Effect of an ICU diary on psychiatric disorders, quality of life, and sleep quality among adult cardiac surgical ICU survivors: a randomized controlled trial.

BACKGROUND: Although studies on the effectiveness of the use of ICU diaries on psychiatric disorders and quality of life have been published, the results still seem to be controversial. The study aimed to determine the effects of using an ICU diary on psychiatric disorders, sleep quality, and quality of life (QoL) in adult ICU survivors in China. METHODS: One hundred and twenty-six patients who underwent a scheduled cardiac surgery and were expected to stay ≥ 24 h in ICU were randomized to two groups (63 in each group). The patients in the intervention group received the use of ICU diaries during the period of post-ICU follow-up, while the patients in the control group received usual care without ICU diaries. The primary outcome was significant PTSD symptoms (Chinese version of Impact of Event Scale-Revised, IES-R; total score ≥ 35 was defined as significant PTSD symptoms) and its severity in patients 3 months post-ICU. The secondary outcomes included memories of the ICU at 1 month, QoL (Medical Outcomes Study 36-item Short-Form, SF-36), sleep quality (Pittsburgh Sleep Quality Index Questionnaire, PSQI), anxiety, and depression symptoms (Hospital Anxiety and Depression Scale, HADS) at 3 months. RESULTS: Eighty-five and 83 patients completed the follow-up interviews at 1 month and 3 months post-ICU, respectively. Significant PTSD symptoms were reported by 6 of 41 (14.63%) in the intervention group vs 9 of 42 (21.43%) in the control group (risk difference, - 9% [95% CI, - 2% to 21%], P = 0.10). There was no significant differences between groups in IES-R score, symptoms of intrusion, symptoms of avoidance, numbers of memories of feeling and delusional memories, SF-36 score and anxiety score (P > 0.05), while significant differences were found in symptom of hyperarousal score, numbers of factual memories and PSQI score (P < 0.05). No adverse effect was reported. CONCLUSIONS: Using an ICU diary is not useful for preventing PTSD symptoms and anxiety symptoms and preserving the quality of life of the patients at 3 months post-ICU, while it significantly improves the survivor's factual memory of ICU and sleep quality, and prevents the hyperarousal symptom. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR-IOR-16009109, registered on 28 August 2016.

Nonpharmacological Interventions for Sleep Promotion on Preterm Infants in Neonatal Intensive Care Unit: A Systematic Review.

BACKGROUND: Nonpharmacological interventions are often used to promote sleep among preterm infants in the neonatal intensive care unit (NICU). However, there is a lack of synthesis in the evidence of their effectiveness. AIM: To synthesize the evidence on the effectiveness of nonpharmacological interventions on NICU preterm infants' sleep during hospital stay. METHODS: Seven databases were searched, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Wan-fang database, China National Knowledge Infrastructure, China Biological Medicine Database, and VIP Journal Integration Platform from their inceptions to August 2017. Randomized controlled trials examining the effects of nonpharmacological interventions on preterm infants' sleep were included. RESULTS: This review included 36 studies. Nonpharmacological interventions included the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), music, non-nutritive sucking, touch, cycled light, cobedding, rocking, oral sucrose, remolding mattresses, and family nurturing. The meta-analysis results showed that 1. the NIDCAP had no significant effect on total sleep time efficiency (TST%; p = .34); 2. mattress interventions had significant effects on TST% (p < .001); and active sleep efficiency (AS%; p = .006) but no significant effect on quiet sleep efficiency (QS%; p = .75); 3. cycled light increased TST (p = .02); and 4. cobedding had no significant effects on QS% and AS% (p = .63 and p = .88, respectively). LINKING EVIDENCE TO ACTION: Remolding mattresses and cycled light had significant effects on sleep promotion in preterm infants, but the quality of the evidence was very low. Further high-quality studies are needed to strengthen this evidence.

Limonoids from the fruits of Cipadessa cinerascens.

A new limonoid, 3-de(2-methylbutanoyl)-3-propanoylcipadesin (1), along with 10 known limonoids and 1 known triterpenoid, was isolated from the fruits of Cipadessa cinerascens. Their structures were elucidated on the basis of spectroscopic analysis. All compounds were evaluated for their antimicrobial activities, and compounds 6 and 12 showed weak antimicrobial activities against MRSA 82(#) and MRSA 92(#).

Two new compounds from Khaya senegalensis.

Two new compounds, khayseneganin I (1) and 2α,3α,16ß-trihydroxy-20-acetoxy-20(R)-pregnane (2), along with six known compounds, 2α,3α,20-trihydroxy-16ß-acetoxy-20(R)-pregnane (3), 2α,3ß-dihydroxypregnan-16-one-2ß,19-hemiketal (4), (+)-catechin (5), ivorenolide A (6), luteolin-7-O-α-l-rhamnoside (7), and ( - )-5'-methoxy-isolariciresinol-2a-O-ß-d-xylopyranoside (8), were isolated from the leaves and twigs of Khaya senegalensis. The structures of new compounds were elucidated by 2D NMR spectroscopy and MS. Selected compounds (2-8) were evaluated for their antimicrobial activities and compounds 5 and 7 showed weak antimicrobial activities against MRSA 92(#) and MRSA 98(#).

[Comparison of single intubating dose and continuous infusion of rocuronium in prolonged gynecologic laparoscopic surgery].

OBJECTIVE: To compare the cardiorespiratory factors and surgical conditions during total intravenous anesthesia for prolonged laparoscopic pelvic surgery with or without supplemental muscle relaxants. METHODS: Forty female ASA I or II patients undergoing laparoscopic pelvic surgeries were randomized into two groups A and B, both with standardized anesthesia via a intravenous bolus injection of rocuronium (0.6 mg/kg). The patients in group B received continuous rocuronium infusion upon observation of one TOF twitch response with the T1 value maintained within 0-10% and rocuronium withdrawal at 20 to 30 min before the completion of the surgery. The patients in group A received no supplemental muscle relaxants. The cardiorespiratory parameters were measured during the operation. The respiratory system compliance (Ceff rs) was calculated as the quotient of the tidal volume (VT) and peak inspiratory pressure (PIP), and the operative conditions were graded by the operating gynecologist. RESULTS: The cardiorespiratory parameters significant increased and Ceff rs decreased after pneumoperitoneum, but no significant differences were found between the two groups. The surgical conditions were also comparable between the two groups, but the duration of intubation and the operating time were significantly shorter in the group A. CONCLUSION: Pneumoperitoneum severely affects the cardiorespiratory parameters during laparoscopy, which can not be lessened by neuromuscular block agents. A single intubating dose of rocuronium can suffice the requirement of prolonged gynecologic laparoscopic surgery.

[Preparation and in vitro drug release performance of morphine-loaded chitosan microspheres].

OBJECTIVE: To prepare morphine-loaded chitosan microspheres by emulsion ionic cross-linking and investigate the effect of initial morphine quantity and different cross-linking degrees on drug loading, encapsulation efficiency and in vitro drug release. METHODS: Chitosan (with a relative molecular mass of 50,000 and deacetylation degree no less than 90%) at 100 mg and morphine at 20, 30, 40, or 50 mg were dissolved by 2% acetate and dripped slowly into 15 ml soy-bean oil containing 0.75 ml Span80. After full emulsification at 35 degrees C; for 1.5 h, the mixture was dripped slowly into sodium tripolyphosphate (10 mg/ml) at the mass ratio of 5:1, 7:1, or 9:1 to allow cross-linking for 2 h. The drug loading, encapsulation efficiency and in vitro drug release of the preparations were measured. RESULTS: The drug loading in the microsphere increased while the encapsulation efficiency reduced with the increment of the initial morphine quantity. High cross-linking degree resulted in prolonged release time of the drug loaded in the preparations. CONCLUSION: The microspheres loaded with morphine allows sustained release of morphine.

Unfolding and inactivation of abalone (Haliotis diversicolor) alkaline phosphatase during denaturation by guanidine hydrochloride.

Abalone, a kind of low poikilothermic invertebrate, is easily exposed to ocean environment stress. Since it is one of the important mariculture animals, the attention paid to the abalone study becomes increasing. Alkaline phosphatase (ALPase, EC 3.1.3.1) is a kind of zinc-contained metalloenzyme, which catalyzes the nonspecific hydrolysis of phosphate monoesters. Unfolding and inactivation of ALPase from abalone (Haliotis diversicolor) during denaturation by guanidine hydrochloride (GuHCl) of different concentrations has first been studied. The kinetic theory of the substrate reaction by enzyme was described by Tsou, which was applied to the study on ALPase's kinetic course of inactivation by GuHCl. The result showed that the inactivation of the enzyme by GuHCl was a slow, reversible reaction with fractional remaining activity. The microscopic rate constants were determined. The result, k(+0) > k'(+0), showed that the enzyme was protected by the substrate to a certain extent during guanidine denaturation. The changes of conformation of the enzyme in different concentrations of GuHCl have been studied by means of measuring the fluorescence spectra. The results showed that the inactivation occurred before the noticeable conformational changes of the enzyme molecule as a whole can be detected, which suggests that the active site of the enzyme has more flexibility than the whole enzyme molecule. These studies will facilitate the understanding of physiological and biochemical features of the H. diversicolor and will also help in the understanding of the abalone immune system.