Background/aims The possibility of proximal lesion without distal polyps is a weak point of sigmoidoscopic colon cancer screening, but the
clinical significance of distal findings for advanced proximal neoplasm (APN) is uncertain. The aim of this study was to assess
the significance of a distal finding as a predictor of APN.
Materials and methods Asymptomatic patients ≥50 years old were enrolled from among patients who underwent polypectomy at 11 tertiary medical centers
during the Korean Association for the Study of Intestinal Disease prospective study conducted between July 2003 and March
2004. Polyps located distal to the splenic flexure were defined as distal polyps. An advanced neoplasm was defined as a polyp
of ≥10 mm in size, and/or with villous features, and/or with high-grade dysplasia, or invasive cancer. Age, gender, and distal
polyp size, appearance, and histology were analyzed as risk factors of APN. The sensitivity and positive predictive value
of distal polyps for APN were calculated.
Results Data from 826 patients were analyzed. Mean patient age was 60.1 years (range 50–86), and 71.3% were men. APN was found in
98 patients, and 45 (45.9%) patients had no distal polyps. Risk factors of APN were a male gender, distal polyp size, and
an advanced distal neoplasm. Sensitivities of a distal polyp of ≥10 mm and of an advanced distal neoplasm for APN were both
38.8% with positive predictive values of 13.3 and 14.4%, respectively.
Conclusions Although distal colon findings were found to be helpful for predicting APN in asymptomatic patients aged ≥50 years, APN without
distal polyps requires careful consideration. 相似文献
BACKGROUND/AIMS: Internet has become an important source of medical information not only for medical personnels but also for patients. The aim of this study was to evaluate the quality of internet based medical information about 'gastroesophageal reflux' or 'reflux esophagitis' in Korea. METHODS: The first 15 internet sites using the key words 'gastroesophageal reflux' or 'reflux esophagitis' were retrieved from the 7 most frequently used internet search engines. The quality of information from a total of 108 websites was evaluated using a checklist. RESULTS: Among total 108 sites related to 'gastroesophageal reflux' or 'reflux esophagitis', fifty-six sites (51.8%) were made by hospitals or clinics and 94 sites (87.0%) were made for patients. Of the 108 sites, eleven web sites (10.1%) had more than three JAMA benchmarks (authorship, references, currency, and disclosure). Higher quality sites (at least three JAMA benchmarks) were less likely to contain inaccurate information than lower quality sites (fewer than three JAMA benchmarks)-3/11 (27.2%) vs. 60/97 (61.9%) (p<0.01). Despite the fact that articles in the literature emphasized an insufficient evidence to support an association between the lifestyle, dietary behaviors, and GERD, such guidelines continue to be recommended as first-line therapy in most websites. CONCLUSIONS: Informations about gastroesophageal reflux disease were incomplete in the majority of medical web sites. These would bring about confusion to patients seeking for an information about GERD through the internet. There is a need for better sources in evidence based informations about gastroesophageal reflux diseases on the web. 相似文献
OBJECTIVE: To study the outcome and prognostic indicators of diffuse proliferative glomerulonephritis (DPGN) in patients with systemic lupus erythematosus (SLE) treated with sequential oral cyclophosphamide (CYC) and azathioprine (AZA). METHODS: SLE patients with biopsy-proven DPGN treated with sequential oral CYC and AZA were studied. Those who achieved renal remission at 12 months were identified, and the clinical predictors of complete remission were evaluated by regression analysis. All patients were followed up until a relapse of the nephritis or a doubling of the serum creatinine level occurred. The timing and risk factors for flares and creatinine doubling were evaluated by Kaplan-Meier analysis and with the Cox proportional hazards model. RESULTS: We studied 55 patients (47 women, 8 men; mean +/- SD age at renal biopsy 31.1 +/- 10.4 years); 25 (46%) had a serum creatinine level >106 micromoles/liter, and 29 (53%) had nephrotic syndrome. At 12 months posttreatment, 37 (67%) had complete remission and 12 (22%) had partial remission. The initial serum creatinine level was an independent predictor of complete remission. Excluding the 4 patients who were treatment- resistant or died, 21 patients (41%) had renal flares during a median followup of 4 years. The cumulative risk of renal flare was 6% at 1 year, 21% at 3 years, and 32% at 5 years. The median time to relapse was 43 months. The histologic activity score and the mean daily dose of CYC were multivariate predictors of renal flare, by Cox regression. At the last followup visit, 9 of 54 patients (17%) had a doubling of the creatinine level, 6 of whom (11%) underwent dialysis. The cumulative risk of creatinine doubling was 8.4% at 5 years and 18.2% at 10 years. An increasing chronicity index at the time of initial renal biopsy was an independent predictor of deterioration in renal function. CONCLUSION: Sequential therapy with oral CYC followed by AZA appears to be an effective treatment regimen for DPGN in patients with SLE, with 89% of patients achieving complete or partial remission at 12 months, 62.8% remaining in remission after 5 years, and 81.8% having stable renal function after 10 years. Predictors of treatment resistance and relapse include increasing serum creatinine level, higher histologic activity scores, and a lower dose of CYC. Increasing chronicity indices predict a deterioration of renal function. 相似文献
Airway smooth muscle growth contributes to the mechanism of airway hyperresponsiveness (AHR) in asthma. Although current steroid use demonstrates anti-inflammatory activity, there is little reported on the action of corticosteroid on smooth muscle of the asthmatic airway. The present study investigated the effect of inhaled corticosteroid on the thickening of airway smooth muscle in bronchial asthma. We developed a mouse model of airway remodeling including smooth muscle thickening in which ovalbumin (OVA)-sensitized female BALB/c-mice were repeatedly exposed to intranasal OVA administration twice a week for 3 months. Mice were treated intranasally with fluticasone during the OVA challenge. Mice chronically exposed to OVA developed sustained eosinophilic airway inflammation compared with control mice. In addition, the mice chronically exposed to OVA developed features of airway remodeling, including thickening of the peribronchial smooth muscle layer. Intranasal administration of fluticasone inhibited the development of eosinophilic inflammation, and importantly, thickening of the smooth muscle layer. Moreover, intranasal fluticasone treatment reduced the transforming growth factor (TGF)-beta 1 level in bronchoalveolar lavage fluid and regulated active TGF-beta 1 signaling with a reduction in the expression of phospho-Smad2/3 and the concomitant up-regulation of Smad7 in lung tissue sections. These results suggest that intranasal administration of fluticasone can modulate the remodeling of airway smooth muscle via regulation of TGF-beta 1 production and active TGF-beta 1 signaling. 相似文献
Over the past decade or more, contradictory evidence of Martian climate, indicating that surface temperatures seldom if ever approach the melting point of water at midlatitudes, and geomorphic features, consistent with liquid flows at these same latitudes, have proven difficult to reconcile. In this article, we demonstrate that several features of liquid-erosional flows can be produced by dry granular materials when individual particle settling is slower than characteristic debris flow speeds. Since the gravitational acceleration on Mars is about one-third that on Earth, and since particle settling speeds scale with gravity, we propose that some (although perhaps not all) Martian geomorphological features attributed to liquid flows may in fact be associated with dry granular flows in the presence of reduced gravity. 相似文献
BACKGROUND/AIMS: 6-Mercaptopurine and its prodrug azathioprine are effective for the treatment of inflammatory bowel disease. Thiopurine methyltransferase is important for the metabolism of thiopurines. However, there is controversy as to the clinical utility of measuring thiopurine methyltransferase enzyme activity and 6-thioguanine nucleotide levels. Our aim was to determine if thiopurine methyltransferase enzyme activity and 6-thioguanine nucleotide level monitoring would predict response to therapy with thiopurines in patients with inflammatory bowel disease. METHODS: Baseline thiopurine methyltransferase enzyme activity prior to initiation of therapy with either 6-mercaptopurine or azathioprine was determined in 39 patients with inflammatory bowel disease. The association between clinical response and thiopurine methyltransferase activity and 6-thioguanine nucleotide levels singly or in combination were analysed. RESULTS: Seventeen of 39 patients (44%) responded to 6-mercaptopurine or azathioprine therapy. Thiopurine methyltransferase enzyme activity below the mean of 30.5 U was significantly associated with clinical response. The thiopurine methyltransferase low phenotype was associated with response in 65% vs. 29% in individuals with thiopurine methyltransferase enzyme activity above 30.5 U (p = 0.05). There was no correlation between thiopurine methyltransferase activity and 6-thioguanine nucleotide levels. The maximal 6-thioguanine nucleotide levels did not predict clinical response. When combining thiopurine methyltransferase enzyme activity and 6-thioguanine nucleotide levels, the combination of thiopurine methyltransferase low/6-thioguanine nucleotide high was associated with response in 7/7 (100%) vs. only 2/8 (25%) with the combination of thiopurine methyltransferase high/6-thioguanine nucleotide low (p=0.01). CONCLUSIONS: Thiopurine methyltransferase activity inversely correlated with clinical response to thiopurine treatment in inflammatory bowel disease. Thiopurine methyltransferase enzyme activity below 30.5 U combined with a post-treatment 6-thioguanine nucleotide level > 230 pmol/8 x 10(8) erythrocytes was the best predictor of response. 相似文献
Identifying and measuring anxiety in young people on the autism spectrum can be challenging. The present study investigated the use of the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD), a self- and caregiver-rated screening tool in a Singaporean sample of ninety-one verbal autistic youths and their caregivers. Internal consistency ranged from satisfactory to desirable (α?=?.74–.92). Convergent validity with medium-large effect size was established using a structured diagnostic interview, the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). ASC-ASD scores were positively associated with autistic symptoms and response patterns indicated strong endorsement of autism-specific items. The findings are discussed in relation to existing literature on assessment of anxiety in ASD and in light of the study’s strengths and limitations.
We present a case of a 71-year-old woman who was incidentally found to have aberrant retropharyngeal internal carotid artery, lying very close to the pharyngeal mucosa, on imaging. Radiologists, otolaryngologists and anaesthetists should be aware of this clinically significant variant which can result in life-threatening bleeding during procedures in the oral cavity or oropharynx. 相似文献