Influencing factors of self-management ability among dry eye patients in west China

AIM:To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China.METHODS:A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University.All participants completed the rating scale of health self-management skill for adults(AHSMSRS),Huaxi Emotional-Distress Index(HEI),e-health literacy scale(e-HEALS)and Brief Illness Perception Questionnaire(Brief-IPQ).A generalized linear model was employed to establish a multivariate linear model with demographic data,psychological state,e-HEALS,and illness perception as independent variables and health selfmanagement skill score as the dependent variable.RESULTS:The mean score for health self-management skill was 165.58±15.79.Multivariate analysis revealed that advanced age,better illness perception and improved psychological state were associated with better health selfmanagement ability among dry eye patients.Furthermore,the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y.CONCLUSION:The health self-management ability of dry eye patients in west China is relatively high.Age,duration of disease,illness perception and psychological state are the influencing factors on the health selfmanagement ability of dry eye patients.

Influencing factors of fear of falling among glaucoma patients in west China:a cross-sectional study

AIM:To investigate the current situation and influencing factors of fear of falling in glaucoma patients in western China.METHODS:In this cross-sectional study,glaucoma patients treated in the Ophthalmology Department of West China Hospital of Sichuan University were conducted to investigate the demographic data,visual acuity,visual field,activities of daily living,risk of falling,fear of falling and psychological states.Generalized linear model was used for multivariate analysis with fear of falling as dependent variable and other factors as independent variables.RESULTS:The mean score of the Chinese version modified Fall Efficacy Scale(MFES)was 7.52±2.09 points.Univariate analysis and multivariate analysis showed that the history of falls within one year,visual acuity,visual field,risk of falling,activities of daily living and psychological states had statistically difference on fear of falling(P<0.05).CONCLUSION:Glaucoma patients in west China have relatively high risk of fear of falling.History of falling within 1y,severe visual function impairment,high risk of falling,incapable of independence of daily living,and abnormal psychological state are risk factors of fear of falling among glaucoma patients.

Research progress of hierarchical division in nursing ladder management in China

This paper reviews the concept, research condition and research progress of hierarchical division in nursing ladder management in China; points out the problem and outlook of this area.

Efficacy of spray flushing in the reprocessing of flexible endoscopes:A randomized controlled trial

BACKGROUND Commonly used cleaning brushes in the reprocessing of flexible endoscopes often cause damage within the working channels.AIM To develop a spray flushing system to achieving effective cleaning of the working channels while minimizing damage.METHODS This prospective study included 60 used endoscopes and 60 Teflon tubes randomly divided into a control group(n=30)and an experimental group(n=30).The material of Teflon tubes was the same as that of the endoscope working channel.Endoscopes in the control group were manually cleaned using traditional cleaning brushes,while those in the experimental group were cleaned using the newly developed spray flushing system.ATP levels,cleanliness,and microbiological testing of the working channels were measured.Additionally,Teflon tubes in the control group underwent 500 passes with a cleaning brush,while those in the experimental group were subjected to the spray flushing system,and channel damage was evaluated.RESULTS The ATP levels(RLU)in the two groups were 32.5(13-66)and 26(16-40),respectively(P>0.05).Cleanliness scores were 1.5(1-2)and 1(1-2),respectively(P>0.05).Debris was found in 73.3%of the control group,which was significantly higher than 46.7%in the experimental group(P<0.05).Microbiological tests for both groups yielded negative results.Teflon tube damage in the control group was rated at 4(4-5.25),which was significantly higher than in the experimental group 4(3-4)(P<0.01).CONCLUSION The spray flushing system demonstrated superior efficacy in removing debris and resulted in less damage to the endoscope working channels compared with traditional cleaning brushes.

Curative effect of hydrogen peroxide combined with silver ion disinfection on pelvic floor dysfunction

BACKGROUND Pelvic floor dysfunction(PFD)is related to muscle fiber tearing during childbirth,negatively impacting postpartum quality of life of parturient.Appropriate and effective intervention is necessary to promote PFD recovery.AIM To analyze the use of hydrogen peroxide and silver ion disinfection for vaginal electrodes in conjunction with comprehensive rehabilitation therapy for postpartum women with PFD.METHODS A total of 59 women with PFD who were admitted to the hospital from May 2019 to July 2022 were divided into two groups:Control group(n=27)received comprehensive rehabilitation therapy and observation group(n=32)received intervention with pelvic floor biostimulation feedback instrument in addition to comprehensive rehabilitation therapy.The vaginal electrodes were disinfected with hydrogen peroxide and silver ion before treatment.Intervention for both groups was started 6 weeks postpartum,and rehabilitation lasted for 3 months.Pelvic floor muscle voltage,pelvic floor muscle strength,vaginal muscle voltage,vaginal muscle tone,pelvic floor function,quality of life,and incidence of postpartum PFD were compared between the two groups.RESULTS Before comprehensive rehabilitation treatment,basic data and pelvic floor function were not significantly different between the two groups.After treatment,the observation group showed significant improvements in the maximum voltage and average voltage of pelvic floor muscles,contraction time of type I and type II fibers,pelvic floor muscle strength,vaginal muscle tone,vaginal muscle voltage,and quality of life(GQOLI-74 reports),compared with the control group.The observation group had lower scores on the pelvic floor distress inventory(PFDI-20)and a lower incidence of postpartum PFD,indicating the effectiveness of the pelvic floor biostimulation feedback instrument in promoting the recovery of maternal pelvic floor function.CONCLUSION The combination of the pelvic floor biostimulation feedback instrument and comprehensive rehabilitation nursing can improve pelvic floor muscle strength,promote the recovery of vaginal muscle tone,and improve pelvic floor function and quality of life.The use of hydrogen peroxide and silver ion disinfectant demonstrated favorable antibacterial efficacy and is worthy of clinical application.

Management strategies in a thoracic surgery ward during COVID-19 pandemic: Experience from West China Hospital

The coronavirus disease 2019 was first reported in Wuhan in December 2019 and then spread rapidly throughout the world.On March 11,2020,the World Health Organization declared coronavirus disease 2019 a pandemic.In response to the pandemic,the management division of West China Hospital oversaw the implementation of hospital-wide emergency measures.In accordance with these measures,the hospital's thoracic surgery ward implemented a new management system by reformulating staff training plans,patient admission procedures,and other systems for managing the ward and protecting perioperative patients.Overall,the ward was successful in restoring normal working order,protecting all staff from occupational exposures,and ensuring the safety of inpatients and their families.

Non-linear relationship between age and subfoveal choroidal thickness in Chinese patients with proliferative diabetic retinopathy

BACKGROUND No study has investigated the change regularity between age and subfoveal choroidal thickness(SFCT)in proliferative diabetic retinopathy(PDR).AIM To investigate the relationship between the SFCT and age in Chinese patients with PDR.METHODS This was a cross-sectional retrospective study.The participants were hospitalized individuals with type 2 diabetes who underwent vitrectomy for PDR.Contralateral eyes that met the criteria were included in the study.All necessary laboratory tests were performed at the time of admission.Central macular thickness(CMT)and SFCT were two quantitative assessments made using enhanced depth imaging optical coherence tomography.CMT was measured automatically and SFCT was measured manually with digital calipers provided by the Heidelberg Eye Explorer software.RESULTS The final analysis included a total of 234 individuals with PDR.The average age was 55.60 years old±10.03 years old,and 57.69%of the population was male.Univariate analysis revealed a significant negative connection between age and SFCT in patients with PDR[β=-2.44,95%confidence interval(95%CI):-3.46 to-1.42;P<0.0001].In the fully adjusted model,the correlation between SFCT and age remained steady(β=-1.68,95%CI:-2.97 to-0.39;P=0.0117).Spline smoothing showed that the relationship between SFCT and age in patients with PDR was non-linear,with an inflection point at 54 years of age.CONCLUSION Our findings suggest that age is a key determinant of choroidal thickness.The non-linear link between SFCT and age in PDR patients should be taken into account.

4种肌少症筛查工具在慢性肝病患者中应用的性能比较

目的比较shii评分、 肌少症筛查5项评分量表(Strength, Assistance with Walking, Rise from aChair, Climb Stairs and Falls , SARC-F).肌少症筛查5项评分联合小腿围量表(SARC-F and Calf Circumferen-ce, SARC-CalF)及迷你肌少症风险评估-7条目问卷(Mini Sarcopenia Risk Assessment-7 ,MSRA-7)筛查慢性肝病患者肌少症的相对准确性。方法该前瞻性研究纳人366例慢性肝病患者。应用Ishii评分.SARC-F、SARC-CalF和MSRA-7对患者进行筛查。肌少症由临床医生根据亚洲肌少症工作组(AsiaWorkingGroupforSarco-penia,AWGS)2019标准进行诊断,以此为金标准对4种筛查工具的性能进行比较。结果基于AWGS2019标准,本组慢性肝病患者的肌少症患病率为17.5%。Ishii评分、SARC-F .SARC-CalF和MSRA-7的受试者工作特征(receiver operating characteristic, ROC)曲线下面积(敏感度,特异度)分别为0.820(8594% ,78.15%)、0.528(6.25% , 99.34%) 0.642(45.31% , 83.1 1%).0.552(87.50% ,22.85%)。根据ROC曲线下面积、决策曲线以及校准曲线分析结果,Ishi评分筛查馒性肝病患者肌少症的性能优于其他3个工具(P<0.0001)。结论Ishii评分比SARC-F.SARC-CalF和MSRA-7更适合用于筛查馒性肝病患者的肌少症。护士在临床工作中可应用Ishii评分对慢性肝病患者进行肌少症筛查,早期发现肌少症风险,为进一步诊断肌少症提供依据。

护士心理负荷的影响因素:一项潜在剖面分析

目的采用潜在剖面分析的方法探讨临床护理人员心理负荷现状及其影响因素。方法于2023年3月-7月,以便利抽样法采用人口学资料调查表、领悟社会支持量表、简易应对方式问卷和NASA-任务负荷指数量表对我国5所三级医院的526名临床护士进行问卷调查。分别使用Mplus 7.3和SPSS 24.0软件进行潜在剖面分析和多元logistic回归分析,探讨心理负荷不同潜在剖面的影响因素。结果护理人员心理负荷总分为(69.57±16.93)分,可分为“低心理负荷-高自评”组(n=70,13.3%)、“中心理负荷”组(n=273,51.9%)和“高心理负荷-低自评”组(n=183,34.8%)3个潜在类型。在“高心理负荷-低自评”亚组中,工作年限≥5年、无子女、月收入≥6000元、健康状况差、近1年未接受过心理培训和遭受过工作场所暴力的护士比例高于其他亚组,组间差异具有统计学意义(P<0.05)。此外,logistic回归分析显示,与较高的心理负荷伴随的是消极的应对方式和较低的领悟社会支持。结论护士工作心理负荷可分为3个潜在类型。月收入、健康状况、心理培训、工作场所暴力、消极应对方式和领悟社会支持是心理负荷的影响因素。

Frequency and risk factors of psychological distress among individuals with epilepsy before and during the outbreak of the SARS-CoV-2 Omicron variant in China:an online questionnaire survey

Background The COVID-19 pandemic substantially increases the risk of severe psychological distress among people with epilepsy(PWE),especially those with monthly household income<5000 RMB or with uncontrolled seizures.Patients with Kessler scores>12 should consult a psychiatrist,especially during major disasters.This study was aimed to compare the frequency of psychological distress among Chinese PWE before and during the outbreak of the SARS-CoV-2 Omicron variant,and to identify risk factors for such distress.Methods In this prospective study,we collected sociodemographic data of PWE aged>14 years,who were treated at our center during December 1 to 15,2022.All participants completed the 6-item Kessler Psychological Distress Scale before the outbreak and again during the outbreak.Health visitors who were unrelated to those patients during the outbreak were included as a control.Multivariate logistic regression analysis was performed to identify risk factors of severe psychological distress and its exacerbation.Results Of the 223 PWE,127 were tested positive for SARS-CoV-2,while 174 of 218 controls were positive for SARS-CoV-2.The neurological symptoms were similar between PWE and controls with SARS-CoV-2.The average Kessler score of PWE was significantly higher during the outbreak than before it(9.93±3.98 vs.8.52±0.23,P<0.001).The average score of controls during the outbreak(5.146±0.35,P<0.001)was significantly lower than that of the PWE.We identified three independent predictors for severe psychological distress in PWE during the outbreak,i.e.,monthly household income<5000 RMB(OR=0.252,95%CI 0.064–0.998,P=0.048),severe psychological distress before the outbreak(OR=0.067,95%CI 0.026–0.174,P<0.001),and seizure onset within 30 days before the assessment during the outbreak(OR=0.356,95%CI 0.157–0.805,P=0.013).Of the three predictors,the last one was also an independent predictor for exacerbation of psychological distress during the outbreak(OR=0.302,95%CI 0.123–0.741,P=0.009).Conclusions Our analysis suggests that the COVID-19 pandemic has substantially increased psychological distress of individuals with epilepsy,regardless of the viral infection or not.Various neurological symptoms similar to those of“long COVID”appeared for the first time among these individuals during the Omicron outbreak,highlighting the need for clinicians to screen carefully for this condition.Management of epilepsy during the pandemic or a similar major disaster should focus on the control of seizures and maintenance of mental health,especially among those with monthly household incomes below 5000 RMB,suffering uncontrolled seizures and having a history of severe psychological distress.

Clinical comparison of antrum-preserving double tract reconstruction vs roux-en-Y reconstruction after gastrectomy for Siewert types Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction

AIM:To explore a reasonable method of digestive tract reconstruction,namely,antrum-preserving double-tract reconstruction(ADTR),for patients with adenocarcinoma of the esophagogastric junction(AEG) and to assess its efficacy and safety in terms of longterm survival,complications,morbidity and mortality.METHODS:A total of 55 cases were retrospectively collected,including 18 cases undergoing ADTR and 37 cases of Roux-en-Y reconstruction(RY) for AEG(Siewert types Ⅱ and Ⅲ) at North Sichuan Medical College. The cases were divided into two groups. The clinicopathological characteristics,perioperative outcomes,postoperative complications,morbidity and overall survival(OS) were compared for the two different reconstruction methods.RESULTS:Basic characteristics including sex,age,body mass index(BMI),Siewert type,p T status,p N stage,and lymph node metastasis were similar in the two groups. No significant differences were found between the two groups in terms of perioperative outcomes(including the length of postoperative hospital stay,operating time,and intraoperative blood loss) and postoperative complications(consisting of anastomosis-related complications,wound infection,respiratory infection,pleural effusion,lymphorrhagia,and cholelithiasis). For the ADTR group,perioperativerecovery indexes such as time to first flatus(P = 0.002) and time to resuming a liquid diet(P = 0.001) were faster than those for the RY group. Moreover,the incidence of reflux esophagitis was significantly decreased compared with the RY group(P = 0.048). The postoperative morbidity and mortality rates for overall postoperative complications and the rates of tumor recurrence and metastasis were not significantly different between the two groups. Survival curves plotted using the Kaplan-Meier method and compared by log-rank test demonstrated similar outcomes for the ADTR and RY groups. Multivariate analysis of significantly different factors that presented as covariates on Cox regression analysis to assess the survival and recurrence among AEG patients showed that age,gender,BMI,pleural effusion,time to resuming a liquid diet,lymphorrhagia and tumor-nodemetastasis stage were important prognostic factors for OS of AEG patients,whereas the selection of surgical method between ADTR and RY was shown to be a similar prognostic factor for OS of AEG patients.CONCLUSION:ADTR by jejunal interposition presents similar rates of tumor recurrence,metastasis and longterm survival compared with classical reconstruction with RY esophagojejunostomy; however,it offers considerably improved near-term quality of life,especially in terms of early recovery and decreased reflux esophagitis. Thus,ADTR is recommended as a worthwhile digestive tract reconstruction method for Siewert types Ⅱ and Ⅲ AEG.

Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients:A retrospective observational study

BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.

Predictive value of the unplanned extubation risk assessment scale in hospitalized patients with tubes

BACKGROUND Critical patients often had various types of tubes,unplanned extubation of any kind of tube may cause serious injury to the patient,but previous reports mainly focused on endotracheal intubation.The limitations or incorrect use of the unplanned extubation risk assessment tool may lead to improper identification of patients at a high risk of unplanned extubation and cause delay or nonimplementation of unplanned extubation prevention interventions.To effectively identify and manage the risk of unplanned extubation,a comprehensive and universal unplanned extubation risk assessment tool is needed.AIM To assess the predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale in inpatients.METHODS This was a retrospective validation study.In this study,medical records were extracted between October 2020 and September 2021 from a tertiary comprehensive hospital in southwest China.For patients with tubes during hospitalization,the following information was extracted from the hospital information system:age,sex,admission mode,education,marital status,number of tubes,discharge mode,unplanned extubation occurrence,and the Huaxi Unplanned Extubation Risk Assessment Scale(HUERAS)score.Only inpatients were included,and those with indwelling needles were excluded.The best cut-off value and the area under the curve(AUC)of the Huaxi Unplanned Extubation Risk Assessment Scale were been identified.RESULTS A total of 76033 inpatients with indwelling tubes were included in this study,and 26 unplanned extubations occurred.The patients’HUERAS scores were between 11 and 30,with an average score of 17.25±3.73.The scores of patients with or without unplanned extubation were 22.85±3.28 and 17.25±3.73,respectively(P<0.001).The results of the correlation analysis showed that the correlation coefficients between each characteristic and the total score ranged from 0.183 to 0.843.The best cut-off value was 21,and there were 14135 patients with a high risk of unplanned extubation,accounting for 18.59%.The Cronbach’sα,sensitivity,specificity,positive predictive value,and negative predictive value of the Huaxi Unplanned Extubation Risk Assessment Scale were 0.815,84.62%,81.43%,0.16%,and 99.99%,respectively.The AUC of HUERAS was 0.851(95%CI:0.783-0.919,P<0.001).CONCLUSION The HUERAS has good reliability and predictive validity.It can effectively identify inpatients at a high risk of unplanned extubation and help clinical nurses carry out risk screening and management.

Prospects and applications of enucleation in solid pseudopapillary neoplasms of the pancreas

Solid pseudopapillary neoplasms(SPNs)of the pancreas are rare,low-grade,malignant neoplasms that are mostly seen in young women in the second and third decades of life and are quite uncommon in children.Standard resection for benign and borderline neoplasms of the pancreas is associated with a substantial risk of postoperative morbidity and long-term functional impairment,whereas enucleation leads to less morbidity and preserves healthy parenchyma as well as exocrine and endocrine function.Enucleation of SPNs has been increasingly reported to be feasible and safe for preserving the normal physiological function of the pancreas,especially in teenagers and children.This review summarizes findings published in recent years on the enucleation of SPNs as well as potential future developments and directions.Enucleation has undoubtedly come to stay as an alternative surgical procedure for SPNs.However,many questions remain unresolved,and future directions toward the best surgical indication,the prevention and intervention of complications,especially pancreatic fistula,intraoperative resection margin safety assessment,and long-term oncology prognosis remain to be evaluated and should be explored in future clinical trials.

Rare case of drain-site hernia after laparoscopic surgery and a novel strategy of prevention:A case report

BACKGROUND Trocar site hernia(TSH)is a rare but potentially dangerous complication of laparoscopic surgery,and the drain-site TSH is an even rarer type.Due to the difficulty to diagnose at early stages,TSH often leads to a delay in surgical intervention and eventually results in life-threatening consequences.Herein,we report an unusual case of drain-site TSH,followed by a brief literature review.Finally,we provide a novel,simple,and practical method of prevention.CASE SUMMARY A 54-year-old female patient underwent laparoscopic subtotal hysterectomy and bilateral adnexectomy for uterine fibroids 8 d ago in another hospital.She was admitted to our hospital with a 2-d history of intermittent abdominal pain,nausea,vomiting,and abdominal enlargement with an inability to pass stool and flatus.The emergency computed tomography scan revealed the small bowel herniated through a 10 mm trocar incision,which was used as a drainage port,with diffuse bowel distension and multiple air-fluid levels with gas in the small intestines.She was diagnosed with drain-site strangulated TSH.The emergency exploratory laparotomy confirmed the diagnosis.A herniorrhaphy followed by standard intestinal resection and anastomosis were performed.The patient recovered well after the operation and was discharged on postoperative day 8 and had no postoperative complications at her 2-wk follow-up visit.CONCLUSION TSH must be kept in mind during the differential diagnosis of post-laparoscopic obstruction,especially after the removal of the drainage tube,to avoid the serious consequences caused by delayed diagnosis.Furthermore,all abdomen layers should be carefully closed under direct vision at the trocar port site,especially where the drainage tube was placed.Our simple and practical method of prevention may be a novel strategy worthy of clinical promotion.

“AFGP” bundles for an extremely preterm infant who underwent difficult removal of a peripherally inserted central catheter:A case report

BACKGROUND There have been few reports on level 3 difficult removal of peripherally inserted central catheter(PICC)in neonates.Here,we reported a case of an extremely preterm infant who underwent level 3 difficult removal of a PICC.CASE SUMMARY Female baby A,weighing 1070 g at 27^(+1) wk of gestational age,was diagnosed with extremely preterm infant and neonatal respiratory distress syndrome.She underwent PICC insertion twice.The first PICC insertion went well;the second PICC was inserted in the right lower extremity,however,phlebitis occurred on the second day after the placement.On the third day of catheterization,phlebitis was aggravated,while the right leg circumference increased by 2.5 cm.On the fourth day of catheterization,more red swelling was found in the popliteal part,covering an area of about 1.5 cm×4 cm,which was diagnosed as phlebitis level 3;thus,we decided to remove the PICC.During tube removal,the catheter rebounded and could not be pulled out(several conventional methods were performed).Finally,we successfully removed the PICC using a new approach termed“AFGP”.On the 36th day of admission,the baby fully recovered and was discharged.CONCLUSION The“AFGP”bundle approach was effective for an extremely preterm infant,who underwent level 3 difficult removal of a PICC.

Peripherally inserted central catheter placement in neonates with persistent left superior vena cava: Report of eight cases

BACKGROUND Reports on peripherally inserted central catheter(PICC)placement in neonates with persistent left superior vena cava(PLSVC)are rare.The majority of PLSVC patients have no clinical symptoms or hemodynamic changes,which are usually detected during cardiac catheterization,cardiac pacemaker implantation,or PICC placement.However,in neonates with PLSVC,PICC placement can be challenging.Here,we report PICC placement in eight neonates with PLSVC.CASE SUMMARY This article introduces the concept of the“TIMB”bundle.After PICC implantation,we found PLSVC in all eight patients.The key points of care regarding PICC placement in neonates with PLSVC included“TIMB”,where“T”indicates a reasonable choice of the catheterization time,“I”refers to a retrospective analysis of imaging data before catheterization,“M”refers to correct measurement of the body surface length,and“B”indicates that the tip of the PICC is placed in the middle and lower 1/3 of the left superior vena cava under the guidance of B-ultrasound.CONCLUSION“TIMB”is a bundle for PICC placement in neonates,especially for those with PLSVC.Using this new approach can improve the first-attempt success rate of PICC placement,reveal cardiovascular abnormalities in advance,allow the selection of different measurement methods reasonably according to the puncture site,and finally,improve the accuracy of catheter positioning through the use of B-ultrasound guidance.

Factors related to early and rapid assessment of in-hospital mortality among older adult trauma patients in an earthquake

BACKGROUND:There is limited evidence for emergency physicians and emergency trauma surgeons regarding the determinants of early and rapid assessment of older adult in-hospital mortality due to earthquakes.This study explored factors related to the early and rapid assessment of the mortality among older adult earthquake trauma patients(OAETPs)and created a screening model.METHODS:Data on 7,308 OAETPs from the West China Earthquake Patients Database were analyzed retrospectively.The 35 variables that can be obtained rapidly on arrival at the hospital were collected.Least absolute shrinkage and selection operator(LASSO)regression analysis was performed.Then,the nomogram for assessing the mortality of OAETPs was constructed.RESULTS:We identified 10 independent mortality-related factors that contributed to the in-hospital mortality of OAETPs.The 10 factors included age(odds ratio[OR]=1.061,95%confidence interval[CI]:1.031-1.090),dementia(OR=5.146,95%CI:1.169-17.856),coronary heart disease(CHD;OR=23.441,95%CI:4.799-83.927),malignant tumor(OR=8.497,95%CI:3.583-17.967),deep vein thrombosis(DVT;OR=7.110,95%CI:1.369-27.168),chronic kidney disease(CKD;OR=11.783,95%CI:5.419-24.407),pulse rate(PR;OR=1.036,95%CI:1.022-1.048),mean artery pressure(MAP;OR=0.960,95%CI:0.945-0.975),Glasgow Coma Scale(GCS;OR=0.864,95%CI:0.760-0.972),and Triage Revised Trauma Score(T-RTS,OR=0.485,95%CI:0.351-0.696).CONCLUSION:The 10 mortality-related factors could be quickly obtained on hospital arrival and should be the focal point of future earthquake response strategies regarding hospitalized older adults with trauma.A nomogram was constructed based on the factors for screening OAETPs with a higher risk of in-hospital mortality.

Role of circular RNA expression in the pathological progression after spinal cord injury

Differential expression of non-coding RNA after traumatic spinal cord injury(TSCI)is closely related to the pathophysiological process.The purposes of this study were to systematically profile and characterize expression of circular RNA(circRNA)in the lesion epicenter of spinal tissues after TSCI,and predict the structure and potential function of the regulatory circRNA/miRNA network.Forty-eight C57BL/6 mice were randomly and equally assigned to two groups:one subjected to TSCI at T8–10 with an Allen’s drop impactor,and a second subjected to laminectomy without TSCI.Spinal cord samples were stained with hematoxylin and eosin,sequenced,and validated.RNA-Seq,Gene Ontology analysis,Kyoto Encyclopedia of Genes and Genomes analysis,and network analyses(Targetscan and miRanda)were used to predict and annotate the circRNA/miRNA/mRNA network.Luciferase reporter,quantitative reverse transcription polymerase chain reaction,and western blot assays were used to profile expression and regulation patterns of the network in mouse models of TSCI.Hematoxylin-eosin staining revealed severe damage to the blood-spinal cord barrier after TSCI.Differentially expressed circRNA and miRNA profiles were obtained after TSCI;differentially expressed circRNAs,which were abundant in the cytoplasm,were involved in positive regulation of transcription and protein phosphorylation.miR-135b-5p was the most significantly downregulated miRNA after TSCI;circRNAAbca1 and KLF4 were predicted to be its target circRNA and mRNA,respectively.Subsequently,the circAbca1/miR-135b-5P/KLF4 regulatory axis was predicted and constructed,and its targeted binding was verified.After inhibiting circAbca1,GAP43 expression was upregulated.Differential expression of circRNAs might play an important role after TSCI.circAbca1 plays a neuroinhibitory role by targeted binding of the miR-135b-5P/KLF4 axis.The identified circRNA/miRNA/mRNA network could provide the basis for understanding pathophysiological mechanisms underlying TSCI,as well as guide the formulation of related therapeutic strategies.All animal protocols were approved by the Research Ethics Committee of West China Hospital of China(approval No.2017128)on May 16,2017.

Relationship of body fat and left ventricular hypertrophy with the risk of all-cause death in patients with coronary artery disease

BACKGROUND Left ventricular hypertrophy(LVH)is prevalent in obese individuals.Besides,both of LVH and obesity is as-sociated with subclinical LV dysfunction.The study aims to investigate the interplay between body fat and LVH in relation to all-cause death in patients with coronary artery disease(CAD).METHODS In this retrospective cohort study,a total of 2243 patients with angiographically proven CAD were included.Body fat and LV mass were calculated using established formulas.Patients were grouped according to body fat percentage and pres-ence or absence of LVH.Cox-proportional hazard models were used to observe the interaction effect of body fat and LVH on all-cause death.RESULTS Of 2243 patients enrolled,560(25%)had a higher body fat percentage,and 1045(46.6%)had LVH.After a median follow-up of 2.2 years,the cumulative mortality rate was 8.2%in the group with higher body fat and LVH,2.5%in those with lower body fat and no LVH,5.4%in those with higher body fat and no LVH,and 7.8%in those with lower body fat and LVH(log-rank P<0.001).There was a statistically significant interaction between body fat percentage and LVH(P interaction was 0.003).After correcting for confounding factors,patients with higher body fat and LVH had the highest risk of all-cause death(HR=3.49,95%CI:1.40-8.69,P=0.007)compared with those with lower body fat and no LVH;in contrast,patients with higher body fat and no LVH had no statistically significant difference in risk of death compared with those with lower body fat and no LVH(HR=2.03,95%CI:0.70-5.92,P=0.195).CONCLUSION A higher body fat percentage was associated with a different risk of all-cause death in patients with CAD,strat-ified by coexistence of LVH or not.Higher body fat was significantly associated with a greater risk of mortality among patients with LVH but not among those without LVH.