The Role of Neutrophils and Neutrophil Elastase in Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a severe vasculopathy characterized by the presence of fibrotic lesions in the arterial wall and the loss of small distal pulmonary arteries. The vasculopathy is accompanied by perivascular inflammation and increased protease levels, with neutrophil elastase notably implicated in aberrant vascular remodeling. However, the source of elevated elastase levels in PAH remains unclear. A major source of neutrophil elastase is the neutrophil, an understudied cell population in PAH. The principal function of neutrophils is to destroy invading pathogens by means of phagocytosis and NET formation, but proteases, chemokines, and cytokines implicated in PAH can be released by and/or prime and activate neutrophils. This review focuses on the contribution of inflammation to the development and progression of the disease, highlighting studies implicating neutrophils, neutrophil elastase, and other neutrophil proteases in PAH. The roles of cytokines, chemokines, and neutrophil elastase in the disease are discussed and we describe new insight into the role neutrophils potentially play in the pathogenesis of PAH

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Aggression und Gewalt gegenüber Gesundheits- und Krankenpflegepersonen am Arbeitsplatz

Einleitung: Gewalt und Aggression stellen ein globales Problem dar, welches im klinischen Setting oft erlebt wird. Gesundheits- und Krankenpflegepersonen sind auf Grund ihrer Nähe zu Patientinnen und Patienten und deren Angehörigen besonders häufig betroffen. Außerdem können Gewalt und Aggression negative Auswirkungen auf betroffene Personen haben. Methode: Es wurde eine umfassende Literaturrecherche im Zeitraum von Jänner 2020 bis März 2020 in elektronischen Datenbanken wie PubMed, CINAHL (via EBSCO Host) und Academic Search Elite (via EBSCO Host) durchgeführt. Insgesamt wurden 13 Studien in die Arbeit eingeschlossen. Ergebnisse: Gesundheits- und Krankenpflegepersonen sind häufig von Gewalt und Aggression am Arbeitsplatz betroffen, da sie sich auf Grund ihrer beruflichen Nähe zu Patientinnen und Patienten und deren Angehörigen in einer besonders verletzlichen und herausfordernden Position befinden. Es konnten zahlreiche Einflussfaktoren und Interventionsmöglichkeiten in Bezug auf Gewalt und Aggression am Arbeitsplatz identifiziert werden. Diskussion: In vielen Institutionen weltweit ist die Umsetzung von Null-Toleranz-Politiken in der Praxis nicht immer einfach und stellt eine wesentliche Herausforderung in Bezug auf Gewalt und Aggression am Arbeitsplatz dar. Außerdem haben Gesundheits- und Krankenpflegepersonen das Recht auf einen sicheren Arbeitsplatz, was durch gewalttätige und aggressive Patientinnen und Patienten und deren Angehörige nicht immer gegeben ist. Weitere Forschung wird empfohlen.Introduction: Violence and aggression are a global issue that is often experienced in the clinical setting. Nurses are particularly affected due to their proximity to patients and their relatives. Additionally, violence and aggression can have negative impacts on affected people. Methods: A thorough literature research was conducted between January 2020 and March 2020 in electronic databases such as PubMed, CINAHL (via EBSCO Host) and Academic Search Elite (via EBSCO Host). A total of 13 studies were included into this work. Results: Nurses are often affected by violence and aggression in the workplace, as they are in a particularly vulnerable and challenging position due to their professional proximity to patients and their relatives. Numerous influencing factors and intervention options relating to violence and aggression in the workplace have been identified. Conclusion: In many institutions around the world, implementing zero-tolerance policies in practice is not always easy and portrays a major challenge to violence and aggression in the workplace. In addition, nurses have the right to a safe workplace, which is not always guaranteed with violent and aggressive patients and their relatives. Further research is recommended

Kindesmisshandlung: Beobachtungen und Interventionen durch Gesundheits- und Krankenpflegepersonen

Einleitung: Kindesmisshandlung stellt ein globales und mehrdimensionales Problem dar, welches im klinischen Setting oft erlebt wird. Betroffene Kinder können lebenslange psychische und/oder physische Folgeschäden mit sich tragen und im schlimmsten Fall auch daran sterben. Gesundheits- und Krankenpflegepersonen spielen bei der Erkennung von Kindesmisshandlung und beim Setzen von Interventionen nach einer Identifizierung eine wesentliche Rolle. Methode: Es wurde eine umfassende Literaturrecherche im Zeitraum von Februar 2019 bis Mai 2019 in elektronischen Datenbanken wie CINAHL (via EBSCO Host), PubMed und Academic Search Elite (via EBSCO Host) durchgeführt. Ebenso erfolgte eine Onlinesuche über die Universitätsbibliothek Wien, die Medizinische Bibliothek Wien, ScienceDirect, Hogrefe Verlag, Wiley Online Library und SpringerLink. Insgesamt wurden acht Studien in die Arbeit eingeschlossen. Ergebnisse: Gesundheits- und Krankenpflegepersonen nehmen in der Identifizierung von Kindesmisshandlung eine wichtige Rolle ein, da sie auf Grund ihrer beruflichen Nähe zu den Patientinnen und Patienten vermehrt relevante Informationen einholen können. Es konnten zahlreiche Identifizierungs- und Interventionsmöglichkeiten in Bezug auf Kindesmisshandlung aufgedeckt werden. Diskussion: In Bezug auf Kindesmisshandlung ergeben sich drei bis vier Problemfelder, die unbedingt beachtet werden müssen. Dazu zählt unter anderem, dass das Umsetzen von Identifizierungs- und Interventionsmöglichkeiten in der Praxis nicht immer einfach ist. Weitere Forschung wird empfohlen.Introduction: Child maltreatment is a global and multidimensional issue, which is often experienced in the clinical setting. Affected children may carry lifelong psychological and/or physical damages and in the worst case may also die from it. Nurses play an essential role in recognizing child abuse and setting interventions after identification. Methods: A thorough literature research was conducted between February 2019 and May 2019 in electronic databases such as CINAHL (via EBSCO Host), PubMed and Academic Search Elite (via EBSCO Host). There was also an online research in the University Library of Vienna, the Medical Library of Vienna, ScienceDirect, Hogrefe Verlag, Wiley Online Library and SpringerLink. A total of eight studies were included into this work. Results: Nurses play an important role in identifying child abuse as they are able to obtain more relevant information due to their professional proximity to patients. Numerous identification and intervention options relating to child abuse have been identified. Conclusion: Regarding child abuse, there are three to four problematic areas that must be taken into account. This includes, among other things, the fact that in practice the implementation of identification and intervention possibilities is not always easy. Further research is recommended