Using computed tomography colonography in patients at high risk of colorectal cancer - a prospective study in a university hospital in South America

OBJECTIVES: The purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer. METHODS: After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. The overall accuracy of computed tomography colonography in the detection of lesions ≥6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher's exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence. RESULTS: Thirteen carcinomas and twenty-two lesions ≥6 mm were characterized. The sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. The preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>;0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p≤0.001). The average effective radiation dose per exam was 7.8 mSv. CONCLUSION: It was possible to institute an efficient computed tomography colonography service at a university hospital that primarily assists patients from the public health system, with high accuracy, good acceptance and effective radiation doses. Our results seem to be comparable to other centers of excellence and fall within acceptable published guidelines, showing that a successful computed tomography colonography program can be reproduced in a South American population screened in a university hospital

Using computed tomography colonography in patients at high risk of colorectal cancer - a prospective study in a university hospital in South America

OBJECTIVES: the purpose of our study was to report the results of the implementation of computed tomography colonography in a university hospital setting serving a Brazilian population at high risk of colorectal cancer.METHODS: After creating a computed tomography colonography service in our institution, 85 patients at high risk of colorectal cancer underwent computed tomography colonography followed by a same-day optical colonoscopy from September 2010 to May 2012. the overall accuracy of computed tomography colonography in the detection of lesions >= 6 mm was compared to that of optical colonoscopy (direct comparison). All colonic segments were evaluated using quality imaging (amount of liquid and solid residual feces and luminal distension). To assess patient acceptance and preference, a questionnaire was completed before and after the computed tomography colonography and optical colonoscopy. Fisher's exact test was used to measure the correlations between colonic distension, discomfort during the exam, exam preference and interpretation confidence.RESULTS: Thirteen carcinomas and twenty-two lesions >= 6 mm were characterized. the sensitivity, specificity and accuracy of computed tomography colonography were 100%, 98.2% and 98.6%, respectively. Computed tomography colonography was the preferred method of investigation for 85% of patients. the preparation was reported to cause only mild discomfort for 97.6% of patients. According to the questionnaires, there was no significant relationship between colonic distension and discomfort (p>0.05). Most patients (89%) achieved excellent bowel preparation. There was a statistically significant correlation between the confidence perceived in reading the computed tomography colonography and the quality of the preparation in each colonic segment (p <= 0.001). the average effective radiation dose per exam was 7.8 mSv.CONCLUSION: It was possible to institute an efficient computed tomography colonography service at a university hospital that primarily assists patients from the public health system, with high accuracy, good acceptance and effective radiation doses. Our results seem to be comparable to other centers of excellence and fall within acceptable published guidelines, showing that a successful computed tomography colonography program can be reproduced in a South American population screened in a university hospital.Universidade Federal de São Paulo, UNIFESP, Dept Diagnost Imaging, Div Abdominal Imaging, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Dept Surg, Sect Colon & Rectum Surg,Div Gastroenterol, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Dept Diagnost Imaging, Div Abdominal Imaging, São Paulo, BrazilUniversidade Federal de São Paulo, UNIFESP, Dept Surg, Sect Colon & Rectum Surg,Div Gastroenterol, São Paulo, BrazilWeb of Scienc

Variable bone fragility associated with an Amish COL1A2 variant and a knock-in mouse model

Osteogenesis imperfecta (OI) is a heritable form of bone fragility typically associated with a dominant COL1A1 or COL1A2 mutation. Variable phenotype for OI patients with identical collagen mutations is well established, but phenotype variability is described using the qualitative Sillence classification. Patterning a new OI mouse model on a specific collagen mutation therefore has been hindered by the absence of an appropriate kindred with extensive quantitative phenotype data. We benefited from the large sibships of the Old Order Amish (OOA) to define a wide range of OI phenotypes in 64 individuals with the identical COL1A2 mutation. Stratification of carrier spine (L1–4) areal bone mineral density (aBMD) Z -scores demonstrated that 73% had moderate to severe disease (less than −2), 23% had mild disease (−1 to −2), and 4% were in the unaffected range (greater than −1). A line of knock-in mice was patterned on the OOA mutation. Bone phenotype was evaluated in four F 1 lines of knock-in mice that each shared approximately 50% of their genetic background. Consistent with the human pedigree, these mice had reduced body mass, aBMD, and bone strength. Whole-bone fracture susceptibility was influenced by individual genomic factors that were reflected in size, shape, and possibly bone metabolic regulation. The results indicate that the G610C OI (Amish) knock-in mouse is a novel translational model to identify modifying genes that influence phenotype and for testing potential therapies for OI. © 2010 American Society for Bone and Mineral ResearchPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65040/1/90720_ftp.pd

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Aspergillus terreus accessory conidia are unique in surface architecture, cell wall composition and germination kinetics.

Infection with Aspergillus terreus is more likely to result in invasive, disseminated disease when compared to other Aspergillus species; importantly this species appears to be less susceptible to the antifungal drug amphotericin B. Unique to this species is the ability to produce specialized structures denoted as accessory conidia (AC) directly on hyphae both in vitro and in vivo. With the hypothesis that production of AC by A. terreus may enhance virulence of this organism, we analyzed the phenotype, structure and metabolic potential of these conidia. Comparison of A. terreus phialidic conidia (conidia that arise from conidiophores, PC) and AC architecture by electron microscopy revealed distinct morphological differences between the two conidial forms; AC have a smoother, thicker outer cell surface with no apparent pigment-like layer. Further, AC germinated rapidly, had enhanced adherence to microspheres, and were metabolically more active compared to PC. Additionally, AC contained less cell membrane ergosterol, which correlated with decreased susceptibility to AMB as determined using a flow cytometry based analysis. Furthermore, AC exhibited surface patches of beta1-3 glucan, suggestive of attachment scarring. Collectively, the findings of this study suggest a possible role for AC in A. terreus pathogenesis

Responses of Guinea Pig Pups During Isolation in a Novel Environment May Represent Stress-Induced Sickness Behaviors

When guinea pig pups are isolated in a novel environment, they show an initial active phase of behavioral responsiveness characterized by vocalizations and locomotor activity. One earlier study found that after about an hour, pups began to exhibit a second, passive stage of responsiveness marked by a crouched stance, eye-closing, and extensive piloerection. The present experiments tested the hypothesis that the responses during the second, passive stage result from the isolation experience activating pathways underlying the acute phase response, i.e., that behaviors of the second stage represent “stress-induced sickness behaviors”. We found the following: (1) the passive stage did not emerge if pups remained with the mother during exposure to a novel cage; (2) injection of lipopolysaccharide, which induces an acute phase response, also led pups to exhibit crouching, eye-closing, and piloerection; and, (3) isolation in the novel cage produced a rise in rectal temperature, but did not affect peripheral or central levels of interleukin-1β (IL-1β)-immunoreactivity. Overall, these results are consistent with the notion that stress-induced sickness behaviors can account for some of the behaviors of isolated guinea pig pups, though if this is the case, cytokines other than IL-1β appear to be involved

Responses of Guinea Pig Pups During Isolation in a Novel Environment May Represent Stress-Induced Sickness Behaviors

When guinea pig pups are isolated in a novel environment, they show an initial active phase of behavioral responsiveness characterized by vocalizations and locomotor activity. One earlier study found that after about an hour, pups began to exhibit a second, passive stage of responsiveness marked by a crouched stance, eye-closing, and extensive piloerection. The present experiments tested the hypothesis that the responses during the second, passive stage result from the isolation experience activating pathways underlying the acute phase response, i.e., that behaviors of the second stage represent “stress-induced sickness behaviors”. We found the following: (1) the passive stage did not emerge if pups remained with the mother during exposure to a novel cage; (2) injection of lipopolysaccharide, which induces an acute phase response, also led pups to exhibit crouching, eye-closing, and piloerection; and, (3) isolation in the novel cage produced a rise in rectal temperature, but did not affect peripheral or central levels of interleukin-1β (IL-1β)-immunoreactivity. Overall, these results are consistent with the notion that stress-induced sickness behaviors can account for some of the behaviors of isolated guinea pig pups, though if this is the case, cytokines other than IL-1β appear to be involved

Responses of Guinea Pig Pups During Isolation in a Novel Environment May Represent Stress-Induced Sickness Behaviors

When guinea pig pups are isolated in a novel environment, they show an initial active phase of behavioral responsiveness characterized by vocalizations and locomotor activity. One earlier study found that after about an hour, pups began to exhibit a second, passive stage of responsiveness marked by a crouched stance, eye-closing, and extensive piloerection. The present experiments tested the hypothesis that the responses during the second, passive stage result from the isolation experience activating pathways underlying the acute phase response, i.e., that behaviors of the second stage represent “stress-induced sickness behaviors”. We found the following: (1) the passive stage did not emerge if pups remained with the mother during exposure to a novel cage; (2) injection of lipopolysaccharide, which induces an acute phase response, also led pups to exhibit crouching, eye-closing, and piloerection; and, (3) isolation in the novel cage produced a rise in rectal temperature, but did not affect peripheral or central levels of interleukin-1β (IL-1β)-immunoreactivity. Overall, these results are consistent with the notion that stress-induced sickness behaviors can account for some of the behaviors of isolated guinea pig pups, though if this is the case, cytokines other than IL-1β appear to be involved