Mindfulness based cognitive therapy for youth with inflammatory bowel disease and depression - Findings from a pilot randomised controlled trial

BACKGROUND

Mindfulness-based cognitive therapy (MBCT) is a promising adjunctive treatment for adolescents and young adults (AYAs) with Inflammatory Bowel Disease (IBD) and comorbid depression.

OBJECTIVES

This pilot randomised controlled trial (RCT) aimed to evaluate feasibility and efficacy of an adapted MBCT program for AYA, aged 16-29, with IBD.

METHODS

Sixty-four AYAs were randomly allocated to MBCT (n = 33) or treatment as usual (TAU) (n = 31). Primary outcome measure was the depression score on Depression, Anxiety and Stress Scale. Secondary outcomes included anxiety, stress, IBD-related quality of life, coping, mindfulness, post-traumatic growth, medication adherence, IBD activity, inflammatory markers, microbiome characteristics and brain functional connectivity.

RESULTS

Study recruitment rate was 75%, retention rate 70%, and session attendance 92%. Intention to treat analyses revealed that, compared to TAU group, MBCT group had significantly lower depression (∆ = -6.0; 95%CI = -10.8 to -1.2; P = 0.015) and stress (∆ = -5.1; 95%CI = -10.1 to -0.0; P = 0.049), higher active coping (∆ = 1.0;95%CI = 0.1-1.9; P = 0.022), and total mindfulness scores (∆ = 10.9;95%CI = 1.1-20.8; P = 0.030) at 8 weeks (post-therapy), and improved coping by positive reframing (∆ = 1.1;95%CI = 0.0-2.2; P = 0.043) and planning (∆ = 0.9;95%CI = 0.0-1.9; P = 0.045), mindful awareness (∆ = 5.2.;95%CI = 2.0-8.5; P = 0.002) and total mindfulness scores (∆ = 10.8.;95%CI = 0.4-21.1; P = 0.042) at 20 weeks. On per protocol analysis, MBCT group had significantly lower depression (∆ = -6.3; 95%CI = -11.4 to -1.2; P = 0.015), stress (∆ = -6.0; 95%CI = -11.2 to -0.5; P = 0.032), increased active coping (∆ = 0.9;95%CI = 0-1.7; P = 0.05) at 8 weeks, and mindful awareness (∆ = 5.4; 95%CI = 2.1-8.6; P = 0.001) at 20 weeks.

CONCLUSION

In AYAs with IBD, MBCT is feasible and beneficial in improving depression, stress, mindfulness and adaptive coping. It holds promise as an important component of integrated IBD care. Trial registration number ACTRN12617000876392, U1111-1197-7370; Pre-results.

Public acceptability of nudging and taxing to reduce consumption of alcohol, tobacco, and food: A population-based survey experiment

There is growing evidence for the effectiveness of choice architecture or 'nudge' interventions to change a range of behaviours including the consumption of alcohol, tobacco and food. Public acceptability is key to implementing these and other interventions. However, few studies have assessed public acceptability of these interventions, including the extent to which acceptability varies with the type of intervention, the target behaviour and with evidence of intervention effectiveness. These were assessed in an online study using a between-participants full factorial design with three factors: Policy (availability vs size vs labelling vs tax) x Behaviour (alcohol consumption vs tobacco use vs high-calorie snack food consumption) x Evidence communication (no message vs assertion of policy effectiveness vs assertion and quantification of policy effectiveness [e.g., a 10% change in behaviour]). Participants (N = 7058) were randomly allocated to one of the 36 groups. The primary outcome was acceptability of the policy. Acceptability differed across policy, behaviour and evidence communication (all ps < .001). Labelling was the most acceptable policy (supported by 78%) and Availability the least (47%). Tobacco use was the most acceptable behaviour to be targeted by policies (73%) compared with policies targeting Alcohol (55%) and Food (54%). Relative to the control group (60%), asserting evidence of effectiveness increased acceptability (63%); adding a quantification to this assertion did not significantly increase this further (65%). Public acceptability for nudges and taxes to improve population health varies with the behaviour targeted and the type of intervention but is generally favourable. Communicating that these policies are effective can increase support by a small but significant amount, suggesting that highlighting effectiveness could contribute to mobilising public demand for policies. While uncertainty remains about the strength of public support needed, this may help overcome political inertia and enable action on behaviours that damage population and planetary health.

Transoesophageal ultrasound and computer tomographic assessment of the equine cricoarytenoid dorsalis muscle: Relationship between muscle geometry and exercising laryngeal function

REASONS FOR PERFORMING STUDY

Early detection of recurrent laryngeal neuropathy (RLN) is of considerable interest to the equine industry.

OBJECTIVES

To describe two imaging modalities, transoesophageal ultrasound (TEU) and computed tomography (CT) with multiplanar reconstruction to assess laryngeal muscle geometry, and determine the relationship between cricoarytenoid dorsalis (CAD) geometry and function.

STUDY DESIGN

Two-phase study evaluating CAD geometry in experimental horses and horses with naturally occurring RLN.

METHODS

Equine CAD muscle volume was determined from CT scan sets using volumetric reconstruction with LiveWire. The midbody and caudal dorsal-ventral thickness of the CAD muscle was determined using a TEU in the same horses; and in horses with a range of severity of RLN (n = 112).

RESULTS

Transoesophageal ultrasound was able to readily image the CAD muscles and lower left:right CAD thickness ratios were observed with increasing disease severity. Computed tomography based muscle volume correlated very closely with ex vivo muscle volume (R² = 0.77).

CONCLUSIONS

Computed tomography reconstruction can accurately determine intrinsic laryngeal muscle geometry. A relationship between TEU measurements of CAD geometry and laryngeal function was established. These imaging techniques could be used to track the response of the CAD muscle to restorative surgical treatments such as nerve muscle pedicle graft, nerve anastomosis and functional electrical stimulation.

Diabetes self-management programmes in older adults: a systematic review and meta-analysis

AIM

The evidence for self-management programmes in older adults varies in methodological approaches, and disease criteria. Using predetermined methodological criteria, we evaluated the effect of diabetes-specific self-management programme interventions in older adults.

METHODS

The EMBASE, MEDLINE and Cochrane Central Register of Controlled Trials databases were searched from January 1980 to November 2013, as were reference lists from systematic reviews, meta-analyses and clinical practice guidelines. A total of 13 trials met the selection criteria, which included 4517 older adult participants; 2361 participants randomized to a diabetes self-management programme and 2156 to usual care.

RESULTS

The pooled effect on HbA(1c) was a reduction of -2 mmol/mol (-0.2%; 95% CI -0.3 to -0.1); tailored interventions [-3 mmol/mol (-0.2%; 95% CI -0.4 to -0.1)] or programmes with a psychological emphasis [-3 mmol/mol (-0.2; 95% CI -0.4 to -0.1)] were most effective. A pooled treatment effect on total cholesterol was a 5.81 mg/dl reduction (95% CI -10.33 to -1.29) and non-significant reductions in systolic and diastolic blood pressure.

CONCLUSIONS

Diabetes self-management programmes for older adults demonstrate a small reduction in HbA(1c), lipids and blood pressure. These findings may be of greater clinical relevance when offered in conjunction with other therapies.

An experimental study of recombination and polarity effect in a set of customized plane parallel ionization chambers

Plane parallel ionization chambers are an important tool for dosimetry and absolute calibration of electron beams used for radiotherapy. Most dosimetric protocols require corrections for recombination and polarity effects, which are to be determined experimentally as they depend on chamber design and radiation quality. Both effects were investigated in electron beams from a linear accelerator (Varian 21CD) for a set of four tissue equivalent plane parallel ionization chambers customized for the present research by Standard Imaging (Madison WI). All four chambers share the same design and air cavity dimensions, differing only in the diameter of their collecting electrode and the corresponding width of the guard ring. The diameters of the collecting electrodes were 2 mm, 4 mm, 10 mm and 20 mm. Measurements were taken using electron beams of nominal energy 6 to 20 MeV in a 10 cm x 10 cm field size with a SSD of 100 cm at various depths in a Solid Water slab phantom. No significant variation of recombination effect was found with radiation quality, depth of measurement or chamber design. However, the polarity effect exceeded 5% for the chambers with small collecting electrode for an effective electron energy below 4 MeV at the point of measurement. The magnitude of the effect increased with decreasing electron energy in the phantom. The polarity correction factor calculated following AAPM protocol TG51 ranged from approximately 1.00 for the 20.0 mm chamber to less than 0.95 for the 2 mm chamber at 4.1 cm depth in a electron beam of nominally 12 MeV. By inverting the chamber it could be shown that the polarity effect did not depend on the polarity of the electrode first traversed by the electron beam. Similarly, the introduction of an air gap between the overlying phantom layer and the chambers demonstrated that the angular distribution of the electrons at the point of measurement had a lesser effect on the polarity correction than the electron energy itself. The magnitude of the absolute difference between charge collected at positive and negative polarity was found to correlate with the area of the collecting electrode which is consistent with the explanation that differences in thickness of the collecting electrodes and the number of electrons stopped in them contribute significantly to the polarity effect. Overall, the polarity effects found in the present study would have a negligible effect on electron beam calibration at a measurement depth recommended by most calibration protocols. However, the present work tested the corrections under extreme conditions thereby aiming at greater understanding of the mechanism underlying the correction factors for these chambers. This may lead to better chamber design for absolute dosimetry and electron beam characterization with less reliance on empirical corrections.

Display of positron emission tomography with Cadplan

Recent clinical experience at Peter MacCallum Cancer Institute (PMCI) with the use of unregistered Positron Emission Tomography (PET) images for radiotherapy target marking in the lung suggests that co-registered PET images would be invaluable. PMCI has three radiotherapy treatment planning systems but none of them currently is able to display or co-register PET images with Computed Tomography (CT) images. This paper details the approach taken to display co-registered PET images with the CADPLAN treatment planning system. CT Image files are normally transferred to Cadplan by DICOM transfer, but the Cadplan DICOM server will not receive (has no presentation context for) PET images. The fundamental design of the CADPLAN system envisages display of only a single image dataset, which must be a CT scan for planning reasons. The problem of data transfer is crudely solved by File Transfer Protocol (FTP) over the network. Fortunately the multislice format of the PET image files makes individual transfer manageable. A menu based C program running at the same time as Cadplan is invoked to sample the DICOM PET Image and create multiple Cadplan CART image format files that are co-registered with each existing transverse CT slice. With the Cadplan in contour mode, the program allows the co-registered PET images to be swapped in and out of the image section of the CART files promptly, while keeping the contour information. This allows radiotherapy target volumes to be marked using transverse PET emission images, and effectively circumvents the design constraints prohibiting the display of more than one image set. Contours can be over-laid for review on reconstructed sagittal or coronal views of CT or PET images constructed using the standard Cadplan tools. Co-registration is facilitated by identical positioning with the aid of lasers and FDG loaded fiducial markers on the PET scanner and CT couch. A polyurethane cast fixed with EFFILOCK is used to ensure identical patient orientation on the CT and PET couches. Since both imaging modalities are without significant geometric distortion the co-registration is then simply a translation. PET transmission images can be used for co-registration verification. The practical implementation of display of PET images with CADPLAN has enabled us to begin a trial of 10 patients, the results of which will be reported separately.

Major birth defects in very low birth weight infants in the Vermont Oxford Network

OBJECTIVE

To study the frequency and types of major birth defects in very low birth weight (VLBW) infants and their impact on mortality and resource use.

STUDY DESIGN

Analysis of data from the Vermont Oxford Network Database from 1994 and 1995 on infants with birth weights of 501 to 1500 g. Major birth defects were reported from a list of 40 defined major defects or if they were considered lethal or life-threatening. Mortality and length of stay were determined.

RESULTS

Major birth defects were present in 823 (4.3%) of 19,228 VLBW infants from 147 hospitals. The most common categories were chromosomal anomalies (20%); named syndromes, sequences, and associations (19%); and gastrointestinal (14%), cardiovascular (11%), and nervous system (10%) anomalies. Infants with major birth defects had a higher mortality rate (58% vs 13%, P <.001) and a higher rate of major surgery (29% vs 5%, P <.001) than infants without such defects. Infants with major birth defects accounted for 16.3% of deaths and 18.9% of major surgical procedures but only for 2.9% of total hospital days.

CONCLUSIONS

Major birth defects accounted for 16% of all deaths in VLBW infants. However, they accounted for a low proportion of total hospital days.

A mutant cholera toxin B subunit that binds GM1- ganglioside but lacks immunomodulatory or toxic activity

GM1-ganglioside receptor binding by the B subunit of cholera toxin (CtxB) is widely accepted to initiate toxin action by triggering uptake and delivery of the toxin A subunit into cells. More recently, GM1 binding by isolated CtxB, or the related B subunit of Escherichia coli heat-labile enterotoxin (EtxB), has been found to modulate leukocyte function, resulting in the down-regulation of proinflammatory immune responses that cause autoimmune disorders such as rheumatoid arthritis and diabetes. Here, we demonstrate that GM1 binding, contrary to expectation, is not sufficient to initiate toxin action. We report the engineering and crystallographic structure of a mutant cholera toxin, with a His to Ala substitution in the B subunit at position 57. Whereas the mutant retained pentameric stability and high affinity binding to GM1-ganglioside, it had lost its immunomodulatory activity and, when part of the holotoxin complex, exhibited ablated toxicity. The implications of these findings on the mode of action of cholera toxin are discussed.

Anaesthesia for electroconvulsive therapy. Personnel and facilities

In order to compare the anaesthetic staffing and facilities provided for patients undergoing electroconvulsive therapy with those provided for patients undergoing elective cystoscopy, a confidential telephone enquiry was conducted. An anaesthetist in each of the 40 hospitals where electroconvulsive therapy is performed in three Health Regions chosen at random was questioned. The results show that a high standard of care is provided for patients undergoing elective cystoscopy in terms of pre-operative assessment, anaesthetic assistance, intra-operative monitoring and postoperative recovery facilities. The standards of care and of facilities for patients undergoing electroconvulsive therapy are substantially inferior and commonly fall short of accepted national guidelines.

Carcinosarcoma arising in eccrine spiradenoma of the breast. Report of a case and review of the literature

Although the vast majority of eccrine spiradenomas behave in a benign fashion, 23 cases of malignant transformation have been reported to date. We describe a unique example of malignant eccrine spiradenoma that arose in the right breast of a 68-year-old woman. The quiescent mass, which was present for approximately 50 years, experienced sudden enlargement with erythematous changes of the overlying skin and nipple discharge. Microscopically, the tumor showed the typical features of an eccrine spiradenoma with areas of adenocarcinoma, squamous cell carcinoma, and sarcoma. The sarcomatous component consisted of rhabdomyosarcoma and osteosarcoma. The immunoperoxidase staining revealed p53 protein expression only in the carcinomatous and sarcomatous components. This suggests that accumulation of p53 protein may be an important event in the malignant transformation of spiradenomas. Because of its location and biphasic nature, this malignant eccrine spiradenoma should be distinguished from metaplastic breast carcinoma. To our knowledge, this represents the first carcinosarcomatous transformation of eccrine spiradenoma in the breast. This case led us to conclude that breast tissue, which often undergoes apocrine metaplasia and gives rise to apocrine neoplasms, is also capable of originating benign and malignant tumors with eccrine sweat duct phenotype.

Synthesis, antiviral activity and enzymatic phosphorylation of 9-phosphonopentenyl derivatives of guanine

(E)-9-(5-Phosphonopent-4-enyl)guanine and (E)-9-[3-(hydroxymethyl)-5- phosphonopent-4-enyl]guanine which bear a vinyl phosphonate moiety as a mimic of the phosphate group were synthesized. Their activities against human immunodeficiency virus type-1 (HIV-1), herpes simplex virus type-1 (HSV-1) and human cytomegalovirus (HCMV) were evaluated in vitro in parallel with those of 9-(5-phosphonopentyl)guanine and 9-(5,5-difluoro-5- phosphonopentyl)guanine. Both vinyl phosphonates exhibited anti-HIV-1 and anti-HCMV activities, whereas the methyl- and difluoromethyl phosphonate analogues were inactive. The selectivity index, calculated as the ratio of the toxicity for the host cells (50% reduction in cell viability or in [methyl-3H]thymidine incorporation) to the 50% inhibitory concentration for HIV-1 replication, was the highest for (E)-9-[3-(hydroxymethyl)-5-phosphonopent-4-enyl]guanine. The acyclonucleotide analogues were also studied as substrates of guanylate kinase, an enzyme believed to play a critical role in the conversion of acyclic phosphate and phosphonate derivatives of guanine to their antivirally active diphosphate derivatives. (E)-9-(5-Phosphonopent-4- enyl)guanine and (E)-9-[3-(hydroxymethyl)-5-phosphonopent-4-enyl]guanine were good substrates of guanylate kinase, being phosphorylated with efficiencies of 14 and 36% of that determined for GMP, respectively. These results contrast with the poor efficiency found for 9-(5-phosphonopentyl)guanine (0.3%) and the lack of phosphorylation of 9-(5,5-difluoro-5-phosphonopentyl)guanine by guanylate kinase (Navé et al. (1992) Arch. Biochem. Biophys. 295, 253-257). The role of the vinyl phosphonate group in the expression of the anti-HIV-1 activity of the phosphonopentenyl derivatives of guanine is discussed.

[Monoclonal immunophenotyping of acute lymphoblastic leukemia cells in children using rapid immune alkaline phosphatase]

Monoclonal immunophenotyping of leukemia cells of the bone marrow was carried out by the method of rapid immune alkaline phosphatase (RIAP) in 30 patients with acute lymphoblastic leukemia (ALL) aged 6 months-14 years. The authors used a panel of monoclonal antibodies (MCA) produced by Leu (Belgium) and DAKO (Denmark) directed to antigens of differentiation clusters: Tdt, HLA-DR, CD: 10, 19, 20, 22, 7, 8, 2, 5, 13, 33, 14. The results indicate diversity of compositions of differentiating antigens on leukemia cells of the dominant population and a different degree of leukemic cell pool heterogenicity. RIAP advantages over flow cytometry in immunotyping of ALL cells are shown. Arguments are provided in favor of introduction of broader MCA panel.

Serum F-protein concentration following halothane or isoflurane anaesthesia

We have investigated the prevalence of hepatic injury following uncomplicated anaesthesia using a sensitive and specific marker of hepatic damage, the serum F-protein concentration. The median variation in serum F-protein in fit adults over six days is 16 ng/ml, minimum 0 ng/ml, maximum 36 ng/ml. A significant rise in serum F-protein was demonstrated six days following anaesthesia and surgery, but not earlier after 3 or 24 h. There was no significant difference between patients who received halothane (n = 12) or isoflurane (n = 13). These changes were not related to duration of anaesthesia, quantity of delivered volatile agent or mode of ventilation. Hepatocellular damage may occur following anaesthesia for minor surgery.

No effect of famotidine on cardiac performance by noninvasive hemodynamic measurements

In a randomized, double-blind, placebo-controlled, two-way crossover study, 12 healthy volunteers were treated once daily for 1 week each with 40 mg famotidine or placebo. Stroke index, cardiac index, preejection period, left ventricular ejection time, and carotid and femoral blood flow were measured noninvasively with Doppler ultrasonography. No significant changes in these hemodynamic parameters were observed when differences between baseline and each time point after administration of famotidine were compared with corresponding differences after placebo. The findings of this study are in accord with those of other studies that have failed to demonstrate a negative inotropic effect after administration of H2-antagonists.

Hostility, hopelessness and deliberate self-harm: a prospective follow-up study

Sixty-one consecutive patients who presented following an episode of deliberate self-harm (DSH) were assessed on a number of variables, including measures of hopelessness and hostility. Attempts were made to follow all of the patients. Those who were known to have had a further episode of DSH had significantly higher levels of hopelessness and intropunitive hostility after the index episode than those who did not repeat. The question of vulnerability to DSH is discussed as well as the possibility of using measures of hopelessness and intropunitive hostility to identify those at greater risk of repetition.

Citrate anticoagulation during in vivo simulation of slow hemofiltration

Citrate anticoagulation has been used as an alternative to heparin for hemodialysis in high-risk patients; however, its use in hemofiltration has not been well studied. We examined citrate in 6 patients placed on slow hemofiltration for up to 6 h duration. During the experiments, the systemic citrate level increased from a baseline average of 0.15 to 0.55 mmol/l, and then decreased to 0.27 mmol/l. The citrate was freely filtered. The systemic total and ionized calcium decreased very slightly and no untoward effects were noted. Anticoagulation was successful. This preliminary study suggests that citrate anticoagulation can be used in slow hemofiltration.

Mass spectrometry studies of a novel digoxin-like substance (DLIS-2) isolated from human plasma ultrafiltrate

Two unique low molecular weight (531) compounds with both digoxin-like immunoreactivity and Na, K-ATPase inhibitory properties have been isolated from human plasma. One of these, digoxin-like substance 2, (DLIS-2), was studied by fast atom bombardment mass spectrometry and collisionally activated dissociation mass spectrometry/mass spectrometry. The fragment patterns were interpreted as being derived from a lysophosphatidyl serine containing a novel 19:4 fatty acid side chain. The molecular formula C25H42O9NP is consistent with these observations.

Two novel endogenous digoxin-like immunoreactive substances isolated from human plasma ultrafiltrate

Two digoxin-like immunoreactive substances (DLIS 1 and DLIS-2) were isolated from human plasma by ultrafiltration, alkaline solvent extraction, and HPLC. Both inhibit canine Na, K-ATPase and cross-react with anti-digoxin antibodies. Their UV spectra are similar, with absorption peaks at 190 and 220 nm. FAB mass spectral analysis of both compounds yield a single dominant (M+H)+ component at m/z 532 otherwise, the fragmentation patterns are slightly different. The spectral data are consistent with the postulate that these compounds are related. Their identity as the natriuretic hormone is being investigated.

Effects of a circulating factor in patients with essential hypertension on intracellular free calcium in normal platelets

Intracellular free (cytosolic) calcium has been reported to be increased in the platelets of patients with essential hypertension. We investigated the possibility that the high cytosolic calcium concentration may be caused by a circulating plasma factor, by incubating platelets from normotensive subjects with plasma ultrafiltrates from patients with essential hypertension. The cytosolic calcium concentration in normal platelets increased after incubation with plasma from patients with untreated hypertension (80 +/- 15 percent [+/- SEM]) or from patients in whom hypertension was well controlled by calcium-influx blockers (129 +/- 33 percent). In contrast, the cytosolic calcium concentration was unchanged after incubation with plasma from normotensive subjects. When platelets from the patients were incubated with plasma from the controls, cytosolic calcium in platelets decreased by more than 30 percent, into the normal range (P less than 0.01). These data demonstrate that plasma from patients with essential hypertension contains a substance that increases the cytosolic calcium concentration in platelets. Cytosolic calcium is a trigger for vascular smooth-muscle-cell contraction, and if the plasma factor acts on these cells as it acts on platelets, it may be responsible for the increased peripheral vascular resistance associated with hypertension.

Decreased calcium pump adenosine triphosphatase in red blood cells of hypertensive subjects

Several operationally defined adenosine triphosphatase (ATPase) activities were determined in vitro in red blood cell lysates of normotensive or hypertensive humans: Mg2+-ATPase, Na+,K+-ATPase, and Ca2+ pump ATPase, the latter in the calmodulin-activated and basal states. Basal Ca2+ pump ATPase was defined as the Ca2+-activated ATPase resistant to 10(-4) M trifluoperazine. Subjects were part of a double-blind study in which treatment was divided into several phases: baseline (4 weeks), placebo or calcium (1 g elemental calcium/day, 8 weeks), placebo washout (4 weeks), placebo or calcium (1 g elemental calcium/day, 8 weeks). Irrespective of the phase of treatment, the basal Ca2+ pump ATPase activity in red blood cell lysates of 36 hypertensive subjects was significantly less than that in lysates from 18 normotensive subjects. Other ATPase activities did not differ significantly, although all ATPases tended to be decreased in hypertension. The data are consistent with previous reports of altered membrane Ca2+ binding and transport in hypertension, but the precise changes are not elucidated.