Field ECG/STEMI activation significantly shortened D2B time. To improve D2B time, hospital and Emergency Medical Service collaboration should be advocated to increase field activation and direct patient transportation to CCL.

Community-based nurse-led interventions have the potential to impact admission rates in Heart Failure (HF) patients. No reviews have focused on identifying the best combination or duration of interventions to reduced hospital admissions.

To assess the impact of nurse-led community-based interventions on hospital admission rates in HF patients.

This study was conducted following Whittmore and Knafl’s Methodology. CINAHL, PubMed, Embase and Web of Science and hand searching were used to identify articles. Selected studies were analyzed using the Matrix Method.

Telemonitoring, home visits, phone calls, care coordination, and telemedicine were identified as interventions in 10 studies. Telemonitoring with phone calls or care coordination was not impactful. Studies with significant results included those with multiple interventions, APN-led, or conducted over one year.

The combination of intervention type and length are important factors when designing interventions for HF management. More research is needed on intervention length.

The combination of intervention type and length are important factors when designing interventions for HF management. More research is needed on intervention length.

There are some qualitative studies on the views of patients with chronic obstructive pulmonary disease (COPD) on telemedicine, however, there are few related qualitative systematic reviews.

To systematically review and synthesize qualitative studies involving the perceptions of patients with COPD about telemedicine to understand patients’ attitudes and expectations for telemedicine and determine the obstacles and stimulus in the use of telemedicine.

We searched PubMed, Web of Science, MEDLINE, Embase and CINAHL for articles published from January 2000 to December 2020. The data were analysed using thematic synthesis.

We included 20 articles involving 19 studies and 301 patients, and we identified four themes perceived ease of use, perceived usefulness, perceived difficulty of use, and perceived uselessness. We found that although patients have different views on telemedicine, most of them have a positive attitude towards it.

The synthesis of views will help us determine the factors that promote or hinder the application of telemedicine and guide the design and implementation of telemedicine in the future.

The synthesis of views will help us determine the factors that promote or hinder the application of telemedicine and guide the design and implementation of telemedicine in the future.We report a novel case of multiple paragangliomas in a patient who was identified with pathogenic variants in both NF1 and SDHD genes. The proband is a man with known familial NF1 disease, diagnosed clinically in childhood. Multiple head and neck paragangliomas (HNPGL) were found during investigations for acute left sided neurological symptoms, in the region of his known plexiform neurofibroma. He was referred for genetic counselling. He underwent surgery to remove a left carotid body tumor (CBT). A pheochromocytoma and paraganglioma gene panel was tested. Blood and HNPGL tumor DNA were analyzed by whole exome sequencing. In addition to the NF1 truncating variant c.5107delA, p.(Ser1703AlafsTer7), the SDHD truncating pathogenic variant c.3G > A, p.(Met1?) was found. Tumor sequencing showed no LOH of SDHD or NF1, but monoallelic loss of 11p15 and 11q12.2-q12.3 was observed. Co-occurrence of pathogenic variants in multiple cancer susceptibility genes is rare but possible, identified by the increased use of panel testing. This is the first description of a patient presenting with NF1 and SDHD dual pathology, with HNPGL development due to SDHD. This case illustrates the central role of genetic sequencing in PPGLs and the strong genotype-phenotype correlations of different genes.A 35-year-old Filipino woman presented with epigastric pain and was found to have two large jejunal and ileal inflammatory fibroid polyps (IFPs) and dozens of subcentimeter small bowel submucosal nodules. Targeted exon sequencing of PDGFRA on the resected jejunum IFP identified a variant c.1664A>G that was subsequently confirmed in the germline. Family history was striking for three relatives with confirmed IFPs, including one with small bowel intussusception on five occasions. All relatives with IFPs were confirmed to have the same PDGFRA germline likely pathogenic variant, all were female, and all had IFPs by age 50 years that necessitated surgery. Two obligate carriers were reported to have had a similar phenotype while at least one obligate male carrier had no reported history of IFPs. This is the sixth reported family with a germline PDGFRA pathogenic variant and history of IFPs or gastrointestinal stromal tumor (GIST). This is the second report of the c.1664A>G likely pathogenic variant in a family that is unrelated to, and of different ethnic origin than, the first family. This second family exhibited a striking history of multiple IFPs without any reported GISTs, suggesting a possible genotype/phenotype association for this variant, and a possible female gender penetrance bias.

Although increases in the prevalence of mental distress have been reported after natural disasters, less is known about the role the environment may play in mitigating posttraumatic stress disorder (PTSD) in hurricane-impacted communities.

This study aims to investigate the extent to which concentration and perceived quality of neighborhood greenness are associated with lower levels of PTSD, along with potential mechanisms through which these effects occur.

We conducted a cross-sectional survey of individuals (N=272) from 30 Houston neighborhoods that were affected during Hurricane Harvey. Perceived quality of neighborhood green space was measured using a scale adapted from the Neighborhood Open Space (NOS) scale, and concentration of greenness was measured objectively using the normalized difference vegetation index (NDVI). Probable PTSD was measured using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), and hurricane-related distress using the Impact of Event Scale (IES-R). Generalized ln disaster recovery policy frameworks, more attention should be paid to the benefits of high-quality neighborhood green infrastructure.

We conclude that living in neighborhoods with greater perceived quality of green space was associated with lower levels of post-hurricane distress, with mediation especially through the emotional resilience pathway. These findings suggest that in disaster recovery policy frameworks, more attention should be paid to the benefits of high-quality neighborhood green infrastructure.

Problem drinking and co-occurring depression symptoms affect men at high rates and are associated with increased risk of family violence. In low- and middle-income countries, there is a large treatment gap for services due to a lack of human resources. Moreover, masculine norms are a barrier to men seeking treatment for drinking and depression in healthcare settings. We examined an approach for engaging peer-fathers to deliver an intervention to reduce alcohol use, improve depressive symptoms, and increase family involvement among fathers in Kenya with problem drinking. The intervention-LEAD (Learn, Engage, Act, Dedicate)-combines motivational interviewing, behavioral activation, and masculinity discussion strategies.

Community and religious leaders nominated fathers with no mental health training to serve as counselors (N=12); clients were recruited through community referrals. Nominated fathers completed a 10-day training beginning with treatment principles followed by manualized content. Three counselotive experiences with counselors.

Findings provide initial support for the acceptability and feasibility of recruitment, selection, and training processes for peer-father lay counselors to deliver LEAD through a lens of masculinity that aligned with clients help-acceptance practices.

Findings provide initial support for the acceptability and feasibility of recruitment, selection, and training processes for peer-father lay counselors to deliver LEAD through a lens of masculinity that aligned with clients help-acceptance practices.Resveratrol is a kind of iPolyphenols widely existing in herbal medicine. Here we aim to investigate whether resveratrol can reduce the degree of myocardial ischemia/reperfusion (IR) injury and inhibit the development of oxidative stress, and elucidate the molecular mechanism of resveratrol in protecting myocardial cells. The primary rat cardiomyocytes were used to establish an ischemia/reperfusion model in vitro, and a series of routine biochemical experiments were conducted to explore the antioxidant and anti-apoptotic effects of resveratrol in myocardial ischemia-reperfusion injury. Compared with that of the simulated ischemia-refusion (SIR) group, cell viability in the SIR and resveratrol co-treatment groups increased significantly (P less then 0.001), the release of lactate dehydrogenase (LDH) and creatine kinase MB (CKMB) decreased, the positive rate of reactive oxygen species (ROS) in cardiomyocytes decreased, and the concentration of catalase and glutathione peroxidase increased significantly (P less then 0.001). Besides, resveratrol can activate PI3K/AKT signaling pathway. PI3K siRNA can inhibit the PI3K/AKT signaling mediated by resveratrol. The addition of resveratrol can significantly increase the activity of mitochondrial superoxide dismutase (SOD) and reduce the malondialdehyde (MDA), which indicates that the oxidative damage of mitochondria induced by resveratrol was significantly weakened. The mitochondrial functional changes induced by resveratrol can be reversed by PI3K siRNA. In conclusion, our study shows that resveratrol can reduce ROS in cardiomyocytes by PI3K/AKT signaling pathway activation, and effectively inhibit the apoptosis of cardiomyocytes, thus having a direct protective effect on cardiomyocytes under SR.Abnormal epigenetics is a critical hallmark of human cancers. Anticancer drug discovery directed at histone epigenetic modulators has gained impressive advances with six drugs available for cancer therapy and numerous other candidates undergoing clinical trials. However, limited therapeutic profile, drug resistance, narrow safety margin, and dose-limiting toxicities pose intractable challenges for their clinical utility. Because histone epigenetic modulators undergo intricate crosstalk and act cooperatively to shape an aberrant epigenetic profile, co-targeting histone epigenetic modulators with a different mechanism of action has rapidly emerged as an attractive strategy to overcome the limitations faced by the single-target epigenetic inhibitors. In this review, we summarize in detail the crosstalk of histone epigenetic modulators in regulating gene transcription and the progress of dual epigenetic inhibitors targeting this crosstalk.

The world is in the midst of the „digital” revolution characterized by the ascendency of computerization, information systems and artificial intelligence with an emphasis on innovation and creativity. This revolution has affected current medical practice and promises to significantly impact it in the future. This requires physician’s understanding and participation in adopting such technology. This study aimed to explore the role technology plays in the future career plans of medical students.

A questionnaire examining selection criteria for medical specialty choice, criteria for choosing a post-residency job and demographic data was completed by a convenience sample of 5th-year Israeli medical students.

Two-hundred forty-two students (51 % men) completed the questionnaire, an 84 % response rate. Only a third (35 %) rated the specialty selection criterion „provides mechanical/ technological challenges” as important, while only 7% considered as important that a specialty requires skills in computer science.