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Chronic heart failure (CHF) is a progressive life-limiting condition that necessitates early implementation of advance care planning (ACP). However, patients and caregivers encounter emotional, informational, and cultural barriers to effective ACP engagement. This meta-synthesis consolidates qualitative evidence to deepen our understanding of ACP practices in CHF care.
This study aimed to explore experiences of CHF patients and their caregivers in ACP, which is defined as a proactive decision-making process to establish future treatment plans based on patients' values. The study also aimed to identify barriers and facilitators influencing ACP decisions and assess the impact of flexible, personalized ACP approaches on care quality.
Using qualitative meta-synthesis, we analyzed 10 qualitative studies on CHF patients' and caregivers' ACP experiences. Data were thematically synthesized to identify emotional, relational, and practical factors that influence engagement in ACP.
Three themes emerged: (1) heart failure patients and caregivers face difficulties in ACP (difficulties from patients, difficulties from the family, and difficulties from the society), (2) multidimensional drivers and impacts of ACP (advance care planning drivers, acceptance and implementation of ACP, emotions and effects of ACP), (3) flexible, personalized ACP delivers tangible benefits (timing and effectiveness of ACP discussions, patients and caregivers have personalized needs for ACP, and patients and caregivers affirm ACP benefits).
ACP plays a critical role in improving end-of-life care quality and reducing emotional and decision-making burdens on caregivers. Flexible and personalized ACP strategies supported by trained healthcare professionals more effectively meet the unique needs of patients and families. To overcome persistent barriers and promote broader ACP adoption, healthcare systems should prioritize provider communication training, ACP education, and support systems tailored to diverse cultural contexts.
Cardiovascular disease (CVD) is a leading cause of mortality and disability worldwide, posing significant challenges to the quality of healthcare services. Social Cognitive Theory (SCT) provides a framework for understanding individual behaviors and guides the development of intervention programs aimed at promoting health-enhancing behaviors.
To evaluate the effectiveness of interventions based on SCT in improving health outcomes among patients with CVD.
From the creation of the databases until September 2024, we searched six databases and manually searched the references included in the study. The outcomes included cardiovascular risk factors (weight, blood pressure, blood lipids), physical capacity (6-min walk test, physical activity, daily steps, exercise self-efficacy), psychological states (anxiety, depression), and health behaviors (self-management, self-efficacy, quality of life). The quality of randomized controlled trials was evaluated with the Cochrane RoB 2 tool, and quasi-experimental studies were assessed using the JBI critical appraisal tool.
A total of 10 studies, involving 1140 participants, were included in the review. Compared to conventional cardiovascular care, interventions based on SCT were able to lower systolic blood pressure (MD = −6.36; 95% CI [−11.30, −1.41]; p = 0.012), total cholesterol (MD = −0.29; 95% CI [−0.49, −0.09]; p = 0.004), and low-density lipoprotein levels (MD = −0.21; 95% CI [−0.38, −0.04]; p = 0.015) in CVD patients. They also increased the 6-min walk test distance (MD = 33.87, 95% CI [5.40, 62.34], p = 0.02) and daily steps (SMD = 0.77; 95% CI [0.46, 1.09]; p < 0.001), improved physical activity (SMD = 0.65; 95% CI [0.25, 1.06]; p = 0.002) and exercise self-efficacy (SMD = 1.23, 95% CI [0.23, 2.23], p = 0.016), and enhanced quality of life (SMD = 0.75, 95% CI [0.06, 1.43], p = 0.032).
Social cognitive theory-based interventions hold promise for improving health outcomes in patients with cardiovascular disease. This study provides further insights into the application of SCT in clinical practice. However, given the limited number of included studies and the potential risk of bias, further high-quality research is required to validate these findings.
This study investigated the current status of nutrition literacy and related influencing factors in stroke patients, with a view to providing a reference for the development of targeted interventions.
Cross-sectional study.
A convenience sampling method was used to select 342 stroke patients from June to November 2024 as the study population, and a cross-sectional survey was conducted using the General Information Questionnaire, Nutrition Literacy Scale, Herth Hope Scale, Chronic Disease Self-Efficacy Scale and Social Support Rating Scale. Descriptive analysis, independent samples t-test, one-way ANOVA, Pearson's correlation analysis and multiple linear regression analysis were used for data analysis.
The results showed that the nutrition literacy score of stroke patients was 122.24 ± 16.66, and gender, age, education level, monthly per capita family income, nutrition education, hope level, self-efficacy and social support were the factors affecting the nutrition literacy of stroke patients (all p < 0.05).
According to the study, stroke patients' nutrition literacy has to be raised, and medical practitioners should create focused intervention plans to raise patients' nutrition literacy levels.
Healthcare professionals should assess the level of nutritional literacy in order to provide targeted interventions. The establishment of a multidisciplinary care team and implementation of long-term nutritional management after stroke are essential to reduce stroke recurrence and mortality.
The study adhered to the STROBE checklist.
No patient or public contribution.
by Linlin Yang, Jianhua Chen, Hui Miao, Na Li, Huilin Bi, Ruizhi Feng, Congxiu Miao
Polycystic ovary syndrome (PCOS) is a prevalent yet complex reproductive endocrine disorder affecting 11–13% of women worldwide. Its main symptoms include elevated androgen levels, irregular menstrual cycles, and long-term metabolic and offspring health implications. Despite the disease’s multifaceted nature involving genetic, epigenetic, and environmental factors, the role of alternative splicing in ovarian granulosa cells remains relatively unexplored. This study aims to investigate the transcriptional and alternative splicing characteristics of granulosa cells in PCOS patients and to elucidate the potential functional consequences of these changes. Analysis of previous published transcriptome sequencing data identified 491 upregulated and 401 downregulated genes in granulosa cells of PCOS patients, significantly involved in immune-related processes. Additionally, 1250 differential splicing events, predominantly involving exon skipping and affecting 947 genes, were detected. These genes with alternative splicing patterns were found to be enriched in endoplasmic reticulum stress and protein post-translational modification processes, suggesting their role in PCOS pathology. Moreover, the study highlighted that the utilization of different splice isoforms of the YAP1 gene may impact its interaction in the Hippo signaling pathway, influencing the pathogenesis of PCOS. These findings underscore substantial alterations in alternative splicing in granulosa cells of PCOS patients, providing a novel viewpoint for comprehending the molecular underpinnings of PCOS and suggesting potential avenues for therapeutic intervention.by Miao Cheng, Siqi Xiao, Shaer Kayi, Yujie Guan, Yingxin Liu, Jianmei Chen, Hua Chen, Lei Wang, Xiaojin He
ObjectiveAnkylosing spondylitis (AS) patients often present with microscopic signs of gut inflammation. We used proteomic techniques to identify the differentially expressed proteins (DEPs) in the colon tissues of patients with AS and patients with gut inflammation, and then used investigated the influence of NMRAL1 protein on inflammatory cytokines to explore its potential role in the pathogenesis of AS and gut inflammation.
MethodsColonic mucosal tissues were collected from four different groups: healthy individuals (group A), patients with gut inflammation only (group B), patients with AS only (group C), and patients with AS combined with gut inflammation (group D). A total of 20 samples were processed for proteomic analysis, wherein proteins were extracted using SDT lysis, followed by separation via sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS-PAGE). The proteins were digested using the filter-aided sample preparation (FASP) method and then analyzed using a timsTOF Pro mass spectrometer. The resulting peptide data were used to identify differentially expressed proteins (DEPs) across the different groups. To further explore the inflammation-related function of NMRAL1 protein, the murine monocyte/macrophage cell line RAW264.7 was used. NMRAL1 mRNA expression levels were assessed via RT-qPCR, and inflammatory cytokine levels (TNF-α, IL-1β, IL-17 and IL-23) were measured using ELISA following NMRAL1 siRNA transfection in LPS-treated macrophages.
ResultsWe collected colonic mucosa specimens from 20 patients, including groups A,B, C and D with 5 patients in each group. We established a database of DEPs and identified 107 (63 upregulated and 44 downregulated) between group B and group A, 78 (16 upregulated and 62 downregulated) between group D and group C, 45 (8 upregulated and 37 downregulated) between group D and group B, and 57 (33 upregulated and 24 downregulated) between group C and group A. Further analysis revealed that the NmrA-like family domain containing 1 (NMRAL1) protein was identified as a DEP specifically associated with group D. The results of in vitro results showed a significant decrease in NMRAL1 mRNA expression in LPS-treated cells (PPPPPPP Conclusion
NMRAL1 is identified as a key differentially expressed protein in AS patients with gut inflammation. Knockdown of NMRAL1 significantly reduced the levels of inflammatory cytokines, suggesting its potential role in the pathogenesis of AS and gut inflammation, and as a possible therapeutic target.
This study aims to comprehensively compare the effects of unicondylar knee arthroplasty (UKA) and high tibial osteotomy (HTO) on wound infection and pain in patients with medial knee osteoarthritis. A computerized search was conducted in Embase, PubMed, Google Scholar, China National Knowledge Infrastructure, Cochrane Library and Wanfang databases, from database inception to October 2023, for studies comparing UKA and HTO for medial knee osteoarthritis. Studies selection, data extraction and study quality evaluation were independently conducted by two researchers. Stata 17.0 software was employed for data analysis. Overall, 10 studies involving 870 patients with medial knee osteoarthritis were included. It was found that the UKA group had significantly lower wound visual analogue scale scores compared to the HTO group (SMD = -0.53, 95%CI: −0.87 to −0.20, p < 0.001). The incidence of wound infection in the UKA group was higher than in the HTO group (OR = 1.92, 95%CI: 0.65–5.69, p = 0.240), and the incidence of complications was lower (OR = 0.89, 95%CI: 0.52–1.54, p = 0.684), though these differences were not statistically significant. This study indicates that UKA is effective in alleviating postoperative wound pain in medial knee osteoarthritis. However, the rates of postoperative wound infection and complications are comparable to those of HTO. Clinicians should consider factors such as patient age and disease severity in making individualized treatment decisions.
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