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Background: Chronic Heart Failure (CHF) still affects millions of people worldwide despite great advances in therapeutic approaches in the cardiovascular field. Cardiac rehabilitation (CR) is known to improve disease-related symptoms, quality of life and clinical outcomes, yet implementation was suboptimal, a frequently low engagement in rehabilitation programs has been found globally. Objective: To quantify diverse CR-engaged processes and elucidate predictors of the various levels of CR engagement in CHF patients. Methods: CHF patients admitted or discharged from cardiology departments between May 1 2022 to November 1 2022 were enrolled. Individuals who met the inclusion criteria filled the questionnaires, including the generalized anxiety disorders scale, patient health questionnaire, cardiac rehabilitation inventory, patient activation measure, Tampa scale for kinesiophobia heart, social frailty, Patient Health Engagement Scale (PHE-s®) We obtained sociodemographic characteristics and clinical data from medical records. The survey was distributed via mobile phone text messaging or face-to-face completed. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with CR engagement phases. Results: A total of 684 patients were included in the study. Univariate analysis showed that only kinesiophobia had no correlation with engagement phases besides socio-demographic and clinical variables. Multivariate logistic regression analysis revealed that compared with the blackout phaseprocess anxiety (Arousal: OR 0.829, 95%CI: 0.73 ~ 0.94; Adhesion: OR 0.725, 95%CI: 0.64 ~ 0.82; Eudaimonic Project: OR 0.674, 95%CI: 0.59 ~ 0.77), monthly income (RMB yuan) equal to or more than 5,000 (Arousal: OR 6.342, 95%CI: 1.30 ~ 31.01; Adhesion: OR 5.226, 95%CI: 1.09 ~ 24.96; Eudaimonic Project: OR 6.658, 95%CI 1.26 ~ 34.76) were the most important factor impacting CHF patients CR engagement. In the Arousal phase, versus the Blackout phase, regular exercise or not (OR 3.29, 95% CI: 1.19 ~ 9.10), severe depression (OR 0.019, 95% CI: 0.00 ~ 0.813), previous cardiac-related hospitalizations 1 or 2 times (OR 3.75, 95% CI: 1.19 ~ 11.86), Age (OR 0.958, 95% CI: 0.92 ~ 0.998) influenced patient CR engagement. Besides, compared to the Blackout phase, outcome anxiety (OR 1.269, 95% CI: 1.11 ~ 1.46) and activation level (level 2: OR 9.357, 95% CI: 1.44 ~ 60.68; level 3: OR 29.96, 95% CI: 3.67 ~ 244.92; level 4: OR 29.71, 95% CI: 3.62 ~ 243.61) were independent factors predicting the Eudaimonic Project phase. Conclusions: This study characterized CR engagement, and explored demographic, medical, and psychological factors— with the most important being process anxiety, monthly income, patient activation, severe depression, and previous cardiac-related hospitalizations. The predictor factors of CR engagement were not identical among different phases which strongly indicates a significant role in quantifying CR engagement. Our findings suggested that factors could potentially be targeted in clinical practice to identify low CR engagement patients, and strategies implemented to strengthen or overcome these associations to address low CR engagement in CHF patients.

Yuanyuan Peng,1 Yan Xu,1 Liping Yue,1 Fanglei Chen,1 Jie Wang,2 Guozhen Sun2,3 1Department of Nursing, School of International Medical Technology, Sanda University, Shanghai, People’s Republic of China; 2Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China; 3School of Nursing, Nanjing Medical University, Nanjing, People’s Republic of ChinaCorrespondence: Guozhen Sun, Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China; School of Nursing, Nanjing Medical University, Nanjing, People’s Republic of China, Tel +86 13851769549, Fax +86 25 6830348, Email gzsun100@126.comBackground: In the fight against heart failure (HF), informal caregivers are an indispensable part of the team. As a protective factor against stress, resilience can help to enhance caregivers’ psychological adaptation and ultimately increase the quality of care during the HF caregiving period. Recognizing its predictors and exploring how these variables interact could promote tailored strategies to enhancing caregivers’ resilience of HF patients. Thus, this study aimed to identify promoting and risk factors of resilience in informal caregivers of HF patients from the Chinese context and to understand the interactions between these factors and resilience.Methods: This cross-sectional study was conducted from December, 2020 to March, 2022 among 210 caregivers in Nanjing, China. The General Information Questionnaire, the Connor-Davidson Resilience Scale, the General Self-Efficacy Scale, the Perceived Social Support Scale, the Positive and Negative Affect Scale, the Simplified Coping Style Questionnaire and the Family Hardiness Index were used in this survey. Data were analysed with Pearson’s correlation analysis, the multiple linear regression model and the structural equation modeling (SEM).Results: The resilience of 210 Chinese HF caregivers was at the moderate and higher level (66.40± 15.08). The SEM had a good fit (root mean square error of approximation=0.047, comparative fit index=0.994, Tucker-Lewis index=0.987). Perceived social support (β=0.390, P< 0.001), positive coping style (β=0.159, P=0.019) and self-efficacy (β=0.332, P< 0.001) had positive direct effects on resilience among HF caregivers, separately. Both perceived social support (β=0.04, P< 0.001) and self-efficacy (β=0.07, P< 0.001) indirectly influenced resilience through positive coping style.Conclusion: We recommended that multi-dimensional and greater social support, higher self-efficacy and especially, positive coping strategies should be offered or encouraged during the caregiving period, which may contribute to enhancing HF caregivers’ resilience.Keywords: heart failure, caregivers, resilience, influencing factors, structural equation model, positive coping style, mediator

BACKGROUND Radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) can generate considerable physical and psychological discomfort under conscious sedation. App-based mindfulness meditation combined with an electroencephalography (EEG)-based brain-computer interface (BCI) shows promise as effective and accessible adjuncts in medical practice. OBJECTIVE This study aimed to investigate the effectiveness of a BCI-based mindfulness meditation app in improving the experience of patients with AF during RFCA. METHODS This single-center pilot randomized controlled trial involved 84 eligible patients with AF scheduled for RFCA, who were randomized 1:1 to the intervention and control groups. Both groups received a standardized RFCA procedure and a conscious sedative regimen. Patients in the control group were administered conventional care, while those in the intervention group received BCI-based app–delivered mindfulness meditation from a research nurse. The primary outcomes were the changes in the numeric rating scale, State Anxiety Inventory, and Brief Fatigue Inventory scores. Secondary outcomes were the differences in hemodynamic parameters (heart rate, blood pressure, and peripheral oxygen saturation), adverse events, patient-reported pain, and the doses of sedative drugs used in ablation. RESULTS BCI-based app–delivered mindfulness meditation, compared to conventional care, resulted in a significantly lower mean numeric rating scale (mean 4.6, SD 1.7 [app-based mindfulness meditation] vs mean 5.7, SD 2.1 [conventional care]; P=.008), State Anxiety Inventory (mean 36.7, SD 5.5 vs mean 42.3, SD 7.2; PP=.01) scores. No significant differences were observed in hemodynamic parameters or the amounts of parecoxib and dexmedetomidine used in RFCA between the 2 groups. The intervention group exhibited a significant decrease in fentanyl use compared to the control group, with a mean dose of 3.96 (SD 1.37) mcg/kg versus 4.85 (SD 1.25) mcg/kg in the control group (P=.003).The incidence of adverse events was lower in the intervention group (5/40) than in the control group (10/40), though this difference was not significant (P=.15). CONCLUSIONS BCI-based app–delivered mindfulness meditation effectively relieved physical and psychological discomfort and may reduce the doses of sedative medication used in RFCA for patients with AF. CLINICALTRIAL ClinicalTrials.gov NCT05306015; https://clinicaltrials.gov/ct2/show/NCT05306015

This study aimed to examine the effectiveness of high-intensity interval training (HIIT) on pulmonary function and exercise capacity in individuals with chronic obstructive pulmonary disease (COPD). Ten databases (PubMed, the Cochrane Library, Web of Science, EMBASE, MEDLINE, CINAHL, CNKI, Wanfang, Weipu, and CBM) were searched for relevant articles published from inception to 30 June 2020. Studies were included if they were randomized controlled trials (RCTs) comparing a HIIT group with usual care or other training groups. Quality was assessed using the Physiotherapy Evidence Database (PEDro) scale, and the overall quality of evidence was assessed using the GRADE approach. The primary outcomes were peak VO2 and FEV1% predicted, and the secondary outcomes were FEV1/FVC, peak VE, peak WR, 6MWD, dyspnea, health-related quality of life, and adverse event. Twelve articles (689 patients) were included. HIIT was shown to have a positive effect on exercise capacity (peak WR, 6MWD), pulmonary function (FEV1% pred, peak VE), dyspnea, and quality of life. However, sensitivity analyses for dyspnea were unstable, and the result changed from positive to negative after removing one study (SMD = − 0.13, 95% CI [− 0.44, 0.17], P = 0.40). HIIT could improve pulmonary function, exercise capacity, and quality of life but may not decrease dyspnea in patients with COPD. It can be recommended as a safe and effective exercise modality in rehabilitation programs. Given that the overall results were based on a limited number of studies with significant heterogeneity and some of the results were based on low GRADE rating evidence, more high-quality, larger sample size, multicenter, and long-term follow-up RCTs are needed to confirm the clinical efficacy of HIIT in patients with COPD. CRD42020165897.

Objective: To assess the effectiveness of tele-monitored cardiac rehabilitation in patients who have undergone ablation for atrial fibrillation. Design: Single-centre, prospective, assessment-blinded, randomised controlled trial. Setting: Domiciliary rehabilitation with support from a tertiary care hospital. Subjects: One hundred patients who underwent ablation for atrial fibrillation were recruited. Interventions: Participants were randomly allocated to a 12-week standard rehabilitation treatment (control group) or a comprehensive, domiciliary, mobile application-guided and tele-monitored cardiac rehabilitation program (intervention group) in a 1:1 fashion. Main outcome measures: The primary endpoint was the improvement in VO2peak. The secondary outcomes included adherence, physical activity, beliefs related to cardiovascular disease and exercise self-efficacy. Results: Ninety-seven patients completed follow-up. The mean VO2peak increased significantly in both the intervention group ( n = 49) (baseline vs 12 weeks: 19.1 ± 4.7 vs 27.3 ± 5.6 ml/(min kg), P Conclusions: Our domiciliary, mobile application-guided and tele-monitored cardiac rehabilitation program could lead to a more significant improvements in physical fitness, adherence and health beliefs than standard cardiac rehabilitation in patients who have undergone ablation for atrial fibrillation.

Yuanyuan Peng,1 Jie Wang,1 Guozhen Sun,1,2 Shenxinyu Liu1 1School of Nursing, Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, People’s Republic of ChinaCorrespondence: Guozhen SunSchool of Nursing, Nanjing Medical University, Nanjing, People’s Republic of ChinaTel +86 13851769549Fax +86 25 6830348Email gzsun100@126.comBackground: Struggling with heart failure (HF) may be a distressful experience for the entire family. As a key variable contributing to positive family functioning, family hardiness can protect against HF-related harm. Thus, recognizing factors associated with family hardiness could promote strategies that enable successful adaptation to HF. This study aimed to explore protective factors linked to family hardiness among HF patients.Patients and Methods: A cross-sectional study was undertaken in 2020 among 167 HF patients in Nanjing, China. The study measures comprised a self-designed general information questionnaire, the Family Hardiness Index, the Mutuality Scale, the Positive and Negative Affect Scale, and the Simplified Coping Style Questionnaire. The data analysis was performed using IBM SPSS, version 25 and comprised Pearson’s correlation analysis, a multiple linear regression model, and an analysis of mediating effects.Results: The average Family Hardiness Index score for the 167 HF patients was 57.95 ± 11.41. The multiple linear regression analysis revealed that mutuality, active coping style, and positive emotions of HF patients positively predicted family hardiness (β = 0.359, 0.308, and 0.215, respectively; all P ˂ 0.05). Mutuality between patients and family members had partial mediating effects between active coping style, positive emotions, and family hardiness.Conclusion: Our results revealed that patients’ active coping styles, positive emotions, and mutuality were protective factors associated with family hardiness. In light of our findings, we suggest that active coping strategies, positive emotions, and, especially, closer relationships within families should be encouraged during the rehabilitation and follow-up care of HF patients.Keywords: family hardiness, protective factors, mutuality, mediator, heart failure

Montmorillonite (MMT) powder, as the most effective hemostats in natural silicates, is restricted for commercial application due to its embolic effect. Until now, it's still a challenge to control the leakage of MMT and avoid its side-effects. Herein, poly aldehyde dextran (PDA)/MMT composite sponge (PM) with commendable tissue adhesion, antibacterial, and wound healing performances is developed for massive hemorrhage control. Based on the high degree of perfect synergism of PDA and MMT, the PM sponge can rapidly seal the wound, and promote cells aggregation and adhesion, whole coagulation system activation, resulting in shortened clotting time from 480 s to

Wound dressing is of significant importance to promote cutaneous wound healing process. To develop an effective wound dressing, a PVA/DA hydrogel was prepared using a Poly (vinyl alcohol)/Dextran-aldehyde solution blend, followed by crosslinking via freeze-thaw method and freeze-drying. We characterized the hydrogel by infrared spectroscopy, mechanical property tests, swelling behavior test and biocompatibility test. Results showed that the PVA/DA hydrogels had a 3-dimensional, highly porous structure with uniformly distributed pores of 5–10 μm, strong tensile strength of 5.6 MPa, efficient ability to absorb fluid of 6 time its weight and suitable water vapor transmission rate of 2100 g m−2 day−1 to keep a moist environment and good biocompatibility shown by very low hemolysis and no cytotoxicity. In wound healing tests using a full-thickness skin wound model, macroscopic observations showed that the wound covered by the PVA/DA hydrogel almost reached complete healing faster by 10 days, while histological analysis indicated a faster regeneration of skin. Thus, the PVA/DA hydrogel was suitable for application as a wound dressing and may have potential for use in various biomedical applications.

Uncontrolled bleeding is thought to be the most deadly cause of pre-hospital, traffic, and military accidents death. However, the popular commercial hemostats can only realize the hemostasis of mild bleeding. Therefore, we developed polydopamine (PDA) composite materials (PMs), which applied hydroxyapatite as the parent body. The PMs were produced via lyophilization and functionalized with amino, phenol hydroxyls groups, which endowed hydrophobicity to materials. This ensured a high aggregation ability of blood cells to the PMs and they were tested to be as high as 300% compared with the negative control group. The clotting time was shortened to 79.7% compared with the usually used commercial hemostat (Celox) in the test of in vitro hemostasis. Through the results of PT and APTT tests, blood coagulation index test, and the analysis of intracellular Ca2+ activation, we further understood the mechanism of the hemostasis of the materials, which explained the low blood loss and quick coagulation time of the PM hemostats in detail. Besides, the low hemolysis and cytotoxicity of the PMs suggested the good biocompatibility of the hemostats, which was further proved by the regular morphology maintained by erythrocytes in the hemolysis tests. The study of nanoscale composites led the research for the methods of hemostasis.

IntroductionHeart failure (HF) is an end-stage of numerous heart diseases including hypertension, coronary heart disease and arrhythmia, in which the heart is unable to perform its circulatory function with sufficient efficiency due to structural or functional dysfunction (systolic or diastolic alterations). Strategies such as exercise rehabilitation may improve cardiac function, exercise capacity and health-related quality of life and reduce anxiety and depression in patients with HF. However, the relative effectiveness as well as the hierarchy of exercise interventions have not been well established, although various exercise options are available. Therefore, this protocol proposes to conduct a network meta-analysis (NMA) aiming to compare the effectiveness of different types of exercise training in patients with HF.Methods and analysisPubMed, Embase and the Cochrane Library will be searched from inception to March 2021 for relevant randomised controlled trials. Other resources, such as Google Scholar and Clinical Trials.gov will also be considered. Studies assessing exercise rehabilitation in patients with HF will be selected. Two independent reviewers will identify eligible trials. The PEDro risk of bias assessment tool will be used to assess the quality of the included studies. Bayesian NMA will be used when possible to determine the comparative effectiveness of the different exercise interventions. The mean ranks and surface will estimate the ranking probabilities for the optimal intervention of various treatments under the cumulative ranking curve. Subgroup, sensitivity and meta-regression will be conducted to explain the included studies’ heterogeneity if possible. We will also use the Grading of Recommendations, Assessment, Development, and Evaluation system to assess the strength of evidence.Ethics and disseminationThis systematic review and NMA will synthesise evidence on the effectiveness of the different exercises in patients with HF. The results will be submitted to a peer-reviewed journal. No ethical approval will be required because the data used for the review will be exclusively extracted from published studies.PROSPERO registration numberCRD42020165870.

BackgroundHigh-intensity interval training, for its characteristic of short-time high oxygen-consumption exercise interphase with periods of low-intensity training or rest for recovery, is easier to persist and execute in cardiac rehabilitation. However, it is little known whether HIIT program has an advantageous effect on patients after percutaneous coronary intervention or not.MethodsRandomized controlled trials (RCTs) focusing on HIIT program in patients after PCI were searched in Cochrane Library, Web of Science Core Collection, EMbase, PubMed, China National Knowledge Infrastructure (CNKI) and SinoMed from the inception to March 24, 2020. Two reviewers conducted the literature retrieval, data extraction, and quality assessment independently. Standard Mean difference (SMD) and 95% confidence intervals (CI) were performed to summarize the effect sizes.Results6 RCTs (247 patients) met the criteria. HIIT program had a statistically significant effect on raising left ventricular ejection function (LVEF) (SMD=0.38, 95%CI[0.03, 0.73], p=0.03), VO2peak (SMD=0.94, 95%CI[0.61, 1.28], pConclusionsHIIT program might be favorable for CAD patients after PCI by improving cardiopulmonary function, such as LVEF and VO2peak, as well as reducing late luminal loss in per stented arteries. Nevertheless, HIIT had no advantage for adjusting heart rate. More researches with rigorous methods are warranted to explore the controversy about lipid profiles.

The chalcogenide glass Ge 4 Se 96 was prepared by melt-quenched method. The characteristic temperatures (the strain point, annealing point, glass transition point, yielding point and soften point) were determined by thermal analysis. The result shows that the glass transition point is 52 °C; the average thermal expansion coefficient is Δ L / L 0 = (0.0557∗ T −1.7576)/1000. The specific heat of Ge 4 Se 96 glass was measured by stepwise method. The difference in specific heat between amorphous structure and undercooled liquid was determined as Δ C p = 0.1812–5.20 × 10 −4 T −4.92 × 10 −7 T 2 JK −1 g −1 . Based on the result of Δ C p , the Gibbs energy and the entropy curves were calculated, and the Kauzmann temperature was determined as T k = 233.5 K, which is between that for pure Se glass (216 K) and that for Ge 7.4 Se 92.6 glass (250 K). It indicates that for Ge-Se glass with low Ge content, the Kauzmann temperature increases with increasing the content of Ge.

This study aimed to systematically evaluate the effect of nursing interventions on reducing dietary sodium intake in patients with chronic heart failure, further to provide insight on the most utilized nursing practices. Only randomized controlled trials on dietary sodium management of nursing interventions were collected from Pubmed, CINAHL, Web of Science, Embase and The Cochrane Library (CENTRAL). Among 515 available studies, a total of 8 ones met the inclusion criteria and were included. The meta-analysis result suggested that nursing interventions could reduce dietary sodium intake in patients with chronic heart failure within 6 months compared with conventional care [SMD (-0.305, 95%CI -0.561, -0.049)]. Considering the sodium levels estimated by the 3-day food record is much lower than those by the 24-hour urinary sodium, it is better to analyze separately to further clarify the effect of nursing interventions. Hence, further meta-analysis results showed that the sodium intake estimated by the 3-day diet record/diary in the experimental group was lower than that in the control group [SMD -0.523, 95%CI (-0.894 to -0.152), P=0.006]. Similarly, the sodium intake in the experimental group was lower than that in the control group by 24-hour urine specimen [WMD -364.318, 95% CI (-603.953 to -124.684), P=0.003]. We concluded that nursing interventions can reduce dietary sodium intake in patients with chronic heart failure in the short term. However, the long-term effects are uncertain, and long-term planned randomized controlled trials in heart failure patients are required to further verify the effect in the future.

Uncontrolled hemorrhage is closely related to the high risk of death. However, local hemostats still have various defects and side effects. Herein, an aldehyde dextran (PDA) sponge with proper absorption and adhesion properties is developed for hemorrhage control. PDA sponge with pore size of ∼30–50 μm fabricated by lyophilization not only absorbs blood quickly (47.7 g/g), but also possesses strong tissue adhesion (∼100 kPa). PDA sponge with low cytotoxicity and hemolysis achieves effective hemostasis and remarkable blood loss reduction in the ear vein, femoral artery and liver injuries of rabbit models. Furthermore, the exploration of hemostatic mechanisms related to tissue, blood, plasma, cells and coagulation system indicates that PDA sponge can significantly accelerate coagulation by rapid wound block, fast cells aggregation and initiation, and high coagulation factors concentration, instead of by the coagulation cascade activation. Importantly, this hemostat exhibits excellent biodegradability and nearly no skin irritation. Overall, the biodegradable and tissue adhesive PDA sponge will be a promising quick-hemostatic dressing for uncontrollable hemorrhage.

This template explains and demonstrates how to prepare your camera-ready manuscript for publisher. The best is to read these instructions and follow the outline of this text. Please make the page settings of your word processor to Letter format (21.59 x 27.94 cm or 8.5 x 11 inches); with the margins: bottom 2.8 cm (1.1 in) and top 2.8 cm (1.1 in), right/left margins must be 2.54 cm (1 in). Your manuscript will be reduced by approximately 20% by the publisher. Please keep this in mind when designing your figures and tables etc.

In order to improve the speed of mean filter algorithm and to reduce the redundancy operation, an efficient algorithm is presented in this paper. At first, an assistant array is built up to store the pixels' value summation of each column. Then, according to the relationship between adjacent windows when filter window is siding along the rows, a recursive formula for calculating the midpoint mean of a new window is schemed out. Meanwhile, the recursive formula for updating assistant array items is obtained based on the relationship between adjacent rows' pixels in the changing row process of midpoint of window. On the basis of these two recursion formulas, a high efficient mean filter algorithm is achieved. The speed of this method is independent of the variation of window size, which made it suitable for the process of large images with large filter kernel. And it is proved by experiments that the new algorithm is more efficient than the others.