Identifying High-Risk Patients With Nonalcoholic Fatty Liver Disease: An Opportunity for Intervention Within the Primary Care Setting.

BACKGROUND/OBJECTIVE: Patients with metabolic syndrome (MetS) are likely to have nonalcoholic fatty liver disease (NAFLD), which can progress to advanced fibrosis. Early recognition of those at highest risk may ameliorate outcomes. Noninvasive liver fibrosis assessment through validated scoring systems such as the fibrosis-4 (FIB-4) index is helpful to identify these high-risk patients, with the process ideally beginning in the primary care setting. The primary objective of this study was to determine rates of disease recognition and initial management of patients with NAFLD and advanced fibrosis in a diverse primary care setting. The secondary objective was to define demographic and clinical predictors of NAFLD identification and management in this population. METHODS: Medical charts from patients seen at three university-based primary care practices in New York City from January 2016 to December 2019 were reviewed. Inclusion criteria consisted of: age 18 years and above, persistent alanine transaminase (ALT) elevation (2 values ≥40 IU/mL ≥6 mo apart), and body mass index ≥30 kg/m 2 . Patients with viral hepatitis or alcohol misuse were excluded. Patients were defined as likely having NAFLD if they met 2 of the following criteria indicating MetS: systolic blood pressure >135 mm Hg or diastolic blood pressure >85 mm Hg or active treatment for hypertension; high-density lipoprotein <40 g/dL; triglycerides >150 mg/dL or active treatment for hyperlipidemia; or hemoglobin A1c ≥5.7% or active treatment for insulin resistance. The primary study endpoints were the frequency of providers' recognition of NAFLD and referral to specialist and/or for imaging based on visit diagnosis codes or chart documentation. The secondary endpoints were frequency of detecting those with NAFLD and advanced fibrosis utilizing previously defined FIB-4 index cutoffs as well as predictors of disease recognition and management. Analysis was completed using descriptive statistics and logistical regression modeling. RESULTS: A total of 295 patients were identified as having persistently elevated ALT, a body mass index ≥30 kg/m 2 , and MetS consistent with likely NAFLD diagnosis. In patients meeting these criteria, ALT elevation was documented by primary care providers in 129 patients (43.7%), NAFLD was noted in chart documentation in 76 patients (25.8%), and a NAFLD ICD-10 diagnosis was assigned to 7 patients (2.4%). 50 patients (16.9%) were referred for ultrasound. Among 51 patients (17.2%) at high risk for advanced fibrosis based on FIB-4 >3.25, 23 patients (45.1%) had NAFLD recognized by their provider and 3 (5.9%) were referred to a specialist. On logistic regression, female gender, dyslipidemia, and private insurance were predictors of disease identification by the primary care physician. CONCLUSION: ALT elevation and NAFLD are under recognized among patients with MetS in the primary care setting. Importantly, while 17.2% of patients with likely NAFLD in our cohort were high risk for advanced fibrosis, less than half of this group had a NAFLD diagnosis recognized by their primary care provider and only three were referred to a liver specialist. Further investigation of disease recognition and management algorithms in the primary care setting are necessary to enhance NAFLD detection, implement clinical care pathways, and reduce disease progression and complications.

Evaluation of the Biofire FilmArray BioThreat-E Test (v2.5) for Rapid Identification of Ebola Virus Disease in Heat-Treated Blood Samples Obtained in Sierra Leone and the United Kingdom.

Rapid Ebola virus (EBOV) detection is crucial for appropriate patient management and care. The performance of the FilmArray BioThreat-E test (v2.5) using whole-blood samples was evaluated in Sierra Leone and the United Kingdom and was compared with results generated by a real-time Ebola Zaire PCR reference method. Samples were tested in diagnostic laboratories upon availability, included successive samples from individual patients, and were heat treated to facilitate EBOV inactivation prior to PCR. The BioThreat-E test had a sensitivity of 84% (confidence interval [CI], 64% to 95%) and a specificity of 89% (CI, 73% to 97%) in Sierra Leone (n = 60; 44 patients) and a sensitivity of 75% (CI, 19% to 99%) and a specificity of 100% (CI, 97% to 100%) in the United Kingdom (n = 108; 70 patients) compared to the reference real-time PCR. Statistical analysis (Fisher's exact test) indicated there was no significant difference between the methods at the 99% confidence level in either country. In 9 discrepant results (5 real-time PCR positives and BioThreat-E test negatives and 4 real-time PCR negatives and BioThreat-E test positives), the majority (n = 8) were obtained from samples with an observed or probable low viral load. The FilmArray BioThreat-E test (v2.5) therefore provides an attractive option for laboratories (either in austere field settings or in countries with an advanced technological infrastructure) which do not routinely offer an EBOV diagnostic capability.

Diagnosis of Febrile Illnesses Other Than Ebola Virus Disease at an Ebola Treatment Unit in Sierra Leone.

Patients with febrile illnesses presenting to an Ebola treatment unit in Sierra Leone had a wide range of diagnoses other than Ebola virus disease. Rapid diagnostic tests were useful in confirming these diagnoses, reducing the length of patient stay with valuable consequences. These alternative diagnoses should assist in future planning.

Manganese alkane complexes: an IR and NMR spectroscopic investigation.

Manganese propane and manganese butane complexes derived from CpMn(CO)(3) were generated photochemically at 130-136 K with the alkane as solvent and characterized by FTIR spectroscopy and by (1)H NMR spectroscopy with in situ laser photolysis. Time-resolved IR spectroscopic measurements were performed at room temperature with the same laser wavelength. The ν(CO) bands in the IR spectra of the photoproducts in propane are shifted to low frequency with respect to CpMn(CO)(3), consistent with formation of CpMn(CO)(2)(propane). The (1)H NMR spectra conform to the criteria for alkane complexes: a high-field resonance for the η(2)-CH protons that shifts substantially on partial deuteration of the alkane and exhibits a coupling constant J(C-H) on (13)C-labeling of ca. 120 Hz. The NMR spectrum of each system exhibits two diagnostic product resonances in the high-field region for the η(2)-CH protons, corresponding to CpMn(CO)(2)(η(2)-C1-H-alkane) and CpMn(CO)(2)(η(2)-C2-H-alkane) isomers. Partial deuteration of the alkane at C1 results in characteristic strong isotopic perturbation of equilibrium of the η(2)-CH resonance of CpMn(CO)(2)(η(2)-C1-H-alkane). With propane-(13)C(1), the η(2)-CH resonance of CpMn(CO)(2)(η(2)-C1-H-alkane) isomer exhibits (13)C satellites with J(C-H) = 119 Hz. The corresponding resonance of CpMn(CO)(2)(η(2)-C2-H-alkane) is identified by use of propane-2,2-d(2). The lifetimes of the (η(2)-C1-H-alkane) isomers of the manganese complexes were determined by NMR spectroscopy as 22 ± 2 min at 134 K (propane) and 5.5 min at 136 K (butane). The corresponding spectra and lifetimes of the CpRe(CO)(2)(alkane) complexes were measured for reference (CpRe(CO)(2)(propane) lifetime ca. 60 min at 161 K; CpRe(CO)(2)(butane) 13 min at 171 K). The lifetimes determined by IR spectroscopy were similar to those determined by NMR spectroscopy, thereby supporting the assignments. These measurements extend the range of alkane complexes characterized by NMR spectroscopy from rhenium and rhodium derivatives to include less stable manganese derivatives.

An oxidized active site model for the FeFe hydrogenase: reduction with hydrogen gas.

Models for the oxidized form of the FeFe hydrogenase active site have been prepared. These cationic complexes contain two iron atoms, carbonyl ligands, a propanedithiolate bridge, and one other bridging group. Reduction of these complexes with hydrogen gas is demonstrated.

DNA methylation mediates the association between breastfeeding and early-life growth trajectories.

BACKGROUND: The role of breastfeeding in modulating epigenetic factors has been suggested as a possible mechanism conferring its benefits on child development but it lacks evidence. Using extensive DNA methylation data from the ALSPAC child cohort, we characterized the genome-wide landscape of DNA methylation variations associated with the duration of exclusive breastfeeding and assessed whether these variations mediate the association between exclusive breastfeeding and BMI over different epochs of child growth. RESULTS: Exclusive breastfeeding elicits more substantial DNA methylation variations during infancy than at other periods of child growth. At the genome-wide level, 13 CpG sites in girls (miR-21, SNAPC3, ATP6V0A1, DHX15/PPARGC1A, LINC00398/ALOX5AP, FAM238C, NATP/NAT2, CUX1, TRAPPC9, OSBPL1A, ZNF185, FAM84A, PDPK1) and 2 CpG sites in boys (IL16 and NREP), mediate the association between exclusive breastfeeding and longitudinal BMI. We found enrichment of CpG sites located within miRNAs and key pathways (AMPK signaling pathway, insulin signaling pathway, endocytosis). Overall DNA methylation variation corresponding to 3 to 5 months of exclusive breastfeeding was associated with slower BMI growth the first 6 years of life compared to no breastfeeding and in a dose-response manner with exclusive breastfeeding duration. CONCLUSIONS: Our study confirmed the early postnatal period as a critical developmental period associated with substantial DNA methylation variations, which in turn could mitigate the development of overweight and obesity from infancy to early childhood. Since an accelerated growth during these developmental periods has been linked to the development of sustained obesity later in life, exclusive breastfeeding could have a major role in preventing the risks of overweight/obesity and children and adults through DNA methylation mechanisms occurring early in life.

A carbonyl-rich bridging hydride complex relevant to the Fe-Fe hydrogenase active site.

Protonation of Fe(2)(µ-S(2)C(3)H(6))(CO)(6) with an acid derived from [SiEt(3)][B(C(6)F(5))(4)] and HCl affords a hydride-bridged dimer.

A systematic approach to the generation of long-lived metal alkane complexes: combined IR and NMR study of (Tp)Re(CO)2(cyclopentane).

Short wavelength photolysis of (Tp)Re(CO)(3) (Tp = tris(pyrazol-1-yl)borate) at low-temperature in cyclopentane yielded (Tp)Re(CO)(2)(cyclopentane), an alkane complex with three nitrogen ligands that was characterised by NMR spectroscopy.

Complete 1H, 13C and 15N NMR assignments for donor-strand complemented AafA, the major pilin of aggregative adherence fimbriae (AAF/II) from enteroaggregative E. coli.

Aggregative adherence fimbriae (AAF) are the primary adhesive factors of enteroaggregative Escherichia coli (EAEC) and are required for intestinal colonization. They mediate binding to extracellular matrix proteins of the enteric mucosa and display proinflammatory effects on epithelial cells in vitro. Among the simplest of bacterial fimbriae, these passive hairlike appendages are composed primarily of a single 16-kDa structural and adhesive subunit, AafA. Oligomerization occurs by incorporating the N-terminal strand of each AafA subunit into an otherwise incomplete ß-sheet of an adjacent AafA subunit. We have engineered a highly soluble AafA monomer by positioning the N-terminal "donor strand" at the C-terminus, following a turn and short linker that were introduced to allow access of the donor strand to the recipient cleft of the same subunit. The resulting "donor-strand complemented" AafA subunit, or AafA-dsc folds autonomously, is monodisperse in solution, and yields high quality NMR spectral data. Here, we report the (1)H, (13)C, and (15)N chemical shift assignments for AafA-dsc.

Photochemical generation of dihydrogen complexes of chromium and tungsten.

Photolysis of solutions of M(CO)(6) (M = Cr, W) at low temperature in the presence of hydrogen gas affords Cr(CO)(5)(H(2)) (1) and W(CO)(5)(H(2)) (2). Complexes 1 and 2 are characterized as dihydrogen complexes based on short T(1) values for the hydride resonances and the observation of a large HD coupling in the HD derivatives. Irradiation of a phosphine-substituted derivative (PMe(3))Cr(CO)(5) in the presence of hydrogen gas gave similar results. Thus cis-(PMe(3))Cr(CO)(4)(H(2)) (3) and trans-(PMe(3))Cr(CO)(4)(H(2)) (4) were prepared and characterized by (1)H and (31)P NMR spectroscopy. When the photolysis reactions were carried out in methylene chloride, solvent binding competitive with hydrogen binding was observed. This was not observed in less coordinating solvents such as alkanes. Subsequent displacement of solvent by H(2) leads to the dihydrogen complexes. Complexes 1 and 2 are moderately acidic, with deprotonation effected by mild bases.

Silane complexes of electrophilic metal centers.

Photolysis of solutions of M(CO)6 (M = Cr, Mo, and W) in the presence of Et3SiH affords the silane complexes Cr(CO)5(eta2-HSiEt3), Mo(CO)5(eta2-HSiEt3), and W(CO)5(eta2-HSiEt3). Observed values of J(SiH) in these complexes are consistent with modest elongation of the Si-H bond. With Ph3SiH, complexes of Cr(CO)5 and W(CO)5 were obtained, but no complex with Mo was observed. When Ph2SiH2 was employed, only one Si-H bond interacts with the metal center. A dynamic exchange process observable on the magnetic resonance time scale exchanges the pendant and coordinated Si-H bonds of the coordinated diphenylsilane. Silanes bound to M(CO)5 are activated with respect to reaction with nucleophiles. With methanol, catalytic methanolysis of HSiEt3 has been observed in the presence of Cr(CO)5(eta2-HSiEt3), affording Et3SiOMe.

Dihydrogen complexes of electrophilic metal centers: observation of Cr(CO)5(H2), W(CO)5(H2) and [Re(CO)5(H2)]+.

Photolysis of dichloromethane solutions of M(CO)6 (M = Cr, W) at low temperature in the presence of hydrogen gas affords W(CO)5(H2) (1) and Cr(CO)5(H2) (2). Complexes 1 and 2 are characterized as dihydrogen complexes based on short T1 values for the hydride resonances and a large HD coupling of 35.3 Hz (W) and 35.8 Hz (Cr) in the HD derivatives. A cationic analogue, [Re(CO)5(H2)]+ (3), was prepared by reaction of Re(CO)5Cl with [Et3Si][B(C6F5)4] in fluorobenzene under hydrogen. Complex 3-d1 exhibits JHD = 33.9 Hz. Complex 3 is strongly acidic, with complete deprotonation by diethyl ether; complexes 1 and 2 are moderately acidic. Deprotonation of 1 is complete in the presence of one equivalent of triethylamine.