Fatigue as a Cause of Professional Dissatisfaction Among Chinese Nurses in Intensive Care Unit During COVID-19 Pandemic.

Aim: To clarify the mediating role of burnout and the moderating role of turnover intention in the association between fatigue and job satisfaction among Chinese nurses in intensive care units (ICU) during the COVID-19 pandemic. Methods: A cross-sectional survey of fifteen provinces in China was conducted, using an online questionnaire, from December 2020 to January 2021, during the COVID-19 pandemic. A total of 374 ICU nurses (effective response rate: 71.37%) provided sufficient responses. Sociodemographic factors, job demographic factors, fatigue, burnout, job satisfaction, and turnover intention were assessed using questionnaires. General linear modeling (GLM), hierarchical linear regression (HLR) analysis, and generalized additive modeling (GAM) were performed to examine all the considered research hypotheses. Results: Fatigue was found to be negatively and significantly associated with job satisfaction. Moreover, burnout played a partial mediating role and turnover intention played a moderating role in the relationship between fatigue and job satisfaction. Conclusion: Over time, a state of physical and mental exhaustion and work weariness among Chinese ICU nurses potentially results in job burnout and consequently promotes the level of job dissatisfaction. The results also found that turnover intention played a moderating role in the relationship between burnout and job satisfaction. Specific policies could be considered to eliminate nurses' fatigue and negative attitudes during times of public health emergencies.

Factors associated with patient delay for older adults with benign prostatic hyperplasia: A descriptive qualitative study.

Based on the theory of planned behavior, the aim of this study was to describe the influencing factors of patient delay intentions and behaviors in benign prostatic hyperplasia (BPH) patients and to provide a reference for the development of a patient delay intention scale. This study was carried out over 4 months in 2021 in Daqing, Heilongjiang, China. The participants were 20 patients with BPH who were aged 60 to 82 years and experienced patient delay; participants were selected through a purposive sampling method. The data were collected via face-to-face semistructured interviews. Five main themes emerged from the interviews, including an insufficient understanding of symptoms, experiences of coping instead of seeking health care, negative attitudes toward care-seeking, the influence of others on decision-making for care-seeking, and obstacles to seeking health care. In conclusion, the patient delay intentions and behaviors of BPH patients are the result of a combination of many factors.

[Problems and countermeasures in clinical studies on acupuncture and moxibustion in course of developing Guideline for Clinical Practice of Acupuncture and Moxibustion: Insomnia].

To explore the problems and countermeasures existing in acupuncture and moxibustion clinical studies, in the perspective of the key steps of Guideline for Clinical Practice of Acupuncture and Moxibustion: Insomnia. The problems include: confusion of disease names and disunity of diagnostic criteria, inadequate refined clinical problems that need to be addressed, lack of targeted analysis of efficacy evaluation index, lack of adequate research on common acupuncture, difficulty to balance innovation and universality, lack of emphasis on the importance of timing for acupuncture, lack of attention to healthy lifestyles and self-care. We suggests that the disease name and diagnostic criteria should refer to the authoritative standards; the clinical study design should based on the realistic clinical problems; the efficacy evaluation index should based on the clinical needs and be analyzed targetedly; further research on common acupuncture or therapy should be carried out.

[Bibliometric analysis of refractory facial paralysis based on CNKI database].

The current development situation and the hotspot of the relevant research on refractory facial paralysis are explored. The articles on refractory facial paralysis are retrieved from CNKI database. The bibliographic items co-occurrence matrix builder (BICOMB) 2.0 is adopted to extract and analyze statistically literature characteristics and generate the high-frequency keywords matrix. The graphical clustering toolkit (gCLUTO) 1.0 is used to cluster the high-frequency keywords. A total of 750 articles are included, mostly published in Journal of Clinical Acupuncture and Moxibustion (63 articles), Chinese Acupuncture & Moxibustion (54 articles) and Shanghai Journal of Acupuncture and Moxibustion (27 articles) separately. The number of published articles by the active first authors are accounted for 10.1% of the total. When the high-frequency keywords are clustered into 4 categories, the topics with good cluster effect including the inheritance of the experiences of famous doctors in the comprehensive treatment of refractory facial paralysis, the comprehensive treatment measures with the a quite high curative effect on refractory facial paralysis based on heat-sensitive moxibustion and those based on the intervention by enhancing acupoint stimulation effect, as well as the study on the comprehensive treatment measures. General speaking, the regimen of acupuncture and moxibustion is a hotspot in the study on refractory facial paralysis. Research fellows give the consideration on the inheritance of the experiences of famous doctors, adopt the comprehensive treatment methods and enhance the actions of "warming" and "promoting" in the regimen by focusing on the pathogenesis. Such an idea has certain enlightening role to the study on the treatment of refractory diseases.

Obesity-related hypertension: Findings from The Korea National Health and Nutrition Examination Survey 2008-2010.

We aimed to investigate the association of various obesity parameters and phenotypes with hypertension in nationally representative Korean adults. Among adults aged 19 years and older who participated in the Korea National Health and Nutrition Examination Survey in 2008-2010, a total of 16,363 subjects (8,184 men and 8,179 women) were analyzed. Hypertension was defined as blood pressure of 140/90 mm Hg or higher or taking antihypertensive medication. Multiple logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Higher obesity parameters [body mass index (BMI) representing general obesity, waist circumference (WC) representing central obesity, and percentage body fat (PBF) representing elevated body fat] were consistently associated with increased odds of prevalent hypertension (OR, 7.54; 95% CI, 5.89-9.65 for BMI ≥30 vs. 18.5-23; OR, 3.97; 95% CI, 3.41-4.63 for WC ≥95 cm in males and ≥90 cm in females vs. <85 cm in males and <80 cm in females; OR, 3.56; 95% CI, 3.05-4.15 for PBF, highest vs. lowest quartile; all p trends<0.0001). These associations were stronger in the younger age group (<40 years), and were observed in both sexes. Furthermore, even in individuals with normal BMI (18.5-23), the odds of prevalent hypertension were consistently increased in those with central obesity (WC≥90 cm in males, WC≥80 cm in females; normal weight central obesity phenotype) (OR, 1.89; 95% CI, 1.63-2.19) and those with high PBF (highest quartile of PBF; normal weight obesity phenotype) (OR, 1.49; 95% CI, 1.25-1.77). These associations were consistent with updated hypertension guidelines in 2017. Obesity may be positively associated with hypertension, regardless of obesity parameters. Even within normal BMI range, high WC and high PBF may be associated with hypertension.

The complete chloroplast genome sequence of Morus cathayana and Morus multicaulis, and comparative analysis within genus Morus L.

Trees in the Morus genera belong to the Moraceae family. To better understand the species status of genus Morus and to provide information for studies on evolutionary biology within the genus, the complete chloroplast (cp) genomes of M. cathayana and M. multicaulis were sequenced. The plastomes of the two species are 159,265 bp and 159,103 bp, respectively, with corresponding 83 and 82 simple sequence repeats (SSRs). Similar to the SSRs of M. mongolica and M. indica cp genomes, more than 70% are mononucleotides, ten are in coding regions, and one exhibits nucleotide content polymorphism. Results for codon usage and relative synonymous codon usage show a strong bias towards NNA and NNT codons in the two cp genomes. Analysis of a plot of the effective number of codons (ENc) for five Morus spp. cp genomes showed that most genes follow the standard curve, but several genes have ENc values below the expected curve. The results indicate that both natural selection and mutational bias have contributed to the codon bias. Ten highly variable regions were identified among the five Morus spp. cp genomes, and 154 single-nucleotide polymorphism mutation events were accurately located in the gene coding region.

Comparison of Body, Auricular, and Abdominal Acupuncture Treatments for Insomnia Differentiated as Internal Harassment of Phlegm-Heat Syndrome: An Orthogonal Design.

Objective. To identify the optimum treatment protocol for insomnia among auricular, body, and abdominal needling methods. Methods. A three-factor (3 needling protocols) and three-level experimental scheme was designed based on orthogonal method. 54 patients of insomnia differentiated as internal harassment of phlegm-heat syndrome were given two courses of acupuncture treatment (each with 20 times of acupuncture). The therapeutic effects were evaluated by comparing the Pittsburgh sleep quality index (PSQI), Hamilton Depression Scale (HAMD) scores, and Hamilton Anxiety Scale (HAMA) scores of patients before treatment, after one course of treatment, and after two courses of treatment as well as one month after treatment. Results. Body, auricular, and abdominal acupuncture treatments all alleviated symptoms of insomnia, depression, and anxiety, but body and auricular acupuncture had stronger therapeutic effects. Conclusions. Body acupuncture at basic points shall be given priority in protocol selection for insomnia. The second-best choice is auricular acupuncture with basic points combined with points based on Traditional Chinese Medicine (TCM) theories. Abdominal needling with very quick effect can be an alternative protocol with basic points combined with syndrome differentiation points.

[Clinical analysis of hemolytic-uremic syndrome associated with Streptococcus pneumoniae serotype 3 infection in a child].

OBJECTIVE: To study the clinical characteristics of Streptococcus pneumonia-associated hemolytic uremic syndrome (SP-HUS) in children. METHOD: Clinical and laboratory data of a pediatric case of SP-HUS were retrospectively analyzed and the key points of diagnosis and therapy were reviewed. RESULT: An 18-month old girl was admitted with chief complaint of fever and cough for 5 days combined with mild labored breath. Breath sound was found weakened in right lung with lower lobe dullness on percussion. Laboratory tests revealed: WBC 3.7×10(9)/L, Hb 83 g/L, PLT 11×10(9)/L, C-reactive protein (CRP) > 180 mg/L. Morphological study of the RBCs showed marked anisocytosis and schistocytosis. Urinalysis showed 42.66 RBCs per high-power field, occult blood (+++), proteinura (++++). Streptococcus pneumoniae was isolated from blood, pleural fluid and sputum. Serotyping with simplified chessboard system was 3. The direct Coombs test was positive. Serum complement levels (C3 and C4) were depressed at 0.699 g/L, 0.064 g/L, respectively. Chest X-ray showed pleural effusion and infection of the right hemothorax. The computerized tomographic scan of the chest revealed pneumatoceles in the right lower lobe. The diagnosis on admission we considered was SP-HUS. Intravenous antibiotic therapy (vancomycin + cefoperazone/sulbactam) was administered. The renal replacement theraphy was administered to maintain electrolyte and fluid balances and adequate nutrition. Transfusions of washed red blood cells were administered to correct the anemia. One month after admission the patient was good with recovery. Liver and renal function recovered and the pneumonia was resolving, anemia and platelets were corrected. The direct Coombs test turned to be negative. Serum complement levels (C3 and C4) were normal. After 3-month follow-up, no clinical anomalies were detected. CONCLUSION: SP-HUS should be suspected when the following occurs in the context of pneumococcal infections: microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure and a positive Coombs test result. Serotype 3 of SP was associated with HUS.

Effects of clinical isolates of Streptococcus pneumoniae on THP-1 human monocytic cells.

Twenty­three clinical Streptococcus pneumoniae (SP) strains were isolated from blood and sputum specimens from the Second Affiliated Hospital of Wenzhou Medical College in 2009. These strains and the ATCC 49619 standard strain were cultured and suspended in normal saline (at a turbidity of 1.0 McFarland). The production of interleukin (IL)­8, intracellular adhesion molecule­1 (ICAM­1) and IL­10 in THP­1 cells following stimulation with the SP suspension was analyzed by an enzyme-linked immunosorbent assay. The concentrations of IL­8, ICAM­1 and IL­10 from the THP­1 monocytes were greater than those of the blank control following stimulation with the SP suspension. No significant difference was identified in the levels of IL­8, ICAM­1 and IL­10 secretion between THP­1 monocytes stimulated by blood­borne SP (bb­SP) and sputum­borne SP (sb­SP).

Roles of virulence genes (PsaA and CpsA) on the invasion of Streptococcus pneumoniae into blood system.

BACKGROUND: Streptococcus pneumoniae (SP) is the major cause of childhood mortality worldwide, we need to understand virulence genes of SP so can better target the treatment.We investigated the expression of virulence genes PsaA and CpsA in different strains of SP interacting with monocyte cell line (THP-1) or pneumocyte cell line (A549) and the possible mechanism of SP invasion of the blood system. METHODS: A total of 23 strains of SP were collected from hospitalized patients (blood-derived and sputum-derived) in the Second Affiliated Hospital of Wenzhou Medical College. The strains and ATCC 49619 were cultured, and RNAs were extracted. THP-1 and A549 cells were stimulated by different SP and ATCC 49619 for 4 h and 8 h, respectively. Quantitative real-time PCR was used to analyze the mRNA expression of PsaA and CpsA. The data were analyzed by SPSS 17.0. RESULTS: The mRNA level of PsaA and CpsA were all significantly increased in clinical SP strains when compared to ATCC49619 after tedTHP-1 and A549 cells were stimulated. Clinical SPs showed higher virulence compared with ATCC49619. CONCLUSIONS: The expression of CpsA is the basis of the pathogenicity of SP. The expression of virulence gene PsaA may be helpful to the invasion of SP to the blood system.

[Clinical features and homological analysis of Pichia ohmeri-caused hospital-acquired fungemia in premature infants].

OBJECTIVE: To analyze the clinical features of fungemia caused by Pichia ohmeri (P. ohmeri) in neonate intensive care unit and explore its molecular biological characteristics so as to improve its diagnosis and treatment level. METHODS: The clinical data of 6 infected infants were retrospectively analyzed. The strains obtained from them were identified and homological analysis was performed through randomly amplified polymorphic assay to explore the epidemiological characteristics of this nosocomial infection. RESULTS: Before the isolation of P. ohmeri, they received intravenous antibacterial therapy for 13 - 45 days. Among them, 4 received mechanical ventilation and 5 had a peripheral insertion of central venous catheters. Five infants were healed after a therapy of caspofungin for 15 - 30 days. One neonate recurred after a 30-day administration of fluconazole. The strain was identified and confirmed as P. ohmeri. RAPD genotyping results showed that all 6 strains were from the same clone. No similar cases occurred after positive control measures despite a negative epidemiological sampling. CONCLUSIONS: P. ohmeri may cause premature infant fungemia and lead to its spread in hospital. Hospital infection control is a key point. And caspofungin is both safe and effective in the therapy of neonate fungemia.

[Function of the present systematic evaluation in establishment of guidance for clinical practice].

OBJECTIVE: Treatment of insomnia with acupuncture is taken as an example to explore the significance and problems existed in the present systematic evaluation in establishment of guidance for clinical practice. METHODS: Fifteen articles on systematic evaluation of both English and Chinese were retrieved and studied carefully, their basic information was analyzed. Through study on the establishing process of the guidance of clinical practice, researches were focused on the possible significance of the articles to the guidance as well as the notes in the reuse of those articles since problem still existed. RESULTS: It is held that the systematic evaluation has great significance on the establishment of the guidance from the aspects of applicable people, recommended standards of diagnosis and therapeutic evaluation, extended recommendation and methodology. Great importance should also be attached to the direct application of the research result and understanding of the evaluation result. The data should be rechecked when necessary. CONCLUSION: Great guiding function can be found on the systematic evaluation of articles to the guidance. Moreover, if information needed to be taken into a full play, specific analysis should also be done on the concrete research targets.

[Study on the best solution of immediate analgesia of acupuncture for migraine].

OBJECTIVE: To select the best solution of immediate analgesia of migraine treated with acupuncture. METHODS: Taken 36 cases of migraine in attack stage as research objects, by means of orthogonal experimental design, applying the L9 (3(4)) orthogonal table, the therapeutic effect of immediate analgesia of acupuncture for migraine in attack stage was analyzed in four factors, which were effective acupoints combination, electroacupuncture therapy, auricular therapy and bloodletting therapy, and three levels of each factors. In the test procession, random approaches (stratified random and central random) and blinding experiment (the appraiser blind) were used. The time points of observation were before treatment, and 10, 20 minutes after treatment. Visual Analogue Scale (VAS) was used to evaluate therapeutic effect. RESULTS: Comparing with the headache before treatment, at the time points of 10 and 20 minutes after treatment, the best solution for headache relief was needling therapy (local and distal points and points selection according to the differentiation), auricular electroacupuncture therapy and bloodletting at Taiyang Zimai (Extra) or Taiyang (EX-HN 5)and Ashi points. CONCLUSION: In the attack stage of migraine, by the therapy combined with puncture on local and distal points and the points according to the differentiation, auricular electroacupuncture and bloodletting at Taiyang Zimai or Taiyang (EX-HN 5) and Ashi points, the favorable effects of immediate analgesia are received.

[Compilation characteristics and clinical applications of Guideline for Clinical Practice of Acupuncture in the Treatment of Migraine].

Refering to the oversea evidence-based guidelines for migraine, the authors analyze the compilation characteristics of Guideline for Clinical Practice of Acupuncture in the Treatment of Migraine (WHO WPR) (herein after referred to as "Guideline"), and briefly explain the range of application, clinical value and attentions of the Guideline. The methodological characteristics of the Guideline are stated from four aspects: general conditions of the included literature, evaluation standard for literature quality, classification standard for evidence level, and classification standard of recommendation. The characteristics of recommended protocol of the Guideline are stated from three aspects: universality, classification method and content.

[Clinical characteristics and antimicrobial resistance of invasive pneumococcal disease in children].

OBJECTIVE: Streptococcus pneumoniae (SP) is a major causative agent of community-acquired pneumonia. In children older than 2 months, SP is also the most common cause of invasive bacterial infections. Invasive pneumococcal diseases (IPD) have become a severe problem of public health worldwide. The aim of this study was to summarize the clinical characteristics and antimicrobial resistance of IPD in children, and to raise the level of diagnosis and treatment of this disease. METHOD: The clinical data from 55 cases of IPD younger than 12 years old seen from January 2004 to June 2009 in Yuying Children's Hospital Affiliated to Wenzhou Medical College were analyzed retrospectively. Blood, cerebrospinal fluid (CSF), seroperitoneum, mediastinum and soft tissue aspirate specimens were collected from these children, and 64 SP strains were cultured, isolated and confirmed and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assessed. RESULT: The 55 cases of IPD were identified, among whom 32 were male and 23 female, the ratio was 1.39. The ages ranged from 47 days to 12 years. Most (62%) of the cases were aged less than 2 years, and 16% were aged from 2 to 5 years. Overall, 38 (69%) had septicemia, of whom 8 cases were complicated with meningitis, 2 with pneumonia complicated with empyema, 1 had pneumonia complicated with mediastinal abscess and 11 with pneumonia. Nine cases (16%) were diagnosed as meningitis. Seven cases (13%) had hip or neck abscess and 1 case had purulent peritonitis. Thirteen cases (24%) had an underlying disease, including mainly leukemia (31%), followed by congenital heart disease (23%) and head trauma (15%). Three cases (5%) had received a surgical operation; 3 cases (5%) had combined virus infections and 2 cases (4%) had mycoplasma infection. Most (73%) episodes occurred in winter and spring. The main origin of infection was community (89%). Forty of the patients were cured, 12 improved and 3 died (5%). Nine cases (16%) developed neurologic complications. There was a statistically significant differences in the annual detection rate of invasive SP (chi(2) = 33.93, P < 0.01). The incidence of penicillin-intermediate S. pneumoniae (PISP) and penicillin-resistant S. pneumoniae (PRSP) were 30% and 41%, respectively; the resistance to erythromycin and lincomycin were found in as high as 94% and 88% of isolates, respectively; while the resistant rate to chloramphenicol and cefotaxime were low, 26% and 22%, respectively. The multidrug resistance rate was 89%. CONCLUSION: Children aged less than 5 years, especially younger than 2 years are prone to IPD and the underlying diseases are found in 24% of cases; septicemia and meningitis are the common diseases.

[Detection of etiologic agents and antibiotic resistance in children with acute lower respiratory tract infection in Wenzhou City].

OBJECTIVE: The etiology of acute lower respiratory tract infection (LRTI) in children in Wenzhou City remains poorly defined. This study investigated the etiological agents responsible for acute LRTI and patterns of the antibiotic resistant bacterial pathogens in children with acute LRTI from Wenzhou City. METHODS: Lower respiratory tract secretions were obtained from 454 children with acute LRTI (aged 1 month to 10 years, median age 6 months) within 24 hrs after admission for bacterial culture. Meanwhile respiratory viruses were detected by the Direct immunofluorescence (DIF) assay. The K-B method was applied for the drug susceptibility test. RESULTS: Etiological agents were identified in 297 cases out of 454 patients (65.4%. Viral pathogens were identified in 229 cases (50.4%), bacteria in 135 cases (29.7%) and mixed viral-bacterial infections in 67 cases (14.8%). The isolating rate of Respiratory syncytial virus (RSV) was the highest (180 cases, 39.6%) in all of the samples. The isolating rates of other viral pathogens were as follows: Parainfluenza virus 3 type (PIV3) (6.6%), Adenovirus (2.2%), Influenza A (0.9%) and Influenza B (0.7%). Of the 135 strains of bacterial pathogens, 19 kinds of bacterial pathogens were isolated. The predominant isolate was Klebsiella pneumoniae (K. pneumoniae) (9.9%), followed by Escherichia coli (E.coli) (4.4%), Streptococcus pneumoniae (S. pneumoniae) (4.2%) and Staphylococcus aureus (S. aureus) (4.2%). The isolating rates of K. pneumoniae and E.coli with extended-spectrum beta-lactamases strains (ESBLs) positive were 42.2% and 65.0%, respectively. The pathogens isolated of the first 5 places in children with acute LRTI under six months were RSV, K. pneumoniae, PIV3, E.coli and S. aureus in turn. RSV, PIV3, S. pneumoniae, K. pneumoniae and E.coli were found to be the pathogens of the first 5 places in children with acute LRTI between six months and three years. The resistant rates of K. pneumoniae and E.coli to ampicillin were 97.8% and 75.0%, respectively. K. pneumoniae and E.coli with positive ESBLs were resistant to cephalosporin. The resistant rates of S. pneumoniae to erythromycin and penicilin were 100% and 68.4%, respectively. The resistant rates of S. aureus to erythromycin and penicillin were 94.7% and 89.5%, respectively. CONCLUSIONS: RSV is the most common pathogen responsible for acute LRTI in children in Wenzhou City, followed by K. pneumoniae and PIV3. The rate of antibiotic resistance of common bacteria and the isolating rate of Gram-negative bacillus with ESBLs positive are high.