1,720,997 research outputs found
PERSONALIZED MANAGEMENT OF CELIAC DISEASE: RISK STRATIFICATION AND NOVEL STRATEGIES FOR COMPLICATED PATIENTS
Full text linkSUMMARY
Background. Celiac disease is a widespread autoimmune disease diagnosed at increasing frequency. Celiac patients regularly attend medical services and present a benign course. The knowledge of clinical and biological factors predictive of malignant evolution is poor. Thus, management of such a large population of patients still lacks evidence-based criteria in order to target diagnostic strategies to the subgroup ”at-risk” to develop small bowel complications.
Aim. To identify celiac patients’ characteristics associated to a higher probability of complicated course and to evaluate the role of available screening and diagnostic approaches and coming biomarkers for the early diagnosis of small bowel malignancies in celiac disease.
Methods. A population-based registry (Varese province) was used to estimate the risk of intestinal lymphomas in undiagnosed celiac subjects, taking into consideration different settings of celiac prevalence and relative risks for intestinal lymphomas in comparison with the incidence of the lymphomas in the population. Treated celiac patients were selected on the basis of clinical flags of non-responsiveness or lack of compliance to treatment for targeted small bowel endoscopic examinations, evaluating the diagnostic yield of capsule endoscopy and double-balloon enteroscopy in the recognition of intestinal tumors at an early stage. miRNA profiles in type I and II enteropathy-associated T cell lymphoma were explored to identify eventual celiac related signature to be applied to subgroups of patients with different levels of risk for stratification purpose.
Results. In the considered population (815,362 inhabitants), during a five years period, the relative risks of undiagnosed celiac disease for gastrointestinal B- and T-cell lymphomas ranged from 1.0 to 2.0 for 1:100 celiac disease prevalence. In the selected series of 105 celiac patients, the diagnostic yield of capsule endoscopy and double-balloon enteroscopy for malignancies was 2.9%. When compared to the registered population, the relative risk for adenocarcinoma and neuroendocrine tumors in the studied cohort was 410 (CI 95% 102-1640, P<0.0001). Double-balloon enteroscopy was useful to histologically characterize even minor lesions detected at capsule endoscopy. A single miRNA (under patent) resulted upregulated in type I enteropathy-associated T cell lymphoma with confirmation at qPCR (p=0.0012). When mucosa specimen were evaluated, miRNA profiling of refractory patients was highly homogeneous (p=0.001 vs both type I and II enteropathy-associated T cell lymphoma).
Conclusions. Undiagnosed/untreated celiac patients did not show a different risk of developing gastrointestinal lymphomas than the general population. Capsule endoscopy and double-balloon enteroscopy could be considered at an early stage in the diagnostic management of a subset of celiac patients at risk for small bowel malignancies. We expect to identify miRNA signatures as a novel biomarker predictive of disease aggressiveness to support the implementation of a personalized clinical approach, in order to optimize resources employment and, through a timely pharmacological intervention, improve prognosis of these subset of celiac patients
Discrepancy between recalled and recorded bowel habits in irritable bowel syndrome
No full textBACKGROUND: A discrepancy between recalled and recorded bowel habit subtypes has been reported in irritable bowel syndrome (IBS), but the reasons for it remain unclear.
AIM: To assess the agreement between recalled and recorded bowel habit subtypes; to determine whether any discrepancy is related to stool form variability or psychological factors; and to test the correlations of recalled and recorded stool form with colonic transit time.
METHODS: Bowel habit subtype was established in 54 IBS patients at the enrolment visit (recalled) and with the aid of diary cards (recorded). Colonic transit time, the variability of stool form and the patients' psychological profiles were also recorded.
RESULTS: Recalled and recorded bowel habit subtypes agreed in only 54% of the patients (kappa = 0.28). Stool form variability was greater among the patients whose recalled and recorded bowel habit subtypes were discordant (P = 0.03), whereas the psychological profiles were not different. Colonic transit time significantly correlated with stool form only when it was recorded on diary cards.
CONCLUSION: The discrepancy between recalled and recorded bowel habits in IBS patients is related more to stool form variability than an altered psychological profile. Diary cards should be used to ensure that stool form reflects colonic transit time
Risk of intestinal lymphoma in undiagnosed coeliac disease : results from a registered population with different coeliac disease prevalence
No full textBACKGROUND:
Coeliac disease is often undiagnosed, early diagnosis and treatment could be relevant to avoid fearful complications as intestinal lymphoma. Our aim is to estimate the risk of intestinal lymphoma in undiagnosed coeliac patients, evaluating the real incidences and applying different theoretical settings of coeliac prevalence.
METHODS:
We collected cases of intestinal lymphomas from the Lombardy Cancer Registry and coeliac patients through computerized search of all Pathology Departments; duodenal pathological reports compatible with a Marsh 3 grade were included. The lymphoproliferative risk was calculated for theoretical different settings of coeliac prevalence (from 1:50 to 1:200), relative risks for intestinal lymphomas and compared to the real incidence of the lymphomas in this population.
RESULTS:
Population consisted in 815,362 inhabitants; during the investigated period of time, 237 intestinal lymphomas and 326 coeliac patients were diagnosed. None of the coeliac patients had lymphoma. In the different scenarios calculated and compared with the real lymphoma incidence the relative risks of undiagnosed celiac disease for gastrointestinal B- and T-cell lymphomas ranges from 1.0 to 2.0 for 1:100 coeliac disease prevalence.
CONCLUSIONS:
Undiagnosed coeliac patients have no increased risk of developing intestinal lymphoma; population screening programmes, aimed at early diagnosis of lymphoma may not be useful in this setting
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Is the subjective perception of lactose intolerance influenced by the psychological profile?
No full textBACKGROUND:
Symptoms of lactose intolerance are often attributed to lactose malabsorption but, as this relationship has not been demonstrated when a small dose of lactose similar to that contained in one cup of milk is ingested by intolerant patients, psychological factors may play a role in altered symptom perception.
AIM:
To assess the hypothesis that the psychological profile influences the symptoms of lactose intolerance.
METHODS:
One hundred and two consecutive patients underwent a 15 g lactose hydrogen breath test to assess lactose malabsorption. The patients recorded the presence and severity of symptoms of lactose intolerance during the breath test using visual analogue scales. The psychological profile was assessed using a psychological symptom checklist, and health-related quality of life by means of the short-form health survey.
RESULTS:
Lactose malabsorption and intolerance were diagnosed in, respectively, 18% and 29% of the patients. The two conditions were not associated, and the severity of intolerance was even less in the patients with malabsorption. Multivariate logistic analysis showed that a high somatisation t-score was significantly associated with lactose intolerance (odds ratio 4.184; 1.704-10.309); the effects of the other psychological variables and of lactose malabsorption were not statistically significant. Health-related quality of life was significantly reduced in the patients with somatisation, but not in those with lactose malabsorption.
CONCLUSIONS:
The symptoms of lactose intolerance during hydrogen breath testing at a low physiological lactose load, are unrelated to lactose malabsorption, but may reveal a tendency towards somatisation that could impair the quality of life
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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