Cancer in inflammatory bowel disease 15 years after diagnosis in a population-based European Collaborative follow-up study

Aim of the study

To determine the occurrence of intestinal and extraintestinal cancers in the 1993–2009 prospective European Collaborative Inflammatory Bowel Disease (EC-IBD) Study Group cohort.

Patients–methods

A physician per patient form was completed for 681 inflammatory bowel disease patients (445UC/236CD) from 9 centers (7 countries) derived from the original EC-IBD cohort. For the 15-year follow up period, rates of detection of intestinal and extraintestinal cancers were computed.

Results

Patient follow-up time was fifteen years. In total 62/681 patients (9.1%) [41 with ulcerative colitis/21 with Crohn's disease, 36 males/26 females] were diagnosed with sixty-six cancers (four patients with double cancers). Colorectal cancer was diagnosed in 9/681 patients [1.3%] (1 Crohn's disease and 8 ulcerative colitis). The remaining 53 cancers were extraintestinal. There was a higher prevalence of intestinal cancer in the Northern centers compared to Southern centers [p = NS]. Southern centers had more cases of extraintestinal cancer compared to Northern centers [p = NS]. The frequency of all observed types of cancers in Northern and in Southern centers did not differ compared to the expected one in the background population.

Conclusions

In the fifteen-year follow up of the EC-IBD Study Group cohort the prevalence of cancer was 9.1% with most patients having a single neoplasm and an extraintestinal neoplasm. In Northern centers there were more intestinal cancers while in Southern centers there were more extraintestinal cancers compared to Northern centers. In this IBD cohort the frequency of observed cancers was not different from that expected in the background population.     

Comparison of 2 methods of clinical data collection, one using the PAINOUT questionnaire (a European database for the management of postoperative pain)

ObjectiveTo compare postoperative pain intensity and incidence of adverse events when the evaluation is performed by a visual numerical scale completed by the patient (PAINOUT), or using a verbal numerical scale completed by ward nurses or the staff of the acute pain unit.MethodsFifty-two postsurgical patients of both sexes (age range 31–80 years) admitted to the general surgery ward were sequentially recruited and evaluated on postoperative day 1. All patients were assessed using both questionnaires, which measure postoperative outcomes using scales of 0 to 10; values ≥ 4 were considered clinically relevant. The test and Cohen coefficient were used for statistical analysis.ResultsUsing the PAINOUT questionnaire, the mean maximum intensity of referred pain was 5.40 (range, 0–10) and the minimum intensity was 1.83 (range, 0–5). Mean values obtained with the verbal numerical scales used by staff on the ward and in the pain clinic were 3.76 (range, 0–10) and 0.97 (range, 0–5), respectively. The differences between the 2 methods of pain assessment were statistically (P = .006) and clinically significant. When evaluating nausea with PAINOUT questionnaire, all patients provided a response; in 88.5% the intensity was less than 4. Six patients reported nausea on the PAINOUT but not in the UDA questionnaire. Moreover, 61% of patients reported drowsiness/sedation in PAINOUT instrument, whereas none reported that effect on the verbal scale.ConclusionsThe intensity of pain and adverse events is significantly higher when the patient evaluates and records its intensity on visual numerical scales compared with verbal numerical scales.     

A practical approach with outcome for the prognostic assessment of non-ST-segment elevation chest pain and normal troponin

Patients with non-ST-elevation chest pain constitute a heterogeneous population. Our aim is to compare the outcome of patients with chest pain, non-ST-segment deviation, and normal troponin, categorized using a risk score, with that of patients with ST depression or troponin increase. A total of 1,449 patients with non-ST-elevation chest pain were evaluated. A validated risk score (using pain characteristics and risk factors) was applied to patients without ST depression or troponin increase. Accordingly, 4 risk categories were defined: group 1, no troponin increase, no ST depression, and risk score <3 points (n = 633); group 2, no troponin increase, no ST depression, but risk score > or = 3 points (n = 158); group 3, no troponin increase, ST depression (n = 106); and group 4, troponin increase (n = 552). Median follow-up was 26 months, and the end point was death or myocardial infarction. Group 1 experienced fewer events at 30 days (1.7%, p = 0.0001) and long-term follow-up (9.4%, p = 0.0001) than groups 2 (10.8% and 26%), 3 (6.6% and 30%), and 4 (9.5% and 25%). Kaplan-Meier curves overlapped among groups 2, 3, and 4, whereas group 1 showed a flatter curve (p = 0.0001). Using multivariate analysis, risk group (group 1 vs remaining groups) predicted 30-day (p = 0.0003) and long-term (p = 0.0001) outcome. There were no differences among groups 2, 3, and 4. In conclusion, application of a risk score to patients without troponin increase or ST deviation identified a high-risk group with prognosis similar to that of patients with troponin increase or ST depression and affords a practical classification for the full spectrum of non-ST-elevation chest pain.     

Theta synchronization between the hippocampus and the nucleus incertus in urethane-anesthetized rats

Oscillatory coupling between distributed areas can constitute a mechanism for neuronal integration. Theta oscillations provide temporal windows for hippocampal processing and only appear during certain active states of animals. Since previous studies have demonstrated that nucleus incertus (NI) contributes to the generation of hippocampal theta activity, in this paper, we evaluated the oscillatory coupling between both structures. We compared hippocampal and NI field potentials that were simultaneously recorded in urethane-anesthetized rats. Electrical and cholinergic stimulations of the reticularis pontis oralis nucleus have been used as hippocampal theta generation models. The spectral analyses reveal that electrical stimulation induced an increase in theta oscillations in both channels, whose frequencies depended on the intensity of stimulation. The intensity range used simultaneously increased the normalized spectral energy in the fast theta band (6–12 Hz) in HPC and NI. Frequencies within the theta range were found to be very similar in both channels. In order to validate coupling, spectral coherence was inspected. The data reveal that coherence in the high theta band also increased while stimuli were applied. Cholinergic activation progressively increased the main frequency in both structures to reach an asymptotic period with stable peak frequency in the low theta range (3–6 Hz), which could be first observed in NI and lasted about 1,500 s. Coherence in this band reached values close to 1. Taken together, these results support an electrophysiological and functional coupling between the hippocampus and the reticular formation, suggesting NI to be part of a distributed network working at theta frequencies.     

Pituitary alterations involved in the decline of growth hormone gene expression in the pituitary of aging rats

Growth hormone (GH) declines during aging. This study investigates whether pituitary constitutive alterations may be involved in the GH decline. Two groups of male Wistar rats were studied (young: 3-month-old; old: 24-month-old). The old rats showed lower pituitary GH messenger RNA (mRNA) levels, immunoreactive rat (IR)-GH content, and GH secretion with no difference in pituitary Pit-1 and cAMP-response element-binding protein (CREB) expression. Pituitary GH releasing hormone receptor (GHRH-R), GH secretagogue receptor (GHS-R), sstr2, and sstr5 mRNA levels were significantly reduced in old rats. The percentage of GH immunoreactive cells was similar in both groups. In vitro, pituitary IR-GH response to GHRH, forskolin (FK), ghrelin, and insulin-like growth factor I (IGF-I) was similar when compared with respective basal secretion and somatostatin-diminished GHRH- and ghrelin-induced IR-GH release in both groups. These results indicate that, as somatotrope function is maintained in aging, the changes observed in GH gene expression and secretion could be reversed by GHS.     

Physicochemical Characterization of Novel Epoxidized Vegetable Oil from Chia Seed Oil

In this study, a novel epoxidized vegetable oil (EVO) from chia seed oil (CSO) has been obtained, with the aim to be employed in a great variety of green products related to the polymeric industry, as plasticizers and compatibilizers. Previous to the epoxidation process characterization, the fatty acid (FA) composition of CSO was analyzed using gas chromatography (GC). Epoxidation of CSO has been performed using peracetic acid formed in situ with hydrogen peroxide and acetic acid, applying sulfuric acid as catalyst. The effects of key parameters as temperature (60, 70, and 75 °C), the molar ratio of hydrogen peroxide:double bond (H₂O₂:DB) (0.75:1.0 and 1.50:1.0), and reaction time (0–8 h) were evaluated to obtain the highest relative oxirane oxygen yield (Y_oo). The evaluation of the epoxidation process was carried out through iodine value (IV), oxirane oxygen content (O_o), epoxy equivalent weight (EEW), and selectivity (S). The main functional groups were identified by means of FTIR and ¹H NMR spectroscopy. Physical properties were compared in the different assays. The study of different parameters showed that the best epoxidation conditions were carried out at 75 °C and H₂O₂:DB (1.50:1), obtaining an O_o value of 8.26% and an EEW of 193 (g·eq⁻¹). These high values, even higher than those obtained for commercial epoxidized oils such as soybean or linseed oil, show the potential of the chemical modification of chia seed oil to be used in the development of biopolymers.