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The communication between professional health caregivers, which mainly composed of medical staff, and patients and their families plays an important role in hospice care. The effective doctor-patient communication can guide terminal patients and their families to establish a correct medical view, reduce excessive medical treatment, and improve the quality of life for terminal patients. This paper briefly described the communication context of hospice care, the communication subject and the current situation of hospice care, analyzed the problems and challenges encountered by professional health caregivers, which mainly including medical staff, in the communication context of hospice care diagnosis and hospice care, and made the prospects of the development of effective communication measures.
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Objective To investigate the mechanism of iron death induced by TRPC6/NF-κB in glomerular podiocytes mediated by high homocysteine(Hcy).Methods Mouse glomerulopocytes were cultured in vitro and divided into Control group(0 μmol/L Hcy)and Hcy group(80 μmol/L Hcy).After 48h of intervention,Western blot was used to detect the expression levels of iron death related proteins GPX4 and SLC7A11 and TRPC6 and NF-κ B.Real-time quantitative fluorescence PCR(qRT-PCR)and immunofluorescence were used to detect the expression of TRPC6.The level of podocyte apoptosis was detected by flow cytometry.Malondialdehyde(MDA)assay kit was used to determine intracellular MDA levels.After transfection of TRPC6 interference fragment and TRPC6 negative control(NC),qRT-PCR was divided into Control,si-NC and si-TRPC6(Si-TRPC6-1,Si-TRPC6-2,Si-TRPC6-3).Western Blot was divided into Control,Hcy,si-NC+Hcy,si-TRPC6+Hcy.The expression of TRPC6 mRNA was detected by qRT-PCR.The expression levels of GPX4,SLC7A11,NF-κB and TRPC6 were detected by Western Blot.The level of podocyte apoptosis after interference was detected by flow cytometry.Results(1)Compared with Control group,the expression levels of iron death related proteins GPX4 and SLC7A11 in Hcy group were decreased,and the apoptosis rate was increased(P<0.05).(2)Compared with Control group,TRPC6 protein,mRNA levels and immunofluorescence expression were increased in Hcy group.The level of MDA and the expression of NF-κB signaling pathway protein increased in Hcy group,and the comparison between the two groups had statistical significance(P<0.05).(3)Compared with the si-NC group,the mRNA expression level of TRPC6 in si-TRPC6(Si-TRPC6-1,Si-TRPC6-2,Si-TRPC6-3)group was decreased,and the interference effect of Si-TRPC6-3 was the best(P<0.05).After transfecting TRPC6 NC and TRPC6 interference fragment and administering Hcy,there was no difference in GPX4,SLC7A11,NF-κB and TRPC6 expression in si-NC+Hcy group compared with Hcy group.Compared with the si-NC+Hcy group,the si-TRPC6+Hcy group had higher expression of iron death related proteins,GPX4 and SLC7A11,lower expression of NF-κB and TRPC6,and decreased apoptosis rate(P<0.05).Conclusion This study confirmed that TRPC6/NF-κB can regulate iron death of renal podocytes under the induc-tion of Hcy,which is one of the mechanisms leading to kidney injury.
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BACKGROUND:Hyperhomocysteinemia is closely related to the function of islet β cells,but its specific molecular mechanism is not fully understood. OBJECTIVE:To investigate the role of N6 methyltransferase-like 3(METTL3)in homocysteine(Hcy)-induced autophagy of mouse islet β cells. METHODS:The 3rd and 4th generation mouse islet β cells were taken for the experiment.(1)Cell modeling and grouping:cells in control group were not treated with Hcy,while those in homocysteine group were treated with 100 μmol/L Hcy for 48 hours.(2)The mouse islet β-cells were transfected with the plasmids overexpressing Ad-METTL3 and si-METTL3 according to the instructions of LipofectamineTM 2000.Three different interfering fragments were designed,and the one with the best interfering efficiency was verified and screened by PCR.(3)After transfection,the cells were divided into control group,Hcy group,Ad-NC(negative control)+Hcy group,Ad-METTL3+Hcy group,si-NC(negative control)+Hcy group and si-METTL3+Hcy group.(4)qRT-PCR and western blot were used to detect the expression levels of METTL3 and autophagy-related proteins LC3Ⅱ/Ⅰ and p62 in cells.Insulin level was determined by ELISA to evaluate insulin secretion capacity of islet cells.Autophagy-related proteins and insulin level were detected after overexpression and interference with METTL3. RESULTS AND CONCLUSION:Compared with the control group,the expression level of LC3Ⅱ/Ⅰ was increased(P＜0.05),the expression of p62 was significantly reduced(P＜0.05),and the insulin secretion capacity was significantly decreased(P＜0.05)in the Hcy group.Compared with the control group,the protein and mRNA levels of METTL3 were reduced in the Hcy group(P＜0.05).After METTL3 silencing in islet β cells,Hcy further upregulated the expression of LC3Ⅱ/Ⅰ(P＜0.05),significantly dowregulated the expression of p62(P＜0.05),and increased the insulin level(P＜0.05).After overexpression of METTL3,Hcy significantly decreased the LC3Ⅱ/Ⅰ expression and increased the p62 expression in islet β cells(P＜0.05).To conclude,METTL3 is involved in the Hcy-induced autophagy regulation of islet β cells and plays a role in the regulation of insulin secretion.
الملخص
The communication between professional health caregivers, which mainly composed of medical staff, and patients and their families plays an important role in hospice care. The effective doctor-patient communication can guide terminal patients and their families to establish a correct medical view, reduce excessive medical treatment, and improve the quality of life for terminal patients. This paper briefly described the communication context of hospice care, the communication subject and the current situation of hospice care, analyzed the problems and challenges encountered by professional health caregivers, which mainly including medical staff, in the communication context of hospice care diagnosis and hospice care, and made the prospects of the development of effective communication measures.
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ObjectiveTo explore the relationship of the fragmented QRS (fQRS) and the fQRS time limit with ventricular arrhythmia in old myocardial infarction (OMI) patients through contrasting the incidence of ventricular arrhythmia in OMI patients whether fQRS or not and ventricular arrhythmia in different fQRS time limit.MethodsAccording to the routine electrocardiogram,321 OMI patients were divided into group A (fQRS appearance,167 cases) and group B(fQRS non-appearance,154 cases).The lead with fQRS extense was ehosen and traced another 50 mm/s electrocardiogram,and 3 consecutive fQRS time limit were measured and them average was taken in group A.According to the fQRS time limit,the patients in group A were divided into 3 groups: group X( ≤0.100 s,96 cases),group Y (0.101-0.119 s,54 cases) and group Z( ≥0.120 s,17 cases).All the patients were continuously monitored with 24 hours dynamic electrocardiogram,and the incidence of ventricular arrhythmia was analyzed.ResultsThe incidence of ventricular arrhythmia in group A [ 78.4％ ( 131/167 ) ] was higher than that in group B [ 63.6％(98/154) ] (P＜ 0.01 ).The incidence of premature ventricular contraction(PVC) ＞ 720/24 hours in group A [ 28.7％(48/167 ) ] was higher than that in group B[ 17.5％(27/154) ] (P ＜ 0.05 ).The incidence of multifocal PVC,coupled PVC,nonsustained ventricular tachycardia and Lown 3-5 grades PVC was 16.2％ (27/167),33.5％ (56/167),12.0％ (20/167),34.1％ (57/167) in group A,7.8％ (12/154),21.4％ (33/154),4.5％(7/154),23.4％(36/154) in group B,there were significant differences between two groups (P＜ 0.05 ).The incidence of ventricular arrhythmia in group Z [ 100.0％( 17/17 ) ] was significantly higher than that in group Y [79.6％(43/54)] and group X [74.0％(71/96)](P＜ 0.05).The incidence of Lown 3-5 grades PVC in group Z[ 70.6％( 12/17 )] was significantly higher than that in group Y[ 42.6％(23/54)] and group X [ 22.9％(22/96) ],and the incidence of Lown 3-5 grades PVC in group Y was significantly higher than that in group X (P＜ 0.05).ConclusionsOMI patients with fQRS have higher incidence and severe degree in ventricular arrlhythmia than those without fQRS.With the fQRS time limit widened,PVC and Iown 3-5 grades PVC significantly increased.So fQRS is a new predicting index of OMI,and fQRS time limit has definite value in predicting the heart event for OMI patients.
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Background To document the pharmacotherapy of chronic heart failure (CHF) and to evaluate the adherence to treatment guidelines in Australian population.Methods The pharmacological management of 677 patients (female 46.7%,75.5±11.6 years) with CHF was retrospectively analyzed.Results The use of angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and fl-blockers were 58.2%and 34.7%,respectively.Major reasons for non-use of ACE inhibitors/ARBs were hyperkalemia and elevated serum creatimne level.For patients who did not receive β-blockers,asthma and chronic obstructive pulmonary disease were the main contraindications.Treatment at or above target dosages for ACE inhibitors/ARBs and β-blockers was low for each medication (40.3% and 28.9%,respectively).Conclusions Evidenced-based medical therapies for heart failure were under used in a rural patient population.Further studies are required to develop processes to improve the optimal use of heart failure medications.
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To determine the level of awareness of hypertension and pharmacological management in patients from a rural community of Australia. A total of 665 patients were studied. Thepatients were recruited from Albury-Wodonga and surrounding districts, which are located in a rural area of south-eastern Australia. Demographic information and medical history were recorded for all patients. Clinical data were also recorded Of the 665 patients, 449 [75%] were hypertensive, and of these 449 hypertensive patients, 195 [43.4%] were aware that they had hypertension. Blood pressure was inadequately controlled in 399 of the hypertensive patients [88.9%] according to the management guidelines of the National Heart Foundation of Australia. Of all the patients who had hypertension, 247 [55.0%] were not receiving antihypertensive therapy. Of those receiving therapy, 132 [65.3%] were being administered only one antihypertensive [monotherapy]. The most commonly prescribed antihypertensive classes were angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, diuretics, beta-blockers and calcium channel blockers The level of awareness of hypertension and its management appeared to be poor in hypertensive patients living in this rural Australian community. Actual hypertension control was extremely poor, and a major potential cause of this may be the poor use of anti-hypertensive medications in these patients. Strategies to improve the awareness of hypertension and its required management in patients residing in rural communities are recommended
الموضوعات
Humans , Male , Female , Health Knowledge, Attitudes, Practice , Rural Population , Antihypertensive Agents/administration & dosage , Drug Utilization , Health Behavior , Awarenessالملخص
Objective To investigate the etiology and relative factors of dilated cardiomyopathy (DCM) in Chinese patients. Methods A case-control study was conducted to compare 233 patients with DCM in high-incidence areas (case group) and 150 patients with stable angina pectoris (control group). Life styles and history of diseases information was collected by questionaire; human anti-myocardial antibody IgG (AMA- IgG), human Coxsackie B virus IgG (CBV- IgG) and human adenovirus antibody IgG (ADV- lgG) were measured with ELISA. General chemical and toxicological indicators in drink water from high and low prevalence areas and serum trace elements also were compared. Results 1 ) Compared with the control group, the case group had more farmers (P < 0.01), with low average incomes (P < 0.01), higher alcohol consumption (P < 0.01) and higher incidence of the history of myocarditis (P < 0.01 ). 2) AMA-IgG, CBV-IgG and ADV-IgG levels were low and the positive rates ofAMA-IgG, CBV-IgG and ADV-IgG of patients with DCM were respectively 7.78%, 6.67% and 6.67%, no statistical significance comparing with those in the control group. 3) The content of iron (1.36±2.18 vs 0.39±0.67 mg/L, P<0.05) and manganese (0.384±0.35 vs 0.15±0.14, P<0.01 ) in drinking water of high-incidence areas was significantly higher than that in low-incidence areas. 4) The content of serum iron (69.14±57.8 vs 20.04±17.5 μ mol/L, P<0.01 ) and copper (25.74±4.2 vs 19.7±4.5 μmol/L, P<0.01) in the case group evidently exceeded the normal range and obviously higher than that in the control group. Conclusions 1) The incidence of some DCM is related with low incomes, high alcohol consumption and myocarditis. 2) These data do not support that DCM is related with persistent virus infection and autoimmunization; 3) Iron and manganese contents exceeding standards in drinking water and the high content of serum iron and copper is comparatively related with the incidence of DCM.
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Many studies have demonstrated a correlation between increasing age and adverse drug reactions. This increased risk is related to aged-related changes in pharmacokinetics and pharmacodynamics. In addition, chronic illnesses such as congestive heart failure, coronary artery disease and hypertension are more prevalent in the elderly who also have an increased risk of diabetes, arthritis and cancer. Consequently elderly patients are often treated with multiple medications, which may cause drug interactions and adverse drug reactions. Adequate undergraduate training in clinical pharmacology and continued professional development in evidence-based therapeutics will undoubtedly reduce inappropriate prescribing and improve the quality of medications. Good communications between physicians and patients are also critically important in avoidance or prevention of adverse drug reactions in the elderly.
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Objective Brain natriuretic peptide(BNP) is released from the cardiac ventricles in response to increased wall tension. The prognostic significance of blood brain natriuretic peptide in Chinese patients with cardiovascular disease has not been established. The purpose of this study was to investigate the value of brain natriuretic peptide for predictin g cardiac death within 1 month in Chinese patients with cardiovascular disease. Methods One hundred and seven inpatients with cardiovascular disease, whose blood brain natriuretic peptide concentration were measured within 1 - 3 days of admission, using triage BNP test, were divided into 2 groups: the survival and the non-survival, according to the results of 1was positively correlated with heart rate, left ventricular end-diastolic dimension, history of heart failure and old myocardial infarction (r=0.28, P=0. 000 4; r=0.49, P＜0. 000 5; r=0.39, P＜0. 000 5; r=Area under the curve of the receiver-operating-characteristic(ROC) of brain natriuretic peptide to predict cardiac death at 1 month in patients with cardiovascular disease was 0.89%, 95% confidence interval 0.79-0. 98, P＜0. 000 5; stepwise logistic regression analysis indicated that brain natriuretic peptide (≥755pg/mL) was the only independent predictor of cardiac death at 1 month in patients with cardiovascular disease (OR= 17.6, 95 % confidence interval, 8.7- 66.5, P＜0. 000 5 ). Conclusion Brain natriuretic peptide might predict cardiac death at 1 month in patients with cardiovascular disease.
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Objective To investigate the safety and efficacy of a 3-pulmonary vein (PV) isolation approach in treating paroxysmal atrial fibrillation (AF). Methods Radiofrequency catheter ablation was used to eliminate PV potential in 11 patterns with frequent paroxysmal AF refractory to anti-arrhythmic agents. During sinus rhythm, PV potential was mapped in the left and right superior PVs and left inferior PV. The procedural success was defined as the elimination of PV potential in the 3 PVs. Restults PV potential was identified and abolished in a total of 24 PVs, mostly in the left and right superior PV. There was no pulmonary stenosis or other complications during or after the procedures. AF recurred in one patient after an average of 12 ± 3 month follow-up. Conclusions PV potemials were present mostly in the left or right superior PV. The 3-PVs isolation approach is safe and effective in preventing drug-resistant paroxysmal AF.
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Objective: To investigate the levels of understanding and implementation of current hypertension guidelines among specialist physicians
Subjects and Methods: A survey of the understanding and practice in the management of hypertension was conducted among 56 physicians who individually had managed more than 150 new hypertensive patients annually
Results: All respondents were familiar with the current hypertension guidelines and 51.8% always or usually followed these guidelines in treating their patients. Most believed that the lowest blood pressure where pharmacological therapy should be initiated was 155/95 mm Hg. Forty-five [80.4%] physicians considered a blood pressure of less than 140/ 90 mm Hg should be achieved in hypertensive patients. Only 12 [21.4%] respondents provided routine advice on lifestyle modification to their patients. Fifty-four [96.4%] respondents ranked poor adherence to antihypertensive drugs as the major patient barrier to blood pressure control
Conclusions: Most physicians are familiar with the current hypertension guidelines but the implementation of these guidelines in clinical practice is inadequate. Systematic educational programs are needed to enhance physicians' awareness of the optimal goals of blood pressure control
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0.05),respectively.Conclusions Sodium channel blocker procainamide results in a similar repolarisation prolongation in the epicardium,midmyocardium and endocardium of the left ventricle.
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Objective To investigate the effect of ?-blockers on spatial dispersion of ventricular repolarization following acute myocardial ischemia.Methods Twenty sheep were randomized into control(normal saline i.v.)and atenolol group.Acute myocardial ischemia was induced by occlusion of the obtuse marginal coronary artery.Unipolar ECG was simultaneously acquired from 64 epicardial sites in both ischemic and non-ischemic regions.Activation-recovery intervals(ARI)were determined from the epicardial ECGs.The difference between the longest and shortest ARI was defined as ARI dispersion.Results Ischemic zone in the atenolol group was less than that of the control group[(13?2)% vs (19?3)%,P
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Aim To investigate the effect of carbachol on ventricular repolarization in an intact animal heart.Methods In 4 sheep,carbachol was injected to the left circumflex coronary artery(LCX) at 1.0 mol?L~(-1) and 2.5 mol?L~(-1) respectively.Multiple unipolar ECGs were acquired from the epicardium of the LCX territory.Activation-recovery interval(ARI) was analysed from these ECGs.Administration with 2.5 mol?L~(-1) was also repeated after pre-treatment with nitro-L-arginine(20 mg?kg~(-1)),a nitric oxide synthase inhibitor.Results Intracoronary injection with carbachol at 1.0 mol?L~(-1) or 2.5 mol?L~(-1) increased ARI by(38?17) ms and(58?14) ms,respectively(P
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M-mode and pulsed Doppler echocardiography was used to evaluate the changes in structure and function of the left ventricle in 30 patients with chronic renal failure (CRF).The left ventricular mass index (LVMI) and systolic function were unchanged in the early stage of the CRF cases as compared with those of the controls (n = 30). However, the decrement in VE (early peak filling velocity) and the increase in VA/VE (late to early peak velocity ratio) indicated damage of the diastolic function. After 13 months follow-up, the LVMI of the CRF group elavated significantly and the VE diminished further.The ejection fraction (EF), shortening fraction (FS) and circumferencial muscular shortening velocity (mVcf) were decreased as compared with those before the follow up. 47.7% of the patients showed left ventricular heart failure.