Increased Th17-Related Cytokine Serum Levels in Patients With Multiple Polyps of Unexplained Origin

OBJECTIVES: Most patients with multiple colonic polyps do not have a known genetic or hereditary origin. Our aim was to analyze the presence of inflammatory cytokines and levels of glucose, insulin, and C-reactive protein (CRP) in patients with multiple colonic polyps. METHODS: Eighty-three patients with 10 or more adenomatous or serrated polyps and 53 control people with normal colonoscopy were included. Smoking habits were registered, and glucose, CRP, and basal insulin in the serum/blood were measured. Quantification of IL-2, IL-4, IL-6, IL-10, IL-11, IL-17A, and IL-23 cytokine levels in the serum was performed by a high-sensitivity enzyme-linked immunosorbent assay. RESULTS: Smoking and diabetes were more prevalent in those with colonic polyps than in the control people (67% vs 16%, P = 0.001; 11% vs 2%, P = 0.048). In addition, the cytokine serum levels were higher, i.e., IL-2 (P = 0.001), IL-4 (P = 0.001), IL-6 (P = 0.001), IL-17A (P = 0.001), IL-23 (P = 0.014), and CRP (P = 0.003). Adjusting for sex, smoking, and diabetes in a multivariate analysis, IL-2, IL-4, IL-6, IL-17A, and IL-23 remained independently elevated in cases with multiple polyps. DISCUSSION: These results indicate that immune responses mediated by Th17 cells may be involved in the pathogenesis of multiple colonic polyps

Distributionally chaotic families of operators on Fréchet spaces

This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Communications on Pure and Applied Analysis (CPAA) following peer review. The definitive publisher-authenticated version Conejero, J. A., Kostić, M., Miana, P. J., & Murillo-Arcila, M. (2016). Distributionally chaotic families of operators on Fréchet spaces.Communications on Pure and Applied Analysis, 2016, vol. 15, no 5, p. 1915-1939, is available online at: http://dx.doi.org/10.3934/cpaa.2016022The existence of distributional chaos and distributional irregular vectors has been recently considered in the study of linear dynamics of operators and C-0-semigroups. In this paper we extend some previous results on both notions to sequences of operators, C-0-semigroups, C-regularized semigroups, and alpha-timesintegrated semigroups on Frechet spaces. We also add a study of rescaled distributionally chaotic C-0-semigroups. Some examples are provided to illustrate all these results.The first and fourth authors are supported in part by MEC Project MTM2010-14909, MTM2013-47093-P, and Programa de Investigacion y Desarrollo de la UPV, Ref. SP20120700. The second author is partially supported by grant 174024 of Ministry of Science and Technological Development, Republic of Serbia. The third author has been partially supported by Project MTM2013-42105-P, DGI-FEDER, of the MCYTS; Project E-64, D.G. Aragon, and Project UZCUD2014-CIE-09, Universidad de Zaragoza. The fourth author is supported by a grant of the FPU Program of Ministry of education of Spain.Conejero, JA.; Kostic, M.; Miana Sanz, PJ.; Murillo Arcila, M. (2016). Distributionally chaotic families of operators on Fréchet spaces. Communications on Pure and Applied Analysis. 15(5):1915-1939. https://doi.org/10.3934/cpaa.2016022S1915193915

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1