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ObjectiveChronic kidney disease is a global health problem, and end-stage renal disease (ESRD) has a major impact on patients' quality of life and prognoses. However, studies on individualized nutritional therapy for patients with ESRD need more complementary evidence.MethodsA clinical study was conducted based on a small population. It included patients with ESRD who underwent dialysis treatment in the Taicang Hospital Department of Nephrology, Soochow University, China, between January 2019 and December 2021. According to the randomized number table method, patients were divided into the nutritional treatment group (NIG) and the non-nutritional intervention control group (NNIG). There were 84 patients in the NIG and 92 patients in the NNIG. This study analyzed the changes in residual renal function (RRF) and indicators of blood and kidney function in ESRD with personalized nutritional therapy.ResultsThe results show that nutritional interventions for ESRD are effective in reducing the rate of decline in RRF and improving indicators of blood and kidney function in patients with ESRD. It was also found that patients with diabetes mellitus gained fewer health benefits per unit of RRF improvement with individualized nutritional therapy.ConclusionThis study provides important information about the treatment effects and factors associated with individual nutritional interventions in a population with ESRD. These results contribute to a better understanding of the effects of nutritional therapy in ESRD and provide a basis for managing it. Further studies should focus on specific populations and potential interventions to improve patient prognosis.

In order to reveal the basic enzymatic properties of the chitinase produced by an endophytic bacterium Bacillus thuringiensis Bt028 isolated from sour orange fruit, the chitinase in the strain fermentation broth were purified by centrifugation, ammonium sulfate precipitation, dextran gel G-100 chromatography and SDS-polyacrylamide gel electrophoresis and the optimum temperature, optimum pH and catalytic kinetic parameters of the chitinase were also investigated. The results showed that electrophoretic pure chitinase was obtained by centrifugation, ammonium sulfate precipitation and dextran G-100 gel chromatography from fermentation broth of the strain Bt028, with the specific activity of 681.78 U/mg, the purification factor of 3.21 and enzymatic activity recovery of 15.52%, and the molecular mass of the chitinase was determined to be 65 kDa by SDS-polyacrylamide gel electrophoresis. The enzymatic characteristics study results showed that the optimum reaction temperature of the chitinase was 60 ℃ with good stability when temperature lower than 60 ℃; and the optimum reaction pH was 6.5 with good stability at pH5.5~7.5. Mg2+, Ca2+, Hg2+ and Co2+ had inhibitory effect on the enzyme activity, while Cu2+ and Fe3+ had a certain promotion effect. Low concentrations of methanol, ethanol, n-propanol and dimethyl sulfoxide increased the enzymatic activity, however, the chitinase would be inhibited when the concentration of these organic solvents were increased to a certain level. The chitinase could be activated by acetone but inhibited by formaldehyde. Under the optimal catalytic conditions, the value of Km, Vmax and Kcat of the chitinase-catalyzed reaction were 29.533 mg/mL, 108.696 μmoL/(L·min) and 0.527/min, respectively. Research results provide technical parameters for the practical application of the chitinase.

In order to improve the chitinase production performance of an endophytic bacterium Bacillus thuringiensis Bt028 isolated from sour orange fruit, the effects of medium composition and fermentation conditions on chitinase production were investigated by single factor test and the shaking flask fermentation conditions of chitinase production were optimized by response surface methodology. The results of single factor test showed that concentration of colloidal chitin, temperature and initial pH had obvious effects on chitinase production. The results of response surface test showed that the optimum fermentation conditions were as follows: Colloidal chitin concentration was 0.8%, yeast powder concentration was 1%, the initial pH was 6.9, inoculation amount was 3%, liquid volume was 100 mL/250 mL, cultured temperature was 30 ℃ and culture time was 48 h. Under these conditions, the highest enzyme activity of the strain fermentation broth was 10.48 U/mL. The studied results laid a foundation for the further development and application of the chitinase produced by Bacillus thuringiensis Bt028.

Abstract Background Pulmonary arterial hypertension (PAH) is a fatal disease that results from cardio-pulmonary dysfunction with the pathology largely unknown. Insulin-like growth factor binding protein 2 (IGFBP2) is an important member of the insulin-like growth factor family, with evidence suggesting elevation in PAH patients. We investigated the diagnostic and prognostic value of serum IGFBP2 in PAH to determine if it could discriminate PAH from healthy controls and if it was associated with disease severity and survival. Methods Serum IGFBP2 levels, as well as IGF1/2 levels, were measured in two independent PAH cohorts, the Johns Hopkins Pulmonary Hypertension program (JHPH, N = 127), NHLBI PAHBiobank (PAHB, N = 203), and a healthy control cohort (N = 128). The protein levels in lung tissues were determined by western blot. The IGFBP2 mRNA expression levels in pulmonary artery smooth muscle cells (PASMC) and endothelial cells (PAEC) were assessed by RNA-seq, secreted protein levels by ELISA. Association of biomarkers with clinical variables was evaluated using adjusted linear or logistic regression and Kaplan-Meier analysis. Results In both PAH cohorts, serum IGFBP2 levels were significantly elevated (p

The objective of this evaluation was to assess the use of public health detailing in a pilot program to increase Expedited Partner Therapy (EPT) uptake among community-based providers in two Maryland jurisdictions. Public health detailing is a method designed to raise awareness and increase implementation of evidence-based clinical practices by delivering educational content via one-on-one meetings with providers. EPT is a voluntary clinical practice of treating all sexual partners of patients diagnosed with STIs by prescribing medications without the provider first examining said sexual partners. The aim of EPT is to prevent STI reinfection and reduce further transmission. From April 2017 to March 2019, detailers visited community-based health care practice sites to conduct EPT detailing with providers. The effectiveness of this program was evaluated by comparing provider responses from pre- to post-detailing surveys, administered six months after detailing. Survey responses assessed EPT awareness and practices, barriers to implementation, and satisfaction with detailing. The proportion of providers (170) aware of EPT for treating chlamydia and gonorrhea increased from 61.7% (114) to 99.4% (169) (p-value

OBJECTIVES:. To assess the effectiveness of a chaplain patient navigator in improving outcomes and reducing costs in the ICU setting. DESIGN:. A randomized controlled trial at a large, urban, academic community hospital in Baltimore, Maryland. SETTING/PATIENTS:. All patients admitted to the Johns Hopkins Bayview Medical Center Cardiac and Medical ICUs between March 2015 and December 2015. INTERVENTIONS:. Patients in the intervention group were assigned a chaplain patient navigator to facilitate communication, offer support, and setup multidisciplinary family meetings. MEASUREMENTS AND MAIN RESULTS:. The primary outcomes were hospital and ICU length of stay. Secondary outcomes included total and ICU charges, 60- and 90-day readmission rates, and the number of palliative care consults. For all outcomes, patients were included in the intention-to-treat analyses only if they remained in the ICU greater than 24 hours. In total, 1,174 were randomly assigned to “usual care” (n = 573) or to the intervention (n = 601). In the intervention group, 44.8% (269/601) had meetings within 24 hours of admission and, of those patients, 32.8% (88/268) took part in the larger multidisciplinary family meeting 2–3 days later. The intervention group had longer mean adjusted hospital length of stay (7.78 vs 8.63 d; p ≤ 0.001) and mean ICU length of stay (3.65 vs 3.87 d; p = 0.029). In addition, they had greater total and ICU charges. There were no differences in other outcomes. Of note, only differences in total and ICU charges remained when controlling for case-mix index, which were greater in the intervention group. CONCLUSIONS:. Although the chaplain patient navigator anecdotally enhanced communication, our study found an increase in hospital and ICU length of stay as well as cost. Since other studies have shown benefits in some clinical outcomes, projects focused on patient navigators may learn lessons from our study in order to better prioritize family meetings, gather indicators of communication quality, and identify the optimal patient navigator operational context.

A decentralized control strategy can effectively solve the control problem of the large-scale time delayed structures. In this paper, combining the overlapping decentralized control method, linear matrix inequality (LMI) method, and H∞ control algorithm, overlapping decentralized H∞ control approach of the time delayed structures has been established. The feedback gain matrixes of all subsystems are obtained by this method based on genetic algorithm optimization tools and the specific goal of optimization control. The whole vibration control system of the time delayed structures is divided into a series of overlapping subsystems by overlapping decentralized control strategy. The feedback gain matrixes of each subsystem can be obtained by using H∞ control algorithm to calculate each subsystem. The vibration control of a twenty layers’ antiseismic steel structure Benchmark model was analyzed with the numerical method. The results show that the proposed method can be applied to control system with time delay. The overlapping decentralized control strategies acquire the similar control effects with that of the centralized control strategy. Moreover, the flexibility of the controller design has been enhanced by using overlapping decentralized control strategies.

Background: Reducing HIV incidence requires addressing persistent racial/ethnic disparities in HIV burden. Our goal was to evaluate preexposure prophylaxis (PrEP) delivery, overall and relative to community need, among 7 clinical sites participating in a health department-led demonstration project to increase PrEP in Baltimore city, MD. Methods: PrEP care continuum stages (screened, indicated, referred, linked, evaluated, prescribed) were examined among HIV-negative individuals receiving services at participating sites between September 30, 2015 and September 29, 2019. Community need was defined using information on new HIV diagnoses (2016-2018). Differences in care continuum progression by demographics/priority population and comparison of demographic compositions between care continuum stages and new HIV diagnoses were examined using modified Poisson regression and x2 tests, respectively. Results: Among 25,886 PrEP-screened individuals, the majority were non-Hispanic (NH) black (81.1%, n = 20,998), cisgender male (61.1%, n = 15,825), and heterosexual (86.7%, n = 22,452). Overall, 31.1% (n = 8063) were PrEP-indicated; among whom, 56.8% (n = 4578), 15.6% (n = 1250), 10.8% (n = 868), and 9.0% (n = 722) were PrEP-referred, linked, evaluated, and prescribed, respectively. Among 2870 men who have sex with men (MSM), 18.7% (n = 538) were PrEP-prescribed. Across all groups, the highest attrition was between PrEP-referred and PrEP-linked. NHblack race (vs. NH-white) was independently associated with lower likelihood of PrEP prescription (aPR, 0.89; 95% confidence interval, 0.81 to 0.98 controlling for age/gender). Relative to the demographic composition of new HIV diagnoses, fewer NH-blacks (80.2% vs. 54.3%) and more NH-whites (10.7% vs. 30.3%) and MSM were PrEP prescribed (55.2% vs. 74.5%). Conclusions: This project showed promise delivering PrEP referrals and prescriptions overall and to MSM. Substantial improvement is needed to improve linkage overall and to decrease disparities in PrEP prescriptions among NH-blacks. Future work should focus on addressing service gaps that hinder PrEP utilization. [ABSTRACT FROM AUTHOR]