Accurate Assessment and Tracking the Process of Liver-Specific Injury by the Residual Tissue Activity of Carboxylesterase 1 and Dipeptidyl Peptidase 4

Accurately assessing and tracking the progression of liver-specific injury remains a major challenge in the field of biomarker research. Here, we took a retrospective validation approach built on the mutuality between serum and tissue biomarkers to characterize the liver-specific damage of bile duct cells caused by a-naphthyl isothiocyanate (ANIT). We found that carboxylesterase 1 (CES1), as an intrahepatic marker, and dipeptidyl peptidase 4 (DPP-IV), as an extrahepatic marker, can reflect the different pathophysiolo-gies of liver injury. Levels of CES1 and DPP-IV can be used to identify liver damage itself and the inflam-matory state, respectively. While the levels of the conventional serological biomarkers alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were all con-comitantly elevated in serum and tissues after ANIT-induced injury, the levels of bile acids decreased in bile, increased in serum, and ascended in intrahepatic tissue. Although the level of c-glutamyl transpeptidase (c-GT) changed in an opposite direction, the duration was much shorter than that of CES1 and was quickly restored to normal levels. Therefore, among the abovementioned biomarkers, only CES1 made it possible to specifically determine whether the liver cells were destroyed or damaged with-out interference from inflammation. CES1 also enabled accurate assessment of the anti-cholestasis effects of ursodeoxycholic acid (UDCA;single component) and Qing Fei Pai Du Decoction (QFPDD;multi-component). We found that both QFPDD and UDCA attenuated ANIT-induced liver damage. UDCA was more potent in promoting bile excretion but showed relatively weaker anti-injury and anti-inflammatory effects than QFPDD, whereas QFPDD was more effective in blocking liver inflammation and repairing liver damage. Our data highlights the potential of the combined use of CES1 (as an intra-hepatic marker of liver damage) and DPP-IV (as an extrahepatic marker of inflammation) for the accurate evaluation and tracking of liver-specific injury-an application that allows for the differentiation of liver damage and inflammatory liver injury.(c) 2021 THE AUTHORS. Published by Elsevier LTD on behalf of Chinese Academy of Engineering and Higher Education Press Limited Company. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Development and validation of a competency evaluation model for hospital infection prevention and control practitioners in the post-pandemic era: a mixed methods study.

BACKGROUND: During the coronavirus disease 2019 pandemic, the management of nosocomial infections became even more crucial. There is an urgent need to develop a competency model for healthcare practitioners to combat public health emergencies. AIM: To determine practitioners' competency in hospital infection prevention and control measures. METHODS: A theoretical framework was developed based on a literature review, key informant interviews, the Delphi method and a questionnaire survey. These items were evaluated based on response rate, maximum score, minimum score and mean score. Factor analyses, both exploratory and confirmatory, were used to determine the structure of the competency model. RESULTS: The effective response rate for the questionnaire was 88.29%, and Cronbach's α-coefficient was 0.964. Factor analysis revealed a Kaiser-Meyer-Olkin score of 0.945. Bartlett's test gave a χ2-value of 10523.439 (df=435; P<0.001). After exploratory factor analysis, the five-factor model was retained, four items were deleted and a five-dimensional, 26-item scale was obtained. The new structure's confirmatory factor analysis revealed high goodness of fit (comparative fit index=0.921; Tucker-Lewis index=0.911; standardized root mean square residual=0.053; root mean square error of approximation=0.044). CONCLUSION: The proposed scale is a useful tool to assess the competency of hospital infection prevention and control practitioners, which can help hospitals to improve infection prevention and control.

Clinical course and outcomes of COVID-19 patients with hypertension

Background: Coronavirus disease 2019 (COVID-19) is now still an emerging, evolving pandemic, causing more than 64 million people infected. Hypertension, a common cardiovascular condition, has been reported as a risk factor for higher mortality. In order to a better management, it is necessary to know the clinical course and identify the factors associated with clinical outcomes in COVID-19 patients with hypertension.Methods and results: A total of 148 COVID-19 cases who had pre-existing hypertension with clarified outcomes (discharge or deceased) were included in this study. Medical history, clinical manifestation, epidemiological, and laboratory data were analyzed. 45 (30.4%) patients had died during hospitalization, multivariate COX regression analysis revealed some predicted factors at admission for in-hospital death including elevated level of hs-cTn (HR: 3.98, 95% CI:1.95-8.16) and IL-6 (HR: 3.31, 95% CI: 1.42-7.72). Patients with uncontrolled blood pressure (BP) (n = 52) which were defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg for more than once (≥ 2 times) during hospitalization, were more likely to have ICU admission (P=0.037), invasive mechanical ventilation(P=0.028), and renal injury(P=0.005). With a stricter criterion which was defined as systolic BP ≥ 130 mmHg or diastolic BP ≥ 80 mmHg for more than once (≥ 2 times) during hospitalization, 105 (70.9%) patients with uncontrolled BP had higher mortality rate (P=0.046). In our study, there were 35 (23.6%) patients taking renin-angiotensin-aldosterone system (RAAS) suppressor including angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB) and spironolactone. Patients with these RAAS suppressors treatment were less likely to be admitted to ICU (P = 0.048). And treatment with RAAS suppressors didn't have an obvious influence in mortality.Conclusion: Among COVID-19 patients with hypertension, elevated hs-cTn and IL-6 at admission were associated with higher mortality, suggesting that they could possibly be used as predictors for fatal outcomes. Blood pressure control with a stricter criterion of less than 130/80mmHg during hospitalization is associated with better prognosis. And treatment with RAAS suppressors didn't not contribute to a higher mortality.

High-Flow Nasal Cannula for COVID-19 Patients: A Multicenter Retrospective Study in China

Background: High-flow nasal cannula (HFNC) may help avoid intubation of hypoxemic patients suffering from COVID-19;however, it may also contribute to delaying intubation, which may increase mortality. Here, we aimed to identify the predictors of HFNC failure among patients with COVID-19.

Super-factors associated with transmission of occupational COVID-19 infection among healthcare staff in Wuhan, China.

BACKGROUND: Globally, there have been many cases of coronavirus disease 2019 (COVID-19) among medical staff; however, the main factors associated with the infection are not well understood. AIM: To identify the super-factors causing COVID-19 infection in medical staff in China. METHODS: A cross-sectional study was conducted between January 1st and February 30th, 2020, in which front-line members of medical staff who took part in the care and treatment of patients with COVID-19 were enrolled. Epidemiological and demographic data between infected and uninfected groups were collected and compared. Social network analysis (SNA) was used to establish socio-metric social links between influencing factors. FINDINGS: A total of 92 medical staff were enrolled. In all participant groups, the super-factor identified by the network was wearing a medical protective mask or surgical mask correctly (degree: 572; closeness: 25; betweenness centrality: 3.23). Touching the cheek, nose, and mouth while working was the super-factor in the infected group. This was the biggest node in the network and had the strongest influence (degree: 370; closeness: 29; betweenness centrality: 0.37). Self-protection score was the super-factor in the uninfected group but was the isolated factor in the infected group (degree: 201; closeness: 28; betweenness centrality: 5.64). For family members, the exposure history to Huanan Seafood Wholesale Market and the contact history to wild animals were two isolated nodes. CONCLUSION: High self-protection score was the main factor that prevented medical staff from contracting COVID-19 infection. The main factor contributing to COVID-19 infections among medical staff was touching the cheek, nose, and mouth while working.