Importance of reporting segmental bowel preparation scores during colonoscopy in clinical practice

AIM: To evaluate the impact of reporting bowel preparation using Boston Bowel Preparation Scale(BBPS) in clinical practice.METHODS: The study was a prospective observational cohort study which enrolled subjects reporting for screening colonoscopy. All subjects received a gallon of polyethylene glycol as bowel preparation regimen. After colonoscopy the endoscopists determined quality of bowel preparation using BBPS. Segmental scores were combined to calculate composite BBPS. Site and size of the polyps detected was recorded. Pathology reports were reviewed to determine advanced adenoma detection rates(AADR). Segmental AADR's were calculated and categorized based on the segmental BBPS to determine the differential impact of bowel prep on AADR. RESULTS: Three hundred and sixty subjects were enrolled in the study with a mean age of 59.2 years, 36.3% males and 63.8% females. Four subjects with incomplete colonoscopy due BBPS of 0 in any segment were excluded. Based on composite BBPS subjects were divided into 3 groups; Group-0(poor bowel prep, BBPS 0-3) n = 26(7.3%), Group-1(Suboptimal bowel prep, BBPS 4-6) n = 121(34%) and Group-2(Adequate bowel prep, BBPS 7-9) n = 209(58.7%). AADR showed a linear trend through Group-1 to 3; with an AADR of 3.8%, 14.8% and 16.7% respectively. Also seen was a linear increasing trend in segmental AADR with improvement in segmental BBPS. There was statistical significant difference between AADR among Group 0 and 2(3.8% vs 16.7%, P 0.05), Group 1 and 2(14.8% vs 16.7%, P 0.05) and Group 0 and 1(3.8% vs 14.8%, P 0.05). χ2 method was used to compute P value for determining statistical significance.CONCLUSION: Segmental AADRs correlate with segmental BBPS. It is thus valuable to report segmental BBPS in colonoscopy reports in clinical practice.     

The distribution of plaque and gingivitis and the influence of toothbrushing hand in a group of South Wales 11–12 year-old children

Numerous factors may affect the distribution of plaque and gingivitis in any individuals mouth. Of considerable importance must be the oral hygiene habits of each person, which will be influenced by compliance and dexterity with tooth cleaning methods. The pattern of gingivitis seen at a young age may, with time, reflect the eventual distribution of attachment loss. This in part, could explain the considerable variation in chronic periodontal disease seen between individuals and at different sites within the same mouth. This study reports the baseline data for the distribution of plaque and gingivitis in 1105, 11-12-year-old children in South Wales. The children were selected by disproportionate stratified random sampling and examined by a multidisciplinary group with the long-term aim of evaluating the importance of malocclusion to dental health and psychosocial variables. Toothbrushing frequency had a very low but significant correlation with the distribution of plaque and gingivitis, accounting therefore for only a small % of the variance in the group. For the total group and right-handed toothbrushers, buccal plaque and gingivitis was significantly increased on right contralateral teeth. No specific pattern for plaque and gingivitis distribution by side was seen for 100 left-handed toothbrushers. Plaque and gingivitis also showed significant differences dependent upon arch, tooth number, and surface. The population is being followed at 4-year intervals to monitor the pattern of periodontal disease with time and correlate changes with these baseline findings.     

A Randomized Controlled Trial of the Clinical Utility of Genotypic Resistance Testing in Patients with Limited Prior Exposure to Antiretroviral Drugs

Abstract

Purpose: To assess the clinical utility of genotypic resistance testing among HIV-1-infected patients with limited prior exposure to antiretroviral drugs. Method: Patients experiencing virological failure were randomly allocated to either centralized genotypic resistance testing or to no testing and were followed for a minimum of 1 year. Results: 55 patients were recruited from 14 centers in the United Kingdom. There were no demonstrable differences between the groups in terms of virological or immunological response. For patients allocated to resistance testing, there was an increased tendency to recycle previously used drugs. Conclusion: The study did not demonstrate a benefit of genotypic resistance testing in this population, although statistical power was low. However, testing did alter prescribing behavior, and clinical effects may become manifest in the longer term.     

Lightness, brightness and transparency: A quarter century of new ideas, captivating demonstrations and unrelenting controversy

The past quarter century has witnessed considerable advances in our understanding of Lightness (perceived reflectance), Brightness (perceived luminance) and perceived Transparency (LBT). This review poses eight major conceptual questions that have engaged researchers during this period, and considers to what extent they have been answered. The questions concern 1. the relationship between lightness, brightness and perceived non-uniform illumination, 2. the brain site for lightness and brightness perception, 3 the effects of context on lightness and brightness, 4. the relationship between brightness and contrast for simple patch-background stimuli, 5. brightness “filling-in”, 6. lightness anchoring, 7. the conditions for perceptual transparency, and 8. the perceptual representation of transparency. The discussion of progress on major conceptual questions inevitably requires an evaluation of which approaches to LBT are likely and which are unlikely to bear fruit in the long term, and which issues remain unresolved. It is concluded that the most promising developments in LBT are (a) models of brightness coding based on multi-scale filtering combined with contrast normalization, (b) the idea that the visual system decomposes the image into “layers” of reflectance, illumination and transparency, (c) that an understanding of image statistics is important to an understanding of lightness errors, (d) Whittle’s log W metric for contrast-brightness, (e) the idea that “filling-in” is mediated by low spatial frequencies rather than neural spreading, and (f) that there exist multiple cues for identifying non-uniform illumination and transparency. Unresolved issues include how relative lightness values are anchored to produce absolute lightness values, and the perceptual representation of transparency. Bridging the gap between multi-scale filtering and layer decomposition approaches to LBT is a major task for future research.     

Increased duration of viral suppression is associated with lower viral rebound rates in patients with previous treatment failures

OBJECTIVE: We investigated whether the rate of viral rebound decreases with increasing duration of viral suppression and, if so, whether rebound rates in patients previously failing antiretroviral regimens ultimately decline to levels as low as those seen in patients who have never experienced virological failure. METHODS: All patients from the UK CHIC Study (n = 21 256) who achieved a viral load (VL) of < or = 50 copies/ml while receiving HAART were followed until viral rebound (two consecutive VL > 400 copies/ml). Patients could re-enter the analysis if they experienced a subsequent VL < or = 50 copies/ml. Rebound rates were calculated according to the number of regimens previously failed and duration of viral suppression. RESULTS: Of 12 648 patients on HAART 10 237 (80.9%) achieved a VL < or = 50 copies/ml. During 26 494 person-years (PY) of follow-up, 1853 (18.1%) patients experienced at least one viral rebound 'event', with 2460 events in total [rebound rate, 9.3 (range, 8.9-9.7)/100 PY). Within the first year of viral suppression, the rate of viral rebound was 8.3 (7.5-9.1)/100 PY in patients who had not previously failed treatment, increasing to 32.7 (27.6-37.8)/100 PY in patients who had failed more than four regimens. Irrespective of previous treatment failure, rebound rates in those who remained suppressed for > 4 years were similar to those in patients who had at no time experienced treatment failure. CONCLUSION: After around 4 years of viral suppression rebound rates in individuals with multiple prior treatment failures approach those of individuals with no prior treatment failure.     

p120连环素与上皮性钙粘附蛋白在基底细胞样乳腺癌中表达的临床意义

目的探讨p120连环素(p120)与上皮性钙粘附蛋白(E-cad)在基底细胞样乳腺癌(BLBC)中表达的临床意义。方法采用免疫组织化学法,观察p120、E-cad在56例BLBC患者中的表达与发病年龄、肿瘤大小、组织学分级、淋巴结转移和pTNM分期的关系以及p120和E-cad表达的相关性。结果①p120在年龄分组中表达差异无统计学意义;在肿瘤大小分组、组织学分级分组、淋巴结转移分组、pTNM分期分组中表达差异均有统计学意义。②E-cad在年龄分组、肿瘤大小分组中表达差异均无统计学意义;在组织学分级分组、淋巴结转移分组、pTNM分期分组中表达差异均有统计学意义。③在BLBC中p120异常表达与E-cad表达减弱/消失的相关性有统计学意义。结论在BLBC中,p120异常表达与E-cad表达减弱/消失均提示预后不良,两者的表达有正相关性。