术前血浆磷脂转运蛋白水平与冠状动脉旁路移植术后 新发心房颤动的相关性

目的 探讨术前血浆磷脂转运蛋白(PLTP)水平与冠状动脉旁路移植术(CABG)后新发房颤(POAF)的相关性及其诊断价值。方法 自2015年1月至2016年6月,在中国医学科学院北京协和医学院泰达国际心血管病医院就诊并接受单独CABG手术的所有病人中,选取40例发生POAF的病人为AF组,未发生POAF的病人40例,为SR组。测量两组病人术前血浆中PLTP水平,评价其与POAF的相关性与其对POAF的诊断价值。结果 AF组PLTP水平(1.5±1.5) mg/mL显著低于SR组 (2.6±1.6) mg/mL(P=0.004);在矫正POAF发生的相关变量后,PLTP仍与POAF独立相关;ROC分析显示PLTP诊断POAF的曲线下面积(AUC)为0.74(P<0.001),其临界值为0.43 mg/mL。结论 发生CABG术后POAF的病人血浆中PLTP水平较未发生病人为低;术前血浆中PLTP水平与CABG术后POAF的发生独立相关,且可能为POAF发生的可靠预测指标。     

Performance of the Steno type 1 risk engine for cardiovascular disease prediction in Italian patients with type 1 diabetes

Background and aimsPremature cardiovascular disease cause excess mortality in type 1 diabetes (T1D). The Steno T1D Risk Engine was developed and validated in northern European countries but its validity in other populations is unknown. We evaluated the performance of the Steno T1D Risk Engine in Italian patients with T1D.Materials and methodsWe included patients with T1D with a baseline visit between July 2013 and April 2014, who were free of cardiovascular disease and had complete information to estimate risk. The estimated cardiovascular risk score was compared with the 5-year rate of cardiovascular events by means of logistic regression.ResultsAmong 223 patients (mean age 43 ± 13 years, 34.5% male, mean duration of diabetes 22 ± 12 years) the mean estimated cardiovascular risk at 5 years was 5.9% (95% C.I. 5.2–6.5%). At baseline, high estimated risk discriminated the presence of asymptomatic atherosclerosis better than microangiopathy, and was not associated with markers of inflammation or endothelial activation. After a mean follow-up of 4.7 ± 0.5 years, only 3 cardiovascular events were observed and nonetheless the risk score was significantly associated with their incidence (OR 1.22; 95% C.I. 1.08–1.39, p = 0.001). However, the observed event rate was significantly lower than the estimated one (3 vs 13; 95% C.I. 12–14; p < 0.001).ConclusionThe Steno T1D Risk Score identified subjects with subclinical atherosclerosis and high cardiovascular risk in an Italian T1D population. However, the absolute risk was significantly overestimated. Further studies in larger population are needed to confirm these results.     

In-situ simulation for nursing students' professional competence development in postanesthesia care: A quasi-experimental study

AimTo evaluate the differences in professional competence development between nursing students in routine clinical practice and those who experienced four additional in-situ simulations.BackgroundThe amount of clinical practice time available to nursing students is limited. Occasionally, clinical settings do not provide all of the content that nursing students are expected to acquire. In high-risk clinical scenarios, such as the postanesthesia care unit, clinical practice may not provide sufficient context for students to develop the professional competence.DesignThis was a non-blinded, non-randomized, quasi-experimental study. The study was conducted in the postanesthesia care unit of a tertiary hospital in China between April 2021 and December 2022. Nursing students' self-assessed professional competence development and faculty-assessed clinical judgment were used as indicators.MethodsA total of 30 final year undergraduate nursing students were divided into two groups according to the time they arrived at the unit for their clinical practice. Nursing students in the control group followed the routine teaching protocol of the unit. Students in the simulation group received four additional in-situ simulations during the second and third weeks of their practice in addition to the routine program. Nursing students self-assessed their postanesthesia care unit professional competence at the end of the first and fourth weeks. At the end of the fourth week, the nursing students were evaluated on their clinical judgment.ResultsNursing students in both groups scored higher on the professional competence at the end of the fourth week than at the end of the first week and there was a trend of higher competence improvement in the simulation group than in the control group. For clinical judgment, nursing students in the simulation group scored higher than the control group.ConclusionsIn-situ simulation contributes to the development of professional competence and clinical judgment of nursing students during their clinical practice in the postanesthesia care unit.     

Methylation status of the T-cadherin gene promotor in peripheral blood mononuclear cells is associated with HBV-related hepatocellular carcinoma progression

DNA methylation is one of the epigenetic mechanisms to regulate gene expression and frequently occurs in human cancer cells. T-cadherin (CDH13) is a new member of the cadherin superfamily and possesses multiple functions. Our study included 26 normal controls (NCs), 65 chronic hepatitis B patients (CHB), 14 liver cirrhosis patients (LC) and 157 hepatocellular carcinoma patients (HCC). We mainly focused on the mRNA expression and methylation status of CDH13 in peripheral blood mononuclear cells (PBMCs), which were detected by semi-quantitative real-time polymerase chain reaction (RT-qPCR) and methylation-specific polymerase chain reaction (MSP) respectively. The CDH13 mRNA level was lower in HCC, especially in early-stage of HCC than in NCs and CHB groups (p < 0.05). Methylation frequency of the CDH13 promoter was significantly higher in HCC patients than in the NCs and CHB groups (67.52 % vs 0.00 %, p < 0.001, 67.52 % vs 52.31 %, p < 0.05, respectively). CDH13 mRNA level was significantly and relatively lower in methylated groups than in unmethylated groups among the whole participants. The methylation level of CDH13 promoter in HCC might be influenced or partly influenced by some critical factors such as TBil, ALB and AFP (p < 0.05). As an important factor in signaling pathway regulating by CDH13 to promote carcinogenesis, JNK level was significantly higher in HCC which had a higher methylation frequency than in NCs, CHB and LC (p < 0.05). Furthermore, the combination of the methylated CDH13 level and AFP level showed a better score: AUC = 0.796 (SE = 0.031, 95 %CI 0.735–0.857; p < 0.001) in male and AUC = 0.832 (SE = 0.057, 95 %CI 0.721–0.944; p < 0.001) in female compared to AFP alone for diagnosing HCC from NCs, CHB and LC. The methylation of CDH13 promoter was an independent predictor for assessing the prognosis of HCC patients (r=-1.378 p < 0.05). In conclusion, hypermethylation of CDH13 in PBMCs was associated with the underexpression of mRNA and the high risk of HCC. The methylation status of the CDH13 promoter in PBMCs was a potential noninvasive biomarker to predict the prognosis of HCC patients.     

Colon cancer bears overexpression of OTUB1

ObjectiveOTUB1 is a member of deubiquitinating enzymes; however, its expression and function in colon cancer are still unclear. The present study aimed at investigating the expression of OTUB1 in colon cancer and the relationship between the expression and some clinicopathologic parameters.MethodsImmunohistochemistry and quantitative real-time PCR were carried out in selected colon cancer and normal mucosa tissues.ResultsThe expression of OTUB1 protein in the colon cancer was significantly higher than normal mucosa, and the OTUB1 mRNA in colon cancer was also 3.15-fold higher than the normal mucosa. The higher expression of OTUB1 in colon cancer was related with tumor size, differentiation and lymph node metastasis.ConclusionsOTUB1 may play an important role in colon cancer development and metastasis.