The impact of flaxseed oil on lipid profiles, weight loss, and inflammatory markers in hemodialysis patients: A systematic review and meta-analysis of randomized controlled trials.

Studies investigating the effects of flaxseed oil on lipid profiles, weight loss, and inflammatory markers have produced inconsistent results. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to explore the impact of flaxseed oil on these parameters in hemodialysis patients. The study protocol was registered online (PROSPERO number: CRD42023484076). The meta-analyses showed a significant decrease in triglyceride (TG) levels (WMD = -85.78 mg/dL, 95% CI: -155.24 to -16.32, I2 = 98.32%) and C-reactive protein (CRP) levels (WMD = -2.66 mg/L, 95% CI: -4.07 to -1.24, I2 = 92.26%) following consumption of flaxseed oil. Subgroup analyses revealed significant changes in LDL-C, HDL-C, and TC levels only in trials utilizing a dosage higher than 10 g per day and using ground flaxseed oil. Based on the results, flaxseed oil improves CRP and TG levels, and higher doses positively affect lipid profiles. However, it has no significant effect on anthropometric measures.

Delirium care in hospitals in Ireland on World Delirium Awareness Day 2023.

BACKGROUND: Acute, transient, but sometimes persistent, delirium is characterized by a sharp disruption in attention, consciousness, and cognitive function, and can be caused by many medications and disorders. Delirium occurrence and negative consequences, such as falls and functional decline, can be decreased with multifactorial prevention and timely detection. AIMS: To describe current clinical practice in relation to the prevention, assessment, and management of delirium in Irish hospitals; awareness-raising and educational activities; and barriers to good practice. METHODS: On World Delirium Awareness Day (15th March 2023), a global survey was conducted of delirium prevalence and care. A senior clinical staff member on each participating ward reported on delirium prevalence at 8AM and 8PM, and on usual ward practice; this data was entered into an online survey by a data collector (typically a clinician from the site, visiting several wards to record data). This study reports data from Irish hospitals. RESULTS: In total, 132 wards from 15 hospitals across Ireland participated. Almost 60% of wards used 'personal judgment' for delirium assessment. Having at least one delirium training session in the preceding year was associated with greater use of a formal assessment tool (60.3% versus 18.8%; p < 0.001). Wards reported staff training/education as the main priority to improve care, but 72.7% of wards identified insufficient time to train staff as a key barrier. CONCLUSIONS: Clinical practice related to delirium care requires improvement. Awareness raising and staff training require more focus and time in busy clinical settings.

Mesenchymal stem cell-derived exosomes decrease Hyperplasia in Psoriasis by inducing transforming growth factor ß2 (TGF-ß2).

BACKGROUND: Psoriasis, a chronic inflammatory skin disease, is increasingly effectively managed with the targeted immunotherapy; however, long-term immunotherapy carries health risks, and loss of response. Therefore, we need to develop the alternative treatment strategies. Mesenchymal stem/stromal cell (M.S.C.) exosomes stand out for their remarkable immunomodulatory properties, gaining widespread recognition. This study investigated whether M.S.C. exosomes can reduce psoriasis-induced hyperplasia by inducing Transforming Growth Factor beta 2 (TGF-beta2) signaling. METHODOLOGY: Exosomes were isolated from M.S.C.s by ultracentrifugation. Then, scanning electron microscopy was used for the morphology of exosomes. To ascertain the exosome concentration, the Bradford test was used. To ascertain the cellular toxicity of exosomes in Human Umbilical Vein Endothelial Cells ( H.U.V.E.C), an MTT experiment was then conducted. Real-time PCR was used to quantify TGF beta2 expression levels, whereas an ELISA immunosorbent assay was used to determine the protein concentration of TGF beta2. RESULTS: In this study, the exosomes of 15-30 nm in size that were uniform, and cup-shaped were isolated. Moreover, the IC50 value for this Treatment was calculated to be 181.750 µg/ml. The concentration of TGF-ß2 gene in the target cells significantly increased following Treatment with the exosomes. Furthermore, the expression level of the studied gene significantly increased due to the Treatment. CONCLUSION: Upregulating the expression of TGF-ß2 in psoriatic cells via TGF-ß2 signaling is one way exosomes can help reduce hyperplasia.

Digital Health Interventions for Heart Failure Management in Underserved Rural Areas of the United States: A Systematic Review of Randomized Trials.

BACKGROUND: Heart failure disproportionately affects individuals residing in rural areas, leading to worse health outcomes. Digital health interventions have been proposed as a promising approach for improving heart failure management. This systematic review aims to identify randomized trials of digital health interventions for individuals living in underserved rural areas with heart failure. METHODS AND RESULTS: We conducted a systematic review by searching 6 databases (CINAHL, EMBASE, MEDLINE, Web of Science, Scopus, and PubMed; 2000-2023). A total of 30 426 articles were identified and screened. Inclusion criteria consisted of digital health randomized trials that were conducted in underserved rural areas of the United States based on the US Census Bureau's classification. Two independent reviewers screened the studies using the National Heart, Lung, and Blood Institute tool to evaluate the risk of bias. The review included 5 trials from 6 US states, involving 870 participants (42.9% female). Each of the 5 studies employed telemedicine, 2 studies used remote monitoring, and 1 study used mobile health technology. The studies reported improvement in self-care behaviors in 4 trials, increased knowledge in 2, and decreased cardiovascular mortality in 1 study. However, 3 trials revealed no change or an increase in health care resource use, 2 showed no change in cardiac biomarkers, and 2 demonstrated an increase in anxiety. CONCLUSIONS: The results suggest that digital health interventions have the potential to enhance self-care and knowledge of patients with heart failure living in underserved rural areas. However, further research is necessary to evaluate their impact on clinical outcomes, biomarkers, and health care resource use. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022366923.

Bacterial nano-factories as a tool for the biosynthesis of TiO2 nanoparticles: characterization and potential application in wastewater treatment.

The development of reliable and eco-conscious processes for nanoparticle synthesis constitutes a significant element in nanotechnology. TiO2 nanoparticles (NPs) are becoming essential due to their potential uses in dentistry, surgery, agriculture, and pharmacy. This leads to the development of various procedures for producing TiO2 NPs using various physicochemical methods. Still, the drawbacks of these conventional methods are associated with the emission of toxic chemicals into the atmosphere and high energy demands in production, hence endangering the health and the environment. Problems issued are solved by green nanotechnology, which offers tools as nano-factories by utilizing biological sources to subside the improper effects of conventional methods and produces nanoparticles through synthesis methods that are clean, safe, energy-efficient, and cost-effective. Among the biogenic sources, microbial cells such as bacteria possess intrinsic pathways of converting metallic salt to nanoparticles due to their ability to produce reductase enzymes. Also, they can offer features to products such as high dispersity and produce sustainable nanoparticles at a large scale. Biosynthesized TiO2 NPs have high oxidizing potential and a wide range of applications, specifically as photosensitizers and antimicrobial agents. This review will address bacterial nano-factories that can be utilized for the biosynthesis of TiO2 NPs, the characterization of biosynthesized nanoparticles, and their potential application in wastewater treatment.

Design and Implementation of an Electronic Health Record-Integrated Hypertension Management Application.

BACKGROUND: High blood pressure affects approximately 116 million adults in the United States. It is the leading risk factor for death and disability across the world. Unfortunately, over the past decade, hypertension control rates have decreased across the United States. Prediction models and clinical studies have shown that reducing clinician inertia alone is sufficient to reach the target of ≥80% blood pressure control. Digital health tools containing evidence-based algorithms that are able to reduce clinician inertia are a good fit for turning the tide in blood pressure control, but careful consideration should be taken in the design process to integrate digital health interventions into the clinical workflow. METHODS: We describe the development of a provider-facing hypertension management platform. We enumerate key steps of the development process, including needs finding, clinical workflow analysis, treatment algorithm creation, platform design and electronic health record integration. We interviewed and surveyed 5 Stanford clinicians from primary care, cardiology, and their clinical care team members (including nurses, advanced practice providers, medical assistants) to identify needs and break down the steps of clinician workflow analysis. The application design and development stage were aided by a team of approximately 15 specialists in the fields of primary care, hypertension, bioinformatics, and software development. CONCLUSIONS: Digital monitoring holds immense potential for revolutionizing chronic disease management. Our team developed a hypertension management platform at an academic medical center to address some of the top barriers to adoption and achieving clinical outcomes. The frameworks and processes described in this article may be used for the development of a diverse range of digital health tools in the cardiovascular space.

Role of sex and gender-related variables in development of metabolic syndrome: A prospective cohort study.

INTRODUCTION: The burden of metabolic syndrome (MetS) and its components has been increasing mainly amongst male individuals. Nevertheless, clinical outcomes related to MetS (i.e., cardiovascular diseases), are worse among female individuals. Whether these sex differences in the components and sequalae of MetS are influenced by gender (i.e., psycho-socio-cultural factors)) is a matter of debate.  Therefore, the purpose of this study was to determine the association between gender-related factors and the development of MetS, and to assess if the magnitude of the associations vary by sex. METHOD: Data from the Colaus/PsyColaus study, a prospective population-based cohort of 6,734 middle-aged participants in Lausanne (Switzerland) (2003-2006) were used. The primary endpoint was the development of MetS as defined by the Adult Treatment Panel III of the National Cholesterol Education Program. Multivariable models were estimated using logistic regression to assess the association between gender-related factors and the development of MetS. Two-way interactions between sex,  age and gender-related factors were also tested. RESULTS: Among 5,195 participants without MetS (mean age=51.3 ± 10.6, 56.1 % females), 27.9 % developed MetS during a mean follow-up of 10.9 years. Female sex (OR:0.48, 95 %CI:0.41-0.55) was associated with decreased risk of developing MetS. Conversely, older age, educational attainment less than university, and low income were associated with an increased risk of developing MetS. Statistically significant interaction between sex and strata of age, education, income, smoking, and employment were identified showing that the reduced risk of MetS in female individuals was attenuated in the lowest education, income, and advanced age strata. However, females who smoke and reported being employed demonstrated a decreased risk of MetS compared to males. Conversely smoking and unemployment were significant risk factors for MetS development among male adults. CONCLUSIONS: Gender-related factors such as income level and educational attainment play a greater role in the development of MetS in female than individuals. These factors represent novel modifiable targets for implementation of sex- and gender-specific strategies to achieve health equity for all people.

Missing Race and Ethnicity Data in Pediatric Studies.

This Viewpoint discusses missing race and ethnicity data in pediatric studies.

The liver-derived exosomes stimulate insulin gene expression in pancreatic beta cells under condition of insulin resistance.

Introduction: An insufficient functional beta cell mass is a core pathological hallmark of type 2 diabetes (T2D). Despite the availability of several effective pharmaceuticals for diabetes management, there is an urgent need for novel medications to protect pancreatic beta cells under diabetic conditions. Integrative organ cross-communication controls the energy balance and glucose homeostasis. The liver and pancreatic islets have dynamic cross-communications where the liver can trigger a compensatory beta cell mass expansion and enhanced hormonal secretion in insulin-resistant conditions. However, the indispensable element(s) that foster beta cell proliferation and insulin secretion have yet to be completely identified. Exosomes are important extracellular vehicles (EVs) released by most cell types that transfer biological signal(s), including metabolic messengers such as miRNA and peptides, between cells and organs. Methods: We investigated whether beta cells can take up liver-derived exosomes and examined their impact on beta cell functional genes and insulin expression. Exosomes isolated from human liver HepG2 cells were characterized using various methods, including Transmission Electron Microscopy (TEM), dynamic light scattering (DLS), and Western blot analysis of exosomal markers. Exosome labeling and cell uptake were assessed using CM-Dil dye. The effect of liver cell-derived exosomes on Min6 beta cells was determined through gene expression analyses of beta cell markers and insulin using qPCR, as well as Akt signaling using Western blotting. Results: Treatment of Min6 beta cells with exosomes isolated from human liver HepG2 cells treated with insulin receptor antagonist S961 significantly increased the expression of beta cell markers Pdx1, NeuroD1, and Ins1 compared to the exosomes isolated from untreated cells. In line with this, the activity of AKT kinase, an integral component of the insulin receptor pathway, is elevated in pancreatic beta cells, as represented by an increase in AKT's downstream substrate, FoxO1 phosphorylation. Discussions: This study suggests that liver-derived exosomes may carry a specific molecular cargo that can affect insulin expression in pancreatic beta cells, ultimately affecting glucose homeostasis.

Leveraging Digital Health to Improve the Cardiovascular Health of Women.

Purpose of Review: In this review, we present a comprehensive discussion on the population-level implications of digital health interventions (DHIs) to improve cardiovascular health (CVH) through sex- and gender-specific prevention strategies among women. Recent Findings: Over the past 30 years, there have been significant advancements in the diagnosis and treatment of cardiovascular diseases, a leading cause of morbidity and mortality among men and women worldwide. However, women are often underdiagnosed, undertreated, and underrepresented in cardiovascular clinical trials, which all contribute to disparities within this population. One approach to address this is through DHIs, particularly among racial and ethnic minoritized groups. Implementation of telemedicine has shown promise in increasing adherence to healthcare visits, improving BP monitoring, weight control, physical activity, and the adoption of healthy behaviors. Furthermore, the use of mobile health applications facilitated by smart devices, wearables, and other eHealth (defined as electronically delivered health services) modalities has also promoted CVH among women in general, as well as during pregnancy and the postpartum period. Overall, utilizing a digital health approach for healthcare delivery, decentralized clinical trials, and incorporation into daily lifestyle activities has the potential to improve CVH among women by mitigating geographical, structural, and financial barriers to care. Summary: Leveraging digital technologies and strategies introduces novel methods to address sex- and gender-specific health and healthcare disparities and improve the quality of care provided to women. However, it is imperative to be mindful of the digital divide in specific populations, which may hinder accessibility to these novel technologies and inadvertently widen preexisting inequities.

Use of Human-Centered Design Methodology to Develop a Digital Toolkit to Optimize Heart Failure Guideline-Directed Medical Therapy.

BACKGROUND: Guideline-directed medical therapies (GDMTs) improve quality of life and health outcomes for patients with heart failure (HF). However, GDMT utilization is suboptimal among patients with HF. OBJECTIVE: The aims of this study were to engage key stakeholders in semistructured, virtual human-centered design sessions to identify challenges in GDMT optimization posthospitalization and inform the development of a digital toolkit aimed at optimizing HF GDMTs. METHODS: For the human-centered design sessions, we recruited (a) clinicians who care for patients with HF across 3 hospital systems, (b) patients with HF with reduced ejection fraction (ejection fraction ≤ 40%) discharged from the hospital within 30 days of enrollment, and (c) caregivers. All participants were 18 years or older, English speaking, with Internet access. RESULTS: A total of 10 clinicians (median age, 37 years [interquartile range, 35-41], 12 years [interquartile range, 10-14] of experience caring for patients with HF, 80% women, 50% White, 50% nurse practitioners) and three patients and one caregiver (median age 57 years [IQR: 53-60], 75% men, 50% Black, 75% married) were included. Five themes emerged from the clinician sessions on challenges to GDMT optimization (eg, barriers to patient buy-in). Six themes on challenges (eg, managing medications), 4 themes on motivators (eg, regaining independence), and 3 themes on facilitators (eg, social support) to HF management arose from the patient and caregiver sessions. CONCLUSIONS: The clinician, patient, and caregiver insights identified through human-centered design will inform a digital toolkit aimed at optimizing HF GDMTs, including a patient-facing smartphone application and clinician dashboard. This digital toolkit will be evaluated in a multicenter, clinical trial.

Audio-visual integration is more precise in older adults with a high level of long-term physical activity.

It is well established that physical activity leads to numerous health, cognitive, and psychological benefits. However, to date, very few studies have investigated the impact of physical activity on multisensory perception, that is, the brain's capacity to integrate information across sensory modalities. Furthermore, it is unknown what level of long-term physical activity is associated with multisensory integration in adults. We explored the relationship between multisensory integration and a ten-year physical activity trajectory in 2,974 adults aged 50+ from The Irish Longitudinal Study on Ageing by measuring susceptibility to the Sound Induced Flash Illusion (SIFI) at multiple audio-visual temporal asynchronies. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ-SF) at 2 years intervals over ten years. We used latent class trajectory modelling to identify latent growth classes of individuals following a similar trajectory of physical activity over time. We analysed the association of this trajectory with performance accuracy to the illusion trials of the SIFI task with generalized logistic mixed effects regression models, adjusted for several covariates. Results showed that more precise integration (i.e., lower SIFI susceptibility with larger temporal asynchronies) was associated with a higher level of sustained physical activity across ten years. Although the use of self-reported physical activity and a short version of the SIFI task limit our conclusions to some extent, nonetheless, the results suggest that sustained physical activity is associated with more precise multisensory integration, which in turn is linked to better balance and a lower risk of falling in older adults.

Synthesis of Silver Nanoparticles from Aeromonas caviae for Antibacterial Activity and In Vivo Effects in Rats.

Silver nanoparticles (AgNPs) have excellent antimicrobial properties, as they can inhibit multidrug-resistant (MDR) pathogens. Furthermore, bio-AgNPs have potential applications in medicine due to their low toxicity and high stability. Here, AgNPs were synthesized from the biomass of Aeromonas caviae isolated from a sediment sample and subsequently characterized. The UV-Vis spectra of AgNPs in aqueous medium peaked at 417 nm, matching their plasmon absorption. The X-ray diffraction analysis (XRD) pattern of AgNPs showed four peaks at 2θ values, corresponding to Ag diffraction faces. Absorption band peaks at 3420.16, 1635.54, and 1399.43 cm-1 were identified by Fourier-transform infrared spectroscopy (FTIR) analysis as belonging to functional groups of AgNP-associated biomolecules. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) showed that the nanoparticles are spherical and pseudospherical, with sizes of 15-25 nm. Agar well diffusion minimal inhibitory concentration (MIC) assays were used to assess the antibacterial activity of the nanoparticles against MDR pathogens. AgNPs exhibited antibacterial activity against MDR bacteria. Two groups of albino rats received intraperitoneal injections of AgNPs at 15 mg/kg or 30 mg/kg for 7 days. Blood, kidney, and liver samples were collected to investigate hematological, biochemical, and histopathological alterations. Administered AgNPs in rats fluctuated in liver and kidney function parameters. The ultrastructural impacts of AgNPs were more prominent at higher doses. The results proved the easy, fast, and efficient synthesis of AgNPs using A. caviae isolates and demonstrated the remarkable potential of these AgNPs as antibacterial agents. Nanotoxicological studies are required to identify the specific dose that balances optimal antibacterial activity with minimal toxicity to human health.

A comparison of synthetic data generation and federated analysis for enabling international evaluations of cardiovascular health.

Sharing health data for research purposes across international jurisdictions has been a challenge due to privacy concerns. Two privacy enhancing technologies that can enable such sharing are synthetic data generation (SDG) and federated analysis, but their relative strengths and weaknesses have not been evaluated thus far. In this study we compared SDG with federated analysis to enable such international comparative studies. The objective of the analysis was to assess country-level differences in the role of sex on cardiovascular health (CVH) using a pooled dataset of Canadian and Austrian individuals. The Canadian data was synthesized and sent to the Austrian team for analysis. The utility of the pooled (synthetic Canadian + real Austrian) dataset was evaluated by comparing the regression results from the two approaches. The privacy of the Canadian synthetic data was assessed using a membership disclosure test which showed an F1 score of 0.001, indicating low privacy risk. The outcome variable of interest was CVH, calculated through a modified CANHEART index. The main and interaction effect parameter estimates of the federated and pooled analyses were consistent and directionally the same. It took approximately one month to set up the synthetic data generation platform and generate the synthetic data, whereas it took over 1.5 years to set up the federated analysis system. Synthetic data generation can be an efficient and effective tool for enabling multi-jurisdictional studies while addressing privacy concerns.

Antifungal Effect of Ginger Essential Oil Spray on Candida albicans Adhering to Self-Cure Acrylic Plates.

Objectives: The present study aimed to evaluate the efficacy of ginger essential oil spray for elimination of Candida albicans (C. albicans) adhering to self-cure acrylic plates. Materials and Methods: In this experimental study, 120 self-cure acrylic discs were contaminated with C. albicans and randomly divided into four main groups: exposure to ginger essential oil, nystatin (positive control), distilled water (negative control), and no exposure. The minimum inhibitory concentration (MIC) of ginger oil and nystatin was determined by the microdilution test. The stability of C. albicans was determined by culturing the samples of treated acrylic plates and comparing the mean number of remaining colonies. Data were analyzed using the Kruskal-Wallis test followed by Dunn test with Bonferroni correction. P<0.05 was considered significant Results: The MIC of ginger essential oil and nystatin was found to be 1560µg/mL and 4µg/mL, respectively. The differences between the mean count of C. albicans colonies before (10175±10730.25) and after the exposure to ginger essential oil (542.86±464.81) and nystatin (257.14±247.67) was statistically significant (P<0.001). The mean number of C. albicans colonies after spraying with nystatin was not significantly different compared with ginger essential oil (P=0.204). The efficacy of nystatin and ginger essential oil at each time was significantly more than distilled water (P<0.001). At 10 and 15min, there was no significant difference between nystatin and ginger essential oil groups (P=0.05). Conclusion: Ginger essential oil spray was found to be a simple and effective method for elimination of C. albicans adhering to acrylic discs.

Natural language processing to identify reasons for sex disparity in statin prescriptions.

Background: Statins are the cornerstone of treatment of patients with atherosclerotic cardiovascular disease (ASCVD). Despite this, multiple studies have shown that women with ASCVD are less likely to be prescribed statins than men. The objective of this study was to use Natural Language Processing (NLP) to elucidate factors contributing to this disparity. Methods: Our cohort included adult patients with two or more encounters between 2014 and 2021 with an ASCVD diagnosis within a multisite electronic health record (EHR) in Northern California. After reviewing structured EHR prescription data, we used a benchmark deep learning NLP approach, Clinical Bidirectional Encoder Representations from Transformers (BERT), to identify and interpret discussions of statin prescriptions documented in clinical notes. Clinical BERT was evaluated against expert clinician review in 20% test sets. Results: There were 88,913 patients with ASCVD (mean age 67.8±13.1 years) and 35,901 (40.4%) were women. Women with ASCVD were less likely to be prescribed statins compared with men (56.6% vs 67.6%, p <0.001), and, when prescribed, less likely to be prescribed guideline-directed high-intensity dosing (41.4% vs 49.8%, p <0.001). These disparities were more pronounced among younger patients, patients with private insurance, and those for whom English is their preferred language. Among those not prescribed statins, women were less likely than men to have statins mentioned in their clinical notes (16.9% vs 19.1%, p <0.001). Women were less likely than men to have statin use reported in clinical notes despite absence of recorded prescription (32.8% vs 42.6%, p <0.001). Women were slightly more likely than men to have statin intolerance documented in structured data or clinical notes (6.0% vs 5.3%, p=0.003). Conclusions: Women with ASCVD were less likely to be prescribed guideline-directed statins compared with men. NLP identified additional sex-based statin disparities and reasons for statin non-prescription in clinical notes of patients with ASCVD.