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Introduction: Intravenous immunoglobulin (IVIG) plus methylprednisolone as initial intensive therapy or additional therapy in Kawasaki disease (KD) has been used in clinical practice. However, its molecular and cellular mechanism is unclear. Methods: We performed single-cell analysis on 14 peripheral blood mononuclear cell (PBMC) samples obtained from 7 KD patients who received either IVIG monotherapy or IVIG plus methylprednisolone therapy. This encompassed 4 samples from KD patients collected before and after IVIG treatment, as well as 3 samples from KD patients before and after IVIG plus methylprednisolone therapy. Results: Both IVIG monotherapy and IVIG plus methylprednisolone therapy can increase lymphocyte counts (e.g. CD4+T, CD8+T, and gdT cells) to address lymphopenia. They can also decrease monocyte counts and repress the expression of S100A12, NLRP3, and genes associated with immune-cell migration in monocytes. IVIG combined with methylprednisolone downregulates more monocyte-driven inflammatory pathways than IVIG alone. Additionally, this combination uniquely enhances NK cell cytotoxicity by modulating receptor homeostasis, while significantly upregulating interferon-related genes in CD4+ T cells, CD8+ T cells, and B cells, particularly type I interferons. Conclusion: The combination of IVIG with methylprednisolone attenuated monocyte-driven inflammation and improved NK cell cytotoxicity which might provide clues for pediatricians to consider treatment options for children with KD. Whether the monocyte-driven hyperinflammatory state and NK cell function can be indicators for the clinical choice of IVIG with methylprednisolone therapy in KD needs further investigation. [ABSTRACT FROM AUTHOR]

Objective: This research aimed to determine how a 12-week PRECEDE-PROCEED model-based intervention affected fatigue in patients with coronary heart disease. Methods: This cluster randomized controlled trial recruited participants diagnosed with coronary heart disease at 2 community health centers in China. Participants in the control group (n = 36) received routine health education, whereas those in the intervention group (n = 38) were given a 12-week PRECEDE-PROCEED model-based intervention and routine health education. The intervention consisted of 6 training sessions on coronary heart disease, fatigue, fatigue management, self-management skills and social support. A primary outcome (fatigue) and 4 secondary outcomes (knowledge of fatigue, self-management, quality of life and body mass index) were assessed using the Fatigue Scale-14, Fatigue Cognitive Questionnaire for Patients with Coronary Heart Disease, Coronary Artery Disease Self-Management Scale, Chinese Cardiovascular Questionnaire of Quality of Life, and electronic weighing scale, respectively. Data were collected 3 times over 12 weeks. Results: Compared with the control group, the intervention group showed a statistically significant improvement in the level of fatigue (8.72 vs 7.06, P <.001), knowledge of fatigue (P <.001), self-management skills (P <.001), and quality of life (P <.001). However, there was no significant difference in body mass index between the 2 groups (P =.504). Conclusions: The findings suggest that a well-designed intervention based on the PRECEDE-PROCEED model could alleviate fatigue symptoms and increase knowledge of fatigue, self-management skills and quality of life in patients with coronary heart disease. [ABSTRACT FROM AUTHOR]

Aims: Secondary prevention of coronary heart disease is of utmost importance to facilitate people to achieve health outcomes and behaviours. This study was to investigate the effect of a nursing intervention based on Cox's interaction model of client health behaviour to improve health outcomes and behaviours of secondary prevention of coronary heart disease. Design: This study is a cluster randomised controlled trial. Methods: Participants were recruited between August and November 2019 in two community settings in Hengyang city, Hunan province, China. Participants in the intervention group received a nursing intervention based on Cox's interaction model of client health behaviour and routine health education, while those in the control group received routine health education only. The outcome variables included self‐management, physical activity, medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, blood pressure, body mass index (BMI), and low‐density lipoprotein cholesterol (LDL‐C). The influential statistical tests applied to analyse the data included χ2 tests and t tests. Results: Seventy‐seven participants completed this study. Compared with the control group (n = 40), the intervention group (n = 37) showed statistically significant better health outcomes and behaviours regarding self‐management, physical activity (except for high energy consumption), medication compliance, anxiety, sexual knowledge, the ability to identify sexual health education needs, systolic blood pressure, BMI, and LDL‐C. However, there was no statistically significant difference in diastolic blood pressure and high energy consumption for physical activity. Conclusion: A well‐developed nursing intervention based on Cox's interaction model of client health behaviour could successfully improve health outcomes and behaviours of secondary prevention of coronary heart disease. Such an intervention may be incorporated into community healthcare practice by nurses to improve patient care. Impact: This study provides a valuable insight to facilitate further development of effective nursing interventions to improve secondary prevention of coronary heart disease in community settings. [ABSTRACT FROM AUTHOR]

Background: CYP2C19 genetic variation and clinical factors have been proved to be related with clopidogrel resistance (CR) in adults, while the presence of CR in children with Kawasaki disease (KD) was seldom reported. Our objective was to evaluate KD patients' response to clopidogrel treatment and determine whether CYP2C19 gene polymorphisms and laboratory indicators are associated with CR in this population., Methods: This was a prospective and single-center study. We recruited children with KD hospitalized in the cardiology department at the Children's Hospital Capital Institute of Pediatrics between January 2019 and October 2021, and the distribution of the CYP2C19 gene polymorphisms was assessed. According to the light transmission aggregometry (LTA) test results, KD patients who were treated with clopidogrel were divided into CR group and non-CR (NCR) group. We also analyzed the influence of CYP2C19 gene polymorphisms and laboratory indicators on CR in children with KD., Results: (1) A total of 346 children with KD were evaluated for the genotypic and phenotypic distributions of CYP2C19. Loss-of-function (LOF) mutated allele was included in 56.9% of CYP2C19 genotypes, and their corresponding phenotypes were intermediate metabolizers (46.2%) and poor metabolizers (10.7%). (2) The incidence of CR in this study population was 31.4%. The multivariate logistic regression showed that carrying CYP2C19 LOF allele (OR, 3.922; 95%CI, 1.504-10.282; P = 0.005) and high levels of low-density lipoprotein (OR, 1.675; 95%CI, 1.069-2.623; P = 0.024) were independent risk factor for CR, while low levels of high-density lipoprotein (OR, 0.120; 95%CI, 0.020, 0.734; P = 0.022) was an independent protective factor for CR. The area under the receiver operator characteristic curve of the multivariate logistic regression model (including high-density lipoprotein, low-density lipoprotein, and CYP2C19 LOF allele carriers) for predicting CR was 0.769 (95% CI, 0.674-0.863; P < 0.001). The sensitivity and specificity were 70.3 and 74.0%, respectively., Conclusion: Carrying CYP2C19 LOF allele, low levels of high-density lipoprotein, and high levels of low-density lipoprotein were independent risk factors for CR in children with KD in China. This may benefit pediatricians in choosing appropriate individualized antiplatelet therapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Meng, Chen, Li and Shi.)

Purpose: Exercise training is crucial to the early intervention of pediatric primary hypertension (PHT). However, much less is known about exercise capacity in this disease. This work investigated the exercise capacity in pediatric PHT and analyzed the factors affecting exercise capacity., Methods: The study enrolled children with PHT at the Children's Hospital Capital Institute of Pediatrics between July 2017 and July 2020. The Bruce protocol of the treadmill exercise test (TET) was used to assess exercise capacity. Multivariate ordinal logistic regression and generalized linear models were used to analyze factors affecting exercise capacity., Results: Of 190 patients, 146 (76.8%) were male, and the median age was 13 (11, 14). Most children accomplished TET and achieved the submaximal heart rates (189 [99.5%]). Children with lower resting diastolic blood pressure (DBP) and 24 h average diastolic blood pressure (ADBP) could achieve a TET stage of 6 or more, whereas children with higher DBP and ADBP could only achieve a TET stage of 3 ( P all < 0.05). Children with lower DBP and 24 h ADBP were also associated with greater metabolic equivalents (METs; r = -0.237, r = -0.179, P all < 0.05). The completion of TET stages was negatively associated with female (OR = 0.163), younger age (OR = 1.198), greater body mass index (BMI, OR = 0.921), and higher 24 h ADBP (OR = 0.952, P all < 0.05). In addition, METs were negatively associated with female (β = -1.909), younger age (β = 0.282), greater BMI (β = -0.134), and higher 24 h ADBP (β = -0.063, P all < 0.05)., Conclusions: Exercise capacity was impaired among pediatric PHT patients. Female gender, younger age, greater BMI, and higher 24 h ADBP are independently associated with the exercise capacity in pediatric PHT. These findings may help developing scientific exercise prescriptions for pediatric PHT., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Chen, Zheng, Zhang, Li and Shi.)