The purpose of this multicenter study was to compare a dissection display and an endoluminal display for CT colonography (CTC) by means of detection rates and evaluation time in a screening ...collective.
4 blinded readers evaluated CTC datasets from 42 patients with 55 endoscopically confirmed polyps. The datasets were read in a randomized order using two different 3D visualization methods (endoluminal view vs. dissection display; EBW 2.0.1, Philips Medical Systems, Best/NL). Patients underwent cathartic cleansing as well as stool and fluid tagging. All readers except one were experienced in performing CTC. The per-lesion/per-patient sensitivity, per-patient specificity, and evaluation time were calculated.
The overall per-lesion sensitivity using the dissection display (and endoluminal view) was 60% (53 %) for reader 1, 58% (60%) for reader 2, 67% (71%) for reader 3 and 55% (58%) for reader 4. The per-patient sensitivity using the dissection display (and endoluminal view) was 85% (85%) for reader 1, 80% (85%) for reader 2, 95% (90%) for reader 3 and 80% (80%) for reader 4. The per-patient specificity was 68% with dissection view (77% endoluminal view) for reader 1, 82% (82%) for reader 2, 59% (59%) for reader 3 and 82% (73%) for reader 4. The experienced readers were significantly faster using the perspective-filet view.
Using a dissection display of CTC datasets does not result in superior detection rates for polyps if datasets are stool and fluid-tagged. 3 out of 4 readers evaluated the datasets significantly faster with the dissection display.
BACKGROUND: Epidermal growth factor (EGF) and transforming growth factor-alpha (TGF alpha) are potent gastric acid inhibitors and stimuli of mucosal growth and protection but their involvement in ...Helicobacter pylori associated duodenal ulcer has been little examined. AIM: To assess gastric acid secretion, plasma gastrin concentrations, mucosal content of EGF and TGF alpha, and mucosal expression of these peptides and their receptor (EGFr) as well as salivary and gastric luminal release of EGF under basal conditions and after pentagastrin stimulation in 10 healthy subjects and in 25 H pylori positive patients with duodenal ulcer before and after two weeks of triple anti-H pylori therapy and four weeks after the termination of this therapy. RESULTS: Pentagastrin stimulation caused a significant increase in salivary and gastric release of EGF both in healthy controls and patients with duodenal ulcers but in the patients, the eradication of H pylori resulted in several fold higher gastric luminal (but not salivary) EGF release than before the anti-H pylori therapy. Mucosal contents of immunoreactive EGF and TGF alpha and mucosal expression of EGF, TGF alpha, and EGFr in H pylori positive patients with duodenal ulcer were significantly higher than those in healthy H pylori negative controls and this increase persisted after eradication of H pylori. Basal plasma gastrin was significantly reduced after two weeks of triple therapy and four weeks after the H pylori eradication all ulcers were completely healed. CONCLUSIONS: (1) H pylori infection in patients with duodenal ulcer was accompanied by enhanced plasma gastrin and increased mucosal content and expression of TGF alpha, EGF, and EGFr; (2) H pylori eradication resulted in ulcer healing, reduction in plasma gastrin, and enhancement of gastric (but not salivary) luminal release of EGF, particularly after pentagastrin stimulation; and (3) enhanced mucosal content and expression of TGF alpha, EGF, and EGFr and increased luminal release of EGF may contribute to ulcer healing after eradication of H pylori.
ABSTRACT
Introduction: For patients with critical conditions including severe sepsis, minimizing the time from presentation to treatment is important to improving outcomes. Understanding the factors ...influencing high hospital mortality and resource utilization in severe sepsis continues to interest clinicians and researchers. This study examined the associations between timing of drotrecogin alfa (activated) (DrotAA) initiation and hospital mortality, length-of-stay, and costs.
Methods: We conducted a cohort study of adult patients (N = 1179) with intensive care unit stays from November 2001 to June 2003 who received DrotAA in US hospitals with data in the Solucient ACTracker† database. We defined evident severe sepsis (ESS) as concurrent antibiotic plus ventilator and/or vasopressor use. We characterized the interval between ESS and DrotAA initiation as Same-day, Next-day, or Day 2+. We compared group characteristics and created multivariate models of hospital mortality, length-of-stay, and costs.
Results: Forty-three percent of patients received Same-day DrotAA, 30% Next-day, and 27% Day 2+. Same-day and Next-day patients had more organ dysfunctions at ICU admission than Day 2+ patients (1.1 ± 0.9 and 1.2 ± 0.8 vs. 1.0 ± 0.8; p = 0.021 and p < 0.001, respectively), but from ESS to DrotAA initiation, organ dysfunctions for Day 2+ patients had increased more (+0.0 and +0.4 vs. +0.6, respectively; all p < 0.0001). Increased mortality was observed with administration later than Same-day, although only for the Day 2+ group did the association remain significant ( p < 0.05) after adjusting for clinical and demographic factors. Only Next-day initiation was associated with significantly decreased costs ( p = 0.0145).
Conclusions: Timing of DrotAA initiation is associated with clinical and economic outcomes in severe sepsis. The potential impact of this timing on hospital mortality, length-of-stay, and costs deserves further study.
The hallmark of fibrosis is the excessive accumulation of collagen. The deposited collagen contains increased pyridinoline cross-link levels due to an overhydroxylation of lysine residues within the ...collagen telopeptides. Lysyl hydroxylase 2b (LH2b) is the only lysyl hydroxylase consistently up-regulated in several forms of fibrosis, suggesting that an enhanced LH2b level is responsible for the overhydroxylation of collagen telopeptides. The present paper reports the effect of profibrotic cytokines on the expression of collagen, lysyl hydroxylases and lysyl oxidase in normal human skin fibroblasts, as well as the effect on pyridinoline formation in the deposited matrix. All three isoforms of TGF-β induce a substantial increase in LH2b mRNA levels, also when expressed relatively to the mRNA levels of collagen type I α2 (COL1A2). The TGF-β isoforms also clearly influence the collagen cross-linking pathway, since higher levels of pyridinoline cross-links were measured. Similar stimulatory effects on LH2b/COL1A2 mRNA expression and pyridinoline formation were observed for IL-4, activin A, and TNF-α. An exception was BMP-2, which has no effect on LH2b/COL1A2 mRNA levels nor on pyridinoline formation. Our data show for the first time that two processes, i.e., up-regulation of LH2b mRNA levels and increased formation of pyridinoline cross-links, previously recognized to be inherent to fibrotic processes, are induced by various profibrotic cytokines.
We study semileptonic B decay to the exclusive charmless states pi, rho/omega, eta, and eta;{'} using the 16 fb(-1) CLEO Upsilon(4S) data sample. We find ...B(B0-->pi-l+nu)=(1.37+/-0.15stat+/-0.11sys)x10(-4) and B(B0-->rho-l+nu)=(2.93+/-0.37stat+/-0.37sys)x10(-4) and find evidence for B+-->eta'l+nu, with B(B+-->eta'l+nu)=(2.66+/-0.80stat+/-0.56sys)x10(-4). From our B-->pilnu rate for q2>16 GeV2 and lattice QCD, we find |Vub|=(3.6+/0.4stat+/0.2syst-0.4thy+0.6)x10(-3) corrected
We present measurements of Collins asymmetries in the inclusive process e + e − → π π X , where π stands for charged pions, at a center-of-mass energy of 10.6 GeV. We use a data sample of 468 fb ...− 1 collected by the BABAR experiment at the PEP-II B factory at SLAC, and consider pairs of charged pions produced in opposite hemispheres of hadronic events. We observe clear asymmetries in the distributions of the azimuthal angles in two distinct reference frames. We study the dependence of the asymmetry on several kinematic variables, finding that it increases with increasing pion momentum and momentum transverse to the analysis axis, and with increasing angle between the thrust and beam axis.
The arterial switch operation is the current treatment for transposition of the great arteries. Long-term outcome mainly depends on the patency of the transferred coronary arteries. This study ...assessed the presence of abnormal coronary findings and neoaortic root dilation late after arterial switch operation.
In 30 adult patients after arterial switch operation (22 men, 22 ± 3 years), computed tomography angiography was performed to assess the coronary anatomy and abnormal coronary findings, defined as significant stenosis, interarterial coronary course, and acute angled coronary origins. Neoaortic root dimensions and coronary takeoff height were also assessed.
The most common coronary anatomy pattern was found in 24 of 30 patients. Variant anatomy patterns were seen in 6 patients (5 with aberrant circumflex artery, 1 with a single ostium). The prevalence of abnormal coronary findings was higher in patients with variant coronary pattern as compared with patients with common coronary pattern (100% and 29%, respectively; p = 0.003). In particular, an acute angle of the coronary origin was frequently observed. In patients with an acute angle, larger dimensions of the aortic annulus (p = 0.016) and the sinus of Valsalva (p = 0.002) were observed. Moreover, a higher takeoff of the right (p = 0.030) and left (p = 0.002) coronary ostium was noted in patients with acute angles.
Abnormal coronary findings were frequently observed in adult patients after arterial switch operation, especially in patients with a variant coronary anatomy pattern. Neoaortic root dilation and a higher coronary takeoff may explain part of the pathophysiology. Long-term follow-up is needed to determine the clinical significance of these findings.
The objective of this investigation was to clarify the epidemiology of idiopathic Parkinson's disease (PD) in the county of Rogaland, Norway. Total case ascertainment and a high diagnostic accuracy ...were attempted through a detailed community study and the use of a new clinical diagnostic classification. The study population comprised 220,858 inhabitants, and a total of nearly 400 patients was interviewed and examined by a neurologist. On prevalence day, January 1, 1993, 245 patients were included in the study. The diagnostic classification revealed 135 patients with clinically definite, 74 with probable, and 36 with possible PD. The crude prevalence rate was shown to be 110.9 per 100,000 inhabitants. The total age-adjusted prevalence was calculated to be 102.4 per 100,000 and to 120.9 per 100,000 men and 89.8 per 100,000 women. Among the 245 patients, 28 patients had a tremor-dominant disease, 50 patients an akinetic-dominant disease, and 167 patients a mixed clinical pattern of PD. Age-adjusted prevalence figures were slightly higher for rural compared to urban areas. About 50% of the PD patients were in need of public help, 15% had complaints about pain related to their parkinsonism, and after approximately 6 years of levodopa treatment, 20% were suffering from clinical fluctuations. The study showed that 40% of the patients had some degree of thought disorder. The prevalence figures for PD in this study are slightly lower than those reported from most previous prevalence studies with a comparable study design for case finding. This may be due to a careful diagnostic evaluation with the use of specified diagnostic criteria, excluding patients with other parkinsonian syndromes.
In this paper, a new approach for the sensitivity analysis of microwave filter networks is presented. It is shown that the standard method of sensitivity calculation based on a tuned filter is only ...valid for infinitesimal geometry changes and not meaningful for practical tolerance values. However, when the sensitivity calculation is expanded to also include sensitivities of detuned filters, it is shown that accurate tolerance predictions can be made even for large geometry variations. It is found that sensitivities can be related to the stored energy distribution in the filter. Transversal and ladder network-type topologies are examined, and it is demonstrated for the first time that, for in-line topologies, sensitivity can be predicted directly from the group delay of the filter in Chebyshev filters. In order to demonstrate the usefulness of the results obtained, the maximum degradation of the in-band performance has been directly obtained from the group delay for different inline filters.
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