Notes

[Advance in investigation associated with occlusal dysesthesia].
Alcoholic hepatitis (AH) is a clinical syndrome of jaundice, abdominal pain, and anorexia due to prolonged heavy alcohol intake, and is associated with alterations in gene expression, cytokines, immune response, and the gut microbiome. Currently, we have limited biomarkers to diagnose and prognosticate in AH, but there are many novel noninvasive biomarkers under development. We evaluate the currently used algorithms to risk-stratify in AH (such as the Maddrey modified discriminant function), and discuss novel biomarkers in development, such as breath biomarkers, microRNAs, cytokeratin-18 fragments, and the AshTest. We also review the characteristics of an ideal biomarker in AH.Alcohol-associated liver disease (ALD) is a consequence of excessive alcohol use. It comprises a spectrum of histopathologic changes ranging from simple steatosis, steatohepatitis, and cirrhosis to hepatocellular carcinoma. The public health impact of ALD is growing because of an increase in the prevalence and incidence of ALD in parallel with liver transplant and mortalities. There are multiple factors involved in the pathogenesis and progression of ALD. Reducing alcohol consumption is the cornerstone of ALD management. The efforts to reduce excessive alcohol use at the individual and population levels are urgently needed to prevent adverse outcomes from ALD.
It is unclear whether the innate immune response represents a therapeutic target for organ protection strategies in cardiac surgery.

A systematic review of trials of interventions targeting the inflammatory response to cardiac surgery reporting treatment effects on both innate immune system cytokines and organ injury was performed. The protocol was registered at the International Prospective Register of Systematic Reviews CRD42020187239. Searches of the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase were performed. Random-effects meta-analyses were used for the primary analysis. A separate analysis of individual patient data from six studies (n=785) explored sources of heterogeneity for treatment effects on cytokine levels.

Searches to May 2020 identified 251 trials evaluating 24 interventions with 20 582 participants for inclusion. Most trials had important limitations. Methodological limitations of the included trials and heterogeneity of the treatment effects on cytokine levels between trials limited interpretation. The primary analysis demonstrated inconsistency in the direction of the treatment effects on innate immunity and organ failure or death between interventions. Analyses restricted to important subgroups or trials with fewer limitations showed similar results. Meta-regression, pooling available data from all trials, demonstrated no association between the direction of the treatment effects on inflammatory cytokines and organ injury or death. The analysis of individual patient data demonstrated heterogeneity in the association between the cytokine response and organ injury after cardiac surgery for people >75 yr old and those with some chronic diseases.

The certainty of the evidence for a causal relationship between innate immune system activation and organ injury after cardiac surgery is low.
The certainty of the evidence for a causal relationship between innate immune system activation and organ injury after cardiac surgery is low.
Allogeneic red blood cell (RBC) transfusion can induce immunosuppression, which can then increase the susceptibility to postoperative infection. However, studies in different types of surgery show conflicting results regarding this effect.

In this retrospective cohort study conducted in a tertiary referral centre, we included adult patients undergoing clean-contaminated surgery from 2014 to 2018. Patients who received allogeneic RBC transfusion from preoperative Day 30 to postoperative Day 30 were included into the transfusion group. The control group was matched for the type of surgery in a 11 ratio. The primary outcome was infection within 30 days after surgery, which was defined by healthcare-associated infection, and identified mainly based on antibiotic regimens, microbiology tests, and medical notes.

Among the 8098 included patients, 1525 (18.8%) developed 1904 episodes of postoperative infection. Perioperative RBC transfusion was associated with an increased risk of postoperative infection after ylactic strategies should be considered after transfusion.The aim of this study is to identify, from the perspectives of key health policy decision-makers, strategies that address barriers to diabetes-related footcare delivery in primary care, and outline key elements required to support implementation into clinical practice. The study utilised a qualitative design with inductive analysis approach. Seven key health policy decisions-makers within Australia were interviewed. Practical strategies identified to support provision and delivery of foot care in primary care were (a) building on current incentivisation structures through quality improvement projects; (b) enhancing education and community awareness; (c) greater utilisation and provision of resources and support systems; and (d) development of collaborative models of care and referral pathways. Key elements reported to support effective implementation of footcare strategies included developing and implementing strategies based on co-design, consultation, collaboration, consolidation and co-commissioning. this website To the authors' knowledge, this is the first Australian study to obtain information from key health policy decision-makers, identifying strategies to support footcare delivery in primary care. Implementation of preventative diabetes-related footcare strategies into 'routine' primary care clinical practice requires multiparty co-design, consultation, consolidation, collaboration and co-commissioning. The basis of strategy development will influence implementation success and thus improve outcomes for people living with diabetes.Developed in partnership with GPs, a new telehealth model of care using remote monitoring, known as telemonitoring (TM), was introduced in South Western Sydney (SWS) in 2015, transmitting clinical readings taken at home to telehealth coordinators. This study explored the experiences, beliefs and attitudes of general practice staff to identify barriers to and facilitators of the SWS TM model. Responses were collected from a purposive sample of 10 participants via semistructured interviews (n=9 interview sessions) and the resulting transcripts were analysed thematically. Four themes were identified lack of understanding and involvement; patient-centred care and empowerment; clinical practice and process factors; and system-wide communication and collaboration. Participants recognised some actual and potential benefits of TM, but barriers to TM were identified across all themes. Feedback provided by participants has informed the ongoing formulation of a more 'GP-led' model of TM.Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.Type 2 diabetes (T2D) is often seen as primarily caused by weight, and its amelioration associated with individual behaviour change, which has the potential for negative consequences for people living with the disease. The aims of this study were to explore how weight was framed by diabetes resource nurses and to determine the implications of that framing for nurse practice in a primary care setting in Australia. The research was a qualitative empirical case study using semistructured interviews with nurses focusing on meanings and interpretations. The findings were interpreted using a constructivist epistemology of both inductive and deductive inference. The study found that nurses viewed overweight and obesity as unhealthy and the primary causes of T2D, and that weight was frequently discussed in the health care encounter. Nurses emphasised individual responsibility through behaviour change to manage T2D, downplaying other known causes such as age and family history and important social inequalities. Studies show that nurses have negative attitudes towards overweight and obese patients. The implications of this research are that the nurses' views could potentially negatively affect clients' management of T2D, which has the potential for poor health outcomes.Lithium sulfur battery has become one of the promising rechargeable battery systems to replace the conventional lithium ion battery. Commonly, it uses carbon-sulfur composites as cathode materials. Biomass based carbons has an important role in enhancing its electrochemical characteristics due to the high conductivity and porous structures. Here, potato peel wastes have been utilized to prepare porous carbon lithium sulfur battery through hydrothermal carbonization followed by the chemical activation method using KOH. After sulfur loading, as prepared carbon-sulfur composite shows stable coulombic efficiencies of above 98% and a reversible specific capacity of 804 mAh g-1 after 100 cycles at current density of 100 mA g-1. These excellent electrochemical properties can be attributed to the unique structure of PPWC showing mesoporous structure with large specific surface areas. These results show the potential application of potato peel waste based porous carbon as electrode's materials for lithium sulfur battery.Micro and nano structures of quartz schist, plagioclase granite, and granitic gneiss in the Xiaomei Shear Zone located in southeastern Hainan Island, China are observed using Scanning Electron Microscope (SEM). Ultramicroscopic analyses indicate that three types of nanoparticles were found in the samples, including spherical nanoparticles, agglomerated nanoparticles and nanofibers. These nanoparticles are mainly developed in the fracture zones. The more fractures there are, the more nanoparticles are developed. Energy dispersive spectrometer (EDS) and X-ray diffraction (XRD) are used to ascertain the composition of the nanoparticles. The results suggest that the nanoparticles are mainly composed of silicate, dolomite and calcite, rich in O, Si, Al, Ca. Based on our results, we suggest that nanoparticle formation is a complex, plastic-brittle transition process. Thermal decomposition driven by steady shearing possibly forms well-organized nanoparticles, while fast-moving dislocations by shock-like stress release possibly forms radial nanofibers.
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