Imaging of Headaches due to Intracranial Pressure Disorders.

Changes in intracranial pressure are a potentially serious etiology of headache. Headache secondary to changes in intracranial pressure frequently present with characteristic clinical features. Imaging plays a key role in the diagnosis and management of this category of headache. In this article, we will review the physiology, clinical presentation, and key imaging findings of major etiologies of changes in intracranial pressure resulting in headache including obstructive and nonobstructive hydrocephalous, idiopathic intracranial hypertension (IIH), and cerebrospinal fluid (CSF) leak.

Quitting electronic cigarettes: Factors associated with quitting and quit attempts in long-term users.

Some electronic cigarette (e-cigarette) users are interested in quitting e-cigarette use, though few studies have assessed what factors contribute to this interest. This study aimed to identify factors associated with e-cigarette quitting interest and quitting behaviors in exclusive, long-term e-cigarette users. These e-cigarette users were surveyed in January 2017 (baseline) and June 2019 (follow-up), with an average follow-up period of 2.4 years. At baseline, the sample had been e-cigarette users for an average of 5.6 years. Among the 221 participants, 205 (92.8%) did not intend to quit using e-cigarettes at baseline. At follow-up, 196 (88.7%) continued exclusive e-cigarette use, 17 (7.7%) quit e-cigarettes, 8 (3.6%) became dual users, and none became exclusive smokers. At baseline, 16 users intended to quit e-cigarettes, 2 (12.5%) of whom quit at follow-up. Predictors of quitting e-cigarettes included no previous cigarette smoking (ß = -3.7, OR = 0.021, p < .01), lower Penn State Electronic Cigarette Dependence Index score (ß = -0.21, OR = 0.81, p = .011), and lower number of devices used per day (ß = -1.9, OR = 0.15, p = .015). Intending to quit e-cigarettes at baseline was not predictive of quitting at follow-up. At follow-up, 57 (25.8%) had tried to quit in the past. Overall predictors of trying to quit included interest in quitting at baseline (ß = 1.7, OR = 5.3, p < .01) and using a drip-fed atomizer (ß = 1.0, OR = 2.7, p = .022). These results suggest that long-term exclusive e-cigarette users generally have little interest in stopping e-cigarette use, and that type of device used, smoking history, e-cigarette dependence, number of devices used, and intention to quit are associated with e-cigarette quitting behaviors.

Esophageal extracellular matrix hydrogel mitigates metaplastic change in a dog model of Barrett's esophagus.

Chronic inflammatory gastric reflux alters the esophageal microenvironment and induces metaplastic transformation of the epithelium, a precancerous condition termed Barrett's esophagus (BE). The microenvironmental niche, which includes the extracellular matrix (ECM), substantially influences cell phenotype. ECM harvested from normal porcine esophageal mucosa (eECM) was formulated as a mucoadhesive hydrogel, and shown to largely retain basement membrane and matrix-cell adhesion proteins. Dogs with BE were treated orally with eECM hydrogel and omeprazole (n = 6) or omeprazole alone (n = 2) for 30 days. eECM treatment resolved esophagitis, reverted metaplasia to a normal, squamous epithelium in four of six animals, and downregulated the pro-inflammatory tumor necrosis factor-α+ cell infiltrate compared to control animals. The metaplastic tissue in control animals (n = 2) did not regress. The results suggest that in vivo alteration of the microenvironment with a site-appropriate, mucoadhesive ECM hydrogel can mitigate the inflammatory and metaplastic response in a dog model of BE.

Restoring Mucosal Barrier Function and Modifying Macrophage Phenotype with an Extracellular Matrix Hydrogel: Potential Therapy for Ulcerative Colitis.

BACKGROUND AND AIMS: Despite advances in therapeutic options, more than half of all patients with ulcerative colitis [UC] do not achieve long-term remission, many require colectomy, and the disease still has a marked negative impact on quality of life. Extracellular matrix [ECM] bioscaffolds facilitate the functional repair of many soft tissues by mechanisms that include mitigation of pro-inflammatory macrophage phenotype and mobilization of endogenous stem/progenitor cells. The aim of the present study was to determine if an ECM hydrogel therapy could influence outcomes in an inducible rodent model of UC. METHODS: The dextran sodium sulphate [DSS]-colitis model was used in male Sprague Dawley rats. Animals were treated via enema with an ECM hydrogel and the severity of colitis was determined by clinical and histological criteria. Lamina propria cells were isolated and the production of inflammatory mediators was quantified. Mucosal permeability was assessed in vivo by administering TRITC-dextran and in vitro using transepithelial electrical resistance [TEER]. RESULTS: ECM hydrogel therapy accelerated healing and improved outcome. The hydrogel was adhesive to colonic tissue, which allowed for targeted delivery of the therapy, and resulted in a reduction in clinical and histological signs of disease. ECM hydrogel facilitated functional improvement of colonic epithelial barrier function and the resolution of the pro-inflammatory state of tissue macrophages. CONCLUSIONS: The present study shows that a non-surgical and non-pharmacological ECM-based therapy can abate DSS-colitis not by immunosuppression but by promoting phenotypic change in local macrophage phenotype and rapid replacement of the colonic mucosal barrier.