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Developing lack of stability inside crazy Nigerian olive baboons (Papio anubis).
Purpose Identify a group with a high risk of postoperative complications after deep bowel endometriosis surgery. Methods We conducted a retrospective study on patients treated from 2012 to 2018 in two departments of gynecological surgery at the Toulouse University Hospital, France. The postoperative complications were evaluated in relation to the surgical management, associated with or without non-digestive surgical procedures, initial disease and patient's characteristics. Results 164 patients were included. A postoperative complication occurred in 37.8% (n = 62) of the cases and required a secondary surgery in 18.3% (n = 30) of the cases. In the univariate analysis, the risk of postoperative complications increased significantly in the presence of segmental resection, disease progression, and associated urinary tract procedure or vaginal incision. UPF 1069 order In the multivariate analysis, the risk of overall postoperative complications was associated with the surgical management (p = 0.013 and 0.017) and particularly in the presence of segmental resection [Odds Ratio (OR) 20.87; CI 95% (1.96-221.79)]. The risk of rectovaginal fistula increased in the presence of segmental resection [OR 22.71; CI 95% (2.74-188.01)] as well as in vaginal incision [OR 19.67; CI 95% (2.43-159.18); p = 0.005]. Conclusion The risk of overall postoperative complications and rectovaginal fistula in particular increases significantly in the presence of vaginal incision, segmental resection and urinary tract procedures after deep bowel endometriosis surgery.Purpose This study is performed to evaluate and compare the efficacy of cervical-lifting suture and lower B-Lynch suture in different severity of placenta previa associated with lower uterine segment bleeding. Methods We evaluated the effectiveness of cervical-lifting suture (n = 51) and lower B-Lynch suture (n = 137) in stopping the bleeding from lower uterine segment. Additionally, we used different statistical methods, including overall analysis, subgroup analysis and approximate randomization analysis, to evaluate the efficacy of the two assessments. Results The medical records of these 188 participants were extracted and all of the patients were followed up for six weeks. The majority of patients were multipara and complicated with previous cesarean delivery and abnormal adherent placenta. The median intraoperative blood loss and the median amount of red blood cell transfusion were lower in the cervical-lifting suture group in comparison to the lower B-Lynch suture group. Conclusion Our study provides evidence that cervical-lifting suture has less intraoperative blood loss and red blood cell transfusion for controlling lower uterine segment bleeding in placenta previa.Modern surgery is currently undergoing a significant change in the sense of the introduction of modern technologies and innovative techniques. Robotic-assisted surgery and modern techniques of visualization confront surgery with unprecedented challenges with respect to possible and meaningful areas of application for these innovations. If an innovation is not to remain only an interesting singularity as proof of feasibility and a sign of unchecked progress but is to have a fixed place within the framework of standardized treatment processes, firm regulations are required which flank the path from innovation to introduction into clinical practice. This overview article critically examines the deficits of the currently practiced models of introducing new technologies into the clinical practice and discusses new aspects that can improve the introduction of innovations with particular respect to patient safety.In humans, dynamic thermoregulation is (presumably) underpinned by a complex hierarchy of functional interactions between constituents of the human thermoregulatory large-scale network. However, these interactions have not been quantified from in vivo fMRI signals acquired during the experimental delivery of whole-body thermal stress. Here, we used directed functional connectivity (dFC) analysis (based on multi-variate autoregressive models) to recover directed interactions within a single thermoregulatory network during an experimental paradigm that involved controlled exposure to whole-body cooling and warming. MRI studies were performed in 30 young adults (15 M/15F, mean age 25.1 ± 3.4 years). Gradient echo EPI fMRI data were acquired on a 3 T Siemens Verio system. The thermoregulatory challenge was applied using a specialized whole-body garment covering the entire body. Tubes lining the innards of the suit were infused with cold (2-4 °C) or neutral (31-34 °C) water to induce whole-body Cooling or Warming induced ascending interactions from the homeostatic sub-network to notably the OFC (executive) and the insulae (interoceptive). Descending interactions were induced from the ACC and the OFC. Sparser effects appear from the executive to the interoceptive sub-network during warming. Our study demonstrates a hierarchical organization of thermoregulatory function between homeostatic, interoceptive and executive sub-networks. The observed information flow between/within these is consistent with a reentrant property of the hierarchical regulatory structure, characterized by the ongoing bi-directional exchange of signals along reciprocal axonal fibers linking the various nodes.Rationale Although both psilocybin and dextromethorphan (DXM) produce psychedelic-like subjective effects, rates of non-medical use of psilocybin are consistently greater than DXM. Objective New data are presented from a study of psilocybin and DXM relevant to understanding the features of psilocybin subjective effects that may account for its higher rates of non-medical use. Methods Single, acute oral doses of psilocybin (10, 20, 30 mg/70 kg), DXM (400 mg/70 kg), and placebo were administered under double-blind conditions to 20 healthy participants with histories of hallucinogen use. Results High doses of both drugs produced similar time courses and increases in participant ratings of peak overall drug effect strength. Nine subjective effect domains are proposed to be related to the reinforcing effects of psilocybin liking, visual effects, positive mood, insight, positive social effects, increased awareness of beauty (both visual and music), awe/amazement, meaningfulness, and mystical experience. For most ratings, (1) psilocybin and DXM both produced effects significantly greater than placebo; (2) psilocybin showed dose-related increases; 3, DXM was never significantly higher than psilocybin; (4) the two highest psilocybin doses were significantly greater than DXM. These differences were consistent with two measures of desire to take the drug condition again. Conclusions This analysis provides new information about domains of psilocybin subjective effects proposed to be related to its reinforcing effects (alternatively described as the "motivation" to use). Observed differences on these domains between psilocybin and DXM are consistent with the relative rates of non-medical use of psilocybin and DXM.Background This study investigated whether patterns of impulsive decision-making (i) differ between individuals with DSM-5 substance use disorders (SUD) or non-substance-related addictive disorders (ND) and healthy controls, and (ii) predict the increase of SUD and ND severity after one year. Methods In a prospective-longitudinal community study, 338 individuals (19-27 years, 59% female) were included in one of three groups SUD (n = 100), ND (n = 118), or healthy controls (n = 120). Group differences in four impulsive decision-making facets were analyzed with the Bayesian priors delay discounting (mean = 0.37, variance = 0.02), probability discounting for gains and for losses (each - 0.16, 0.02), and loss aversion (- 0.44, 0.02). SUD and ND severity were assessed at baseline and after 1 year (n = 312, 92%). Predictive associations between decision-making and SUD/ND severity changes were analyzed with the Bayesian prior mean = 0.25, variance = 0.016. Results Compared with controls, the SUD group displayed steeper delay discounting and lower probability discounting for losses; the ND group displayed lower probability discounting for losses (posterior probabilities > 98%). SUD symptom increase after 1 year was predicted by steeper delay discounting and lower loss aversion; ND symptom increase by lower probability discounting for losses and lower loss aversion (posterior probabilities > 98%). There was low evidence for predictive relations between decision-making and the quantity-frequency of addictive behaviours. Discussion Impulsive decision-making characterizes SUD and ND and predicts the course of SUD and ND symptoms but not the engagement in addictive behaviours. Strength of evidence differed between different facets of impulsive decision-making and was mostly weaker than a priori expected.Rationale 3,4-Methylenedioxypyrovalerone (MDPV) is a synthetic cathinone abused for its cocaine-like psychostimulant effects in "bath salts" products. While there are currently no pharmacotherapies for MDPV abuse, rodent studies suggest immunotherapy may offer a feasible treatment option. Objectives These studies tested the capacity of active vaccination to reduce the reinforcing effects of MDPV in Sprague-Dawley rats. Methods Rats acquired cocaine self-administration (0.32 mg/kg/inf) on an FR1 schedule. Dose-effect functions for cocaine (0.032-1.0 mg/kg/inf) and MDPV (0.001-0.32 mg/kg/inf) were determined under an FR5 schedule. Rats in the vaccine group were immunized during cocaine self-administration. All rats transitioned to a progressive-ratio (PR) schedule to establish breakpoints for cocaine (0.1-1.0 mg/kg/inf) and MDPV (0.01-0.32 mg/kg/inf). Responding was extinguished, and cue-induced and MDPV-primed reinstatement (0.56 mg/kg, IP) were evaluated. Results No endpoints of cocaine self-administration differed between groups, but the ED50 for MDPV self-administration was significantly lower in control relative to vaccinated rats. Under the PR schedule, MDPV was ~ 2.5-fold more potent in maintaining responding in control than vaccinated rats, but Emax was not different between groups. Vaccination did not reduce MDPV-primed reinstatement, perhaps due to a decrease in antibody titer. Conclusions Vaccination did not alter acquisition of cocaine self-administration, demonstrating pharmacological selectivity and suggesting that the vaccine did not affect learning or motivation, while effectively reducing the potency of MDPV as a reinforcer. The protective effects of the vaccine were surmounted by large unit doses of MDPV, suggesting maximal efficacy of drug-conjugate vaccines in substance abuse disorders will likely require concurrent behavior modification therapy.Rationale Posttraumatic stress disorder (PTSD) is a chronic condition that has wide-ranging negative effects on an individual's health and interpersonal relationships. Treatments with long-term benefits are needed to promote the safety and well-being of those suffering from PTSD. Objectives To examine long-term change in PTSD symptoms and additional benefits/harms after 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for treatment of PTSD. Methods Participants received two to three active doses of MDMA (75-125 mg) during blinded or open-label psychotherapy sessions with additional non-drug therapy sessions. PTSD symptoms were assessed using the Clinician-Administered PTSD Scale for DSM IV (CAPS-IV) at baseline, 1 to 2 months after the last active MDMA session (treatment exit), and at least 12 months post final MDMA session (LTFU). A mixed-effect repeated-measures (MMRM) analysis assessed changes in CAPS-IV total severity scores. The number of participants who met PTSD diagnostic criteria was summarized at each time point.
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