Translation and validation of the Chinese version of the comprehensive breastfeeding knowledge scale (CBKS).

BACKGROUND: The level of breastfeeding knowledge of nursing students may influence their ability to support breastfeeding families. However, to date, it has not been possible to measure this accurately due to the lack of existence of a validated tool in Chinese. OBJECTIVES: To translate the Comprehensive Breastfeeding Knowledge Scale (CBKS) into Chinese, and then evaluate its psychometric properties among Chinese undergraduate nursing students in order to inform and evaluate a nursing breastfeeding education programme. METHODS: The Brislin translation model was followed, and a three-phase process (translation, back-translation and cultural adaptation) was used to sinicize the CBKS and evaluate its content validity. Construct validity was evaluated with exploratory factor analysis (EFA), and the reliability of internal consistency of the Chinese version of the CBKS was tested by calculating Cronbach's alpha coefficient and the half reliability coefficient. SETTINGS: Two nursing schools in Beijing and Nanjing, China. PARTICIPANTS: Four hundred and thirty-nine undergraduate nursing students (257 from Beijing and 182 from Nanjing). RESULTS: Five experts rated the content validity of the Chinese version of the CBKS as excellent. EFA showed that the Chinese version of the CBKS had three subscales and 23 items. Cronbach's alpha coefficient of the Chinese version of the CBKS and the half reliability coefficient were 0.70 and 0.73, respectively. Students who had completed an obstetrics or paediatric nursing course had significantly higher total scores and mean scores for most items compared with those who had not taken a course. Most of the indictors of EFA met the standards of construct validity, and some were very close to the cut-off. CONCLUSION: Overall, the 23-item Chinese version of the CBKS is an acceptable tool to measure the level of breastfeeding knowledge among undergraduate nursing students. This scale can be used to inform the design and evaluation of breastfeeding education materials for nursing students or other health profession students.

Circ_0022920 Maintains the Contractile Phenotype of Human Aortic Vascular Smooth Muscle Cells Via Sponging microRNA-650 and Promoting Transforming Growth Factor Beta Receptor 1 Expression in Angiotensin II-Induced Models for Aortic Dissection.

Background Abnormal regulation of vascular smooth muscle cells is regarded as the iconic pathological change of aortic dissection (AD). Herein, we aim to identify circ_0022920 as a crucial regulator in AD. Methods and Results Microarray analysis of circular RNAs, messenger RNAs, and micro RNAs in patients with AD was performed, and we identified that circ_0022920 was significantly downregulated in these patients. The Pearson correlation analysis uncovered the negative correlation between miR-650 and circ_0022920 or TGFßR1 (transforming growth factor beta receptor 1). Angiotensin II was used to treat human aortic vascular smooth muscle cells (HASMCs) and mice as models for AD. Hematoxylin and eosin and Masson's trichrome staining were used to analyze AD histopathology. Cell proliferation was analyzed with Cell Counting Kit-8 assay and EdU incorporation. Cell migration was assessed with transwell and wound healing assays. Enhanced circ_0022920 expression dramatically inhibited HASMC proliferation and migration and maintained contractile marker expression induced by angiotensin II, whereas miR-650 exerted opposite effects. MiR-650 was a target of circ_0022920. MiR-650 targeted IRF1 (interferon regulatory factor 1) and thus negatively regulated TGFßR1 expression to promote HASMC proliferation and migration and inhibit contractile marker expression. Circ_0022920 suppressed the progression of AD in vivo. Conclusions Circ_0022920 modulates the contractile phenotype of HASMCs via regulating the miR-650-IRF1-TGFßR1 axis in angiotensin II-induced models for AD, which provides potential therapeutic targets for AD.

Toll-Like Receptor 4 Signaling in Neurons Mediates Cerebral Ischemia/Reperfusion Injury.

In microglia, Toll-like receptor 4 (TLR4) is well known to contribute to neuroinflammatory responses following brain ischemia. TLR4 is also expressed in neurons and can mediate the conduction of calcium (Ca2+) influx, but the mechanistic link between neuronal TLR4 signaling and brain ischemic injury is still poorly understood. Here, primary neuronal cell cultures from TLR4 knockout mice and mice with conditional TLR4 knockout in glutamatergic neurons (TLR4cKO) were used to establish ischemic models in vitro and in vivo, respectively. We found that deleting TLR4 would reduce the neuronal death and intracellular Ca2+ increasement induced by oxygen and glucose deprivation (OGD) or lipopolysaccharide treatment. Infarct volume and functional deficits were also alleviated in TLR4cKO mice following cerebral ischemia/reperfusion (I/R). Furthermore, TLR4 and N-methyl-D-aspartate receptor subunit 2B (NMDAR2B) were colocalized in neurons. Deletion of TLR4 in neurons rescued the upregulation of phosphorylated NMDAR2B induced by ischemia via Src kinase in vitro and in vivo. Downstream of NMDAR2B signaling, the interaction of neuronal nitric oxide synthase (nNOS) with postsynaptic density protein-95 (PSD-95) was also disrupted in TLR4cKO mice following cerebral I/R. Taken together, our results demonstrate a novel molecular neuronal pathway in which TLR4 signaling in neurons plays a crucial role in neuronal death and provide a new target for neuroprotection after ischemic stroke.

Long-term atorvastatin improves cognitive decline by regulating gut function in naturally ageing rats.

BACKGROUND: Statins have been widely used to prevent cardiovascular disease in middle-aged and elderly populations; however, the effect of long-term treatment on cognitive function is controversial. To simulate clinical conditions, middle-aged rats were given atorvastatin for 9 consecutive months to investigate the effect on natural cognitive decline and the possible mechanisms. RESULTS: The results showed that compared with the control group, long-term atorvastatin treatment naturally improved cognitive decline. Furthermore, long-term treatment regulated intestinal retinoic acid (RA) metabolism and storage by altering retinol dehydrogenase 7 (Rdh7) expression in the intestine, while RA metabolism affected the proliferation of intestinal Treg cells and inhibited IL-17+γδ T-cell function. In addition, long-term atorvastatin increased intestinal flora richness and decreased IL-17 expression in hippocampal tissue. CONCLUSION: Collectively, these findings provide the first evidence that long-term atorvastatin intervention may prevent cognitive decline in naturally ageing rats by inhibiting neuroinflammation via the gut-brain axis.

Successful management of a breastfeeding mother with severe eczema of the nipple beginning from puberty: A case report.

BACKGROUND: Nipple eczema is the most common presentation of atopic dermatitis of the breast, which seriously influences breastfeeding of mothers. We here present a case of severe nipple eczema that started in puberty and received continuous care and interventions during pregnancy. The patient succeeded in breastfeeding after the interventions. CASE SUMMARY: A 36-year-old woman at 16 wk of gestation (gestation 1 parturition 0), visited the breastfeeding consultation clinic, complaining of excessive nipple secretion, severe itching, and concerns about breastfeeding. She was diagnosed with severe nipple eczema. Health education, consultation with dermatologists, topical medication, psychological support, and postpartum care were carried out. Through continuous interventions, her nipple eczema significantly improved, lactating confidence enhanced, anxiety symptoms were reduced, and exclusive breastfeeding was achieved. CONCLUSION: For lactating women with nipple eczema, breastfeeding consultants should play an important role in patient education and provide whole-process and individual guidance.

Direct Endovascular Thrombectomy or With Prior Intravenous Thrombolysis for Acute Ischemic Stroke: A Meta-Analysis.

Background and purpose: It is unclear whether endovascular thrombectomy alone compared with intravenous thrombolysis combination with endovascular thrombectomy can achieve similar neurological outcomes in patients with acute large vessel occlusion stroke. We aimed to perform a systematic review and meta-analysis of randomized controlled trials to compare endovascular thrombectomy alone or intravenous thrombolysis plus endovascular thrombectomy in this population. Methods: We systematically searched PubMed, Embase, and ClinicalTrials.gov. We restricted our search to randomized clinical trials that examined the clinical outcomes of endovascular thrombectomy alone vs. intravenous thrombolysis plus endovascular thrombectomy. The Cochrane risk of bias tool was used to assess study quality. Random-effects meta-analyses were used for evaluating all outcomes. Results: Total three randomized controlled trials with 1,092 individuals enrolled were included in the meta-analysis, including 543 (49.7%) who received endovascular thrombectomy alone and 549 (50.3%) who received intravenous thrombolysis plus endovascular thrombectomy. The primary outcome of 90-day functional independence (modified Rankin scale (mRS) score ≤ 2) was 44.6% (242/543) in the endovascular thrombectomy alone group vs. 42.8% (235/549) in the alteplase with endovascular thrombectomy group (odds ratio (OR), 1.08 [95% CI, 0.85-1.38]; P = 0.0539). Among pre-specified secondary outcomes, no significant between-group differences were found in excellent outcome (mRS score ≤ 1) (OR, 1.12 [95% CI, 0.85-1.47]; P = 0.418), mortality at 90 days (OR, 0.93 [95% CI, 0.68-1.29]; P = 0.673), successful reperfusion (thrombolysis in cerebral infarction 2b-3) (OR, 0.75 [95% CI, 0.54-1.05]; P = 0.099), and symptomatic intracranial hemorrhage (OR, 0.72 [95% CI, 0.45-1.15]; P = 0.171). Conclusions: Among patients with acute ischemic stroke in the anterior circulation within 4.5 h from the onset, endovascular thrombectomy alone was non-inferior to combined intravenous thrombolysis and endovascular thrombectomy.

Lactating Women's Knowledge and Attitudes About Donor Human Milk in China.

BACKGROUND: Donor milk is the preferred substitute to mother's own milk, which can protect high-risk infants from many complications. Several milk banks have been established in China. However, the small number of donors and insufficient milk donated have become the primary obstacles for these milk banks. RESEARCH AIMS: To explore the level of, and the factors influencing, knowledge and attitude about donor milk among currently lactating women across mainland China and to provide a reference for the development of Chinese milk banks. METHODS: A brief, self-reporting, prospective, cross-sectional, online survey was conducted in 2018 using The Knowledge and Attitude Questionnaire of Human Donor Milk for Hospitalized Women. Lactating women aged >18 years and willing to consent to study participation were recruited throughout China. RESULTS: All completed questionnaires (N = 489) were included. 40.1% (n = 196) of the participants had heard of donor milk or milk banks, and 76.7% (n = 375) were willing to donate their milk. In the multiple linear regression analysis, educational level, cohabitation status, parity, history of delivering preterm or low-birth-weight infants, education provided by health professionals, and infants' gestational age, weight, and feeding patterns were associated with the participants' knowledge about donor milk (F = 12.387, p < .001). The parity, delivery mode, mothers' milk production, history of delivering preterm or low-birth-weight infants, education provided by health professionals, and infants' age were associated with their attitude (F = 9.420, p < .001). CONCLUSION: The participants' attitudes about donor milk were positive. However, there were gaps in their knowledge about donor milk.

Effects of Training-for-Transformation Program on TB/MDR-TB Developed by the International Council of Nurses in China.

BACKGROUND: This study evaluated the effects of the Training-for-Transformation (TFT) program on tuberculosis (TB)/multidrug-resistant TB (MDR-TB) in China. METHOD: Participants who received training from 2009 to 2017 (n = 230) were invited to complete an online survey using a self-designed questionnaire. RESULTS: A total of 130 (56.5%) trainees completed the survey for a valid response rate of 70% (91 of 130). All of the participants created a schedule and offered a TFT program on TB/MDR-TB for health care providers, clients, and communities by a variety of methods that included brainstorming, group work, and role-play, in addition to lectures. The most important supporting factors to train others were related to opportunity and managers' support, and the biggest barriers were lack of space and time. Trainees also made changes to practices that influenced the way nurses worked within their institution, infection control, team cooperation, extended care, and nurses' attitudes toward patients. CONCLUSION: The TFT program led to ongoing training provision and practical improvements, and can transform attitudes, practices, and changes in patient care. [J Contin Educ Nurs. 2020;51(5):233-237.].

Azo-capped polysarcosine-b-polylysine as polypeptide gene vector: A new strategy to improve stability and easy optimization via host-guest interaction.

Polypeptide has been extensively researched in gene/drug delivery system due to the good biocompatibility. Herein, we synthesized total-polypeptide copolymers, i.e. Azo(azobenzene)-capped polysarcosine-b-polylysine (ASL) with narrow molecular weight distribution by α-amino acid N-carboxyanhydride (NCA) polymerization. Although the molecular weight of PLL segment was only about 6 kDa, ASL could condense DNA effectively and form about 150 nm spherical nanoparticles at N/P ratio of 15. The surface charge was significantly reduced due to the shielding effect of polysarcosine (PSAR) shell. ASL/DNA PeptoPlexes showed good colloidal stability under physiological salt condition and complexation competition stability in the presence of counter polyanion, which might improve the circulation time in vivo. The tip design of azobenzene provided a facile way for ligand modification via host-guest interaction, which could be flexibly optimized by changing its functional tags responding to a request. Our data showed that the introduction of CD-R8 could promote the internalization of gene into cytoplasm and even nucleus owing to the membrane penetrating effect of R8. Cell culture experiments indicated as a total-polypeptide system, ASL showed good cellular viability and comparable gene transfection level as PLL with molecular weight of 50 kDa. Overall, PSAR served as an ideal alternative of PEG and this total-polypeptide system showed us a good direction for gene carrier design.