Minimally Invasive Surgery for Colorectal Cancer: Past, Present, and Future

A rapid progression from conventional open surgery to minimally invasive approaches in the surgical management of colorectal cancer has occurred over the last 2 decades. Initial concerns that this new approach was oncologically inferior to open surgery were ultimately refuted when several prospective randomized trials concluded that laparoscopic colectomy could achieve similar oncologic outcomes to open surgery. On the contrary, level 1 data has not yet matured regarding the oncologic safety of minimally invasive approaches for rectal cancer. We review the published literature pertaining to the evolution of minimally invasive techniques used to treat colorectal cancer surgery, including barriers to adoption, and the prospects for future advances related to innovative techniques

If it be love indeed tell me how much: Early core beliefs associated with excessive reassurance seeking in depression.

This study explored core beliefs associated with excessive reassurance seeking (ERS) in depression. Undergraduate students (n = 303) completed measures of early maladaptive schemas, attachment styles, ERS, and depression, along with a subsequent measure of depressive symptoms 6 weeks later. Anxious attachment, avoidant attachment, and an abandonment/instability schema each added to the prediction of ERS beyond the effects of depression. Moreover, avoidant attachment and the abandonment/instability schema moderated the relationship between ERS and depression over time. These results are consistent with the idea that individuals with early core beliefs reflecting insecurity in relationships seek reassurance. The findings also suggest that it may not be ERS behaviour per se, but rather characteristics of the individual in combination with ERS that are associated with depression

An integrative model of excessive reassurance seeking and negative feedback seeking in the development and maintenance of depression.

Depression and interpersonal dysfunction are inextricably linked. Interpersonal behaviors in individuals with depression, specifically excessive reassurance seeking (ERS) and negative feedback seeking (NFS), have recently emerged as possible risk factors for interpersonal rejection and future depression. However, existing models integrating ERS and NFS in individuals with depression lack empirical support and fail to provide an adequate explanation for the negative social and psychological consequences that concurrent ERS and NFS create. The proposed model, based on the bias and accuracy literature in close relationships, suggests that individuals with depression desire and elicit global enhancement (through ERS) and specific verification (through NFS) from close others. This model has strong theoretical and empirical foundations and suggests that depression chronicity and interpersonal distress stem from the influence that early core-beliefs about relationships and self-views have on the seemingly adaptive combination of global enhancement and specific verification

Influence of Priming Attachment Styles on Excessive Reassurance Seeking and Negative Feedback Seeking in Depression

Two studies examined the associations among attachment styles, excessive reassurance seeking (ERS) and negative feedback seeking (NFS) in depression. In Study 1 (n = 303), undergraduate students completed measures assessing attachment style, depressive symptoms, and ERS following either an imaginary interpersonal (friend and partner) or achievement prime. In Study 2 (n = 202), undergraduates completed the same measures in addition to completing an index of NFS following an imaginary interpersonal (partner) and achievement prime. Controlling for symptoms of depression, anxious attachment was positively related to ERS, and avoidant attachment was negatively related to ERS and positively associated with NFS. These results suggest that ERS and NFS may be a function of non-secure attachment rather than symptoms of depression per se. More specifically, anxiously attached individuals may attempt to reduce fears of abandonment by seeking reassurance from close others, whereas avoidantly attached individuals may strive to confirm negative perceptions of the self and relationships by seeking out unfavorable feedback from close others

Changes in Core Beliefs (Early Maladaptive Schemas) and Self-Representation in Cognitive Therapy and Pharmacotherapy for Depression

Randomized clinical trials suggest that cognitive therapy (CT) is comparable to antidepressant medication for the acute treatment of depression. Compelling data also indicate that CT has an added prophylactic benefit relative to pharmacotherapy (PT). The purpose of this study was to examine cognitive change in CT for depression. Participants (N = 42) met diagnostic criteria for a current major depressive episode and were randomly assigned to CT + PT or PT. Participants completed indices of depressive symptomatology, core beliefs (i.e., early maladaptive schemas), and self-attribute redundancy before and after therapy. Self-attribute redundancy was conceptualized as a form of schema organization and operationalized as the number of similar traits that permeate different aspects of self (e.g., as a partner, friend, employee). Treatment change was evident in both groups on self-reported core belief domains, with few between-group differences. Although no group differences were found on attribute redundancy at pre-treatment, there was a significant increase in positive redundancy at post-treatment favoring CT + PT. No group differences were found for negative content. These findings suggest that something about CT may uniquely impact self-representation and that CT may operate by bolstering compensatory schemas

The stress-responsive Hsp90 chaperone is required for the production of the genotoxin colibactin and the siderophore yersiniabactin by Escherichia coli

The genotoxin colibactin synthesized by Escherichia coli is a secondary metabolite belonging to the chemical family of hybrid polyketide/non-ribosomal peptide compounds. It is produced by a complex biosynthetic assembly line encoded by the pks pathogenicity island. The presence of this large cluster of genes in the E. coli genome is invariably associated with the High-Pathogenicity Island, encoding the siderophore yersiniabactin that belongs to the same chemical family as colibactin. The E. coli heat shock protein HtpG (Hsp90Ec) is the bacterial homolog of the eukaryotic molecular chaperone Hsp90 involved in the protection of cellular proteins against a variety of environmental stresses. In contrast to the eukaryotic Hsp90, the functions and client proteins of Hsp90Ec are poorly known. Here, we demonstrated that production of colibactin and yersiniabactin is abolished in the absence of Hsp90Ec We further characterized an interplay between the Hsp90Ec molecular chaperone and the ClpQ protease involved in colibactin and yersiniabactin synthesis. Finally, we demonstrated that Hsp90Ec is required for the full in vivo virulence of extraintestinal pathogenic E. coli This is the first report highlighting the role of heat shock protein Hps90Ec in the production of two secondary metabolites involved in E. coli virulence

Capturing human intelligence for modelling cognitive-based clinical decision support agents

The success of intelligent agents in clinical care depends on the degree to which they represent and work with human decision makers. This is particularly important in the domain of clinical risk assessment where such agents either conduct the task of risk evaluation or support human clinicians with the task. This paper provides insights into how to understand and capture the cognitive processes used by clinicians when collecting the most important data about a person’s risks. It attempts to create some theoretical foundations for developing clinically justifiable and reliable decision support systems for initial risk screening. The idea is to direct an assessor to the most informative next question depending on what has already been asked using a mixture of probabilities and heuristics. The method was tested on anonymous mental health data collected by the GRiST risk and safety tool (www.egrist.org)

Contamination of Fresh Produce by Microbial Indicators on Farms and in Packing Facilities: Elucidation of Environmental Routes

ABSTRACT To improve food safety on farms, it is critical to quantify the impact of environmental microbial contamination sources on fresh produce. However, studies are hampered by difficulties achieving study designs with powered sample sizes to elucidate relationships between environmental and produce contamination. Our goal was to quantify, in the agricultural production environment, the relationship between microbial contamination on hands, soil, and water and contamination on fresh produce. In 11 farms and packing facilities in northern Mexico, we applied a matched study design: composite samples (n � 636, equivalent to 11,046 units) of produce rinses were matched to water, soil, and worker hand rinses during two growing seasons. Microbial indicators (coliforms, Escherichia coli, Enterococcus spp., and somatic coliphage) were quantified from composite samples. Statistical measures of association and correlations were calculated through Spearman’s correlation, linear regression, and logistic regression models. The concentrations of all microbial indicators were positively correlated between produce and hands ( � range, 0.41 to 0.75; P � 0.01). When E. coli was present on hands, the handled produce was nine times more likely to contain E. coli (P � 0.05). Similarly, when coliphage was present on hands, the handled produce was eight times more likely to contain coliphage (P � 0.05). There were relatively low concentrations of indicators in soil and water samples, and a few sporadic significant associations were observed between contamination of soil and water and contamination of produce. This methodology provides a foundation for future field studies, and results highlight the need for interventions surrounding farmworker hygiene and sanitation to reduce microbial contamination of farmworkers’ hands. IMPORTANCE This study of the relationships between microbes on produce and in the farm environment can be used to support the design of targeted interventions to prevent or reduce microbial contamination of fresh produce with associated reductions in foodborne illness. KEYWORDS environmental microbiology, food-borne pathogens, produc

Infections with Avian Pathogenic and Fecal Escherichia coli Strains Display Similar Lung Histopathology and Macrophage Apoptosis

The purpose of this study was to compare histopathological changes in the lungs of chickens infected with avian pathogenic (APEC) and avian fecal (Afecal) Escherichia coli strains, and to analyze how the interaction of the bacteria with avian macrophages relates to the outcome of the infection. Chickens were infected intratracheally with three APEC strains, MT78, IMT5155, and UEL17, and one non-pathogenic Afecal strain, IMT5104. The pathogenicity of the strains was assessed by isolating bacteria from lungs, kidneys, and spleens at 24 h post-infection (p.i.). Lungs were examined for histopathological changes at 12, 18, and 24 h p.i. Serial lung sections were stained with hematoxylin and eosin (HE), terminal deoxynucleotidyl dUTP nick end labeling (TUNEL) for detection of apoptotic cells, and an anti-O2 antibody for detection of MT78 and IMT5155. UEL17 and IMT5104 did not cause systemic infections and the extents of lung colonization were two orders of magnitude lower than for the septicemic strains MT78 and IMT5155, yet all four strains caused the same extent of inflammation in the lungs. The inflammation was localized; there were some congested areas next to unaffected areas. Only the inflamed regions became labeled with anti-O2 antibody. TUNEL labeling revealed the presence of apoptotic cells at 12 h p.i in the inflamed regions only, and before any necrotic foci could be seen. The TUNEL-positive cells were very likely dying heterophils, as evidenced by the purulent inflammation. Some of the dying cells observed in avian lungs in situ may also be macrophages, since all four avian E. coli induced caspase 3/7 activation in monolayers of HD11 avian macrophages. In summary, both pathogenic and non-pathogenic fecal strains of avian E. coli produce focal infections in the avian lung, and these are accompanied by inflammation and cell death in the infected areas