Factors Influencing Nurses' Work Interruption in Wuhan Isolation Wards During the COVID-19 Pandemic.

BACKGROUND Through January 2021, the novel coronavirus (COVID-19) continued to create significant pressure on medical staff who have worked to treat patients with the disease and control its spread. This study aimed to increase understanding of the situation and influencing factors of nurses' work interruption in Wuhan's isolation ward during the COVID-19 pandemic. MATERIAL AND METHODS A self-designed general situation questionnaire and work interruption questionnaire were used to survey 160 nurses from Beijing, Chongqing, and Jilin who worked during the COVID-19 pandemic in Wuhan in March 2020. The questionnaire could only be answered once by each nurse via a WeChat account. The submitted answers were verified by 2 researchers. RESULTS The results showed that the rate of interruption of work among nurses in the isolation ward was 25%, and the rate of nurses experiencing a negative experience was 96.9%. The results of univariate analysis showed that the following factors were related to the work interruption of the nurses in the isolation ward (all P<0.05): emergency public incident training; emergency public incident treatment experience; knowledge of COVID-19 pneumonia; hours worked per shift in the quarantine area; and negative physiologic experience. Logistic regression analysis showed that negative experience, hours worked per shift, and emergency public incident training were the independent factors influencing work interruption among nurses in the isolation wards. CONCLUSIONS The incidence of interruption of work among nurses in the isolation ward was 25%. Negative experiences, long working hours per shift, and lack of emergency public incident training made the nurses more prone to work interruption.

Carotid Artery Stenting for the Treatment of Fatal Acute Cerebral Infarction Associated with Aortic Dissection.

Acute aortic dissection (AAD) complicated with acute cerebral infarction lacks a unified treatment plan. We report probably the most effective treatment of a type A AAD with acute cerebral infarction leading to coma. A 43-year-old man presented with acute hemiplegia and unconsciousness. He was diagnosed as acute cerebral infarction. After an ineffective emergency intravenous thrombolysis, a Digital Subtraction Angiography (DSA) examination revealed the severe cerebral artery occlusion, and the TICI 3 level was achieved by stent implantation in the left common carotid artery with significant neurological recovery. A type A AAD was found at the 1 month follow-up ultrasound examination and a further thoracic surgery was performed successfully. Carotid ultrasound is helpful for the diagnosis of AAD from acute cerebral infarction. Carotid artery stenting followed by thoracic surgery is effective in this kind of emergency situations. Further studies are needed to determine the exact indications.

Association Between Preoperative US, Elastography Features and Prognostic Factors of Papillary Thyroid Cancer With BRAFV600E Mutation.

Purpose: To investigate the value of US and elastography for predicting prognostic factors of papillary thyroid cancer (PTC) in the positive BRAFV600E Mutation group. Materials and Methods: A total of 116 BRAFV600E Mutation patients with PTCs were enrolled in this prospective study, who were preoperatively evaluated by US, US elasticity imaging (EI), and Virtual Touch tissue imaging (VTI) and Virtual Touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging. Multivariate logistic regression analysis was performed to assess 23 independent variables for predicting prognostic factors. Diagnostic performance was evaluated with receiver operating characteristic (ROC) curve analysis. Results: Forty-two (36.2%) of 116 PTC patients with BRAFV600E Mutation had central lymph node metastasis (LNM). Nine (7.8%) and fifty-six (48.3%) had lateral LNM and extra-thyroidal extension (ETE), respectively. In multivariate logistic regression analyses, rich internal flow [odds ratio [OR]: 6.66] was the best predictor for central LNM, followed by male sex (OR: 4.22), halo sign absence (OR: 2.78) (all P < 0.05). VTQ ratio (OR: 1.57) was the only predictor for lateral LNM (P = 0.02). Rich internal flow (OR: 6.33) was the strongest predictor for ETE, followed by male sex (OR: 3.29), halo sign absence (OR: 2.90), and VTQ ratio (OR: 1.63) (all P < 0.05). Conclusion: VTQ ratio on ARFI imaging, rich internal flow and halo sign absence on US are the predicting prognostic factors in PTC patients with BRAFV600E Mutation. The specificities were significantly increased by combining ARFI imaging and US features, which has a potential to avoid unnecessary therapeutic neck dissection in the high-risk PTC patients.

Endoscopic biopsy of a B-cell lymphoma involving the entire ventricular system: A case report.

A 62-year-old male suffering from vomiting and mild preceding nausea for 15 days was examined in the present case report. Magnetic resonance imaging revealed a homogeneously enhancing cluster-like lesion involving the lateral, third and fourth ventricles. An endoscopic biopsy was performed, and histopathological examination led to the diagnosis of a high-grade diffuse large B-cell lymphoma. To the best of our knowledge, the present study reports the first case of a primary lymphoma involving the entire ventricular system. Therefore, primary lymphomas should be considered in the list of ventricular tumors. An endoscopic biopsy requires minimal invasion to obtain an adequate tissue sample, and frequently leads to the correct diagnosis and subsequent treatment protocols.

Local Injection of Lenti-BDNF at the Lesion Site Promotes M2 Macrophage Polarization and Inhibits Inflammatory Response After Spinal Cord Injury in Mice.

There is much evidence to suggest that brain-derived neurotrophic factor (BDNF) is a prominent candidate in promoting neuroprotection, axonal regeneration, and synaptic plasticity following spinal cord injury (SCI). Although some evidence indicates that BDNF has potent anti-oxidative effects and may be involved in the regulation of the immune response, the effects of BDNF in the inflammatory response during the course of secondary damage after SCI is still unclear. The present study was designed to investigate the effects of BDNF with a special focus on their effect on macrophage polarization after SCI. Adult C57 mice underwent T10 spinal cord clip compression injury and received lenti-BDNF vector injections at the epicenter of the lesion site. Four days later, total BDNF levels were greatly increased in animals that received lenti-BDNF injections. Confocal imaging showed that more than 80 % of the lenti-virus infected cells were CD11b-positive macrophages. In addition, the expression of arginase-1 and CD206 (associated with M2 macrophage phenotype) significantly increased in the animals that received lenti-BDNF injections compared with those that received lenti-EGFP injections. On the contrary, the expression of CD16/32 and inducible nitric oxide synthase (M1 phenotype marker) was down-regulated as demonstrated using flow cytometry and immunohistochemistry. Furthermore, the production of interleukin 1ß and tumor necrosis factor alpha was significantly reduced whereas the levels of interleukin 10 and interleukin 13 were elevated in subjects that received lenti-BDNF vector injections. The time course of functional recovery revealed that gradual recovery was observed in the subacute phase in lenti-BDNF group, little improvement was observed in lenti-EGFP group. At the axonal level, significant retraction of the CST axons were observed in lenti-EGFP injected animals relative to lenti-BDNF group by biotinylated dextran amine tracing. In addition, compared to lenti-BDNF group markedly demyelination was observed in the lenti-EGFP group using luxol fast blue staining. In conclusion, we found that BDNF could promote the shift of M1 to M2 phenotype and ameliorate the inflammatory microenvironment. Furthermore, the roles of BDNF in immunity modulation may enhance neuroprotective effects and partially contribute to the locomotor functional recovery after SCI.

Hyperactive external awareness against hypoactive internal awareness in disorders of consciousness using resting-state functional MRI: highlighting the involvement of visuo-motor modulation.

Resting-state functional MRI (fMRI) has emerged as a valuable tool to characterize the complex states encompassing disorders of consciousness (DOC). Awareness appears to comprise two coexistent, anticorrelated components named the external and internal awareness networks. The present study hypothesizes that DOC interrupts the balance between the internal and external awareness networks. To gain more understanding of this phenomenon, the present study analyzed resting-state fMRI data from 12 patients with DOC versus 12 healthy age-matched controls. The data were explored using independent component analysis and amplitude of low-frequency fluctuation (ALFF) analysis. The results indicated that DOC deactivated midline areas associated with internal awareness. In addition, external awareness was strengthened in DOC because of increased activation in the insula, lingual gyrus, paracentral and supplementary motor area. The activity patterns suggested strengthened external awareness against weakened internal awareness in DOC. In particular, increased activity found in the insula, lingual gyrus, paracentral and supplementary motor area of patients with DOC implied possible involvement of augmented visuo-motor modulation in these patients. DOC is probably related to hyperactive external awareness opposing hypoactive internal awareness. This unique pattern of brain activity may potentially be a prognostic marker for DOC.

Contrast-enhanced ultrasonography is a valid technique for the assessment of renal microvascular perfusion dysfunction in diabetic Goto-Kakizaki rats.

AIM: To evaluate the reliability of contrast-enhanced ultrasonography (CEUS) for the detection of renal microvascular blood perfusion in a type 2 diabetic Goto-Kakizaki (GK) rat model. METHODS: Male GK and Wistar rats at the age of 4, 12 and 20 weeks (n=10, respectively) were used for the study. Real-time and haemodynamic imaging of the renal cortex was performed using CEUS with SonoVue. Outage time-intensity curves (TICs) were applied for the analysis of basic intensity, slope rates of the ascending (S1) and descending curves (S2), time to peak (TTP), half time of peak descending (HDT), peak intensity (PI), and total area under the curve (AUC). Immunohistochemical staining for endothelial cells (ECs) was performed using the CD34 monoclonal antibody for the quantification of microvessel density and distribution. RESULTS: Images of the renal cortex microvascular beds after injection of SonoVue in the rats were rapidly and clearly displayed, and it is easy to differentiate the enhanced and faded images of renal perfusion. The TICs of the GK rats were much wider than the controls; however, no significant changes in PI were found in all aged rats. Ultrasonographic quantitative analysis revealed a decrease in S1 and S2, and an increase in TTP, HDT and AUC in the 12- and 20-week-old GK rats compared with the controls (P<0.05). Moreover, the 20-week-old GK rats had much lower glomerular density and smaller distribution area of CD34-positive ECs, which was in parallel with more severe proteinuria, GBM thickening, glomerulosclerosis and interstitial vascular damages (P<0.05). Interestingly, negative correlations between AUC and glomerular microvessel density or distribution were detected, respectively (P<0.05). CONCLUSIONS: Contrast-enhanced ultrasonography is a valid technique for the real-time and dynamic assessment of renal cortex microvascular perfusion and haemodynamic characterization in GK rats.

Usefulness of enhanced power Doppler imaging in monitoring acral microcirculation in type 2 diabetes mellitus and its complications.

This study compared hemodynamic changes of acral arterioles (pulps and nail beds of fingers and toes) and the microcirculatory status of acra between patients with uncomplicated (n = 45) or complicated (n = 36) type 2 diabetic mellitus (type 2 DM) and healthy subjects (n = 40). Enhanced power Doppler imaging (e-Flow) was used to display the nail bed arterioles and distal branches of pulp arterioles (digitales palmares propriea and digitales plantares propriea) in the end knuckle of the right middle finger and right big toe. Arteriolar density (AD) was assessed by vascular pixel percentage. Compared to healthy subjects, in patients with DM the end diastolic velocity (EDV) of the nail bed arterioles of both finger and toe was diminished, while the vascular resistance index (RI) was increased. These changes became more prominent with a longer duration of the disease. Furthermore, both the peak systolic velocity (PSV) and AD were decreased in patients with DM. These hemodynamic changes were also evident in the pulp arterioles of fingers and toes, although they appeared at more advanced stages of the disease. Overall, the abnormal changes were more pronounced in patients with complications. In conclusion, hemodynamic changes (e.g. decrease in the number of acral arterioles) progress with a longer duration of the disease. The acral arteriolar damage is more pronounced in patients with a complicated type 2 DM.