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عندما لا يكون الاعتذار كافيا : إصلاح الأمور مع من تحب
يتحدث هذا الكتاب عندما لا يكون الاعتذار كافيا إصلاح الأمور مع من تحب، كتاب يبين أنه حتى في أفضل العلاقات، يقترف كل منا أخطاء، نقول ونفعل أشياء كثيرة نندم عليها فيما بعد، ونجرح من نحبهم بصورة أو بأخرى، سواء كان هذا بقصد أو بدون، ولذا نحتاج إلى إصلاح الأمور معهم، لكن مجرد قول (أنا آسف) عادة لا يعد كافيا، فيسلط الكتاب الضوء على أهم طرق الاعتذار وكيف نتعامل بها ومعها.
Book
Expanding therapeutic options in Crohn's disease
Use of a treat-through study design allows evaluation of both induction and maintenance without the need for re-randomisation, and might improve understanding of long-term treatment effects including in initial non-responders, whereas also avoiding carry-over of drug effect in those re-randomised from active drug to placebo. 6 However, it does differ from clinical practice, in which clinicians would not persist with a drug therapy without initial benefit. Absence of disability and restoration of quality of life are two other key targets, 10 with treatment of fatigue central to success yet often neglected. 11 Therefore, it was encouraging to note a statistically significant improvement in a well validated fatigue score in patients treated with mirikizumab. [...]the development of validated biomarkers that reliably predict treatment response remains a huge unmet need, and will be essential if we are to fully leverage the rapidly expanding treatment armamentarium at our disposal, and select the right drug, for the right patient, at the right time.
Journal Article
Head-to-head biologic therapy in Crohn's disease
The therapeutic armamentarium for the chronic inflammatory bowel diseases—Crohn's disease and ulcerative colitis—is rapidly expanding, yet treatment failure remains common, with substantial impact upon patients’ quality of life and health-care costs, including hospitalisation and surgery.1 There is increasing emphasis on the attainment of deep remission with mucosal healing in the hope of improving outcomes,2 leading to a shift in treatment paradigm towards top-down therapy, with early use of biologic therapy increasingly favoured over conventional therapy (corticosteroids and immunomodulators). Combination therapy reduces immunogenicity, which has been associated with anti-TNF treatment failure.8 The clinical benefits of co-immunosuppression appear to be stronger for infliximab than adalimumab, with the largest randomised trial comparing adalimumab monotherapy versus combination therapy with azathioprine reporting enhanced endoscopic healing, but not clinical remission, at week 26 in the combination therapy group.9 In SEAVUE, immunogenicity rates in patients who received adalimumab reached 74% by week 52, with low-concentration antibody titre inversely related to trough serum drug concentration, versus only 2% in patients who received ustekinumab. [...]at a time of ever-increasing strain on health-care budgets, it should be noted that adalimumab is now widely available as a generic biosimilar, with associated cost savings.
Journal Article
Plasticity Is Key to Success of Drosophila suzukii (Diptera: Drosophilidae) Invasion
After its initial discovery in California in 2008, Drosophila suzukii Matsumura has become one of the most important invasive agricultural pest insects across climate zones in much of Asia, Europe, North America, and South America. Populations of D. suzukii have demonstrated notable behavioral and physiological plasticity, adapting to diverse environmental and climatic conditions, interspecific competition, novel food sources, and potential predators. This adaptability and plasticity have enabled rapid range expansion and diversified niche use by D. suzukii, making it a species particularly suited to changing habitats and conditions. This article reviews factors and evidence that influence plasticity in D. suzukii and promotes this species’ invasiveness.
Journal Article
Inflammatory Bowel Disease Through the Lens of Single-cell RNA-seq Technologies
Abstract
The intestinal mucosa represents a unique environment where the coordinated function of diverse epithelial, mesenchymal, and immune cells maintains a physiologically balanced environment in the presence of gut microbiota. The intestinal mucosa plays a central role in the pathogenesis of inflammatory bowel disease (IBD), yet the molecular and cellular composition of this diverse environment is poorly understood. However, the recent advent of multimodal single-cell technologies, including single-cell RNA sequencing (scRNA-seq), now provides an opportunity to accurately map the tissue architecture, characterize rare cell types that were previously overlooked, and define function at a single-cell level. In this review, we summarize key advances in single-cell technology and provide an overview of important aspects of computational analysis. We describe emerging data in the field of IBD and discuss how the characterization of novel intestinal mucosa cell populations is reshaping our understanding of this complex disease. We conclude by considering the potential clinical applications, including the definition of novel drug targets and the opportunity for personalization of care in this exciting new era of precision medicine.
This review describes the recent advent of multimodal single-cell technologies, including single-cell RNA sequencing, and discusses how characterization of novel intestinal mucosa cell populations in health and IBD may have potential clinical applications, including drug discovery and personalization of care.
Journal Article
Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response
ObjectivesWe aimed to determine whether changes in acute severe colitis (ASC) management have translated to improved outcomes and to develop a simple model predicting steroid non-response on admission.DesignOutcomes of 131 adult ASC admissions (117 patients) in Oxford, UK between 2015 and 2019 were compared with data from 1992 to 1993. All patients received standard treatment with intravenous corticosteroids and endoscopic disease activity scoring (Ulcerative Colitis Endoscopic Index of Severity (UCEIS)). Steroid non-response was defined as receiving medical rescue therapy or surgery. A predictive model developed in the Oxford cohort was validated in Australia and India (Gold Coast University Hospital 2015–2020, n=110; All India Institute of Medical Sciences, New Delhi 2018–2020, n=62).ResultsIn the 2015–2019 Oxford cohort, 15% required colectomy during admission vs 29% in 1992–1993 (p=0.033), while 71 (54%) patients received medical rescue therapy (27% ciclosporin, 27% anti-tumour necrosis factor, compared with 27% ciclosporin in 1992–1993 (p=0.0015). Admission C reactive protein (CRP) (false discovery rate, p=0.00066), albumin (0.0066) and UCEIS scores (0.015) predicted steroid non-response. A four-point model was developed involving CRP of ≥100 mg/L (one point), albumin of ≤25 g/L (one point), and UCEIS score of ≥4 (1 point) or ≥7 (2 points). Patients scoring 0, 1, 2, 3 and 4 in the validation cohorts had steroid response rates of 100, 75.0%, 54.9%, 18.2% and 0%, respectively. Scoring of ≥3 was 84% (95% CI 0.70 to 0.98) predictive of steroid failure (OR 11.9, 95% CI 10.8 to 13.0). Colectomy rates in the validation cohorts were were 8%–11%.ConclusionsEmergency colectomy rates for ASC have halved in 25 years to 8%–15% worldwide. Patients who will not respond to corticosteroids are readily identified on admission and may be prioritised for early intensification of therapy.
Journal Article
Overcoming Technological Inequity in Synchronous Online Learning
The recent coronavirus disease of 2019 (COVID-19) pandemic possibly represents a catalyst for broader changes looming ahead for higher education, which includes a shift to online learning. Researchers have proven synchronous learning components to reduce the transactional distance that students experience in online learning environments, and such components play an important role in many information systems (IS) courses. However, students who cannot reliably access the technological resources that they need for synchronous learning remain left behind in these learning environments. We summarize strategies that individual IS faculty and institutional information technology (IT) departments can implement to assist such students. Faculty-level strategies include implementing complementary asynchronous features, clearly communicating expectations, and implementing intervention strategies to foster collaborative work. Institutional solutions include providing software applications via the cloud for students who need to access them remotely and loaning computer resources such as laptops to students who lack them and effectively training faculty and students in online learning. These measures will help higher education institutions to bridge the transactional distance that students experience as online learning becomes more prevalent in the months and years ahead.
Journal Article
Considerations for Insect Learning in Integrated Pest Management
The past 100 yr have seen dramatic philosophical shifts in our approach to controlling or managing pest species. The introduction of integrated pest management in the 1970s resulted in the incorporation of biological and behavioral approaches to preserve ecosystems and reduce reliance on synthetic chemical pesticides. Increased understanding of the local ecosystem, including its structure and the biology of its species, can improve efficacy of integrated pest management strategies. Pest management strategies incorporating insect learning paradigms to control insect pests or to use insects to control other pests can mediate risk to nontarget insects, including pollinators. Although our understanding of insect learning is in its early stages, efforts to integrate insect learning into pest management strategies have been promising. Due to considerable differences in cognitive abilities among insect species, a case-by-case assessment is needed for each potential application of insect learning within a pest management strategy.
Journal Article
Caecal surprise
Intussusception in adults is a rare phenomenon, with 95% of cases occurring in the paediatric population.1 It can lead to life-threatening intestinal obstruction, and in adults, unlike in children, it has a pathological lead point in up to 90% of cases with two thirds due to malignancy.2 Importantly, it can present insidiously and typical symptoms such as abdominal pain, vomiting and bloody stools occur infrequently, making the clinical diagnosis difficult. [...]the cause of intussusception in children is often idiopathic, so ultrasound is the preferred imaging modality which avoids radiation exposure. Reduction is recommended with an air or barium enema as first line, though some cases may require subsequent surgical intervention.3 While the GI tract is the most common site for extranodal lymphoma, with the majority being non-Hodgkin type, it is usually secondary to widespread nodal disease.
Journal Article
Endoscopic characterization of neoplastic and non-neoplastic lesions in inflammatory bowel disease: systematic review in the era of advanced endoscopic imaging
Background:
Current guidelines strongly recommend the use of validated classifications to support optical diagnosis of lesions with advanced endoscopic imaging in the lower gastrointestinal tract. However, the optimal strategy in inflammatory bowel disease (IBD) is still a matter of debate.
Objectives:
To analyze the accuracy of endoscopic classifications or single predictors for in vivo lesion characterization during endoscopic surveillance of IBD with advanced endoscopic imaging.
Design:
Systematic review.
Data sources and methods:
Medline and PubMed were used to extract all studies which focused on lesion characterization of neoplastic and non-neoplastic lesions in IBD. The diagnostic accuracy of endoscopic classifications and single endoscopic predictors for lesion characterization were analyzed according to type of patients, lesions, and technology used. When available, the rates of true and false positives or negatives for neoplasia were pooled and the sensitivity (SE), specificity (SP), positive predictive value, and negative predictive value (NPV) were calculated.
Results:
We included 35 studies (2789 patients; 5925 lesions – 1149 neoplastic). Advanced endoscopic imaging included dye-based chromoendoscopy, virtual chromoendoscopy (VCE), magnification and high-definition endoscopy, confocal laser endomicroscopy (CLE), endocytoscopy, and autofluorescence imaging. The Kudo classification of pit patterns was most frequently used, with pooled SE 83%, SP 83%, and NPV 95%. The endoscopic criteria with the highest accuracy, with minimum SE ⩾ 90%, SP ⩾ 80%, and NPV ⩾ 90% were: the Kudo-IBD classification used with VCE (Fuji Intelligent Color Enhancement and i-SCAN); combined irregular surface and vascular patterns used with narrow band imaging; the Mainz classification used with CLE. Multiple clinical and technical factors were found to influence the accuracy of optical diagnosis in IBD.
Conclusion:
No single endoscopic factor has yet shown sufficient accuracy for lesion characterization in IBD surveillance. Conventional classifications developed in the non-IBD setting have lower accuracy in IBD. The use of new classifications adapted for IBD (Kudo-IBD), and new technologies based on in vivo microscopic analysis show promise.
Journal Article