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.

Circulating miRNAs act as potential biomarkers for asthma.

Background: Identification of new clinical markers contributes to a better understanding of the pathogenesis of asthma. Considering the crucial role of LIGHT in asthma, it may become a potential target for asthma. The aim of current study was to determine if circulating microRNAs (miRNAs) targeting LIGHT may be used as diagnostic biomarkers to distinguish asthma. Methods: Blood serum from a cohort of 60 subjects, including 20 cases with mild asthma, 20 cases with moderate-to-severe asthma, and 20 healthy controls were included. Serum was analyzed for circulating miRNAs profiles through miRNAs microarray. Real Time PCR was conducted to verify the results of miRNA microarray. Correlations between circulating miRNAs targeting LIGHT and clinical characteristics were investigated. Results: A total of 365 miRNAs were differentially expressed in asthma patients. Among them, miR-107 and miR-140-5p were found to target LIGHT, and varied in asthmatics. Additionally, miR-107 and miR-140-5p expressions were positively correlated with the absolute value of peripheral eosinophils. Finally, miR-140-5p and miR-107 were demonstrated to have good diagnostic efficacy for asthma (AUC= 0.8667 and 0.9400) with good sensitivity (0.8000 and 0.8667,respectively) and specificity (0.8667 and 0.867). Thus, circulating miRNAs expressed differentially between healthy control and asthma patients. Conclusion: Plasma miR-140-5p and miR-107 can be used as diagnostic biomarkers to distinguish patients with asthma from healthy control, and may take part in asthma pathogenesis by negatively regulating LIGHT. Further research was needed to evaluate their roles as potential biomarkers in the diagnosis of asthma.

Work experience of triage nurses in emergency departments during the prevalence of COVID-19.

OBJECTIVE: In December 2019, the global outbreak of Corona Virus Disease 2019 (COVID 19) was reported. As of March 8, 2020, more than 90,000 cases were reported worldwide, resulting in a shortage of global medical resources. The purpose of this study was to understand the working experience of triage nurses in the emergency department (ED) of a large teaching general hospital in Shenzhen (Guangdong province, China) during the COVID-19 epidemic. This will provide a basis for improving the emergency nursing strategies and the epidemic response capabilities of triage nurse. METHODS: Ten triage nurses were selected as subjects by objective sampling for in- depth interviews, and the data were analyzed by the Colaizzi seven-step analysis method. RESULTS: There were four themes in the working experience of triage nurses, including fear of infection and transmission, job stress, gratitude, and expectations of managers. CONCLUSION: During the COVID-19, the work experience of triage nurses mainly included the fear of infection and transmission, the high work pressure, the sense of team strength and the care of leaders. It was suggested that nursing managers should ensure the human resources of triage nurses, increase training, strengthen emergency drills, improve emergency nursing countermeasures, and improve the response capability of triage nurses during the epidemic.

Mortality prediction using a novel combination of biomarkers in the first day of sepsis in intensive care units.

Early identification of infection severity and organ dysfunction is crucial in improving outcomes of patients with sepsis. We aimed to develop a new combination of blood-based biomarkers that can early predict 28-day mortality in patients with sepsis or septic shock. We enrolled 66 patients with sepsis or septic shock and compared 14 blood-based biomarkers in the first 24 h after ICU admission. The serum levels of interleukin-6 (IL-6) (median 217.6 vs. 4809.0 pg/ml, P = 0.001), lactate (median 2.4 vs. 6.3 mmol/L, P = 0.014), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (median 1596.5 vs. 32,905.3 ng/ml, P < 0.001), prothrombin time (PT) (median 15.6 vs. 20.1 s, P = 0.030), activated partial thrombin time (APTT) (median 45.1 vs. 59.0 s, P = 0.026), and international normalized ratio (INR) (median 1.3 vs. 1.8, P < 0.001) were significantly lower in the survivor group. IL-6, NT-proBNP, and INR provided the best individual performance in predicting 28-day mortality of patients with sepsis or septic shock. Furthermore, the combination of these three biomarkers achieved better predictive performance (AUC 0.890, P < 0.001) than conventional scoring systems. In summary, the combination of IL-6, NT-proBNP, and INR may serve as a potential predictor of 28-day mortality in critically ill patients with sepsis or septic shock.

The risk factors for the postoperative pulmonary infection in patients with hypertensive cerebral hemorrhage: A retrospective analysis.

ABSTRACT: The risk factors for the pulmonary infections after hypertensive cerebral hemorrhage remains unclear. We aimed to investigate the potential risk factors for the postoperative pulmonary infection in patients with hypertensive cerebral hemorrhage.Patients with hypertensive cerebral hemorrhage undergone surgery from January 2018 to December 2019 were included. Related personal and medical information were collected. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for the postoperative pulmonary infection.A total of 264 patients were included, and the incidence of pulmonary infection for patients with hypertensive cerebral hemorrhage after surgery was 19.70%. Escherichia coli is the most common bacteria of pulmonary infection. Multivariate regression analysis revealed that the preoperative hypoalbuminemia (OR2.89, 1.67∼4.78), tracheotomy (OR5.31, 1.24∼11.79), diabetes (OR4.92, 1.32∼9.80), preoperative GCS (OR5.66, 2.84∼11.21), and the duration of mechanical ventilation (OR2.78, 2.32∼3.61) were the independent risk factors for the pulmonary infection in patients with hypertensive cerebral hemorrhage (all P < .05).Patients with hypertensive intracerebral hemorrhage after surgery have a higher risk of postoperative pulmonary infections, and there are many related risk factors, which should be taken seriously in clinical practice.

Evaluation of effect of atorvastatin on left ventricular systolic function in rats with myocardial infarction via 2D-STI technique.

This report aims to evaluate the effect of atorvastatin (Ator) on left ventricular systolic function in myocardial infarction (MI) rats. Forty healthy adult Sprague-Dawley rats were randomly divided into four groups: Ator group, MI group, sham-operation group and normal group. The left anterior descending coronary arteries were ligated to establish the MI model; after modeling, the Ator group was treated with Ator for 4 consecutive weeks. The echocardiographic detection was performed; the left ventricular myocardial systolic peak velocities, strain and strain rates were analyzed using the 2D-STI technique. After 4 weeks, myocardial tissues were taken from all rats and received the pathological examination. Left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) in Ator group and MI group were increased after operation, but left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were decreased; myocardial function were decreased significantly (p<0.05). After Ator treatment, myocardial function at the 3rd and 4th week after operation increased significantly (p<0.05). After Ator treatment, LVEDD and LVESD decreased while LVEF and LVFS increased in Ator group at the 3rd and 4th week after operation compared with MI group (p<0.05). At the 4th week after operation, LVEDD and LVESD in Ator group were decreased compared with those at the 1st and 2nd week after operation, but LVEF and LVFS were increased compared with those at the 1st, 2nd and 3rd week after operation (p<0.05). Pathological examination showed that necrosis and fibrosis of myocardial cells and inflammatory reaction were obvious in MI group. The inflammatory reaction of myocardial cells and myocardial fibrosis were lighter in Ator group. Ator can effectively improve the left ventricular systolic function in MI rats, which could be related to the reduction of response to inflammation and fibrosis.

Clinical value of diagnosing aortico-left ventricular tunnel by echocardiography.

In order to assess the clinical value of echocardiography in the diagnosis of aortico-left ventricular tunnel (ALVT) the echocardiographic data and clinical manifestations of six patients with ALVT were analyzed in the present study. Based on the results, a comprehensive study was conducted regarding 147 cases from related documents. Six patients were confirmed with ALVT by surgery. The echocardiographic images of the patients revealed an abnormal communication beginning in the ascending aorta above the coronary arteries, bypassing the aortic valve, and ending in the left ventricle. The color Doppler flow imaging showed a high-speed to- and -fro flow with or without the involvement of the aortic valve. According to Hovaguimian type casting, there were two cases of type I, two cases of type III, one case of type IV, and one case of type II (postoperative recanalization). Of the 153 cases reported, the accuracy rate of the ultrasound diagnosis was 79.6%, the misdiagnosis rate was 17.1%, and the missed diagnostic rate was 3.3%. In conclusion, echocardiography is the preferred method for non-invasive preoperative diagnosis of the ALVT and can accurately describe the type and involvement of the cardiac structure.

Analysis of real-time three dimensional transesophageal echocardiography in the assessment of left atrial appendage function in patients with atrial fibrillation.

The aim of the study was to examine changes in left atrial appendage volume (LAA-V) in patients with non-valvular atrial fibrillation (AF) using real-time three-dimensional transesophageal echocardiography (RT3D-TEE) and evaluate the prediction value on the high risk of thrombosis of LAA. Using RT3D-TEE we measured: i) LAA peak empty velocity (LAA-PEV), ii) LAA-V including LAA end-diastolic volume (LAA-EDV) and end-systolic volume (LAA-ESV). We also calculated LAA ejection fraction (LAA-EF). RT3D-TEE was applied in 20 control cases and 74 patients with non-valvular AF. According to the presence of thrombosis, 74 patients were divided into the no thrombosis group (NTH group, n=52) and thrombosis group (TH group, n=22). Our results showed that there were significant differences in LAA-V and LAA-EF values in different groups (P<0.05). LAA-EDV moderately correlated with LAA-PEV (r=-0.531, P<0.001) while LAA-ESV demonstrated a strong correlation with LAA-PEV (r=-0.741, P<0.001). LAA-EF also showed a strong correlation with LAA-PEV (r=0.693, P<0.001). Through receiver operating characteristic (ROC) curves, the cut-off values of LAA-EDV and LAA-ESV in thrombosis of LAA were 18.45 and 9.69 ml, respectively. RT3D-TEE effectively evaluated the LAA-V, LAA-PEV and LAA-EF parameters, and proved to be valuable in the process of evaluation of thrombosis of LAA.