Diagnosis and outcome of oesophageal Crohn's disease

BACKGROUND AND AIMS: Crohn's disease (CD) can involve any part of the gastrointestinal tract. We aimed to characterize clinical, endoscopic, histologic features and treatment outcomes of CD patients with oesophageal involvement. METHODS: We collected cases through a retrospective multicentre European Crohn's and Colitis Organisation CONFER [COllaborative Network For Exceptionally Rare case reports] project. Clinical data were recorded in a standardized case report form. RESULTS: A total of 40 patients were reported [22 males, mean (±SD, range) age at oesophageal CD diagnosis: 25 (±13.3, 10-71) years and mean time of follow-up: 67 (±68.1, 3-240) months]. Oesophageal involvement was established at CD diagnosis in 26 patients (65%) and during follow-up in 14. CD was exclusively located in the oesophagus in 2 patients. Thirteen patients (32.2%) were asymptomatic at oesophageal disease diagnosis. Oesophageal strictures were present in 5 patients and fistulizing oesophageal disease in one. Eight patients exhibited granulomas on biopsies. Proton-pump inhibitors (PPIs) were administered in 37 patients (92.5%). Three patients underwent endoscopic dilation for symptomatic strictures and none oesophageal-related surgery. Diagnosis in pre-established CD resulted in treatment modifications in 9/14 patients. Clinical remission of oesophageal disease was seen in 33/40 patients (82.5%) after a mean time of 7 (±5.6, 1-18) months. Follow-up endoscopy was performed in 29/40 patients and 26/29 (89.7%) achieved mucosal healing. CONCLUSION: In this case series the endoscopic and histologic characteristics of isolated oesophageal CD were similar to those reported in other sites of involvement. Treatment was primarily conservative, with PPIs administered in the majority of patients and modifications in pre-existing IBD-related therapy occurring in two thirds of them. Clinical and endoscopic remission was achieved in more than 80% of the patients.info:eu-repo/semantics/publishedVersio

Improving search filter development: a study of palliative care literature

Background It is difficult to systematically search for literature relevant to palliative care in general medical journals. A previously developed search filter for use on OVID Medline validated using a gold standard set of references identified through hand searching, achieved an unacceptably low sensitivity (45.4%). Retrieving relevant literature is integral to support evidence based practice, and understanding the nature of the incorrectly excluded citations (false negatives) using the filter may lead to improvement in the filter's performance. Methods The objectives were to describe the nature of subjects reflected in the false negative citations and to empirically improve the sensitivity of the search filter. A thematic analysis of MeSH terms by three independent reviewers was used to describe the subject coverage of the missed records. Using a frequency analysis of MeSH terms, those headings which could individually contribute at least 2.5% to sensitivity (occurring 19 or more times) were added to the search filter. All previously run searches were rerun at the same time as the revised filter, and results compared. Results Thematic analysis of MeSH terms identified thirteen themes reflected in the missing records, none of them intrinsically palliative. The addition of six MeSH terms to the existing search filter (physician-patient relations, prognosis, quality of life, survival rate, treatment outcome and attitude to health) led to an increase in sensitivity from 46.3% to 64.7%, offset by a decrease in precision from 72.6% to 21.9%. Conclusion The filter's sensitivity was successfully increased using frequency analysis of MeSH terms, offset by a decrease in precision. A thematic analysis of MeSH terms for the false negative citations confirmed the absence of any intrinsically palliative theme or term, suggesting that future improvements to search filters for palliative care literature will first depend on better identifying how clinicians and researchers conceptualise palliative care. It is suggested that a constellation of parameters: stage of disease (advanced or active), prospect of cure (little or none), and treatment goals (primarily quality of life) may ultimately inform search strategies. This may be similarly true for chronic diseases, which share the inherent passage of time which marks them apart from acute, and therefore more readily identifiable, episodes of care

Analysis of some localized boundary-domain integral equations for transmission problems with variable coefficients

This is the post-print version of the Article. The official published version can be found at the links below - Copyright @ 2011 Birkhäuser Boston.Some segregated systems of direct localized boundary-domain integral equations (LBDIEs) associated with several transmission problems for scalar PDEs with variable coefficients are formulated and analyzed for a bounded domain composed of two subdomains with a coefficient jump over the interface. The main results established in the paper are the LBDIE equivalence to the original transmission problems and the invertibility of the corresponding localized boundary-domain integral operators in corresponding Sobolev spaces function spaces.This research was supported by the EPSRC grant EP/H020497/1: ”Mathematical analysis of Localized Boundary-Domain Integral Equations for Variable-Coefficient Boundary Value Problems” and partly by the Georgian Technical University grant in the case of the third author

Development and Validation of Makeup and Sexualized Clothing Questionnaires

Background: Body acceptance programs on college campuses indicated that collegiate women often report feeling pressure to dress in a sexualized manner, and use makeup to enhance beauty. Currently, no quantitative measures exist to assess attitudes and daily behaviors that may arise in response to perceived pressure to wear makeup or dress in a provocative manner. The goal of the current studies was to develop brief self-report questionnaires aimed at assessing makeup and sexualized clothing use and attitudes in young women. Methods: An exploratory factor analysis in a sample of 403 undergraduate women was used in Study 1 to create items to measure the pressure women feel to wear makeup and sexualized clothing. A confirmatory factor analysis (N = 153) was used in Study 2 to confirm the factor structure found in Study 1. An incremental validity analysis was also conducted in Study 2. Across both studies, participants completed online questionnaires. Results: In Study 1, items were developed for two questionnaires to assess perceived pressure to wear makeup and discomfort when not wearing makeup, and perceived pressure to wear sexualized clothing, and body image concerns with regards to sexualized clothing. The exploratory factor analyses revealed Unconfident and Unease scales for the Makeup Questionnaire (MUQ) and Body Dissatisfaction and Pressure scales for the Sexualized Clothing Questionnaire (SCQ). In Study 2, the confirmatory factor analyses confirmed the factor structure for the MUQ and SCQ. The incremental validity analysis revealed that these measures can be used to predict self-objectification and shape and weight concern in women. Conclusion: These studies provide preliminary support for the factor structure of two novel questionnaires aimed at assessing perceived pressure to wear makeup and sexualized clothing

The role of marine reserves in achieving sustainable fisheries (One contribution of 15 to a Theme Issue 'Fisheries: a Future?')

Many fishery management tools currently in use have conservation value. They are designed to maintain stocks of commercially important species above target levels. However, their limitations are evident from continuing declines in fish stocks throughout the world. We make the case that to reverse fishery declines, safeguard marine life and sustain ecosystem processes, extensive marine reserves that are off limits to fishing must become part of the management strategy. Marine reserves should be incorporated into modern fishery management because they can achieve many things that conventional tools cannot. Only complete and permanent protection from fishing can protect the most sensitive habitats and vulnerable species. Only reserves will allow the development of natural, extended age structures of target species, maintain their genetic variability and prevent deleterious evolutionary change from the effects of fishing. Species with natural age structures will sustain higher rates of reproduction and will be more resilient to environmental variability. Higher stock levels maintained by reserves will provide insurance against management failure, including risk-prone quota setting, provided the broader conservation role of reserves is firmly established and legislatively protected. Fishery management measures outside protected areas are necessary to complement the protection offered by marine reserves, but cannot substitute for it

T-cell derived acetylcholine aids host defenses during enteric bacterial infection with Citrobacter rodentium.

The regulation of mucosal immune function is critical to host protection from enteric pathogens but is incompletely understood. The nervous system and the neurotransmitter acetylcholine play an integral part in host defense against enteric bacterial pathogens. Here we report that acetylcholine producing-T-cells, as a non-neuronal source of ACh, were recruited to the colon during infection with the mouse pathogen Citrobacter rodentium. These ChAT+ T-cells did not exclusively belong to one Th subset and were able to produce IFNγ, IL-17A and IL-22. To interrogate the possible protective effect of acetylcholine released from these cells during enteric infection, T-cells were rendered deficient in their ability to produce acetylcholine through a conditional gene knockout approach. Significantly increased C. rodentium burden was observed in the colon from conditional KO (cKO) compared to WT mice at 10 days post-infection. This increased bacterial burden in cKO mice was associated with increased expression of the cytokines IL-1β, IL-6, and TNFα, but without significant changes in T-cell and ILC associated IL-17A, IL-22, and IFNγ, or epithelial expression of antimicrobial peptides, compared to WT mice. Despite the increased expression of pro-inflammatory cytokines during C. rodentium infection, inducible nitric oxide synthase (Nos2) expression was significantly reduced in intestinal epithelial cells of ChAT T-cell cKO mice 10 days post-infection. Additionally, a cholinergic agonist enhanced IFNγ-induced Nos2 expression in intestinal epithelial cell in vitro. These findings demonstrated that acetylcholine, produced by specialized T-cells that are recruited during C. rodentium infection, are a key mediator in host-microbe interactions and mucosal defenses

Magnetotransport properties of a polarization-doped three-dimensional electron slab

We present evidence of strong Shubnikov-de-Haas magnetoresistance oscillations in a polarization-doped degenerate three-dimensional electron slab in an Al$_{x}$Ga$_{1-x}$N semiconductor system. The degenerate free carriers are generated by a novel technique by grading a polar alloy semiconductor with spatially changing polarization. Analysis of the magnetotransport data enables us to extract an effective mass of $m^{\star}=0.19 m_{0}$ and a quantum scattering time of $\tau_{q}= 0.3 ps$. Analysis of scattering processes helps us extract an alloy scattering parameter for the Al$_{x}$Ga$_{1-x}$N material system to be $V_{0}=1.8eV$