A novelty in laparoscopic total colectomy with natural orifice specimen extraction using a plastic cover Uma novidade na colectomia total laparoscópica com extração de espécime em orifício natural usando uma cobertura plastic

Introduction: Minimally invasive colectomy has been performed for some years for many patients worldwide without much complications compared to the open approach. In this study we explained our experience regarding a modification in laparoscopic total colectomy and removing the specimen with Natural Orifice Specimen Extraction (NOSE) through rectum using a plastic cover for the first time. Methods and material: This was an experimental study on a new technique of total colectomy with a small modification. Total colectomy was performed based on 7 port laparoscopic approach. Rectum was sparred. Colon was then taken out through the anal canal using a plastic cover. Results: Thirteen patients underwent laparoscopic total colectomy by removal of the specimen through rectum. Mean age of patients was 42.23 ± 8.15 years. Mean duration of operation was 130 ± 32.4 min. All patients had an uneventful postoperative hospitalization. Discussion: Laparoscopic total colectomy has been proven to have superior benefits than the open approach. In NOSE technique, colon is removed from the anal canal without any complication or consuming much time. This technique might have less pain and removes the complications associated with an incision on the skin to remove the specimen. Also, due to low price of a usual plastic cover, it can be used instead of other techniques to remove the specimen through the rectum. © 2020 Sociedade Brasileira de Coloproctologi

The diagnosis of early fetal cardiac changes of the gestational diabetic mothers: Presenting the preload index

Objectives: To evaluate fetal cardiac changes in gestational diabetic mothers, compared to healthy ones by means of different indices and to determine which index can first represent the alterations. Methods: The study was conducted as an observational cross-sectional study, including 25 pregnant women with gestational diabetes as the cases and 50 healthy pregnant women as the controls. The preload index, left and right side myocardial performance index (MPI), Interventricular septal hypertrophy, the left and right side cardiac output were assessed in all the patients. Results: The gestational ages were 31.65 ± 8.02 and 31.64 ± 5.37 weeks in case and control group respectively, without any significant difference. Both of the left and right ventricular MPI did not differ statistically between the case and controls. The cases had a greater Interventricular septal hypertrophy but the cardiac output was similar. The preload index was higher in the fetuses of the gestational diabetic mothers. Conclusions: In our study, the MPI did not show any difference between the fetuses of the gestational diabetic mothers and non-diabetic ones; but, fetuses of gestational diabetic mothers had a greater value of PLI, representing early diastolic function changes in right heart even before the overt heart failure occurred. This could be a sign of vasculopathy in gestational diabetic mothers. Copyright © 2019, Author(s)

Puckering behavior in six new phosphoric triamides containing aliphatic six- and seven-membered ring groups and a database survey of analogous ring-containing structures

The influence of a N heteroatom on the ring conformations of six- and seven- membered aliphatic rings in six new C(O)NHP(O)-based phosphoric triamide structures (analysed by X-ray crystallography) is investigated. Additionally the influence of steric and crystal packing effects is also studied by the analysis of Hirshfeld surfaces. The results are compared to analogous structures with three- to seven- aliphatic membered rings deposited in the Cambridge Structural Database. In the newly determined structures, the six-membered rings only show the near-chair conformation with a maximum deviation of the θ puckering parameter of 4.4° from the ideal chair value of 0°/180°, while the seven-membered rings are found in different conformations such as near-chair, twist chair and twist sofa

Current state of cannabis use, policies, and research across sixteen countries : cross-country comparisons and international perspectives

INTRODUCTION : Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. METHODS : PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., “Iran”), as well as relevant predefined keywords such as “cannabis,” “marijuana,” “hashish,” “bhang “dual diagnosis,” “use,” “addiction,” “prevalence,” “co-morbidity,” “substance use disorder,” “legalization” or “policy” (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies’ titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. RESULTS : The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). CONCLUSIONS : Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.The Indian Council of Medical Research.https://www.scielo.br/j/trendsam2023Family Medicin

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

A Review and Classification of Approaches for Dealing with Uncertainty in Multi-Criteria Decision Analysis for Healthcare Decisions

The Author(s) 2015. This article is published with open access at Springerlink.com Abstract Multi-criteria decision analysis (MCDA) is increasingly used to support decisions in healthcare involving multiple and conflicting criteria. Although uncertainty is usually carefully addressed in health eco-nomic evaluations, whether and how the different sources of uncertainty are dealt with and with what methods in MCDA is less known. The objective of this study is to review how uncertainty can be explicitly taken into account in MCDA and to discuss which approach may be appro-priate for healthcare decision makers. A literature review was conducted in the Scopus and PubMed databases. Two reviewers independently categorized studies according to research areas, the type of MCDA used, and the approach used to quantify uncertainty. Selected full text articles wer

T‌H‌E A‌S‌S‌E‌S‌S‌M‌E‌N‌T O‌F S‌P‌A‌C‌I‌N‌G A‌N‌D S‌O‌I‌L S‌O‌L‌I‌D‌I‌T‌Y I‌N‌F‌L‌U‌E‌N‌C‌E I‌N M‌U‌L‌T‌I‌P‌L‌E S‌T‌R‌U‌C‌T‌U‌R‌E-S‌O‌I‌L-\\S‌T‌R‌U‌C‌T‌U‌R‌E I‌N‌T‌E‌R‌A‌C‌T‌I‌O‌N‌S I‌N H‌I‌G‌H-R‌I‌S‌E B‌U‌I‌L‌D‌I‌N‌G‌S

S‌i‌m‌u‌l‌t‌a‌n‌e‌o‌u‌s e‌f‌f‌e‌c‌t‌s o‌f s‌o‌i‌l a‌n‌d s‌e‌v‌e‌r‌a‌l s‌t‌r‌u‌c‌t‌u‌r‌e‌s a‌r‌e k‌n‌o‌w‌n a‌s t‌h‌e s‌i‌t‌e-c‌i‌t‌y i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n (s‌t‌r‌u‌c‌t‌u‌r‌e-s‌o‌i‌l-s‌t‌r‌u‌c‌t‌u‌r‌e i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n), w‌h‌i‌c‌h i‌s v‌e‌r‌y i‌m‌p‌o‌r‌t‌a‌n‌t i‌n a‌r‌e‌a‌s w‌i‌t‌h h‌i‌g‌h c‌o‌n‌s‌t‌r‌u‌c‌t‌i‌o‌n d‌e‌n‌s‌i‌t‌y a‌n‌d h‌a‌s b‌e‌e‌n c‌o‌n‌s‌i‌d‌e‌r‌e‌d b‌y m‌a‌n‌y s‌c‌h‌o‌l‌a‌r‌s o‌v‌e‌r t‌h‌e p‌a‌s‌t t‌w‌o d‌e‌c‌a‌d‌e‌s. S‌i‌t‌e-c‌i‌t‌y i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n c‌a‌n a‌f‌f‌e‌c‌t t‌h‌e s‌t‌r‌u‌c‌t‌u‌r‌e b‌e‌h‌a‌v‌i‌o‌r d‌u‌e t‌o t‌h‌e w‌a‌v‌e p‌r‌o‌p‌a‌g‌a‌t‌i‌o‌n b‌e‌t‌w‌e‌e‌n s‌t‌r‌u‌c‌t‌u‌r‌e‌s. I‌n f‌a‌c‌t, i‌t d‌e‌c‌r‌e‌a‌s‌e‌s t‌h‌e s‌t‌r‌u‌c‌t‌u‌r‌e r‌e‌s‌p‌o‌n‌s‌e‌s i‌n s‌o‌m‌e c‌a‌s‌e‌s, w‌h‌i‌l‌e i‌t i‌n‌c‌r‌e‌a‌s‌e‌s t‌h‌e r‌e‌s‌p‌o‌n‌s‌e‌s i‌n s‌o‌m‌e o‌t‌h‌e‌r c‌a‌s‌e‌s. M‌a‌n‌y p‌a‌r‌a‌m‌e‌t‌e‌r‌s p‌l‌a‌y a r‌o‌l‌e i‌n a‌s‌s‌e‌s‌s‌i‌n‌g s‌i‌t‌e-c‌i‌t‌y i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n s‌u‌c‌h a‌s t‌h‌e g‌e‌n‌d‌e‌r o‌f s‌o‌i‌l, n‌u‌m‌b‌e‌r a‌n‌d a‌r‌r‌a‌n‌g‌e‌m‌e‌n‌t o‌f s‌t‌r‌u‌c‌t‌u‌r‌e‌s, h‌e‌i‌g‌h‌t o‌f b‌u‌i‌l‌d‌i‌n‌g‌s, s‌h‌a‌p‌e o‌f e‌a‌r‌t‌h‌q‌u‌a‌k‌e w‌a‌v‌e‌s, a‌n‌d t‌h‌e m‌a‌i‌n p‌e‌r‌i‌o‌d o‌f s‌t‌r‌u‌c‌t‌u‌r‌e‌s a‌n‌d s‌o‌i‌l. T‌h‌e p‌r‌e‌s‌e‌n‌t s‌t‌u‌d‌y a‌i‌m‌e‌d t‌o e‌v‌a‌l‌u‌a‌t‌e t‌h‌e e‌f‌f‌e‌c‌t‌s o‌f g‌e‌n‌d‌e‌r a‌n‌d s‌o‌l‌i‌d‌i‌t‌y o‌f t‌h‌e s‌o‌i‌l b‌a‌s‌e‌d o‌n 2800 s‌t‌a‌n‌d‌a‌r‌d‌s a‌n‌d b‌u‌i‌l‌d‌i‌n‌g d‌i‌s‌t‌a‌n‌c‌e‌s i‌n s‌i‌t‌e-c‌i‌t‌y i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n i‌n t‌h‌r‌e‌e d‌i‌m‌e‌n‌s‌i‌o‌n‌s. T‌h‌e e‌f‌f‌e‌c‌t‌s o‌f t‌h‌e‌s‌e p‌a‌r‌a‌m‌e‌t‌e‌r‌s o‌n t‌h‌e f‌o‌u‌n‌d‌a‌t‌i‌o‌n a‌n‌d t‌o‌p o‌f s‌t‌r‌u‌c‌t‌u‌r‌e r‌e‌s‌p‌o‌n‌s‌e‌s i‌n‌c‌l‌u‌d‌i‌n‌g m‌a‌x‌i‌m‌u‌m a‌c‌c‌e‌l‌e‌r‌a‌t‌i‌o‌n v‌a‌l‌u‌e‌s a‌n‌d R‌o‌o‌t M‌e‌a‌n S‌q‌u‌a‌r‌e a‌c‌c‌e‌l‌e‌r‌a‌t‌i‌o‌n w‌e‌r‌e a‌s‌s‌e‌s‌s‌e‌d. S‌A‌S‌S‌I 2000 s‌o‌f‌t‌w‌a‌r‌e w‌a‌s e‌m‌p‌l‌o‌y‌e‌d t‌o m‌o‌d‌e‌l s‌t‌r‌u‌c‌t‌u‌r‌e‌s a‌n‌d s‌o‌i‌l a‌n‌d a‌n‌a‌l‌y‌z‌e t‌h‌e s‌y‌s‌t‌e‌m. I‌n t‌h‌i‌s s‌t‌u‌d‌y, s‌t‌r‌u‌c‌t‌u‌r‌a‌l m‌o‌d‌e‌l‌s w‌e‌r‌e c‌o‌n‌s‌i‌d‌e‌r‌e‌d i‌n b‌o‌t‌h s‌i‌n‌g‌l‌e s‌t‌r‌u‌c‌t‌u‌r‌e a‌n‌d t‌h‌e i‌d‌e‌a‌l c‌i‌t‌y (s‌t‌r‌u‌c‌t‌u‌r‌a‌l g‌r‌o‌u‌p‌s). T‌h‌e g‌r‌o‌u‌p‌s w‌e‌r‌e 3\t‌i‌m‌e‌s 3 i‌n‌c‌l‌u‌d‌i‌n‌g n‌i‌n‌e i‌d‌e‌n‌t‌i‌c‌a‌l s‌t‌r‌u‌c‌t‌u‌r‌e‌s. I‌n t‌h‌e s‌i‌n‌g‌l‌e m‌o‌d‌e‌l, t‌h‌e s‌i‌t‌e-c‌i‌t‌y i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n w‌a‌s n‌o‌t c‌o‌n‌s‌i‌d‌e‌r‌e‌d, a‌n‌d t‌h‌e‌s‌e e‌f‌f‌e‌c‌t‌s w‌e‌r‌e c‌o‌n‌s‌i‌d‌e‌r‌e‌d i‌n t‌h‌e g‌r‌o‌u‌p m‌o‌d‌e‌l. L‌u‌m‌p‌e‌d-M‌a‌s‌s S‌t‌i‌c‌k M‌o‌d‌e‌l w‌a‌s u‌s‌e‌d t‌o m‌o‌d‌e‌l e‌a‌c‌h s‌t‌r‌u‌c‌t‌u‌r‌e a‌n‌d t‌h‌e s‌o‌i‌l, w‌h‌i‌c‌h w‌a‌s m‌o‌d‌e‌l‌e‌d i‌n t‌h‌e s‌o‌f‌t‌w‌a‌r‌e i‌n‌c‌l‌u‌d‌i‌n‌g a s‌e‌m‌i-i‌n‌f‌i‌n‌i‌t‌e e‌l‌a‌s‌t‌i‌c e‌n‌v‌i‌r‌o‌n‌m‌e‌n‌t w‌i‌t‌h h‌o‌r‌i‌z‌o‌n‌t‌a‌l l‌a‌y‌e‌r‌i‌n‌g, l‌o‌c‌a‌t‌e‌d o‌n t‌h‌e v‌i‌s‌c‌o‌e‌l‌a‌s‌t‌i‌c h‌a‌l‌f-i‌n‌f‌i‌n‌i‌t‌e‌l‌y s‌e‌m‌i-s‌p‌a‌c‌e. B‌a‌s‌e‌d o‌n t‌h‌e r‌e‌s‌u‌l‌t‌s, r‌e‌g‌a‌r‌d‌i‌n‌g t‌h‌e t‌o‌p o‌f s‌t‌r‌u‌c‌t‌u‌r‌e, t‌h‌e e‌x‌i‌s‌t‌e‌n‌c‌e o‌f s‌t‌r‌u‌c‌t‌u‌r‌e‌s a‌l‌o‌n‌g‌s‌i‌d‌e e‌a‌c‌h o‌t‌h‌e‌r b‌y c‌o‌n‌s‌i‌d‌e‌r‌i‌n‌g s‌i‌t‌e-c‌i‌t‌y i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n e‌f‌f‌e‌c‌t‌s i‌n d‌i‌f‌f‌e‌r‌e‌n‌t s‌o‌i‌l‌s r‌e‌s‌u‌l‌t‌e‌d i‌n d‌e‌c‌r‌e‌a‌s‌i‌n‌g t‌h‌e s‌t‌r‌u‌c‌t‌u‌r‌a‌l a‌c‌c‌e‌l‌e‌r‌a‌t‌i‌o‌n r‌e‌s‌p‌o‌n‌s‌e‌s (25\% a‌v‌e‌r‌a‌g‌e) c‌o‌m‌p‌a‌r‌e‌d t‌o t‌h‌e i‌n‌d‌i‌v‌i‌d‌u‌a‌l s‌t‌r‌u‌c‌t‌u‌r‌e s‌i‌t‌e-c‌i‌t‌y i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n e‌f‌f‌e‌c‌t‌s, w‌h‌i‌c‌h i‌n‌c‌r‌e‌a‌s‌e‌d b‌y d‌e‌c‌r‌e‌a‌s‌i‌n‌g t‌h‌e s‌o‌i‌l s‌t‌i‌f‌f‌n‌e‌s‌s (5-10\% a‌v‌e‌r‌a‌g‌e). F‌u‌r‌t‌h‌e‌r, t‌h‌e e‌f‌f‌e‌c‌t‌s o‌f m‌u‌l‌t‌i‌p‌l‌e s‌t‌r‌u‌c‌t‌u‌r‌e-s‌o‌i‌l-s‌t‌r‌u‌c‌t‌u‌r‌e i‌n‌t‌e‌r‌a‌c‌t‌i‌o‌n d‌e‌c‌r‌e‌a‌s‌e‌d (10-15\% a‌v‌e‌r‌a‌g‌e) b‌y i‌n‌c‌r‌e‌a‌s‌i‌n‌g t‌h‌e d‌i‌s‌t‌a‌n‌c‌e b‌e‌t‌w‌e‌e‌n s‌t‌r‌u‌c‌t‌u‌r‌e‌s

The Impact of Mindfulness-Based Stress Reduction on Emotional Wellbeing and Glycemic Control of Patients with Type 2 Diabetes Mellitus

Objective. The aim of the study was to determine the effect of mindfulness-based stress reduction (MBSR) intervention on emotion regulation and glycemic control of patients with type 2 diabetes. Materials and Methods. Sixty patients with type 2 diabetes were recruited for this randomized controlled trial from an outpatient clinic at Imam Hospital in Iran. The intervention group participated in 8 sessions of MBSR, and the control group continued the treatment as usual. Fasting blood sugar and HbA1c were measured as two indices of glycemic control. Overall mental health, depression, and anxiety were measured using the General Health Questionnaire (GHQ-28), Hamilton Depression Rating Scale (HDRS), and Hamilton Anxiety Rating Scale (HARS), respectively. All the assessments were performed at baseline and after 8 weeks and 3 months as follow-up. Results. In comparison with the control group, the MBSR intervention group showed a significant reduction on all outcome measures including FBS, HbA1C, HARS, and HDRS scores (p<0/05). Conclusion. MBSR had a remarkable improvement on emotional wellbeing and glycemic control of patients with type 2 diabetes