Development and validation on death risk model of Stanford type A aortic dissection based on Cox regression / 中华危重病急救医学

Objective:To construct the prediction model of death risk of Stanford type A aortic dissection (AAD) based on Cox proportional risk regression model.Methods:AAD patients who were diagnosed and received surgical treatment admitted to the department of cardiothoracic surgery of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 1st, 2019 to April 30th, 2020 were enrolled. The general situation, clinical manifestations, pre-hospital data, laboratory examination and imaging examination results of the patients were collected. The observation period was up to the death of the patients or ended on April 30th, 2021. They were divided into the model group and the verification group according to the ratio of 7∶3. Lasso method was used to screen prognostic variables from the data of the modeling group, and multivariate Cox regression analysis was included to construct the AAD death risk prediction model, which was displayed by nomogram. The receiver operator characteristic curve (ROC curve) was used to evaluate the discrimination of the model, the calibration curve to evaluate the accuracy of the model, and the clinical decision curve (DCA) to evaluate the effectiveness of the model.Results:A totel of 454 patients with AAD were finally included, and the mortality was 19.4% (88/454). Lasso regression analysis was used to screen out 10 variables from the data of 317 patients in the model group, and the prediction model of death risk was constructed: 0.511×abdominal pain+1.061×syncope+0.428×lower limb pain/numbness-0.365×emergency admission-1.933×direct admission-1.493×diagnosis before referral+0.662×preoperative systolic blood pressure (SBP) < 100 mmHg (1 mmHg = 0.133 kPa)+0.632×hypersensitivity cardiac troponin I (hs-cTnI) > 34.2 ng/L+1.402×De Bakey type+0.641× pulmonary infection+1.472×postoperative delirium. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) of the AAD death risk prediction model were 0.873 (0.817-0.928), and that of the verification group was 0.828 (0.740-0.916). DCA showed that the net benefit value of the model was higher. The calibration curve showed that there was a good correlation between the actual observation results and the model prediction results. Conclusion:The AAD death risk prediction model based on abdominal pain, syncope, lower limb pain/numbness, mode of admission, diagnosis before referral, preoperative SBP < 100 mmHg, hs-cTnI > 34.2 ng/L, De Bakey type , pulmonary infection, and postoperative delirium can effectively help clinicians identify patients at high risk for AAD, evaluate their postoperative survival and timely adjust treatment strategies.

Xenobiotic transcription factors CncC and maf regulate expression of CYP321A16 and CYP332A1 that mediate chlorpyrifos resistance in Spodoptera exigua.

Insect cytochrome P450 s (P450 s) are associated with the metabolic detoxification of toxic xenobiotics and their constitutive upregulation is often associated with resistance to natural and synthetic toxicants. The P450 s CYP321A16 and CYP332A1 are constitutively overexpressed in an insecticide-resistant strain of beet armyworm, Spodoptera exigua. However, the function and upstream regulation of these two P450 s remain unknown. Here, we investigated the function of CYP321A16 and CYP332A1 in resistance to the organophosphate insecticide, chlorpyrifos and their regulation by the transcription factors CncC and Maf. Transgenic strains of Drosophila melanogaster expressing CYP321A16 or CYP332A1 showed higher levels of tolerance to chlorpyrifos than the control flies with the same genetic background. Furthermore, recombinant CYP321A16 and CYP332A1 proteins metabolized chlorpyrifos. Analysis of the putative promoter sequences of the genes coding for CYP321A16 and CYP332A1 revealed conserved CncC/Maf binding sites. Transfection of luciferase reporter plasmids containing the promoter of CYP450 gene together with CncC and Maf expression plasmids significantly enhanced the activity of the reporter. Promoter truncation identified a site in the promoter of CYP321A16 that is critical for the CncC/Maf binding. These data demonstrate that resistance to chlorpyrifos in S. exigua is conferred by the combined action of CYP321A16 and CYP332A1 and uncovered their regulation by the transcription factors CncC and Maf.

Evaluation of the clinical characteristics of suspected or confirmed cases of COVID-19 during home care with isolation: A new retrospective analysis based on O2O

BackgroundThe recent outbreak of the novel coronavirus in December 2019 (COVID-19) has activated top-level response nationwide. We developed a new treatment model based on the online-to-offline (O2O) model for the home isolated patients, because in the early stages the medical staff were insufficient to cope with so many patients. MethodsIn this single-centered, retrospective study, we enrolled 48 confirmed/suspected COVID-19 patients who underwent home isolation in Wuhan between January 6 and January 31, 2020. By WeChat and online document editing all patients were treated with medical observation scale. The clinical indications such as Fever, Muscle soreness, Dyspnea and Lack of strength were collected with this system led by medical staff in management, medicine, nursing, rehabilitation and psychology. FindingsThe mean age of 48 patients was 39{middle dot}08{+/-}13{middle dot}88 years, 35(72{middle dot}9%) were women. Compared with non-hospitalized patients, inpatients were older([≥]70years, 2{middle dot}4% vs 33{middle dot}3%, P<0{middle dot}04). All inpatients had fever, 50% inpatients had coughs and showed infiltration in both lungs at the time of diagnosis. 33{middle dot}3% inpatients exhibited negative changes in their CT results at initial diagnosis. The body temperature of non-hospitalized patients with mild symptoms returned to normal by day 4-5. While dyspnea peaked on day 6 for non-hospitalized patients with mild symptoms, it persisted in hospitalized patients and exacerbated over time. The lack of strength and muscle soreness were both back to normal by day 4 for non-hospitalized patients. InterpretationMonitoring the trends of symptoms is more important for identifying severe cases. Excessive laboratory data and physical examination are not necessary for the evaluation of patients with mild symptoms. The system we developed is the first to convert the subjective symptoms of patients into objective scores. This type of O2O, subjective-to-objective strategy may be used in regions with similar highly infectious diseases to minimize the possibility of infection among medical staff.

The effect of injecting mouse nerve growth factor on the recovery of hand function in patients with cubital tunnel syndrome / 中华物理医学与康复杂志

Objective To observe the effectiveness of injecting mouse nerve growth factor ( mNGF) on the recovery of hand motor function among patients with cubital tunnel syndrome. Methods A total of 138 patients with moderate to severe cubital tunnel syndrome were randomly divided into groups designated as A, B and C, each of 46. Twenty micrograms of mNGF was injected daily 1 mm from the ulnar nerve at the cubital tunnel for the patients of group A and the injection site was moved 1 mm distally everyday along the nerve , but injected intramuscularly for those in group B. Those in group C received 500 μg of mecobalamin injected intramuscularly 3 times a week. The whole intervention consisted of two 4-week phases, with an interval of 2 months. Before and after the intervention, the function of internal hand muscles, hand function recovery rates and any electrophysiological changes in the ulnar nerve were measured and compared between the two groups. Results All of the patients showed significant improve-ment in hand muscle function and neuroelectrophysiology. The incidence of had muscle atrophy, Tinel′s sign, posi-tiveness in the paper clamping test and claw hand all significantly improved compared with before the treatment in all three groups. The average Disability of Arm Shoulder and Hand score in group A after the treatment was significantly higher than the group B and group C averages. The average ulnar nerve conduction velocity, incubation period and amplitude of group A after the treatment were all significantly better than before the treatment and better than the other groups′averages. After the treatment, the average hand function recovery in group A reached 91％, significantly high-er than in groups B ( 76％) and C ( 59％) . Conclusion Injecting mNGF next to the ulnar nerve is superior to in-jecting it intramuscularly in promoting the recovery of the ulnar nerve and hand function for patients with moderate to severe cubital tunnel syndrome.

Characteristics of and surgical strategies for distal tibiofibular syndesmosis separation based on ankle axial CT scan / 中华创伤骨科杂志

Objective To explore the clinical characteristics of and surgical strategies for distal tibiofibular syndesmosis separation based on ankle axial CT scan.Methods From January 2009 to January 2016,63 patients with injury to the distal tibiofibular syndesmosis were treated.Their injuries were characterized according to the anatomic characteristics on their ankle axial CT scan images as pronation-extorsion type (28 cases),supination-extorsion type (11 cases) and abduction type (24 cases).Specific strategies of reduction and fixation depended on the specific characteristics of distal tibiofibular syndesmosis separation.After 12 months postoperatively,the reduction quality was assessed by Burwell-Charnley's radiological evaluation system and the function of ankle joint was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score system.Results The patients were followed up for 6 to 48 months (average,19.3 months).Anatomical reduction was achieved in 19 cases,good reduction in 7 and fair reduction in 2 in the pronation-extorsion type,yielding an excellent to good rate of 92.8％;anatomical reduction was achieved in 6 cases,good reduction in 4 and fair reduction in one in the supination-extorsion type,yielding an excellent to good rate of 90.9％;anatomical reduction was achieved in 17 cases,good reduction in 6 and fair reduction in one in the abduction type,yielding an excellent to good rate of 95.8％.By the AOFAS system,the pronation-extorsion type scored 88.6 points,the supination-extorsion type 89.4 points and the abduction type 86.6 points.Conclusion In the treatment of distal tibiofibular syndesmosis separation,reduction and fixation strategies should depend on analysis of the characteristics on the ankle axial CT scan,so as to achieve positive outcomes.

The current situation of safety climate perception in nurses of emergency department / 中华护理杂志

Objective Investigate the current situation of emergency nurses' perception of hospital safety climate in tertiary hospitals. MethodsA total of 866 emergency nurses from 114 hospitals in 29 provinces,municipalities and autonomous re.gions were randomly selected,and the self-designed general information questionnaire and Chinese version of the hospital safety climate scale were used to investigate. ResultsThe overall hospital safety climatel was(3.97+0.61). Univariate analysis of variance showed that there were statistically significant differences in the hospital safe.ty climate of emergency nurses with educational background and employment form (P<0.05). ConclusionThe e-mergency nurses have a better sense of the overall hospital safety climate,but the obstruction of' the safety work and the cleanliness and neatness of the. working: environment need to be improved. Therefore,il is suggested Lhal the construction of hospital safety climate should be further strengthened in the rational allocation of human re-sources and emergency working environment.

The postoperative secondary xerostomia′s uncomfortable experience of patients with fating in gastrointestinal surgery：a qualitative study / 中国实用护理杂志

Objective To explore the postoperative secondary xerostomia′s uncomfortable experience of patients with long fating in gastrointestinal surgery, providing basis for medical staff to understand comfort needs of patients and to take targeted nursing intervention. Methods The phenomenological methodology was used in the study. Totally 12 patients with postoperative secondary xerostomia′s uncomfortable experience were interviewed, and tape recording was used. The data was analyzed by Colaizzi analysis method. Results Four themes were extracted: emotional response to patients with postoperative xerostomia, uncomfortable experience of mouth, the insufficient cognition of fating in perioperative period, desire for attention to solve the problem of dry mouth. Conclusions Medical staff should strengthen the awareness of the patients′experience with secondary and temporary dry mouth, and improve the nursing intervention measures according to need, in order to increase patients′comfort and to promote them recover soon.

The effect of Utstein registry on cardiopulmonary resuscitation quality control / 中国实用护理杂志

Objective To explore the effect of Utstein registry on improving the missing key information during cardiopulmonary resuscitation.Methods A total of 111 emergency medical records of cardiopulmonary resuscitation from January 1 to December 31 2012 were as control group,and 100 Utstein registry of cardiopulmonary resuscitation from June 1 2013 to May 31 2014 were as experimental group.The missing key information during cardiopulmonary resuscitation were compared between two groups.Results The missing key information during cardiopulmonary resuscitation in monitoring the rhythm of the heart for the first time,cardiopulmonary resuscitation start time,defibrillation time for the first time,established assisted ventilation time,recovery delivery time for the first time,recovery termination time were 84.68％(94/111),16.22％ (18/111),89.58％ (43/48),76.58％ (85/111),72.07％ (80/111),30.63％ (34/111) in control group,and 9.00％(9/100),0,0,4.00％(4/100),7.00％97/1000,2.00％(2/100) in experimental group,and there were significant differences (P＜ 0.01).Conclusions Utstein registry can promote perfect cardiopulmonary resuscitation information registration,so as to provide the basis for cardiopulmonary resuscitation quality continuous improvement.

Experiences of being informed of patients with aortic dissection during the early phase of the dis-ease：a qualitative study / 中国实用护理杂志

Objective To explore the real experience of patients with aortic dissection (AD) disease during the early phase of the disease. Methods Interpretation phenomenological analysis method was used in the study. Self- structured in- depth interviews were conducted with AD patients who were admitted to the hospital from November 2013 to February 2014, and combining the participation observation method to collect relevant data. Data were analyzed by content analysis. Results 16 cases were interviewed and four advanced themes were extracted: experience of disease symptoms; negative emotion; coping styles; the insight of life. Conclusions AD patients can produce complex psychological experiences when they are informed of the diagnosis because of the experience of pain, sudden critical illness, the role change and so on. Medical staff should pay attention to their psychological status and needs, take corresponding effective measures to promote the further treatment and their physical and psychological rehabilitation.

Study of the correlations between chest compression quality items / 中华急诊医学杂志

Objective To explore the relationship between quality items of chest compression for resuscitation of cardiac arrest and to identify the key points in chest compression training and practice.Method The training project was offered to 219 healthcare workers by using Laerdal ACLS advanced life support resuscitation model, and the quality issues of chest compression were monitored including compression hands placement,compression rate,compression depth,and chest wall recoil,as well as selfreported fatigue time by Laerdal Computer Skills and Reporting System.Results The quality of chest compression was related to the geuder of the practitioner.The items in males including self-reported fatigue time,the accuracy of compression depth and the compression rate,the accuracy of compression rate were higher than those in females.However,the chest recoil rate was higher in females than that in males.The quality items of chest compression were correlated with one another. The self-reported fatigue time was related to all the items except the compression rate.Conclusions It is necessary to offer cardiopulmonary resuscitation (CPR) training courses regularly. In clinical practice,it might be better to change the practitioner before fatigue,especially for female or weak practitioners.In training projects,more attention should be paid to the control of compression rate, in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression.

Surgical patients' needs and actual utilization of community nursing services / 中国实用护理杂志

Objective To investigate the surgical patients' needs of community nursing services and actual utilization within one week of out hospital. Methods Sampled 257 adults surgical patients from certain general hospital, interviewed them by self-designed queostionnair to know their needs of community nursing services and actual utilization within one week after out of hospital. Results There were 96% pa-tients required community nursing services at the point of discharge. The content of services needs included dise ases cares, health teaching and prevention services. Different moded of community nursing cares were required. The actual utilization rate within one week was 16.5%, there were 54.5% and 63.6% of patients received wound care and medication administration separately, which were mainly provided by center visit. Conclusions There is a contradiction between the needs and actual utilization of com-munity nursing services. It is meaningful to enhance the utilization rate, extend the content and perfect the modes of community nursing services so as to satisfy discharged surgical patients' needs.

Comparative study for the effect of ICNSS and APACHE Ⅱ scoring in nursing resource allocation of intensive care unit / 中国实用护理杂志

Objective To study the value of intensive care nursing scoring system(ICNSS) on care resource allocation in intensive care unit(ICU). Methods 108 ICU patients were divided into the observation group (55 cases) and the control group (53 cases) randomly. In the observation group,the ICNSS scale was applied to evaluate nursing workload, and care resource was allocated according to intensive care nursing scoring. In the control group, care resource was allocated according to dynamic monitoring of acute physiology and chronic health evaluation (APACHE Ⅱ ) scoring. The ICU monitoring time,medical cost,incidence of complications during the hospitalization,satisfaction of the nurses and the patients or their relatives were compared between two groups. Results The ICU monitoring time,medical cost and incidenceof complications during the hospitalization in the observation group were significantly less than those in the control group, while the satisfaction of the nurses and the patients or their relatives in the observation group was markedly better than that in the control group. Conclusions Care resource allocation according to ICNSS is worthy of promotion and application in ICU because it can more significantly improve nursing quality,satisfaction of nurses and patients or their relatives than care resource allocation according to APACHE Ⅱ scoring.

Isolation, purification and structure analysis of polysaccharides from Peacilomyces lilacinus / 生物工程学报

The paper dealt with the characterization of polysaccharide of Paecilomyces lilacinus NH-PL-03 strain. First, we extracted and purified exude polysaccharide from the fungal fermentation broth by ethanol depositing method. Second, the proteins were removed by the Sevage method from the crude polysaccharide. Third, the purified polysaccharide (EP-1) was obtained after Superdex G-75 column separation. The results of UV-spectrometer and Sephacryl S-200 HR chromatography experiments showed that the EP-1 was a homogeneous pure polysaccharide with molecular weight of 35.2 kDa. Tested by paper chromatography analysis using the complete hydrolysis by sulfuric acid, we found that the EP-1 comprise single component as glucose. The chemical structure of EP-1 was confirmed as a kind of linear glucan linked by beta-(1,3) linkage. The Congo red reaction performed that EP-1 probable presented a triple-helical conformation in the dilute alkali.

康复病房实施人性化护理的效果 / 中国康复理论与实践

@#Objective To observe the effect of humanistic nursing care in rehabilitation ward.Methods 440 inpatients in rehabilitation ward were randomly divided into the observation group(228 cases,treated with humanistic nursing)and control group(212 cases,treated with traditional nursing).40 cases in each group received the investigation of patients' satisfaction to the service.Results The satisfactory rate of the patients in the control group to the attitude of the service,the nursing skill and health education missionary were 72.5%,75% and 67.5% respectively,but that of the patients in the observation group were all 100%,there was a significant difference between two groups(P<0.01).Conclusion Humanistic nursing care in rehabilitation ward can improve nursing qualification and increase patients' satisfactory rate.

Reflection on the Constructive and Management Models of Campus Culuture in New Campus / 中华医学教育探索杂志

The article discussed the significance of studying campus culuture constructive and management models in New Campus,and then advanced the guiding ideology,basic thinking,key problems of improving the level of campus culuture constructive and management in new campus.