Factors associated with professional identity among ICU nurses during COVID-19: A cross-sectional study.

AIM: To determine the associated factors of professional identity among intensive care unit (ICU) nurses during the COVID-19 pandemic in China. DESIGN: Multicentre cross-sectional study. METHODS: This study invited 348 ICU nurses in five hospitals in China from May to July 2020. Online self-report questionnaires were adopted to collect their demographic and occupational characteristics, perceived professional benefits and professional identity. Based on univariate and multiple linear regression analysis, a path analysis was performed to determine the associated factors' effects on professional identity. RESULTS: The mean score of professional identity was 102.38 ± 16.46. Perceived professional benefits, doctor recognition level and family support level were associated with ICU nurses' professional identity. The path analysis revealed that perceived professional benefits and doctor recognition level had direct effects on professional identity. In addition, doctor recognition level and family support level had indirect effects on professional identity through the mediation of perceived professional benefits.

Association Between Visceral Fat, Blood Pressure and Arterial Stiffness in Patients with HFpEF: A Mediation Analysis.

Purpose: To investigate the association of visceral fat with arterial stiffness of heart failure patients with preserved ejection fraction (HFpEF) and to evaluate the extent to which this association is mediated by blood pressure (BP). Patients and Methods: This cross-sectional descriptive study (clinicaltrials.gov identifier: NCT04535726) recruited 94 patients with HFpEF totally from October to December 2020. The obesity-related measurements included visceral fat area (VFA), body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-hip ratio (WC/HC), abdominal circumference (AC), body fat mass and fat percentage. Brachial-ankle pulse wave velocity (baPWV) was used to estimate the degree of arterial stiffness. Mediation analysis was performed to reveal whether the effect of visceral fat area on arterial stiffness can be mediated by BP in patients with HFpEF and the extent to which this association was mediated by BP. Results: About 93.6% of HFpEF patients were accompanied with abdominal obesity. Patients in baPWV ≥1800cm/s group were older, with a higher incidence of type 2 diabetes mellitus (T2DM), hypertension and abdominal obesity. VFA, systolic BP (SBP), diastolic BP (DBP) and pulse pressure (PP) were correlated with baPWV in total group. Adjusted for age ≥75 years old, gender, smoking, T2DM, calcium channel blocker and statins, the mediation effect of systolic SBP and PP on the VFA-baPWV association were 53.3% (indirect effect was 2.28, 95% CI 0.62-4.73) and 48.4% (indirect effect was 2.07, 95% CI 0.51-4.38), respectively. DBP failed to mediate the association between VFA and baPWV (indirect effect was 0.50, 95% CI -0.41-2.14). Conclusion: The association of visceral fat with baPWV in HFpEF patients may be partly accounted for SBP or PP. Elevated SBP and PP might be important potential targets for preventing arterial stiffness in HFpEF patients.

Succinate level is increased and succinate dehydrogenase exerts forward and reverse catalytic activities in lipopolysaccharides-stimulated cardiac tissue: The protective role of dimethyl malonate.

This study aimed to investigate the alterations of myocardial succinate and fumarate levels with or without succinate dehydrogenase (SDH) inhibitor dimethyl malonate during 24 h of lipopolysaccharides (LPS) challenge, as well as the effects of dimethyl malonate on the impaired cardiac tissue. Myocardial succinate and fumarate levels were increased in the initial 9 h of LPS challenge. During this time, dimethyl malonate increased the succinate level, decreased the fumarate level, aggravated the cardiac dysfunction, reduced the oxidative stress, had little effect on interleukin-1ß production, promoted interleukin-10 production and bothered the ATP production. Co-treatment with exogenous succinate significantly increased interleukin-1ß production in this period. After 12 h of LPS challenge, myocardial the succinate level increased sharply, while the fumarate level gradually decreased. During 12-24 h of LPS challenge, dimethyl malonate effectively reduced the succinate level, increased the fumarate level, improved cardiac dysfunction, inhibited interleukin-1ß production, and had little effect on oxidative stress, interleukin-10 production, and ATP production. LPS challenge also significantly increased the myocardial succinate receptor 1 expression and circulating succinate level. Inhibition of succinate receptor 1 significantly reduced the mRNA expression of interleukin-1ß. In conclusion, the current study suggests that myocardial succinate accumulates during LPS challenge, and that SDH activity may be transformed (from forward to reversed) and involved in a line of stress response. Dimethyl malonate inhibits SDH and, depending on the time of treatment, reduces LPS-induced cardiac impairment. Furthermore, accumulated succinate exerts pro-inflammatory effects partly via succinate receptor 1 signaling.

Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer-A cross-sectional survey in China.

Objective: This study explores the factors influencing death anxiety in patients with advanced cancer, and to investigate the role of family function on death anxiety, and the correlation between meaning in life and death anxiety. Methods: Patients with advanced cancer who were hospitalized in three institutions from November 2020 to May 2021 were recruited in this cross-sectional study. The Chinese version of the Death and Dying Distress Scale, Meaning in Life Scale For Advanced Cancer Patients and Family APGAR Index were used to assess death anxiety, meaning in life and family function. Pain symptoms were evaluated by the Numeric Rating Scale. Karnofsky Performance Status, patients' socio-demographic and clinical variables were also recorded. Statistical analyses were performed using IBM SPSS Statistics for Windows (version 26.0). Multivariate regression analysis was performed to examine the correlations of social-demographic and clinical variables with family function and death anxiety. Results: Three hundred and twenty-eight patients with advanced cancer were included in this study. The results showed that 12.2% of patients experienced moderate to severe death anxiety. Meaning in Life Scale For Advanced Cancer Patients (acceptance of death, controlling one's life), types of institution (oncology department of tertiary hospitals), self-perceived economic burden (extreme), Karnofsky Performance Status score, age, and medical insurance status (self-paid, inter-provincial medical insurance) were identified as associated factors of death anxiety (R 2 â€‹= â€‹0.335, F â€‹= â€‹20.072, P â€‹< â€‹0.001). Patients with good family function scores had significantly low level of death anxiety in univariate analysis (F â€‹= â€‹5.892, P â€‹= â€‹0.003). Multivariate analysis revealed no significant association between family function and death anxiety. Conclusions: Our results demonstrated that the oncology department of a tertiary hospital, extremely high of self-perceived economic burden, self-pay, and inter-provincial medical insurance might be associated with higher death anxiety in patients with advanced cancer. Lower level death anxiety was associated with higher level acceptance of death, a greater sense of life control, better physical performance, and older age. Further confirmation about the association between family function and death anxiety in patients with advanced cancer is warranted in the future.

Neutrophils to high-density lipoprotein cholesterol ratio as a new prognostic marker in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a retrospective study.

BACKGROUND: Neutrophils and high-density lipoprotein cholesterol (HDL-c) play critical roles in the pathogenesis of acute myocardial infarction. We aimed to investigate the value of neutrophils count to high-density lipoprotein cholesterol ratio (NHR) in predicting occurrence of in-hospital adverse events in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI). METHODS: We retrospectively analyzed 532 patients who had been diagnosed with acute STEMI and treated with PPCI. Demographic and clinical data, admission laboratory parameters and NHR values were recorded. Major adverse cardiac events (MACE) were defined as stent thrombosis, cardiac rupture, cardiac arrest, ventricular aneurysm, malignant arrhythmia and cardiac death. Based on the receiver operating characteristic (ROC) analysis, all patients were divided into 2 groups based on the cut-off NHR value (NHR ≤ 11.28, NHR > 11.28). Cox regression analyses and the Kaplan-Meier survival curve were used to assess the prognostic ability of NHR in in-hospital MACE. RESULTS: MACE was observed in 72 patients (13.5%) during in-hospital follow-up. NHR was significantly higher in MACE group compared to MACE-free group (10.93 [6.26-13.97] vs. 8.13 [5.89-11.16]; P = 0.001). The incidence of in-hospital MACE was significantly higher in the NHR > 11.28 group than in NHR ≤ 11.28 group (24.8% vs. 9.6%; P < 0.001). In multivariable Cox regression analyses, ALT, Killip III-IV and increased NHR (hazard ratio, 2.211; 95% confidence interval,1.092-4.479; P = 0.027) were identified as independent predictive factors of occurrence of in-hospital MACE. Higher NHR group had worse cumulative survival compared with the lower group. CONCLUSIONS: NHR value on admission, which is an easily calculated and universally available maker, may be useful in in-hospital risk classification of STEMI patients undergoing PPCI.

Non-invasive global myocardial work index as a new surrogate of ventricular-arterial coupling in hypertensive patients with preserved left ventricular ejection fraction.

Objective: As a new method of left ventricular-arterial coupling (VAC), the non-invasive myocardial work index (MWI) may provide more useful information than the classical methods of arterial elastance/left ventricular (LV) elastance index (the ratio of effective arterial elastance (Ea) over end-systolic elastance [Ea/Ees]). This research aims to investigate if MWI might be better associated with hypertension-mediated organ damage (HMOD) and diastolic dysfunction than Ea/Ees in hypertension. Methods: We prospectively enrolled 104 hypertensives and 69 normotensives. All subjects had speckle-tracking echocardiography for myocardial work, conventional echocardiography, and brachial-ankle pulse wave velocity (baPWV) measurements. The global work index (GWI) is a myocardial work component. The correlation between GWI and HMOD, as well as diastolic dysfunction, was analyzed. The receiver operating characteristic (ROC) curve was utilized for evaluating the GWI predicting efficacy. Results: The global work index was significantly higher in hypertensives than in normotensives (2,021.69 ± 348.02 vs. 1,757.45 ± 225.86 mmHg%, respectively, p < 0.001). Higher GWI was a risk factor on its own for increased baPWV, pulse pressure (PP), echocardiographic LV hypertrophy (LVH), and left atrial volume index (LAVI) (p = 0.030, p < 0.001, p = 0.018 p = 0.031, respectively), taking into account the sex, age, mean arterial pressure (MAP), body mass index (BMI), and antihypertensive therapy. However, no considerable associations were found between Ea/Ees and HMOD parameters and the diastolic dysfunction markers. The GWI area under the ROC curve for increased PP and baPWV, echocardiographic LVH, and increased LAVI were 0.799, 0.770, 0.674, and 0.679, respectively (p < 0.05). Conclusions: The global work index but not traditionally echocardiographic-derived Ea/Ees of VAC is independently related to HMOD and diastolic impairment in hypertensives with preserved LV ejection fraction. The GWI may be a potential marker for evaluating the VAC in hypertension.

Association between familism and mental health in dementia caregivers: a systematic review and meta-analysis.

BACKGROUND: Dementia caregivers suffer from mental health problems while caring for dementia patients. As a core value, familism has been linked to the mental health of dementia caregivers. This study aims to systematically review the familism of dementia caregivers and to examine the association between familism and mental health of anxiety, depression, and burden in empirical research studies. METHODS: We conducted a systematic search in various databases like Medline, PubMed, and Embase databases from inception till April 2021. Fisher's z was calculated with correlation coefficient or regression coefficient values for three familism dimensions and mental health of anxiety, depression, and burden. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA) version 2.0 software. RESULTS: A total of seven studies with 1178 participants were eligible for the meta-analysis. For caregivers' anxiety, three of seven studies, with 358 participants, were examined in terms of the average corrected correlation coefficient across the studies. It was found that dementia caregivers' familism was significantly related to anxiety. The pooled z-value was 0.148 (95% CI = 0.043-0.253). In addition, caregivers' familism significantly affected depression (z = 0.080; 95% CI = 0.003-0.156), as did familial obligation (z = 0.122; 95% CI = 0.034-0.211), but perceived family support was not associated with this (z = 0.051, 95% CI = -0.038-0.140). As for caregiver burden, there was no evidence that familism was significantly associated with it (z = -0.073; 95% CI = -0.297 to 0.151), including familial obligation and perceived family support (z = -0.087 and -0.089, respectively; 95% CI = -0.278 to 0.104 and -0.335 to 0.157, respectively). CONCLUSIONS: An association between caregiver familism and anxiety/depression exists in dementia patients. More research is needed to explore the relationship between familism and burden.

EAT Thickness as a Predominant Feature for Evaluating Arterial Stiffness in Patients with Heart Failure with Preserved Ejection Fraction.

Objective: Heart failure with preserved ejection fraction (HFpEF) is an intricacy heterogeneous syndrome. However, the association between EAT and arterial stiffness in HFpEF patients remains unknown. Methods: A total of 102 patients were enrolled into the study, and brachial-ankle pulse-wave velocity (baPWV), epicardial adipose tissue (EAT) and body composition were assessed. Linear regression analysis was carried out to model the relationship between variables (especially EAT thickness) and baPWV. Results: The results showed that patients with the thicker EAT fat pad (≥3.55 mm) tended to have comorbidities of hypertension, coronary artery disease (CAD), diabetes and hyperlipidemia, also with a higher level of obesity, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total cholesterol (TC) and triglyceride (TG). The level of baPWV was higher in EAT ≥3.55 mm group than the other group. BaPWV was positively associated with EAT, age, heart rate, waist circumference, visceral fat area, systolic and diastolic blood pressure, CRP and FBG. After adjusting for EAT, age and visceral fat area, EAT thickness (ß = 0.256, P = 0.009) and visceral fat area (ß = 0.229, P = 0.036) significantly associated with baPWV. Conclusion: The study assessed for the first time that the increased EAT thickness was closely related with baPWV in HFpEF patients, suggesting patients with the thicker EAT may be independently associated with arterial stiffness under the context of HFpEF.

Correlation research between fear of disease progression and quality of life in patients with lung cancer.

BACKGROUND: Lung cancer has the highest incidence rate and mortality rate of all malignancies. In recent years, the therapeutic effect of lung cancer has been greatly improved, but the fear of disease progression still directly affects the quality of life (QOL) of patients. The aim of this study was to evaluate the factors affecting the progression of fear of disease and its impact on the quality of life in patients with lung cancer. METHODS: From December 2019 to February 2020, 102 patients with lung cancer in the Department of Thoracic Oncology of a top three hospital were investigated by using the simplified fear of disease progression scale (FoP-Q-SF) and the quality-of-life scale for cancer patients (FACT-G). Data were collected and statistically analyzed by SPSS25.0 software. RESULTS: A total of 110 questionnaires were distributed and 102 valid questionnaires were recovered, indicating a recovery rate of 92.7%. The results of multiple stepwise regression analyses showed that blood group, monthly income, and mood state were the influencing factors for the progression of phobic diseases in cancer patients (P<0.05), and the score of progression of phobic disease was negatively correlated with the quality-of-life score (r=-0.382). CONCLUSIONS: The progress of phobic diseases in patients with lung cancer seriously affects their QOL, and further attention by medical staff in providing health education, psychological counseling, social support, and other measures is required.

Efficacy of family rehabilitation treatment performed by parents under the guidance of professionals in children with autism spectrum disorder: a prospective study. / ä¸“ä¸šäººå‘˜æŒ‡å¯¼ä¸‹å­¤ç‹¬ç—‡è°±ç³»éšœç¢å„¿ç«¥å®¶é•¿æ‰§è¡Œçš„å®¶åº­åº·å¤ç–—æ•ˆè§‚å¯Ÿçš„å‰çž»æ€§ç ”ç©¶.

OBJECTIVES: To study the efficacy of family rehabilitation treatment performed by parents under the guidance of professionals in children with autism spectrum disorder (ASD). METHODS: In the prospective study, 60 children with ASD, aged 24-60 months, were randomly divided into an observation group and a conventional group. The parents of the children in the conventional group received an online training on basic knowledge and rehabilitation training of ASD alone, and those in the observation group received the online training and performed family rehabilitation treatment under the guidance of a professional team. Psycho-Education Profile Third Edition (PEP-3) and Childhood Autism Rating Scale (CARS) were used to evaluate the changes in related abilities after intervention. RESULTS: After 6 months of intervention, the scores of all dimensions of the PEP-3 scale in the observation group and most dimensions of the conventional group significantly increased (P<0.01); the CARS scale scores of the two groups significantly decreased (P<0.05). Compared with the conventional group, the observation group had significant increases in the scores of the dimensions of language understanding, language expression, gross motor, fine motor, self-care ability of daily living (P<0.05), and adaptive behavior (P<0.05), as well as a significant reduction in the CARS score (P<0.05). CONCLUSIONS: An online training on basic knowledge and rehabilitation training of ASD for parents can improve the abilities and core clinical symptoms of children with ASD. The family rehabilitation treatment model with a team of professionals as the resource platform and parents as the performer has a more significant efficacy on improving the language, sports, and other abilities and alleviating the severity of the symptoms in children with ASD.

Validation of the Chinese version of the Care Evaluation Scale for measuring the quality of structure and process of end-of-life care from the perspective of bereaved family.

BACKGROUND: Assessing the quality of structure and process of end-of-life care can help improve outcomes. There was currently no valid tool for this purpose in Mainland China. The aim of this study is to validate the Chinese version of the Care Evaluation Scale (CES). METHODS: From January to December 2017, a cross-sectional online survey was conducted among bereaved family members of cancer patients from 10 medical institutes. The reliability of the CES was assessed with Cronbach's α, and structural validity was evaluated by confirmatory factor analysis. Concurrent validity was tested by examining the correlation between the CES total score and overall satisfaction with end-of-life care, quality of dying and death, and quality of life. RESULTS: A total of 305 valid responses were analyzed. The average CES score was 70.7 ± 16.4, and the Cronbach's α of the CES was 0.967 (range: 0.802-0.927 for the 10 domains). The fit indices for the 10-factor model of CES were good(root-mean-square error of approximation, 0.047; comparative fit index, 0.952; Tucker-Lewis index, 0.946; standardized root mean square residual, 0.053). The CES total score was highly correlated with overall satisfaction with medical care (r = 0.775, P < 0.01), and moderately correlated with patients' quality of life (r = 0.579, P < 0.01) and quality of dying and death (r = 0.570, P < 0.01). In addition, few associations between CES total score and demographic characteristics, except for the family members' age. CONCLUSIONS: The Chinese version of the CES is a reliable and valid tool to evaluate the quality of structure and process of end-of-life care for patients with cancer from the perspective of bereaved family in Mainland China.

The effects of dyadic coping and marital satisfaction on posttraumatic growth among breast cancer couples.

OBJECTIVES: To examine the dyadic relationships of dyadic coping, marital satisfaction, and posttraumatic growth and to confirm the mediating effect of marital satisfaction between dyadic coping and posttraumatic growth among breast cancer patients and their spouses. METHODS: A total of 206 pairs of female breast cancer patients and their spouses from one tertiary hospital in Guangzhou, China, from August 2018 to July 2019 were invited to complete the demographics and disease-related information questionnaire, the Posttraumatic Growth Inventory, the Marital Adjustment Scale, and the Dyadic Coping Inventory. RESULTS: Patients' and spouses' positive/negative dyadic coping exerted actor effects and partner effects on marital satisfaction, while their marital satisfaction and positive dyadic coping only exerted actor effects on posttraumatic growth. In addition, the mediating effects of marital satisfaction on the impact of dyadic coping on posttraumatic growth were confirmed in both patients and spouses. CONCLUSION: Our findings provide a new perspective on the relationships between dyadic coping, marital satisfaction, and posttraumatic growth at the individual and dyadic levels. Promoting positive dyadic coping and decreasing negative dyadic coping among breast cancer patients and spouses can improve their marital satisfaction and posttraumatic growth.

Correlation between nurses' attitudes towards death and their subjective well-being.

BACKGROUND: With China's ageing society, the number of deaths increased gradually. Clinical nursing staff are among the first to come into contact with dying patients and scientific attitudes towards death will affect not only the quality of hospice care but also the physical and mental health of the nursing staff. Subjective well-being (SWB) mainly points to the overall emotional and cognitive evaluation of life quality. However, few studies have examined the correlation between attitudes towards death and subjective well-being in nurses. METHODS: A total of 810 nurses recruited from a tertiary hospital in Zhuhai were surveyed using the Chinese version of the Death Attitude Profile-Revised and the Subjective Well-being Scale. Pearson correlation coefficient was computed to analyze the correlation between attitudes towards death and the subjective well-being of the nursing staff. RESULTS: Subjective well-being was correlated with attitudes towards death (P<0.05). Multivariate analysis found that serious illness/acute or chronic disease, night shifts, and initial education level among nurses were also factors significantly related to subjective well-being (P<0.05). CONCLUSIONS: The findings indicate a close correlation between nurses' attitudes towards death and their subjective well-being. Nursing managers should guide nursing staff to develop a more appropriate and healthier view of death so as to enhance their subjective well-being.

Factors for peripherally inserted central catheters care delay in cancer patients during the COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. The public health systems have consequently been placed under tremendous pressure. Peripherally inserted central catheters (PICCs) are widely used in patients with cancers. Little is known about the provision of PICCs care amongst cancer patients during this pandemic. METHODS: We studied 156 cancer patients with PICCs treated at the Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University between January 2020 and March 2020. Their clinical characteristics, social features, psychological characteristics, and PICCs care situations were analyzed. The chi-squared (χ2) test or Fisher's exact test were used for univariate analyses. Multivariate logistic regression analyses were performed using stepwise variable selection. Differences were evaluated using a two-tailed test, and P<0.05 was considered statistically significant. RESULTS: Of 156 patients, 57 (36.5%) experienced delays of PICCs care, and 12 (21.1%) suffered from complications including infection, thrombosis, and mechanical failure. Univariate analysis detected that the increased risk of PICCs care delay was associated with older age (≥30), lower level of education (<9 years), working, taking public transport to the hospital, anxiety about COVID-19, lower social support rating scale (SSRS) score (<30). Multivariate analysis detected level of education, being employed or not, mode of transport, and SSRS score were independent predictive factors for the delay in PICCs care. CONCLUSIONS: Physical aspects, social factors, and psychological status commonly influenced patients' health care seeking behaviors such as PICCs maintenance. An increase in effort is required from patients' families and society to assure optimal care for cancer patients during this pandemic.

TRPC6 participates in the development of blood pressure variability increase in sino-aortic denervated rats.

Increased blood pressure variability (BPV) has been proved to be associated with cardiovascular morbidity and mortality. It is of great significance to elucidate the mechanism of BPV increase. The cation channel transient receptor potential canonical 6 (TRPC6) is involved in a series of cardiovascular disease. Our experiment aimed to explore the role of TRPC6 in the development of BPV increase. Sino-aortic denervation (SAD) operation was applied to establish the model of BPV increase in rats. The BPV was presented as the standard deviation to the mean of systolic or diastolic blood pressure every 1 h during 12 h of the light period. SAD was performed in male Sprague Dawley (SD) rats at the age of 10 weeks. At 8 weeks after SAD operation, the hemodynamic parameters were determined non-invasively via a Rodent Blood Pressure Analysis System. The TRPC6 expressions in myocardial and thoracic aortic tissue was determined utilizing Western Blot, immunofluorescence and quantitative RT-PCR. The expression of TRPC3 was detected as well. To investigate whether TRPC6 was a causative factor of BPV increase in SAD rats, TRPC6 activator and inhibitor with three progressively increasing doses were intraperitoneally injected to the SAD rats. We found that SAD rats presented significant augmentation of systolic and diastolic BPV with no change of BP level and heart rate. The mRNA and protein expression levels of TRPC6 in myocardial and thoracic aortic tissue in SAD rats were substantially increased, but there was no obvious change in TRPC3 expression. The systolic and diastolic BPV increase were dose-dependently exacerbated after TRPC6 activation with GSK1702934A but were dose-dependently attenuated after TRPC6 inhibition with SAR7334. In Conclusion, the TRPC6 (but not TRPC3) expressions in myocardial and thoracic aortic tissue were substantially increased in SAD rats, and TRPC6 probably played an important role in the development of BPV elevation.

TNAP inhibition attenuates cardiac fibrosis induced by myocardial infarction through deactivating TGF-ß1/Smads and activating P53 signaling pathways.

Tissue nonspecific alkaline phosphatase (TNAP) is expressed widely in different tissues, modulating functions of metabolism and inflammation. However, the effect of TNAP on cardiac fibrosis remains controversial and needs to be further studied. The present study aims to investigate the role of TNAP on myocardial infarction (MI)-induced fibrosis and its mechanism. TNAP was upregulated in patients with MI, both in serum and injured hearts, and predicted in-hospital mortality. TNAP was also significantly upregulated after MI in rats, mostly in the border zone of the infarcted hearts combined with collagen synthesis. Administration of TNAP inhibitor, tetramisole, markedly improved cardiac function and fibrosis after MI. In the primary cultures of neonatal rat cardiac fibroblasts (CFs), TNAP inhibition significantly attenuated migration, differentiation, and expression of collagen-related genes. The TGF-ß1/Smads signaling suppression, and p-AMPK and p53 upregulation were involved in the process. When p53 inhibitor was administered, the antifibrotic effect of TNAP inhibition can be blocked. This study provides a direct evidence that inhibition of TNAP might be a novel regulator in cardiac fibrosis and exert an antifibrotic effect mainly through AMPK-TGF-ß1/Smads and p53 signals.

Validation of the Chinese Version of the Good Death Inventory for Evaluating End-of-Life Care From the Perspective of the Bereaved Family.

CONTEXT: It is essential to evaluate good death of patients with cancer. However, currently, there is no validated measurement tool available in Mainland China. OBJECTIVES: To validate the Chinese version of the Good Death Inventory (GDI). METHODS: An online survey was distributed to the bereaved family members of patients with cancer (from 10 medical institutes) who died between January 2014 and December 2016. The survey included the demographic characteristics of the patients and their family members, the Chinese version of the GDI, overall satisfaction of family members regarding the end-of-life care, as well as the patients' overall quality of death and dying, and overall quality of life. RESULTS: A total of 305 valid responses were analyzed. The average score of the GDI was 241.20 ± 39.45. The Cronbach's α coefficient of the GDI was 0.896 overall and ranged from 0.561 to 0.950 for the subdomains. The fit indices for the original 18-factor model were acceptable: root mean square error of approximation = 0.044, Comparative Fit Index = 0.900, Tucker-Lewis Index = 0.892, and standardized root mean square residual = 0.073. The total scores of the GDI were moderately correlated with overall satisfaction with medical care (r = 0.411, P < 0.01), patient's quality of life (r = 0.468, P < 0.01), and quality of death and dying (r = 0.441, P < 0.01). CONCLUSIONS: The psychometric characteristics of the Chinese version of the GDI indicate that this questionnaire is reliable and valid. It can be used as a tool for the assessment of quality of death and dying of patients with cancer among the Chinese population.

DNA hydroxymethylation combined with carotid plaques as a novel biomarker for coronary atherosclerosis.

Little is known about the diagnostic value of DNA methylation and hydroxymethylation for coronary atherosclerosis. Carotid plaque is a common marker for coronary atherosclerosis. Our aim is to determine whether DNA methylation and hydroxymethylation combined with carotid plaques can be useful to the diagnosis of coronary atherosclerosis. The 5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) levels from peripheral blood mononuclear cells (PBMCs) were measured in 113 enrolled patients. Crouse score and Gensini score were used to evaluate the severity of carotid and coronary atherosclerosis, respectively. With the increasing of severity of carotid plaque, a stepwise upward trend was observed in 5-mC and 5-hmC levels from PBMCs, which were significantly correlated with the risk factors, Crouse score and Gensini score. Crouse score and 5-hmC, not 5-mC, were the risk factors for coronary atherosclerosis after adjustment for the risk factors (the history of diabetes, FPG and HbA1c). Receiver operating characteristic (ROC) analysis indicated that 5-hmC combined with Crouse score was the diagnostic biomarker for coronary atherosclerosis, with the highest areas under the curve (AUC) for 0.980 (0.933-0.997), valuable sensitivity for 96.23% and specificity for 91.67%. These findings suggest 5-hmC level combined with Crouse score may provide the meaningful information for coronary atherosclerosis diagnosis.

DNA methylation and hydroxymethylation are associated with the degree of coronary atherosclerosis in elderly patients with coronary heart disease.

AIMS: DNA methylation and hydroxymethylation are significantly related to the occurrence and development of coronary heart disease (CHD) and atherosclerosis (AS). 5-Methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) are used to assess DNA methylation and hydroxymethylation levels, respectively. However, 5-mC and 5-hmC levels associated with CHD remain controversial. In the present study, we aimed to investigate the association of the peripheral blood levels of 5-mC and 5-hmC and the degree of coronary atherosclerosis in elderly CHD patients. MAIN METHODS: 5-mC and 5-hmC levels in peripheral blood mononuclear cells (PBMCs) were measured in 44 CHD patients and 42 matched control subjects by ELISA and dot blot analysis. Immunohistochemical staining was used to observe 5-mC, 5-hmC and TET2 expression in human aortic tissue. Gensini score was used to evaluate the degree of coronary atherosclerosis. KEY FINDINGS: 5-mC and 5-hmC levels in PBMCs from CHD patients and in human aortic atherosclerosis plaque were both higher than those in control subjects and in tissue samples. TET2 expression was significantly upregulated in CHD patients compared with control subjects, while only an increasing trend in the expression of DNMT1, DNMT3A and all the other TET genes were found. Spearman correlation analysis demonstrated that 5-mC and 5-hmC levels were positively correlated with Gensini score. 5-mC and 5-hmC were considered as the risk factors for CHD after adjustment. SIGNIFICANCE: DNA methylation and hydroxymethylation levels in PBMCs from elderly CHD patients were significantly increased, showing a positive correlation with the degree of coronary atherosclerosis.

Factors that contribute to poor adherence to statin therapy in coronary heart disease patients from Chongqing and measures to improve their therapeutic outcomes.

To assess the efficacy and short-term outcomes of adherence to statin therapy among coronary heart disease (CHD) patients following their hospital discharge, we enrolled 615 CHD patients who were prescribed statins from The First Affiliated Hospital of Chongqing Medical University in China between February 1st and October 31st of 2013. Statin adherence was evaluated by identifying the proportion of patients who remained adherent or became non-adherent to statin therapy over 4-8 months post-discharge from the hospital. The composite outcomes included all-cause mortality and re-hospitalization with cardiovascular disease. We found that 15.9% patients were non-adherent to their statin therapies and that coronary artery stenosis<75% (OR = 3.433, 95% CI: 2.191-5.380, p < 0.001) and adverse effects (OR = 2.542, 95% CI: 1.327-4.869, p = 0.005) both clearly contributed to poor adherence. The primary self-reported reasons for non-adherence included a lack of knowledge about the benefits of statin therapy (36.7%), the treatment being halted at the advice of their doctor (19.4%), and the difficulty in obtaining statins (12.2%). Non-adherence to statin therapy was significantly associated with an increased risk of cardiovascular events (OR = 1.741, 95% CI: 1.035-2.929, p = 0.037). In conclusion, CHD patients with moderate stenosis or adverse effects tended to have poor statin adherence, and this was significantly associated with increased cardiovascular events. We should strengthen education of the importance of statin therapy for both patients and doctors and facilitate the ability of patients to obtain their statin medication. Clinical Study Register Code: ChiCTR-EPC-16007839.