Nevin Manimala

Inflamm Bowel Dis. 2023 Oct 4:izad227. doi: 10.1093/ibd/izad227. Online ahead of print.

ABSTRACT

BACKGROUND: Very few risk factors for postoperative recurrence (POR) of Crohn’s Disease (CD) after ileocecal resection have been identified. The aim of the present study was to verify the association between an a priori defined list of intraoperative macroscopic findings and POR.

METHODS: This was a prospective observational study including patients undergoing primary ileocecal resection for CD. Four intraoperative factors were independently evaluated by 2 surgeons: length of resected ileum, mesentery thickness, presence of areas of serosal fat infiltration, or abnormal serosal vasodilation on normal bowel proximal to the resected bowel. The primary end point was early endoscopic POR at month 6 and defined as modified Rutgeerts score ≥i2b. Secondary end points were clinical and surgical recurrence.

RESULTS: Between September 2020 and November 2022, 83 consecutive patients were included. Early endoscopic recurrence occurred in 45 of 76 patients (59.2%). Clinical and biochemical recurrence occurred in 17.3% (95% confidence interval, [CI], 10.4%-28.0%) and 14.6% of the patients after 12 months. The risk of developing endoscopic and clinical recurrence was 1.127 (95% CI, 0.448;2.834, P = .799) and 0.896 (95% CI, 0.324-2.478, P = .832) when serosal fat infiltration was observed, and 1.388 (95% CI, 0.554-3.476, P = .484), and 1.153 (95% CI, 0.417;3.187, P = .783) when abnormal serosal vasodilation was observed. Similarly, length of the resected bowel and mesentery thickness showed no association with POR. A subgroup analysis on patients who received no postoperative medical prophylaxis did not identify any risk factor for endoscopic POR.

CONCLUSIONS: The macroscopic appearance of the bowel and associated mesentery during surgery does not seem to be predictive of POR after ileocecal resection for CD.

PMID:37793044 | DOI:10.1093/ibd/izad227

Psychiatriki. 2023 Sep 29. doi: 10.22365/jpsych.2023.023. Online ahead of print.

ABSTRACT

The COVID-19 pandemic has caused a mental health crisis. The purpose of this study was to estimate the prevalence of depression in medical students in Greece during a nationwide lockdown. The secondary aims were to assess the association of depression with socio-demographic factors and students’ attitudes regarding the quality of their studies. The data was gathered anonymously through a self-administered online questionnaire between January 11 and 27, 2021. The CES-D scale was used to measure depression rates. Multiple logistic regression was used to identify factors independently associated with depression. Analyses were conducted using Stata version 16.0 and the IBM® SPSS® software. In total, 978 sixth- and fifth-year medical students participated; their mean age was 23.2 years and 65.6% were females. The prevalence of clinical depression was 21.3% (95% CI: 18.7%, 24.0%), whereas 17.9% (95% CI: 15.5%, 20.4%) experienced severe distress. Depression was more prevalent in females (25.4% vs 13.1% in males, p<0.001). Approximately half (53.4%) of the participants reported a change in plans regarding their medical career due to the pandemic and 16.9% expressed a decreased willingness to practice medicine. Factors independently associated with depression were female gender, living alone or with housemates at high risk for COVID-19, being anxious about becoming infected with SARS-CoV-2, studying in one of the three largest medical schools, negatively evaluating the adjustment of the teaching personnel to online teaching and the university’s response to the pandemic. The findings of this study report depression in one out of five medical students during the COVID-19 pandemic, highlighting the need to protect the most vulnerable medical students during a pandemic. Medical students must be able to seek professional mental health services, even in the era of a pandemic. Universities should increase accessibility to support services and provide a student-centered approach in their strategies, as the pandemic has placed a spotlight on an existing phenomenon.

PMID:37793037 | DOI:10.22365/jpsych.2023.023

Psychiatriki. 2023 Sep 29. doi: 10.22365/jpsych.2023.022. Online ahead of print.

ABSTRACT

Despite its significant decline in the general population, smoking remains endemic and highly prevalent among people with mental disorders. The impact of smoking-attributable morbidity on life expectancy is significant since, in comparison to the general population, people with severe mental disorders have a 15-20-year reduction in life expectancy. A cross-sectional study was conducted among 1015 people with mental disorders through personal interviews. The questionnaire was designed to examine these patients’ knowledge, perceptions, and attitudes towards smoking. Individuals were recruited from the mental health residential community services, the outpatient department, and the inpatient facilities of the Psychiatric Hospital of Attica. Statistical analysis was performed using SPSS 26.0. In the sample analyzed, the current-smoking prevalence stood at 68.4% (n=643), while 12.3% reported being former smokers. A staggering 86.3% smoked their first cigarette within 30 minutes of waking up, indicating a high level of dependence. Most of the former smokers (83.6%) reported that their main reason for quitting smoking was to improve their health, and the overwhelming majority (97.4%) had done so using no smoking cessation aid. Although slightly over half of the participants (53.7%) believed that health professionals adequately inform smokers about the harmful health effects of tobacco products, the information provided by health professionals on smoking cessation programs and tobacco harm reduction alternatives was considered sufficient by a mere 11.2%. Multiple logistic regression analysis demonstrated that outpatients tended to have a greater likelihood of being current smokers as compared to inpatients (OR=1.45), while users of mental health residential community services showed a significantly lower likelihood of being current smokers in comparison to inpatients (OR=0.49). Additionally, it was found that women had a lower likelihood of being current smokers compared to men (OR=0.51), while divorced/ widowed participants had a greater likelihood of being current smokers compared to single ones (OR=1.93). Finally, multiple regression analysis indicated that participants with psychotic disorders displayed a 2.39 times greater likelihood of being current smokers compared to those with mood disorders (OR=2.39). Understanding the knowledge, beliefs, and attitudes of people with mental disorders towards tobacco is an essential first step to confronting this neglected epidemic.

PMID:37793036 | DOI:10.22365/jpsych.2023.022

J Chem Theory Comput. 2023 Oct 4. doi: 10.1021/acs.jctc.3c00571. Online ahead of print.

ABSTRACT

Most electrochemical reactions should be studied under a grand canonical ensemble condition with a constant potential and/or a constant pH value. Free energy profiles provide key insights into understanding the reaction mechanisms. However, many molecular dynamics (MD)-based theoretical studies for electrochemical reactions did not employ an exact grand canonical ensemble sampling scheme for the free energy calculations, partially due to the issues of discontinuous trajectories induced by the particle-number variations during MD simulations. An alternative statistical sampling approach, the Monte Carlo (MC) method, is naturally appropriate for the open-system simulations if we focus on the thermodynamic properties. An advanced MC scheme, the hybrid Monte Carlo (HMC) method, which can efficiently sample the configurations of a system with large degrees of freedom, however, has limitations in the constrained-sampling applications. In this work, we propose an adjusted constrained HMC method to compute free energy profiles using the thermodynamic integration (TI) method. The key idea of the method for handling the constraint in TI is to integrate the reaction coordinate and sample the rest degrees of freedom by two types of MC schemes, the HMC scheme and the Metropolis algorithm with unbiased trials (M(RT)²-UB). We test the proposed method on three different systems involving two kinds of reaction coordinates, which are the distance between two particles and the difference of particles’ distances, and compare the results to those generated by the constrained M(RT)²-UB method serving as benchmarks. We show that our proposed method has the advantages of high sampling efficiency and convenience of implementation, and the accuracy is justified as well. In addition, we show in the third test system that the proposed constrained HMC method can be combined with the path integral method to consider the nuclear quantum effects, indicating a broader application scenario of the sampling method reported in this work.

PMID:37793028 | DOI:10.1021/acs.jctc.3c00571

J Phys Chem A. 2023 Oct 4. doi: 10.1021/acs.jpca.3c04993. Online ahead of print.

ABSTRACT

In the present work, a new statistical theory is developed to describe adsorption and desorption in mesoporous materials (pore sizes ranging from 2 to 50 nm) represented by pore networks in the form of Bethe lattices. The new theory is an extension of a previous theory applied for Statistically Disordered Chain Model (SDCM) structures and incorporates the cooperative effects emerging during phase transitions in pore networks. The theory is validated against simulations and algorithmic models that describe sorption of lattice and real fluids in Bethe lattices. It is seen that the pore network coordination number, or pore connectivity, z, has a significant impact on two important processes observed in pore networks: pore assisting condensation during adsorption and evaporation by percolation during desorption. The inclusion of pore connectivity in the earlier developed framework accounting for cooperativity effects is an important step, rendering the existing models to mimic fluid behavior in real materials more accurately. Hence, the new theory inherently contains all essential elements that may offer the extraction of more reliable pore size distributions utilizing both the adsorption and desorption branches of the isotherm.

PMID:37793009 | DOI:10.1021/acs.jpca.3c04993

J Chin Med Assoc. 2023 Oct 4. doi: 10.1097/JCMA.0000000000001006. Online ahead of print.

ABSTRACT

BACKGROUND: Endometrial cancer is the most common gynecological cancer in developed countries. With recent advances in equipment and knowledge, minimally invasive surgery (MIS) is widely accepted for the treatment of endometrial cancer. This study had the largest number of cases to date in Taiwan, comparing outcomes between MIS and laparotomy staging surgery using real-world data with long-term follow up.

METHODS: We retrospectively reviewed patients with clinical stage 1 endometrial cancer from 2009 to 2020 in our institute. All patients underwent comprehensive surgical staging procedures by MIS or laparotomy. The safety, morbidity, progression-free survival, and overall survival rates of the two groups were compared. Clinical and pathologic factors were compared with Chi-square and Fisher’s Exact Test. Progression-free (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Differences between survival curves were analyzed using the log-rank test. A p-value less than 0.05 was considered statistically significant. Using Cox proportional hazards models, all factors found to be significantly associated with risk of recurrence on univariate analyses were then assessed together through multivariable models, resulting in a final oncologic outcome between MIS and laparotomy.

RESULTS: 665 cases (412 cases in MIS group and 253 cases in laparotomy group) were enrolled for data analysis. Median operation time was shorter in MIS group (244 and 265 minutes, p<0.001). Median blood loss was also less (75 and 430 mL, p<0.001). Median postoperative hospitalization duration was longer in the laparotomy group (2 and 7 days, p=0.001). After adjusting pre-surgery risk factors, the PFS and OS were no significant difference in MIS and laparotomy groups.

CONCLUSION: Using real-world data with long-term follow up, we could confirm excellent PFS and OS in selective patients with clinical stage 1 endometrial carcinoma who received MIS, and the surgical time, hospital day and blood loss were also less.

PMID:37792993 | DOI:10.1097/JCMA.0000000000001006

Sci Adv. 2023 Oct 6;9(40):eadh0761. doi: 10.1126/sciadv.adh0761. Epub 2023 Oct 4.

ABSTRACT

Laboratory evidence suggests a possibility of immune imprinting for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the differences in the incidence of SARS-CoV-2 reinfection in a cohort of persons who had a primary Omicron infection, but different vaccination histories using matched, national, retrospective, cohort studies. Adjusted hazard ratio for reinfection incidence, factoring adjustment for differences in testing rate, was 0.43 [95% confidence interval (CI): 0.39 to 0.49] comparing history of two-dose vaccination to no vaccination, 1.47 (95% CI: 1.23 to 1.76) comparing history of three-dose vaccination to two-dose vaccination, and 0.57 (95% CI: 0.48 to 0.68) comparing history of three-dose vaccination to no vaccination. Divergence in cumulative incidence curves increased markedly when the incidence was dominated by BA.4/BA.5 and BA.2.75* Omicron subvariants. The history of primary-series vaccination enhanced immune protection against Omicron reinfection, but history of booster vaccination compromised protection against Omicron reinfection. These findings do not undermine the public health utility of booster vaccination.

PMID:37792951 | DOI:10.1126/sciadv.adh0761

Sci Adv. 2023 Oct 6;9(40):eadd9973. doi: 10.1126/sciadv.add9973. Epub 2023 Oct 4.

ABSTRACT

The Amazon rainforest is threatened by land-use change and increasing drought and fire frequency. Studies suggest an abrupt dieback of large parts of the rainforest after partial forest loss, but the critical threshold, underlying mechanisms, and possible impacts of forest degradation on the monsoon circulation remain uncertain. Here, we use a nonlinear dynamical model of the moisture transport and recycling across the Amazon to identify several precursor signals for a critical transition in the coupled atmosphere-vegetation dynamics. Guided by our simulations, we reveal both statistical and physical precursor signals of an approaching critical transition in reanalysis and observational data. In accordance with our model results, we attribute these characteristic precursor signals to the nearing of a critical transition of the coupled Amazon atmosphere-vegetation system induced by forest loss due to deforestation, droughts, and fires. The transition would lead to substantially drier conditions, under which the rainforest could likely not be maintained.

PMID:37792950 | DOI:10.1126/sciadv.add9973

Sci Adv. 2023 Oct 6;9(40):eadk5668. doi: 10.1126/sciadv.adk5668. Epub 2023 Oct 4.

ABSTRACT

People with booster vaccinations appear more prone to reinfection than those with primary series vaccination only; however, selection bias in the study design complicates interpretation.

PMID:37792936 | DOI:10.1126/sciadv.adk5668

J Child Psychol Psychiatry. 2023 Oct 4. doi: 10.1111/jcpp.13895. Online ahead of print.

ABSTRACT

BACKGROUND: Stress is a universal phenomenon and one of the most common precipitants of insomnia. However, not everyone develops insomnia after experiencing a stressful life event. This study aims to test aspects of Spielman’s ‘3P model of insomnia’ (during adolescence) by exploring the extent to which: (a) insomnia symptoms are predicted by polygenic scores (PGS); (b) life events predict insomnia symptoms; (c) the interaction between PGS and life events contribute to the prediction of insomnia symptoms; (d) gene-environment interaction effects remain after controlling for sex.

METHODS: The sample comprised 4,629 twins aged 16 from the Twin Early Development Study who reported on their insomnia symptoms and life events. PGS for insomnia were calculated. In order to test the main hypothesis of this study (a significant interaction between PGS and negative life events), we fitted a series of mixed effect regressions.

RESULTS: The best fit was provided by the model including sex, PGS for insomnia, negative life events, and their interactions (AIC = 26,158.7). Our results show that the association between insomnia symptoms and negative life events is stronger for those with a higher genetic risk for insomnia.

CONCLUSIONS: This work sheds light on the complex relationship between genetic and environmental factors implicated for insomnia. This study has tested for the first time the interaction between genetic predisposition (PGS) for insomnia and environmental stressors (negative life events) in adolescents. This work represents a direct test of components of Spielman’s 3P model for insomnia which is supported by our results.

PMID:37792459 | DOI:10.1111/jcpp.13895