Predictive model for acute abdominal pain after transarterial chemoembolization for liver cancer.

BACKGROUND: Transarterial chemoembolization (TACE) is the first-line treatment for patients with unresectable liver cancer; however, TACE is associated with postembolization pain. AIM: To analyze the risk factors for acute abdominal pain after TACE and establish a predictive model for postembolization pain. METHODS: From January 2018 to September 2018, all patients with liver cancer who underwent TACE at our hospital were included. General characteristics; clinical, imaging, and procedural data; and postembolization pain were analyzed. Postembolization pain was defined as acute moderate-to-severe abdominal pain within 24 h after TACE. Logistic regression and a classification and regression tree were used to develop a predictive model. Receiver operating characteristic curve analysis was used to examine the efficacy of the predictive model. RESULTS: We analyzed 522 patients who underwent a total of 582 TACE procedures. Ninety-seven (16.70%) episodes of severe pain occurred. A predictive model built based on the dataset from classification and regression tree analysis identified known invasion of blood vessels as the strongest predictor of subsequent performance, followed by history of TACE, method of TACE, and history of abdominal pain after TACE. The area under the receiver operating characteristic curve was 0.736 [95% confidence interval (CI): 0.682-0.789], the sensitivity was 73.2%, the specificity was 65.6%, and the negative predictive value was 92.4%. Logistic regression produced similar results by identifying age [odds ratio (OR) = 0.971; 95%CI: 0.951-0.992; P = 0.007), history of TACE (OR = 0.378; 95%CI: 0.189-0.757; P = 0.007), history of abdominal pain after TACE (OR = 6.288; 95%CI: 2.963-13.342; P < 0.001), tumor size (OR = 1.978; 95%CI: 1.175-3.330; P = 0.01), multiple tumors (OR = 2.164; 95%CI: 1.243-3.769; P = 0.006), invasion of blood vessels (OR = 1.756; 95%CI: 1.045-2.950; P = 0.034), and TACE with drug-eluting beads (DEB-TACE) (OR = 2.05; 95%CI: 1.260-3.334; P = 0.004) as independent predictive factors for postembolization pain. CONCLUSION: Blood vessel invasion, TACE history, TACE with drug-eluting beads, and history of abdominal pain after TACE are predictors of acute moderate-to-severe pain. The predictive model may help medical staff to manage pain.

Using the Delphi method to establish nursing-sensitive quality indicators for ICU nursing in China.

In this study, the Delphi method was used to develop evidence-based indicators of intensive care unit (ICU) nursing quality of care in China. Nursing quality indicators reflect elements of patient care that are directly affected by nursing practice. A comprehensive literature search identified 2,857 potentially relevant articles. From the 50 articles that were included in this study, researchers identified 38 commonly used nursing quality indicators. A panel of experts reduced these to 20, which were then subjected to two rounds of Delphi discussion by a different panel, and a final consensus was achieved. The 20 indicators were grouped into three dimensions: structure, process, and outcome (including adverse consequences). The agreement among the experts for the 20 indicators was high. These evidence-based nursing quality indicators provide for ease in data collection and a basis for clinical application and improvement in the quality of ICU nursing throughout China.

Development of evidence-based nursing-sensitive quality indicators for emergency nursing: A Delphi study.

AIMS AND OBJECTIVES: To establish evidence-based nursing-sensitive quality indicators for emergency nursing in China. BACKGROUND: China lacks nursing-sensitive quality indicators necessary for assessing the quality of emergency nursing and essential to nursing management. DESIGN: Prospective. METHODS: A literature search for relevant evidence-based studies was performed using several databases from January 2009-May 2014. Previously reported quality indicators were identified as appropriate for assessment by a panel of 40 experts in emergency medicine and nursing. Two successive rounds of Delphi surveys were conducted using questionnaires designed by the experts. Kendal's W coordination coefficients were calculated for indicator importance, rationality of calculation and feasibility of data collection. RESULTS: Thirty-three quality indicators were initially proposed for expert evaluation. After round 1 of expert discussion, Kendal's W coordination coefficients were .152 for importance, .092 for rationality and .141 for feasibility of data collection (all p < .001). Seven unsuitable items were discarded in round 1 and 11 discarded in round 2, which also added one new item. Finally, the experts reached consensus on 16 items established as appropriate nursing-sensitive quality indicators for emergency nursing care. CONCLUSION: Evidence-based nursing-sensitive quality indicators were established through a consensus of experts in emergency nursing and medicine. RELEVANCE TO CLINICAL PRACTICE: The current findings may provide a theoretical basis for establishing an emergency nursing quality database and improving the quality of emergency nursing care in China.

A Singular Value Decomposition Method for Tunable Diode Laser Absorption Spectroscopy System to Remove Systematic Noises.

Detection of gas concentration with tunable diode laser absorption spectroscopy (TDLAS) techniques is affected by baseline drift and high-frequency noise. Therefore, how to remove the systematic noises has been a hot spot. This paper analyzes the significance of singular value decomposition (SVD) in TDLAS detection system with two different methods of constructing a matrix, and it discusses the differences of processing results for different noises. The second harmonic signal is arranged in a matrix and decomposed. We select the appropriate threshold and putthose singular values smaller than the threshold into zero, then reconstruct the matrix. Experiments show that SVD method does not require additional system components or pass into the zero gas to subtract background. This method is able to remove noises of TDLAS system quickly and effectively. We found that the method of constructing a hankel matrix is suitable for removing high-frequency noise. However, the method of constructing a continuous-cutoff-signal matrix is suitable for removing baseline drift. For example, we set up a TDLAS system to measure the concentration of NH3 while the noise removal rate of the second harmonic curve is up to 80% with this method.

Evaluation of efficacy of resin hemoperfusion in patients with acute 2,4-dinitrophenol poisoning by dynamic monitoring of plasma toxin concentration.

OBJECTIVE: The intoxications caused by 2,4-dinitrophenol (2,4-DNP), even death, have been frequently reported in recent years. This study aims to investigate the dynamic changes of plasma toxin concentration and explore the clinical value of resin hemoperfusion (HP) in the treatment of patients with acute 2,4-DNP poisoning. METHODS: We reported 16 cases of acute 2,4-DNP poisoning through occupational exposure due to ignoring the risk of poisoning. The blood samples were collected from the 14 survivors. According to the different treatments of resin HP, the survivors were divided into routine HP (n=5) and intensive HP (n=9) groups. Ultra high performance liquid chromatography/ tandem mass spectroscopy (UPLC-MS/MS) was used to detect the 2,4-DNP concentration in plasma in this study. RESULTS: The 14 survivors recovered very well after treatment. The initial plasma 2,4-DNP concentrations (C1) of survivors ranged from 0.25 to 41.88 µg/ml (mean (12.56±13.93) µg/ml). A positive correlation existed between initial plasma 2,4-DNP concentration (C1) and temperature. The elimination of 2,4-DNP was slow and persistent, and the total clearance rates of plasma toxin from the 1st to 3rd day (R3), the 3rd to 7th day (R3-7), and the 1st to 7th day (R7), were only (53.03±14.04)%, (55.25±10.50)%, and (78.29±10.22)%, respectively. The plasma toxin was cleared up to 25 d after poisoning in most of the patients. The R3, R3-7, and R7 in the intensive HP group were all apparently higher than those in the routine HP group, with statistical significance (P<0.05). Simultaneously, the elimination half-life (t1/2) of 2,4-DNP in the intensive HP group was apparently shorter than that in the routine HP group, with statistical significance (P<0.05). CONCLUSIONS: The clinicians should be aware of this slow and persistent process in the elimination of plasma 2,4-DNP. Higher initial plasma toxin concentration resulted in a more severe fever for the patient. According to the limited data, longer and more frequent resin HP may accelerate to eliminate the poison.

Full Airway Drainage by Fiber Bronchoscopy Through Artificial Airway in the Treatment of Occult Traumatic Atelectasis.

The objective of this study is to investigate the effects of full airway drainage by fiber bronchoscopy through artificial airway in the treatment of traumatic atelectasis with occult manifestations. From May 2006 to May 2011, 40 cases of occult traumatic atelectasis were enrolled into our prospective study. Group A (n = 18) received drainage by nasal bronchoscope; group B underwent airway drainage by fiber bronchoscopy through artificial airway (n = 22). The effects of treatment were evaluated by the incidence of adult respiratory distress syndrome (ARDS), lung abscess, and the average length of hospital stay. Compared with nasal fiber-optic treatment, airway drainage by fiber bronchoscopy through artificial airway reduced the incidence of ARDS (p = 0.013) and lung abscess (p = 0.062) and shortened the mean length of stay (p = 0.018). Making the decision to create an artificial airway timely and carry out lung lavage by fiber bronchoscopy through artificial airway played a significant role in the treatment of occult traumatic atelectasis.

[A New Method for Eliminating Background Signal Drift to Improve the Detection Precision in Continuous Harmonic Detection].

To overcome the second harmonic background signal drift in gas continuous detection based on tunable diode laser absorption spectroscopy(TDLAS), a new method of background elimination was proposed by changing center current of the laser. This method can eliminated the effects of background signal drifting on concentration inversion. Based on the wavelength modulation theory, the theoretical expression of the second harmonic of the background signal is derived. In addition, the second harmonic background signal components and the factors that affect it are described. In different working temperatures, the relationship curve between thelaser current and output light intensity. In the process of continuous detection, we analyzes the feasibility ofchangingthe laser center current extraction of background signal. Combined with the principle of the background signal searching, the LabView flow chart was designed to search background center current. Ammonia (NH3) was detected by the TDLAS experimental system, which demonstrated the feasibility of the new method. The range of experiment parameters and the range of background center current searches were determined, in the situation that there was only one absorption line in the full laser workspace. The experimental results showed that this method realizes background signal extraction, reduces the error of concentration inversion and the effects of concentration inversion bybackground signal. Thus it improved the detection accuracy of the concentration. In the continuous detection experiment, the standarddeviation of inversion concentration reduced from 2.688 3 to 1.856 1, which demonstrated. that the degree of dispersion of detected concentration is reduced, even eliminate the effects of background signal drifting on concentration inversion and the accuracy of detection is improved. This method provides an effective background drifting elimination approach for improving the detection accuracy of the concentration.

Detection of mutations by fill-in ligation reaction with enzyme-linked immunosorbent assay for rapid medical diagnosis.

Several approaches for parallel genotyping have been developed with increasingly available information on DNA variation. However, these methods require either complex laboratory procedures or expensive instrumentation. None of these procedures is readily performed in local clinical laboratories. In this study, we developed a flexible genotyping method involving fill-in ligation reaction with enzyme-linked immunosorbent assay successfully applied to detect important single-nucleotide polymorphisms (SNPs) for EGFR c.2573T > G (L858R), EGFR c.2582T > A (L861Q), and EGFR c.2155G > T (G719C). This assay exhibited excellent specificity, with a sensitivity as low as 0.5%. Eight out of 62 clinical samples were identified as heterozygotes for the SNP site of L858R, whereas only two samples were identified as heterozygotes by direct sequencing. The developed method enabled accurate identification of SNP in a simple and cost-effective manner adapted to routine analysis.

[Research on optimization of mathematical model of flow injection-hydride generation-atomic fluorescence spectrometry].

Flow injection-hydride generation-atomic fluorescence spectrometry was a widely used method in the industries of health, environmental, geological and metallurgical fields for the merit of high sensitivity, wide measurement range and fast analytical speed. However, optimization of this method was too difficult as there exist so many parameters affecting the sensitivity and broadening. Generally, the optimal conditions were sought through several experiments. The present paper proposed a mathematical model between the parameters and sensitivity/broadening coefficients using the law of conservation of mass according to the characteristics of hydride chemical reaction and the composition of the system, which was proved to be accurate as comparing the theoretical simulation and experimental results through the test of arsanilic acid standard solution. Finally, this paper has put a relation map between the parameters and sensitivity/broadening coefficients, and summarized that GLS volume, carrier solution flow rate and sample loop volume were the most factors affecting sensitivity and broadening coefficients. Optimizing these three factors with this relation map, the relative sensitivity was advanced by 2.9 times and relative broadening was reduced by 0.76 times. This model can provide a theoretical guidance for the optimization of the experimental conditions.

[The noise filtering and baseline correction for harmonic spectrum based on wavelet transform].

The problem of noise and baseline drift is a hot topic in infrared spectral harmonic detection system. This paper presents a new algorithm based on wavelet transform Mallet decomposition to solve the problem of eliminating a variety of complex noise and baseline drift in the harmonic detection. In the algorithm, the appropriate wavelet function and decomposition level were selected to decomposed the noise, baseline drift and useful signal in the harmonic curve into different frequency bands. the bands' information was analysed and a detecting band was set, then the information in useful frequency was reserved by zeroing method of treatment and the coefficient of the threshold. We can just use once transform and reconstruction to remove interference noise and baseline from double-harmonic signal by applying the wavelet transform technique to the harmonic detection spectrum pretreatment. Experiments show that the wavelet transform method can be used to different harmonic detection systems and has universal applicability.

[Method of isolation of intrafusal fibres of muscle spindle in soleus of rats].

Capsule restricts the further study on muscle spindle function and the involved mechanism. The aim of this study was to establish the isolation method of intrafusal fibres from the isolated rat muscle spindle. Intrafusal fibres were harvested from muscle spindle of soleus muscle in rats using neutrase-collagenase digestion. A variety of incubation mediums have been tested to find out an appropriate medium of intrafusal fibers in vitro. Trypan blue staining was used to detect cell death, and patch clamp was used to record resting potential. The results showed that the intrafusal fibres incubated with amine acid-saline solution were almost all dead. DMEM could maintain good condition of the fibres, but excess CO2 ventilation would induce cellular swelling or even death. While Leiboviz's 15 (L-15) medium can guarantee 1-2 h of physiological condition of the intrafusal fibres. Coverslips treated with gelatin, polylysine and serum was the better interfaces for the intrafusal fibres to adhere easily, compared with regularly treated coverslip. The resting potential of intrafusal fibres was (-45.3 ± 5.1) mV, consistent with others obtained from in vivo muscle spindle from cats and frogs. These results suggest that the isolation method of the intrafusal fibres has been successfully established in the present study, providing a new approach in better understanding of muscle spindle activities and the involved mechanism.

[Relationship between simulated weightlessness-induced muscle spindle change and muscle atrophy].

One of the most important and urgent issues in the field of space medicine is to reveal the potential mechanism underlying the disused muscle atrophy during the weightlessness or microgravity environment. It will conduce to find out effective methods for the prevention and treatment of muscle atrophy during a long-term space flight. Increasing data show that muscle spindle discharges are significantly altered following the hindlimb unloading, suggesting a vital role in the progress of muscle atrophy. In the last decades, we have made a series of studies on changes in the morphological structure and function of muscle spindle following simulated weightlessness. This review will discuss our main results and related researches for understanding of muscle spindle activities during microgravity environment, which may provide a theoretic basis for effective prevention and treatment of muscle atrophy induced by weightlessness.

[Effects of tetramethylpyrazine on nitric oxide synthase activity and calcium ion concentration of skeletal muscle in hindlimb unloading rats].

OBJECTIVE: To explore the effects of tetramethylpyrazine on the nitric oxide synthase activity and calcium ion concentration in skeletal muscle fiber and decipher the possible mechanisms of anti-muscle atrophy function of tetramethylpyrazine in hindlimb unloading rats. METHODS: Hindlimb unloading (HLU) rats were used as a muscle atrophy model to study the activity of nitric oxide synthase by colorimetry. The concentration of intracellular calcium ion was measured by laser scanning confocal microscope. A total of 18 female rats were randomly divided into 3 groups: control (CON), hindlimb unloading with water (HLU + W) and hindlimb unloading with tetramethylpyrazine (HLU + Tmp) (n = 6 each). RESULTS: (1) Compared with CON, the activity of nitric oxide synthase decreased by 28% in HLU + W (P < 0.05) and decreased by 46% in HLU + Tmp (P < 0.01). The activity of nitric oxide synthase less decreased in HLU + Tmp than that in HLU + W, but it was not statistically significant (P > 0.05). (2) Compared with CON, the concentrations of intracellular calcium ion in HLU + W and HLU + Tmp increased by 330% and 86% respectively (P < 0.01). Compared with HLU + W, the concentration of intracellular calcium ion decreased by 130% in HLU + Tmp (P < 0.01). CONCLUSION: The activity of nitric oxide synthase decreases and the concentration of calcium ion increases in hindlimb unloading rats. And tetramethylpyrazine may suppress the calcium ion overloading but not the activity of NOS associated with disuse muscular atrophy.

Prolonged hindlimb unloading leads to changes in electrophysiological properties of L5 dorsal root ganglion neurons in rats after 14 days.

INTRODUCTION: The purpose of this study was to evaluate the electrophysiological changes observed in dorsal root ganglion (DRG) neurons in a simulated weightlessness rat model and to assess the mechanisms involved in these changes. METHODS: The simulated weightlessness model was created by hindlimb unloading (HU). Whole-cell patch-clamp recordings, conduction velocity measurement, and ultrastructural observation were performed. RESULTS: In the HU rats, the action potentials had a longer duration and slower falling rate, but there was no significant effect on amplitude or rate of rise. HU also induced lowering of rheobase and of the threshold potential, making the cells more excitable. The conduction velocities in the proximal branches of ganglion cells were also decreased, and some degenerative changes in the myelin sheath were noted. CONCLUSIONS: This study provides evidence of plasticity of DRG neurons induced by HU. The changes observed might contribute to impaired motor performance in rats submitted to HU.

[Effects of 100 Hz sinusoidal vibration on H reflex and M wave in rat soleus muscle following immobilization].

OBJECTIVE: To investigate the effects of 100 Hz sinusoidal vibration on H reflex and M wave in rat soleus muscle following immobilization. METHODS: The immobilization of rat soleus muscle was induced as a disuse muscle model, and 100 Hz sinusoidal vibration was generated by a vibrator and applied to the immobilized soleus muscle, then the changes of H reflex and M wave in muscle were observed after 14 d. RESULTS: Compared to control, after 14 d of immobilization M(max) in soleus muscle decreased (P<0.01), stimulus threshold and S(max) increased (P<0.01); Hmax and H(max)/M(max) decreased (P<0.05, S(max) increased (P<0.05). Compared to immobilized soleus muscle, after 14 d of immobilization with 100 Hz sinusoidal vibration, the M(max) increased(P<0.01), stimulus threshold and S(Mmax) decreased (P<0.05), H(max) (P<0.01) increased and H(max)/M(max) increased (P<0.05). CONCLUSION: 100 Hz sinusoidal vibration plays a significant antagonist role against the changes in H reflex and M wave in rat soleus muscle following immobilization.

[Electrophysiological characteristics of the isolated muscle spindle in rats].

The aim of this study was to observe the electrophysiological characteristics of the isolated rat muscle spindle. The muscle spindle was isolated from rat soleus and the afferent discharge of the isolated muscle spindle was recorded by air-gap technique. In the basic physiological salt solution, the spontaneous impulses of muscle spindle were at a lower level with irregular intervals. The mean frequency of afferents was (51.78 ± 25.63) impulses/1 000 s (n = 13). The muscle spindle afferents were significantly increased and maintained over time by the addition of certain amino acids during the observation. The number of the action potential recorded per 1 000 s was 200-1 000 [mean: (687.62 ± 312.56) impulses/1 000 s, n = 17]. In addition to the typical propagated action potential, a large number of abortive spikes were observed. The results indicate that the activities of isolated muscle spindles in rats can be well maintained by the addition of certain amino acids. The results initially establish and provide the possibility for further research conducted in isolated rat muscle spindles.

Influence of 14-day hind limb unloading on isolated muscle spindle activity in rats.

During hind limb unloading (HU), the soleus is often in a shortened position and the natural physiological stimulus of muscle spindles is altered, such that muscle spindle activity also changes. Using isolated spindle conditions, the present study investigates the electrophysiological activity and ultrastructure of muscle spindles following HU. Results show that muscle spindle discharges fall into either of two main patterns, single spikes or spike clusters in shortened positions, with a steady frequency of 18-38 spikes/s (mean 29.08 +/- 2.45) in an extended position. Following 14-day HU, afferent discharge activity was significantly altered in soleus muscle spindles. Duration of individual spikes was significantly prolonged, from 0.54 +/- 0.05 ms for control rats to 1.53 +/- 0.25 ms for rats in the HU group. In a shortened position, regular rhythm afferent discharges were obviously depressed, and the majority of muscle spindles became silent, while in an extended position, the discharges remained continuous but with decreased frequency. Results also show that the ultrastructure of muscle spindles experience degenerative changes during HU. Altered muscle spindle afference could possibly modify the activity of motor neurons and further affect the activity of extrafusal fibers.

Pre-existing cirrhosis is associated with increased mortality of traumatic patients: analysis of cases from a trauma center in east China.

AIM: To determine the impact of cirrhosis on trauma patients and define the factors predicting death. METHODS: The data on patients admitted to the trauma center from January 2000-2005 were studied retrospectively. The clinical variables were recorded and compared to identify the factors differentiating cirrhotic trauma survivors from non survivors. Child's classification criteria were derived from the reviewed charts of cirrhotic trauma patients to evaluate their predictive value in cirrhotic trauma. Trauma registry was also used to generate a trauma control group by matching for age, sex, abbreviated injury score (AIS) over the same period of time. The outcome variables compared were mortality rate, time of ICU and hospital stay. Results were expressed as mean +/- SD. These data were analyzed by SPSS.11.0 statistical software. Univariate analysis was performed to identify significant medical factors for survivor and non survivors subjected to chi-square test. Fisher's exact test and Student's t test were performed to determine the statistical difference between cirrhotic and control groups. P < 0.05 was considered statistically significant. RESULTS: Poor prognosis of traum patients was associated with one or more of the following findings: ascitcs, yperbilirubinemia (more than 2 mg/dL), hypoalbuminemia (less than 3.5 mg/dL), and prolonged prothrombin time (more than 12.5 s). Although Child's classification was used to predict the outcome in cirrhotic patients undergoing portacaval shunt procedures, no significant difference was found in mortality rate as a function of Child's classification. CONCLUSION: Cirrhosis is associated with a higher mortality, a longer time of ICU and hospital stay of trauma patients. It seems that treatment of trauma patients with pre-existing severe liver disease is a challenge to surgeons.

Protective effect of albumin on lungs injury in traumatic/hemorrhagic shock rats.

OBJECTIVE: To determine the effect of albumin administration on lung injury in traumatic/hemorrhagic shock (T/HS) rats. METHODS: Forty-eight adult Sprague-Dawley rats were divided into three groups randomly (n=16 in each group): Group A, Group B, Group C. In Group A, rats underwent laparotomy without shock. In Group B, rats undergoing T/HS were resuscitated with their blood plus lactated Ringer's (twice the volume of shed blood). In Group C, rats undergoing T/HS were resuscitated with their shed blood plus additional 3 ml of 5% human albumin. The expression of polymorphonuclear neutrophils CD18/CD11b in jugular vein blood was evaluated. The main lung injury indexes (the activity of myeloperoxidase and lung injury score) were measured. RESULTS: Significant differences of the expression of CD18/11b and the severity degree of lung injury were founded between the three groups. (P<0.05). The expression of CD18/CD11b and the main lung injury indexes in Group B and Group C increased significantly compared with those in Group A (P<0.05). At the same time, the expression of CD18/CD11b and the main lung injury indexes in Group C decreased dramatically, compared those in Group B (P<0.05). CONCLUSIONS: The infusion of albumin during resuscitation period can protect lungs from injury and decrease the expression of CD18/CD11b in T/HS rats.