Development of an educational program for ultrasound-based tip location during placement of PICC-port to improve the competence of specialized nurse.

OBJECTIVES: To create an educational program and provide a valid, evidence-based course for ultrasound-based tip location during placement of PICC-port for specialized nurses. MATERIALS AND METHODS: We designed three phases for program development. Phase 1: summarizing the evidences as a knowledge foundation; Phase 2: developing an educational program for ultrasound-based tip location during placement of PICC-port; Phase 3: expert panel to validate the developed program. RESULTS: The educational program was composed of five parts and 12 lessons, with three lessons each devoted to basic knowledge, practice, and testing, respectively. First, the criteria for defining an expert trainer is determined. Second, some basic conditions are confirmed. Third, the image acquisition windows of transthoracic echocardiographic are recommended. Fourth, the knowledge about ultrasound-based tip location is categorized. Fifth, the procedures for ultrasound-based tip location combined with "bubble test" were listed. The program's content was verified by experts and found to have a validity coefficient of 0.95. CONCLUSION: The program, encompassing theoretical and practical components, as well as assessment items, can be applied in specialized nursing education and skills training, and it enhances nurses' competence in accurately identifying the tip location during the placement of PICC-ports and other central venous access implants.

Acute fatty liver of pregnancy causing multiple organ dysfunction syndrome in a Chinese intensive care unit.

Acute fatty liver of pregnancy (AFLP) is a rare but severe condition associated with high rates of maternal and foetal morbidity and mortality. Timely discontinuation of pregnancy, professional supervision and appropriate management are helpful for a successful discharge. This article reports the presentation and nursing care of a pregnant woman who was diagnosed with AFLP and discharged from the intensive care unit (ICU) after a prolonged hospitalization. The patient was admitted to the ICU on the first day after a caesarean section, with deterioration of liver, kidney and coagulation function. On day 1 of ICU admission, she underwent transnasal high-flow oxygen therapy. Owing to worsening respiratory status and oxygen saturation <85%, the patient was intubated on day 3 in the ICU. Her urine output decreased significantly, her bilirubin level progressively increased, and she was treated with bilirubin adsorption and haemodialysis. Multiple organ dysfunction syndrome occurred, along with many other complications, including subarachnoid haemorrhage and lower extremity venous thrombosis. The patient was finally extubated on day 7, and haemodialysis was discontinued on day 42, with a daily urine output of approximately 2000 mL. The patient was discharged from the ICU 43 days after admission. Treatment and care activities under qualified nursing care, including managing haemorrhage and anticoagulation in haemodialysis, pain care based on psychological support, early rehabilitation and nutrition and providing appropriate care for respiratory support, contributed to the successful discharge of the patient from the ICU. During the patient's 43-day stay in the ICU, strict monitoring and personalized nursing care were implemented.

Livestock grazing-exclusion under global warming scenario decreases phosphorus mineralization by changing soil food web structure in a Tibetan alpine meadow.

The exclusion of grazing has been used extensively in alpine meadows on the Tibetan Plateau. Studies, however, have shown reported recent trends of decreasing concentrations of soil nutrients because of grazing exclusion and climate change. The effects of excluding grazing on the soil biogeochemical process of phosphorus cycling in alpine meadows are unclear, especially under climatic warming. We conducted a 5-year grazing-exclusion and warming-manipulation experiment to examine the effects of excluding grazing on fractions of soil phosphorus, microbial and nematode communities and enzymatic activities in treatments of low grazing intensity, grazing exclusion, and combined grazing exclusion and warming. Our results indicated that excluding grazing significantly decreased bacterivore and omnivore-predator densities, phoD gene abundance and alkaline phosphomonoesterase activity (in the 0-5 cm layer by -34, -41, -38 and -42 %) at altitudes of 3850 m, 4000 m, 4150 m and 4250 m, respectively. Structural equation modeling indicated that bacterivores positively affected phoD gene abundance, alkaline phosphomonoesterase activity and inorganic­phosphorus fractions. Combined grazing exclusion and warming significantly decreased bacterivore and omnivore-predator densities but significantly increased fungivore density (in the 0-5 cm layer by 238, 172, 119 and 65 %) at altitudes of 3850, 4000, 4150 and 4250 m, respectively. Structural equation modeling also indicated that the combined grazing-exclusion and warming treatment increased the soil fungi and fungivores, but the higher abundances of fungi and fungivores did not significantly affect acid phosphomonoesterase activity or inorganic­phosphorus fractions. Alternatively, the combined grazing-exclusion and warming treatment significantly increased the concentrations of amorphous and free aluminum, which were positively correlated with the maximum adsorption of phosphorus. The combined grazing-exclusion and warming treatment thus significantly decreased the availability of resin phosphorus (-63, -51, -81 and -67 %) in the 0-5 cm layer at altitudes of 3850, 4000, 4150 and 4250 m, respectively. Our results suggested that light grazing (0.5 yak ha-1 year-1) could increase phosphorus mineralization and the activity of soil enzymes in alpine meadows under global warming. An adequate load of livestock pressure at each altitude can be an effective management technique, mainly under warming, to maintain an adequate, sustainable and equilibrated phosphorus cycle in the plant-soil system.

Transverse incision versus longitudinal incision in the implantation of PICC-port: A before-after study.

BACKGROUND: The peripherally inserted central catheter-port (PICC-port) technique is an innovation of the standard arm-totally implantable vascular access device. The design of surgical skin incision may have an important impact on the postoperative life of patients, the cosmetic result is important for patient satisfaction as well. OBJECTIVES: To compare two different incision methods in the implantation of PICC-port. DESIGN: A before-after study. SETTINGS AND PARTICIPANTS: A total of 62 adult patients with malignant tumor requiring chemotherapy in Shanghai General Hospital were selected by convenience sampling, 31 in each group. All participants agreed to install PICC-port with signature from 1 Jan to 30 April, 2022. METHODS: 31 patients were given longitudinal incision, about 3 cm below the puncture point obliquely. Another 31 patients were given transverse incision, about 3 cm below the puncture point. T-test, chi-square test and rank sum test were used to compare the differences between the two groups in incision healing, scar score, and operation time. RESULTS: There was no statistically significant difference in incision healing between the two groups(p > 0.05). The scar scores of patients with transverse incision were higher than that of patients with longitudinal incision at 3 months (p < 0.05). And the operation time of longitudinal incision group was longer than that of transverse incision group(p < 0.05). CONCLUSIONS: Our study revealed that PICC-port implantation could be considered as safe as PICC insertion conducted by nurse. During our follow-up, all patients with PICC-port implantation had good wound healing, and there were no complications such as local infection happened. The transverse incision was more easier to be operated in bag making in PICC-port implantation.

Application of nursing based on the authorization theory in asthmatic children aged 7 to 14 years.

OBJECTIVE: To investigate the effect of a nursing model based on the authorization theory of asthma in children aged 7 to 14 years. METHODS: In total, 200 children who were 7 to 14 years with asthma in remission were recruited in this study. These children were admitted to our hospital and were randomly divided into the control group (n=100) and the experimental group (n=100). Patients in the control group received routine nursing, while those in the experimental group received routine nursing and nursing based on the authorization theory. Treatment compliance, the time of disappearance of symptoms (like sputum, cough, wheeze, and wet rales), the length of hospitalization, lung function, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC, general self-efficacy scale (GSES) score, MOS 36-item short form health survey (SF-36) score, and parents' satisfaction with nursing were compared between the two groups. RESULTS: FEV1, FVC, FEV1/FVC, GSES score, and SF-36 scores in all aspects in the two groups after intervention were increased when compared with before intervention; in addition, FEV1, FVC, FEV1/FVC, GSES score, and SF-36 scores in all aspects in the experimental group after intervention were significantly higher than those in the control group (all P<0.05). The time of disappearance of symptoms (like sputum, cough, wheeze, and wet rales) and length of hospitalization in the experimental group were shorter than those in the control group (all P<0.05). Compared with the control group, treatment compliance and satisfaction in nursing in the experimental group were increased (both P<0.05). CONCLUSION: Nursing based on the authorization theory can effectively improve treatment compliance, lung function, SF-36 scores, and satisfaction in nursing, and shorten the length of hospitalization.

Inorganic nitrogen uptake rate of Picea asperata curtailed by fine root acclimation to water and nitrogen supply and further by ectomycorrhizae.

Ectomycorrhizal (ECM) fungi colonization and function depend on soil water and nutrient supply. To study the effects of resource supply on ECM colonization and inorganic nitrogen (N) uptake by roots of Picea asperata seedlings, we conducted a study at the end of a 5-year long experiment consisting of five watering regimes (40, 50, 60, 80, and 100% of field capacity) and three NH4 NO3 application rates (0 [N0], 20 [N1], and 40 [N2] g N m-2  year-1 ). We measured fluxes of ammonium ( NH 4 + ) and nitrate ( NO 3 - ) into colonized and uncolonized roots using noninvasive microtest technology. We found that, across the N supply levels, ECM colonization rate increased by 53 ± 14% from the highest to the lowest level of water supply. Across the watering regimes, the fraction of mycorrhizal root tips was 39 ± 4% higher under native N supply compared to roots grown under N additions. As expected for conifers, both colonized and uncolonized roots absorbed NH 4 + at a higher rate than NO 3 - . N additions reduced the instantaneous ion uptake rates of uncolonized roots grown under low water supply but enhanced the fluxes into roots grown under sufficient soil water availability. Soil water supply improves inorganic N uptake by uncolonized roots but reduces the efficiency of colonized roots. Under the lowest water supply regime, the uptake rate of NH 4 + and NO 3 - by colonized roots was 40-80% of those by uncolonized roots, decreasing to 20-30% as soil water supply improved. Taken together, our results suggest that the role ectomycorrhizae play in the nutrient acquisition of P. asperata seedling likely diminishes with increasing availability of soil resources.

Effect of intranasal oxytocin administration on self-other distinction: Modulations by psychological distance and gender.

Preliminary evidence indicates that intranasal oxytocin (OT) administration modulates one's ability to distinguish oneself from others (i.e., self-other distinction). However, previous findings on this topic are contradictory. The current study addressed this issue by (i) using a novel perceptual matching task examining self-other distinction compared to both close and distant others, and (ii) tentatively exploring potential modulations by gender. In a double-blind, placebo-controlled, randomized OT administration study, 100 participants (50 males and 50 females) were randomized to receive intranasal spray of 24 IU OT or placebo (PL). Afterwards, participants completed a geometry perceptual matching task in which different shapes were paired to the self, a friend, or a stranger. Participants were then asked to judge whether each pair of shapes and labels was correctly matched. The results revealed that compared to PL administration, OT facilitated distinction between the self and a friend in males but not in females. These findings provide insights for debates on the role of OT in self-other distinction by revealing modulations by psychological distance and gender, which have implications for the potential clinical applications of OT.

Intestinal morphology, immunity and microbiota response to dietary fibers in largemouth bass, Micropterus salmoide.

This study is aimed at identifying the effects of dietary fiber on gut health, as well as the association between that understanding and fiber consumption in fish. A total of 300 juvenile largemouth bass (micropterus salmoides, initial average weight: 15.38 ± 0.16g) were randomly divided into three treatment groups (4 replicates per group). Fish were fed with isoproteic and isolipidic diets containing 0% (low fiber, LF), 4% (moderate fiber, MF) and 8% (high fiber, HF) soybean fiber, respectively. The intestine and intestinal content of test fish per treatment group after 56 days of treatment were sampled. The results showed that the anterior intestinal sections had normal histological architecture, and no considerable damage or inflammation was observed in any histological section from all subjects examined. Curiously, fish fed the MF diet had better histological alterations than the other treatments. Meanwhile, the intestinal antioxidant capacity in the MF group was significantly promoted when compared to the other groups, as well as up-regulated expression of antioxidant-related genes including sod, cat and gpx with increasing dietary fiber concentrations. Importantly, the administrations of MF diet remarkably elevated largemouth bass innate immune parameters include intestinal inducible nitric oxide synthase (iNOS) activity, nitric oxide (NO) and total protein content. Similarly, dietary administrations of fiber down-regulated notablely the expression of pro-inflammatory cytokines including IL-8, IL-1ß and TNFα, whereas up-regulated tolerogenic cytokine IL-10 and TGF-ß1 mRNA levels. In addition, dietary fibers also modulated the community structure of the intestinal microbiota by significantly altering bacterial diversity. Dietary supplemental fibers regulated intestinal microbiota in largemouth bass, characterized by a reduced abundance of Fusobacteria along with increased abundances of Proteobacteria and Firmicutes. Taken together, the present results suggested that moderate fiber supplementation was beneficial to promoting intestinal health status of fish through antioxidant and anti-inflammatory effects, which could be at least partially responsible by the modulation of gut microbial composition.

Characterization of Trichococcus paludicola sp. nov. and Trichococcus alkaliphilus sp. nov., isolated from a high-elevation wetland, by phenotypic and genomic analyses.

Two psychrotolerant facultative anaerobes, strains B7-2T and B5T, were isolated from the Zoige Wetland on the Qinghai-Tibetan Plateau. The 16S rRNA gene sequences of strains B7-2T and B5T shared high similarity (>99 %) with those of the type strains of the genus Trichococcus, while their digital DNA-DNA hybridization values with each other (49 %) and with the reference type strains (48-23 %) were lower than 70 %, which suggest that they represent two novel species of the genus Trichococcus. Cells of strains B7-2T and B5T were immotile cocci, grew in the temperature range of 4-37 °C (optimum 25 °C) and were alkaliphilic with optimum growth at pH 9.0. The major components of the cellular fatty acids were C16 : 0, anteiso-C17 : 0 and C18 : 0 for strain B7-2T, and C16 : 0, anteiso-C17 : 0, C18 : 1ω9c and C18 : 0 for strain B5T. The genomic DNA G+C contents were 46.0 and 46.7 mol% for strains B7-2T and B5T, respectively. Based on physiological and genomic characteristics, it is suggested that strains B7-2T and B5T represent two novel species within the genus Trichococcus, for which the names Trichococcus paludicola sp. nov. and Trichococcus alkaliphilus sp. nov. are proposed. The type strains are B7-2T (=DSM 104691T=KCTC 33886T) and B5T (=DSM 104692T=KCTC 33885T), respectively.

Photoprotection regulated by phosphorus application can improve photosynthetic performance and alleviate oxidative damage in dwarf bamboo subjected to water stress.

Water and nutrients, particularly phosphorus (P), are the two most limiting factors for dwarf bamboo growth in tropical and subtropical areas. Dwarf bamboo is highly sensitive to water stress and often causes severe P deficiency in its growing soils due to the characteristics of shallower roots and expeditious growth. However, little is known about its photoprotective response to soil water deficit and the underlying mechanisms regulated by P application. In this study, a completely randomized design with two factors of two water regimes (well-watered and water-stressed) and two P levels (with and without P application) was arranged to investigate this issue in dwarf bamboo (Fargesia rufa) plants. Water stress not only decreased water status and photochemical activity but also increased lipid peroxidation due to reactive oxygen species (ROS) accumulation irrespective of P application. In this case, thermal dissipation and antioxidative defense were promoted. Moreover, the role of the water-water cycle under this stress still could not be ignored because it accounted for a large proportion of total energy (JPSII). P application significantly enhanced photochemical activity accompanied by increased chlorophyll content in water-stressed plants. Meanwhile, P application remarkably reduced thermal dissipation and hardly affected photorespiration and the water-water cycle under water stress. Although P application only enhanced ascorbate (AsA) level, ROS, particularly hydrogen peroxide (H2O2), and lipid peroxidation were significantly reduced in water-stressed plants. Therefore, P application can improve the photosynthetic capacity by regulating the redistribution of energy absorbed by PSII antennae and independently activating of the H2O2-scavenging function of AsA to alleviate oxidative damage in F. rufa plants, thereby improving their survival under water stress conditions.