Clinical application of water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation for critical patients / 中国实用护理杂志

Objective:To evaluate the clinical application of water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation for critical patients.Methods:This study was a randomized controlled trial. Eighty patients who needed indwelling nasobenteric tube were selected from June 2021 to April 2022 in the Department of Critical Care Medicine, Xiangya Hospital, Central South University. They were divided into control group ( n=40) and experimental group ( n=40) by systemic randomization. For the patients in the experimental group, the intubation was performed by water-filling with "four-eyes" sign under the guidance of ultrasound. For the control group, the traditional method was applicated under the guidance of ultrasound. Using abdominal X-ray as the gold standard of successful pylorus posterior catheterization, the result of catheterization, time of operation, efficiency of positioning in the two groups were analyzed and compared. Results:In the experimental group, 38 cases were successfully intubated, 2 were failed; in the control group, 27 cases were successfully intubated, 13 were failed, and all the failed cases in the control group were then successfully intubated again by using method of the experimental group. The success rate of tube placement in the experimental group was 95.0% (38/40), which was higher than 67.5% (27/40) in the control group ( χ2 = 9.93, P<0.05). The average time of operation in the experimental group was (45.2 ± 14.2) min, which was significantly lower than (70.2 ± 17.7) min in the control group, the difference was significantly different ( t=-5.51, P<0.05). The specificity, sensitivity, positive predictive value, negative predictive value and diagnostic rate of nasal-jejunum intubation positioning in the experimental group were 100.0% respectively, higher than 38.4%, 77.7%, 72.4%, 45.4%, 65.0% in the control group; the false positive rate, false negative rate in the experimental group were both 0, lower than 22.2%, 61.5% in the control group, with statistically significant differences( χ2 values were 4.69- 16.97, all P<0.05). Conclusions:Water-filling with "four-eyes" sign under the guidance of ultrasound in nasal-jejunum intubation was a new method which can shorten the operation time and increase the success rate for intubation. It has relatively high positioning accuracy and possess valuable clinical application.

Efficacy and Safety of Decitabine Combined with Modified CAG Regimen in Patients Aged ≥ 70 Years with Newly Diagnosed Acute Myeloid Leukemia / 中国实验血液学杂志

OBJECTIVE@#To evaluate the clinical efficacy and safety of decitabine combined with modified CAG regimen (D-CAG regimen) in patients aged ≥70 years with newly diagnosed acute myeloid leukemia (AML).@*METHODS@#The clinical data of 59 AML patients (≥70 years old) who were newly diagnosed and treated in the Hematology Department of the First Affiliated Hospital of Nanjing Medical University from November 2010 to June 2021 were retrospectively analyzed.@*RESULTS@#Among the 59 AML patients, 28 were males and 31 were females, with a median age of 74 (70-86) years. The complete remission (CR) rate was 69.4% (34/49), and the median duration of CR was 10.7 (0.6-125.4) months after 2 courses of D-CAG treatment. According to the British Medical Research Council (MRC) classification, there was only one patient in the favorable-risk group, and the CR rate was 71.8% (28/39) in the intermediate-risk group, and 55.6% (5/9) in the adverse-risk group, respectively. There was no statistical difference in the CR rate between the intermediate-risk and adverse-risk group. Referring to ELN 2017 genetic risk classification, CR rate was 88.2% (15/17) in the favorable-risk group, 45.5% (5/11) in the intermediate-risk group, and 66.7% (14/21) in the adverse-risk group. There was no significant difference in CR rate between the favorable-risk and adverse-risk categories, but both were significantly higher than that in the intermediate-risk group (P <0.05). Next-generation sequencing (NGS) analysis showed that 11 gene mutations with a frequency of more than 10%, including TET2 mutation (35.6%), ASXL1 mutation (30.5%), NPM1 mutation (28.8%), FLT3-ITD mutation (27.1%), DNMT3A mutation (22.0%), IDH1 mutation (15.3%), CEBPA single mutation (13.6%), TP53 mutation (13.6%), IDH2 mutation (11.9%), RUNX1 mutation (11.9%), and NRAS mutation (10.2%). There were no statistical differences in mutation frequency of these 11 genes between CR group and non-CR group. Compared with normal karyotypes, patients with complex karyotypes were more likely to develop TP53 mutations (P <0.001), while FLT3-ITD and DNMT3A mutations were more likely to occur in patients with normal karyotypes (P =0.04, P =0.047). The median follow-up, overall survival (OS), and event-free survival (EFS) of all the patients was 11.7 (1.5-128.2) months, 12.3 (1.5-128.2) months, and 8.5 (1.5-128.2) months, respectively. The median OS and EFS of CR patients were 19.8 and 13.3 months, respectively, which were significantly longer than 6.4 and 5.7 months in patients experiencing treatment failure (P < 0.001, P =0.009). In regard to genes with mutation frequency >10%, there were no statistical differences in CR rate, median OS, and median EFS between mutated and wild-type patients by Chi-square test and survival analysis. Univariate analysis showed that age, hemoglobin, lactate dehydrogenase, cytogenetics and CR were factors affecting prognosis, while multivariate analysis showed that only CR failure was an independent adverse prognostic factor for OS. The major adverse reactions to D-CAG regimen were grade 3-4 myelosuppression, pulmonary infection, and fever (infection focus was not identified).@*CONCLUSION@#D-CAG regimen is safe and effective in the treatment of AML patients ≥70 years old, and can partially improve the prognosis of elderly and high-risk patients.

Salidroside Regulates the miRNA-1343-3p/MAP3K6/MMP24 Signaling Molecules to Inhibit Proliferation and Invasion of Gastric Cancer Cells / 中山大学学报(医学科学版)

ObjectiveThe aim of this study is to investigate the role of salidroside in regulating the miR-1343-3p/MAP3K6 （mitogen-activated protein kinase kinase kinase 6）/MMP24 （membrane-type matrix metalloproteinase 24） signaling pathway to inhibit gastric cancer cell proliferation and migration. MethodsHuman gastric cancer cells （MGC-803） were divided into several groups based on different salidroside concentrations： a control group （0 μmol/mL）， a low-dose group （6 μmol/mL）， a medium-dose group （12 μmol/mL）， and a high-dose group （24 μmol/mL）. The anti proliferative effects of salidroside on human gastric cancer cells were evaluated by CCK-8 assay. Clonogenic assay was used to examine the effects of salidroside drugs on the clonogenic ability of human gastric cancer cells. Transwell assay was performed to detect the effect of salidroside on the invasive ability of human gastric cancer cells. Cell scratch assay was performed to detect the effect of salidroside on the migration ability of human gastric cancer cells. The miRNA expression profile was analyzed by using RNA-seq in cancer cells for 24 h after salidroside treatment. The differentially expressed miRNAs were clustered and their target genes were predicted. Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） were used to analyze and predict the functions of these target genes， and the interaction networks were established. Immunocytofluorescence was used to detect the expression of target proteins， and the transcription of candidate genes was detected by q-PCR. ResultsCCK-8 cytotoxicity experiments showed that salidroside inhibited the proliferation of MGC-803 cells （P < 0.01）. Cell cloning experiments showed that salidroside reduced the clonal formation capacity of MGC-803 cells （P < 0.000 1）. Cell invasion experiments showed that salidroside reduced the MGC-803 cell invasion capacity （P < 0.000 1）. Cell scratch experiments showed that salidroside reduced the cell migration capacity （P < 0.000 1）. RNA-seq findings showed that the expression of 44 miRNAs changed significantly after salidroside treatment in cancer cells （P < 0.05）. Bioinformatic analysis showed that there were 1 384 target mRNAs corresponding to the differentially expressed miRNAs， and the expression of the tumor suppressor miR-1343-3p was significantly upregulated after salidroside treatment （P < 0.01），and resulted in down-regulated transcription of MAP3K6 and MMP24 genes which are related to the proliferation and migration of cancer cells （P < 0.05）. Immunofluorescence experiments demonstrated that salidroside reduced protein expression levels in MAP3K6 and MMP24 genes （P < 0.000 1）. q-PCR experiments showed that salidroside reduced the mRNA expression level of MAP3K6 and MMP24 genes （P < 0.000 1）， while miRNA expression in miR-1343-3p gene was upregulated （P < 0.000 1）. ConclusionSalidroside regulates the miRNA-1343-3p/MAP3K6/MMP24 signaling molecules to inhibit proliferation and invasion of gastric cancer cells.

Effect of Gegen Qinliantang-medicated Serum on Nonalcoholic Steatohepatitis Based on Nrf2/TXNIP Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the effect of Gegen Qinliantang （GGQLT）-medicated serum on free fatty acid （FFA）-induced nonalcoholic steatohepatitis （NASH） in vitro model of human hepatoma cells HepG2. MethodNASH model of HepG2 cells was established in vitro， and the cells were intervened with different volume fractions of GGQLT-medicated serum and resveratrol. Intracellular lipid deposition in each group was detected by oil red O staining， the level of reactive oxygen species （ROS） in each group were detected by flow cytometry， the levels of glutathione peroxidase （GSH-Px）， superoxide dismutase （SOD）， triglyceride （TG） and malondialdehyde （MDA） in each group were detected by kits. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） was used to measure the mRNA expression levels of nuclear transcription factor （NF）E2-related factor 2 （Nrf2）， heme oxygenase-1 （HO-1）， quinone oxidoreductase 1 （NQO1）， Kelch-like epichlorohydrin-associated protein-1 （Keap1）， NF-κB， thioredoxin interacting protein （TXNIP）， interleukin-1β （IL-1β） in HepG2 cells of each group. The protein expression of Nrf2， TXNIP in cells of each group was detected by Western blot. ResultFFA induced large accumulation of intracellular lipids. Compared with the normal group， the activities of GSH-Px and SOD were significantly decreased （P<0.01） and the contents of TG， ROS and MDA were significantly increased （P<0.05， P<0.01） in the model group. Compared with the model group， all GGQLT groups and resveratrol group could elevate intracellular SOD activity to different degrees （P<0.05， P<0.01） and significantly reduce the levels of intracellular ROS and MDA （P<0.05， P<0.01）， GGQLD high- and medium-dose groups and resveratrol group significantly elevated GSH-Px activity （P<0.01）， GGQLD medium- and low-dose groups and resveratrol group significantly decreased TG content （P<0.05， P<0.01）. Compared with the model group， GGQLT high- and medium-dose groups and resveratrol group could significantly upregulate the mRNA expression levels of Nrf2， HO-1 and NQO1 （P<0.01）， all GGQLT groups and resveratrol group could significantly downregulate the TXNIP protein expression level， as well as significantly downregulate the mRNA expression levels of Keap1， NF-κB （P<0.05， P<0.01）. Nrf2-siRNA transfection of cells revealed that Nrf2 expression was significantly downregulated （P<0.01） in the Nrf2-siRNA group of cells by comparing with NC-siRNA group at the corresponding dose of drugs， and the inhibitory effects of GGQLT and resveratrol on TXNIP， IL-1β were attenuated. ConclusionFFA induces the production of ROS and inflammatory factors in HepG2 cells， and GGQLT can improve the anti-inflammatory and antioxidant capacities of cells， and its mechanism may be related to the regulation of Nrf2/TXNIP signaling pathway， so as to improve NASH.

Individualized enteral nutrition support nursing for the patient with severe pneumonia who underwent extracorporeal membrane oxygenation with prone position ventilation: a case report / 中国实用护理杂志

Objective:To summarize the nursing experience of enteral nutritionin a patient with severe pneumonia who received extracorporeal membrane oxygenation combined with prone ventilation.Methods:A patient with severe pneumonia who underwent extracorporeal membrane oxygenation combined with prone ventilation from Xiangya Hospital of Central South University on November 8, 2020 was given individualized nutrition support program. The patient′s condition was evaluated, individual nutrition support plan was formulated, early nutrition was implemented, appropriate feeding route was selected, tolerance was evaluated during the implementation process, and enteral nutrition-related complications were nursing.Results:After careful treatment and nursing, the patient′s condition was improved and was transferred out of ICU for continued treatment.Conclusions:For this kind of patients with severe pneumonia who underwent extracorporeal membrane oxygenation combined with prone ventilation to choose the pyloric feeding to reduce aspiration. Early nourishing nutrition to protect the intestinal mucosa; ultrasonic monitoring of antral motility index was used to guide the implementation of enteral nutrition. Regular evaluation of feeding tolerance during nutrition implementation, the strategy and implementation of enteral nutrition were adjusted according to the intra-abdominal pressure combined with feeding tolerance, and the prevention and nursing of enteral nutrition complications were carried out at the same time.

Identification of Chemical Constituents in Chaishi Tuire Granules by UPLC-ESI-Q-TOF-MS/MS / 中国实验方剂学杂志

Objective:To rapidly identify the chemical constituents of Chaishi Tuire granules by ultra-performance liquid chromatography-electrospray/quadrupole time-of-flight tandem mass spectrometry （UPLC-ESI-Q-TOF-MS/MS）. Method:Chromatographic separation was conducted on a Phenomenex^® Luna omega C₁₈ column （2.1 mm×100 mm， 1.6 μm） with 0.1% formic acid aqueous solution （A）-acetonitrile （B） as the mobile phases for gradient elution （0-20 min， 5%-40%B； 20-40 min， 40%-95%B； 40-43 min， 95%B）， the flow rate was set at 0.3 mL·min^-1. MS data were collected in positive and negative ion modes， the scanning range was <italic>m</italic>/<italic>z</italic> 150-1 500 and electrospray ionization （ESI） was employed. The chemical constituents of Chaishi Tuire granules were identified by comparing with the retention time and the mass data of the reference substances， as well as the accurate mass， MS/MS fragment ions， mass spectrometry databases （PubChem， MassBank， ChemicalBook and others） and related literature. Result:A total of 85 chemical constituents were identified， including 28 flavonoids， 24 phenylpropanoids， 11 terpenoids， 10 alkaloids， 4 quinones， and 8 others. Among them， 19 constituents derived from Lonicerae Japonicae Flos， 14 constituents derived from Scutellariae Radix， 10 constituents derived from Isatidis Radix， 9 constituents derived from Taraxaci Herba， 9 constituents derived from Forsythiae Fructus， 4 constituents derived from Bupleuri Radix， 4 constituents derived from Anemarrhenae Rhizoma， and 4 constituents derived from Rhei Radix et Rhizoma. Conclusion:Chaishi Tuire granules is rich in phytochemicals， which are derived from many of traditional Chinese medicines. This study can lay a foundation for the quality control， material basis and <italic>in vivo</italic> metabolic analysis of this preparation.

The monitoring movement index by ultrasound guided the implementation of enteral nutrition in patients with prone mechanical ventilation / 中国实用护理杂志

Objective:To evaluate the effect of monitoring movement index transverse section by bedside ultrasound in patients who undergoing mechanical ventilation in prone position.Methods:From June 2018 to June 2019, 78 patients with acute respiratory distress syndrome undergoing mechanical ventilation in prone position in ICU of Xiangya Hospital of Central South University were divided into observation group and control group according to random number table method with 39 cases each. The observation group was guided by movement index monitored by ultrasound to implement enteral nutrition, while the control group was guided by enteral nutrition plan according to doctor′s advice. The incidence of feeding interruption, reflux, aspiration, time to complete enteral nutrition, mechanical ventilation time and ICU length of stay were compared between the two groups.Results:The time of reaching full nutrition was (2.8 ± 0.8) d in the observation group, and (4.1 ± 1.1) d in the control group, there was significant difference between the two groups ( t value was -5.596, P < 0.01). There was no significant difference in the incidence of feeding interruption, reflux, aspiration, mechanical ventilation time and ICU length of stay between the two groups ( P > 0.05). Conclusions:The monitoring movement index transverse section by ultrasound can guide the implementation of enteral nutrition in patients with prone mechanical ventilation, and shorten the time to complete enteral nutrition.

Fatigue correlates with sleep disturbances in Parkinson disease / 中华医学杂志(英文版)

BACKGROUND@#Many Parkinson disease (PD) patients complain about chronic fatigue and sleep disturbances during the night. The objective of this study is to determine the relationship between fatigue and sleep disturbances by using polysomnography (PSG) in PD patients.@*METHODS@#Two hundred and thirty-two PD patients (152 with mild fatigue and 80 with severe fatigue) were recruited in this study. Demographic information and clinical symptoms were collected. Fatigue severity scale (FSS) was applied to evaluate the severity of fatigue, and PSG was conducted in all PD patients. FSS ≥4 was defined as severe fatigue, and FSS <4 was defined as mild fatigue. Multivariate logistic regression and linear regression models were used to investigate the associations between fatigue and sleep disturbances.@*RESULTS@#Patients with severe fatigue tended to have a longer duration of disease, higher Unified Parkinson Disease Rating Scale score, more advanced Hoehn and Yahr stage, higher daily levodopa equivalent dose, worse depression, anxiety, and higher daytime sleepiness score. In addition, they had lower percentage of rapid eye movement (REM) sleep (P = 0.009) and were more likely to have REM sleep behavior disorder (RBD) (P = 0.018). Multivariate logistic regression analyses found that the presence of RBD and proportion of REM sleep were the independent predictors for fatigue. After the adjustment of age, sex, duration, body mass index, severity of disease, scores of Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, and other sleep disorders, proportion of REM sleep and degree of REM sleep without atonia in patients with PD were still associated with FSS score.@*CONCLUSION@#Considering the association between fatigue, RBD, and the altered sleep architecture, fatigue is a special subtype in PD and more studies should be focused on this debilitating symptom.

ISSR Analysis of Genetic Relationship and Population Structure of Turpinia arguta Fresh Leaves in Jiangxi Province / 中国实验方剂学杂志

Objective:To explore genetic relationship and population structure of Turpinia arguta in six locations of Jiangxi province by inter-simple sequence repeat （ISSR） molecular marker technique， and to provide theoretical basis for the protection and utilization of this medicinal material resource. Method:A total of 22 samples from six locations in four counties in Jiangxi province were collected， and genomic DNA was extracted by kit method. Polymerase chain reaction （PCR） amplification was performed using sixty-four universal ISSR molecular marker primers， and the products were detected with polyacrylamide gel electrophoresis （PAGE）. NTsys 2.10e software was selected to calculate the genetic similarity coefficient by unweighted pair group method with arithmetic mean （UPGMA） and cluster analysis. Population genetic structure was analyzed by Structure 2.1 software. Result:A total of forty-eight ISSR primers were amplified to obtain the product， the percent of polymorphic bands ranged from 45.45% to 100%. UPGMA cluster analysis showed that these plant individuals could not be clustered according to their respective executive locations. Analysis of population genetic structure showed that 22 samples of T. arguta could be divided into three populations. Conclusion:There is gene exchange among the populations of T. arguta in Jiangxi province， and it can affect the genetic structure of germplasm resources from different geographical sources.

Analysis on the efficacy and safety of fibrinolytic therapy in patients with acute ST-segment elevation myocardial infarction during the COVID-19 epidemic / 中华心血管病杂志

Objective: To evaluate the efficacy and safety of fibrinolysis strategy in patients with acute ST-segment elevation myocardial infarction (STEMI) during the COVID-19 epidemic, and to provide reference value for optimization of fibrinolytic process on the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff. Methods: The efficacy and safety of fibrinolysis were retrospectively analyzed in 7 patients with acute STEM, who hospitalized from February 29, 2020 to April 3, 2020 in the Department of Cardiology, Wuhan Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. To optimize the fibrinolytic process on the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff, a full-time medical team in charge of fibrinolysis under third-grade protection was established. The acute STEMI patients were treated immediately in a fixed and isolated area in emergency department before receiving green channel fibrinolysis. Blood samples for complete blood count, COVID-19 antibody test and nasopharyngeal swab samples for COVID-19 nucleic acid test were made before fibrinolysis, while the chest CT examination was accomplished after fibrinolysis. By comparing differences of time from the first electrocardiogram (ECG) to fibrinolysis before and after the improvement of fibrinolytic process, the effect of optimization of the fibrinolytic process was evaluated. Results: In the present study, seven patients with acute STEMI received fibrinolysis therapy, 6 of them achieved reperfusion and no bleeding was observed in all of the patients. Five out of the 7 patients were hospitalized after fibrinolysis, and the hospitalization days were 19.6 days on average. By following up to April 14, 2020, none of the 7 patients died. The first 2 patients were treated according to the routine medical procedure and the time from the first ECG to fibrinolysis were 201 and 106 minutes, respectively. After the optimization of the fibrinolytic process, the time from the first ECG to fibrinolysis of the last 5 patients were 42, 46, 51, 43 and 54 minutes, respectively，which was significantly shorter than that before optimization. Conclusions: During the COVID-19 epidemic, fibrinolysis in patients with acute STEMI is safe, effective and easy to implement. Therefore, it is recommended as the top priority for the patients with acute STEMI with indications for fibrinolysis. On the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff, the duration of myocardial ischemia can be shortened by optimization of the fibrinolytic process.

A preliminary study on the evaluation of diaphragm function by ultrasound in patients with invasive mechanical ventilation / 中华内科杂志

Objectives:To study the feasibility of using ultrasound to evaluate diaphragm function in patients with invasive mechanical ventilation.Methods:From March to December 2017, 40 adult patients with acute respiratory distress syndrome who were admitted to the Department of Critical Care Medicine, Xiangya Hospital, Central South University for more than 48 hours were included. Diaphragmatic excursion and thickness of bilateral anterior, middle and posterior parts were measured by ultrasound for 5 consecutive days.Results:(1) Compared with the diaphragmatic excursion of the right [anterior: (11.05±3.04) mm; middle: (12.08±2.71) mm; posterior: (11.51±3.33) mm] and left [anterior: (13.63±7.52) mm; middle: (15.44±7.52) mm; posterior: (14.76±6.93) mm] sides on day 1, the diaphragmatic excursion of the right [anterior: (8.90±3.65) mm; middle: (10.02±4.24) mm; posterior: (10.25±4.38) mm] and left [anterior: (9.82±1.96) mm; middle: (11.60±1.13) mm; posterior: (11.52±1.98) mm] sides decreased significantly on day 3 ( P<0.05). Bilateral anterior, middle and posterior diaphragmatic excursion recovered on day 5, and was higher than the baseline levels on day 1, with the left middle and posterior diaphragmatic excursion changing most significantly. (2) Compared with day 1, 2, 3, the thickening fraction of bilateral anterior, middle and posterior diaphragm were significantly decreased on day 4, with the left middle part [day 1: (33.87±14.34)%; day 2: (37.26±13.91)%; day 3: (30.56±14.27)%; day 4: (15.53±5.68)%] and the left posterior part [day 1: (35.50±15.69)%; day 2: (39.84±15.32)%; day 3: (29.06±14.96)%; day 4: (13.30±5.79)%] changing most significantly ( P<0.05). The thickening fractions of left anterior, middle and posterior diaphragm recovered on day 5 compared with that on day 4, but still lower than those on day 1 ( P<0.05). Conclusions:It is feasible to evaluate the diaphragm function in patients with invasive mechanical ventilation by ultrasound, which can provide guidance for preventing diaphragmatic atrophy and withdrawing from mechanical ventilation.

The impact of removing restraint on ICU acquired weakness,limb muscle strength and unplanned extubation in pancreatitis patients with normal cognitive function / 中国实用护理杂志

Objective@#To investigate the impact of removing restraint on intensive care unit acquired weakness(ICU-AW), muscle strength and the incidence of extubation in patients with pancreatitis but normal cognitive function.@*Methods@#Eighty patients with pancreatitis but normal cognitive function hospitalized from February 2017 to November 2018 were divided into experimental group (40 cases) and control group (40 cases) by random digits table method. The control group received routine care and restraint, while the experimental group was removed from restraint compared with the control group. The Medical Research Council (MRC) score, incidence rate of ICU-AW, and extubation rate were compared between the two groups.@*Results@#The MRC scores of the experimental group before intervention, on 3rd, 7th and 10th day were (55.1±4.2), (54.2±4.6), (53.4±4.3), and (52.3±4.8) respectively. The MRC scores before the intervention, on the 3rd, 7th, and 10th day in the control group were (53.8±5.6), (52.0±6.2), (49.7±6.2), and (48.7±5.7) respectively. The MRC scores of the experimental group were significantly higher than those of the control group. The difference of MRC scores between the two groups was statistically significant on the 7th and 10th day(t=3.012, 3.060, P<0.05). The incidence of ICU-AW was 25.0%(10/40) in the experimental group and 37.5%(15/40) in the control group. The experimental group was lower than the control group, but the difference was not statistically significant (χ2=1.455, P>0.05). There was no unplanned extubation in both groups.@*Conclusions@#The removal of restraint in patients with pancreatitis but normal cognitive function can slow down the decline in muscle strength but has no positive impact on the incidence rate of ICU-AW.

The application of nursing scheduling software combined with mobile phone APP in the nursing manpower arrangement in intensive care unit / 中国实用护理杂志

Objective@#To explore the effect of nursing scheduling software combined with mobile phone APP in the nursing manpower arrangement in intensive care unit.@*Methods@#The nursing scheduling software and mobile phone APP were applied to management resources of 82 nurses in ICU, substituted for traditional manual way. The work efficiency, nursing quality and nurse satisfaction were compared before and after implementing in intensive care unit.@*Results@#After implementation of nursing scheduling software combined with mobile phone APP, the average time of scheduling was reduced from (6.49±0.62) h to (4.29±0.44) h, the difference was statistically significant (t=19.97, P<0.01). The nursing quality score was improved from (97.54±1.19) points to (95.16±1.29) points, the difference was statistically significant (t=-4.70, P<0.01). The nurses′ satisfaction about scheduling was improved from 73.2%(60/82) to 96.3%(79/82), the difference was statistically significant (χ2=17.04, P<0.01).@*Conclusions@#The mode of nursing scheduling software combined with mobile phone APP in intensive care unit has a good effect, which can improve the scheduling efficiency, the job satisfaction of nursing staff and the quality of nursing,and promote the nursing information management.

Application of graded nursing intervention based on the early delirium prediction model to prevent delirium in ICU patients / 中国实用护理杂志

Objective@#To study the application effect of graded nursing intervention for ICU patients combined with the Pre-Deliric prediction model.@*Methods@#A total of 288 ICU patients were elected and divided into the control group (141 cases from May 2017 to October 2017) and the intervention group (147 cases from November 2017 to April 2018) according to hospitalization time. The control group received conventional delirium prevention measures. The intervention group was assessed within 24 h following admission with Pre-Deliric prediction model to screen the risk of delirium, and then they received grading prevention care based on the assessment results of delirium risks. The data of this study were collected by Numeric Rating Scale, Critical-Care Pain Observation Tool, Richmond Agitation and Sedation Scale, Confusion Assessment Method for the ICU. The incidence and duration of delirium, 28d survival rate, ICU length of stay of the two groups were statistically analyzed.@*Results@#Compared with the control group, we detected that the incidence of delirium in the intervention group was significantly lower (χ2=5.043, P<0.05), 21.7%(32/147) vs. 35.5%(50/141). Compared with the control group, we found that the duration of delirium in the intervention group was significantly shorter,(1.68±1.24) vs.(2.82±1.60)d, the ICU length of stay in the intervention group were significantly shorter than the control group(t=4.45, P<0.01), (3.42±3.02)d vs (6.21±4.56)d. There was no significant difference in the 28-day ICU survival rate between the two groups (P>0.05).@*Conclusions@#the risk assessment and grading nursing care combined with Pre-Deliric prediction model could effectively prevent the occurrence and shorten the duration of delirium, and also shorten the ICU length of stay.It was significant for improve the quality of nursing.

Protective effects and action mechanism of extract from Tibetan medicine Yajima(Chrysosplenium nudicaule) on mice with intrahepatic cholestasis induced by ANIT / 中国中药杂志

Chrysosplenium nudicaule,Tibetan name " Yajima",is recorded as an effective medicine for the treatment of liver and gallbladder diseases by Tibetan Pharmacopoeia published in the past dynasties,but its traditional efficacy has not yet been investigated by means of modern pharmacological research methods. In this paper,the protective effect of extract of C. nudicaule(ECN) on liver injury in mice was observed by using the mice model of intrahepatic cholestasis(IC) induced by α-naphthyl isothiocyanate(ANIT) and the possible mechanism by which ECN work as the therapeutic agent was discussed. The results showed that the serum levels of AST,ALT,ALP,DBIL,TBIL and TBA of the model mice were notably reduced in dose-dependent manner(P<0. 01,P<0. 05). The activity of SOD and GSH-Px in the liver homogenate of mice was increased,while the content of MDA was decreased(P<0. 01,P<0. 05).Pathological examination of liver in mice showed that ECN could improve the pathological changes of liver tissue in mice. The mRNA expression level of genes related to bile acid metabolism were detected by RT-PCR and the results suggested that ECN could significantly increase the expression of genes such as BSEP,FXR and MRP2(P<0. 01,P<0. 05),meanwhile significantly reduce the expression of CYP7 A1(P<0. 01,P<0. 05). These results confirmed the protective effect of ECN on intrahepatic cholestasis-induced liver injury in mice,and indicated that the mechanism may be related to activating FXR and its target genes,reducing bile acid synthesis and increasing bile acid excretion. This study provides a modern pharmacological basis for the clinical application of Yajima in Tibetan medicine.

The epidemiological characteristics and the source of infection of reemerge human rabies from 2012 to 2017 in Qinghai / 中华疾病控制杂志

Objective To understand the epidemic situation and the source of infection of the reemerge human rabies in Qinghai. Methods We collected the data on human rabies and the data on the cases of multi- victims bitten by the identical dog, and also the laboratory data of the nucleoprotein ( N) gene of rabies virus from the samples which were detected by reverse transcription-polymerase chain reaction (RT-PCR) and direct immunofluorescence assay (DFA) from 2012 to 2017, to describe the epidemiological characteristics of human rabies and the prevalence of rabies virus in host animals, and to explore the source of infection of reemerge human rabies. Results A total of 7 human cases were reported in 2012-2017 in Qinghai province, among which 1 was bitted by wolf, 2 were bitted by stray dogs, 3 were bitted by domestic dogs which injured by stray dogs or wolfs. A total of 892 canine brain tissue samples were collected, from which 46 positive samples were detected with the positive rate of 5.16% (95% CI：3.70%-6.61%). The positive samples were collected from the nomadic region, which were consistent had the location of the human rabies. The samples collected from the cases of multi-victims bitten by the identical dog/animal had the positive rate of 73.08%, and 4 out of 7 human rabies were exposed to the cases of multi-victims bitten by the identical dog/animal. Genetic sequencing of the rabies virus detected from canine brain tissue samples were belong to China IV lineage, which was closely related to the Arctic clade. Conclusions The reemerging rabies happened in nomadic region of Qinghai province could be a consequence of spillover from wildlife especially from wolfs. The better surveillance system covering the human, livestock and wildlife should be set up to mitigate the rabies virus spread from the wildlife.

Surveillance analysis on influenza-like illness from 2017 to 2018 in the plateau of Qinghai Province / 中华疾病控制杂志

Objective To analyze the surveillance results of influenza-like illness ( ILI) and investigate the prevalent trend of influenza from 14th week 2017 to 13th week 2018 (April 3, 2017-April 1, 2018) in Qinghai Province so as to provide the scientific basis for the development of prevention and control measures. Methods The epidemiological and pathogenic characteristics of influenza-like cases in qinghai province from 14th week 2017 to 13th week 2018 were collected and analyzed. Results ILI mainly occurred in winter and spring from 14th week 2017 to 13th week 2018,26 086 ILI cases reported in total，accounting for 2.95% (26 086/884 529) of total number of outpatients and emergency cases; including 18 655 cases under 5 years old，accounting for 71.51%; 1 991 cases were detected with positive by real -time RT PCR with the positive rate of 17.48% (1 991/11 391), In the early stage, H3 and H1 were the predominate strains and the middle period was mixed with H3, H1 and B, and the latter was dominated by type B. Positive rates of influenza virus testing had no statistical differences in different gender ( 2=5.33, P=0.021)，while with statistical differences in different age and time ( 2=108.59, P<0.001; 2= 1 629.13, P<0.001). Number of ILI cases and the percentage in the outpatients was significantly related with influenza virus positive rates (Pearson correlation coefficient was 0.896 and 0.699, respectively, P<0.001). Conclusions Influenza-like cases at sentinel hospital of Qinghai Province can accurately reflect actual activity level. The peak of positive detection of influenza samples in Qinghai province from 14 weeks 2017 to 13 weeks 2018 season was from mid-December to mid-January. The dominant strain of influenza viruses alternated, and the majority of the affected population is mainly in children under 5 years old. In the future, we should strengthen monitoring works in epidemic season, from October to March of next year and focus on the children under 5 years old and the fever clinic. The collection of samples of influenza-like cases in the 0-year-old group should be strengthened, and collective organizations should focus on influenza prevention and control.

Application of graded nursing intervention based on the early delirium prediction model to prevent delirium in ICU patients / 中国实用护理杂志

Objective To study the application effect of graded nursing intervention for ICU patients combined with the Pre-Deliric prediction model. Methods A total of 288 ICU patients were elected and divided into the control group (141 cases from May 2017 to October 2017) and the intervention group (147 cases from November 2017 to April 2018) according to hospitalization time. The control group received conventional delirium prevention measures. The intervention group was assessed within 24 h following admission with Pre-Deliric prediction model to screen the risk of delirium, and then they received grading prevention care based on the assessment results of delirium risks. The data of this study were collected by Numeric Rating Scale, Critical-Care Pain Observation Tool, Richmond Agitation and Sedation Scale, Confusion Assessment Method for the ICU. The incidence and duration of delirium, 28d survival rate, ICU length of stay of the two groups were statistically analyzed. Results Compared with the control group, we detected that the incidence of delirium in the intervention group was significantly lower (χ2=5.043, P<0.05), 21.7%(32/147) vs. 35.5%(50/141). Compared with the control group, we found that the duration of delirium in the intervention group was significantly shorter,(1.68 ± 1.24) vs.( 2.82 ± 1.60)d, the ICU length of stay in the intervention group were significantly shorter than the control group(t=4.45﹐P<0.01), (3.42±3.02)d vs (6.21± 4.56)d. There was no significant difference in the 28-day ICU survival rate between the two groups (P>0.05). Conclusions the risk assessment and grading nursing care combined with Pre-Deliric prediction model could effectively prevent the occurrence and shorten the duration of delirium, and also shorten the ICU length of stay. It was significant for improve the quality of nursing.

Comparison of PRE-DELIRIC and E-PRE-DELIRIC delirium prediction models in ICU patients / 中国实用护理杂志

Objective To assess and compare the predicted abilities of PRE- DELIRIC and E-PRE-DELIRIC two delirium prediction models in ICU patients. Methods From January 2017 to April 2017, 265 critically ill patients who met the inclusion criteria were included in this study. The clinical data of all the included patients, respectively calculated the scores with both PRE-DELIRIC and E-PRE-DELIRIC rating software were collected. Forecasting performance of two different models of discrimination and calibration were assessed. 2 medical staff assessed 20 patients with the Chinese version PRE-DELIRIC and E-PRE-DELIRIC,while the intraclass correlation coefficients were accumulated to evaluate the inter-rater reliability. Results The average scores of PRE-DELIRIC were46.41 ± 14.05in delirium group and20.08 ± 9.96 in patients without delirium, the difference between scores was statistically significant (t=14.34, P<0.05). The average scores of E-PRE-DELIRIC were36.23±13.34in delirium group and14.45±9.56 in patients without delirium, the difference between scores was statistically significant (t=14.59, P<0.05). The AUROCC and its 95％CI of the PRE-DELIRIC and E-PRE-DELIRIC for prediction of delirium were 0.928(0.891-0.965) and 0.904(0.861-0.947) respectively in all patients. Discrimination was generally good for two models. The PRE-DELIRIC and E-PRE-DELIRIC sensitivity were 0.841, 0.812, specificity was 0.939, 0.913, the threshold values of PRE-DELIRIC model was 36.5％and E-PRE-DELIRIC model was 30.5％. The Youden′s index of PRE–DELIRIC model was 0.779, which better than 0.725 of E-PRE-PREDIRIC model. Conclusions The PRE-DELIRIC and E-PRE-DELIRIC models both have high accuracy in predicting delirium of patients in intensive care unit. PRE-DELIRIC does better performance than E-PRE-DELIRIC, but has imitation in terms of time. E-PRE-DELIRIC model can be used in ICU patients who develop delirium within 24 h following admission.

Application of albumen powder during the early standardized nutritional support in ICU / 中国实用护理杂志

Objective To explore the value of the application of albumen powder during the early standardized nutritional support in ICU. Methods Totally 80 patients treated in ICU were enrolled. Randomized digital tables were used to divide patients into experimental and control groups. Nutritive medium was used for enteral nutrition in the control group, and intermixture of nutritive medium and albumen powder was used in experimental group. Results After the intervention, the value of index was significantly better than the control group. The sebum thickness, muscle thickness and plasma total protein and serum album in experimental group before intervention were (0.99±0.72) cm, (2.19±1.14) cm, (62.14±6.87) g/L,(35.32±2.98) g/L, and were (1.01±0.72) cm, ( 2.18±1.13) cm,(64.31±6.97) g/L, ( 36.13± 3.02)g/L in control group, the difference between the two groups was not statistically significant .After intervention, the value were (1.06±0.53)cm,(2.25±0.69) cm,(69.87±7.16)g/L,(40.32±3.17) g/L in control group, (1.39±0.63)cm,(2.62±0.81)cm,(44.21±3.22)g/L,(75.24±7.32)g/L in experimental group, there were significant difference between two groups (t=2.182- 5.445, P<0.01 or 0.05). The incidence of gastrointestinal reaction in experimental group was 20％ (8/40) which was lower than 35％(14/40) of control group significantly(χ2=19.57,P=0.000). Conclusion Application of albumen powder could improve the index including sebum thickness, muscle thickness, plasma total protein and serum album and reduce the incidence of gastrointestinal reaction of patients in ICU.