients. Typical presenting symptoms for CMV colitis, including abdominal pain, diarrhea, and intestinal bleeding, can overlap significantly with symptoms of a non-infectious IBD flare. A high degree of clinical suspicion and appropriate laboratory testing is therefore needed to distinguish these two disease processes. Diagnosis is typically established by a combination of CMV viral load and immunohistochemical testing of colonic biopsy specimens. CMV colitis can be treated with antiviral medications, as in this case, but is associated with poor overall clinical outcomes, possibly requiring colectomy. After completing treatment for CMV colitis, the decision to reintroduce immunomodulatory therapy is made on a case-by-case basis.
3167 Rare Case of UTI: Complicated by Pylephlebitis With Hepatic Abscesses
Authors: Yella Prashanth Reddy , Choksi Vivek , Dermendjian Daniel , Patel Nehal , Dave Kairavee , Surapaneni Balarama K. , Priyadarshni Shivani , Obrien Keith , Rivas John 
Published: October 2019

INTRODUCTION:
Pylephlebitis, also known as infective suppurative thrombosis of the portal vein, requires imaging revealing portal vein thrombosis in a bacteremic patient. It has high mortality as the symptoms are nonspecific. We present a rare case of UTI complicated by PV thrombosis, further complicated by liver abscesses.

CASE DESCRIPTION/METHODS:
76 y/o female presented to ER with non-specific symptoms like fevers, chills, lethargy, decreased appetite, dark-foul smelling urine, for a week. Her vital were WNL. She had no abdominal pain, but had RUQ tenderness on exam. On labs, she had leukocytosis, elevated liver enzymes (cholestatic pattern), and abnormal UA. Hepatitis panel was negative. RUQ ultrasound showed gallstones, but no features of cholecystitis, which was confirmed by -ve HIDA scan. She was started on empiric antibiotics, for UTI. MRCP showed no choledocholithiasis and CT abdomen with IV contrast showed incidental hepatic-splenic cysts as well as a hepatic abscess. Meanwhile, urine culture was -ve and blood culture grew Proteus mirabilis. Antibiotic coverage was broadened to Merrem based on sensitivities. IR was consulted for possible drainage of liver abscess. A closer review of the imaging with IR showed suspicious small filling defects in the portal circulation. MRI abdomen showed thrombus within the branches of the right portal vein and 2 right hepatic abscesses. The diagnosis of pylephlebitis was made and the patient was continued on appropriate treatment with IV antibiotics. Her clinical condition improved and she was discharged on Day 10 with PO antibiotics for 4 more weeks. Repeat imaging in 4 weeks, showed resolution of the abscess.

DISCUSSION:
Pylephlebitis, a serious life-threatening condition is characterized by infected suppurative thrombosis of PV or its branches. It is often a delayed diagnosis, however outcome has improved with modern diagnostic & therapeutic modalities and with the use of broad-spectrum antibiotics. It occurs as a result of intraabdominal or intrapelvic infections draining into PV system, with the most common inciting infections being diverticulitis and appendicitis. The infection is frequently polymicrobial. Diagnosis requires demonstration of PV thrombosis on abdominal imaging in a bacteremic patient. Treatment includes antibiotics for at least 4-6 weeks. Role of anticoagulation in pylephlebitis is not well known. After our extensive literature search, we did not come across any reported case of UTI causing pylephlebitis, as in our patient.
3170 Autoimmune Hepatitis in an Elderly Patient
Authors: Madhani Kamraan , Leventhal Robert 
Published: October 2019

INTRODUCTION:
Autoimmune hepatitis (AIH) is a chronic inflammatory disease associated with younger age and female predominance. While patients presenting ≥65 years has been described, these are based on small cohorts.
1,2
We present a case of an elderly man admitted with painless jaundice, found to have AIH. Given favorable prognosis if diagnosed and treated early, AIH is an important differential diagnosis regardless of age.

CASE DESCRIPTION/METHODS:
An 85-year old man presented with 5-week history of weakness. Physical exam revealed jaundice of the eyes and skin. Laboratory data revealed alanine transaminase (ALT) 173 IU/L, aspartate aminotransferase (AST) 258 IU/L, alkaline phosphatase 306 IU/L, total bilirubin 9.9 mg/dL, and serum albumin 2.7 g/dL. Abdominal CT revealed normal liver size and contour without biliary ductal dilatation. MRCP showed filling defect within distal common bile duct to the ampulla however ERCP did not identify filling defect and sphincterectomy did not reveal stone or sludge (Figure 1). Liver biopsy revealed interface and lobular hepatitis with abundant plasma cells and minimal bile duct damage (Figures 2 and 3). Anti smooth muscle antibody and immunoglobulin G (IgG) were elevated to 76 U and 2,875 mg/dL, respectively. Anti liver-kidney microsomal antibody IgG, viral hepatitis, anti nuclear antibody, and anti mitochondrial antibody studies were negative. The patient began Azathioprine and Prednisone and within 9 weeks, ALT and AST normalized with improved sense of well being.

DISCUSSION:
AIH reported in the elderly has been described, however onset <40 years is more common.
1
Thus, this diagnosis is often delayed in elderly patients. It has been suggested that AIH in the elderly may represent a less severe, indolent process, which presents clinically at a later age. Unlike other autoimmune processes, few differences in disease course have been described between younger and older patients. Compared to other etiologies of chronic liver disease, AIH carries an excellent prognosis once therapy is initiated using prednisone ± Azathioprine. Untreated, AIH carries a dismal prognosis, with 5 and 10-year survival reported to be 50% and 10%, respectively.
3
3179 Case Report: Spontaneous Hemobilia After Liver Transplantation
Authors: Sobotka Lindsay , Wellner Michael , Black Sylvester , Michaels Anthony 
Published: October 2019

INTRODUCTION:
Liver transplantation is a safe and effective intervention for cirrhosis and acute liver failure with a survival rate greater than 90% at five years. Despite medical and surgical advancements, biliary complications affect about 10 to 30% of patients after liver transplantation and typically include a biliary stricture or leak. Hemobilia affects 1% of patients after transplantation and can present with abdominal pain, elevated liver function tests or anemia. This case report highlights the presentation and management of hemobilia after liver transplantation.

CASE DESCRIPTION/METHODS:
A 61 year old female with a past medical history of cryptogenic cirrhosis complicated by hepatic hydrothorax underwent a orthotopic liver transplantation. There were no complications during surgery. She developed worsening abdominal pain and increasing liver function tests within a week after transplantation. Given concern for biliary pathology, she underwent an endoscopic retrograde cholangiopancreatography (ERCP) which revealed hemobilia with spontaneous blood flow from the major papilla prior to biliary cannulation. Cholangiogram was performed and did not reveal any evidence of bile leak, anastomotic stricture or vascular communication. Clots were swept from the biliary tree and a stent was placed for continued drainage. Liver function tests returned to normal and abdominal pain resolved. The stent was removed 6 weeks later.

DISCUSSION:
Spontaneous hemobilia is a rare complication after liver transplantation that presents with rising liver function tests, abdominal pain or upper gastrointestinal bleeding. Diagnosis and management are typically with ERCP.
3215 Duodenal Blackout: A Rare, Benign Endoscopic Finding
Authors: Aggarwal Pankaj , Garapati Karthik , Kim David 
Published: October 2019

INTRODUCTION:
First described in 1976, psuedomelanosis is a rare, benign, incidental endoscopic finding most commonly seen in the duodenum. PD has been associated with chronic renal disease and the ingestion of various medications including hydralazine and iron supplements. Here we describe a classic presentation of an uncommon endoscopic abnormality.

CASE DESCRIPTION/METHODS:
A 66-year-old woman with decompensated cirrhosis, end stage renal disease, and hypertension presented to the hospital with hepatic encephalopathy and failure to thrive. Her medications included hydralazine and a history of iron supplementation. An esophagogastroduodenoscopy (EGD) performed for early satiety, weight loss and to initiate a liver transplant evaluation demonstrated diffuse mucosal hyperpigmentation in a striped pattern, predominantly in the second portion of the duodenum (Figure 1). Mucosal biopsy revealed an abundance of brown pigment deposition in the lamina propria (Figure 2) which was negative on Prussian blue stain and immunohistochemistry—consistent with a diagnosis of pseudomelanosis duodeni (PD).

DISCUSSION:
Despite its striking endoscopic appearance, there is no evidence that pseudomelanosis duodeni is associated with any progressive pathology. Though PD has been described anecdotally in case report and case series, little is known about the pathophysiology. Some have posited PD is related to iron or lipofuscin deposition in the lamina propria. PD has been associated with end-stage renal disease, hydralazine, thiazide diuretics, and iron supplementation. This case describes a classic presentation of PD with the archetypal imaging and histopathology to support the diagnosis of this uncommon condition.
3227 Can a Gluten-Free Diet Be an Option in Treating Collagenous Colitis in the Absence of Celiac Disease?
Authors: Florian Rosemarie , Jackson Christian 
Published: October 2019

INTRODUCTION:
Collagenous colitis (CC), a subtype of Microscopic Colitis, is known to cause chronic diarrhea in the elderly. Steroid medication, particularly budesonide, has been rigorously studied and shown to be effective, leading to remission. Few studies have revealed the role diet has on decreasing these symptoms.

CASE DESCRIPTION/METHODS:
69 y/o male with past medical history of chronic intermittent diarrhea for the past thirteen years. He initially presented with recurrence of non-bloody watery diarrhea, alternating with constipation and fecal incontinence for 2 weeks. Previous colonoscopy performed thirteen years ago revealed normal mucosa with diverticulosis. Further workup revealed a negative tTG- IgA, polypharmacy, or an infectious etiology. Labs were unremarkable. He underwent repeat colonoscopy, which demonstrated a fractured and nodular appearance of the cecum and ascending colon with small tears. Biopsies showed a focal increase in intraepithelial lymphocytes with a positive trichrome stain consistent with the diagnosis of CC. He was started on a GFD trial and had complete remission of his symptoms for three years.

DISCUSSION:
Chronic diarrhea affects approximately 5% of the population and at times can be challenging for gastroenterologists. When working up chronic diarrhea, microscopic colitis and celiac disease often play a large role. In this case, the patient was diagnosed with CC, however symptoms resolved on a GFD alone despite having multiple negative TTG levels. We believe that the multiple negative TTG levels were indicative of negative celiac disease. However, there is evidence showing that gluten can induce microscopic colitis. However, in women dietary gluten intake may not be a risk factor for the development of microscopic colitis in the absence of celiac disease. Nevertheless, the effects of gluten may be different in male veterans. CC is usually treated with a steroid based regimen, budesonide, to obtain remission. There are limited studies that have evaluated the impact that a GFD has upon the symptoms and histological findings in CC. Use of these medications can be associated with hyperglycemia, hypertension and metabolic bone disease which may be detrimental to the patient's health and prognosis. In conclusion, in patients diagnosed with CC consider starting a trial of GFD. Further studies are needed to evaluate the response of how a GFD affects the spectrum of severity in symptoms and histologic findings in patients diagnosed with CC, specifically in male veterans.
Role of apolipoprotein A-I in the anabolic effect of steroid hormones
Authors: Panin L. Ye. , Khoshchenko O. M. , Usynin I. F. 
Published: October 2019

As early shown, a portion of steroid hormones binds to blood lipoproteins, primarily to high-density lipoproteins (HDL) [Panin et al. 1988]. Steroid hormones together with HDL are captured by resident macrophages of the liver where in secondary lysosomes HDL are degraded to form apoA-I and steroid hormones restore a ∆4, 3-keto group with the participation of 5-α and 5β- reductases to give rise to tetrahydro compounds. In this study, an attempt was undertaken to show a role of a complex of some steroid hormones with apo A-I in realization of the anabolic action of these steroid hormones by using the cultured hepatocytes and concurrently cultured hepatocytes and Kupffer’s cells isolated from the liver of male Wistar rats weighing 180-200 g.
Steroid hormones having an anabolic action, such as androsterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate and tetrahydrocortisol as ingredients of a complex with apolipoprotein A-I (apoA-I), increased the rate of protein biosynthesis and dehydroepiandrosterone sulfate and tetrahydrocortisol also did the rate of DNA synthesis in the cultured hepatocytes. All the hormones had a restored ∆4,3-keto group in the A ring structure. Restoration of this group of steroid hormones and formation of their complex with apoA-I are associated with the action of resident macrophages (Kupffer’s cells). That is the reason that addition of HDL (a source of apoA-I) and cortisol (a source of the restored form - tetrahydrocortisol) to the coculture of hepatocytes and macrophages, by concurrently stimulating the latter by lipopolysaccharide led to a significant increase in the rate of protein and DNA biosynthesis. The findings show an important role of a ∆4,3-keto group of the A ring of steroid hormones and their complex with apo A-I in realizing the anabolic action of steroids.
How memories of study abroad experience are contextualized in the language classroom
Authors: Lee Sheng-Hsun 
Published: October 2019

Abstract
Many study abroad researchers recruit genres, such as diary, interview, and questionnaire, to study memories of study abroad experience and their relationship with language learning. Whether quantitative or qualitative, much emphasis is on individual representations and circulation of past experience, not the here-and-now, nor the impact a person’s study abroad memories has on their subsequent life practices. In this study, I draw on sociocultural theory to analyze study abroad experiences recounted in various types of language classroom activity. I show that memory is constantly (re)shaped by intermental, interactional, and institutional forces, as when students are mediated at lexical, grammatical, and discursive levels to reconstruct their experienced past vis-à-vis goal-directed activity in class. I highlight discursive practices rememberers adopt to render their version of the past credible and authentic, and explain how such practices create opportunities for mediation in the classroom. The findings demonstrate that contextualized remembering is a mediated process of objectifying personal experience, and that memory discourse is a mediating tool for transforming mental and social activity. Thus, remembering is not simply the retrieval or circulation of individual subjectivities, but also an active social practice.
Migrant women, work, and investment in language learning: Two success stories
Authors: Iikkanen Päivi 
Published: October 2019

Abstract
In the media, migrant mothers are often portrayed as uneducated, having trouble learning a new language, and preferring to stay at home rather than entering paid employment. This article offers a contrasting point of view as a result of examining how two migrant women narrativize their experiences of language learning and working-life-related integration during a three-year period. Specific attention is paid to how the women make sense of their language use over time, and how this may have contributed to their integration into working life and the wellbeing of their families. Interview data was analyzed using the short story analytical approach, focusing on both the content and the various scales of context portrayed in the stories. The analysis is informed theoretically by the concept of investment. The findings indicate that, first, English was used when interacting with members and institutions of the Finnish society, but gradually the use of English was replaced by an emerging Finnish proficiency. At first with the help of English and later, by deciding to invest in learning Finnish, both key participants managed to build new careers and meaningful lives for themselves and their families in a new environment.
Influence of hypertriglyceridemia, hyperbilirubinemia and hemolysis on thrombin generation in human plasma
Authors: Salvagno Gian Luca , Favaloro Emmanuel J. , Demonte Davide , Gelati Matteo , Poli Giovanni , Targher Giovanni , Lippi Giuseppe 
Published: October 2019

Abstract

Background
Although accumulating evidence suggests that the hemostatic balance is impaired in patients with hypertriglyceridemia, hyperbilirubinemia or hemolytic anemias, little is known on the underlying biological mechanisms. This experimental study was aimed at exploring whether increasing values of triglycerides, bilirubin or cell-free hemoglobin promote thrombin generation in plasma.

Methods
Three different pools were prepared from three different sets of 20 normal routine plasma citrate samples. The native pools were spiked with increasing amounts of exogenous triglycerides (up to 8.8 mmol/L), bilirubin (up to 350 μmol/L) or autologous hemolyzed blood (up to 3.5 g/L cell-free hemoglobin). Using the fully-automated thrombin generation analyzer ST Genesia, we measured the following parameters: lag time (LT), time to peak (TP), peak height (PH) and endogenous thrombin potential (ETP).

Results
A sustained increase of PH and ETP was found in parallel with increasing triglyceride concentrations, peaking in the aliquot with 8.8 mmol/L. Conversely, LT and TP displayed an opposite trend, reaching a maximum decrease in the 8.8 mmol/L aliquot. Increasing bilirubin concentrations promoted remarkable increases of PH and ETP and decreases of TP and LT, up to 211 μmol/L. After this threshold, all parameters tended to return towards baseline values. A constant increase of PH and ETP was also noted in hemolyzed samples, peaking in the 3.5 g/L cell-free hemoglobin aliquot, whereas the TP and LT remained unchanged in all hemolyzed aliquots.

Conclusions
Our findings suggest that hypertriglyceridemia, hyperbilirubinemia and hemolysis may promote a hypercoagulable state in human plasma.
Protective effects of specneuzhenide on renal injury in rats with diabetic nephropathy
Authors: Yin Jiangning , Jiang Jun , Wang Huajun , Lu Guoyuan 
Published: October 2019

Abstract

Background
We aim to investigate the protective effects and potential mechanisms in specneuzhenide (SPE) on renal injury in rats with diabetic nephropathy (DN).

Results
SPE could inhibit the decrease of body weight compared with the model group (P<0.05), and trigger improvement in the renal index (P<0.05). High dose and low dose SPE could trigger a significant decrease in serum IL1β, IL-6 and TNF-α compared with the model group (P<0.05). SPE could attenuate the glomerular lesions in DN rats. SPE induced up-regulation of podocin and CD2AP (P<0.05).

Conclusion
SPE showed protective effects on renal injury through attenuating the pathological injury and urine protein. This process may be closely related to the modulation of CD2AP and podocin expression.
Demand for Selected Animal Sourced Protein Food Items in United States
Authors: Tamim Rahman Kazi , Amin Md. Ruhul , Salauddin Palash M. 
Published: October 2019

Abstract
Consumers’ preference for food is ever-changing from carbohydrate to protein since protein plays a vital role in the balanced and healthy growth of human being. Among different sources of protein, animal sourced protein foods are getting popularity over time in United States. How demand for animal sourced protein food items are changing, and to be specific which animal food items are preferred by consumers are necessary to know both for producers and suppliers. This study estimates consumer demand for animal sourced food items in U.S. employing linear approximation of AIDS (LA-AIDS) model. Monthly per capita consumption expenditure data on aggregate and disaggregate animal protein items and price indices at national level from 1995 to 2016 have been collected from the Bureau of Economic Analysis of United States. The data consists of monthly per capita consumption expenditure on beef and veal, pork, other meats, poultry, and fish and seafood, and their price indices. The result shows exogenous growth in the budget share of all meat items. Estimated expenditure and cross price elasticities suggest that all goods are normal in nature and substitute to each other. In addition, weak separability test suggests that meat items are separable from non-meat items. The findings of the study would be helpful understanding consumer preferences and behavior for allocating budget among different sources of animal protein.