Central Processing of Gut Pain in Diabetic Patients With Gastrointestinal Symptoms

OBJECTIVE: To evaluate the brain's responses to painful visceral and somatic stimuli in diabetic patients with gastrointestinal symptoms. RESEARCH DESIGN AND METHODS: The sensitivity to electrical esophageal and median nerve stimulations was assessed in 15 healthy volunteers and 14 type 1 diabetic patients with autonomic neuropathy and gastrointestinal symptoms using a euglycemic-hyperinsulinemic clamp. Evoked brain potentials were recorded. RESULTS: Patients had reduced sensitivity to esophageal (48%; P < 0.001) and median nerve (80%; P < 0.001) stimulations. They also had increased (8.8%; P = 0.007) and nonreproducible (P = 0.006) latencies of evoked potentials in response to esophageal stimulations, with 26% reduction in amplitude (P = 0.011). No potential differences were seen to median nerve stimulations. In diabetic patients, the topographic location of the first peak in potentials was more central (P < 0.001) and gastrointestinal symptoms correlated with characteristics of brain potentials (P = 0.049). CONCLUSIONS: This study supports that diabetes induces changes in peripheral visceral nerves as well as in the central nervous system

What scans we will read: imaging instrumentation trends in clinical oncology

Oncological diseases account for a significant portion of the burden on public healthcare systems with associated costs driven primarily by complex and long-lasting therapies. Through the visualization of patient-specific morphology and functional-molecular pathways, cancerous tissue can be detected and characterized non- invasively, so as to provide referring oncologists with essential information to support therapy management decisions. Following the onset of stand-alone anatomical and functional imaging, we witness a push towards integrating molecular image information through various methods, including anato-metabolic imaging (e.g., PET/ CT), advanced MRI, optical or ultrasound imaging. This perspective paper highlights a number of key technological and methodological advances in imaging instrumentation related to anatomical, functional, molecular medicine and hybrid imaging, that is understood as the hardware-based combination of complementary anatomical and molecular imaging. These include novel detector technologies for ionizing radiation used in CT and nuclear medicine imaging, and novel system developments in MRI and optical as well as opto-acoustic imaging. We will also highlight new data processing methods for improved non-invasive tissue characterization. Following a general introduction to the role of imaging in oncology patient management we introduce imaging methods with well-defined clinical applications and potential for clinical translation. For each modality, we report first on the status quo and point to perceived technological and methodological advances in a subsequent status go section. Considering the breadth and dynamics of these developments, this perspective ends with a critical reflection on where the authors, with the majority of them being imaging experts with a background in physics and engineering, believe imaging methods will be in a few years from now. Overall, methodological and technological medical imaging advances are geared towards increased image contrast, the derivation of reproducible quantitative parameters, an increase in volume sensitivity and a reduction in overall examination time. To ensure full translation to the clinic, this progress in technologies and instrumentation is complemented by progress in relevant acquisition and image-processing protocols and improved data analysis. To this end, we should accept diagnostic images as “data”, and – through the wider adoption of advanced analysis, including machine learning approaches and a “big data” concept – move to the next stage of non-invasive tumor phenotyping. The scans we will be reading in 10 years from now will likely be composed of highly diverse multi- dimensional data from multiple sources, which mandate the use of advanced and interactive visualization and analysis platforms powered by Artificial Intelligence (AI) for real-time data handling by cross-specialty clinical experts with a domain knowledge that will need to go beyond that of plain imaging

Recurrence of urogenital Chlamydia trachomatis infection evaluated by mailed samples obtained at home: 24 weeks' prospective follow up study

Objectives: To evaluate the rate of recurrence of genital Chlamydia trachomatis infection after antibiotic therapy in a population of patients drawn from general practice, and to evaluate whether retesting after antibiotic therapy was advisable and, if so, whether it could be based on a strategy involving samples obtained at home and mailed to the laboratory for analysis. Methods: Prospective follow up study of 42 patients with genital C trachomatis infection drawn from general practice. Patients at or above the age of 18, with a positive urogenital swab sample obtained by a general practitioner were invited to participate. Follow up testing was based on LCR testing (LCx, Abbott diagnostics) of first void urinary and vaginal flush samples taken by the patients at home and mailed to the laboratory at weeks 2, 4, 8, 12, and 24 after antibiotic therapy. Results: Cumulated incidence of recurrent infection was calculated to 29% (95% CI: 12%–46%) during the 24 weeks of follow up. Previous or present sexually transmitted diseases other than C trachomatis were significantly associated with recurrence (OR 6.1, p=0.03). 89% of patients tested negative at week 2, and all patients tested negative at some point during the first 4–8 weeks. 84% of the test kits mailed to the patients were returned to the laboratory for analysis. Conclusions: Recurrence of C trachomatis after antibiotic treatment is a substantial problem. Retesting should be carried out, but not sooner than 12–24 weeks after treatment. Requiring patients to take tests at home appears to be a promising method for retesting. Key Words: recurrent infection; ligase chain reaction; Chlamydia trachomati

Comparing radiopaque markers and 13C-labelled breath test in diabetic gastroparesis diagnostics

Dag A Sangnes,1&ndash;3 Eirik S&oslash;fteland,1,4 Tonje Teigland,1,5 Georg Dimcevski1,31Department of Medicine, Haukeland University Hospital, Bergen, Norway; 2The National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital, Bergen, Norway; 3Clinical Institute 1, University of Bergen, Bergen, Norway; 4Hormone Laboratory, Haukeland University Hospital, Bergen, Norway; 5Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, NorwayPurpose: Determining gastric emptying is mandatory in the diagnosis of diabetic gastroparesis. Several methods of investigation exist, but none has proven reliable, inexpensive and accessible. In this study, we aimed to compare gastric emptying of radiopaque markers (ROM) and 13carbon-labelled gastric emptying breath tests for solids (GEBT). We also aimed to determine any association between gastric emptying and patient-reported symptoms, glycemic control and the patients&rsquo; age, diabetes duration and occurrence of other late complications.Patients and methods: Forty-five patients (30 women, 15 men) with diabetes mellitus types 1 or 2 (40, 5) and symptoms of gastroparesis were examined with ROM and GEBT. All were interviewed, filled out symptom questionnaires and had HbA1c levels measured.Results: Forty percent of patients had delayed gastric emptying of ROM, while 55% had delayed gastric emptying of GEBT. Correlation between ROM and GEBT was not significant. Compared to GEBT, sensitivity for a positive ROM test was 0.52, while specificity was 0.74. In women, we found a higher specificity of 0.92, sensitivity 0.47. Difference in HbA1c between patients with positive and negative results was of borderline significance for both tests. GEBT (r=0.41, P=0.008) correlated with HbA1c. Patients with any late complications of diabetes had higher gastric retention of ROM (P=0.028), while patients with polyneuropathy (P=0.014) and diabetic wounds (P=0.004) had slower emptying with GEBT. None of the methods identified significant associations between gastric emptying and symptom scores, age or diabetes duration.Conclusions: As a measure of gastric emptying, the ROM test has benefits of being affordable and available. Compared to GEBT, the method has low diagnostic reliability. Before continued use, we recommend additional studies validating the test in diabetes patients.Keywords: diabetes mellitus, gastroparesis, gastric emptying, radiopaque markers, 13carbon-labelled gastric emptying breath tests, patient-reported outcome