Patients’ perceptions of conservative treatment for a small abdominal aortic aneurysm

Stephanie M Tomee,1 Winifred A Gebhardt,2 Jean-Paul PM de Vries,3 Victoria C Hamelinck,1 Jaap F Hamming,1 Jan HN Lindeman1 1Department of Surgery, Leiden University Medical Center, Leiden, 2Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, 3Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, Leiden, the Netherlands Background: An abdominal aortic aneurysm (AAA) is a progressive, generally symptomless disease that could ultimately result in a fatal rupture. Current guidelines advise conservative follow-up, and preventive surgical repair once the risk of rupture outweighs the cost of repair (55 mm in men). In developed countries, the majority of patients are diagnosed with AAAs less than 55 mm, and so enter a period of conservative surveillance. An important question is how patients perceive and cope with risk of rupture, AAA diagnosis and treatment, and presented AAA information. The goal of this study was to gain insight into patients’ perceptions of conservative treatment for a small AAA to increase patient satisfaction.Methods: We conducted semistructured in-depth interviews and used questionnaires measuring health-related quality of life (RAND 36-Item Health Survey 1.0), illness-perceptions (Illness Perception Questionnaire – Revised), and anxiety and depression (Hospital Anxiety and Depression Scale). Interviews were audio recorded and transcript contents were analyzed based on grounded theory. Mean scores of the questionnaires were compared to (population) reference groups.Results: This study included ten male patients under surveillance for a small AAA from two hospitals in the Netherlands. Patients expressed no fear for AAA rupture, and also reported low levels of anxiety and depression in both the interviews and the Hospital Anxiety and Depression Scale. The presence of an AAA did not affect their social life or emotional well-being. The reported poorer physical health on RAND 36-Item Health Survey 1.0 presumably reflected common presence of comorbidities. Participants stated to that they were content with the frequency and setup of AAA surveillance. However, they generally lacked knowledge about AAA disease and/or treatment options.Conclusion: Conservative AAA follow-up ensures patients that the risks of AAA disease are limited. The vascular surgeon is the most important source of AAA information to patients, and patients fully rely on their vascular surgeon to take control in AAA treatment. Keywords: abdominal aortic aneurysm, patient perceptions, patient preference, quality of life, interviews, patient-reported outcome measure

WAPing out pathogens and disease in the mucosa: roles for SLPI and Trappin-2

The interface between the external environment and the body’s internal structures is defined by the mucosal tissue and the viscous lining fluid that is responsible for maintaining its integrity and protecting internal structures from damage or infection. Human mucosal fluids include seminal fluid, cervical mucus, bronchial and nasal secretions and tears whose composition is particularly complicated. This review will focus on just two related molecules that are present in the mucosal lining fluid, namely, trappin-2 and secretory leucocyte protease inhibitor (SLPI), that are responsible for many of the homeostatic and host defence functions of these uniquely situated viscous sols. This review will focus on our increasing understanding of these two molecules from a simple role as local antibiotics that respond to pathogen invasion to major orchestrators of cellular interplays, host defence mechanisms and immune homeostasis

Death at the airway epithelium in asthma

Allergic asthma is an inflammatory disease of the airways in which epithelial cells, dendritic cells and innate lymphoid cells are increasingly implicated. Recent findings suggest that apoptotic cells are phagocytosed by airway epithelial cells in a Rac1-dependent manner and this leads to dampening of innate and adaptive immunity to allergens