Psychological distress and health-related quality of life in implantable cardioverter defibrillator patients with coronary artery disease

Implantable cardioverter defibrillator (ICD) patients are found to have poorer health-related quality of life (HRQoL) and heightened psychological distress, particularly depression. Coronary artery disease (CAD) is evidenced to be associated with lowered HRQoL and more negative emotions. This study was to examine psychological status and HRQoL as well as identify factors associated with these two areas among ICD patients with a history of CAD. Of 57 ICD patients with CAD, most of them (91.2%) aged 60 or older with mean age 63.04 years old (SD=14.58). A majority of them were married (84.2%) and selfcare dependent (89.5%). All participants had a history of SCA experience. Almost 80% were the first ICD recipients and had ICD implantation more than one year. Only two of them had ICD shock experience. The participants were more depressive (mean 3.67±3.57). About 8.8% of patients had severe clinical depression (score ≥8) and 19.3% had severe clinical anxiety (score ≥8). The participants had relatively poorer mental health (mean 58.35±9.31) than physical health (mean 38.15±14.98). Female gender was found to have positive association with anxiety; whereas, having a history of DM has positive association with depression. Self-care dependence was the most significant factor associated with anxiety and depression. Depression was found to be negatively associated with physical health; whereas, anxiety was negatively associated with mental health. By contrast, having occupation and having a history of hyperlipidemia were found to be positively associated with physical health. The results showed that identification of factors enables nurses to develop strategies to remove or reduce the negative effects but to provide more support to foster the positive effects arising from the factors. The study results can direct healthcare policy makers implement strategies for optimizing HRQoL and reducing psychological burdens

Health-related quality of life and psychological distress in implantable cardioverter defibrillator patients with and without heart failure

Heart failure (HF) is one of the major health concerns worldwide due to high incidence and mortality. HF patients experience high level of psychological distress, particularly anxiety and depression. To increase survival rate, implantable cardioverter defibrillator (ICD) acts as a life-savor to deliver immediate shock to correct life-threatening arrhythmias as HF patients are the high-risk population for sudden cardiac arrest. It was attributed to unpredictable ICD shock. Moreover, some studies reported that ICD can improve health-related quality of life (HRQoL) among HF patients. However, ICD was evidenced to increase anxiety and depression. Psychological distress can also impair HRQoL of ICD patients. Due to different health conditions and health needs, ICD patients with and without HF can perceive different degrees of heightened psychological distress and declined HRQoL. Although the number of HF patients receiving ICD implantation has been increasing, inadequate knowledge is reported about their psychological status and HRQoL. To improve current ICD care to patients with and without HF, this study aimed to compare psychological status (anxiety and depression) and HRQoL and identify the relationships of personal and clinical characteristics with psychological status and HRQoL between ICD patients with and without HF. A total of 139 ICD patients were recruited, including 68 patients with HF. Those with HF perceived relatively higher depression and poorer physical HRQoL. Patients without HF who were married perceived better physical and mental health. Patients with HF who were more dependent have heightened anxiety and depression. The results shed light on the differences from the level of anxiety and depression among ICD patients with and without HF as well as their HRQoL so that ICD care for these two specific ICD patient groups can be directed. Family involvement is more significant for patients with and without HF

A cross-sectional study: Collaborative learning approach enhances learning attitudes of undergraduate nursing students

Collaborative learning approach is an effective teaching method to receive optimal achievement in knowledge and skills. Since nursing is a profession that emphasizes multidisciplinary collaboration, collaborative learning approach has been commonly adopted in current nursing education to maximize students’ learning and develop their collaborative attributes. It is important that learning attitudes shall be positive to reach benefits of collaborative learning. This study was to examine how learning attitudes of nursing undergraduate students in respond to collaborative learning approach. The results may help nursing school administrators design more appropriate learning activities and give educators insights to implement collaborative learning approach more effectively

EZH2-Mediated H3K27me3 Is Involved in Epigenetic Repression of Deleted in Liver Cancer 1 in Human Cancers

Enhancer of zeste homolog 2 (EZH2), the histone methyltransferase of the Polycomb Repressive complex 2 catalyzing histone H3 lysine 27 tri-methylation (H3K27me3), is frequently up-regulated in human cancers. In this study, we identified the tumor suppressor Deleted in liver cancer 1 (DLC1) as a target of repression by EZH2-mediated H3K27me3. DLC1 is a GTPase-activating protein for Rho family proteins. Inactivation of DLC1 results in hyper-activated Rho/ROCK signaling and is implicated in actin cytoskeleton reorganization to promote cancer metastasis. By chromatin immunoprecipitation assay, we demonstrated that H3K27me3 was significantly enriched at the DLC1 promoter region of a DLC1-nonexpressing HCC cell line, MHCC97L. Depletion of EZH2 in MHCC97L by shRNA reduced H3K27me3 level at DLC1 promoter and induced DLC1 gene re-expression. Conversely, transient overexpression of GFP-EZH2 in DLC1-expressing Huh7 cells reduced DLC1 mRNA level with a concomitant enrichment of EZH2 on DLC1 promoter. An inverse relation between EZH2 and DLC1 expression was observed in the liver, lung, breast, prostate, and ovarian cancer tissues. Treating cancer cells with the EZH2 small molecular inhibitor, 3-Deazaneplanocin A (DZNep), restored DLC1 expression in different cancer cell lines, indicating that EZH2-mediated H3K27me3 epigenetic regulation of DLC1 was a common mechanism in human cancers. Importantly, we found that DZNep treatment inhibited HCC cell migration through disrupting actin cytoskeleton network, suggesting the therapeutic potential of DZNep in targeting cancer metastasis. Taken together, our study has shed mechanistic insight into EZH2-H3K27me3 epigenetic repression of DLC1 and advocated the significant pro-metastatic role of EZH2 via repressing tumor and metastasis suppressors.published_or_final_versio

A survey: Knowledge about breast cancer and health beliefs towards screening practice among menopausal and postmenopausal women

Breast cancer is a major health problem with high mortality in women worldwide and has become the third most prevalent disease among women in Hong Kong. Knowledge about breast cancer is closely related to health beliefs towards screening practices for breast cancer. This study examined knowledge about breast cancer and breast cancer screening (BCS) beliefs among menopausal and postmenopausal women. A total of 213 eligible women, mostly aged 55 to 60, who were housewives or retired and were educated at secondary school level or above, were selected. A survey using the Chinese Breast Cancer Screening Beliefs (CBCSB) questionnaire was conducted. The results revealed that menopausal and postmenopausal women had better health beliefs towards breast cancer screening practices. Education was found to be positively associated with attitudes of BCS health beliefs. It indicates that education can affect attitudes towards breast cancer screening practice. Most of the women presented inadequate knowledge and they wished to receive more information about breast cancer although they were well-educated. It is important to note that knowledge about breast cancer cannot be effectively delivered to the at-risk women. In addition, menopausal and postmenopausal women can be more likely to seek more information about the effectiveness and side effects of the medication for breast cancer. Therefore, treatment about effectiveness, side effects, and prices ought to be included in current educational programs and healthcare services in the promotion schemes. Healthcare professionals should also pay more attention to better BCS practices in community-based educational programs with information on preventive measures for breast cancer to menopausal and postmenopausal women, particularly to those in lower socioeconomic classes

A survey of the perceived lifestyle risks of breast cancer in menopausal and postmenopausal women in Hong Kong

Breast cancer ranks as the most common cause of cancer death in women. If menopausal and postmenopausal women know the lifestyle risks associated with breast cancer and its preventive measures, they will make appropriate choices in order to enjoy their life and have a better chance of preventing this disease. This study attempted to explore perceived beliefs with regard to the lifestyle risks associated with breast cancer among menopausal and postmenopausal women in Hong Kong. A survey was designed that used a self-reporting questionnaire to assess the perceived beliefs of 223 women. Results showed that more than half of the participants held misconceptions about lifestyle breast cancer risks. Only those women who were well-educated and were worried about having breast cancer performed breast screening for cancer. The findings of this study suggest that health care professionals should channel resources to educate menopausal and postmenopausal women about the risks of breast cancer and to promote awareness of breast wellness and the value of breast cancer screening

Menopausal-specific quality of life among women in Hong Kong

This study aimed to explore the menopausal-specific quality of life and assess its relationship with the sociodemographic characteristics in menopausal and post-menopausal women in Hong Kong. A cross-sectional survey was conducted with 218 women aged between 45 and 80 or over. The quality of life was assessed by Menopause-Specific Quality of Life Questionnaire (MENQOLTM). Results showed that the mean scores for vasomotor domain: 2.59 ± 1.71; psycho-social domain: 2.77 ± 1.39; physical domain: 2.89 ± 1.23 and sexual domain 2.60 ± 1.16. The physical domain had the highest score in menopausal and post-menopausal women. Univariate analysis demonstrated that younger and less educated working post-menopausal women perceive lower quality of life. Our findings suggest that menopausal-related symptoms affect the quality of life

RhoE/ROCK2 regulates chemoresistance through NF-κB/IL-6/ STAT3 signaling in hepatocellular carcinoma

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Role of hepatitis B virus genotypes in chronic hepatitis B exacerbation

Hepatitis B virus (HBV) genotypes and precore and core promoter mutations were determined in 318 patients with HBV. Patients infected with HBV genotype B had a higher median alanine aminotransferase level and bilirubin level and a lower median albumin level during exacerbations of disease, compared with patients infected with HBV genotype C (all P < .001). By logistic regression analysis, HBV genotype B infection (P = .014) and low albumin levels (P = .006) were independently associated with a higher risk of hepatic decompensation during severe exacerbations of disease. Patients infected with genotype B had a significantly higher mortality due to hepatic decompensation than did patients with genotype C (70% vs. 27.8%; P = .05).published_or_final_versio

Down-regulation of TIMP2 by HIF-1α/miR-210/HIF-3α regulatory feedback circuit enhances cancer metastasis in hepatocellular carcinoma

Cancer metastasis is a multistep process that involves a series of tumor-stromal interaction, including extracellular matrix (ECM) remodeling, which requires a concerted action of multiple proteolytic enzymes and their endogenous inhibitors. This study investigated the role of tissue inhibitor of metalloproteinases (TIMP) 2 in the context of hepatocellular carcinoma (HCC) metastasis. We found that TIMP2 was the most significantly down-regulated member among the TIMP family in human HCCs. Moreover, TIMP2 underexpression was frequent (41.8%; 23 of 55) in human HCCs and was significantly associated with liver invasion and poorer survival outcomes of HCC patients. Furthermore, stable silencing of TIMP2 in HCC cell lines enhanced cell invasive ability and ECM degradation associated with formation of invadopodia-like feature, suggesting that TIMP2 is a negative regulator of HCC metastasis. Using an orthotopic tumor xenograft model, we demonstrated that ectopic expression of TIMP2 open reading frame in the highly metastatic HCC cell line, MHCC-97L, significantly reduced HCC progression as well as pulmonary metastasis. Mechanistically, TIMP2 suppression, in a hypoxic environment, was induced through a regulatory feedback circuit consisting of hypoxia-inducible factor (HIF) 1 alpha, microRNA-210 (miR-210), and HIF-3alpha. CONCLUSION: TIMP2 is frequently down-regulated in human HCCs and its down-regulation is associated with aggressive tumor behavior and poorer patient outcome. Its suppression is under the regulation of a novel feedback circuit consisting of HIF-1alpha/miR-210/HIF-3alpha. TIMP2 is an important regulator of ECM degradation and HCC metastasis. (Hepatology 2016;64:473-487).published_or_final_versio