bluuebunny/crossref_metadata_2025 huggingface dataset:
Japanese subgroup analysis of GLIMMER: A global Phase IIb study of linerixibat for the treatment of cholestatic pruritus in patients with primary biliary cholangitis
Authors: Tanaka Atsushi , Atsukawa Masanori , Tsuji Keiji , Notsumata Kazuo , Suyama Akari , Ito Hiroshi , Das Sugato , von Maltzahn Robyn , McLaughlin Megan M.
Published: March 2023

Aim

To compare patient characteristics and outcomes between the overall and Japanese populations of GLIMMER.

Methods

GLIMMER was a multicenter, double‐blind, randomized, placebo‐controlled, Phase IIb study evaluating linerixibat for the treatment of pruritus in patients with primary biliary cholangitis.

Results

In total, 147 patients were randomized in the GLIMMER overall population with 38 patients comprising the Japanese population. Demographics and baseline clinical characteristics were similar across treatment groups and between both populations. A reduction in mean worst daily itch score from baseline to week 16 (primary endpoint) was seen in all groups, with the largest reduction observed with linerixibat 40 mg twice daily (BID; −2.92 [95% confidence interval: −5.07, −0.76] and −2.86 [95% confidence interval: −3.76, −1.95] for Japanese and overall populations, respectively). The highest proportion of responders was generally in the 40 mg BID group in both populations regardless of the responder definition applied. Improvements in health‐related quality of life were generally consistent in both populations. In the Japanese and overall populations, on‐treatment drug‐related adverse events were reported in 25% and 19% of patients in the placebo group and 0%–86% and 31%–78% of patients in the linerixibat groups, respectively. Consistent with the mechanism of action, the most common events were gastrointestinal in nature. The effects of linerixibat on pharmacodynamic biomarkers favored BID dosing.

Conclusions

Therapeutic responses and safety of linerixibat were consistent between the Japanese and overall populations of GLIMMER. Linerixibat may provide an effective treatment option for cholestatic pruritus in patients with primary biliary cholangitis.

Clinical Trial Registration

NCT02966834.
Patient public involvement (PPI) in health literacy research: Engagement of adults with literacy needs in the co‐creation of a hospital‐based health literacy plan
Authors: McKenna Verna B. , Sixsmith Jane , Byrne Niki
Published: March 2023

Background

People with literacy needs can experience many challenges in accessing, understanding and using health services and health information. Such challenges can adversely impact patient‐provider interactions and ultimately, health outcomes. Healthcare providers need to be aware of health literacy (HL) to address the demands of healthcare systems, improve their interactions with communities and patients and promote patient engagement for improved health outcomes.

Methods

This paper reports on a process of patient and public involvement (PPI) with participants in an adult literacy programme acting as PPI contributors to identify priority areas for a local hospital HL action plan and to develop a protocol for a PPI process with other groups. A qualitative community‐based participatory research study design informed by principles of PPI was undertaken, drawing on the tools of participatory and visual methods, open discussion and workshop format to facilitate a process of co‐creation. Three workshops with six PPI contributors took place to identify issues to be included in the hospital action plan. PPI contributors identified issues and grouped these into priority areas using discussion and ranking procedures.

Results

Key areas prioritised for HL action by the PPI contributors were: verbal communication, emphasising the patient's right to understand, and improved understanding of medication use. These were incorporated into the action plan. The workshop format and process were deemed acceptable to the group and input on improvements will be incorporated into further work in this area.

Conclusion

PPI acts as a lever in the knowledge translation process. Genuine engagement with service users can meaningfully contribute to relevant and sustainable changes to services as well as foster the empowerment of service users.

Patient or Public Contribution

Members of the public with literacy needs actively participated in the co‐creation of a HL action plan for a local hospital and in the development of a protocol for a patient and public process for HL research.
Development of the Pharm‐SAVES educational module for gatekeeper suicide prevention training for community pharmacy staff
Authors: Stover Amanda N. , Lavigne Jill E. , Shook Alexis , MacAllister Catherine , Cross Wendi F. , Carpenter Delesha M.
Published: March 2023

Introduction

Pharmacists are one of the most accessible health professionals in the United States, who, with training, may serve as gatekeepers who recognize suicide warning signs and refer at‐risk individuals to care. Our objective was to codesign a 30‐min online gatekeeper training module (Pharm‐SAVES) specifically for community pharmacy staff.

Methods

Over a period of 8 months, a nine‐member pharmacy staff stakeholder panel and the Finger Lakes (New York) Veterans Research Engagement Review Board each worked with the study team to codesign Pharm‐SAVES. Formative data from previous interviews with community pharmacists were presented to the panels and guided website development.

Results

Four key topics were identified for brief skills‐based modules that could be delivered asynchronously online. To help pharmacy staff understand their opportunities as gatekeepers in suicide prevention, statistics and statements from the Joint Commission and pharmacy professional organizations were highlighted in Module 1 (‘Why Me?’). Module 2 (‘What can I do?’) presents the five gatekeeping steps (SAVES): (1) Recognize suicide warning Signs, (2) Ask if someone is considering suicide, (3) Validate feelings, (4) Expedite referral, and (5) Set a reminder to follow‐up. Module 3 (‘How does it work?’) provides three video scenarios modeling SAVES steps and two interactive video cases for participant practice. Module 3 demonstrates use of the 24/7 National Suicide Prevention Lifeline, including the DOD/VA Crisis Line. Module 4 (Resources) includes links to national resources and a searchable zip code‐based provider directory. Pharm‐SAVES was codesigned with pharmacy and veteran stakeholders to deliver brief, skills‐focused, video‐based interactive training that is feasible to implement in busy community pharmacy settings.

Conclusion

Pharm‐SAVES is a brief, online suicide prevention gatekeeper training program codesigned by researchers, community pharmacy and veteran stakeholders. By actively engaging stakeholders at each stage of the design process, we were able to create training content that was not only realistic but more relevant to the needs of pharmacy staff. Currently, Pharm‐SAVES is being evaluated in a pilot randomized controlled trial for changes in pharmacy staff suicide prevention communication behaviors.

Patient or Public Contribution

Stakeholder engagement was purposefully structured to engage pharmacy staff and pharmacy consumers, with multiple opportunities for study contribution. Likewise, the involvement of patient/public contribution was paramount in study design and overall development of our study team.
How do social media influencers inspire consumers' purchase decisions? The mediating role of parasocial relationships
Authors: Ashraf Arif , Hameed Irfan , Saeed S. Amir
Published: March 2023

In recent years, social media influencers (SMIs) have become part of the strategic communication of firms because the traditional form of mass media communication is losing its effectiveness. Thus, it is imperative to study the effects of communication through SMIs on marketing outcomes, such as purchase intentions. Based on the fairness dimensions, that is, information, distributive, interpersonal, and procedural, and dimensions of source credibility, that is, attractiveness, expertise, trustworthiness, and similarity, this research investigated how technology‐oriented SMIs (T‐SMIs) foster parasocial relationships (PSRs) with followers. Purposive sampling was employed to collect data from 506 active social media users. Data were analysed through IBM AMOS and SPSS 26. The results of the study suggested that attractiveness, expertise, trustworthiness, similarity, interpersonal, procedural, and information fairness are positively related to fostering PSR with followers. In contrast, distributive fairness does not strengthen PSR with followers; furthermore, the study findings suggested an indirect positive influence of attractiveness, expertise, trustworthiness, similarity, interpersonal, procedural, and information fairness on the purchase intentions of consumers via PSR. This study is useful for academia and industry since it fills important gaps in the literature and provides recommendations to brand managers of technology companies about selecting appropriate SMIs for the endorsement of their brands.
The current state of family caregiver burden and support of toilet problems for elderly with mild cognitive impairment and Alzheimer's disease
Authors: Kamiya Masaki , Osawa Aiko , Shinoda Yusuke , Nishii Hisae , Kondo Izumi
Published: March 2023

Objective

To conduct an exploratory examination of caregiver burden involving toilet problems in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) and related characteristics.

Methods

We included 50 outpatients with amnestic MCI and AD and their caregivers. Patients were subclassified into three groups: MCI, mild AD, and moderate/severe AD. We used the Japanese version of the Zarit Burden Interview (J‐ZBI) to evaluate caregiver burden and conducted a questionnaire on the frequency of lower urinary tract symptoms and related caregiver burden. We compared the frequency of questionnaire items with the level of burden in each group and subsequently determined the J‐ZBI correlation coefficient.

Results

Among the questionnaire items, the caregiver's burden of “increased daytime urinary frequency,” “nocturia,” “urinary incontinence,” and “they cannot clean the toilet” statistically significantly correlated with J‐ZBI scores (ρ = 0.52, 0.65, 0.79, and 0.83, respectively). Items including “they cannot clean the toilet,” “the smell of excrement is bothersome,” “assistance for transfer is necessary,” “they soil the clothes and bed,” and “they cannot clean the genital region” were significantly more common in the patient group with moderate/severe AD.

Conclusions

Lower urinary tract symptoms and toilet problems were significantly correlated with caregiver burden. Toilet problems differ depending on the severity of dementia. Therefore, a support system based on dementia severity is required to address toilet problems.
Correlation between serum copeptin and urinary aquaporin‐2 levels in children with primary monosymptomatic nocturnal enuresis
Authors: Fathi Basem A. , El Gammal Ahmed A. , Abd Alrahim Nosaiba M. , Abd Elalim Alshaymaa A. , Abd Elhalim Eatemad N.
Published: March 2023

Objectives

To determine the utility of serum copeptin and urinary aquaporin‐2 (AQP2) levels in diagnosing primary monosymptomatic nocturnal enuresis (PMNE) in children.

Methods

This study comprised 58 children (30 males and 28 females), aged 9.7 (±2.9) years with PMNE enuresis. Another 29 children (16 males and 13 females) aged 10.2 (±3.3) without nocturnal enuresis (NE) were recruited as a control group. History taking, clinical examination, and assessment of serum copeptin (blood) and AQP‐2 levels (urine) were performed in all participants.

Results

Serum levels of copeptin, potassium and urinary AQP‐2, and urine creatinine levels were lower in the PMNE group compared to the control group (p < 0.001 for all). No significant differences in body mass index, urine specific gravity, serum sodium, serum creatinine, or estimated glomerular filtration rate were observed between groups. This study evaluated both serum copeptin and AQP‐2 levels in healthy and enuretic children.

Conclusions

In this study, serum levels of copeptin (blood) and AQP2 (urine) were significantly lower in enuretic patients compared to healthy controls. Further, the measurement of urinary AQP‐2 levels is more practical than serum copeptin levels due to lower invasiveness.
An insight into population structure and genetic progress of Argentinean Holstein cattle
Authors: Pardo Alan M. , Casanova Daniel , Rubio Natalia , Andere Cecilia , Rodríguez Edgardo , Corva Pablo M.
Published: March 2023

The objective of the present study was to investigate the most critical issues associated with the limited genetic progress evidenced in the Argentinean Holstein (“Holando Argentino”) breed in the last 20 years (only 26% of the phenotypic trend in milk yield was due to genetics). The study comprised the analysis of population structure, realized genetic selection differentials, genetic progress and partition of genetic trends by sex and country of origin from 1936 to 2019 (1,045,582 records; 24,680 sires and 619,322 dams in the pedigree). Average inbreeding steadily increased in the last 15 generations (ΔF = 0.6%, which translates to Ne = 75). Partition of genetic trends revealed that local genetics made a negligible contribution to genetic progress, which for most traits was highly dependent on imported genetics (>80%). Mean generation intervals were fairly constant until 2009 (8–9 years for males and 5–6 years for females, respectively) and then decreased, especially in the paths of sires of bulls and dams of bulls (to 5 and 4 years, respectively) mostly due to the influence of imported sires. The reduction in generation intervals was counterbalanced by a marked deterioration of realized selection differentials, particularly in the path of sires of bulls that nevertheless made the largest contribution to genetic progress. In the last 20 years, realized selection differentials in this path went from 533.6 to 170.8 kg for milk yield and from 16.7 to 13.3 kg for protein yield (1.7–0.5 and 1.6–1.3 standard deviation units, respectively). Among all considered traits (milk yield, fat yield, protein yield, stature, final score and daughter pregnancy rate) in the analysed period, annual genetic gain was negative for milk yield, fairly constant for composition and conformation traits, and positive only in the case of daughter pregnancy rate. Considered together, these results suggest that limited genetic progress is due to the absence of a sound breeding programme that includes genomic selection and a carefully defined selection objective, together with the absence of stronger regulations in germplasm importation; however, other factors such as potential genetics by environment interactions cannot be ruled out.
Distribution of excitation recoverable myocardium after radiofrequency ablation and its relation to energy application time and irrigation
Authors: Saitoh Osamu , Kasai Takumi , Fuse Kyogo , Chinushi Masaomi
Published: March 2023

Introduction

Radiofrequency (RF) catheter ablation induces excitation recoverable myocardium around durable core lesions, and its distribution may be different depending on energy delivery methods.

Methods and Results

In coronary perfusing porcine hearts, pacing threshold through the ventricle was measured using eight‐pole (1‐mm distance) needle electrodes vertically inserted into myocardium before, within 3 min after and 40 min after 40 W ablation with 10‐g catheter contact (Group 1: irrigation catheter for 15 s, Group 2: irrigation catheter for 40 s, Group 3: nonirrigation catheter for 15 s, Group 4: nonirrigation catheter for 40 s). Ablation was accomplished in all 12 ablations in Groups 1–3 whereas in 8/12 ablations in Group 4 because of high‐temperature rise. Within 3 min after ablation, 10.0 V pacing uncaptured electrodes were distributed from the surface to inside the myocardium, and its depth was deeper in 40 s than in 15 s ablation. 40 min after ablation, excitation recovery at one or more electrodes below the durable lesion was observed in all Groups. Excitation recovery electrodes were also observed on the surface in Group 1 but not the other Groups. Accordingly, the number of excitation‐recovered electrodes were larger in Group 1 than the other Groups.

Conclusions

Regardless of the ablation methods, excitation recoverable myocardium was present around 1.0 mm below the durable lesions. Lesions created by short application time using an irrigation catheter may have included large excitation recoverable myocardium soon after ablation because of the presence of reversible myocardium on well‐irrigated myocardial surfaces.
Ambient circulation surrounding an ablation catheter tip affects ablation lesion characteristics
Authors: Nussinovitch Udi , Wang Paul , Babakhanian Meghedi , Narayan Sanjiv M. , Viswanathan Mohan , Badhwar Nitish , Zheng Lijun , Sauer William H. , Nguyen Duy T.
Published: March 2023

Introduction

The association between ambient circulating environments (CEs) and ablation lesions has been largely underexplored.

Methods

Viable bovine myocardium was placed in a saline bath in an ex vivo endocardial model. Radiofrequency (RF) ablation was performed using three different ablation catheters: 3.5 mm open irrigated (OI), 4, and 8 mm. Variable flow rates of surrounding bath fluids were applied to simulate standard flow, high flow, and no flow. For in vivo epicardial ablation, 24 rats underwent a single OI ablation and performed with circulating saline (30 ml/min; n = 12), versus those immersed in saline without circulation (n = 12).

Results

High flow reduced ablation lesion volumes for all three catheters. In no‐flow endocardial CE, both 4 mm and OI catheters produced smaller lesions compared with standard flow. However, the 8 mm catheter produced the largest lesions in a no‐flow CE. Ablation performed in an in vivo model with CE resulted in smaller lesions compared with ablation performed in a no‐flow environment. No statistically significant differences in steam pops were found among the groups.

Conclusion

A higher endocardial CE flow can decrease RF effectiveness. Cardiac tissue subjected to no endocardial CE flow may also limit RF for 4 mm catheters, but not for OI catheters; these findings may have implications for RF ablation safety and efficacy, especially in the epicardial space without circulating fluid or in the endocardium under varying flow conditions.
Comparison of three different approaches to very high‐power short‐duration ablation using the QDOT‐MICRO catheter
Authors: Yamaguchi Junji , Takigawa Masateru , Goya Masahiko , Martin Claire A. , Yamamoto Tasuku , Ikenouchi Takashi , Shigeta Takatoshi , Nishimura Takuro , Tao Susumu , Miyazaki Shinsuke , Sasano Tetsuo
Published: March 2023

Background/Objectives

The QDOT‐MICRO™ catheter allows very high‐power and short‐duration (vHPSD) ablation. This study aimed to investigate lesion characteristics using different ablation settings.

Methods

Radiofrequency applications (90 W/4 s, temperature‐control mode with 55°C or 60°C target) were performed in excised porcine myocardium using three different approaches: single (SA), double nonrepetitive (DNRA), and double repetitive applications (DRA). Applications were performed with an interval of 1 min for DNRA, and without interval for DRA.

Results

A total of 480 lesions were analyzed. Lesion depth and volume were largest for DRA followed by DNRA and SA regardless of catheter direction (depth: 3.8 vs. 3.3 vs. 2.6 mm, p < .001 for all comparisons; volume: 176.6 vs. 145.1 vs. 97.0 mm3, p < .001 for all comparisons). Surface area was significantly larger for DRA than for SA (45.1 vs. 38.3 mm2, p < .001) and larger for DNRA than for SA (44.5 vs. 38.3 mm2, p < .001), but was similar between DRA and DNRA (45.1 vs. 44.5 mm2, p = .54). Steam‐pops more frequently occurred for DRA than for SA (15.6% vs. 4.4%, p = .004) and DNRA (15.6% vs. 6.9%, p = .061), but the incidence was similar between SA and DNRA (4.4% vs. 6.9%, p = 1). Although surface area and lesion volume were larger in lesions with steam‐pops than without steam‐pops (46.5 vs. 38.1 mm2, p = .018 and 128.3 vs. 96.8 mm3, p = .068, respectively), lesions were not deeper (pop(+): 2.5 mm vs. pop(−): 2.6 mm, p = .75).

Conclusions

DNRA produces larger lesions than SA without increasing the risk of steam‐pops. DRA produces the largest lesions among the three groups, but with an increased risk of steam‐pops. Even with steam‐pops, lesions do not become deeper in vHPSD ablation.
Differences in postablation cardiac MRI scar between radiofrequency and cryoballoon ablation: A DECAAF II subanalysis
Authors: Nelson Daniel Wetherbee , Dhorepatil Aneesh , Kreidieh Omar , Mekhael Mario , Noujaim Charbel , Assaf Ala , Feng Han , Marrouche Nassir
Published: March 2023

Introduction

Pulmonary vein isolation (PVI) using radiofrequency (RF) and cryoballoon (Cryo) ablation are standard approaches for rhythm control in patients with symptomatic atrial fibrillation. Both strategies create scars in the left atrium (LA). There have been few studies investigating the difference in scar formation between patients undergoing RF and Cryo using cardiac magnetic resonance (CMR) imaging.

Methods

The current study is a subanalysis of the control arm of the Delayed‐Enhancement MRI Determinant of Successful Catheter Ablation of Atrial Fibrillation study (DECAAF II). The study was a multicenter, randomized, controlled, single‐blinded trial that evaluated atrial arrhythmia recurrence (AAR) between PVI alone and PVI plus CMR atrial fibrosis‐guided ablation. Preablation CMR and 3‐ to 6‐month postablation CMR were obtained to assess baseline LA fibrosis and scar formation, respectively.

Results

Of the 843 patients randomized in the DECAAF II trial, we analyzed the 408 patients in the primary analysis control arm that received standard PVI. Five patients received combined RF and Cryo ablations, so they were excluded from this subanalysis. Of the 403 patients analyzed, 345 underwent RF and 58 Cryo. The average procedure duration was 146 min for RF and 103 min for Cryo (p = .001). The rate of AAR at ~15 months occurred in 151 (43.8%) patients in the RF group and 28 (48.3%) patients in the Cryo group (p = .62). On 3‐month post‐CMR, the RF arm had significantly more scar (8.8% vs. 6.4%, p = .001) compared to Cryo. Patients with ≥6.5% LA scar (p < .001) and ≥2.3% LA scar around the PV antra (p = .01) on 3‐month post‐CMR had less AAR independent of the ablation technique. Cryo caused a greater percentage of right and left pulmonary vein (PV) antral scar (p = .04, p = .02) and less non‐PV antral scar (p = .009) compared to RF. On Cox regression, Cryo patients free of AAR had a greater percentage of left PV antral scar (p = .01) and less non‐PV antral scar (p = .004) compared to RF free of AAR.

Conclusion

In this subanalysis of the control arm of the DECAAF II trial, we observed that Cryo formed a more significant percentage of PV antral scar and less non‐PV antral scar compared to RF. Post ablation LA scar ≥6.5% predicted freedom from AAR, independent of ablation technique. These findings may have prognostic implications in ablation technique selection and freedom from AAR.
Effect of sacubitril–valsartan on the incidence of atrial fibrillation: A meta‐analysis
Authors: Mohammad Zoya , Ahmad Javaria , Sultan Ali , Penagaluri Ashritha , Morin Daniel , Dominic Paari
Published: March 2023

Introduction

Sacubitril/valsartan reduces all‐cause mortality in heart failure (HF) patients compared to angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). ACEIs/ARBs have been shown to decrease the incidence of atrial fibrillation (AF). We hypothesized sacubitril–valsartan decreases the incidence of AF compared to ACEis/ARBs.

Methods

Clinicaltrials.gov was searched for trials by terms sacubitril/valsartan, entresto, sacubitril, valsartan. Randomized controlled human trials of sacubitril/valsartan reporting AF were included. Data were extracted independently by two reviewers. Data was pooled using a random effect model. Publication bias was evaluated by funnel plots.

Results

A total of 11 trials including 11,458 patients on sacubitril/valsartan and 10,128 patients on ACEI/ARBs were identified. A total of 284 AF events were reported in the sacubitril/valsartan group compared to 256 AF events in ACEIs/ARBs. Patients on sacubitril/valsartan were as likely as patients on ACEIs/ARBs to develop AF (pooled odds ratio [OR] = 1.091, 95% confidence interval [CI] = 0.917–1.298, p = .324). Six atrial flutter (AFl) events were reported in six trials; 48 out of 9165 patients in the sacubitril/valsartan group developed AFl compared to 46 out of 8759 in ACEi/ARBs group. There was no difference in AFl risk between the two groups (pooled OR = 1.028, 95% CI = 0.681–1.553, p = .894). Finally, sacubitril/valsartan did not reduce the risk of atrial arrhythmias (AF + AFl) compared to ACEi/ARBs (pooled OR = 1.081, 95% CI = 0.922–1.269, p = .337).

Conclusion

Although sacubitril/valsartan reduces mortality compared to ACEIs/ARBs in HF patients, they do not reduce AF risk compared to these drugs.
Effects of switching from liraglutide to semaglutide or dulaglutide in patients with type 2 diabetes: A randomized controlled trial
Authors: Iijima Takahiro , Shibuya Makoto , Ito Yuzuru , Terauchi Yasuo
Published: March 2023

Introduction

Few studies have examined the effects of glucagon‐like peptide‐1 receptor agonist switching, particularly in Japanese patients. Therefore, we aimed to investigate the effects of switching from liraglutide to semaglutide or dulaglutide on blood glucose, body weight, and the occurrence of adverse effects in clinical practice.

Materials and Methods

This was an open‐label, prospective, randomized, parallel‐group controlled trial. Patients with type 2 diabetes treated with liraglutide (0.6 or 0.9 mg) at Yokosuka Kyosai Hospital in Japan were recruited from September 2020 to March 2022 and, after obtaining informed consent, randomly assigned to the semaglutide or dulaglutide group (1:1). Changes in the glycated hemoglobin level from baseline to weeks 8, 16, and 26 were evaluated post‐treatment.

Results

Initially, 32 participants were enrolled, of whom 30 completed the study. Glycemic control was significantly better in the semaglutide group than in the dulaglutide group (−0.42 ± 0.49% vs −0.00 ± 0.34%, P = 0.0120). Body weight significantly decreased in the semaglutide group (−2.6 ± 3.6 kg, P = 0.0153), whereas no change was observed in the dulaglutide group (−0.1 ± 2.7 kg, P = 0.8432). We found a significant difference in body weight between the groups (P = 0.0469). The proportion of participants who reported adverse events was 75.0% and 18.8% in the semaglutide and dulaglutide groups, respectively. One patient in the semaglutide group had difficulty continuing treatment due to severe vomiting and weight loss.

Conclusions

Switching from once‐daily liraglutide to once‐weekly semaglutide 0.5 mg significantly improved glycemic control and body weight compared with switching to once‐weekly dulaglutide 0.75 mg.
Evidence‐based guideline for the prevention and management of perioperative infection
Authors: Wang Qiaoyu , Cao Mingnan , Tao Hua , Fei Zhimin , Huang Xiufeng , Liang Pixia , Liu Baiyun , Liu Jianping , Lu Xiaoyang , Ma Penglin , Si Shuyi , Wang Shuo , Zhang Yuewei , Zheng Yingli , Zang Lei , Chen Xiao , Dong Zhanjun , Ge Weihong , Guo Wei , Hu Xin , Huang Xin , Li Ling , Liang Jianshu , Liu Baoge , Liu Dong , Liu Linna , Liu Songqing , Liu Xianghong , Miao Liyan , Ren Haixia , Shi Guangzhi , Shi Luwen , Sun Shumei , Tao Xia , Tong Rongsheng , Wang Cheng , Wang Bin , Wang Jincheng , Wang Jingwen , Wang Xiaoling , Wang Xiaoyan , Xie Jian , Xie Shouxia , Yang Hua , Yang Jianxin , You Chao , Zhang Hongyi , Zhang Yi , Zhao Chengson , Zhao Qingchun , Zhu Jiangguo , Ji Bo , Guo Ruichen , Hang Chunhua , Xi Xiaowei , Li Sheyu , Gong Zhicheng , Zhou Jianxin , Wang Rui , Zhao Zhigang
Published: March 2023

Background

We have updated the guideline for preventing and managing perioperative infection in China, given the global issues with antimicrobial resistance and the need to optimize antimicrobial usage and improve hospital infection control levels.

Methods

We conducted a comprehensive evaluation of the evidence for prevention and management of perioperative infection, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Revisions were made to the guidelines in response to feedback from the experts.

Results

There were 17 questions prepared, for which 37 recommendations were made. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the meta‐analysis results, recommendations were graded using the Delphi method to generate useful information.

Conclusions

This guideline provides evidence to perioperative antimicrobial prophylaxis that increased the rational use of prophylactic antimicrobial use, with substantial improvement in the risk‐benefit trade‐off.
Why Bhutan needs a policy push on person‐centred care
Authors: Pelzang Rinchen
Published: March 2023

Delivering quality healthcare services to people has become a core issue for the Bhutanese healthcare system. There are considerable challenges for healthcare policymakers to recognise and implement an appropriate healthcare model to enhance quality healthcare services in the Bhutanese healthcare system. Actions to improve quality healthcare services in Bhutan requires careful analysis of the healthcare model in the context of the Bhutanese socio‐political and healthcare environment. This article provides a brief concept analysis of person‐centred care in the context of the Bhutanese socio‐political and healthcare environment and describes why it is important to integrate person‐centred care into the healthcare system. The article argues that person‐centred care is important and relevant to the Bhutanese healthcare system to achieve quality healthcare services and Gross National Happiness.
The Demand for Trade Protection over the Business Cycle
Authors: AURAY STÉPHANE , DEVEREUX MICHAEL B. , EYQUEM AURÉLIEN
Published: March 2023

We build measures of the demand for trade protection, and relate them to permanent productivity and transitory monetary shocks identified from U.S. data. The demand for trade protection is countercyclical conditional on productivity shocks and procyclical conditional on monetary shocks. A two‐country dynamic stochastic general equilibrium (DSGE) model with trade in intermediate and final goods, sticky prices, and incomplete financial markets is proposed, in which tariffs are determined in a repeated noncooperative policy game. The resulting trade policies are consistent with the empirical evidence about the cyclical pattern of trade protection demand.
A rutile and titanite record of subduction fluids: Integrated oxygen isotope and trace element analyses in Franciscan high‐pressure rocks
Authors: Page F. Zeb , Storey Craig D. ,   EIMF
Published: March 2023

In situ oxygen analysis of garnet in eclogite and related rocks is increasingly being used to probe the composition of subduction fluids. However, in many cases, these samples contain textural signs of both fluid flow and retrograde metamorphism, some of which may take place outside the garnet stability field. In order to test the connection between polymetamorphism and fluid infiltration, rutile rimmed by titanite from high‐grade tectonic blocks of the Franciscan Formation (California, USA) was analysed for oxygen isotope ratios and trace element concentrations. Zirconium concentrations in rutile yield temperatures of ~600°C for eclogite and hornblende eclogite from three well‐studied localities (Junction School, Tiburon and Ward Creek). Rutile trace element concentrations are generally low and consistent with a mafic protolith. Titanite surrounding rutile has inherited much of its trace element content from rutile, and Zr‐in‐titanite temperatures are spuriously high. Titanite in rutile‐free samples (blueschist and eclogite from Jenner beach) have similar compositions suggesting that they were formed at the expense of rutile as well. Oxygen isotope ratios from rutile and titanite in the same sample are fortuitously similar, indicating disequilibrium between these minerals, which formed at different times and temperatures but in equilibrium with the same oxygen reservoir. Rutile in blocks with garnets zoned in oxygen isotopes are generally in equilibrium with the rims rather than the cores. Slow oxygen diffusion in rutile and the low temperatures of formation require that rutile recrystallized after fluid interaction and before blueschist facies metamorphism. External fluid interaction of Franciscan eclogites took place near the peak of metamorphism.
The mechanism of Croci stigma in the treatment of melasma based on network pharmacology and molecular docking
Authors: Yin Wenxian , Zhao Fulan , He Yingmeng , Lai Hui , Sun Mengqi
Published: March 2023

Purpose

To investigate the molecular mechanism of Croci stigma (CS) in the treatment of melasma by network pharmacology and molecular docking.

Methods

TCMSP, CTD, STITCH, SymMap, GeneCard, GenBank, OMIM and DrugBank databases were used to obtain the components and targets of CS and the targets of chloasma. STRING was used to build a protein–protein interaction (PPI) network of intersecting targets between drugs and diseases. Cytoscape was used to establish drug‐compounds‐targets‐disease network and analyze PPI network. R was used for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis and visualization. AutoDock was used for molecular docking and R was used to visualize docking results.

Results

Four active compounds were screened out from CS, and 31 target genes intersecting with melasma were found after further analysis. The top 10 hub genes were found after analysis of the PPI network, including TYR, TYRP1, DCT, CREB1, KITLG, MITF, ESR1, EDNRB, CD4, and PTGS2. In the enrichment analysis, melanogenesis was considered as the core pathway through which CS exerts its therapeutic effect on melasma. Molecular docking results showed that the core genes in the regulatory network had high binding activity with related active components, especially crocetin.

Conclusion

CS may treat melasma by regulating core targets, such as TYR, TYRP1, DCT, CREB1, KITLG, MITF, EDNRB, and PTGS2, and acting on melanogenesis. And crocetin may be the core compound worthy of further study.
Chitosan combined with intrauterine device prevents intrauterine adhesions after hysteroscopic adhesiolysis: A target trial emulation study
Authors: Zhang Hongjuan , Shao Lijin , Wang Lina , Gao Yu , Cui Wei , Chu Dongmei , Zhang Ying
Published: March 2023

Aim

To compare the efficacy of chitosan and intrauterine device (IUD) combination with an IUD alone in patients with intrauterine adhesions (IUAs) who underwent hysteroscopic adhesiolysis.

Methods

This retrospective study assessed 303 patients with moderate‐to‐severe IUA (American Fertility Society [AFS] score ≥5) who underwent hysteroscopic adhesiolysis between January 2018 and December 2020. Using observational data under a cohort design, we emulated a target trial with two treatment arms: chitosan plus IUD and IUD alone groups. Second‐look hysteroscopy was performed in all patients 3 months after the initial hysteroscopy. The primary outcome was improved adhesion assessed using the AFS scoring system.

Results

The baseline characteristics were balanced between the two groups. The second hysteroscopy revealed significantly better AFS scores in group A than in group B (values: 3 [1–4] vs. 4 [2–6], p < 0.001; change: 63% [50%–80%] vs. 44% [33%–67%], p < 0.001, respectively). Significantly better menstruation conditions (improved rate: 66% vs. 49%, p = 0.004) and endometrial thickness (mean: 7.0 mm vs. 6.0 mm, p < 0.001) were also observed in group A than in group B. Moreover, group A showed a significantly higher 1‐year clinical pregnancy rate (40% vs. 28%, p = 0.037) and better quality of life (p < 0.001) than group B.

Conclusions

Chitosan and IUD combination showed better efficacy in reducing adhesions and improving clinical outcomes in patients with moderate‐to‐severe IUA after hysteroscopic adhesiolysis.
Diagnostic accuracy of amniotic fluid interleukin‐6 for fetal inflammatory response syndrome
Authors: Ohkuma Kana , Ono Takeshi , Oshima Yuko , So Kunio , Tsumura Keisuke , Yamasaki Fumio , Nakura Yukiko , Yanagihara Itaru , Nomiyama Makoto , Yokoyama Masatoshi
Published: March 2023

Aim

This study aimed to clarify the diagnostic accuracy of amniotic fluid interleukin‐6 for fetal inflammatory response syndrome (FIRS).

Methods

This retrospective cohort study was conducted in a single institution and targeted cases of preterm birth within 24 h after amniocentesis among singleton cases that underwent amniocentesis at our hospital for suspected intraamniotic inflammation (IAI) from gestational ages of 22–36 weeks between August 2014 and March 2020. FIRS was defined as >11.0 pg/mL of umbilical cord blood interleukin‐6.

Results

The analysis included 158 pregnant women. There was a strong correlation between amniotic fluid interleukin‐6 and umbilical cord blood interleukin‐6 (r = 0.70, p < 0.001). The area under the receiver operating characteristic curve of amniotic fluid interleukin‐6 for FIRS was 0.93, with a cutoff value of 15.5 ng/mL, and showed high sensitivity and specificity (0.91 and 0.88, respectively). An amniotic fluid interleukin‐6 cutoff value of ≥15.5 ng/mL was associated with a significant risk of FIRS (adjusted odds ratio: 27.9; 95% confidence interval: 6.3–123.0; p < 0.001).

Conclusions

The results of this study show that amniotic interleukin 6 alone can be used to diagnose FIRS prenatally. While there is a need for validation, it may be possible to treat IAI while preventing damage to the central nervous and respiratory systems in the uterus by keeping the amniotic fluid interleukin‐6 below the cutoff value.
Good is sweet and bad is bitter: Conflation of affective value of aromas with taste qualities in untrained participants
Authors: Davis Lissa A. , Running Cordelia A.
Published: March 2023

In sensory evaluation, trained panelists are recommended to accurately assess complex flavors. However, many researchers assume that “simpler” qualities such as basic tastes can be reliably assessed by untrained individuals. In this work, we tested whether untrained participants would conflate the basic tastes of “bitter” and “sweet” with the hedonic aspects of an aroma by using Jelly Belly BeanBoozled® candies. These products are sweet candies which have either pleasant (e.g., coconut) or unpleasant (e.g., sour milk) aromas. In the first test, all participants rated candies with their nose open. In the second test, all participants rated candies with nose closed immediately followed by nose open. Both experiments demonstrated that sweetness was rated higher for good beans than bad beans and bitterness was rated higher for bad beans than good beans when rated with nose open. Closing the nose eliminated this difference, as all beans were actually sweet and not bitter.

Practical applications

Researchers should use caution when interpreting sensory ratings from untrained participants, even for “simple” sensations such as basic tastes. While it is often necessary to use untrained participants, these individuals may conflate the hedonic aspects of the product with other sensory qualities.
Exceptionally well‐preserved seed cones of a new fossil species of hemlock, Tsuga weichangensis sp. nov. (Pinaceae), from the Lower Miocene of Hebei Province, North China
Authors: Li Ya , Gee Carole T. , Tan Zhen‐Zhen , Zhu Yan‐Bin , Yi Tie‐Mei , Li Cheng‐Sen
Published: March 2023

Tsuga (hemlock) is a small genus of 10 extant species in the Pinaceae, with a disjunct distribution in East Asia and eastern and western North America. Reliable species‐level identification of Tsuga fossils depends on the discovery of seed cones with intact bracts, but such cones are rare in the fossil record. Here we describe a new fossil species of hemlock as T. weichangensis sp. nov. based on exquisitely preserved seed cones with nearly complete bracts from the Lower Miocene of Weichang, Hebei Province, North China. This fossil species displays a mosaic of characters between Tsuga and Nothotsuga. The well‐developed and slightly exserted bract scales of T. weichangensis are reminiscent of Nothotsuga, but other characters, such as nonleaved peduncles and tongue‐shaped bract scales, in addition to monosaccate pollen found at the same fossil locality, suggest an affinity closer to Tsuga. Cladistic analysis based on 15 morphological characters and a molecular backbone constraint supports the assignment of these fossil cones to Tsuga rather than Nothotsuga, and places the fossil species of T. weichangensis in an unresolved polytomy within the genus Tsuga. The occurrence of Tsuga seed cone fossils indicate the paleoclimate in the Miocene of Weichang was warmer and more humid than today's climate, which is consistent with the paleoclimate reconstructed by paleopalynology.
Prognostic value of serum cystatin C concentration in dogs with myxomatous mitral valve disease
Authors: Iwasa Naoki , Kumazawa Rie , Nomura Saki , Shimizu Mamu , Iwata Munetaka , Hara Mayuka , Kawabe Mifumi , Kobatake Yui , Takashima Satoshi , Nishii Naohito
Published: March 2023

Background

Impaired renal function is 1 of the poor prognostic factors in dogs with myxomatous mitral valve disease (MMVD). However, the value of cystatin C (Cys‐C), a marker of renal function, as a prognostic marker for MMVD in dogs has not yet been explored.

Objective

This study aims to investigate the prognostic value of Cys‐C in dogs with MMVD.

Animals

Fifty client‐owned small‐breed dogs with MMVD were included in this study.

Methods

This is a retrospective, cross‐sectional study. The prognostic value of serum Cys‐C concentration was assessed using univariable and multivariable Cox hazard regression analyses. Kaplan‐Meier survival curves for MMVD‐specific survival in dogs stratified into high and low Cys‐C groups were generated and analyzed using the log‐rank test.

Results

Serum Cys‐C concentrations were significantly associated with MMVD‐related death (P < .01) in both univariable (hazard ratio [HR], 5.086; 95% confidence interval [CI], 1.950‐13.270) and multivariable Cox hazard regression analysis (HR, 4.657; 95% CI, 1.767‐12.270). The high Cys‐C group (n = 14) had a significantly shorter MMVD‐specific survival time than the low Cys‐C group (n = 36;P < .01). In dogs with normal blood creatinine concentrations, the high Cys‐C group (n = 10) had a significantly shorter MMVD‐specific survival time than the low Cys‐C group (n = 36;P < .01).

Conclusions and Clinical Importance

High serum Cys‐C concentrations were associated with a worse prognosis of MMVD. Furthermore, serum Cys‐C could be a predictor of MMVD prognosis even in dogs with normal blood creatinine concentration.
Metatranscriptomics and metabarcoding reveal spatiotemporal shifts in fungal communities and their activities in Chinese coastal waters
Authors: Wang Mengmeng , Mara Paraskevi , Burgaud Gaëtan , Edgcomb Virginia , Long Xuedan , Yang Haiping , Cai Lei , Li Wei
Published: March 2023

Fungal communities are diverse and abundant in coastal waters, yet, their ecological roles and adaptations remain largely unknown. To address these gaps, ITS2 metabarcoding and metatranscriptomic analyses were used to capture the whole suite of fungal diversity and their metabolic potential in water column and sediments in the Yellow Sea during August and October 2019. ITS2 metabarcoding described successfully the abundance of Dikarya during August and October at the different examined habitats, but strongly underrepresented or failed to identify other fungal taxa, including zoosporic and early‐diverging lineages, that were abundant in the mycobiome as uncovered by metatranscriptomes. Metatranscriptomics also revealed enriched expression of genes annotated to zoosporic fungi (e.g., chytrids) mainly in the surface water column in October. This enriched expression was correlated with the two‐fold increase in chlorophyll‐a intensity attributed to phytoplanktonic species which are known to be parasitized by chytrids. The concurrent high expression of genes related to calcium signalling and GTPase activity suggested that these metabolic traits facilitate the parasitic lifestyle of chytrids. Similarly, elevated expression of phagosome genes annotated to Rozellomycota, an early‐diverging fungal phylum not fully detected with ITS2 metabarcoding, suggested that this taxon utilizes a suite of feeding modes, including phagotrophy in this coastal setting. Our data highlight the necessity of using combined approaches to accurately describe the community structure of coastal mycobiome. We also provide in‐depth insights into the fungal ecological roles in coastal waters, and report potential metabolic mechanisms utilized by fungi to cope with environmental stresses that occur during distinct seasonal months in coastal ecosystems.
A reflection on the decolonization discourse in nursing
Authors: Iradukunda Favorite
Published: March 2023

Colonialism, in its many forms and stages is often imposed as being central to the narratives of colonizedpeople and their cultures, as well as the genesis of their knowledge. In colonial discourse, lands and the occupants of these lands were ‘discovered’, further implying that colonized people did not have their own ways of knowing (nor even existence) before colonization. This narrative has been embedded within Euro‐American fields of study, including nursing, in which caring and healing practices that exist outside of a colonial lens are dismissed and complicity with colonialism is downplayed or sanitized. This paper is a reflection on the current discourse on decolonizing nursing shaped by postcolonial, critical and Black feminist philosophies. After examining the decolonization discourse in nursing, I argue that current calls to decolonize nursing lack a clear description of the goals and process of doing so, making it unfeasible to hold those in the process of decolonizing accountable. In addition, the lack of intentionality in reckoning with past and current forms of colonialism embedded in nursing hinders the ability to engage with lessons that could shape the future. I conclude this discourse by discussing practical steps toward centrering diverse ways of knowing, and ensuring this process prioritizes communities and nurse scholars who have historically been silenced.
Asymptotic Behavior of Temporal Aggregation in Mixed‐Frequency Datasets
Authors: Taufemback Cleiton Guollo
Published: March 2023

Here, we present an unexplored issue regarding temporal aggregation. When a model contains frequency‐dependent coefficients, such as a distinct long‐ and short‐term coefficient, temporal aggregation leads to inconsistent least squares estimates. Because the sub‐sampled variable's spectrum is equal to its folded original spectrum, the low‐frequency variable may exhibit a mixture of distinct linear relations for a given frequency. We propose a new method to disentangle the frequencies superposition based on band spectrum regression, thus avoiding the inconsistency problem. As a result, we can test for the presence of frequency‐dependent coefficients. We use stationary and non‐stationary linear semi‐parametric models to demonstrate our findings. Our Monte Carlo simulations show good finite sample size and power properties. Finally, our empirical study rejects the presence of a single coefficient for all frequencies between quarterly GDP and monthly US indicators.