Risk of Malignant Progression in Barrett’s Esophagus Patients: Results from a Large Population-Based Study

Background: Barrett's esophagus (BE) is a premalignant lesion that predisposes to esophageal adenocarcinoma. However, the reported incidence of esophageal adenocarcinoma in patients with BE varies widely. We examined the risk of malignant progression in patients with BE using data from the Northern Ireland Barrett's esophagus Register (NIBR), one of the largest population-based registries of BE worldwide, which includes every adult diagnosed with BE in Northern Ireland between 1993 and 2005.

Subjects and Methods: We followed 8522 patients with BE, defined as columnar lined epithelium of the esophagus with or without specialized intestinal metaplasia (SIM), until the end of 2008. Patients with incident adenocarcinomas of the esophagus or gastric cardia or with high-grade dysplasia of the esophagus were identified by matching the NIBR with the Northern Ireland Cancer Registry, and deaths were identified by matching with records from the Registrar General's Office. Incidence of cancer outcomes or high-grade dysplasia was calculated as events per 100 person-years (% per year) of follow-up, and Cox proportional hazard models were used to determine incidence by age, sex, length of BE segment, presence of SIM, macroscopic BE, or low-grade dysplasia. All P values were from two-sided tests.

Results: After a mean of 7.0 years of follow-up, 79 patients were diagnosed with esophageal cancer, 16 with cancer of the gastric cardia, and 36 with high-grade dysplasia. In the entire cohort, incidence of esophageal or gastric cardia cancer or high-grade dysplasia combined was 0.22% per year (95% confidence interval [CI] = 0.19% to 0.26%). SIM was found in 46.0% of patients. In patients with SIM, the combined incidence was 0.38% per year (95% CI = 0.31 to 0.46%). The risk of cancer was statistically significantly elevated in patients with vs without SIM at index biopsy (0.38% per year vs 0.07% per year; hazard ratio [HR] = 3.54, 95% CI = 2.09 to 6.00, P <. 001), in men compared with women (0.28% per year vs 0.13% per year; HR = 2.11, 95% CI = 1.41 to 3.16, P <. 001), and in patients with low-grade dysplasia compared with no dysplasia (1.40% per year vs 0.17% per year; HR = 5.67, 95% CI = 3.77 to 8.53, P <. 001).

Conclusion: We found the risk of malignant progression among patients with BE to be lower than previously reported, suggesting that currently recommended surveillance strategies may not be cost-effective. © The Author 2011. Published by Oxford University Press. All rights reserved.

Target Structure Induced Suppression of the Ionization Cross Section for Very Low Energy Antiproton-Hydrogen Collisions

Low energy antiprotons have been used previously to give benchmark data for theories of atomic collisions. Here we present measurements of the cross section for single, nondissociative ionization of molecular hydrogen for impact of antiprotons with kinetic energies in the range 2-11 keV, i.e., in the velocity interval of 0.3-0.65 a.u. We find a cross section which is proportional to the projectile velocity, which is quite unlike the behavior of corresponding atomic cross sections, and which has never previously been observed experimentally.

Concomitant and antecedent deep venous thrombosis and cancer survival in male US veterans

Survival is reportedly worse in patients with cancer concurrently diagnosed with deep venous thrombosis. However, information on specific malignancies is limited. From a cohort study of male US veterans we identified incident cancer cases (n aEuroS== aEuroS412 008) and compared survival patterns among those with versus without a history of deep venous thrombosis. Using Cox proportional hazard models, we estimated hazard ratios (HRs) and 95%% confidence intervals as measures of the relative risk of dying. Individuals with (versus without) a concomitant deep venous thrombosis and cancer diagnosis had a higher risk of dying (HR aEuroS== aEuroS1.38; 1.28--1.49). The most prominent excess mortality (HR aEuroS== aEuroS1.29--2.55) was observed among patients diagnosed with deep venous thrombosis at the time of diagnosis of lung, gastric, prostate, bladder, or kidney cancer. Increased risk of dying was also found among cancer patients diagnosed with deep venous thrombosis 1 year (HR aEuroS== aEuroS1.14; 1.07--1.22), 1--5 years (HR aEuroS== aEuroS1.14; 1.10--1.19), and > 5 years (HR aEuroS== aEuroS1.27; 1.23--1.31) before cancer; this was true for most cancer sites (HR aEuroS== aEuroS1.17--1.64). In summary, antecedent deep venous thrombosis confers a worse prognosis upon cancer patients. Advanced stage at diagnosis, treatment effects, lifestyle factors, and comorbidity could explain differences by cancer site and time frame between a prior deep venous thrombosis diagnosis and cancer outcome.

Extruder Melt Temperature Control with Fuzzy Logic

In polymer extrusion, the delivery of a melt which is homogenous in composition and temperature is paramount for achieving high quality extruded products. However, advancements in process control are required to reduce temperature variations across the melt flow which can result in poor product quality. The majority of thermal monitoring methods provide only low accuracy point/bulk melt temperature measurements and cause poor controller performance. Furthermore, the most common conventional proportional-integral-derivative controllers seem to be incapable of performing well over the nonlinear operating region. This paper presents a model-based fuzzy control approach to reduce the die melt temperature variations across the melt flow while achieving desired average die melt temperature. Simulation results confirm the efficacy of the proposed controller.

Effect of resonance frequency, power input, and saturation gas type on the oxidation efficiency of an ultrasound horn

The sonochemical oxidation efficiency (eta(ox)) of a commercial titanium alloy ultrasound horn has been measured using potassium iodide as a dosimeter at its main resonance frequency (20 kHz) and two higher resonance frequencies (41 and 62 kHz). Narrow power and frequency ranges have been chosen to minimise secondary effects such as changing bubble stability, and time available for radical diffusion from the bubble to the liquid. The oxidation efficiency, eta(ox), is proportional to the frequency and to the power transmitted to the liquid (275 mL) in the applied power range (1-6 W) under argon. Luminol radical visualisation measurements show that the radical generation rate increases and a redistribution of radical producing zones is achieved at increasing frequency. Argon, helium, air, nitrogen, oxygen, and carbon dioxide have been used as saturation gases in potassium iodide oxidation experiments. The highest eta(ox) has been observed at 5 W under air at 62 kHz. The presence of carbon dioxide in air gives enhanced nucleation at 41 and 62 kHz and has a strong influence on eta(ox). This is supported by the luminol images, the measured dependence of eta(ox). on input power, and bubble images recorded under carbon dioxide. The results give insight into the interplay between saturation gas and frequency, nucleation, and their effect on eta(ox). (C) 2010 Elsevier B.V. All rights reserved.

Clustering and synchrony in laying hens: The effect of environmental resources on social dynamics

Laying hens generally choose to aggregate, but the extent to which the environments in which we house them impact on social group dynamics is not known. In this paper the effect of pen environment on spatial clustering is considered. Twelve groups of four laying hens were studied under three environmental conditions: wire floor (W), shavings (Sh) and perches, peat, nestbox and shavings (PPN). Groups experienced each environment twice, for five weeks each time, in a systematic order that varied from group to group. Video recordings were made one day per week for 30 weeks. To determine level of clustering, we recorded positional data from a randomly selected 20-min excerpt per video (a total of 20 min x 360 videos analysed). On screen, pens were divided into six equal areas. In addition, PPN pens were divided into an additional four (sub) areas, to account for the use of perches (one area per half perch). Every 5 s, we recorded the location of each bird and calculated location use over time, feeding synchrony and cluster scores for each environment. Feeding synchrony and cluster scores were compared against unweighted and weighted (according to observed proportional location use) Poisson distributions to distinguish between resource and social attraction.

Scaling in the time-dependent failure of a fiber bundle with local load sharing

We study the scaling behaviors of a time-dependent fiber-bundle model with local load sharing. Upon approaching the complete failure of the bundle, the breaking rate of fibers diverges according to r(t)proportional to(T-f-t)(-xi) where T-f is the lifetime of the bundle and xi approximate to 1.0 is a universal scaling exponent. The average lifetime of the bundle [T-f] scales with the system size as N-delta, where delta depends on the distribution of individual fiber as well as the breakdown rule. [S1063-651X(99)13902-3].

BURST-SIZE DISTRIBUTION IN FIBER-BUNDLES WITH LOCAL LOAD-SHARING

A critical load x(c) is introduced into the fiber-bundle model with local load-sharing. The critical load is defined as the average load per fiber that causes the final complete failure. It is shown that x(c) --> 0 when the size of the system N --> infinity. A power law for the burst-size distribution, D(DELTA) is-proportional-to DELTA(-xi) is approximately correct. The exponent xi is not universal, since it depends on the strength distribution as well as the size of the system.

Tobacco smoking increases the risk of high-grade dysplasia and cancer among patients with Barrett's esophagus

Background & Aims: Esophageal adenocarcinoma arises from Barrett's esophagus (BE); patients with this cancer have a poor prognosis. Identification of modifiable lifestyle factors that affect the risk of progression from BE to esophageal adenocarcinoma might prevent its development. We investigated associations among body size, smoking, and alcohol use with progression of BE to neoplasia. Methods: We analyzed data from patients with BE identified from the population-based Northern Ireland BE register, diagnosed between 1993 and 2005 with specialized intestinal metaplasia (n = 3167). Data on clinical, demographic, and lifestyle factors related to diagnosis of BE were collected from hospital case notes. We used the Northern Ireland Cancer Registry to identify which of these patients later developed esophageal adenocarcinoma, adenocarcinomas of the gastric cardia, or esophageal high-grade dysplasia. Cox proportional hazards models were used to associate lifestyle factors with risk of progression.
Results: By December 31, 2008, 117 of the patients with BE developed esophageal high-grade dysplasia or adenocarcinomas of the esophagus or gastric cardia. Current tobacco smoking was significantly associated with an increased risk of progression (hazard ratio = 2.03; 95% confidence interval, 1.29-3.17) compared with never smoking, and across all strata of smoking intensity. Alcohol consumption was not related to risk of progression. Measures of body size were infrequently reported in endoscopy reports, and body size was not associated with risk of progression.
Conclusions: Smoking tobacco increases the risk of progression to cancer or high-grade dysplasia 2-fold among patients with BE, compared with patients with BE that have never smoked. Smoking cessation strategies should be considered for patients with BE.

Dinitrogen formation over low-exchanged Cu-ZSM-5 in the selective reduction of NO by propane

The role of gaseous NO and C3H8 has been studied over low-exchanged Cu-ZSM-5 zeolite employing TPD, FTIR and pulse technique with the alternate introduction of NO or C3H8 onto the catalyst surface. The rate of the N-2 formation is directly proportional to the content of gaseous NO and the surface coverage with 2-nitrosopropane. There was no formation of N-2 during interaction of gaseous C3H8 with NO adsorbates. However, 2-nitrosopropane and its isomer acetone oxime were also formed in this reaction.

A comprehensive aerosol spray method for the rapid photocatalytic grid area analysis of semiconductor photocatalyst thin films

Indicator inks, previously shown to be capable of rapidly assessing photocatalytic activity via a novel photo-reductive mechanism, were simply applied via an aerosol spray onto commercially available pieces of Activ (TM) self-cleaning glass. Ink layers could be applied with high evenness of spread, with as little deviation as 5% upon UV-visible spectroscopic assessment of 25 equally distributed positions over a 10 cm x 10 cm glass cut. The inks were comprised of either a resazurin (Rz) or dichloroindophenol (DCIP) redox dye with a glycerol sacrificial electron donor in an aqueous hydroxyethyl cellulose (HEC) polymer media. The photo-reduction reaction under UVA light of a single spot was monitored by UV-vis spectroscopy and digital images attained from a flat-bed scanner in tandem for both inks. The photo-reduction of Rz ink underwent a two-step kinetic process, whereby the blue redox dye was initially reduced to a pink intermediate resorufin (Rf) and subsequently reduced to a bleached form of the dye. In contrast, a simple one-step kinetic process was observed for the reduction of the light blue redox dye DCIP to its bleached intermediates. Changes in red-green-blue colour extracted from digital images of the inks were inversely proportional to the changes seen at corresponding wavelengths via UV-visible absorption spectroscopy and wholly indicative of the reaction kinetics. The photocatalytic activity areas of cuts of Activ (TM) glass, 10 cm x 10 cm in size, were assessed using both Rz and DCIP indicator inks evenly sprayed over the films: firstly using UVA lamp light to activate the underlying Activ (TM) film (1.75 mW cm(-2)) and secondly under solar conditions (2.06 +/- 0.14 mW cm(-2)). The photo-reduction reactions were monitored solely by flat-bed digital scanning. Red-green-blue values of a generated 14 x 14 grid (196 positions) that covered the entire area of each film image were extracted using a Custom-built program entitled RGB Extractor(C). A homogenous degradation over the 196 positions analysed for both Rz (Red colour deviation = 19% UVA, 8% Solar: Green colour deviation = 17% UVA, 12% Solar) and DCIP (Red colour deviation = 22% UVA, 16% Solar) inks was seen in both UVA and solar experiments, demonstrating the consistency of the self-cleaning titania layer on Activ (TM). The method presented provides a good solution for the high-throughput photocatalytic screening of a number of homogenous photocatalytically active materials simultaneously or numerous positions on a single film; both useful in assessing the homogeneity of a film or determining the best combination of reaction components to produce the optimum performance photocatalytic film. (C) 2010 Elsevier B.V. All rights reserved.

Simple method for the rapid simultaneous screening of photocatalytic activity over multiple positions of self-cleaning films

An intelligent ink, previously shown to be capable of rapidly assessing photocatalytic activity, was simply applied via a felt-pen onto a commercially available piece of Activ (TM) self-cleaning glass. The ink, comprising of redox dye resazurin and the sacrificial electron donor glycerol within an aqueous hydroxy ethyl cellulose (HEC) polymer media, was photocatalytically degraded in a two-step process. The key initial stage was the photo-reductive conversion of resazurin to resorufin, whereby a colour change from blue to pink occurred. The latter stage was the subsequent photo-reduction of the resorufin, where a slower change from pink to colourless was seen. Red and green components of red-green-blue colour extracted from flat-bed scanner digital images of resazurin ink coated photocatalytic films at intervals during the photocatalysis reaction were inversely proportional to the changes seen via UV-visible absorption spectroscopy and indicative of reaction kinetics. A 3 x 3 grid of intelligent ink was drawn onto a piece of Activ (TM) and a glass blank. The photocatalysis reaction was monitored solely by flat-bed digital scanning. Red-green-blue values of respective positions on the grid were extracted using a custom-built program entitled RGB Extractor (c). The program was capable of extracting a number of 5 x 5 pixel averages of red-green-blue components simultaneously. Allocation of merely three coordinates allowed for the automatic generation of a grid, with scroll-bars controlling the number of positions to be extracted on the grid formed. No significant change in red and green components for any position on the glass blank was observed; however, the Activ (TM) film displayed a homogenous photo-reduction of the dye, reaching maxima in red and minima in green components in 23 +/- 3 and 14 +/- 2 min, respectively. A compositionally graded N-doped titania film synthesised in house via a combinatorial APCVD reaction was also photocatalytically tested by this method where 247 positions on a 13 x 19 grid were simultaneously analysed. The dramatic variation in photocatalysis observed was rapidly quantified for all positions (2-3 hours) allowing for correlations to be made between thicknesses and N : Ti% compositions attained from Swanepoel and WDX analysis, respectively. N incorporation within this system was found to be detrimental to film activity for the photocatalysis reaction of intelligent ink under 365 nm light.

Nanocrystalline SnO2-based, UVB-activated, colourimetric oxygen indicator

Nanocrystalline SnO2, ncSnO(2), is used as a photosensitiser in a colourimetric O-2 indicator that comprises a sacrificial electron donor, glycerol, a redox dye, methylene blue (MB), and an encapsulating polymer, hydroxyethyl cellulose (HEC). Upon exposure to a burst of UVB light the indicator is activated (photo-bleached) as the MB is photoreduced by the ncSnO(2) particles. In the absence of oxygen, the film stays bleached, but recovers its original colour upon exposure to oxygen. Unlike its TiO2-based predecessor, the HEC/glycerol/MB/ncSnO(2) O-2 indicator is not activated by UVA light from white fluorescent lamps, but is by UVB light. This feature provides much greater control in the activation of the indicator. Other work shows the rate of activation depends upon I-0.75, where I is the UVB irradiance, indicating a partial dependence upon the electron-hole recombination process. The half-life of the recovery of the original colour of a UV-activated film, t(50), is directly proportional to the ambient level of oxygen. The advantages of using this indicator in modified atmosphere packaging as a possible quality assurance indicator are discussed briefly. (c) 2008 Elsevier B.V. All rights reserved.

Hydrogen peroxide vapour indicator

A hydrogen peroxide vapour indicator is described comprising a triarylmethane dye, lissamine green (LG), dissolved in a polymer, polyvinyl alcohol (PVA). The indicator is green/blue in the absence of hydrogen peroxide vapour but is rapidly bleached in the presence of hydrogen peroxide vapour. The kinetics of LG bleaching appear approximately first order with respect [LG] and the concentration of H2O2, which, in turn, is proportional to the partial pressure of H2O2. However, the kinetics also appear to depend directly upon the reciprocal of the film thickness, implying some dependence upon the diffusion of the H2O2 vapour through the indicator film. Like most other H2O2 indicator films (such as starch-iodide paper), the LG/PVA indicator is not particularly selective and responds to most other volatile strong oxidising agents, such as ozone and chlorine. However, it is rapid in response (

Novel UV-activated colorimetric oxygen indicator

The results of a detailed characterization study of a novel UV-activated colorimetric oxygen indicator are described. The indicator uses nanoparticles of titania to photosensitize the reduction of methylene blue by triethanolamine in a polymer encapsulation medium, using UVA light. Upon UV irradiation, the indicator bleaches and remains in this colorless state in the dark, unless and until it is exposed to oxygen, whereupon its original color is restored. The indicator is reusable and irreversible. The rate of color recovery is proportional to the level of oxygen present. A layer of PET (poly(ethylene terephthalate)), of thickness b, placed on top of the indicator film slows down its response, and the 90% recovery time is proportional to b.