Background The microbiota in the lumen of patients with Crohn’s disease (CD) is characterized by reduced diversity, particularly Firmicutes and Bacteroidetes. It is unknown whether the introduction of the intestinal microbiota from healthy individuals could correct this dysbiosis and reverse mucosal inflammation. We investigated the response to fecal microbial transplantation (FMT) from healthy individuals to subjects with active CD Methods We performed a prospective open-label study (uncontrolled) of FMT from healthy donors to subjects with active CD. A single FMT was performed via colonoscopy. Recipients’ microbial diversity, mucosal T-cell phenotypes and clinical and inflammatory parameters were measured over 12 weeks, and safety over 26 weeks. Results Nineteen subjects were treated with FMT and completed the study follow-up. Fifty-eight percent (11/19) demonstrated a clinical response (HBI decrease > 3) following FMT. Fifteen subjects had sufficient pre/post fecal samples for analysis. A significant increase in microbial diversity occurred after FMT (p=0.02). This was greater in clinical responders than non-responders. Patients who experienced a clinical response demonstrated a significant shift in fecal microbial composition towards their donor’s profile as assessed by the Bray-Curtis index at 4 weeks (p=0.003). An increase in regulatory T-cells (CD4+CD25+CD127lo) was also noted in recipients’ lamina propria following FMT. No serious adverse events were noted over the 26-week study period. Conclusion In this open label study, FMT led to an expansion in microbial bacterial diversity in patients with active CD. FMT was overall safe, although the clinical response was variable. Determining donor microbial factors that influence clinical response is needed prior to randomized clinical trials of FMT in CD. ClinicalTrials ID # NCT01847170
We have developed and validated an IBD-specific scale to assess the psychosexual impact of IBD. This new survey tool may help physicians screen for and identify factors contributing to impaired sexual functioning in their male patients.
Background: Cancer affects both men and women, yet systematic understanding of the role of gender in caregiving and dyadic caregiver-patient interactions is lacking.Thus, it may be useful to review how gender theories apply to cancer caregiving and to evaluate the adequacy of current cancer caregiving studies to the gender theories.Methods: Several databases, including MEDLINE (Ovid), PsychINFO, PubMed, and CINAHL, were used for searching articles published in English between 2000 and 2016. The search was restricted by age (≥18) and yielded 602 articles, which were subject to further screen and review based on selection criteria. Of 108 full texts reviewed to determine inclusion eligibility for this review, 55 met the criteria and included for review. Results:The reviewed studies supported the "gender role" and "doing gender" perspectives for caregiver selection. The role identity, role strain, and transactional stress theories were supported for predicting caregiving outcomes at the individual level.Furthermore, attachment, self-determination, and interdependence theories incorporated caregiver factors that predicted the patients' outcomes, and vice versa. Conclusion: Despite limited gender theory-driven research in cancer caregiving and psycho-oncology in general, the utility of gender theories in (a) identifying subgroups of caregiver-patient dyads who are vulnerable to the adverse effects of cancer in the family and (b) developing evidence-based interventions is promising. Integrating broader issues of medical trajectory, lifespan, sociocultural, and biological factors in gender-oriented research and practice in psycho-oncology is encouraged.
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