A randomized clinical trial of the Unified Protocol for Transdiagnostic treatment of emotional and gastrointestinal symptoms in patients with irritable bowel syndrome: evaluating efficacy and mechanism of change

Abstract Objective The aim of this randomized controlled trial was to evaluate the efficacy of Unified Protocol (UP) for transdiagnostic treatment of psychological problems, such as anxiety, depression, and stress, and treating the intensity of gastrointestinal symptoms in individuals with Irritable Bowel Syndrome (IBS). Another aim of the study was to test whether emotion regulation mediates the effect of UP. Methods Among 91 patients diagnosed with IBS (using ROME III criteria), 64 patients were eligible to participate in the study based on the inclusion/exclusion criteria. These patients were randomly assigned to either an intervention group (n = 32) that participated in 12 weekly UP treatment sessions or to a wait-list control group (n = 32). All patients completed the Depression, Anxiety, and Stress Scale (DASS-42), Emotion Regulation Questionnaire (ERQ), and Gastrointestinal Symptoms Rating Scale (GSRS) pre- and post-intervention. The data were analyzed with SPSS 20.0 software. Results The results of intention-to-treat (ITT) analysis indicated a significant decrease in depression, anxiety, stress, and gastrointestinal symptoms, as well as significant improvements in emotion regulation scores in the intervention group post intervention. All results were significant at P < .001. Mediation analyses indicated that changes in emotion regulation mediated the effect of UP on changes in emotional and gastrointestinal symptoms. Conclusion UP was effective and influential in emotion regulation among the intervention group and caused a decline in emotional and gastrointestinal symptoms. Hence, this intervention is promising, but larger RCTs are needed to more investigate its efficacy. Future studies could also examine the efficacy of the UP in other medical conditions with co-occurring psychological conditions. Keywords Anxiety Depression Stress Emotion Regulation Irritable Bowel Syndrome Transdiagnostic Treatment Unified Protocol Randomized Clinical Tria

Optimizing cholecystectomy time in moderate acute biliary pancreatitis: A randomized clinical trial study

Background: In mild to moderate gallstone pancreatitis, cholecystectomy is the most appropriate treatment for prevention of further biliary attacks. However, the timing of cholecystectomy is not precisely determined. The present study was conducted to compare outcomes of very early (within 48 h) versus delayed (more than 1 week) laparoscopic cholecystectomy in patients with acute biliary pancreatitis (ABP). Methods: This randomized clinical trial study was conducted in Shahid Beheshti Hospital of Kashan University of Medical Sciences from September 2016 to Mar 2019. Two hundred and eight cases with mild to moderate ABP were randomly assigned to 2 groups, with 104 patients in group 1 (operation within 48 h) and 104 in group 2 (operation after one week). Age, sex, biochemical parameters, clinical manifestation at the time of admission, operation time, recurrent biliary problems, relapse, peri-operative complications, conversion rate, and hospital length of stay in the two groups were recorded and compared. In addition, Ranson's score and Revised Atlanta criteria, the American Society of Anaesthesiologists Physical Status ASA-PS, Charlson Co-Morbidity Index (CCI), complexity of surgery and Clavien-Dindo score were also determined. Results: There were no differences in demographics, peri-operative complications 4 (4) vs. 4 (4), P = 1), conversion rate (10.6 vs. 11.5; P = 0.825) and procedure time (83 vs. 81 minutes, P = 0.110) between the two groups. There were no deaths in either group; however, the length of hospital stay was shorter in the early group compared to the delayed one, (3.66 ± 1.12 vs. 10.35 ± 1.76, P < 0.001). Conclusion: Cholecystectomy within 48 h decreases significantly the length of hospital stay, without any difference in conversion rate, procedure time, or complication rate. © 2020 The Author(s) Biological sciences; Health sciences; Surgery; Internal medicine; Acute biliary pancreatitis; Laparoscopic cholecystectomy; Mild to moderate acute biliary pancreatitis. © 2020 The Author(s

A novel pathway producing dimethylsulphide in bacteria is widespread in soil environments

The volatile compound dimethylsulphide (DMS) is important in climate regulation, the sulphur cycle and signalling to higher organisms. Microbial catabolism of the marine osmolyte dimethylsulphoniopropionate (DMSP) is thought to be the major biological process generating DMS. Here we report the discovery and characterisation of the first gene for DMSP-independent DMS production in any bacterium. This gene, mddA, encodes a methyltransferase that methylates methanethiol (MeSH) and generates DMS. MddA functions in many taxonomically diverse bacteria including sediment-dwelling pseudomonads, nitrogen-fixing bradyrhizobia and cyanobacteria, and mycobacteria, including the pathogen Mycobacterium tuberculosis. The mddA gene is present in metagenomes from varied environments, being particularly abundant in soil environments, where it is predicted to occur in up to 76% of bacteria. This novel pathway may significantly contribute to global DMS emissions, especially in terrestrial environments, and could represent a shift from the notion that DMSP is the only significant precursor of DMS

Can the NHS be a learning healthcare system in the age of digital technology?

‘Big data’ is defined by ‘7 V’s’: volume (most frequently cited1), velocity, veracity, variety, volatility, validity and value. In healthcare, ‘big data’ is associated with a step-change in the way information is gathered, analysed and used to facilitate disease management and prevention. With greater electronic data capture, there is enthusiasm for increased safety, efficiency and effectiveness in health and social care through, for example, machine learning and other forms of artificial intelligence (AI). However, factors maintaining and widening the gap between the promise and the reality need to be addressed

Multifunctional design, feasibility and requirements for structural power composites in future electric air taxis

This study investigates the viability of implementing multifunctional structural power composites in a four-seater air taxi, the CityAirbus. For a given specific energy of the power source, the cruise endurance can be approximately doubled by using structural power composites as opposed to conventional batteries. Replacing all the eligible composite mass and batteries with structural power composites can reduce the CityAirbus weight by 25%. To achieve the current design performance, the minimum required elastic modulus, strength, specific energy and power for the structural power composite are 54 GPa, 203 MPa, 74 Wh/kg and 376 W/kg, respectively: current state-of-the-art structural power composites are now approaching this level of performance. Hence, structural power composites are considered feasible for adoption in the urban air mobility sector and have the potential to improve endurance and facilitate commercialization. This paper also discusses several key challenges that must be addressed to realize the adoption of structural power composites in future electric air taxis

The correlation between the numerical status of Th22 cells and serum level of IL-22 with severity of ulcerative colitis

Abstract Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease, yet its etiology as well as pathogenesis remain poorly understood. There is increasing evidence that aberrant expression of CD4+T lymphocytes plays an essential role in the progression of different pathologies such as UC. This study aimed to evaluate the circulatory frequency of T-helper 22 (Th22), a subset of CD4+ T cells, and serum level of its signature cytokine, IL-22, in patients with UC. Blood samples from 30 patients with UC and 30 controls (n=30) were tested for IL-22 level and circulatory Th22-cell count by ELISA and Flow cytometric analysis, respectively. Our results revealed higher serum level of IL-22 as well as circulatory frequency of Th22 cells in patients with UC compared to those in healthy controls. Notably, effective factors on severity of the disease were age, Th22, IL-22, ESR and CRP. We conclude that elevated circulating Th22 cells and their signature cytokine, IL-22, may be implicated in the pathogenesis of UC. These findings may provide preliminary experimental clues for the development of new therapies for UC and its severity judgment. Keywords: Interleukin-22, Th22 cells, Ulcerative coliti

The correlation between the numerical status of Th22 cells and serum level of IL-22 with severity of ulcerative colitis

Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease, yet its etiology as well as pathogenesis remains poorly understood. There is increasing evidence that aberrant expression of CD4+T lymphocytes plays an essential role in the progression of different pathologies such as UC. This study aimed to evaluate the circulatory frequency of T-helper 22 (Th22), a subset of CD4+ T cells, and serum level of its signature cytokine, IL-22, in patients with UC. Blood samples from 30 patients with UC and 30 controls (n=30) were tested for IL-22 level and circulatory Th22-cell count by ELISA and Flow cytometric analysis, respectively. Our results revealed higher serum level of IL-22 as well as circulatory frequency of Th22 cells in patients with UC compared to those in healthy controls. Notably, effective factors on severity of the disease were age, Th22, IL-22, ESR and CRP. We conclude that elevated circulating Th22 cells and their signature cytokine, IL-22, may be implicated in the pathogenesis of UC. These findings may provide preliminary experimental clues for the development of new therapies for UC and its severity judgment. © February 2018, Iran J Allergy Asthma Immunol. All rights reserved

Dectin-1-Mediated Production of Pro-Inflammatory Cytokines Induced by Yeast β-Glucans in Bovine Monocytes

Yeast-derived products containing β-glucans have long been used as feed supplements in domesticated animals in an attempt to increase immunity. β-glucans are mainly recognized by the cell surface receptor CLEC7A, also designated Dectin-1. Although the immune mechanisms elicited through Dectin-1 activation have been studied in detail in mice and humans, they are poorly understood in other species. Here, we evaluated the response of bovine monocytes to soluble and particulate purified β-glucans, and also to Zymosan. Our results show that particulate, but not soluble β-glucans, can upregulate the surface expression of costimulatory molecules CD80 and CD86 on bovine monocytes. In addition, stimulated cells increased production of IL-8 and of TNF, IL1B, and IL6 mRNA expression, in a dose-dependent manner, which correlated positively with CLEC7A gene expression. Production of IL-8 and TNF expression decreased significantly after CLEC7A knockdown using two different pairs of siRNAs. Overall, we demonstrated here that bovine monocytes respond to particulate β-glucans, through Dectin-1, by increasing the expression of pro-inflammatory cytokines. Our data support further studies in cattle on the induction of trained immunity using dietary β-glucans.This work received financial support from PT national funds (FCT/MCTES, Fundação para a Ciência e Tecnologia and Ministério da Ciência, Tecnologia e Ensino Superior) through the project UIDB/info:eu-repo/grantAgreement/FCT/6817 - DCRRNI ID/UIDB/50006/2020/PT. AP was supported by FCT phD grant PD/BDE/135540/2018. AC was supported by FCT Individual CEEC 2017 Assistant Researcher Grant CEECIND/01514/2017. MM was supported by FCT through program DL 57/2016 – Norma transitória (SFRH/BPD/70716/2010)