Rehabilitation care for pain in elderly knee replacement patients

BACKGROUND Total knee arthroplasty(TKA)is recognized as the most effective surgical intervention for relieving pain and improving joint mobility and deformity in patients with knee osteoarthritis and other synovial diseases.The application of accelerated postoperative rehabilitation(enhanced recovery after surgery)has demonstrated its efficacy in improving patient outcomes,and early postoperative joint function exercise has become a key prognostic factor in knee replacement.The unexpected appearance of limb pain and swelling hindered the patient’s tendency for early mobilization,leading in prolonged hospitalization,delayed functional recovery and negative psychological responses.A retrospective analysis was conducted on a cohort of 116 patients who under-went TKA at our hospital between July 2019 and July 2021.The patients were divided into two groups:A control group(n=58)receiving programmatic nur-sing,and an observed group(n=58)receiving programmed nursing combined with a collaborative nursing model.A pain management team consisting of attending physicians,head nurses,and responsible nurses was established.Outcome measures included visual analogue scale(VAS)scores,activities of daily living(ADL)scale scores,and functional scores.The ADL scores of patients in both groups exhibited a continuous increase.However,there was no statistically significant difference in the ADL scores between the two groups at 48 h and the 7th d post-surgery(P>0.05).Upon reexamination at the 3rd mo,the observation group demonstrated higher ADL scores compared to the control group(67.48±14.69 vs 59.40±16.06,P<0.05).The VAS scores of both groups significantly decreased,with no significant difference observed between the groups at each time point(P>0.05).The functional status of patients in both groups exhibited a gradual increase prior to intervention and at the 1st,2nd,and 3rd month following discharge(P<0.05).There was no statistically significant difference in knee joint function scores between the two groups at the 1st month after discharge(47.52 vs 45.81,P>0.05).However,the knee joint function scores of patients in the observation group were significantly higher than those in the control group at the 2nd(59.38 vs 53.19,P<0.05)and 3rd month(71.92 vs 64.34,P<0.05)following discharge.CONCLUSION The utilization of programmed pain nursing in conjunction with collaborative nursing for out-of-hospital care of TKA patients has demonstrated favorable outcomes,encompassing pain reduction,enhanced prognosis,and improved nursing quality for patients.

Clinical nursing value of predictive nursing in reducing complications of pregnant women undergoing short-term massive blood transfusion during cesarean section

BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.

Endoscopic ultrasound features of rectal melanoma:A case report and review of literature

BACKGROUND Rectal mucosal melanoma is a rare and highly aggressive disease.Common symptoms include anal pain,an anal mass,or bleeding.As such,the disease is usually detected on rectal examination of patients with other suspected anorectal diseases.However,due to its rarity and nonspecific symptoms,melanoma of the rectal mucosa is easily misdiagnosed.CASE SUMMARY This report describes the case of a 58-year-old female patient who presented with a history of blood in her stool for the prior one or two months,without any identifiable cause.During colonoscopy,a bulge of approximately 2.2 cm×2.0 cm was identified.Subsequently,the patient underwent endoscopic ultrasound(EUS)to characterize the depth of invasion of the lesions.EUS suggested a hypoechoic mucosal mass with involvement of the submucosal layer and heterogeneity of the internal echoes.Following surgical intervention,the excised tissue samples were examined and confirmed to be rectal malignant melanoma.The patient recovered well with no evidence of recurrence during follow-up.CONCLUSION This case shows that colonoscopy with EUS and pathological examination can accurately diagnose rare cases of rectal mucosal melanoma.

Nursing effect of narrative nursing intervention on postoperative patients with severe lung cancer

BACKGROUND Lung cancer is a common disease with high mortality,and psychological support is very important in the diagnosis and treatment of postoperative patients with cancer pain.AIM To explore the application effect of the narrative nursing method in postoperative lung cancer patients in the intensive care unit.METHODS A total of 120 patients diagnosed with lung cancer and experiencing cancer-related pain were randomly allocated into two groups:an observation group and a control group,each consisting of 60 cases.The control group was given routine analgesic and psychological care,while the research group applied the five-step narrative nursing method based on routine care,comparing the visual analogue scale scores,sleep status,anxiety and depression status,and quality of life of the two groups of patients before and after the intervention.RESULTS The pain scores,anxiety scores,and depression scores of the study group were lower than those of the control group after the intervention using the narrative nursing method,and the difference was statistically significant(P<0.05).CONCLUSION Using narrative nursing methods to intervene in patients with lung cancer combined with cancerous pain can help patients to correctly recognize their disease,adjust their mentality,establish confidence,alleviate patients'subjective pain feelings,and improve their adverse emotions.

Left inferior phrenic arterial malformation mimicking gastric varices: A case report and review of literature

BACKGROUND Gastric submucosal arterial dilation resulting from splenic artery occlusion represents an exceedingly rare etiology of acute upper gastrointestinal bleeding(UGIB).Although endoscopy is a widely utilized diagnostic and therapeutic modality for gastrointestinal bleeding,it has limitations in detecting arterial abnormalities.CASE SUMMARY This report presents a rare case of massive UGIB in a 57-year-old male with a tortuous left inferior phrenic artery accompanied by splenic artery occlusion.“Gastric varices”was identified during the patient's endoscopy one year before hemorrhage.Despite initial hemostasis by endoscopic clipping,the patient experienced massive rebleeding after one month,requiring intervention with transcatheter arterial embolization(TAE)to achieve hemostasis.CONCLUSION This is the first case to report UGIB due to a tortuous left inferior phrenic artery.This case highlights the limitations of endoscopy in identifying arterial abnormalities and emphasizes the potential of TAE as a viable alternative for the management of arterial bleeding in the gastrointestinal tract.

Stressors and Coping Strategies of Medical Staff in the COVID-19 Pandemic in Wuhan

Exploring whether medical staff perceive stress on the assigned medical tasks,what are the specific sources of stress,what are the tangible sources of support they expected to be helpful,and individual coping with stress to provide more accurate,personal support for psychological crisis.This study uses a cross-sectional descriptive survey adopting convenience sampling among the medical staff who worked for over seven days in the infected areas of one Grade 2A and three Grade 3A hospitals during the COVID-19 pandemic.The assessment includes attitude when receiving tasks,major stressors,factors relieving stress,and personal management of stress.A total of 104(76.8%)valid questionnaires are received.A majority(94.3%)of the medical staff held a positive attitude taking duty for granted but feeling nervous and afraid(81.1%).Contacting the infected(90.6%)and compensation(92.5%)are the main concerns.The major pressure sources are regarding safety for oneself(98.1%),colleagues(92.5%),and family(94.3%),as well as lack of effective treatment(92.5%),inadequate protective equipment(94.3%)and incomplete disinfection(94.3%).The main positive pressure adjustments include strict infection controlling measures(98.4%),maintaining a positive attitude(95.2%),actively attain more information 95.2%,and engage in recreational activities(93.6%),but more than 40%takes negative adjustments to vent their emotions and relieve anxiety,suggesting the importance of early psychological intervention.During the COVID-19 pandemic,the main stressors among medical staff are safety,uncertainty and shortage of resources.Positive coping includes taking effective protective measures and achieving thorough understanding of the virus.

The Effectiveness of Antiviral Treatment in Severe COVID-19 Patients in Wuhan,China:A Multicenter Study

Coronavirus disease 2019(COVID-19)has inarguably caused the most challenging pandemic.In less than 2 years,greater than 200 million cases of COVID-19 and 4.5 million deaths have been reported worldwide[1].The treatment strategy of an emerging infectious disease is a huge challenge for clinical practitioners because of missing key knowledge about the disease.

Influence of standardized nursing intervention combined with mindfulness stress reduction training on the curative effect in patients with acute pancreatitis

BACKGROUND Acute pancreatitis(AP)is a common inflammatory disease of the pancreas with high mortality rates.It is of great significance to take scientific intervention measures for patients with AP in time.AIM To explore the effect of standardized nursing combined with mindfulness stress reduction training on the curative effect,negative emotion,and quality of life in patients with acute pancreatitis.METHODS A total of 80 patients with acute pancreatitis admitted to The First People's Hospital of Jiangxia District Hospital from May 2021 to May 2023 were randomly divided into control group and observation group(n=40).Patients in control group were given the standardized nursing intervention,and the observation group were given standardized nursing plus mindfulness stress reduction training intervention.The time of clinical symptom disappeared or improved,complication occurrence rate,emotional state,and quality of life score of the two groups were observed and compared.RESULTS In comparison with the control group,the bowel sound recovery time,ventosity and abdominal pain improvement time,and venting and cacation time in observation group were shorter,and the total incidence rate of complications was reduced,showing statistically significant difference(P<0.05).The scores of anxiety and depression in observation group were lower than those in control group(P<0.05).Serum levels of tumour necrosis factor alpha,interleukin(IL)-6,IL-1βand IL-8 in observation group were lower than those in control group(P<0.05).The scores of life quality in physiology,psychology,environment and social relations in observation group were higher than those in control group,and the differences were statistically significant(P<0.05).CONCLUSION The application of standardized nursing intervention combined with mindfulness stress reduction training in patients with acute pancreatitis has a definite effect,which can help to ameliorate the clinical symptoms,anxiety and depression of patients,reduce the incidence rate of complications,and improve the prognosis of patients.

Neural-like cells from adipose-derived stem cells for cavernous nerve injury in rats

Although the remaining nerve tissue can regenerate and partly restore erectile function when the cavernous nerve is compressed/severed and function lost, the limited regenerative ability of these nerve tissues often fails to meet clinical needs. Adipose-derived stem cells are easy to obtain and culture, and can differentiate into neural cells. Their proliferation rate is easy to control and they may be used to help restore injured cavernous nerve function. Sprague-Dawley male rats(n = 45) were equally randomized into three groups: fifteen rats as a sham-operated group, fifteen rats as a bilateral nerve crush(BINC) group(with no further intervention), fifteen rats as a BINC with intracavernous injection of one million neural-like cells from adipose-derived stem cells(NAS)(BINC + NAS) group. After 4 weeks, erectile function was assessed by stimulating the cavernous body. The number of myelinated axons in the dorsal cavernous nerve was determined by toluidine blue staining. The area of neuronal nitric oxide synthase-positive fibers in the dorsal penile nerve was measured by immunohistochemical staining. Masson staining was used to analyze the ratio of smooth muscle to collagen in penile tissue. The results demonstrate that maximal intracavernous pressure, the ratio of maximal intracavernous pressure to mean arterial pressure, the numbers of myelinated axons and neuronal nitric oxide synthase-positive fibers in the dorsal penile nerve, and the ratio of smooth muscle to collagen could be increased after cell transplantation. These findings indicate that neural-like cells from adipose-derived stem cells can effectively alleviate cavernous nerve injury and improve erectile function. All animal experiments were approved by the Animal Ethics Committee of Huazhong University of Science and Technology, China(approval No. 2017-1925) on September 15, 2017.

The expression of MYH9 in osteosarcoma and its effect on the migration and invasion abilities of tumor cell

Objective: To determine the expression of non-muscle myosin heavy chain 9(MYH9) in osteosarcoma and its effect on the migration and invasion abilities of tumor cell. Methods: A total of 65 cases of osteosarcoma and 20 cases with benign osteochondroma who underwent resection operation in the Orthopaedics Department of our hospital from January 1st 2009 to January 1st 2015 were selected. Their mR NA levels of MYH9 were tested by q rt-PCR. Immunohistochemical method was used to examine the expression of MYH9 in osteosarcoma and the correlation between the positive expression of MYH9 and the clinicopathological features of patients was illustrated by statistical analysis. MYH9 was compounded artificially. The expression of MYH9 in SAOS2 osteosarcoma cells was decreased by si RNA. Scratch test was used to determine the change of SAOS2 cell migration ability after MYH9 silence. Transwell assay was employed to detect the change of cell invasion ability after MYH9 silence.Results: The expression levels of m RNA of MYH9 and protein in osteosarcoma tissues were significant higher than those in benign osteochondroma tissues. The high expression of MYH9 in osteosarcoma tissues was apparently related to the high Enneking classification(III classification) and lung metastasis. SiR NA of MYH9 could evidently decrease the expression level of MYH9 in SAOS2. The down-regulated expression of MYH9 could inhibit the migration and invasion abilities of SAOS2 cells. Conclusions: MYH9 shows a trend of high expression in osteosarcoma tissues, and its high expression is associated with features such as tumor invasion and metastasis. The down-regulated MYH9 can realize an anti-tumor effect by inhibiting the migration and invasion of osteosarcoma cells.

Impact of Probiotics on Toll-like Receptor 4 Expression in an Experimental Model of Ulcerative Colitis

Toll-like receptors （TLRs） are key components of the innate immune system which trigger antimicrobial host defense responses. This study aimed to investigate the impact of probiotics （Lactoba- cillus, Bifiidobacterium） on the expression of TLR4 and tumor necrosis factor-alpha （TNF-α in the co- lon mucosa of rat experimental ulcerative colitis model induced by trinitrobenzene sulfonic acid （TNBS）/ethanol and immune complexes. The gross and histological changes of the colonic mucosa were observed and assessed by the means-standard deviation and independent samples t-test. The pro- tein expression levels of TLR4 and TNF-α were detected by using immunohistochemistry and Westem blotting, respectively. It was revealed that there was visible infiltration of inflammatory cells, formation of crypt abscess, and the reduction of goblet cells in the colon tissue of experimental models. As com- pared with the control group, the levels of TLR4 and TNF-α protein were significantly increased in the model group （P〈0.01 for both）. No significant difference was found in the expression of TLR4 and TNF-α between the two-week probiotics treatment group and the model group （P〉0.05）, whereas sig- nificant reductions were shown in rats which were treated with probiotics for four weeks as compared with the model group （P〈0.01）. There was no significant difference between two probiotics-treated groups. Our results implied that probiotics were likely to play a key role in protecting ulcerative colitis by reducing the inflammatory factor TNF-α expression through inhibiting the TLR4 expression in the colon tissue of experimental models.

Adipose-derived stem cells modified by BDNF gene rescue erectile dysfunction after cavernous nerve injury

Cavernous nerve injury is the main cause of erectile dysfunction following radical prostatectomy.The recovery of erectile function following radical prostatectomy remains challenging.Our previous studies found that injecting adipose-derived stem cells(ADSCs)into the cavernosa could repair the damaged cavernous nerves,but the erectile function of the treated rats could not be restored to a normal level.We evaluated the efficacy of ADSCs infected with a lentiviral vector encoding rat brain-derived neurotrophic factor(lenti-rBDNF)in a rat model of cavernous nerve injury.The rats were equally and randomly divided into four groups.In the control group,bilateral cavernous nerves were isolated but not injured.In the bilateral cavernous nerve injury group,bilateral cavernous nerves were isolated and injured with a hemostat clamp for 2 minutes.In the ADSCGFP and ADSCrBDNF groups,after injury with a hemostat clamp for 2 minutes,rats were injected with ADSCs infected with lenti-GFP(1×106 in 20μL)and lenti-rBDNF(1×106 in 20μL),respectively.Erectile function was assessed 4 weeks after injury by measuring intracavernosal pressures.Then,penile tissues were collected for histological detection and western blot assay.Results demonstrated that compared with the bilateral cavernous nerve injury group,erectile function was significantly recovered in the ADSCGFP and ADSCrBDNF groups,and to a greater degree in the ADSCrBDNF group.Neuronal nitric oxide synthase content in the dorsal nerves and the ratio of smooth muscle/collagen were significantly higher in the ADSCrBDNF and ADSCGFP groups than in the bilateral cavernous nerve injury group.Neuronal nitric oxide synthase expression was obviously higher in the ADSCrBDNF group than in the ADSCGFP group.These findings confirm that intracavernous injection with ADSCs infected with lenti-rBDNF can effectively improve erectile dysfunction caused by cavernous nerve injury.This study was approved by the Medical Animal Care and Welfare Committee of Wuhan University,China(approval No.2017-1638)on June 20,2017.

Effects of Vascular Endothelial Cell Growth Factor on Fibrovascular Ingrowth into Rabbit's Hydroxyapatite Orbital Implant

Summary: The effects of different concentrations of vascular endothelial cell growth factor (VEGF) on the fibrovascular ingrowth into rabbits hydroxyapatite orbital implant were investigated. Twelve New Zealand white rabbits were divided into 3 groups and received hydroxyapatite orbital implant surgery in their right eyes. Before and after the operation, the implants were treated with 10 ng/ml VEGF, 100 ng/ml VEGF, or normal saline as control group. The animals received technetium bones scan at 2, 4, and 6 weeks postoperatively. The mean radioactivity counts within region of interest (ROI) of the surgery eye (R) and the non-surgery eye (L) in the same animal were tested, and the R/L ratios were calculated. The implants were harvested at 6th weeks and examined histopathologically. The results showed that at second week, there was no significant difference in mean R/L ratios between VEGF group and control group (F=2.83, P=0.111); At 4th week (F=7.728, P=0.011) and 6th week (F=7.831, P=0.011) postoperatively, the mean ratios in VEGF groups were significantly higher than that in control group. At 6th week postoperatively, the fibrovascularization rates in VEGF groups were higher than in control group significantly (F=8.711, P=0.008). It was suggested that VEGF could promote the fibrovascular ingrowth into hydroxyapatite orbital implant, thus might shorten the time required for complete vascularization of the HA orbital implant.

Dexamethasone Decreases IL-29 Expression in House Dust Mite-stimulated Human Bronchial Epithelial Cells

Summary： The aim of this study was to explore the effect of IL-29 on the progression of airway aller- gic disease by detecting the level of IL-29 in airway allergic cell models stimulated by house dust mite （HDM） in the presence or absence of dexamethasone （DEX）. The same batch of human bronchial epithelial cells in exponential growth phase was randomly divided into five groups： blank group （A）, 300 ng/mL HDM group （B）, 1000 ng/mL HDM group （C）, 3000 ng/mL HDM group （D）, and 300 ng/mL HDM＋100 ng/mL DEX group （E）. The IL-29 mRNA expression was detected by quantitative reverse transcription polymerase chain reaction （qRT-PCR）. The IL-29 protein expression in cell sus- pension was detected by ELISA. The results showed that after stimulation with HDM for 24 h, the ex- pression oflL-29 was increased significantly, and after co-stimulation with HDM and DEX for 24 h, the expression oflL-29 in group E was significantly lower than that in the groups stimulated by HDM alone but higher than that in the group A. The differences between the different groups were significant （F=132.957, P〈0.01）. Additionally, the higher the concentration of HDM was, the more significant the increase in the IL-29 expression was. In conclusion, IL-29 may play a role in the progression of airway allergic disease including asthma.

Electronic Structure and Transport Coefficients of the Thermoelectric Materials Bi_2Te_3 from First-principles Calculations

The electronic structures of bulk Bi_2Te_3 crystals were investigated by the first-principles calculations.The transport coefficients including Seeback coefficient and power factor were then calculated by the Boltzmann theory,and further evaluated as a function of chemical potential assuming a rigid band picture.The results suggest that p-type doping in the Bi_2Te_3 compound may be more favorable than n-type doping.From this analysis results,doping effects on a material will exhibit high ZT.Furthermore,we can also find the right doping concentration to produce more efficient materials,and present the ＂advantage filling element map＂ in detail.

Ultrasound-based artificial intelligence in gastroenterology and hepatology

Artificial intelligence (AI), especially deep learning, is gaining extensive attentionfor its excellent performance in medical image analysis. It can automatically makea quantitative assessment of complex medical images and help doctors to makemore accurate diagnoses. In recent years, AI based on ultrasound has been shownto be very helpful in diffuse liver diseases and focal liver lesions, such asanalyzing the severity of nonalcoholic fatty liver and the stage of liver fibrosis,identifying benign and malignant liver lesions, predicting the microvascularinvasion of hepatocellular carcinoma, curative transarterial chemoembolizationeffect, and prognoses after thermal ablation. Moreover, AI based on endoscopicultrasonography has been applied in some gastrointestinal diseases, such asdistinguishing gastric mesenchymal tumors, detection of pancreatic cancer andintraductal papillary mucinous neoplasms, and predicting the preoperative tumordeposits in rectal cancer. This review focused on the basic technical knowledgeabout AI and the clinical application of AI in ultrasound of liver and gastroenterologydiseases. Lastly, we discuss the challenges and future perspectives of AI.

No significant association between dipeptidyl peptidase-4 inhibitors and adverse outcomes of COVID-19

BACKGROUND Dipeptidyl peptidase-4(DPP4)is commonly targeted to achieve glycemic control and has potent anti-inflammatory and immunoregulatory effects.Recent structural analyses indicated a potential tight interaction between DPP4 and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),raising a promising hypothesis that DPP4 inhibitor(DPP4i)drugs might be an optimal strategy for treating coronavirus disease 2019(COVID-19)among patients with diabetes.However,there has been no direct clinical evidence illuminating the associations between DPP4i use and COVID-19 outcomes.AIM To illuminate the associations between DPP4i usage and the adverse outcomes of COVID-19.METHODS We conducted a multicenter,retrospective analysis including 2563 patients with type 2 diabetes who were hospitalized due to COVID-19 at 16 hospitals in Hubei Province,China.After excluding ineligible individuals,142 patients who received DPP4i drugs and 1115 patients who received non-DPP4i oral anti-diabetic drugs were included in the subsequent analysis.We performed a strict propensity score matching(PSM)analysis where age,sex,comorbidities,number of oral hypoglycemic agents,heart rate,blood pressure,pulse oxygen saturation(SpO2)<95%,CT diagnosed bilateral lung lesions,laboratory indicators,and proportion of insulin usage were matched.Finally,111 participants treated with DPP4i drugs were successfully matched to 333 non-DPP4i users.Then,a linear logistic model and mixed-effect Cox model were applied to analyze the associations between inhospital DPP4i use and adverse outcomes of COVID-19.RESULTS After rigorous matching and further adjustments for imbalanced variables in the linear logistic model and Cox adjusted model,we found that there was no significant association between in-hospital DPP4i use(DPP4i group)and 28-d allcause mortality(adjusted hazard ratio=0.44,95%CI:0.09-2.11,P=0.31).Likewise,the incidences and risks of secondary outcomes,including septic shock,acute respiratory distress syndrome,or acute organ(kidney,liver,and cardiac)injuries,were also comparable between the DPP4i and non-DPP4i groups.The performance of DPP4i agents in achieving glucose control(e.g.,the median level of fasting blood glucose and random blood glucose)and inflammatory regulation was approximately equivalent in the DPP4i and non-DPP4i groups.Furthermore,we did not observe substantial side effects such as uncontrolled glycemia or acidosis due to DPP4i application relative to the use of non-DPP4i agents in the study cohort.CONCLUSION Our findings demonstrated that DPP4i use is not significantly associated with poor outcomes of COVID-19 or other adverse effects of anti-diabetic treatment.The data support the continuation of DPP4i agents for diabetes management in the setting of COVID-19.

Clinical diagnosis of severe COVID-19:A derivation and validation of a prediction rule

BACKGROUND The widespread coronavirus disease 2019(COVID-19)has led to high morbidity and mortality.Therefore,early risk identification of critically ill patients remains crucial.AIM To develop predictive rules at the time of admission to identify COVID-19 patients who might require intensive care unit(ICU)care.METHODS This retrospective study included a total of 361 patients with confirmed COVID-19 by reverse transcription-polymerase chain reaction between January 19,2020,and March 14,2020 in Shenzhen Third People’s Hospital.Multivariate logistic regression was applied to develop the predictive model.The performance of the predictive model was externally validated and evaluated based on a dataset involving 126 patients from the Wuhan Asia General Hospital between December 2019 and March 2020,by area under the receiver operating curve(AUROC),goodness-of-fit and the performance matrix including the sensitivity,specificity,and precision.A nomogram was also used to visualize the model.RESULTS Among the patients in the derivation and validation datasets,38 and 9 participants(10.5%and 2.54%,respectively)developed severe COVID-19,respectively.In univariate analysis,21 parameters such as age,sex(male),smoker,body mass index(BMI),time from onset to admission(>5 d),asthenia,dry cough,expectoration,shortness of breath,asthenia,and Rox index<18(pulse oxygen saturation,SpO2)/(FiO2×respiratory rate,RR)showed positive correlations with severe COVID-19.In multivariate logistic regression analysis,only six parameters including BMI[odds ratio(OR)3.939;95%confidence interval(CI):1.409-11.015;P=0.009],time from onset to admission(≥5 d)(OR 7.107;95%CI:1.449-34.849;P=0.016),fever(OR 6.794;95%CI:1.401-32.951;P=0.017),Charlson index(OR 2.917;95%CI:1.279-6.654;P=0.011),PaO2/FiO2 ratio(OR 17.570;95%CI:1.117-276.383;P=0.041),and neutrophil/lymphocyte ratio(OR 3.574;95%CI:1.048-12.191;P=0.042)were found to be independent predictors of COVID-19.These factors were found to be significant risk factors for severe patients confirmed with COVID-19.The AUROC was 0.941(95%CI:0.901-0.981)and 0.936(95%CI:0.886-0.987)in both datasets.The calibration properties were good.CONCLUSION The proposed predictive model had great potential in severity prediction of COVID-19 in the ICU.It assisted the ICU clinicians in making timely decisions for the target population.

Effects of remifentanil combined with propofol anesthesia on IL-1β, IL-6, TNF-α and hemodynamics in patients with brain surgery

Objective: To observe clinical application of remifentanil combined with propofol anesthesia and fentanyl combined with propofol anesthesia in patients with brain surgery, and analyze the change of hemodynamics and serum IL-1β, IL-6 and TNF-α before and after operation. Methods: A total of 90 cases of patients with brain surgery were randomly divided into control group and observation group according to lottery. The control group was given fentanyl combined with propofol anesthesia and the observation group was given remifentanil combined with propofol anesthesia, other combined anesthetic drug was same in both groups. Hemodynamics of all subjects before tracheal intubation (T1), after tracheal intubation (T2), when shin incision (T3) and when extubation (T4) and serum IL-1β, IL-6 and TNF-α before and after surgery 24 hours were measured. Results: There was no significant difference in hemodynamic indexes of all patients in both groups at T1. At T2, T3 and T4, heart rate (HR) and mean arterial pressure (MAP) of the observation group were significantly lower than those in the control group at same period, however blood oxygen saturation (SpO2) was higher than that in the control group at corresponding period, it was significant difference. At T2, T3 and T4, observation indexes HR and MAP of the control group were significantly higher than those at T1, while SpO2 was significantly lower than T1, there was statistical significant difference. While there was no significant difference in HR, MAP and SpO2 in observation group at T1, T2, T3 and T4. There was no significant differences in serum IL-1β, IL-6 and TNF-α levels between the control group and the observation group before surgery. After 24 h of operation, the levels of IL-1β, IL-6 and TNF-α in both groups were higher than those before operation;Moreover levels of IL-1β, IL-6 and TNF-α in observation group were significantly lower than those in the control group at same period after 24 h of operation it was statistical significant difference. Conclusion: Remifentanil combined with propofol anesthesia was able to maintain hemodynamic stability and reduce concentration of serum inflammatory factors, which was one of the potential effective anesthetic compounds.

Establishment and evaluation of Type 2 Diabetes Mellitus andits complications induced by low dose of multiple streptozotocin

Objective: To explore a simple, economical and feasible method for establishing type 2 diabetes mellitus and its complication model. Method: SD rats were randomly divided into two groups: normal group (15 rats) normal diet, model group (20 rats) with high glucose and high fat diet. After 2 weeks of feeding, model group was injected low dose(30mg/Kg) streptozotocin in the abdominal cavity, once a day for 6 days, normal group was injected with the same dose of citric acid buffer. Observe the changes of rat diet, body, hair, spirit, urine volume, and monitor weight, blood glucose. After 6 weeks, fast insulin, blood lipid, serum calcium, phosphorus and other biochemical indexes of rats, after HE staining observe morphologic variations changes of pancreas and kidney using microscope, and the changes of femoral bone in SD rats. Results: Compared with the normal group, the model group showed obvious symptoms, drink more, eat more, polyuria, emaciation, hyperglycemia, low calcium, low phosphorus, hyperlipidemia and other metabolic abnormalities, pancreatic atrophy, tissue fibrosis, glomerular area increased, basement membrane thickening, osteoporosis. Conclusion:High glucose and high fat diet combined with repeated intraperitoneal injecti on of low dose STZ can be successfully established the model of type 2 diabetes, and its high successful rate, low mortality rate, relatively simple, economical and feasible, has a certain significance of research on diabetes and its complications.