Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gatric cardia cancer.

<b>INTRODUCTION</b> Atrophic gastritis is a risk factor for non-cardia gastric cancer, and gastro-oesophageal reflux disease (GORD) for oesophageal adenocarcinoma. The role of atrophic gastritis and GORD in the aetiology of adenocarcinoma of the cardia remains unclear. We have investigated the association between adenocarcinoma of the different regions of the upper gastrointestinal tract and atrophic gastritis and GORD symptoms. <b>METHODS</b> 138 patients with upper GI adenocarcinoma and age and sex matched controls were studied. Serum pepsinogen I/II was used as a marker of atrophic gastritis and categorised to five quintiles. History of GORD symptoms, smoking and H.pylori infection was incorporated in logistic regression analysis. Lauren classification of gastric cancer was used to subtype gastric and oesophageal adenocarcinoma. <b>RESULTS</b> Non-cardia cancer was associated with atrophic gastritis but not with GORD symptoms; 55% of these cancers were intestinal subtype. Oesophageal adenocarcinoma was associated with GORD symptoms, but not with atrophic gastritis; 84% were intestinal subtype. Cardia cancer was positively associated with both severe gastric atrophy [OR, 95% CI: 3.92 (1.77 – 8.67)] and with frequent GORD symptoms [OR, 95% CI: 10.08 (2.29 – 44.36)] though the latter was only apparent in the nonatrophic subgroup and in the intestinal subtype. The association of cardia cancer with atrophy was stronger for the diffuse versus intestinal subtype and this was the converse of the association observed with non-cardia cancer. <b>CONCLUSION</b> These findings indicate two distinct aetiologies of cardia cancer, one arising from severe atrophic gastritis and being of intestinal or diffuse subtype similar to non-cardia cancer, and one related to GORD and intestinal in subtype, similar to oesophageal adenocarcinoma. Gastric atrophy, GORD symptoms and histological subtype may distinguish between gastric versus oesophageal origin of cardia cancer

Response to Crocetti et al.

No abstract available

The gastric acid pocket is attenuated in H. pylori infected subjects

Objective Gastric acid secretory capacity in different anatomical regions, including the postprandial acid pocket, was assessed in Helicobacter pylori positive and negative volunteers in a Western population. Design We studied 31 H. pylori positive and 28 H. pylori negative volunteers, matched for age, gender and body mass index. Jumbo biopsies were taken at 11 predetermined locations from the gastro-oesophageal junction and stomach. Combined high-resolution pH metry (12 sensors) and manometry (36 sensors) was performed for 20 min fasted and 90 min postprandially. The squamocolumnar junction was marked with radio-opaque clips and visualised radiologically. Biopsies were scored for inflammation and density of parietal, chief and G cells immunohistochemically. Results Under fasting conditions, the H. pylori positives had less intragastric acidity compared with negatives at all sensors >1.1 cm distal to the peak lower oesophageal sphincter (LES) pressure (p<0.01). Postprandially, intragastric acidity was less in H. pylori positives at sensors 2.2, 3.3 and 4.4 cm distal to the peak LES pressure (p<0.05), but there were no significant differences in more distal sensors. The postprandial acid pocket was thus attenuated in H. pylori positives. The H. pylori positives had a lower density of parietal and chief cells compared with H. pylori negatives in 10 of the 11 gastric locations (p<0.05). 17/31 of the H. pylori positives were CagA-seropositive and showed a more marked reduction in intragastric acidity and increased mucosal inflammation. Conclusions In population volunteers, H. pylori positives have reduced intragastric acidity which most markedly affects the postprandial acid pocket

Dentistry where there is no Dentist: A retrospective analysis of urgent dental care reported through the British Antarctic Survey Medical Unit (BASMU), 2015 - 2020.

File replaced (incorrect version) on 04/10/2022 by KT (LDS).AIM: To evaluate the nature of dental related morbidity in British Antarctic Survey (BAS) deployed personnel, and to compare the findings to those in other deployed population groups. Additional aims include outlining the evidence-based approach to further developing a training programme for non-dentists, to manage dental emergencies. METHODS: A retrospective analysis of dental morbidity between 2015 - 2020 reported through the British Antarctic Survey Medical Unit (BASMU) database of dental reported morbidity recorded by deployed medical officers. RESULTS: Analysis and comparison of dental morbidity in deployed personnel to austere environments revealed similarity, in that relatively minor conditions led to the most significant number of presentations for personnel seeking dental advice when deployed. CONCLUSIONS: Dental morbidity for deployed personnel in austere conditions can present with a range of symptoms from relatively minor to severe. Use of best evidence to configure training packages to likely presentations, may limit likelihood of necessitating evacuation from remote locations, or limit morbidity when evacuation is not feasible

Successful elimination of factor VIII inhibitor using cyclosporin A

No abstract available

Customer effort in value cocreation activities: improving quality of life and behavioral intentions of health care customers

Transformative service research is particularly relevant in health care where the firm and customer can contribute to individual as well as societal well-being. This article explores customer value cocreation in health care, identifying a hierarchy of activities representing varying levels of customer effort from complying with basic requirements (less effort and easier tasks) to extensive decision making (more effort and more difficult tasks). We define customer Effort in Value Cocreation Activities (EVCA) as the degree of effort that customers exert to integrate resources, through a range of activities of varying levels of perceived difficulty. Our findings underscore the importance of viewing health care service as taking place within the customer's service network that extends well beyond the customer-firm dyad to include other market-facing as well as public and private resources. Moreover, we demonstrate the transformative potential of customer EVCA linking customer EVCA to quality of life, satisfaction with service and behavioral intentions. We do so across three prevalent chronic diseasescancer, heart disease, and diabetes. Our findings highlight how an integrated care model has benefits for both customers and providers and can enhance customer EVCA

Early surgery versus initial conservative treatment in patients with traumatic intracerebral haemorrhage [STITCH(Trauma)] : the first randomized trial

Acknowledgements This project was funded by the NIHR Health Technology Assessment programme (project number 07/37/16). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health.Peer reviewedPublisher PD

Professional service firms are relationship marketers: But does size matter?

There are few research-based insights into professional service firms’ (PSFs) contemporary marketing practices. This is unfortunate as the professional services sector is a key contributor to growth in Australian and other economies around the world. As professional services are unique in a number of ways and their operations and marketing activities inextricably intertwined, the present study investigated the extent to which PSFs practice marketing and whether this differs according to size. Depth interviews were held with thirty seven Australian senior managers in four key industries. We examined the extent of relationship marketing, conceptualised at an overall managerial level as well as four sub-practices identified in research by Coviello and colleagues. We found relationship management and interaction marketing were the most common practices, which is consistent with the inseparability concept, and that relationship management and database marketing were more common in larger firms, which is consistent with their relative resource strength