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Gerrard AD, Maeda Y, Miller J, Gunn F, Theodoratou E, Noble C, Porteous L, Glancy S, MacLean P, Pattenden R, Dunlop MG, Din FVN. Double faecal immunochemical testing in patients with symptoms suspicious of colorectal cancer. Br J Surg 2023; 110:471-480. [PMID: 36785496 PMCID: PMC10364540 DOI: 10.1093/bjs/znad016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/31/2022] [Accepted: 01/05/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Faecal immunochemical test (FIT)-directed pathways based on a single test have been implemented for symptomatic patients. However, with a single test, the sensitivity is 87 per cent at 10 µg haemoglobin (Hb) per g faeces. This aims of this study were to define the diagnostic performance of a single FIT, compared with double FIT in symptomatic populations. METHODS Two sequential prospective patient cohorts referred with symptoms from primary care were studied. Patients in cohort 1 were sent a single FIT, and those in cohort 2 received two tests in succession before investigation. All patients were investigated, regardless of having a positive or negative test (threshold 10 µg Hb per g). RESULTS In cohort 1, 2260 patients completed one FIT and investigation. The sensitivity of single FIT was 84.1 (95 per cent c.i. 73.3 to 91.8) per cent for colorectal cancer and 67.4 (61.0 to 73.4) per cent for significant bowel pathology. In cohort 2, 3426 patients completed at least one FIT, and 2637 completed both FITs and investigation. The sensitivity of double FIT was 96.6 (90.4 to 99.3) per cent for colorectal cancer and 83.0 (77.4 to 87.8) per cent for significant bowel pathology. The second FIT resulted in a 50.0 per cent reduction in cancers missed by the first FIT, and 30.0 per cent for significant bowel pathology. Correlation between faecal Hb level was only modest (rs = 0.58), and 16.8 per cent of double tests were discordant, 11.4 per cent in patients with colorectal cancer and 18.3 per cent in those with significant bowel pathology. CONCLUSION FIT in patients with high-risk symptoms twice in succession reduces missed significant colorectal pathology and has an acceptable workload impact.
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Affiliation(s)
- A D Gerrard
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Colorectal surgery, Western General Hospital, Edinburgh, UK
| | - Y Maeda
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - J Miller
- Department of Colorectal surgery, Western General Hospital, Edinburgh, UK
| | - F Gunn
- Department of Colorectal surgery, Western General Hospital, Edinburgh, UK
| | - E Theodoratou
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Noble
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - L Porteous
- Lead GP for Cancer and Palliative Care, NHS Lothian, Edinburgh, UK
| | - S Glancy
- Department of Radiology, Western General Hospital, Edinburgh, UK
| | - P MacLean
- Department of Radiology, Western General Hospital, Edinburgh, UK
| | - R Pattenden
- Department of Biochemistry, Western General Hospital, Edinburgh, UK
| | - M G Dunlop
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- UK Colon Cancer Genetics Group, Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics & Cancer, Western General Hospital, The University of Edinburgh, Edinburgh, UK
| | - F V N Din
- Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Department of Colorectal surgery, Western General Hospital, Edinburgh, UK
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2
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Grecian SM, McLachlan S, Fallowfield JA, Hayes PC, Guha IN, Morling JR, Glancy S, Williamson RM, Reynolds RM, Frier BM, Zammitt NN, Price JF, Strachan MWJ. Addition of hyaluronic acid to the FIB-4 liver fibrosis score improves prediction of incident cirrhosis and hepatocellular carcinoma in type 2 diabetes: The Edinburgh Type 2 Diabetes Study. Obes Sci Pract 2021; 7:497-508. [PMID: 34631129 PMCID: PMC8488456 DOI: 10.1002/osp4.484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is associated with increased risk of progression to cirrhosis and hepatocellular carcinoma (HCC) in people with chronic liver diseases, particularly non-alcoholic fatty liver disease (NAFLD). However, the absolute risk of progression is low. So, it is crucial to accurately identify patients who would benefit most from hepatology referral and intensified management. Current risk-stratification tools are suboptimal and perform worse in people with diabetes. AIMS To determine whether the addition of complementary biomarker(s) to current NAFLD risk-stratification tools in people with T2D could improve the identification of people who are at increased risk of developing incident cirrhosis or HCC. METHODS The Edinburgh Type 2 diabetes Study (ET2DS) is a cohort study of men and women with T2D (n = 1066, age 60-75 at baseline). Cases of cirrhosis and HCC were identified over 11 years of follow-up. Biomarkers were measured at baseline and year 1 and association with incident disease was assessed using logistic regression. RESULTS Of existing risk-stratification scores tested, the Fibrosis-4 (FIB-4) index and the AST:platelet ratio index (APRI) performed best in this cohort. Addition of hyaluronic acid (cut-point ≥ 50 μ g/L) to FIB-4 (cut-point ≥ 1.3) maintained a false negative rate of ≤25% and reduced the number of people incorrectly identified as "high risk" for incident disease by ∼50%. CONCLUSIONS The addition of hyaluronic acid to FIB-4 reduced the proportion of people inappropriately identified as "high risk" for development of cirrhosis/HCC in a community population of otherwise asymptomatic people with T2D. These findings require a validation in independent cohorts.
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Affiliation(s)
- Sheila M. Grecian
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - Stela McLachlan
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - Jonathan A. Fallowfield
- Centre for Inflammation ResearchQueen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | - Peter C. Hayes
- Centre for Inflammation ResearchQueen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and the University of NottinghamNottinghamUK
| | - Joanne R. Morling
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
- NIHR Nottingham Biomedical Research CentreNottingham University Hospitals NHS Trust and the University of NottinghamNottinghamUK
- Division of Epidemiology and Public HealthUniversity of NottinghamNottinghamUK
| | - Stephen Glancy
- Department of RadiologyWestern General HospitalEdinburghUK
| | - Rachel M. Williamson
- Metabolic UnitWestern General HospitalEdinburghUK
- Metabolic UnitBorders General HospitalMelroseUK
| | - Rebecca M. Reynolds
- Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | - Brian M. Frier
- Centre for Cardiovascular ScienceQueen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | | | - Jackie F. Price
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
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3
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Srinivas R, Burd SC, Knaack HM, Sutherland RT, Kwiatkowski A, Glancy S, Knill E, Wineland DJ, Leibfried D, Wilson AC, Allcock DTC, Slichter DH. High-fidelity laser-free universal control of trapped ion qubits. Nature 2021; 597:209-213. [PMID: 34497396 DOI: 10.1038/s41586-021-03809-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/07/2021] [Indexed: 11/09/2022]
Abstract
Universal control of multiple qubits-the ability to entangle qubits and to perform arbitrary individual qubit operations1-is a fundamental resource for quantum computing2, simulation3 and networking4. Qubits realized in trapped atomic ions have shown the highest-fidelity two-qubit entangling operations5-7 and single-qubit rotations8 so far. Universal control of trapped ion qubits has been separately demonstrated using tightly focused laser beams9-12 or by moving ions with respect to laser beams13-15, but at lower fidelities. Laser-free entangling methods16-20 may offer improved scalability by harnessing microwave technology developed for wireless communications, but so far their performance has lagged the best reported laser-based approaches. Here we demonstrate high-fidelity laser-free universal control of two trapped-ion qubits by creating both symmetric and antisymmetric maximally entangled states with fidelities of [Formula: see text] and [Formula: see text], respectively (68 per cent confidence level), corrected for initialization error. We use a scheme based on radiofrequency magnetic field gradients combined with microwave magnetic fields that is robust against multiple sources of decoherence and usable with essentially any trapped ion species. The scheme has the potential to perform simultaneous entangling operations on multiple pairs of ions in a large-scale trapped-ion quantum processor without increasing control signal power or complexity. Combining this technology with low-power laser light delivered via trap-integrated photonics21,22 and trap-integrated photon detectors for qubit readout23,24 provides an opportunity for scalable, high-fidelity, fully chip-integrated trapped-ion quantum computing.
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Affiliation(s)
- R Srinivas
- National Institute of Standards and Technology, Boulder, CO, USA. .,Department of Physics, University of Colorado, Boulder, CO, USA. .,Department of Physics, Clarendon Laboratory, University of Oxford, Oxford, UK.
| | - S C Burd
- National Institute of Standards and Technology, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA.,Department of Physics, Stanford University, Stanford, CA, USA
| | - H M Knaack
- National Institute of Standards and Technology, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA
| | - R T Sutherland
- Physics Division, Physical and Life Sciences, Lawrence Livermore National Laboratory, Livermore, CA, USA.,Department of Electrical and Computer Engineering, University of Texas at San Antonio, San Antonio, TX, USA.,Department of Physics and Astronomy, University of Texas at San Antonio, San Antonio, TX, USA
| | - A Kwiatkowski
- National Institute of Standards and Technology, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA
| | - S Glancy
- National Institute of Standards and Technology, Boulder, CO, USA
| | - E Knill
- National Institute of Standards and Technology, Boulder, CO, USA.,Center for Theory of Quantum Matter, University of Colorado, Boulder, CO, USA
| | - D J Wineland
- National Institute of Standards and Technology, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA.,Department of Physics, University of Oregon, Eugene, OR, USA
| | - D Leibfried
- National Institute of Standards and Technology, Boulder, CO, USA
| | - A C Wilson
- National Institute of Standards and Technology, Boulder, CO, USA
| | - D T C Allcock
- National Institute of Standards and Technology, Boulder, CO, USA.,Department of Physics, University of Colorado, Boulder, CO, USA.,Department of Physics, University of Oregon, Eugene, OR, USA
| | - D H Slichter
- National Institute of Standards and Technology, Boulder, CO, USA.
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4
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Miller J, Maeda Y, Au S, Gunn F, Porteous L, Pattenden R, MacLean P, Noble CL, Glancy S, Dunlop MG, Din FVN. Short-term outcomes of a COVID-adapted triage pathway for colorectal cancer detection. Colorectal Dis 2021; 23:1639-1648. [PMID: 33682302 PMCID: PMC8250907 DOI: 10.1111/codi.15618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/16/2021] [Accepted: 03/01/2021] [Indexed: 12/29/2022]
Abstract
AIM The dramatic curtailment of endoscopy and CT colonography capacity during the coronavirus pandemic has adversely impacted timely diagnosis of colorectal cancer (CRC). We describe a rapidly implemented COVID-adapted diagnostic pathway to mitigate risk and maximize cancer diagnosis in patients referred with symptoms of suspected CRC. METHOD The 'COVID-adapted pathway' integrated multiple quantitative faecal immunochemical tests (qFIT) to enrich for significant colorectal disease with judicious use of CT with oral contrast to detect gross pathology. Patients reporting 'high-risk' symptoms were triaged to qFIT+CT and the remainder underwent an initial qFIT to inform subsequent investigation. Demographic and clinical data were prospectively collected. Outcomes comprised cancer detection frequency. RESULTS Overall, 422 patients (median age 64 years, 220 women) were triaged using this pathway. Most (84.6%) were referred as 'urgent suspicious of cancer'. Of the 422 patients, 202 (47.9%) were triaged to CT and qFIT, 211 (50.0%) to qFIT only, eight (1.9%) to outpatient clinic and one to colonoscopy. Fifteen (3.6%) declined investigation and seven (1.7%) were deemed unfit. We detected 13 cancers (3.1%), similar to the mean cancer detection rate from all referrals in 2017-2019 (3.3%). Compared with the period 1 April-31 May in 2017-2019, we observed a 43% reduction in all primary care referrals (1071 referrals expected reducing to 609). CONCLUSION This COVID-adapted pathway mitigated the adverse effects on diagnostic capacity and detected cancer at the expected rate within those referred. However, the overall reduction in the number of referrals was substantial. The described risk-mitigating measures could be a useful adjunct whilst standard diagnostic services remain constrained due to the ongoing pandemic.
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Affiliation(s)
- Janice Miller
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
- Clinical SurgeryRoyal Infirmary of EdinburghUniversity of EdinburghEdinburghUK
| | - Yasuko Maeda
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
- Clinical SurgeryRoyal Infirmary of EdinburghUniversity of EdinburghEdinburghUK
| | - Stephanie Au
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
| | - Frances Gunn
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
| | - Lorna Porteous
- Lead GP for Cancer and Palliative CareNHS LothianEdinburghUK
| | | | - Peter MacLean
- Department of RadiologyWestern General HospitalEdinburghUK
| | - Colin L. Noble
- Department of GastroenterologyWestern General HospitalEdinburghUK
| | - Stephen Glancy
- Department of RadiologyWestern General HospitalEdinburghUK
| | - Malcolm G. Dunlop
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
- Clinical SurgeryRoyal Infirmary of EdinburghUniversity of EdinburghEdinburghUK
- Edinburgh CRUK Cancer Research CentreEdinburghUK
- Institute if Genetics and Molecular MedicineEdinburghUK
| | - Farhat V. N. Din
- Department of Colorectal SurgeryWestern General HospitalEdinburghUK
- Clinical SurgeryRoyal Infirmary of EdinburghUniversity of EdinburghEdinburghUK
- Edinburgh CRUK Cancer Research CentreEdinburghUK
- Institute if Genetics and Molecular MedicineEdinburghUK
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5
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Grecian SM, McLachlan S, Fallowfield JA, Kearns PKA, Hayes PC, Guha NI, Morling JR, Glancy S, Williamson RM, Reynolds RM, Frier BM, Zammitt NN, Price JF, Strachan MWJ. Non-invasive risk scores do not reliably identify future cirrhosis or hepatocellular carcinoma in Type 2 diabetes: The Edinburgh type 2 diabetes study. Liver Int 2020; 40:2252-2262. [PMID: 32638496 DOI: 10.1111/liv.14590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/06/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The incidence of cirrhosis and hepatocellular carcinoma (HCC) is increased in Type 2 diabetes, primarily secondary to non-alcoholic fatty liver disease (NAFLD). European guidelines recommend screening for NAFLD in Type 2 diabetes. American guidelines, while not advocating a screening protocol, suggest using non-invasive markers of fibrosis for risk-stratification and guiding onward referral. AIMS To test the ability of individual fibrosis scores and the European screening algorithm to predict 11-year incident cirrhosis/HCC in an asymptomatic community cohort of older people with Type 2 diabetes. METHODS The Edinburgh Type 2 Diabetes Study investigated men and women with Type 2 diabetes (n = 1066, aged 60-75 at baseline). Liver markers were measured at baseline and year 1; steatosis and fibrosis markers were calculated according to independently published calculations. During 11 years of follow-up, cases of cirrhosis and HCC were identified. RESULTS Forty-three out of 1059 participants with no baseline cirrhosis/HCC developed incident disease. All scores were significantly associated with incident liver disease by odds ratio (P < .05). The ability of the risk-stratification tools to accurately identify those who developed incident cirrhosis/HCC was poor with low-positive predictive values (5-46%) and high false-negative and -positive rates (up to 60% and 77%) respectively. When fibrosis risk scores were used in conjunction with the European algorithm, they performed modestly better than when applied in isolation. CONCLUSIONS In a cohort with a moderately low incidence of cirrhosis/HCC, existing risk scores did not reliably identify participants at high risk. Better prediction models for cirrhosis/HCC in people with Type 2 diabetes are required.
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Affiliation(s)
- Sheila M Grecian
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Stela McLachlan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Jonathan A Fallowfield
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, UK
| | | | - Peter C Hayes
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, UK
| | - Neil I Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Joanne R Morling
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Stephen Glancy
- FRCR, Department of Radiology, Western General Hospital, Edinburgh, UK
| | | | - Rebecca M Reynolds
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, UK
| | - Brian M Frier
- University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, UK
| | | | - Jackie F Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
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6
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Jones GR, Fascì-Spurio F, Kennedy NA, Plevris N, Jenkinson P, Lyons M, Wong L, MacLean P, Glancy S, Lees CW. Faecal Calprotectin and Magnetic Resonance Enterography in Ileal Crohn's Disease: Correlations Between Disease Activity and Long-Term Follow-Up. J Crohns Colitis 2019; 13:442-450. [PMID: 30452618 DOI: 10.1093/ecco-jcc/jjy187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Magnetic resonance enterography [MRE] is the gold standard for assessing ileal inflammation in Crohn's disease [CD]. The aim of the present study was to correlate faecal calprotectin [FC] to MRE via a simple score in an exclusive ileal cohort with long-term follow-up for association with time to surgery or biologic therapy. METHODS In total, 150 MRE studies with matched FC [±30 days] were identified from the Edinburgh FC Register [2008-12; n = 18138]. Scans were re-read blinded to clinical data, independently, by two expert gastrointestinal radiologists, to generate a simple MRE score [range 0-10] from assessment of the worst intestinal segment plus total disease extent. RESULTS In total, 119 MRE scans were evaluated from 104 patients with ileal CD [L1 or L3 with panproctocolectomy]. Receiver operating characteristic analysis showed an area under the curve of 0.77 [0.67-0.87, p < 0.0001] for FC and MRE score >1, with an optimal cut-off of 145 μg/g for severe inflammation on MRE with 69.3% [57.6-79.5] sensitivity and 71.4% [53.7-85.4] specificity. Long-term follow-up over a median [interquartile range] of 2086 days [1786-2353] revealed FC ≥ 145 μg/g was associated with reduced biologic-free survival until 3 years following MRE, whereas MRE score [severe vs absent] was associated with reduced surgery- and biologic-free survival throughout follow-up. Backwards stepwise logistic regression revealed that length of ileal disease (odds ratio [OR] 3.8, 1.1-13.2, p = 0.034) and increased bowel wall thickness at MRE [OR 4.2, 1.6-10.7, p < 0.0001] or female sex [OR 5.2, 1.5-18.7, p = 0.011] increased the risk of biologic use or surgery, respectively. CONCLUSIONS FC correlates well with MRE assessment of ileal CD with MRE parameters associated with long-term biologic- and surgery-free remission.
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Affiliation(s)
- G R Jones
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.,University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, UK
| | - F Fascì-Spurio
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.,Sapienza University, Gastroenterology Unit, Rome, Italy
| | - N A Kennedy
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.,University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, UK
| | - N Plevris
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK
| | - P Jenkinson
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK
| | - M Lyons
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK
| | - L Wong
- Western General Hospital, Department of Radiology, Edinburgh, UK
| | - P MacLean
- Western General Hospital, Department of Radiology, Edinburgh, UK
| | - S Glancy
- Western General Hospital, Department of Radiology, Edinburgh, UK
| | - C W Lees
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.,University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, UK
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7
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Abstract
Quantum state tomography aims to determine the quantum state of a system from measured data and is an essential tool for quantum information science. When dealing with continuous variable quantum states of light, tomography is often done by measuring the field amplitudes at different optical phases using homodyne detection. The quadrature-phase homodyne measurement outputs a continuous variable, so to reduce the computational cost of tomography, researchers often discretize the measurements. We show that this can be done without significantly degrading the fidelity between the estimated state and the true state. This paper studies different strategies for determining the histogram bin widths. We show that computation time can be significantly reduced with little loss in the fidelity of the estimated state when the measurement operators corresponding to each histogram bin are integrated over the bin width.
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Affiliation(s)
- J. L. E. Silva
- Departamento de Engenharia de Teleinformática, Universidade Federal do Ceará, Fortaleza, Ceará, 60440, Brazil
| | - S. Glancy
- Applied and Computational Mathematics Division, National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - H. M. Vasconcelos
- Departamento de Engenharia de Teleinformática, Universidade Federal do Ceará, Fortaleza, Ceará, 60440, Brazil
- Applied and Computational Mathematics Division, National Institute of Standards and Technology, Boulder, Colorado 80305, USA
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8
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Tan TR, Wan Y, Erickson S, Bierhorst P, Kienzler D, Glancy S, Knill E, Leibfried D, Wineland DJ. Chained Bell Inequality Experiment with High-Efficiency Measurements. Phys Rev Lett 2017; 118:130403. [PMID: 28409945 DOI: 10.1103/physrevlett.118.130403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Indexed: 06/07/2023]
Abstract
We report correlation measurements on two ^{9}Be^{+} ions that violate a chained Bell inequality obeyed by any local-realistic theory. The correlations can be modeled as derived from a mixture of a local-realistic probabilistic distribution and a distribution that violates the inequality. A statistical framework is formulated to quantify the local-realistic fraction allowable in the observed distribution without the fair-sampling or independent-and-identical-distributions assumptions. We exclude models of our experiment whose local-realistic fraction is above 0.327 at the 95% confidence level. This bound is significantly lower than 0.586, the minimum fraction derived from a perfect Clauser-Horne-Shimony-Holt inequality experiment. Furthermore, our data provide a device-independent certification of the deterministically created Bell states.
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Affiliation(s)
- T R Tan
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
- Department of Physics, University of Colorado, Boulder, Colorado 80309, USA
| | - Y Wan
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - S Erickson
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
- Department of Physics, University of Colorado, Boulder, Colorado 80309, USA
| | - P Bierhorst
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - D Kienzler
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - S Glancy
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - E Knill
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
- Center for Theory of Quantum Matter, University of Colorado, Boulder, Colorado 80309, USA
| | - D Leibfried
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - D J Wineland
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
- Department of Physics, University of Colorado, Boulder, Colorado 80309, USA
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9
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Abstract
Maximum-likelihood quantum-state tomography yields estimators that are consistent, provided that the likelihood model is correct, but the maximum-likelihood estimators may have bias for any finite data set. The bias of an estimator is the difference between the expected value of the estimate and the true value of the parameter being estimated. This paper investigates bias in the widely used maximum-likelihood quantum-state tomography. Our goal is to understand how the amount of bias depends on factors such as the purity of the true state, the number of measurements performed, and the number of different bases in which the system is measured. For this, we perform numerical experiments that simulate optical homodyne tomography of squeezed thermal states under various conditions, perform tomography, and estimate bias in the purity of the estimated state. We find that estimates of higher purity states exhibit considerable bias, such that the estimates have lower purities than the true states.
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Affiliation(s)
- G. B. Silva
- Departamento de Engenharia de Teleinformática, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - S. Glancy
- Applied and Computational Mathematics Division, National Institute of Standards and Technology, Boulder, Colorado 80305, USA
| | - H. M. Vasconcelos
- Departamento de Engenharia de Teleinformática, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
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10
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Lin Y, Gaebler JP, Reiter F, Tan TR, Bowler R, Wan Y, Keith A, Knill E, Glancy S, Coakley K, Sørensen AS, Leibfried D, Wineland DJ. Preparation of Entangled States through Hilbert Space Engineering. Phys Rev Lett 2016; 117:140502. [PMID: 27740826 DOI: 10.1103/physrevlett.117.140502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Indexed: 06/06/2023]
Abstract
We apply laser fields to trapped atomic ions to constrain the quantum dynamics from a simultaneously applied global microwave field to an initial product state and a target entangled state. This approach comes under what has become known in the literature as "quantum Zeno dynamics" and we use it to prepare entangled states of two and three ions. With two trapped ^{9}Be^{+} ions, we obtain Bell state fidelities up to 0.990_{-5}^{+2}; with three ions, a W-state fidelity of 0.910_{-7}^{+4} is obtained. Compared to other methods of producing entanglement in trapped ions, this procedure can be relatively insensitive to certain imperfections such as fluctuations in laser intensity.
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Affiliation(s)
- Y Lin
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - J P Gaebler
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - F Reiter
- The Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, DK-2100 Copenhagen Ø, Denmark
| | - T R Tan
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - R Bowler
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - Y Wan
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - A Keith
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - E Knill
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - S Glancy
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - K Coakley
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - A S Sørensen
- The Niels Bohr Institute, University of Copenhagen, Blegdamsvej 17, DK-2100 Copenhagen Ø, Denmark
| | - D Leibfried
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - D J Wineland
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
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Gaebler JP, Tan TR, Lin Y, Wan Y, Bowler R, Keith AC, Glancy S, Coakley K, Knill E, Leibfried D, Wineland DJ. High-Fidelity Universal Gate Set for ^{9}Be^{+} Ion Qubits. Phys Rev Lett 2016; 117:060505. [PMID: 27541451 DOI: 10.1103/physrevlett.117.060505] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Indexed: 06/06/2023]
Abstract
We report high-fidelity laser-beam-induced quantum logic gates on magnetic-field-insensitive qubits comprised of hyperfine states in ^{9}Be^{+} ions with a memory coherence time of more than 1 s. We demonstrate single-qubit gates with an error per gate of 3.8(1)×10^{-5}. By creating a Bell state with a deterministic two-qubit gate, we deduce a gate error of 8(4)×10^{-4}. We characterize the errors in our implementation and discuss methods to further reduce imperfections towards values that are compatible with fault-tolerant processing at realistic overhead.
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Affiliation(s)
- J P Gaebler
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - T R Tan
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - Y Lin
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - Y Wan
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - R Bowler
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - A C Keith
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - S Glancy
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - K Coakley
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - E Knill
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - D Leibfried
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
| | - D J Wineland
- National Institute of Standards and Technology, 325 Broadway, Boulder, Colorado 80305, USA
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Morling JR, Fallowfield JA, Guha IN, Williamson RM, Ali M, Glancy S, Strachan MWJ, Price JF. Clinically significant chronic liver disease in people with Type 2 diabetes: the Edinburgh Type 2 Diabetes Study. QJM 2016; 109:249-56. [PMID: 26454513 PMCID: PMC4815616 DOI: 10.1093/qjmed/hcv191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/05/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Type 2 diabetes is an independent risk factor for chronic liver disease, however disease burden estimates and knowledge of prognostic indicators are lacking in community populations. AIMS To describe the prevalence and incidence of clinically significant chronic liver disease amongst community-based older people with Type 2 diabetes and to determine risk factors which might assist in discriminating patients with unknown prevalent or incident disease. DESIGN Prospective cohort study. METHODS Nine hundred and thirty-nine participants in the Edinburgh Type 2 Diabetes Study underwent investigation including liver ultrasound and non-invasive measures of non-alcoholic steatohepatitis (NASH), hepatic fibrosis and systemic inflammation. Over 6-years, cases of cirrhosis and hepatocellular carcinoma were collated from multiple sources. RESULTS Eight patients had known prevalent disease with 13 further unknown cases identified (prevalence 2.2%) and 15 incident cases (IR 2.9/1000 person-years). Higher levels of systemic inflammation, NASH and hepatic fibrosis markers were associated with both unknown prevalent and incident clinically significant chronic liver disease (allP < 0.001). CONCLUSIONS Our study investigations increased the known prevalence of clinically significant chronic liver disease by over 150%, confirming the suspicion of a large burden of undiagnosed disease. The disease incidence rate was lower than anticipated but still much higher than the general population rate. The ability to identify patients both with and at risk of developing clinically significant chronic liver disease allows for early intervention and clinical monitoring strategies. Ongoing work, with longer follow-up, including analysis of rates of liver function decline, will be used to define optimal risk prediction tools.
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Affiliation(s)
- J R Morling
- From the Centre for Population Health Sciences, University of Edinburgh, Old Medical Buildings, Teviot Place, Edinburgh EH8 9AG, UK
| | - J A Fallowfield
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - I N Guha
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, University of Nottingham, Nottingham, UK
| | | | - M Ali
- Department of Metabolic Medicine, Edinburgh, UK
| | - S Glancy
- Department of Radiology, Western General Hospital, Edinburgh, UK
| | | | - J F Price
- From the Centre for Population Health Sciences, University of Edinburgh, Old Medical Buildings, Teviot Place, Edinburgh EH8 9AG, UK
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13
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Morling JR, Fallowfield JA, Williamson RM, Robertson CM, Glancy S, Guha IN, Strachan MWJ, Price JF. γ-Glutamyltransferase, but not markers of hepatic fibrosis, is associated with cardiovascular disease in older people with type 2 diabetes mellitus: the Edinburgh Type 2 Diabetes Study. Diabetologia 2015; 58:1484-93. [PMID: 25820150 PMCID: PMC4473275 DOI: 10.1007/s00125-015-3575-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/04/2015] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS We examined the association of prevalent and incident cardiovascular disease (CVD) with chronic liver disease in a cohort of community-based people with type 2 diabetes, in order to clarify the relationship between these two important conditions. METHODS 1,066 participants with type 2 diabetes aged 60-75 years underwent assessment of a range of liver injury markers (non-specific injury, steatosis, steatohepatitis, fibrosis, portal hypertension). Individuals were followed up for incident cardiovascular events. RESULTS At baseline there were 370/1,033 patients with prevalent CVD, including 317/1,033 with coronary artery disease (CAD). After a mean follow-up of 4.4 years there were 44/663 incident CVD events, including 27/663 CAD events. There were 30/82 CVD-related deaths. Risk of dying from or developing CVD was no higher in participants with steatosis than in those without (HR 0.90; 95% CI 0.40, 2.00; p > 0.05). The only notable relationship was with γ-glutamyltransferase (GGT) (incident CVD: adjusted HR for doubling GGT 1.24 [95% CI 0.97, 1.59] p = 0.086; incident CAD: adjusted HR 1.33 [95% CI 1.00, 1.78] p = 0.053), suggesting that in our study population, chronic liver disease may have little effect on the development of, or mortality from, CVD. CONCLUSIONS/INTERPRETATION An independent association between GGT and CVD warrants further exploration as a potentially useful addition to current cardiovascular risk prediction models in diabetes. However, overall findings failed to suggest that there is a clinical or pathophysiological association between chronic liver disease and CVD in elderly people with type 2 diabetes.
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Affiliation(s)
- Joanne R Morling
- Centre for Population Health Sciences, University of Edinburgh, Old Medical Buildings, Teviot Place, Edinburgh, EH8 9AG, UK,
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Morling JR, Fallowfield JA, Williamson RM, Nee LD, Jackson AP, Glancy S, Reynolds RM, Hayes PC, Guha IN, Strachan MWJ, Price JF. Non-invasive hepatic biomarkers (ELF and CK18) in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Liver Int 2014; 34:1267-77. [PMID: 24237940 DOI: 10.1111/liv.12385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 11/09/2013] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS Type 2 diabetes is an established risk factor for the presence and progression of fatty liver. Little is known about the distributions and correlates of hepatic non-invasive biomarkers in community-based populations with diabetes, unselected for liver disease. We aimed to identify the distribution of, and metabolic risk factors associated with serum cytokeratin-18 (CK18) and the Enhanced Liver Fibrosis score (ELF), in a large, representative cohort of people with type 2 diabetes (the Edinburgh Type 2 Diabetes Study, ET2DS). METHODS Nine hundred and thirty-nine ET2DS participants, aged 60-74 years underwent physical examination including ultrasound for assessment of liver fat. Representative subgroups were assessed for markers of chronic liver disease (CK18 and ELF). RESULTS CK18 values ranged from 29-993 U/L (median 102, IQR 76-137 U/L) and ELF scores ranged from 6.9-11.6 (mean 8.9, SD 0.8). Statistically significant associations were found between both biomarkers and a number of metabolic risk factors. Neither CK18 nor ELF was consistently or strongly associated with established hepatic risk factors (alcohol excess, hepatotoxic medication use and positive immunology titres). CONCLUSIONS We identified the distribution of CK18 and ELF in a large cohort of older people with type 2 diabetes and showed that these markers are associated with an adverse metabolic risk factor profile, although much of the variation in biomarkers remained unexplained. Prospective studies are required to determine the extent to which CK18 and/or ELF predict the development of symptomatic liver disease and to identify additional risk factors which may influence the development of advanced liver disease in people with type 2 diabetes.
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Affiliation(s)
- Joanne R Morling
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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15
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Davis ZA, Fascì-Spurio F, Kennedy NA, Wong L, MacLean P, Glancy S, Satsangi J, Lees CW. Interobserver agreement of small bowel Crohn's disease features in MR enterography: derivation of a MR severity score. Clin Radiol 2014. [DOI: 10.1016/j.crad.2014.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Laird A, Couper CH, Glancy S, O'Donnell M, Riddick ACP. Renal cell carcinoma needle biopsy: sowing the seed for later complications? BMJ Case Rep 2014; 2014:bcr-2014-203691. [PMID: 24788630 DOI: 10.1136/bcr-2014-203691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pathological examination of a radical nephrectomy for papillary renal cell carcinoma showed tumour present within the perinephric fat, with a morphology indicative of iatrogenic tumour cell tracking caused by previous biopsy of the mass. This is a rare complication of percutaneous biopsy, and as this procedure is becoming more common in investigating renal masses, it is important that the professionals are aware of the potential risks posed by renal mass biopsy.
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Affiliation(s)
- Alexander Laird
- Department of Urology, University of Edinburgh, Edinburgh, UK
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17
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Morling JR, Fallowfield JA, Guha IN, Nee LD, Glancy S, Williamson RM, Robertson CM, Strachan MWJ, Price JF. Using non-invasive biomarkers to identify hepatic fibrosis in people with type 2 diabetes mellitus: the Edinburgh type 2 diabetes study. J Hepatol 2014; 60:384-91. [PMID: 24512822 DOI: 10.1016/j.jhep.2013.10.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 09/05/2013] [Accepted: 10/09/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS It is difficult to determine the different stages of non-alcoholic fatty liver disease without the use of invasive liver biopsy. In this study we investigated five non-invasive biomarkers used previously to detect hepatic fibrosis and determined the level of agreement between them in order to inform future research. METHODS In the Edinburgh Type 2 Diabetes Study, a population-based cohort aged 60-74 years with type 2 diabetes, 831 participants underwent ultrasound assessment for fatty liver and had serum aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), aspartate to platelet ratio index (APRI), European Liver Fibrosis panel (ELF), Fibrosis-4 Score (FIB4) and liver stiffness measurement (LSM) measured. RESULTS Literature based cut-offs yielded marked differences in the proportions of the cohort with probable liver fibrosis in the full cohort. Agreement between the top 5% of the distribution for each biomarker pair was poor. APRI and FIB4 had the best positive agreement at 76.4%, but agreement for all of the other serum biomarker pairs was between 18% and 34%. Agreement with LSM was poor (9-16%). CONCLUSIONS We found poor correlation between the five biomarkers of liver fibrosis studied. Using the top 5% of each biomarker resulted in good agreement on the absence of advanced liver disease but poor agreement on the presence of advanced disease. Further work is required to validate these markers against liver biopsy and to determine their predictive value for clinical liver-related endpoints, in a range of different low and high risk population groups.
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Wong LF, Glancy S. Accuracy of minimal-preparation computerized tomography in the investigation of suspected colorectal cancer in frail patients: the experience of Western General Hospital, Edinburgh. Scott Med J 2012; 57:131-5. [PMID: 22859802 DOI: 10.1258/smj.2012.012016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Traditional methods of investigating suspected colorectal carcinoma (CRC) such as barium enema, colonoscopy and computerized tomography (CT) pneumocolon are often poorly tolerated by frail or elderly patients. Comparatively, minimal-preparation CT (MPCT) is a non-invasive investigation that does not require bowel preparation. The aim of this study was to review MPCTs carried out at the Western General Hospital, Edinburgh, and compare findings with current published data. Retrospective analysis of 85 patients (age range 55-99 years) who underwent MPCTs at the Western General Hospital between May 2005 and June 2008 was undertaken. Results were followed up using clinical notes, pathological and surgical databases. Subsequent outcomes were analysed (average follow-up 22 months). The prevalence of CRC within the study cohort was 0.14. Sensitivity of MPCT was 1 (95% confidence interval [CI], 0.69-1) with a specificity of 0.93 (95% CI, 0.84-0.97). Thirty percent of patients were found to have extracolonic findings requiring further investigation or intervention. Of the patients, 4.7% had an extracolonic malignancy diagnosed on MPCT. MPCT is a sensitive and specific method of investigating CRC in the elderly, infirm or immobile. Our results were found to be comparable with that of current published data, validating the service provided at the Western General Hospital.
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Affiliation(s)
- L F Wong
- Department of Radiology, Western General Hospital, Edinburgh, Scotland, UK.
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19
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Abstract
BACKGROUND Type 2 diabetes is a risk factor for progression of non-alcoholic fatty liver disease (NAFLD) to fibrosis and cirrhosis. We examined the prevalence of advanced liver disease in people with type 2 diabetes and analysed the effectiveness of liver function tests (LFTs) as a screening tool. METHODS Participants (n = 939, aged 61-76 years) from the Edinburgh Type 2 Diabetes Study, a randomly selected population of people with type 2 diabetes, underwent abdominal ultrasonography. Hyaluronic acid (HA) and platelet count/spleen diameter ratio (PSR) were used as non-invasive markers of hepatic fibrosis and portal hypertension. Subjects were screened for secondary causes of liver disease that excluded them from a diagnosis of NAFLD. The efficacy of LFTs [alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT)] in screening for liver disease was determined. RESULTS Cirrhosis was identified by ultrasound in four participants (0.4%). Ten (1.1%) had evidence of portal hypertension (PSR < 909), and two (0.2%) had hepatocellular carcinoma. Fifty-three participants (5.7%) had evidence of hepatic fibrosis (HA > 100 ng/ml in the absence of joint disease); a further 169 had HA > 50 ng/ml. In participants with NAFLD-related fibrosis (HA > 100 ng/ml), 12.5% had an elevated ALT level and 17.5% had an elevated GGT level. CONCLUSION The prevalence of hepatic fibrosis and cirrhosis were lower than expected. The use of LFTs to screen for liver disease missed most cases of fibrosis predicted by raised HA levels.
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Affiliation(s)
- R M Williamson
- Metabolic Unit, Western General Hospital, Edinburgh EH4 2XU, UK.
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20
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Morling J, Williamson R, Strachan M, Price J, Glancy S, Nee L. P2-201 Changes in aminotransferases indicate changes in hepatosteatosis in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Morling J, Williamson R, Strachan M, Price J, Nee L, Glancy S. P2-202 Thiazolidinediones are associated with regression of hepatosteatosis in people with type 2 diabetes: the Edinburgh type 2 diabetes study. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976j.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mallet F, Castellanos-Beltran MA, Ku HS, Glancy S, Knill E, Irwin KD, Hilton GC, Vale LR, Lehnert KW. Quantum state tomography of an itinerant squeezed microwave field. Phys Rev Lett 2011; 106:220502. [PMID: 21702586 DOI: 10.1103/physrevlett.106.220502] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Indexed: 05/31/2023]
Abstract
We perform state tomography of an itinerant squeezed state of the microwave field prepared by a Josephson parametric amplifier (JPA). We use a second JPA as a preamplifier to improve the quantum efficiency of the field quadrature measurement from 2% to 36%±4%. Without correcting for the detection inefficiency we observe a minimum quadrature variance which is 68(-7)(+9)% of the variance of the vacuum. We reconstruct the state's density matrix by a maximum likelihood method and infer that the squeezed state has a minimum variance less than 40% of the vacuum, with uncertainty mostly caused by calibration systematics.
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Affiliation(s)
- F Mallet
- JILA, National Institute of Standards and Technology and the University of Colorado, Boulder, Colorado 80309, USA
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Williamson RM, Price JF, Glancy S, Perry E, Nee LD, Hayes PC, Frier BM, Van Look LAF, Johnston GI, Reynolds RM, Strachan MWJ. Prevalence of and risk factors for hepatic steatosis and nonalcoholic Fatty liver disease in people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study. Diabetes Care 2011; 34:1139-44. [PMID: 21478462 PMCID: PMC3114489 DOI: 10.2337/dc10-2229] [Citation(s) in RCA: 282] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Type 2 diabetes is an established risk factor for development of hepatic steatosis and nonalcoholic fatty liver disease (NAFLD). We aimed to determine the prevalence and clinical correlates of these conditions in a large cohort of people with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 939 participants, aged 61-76 years, from the Edinburgh Type 2 Diabetes Study (ET2DS)-a large, randomly selected population of people with type 2 diabetes-underwent liver ultrasonography. Ultrasound gradings of steatosis were compared with magnetic resonance spectroscopy in a subgroup. NAFLD was defined as hepatic steatosis in the absence of a secondary cause (screened by questionnaire assessing alcohol and hepatotoxic medication use, plasma hepatitis serology, autoantibodies and ferritin, and record linkage to determine prior diagnoses of liver disease). Binary logistic regression was used to analyze independent associations of characteristics with NAFLD. RESULTS Hepatic steatosis was present in 56.9% of participants. After excluding those with a secondary cause for steatosis, the prevalence of NAFLD in the study population was 42.6%. Independent predictors of NAFLD were BMI, lesser duration of diabetes, HbA(1c), triglycerides, and metformin use. These remained unchanged after exclusion of participants with evidence of hepatic fibrosis from the group with no hepatic steatosis. CONCLUSIONS Prevalences of hepatic steatosis and NAFLD were high in this unselected population of older people with type 2 diabetes, but lower than in studies in which ultrasound gradings were not compared with a gold standard. Associations with features of the metabolic syndrome could be used to target screening for this condition.
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Abstract
Most quantum computation schemes propose encoding qubits in two-level systems. Others exploit the use of an infinite-dimensional system. In "Encoding a qubit in an oscillator" [Phys. Rev. A 64, 012310 (2001)], Gottesman, Kitaev, and Preskill (GKP) combined these approaches when they proposed a fault-tolerant quantum computation scheme in which a qubit is encoded in the continuous position and momentum degrees of freedom of an oscillator. One advantage of this scheme is that it can be performed by use of relatively simple linear optical devices, squeezing, and homodyne detection. However, we lack a practical method to prepare the initial GKP states. Here we propose the generation of an approximate GKP state by using superpositions of optical coherent states (sometimes called "Schrödinger cat states"), squeezing, linear optical devices, and homodyne detection.
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Affiliation(s)
- H M Vasconcelos
- Departamento de Engenharia de Teleinformática, Universidade Federal do Ceará, Fortaleza, Brazil.
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Parisinos CA, McIntyre VED, Heron T, Subedi D, Arnott IDR, Mowat C, Wilson DC, McGurk S, Glancy S, Zealley IA, Satsangi J, Lees CW. Magnetic resonance follow-through imaging for evaluation of disease activity in ileal Crohn's disease: an observational, retrospective cohort study. Inflamm Bowel Dis 2010; 16:1219-26. [PMID: 19924804 DOI: 10.1002/ibd.21168] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Magnetic resonance follow-through (MRFT) is a new cross-sectional imaging modality with the potential to accurately stage ileal Crohn's disease (CD), while avoiding ionizing radiation and the discomfort associated with enteroclysis. We aimed to assess the reliability of this technique in assessing the extent and activity of ileal CD, and to assess its influence on subsequent management. METHODS Out of a total of 342 patients undergoing MRFT between 2004 and 2008, 221 were performed in 191 patients with confirmed CD. Case notes were reviewed in detail with documentation of all investigations pre- and post-MRFT. Agreement between inflammatory markers, histopathology, and MRFT findings was determined. RESULTS Overall, 116/221 (52.5%) of MRFTs showed active ileal CD, and 76/221 (34.4%) quiescent CD, while 29/221 (13.1%) were suboptimal. Overall, 66 strictures and 18 fistulae were identified. There was substantial agreement between active ileal CD on MRFT and histopathology (n = 59; kappa = 0.66; P = 0.0006; sensitivity 85.1%, specificity 85.7%) and fecal calprotectin (n = 14; kappa = 0.72; P = 0.047), while C-reactive protein (CRP) showed moderate agreement (n = 107; kappa = 0.402; P = 0.00028). Management was influenced by MRFT reports following active (52/84, 62% treated medically) or quiescent (48/62, 77.4% managed conservatively) disease. Fibrotic strictures were predominantly treated surgically (7/14, 50%). In all, 13/32 (40.6%) patients with inflammatory ileal strictures required surgery, mostly due to steroid-resistant disease. Overall, 75 MR findings were documented in 221 MRFTs, including 1 renal cancer. CONCLUSIONS MRFT provides accurate information on ileal CD activity, with close agreement to inflammatory markers and histopathology. It represents a substantial advance in the staging of CD, while avoiding painful enteroclysis and radiation exposure in young patients.
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Affiliation(s)
- C A Parisinos
- Gastrointestinal Unit, Molecular Medicine Centre, University of Edinburgh, Western General Hospital, Edinburgh, UK
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Sharkey J, Palmer KR, Arnott IDR, Glancy S. Multiple liver lesions in a smoker. Case Reports 2009; 2009:bcr2006104893. [DOI: 10.1136/bcr.2006.104893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Scott DA, Glancy S. Spontaneous resolution of a giant colonic diverticulum. Clin Radiol 2008; 63:833-5. [PMID: 18555044 DOI: 10.1016/j.crad.2007.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Revised: 08/12/2007] [Accepted: 08/20/2007] [Indexed: 12/16/2022]
Affiliation(s)
- D A Scott
- Western General Hospital, Crewe Rd South, Edinburgh, EH4 2XU, UK.
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Abstract
OBJECTIVE Colonic obstruction may be relieved by the insertion of a self-expanding metallic stent (SEMS), either for permanent palliative relief or as a bridge to surgery. Lesions proximal to the descending colon can be more difficult to intubate and stent [1]. SEMS placement in the more proximal colon lesions has been reported in only a few cases [2,4]. The aim of this study was to review the outcome of SEMS for obstruction at the splenic flexure and above. METHOD A study of all colonic stents inserted in one specialist unit was undertaken. Patients' demographics, site and aetiology of the underlying obstruction, success or other outcome of the procedures were collected. Thirty-day morbidity and mortality were documented. RESULTS Seven patients had proximal lesions: four in the transverse colon and three at the splenic flexure. Six patients had colorectal carcinoma and one had extrinsic compression from a gastric carcinoma. Six of the SEMS were inserted for permanent palliation, and one as a bridge to surgery. Stent placement was technically successful in six of the seven patients. In the seventh patient, there was a failure of expansion of the stent, after successful intubation of the lesion, which was in the distal transverse colon. One patient suffered from minor self-limiting abdominal pain in the first 24 h after the procedure. There was no other SEMS related morbidity or mortality. All of the successfully stented patients were discharged from the surgical ward within 3 days after the procedure. Median survival time was 4.3 months (range 3-12 months). Three patients are still alive. CONCLUSION The SEMS is a useful tool in managing acute bowel obstruction. Placement of colonic stents proximal to the descending colon is safe, feasible and effective.
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Affiliation(s)
- B Elsberger
- Colorectal Unit, Western General Hospital, Edinburgh, UK.
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Sharkey J, Palmer KR, Arnott IDR, Glancy S. Multiple liver lesions in a smoker. Gut 2007; 56:1336, 1352. [PMID: 17872563 PMCID: PMC2000238 DOI: 10.1136/gut.2006.104893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- J Sharkey
- Gastrointestinal Unit, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
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Gilchrist A, Nemoto K, Munro WJ, Ralph TC, Glancy S, Braunstein SL, Milburn GJ. Schrödinger cats and their power for quantum information processing. ACTA ACUST UNITED AC 2004. [DOI: 10.1088/1464-4266/6/8/032] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
There is debate as to the optimal management of children with hip joint effusions especially regarding the decision to aspirate. The objective of this study was to determine whether there is a need to aspirate hip joint effusions detected on ultrasound in patients with clinical transient synovitis (TS) and to identify the natural history of these effusions. Twenty-five children with proven hip joint effusions were followed up sequentially by clinical and radiological examination until symptom free. The mean age was 6 years with equal right/left distribution. No child underwent hip aspiration and no cases of sepsis were missed. The median size of hip effusion detected on ultrasound at presentation was 9 mm. At 7 days 60% (15/25) of patients had a normal clinical examination with no detectable effusion on ultrasound. At 14 days 16% (4/25) had an effusion detectable on ultrasound but they were all pain and limp free and their effusions were reducing in size. These results support the known benign nature of TS and that it will settle with conservative treatment.
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Affiliation(s)
- J Skinner
- Department of Accident and Emergency Medicine, Royal Hospital for Sick Children, Edinburgh, UK
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