22 research outputs found
Australian infection control in endoscopy consensus statements on carbapenemase-producing Enterobacteriaceae
Outbreaks of carbapenemase-producing Enterobacteriaceae clinical infections related to endoscopic transmission are well documented. The high morbidity and mortality associated with these infections emphasizes the need to reassess endoscopic reprocessing protocols. The Gastroenterological Society of Australia established a multi-society committee to formulate evidence-based consensus statements on the prevention and management of endoscopic transmission of carbapenemase-producing Enterobacteriaceae. A literature search was undertaken utilizing the MEDLINE database. Further references were sourced from published paper bibliographies. Nine statements were formulated. Using the Delphi methodology, the statements were initially reviewed electronically by the committee members and subsequently at a face-to-face meeting in Melbourne, Australia. After further discussion, four additional sub-statements were added resulting in a total of 13 statements. Each statement was assessed for level of evidence, recommendation grade and the voting on recommendation was recorded. For a statement to be accepted, five out of six committee members had to âaccept completelyâ or âaccept with some reservation.â All 13 statements achieved consensus agreement. Eleven statements achieved 100% âaccepted completely.â Two statements were 83% âaccepted completelyâ and 17% âaccepted with some reservation.â Of particular significance, automated flexible endoscope reprocessors were mandated for high-level disinfection, and the use of forced-air drying cabinets was mandated for endoscope storage. These evidence-based statements encourage preventative strategies with the aim of ensuring the highest possible standards in flexible endoscope reprocessing thereby optimizing patient safety. They must be considered in addition to the broader published guidelines on infection control in endoscopy
Enteroendocrine and adipokine associations with type 2 diabetes: phenotypic risk scoring approaches
The contribution of gut-derived factors to the mechanisms linking obesity and metabolic disease remain under-investigated. The aim of the current study was examine the associations between glucagon and enteroendocrine signaling and type 2 diabetes (T2D) using a derived risk score approach. To compare the relative importance of the enteroendocrine system, associations between adipokine measures and T2D were also investigated METHODS: A total of 130 individuals with T2D and 161 individuals without T2D were included in the study. Circulating concentrations of enteroendocrine (glucagon, ghrelin, glucagon-like peptide-1 and gastric inhibitory peptide) and adipokine mediators (adiponectin, leptin, resistin, visfatin, adipsin) were measured. Standard scores (Z-scores) were determined for each measure and enteroendocrine (ERS) and adipokine (ARS) risk scores calculated based on summation of the component measures. Associations between both the ERS and ARS and T2D status were assessed using logistic regression models.The ERS was significantly associated with T2D status in an adjusted model (OR: 1.36; 95%CI: 1.08-1.72; p=0.009). Associations between the ARS and T2D status were not independent of age, sex and BMI (OR: 1.21; 95%CI: 0.99-1.47; p=0.06). Quantification of risk across ERS tertiles revealed that individuals with an ERS in the upper tertile were 10 times more likely (CI: 3.23-32.73;
Using single-operator cholangioscopy for endoscopic evaluation of indeterminate biliary strictures: results from a large multinational registry
BACKGROUND: âPeroral cholangioscopy (POCS) of indeterminate biliary strictures aims to achieve a diagnosis through visual examination and/or by obtaining targeted biopsies under direct visualization. In this large, prospective, multinational, real-life experience of POCS-guided evaluation of indeterminate biliary strictures, we evaluated the performance of POCS in this difficult-to-manage patient population. METHODS: âThis prospective registry enrolled patients, with indeterminate biliary strictures across 20 centers in Asia, the Middle East, and Africa. The primary end points were the ability to visualize the lesion, obtain histological sampling when intended, and an assessment of the diagnostic accuracy of POCS for malignant strictures. Patients were followed for 6 months after POCS or until a definitive malignant diagnosis was made, whichever occurred first. RESULTS: â289 patients underwent 290 POCS procedures with intent to biopsy in 182 cases. The stricture/filling defect was successfully visualized in 286/290 (98.6â%), providing a visual diagnostic impression in 253/290 (87.2â%) and obtaining adequate biopsies in 169/182 (92.9â%). Procedure-related adverse events occurred in 5/289 patients (1.7â%). POCS influenced patient management principally by elucidating filling defects or the causes of bile duct stricture or dilation. The visual impression of malignancy showed 86.7â% sensitivity, 71.2â% specificity, 65.8â% positive and 89.4â% negative predictive value, and 77.2â% overall accuracy compared with final diagnosis. Histological POCS-guided samples showed 75.3â% sensitivity, 100â% specificity, 100â% positive and 77.1â% negative predictive value, and 86.5â% overall accuracy. CONCLUSION: âIn this large, real-life, prospective series, POCS was demonstrated to be an effective and safe intervention guiding the management of patients with indeterminate biliary strictures
Measurement of the impact-parameter dependent azimuthal anisotropy in coherent Ï0 photoproduction in PbâPb collisions at âsNN = 5.02 TeV
The first measurement of the impact-parameter dependent angular anisotropy in the decay of coherently photoproduced Ï0 mesons is presented. The Ï0 mesons are reconstructed through their decay into a pion pair. The measured anisotropy corresponds to the amplitude of the cos(2Ï) modulation, where Ï is the angle between the two vectors formed by the sum and the difference of the transverse momenta of the pions, respectively. The measurement was performed by the ALICE Collaboration at the LHC using data from ultraperipheral PbâPb collisions at a center-of-mass energy of sNNââââ = 5.02 TeV per nucleon pair. Different impact-parameter regions are selected by classifying the events in nuclear-breakup classes. The amplitude of the cos(2Ï) modulation is found to increase by about one order of magnitude from large to small impact parameters. Theoretical calculations, which describe the measurement, explain the cos(2Ï) anisotropy as the result of a quantum interference effect at the femtometer scale that arises from the ambiguity as to which of the nuclei is the source of the photon in the interaction
Measurement of the production cross section of prompt Î0c baryons in pâPb collisions at âsNN = 5.02 TeV
The transverse momentum (pT) differential production cross section of the promptly-produced charm-strange baryon Î0c (and its charge conjugate Î0cÂŻÂŻÂŻÂŻÂŻÂŻ) is measured at midrapidity via its hadronic decay into Ï+Îâ in pâPb collisions at a centre-of-mass energy per nucleonânucleon collision sNNââââ = 5.02 TeV with the ALICE detector at the LHC. The Î0c nuclear modification factor (RpPb), calculated from the cross sections in pp and pâPb collisions, is presented and compared with the RpPb of Î+c baryons. The ratios between the pT-differential production cross section of Î0c baryons and those of D0 mesons and Î+c baryons are also reported and compared with results at forward and backward rapidity from the LHCb Collaboration. The measurements of the production cross section of prompt Î0c baryons are compared with a model based on perturbative QCD calculations of charm-quark production cross sections, which includes only cold nuclear matter effects in pâPb collisions, and underestimates the measurement by a factor of about 50. This discrepancy is reduced when the data is compared with a model in which hadronisation is implemented via quark coalescence. The pT-integrated cross section of prompt Î0c-baryon production at midrapidity extrapolated down to pT = 0 is also reported. These measurements offer insights and constraints for theoretical calculations of the hadronisation process. Additionally, they provide inputs for the calculation of the charm production cross section in pâPb collisions at midrapidity