Inflammatory bowel disease cancer surveillance in a tertiary referral hospital: attitudes and practice

BACKGROUND

Physician adherence to guidelines for colorectal cancer (CRC) surveillance in inflammatory bowel disease (IBD) is often poor. This may lead to adverse patient outcomes and excess endoscopic workload.

AIMS

To assess the attitudes and practice of IBD specialists in a tertiary centre towards colonoscopic surveillance.

METHODS

First, a questionnaire evaluating attitudes and approach to CRC surveillance was issued to 36 clinicians at one tertiary referral hospital. Second, a retrospective audit of IBD surveillance colonoscopy practice over a 2-year period was performed.

RESULTS

Questionnaire response rate was 97%. Sixty-nine per cent of respondents were aware of, and used, Australian guidelines. Surveillance was undertaken by all clinicians in patients with extensive colitis, 83% in patients with left-sided colitis and 51% in patients with proctitis. Seventy-six per cent used chromoendoscopy, and 47% took 10 to 20 random biopsies. Colectomy was considered appropriate in 0% for unifocal low-grade dysplasia, 35% for multifocal low-grade dysplasia and 83% for high-grade dysplasia. Sixty-six per cent would remove elevated dysplastic lesions endoscopically. The audit identified 103 surveillance colonoscopies in 81 patients. Chromoendoscopy was used in 21% of cases, and the median number of random biopsies was 13. Sixty-two per cent of colonoscopies were performed outside the guidelines in relation to colonoscopic frequency. Following colonoscopy, an appropriate recommendation for subsequent surveillance was documented in 40% of cases.

CONCLUSIONS

Knowledge and practice of CRC surveillance in IBD vary among specialist clinicians and often deviate from guidelines. Many clinicians perform surveillance earlier and more frequently than recommended. These findings have implications for patient outcomes and workload.

Determination of dose rate from Chernobyl-derived radiocaesium in Estonian soil

The deposition and vertical depth distribution of 134Cs and 137Cs in the natural undisturbed soil profiles down to 20-25 cm were studied at locations in the North Eastern Estonia, which were most strongly affected by the Chernobyl fallout in 1986. The total depositions were estimated based on summing the sampled and measured activities of 134Cs and 137Cs in all sections of soil profiles. The Chernobyl 137Cs deposition values varied considerably from site to site and the range was from 3.9 kBq m(-2) to 50.2 kBq m(-2), with the average of 22.8 kBq m(-2) for the region (reference data May 1, 1986). The ratio of total activities, A(134Cs)/A(137Cs), varied in the range from 0.47 to 0.55. Using a compartment model and the observed data on the 134Cs and 137Cs activity concentrations (Bq m(-2)) in four compartments, 0-1 cm, 1-5 cm, 5-15 cm and 15-30 cm, of soil collected in 1991-2003, the approximate residence half-times of radiocaesium in soil were determined. The latter increased from 3.7 y in the top-most compartment to 8.6 y and 36.4 y in the deeper compartments, respectively. The time dependence of the external gamma-dose rate at the height of 1 m above a flat ground area arising from the deposited and migrating radiocaesium was calculated using the modeled data on the 134Cs and 137Cs activity in soil compartments. Considering the total depositions of radiocaesium in soil from the Chernobyl 1986 accident, the 50 year effective doses caused by external gamma exposure varied in the range from 0.13 mSv to 1.74 mSv, with the mean of 0.79 mSv in the region.

A unique clinical phenotype of primary sclerosing cholangitis associated with Crohn's disease

BACKGROUND AND AIMS

A distinct clinical phenotype has been demonstrated for ulcerative colitis with concomitant primary sclerosing cholangitis (PSC). The course and behaviour of Crohn's disease (CD) with PSC has, in contrast, never been defined. We aimed to define the characteristics of patients with concomitant PSC and CD.

METHODS

The Oxford PSC and IBD databases were abstracted for: PSC subtype, date of diagnosis, symptom onset, smoking history, Mayo Clinic PSC score and outcomes (hepatic failure, liver transplantation, Montréal CD classification, treatment, cancer and death). Patients with PSC/CD were matched 1:2 to two control groups: one with PSC/UC and one with isolated CD.

RESULTS

240 patients with PSC were identified; 32 (13%) with CD, 129 (54%) with co-existing UC, and 79 had PSC without IBD. For PSC/CD vs. CD controls, isolated ileal CD was less common (6% vs. 31%, p=0.03). Smoking was less common in PSC/CD (13% vs. 34%, p=0.045). No difference in the distribution of CD, or treatment required was observed. For PSC/CD vs. PSC/UC controls, more patients with PSC/CD were female (50% vs. 28%, p=0.021). 22% of PSC/CD patients had small duct PSC compared with 6% with PSC/UC, (p=0.038). Major event-free survival was prolonged in the PSC/CD group compared with PSC/UC, (Cox regression p=0.04).

CONCLUSION

Unlike PSC/UC, patients with PSC/CD were as likely to be female as male, more commonly had small duct PSC and less commonly progressed to cancer, liver transplantation, or death. Compared to patients with isolated CD, patients with PSC/CD were less likely to smoke or have ileal disease.

A mechanistic model for fate and removal of estrogens in biological nutrient removal activated sludge systems

Two estrogen fate and transformation models were integrated with a comprehensive activated sludge model (ASM) to predict estrogen removal based on biomass and solids production. Model predictions were evaluated against published full-scale plant data as well as results from a laboratory-scale sequencing batch reactor (SBR) fed synthetic wastewater. The estrogen fate model relating the rate of total estrogen degradation to soluble estrogen concentrations successfully predicted estrogen removals when compared with measured concentrations. Model fit 17α-ethinylestradiol (EE2) biodegradation rate constant was 19 to 43% of the estrone (E1) value and 31 to 72% of the 17β-estradiol (E2) value.

Adenosine analogue-oligo-arginine conjugates (ARCs) serve as high-affinity inhibitors and fluorescence probes of type I cGMP-dependent protein kinase (PKGIalpha)

INTRODUCTION

Type I cGMP-dependent protein kinase (PKGIalpha) belongs to the family of cyclic nucleotide-dependent protein kinases and is one of the main effectors of cGMP. PKGIalpha is involved in regulation of cardiac contractility, vasorelaxation, and blood pressure; hence, the development of potent modulators of PKGIalpha would lead to advances in the treatment of a variety of cardiovascular diseases.

AIM

Representatives of ARC-type compounds previously characterized as potent inhibitors and high-affinity fluorescent probes of PKA catalytic subunit (PKAc) were tested towards PKGIalpha to determine that ARCs could serve as activity regulators and sensors for the latter protein kinase both in vitro and in complex biological systems.

RESULTS

Structure-activity profiling of ARCs with PKGIalpha in vitro demonstrated both similarities as well as differences to corresponding profiling with PKAc, whereas ARC-903 and ARC-668 revealed low nanomolar displacement constants and inhibition IC(50) values with both cyclic nucleotide-dependent kinases. The ability of ARC-based fluorescent probes to penetrate cell plasma membrane was demonstrated in the smooth muscle tissue of rat cerebellum isolated arteries, and the compound with the highest affinity in vitro (ARC-903) showed also potential for in vivo applications, fully abolishing the PKG1alpha-induced vasodilation.

Small-molecule FRET probes for protein kinase activity monitoring in living cells

In this study, the applicability of fluorescently labeled adenosine analogue-oligoarginine conjugates (ARC-Photo probes) for monitoring of protein kinase A (PKA) activity in living cells was demonstrated. ARC-Photo probes possessing subnanomolar affinity towards the catalytic subunit of PKA (PKAc) and competitive with the regulatory subunit (PKAr), penetrate cell plasma membrane and associate with PKAc fused with yellow fluorescent protein (PKAc-YFP). Detection of inter-molecular Förster resonance energy transfer (FRET) efficiency between the fluorophores of the fusion protein and ARC-Photo probe can be used for both the evaluation of non-labeled inhibitors of PKAc and for monitoring of cAMP signaling via detection of changes in the activity of PKA as a cAMP downstream effector.

Conjugation of adenosine and hexa-(D-arginine) leads to a nanomolar bisubstrate-analog inhibitor of basophilic protein kinases

Conjugates of oligoarginine peptides with adenine, adenosine, adenosine-5'-carboxylic acid, and 5-isoquinolinesulfonic acid were synthesized and characterized as bisubstrate-analog inhibitors of cAMP-dependent protein kinase. Adenosine and adenine derivatives were connected to the N- or C-terminus of peptides containing four to six L- or D-arginine residues via a linker with a length that had been optimized in structure-activity studies. The orientation of the peptide chain strongly affected the activity of compounds incorporating D-arginines. The biligand inhibitor containing Hidaka's H9 isoquinolinesulfonamide connected to the L-peptide had 65 times higher potency than the corresponding adenosine-containing conjugate, while both types of the conjugate comprising D-peptides had similar low nanomolar activity. Two of the most active adenosine- and H9-peptide conjugates were tested in the panel of 52 different kinases. At 1 microM concentration, both compounds showed strong (more than 95%) inhibition of several basophilic AGC kinases, including pharmaceutically important kinases ROCK II and PKB/Akt.

Surface-plasmon-resonance-based biosensor with immobilized bisubstrate analog inhibitor for the determination of affinities of ATP- and protein-competitive ligands of cAMP-dependent protein kinase

Interactions between adenosine-oligoarginine conjugates (ARC), bisubstrate analog inhibitors of protein kinases, and catalytic subunits of cAMP-dependent protein kinase (cAPK Calpha) were characterized with surface-plasmon-resonance-based biosensors. ARC-704 bound to the immobilized kinase with subnanomolar affinity. The immobilization of ARC-704 to the chip surface via streptavidin-biotin complex yielded a high-affinity surface (K(D)=16nM). The bisubstrate character of ARC-704 was demonstrated with various ligands targeted to ATP-binding pocket (ATP and inhibitors H89 and H1152P) and protein-substrate-binding domain of Calpha (RIIalpha and GST-PKIalpha) in competition assays. The experiments performed on surfaces with different immobilization levels of ARC-704 produced similar results. The closeness of the obtained affinities of the tested compounds to the inhibitory potencies and affinities of the compounds measured with other methods demonstrates the applicability of the chip with the immobilized biligand inhibitor for the characterization of both ATP- and substrate protein-competitive ligands of basophilic protein kinases.

Measurement of faecal fat excretion: an evaluation of attitudes and practices of Australian gastroenterologists

BACKGROUND

Although faecal fat excretion over 72 h is the gold standard for quantifying fat malabsorption, there has been a push from chemical pathology laboratories to discontinue this test, arguing that it is unreliable and of limited clinical value.

AIMS

To assess attitudes, knowledge and practices of Australian gastroenterologists in relation to the test and to gauge opinion as to whether it should remain available.

METHODS

A self-administered questionnaire was developed to assess attitudes towards, patterns of use and understanding of 72-h faecal fat collections. This was posted to all members of the Gastroenterological Society of Australia.

RESULTS

Of 429 eligible gastroenterologists, 124 (29%) responded. Eighty-two per cent utilized the test; 62% at least once per year. Main indications were suspected steatorrhoea (55%), unexplained chronic diarrhoea (39%) or weight loss (29%). Thirty-eight per cent ordered the test to determine stool volume. Only 26% attempted to appropriately fat load patients and approximately half did not recognize the potential influence of medications and stool volume. This was also reflected in poor interpretation of results in specific clinical scenarios. Of those who use the test at least once per year, 97% wanted its continued availability and 51% felt their practice would be significantly affected if the test was discontinued.

CONCLUSIONS

Although continued availability of 72-h faecal fat estimation is supported by many Australian gastroenterologists, the test appears to be often performed and interpreted suboptimally. Rather than discard the test, efforts should more appropriately be directed to improving baseline knowledge to ensure its optimal performance and interpretation.

Effect of light and humus on survival and height growth of ash (Fraxinus excelsior L.) seedlings

In  1997, 300 3-month-old ash (Fraxinus excelsior L.) seedlings were removed out of the three    different humus types (100 seedlings from each humus type) in the  experimental forest of    Aelmoeseneie (University of Ghent) with a closed canopy, in north of  Belgium. Humus types were    described as active mull with pH of 5.3-6.5, acid mull with pH of 4.4-5.2  and moder mull with pH of    3.8-4.3. Seedlings were transplanted in plastic pots, filled by the  original soil, and placed under five    levels of light intensity (2.5, 10, 18,28 and 92%), inside and outside the  forest. Only with 92% light    intensity seedlings were watered as necessary to avoid any appreciable  water deficit.    The results after 1 growing season revealed that seedlings attained a very  high survival rate    (95.3%). Survival was the highest when seedlings grew under semi-closed  canopy (10, 18, and    28%) and also outside the forest at the 92% light intensity, compared with  those under closed    canopy (2.5%). It also confirmed that ash seedlings are shade tolerant, but  with little growth.    Height growth indicated an increasing growth response to nutrient  availability with increasing light    intensity. In fact, minimum height growth was observed in lower light  intensities (2.5 and 10%) and    the maximum value in higher light intensities (28 and 92%). Height growth  of ash seedlings    increased at humus types of active and acid mull, compared with moder  mull.    At the end of the first growing season, lack of differences in survival  rate and height growth,    produced under 18, 28 and 92% light intensity, revealed that training the  seedlings under semiclosed    canopy (18 and 26%) has a preference to those under relatively full  daylight (92%)    associated with watering. Therefore, the first year observations showed  that ash seedlings, either in    view of stem quality and growth or with regard to the facilities of  maintenance, are preferable to be    trained under intermediate light intensities (preferably 28%), at the high  nutritional humus (active    and acid mull).