Barrett’s Esophagus

Barrett’s esophagus is a medical condition characterized by intestinal metaplasia of esophageal epithelium. In other words, Barrett’s esophagus refers to a change in the cells lining the esophagus that occurs due to repeated exposure to stomach acid. What should be noted is that Barrett’s esophagus is a premalignant lesion that can result in esophageal adenocarcinoma.

Causes of Barrett’s esophagus

Causes of Barrett’s esophagus are not known exactly, but most commonly this medical condition is associated with reflux disease. It is estimated that Barrett’s esophagus occurs in about 10% of patients suffering from gastroesophageal reflux disease and presumably a longer exposure to gastric acidity leads to a higher risk of developing Barrett’s esophagus. It seems that patients who develop Barrett’s esophagus have a low pressure in the lower esophageal sphincter as demonstrated by manometric studies.  Genetic factors may also be involved because not all patients who develop severe esophagitis also develop Barrett’s esophagus. It should be noted that there are cases, though rare, when Barrett’s esophagus is congenital.

Barrett’s Esophagus

Symptoms of Barrett’s esophagus

Patients with Barrett’s esophagus have the same symptoms as those suffering from gastroesophageal reflux disease, that is heartburn, acid regurgitation, salivation, laryngeal symptoms, dysphagia etc. The cardinal symptom of the disease is heartburn or retrosternal discomfort that occurs mainly in the first hour after heavy meals, high in fat, and is improved by ingestion of antacids. There are patients with Barrett’s esophagus who are asymptomatic,  and the disease in this situation is diagnosed because of complications: stenosis, ulcers, cancer.

Barrett’s esophagus diagnosis

The gold standard in Barrett’s esophagus  diagnosis is endoscopy along with biopsy and histopathological examination. Endoscopic recognition of this disease can sometimes be difficult, but there have been developed special techniques that improve endoscopic recognition,  such as chromoendoscopy, which uses special stains.

Treatment of Barrett’s esophagus

Treatment of Barrett’s esophagus refers either to drugs or surgical treatment ( esophagectomy and endoscopic ablation). Drug treatment refers to administration of proton pump inhibitors in high doses (omeprazole, pantoprazole etc.) and for longer periods than in patients with gastroesophageal reflux disease.

Surgery is recommended for patients who do not respond to drugs and includes various antireflux techniques to relieve esophageal exposure to gastric acidity. Other options are endoscopic ablation or resection of esophageal intestinal metaplasia. Endoscopic ablation can be performed by several methods: thermal ablation, electrocoagulation, argon plasma coagulation, photodynamic therapy ect. Esophageal resection is indicated only for high-grade dysplasia in selected patients.

Deep brain stimulation brings benefits in patients with neuropathic pain

According to a report released by the University of Oxford, deep brain stimulation has promising results in treating neuropathic pain. The study was published in the February issue of Neurosurgery and is one of the largest studies conducted up to now on the treatment of neuropathic pain using DBS. It seems that patients with neuropathic pain who undergo deep brain stimulation have significant improvement in symptoms and the results are long-lasting. In the study led by Sandra G.J. Boccardi, PhD, University of Oxford, two-thirds of DBS patients had a significant improvement not only in terms of symptoms, but also in terms of quality of life and overall health. The study also showed that for some outcomes, improvement continued in the first year after DBS treatment.

Neuropathic pain, which is caused by nerve damage ( mechanical factors such as trauma or certain diseases, like diabetes) is a type of pain  resistant to medication. Deep brain stimulation involves placing a small electrode in a certain area of the brain through which is delivered an electric current that disrupts abnormal activity. It should be noted that this method is not new as it is already in use to treat several neurological diseases such as Parkinson’s disease. It must be said that deep brain stimulation has been used to treat chronic pain, but its role in neuropathic pain remains somewhat unclear.

Brain Stimulation

To see how effective  DBS is in treating neuropathic pain, researchers evaluated 197 patients who were selected to undergo this procedure. Of these, only 85 underwent DBS, that is 65 men and 25 women aged over 52 years. Regarding the etiology of neuropathic pain, the most common cause was stroke, then facial and head pain, spinal pain, amputation and pain caused by damage to the brachial plexus. Of the 85 patients, 74 underwent implantation of electrical pulse generator for DBS, because after the first session, they had a significant pain relief. In addition, 39 patients had an improvement in overall health status 4 years later after DBS. The study results showed that, in the end, DBS brought benefits in 66% patients.

Most benefits had the patients with amputation (89%), followed by those with stroke (70%) and then by those with brachial plexus lesions (50%). In terms of pain relief, in a 10-point pain scale, patients reported a decrease from 8 to 4, which indicates a significant improvement. Although the results are promising, Dr. Boccard pointed out that further studies must be done in order to confirm the findings.

New imaging tool diagnoses Alzheimer’s with unprecedented accuracy

Researchers at the Montreal Neurological Institute and Hospital have discovered a more accurate imaging method to diagnose Alzheimer’s disease. This new sophisticated tool , called SNIPE, involves magnetic resonance imaging and is useful not only for diagnosis but also for prognosis of Alzheimer’s disease.

Alzheimer’s disease is the most common cause of dementia in patients usually over 65 years, and is characterized by progressive cognitive impairment, that is memory loss. It is a neurodegenerative disease that once appeared, it cannot be stopped although there are several medical treatments or recreational activities to delay its progression. Medical treatment varies depending on the stage of the disease. In mild Alzheimer’s disease, drugs of choice are cholinesterase inhibitors such as donepezil, rivastigmine, galantamine. Patients with moderate or severe Alzheimer’s may use, in addition to cholinesterase inhibitors, memantine, which is an antagonist of NMDA receptors.

Neuron

Diagnosis of Alzheimer’s disease is supported by tests of memory, family history of dementia, normal laboratory tests (normal cerebrospinal fluid, normal EEG) and imaging investigations (cerebral atrophy). Unfortunately, there has not been yet established a clear test to diagnose Alzheimer’s disease, although it is assumed that in the future this disease will be identified using specific biomarkers. A specific and sensitive test to help diagnose Alzheimer’s disease at an early stage would be very useful because actual cases of dementia are identified in a relatively advanced stage, when treatment cannot help very much the patient.

But now Drs. Louis Collins and Pierrick Coupé and Their colleagues at The Neuro, McGill University and the MUHC at, have created a tool to predict which of the patients with mild cognitive impairment will develop or not Alzheimer’s disease. They created a computerized analytics program that shows cerebral atrophy ( which is characteristic of Alzheimer’s disease) using magnetic resonance imaging. With SNIPE, there are compared areas of the hippocampus of cognitively normal brains with similar portions of the brains of patients with Alzheimer’s. Besides this, it is estimated the percentage of brain atrophy correlated with clinical status and patient age. Accuracy of this method is 75%, and researchers hope that in the future to discover new ways to treat the disease.

SNIPE has several advantages, such as that it is rapid, non-invasive and more accurate. In addition, it is low-cost compared to the anterior diagnostic imaging tools ( SPECT, single photon emission computed tomography, PiB PET, positron emission tomography) and is highly practical because it uses MRI scans.

Human Lifespan Linked to Copy Number Variants According to Study

A research team managed to identify the gene variants which have an influence on the lifespan of an individual. This was achieved through  a broad comparison between the DNA of children and the DNA of adults and elderly patients. Hakon Hakonarson, who is the leader of the study and the director of the Center for Applied Genomics, from Philadelphia, reports that this is the first study that investigates the gene variations in children, that are linked to lifespan. The study was published in the journal PLOS ONE, in late January.

Studies have shown that CNVs (copy number variations) are either losses or gains that rarely occur in the DNA sequence. These have been shown to either lower or raise the risk of a disease onset. The research team used data gathered from more than 7,000 patients aged 18 or below and compared it to data gathered from almost 3,000 Icelandic patients aged 67 or above. The analysis of the gathered data was investigated through the use of microchip arrays. “Our assumption was that CNVs appearing in children but not in the elderly were more likely to be disease-causing, while CNVs that were proportionately higher in older people were more likely to be protective, allowing them to live longer”, said Hakonarson.

Furthermore, the researchers conducted a replication study on approximately 2,000 young patients and 4,700 older patients. After adjusting the results in order to resolve the population stratification, researchers discovered 7 copy number variations that are believed to be significant to lifespan. Out of the 7 copy number variations, 4 are duplications and 3 are deletions. According to the reports, the genes that were impacted by these variations are involved in a process called alternative splicing. Through this process, genes that would normally express a single protein, now express different proteins based on the DNA contained by the gene. Hakonarson said that these results show that there is a possibility for these CNVs to have either beneficial or detrimental effects on the human organism. He notes that there is a lot of work that still needs to be done in this domain. Some of the copy number variations that are present in children could be a possible target for future therapy against short lifespan. Moreover, should these CNVs be incorporated into clinical screening, the mere presence would be an indicator for patients requiring preventive therapy.

Study Reveals That Early Therapy is Critical for HIV Patients

A new study that was recently published in the New England Journal of Medicine reveals the optimal timing for therapy against HIV infection, thus giving patients a higher chance to respond well to treatment. The study is led by researchers from the University of Texas and the University of California, in the United States and from Monash University, in Australia. According to the study, if antiretroviral medication is administered in within the first 4 months of infection, the immune system is able to recover close to normal levels.

The data, which was gathered from 468 patients who were observed during a 48-month period, shows that patients who received the antiretroviral medication earlier managed to recover faster from the deficit of CD4+ T-cells, in comparison with the patients who received the medication after a longer period. The CD4+ T-cells are responsible for the immune system’s response to infection. An HIV infection causes the number of CD4+ T-cells to drop significantly, almost depleting their number. Furthermore, the study reveals that patients with a higher number of CD4+ T-cells have a better recovery rate than patients with lower starting number of CD4+ T-cells, even if the medication is started at the same time.

Antiretroviral Medication

Professor Wright, an associate professor and co-author of the study, notes that future clinical trials are needed in order to investigate whether medication that is administered sooner can also help improve the chance for a better response from future therapies. “In the four months after HIV infection the immune system mounts an immune response and starts to recover naturally before it subsequently progressively declines”, notes Wright, whilst adding that this observation could mean that future therapies could target this time window and aid the recovery of the CD4+ T-cells. Researchers note that early therapy with potent antiretroviral medication could lead to a full recovery of the immune system through the replenishment of CD4+ T-cells. The recovery of these cells would aid the capacity of the immune system to respond to infections and other diseases. The study concludes that if antiretroviral therapy is delayed by even a short period of time, it could mean an insufficient recovery of the CD4+ T-cells.

Wright and his fellow researchers from the Monash University are currently conducting a clinical trial called START. The team is researching the effects and benefits of administering antiretroviral medication early after HIV infection. 30+ countries are involved in the study, with more than 4000 HIV positive patients. Patients will be followed up for 5 years and results will be compared between early and deferred antiretroviral medication.

Novel Radiation Therapy Method Shortens Prostate Cancer Treatment Time

A new study published in the newest edition of the journal American College of Radiology reveals a novel radiation therapy that would help decrease the treatment period of prostate cancer patients by almost 14%. The new technique is called VMAT (Volume-Modulated Arc Therapy) and it uses intensity-modulated radiation. Researchers who performed the study are from the Winship Cancer Institute, from Emory University, in Atlanta.

Currently, intensity-modulated radiation therapy, or IMRT, is widely regarded as a standard procedure for patients with prostate cancer. There are many benefits from using this procedure, however, due to its complexity and the fact that it is a time-consuming treatment method, it forces patients to commit to a daily treatment plan. This particular therapy also requires a large number of monitors and several gantry positions. According to William Hall, the author of the study, his research team compared the efficiency of VMAT compared to IMRT.

In order to determine the exact time it takes patients to complete the daily therapy schedule, a custom software was used. This software monitored the in-room time, which is the time passed between the moment the patient entered the therapy room and the moment the patient exited the room. The average in-room time from patients using VMAT was compared to that of patients using IMRT. Subgroup comparisons were also performed. These subgroup comparisons included 1- and 2-arc VMAT and 5- and 7-field IMRT, among others.

The final results of the comparisons show that the in-room time for patients undergoing VMAT was significantly shorter. According to the researchers, the in-room time for IMRT patients was 14.69 ± 4.36 minutes, compared to the in-room time of VMAT patients, which was 12.6 ± 2.62 minutes.

“With an aging population and rapidly rising rates of prostate cancer, the ability to determine the most efficient method by which patients with adenocarcinoma of the prostate should be treated is critical”, said Dr Hall. He notes that according to their recent paper, both 5-field IMRT and VMAT have a high efficiency rating. Dr Hall concluded that their study provides important information for researchers and doctors who are trying to maximize the quality and efficiency of the radiation therapy they use to treat their patients.

Researchers at the University of California, San Diego School of Medicine, have made new discoveries about diabetes. It seems that they have been able to stimulate the pancreas to generate new beta cells to produce insulin, which means that diabetes could be treated in the future with stem cell therapy.

Diabetes occurs due to exhaustion of pancreas which can not produce enough insulin for glucose metabolism. This is one of the mechanisms of diabetes. Another mechanism is insulin resistance, that is insulin can not cause glucose to enter cells so as to be used as energy. In this way there is a high level of glucose in the blood which in turn lead to serious complications such as ocular complications (diabetic retinopathy) or kidney complications (renal failure). Diabetes can be kept under control through diet (carbohydrate restriction), drugs and sports, but sometimes it is difficult to treat  due to low patient compliance. Now researchers at the University of California, San Diego School of Medicine have made a discovery that could change the fate of patients with diabetes.

Diabetes

There are two ways to create endocrine cells from human embryonic stem cells (hESCs). One method is aimed to create endocrine cells in vitro, while the other is aimed to create endocrine cells by transplanting immature endocrine cell precursors into mice. To create a new treatment for diabetes, the researchers wanted to see the differences between hESC-derived cell populations and primary human endocrine cells. After comparing the structure of DNA in the two cell types, it was found that there is a remarkable similarity between hESC-derived cell populations and primary human endocrine cells. Principal investigator Maike Sander, MD, professor of pediatrics and cellular and molecular medicine, and director of UC San Diego’s Pediatric Diabetes Research Center, said: “This shows that hESCs can differentiate into endocrine cells that are almost indistinguishable from their primary human counterparts.”

Even so, researchers found that compared to primary human endocrine cells, hESC-derived endocrine cells do not express a number of genes that are essential for insulin production. This finding demonstrates that these cells cannot treat diabetes in laboratory animals. One method that might work, however, is the maturation process, which consists of endocrine precursor cells transplantation into humans. Even though it is not known yet whether the method will have the same success it had in experiments in laboratory animals, researchers  now want to stimulate the cells to reach their final differentiated endocrine state using gene manipulation.