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    <recommendedItem id="20100101_19_226"
                     title="ASCO GI: Blood Test Detects Colorectal Cancer"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/ASCOGI/tb/18079?impressionId=1265782487361"
                     
      &lt;p&gt;ORLANDO  --  A novel blood test that measures CD24 protein levels may detect early colorectal cancer and precancerous adenomas, researchers found.&lt;/p&gt;
&lt;p&gt;The investigational assay had 78.4%% sensitivity and 86.8% specificity for distinguishing patients with colorectal adenoma or cancer from healthy controls in a study led by Sarah Kraus, PhD, of Tel Aviv Souraski Medical Center in Israel.&lt;/p&gt;
&lt;p&gt;Further validation for the biomarker would be needed before considering clinical use in surveillance, they cautioned here at the ASCO Gastrointestinal Cancers Symposium.&lt;/p&gt;
&lt;p&gt;But the results were exciting and could represent &quot;a very significant advance,&quot; commented Robert P. Sticca, MD, of the University of North Dakota in Grand Forks.&lt;/p&gt;
&lt;p&gt;&quot;It looks like it may be a very reliable marker for not only the early detection of colon cancer and even precancerous conditions, but also could be used for follow-up for patients who previously had cancer for recurrence,&quot; he said as moderator of a press briefing at which the results were discussed.&lt;/p&gt;
&lt;p&gt;Colorectal cancer screening is effective, with early detection and treatment shown to improve survival.&lt;/p&gt;
&lt;p&gt;However, colorectal cancer is often diagnosed at a late stage with poor prognosis, in part because of &lt;a href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; mce_href=&quot;http://www.medpagetoday.com/Gastroenterology/ColonCancer/10115&quot; target=&quot;_blank&quot;&gt;poor uptake of colonoscopy&lt;/a&gt;, Kraus said at the press briefing.&lt;/p&gt;
&lt;p&gt;Unfortunately, there are no sufficiently accurate blood-based screening tests, he noted, although there have been &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ECCO-ESMO/16057&quot; target=&quot;_blank&quot;&gt;attempts&lt;/a&gt; to develop them.&lt;/p&gt;
&lt;p&gt;Her group had previously found that the CD24 protein  --  expressed on the cell surface, where it plays a role in cell adhesion and metastasis  --  was associated with development of colorectal cancer in a gene expression study.&lt;/p&gt;
&lt;p&gt;So, with two independent cohorts, they tested whether CD24 could be a good biomarker for colorectal cancer.&lt;/p&gt;
&lt;p&gt;The first cohort included 63 patients with colorectal cancer, 19 with adenoma, and 68 controls with a clean bill of health on colonoscopy. Of these 150 individuals, 143 were externally evaluated by a blinded investigator.&lt;/p&gt;
&lt;p&gt;CD24 expression was nearly six-fold higher among adenoma and colorectal cancer cases than among controls, a significant difference. Levels were similar between the cancer and adenoma groups.&lt;/p&gt;
&lt;p&gt;The second cohort included 73 subjects: 38 normal controls, 24 with colorectal adenoma, and 11 with colorectal cancer.&lt;/p&gt;
&lt;p&gt;The test could distinguish colorectal cancer cases from controls with &quot;relatively high&quot; sensitivity and specificity (92.3% and 83.8%, respectively), Kraus said.&lt;/p&gt;
&lt;p&gt;Its performance in detecting adenoma versus normal colonoscopy results was lower, 75.0% sensitivity and 89.2% specificity.&lt;/p&gt;
&lt;p&gt;Kraus said her group is now testing this CD24 approach in a larger sample and developing an enzyme-linked immunosorbent assay (ELISA) that could be more widely used.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_3483"
                     title="ACG: &lt;em&gt;C. Difficile Spreads&lt;/em&gt; from Hospital to Community (CME/CE)"
                     score="-0.006"
                     href="http://www.medpagetoday.com/MeetingCoverage/ACG/tb/16727?impressionId=1265782487361"
                     
      &lt;p&gt;SAN DIEGO  --  &lt;em&gt;Clostridium difficile&lt;/em&gt; infection has spread from the hospital to the community but has proved manageable thus far, according to data reported here.&lt;/p&gt;
&lt;p&gt;From 1991 to 2005, the incidence of community-acquired &lt;em&gt;C. difficile&lt;/em&gt; in Olmsted County, Minn., quadrupled but still remained less common than the hospital-acquired gastrointestinal infection, Sahil Khanna, MD, of the Mayo Clinic in Rochester, Minn., said at the American College of Gastroenterology meeting.&lt;/p&gt;
&lt;p&gt;&quot;Patients with community-acquired &lt;em&gt;C. difficile&lt;/em&gt; infection were younger, more likely to be female, and less likely to have severe infections,&quot; Khanna observed.&lt;/p&gt;
&lt;p&gt;Epidemiologic studies have shown an increasing incidence of both nosocomial and community-acquired infections. However, few studies have looked at the incidence of community-acquired &lt;em&gt;C. difficile&lt;/em&gt;, said Khanna.&lt;/p&gt;
&lt;p&gt;Moreover, no population-based studies have included comparisons of nosocomial and community-acquired infection.&lt;/p&gt;
&lt;p&gt;To examine recent trends in &lt;em&gt;C. difficile&lt;/em&gt; infection, researchers examined computer-linked records of patients in Olmsted County, which includes the Mayo Clinic, and identified all cases of &lt;em&gt;C. difficile &lt;/em&gt;documented from 1991 to 2005. Diagnosis was based on a positive stool assay and appearance of pseudomembranous colitis.&lt;/p&gt;
&lt;p&gt;Investigators defined severe disease as infection associated with a white blood cell count &amp;gt;15,000/mm&lt;sup&gt;3&lt;/sup&gt; and a rise in serum creatinine of more than 50% from baseline.&lt;/p&gt;
&lt;p&gt;Severely complicated infection included the same criteria plus hypotension, ileus, toxic megacolon, perforation, ICU admission, surgery, or death.&lt;/p&gt;
&lt;p&gt;The review uncovered 385 cases of &lt;em&gt;C. difficile&lt;/em&gt; infection. Nosocomial infection accounted for 192 cases, nursing homes for 35, and community-acquired infection for 158 cases. Patients with nosocomial infections had a median age of 72 compared with 50 for patients with community-acquired infection (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001). Additionally, women accounted for 60% of hospital-acquired versus 75% of community-acquired cases (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Overall, the infection rate increased from fewer than 10 cases per 100,000 person-years during 1991 to 1993 to about 45 cases per 100,000 person-years during 2003 to 2005.&lt;/p&gt;
&lt;p&gt;The rate among women exceeded 50 cases per 100,000 person years and was significantly higher than the rate in men (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Broken down by source, the rate of nosocomial &lt;em&gt;C. difficile&lt;/em&gt; infection increased from fewer than five cases per 100 hospital bed-years to about 16 cases during the period reviewed and was similar among men and women.&lt;/p&gt;
&lt;p&gt;The overall rate of community-acquired infection increased from about three cases per 100,000 person-years to more than 12 cases per 100,000 person-years.&lt;/p&gt;
&lt;p&gt;The rate in women exceeded 20 cases per 100,000 person-years during 2000 to 2002 before decreasing to 17 to 18 cases per 100,000 person-years during 2003 to 2005 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Infection was associated with antibiotic use within the previous 90 days in 94% of the hospital-acquired cases and 78% of the community-acquired infections.&lt;/p&gt;
&lt;p&gt;About 20% of community-acquired infections met criteria for severe illness, compared with about 35% of nosocomial infections (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;Metronidazole was the choice for initial therapy in 84% of community cases and 91% of nosocomial cases. Metronidazole failure occurred in about 20% of cases in both groups, and the rate of recurrent infection was about 30% in both groups.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by ViroPharma and the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Khanna and co-investigators reported no disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_2_976"
                     title="ACG: GERD Patients on PPIs Still Have Reflux"
                     score="-0.006"
                     href="