Raman spectroscopy: elucidation of biochemical changes in carcinogenesis of oesophagus

Several techniques are under development to diagnose oesophageal adenocarcinoma at an earlier stage. We have demonstrated the potential of Raman spectroscopy, an optical diagnostic technique, for the identification and classification of malignant changes. However, there is no clear recognition of the biochemical changes that distinguish between the different stages of disease. Our aim is to understand these changes through Raman mapping studies. Raman spectral mapping was used to analyse 20-μm sections of tissue from 29 snap-frozen oesophageal biopsies. Contiguous haematoxylin and eosin sections were reviewed by a consultant pathologist. Principal component analysis was used to identify the major differences between the spectra across each map. Pseudocolour score maps were generated and the peaks of corresponding loads identified enabling visualisation of the biochemical changes associated with malignancy. Changes were noted in the distribution of DNA, glycogen, lipids and proteins. The mean spectra obtained from selected regions demonstrate increased levels of glycogen in the squamous area compared with increased DNA levels in the abnormal region. Raman spectroscopy is a highly sensitive and specific technique for demonstration of biochemical changes in the carcinogenesis of Barrett's oesophagus. There is potential for in vivo application for real-time endoscopic optical diagnosis

Decision analysis of Histamine H₂ - Receptor Antagonist Maintenance Therapy versus <em>Helicobacter Pylori</em> Eradication Therapy

Background: Much has been published on the efficacy and cost effectiveness of Helicobacter pylori eradication treatment as an alternative to histamine H2-receptor antagonist maintenance treatment in peptic ulcer disease. However, most studies have analysed and emphasised H. pylori eradication rates rather than management/control of symptoms and the associated cost savings. Although H. pylori eradication therapy is very successful in clearing the infection, dyspeptic symptoms may persist and management of these can be expensive.Objective: The aim of this studywas to assess the cost implications in controlling symptoms using either H2-receptor antagonist maintenance therapy or H. pylori eradication therapy in patients with duodenal ulcer disease.Design: This was a non-blind, prospective, randomised, parallel-group study comparing maintenance H2-receptor antagonist treatment using ranitidine with H. pylori eradication therapy, with a 1-year follow-up.Setting: This was a study of outpatients from general practices in Dundee, Scotland, or the Ninewells Hospital, Dundee, gastroenterology clinic.Patients and participants: 119 patientswith confirmed duodenal ulcer, free from active ulceration at study entry but positive for H. pylori infection, who were receiving maintenance H2-receptor antagonist therapy.Interventions: Patients were randomised to receive either continuing maintenance therapy with ranitidine (initially 150mg daily; 58 patients) or H. pylori eradication therapy using an omeprazole/amoxicillin/metronidazole regimen (or omeprazole/clarithromycin if allergic to penicillin).Main outcome measures and results: Overall, H. pylori eradication rates were 100% per protocol and 95.1% intention-to-treat. At completion of 1 year of follow-up, 12 of the 61 (19.7%) patients successfully eradicated of H. pylori were still dependent on acid suppression for symptom relief. H. pylori eradication treatment was the least-cost strategy in managing/controlling symptoms at 1 year (£168 vs £210 per patient; 1996 values). However, over time, post-eradication treatment costs were greater than H2-receptor antagonist therapy costs. Any potential savings were directly related to the proportion of patients needing further treatment post-eradication, the cost of endoscopy and the urea breath test.Conclusions: If dyspepsia persists long term, H. pylori eradication treatment may not be the least-cost option for patients with duodenal ulcer

Appropriate aspirations for effective post-mining restoration and rehabilitation: a response to Kaźmierczak et al.

Confusion surrounding the definition and application of terminology in post-mining ecological repair has resulted in uncertainty for industry, the scientific community and regulators. This lack of clarity may underrepresent high aspirations or could be misused to disguise low aspirations and so is problematic for setting objectives, establishing goals and assessing recovery trajectories. We respond to a recently published analysis of the ecosystem repair literature, where we highlight inconsistencies stemming from inadequate reference to a large proportion of the restoration and rehabilitation literature. We outline increasingly well-accepted and internationally applied definitions concerning the restoration and recovery process and invite both the mining industry and policy-makers to re-examine their terminology in the interests of attaining an internationally agreed nomenclature. Clarity in the use and understanding of terminology will align post-mining targets with community expectation, enhance the capacity of the mining industry to understand and meet these targets, and foster better analysis and more industry-relevant discussion of recovery methodologies by the scientific community and practitioners