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SUMMARY BackgroundLymphocytic duodenosis is defined by normal villous architecture and intraepithelial lymphocytes (IELs) >25 per 100 enterocytes. Such patients should not be diagnosed with coeliac disease, solely by histology, as previous retrospective studies have suggested other associations with lymphocytic duodenosis.

The extant literature documents burden among caregivers of patients undergoing a hematopoietic stem cell transplant (HSCT), but little is known about the burden of caregivers of patients receiving outpatient and homebound HSCTs. This scoping study sought to evaluate what is known about the burden of the increasing number of adult caregivers of patients receiving outpatient HSCTs and to create practice guidelines for how to best support this vulnerable group. Online databases were searched for studies that evaluated caregiver burden in adult caregivers of HSCT patients since 2010 (the publication date of the most recent systematic review on HSCT caregiver burden). Of the 1,271 articles retrieved, 12 met inclusion criteria, though none specifically examined outpatient or homebound caregivers. Overall, studies corroborated existing literature on the experience of significant burden among HSCT caregivers across the HSCT trajectory, and highlighted the emotional costs of outpatient transplants on caregivers and the need to identify caregivers at high risk for burden early in the transplant process. Future studies of outpatient caregivers should include a comprehensive assessment of burden and seek to identify points along the transplant trajectory at which caregivers are at particular risk for negative outcomes and when intervention is most appropriate.

VA may be present only in the duodenal bulb. This study suggests that the optimal assessment of patients in whom celiac disease is suspected (with positive serology) and those with established celiac disease requires a duodenal bulb biopsy in addition to distal duodenal biopsies.

Cells of the developing lung express the constitutive nitric oxide synthases (NOSs) I and III. The developmental importance of these enzymes is largely unknown, although a role for nitric oxide (NO) in the regulation of pulmonary blood flow at birth is established. Known effects of NO on transcription factors, apoptosis, and cellular proliferation, plus the time and spatial limits of pulmonary NOS expression, suggest that NO might influence lung development. We tested the potential of NO to modulate lung branching morphogenesis by exposing lung explants from gestational day 13 rat fetuses to varying doses of several NO donors (NONO-ate). We counted the number of airway branches that were added between the first and 72nd h of culture. NO released only from a NONO-ate with a long half-life {( Z)-1-[2-(2-aminoethyl)- N-(2-ammonioethyl)amino]-diazen-1-ium-1,2-diolate-NO}, increased branching in ambient O2 by twofold. The NO effect was not mimicked with a cyclic guanine monophosphate analog; nonspecific NOS inhibitors in millimolar concentrations inhibited branching. We conclude that endogenous and exogenous NO can modulate branching morphogenesis in the rat lung.

The CCC Workshop was feasible and acceptable. Based on effect sizes reported here, a larger study will likely establish the efficacy of the CCC Workshop, which has the potential to address unmet needs of caregivers who underutilize in-person supportive care services.

IntroductionThe cornerstone of treatment for coeliac disease is a gluten-free diet (GFD). However, adherence to a GFD is reported to vary between 50 and 70%. Recently other investigators have been reporting their preliminary findings using novel therapies (anti-zonulin or peptidases). Both these observations suggest that patients with coeliac disease may be seeking an alternative therapy for their disease.In both irritable bowel syndrome and inflammatory bowel disease the incidence of complementary or alternative medicine (CAM) use is reported to be as high as 50%. There has never been any data assessing the use of CAM in patients with coeliac disease.MethodsWe sought to assess whether patients with adult coeliac disease are taking complementary or alternative medicines (CAM) and also questioned this group about their interest in novel therapies.This was a survey conducted in an out-patient setting. We also obtained information from a control group (without any GI disease) about their use of CAM.Results310 patients with coeliac disease completed the survey (83 male and age range 19–97, mean age 56). Patients were classified according to their presenting symptoms with 258 having “typical” symptoms (gastrointestinal presenting symptoms, anaemia or a combination of both) and 52 with neither (described as atypical, for example, osteoporosis). The control group was 477 individuals (228 male, age range 17–88, mean age 45.9).The incidence of CAM in patients with coeliac disease was 21.6% (67/310) and in the control group the incidence of CAM usage was 27% (129/477), p=0.08. There were no statistically significant differences in incidence when comparing the two subgroups of coeliac disease.Patients were also asked if they were satisfied with the GFD using a Likert scale. The outcomes reported were very poor 7.4% (23/310), poor 34.5% (107/310), average 34.8% (108/310), 19.4% good (60/310) and 3.9% excellent (12/310).Finally patients were asked about their preferences for possible novel therapies. Patients were asked to arrange in order of preference 1–4 whether they would like a vaccine, genetically modified wheat, peptidase or anti-zonulin. Universally patients placed genetically modified wheat as the lowest preference. A vaccine was reported to be the first choice in 42% of patients, 35% for Anti- Zonulin and 23% for Peptidases.ConclusionMore than 40% of patients with coeliac disease are dissatisfied with their GFD. These patients are not taking CAM any more than individuals without coeliac disease. This suggests they do not view CAM as alternative to the GFD. However, all the patients in this survey were keen to consider novel therapies with a vaccine being the most preferred option.