Advancing arrhythmia education through the CDIO approach: a new paradigm in nursing student training.

BACKGROUND: The accurate diagnosis and effective management of arrhythmias are crucial, with nurses playing a key role in the early detection and treatment, significantly impacting patient outcomes. Improving education on arrhythmias among nurses, especially in critical care and perioperative settings, can enhance patient safety and the quality of care. METHODS: A total of 116 trainee nurses were randomly divided into two groups: one utilizing the conceive-design-implement-operate (CDIO) model and the other employing a traditional lecture-based learning (LBL) method, to undergo arrhythmia training. The studyassessed the effects of the two teaching methods and investigated the students' attitudes toward these educational practices, with all participants completing pre- and post-course tests. RESULTS: The CDIO model significantly enhances nursing students' arrhythmia proficiency, yielding higher test scores and sustained improvement after 24-week compared to the traditional LBL method, alongside markedly better self-learning enthusiasm, understanding, satisfaction with the teaching approach and effectiveness, and interest in learning arrhythmia. The CDIO model in nursing arrhythmia courses boosts theoretical knowledge and application, showing potential in clinical skill enhancement. CONCLUSIONS: Our study introduces the CDIO model in nursing arrhythmia courses, with improvement in knowledge and skills, and promise for broader application.

Application of the BOPPPS-CBL model in electrocardiogram teaching for nursing students: a randomized comparison.

BACKGROUND/AIM: Interpreting an electrocardiogram (ECG) is a vital skill for nurses in cardiology. This study aimed to evaluate the efficacy of the bridge-in, objective, preassessment, participatory learning, post-assessment, and summary (BOPPPS) model, when combined with case-based learning (CBL), in enhancing nursing students' ECG interpretation capabilities. MATERIALS & METHODS: Nursing students were randomly divided into two groups: one utilizing the BOPPPS model combined with CBL (BOPPPS-CBL), and the other employing a traditional lecture-based learning (LBL) model. All participants underwent training and completed pre- and post-course quizzes. RESULTS: The BOPPPS-CBL model significantly improved nursing students' abilities in ECG interpretation compared to the traditional LBL model group. The BOPPPS-CBL model proved to be a comprehensive and effective method for enhancing students' attitudes towards teaching and learning. DISCUSSION: Our study demonstrated for the first time that the BOPPPS-CBL model is an innovative and effective method for promoting nurses' accuracy in ECG interpretation. It highlights the potential of this approach as a superior alternative to traditional learning methods.

CRISP method with flipped classroom approach in ECG teaching of arrhythmia for trainee nurses: a randomized controlled study.

BACKGROUND: This study aimed to explored the effects of the Cardiac Rhythm Identification for Simple People (CRISP) method with flipped classroom approach for arrhythmia interpretation in electrocardiogram (ECG) by trainee nurses. METHODS: A total of 120 trainee nurses were enrolled and randomly divided into the experimental group and the control group using lecture-based learning method. We observed the effects of the two methods in ECG interpretation training and investigated the students' attitudes toward the teaching practices. RESULTS: After training, the ECG test scores in the experimental group were significantly higher than that of the control group. Six months later, the ECG test scores of the experimental group was still higher. Self-learning enthusiasm, understanding of teaching content, satisfaction of teaching mode, satisfaction of teaching effectiveness, and interest in learning ECG were significantly higher in the experimental group. CONCLUSION: CRISP method with flipped classroom approach is a new and effective mode worth trying in ECG teaching for trainee nurses.

The effect of immune cell-derived exosomes in the cardiac tissue repair after myocardial infarction: Molecular mechanisms and pre-clinical evidence.

After a myocardial infarction (MI), the inflammatory responses are induced and assist to repair ischaemic injury and restore tissue integrity, but excessive inflammatory processes promote abnormal cardiac remodelling and progress towards heart failure. Thus, a timely resolution of inflammation and a firmly regulated balance between regulatory and inflammatory mechanisms can be helpful. Molecular- and cellular-based approaches modulating immune response post-MI have emerged as a promising therapeutic strategy. Exosomes are essential mediators of cell-to-cell communications, which are effective in modulating immune responses and immune cells following MI, improving the repair process of infarcted myocardium and maintaining ventricular function via the crosstalk among immune cells or between immune cells and myocardial cells. The present review aimed to seek the role of immune cell-secreted exosomes in infarcted myocardium post-MI, together with mechanisms behind their repairing impact on the damaged myocardium. The exosomes we focus on are secreted by classic immune cells including macrophages, dendritic cells, regulatory T cells and CD4+ T cells; however, further research is demanded to determine the role of exosomes secreted by other immune cells, such as B cells, neutrophils and mast cells, in infarcted myocardium after MI. This knowledge can assist in the development of future therapeutic strategies, which may benefit MI patients.

Boeravinone B alleviates gut dysbiosis during myocardial infarction-induced cardiotoxicity in rats.

Myocardial infarction (MI) is the most common heart disease, and also, it is one of the leading causes of death from cardiovascular disease. It is well known that MI causes additional injury during blood flow restoration in ischaemic myocardium. Boeravinone B (BB) is a well-known antioxidant and anti-inflammatory drug. We investigated the cardioprotective effect of BB drug against isoproterenol (ISO)-induced MI in rats in this experimental study, along with we analysed its underlying mechanism. Adult Sprague Dawley (SD) rats were treated subcutaneously with ISO (45 mg/kg), then divided into groups and then given BB drug was administered orally. The cardioprotective effect of BB on ISO-induced MI rats was analysed by estimating the heart injury markers, antioxidant pro-inflammatory cytokines and inflammatory parameters. We also detected quantified expression of inflammation and apoptosis-related marker protein family. We estimated the effect of BB drug on GUT microbiota in ISO-induced MI rats and scrutinized the histopathological variations in heart tissues. BB treatment significantly (P < .001) diminished the level of heart markers such as lactate dehydrogenase (LDH), troponin (TnT), creatine kinase (CK) and creatine kinase isoenzymes MB (CK-MB). BB treatment also altered the antioxidant parameters and reduced the pro-inflammatory cytokines in the serum and tissues. Additionally, the histopathological aspects demonstrated that the pathological changes observed in the heart tissue of the ISO group rats were suppressed by the BB treatment to varying degrees. Furthermore, the expressions of caspase-3, p53, caspase-9, Bax, interleukin-6 (IL-6), cytochrome C, neutrophil gelatinase-associated lipocalin (NGAL), tumour necrosis factor-α (TNF-α), nuclear factor kappa B (NF-κB) and interleukin-1ß (IL-1ß) in the heart tissue were down-regulated whereas the Bcl-2 expression seemed to be enhanced. BB treatment not only alleviated ISO-induced gut dysbiosis by its enhanced specified Firmicutesto-Bacteroidetes (F/B) ratio but also maintained the relative abundance of major bacteria such as Clostridium IV, Butyricicoccus, Clostridium XIVs, Akkermansia and Roseburia. Collectively, our findings showed that the BB drug acted against myocardial infraction and prevented the damage by reducing the oxidative stress and controlling the inflammatory pathways, and gut microbiota.

Left ventricular systolic function between left bundle branch pacing and right ventricular septum pacing in patients with pacemaker dependence by three-dimensional speckle tracking imaging. / ä¸‰ç»´æ–‘ç‚¹è¿½è¸ªæŠ€æœ¯è¯„ä»·å·¦æŸæ”¯èµ·æã€å³å®¤é—´éš”éƒ¨èµ·æçš„å¿ƒå®¤èµ·æä¾èµ–æ‚£è€ å·¦å¿ƒå®¤æ”¶ç¼©åŠŸèƒ½.

OBJECTIVES: To compare the left ventricular systolic function between the 1eft bundle branch pacing (LBBP) and right ventricular septum pacing (RVSP) in patients with pacemaker dependence by three-dimensional speckle tracking imaging (3D-STI). METHODS: A total of 65 patients with atrioventricular block (AVB) (Mobitz type II second-degree AVB, high-degree AVB, or third-degree AVB), who underwent permanent cardiac pacing implantation including 32 patients receiving LBBP (LBBP group) and 33 patients receiving RVSP (RVSP group) from June 2018 to June 2019,were enrolled in this study. These patients met the following inclusion criterion: pre-operative left ventricular ejection fraction (LVEF)>50% and ventricular pacing rate>40% at 6-month programming follow-up; and the patients underwent echocardiography at pre-operation and 6 months after operation. The 3D-STI was used to obtain global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and global area strain (GAS). RESULTS: All the patients in the LBBP group and the RVSP group had normal LVEF, there was no significant difference between the 2 group (P>0.05). The LVEF was slightly decreased at 6-month follow-up in the RVSP group, but there was no significant change compared with pre-operation (P>0.05). There were no significant difference in LVEF, GLS, GCS, GRS and GAS at pre-operation and 6-month after operation between the LBBP group and the RVSP group (all P>0.05). Compared with pre-operation, the GLS and GCS were significantly decreased in the LBBP group; while the GLS, GCS, GRS and GAS in the RVSP group were also significantly decreased at 6-month follow-up (all P<0.05). CONCLUSIONS: For patients with pacemaker dependence and normal LVEF at pre-operation, the cardiac function in the LBBP group is not significantly better than that in the RVSP group in short term follow-up. But in terms of physiologic pacing and long-term cardiac function protection, the 1eft bundle branch pacing is an optimal pacing mode.

Anti-inflammatory effects of triptolide improve left ventricular function in a rat model of diabetic cardiomyopathy.

AIMS: Given the importance of inflammation in the onset and progression of diabetic cardiomyopathy, we investigated the potential protective effects of triptolide, an anti-inflammatory agent, in streptozotocin-induced diabetic rat model and in H9c2 rat cardiac cells exposed to high glucose. METHODS AND RESULTS: Diabetic rats were treated with triptolide (100, 200, or 400 µg/kg/day respectively) for 6 weeks. At the end of this study, after cardiac function measurements were performed, rats were sacrificed and their hearts were harvested for further histologic and molecular biologic analysis. Enhanced activity and expression of nuclear factor-kappaB (NF-κB) p65 in diabetic hearts were associated with increased inflammatory response, as demonstrated by increased pro-inflammatory cytokines, cell adhesion molecules and invading inflammatory cells, as well as increased fibrosis, in line with impaired left ventricular function. Triptolide attenuated these morpho-functional alterations. Furthermore, triptolide (20 ng/ml) also attenuated high glucose-induced inflammation in H9c2 rat cardiac cells. CONCLUSION: Our data demonstrate that anti-inflammatory effects of triptolide involving the NF-κB signaling pathway can improve left ventricular function under diabetic conditions, suggesting triptolide treatment might be beneficial in diabetic cardiomyopathy.

Stem cell-derived and circulating exosomal microRNAs as new potential tools for diabetic nephropathy management.

BACKGROUND: Despite major advances in the treatment of diabetic nephropathy (DN) in recent years, it remains the most common cause of end-stage renal disease. An early diagnosis and therapy may slow down the DN progression. Numerous potential biomarkers are currently being researched. Circulating levels of the kidney-released exosomes and biological molecules, which reflect the DN pathology including glomerular and tubular dysfunction as well as mesangial expansion and fibrosis, have shown the potential for predicting the occurrence and progression of DN. Moreover, many experimental therapies are currently being investigated, including stem cell therapy and medications targeting inflammatory, oxidant, or pro-fibrotic pathways activated during the DN progression. The therapeutic potential of stem cells is partly depending on their secretory capacity, particularly exosomal microRNAs (Exo-miRs). In recent years, a growing line of research has shown the participation of Exo-miRs in the pathophysiological processes of DN, which may provide effective therapeutic and biomarker tools for DN treatment. METHODS: A systematic literature search was performed in MEDLINE, Scopus, and Google Scholar to collect published findings regarding therapeutic stem cell-derived Exo-miRs for DN treatment as well as circulating Exo-miRs as potential DN-associated biomarkers. FINDINGS: Glomerular mesangial cells and podocytes are the most important culprits in the pathogenesis of DN and, thus, can be considered valuable therapeutic targets. Preclinical investigations have shown that stem cell-derived exosomes can exert beneficial effects in DN by transferring renoprotective miRs to the injured mesangial cells and podocytes. Of note, renoprotective Exo-miR-125a secreted by adipose-derived mesenchymal stem cells can improve the injured mesangial cells, while renoprotective Exo-miRs secreted by adipose-derived stem cells (Exo-miR-486 and Exo-miR-215-5p), human urine-derived stem cells (Exo-miR-16-5p), and bone marrow-derived mesenchymal stem cells (Exo-miR-let-7a) can improve the injured podocytes. On the other hand, clinical investigations have indicated that circulating Exo-miRs isolated from urine or serum hold great potential as promising biomarkers in DN.

Feasibility of detecting early left ventricular systolic dysfunction using global area strain: a novel index derived from three-dimensional speckle-tracking echocardiography.

AIMS: Area strain (AS), derived from three-dimensional speckle-tracking echocardiography (3D-STE), is a novel parameter integrating longitudinal and circumferential deformation. We sought to evaluate the ability of global AS to detect early left ventricular (LV) systolic dysfunction in patients with risk factors for heart failure (HF). METHODS AND RESULTS: Standard echocardiography and 3D-STE were performed in 160 subjects with or without HF. Three-dimensional speckle-tracking echocardiography was measured with reliable tracking quality in 137 (86%) of the 160 subjects initially enrolled in this study: 30 healthy volunteers, 29, 37, 26, and 15 patients with Stage A, B, C, and D HF, respectively. Global strain values were automatically calculated by 3D wall motion tracking (3D-WMT) software. Although global longitudinal strain (LS), circumferential strain (CS), radial strain (RS), and LV ejection fraction (LVEF) showed the downward trend from normal controls to patients with Stage D HF, the difference did not reach statistical significance between normal controls and patients with Stage A HF. In contrast, we observed the progressive decrease in global AS from normal to Stage A HF to Stage D HF (P< 0.05). In addition, global AS showed an excellent correlation with LVEF, global LS and CS. The optimal cut-off value for global AS, to detect LV dysfunction (Simpson's rule-based LVEF <50%), was -29.23% at a sensitivity of 86.3% and at a specificity of 88.4%. CONCLUSION: Global AS is a sensitive and reproducible parameter to detect early and subtle LV systolic dysfunction, showing greater feasibility than other conventional strain parameters.

[Carotid arterial wave intensity in assessing the hemodynamic change in patients with chronic heart failure].

Wave intensity (WI) is a newly proposed hemodynamic index that assesses the working condition of cardiovascular system. The purpose of this study is to investigate the clinical value of WI in assessing the function of cardiovascular system in patients with chronic heart failure (CHF). We used a combined Doppler and echo-tracking system to calculate the carotid artery WI in 16 patients with CHF and 35 normal subjects, and examined the characteristics of WI. The main WI indices included W1, W2, NA, R-W1 and W1-W2. Compared with those in the control group, W1 and W2 were significantly decreased in CHF group (5.44 +/- 3.24 vs. 10.05 +/- 46.33, P < 0.01, 0.83 +/- 0.42 vs. 1.50 +/- 0.95, P < 0.01, respectively), the temporal indices R-W1 shortened (141.06 +/- 41.14 vs. 109.77 +/- 22.50, P < 0.05) and W1-W2 prolonged (214.63 +/- 39.93 vs. 260.51 +/- 20.58, P < 0.01), and the (R-W1)/(W1-W2) ratio was significantly larger in CHF group (0.69 +/- 0.26 vs. 0.43 +/- 0.10, P < 0.01). WI provides a great deal of information about the dynamic behavior of the interaction between the heart and vascular system, so it is a new quantitative approach for analysis of CHF.

ERK Activation-Mediated Autophagy Induction Resists Licochalcone A-Induced Anticancer Activities in Lung Cancer Cells in vitro.

INTRODUCTION: The incidence and mortality rates of lung cancer rank top in the different types of cancers in China. Licochalcone A (LA) is a flavonoid extracted from the roots of licorice with antitumor effects in various cancers in vitro and in vivo. However, the role of LA in non-small cell lung cancer (NSCLC) remains largely unclear. METHODS: The cell viability was measured by MTT assay, Edu staining and colony formation assay. Apoptosis was investigated using Annexin V/PI double-stained assays with flow cytometry. Real-time quantitative RT-PCR was carried out to investigate the expression of mRNA of related proteins. Western blotting was used to investigate the expression of related proteins. RESULTS: The results show that LA inhibits the proliferation of NSCLC cells in a dose-dependent manner and induces apoptotic cell death. Moreover, LA significantly suppresses the expression of c-IAP1, c-IAP2, XIAP, Survivin, c-FLIPL and RIP1 without influencing the level of mRNA. Cycloheximide chase assay demonstrates that LA greatly decreases the stability of Survivin, XIAP and RIP1. Mechanistic studies indicate that LA induces cytoprotective autophagy since block of autophagy with CQ greatly enhances LA-induced anticancer activities. Furthermore, LA rapidly induces ERK and p38 activation in a time-dependent manner in both A549 and H460 cells, but suppresses the activities of c-Jun N-terminal kinase (JNK); suppression of ERK not p38 with inhibitor attenuates LA-induced autophagy, while it remarkably enhances LA-induced cytotoxicity in lung cancer cells and further promotes the degradation of apoptosis-related proteins. DISCUSSION: The results of this study provide novel insights on the role of apoptosis-related proteins and the MAPKs pathway in the anticancer activities of LA.

Association between functional polymorphisms in the promoter of the miR-143/145 cluster and risk of conotruncal heart defects.

Aim: Conotruncal heart defects (CTDs) are the most common form of congenital heart disease. We investigated the association of these two single-nucleotide polymorphisms (SNPs) in the promoter of miR-143/145 (rs353292 and rs4705343) with the susceptibility to CTDs in a Chinese population. Materials & methods: Two SNPs in the promoter of miR-143/145 (rs353292 and rs4705343) have been examined by PCR-RFLP methodology for 259 CTDs patients and 303 control subjects. Results: An association between SNP rs4705343 of miR-143/145 and CTDs has been confirmed in the Chinese Han population. Conclusion: Our results indicated that SNP rs4705343 in miR-143/145 is a potential genetic marker for CTDs in the Chinese Han population.