Caspase-8 cleaves BID to tBID, which targets mitochondria and induces oligomerization of BAX and BAK within the outer membrane, resulting in release of cytochrome c from the organelle. Here, we have ...initiated these steps in isolated mitochondria derived from control and BCL-2-overexpressing cells using synthetic BH3 peptides and subsequently analyzed the BCL members by chemical cross-linking. The results show that the BH3 domain of BID interacts with and induces an "open" conformation of BAK, exposing the BAK N terminus. This open (activated) conformer of BAK potently induces oligomerization of non-activated ("closed") conformers, causing a cascade of BAK auto-oligomerization. Induction of the open conformation of BAK occurs even in the presence of excess BCL-2, but BCL-2 selectively interacts with this open conformer and blocks BAK oligomerization and cytochrome c release, dependent on the ratio of BID BH3 and BCL-2. This mechanism of inhibition by BCL-2 also occurs in intact cells stimulated with Fas or expressing tBID. Although BID BH3 interacts with both BCL-2 and BAK, the results indicate that when BCL-2 is in excess it can sequester the BID BH3-induced activated conformer of BAK, effectively blocking downstream events. This model suggests that the primary mechanism for BCL-2 blockade targets activated BAK rather than sequestering tBID.
Aim Despite advances in the treatment of Crohn’s disease (CD), the treatment of rectovaginal (RV) fistula remains challenging. Transrectal (RAF) and transvaginal advancement flaps (VAF) represent ...two possible alternative surgical approaches to this problem. The study aims to review and compare the results of these approaches for RV fistula in CD.
Method Medical databases from January 1983 to August 2008 were consulted for potentially relevant publications. All studies dealing with the RV fistula repair in CD with RAF or VAF were included. Two researchers worked independently on the study selection, quality assessment, data extraction and analysis phases of the study. Analyses were performed with Review Manager 2.0 software.
Results Eleven observational studies were included with a total of 219 flap procedures for RV fistula. The primary fistula closure pooled rate was 54.2% (range 33.3–100%) after RAF and 69.4% (range 0–92.9%) after VAF (P = 0.13). Four studies were eligible for direct comparison between the two procedures. No clearly significant difference between RAF compared with VAF in terms of primary fistula closure rate, nor in terms of overall fistula closure rate, was apparent. The risk of recurrence after RAF compared with VAF seemed similar; in this case, only two studies were taken into consideration.
Conclusions Although limited by a small number of studies of low clinical evidence level, this systematic review suggests that there is no significant difference in terms of outcome between RAF and VAF for RV fistula in CD.
Conventional trans-arterial chemoembolization (cTACE) for intermediate stage hepatocellular carcinoma (HCC) achieves a partial response in up to 72% of patients and improves median survival. ...Drug-eluting-beads-TACE (DEBTACE) improves treatment efficacy and tolerance as compared to cTACE. Our aim was to retrospectively evaluate our experience in the treatment of intermediate/advanced HCC with cTACE versus DEBTACE. Overall survival (OS) was the first endpoint. We retrospectively considered our department register data between 2006 and 2012. A total of 82 non-surgical patients, who underwent cTACE or DEBTACE, with a minimum of 12 months follow-up, met the inclusion criteria. Patients received a standard chemotherapy dose (50 mg). Radiological response was evaluated by CT after 30 days and re-treatment was considered. Statistical analysis was performed with SPSS software. 54 patients received cTACE and 28 DEBTACE. In the DEBTACE group the median survival times was 22.7 months (CI 11.6–33.8), while in the cTACE group it was 21.8 months (CI 15.7–27.9). The survival analysis at log-rank (
p
= 0.708) and Wilcoxon (
p
= 0.661) tests demonstrated no differences between DEBTACE and cTACE. The probability of death in function of time was significantly associated only to the Child–Pugh score. A Child A score was shown to be protective instead of Child B (OR 0.583; IC 95% = 0.344–0.987). DEBTACE for treating HCC is comparable to cTACE in terms of effectiveness, but seems to be better tolerated. Both treatments can be performed in case of tumor recurrence without substantial increase in procedural complications and risk of liver failure. We do confirm that there are no differences between the two techniques in terms of survival and that it is mainly affected by the reserved liver function proper of each patient.
This case study highlights the partnership development between a large, urban, public, community-based behavioral health system and an academic program. Using principles of partnership building and ...facilitators that enhance partnership building, we describe the process of initiating, building, and sustaining the partnership. The Health Resources and Services Administration (HRSA) workforce development initiative was the primary catalyst for the partnership development. The public, community-based behavioral health system is located in an urban, medically underserved area and health care professional shortage area. The academic partner is a master in social work (MSW) program in Michigan. We assessed partnership development by using process and outcome measures that captured changes in the partnerships and in implementation of the HRSA workforce development grant. The goals of this partnership were to develop the infrastructure to support the training of MSW students, expand workforce skills in integrated behavioral health, and increase the number of MSW graduates who work with medically underserved populations. During 2018-2020, the partnership trained 70 field instructors, engaged 114 MSW students in HRSA field placements, and developed 35 community-based field sites (including 4 federally qualified health centers). The partnership provided training for field supervisors and for HRSA MSW students and developed new courses/trainings focusing on integrated behavioral health assessment/intervention practices, trauma-informed care, cultural awareness, and telebehavioral health practices. Of 57 HRSA MSW graduates who responded to a postgraduation survey, 38 (66.7%) were employed in medically underserved, high-need/high-demand urban areas. Partnership sustainability was helped by formal agreements, regular communication, and a collaborative decision-making approach.
Aim
This multicentric prospective study aimed to investigate how postoperative complications after surgery for colorectal cancer affect patients' quality of life and satisfaction with care.
Method
...One hundred and sixteen patients operated on for colorectal cancer were enrolled in this study. Patients answered three questionnaires about generic (EORTC QLQ‐C30) and disease‐specific (EORTC QLQ‐CR29) quality of life and treatment satisfaction (EORTC IN‐PATSAT32) at the time of admission and at 1 and 6 months after surgery. Non‐parametric tests and linear multiple regression models were used for statistical analysis.
Results
Twelve patients had complications requiring further surgery (anastomotic leakage, abdominal bleeding, abdominal wall sepsis, wound infection). Patients with complications that required surgery reported a worse score of physical function, emotional function and anxiety than patients without such complications 1 month after surgery. These patients judged their general satisfaction with the quality of care and doctors' interpersonal skills, technical skills, information provision and availability to be worse than in patients without such complications. The presence of postoperative psychiatric complications and anastomotic leakage were independent predictors of quality of life (β = −0.30, P = 0.004, and β = −0.42, P < 0.001).
Conclusion
In patients undergoing surgery for colorectal cancer, complications requiring any kind of surgical management significantly affected patients' perception of all doctor‐related items suggesting an impairment of the entire surgeon–patient relationship. Convincing patients that ‘zero risk’ cannot be achieved in surgical practice is therefore a priority.
Summary
Background Ulcerative colitis (UC) and Crohn’s disease (CD) can cause metabolic and inflammatory alterations.
Aim To evaluate the relationships between inflammatory parameters, plasma ...lipids and phospholipid fatty acid (FA) composition in patients with active UC and CD.
Methods Diet, the Harvey–Bradshaw Activity Index (HBAI), inflammatory parameters, lipoproteins and FA composition were assessed in 60 CD and 34 UC.
Results No differences in clinical parameters were observed in the two groups. Total cholesterol correlated inversely with the number of bowel movements in both groups and directly with BMI in UC. Arachidonic acid correlated inversely with HBAI in UC and total and HDL cholesterol were inversely related to C‐reactive protein (CRP) in CD while HDL correlated with CRP in UC. Docosapentaenoic acid was the only polyunsaturated n‐3 FA that was correlated to CRP in both groups. Total cholesterol was independently associated in the multiple regression analysis with the number of bowel movements and systemic inflammation.
Conclusions Total and LDL cholesterol were lower in the active UC and CD than in the healthy subjects and were correlated with the systemic inflammatory status. Phospholipid FA composition was correlated to the systemic inflammatory status, but was unrelated to dietary intake and intestinal disease activity.
Abstract
This cross-national study examined the mental health between those individuals working and those not working nine months post initial COVID-19 social distancing implementation. Respondents ...(N = 3,474) were recruited through social media (e.g. Facebook, Twitter) and completed an online survey in October/November 2020. The respondents were from Norway, the UK, the USA and Australia. The mental health of those working and not working were analysed using t tests and socio-demographics were compared using one-way analysis of variance. Respondents who were working were significantly more likely to experience better mental health, were younger, report higher levels of education, and significantly less likely to worry about their own situation, health or financial situation than respondents who were not employed. Respondents who were retired reported better mental health than respondents who were not working for other reasons (laid off/dismissed, receiving benefits, studying, other). These findings raise the importance for social workers and other health service providers to monitor the overall mental health of individuals especially when social distancing protocols are in place and as countries begin to recover from the pandemic.
This cross-national study (Norway, the UK, the USA and Australia) examined the mental health between those individuals working and not working nine months post initial COVID-19 social distancing implementation. The sample (N=3,474) was recruited through social media (e.g. Facebook, Twitter). Respondents completed an online survey in October/November 2020. Individuals who were working were significantly more likely to experience better mental health, were younger, report high levels of education and significantly less likely to worry about their own situation, health or financial situation than individuals who were not working. If individuals were retired, they reported better mental health than individuals who were not working for other reasons (e.g. laid off/dismissed, receiving benefits, studying). Based on the findings of this study social workers and other health service providers need to address ways to enhance mental health services especially for individuals who are not working when social distancing protocols are in place.
In the past few decades, both the local and international press have addressed flaws within the juvenile justice systems in Chile. However, very few studies have examined the support provided to ...social workers working in this field. This article, using exploratory survey research methods, explores the perspective of social workers about how these systems support their well-being and overall work functioning. The survey uses a snowball sampling technique to reach social workers who work in nonprofit organizations serving juvenile offenders in the metropolitan region in Chile. The results show that social workers are experiencing moderate levels of compassion fatigue. Different issues emerged centered on a lack of organizational support related to teamwork, training, and pay.
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