Improving the Efficiency of Medication Reconciliation in Two Taiwanese Hospitals by Using the Taiwan National Health Insurance PharmaCloud Medication System.

Purpose: Medication reconciliation (MedRec) is a process to ensure complete and accurate communication of patient medication information throughout care transitions to prevent medication errors. Hospitals in Taiwan have stride to implement a universal protocol for MedRec. To establish a feasible protocol indigenously, the World Health Organization (WHO) protocol was incorporated with the Taiwan National Health Insurance (NHI) PharmaCloud patient medication profile. The efficiency and error detection capability of this modified protocol was evaluated in two hospitals. Methods: A prospective, non-randomized, unblinded, multicenter cohort study was conducted. Subjects were recruited among patients admitted for colorectal or orthopedic surgery with at least 4 or more chronic drugs. To obtain the best possible medication history (BPMH), the control group was conducted according to the WHO protocol, and the experimental group used the modified WHO protocol with the medication data from the PharmaCloud system. The time spent on the two protocols was recorded. Admission and discharge orders were reconciled against the BPMH to identify any discrepancies. Discrepancies were evaluated by appropriateness, prescribing intentions, and types of inappropriateness. The levels of potential harm were classified for inappropriate discrepancies. Results: The mean time to obtain BPMH in the control group was 34.3±10.8 minutes and in the experimental group 27.5±11.5 minutes (P = 0.01). The experimental group had more subjects with discrepancies (87.9%) than the control (58.3%) (p < 0.001). The discrepancies in both admission and discharge orders for the experimental group (84.5 and 67.2%) were higher than those of the control (47.9 and 37.5%). Many inappropriate discrepancies were classified as the potential harm of level 2 (77.8%). Conclusion: Through the establishment of BPMH with the medication data from the Taiwan NHI PharmaCloud, MedRec could be achieved with greater efficiency and error detection capability in both the admission and discharge order validation processes.

Neuroanatomy and Functional Connectivity in Patients with Parkinson's Disease with or without Restless Legs Syndrome.

INTRODUCTION: Restless legs syndrome (RLS) is a common non-motor symptom in Parkinson's disease (PD), but its pathogenesis remains unclear. This study aimed to explore the potential neural substrates of RLS in a large sample of patients with PD. METHODS: A total of 42 patients with PD with RLS and 124 patients with PD without RLS were prospectively recruited at our hospital between February 2019 and October 2020 and underwent structural and resting-state functional magnetic resonance imaging. Differences between the two patient groups were assessed using voxel-based morphometry and functional connectivity analysis. PD duration, Part III of the Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III) score, and levodopa equivalent daily dose were treated as covariates. RESULTS: Patients with PD with RLS had significantly larger gray matter volume in the bilateral posterior cingulate cortex than patients with PD without RLS (FDR-adjusted P < 0.05). Compared to patients without RLS, those with RLS had significantly lower functional connectivity between the left central opercular cortex and the bilateral precentral gyri and postcentral gyri (FDR-adjusted P < 0.001). CONCLUSION: Our study provides the first evidence that in patients with PD, RLS is associated with significantly larger gray matter volume in the posterior cingulate cortex and lower resting-state functional connectivity within the sensorimotor network. Our results may help clarify the pathophysiology of RLS in PD and identify possible therapeutic targets.

Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model.

BACKGROUND: Gastric lavage (GL) is one of the most critical early therapies for acute paraquat (PQ) poisoning; however, details of the treatment protocol remain to be established. METHODS: A rapid quantitative method involving sodium dithionite testing was developed. It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL, or without. The vital signs, laboratory testing, and PQ plasma concentrations were collected for therapeutic effect evaluation. RESULTS: The reaction conditions of the test were optimized for two types of samples. Early GL at one hour (H1) could improve the signs and symptoms after acute PQ poisoning at 24 hours (H24). In contrast, GL at 6 hours (H6) could only partially relieve the vital signs. The H1 GL group effectively reduced the peak of the plasma PQ concentration. In addition, the PQ concentrations in the plasma and the gastric juice were significantly decreased in both the GL groups as compared to the untreated group at H24. Moreover, there was no significant difference in the washing efficiencies calculated from the total eluates between the two GL groups. However, the washing efficiency of the first 10 L eluate is superior to that of the additional 10 L eluate. CONCLUSION: GL only at early stage may it benefit PQ poisoning in an animal model. The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate. The rapid quantitative method can be used for gastric juice sample and has a certain value for clinical GL practices.

Association between lifestyle, gender and risk for developing end-stage renal failure in IgA nephropathy: a case-control study within 10 years.

Purpose: To investigate the potential association between lifestyles, including cigarette smoking, alcohol consumption, and physical exercise at the time of biopsy and the risk for developing end-stage renal failure (ESRF) among IgA nephropathy (IgAN) patients within 10 years. Methods: A case-control study was carried out. Seventy-seven ESRF patients with the primary cause of IgAN were enrolled as cases. Seventy-seven IgAN patients who had not progressed to ESRF after being diagnosed for over 10 years served as controls. Smoking, alcohol consumption and physical exercise related data and baseline clinical features were collected from their medical records and confirmed by phone calls. Results: The case group had higher proportions of males, smokers, drinkers, and physical inactivity individuals than the controls had. Alcohol drinking history (/1 year, OR 1.32, p < .05) is independently associated with an increased risk of ESRF, while physical exercise habits (OR 0.06, p < .05) associated with a decreased risk of ESRF in multivariate logistic analysis. Male gender, lower eGFR, and higher urinary protein at the time of biopsy were also independent risk factors. Moreover, male-non-exercise population seems to be more likely to progress to ESRF than others (male-exercise, female-exercise, and female-none-exercise populations). Conclusion: Physical exercise should be encouraged in IgAN patients, especially in males, for a better renal outcome. Alcohol cessation might have a renal survival benefit in IgAN patients.

Aquaporin 11 rs2276415 variant and progression of chronic kidney disease.

BACKGROUND: The Aquaporin 11 (AQP11) rs2276415 variant has been implicated in kidney disease in Type 2 diabetes. Association of the AQP11 variant with chronic kidney disease (CKD) beyond diabetic nephropathy is unknown, with no studies reported in the Chinese population. We explored the risk of CKD progression associated with the AQP11 rs2276415 variant in a population-based study in China. METHODS: We conducted a prospective cohort study of 620 participants with CKD (Stages 2-5 and who were not receiving dialysis) at the Nephrology Center of First Affiliated Hospital of Jiaxing University between July 2011 and December 2014 and followed up for 3 years. Incident CKD progression, defined as an increase in creatinine levels of at least 0.4 mg/dL (35 µmol/L) above baseline or maintenance dialysis initiation or transplantation, was examined by AQP11 genotypes. RESULTS: During the follow-up period, CKD progression developed in 170 individuals. Cumulative events-free survival was significantly dependent on AQP11 genotypes with an apparent gene-dose effect (log-rank P < 0.001). Adjusting for sex, age and major CKD risk factors, the A allele of AQP11 gene (GA + AA) increased the risk of CKD progression by 1.92 (95% confidence interval 1.31- 2.84). CONCLUSIONS: The AQP11 rs2276415 variant predicts CKD progression in the Chinese population, independent of traditional risk factors. Exploring the pathways mediating the association may shed light on novel therapeutic targets in the pathophysiology of CKD.

Renal sympathetic denervation attenuates hypertension and vascular remodeling in renovascular hypertensive rats.

Li P, Huang P, Yang Y, Liu C, Lu Y, Wang F, Sun W, Kong X. Renal sympathetic denervation attenuates hypertension and vascular remodeling in renovascular hypertensive rats. J Appl Physiol 122: 121-129, 2017. First published October 14, 2016; doi:10.1152/japplphysiol.01019.2015-Sympathetic activity is enhanced in patients with essential or secondary hypertension, as well as in various hypertensive animal models. Therapeutic targeting of sympathetic activation is considered an effective antihypertensive strategy. We hypothesized that renal sympathetic denervation (RSD) attenuates hypertension and improves vascular remodeling and renal disease in the 2-kidney, 1-clip (2K1C) rat model. Rats underwent 2K1C modeling or sham surgery; then rats underwent RSD or sham surgery 4 wk later, thus resulting in four groups (normotensive-sham, normotensive-RSD, 2K1C-sham, and 2K1C-RSD). Norepinephrine was measured by ELISA. Echocardiography was used to assess heart function. Fibrosis and apoptosis were assessed by Masson and TUNEL staining. Changes in mean arterial blood pressure in response to hexamethonium and plasma norepinephrine levels were used to evaluate basal sympathetic nerve activity. The 2K1C modeling success rate was 86.8%. RSD reversed the elevated systolic blood pressure induced by 2K1C, but had no effect on body weight. Compared with rats in the 2K1C-sham group, rats in the 2K1C-RSD group showed lower left ventricular mass/body weight ratio, interventricular septal thickness in diastole, left ventricular end-systolic diameter, and left ventricular posterior wall thickness in systole, whereas fractional shortening and ejection fraction were higher. Right kidney apoptosis and left kidney hypertrophy were not changed by RSD. Arterial fibrosis was lower in animals in the 2K1C-RSD group compared with those in the 2K1C-sham group. RSD reduced plasma norepinephrine and basal sympathetic activity in rats in the 2K1C-RSD group compared with rats in the 2K1C-sham group. These results suggest a possible clinical efficacy of RSD for renovascular hypertension. NEW & NOTEWORTHY: The effects of renal sympathetic denervation (RSD) on hypertension, cardiac function, vascular fibrosis, and renal apoptosis were studied in the 2K1C rat model. Results showed that RSD attenuated hypertension, improved vascular remodeling, and reduced vascular fibrosis through decreased sympathetic activity in the 2K1C rat model, but it did not change the kidney size, renal apoptosis, or renal caspase-3 expression. These results could suggest possible clinical efficacy of RSD for renovascular hypertension.

The formation of an ordered microporous aluminum-based material mediated by phthalic acid.

By using phthalic acid as a soft template, we showed that it was possible to prepare a microporous aluminum-based material when the precipitation of Al(3+) was properly controlled. We also identified that this microporous aluminum-based material could be promising for the removal of fluoride ions in water treatment.

Catalytic Performance of Pt/Reduced Graphene Oxide Composites to Methanol Electrochemical Oxidation: Optimization of Mass-Specific Activity.

Series of catalysts made of Pt nanoparticles supported on reduced graphene oxides (Pt/RGO) were synthesized and tested in methanol oxidation reaction, aiming for optimizing the mass-specific activity of prepared Pt/RGO composites. The loading amount of Pt is controlled through setting different reaction time and determined precisely by atomic absorption spectrophotometer. The structure of Pt/RGO composites is characterized by X-ray diffraction, transmission electron microscopy and Raman spectroscopy. The electrochemical testing data reveal that the Pt/RGO-mass-specific activity, judged by current density and long-term stability, is maximized in the sample in which cooperation of the Pt loading amount and electrochemical active surface area (ECSA) per amount of Pt is best optimized. The performance of the catalyst with smallest Pt particles or highest Pt loading amount is dragged down by either too less Pt loading or poor ECSA per amount of Pt. The results in this research demonstrate that the mass-normalized activity of whole catalyst, which is associated with the anticipated power output per amount of catalyst, could be enhanced significantly by deliberate tuning of fabrication process.

Influence of simvastatin on dopaminergic neurons of lipopolysaccharide-induced rat model of Parkinson's disease.

OBJECTIVE: To investigate the neuroprotective effects of simvastatin on lipopolysaccharide (LPS)-induced rat model of Parkinson's disease (PD) and the mechanisms involved. METHODS: Hemiparkinsonian rat models were induced by stereotaxieal injection of LPS in the right substantia nigra compacta. After 2 weeks of simvastatin treatment, rotational behavior test was performed after the intraperitoneal injection of apomorphine. Expression of tyroxine hydroxylase (TH) and glial fibrillary acidic protein were analyzed through immunohistochemical staining of substantia nigra and striatum, and the level of TNF- α was evaluated using enzyme-linked immunosorbent assay. RESULTS: Comparing with untreated group, behavioral symptoms of the rats were significantly less in the rats that received simvastatin treatment. The TH positive cell count in substantia nigra and striatum were significantly increased (P<0.05) and TNF- α expression was significantly decreased (P<0.05) in simvastatin group compared to untreated group. CONCLUSIONS: Simvastatin could effectively inhibit the activation of astrocytes, reduce TNF- α expression, and exert anti-inflammatory effects, and thus protect the dopaminergic neurons in substantia nigra and striatum of the rat model of PD.

C60 fullerenol as an active and stable catalyst for the synthesis of cyclic carbonates from CO2 and epoxides.

C60 fullerenol was found to be a highly active, selective and stable catalyst for cycloaddition between CO2 and epoxides to produce various cyclic carbonates with excellent yields (89-99%). A solid/liquid interfacial hydrogen-bond assisted mechanism was proposed to account for its high efficiency.

Sandwichlike magnesium silicate/reduced graphene oxide nanocomposite for enhanced Pb²âº and methylene blue adsorption.

A sandwichlike magnesium silicate/reduced graphene oxide nanocomposite (MgSi/RGO) with high adsorption efficiency of organic dye and lead ion was synthesized by a hydrothermal approach. MgSi nanopetals were formed in situ on both sides of RGO sheets. The nanocomposite with good dispersion of nanopetals exhibits a high specific surface area of 450 m(2)/g and a good mass transportation property. Compared to MgSi and RGO, the mechanical stability and adsorption capacity of the nanocomposite is significantly improved due to the synergistic effect. The maximum adsorption capacities for methylene blue and lead ion are 433 and 416 mg/g, respectively.

Embryonic and developmental toxicity of the ionic liquid 1-methyl-3-octylimidazolium bromide on goldfish.

The embryonic developmental toxicity of the ionic liquid (IL) 1-methyl-3-octylimidazolium bromide ([C(8)mim]Br) on the goldfish Carassius auratus was evaluated in this study. First, the 72 h 50% lethal concentrations (72 h-LC(50)) for [C(8)mim]Br in goldfish embryos at the stages of cleavage, early gastrula, closure of blastopore, and heart beating were determined by preliminary acute toxicity tests. After that, fish embryos in different developmental stages (cleavage, early gastrula, closure of blastopore, and heart beating) were exposed to 10.4, 20.8, 41.6, and 104 mg/L of [C(8)mim]Br until their hatching stage. The results of the acute toxicity tests showed that 72 h-LC(50) values at the early cleavage, early gastrula, closure of blastopore, and heart beating stages of development were 208.96, 187.1, 245.03, and 298.33 mg/L, respectively. In the subchronic tests, [C(8)mim]Br exposure prolonged the duration of embryo dechorionation and decreased the hatching rates of the treated embryos compared to control embryos. In addition, [C(8)mim]Br treatment also caused remarkable increases of embryonic malformation and mortality ratio in most treatment groups. Finally, we also found that the embryonic and developmental toxicity of [C(8)mim]Br on fish embryos was dose-response and developmental stage-specific. These results indicate that [C(8)mim]Br has toxic effects on the early embryonic development of goldfish, and the risk to aquatic ecosystem by ILs leaking into the water body must be evaluated in the future.