Effect of Improved Nursing Strategy on Prognosis of Immunosuppressed Patients With Pneumonia and Sepsis: A Prospective Cohort Study.

Objectives: To investigate the effect of our improved nursing strategy on prognosis in immunosuppressed patients with pneumonia and sepsis. Methods: Immunosuppressed patients (absolute lymphocyte count <1000 cells/mm3) with pneumonia and sepsis were enrolled and divided into a control group and treatment group. The treatment group received the improved nursing strategy. The primary outcome in this study was 28-day mortality. Results: In accordance with the study criteria, 1019 patients were finally enrolled. Compared with patients in the control group, those in the treatment group had significantly fewer days on mechanical ventilation [5 (4, 7) versus 5 (4, 7) days, P = .03] and lower intensive care unit (ICU) mortality [21.1% (132 of 627) vs 28.8% (113 of 392); P = .005] and 28-day mortality [22.2% (139 of 627) vs 29.8% (117 of 392); P = .006]. The treatment group also had a shorter duration of ICU stay [9 (5, 15) vs 11 (6, 22) days, P = .0001] than the control group. The improved nursing strategy acted as an independent protective factor in 28-day mortality: odds ratio 0.645, 95% confidence interval: 0.449-0.927, P = .018. Conclusion: Our improved nursing strategy shortened the duration of mechanical ventilation and the ICU stay and decreased ICU mortality and 28-day mortality in immunosuppressed patients with pneumonia and sepsis. Trial registration: ChiCTR.org.cn, ChiCTR-ROC-17010750. Registered 28 February 2017.

[Effect of improved nursing strategy on prognosis of older immunosuppressed patients with pneumonia and sepsis].

OBJECTIVE: To investigate the effect of improved nursing strategy on prognosis of older immunosuppressed patients with pneumonia and sepsis. METHODS: A prospective study was conducted. The older immunosuppressed patients with pneumonia and sepsis admitted to the department of intensive care medicine and emergency intensive care unit (ICU) of Peking Union Medical College Hospital from January 2017 to July 2022 were enrolled. In the first stage (from January 2017 to December 2019), patients received the original nursing strategy (original nursing strategy group), including: (1) nurses were randomly assigned; (2) routine terminal cleaning; (3) ICU environmental cleaning twice a day; (4) oral care was performed with chlorhexidine twice a day; (5) original lung physiotherapy [head of bed elevated at 30 degree angle-45 degree angle, maintaining a Richmond agitation-sedation scale (RASS) -2 to 1, sputum aspiration as needed]. After 1 month of learning and training of the modified nursing treatment strategy for nurses and related medical staff, the patients in the second stage (from February 2020 to July 2022) received the improved nursing strategy (improved nursing strategy group). The improved nursing strategy improved the hospital infection prevention and control strategy and lung physical therapy strategy on the basis of the original nursing strategy, including: (1) nurses were fixed assigned; (2) patients were placed in a private room; (3) enhanced terminal cleaning; (4) ICU environmental cleaning four times a day; (5) education and training in hand hygiene among health care workers was improved; (6) bathing with 2% chlorhexidinegluconate was performed once daily; (7) oral care with a combination of chlorhexidine and colistin was provided every 6 hours; (8) surveillance of colonization was conducted; (9) improved lung physiotherapy (on the basis of the original lung physiotherapy, delirium score was assessed to guide early mobilization of the patients; airway drainage was enhanced, the degree of airway humidification was adjusted according to the sputum properties, achieving sputum viscosity grade II; lung ultrasound was also used for lung assessment, and patients with atelectasis were placed in high lateral position and received the lung recruitment maneuver). Baseline patient information were collected, including gender, age, underlying diseases, source of admission, disease severity scores, vital signs, ventilatory parameters, blood gas analysis, life-sustaining treatments, clinical laboratory evaluation, indicators of infection and inflammation, pathogens and drug therapy. The primary outcome was 28-day mortality, and the secondary outcomes were duration of mechanical ventilation, length of ICU stay, and ICU mortality. Multivariate Logistic regression analysis was used to determine the risk factors for 28-day death in older immunosuppressed patients with pneumonia and sepsis. RESULTS: Finally, 550 patients were enrolled, including 199 patients in the original nursing strategy group and 351 patients in the improved nursing strategy group. No significant differences were found in gender, age, underlying diseases, source of admission, disease severity scores, vital signs, ventilatory parameters, blood gas analysis, life-sustaining treatments, clinical laboratory evaluation, indicators of infection and inflammation, coexisting pathogens or drug therapy between the two groups. Compared with patients in the original nursing strategy group, those in the improved nursing strategy group had significantly fewer duration of mechanical ventilation and length of ICU stay [duration of mechanical ventilation (days): 5 (4, 7) vs. 5 (4, 9), length of ICU stay (days): 11 (6, 17) vs. 12 (6, 23), both P < 0.01], and lower ICU mortality and 28-day mortality [ICU mortality: 23.9% (84/351) vs. 32.7% (65/199), 28-day mortality: 23.1% (81/351) vs. 33.7% (67/199), both P < 0.05]. Multivariate Logistic regression analysis showed that the improved nursing strategy acted as an independent protective factor in 28-day death of older immunosuppressed patients with pneumonia and sepsis [odds ratio (OR) = 0.543, 95% confidence interval (95%CI) was 0.334-0.885, P = 0.014]. CONCLUSIONS: Improved nursing strategy shortened the duration of mechanical ventilation and the length of ICU stay, and decreased ICU mortality and 28-day mortality in older immunosuppressed patients with pneumonia and sepsis, significantly improving the short-term prognosis of such patients.

Impact of abdominal massage on enteral nutrition complications in adult critically ill patients: A systematic review and meta-analysis.

BACKGROUND: Adult critically ill patients are prone to complications when receiving enteral nutrition, including feeding intolerance. Although abdominal massage is an effective intervention, its effects on enteral nutrition complications in adult critically ill patients are controversial. OBJECTIVE: To summarize and evaluate the effect of abdominal massage on enteral nutrition complications in adult critically ill patients. METHODS: We searched databases (e.g., PubMed, the Cochrane Library, Embase, and Web of Science) from inception until November 2020 for relevant studies published in English. The methodological quality of selected studies was assessed with the Cochrane Risk of Bias 2.0 tool. And we used of PRISMA 2020 guidelines. The meta-analysis results were reported as mean difference (MD) and events, and the heterogeneity of the studies was evaluated using I2. RESULTS: Seven studies including 472 participants (aged≥18 years) met the inclusion criteria. The mean gastric residual volume (GRV) (MD=-42.41, 95% confidence interval [CI]: -71.43, -13.39; P = 0.004) and incidence of abdominal distension (odds ratio [OR]=0.08, 95%CI: 0.03, 0.19; P < 0.00001) were significantly lower in the massage therapy group compared with controls. The incidence of vomiting (OR=0.09, 95%CI: 0.01, 0.72; P = 0.02) and ventilator-associated pneumonia (VAP) (OR=0.20, 95%CI: 0.05, 0.77; P = 0.02) were statistically significantly lower in the abdominal massage group compared with controls. CONCLUSION: Abdominal massage reduces GRV, vomiting, abdominal distension, and VAP in adult critically ill patients. Given the limited number of reviewed studies, small number of patients examined, and short intervention periods, further randomized controlled trials are needed that use accurate methodology, longer interventions, and larger sample sizes to confirm the effect of abdominal massage on feeding intolerance in adult critically ill patients.

Implementation of Nurse-Led, Goal-Directed Lung Physiotherapy for Older Patients With Sepsis and Pneumonia in the ICU.

Objectives: This study aimed to investigate the effect of nurse-led, goal-directed lung physiotherapy (GDLPT) on the prognosis of older patients with sepsis caused by pneumonia in the intensive care unit. Methods: We conducted a prospective, two-phase (before-and-after) study over 3 years called the GDLPT study. All patients received standard lung therapy for sepsis caused by pneumonia and patients in phase 2 also received GDLPT. In this study, 253 older patients (age ≥ 65 years) with sepsis and pneumonia were retrospectively analyzed. The main outcome was 28 day mortality. Results: Among 742 patients with sepsis, 253 older patients with pneumonia were divided into the control group and the treatment group. Patients in the treatment group had a significantly shorter duration of mechanical ventilation [5 (4, 6) vs. 5 (4, 8) days; P = 0.045], and a lower risk of intensive care unit (ICU) mortality [14.5% (24/166) vs. 28.7% (25/87); P = 0.008] and 28 day mortality [15.1% (25/166) vs. 31% (27/87); P = 0.005] compared with those in the control group. GDLPT was an independent risk factor for 28 day mortality [odds ratio (OR), 0.379; 95% confidence interval (CI), 0.187-0.766; P = 0.007]. Conclusions: Nurse-led GDLPT shortens the duration of mechanical ventilation, decreases ICU and 28-day mortality, and improves the prognosis of older patients with sepsis and pneumonia in the ICU.

Nucleolar protein 6 promotes cell proliferation and acts as a potential novel prognostic marker for hepatocellular carcinoma.

BACKGROUND: Nucleolar protein 6 (NOL6) is a nucleolar RNA-associated protein that is highly conserved between species. It has been proved to be associated with the prognosis of liver cancer. However, the underlying mechanism has not been fully established. This study aimed to assess the relationship between NOL6 and liver cancer prognosis. METHODS: We constructed an NOL6-short hairpin RNA (shRNA)-expressing lentivirus. Through viral transfection, cell growth assay and fluorescence-activated cell sorting, we evaluated the effect of shRNA-mediated NOL6 knockdown on the proliferation, colony formation, and apoptosis of hepatocellular carcinoma (HCC) cells. The relationship between NOL6 expression and HCC patient survival has been established through bioinformatics analysis. We also explored the downstream molecular regulatory network of NOL6 in HCC by performing an Ingenuity Pathway Analysis in the database. RESULTS: Increased NOL6 expression was detected in HCC cells compared to normal controls; HCC patients with high NOL6 expression had poorer prognoses than those with low expression. NOL6 knockdown inhibited HCC cell proliferation, apoptosis, and colony formation. Also, MAPK8, CEBPA, and FOSL1 were selected as potential downstream genes of NOL6. CONCLUSIONS: NOL6 up-regulates HCC cell proliferation and affects downstream expression of related genes. Moreover, NOL6 is considered to be associated with poor prognosis in HCC patients.

Microstructure and Dielectric Properties of LPCVD/CVI-SiBCN Ceramics Annealed at Different Temperatures.

SiBCN ceramics were introduced into porous Si3N4 ceramics via a low-pressure chemical vapor deposition and infiltration (LPCVD/CVI) technique, and then the composite ceramics were heat-treated from 1400 °C to 1700 °C in a N2 atmosphere. The effects of annealing temperatures on microstructure, phase evolution, dielectric properties of SiBCN ceramics were investigated. The results revealed that α-Si3N4 and free carbon were separated below 1700 °C, and then SiC grains formed in the SiBCN ceramic matrix after annealing at 1700 °C through a phase-reaction between free carbon and α-Si3N4. The average dielectric loss of composites increased from 0 to 0.03 due to the formation of dispersive SiC grains and the increase of grain boundaries.

Complete genome sequence of an avian-origin H3N2 canine influenza A virus isolated in farmed dogs in southern China.

We report here the complete genomic sequence of an avian-origin H3N2 canine influenza A virus containing multiple mutations in farmed dogs in southern China. Phylogenetic analyses of the sequences of all eight viral RNA segments demonstrated that these are wholly avian influenza viruses of the Asia lineage. To our knowledge, this is the first report of interspecies transmission of an avian H3N2 influenza virus to domestic farm dogs under natural conditions in Southern China. The amino acid information provided herein suggests that continued study is required to determine if this virus could be established in the farm dog population and pose potential threats to public health.

Waveform descriptor for pulse onset detection of intracranial pressure signal.

We present an algorithm to identify the onset of intracranial pressure (ICP) pulses. The algorithm creates a waveform descriptor to extract the feature of each local minimum of the waveform and then identifies the onset by comparing the feature with a customized template. The waveform descriptor is derived by transforming the vectors connecting a given point and the local waveform samples around it into log-polar coordinates and ranking them into uniform bins. Using an ICP dataset consisting of 40933 normal beats and 306 segments of artifacts and noise, we investigated the performance of our algorithm (waveform descriptor, WD), global minimum within a sliding window (GM) and two other algorithms originally proposed for arterial blood pressure (ABP) signal (slope sum function, SSF and pulse waveform delineator, PUD). As a result, all the four algorithms showed good performance and WD showed overall better one. At a tolerance level of 30 ms (i.e., the predicted onset and ground truth were considered as correctly matched if the distance between the two was equal or less than 30 ms), WD achieved a sensitivity of 0.9723 and PPV of 0.9475, GM achieved a sensitivity of 0.9226 and PPV of 0.8968, PUD achieved a sensitivity of 0.9599 and PPV of 0.9327 and SSF, a sensitivity of 0.9720 and PPV of 0.9136. The evaluation indicates that the algorithms are effective for identifying the onset of ICP pulses.

Interactive tooth segmentation of dental models.

The accurate segmentation of the teeth from the triangle mesh is an important step in computer-aided orthodontic. Because teeth come in different shapes and their arrangements vary substantially from one individual to another, tooth segmentation is difficult. This paper proposes a new method to accurately segment the teeth interactively. Based on curvature values of the triangle mesh, feature points are connected to feature regions. After feature lines are extracted from regions, feature contour can be obtained with the help of user supplied information. Using feature contour, the tooth are segmented accurately and individually.