Effectiveness and safety of 1L PEG-ASC preparation for colonoscopy in patients with inflammatory bowel diseases.

INTRODUCTION: The effectiveness of bowel cleansing is a key element for high-quality colonoscopy. Recently, a 1 L polyethylene glycol plus ascorbate (PEG-ASC) solution has been introduced, but effectiveness and safety of this preparation have not been assessed in IBD patients. This study aims to evaluate effectiveness and safety of 1 L PEG-ASC solution in patients with IBD compared to controls. METHODS: We retrospectively analysed prospectively collected data on a cohort of 411 patients performing a colonoscopy after preparation with 1 L PEG-ASC, consecutively enrolled in 5 Italian centres. RESULTS: Overall, 185/411 (45%) were patients with IBD and 226/411 (55%) served as controls. A significantly higher cleansing success was achieved in IBD patients (92.9% vs 85.4%, p = 0.02). The multiple regression model showed that presence of IBD (OR=2.514, 95%CI=1.165-5.426; P = 0.019), lower age (OR=0.981, 95%CI=0.967-0.996; P = 0.014), split preparation (OR=2.430, 95%CI=1.076-5.492; P = 0.033), absence of diabetes (OR=2.848, 95%CI=1.228-6.605; P = 0.015), and of chronic constipation (OR=3.350, 95%CI=1.429-7.852; P = 0.005), were independently associated with cleansing success. The number of treatment-emergent adverse events (TEAEs) (51 vs 62%, p = 0.821), and of patients with TEAEs (22.2% vs 21.2%, p = 0.821), were similar in IBD patients and in controls, respectively. CONCLUSIONS: Results from this study support the effectiveness and safety of 1 L PEG-ASC solution in IBD patients, which may improve the definition of endoscopic outcomes both in Crohn's disease and ulcerative colitis.

Human clinical experience with adipose precursor cells seeded on hyaluronic acid-based spongy scaffolds.

Histioconductive approaches to soft-tissue defects use scaffolds seeded with lineage- and tissue-specific progenitors to generate tissue which should reside in equilibrium with adjacent tissue. Scaffolds guide histiogenesis by ensuring cell-cell and cell-matrix interactions. Hyaluronic acid-based (HA) preadipocyte-seeded scaffolds were evaluated for their adipo-conductive potential and efficacy in humans. Preadipocytes were isolated from lipoaspirate material and seeded on HA scaffolds. The cellular bio-hybrid (ADIPOGRAFT) and an acellular control scaffold (HYAFF11) were implanted subcutaneously. At specific time points (2, 8 and 16 weeks) explants were analyzed histopathologically with immunohistochemistry. No adverse tissue effects occurred. Volume loss and consistent degradation of the HYAFF11 scaffolds compared to the ADIPOGRAFT group indicated progressive tissue integration. No consistent histological differences between both groups were observed. By 8 weeks all void spaces within the scaffolds were filled with cells with pronounced matrix deposition in the ADIPOGRAFT bio-hybrids. Here we show that HA scaffolds were stable cell carriers and had the potential to generate volume-retaining tissue. However, no adipogenic differentiation was observed within the preadipocyte-seeded scaffolds.

Design of experiments in medical physics: Application to the AAA beam model validation.

PURPOSE: The purpose of this study is to evaluate the usefulness of the design of experiments in the analysis of multiparametric problems related to the quality assurance in radiotherapy. The main motivation is to use this statistical method to optimize the quality assurance processes in the validation of beam models. METHOD: Considering the Varian Eclipse system, eight parameters with several levels were selected: energy, MLC, depth, X, Y1 and Y2 jaw dimensions, wedge and wedge jaw. A Taguchi table was used to define 72 validation tests. Measurements were conducted in water using a CC04 on a TrueBeam STx, a TrueBeam Tx, a Trilogy and a 2300IX accelerator matched by the vendor. Dose was computed using the AAA algorithm. The same raw data was used for all accelerators during the beam modelling. RESULTS: The mean difference between computed and measured doses was 0.1±0.5% for all beams and all accelerators with a maximum difference of 2.4% (under the 3% tolerance level). For all beams, the measured doses were within 0.6% for all accelerators. The energy was found to be an influencing parameter but the deviations observed were smaller than 1% and not considered clinically significant. CONCLUSION: Designs of experiment can help define the optimal measurement set to validate a beam model. The proposed method can be used to identify the prognostic factors of dose accuracy. The beam models were validated for the 4 accelerators which were found dosimetrically equivalent even though the accelerator characteristics differ.

Consistent canonical quantization of general relativity in the space of vassiliev invariants

We present a quantization of the Hamiltonian and diffeomorphism constraint of canonical quantum gravity in the spin network representation. The novelty consists in considering a space of wave functions based on the Vassiliev invariants. The constraints are finite, well defined, and reproduce at the level of quantum commutators the Poisson algebra of constraints of the classical theory. A similar construction can be carried out in 2+1 dimensions leading to the correct quantum theory.

[Pleural effusion: diagnostic usefulness of pleural puncture biopsy]. / Derrame pleural: utilidad diagnóstica de la punción biopsia pleural.

To assess the diagnostic usefulness of thoracocentesis with pleural needle biopsies, we retrospectively studied 316 procedures performed in 254 patients between 1977 and 1984. Of these, 130 were ultimately found to have pleural malignant disease, with a diagnostic cytologic study in 60% of the patients, a positive pleural biopsy in 52.30% and both methods combined in 81.53% of the patients. The marginal gains from pleural biopsy in the presence of negative cytology results were 63.46%. In 59 patients, the primary neoplasm was lung cancer, the most frequent tumor (45.30%); in second place, 30 patients presented carcinoma of the breast (23%). Needle biopsy of the pleura proved to be nonspecific for the diagnosis of nonmalignant diseases except for tuberculous pleurisy: in our study 55 patients presented tuberculosis (21.65%) and in 35 of them, the pleural biopsy was characteristic. The culture of pleural fluid revealed Koch bacillus in 5.45% of these patients. Routine culture of biopsy specimen for tubercle bacillus was not carried out. Complications occurred in 4.4% of needle biopsies, with no death.

To E or not to E? Can an IL-4-induced B cell choose between IgE and IgG4?

Parasite immunologists had known for some time that IgE-mediated hypersensitivity reactions are rare in patients with chronic helminth infections, even though basophils and mast cells in these patients are sensitized with antiparasite IgE and exposed, often continuously, to parasite antigens. The inhibition of allergic reactivity in chronic helminth infections is mainly due to IgG4 'blocking antibodies' in the serum of the infected individual. IgG4 do not fix complement and bind weakly to Fcgamma receptors. Thus, antigen binding by IgG4, unlike IgE, is likely to have no or minimally harmful consequences. The discovery that, similar to IgE, expression of IgG4 is IL-4-dependent and is an intermediate step in sequential switching from IgM to IgE makes it imperative to understand how the two isotypes are coregulated and whether the two responses can be uncoupled, selectively boosting IgG4 over IgE. The ultimate goal is to apply to allergy the lesson we learnt from helminth infections.

Derrame pleural: utilidad diagnóstica de la punción biopsia pleural. / [Pleural effusion: diagnostic usefulness of pleural puncture biopsy]

To assess the diagnostic usefulness of thoracocentesis with pleural needle biopsies, we retrospectively studied 316 procedures performed in 254 patients between 1977 and 1984. Of these, 130 were ultimately found to have pleural malignant disease, with a diagnostic cytologic study in 60

of the patients, a positive pleural biopsy in 52.30

and both methods combined in 81.53

of the patients. The marginal gains from pleural biopsy in the presence of negative cytology results were 63.46

. In 59 patients, the primary neoplasm was lung cancer, the most frequent tumor (45.30

); in second place, 30 patients presented carcinoma of the breast (23

). Needle biopsy of the pleura proved to be nonspecific for the diagnosis of nonmalignant diseases except for tuberculous pleurisy: in our study 55 patients presented tuberculosis (21.65

) and in 35 of them, the pleural biopsy was characteristic. The culture of pleural fluid revealed Koch bacillus in 5.45

of these patients. Routine culture of biopsy specimen for tubercle bacillus was not carried out. Complications occurred in 4.4

of needle biopsies, with no death.