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ABSTRACT: Malignant atrophic papulosis/Köhlmeier-Degos disease was first described in 1941 by Köhlmeier in an anecdotal case report that described a young man who presented with extensive multiple intestinal perforations and a papular skin rash. Köhlmeier-Degos disease represents a unique vasculopathy targeting both the microvasculature and the arterial system. One of its most characteristic features is reflected by the discrete multifocal depressed porcelain lesions involving the skin and gastrointestinal tract. The pathological findings are striking and can be broadly categorized into those that are vascular in nature versus extravascular matrix production in the context of extensive extravascular hyaluronic acid and collagen deposition. A dynamic evolutionary morphology is observed not only clinically but also histologically. The microvascular alterations are particularly evident in the skin and are characterized by endothelial cell necrosis with subsequent endothelial cell detachment accompanied by intraluminal fibrin deposition, defining a thrombogenic microangiopathy that in later stage lesions is typically pauci-inflammatory. The arterial lesions are very distinctive and include significant neointimal proliferation with vascular luminal occlusion by amorphous plugs of collagen intimately admixed with platelets. Pathogenetically enhanced type I interferon signaling and endothelial cell injury mediated by the membranolytic attack complex (ie, C5b-9) are key in the evolution of the thrombotic microvascular and obliterative fibrosing arteriopathic changes. We describe a case of Köhlmeier-Degos disease that developed in the setting of tumor necrosis factor (TNF)-alpha inhibitor therapy with the drug golimumab. The clinical features, light microscopic findings, and a pathophysiologic paradigm based on the critical role of TNF-alpha in controlling the type I interferon response are discussed.
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Interferon Tipo I , Papulose Atrófica Maligna , Fator de Necrose Tumoral alfa , Humanos , Papulose Atrófica Maligna/patologia , Masculino , Interferon Tipo I/efeitos adversos , Interferon Tipo I/metabolismo , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Doença IatrogênicaRESUMO
This paper addresses the challenge of understanding the dynamics of the interaction between partially evaporated metal and the liquid metal melt pool in electron beam melting (EBM), an additive manufacturing technology. Few contactless, time-resolved sensing strategies have been applied in this environment. We used tunable diode-laser absorption spectroscopy (TDLAS) to measure vanadium vapor in the EBM of a Ti-6Al-4V alloy at 20 kHz. Our study includes, to our knowledge, the first-time use of a blue GaN vertical cavity surface emitting laser (VCSEL) for spectroscopy. Our results reveal a plume that is roughly symmetrical with a uniform temperature. Moreover, we believe this work presents the first application of TDLAS for time-resolved thermometry of a minor alloying element in EBM.
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Seasonal changes of trace elements, nutrients, dissolved organic matter (DOM), and carbonate system parameters were evaluated over the largest deteriorating oyster reef in the Western Mississippi Sound using data collected during spring, summer, and winter of 2018, and summer of 2019. Higher concentrations of Pb (224%), Cu (211%), Zn (2400%), and Ca (240%) were observed during winter of 2018 compared to summer 2019. Phosphate and ammonia concentrations were higher (> 800%) during both summers of 2018 and 2019 than winter of 2018. Among the three distinct DOM components identified, two terrestrial humic-like components were more abundant during both spring (12% and 36%) and summer (11% and 33%) of 2018 than winter of 2018, implying a relatively lesser supply of humic-like components from terrestrial sources during winter. On the other hand, the protein-like component was more abundant during summer of 2019 compared to rest of the study period, suggesting a higher rate of autochthonous production during summer 2019. In addition, to their significant depth-wise variation, ocean acidification parameters including pH, pCO2, CO32-, and carbonate saturation states were all higher during both summers of 2018 and 2019. The measured variables such as trace elements, organic carbon, suspended particulates, and acidification parameters exhibited conservative mixing behavior against salinity. These observations have strong implications for the health of the oyster reefs, which provides ecologically important habitats and supports the economy of the Gulf Coast.
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Ostreidae , Oligoelementos , Animais , Oligoelementos/análise , Rios , Matéria Orgânica Dissolvida , Estações do Ano , Concentração de Íons de Hidrogênio , Mississippi , Monitoramento Ambiental , Água do MarRESUMO
Tomographic absorption spectroscopy (TAS) has an advantage over other optical imaging methods for practical combustor diagnostics: optical access is needed in a single plane only, and the access can be limited. However, practical TAS often suffers from limited projection data. In these cases, priors such as smoothness and sparseness can be incorporated to mitigate the ill-posedness of the inversion problem. This work investigates use of dictionary learning (DL) to effectively extract useful a priori information from the existing dataset and incorporate it in the reconstruction process to improve accuracy. We developed two DL algorithms; our numerical results suggest that they can outperform classical Tikhonov reconstruction under moderate noise conditions. Further testing with experimental data indicates that they can effectively suppress reconstruction artifacts and obtain more physically plausible solutions compared with the inverse Radon transform.
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AIM: Bypass, or utilizing healthcare outside of one's community rather than local health care, can have serious consequences on rural healthcare availability, quality, and outcomes. Previous studies of the likelihood of healthcare bypass used various individual and community characteristics. This study includes measures for individuals and communities, as well as place-based characteristics. The authors introduce the Social Vulnerability of Place Index (SoVI) - a well-established measure in disaster literature - into healthcare studies to further explain the impact of place on healthcare selection behavior. Additionally, with the use of open-ended questions, this study explains why people choose to bypass. By including each of these measures, this study provides a more nuanced and detailed understanding of how individual healthcare selection is affected by the privilege of the individual, community ties, place of residence, and primary motivator for bypass. METHODS: A systematic random sample of residents from 25 rural towns in the western US state of Utah were surveyed in 2017 in the Rural Utah Community Survey. After accounting for missing data, the total sample size was 1061. This study used logistic regression to better predict the likelihood of rural healthcare bypass behavior. Measures associated with community push factors (dissatisfaction with various local amenities), community pull factors (friends in community and length of residence), individual ability (demographics, self-reported health, and distance to a hospital), and SoVI, were added to the models to examine their impact on the likelihood of bypass. The SoVI was made using census data with variables that measure both social and place inequality. Each town in the study received a SoVI score and was then categorized as having low, mean, or high social vulnerability. Qualitative open-ended responses about healthcare selection were coded for explanations given for bypassing. RESULTS: The pooled model showed that bypass was more likely amongst residents who were dissatisfied with local health care and more likely for females. Breaking bypass down, according to SoVI, provides a more nuanced understanding of bypass. For people living in low socially vulnerable areas, privileges such as graduating college made them more likely to bypass. For high socially vulnerable areas, privilege did not help people bypass, but disadvantages such as aging made residents less likely to bypass. Thus, by introducing the SoVI into healthcare literature, this study can compare healthcare selection behaviors of residents in low vulnerable towns, average vulnerable towns, and highly vulnerable towns. Additionally, the analysis of open-ended responses showed patterns explaining why people bypass. CONCLUSION: Policymakers and public health workers can use the SoVI to better target their healthcare outreach. Reasons for bypass include quality, selection, consistency, cost of insurance, one-stop shop, and confidentiality. Rural clinics can help residents avoid the need to bypass by improving in these areas and thus gaining patients and minimizing the risk of closure. Healthcare policymakers should focus resources on high socially vulnerable places as well as underprivileged people in low socially vulnerable places.
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Acessibilidade aos Serviços de Saúde , População Rural , Comportamento , Feminino , Mão de Obra em Saúde , Humanos , Masculino , Inquéritos e Questionários , Populações VulneráveisRESUMO
BACKGROUND: Oesophageal adenocarcinoma is the sixth most common cause of cancer death worldwide and Barrett's oesophagus is the biggest risk factor. We aimed to evaluate the efficacy of high-dose esomeprazole proton-pump inhibitor (PPI) and aspirin for improving outcomes in patients with Barrett's oesophagus. METHODS: The Aspirin and Esomeprazole Chemoprevention in Barrett's metaplasia Trial had a 2â×â2 factorial design and was done at 84 centres in the UK and one in Canada. Patients with Barrett's oesophagus of 1 cm or more were randomised 1:1:1:1 using a computer-generated schedule held in a central trials unit to receive high-dose (40 mg twice-daily) or low-dose (20 mg once-daily) PPI, with or without aspirin (300 mg per day in the UK, 325 mg per day in Canada) for at least 8 years, in an unblinded manner. Reporting pathologists were masked to treatment allocation. The primary composite endpoint was time to all-cause mortality, oesophageal adenocarcinoma, or high-grade dysplasia, which was analysed with accelerated failure time modelling adjusted for minimisation factors (age, Barrett's oesophagus length, intestinal metaplasia) in all patients in the intention-to-treat population. This trial is registered with EudraCT, number 2004-003836-77. FINDINGS: Between March 10, 2005, and March 1, 2009, 2557 patients were recruited. 705 patients were assigned to low-dose PPI and no aspirin, 704 to high-dose PPI and no aspirin, 571 to low-dose PPI and aspirin, and 577 to high-dose PPI and aspirin. Median follow-up and treatment duration was 8·9 years (IQR 8·2-9·8), and we collected 20â095 follow-up years and 99·9% of planned data. 313 primary events occurred. High-dose PPI (139 events in 1270 patients) was superior to low-dose PPI (174 events in 1265 patients; time ratio [TR] 1·27, 95% CI 1·01-1·58, p=0·038). Aspirin (127 events in 1138 patients) was not significantly better than no aspirin (154 events in 1142 patients; TR 1·24, 0·98-1·57, p=0·068). If patients using non-steroidal anti-inflammatory drugs were censored at the time of first use, aspirin was significantly better than no aspirin (TR 1·29, 1·01-1·66, p=0·043; n=2236). Combining high-dose PPI with aspirin had the strongest effect compared with low-dose PPI without aspirin (TR 1·59, 1·14-2·23, p=0·0068). The numbers needed to treat were 34 for PPI and 43 for aspirin. Only 28 (1%) participants reported study-treatment-related serious adverse events. INTERPRETATION: High-dose PPI and aspirin chemoprevention therapy, especially in combination, significantly and safely improved outcomes in patients with Barrett's oesophagus. FUNDING: Cancer Research UK, AstraZeneca, Wellcome Trust, and Health Technology Assessment.
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Anti-Inflamatórios não Esteroides/uso terapêutico , Aspirina/uso terapêutico , Esôfago de Barrett/tratamento farmacológico , Esomeprazol/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Adolescente , Adulto , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Esquema de Medicação , Quimioterapia Combinada , Esomeprazol/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Bomba de Prótons/administração & dosagem , Adulto JovemRESUMO
We present a novel spectroscopic technique that exhibits high sensitivity and a large dynamic range for the measurement of absolute absorption coefficients. We perform a simultaneous and correlated laser-induced fluorescence and cavity ring-down measurement of the same sample in a single pulsed laser beam. The combined measurement offers a large dynamic range and a lower limit of detection than either technique on its own. The methodology, dubbed cavity-enhanced laser-induced fluorescence, is developed and rigorously tested against the electronic spectroscopy of 1,4-bis(phenylethynyl)benzene in a molecular beam and density measurements in a cell. We outline how the method can be used to determine absolute quantities, such as sample densities, absorption cross sections, and fluorescence quantum yields, particularly in spatially confined samples.
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BACKGROUND & AIMS: Barrett's esophagus (BE) increases the risk of esophageal adenocarcinoma (EAC). We found the risk to be BE has been associated with single nucleotide polymorphisms (SNPs) on chromosome 6p21 (within the HLA region) and on 16q23, where the closest protein-coding gene is FOXF1. Subsequently, the Barrett's and Esophageal Adenocarcinoma Consortium (BEACON) identified risk loci for BE and esophageal adenocarcinoma near CRTC1 and BARX1, and within 100 kb of FOXP1. We aimed to identify further SNPs that increased BE risk and to validate previously reported associations. METHODS: We performed a genome-wide association study (GWAS) to identify variants associated with BE and further analyzed promising variants identified by BEACON by genotyping 10,158 patients with BE and 21,062 controls. RESULTS: We identified 2 SNPs not previously associated with BE: rs3072 (2p24.1; odds ratio [OR] = 1.14; 95% CI: 1.09-1.18; P = 1.8 × 10(-11)) and rs2701108 (12q24.21; OR = 0.90; 95% CI: 0.86-0.93; P = 7.5 × 10(-9)). The closest protein-coding genes were respectively GDF7 (rs3072), which encodes a ligand in the bone morphogenetic protein pathway, and TBX5 (rs2701108), which encodes a transcription factor that regulates esophageal and cardiac development. Our data also supported in BE cases 3 risk SNPs identified by BEACON (rs2687201, rs11789015, and rs10423674). Meta-analysis of all data identified another SNP associated with BE and esophageal adenocarcinoma: rs3784262, within ALDH1A2 (OR = 0.90; 95% CI: 0.87-0.93; P = 3.72 × 10(-9)). CONCLUSIONS: We identified 2 loci associated with risk of BE and provided data to support a further locus. The genes we found to be associated with risk for BE encode transcription factors involved in thoracic, diaphragmatic, and esophageal development or proteins involved in the inflammatory response.
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Esôfago de Barrett/genética , Proteínas Morfogenéticas Ósseas/genética , Predisposição Genética para Doença , Fatores de Diferenciação de Crescimento/genética , Polimorfismo de Nucleotídeo Único , Proteínas com Domínio T/genética , Esôfago de Barrett/etiologia , Neoplasias Esofágicas/genética , Estudo de Associação Genômica Ampla , Humanos , RiscoRESUMO
A mid-infrared fiber-coupled laser system constructed around three time-division-multiplexed quantum-cascade lasers capable of measuring the absorption spectra of CO, CO2, and N2O at 100 kHz over a wide range of operating pressures and temperatures is demonstrated. This system is first demonstrated in a laboratory burner and then used to measure temperature, pressure, and concentrations of CO, CO2, and N2O as a function of time in a detonated mixture of N2O and C3H8. Both fuel-rich and fuel-lean detonation cases are outlined. High-temperature fluctuations during the blowdown are observed. Concentrations of CO are shown to decrease with time for fuel-lean conditions and increase for fuel-rich conditions.
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OBJECTIVES: Barrett's esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD). METHODS: We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. RESULTS: In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients. CONCLUSIONS: In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.
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Esôfago de Barrett/patologia , Esôfago de Barrett/terapia , Biomarcadores Tumorais/análise , Consenso , Técnica Delphi , Neoplasias Esofágicas/patologia , Esôfago/patologia , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/terapia , Técnicas de Ablação , Fatores Etários , Biópsia , Metilação de DNA , Esofagoscopia , Humanos , Lesões Pré-Cancerosas/química , Lesões Pré-Cancerosas/genética , Fatores de Risco , Fatores Sexuais , Conduta Expectante/métodosRESUMO
A simultaneous optimization method is proposed for absorption spectroscopy postprocessing. This method is particularly useful for thermometry measurements based on congested spectra, as commonly encountered in combustion applications of H2O absorption spectroscopy. A comparison test demonstrated that the simultaneous optimization method had greater accuracy, greater precision, and was more user-independent than the common step-wise postprocessing method previously used by the authors. The simultaneous optimization method was also used to process experimental data from an environmental chamber and a constant volume combustion chamber, producing results with errors on the order of only 1%.
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This paper introduces temperature imaging by total-variation-based compressed sensing (CS) tomography of H2O vapor absorption spectroscopy. A controlled laboratory setup is used to generate a constant two-dimensional temperature distribution in air (a roughly Gaussian temperature profile with a central temperature of 677 K). A wavelength-tunable laser beam is directed through the known distribution; the beam is translated and rotated using motorized stages to acquire complete absorption spectra in the 1330-1365 nm range at each of 64 beam locations and 60 view angles. Temperature reconstructions are compared to independent thermocouple measurements. Although the distribution studied is approximately axisymmetric, axisymmetry is not assumed and simulations show similar performance for arbitrary temperature distributions. We study the measurement error as a function of number of beams and view angles used in reconstruction to gauge the potential for application of CS in practical test articles where optical access is limited.
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Compressão de Dados/métodos , Termografia/instrumentação , Tomografia Óptica/instrumentação , Água/análise , Absorção Fisico-Química , Desenho de Equipamento , Análise de Falha de Equipamento , Estudos de Viabilidade , Gases/análise , Gases/química , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Análise Espectral , Temperatura , Termografia/métodos , Tomografia Óptica/métodos , Água/químicaRESUMO
These guidelines provide a practical and evidence-based resource for the management of patients with Barrett's oesophagus and related early neoplasia. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was followed to provide a methodological strategy for the guideline development. A systematic review of the literature was performed for English language articles published up until December 2012 in order to address controversial issues in Barrett's oesophagus including definition, screening and diagnosis, surveillance, pathological grading for dysplasia, management of dysplasia, and early cancer including training requirements. The rigour and quality of the studies was evaluated using the SIGN checklist system. Recommendations on each topic were scored by each author using a five-tier system (A+, strong agreement, to D+, strongly disagree). Statements that failed to reach substantial agreement among authors, defined as >80% agreement (A or A+), were revisited and modified until substantial agreement (>80%) was reached. In formulating these guidelines, we took into consideration benefits and risks for the population and national health system, as well as patient perspectives. For the first time, we have suggested stratification of patients according to their estimated cancer risk based on clinical and histopathological criteria. In order to improve communication between clinicians, we recommend the use of minimum datasets for reporting endoscopic and pathological findings. We advocate endoscopic therapy for high-grade dysplasia and early cancer, which should be performed in high-volume centres. We hope that these guidelines will standardise and improve management for patients with Barrett's oesophagus and related neoplasia.
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Esôfago de Barrett , Técnicas de Ablação , Adenocarcinoma/diagnóstico , Adenocarcinoma/economia , Adenocarcinoma/etiologia , Adenocarcinoma/terapia , Esôfago de Barrett/complicações , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/economia , Esôfago de Barrett/terapia , Biópsia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/economia , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/terapia , Esofagectomia , Esofagoscopia/economia , Esofagoscopia/métodos , Esôfago/patologia , Esôfago/cirurgia , Humanos , Medição de Risco/métodos , Fatores de Risco , Reino Unido , Estados UnidosRESUMO
BACKGROUND: Early detection and targeted endoscopic resection of Barrett's esophagus-associated high-grade dysplasia (HGD) can prevent progression to invasive esophageal malignancy. Raman spectroscopy, a highly sophisticated analytical technique, has been translated into an endoscopic tool to facilitate rapid, objective diagnosis of dysplasia in the esophagus. OBJECTIVE: To evaluate the ability of endoscopic Raman spectroscopy (ERS) to objectively detect esophageal HGD and adenocarcinoma. DESIGN: A total of 798 one-second spectra were measured from 673 ex vivo esophageal tissue samples, collected from patients with Barrett's esophagus by using a novel endoscopic Raman probe. Spectra were correlated with consensus histopathology. Multivariate analysis was used to evaluate the classification accuracy of ERS ex vivo. SETTING: Probe measurements were conducted in the laboratory. Tissue specimens were collected from the operating theatre and endoscopy unit. PATIENTS: Tissue from 62 patients was included in the study. INTERVENTIONS: Endoscopic biopsy/resection or esophagectomy was performed where indicated clinically. MAIN OUTCOME MEASUREMENT: Diagnostic performance of ERS for detection of HGD and esophageal adenocarcinoma. RESULTS: ERS demonstrated a sensitivity of 86% and a specificity of 88% for detecting HGD and adenocarcinoma. The ability to grade dysplasia and differentiate intestinal metaplasia from nonintestinal metaplasia columnar-lined esophagus was also demonstrated. Diagnostic classification was based on objective measurement of the biochemical profile of different tissue types. The potential for combination ERS and narrow-band imaging was also demonstrated. LIMITATIONS: Measurements were taken from ex vivo tissue. CONCLUSION: ERS enables rapid, accurate, objective diagnosis of superficial esophageal disease (metaplasia, dysplasia, intramucosal cancer) in clinically applicable time scales.
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Adenocarcinoma/química , Adenocarcinoma/patologia , Esôfago de Barrett/patologia , Neoplasias Esofágicas/química , Neoplasias Esofágicas/patologia , Esofagoscopia , Esôfago/patologia , Análise Espectral Raman , Biópsia , Esofagectomia , Esôfago/química , Humanos , Metaplasia/patologia , Imagem de Banda Estreita , Sensibilidade e EspecificidadeRESUMO
The application of semi-supervised methodology to improve the classification performance of a Raman spectroscopic probe for the diagnosis of oesophageal cancer is described. It is well known that gold standard histopathology diagnosis can be highly subjective, particularly for diseases which have several stages, such as cancer. A 'consensus' pathology decision can be obtained to ensure a robust gold standard by obtaining a diagnosis from several experts and samples are then only included in standard classification models if they have been assigned the same pathology by all experts. This can result in a significant number of samples that are excluded from the analysis as no consensus was reached. In this work semi-supervised methodology was used to extend Principal Component Analysis followed by Linear Discriminant Analysis (PCA-LDA) to incorporate samples without consensus pathology when discriminating between benign and oesophageal cancer specimens measured using a Raman endoscopic probe ex vivo. We demonstrate that a fully semi-supervised approach improved sensitivity and specificity from 73% and 78% (PCA-LDA) to 78% and 84% (semi-supervised) for discriminating between intestinal metaplasia and dysplasia and from 44% and 66% (PCA-LDA) to 63% and 72% (semi-supervised) when discriminating between intestinal metaplasia and low grade dysplasia.
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Neoplasias Esofágicas/diagnóstico , Análise Espectral Raman/métodos , Estatística como Assunto/métodos , Análise de Componente PrincipalRESUMO
Many baseline correction approaches have been developed to address baseline artifacts observed in measured infrared (IR) absorption spectra during post-processing. These approaches offer distinct advantages and disadvantages, and the choice of which one to employ depends on the complexity of baseline artifacts present in a particular application. In this paper, we compare the performance of two baseline correction approaches: a frequency-domain polynomial fitting approach and a time-domain modified free induction decay approach, under various baseline scenarios, spectral resolutions, and noise levels for mixtures containing up to 464 species. Our results showed that the frequency-domain approach outperformed the time-domain approach by a factor of up to 16 when the baseline was represented by a sine wave with fewer than two cycles over the full spectral range. On the other hand, the time-domain approach performed up to 12 times better when the baseline featured two cycles of a sine wave. Additionally, we observed that the time-domain approach exhibited higher sensitivity to spectral resolution and underperformed when the noise level was high. The findings of this study emphasize the importance of numerically testing a few candidate approaches for a given application, taking into consideration baseline characteristics, as well as the spectral resolution and noise constraints of the application.
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BACKGROUND & AIMS: Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, high-grade dysplasia (HGD), or early-stage EA. METHODS: We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. RESULTS: Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) high-resolution endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. CONCLUSIONS: We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies.
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Adenocarcinoma/terapia , Esôfago de Barrett/terapia , Ablação por Cateter , Neoplasias Esofágicas/terapia , Esofagectomia , Esofagoscopia , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiologia , Adenocarcinoma/mortalidade , Esôfago de Barrett/complicações , Esôfago de Barrett/diagnóstico , Esôfago de Barrett/mortalidade , Técnica Delphi , Progressão da Doença , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/etiologia , Neoplasias Esofágicas/mortalidade , Esofagectomia/mortalidade , Humanos , RiscoRESUMO
This paper describes a novel laser diagnostic and its demonstration in a practical aero-propulsion engine (General Electric J85). The diagnostic technique, named hyperspectral tomography (HT), enables simultaneous 2-dimensional (2D) imaging of temperature and water-vapor concentration at 225 spatial grid points with a temporal response up to 50 kHz. To our knowledge, this is the first time that such sensing capabilities have been reported. This paper introduces the principles of the HT techniques, reports its operation and application in a J85 engine, and discusses its perspective for the study of high-speed reactive flows.
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Diffusion-weighted magnetic resonance (MR) imaging has emerged as an important tool in the diagnostic work-up of patients with bowel cancer and inflammatory conditions of the gastrointestinal tract. It functions on the basis of the microscopic motion of water molecules in a cellular environment and provides functional information about the water in body tissues. Diffusion-weighted imaging serves to complement conventional MR imaging, and its use may improve the accuracy of tumor detection and staging. It does not rely on the use of intravenous contrast material and may be performed in patients with renal impairment. Because it provides quantitative information about tissue cellularity, diffusion-weighted imaging may be used to distinguish between tissues with altered cellularity (eg, tumors and metastases) and normal tissues. Data from diffusion-weighted MR images enable the calculation of apparent diffusion coefficient (ADC) values, which provide useful information about response to treatment. Malignant gastrointestinal tract tumors have low ADC values, which increase after successful therapy. Diffusion-weighted imaging also plays a role in the evaluation of patients with inflammatory bowel disease and may help assess inflammation and complications, such as abscesses and fistulas. Quantitative measurements of signal intensity at diffusion-weighted imaging may help differentiate actively inflamed bowel from normal bowel, and ADC values provide useful information about disease activity and response to treatment.
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Imagem de Difusão por Ressonância Magnética/métodos , Gastroenteropatias/patologia , Trato Gastrointestinal/patologia , Aumento da Imagem/métodos , Posicionamento do Paciente/métodos , HumanosRESUMO
Hyperspectral absorption spectroscopy is being used to monitor gas temperature, velocity, pressure, and H(2)O mole fraction in a research-grade pulsed-detonation combustor (PDC) at the Air Force Research Laboratory. The hyperspectral source employed is termed the TDM 3-FDML because it consists of three time-division-multiplexed (TDM) Fourier-domain mode-locked (FDML) lasers. This optical-fiber-based source monitors sufficient spectral information in the H(2)O absorption spectrum near 1350 nm to permit measurements over the wide range of conditions encountered throughout the PDC cycle. Doppler velocimetry based on absorption features is accomplished using a counterpropagating beam approach that is designed to minimize common-mode flow noise. The PDC in this study is operated in two configurations: one in which the combustion tube exhausts directly to the ambient environment and another in which it feeds an automotive-style turbocharger to assess the performance of a detonation-driven turbine. Because the enthalpy flow [kilojoule/second] is important in assessing the performance of the PDC in various configurations, it is calculated from the measured gas properties.