Risk factors of aspiration occurrence with different feeding patterns in elderly intensive care unit patients: a cross-sectional study.

Background: Elderly intensive care unit (ICU) patients represent a high-risk group of aspiration. Different feeding patterns will lead to different incidences of aspiration. However, there are few studies on the risk factors of aspiration in elderly ICU patients under different feeding patterns. The aim of this study was to analyze the effects of different eating styles on the occurrence of overt and silent aspiration in elderly ICU patients and to compare the independent risk factors, in order to provide a basis for targeted aspiration prevention. Methods: We retrospectively analyzed the incidence of aspiration in elderly patients admitted to the ICU from April 2019 to April 2022, a total of 348 cases. The patients were divided into the oral feeding group, gastric tube feeding group, and post-pyloric feeding group according to their feeding method. Multi-factor logistic regression was used to analyze the independent risk factors for overt and silent aspiration caused by the different eating patterns of patients. Results: Among the 348 elderly ICU patients included, the overall incidence of aspiration was 72%, with a 22% rate of overt aspiration and a 49% rate of silent aspiration. The overt aspiration rates were 16%, 30%, and 21% in the oral, the gastric tube and the post-pyloric feeding group, respectively; while the silent aspiration rates were 52%, 55%, and 40% in the three groups, respectively. Multiple logistic regression analysis showed that the independent risk factors for both overt and silent aspiration were history of aspiration [odds ratio (OR) =0.075, P=0.004; OR =0.205, P=0.042] and gastrointestinal tumor (OR =0.100, P=0.028; OR =0.063, P=0.003) in the oral feeding group. In the gastric tube feeding group, the independent risk factor for both overt and silent aspiration was the history of aspiration (OR =4.038, P=0.040; OR =4.658, P=0.012). In the post-pyloric feeding group, the independent risk factors for both overt and silent aspiration were mechanical ventilation (OR =0.211, P=0.019; OR =0.336, P=0.037) and intra-abdominal hypertension (OR =0.225, P=0.020; OR =0.329, P=0.032). Conclusions: There were significant differences in the influencing factors and characteristics of aspiration among the elderly patients in the ICU with different feeding patterns. Personalized precautions should be implemented early, so as to reduce the possibility of aspiration.

Efficacy of an internet-based cognitive behavioral therapy for subthreshold depression among Chinese adults: a randomized controlled trial.

BACKGROUND: Subthreshold depression (sD) negatively impacts well-being and psychosocial function and is more prevalent compared with major depressive disorder (MDD). However, as adults with sD are less likely to seek face-to-face intervention, internet-based cognitive-behavioral therapy (ICBT) may overcome barriers of accessibility to psychotherapy. Although several trials explored the efficacy of ICBT for sD, the results remain inconsistent. This study evaluated whether ICBT is effective in reducing depressive symptoms among Chinese adults with sD. METHODS: A randomized controlled trial was performed. The participants were randomly assigned to 5 weeks of ICBT, group-based face-to-face cognitive-behavioral therapy (CBT), or a waiting list (WL). Assessments were conducted at baseline, post-intervention and at a 6-month follow-up. The primary outcome measured depressive symptoms using the Center for Epidemiological Studies Depression Scale (CES-D). Outcomes were analyzed using a mixed-effects model to assess the effects of ICBT. RESULTS: ICBT participants reported greater reductions on all the outcomes compared to the WL group at post-intervention. The ICBT group showed larger improvement on the Patient Health Questionnaire-9 (PHQ-9) at post-intervention (d = 0.12) and at follow-up (d = 0.10), and with CES-D at post-intervention (d = 0.06), compared to the CBT group. CONCLUSIONS: ICBT is effective in reducing depressive symptoms among Chinese adults with sD, and improvements in outcomes were sustained at a 6-month follow-up. Considering the low rates of face-to-face psychotherapy, our findings highlight the considerable potential and implications for the Chinese government to promote the use of ICBT for sD in China.

Internet-based cognitive behavioral therapy for psychological distress in older adults without cognitive impairment living in nursing homes during the COVID-19 pandemic: A feasibility study.

BACKGROUND: The COVID-19 pandemic has had a detrimental effect on the mental health of older adults living in nursing homes. Very few studies have examined the effects of Internet-based Cognitive Behavioral Therapy (ICBT) on older adults living in nursing homes during the pandemic. We conducted a feasibility study using a single-group design, to explore the effectiveness of ICBT on psychological distress in 137 older adults (without cognitive impairment) from 8 nursing homes in 4 southeast cities in China, between January and March 2020. METHODS: Symptoms of depression, anxiety, general psychological distress, and functional disability were measured at baseline, post-treatment (5 weeks) and at a 1-month follow-up. Mixed-effects model was used to assess the effects of ICBT. RESULTS: Statistically significant changes with large effect sizes were observed from pre- to post-treatment on the PHQ-9 (p < .001, Cohen's d = 1.74), GAD-7 (p < .001, d = 1.71), GDS (p < .001, d = 1.30), K-10 (p < .001, d = 1.93), and SDS (p < .001, d = 2.03). Furthermore, improvements in treatment outcomes were sustained at 1-month follow-up, and high levels of adherence and satisfaction were indicated. CONCLUSION: ICBT was effective in reducing psychological distress in older adults without cognitive impairments living in nursing homes during the COVID-19 pandemic. Thus, it could be applied in improving the mental health of this vulnerable group during the pandemic.

Circ-ZFR Promotes Progression of Bladder Cancer by Upregulating WNT5A Via Sponging miR-545 and miR-1270.

BACKGROUND: Bladder cancer is one of the most common cancers all over the world. CircZFR is a circular RNA and has been implicated in tumor generation and invasion. However, the exact role of circZFR in the development of bladder cancer (BCa) remains unknown. This study aimed to investigate the function of circZFR in BCa, and further to probe into the association between circ-ZFR, miR-545/miR-1270 and WNT5A. METHODS: The expression of circZFR in BCa was quantified by qRT-PCR and was positively correlated with the prognosis of BCa patients. Next, the stable knockdown of circZFR BCa cell lines was established and the resulting capacities of proliferation, migration and invasion were measured. The association of circZFR with miR-1270/miR-545 was predicted by circinteractome prediction, and was confirmed by luciferase assay as well as RNA pull down assay. Furthermore, miRNA inhibitors, WNT5A overexpression and Pearson correlation analysis were used to examine the relationship between circZFR, miR-1270/miR-545 and WNT5A. RESULTS: The expression of CircZFR was up-regulated both in BCa tissues and in BCa cell lines, and was positively correlated with patient survival rates. Blocking of circZFR's expression by RNA inhibitors suppressed the proliferation, migration and invasion of BCa cells both in vitro and in vivo. On the other hand, overexpression of target miRNA supported that circZFR directly interact with miR-545 and miR-1270. Moreover, we demonstrated that circZFR promotes the progression of BCa by upregulating WNT5A's expression via sponging miR-545 and miR-1270. CONCLUSIONS: CircZFR promotes the proliferation, migration and invasion of BCa cells by upregulating WNT5A signaling pathway via sponging miR-545 and miR-1270. These results provide new insights into the molecular mechanism of circZFR in BCa progression, and more important, a novel target for BCa clinical treatment.

Risk grade assessment of sudden water pollution based on analytic hierarchy process and fuzzy comprehensive evaluation.

Sudden water pollution is a global environmental issue. On a large spatial scale, any pollution source may cause water pollution incidents. Dividing a large watershed into several units and giving each unit a different level would be favorable for managing sudden water pollution incidents. To scientifically divide an area into units and determine their risk grade of sudden water pollution, data of pollution sources were collected, and an area was divided into risk assessment units of sudden water pollution. The risk grade assessment was conducted following the analytic hierarchy process (AHP) and fuzzy comprehensive evaluation method. The technology combined with the AHP and fuzzy comprehensive evaluation (F-AHP) can generate the hydrology, pollution source, natural geography, and socioeconomic characteristics of each unit and provide a risk grade evaluation. A risk grade assessment was conducted using the Yongding River as a case study. The results show that the areas with high sudden water pollution risk were mainly distributed in Shanxi Datong and Hebei Zhangjiakou. Sufficient control of pollution sources in production processes and the establishment of necessary measures to strengthen inspections should reduce the risk of sudden water pollution.