Antioxidant Supplements and Oxidative Stress: The debate extends to the Middle East

Editoria

Integrating Technical and Nontechnical Skills in Hands-On Surgical Training

Safe and effective surgery requires high-quality technical and nontechnical skills. Although the importance of nontechnical skills has become increasingly clear, today’s surgical curricula still lack formal training in nontechnical skills. In this chapter, we discuss how to integrate technical and nontechnical skills training into surgical curricula and provide strategies on how to teach both skill sets concurrently in a hands-on setting

Clinical Value of Multiomics-Based Biomarker Signatures in Inflammatory Bowel Diseases:Challenges and Opportunities

Inflammatory bowel diseases (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), are complex and heterogeneous diseases characterized by a multifactorial etiology, therefore demanding a multimodal approach to disentangle the main pathophysiological components driving disease onset and progression. Adoption of a systems biology approach is increasingly advocated with the advent of multi-omics profiling technologies, aiming to improve disease classification, to identify disease biomarkers and to accelerate drug discovery for patients with IBD. However, clinical translation of multi-omics-derived biomarker signatures is lagging behind, since there are several obstacles that need to be addressed in order to realize clinically useful signatures. Multi-omics integration and IBD-specific identification of molecular networks, standardization and clearly defined outcomes, strategies to tackle cohort heterogeneity, and external validation of multi-omics-based signatures are critical aspects. While striving for personalized medicine in IBD, careful consideration of these aspects is however needed to adequately match biomarker targets (e.g. the gut microbiome, immunity or oxidative stress) with their corresponding utilities (e.g. early disease detection, endoscopic and clinical outcome). Theory-driven disease classifications and predictions are still governing clinical practice, while this could be improved by adopting an unbiased, data-driven approach relying on molecular data structures integrated with patient and disease characteristics. In the foreseeable future, the main challenge will lie in the complexity and impracticality of implementing multi-omics-based signatures into clinical practice. Still, this could be achieved by developing easy-to-use, robust and cost-effective tools incorporating omics-derived predictive signatures and through the design and execution of prospective, longitudinal, biomarker-stratified clinical trials

The Role of Gasotransmitters in Gut Peptide Actions

Although gasotransmitters nitric oxide (NO), carbon monoxide (CO) and hydrogen sulfide (H(2)S) receive a bad connotation; in low concentrations these play a major governing role in local and systemic blood flow, stomach acid release, smooth muscles relaxations, anti-inflammatory behavior, protective effect and more. Many of these physiological processes are upstream regulated by gut peptides, for instance gastrin, cholecystokinin, secretin, motilin, ghrelin, glucagon-like peptide 1 and 2. The relationship between gasotransmitters and gut hormones is poorly understood. In this review, we discuss the role of NO, CO and H(2)S on gut peptide release and functioning, and whether manipulation by gasotransmitter substrates or specific blockers leads to physiological alterations

Association Between Serum Carnosinase Concentration and Activity and Renal Function Impairment in a Type-2 Diabetes Cohort

Introduction: Genetic studies have identified associations of carnosinase 1 (CN1) polymorphisms with diabetic kidney disease (DKD). However, CN1 levels and activities have not been assessed as diagnostic or prognostic markers of DKD in cohorts of patients with type 2 diabetes (T2D).Methods: We established high-throughput, automated CN1 activity and concentration assays using robotic systems. Using these methods, we determined baseline serum CN1 levels and activity in a T2D cohort with 970 patients with no or only mild renal impairment. The patients were followed for a mean of 1.2 years. Baseline serum CN1 concentration and activity were assessed as predictors of renal function impairment and incident albuminuria during follow up.Results: CN1 concentration was significantly associated with age, gender and estimated glomerular filtration rate (eGFR) at baseline. CN1 activity was significantly associated with glycated hemoglobin A1c (HbA1c) and eGFR. Serum CN1 at baseline was associated with eGFR decline and predicted renal function impairment and incident albuminuria during the follow-up.Discussion: Baseline serum CN1 levels were associated with presence and progression of renal function decline in a cohort of T2D patients. Confirmation in larger cohorts with longer follow-up observation periods will be required to fully establish CN1 as a biomarker of DKD

Systemic oxidative stress and antioxidant capacity in cancer patients

Various factors impact the outcome of patients with the diagnosis of cancer. Common treatment modalities of cancer, including surgery, radiation therapy and cytostatic agents, all lead to a systemic inflammatory reaction. In particular, this reaction is of physiological importance as it is crucial for patient recovery. However, in some patients, a self-perpetuating inflammatory response develops due to the presence of unfavorable risk factors, several of which are still unknown, but might lead to a worse disease prognosis. Inflammation has been intimately associated with oxidative stress, that is characterized by an imbalance between pro-oxidants, also termed reactive species, and antioxidants. Systemically, oxidative stress can be quantified by measuring thiols (R-SH, sulfhydryl compounds), which are considered to be regulatory nodes within the extracellular antioxidant network. Most importantly, thiol measurements in serum or plasma form a robust and powerful read-out of the in vivo reduction-oxidation (redox) status as thiols are highly redox-active and thus readily oxidized by circulating reactive species. Therefore, systemic quantification of thiols might be a valuable addition to the clinically available diagnostic and prognostic armamentarium as it is able to reliably capture the overall balance between oxidants and the antioxidant capacity of patients. In this review, we summarized the currently available literature on thiol levels as amendable markers for oxidative stress in patients with lung, prostate and colorectal cancer. Total thiols, native (free) thiols and disulfide levels are significantly altered in these patients compared to healthy individuals. In general, these findings indicate that the extracellular antioxidant capacity is severely affected in patients with these types of cancer. Moreover, lower thiol levels are associated with a lowered overall survival. Future research should focus on exploration of the clinical significance of thiols in cancer

Adhesive Small Bowel Obstruction in the Minimally Invasive Era

Roughly 60% of all cases of small bowel obstruction are caused by adhesions. Adhesions are a form of internal scar tissue, which develop in over 45–93% of patients who undergo abdominal surgery. With this relatively high incidence, the population at risk for adhesive small bowel obstruction (ASBO) is enormous. Minimally invasive surgery reduces surgical wound surface and thus holds promise to reduce adhesion formation. The use of minimally invasive techniques results in a 50% reduction of adhesion formation as compared to open surgery. However, since ASBO can be caused by just a single adhesive band, it is uncertain whether a reduction in adhesion formation will also lead to a proportional decrease in the incidence of ASBO. Minimally invasive surgery might also improve operative treatment of ASBO, accelerating gastro-intestinal recovery time and lowering the risk of recurrent ASBO associated with adhesion reformation. We will discuss recent evidence on the impact of minimally invasive surgery on the incidence of ASBO and the role of minimally invasive surgery to resolve ASBO. Finally, we will debate additional measures, such as the use of adhesion barriers, to prevent adhesion formation and adhesion-related morbidity in the minimally invasive era