Intensivists’response to hyperoxemia in mechanical ventilation patients:The status quo and related factors

BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased.Patients may be at a risk of oxygen toxicity because of the liberal oxygen strategy.Therefore,further research is needed to improve oxygen management for patients with MV in the ICUs.

A novel mutation of p.F32I in GJA8 in human dominant congenital cataracts

AIM： To identify a causative mutation in a three-generation family with autosomal dominant congenital total cataract and dissect the molecular consequence of the identified mutation.METHODS： Clinical and ophthalmological examinations were performed on the affected and unaffected family members. Mutation were screened in recruited family members by polymerase chain reaction（PCR） of the two reported genes（CRYAA and GJA8） which were linked to human total cataracts and direct sequencing of the PCR product. The molecular consequences of the identified mutation was dissected. The plasmids carrying wild-type and mutant mouse ORF of Gja8, coding for connexin 50（Cx50）, were generated and ectopic expressed in 293 cells. Recombinant protein expression and cellular localization of recombinated Cx50 were assessed by confocal microscopy.RESULTS： Clinical and ophthalmological examinations were performed on the affected and unaffected family members. Mutation were screened in recruited family members by PCR of the two reported genes（CRYAA and GJA8） which were linked to human total cataractsand direct sequencing of the PCR product. The molecular consequences of the identified mutation was dissected.The plasmids carrying wild-type and mutant mouse ORF of Gja8, coding for Cx50, were generated and ectopic expressed in 293 cells. Recombinant protein expression and cellular localization of recombinated Cx50 were assessed by confocal microscopy. CONCLUSION： This study has identified a novel cataract mutation in GJA8, which adds a novel mutation to the existing spectrum of Cx50 mutations with cataract.The molecular consequences of p.F32 I mutation in GJA8 exclude instability and the mislocalization of mutant Cx50 protein.

Prevalence and predictive factors of elder mistreatment in Chinese migrant families

Objectives:To examine the prevalence of and identify the predictive factors for elder mistreatment(EM)in Chinese migrant families.Methods:This was a cross-sectional study.A total of 489 rural migrant elderly were recruited using multistage sampling technique from communities in Wenzhou city between June 2020 and October 2020.All par ticipants completed the Mini-Cog,and then data were collected in a survey using the 12-Item Shor t-Form Health Survey Questionnaire,Abuser’s Dependency Scale,the Friendship Scale(FS),Intergenerational Ambivalence Scale,Filial Piety Index,the Assessment Tool of Domestic Elder Abuse,and a demographic questionnaire.Descriptive statistics and multiple regression were carried out to analyze the data.Results:The prevalences of physical mistreatment,psychological mistreatment,neglect,economic mistreatment,and social mistreatment among the migrant elderly were 1.23%,20.65%,22.50%,0.61%,and 9.41%,respectively.Significant predictive factors were migrant elderlies’mental health status(β=–0.118,P<0.01),adult children’s filial piety(FP)(β=–0.245,P<0.001),and intergene rational ambivalence(β=0.365,P<0.001).Conclusions:EM was common among the migrant elderly.Predictive factors for EM in Chinese migrant families were identified.The findings could be useful in developing nursing interventions to promote migrant elderlies’mental health,uphold their children’s FP,and harmonize intergenerational relationship to avoid EM.