Introduction: Coronavirus disease 2019 (COVID-19) results from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). it is now a pandemic that affects us all. For patients referring to the ...addiction care systems, this pandemic can create additional vulnerabilities. A great deal of effort has made to re-organize the care systems for patients with addiction. Our study focuses on the voice of our patients, on clues to adapt treatment, and on the impact of the pandemic on the therapeutic alliance. Methods: A qualitative design was used to develop a description and understanding of general and clinically relevant aspects of the impact of the COVID-19 pandemic. Fifteen addicted patients (11 under treatment and 4 in recovery) were interviewed by 4 interviewers according to the COREQ (consolidated criteria for reporting qualitative research). Results: COVID-19 has had a serious impact on thoughts, feelings, and behaviors. Interviewees shared their anxieties about their health and the health of their relatives. Frightening thoughts were associated with a range of negative feelings and behaviors, such as stress, anger, avoidance, and isolation. The use of psychoactive substances differed between the patients in treatment with those who are in stable recovery. In the former, all succeeded in staying abstinent. They have experienced that solidarity and connectedness were essential in sustaining their recovery. Those still in treatment were fighting against the temptation to start using again; they felt emotionally isolated and sometimes patronized by health care workers. Conclusion: The elaboration of the interviewees on the therapeutic relationship provides promising clues to optimize that relationship. Remembering this common expression, “we are all in this together,” shared decision making could very well be used to shape effective and receptive treatment interventions during the different challenges faced at different stages of the COVID-19 epidemic.
Background
Cancer cachexia and skeletal muscle wasting are related to poor survival. In this study, quantitative body composition measurements using computed tomography (CT) were investigated in ...relation to survival, post‐operative complications, and surgical site infections in surgical patients with cancer of the head of the pancreas.
Methods
A prospective cohort of 199 patients with cancer of the head of the pancreas was analysed by CT imaging at the L3 level to determine (i) muscle radiation attenuation (average Hounsfield units of total L3 skeletal muscle); (ii) visceral adipose tissue area; (iii) subcutaneous adipose tissue area; (iv) intermuscular adipose tissue area; and (v) skeletal muscle area. Sex‐specific cut‐offs were determined at the lower tertile for muscle radiation attenuation and skeletal muscle area and the higher tertile for adipose tissues. These variables of body composition were related to overall survival, severe post‐operative complications (Dindo–Clavien ≥ 3), and surgical site infections (wounds inspected daily by an independent trial nurse) using Cox‐regression analysis and multivariable logistic regression analysis, respectively.
Results
Low muscle radiation attenuation was associated with shorter survival in comparison with moderate and high muscle radiation attenuation median survival 10.8 (95% CI: 8.8–12.8) vs. 17.4 (95% CI: 14.7–20.1), and 18.5 (95% CI: 9.2–27.8) months, respectively; P < 0.008. Patient subgroups with high muscle radiation attenuation combined with either low visceral adipose tissue or age <70 years had longer survival than other subgroups (P = 0.011 and P = 0.001, respectively). Muscle radiation attenuation was inversely correlated with intermuscular adipose tissue (rp = −0.697, P < 0.001). High visceral adipose tissue was associated with an increased surgical site infection rate, OR: 2.4 (95% CI: 1.1–5.3; P = 0.027).
Conclusions
Low muscle radiation attenuation was associated with reduced survival, and high visceral adiposity was associated with an increase in surgical site infections. The strong correlation between muscle radiation attenuation and intermuscular adipose tissue suggests the presence of ectopic fat in muscle, warranting further investigation. CT image analysis could be implemented in pre‐operative risk assessment to assist in treatment decision‐making.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Aim The purpose of this multicenter cohort study was to evaluate whether a differentiated treatment of primary rectal cancer based on magnetic resonance imaging (MRI) can reduce the number ...of incomplete resections and local recurrences and improve recurrence-free and overall survival. Methods From February 2003 until January 2008, 296 patients with rectal cancer underwent preoperative MRI using a lymph node specific contrast agent to predict circumferential resection margin (CRM), T- and N-stage. Based on expert reading of the MRI, patients were stratified in: (a) low risk for local recurrence (CRM > 2 mm and N0 status), (b) intermediate risk and (c) high risk (close/involved CRM, N2 status or distal tumours). Mainly based on this MRI risk assessment patients were treated with (a) surgery only (TME or local excision), (b) preoperative 5 × 5 Gy + TME and (c) a long course of chemoradiation therapy followed by surgery after a 6–8 week interval. Results Overall 228 patients underwent treatment with curative intent: 49 with surgery only, 86 with 5 × 5 Gy and surgery and 93 with chemoradiation and surgery. The number of complete resections (margin > 1 mm) was 218 (95.6%). At a median follow-up of 41 months the three-year local recurrence rate, disease-free survival rate and overall survival rate is 2.2%, 80% and 84.5%, respectively. Conclusion With a differentiated multimodality treatment based on dedicated preoperative MR imaging, local recurrence is no longer the main problem in rectal cancer treatment. The new challenges are early diagnosis and treatment, reducing morbidity of treatment and preferably prevention of metastatic disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Intestinal ischemia-reperfusion (IR) injury is associated with high mortality rates, which have not improved in the past decades despite advanced insight in its pathophysiology using in vivo animal ...and human models. The inability to translate previous findings to effective therapies emphasizes the need for a physiologically relevant in vitro model to thoroughly investigate mechanisms of IR-induced epithelial injury and test potential therapies. In this study, we demonstrate the use of human small intestinal organoids to model IR injury by exposing organoids to hypoxia and reoxygenation (HR). A mass-spectrometry-based proteomics approach was applied to characterize organoid differentiation and decipher protein dynamics and molecular mechanisms of IR injury in crypt-like and villus-like human intestinal organoids. We showed successful separation of organoids exhibiting a crypt-like proliferative phenotype, and organoids exhibiting a villus-like phenotype, enriched for enterocytes and goblet cells. Functional enrichment analysis of significantly changing proteins during HR revealed that processes related to mitochondrial metabolism and organization, other metabolic processes, and the immune response were altered in both organoid phenotypes. Changes in protein metabolism, as well as mitophagy pathway and protection against oxidative stress were more pronounced in crypt-like organoids, whereas cellular stress and cell death associated protein changes were more pronounced in villus-like organoids. Profile analysis highlighted several interesting proteins showing a consistent temporal profile during HR in organoids from different origin, such as NDRG1, SDF4 or DMBT1. This study demonstrates that the HR response in human intestinal organoids recapitulates properties of the in vivo IR response. Our findings provide a framework for further investigations to elucidate underlying mechanisms of IR injury in crypt and/or villus separately, and a model to test therapeutics to prevent IR injury.
Background
Students without intellectual disability (ID) start experimenting with tobacco and alcohol between 12 and 15 years of age. However, data for 12‐ to 15‐year old students with ID are ...unavailable. Prevention programs, like ‘prepared on time’ (based on the attitude–social influence–efficacy model), are successful, but their efficacy has not been studied in students with ID. The objectives of this study were (1) to undertake a cluster randomised control trial to test the efficacy of the e‐learning program among 12‐ to 15‐year old students with mild and borderline ID in secondary special‐needs schools and (2) to examine the tobacco and alcohol use for this population.
Methods
Five schools, randomly selected to be part of either the experimental group or the control group, participated in this study. Passive informed consent was used in which parents and their children can refuse to participate in the study, resulting in 111 students in the experimental group and 143 students in the control group. A total of 210 students completed both baseline and follow‐up questionnaires. Primary outcome variables are the knowledge and attitude towards alcohol and tobacco use. This study is registered in the ISRCTN registry with number ISRCTN95279686.
Results
Baseline findings showed that a large proportion of all respondents had initiated smoking (49%) and drinking (75%), well above the expected numbers based on national figures. ‘prepared on time’ did not affect the behavioural determinants (i.e. attitude, subjective norm and self‐efficacy), except modelling on smoking. Additionally, alcohol‐related knowledge of students in the experimental group increased after the completion of the program.
Conclusions
To obtain effective results on behavioural outcomes from ‘prepared on time’, a greater degree of flexibility (i.e. repetition, extension of the program, role playing, etc.) is required. Furthermore, prevention needs to be implemented at a younger age, as 6% of the students tried their first cigarette and 15% of the students drank alcohol at the age of 10 years or younger.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Abstract
Despite dominating industrial processes, heterogeneous catalysts remain challenging to characterize and control. This is largely attributable to the diversity of potentially active sites at ...the catalyst-reactant interface and the complex behaviour that can arise from interactions between active sites. Surface-supported, single-site molecular catalysts aim to bring together benefits of both heterogeneous and homogeneous catalysts, offering easy separability while exploiting molecular design of reactivity, though the presence of a surface is likely to influence reaction mechanisms. Here, we use metal-organic coordination to build reactive Fe-terpyridine sites on the Ag(111) surface and study their activity towards CO and C
2
H
4
gaseous reactants using low-temperature ultrahigh-vacuum scanning tunnelling microscopy, scanning tunnelling spectroscopy, and atomic force microscopy supported by density-functional theory models. Using a site-by-site approach at low temperature to visualize the reaction pathway, we find that reactants bond to the Fe-tpy active sites via surface-bound intermediates, and investigate the role of the substrate in understanding and designing single-site catalysts on metallic supports.
A multicenter, randomized trial of patients with infected necrotizing pancreatitis evaluated immediate drainage within 24 hours after infected necrosis was diagnosed as compared with postponed ...drainage. Immediate drainage was not superior to postponed drainage in reducing complications. Patients assigned to immediate drainage underwent a greater number of invasive procedures.
Abstract Background The impact of body composition on outcomes after surgery for colorectal liver metastases (CRLM) remains unclear. The aim of the present study was to determine the influence of ...sarcopenia, obesity and sarcopenic obesity on morbidity, diseasefree (DFS) and overall survival (OS). Method Between 2005 and 2012, all patients undergoing a partial liver resection for CRLM in the Maastricht University Medical Centre, and who underwent computed tomography (CT) imaging within 3 months before liver surgery, were included. Body composition was primarily based on preoperative CT measurements. Sarcopenia was based on total muscle area at the level of the third lumbar vertebra and predefined body mass index (BMI) and genderspecific cutoff values for sarcopenia were used. Body fat percentages were calculated and the top 40% for men and women were considered obese. Results Of the 171 included patients undergoing liver surgery for CRLM, 80 (46.8%) patients were sarcopenic, 69 (40.4%) obese and 49 (28.7%) sarcopenic obese. The presence of sarcopenia, obesity or sarcopenic obesity did not affect the complication rates. However, readmission rates were significantly increased in patients with (sarcopenic) obesity ( P < 0.05). Surprisingly, obesity seemed to prolong OS ( P = 0.021) and was identified as an independent predictor hazard ratio (HR):0.58 and P = 0.046 for better OS. Sarcopenia and sarcopenic obesity did not affect DFS or OS. Conclusion Sarcopenia, obesity and sarcopenic obesity did not worsen DFS, OS and complication rates after a partial liver resection for CRLM.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
We present cosmological parameter constraints from a tomographic weak gravitational lensing analysis of ~450 deg super( 2) of imaging data from the Kilo Degree Survey (KiDS). For a flat ... cold dark ...matter (...CDM) cosmology with a prior on H sub( 0) that encompasses the most recent direct measurements, we find S sub( 8) ... = 0.745 plus or minus 0.039. This result is in good agreement with other low-redshift probes of large-scale structure, including recent cosmic shear results, along with pre-Planck cosmic microwave background constraints. A 2.3... tension in S sub( 8) and 'substantial discordance' in the full parameter space is found with respect to the Planck 2015 results. We use shear measurements for nearly 15 million galaxies, determined with a new improved 'self-calibrating' version of lensfit validated using an extensive suite of image simulations. Four-band ugri photometric redshifts are calibrated directly with deep spectroscopic surveys. The redshift calibration is confirmed using two independent techniques based on angular cross-correlations and the properties of the photometric redshift probability distributions. Our covariance matrix is determined using an analytical approach, verified numerically with large mock galaxy catalogues. We account for uncertainties in the modelling of intrinsic galaxy alignments and the impact of baryon feedback on the shape of the non-linear matter power spectrum, in addition to the small residual uncertainties in the shear and redshift calibration. The cosmology analysis was performed blind. Our high-level data products, including shear correlation functions, covariance matrices, redshift distributions, and Monte Carlo Markov chains are available at http://kids.strw.leidenuniv.nl. (ProQuest: ... denotes formulae/symbols omitted.)
Background
This study examined the feasibility, safety, and efficacy of addiction‐focused eye movement desensitization and reprocessing (AF‐EMDR) treatment, as an add‐on intervention to treatment as ...usual (TAU).
Methods
Adult outpatients with alcohol use disorder (AUD) (N = 109) who already received or had just started with TAU (Community Reinforcement Approach) were recruited at 6 outpatient addiction care facilities. They were randomly assigned to either TAU + 7 weekly 90‐minute sessions of AF‐EMDR (N = 55) or TAU‐only (N = 54). Assessments were made at baseline, after AF‐EMDR therapy (+ 8 weeks in the TAU‐only group), and at 1‐ and 6‐month follow‐up. The primary outcomes were changes in drinking behavior as reported by the participant and biomarker indices.
Results
Data were analyzed as intent‐to‐treat with linear mixed models. Additionally, sensitivity analyses were performed. No group or interaction effects were found for any of the outcome variables. Only limited change over time was seen with regard to indices of personal and societal recovery and in some secondary indices of clinical recovery (craving, desire thinking, and rumination). Reliable Change Index calculations showed that more TAU‐only participants showed clinical improvement with regard to alcohol consumption while a somewhat higher proportion of participants in the TAU + AF‐EMDR group experienced less craving. The acceptability, safety, and feasibility of the treatments received in both groups were comparable.
Conclusions
There was no add‐on effect of AF‐EMDR on TAU with regard to drinking behavior in outpatients with an AUD. Possible explanations are discussed. Future studies should first establish proof of principle regarding the potential of AF‐EMDR therapy to disrupt operant learning and habits relevant in addiction.
The efficacy of addiction‐focused EMDR therapy (AF‐EMDR) was studied in 109 outpatients with alcohol use disorder using a randomized controlled design. The experimental group received 7 sessions AF‐EMDR in addition to routine clinical care (TAU). The control group received TAU only. Unexpectedly, both groups experienced null changes in the primary outcomes. Reconsolidation‐based adaptations may be needed to demonstrate proof‐of‐principle with AF‐EMDR.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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