Summary
Background
Crohn's disease recurs in the majority of patients after intestinal resection.
Aim
To compare the relative efficacy of thiopurines and anti‐TNF therapy in patients at high risk of ...disease recurrence.
Methods
As part of a larger study comparing post‐operative management strategies, patients at high risk of recurrence (smoker, perforating disease, ≥2nd operation) were treated after resection of all macroscopic disease with 3 months metronidazole together with either azathioprine 2 mg/kg/day or mercaptopurine 1.5 mg/kg/day. Thiopurine‐intolerant patients received adalimumab induction then 40 mg fortnightly. Patients underwent colonoscopy at 6 months with endoscopic recurrence assessed blind to treatment.
Results
A total of 101 patients 50% male; median (IQR) age 36 (25–46) years were included. There were no differences in disease history between thiopurine‐ and adalimumab‐treated patients. Fifteen patients withdrew prior to 6 months, five due to symptom recurrence (of whom four were colonoscoped). Endoscopic recurrence (Rutgeerts score i2–i4) occurred in 33 of 73 (45%) thiopurine vs. 6 of 28 (21%) adalimumab‐treated patients intention‐to‐treat (ITT); P = 0.028 or 24 of 62 (39%) vs. 3 of 24 (13%) respectively per‐protocol analysis (PPA); P = 0.020. Complete mucosal endoscopic normality (Rutgeerts i0) occurred in 17/73 (23%) vs. 15/28 (54%) (ITT; P = 0.003) and in 27% vs. 63% (PPA; P = 0.002). The most advanced disease (Rutgeerts i3 and i4) occurred in 8% vs. 4% (thiopurine vs. adalimumab).
Conclusions
In Crohn's disease patients at high risk of post‐operative recurrence adalimumab is superior to thiopurines in preventing early disease recurrence.
Software reuse enables developers to leverage past accomplishments and facilitates significant improvements in software productivity and quality. Software reuse catalyzes improvements in productivity ...by avoiding redevelopment and improvements in quality by incorporating components whose reliability has already been established. This study addresses a pivotal research issue that underlies software reuse - what factors characterize successful software reuse in large-scale systems. The research approach is to investigate, analyze, and evaluate software reuse empirically by mining software repositories from a NASA software development environment that actively reuses software. This software environment successfully follows principles of reuse-based software development in order to achieve an average reuse of 32 percent per project, which is the average amount of software either reused or modified from previous systems. We examine the repositories for 25 software systems ranging from 3,000 to 112,000 source lines from this software environment. We analyze four classes of software modules: modules reused without revision, modules reused with slight revision (<25 percent revision), modules reused with major revision (/spl ges/25 percent revision), and newly developed modules. We apply nonparametric statistical models to compare numerous development variables across the 2,954 software modules in the systems. We identify two categories of factors that characterize successful reuse-based software development of large-scale systems: module design factors and module implementation factors. We also evaluate the fault rates of the reused, modified, and newly developed modules. The module design factors that characterize module reuse without revision were (after normalization by size in source lines): few calls to other system modules, many calls to utility functions, few input-output parameters, few reads and writes, and many comments. The module implementation factors that characterize module reuse without revision were small size in source lines and (after normalization by size in source lines): low development effort and many assignment statements. The modules reused without revision had the fewest faults, fewest faults per source line, and lowest fault correction effort. The modules reused with major revision had the highest fault correction effort and highest fault isolation effort as wed as the most changes, most changes per source line, and highest change correction effort. In conclusion, we outline future research directions that build on these software reuse ideas and strategies.
Objective
To determine the prevalence of the inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD), in pregnant women and determine pregnancy and fetal/neonatal ...outcomes.
Design
Population‐based cohort study.
Setting
New South Wales, Australia, 2001–11.
Population
A total of 630 742 women who delivered at ≥20 weeks of gestation.
Methods
Descriptive and multivariate regression analyses of perinatal data linked to hospital admission data. We compared birth outcomes of women with and without a documented diagnosis of IBD.
Main outcome measures
Caesarean section, severe maternal morbidity, preterm birth <37 weeks of gestation, planned preterm birth, small‐for‐gestational‐age (birthweight <10th centile), perinatal mortality (stillbirth/neonatal death ≤28 days).
Results
In all, 1960 women (0.31%) with IBD, who had 2781 births (1183 UC, 1287 CD and 311 IBD‐indeterminate). Women with IBD were more likely than women without IBD to have a caesarean section 41.5 versus 28.2%, adjusted risk ratio (aRR) 1.38, 95% CI 1.31–1.45, severe maternal morbidity (2.6 versus 1.6%, aRR 1.54, 95% CI 1.17–2.03), preterm birth (9.7 versus 6.6%, aRR 1.47, 95% CI 1.30–1.66), planned preterm birth (5.3 versus 2.9%, aRR 1.74, 95% CI 1.47–2.07), and their infants to be small‐for‐gestational‐age (9.7 versus 9.5%, aRR 1.19, 95% CI 1.04–1.36). There was no evidence of a difference in perinatal mortality.
Conclusion
Pregnancy‐associated IBD is more common than previously reported. Pregnancies complicated by IBD at or near the time of birth have significantly higher rates of adverse pregnancy outcomes than pregnancies of women without IBD.
Tweetable
Increased rates preterm birth and caesarean section in women with inflammatory bowel disease.
Tweetable
Increased rates preterm birth and caesarean section in women with inflammatory bowel disease.
Bulk NMR Measurements of Spray Dynamics Osmond, D.; Selby, W.; Romero-Zeron, L. ...
Applied magnetic resonance,
12/2023, Letnik:
54, Številka:
11-12
Journal Article
Recenzirano
Spray systems present unique challenges for fluid mechanics research due to their complex dynamics. Non-optical techniques such as synchrotron X-rays and magnetic resonance imaging (MRI) are ...promising measurement avenues for non-invasive studies of opaque or enclosed sprays. Previous MRI studies of sprays employed sophisticated pulse sequences possible only with an MRI scanner. In this work, we explore the potential of simple bulk NMR techniques, pulsed-field-gradient (PFG), time-of-fight (TOF), and dynamic magnetic resonance scattering to investigate spray dynamics in three distinct regions. A variable recovery delay was employed to filter signal contributions based on velocity. The PFG measurements of mechanical dispersion are the first of their kind to our knowledge, yielding dispersion coefficients in the range of 10
–4
–10
–3
m
2
/s. Velocity measurements successfully detected velocities surpassing 30 m/s near the nozzle, with the flow slowing down to several m/s downstream. These techniques show potential for investigating spray dynamics and simple gradient requirements making them suitable for portable NMR applications and in situ measurements.
Summary
Background
Inflammatory bowel diseases (IBD) require complex therapeutic decisions and life choices concerning pregnancy, but little is known about patient's knowledge of IBD and its ...treatment before and during pregnancy.
Aim
To develop a novel tool (Crohn's and Colitis Pregnancy Knowledge Score ‘CCPKnow’) to assess knowledge of pregnancy‐related issues in IBD. The validated tool was then applied to determine knowledge in patients.
Method
Discriminate ability of ‘CCPKnow’ was validated in four groups with different levels of IBD knowledge. Reliability and readability were tested by Cronbach‐α and Flesch‐Kencaid. Construct validity was subsequently assessed against general IBD knowledge (CCKnow) in 145 women with IBD. Associations between patient factors and knowledge were studied.
Results
Median CCPKnow scores differed significantly between the validation groups (P < 0.001). CCPKnow displayed excellent internal consistency, reliability (Cronbach‐α 0.94), readability (reading age 9 years) and close correlation with CCKnow (Spearman's ρ 0.64; P < 0.001). Of 145 patients, 44.8% had poor, 27.6% adequate, 17.3% good and only 10.3% very good knowledge. Better knowledge was associated with Caucasian ethnicity, higher income, having a partner, having children, Crohn's and Colitis Association membership, longer disease duration and Crohn's disease.
Conclusions
Crohn's and Colitis Pregnancy Knowledge Score, a novel knowledge assessment tool of pregnancy and IBD, demonstrated excellent test characteristics. We found that nearly half of the women with IBD had poor knowledge, identifying a pressing need for better education.
Removal of colonic polyps prevents progression of colonic neoplasia. Miss rates of polyps range from 5 % to 32 %. The effect of colonic contractility on polyp detection has not been studied ...adequately. Hyoscine butylbromide results in colonic spasmolysis and may improve polyp detection.
Patients undergoing colonoscopy for standard indications were included and randomized to receive either 20 mg hyoscine butylbromide or placebo at cecal intubation. Operators were blind to the intervention. Data on indication, preparation, sedation, colonoscope type, times of insertion/withdrawal, polyps, and failure were recorded. The primary end point was the number of polyps detected per patient. Secondary endpoints were adenoma detection rate and polyp detection rate.
A total of 303 patients received hyoscine butylbromide and 298 received placebo. More polyps per patient were identified in the hyoscine group than in the placebo group (0.91 vs. 0.70; P = 0.044). Adenoma detection rate and polyp detection rate were higher in the hyoscine arm but not significantly different (27.1 % vs. 21.8 % P = 0.13 and 43.6 % vs. 36.6 % P = 0.08, respectively). After adjusting for confounding variables, the odds of detecting any polyp were 1.56 higher in the hyoscine than the placebo group (95 % confidence interval CI 1.09 - 2.21, P = 0.014). The adjusted odds of detecting any adenoma were 1.62 higher in the hyoscine group compared with the placebo group (95 %CI 1.09 - 2.42, P = 0.017). There were no differences in baseline characteristics between the groups. No adverse colonoscopy-related events were recorded. One patient experienced transient tachycardia without sequelae.
Hyoscine butylbromide administered at the cecum aids polyp detection. Further studies are required to determine the contribution of colonic spasm to polyp miss rates.
Aim
When treating patients with refractory ulcerative colitis (UC), the choice between escalating medical management or surgery can be difficult. The aim of this study was to quantify the preferences ...of patients and clinicians for the treatment options in UC.
Method
Ulcerative colitis outpatients were interviewed to measure their preferences for five scenarios examining the management of acute and chronic UC, using a prospective measure of preference method that generates two utility scores: willingness and amount of expected life to trade or gamble. A self‐administered questionnaire was mailed to Australian and New Zealand colorectal surgeons and gastroenterologists.
Results
Fifty‐five patients (26 medical and 29 surgical), 91 surgeons and 78 gastroenterologists were surveyed. In the acute setting, 89% of patients, 69% of gastroenterologists and 55% of surgeons were willing to trade part of their life expectancy to avoid a permanent stoma, while for chronic disease 71% of patients were prepared to trade to avoid an operation with a permanent stoma compared with 55% for an operation with a pouch (P = 0.01). Both patients and gastroenterologists were more prepared to gamble or trade to avoid any surgery than were colorectal surgeons. All groups were aligned in their decision to undergo yearly colonoscopy surveillance rather than to undergo definitive surgery that would result in a stoma.
Conclusion
Patient preferences for the treatment of UC were more aligned to those of gastroenterologists than those of colorectal surgeons. Despite postoperative studies revealing an equal quality of life for pouch and stoma patients, this study confirmed that a pouch is the preferred surgical option.
Introduction:
Patients with Crohn’s disease have poorer health-related quality of life HRQoL than healthy individuals, even when in remission. Although HRQoL improves in patients who achieve ...drug-induced or surgically induced remission, the effects of surgery overall have not been well characterised.
Methods:
In a randomised trial, patients undergoing intestinal resection of all macroscopically diseased bowel were treated with postoperative drug therapy to prevent disease recurrence. All patients were followed prospectively for 18 months. C-reactive protein CRP, Crohn’s Disease Activity Index CDAI, and faecal calprotectin FC were measured preoperatively and at 6, 12, and 18 months. HRQoL was assessed with a general SF36 and disease-specific IBDQ questionnaires at the same time points.
Results:
A total of 174 patients were included. HRQoL was poor preoperatively but improved significantly p < 0.001 at 6 months postoperatively. This improvement was sustained at 18 months. Females and smokers had a poorer HRQoL when compared with males and non-smokers, respectively. Persistent endoscopic remission, intensification of drug treatment at 6 months, and anti-tumour necrosis factor therapy were not associated with HRQoL outcomes different from those when these factors were not present. There was a significant inverse correlation between CDAI, but not endoscopic recurrence, CRP, or FC on HRQoL.
Conclusion:
Intestinal resection of all macroscopic Crohn’s disease in patients treated with postoperative prophylactic drug therapy is associated with significant and sustained improvement in HRQoL irrespective of type of drug treatment or endoscopic recurrence. HRQoL is lower in female patients and smokers. A higher CDAI, but not direct measures of active disease or type of drug therapy, is associated with a lower HRQoL.
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