Systemic enzyme therapy in chronic venous disease: a review

Chronic venous disease (CVD), a sequel of venous insufficiency, has great medical and socioeconomic impact. Varicose veins and venous ulcer are amongst its commonest manifestations. In CVD, incompetent valves, weakened vascular walls, venous hypertension and increased permeability of venous walls lead to the release of proinflammatory mediators like tumor necrosis factor (TNF)-α, interleukin (IL)-1β, reactive oxygen species (R.O.S.), and reactive nitrogen species (R.N.S.) in the venous milieu. Pharmacotherapy with nonsteroidal anti-inflammatory drugs (NSAIDs) is often used to relieve pain caused by venous disease. However, there is a need for therapies that target the microcirculatory disorders and act on chronic inflammatory processes. Systemic enzyme therapy (SET), with orally administered combination of proteolytic enzymes- trypsin, bromelain, and flavonoid rutoside, has been used since decades for their anti-inflammatory, analgesic, anti-edematous, antithrombotic and antioxidant properties. This review discusses the various relevant pharmacodynamic properties demonstrated by the ingredients, followed by clinical studies of SET, which have demonstrated benefit in both subjective and objective parameters. These studies indicate that SET has good efficacy, tolerability and holds great promise to improve the quality of life of a patient with CVD.  

The design of a survey questionnaire to measure perceptions and behaviour during an influenza pandemic: the Flu TElephone Survey Template (FluTEST)

Background: During the 2009–10 influenza (flu) pandemic, surveys to assess behaviour among the general public were designed quickly and suffered from methodological deficits as a result. To facilitate survey work in a future pandemic we (1) identified variables relating to behaviour, perceptions and presence of symptoms that were of relevance to policy-makers and other public health experts; (2) tested and refined the wording of questions to measure these variables; (3) assessed the reliability of responses to these questions; and (4) tested whether non-response bias due to attrition might prevent the use of a longitudinal design for future pandemic-related surveys. Objective: To design, test and refine a set of questions to assess perceptions and behaviours in relation to a pandemic flu outbreak. Method: We identified variables via existing systematic reviews and through consultation with pandemic flu planners from Public Health England, the English Department of Health, their advisory groups and academic colleagues. We adapted questions from existing scales or developed them afresh, and tested their clarity in three rounds of qualitative interviews with members of the public (total n = 78). We used a random digit dial telephone survey of adults from Great Britain (n = 1080) to assess the internal reliability of scales. We used a follow-up survey 1–2 weeks later to assess the test–retest reliability of responses and the differences between responders (n = 621) and non-responders (n = 459). Results: We identified seven core sets of outcome variables relating to the presence of flu-like illness and to various protective behaviours, as well as a set of likely predictor variables for the behaviours. Qualitative interviews identified multiple issues with our questions, most of which we resolved. Reliability of the items was largely satisfactory. Evidence of non-response bias was found, with non-responders being younger and less well educated than responders, and differing on several flu-related variables. Conclusions: It would be ill advised for public health bodies to enter the next pandemic without a plan for how to measure the public’s behaviours and perceptions. The extensive set of items that we compiled as part of this work has the benefit of being evidence based, policy relevant and readily understood. Although choosing how to gather data still requires consideration, these items can be used with confidence as soon as the next pandemic begins. Future work should consider the most appropriate method for conducting surveys using these items

Feasibility and acceptability of a classroom-based active breaks intervention for 8-12- year old children

This study explored the feasibility of conducting a classroom-based active breaks intervention on sedentary behaviour (SB), physical activity (PA) and attention in 8-12 year old children. Eight schools were randomised on a 1:1 basis to the control or intervention. Teachers selected ten cards detailing an activity break at random. Children then undertook each of the ten activity breaks for 30 sec, three times per day for six weeks. School and participant recruitment, attrition rates, % of outcome measures collected, and acceptability were used to explore the feasibility of the study. Mixed effects models were undertaken to examine intervention effects upon measures of PA, SB and attention. Two hundred and thirty-nine consent forms were issued and 153 were returned (64%). Of the 153 consents, 146 children (95%) were measured at baseline, and 117 participated in the follow-up measures (80%) six weeks later suggesting the intervention was acceptable for the participants. From teacher interviews it was noted that the intervention was feasible to implement, and teachers observed positive classroom behaviour changes in children. Inclusion rates for outcome measures ranged from 49 to 66%. Significant, intervention effects were observed for sitting time (B = -27.19; 95%CI: -36.84, -17.17), standing time (B = 23.51; 95%CI 14.1, 32.45) and the number of sit to stand transitions (B = 16.1; 95%CI 4.7, 26.79). Findings suggest that it was feasible and acceptable to implement an active breaks intervention within the classroom setting. Future work should consider the effectiveness of implementing this intervention across a full academic year

Recurrent hemorrhagic pericardial effusion in a child due to diffuse lymphangiohemangiomatosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Recurrent hemorrhagic pericardial effusion in children with no identifiable cause is a rare presentation.</p> <p>Case presentation</p> <p>We report the case of a 4-year-old Indian girl who presented with recurrent hemorrhagic pericardial effusion. Diffuse lymphangiomatosis was suspected when associated pulmonary involvement, soft tissue mediastinal mass, and lytic bone lesions were found. Pericardiectomy and lung biopsy confirmed the diagnosis of diffuse lymphangiohemangiomatosis. Partial clinical improvement occurred with thalidomide and low-dose radiotherapy, but our patient died from progressive respiratory failure.</p> <p>Conclusion</p> <p>Diffuse lymphangiohemangiomatosis should be considered in the differential diagnosis of hemorrhagic pericardial effusion of unclear cause.</p

IKZF1 Deletions with COBL Breakpoints Are Not Driven by RAG-Mediated Recombination Events in Acute Lymphoblastic Leukemia

IKZF1 deletion (ΔIKZF1) is an important predictor of relapse in both childhood and adult B-cell precursor acute lymphoblastic leukemia (B-ALL). Previously, we revealed that COBL is a hotspot for breakpoints in leukemia and could promote IKZF1 deletions. Through an international collaboration, we provide a detailed genetic and clinical picture of B-ALL with COBL rearrangements (COBL-r). Patients with B-ALL and IKZF1 deletion (n = 133) were included. IKZF1 ∆1-8 were associated with large alterations within chromosome 7: monosomy 7 (18%), isochromosome 7q (10%), 7p loss (19%), and interstitial deletions (53%). The latter included COBL-r, which were found in 12% of the IKZF1 ∆1-8 cohort. Patients with COBL-r are mostly classified as intermediate cytogenetic risk and frequently harbor ETV6, PAX5, CDKN2A/B deletions. Overall, 56% of breakpoints were located within COBL intron 5. Cryptic recombination signal sequence motifs were broadly distributed within the sequence of COBL, and no enrichment for the breakpoint cluster region was found. In summary, a diverse spectrum of alterations characterizes ΔIKZF1 and they also include deletion breakpoints within COBL. We confirmed that COBL is a hotspot associated with ΔIKZF1, but these rearrangements are not driven by RAG-mediated recombination

Nudging art lovers to donate.

Many nonprofit organizations face revenue uncertainty due to funding cuts. It is crucial for them to supplement existing revenue streams by private donations, and apply thoughtful market segmentation in their pursuit of donors. We introduce the behavioral concept of ‘nudge’ based on the possibility of loss aversion affecting willingness-to-donate, and investigate its implications for fundraising strategies. Potential donors are nudged to donate by the hypothetical scenario of ‘losing’ an existing exhibition, and also by that of ‘gaining’ an additional exhibition. We observe significant loss aversion effects as frequent gallery-goers donate more in order to avoid losing an exhibition. While both prospective gain and loss scenarios are effective in nudging non-frequent gallery-goers, the prospect of enjoying ‘one more’ event is observed to be stronger. We argue that there may be scope to increase support for nonprofit organizations, particularly in the cultural sector, by exploiting the psychological characteristics of prospective donors

Bcl-2 protein family: Implications in vascular apoptosis and atherosclerosis

Apoptosis has been recognized as a central component in the pathogenesis of atherosclerosis, in addition to the other human pathologies such as cancer and diabetes. The pathophysiology of atherosclerosis is complex, involving both apoptosis and proliferation at different phases of its progression. Oxidative modification of lipids and inflammation differentially regulate the apoptotic and proliferative responses of vascular cells during progression of the atherosclerotic lesion. Bcl-2 proteins act as the major regulators of extrinsic and intrinsic apoptosis signalling pathways and more recently it has become evident that they mediate the apoptotic response of vascular cells in response to oxidation and inflammation either in a provocative or an inhibitory mode of action. Here we address Bcl-2 proteins as major therapeutic targets for the treatment of atherosclerosis and underscore the need for the novel preventive and therapeutic interventions against atherosclerosis, which should be designed in the light of molecular mechanisms regulating apoptosis of vascular cells in atherosclerotic lesions