A mixed methods study of the relationships between self-harm, suicidal behaviour, and disordered eating in BPD: the role of psychological factors

Co-occurring borderline personality disorder and eating disorders confer a greater risk for self-harm and suicide attempts than either diagnosis alone. The nature of, and possible reasons for, the relationships between disordered eating, borderline personality disorder, and self-harm behaviour remains unclear. This study used a cross-sectional mixed methods approach to examine the prevalence of self-harm, suicide attempts, and eating disorder symptoms in borderline personality disorder; investigate the effect of psychological factors on these relationships; and to explore lived experiences of self-harm, suicidal behaviour, and disordered eating in borderline personality disorder. 52 individuals with borderline personality disorder in NHS Highland completed questionnaires assessing various psychological factors. A subset of these (n=7) took part in semi-structured interviews exploring experiences of self-harm/suicide attempts, and disordered eating, analysed using interpretative phenomenological analysis. Results demonstrated that self-harm and/or suicide attempts were reported by all participants, and the mean scores on the EDE-Q were high. Social perfectionism, emotional dysregulation, depression, and low resilience were associated with eating disorder severity; social perfectionism uniquely so. Three superordinate themes describing participants’ experiences of self-harm, suicide attempts and disordered eating emerged from the analysis: ‘self as defective’; ‘need for control’; and self-harm as ‘friend and foe’. These findings highlight that high rates of self-harm, suicide attempts, and disordered eating are reported by individuals with borderline personality disorder. Social perfectionism in particular appears to be a risk factor in those with co-occurring borderline personality disorder and disordered eating, alongside emotion dysregulation, depression, and low resilience. More attention needs to be given to assessing and treating eating disorder symptomatology and self-harm/suicide attempts in individuals with borderline personality disorder

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Characterizing and Exploiting Tumor Microenvironments to Optimize Treatment Outcomes

SIMPLE SUMMARY: The Irish Association for Cancer Research (IACR) held its 57th annual conference from the 24–26 March 2021 in a virtual format due to the ongoing pandemic. This report provides a summary overview of the work presented at the conference, which had a particular focus on the tumor microenvironment. Tumors do not develop and grow in isolation, but rather within the context of their surrounding environment. The work presented at the conference outlined the complexity of the tumor microenvironment and highlighted several ways in which it influences tumor growth and progression. Moreover, the tumor microenvironment was discussed as a potential target for new cancer treatments. Traditionally, laboratory research has focused on the tumor only, but conference speakers highlighted the importance of modeling the surrounding microenvironment to gain a more physiologically relevant view of tumorigenesis. Finally, conference attendees heard from the patient’s perspective regarding the development of novel targeted therapies. ABSTRACT: Our understanding of cancer initiation, progression, and treatment is continually progressing through dedicated research achieved through laboratory investigation, clinical trials, and patient engagement. The importance and complexity of the microenvironment and its role in tumor development and behavior is pivotal to the understanding of tumor growth and the best course of treatment. The 57th Irish Association for Cancer Research (IACR) Annual Conference collected key researchers, clinicians, and patient advocates together to highlight and discuss the recognized importance of the microenvironment and treatment advances in cancer. In this article, we describe the key components of the microenvironment that influence tumor development and treatment, including the microbiome, metabolism, and immune response and the progress of preclinical models to reflect these complex environments. From a psycho-social oncology perspective, we highlight expert opinion and data on the process of shared decision-making in the context of emerging cancer treatments

Impulsivity, aggression, and suicide: a systematic review and meta-analysis

Background The aim of the study was to crystallize the nature of relationships between impulsivity, aggression, and suicidality. We reviewed studies of adults with published, psychometric measures of impulsivity and aggression, and measures of suicidality. Methods Our primary data source was Web of Science (from inception to 31st December 2021). Quality of articles was assessed using a Joanna Briggs Appraisal Tool and publication bias using Trim and Fill. We synthesised results using random effects meta-analyses and explored moderation by measure of impulsivity, aggression, and suicidality, and population. Findings 77 studies were included in our analysis. We found weak positive relationships between impulsivity (r = 0·19 [95% CI: 0·15–0·22]), aggression (0·23 ([0·17, 0·29]), and impulsive aggression (0·16 [0·1, 0·22]) with suicidality. Heterogeneity was significant and only partially explained by moderators. Limitations included the lack of studies which assess impulsivity or aggression proximal to suicidality. Interpretation Given small effect sizes and significant heterogeneity, the study suggests that additional studies are needed in the field to analyze the relation between impulsivity and aggression with suicidality

Pro-inflammatory and tumour proliferative properties of excess visceral adipose tissue

Obesity has been associated with increased incidence and mortality of oesophageal and colorectal adenocarcinoma. Excess central adiposity may drive this association through an altered inflammatory milieu. Utilizing a unique adipose tissue bioresource we aimed to determine the pro-tumour properties of visceral adipose tissue. Comparing subcutaneous and visceral adipose tissue depots, we observed significantly higher levels of VEGF and IL-6, along with significantly higher proportions of CD8+ T cells and NKT cells in visceral adipose tissue. Significantly higher levels of VEGF were observed in the conditioned media from visceral adipose tissue of centrally obese compared to non-obese patients. We also report a significant increase in oesophageal and colorectal tumour cell proliferation following culture with conditioned media from visceral adipose tissue of centrally obese patients. Neutralizing VEGF in the conditioned media significantly decreased tumour cell proliferation. This novel report highlights a potential mechanism whereby visceral adipose tissue from centrally obese cancer patients may drive tumour progression

Carbon Loss Pathways in Degraded Peatlands: New Insights From Radiocarbon Measurements of Peatland Waters

Peatland carbon stores are under widespread anthropogenic pressure, resulting in degradation and carbon loss. This paper presents DO14C (Dissolved Organic Carbon) dates from waters draining two eroded blanket peatland catchments in the UK. Both catchments are characterized by severe gully erosion but one additionally has extensive surface erosion on unvegetated surfaces. DO14C values ranged from 104.3 to 88.6 percent modern (present to 976 Before Present). The oldest DOC dates came from the catchment characterized by both gully and surface erosion and are among the oldest reported from waters draining temperate peatlands. Together with peat age-depth data from across the peatland landscape, the DO14C ages identify where in the peat profile carbon loss is occurring. Source depths were compared with modeled water table data indicating that in the catchment where gully erosion alone dominated, mean water table was a key control on depth of DOC production. In the system exhibiting both gully erosion and surface erosion, DOC ages were younger than expected from the age of surficial peats and measured water tables. This may indicate either that the old organic matter exposed at the surface by erosion is less labile or that there are modifications of hydrological flow pathways. Our data indicate that eroded peatlands are losing carbon from depth, and that erosion form may be a control on carbon loss. Our approach uses point measurements of DO14C to indicate DOC source depths and has the potential to act as an indicator of peatland function in degraded and restored systems