Fujian Provincial Hospital

To investigate benefits of diary intervention in a pediatric intensive care unit (PICU) on sleep quality and stress-related disorders in critically ill children and anxiety and depression in their parents.

This single-blind, two-arm, randomized controlled trial enrolled 94 dyads. The control group (n = 47) received standard care; the experimental group (n = 47) additionally received a diary intervention. We compared the sleep quality and stress disorders of children, and anxiety, depression, and stress disorders among parents at various time-points, between groups.

Data of 83 dyads were ultimately analyzed (loss-to-visit rate: 11.7 %). During the PICU stay, the experimental group showed significantly shorter total awakening time of each sleep episode and mean duration of each awakening per sleep session than the control group (P = 0.006; P = 0.032). The Childhood Stress Disorder Checklist scores of children in the experimental group were significantly lower than those in the control group at 1 and 3 months post-discharge (P = 0.003; P = 0.006). Parents in the experimental group reported significantly lower anxiety scores at PICU discharge and 1 month thereafter (P < 0.001; P = 0.015). At discharge, depression scores were significantly lower in the experimental group; this difference remained significant at 1 and 3 months post-discharge (P < 0.001; P < 0.05). At PICU discharge, parental scores were significantly lower in the experimental group than in the control group (P < 0.001).

The PICU diary intervention effectively improved the children's sleep quality and was associated with stress reduction in parents during their children's PICU stay and up to 3 months post-discharge. The intervention was also associated with a reduction in negative parental emotions up to 3 months after PICU discharge.

These findings offer valuable insights into supporting the psychological well-being of pediatric patients and their caregivers during and after PICU admission.

This study aimed to investigate whether liver-specific soluble epoxide hydrolase (sEH) mediates osteoclast differentiation by regulating the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway, thereby contributing to molecular mechanisms underlying bone homeostasis imbalance.

Clinical samples, an ovariectomy (OVX)-induced mouse osteoporosis model, and in vitro osteoclast induction experiments were systematically employed to evaluate the role of sEH in osteoclast differentiation.

Osteoporosis patients exhibited decreased plasma levels of 14,15-epoxyeicosatrienoic acid (14,15-EET), increased levels of 14,15-dihydroxyeicosatrienoic acid (14,15-DHET), and elevated pro-inflammatory cytokines tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β). OVX mice demonstrated enhanced osteoclast differentiation associated with upregulated hepatic sEH expression, decreased plasma 14,15-EET, increased 14,15-DHET, and elevated pro-inflammatory cytokines (TNF-α, IL-6, IL-1β). Treatment with sEH inhibitors or liver-specific sEH knockdown ameliorated osteoclast differentiation by restoring 14,15-EET and 14,15-DHET levels and reducing pro-inflammatory cytokine concentrations. Transcriptome sequencing revealed that sEH inhibitors suppress osteoclast differentiation by activating the Nrf2-antioxidant response element (ARE) signaling pathway. Furthermore, 14,15-EET directly inhibited osteoclast differentiation in an Nrf2-dependent manner, underscoring a direct link between the metabolite and the antioxidant transcription factor.

This study reveals, for the first time, a novel regulatory mechanism of bone metabolism mediated by the "liver-bone axis." Liver-derived sEH remotely modulates the Nrf2-ARE signaling pathway in bone tissue by controlling circulating levels of 14,15-EET, 14,15-DHET, and pro-inflammatory cytokines, thereby influencing osteoclast differentiation and bone homeostasis. These findings provide new insights into the pathogenesis of osteoporosis.

Quality of life (QoL) is increasingly recognized as an important prognostic indicator and has been identified to be associated with reduced survival in patients with advanced cancer during the last months of life. This study aimed to compare the initial QoL and influencing factors of patients with advanced cancer receiving home hospice care with less than 3-month survival period.

A secondary data analysis study was conducted using the data from a Fujian provincial home hospice center, in China, between 2010 and 2020. Propensity score matching was performed in 2761 cases to match patients with a less than 1 month survival period and those with a 1-3 months survival period. Differences in QoL between the two groups were analyzed using the ANOVA or Wilcoxon Mann-Whitney test, and the influencing factors were analyzed using multiple linear regression analysis.

No significant differences in QoL were identified between cancer patients with a 1-3 month survival period and those with a survival period of less than 1 month. However, a significant difference was detected after the propensity score matching adjustment (P ​< ​0.05). Sources of living, awareness of disease, and performance status commonly affected the QoL of patients with different survival periods (P ​< ​0.05). Chemotherapy, weight loss, anorexia, and tumor type only affected the QoL of patients with a survival period of less than 1 month (P ​< ​0.05).

The QoL of patients with advanced cancer receiving home hospice care is poor but does not necessarily deteriorate continuously during the last 3 months. Notably, the complexity of factors influencing QoL increases significantly as patients approach death.