To define the validity of fecal blood as a marker for colorectal neoplasia in the screening setting and to compare yields by Hemoccult and HemoQuant fecal occult blood screening tests.
A multicenter ...masked comparison of fecal blood test results against structural colorectal evaluations and longitudinal follow-up, serving as criterion standards, in nonreferred subjects at risk for colorectal neoplasia.
Communities, primary care centers, referral centers.
Two groups: (1) 1217 patients aged at least 18 years undergoing routine structural surveillance evaluations following curative resection of a colorectal tumor and (2) 12312 relatives of colorectal cancer patients aged at least 50 years.
Blinded Hemoccult II and HemoQuant testing on three mailed-in stool samples per subject.
Sensitivity of fecal blood tests for colorectal neoplasia.
In the postresection group, surveillance evaluations revealed 46 malignant colorectal neoplasms and 402 polyps. At matched specificity, sensitivity of either test for cancer was 26% (95% confidence interval, 13% to 39%). Hemoccult was positive in 21% of intraluminal recurrences, 33% of all new primary tumors, and 29% of Dukes A or B cancers; HemoQuant was elevated in 24%, 28%, and 29%, respectively. Sensitivity for polyps 1.0 cm or larger was 13% by Hemoccult and 11% by HemoQuant. In the group of relatives, estimated sensitivity for cancer at 1 to 3 years of follow-up was 25% to 33% by Hemoccult, not significantly different from the 29% to 43% by HemoQuant.
Based on our observations in the screening setting, fecal blood appears to be a poor marker for colorectal neoplasia. Most cancers and the vast majority of polyps will be missed. Hemoccult and HemoQuant are similarly insensitive.
Nonalcoholic steatohepatitis LUDWIG, J; MCGILL, D. B; LINDOR, K. D
Journal of gastroenterology and hepatology,
05/1997, Letnik:
12, Številka:
5
Conference Proceeding
Polystyrene films were deposited using resonant infrared pulsed laser depositions (RIR–PLD). Thin films were grown on Si(1
1
1) wafers and NaCl substrates and analyzed by Fourier transform infrared ...spectroscopy (FTIR) and gel permeation chromatography (GPC). The depositions were carried out in vacuum (10
−4–10
−5 Torr) at wavelengths 3.28, 3.30, 3.42 and
3.48
μm
which are resonant with CH
2 stretching modes in the polymer. We also attempted to deposit a films using non-resonant infrared (RIR) excitation (
2.90
μm
). At this wavelength no films were deposited, and evidence for laser-induced damage to the target can be seen. RIR–PLD is a fundamentally new approach to polymer thin film growth as the absorption of radiation resonant with vibrational modes allow the energy to be deposited into the polymer and transfers between macromolecules in such a way as to promote efficient, non-destructive desorption into the gas phase.
Thin films of the biodegradable polymer poly(DL-lactide-co-glycolide) (PLGA) were deposited using resonant infrared pulsed laser deposition (RIR-PLD). The output of a free-electron laser was focused ...onto a solid target of the polymer, and the films were deposited using 2.90 (resonant with O-H stretch) and 3.40 (C-H) *mm light at macropulse fluences of 7.8 and 6.7 J/cm, respectively. Under these conditions, a 0.5-*mm thick film can be grown in less than 5 min. Film structure was determined from infrared absorbance measurements and gel permeation chromatography (GPC). While the infrared absorbance spectrum of the films is nearly identical with that of the native polymer, the average molecular weight of the films is a little less than half that of the starting material. Potential strategies for defeating this mass change are discussed.
We have combined some of the major positive advantages of laser-induced forward transfer (LIFT) and matrix-assisted pulsed laser evaporation (MAPLE), to produce a novel excimer laser driven direct ...writing technique which has demonstrated the deposition in air and at room temperature and with sub-10 μm resolution of active and passive prototype circuit elements on planar and nonplanar substrates. We have termed this technique MAPLE DW (matrix-assisted pulsed laser evaporation direct write) and present its historical evolution from pulsed laser deposition. This paper describes the simplistic approach to carry out MAPLE DW, gives experimental conditions, and physical characterization results for the deposition of NiCr thin film resistors, Au conducting lines, and multilayer depositions of Au conductors and BaTiO
3 dielectrics to produce prototype capacitors. In general, the electrical properties of the materials deposited (conductivity, dielectric constant, and loss tangent) are comparable or superior to those produced by other commonly used industrial processes such as screen printing. The mechanism of the MAPLE DW process, especially the novel aspects making it a powerful approach for direct writing all classes of materials (metals, oxide ceramics, polymers and composites), is also described.
Background How cardiovascular (CV) events affect progression to end-stage renal disease (ESRD), particularly in the setting of type 2 diabetes, remains uncertain. Study Design Observational study. ...Setting & Participants 4,022 patients with type 2 diabetes, anemia, and chronic kidney disease from the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Predictor Postrandomization CV events. Outcomes ESRD (defined as initiation of dialysis for >30 days, kidney transplantation, or refusal or nonavailability of renal replacement therapy) and post-ESRD mortality within 30 days and during overall follow-up after an intercurrent CV event. Limitations Population limited to clinical trial participants with diabetes and anemia. Results 155 of 652 (23.8%) ESRD cases occurred after an intercurrent CV event; 110 (16.9%) cases followed heart failure, 28 (4.3%) followed myocardial infarction, 12 (1.84%) followed stroke, and 5 (0.77%) followed multiple CV events. ESRD rate was higher within 30 days in individuals with an intercurrent CV event compared with those without an intercurrent event (HR, 22.2; 95% CI, 17.0-29.0). Compared to no intercurrent CV events, relative risks for ESRD were higher after the occurrence of heart failure overall (HR, 3.4; 95% CI, 2.7-4.2) and at 30 days (HR, 20.1; 95% CI, 14.5-27.9) than after myocardial infarction or stroke ( P < 0.001). Compared with individuals without pre-ESRD events, those with ESRD following intercurrent CV events were older, were more likely to have prior CV disease, and had higher (24.4 vs 23.1 mL/min/1.73 m2 ; P = 0.01) baseline estimated glomerular filtration rates (eGFRs) and higher eGFRs at last measurement before ESRD (18.6 vs 15.2 mL/min/1.73 m2 ; P < 0.001), whereas race, sex, and medication use were similar. Post-ESRD mortality was similar ( P = 0.3) with and without preceding CV events. Conclusions Most ESRD cases occurred in individuals without intercurrent CV events who had lower eGFRs than individuals with intercurrent CV events, but similar post-ESRD mortality. Nevertheless, intercurrent CV events, particularly heart failure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes.
Abstract Objective To determine the effects of weight-bearing (WB) versus nonweight-bearing (NWB) exercise for persons with diabetes mellitus (DM) and peripheral neuropathy (PN). Design Randomized ...controlled trial with evaluations at baseline and after intervention. Setting University-based physical therapy research clinic. Participants Participants with DM and PN (N=29) (mean age ± SD, 64.5±12.5y; mean body mass index kg/m2 ± SD, 35.5±7.3) were randomly assigned to WB (n=15) and NWB (n=14) exercise groups. All participants (100%) completed the intervention and follow-up evaluations. Interventions Group-specific progressive balance, flexibility, strengthening, and aerobic exercise conducted sitting or lying (NWB) or standing and walking (WB) occurred 3 times a week for 12 weeks. Main Outcome Measures Measures included the 6-minute walk distance (6MWD) and daily step counts. Secondary outcome measures represented domains across the International Classification of Functioning, Disability and Health. Results The WB group showed greater gains than the NWB group over time on the 6MWD and average daily step count ( P <.05). The mean and 95% confidence intervals (CIs) between-group difference over time was 29m (95% CI, 6–51) for the 6MWD and 1178 (95% CI, 150–2205) steps for the average daily step count. The NWB group showed greater improvements than the WB group over time in hemoglobin A1c values ( P <.05). Conclusions The results of this study indicate the ability of this population with chronic disease to increase 6MWD and daily step count with a WB exercise program compared with an NWB exercise program.
Aims This study aims to examine predictors of cardiovascular mortality and morbidity in patients with chronic kidney disease (CKD). Individuals with the triad of diabetes, CKD, and anemia represent a ...significant proportion of patients with cardiovascular disease and are at particularly high risk for adverse outcomes. Methods and Results Using Cox proportional hazards models, we identified independent predictors of the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for myocardial ischemia, or heart failure (HF) in 3,847 patients in the TREAT, 961 (25%) of whom experienced this outcome. The predictors (ranked by χ2 value) were prior HF (hazard ratio HR 1.74, 95% CI 1.51-2.01), age (HR 1.03, 95% CI 1.02-1.04 per year), log urine protein/creatinine ratio (HR 1.19, 95% CI 1.13-1.26 per log unit ), C-reactive protein ≥6.6 mg/L (HR 1.44, 95% CI 1.23-1.69, compared with C-reactive protein ≤3.0 mg/L), and abnormal electrocardiogram (HR 1.42, 95% CI 1.21-1.66 ), all P < .0001. Addition of cardiac-derived biomarkers (subset of first 1,000 patients enrolled) significantly enhanced risk estimation, with N-terminal pro B-type natriuretic peptide becoming the highest ranked predictor of outcome (HR 1.30, 95% CI 1.15-1.46 per log unit, P < .001) and troponin T providing additional predictive information. These biomarkers improved risk classification in 17.8% (9.4%-26.2%) of patients. Conclusion In patients with diabetes, CKD, and anemia, cardiovascular risk is most strongly predicted by age, history of HF, C-reactive protein, urinary protein/creatinine ratio, abnormal electrocardiogram, and 2 specific cardiac biomarkers, serum N-terminal pro B-type natriuretic peptide and troponin T, which are elevated in many. These findings suggest ways to improve cardiovascular risk stratification of patients with predialysis CKD, support the concept of cardiorenal syndrome , and may help target therapy.
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