Opioid Use is Associated with Decreased Quality of Life in Patients with Crohn's Disease

Background/Aims:

Quality of life is an important consideration in the management of patients with Crohn''s disease. Previous studies suggest that Crohn''s disease patients using opioids may have decreased quality of life and increased risk of mortality. Our aim was to determine the association between health-related quality of life (HRQoL) and opioid use in patients with Crohn''s disease while controlling for disease severity.

Patients and Methods:

We conducted a cross-sectional study recruiting Crohn''s disease patients at our center. Disease activity was measured using the Harvey-Bradshaw Index (HBI), and HRQoL was measured using the Inflammatory Bowel Disease Questionnaire (IBDQ).

Results:

We enrolled 38 Crohn''s disease patients using opioids and 62 patients not using opioids. Patients using opioids had an increased duration of disease (median 18.5 vs. 9 years, P = 0.005), increased surgeries related to Crohn''s disease (median 3 vs. 0, P < 0.001), and increased prednisone use (29% vs. 11.3%, P = 0.03). Patients using opioids had increased disease activity (median HBI score 9.0 vs. 3.0, P < 0.001). Quality of life was lower in patients using opioids (mean IBDQ score 109.3 vs. 162.9, P < 0.001). This finding was significant when controlling for HBI scores, number of previous surgeries, and prednisone use (P = 0.003).

Conclusions:

Opioid use in Crohn''s disease patients appears to be associated with disease activity and severity. HRQoL is markedly decreased in patients using opioids and this association is significant even when controlling for variables reflecting disease severity. Our findings suggest that Crohn''s disease patients using opioids are likely to be significantly impacted by their disease.     

Novel splice variants of type I pituitary adenylate cyclase-activating polypeptide receptor in frog exhibit altered adenylate cyclase stimulation and differential relative abundance

Pituitary adenylate cyclase-activating polypeptide (PACAP) exerts its various effects through activation of two types of G protein-coupled receptors, a receptor with high affinity for PACAP named PAC1-R and two receptors exhibiting similar affinity for both PACAP and vasoactive intestinal polypeptide named VPAC1-R and VPAC2-R. Here, we report the characterization of PAC1-R and novel splice variants in the frog Rana ridibunda. The frog PAC1-R has 78% homology with human PAC1-R and is highly expressed in the central nervous system. Two splice variants of the frog receptor that display additional amino acid cassettes in the third intracellular loop were characterized. PAC1-R25 carries a 25-amino acid insertion that matches the hop cassette of the mammalian receptor, whereas PAC1-R41 carries a cassette with no homology to any mammalian PAC1-R variant. A third splice variant of PAC1-R, exhibiting a completely different intracellular C-terminal domain, named PAC1-Rmc has also been identified. Determination of cAMP formation in cells transfected with the cloned receptors showed that PACAP activated PAC1-R, PAC1-R25, and PAC1-R41 with similar potency. In contrast, PACAP failed to stimulate adenylate cyclase in cells transfected with PAC1-Rmc. Fusion of PAC1-R or PAC1-Rmc with the green fluorescent protein revealed that both receptors are expressed and targeted to the plasma membrane in transfected cells. The different PAC1-R variants are highly expressed in the frog brain and spinal cord and to a lesser extent in peripheral tissues, where only certain isoforms could be detected. The present data indicate that in frog, PACAP may act through different PAC1-R splice variants that differ in their G(s) protein coupling and their abundance in various tissues.     

Incidental durotomy during spine surgery: Incidence,management and complications. A retrospective review

Study designRetrospective review of a series of patients who underwent spinal surgery at a single spine unit during a 1 year period.ObjectivesTo assess the incidence, treatment, clinical consequence, complications of incidental durotomy during spine surgery and results of 37 months clinical follow-up.Summary of background dataIncidental durotomy is an underestimated and relatively adverse event during spinal surgery. Several consequences of inadequately treated dural tears have been reported.MethodsA retrospective review was conducted on 1326 consecutive patients who underwent spinal surgery performed in one French spine unit from January 2005 to December 2005. We excluded from this study patients treated for emergency spine cases.ResultsFifty-one dural tears were identified (3.84%). Incidental durotomies were associated with anterior cervical approach in 1 case, with posterior cervical approach in 1 case, with anterior retroperitoneal approach in 1 case and with posterior thoracolumbar approach in 48 cases. In addition, any clinically significant durotomy unrecognised during surgical procedure were included. Thirteen patients presented postoperative complications including 7 cerebrospinal fluid leaks, 2 wound infections, 2 postoperative haematomas, and 2 pseudomeningoceles. Nine of these 13 patients required a revision procedure. A mean follow-up of 37 months showed good long-term clinical results.ConclusionsIncidental durotomy is a common complication of spine surgery. All incidental durotomies must be repaired primarily. Dural tears that were immediately recognised and treated accordingly did not lead to any significant sequelae at a mean follow-up of 37 months. However, long-term follow-up studies will be needed to confirm this finding. The risks associated with dural tears and cerebrospinal fluid leaks are serious and should be discussed with any patients undergoing spine surgery.     

Chromogranins A and B and secretogranin II: evolutionary and functional aspects

Chromogranins/secretogranins or granins are a class of acidic, secretory proteins that occur in endocrine, neuroendocrine, and neuronal cells. Granins are the precursors of several bioactive peptides and may be involved in secretory granule formation and neurotransmitter/hormone release. Characterization and analysis of chromogranin A (CgA), chromogranin B (CgB), and secretogranin II (SgII) in distant vertebrate species confirmed that CgA and CgB belong to related monophyletic groups, probably evolving from a common ancestral precursor, while SgII sequences constitute a distinct monophyletic group. In particular, selective sequences within these proteins, bounded by potential processing sites, have been remarkably conserved during evolution. Peptides named vasostatin, secretolytin and secretoneurin, which occur in these regions, have been shown to exert various biological activities. These conserved domains may also be involved in the formation of secretory granules in different vertebrates. Other peptides such as catestatin and pancreastatin may have appeared late during evolution. The function of granins as propeptide precursors and granulogenic factors is discussed in the light of recent data obtained in various model species and using knockout mice strains.     

Évaluation de la voie radiale distale dans les interventions coronaires percutanées. Essai contrôlé, randomisé de non infériorité

Research Problem: The conventional radial approach is the recommended vascular access for percutaneous coronary interventions. It is effective and feasible but associated with a risk of occlusion of the radial artery.The distal radial approach is proposed as a new approach to reduce complications and preserve the radial artery. However, few clinical trials in real life were conducted in North African patients.This trial aims to evaluate the efficacy and safety of the distal radial approach versus the conventional radial approach. Investigative process: This trial is a non-inferiority, randomized controlled trial with two parallel arms: distal radial approach and conventional radial approach. Two hundred fifty patients scheduled for percutaneous coronary intervention will be included.The two main endpoints are the puncture success rate with a non-inferiority margin of 10% and the occlusion rate of the punctured radial artery attributed to the end of hemostasis and to 30 days. Secondary endpoints: catheterization success, crossover rate, procedure time, radial artery spasm, bleeding complications, QuickDASH pain score, Operator satisfaction.A single blind analysis will be led according to the per-protocol and intention-to-treat methods. Research Plan: Ethical considerations will be undertaken and respected. This trial will run for four months from February 2022. The results will provide parameters related to the efficacy and safety of the distal radial approach, improving clinical practice.Trial registration : {"type":"clinical-trial","attrs":{"text":"NCT05311111","term_id":"NCT05311111"}}NCT05311111     

Transient ischemic attack due to multiple spontaneous calcified embolus of the cerebral arteries on a calcified mitral and aortic stenosis

We report a case of calcified mitral and aortic stenosis revealed by a reversible ischemic stroke. A 59-year-old male patient, with background of hypertension, kidney failure, diabetes, and dyslipidemia, presented with neither acute onset of right-sided hemiparesis without aphasia nor any loss of consciousness. Head computed tomography (CT) revealed multiple rounded and amorph calcified high-density calcifications within the distal segments of both sylvian and posterior cerebral arteries. Angiographic CT of the carotids didn''t reveal any stenosis or atherosclerotic plaques. Thoracic CT showed massive mitral and aortic valvular calcifications with a left ventricular hypertrophy.