Background: Endoscopic optical coherence tomography (EOCT) is a high-resolution, cross-sectional tissue-imag- ing technique that provides microscopic morphologic information. EOCT should detect dysplasia in Barrett‘s...Background: Endoscopic optical coherence tomography (EOCT) is a high-resolution, cross-sectional tissue-imag- ing technique that provides microscopic morphologic information. EOCT should detect dysplasia in Barrett‘s epithelium, but this has not been established in a prospective blinded study. This study evaluated the accuracy of EOCT for the diagnosis and the exclusion of dysplasia in patients with Barrett‘s esophagus. Methods: A 2.4 mm diameter EOCT probe was modified for use with a cap-fitted, two -channel endoscope. Pairs of EOCT image streams and jumbo biopsy specimens were obtained. Endoscopy/EOCT procedures were performed by 4 endoscopists who separa tely reviewed the EOCT digital images for the absence or the presence of dysplas ia (low grade, high grade, or cancer) for each biopsy specimen obtained. The end oscopists were blinded to the interpretation of the pathology. An experienced pa thologist blinded to the endoscopic/EOCT findings evaluated each biopsy for the absence or the presence of dysplasia. The setting of the study was a major acade mic medical center. Adult patients with documented Barrett‘s esophagus greater than 2 cm were included in the study. The main outcome measurement was the accur acy of EOCT in the detection of dysplasia in patients with Barrett‘s esophagus. Results: A total of 314 usable EOCT image stream/biopsy pairs were obtained in 33 patients. By using histology as the standard, the performance of EOCT was sensitivity, 68%; specificity, 82%; positive predictive value, 53%; negative predictive value, 89%; and diagnostic accuracy, 78%. Diagnostic accuracy for the 4 endoscopists ranged from 56%to 98%. Limitations of the study were the variability in endoscopists‘accuracy rates, difficulty in real-time interpretation, and the need for refined criteria of dysplasia by EOCT imaging. Conclusions: The current EOCT system has an accuracy of 78%for the detection of dysplasia in patients with Barrett‘s esophagus. EOCT could be used to target biopsies to areas of Barrett‘s epithelium with a higher probability for the presence of dysplasia. However, further modifications, including increased resolution and identification of further pot ential OCT characteristics of dysplasia, are needed before EOCT can be used clin ically.展开更多
Background: The catechol O methyltransferase inhibitor entacaponeacts by exte nding the elimination half life of levodopaand is currently approved as an adju nct to levodopa for thetreatment of patients with Parkinson...Background: The catechol O methyltransferase inhibitor entacaponeacts by exte nding the elimination half life of levodopaand is currently approved as an adju nct to levodopa for thetreatment of patients with Parkinson disease (PD) with mo torfluctuations. Objective: To determine if the addition of entacapone administr ation provides benefit to levodopa treated PD patients who have a stable respon se to levodopa and do notexperience motor complications. Design: Prospective, do ubleblind,placebo controlled trial. Setting: Outpatient multicenter study. Pati ents: Female and male patients 30 years or older with idiopathic PD receiving st able doses of levodopa or carbidopa with or without other dopaminergic therapies and who did not experience motor fluctuations were eligible for the study. Main Outcome Measures: Parkinsonian function and quality of life. Results: The addit ion of entacapone did not improve motor scores on the Unified Parkinsons Disea se Rating Scale in levodopa treated PD patients who did not experience motor fl uctuations. The mean ±SE adjusted change between baseline and final treatment v isitwas -0.9±0.35 in the entacapone group and -0.8 ±0.35 in the placebo grou p (P = .83). Significant improvement with entacapone treatment was detected in s everal quality of life measures, including the Parkinson Disease Questionnaire 39, the 36 item Short Form Health Survey, the Parkinsons Symptom Inventory, and investigator and subject Clinical Global Assessments. The drug was well tolerated by patients in this population . Conclusions: The catechol Omethyltransferase inhibitor entacapone, used as an adjunct to levodopa in PD patients who do not experience motor fluctuations, doe s not improve Unified Parkinsons Disease Rating Scale motor scores but does im prove a variety of quality of life measures.展开更多
文摘Background: Endoscopic optical coherence tomography (EOCT) is a high-resolution, cross-sectional tissue-imag- ing technique that provides microscopic morphologic information. EOCT should detect dysplasia in Barrett‘s epithelium, but this has not been established in a prospective blinded study. This study evaluated the accuracy of EOCT for the diagnosis and the exclusion of dysplasia in patients with Barrett‘s esophagus. Methods: A 2.4 mm diameter EOCT probe was modified for use with a cap-fitted, two -channel endoscope. Pairs of EOCT image streams and jumbo biopsy specimens were obtained. Endoscopy/EOCT procedures were performed by 4 endoscopists who separa tely reviewed the EOCT digital images for the absence or the presence of dysplas ia (low grade, high grade, or cancer) for each biopsy specimen obtained. The end oscopists were blinded to the interpretation of the pathology. An experienced pa thologist blinded to the endoscopic/EOCT findings evaluated each biopsy for the absence or the presence of dysplasia. The setting of the study was a major acade mic medical center. Adult patients with documented Barrett‘s esophagus greater than 2 cm were included in the study. The main outcome measurement was the accur acy of EOCT in the detection of dysplasia in patients with Barrett‘s esophagus. Results: A total of 314 usable EOCT image stream/biopsy pairs were obtained in 33 patients. By using histology as the standard, the performance of EOCT was sensitivity, 68%; specificity, 82%; positive predictive value, 53%; negative predictive value, 89%; and diagnostic accuracy, 78%. Diagnostic accuracy for the 4 endoscopists ranged from 56%to 98%. Limitations of the study were the variability in endoscopists‘accuracy rates, difficulty in real-time interpretation, and the need for refined criteria of dysplasia by EOCT imaging. Conclusions: The current EOCT system has an accuracy of 78%for the detection of dysplasia in patients with Barrett‘s esophagus. EOCT could be used to target biopsies to areas of Barrett‘s epithelium with a higher probability for the presence of dysplasia. However, further modifications, including increased resolution and identification of further pot ential OCT characteristics of dysplasia, are needed before EOCT can be used clin ically.
文摘Background: The catechol O methyltransferase inhibitor entacaponeacts by exte nding the elimination half life of levodopaand is currently approved as an adju nct to levodopa for thetreatment of patients with Parkinson disease (PD) with mo torfluctuations. Objective: To determine if the addition of entacapone administr ation provides benefit to levodopa treated PD patients who have a stable respon se to levodopa and do notexperience motor complications. Design: Prospective, do ubleblind,placebo controlled trial. Setting: Outpatient multicenter study. Pati ents: Female and male patients 30 years or older with idiopathic PD receiving st able doses of levodopa or carbidopa with or without other dopaminergic therapies and who did not experience motor fluctuations were eligible for the study. Main Outcome Measures: Parkinsonian function and quality of life. Results: The addit ion of entacapone did not improve motor scores on the Unified Parkinsons Disea se Rating Scale in levodopa treated PD patients who did not experience motor fl uctuations. The mean ±SE adjusted change between baseline and final treatment v isitwas -0.9±0.35 in the entacapone group and -0.8 ±0.35 in the placebo grou p (P = .83). Significant improvement with entacapone treatment was detected in s everal quality of life measures, including the Parkinson Disease Questionnaire 39, the 36 item Short Form Health Survey, the Parkinsons Symptom Inventory, and investigator and subject Clinical Global Assessments. The drug was well tolerated by patients in this population . Conclusions: The catechol Omethyltransferase inhibitor entacapone, used as an adjunct to levodopa in PD patients who do not experience motor fluctuations, doe s not improve Unified Parkinsons Disease Rating Scale motor scores but does im prove a variety of quality of life measures.
