Serum PRO-C3 is useful for risk prediction and fibrosis assessment in MAFLD with chronic kidney disease in an Asian cohort.

BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) is an emerging risk factor for chronic kidney disease (CKD). N-terminal propeptide of collagen type 3 (PRO-C3) is a biomarker of advanced fibrosis in MAFLD and PRO-C3 may be involved in renal fibrosis. We aimed to use PRO-C3 measurements to generate a new algorithmic score to test the prediction of MAFLD with chronic kidney disease (MAFLD-CKD). METHODS: A derivation and independent validation cohort of 750 and 129 Asian patients with biopsy-confirmed MAFLD were included. Serum PRO-C3 concentration was measured and regression analyses were performed to examine associations with MAFLD-CKD. A derivative algorithm for MAFLD-CKD risk prediction was evaluated with receiver operator characteristic (ROC) curve analysis. RESULTS: The study included two Asian cohorts (n = 180 with MAFLD-CKD; mean-eGFR: 94.93 mL/min/1.73 m2; median-urinary albumin-to-creatinine ratio: 6.58 mg/mmol). PRO-C3 was associated with the severity of MAFLD-CKD and independently associated with MAFLD-CKD (adjusted odds ratio = 1.16, 95% confidence interval [CI]: 1.08-1.23, p < .001). A new non-invasive score (termed PERIOD) including PRO-C3 efficiently predicted MAFLD-CKD (AUROC = .842, 95% CI: .805-.875). Accuracy, specificity and negative predictive values were 80.2%, 85.1% and 88.4%, respectively. In the validation cohort, the PERIOD score had good diagnostic performance (AUROC = .807, 95% CI: .691-.893) with similar results in all patient subgroups. In the MAFLD-CKD subgroup, the accuracy for identifying advanced fibrosis was further improved by combining the PRO-C3-based ADAPT with the Agile 3+ scores (AUROC = .90, 95% CI: .836-.964). CONCLUSIONS: The PERIOD score is helpful for accurately predicting the risk of MAFLD-CKD. PRO-C3 can also be used to assess liver fibrosis in people with MAFLD-CKD.

RNA m6 A Methylation Suppresses Insect Juvenile Hormone Degradation to Minimize Fitness Costs in Response to A Pathogenic Attack.

Bioinsecticides and transgenic crops based on the bacterial pathogen Bacillus thuringiensis (Bt) can effectively control diverse agricultural insect pests, nevertheless, the evolution of resistance without obvious fitness costs has seriously eroded the sustainable use of these Bt products. Recently, it has been discovered that an increased titer of juvenile hormone (JH) favors an insect host (Plutella xylostella) to enhance fitness whilst resisting the Bt pathogen, however, the underlying regulatory mechanisms of the increased JH titer are obscure. Here, the involvement of N6 -methyladenosine (m6 A) RNA modification in modulating the availability of JH in this process is defined. Specifically, it is found that two m6 A methyltransferase subunit genes, PxMettl3 and PxMettl14, repress the expression of a key JH-degrading enzyme JH esterase (JHE) to induce an increased JH titer, mitigating the fitness costs associated with a robust defense against the Bt pathogen. This study identifies an as-yet uncharacterized m6 A-mediated epigenetic regulator of insect hormones for maintaining fitness during pathogen defense and unveils an emerging Bt resistance-related m6 A methylation atlas in insects, which further expands the functional landscape of m6 A modification and showcases the pivotal role of epigenetic regulation in host-pathogen interactions.

Assessment and therapeutic management of acute asthma: The approaches of nursing staff in patient care.

Acute severe asthma describes serious asthmatic attacks, which remain a major treatment challenge and a significant source of morbidity in adults. It places the patient in danger of developing respiratory failure, a condition known as status asthmaticus. It is often fatal if not recognized and treated early. Many patients are at risk for numerous reasons; thus, the key issues are early detection, assessment and management. A multidisciplinary and collaborative approach is needed to effectively treat acute respiratory failure (ARF). Considerable research has investigated the range of opportunities available for treating asthma. Current treatment options include conventional agents, such as inhalational corticosteroids, â-agonists, leukotriene modulators, monoclonal antibodies, and oral corticosteroids (OCS). Nurses are in a perfect position to assess patients' risk of developing respiratory failure, monitor them, evaluate their care, and coordinate a multidisciplinary approach. In this review, we discuss acute asthma and the role of the nursing officer (NO) in the management of the illness. The review will also emphasize various current treatment approaches available for the NO that can effectively target and prevent respiratory failure. This review provides nurses and other healthcare workers with updated information on timely, effective and safe supportive management of patients with asthma.

A low-cost microbial fuel cell based sensor for in-situ monitoring of dissolved oxygen for over half a year.

In order to address the need for long-term, in-situ and inexpensive monitoring of dissolved oxygen (DO), a chitin-carrying microbial fuel cell (MFC) based DO sensor was developed using sediment anolyte, which had an extremely low cost of US$12.17 and comparable performance to certain commercial sensors. The MFC based DO sensor had a long lifetime of over half a year with chitin as the fuel, attributed to the syntrophic interactions between fermentative and exoelectrogenic microbes that were well developed for chitin degradation in anaerobic condition with sediment filling in the anode chamber. The use of sediment anolyte introduced hindered diffusion in the porous media, enabling the use of glass fiber as the separator to replace the ion exchange membrane and thus resulting in a much lower cost. Field tests of this MFC based DO sensor were conducted in fresh and saline waters respectively. Excellent performance was achieved with average deviations of <4.5% to three commercial methods of fiber optic sensor (HQ40d, HACH company, USA), Clark type sensor (Pro20i, YSI company, USA) and iodometry. This low-cost MFC sensor also showed a high reliability, with the same response of current generation to different DO levels in random 17-times tests, indicating its great market potentials for in-situ DO monitoring.

Influence analysis of green finance development impact on carbon emissions: an exploratory study based on fsQCA.

Increasing environmental degradation has forced policymakers to include sustainability in the economic growth agenda. Green finance has attracted the attention of policymakers and the industry, but the impact of green finance on social and environmental sustainability has not been confirmed. This study uses the panel data of 34 Chinese provinces to investigate the relationship between green finance and environmental degradation. The fuzzy set qualitative comparative analysis (fsQCA) method is utilized to analyze the mixed effect of green finance on CO2 emissions. These factors include green innovation, green insurance, green investment, and industrial structure. The results show that exogenous demand factors, including green insurance and industrial structure, have auxiliary effects when endogenous demand factors, including green investment and green innovation, exist as the core antecedent conditions among green finance and environmental degradation. Finally, the policymakers should encourage financial technology to actively participate in environmental protection initiatives that promote green consumption while minimizing the systemic risks caused by financial technology.

The recommended dosage regimen for caspofungin in patients with higher body weight or hypoalbuminaemia will result in low exposure: Five years of data based on a population pharmacokinetic model and Monte-Carlo simulations.

Background: To develop a population pharmacokinetic (PPK) model for caspofungin, identify parameters influencing caspofungin pharmacokinetics, and assess the required probability of target attainment (PTA) and cumulative fraction of response (CFR) for various dosing regimens of caspofungin in all patients and intensive care unit (ICU)-subgroup patients. Method: The general PPK model was developed based on data sets from all patients (299 patients). A ICU-subgroup PPK model based on data sets from 136 patients was then analyzed. The effects of demographics, clinical data, laboratory data, and concomitant medications were tested. Monte-Carlo simulations (MCS) were used to evaluate the effectiveness of different caspofungin dosage regimens. Results: One-compartment model best described the data of all patients and ICU patients. Clearances (CL) were 0.32 L/h and 0.40 L/h and volumes of distribution (V) were 13.31 L and 10.20 L for the general and ICU-subgroup PPK models, respectively. In the general model, CL and V were significantly associated with albumin (ALB) concentration and body weight (WT). In the ICU-subgroup model, CL was associated with WT. The simulated exposure in ICU patients was lower than that in all patients (p < 0.05). MCS indicated that higher caspofungin maintenance doses of 70-150 mg may achieve target CFR of >90% for patients with higher WT (>70 kg) or with C. albicans or C. parapsilosis infections, and especially for ICU patients with hypoalbuminaemia. Conclusion: The PPK model and MCS presented in the study demonstrated that the recommended dosage regimen for caspofungin in patients with higher body weight or hypoalbuminaemia will result in low exposure.

The effectiveness of formative assessment for enhancing reading achievement in K-12 classrooms: A meta-analysis.

This quantitative synthesis included 48 qualified studies with a total sample of 116,051 K-12 students. Aligned with previous meta-analyses, the findings suggested that formative assessment generally had a positive though modest effect (ES = + 0.19) on students' reading achievement. Meta-regression results revealed that: (a) studies with 250 or less students yielded significantly larger effect size than large sample studies, (b) the effects of formative assessment embedded with differentiated instruction equated to an increase of 0.13 SD in the reading achievement score, (c) integration of teacher and student directed assessment was more effective than assessments initiated by teachers. Our subgroup analysis data indicated that the effect sizes of formative assessment intervention on reading were significantly different between Confucian-heritage culture and Anglophone culture and had divergent effective features. The result cautions against the generalization of formative assessment across different cultures without adaptation. We suggest that effect sizes could be calculated and intervention features be investigated in various cultural settings for practitioners and policymakers to implement tailored formative assessment.

Population Pharmacokinetic Analysis and Dosing Optimization of Sirolimus in Children With Tuberous Sclerosis Complex.

Sirolimus is confirmed to be effective in the treatment of tuberous sclerosis complex (TSC) and related disorders. The study aims to establish a population pharmacokinetic model of oral sirolimus for children with TSC and provide an evidence-based approach for individualization of sirolimus dosing in the pediatric population. A total of 64 children were recruited in this multicenter, retrospective pharmacokinetic study. Whole-blood concentrations of sirolimus, demographic, and clinical information were collected and analyzed using a nonlinear mixed-effects population modeling method. The final model was internally and externally validated. Then Monte Carlo simulations were performed to evaluate and optimize the dosing regimens. In addition, the efficacy and safety of sirolimus therapy was assessed retrospectively in patients with epilepsy or cardiac rhabdomyomas associated with TSC. Finally, the sirolimus pharmacokinetic profile was described by a 1-compartment model with first-order absorption and elimination along with body weight and total daily dose as significant covariates. The typical population parameter estimates of apparent volume of distribution and apparent clearance were 69.48 L and 2.79 L/h, respectively. Simulations demonstrated that dosage regimens stratified by body surface area may be more appropriate for children with TSC. These findings could be used to inform individualized dosing strategies of sirolimus for pediatric patients with TSC.

Effect of the Mini-Nutritional Assessment-Short Form in Elderly Burn Patients.

Nutritional assessment can early identify patients who are malnourished and at risk of malnutrition. To examine the effect of nutritional status on wound healing in elderly burn patients, we used the Mini-Nutritional Assessment-Short Form (MNA-SF) to measure the nutritional status of elderly patients. This study aimed to examine the role of MNA-SF in elderly burn patients through the correlation analysis of wound healing indicators and MNA-SF score. This was a prospective observational and cross-sectional study. This study used the MNA-SF to investigate the elderly burn patients at the department of burn. According to the score, the patients fell into three groups: good nutritional status (more than 12 points), malnutrition risk (8-11 points), and malnutrition (0-7 points). At the same time, we measured and compared the wound healing indicators among the three groups of patients, and detected the correlation. The results showed gender had a slight influence on the score of nutritional status, while age was negatively correlated with the MNA-SF score and nutrition-related indicators. There was a low positive linear correlation between the wound healing percent area change or wound healing rate of patients and the score of the MNA-SF. This study finds malnutrition is common among hospitalized elderly burn patients. The application of the MNA-SF in elderly burn patients is efficient and accurate to identify malnutrition early and prevent further obstruction of the normal wound healing, which can provide reference points for early nutrition intervention programs.

Clinical Efficacy and Cost-Effectiveness of ß-Lactam/ß-Lactamase Inhibitor Combinations and Carbapenems in Liver Cirrhosis Patients with Gram-Negative Bacteria Bloodstream Infection.

BACKGROUND: Gram-negative bacteria bloodstream infection (GNB-BSI) results in considerable mortality and hospitality costs in cirrhotic patients. ß-lactam/ß-lactamase inhibitor combinations (BLBLIs) and carbapenems (CARs) are widely recommended for treating GNB-BSI in cirrhotic patients, while the efficacy and cost-effectiveness of two strategies have never been evaluated. Therefore, we conducted a retrospective cohort study to evaluate the efficacy and the cost-effectiveness of BLBLIs and CARs. PATIENTS AND METHODS: Cirrhotic patients with GNB-BSI treated by BLBLIs or CARs were included. A propensity score-matching analysis was performed to compare the efficacy between BLBLIs and CARs. A decision tree was used to estimate the clinical outcomes and direct costs of treating BSI using two strategies from the patients' perspective. RESULTS: No statistically significant difference was found between the BLBLIs (n = 41) group and the CARs (n = 43) group regarding the time to defervescence (2.4 ± 0.2 vs 2.5 ± 0.3, P = 0.94). Thirty-seven patients from each group were matched in propensity-score-matched cohort, and there was no significant difference between two groups in terms of the time to defervescence (2.4 ± 0.3 vs 2.4 ± 0.3, P = 0.75) and success rate (86.5% vs 78.4%; OR = 0.57; P = 0.36). Based on the drug and hospital costs in China, cefoperazone/sulbactam was cost-effective in the present analysis under the willingness-to-pay threshold (¥64,644). CONCLUSION: The efficacy of BLBLIs is similar to CARs. Cefoperazone/sulbactam could be a cost-effective therapy in cirrhotic patients with GNB-BSI. Carbapenems-sparing regimens should be encouraged in regions with a low prevalence of MDR bacteria.

Therapeutic Drug Monitoring Coupled With Bayesian Forecasting Could Prevent Vancomycin-Associated Nephrotoxicity in Renal Insufficiency Patients: A Prospective Study and Pharmacoeconomic Analysis.

BACKGROUND: Vancomycin is a critical antibiotic used in important infections, and therapeutic drug monitoring (TDM) is recommended. Bayesian forecasting is demonstrated to provide an approach that can improve trough concentration monitoring for dose adjustment. The objective of this study was to determine whether TDM coupled with a Bayesian approach could increase trough concentration target attainment and prevent vancomycin-associated nephrotoxicity in patients with renal insufficiency. METHODS: A prospective study was performed using propensity score matching to provide covariate balance in renal insufficiency patients with gram-positive bacterial infections treated with vancomycin. Patients were divided into non-TDM (84 cases) and TDM (84 cases) groups, and their clinical outcomes were compared. The primary endpoints were probability of trough concentration target attainment and incidence of vancomycin-associated nephrotoxicity. A decision-tree model was developed to assess the cost effectiveness of TDM to prevent vancomycin-associated nephrotoxicity. RESULTS: Of the 168 eligible patients, 69 from each group (non-TDM and TDM) were matched based on propensity scores. In the matched cohort, trough concentration target attainment was higher with TDM (P = 0.003). Furthermore, reaching toxic trough concentrations was avoided (P = 0.027) in the TDM group. Multivariate logistic regression analysis confirmed that TDM practice independently reduced the incidence of vancomycin-associated nephrotoxicity in renal insufficiency patients (P = 0.021). According to this reduced nephrotoxicity, the incremental cost-effectiveness ratios of ¥22,638 per nephrotoxic episode prevented was found for vancomycin TDM. CONCLUSIONS: TDM coupled with Bayesian forecasting led to an increase in trough concentration target attainment and a decrease in the incidence of vancomycin-associated nephrotoxicity in renal insufficiency patients. In this high-risk population, TDM was demonstrated to be a cost-effective procedure.

Associations between work environment and implicit rationing of nursing care: A systematic review.

AIM: To systematically evaluate the effect of working environment on implicit rationing of nursing care. BACKGROUND: Research has established direct and indirect associations between work environment and adverse patient outcomes. However, the causal nature of this relationship is uncertain, and implicit rationing has been proposed as a mediating factor between the work environment and patient outcomes. METHOD: Eight databases were searched for articles published between May 2000 and May 2019. RESULTS: The reviewed articles provided evidence for the negative correlation between working environment and implicit rationing in 15 studies, and one of the studies showed that the correlation was not strong. There were differences in the levels of implicit rationing in different hospitals, units and shifts. CONCLUSION: The degree of influence of various factors in the working environment on implicit rationing is different. In addition, the working environment is only one of the factors that affects implicit rationing. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers initiatives to improve nurses' work environments should include improve nurses' perception of the adequacy of staffing and resources and improving teamwork to decrease nursing care left undone, so as to improve nurse outcomes and quality of care.

Theory-Based Interventions to Promote Fluid Intake Adherence Among Dialysis Patients: A Systematic Review.

BACKGROUND AND PURPOSE: Dialysis involves a complex regimen including diet, fluid, medication, and treatment. Therapeutic regimen adherence determines the therapeutic success, quality of life, and survival of patients on dialysis. Complying with fluid management is the most difficult among the therapeutic regimen. Several theory-based interventions have been designed to promote fluid intake compliance in patients receiving dialysis. This review has two aims. One is to explore the effectiveness of theory-based interventions. The other is to examine the extent of the combination of theory and interventions in improving adherence to fluid intake among dialysis patients. METHODS: A literature review was performed using PubMed, PsycINFO, Embase, Web of Science, and the Cochrane Library to acquire associated studies. Data were extracted independently by two researchers. The degree of theory application was accessed using a theory coding scheme (TCS). RESULTS: Eight studies were identified as eligible for inclusion, and five theories were cited as basis (health belief model, social cognitive theory, self-regulation model, transtheoretical model). According to the TCS, adherence outcomes and the extent of theory use were not optimal. IMPLICATIONS FOR PRACTICE: Combining theory with patient health education might be beneficial in improving fluid intake adherence of dialysis patients. The framework and TCS could be considered to guide theory utilization and promote nursing education in improving the quality of renal nursing care.

Assessment of heavy metal pollution and human health risks in urban soils around an electronics manufacturing facility.

Heavy metal pollution has pervaded many parts of the world, especially in developing countries. The purpose of this study was to determine the concentrations and health risks of heavy metals in urban soils around an electronics manufacturing site in the Hubei Province of China. Soils samples were collected from commercial, roadside, farmland, and residential areas around the electronics manufacturing facility. A total of 136 topsoil samples were collected, and these samples were analyzed for Cr, Cu, Zn, As, Cd, Ni, and Pb. The geoaccumulation index (Igeo), pollution index (PI), and potential ecological risk index (PER) were calculated to assess the soil pollution levels. The hazard index (HI) was used to assess the human health risks posed by the presence of heavy metals. The total concentrations of the seven congeners (∑metals) ranged from 3738.86 to 5173.25mgkg-1, and the concentrations were highest in the commercial area followed (in decreasing order) by the roadside, farmland, and residential areas. The HI for children and adults descended in the order of Cr>As>Pb>Cd>Cu>Ni>Zn. The carcinogenic risks of two metals, namely, Cr and As, for children and adults were higher than 10-4, and children faced greater health risks.

[Surface water quality assessment in Miyun reservoir watershed, Beijing in the period 1980-2003].

Single factor water quality identification index was adopted to assess the surface water quality of Miyun reservoir watershed in Beijing using nearly 20 years monitoring data of 4 sites, also the surface water quality pollution sources were analyzed. The results indicated TP had the largest temporal variation at every monitoring site, coefficients of variation were 93.86%, 86.08%, 50.56% and 139.47%, respectively. The following element was Hg, the coefficients of its variation were 86.08%, 25.75%, 56.52% and 47.01%, respectively. While TN, permanganate index, BOD5, Pb and Cr were relatively stable with small coefficient of temporal variation. The permanganate index, BOD5, Pb and Cr did not exceed to the Chinese surface drinking water standard limit in the study period, while Hg had high pollution risk in several years, such as monitoring sites S1 and S3 in 1992, monitoring sites S4 in 1996. The major pollutants of Miyun reservoir watershed in Beijing were TN and TP, and TN had larger pollution risk compared with TP in most years. Comparing to that before the 1990s, the decade average fertilizer, pesticide and agricultural plastic mulch inputs after the 1990s had increased by 46%, 173% and 359%, respectively. The husbandry proportion in agriculture rose from 24.4% to 39.8%, and the average gross industrial production by 424%. The upstream of Miyun reservoir had larger pollution risk than its downstream. In addition, Chaohe watershed contributed more TN and TP to the reservoir than Baihe watershed.