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Background: Burnout threatens patient care and clinicians are experiencing challenges within the practice environment. Little is known about nurse practitioner (NP) perceptions of burnout and its relationship to care quality and practice environment. We investigate the relationship between primary care NP burnout on perceptions of care quality and if the practice environment moderates the relationship between burnout and care quality. Methods: This is a secondary analysis of cross‐sectional survey data from 396 NPs. Burnout and care quality were measured using a single item, but the practice environment was measured using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. Multi‐level proportional odds cumulative logit models were built to test for associations between burnout and care quality and for moderation. Results: Total, 25.3% of NPs reported burnout. Odds of perceiving higher quality of care was 85% less for NPs experiencing burnout compared to those not experiencing burnout. Practice environment did not moderate the relationship between burnout and care quality, but with a one unit increase in the practice environment subscales, the odds of NPs perceiving higher care quality increased anywhere from 3.83 to 7.57 times. Conclusion: Burnout is related to lower perceptions of care quality but favorable environments were related to higher perceptions of quality. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality worldwide since December 2019. This retrospective study determined the characteristics and prognostic factors of COVID-19 patients, focusing on inpatients who died or were discharged between 30 December 2019 and 29 February 2020 at Renmin Hospital of Wuhan University. Patients' medical histories, comorbidities, symptoms, signs, laboratory findings, computed tomography (CT) findings, and clinical management were recorded. All 293 patients were divided into the nonsurviving (n = 116) and surviving (n = 177) groups. The median age was older in the nonsurviving group than in the surviving group; most patients were older than 65 years in the nonsurviving group. The incidence rates of lymphopenia, neutrophilia, and leukocytosis were significantly higher in the nonsurviving group than in the surviving group. More patients in the nonsurviving group had increased levels of nonspecific infection markers, abnormal liver and kidney function, cardiac injury, and blood coagulation abnormalities on admission. Immune and inflammatory responses were more severely disturbed in the nonsurviving group than in the surviving group. The incidence rates of complications during hospitalization were higher in the nonsurviving group than in the surviving group. Cox regression results also showed that older age, symptoms of dyspnea, comorbidities, and complications were all predictors of death. Close monitoring and timely treatment are needed for high-risk COVID-19 patients. [ABSTRACT FROM AUTHOR]

The current study demonstrates that a disintegrin and metalloproteinase with thrombospondin type 1 motif- (ADAMTS-) 5 is a key extracellular matrix protease and associated with cardiovascular diseases. However, the plasma ADAMTS-5 levels and relevance of coronary artery disease (CAD) remain largely unknown. This study is aimed at examining the relationship between the plasma ADAMTS-5 levels and the severity of coronary stenosis in patients with CAD. In the present study, the expression of ADAMTS-5 was analyzed in coronary artery samples and blood. The results showed that the plasma ADAMTS-5 levels were lower in the CAD group than in the control group. In addition, significantly higher matrix metalloproteinase- (MMP-) 2 and MMP-9 levels were also observed in the patients with CAD, and the ADAMTS-5 levels were negatively correlated with the MMP-2 and MMP-9 levels. Spearman's correlation analysis showed that the Gensini score was negatively correlated with the ADAMTS-5 levels but was positively correlated with the MMP-2 and MMP-9 levels. Receiver-operating characteristic (ROC) analysis revealed that ADAMTS-5, MMP-2, and MMP-9 may have a certain diagnostic value in CAD and that the combination of all three metalloproteinases had a higher diagnostic value. The findings provided a better understanding of the role of ADAMTS-5 in the diagnosis of CAD. [ABSTRACT FROM AUTHOR]

Background. Interleukin-11 (IL-11) is an important inflammatory cytokine and has been demonstrated to participate in cardiovascular diseases. However, there have been no studies about the role of IL-11 in heart failure (HF). The present study is aimed at investigating whether IL-11 levels are associated with the cardiac prognosis in patients with HF. Methods. The plasma concentrations of IL-11 were measured in 240 patients with chronic HF (CHF) and 80 control subjects without signs of significant heart disease. In addition, we prospectively followed these CHF patients to endpoints of cardiac events. Results. Compared with the control group, the plasma IL-11 concentrations were significantly increased in the CHF patients and gradually increased in the New York Heart Association (NYHA) functional class II group, the NYHA functional class III group, and the NYHA functional class IV group. The receiver operating characteristic (ROC) curve revealed that the predictive role of IL-11 in HF is not as good as N-terminal B-type natriuretic peptide (BNP), although IL-11 has a certain value in predicting cardiac events. In addition, the CHF patients were divided into 3 groups according to the plasma IL-11 concentration category (low, T1; middle, T2; and high, T3). The multivariate Cox hazard analysis showed that the high plasma IL-11 concentrations were independently associated with the presence of cardiac events after adjustment for confounding factors. Furthermore, the CHF patients were divided into two groups based on the median plasma IL-11 concentrations. The Kaplan-Meier analysis revealed that the patients with high IL-11 concentrations had a higher risk of cardiac events compared with those with low IL-11 concentrations. Conclusions. Higher plasma IL-11 levels significantly increase the presence of cardiac events and suggest a poor outcome; although the diagnostic value of IL-11 in CHF is not as good as BNP, there is a certain value in predicting cardiac events in CHF. [ABSTRACT FROM AUTHOR]

Background. Interleukin- (IL-) 22 is considered a proinflammatory cytokine. Recent evidence has demonstrated that it plays a role in cardiovascular diseases. In the recent study, we investigate whether IL-22 is involved in cardiac hypertrophy. Methods. Angiotensin II was used to build hypertrophy model and the IL-22 and IL-22 receptor 1 (IL-22R1) levels in heart tissue were measured. In addition, angiotensin II-treated mice received an injection of anti-IL-22-neutralizing antibody (nAb) to investigate the effects of IL-22 nAb on myocardial hypertrophy, cardiac function, and cardiac fibrosis; the activation of the signaling pathway and the prohypertrophic inflammatory cytokine mRNA levels was detected. Furthermore, the effect of IL-22 nAb on angiotensin II-induced hypertrophy in vitro was also determined. Results. IL-22 and IL-22R1 levels were significantly increased after angiotensin II infusion. Anti-IL-22 nAb significantly alleviated the severity of hypertrophy, prevented systolic and diastolic abnormalities, reduced cardiac fibrosis, STAT3 and ERK phosphorylation, and downregulated the mRNA expression of IL-17, IL-6, IL-1β, IFN-γ, and TNF-α. In addition, IL-22 nAb attenuated angiotensin II-induced hypertrophy in H9C2 cells. Conclusion. Our data demonstrated that neutralization of IL-22 alleviated angiotensin II-induced cardiac hypertrophy. The downregulation of IL-22 may be a novel therapeutic strategy to prevent cardiac hypertrophy. [ABSTRACT FROM AUTHOR]

Human umbilical cord-derived mesenchymal stem cells (hUCMSCs) are considered to be an ideal cell source for cell therapy of many diseases. The aim of this study was to investigate the contribution of the microenvironment to the hepatic differentiation potential of hUCMSCs in vitro and in vivo and to explore their therapeutic use in acute liver injury in rats. We established a new model to simulate the liver tissue microenvironment in vivo using liver homogenate supernatant (LHS) in vitro. This induced environment could drive hUCMSCs to differentiate into hepatocyte-like cells within 7 days. The differentiated cells expressed hepatocyte-specific markers and demonstrated hepatocellular functions. We also injected hUCMSCs into rats with CCl4-induced acute hepatic injury. The hUCMSCs were detected in the livers of recipient rats and expressed the human hepatocyte-specific markers, suggesting that hUCMSCs could differentiate into hepatocyte-like cells in vivo in the liver tissue microenvironment. Levels of biochemistry markers improved significantly after transplantation of hUCMSCs compared with the nontransplantation group (P<0.05). In conclusion, this study demonstrated that the liver tissue microenvironment may contribute to the differentiation of hUCMSCs into hepatocytes both in vitro and in vivo. [ABSTRACT FROM AUTHOR]

To prepare the gold nanoparticles (AuNPs) with uniform sizes, fine morphology, and good monodispersity, a pulsed mixing microfluidic system based on PZT actuation was presented. The system includes PZT micropump and Y type micromixer. By adjusting voltage (entrance flow rate), pulsed frequency, phase, and other parameters, a variety of mixing modes can be achieved, so as to realize the controllable synthesis of nanoparticles in a certain range. By numerical simulation and analysis, the channel section size, entrance angle, and pulse frequency were optimized. Based on the optimized structure and working parameters, the test prototype has been manufactured in lab, and the related synthesis tests of AuNPs were carried out. The test results indicate that AuNPs with uniform morphology and good monodispersity can be synthesized using the system with the section size (0.4 mm × 0.4 mm), the entrance channel angle (60°) under condition of the pulsed frequency (300 Hz), and the entrance flow rate (4 mL/min). The average diameter and its standard deviation of AuNPs synthesized were 21.6 nm, 4.83 nm, respectively. The research work above can be applied to the fields such as the controlled synthesis of noble metal nanoparticles, biomedicine, and microchemical system. [ABSTRACT FROM AUTHOR]