Three patients were treated at each dose level. In each group, at least eight injections (one injection/week) were intended.
Fat-saturated coronal proton-density (FS-PD-TSE), non-enhanced and enhanced T1-TSE with subtraction, coronal and axial fat-saturated postintravenous gadolinium (Dotarem, 0.2 ml/kg/body weight) (FS-T1-TSE) sequences of the clinically dominant hand were performed in 25 patients (1.5 T MRI; Siemens Magnetom Symphony, Erlangen, Germany). MRI findings (MCP 1-5, interphalangeal joint finger 1 (IP), PIP 2-5, DIP 5 and wrist as a whole) were scored according to the OMERACT (Outcome Measures in Rheumatoid Arthritis Clinical Trials) criteria.19, -, 21 The RAMRI score was calculated. We report the results of the first comparative study of this commercially available FOI system with CE, US and contrast-enhanced MRI in two major cohorts of patients with arthritis and allied conditions and controls. Careful clinical examination (CE) is a prerequisite but may miss subclinical inflammation in early disease as well as in clinical remission under treatment.3, -, 5 Conventional radiography is commonly used as an indicator of prognosis and represents the standard outcome measure of disease progression in clinical studies but is displaying the result of previous inflammatory processes rather than presenting current disease activity.
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.
In the remaining 200 patients, a clinical diagnosis by history had a sensitivity of 78% and specificity of 60%. A discriminant analysis of symptoms was inferior to a history taken by an experienced gastroenterologist. Use of antireflux medication, Gastroesophageal Reflux Disease Activity Index (GRACI) scores, grade of esophagitis, frequency of treatment of esophageal stricture, frequency of subsequent antireflux operations, 36-item Short Form health survey (SF-36) scores, satisfaction with antireflux therapy, survival, and incidence of esophageal adenocarcinoma, compared between the medical antireflux therapy group and the fundoplication surgery group. Information on cause of death was obtained from autopsy results, hospital records, and death certificates. Our aim in the present study was to compare patients presenting with gastroesophageal reflux disease in the presence or absence of mild-grade esophagitis (grade I or II according to the Savary-Miller classification).
The patient received 28 injections with a cumulative dose of 2124 mg of MTX conjugated to HSA (152 mg MTX/month). A 30% tumor regression was documented by CT scans and lasted 14 months until tumor progression.
Pantoprazole and esomeprazole are two of the newer proton pump inhibitors and are the first to be systematically reviewed using the ReQuest(trade mark) questionnaire. Results from recent head-to-head trials have shown pantoprazole and esomeprazole to be highly and equally effective treatments for (i) rapid and sustained relief of ReQuest-assessed GORD-related symptoms in patients with non-erosive GORD or endoscopically confirmed erosive GORD, and (ii) achieving a combined outcome comprising endoscopically confirmed healing and ReQuest-assessed symptom relief in patients with erosive GORD. There is some preliminary evidence to suggest that pantoprazole may be the better choice of treatment in terms of its potential to maintain control of symptoms in patients for whom night-time symptoms are a concern and if taken as on-demand rather than continuous maintenance therapy. Grade A), 12 with peptic ulcer, and two with gastric cancer. Among the 70 patients with no evidence of organic disease, the modified FSSG diagnosed functional dyspepsia (FD) in 41 and non-erosive gastric disease (NERD) in 29.
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.
FOI was compared with GSUS and PDUS findings of the clinically dominant hand in 962 joints. Four hundred and fifty-three joints were positive in GSUS, 148 in PDUS and 136 in GSUS and PDUS (including tenosynovitis).
The declines in plasma baseline concentration during treatment interruptions clearly showed that the half-lives of the MTX-HSA conjugate were close to 3 weeks. If administered in 2-3-week intervals, steady-state conditions were achieved during poststudy treatment. MTX-HSA injections every 2-4 weeks. No toxicity was observed.
Even individuals without evidence of GERD may experience some mild symptoms that are commonly ascribed to GERD. GERD symptom thresholds derived in this study can be used to define the global symptom relief in patients with GERD. Subjects included 488 consecutive adults (mean age, 56.1 Â± 8.9 years) who underwent transoral EGD for gastric cancer screening between February 2010 and March 2011. All procedures were performed by an endoscopist with 15 years of experience. Based on a questionnaire survey using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG), symptoms (dyspepsia and acid reflux symptoms) and the number of vomiting reflexes during EGD were recorded.
This observation supports the interpretation that the disagreement of FOI with MRI and US in the majority of cases did not result from false-positive findings. ICG-enhanced FOI with the Xiralite system is a new imaging technology. To our knowledge, this is the first study to evaluate the application in patients with arthritis and to compare it with CE, US and MRI.
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.
FOI agreed in a higher range with PDUS, which also displays vascularity. FOI agreed well with MRI synovitis and tenosynovitis. Taking MRI as reference, FOI had a sensitivity of 76% and a specificity of 54%, with a higher specificity (94% and 89%) and a lower sensitivity (27% and 47%) for P1 and P3, respectively.
Analysing a single FOI sequence, we found that, within each image stack, three phases (P1-P3) may be distinguished as defined by the different time points’ increased signal intensities in the fingertips. Figure 2 shows a typical FOI image of highly active RA, displaying focal increased signal intensity in all three phases. Inflammatory activity in a variety of affected structures was also detected in PsA (figure 3). A triangular, slightly arcuate enhancement from nail bed into DIP was observed in 60 out of 64 (94%) subjects with PsA compared with 8 out of 38 (21%) in patients with definite RA (sensitivity 94%, specificity 79%, positive predictive value 0.88, negative predictive value 0.88; subjects with both RA and psoriasis have been excluded from the calculation). test22 to cover correlations of multiple joints within the same patient.