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Atrophic gastritis: Risk factor for esophageal squamous cell carcinoma in a Latin-American population

World Journal of Gastroenterology 2013年第13期19卷 2060-2064页

作者： Emiliano de Carvalho Almodova Walmar Kerche de Oliveira Lucas Faria Abraho Machado Juliana Rigotto Grejo thiago rabelo da cunha Wagner Colaiacovo Erika Veruska Paiva Ortolan Endoscopy Department Cancer Hospital of Barretos Surgery Post Graduate Course Botucatu Medical SchoolState of Sao Paulo University Surgery and Orthopedics Department Botucatu Medical SchoolState of Sao Paulo University Pathology Department Cancer Hospital of Barretos Endoscopy Department Botucatu Medical SchoolState of Sao Paulo University

AIM: To study the association between atrophic gastritis (AG) and esophageal squamous cell carcinoma (ESCC) in a Latin-America population. METHODS: A case-control study was performed at two reference Brazilian hospitals including patients diagnosed with advanced ESCC and dyspeptic patients who had been subjected to upper gastrointestinal endoscopy, with biopsies of the gastric antrum and *** cases with ESCC were reviewed by a single pathologist, who applied standard criteria for the diagnosis of mucosal atrophy, intestinal metaplasia, and dysplasia, all classified as AG. The data on the patients' age, sex, smoking status, and alcohol consumption were collected from clinical records, and any missing information was completed by telephone interview. The association between AG and ESCC was assessed by means of univariate and multiple conditional logistic regressions. RESULTS: Most patients were male, and the median age was 59 years (range: 37-79 years) in both the ESCC and control groups. Univariate analysis showed that an intake of ethanol greater than 32 g/d was an independent risk factor that increased the odds of ESCC 7.57 times (P = 0.014); upon multiple analysis, alcohol intake of ethanol greater than 32 g/d exhibited a risk of 4.54 (P = 0.081), as adjusted for AG and smoking. Smoking was shown to be an independent risk factor that increased the odds of ESCC 14.55 times (P = 0.011) for individuals who smoked 0 to 51 packs/year and 21.40 times (P = 0.006) for those who smoked more than 51 packs/year. Upon multiple analyses, those who smoked up to 51 packs/year exhibited a risk of 7.85 (P = 0.058), and those who smoked more than 51 packs/ year had a risk 11.57 times higher (P = 0.04), as adjusted for AG and alcohol consumption. AG proved to be a risk factor that increased the odds of ESCC 5.33 times (95%CI: 1.55-18.30, P = 0.008) according to the results of univariate conditional logistic regression. CONCLUSION: There was an association by univariate condition

关键词： Atrophic gastritis Esophagus Squamous cell carcinoma Risk factor Alcohol Tobacco

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Accuracy of gestalt perception of acute chest pain in predicting coronary artery disease

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World Journal of Cardiology 2017年第3期9卷 241-247页

作者： Cláudio Marcelo Bittencourt das Virgens Laudenor Lemos Jr Márcia Noya-rabelo Manuela Campelo Carvalhal Antonio Maurício dos Santos Cerqueira Junior Fernanda Oliveira de Andrade Lopes Nicole Cruz de Sá Jéssica Gonzalez Suerdieck thiago Menezes Barbosa de Souza Vitor Calixto de Almeida Correia Gabriella Sant’Ana Sodré AndréBarcelos da Silva Felipe Kalil Beirao Alexandre Felipe Rodrigues Marques Ferreira Luís Cláudio Lemos Correia Department of Cardiology Hospital Sao Rafael Department of Cardiology Hospital Português Bahiana School of Medicine and Public Health

AIM To test accuracy and reproducibility of gestalt to predict obstructive coronary artery disease(CAD)in patients with acute chest *** We studied individuals who were consecutively admitted to our Chest Pain *** admission,investigators performed a standardized interview and recorded14 chest pain *** on these features,a cardiologist who was blind to other clinical characteristics made unstructured judgment of CAD probability,both numerically and *** the reference standard for testing the accuracy of gestalt,angiography was required to rule-in CAD,while either angiography or non-invasive test could be used to *** order to assess reproducibility,a second cardiologist did the same *** In a sample of 330 patients,the prevalence of obstructive CAD was 48%.Gestalt’s numerical probability was associated with CAD,but the area under the curve of0.61(95%CI:0.55-0.67)indicated low level of ***,categorical definition of typical chest pain had a sensitivity of 48%(95%CI:40%-55%)and specificity of 66%(95%CI:59%-73%),yielding a negligible positive likelihood ratio of 1.4(95%CI:0.65-2.0)and negative likelihood ratio of 0.79(95%CI:0.62-1.02).Agreement between the two cardiologists was poor in the numerical classification(95%limits of agreement=-71%to 51%)and categorical definition of typical pain(Kappa=0.29;95%CI:0.21-0.37).CONCLUSION Clinical judgment based on a combination of chest pain features is neither accurate nor reproducible in predicting obstructive CAD in the acute setting.

关键词： Acute chest pain Clinical judgment Gestalt Coronary artery disease Acute coronary syndrome

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