Intraoperative central venous pressure during cardiopulmonary bypass is an alternative indicator for early prediction of acute kidney injury in adult cardiac surgery.

BACKGROUND: The relationship between venous congestion in cardiopulmonary bypass (CPB) and acute kidney injury (AKI) in cardiac surgery has not utterly substantiated. This study aimed at investigate the relationship between CVP in CPB and the occurrence of AKI. METHODS: We retrospectively reviewed 2048 consecutive patients with cardiovascular disease undergoing cardiac procedure with CPB from January 2018 to December 2022. We used the median CVP value obtained during CPB for our analysis and patients were grouped according to this parameter. The primary outcomes were AKI and renal replacement therapy(RRT). Multivariable logistic regression was used to explore the association between CVP and AKI. RESULTS: A total of 2048 patients were enrolled in our study and divided into high CVP group (CVP ≥ 6.5 mmHg) and low CVP group (CVP < 6.5 mmHg) according to the median CVP value. Patients in high CVP group had the high AKI and RRT rate when compared to the low CVPgroup[(367/912,40.24%)vs.(408/1136,35.92%),P = 0.045;(16/912,1.75%vs.9/1136;0.79%), P = 0.049]. Multivariate logistic regression analysis displayed CVP played an indispensable part in development of renal failure in surgical. CONCLUSIONS: Elevated CVP(≥ 6.5mmH2OmmHg) in CPB during cardiac operation is associated with an increased risk of AKI in cardiovascular surgery patients. Clinical attention should be paid to the potential role of CVP in predicting the occurrence of AKI.

Attitudes and behaviors on prevention and control of COVID-19 in a less developed village of Southwest China: a cross-sectional survey.

Background: At present new epidemic has entered a stage of normalized management, but there is still sporadic distribution, public already had certain protective knowledge of coronavirus disease 2019 (COVID-19). G County of Liangshan Yi Autonomous Prefecture is located in the mountainous area of southwest Sichuan Province, which also is ethnic minorities and as national-level poverty-stricken areas, residents in the region to the migrant workers as the main economic source of personnel with high mobility. In order to ensure the resumption of work and production, the effective implementation of epidemic prevention measures has certain guiding significance for epidemic prevention and control and economic recovery. This study investigated and analyzed the status quo of villagers' attitudes and behaviors toward COVID-19 prevention and control in Liangshan Yi Autonomous Prefecture, providing evidence for COVID-19 prevention and control measures in the resumption of rural work and agricultural production. Methods: Snowball sampling was used to survey 117 villagers from an impoverished village in Liangshan Yi Autonomous Prefecture on February 10-19, 2020. A total of 120 questionnaires were collected, the recovery rate is 97.5%. Based on literature review, a self-designed questionnaire on attitudes and behaviors related to COVID-19 prevention and control was designed, the expert validity score was 0.912, and Cronbach α coefficient was 0.903. Results: The overall score for respondents' attitude toward COVID-19 prevention and control was 29.65±3.23, which was considered a good level. The total score for prevention and control behavior was 114.74±17.09, which was medium level. A statistically significant difference was found for the attitudes and behaviors of different ethnic groups toward epidemic prevention and control. Conclusions: The people in this village had a positive attitude toward epidemic prevention and control, but there was still room for improvement in prevention and control behavior. Training on hand hygiene and wearing masks outside should be strengthened, and relevant training for ethnic minorities should be further strengthened.

Standard Process for Palliative Sedation in Peking Union Medical College Hospital / 中国医学科学院学报

End-stage patients experience unbearable pain because of refractory symptoms.Palliative sedation is a form of palliative care which relieves patients' agony by lowering their consciousness.Standard palliative sedation can help patients die with dignity.It is distinct from euthanasia and does not alter the survival of patients.Sufficient palliative care is the premise of palliative sedation.Repeated and detailed clinical evaluation,as well as multidisciplinary involvement,is necessary for the standardized implementation of palliative sedation.Here,we proposed the standard process and specifications of palliative sedation in Peking Union Medical College Hospital.Furthermore,we reported a case of palliative sedation for an advanced cancer patient with refractory delirium and living pain to demonstrate its application in clinical practice.

Clinical Practice of Multiple Disciplinary Team Care Model Following the Concept of Palliative Care for Advanced Head and Neck Cancer:Report of One Case / 中国医学科学院学报

We provided the palliative care of a multiple disciplinary team care mode to a patient diagnosed with advanced head and neck cancer and her caregivers.People-centered integrated health services were provided according to the specific needs and preferences of individuals.The team-based palliative care relieved the suffering and improved the quality of life of the patient and that of her family who were facing challenges associated with life-threatening illness.

Two cases of airway dysfunction related to diacetyl exposure / 中华劳动卫生职业病杂志

Occupational exposure to diacetyl can lead to bronchiolitis obliterans. In this paper, two patients with severe obstructive ventilation disorder who were exposed to diacetyl at a fragrance and flavours factory were analyzed. The clinical manifestations were cough and shortness of breath. One of them showed Mosaic shadows and uneven perfusion in both lungs on CT, while the other was normal. Field investigation found that 4 of the 8 workers in the factory were found to have obstructive ventilation disorder, and 2 had small airway dysfunction. This paper summarizes the diagnostic process of patients in order to improve the understanding of airway dysfunction caused by occupational exposure to diacetyl and promote the development of relevant standards.

Establishment method and significance of birthweight curve and reference in single center / 中华妇产科杂志

Objective: To establish neonatal birthweight percentile curves based on single-center cohort database using different methods, compare them with the current national birthweight curves and discuss the appropriateness and significance of single-center birthweight standard. Methods: Based on a prospective first-trimester screening cohort at Nanjing Drum Tower Hospital from January 2017 to February 2022, the generalized additive models for location, scale and shape (GAMLSS) and semi-customized method were applied to generate local birthweight percentile curves (hereinafter referred to as the local GAMLSS curves, semi-customized curves) for 3 894 cases who were at low risk of small for gestation age (SGA) and large for gestation age (LGA). Infants were categorized as SGA (birth weight<10th centile) by both semi-customized and local GAMLSS curves, semi-customized curves only, or not SGA (met neither criteria). The incidence of adverse perinatal outcome between different groups was compared. The same method was used to compare the semi-customized curves with the Chinese national birthweight curves (established by GAMLSS method as well, hereinafter referred to as the national GAMLSS curves). Results: (1) Among the 7 044 live births, 404 (5.74%, 404/7 044), 774 (10.99%, 774/7 044) and 868 (12.32%, 868/7 044) cases were diagnosed as SGA according to the national GAMLSS curves, the local GAMLSS curves and the semi-customized curves respectively. The birth weight of the 10th percentile of the semi-customized curves was higher than that of the local GAMLSS curves and the national GAMLSS curves at all gestational age. (2) When comparing semi-customized curves and the local GAMLSS curves, the incidence of admission to neonatal intensive care unit (NICU) for more than 24 hours of infants identified as SGA by semi-customized curves only (94 cases) and both semi-customized and local GAMLSS curves (774 cases) was 10.64% (10/94) and 5.68% (44/774) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks of infants identified as SGA by the semi-customized curves only and both semi-customized and local GAMLSS curves was 12.77% (12/94) and 9.43% (73/774), 9.57% (9/94) and 2.71% (21/774), 24.47% (23/94) and 7.24% (56/774) respectively, which were significantly higher than those of the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. (3) When comparing semi-customized curves and the national GAMLSS curves, the incidence of admission to NICU for more than 24 hours of infants identified as SGA by semi-customized curves only (464 cases) and both semi-customized and national GAMLSS curves (404 cases) was 5.60% (26/464) and 6.93% (28/404) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); all P<0.001]. The incidence of emergency cesarean section or forceps delivery for non-reassuring fetal status (NRFS) in infants identified as SGA by semi-customized curves only and both semi-customized and national GAMLSS curves was 4.96% (23/464) and 12.38% (50/404), both significantly higher than that in the non SGA group [2.57% (159/6 176); all P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks in the semi-customized curves only group and both semi-customized and national GAMLSS curves group was 8.84% (41/464) and 10.89% (44/404), 4.31% (20/464) and 2.48% (10/404), 10.56% (49/464) and 7.43% (30/404) respectively, all significantly higher than those in the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. Conclusion: Compared with the national GAMLSS birthweight curves and the local GAMLSS curves, the birth weight curves established by semi-customized method based on our single center database is in line with our center' SGA screening, which is helpful to identify and strengthen the management of high-risk infants.

Application and progress of dual-linked collaborative care model in patients undergoing liver cancer surgery / 中华消化外科杂志

Hepatocellular carcinoma is a malignant tumor with a high incidence and morta-lity, which adversely affects the life quality of patients. For hepatocellular carcinoma, surgical trea-tment is advocated to stop the proliferation and metastasis of tumor cells by removing the diseased tissue and prolong the survival time. At the same time, the combination of scientific nursing services during surgery can ensure the smooth completion of surgery, reduce the occurrence of complica-tions, and promote early recovery of patients. The authors review the application and progress of dual-linked collaborative care model in patients undergoing liver cancer surgery, with the aim of providing reference for clinical research on the nursing plan for patients undergoing liver cancer surgery.

Diagnosis status and genetic characteristics analysis of Fanconi anemia in China / 中华儿科杂志

Objective: To analyze the clinical and molecular diagnostic status of Fanconi anemia (FA) in China. Methods: The General situation, clinical manifestations and chromosome breakage test and genetic test results of 107 pediatric FA cases registered in the Chinese Blood and Marrow Transplantation Registry Group (CBMTRG) and the Chinese Children Blood and Marrow Transplantation Registry Group (CCBMTRG) from August 2009 to January 2022 were analyzed retrospectively. Children with FANCA gene variants were divided into mild and severe groups based on the type of variant, and Wilcoxon-test was used to compare the phenotypic differences between groups. Results: Of the 176 registered FA patients, 69 (39.2%) cases were excluded due to lack of definitive genetic diagnosis results, and the remaining 107 children from 15 hospitals were included in the study, including 70 males and 37 females. The age at transplantation treatment were 6 (4, 9) years. The enrolled children were involved in 10 pathogenic genes, including 89 cases of FANCA gene, 7 cases of FANCG gene, 3 cases of FANCB gene, 2 cases of FANCE gene and 1 case each of FANCC, FANCD1, FANCD2, FANCF, FANCJ, and FANCN gene. Compound heterozygous or homozygous of loss-of-function variants account for 69.2% (72/104). Loss-of-function variants account for 79.2% (141/178) in FANCA gene variants, and 20.8% (37/178) were large exon deletions. Fifty-five children (51.4%) had chromosome breakage test records, with a positive rate of 81.8% (45/55). There were 172 congenital malformations in 80 children.Café-au-Lait spots (16.3%, 28/172), thumb deformities (16.3%,28/172), polydactyly (13.9%, 24/172), and short stature (12.2%, 21/172) were the most common congenital malformations in Chinese children with FA. No significant difference was found in the number of congenital malformations between children with severe (50 cases) and mild FANCA variants (26 cases) (Z=-1.33, P=0.185). Conclusions: FANCA gene is the main pathogenic gene in children with FA, where the detection of its exon deletion should be strengthened clinically. There were no phenotypic differences among children with different types of FANCA variants. Chromosome break test is helpful to determine the pathogenicity of variants, but its accuracy needs to be improved.

Expression of serum miR-384 and LIN28B in diabetic retinopathy and their diagnostic value / 局解手术学杂志

Objective To investigate the expression levels of microRNA-384(miR-384)and LIN28B in serum of patients with diabetic retinopathy(DR)and their diagnostic value.Methods A total of 100 patients with type 2 diabetes diagnosed in our hospital from January 2020 to November 2021 were selected as the research subjects.According to the occurrence of retinopathy,the patients were divided into the non-DR group(40 cases)and the DR group(60 cases).In addition,40 healthy person who underwent physical examination in our hospital during the same period were regarded as the control group.The relative expression levels of serum miR-384 and LIN28B were detected by qRT-PCR,and the relationship between the two indexes and the general clinical data of DR patients was analyzed.Pearson method was applied to analyze the correlation between the expression of miR-384 and LIN28B in serum of DR patients.Logistic regression was applied to analyze the influencing factors of DR.The diagnostic value of serum miR-384 and LIN28B levels for DR patients was analyzed by receiver operating characteristic(ROC)curve.Results The level of serum miR-384 in the DR group was obviously lower than that in the non-DR group and the control group(P<0.05),and the non-DR group was lower than the control group(P<0.05).The level of serum LIN28B in the DR group was obviously higher than that in the non-DR group and the control group(P<0.05),and the non-DR group was higher than the control group(P<0.05).The expression levels of miR-384 and LIN28B were related to the course of diabetes and blood glucose(P<0.05).Pearson's correlation analysis showed that the expression of miR-384 was negatively correlated with LIN28B in serum of DR patients(r=-0.296,P<0.05).Logistic regression analysis showed that miR-384 and LIN28B were the independent influencing factors for DR(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of miR-384,LIN28B and the combination of two in DR patients was 0.625,0.646,and 0.682,respectively,and the specificity was 67.50%,85.00%,and 97.50%,respectively.Conclusion The serum expression of miR-384 is low and LIN28B is high in DR patients.Both miR-384 and LIN28B are the influencing factors for the occurrence of DR and are expected to be potential serological markers for the diagnosis of DR.

The relationship between resilience and psychological distress of left-behind female college students: the mediating role of cognitive reappraisal and the moderating role of stress perception / 中华行为医学与脑科学杂志

Objective:To explore the relationship between resilience and psychological distress among female college students with left-behind experience, and the role of cognitive reappraisal and stress perception in it.Methods:From May to June 2020, a total of 4 008 female college students with experience of being left-behind were sampled by the whole group sampling method. All participants were evaluated by the Connor-Davidson resilience scale, the cognitive reappraisal scale of the emotion regulation questionnaire, the stress perception scale-10 and Kessler psychological distress scale. The PROCESS macro program of SPSS 25.0 was used to test the mediating effect of cognitive reappraisal and the moderating effect of stress perception.Results:(1) The measure of psychological distress showed that the detection rate was 13.46% for male college students with left-behind experience, 12.93% for male college students without left-behind experience, and 11.40% for female college students with left-behind experience and 9.26% for female college students without left-behind experience.(2) The scores of cognitive reappraisal, stress perception and psychological distress for female college students with left-behind experience were significantly different in terms of grade level ( F= 3.52, 3.54, 3.49, all P<0.05). (3) Resilience(58.39±13.64) showed a significant positive correlation with cognitive reappraisal(31.28±5.09) ( r=0.51, P<0.001) and a significant negative correlation with stress perception(16.42±5.49)and psychological distress(21.62±7.76)( r=-0.41, -0.30, both P<0.001). Cognitive reappraisal showed a significant negative correlation with stress perception and psychological distress ( r=-0.33, -0.27, both P<0.001). Psychological distress showed a significant positive correlation with stress perception ( r=0.67, P<0.001). (4)Stress perception played a moderating role between cognitive reappraisal and psychological distress. The effect of cognitive reappraisal on psychological distress was not significant under low levels of stress perception( βsimple=-0.01, P=0.52). Under high levels of stress perception, cognitive reappraisal had a significant negative effect on psychological distress( βsimple=-0.08, P<0.001). Conclusion:Resilience of female college students with left-behind experiences can directly affect psychological distress or indirectly through cognitive reappraisal, and this mediating model is moderated by stress perception.