What can GP data tell us about the treatment of onychomycosis in the UK?

Background

Treatment of onychomycosis is challenging, and there is much literature on optimal treatment strategies. In contrast, information on how onychomycosis is actually treated in primary care is scarce. Information on practice is important as it can reveal much, such as, to what extent national guidelines are followed and which population groups seek/receive treatment or do not do so.

Objectives

To describe the pattern of onychomycosis treatment in primary care in the UK, by patient's gender and age.

Methods

A population‐based retrospective cross‐sectional study was conducted. The Health Improvement Network (THIN) database was used to calculate incidence rates of onychomycosis in the years 2001–2017. The prescription of oral and topical anti‐fungal drugs to patients with onychomycosis was reviewed.

Results

THIN data showed an onychomycosis incidence rate of about 50 per 100,000. More males than females (52% vs. 48%), and more people aged 50–59 years had received treatment for onychomycosis. Oral terbinafine was the most commonly prescribed drug, followed by topical amorolfine, although terbinafine was used more commonly by men and amorolfine by women. Patients with onychomycosis were also prescribed other antifungals, including itraconazole, griseofulvin, tioconazole, ketoconazole shampoo, fluconazole and clotrimazole. A greater proportion of women, compared to men, were prescribed fluconazole.

Conclusions

Onychomycosis treatment in primary care in the UK is broadly in concordance with national guidelines.

Externally-induced shear waves in the right ventricular free wall throughout the cardiac cycle

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1. NWO STW/Dutch Heart foundation 2. NWO Vidi TTW

Background

The right ventricular (RV) size and function have prognostic value, not only in right heart conditions (pulmonary hypertension, congenital heart disease), but also in left ventricular (LV) disease states. There is currently no noninvasive method for measuring the elastic properties of the RV walls. Increased RV diastolic stiffness however, as determined invasively, is linked to adverse prognosis in pulmonary arterial hypertension. In the LV, new high frame rate (HFR) echocardiography applications have been used in order to determine the propagation speed of naturally-occurring or externally-induced shear waves (SW) in the septum, which is related to myocardial stiffness.

Purpose

We show for the first time that SWs in the RV free wall (RVFW) can be externally induced and imaged transthoracically with ultrasound.

Methods

SW imaging was performed using a linear array with a programmable research ultrasound system, aimed at the parasternal long-axis view of a 5-weeks-old Yorkshire-Landrace pig (Fig. 1a). SWs were induced by a high intensity focused beam (f0 = 4.5 MHz) on the RVFW (Fig. 1a). This push beam generates a downwards force at the focus, which induces SWs that propagate left and right from the focus along the RVFW, visible on tissue Doppler images (TDI) shown in Figure 1b-c. SW propagation was imaged (f0 = 5.2 MHz) using HFR ultrasound (Fig. 1b, frame rate = 3 kHz). Three acquisitions of 1 second were performed, where 14 SWs were sequentially induced during each acquisition. ECG signal was captured simultaneously and synchronized offline. SW speeds were estimated using a custom, semi-automatic pipeline that includes TDI calculation, and SW speed estimation along a manually traced spline on the RVFW. This was repeated two times to include variability due to the manual processes. Up to four SW speed estimates were made after each push beam. SW speed estimation was repeated for all push pulses throughout the cardiac cycle, and the mean and standard deviation of the estimates were plotted (Fig. 2).

Results

At least 85% of the waves were tracked successfully for all acquisitions. Diastole and systole were identified using the ECG signal (Fig. 2a). The average SW speed was 0.6 ± 0.1 m/s at end-diastole (Fig. 2b). The measured speeds ranged from 0.5 ± 0.1 m/s during diastole to 1.9 ± 0.3 m/s during systole. The changes in SW speeds correspond to the expected variation in muscle stiffness during the heart cycle as the RV relaxes and contracts.

Conclusions

We demonstrate for the first time the induction and tracking of shear waves in the RVFW of a closed-chest pig. The possibility to noninvasively quantify RV wall stiffness opens a large field of translational research, with direct applications in pulmonary hypertension, congenital heart disease and heart failure in general. Pathological increase in stiffness should be further investigated in longitudinal case/control studies. Abstract Figure. Fig1: Induction and tracking of RV SW  Abstract Figure. Fig2: SW speeds during cardiac cycle

Unidirectional single-mode lasing realization and temperature-induced mode switching in asymmetric GaN coupled cavities

Effective lasing mode control and unidirectional coupling of semiconductor microlasers are vital to boost their applications in optical interconnects, on-chip communication, and bio-sensors. In this study, symmetric and asymmetric GaN floating microdisks and coupled cavities are designed based on the Vernier effect and then fabricated via electron beam lithography, dry-etching of GaN, and isotropic wet-etching of silicon (Si) support. The lasing properties, including model number, threshold, radiation direction, and mode switching method, are studied. Compared to its symmetrical structure, both experimental and simulated optical field distributions indicate that the lasing outgoing direction can be controlled with a vertebral angle on the disk. The whispering gallery mode (WGM) lasing of the structures, with a quasi-single-mode lasing at 374.36 nm, a dual-mode lasing at 372.36 nm, and 373.64 nm at coupled cavities, are obtained statically. More interestingly, a switching between dual-mode and single-mode can be achieved dynamically via a thermal-induced mode shifting.

Theoretical investigations on the superhydrophobicity of intrinsic hydrophilic surfaces with overhang microstructures

It has been accepted generally that it is necessary to obtain the so-called surface superhydrophobicity on intrinsically hydrophobic materials. However, recent experiments have indicated that it could be possible to prepare superhydrophobic surfaces on intrinsically hydrophilic materials by creating adequate roughness. In this work, such a strategy for surface superhydrophobicity on hydrophilic materials with an intrinsic contact angle less than 90° was demonstrated thermodynamically based on a proposed 2-D analytical model. In particular, different (trapezoidal, vertical and inverse-trapezoidal) microstructures were employed to analyze their wetting states such as composite and noncomposite and superhydrophobic behavior as well as the previous corresponding experimental observations. Based on the thermodynamic calculations, it was demonstrated that for an overhang microstructure, intrinsic contact angle, which was restricted by the sidewall angle of micropillars, was not an independent parameter to affect superhydrophobicity. Furthermore, an overhang microstructure was critical to realize the transition from hydrophilicity to superhydrophobicity, and for such a transition, the sidewall angle should be less than the intrinsic contact angle where a positive free energy barrier could support the liquid/vapor interfaces and separate the Wenzel and Cassie states on such hydrophilic surfaces. Most importantly, it was found that for such hydrophilic surfaces, generally, the free energy of the noncomposite or Wenzel states were lower than that of the composite or Cassie states for those trapezoidal, vertical and inverse-trapezoidal microstructures, implying that once a noncomposite state was formed, it can hardly become a composite state, or in other words, even if superhydrophobic behavior was possible, it could be temporary or unstable.

Free energy variations with contact angle.

Dual targeting, a new strategy for novel PARP inhibitor discovery

As a hallmark for cancer treatment, PARP inhibitors can effectively kill tumor cells with a mechanism termed as synthetic lethality, and are used to treat various cancers including ovarian, breast, prostate, pancreatic and others with DNA repair defects. However, along with the clinical trials progressing, the limitations of PARP-1 inhibitors became apparent such as limited activity and indications. Studies have shown that a molecule that is able to simultaneously restrict two or more targets involving in tumors is more effective in preventing and treating cancers due to the enhancing synergies. In order to make up for the shortcomings of PARP inhibitors, reduce the development cost and overcome the pharmacokinetic defects, multiple works were carried out to construct dual targeting PARP inhibitors for cancer therapy. Herein, they were summarized briefly.

Antigen Presentation and Proteome Study of Exosomes Secreted by Co-Culture of Macrophages and Talaromyces marneffei

It is known that intracellular pathogens interact and react with the cellular immune system through exosomes produced by macrophages. This study aimed to determine whether co-culture of macrophages and Talaromyces marneffei induces exosomes and leads to immune responses. T. marneffei was incubated to collect conidia, co-cultured with human macrophages, which then induced exosomes. In cellular experiments, after extraction and purification, the exosomes were then observed by electron microscopy and detected by flow cytometry and mass spectrometry. In animal experiments, flow cytometry and enzyme-linked immunosorbent assay were used to examine whether exosomes were antigenpresenting. The results showed that purified exosomes produced a pro-inflammatory response and stimulated production of TNF-α in non-fungal-treated macrophages. Protein mass spectrometry analysis of exosomes also indicated their potential ability to activate the internal immune response system and the pro-inflammatory response. Translation and ribosomes were the most abundant GO terms in proteins, and the most relevant KEGG pathway was the biosynthesis of secondary metabolites. Furthermore, in vivo experiments revealed that exosomes induced activation of lymphocytes and increased expression of TNF-α and IL-12 in the lung, mediastinum, and spleen area. In conclusion, exosomes can be released by co-culture of T. marneffei and macrophages, having antigen-presenting functions, promoting macrophage inflammation, and initiating adaptive immune responses. These processes are inextricably linked to the translation of secondary metabolites, ribosomes and biosynthesis.

Gut Microbiota and SCFAs Play Key Roles in QingFei Yin Recipe Anti-Streptococcal Pneumonia Effects

Emerging evidence has revealed the presence in animals of a bidirectional regulatory “lung-gut axis” that provides resistance to respiratory infections. Clues to the existence of this system stem from observations that respiratory infections are often accompanied by gastrointestinal symptoms, whereby intestinal microbiota appear to play pivotal roles in combating pathogenic infections. Importantly, short-chain fatty acids (SCFAs) produced by the gut microbiota appear to serve as the biological link between host immune defenses and gut flora. Streptococcus pneumoniae (S.pn), the main cause of lower respiratory tract infections, is involved in more than 1.189 million deaths per year. QingFei Yin (QFY) is known for its excellent therapeutic efficacy in combating bacterial lung infections. In this study, effects of S.pn infection on gut homeostasis were assessed using 16S RNA-based microbiota community profiling analysis. In addition, potential mechanisms underlying QFY recipe beneficial therapeutic effects against bacterial pneumonia were explored using S.pn-infected gut microbiota-depleted mice. Results of data analysis indicated that QFY treatment alleviated lung infection-associated pathogenic processes, while also promoting repair of disordered gut flora and counteracting S.pn infection-associated decreases in levels of SCFAs, particularly of acetate and butyrate. Mechanistically, QFY treatment suppressed inflammatory lung injury through inhibition of the host NF-κB-NLRP3 pathway. These results inspired us to identify precise QFY targets and mechanisms underlying QFY anti-inflammatory effects. In addition, we conducted an in-depth evaluation of QFY as a potential treatment for bacterial pneumonia.

Efficacy and safety of Tuina for treatment of pediatric recurrent respiratory tract infections: A protocol for systematic review and meta-analysis

BACKGROUND

Recurrent respiratory tract infections (RRTIs) are common respiratory ailments in children. RRTIs are often difficult to control and thus generally have a long-term disease course. Children who receive ineffective treatments or those that experience poor treatment outcomes are prone to developing complications such as edema, cough and asthma. Such complications can seriously hinder a child's growth and development, while also adversely affecting the child's physical and mental health. Tuina massage, a traditional Chinese technique that has been practiced in China for >5000 years, has recently been used to treat RRTIs, with good effect. However, no systematic review of research studies focusing on massage as a treatment for RRTIs can be found in the literature to date. The purpose of this study will be to evaluate the efficacy and safety of Tuina massage for the treatment of pediatric patients who experience RRTIs.

METHODS

We will search the following databases using electronic methods: the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure (CNKI), Wanfang Data (WAN FANG), VIP Information (VIP), MEDLINE, PUBMED, EMBASE, and CINAHL. For each database search, the scope will include articles published between the date of database inception to September 2021. Revman5.4 software will be used to conduct this systematic review and meta-analysis.

RESULTS

This meta-analysis will confirm whether Tuina massage is of clinical benefit to pediatric patients who experience RRTIs.

CONCLUSION

The results of our systematic review and meta-analysis will be used to formulate conclusions as to whether massage therapy is an effective treatment for children suffering from RRTIs.

ETHICS AND DISSEMINATION

This systematic review will evaluate the efficacy and safety of tuina in the treatment of recurrent respiratory tract infections. Since all the data included were published, the systematic review did not require ethical approval.

INPLASY REGISTRATION NUMBER

INPLASY202190107.

Therapeutic efficacy of a combination of mesalazine and Bifid Triple Viable Capsules (BTVCs) on ulcerative colitis patients, and its effect on inflammation and oxidative stress

Purpose: To determine the curative impact of mesalazine (MSZ)-BTVCs combination on ulcerative colitis (UC), and its influence on inflammation and oxidative stress in the patients.Methods: 100 UC patients were randomely assigned to a control group given MSZ capsule treatment only, and a combination group treated with BTVCs and MSZ. Treatment effectiveness, inflammatory response, and oxidative stress in the two groups before and after treatment were compared.Results: The combination group had higher total effectiveness than the control group. The serum levels of MDA, high-sensitivity C-reactive protein (hs-CRP), TNF-α and interleukin-6 (IL-6) were lower, while serum levels of superoxide dismutase (SOD) and interleukin-10 (IL-10) were markedly increased in patients given combination treatment, when compared with controls. Pre-drug exposure UC disease activity index (UC-DAI) and clinical symptom scores were similar in both cohorts of patients, but the post-treatment scores were statistically decreased, especially in the combination group.Conclusion: The combined use of MSZ and BTVCs was more effective against UC than monotherapy, as it effectively relieved inflammation and oxidative stress in patients, resulting in better clinical efficacy.

Evaluation of the effectiveness and safety of cupping therapy in the treatment of asthma: A protocol for systematic review and meta-analysis

BACKGROUND

Asthma is one of the most common chronic airway diseases and is characterized by wheezing, dyspnea, chest tightness, and coughing. These symptoms reduce the patient's quality of life and limit physical activity in daily life. However, there is no systematic review of the efficacy of cupping therapy in the treatment of asthma. To evaluate the efficacy and safety of cupping in the treatment of asthma, we conducted a systematic review and meta-analysis of published randomized clinical trials of cupping in the treatment of asthma.

METHODS

We will search the following Chinese and English databases: China National Knowledge Infrastructure, China Science and Periodical Database, Wanfang Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library. All of the above electronic databases will be searched from inception to August 22, 2021. In addition, we will manually search for conference papers, ongoing experiments, and internal reports to supplement the studies retrieved via electronic search. We will use the Review Manager 5.4 provided by Cochrane Collaboration Network for statistical analysis.

RESULTS

The study will prove the effectiveness and safety of cupping in the treatment of asthma.

CONCLUSION

We plan to submit this systematic review to a peer-reviewed journal.

INPLASY REGISTRATION NUMBER

INPLASY202180104.

Derivation of an electronic frailty index for short-term mortality in heart failure: a machine learning approach

Objective

Frailty may be found in heart failure patients especially in the elderly and is associated with a poor prognosis. However, assessment of frailty status is time-consuming and the electronic frailty indices developed using health records have served as useful surrogates. We hypothesized that an electronic frailty index developed using machine learning can improve short-term mortality prediction in patients with heart failure.

Methods

This was a retrospective observational study included patients admitted to nine public hospitals for heart failure from Hong Kong between 2013 and 2017. Age, sex, variables in the modified frailty index, Deyo's Charlson comorbidity index (≥2), neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) were analyzed. Gradient boosting, which is a supervised sequential ensemble learning algorithm with weak prediction submodels (typically decision trees), was applied to predict mortality. Variables were ranked in the order of importance with a total score of 100 and used to build the predictive models. Comparisons were made with decision tree and multivariate logistic regression.

Results

A total of 8893 patients (median: age 81, Q1-Q3: 71–87 years old) were included, in whom 9% had 30-day mortality and 17% had 90-day mortality. PNI, age and NLR were the most important variables predicting 30-day mortality (importance score: 37.4, 32.1, 20.5, respectively) and 90-day mortality (importance score: 35.3, 36.3, 14.6, respectively). Gradient boosting significantly outperformed decision tree and multivariate logistic regression (area under the curve: 0.90, 0.86 and 0.86 for 30-day mortality; 0.92, 0.89 and 0.86 for 90-day mortality).

Conclusions

The electronic frailty index based on comorbidities, inflammation and nutrition information can readily predict mortality outcomes. Their predictive performances were significantly improved by gradient boosting techniques.

Funding Acknowledgement

Type of funding sources: None.

Telomerase enhances osteogenic ifferentiation of sheep bone marrow mesenchymal stem cells (BMSCs) by up-regulating PI3K/Akt pathway in vitro

Telomerase reverse transcriptase (TERT) vectors were transfected into bone marrow mesen- chymal stem cells (BMSCs) which were then cultured and selected to establish TERT-BMSC cell lines whilst sequencing BMSCs and TERT-BMSCs via transcriptome in this study to explore their regulatory mechanism and effect on osteogenic differentiation after TERT ectopic expres- sion in sheep BMSCs. After sequencing and analysing differential genes, PI3K/Akt signalling pathway related to osteogenic differentiation was investigated. Western blot was used before and after applying the PI3K/Akt signalling pathway inhibitor LY294002 to detect protein expression levels of AKT and p-AKT. On the twenty-first day of osteogenic differentiation, RT-qPCR and Western blot were used to detect mRNA and protein expression levels of RUNX2 and OPN and alizarin red staining was utilised to analyse calcium salt deposition. Results showed that pro- tein expression levels of AKT and p-AKT were significantly up-regulated, mRNA and protein expression levels of RUNX2 and OPN increased and calcium salt deposition increased after ectopic expression of TERT. After applying LY294002, the protein expression of AKT and p-AKT was down-regulated, mRNA and protein expression levels of RUNX2 and OPN were reduced and calcium salt deposition was reduced. These results confirmed the stable integration and expression of the exogenous TERT gene in BMSCs to promote the differentiation of BMSC osteoblasts, which may be mediated by the PI3K/Akt signalling pathway.