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Liver progenitor cells (LPCs)/ductular reactions (DRs) are associated with inflammation and implicated in the pathogenesis of chronic liver diseases. However, how inflammation regulates LPCs/DRs remains largely unknown. Identification of inflammatory processes that involve LPC activation and expansion represent a key step in understanding the pathogenesis of liver diseases. In the current study, we found that diverse types of chronic liver diseases are associated with elevation of infiltrated interleukin (IL)‐17‐positive (+) cells and cytokeratin 19 (CK19)+ LPCs, and both cell types colocalized and their numbers positively correlated with each other. The role of IL‐17 in the induction of LPCs was examined in a mouse model fed a choline‐deficient and ethionine‐supplemented (CDE) diet. Feeding of wild‐type mice with the CDE diet markedly elevated CK19+Ki67+ proliferating LPCs and hepatic inflammation. Disruption of the IL‐17 gene or IL‐27 receptor, alpha subunit (WSX‐1) gene abolished CDE diet‐induced LPC expansion and inflammation. In vitro treatment with IL‐17 promoted proliferation of bipotential murine oval liver cells (a liver progenitor cell line) and markedly up‐regulated IL‐27 expression in macrophages. Treatment with IL‐27 favored the differentiation of bipotential murine oval liver cells and freshly isolated LPCs into hepatocytes. Conclusion: The current data provide evidence for a collaborative role between IL‐17 and IL‐27 in promoting LPC expansion and differentiation, respectively, thereby contributing to liver regeneration. (Hepatology Communications 2018;2:329‐343) Liver Progenitor Cells (LPC) are frequently observed in chronic liver disease and associated with the severity of the pathology. In the present study, we report a clinical association between LPC accumulation in diseased livers, and IL‐17 mediated immune response as a key step in triggering and controlling LPC compartment expansion. [ABSTRACT FROM AUTHOR]

Pregnancy-induced hypertension diseases are classified as gestational hypertension, preeclampsia, or eclampsia. The mechanisms of their development and prediction are still to be discovered. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is an angiogenic factor secreted by the placenta during the first trimester of human pregnancy that was shown to control trophoblast invasion, to be upregulated by hypoxia, and to be abnormally elevated in pathological pregnancies complicated with preeclampsia and intrauterine growth restriction. These findings suggested that sustaining EG-VEGF levels beyond the first trimester of pregnancy may contribute to pregnancy-induced hypertension. To test this hypothesis, osmotic minipumps delivering EG-VEGF were implanted subcutaneously into gravid OF1 (Oncins France 1) mice on day 11.5 post coitus, which is equivalent to the end of the first trimester of human pregnancy. Mice were euthanized at 15.5 and 18.5 days post coitus to assess (1) litter size, placental, and fetal weights; (2) placental histology and function; (3) maternal blood pressure; (4) renal histology and function; and (5) circulating soluble fms-like tyrosine kinase 1 and soluble endoglin. Increased EG-VEGF levels caused significant defects in placental organization and function. Both increased hypoxia and decreased trophoblast invasion were observed. Treated mice had elevated circulating soluble fms-like tyrosine kinase 1 and soluble endoglin and developed gestational hypertension with dysregulated maternal kidney function. EG-VEGF effect on the kidney function was secondary to its effects on the placenta as similarly treated male mice had normal kidney functions. Altogether, these data provide a strong evidence to confirm that sustained EG-VEGF beyond the first trimester of pregnancy contributes to the development of pregnancy-induced hypertension. [ABSTRACT FROM AUTHOR]

Responds to readers' queries on the legal aspects of nursing practice. Reducing the use of restraints on a self-sufficient patient without written permission; Revoking do-not-resuscitate (DNR) orders; Violations of patient privacy.

Answers a question on the liability of a nurse for patients that are not monitored due to multiple duties and large number of patients assigned. Need to inform the nurse-manager about the situation; Prioritizing the assignments; Documenting all facts about the problem.

Discusses the liability risk of nurses at a public health department who are tasked to perform physical examinations on children. Immunity of public health facilities from lawsuits; Recommendations in minimizing the risk.

Answers an inquiry on obligation of nurses to tell current nurse-managers of lawsuit filed against them by former patients of another hospital. Lack of involvement of current employer in the lawsuit; Provision of information if lawsuit goes on trial; Honesty over lawsuit to prospective employer.

Provides legal opinion regarding issues in medical and nursing practice. Legal and ethical duty of a nurse to give safe care to any patient assigned to him/her; Refusal of emergency doctors to include time on their written orders; Safety issues associated with a timesaving idea for drug administration.

Provides legal advice on problems related with the practice of nursing. Legal implications of countersigning chart entries on nursing care; Nurses' liability in prescribing medication outside the scope of their nursing practice; Concerns regarding autologous blood donation required for pregnant women who will need cesarian deliveries; Legal implications of releasing information and medical records.

Presents the query of a nurse in a cardiac surgical step-down unit who wanted to know the job description of critical care technicians. Objection to critical care technicians who cannot document tasks in the chart; Concern on legal accountability by the nurse; Advice to concur with medial laws and legislation in her state; Awareness of the legality of unlicensed assistive personnel.

Presents the query of a nurse concerning the legality of her termination. Nurse's refusal to take an assignment she is not competent with; Legality of the decision of the director of nursing to fire her; Legal advice on her situation; Need to refer to a written termination policy and the protection by her union.

Presents the query of a nurse who had been named defendant in a malpractice lawsuit initiated by a patient who claims of an injury which occurred eight years ago. Concern over the length of time that passed; Advice on the best way to find a lawyer; Considerations in looking for a lawyer; Consultation with several medical and legal personnel.

Presents a legal advisory on the issue of HIV confidentiality. Endorsement of a limited chain of access used for all patient information; Close regulation of the handling of HIV specimens and reports.

Presents legal advice for nurses concerning informed consent. Nurse's lack of responsibility for obtaining a patient's signature on a consent form; Need for the nurse to assess mental status of patient.

Presents a legal advisory on a possible negligence lawsuit against a nurse. Intoxicated patient's incompetency to care for himself; Importance of a detailed documentation of incident.

Answers a question on the legal advisability of keeping personal journals on incidents that occur in nursing. Right of patient's attorney to examine the journal in case of a lawsuit; Keeping a journal only to protect oneself in unusual circumstances.

Answers a question on the liability of nurses for patients injured by malfunctioning equipment. Instances when nurses, manufacturers and hospitals are liable; Need to follow policy for reporting malfunctioning equipment.

Answers a question on the proper thing to do when a nurse disagrees with a head doctor's clinical opinion in the United States. Need to seek guidance from the nurse-manager; Role of nursing administrator in solving the problem.

Advises on intensive care unit staffing problems. Includes documentation of every instance of patient safety jeopardy; Staffing recommendations from the American Association of Critical-Care Nurses; Guidelines from the Joint Commission on Accreditation of Health Care Organizations.

Discusses the liability of nurses in handling unlocked blood and rine specimen boxes. Referral to the guidelines by the Center for Disease Control and Prevention and the Environmental Protection Agency.

Provides information on the liability of nurses for problems arising from sexual activity between patients in a psychiatric hospital. Liability due to responsibility over patient safety; Hospital policy; Possibility of negligence and criminal prosecution; Need for specific policies; Procedures and protocols in one's unit to cover the behavior.

Looks at the California law on taking home needles or intravenous start sets. Possibility of arrest or prosecution; Advice on leaving needles and I.V. start set at the hospital.

Provides information on reliability for actions of unprepared nurses at intensive care unit/coronary care unit. Court decision based on written job description, hospital manual, nursing standards and state's practice act; Potential liability due to knowledge of unpreparedness; Tips to avoid liability.

Type II secreted phospholipase A(2) (sPLA(2)) releases precursors of important inflammatory lipid mediators from phospholipids. Some observations have indicated that the sPLA(2), which has been implicated in chronic inflammatory conditions such as arthritis, contributes to atherosclerosis in the arterial wall. sPLA(2) was not detected in control vascular smooth muscle cells (VSMC). Treatment of VSMC with agents that increase intracellular cAMP (eg, forskolin, dibutyryl [db]-cAMP) resulted in a time- and concentration-dependent increase in sPLA(2) gene expression. Semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR) showed a marked dose-dependent inhibition of forskolin-induced mRNA by protein kinase A inhibitor. Electrophoretic mobility shift analysis of nuclear proteins from forskolin-treated and db-cAMP-treated VSMC with C/EBP consensus oligonucleotides and C/EBP oligonucleotides from the rat promoter revealed greater binding than in control VSMC. Incubation of VSMC with H89, a specific protein kinase inhibitor, also blocked the binding of nuclear C/EBP to the C/EBP site of the rat promoter induced by db-cAMP and forskolin. Binding was unchanged with the use of CRE consensus oligonucleotides. Antibodies revealed the specific formation of C/EBP/DNA complexes, the majority of which were supershifted by C/EBP-ss and -delta antibodies. Functional activation of C/EBP was confirmed by a luciferase reporter gene assay. A construct comprising 4 tandem repeat copies of the C/EBP element from the rat sPLA(2) promoter linked to luciferase was transcriptionally activated in VSMC by cotransfection with expression vector for the protein kinase A catalytic subunit. It was also significantly activated in transfected VSMC treated by forskolin or db-cAMP. H89 inhibited this activations. We therefore conclude that the increases in sPLA(2) mRNA and enzyme activity produced by cAMP-elevating agents is controlled by a mechanism involving nuclear C/EBP-ss and -delta acting through a protein kinase A signaling pathway.