Clinical significance and long-term prognosis of ulcerative colitis patients with appendiceal orifice inflammation.

BACKGROUND: Appendiceal orifice inflammation (AOI) or peri-appendiceal red patch is a skip lesion with segments of continuous colitis from the rectum. Frequently observed in ulcerative colitis (UC) patients, this lesion might be associated with proximal extension in some studies. However, the clinical significance of this lesion and long-term outcomes including therapy remain unclear. Thus, the aim of this study was to evaluate the clinical implication of AOI during long-term periods in patients with UC. METHODS: We retrospectively reviewed 376 patients with UC who performed complete colonoscopic examinations between April 2000 and December 2020. We compared clinical characteristics and outcomes of patients manifesting AOI with those who did not show AOI during a mean follow-up period of 66.1 months. Long-term outcomes included maximal extent of colitis, proximal extension, therapeutic medical histories, UC-related hospitalization, and relapse. RESULTS: Ninety-eight (26.1%) patients showed AOI without evidence of inflammation in the right colon. Mild disease activity at the diagnosis of UC was more included in patients with AOI than in those without AOI. Other baseline characteristics including disease extent, smoking history, external intestinal manifestation, and terminal ileal ulceration were not significantly different between the two groups. During follow-up periods, patients with and without AOI showed no significant difference in proximal extension, Mayo endoscopic score at the last endoscopic examination, UC-related hospitalization, or relapse. Of medication history, patients with AOI were less included in the group treated with high-dose aminosalicylates than those without AOI. However, therapeutic histories of steroids, immunosuppressive agents, and biologics were not significantly different. Of 62 patients with AOI who underwent follow-up colonoscopy, 36 (58.1%) showed resolution of AOI. Clinical outcomes of the resolution group were not different than those of the non-resolution group. Biopsy results of 77 patients with AOI showed chronic active or erosive colitis. CONCLUSIONS: Long-term outcomes of UC patients with AOI were not different from those without AOI. Outcomes of resolution and non-resolution groups of AOI patients were not different either. Thus, AOI might have no prognostic implication in distal UC patients.

Ten-year trends of utilizing palliative care and palliative procedures in patients with gastric Cancer in the United States from 2009 to 2018 - a nationwide database study.

OBJECTIVES: Little is known about the current status and the changing trends of hospitalization and palliative care consultation of patients with gastric cancer in the United States. The aim of this study was to evaluate the changing trend in the number of hospitalization, palliative care consultation, and palliative procedures in the US during a recent 10-year period using a nationwide database. METHODS: This was a retrospective study that analyzed the National Inpatient Sample (NIS) database of 2009-2018. Patients aged more than 18 years who were diagnosed with a gastric cancer using International Classification of Diseases (ICD)-9 and 10 codes were included. Palliative care consultation included palliative care (ICD-9, V66.7; ICD-10, Z51.5) and advanced care planning (ICD-9, V69.89; ICD-10, Z71.89). Palliative procedures included percutaneous or endoscopic bypass, gastrostomy or enterostomy, dilation, drainage, nutrition, and irrigation for palliative purpose. RESULTS AND DISCUSSION: A total of 86,430 patients were selected and analyzed in this study. Using a compound annual growth rate (CAGR) approach, the annual number of hospitalizations of gastric cancer patients was found to be decreased during 2009-2018 (CAGR: -0.8%, P = 0.0084), while utilization rates of palliative care and palliative procedures increased (CAGR: 9.3 and 1.6%, respectively; P < 0.0001). Multivariable regression analysis revealed that palliative care consultation was associated with reduced total hospital charges (-$34,188, P < 0.0001). CONCLUSION: Utilization of palliative care consultation to patients with gastric cancer may reduce use of medical resources and hospital costs.

The Impact of the Amendment of the Health Insurance Coverage for F-18 Fluorodeoxyglucose Positron Emission Tomography on the Healthcare Behaviors for Breast Cancer: An Interrupted Time Series Analysis of the Korean National Data From 2013 to 2018.

BACKGROUND: F-18 Fluorodeoxyglucose positron emission tomography (F-18 FDG PET), which can cover the body from the skull base to the thigh in one scan, is beneficial for evaluating distant metastasis. F-18 FDG PET has interested policymakers because of its relatively high cost. This study investigated the effect of the F-18 FDG PET reimbursement criteria amendment on healthcare behavior in breast cancer using an interrupted time series (ITS) analysis. METHODS: We retrospectively analyzed the inpatient and outpatient data from Korea's Health Insurance Review and Assessment Service (HIRA) from January 1, 2013 to December 31, 2018. ITS analysis was performed for the number of each medical imaging modality and the total medical imaging cost of the breast cancer patients. RESULTS: The annual number of breast cancer patients has been increasing steadily since 2013. The trend of F-18 FDG PET increased before the reimbursement criteria was amended, but intensely decreased immediately thereafter. The chest and abdomen computed tomography scans showed a statistically significant increase immediately after the amendment and kept steadily increasing. A change in the total medical imaging cost for the breast cancer patient claimed every month showed an increasing trend before the amendment (ß = 5,475, standard error [SE] = 1,992, P = 0.008) and rapid change immediately after (ß = -103,317, SE = 16,152, P < 0.001). However, there was no significant change in the total medical imaging cost at the long-term follow-up (ß = -912, SE = 1,981, P = 0.647). CONCLUSION: Restriction of health insurance coverage for cancer may affect healthcare behaviors. To compensate for it, the policymakers must consider this and anticipate the impact following implementation.

Association between body weight variability and incidence of Parkinson disease: A nationwide, population-based cohort study.

BACKGROUND AND PURPOSE: Although body weight variability has been associated with mortality, cardiovascular disease, and dementia, the relationship between body weight variability and Parkinson disease (PD) has rarely been studied. We aimed to investigate the longitudinal association between body weight variability and PD incidence. METHODS: A nationwide population-based, cohort study was conducted using the database from the Health Insurance Review and Assessment Service of the whole Korean population. We analyzed 2,815,135 participants (≥40 years old, mean age = 51.7 ± 8.6 years, 66.8% men) without a previous PD diagnosis. We determined individual body weight variability from baseline weight and follow-up visits. We used Cox proportional hazards regression models. RESULTS: The highest quartile group was associated with increased PD incidence compared with the lowest quartile group after adjustment for confounding factors (hazard ratio [HR] = 1.18, 95% confidence interval [CI] = 1.08-1.29). In contrast, baseline body mass index, baseline waist circumference, and waist circumference variability were not associated with increased PD incidence. In the body weight loss group, individuals within the quartile of the highest variation in body weight showed a higher HR of PD risk than those within other quartiles (HR = 1.41, 95% CI = 1.18-1.68). CONCLUSIONS: Body weight variability, especially weight loss, was associated with higher PD incidence. This finding has important implications for clinicians and supports the need for preventative measures and surveillance for PD in individuals with fluctuating body weight.

Does low income effects 5-year mortality of hepatocellular carcinoma patients?

BACKGROUND: In Korea, the universal health system offers coverage to all members of society. Despite this, it is unclear whether risk of death from hepatocellular carcinoma (HCC) varies depending on income. We evaluated the impact of low income on HCC mortality. METHODS: The Korean National Health Insurance sampling cohort was used to identify new HCC cases (n = 7325) diagnosed between 2004 and 2008, and the Korean Community Health Survey data were used to investigate community-level effects. The main outcome was 5-year all-cause mortality risk, and Cox proportional hazard models were applied to investigate the individual- and community-level factors associated with the survival probability of HCC patients. RESULTS: From 2004 to 2008, there were 4658 new HCC cases among males and 2667 new cases among females. The 5-year survival proportion of males was 68%, and the incidence per person-year was 0.768; the female survival proportion was 78%, and the incidence per person-year was 0.819. Lower income was associated with higher hazard ratio (HR), and HCC patients with hepatitis B (HBV), alcoholic liver cirrhosis, and other types of liver cirrhosis had higher HRs than those without these conditions. Subgroup analyses showed that middle-aged men were most vulnerable to the effects of low income on 5-year mortality, and community-level characteristics were associated with survival of HCC patients. CONCLUSION: Having a low income significantly affected the overall 5-year mortality of Korean adults who were newly diagnosed with HCC from 2004 to 2008. Middle-aged men were the most vulnerable. We believe our findings will be useful to healthcare policymakers in Korea as well as to healthcare leaders in countries with NHI programs who need to make important decisions about allocation of limited healthcare resources according to a consensually accepted and rational framework.

Accuracy of Continuous and Noninvasive Hemoglobin Monitoring in the Presence of CO2 Insufflation: An Observational Pilot Study.

BACKGROUND Laparoscopic surgery has several benefits, but it requires prolonged carbon dioxide (CO2) insufflation. Several factors affect the accuracy of continuous and noninvasive hemoglobin (SpHb) monitoring, but the effects of CO2 insufflation are undetermined. This study investigated the effect of CO2 insufflation on SpHb monitoring in laparoscopic surgery. MATERIAL AND METHODS Twenty patients undergoing laparoscopic gastrectomy were enrolled. Anesthesia was maintained using sevoflurane and remifentanil within an end-tidal CO2 of 30-45 mmHg. The CO2 insufflation was maintained at 12 mmHg using CO2. SpHb was monitored with a Radical-7 Pulse CO-Oximeter, and laboratory hemoglobin (tHb) was analyzed using a satellite blood analyzer. RESULTS Forty paired measurements were analyzed. The mean perfusion index, SpHb, and tHb were 3.10±1.77%, 10.92±1.48 g/dL, and 11.51±0.88 g/dL, respectively. SpHb underestimated tHb with a bias (precision) of -0.59 (1.28 g/dL), and the 95% limit of agreement was wide (-3.11 to 1.92 g/dL). SpHb was moderately correlated with tHb (r=0.50, 95% CI: 0.23 to 0.70). The concordance rate was 67%. ΔSpHb was not correlated with ΔtHb (r=0.29, 95% CI: -0.18 to -0.65). A similar bias, wider limits of agreement, a higher |SpHb-tHb|, but more significant correlation between SpHb and tHb were observed for the "PaCO2 <40 mmHg" range compared with the "40 mmHg ≤PaCO2" range. CONCLUSIONS SpHb may have an acceptable accuracy but has a weak trending ability in the presence of CO2 insufflation, and it can be affected by PaCO2. Further research on the effects of CO2 insufflation on SpHb is needed.

The association of education in a new society and social support from the education with the health of North Korean defectors: a cross-sectional study.

BACKGROUND: The number of North Korean defectors (NKDs) escaping to South Korea has increased. The health status of NKDs is an essential factor for a successful settlement into South Korean society. However, no studies have been conducted on the health status of NKDs in terms of education and social support. The aim of this study was to determine the associations of education and social support with the self-rated health status among NKDs. METHODS: This study utilized data gained from face-to-face interviews with 126 NKDs. A multivariable logistic regression and path analysis were performed to assess the effects of education in South Korea and social support on their self-rated health status and to explore the complex relationships between direct and indirect effects of the variables. RESULTS: NKDs who did not experience regular education in South Korea responded that they were in poor health compared to their counterpart (OR = 5.78). Although a direct association between education in South Korea and self-rated health was not shown, there was an indirect path from education in South Korea to self-rated health through social support. CONCLUSIONS: Participation in regular education in South Korea is important for the health status of NKDs. Moreover, social support has an important role in the association between education and self-rated health. Social policies and NKD assistance programs should consider and reflect the combination of education and social support interventions relevant to the health status of NKDs.

Advanced glycation end products promote triple negative breast cancer cells via ERK and NF-κB pathway.

Advanced glycation end products (AGEs) are harmful compounds generated by nonspecific glycation of proteins and lipids. The accumulation of AGEs is associated with various diseases, including breast cancer. AGEs have been shown to promote a breast cancer cell line by enhancing proliferation, invasion and migration. In this study, we investigated the effect and associated mechanism of AGEs on triple negative breast cancer cells. AGEs enhanced the proliferation, tumorigenicity, invasion and migration of primary breast cancer cells. AGEs also enhanced the RNA and protein expression of matrix metalloproteinase (MMP)-9 and its gelatinase activity. Enhanced MMP-9 expression was mediated by extracellular-signal regulated kinase (ERK) and nuclear factor kappa B (NF-κB) pathways. Moreover, inhibitors of ERK and NF-κB signaling attenuated the effect of AGEs on tumorigenicity, invasion and migration of primary breast cancer cells. Taken together, we suggest that AGEs directly promote primary breast cancer cells via the ERK and NF-κB pathway, which may lead to advanced therapeutic modalities of breast cancer.

Association between residual teeth number in later life and incidence of dementia: A systematic review and meta-analysis.

BACKGROUND: It has been suggested that tooth loss in later life might increase dementia incidence. The objective of this analysis is to systematically review the current evidence on the relationship between the number of remaining teeth and dementia occurrence in later life. METHODS: A search of multiple databases of scientific literature was conducted with relevant parameters for articles published up to March 25th, 2017. Multiple cohort studies that reported the incidence of dementia and residual teeth in later life were found with observation periods ranging from 2.4 to 32 years. Random-effects pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated to examine whether high residual tooth number in later life was associated with a decreased risk of dementia. Heterogeneity was measured by I2. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assess the overall quality of evidence. RESULTS: The literature search initially yielded 419 articles and 11 studies (aged 52 to 75 at study enrollment, n = 28,894) were finally included for analysis. Compared to the low residual teeth number group, the high residual teeth number group was associated with a decreased risk of dementia by approximately 50% (pooled OR = 0.483; 95% CI 0.315 to 0.740; p < 0.001; I2 = 92.421%). The overall quality of evidence, however, was rated as very low. CONCLUSION: Despite limited scientific strength, the current meta-analysis reported that a higher number of residual teeth was associated with having a lower risk of dementia occurrence in later life.

Life-Sustaining Procedures, Palliative Care Consultation, and Do-Not Resuscitate Status in Dying Patients With COPD in US Hospitals: 2010-2014.

AIM: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in US hospitals. We examined temporal trends and the impact of palliative care on the use of life-sustaining procedures in this population. MATERIALS AND METHODS: A retrospective nationwide cohort analysis was performed using weighted National Inpatient Sample (NIS) data obtained from 2010 to 2014. Decedents ≥18 years of age at the time of death and with a principal diagnosis of COPD were included. We examined the receipt of life-sustaining procedures, defined as1 ventilation (intubation, mechanical ventilation, and noninvasive ventilation),2 vasopressor use (infusion and intravascular monitoring),3 nutrition (enteral and parenteral infusion of concentrated nutrition),4 dialysis, and5 cardiopulmonary resuscitation as well as palliative care consultation and do not resuscitate (DNR). We used compound annual growth rates (CAGRs) and the Rao-Scott correction of the χ2 statistic to determine the statistical significance of temporal trends of life-sustaining procedures, palliative care utilization, and DNR status. RESULTS: Among 37 312 324 hospitalizations, 38 425 patients were examined. The CAGRs of life-sustaining procedures were 6.61% and -9.73% among patients who underwent multiple procedures and patients who did not undergo any procedure, respectively (both P < .001). The CAGRs of palliative consultation and DNR were 5.25% and 36.62%, respectively (both P < .001). CONCLUSIONS: Among adults with COPD dying in US hospitals between 2010 and 2014, the utilization of life-sustaining procedures, palliative care, and DNR status increased.

Do Reduced Copayments Affect Mortality after Surgery due to Stroke? An Interrupted Time Series Analysis of a National Cohort Sampled in 2003-2012.

BACKGROUND: The South Korean government introduced a policy in 2 phases, in September 2005 and in January 2010, for reducing copayments for patients with critical diseases, including stroke, to prevent excessive medical expenditures and to ease economic barriers. Previous studies of the effect of this policy were focused primarily on cancer. Therefore, we investigated the relationship between this policy and 1-year mortality after surgery among patients with stroke. METHODS: We used data from the Korean National Health Insurance sampling cohort (n = 2173 in 2003-2012) and performed an interrupted time series analysis. RESULTS: Approximately 26% of the patients died within 1 year after surgery. The time trends after reducing copayments from 10% to 5% (phase 2) were inversely associated with risk of 1-year mortality (relative risk = .855, 95% confidence interval: .749-.975; P = .0196). In addition, this inverse association was greater in patients with low incomes, of older ages, and with higher Charlson comorbidity indices. CONCLUSIONS: The introduction of a policy for reducing copayments to ease excessive cost burdens for patients with stroke was positively associated with a reduced risk of 1-year mortality after surgical treatment due to stroke. On the basis of our results, health policy makers should make an effort to identify vulnerable populations and to overcome economic barriers for providing effective alternatives to ensure patients receive optimal health care.

Effects of the 2009 Medical Cannabinoid Legalization Policy on Hospital Use for Cannabinoid Dependency and Persistent Vomiting.

BACKGROUND & AIMS: In 2009, the U.S. Department of Justice issued a memo stating that it would not prosecute users and sellers who complied with the state laws allowing for medical use of marijuana. There are growing concerns about legalization of marijuana use and its related public health effects. We performed an interrupted time series analysis to evaluate these effects. METHODS: We collected a representative sample of hospital discharge data from the Healthcare Cost and Utilization Project, from January 1993 to December 2014. We divided the data in to 3 groups: the prelegalization period (1993-2008), the legalization period (2009), and the postlegalization period (2010-2014). The disease variables were International Classification of Disease-Ninth Revision-Clinical Modification 304.30 cannabinoid dependency unspecified (CDU), 536.2 persistent vomiting, and an aggregate of CDU and persistent vomiting. We performed interrupted time series and Poisson-Gamma regression analysis to calculate each year's incidence rate of unspecified and persistent vomiting and CDU per 100,000 hospital discharges. CDU, persistent vomiting, and aggregate of CDU and persistent vomiting were modeled separately to estimate average incidence rate ratio and 95% confidence interval for each study phase. RESULTS: We observed an increasing trend of CDU or an aggregate of CDU and persistent vomiting during the prelegalization period. The legalization of marijuana significantly increased the incidence rate during the legalization period (by 17.9%) and the yearly average increase in rate by 6% after policy implementation, compared to the prelegalization period. The increase in rate of persistent vomiting after policy implementation increased significantly (by about 8%), although there were no significant trends in increase prior to or during marijuana legalization in 2009. CONCLUSIONS: In an interrupted time series analysis of before, during, and after medical marijuana legalization, we estimated levels and rate changes in CDU and persistent vomiting. We found persistent increases in rates of CDU and persistent vomiting during and after legalization of marijuana.

Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis.

OBJECTIVE: Hospital palliative care has been shown to improve quality of life and optimize hospital utilization for seriously ill patients who need intensive care. The present review examined whether hospital palliative care in intensive care (ICU) and non-ICU settings will influence hospital length of stay and in-hospital mortality. METHOD: A systematic search of CINAHL/EBSCO, the Cochrane Library, Google Scholar, MEDLINE/Ovid, PubMed, and the Web of Science through 12 October 2016 identified 16 studies that examined the effects of hospital palliative care and reported on hospital length of stay and in-hospital death. Random-effects pooled odds ratios and mean differences with corresponding 95% confidence intervals were estimated. Heterogeneity was measured by the I 2 test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to assess the overall quality of the evidence. RESULTS: Of the reviewed 932 articles found in our search, we reviewed the full text of 76 eligible articles and excluded 60 of those, which resulted in a final total of 16 studies for analysis. Five studies were duplicated with regard to outcomes. A total of 18,330 and 9,452 patients were analyzed for hospital length of stay and in-hospital mortality from 11 and 10 studies, respectively. Hospital palliative care increased mean hospital length of stay by 0.19 days (pooled mean difference = 0.19; 95% confidence interval [CI 95%] = -2.22-2.61 days; p = 0.87; I 2 = 95.88%) and reduced in-hospital mortality by 34% (pooled odds ratio = 0.66; CI 95% = 0.52-0.84; p < 0.01; I 2 = 48.82%). The overall quality of evidence for both hospital length of stay and in-hospital mortality was rated as very low and low, respectively. SIGNIFICANCE OF RESULTS: Hospital palliative care was associated with a 34% reduction of in-hospital mortality but had no correlation with hospital length of stay.

A high-value cost conscious approach to minimize heparin induced thrombocytopenia antibody (HITAb) testing using the 4T score.

Heparin Induced Thrombocytopenia (HIT) is a serious complication from administration of heparin products. The 4T score is a validated pre-test probability tool to screen for HIT in hospitalized patients. As the negative predictive value (NPV) is very high further testing for HIT in patients with a low score can be avoided. Our objective was to determine trends at our hospital with respect to utilization of HIT antibody (HITAb) testing and evaluate economic burden from unnecessary HIT testing. A retrospective cohort review was performed on patients age 18 and above admitted to a tertiary care center from February 2013 to December 2014 who underwent HITAb testing. Surgical ICU patients were excluded. Patients were stratified into low, intermediate, and high risk for HIT based on the 4T model. Statistical analysis was performed using Chi square and regression models. Of 150 patients that underwent HITAb testing, 134 met inclusion criteria. 73 were male (54.47 %) and mean age was 55.50 ± 17.27 years. 81 patients had a low 4T score 0-3. Analysis of testing trends showed 60.44 % of patients were tested for HITAb despite being low risk using the 4T model. Only three patients with low 4T score were positive on confirmatory SRA testing (NPV 96.29 % CI 95 = 89.56-99.23 %). Expenditure due to inappropriate testing and treatment was estimated at $103,348.13. The majority of HITAb testing was found unnecessary based on the investigator calculated 4T score. We propose implementation of an electronic medical record (EMR) based calculator in order to reduce unneeded tests and reduce use of costlier alternative anticoagulants.

Variations in the distance between the cricoid cartilage and targets of stellate ganglion block in neutral and extended supine positions: an ultrasonographic evaluation.

PURPOSE: Anatomic variations complicate surface landmark-guided needle placement, thereby increasing nerve blockade failure rate. However, little is understood about how anatomic distances change under different clinical conditions. As the cricoid cartilage is an easy and accurate landmark, we investigated changes in distance between the sixth or seventh cervical transverse processes (C6TP or C7TP) and the cricoid cartilage in neutral and extended supine positions. METHODS: Forty-two patients (16 men, 26 women) were included in this study. Distances between the cricoid cartilage and C6TP/C7TP were measured using ultrasonography with the patient in neutral and extended supine positions. RESULTS: C6TP and C7TP were caudally located at 6.0 ± 8.1 and 15.1 ± 7.2 mm, respectively, from the cricoid cartilage in the neutral supine position, and at 15.2 ± 8.0 and 25.3 ± 8.0 mm, respectively, in the extended supine position. In the extended supine position, the cricoid cartilage was more cephalad than C6TP and C7TP in all patients. The distance from the cricoid cartilage to C6TP was 12.1 ± 7.6 mm in men and 17.2 ± 7.7 mm in women. CONCLUSION: C6TP and C7TP are located approximately 15 and 25 mm, respectively, caudal to the cricoid cartilage in the extended supine position. Our results highlight the fact that there can be significant anatomic variation between the extended and neutral supine positions used in stellate ganglion block, which should be kept in mind when devising easily identifiable and palpable surface landmarks.

Systematic review of multiple versus single device closure of Secundum atrial septal defects in adults.

INTRODUCTION: Multiple device closure (MDC) strategy has been used in treating of complex Atrial septal defects (ASDs) in adults. The safety profile of MDC compared to conventional single device closure (SDC) is unknown in this population. This report represents the first review examining the outcomes of single versus multiple device ASD closure in adults with ostium secundum defects. METHODS: Literature databases and manual search from their inception until June 30th, 2017 followed the Preferred Reporting Items of Systemic Review and Meta-Analysis (PRISMA) guideline. Main outcomes are 1) overall complication incidence, 2) arrhythmia incidence, 3) residual shunt rate. Each outcome profile was pooled by MDC and SDC, respectively and chi-square analysis was applied to examine statistical significance between MDC and SDC strategies (two-sided and p < .050). RESULTS: A total of 1806 + studies were initially screened, and 20 studies were finally selected (MDC group, 147 patients; SDC group, 1706 patients). There was no difference in overall complication incidence (χ2 = 1.269; p = .259) and arrhythmia incidence (χ2 = 0.325; p = .568) between MDC and SDC. There was no difference in residual shunt rate between the SDC (4.10 %; 70/1706) and MDC groups (6.80 %; 10/147; χ2 = 2.387; p = .122). CONCLUSIONS: The outcomes of percutaneous multiple ASD closure (MDC) seem to be safe and effective as compared to conventional single ASD (SDC) closure in terms of device - related complications and technical success of the procedure. Prospective registry data and randomized trials are needed to determine the long-term outcomes of percutaneous ASD closure using MDC.

Trends of emergency department visits for cannabinoid hyperemesis syndrome in Nevada: An interrupted time series analysis.

Cannabis-related emergency department visits have increased after legalization of cannabis for medical and recreational use. Accordingly, the incidence of emergency department visits due to cannabinoid hyperemesis syndrome in patients with chronic cannabis use has also increased. The aim of this study was to examine trends of emergency department visit due to cannabinoid hyperemesis syndrome in Nevada and evaluate factors associated with the increased risk for emergency department visit. The State Emergency Department Databases of Nevada between 2013 and 2021 were used for investigating trends of emergency department visits for cannabinoid hyperemesis syndrome. We compared patients visiting the emergency department due to cannabinoid hyperemesis syndrome with those visiting the emergency department due to other causes except cannabinoid hyperemesis and estimated the impact of cannabis commercialization for recreational use. Emergency department visits due to cannabinoid hyperemesis syndrome have continuously increased during the study period. The number of emergency department visits per 100,000 was 1.07 before commercialization for recreational use. It increased to 2.22 per 100,000 (by approximately 1.1 per 100,000) after commercialization in the third quarter of 2017. Those with cannabinoid hyperemesis syndrome were younger with fewer male patients than those without cannabinoid hyperemesis syndrome. A substantial increase in emergency department visits due to cannabinoid hyperemesis syndrome occurred in Nevada, especially after the commercialization of recreational cannabis. Further study is needed to explore factors associated with emergency department visits.