Early mobilization implementation for critical ill patients:A cross-sectional multi-center survey about knowledge,attitudes,and perceptions of critical care nurses

Objective To explore critical care clinicians’knowledge,attitudes and perceptions toward early mobilization of critically ill patients in ICUs.Design A cross-sectional national survey was conducted.From January to August 2020,ICU nurses in 11 hospitals were surveyed by using a questionnaire on the knowledge,attitudes and perceptions of ICU early mobilization.Results Totally 512 nurses completed the questionnaire.The respondents’mean score for knowledge of early mobilization was 6.89±2.91.The level of knowledge was good in 2.5%(13/512),fair in 52.3%(268/512).The attitudes toward early mobilization were positive in 31.4%(161/512).In terms of perceived implementation of ICU early mobilization,42.9%(220/512)of nurses did not believe that this should be a top priority in intensive care.The attitudes of nurses from different ICUs were significantly different(F=3.58,P<0.05).The knowledge(7.34±2.78 vs.6.49±2.97,t=3.37,P<0.001)and attitudes(3.82±0.58 vs.3.52±0.56,t=5.63,P<0.001)of nurses who had early mobilization related training were higher than those of nurses who had no training.Conclusions The importance of early ICU early mobilization is increasingly recognized by critical care providers.However,there is still a gap in the knowledge,attitudes and perceptions of ICU early mobilization among nurses.In future studies,it is necessary to further systematically identify the reasons leading to the gaps in these aspects and implement targeted interventions around these gaps.Meanwhile,more nurses should be encouraged to participate in decision-making to ensure the efficient and quality implementation of ICU early mobilization practices.

Lived experiences of the disease journey among patients with idiopathic pulmonary fibrosis

Objective:This study aimed to explore the lived experiences of the disease journey and patients'care needs with idiopathic pulmonary fibrosis(IPF).Methods:Face-to-face semi-structured interviews were conducted with a purposive sampling of IPF patients admitted to the department of respiratory medicine in a tertiary hospital in Beijing.Interview data were analyzed using the thematic analysis method.In the end,16 patients were interviewed.Results:Four themes emerged from the qualitative data included the long and confusing journey to reach a diagnosis,living with the disease,understanding the disease and treatment and desire for continuity of care.A series of subthemes were also identified,including uncertainty of diagnosis,delaying the process,living with physical symptoms,living with emotional distress,loss of independence,uncertainty with the prognosis,questioning the cause of the disease,concerning the side effects of treatments,lacking continuity of care,and wanting a better quality ofhealthcare in community hospitals.Conclusions:Based on the findings,there is an urgent need to improve the care delivery to this vulnerable population in China.To meet their health needs,it is of paramount importance to develop effective education programs for health professionals and IPF patients and improve care models of healthcare systems,especially in remote areas,to enhance care continuity in the communities.

Anti-atherosclerotic effects and molecular targets of ginkgolide B from Ginkgo biloba

Bioactive compounds derived from herbal medicinal plants modulate various therapeutic targets and signaling pathways associated with cardiovascular diseases(CVDs),the world’s primary cause of death.Ginkgo biloba,a well-known traditional Chinese medicine with notable cardiovascular actions,has been used as a cardio-and cerebrovascular therapeutic drug and nutraceutical in Asian countries for centuries.Preclinical studies have shown that ginkgolide B,a bioactive component in Ginkgo biloba,can ameliorate atherosclerosis in cultured vascular cells and disease models.Of clinical relevance,several clinical trials are ongoing or being completed to examine the efficacy and safety of ginkgolide B-related drug preparations in the prevention of cerebrovascular diseases,such as ischemia stroke.Here,we present a comprehensive review of the pharmacological activities,pharmacokinetic characteristics,and mechanisms of action of ginkgolide B in atherosclerosis prevention and therapy.We highlight new molecular targets of ginkgolide B,including nicotinamide adenine dinucleotide phosphate oxidases(NADPH oxidase),lectin-like oxidized LDL receptor-1(LOX-1),sirtuin 1(SIRT1),platelet-activating factor(PAF),proprotein convertase subtilisin/kexin type 9(PCSK9)and others.Finally,we provide an overview and discussion of the therapeutic potential of ginkgolide B and highlight the future perspective of developing ginkgolide B as an effective therapeutic agent for treating atherosclerosis.

Targeting protein modifications in metabolic diseases:molecular mechanisms and targeted therapies

The ever-increasing prevalence of noncommunicable diseases(NCDs)represents a major public health burden worldwide.The most common form of NCD is metabolic diseases,which affect people of all ages and usually manifest their pathobiology through life-threatening cardiovascular complications.A comprehensive understanding of the pathobiology of metabolic diseases will generate novel targets for improved therapies across the common metabolic spectrum.Protein posttranslational modification(PTM)is an important term that refers to biochemical modification of specific amino acid residues in target proteins,which immensely increases the functional diversity of the proteome.The range of PTMs includes phosphorylation,acetylation,methylation,ubiquitination,SUMOylation,neddylation,glycosylation,palmitoylation,myristoylation,prenylation,cholesterylation,glutathionylation,S-nitrosylation,sulfhydration,citrullination,ADPribosylation,and several novel PTMs.Here,we offer a comprehensive review of PTMs and their roles in common metabolic diseases and pathological consequences,including diabetes,obesity,fatty liver diseases,hyperlipidemia,and atherosclerosis.Building upon this framework,we afford a through description of proteins and pathways involved in metabolic diseases by focusing on PTM-based protein modifications,showcase the pharmaceutical intervention of PTMs in preclinical studies and clinical trials,and offer future perspectives.Fundamental research defining the mechanisms whereby PTMs of proteins regulate metabolic diseases will open new avenues for therapeutic intervention.

The zinc finger transcription factor,KLF2,protects against COVID-19 associated endothelial dysfunction

Coronavirus disease 2019(COVID-19)is regarded as an endothelial disease(endothelialitis)with its patho-mechanism being incompletely understood.Emerging evidence has demonstrated that endothelial dysfunction precipitates COVID-19 and its accompanying multi-organ injuries.Thus,pharmacotherapies targeting endothelial dysfunction have potential to ameliorate COVID-19 and its cardiovascular complications.The objective of the present study is to evaluate whether kruppel-like factor 2(KLF2),a master regulator of vascular homeostasis,represents a therapeutic target for C0VID-19-induced endothelial dysfunction.Here,we demonstrate that the expression of KLF2 was reduced and monocyte adhesion was increased in endothelial cells treated with COVID-19 patient serum due to elevated levels of pro-adhesive molecules,ICAM1 and VCAM1.IL-1β and TNF-α;two cytokines elevated in cytokine release syndrome in COVID-19 patients,decreased KLF2 gene expression.Pharmacologic(atorvastatin and tannic acid)and genetic(adenoviral overexpression)approaches to augment KLF2 levels attenuated COVID-19-serum-induced increase in endothelial inflammation and monocyte adhesion.Next-generation RNA-sequencing data showed that atorvastatin treatment leads to a cardiovascular protective transcriptome associated with improved endothelial function(vasodilation,antiinflammation,antioxidant status,anti-thrombosis/-coagulation,anti-fibrosis,and reduced angiogenesis).Finally,knockdown of KLF2 partially reversed the ameliorative effect of atorvastatin on COVID-19-serum-induced endothelial inflammation and monocyte adhesion.Collectively,the present study implicates loss of KLF2 as an important molecular event in the development of COVID-19-induced vascular disease and suggests that efforts to augment KLF2 levels may be therapeutically beneficial.