Zinc Gluconate Induces Potentially Cancer Chemopreventive Activity in Barrett's Esophagus: A Phase 1 Pilot Study

BACKGROUND

Chemopreventive effects of zinc for esophageal cancer have been well documented in animal models. This prospective study explores if a similar, potentially chemopreventive action can be seen in Barrett's esophagus (BE) in humans.

AIMS

To determine if molecular evidence can be obtained potentially indicating zinc's chemopreventive action in Barrett's metaplasia.

METHODS

Patients with a prior BE diagnosis were placed on oral zinc gluconate (14 days of 26.4 mg zinc BID) or a sodium gluconate placebo, prior to their surveillance endoscopy procedure. Biopsies of Barrett's mucosa were then obtained for miRNA and mRNA microarrays, or protein analyses.

RESULTS

Zinc-induced mRNA changes were observed for a large number of transcripts. These included downregulation of transcripts encoding proinflammatory proteins (IL32, IL1β, IL15, IL7R, IL2R, IL15R, IL3R), upregulation of anti-inflammatory mediators (IL1RA), downregulation of transcripts mediating epithelial-to-mesenchymal transition (EMT) (LIF, MYB, LYN, MTA1, SRC, SNAIL1, and TWIST1), and upregulation of transcripts that oppose EMT (BMP7, MTSS1, TRIB3, GRHL1). miRNA arrays showed significant upregulation of seven miRs with tumor suppressor activity (-125b-5P, -132-3P, -548z, -551a, -504, -518, and -34a-5P). Of proteins analyzed by Western blot, increased expression of the pro-apoptotic protein, BAX, and the tight junctional protein, CLAUDIN-7, along with decreased expression of BCL-2 and VEGF-R2 were noteworthy.

CONCLUSIONS

When these mRNA, miRNA, and protein molecular data are considered collectively, a cancer chemopreventive action by zinc in Barrett's metaplasia may be possible for this precancerous esophageal tissue. These results and the extensive prior animal model studies argue for a future prospective clinical trial for this safe, easily-administered, and inexpensive micronutrient, that could determine if a chemopreventive action truly exists.

Evidence-based reporting, methods and content of allergy-specific digital training programs

Background

The World Allergy Organization frames allergies as a “major global public health issue”, due to the consistently high prevalence of, e.g., allergic rhinitis (up to 30%). Digital training programs (DTPs) may help fostering self-management and provide allergy-specific information, given, for instance, their good accessibility. We aimed to assess an exploratory sample of allergy-specific, interactive and feedback-oriented DTPs towards the extent to which these tools meet established criteria for the reporting, methods, and content of evidence-based (digital) health information.

Methods

We searched for DTPs via scientific databases and online sources and developed a checklist from established scientific guidelines for digital health information. The checklist contained 44 items covering 11 domains related to content (e.g. evidence-base), structure (e.g. trainer qualification) and impact (e.g. user perspective).

Results

15 DTPs covered an average of 37% of the items (score 33/88). Items relating to intervention (58%), content (49%), and data safety (60%) were frequently considered, as opposed to user safety (10%), qualification of staff (10%), effectiveness (16%), and user perspective (45%). In 13 of 15 DTPs, a minimum of 3 domains were not covered at all. Regarding evidence-based content, 46% scored on use of scientific research, 53% on regular information update, and 33% on provision of references.

Conclusions

Allergy-specific DTPs conform only partly to established criteria for evidence-based (digital) health information and education. The named methodological and content-wise shortcomings pose considerable obstacles for users. While there have been related, general criticisms earlier, this study provides empirical evidence via the example of allergy-specific DTPs.

Key messages

For DTPs to add value, service providers and health information experts need to cooperate much closer to reduce the 'reporting vs. requirements' gap. Cooperation is also needed to agree essential methodological and content-wise features of DTPs and similar services.

Patient and Public Involvement in health research: evidence on the practice of participant selection

Background

Research on Patient and Public Involvement (PPI) largely focusses on its aims and methods. Aspects regarding who participates in PPI are largely overlooked, though they may impact considerably on the planning, process and outcomes: who exactly are 'patients and public' in PPI? How are participants selected and why? Are and should participants be representative? Our objective was to explore respective practices and perceptions to inform future PPI.

Methods

We conducted a systematic database search to select published PPI in medical and health research. Authors of included publications (n = 315) were addressed via an electronic survey, closed and open responses were assessed using descriptive statistics and thematic content evaluation.

Results

Respondents (40%) reported to have recruited a broad spectrum of participants, often including more than one specific group (56%), e.g. publics with and without topic-wise experience. There were only little differences with respect to selecting participants for different involvement aims and using different recruiting methods. Representativeness was often seen as a crucial recruiting objective (71%), while many considered achieving it (very) difficult (69%). They identified significant respective challenges and desired more guidance on various aspects of planning and conducting PPI (56%).

Conclusions

Recruiting PPI participants and handling representativeness are controversial and are associated with various obstacles. While few prior studies addressed single related aspects using debates and theory, our results add a more comprehensive and empirical perspective, particularly regarding the (real) relevance of representativeness.

Key messages

Study authors need to be more systematic and reasonable in selecting PPI participants and in deciding about the need for representativeness. PPI-guidelines should concretize the most relevant steps for planning and conducting participant selection, so that the practice of PPI can be regarded sound and meaningful.

[What motivates patients with atopic diseases to search the internet-a focus group study on expectations and demands]

BACKGROUND

People affected by allergies with mild-to-moderate symptoms are often not treated adequately, despite the availability of prevention and self-therapy measures. Given their good and quick accessibility when seeking information, evidence- and web-based services that are user-friendly may strengthen a more independent way of handling an allergy and may also increase health literacy. In order for such services to be found and read, developers and providers need to know about information needs, demands and users' behavior.

OBJECTIVES

On which occasions does the target group search for allergy-specific information? Which preferences and demands do affected persons have regarding a web-based service?

MATERIALS AND METHODS

Three individual interviews and four focus groups with 37 participants (19-81 years; hay fever, n = 30; asthma, n = 17; eczema, n = 15) were conducted in four German cities. These were recorded and transcribed verbatim. A multiprofessional team developed a system for coding the texts (two independent encoders, MAXQDA analysis software).

RESULTS

Those who are affected usually seek information only in case of a concrete need for action. Impulses are, among others, symptoms, suggestions from the social environment, the beginning of the allergy season or an allergy-related contact with the health system. A web-based service should primarily include information about treatment options, provide individualized support for everyday life action strategies, and promote adequate self-management skills.

DISCUSSION

In order to promote self-management skills, a web-based service should focus on allergy symptoms, treatment options and day-to-day help.

Navigating the health care system: perceptions of patients with chronic pain

A new framework is needed for patients with chronic pain and their primary care physicians that acknowledges the individual’s experiences and provides evidence-informed education and better linkages to community-based resources. This study describes the experience of 19 chronic-pain sufferers who seek relief via the health care system. Their experiences were recorded through in-depth semistructured interviews and analyzed through qualitative methods. The participants reported early optimism, then disillusionment, and finally acceptance of living with chronic pain. Both individuals with chronic pain and their health care professionals need evidence-informed resources and information on best practices to assist them to manage pain. Empathetic communication between health care professionals and individuals with chronic pain is crucial because insensitive communication negatively affects the individual, reduces treatment compliance and increases health care utilization.

Navigating the health care system: perceptions of patients with chronic pain

A new framework is needed for patients with chronic pain and their primary care physicians that acknowledges the individual's experiences and provides evidence-informed education and better linkages to community-based resources. This study describes the experience of 19 chronic-pain sufferers who seek relief via the health care system. Their experiences were recorded through in-depth semistructured interviews and analyzed through qualitative methods. The participants reported early optimism, then disillusionment, and finally acceptance of living with chronic pain. Both individuals with chronic pain and their health care professionals need evidence-informed resources and information on best practices to assist them to manage pain. Empathetic communication between health care professionals and individuals with chronic pain is crucial because insensitive communication negatively affects the individual, reduces treatment compliance and increases health care utilization.

15-Deoxy-Delta(12,14)-prostaglandin J(2), a ligand for peroxisome proliferator-activated receptor-gamma, induces apoptosis in JEG3 choriocarcinoma cells

Apoptosis has been described in placental (trophoblast) tissues during both normal and abnormal pregnancies. We have studied the effects of the cyclopentenone prostaglandins (PGs) on trophoblast cell death using JEG3 choriocarcinoma cells. PGJ(2), Delta(12)PGJ(2), and 15-deoxy-Delta(12,14)-PGJ(2) (15dPGJ(2)) (10 microM) significantly reduced mitochondrial activity (MTT assay) over 16 h by 17.4 +/- 4.7%, 28 +/- 9.3%, and 62.5 +/- 2.8%, respectively (mean +/- sem), while PGA(2) and PGD(2) had no effect. The synthetic PPAR-gamma ligand ciglitizone (12.5 microM) had a potency similar to 15dPGJ(2) (69 +/- 3% reduction). Morphological examination of cultures treated with PGJ(2) and its derivatives revealed the presence of numerous cells with dense, pyknotic nuclei, a hallmark of apoptosis. FACS analysis revealed an abundance (approximately 40%) of apoptotic cells after 16-h treatment with 15dPGJ(2) (10 microM). The caspase inhibitor ZVAD-fmk (5 microM) significantly diminished the apoptotic effects of Delta(12)PGJ(2) and 15dPGJ(2). JEG3 cells expressed PPAR-gamma mRNA by Northern analysis. These novel findings imply a role for PPAR-gamma ligands in various processes associated with pregnancy and parturition.

Supporting the parents of children in day surgery

Certainly, day surgery helps reduce health care costs, but what are the effects on the families of children undergoing surgical procedures and same-day discharge? Our research was aimed at identifying the family outcomes of day surgery, and making recommendations for change as appropriate.

Assessing children's state anxiety

Anxiety is an important component of children's pain and is routinely assessed in pain research. Two forms of the State-Trait Anxiety Inventory have been used frequently by researchers investigating children's pain and state anxiety (form C-1 and Y-1). We were unable to find psychometric information about this tool when used with a population of hospitalized children. Therefore, we undertook to assess reliability and validity, and identify problem items using data from 881 hospitalized children (aged 5-18 years) whom we had tested. Considering results of all analyses together, we concluded that the tools lack validity and reliability, and contain many problem items that are in need of revision.

Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial

CONTEXT

Beliefs about the safety and effectiveness of current anesthetics have resulted in many newborns being circumcised without the benefit of anesthesia.

OBJECTIVE

To compare ring block, dorsal penile nerve block, a topical eutectic mixture of local anesthetics (EMLA), and topical placebo when used for neonatal circumcision. The placebo represented current practice, with no anesthetic for neonatal circumcision.

DESIGN

A randomized controlled trial.

SETTING

Antenatal units in 2 tertiary care hospitals in Edmonton, Alberta.

PARTICIPANTS

A consecutive sample of 52 healthy, full-term, male newborns, aged 1 to 3 days.

INTERVENTIONS

Physiological and behavioral monitoring occurred in a series of trials: baseline, drug application, preparation, circumcision, and postcircumcision. Surgical procedures defined the following 4 stages of the circumcision: cleansing, separation, clamp on, and clamp off. Methemoglobin level was assessed 6 hours after surgery.

MAIN OUTCOME MEASURES

Heart rate, cry, and methemoglobin level.

RESULTS

Newborns in the untreated placebo group exhibited homogeneous responses that consisted of sustained elevation of heart rate and high-pitched cry throughout the circumcision and following. Two newborns in the placebo group became ill following circumcision (choking and apnea). The 3 treatment groups all had significantly less crying and lower heart rates during and following circumcision compared with the untreated group. The ring block was equally effective through all stages of the circumcision, whereas the dorsal penile nerve block and EMLA were not effective during foreskin separation and incision. Methemoglobin levels were highest in the EMLA group, although no newborn required treatment.

CONCLUSIONS

The most effective anesthetic is the ring block; EMLA is the least effective. It is our recommendation that an anesthetic should be administered to newborns prior to undergoing circumcision.

Children's coping with venipuncture

Children's strategies for coping with the pain and distress of venipuncture were examined in this descriptive study. Eighty-five children (aged 5-13 years) were interviewed prior to and following blood collection. Prior to the procedure, children reported pain expectations and coping strategies that might be used. Self-reports of the pain experienced and coping strategies used were obtained immediately after the procedure. Twenty-seven different strategies were identified from the children's responses. These strategies were subsequently grouped into 11 coping categories: Active Involvement in Procedure, Behavior-Regulating Cognitions, Cognitive Reappraisal, Direct Efforts to Maintain Control, Diversionary Thinking, Emotion-Regulating Cognitions, Information Seeking, Reality-Oriented Working Through, Reliance on Health-Care Interventions, Support Seeking, and Avoidance and Catastrophizing. Direct Efforts to Maintain Control was the most frequently used category. Age and gender differences were observed in both number and type of strategies reported by the children. Further research is needed to examine the observed relationship between the type of coping strategies generated and the children's pain experience.

Strategies to improve clinical judgments about pain

To assess a strategy to improve 288 nurses' clinical decisions about management of pain saliency of information and cue about the information were manipulated. Scores indicated that the combination of vivid information and a cue to use the information led to the best decisions.

Determinants of success and failure of EMLA

Although EMLA is known to be an effective topical anesthetic, its rate of success is unknown. Indeed, researchers have suggested that EMLA may fail with young and apprehensive children. Therefore, the objectives of this study were to assess EMLA's rate of success as well as factors which predict success. A double-blind, placebo-controlled design was utilized. The sample included 258 children and adolescents aged 5-18 years who were having venipuncture or intravenous (i.v.) cannulation. After having their anxiety assessed, subjects were randomly assigned to have EMLA or placebo applied over the procedure site for 90 min. The visual analogue scale was used to assess pain caused by removal of the semi-permeable dressing and by the procedure. Other information that was collected included: duration of drug application, interval between drug removal and procedure, skin changes at bandage and drug sites and rated difficulty of the procedure. EMLA was successful 84% of the time for venipuncture and 51% of the time for i.v. cannulation. Factors which predicted success of EMLA included type of procedure, duration of drug application and anxiety. EMLA was less successful for i.v. cannulation compared to venipuncture even with duration of drug application controlled. Those who had a poor outcome were more anxious than those with a good outcome. Age of child was not a factor. Strategies for improving efficient use of EMLA were recommended.

Evaluation of a decision tree for management of chronic wounds

Nurses routinely make complex clinical decisions under conditions of uncertainty. They collect large, unwieldy data sets in the process of making these clinical decisions. To assist nurses in collecting and organizing data and in making complex clinical decisions, some nursing scholars recommend decision support systems. One such support system, a decision tree leads the nurse from general to specific assessments and ultimately to a decision choice or outcome. In this study, a decision tree was examined for its utility in promoting accuracy in decision making for management of chronic wounds among home care nurses. Home care nurses who used the decision tree made better decisions about staging and product choices for chronic wounds. More research is necessary to discover whether decision trees for the management of chronic wounds translate into improved client outcomes.

Cognitive status and postoperative pain: older adults

The purpose of this study was to assess older adults to determine (a) the course of postoperative pain, (b) influences of pain and analgesics on mental status, and (c) relationships among age, mental status and pain. Sixty adults, aged 50-80 yr, who had total hip replacement surgery were included in this study. All subjects had met a preoperative criterion for mental status. Data collection took place over 5 days following surgery. Pain intensity and distress were assessed three times a day for 5 days. Recalled night pain intensity, pain distress, and sleep disturbance from pain were assessed daily in the early morning prior to assessment of mental status. Although no within day or day-to-day pain patterns were observed, the greatest decreases in pain occurred during the first 2 days. Night pain also improved after the third day. One-third of subjects recorded one or more episodes where mental status declined below criterion after surgery. Multivariate analysis indicated that pain, not analgesic intake, predicted mental status decline. Age was not related to pain or mental status. In general, pain was poorly managed in this group of subjects. The results suggest an explanation for acute confusion in older patients after surgery and recommend improved pain management.

Taking the jab out of needles

Typically, health professionals regard injections and venipuncture as routine for them and a minor nuisance for the patient. Yet for others, needles arouse dread and anxiety. This fear of needles may even lead some people to avoid dental and health care.

Children's venipuncture pain: influence of technical factors

Several aspects of venipuncture technique were evaluated to assess their relationship to reported pain. Subjects were 514 children aged 5-17 who had venipuncture performed by a technician in a hospital outpatient laboratory. A research assistant timed the duration of venipuncture and then obtained visual analogue pain scores from the children following venipuncture. Blood volume obtained from venipuncture was also measured. The technician who performed the procedure, amount of blood drawn, and time required to complete the venipuncture did not contribute to the prediction of children's pain. Age and anxiety, which were treated as covariates, were significant predictors of pain. The distribution of pain experienced by children was positively skewed and about one-third of children were above the mean pain score. From the results of this study, venipuncture pain can be recommended for the study of issues in children's pain. Further, the findings recommend the development and utilization of interventions to reduce children's venipuncture pain.

Children's pain predictions and memories

A cross-sectional descriptive design was utilized to explore expected, experienced and recalled pain, and anxiety. Subjects were 138 children (5-17 yr) who were attending an outpatient laboratory for venipuncture. They reported state anxiety and expected visual analogue scale pain prior to having venipuncture. Following venipuncture, they reported sensory and affective pain. Two months afterward, subjects were contacted and asked to recall sensory and affective pain from the venipuncture. Analysis of data determined that children's recall of pain was quite good although better for affective pain than sensory pain. Prediction accuracy for pain was not good. From analysis it was determined that overestimation of pain was related to anxiety but not to greater experienced pain. Four patterns of responses were identified when prediction and recall accuracy were further examined. These patterns were designated as realism, irrelevance, over-reaction and denial. It was suggested that these patterns of response may provide clues about avoidance and coping behavior for children's pain. In general, the results of this study did not support previous research. It was demonstrated that various statistical techniques which have been employed in research on this topic have influenced the interpretation of pain prediction and recall data.

Patient-controlled analgesia for older adults

Use of patient-controlled analgesia (PCA) was compared with nurse-administered intermittent intramuscular (IM) injections of morphine in older adults during their postoperative recovery. Data analyses indicated that the PCA and IM groups did not differ in pain intensity, pain distress, and satisfaction. The PCA group had significantly less sleep disturbance from pain than the IM group. Neither group was considered to have acceptable pain management.

Assessment of sex differences in children's and adolescents' self-reported pain from venipuncture

Examined venipuncture pain and anxiety among 90 male and 90 female children and adolescents (5 to 17 years) who were attending a hospital laboratory. The purpose of the study was to assess sex differences in pain. Ss reported state anxiety and expected pain prior to having venipuncture and sensory and affective pain following venipuncture. Analysis of data determined that male and female were alike regarding age, state anxiety, expected pain, and perceived sensory and affective venipuncture pain. From analysis of pain estimation errors, it was found that males were significantly more likely to underestimate pain and females were significantly more likely to overestimate pain. These findings were discussed in terms of implications for coping research and for clinical practice.

Age differences in children's pain

A cross-sectional study of venipuncture pain and anxiety was conducted with 180 consecutively referred children and their parents. Analysis indicated that younger children report more venipuncture pain than older children. Anxiety was related to both age and pain. As well, anxiety was lowest among children with no previous venipuncture experience and among those with the greatest experience.

Fallacies and phobias about addiction and pain

Research has indicated that approximately three-quarters of patients in acute care hospitals experience moderate to severe pain. It is thought that inadequately controlled pain is the result of poor clinical performance on the part of nurses and physicians. Faculty knowledge about pain mechanisms and pharmacology have been targeted as the source of their poor performance. In addition, practitioners may have fallacious beliefs about narcotics and pain. This study examined some of the misconceptions nurses have about addiction and pain management. A number of fallacies were identified. These included a very strong opiophobia or fallacy about addiction liability of narcotics even under conditions of normal hospital use.

Gender effects in pain perception

Studies have shown that women report more pain than men when pain is induced in the laboratory. As sex differences in perceived pain have not been established with clinical or endogenous pain, research was undertaken to compare reported pain of males and females arising from one of three sources. Two groups of adults and one group of children were studied. Analysis indicated no sex differences in reported clinical or endogenous pain for children or adults.

Use of transcutaneous electrical nerve stimulation for postoperative pain

This study examined the effects of transcutaneous electrical nerve stimulation (TENS) on incisional pain caused by the procedure of cleaning and packing an abdominal surgical wound. Seventy-five subjects (mean age 56.9 years) were randomly assigned to one of three intervention groups: TENS, placebo-TENS, or no-treatment control. The appropriate experimental treatment was administered during the routine dressing change which took place two mornings after surgery. Using an 11-point, visual analogue pain scale, subjects described pain experienced during the dressing change. Subjects who received TENS reported a significantly lower level of pain after dressing change than did those subjects who received either placebo-TENS or no-treatment. Drug administration variables did not contribute significantly to level of reported pain.

Electromyographic patterns accompanying isokinetic exercise under varying speed and sequencing conditions

The purposes of this study were: a) to investigate electromyographic patterns accompanying isokinetic exercise under varying speed and sequencing conditions, and b) to investigate the role of antagonist coactivation under these same conditions. Five adult males performed maximal knee extensions and flexions on a modified Orthotron isokinetic dynamometer. Tests were done at four speeds (100-400 degrees/sec) and under two counterbalanced conditions: extension followed by flexion (E/F) and flexion followed by extension (F/E). Simultaneous recordings of torque, knee joint position and agonist/antagonist EMG changes from the quadriceps and hamstring musculature were collected and analyzed. No consistent EMG patterns emerged that inferred intermittent surges of muscular activity as the primary mechanism yielding double peaked torques that characteristically occur in isokinetic exercise. Further analyses revealed relatively small co-contractions of antagonists during the various phases of movement. The findings suggest that gravity and inertia of the limb/lever system were the major factors responsible for limb deceleration and substantive antagonist co-contraction was not required for braking. If isokinetic knee flexion and extension exercises are used for conditioning or developmental purposes of healthy subjects, any distraction of the co-contracting antagonist from the recorded force of the agonist appears to be small once the activity is learned.

Investigation of the mode of action of the anaesthetic agent, ketamine, in the heart of the bivalve mollusc Tapes watlingi

In the isolated heart preparation from the bivalve mollusc Tapes watlingi the anaesthetic agent ketamine produced two distinct effects; a positive inotropic effect and bradycardia. The dose-dependent positive inotropic effect was considered to be a direct effect on the cardiac muscle since it was not blocked by antagonists specific for the excitatory actions of acetylcholine, dopamine, serotonin and octopamine. Verapamil, a calcium ion antagonist, did not affect the inotropic response. The bradycardia caused by ketamine was blocked by inhibitors specific for the acetylcholine receptor but not by specific antagonists to the inhibitory dopamine receptor.