A Systematic Review of Crohn's Disease Case Definitions in Administrative or Claims Databases.

BACKGROUND: We sought to review Crohn's disease (CD) case definitions that use diagnosis, procedure, and medication claims. METHODS: We searched PubMed and Embase from inception through January 31, 2022, using terms related to CD, inflammatory bowel disease, administrative claims, or validity. Each article was scrutinized by 2 authors independently screening and abstracting data. Collected data included participant characteristics, case definition characteristics, and case definition validity. When diagnostic accuracy was provided for multiple case definitions, we extracted the case definition selected by the authors. All diagnostic accuracy characteristics were captured. RESULTS: We identified 30 studies that evaluated a case definition using claims data to identify CD patients. The most common case definition included counts of diagnosis codes (57%) followed by a combination of diagnosis codes and medications (20%). All but 1 study validated the case definition with a medical chart review. In 2 studies, the patient's primary care provider completed a survey to confirm disease status. The positive predictive value of the case definitions ranged from 18% (≥1 code at a single U.S. health plan) to 100% (≥1 code plus a relevant prescription at a U.S. hospital). More complex case definitions (eg, ≥1 code + prescription or ≥2 codes) had lower variability in positive predictive value (≥80%) and specificity (≥85%) than the ≥1 code requirement. CONCLUSIONS: Health services researchers should validate case definitions in their research cohorts. When such validation cannot be performed, we recommend using a more complex case definition. Studies without a validated CD case definition should use sensitivity analyses to confirm the robustness of their results.

This systematic review of Crohn's disease (CD) case definitions identified that complex case definitions such as ≥1 diagnosis code + ≥1 prescription had desirable diagnostic accuracy properties.

Sustained Resolution of Multifocal Low-Grade Dysplasia in Ulcerative Colitis.

In inflammatory bowel disease, prolonged disease duration, pancolitis, histological inflammation, and subsequent dysplasia are associated with an increased risk for colorectal cancer. Recommendations regarding treatment of low-grade dysplasia (LGD) indicate an individualized approach between colectomy and surveillance. We present a unique case of a patient with ulcerative colitis who had multifocal LGD on 2 consecutive colonoscopies. However, after 10 years and 16 surveillance colonoscopies, she had no further evidence of dysplasia. This appears to be the first case of proven, permanently resolved multifocal LGD in inflammatory bowel disease that challenges our understanding of the natural history of LGD.

Treatment of Intermittent Exotropia of the Convergence Insufficiency Type with Bupivacaine 0.75%: 5-Year Experience and Outcomes.

INTRODUCTION: Bupivicaine has been shown to stimulate ocular muscle structure and length after injection into ocular muscles. Bupivicaine 0.75% has been utilized in the treatment of strabismus to alter ocular alignment by strengthening an ocular muscle. This study is designed to report 5-year follow-up outcomes after bupivicaine injection. METHODS: A retrospective chart review of all bupivicaine treated strabismus patients with symptomatic intermittent exotropia of the convergence insufficiency type (CIXT) from 2009 through 2016. Success was measured as resolution of symptoms (diplopia, difficulty reading, intermittent blurry vision, and headaches) with or without prisms (<5Δ). RESULTS: At a 5-year outcome, success rate was 80%. Mean near deviation changed from 10.6Δ to 3.8Δ. Outcome was the same at 6 months (n = 124) vs 5 years (n = 30) unless a new onset strabismus occurred (TAED, CN palsy, CVA). In older patients, a large number (10%) of patients developed new onset strabismus. There were no moderate or severe complications after injection. There appears to be a predictable dose response curve. DISCUSSION: At 6 months outcome, treatment of CIXT with bupivacaine (91%) has a similar rate of success as traditional resection (92%). Older patients need to be informed of the incidence of new onset strabismus causing recurrence of symptoms (10%). CONCLUSION: At 5 years outcome, bupivicaine 0.75% offers a simple alternative therapy for CIXT type strabismus patients. There is little risk and less expense than traditional resection surgery without the overcorrections.

The Caenorhabditis elegans NF2/Merlin Molecule NFM-1 Nonautonomously Regulates Neuroblast Migration and Interacts Genetically with the Guidance Cue SLT-1/Slit.

During nervous system development, neurons and their progenitors migrate to their final destinations. In Caenorhabditis elegans, the bilateral Q neuroblasts and their descendants migrate long distances in opposite directions, despite being born in the same posterior region. QR on the right migrates anteriorly and generates the AQR neuron positioned near the head, and QL on the left migrates posteriorly, giving rise to the PQR neuron positioned near the tail. In a screen for genes required for AQR and PQR migration, we identified an allele of nfm-1, which encodes a molecule similar to vertebrate NF2/Merlin, an important tumor suppressor in humans. Mutations in NF2 lead to neurofibromatosis type II, characterized by benign tumors of glial tissues. Here we demonstrate that in C. elegans, nfm-1 is required for the ability of Q cells and their descendants to extend protrusions and to migrate, but is not required for direction of migration. Using a combination of mosaic analysis and cell-specific expression, we show that NFM-1 is required nonautonomously, possibly in muscles, to promote Q lineage migrations. We also show a genetic interaction between nfm-1 and the C. elegans Slit homolog slt-1, which encodes a conserved secreted guidance cue. Our results suggest that NFM-1 might be involved in the generation of an extracellular cue that promotes Q neuroblast protrusion and migration that acts with or in parallel to SLT-1 In vertebrates, NF2 and Slit2 interact in axon pathfinding, suggesting a conserved interaction of NF2 and Slit2 in regulating migratory events.