Cost consciousness among physicians in the neonatal intensive care unit

OBJECTIVE

The objectives of this study were (1) to describe the prevalence and correlates of cost consciousness among physician providers in neonatology and (2) to describe knowledge of cost of common medications, laboratory/imaging evaluations, hospitalization costs and reimbursements.

STUDY DESIGN

A 54-item survey was administered to members of the Section on Neonatal-Perinatal Medicine of the American Academy of Pediatrics.

RESULTS

Of the 602 participants, 37% reported cost consciousness in decision making. Adjusting for years in practice, gender, training level, type of practice setting and region of practice, formalized education about costs was associated with increased cost consciousness in practice (adjusted odds ratio (AOR): 3.4; 95% confidence interval (CI): 1.2 to 9.8). Working in a private practice setting was also associated with increased cost consciousness when ordering laboratory (AOR: 3.0; (95% CI: 1.2 to 7.6)) or imaging tests (AOR: 2.0; 95% CI: 1.0 to 4.8).

CONCLUSIONS

We found variation in knowledge of cost. Formal education about costs and working in a private practice setting were associated with increased cost consciousness.

Poor medication adherence to bisphosphonates and high self-perception of aging in elderly female patients with osteoporosis

Non-adherence to bisphosphonates exposes the elderly female osteoporosis patients to an increased risk of fracture. This was one of the first studies to explore the relationship between medication adherence and self-perception of aging. Feelings of lacking control and expectations for negative events, beliefs of illness's chronic duration nature, and its linkage with aging were associated with of poor medication adherence.

INTRODUCTION

To examine the relationship between medication adherence to bisphosphonates and self-perception of aging in elderly female patients with osteoporosis.

METHODS

This was a cross-sectional survey. A convenience sample of 245 elderly female patients with osteoporosis prescribed regular oral bisphosphonate therapy was recruited from three tertiary hospitals in China. Sociodemographic and osteoporosis-related data, Morisky Medication Adherence Scale-8 (MMAS-8) and Aging Perceptions Questionnaire (APQ) data were collected.

RESULTS

Mean adherence score measured by MMAS-8 was 4.46(SD = 1.91; range, 0.25-7.00). Percentages of good and poor adherence were 28.6 and 71.4 %, which showed a poor medication adherence. Six domains of APQ statistically significantly associated with medication adherence. Interestingly, with control of age, educational status, marital status, and symptoms accompanying osteoporosis as covariates in the multivariate linear regression model, the effects of three domains disappeared. Significantly, worse adherence was observed in those patients who had higher feelings of lack of control, more expectations for negative events, more beliefs of osteoporosis's chronic duration nature and its linkage with aging.

CONCLUSIONS

We conclude that feelings of lacking control, expectations for negative events, beliefs of illness's chronic duration nature, and its linkage with aging were associated with poor medication adherence in elderly female patients with osteoporosis. Concerns about self-perception of aging need to be addressed in order to improve medication adherence.

Experimental studies of thermal environment and contaminant transport in a commercial aircraft cabin with gaspers on

Gaspers installed in commercial airliner cabins are used to improve passengers' thermal comfort. To understand the impact of gasper airflow on the air quality in a cabin, this investigation measured the distributions of air velocity, air temperature, and gaseous contaminant concentration in five rows of the economy-class section of an MD-82 commercial aircraft. The gaseous contaminant was simulated using SF6 as a tracer gas with the source located at the mouth of a seated manikin close to the aisle. Two-fifths of the gaspers next to the aisle were turned on in the cabin, and each of them supplied air at a flow rate of 0.66 l/s. The airflow rate in the economy-class cabin was controlled at 10 l/s per passenger. Data obtained in a previous study of the cabin with all gaspers turned off were used for comparison. The results show that the jets from the gaspers had a substantial impact on the air velocity and contaminant transport in the cabin. The air velocity in the cabin was higher, and the air temperature slightly more uniform, when the gaspers were on than when they were off, but turning on the gaspers may not have improved the air quality.

Identification, characterization and functional analysis of a chitin synthase gene in the brown citrus aphid, Toxoptera citricida (Hemiptera, Aphididae)

Chitin synthase (CHS) is a crucial enzyme involved in the final step of the insect chitin biosynthetic pathway. In this study, we cloned the full-length cDNA sequence of a chitin synthase gene (TCiCHS) from the brown citrus aphid, Toxoptera citricida, an important citrus pest and the main vector of citrus tristeza virus worldwide. TCiCHS was expressed during the entire lifecycle and in all insect tissues examined. Expression was highest in first-second-instar nymphs, nymph-adult transitions and in the abdomen (6.7-fold higher than head). Embryos had a higher expression level than the integument. Fourth-instar nymphs were exposed to 5 and 500 mg/l concentrations of the chitin synthesis inhibitor diflubenzuron (DFB) for 48 h and had the highest mortality at the 500 mg/l concentration. The mRNA expression levels of TCiCHS were significantly enhanced upon the exposure of nymphs to both low and high DFB concentrations. Silencing of TCiCHS occurred through plant-mediated double-stranded RNA (dsRNA) feeding. Most dsRNA-fed nymphs were unable to moult to the next stage, and the expression of TCiCHS decreased 48% compared with controls. These results demonstrate that TCiCHS plays an important role in nymph to adult development, is possibly help identify molecular targets for To. citricida control.

Evidence for a role of GPRC6A in prostate cancer metastasis based on case-control and in vitro analyses

OBJECTIVE

G protein-coupled receptor, family C, group 6, member A, (GPRC6A) is a prostate cancer (PCa) susceptibility gene and has been shown to regulate PCa progression. However, its role in PCa metastasis is largely unknown. The aim of this study was to confirm the association between GPRC6A and aggressive PCa in a case-control analysis, and to explore the function of GPRC6A in PCa metastasis in vitro.

PATIENTS AND METHODS

The association of 14 single nucleotide polymorphisms (SNPs) of GPRC6A and linked to GPRC6A were evaluated with PCa risk and aggressive PCa in 916 subjects. Metastasis behavior was determined in GPRC6A knockdown PC3 cells, and the expressions of matrix metalloproteinase (MMP)2 and MMP9 were detected. Bone transcription factor runt-related transcription factor 2 (RUNX2) and epithelial-mesenchymal transition (EMT) marker genes were examined in the GPRC6A overexpression PC3 cells.

RESULTS

Among the 14 SNPs tested in PCa patients and controls, 4 were associated with aggressive PCa (p = 0.032-0.037, odds ratio = 1.38-1.41). Both the migration and invasion abilities were reduced in PC3 cells that were transiently transfected with GPRC6A short interfering RNA (siRNA). The GPRC6A knockdown cells showed reduced activity levels of MMP2 and MMP9. Furthermore, RUNX2, EMT and ERK signaling were shown to be up-regulated in GPRC6A overexpression cells.

CONCLUSIONS

These findings suggest that GPRC6A is associated with aggressive PCa. GPRC6A knockdown inhibits the PCa cells migration and invasion, and GPRC6A overexpression promotes the EMT. It is suggested that GPRC6A may serve as a potential therapeutic target for metastatic PCa.

Single-material semiconductor hyperbolic metamaterials

Layered semiconductor hyperbolic metamaterials for the mid-infrared are grown by molecular beam epitaxy using a single material system, doped and undoped InAs. The onset wavelength for metamaterial behavior can be tuned from 5.8μm to beyond 10μm, while the fill factor ranges from 0.25 to 0.75, resulting in designer optical behavior. The reflection and transmission behavior were studied by Fourier transform spectroscopy and modeled using effective medium theory. We also conducted a geometric optics experiment to demonstrate negative refraction of our materials.

Effect and safety of paroxetine for vasomotor symptoms: systematic review and meta-analysis

BACKGROUND

Paroxetine is the first non-hormone therapy for vasomotor symptoms (VMS) approved based on the results of two phase 3, randomised, placebo-controlled trials by the Food and Drug Administration (FDA) in 2013.

OBJECTIVE

To confirm the effect and safety of paroxetine for vasomotor symptoms (VMS).

SEARCH STRATEGY

MEDLINE, EMBASE, PsycINFO, CENTRAL, WHO International Clinical Trials Registry Platform (ICTRP) and four Chinese databases was searched from the date of their inception to 7 June 2014.

SELECTION CRITERIA

We included RCTs on the effect of paroxetine compared with placebo or no treatment for perimenopausal and postmenopausal women who experienced moderate-to-severe vasomotor symptoms.

DATA COLLECTION AND ANALYSIS

Two reviewers screened records and extracted the information independently. The included studies were appraised by two independent reviewers using the Cochrane risk of bias tool. We synthesised the data in random-effects models and rated the quality of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.

MAIN RESULTS

Five articles with six RCTs (1571 participants) were included. Paroxetine significantly reduced the frequency of hot flushes by 8.86 per week (95% confidence interval (CI) 5.69-12.04, P < 0.00001, I(2)  = 83%) at week 4 and 7.36 per week (95% CI, 4.25-10.46, P < 0.00001, I(2)  = 62%) at week 12. The quality of the evidence on the effect of paroxetine for VMS was moderate.

CONCLUSIONS

There was moderate quality of evidence supporting the effectiveness of paroxetine for vasomotor symptoms; however, it causes nausea and dizziness.

TWEETABLE ABSTRACT

Review finds paroxetine effective for menopausal symptoms with some side effects: evidence strength moderate.

Attentional bias modification (ABM) training induces spontaneous brain activity changes in young women with subthreshold depression: a randomized controlled trial

BACKGROUND

Attention bias modification (ABM) training has been suggested to effectively reduce depressive symptoms, and may be useful in the prevention of the illness in individuals with subthreshold symptoms, yet little is known about the spontaneous brain activity changes associated with ABM training.

METHOD

Resting-state functional MRI was used to explore the effects of ABM training on subthreshold depression (SubD) and corresponding spontaneous brain activity changes. Participants were 41 young women with SubD and 26 matched non-depressed controls. Participants with SubD were randomized to receive either ABM or placebo training during 28 sessions across 4 weeks. Non-depressed controls were assessed before training only. Attentional bias, depressive severity, and spontaneous brain activity before and after training were assessed in both training groups.

RESULTS

Findings revealed that compared to active control training, ABM training significantly decreased depression symptoms, and increased attention for positive stimuli. Resting-state data found that ABM training significantly reduced amplitude of low-frequency fluctuations (ALFF) of the right anterior insula (AI) and right middle frontal gyrus which showed greater ALFF than non-depressed controls before training; Functional connectivity strength between right AI and the right frontoinsular and right supramarginal gyrus were significantly decreased after training within the ABM group; moreover, the improvement of depression symptoms following ABM significantly correlated with the connectivity strength reductions between right AI and right frontoinsular and right supramarginal gyrus.

CONCLUSION

These results suggest that ABM has the potential to reshape the abnormal patterns of spontaneous brain activity in relevant neural circuits associated with depression.

HGF/Met and FOXM1 form a positive feedback loop and render pancreatic cancer cells resistance to Met inhibition and aggressive phenotypes

Purpose

Hepatocyte growth factor (HGF)/Met signaling plays critical roles in pancreatic ductal adenocarcinoma (PDA) development and progression and is considered a potential therapeutic target for this disease. However, the mechanism of aberrant activation of HGF/Met signaling and resistance to Met inhibition in PDA remains unclear.

Experimental Design

The mechanistic role of cross-talk between Forkhead box M1 (FOXM1) and HGF/Met signaling in promotion of PDA growth and resistance to Met inhibition was examined using cell culture, molecular biology and mouse models; and the relevance of our experimental and mechanistic findings were validated using human PDA tissues.

Results

Met was markedly overexpressed in both PDA cell lines and pancreatic tumor specimens, and the expression of Met correlated directly with that of FOXM1 in human tumor specimens. Mechanistically, FOXM1 bound to the promoter region of the Met gene and transcriptionally increased the expression of Met. Increased expression of FOXM1 enhanced the activation of HGF/Met signaling and its downstream pathways, including RAS/extracellular signal-regulated kinase 1/2, phosphoinositide 3-kinase/AKT, and signal transducer and activator of transcription 3. Furthermore, activation of HGF/Met signaling increased the expression and transcriptional activity of FOXM1, and the cross-talk between FOXM1 and HGF/Met signaling promoted PDA growth and resistance to Met inhibition.

Conclusions

Collectively, our findings identified a positive feedback loop formed by FOXM1 and HGF/Met and revealed that this loop is a potentially effective therapeutic target for PDA.

Minimally invasive manipulative reduction with poking k-wire fixation in the treatment of various types of calcaneal fractures

OBJECTIVE

The aim of this study is to investigate the safety and clinical efficacy of minimally invasive manipulative reduction with poking k-wire fixation in the treatment of various types of calcaneal fractures.

PATIENTS AND METHODS

Between July 2012 and July 2014, a prospective parallel controlled study was conducted on 96 patients with closed calcaneal fractures who were admitted to our institution. These patients were randomly divided into two groups, with 48 in each group. Patients in plate group were treated using open reduction and internal fixation, whereas those of manipulation group were treated with minimally invasive manipulative reduction with poking k-wire fixation. All patients were followed up for six months to assess the postoperative recovery and complications. Kerr's scale was adopted to evaluate the functional recovery of fractured calcaneus.

RESULTS

A mean healing duration of 9.48 ± 1.92 weeks was achieved in patients of plate group compared with a healing duration of 9.35 ± 1.66 weeks in those of manipulation group, with no statistical significance (p > 0.05). Complications occurred in 20 cases in plate group versus in seven cases in manipulation group with significant difference (p < 0.05). As for Sanders type II fracture, among patients with compression fracture and tongue type fracture, > 70% of patients achieved with excellent and good outcomes in both groups with no significant difference in clinical efficacy (p > 0.05). The rate of excellent and good outcomes in Sanders type III compression fractures was lower in manipulation group than in plate group (p < 0.05). As for Sanders type II fractures, the Kerr's score of tongue type fractures in manipulation group was higher than that in plate group, and comparison within manipulation group showed that the score of tongue type fractures was significantly higher than that of compression fractures (p < 0.05). However, as for Sanders type III fractures, the score of tongue type fractures in manipulation group was significantly higher than that in plate group, and the score of compression fractures in plate group was significantly higher than that in manipulation group (p < 0.05).

CONCLUSIONS

Minimally invasive manipulative reduction with poking k-wire fixation is suitable for the treatment of Sanders type II tongue type and compression calcaneal fractures, as well as the treatment of Sanders type III tongue type fractures with several advantages, including easy operation, lower cost, fewer complications and favorable recovery.

Individual differences in rumination in healthy and depressive samples: association with brain structure, functional connectivity and depression

BACKGROUND

Rumination is an important cognitive risk factor for onset and relapse of depression. However, no studies have employed a dimensional approach in investigating the neural correlates of rumination and the relationship with depression.

METHOD

Non-clinical healthy subjects (n = 306), who completed the classical rumination and depression scales, were studied using voxel-based morphometry and regional homogeneity (ReHo). Subsequently, mediation analysis was conducted to examine the influence of rumination on the relationship between brain structure and depression. Moreover, depressive patients (n = 60) and a control group (n = 63) of comparable age and education were studied with regions of interest that were identified in the healthy individuals.

RESULTS

For healthy individuals, regional grey-matter volume (rGMV) of dorsolateral prefrontal cortex (DLPFC) and parahippocampal gyrus (PHG) were positively correlated with rumination. In addition, rumination had a mediating effect on the relationship between the DLPFC and PHG and depression. Moreover, ReHo analysis showed that rumination had a significantly negative correlation with functional homogeneity of DLPFC. However, compared to the control group, depressed patients showed significant decrease of rGMV in the DLPFC and PHG and there was a significant negative correlation between DLPFC volume and depressive rumination.

CONCLUSIONS

Increased DLPFC volume (decreased ReHo) in healthy individuals while decreased in depression indicated the trend of DLPFC from inefficient inhibition ('overload state') to impaired regulatory mechanism ('paralysis state'). This finding might elucidate when and why healthy individuals would develop sustained negative mood and depression eventually.

Overexpression of two α-esterase genes mediates metabolic resistance to malathion in the oriental fruit fly, Bactrocera dorsalis (Hendel)

Esterase has been reported to be involved in malathion resistance in the oriental fruit fly, Bactrocera dorsalis (Hendel). However, the underlying molecular mechanism of the esterase-mediated resistance remains largely unknown in this species. Here, with the use of a strain selected for malathion resistance in the laboratory (MR), we found that two overexpressed α-esterase genes, namely BdCarE4 and BdCarE6, predominant in the adult midgut and fat body, function in conferring malathion resistance in B. dorsalis. Notably, these two genes were found to be mostly close to the esterase E3, which are usually implicated in detoxifying organophosphate insecticides. The transcript levels of BdCarE4 and BdCarE6 were investigated and compared between the MR and a susceptible (MS) strain of B. dorsalis. Both genes were significantly up-regulated in the MR strain, which was consistent with the enhanced esterase activity in the MR strain. However, no changes in either the coding sequence or gene copy number were observed between the two strains. Subsequently, heterologous expression combined with cytotoxicity assay in Sf9 cells demonstrated that BdCarE4 and BdCarE6 can probably detoxify malathion. Furthermore, RNA interference-mediated knockdown of each of these two genes significantly increased malathion susceptibility in the MR strain adults. In conclusion, these results expand our molecular understanding of the important role of α-esterases during the development of resistance to organophosphorous insecticides in B. dorsalis.

Genetic variations in microRNA genes and susceptibility to hepatocellular carcinoma

We conducted a hospital-based case-control study to investigate the effect of the miR-146aG>C and miR-499A>G polymorphisms on the risk of hepatocellular carcinoma (HCC) in a Chinese population. This study was 1:1 matched case-control study consisting of 184 HCC patients and 184 control subjects. miR-146aG>C and miR-499A>G polymorphisms were genotyped by polymerase chain reaction-restriction fragment length polymorphism. Multivariate regression analyses showed that subjects carrying the miR-146a G allele and miR-499 G allele were associated with a non-significant increased risk of HCC compared with subjects with the homozygous allele, with adjusted odds ratios (95% confidence interval) of 1.38 (0.97-1.84) and 1.40 (0.99-2.08), respectively. Moreover, subjects carrying the miR-499 A allele showed a greatly increased risk of HCC in subjects infected with HBV compared with subjects carrying the miR-499 A allele, with an adjusted odds ratio (95% confidence interval) of 1.53 (1.34-2.41). In conclusion, the miR-146aG>C and miR-499A>G polymorphisms do not have a role in the genetic susceptibility to HCC.

Roles of p38 MAPK in the regulation of the inflammatory response to swine influenza virus-induced acute lung injury in mice

Swine influenza virus (SIV), one of the most important zoonotic agents, is associated with major public health concerns. The current study was conducted to investigate the role of p38 mitogen-activated protein kinase (p38 MAPK) in the regulation of the inflammatory response to acute lung injury (ALI) induced by SIV of H9N2 subtype (H9N2-SIV) in mice. For this purpose, BALB/c mice were intranasally infected with 20 LD(50) of H9N2-SIV (infected group), while non-infected mice served as control (control group). To assess the effect of p38 MAPK, its specific inhibitor SB203580 was employed followed by SIV infection (SB group). At various times after infection, mouse lungs were subjected to pathological and histological observations and detection of inflammatory cytokines tumor necrosis factor α (TNF)-α, interleukin (IL)-1β, IL-6, and IL-10 and phosphorylated p38 MAPK. The obtained results showed obvious inflammatory responses, injury and raised levels of inflammatory cytokines and phosphorylated p38 MAPK in the lungs of virus-infected mice. In the mice inoculated with the virus alone, the level of phosphorylated p38 MAPK increased from day 2 and peaked at day 6 post infection (p.i.). However, SB203580 caused lower increases in inflammatory cytokines and phosphorylated p38 MAPK and a milder lung injury. These findings indicate that the activation of p38 MAPK upregulated the inflammatory responses to H9N2-SIV-induced ALI, increased its severity and promoted the production of inflammatory cytokines.

Transcriptome profiling of the testis reveals genes involved in spermatogenesis and marker discovery in the oriental fruit fly, Bactrocera dorsalis

The testis is a highly specialized tissue that plays a vital role in ensuring fertility by producing spermatozoa, which are transferred to the female during mating. Spermatogenesis is a complex process, resulting in the production of mature sperm, and involves significant structural and biochemical changes in the seminiferous epithelium of the adult testis. The identification of genes involved in spermatogenesis of Bactrocera dorsalis (Hendel) is critical for a better understanding of its reproductive development. In this study, we constructed a cDNA library of testes from male B. dorsalis adults at different ages, and performed de novo transcriptome sequencing to produce a comprehensive transcript data set, using Illumina sequencing technology. The analysis yielded 52 016 732 clean reads, including a total of 4.65 Gb of nucleotides. These reads were assembled into 47 677 contigs (average 443 bp) and then clustered into 30 516 unigenes (average 756 bp). Based on BLAST hits with known proteins in different databases, 20 921 unigenes were annotated with a cut-off E-value of 10(-5). The transcriptome sequences were further annotated using the Clusters of Orthologous Groups, Gene Orthology and the Kyoto Encyclopedia of Genes and Genomes databases. Functional genes involved in spermatogenesis were analysed, including cell cycle proteins, metalloproteins, actin, and ubiquitin and antihyperthermia proteins. Several testis-specific genes were also identified. The transcripts database will help us to understand the molecular mechanisms underlying spermatogenesis in B. dorsalis. Furthermore, 2913 simple sequence repeats and 151 431 single nucleotide polymorphisms were identified, which will be useful for investigating the genetic diversity of B. dorsalis in the future.