Longitudinal Changes in Symptom Cluster Membership in Inflammatory Bowel Disease

Purpose: To describe changes in symptom cluster membership over 1 year and to examine which demographic and clinical factors predict changes in symptom cluster membership among adults with inflammatory bowel disease. Design: A retrospective longitudinal study of the Crohn's & Colitis Foundation of America Partners Cohort from 2012 to 2015. Methods: We measured symptoms of pain interference, fatigue, sleep disturbance, depression, and anxiety. We used latent transition analysis to describe changes in symptom cluster membership (baseline, 6 months, and 12 months) and multinomial regressions to examine factors associated with symptom cluster membership transition. Findings: Four groups were identified (N = 5,296): high symptom burden (32.3%–35.3%), low symptom burden (24.2%–27.1%), physical symptoms (19.0%–20.9%; pain, fatigue, sleep disturbance), and psychological symptoms (20.0%–21.5%; depression, anxiety). The probability of staying in the same group was.814 to.905. Moving from active disease into remission was associated with moving from the high burden to low burden and psychological symptom groups. Conclusions: Symptom cluster membership was quite stable over 1 year. Research is needed to understand the underlying etiology of symptom clusters better and to develop interventions to reduce symptom burden in this vulnerable population. Clinical Relevance: Careful consideration of symptom management options should be done with patients to select options that are effective and potentially target multiple symptoms

Comprehensive lung injury pathology induced by mTOR inhibitors

Molecular Targets in Oncology[Abstract] Interstitial lung disease is a rare side effect of temsirolimus treatment in renal cancer patients. Pulmonary fibrosis is characterised by the accumulation of extracellular matrix collagen, fibroblast proliferation and migration, and loss of alveolar gas exchange units. Previous studies of pulmonary fibrosis have mainly focused on the fibro-proliferative process in the lungs. However, the molecular mechanism by which sirolimus promotes lung fibrosis remains elusive. Here, we propose an overall cascade hypothesis of interstitial lung diseases that represents a common, partly underlying synergism among them as well as the lung pathogenesis side effects of mammalian target of rapamycin inhibitors

Hypoxia sustains cyanobacteria blooms in the Baltic Sea

Nutrient over-enrichment is one of the classic triggering mechanisms for the occurrence of cyanobacteria blooms in aquatic ecosystems. In the Baltic Sea, cyanobacteria regularly occur in the late summer months and form nuisance accumulations in surface waters and their abundance has intensified significantly in the past 50 years attributed to human-induced eutrophication. However, the natural occurrence of cyanobacteria during the Holocene is debated. In this study, we present records of cyanobacteria pigments, water column redox proxies, and nitrogen isotopic signatures for the past ca. 8000 years from Baltic Sea sediment cores. Our results demonstrate that cyanobacteria abundance and nitrogen fixation are correlated with hypoxia occurring during three main intervals: (1) ca. 7000–4000 B.P. during the Littorina transgression, (2) ca. 1400–700 B.P. during the Medieval Climate Anomaly, and (3) from ca. 1950 A.D. to the present. Issues of preservation were investigated, and we show that organic matter and pigment profiles are not simply an artifact of preservation. These results suggest that cyanobacteria abundance is sustained during periods of hypoxia, most likely because of enhanced recycling of phosphorus in low oxygen conditions

Hypoxia sustains cyanobacteria blooms in the Baltic Sea

Nutrient over-enrichment is one of the classic triggering mechanisms for the occurrence of cyanobacteria blooms in aquatic ecosystems. In the Baltic Sea, cyanobacteria regularly occur in the late summer months and form nuisance accumulations in surface waters and their abundance has intensified significantly in the past 50 years attributed to human-induced eutrophication. However, the natural occurrence of cyanobacteria during the Holocene is debated. In this study, we present records of cyanobacteria pigments, water column redox proxies, and nitrogen isotopic signatures for the past ca. 8000 years from Baltic Sea sediment cores. Our results demonstrate that cyanobacteria abundance and nitrogen fixation are correlated with hypoxia occurring during three main intervals: (1) ca. 7000–4000 B.P. during the Littorina transgression, (2) ca. 1400–700 B.P. during the Medieval Climate Anomaly, and (3) from ca. 1950 A.D. to the present. Issues of preservation were investigated, and we show that organic matter and pigment profiles are not simply an artifact of preservation. These results suggest that cyanobacteria abundance is sustained during periods of hypoxia, most likely because of enhanced recycling of phosphorus in low oxygen conditions

Disparities among Minority Women with Breast Cancer Living in Impoverished Areas of California

Background: Interaction effects of poverty and health care insurance coverage on overall survival rates of breast cancer among women of color and non-Hispanic white women were explored. Methods: We analyzed California registry data for 2,024 women of color (black, Hispanic, Asian, Pacific Islander, American Indian, or other ethnicity) and 4,276 non-Hispanic white women (Anglo-European ancestries and no Hispanic-Latin ethnic backgrounds) diagnosed with breast cancer between the years 1996 and 2000 who were then followed until 2011. The 2000 US census categorized rates of neighborhood poverty. Health care insurance coverage was either private, Medicare, Medicaid, or none. Cox regression was used to model rates of survival. Results: A 3-way interaction between ethnicity, health care insurance coverage, and poverty was observed. Women of color inadequately insured and living in poor or near-poor neighborhoods in California were the most disadvantaged. Women of color adequately insured and who lived in such neighborhoods in California were also disadvantaged. The incomes of such women of color were typically lower than the incomes of non-Hispanic white women. Conclusions: Women of color with or without insurance coverage are disadvantaged in poor and near-poor neighborhoods of California. Such women may be less able to bare the indirect, direct, or uncovered costs of health care for breast cancer treatment

Problematic pigmented lesions: approach to diagnosis

A number of pigmented lesions are difficult to classify and raise the possibility of a melanoma diagnosis. Care should be exercised to exclude non-melanocytic lesions, and benign melanocytic entities, both of which can mimic melanoma histologically. In addition, the possibility of the lesion being a melanoma variant or epidermotropic metastasis should be considered. There will still be some cases that are difficult to resolve. These usually fall into one of three categories: atypical junctional melanocytic lesion versus early melanoma; naevus versus naevoid melanoma; and atypical Spitz, cellular blue, and deep penetrating naevi versus thick melanoma. These will pose problems even for experts. The atypical Spitz lesions are perhaps the most important category because they tend to be from younger individuals, the differential diagnosis is thick melanoma, and there is no single discriminating histological feature. Key Words: difficult diagnosis • pigmented lesions • melanom