TGF-β1–induced endothelial-mesenchymal transition: a potential contributor to fibrotic remodeling in atrial fibrillation?

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide, with an unmet therapeutic need. Fibrotic remodeling, in which collagen-producing atrial fibroblasts play a crucial role, substantially contributes to arrhythmia promotion and progression. In this issue of the JCI, Lai, Tsai, and co-authors reveal that TGF-β1 promoted endothelial-mesenchymal transition during AF and put forward the notion that, in the adult heart, atrial fibroblasts can originate from different cellular sources. These important findings extend our understanding of the origin, biology, and function of fibroblasts and offer possibilities for therapeutic targeting of fibrosis in AF.     

Acupuncture for Chronic Pain: Is Acupuncture More than an Effective Placebo? A Systematic Review of Pooled Data from Meta‐analyses

Objectives: There is controversy as to whether or not acupuncture is more effective than placebo. To help clarify this debate, we synthesized the evidence gathered from systematic reviews on the pooled data of high‐quality randomized controlled trials comparing acupuncture to sham acupuncture for chronic pain. Method: Systematic reviews of acupuncture for the most commonly occurring forms of chronic pain (back, knee, and head) published between 2003 and 2008 were sourced from Ovid databases: Medline, Allied and Complementary Medicine database, Cochrane Library and Web of Science during December 2008. Eight systematic reviews with meta‐analyses of pooled data were eligible for inclusion. Data were extracted for short‐ and longer‐term outcomes for the most commonly occurring forms of pain. Two independent reviewers assessed methodological quality. Results: For short‐term outcomes, acupuncture showed significant superiority over sham for back pain, knee pain, and headache. For longer‐term outcomes (6 to12 months), acupuncture was significantly more effective for knee pain and tension‐type headache but inconsistent for back pain (one positive and one inconclusive). In general, effect sizes (standardized mean differences) were found to be relatively small. Discussion: The accumulating evidence from recent reviews suggests that acupuncture is more than a placebo for commonly occurring chronic pain conditions. If this conclusion is correct, then we ask the question: is it now time to shift research priorities away from asking placebo‐related questions and shift toward asking more practical questions about whether the overall benefit is clinically meaningful and cost‐effective?     

Is Aerobic or Resistance Training the Most Effective Exercise Modality for Improving Lower Extremity Physical Function and Perceived Fatigue in People With Multiple Sclerosis? A Systematic Review and Meta-analysis

ObjectiveThe purpose of this systematic review was to investigate whether aerobic training (AT) or resistance training (RT) is most effective in terms of improving lower limb physical function and perceived fatigue in persons with multiple sclerosis (PwMS).Data SourcesNine databases (MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, Physiotherapy Evidence Database, SPORTDiscus, PsycINFO, Web of Science, and Scopus) were electronically searched in April 2020.Study SelectionIncluded studies were randomized controlled trials (RCTs) involving PwMS attending 1 of 2 exercise interventions: AT or RT. Studies had to include at least 1 objective or self-reported outcome of lower extremity physical function and/or perceived fatigue.Data ExtractionData were extracted using a customized spreadsheet, which included detailed information on patient characteristics, interventions, and outcomes. The methodological quality of the included studies was independently assessed by 2 reviewers using the Tool for Assessment of Study Quality for Reporting on Exercise rating scale.Data SynthesisTwenty-seven articles reporting data from 22 RCTS (AT=14, RT=8) including 966 PwMS. The 2 modalities were found to be equally effective in terms of improving short walk test (AT: effect size [ES]=0.33 [95% confidence interval (CI), −1.49 to 2.06]; RT: ES=0.27 [95% CI, 0.07-0.47]) and long walk test performance (AT: ES=0.37 [95% CI, −0.04 to 0.78]; RT: ES=0.36 [95% CI, −0.35 to 1.08]), as well as in reducing perceived fatigue (AT: ES=−0.61 [95% CI, −1.10 to −0.11]; RT: ES=−0.41 [95% CI, −0.80 to −0.02]). Findings on other functional mobility tests along with self-reported walking performance were sparse and inconclusive.ConclusionsAT and RT appear equally highly effective in terms of improving lower extremity physical function and perceived fatigue in PwMS. Clinicians can thus use either modality to target impairments in these outcomes. In a future perspective, head-to-head exercise modality studies are warranted. Future MS exercise studies are further encouraged to adapt a consensus “core battery” of physical function tests to facilitate a detailed comparison of results across modalities.     

Review of dyspnoea quantification in the emergency department: Is a rating scale for breathlessness suitable for use as an admission prediction tool?

Acute shortness of breath is a potential marker of serious cardiopulmonary disease and requires rapid assessment. In our current health-care system, increasing pressure on the ED to limit costs and waiting times has resulted in the development of many clinical decision aids and admission prediction tools designed to assist ED physicians in meeting these demands. However, most of these tools are disease specific, and none are currently available for application to patients presenting to the ED with shortness of breath. Although somewhat limited, current evidence supports the utilization of a simple dyspnoea rating scale, to assist in the streamlining of clinical severity assessments and urgency evaluations, and to potentially provide useful information to facilitate rapid and accurate site-of-care decisions in this setting.     

Access to Physical Health Care for People with Serious Mental Illness: A Nursing Perspective and a Human Rights Perspective-Common Ground?

Relative to the general population, people with serious mental illness (SMI) experience elevated risks of physical disease and illness and live shorter lives. A human rights perspective argues that people with serious mental illness have a right to equal access to physical health care. Nurses in mental health services can contribute to improving the availability and accessibility of physical health care. This study, involving focus group interviews with nurses in a large regional and rural mental health care district of Queensland, Australia, revealed significant problems in access to physical health care for service users. The current article reports on our exploratory analysis of nurses’ views and perceptions to identify (1) orientation of nurses to human rights, and (2) access of consumers with SMI to general practitioner services. It was rare for nurses to raise the topic of human rights, and when raised, it was not as a strategy for improving access to physical health care services that they felt consumers with SMI greatly needed. Two main themes were identified as causes of poor access: clinical barriers to physical care and attitudinal barriers to physical care. In light of these results, the authors explore a human rights perspective on access and how this provides an inclusive lobbying umbrella under which nurses and other groups can pursue access to physical health services that are adequate, accessible, and non-discriminatory. The article then discusses the implications for these findings for the value of human rights as a perspective and means of increasing physical health of people with SMI.     

Eosinopenia: Is it a good marker of sepsis in comparison to procalcitonin and C-reactive protein levels for patients admitted to a critical care unit in an urban hospital?

IntroductionThe role of eosinopenia as a marker of sepsis has recently been evaluated. The aim of our study was to test the value of eosinopenia as a diagnostic marker of sepsis in comparison to procalcitonin and C-reactive protein levels.MethodsA prospective study of critically ill adult patients admitted to the medical intensive care unit at an urban hospital. Procalcitonin, C-reactive protein (CRP) levels and eosinophil counts were measured on admission. Patients were classified as non-infected or infected by the medical residents, fellows, and attendings.ResultsA total of 68 patients were enrolled into the study. At a cut-off value of 70 mg/L, the CRP level yielded a sensitivity of 94%, a specificity of 84%, a positive predicted value (PPV) of 83% and a negative predicted value (NPV) of 94%. At a cutoff value of 1.5 μg/L, the sensitivity of the procalcitonin test was 84%, specificity of 92%, PPV 90%, and NPV of 87%. The eosinophil cell count (cutoff of 50 cells/mm³) produced a sensitivity of 81%, specificity of 65%, a PPV of 66%, and a NPV of 80%.The comparison of the eosinophil cell count (<50 cells/mm³) and procalcitonin levels among the non-infected and infected groups showed a significant statistical difference (Fisher exact test, P = .0239). There was no statistical difference observed when comparisons were made between CRP levels and eosinophil count (Fisher exact test, P = .12). There was also a lack of significant statistical difference when CRP levels were compared to procalcitonin levels (Fisher exact test, P = .49).ConclusionEosinopenia is a very sensitive yet not specific serological marker of sepsis in the intensive care unit and can be utilized to guide physicians in the diagnosis of sepsis.     

Is intravenous ascorbic acid an effective and safe option for increasing hemoglobin levels in patients with a hyporesponse to epoetin alfa?

Despite the use of epoetin alfa, over one-third of patients with end stage renal disease have persistent anemia. The nephrology literature cites various erythropoietin adjuvants that may have the potential to improve the efficiency of anemia management, and one option is ascorbic acid. This article reviews the published data on the effectiveness of intravenous ascorbic acid in increasing the hemoglobin levels of patients with hyporesponse to epoetin alfa, as well as adverse effects of the administration of intravenous ascorbic acid specifically in relation to hyperoxalemia.     

Gene‐activated tissue grafts for sustained bone morphogenetic protein‐2 delivery and bone engineering: Is muscle with fascia superior to muscle and fat?

Previously, we have presented an expedited strategy for sustained delivery of bone morphogenetic protein‐2 (BMP‐2) to bone lesions based on the implantation of gene‐activated fat and muscle fragments. The aim of the present in vitro experiments was to evaluate the potential of muscle with fascia as a BMP‐2 delivering osteo‐regenerative implant in comparison to fat tissue and muscle alone. Subcutaneous fat, muscle, and muscle with fascia were harvested from Fischer 344 rats. The tissues were cut into small pieces and cultured for up to 90 days after direct transduction with adenoviral BMP‐2 or green fluorescence protein vectors. Different vector doses were applied, and proliferation, long‐term BMP‐2 production, and osteogenic differentiation of the 3 different tissues were investigated in vitro. Muscle with fascia produced the largest amounts of BMP‐2. Expression of the transgene was detected for up to 90 days. Proliferation was reduced with increased vector doses. Muscle with fascia showed a higher potential for osteogenic differentiation than fat, but it was not improved as compared to muscle alone. A dose of 4 × 10⁸ plaque forming units of the adenoviral BMP‐2 vector appeared to be the optimal dose for transduction of muscle with fascia. Because muscle with fascia produced higher amounts of BMP‐2 as compared to muscle alone or fat tissue grafts, showing a high potential for osteogenic differentiation, it might represent an improved osteo‐regenerative implant facilitating endogenous repair. Future studies should investigate the effect of muscle with fascia transduced with 4 × 10⁸ plaque forming units on bone healing in vivo.     

Is the SF‐12 version 2 Health Survey a valid and equivalent substitute for the SF‐36 version 2 Health Survey for the Chinese?

Rationale and objectives The scoring algorithm of the 12‐item Short‐Form Health Survey (SF‐12) was revised in the second version (SF‐12v2), but information on its psychometric properties is lacking. This study determined whether the SF‐12v2 was a valid and equivalent substitute for the SF‐36v2 Health Survey (version 2) for the Chinese. Methods A total of 2410 Chinese adults in Hong Kong completed the SF‐36 Health Survey by telephone. The SF‐12v2 data were extracted from the SF‐36 data. Internal consistency was assessed by Cronbach's alpha, and test–retest reliabilities were evaluated by intraclass correlation. Criterion validity and equivalence were assessed using the SF‐36v2 scores as a gold standard. Construct validity and sensitivity were assessed by known‐group comparison. Results Internal consistency and test–retest reliabilities were good (range 0.67–0.82) for all except three scales. The SF‐12v2 summary scores explained >80% of the total variances of the SF‐36v2 summary scores. Construct validity and sensitivity were confirmed by significantly lower SF‐12v2 scores in people with chronic diseases than those without. Effect size differences were less than 0.3 and relative validities were greater than 0.7 between SF‐12v2 and SF‐36v2 scores for different groups. Conclusion The SF‐12v2 was valid, reliable and sensitive for the Chinese. It is an equivalent substitute for the SF‐36v2 for the summary scales.