B12 deficiency-related glossitis is highly associated with high gastrin-17 and low pepsinogen I.

BACKGROUND: The causes of vitamin B12 (B12) deficiency are varied and mainly related to gastric disorders. Glossitis is a common oral manifestation of B12 deficiency and is often first seen by dentists. This study aimed to investigate the correlation between B12 deficiency-related glossitis (B12-def glossitis) and gastric serum biomarkers [gastrin-17(G17), pepsinogen I (PGI), pepsinogen II (PGII), and anti-Helicobacter pylori (H. pylori) antibodies], and preliminarily discuss the etiology of B12-def glossitis. METHODS: A cross-sectional study was conducted in patients complaining of glossodynia, burning sensation, or severe recurrent oral ulcers, but patients with a history of gastrectomy were excluded. All subjects underwent a uniform oral examination and hematological tests. RESULTS: Of 243 patients, 133 with B12-def glossitis were in the case group, and 110 with other oral mucosal diseases (non-glossitis) and normal B12 levels were in the control group. In the case group, 84.2% (112/133) showed high G17 and low PGI levels (G17hi PGIlow ). Univariate logistic regression showed that G17hi PGIlow was a high-risk factor for B12-def glossitis (OR: 92.44; 95% CI: 35.91, 238.02). Subgroup analyses in the case group showed that the G17hi PGIlow group presented with lower B12 levels and a lower positive rate of anti-H. pylori antibodies compared to the non-G17hi PGIlow group. CONCLUSION: Gastric serum biomarkers in patients with B12-def glossitis generally showed G17hi PGIlow , suggesting possible atrophy of gastric corpus and fundus mucosa. The G17hi PGIlow and non-G17hi PGIlow groups may represent different etiologies of B12 deficiency.

[Practical Application of Body Mechanics Principles in the Process of Health Workers Doffing Personal Protective Equipment].

Objective: To examine the application effect of body mechanics principles in the process of health workers doffing personal protective equipment (PPE). Methods: A total of 360 health workers from a Fangcang shelter hospital, also known as alternate care site, in Shanghai were involved in a centralized 1-day training concerning essential skills for taking off PPE. The training was focused on integrating body mechanics principles, including expanding the support surface, lowering the center of gravity, reducing the shift in the the center of gravity, using the principle of leverage, and creating the appropriate operating space, in the PPE doffing process. Through remote video monitoring and recording, observations were made of the physical stability, pollution risks, and operational smoothness of the health workers when they applied body mechanics principles in their actions. Results: The results of binary logistic regression showed that, compared with the actions taken without applying body mechanics principles, performing the operation of the body leaning forward and then slightly leaning backward was positively correlated with stability in the doffing process (odds ratio [O R]=3.291, 95% confidence interval [ CI]: 1.627-6.656), negatively correlated with pollution risks ( OR=0.203, 95% CI: 0.100-0.412), and positively correlated with operational smoothness ( OR=20.847, 95% CI: 8.061-53.916); performing the operation of taking off the boot sleeve in a horse-riding stance, with one foot standing ahead of the other, was positively correlated with stability ( OR=5.299, 95% CI: 1.041-26.957), negatively correlated with pollution risks ( OR=0.079, 95% CI: 0.009-0.692), and positive correlated with operational smoothness ( OR=16.729, 95% CI: 1.238-226.077); performing the operation of taking off the boot sleeve by lifting the heel and then the toes was positively correlated with stability ( OR=19.361, 95% CI: 8.391-44.671), negatively correlated with pollution risks ( OR=0.181, 95% CI: 0.084-0.393), and positively correlated with operational smoothness ( OR=10.977, 95% CI: 3.764-32.008); performing the operation of the leaning forward and keeping the face looking forward when taking off the mask was positively correlated with stability ( OR=2.935, 95% CI: 1.412-6.101), negatively correlated with pollution risks ( OR=0.123, 95% CI: 0.059-0.258), and positively correlated with operational smoothness ( OR=18.126, 95% CI: 6.665-49.297). Conclusion: In the process of medical staffs doffing PPE, correct and proper mechanical postures and actions can effectively assist medical staffs to maintain balance and stability and reduce the risks of infection, which has major significance and should be widely incorporated in personal protection skills training and applied in clinical practice.

Preventive strategies for feeding intolerance among patients with severe traumatic brain injury: A cross-sectional survey.

Objectives: This study aimed to investigate the application status of preventive measures for feeding intolerance in patients with severe traumatic brain injury (STBI) in China and analysis the differences and their causes. Methods: A cross-sectional survey was conducted. From December 2019 to January 2020, ICU nurses and physicians of 89 hospitals in China were surveyed by using a questionnaire on preventive strategies for feeding intolerance in patients with STBI. The questionnaire included two parts: the general information of participants (10 items) and application of preventive measures for feeding intolerance in STBI patients (18 items). Results: Totally 996 nurses and physicians completed the questionnaire. Among various methods, gastrointestinal symptoms(85.0%) and injury severity (71.4%) were mostly used to assess gastrointestinal functions and risk of feeding intolerance among STBI patients, respectively. Initiating enteral nutrition (EN) within 24-48 h (61.5%), nasogastric tubes (91.2%), 30°-45° of head-of-bed elevation (89.5%), continuous feeding by pump (72.9%), EN solution temperature of 38-40 °C (65.5%), <500 ml initial volume of EN solution (50.0%), monitoring gastric residual volume with a syringe (93.7%), and assessing gastric residual volume every 4 h (51.5%) were mostly applied for EN delivery among STBI patients. Prokinetic agents (73.3%), enema (73.6%), probiotics (79.0%), antacid agents (84.1%), and non-nutritional preparations as initial EN formula (65.6%) were commonly used for preventing feeding intolerance among STBI patients. Conclusions: The survey showed that nurses and clinicians in China have a positive attitude towards preventive strategies for feeding intolerance. However, some effective new technologies and methods have not been timely applied in clinical practice. We suggest that managers, researchers, clinicians, nurses, and other health professionals should collaborate to explore effective and standard preventive strategies for feeding intolerance among patients with STBI.

Early versus delayed oral feeding after gastrectomy for gastric cancer: A systematic review and meta-analysis.

BACKGROUND: Early oral feeding has been shown to be safe and effective for most surgeries, while surgeons and nurses are still hesitant to implement it in gastric cancer patients who undergo gastrectomy. OBJECTIVES: This review aimed to investigate the safety and feasibility of early versus delayed oral feeding in gastric cancer patients after gastrectomy. DESIGN: A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES: The literature search was performed in 7 databases from inception to March 7, 2021. REVIEW METHODS: Randomized controlled trials that compared the effects of early oral feeding and delayed oral feeding in gastric cancer patients who undergo gastrectomy were included. The primary outcome was hospital days, and secondary outcomes included hospital costs, postoperative complication rates, feeding intolerance rates, annal exhaust time, albumin levels and prealbumin levels. According to the presence of heterogeneity, fixed or random effect meta-analysis was applied. RESULTS: Nine trials involving 1087 gastric cancer patients who undergo gastrectomy were pooled in this systemic review and meta-analysis. The results showed that early oral feeding significantly decreased hospital days (mean difference = -1.50, 95% confidence interval = -1.91 to -1.10, P < 0.001) and hospital costs (mean difference = -4.21, 95% confidence interval = -5.00 to -3.42, P < 0.001) compared to delayed oral feeding, while the incidences of postoperative complications (risk ratio = 0.96, 95% confidence interval = 0.72 to 1.26, P = 0.76) and feeding intolerance (risk ratio = 0.95, 95% confidence interval = 0.79 to 1.15, P = 0.62) were comparable between the two groups. In comparison to delayed oral feeding, early oral feeding was associated with shorter annal exhaust time (mean difference = -0.61, 95% confidence interval = -0.81 to -0.40, P < 0.001) and higher levels of albumin (mean difference = 3.77, 95% confidence interval = 2.42 to 5.12, P < 0.001) and prealbumin (mean difference = 18.11, 95% confidence interval = 15.33 to 20.88, P < 0.001). Furthermore, the results of distal gastrectomy subgroup analysis indicated that hospital days were shorter in the early oral feeding group than in the delayed oral feeding group. CONCLUSIONS: For gastric cancer patients who undergo gastrectomy, early oral feeding was associated with shorter hospital days and lower hospital costs, but early oral feeding did not increase the incidences of postoperative complications or feeding intolerance. Moreover, early oral feeding also decreased the annal exhaust time but increased the levels of albumin and prealbumin.

Factors Associated with Willingness to Choose the Way for Old-Age Care: A Population-Based Cross-sectional Study in Chongqing, China.

The objective of this study is to investigate the factors associated with the willingness for old-aged care and the demands for health care among elders, which might provide a reference for the establishment of health care strategies. A cross-sectional study was conducted via questionnaires among 1553 randomly selected residents aged 65 or older from Chongqing, China during 2016. Data of demographics, and demands for old-age care and health care services were collected. Descriptive analysis was used to examine the characteristics of the respondents. A chi-squared test and multiple logistic regression were performed to explore the relevant factors associated with the preference of old-age care among older people in Chongqing. We found that 85.4% of the respondents were willing to select home-based care: family old age care (55.9%), and its combination form for old-age care: family old age care plus community old age care (29.5%) old age care. Multivariable logistic regression analysis showed that willingness to choose family old age care for old-age care was associated with lower monthly income, more children, worse commercial insurance, better health status, and shorter distance to their children. Most older adults had the demands for health-related services, including regular check-up, regular health seminars, establishment of health files. Hospital was the most acceptable provider for care services, and there was a preference for long-term care and emergency call among the elders. The majority of older Chinese prefer the family old age care and its combination form with community old age care for old-age care, and demand for a variety of health-related services. Home- and community-based care with sound and perfect medical and health mechanism should be the main pattern of old-age care system in China.

Top-Down and Bottom-Up Lockdown: Evidence from COVID-19 Prevention and Control in China.

Utilizing national migration data regarding the outbreak of the novel coronavirus (2019-nCoV), this paper employs a difference-in-differences approach to empirically analyze the relationship between human mobility and the transmission of infectious diseases in China. We show that national human mobility restrictions ascribed to the first-level public health emergency response policy effectively reduce both intercity and intracity migration intensities, thus leading to a declining scale of human mobility, which improves the effectiveness in controlling the epidemic. Human mobility restrictions have greater influences on cities with better economic development, denser populations, or larger passenger volumes. Moreover, mobility restriction measures are found to be better implemented in regions with increased public awareness, or with provincial leaders who have healthcare crisis management experience, local administrative experience, or the opportunity to serve a consecutive term.

Soluble Dietary Fiber Reduces Feeding Intolerance in Severe Acute Pancreatitis: A Randomized Study.

BACKGROUND: Feeding intolerance of enteral nutrition (EN) frequently occurs in patients with severe acute pancreatitis (SAP) because of intestinal motility disorders. Soluble dietary fiber (SDF) modulates the intestinal motility. The present study examined whether SDF can improve intestinal motility and permeability, and thereby reduce feeding intolerance, in patients with SAP. METHODS: This study was a single-blind, randomized, controlled, single-center trial. Forty-nine patients with SAP were included. The control and SDF groups received the same EN solution via a nasojejunal tube. The SDF group additionally received 20-g/d polydextrose. The primary outcome was the time to reach the energy goal. Follow-up was continued for 28 days after admission or until discharge from the hospital. RESULTS: Among 49 randomized patients, 46 patients (n = 22, control group; n = 24, SDF group) were included in the intent-to-treat analysis. The time to reach the energy goal was 7.00 (6.00, 8.25) days and 5.00 (4.25, 6.00) days in the control and SDF groups, respectively (P < 0.001). The rates of feeding intolerance were significantly reduced in the SDF group (59.09% vs 25.00%, P < .05). SDF was associated with decreases in the incidence of abdominal distension (72.73% vs 29.17%, P < .01), diarrhea (40.91% vs 8.33%, P < .05), and constipation (72.73% vs 12.50%, P < .001). The time to first flatus and first defecation were significantly shorter in the SDF group (P < .001). The intestinal mucosal barrier function and levels of gastrointestinal hormone were improved by SDF, as evidenced by significantly reduced blood levels of diamine oxidase, D-lactic acid, endotoxin, and vasoactive intestinal peptide (P < .05). CONCLUSIONS: SDF shortens the time to reach the energy goal during EN and improves intestinal permeability and motility disorders, thus reducing the incidence of feeding intolerance in SAP patients.

Intermittent versus continuous enteral nutrition on feeding intolerance in critically ill adults: A meta-analysis of randomized controlled trials.

OBJECTIVES: Enteral formula delivery strategy is an important part of enteral nutrition. We aimed to synthesize up-to-date studies to clarify the effects of intermittent versus continuous feeding on feeding intolerance during enteral nutrition in critically ill adults. DESIGN: A meta-analysis of randomized controlled trials. DATA SOURCES: Embase, PubMed, Information Sciences Institute Web of Science, CINAHL EBSCO, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure databases were searched from inception to 17th of June 2020. REVIEW METHODS: The Cochrane "risk of bias" tool was used to assess the quality of individual studies, and the quality of each outcome was assessed by GRADE approach. Fixed or random effect meta-analysis was used pending the presence of heterogeneity. Dichotomous data synthesis was presented as risk ratio and 95% confidence interval, and quantitative data synthesis was shown as mean difference and 95% confidence interval. RESULTS: Fourteen trials with 1025 critically ill adults were included in the meta-analysis. We found that intermittent feeding could significantly increase the occurrence of feeding intolerance (risk ratio = 1.64, 95% confidence interval = 1.23 to 2.18, P < 0.001) compared with continuous feeding, as well as the incidence of high gastric volume (risk ratio = 3.62, 95% confidence interval = 1.43-9.12, P = 0.006) and aspiration (risk ratio = 3.29, 95% confidence interval = 1.18-9.16, P = 0.02) in > 1-week trial duration, while constipation rate was reduced in intermittent feeding group (risk ratio = 0.66, 95% confidence interval = 0.45-0.98, P = 0.04). Patients in intermittent feeding group received more calories compared with continuous feeding group (mean difference = 184.81, 95% confidence interval = 56.61-313.01, P = 0.005). The quality of all evidence synthesis was "low" or "very low". CONCLUSIONS: In critically ill adults, continuous feeding was associated with lower overall incidence of feeding intolerance, especially in high gastric volume and aspiration. However, decreased constipation incidence and more calorie intake were observed in intermittent feeding group. Because quality of the synthesized evidence was "low" or "very low", there is considerable uncertainty about this estimate.

MMP-9-C1562T polymorphism and susceptibility to chronic obstructive pulmonary disease: A meta-analysis.

BACKGROUND: To comprehensively evaluate the association between the polymorphism of matrix metalloproteinase-9 (MMP-9)-C1562T (rs3918242) and susceptibility to chronic obstructive pulmonary disease (COPD) in middle-aged and elderly patients through Meta-analysis. METHODS: PubMed, EMBASE, CNKI, Wanfang, VIP, and other databases were searched by computer in the inception to August 2019 to collect all the case-control studies that met the inclusion criteria in this literature. Meta-analysis was performed using Stata 15.0, including the OR value calculations of the association between the merged MMP-9-C1562T polymorphism and the COPD susceptibility. Subgroup analysis, sensitivity analysis, and publication bias test were also performed. A total of 13 literature were included in this Meta-analysis with a total of 2512 cases and 2716 controls. RESULTS: The results have shown that the OR of MMP-9-C1562T T allele to C allele was 0.35 (95% confidence interval [CI]: 0.23-0.52, P < .01). The subgroup analysis of ethnicity result showed that the merged OR of MMP-9-C1562T T allele to C allele was 0.24 (95% CI: 0.17-0.34, P < .01) in Caucasian while the merged OR was 0.62 (95% CI: 0.22-1.70, P > .05) in Asian. However, there were no statistically significant models in the dominant, recessive, homozygote and heterozygote genetic models. CONCLUSION: The MMP-9-C1562T polymorphism was associated with the susceptibility to middle-aged and elderly COPD patients. Compared with T allele, C allele increased the risk of disease, especially in Caucasian, but not found in Asian.

Da-Cheng-Qi Decoction () Combined with Lactobacillus Acidophilus Improves Gastrointestinal Function of Traumatic Brain-Injured Model Mice.

OBJECTIVE: To investigate the effects of Da-Cheng-Qi Decoction (DCQD, ) combined with Lactobacillus acidophilus (LA) on the recovery of gastrointestinal (GI) function in traumatic brain-injured (TBI) mice. METHODS: A total of 150 male C57BL/6 mice were randomly divided into sham-injury, normal saline (NS), DCQD (0.4 mL/day), LA (⩾1 × 1010 cfu/day LA), DCQD+LA (LA administration at the same dosage after 4 h of feeding DCQD), and ½ DCQD+LA groups (LA administration at the same dosage after 4 h of feeding ½ DCQD dose) by a random number table, 5-8 mice in each group. The sever TBI model was constructed according to Feeney's enhanced gravitational forces of free falling. On days 1, 3, and 7 post-TBI, plasma diamine oxidase (DAO) and D-lactic acid levels were assessed by enzyme-linked immunosorbent assay (ELISA). Occludin expression in the intestinal epithelium was assessed by Western blot analysis. Transmission electron microscopy (TEM) was used to observe the morphological changes in the network structure of interstitial cells of Cajal (ICC) and change of enteric nervous system-ICC-smooth muscle cell (ENS-ICC-SMC). Immunofluorescence staining was used to detect changes in the network structure of the ICC. RESULTS: Compared with the NS group, occludin expression in the DCQD+LA group significantly increased on Day 1, 3, and 7 post-TBI (P<0.05 or P<0.01). The concentration of DAO significantly decreased in the LA, DCQD, and DCQD+LA groups on Day 3 and 7, whilst the D-lactate concentrations in the LA and ½ DCQD+LA groups decreased on Day 1 and 3 post-injury (P<0.05 or P<0.01). The NS group experienced a great damage on the ENS-ICC-SMC network morphology and ICC network structure, and all treatment groups had some improvements, among which the DCQD+LA group presented relatively intact network morphology. CONCLUSIONS: DCQD combined with LA treatment could effectively repair the intestinal mucosal barrier and improve GI motility in mice after TBI. The combination of DCQD and LA was more effective than their respective monotherapies.

Lactobacillus acidophilus Exerts Neuroprotective Effects in Mice with Traumatic Brain Injury.

BACKGROUND: Traumatic brain injury (TBI) causes dysbiosis and intestinal barrier disruption, which further exacerbate brain damage via an inflammatory pathway. Gut microbiota remodeling by Lactobacillus acidophilus (LA) is a potential intervention. OBJECTIVE: The aim of this study was to investigate the neuroprotective effects of LA in TBI and elucidated underlying mechanisms. METHODS: C57BL/6 male mice (aged 8-9 wk) were subjected to weight-drop impact and gavaged with saline (TBI + vehicle) or LA (1 × 1010 CFU) (TBI + LA) on the day of injury and each day after for 1, 3, or 7 d. The sham + vehicle mice underwent craniotomy without brain injury and were gavaged with saline. Sensorimotor functions were determined pre-TBI and 1, 3, and 7 d postinjury. Indexes of neuroinflammation, peripheral inflammation, and intestinal barrier function were measured on days 3 and 7. Microbiota composition was measured 3 d postinjury. The data were mainly analyzed by 2-factor ANOVA. RESULTS: Compared with sham + vehicle mice, the TBI + vehicle mice exhibited impairments in the neurological severity score (+692%, day 3; +600%, day 7) and rotarod test (-58%, day 3; -45%, day 7) (P < 0.05), which were rescued by LA. The numbers of microglia (total and activated) and astrocytes and concentrations of TNF-α and IL1-ß in the perilesional cortex were elevated in the TBI + vehicle mice on day 3 or 7 compared with sham + vehicle mice (P < 0.05) and were normalized by LA. Compared with sham + vehicle mice, the TBI + vehicle mice exhibited increased serum concentrations of endotoxin and TNF-α, and intestinal barrier permeability (D-lactate) on days 3 and 7 (P < 0.05), and these changes were alleviated by LA. Three days postinjury, the microbiota composition was disrupted in the TBI + vehicle mice compared with sham + vehicle mice (P < 0.05), which was restored by LA. CONCLUSION: Our results demonstrate that LA exerts neuroprotective effects that may be associated with gut microbiota remodeling in TBI mice.

Silica nanoparticle exposure during the neonatal period impairs hippocampal precursor proliferation and social behavior later in life.

INTRODUCTION: Silica nanoparticles (SiO2-NPs) are currently among the most widely used nanomaterials, but their potentially adverse effects on brain development remain unknown. The developing brain is extremely sensitive to NP neurotoxicity during the early postnatal period. MATERIALS AND METHODS: Herein, we investigated the effects of SiO2-NPs (doses of 10, 20, or 50 mg with a particle size of ~91 nm, equivalent to aerosol mass concentrations 55.56, 111.11, and 277.78 mg/m3, respectively) exposure from postnatal day (P) 1 to P7 on hippocampal precursor proliferation at P8 and long-term neurobehavior in adults. RESULTS: SiO2-NP exposure resulted in inflammatory cell infiltration in lung tissue, microglia over-activation in the hippocampal dentate gyrus (DG), and decreased hippocampal precursor proliferation in the DG-subgranular zone at P8. Moreover, after exposure to 20 mg of SiO2-NPs, mice exhibited social interaction deficits and slight anxiety-like behaviors in adulthood, but this exposure did not induce locomotor activity impairment, depression-like behavior, or short-term memory impairment. DISCUSSION: These findings suggest that early-age SiO2-NP exposure induced inflammation and inhibited precursor proliferation in the DG in a dose-dependent manner, which might be related to the social dysfunction observed in adulthood.

Identification of risk factors for enteral feeding intolerance screening in critically ill patients.

OBJECTIVES: To identify risk factors for enteral feeding intolerance screening in critically ill patients, thereby, provide some reference for healthcare staff to assess the risk of feeding intolerance, and lay the foundation for future scale development.  Methods: This study used a mixed methodology, including a literature review, semi-structured interviews, the Delphi technique, and the analytic hierarchy process. We used the literature review and semi-structured interviews (n=22) to draft a preliminarily item pool for feeding intolerance, Delphi technique (n=30) to screen and determine the items, and the analytic hierarchy process to calculate the weight of each item. The study was conducted between June 2014 and September 2015 in Daping Hospital, Third Military Medical University, Chongqing, China.  Results. Twenty-three risk factors were selected for the scale, including 5 dimensions. We assigned a weight to each item according to their impact on the feeding intolerance, with a higher score indicating a greater impact. The weight of each dimension was decreasing as follows: patient conditions, weight score equals 42; general conditions, weight score equals 23; gastrointestinal functions, weight score equals 15; biochemical indexes, weight score equals 14; and treatment measures, weight score equals 6. Conclusion. Developed list of risk factors based on literature review, survey among health care professionals and expert consensus should provide a basis for future studies assessing the risk of feeding intolerance in critically ill patients.

Effects of Synbiotic2000™ Forte on the Intestinal Motility and Interstitial Cells of Cajal in TBI Mouse Model.

The main objective of this study was to investigate the effects of Synbiotic2000™ Forte on the intestinal motility and interstitial cells of Cajal (ICC) in traumatic brain injury (TBI) mouse model. Kunming mice were randomly divided into sham operation group (S group), enteral nutrition group with TBI (E group), and Synbiotic2000™ Forte group with TBI (P group). The contractile activity of the intestinal smooth muscle, densities and ultrastructure of the ICC, kit protein concentration, weight, and defecation of mice were monitored and analyzed. TBI markedly suppressed contractile activity of the intestinal smooth muscle (P < 0.01), which led to a reduction of defecation (P < 0.01) and weight (P < 0.01). However, application of Synbiotic2000™ Forte significantly improved contractile activity of the small intestine (P < 0.01), which may be related to protective effects to the interstitial cells of Cajal, smooth muscle cells, and enteric neurons. TBI impaired ICC networks and densities (P < 0.01), events that were protected by the application of Synbiotic2000™ Forte. Synbiotic2000™ Forte may attenuate TBI-mediated inhibition of the kit protein pathway. Synbiotic2000™ Forte may improve intestinal motility and protect the ICC in the TBI mouse. These findings provide a novel support for the application of Synbiotic2000™ Forte in intestinal motility disturbance after TBI.

Selection of nursing teaching strategies in mainland China: A questionnaire survey.

BACKGROUND: In nursing education, the traditional lecture and direct demonstration teaching method cannot cultivate the various skills that nursing students need. How to choose a more scientific and rational teaching method is a common concern for nursing educators worldwide. OBJECTIVE: To investigate the basis for selecting teaching methods among nursing teachers in mainland China, the factors affecting the selection of different teaching methods, and the application of different teaching methods in theoretical and skill-based nursing courses. DESIGN: Questionnaire survey. SETTINGS: Seventy one nursing colleges from 28 provincial-level administrative regions in mainland China. PARTICIPANTS: Following the principle of voluntary informed consent, 262 nursing teachers were randomly selected through a nursing education network platform and a conference platform. METHODS: The questionnaire contents included the basis for and the factors influencing the selection of nursing teaching methods, the participants' common teaching methods, and the teaching experience of the surveyed nursing teachers. The questionnaires were distributed through the network or conference platform, and the data were analyzed by SPSS 17.0 software. RESULTS: The surveyed nursing teachers selected teaching methods mainly based on the characteristics of the teaching content, the characteristics of the students, and their previous teaching experiences. The factors affecting the selection of teaching methods mainly included large class sizes, limited class time, and limited examination formats. The surveyed nursing teachers primarily used lectures to teach theory courses and the direct demonstration method to teach skills courses, and the application frequencies of these two teaching methods were significantly higher than those of other teaching methods (P=0.000). CONCLUSION: More attention should be paid to the selection of nursing teaching methods. Every teacher should strategically choose teaching methods before each lesson, and nursing education training focused on selecting effective teaching methods should be more extensive.

The Effects of Lactobacillus acidophilus on the Intestinal Smooth Muscle Contraction through PKC/MLCK/MLC Signaling Pathway in TBI Mouse Model.

Clinical studies have shown that probiotics influence gastrointestinal motility. However, the molecular mechanisms by which probiotic Lactobacillus modulates intestinal motility in traumatic brain injury (TBI) mouse model have not been explored. In the present study, we provided evidence showing that treatment of TBI mice with Lactobacillus acidophilus significantly improved the terminal ileum villus morphology, restored the impaired interstitial cells of Cajal (ICC) and the disrupted ICC networks after TBI, and prevented TBI-mediated inhibition of contractile activity in intestinal smooth muscle. Mechanistically, the decreased concentration of MLCK, phospho-MLC20 and phospho-MYPT1 and increased concentration of MLCP and PKC were observed after TBI, and these events mediated by TBI were efficiently prevented by Lactobacillus acidophilus application. These findings may provide a novel mechanistic basis for the application of Lactobacillus acidophilus in the treatment of TBI.

[Effects of probiotics on blood glucose levels and clinical outcomes in patients with severe craniocerebral trauma].

OBJECTIVE: To investigate the effects of probiotics on blood glucose levels and clinical outcomes in patients suffering from severe craniocerebral trauma. METHODS: A prospective randomized control study was conducted. Fifty-two severe craniocerebral trauma patients admitted to intensive care unit (ICU) were randomized into experimental or control group (each n=26). All patients received conventional treatment according to Guidelines for the Clinical Management of Traumatic Brain Injury and enteral nutrition within 24-48 hours after admission through nasogastric tube. In addition, the experimental group received 1×10(9) bacteria of viable probiotics (Golden Bifid, 3.5 g for 3 times per day) per day for 21 days. The fasting blood glucose levels were determined in the morning before intervention and on day 4, 8, 15, 21 after intervention. Amount of insulin used during hospitalization, Glasgow coma scale (GCS) scores, length of ICU stay, and 28-day mortality rate were studied. RESULTS: There was no difference in term of the blood glucose levels between two groups before intervention. On day 8 and 15 after intervention, significantly lower levels of fasting blood glucose were observed in the experimental group compared with those of the control group (8 days: 6.6±1.2 mmol/L vs. 8.0±2.7 mmol/L, t=-2.500, P=0.017; 15 days: 6.1±1.4 mmol/L vs. 7.2±2.2 mmol/L, t=-2.269, P=0.028). There were significantly less patients treated with insulin or shorter days of insulin therapy in experimental group than in control group [19.2% (5/26) vs. 46.2% (12/26), χ(2)=4.282, P=0.039; 1.6±0.9 vs. 4.3±3.1, t=-2.698, P=0.017]. The length of ICU stay was significantly shorter in the experimental group than that of control group (6.8±3.8 days vs. 10.7±7.3 days, t=-2.123, P=0.034). No significant differences were found about the GCS scores (before intervention: 6.3±1.0 vs. 6.4±1.0, t=-0.408, P=0.685; 21 days after intervention: 10.1±4.0 vs. 9.6±4.3, t=0.435, P=0.665) and 28-day mortality rate [11.5% (3/26) vs. 19.2% (5/26), χ(2)=0.148, P=0.701] between experimental group and control group. CONCLUSIONS: Probiotics could facilitate blood glucose control in patients with severe craniocerebral injury. The underlying mechanisms and its long-term efficacy in this category of patients, however, need to be further investigated.

Phosphorylation of DYNLT1 at serine 82 regulates microtubule stability and mitochondrial permeabilization in hypoxia.

Hypoxia-induced microtubule disruption and mitochondrial permeability transition (mPT) are crucial events leading to fatal cell damage and recent studies showed that microtubules (MTs) are involved in the modulation of mitochondrial function. Dynein light chain Tctex-type 1 (DYNLT1) is thought to be associated with MTs and mitochondria. Previously we demonstrated that DYNLT1 knockdown aggravates hypoxia-induced mitochondrial permeabilization, which indicates a role of DYNLT1 in hypoxic cytoprotection. But the underlying regulatory mechanism of DYNLT1 remains illusive. Here we aimed to investigate the phosphorylation alteration of DYNLT1 at serine 82 (S82) in hypoxia (1% O2). We therefore constructed recombinant adenoviruses to generate S82E and S82A mutants, used to transfect H9c2 and HeLa cell lines. Development of hypoxia-induced mPT (MMP examining, Cyt c release and mPT pore opening assay), hypoxic energy metabolism (cellular viability and ATP quantification), and stability of MTs were examined. Our results showed that phosph-S82 (S82-P) expression was increased in early hypoxia; S82E mutation (phosphomimic) aggravated mitochondrial damage, elevated the free tubulin in cytoplasm and decreased the cellular viability; S82A mutation (dephosphomimic) seemed to diminish the hypoxia-induced injury. These data suggest that DYNLT1 phosphorylation at S82 is involved in MTs and mitochondria regulation, and their interaction and cooperation contribute to the cellular hypoxic tolerance. Thus, we provide new insights into a DYNLT1 mechanism in stabilizing MTs and mitochondria, and propose a potential therapeutic target for hypoxia cytoprotective studies.

[Atrophic glossitis is attributed to cobalamin deficiency].

PURPOSE: To analyze the causes of atrophic glossitis(AG) and to explore the relationship between AG and serum cobalamin, folate levels. METHODS: A total of 213 patients with AG treated from Jan.1979 to Jun. 2010 were analyzed for the causes of AG. Serum cobalamin, folate levels and complete blood count were tested in newly enrolled AG patients from Sep. 2010 to Aug. 2011. All data were analyzed with SPSS 16.0 software package for Student's t test. RESULTS: There were 97 AG patients (45.4%) suffering from megaloblastic anemia (MA)/ macrocytosis. Among the 72 newly enrolled AG patients, fifty had cobalamin deficiency. Meanwhile, serum folate levels were increased in cobalamin deficiency group. CONCLUSIONS: Cobalamin deficiency is the common cause both of MA/macrocytosis and AG, also may be the main cause of AG. Furthermore, AG may be the early clinical manifestation of cobalamin deficiency.

Optimal qualifications, staffing and scope of practice for first responder nurses in disaster.

AIMS AND OBJECTIVES: To explore: the selection criteria for first responder nurses during disaster; scope of practice for disaster relief nurses; appropriate nurse - medical practitioner ratio at the disaster site. BACKGROUND: Nurses are key members of disaster response medical teams. A scarcity of literature exists relating to nurses attending disasters, their qualifications, experience, scope of practice and appropriate staffing ratios. DESIGN: Qualitative and quantitative data were collected via survey using self-developed questionnaires. Participants were 95 medical workers, who participated in emergency rescue teams following the 2008 Wenchuan earthquake in China. A response rate of 93·7% achieved. METHOD: The questionnaire included questions relating to nurses: previous experience in disaster relief; scope of practice at the disaster site; optimal ratio of medical practitioners to nurses in disaster relief teams. RESULTS: Following a disaster, first responder nurses considered most suitable were those with at least three years clinical experience, particularly in the emergency department or having emergency rescue skills training. The scope of practice for disaster relief nurses was different to that of nurses working in a hospital. The majority of participants reported insufficient nurses during the relief effort, concluding the optimal ratio of medical practitioner to nurse should range between 1:1-1:2 depending on the task and situation. CONCLUSION: At the scene of disaster, the preferred first responder nurses were nurses: with emergency rescue training; experienced in the emergency department; with at least three years clinical experience. The scope of practice for first responder nurses needs to be extended. Appropriate nurse - medical practitioner ratios in responding medical teams is dependant on the specific medical requirements of the disaster. RELEVANCE TO CLINICAL PRACTICE: The recommendations made by this study provide a guide to ensure that nurses can contribute effectively as essential members of first responder emergency disaster relief teams.