Sticky Mucus Research Articles

Vocal Disorders in Patients with COVID 19 in Egypt.

COVID-19 is considered a respiratory disease which has many symptoms associated with the larynx and the lungs infections. COVID-19 has wide spectrum of clinical features starting from mild symptoms to severe illness. Otolaryngological symptoms as nasal obstruction, loss of smell, taste dysfunction, sore throat, sticky mucus, and dysphagia are common in COVID-19 patients. Other vocal symptoms as dysphonia and phonesthenia are common in COVID-19 patients. The aim of this study is to detect the occurrence of vocal symptoms in COVID-19 patients in Egypt and to investigate the videolaryngoscopic findings associated with these symptoms. A total number of 106 patients diagnosed with COVID-19 were randomly assessed for vocal symptoms. The following epidemiological and clinical data were collected: age, gender, smoking consumption, general symptoms, otolaryngological and vocal symptoms as dysphonia and phonesthenia. Auditory perceptual assessment of voice and videolaryngoscopic examination were done. The occurrence of dysphonia and phonesthenia were observed in COVID -19 patients. Of the 106 patients, 84 patients (79%) were dysphonic, 20 (18.8%) patients were phonesthenic. The correlation of the different otolaryngological symptoms with dysphonia and phonesthenia were reported. A significant correlation was found between dysphonic patients and rhinorrhea, taste dysfunction, sore throat, and cough. A significant correlation was found between phonesthenic patients and allergic rhinitis. Videolaryngoscopic findings were detected in COVID-19 patients. Vocal fold congestion was found in 42 patients (39.6%), benign vocal fold swellings was found in 18 patients (16.9%), ventricular hypertrophy was found in 6 patients (0.05%), unilateral vocal fold immobility was found in 14 patients (13.2%), and vocal fold congestion associated with ventricular fold hypertrophy was found in 20 patients (18.8%).There was significant correlation of dysphonia and phonesthenia with vocal fold congestion (P value:0.001, P value:0.039 respectively).There was a significant correlation between cough and vocal fold congestion (P value: 0.000). Benign vocal fold swellings were associated with 18 patients (16.9%), but it was not statistically significant (P value: 0.931). Dysphonia and phonesthenia were observed in patients with mild to moderate COVID-19.The vocal symptoms were associated with different laryngoscopic findings, in which, vocal fold congestion was the commonest.

The Future of CRISPR: Looking at Gene Editing as a Treatment For Cystic Fibrosis

Cystic Fibrosis (CF) is a genetically inherited chronic disease that causes the production of a thick and sticky mucus primarily in the lungs. The condition tends to become worse over time. Clogged lungs and other internal organs result in breathing issues, susceptibility to infections, digestive problems, and lack of nutrition. CF is an autosomal recessive disease, indicating that an individual must inherit two copies of the defective Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene, which then encodes for a malfunctioning CFTR protein. Because of the large number of CF patients that cannot be treated with these CFTR modulators, using gene editing to directly target the mutation can be more effective and efficient in treating cystic fibrosis. In this paper, we will discuss the promises and limitations for using gene editing as a treatment for CF.

Assisting PNA transport through cystic fibrosis human airway epithelia with biodegradable hybrid lipid-polymer nanoparticles

Cystic fibrosis (CF) is characterized by an airway obstruction caused by a thick mucus due to a malfunctioning Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein. The sticky mucus restricts drugs in reaching target cells limiting the efficiency of treatments. The development of new approaches to enhance drug delivery to the lungs represents CF treatment's main challenge. In this work, we report the production and characterization of hybrid core–shell nanoparticles (hNPs) comprising a PLGA core and a dipalmitoylphosphatidylcholine (DPPC) shell engineered for inhalation. We loaded hNPs with a 7-mer peptide nucleic acid (PNA) previously considered for its ability to modulate the post-transcriptional regulation of the CFTR gene. We also investigated the in vitro release kinetics of hNPs and their efficacy in PNA delivery across the human epithelial airway barrier using an ex vivo model based on human primary nasal epithelial cells (HNEC) from CF patients. Confocal analyses and hNPs transport assay demonstrated the ability of hNPs to overcome the mucus barrier and release their PNA cargo within the cytoplasm, where it can exert its biological function.

Extraction of the molecular level biomedical event trigger based on gene ontology using radial belief neural network techniques

Detection of molecular level biomedical event extraction plays a vital role in creating and visualizing the applications related to natural language processing. Cystic Fibrosis is an inherited genetic and debilitating pathology involving the respiratory and digestive systems. The excessive production of thick sticky mucus on the outside of the cells is the main consequence of such disease. This includes disease prevention and medical search to signify the occurrence and detection of event triggers, which is regarded as a proper step in an event extraction of molecular level in biomedical applications. In this model, use a rich set of extracted features to feed the machine learning classifier that helps in better extraction of events. The study uses an automatic feature selection and a classification model using Radial Belief Neural Network (RBNN) for the optimal detection of molecular biomedical event detection. The Radial Belief Neural Network (RBNN) is the proposed system is implemented and it is the classifier to give accurate result of the disease detection. These three algorithms are used to enhance the generalization performance and scalability of detecting the molecular event triggers. The validation is conducted on the cystic fibrosis event trigger based on the gene ontology bio system using the RBNN model with a lung molecular event-level extraction dataset. The extensive computation shows that the Radial Belief Neural Network (RBNN) is proposed to given the better performance results like Accuracy, Sensitivity, Specificity, F-measure and Execution time.

Novel therapeutic approaches for the management of cystic fibrosis.

Cystic fibrosis (CF) is a genetic condition characterised by the build-up of thick, sticky mucus that can damage many of the body’s organs. It is a life-long disease that results in a shortened life expectancy, often due to the progression of advanced lung disease. Treatment has previously targeted the downstream symptoms such as diminished mucus clearance and recurrent infection. More recently, significant advances have been made in treating the cause of the disease by targeting the faulty gene responsible. Hope for the development of potential therapies lies with ongoing research into new pharmacological agents and gene therapy. This review gives an overview of CF, and summarises the current evidence regarding the disease management and upcoming strategies aimed at treating or potentially curing this condition.

A Concomitant Allergic Fungal Otomastoiditis with an Allergic Fungal Rhinosinusitis

Background: Allergic fungal otomastoiditis is a rare ear condition characterized by the presence of a specific middle ear mucus usually found in allergic bronchopulmonary aspergillosis. Methods: We report a case of concomitant allergic fungal otomastoiditis and rhinosinusitis in an immunocompetent 27-year-old man complaining of right otorrhea and nasal discharge for 6 months resistant to any medical treatment. Examination revealed a sticky mucus arising from a polypoid middle ear associated with a right middle meatus purulent discharge. Surgical treatment revealed no cholesteatoma but thick yellowish mucus and a fungal ball, as targeted by imaging, both of which containing Aspergillus species. Result: The patient received short postoperative systemic corticotherapy and showed no recurrence 6 months after. Discussion: Allergic fungal otomastoidis should be considered in the face of a sticky mucus arising from perforated chronic otitis, especially when associated with allergic fungal rhinosinusitis. Complete surgical debridement is essential.

Mediated Drug Release from Nanovehicles by Black Phosphorus Quantum Dots for Efficient Therapy of Chronic Obstructive Pulmonary Disease

AbstractChronic obstructive pulmonary disease (COPD) is an intractable disease involving a sticky mucus layer and nanoagents with mucus‐penetrating capability offer a new way to deliver drugs. However, drug release from nanovehicles requires optimization to enhance the therapeutic effects of COPD therapy. Herein, black phosphorus quantum dots (BPQDs) are combined with PEGylated chitosan nanospheres containing the antibiotic amikacin (termed PEG@CS/BPQDs‐AM NPs). As a drug‐delivery system, the hydrophilicity of PEG and positive charge of CS facilitate the penetration of nanovehicles through the mucus layer. The nanovehicles then adhere to the mucous membrane. Furthermore, the BPQDs degrade rapidly into nontoxic PO43− and acidic H+, thereby promoting the dissociation of PEGylated CS nanospheres, accelerating the release of AM, decreasing the vitality of biofilms for ease of eradication. Our results reveal that drug delivery mediated by BPQDs is a feasible and desirable strategy for precision medicine and promising for the clinical therapy of COPD.

Mediated Drug Release from Nanovehicles by Black Phosphorus Quantum Dots for Efficient Therapy of Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is an intractable disease involving a sticky mucus layer and nanoagents with mucus-penetrating capability offer a new way to deliver drugs. However, drug release from nanovehicles requires optimization to enhance the therapeutic effects of COPD therapy. Herein, black phosphorus quantum dots (BPQDs) are combined with PEGylated chitosan nanospheres containing the antibiotic amikacin (termed PEG@CS/BPQDs-AM NPs). As a drug-delivery system, the hydrophilicity of PEG and positive charge of CS facilitate the penetration of nanovehicles through the mucus layer. The nanovehicles then adhere to the mucous membrane. Furthermore, the BPQDs degrade rapidly into nontoxic PO43- and acidic H+ , thereby promoting the dissociation of PEGylated CS nanospheres, accelerating the release of AM, decreasing the vitality of biofilms for ease of eradication. Our results reveal that drug delivery mediated by BPQDs is a feasible and desirable strategy for precision medicine and promising for the clinical therapy of COPD.

Molecular Viscometer Identified a Population of Mucin Granules of Higher Viscosity in Cystic Fibrosis Cells

The cystic fibrosis (CF) disease is characterized by abnormally thick and sticky mucus. Normal airway mucus has bulk viscosity (macroviscosity) in the range of 12–15×103 cP increasing to 14–110×103 cP for CF patients. At micro‐length scale (≤1 μm), due to the presence of fluid‐filled spaces between mucin fibers, mucus microrheological properties are similar to that of water (~1 cP). However, they are only slightly higher in CF mucus (~3 cP). Our study was designed to verify if similar viscosity differences exist between normal and CF mucin granules and secreted mucus.We used a custom‐designed membrane‐permeant molecular viscometer (phenyl‐BODIPY) and fluorescence lifetime imaging microscopy (FLIM) to study the microviscosity of mucin granules and secreted mucus. FLIM microviscosity measurements were validated in calibration experiments with sucrose (low microviscosity range), glycerol (high microviscosity range), agarose (gel‐like structure) and reconstituted mucus of isolated bovine mucin proteins in solution. Human bronchial epithelial (HBE) cells, isolated from tissues of 4 normal and 5 CF donors, were seeded on filters and cultured at the air‐liquid interface.FLIM measurements revealed that median values of microviscosity for normal granules are 41±7 cP (nfilters=30) and 49±11 cP (nfilters=31) for CF granules (p<0.001, Mann–Whitney U test). Next, we classified mucin granules in three categories based on their microviscosity: low (1–30 cP), medium (30–60 cP) and high (>60 cP). The quantity of granules with medium microviscosity does not differ between normal (74%) and CF (77%) donors. However, normal phenotype was characterized by the presence of a larger fraction of low microviscosity mucin granules (19%) compared to CF (4%), while CF phenotype displayed a larger proportion of high microviscosity granules (19%) compared to normal (7%). Raising the pH inside granules by blocking H+‐ATPase with 10 nM bafilomycin lowered microviscosity values of CF granules towards normal phenotype. Microviscosity of secreted mucus covering HBE cells was measured in situ and reached values of 147±54 cP (nfilters=7) for normal donors and 198±75 cP (nfilters=7) for CF donors.Our study demonstrates the presence of a subpopulation of mucin granules with higher microviscosity in CF that is less pronounced in normal patients. FLIM microviscosity measurements of secreted mucus show much higher values than expected for a water‐filled interfiber spaces in a gel. This may indicate that mucus covering HBE cells resembles an amorphous colloid rather than a well‐structured hydrogel. Relative differences in mucus microviscosity between normal and CF, however, are much smaller than those reported for a bulk viscosity of mucus collected from patients.Support or Funding InformationSupported by the Cystic Fibrosis Canada (R.G.) and CIHR PJT148593 (E.B.).

Small Molecule Anion Carriers Correct Abnormal Airway Surface Liquid Properties in Cystic Fibrosis Airway Epithelia.

Cystic fibrosis (CF) is a genetic disease characterized by the lack of cystic fibrosis transmembrane conductance regulator (CFTR) protein expressed in epithelial cells. The resulting defective chloride and bicarbonate secretion and imbalance of the transepithelial homeostasis lead to abnormal airway surface liquid (ASL) composition and properties. The reduced ASL volume impairs ciliary beating with the consequent accumulation of sticky mucus. This situation prevents the normal mucociliary clearance, favouring the survival and proliferation of bacteria and contributing to the genesis of CF lung disease. Here, we have explored the potential of small molecules capable of facilitating the transmembrane transport of chloride and bicarbonate in order to replace the defective transport activity elicited by CFTR in CF airway epithelia. Primary human bronchial epithelial cells obtained from CF and non-CF patients were differentiated into a mucociliated epithelia in order to assess the effects of our compounds on some key properties of ASL. The treatment of these functional models with non-toxic doses of the synthetic anionophores improved the periciliary fluid composition, reducing the fluid re-absorption, correcting the ASL pH and reducing the viscosity of the mucus, thus representing promising drug candidates for CF therapy.

Multicenter study of autoimmune gastritis in Japan: Clinical and endoscopic characteristics

In Japan, the prevalence of autoimmune gastritis (AIG) is assumed to be very low. With the recent rapid decrease in Helicobacter pylori (Hp) prevalence, reports on AIG are increasing. This multicenter registry study aimed to clarify the characteristics of AIG, especially its endoscopic appearance. A total of 245 patients with AIG from 11 institutions in Japan from January 2010 to October 2016 were included, and their clinical and endoscopic findings were evaluated. Mean age was 67.2±11.4years, and 63.7% of the participants were women. The most common approach to diagnose AIG was endoscopic examination. Repeated incorrect treatment for Hp infection, due to a false-positive result in 13 C-urea breath test, ranked third among the basis for diagnosis of AIG. Associated gastric lesions were type 1 neuroendocrine tumor (11.4%), adenocarcinoma (9.8%), and hyperplastic polyps (21.1%). Corpus pan-atrophy was the most common appearance (90.1%); however, remnant oxyntic mucosa was found in 31.5% of the patients (flat, localized type, 48.6%). Sticky adherent dense mucus and scattered minute whitish protrusions were also observed in approximately 30% of the patients. Despite the prevailing presumption of the antral mucosa remaining normal, 42.3% of the patients presented with various extents of atrophy, and patchy redness and circular wrinkle-like patterns were both observed in approximately 20% of the patients. The present study showed some prominent clinical characteristics and endoscopic findings of AIG. We believe that our study will facilitate the diagnosis of potential AIG.

Validity of endoscopic features for the diagnosis of Helicobacter pylori infection status based on the Kyoto classification of gastritis.

Evaluation of Helicobacter pylori infection status (non-infection, past infection, current infection) has become important. This study aimed to determine the usefulness of the Kyoto classification of gastritis for diagnosing H.pylori infection status by endoscopy. In this prospective study, 498 subjects were recruited. Seven well-experienced endoscopists blinded to the history of eradication therapy performed the examinations. Endoscopic findings were assessed according to the Kyoto classification of gastritis: diffuse redness, regular arrangement of collecting venules (RAC), fundic gland polyp (FGP), atrophy, xanthoma, hyperplastic polyp, map-like redness, intestinal metaplasia, nodularity, mucosal swelling, white and flat elevated lesion, sticky mucus, depressive erosion, raised erosion, red streak, and enlarged folds. We established prediction models according to a machine learning procedure and compared them with general assessment by endoscopists using the Kyoto classification of gastritis. Significantly higher diagnostic odds were obtained for RAC (32.2), FGP (7.7), and red streak (4.7) in subjects with non-infection, map-like redness (12.9) in subjects with past infection, and diffuse redness (26.8), mucosal swelling (13.3), sticky mucus (10.2) and enlarged fold (8.6) in subjects with current infection. The overall diagnostic accuracy rate was 82.9% with the Kyoto classification of gastritis. The diagnostic accuracy of the prediction model was 88.6% for the model without H.pylori eradication history and 93.4% for the model with eradication history. The Kyoto classification of gastritis is useful for diagnosing H.pylori infection status based on endoscopic findings. Our prediction model is helpful for novice endoscopists. (UMIN000016674).

Prey capture and feeding behaviour in an endemic land flatworm from São Tomé Island

ABSTRACTTwo specimens of the endemic land flatworm species Othelosoma impensum Sluys & Neumann, 2017 from the volcanic island São Tomé were observed in the wild in Obo-National Park while they were preying on ants that had descended on a tree trunk after their nuptial flight. A maximum of 41 ants were assembled in a cluster by one of the flatworms, the insects being immobilised by mucus secreted by the worms. A strong cephalic retractor muscle facilitated capture of the mobile prey. Presence or absence of similar cephalic adaptations in other species of Othelosoma and other genera of land flatworms is discussed, as well as the effectiveness of the sticky mucus secreted by the worms during prey capture.

Adhesive defence mucus secretions in the red triangle slug (Triboniophorus graeffei) can incapacitate adult frogs

AbstractGastropods are known to secrete mucus for a variety of purposes, including locomotion, reproduction, adhesion to surfaces and lubrication. A less commonly known function of mucus secretion in this group involves its use as a defence against predation. Amongst the terrestrial slugs, mucus that serves this particular purpose has been studied for only a handful of species under laboratory conditions, where it is thought to be produced to make individuals unpalatable or difficult to consume. However, the mechanisms of how these defensive secretions operate and their effectiveness in deterring predation in the natural world have not been described in much detail. In this study, we provide evidence of adhesive mucus secretions in the red triangle slug (Triboniophorus graeffei) as an adaptation against predation. Field observations of a large red‐eyed green tree frog (Litoria chloris) trapped in the mucus secretions of a nearby T. graeffei revealed that this mucus serves to incapacitate predators rather than just an overall deterrence. Mechanical stimulation of T. graeffei under laboratory conditions revealed that adhesive secretions were produced from discrete sections of the dorsal surface when disturbed, leading to the production of a highly sticky and elastic mucus that was unlike the thin and slippery mucus used during locomotion. The adhesiveness of the defensive secretions was strengthened and reactivated when in contact with water. This appears to not only be the first description of defensive mucus production in this slug species but one of the first natural observations of slug secretions incapacitating a relatively large vertebrate. The biomechanical properties of this mucus and its ability to maintain and strengthen its hold under wet conditions make it potentially useful in the development of new adhesive materials.

Potentiators (specific therapies for class III and IV mutations) for cystic fibrosis.

Potentiators (specific therapies for class III and IV mutations) for cystic fibrosis.

Prenatal Diagnosis of Cystic Fibrosis.

Cystic fibrosis (CF) is an inherited disease characterized by the accumulation of thick, sticky mucus which damages epithelia in organs such as the lungs, pancreas, liver, intestines, and other parts of the body. The most common symptoms are sinopulmonary disease and chronic gastrointestinal tract problems resulting from decreased mucociliary clearance and inflammation. CF is the most common life-limiting autosomal recessive disorder in people of northern European ancestry and it affects other populations with different prevalence. CF can be diagnosed by many methods including testing for blood immunoreactive trypsin, sweat chloride, transepithelial nasal potential difference, and molecular genetic testing.

Childhood disorders: Cystic fibrosis

Cystic fibrosis (CF) is an inherited condition that causes sticky mucus to build up in the lungs and digestive system, leading to lung infections and problems with digesting food. CF is most commonly picked up in the UK via the newborn screening heel prick test. The onset of symptoms varies from child to child but usually begins in early childhood. The symptoms worsen over time with the lungs and digestive system becoming damaged.

Interventions for treating distal intestinal obstruction syndrome (DIOS) in cystic fibrosis.

Cystic fibrosis is the most common life-limiting autosomal recessive genetic disorder in white populations. Distal intestinal obstruction syndrome (DIOS) is an important morbidity in cystic fibrosis. It is the result of the accumulation of viscid faecal material within the bowel which combines with thick, sticky mucus produced in the intestines of people with cystic fibrosis. The intestine may be completely blocked (complete DIOS) or only partially blocked (incomplete DIOS). Once a diagnosis of DIOS has been made, the goal of therapy is to relieve the acute complete or incomplete faecal obstruction and ultimately prevent the need for surgical intervention. This review aimed to evaluate the effectiveness and safety of different treatment regimens for the treatment of DIOS (complete and incomplete) in children and adults with cystic fibrosis. We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the reference lists of relevant articles and reviews.Date of last search: 24 July 2018.We also searched the following trials registries and other resources: ClinicalTrials.gov; International Standard Randomised Controlled Trial Number (ISRCTN) Registry; the WHO International Clinical Trials Registry; and Open Grey.Date of last searches: 10 June 2018. Randomised controlled trials, quasi-randomised controlled trials (including cross-over trials (to be judged on an individual basis)) comparing the use of laxative agents or surgery for treating DIOS in children, young people and adults with cystic fibrosis to each other, placebo or no intervention. Two authors independently screened papers, extracted trial details and assessed for risk of bias. The authors assessed the quality of evidence using GRADE. There was one trial with 20 participants (16 females) included in the review. The mean age of participants was 13.1 years. The trial was a double-blinded, randomised cross-over trial which had a duration of 12 months in total and compared high-dose and low-dose pancreatic enzyme therapy. As only the abstract of the trial was available, the overall risk of bias was judged to be unclear. The trial did not address either of our primary outcomes (time until resolution of DIOS and treatment failure rate), but reported episodes of acute DIOS, presence of abdominal mass and abdominal pain. There were no numerical data available for these outcomes, but the authors stated that there was no difference between treatment with high-dose or low-dose pancreatic enzymes. The overall quality of the evidence was found to be very low. There is a clear lack of evidence for the treatment of DIOS in people with cystic fibrosis. The included abstract did not address our primary outcome measures and did not provide numerical data for the two secondary outcomes it did address. Therefore, we cannot justify the use of high-dose pancreatic enzymes for treating DIOS, nor can we comment on the efficacy and safety of other laxative agents. From our findings, it is clear that more randomised controlled trials need to be conducted in this area.

Interventions for preventing distal intestinal obstruction syndrome (DIOS) in cystic fibrosis.

Cystic fibrosis (CF) is the most common, life-limiting, genetically inherited disease. It affects multiple organs, particularly the respiratory system. However, gastrointestinal problems such as constipation and distal intestinal obstruction syndrome (DIOS) are also important and well-recognised complications in CF. They share similar symptoms e.g. bloating, abdominal pain, but are distinct conditions. Constipation occurs when there is gradual faecal impaction of the colon, but DIOS occurs when there is an accumulation of faeces and sticky mucus, forming a mass in the distal part of the small intestine. The mass may partially block the intestine (incomplete DIOS) or completely block the intestine (complete DIOS). Symptoms of DIOS can affect quality of life and other aspects of CF health, such as airway clearance, exercise, sleep and nutritional status. Treatment of constipation and prevention of complete bowel obstruction are required for gastrointestinal management in CF. However, many different strategies are used in clinical practice and there is a lack of consensus. The importance of this topic was highlighted in a recent research priority setting exercise by the James Lind Alliance. To evaluate the effectiveness and safety of laxative agents of differing types for preventing DIOS (complete and incomplete) in children and adults with CF. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of search: 22 May 2018.We also searched online trial registries. Date of last search: 10 June 2018. Randomised and quasi-randomised controlled parallel trials comparing laxative therapy for preventing DIOS (including osmotic agents, stimulants, mucolytics and substances with more than one action) at any dose to placebo, no treatment or an alternative laxative therapy, in people of any age with pancreatic sufficient or insufficient CF and any stage of lung disease. Randomised cross-over trials were judged on an individual basis. Two authors independently assessed trials for inclusion, extracted outcome data and performed a risk of bias assessment for the included data. We judged the quality of the evidence using GRADE criteria. We included one cross-over trial (17 participants) with a duration of 12 months, in which participants were randomly allocated to either cisapride (a gastro-prokinetic agent) or placebo for six months each. The trial had an unclear risk of bias for most domains but had a high risk of reporting bias.Radiograph scores revealed no difference in occurrence of DIOS between cisapride and placebo (narrative report, no data provided). There were no adverse effects. Symptom scores were the only secondary outcome within the review that were reported. Total gastrointestinal symptom scores favoured cisapride with a statistically significant mean difference (MD) of -7.60 (95% confidence interval (CI) -14.73 to -0.47). There was no significant difference at six months between cisapride and placebo for abdominal distension, MD -0.90 (95% CI -2.39 to 0.59) or abdominal pain, MD -0.4 (95% CI -2.05 to 1.25). The global symptom scores (whether individuals felt better or worse) were reported in the paper to favour cisapride and be statistically significant (P < 0.05).We assessed the available data to be very low quality. There was a great deal of missing data from the included trial and the investigators failed to report numerical data for many outcomes. The overall risk of bias of the trial was unclear and it had a high risk for reporting bias. There was also indirectness; the trial drug (cisapride) has since been removed from the market in several countries due to adverse effects, thus it has no current applicability for preventing DIOS. The included trial also had very few participants, which downgraded the quality a further level for precision. There is an absence of evidence for interventions for the prevention of DIOS. As there was only one included trial, we could not perform a meta-analysis of the data. Furthermore, the included trial compared a prokinetic agent (cisapride) that is no longer licensed for use in a number of countries due to the risk of serious cardiac events, a finding that came to light after the trial was conducted. Therefore, the limited findings from the trial are not applicable in current clinical practice.Overall, a great deal more research needs to be undertaken on gastrointestinal complications in CF, as this is a very poorly studied area compared to respiratory complications in CF.

Long-term dietary (n-3) polyunsaturated fatty acids show benefits to the lungs of Cftr F508del mice.

IntroductionThe pro-inflammatory status of cystic fibrosis (CF) patients promotes pulmonary colonization with opportunist and pathogenic bacteria, which is favored by a sticky mucus. Oral supplementation with (n-3) long chain polyunsaturated fatty acids (LC-PUFA) has shown anti-inflammatory effects. The aim of this study was to demonstrate the positive effects of a long-term diet enriched in (n-3) LC-PUFA on the lungs of Cftr F508del mice.Materials and methodsBreeding CftrΔF508del/+ mice received a control diet or a diet enriched in (n-3) LC-PUFA for 5 weeks before mating, gestation and lactation. After weaning, the offspring were given the same diet as their mother until post-natal day 60. The effects of (n-3) LC-PUFA supplementation on the lungs were evaluated in homozygous Cftr F508del mice and their wild-type littermates after acute lung inflammation induced by Pseudomonas aeruginosa lipopolysaccharide (LPS) inhalation.Results(n-3) LC-PUFA enrichment of mothers contributes to enrichment of mammary milk and cell membrane of suckling pups. Cftr F508del mice exhibited growth retardation and lung damage with collapsed alveoli, hyperplasia of bronchial epithelial cells and inflammatory cell infiltration. The (n-3) LC-PUFA diet corrected the growth delay of Cftr F508del mice and decreased hyperplasia of bronchial epithelial cells. Besides decreasing metaplasia of Club cells after LPS inhalation, (n-3) LC-PUFA modulated lung inflammation and restricted lung damage.ConclusionLong-term (n-3) LC-PUFA supplementation shows moderate benefits to the lungs of Cftr F508del mice.