Considerations for Colorectal Neoplasia Detection in Inflammatory Bowel Disease Clinical Trials.

BACKGROUND: High-quality colonoscopic surveillance can lead to earlier and increased detection of colorectal neoplasia in patients with inflammatory bowel disease (IBD). In IBD clinical trials, endoscopy is used to assess mucosal disease activity before and after treatment but also provides an opportunity to surveil for colorectal neoplasia during follow-up. SUMMARY: Best practices for colorectal cancer identification in IBD clinical trials require engagement and collaboration between the clinical trial sponsor, site endoscopist and/or principal investigator, and central read team. Each team member has unique responsibilities for maximizing dysplasia detection in IBD trials. KEY MESSAGES: Sponsors should work in accordance with scientific guidelines to standardize imaging procedures, design the protocol to ensure the trial population is safeguarded, and oversee trial conduct. The site endoscopist should remain updated on best practices to tailor sponsor protocol-required procedures to patient needs, examine the mucosa for disease activity and potential dysplasia during all procedures, and provide optimal procedure videos for central read analysis. Central readers may detect dysplasia or colorectal cancer and a framework to report these findings to trial sponsors is essential. Synergistic relationships between all team members in IBD clinical trials provide an important opportunity for extended endoscopic evaluation and colorectal neoplasia identification.

Composite score of physiomechanical esophageal function using functional lumen imaging probe panometry in eosinophilic esophagitis.

BACKGROUND AND AIMS: The evaluation provided by functional lumen imaging probe (FLIP) panometry includes esophageal distensibility/compliance (mechanics) of the esophageal body and esophagogastric junction (EGJ) and esophageal motility (secondary peristalsis). We developed a composite score using these parameters to characterize physiomechanical function in patients with eosinophilic esophagitis (EoE). METHODS: Two hundred fifteen adult patients with EoE who completed FLIP panometry during sedated endoscopy with esophageal biopsy sampling were included. FLIP metrics of esophageal body Compliance, Contractile response, Distensibility plateau, and maximum EGJ Diameter (C2D2) were scored as 0 for normal versus 1 or 2 for increasing degree of abnormality. Scores were summed to calculate the composite C2D2 score. RESULTS: The C2D2 score had a significant positive correlation with mucosal eosinophil count (ρ = .241) and total Endoscopic EoE Reference Score (ρ = .467). Among 46 patients off treatment at the baseline evaluation, future proton pump inhibitor (PPI) responders (ie, achieved mucosal eosinophil count <15 per high-powered field after PPI treatment) had lower C2D2 scores than PPI nonresponders (median, 2 [interquartile range, 1-3] vs 4 [interquartile range, 2-6], respectively; P = .003). A regression model (that controlled for age, sex, and baseline eosinophil count) showed a C2D2 score ≤3 had an odds ratio of 14.5 (95% confidence interval, 2.6-85) to predict future PPI response. However, total Endoscopic EoE Reference Scores (P = .142) and baseline eosinophil count (P = .480) did not differ between PPI responders and PPI nonresponders. CONCLUSIONS: This composite score of FLIP panometry metrics, the C2D2 score, may facilitate characterizing physiomechanical function in EoE and serve as an objective outcome measure.

A PhysioMechanical Model of Esophageal Function in Eosinophilic Esophagitis.

BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is characterized by eosinophilic inflammation, but also heterogeneous presentations involving fibrostenotic esophageal remodeling and esophageal dysmotility. We aimed to define and evaluate phenotypes of EoE using functional lumen imaging probe (FLIP) panometry (ie, a PhysioMechanical classification of EoE). METHODS: Patients with EoE who completed FLIP during endoscopy were included in a cross-sectional study. FLIP studies were analyzed for distensibility plateau and compliance of the esophageal body, maximum esophagogastric junction diameter, and contractile response pattern. These FLIP features were then applied to define PhysioMechanical classifications. RESULTS: A total of 215 patients with EoE (mean [standard deviation] age 38 [12] years; 31% female) were included. Seven PhysioMechanical classifications were identified that differed by various clinical characteristics, including symptom duration (P < .001) and Endoscopic EoE Reference Scores (EREFS) (P < .001). In particular, patients with "nonreactive fibrostenosis" (n = 14), had greater symptom duration (median [interquartile range] 20 [10-30] years) and more frequently had EREFS grade 2 or 3 ring scores (14 of 14 patients) than patients with a "normal" PhysioMechanical classification (symptom duration: 3 [1-8] years; 4 of 50 [8%] had EREFS grade 2 or 3 rings). In addition, among patients off treatment at cross-sectional evaluation (n = 46), there was a difference between PhysioMechanical classifications in future proton pump inhibitor (PPI) response rates (ie, achieving peak mucosal eosinophil count <15 per high-powered field after PPI treatment); P = .009. PPI response ranged from 87% (13 of 15 patients) with "isolated esophagogastric junction outflow obstruction" to 11% (1 of 9 patients) with "spastic-reactive fibrostenosis." CONCLUSIONS: Classifying PhysioMechanical esophageal function in EoE based on FLIP panometry features may facilitate defining disease severity and directing management in EoE.

Health-Related Quality of Life and Adherence to Hydroxyurea and Other Disease-Modifying Therapies among Individuals with Sickle Cell Disease: A Systematic Review.

Background: Sickle cell disease (SCD) is a hemoglobinopathy with increasing global prevalence resulting in pain episodes and multiorgan complications. Complications of SCD have been shown to adversely impact health-related quality of life (HRQOL) comprised of physical, social, and emotional domains; hence, HRQOL measures can serve as an effective evaluator of disease burden. Hydroxyurea (HU) and other disease-modifying therapies have demonstrated to significantly improve clinical outcomes in patients with SCD. Medication adherence is an essential mediator of the clinical benefits of these therapies; low adherence has been shown to increase disease burden and healthcare utilization. This systematic literature review intends to determine the association between adherence to disease-modifying therapies and HRQOL in patients with SCD. Methods: We found a total of 12 articles involving 788 participants, which included both patients with SCD and caregivers/parents. Adherence was measured using self-report instruments, laboratory markers, such as fetal hemoglobin and mean corpuscular volume, and mHealth medication trackers. HRQOL was measured using self-report instruments. Results: All studies demonstrated a correlation between higher HU adherence and better HRQOL scores. Higher HU adherence was associated with lower pain impact, less frequent pain episodes, less fatigue, and improved physical function and mobility, reflecting better physical HRQOL outcomes. Higher adherence was also associated with improved emotional response, decreased anxiety and depressive symptoms, and better social functioning and peer relationships. In addition, our findings indicated that having less frequent barriers to HU adherence was associated with better HRQOL scores. No studies evaluated HRQOL outcomes in relation to adherence to l-glutamine, voxelotor, or crizanlizumab. Conclusions: Optimizing HU adherence has the potential to improve HRQOL in patients with SCD in addition to reducing healthcare utilization and improving treatment satisfaction. Addressing barriers to HU adherence can positively strengthen the relationship between adherence and HRQOL to potentially improve patient outcomes.

Effect of packaging method and storage time on physicochemical characteristics of dry-cured pork neck products at 10°c.

Dry-cured pork neck samples were stored at 10°C for 90 days under vacuum packaging (VP) or modified atmosphere packaging (MAP; 25% CO2+75% N2) conditions. The pH, moisture, water activity, total aerobic bacteria, and Enterobacteriaceae counts of dry-cured pork neck products with MAP were significantly lower than those with VP (p<0.05) after 90 days of storage. However, CIE b* and 2-thiobarbituric acid reacted substance (TBARS) values of the pork product with MAP were significantly higher (p<0.05) than those with VP. Total aerobic bacterial counts and Enterobacteriaceae counts of samples with MAP were lower than those with VP after 30 days of storage. Sensory results indicated that aroma, flavor and tenderness scores of the samples with both VP and MAP decreased during storage and the scores after >60 days of storage were lower than those at Day 1. In conclusion, despite presenting higher lipid oxidation, the samples stored in packages containing 25% CO2 for 90 days at 10°C have lower bacterial counts than vacuum-packed samples. Therefore, further studies should be performed on the packaging of dry-cured meat at adjusted concentrations of CO2.

Antioxidant and antimicrobial activities of ethanol extract from the stem and leaf of Impatiens balsamina L. (Balsaminaceae) at different harvest times.

The aim of this study was to investigate the total phenolic content, total flavonoid contents, antioxidant activity and antimicrobial activity of ethanolic extract from stems (S) and leaves (L) of Impatiens balsamina L. (Balsaminaceae), which were harvested in Korea on March 10, 2011 (S1 and L1), May 14, 2011 (S2 and L2), and July 5, 2011 (S3 and L3), respectively. Our results revealed that the total phenolic (79.55-103.94 mg CE/g extract) and flavonoid (57.43-104.28 mg QE/g extract) contents of leaf extract were higher (p < 0.01) than those of stem extract. Leaf extracts (L1, L2, and L3) exhibited stronger (p < 0.01) free radical scavenging activity (66.06, 63.71, and 72.19%, respectively) than that of the positive control. In terms of antimicrobial activity, leaf extracts showed higher inhibitory effects against microorganisms than those of stem extracts (S1, S2, and S3). Among the leaf extracts at different harvest times, L3 showed the greatest antimicrobial activity against both Gram negative and Gram positive strains. From these results, the leaf extract from I. balsamina L. might be a valuable bioactive resource, and would seem to be applicable as a natural antioxidant in food preservation.

Radical scavenging-linked antioxidant activities of commonly used herbs and spices in Korea.

Herbs and spices not only variety and racy flavour to Korean foods, they also are the richest source for antioxidant power. The present study evaluates the radical scavenging-linked antioxidant activities of hot water extracts from commonly used herbs and spices in Korea. 2,2-Diphenyl-1-picrylhydrazyl (DPPH) radical and superoxide anion scavenging activities of bay extract were 39.5% and 22.1%, respectively. The hydroxyl radical scavenging activity was in order of dill (50.0%) > bay (31.3%) > garlic (27.9%) > white pepper and black pepper (15.1-15.3%) > onion (10.1%) extracts. Bay extract had the highest total phenolic content (17.86 µg CE/g). High correlation coefficients were found between the total phenol content and DPPH radical scavenging activity (R = 0.9162). These results indicate that herbs and spices had high antioxidant activity that is partly due to the phenolic compounds and provide basic data for further development of processed food products.

Antioxidant activities of hot water extracts from various spices.

Recently, the natural spices and herbs such as rosemary, oregano, and caraway have been used for the processing of meat products. This study investigates the antioxidant activity of 13 spices commonly used in meat processing plants. The hot water extracts were then used for evaluation of total phenolic content, total flavonoids content and antioxidant activities. Our results show that the hot water extract of oregano gave the highest extraction yield (41.33%) whereas mace (7.64%) gave the lowest. The DPPH radical scavenging ability of the spice extracts can be ranked against ascorbic acid in the order ascorbic acid > clove > thyme > rosemary > savory > oregano. The values for superoxide anion radical scavenging activities were in the order of marjoram > rosemary > oregano > cumin > savory > basil > thyme > fennel > coriander > ascorbic acid. When compared to ascorbic acid (48.72%), the hydroxyl radical scavenging activities of turmeric and mace were found to be higher (p < 0.001). Clove had the highest total phenolic content (108.28 µg catechin equivalent (CE)/g). The total flavonoid content of the spices varied from 324.08 µg quercetin equivalent (QE)/g for thyme to 3.38 µg QE/g for coriander. Our results indicate that hot water extract of several spices had a high antioxidant activity which is partly due to the phenolic and flavonoid compounds. This provides basic data, having implications for further development of processed food products.

The covalent modification of spectrin in red cell membranes by the lipid peroxidation product 4-hydroxy-2-nonenal.

Spectrin strengthens the red cell membrane through its direct association with membrane lipids and through protein-protein interactions. Spectrin loss reduces the membrane stability and results in various types of hereditary spherocytosis. However, less is known about acquired spectrin damage. Here, we showed that alpha- and beta-spectrin in human red cells are the primary targets of the lipid peroxidation product 4-hydroxy-2-nonenal (HNE) by immunoblotting and mass spectrometry analyses. The level of HNE adducts in spectrin (particularly alpha-spectrin) and several other membrane proteins was increased following the HNE treatment of red cell membrane ghosts prepared in the absence of MgATP. In contrast, ghost preparation in the presence of MgATP reduced HNE adduct formation, with preferential beta-spectrin modification and increased cross-linking of the HNE-modified spectrins. Exposure of intact red cells to HNE resulted in selective HNE-spectrin adduct formation with a similar preponderance of HNE-beta-spectrin modifications. These findings indicate that HNE adduction occurs preferentially in spectrin at the interface between the skeletal proteins and lipid bilayer in red cells and suggest that HNE-spectrin adduct aggregation results in the extrusion of damaged spectrin and membrane lipids under physiological and disease conditions.