Certolizumab pegol for active Crohn's disease: a placebo-controlled, randomized trial.

BACKGROUND & AIMS: Certolizumab pegol (CZP) is a pegylated-conjugated Fab' against tumor necrosis factor (TNF). Additional data are needed regarding the efficacy of induction therapy with CZP in active Crohn's disease (CD). METHODS: A placebo-controlled trial evaluated the efficacy of CZP therapy in 439 adults with moderate to severe CD naive to anti-TNF therapy. Patients were randomized to receive CZP (400 mg subcutaneously) or placebo at weeks 0, 2, and 4. The primary end point was clinical remission at week 6. RESULTS: Clinical remission rates at week 6 in the CZP and placebo groups were 32% and 25% (P = .174), respectively. Remission rates at weeks 2 and 4 in the CZP and placebo groups were 23% and 16% (P = .033) and 27% and 19% (P = .063), respectively. Clinical response rates at weeks 2, 4, and 6 in the CZP and placebo groups were 33% and 20% (P = .001), 35% and 26% (P = .024), and 41% and 34% (P = .179), respectively. There were significantly greater rates of clinical remission at week 6 for CZP in patients with increased concentrations of C-reactive protein (≥5 mg/L) at entry. Serious adverse events developed in 5% and 4% of patients in the CZP and placebo groups, respectively. CONCLUSIONS: The primary end point did not reach statistical significance. Significant differences between CZP and placebo were observed in patients who had increased concentrations of C-reactive protein when the study began. Future clinical trials should emphasize the treatment of patients who have objective evidence of inflammation in addition to symptoms of active disease.

Location of colorectal cancer: colonoscopy versus surgery. Yield of colonoscopy in predicting actual location.

BACKGROUND AND STUDY AIMS: Recent studies suggest that differences in biological characteristics and risk factors across cancer site within the colon and rectum may translate to differences in survival. It can be challenging at times to determine the precise anatomical location of a lesion with a luminal view during colonoscopy. The aim of this study is to determine if there is a significant difference between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative and pathology reports after colon surgery. PATIENTS AND METHODS: A single-center retrospective analysis of colonoscopies of patient with reported colonic masses from January 2005 to April 2014 (n = 380) was carried. Assessed data included demography, operative and pathology reports. Findings were compared: between the location of colorectal cancers described by gastroenterologists in colonoscopies and the actual anatomical location noted on operative reports or pathology samples. RESULTS: We identified 380 colonic masses, 158 were confirmed adenocarcinomas. Of these 123 underwent surgical resection, 27 had to be excluded since no specific location was reported on their operative or pathology report. An absolute difference between endoscopic and surgical location was found in 32 cases (33 %). Of these, 22 (23 %) differed by 1 colonic segment, 8 (8 %) differed by 2 colonic segments and 2 (2 %) differed by 3 colonic segments. CONCLUSION: There is a significant difference between the location of colorectal cancers reported by gastroenterologists during endoscopy and the actual anatomical location noted on operative or pathology reports after colon surgery. Endoscopic tattooing should be used when faced with any luminal lesions of interest.

Identificacion de las proteinas antigenicas de Klebsiella pneumoniae / Identification of antigenic proteins of klebsiella pneumoniae

La klebsiella pneumoniae es un microorganismo causante de multiples infecciones que cursan con una alta mortalidad. Es uno de los agentes nosocomiales mas frecuentes en Colombia y en otros paises sin que se haya podido controlar adecuadamente, debido a su virulencia y su alta resistencia a los antibioticos. A pesar de que sus componentes antigenicos polisacaridos y lipopolisacaridos han sido ampliamente estudiados, no ocurre asi con los antigenos proteicos. Esta investigacion describe la identificacion de proteinas antigenicas de klebsiella pneumoniae por medio de la PAGE y el inmunoblot. Se utilizaron cepas aisladas en muestras clinicas y sueros de pacientes de cuatro hospitales generales de Bogota. Se demostro la existencia de por lo menos 32 proteinas diferentes de klebsiella pneomoniae con pesos moleculares entre 11 y 210K, de las cuales alrededor de 18 se mostraron ser antigenicas. Se encontraron tres proteinas antigenicas de 167 K, 54 K y 39 K que son reconocidas por el sistema inmune humoral despues de que se ha superado la infeccion y estas podrian tener algun papel inmunogencio protector.