[Establishment and application of a clustered management plan for pulmonary care of massive burn casualties].

Objective: To establish a clustered management plan for pulmonary care of massive burn casualties (hereinafter referred to as the clustered management plan for pulmonary care), and to explore its application effects. Methods: (1) A clustered care intervention group was established, including the medical and nursing staff from the Department of Burns and Plastic Surgery, Department of Respiratory Medicine, and Department of Infection Control at the Fourth Medical Center of PLA General Hospital (hereinafter referred to as our hospital). Four major links, including pulmonary care assessment, chest and lung physical therapy, artificial airway management, and specialized infection control were sorted out according to the key points and difficulties in pulmonary care for massive burn casualties. Evidence-based nursing methods were employed to retrieve articles related to the above-mentioned four links from PubMed, Chinese Journal Full-Text Database, VIP Database and Wanfang Data using terms of " mass burn, respiratory management and airway management" and terms of ",," , and the clustered management plan for pulmonary care was established based on reading and discussion in combination with clinical practice and experience. (2) In this non-randomized controlled study, the clustered management plan for pulmonary care was applied to 73 massive burn patients (48 males and 25 females, aged 32 (25, 38) years) who were admitted to our hospital from January 2016 to December 2019 and met the inclusion criteria, and they were included into the clustered care group; 43 massive burn patients (25 males and 18 females, aged 35 (17, 45) years) who were admitted to our hospital from January 2013 to December 2015, received routine care and met the inclusion criteria were retrospectively included into routine care group. The pulmonary infection rate and mortality of patients in the two groups were recorded during the hospital stay. Data were statistically analyzed with chi-square test, Mann-Whitney U test, and independent sample t test. Results: (1) The clustered management plan for pulmonary care included a total of 12 specific measures covering four aspects of pulmonary care. The contents in pulmonary care assessment clearly stated to include the previous medical history, history of injury, respiratory status, hoarseness, pulmonary auscultation, etc. Chest and lung physical therapy included how to guide patients to effectively cough and do pursed lip breathing and abdominal breathing exercise, etc. Artificial airway management specified the preparation for the establishment of artificial airway at clinical reception, the observation index and frequency after tracheotomy, the method of humidification, the method and frequency of sputum suction, and the management of mechanical ventilation, etc. Specialized infection control required to strengthen hand hygiene and ventilator management. (2) The pulmonary infection rate and mortality of patients in the clustered care group were 2.74% (2/73) and 4.11% (3/73), respectively, significantly lower than 25.58% (11/43) and 18.60% (8/43) in routine care group (χ(2)=11.986, 5.043, P<0.05 or P<0.01). Conclusions: The clustered management plan for pulmonary care developed for massive burn casualties focuses on the major links and key points. The measures are systemic and comprehensive, simple but precise, and highly operable, covering the entire process of massive burn care, hereby reducing the pulmonary infection rate significantly and improving the success rate of treatment.

The morphological and physiological basis of delayed pollination overcoming pre-fertilization cross-incompatibility in Nicotiana.

Delayed pollination is widely used to overcome pre-fertilization incompatibility, but its regulatory mechanisms are unclear. When Nicotiana tabacum was cross-pollinated with pollen of N. alata, the incompatibility occurring in the basal 1/4 region of the style (pollinated at anthesis: 0-day-old pistil) was overcome by delayed pollination (of 6-day-old pistil), and the morphological changes and corresponding physiological basis are explored here. The structure and ultrastructure of the pistil were observed under fluorescence microscopy and transmission electron microscopy. Differentially expressed proteins were screened with a monoclonal antibody chip for Nicotiana, and protein expression and distribution were analysed by immunofluorescence. Cellulase and pectinase activities were tested using enzyme-linked immunosorbent assay kits. The style of Nicotiana is solid in the basal region and pollen tubes grow in the extracellular spaces (ECM) of the transmitting tissue (TTS) cells. Seven of the 22 identified proteins were cell wall-associated proteins and were expressed at higher levels during pistil senescence. Cellulase and pectinase activities increased. The TTS cells in the basal 1/4 region of the 0-day-old style were polygonal and tightly arranged, with narrow ECM, but these were oval or partially dissolved in the 6-day-old pistil, leading to wider ECM and richer secretions. The increased expression of cell wall proteins and enhanced enzyme activity during pistil senescence might partially be responsible for the cells becoming oval and the ECM enlarged, providing the morphological basis for delayed pollination overcoming the pre-fertilization incompatibility between N. tabacum and N. alata.

[Clinical observation of the relationship between the newborn hearing screening and ABO blood groups].

Objective:To analyze the relationship between ABO blood groups and otoacoustic emissions in full-term newborns, including the occurrence of SOAE and the amplitudes of DPOAE. Method:A total of eighty normal hearing female neonates were included in the study, with equal number of participants in each of the ABO blood group. Measurements of SOAE and DPOAE were collected from both ears of all participants. Result:The blood group O subjects showed significantly fewer SOAE occurrences and lower DPOAE amplitudes at 793 Hz, 1 257 Hz and 1 587 Hz than subjects with other three blood groups both in the left and right ears. Conclusion:The full-term neonates with blood group O have lower SOAE occurrence than other three blood group individual. The blood group O individuals have the lowest amplitude at 793 Hz, 1 257 Hz and 1 587 Hz of both ears.

Strengthening teachers' abilities to implement a vision health program in Taiwanese schools.

We designed a school-based, nationwide program called the 'New Era in Eye Health' to strengthen teacher training and to examine whether the existence of a government vision care policy influenced teachers' vision care knowledge and students' behavior. Baseline data and 3-month follow-up data were compared. A random sample of teachers (n = 660) from school vision health clusters in 22 cities/counties in Taiwan were invited to participate in our study and 436 agreed to participate (response rate = 66.1%). The mean age of participant teachers was 41.2 years, while the length of service mean was 14.6 years. For monitoring teacher outcomes, five cities/counties were selected as the intensely monitored group based on certain criteria. Sunlight diaries (n = 5434) were distributed and 3342 (61.5%) were returned. Teachers showed significant improvements in knowledge and behavior on the school vision health questionnaire. At the 3-month follow-up, the number of recesses as recorded by students' 'sunlight diary' increased. When teachers had better knowledge and behavior, recesses also increased. This study provided valuable insights to guide dissemination efforts for school vision health interventions and to help teachers implement research into their school vision health activities.

[A 212 cases analysis of treatment for traumatic optic neuropathy by nasal endoscopic opticnerve decompression].

Objective:To explore the clinical features and therapeutic efficacy of nasal endoscopic optic nerve decompression for traumatic optic neuropathy (TON)treatment.Method:Two hundred and twelve cases (217 eyes) with TON were retrospectively analyzed in our study, who were treated with nasal endoscopic optic nerve decompression in our institution from 1999 to 2016. χ ² -test was used to explore the potential prognostic factors on visual acuity.Result:All patients were followed up from 6 months to 2 years postoperatively, and the effective rate was 54.38%(118/217).In the 166 eyes with no light perception (NLP), the effective rate was 46.39% (77/166), while in the 51 eyes with light perception (LP), the effective rate was 80.39% (41/51).The therapeutic efficacy of patients with LP or above LP was better than that of NLP, and the difference was statistically significant(χ ²=18.186, P< 0.01).Moreover, the therapeutic efficacy of patients without an optic canal fracture was better than that with an optic canal fracture，and the difference had statistical significance (χ ²=10.096, P<0.01).Conclusion:The efficacy of nasal endoscopic optic nerve decompression on TON was positive, and even for the patients with NLP or a long history also should have a try.