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Hypertensive vascular remodeling is defined as the changes in vascular function and structure induced by persistent hypertension. Maresin‐1 (MaR1), one of metabolites from Omega‐3 fatty acids, has been reported to promote inflammation resolution in several inflammatory diseases. This study aims to investigate the effect of MaR1 on hypertensive vascular remodeling. Here, we found serum MaR1 levels were reduced in hypertensive patients and was negatively correlated with systolic blood pressure (SBP). The treatment of MaR1 reduced the elevation of blood pressure and alleviated vascular remodeling in the angiotensin II (AngII)‐infused mouse model. In addition, MaR1‐treated vascular smooth muscle cells (VSMCs) exhibited reduced excessive proliferation, migration, and phenotype switching, as well as impaired pyroptosis. However, the knockout of the receptor of MaR1, leucine‐rich repeat‐containing G protein‐coupled receptor 6 (LGR6), was seen to aggravate pathological vascular remodeling, which could not be reversed by additional MaR1 treatment. The mechanisms by which MaR1 regulates vascular remodeling through LGR6 involves the Ca2+/calmodulin‐dependent protein kinase II/nuclear factor erythroid 2‐related factor 2/heme oxygenase‐1 signaling pathway. Overall, supplementing MaR1 may be a novel therapeutic strategy for the prevention and treatment of hypertension. [ABSTRACT FROM AUTHOR]

Background: Primary care structural capabilities (i.e., electronic health records, care coordination, community integration, and reminder systems) can address the multiple needs of persons living with dementia (PLWD). Objectives: This study describes structural capabilities in primary care practices where nurse practitioners (NPs) provide care to PLWD and compares the presence of structural capabilities in practices with a high and low volume of PLWD. Methods: We conducted a secondary analysis of cross‐sectional data from 293 NPs in 259 practices in California. Logistic regression models were used to determine the association between the volume of PLWD and the presence of structural capabilities. Results: NPs reported that 96% of practices had electronic health records, 61% had community integration, 55% had reminder systems and 35% had care coordination capabilities. Practices with a high volume of PLWD were less likely to have community integration compared to practices with a low volume of PLWD. Conclusion: Many PLWD‐serving practices do not have the essential infrastructure for providing optimal dementia care. Practice managers should focus on implementing the essential structural capabilities to address the complex needs of PLWD. Implications for practice: Clinicians and practice administrations can use the findings of this study to improve the delivery of care in practices that provide care to PLWD. [ABSTRACT FROM AUTHOR]

Accurate in‐hospital mortality prediction can reflect the prognosis of patients, help guide allocation of clinical resources, and help clinicians make the right care decisions. There are limitations to using traditional logistic regression models when assessing the model performance of comorbidity measures to predict in‐hospital mortality. Meanwhile, the use of novel machine‐learning methods is growing rapidly. In 2021, the Agency for Healthcare Research and Quality published new guidelines for using the Present‐on‐Admission (POA) indicator from the International Classification of Diseases, Tenth Revision, for coding comorbidities to predict in‐hospital mortality from the Elixhauser's comorbidity measurement method. We compared the model performance of logistic regression, elastic net model, and artificial neural network (ANN) to predict in‐hospital mortality from Elixhauser's measures under the updated POA guidelines. In this retrospective analysis, 1,810,106 adult Medicare inpatient admissions from six US states admitted after September 23, 2017, and discharged before April 11, 2019 were extracted from the Centers for Medicare and Medicaid Services data warehouse. The POA indicator was used to distinguish pre‐existing comorbidities from complications that occurred during hospitalization. All models performed well (C‐statistics >0.77). Elastic net method generated a parsimonious model, in which there were five fewer comorbidities selected to predict in‐hospital mortality with similar predictive power compared to the logistic regression model. ANN had the highest C‐statistics compared to the other two models (0.800 vs. 0.791 and 0.791). Elastic net model and AAN can be applied successfully to predict in‐hospital mortality. [ABSTRACT FROM AUTHOR]

People with mental illness experience significant health disparities, including morbidity and premature mortality. Evidence suggests that stigma is a contributing factor to these observed inequities. The tripartite conceptualization of stigma proposes that three problems underlie stigma: problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). There is limited prior research concerning stigma towards mental illness among nurses in the United States (US). The aims of this study were to assess stigma among US nurses towards patients with mental illness, compare the stigma expressed by nurses working in medical/surgical settings with mental health settings, and identify factors associated with stigma. Participants were recruited online from national professional nursing organizations in the US. We collected demographic data and administered measures of mental health stigma and stigma‐related mental health knowledge. Mental health nurses demonstrated comparatively lower levels of stigma and higher levels of knowledge than the medical/surgical nurses. Nursing speciality and personal contact with mental illness were the most significant predictors of stigma and knowledge. Knowledge was found to partially mediate the relationship between nursing speciality and stigma. We found support for the 'contact hypothesis', that is, having a personal experience of mental illness or a friend or family member who has a mental illness is associated with lower stigma towards mental illness. These findings support the development of contact‐based and educational anti‐stigma interventions for nurses in order to reduce stigma towards mental illness. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has forced nursing homes to adapt new models of care in response to the evolving crisis including rapid implementation of telehealth services. The purpose of our study was to investigate implementation of telehealth in nursing homes amidst the COVID‐19 pandemic using a human factors model. Methods: Using a mixed methods design, we conducted a secondary analysis of data from a national survey of nursing home administrative leaders (n = 204). Using six survey questions, we calculated a total telehealth score (range 0–42). Descriptive statistics and paired sample t‐test were used to explore the change in telehealth in two consecutive years (2019–2021). Next, we conducted semi‐structured interviews with (n = 21) administrators and clinicians to assess differences in implementation according to extent of telehealth use. Results: The mean telehealth score in year 1 was 12.11 (SD = 9.85) and year 2 was 19.25 (SD = 11.25). There was a significant difference in telehealth scores from year 1 to year 2 (t = 6.83, p < 0.000). While 64% of nursing homes reported higher telehealth scores in year 2 compared to year 1, over 32% reported a decline. Qualitative analysis revealed facilitators of telehealth including training, use of integrated equipment, having staff present for the visit, and using telehealth for different types of visits. Barriers included using smart phones to conduct the visit, billing, interoperability and staffing. Conclusion: Training, adaptation of work processes to support communication, and restructuring teams and tasks are the result of interactions between system components that could improve usability and sustainability of telehealth in nursing homes. [ABSTRACT FROM AUTHOR]

Efferocytosis is defined as the clearance of apoptotic cells (ACs) in physiological and pathological states and is performed by efferocytes, such as macrophages. Efferocytosis can lead to the resolution of inflammation and restore tissue homoeostasis; however, the mechanisms of efferocytosis in determining inflammation resolution are still not completely understood, and the effects of efferocytosis on other proresolving properties need to be explored and explained. In this review, the process of efferocytosis will be summarized briefly, and then these mechanisms and effects will be thoroughly discussed. In addition, the association between mechanisms of efferocytosis in determining resolution of inflammation and cardiovascular diseases will also be reviewed, as an understanding of this association may provide information on novel treatment targets. [ABSTRACT FROM AUTHOR]

Nurse practitioner (NP) scope of practice (SOP) policies are different across the United States. Little is known about their impact on NP work environment in healthcare organizations. We investigated the association between SOP policies and organizational‐level work environment of NPs. Through a cross‐sectional survey design, data were collected from 1244 NPs in six states with variable SOP regulations (Arizona, New Jersey, Washington, Pennsylvania, Texas, and California) in 2018–2019. Arizona and Washington had full SOP—NPs had full authority to deliver care. New Jersey and Pennsylvania had reduced SOP with physician collaboration requirement; California and Texas had restricted SOP with physician supervision requirement. NPs completed mail or online surveys containing the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has these subscales: NP‐Administration Relations (NP‐AR), NP‐Physician Relations (NP‐PR), Independent Practice and Support (IPS), and Professional Visibility (PV). Regression models assessed the relationship between state‐level SOP and practice‐level NP work environment. NP‐AR scores were higher in full SOP states compared to reduced (β = 0.22, p < 0.01) and restricted (β = 0.15, p < 0.01) SOP states. Similarly, IPS scores were higher in full SOP states. The PV scores were also higher in full SOP states compared to reduced (β = 0.16, p < 0.001) and restricted (β = 0.12, p < 0.05) SOP states. There was no relationship between SOP and NP‐PR score. State‐level policies affect NP work environment. In states with more favorable policies, NPs have better relationships with administration and report more role visibility and support. Efforts should be made to remove unnecessary SOP restrictions. [ABSTRACT FROM AUTHOR]

Background: Radiomics has shown promising results in the diagnosis, efficacy, and prognostic assessments of multiple myeloma (MM). However, little evidence exists on the utility of radiomics in predicting a high‐risk cytogenetic (HRC) status in MM. Purpose: To develop and test a magnetic resonance imaging (MRI)‐based radiomics model for predicting an HRC status in MM patients. Study Type: Retrospective. Population: Eighty‐nine MM patients (HRC [n: 37] and non‐HRC [n: 52]). Field Strength/Sequence: A 3.0 T; fast spin‐echo (FSE): T1‐weighted image (T1WI) and fat‐suppression T2WI (FS‐T2WI). Assessment: Overall, 1409 radiomics features were extracted from each volume of interest drawn by radiologists. Three sequential feature selection steps—variance threshold, SelectKBest, and least absolute shrinkage selection operator—were repeated 10 times with 5‐fold cross‐validation. Radiomics models were constructed with the top three frequency features of T1WI/T2WI/two‐sequence MRI (T1WI and FS‐T2WI). Radiomics models, clinical data (age and visually assessed MRI pattern), or radiomics combined with clinical data were used with six classifiers to distinguish between HRC and non‐HRC statuses. Six classifiers used were support vector machine, random forest, logistic regression (LR), decision tree, k‐nearest neighbor, and XGBoost. Model performance was evaluated with area under the curve (AUC) values. Statistical Tests: Mann–Whitney U‐test, Chi‐squared test, Z test, and DeLong method. Results: The LR classifier performed better than the other classifiers based on different data (AUC: 0.65–0.82; P < 0.05). The two‐sequence MRI models performed better than the other data models using different classifiers (AUC: 0.68–0.82; P < 0.05). Thus, the LR two‐sequence model yielded the best performance (AUC: 0.82 ± 0.02; sensitivity: 84.1%; specificity: 68.1%; accuracy: 74.7%; P < 0.05). Conclusion: The LR‐based machine learning method appears superior to other classifier methods for assessing HRC in MM. Radiomics features based on two‐sequence MRI showed good performance in differentiating HRC and non‐HRC statuses in MM. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Research Objective: The growing nurse practitioner (NP) workforce can play a critical role in meeting the demand for health care services especially in primary care. Yet, many policy and organizational barriers affect this workforce and their ability to deliver high quality care. State‐level scope of practice (SOP) regulations have received substantial attention due to their impact on access and quality of care. Yet, little is known how these state‐level polices also affect organizations employing NPs and potentially NPs' ability to deliver care. This study investigated the relationship between SOP policies governing NP practice and organizational‐level work environment in primary care practices. Study Design: We collected survey data from primary care NPs about their work environments from six states (Arizona, Washington, New Jersey, Pennsylvania, California, and Texas) in 2018–2019. All NPs in Arizona and New Jersey, a 75% random sample of NPs in Pennsylvania, and a 50% random sample of NPs for California and Texas were sampled. NPs completed a validated work environment tool, the Nurse Practitioner‐Primary Care Organizational Climate Questionnaire, which measures four domains of work environment: NP Administration Relations (NP‐AR), NP‐Physician Relations (NP‐PR), Independent Practice and Support (IPS), and Professional Visibility (PV). Regression models were used to assess the relationship between state level‐SOP and organizational‐level work environment domains. The models were controlled for demographic and work characteristics. Population Studied: Data were collected from 1244 NPs in 1109 practices. Arizona and Washington were characterized as having full SOP for NPs‐NPs independently deliver care. New Jersey and Pennsylvania had reduced SOP‐physician collaboration is required for care delivery; and California and Texas had restricted SOP‐physician supervision required. Principal Findings: NP practices from full SOP states were more likely to have higher PV scores compared to practices within reduced (B = 0.16; P‐value = 0.005) and restricted (B = 0.12; P‐value = 0.02) SOP states. Practices from full SOP states were more likely to have higher NP‐AR scores compared to practices from reduced (B:0.22; P‐value = 0.0003) and restricted (B = 0.15; P‐value = 0.009) SOP states. In addition, practices from full SOP states were more likely to have higher IPS score compared to practices from reduced (B:0.14; P‐value = 0.0003) and restricted (B = 0.09; P‐value = 0.01) SOP states. There was no relationship between SOP type and practice‐level NP‐PR score. Conclusions: Findings show that state‐level policies indeed affect organizational‐level work environment. NP work environment is more favorable in states with more favorable policy environment which does not require physician supervision or collaboration for NP care delivery. NPs practicing in full SOP states have better relationships with administration, report more visibility in NP role, and more support within their organizations for independent NP practice. Implications for Policy or Practice: NPs play a critical role in the U.S. health care system and creating optimal state‐ and organizational‐ level policies will help to optimally utilize NPs and maximize their contributions to patient care and the overall health care system. Full SOP regulations should be the gold‐standard, and policy makers in reduced and restricted SOP states should invest efforts to remove unnecessary restrictions. Practice administrators should create favorable work environments for NPs. Primary Funding Source: National Institutes of Health. [ABSTRACT FROM AUTHOR]

Background: Dilated cardiomyopathy (DCM) is the leading cause of heart failure with a poor prognosis. Recent studies suggest that endothelial to mesenchymal transition (EndMT) may be involved in the pathogenesis and cardiac remodeling during DCM development. EDIL3 (epidermal growth factor-like repeats and discoidin I-like domains 3) is an extracellular matrix glycoprotein that has been reported to promote EndMT in various diseases. However, the roles of EDIL3 in DCM still remain unclear., Methods and Results: A mouse model of DCM and human umbilical vein endothelial cells were used to explore the roles and mechanisms of EDIL3 in DCM. The results indicated that EndMT and EDIL3 were activated in DCM mice. EDIL3 deficiency attenuated cardiac dysfunction and remodeling in DCM mice. EDIL3 knockdown alleviated EndMT by inhibiting USP10 (ubiquitin specific peptidase 10) dependent Smad4 deubiquitination in vivo and in vitro. Recombinant human EDIL3 promoted EndMT via reinforcing deubiquitination of Smad4 in human umbilical vein endothelial cells treated with IL-1β (interleukin 1β) and TGF-β (transforming growth factor beta). Inhibiting USP10 abolished EndMT exacerbated by EDIL3. In addition, recombinant EDIL3 also aggravates doxorubicin-induced EndMT by promoting Smad4 deubiquitination in HUVECs., Conclusions: Taken together, these results indicate that EDIL3 deficiency attenuated EndMT by inhibiting USP10 dependent Smad4 deubiquitination in DCM mice.

Background Sympathetic hyperactivity contributes to pathological remodeling after myocardial infarction (MI). However, the mechanisms underlying the increase in sympathetic activity remain unknown. Microglia are the predominant immune cells in the central nervous system and can regulate sympathetic neuron activity through neuroimmune response in the hypothalamic paraventricular nucleus. The present study aimed to investigate whether microglia-mediated neuroimmune response can regulate sympathetic activity and cardiac remodeling after MI. Methods and Results PLX3397 (pexidartinib) was used to deplete central microglia via intragastric injection or intracerebroventricular injection. After that, MI was induced by ligation of the left anterior descending coronary artery. Our study showed that MI resulted in the activation of microglia in the paraventricular nucleus. Microglia depletion, which was induced by PLX3397 treatment via intragastric injection or intracerebroventricular injection, improved cardiac function, reduced infarction size, and attenuated cardiomyocyte apoptosis, fibrosis, pathological electrical remodeling, and myocardial inflammation after MI. Mechanistically, these protective effects were associated with an attenuated neuroimmune response in the paraventricular nucleus, which contributed to the decrease of sympathetic activity and attenuation of sympathetic remodeling in the heart. However, intragastric injection with PLX3397 obviously depleted macrophages and induced neutrophil and T-lymphocyte disorders in the heart, blood, and spleen. Conclusions Microglia depletion in the central nervous system attenuates pathological cardiac remodeling after MI by inhibiting neuroimmune response and sympathetic activity. Intragastric administration of PLX3397 leads to serious deleterious effects in peripheral immune cells, especially macrophages, which should be a cause for concern in animal experiments and clinical practice.

Background: Geographic differences exist in the antibiotic resistance patterns of Helicobacter pylori. Personalized treatment regimens based on local or individual resistance data are essential. We evaluated the current status of H. pylori resistance in Ningxia, analyzed resistance-related factors, and assessed the concordance of phenotypic and genotypic resistance., Methods: Strains were isolated from the gastric mucosa of patients infected with H. pylori in Ningxia and relevant clinical information was collected. Phenotypic antibiotic susceptibility assays (Kirby-Bauer disk diffusion) and antibiotic resistance gene detection (Sanger sequencing) were performed., Results: We isolated 1955 H. pylori strains. The resistance rates of H. pylori to amoxicillin, levofloxacin, clarithromycin, and metronidazole were 0.9%, 42.4%, 40.4%, and 94.2%, respectively. Only five tetracycline-resistant and one furazolidone-resistant strain were identified. Overall, 3.3% of the strains were sensitive to all six antibiotics. Multidrug-resistant strains accounted for 22.9%, of which less than 20% were from Wuzhong. Strains isolated from women and patients with nonulcerative disease had higher rates of resistance to levofloxacin and clarithromycin. Higher rates of resistance to metronidazole, levofloxacin, and clarithromycin were observed in the older age group than in the younger age group. The kappa coefficients of phenotypic resistance and genotypic resistance for levofloxacin and clarithromycin were 0.830 and 0.809, respectively, whereas the remaining antibiotics showed poor agreement., Conclusion: H. pylori antibiotic resistance is severe in Ningxia. Therefore, furazolidone, amoxicillin, and tetracycline are better choices for the empirical therapy of H. pylori infection in this region. Host sex, age, and the presence of ulcerative diseases may affect antibiotic resistance of the bacteria. Personalized therapy based on genetic testing for levofloxacin and clarithromycin resistance may be a future direction for the eradication therapy of H. pylori infection in Ningxia., (© 2023 The Authors. Helicobacter published by John Wiley & Sons Ltd.)

Scavenger receptors (SRs) are a structurally heterogeneous superfamily of evolutionarily conserved receptors that are divided into classes A to J. SRs can recognize multiple ligands, such as modified lipoproteins, damage-associated molecular patterns, and pathogen-associated molecular patterns, and regulate lipid metabolism, immunity, and homeostasis. According to the literature, SRs may play a critical role in myocardial infarction and ischemia/reperfusion injury, and the soluble types of SRs may be a series of promising biomarkers for the diagnosis and prognosis of patients with acute coronary syndrome or acute myocardial infarction. In this review, we briefly summarize the structure and function of SRs and discuss the association between each SR and ischemic cardiac injury in patients and animal models in detail. A better understanding of the effect of SRs on ischemic cardiac injury will inspire novel ideas for therapeutic drug discovery and disease evaluation in patients with myocardial infarction.