Development and validation of a nomogram to predict postoperative delirium in type B aortic dissection patients underwent thoracic endovascular aortic repair.

Objective: Postoperative delirium (POD) is a common postoperative complication after cardiovascular surgery with adverse outcomes. No prediction tools are currently available for assessing POD in the type B aortic dissection (TBAD) population. The purposes of this study were to develop and validate a nomogram for predicting POD among TBAD patients who underwent thoracic endovascular aortic repair (TEVAR). Methods: The retrospective cohort included 631 eligible TBAD patients who underwent TEVAR from January 2019 to July 2021. 434 patients included before 2021 were in the develop set; 197 others were in the independent validation set. Least absolute shrinkage and selection operator (LASSO) and logistic regression were applied to identify the most useful predictive variables for constructing the nomogram. Discrimination and the agreement of the model was assessed with the area under the receiver operating characteristic curve (AUC), Brier score and the Hosmer-Lemeshow goodness-of-fit test. The results were validated using a bootstrap resampling and the validation set. Results: The incidence rate of POD observed in the development and validation cohort were 15.0% and 14.2%, respectively. Seven independent risk factors, including age ≥60 years, syncope or coma, postoperative blood transfusion, atelectasis, estimated glomerular filtration rate (eGFR) <80 ml/min/1.73 m2, albumin <30 g/L, and neutrophil to lymphocyte ratio, were included in the nomogram. The model showed a good discrimination with an AUC of 0.819 (95% CI, 0.762-0.876) in the developed set, and adjusted to 0.797 (95% CI, 0.735-0.849) and 0.791 (95% CI, 0.700-0.881) in the internal validation set and the external validation, respectively. Favorable calibration of the nomogram was confirmed in both the development and validation cohorts. Conclusion: The nomogram based on seven readily available predictors has sufficient validity to identify POD risk in this population. This tool may facilitate targeted initiation of POD preventive intervention for healthcare providers.

Impact of the COVID-19 pandemic on patients with chronic kidney disease: A narrative review.

ABSTRACT: Severe acute respiratory disease coronavirus 2 is currently causing the coronavirus disease 2019 (COVID-19) pandemic, placing extreme strain on the global health system. Vaccination is the main measure for preventing the COVID-19 epidemic, especially for high-risk groups including patients with chronic kidney disease (CKD). However, CKD patients receiving dialysis or kidney transplant may be characterized by decreased renal function and immune disorders, which may have uncertainties in their health. This overview aims to introduce the possible impact of the COVID-19 vaccine on kidney disease and its application in patients with CKD to provide evidence for the COVID-19 vaccine in patients with CKD. The data for this study were collected from PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and the China Knowledge Resource Integrated Database (CNKI). The following keywords were used: "COVID-19", "COVID-19 vaccine," and "CKD". The publication time of the papers was set from the establishment of the databases to September 2021. A total of 47 studies were included, and patients with CKD are a high-risk group for COVID-19 infection and severe illness. Vaccination is a powerful tool for preventing CKD patients from COVID-19. Because of possible side effects, the recurrence or deterioration of kidney disease may occur in CKD patients after vaccination. Although vaccination for patients with CKD remains a problem, with the advantages outweighing the disadvantages, stable CKD patients should complete a vaccination plan, and doctors should be aware of the recurrence or deterioration of kidney disease and close monitoring. DATA ACCESS STATEMENT: Research data supporting this publication are available from the electronic databases of PubMed, Cochrane Library, Embase, ClinicalTrials.gov, and the China Knowledge Resource Integrated Database (CNKI).

Preliminary evaluation of the Chinese version of the patient-reported outcomes measurement information system 29-item profile in patients with aortic dissection.

BACKGROUND: The Patient-Reported Outcomes Measurement Information System 29-item Profile (PROMIS-29) has been widely used to measure health outcomes from the patient's perspective. It has not been validated in adults with aortic disease. The aim of this study was to explore the reliability and validity of the Chinese PROMIS-29 among patients undergoing surgery for aortic dissection (AD). METHODS: A cross-sectional design was applied. Eligible patients completed a questionnaire that contained the PROMIS-29 and legacy measures, including the Short Form-12 Health Survey (SF-12), 8-item Somatic Symptom Scale (SSS-8), Generalized Anxiety Disorder-2 (GAD-2), and Patient Health Questionnaire-2 (PHQ-2). The structural validity of the PROMIS-29 was evaluated using confirmatory factor analysis (CFA). Reliability was evaluated with Cronbach's α. Construct validity was assessed by calculating Spearman's rank correlations and comparing known-group differences. RESULTS: In total, a sample of 327 AD patients was included in the final analysis. Most of them were male (89%) with a mean age of 52.7 (± 10.3). CFA revealed good model fit of the seven-factor structure within PROMIS-29, as well as most domains in single-factor analysis. Reliability was confirmed with Cronbach's α > 0.90. Correlations between comparable domains of the PROMIS-29 and those of legacy questionnaires and most know-group comparisons were observed as hypothesized. CONCLUSIONS: This study found evidence for acceptable structural validity, construct validity and internal consistency of the PROMIS-29 in a sample of AD patients. It can be applied to AD survivors by researchers or clinicians, measuring outcomes after surgery and identifying those with worse health status.

Illness perceptions and adherence to breast cancer-related lymphedema risk management behaviours among breast cancer survivors.

PURPOSE: To describe illness perceptions of breast cancer-related lymphedema (BCRL) and adherence to BCRL risk management behaviours and analyse the relationship between these factors in postoperative breast cancer survivors in China. METHODS: A cross-sectional study was conducted in the first half of 2019 using 281 breast cancer survivors. Participants' illness perceptions and adherence to BCRL risk management behaviours at the 3rd month after surgery were investigated using the Revised Illness Perception Questionnaire for BCRL (IPQ-R [BCRL]), Lymphedema Risk Management Behaviour Questionnaire (LRMBQ), and Functional Exercise Adherence Scale (FEAS). The relationship between these variables was studied using correlation analysis and multiple linear regression analysis. RESULTS: Among the four dimensions of the LRMBQ, the mean score of our respondents received in "skin care" was 3.63 (S.D. 0.67), which was the lowest on the dimension, demonstrating the worst performance in this aspect. Regarding the FEAS results, better functional exercise adherence was observed in our sample compared to previous Chinese research. The results also showed that adherence to BCRL risk management behaviours was related to patient age and degree of education. Furthermore, other dimensions of illness perceptions, such as consequence, timeline acute/chronic, illness coherence and identity, follow their multiple linear regression equations with their corresponding BCRL risk management behaviour adherence. CONCLUSIONS: Our findings confirmed the importance of illness perceptions for adherence to BCRL risk management behaviours, suggesting that we need to pay attention to patients' cognition in this respect and supply necessary interventions.

Psychometric evaluation of the Chinese version of the revised illness perception questionnaire for breast cancer-related lymphedema.

The aim of this study was to modify and test the Chinese version of the Revised Illness Perception Questionnaire to measure the illness perception of breast cancer-related lymphedema among breast cancer survivors. Before the investigation, identity and causal subscales were modified and the wording of the remaining scales was also adjusted. The psychometric properties of this instrument was evaluated using the technique of explore and confirmatory factor analysis. Data from 203 breast cancer survivors was entered into factor analysis. Five causal factors were extracted after removing one item, accounting for 68.02% of the variance in total. An acceptable fit with the data for the proposed seven-factor model was obtained after eliminating three items and resetting seven error covariances. The Cronbach's α values and composite reliability coefficients were acceptable. This measurement is reliable and valid for measuring illness perceptions of breast cancer-related lymphedema in Chinese breast cancer survivors. It could be helpful for further studies that examine the effect of illness perceptions on health-related behaviours, such as lymphedema risk-reduction behaviours in the Chinese cultural context.

Illness perceptions of Chinese women with breast cancer and relationships with socio-demographic and clinical characteristics.

AIMS: The aim of the study is to explore the illness perceptions of Chinese women with breast cancer and relationships with their socio-demographic and clinical characteristics. METHODS: A descriptive, correlational, and exploratory design was used. The Chinese version of the Revised Illness Perception Questionnaire was modified and used to collect data. RESULTS: Of the 16 common symptoms of breast cancer, the participants recognized only 2.81 symptoms, on average. Of the 6 causal factors, "uncontrollable factors" had the highest mean score, while "behavioural factors" received the lowest score. Most of the participants knew little about the disease, perceived that this illness is cyclic in nature and would not last for a long time, believed that the illness could have serious consequences but could be controlled, and reported having negative emotional responses to this illness. Most of the dimensions of illness perception were significantly correlated with one another. Furthermore, some socio-demographic and clinical characteristics were confirmed to be predictors of illness perceptions. CONCLUSIONS: These findings suggest that illness perceptions should be regarded as a whole to guide the coping process of Chinese women with breast cancer and provide new clinical information to support care for this group.

Activation of Sirtuin 3 by Silybin Attenuates Mitochondrial Dysfunction in Cisplatin-induced Acute Kidney Injury.

Silybin is a secondary metabolite isolated from the seeds of blessed milk thistle (Silybum marianum) that has anti-inflammatory, antioxidative, antifibrotic, and antitumor properties. Here, we showed that silybin protected against cisplatin-induced acute kidney injury (AKI) by improving mitochondrial function through the regulation of sirtuin 3 (SIRT3) expression. Male SV129 and SIRT3 knockout (KO) mice were administered a single intraperitoneal (i.p.) injection of cisplatin with or without treatment with silybin. Moreover, cultured HK2 cells were used to evaluate mitochondrial morphology and function. Our data suggested that silybin enhanced SIRT3 expression after cisplatin administration both in vivo and in vitro. Silybin treatment improved mitochondrial function and bioenergetics in wild-type, but not SIRT3-defective, cells and mice. Moreover, we demonstrated that silybin markedly attenuated cisplatin-induced AKI and tubular cell apoptosis and improved cell regeneration in a SIRT3-dependent manner. Collectively, these results suggest that silybin is a pharmacological activator of SIRT3 capable of protecting against cisplatin-induced tubular cell apoptosis and AKI by improving mitochondrial function. Thus, silybin could serve as a potential clinical renoprotective adjuvant treatment in cisplatin chemotherapy.

The RhoA/ROCK Pathway Ameliorates Adhesion and Inflammatory Infiltration Induced by AGEs in Glomerular Endothelial Cells.

A recent study demonstrated that advanced glycation end products (AGEs) play a role in monocyte infiltration in mesangial areas in diabetic nephropathy. The Ras homolog gene family, member A Rho kinase (RhoA/ROCK) pathway plays a role in regulating cell migration. We hypothesized that the RhoA/ROCK pathway affects adhesion and inflammation in endothelial cells induced by AGEs. Rat glomerular endothelial cells (rGECs) were cultured with AGEs (80 µg/ml) in vitro. The ROCK inhibitor Y27632 (10 nmol/l) and ROCK1-siRNA were used to inhibit ROCK. We investigated levels of the intercellular adhesion molecule 1 (ICAM-1) and monocyte chemoattractant protein1 (MCP-1) in rGECs. Db/db mice were used as a diabetes model and received Fasudil (10 mg/kg/d, n = 6) via intraperitoneal injection for 12 weeks. We found that AGEs increased the expression of ICAM-1 and MCP-1 in rGECs, and the RhoA/ROCK pathway inhibitor Y27632 depressed the release of adhesion molecules. Moreover, blocking the RhoA/ROCK pathway ameliorated macrophage transfer to the endothelium. Reduced expression of adhesion molecules and amelioration of inflammatory cell infiltration in the glomerulus were observed in db/db mice treated with Fasudil. The RhoA/ROCK pathway plays a role in adhesion molecule expression and inflammatory cell infiltration in glomerular endothelial cells induced by AGEs.