Evaluation of different bowel preparations for small bowel capsule endoscopy: a prospective, randomized, controlled study

To obtain an adequate view of the whole small intestine during capsule endoscopy (CE) a clear liquid diet and overnight fasting is recommended. However, intestinal content can hamper vision in spite of these measures. Our aim was to evaluate tolerance and degree of intestinal cleanliness during CE following three types of bowel preparation. PATIENTS AND METHODS: This was a prospective, multicenter, randomized, controlled study. Two-hundred ninety-one patients underwent one of the following preparations: 4 L of clear liquids (CL) (group A; 92 patients); 90 mL of aqueous sodium phosphate (group B; 89 patients); or 4 L of a polyethylene glycol electrolyte solution (group C; 92 patients). The degree of cleanliness of the small bowel was classified by blinded examiners according to four categories (excellent, good, fair or poor). The degree of patient satisfaction, gastric and small bowel transit times, and diagnostic yield were measured. RESULTS: The degree of cleanliness did not differ significantly between the groups (P = 0.496). Interobserver concordance was fair (k = 0.38). No significant differences were detected between the diagnostic yields of the CE (P = 0.601). Gastric transit time was 35.7 +/- 3.7 min (group A), 46.1 +/- 8.6 min (group B) and 34.6 +/- 5.0 min (group C) (P = 0.417). Small-intestinal transit time was 276.9 +/- 10.7 min (group A), 249.7 +/- 13.1 min (group B) and 245.6 +/- 11.6 min (group C) (P = 0.120). CL was the best tolerated preparation. Compliance with the bowel preparation regimen was lowest in group C (P = 0.008). CONCLUSIONS: A clear liquid diet and overnight fasting is sufficient to achieve an adequate level of cleanliness and is better tolerated by patients than other forms of preparation

Factor von Willebrand como intermediario entre la hemostasia y la angiogénesis de origen tumoral

Cancer patients often show an imbalance condition between coagulation system and fibrinolysis which causes a prothrombotic state. Different molecular factors like von Willebrand factor (vWf), presenting higher plasmatic rates in these patients, play an important role in this situation. During active angiogenesis taking place in tumor growth, the vascular endothelial growth factor (VEGF) and the fibroblast growth factor (FGF-2) contribute to the proliferation and differentiation of endothelial tissue, the main vWf producer, promoting increased rates of vWf in the serum of neoplastic patients. Recently vWf's contribution to tumor cells and platelet adhesion has been described. In this process, the discovery of platelet, endothelial and tumor cell membrane integrins and their implication in cellular adhesion has represented a major step in demonstrating how blood clotting and platelet aggregation are mediated by tumor cell and platelet linkage. Migration properties acquired by tumor cells as a result of this binding have been also pointed out. Clinical trials show higher rates of plasmatic vWf in cancer patients the more advanced clinical and radiological stage they present (metastasic versus localized). Moreover, higher pre-surgical serum vWf rates in patients can be used to predict poorer survival after resection surgery. vWf high molecular weight multimers have been also related to a cleavage protease deficiency in the serum of the oncologic population. The promising results of antiaggregation/anticoagulation therapies in these patients permit us to envisage new therapeutic target

Development of Vacuum Chambers in Low Z Material

Highly transparent vacuum chambers are increasingly required in high energy particle physics. In particular, vacuum chambers in the experiments should be as transparent as possible to minimize the background to the detectors, whilst also reducing the material activation. Beryllium is, so far, the most performant material for this application, but it presents some drawbacks such as brittleness, manufacturing issues, toxic if broken, high cost and low availability. A development work to obtain an alternative material to beryllium with similar performance is being carried out at CERN. Three categories have been defined and considered: raw bulk material, material composites and structural composites. The main functional requirements are: vacuum compatibility (leak tightness, low outgassing rate), temperature resistance (in the range 200-230 °C), transparency, and mechanical stiffness and strength. After beryllium, carbon is the element with the lowest atomic number that is practical for this application; therefore carbon based materials have been considered in a variety of options. In this paper, several technologies are presented and discussed. Results of preliminary tests on samples are also shown

Development of Aluminium Vacuum Chambers for the LHC Experiments at CERN

Beam losses may cause activation of vacuum chamber walls, in particular those of the Large Hadron Collider (LHC) experiments. For the High Luminosity (HL-LHC), the activation of such vacuum chambers will increase. It is therefore necessary to use a vacuum chamber material which interacts less with the circulating beam. While beryllium is reserved for the collision point, a good compromise between cost, availability and transparency is obtained with aluminium alloys; such materials are a preferred choice with respect to austenitic stainless steel. Manufacturing a thin-wall aluminium vacuum chamber presents several challenges as the material grade needs to be machinable, weldable, leak-tight for small thicknesses, and able to withstand heating to 250°C for extended periods of time. This paper presents some of the technical challenges during the manufacture of these vacuum chambers and the methods for overcoming production difficulties, including surface treatments and Non-Evaporable Getter (NEG) thin-film coating

Chapter 8: Collider-experiment interface

The HL-LHC targeted luminosities for the four main experiments will require upgrades of multiple subsystems in In particular, the LHCb experiment subsystems as the vertex locator (VELO), the ring-imaging Cherenkov (RICH) detectors and the tracking system will undergo a major upgrade in LS2, and its surrounding protection systems will be upgraded with neutral absorbers (TANB) to allow to reach the HL-LHC foreseen peak luminosity as from Run 3. Also, in LS2, ALICE will replace its beam-pipe for a new one, with smaller diameter and will also replace its tracking system, time projection chamber and will install a new fast interaction trigger detector. In ATLAS and CMS during Long Shutdown 2 (LS2) and Long Shutdown 3 (LS3) the inner tracker, trigger system, calorimeter, and muon detection systems capable of operating at the foreseen pile-up density, increased radiation environment and minimisation of activation will be replaced

Low dose alpha interferon therapy can be effective in chronic active hepatitis C. Results of a multicentre, randomised trial

BACKGROUND--There is some controversy concerning the efficacy of low dose alpha interferon therapy in chronic hepatitis C. AIMS--To evaluate the effectiveness of treatment with low doses of alpha interferon in chronic hepatitis C. PATIENTS--One hundred and forty one patients with anti-HCV positive chronic active hepatitis C from six hospitals were enrolled in the study. METHODS--Patients were randomised to treatment with 5 MU (group A) or 1.5 MU (group B) injections. The dose was reduced in responders from group A or increased in non-responders from group B to maintain treatment with the minimal effective dose. Patients were treated for 48 weeks and followed up for 24 additional weeks with no treatment. Normalisation of alanine aminotransferase (ALT) was used to evaluate response. RESULTS--A sustained response was seen in eight patients from group A (12%) and in 15 (21%) from group B. This difference was not statistically significant. Increasing the dose of interferon led to sustained response in only five of 58 patients (9%) from group B who did not respond to 1.5 MU injections. In contrast, 15 of 21 patients (71%) in whom ALT remained normal with 1.5 MU injections developed a sustained response. By multivariate analysis sustained response seemed associated with young age and was more frequent in patients with genotype 3 HCV infection. Sustained response was preceded by a rapid normalisation of ALT and was inversely related to the amount of alpha interferon necessary to maintain ALT at low values during treatment. CONCLUSIONS--Some patients with chronic hepatitis C are very sensitive to alpha interferon and can be successfully treated with low doses. Treatment with higher doses may be effective in a minority of patients who do not respond to low doses