The use of complementary and alternative medicine is frequent in patients with pancreatic disorder

BACKGROUND: Herbal remedies and other complementary and alternative medicine (CAM) are used by 30% of the patients with liver and inflammatory bowel diseases. However, there are no data regarding CAM use in patients with pancreatic disorders, including potential pancreatotoxicity. AIM OF THE STUDY: The aim of the study was to assess the prevalence of CAM use in patients with pancreatic disorders and screen for pancreatotoxicity. MATERIALS AND METHODS: This was a cross-sectional survey of consecutive outpatients seen at a Pancreas Center. Data were collected in a specific questionnaire. Descriptive statistics were used to analyze the prevalence and the patterns of CAM use. Characteristics associated with CAM use were analyzed by appropriate statistics. RESULTS: Of 108 patients (52% male; mean age, 65±13 years), 47 (43.5%) used CAM. The use of CAM was more frequent among patients with previous acute pancreatitis (47%). Reported reasons for the use of CAM were to help standard therapies and for an overall better feeling. About 61% of the patients reported advantages with treatment. As compared with nonusers, CAM users were more often female (55% vs. 42%), with a higher school degree (43% vs. 36%), more frequently performing physical activity (51% vs. 41%), and reporting anxiety (45% vs. 31%). However, none of these differences were statistically significant. Three patients with previous acute pancreatitis reported the use of Serenoa repens that is potentially pancreatotoxic. DISCUSSION: The rate of CAM use in patients with pancreatic disorders is similar to those reported for other digestive diseases. CAM use seems to be more frequent in women with a higher education level and a "healthier lifestyle." Patients might not be aware of the potential pancreatotoxicity of CAM, which should be carefully considered by physician

Modelling the role of consideration of alternatives in mode choice: An application on the Rome-Milan corridor

In this paper, we investigate the role consideration of the alternatives plays in mode choice models. On the Rome-Milan corridor, in Italy, where seven alternative modes of transport are available, we administered a stated choice (SC) experiment. Responses to supplementary questions on consideration of the different modes of transport and the presence of thresholds for the travel time attribute indicate travellers are less likely to consider the slower modes. Two model specifications, in which consideration for the slower alternatives is measured using both sets of supplementary questions, are proposed and contrasted against a model which assumes all alternatives are considered. Our results suggests that some of the unobserved preference heterogeneity could potentially be due to consideration effects. Accounting for consideration of alternatives also has direct impacts on choice probabilities, parameter estimates and willingness-to-pay measures

Modulation of PKM alternative splicing by PTBP1 promotes gemcitabine resistance in pancreatic cancer cells

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive and incurable disease. Poor prognosis is due to multiple reasons, including acquisition of resistance to gemcitabine, the first-line chemotherapeutic approach. Thus, there is a strong need for novel therapies, targeting more directly the molecular aberrations of this disease. We found that chronic exposure of PDAC cells to gemcitabine selected a subpopulation of cells that are drug-resistant (DR-PDAC cells). Importantly, alternative splicing (AS) of the pyruvate kinase gene (PKM) was differentially modulated in DR-PDAC cells, resulting in promotion of the cancer-related PKM2 isoform, whose high expression also correlated with shorter recurrence-free survival in PDAC patients. Switching PKM splicing by antisense oligonucleotides to favor the alternative PKM1 variant rescued sensitivity of DR-PDAC cells to gemcitabine and cisplatin, suggesting that PKM2 expression is required to withstand drug-induced genotoxic stress. Mechanistically, upregulation of the polypyrimidine-tract binding protein (PTBP1), a key modulator of PKM splicing, correlated with PKM2 expression in DR-PDAC cell lines. PTBP1 was recruited more efficiently to PKM pre-mRNA in DR- than in parental PDAC cells. Accordingly, knockdown of PTBP1 in DR-PDAC cells reduced its recruitment to the PKM pre-mRNA, promoted splicing of the PKM1 variant and abolished drug resistance. Thus, chronic exposure to gemcitabine leads to upregulation of PTBP1 and modulation of PKM AS in PDAC cells, conferring resistance to the drug. These findings point to PKM2 and PTBP1 as new potential therapeutic targets to improve response of PDAC to chemotherapy.Oncogene advance online publication, 3 August 2015; doi:10.1038/onc.2015.270

Apolipoprotein E (APOE) polymorphism influences serum APOE levels in Alzheimer's disease patients and centenarians.

Vascular factors may play a role in the etiology of Alzheimer’s disease (AD) and increased serum apolipoprotein E (APOE) levels in AD could be of interest, as APOE concentration is associated with vascular disease. Aims of this study were to evaluate the inluence of APOE genotype on serum APOE levels, and, secondly, to study serum APOE concentrations in relation to age and AD. APOE genotypes, serum total cholesterol, LDL cholesterol, HDL cholesterol, total cholesterol/HDL cholesterol ratio, triglycerides, and serum APOE were performed on 52 healthy centenarians, 49 AD patients, 45 age-matched controls, and 72 young healthy adults. In all study population a significant trend in reduction of serum APOE levels from APOE E2- to E4 carriers was observed.The diffeerence in serumAPOE levels amonga ge groups signi¢cantly decreased in E4 carriers only, includingH DL cholesterol; no significant differences between AD patients and age-matched controls were found. In these highly selected populations, APOE genotype distribution strongly influences serum APOE concentration, not suggesting, at present, a possible role as a biochemical marker for AD, but only as a putative longevity factor

Clinical application of mindfulness-oriented meditation: A preliminary study in children with ADHD

Mindfulness-oriented meditation (MOM) is a self-regulatory training used for attentional and behavioral problems. With its focus on attention, MOM is a promising form of training that is gaining empirical support as a complementary or alternative intervention for attention deficit/hyperactivity disorder (ADHD). In this study, we tested the preliminary efficacy of MOM training in children with ADHD, by comparing its efficacy with an active control condition (Emotion Education Program, EEP). Twenty-five children with ADHD aged 7\u201311 years participated in MOM training (n = 15) or EEP (n = 10) 3 times per week for 8 weeks. Neuropsychological and academic measures and behavioral, emotional, and mindfulness ratings were collected before and after the two programs. On average, MOM training had positive effects on neuropsychological measures, as evidenced by a significant mean improvement in all outcome measures after training. Moreover, positive effects on ADHD symptoms were found only in the MOM group. Although they are preliminary, our results documented that MOM training promotes changes in neuropsychological measures and in certain behavioral symptoms, suggesting it as a promising tool for ameliorating cognitive and clinical manifestations of ADHD

Stated consideration and attribute thresholds in mode choice models: a hierarchical ICLV approach

Consideration of alternatives, as many other aspects related to the decision-making process, is not observable and challenging to measure. Even when supplementary information is collected during stated choice experiments, its use as an additional explanatory variable is discouraged due to potential endogeneity issues, measurement error and limited suitability for forecasting. To overcome these limitations, we propose an Integrated Choice and Latent Variable model where consideration of an alternative is treated as a latent variable. The novelty of the presented model is that the latent variable for consideration of an alternative itself is a function of another set of latent variables that represent thresholds applied by the decision maker to individual attributes (such as travel time and cost). The proposed hierarchical relationship between latent thresholds and latent consideration enables us to explain a share of otherwise purely random heterogeneity, and identify the structural drivers of consideration. The latter is of interest to policymakers and private operators

Modelling regional accessibility to airports using discrete choice models: An application to a system of regional airports

In this paper, we analyse residents' decisions regarding airport access mode in Apulia, a relatively peripheral multi-airport region in Italy. Both revealed and stated preferences data are used to estimate probabilistic demand models. The results are employed to calculate the relevant elasticities, separately for airport users and non-users, with respect to dedicated existing and planned/potential public transport services. We measure the effectiveness of specific policies/actions aimed at generating a shift from private modes (car and taxi) towards public transport, rationalising mobility towards the existing airports. Accessibility is one of the key factors in airports' provision, and an efficient public transport system might represent both an alternative to opening “local” – often costly and inefficient – airports in the same catchment area and a means to exploit economies of scale aggregating demand for existing airports

Diagnostic delay does not influence survival of pancreatic cancer patients

Background: Most pancreatic ductal adenocarcinoma patients present with advanced disease. Whether it is possible to increase survival by earlier diagnosis is unclear. Objective: The purpose of this study was to investigate the association between presenting complaints and risk factors for pancreatic cancer with diagnostic delay, stage and survival. Methods: This was a single-centre retrospective cohort study. Consecutive patients were interviewed and data on demographics, medical history, risk factors and complaints leading to pancreatic ductal adenocarcinoma diagnosis and disease stage were recorded. Diagnostic delay was considered as time between first complaint and diagnosis. Patients received appropriate treatments and their outcome was recorded in a dedicated database. The Chi-square test for comparison of categorical variables and the Mann–Whitney test for continuous variables were employed with Bonferroni corrections. Correlation between continuous variables was evaluated by means of the Spearman correlation coefficient. Survival analysis was performed with the Kaplan–Meier method and a log-rank test. Results: The median diagnostic delay for 477 pancreatic ductal adenocarcinoma patients was two months (interquartile range 1–5), being significantly shorter for patients presenting with jaundice compared with those with pain, weight loss, diabetes (p < 0.001). The global rate of metastatic disease at diagnosis was 40%, being only 22% in those presenting with jaundice. The median diagnostic delay, however, was not significantly different among disease stages but was significantly longer in patients with a body mass index>25 kg/m2. The median survival time was seven months. Factors associated with worse survival at the multivariable analysis were older age (hazard ratio 1.02 per year), metastatic disease (hazard ratio 2.12) and pain as presenting complaint (hazard ratio 1.32), while diagnostic delay was not. Conclusion: While some complaints are associated with a shorter diagnostic delay and less advanced disease stage, we could not demonstrate that delay is associated with survival, possibly suggesting that prevention rather than early recognition is important to tackle pancreatic cancer lethality

Allowing for Heterogeneity in the Consideration of Airport Access Modes: The Case of Bari Airport

Mode choice models traditionally assume that all objectively available alternatives are considered. This might not always be a reasonable assumption, even when the number of alternatives is limited. Consideration of alternatives, like many other aspects of the decision-making process, cannot be observed by the analyst, and can only be imperfectly measured. As part of a stated choice survey aimed at unveiling air passengers’ preferences for access modes to Bari International Airport in Italy, we collected a wide set of indicators that either directly or indirectly measure respondents’ consideration of the public transport alternatives. In our access mode choice model, consideration of public transport services was treated as a latent variable, and entered the utility function for this mode through a “discounting” factor. The proposed integrated choice and latent variable approach allows the analyst not only to overcome potential endogeneity and measurement error issues associated with the indicators, but also makes the model suitable for forecasting. As a result of accounting for consideration effects, we observed an improvement in fit that also held in a validation sample; moreover, the effects of policy changes aimed at improving the modal share of public transport were considerably reduced