Inflammatory bowel disease(IBD)is entering a potentially new era of combined therapeutics.Triantafillidis et al provide an insightful review of the current state of combination therapy,with a focus on the use of a com...Inflammatory bowel disease(IBD)is entering a potentially new era of combined therapeutics.Triantafillidis et al provide an insightful review of the current state of combination therapy,with a focus on the use of a combined biologic and immunomodulator,as well as emerging data on the future potential of dual-biologic therapy(DBT).While current evidence for DBT is limited,encouraging safety profiles and ongoing trials suggest a brighter future for this approach.The importance of controlled trials should be stressed in establishing new treatment paradigms.Ongoing prospective randomized trials of DBT and perhaps future combinations of biologics and small molecule therapies will hopefully guide the next generation of IBD care.展开更多
Sleep plays a vital role in restoring the physical and mental health of people with cardiovascular disease.However,the hospital setting is not a conducive environment for sleep.Sleep interruptions by members of the ca...Sleep plays a vital role in restoring the physical and mental health of people with cardiovascular disease.However,the hospital setting is not a conducive environment for sleep.Sleep interruptions by members of the care team,including vital sign checks,medication delivery,and blood draws for laboratory investigations,are routinely done in many hospitals.Frequent interruptions by staff and noise by other patients have been cited as barriers to restorative sleep in the hospital.展开更多
Applied ethics finds application in all spheres of social life,one of which is the field of library and information science.Ethics is an important pillar contributing to the systematic order of the library and its col...Applied ethics finds application in all spheres of social life,one of which is the field of library and information science.Ethics is an important pillar contributing to the systematic order of the library and its collection.Ethical principles are contained in key documents such as the Librarian’s Code of Ethics,partly in the Library(Lending)Regulations,and should therefore be adopted by every member of staff.The library profession consists not only of working with information,namely making it available,but also of setting up effective communication towards users(readers)in the form of defining optimal solutions eliminating the problems that arise.The aim of our efforts is to capture the most common problems that arise from misunderstandings between librarian and user(reader)and to make clear what specific role ethical values play in library and information practice.展开更多
BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),formally known as nonalcoholic fatty liver disease,is the most common chronic liver disease in the United States.Patients with MASLD have been...BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),formally known as nonalcoholic fatty liver disease,is the most common chronic liver disease in the United States.Patients with MASLD have been reported to be at a higher risk of developing severe coronavirus disease 2019(COVID-19)and death.However,most studies are single-center studies,and nationwide data in the AIM To study the influence of MASLD on COVID-19 hospitalizations during the initial phase of the pandemic.METHODS We retrospectively analyzed the 2020 National Inpatient Sample(NIS)database to identify primary COVID-19 hospitalizations based on an underlying diagnosis of MASLD.A matched comparison cohort of COVID-19 hospit-alizations without MASLD was identified from NIS after 1:N propensity score matching based on gender,race,and comorbidities,including hypertension,heart failure,diabetes,and cirrhosis.The primary outcomes included inpatient mortality,length of stay,and hospitalization costs.Secondary outcomes included the prevalence of systemic complications.RESULTS A total of 2210 hospitalizations with MASLD were matched to 2210 hospitalizations without MASLD,with a good comorbidity balance.Overall,there was a higher prevalence of severe disease with more intensive care unit admissions(9.5%vs 7.2%,P=0.007),mechanical ventilation(7.2%vs 5.7%,P=0.03),and septic shock(5.2%vs 2.7%,P<0.001)in the MASLD cohort than in the non-MASLD cohort.However,there was no difference in mortality(8.6%vs 10%,P=0.49),length of stay(5 d vs 5 d,P=0.25),and hospitalization costs(42081.5$vs 38614$,P=0.15)between the MASLD and non-MASLD cohorts.CONCLUSION The presence of MAFLD with or without liver cirrhosis was not associated with increased mortality in COVID-19 hospitalizations;however,there was an increased incidence of severe COVID-19 infection.This data(2020)predates the availability of COVID-19 vaccines,and many MASLD patients have since been vaccinated.It will be interesting to see if these trends are present in the subsequent years of the pandemic.展开更多
INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]T...INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]The evaluation of patients with chest pain in the ED is a time-consuming and challenging process because the physician must identify those with life-threatening cardiac chest pain, while avoiding unnecessary and costly evaluations of those with non-cardiac chest pain.展开更多
BACKGROUND Laparoscopic Heller myotomy(LHM)has been the traditional surgical treatment for achalasia.Recently,peroral endoscopic myotomy(POEM)has demonstrated similar clinical outcomes with shorter procedure times.Stu...BACKGROUND Laparoscopic Heller myotomy(LHM)has been the traditional surgical treatment for achalasia.Recently,peroral endoscopic myotomy(POEM)has demonstrated similar clinical outcomes with shorter procedure times.Studies comparing the direct cost-effectiveness of POEM vs LHM are limited.AIM To compare costs of POEM vs LHM.METHODS Haider SA et al.Comparing costs:POEM vs Heller myotomy WJGE https://www.wjgnet.com 594 October 16,2023 Volume 15 Issue 10 This retrospective chart review aimed to compare the outcomes and cost of clinical care between patients who underwent POEM and LHM procedures for achalasia.The study was conducted at a tertiary academic center from January 2019 to December 2020.Clinical outcomes,including post-operative Eckardt scores and adverse events,were assessed and compared between the two groups.Direct cost variance analysis was utilized to evaluate the cost of clinical care incurred by patients undergoing POEM in the year preceding the procedure,during the index admission,and one year post-procedure,in comparison to patients undergoing LHM.RESULTS Of 30 patients were included(15 POEM and 15 LHM)in the study.Patients in the POEM group had a mean Eckardt score of 0.5±0.5 post-procedure,which was no different from patients in the LHM group(0.7±0.6,P=0.17)indicating comparative efficacy.However,the total costs of the admission for the procedure in the LHM group were on average$1827 more expensive than in the POEM group(P<0.01).Total healthcare costs one year prior to index procedure were$7777 higher in the LHM group,but not statistically different(P=0.34).The patients in the LHM group one year after the index procedure had accrued$19730.24 larger total cost,although this was not statistically different from POEM group(P=0.68).CONCLUSION Despite similar clinical outcomes,the cost of the index procedure admission for POEM was significantly lower than for LHM.The difference was primarily related to shorter time increments utilized in the operating room during the index procedure,and shorter length of hospital stay following POEM.展开更多
To address the management of Clostridium difficile (C. difficile) infection (CDI) in the setting of suspected inflammatory bowel disease (IBD)-flare. METHODSA systematic search of the Ovid MEDLINE and EMBASE databases...To address the management of Clostridium difficile (C. difficile) infection (CDI) in the setting of suspected inflammatory bowel disease (IBD)-flare. METHODSA systematic search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 70 articles including a total of 932141 IBD patients or IBD-related hospitalizations. RESULTSIn those with IBD, CDI is associated with increased morbidity, including subsequent escalation in IBD medical therapy, urgent colectomy and increased hospitalization, as well as excess mortality. Vancomycin-containing regimens are effective first-line therapies for CDI in IBD inpatients. No prospective data exists with regards to the safety or efficacy of initiating or maintaining corticosteroid, immunomodulator, or biologic therapy to treat IBD in the setting of CDI. Corticosteroid use is a risk factor for the development of CDI, while immunomodulators and biologics are not. CONCLUSIONStrong recommendations regarding when to initiate IBD specific therapy in those with CDI are precluded by a lack of evidence. However, based on expert opinion and observational data, initiation or resumption of immunosuppressive therapy after 48-72 h of targeted antibiotic treatment for CDI may be considered.展开更多
AIM: To evaluate the completion rate and diagnostic yield of the Pill Cam SB2-ex in comparison to the Pill Cam SB2.METHODS:Two hundred cases using the 8-h Pill Cam SB2 were retrospectively compared to 200 cases using ...AIM: To evaluate the completion rate and diagnostic yield of the Pill Cam SB2-ex in comparison to the Pill Cam SB2.METHODS:Two hundred cases using the 8-h Pill Cam SB2 were retrospectively compared to 200 cases using the 12 h Pill Cam SB2-ex at a tertiary academic center.Endoscopically placed capsules were excluded from the study.Demographic information,indications for capsule endoscopy,capsule type,study length,completion of exam,clinically significant findings,timestamp of most distant finding,and significant findings beyond 8 h were recorded.RESULTS:The 8 and 12 h capsule groups were well matched respectively for both age(70.90±14.19vs 71.93±13.80,P=0.46)and gender(45.5%vs48%male,P=0.69).The most common indications for the procedure in both groups were anemia and obscure gastrointestinal bleeding.Pill Cam SB2-ex had a significantly higher completion rate than Pill Cam SB2(88%vs 79.5%,P=0.03).Overall,the diagnostic yield was greater for the 8 h capsule(48.5%for SB2vs 35%for SB2-ex,P=0.01).In 4/70(5.7%)of abnormal SB2-ex exams the clinically significant findingwas noted in the small bowel beyond the 8 h mark.CONCLUSION:In our study,we found the Pill Cam SB2-ex to have a significantly increased completion rate,though without any improvement in diagnostic yield compared to the Pill Cam SB2.展开更多
AIM To determine levels of cytokines incolonic mucosa of asymptomatic first degreerelatives of Crohn’s disease patients.METHODS Cytokines(Interleukin(IL)1-Beta,IL-2,IL-5 and IL-8)were measured using ELISAin biopsy sa...AIM To determine levels of cytokines incolonic mucosa of asymptomatic first degreerelatives of Crohn’s disease patients.METHODS Cytokines(Interleukin(IL)1-Beta,IL-2,IL-5 and IL-8)were measured using ELISAin biopsy samples of normal looking colonicmucosa of first degree relatives of Crohn’sdisease patients(n = 9)and from normalcontrols(n = 10)with no family history ofCrohn’s disease.RESULTS Asymptomatic first degree relativesof patients with Crohn’s disease had significantlyhigher levels of basal intestinal mucosalcytokines(IL-2,IL-5 and IL-8)than normalcontrols.Whether these increased cytokinelevels serve as phenotypic markers for a geneticpredisposition to developing Crohns diseaselater on,or whether they indicate early(pre-clinical)damage has yet to be further defined.CONCLUSION Asymptomatic first degreerelatives of Crohn’s disease patients have higherlevels of cytokines in their normal-lookingintestinal mucosa compared to normal controls,This supports the hypothesis that increasedcytokines may be a cause or an early event inthe inflammatory cascade of Crohns disease andare not merely a result of the inflammatoryprocess.展开更多
Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prostheti...Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET suggests that the diagnostic paradigm may be shifting again.By providing the anatomic information lacking in conventional radionuclide studies,there is renewed interest in bone scintigraphy,performed as a SPECT/CT procedure,for detecting joint instability,mechanical loosening and component malpositioning.Fluoride-PET may provide new insights into periprosthetic bone metabolism.The objective of this manuscript is to provide a comprehensive review of the evolution of nuclear medicine imaging of joint replacements.展开更多
AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's d...AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's disease. A group of 206 patients without inflammatory bowel disease served as controls. Primary outcome was thyroid disorder. Secondary outcomes included use of steroids, immunosuppressive medications, surgery and incidence of fracture.RESULTS: The prevalence of hyperthyroidism was similar in both groups. However, the prevalence of hypothyroidism was lower in Crohn's patients (3.8 % vs 8.2 %, P=0.05).Within the Crohn's group, the use of immunosuppressive agents (0 % vs11 %), steroid usage (12.5 % vs37 %), small bowel surgery (12.5 % vs 28 %) and large bowel surgery (12.5 % vs27 %) were lower in the hypothyroid subset as compared to the euthyroid subset. Seven (3.4 %) Crohn'spatients suffered fracture, all of whom were euthyroid.CONCLUSION: Thyroid disorder was not found to be associated with Crohn's disease and was not found to increase the risk for fractures. Therefore, screening for thyroid disease is not a necessary component in the management of Crohn's disease.展开更多
文摘Inflammatory bowel disease(IBD)is entering a potentially new era of combined therapeutics.Triantafillidis et al provide an insightful review of the current state of combination therapy,with a focus on the use of a combined biologic and immunomodulator,as well as emerging data on the future potential of dual-biologic therapy(DBT).While current evidence for DBT is limited,encouraging safety profiles and ongoing trials suggest a brighter future for this approach.The importance of controlled trials should be stressed in establishing new treatment paradigms.Ongoing prospective randomized trials of DBT and perhaps future combinations of biologics and small molecule therapies will hopefully guide the next generation of IBD care.
基金supported by a Clinical Research Award from the Fonds de recherche du Québec.
文摘Sleep plays a vital role in restoring the physical and mental health of people with cardiovascular disease.However,the hospital setting is not a conducive environment for sleep.Sleep interruptions by members of the care team,including vital sign checks,medication delivery,and blood draws for laboratory investigations,are routinely done in many hospitals.Frequent interruptions by staff and noise by other patients have been cited as barriers to restorative sleep in the hospital.
文摘Applied ethics finds application in all spheres of social life,one of which is the field of library and information science.Ethics is an important pillar contributing to the systematic order of the library and its collection.Ethical principles are contained in key documents such as the Librarian’s Code of Ethics,partly in the Library(Lending)Regulations,and should therefore be adopted by every member of staff.The library profession consists not only of working with information,namely making it available,but also of setting up effective communication towards users(readers)in the form of defining optimal solutions eliminating the problems that arise.The aim of our efforts is to capture the most common problems that arise from misunderstandings between librarian and user(reader)and to make clear what specific role ethical values play in library and information practice.
文摘BACKGROUND Metabolic dysfunction-associated steatotic liver disease(MASLD),formally known as nonalcoholic fatty liver disease,is the most common chronic liver disease in the United States.Patients with MASLD have been reported to be at a higher risk of developing severe coronavirus disease 2019(COVID-19)and death.However,most studies are single-center studies,and nationwide data in the AIM To study the influence of MASLD on COVID-19 hospitalizations during the initial phase of the pandemic.METHODS We retrospectively analyzed the 2020 National Inpatient Sample(NIS)database to identify primary COVID-19 hospitalizations based on an underlying diagnosis of MASLD.A matched comparison cohort of COVID-19 hospit-alizations without MASLD was identified from NIS after 1:N propensity score matching based on gender,race,and comorbidities,including hypertension,heart failure,diabetes,and cirrhosis.The primary outcomes included inpatient mortality,length of stay,and hospitalization costs.Secondary outcomes included the prevalence of systemic complications.RESULTS A total of 2210 hospitalizations with MASLD were matched to 2210 hospitalizations without MASLD,with a good comorbidity balance.Overall,there was a higher prevalence of severe disease with more intensive care unit admissions(9.5%vs 7.2%,P=0.007),mechanical ventilation(7.2%vs 5.7%,P=0.03),and septic shock(5.2%vs 2.7%,P<0.001)in the MASLD cohort than in the non-MASLD cohort.However,there was no difference in mortality(8.6%vs 10%,P=0.49),length of stay(5 d vs 5 d,P=0.25),and hospitalization costs(42081.5$vs 38614$,P=0.15)between the MASLD and non-MASLD cohorts.CONCLUSION The presence of MAFLD with or without liver cirrhosis was not associated with increased mortality in COVID-19 hospitalizations;however,there was an increased incidence of severe COVID-19 infection.This data(2020)predates the availability of COVID-19 vaccines,and many MASLD patients have since been vaccinated.It will be interesting to see if these trends are present in the subsequent years of the pandemic.
文摘INTRODUCTION Chest pain is a common chief complaint and encompasses nearly 5.2% of all patients seen in emergency departments(ED). In the United States, this accounts for approximately six million annual visits.[1-4]The evaluation of patients with chest pain in the ED is a time-consuming and challenging process because the physician must identify those with life-threatening cardiac chest pain, while avoiding unnecessary and costly evaluations of those with non-cardiac chest pain.
文摘BACKGROUND Laparoscopic Heller myotomy(LHM)has been the traditional surgical treatment for achalasia.Recently,peroral endoscopic myotomy(POEM)has demonstrated similar clinical outcomes with shorter procedure times.Studies comparing the direct cost-effectiveness of POEM vs LHM are limited.AIM To compare costs of POEM vs LHM.METHODS Haider SA et al.Comparing costs:POEM vs Heller myotomy WJGE https://www.wjgnet.com 594 October 16,2023 Volume 15 Issue 10 This retrospective chart review aimed to compare the outcomes and cost of clinical care between patients who underwent POEM and LHM procedures for achalasia.The study was conducted at a tertiary academic center from January 2019 to December 2020.Clinical outcomes,including post-operative Eckardt scores and adverse events,were assessed and compared between the two groups.Direct cost variance analysis was utilized to evaluate the cost of clinical care incurred by patients undergoing POEM in the year preceding the procedure,during the index admission,and one year post-procedure,in comparison to patients undergoing LHM.RESULTS Of 30 patients were included(15 POEM and 15 LHM)in the study.Patients in the POEM group had a mean Eckardt score of 0.5±0.5 post-procedure,which was no different from patients in the LHM group(0.7±0.6,P=0.17)indicating comparative efficacy.However,the total costs of the admission for the procedure in the LHM group were on average$1827 more expensive than in the POEM group(P<0.01).Total healthcare costs one year prior to index procedure were$7777 higher in the LHM group,but not statistically different(P=0.34).The patients in the LHM group one year after the index procedure had accrued$19730.24 larger total cost,although this was not statistically different from POEM group(P=0.68).CONCLUSION Despite similar clinical outcomes,the cost of the index procedure admission for POEM was significantly lower than for LHM.The difference was primarily related to shorter time increments utilized in the operating room during the index procedure,and shorter length of hospital stay following POEM.
文摘To address the management of Clostridium difficile (C. difficile) infection (CDI) in the setting of suspected inflammatory bowel disease (IBD)-flare. METHODSA systematic search of the Ovid MEDLINE and EMBASE databases by independent reviewers identified 70 articles including a total of 932141 IBD patients or IBD-related hospitalizations. RESULTSIn those with IBD, CDI is associated with increased morbidity, including subsequent escalation in IBD medical therapy, urgent colectomy and increased hospitalization, as well as excess mortality. Vancomycin-containing regimens are effective first-line therapies for CDI in IBD inpatients. No prospective data exists with regards to the safety or efficacy of initiating or maintaining corticosteroid, immunomodulator, or biologic therapy to treat IBD in the setting of CDI. Corticosteroid use is a risk factor for the development of CDI, while immunomodulators and biologics are not. CONCLUSIONStrong recommendations regarding when to initiate IBD specific therapy in those with CDI are precluded by a lack of evidence. However, based on expert opinion and observational data, initiation or resumption of immunosuppressive therapy after 48-72 h of targeted antibiotic treatment for CDI may be considered.
文摘AIM: To evaluate the completion rate and diagnostic yield of the Pill Cam SB2-ex in comparison to the Pill Cam SB2.METHODS:Two hundred cases using the 8-h Pill Cam SB2 were retrospectively compared to 200 cases using the 12 h Pill Cam SB2-ex at a tertiary academic center.Endoscopically placed capsules were excluded from the study.Demographic information,indications for capsule endoscopy,capsule type,study length,completion of exam,clinically significant findings,timestamp of most distant finding,and significant findings beyond 8 h were recorded.RESULTS:The 8 and 12 h capsule groups were well matched respectively for both age(70.90±14.19vs 71.93±13.80,P=0.46)and gender(45.5%vs48%male,P=0.69).The most common indications for the procedure in both groups were anemia and obscure gastrointestinal bleeding.Pill Cam SB2-ex had a significantly higher completion rate than Pill Cam SB2(88%vs 79.5%,P=0.03).Overall,the diagnostic yield was greater for the 8 h capsule(48.5%for SB2vs 35%for SB2-ex,P=0.01).In 4/70(5.7%)of abnormal SB2-ex exams the clinically significant findingwas noted in the small bowel beyond the 8 h mark.CONCLUSION:In our study,we found the Pill Cam SB2-ex to have a significantly increased completion rate,though without any improvement in diagnostic yield compared to the Pill Cam SB2.
文摘AIM To determine levels of cytokines incolonic mucosa of asymptomatic first degreerelatives of Crohn’s disease patients.METHODS Cytokines(Interleukin(IL)1-Beta,IL-2,IL-5 and IL-8)were measured using ELISAin biopsy samples of normal looking colonicmucosa of first degree relatives of Crohn’sdisease patients(n = 9)and from normalcontrols(n = 10)with no family history ofCrohn’s disease.RESULTS Asymptomatic first degree relativesof patients with Crohn’s disease had significantlyhigher levels of basal intestinal mucosalcytokines(IL-2,IL-5 and IL-8)than normalcontrols.Whether these increased cytokinelevels serve as phenotypic markers for a geneticpredisposition to developing Crohns diseaselater on,or whether they indicate early(pre-clinical)damage has yet to be further defined.CONCLUSION Asymptomatic first degreerelatives of Crohn’s disease patients have higherlevels of cytokines in their normal-lookingintestinal mucosa compared to normal controls,This supports the hypothesis that increasedcytokines may be a cause or an early event inthe inflammatory cascade of Crohns disease andare not merely a result of the inflammatoryprocess.
文摘Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET suggests that the diagnostic paradigm may be shifting again.By providing the anatomic information lacking in conventional radionuclide studies,there is renewed interest in bone scintigraphy,performed as a SPECT/CT procedure,for detecting joint instability,mechanical loosening and component malpositioning.Fluoride-PET may provide new insights into periprosthetic bone metabolism.The objective of this manuscript is to provide a comprehensive review of the evolution of nuclear medicine imaging of joint replacements.
文摘AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's disease. A group of 206 patients without inflammatory bowel disease served as controls. Primary outcome was thyroid disorder. Secondary outcomes included use of steroids, immunosuppressive medications, surgery and incidence of fracture.RESULTS: The prevalence of hyperthyroidism was similar in both groups. However, the prevalence of hypothyroidism was lower in Crohn's patients (3.8 % vs 8.2 %, P=0.05).Within the Crohn's group, the use of immunosuppressive agents (0 % vs11 %), steroid usage (12.5 % vs37 %), small bowel surgery (12.5 % vs 28 %) and large bowel surgery (12.5 % vs27 %) were lower in the hypothyroid subset as compared to the euthyroid subset. Seven (3.4 %) Crohn'spatients suffered fracture, all of whom were euthyroid.CONCLUSION: Thyroid disorder was not found to be associated with Crohn's disease and was not found to increase the risk for fractures. Therefore, screening for thyroid disease is not a necessary component in the management of Crohn's disease.
