High dependency unit reduce ICU readmission rate in patients with severe liver disease: A clinical study / 中华肝脏病杂志

Objective: To explore the difference in intensive care unit (ICU) readmission rate between high dependency unit (HDU) and general ward for the patients with severe liver disease (SLD), and reflect the effect of HDU on SLD patientse. Methods: A clinical cohort of patients transferred out of ICU was established, and patients with severe liver disease who were transferred to HDU& general ward from July 2017 to December 2021 in the intensive care Unit of the Fifth Medical Center of PLA General Hospital were continuously enrolled. The main liver function indexes and MELD scores between the two groups were compared. Analyze the differences in severity and ICU readmission rate of SLD patients transferred to different wards, and clarify the role of HDU in the management of SLD patient. Area under the receiver operating characteristic (AUROC) was used to investigate the value of MELD score in predicting the occurrence of return to ICU. Results: The level of INR, TB, ALT and MELD scores of SLD patients transferred to HDU were significantly higher than those of patients transferred to general ward (all P < 0.05). MELD > 17 was found in 70.7% of SLD patients transferred to HDU group, while MELD ≤ 17 was found in 61.9% of SLD patients in general ward group. The ICU readmission rate of all patients in this cohort was 11.4%. By MELD quartile stratification, patients with SLD whose MELD > 23 had a significantly higher ICU readmission rate (20.0%) than those with SLD whose MELD ≤ 23 (8.6%) (P = 0.020). The ICU readmission rate was 8.2% when MELD ≤ 23 in the HDU group and 9.1% when MELD > 23, showing no significant difference (P = 1.000). The ICU readmission rate was 8.8% when MELD ≤ 23 in the general ward group. ICU reentry rate increased significantly to 36.4% when MELD > 23 (P = 0.001). MELD Score predicts that the optimal cut-off value of SLD patients in general ward readmitted to ICU was 23.5. Conclusion: The high dependency unit could better admit patients with SLD who were transferred out of ICU and required step-down treatment, and significantly reduced the ICU readmission rate of patients with SLD who were transferred out of ICU with MELD > 23. The patients with SLD and MELD score > 23 are suitable to be transferred from ICU to HDU.

Factors influencing super-long hospital stays in patients undergoing radical gastrectomy in the age of enhanced recovery after surgery / 中华胃肠外科杂志

Objective: To obtain experience and generate suggestions for reducing average hospital stays, optimizing perioperative management of patients with gastric cancer and improving utilization of medical resources by analyzing the factors influencing super-long hospital stays in patients undergoing radical gastrectomy in the age of enhanced recovery after surgery (ERAS). Methods: This was a case-control study. Inclusion criteria: (1) pathologically diagnosed gastric adenocarcinoma; (2) radical surgery for gastric cancer; and (3) complete clinicopathologic data. Exclusion criteria: (1) history of upper abdominal surgery; (2) presence of distant metastasis of gastric cancer or other ongoing neoplastic diseases; (3) concurrent chemoradiotherapy; and (4) preoperative gastric cancer-related complications such as obstruction or perforation. The study cohort comprised 285 eligible patients with hospital stays of ≥30 days (super-long hospital stay group). Using propensity score matching in a 1:1 ratio, age, sex, medical insurance, pTNM stage, and extent of surgical resection as matching factors, 285 patients with hospital stays of < 30 days during the same period were selected as the control group (non-long hospital stay group). The primary endpoint was relationship between pre-, intra-, and post-operative characteristics and super-long hospital stays. Clavien-Dindo grade was used to classify complications. Results: Univariate analysis showed that number of comorbidities, number of preoperative consultations, preoperative consultation, inter-departmental transference, operation time, open surgery, blood loss, intensive care unit time, presence of surgical or non-surgical complications, Clavien-Dindo grade of postoperative complications, and reoperation were associated with super-long hospital stays (all P<0.05). Inter-departmental transference (OR=4.876, 95% CI: 1.500-16.731, P<0.001), preoperative consultation time ≥ 3 d (OR=1.758, 95%CI: 1.036-2.733, P=0.034), postoperative surgery-related complications (OR = 6.618, 95%CI: 2.141-20.459, P=0.01), and higher grade of complications (Clavien-Dindo Grade I: OR = 7.176, 95%CI: 1.785-28.884, P<0.001; Clavien-Dindo Grade II: OR = 18.984, 95%CI: 6.286-57.312, P<0.001; Clavien-Dindo Grade III-IV: OR=7.546, 95%CI:1.495-37.952, P=0.014) were independent risk factors for super-long hospital stays. Conclusion: Optimizing preoperative management, enhancing perioperative management, and surgical quality control can reduce the risk of prolonging average hospital stay.

Advisory Panel Review on the Feasibility of Three Intervention Programmes for Children with Autism Spectrum Disorder

@#Introduction: The prevalence of children with autism spectrum disorder is increasing each year. Intervention programmes towards improving the occupational needs such as daily activities of these children are limited. This study aimed to collect opinions from advisory panel for the content validation of the three developed intervention programmes to be implemented among children with autism spectrum disorder aged between 6 to 12 years. The intervention programmes are; i) self-regulated learning, ii) sensory integration intervention and iii) activity-based intervention. Methods: A cross-sectional study was conducted. Twenty occupational therapists with more than three years’ experience working with children with autism spectrum disorders were recruited as advisory panel members. Researchers-developed questionnaire was used. The questionnaire consists of nine to eleven items. Each item consists of a five-point Likert scale for quantitative responses and open-ended questions for qualitative responses. Results: Advisory panel ratings of ‘Good’ to ‘Excellent’ was reported across most items in all three intervention programmes. Overall results suggested that the intervention programmes content was rated to be suitable for children with autism spectrum disorder. Constructive comments were adopted to clarify the activities and structure of the intervention programmes. Final development of the intervention programmes is presented. Conclusion: This study provides confidence for the interventions to be incorporated into the future randomised controlled trial.

Long-term effect of iodine deficiency on growth and food utilization rate in second filial generation rats / 中华预防医学杂志

To study the effect of iodine deficiency on body weight, food consumption, and food utilization rate of second filial generation Wistar rats.According to the food pattern of a high-iodine deficient population, two types of low-iodine food have been produced using the main crops grown in this area (iodine levels of 50 and 20 μg/kg, respectively). Wistar rats were randomly divided into three groups, normal iodine group (NI group), low-iodine group one (LI group) and low-iodine group two (LII group), using the random number table method and fed diets containing 300, 50, and 20 μg/kg of iodine, respectively. Parental generation rats were fed until they reached reproductive age; first filial generation rats were allocated to the same diet as their mothers. After 3 months of feeding, first filial generation rats gave birth to second filial generation rats; second filial generation rats were allocated to the same diet as their mothers. After feeding for 90, 180, and 270 days, rats were sacrificed. One-way analysis of variance was used to analyze body weight, food intake, and food utilization rate data collected during the time of feeding and blood iodine hormone level, which was determined after sacrifice.The LI and LII groups generally demonstrated decreased activity, slow reaction, and growth retardation compared with the NI group. After 270 days, the urine iodine levels of the LI and LII groups were 1.7 and 0.2 μg/L, respectively, which were significantly lower than the NI group (255.2 μg/L) (0.001). Additionally, the weight of female rats in the LI and LII groups were (288.1±10.5) and (275.7±2.7) g, respectively, which was significantly lower than that of the NI group ((311.0±2.3) g) (0.001). The weight of male rats were (446.0±4.6) and (451.8±19.1) g, respectively, which were significantly lower than that of the NI group ((517.2±7.8) g) (0.001). In the LI and LII groups, food intake of female and male rats after 270 days were (465.0±27.7), (658.4±28.6) and (423.0±13.2), (548.0±18.8) g, respectively, which were significantly lower than that of the NI group ((499.5±21.8), (760.8±33.0) g) (0.001). Moreover, the food utilization rate of female rats in the LI and LII groups was (8.7±0.4)% and (6.0±0.58)%, which was lower than that of the NI group ((11.7±3.5)%) (0.001); similarly, male rats showed rates of (8.9±1.5)% and (6.9±1.31)%, respectively, which were lower than that of the NI group ((13.7±3.0)%) (0.001). After 270 days, the level of T3 in the LI and LII groups were (0.45±0.10) and (0.34±0.15) ng/ml, respectively, which was significantly lower than that of the NI group ((0.91±0.49) ng/ml) (0.01). Moreover, the level of T4 were (69.02±27.87) , (53.18±13.53) ng/ml in LI and LII groups, respectively, which was lower than that of the NI group ((76.69±29.42) ng/ml) (0.05).This study indicated that iodine deficiency induced by a long-term low-iodine diet can cause changes in weight, food intake, and food utilization rate among second filial iodine deficiency rats. More importantly, the iodine content in low-iodine food impacts these parameters.

[Development of an indirect ELISA for bovine mastitis using Sip protein of Streptococcus agalactiae]

The sip gene encoding for a conserved highly immunogenic surface protein of Streptococcus agalactiae was amplified using polymerase chain reaction [PCR] and subcloned into prokaryotic expression vector pET32a [+] and expressed as a recombinant protein in E. coli BL21 [DE3]. An indirect enzyme linked immunosorbent assay [ELISA] was developed using the purified Sip protein as a coating antigen, which could identify S. agalactiae specific antibody in sera. The coating antigen at a concentration of 3.125 µg/ml, serum diluted to 1:160, and HRP-conjugated secondary antibody concentration at 1:4000 was found to be most effective in exhibiting positive result. The ELISA was found to be highly specific for S. agalactiae that may be used for the detection of the pathogen in mastitis cases, for epidemiological studies and for surveillance.

Distribution and diversity of coliform bacteria in estuary of jiahe river, china

Waterborne outbreaks of pathogenic bacteria from contaminated water are serious threats for public health. Coliform bacteria have been regarded as one of the most important indicators for monitoring pathogenic bacteria. To address potential pathogenic bacterial outbreaks, the distribution and diversity of coliform bacteria in Jiahe river, which flows through densely-populated urban area in China, were detected. Escherichia Coli and other coliform bacteria were counted using the membrane filter technique to describe the distribution of the coliform bacteria. Phylogenetic analysis was applied to investigate the diversity of the coliform bacteria. The results suggested that the quantities of coliform bacteria varied greatly between five sampling sites with the highest value at site YT4 and the lowest value at site YT2. Highest concentrations of E. coli and other coliform bacteria were also observed at YT4, while the lowest value was detected at sites YT3 and YT2, respectively. Various coliform bacteria were classified by phylogenetic analysis, including Citrobacter, Klebsiella, Enterobacter, and Raoultella. Components of coliform bacteria affiliated into these four genera were various in all sampling sites. The statistical analysis suggested that the distribution of coliform bacteria were remarkably influenced by total bacteria amount. Multiple environmental parameters were proved to affect the diversity of coliform bacteria. The results of this study revealed the correlation between coliform bacteria and the environmental parameters, which is important for predicting and preventing waterborne transmission of pathogenic bacteria

Framingham risk score inadequately predicts cardiac risk in young patients presenting with a first myocardial infarction

<p><b>INTRODUCTION</b>The Framingham Risk Score (FRS) is a well-validated epidemiologic tool used to assess the risk for a fi rst cardiac event. Because young patients presenting with a fi rst myocardial infarction (MI) tend to have less significant risk profiles compared with older patients, we hypothesized that FRS may underestimate cardiac risk in these patients.</p><p><b>MATERIALS AND METHODS</b>We studied 1267 patients between January 2002 and November 2007 presenting with a fi rst MI. Patients with pre-existing diabetes mellitus and vascular disease were excluded. FRS was calculated for each patient. Patients were divided based on their age: group A (<40 years), group B (40 to 64 years) and group C (> or =65 years).</p><p><b>RESULTS</b>The mean age was 54.7 +/- 11 years, 88.4% of the patients were males. Younger patients were more likely to be assigned with lower scores. Based on FRS, 63.0%, 29.3% and 14.2% of group A, B and C patients were classified as low risk (10-year risk for cardiac events<10%) respectively, P <0.001. The sensitivity of FRS in identifying at least intermediate risk subjects (10-year risk for cardiac events >10%) was 37.0% in group A vs 85.8% in group C (P <0.001). The incidence of newly diagnosed diabetes mellitus was higher in younger patients (12.0% vs 13.2% vs 7.1 % in groups A, B and C respectively, P = 0.027).</p><p><b>CONCLUSIONS</b>FRS inadequately predicts cardiac risk in young patients presenting with a fi rst MI. This could be because a significant proportion of these young patients have undiagnosed diabetes mellitus, a coronary artery disease risk equivalent.</p>