bluuebunny/crossref_metadata_2025 huggingface dataset:
An Implementation Science Approach to Antibiotic Stewardship in Emergency Departments and Urgent Care Centers
Authors: Yadav Kabir , Stahmer Aubyn , Mistry Rakesh D. , May Larissa
Published: October 2019

Background

Antibiotic stewardship efforts have expanded focus from inpatient to include outpatient settings. However, stewardship is urgently needed in acute care ambulatory settings: emergency departments (EDs) and urgent care centers (UCCs). Implementation of antibiotic stewardship in acute ambulatory care settings has been limited. Two major barriers to effective implementation exist: 1) lack of adaptation of successful outpatient stewardship interventions to the acute care ambulatory setting and 2) absence of rigorous measurement of implementation processes in EDs and UCCs in a manner that informs future scale and spread.

Objectives

Our objective was to apply an implementation science approach to address antibiotic overuse and inappropriate use in EDs and UCCs.

Methods

This study was a redesign of an evidence‐based outpatient antibiotic stewardship intervention at participating EDs and UCCs using an innovative implementation science framework (dynamic adaptation process), adaptable for local clinical workflow and local champion provision. We evaluated multiple implementation outcome metrics throughout a cluster‐randomized comparative effectiveness clinical trial of two approaches to the adapted antibiotic stewardship interventions.

Results

Our preimplementation phase included 21 in‐depth interviews and online provider surveys (52% response rate). For the postimplementation survey, we had a 39% response rate. We identified common themes including patient expectations, lack of knowledge of existing guidelines, and maintenance of education over time. Additional themes indicated differences in modifications needed by type of clinical setting. Adoption of public commitment was high, with 79% of providers signing a commitment log, and 84% received public commitment flair. Signing of public commitment posters rate was 62%, as several sites chose not to use this component. Acceptability, fidelity, and appropriateness were also measured.

Conclusions

We demonstrate that implementation science approaches can help address the problem of unnecessary antibiotic use in EDs and UCCs with high acceptability and adoption. Similar approaches could be used to tailor quality improvement interventions in these settings.
Case Series: Limited Opioid Withdrawal With Use of Transdermal Buprenorphine to Bridge to Sublingual Buprenorphine in Hospitalized Patients
Authors: Tang Victor M. , Lam‐Shang‐Leen Jessica , Brothers Thomas D. , Hansen Keith , Caudarella Alexander , Lamba Wiplove , Guimond Tim
Published: October 2019

Background

Prerequisite opioid withdrawal symptoms prior to buprenorphine induction are unacceptable to many patients. We assessed whether transdermal buprenorphine minimized withdrawal while bridging to sublingual therapy among hospital inpatients.

Methods

Retrospective chart review of (n = 23) inpatients with opioid use disorder or opioid dependence due to chronic pain.

Results

Of 23 inpatients, 65% transitioned without symptoms, while 35% experienced mild withdrawal. Ninety‐six percent completed planned hospitalizations, with 83% engaged in treatment 4 weeks post‐discharge.

Discussion and Conclusions

Bridging to sublingual therapy with transdermal buprenorphine patches was feasible without withdrawal symptoms.

Scientific Significance

This strategy may facilitate buprenorphine therapy in hospital inpatients. (Am J Addict 2019;00:1–4)
Over‐ordering of ultrasound and pre‐operative investigations for inguinal hernia repair at Northern Health: a Choosing Wisely audit
Authors: Chmiel Edward , Pearson Kristen , Mori Krinal
Published: October 2019

Background

Choosing Wisely Australia is an initiative aimed at reducing the incidence of unnecessary investigations. This study is an audit of Northern Health's adherence to two Choosing Wisely recommendations in the context of inguinal hernia repair. Recommendation 1: Avoid routinely performing pre‐operative investigations in patients, but instead order in response to patient factors, signs and symptoms, disease or planned surgery. Recommendation 2: Do not order ultrasound for clinically apparent inguinal hernias.

Methods

Records of 264 patients who underwent elective inguinal hernia repair at Northern Health in 2016 were reviewed.

Results

Recommendation 1: Results demonstrated over‐ordering of coagulation studies. Thirty‐four percent of patients received coagulation studies, 86% of which were unindicated. There was better adherence to Choosing Wisely guidelines for other investigations: 38% of patients received a full blood examination (42% unindicated), 38% received a urea, electrolytes and creatinine (14% unindicated), 7% received a glycated haemaglobin (0% unindicated) and 38% received an electrocardiogram (11% unindicated). Recommendation 2: Seventy percent (n = 186) of patients received an ultrasound of which 25% (n = 46) had a documented indication. Correlation with surgical findings showed a positive predictive value of 95.6% and sensitivity of 97.8% for ultrasound.

Conclusion

Recommendation 1: Most pre‐operative coagulation studies were unindicated, while adherence to Choosing Wisely guidelines was better for pre‐operative full blood examination, urea, electrolytes and creatinine, glycated haemaglobin and electrocardiogram. Recommendation 2: The majority of patients received an inguinal hernia ultrasound, most of which had no documented indication.
Hidden blood loss and the influencing factors after laparoscopic cholecystectomy
Authors: Wan Ren‐Rui , Wang Yong‐Li , Wu Xiao‐Chang , Qian Hai , Tan Zhen‐Hua , Xiao Ren‐Yi , Xie Pin
Published: October 2019

Background

A small amount of bleeding usually occurs during laparoscopic cholecystectomy (LC), but the occurrence of perioperative hidden blood loss (HBL) is ignored. So our objective is to investigate the amount of HBL and find out the influential factors in LC.

Methods

From January 2017 to May 2019, 139 patients scheduled for LC were enrolled in the study. The data of patients' sex, age, height, weight, body mass index (BMI), form of gallbladder bed, gallbladder status, hypertension, diabetes, liver cirrhosis, drainage volume and operation time were recorded. The patients' height, weight and preoperative and postoperative haematocrit and haemoglobin were recorded and applied to the Gross formula to determine the amount of blood loss. The data of sex, age, BMI, hypertension, diabetes, gallbladder status, liver cirrhosis and operation time were analysed by multivariate linear regression analysis. One‐way analysis of variance was performed to find out the relative correlation between HBL and the type of gallbladder bed.

Results

The HBL was 259.3 ± 188.5 mL. On the basis of multivariate linear regression analysis and analysis of variance, the gallbladder bed, hypertension and the operation time are influential factors of HBL in patients with LC. However, sex, age, BMI, gallbladder status, liver cirrhosis and diabetes are not significantly correlated with HBL.

Conclusions

HBL should not be overlooked during the perioperative period of LC, especially in patients with hypertension, gallbladder bed >50% gallbladder surface or operation time >60 min.
Results of racetrack examinations of Standardbred horses at race meetings in New South Wales
Authors: Knight PK
Published: October 2019

This study analysed the race day veterinary reports from harness racing meetings controlled by the New South Wales Greyhound and Harness Racing Regulatory Authority between 1 September 2008 and 30 June 2009. The findings of all prerace and postrace examinations were analysed, and the frequency of observations was recorded. Chi‐square testing was used to determine whether the incidence of abnormalities differed between age groups and tracks. A total of 542 meetings were conducted during the period of the study, with veterinary examinations conducted at 395 of these meetings. A total of 520 veterinary examinations (60 prerace and 460 postrace) were conducted. During the period of the study, 3685 horses started 31,393 times. Injuries occurring during the warm‐up or start were the most common finding on prerace examination (11 reports) followed by lameness (6 reports). Lameness was the most common problem identified during postrace examinations, occurring at a rate of 2.10 cases per 1000 starts. Other problems identified at a rate of more than 1 per 1000 starts were poor postrace recovery/heat stress (2.04) and lacerations (1.75). Falls occurred at a rate of 1.72 cases per 1000 starts. Two‐year‐old horses were less likely to be lame than 3, 5 and 6‐year‐old horses. There was no difference in the rate of falls or lameness between tracks. This study provides a benchmark against which ongoing improvements in welfare can be assessed.
Opposite effects of statins on the risk of tuberculosis and herpes zoster in patients with diabetes: A population‐based cohort study
Authors: Pan Sheng‐Wei , Yen Yung‐Feng , Feng Jia‐Yih , Chuang Pei‐Hung , Su Vincent Yi‐Fong , Kou Yu Ru , Su Wei‐Juin , Chan Yu‐Jiun
Published: October 2019

Aims

It remains uncertain whether statin use is associated with the risks of tuberculosis (TB) and herpes zoster in patients with type 2 diabetes. This study aims to assess the effects of statins vs nonstatin lipid‐lowering agents on the risk of these infectious diseases in patients with diabetes.

Methods

Participants in the Taiwan National Health Insurance Research Database diagnosed with type 2 diabetes in 2001–2013 were classified as statin users, nonstatin users and lipid‐lowering drug‐free groups. Participants were observed for incident TB and herpes zoster from diabetes diagnosis until treatment crossover or December 2013. Statin user and nonstatin user were the time‐dependent variables in Cox regression analysis.

Results

Over 240 782 person‐years of observation, statin users (n = 17 696) were associated with a lower TB risk than nonstatin users (n = 5327) and the drug‐free group (n = 22 316) (adjusted hazard ratio [aHR]: 0.66; 95% confidence interval [CI]: 0.44–0.99 and aHR: 0.57; 95% CI: 0.44–0.73). Compared with nonstatin users, statin users showed a dose‐dependent association with TB risk (low‐potency statin users, aHR: 0.692; 95% CI: 0.455–1.053; high‐potency users, aHR: 0.491; 95% CI: 0.241–0.999). Statin users presented with a higher risk of herpes zoster than nonstatin users and the drug‐free group (aHR: 1.23; 95% CI: 1.01–1.50 and aHR: 1.20; 95% CI: 1.09–1.33). The risks of TB and herpes zoster were not statistically different between nonstatin users and the drug‐free group.

Conclusion

Compared with nonstatin drugs, statin use was specifically associated with a decreased risk of TB but a moderately increased risk of herpes zoster in this cohort study.
Being a burden to others and wishes to die: The importance of the sociopolitical context
Authors: Roest Bernadette , Trappenburg Margo , Leget Carlo
Published: October 2019

All articles in May 2019’s special issue of Bioethics offer profound insights into the issue of “being a burden to others” in relation to wishes to die, which are highly relevant for ethical debates about end‐of‐life care and physician‐assisted dying. In this reply, we wish to stress the importance of acknowledging and analyzing the sociopolitical context of the phenomenon “being a burden” in relation to wishes to die and we will show how this analysis could benefit from a care ethical approach. As discussions in care ethics have made clear, caring practices are both social and political practices. An empirical and ethical analysis of “being a burden” therefore needs to take institutional and societal norms and structures into account, in addition to first‐person experiences and concepts such as caring needs, relational autonomy, and interdependency. Besides the relevance of the sociopolitical context for the phenomenon “being a burden” as such, the sociopolitical context also seems relevant for the investigation of the phenomenon, which we will illustrate by reflecting on “being a burden” in relation to the practice of physician‐assisted dying in the Netherlands.
Guideline of guidelines: social media in urology
Authors: Taylor Jacob , Loeb Stacy
Published: October 2019

The use of social media is rapidly expanding. This technology revolution is changing the way healthcare providers share information with colleagues, patients, and other stakeholders. As social media use increases in urology, maintaining a professional online identity and interacting appropriately with one's network are vital to engaging positively and protecting patient health information. There are many opportunities for collaboration and exchange of ideas, but pitfalls exist without adherence to proper online etiquette. The purpose of this article is to review professional guidelines on the use of social media in urology, and outline best practice principles that urologists and other healthcare providers can reference when engaging in online networks.
New insight into sortilin in controlling lipid metabolism and the risk of atherogenesis
Authors: Su Xin , Peng Daoquan
Published: October 2019

Dyslipidemia, including increased plasma levels of low‐density lipoprotein cholesterol (LDL‐C), very low‐density lipoprotein cholesterol and triglyceride, and decreased plasma levels of high‐density lipoprotein cholesterol, has been considered a key factor associated with a series of health problems grouped together as metabolic syndrome. Worldwide, dyslipidemia has become a pressing issue, together with the rising prevalence of metabolic syndrome and cardiovascular disease (CVD). Recently, multiple genome‐wide association studies and experimental analyses have been used to assess the underlying genetic basis of lipid metabolism and to identify novel gene loci that contribute to the alterations in lipid levels. The results have demonstrated that sortilin, which is encoded by SORT1, plays an important role in modulating the level of LDL‐C and the risk of CVD. Herein, we summarize the current understanding of the role of sortilin in the pathogenesis of dyslipidemia and atherosclerosis. Furthermore, we provide new insights into the potential mechanisms by which sortilin affects lipid metabolism in hepatocytes, adipocytes, and macrophages.
Childhood Maltreatment, Gender Nonconformity, and Adolescent Sexual Orientation: A Prospective Birth Cohort Study
Authors: Xu Yin , Norton Sam , Rahman Qazi
Published: October 2019

This study tested whether associations between childhood maltreatment and adolescent sexual orientation were accounted for by childhood gender nonconforming behavior (GNCB) in a prospective birth cohort (N = 5,007). Childhood parental maltreatment (physical and emotional) and GNCB were assessed on multiple occasions up to age 6 years, and sexual orientation at 15.5 years. Boys with a history of maltreatment were significantly more likely to be nonheterosexual. Using propensity score weighting, maltreatment was associated with a 3.5% (p = .03) increase in the prevalence of nonheterosexuality accounting for confounders not including GNCB, and by 2.9% (p = .06) when also accounting for GNCB. These findings suggest that maltreatment is associated with an increased prevalence of nonheterosexuality in boys but may be explained by confounding factors including GNCB.
Can dietary strategies in early life prevent childhood food allergy? A report from two iFAAM workshops
Authors: Roberts Graham , Grimshaw Kate , Beyer Kirsten , Boyle Robert , Lack Gideon , Austin Moira , Garcia‐Larsen Vanessa , Grabenhenrich Linus , Halken Susanne , Keil Thomas , Madsen Charlotte , Regent Lynne , Schnadt Sabine , Szajewska Hania , Van Ree Ronald , Mills E. N. Clare
Published: October 2019

Food allergy affects a small but significant number of children and adults. Food allergy is responsible for considerable morbidity and is the commonest cause of anaphylaxis in children. One of the aims of the European Union‐funded “Integrated Approaches to Food Allergen and Allergy Risk Management” (iFAAM) project was to improve our understanding of the best way to prevent the development of food allergy. Groups within the project worked on integrating the current prevention evidence base as well as generating new data to move our understanding forward. This paper from the iFAAM project is a unique addition to the literature on this topic as it not only outlines the recently published randomized controlled trials (as have previous reviews) but also summarizes two iFAAM‐associated project workshops. These workshops focused on how we may be able to use dietary strategies in early life to prevent the development of food allergy and summarized the range of opinions amongst experts in this controversial area.
High prescription rate of oral glucocorticoids in children and adults: A retrospective cohort study from Western Sweden
Authors: Einarsdottir Margret J. , Ekman Per , Trimpou Penelope , Olsson Daniel S. , Johannsson Gudmundur , Ragnarsson Oskar
Published: October 2019

Objective

Glucocorticoids (GCs) are a cornerstone in treating various common and uncommon diseases. The aim of this study was to estimate the prevalence of GC use in terms of doses associated with risk of tertiary adrenal insufficiency in adults and children, and treatment indications.

Methods

This was a retrospective cohort study. Information on dispensed prescriptions was obtained from the Swedish Prescribed Drug Register. Patients with prescriptions of prednisolone (or equivalent dose of other GCs) ≥5 mg daily for ≥21 days between 2007 and 2014 were included. Information on concurrent diseases was obtained from the Swedish National Patient Register and the Västra Götaland Regional Healthcare Database.

Results

Of 1 585 335 inhabitants in Västra Götaland County, 223 211 were included in the study (women 55.6%). Mean age was 48 ± 24 years. Period prevalence of oral GC use during the 8‐year study period was 14.1%. The highest prevalence (27.4%) was in men aged 80‐89 years and lowest (7.5%) in men 10‐19 years of age. The period prevalence in children 0‐9 years of age was 10.6%. COPD and asthma were the most common indications for treatment (17.2%) followed by allergy (12.5%) and malignant neoplasms (11.5%). Allergy was the most frequent indication (20.5%) in children and adolescents.

Conclusion

Between 2007 and 2014, every seventh inhabitant in western Sweden received a GC prescription at doses associated with risk of developing tertiary adrenal insufficiency. These findings illustrate the importance of awareness of the potential development of tertiary adrenal insufficiency in both paediatric and adult patients.
The curative treatment of familial hypercholesterolemia: Liver transplantation
Authors: Gulsoy Kirnap Nazli , Kirnap Mahir , Bascil Tutuncu Neslihan , Moray Gokhan , Haberal Mehmet
Published: October 2019

Background

Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder characterized by premature mortal cardiovascular complications. Liver transplantation (LT) is the only curative treatment option. In this study, the long‐term clinical follow‐up data of 8 patients who underwent LT with a diagnosis of FH in our center are presented.

Materials and Methods

A total of 638 LT were performed between December 1985 and June 2019 at Baskent University, of which 8 patients underwent LT with a diagnosis of FH and were evaluated retrospectively.

Results

Of the 8 patients, 4 underwent deceased donor and 4 living donor transplantation. Five patients had preoperative cardiovascular disease and consequent interventional operations. There was significant reduction in postoperative LDL‐C and TC levels starting from the first week, and stabilizing at the first month and first year. The median survival time of patients was 5 years (2‐12 years). All patients are still alive. None of the complications of patients with preoperative cardiovascular complications had progressed.

Conclusion

Liver transplantation is the preferred curative treatment for the pathophysiology of FH. In our study, LDL‐C levels were brought under control with LT performed on patients with FH. Median 5‐year follow‐up of patients showed that the progression of cardiac complications was abated.
A restrictive alcohol social supply law change is associated with less supply to friends under 18 years
Authors: Huckle Taisia , Romeo Jose , Casswell Sally
Published: October 2019

Introduction and Aims

This study aimed to assess the early impacts of a 2013 law change to restrict the social supply of alcohol to under 18s in New Zealand by assessing changes in social suppliers' behaviour.

Design and Methods

National surveys of drinkers aged 16–65 years were collected before (2013) and after (2015) the law change. Suppliers were asked: to whom they supplied alcohol, how often and how much; if the supplier thought the alcohol they provided would be shared; whether the supplier had permission to supply from parent/guardian, and if they supervised their supply. General estimating equation models were used to conduct analyses.

Results

Sons and daughters were commonly supplied to, as were friends, but friends were supplied greater quantities on average [13 drinks compared to four drinks for sons/daughters (at baseline)]. Following the law change, friends were less commonly supplied to (8% decrease), were supplied with fewer drinks (down from 13 to 11 drinks) and there was greater supervision of social supply to friends (16% increase) (and to other relatives). However, the number of drinks supplied by parents increased from four to six drinks.

Discussion and Conclusions

There was evidence of some early reductions in social supply in relation to the law change, in particular where the legislation aimed to have effect; specifically, less supply to friends under 18 years. We found no effect of the new law on parental supply. As quantities supplied are still very high, further policy restriction and public health interventions would be appropriate.
Dermatological complications of therapy with biologics in inflammatory autoimmune diseases
Authors: Sondermann Wiebke , Herz Saskia , Sody Elsa , Körber Andreas
Published: October 2019

Background and objective

Cutaneous adverse events (CAEs) occur in up to 10 % of patients with immune‐mediated inflammatory disease (IMID) treated with antitumor necrosis factor (TNF)α agents. The aim of this clinical study was to track and observe the course of CAEs in all biologic therapies.

Patients and methods

The population for this study consisted of patients with CAEs under biologic therapy who were examined by experienced board‐certified dermatologists in the outpatient department of the University Hospital Essen, Department of Dermatology.

Results

Altogether 39 patients with a total of 45 CAEs were included in this study. In 60 % of the cases a form of paradoxical psoriasis was diagnosed. Two thirds (66.6 %) of the patients with CAEs were diagnosed with an underlying inflammatory bowel disease (IBD). TNFα antagonists were the triggering agents in about 95 % of the cases. Changes in biological therapy were required in nearly half of the cases (46.2 %). Almost 90 % of the patients had either a complete (42.1 %) or a partial response (47 %).

Conclusions

Management of CEAs under biological therapy can be challenging in clinical practice. Case discussions between gastroenterologists, rheumatologists and dermatologists should be undertaken to best manage patients with CAEs and avoid unnecessary changes of therapy.
Underwater endoscopic mucosal resection for complete R0 removal of an adenoma extending into the appendiceal orifice
Authors: Shiotsuki Kazuo , Imai Kenichiro , Hotta Kinichi
Published: October 2019

Watch a video of this article
Does time matter? WhatsApp vs electronic mail for dental education. A pilot study
Authors: Poblete Paulina , Nieto Eugenio
Published: October 2019

Introduction

WhatsApp is an instant multimedia messaging and social media software which can be used for multiple purposes such as data, text, photographs and document transfer. Due to its versatility and multiple utilities, WhatsApp has been used within the educational setting in medicine and dentistry, proving a positive attitude of students towards its use.

Aim

To compare the reception time and the response time of WhatsApp with the traditional electronic email within the dental educational environment.

Method

A two‐group comparative study was designed. Four multiple choice questions were sent via WhatsApp (group WA) and via electronic mail (group eM) to dental students. Data collected focused on the reception time and response time of students. Specifications of WhatsApp were used to collect data whilst an email tracker was used for the eM group. Excel software and Stata/IC version 15.1 software were used for data analysis.

Results

Seventy‐four dental students from the University x (anonymised for reviewing purposes) dental school agreed to take part in this experience. However, 59 provided their responses (80%). Forty‐four were females, and 15 were males. Twenty‐seven participants were randomly allocated to the WA group and 32 to the eM group. The statistical analysis revealed a significant difference between groups: Reception time, P: .0286 value and response time, P: .0448 value indicating that the WA group was significantly faster in terms of reception and response time.

Conclusion

This pilot study suggests that WhatsApp is more efficient in terms of reception and response time than electronic emails.
The involvement of school teachers in research‐related activities: Extent, quality and predictors
Authors: Papanastasiou Elena C. , Karagiorgi Yasemina
Published: October 2019

In view of the need to develop school teachers as research‐oriented professionals and the reported complexities of this endeavour internationally, this article explores teacher involvement in research‐related‐activities in Cyprus. It aims to measure the extent and quality of such involvement and explore possible predictors. Data were collected from a sample of 420 public primary and secondary school teachers. Most respondents reported involvement in activities for the consumption of research, which was found to be related to teachers' background in research methods courses and work context (primary/secondary school). Teachers' involvement in activities for the production of research was less extensive, whilst statistical associations with the specific background variables were not traced. On the basis of the findings, recommendations for the transition towards research‐oriented teachers are discussed in terms of developing research knowledge, skills and attitudes and providing supportive measures to schools.
Complementarity effects are strengthened by competition intensity and global environmental change in the central boreal forests of Canada
Authors: Searle Eric B. , Chen Han Y. H.
Published: October 2019

Increases in niche complementarity have been hypothesised to reduce the intensity of interspecific competition within natural forests. In regions currently experiencing potentially enhanced growth under global environmental change, niche complementarity may become even more beneficial. However, few studies have provided direct evidence of this mechanism. Here, we use data from 180 permanent sample plots in Manitoba, Canada, with a full spatial mapping of all stems, to show that complementarity effects on average increased with neighbourhood competition intensity and temporally rising CO2, warming and water availability. Importantly, complementarity effects increased with both shade tolerance and phylogenetic dissimilarity between the focal tree and its neighbours. Our results provide further evidence that increasing stand functional and phylogenetic diversity can improve individual tree productivity, especially for individuals experiencing intense competition and may offer an avenue to maintain productivity under global environmental change.
Sex differences in main olfactory system pathways involved in psychosexual function
Authors: Cherry James A. , Baum Michael J.
Published: October 2019

We summarize literature from animal and human studies assessing sex differences in the ability of the main olfactory system to detect and process sex‐specific olfactory signals (“pheromones”) that control the expression of psychosexual functions in males and females. A case is made in non primate mammals for an obligatory role of pheromonal signaling via the main olfactory system (in addition to the vomeronasal‐accessory olfactory system) in mate recognition and sexual arousal, with male‐specific as well as female‐specific pheromones subserving these functions in the opposite sex. Although the case for an obligatory role of pheromones in mate recognition and mating among old world primates, including humans, is weaker, we review the current literature assessing the role of putative human pheromones (eg, AND, EST, “copulin”), detected by the main olfactory system, in promoting mate choice and mating in men and women. Based on animal studies, we hypothesize that sexually dimorphic effects of putative human pheromones are mediated via main olfactory inputs to the medial amygdala which, in turn, transmits olfactory information to sites in the hypothalamus that regulate reproduction.
Profiles of advanced hepatic fibrosis evaluated by FIB‐4 index and shear wave elastography in health checkup examinees
Authors: Yamamura Sakura , Kawaguchi Takumi , Nakano Dan , Tomiyasu Yoshiko , Yoshinaga Shinobu , Doi Yumi , Takahashi Hirokazu , Anzai Keizo , Eguchi Yuichiro , Torimura Takuji , Shiba Naoto
Published: October 2019

Aim

Advanced hepatic fibrosis is seen in individuals with potential hepatocellular carcinoma and cardiovascular disease. Hepatic fibrosis can be assessed using a combination of the FIB‐4 index and imaging modalities, including shear wave elastography. We aimed to investigate the prevalence of advanced fibrosis in the general population and the profiles associated with advanced fibrosis using a data‐mining analysis.

Methods

We enrolled 1155 health checkup examinees (median age 53 years, 685 women, 470 male). Advanced fibrosis was defined by FIB‐4 index ≥1.3 and liver stiffness ≥8.07 kPa using shear wave elastography. Participants were classified as normal‐mild fibrosis (n = 1035) or advanced fibrosis (n = 120). Factors associated with advanced fibrosis were analyzed by logistic regression and decision‐tree analyses.

Results

Advanced fibrosis was observed in 10.4% of participants (120/1155). In the logistic regression analysis, independent factors for advanced fibrosis were age (≥75 years; OR 2.12, 95% CI 1.021–4.415; P = 0.0419) and the presence of metabolic syndrome (OR 2.51, 95% CI 1.416–4.462; P = 0.0017). The decision‐tree analysis showed two profiles associated with advanced fibrosis: profile 1 – individuals aged ≥65 years with metabolic syndrome and mild‐to‐moderate alcohol consumption (prevalence of advanced fibrosis 73.3%); and profile 2 – individuals without metabolic syndrome, aged ≥75 years, with no exercise habit (prevalence of advanced fibrosis 56.3%).

Conclusions

Advanced fibrosis was observed in 10.4% of health checkup examinees. Furthermore, we showed that aging, metabolic syndrome with mild‐to‐moderate alcohol consumption, and physical inactivity were associated with advanced fibrosis. Thus, prevention of metabolic syndrome and alcohol withdrawal, as well as exercise habits, might inhibit the progression of hepatic fibrosis.
Chlorhexidine gluconate transparent dressing does not decrease central line‐associated bloodstream infection in critically ill patients: A randomized controlled trial
Authors: Yu Kunrong , Lu Meishan , Meng Yanling , Zhao Yanwei , Li Zheng
Published: October 2019

Background

Central line‐associated blood stream infections are accompanied by increased mortality and health care costs. The application of different types of dressings in infection control has not been fully investigated to date.

Aim

To assess the effects of two different dressing types on central line‐associated bloodstream infections.

Methods

A randomized, nonblinded, controlled trial was conducted. Central lines were randomly allocated to intervention (chlorhexidine gluconate transparent dressing, n = 259) and control groups (standard dressing, n = 215). The central line‐associated bloodstream infection rate was assessed.

Results

A statistically nonsignificant difference was noted in the overall central line‐associated bloodstream infection rates between the two groups. The frequency of dressing changes in the patients with the chlorhexidine gluconate transparent dressing was significantly lower than that in the patients with a standard dressing. The predominant type of infectious microorganisms isolated from the central line‐associated bloodstream infection episodes was Gram‐negative bacteria (57.2%). Gram‐positive bacteria and fungi were noted at lower percentages (28.5% and 14.3%, respectively).

Conclusion

The use of a chlorhexidine gluconate transparent dressing does not decrease the central line‐associated bloodstream infection rate, although it decreases the frequency of dressing changes so may save nursing time.
Subgroup differences in situational judgment test scores: Evidence from large applicant samples
Authors: Herde Christoph N. , Lievens Filip , Jackson Duncan J. R. , Shalfrooshan Ali , Roth Philip L.
Published: October 2019

To promote diversity in organizations it is important to have accurate knowledge about subgroup differences associated with selection procedures. However, current estimates of subgroup differences in situational judgment tests (SJTs) are overwhelmingly based on range‐restricted incumbent samples that are downwardly biased. This study provides much‐needed applicant level estimates of SJT subgroup differences (N = 37,530). As a key finding, Black‐White differences (d = 0.66) were higher than in incumbent samples (d = 0.38). Overall, sex differences were small. Females scored higher for management jobs (d = −0.13) and males scored higher for administrative jobs (d = 0.15). By analyzing applicant samples that do not suffer from range restriction, this study adds knowledge about subgroup differences in SJTs.
Hyperglycemia aggravates acute liver injury by promoting liver‐resident macrophage NLRP3 inflammasome activation via the inhibition of AMPK/mTOR‐mediated autophagy induction
Authors: Wang Qi , Wei Song , Zhou Shun , Qiu Jiannan , Shi Chenyu , Liu Rui , Zhou Haoming , Lu Ling
Published: October 2019

Although the detrimental effects of diabetes mellitus/hyperglycemia have been observed in many liver disease models, the function and mechanism of hyperglycemia regulating liver‐resident macrophages, Kupffer cells (KCs), in thioacetamide (TAA)‐induced liver injury remain largely unknown. In this study, we evaluated the role of hyperglycemia in regulating NOD‐like receptor family pyrin domain‐containing 3 protein (NLRP3) inflammasome activation by inhibiting autophagy induction in KCs in the TAA‐induced liver injury model. Type I diabetes/hyperglycemia was induced by streptozotocin treatment. Compared with the control group, hyperglycemic mice exhibited a significant increase in intrahepatic inflammation and liver injury. Enhanced NLRP3 inflammasome activation was detected in KCs from hyperglycemic mice, as shown by increased gene induction and protein levels of NLRP3, cleaved caspase‐1, apoptosis‐associated speck‐like protein containing a caspase recruitment domain and interleukin‐1β, compared with control mice. NLRP3 inhibition by its antagonist CY‐09 effectively suppressed inflammasome activation in KCs and attenuated liver injury in hyperglycemic mice. Furthermore, inhibited autophagy activation was revealed by transmission electron microscope detection, decreased LC3B protein expression and p‐62 protein degradation in KCs isolated from TAA‐stressed hyperglycemic mice. Interestingly, inhibited 5′ AMP‐activated protein kinase (AMPK) but enhanced mammalian target of rapamycin (mTOR) activation was found in KCs from TAA‐stressed hyperglycemic mice. AMPK activation by its agonist 5‐aminoimidazole‐4‐carboxamide ribonucleotide (AICAR) or mTOR signaling knockdown by small interfering RNA restored autophagy activation, and subsequently, inhibited NLRP3 inflammasome activation in KCs, leading to ultimately reduced TAA‐induced liver injury in the hyperglycemic mice. Our findings demonstrated that hyperglycemia aggravated TAA‐induced acute liver injury by promoting liver‐resident macrophage NLRP3 inflammasome activation via inhibiting AMPK/mTOR‐mediated autophagy. This study provided a novel target for prevention of toxin‐induced acute liver injury under hyperglycemia.
Efficient gene correction of an aberrant splice site in β‐thalassaemia iPSCs by CRISPR/Cas9 and single‐strand oligodeoxynucleotides
Authors: Xiong Zeyu , Xie Yingjun , Yang Yi , Xue Yanting , Wang Ding , Lin Shouheng , Chen Diyu , Lu Dian , He Lina , Song Bing , Yang Yinghong , Sun Xiaofang
Published: October 2019

β‐thalassaemia is a prevalent hereditary haematological disease caused by mutations in the human haemoglobin β (HBB) gene. Among them, the HBB IVS2‐654 (C > T) mutation, which is in the intron, creates an aberrant splicing site. Bone marrow transplantation for curing β‐thalassaemia is limited due to the lack of matched donors. The clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR‐associated protein 9 (Cas9), as a widely used tool for gene editing, is able to target specific sequence and create double‐strand break (DSB), which can be combined with the single‐stranded oligodeoxynucleotide (ssODN) to correct mutations. In this study, according to two different strategies, the HBB IVS2‐654 mutation was seamlessly corrected in iPSCs by CRISPR/Cas9 system and ssODN. To reduce the occurrence of secondary cleavage, a more efficient strategy was adopted. The corrected iPSCs kept pluripotency and genome stability. Moreover, they could differentiate normally. Through CRISPR/Cas9 system and ssODN, our study provides improved strategies for gene correction of β‐Thalassaemia, and the expression of the HBB gene can be restored, which can be used for gene therapy in the future.
Long non‐coding RNA MEG3 knockdown attenuates endoplasmic reticulum stress‐mediated apoptosis by targeting p53 following myocardial infarction
Authors: Li Xueling , Zhao Jinxuan , Geng Jin , Chen Fu , Wei Zilun , Liu Chen , Zhang Xinlin , Li Qiaoling , Zhang Jingmei , Gao Ling , Xie Jun , Xu Biao
Published: October 2019

Mounting evidence has indicated that long non‐coding RNA maternally expressed gene 3 (lncRNA MEG3) regulates cell apoptosis, and is involved in a variety of diseases. However, its exact role in myocardial infarction (MI) has not been fully elucidated. In the present study, we firstly observed that the expression levels of the lncRNA MEG3 in infarct hearts and hypoxic neonatal mice ventricular myocytes (NMVMs) were up‐regulated by quantitative real‐time PCR (qRT‐PCR). Then, we knocked down lncRNA MEG3 by lentiviral delivery in the myocardial border region following multipoint injection. Following 28 days of MI, the lncRNA MEG3 knockdown mice indicated better cardiac function, and less cardiac remodelling by ultrasonic cardiogram and histological analysis. In addition, we indicated that lncRNA MEG3 knockdown reduced myocyte apoptosis and reactive oxygen species production in MI mice model and hypoxic NMVMs. Furthermore, we revealed that knockdown of lncRNA MEG3 protected against endoplasmic reticulum stress (ERS)‐mediated myocardial apoptosis including the induction of PERK‐eIF2α and caspase 12 pathways. At last, we provided evidence that p53 was identified as a protein target of lncRNA MEG3 to regulate NF‐κB‐ and ERS‐associated apoptosis. Taken collectively, our findings demonstrated that lncRNA MEG3 knockdown exerted cardioprotection by reducing ERS‐mediated apoptosis through targeting p53 post‐MI.
Down‐regulation of GAS5 ameliorates myocardial ischaemia/reperfusion injury via the miR‐335/ROCK1/AKT/GSK‐3β axis
Authors: Wu Nan , Zhang Xiaowen , Bao Yandong , Yu Hang , Jia Dalin , Ma Chunyan
Published: October 2019

Growth arrest‐specific transcript 5 (GAS5), along non‐coding RNA (LncRNA), is highly expressed in hypoxia/reoxygenation (H/R)‐cardiomyocytes and promotes H/R‐induced apoptosis. In this study, we determined whether down‐regulation of GAS5 ameliorates myocardial ischaemia/reperfusion (I/R) injury and further explored its mechanism. GAS5 expression in cardiomyocytes and rats was knockdown by transfected or injected with GAS5‐specific small interfering RNA or adeno‐associated virus delivering small hairpin RNAs, respectively. The effects of GAS5 knockdown on myocardial I/R injury were detected by CCK‐8, myocardial enzyme test, flow cytometry, TTC and terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) staining. qRT‐PCR and luciferase reporter assay were carried out to analyse the relationship between GAS5 and miR‐335. The regulation of GAS5 on Rho‐associated protein kinase 1 (ROCK1) expression, the activation of PI3K/AKT/GSK‐3β pathway and mitochondrial permeability transition pore (mPTP) opening was further evaluated. The results indicated that GAS5 knockdown enhanced the viability, decreased apoptosis and reduced the levels of lactate dehydrogenase and creatine kinase‐MB in H/R‐treatment cardiomyocytes. Meanwhile, down‐regulation of GAS5 limited myocardial infarct size and reduced apoptosis in I/R‐heart. GAS5 was found to bind to miR‐335 and displayed a reciprocal inhibition between them. Furthermore, GAS5 knockdown repressed ROCK1 expression, activated PI3K/AKT, thereby leading to inhibition of GSK‐3β and mPTP opening. These suppressions were abrogated by miR‐335 inhibitor treatment. Taken together, our results demonstrated that down‐regulation of GAS5 ameliorates myocardial I/R injury via the miR‐335/ROCK1/AKT/GSK‐3β axis. Our findings suggested that GAS5 may be a new therapeutic target for the prevention of myocardial I/R injury.
Cosmc overexpression enhances malignancies in human colon cancer
Authors: Gao Tianbo , Du Tan , Hu Xin , Dong Xichen , Li Lina , Wang Yakun , Liu Jian , Liu Lijie , Gu Tao , Wen Tao
Published: October 2019

Cosmc is known as a T‐synthase‐specific molecular chaperone that plays a crucial role in the process of O‐glycosylation. Cosmc dysfunction leads to inactive T‐synthase and results in aberrant O‐glycosylation, which is associated with various tumour malignancies. However, it is unclear whether Cosmc has some other functions beyond its involvement in O‐glycosylation. In this study, we aimed to investigate the functional role of Cosmc in human colorectal cancer (CRC). We first assessed the expression levels of Cosmc in human CRC specimens and then forcedly expressed Cosmc in human CRC cell lines (HCT116, SW480) to examine its impact on cellular behaviours. The mechanisms for aberrant expression of Cosmc in CRC tissues and the altered behaviours of tumour cells were explored. It showed that the mRNA and protein levels of Cosmc were markedly elevated in human CRC specimens relative to normal colorectal tissues. The occurrence of endoplasmic reticulum (ER) stress may largely contribute to the increased Cosmc expression in cancer tissue and cells. Cosmc overexpression in CRC cells significantly promoted cell migration and invasion, which could be attributed to the activation of the epithelial‐mesenchymal transition (EMT) pathway rather than aberrant O‐glycosylation. These data indicate that Cosmc expression was elevated in human CRC possibly caused by ER stress, which further enhanced malignancies through the activation of EMT but independently of aberrant O‐glycosylation.
Dyslexia and Developmental Language Disorder: comorbid disorders with distinct effects on reading comprehension
Authors: Snowling Margaret J. , Hayiou‐Thomas Marianna E. , Nash Hannah M. , Hulme Charles
Published: October 2019

Background

Reading comprehension draws on both decoding and linguistic comprehension, and poor reading comprehension can be the consequence of a deficit in either of these skills.

Methods

Using outcome data from the longitudinal Wellcome Language and Reading Project, we identified three groups of children at age 8 years: children with dyslexia (N = 21) who had deficits in decoding but not oral language, children with Developmental Language Disorder (DLD; N = 38) whose decoding skills were in the normal range, and children who met criteria for both dyslexia and DLD (N = 29).

Results

All three groups had reading comprehension difficulties at the ages of 8 and 9 years relative to TD controls though those of the children with dyslexia were mild (relative to TD controls, d = 0.51 at age 8, d = 0.60 at age 8); while the most severe problems were found in the comorbid dyslexia + DLD group (d = 1.79 at age 8, d = 2.06 at age 9) those with DLD also had significant difficulties (d = 1.56 at age 8, d = 1.56 at age 9).

Conclusions

These findings confirm that children with dyslexia or DLD are at‐risk for reading comprehension difficulties but for different reasons, because of weak decoding in the case of dyslexia or weak oral language skills in the case of DLD. Different forms of intervention are required for these groups of children, targeted to their particular area(s) of weakness.
Life cycle assessment of emerging environmental technologies in the early stage of development: A case study on nanostructured materials
Authors: Bartolozzi Irene , Daddi Tiberio , Punta Carlo , Fiorati Andrea , Iraldo Fabio
Published: October 2019

The use of nanostructured materials has been recently proposed in the field of environmental nanoremediation. This approach consists in using nanomaterials not directly, but as building blocks for the design of nano‐porous micro‐dimensional systems, overcoming the eco‐ and health‐toxicology risks generally associated with the use of nano‐sized technologies. Herein we report the use of life cycle assessment (LCA) as an eco‐design tool for optimizing the production of cellulose nanosponges (CNS), nanostructured materials recently developed for water remediation purposes. LCA was applied from the acquisition of raw materials to the synthesis of CNS (from cradle‐to‐gate), considering three production systems, from the lab‐level to a modeled scale‐up system. The lab‐scale LCA identified the main environmental hotspots, namely the energy‐consuming steps and the final purification of the material (washing step). In a second lab‐scale production, an improvement action could be implemented, switching the washing solvent from methanol to water and decreasing the washing temperature. A second LCA showed a reduced contribution to the impacts from the materials, while the global impacts remained within the same order of magnitude. A simulated scale‐up of the process allowed to optimize the energy‐consuming steps and the water consumption, through internal recycling. A third LCA assessed the resulting benefits and a decrease in the global impacts by two orders of magnitude. Our study contributes to the discussion of LCA community, providing a focus on the importance of scaling‐up of emerging technologies, namely nanostructured porous materials, highlighting the benefits of a LCA based approach since the very beginning of product design (eco‐design).