Neuromodulation in Psychiatric disorders: Experimental and Clinical evidence for reward and motivation network Deep Brain Stimulation: Focus on the medial forebrain bundle

Deep brain stimulation (DBS) in psychiatric illnesses has been clinically tested over the past 20 years. The clinical application of DBS to the superolateral branch of the medial forebrain bundle in treatment‐resistant depressed patients—one of several targets under investigation—has shown to be promising in a number of uncontrolled open label trials. However, there are remain numerous questions that need to be investigated to understand and optimize the clinical use of DBS in depression, including, for example, the relationship between the symptoms, the biological substrates/projections and the stimulation itself. In the context of precision and customized medicine, the current paper focuses on clinical and experimental research of medial forebrain bundle DBS in depression or in animal models of depression, demonstrating how clinical and scientific progress can work in tandem to test the therapeutic value and investigate the mechanisms of this experimental treatment. As one of the hypotheses is that depression engenders changes in the reward and motivational networks, the review looks at how stimulation of the medial forebrain bundle impacts the dopaminergic system.     

The identification of higher forefoot temperatures associated with peripheral arterial disease in type 2 diabetes mellitus as detected by thermography

Aims

The purpose of this study was to investigate whether heat emitted from the feet of patients with type 2 diabetes (DM) and peripheral arterial disease (PAD) differed from those with type 2 diabetes without complications (DM).

Intraoperative assessment of colorectal anastomotic integrity: a systematic review

Background

Surgeons have attempted to minimize postoperative anastomotic complications by employing intraoperative tests and manoeuvres to assess colorectal anastomotic integrity. These have evolved over time with improvement in operative technology and techniques. This systematic review aims to examine the impact of such intraoperative assessments.

Methods

A systematic review of studies assessing intraoperative anastomotic assessments and their impact on postoperative anastomotic complications was performed. Intraoperative measures undertaken as a result of intraoperative assessments and postoperative anastomotic complications were analysed.

Results

37 Studies were identified. 13 studies evaluated basic mechanical patency tests, ten studies evaluated endoscopic visualisation techniques and 14 studies evaluated microperfusion techniques. Postoperative anastomotic complications were significantly lower in patients tested with basic mechanical patency tests compared to those untested (non-RCT: 4.1 vs. 8.1 %, p = 0.03, RCTs: 5.8 vs. 16.0 %, p = 0.024). There were no differences in postoperative anastomotic complications between tested and non-tested cohorts in non-randomised cohort studies evaluating endoscopic visualisation techniques. However, intraoperative measures taken after abnormal intraoperative tests may have reduced the number of postoperative complications. Perfusion analysis techniques are not in routine widespread clinical practice as yet, but newer techniques such as fluorescent dyes and imaging under near infrared light show technical feasibility.

Conclusions

Intraoperative colorectal anastomotic assessment has evolved together with advancement of technology in the surgical setting. Moderate benefit in terms of lower postoperative anastomotic complications has been shown with basic mechanical patency testing and more recently with intraoperative endoscopic visualisation of colorectal anastomoses. The next advance and possible introduction into routine practice may include the use of microperfusion techniques. The latest in this group of techniques, which utilise autofluorescent dyes such as Indocyanine green, hold great potential. Well-planned controlled studies or ideally, randomised controlled trials need to be conducted to further assess the benefit of these latest techniques.     

Spheciosterol sulfates, PKCzeta inhibitors from a philippine sponge Spheciospongia sp

Three new sterol sulfates, spheciosterol sulfates A-C (1-3), and the known sterol sulfate topsentiasterol sulfate E (4) have been isolated from the sponge Spheciospongia sp., collected in the Philippines. Structures were assigned on the basis of extensive 1D and 2D NMR studies as well as analysis by HRESIMS. Compounds 1-4 inhibited PKCzeta with IC50 values of 1.59, 0.53, 0.11, and 1.21 microM, respectively. In a cell-based assay, 1-4 also inhibited NF-kappaB activation with EC50 values of 12-64 microM.     

Ethanol‐mediated promotion of oral carcinogenesis in hamsters: Association with lipid peroxidation

Pouches of male Syrian Golden hamsters were painted with 1% 7,12‐dimethylbenz[a]anthra‐cene (DMBA) three times for one week. One week after DMBA treatment, hamsters were fed an ethanolic diet and continued on this diet until they were killed 22 and 35 weeks after the start of the experiment. Phospholipids, cholesterol, indexes of lipid peroxidation (malondialdehyde, diene and triene conjugates, lipid fluorescence), and the antioxidants glutathione and vitamin E were determined in the buccal mucosa, as was the incidence of tumors. At 22 weeks, the relative proportion of cholesterol to phospholipids in ethanol‐consuming hamsters was significantly increased. At 35 weeks, most of the treatments showed a return of cholesterol vs. phospholipids toward that of untreated mucosa at 22 weeks. Ethanol consumption also increased the indexes of lipid peroxidation at 22 weeks; the largest increases occurred when ethanol use was combined with DMBA treatment. However, at 35 weeks such increases in lipid peroxidation had either returned to intermediate levels or were not different from the untreated controls at 22 weeks. Glutathione decreased in pouches of hamsters fed ethanol diets at 22 weeks, but at 35 weeks there was no appreciable difference. However, vitamin E increased significantly with ethanol consumption at 22 weeks, which increased further when combined with DMBA treatment, but at 35 weeks these values were intermediate. No tumors were seen at 22 weeks. At 35 weeks, DMBA‐treated ethanol‐fed hamsters had a significantly higher incidence of tumors, more multiple tumors per hamster with tumors, and more of the larger tumors than DMBA‐treated control‐fed hamsters. The results suggest that an increase in lipid peroxidation occurs with ethanol‐related tumor promotion processes, but this lipid peroxidation declines when tumors appear to be preceded by increases in cholesterol relative to phospholipids and increases in vitamin E.