Development of ZnO/selenium nanoparticles embedded chitosan-based anti-bacterial wound dressing for potential healing ability and nursing care after paediatric fracture surgery.

The current study was aimed at the assessment of the effect of chitosan-ZnO/Selenium nanoparticles scaffold on infected wound healing and care of paediatric surgery treatment. The nanoparticle scaffolds were developed from sources such as chitosan (CS), different concentrations of zinc oxide (ZnO), and Selenium (SeNPs) nanoparticles by freeze-drying method. The structural and chemical properties of nanoparticles were investigated by UV-Vis, fourier transform infrared spectroscopy (FTIR), and phase identification by x-ray diffraction analysis. The surface morphology of CS, chitosan-ZnO (CS-ZnO) and chitosan-ZnO/SeNPs was analysed using a scanning electron microscope. The incorporation of ZnO and SeNPs along with CS polymer induces antioxidant and antimicrobial functions. The bacterial susceptibility to nanoparticle scaffolds against Escherichia coli and Staphylococcus aureus showed the excellent antibacterial effects of ZnO and SeNPs. In-vitro studies of fibroblast of NIH 3 T3 and HaCaT cell lines revealed the biocompatibility, cell adhesion, cell viability, and proliferation of scaffold in the wound site. Also, results of in-vivo studies strongly enhanced collagen synthesis, re-epithelialization, and rapid wound closure. Thus, the synthesised chitosan-ZnO/SeNPs nanoparticle scaffold resulted in significant improvement in histopathological indices in the full thickness of wound healing after nursing care of paediatric fracture surgery.

De Winter syndrome may be an early electrocardiogram pattern of acute myocardial infarction, two cases report.

BACKGROUND: De Winter syndrome is an electrocardiogram (ECG) pattern related to acute occlusion of the anterior descending artery. The incidence rate of De Winter syndrome is rare, but still requires much attention from clinicians. METHODS: Two patients who finnaly diagnosed with De Winter syndrome were included in our study. RESULTS: A 55-year-old male farmer, who was previously healthy, came to the emergency room due to sudden pain in the precordial area for 6 hours, accompanied with back pain and sweating. The second ECG revealed De Winter syndrome. Emergency coronary angiography was taken, which showed a severe atrioventricular block; diffuse stenosis in the proximal and middle segments of the left anterior descending branch, with 90% stenosis in the severest region. Percutaneous coronary intervention (PCI) of the left anterior descending artery was performed. A 70-year-old man with a history of hypertension arrived at the Emergency Department with chest pain for 3 hours. The first ECG was performed, which was contacted with de winter syndrome. The second ECG demonstrated acute anterior Myocardial infarction. Emergency coronary angiography showed approximately 95% stenosis at the junction of the proximal and middle segments. PCI of the proximal and middle segments of the left anterior descending artery was performed. CONCLUSION: De Winter syndrome is a type of acute coronary syndrome, which may be an early ECG pattern in the development of acute ST-segment elevation myocardial infarction. Therefore, once De Winter syndrome is observed on the ECG, acute coronary syndrome, especially acute anterior descending occlusion should not be ignored.

Application and the Effect of the Triple Prerehabilitation Nursing Model in the Perioperative Period of Knee Arthroplasty in Diabetic Patients.

Objective: The aim of the study was to explore the application and the effect of the triple prerehabilitation nursing model in the perioperative period of knee arthroplasty in diabetic patients. Methods: The prospectively included 60 patients with diabetes who underwent total knee replacement were admitted from August 2021 to April 2022 and were divided into 2 groups according to the (1 : 1) ratio. The control group was mainly given routine nursing care. On the basis of the control group, the observation group received triple prerehabilitation nursing. The postoperative knee flexion, hospital for the special surgery knee score (HSS), the daily living ability (Barthel) score, the modified fall efficacy scale (MFES) score, the recovery of the lower-limb muscle strength, and the incidence of complications were compared between the two groups. Results: The knee flexion degree and lower-limb muscle recovery of the observation group were better than those of the control group at 3 d, 7 d, and 14 d after operation (P < 0.05). The HSS score, Barthel score, and MFES score of the observation group were higher than those of the control group (P < 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusion: The triple prerehabilitation nursing care for diabetic patients undergoing total knee replacement can promote the recovery of limb function.

Prognostic value of international normalized ratio to albumin ratio among critically ill patients with cirrhosis.

BACKGROUND AND AIM: Critically ill patients with cirrhosis are at an increased risk of mortality. Our study aimed to externally validate the ability of the prothrombin time-international normalized ratio to albumin ratio (PTAR), an objective and simple scoring system, to predict 90-day mortality in critically ill patients with cirrhosis. PATIENTS AND METHODS: A total of 865 patients were entered into the study, and all the participants were followed up for at least 90 days. Clinical parameters on the first day of intensive care unit admission were included to compare survivors with nonsurvivors. RESULTS: After multivariable adjustment, the association between the risk of 90-day mortality and PTAR remained statistically significant with a hazard ratio of 2.71 (95% confidence interval: 1.99-3.68). The PTAR score showed good discrimination ability for predicting 90-day mortality with an area under receiver operating characteristic curve of 0.72 (95% confidence interval: 0.68-0.75). To improve its feasibility, we regrouped the PTAR scores into three levels of risk (low risk: <0.55, intermediate risk: 0.55-1.00, and high risk: ≥1.00); the 90-day mortality rates were 20.1% (74/368), 41.7% (168/403), and 73.4% (69/94), respectively. CONCLUSION: The PTAR score system is a convenient and practical tool for predicting the prognosis of critically ill patients with cirrhosis.

Model for end-stage liver disease and pneumonia: An improved scoring model for critically ill cirrhotic patients with pneumonia.

BACKGROUND/AIMS: Critically ill patients with cirrhosis with pneumonia are at an increased risk for mortality. Only a few accurate predictive models are existing specific to these patients. The aim of the present study was to compare the existing prognostic models and to develop an improved mortality risk model for patients with cirrhosis and pneumonia. MATERIALS AND METHODS: A total of 231 patients were enrolled in our study (70% training and 30% validation cohorts). All participants were followed up for at least 21 days. Model for End-stage Liver Disease and Pneumonia (MELD-P) was derived by the Cox proportional hazards model. The performances of prognostic scoring systems were compared by calculation of the area under the receiver operating characteristic (AUROC) curve. RESULTS: MELD-P showed better discriminative capabilities than existing scoring systems. Four clinical variables, including loge bilirubin (hazard ratio (HR) 1.29, 95% confidence interval (CI) 1.01-1.73), loge international normalized ratio (HR 3.57, 95% CI 1.30-9.78), loge pulse oxygen saturation/fraction of inspired oxygen (HR 0.38, 95% CI 0.14-0.99), and vasopressors used (HR 3.72, 95% CI 1.85-7.49), were considered as independent prognostic values associated with 21-day mortality. MELD-P had AUROC curve values of 0.78 (95% CI 0.71-0.84) in predicting in-hospital mortality, 0.78 (95% CI 0.70-0.84) at 21-day, 0.88 (95% CI 0.82-0.93) at 14-day, and 0.87 (95% CI 0.81-0.92) at 7-day. A similar result was obtained in validation cohort. CONCLUSION: MELD-P, as the first model specifically designed to evaluate the risk of mortality in critically ill patients with cirrhosis and pneumonia, performs well on the mortality assessment of short-term mortality.