Surgery for Inflammatory Bowel Disease in the Era of Biologic Therapy: A Multicenter Experience from Romania.

Background and Objectives: Biologic therapy has fundamentally changed the opportunity of medical treatment to induce and maintain remission in inflammatory bowel disease (IBD). Nevertheless, the rate of surgery is still at a very high rate, profoundly affecting the quality of life. We aimed to analyze surgical cases at three major IBD units in order to identify the main risk factors and the impact of biologic therapy on pre- and postsurgical outcomes. Material and Methods: This was a multicenter retrospective cohort study that included 56 patients with IBD-related surgical interventions from 3 tertiary care hospitals in Bucharest, Romania. The study was conducted between January 2017 and June 2021. All data were retrospectively collected from the medical records of the patients and included the age at diagnosis, age at the time of surgery, IBD type and phenotype, biologic therapy before or/and after surgery, timing of biologic therapy initiation, extraintestinal manifestations, type of surgery (elective/emergency), early and long-term postoperative complications and a history of smoking. Results: A low rate of surgical interventions was noted in our cohort (10.3%), but half of these occurred in the first year after the IBD diagnosis. A total of 48% of the surgical interventions had been performed in an emergency setting, which seemed to be associated with a high rate of long-term postoperative complications. We found no statistically significant differences between IBD patients undergoing treatments with biologics before surgery and patients who did not receive biologics before the surgical intervention in terms of the IBD phenotype, type of surgery and postoperative complications. Conclusion: Our study showed that biologics initiated before the surgical intervention did not influence the postoperative complications. Moreover, we demonstrated that patients with Crohn's disease and no biologics were the most susceptible to having to undergo surgery. Conclusion: In conclusion, the management of patients with IBD requires a multidisciplinary approach that considers an unpredictable evolution.

Ultra-Early and Early Changes in Bile Acids and Insulin After Sleeve Gastrectomy Among Obese Patients.

BACKGROUND AND OBJECTIVE: In obese patients, sleeve gastrectomy (SG) has shown mixed results on bile acid (BA) values. The aim of our study was to examine the potential ultra-early and early changes of the circulating total BA in relation with the changes of insulin resistance (IR) in obese patients submitted to laparoscopic SG. Materials and Methods: Twenty-four obese subjects were investigated for body mass index (BMI), total fasting BA, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), and leptin before and at 7 and 30 d after SG. Results: After surgery, mean BMI decreased at the first (p < 0.001) and at the second time point (p < 0.001) relative to baseline. Total fasting BA values did not change significantly at 7 d (p = 0.938) and at 30 d (p = 0.289) after SG. No significant changes were found at 7 d (p = 0.194, p = 0.34) and 30 d (p = 0.329, p = 0.151) after surgery regarding fasting insulin and HOMA-IR, respectively. However, a trend of increased total fasting BA and decreased fasting insulin and HOMA- after laparoscopic SG has been found. Negative correlations between total fasting BA and insulin (r = -0.807, p = 0.009), HOMA-IR (r = -0.855, p = 0.014), and blood glucose (r = -0.761, p = 0.047), respectively, were observed at one month after SG. Conclusion: In conclusion, here, we found a lack of significant changes in total fasting BA, insulin, and HOMA-IR ultra-early and early after SG, which precluded us to consider a possible relation between the variations of BA and IR. However, the presence of the tendency for total fasting BA to increase and for insulin and HOMA-IR to decrease, as well as of the negative correlations one month after laparoscopic SG, suggest that this surgery brings about some changes that point towards the existence, and possibly towards the restoration, at least to some extent, of the link between BA and glucose metabolism.

Vitamin K Antagonists Versus Novel Oral Anticoagulants for Elective Electrical Cardioversion of Atrial Fibrillation.

BACKGROUND: The management strategy for patients with atrial fibrillation (AF) is often very complex, electrical cardioversion (EC) being often used to restore sinus rhythm in those patients. The increased risk of thromboembolic complications was lowered using anticoagulation therapy. Usually, the anticoagulation was achieved using vitamin K antagonists (VKAs), but over the last years we witnessed a wide implementation of the novel oral anticoagulants (NOACs). STUDY QUESTION: Study question was to compare the efficacy of NOACs versus VKAs in patients undergoing elective EC for persistent AF, by assessing the presence of left atrial spontaneous contrast and left atrial thrombi (LACS), as well as the occurrence of the thromboembolic events in the first month after the procedure. STUDY DESIGN: A prospective study, including patients with persistent AF enrolled between January 1, 2015 and December 31, 2016, was conducted in 2 tertiary cardiology clinics. In all these patients, a management strategy based on EC was considered for the treatment of the disease. All patients received anticoagulant therapy for at least 3 weeks before cardioversion. The data of 103 patients were analyzed. RESULTS: The patients were divided into 2 groups: group A-VKAs treated-included 45 patients (43.68%), mean age 65.3 ± 12.47, 36% women; group B-NOACs treated-included 58 patients (56.31%), mean age 66.4 ± 9.79, 46% women. There was a trend toward higher incidence of left atrial thrombi in group B (16.28%) versus group A (7.69%), but the difference was not statistically significant (P = 0.5). The incidence of LACS was 40% in group A and 29% in group B, (P = 0.54). CONCLUSION: There are no statistically significant differences between the transesophageal echocardiography characteristics of left atrium and left atrial appendage examinations in the patients who received anticoagulation with VKAs as compared to patients who received anticoagulation with NOACs.

Synchrotron light-based µCT to analyse the presence of dentinal microcracks post-rotary and reciprocating NiTi instrumentation.

OBJECTIVES: The purpose of this study was to determine in vitro using a synchrotron radiation-based µCT (SRCT) whether rotary and reciprocating nickel titanium (NiTi) instrumentations lead to the formation of dentine microcracks. MATERIAL AND METHODS: Fourteen extracted human molars were obtained with ethical approval. Seven distobuccal roots of the maxillary molars and seven mesial roots of the mandibular molars were assigned to two experimental groups: (A) prepared with rotary Pro Taper instrumentation (n = 6) and (B) reciprocating WaveOne (n = 6). Irrigation with 1 % NaOCl and 17 % EDTA solutions was carried out. The remaining roots served as positive control with induced fractures (group C). SRCT was used to scan all samples pre and post-operatively. An imaging software was used to determine the number and length of microcracks. Statistical analyses weighed differences between pre and post-instrumentation and between shaping methods. RESULTS: A significant increase in the number and length of microcracks was detected post-shaping. No significant difference between rotary and reciprocating instrumentation was observed. CONCLUSIONS: Within the limitations of this in vitro study, an increased number and length of microcracks was induced by mechanical instrumentation. Reciprocating and rotary instrumentation are similar in terms of effect. CLINICAL SIGNIFICANCE: Dentinal damage may occur following rotary and reciprocating instrumentation.

Unlocking the self: Can microdosing psychedelics make one feel more authentic?

Background and aim: In the present study, we focus on the relationship between state authenticity - the experience of being true to oneself in a particular moment - and microdosing - a practice that implies repeatedly ingesting very small doses of psychedelics that do not reach the threshold for perceptual alterations. We propose that microdosing could increase state authenticity through influencing people's mood and the number and satisfaction with daily activities. Methods: We used self-assessments of state authenticity collected from 18 microdosers in the Netherlands across the period of 1 month for a total of 192 observations. Results: We found that on the microdosing day and the day thereafter, state authenticity was significantly higher. Furthermore, the number of activities and the satisfaction with them were higher on the day when participants microdosed, while the following day only the number of activities was higher. Both the number or activities and the satisfaction with them were positively related to state authenticity. Conclusion: We propose that feeling and behaving authentically could have a central role in explaining the positive effects of microdosing on health and wellbeing that are reported by current research.

Exploring the discourses around microdosing psychedelics within the r/microdosing online community.

In the present contribution, we examine the practice of microdosing psychedelics (microdosing) through textual analysis of the content produced by a dedicated online community, the r/microdosing subreddit. We collected a comprehensive dataset of publicly available submissions from this community and used structural topic modelling to identify and analyse the prevalent topics within the discussions. Through our analysis, we identified 16 distinct topics that mapped into clinical, human enhancement, as well as self-medication narratives. Notably, we found that the majority of discussions revolved around "how to" topics, supporting our argument that such online communities serve as essential information hubs, facilitating the dissemination of practical knowledge related to microdosing practices among the general population. The identified impact of the Covid-19 pandemic on the prevalence of discussion topics suggests that individuals within the online community may perceive microdosing primarily as a means of self-medication during times of heightened stress and uncertainty. Our findings contribute to the field of health sociology and psychedelic research by shedding light on the sociocultural factors influencing healthcare practices, including the role of online communities in facilitating processes of self-medicalization and self-medication.

Correction: Wilderink et al. A Theoretical Perspective on Why Socioeconomic Health Inequalities Are Persistent: Building the Case for an Effective Approach. Int. J. Environ. Res. Public Health 2022, 19, 8384.

In the original publication [...].

Sedation scales and measures--a literature review.

The monitoring and assessment of the degree of conscious sedation experienced by patients is important for both clinical practice and in research. Whereas clinical monitoring remains the gold standard for safety in patient care, numerous measures are available to supplement this and to provide quantitative data on level of sedation. This manuscript provides an overview of existing measures of the degree of sedation. Scales that have been used in published research were identified from a search of Medline and Google Scholar, and for each scale we identified the characteristics of the scale and degree to which the reliability and validity of the scale had been measured.

Occurrence of Types A and B Trichothecenes in Cereal Products Sold in Romanian Markets.

In view of the frequent occurrences of mycotoxins in cereals, this study assessed the presence of trichothecenes in 121 samples from Romanian markets. These samples were divided into five groups based on product type: (1) bread and bakery products containing white flour, (2) half-brown bread with whole wheat flour, (3) brown bread containing rye flour, (4) pasta, and (5) raw wheat. Gas Chromatography-Mass Spectrometry was used to detect 13 different mycotoxins, which included the Type A compounds HT-2 toxin and T-2 toxin, as well as the Type B compounds deoxynivalenol and nivalenol. Results indicated trichothecene contamination in 90.08% of our samples, with deoxynivalenol predominating by at least 78% in each examined group. Co-occurrence of three or four trichothecenes were found in 23.85% of our samples. Our study underscores the necessity of consistent monitoring of staple foods to prevent the intake of harmful trichothecenes by consumers.

Unnecessary hospitalisations and polypharmacy practices in Romania: A health system evaluation for strengthening primary health care.

Background: Children and pregnant women usually have multiple contacts with the health care system. While most conditions can be managed by primary health care (PHC) providers, hospitalisations are nevertheless common and often unjustified. The number of hospitalizations decreased in Romania at the start of the COVID-19 pandemic. While this is likely due to the disruption of health services and public health measures established to limit the spread of COVID-19, it also suggests that a proportion of hospitalisations prior to the pandemic were unnecessary. This healthcare system evaluation in Romania quantified unnecessary and unnecessarily prolonged hospitalisations in children, pregnant women and women hospitalised for delivery, and assessed antibiotic and polypharmacy practices in these groups. Methods: We conducted the healthcare system evaluation in 10 hospitals across the country. We extracted data from medical records of patients hospitalized between 2019 and 2020. In each hospital, we randomly selected 40 medical records for each of the following groups: children 2-59 months of age, pregnant women, and women hospitalised for delivery. Clinical data were compared against WHO standards indicating a need for inpatient treatment or antibiotic therapy. Results: Among 209 children and 349 pregnant women, unnecessary hospitalisations accounted for 57.9% and 56.2% of hospitalisations, respectively. Among necessary hospitalisations, a large proportion was unnecessarily prolonged, including 44.4% (n = 32/72) in children, 23.3% (n = 34/146) in pregnant women, and 45.8% (n = 110/240) in women after delivery. The proportion of unnecessary and unnecessarily prolonged hospitalisations did not differ between the pre-pandemic, the lockdown, and the post-lockdown periods. Antibiotics were prescribed to 53.1% (n = 43/81) of children with diarrhoea, while 50.8% (n = 61/120) of women with caesarean section received an unjustified prolonged course of antibiotics. Children and women were commonly prescribed unnecessary medications. Conclusions: Findings of this evaluation should inform evidence-based decisions and actions for strengthening PHC and the healthcare system structure and improving the management of common diseases in mothers, newborns, and children. The evaluation should be repeated periodically to monitor progress.

Genetic deletion of the P2Y2 receptor offers significant resistance to development of lithium-induced polyuria accompanied by alterations in PGE2 signaling.

Lithium (Li)-induced polyuria is due to resistance of the medullary collecting duct (mCD) to the action of arginine vasopressin (AVP), apparently mediated by increased production of PGE(2). We previously reported that the P2Y(2) receptor (P2Y(2)-R) antagonizes the action of AVP on the mCD and may play a role in Li-induced polyuria by enhancing the production of PGE(2) in mCD. Hence, we hypothesized that genetic deletion of P2Y(2)-R should ameliorate Li-induced polyuria. Wild-type (WT) or P2Y(2)-R knockout (KO) mice were fed normal or Li-added diets for 14 days and euthanized. Li-induced polyuria, and decreases in urine osmolality and AQP2 protein abundance in the renal medulla, were significantly less compared with WT mice despite the lack of differences in Li intake or terminal serum or inner medullary tissue Li levels. Li-induced increased urinary excretion of PGE(2) was not affected in KO mice. However, prostanoid EP(3) receptor (EP3-R) protein abundance in the renal medulla of KO mice was markedly lower vs. WT mice, irrespective of the dietary regimen. The protein abundances of other EP-Rs were not altered across the groups irrespective of the dietary regimen. Ex vivo stimulation of mCD with PGE(2) generated significantly more cAMP in Li-fed KO mice (130%) vs. Li-fed WT mice (100%). Taken together, these data suggest 1) genetic deletion of P2Y(2)-R offers significant resistance to the development of Li-induced polyuria; and 2) this resistance is apparently due to altered PGE(2) signaling mediated by a marked decrease in EP3-R protein abundance in the medulla, thus attenuating the EP3-mediated decrease in cAMP levels in mCD.

Chemical and Enzymatic Synthesis of Biobased Xylo-Oligosaccharides and Fermentable Sugars from Wheat Straw for Food Applications.

Xylo-oligosaccharides are sugar oligomers with 2~7 xylose units considered non-digestible fibers that can be produced from biodegradable and low-cost biomass like wheat straw. An integrated approach consisting of hydrothermal pretreatment, alkaline treatment, enzymatic treatment and the combinations thereof was applied to overcome the recalcitrance structure of the wheat straw and allow selective fractioning into fermentable sugars and xylo-oligosaccharides. The hydrolysates and processed solids were chemically characterized by High-performance liquid chromatography and Ion chromatography, and the results were expressed as function of the severity factor and statistically interpreted. The concentration of fermentable sugars (glucose, xylose, arabinose) was the highest after the combination of alkaline and enzymatic treatment with xylanase (18 g/L sugars), while xylo-oligosaccharides (xylotriose and xylotetraose) were released in lower amounts (1.33 g/L) after the same treatment. Refining experiments were carried out to obtain a purified fraction by using anion and cation exchange chromatography. The polymer adsorber resin MN-502 showed efficient removal of salts, phenols and furan derivatives. However, the xylo-oligosaccharides yields were also slightly reduced. Although still requiring further optimization of the treatments to obtain higher purified oligomer yields, the results provide information on the production of xylo-oligosaccharides and fermentable sugars from wheat straw for potential use in food applications.

A Theoretical Perspective on Why Socioeconomic Health Inequalities Are Persistent: Building the Case for an Effective Approach.

Despite policy intentions and many interventions aimed at reducing socioeconomic health inequalities in recent decades in the Netherlands and other affluent countries, these inequalities have not been reduced. Based on a narrative literature review, this paper aims to increase insight into why socioeconomic health inequalities are so persistent and build a way forward for improved approaches from a theoretical perspective. Firstly, we present relevant theories focusing on individual determinants of health-related behaviors. Thereafter, we present theories that take into account determinants of the individual level and the environmental level. Lastly, we show the complexity of the system of individual determinants, environmental determinants and behavior change for low socioeconomic position (SEP) groups and describe the next steps in developing and evaluating future effective approaches. These steps include systems thinking, a complex whole-system approach and participation of all stakeholders in system change.

Biofunctional soy-based sourdough for improved rheological properties during storage.

Frozen dough storage, along with its thawing process, negatively affects the quality of the final product. Thus, fermentation with selected cultures and the enrichment of wheat-based dough using a specific soy powder could optimize the viscoelastic quality of frozen dough and increase its nutritional characteristics. Based on these aspects, the present study's objective was to examine the effects of soy powder addition to wheat flour with single cultures of Fructilactobacillus florum DSM 22689 or Saccharomyces cerevisiae and coculture with these two microorganisms for 72 h of fermentation. Additionally, the fermentation process was monitored, and viscoelastic behavior and physical-chemical analyses of the fermented sourdough before and after frozen storage were assessed, as soy protein has been proposed to hinder water migration throughout frozen storage. As observed, soy powder, an essential functional ingredient, had a favorable impact on the water-starch-gluten system, and enhanced the viscoelastic behavior before and after 4 weeks of frozen storage.

Clustering and Correlations amongst NEFA, Selected Adipokines and Morphological Traits-New Insights into Equine Metabolic Syndrome.

Obesity is a common feature in horses suffering from metabolic syndrome. While adipokines involvement as biomarkers is better established in human pathology, little data are available on horses. This study aimed to investigate the possible association and relationship between selected metabolic parameters and morphological traits in equine metabolic syndrome. Adiposity was evaluated using body condition score (BCS) and cresty neck score (CNS). Plasma levels of total cholesterol, insulin, NEFA, and adipokines (omentin and chemerin) were determined using enzyme-linked immunosorbent assays. Spearman correlation, univariate linear regression analysis and hierarchical clustering were performed. Significant positive correlations were observed between NEFA and bodyweight (r = 0.322; p = 0.006), BCS (r = 0.295; p = 0.013), and CNS (r = 0.267; p = 0.024), total cholesterol and bodyweight (r = 0.262; p = 0.027), and omentin and CNS (r = 0.234; p = 0.049). Cluster analysis supported these results and provided more details on the relationships between studied variables within and between the four resulting groups. These findings highlight NEFA, chemerin, and omentin as valuable biomarkers that could be further analyzed in other horse breeds for a better understanding of equine metabolic pathology.

Mucosal-Associated Invariant T (MAIT) cells are highly activated in duodenal tissue of humans with Vibrio cholerae O1 infection: A preliminary report.

Mucosal-associated invariant T (MAIT) cells are unconventional T lymphocytes with a semi-conserved TCRα, activated by the presentation of vitamin B metabolites by the MHC-I related protein, MR1, and with diverse innate and adaptive effector functions. The role of MAIT cells in acute intestinal infections, especially at the mucosal level, is not well known. Here, we analyzed the presence and phenotype of MAIT cells in duodenal biopsies and paired peripheral blood samples, in patients during and after culture-confirmed Vibrio cholerae O1 infection. Immunohistochemical staining of duodenal biopsies from cholera patients (n = 5, median age 32 years, range 26-44, 1 female) identified MAIT cells in the lamina propria of the crypts, but not the villi. By flow cytometry (n = 10, median age 31 years, range 23-36, 1 female), we showed that duodenal MAIT cells are more activated than peripheral MAIT cells (p < 0.01 across time points), although there were no significant differences between duodenal MAIT cells at day 2 and day 30. We found fecal markers of intestinal permeability and inflammation to be correlated with the loss of duodenal (but not peripheral) MAIT cells, and single-cell sequencing revealed differing T cell receptor usage between the duodenal and peripheral blood MAIT cells. In this preliminary report limited by a small sample size, we show that MAIT cells are present in the lamina propria of the duodenum during V. cholerae infection, and more activated than those in the blood. Future work into the trafficking and tissue-resident function of MAIT cells is warranted.

Informal help in a local setting: The Dutch Social Support Act in practice.

The Dutch Social Support Act provides municipal social support for people that experience limitations in daily life and cannot rely on informal help from their social network to compensate these limitations. In this paper, we study whether the probability and intensity (number of services) of receiving municipal social support for daily limitations is affected by informal help by the social network (i.e. family, friends and neighbors). This study took place in Breda, a middle large city in the South of the Netherlands. We combined data from the Municipal Personal Records Database, the registration containing information on demographics and municipal social support receipt of all inhabitants, with data from the Municipality Policy Monitor, a survey containing information on daily limitations and informal help (n = 5256). We find that people experiencing daily limitations are more likely to receive municipal social support and also receive a higher number of support services (intensity). However, the perceived help from family and friends does not decrease either the probability or intensity of receiving municipal social support. Informal help from neighbors decreased the likelihood of receiving of municipal social support, but not the intensity. This implies that the overall relation between daily limitations and municipal social support is not different for people who indicate that they can or cannot rely on their informal network for help.

The relative effects of self-reported noise and odour annoyance on psychological distress: Different effects across sociodemographic groups?

In earlier research, both higher levels of noise and odour annoyance have been associated with decreased mental health. Presumably, these perceptions can trigger feelings of threat and stress reactions and in turn evoke psychological distress. There are two important lacunas in the research on this topic: most studies only consider either noise or odour annoyance and not their relative effect on psychological distress and there is scarce evidence about whether different sociodemographic groups experience more psychological distress due to noise and odour annoyance. Starting from the diversity in the available coping resources and in their daily life patterns, we distinguish gender, age and educational level as relevant sociodemographic variables. Using data from the Health Monitor (n = 25236) in Noord-Brabant, we found using Ordinary Least Squares Regression that individuals that reported higher levels of noise and odour annoyance reported higher levels of psychological distress. Furthermore, the effect of noise annoyance was relatively stronger compared to that of odour annoyance. Regarding the interaction effects, we found that younger adults' psychological distress was more strongly affected by noise annoyance compared to older adults, but not by odour annoyance. The psychological distress of individuals with no or primary education was more strongly affected by both noise and odour annoyance compared those with tertiary education, but not when compared to those who completed lower or higher secondary education. Contrary to our expectations, we did not find different effects between men and women. Though the evidence for the interactions was mixed, classic health inequalities along age and education lines are reinforced when considering the relationship between noise and odour annoyance and psychological distress.

Enrichment in Different Health Components of Barley Flour Using Twin-Screw Extrusion Technology to Support Nutritionally Balanced Diets.

Due to its good dietary role, barley has attracted a growing amount of interest for the manufacture of functional foods in recent years. In barley, a number of bioactive components, including as phenolic compounds, have been discovered, and barley extrudates could be used to formulate various processed foods, including ready-to-eat cereals, baby, and pet foods and support nutritionally balanced diets. This study was conducted to investigate the effect of extrusion processing on resistant starch (RS), glycemic index (GI), and antioxidant compounds of barley flour. The L * and ΔE values of barley flours decreased significantly (p < 0.05) after extrusion is done at 150 and 180°C. The a * and b * values, however, increased after extrusion. Extrusion increased antioxidant activity (AOA), metal chelating activity (MCA), and ABTS+ scavenging activity, whereas total phenolic content (TPC) and total flavonoids content (TFC) decreased. Barley extrudates at 150 and 180°C showed decreased TPC by 16.4-34.2% and 23.4-38.1%. Moreover, improved RS and reduced GI values were recorded for barley extrudates as compared to barley non-extrudates. Therefore, extrusion of barley could be an alternative to produce pregelatinized barley flour with improved RS low GI values and improved antioxidant potential.

Apple Pomace as a Sustainable Substrate in Sourdough Fermentation.

Innovations range from food production, land use, and emissions all the way to improved diets and waste management. Global apple production has amounted to over 87 million tons/year, while 18% are processed, resulting in 20-35% (apple fruit fresh weight) apple pomace (AP). Using modern AP management, integrated knowledge in innovative fermentation demonstrates opportunities for reducing environmental pollution and integration into a circular economy. With this association in view, integrating AP flour during sourdough fermentation increases the nutritional value, highlighting a new approach that could guide innovative fermented foods. In this study, the wheat flour (WF) and AP flour were mixed at different ratios, hydrated with water (1:1 w/v), and fermented using a selective culture of Fructilactobacillus florum DSM 22689 and baker's yeast (single and co-culture). Sourdough fermentation was monitored and analyzed for 72 h. Results suggested that AP may be an important source of organic acids and fermentable sugars that increase nutritional sourdough value. AP flour addition in WF had a positive effect, especially in fermentations with 95% WF and 5% AP, mainly in co-culture fermentation.