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Free fatty acids correlate with the interleukin-1 beta and interleukin-1 receptor antagonist in the early subacute phase of stroke
No full textInflammation contributes to the pathogenesis of ischaemic stroke both as a long-term causal factor and through the inflammatory cascade in acute stroke. Interleukin-1 beta (IL-1β) is a potent pro-inflammatory molecule, while interleukin-1 receptor antagonist (IL-1Ra) acts as its antagonist. Free fatty acids (FFAs) play a role in atherosclerosis formation and serve as substrates for inflammatory molecules. This study aimed to determine the potential interplay between FFAs, IL-1β, and IL-1Ra in stroke patients. A prospective analysis was conducted on 73 ischaemic stroke patients. All participants had their FFA, IL-1β, and IL-1Ra levels assessed. Significant correlations between IL-1β and certain FFAs were detected: C15:0 pentadecanoic acid (rho = 0.488), C15:1 cis-10 pentadecanoic acid (rho = 0.473), C17:1 cis-10 heptadecanoic acid (rho = 0.411), C18:0 stearic acid (rho = 0.302), C24:0 lignoceric acid (rho = −0.280), C24:1 nervonic acid (rho = −0.276), C18:2n6t linoleic acid (rho = −0.272), C17:0 heptadecanoic acid (rho = 0.241), and C13:0 tridecanoic acid (rho = 0.238). After multivariate analysis C15:0 pentadecanoic acid remained statistically significant. The strongest correlation was found between IL-1Ra and fatty acids: C15:1 cis-10-pentadecanoid acid (rho = −0.357), C18:2n6t linoleic acid (rho 0.341) and C24:1 nervonic acid (rho 0.302), but after multivariate analysis significantly correlated remained: C22:1n9 13 erucic acid (rho = 0.299), C18:3n6 gamma-linoleic acid (rho = 0.277), with close to significant correlation with C22:4n6 docosatetraenoate (rho = −0.241, p = 0.055). Certain FFAs may play a role in enhancing both pro- and anti-inflammatory responses in the early subacute phase of stroke, where inflammatory and resolving processes are ongoing. Fatty acids such as C15:0 pentadecanoic acid, C15:1 cis-10 pentadecanoic acid and C22:4n6 docosatetraenoate might be involved in pro-inflammatory responses, while C22:1n9 13 erucic acid and C18:3n6 gamma-linoleic acid in the anti-inflammatory pathways with the overlay of IL-1β and IL-1Ra.https://www.mdpi.com/2218-273X/15/11/153
Investigating the disturbance in cortical glutamate and GABA function in psychosis and its origins and consequences
No full text© The Author(s) 2025. Open Access This article is licensed under a Creative Commons
Attribution 4.0 International License, which permits use, sharing,
adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative
Commons licence, and indicate if changes were made. The images or other third party
material in this article are included in the article's Creative Commons licence, unless
indicated otherwise in a credit line to the material. If material is not included in the
article's Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly
from the copyright holder. To view a copy of this licence, visit http://
creativecommons.org/licenses/by/4.0/.We investigated the longstanding idea that the onset of psychotic symptoms in schizophrenia arises from an early phase of glutamate neurotoxicity, possibly related to loss of GABA restraint, oxidative stress or inflammation, that cumulatively results in a later phase of synaptic loss in keeping with magnetic resonance spectroscopy (MRS) evidence of reduced glutamate in schizophrenia, especially in older patients. We evaluated this hypothesis in a 3-centre MRS study to determine whether abnormalities in glutamate in dorsal anterior cingulate cortex (dACC) differed between people with minimally treated ‘Recent’ onset schizophrenia and an ‘Established’ group with > 10 years of illness. We tested the hypothesised mechanisms of reduced GABA in either or both dACC and occipital cortex, and depletion of dACC glutathione, a measure of central inflammation. We explored predicted associations between MRS variables, circulating cytokines and clinical symptoms. The Established group showed significantly greater dACC glutamate deficit than the Recent group which was not accounted for by lifetime exposure to antipsychotic drugs or by their greater CRP or IL-6 levels nor was the deficit associated with glutathione depletion. The greater dACC glutamate deficit in established illness is compatible with loss of synapses occurring after onset of symptoms but there was little to suggest underpinning excitotoxicity, inflammation, or oxidative stress. GABA was reduced in patients versus controls across dACC and occipital voxels. Only dACC GABA content correlated significantly with symptoms, lower content with greater positive and negative symptoms across both groups and this is supportive of a pathophysiological role of GABA in psychosis.https://www.nature.com/articles/s41380-025-03337-
Implementation strategies for inpatient continuous glucose monitoring-based diabetes management: a systematic review.
No full textINTRODUCTION: Continuous glucose monitoring (CGM) provides real-time glucose data that has revolutionised outpatient diabetes care; however, its impact on inpatient care remains limited, likely due to the lack of standardised CGM-based insulin titration protocols, implementation strategies, and proper familiarity with the technology among others. METHODS: A systematic literature search was conducted on October 15, 2024, using PubMed and Embase, without a restriction on publication date. The search focused on CGM-based insulin titration protocols and related implementation strategies in non-intensive care unit (non-ICU) settings. This systematic review was registered with PROSPERO (RD42024596819). RESULTS: A total of 7,625 references were screened. Nine protocols for inpatient CGM-based insulin titration and related implementation strategies were identified. Six protocols recommended a weight-based basal-bolus insulin regimen. Insulin titration on basal and bolus insulin was mostly done daily based on either clinical discretion or clearly defined insulin titration protocols. All protocols employed a hybrid approach, utilising both CGM and finger prick glucose testing to guide glucose management. Diabetes-trained staff oversaw CGM-based insulin titration and glucose management in five protocols. CGM-alarm settings varied widely, with hyperglycaemic alarm thresholds between >13.9 and >22.2 mmol/l, and hypoglycaemia alarm thresholds between <3.9 and <5.0 mmol/l. CONCLUSION: We observed considerable variation in the detail and clarity provided by the reviewed protocols. This highlights the need for standardised operational protocols for CGM-based insulin titration and related implementation strategies to implement CGM effectively in non-ICU settings
Spontaneous Jejunal perforation in coeliac disease: diagnostic dilemma and navigating treatment beyond gluten-free diet in the absence of refractory disease.
Get PDFExamining the effects of mental health literacy on stigma : study of Zimbabwe Prisons and Correctional Service (ZPCS)
Get PDF© The Author(s), 2025. Published
by Cambridge University Press on
behalf of Royal College of
Psychiatrists. This is an Open
Access article, distributed under
the terms of the Creative
Commons Attribution licence
(https://creativecommons.org/
licenses/by/4.0/), which permits
unrestricted re-use, distribution
and reproduction, provided the
original article is properly cited.Background Mental illness affects an estimated 500 million people globally, with 85% living in low- and medium-income countries (LMICs). Research has shown that people with mental illness are over-represented in the criminal justice system compared with the general population. There is limited information available on institutional attitudes towards mental illness in LMICs. Aims This study aimed to examine mental health literacy (MHL) and mental health stigma (MHS) among Zimbabwe Prisons and Correctional Service (ZPCS) officers. Method A cross-sectional study using an online survey was conducted among ZPCS officers (N = 163) between August and December 2022. Data were collected using the Mental Health Literacy Scale (MHLS) and Attitudes Towards Mentally Ill Offenders (ATMIO). The primary hypothesis was that increased MHL is inversely related to MHS in this group. Results A significant inverse correlation was found between MHL and MHS (r = 0.36, P < 0.001). A regression analysis controlling for age and sex showed that MHLS is a statistically significant component in this model, indicating that MHL is associated with reduced MHS (P < 0.001). Conclusions In this group, increased MHL is associated with decreased MHS. This suggests that interventions to increase MHL should be further evaluated in these settings. Copyright © 2025 The Author(s).https://www.cambridge.org/core/journals/bjpsych-international/article/examining-the-effects-of-mental-health-literacy-on-stigma-study-of-zimbabwe-prisons-and-correctional-service-zpcs/7BD6C9183F54CD2447C1E5D463D7402
Intracorporeal versus extracorporeal anastomosis in laparoscopic total gastrectomy: a systematic review and meta-analysis.
Get PDFBACKGROUND: To evaluate outcomes of intracorporeal (IOJ) versus extracorporeal (EOJ) oesophagojejunostomy following laparoscopic total gastrectomy (LTG) for the treatment of gastric cancer. METHODS: A comprehensive search of various electronic databases was conducted. Comparative studies of IOJ versus EOJ following LTG in patients with gastric malignancy were included. Primary outcomes were anastomotic leak, anastomotic bleeding, and anastomotic stricture formation. Secondary outcomes included operative time, length of hospital stay (LOS), volume of intra-operative haemorrhage, number of harvested lymph nodes, time to flatus, time to soft diet, intra-abdominal infection, pulmonary infection, surgical site infection (SSI), duodenal stump leak, pancreatic fistula occurrence, postoperative ileus, re-operation, and mortality. Combined overall effect sizes were calculated using the random-effects model, and the Newcastle-Ottawa Scale was used to assess risk of bias. RESULTS: Seventeen non-randomised studies enrolling 2,960 patients divided between an IOJ (n = 1430) and EOJ (n = 1530) group were included. IOJ was associated with significantly lower risk of anastomotic stricture (P = 0.01), volume of intra-operative bleeding (P = < 0.001), and SSI (P = 0.04) compared to EOJ. No difference was found in anastomotic leak (P = 0.93); anastomotic bleeding (P = 0.35); operative time (P = 0.63); LOS (P = 0.30); lymph node yield (P = 0.17); time to first flatus (P = 0.77); time to resumption of soft diet (P = 0.32); intra-abdominal infection (P = 0.22); pulmonary infection (P = 0.45); duodenal stump leak (P = 0.46); pancreatic fistula occurrence (P = 0.16); and paralytic ileus (P = 0.59), re-operation (P = 0.50), and mortality (P = 0.23) between the two groups. CONCLUSIONS: LTG for gastric malignancy with IOJ may be associated with lower risk of anastomotic stricture and SSI compared to the extracorporeal approach. However, future adequately powered randomized studies are needed to compare the two techniques
Magnetic resonance spectroscopy and the menstrual cycle : a multi-centre assessment of menstrual cycle effects on GABA & GSH
Get PDF© 2025 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)BACKGROUND: Gamma-aminobutyric acid (GABA) and glutathione (GSH) play a significant role in the functioning of a healthy brain and can both be quantified using magnetic resonance spectroscopy (MRS). Several small-scale studies have suggested MRS measured GABA may fluctuate with the menstrual cycle, but the effects on GSH are unknown. Utilising recent developments in MRS acquisition, this multi-lab study explores this issue across 4 distinctive brain regions. NEW METHODS: Data were analysed from 12 independent sites from which a total of 30 women were scanned during three phases of their menstrual cycle corresponding to early follicular, ovulation and mid luteal phases. HERMES and HERCULES sequences were used to measure GABA and GSH in voxels located in the left motor cortex, left posterior insular, medial parietal and medial frontal. Linear mixed models were used to assess the variability contributed by site, participant and menstrual cycle phase. RESULTS: Similar variance was attributed to site and menstrual cycle phase for both GABA and GSH data. No systematic changes in GABA or GSH were revealed for any voxel as a consequence of menstrual cycle phase. COMPARISON WITH EXISTING METHODS: Despite our larger sample size and inclusion of more brain regions we fail to replicate previous findings of GABA change as a consequence of menstrual cycle phase. We also show for the first time that MRS measures of GSH so not significantly alter with cycle. CONCLUSIONS: Our findings suggest that the menstrual cycle has minimal impact on MRS measures of GABA and GSH. The presence of a menstrual cycle should not be used as justification for exclusion of women in MRS studies.https://www.sciencedirect.com/science/article/pii/S016502702500071
Seminal contributions of Timothy J. Crow
Get PDF© The Author(s), 2025. Published by Cambridge
University Press. This is an Open Access article,
distributed under the terms of the Creative
Commons Attribution licence (http://
creativecommons.org/licenses/by/4.0), which
permits unrestricted re-use, distribution and
reproduction, provided the original article is
properly cited.We recall the life and work of Timothy J. Crow, whose contributions provided great insights into the pathophysiology of schizophrenia and continue to shape many questions in the field. We compile his key works relating to psychotic disorders, focusing on the trajectory of his theoretical stance. Our account is interlaced with our own interpretation of the evidence that influenced Crow's arguments over the years as well as his scientific method. Crow has had a significant impact on the neuroscience of schizophrenia. Many of his observations are still valid and several questions he raised remain unanswered to date.https://www.cambridge.org/core/journals/psychological-medicine/article/seminal-contributions-of-timothy-j-crow/25B0EA70F496D0D3351937E44ADDD45
International expert consensus on a structured approach to robotic multiport right hemicolectomy with complete mesocolic excision and intracorporeal anastomosis.
Get PDFAIM: To develop and operationally define 'performance metrics' that characterize a reference approach to robotic multiport right hemicolectomy with complete mesocolic excision (CME) and intracorporeal anastomosis (ICA) and to obtain evidence supporting face and content validity through a consensus meeting. METHOD: Three expert colorectal surgeons with advanced minimally invasive surgical experience, a senior behavioural scientist and a colorectal surgeon with experience in performance metrics development formed the Metrics Group. Published guidelines, clinical evidence, training materials and unedited videos of robotic multiport right hemicolectomy were used to deconstruct the task-robotic right hemicolectomy with CME and ICA-into defined, observable performance units or metrics (i.e. procedure Phases, Steps, Errors and Critical Errors). The performance metrics were then subjected to detailed review by nine expert colorectal surgeons in a modified Delphi process. RESULTS: Performance metrics for robotic multiport right hemicolectomy with CME and ICA were deconstructed and described as 15 procedure phases with 124 steps, all of them associated with 146 errors and 136 critical errors. After the modified Delphi process, the agreed performance metrics consisted of 15 procedure phases and 125 steps, 150 errors and 139 critical errors. After discussion, agreed modifications to the metrics an international group of expert colorectal surgeons reached 100% consensus on them, thus providing evidence to support the face and content validity of the metrics. CONCLUSION: Robotic multiport right hemicolectomy with CME and ICA can be broken down into explicitly defined procedure phases and steps, with errors and critical errors known as performance metrics. We consider the metrics imperative for the development of a safe and structured training in robotic multiport right hemicolectomy with CME and ICA
Environmental sustainability in pediatric otolaryngology: An international survey of operating room practice patterns.
Get PDFObjectives: The primary objective of this study was to evaluate international practice patterns related to environmental sustainability in pediatric otolaryngology ORs, with a focus on the use of single-use versus reusable supplies. Methods: An electronic survey was distributed using REDCap to members of an international pediatric otolaryngology WhatsApp group (n = 324). The survey included multiple-choice, Likert-scale, and open-ended questions regarding drape, gown, and glove usage for adenotonsillectomy, ear tube insertion, and laryngoscopy/bronchoscopy procedures, and broader sustainability practices including barriers and enablers. Results: Response rate was 16.0 % (n = 52/324). Respondents were from North America (30.8 %), Europe (25.0 %), Australia/New Zealand (23.1 %), Asia (15.4 %), South America (3.8 %), and Africa (1.9 %). For adenotonsillectomy 61.5 % reported using single-use patient drapes, 61.5 % use single-use table drapes, and 44.2 % use single-use gowns. For ear tube insertions, single-use table drapes (53.8 %) were most frequently reported; single-use patient drapes (38.4 %) and gowns (21.2 %) were less common. For laryngoscopy/bronchoscopy, the majority did not use patient drapes (31.4 %) or gowns (32.7 %), while 62.8 % use single-use table drapes. Top barriers to improving sustainability in the OR were cost (51.9 %) and infection prevention and control (IPAC) practices (44.2 %). Enablers included sufficient technological (46.2 %) and financial (36.6 %) resources, dedicated policies (30.8 %), and supportive leadership (34.6 %). Conclusion: There remains a strong reliance on single-use materials in pediatric otolaryngology ORs globally. Cost, IPAC, education, and leadership are important considerations in sustainability efforts. These findings identify actionable targets for waste reduction and support the need for specialty-specific sustainability interventions.https://www.sciencedirect.com/science/article/pii/S0165587625003192?via%3Dihu