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

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)

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

Outcomes for 18 to 25-year-olds with borderline personality disorder in a dedicated young adult only DBT programme compared to a general adult DBT programme for all ages 18

Aim Targeting young adults with borderline personality disorder (BPD) for treatment may carry significant social and clinical benefits. We aimed to evaluate a community‐based Dialectical Behaviour Therapy (DBT) programme delivered exclusively to young adults with BPD. Methods We describe a naturally occurring non‐equivalent, quasi‐experimental comparison of outcomes for young adults (18‐25 years) with BPD following 1 year of treatment in either a young adult only DBT programme or a general adult DBT programme (18+ years). Twenty‐four young adults enrolled in a community‐based young adult DBT programme open only to 18‐ to 25‐year‐olds with BPD. Another 13 young adults, also 18‐25 years, enrolled in a general adult DBT programme open to all ages above 18 years. Both treatment conditions offered all modes of standard DBT for 1 year. Participants completed a battery of self‐report measures on mental health symptoms at baseline and again at treatment completion after 1 year. Discharge rates at 2 years post‐treatment completion were also recorded. Results Better outcomes were found on borderline symptom severity and general psychopathology among completers of young adult DBT, with a large effect size for treatment condition as well as greater clinically significant change. Discharge rates from mental health services 24 months later were also higher for completers of young adult DBT. Conclusions There may be advantages in delivering DBT to young adults in an age‐specific programme, possibly due to group cohesion. Methodological limitations apply, such as small sample size and non‐randomization. Further controlled research is needed

Revisiting Gender Differences in Somatic Symptoms of Depression: Much Ado about Nothing?

Women have a higher prevalence of Major Depressive Disorder (MDD) and report more severe depressive symptoms than men. Several studies have suggested that gender differences in depression may occur because women report higher levels of somatic symptoms than men. Those studies, however, have not controlled or matched for non-somatic symptoms. The objective of this study was to examine if women report relatively more somatic symptoms than men matched on cognitive/affective symptoms.Male and female patients receiving treatment for MDD in outpatient psychiatric clinics in New Jersey and Pennsylvania, USA were matched on Beck Depression Inventory-II (BDI-II) cognitive/affective symptom scores. Male and female BDI-II somatic symptom scores were compared using independent samples 2-tailed t-tests.Of 472 male and 1,026 female patients, there were 470 male patients (mean age = 40.1 years, SD = 15.1) and 470 female patients (mean age = 43.1 years, SD = 17.2) successfully matched on BDI-II cognitive/affective symptom scores. Somatic symptoms accounted for 35% of total BDI-II scores for male patients versus 38% for matched female patients. Female patients had somatic symptom scores on average 1.3 points higher than males (p<.001), equivalent to 4% of the total BDI-II scores of female patients. Only 5% of male patients and 7% of female patients scored 2 or higher on all BDI-II somatic symptom items.Gender differences in somatic scores were very small. Thus, differences in the experience and reporting of somatic symptoms would not likely explain gender differences in depression rates and symptom severity