In cirrhosis, increased intrahepatic vascular resistance (IHVR) is the primary factor for portal hypertension (PH) development. Hepatic stellate cells (HSCs) play a major role increasing IHVR ...because, when activated, they are contractile and promote fibrogenesis. Protease‐activated receptors (PARs) can activate HSCs through thrombin and factor Xa, which are known PAR agonists, and cause microthrombosis in liver microcirculation. This study investigates the effects of the oral anticoagulant, rivaroxaban (RVXB), a direct antifactor Xa, on HSC phenotype, liver fibrosis (LF), liver microthrombosis, and PH in cirrhotic rats. Hepatic and systemic hemodynamic, nitric oxide (NO) bioavailability, LF, HSC activation, and microthrombosis were evaluated in CCl4 and thioacetamide‐cirrhotic rats treated with RVXB (20 mg/kg/day) or its vehicle for 2 weeks. RVXB significantly decreased portal pressure (PP) in both models of cirrhosis without changes in portal blood flow, suggesting a reduction in IHVR. RVXB reduced oxidative stress, improved NO bioavailability, and ameliorated endothelial dysfunction. Rivaroxaban deactivated HSC, with decreased alpha‐smooth muscle actin and mRNA expression of other HSC activation markers. Despite this marked improvement in HSC phenotype, no significant changes in LF were identified. RVXB markedly reduced fibrin deposition, suggesting reduced intrahepatic microthrombosis. Conclusion: RVXB decreases PP in two rat models of cirrhosis. This effect is mostly associated with decreased IHVR, enhanced NO bioavailability, HSC deactivation, and reduced intrahepatic microthrombosis. Our findings suggest that RVXB deserves further evaluation as a potential treatment for cirrhotic PH. (Hepatology 2017;65:2031‐2044).
Abstract Purpose The purpose of this study was to reach an international consensus to determine what key elements should be part of a transition program and what indicators could be used to assess ...its success. Methods For this purpose, a Delphi study including an international panel of 37 experts was carried out. The study consisted of three rounds, with response rates ranging from 86.5% to 95%. At each round, experts were asked to assess key elements (defined as the most important elements for the task) and indicators (defined as quantifiable characteristics). At each round, panelists were contacted via e-mail explaining them the tasks to be done and giving them the Web link where to complete the questionnaire. At Round 3, each key element and indicator was assessed as essential, very important, important, accessory, or unnecessary. A 70% agreement was used as cutoff. Results At Round 3, more than 70% of panelists agreed on six key elements being essential, with one of them (Assuring a good coordination between pediatric and adult professionals) reaching an almost complete consensus (97%). Additionally, 11 more obtained more than 70% agreement when combined with the Very important category. Among indicators, only one (Patient not lost to follow-up) was considered almost unanimously (91%) as essential by the panelists and seven others also reached consensus when the Very important category was included. Conclusions Using these results as a framework to develop guidelines at local, national, and international levels would allow better assessing and comparing transition programs.
Sexting and the Definition Issue Barrense-Dias, Yara; Berchtold, André; Surís, Joan-Carles ...
Journal of adolescent health,
November 2017, 2017-Nov, 2017-11-00, 20171101, Volume:
61, Issue:
5
Journal Article
Peer reviewed
Open access
Sexting among youths has become a necessary topic of interest in research because of the negative consequences that this activity could create, especially when content is shared with others. Indeed, ...this loss of control could lead to humiliation, (cyber)bullying, or harassment. The development of new technologies, press coverage, and increase of prevalence rates could also explain the growth of interest in sexting. However, its definition is still a gray area. This review examines the different definitions of sexting used in the literature and its correlates. Several elements of the definition of sexting were assessed: actions (sending, receiving, and forwarding); media types (text, images, and videos); sexual characteristics; and transmission modes. Nine databases were searched for studies on sexting among youths up to 18 years of age. Eighteen studies published between 2012 and 2015 were included. Prevalence rates of sexting ranged between .9% and 60% partly depending on the definition. Most studies assessed sending, but when sending and receiving were measured, prevalence rates were higher for receiving. Some articles found associations with age, gender, race, sexual behavior, romantic relationships, risky behaviors, online activity, psychological difficulties, and social pressure. Finding a consensus regarding the definition is essential to assess accurately the activity and adapt prevention. Adolescents' interpretations of the activity are important as sexting could be used as a sexual behavior between two consenting persons. Prevention strategies should focus on sexting that goes wrong when it is forwarded to a third party and when it occurs in a context of pressure or harassment.
Netting the Stress Responses in Fish Balasch, Joan Carles; Tort, Lluís
Frontiers in endocrinology (Lausanne),
02/2019, Volume:
10
Journal Article
Peer reviewed
Open access
In the last decade, the concept of animal stress has been stressed thin to accommodate the effects of short-term changes in cell and tissue physiology, major behavioral syndromes in individuals and ...ecological disturbances in populations. Seyle's definition of stress as "the nonspecific (common) result of any demand upon the body" now encompasses homeostasis in a broader sense, including all the hierarchical levels in a networked biological system. The heterogeneity of stress responses thus varies within individuals, and stressors become multimodal in terms of typology, source and effects, as well as the responses that each individual elicits to cope with the disturbance. In fish, the time course of changes after stress strongly depends on several factors, including the stressful experiences in early life, the vertical transmission of stressful-prone phenotypes, the degree of individual phenotypic plasticity, the robustness and variety of the epigenetic network related to environmentally induced changes, and the intrinsic behavioral responses (individuality/personality) of each individual. The hierarchical heterogeneity of stress responses demands a code that may decrypt and simplify the analysis of both proximate and evolutionary causes of a particular stress phenotype. We propose an analytical framework, the
, defined as an adaptive scenario dominated by common environmental selective pressures that elicit common multilevel acute stress-induced responses and produce a measurable allostatic load in the organism. The stressotope may constitute a blueprint of embedded interactions between stress-related variations in cell states, molecular mediators and systemic networks, a map of circuits that reflect the inherited and acquired stress responses in an ever-changing, microorganismal-loaded medium. Several features of the proposed model are discussed as a starting point to pin down the maximum common stress responses across immune-neuroendocrine relevant physiological levels and scenarios, including the characterization of behavioral responses, in fish.
Problem-based learning (PBL) is a pedagogical approach that shifts the role of the teacher to the student (student-centered) and is based on self-directed learning. Although PBL has been adopted in ...undergraduate and postgraduate medical education, the effectiveness of the method is still under discussion. The author's purpose was to appraise available international evidence concerning to the effectiveness and usefulness of PBL methodology in undergraduate medical teaching programs.
The authors applied the Arksey and O'Malley framework to undertake a scoping review. The search was carried out in February 2021 in PubMed and Web of Science including all publications in English and Spanish with no limits on publication date, study design or country of origin.
The literature search identified one hundred and twenty-four publications eligible for this review. Despite the fact that this review included many studies, their design was heterogeneous and only a few provided a high scientific evidence methodology (randomized design and/or systematic reviews with meta-analysis). Furthermore, most were single-center experiences with small sample size and there were no large multi-center studies. PBL methodology obtained a high level of satisfaction, especially among students. It was more effective than other more traditional (or lecture-based methods) at improving social and communication skills, problem-solving and self-learning skills. Knowledge retention and academic performance weren't worse (and in many studies were better) than with traditional methods. PBL was not universally widespread, probably because requires greater human resources and continuous training for its implementation.
PBL is an effective and satisfactory methodology for medical education. It is likely that through PBL medical students will not only acquire knowledge but also other competencies that are needed in medical professionalism.
The use of biomass as a source of energy has been further enhanced in recent years and special attention has been paid to biomass gasification. Due to the increasing interest in biomass gasification, ...several models have been proposed in order to explain and understand this complex process, and the design, simulation, optimisation and process analysis of gasifiers have been carried out. This paper presents and analyses several gasification models based on thermodynamic equilibrium, kinetics and artificial neural networks. The thermodynamic models are found to be a useful tool for preliminary comparison and for process studies on the influence of the most important fuel and process parameters. They have the advantage of being independent of gasifier design, but they cannot give highly accurate results for all cases. The kinetic-based models are computationally more intensive but give accurate and detailed results. However, they contain parameters that limit their applicability to different plants.
Objective
One of the main concerns of parents is the amount of screen time of their teenagers, and most of them try to set rules about it. The objective of this exploratory study was to compare ...whether parents' rules changed during confinement and whether these changes were successful.
Methods
We studied a group of parents (N = 47) of 13‐year‐olds in Switzerland surveyed before and during the COVID‐19 pandemic.
Results
Most parents (83%) indicated that screen‐time rules for their teens had changed during containment, mainly to be less strict. Although only a minority of parents were successful in defining screen‐time spaces or schedules for their teenagers, almost three out of four were successful when they encouraged non‐screen‐based activities.
Conclusions
This exploratory study reveals that, during containment, parents decided to be less strict with their teens' screen‐time use even though it remained their main worry. However, it also suggests that when activities non‐involving screens are proposed, teens are likely to participate. These results seem to indicate that reducing screen time is not a matter of imposing restrictions but, rather, of proposing alternatives. Finally, further research is warranted to assess whether these changes in screen‐time use are exceptional or here to stay.
To compare antimüllerian hormone (AMH) and antral follicle count (AFC) as predictors of ovarian response to controlled ovarian stimulation at individual fertility clinics.
Retrospective analysis of ...individual study center data in two multicenter trials. Centers that provided >10 patients were included in the analysis.
A total of 19 (n = 519 patients) and 18 study centers (n = 686 patients) participating in a long GnRH agonist trial (MERIT) and a GnRH antagonist trial (MEGASET), respectively.
Infertile women of good prognosis.
Long GnRH agonist or GnRH antagonist cycles.
Correlation between AMH and AFC, and oocyte yield by each study center for each trial.
Antimüllerian hormone was more strongly correlated with oocyte yield than AFC: r = 0.56 vs. r = 0.28 in the GnRH agonist cohort, and r = 0.55 vs. r = 0.33 in the GnRH antagonist cohort. The correlation was numerically higher for AMH than for AFC at a significantly higher proportion of study centers: 17 (89%) and 15 (83%) centers in the long GnRH agonist and GnRH antagonist trial, respectively. Assessment of the relative capacity of AMH and AFC for predicting oocyte yield demonstrated that AMH dominated the model: AMH, R2 = 0.29 and 0.23; AFC: R2 = 0.07 and 0.07; AMH + AFC: R2 = 0.30 and 0.23 for long GnRH agonist and GnRH antagonist trials, respectively.
Antimüllerian hormone was a stronger predictor of ovarian response to gonadotropin therapy than AFC at the study center level in both randomized trials utilizing GnRH agonist and GnRH antagonist protocols. Antral follicle count provided no added predictive value beyond AMH.
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