Latent profile analysis of benefit finding among family caregivers of Chinese older adults with disabilities and its influencing factors.

OBJECTIVES: The increase in the number of older adults with disability creates new challenges for caregivers. Benefit finding is the positive experience that caregivers get from caregiving, helping to reduce the negative impact on the caregiver's quality of life. However, there is less research on the positive experiences of family caregivers of older adults with disabilities. This study aimed to identify different benefit finding profiles among family caregivers of older adults with disabilities in China and to explore the sociodemographic characteristics and psychosocial factors with different benefit finding profiles. METHODS: A cross-sectional study of 218 family caregivers of Chinese older adults with disabilities using the sociodemographic questionnaire, the Family-APGAR, the Sense of Coherence-13, the Emotion Regulation Scale and Benefit Finding Scale from October 2022 to June 2023 in communities and hospitals of China, Shenyang, Liaoning Province. Latent profile analysis was used to analyze the latent profiles of benefit finding among family caregivers of Chinese older adults with disability. Multiple logistic regression was used to explore the predictors of different profiles. RESULTS: The benefit finding among family caregivers of Chinese older adults with disability can be classified into three potential profiles: Profile 1 - high-level benefit finding group (12.84%), Profile 2 - medium-level benefit finding group (43.58%), Profile 3 - low-level benefit finding group (43.58%). Working status, family function, and cognitive reappraisal of caregiver were predictors of different profiles. CONCLUSIONS: Nurses and community health care staffs should pay attention to the characteristics, family function, and emotion regulation strategies of family caregivers of older adults with different disability. Help family caregivers enhance family cohesion and cognitive reappraisal to improve positive experiences for caregivers in different profiles.

The induction of ferroptosis by KLF11/NCOA4 axis: the inhibitory role in clear cell renal cell carcinoma.

Ferroptosis is a form of cell death and has great potential application in the treatment of many cancers, including clear cell renal cell carcinoma (ccRCC). Herein, we identified the essential roles of Krüppel-like factor 11 (KLF11) in suppressing the progression of ccRCC. By analyzing mRNA expression data from the Gene Expression Omnibus (GEO) database, we found that KLF11 was a significantly downregulated gene in ccRCC tissues. The results of subsequent functional assays verified that KLF11 played an antiproliferative role in ccRCC cells and xenograft tumors. Furthermore, gene set enrichment analysis indicated that ferroptosis was involved in ccRCC development, and correlation analysis revealed that KLF11 was positively related to ferroptosis drivers. We also found that KLF11 promoted ferroptosis in ccRCC by downregulating the protein expression of ferritin, system xc (-) cystine/glutamate antiporter (xCT), and glutathione peroxidase 4 (GPX4), acting as the inhibitory factors of ferroptosis and increasing the intracellular levels of lipid reactive oxygen species (ROS). As a transcriptional regulator, KLF11 significantly increased the promoter activity of nuclear receptor coactivator 4 (NCOA4), a gene significantly downregulated in ccRCC and whose low expression is associated with poor survival. The characteristics of ccRCC cells caused by KLF11 overexpression were reversed after NCOA4 silencing. In summary, the present study suggests that KLF11 suppresses the progression of ccRCC by increasing NCOA4 transcription. Therefore, the KLF11/NCOA4 axis may serve as a novel therapeutic target for human ccRCC.

A Conceptual Model of Home-Based Cardiac Rehabilitation Exercise Adherence in Patients with Chronic Heart Failure: A Constructivist Grounded Theory Study.

Purpose: This study aimed to explore a conceptual model of home-based cardiac rehabilitation exercise adherence and reveal its internal behavioral logic. Patients and Methods: A constructivist grounded theory design was adopted to explore the conceptual model of home-based cardiac rehabilitation exercise adherence. Semi-structured interviews were completed to collect qualitative data for constructing the conceptual model. The theoretical saturation and validation strategies were adopted to demonstrate the adequacy of qualitative data. A three-level coding procedure with constant comparisons was completed to analyze this qualitative data. Results: A total of 21 patients with chronic heart failure were recruited in this study. As a result of this study, 32 initial codes, 12 category codes, and four core categories were extracted, namely, seeking supports, rehabilitation exercise, exercise monitoring and information feedback. According to the internal behavioral logic, the conceptual model of home cardiac rehabilitation exercise adherence was finally formed. In this closed-chain model, seeking supports is the initial adherence behavior, and rehabilitation exercise is the core adherence behavior, and exercise monitoring is the key adherence behavior, and information feedback is the driving adherence behavior. Conclusion: The conceptual model of home-based cardiac rehabilitation exercise adherence in patients with chronic heart failure was developed, revealing its internal behavioral logic and providing theoretical references for developing relevant clinical research tools with comprehensive coverage and identifying weak links.

Activated Partial Thromboplastin Time and Mortality in Coronary Artery Bypass Grafting Patients.

Background: To evaluate the prognostic value of preoperative activated partial thromboplastin time (APTT) in patients who underwent coronary artery bypass grafting (CABG). Methods: All data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. The study population was divided to two groups according to the optimal cut-off value of APTT calculated by X-tile software, and Cox proportional hazard model was used to define independent effect of APTT on 4-year mortality. Survival curves were estimated by the Kaplan-Meier method, and the area under the receiver-operating characteristic curve (AUC) was calculated to compare APTT with other severity scores. Propensity score matching (PSM) analysis were applied to ensure the robustness of this study. Results: A total of 2,706 patients were included. The optimal cut-off value of APTT for 4-year mortality was 44 seconds. The Cox proportional hazard model showed that patients with APTT ≥ 44 had a significantly higher risk of all-cause death than those with APTT < 44 both before (HR (95% CI), 1.42 (1.16-1.74), P < 0.001) and after PSM (HR (95% CI), 1.47 (1.14-1.89), P = 0.003). The survival curves showed that patients with longer APTT had a significantly lower 1-year and 4-year cumulative survival probability. The ROC of APTT combined with other severity scores significantly increased predictive ability for 1-year and 4-year mortality. Conclusions: A longer APTT (≥44) was associated with a higher risk of mortality and can serve as a prognostic predictor in CABG patients.

Comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions in Liaoning Province, China: a cross-sectional study.

BACKGROUND: With the global aging problem is becoming increasingly severe, the elderly care has become an important issue that needs attention. Chinese government attaches great importance to the development of medical and health care institutions, and is committed to improving the comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions. METHODS: From June to September 2019, a cross-sectional study among 193 elderly rehabilitation nursing staff was conducted in Liaoning Province, China. Using a self-designed questionnaire, the comprehensive quality of elderly rehabilitation nursing staff in medical and health care institutions was investigated by face to face. The multiple linear regression model was explored to analyze the influencing factors. RESULTS: A total of 193 questionnaires were distributed, and 189 (97.93%) valid questionnaires were recovered. Age was from 19 to 65 years old, with an average age of (38.34 ± 9.76) years old. Bachelor degree or above accounted for 54.00%. 57.10% have engaged in elderly rehabilitation nursing for more than one year. There were 163 nurses with qualification certificates, accounting for 86.20%. The total score of comprehensive quality was 118.52 ± 22.90. The total Cronbach ' s α coefficient of the questionnaire was 0.967, and the content validity index was 0.991. Only 61 (32.30%) elderly rehabilitation nurses received professional training in elderly rehabilitation nursing. The results of multiple linear regression analysis showed that the educational level of elderly rehabilitation nursing staff (P = 0.002) and the number of years engaged in elderly rehabilitation nursing (P = 0.005) were the main influencing factors of comprehensive quality. CONCLUSIONS: The comprehensive quality of elderly rehabilitation nursing staff is at a medium level in Liaoning Province's medical and health care institutions. However, the professional nursing talents were very short, and the education level and years of experience in elderly care were the main influencing factors of the comprehensive quality.

Self-neglect among older adults with disabilities in Liaoning Province during the COVID-19 outbreak: A cross-sectional study.

Background: Self-neglect among older adults is a well-recognized public health issue. During the novel coronavirus disease 2019 (COVID-19), older adults with disabilities may be at increased risk for self-neglect. This study aimed to assess the prevalence of self-neglect and associated factors among older adults with disabilities in Liaoning Province during the COVID-19 outbreak. Methods: A cross-sectional study was conducted from January 2021 to April 2021. A convenience sample of 230 older adults with disabilities filled out questionnaires that collected data on socioeconomic and demographic characteristics alongside data using the Barthel Index (BI), the Elder Self-Neglect Assessment (ESNA), the Geriatric Depression Scale-Short Form (GDS-SF), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Mini-Mental State Examination (MMSE). Results: The overall self-neglect rate was 86%. The study revealed that self-neglect correlates positively with the degree of disability (p < 0.001) and depressive symptoms (p < 0.001). In contrast, monthly income (p = 0.002) and perceived social support (p = 0.001) were negatively associated with self-neglect. Conclusion: During the COVID-19 outbreak, self-neglect has been a serious public health problem among older adults with disabilities. Lower monthly income, decreased physical function, depressive symptoms, and perceptions of poor social support contributed to self-neglect among older adults with disabilities.

MicroRNA-1298-5p inhibits cell proliferation and the invasiveness of bladder cancer cells via down-regulation of connexin 43.

MicroRNA (miR)-1298 is widely down-regulated in a variety of malignant tumors, which facilitates cell proliferation, invasiveness, and migration. However, the specific biological function of miR-1298 in bladder cancer (BC) is still unknown. Connexin 43 (Cx43) is often up-regulated in tumors. Identifying miRNAs that target Cx43 in the setting of BC will help to develop Cx43-based therapies for BC. In this study, the results demonstrated that the expression levels of miR-1298 and Cx43 were significantly down-regulated and up-regulated, respectively, in BC tissues. Overexpression of miR-1298 inhibited cell proliferation, migration, and invasiveness in two BC cell lines as determined using MTT assays, cell cycle assays, colony formation assays, Transwell assays, gelatin zymography, and Western blot. In addition, we found that miR-1298 decreased Cx43 expression by directly targeting the 3'-UTR. Further, we observed that the promotion of BC cell proliferation, migration, and invasiveness from Cx43 on could be partially attenuated by overexpressing miR-1298. Moreover, the protein expression of p-ERK was ameliorated after transfection with overexpressed-miR-1298. Knockdown of Cx43 reversed the promotion of cell migration and invasiveness due to decreased expression of miR-1298. All of the data from our study indicate that miR-1298 could be a diagnostic marker of BC and a potential therapeutic agent via inhibiting Cx43.

A soluble star-shaped silsesquioxane-cored polymer-towards novel stabilization of pH-dependent high internal phase emulsions.

A well-defined pH-responsive star-shaped polymer containing poly(N,N-dimethylaminoethyl methacrylate) (PDMA) arms and a cage-like methacryloxypropyl silsesquioxane (CMSQ-T10) core was used as an interfacial stabilizer for emulsions consisting of m-xylene and water. We explored the properties of the CMSQ/PDMA star-shaped polymer using the characteristic results of nuclear magnetic resonance (NMR) spectroscopy, size exclusion chromatography (SEC), dynamic light scattering (DLS), and zeta potential and conductivity measurements. The interfacial tension results showed that the CMSQ/PDMA star-shaped polymer reduced the interfacial tension between water and oil in a pH-dependent manner. Gelled high internal phase emulsions (HIPEs) including o/w and w/o types were formed in the pH ranges of 1.2-5.8 and 9.1-12.3 with the CMSQ/PDMA star-shaped polymer as a stabilizer, when the oil fractions were 80-90 vol% and 10-20 vol%, respectively. The soluble star-shaped polymer aggregated spontaneously to form a microgel that adsorbed to the two immiscible phases. Images of the fluorescently labeled polymers demonstrated that there was a star-shaped polymer in the continuous phase, and the non-Pickering stabilization based on the percolating network of the star-shaped polymer also contributed to the stabilization of the HIPE. This pH-dependent HIPE was prepared with a novel stabilization mechanism consisting of microgel adsorption and non-Pickering stabilization. Moreover, the preparation of HIPEs provided the possibility of their application in porous materials and responsive materials.

Actinidia chinensis Planch. Improves the Indices of Antioxidant and Anti-Inflammation Status of Type 2 Diabetes Mellitus by Activating Keap1 and Nrf2 via the Upregulation of MicroRNA-424.

The fruit juice of Actinidia chinensis Planch. has antioxidant and anti-inflammation properties on patients with type 2 diabetes mellitus (T2DM), but the molecular mechanism was unclear. The patients took the juice and the serum level of antioxidant miR-424, Kelch-like ECH-associated protein 1 (Keap1), erythroid-derived 2-like 2 (Nrf2), and biochemical indices were measured. The juice increased the levels of serum microRNA-424, Keap1, and Nrf2 and reduced the levels of interleukin-1 (IL-1) beta and IL-6 in T2DM patients. The levels of SOD and GSH were higher while the levels of ALT and AST were lower in the patients consuming the juice when compared to the patients without taking the juice. The Spearman rank correlation analysis showed that the serum levels of miR-424 were positively related to Keap1 and Nrf2 levels while Keap1 and Nrf2 levels were positively related to the levels of SOD and GSH and negatively related to IL-1 beta and IL-6. Thus, FJACP improves the indices of antioxidant and anti-inflammation status by activating Keap1 and Nrf2 via the upregulation of miR-424 in the patients with T2DM. This trial is registered with ChiCTR-ONC-17011087 on 04/07/2017.

Silence of MACC1 expression by RNA interference inhibits proliferation, invasion and metastasis, and promotes apoptosis in U251 human malignant glioma cells.

The overexpression of metastasis­associated in colon cancer 1 (MACC1) has been demonstrated not only in colon cancer, but also in various other types of cancer. Gliomas are the most common type of intracranial tumors, and recent studies have reported MACC1 to be involved in human glioma progression. The present study aimed to investigate the effects of MACC1 expression silencing in glioma cells using RNA interference, in order to determine the underlying biological mechanisms of glioma progression, including proliferation, apoptosis, invasion and metastasis. The expression levels of MACC1 were determined in various types of U251 glioma cells using western blot analyses. MACC1­specific short hairpin RNA (shRNA) was used to silence the expression of MACC1 in the U251 cells. The results obtained following MACC1 silencing demonstrated a significant inhibition of cell proliferation, invasion and migration, as well as a marked enhancement of apoptosis. MACC1 shRNA­induced inhibition of cell proliferation was observed by colony forming and MTT assays, and cell apoptosis was measured using flow cytometry and Hoechst staining. In addition, inhibition of cell invasion and migration was assessed using wound healing and transwell assays. Western blotting and fluorescence­activated cell sorting (FACS) revealed a G0/G1 phase cell cycle arrest regulated by cyclins D1 and E; cell apoptosis regulated by caspase­3; and cell invasion and migration regulated by matrix metalloproteinases 2 and 9, respectively. The present study demonstrated that the expression levels of MACC1 were significantly correlated with the biological processes underlying glioma cell proliferation, invasion and metastasis. Therefore, MACC1 may serve as a promising novel therapeutic target in human glioma. Notably, the inhibition of MACC1 expression by shRNA may prove to be an effective genetic therapeutic strategy for glioma treatment.

Ectopic WWOX Expression Inhibits Growth of 5637 Bladder Cancer Cell In Vitro and In Vivo.

WW domain-containing oxidoreductase (WWOX) gene located in the common fragile site FRA16D region exhibits loss or reduction of expression in multiple types of carcinomas including bladder cancer. However, the role of WWOX in the tumorigenesis and development of bladder cancer remains elusive. In this study, WWOX overexpression construct was transfected into 5637 bladder cancer cell line in which WWOX expression was compromised. Constitutive expression of ectopic WWOX in 5637 cells suppressed cell proliferation and cell cycle progression, which was associated with downregulation of Cyclin B, D1, and E. Moreover, WWOX overexpression promoted apoptosis in 5637 cells and resulted in upregulation of Bax, downregulation of Bcl-2, and elevated levels of cleaved caspase-3 and cleaved PARP, indicating activation of the intrinsic apoptosis pathway. Furthermore, WWOX overexpression suppressed tumorigenicity of 5637 cells and promoted apoptosis in the xenograft tumors as demonstrated in a xenograft mouse model. In summary, our data indicate that WWOX plays a critical role in the regulation of proliferation, cell cycle, apoptosis, and tumorigenesis of bladder cancer cells, suggesting that WWOX may have potential clinical implications in bladder cancer therapy.

Raphe serotonergic neurons modulate genioglossus corticomotor activity in intermittent hypoxic rats.

BACKGROUND: Genioglossus activity is greater during wakefulness but decreases to a weaker state during sleep in obstructive sleep apnea syndrome (OSAS) patients, compared to healthy subjects. Previous studies suggested that the corticomotor control of the genioglossus was modified in OSAS patients. Intermittent hypoxia (IH), the typical pathophysiological change in OSAS, can induce genioglossus facilitation. The serotonergic neurons of the raphe dorsal (DRN) and magnus nuclei (RMg) are responsive to hypoxia and play important roles in the control of the genioglossus. However, it remains unknown whether DRN and RMg serotonergic neurons are responsible for the facilitated corticomotor activity of the genioglossus during IH. This study explored the influence of IH on the corticomotor activity of the genioglossus by transcranial magnetic stimulation (TMS), and the role of DRN and RMg serotonergic neurons in this effect. METHODS: Rats were exposed to IH and divided into two groups. In one group, anti-SERT-SAP was microinjected into the DRN and RMg respectively to kill serotonergic neurons. In the other group, artificial cerebrospinal fluid (ACSF) was injected. Comparisons were conducted between the two groups during four weeks of IH and four weeks after IH. RESULTS: Compared to the corresponding ACSF-injected group, the DRN lesion group and RMg lesion group showed longer TMS latencies and lower amplitudes during IH from the 1st to the 28th day. After 28 days of IH, longer latencies and lower amplitudes were seen only in the DRN lesion group. CONCLUSION: These results indicate that DRN and RMg serotonergic neurons play different roles in the facilitation of genioglossus corticomotor activity induced by IH.

Influence of exhalation valve and nebulizer position on albuterol delivery during noninvasive positive pressure ventilation.

BACKGROUND: Early studies have found better clinical efficiency when a nebulizer was used with noninvasive positive pressure ventilation (NPPV), compared with spontaneous breathing without NPPV. However, very limited research addressed factors that might affect aerosol delivery. This study aimed to investigate the influence of exhalation valves and nebulizer positions on aerosol delivery during NPPV. METHODS: We determined the efficiency of aerosol delivery in patients receiving NPPV with a lung model that simulates spontaneous breathing. Single-arch exhalation port, plateau exhalation valve, and whisper swivel were chosen as exhalation valves under different levels of inspiratory and expiratory pressures. A nebulizer was filled with 1 mL of 0.5% albuterol solution in 3 mL of normal saline, driven with 8 L/min oxygen, and placed at either a proximal position in the ventilator circuit (near the ventilator outlet, where humidifiers are usually connected) or a distal position in the ventilator circuit (between exhalation valve and lung model connection). Albuterol was collected by filters and then measured by ultraviolet spectrophotometry. The velocities of gas flow were also measured at different nebulizer positions. RESULTS: Significant differences in the gas flow velocity were shown between proximal and distal positions of the breathing circuit under four combinations of inspiratory and expiratory pressure levels (15/5, 15/10, 25/5, and 25/10 cmH2O) (p<0.05). When the nebulizer was positioned distally, the single-arch exhalation port had the highest aerosol delivery, and the whisper swivel had the lowest aerosol delivery (p<0.05). When the nebulizer was placed proximally, the single-arch exhalation port had lower efficiency of aerosol delivery than the whisper swivel and plateau exhalation valve (p<0.05). In addition, higher inspiratory pressure was associated with increased aerosol delivery (p<0.05). The influence of expiratory pressure on aerosol delivery appeared too complex to predict. CONCLUSIONS: The type of exhalation valve and the position of the nebulizer in the ventilator circuit have a significant influence on the efficiency of aerosol delivery during NPPV. As a result, with different exhalation valves, an appropriate nebulizer position should be carefully chosen, and the inhaled dose should be adjusted after accurate prediction of aerosol delivery to ensure optimal clinical efficacy.

[The comparative analysis of the common reasons of invasive ventilator alarms between medical and specialist intensive care unit].

OBJECTIVE: To analyze the common reasons of invasive ventilator alarms between medical intensive care unit (ICU) and specialist ICU, and its related management methods. METHODS: Patients admitted to medical ICU and specialist ICU from January to December in 2011 of the First Hospital of China Medical University were studied. Ventilator alarms and their reasons need to be handle by the front-line doctors, respiratory therapists, attending physicians or medical ICU doctors were analyzed and compared. RESULTS: There were 375 ventilator alarms of the 59 patients in the medical ICU, incidence of the top three alarms parameters were high airway pressure alarms for 21.87%, high tide volume alarms for 15.73% and high minute ventilation alarms for 14.13%. In specialist ICU there were a total of 403 ventilator alarms with 249 patients, incidence of the top three alarms parameters were high airway pressure alarms for 32.51%, low airway pressure alarms for 15.38%, high respiratory rate alarms for 10.42%. The incidence of high airway pressure and low airway pressure alarms in medical ICU were significantly lower than the specialist ICU (21.87% vs. 32.51%, 8.53% vs. 15.38%, both P<0.01), and the incidence of high minute ventilation and high tidal volume alarms in medical ICU were higher than specialist ICU (14.13% vs. 7.20%, 15.73% vs. 9.68%, P<0.01 and P<0.05). The top three causes of the alarms were aerosol inhalation, sputum blockage, and oxygen battery expired in medical ICU, and sputum blockage, respiratory distress, and pipeline leak and oxygen expired battery in specialist ICU. The reasons of sputum blockage, tubes factors (intubation position change, pipeline water) and improper alarm parameters setting in medical ICU was significantly lower than those in specialist ICU (10.93% vs. 17.12%, 1.87% vs. 4.47%, 1.33% vs. 3.72%, 1.60% vs. 3.97%, all P<0.05). High tidal volume, high minute ventilation and serious breath-side filter blockage because of aerosol inhalation in medical ICU were significantly higher than those in specialist ICU (18.93% vs. 3.97%, P<0.01). CONCLUSION: Doctors in medical ICU and specialist ICU should understand the ventilator alarms characteristics, prevention, detect and timely problems management.