Fluorescence optical imaging and musculoskeletal ultrasonography in juvenile idiopathic polyarticular disease before and during antirheumatic treatment – a multicenter non-interventional diagnostic evaluation
Follow-up study conducted from October 1997 through October 1999 of a prospective randomized trial of medical and surgical antireflux treatments in patients with complicated GERD. Mean (median) duration of follow-up was 10.6 years (7.3 years) for medical patients and 9.1 years (6.3 years) for surgical patients. Although frequent vomiting reflexes during esophagogastroduodenoscopy (EGD) causes suffering in patients, very few studies have investigated the characteristics of subjects who frequently develop vomiting reflexes. This study examined the incidence of the vomiting reflex and related factors, especially upper gastrointestinal symptoms, among individuals undergoing transoral EGD. The differential diagnosis of BehÃ§et’s syndrome or Crohn’s disease can be extremely difficult.
If no DLT was observed during the first three administrations, the next dose level was started. If an episode of DLT occurred, up to six patients were treated at that level.
FOI findings were compared with clinical findings in 750 joints (128 tender, 148 swollen, 83 swollen and tender). FOI was compared with MRI findings in 300 joints (figure 4). Fifty-nine joints showed MRI synovitis, and 75 joints showed synovitis or tenosynovitis. MRI detected inflammatory changes in 31 out of 194 (16%) clinically asymptomatic joints. FOI displayed positive findings in 387 out of 750 (77%) joints and in 250 out of 557 (45%) clinically asymptomatic joints.
Evaluation of the GSRS and UESS with regard to internal consistency, construct validity, and the ability to detect changes showed them to be satisfactory. The psychometric documentation of the measures indicates that they may give reliable and clinically valid information when used for evaluation of medical treatments in upper gastrointestinal disease. Further documentation of the methods is, however, needed to establish a generally acceptable QoL assessment in gastroenterology. Many questionnaires that assess subjective symptoms or health-related quality of life (HRQOL) have been developed to confirm the efficacy of treatment in patients with gastroesophageal reflux disease (GERD). However, few reports have correlated early improvements in scale scores with predictions of subsequent therapeutic responses.
FOI was more sensitive than CE. In addition, FOI could be helpful in the differentiation of nail involvement and arthritis of DIPs in patients with psoriasis and/or PsA. However, further investigations are needed for a comprehensive definition of FOI pathologies, advancement of methodical standards and evaluation of sensitivity to change and prognostic value.
An interview-based rating scale consisting of 15 items for assessment of gastrointestinal symptoms in irritable bowel syndrome and peptic ulcer disease has been developed. The interrater reliability was estimated by means of independent and simultaneous duplicate ratings by two raters in 20 cases and ranged from 0.86 to 1.00.
Due to the significant expense of obtaining frequent endoscopy and pH monitoring measures as outcome variables available for use in a multihospital clinical trial of gastroesophageal reflux disease, and the lack of a suitable inexpensive index of disease activity, evaluated for both reliability and validity, the study planning committee decided to develop an index of gastroesophageal reflux disease activity in a pilot study–to precede the clinical trial. In particular, the purpose of the pilot study was to find a reliable, valid, and inexpensive index of gastroesophageal reflux disease which could be obtained independently of the treating physician and used as an outcome variable in the clinical trial. This paper describes the pilot study and the statistical methodology used to derive and evaluate a gastroesophageal reflux disease activity index model. In addition, the results of the activity index’s use in the subsequent clinical trial’s longitudinal analyses are presented.
Ultrasonography (US) in greyscale mode (GSUS) and US in power Doppler mode (PDUS) have been demonstrated as valid tools for the assessment of synovitis and scoring of clinical activity in RA.8, -, 10 In daily clinical practice, PDUS is more available than MRI and often used for fast and dynamic assessment of joint inflammation.11 However, apart from clinical studies, the examination procedure is usually limited to a reduced number of joints12 due to time constraints. With recent advances in the management of rheumatic diseases, imaging plays a major role in early diagnosis, estimation of prognosis and evaluation of therapeutic outcome. In rheumatoid arthritis (RA), treat-to-target strategies1 and the adequate use of disease-modifying drugs1 2 require sensitive instruments that allow a valid detection of affected joints. This study was supported by BMBF project â€œArthroMarkâ€, subproject no. 7 â€œClinical study on Biomarkers and Imagingâ€. One of the technical devices (FOI) was provided via an unrestricted educational grant by Pfizer Company, Berlin, Germany.
At the time this article was completed, there had been no signs of tumor progression, the patient had reported well-being, and the MTX-HSA treatment was being continued (tumor response time, 30 months, ongoing). and then de-escalated to 50 mg/m 2 .
Bernardo Aldrete and Celso Cittadini: Shared Sophistication in Renaissance Linguistic Investigation
Symptom-based evaluative tools should greatly aid the objective evaluation of GERD symptoms, monitor precisely how patients respond to therapy and thereby lead to improvements in GERD management. MTX-HSA is a novel chemotherapeutic prodrug conjugate. Phase I testing revealed an excellent toxicological profile, allowing outpatient treatment and maintaining a high quality of life status for all cancer patients.
With MRI or US as reference, FOI was more sensitive than CE. In the present study, FOI was compared to CE, MRI and US in two larger cohorts of patients with arthritis and in healthy controls. The major findings were comparable in both centres. We found that FOI agreed well with CE, MRI and US. FOI was more sensitive for detecting synovitis and tenosynovitis than CE.
Grade 2 stomatitis was observed, and the treatment was paused. On weeks 27 and 28, the patient received injections of MTX-HSA, but only baseline concentrations were measured. After keeping the MTX-HSA concentrations between 10 and 20 Î¼mol/liter, no major side effects of long-term MTX-HSA have been reported in this patient.
MRI is considered the gold standard for imaging of synovitis, and MRI bone marrow oedema has been shown to be the strongest independent predictor of radiographic progression in RA.6 7 However, broader usage of MRI in clinical routine settings may be restricted by workflow considerations, cost and limited availability. MTX-HSA every 2-4 weeks, achieving plasma concentrations between 10 and 20 Î¼mol/liter, proved to be safe and effective, based on observation of the three responding patients. All 17 patients were evaluable for DLT within the first two consecutive courses; 13 patients received at least three courses, 12 patients received at least seven courses, and 8 patients received more than seven consecutive courses. One patient withdrew informed consent after two courses, and treatment was discontinued in two patients because of tumor-induced health deterioration after the second or third injection. Indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) is an established technology for imaging of inflammation in animal models.
Allergic reactions or other acute toxic reactions did not occur, even in patients with tumor responses, each patient receiving more than 35 injections of MTX-HSA. This study evaluated changes in health-related quality of life (HRQL) outcomes of once-daily omeprazole compared with ranitidine for the short-term treatment of patients with poorly responsive symptomatic gastroesophageal reflux disease (GERD).