Round one of the Adelaide and Meath Hospital/Trinity College Colorectal Cancer Screening Programme: programme report and analysis based on established international key performance indices

BACKGROUND

In Ireland, colorectal cancer (CRC) is the second most frequently diagnosed cancer in men, after prostate cancer, and the second most frequently diagnosed cancer in women, after breast cancer. By 2020, the number of new cases diagnosed annually in Ireland is projected to have increased by 79% in men and 56% in women. Organised screening for CRC is already underway or is in the process of being rolled out in several European countries, either at a regional or national level. The Adelaide and Meath Hospital/ Trinity College Dublin Colorectal Cancer Screening Programme (TTC-CRC-SP) is Ireland's first pilot population based bowel screening programme.

METHOD

Based on a biennial test model the pilot aimed to assess the accuracy of FIT and to evaluate the whole programme based on established international key performance indices.

RESULTS

To date 9,993 individuals aged 50-74 years have been invited to participate in the TTC-CRC-SP with over 5,000 FIT's analysed. Overall uptake was 51% and FIT positivity was 10%. The programme has undertaken over 400 screening colonoscopies and detected 154 precancerous adenomas and 38 cancerous lesions.

CONCLUSIONS

The first round of The Adelaide and Meath Hospital Tallaght/Trinity College Dublin Colorectal Cancer Screening Programme has been highly successful and confirmed that there is an advantage for FIT based two stage bowel cancer screening programmes.

Alemtuzumab induction prior to cardiac transplantation with lower intensity maintenance immunosuppression: one-year outcomes

Induction therapy with alemtuzumab (C-1H) prior to cardiac transplantation (CTX) may allow for lower intensity maintenance immunosuppression. This is a retrospective study of patients who underwent CTX at a single institution from January 2001 until April 2009 and received no induction versus induction with C-1H on a background of tacrolimus and mycophenolate. Those with C-1H received dose-reduced calcineurin inhibitor and no steroids. A total of 220 patients were included, 110 received C-1H and 110 received no induction. Recipient baseline characteristics, donor age and gender were not different between the two groups. Mean tacrolimus levels (ng/mL) for C-1H versus no induction: months 1-3 (8.5 vs. 12.9), month 4-6 (10.2 vs. 13.0), month 7-9 (10.2 vs. 11.9) and month 10-12 (9.9 vs. 11.3) were all significantly lower for the C-1H group, p < 0.001. There were no differences between the C-1H and no induction groups at 12 months for overall survival 85.1% versus 93.6% p = 0.09, but freedom from significant rejection was significantly higher for the C-1H group, 84.5% versus 51.6%, p < 0.0001. In conclusion, induction therapy after CTX with C-1H results in a similar 12 month survival, but a greater freedom from rejection despite lower calcineurin levels and without the use of steroids.

Neo-adjuvant chemoradiotherapy in advanced rectal carcinoma: a note of caution

Rectal cancer remains a major source of morbidity and mortality with its prognosis relating directly to the initial stage of the disease at presentation. This report highlights the potentially serious morbidity and mortality, which may be associated with neo-adjuvant chemoradiotherapy in advanced rectal cancer, emphasising the need for thorough discussion with patients on the risks and benefits of such treatment.

Helicobacter pylori infection and the pathogenesis of gastric cancer: a paradigm for host-bacterial interactions

Helicobacter pylori infection is the most important acquired risk factor for gastric cancer. The infection initiates a chronic inflammatory process that eventually alters the physiology of the gastric environment and leads to achlorohydria. Gastric atrophy may be part of this process but cancer can arise without this precursor. The net effect of decades of inflammation is the establishment of a milieu awash with pro-inflammatory cytokines and characterized by the activation of signalling pathways that cross-talk between inflammation and carcinogenesis. Many of the factors involved in chronic inflammation play a dual role in the process-promoting neoplastic progression but also facilitating cancer prevention. H. pylori bacterial virulence factors as well as host genetic factors play a major role in orchestrating the increased risk of cancer. The study of such host-bacterial interaction is key to uncovering the molecular and cellular pathways involved and will ultimately lead to developing preventive and therapeutic strategies against this global killer.

A novel VOCODER for cochlear implants

A new VOCODER-based speech processing strategy for cochlear implants is presented. The proposed method improves upon existing VOCODER techniques in time-frequency resolution and can offer higher noise immunity. The presented method is based on the effective tracking of nonstationary sinusoid components using a non-linear sinusoid tracking algorithm (STA). The structure of the proposed technique, as well as the underlying STA are presented. It is expected that the improvement in time-frequency resolution will offer superior performance in cochlear implants, as well as improvements in speech coding applications. An eight-band version of the proposed technique is presented and superior performance to existing techniques is shown.

High-resolution analysis of transient evoked otoacoustic emissions

A new decomposition and time-frequency method applied to the estimation of transient evoked otoacoustic emissions (TEOAEs) is presented. TEOAEs are low-level signals in response to auditory stimuli that are used to monitor the functionality of the cochlea. TEOAE parameter estimation is challenging due to the short duration of the signal (about 20ms) and its highly nonstationary nature. Existing time-frequency methods are incapable of providing accurate estimates of the components within the TEOAE signal. The proposed decomposition and time-frequency method is based on the effective tracking of nonstationary sinusoidal components using a nonlinear iterative sinusoid tracking algorithm. The presented technique improves upon existing techniques by offering a high time-frequency resolution and is capable of providing accurate estimates of components within a TEOAE signal. The structure of the proposed decomposition technique as well as the underlying algorithm are presented. Simulation results are presented to show the performance of the proposed technique. Its performance is also demonstrated on a clinically recorded signal.

A novel approach for Doppler blood flow measurement

A new approach to frequency estimation for the velocity estimation in Doppler ultrasound blood flow analysis is presented. The basis of the approach is an adaptive sinusoid-tracking algorithm which is effective in extracting nonstationary signals from within noise and estimating their time-varying parameters, such as the frequency, over time. The preliminary studies conducted using simulated signals show the potential of this approach in estimating Doppler frequency shifts under noisy conditions. A qualitative comparison with the short-time Fourier transform (STFT) is presented to show the advantages of the proposed technique over the STFT. The proposed approach offers advantages over conventional time-frequency analysis techniques in terms of high time-frequency resolution and high noise immunity.

A labview-based GUI for the measurement of otoacoustic emissions

This paper presents the outcome of a software development project aimed at creating a stand-alone user-friendly signal processing algorithm for the estimation of distortion product otoacoustic emission (OAE) signals. OAE testing is one of the most commonly used methods of first screening of newborns' hearing. Most of the currently available commercial devices rely upon averaging long strings of data and subsequent discrete Fourier analysis to estimate low level OAE signals from within the background noise in the presence of the strong stimuli. The main shortcoming of the presently employed technology is the need for long measurement time and its low noise immunity. The result of the software development project presented here is a graphical user interface (GUI) module that implements a recently introduced adaptive technique of OAE signal estimation. This software module is easy to use and is freely disseminated on the Internet for the use of the hearing research community. This GUI module allows loading of the a priori recorded OAE signals into the workspace, and provides the user with interactive instructions for the OAE signal estimation. Moreover, the user can generate simulated OAE signals to objectively evaluate the performance capability of the implemented signal processing technique.

Polymorphisms in Adenosine Receptor Genes are Associated with Infarct Size in Patients with Ischemic Cardiomyopathy

The goal of this experiment was to identify the presence of genetic variants in the adenosine receptor genes and assess their relationship to infarct size in a population of patients with ischemic cardiomyopathy. Adenosine receptors play an important role in protecting the heart during ischemia and in mediating the effects of ischemic preconditioning. We sequenced DNA samples from 273 individuals with ischemic cardiomyopathy and from 203 normal controls to identify the presence of genetic variants in the adenosine receptor genes. Subsequently, we analyzed the relationship between the identified genetic variants and infarct size, left ventricular size, and left ventricular function. Three variants in the 3'-untranslated region of the A(1)-adenosine gene (nt 1689 C/A, nt 2206 Tdel, nt 2683del36) and an informative polymorphism in the coding region of the A3-adenosine gene (nt 1509 A/C I248L) were associated with changes in infarct size. These results suggest that genetic variants in the adenosine receptor genes may predict the heart's response to ischemia or injury and might also influence an individual's response to adenosine therapy.

A new adaptive technique of estimation of steady state auditory evoked potentials

A novel technique of fast estimation of steady state auditory evoked potentials (SSAEPs) for rapid assessment of the functionality of the human auditory nervous system is presented. The proposed SSAEP signal estimation is based on a new nonlinear adaptive signal processing method that has shown a great promise in the fast extraction of weak signals buried under large amounts of noise. Currently, the main technical impediment in the widespread clinical use of the SSAEP testing for hearing assessment is the excessively long measurement time needed for the estimation process due to the presence of large amounts of background noise. The studies in this paper show significant reduction in the measurement time achieved by the proposed technique.