The comparison of fluidized positioners and traditional gel pads for skin protection in neurosurgical patients undergoing lateral and prone positions: A retrospective analysis with propensity score matching method.

To compare fluidized positioners and gel pads for skin protection in neurosurgery patients placed in lateral and prone positions. It is one of the major challenges that operating room nurses face in protecting the skin during the long duration of neurosurgery. Currently, there are increasing tools available to protect the skin under pressure, and various tools practice well in the clinic. Fluidized positioners are newly emerging protective pads that have been clinically effective in protecting the skin, but no studies have compared them to previous pads. This is a retrospective cohort study. Data from 706 patients who underwent neurosurgery between January 2018 and December 2021 were systemically reviewed. Patients undergoing long-term neurosurgery in the neurosurgical lateral and prone positions were divided into two groups: fluidized positioners or gel pads. Propensity score matching (PSM) was performed for group balance (1:1 ratio) using the following baseline characteristics: age, gender, ASA (American Society of Anesthesiologists) classification, duration of surgery, surgical position and underlying disease. The incidence of decubitus, and length of stay (LOS) in the hospital were compared between the two groups. The results were obtained for 394 patients in the fluidized positioner group with a 3.8% incidence of pressure ulcers and 312 patients in the gel pad group with an 8% incidence of pressure ulcers, which were unbalanced in terms of gender, ASA, hypertension and diabetes data. After a PSM, patients were compared in terms of pressure ulcer incidence (3.7% vs. 7.8%, p = 0.034) and LOS (22.35 vs. 25.65 days, p < 0.001). Fluidized positioners can effectively reduce the incidence of pressure injury in lateral and prone positions of neurosurgery. The results of this study may contribute to the development of policies to prevent the development of pressure ulcers during neurosurgical procedures.

Transplantation of a beating heart: A first in man.

Background: In the current practice, graft ischaemia and reperfusion injury (IRI) is considered an inevitable component in organ transplantation, contributes to compromised organ quality, inferior graft survival and limitations in organ availability. Among all the donor organs, the heart is most vulnerable to IRI and the tolerated ischaemic time is the shortest. Methods: By combining adapted surgical techniques and normothermic machine perfusion (NMP), we performed the first case of ischaemia-free beating heart transplantation (IFBHT) in man. The donor heart was procured after an in situ NMP circuit was established, then underwent ex situ NMP and implanted under NMP support. The post-transplant graft function was monitored. Findings: The donor heart was procured, preserved, and implanted under a continuously perfused, normothermic, oxygenated, beating state. During ex situ NMP, the donor heart beat with sinus rhythm and adequate ventricular contraction, consumed oxygen and lactate, suggesting a good cardiac function. The dynamic electrocardiogram demonstrated an absence of ischaemic injury of the donor heart during the entire procedure. The echocardiogram showed an immediate graft function with a left ventricle ejection fraction (LVEF) of 70%. The patient was discharged on post-transplantation day 20 and was followed up for 8 months with normal cardiac function and life. Interpretation: This study shows the feasibility of IFBHT procedure, which might be able to completely avoid graft IRI, has thus the potential to improve transplant outcome while increasing organ utilization. Funding: This study was funded by National Natural Science Foundation of China, Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology, and Guangdong Provincial International Cooperation Base of Science and Technology.

Ischaemia-free liver transplantation in humans: a first-in-human trial.

Background Ischaemia-reperfusion injury is considered an inevitable component of organ transplantation, compromising organ quality and outcomes. Although several treatments have been proposed, none has avoided graft ischaemia and its detrimental consequences. Methods Ischaemia-free liver transplantation (IFLT) comprises surgical techniques enabling continuous oxygenated blood supply to the liver of brain-dead donor during procurement, preservation, and implantation using normothermic machine perfusion technology. In this non-randomised study, 38 donor livers were transplanted using IFLT and compared to 130 conventional liver transplants (CLT). Findings Two recipients (5•3%) in the IFLT group experienced early allograft dysfunction, compared to 50•0% in patients receiving conventional transplants (absolute risk difference, 44•8%; 95% confidence interval, 33•6-55•9%). Recipients of IFLT had significantly reduced median (IQR) peak aspartate aminotransferase levels within the first week compared to CLT recipients (365, 238-697 vs 1445, 791-3244 U/L, p<0•001); likewise, median total bilirubin levels on day 7 were significantly lower (2•34, 1•39-4•09 mg/dL) in the IFLT group than in the CLT group (5•10, 1•90-11•65 mg/dL) (p<0•001). Moreover, IFLT recipients had a shorter median intensive care unit stay (1•48, 0•75-2•00 vs 1•81, 1•00-4•58 days, p=0•006). Both one-month recipient (97•4% vs 90•8%, p=0•302) and graft survival (97.4% vs 90•0%, p=0•195) were better for IFLT than CLT, albeit differences were not statistically significant. Subgroup analysis showed that the extended criteria donor livers transplanted using the IFLT technique yielded faster post-transplant recovery than did the standard criteria donor livers transplanted using the conventional approach. Interpretation IFLT provides a novel approach that may improve outcomes, and allow the successful utilisation of extended criteria livers. Funding This study was funded by National Natural Science Foundation of China, Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology, and Guangdong Provincial international Cooperation Base of Science and Technology. Panel: Research in context.

Rapid screening and characterization of triterpene saponins in Acanthopanax senticosus leaves via untargeted MSAll and SWATH techniques on a quadrupole time of flight mass spectrometry.

This paper focused on untargeted MSAll, also called MSE, and sequential window acquisition of all theoretical fragment-ion spectra (SWATH) fragmentations for comprehensive structural characterization of triterpene saponins (TSs) in leaves of Acanthopanax senticosus through ultra-high performance liquid chromatography electrospray quadrupole time-of-flight mass spectrometry (UPLC-ESI-QTOF). [M+H]+, [M + NH4]+ and [M + Na]+ precursor ions and the corresponding fragment ions were collected simultaneously in energy-resolved MSAll. SWATH fragmentation was applied as a comparable and complementary method for resolving co-eluting species. A workflow based on MSAll and SWATH fragmentations was constructed for comprehensive structural characterization and rapid discovery of TSs in leaves of A. senticosus. As a result, 89 TSs, along with 14 sapogenins, were unambiguously characterized or tentatively identified. Of these, 33 compounds were characterized as potentially new compounds, including the first report of malonyl-saponin in genus Acanthopanax. This study aimed to systematically analyze TSs in leaves of A. senticosus, and the results are significant for the utilization of A. senticosus leaves.

A generic strategy based on gas phase decomposition of protonated and ammoninted precursors producing predictable MRM-MS ion pairs and collision energies for direct analysis of plant triterpene glycosides.

Optimization of multiple reaction monitoring mass spectrometry (MRM-MS) parameters of triterpene glycosides (TGs) using traditional infusion methods remains to be labor-intensive. However, it was found that mild gas phase decompositions of protonated and ammoninted precursors (DPAP) of TGs could produce a series of abundant dehydrated product ions of aglycones ([A+H-nH2O]+ (n = 0, 1, 2, 3…)) with high efficiency and stability. Based on these considerations and findings, an innovative ESI+-MRM-DPAP-MS strategy was devised on a QTRAP 4000 instrument allowing for rapid the qualitative and quantitative analysis of plant TGs. A detailed study of 85 model compounds from 20 herbal medicines was implemented for validation and evaluation of the ESI+-MRM-DPAP-MS strategy proposed. The central composition design confirmed that collision energy (CE) played more significant roles than declustering potentials (DP) for the formation of these Q1/Q3 ion pairs based on MRM-DPAP-MS. It is also noted that Q1 and Mw were the most important factors for the prediction of CE values by a partial least square regression model. Here, we demonstrated this generic workflow and its merits in: (1) early prediction and selection of MRM ion pairs, no matter which type of TGs, employing a new-found Q1/Q3 calculation formula (Q1=[M+H/NH4]+ and Q3= [A+H-nH2O]+ (n = 0, 1, 2, 3…)); (2) direct determination of practicable CE values using TGs-specific CE-estimating linear equations; (3) appearances of excellent sensitivity, stability and repeatability through real application in Aralia elata, Panax notoginseng and Caulophyllum robustum; (4) seamless application of optimal CE parameters in other triple quadrupole MS instruments such as Thermo TSQ Quantum Ultra. The ESI+-MRM- DPAP-MS may service as an effective and feasible approach for analytical characterization of biological TGs from herbal medicines.

Degree of Acceptance of Breast Reconstruction and the Associated Factors Among a Population of Chinese Women with Breast Cancer.

BACKGROUND: Breast cancer is one of the most common female "malignancies" reported worldwide in recent years. This study is aimed to understand the degree of acceptance of breast reconstruction among breast cancer patients in Chinese women and to explore the related factors. METHODS: Breast cancer patients were asked to fill in the demographic questionnaire, and consent for evaluation of Breast Reconstruction Acceptance Scale, Social Support Scale, and Functional Assessment of Cancer Therapy-breast Quality of Life Instrument (FACT-B). The data were assessed using multivariate logistic regression analysis for the correlations between the degree of acceptance of breast reconstruction and age, marital status, family monthly income, quality of life, and social support. RESULTS: 57.5% of 715 patients were not familiar with breast reconstruction. Results showed correlation with the degree of acceptance of breast reconstruction. Multivariate analysis indicated that age (41-50 years old, OR: 0.25, 95% CI: 0.08-0.76; > 50, OR: 0.05, 95% CI: 0.02-0.15), marital status (married, OR: 0.15, 95% CI: 0.05-0.43; divorced/widowed, OR: 0.11, 95% CI: 0.03-0.42), family income (3-10 thousand RMB, OR: 2.01, 95% CI: 1.08-3.76; > 10 thousand RMB, OR: 2.14, 95% CI: 1.05-4.37), quality of life (fair, OR: 0.59, 95% CI: 0.39-0.91), and social support (excellent, OR: 0.50, 95% CI: 0.30-0.83) were all correlated with the degree of acceptance of breast reconstruction. CONCLUSION: Chinese breast cancer patients have a low degree of acceptance of breast reconstruction. The degree of acceptance was found to be correlated with age, marital status, family monthly income, quality of life, and social support. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Simultaneous Separation of Eight Lignans in Forsythia suspensa by ß-Cyclodextrin-Modified Capillary Zone Electrophoresis.

The aim of the study was to develop an alternative capillary zone electrophoresis (CZE) for simultaneous determination of phillyrin (1), phillygenin (2), epipinoresinol-4-O-ß-glucoside (3), pinoresinol-4-O-ß-glucoside (4), lariciresinol (5), pinoresinol (6), isolariciresinol (7) and vladinol D (8) in Forsythia suspensa. The structural types of lignans 1-8 could be attributed to bisepoxylignans (1-4 and 6), monoepoxylignans (5 and 8) and cyclolignan (7). The major difficulties in the CZE separation of 1-8 could be summarization as the simultaneous presence of free lignans (1, 2 and 5-8) and lignan glucosides (3 and 4) and simultaneous occurrence of two pairs of isomers (3 and 4 as well as 5 and 7). Without the addition of ß-CD and methanol, the resolution of these analytes was quite poor. However, in this study, compounds 1-8 were excellently separated from each other within 15 min under optimized conditions with a borax running buffer (40 mM borax, pH 10.30) containing 2 mM ß-CD and 5% methanol (v/v) at the voltage of 20 kV, temperature of 35 °C and detection wavelength of 234 nm. Validation of the method included tests of linearity, precision, repeatability, stability and accuracy. In addition, the method offered inherent advantages such as lower analytical cost, no need of specific columns and use of small amounts of organic solvents and reagents. Finally, this green and economic CZE was successfully applied for the determination of these bioactive components 1-8 in F. suspensa fruits and its commercial extracts.

Nurse vs. physician-led care for obstructive sleep apnoea: A systematic review and meta-analysis of randomized trials.

AIM: To evaluate the effectiveness of nurse-led care for obstructive sleep apnoea compared with physician-led care. BACKGROUND: The incidence of obstructive sleep apnoea is increasing worldwide. There is a need for cost-effective care models to ease off the pressure on tertiary care centres and divert care to the community. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched major electronic databases (MEDLINE, EMBASE, AMED, British Nursing Index, CINAHL, HMIC, PsycINFO, Health Business Elite and the Cochrane Central Register of Controlled Trials CENTRAL) from inception till December 2016 using a structured search strategy for all randomized trials evaluating nurse-led treatment interventions for adults with obstructive sleep apnoea compared with physician-led ones. We screened relevant articles against a predefined inclusion criterion. We applied no search limitations. REVIEW METHODS: We assessed the risk of bias as per Cochrane recommendations. We calculated weighted mean difference with 95% confidence intervals for continuous outcomes and used a random-effects model to meta-analyse data. RESULTS: We screened 309 articles and only four studies met our inclusion criteria. All studies used continuous-positive airway pressure as the main treatment strategy with similar compliance rate in both comparison groups. The scores of the Epworth Sleepiness Scale, the SF-36 questionnaires for vitality, physical function and the SF-36 mental health were all similar between the two groups. There was a significant heterogeneity in all meta-analyses (I2  > 92%). CONCLUSION: Nurse-led care for adults with obstructive sleep apnoea is non-inferior to physician-led care. More research is needed to standardize nurse-led interventions and evaluate their long-term effectiveness and cost-effectiveness.

Early pregnancy following multidrug regimen chemotherapy in a gestational trophoblastic neoplasia patient: A case report.

RATIONALE: Gestational trophoblastic neoplasia is a group of rare tumors that can be cured using chemotherapy. The use of artificial contraception for at least 1 year is recommended not only due to the high recurrence rate in the first year after treatment, but also because of the unclear genetic toxic effects of multidrug regimen chemotherapy on reproductive cells. There is no consensus about the contraception duration, but most patients want to have children. PATIENT CONCERNS: This case involved a 33-year-old female suffering from gestational trophoblastic neoplasia and 5-fluorouracil + actinomycin-D chemotherapy. She became pregnant 1 month after finishing the chemotherapy. DIAGNOSIS: Gestational trophoblastic neoplasia. INTERVENTIONS: No treatment during pregnancy. OUTCOMES: The patient had a full-term normal delivery, and the baby showed normal development and growth after a follow-up of 48 months. LESSONS: Pregnancy soon after chemotherapy can be viable with rigorous prenatal care.

Clinical observation and nursing care on the prevention of abdominal organ cluster transplantation rejection.

AIMS AND OBJECTIVES: To investigate the clinical characteristics of rejection after upper abdominal cluster transplantation. BACKGROUND: Abdominal organ cluster transplantation is used to treat multiple abdominal organ diseases. Delay in monitoring and treatment can lead to graft failure. DESIGN: A descriptive study. METHODS: Data collected from eight patients who underwent abdominal organ cluster transplantation from May 2004-March 2009 in our hospital were retrospectively assessed. The clinical manifestations of graft rejection and variations in characteristics associated with graft function were analysed. RESULTS: In all eight cases, graft function recovered successfully without rejection during the perioperative period. In one case, liver graft rejection occurred 1·5 months postoperatively, but dose adjustment of the anti-rejection drugs provided symptom relief. CONCLUSIONS: Rejection can be prevented and cured successfully through monitoring and early detection of rejection characteristics by the nursing staff. RELEVANCE TO CLINICAL PRACTICE: With the increase of awareness and knowledge on the clinical observation and nursing care, the rate of transplantation rejection decreased among abdominal cluster transplant patients.