The Impact of Finerenone on Changes in Pulse Wave Velocity, Arterial Pressure and Heart Related Deaths in Hemodialysis Patients—Study Perspective

The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order of (research background), purpose/aim, method, results and conclusions. The introduction of the abstract and preface is rather lengthy, but the summary of the whole study and the presentation of the research background are not perfect (mainly because the logic of the context is not clear and orderly), so it will appear a bit messy. Hope to be able to modify (this has been mentioned in the preliminary opinion). Cardiovascular events (CVE) pose a significant threat to individuals with end-stage renal disease (ESRD), yet these patients are often excluded from cardiovascular clinical trials, leaving prognostic factors associated with CVE in ESRD patients largely unexplored. Recent human studies have demonstrated elevated circulating aldosterone levels in ESRD patients, correlating with left ventricular hypertrophy. Additionally, animal models have shown improvements in uremic cardiomyopathy with spironolactone therapy, prompting interest in assessing the efficacy of spironolactone or eplerenone in reducing mortality and improving cardiovascular function in dialysis patients. Clinicians have historically been cautious about prescribing mineralocorticoid receptor antagonists (MRAs) to congestive heart failure patients with chronic kidney disease (CKD) due to hyperkalemia risk. However, the emergence of finerenone, a novel MR antagonist with a favorable safety profile and lower hyperkalemia risk, has renewed interest in MRA therapy in this population. Heart disease, including coronary artery disease, hypertension, and left ventricular failure, is alarmingly prevalent in dialysis patients, contributing significantly to elevated mortality rates compared to the general population. Arterial stiffness, as indicated by pulse wave velocity (PWV), progressively worsens with advancing CKD stages, peaking in severity among ESRD patients undergoing dialysis. High PWV serves as a crucial risk stratification tool in ESRD. Elevated NT-proBNP and BNP levels in ESRD patients are well-documented, with significant associations observed between baseline peptide concentrations and cardiovascular morbidity and mortality. By incorporating finerenone into our study, we aim to investigate its potential benefits in reducing arterial stiffness, lowering blood pressure, and ultimately mitigating heart-related mortality among hemodialysis patients. This study holds substantial implications for hypertension and cardiovascular risk management in this vulnerable patient population. Eligible participants must have been on chronic hemodialysis for at least three months, with ACE inhibitors or angiotensin receptor blockers included in their therapy at maximum tolerable doses. Serum potassium levels 5.7 mmol/L, left ventricular ejection fraction 50%, and PWV higher than age-estimated values are also prerequisites for study entry. Randomized allocation will be conducted using a permuted block design, stratified by center, with allocation communicated via signed study forms during initial examinations. All steps of this research will be conducted in accordance with the principles of the Helsinki Declaration.

Intensive care environment: Perspective of relatives of critically ill patient sustained by health technology

The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fatality rate.The demands placed on nurses to care for critically ill patients in this environment frequently prevent nurses and other health‑care professionals from acknowledging the feelings of patient’s relatives or family caregivers,resulting in a hostile environment from the patient’s relative’s perspective.When a patient’s family enters the ICU,they feel that hospital administrators do little to nothing to alleviate their discomfort and fear.Despite research demonstrating the importance of providing a homely environment for patients’families,In Nigeria ICU is still far behind how a conventional ICU environment should be structured to accommodate patient’s relations in the unit.The goal of this study was to look at the patient’s relative’s perspective on providing care for a critically ill patient in an ICU,with a focus on the unit’s complexity and overall experience.Based on the findings of this study,we recommend that hospital administrators ensure that the environment of the upcoming ICU is designed to meet the needs of patient’s relatives by addressing identified environmental concerns,like caring neglect,by providing a friendly and stress‑free environment.

Cancer risk in relatives of BRCA1/2 pathogenic variant carriers in a large series of unselected patients with breast cancer

Objective:The spectrum and risk of cancer in relatives of BRCA1/2 pathogenic variant carriers in the Chinese population have not been established.Methods:A family history of cancer in 9903 unselected breast cancer patients was retrospectively analyzed.BRCA1/2 status was determined for all patients and relative risks(RRs)were calculated to evaluate cancer risk in relatives of the patients.Results:The incidences of breast cancer in female relatives of BRCA1 carriers,BRCA2 carriers,and non-carriers were 33.0%,32.2%,and 7.7%,respectively.The corresponding incidences of ovarian cancer were 11.5%,2.4%,and 0.5%,respectively.The incidences of pancreatic cancer in male relatives of BRCA1 carriers,BRCA2 carriers,and non-carriers were 1.4%,2.7%,and 0.6%,respectively.The corresponding incidences of prostate cancer were 1.0%,2.1%,and 0.4%,respectively.The risks of breast and ovarian cancers in female relatives of BRCA1 and BRCA2 carriers were significantly higher than female relatives of non-carriers(BRCA1:RR=4.29,P<0.001 and RR=21.95,P<0.001;BRCA2:RR=4.19,P<0.001 and RR=4.65,P<0.001,respectively).Additionally,higher risks of pancreatic and prostate cancers were noted in male relatives of BRCA2 carriers than non-carriers(RR=4.34,P=0.001 and RR=4.86,P=0.001,respectively).Conclusions:Female relatives of BRCA1 and BRCA2 carriers are at increased risk for breast and ovarian cancers,and male relatives of BRCA2 carriers are at increased risk for pancreatic and prostate cancers.

Higher vitamin D serum concentration increases health related quality of life in patients with inflammatory bowel diseases

AIM: To investigate the effect of vitamin D (VD) concentrations and VD supplementation on health related quality of life in inflammatory bowel disease (IBD) patients.

Induced pluripotent stem cells from Huntington's disease patients:a promising approach to define and correct disease-related alterations

Adult somatic cells such as skin or blood cells from either health donors or patients can be reprogrammed into induced pluripotent stem cells(iPSCs).Given their unlimited self-renewal and differentiation capacities,iPSCs are an invaluable resource to generate terminally differentiated cells.Thus,iPSCs can facilitate the study of human diseases and drug screening,holding great promise for regenerative medicine.Another significant advantage of iPSC disease-modeling is that normal and mutant proteins are expressed at endogenous levels.In addition,subtle phenotypes and the effects of genetic background variations can be assessed by comparison between iPSC lines obtained from different patients and healthy donors as well as isogenic lines,in which disease-related mutations are corrected.

The Impact of Nursing Staff’s Work Attitude on the Fear of Patients Recovering from Benign Tumors:Family Support as a Mediating Variable

The perception of nursing staff’s attitude influences patient fear.Understanding this dynamic is crucial for fostering a supportive environment conducive to patient well-being and effective healthcare practices.The purpose of this research is to investigate how the attitudes and behaviours of nursing staff influence the fear and anxiety levels of patients recovering from benign tumors,aiming to improve patient care and recovery outcomes.Data was collected from a sample of 100 participants,comprising 20 nursing staff and 80 patients recovering from benign tumors.Surveys were administered to gather quantitative data on attitudes and fear levels.Participants were selected randomly from hospital records and outpatient clinics.Our analysis encompassed nursing staff attitude,patient fear levels,the influence of family support,progression of tumor recovery,patient-reported satisfaction,and the quality of healthcare services provided.The quantitative aspect utilized PLS-SEM software to perform regression analysis,evaluating both direct and indirect effects.Statistical analysis assessed the relationships between nursing staff attitudes,patient fear during benign tumor recovery,and the mediating role of family support.The findings of the study demonstrate that better nurse attitudes(Hypothesis 1,β=0.45,p<0.001)and stronger family support(Hypothesis 2,β=0.32;p<0.001) are linked to lower levels of patient fear.Partially mediating the relationship between nurse attitudes and patient fear,according to Hypothesis 3(β=0.28,p<0.002),is family support.Patients’perceptions of family support are highly influenced by nursing behaviour,as demonstrated by Hypothesis 4(β=0.38;p<0.001).Our research showed a strong relationship between the attitudes of nursing personnel and patient fear levels.Family support demonstrated a strong mediating effect on patient fear.Patient-reported satisfaction is positively correlated with family support.However,no significant relationship was found between healthcare service quality and patient fear.

Health-related quality of life in high-grade glioma patients

Gliomas are malignant primary brain tumors and yet incurable. Palliation and the maintenance or improvement of the patient's quality of life is therefore of main importance. For that reason, health-related quality of life(HRQoL) has become an important outcome measure in clinical trials, next to traditional outcome measures such as overall and progression-free survivals, and radiological response to treatment. HRQoL is a multidimensional concept covering physical, psychological, and social domains, as well as symptoms induced by the disease and its treatment. HRQoL is assessed by using self-reported, validated questionnaires. Various generic HRQoL questionnaires, which can be supplemented with a brain tumor- specific module, are available. Both the tumor and its treatment can have a negative effect on HRQoL. However, treatment with surgery, radiotherapy, chemotherapy, and supportive treatment may also improve patients' HRQoL, in addition to extending survival. It is expected that the impact of HRQoL measurements in both clinical trials and clinical practice will increase. Hence, it is important that HRQoL data are collected, analyzed, and interpreted correctly. Methodological issues such as selection bias and missing data may hamper the interpretation of HRQoL data and should therefore be accounted. In clinical trials, HRQoL can be used to assess the benefits of a new treatment strategy, which should be weighed carefully against the adverse effects of that treatment. In daily clinical practice, HRQoL assessments of an individual patient can be used to inform physicians about the impact of a specific treatment strategy, and it may facilitate the communication between the physicians and the patients.

The Alzheimer’s Dementia Patients’ Observed Illness Course and Experience in Ghana and Care Lessons to Be Learnt: A Mental Health Professional’s Perspective

Alzheimer’s disease (AD) and associated dementia patient numbers continue to increase globally with associated economic costs to healthcare systems. Of note is the increase in numbers in lower and middle-income countries (LMICs) including Sub-Saharan African (SSA) countries, which already face challenges with their health budgets from communicable and non-communicable diseases. Ghana, an SSA country, faces the problem of healthcare budgetary difficulties and the additional impact of AD as a consequence of increasing population strata of old aged persons (OAPs) due to the demographic transition effect. This article uses examples of known patients’ illness courses to give a perspective on the lived experience of patients with dementia (PWD) in Ghana, living amongst a populace with a culture of stigmatization of PWD, and a relatively fragile public mental health system (PMHS) for those with mental illness, including AD. The lived experience of AD patients is characterised by stigmatisation, discrimination, non-inclusiveness, diminished dignity and human rights abuses in the face of their mental disability, and eventually death. This article is an advocacy article giving voice to the voiceless and all persons suffering from AD and other dementias in Ghana, whilst pleading for a call to action from healthcare professionals and responsible state agencies.

Expectations and Level of Satisfaction of the Patient with Parkinson’s Disease Undergoing Deep Brain Stimulation Surgery at the National Institute of Neurology and Neurosurgery

Background: Deep brain stimulation (DBS) is an established treatment for patients with advanced Parkinson’s disease (PD). Reports show continued patient satisfaction after surgery despite not maintaining clinical improvement as measured by evolution scales. Objectives: The present study sought to explore expectations and level of satisfaction in patients after DBS surgery with a semi-structured questionnaire and subsequent correlation with functional scales, Quality of Life (QoL), and motor and non-motor symptoms. Methods: We performed descriptive statistics to represent demographic data, Wilcoxon rank tests to determine significant differences, and Spearman correlation between the applied scales. Results: We evaluated 20 patients with a history of DBS surgery. 45% were female, with a mean age of 55.7 ± 14.15 years, a mean disease duration of 13.42 ± 8.3 years, and a mean time after surgery of 3.18 ± 1.86 years. Patients reported surgery meeting expectations in 85.5% and continued satisfaction in 92%. These two variables showed a significant correlation. Conclusions: This sample of patients remained satisfied after DBS surgery, although we found no differences in motor and non-motor clinimetric scales. Further studies are needed to confirm the importance of assessing quality of life in patients with DBS.

Central Venous Catheter-related Thrombosis in Senile Male Patients: New Risk Factors and Predictors

Central venous catheterization（CVC）-related venous thrombosis is a common but serious clinical complication, thus prevention and treatment on this problem should be extensively investigated. In this research, we aimed to investigate the incidence rate of CVC-related venous thrombosis in senile patients and give a further discussion on the related risk factors and predictors. A total of 324 hospitalized senile male patients subjected to CVC were selected. Retrospective investigation and analysis were conducted on age, underlying diseases, clinical medications, catheterization position and side, catheter retention time, and incidence of CVC-related venous thrombosis complications. Basic laboratory test results during catheterization and thrombogenesis were also collected and analyzed. Among the 324 patients, 20 cases（6.17%） of CVC-related venous thrombosis were diagnoseds. The incidence rate of CVC-related venous thrombosis in subclavian vein catheterization was significantly lower than that in femoral vein catheterization（P〈0.01） and that in internal jugular vein catheterization（P〈0.05）. No statistically significant difference was found between femoral vein catheterization and internal jugular vein catheterization（P〉0.05）. Previous venous thrombosis history（P〈0.01）, high lactate dehydrogenase level（P〈0.01）, low high-density lipoprotein（HDL） level（P〈0.05）, and low albumin level（P〈0.05） were found as risk factors or predictors of CVC-related venous thrombosis in senile male patients. Subclavian vein catheterization was the most appropriate choice among senile patients to decrease the incidence of CVC-related venous thrombosis. Previous venous thrombosis history, high lactate dehydrogenase level, low HDL level, and low albumin level were important risk factors in predicting CVC-related venous thrombosis.

Comparative proteomic analysis of plasma proteins in patients with age-related macular degeneration

AIM:To find the significant altered proteins in agerelated macular degeneration(AMD)patients as potential biomarkers of AMD.METHODS:A comparative analysis of the protein pattern of AMD patients versus healthy controls was performed by means of proteomic analysis using twodimensional gel electrophoresis followed by protein identification with MALDI TOF/TOF mass spectrometry.RESULTS:We identified 28 proteins that were significantly altered with clinical relevance in AMD patients.These proteins were involved in a wide range of biological functions including immune responses,growth cytokines,cell fate determination,wound healing,metabolism,and anti-oxidance.CONCLUSION:These results demonstrate the capacity of proteomic analysis of AMD patient plasma.In addition to the utility of this approach for biomarker discovery,identification of alterations in endogenous proteins in the plasma of AMD patient could improve our understanding of the disease pathogenesis.

Reciprocity Relation between Alternative Gravity Formulas

We compare Newton’s force law of universal gravitation with a corrected simple approach based on Bhandari’s recently presented work, where the gravitation constant G is maintained. A reciprocity relation exists between both alternative gravity formulas with respect to the distances between mass centers. We conclude a one-to-one mapping of the two gravitational formulas. We don’t need Einstein’s construct of spacetime bending by matter.

Association between the related characters of hemispatial neglect and prognosis in stroke patients

OBJECTIVE： To recognize the significances of the classification, evaluation, treatment, pathogenesis, etiological factors and related loci of hemispatial neglect （HSN） in the treatment and prognosis of stroke patients. DATA SOURCES： Articles related to HSN in stroke published in English from January 1985 to December 2002 were searched in Medline database by using the keywords of ＂stroke, hemispatial neglect （HSN）, rehabilitation＂. Chinese relevant professional works and articles were also referred to. STUDY SELECTION： The data were primarily checked. Inclusive criteria： ① articles about the HSN symptoms in stroke; ② articles about the classification, evaluation, treatment, pathogenesis, etiological factors and related loci of HSN, as well as the treatment and prognosis of stroke. The repetitive studies or reviews were excluded. DATA EXTRACTION ： Totally 474 articles related to HSN in stroke were collected, 43 of them were involved and 431 repetitive studies or reviews were excluded. DATA SYNTHESES： HSN can be classified as sensory neglect and motor neglect. Because HSN is caused by the injury of network structure which mediated directed attention, it is generally believed that the inferior parietal Iobule of dominant hemisphere is the most closely correlated with neglect. The main theories related to the pathogenesis of HSN at present include ＂internal instruction＂, ＂directed bradykinesia＂, ＂sensory attention＂, etc. The main clinical manifestations are setover in drawing lines, picture drawing towards one side, imitation towards one side, picture description towards one side, etc., which can be evaluated by the line bisection test, target cancellation test, picture drawing test and pegboard test. The most important thing for the treatment is to make the patients continuously concentrate on the neglected side. CONCLUSION： HSN is an indicator for the bad outcome of cerebrovascular disease, the symptoms take longer time to rehabilitate with slow recovery, but quite a few HSN patients will get good prognosis if timely treatment and proper program are given.

Prognostic Value of Th-22 Cells and Related Functional Cytokines in Patients with Vitiligo

Objective:To investigate the prognostic value of Th-22 cells and related functional cytokines in patients with vitiligo.Methods:Thirty-five patients with vitiligo who admitted to the outpatient clinic from June 2016 to November 2018 in the hospital were selected as the study group.Thirty healthy controls were selected as the control group.Th-22 cells and their related cytokines were analyzed in both groups.Resylts:The levels of cytokines in Th-22 and Th-17 cells in the study group were significantly higher than those in the control group(P<0.05).The expression of Treg lymphocyte-related factors in the study group was lower than that in the control group(P<0.05).The changes in cell and factor levels in patients with vitiligo before and after treatment were significantly different(P<0.05).Conclusion:It is shown that three cells,including Th-22,Th-17 and Treg are related to each other,and they can inhibit and promote the pathogenesis of vitiligo which provides a reference for prognosis and treatment.

Study on Related Factors of Acute Kidney Injury in Patients under Intensive Care

Objectives:To study the related factors of acute kidney injury(AKI)in intensive care unit(ICU)patients.Methods:The clinical data of 879 patients in the intensive care unit were retrospectively analyzed.AKI patients were selected according to the AKI clinical diagnostic criteria,the causal analysis was performed,the indicators of AKI patients were tested,and the urine volume and the time of admission to the ICU were recorded.Finally,logistic regression analysis was used to analyze the risk factors that affect the prognosis.Results:Among the 879 patients in the intensive care unit,96 patients(10.9%)met the KDIGO-AKI diagnostic criteria,of which 29(30.31%)died and 49(51.04%)required renal replacement therapy.As the age and stage of AKI patients increase,the mortality rate also increases.The pathology constituted 46 septic patients(47.92%)and 50 non-septic patients(52.08%).Patients with septic AKI have longer ICU and hospital stay than patients with non-septic AKI(t=2.291,0.023;t=2.082,0.041),and the rate of renal replacement therapy is higher(χ2=4.091,P=0.042).Logistic regression analysis shows that old age,low urine volume,shock,acidosis,stage 3 of AKI,intake of blood pressure drugs,infections,and the need for renal replacement therapy are relevant factors that affect AKI.Conclusions:In the intensive care unit,the incidence and mortality of AKI are very high;the treatment of AKI is related to many factors;early detection and treatment is very crucial to reduce the mortality of AKI.

Perceived health-related stigma among patients with breast cancer

Breast cancer survivors face many challenges(particularly changes in body image) on their road to restoring physical and psychosocial health following diagnosis. Perceived health-related stigma(PHS)refers to the attachment of negative connotations to some types of disease diagnoses. PHS is common among patients with breast cancer and is associated with adverse emotions, attitudes and behaviors. This article summarizes the latest advances and new perspectives on PHS of breast cancer patients and approaches to block this deleterious process. Effects of PHS on patients with breast cancer, in this paper,and measures, predictors and interventions of PHS have been discussed in depth. Future studies should continue to develop more effective instruments that are specialized for measuring PHS of breast cancer patients, explore the predictors of PHS, and discuss effective interventions on the basis of the predictors.

Patient-Related Factors Influencing Adherence to ART, A Case of Chivuna, Southern Province of Zambia

Despite the roll out of free life prolonging HIV and AIDS drugs in many public clinics in Zambia and the well documented effects of Anti Retrovirals (ARVs) in reducing mortality among people living with HIV, some people living with HIV still abandon treatment. This study explores patient-related factors that influence adherence to the life prolonging drugs. It is hoped that such information would be useful in enhancing adherence so as to achieve the goal of ART. This information is critical considering irrefutable evidence that non-adherence to Anti-Retroviral Therapy (ART) can lead to drug resistance and consequently, transmission of drug resistant HIV. Drug resistant HIV is not only expensive to handle, but can lead to increased morbidity, mortality and increased incidence of HIV cases particularly, for a low income country like Zambia. Methods: This paper uses data from a large mixed method study which was conducted in a rural setting. The study explored how patient-related factors influence people living with HIV in continuing taking of medication. The paper, therefore, discusses the major reasons reported by HIV infected people on ART for either being able to consistently take their medication or failing to do so. Results: Both limiting and facilitating factors were identified as influencing adherence. Among the facilitators identified were one having a reminder, feeling better after being on ART, seeing someone on ART recover, desire to live longer and disclosure of one’s positive status. The limiting factors included forgetting to take medication, non-recovery while on treatment for some time and drug fatigue. A significant association was found between adherence treatment and one having a reminder, desire to live longer and seeing someone on ART get better. Conclusion: While facilitators enhanced adherence, the barriers prevented or discouraged people on ART from continuing taking AIDS medicines as prescribed by their health care providers. In order to avoid drug resistance and other public health implications, such as transmission of drug resistant HIV virus and deaths, there is need to address these patient-related barriers.

Good Relations between Nurses and Patients: Spreading the Wings of Imagination, Protecting Patients’ Souls

Objective: To ascertain a method for building good nurse-patient relations from the narratives of veteran nurses who have accumulated profound nursing experience, and to show these phenomena in model form. Methods: Semi-structured interviews were conducted, verbatim records of the contents of the interviews produced, and qualitative analysis undertaken. Results of analysis and concepts considered important were shown in model form. Results: Veteran nurses, utilizing their nursing specialization, showed “Concern as humans,” transcending their professional specialty. This was expressed as “spreading the wings of imagination” in order to know what is important to patients, and “protecting souls” in order to defend, together with patients, what is most important to the latter. “Spreading the wings of imagination to protect patients’ souls” became the key to build good nurse-patient relations. Conclusion: Nurses with deep experience expressed building good nurse-patient relations as “spreading the wings of imagination and protecting patients’ souls.” We were able to ascertain that in nursing practice, using the sensitivity of veteran nurses, is one way of manifesting nursing conduct.

A Study on Oral Health-Related Quality of Life and Its Influencing Factors in Elderly Diabetic Patients

Objective:To investigate the oral health related quality of life in elderly diabetic patients and analyze its influencing factors.Methods:Convenience sampling was used to select 190 elderly patients with diabetes under the Department of Endocrinology and Department of Integrated Traditional Chinese and Western Medicine in the Affiliated Hospital of Hebei University as the research subjects.The Chinese version of the Oral Health Influence Scale(OHIP-14)was used to conduct a questionnaire survey,and univariate analysis and multiple stepwise regression analysis were used to analyze the influencing factors of oral health related quality of life in elderly diabetic patients.Results:The elderly diabetic patients'oral health related quality of life score was 34.48±3.23,which is in the middle-lower range.The findings of multivariate stepwise regression analysis revealed that the course of disease,regular visits to the dentist,sleep quality,oral health knowledge,and oral health attitude together explained 58.9%of the total variance in elderly diabetic patients in terms of their oral health related quality of life(p<0.05).Conclusion:The oral health related quality of life of elderly diabetic patients is generally low,and is affected by the duration of diabetes,sleep quality,and oral health knowledge,attitude,and behavior(regular visits to the dentist).Improving patientsJ attention to oral health problems by improving sleep as well as their own oral health knowledge,attitude,and behavior is an effective way to enhance oral health related quality of life.