The impact of endoscopic treatment on health-related quality of life in patients with Barrett's neoplasia: a scoping review.

PURPOSE: The objective of this scoping review is to understand the extent, type of evidence, and overall findings in relation to the impact of endoscopic treatment (ET) on health-related quality of life (HR-QoL) in patients with Barrett's dysplasia and early oesophageal cancer. METHODS: A comprehensive search was conducted for literature between 2001 and 2022 in computerised databases (PubMed, Embase, Cochrane Library, and CINAHL Complete). Additionally, sources of unpublished literature were searched in Google Advanced Search. After title and abstract checking, full-text papers were retrieved. Data were extracted, synthesised, key information tabulated, and a narrative synthesis completed. RESULTS: Six studies were included in the final analysis. Twelve different survey tools were utilised across all studies. Study designs included three randomised controlled studies, two prospective observational studies, and a single retrospective observational study. The average age of study participants ranged from 60.3 to 71.0 years. Two studies evaluated HR-QoL as primary outcome measures, but most research evaluated HR-QoL as a secondary outcome. Health domains evaluated in the studies focussed on the biophysical and psychosocial aspects of quality of life. CONCLUSION: A small number of research studies have been conducted in this area. Due to the heterogeneity and small number of included studies, it was difficult to draw conclusions about the impact of specific ET types on HR-QoL. Overall, there were perceived psychological benefits while undergoing ET. Future research could target specific ET subtypes and measure HR-QoL at baseline and post-procedures in the short and long term.

Being Uncertain: Rural-Living Cardiac Patients' Experience of Seeking Health Care.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Secondary prevention strategies reduce disease progression to heart failure. Rural cardiac patients typically have less access to health care resources to support them in managing secondary prevention, and services to improve quality of life tend to be lacking in rural settings. The study aim was to examine the process that rural cardiac patients go through to access health care and cardiac rehabilitation (CR) following myocardial infarction (MI). In-depth interviews with 11 post-MI participants using Straussian grounded theory were undertaken. Analysis revealed a linear process from hospital discharge to maintaining health. There were five elements: comfort with health information, relationship with health care providers, social support, taking ownership, and availability of/for CR. The core category was "being uncertain." Findings can be used to identify ways to improve access and address uncertainty stemming from a lack of perceived information and supports following discharge.

Mycosis Fungoides Preceding Pityriasis Lichenoides et Varioliformis Acuta by Twelve Years in a Pediatric Patient.

ABSTRACT: A 15-year-old boy presented to the pediatric dermatology department with long-standing patch stage CD8+ mycosis fungoides and subsequent development of recurrent pityriasis lichenoides et varioliformis acuta eruptions. There have been rare reports of patients with chronic, recalcitrant pityriasis lichenoides developing mycosis fungoides, but we believe this to be the second case of mycosis fungoides preceding a diagnosis of pityriasis lichenoides, and the first case reported in the pediatric population.

Assessment of PCXMC for patients with different body size in chest and abdominal x ray examinations: a Monte Carlo simulation study.

A PC Program for x ray Monte Carlo (PCXMC) has been used to calculate organ doses in patient dosimetry and for the exposure assessment in epidemiological studies of radiogenic health related risks. This study compared the dosimetry from using the built-in stylized phantoms in the PCXMC to that of a newer hybrid phantom library with improved anatomical realism. We simulated chest and abdominal x ray projections for 146 unique body size computational phantoms, 77 males and 69 females, with different combinations of height (125-180 cm) and weight (20-140 kg) using the built-in stylized phantoms in the PCXMC version 2.0.1.4 and the hybrid phantom library using the Monte Carlo N-particle eXtended transport code 2.7 (MCNPX). Unfortunately, it was not possible to incorporate the hybrid phantom library into the PCXMC. We compared 14 organ doses, including dose to the active bone marrow, to evaluate differences between the built-in stylized phantoms in the PCXMC and the hybrid phantoms (Cristy and Eckerman 1987 Technical Report ORNL/TM-8381/V1, Oak Ridge National Laboratory, Eckerman and Ryman 1993 Technical Report 12 Oak Ridge, TN, Geyer et al 2014 Phys. Med. Biol. 59 5225-42). On average, organ doses calculated using the built-in stylized phantoms in the PCXMC were greater when compared to the hybrid phantoms. This is most prominent in AP abdominal exams by an average factor of 2.4-, 2.8-, and 2.8-fold for the 10-year-old, 15-year-old, and adult phantoms, respectively. For chest exams, organ doses are greater by an average factor of 1.1-, 1.4-, and 1.2-fold for the 10-year-old, 15-year-old, and adult phantoms, respectively. The PCXMX, due to its ease of use, is often selected to support dosimetry in epidemiological studies; however, it uses simplified models of the human anatomy that fail to account for variations in body morphometry for increasing weight. For epidemiological studies that use PCXMC dosimetry, associations between radiation-related disease risks and organ doses may be underestimated, and to a greater degree in pediatric, especially obese pediatric, compared to adult patients.

Unraveling the contact patterns and network structure of pig shipments in the United States and its association with porcine reproductive and respiratory syndrome virus (PRRSV) outbreaks.

The analysis of the pork value chain is becoming key to understanding the risk of infectious disease dissemination in the swine industry. In this study, we used social network analysis to characterize the swine shipment network structure and properties in a typical multisite swine production system in the US. We also aimed to evaluate the association between network properties and porcine respiratory and reproductive syndrome virus (PRRSV) transmission between production sites. We analyzed the 109,868 swine shipments transporting over 93 million swine between more than 500 production sites from 2012 to 2014. A total of 248 PRRSV positive occurrences were reported from 79 production sites during those 3 years. The temporal dynamics of swine shipments was evaluated by computing network properties in one-month and three-month networks. The association of PRRS occurrence in sow farms with centrality properties from one-month and three-month networks was assessed by using the multilevel logistic regression. All monthly networks showed a scale-free network topology with positive degree assortativity. The regression model revealed that out-degree centrality had a negative association with PRRS occurrence in sow farms in both one-month and three-month networks [OR=0.79 (95% CI, 0.63-0.99) in one-month network and 0.56 (95% CI, 0.36, 0.88) in three-month network] and in-closeness centrality model was positively associated with PRRS occurrence in sow farms in the three-month network [OR=2.45 (95% CI, 1.14-5.26)]. We also describe how the occurrence of porcine epidemic diarrheac (PED) outbreaks severely affected the network structure as well as the PRRS occurrence reports and its association with centrality measures in sow farms. The structure of the swine shipment network and the connectivity between production sites influenced on the PRRSV transmission. The use of network topology and characteristics combining with spatial analysis based on fine scale geographical location of production sites will be useful to inform the design of more cost-efficient, risk-based surveillance and control measures for PRRSV as well as other diseases in the US swine industry.

Paradoxical Erythema Reaction of Long-term Topical Brimonidine Gel for the Treatment of Facial Erythema of Rosacea.

In 2013 brimonidine tartrate gel 0.33% (Mirvaso Gel, Galderma Laboratories, LP, Fort Worth, TX) was approved by the US Food and Drug Administration for the treatment of facial erythema of rosacea. It is the first and only drug on the market to address the hallmark redness of this chronic, inflammatory disease. Commonly reported adverse events include erythema/flushing worse than at baseline, most often occurring with the first application. We report a unique case of facial erythema of rosacea that responded to brimonidine gel with effective blanching for two years until the patient developed a paradoxical erythema reaction. This is an adverse reaction physicians should be aware of with continued prescription of brimonidine gel for their rosacea patients.

J Drugs Dermatol. 2016;15(6):763-765.

Impact of tobacco smoking cessation on stable clozapine or olanzapine treatment.

OBJECTIVE: To examine the pharmacokinetic implications and potential clinical effects of tobacco smoking cessation in patients on stable clozapine or olanzapine treatment. DATA SOURCES: A literature search of MEDLINE (1950-November 2009) and EMBASE (1980-November 2009) was conducted using the search terms smoking, tobacco, cigarette, cannabis, smoking cessation, cytochrome P450, antipsychotic, clozapine, and olanzapine. In addition, reference lists from publications identified were searched manually. STUDY SELECTION AND DATA EXTRACTION: English-language articles and human studies were identified, yielding 111 returns. Articles that reported clinical outcomes following smoking cessation were selected. Pharmacokinetic data for these drugs were reviewed and articles that provided relevant background information were also included. DATA SYNTHESIS: Pharmacokinetic studies have demonstrated more rapid clearance of olanzapine and lower clozapine and norclozapine (desmethylclozapine) concentrations in smokers compared to nonsmokers. These studies also found that smokers require higher doses of these agents than nonsmokers. There are case reports of adverse clinical outcomes following smoking cessation in patients being treated with olanzapine and clozapine. Reports that included serum concentrations consistently found elevations following smoking cessation, and dosage reductions of 30-40% were required to achieve pre-cessation concentrations. Worsening psychiatric symptoms, somnolence, hypersalivation, extreme fatigue, extrapyramidal effects, and seizures have all been reported following smoking cessation in this patient group. CONCLUSIONS: Pharmacists need to be aware of potential risks associated with smoking cessation in patients stabilized on clozapine or olanzapine. Toxicity as a result of recent smoking reduction or cessation may be a reason for hospital admission. For hospitalized patients, pharmacists should obtain information concerning smoking status, including cessation attempts. Nonspecific signs and symptoms of elevated clozapine or olanzapine concentrations should be considered in relation to clinical status while the patient is hospitalized. Measurement of baseline serum clozapine concentrations and/or empiric dosage adjustment in patients expected to have a prolonged hospital stay with forced smoking cessation may be appropriate.

CCAAT/enhancer-binding protein beta deletion reduces adiposity, hepatic steatosis, and diabetes in Lepr(db/db) mice.

CCAAT/enhancer-binding protein beta (C/EBPbeta) plays a key role in initiation of adipogenesis in adipose tissue and gluconeogenesis in liver; however, the role of C/EBPbeta in hepatic lipogenesis remains undefined. Here we show that C/EBPbeta inactivation in Lepr(db/db) mice attenuates obesity, fatty liver, and diabetes. In addition to impaired adipogenesis, livers from C/EBPbeta(-/-) x Lepr(db/db) mice had dramatically decreased triglyceride content and reduced lipogenic enzyme activity. C/EBPbeta deletion in Lepr(db/db) mice down-regulated peroxisome proliferator-activated receptor gamma2 (PPARgamma2) and stearoyl-CoA desaturase-1 and up-regulated PPARalpha independent of SREBP1c. Conversely, C/EBPbeta overexpression in wild-type mice increased PPARgamma2 and stearoyl-CoA desaturase-1 mRNA and hepatic triglyceride content. In FAO cells, overexpression of the liver inhibiting form of C/EBPbeta or C/EBPbeta RNA interference attenuated palmitate-induced triglyceride accumulation and reduced PPARgamma2 and triglyceride levels in the liver in vivo. Leptin and the anti-diabetic drug metformin acutely down-regulated C/EBPbeta expression in hepatocytes, whereas fatty acids up-regulate C/EBPbeta expression. These data provide novel evidence linking C/EBPbeta expression to lipogenesis and energy balance with important implications for the treatment of obesity and fatty liver disease.

RU486 inhibits expression of lysophosphatidic acid induced glycodelin.

OBJECTIVE: This study was undertaken to provide evidence for the mode of action of RU486 on glycodelin produced in K562 cells. To show that histiocytes may be a source of glycodelin in leiomyoma. STUDY DESIGN: With the use of K562, a leukemia cell line, the effect of lysophosphatidic acid (LPA), RU486, antioxidants, and ZK112,993 on glycodelin protein and gene expression was studied. Immunocytochemistry for glycodelin and HAM-56 (macrophage) was performed on leiomyoma and myometrium. RESULTS: Incubation of K562 cells with LPA, progesterone, ZK112,933 and RU486 significantly induced the expression of glycodelin protein and messenger RNA. The addition of RU486 to LPA activated cells markedly reduced expression of glycodelin. Addition of ZK112,993, an antiprogestin without antioxidant properties, to LPA activated cells did not reduce glycodelin. Histiocytes in leiomyoma and myometrium co-localize with glycodelin. CONCLUSION: RU486, partly acting as an antioxidant, markedly reduces LPA stimulated glycodelin production. Histiocytes in leiomyoma and myometrium immunostain for glycodelin and suggests a source for glycodelin in leiomyoma.