Background
Functional gastrointestinal disorders (FGIDs) are common and cause significant morbidity. Psychiatric comorbidities associated with FGIDs include anxiety and depression. However, little is ...understood about the factors that modulate this association. The aim of this study was to examine the association between FGIDs and depression and anxiety, and to determine the covariates influencing this association in a New Zealand cohort.
Methods
The Christchurch IBS cOhort to investigate Mechanisms FOr gut Relief and improved Transit (COMFORT) study is an observational case–control study that recruited FGID cases and healthy controls between 2016 and 2018. In addition to the collection of a wide range of biological samples, participants completed questionnaires concerning socioeconomic status, physical activity, smoking, alcohol intake, anxiety, and depression (the latter two measured using the Hospital Anxiety and Depression Score HADS). A multivariate analysis was performed using the significant covariates from the univariate analyses to test whether their effect was independently significant on anxiety and depression.
Key Results
A total of 315 participants (57 with diarrhea‐predominant IBS (IBS‐D), 30 with constipation‐predominant IBS (IBS‐C), 41 with mixed‐IBS (IBS‐M), 16 with functional diarrhea (FD), 42 with functional constipation (FC), and 129 controls); mean age 53 years (range 18–70 years), 221 (70%) female) completed the questionnaires. Anxiety (odds ratio OR 2.85 95% confidence interval CI 1.64–4.94, p < 0.01) and depression (OR 3.40 95% CI 1.35–8.55, p = 0.01) were strongly associated with FGID cases versus controls. Lower economic living status (p < 0.01) was an independent covariate associated with depression, while lower economic living status (p < 0.005) and abdominal pain (p = 0.005) were both independently associated with anxiety.
Conclusions & Inferences
In addition to the established associations between FGIDs and anxiety and depression, we have shown that the economic standard of living, pain, and IBS phenotype are significant independent covariates. This study demonstrates the range of lifestyle and demographic factors that modulate morbidity associated with FGIDs and may provide targets for intervention.
In this observational study, we demonstrate that economic living standard influenced the association between functional GI disorders and both anxiety and depression, whereas abdominal pain modified the association between functional GI disorders and anxiety.
Background
The shift from routine antibiotics towards omitting antibiotics for uncomplicated acute diverticulitis opens up the possibility for outpatient instead of inpatient treatment, potentially ...reducing the burden of one of the most common gastrointestinal diseases in the Western world.
Purpose
Assessing the safety and cost savings of outpatient treatment in acute colonic diverticulitis.
Methods
PubMed and EMBASE were searched for studies on outpatient treatment of colonic diverticulitis, confirmed with computed tomography or ultrasound. Outcomes were readmission rate, need for emergency surgery or percutaneous abscess drainage, and healthcare costs.
Results
A total of 19 studies with 2303 outpatient treated patients were included. These studies predominantly excluded patients with comorbidity or immunosuppression, inability to tolerate oral intake, or lack of an adequate social network. The pooled incidence rate of readmission for outpatient treatment was 7% (95%CI 6–9%,
I
2
48%). Only 0.2% (2/1288) of patients underwent emergency surgery, and 0.2% (2/1082) of patients underwent percutaneous abscess drainage. Only two studies compared readmission rates outpatients that had similar characteristics as a control group of inpatients; 4.5% (3/66) and 6.3% (2/32) readmissions in outpatient groups versus 6.1% (4/66) and 0.0% (0/44) readmissions in inpatient groups (
p
= 0.619 and
p
= 0.174, respectively). Average healthcare cost savings for outpatient compared with inpatient treatment ranged between 42 and 82%.
Conclusion
Outpatient treatment of uncomplicated diverticulitis resulted in low readmission rates and very low rates of complications. Furthermore, healthcare cost savings were substantial. Therefore, outpatient treatment of uncomplicated diverticulitis seems to be a safe option for most patients.
Summary
This international multidisciplinary consensus statement was developed to provide balanced guidance on the safe peri‐operative use of opioids in adults. An international panel of healthcare ...professionals evaluated the literature relating to postoperative opioid‐related harm, including persistent postoperative opioid use; opioid‐induced ventilatory impairment; non‐medical opioid use; opioid diversion and dependence; and driving under the influence of prescription opioids. Recommended strategies to reduce harm include pre‐operative assessment of the risk of persistent postoperative opioid use; use of an assessment of patient function rather than unidimensional pain scores alone to guide adequacy of analgesia; avoidance of long‐acting (modified‐release and transdermal patches) opioid formulations and combination analgesics; limiting the number of tablets prescribed at discharge; providing deprescribing advice; avoidance of automatic prescription refills; safe disposal of unused medicines; reducing the risk of opioid diversion; and better education of healthcare professionals, patients and carers. This consensus statement provides a framework for better prescribing practices that could help reduce the risk of postoperative opioid‐related harm in adults.
Background
Routine colonoscopy was traditionally recommended after acute diverticulitis to exclude coexistent malignancy. Improved CT imaging may make routine colonoscopy less required over time but ...most guidelines still recommend it. The aim of this review was to assess the role of colonoscopy in patients with CT‐proven acute diverticulitis.
Methods
PubMed and Embase were searched for studies reporting the prevalence of advanced colorectal neoplasia (ACN) or colorectal carcinoma in patients who underwent colonoscopy within 1 year after CT‐proven left‐sided acute diverticulitis. The prevalence was pooled using a random‐effects model and, if possible, compared with that among asymptomatic controls.
Results
Seventeen studies with 3296 patients were included. The pooled prevalence of ACN was 6·9 (95 per cent c.i. 5·0 to 9·4) per cent and that of colorectal carcinoma was 2·1 (1·5 to 3·1) per cent. Only two studies reported a comparison with asymptomatic controls, showing comparable risks (risk ratio 1·80, 95 per cent c.i. 0·66 to 4·96). In subgroup analysis of patients with uncomplicated acute diverticulitis, the prevalence of colorectal carcinoma was only 0·5 (0·2 to 1·2) per cent.
Conclusion
Routine colonoscopy may be omitted in patients with uncomplicated diverticulitis if CT imaging is otherwise clear. Patients with complicated disease or ongoing symptoms should undergo colonoscopy.
This systematic review demonstrates that the prevalence of colorectal cancer in all patients with diverticulitis is slightly higher than in controls, whereas patients with uncomplicated diverticulitis have a colorectal cancer prevalence comparable to that of asymptomatic controls from the literature. Therefore, routine colonoscopy should be omitted in those with uncomplicated diverticulitis and these patients may be referred back to the colorectal cancer screening programme. However, routine colonoscopy should remain the protocol for differential diagnosis after non‐surgical treatment of complicated diverticulitis.
Not needed routinely
Objective
To develop a deep learning algorithm for anatomy recognition in thoracoscopic video frames from robot-assisted minimally invasive esophagectomy (RAMIE) procedures using deep learning.
...Background
RAMIE is a complex operation with substantial perioperative morbidity and a considerable learning curve. Automatic anatomy recognition may improve surgical orientation and recognition of anatomical structures and might contribute to reducing morbidity or learning curves. Studies regarding anatomy recognition in complex surgical procedures are currently lacking.
Methods
Eighty-three videos of consecutive RAMIE procedures between 2018 and 2022 were retrospectively collected at University Medical Center Utrecht. A surgical PhD candidate and an expert surgeon annotated the azygos vein and vena cava, aorta, and right lung on 1050 thoracoscopic frames. 850 frames were used for training of a convolutional neural network (CNN) to segment the anatomical structures. The remaining 200 frames of the dataset were used for testing the CNN. The Dice and 95% Hausdorff distance (95HD) were calculated to assess algorithm accuracy.
Results
The median Dice of the algorithm was 0.79 (IQR = 0.20) for segmentation of the azygos vein and/or vena cava. A median Dice coefficient of 0.74 (IQR = 0.86) and 0.89 (IQR = 0.30) were obtained for segmentation of the aorta and lung, respectively. Inference time was 0.026 s (39 Hz). The prediction of the deep learning algorithm was compared with the expert surgeon annotations, showing an accuracy measured in median Dice of 0.70 (IQR = 0.19), 0.88 (IQR = 0.07), and 0.90 (0.10) for the vena cava and/or azygos vein, aorta, and lung, respectively.
Conclusion
This study shows that deep learning-based semantic segmentation has potential for anatomy recognition in RAMIE video frames. The inference time of the algorithm facilitated real-time anatomy recognition. Clinical applicability should be assessed in prospective clinical studies.
Background
Minimally invasive surgery is complex and associated with substantial learning curves. Computer-aided anatomy recognition, such as artificial intelligence-based algorithms, may improve ...anatomical orientation, prevent tissue injury, and improve learning curves. The study objective was to provide a comprehensive overview of current literature on the accuracy of anatomy recognition algorithms in intrathoracic and -abdominal surgery.
Methods
This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Pubmed, Embase, and IEEE Xplore were searched for original studies up until January 2022 on computer-aided anatomy recognition, without requiring intraoperative imaging or calibration equipment. Extracted features included surgical procedure, study population and design, algorithm type, pre-training methods, pre- and post-processing methods, data augmentation, anatomy annotation, training data, testing data, model validation strategy, goal of the algorithm, target anatomical structure, accuracy, and inference time.
Results
After full-text screening, 23 out of 7124 articles were included. Included studies showed a wide diversity, with six possible recognition tasks in 15 different surgical procedures, and 14 different accuracy measures used. Risk of bias in the included studies was high, especially regarding patient selection and annotation of the reference standard. Dice and intersection over union (IoU) scores of the algorithms ranged from 0.50 to 0.98 and from 74 to 98%, respectively, for various anatomy recognition tasks. High-accuracy algorithms were typically trained using larger datasets annotated by expert surgeons and focused on less-complex anatomy. Some of the high-accuracy algorithms were developed using pre-training and data augmentation.
Conclusions
The accuracy of included anatomy recognition algorithms varied substantially, ranging from moderate to good. Solid comparison between algorithms was complicated by the wide variety of applied methodology, target anatomical structures, and reported accuracy measures. Computer-aided intraoperative anatomy recognition is an upcoming research discipline, but still at its infancy. Larger datasets and methodological guidelines are required to improve accuracy and clinical applicability in future research.
Trial registration: PROSPERO registration number: CRD42021264226
•We modelled the fine-scale spatial and temporal distribution of harbour porpoises.•Porpoises preferred westward, ebbing flows and medium depths with SE facing slopes.•Tidal-topographic interactions ...created identifiable hydraulic jumps and lee waves.•Times/areas of high porpoise density were influenced by these hydrodynamic features.•Results shed light on the mechanistic links between porpoises and physical habitat.
The coastal Runnelstone Reef, off southwest Cornwall (UK), is characterised by complex topography and strong tidal flows and is a known high-density site for harbour porpoise (Phocoena phocoena); a European protected species. Using a multidisciplinary dataset including: porpoise sightings from a multi-year land-based survey, Acoustic Doppler Current Profiling (ADCP), vertical profiling of water properties and high-resolution bathymetry; we investigate how interactions between tidal flow and topography drive the fine-scale porpoise spatio-temporal distribution at the site. Porpoise sightings were distributed non-uniformly within the survey area with highest sighting density recorded in areas with steep slopes and moderate depths. Greater numbers of sightings were recorded during strong westward (ebbing) tidal flows compared to strong eastward (flooding) flows and slack water periods. ADCP and Conductivity Temperature Depth (CTD) data identified fine-scale hydrodynamic features, associated with cross-reef tidal flows in the sections of the survey area with the highest recorded densities of porpoises. We observed layered, vertically sheared flows that were susceptible to the generation of turbulence by shear instability. Additionally, the intense, oscillatory near surface currents led to hydraulically controlled flow that transitioned from subcritical to supercritical conditions; indicating that highly turbulent and energetic hydraulic jumps were generated along the eastern and western slopes of the reef. The depression and release of isopycnals in the lee of the reef during cross-reef flows revealed that the flow released lee waves during upslope currents at specific phases of the tidal cycle when the highest sighting rates were recorded. The results of this unique, fine-scale field study provide new insights into specific hydrodynamic features, produced through tidal forcing, that may be important for creating predictable foraging opportunities for porpoises at a local scale. Information on the functional mechanisms linking porpoise distribution to static and dynamic physical habitat variables is extremely valuable to the monitoring and management of the species within the context of European conservation policies and marine renewable energy infrastructure development.
The aim of this study was to assess body composition and physical strength changes during neoadjuvant chemoradiotherapy (nCRT) and assess their predictive value for (severe) postoperative ...complications and overall survival in patients who underwent oesophagectomy for oesophageal cancer.
Consecutive patients who underwent nCRT and oesophagectomy with curative intent in a tertiary referral center were included in the study. Perioperative data were collected in a prospectively maintained database. The CT images before and after nCRT were used to assess skeletal muscle index (SMI), subcutaneous fat index (SFI), and visceral fat index (VFI). To assess physical strength, handgrip strength (HGS) and the exercise capacity of the steep ramp test (SRT Wpeak) were acquired before and after nCRT.
Between 2015 and 2020, 126 patients were included. SMI increased in female subgroups and decreased in male subgroups (35.38 to35.60 cm2/m2 for females, P value 0.048, 46.89 to 45.34 cm2/m2 for males, P value < 0.001). No significant changes in SFI, VFI, HGS, and SRT Wpeak were observed. No predictive value of changes in SMI, HGS, and SRT Wpeak was shown for (severe) postoperative complications and overall survival.
A significant but minimal decrease in SMI during nCRT was observed for males only, it was not associated with postoperative complications or overall survival. Physical strength measurements did not decrease significantly over the course of nCRT. No associations with postoperative complications or overall survival were observed.
We investigated the effects of targeting the mitotic regulators aurora kinase A and B in pediatric acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). Aurora protein expression ...levels in pediatric ALL and AML patient samples were determined by western blot and reverse phase protein array. Both kinases were overexpressed in ALL and AML patients (P<0.0002), especially in E2A-PBX1-translocated ALL cases (P<0.002), compared with normal bone-marrow mononuclear cells. Aurora kinase expression was silenced in leukemic cell lines using short hairpin RNAs and locked nucleic acid-based mRNA antagonists. Aurora B knockdown resulted in proliferation arrest and apoptosis, whereas aurora A knockdown caused no or only minor growth delay. Most tested cell lines were highly sensitive to the AURKB-selective inhibitor barasertib-hydroxyquinazoline-pyrazol-anilide (AZD1152-HQPA) in the nanomolar range, as tested with an MTS (3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay. But most importantly, primary ALL cells with a high aurora B protein expression, especially E2A-PBX1-positive cases, were sensitive as well. In adult AML early clinical trials, clear responses are observed with barasertib. Here we show that inhibition of aurora B, more than aurora A, has an antiproliferative and pro-apoptotic effect on acute leukemia cells, indicating that particularly targeting aurora B may offer a new strategy to treat pediatric ALL and AML.
Aim
Diagnosing heart failure with preserved ejection fraction (HFpEF) in the non‐acute setting remains challenging. Natriuretic peptides have limited value for this purpose, and a multitude of ...studies investigating novel diagnostic circulating biomarkers have not resulted in their implementation. This review aims to provide an overview of studies investigating novel circulating biomarkers for the diagnosis of HFpEF and determine their risk of bias (ROB).
Methods and results
A systematic literature search for studies investigating novel diagnostic HFpEF circulating biomarkers in humans was performed up until 21 April 2020. Those without diagnostic performance measures reported, or performed in an acute heart failure population were excluded, leading to a total of 28 studies. For each study, four reviewers determined the ROB within the QUADAS‐2 domains: patient selection, index test, reference standard, and flow and timing. At least one domain with a high ROB was present in all studies. Use of case‐control/two‐gated designs, exclusion of difficult‐to‐diagnose patients, absence of a pre‐specified cut‐off value for the index test without the performance of external validation, the use of inappropriate reference standards and unclear timing of the index test and/or reference standard were the main bias determinants. Due to the high ROB and different patient populations, no meta‐analysis was performed.
Conclusion
The majority of current diagnostic HFpEF biomarker studies have a high ROB, reducing the reproducibility and the potential for clinical care. Methodological well‐designed studies with a uniform reference diagnosis are urgently needed to determine the incremental value of circulating biomarkers for the diagnosis of HFpEF.
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