Circadian rhythm disturbance and delirium in ICU patients: a prospective cohort study.

BACKGROUND: Patients treated in the intensive care unit (ICU) may experience a reversal of day and night. The circadian rhythm in ICU patients can be disturbed. METHODS: To explore the relationship between ICU delirium and the circadian rhythms of melatonin, cortisol and sleep. A prospective cohort study was carried out in a surgical ICU of a tertiary teaching hospital. Patients who were conscious during the ICU stay after surgery and were scheduled to stay in the ICU for more than 24 h were enrolled. Serum melatonin and plasma cortisol levels were measured three times a day by drawing arterial blood on the first three days after ICU admission. Daily sleep quality was assessed by the Richard-Campbell Sleep Questionnaire (RCSQ). The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was performed twice a day to screen for ICU delirium. RESULTS: A total of 76 patients were included in this study, and 17 patients developed delirium during their ICU stay. Melatonin levels were different at 8:00 (p = 0.048) on day 1, at 3:00 (p = 0.002) and at 8:00 (p = 0.009) on day 2, and at all three time points on day 3 (p = 0.032, 0.014, 0.047) between delirium and non-delirium patients. The plasma cortisol level in the delirium patients was significantly lower than that in the non-delirium patients at 16:00 on day 1 (p = 0.025). The changes in melatonin and cortisol secretion levels exhibited obvious biological rhythmicity in non-delirium patients (p < 0.001 for melatonin, p = 0.026 for cortisol), while no rhythmicity was found in melatonin and cortisol secretion levels in the delirium group (p = 0.064 for melatonin, p = 0.454 for cortisol). There was no significant difference in RCSQ scores in the first three days between the two groups. CONCLUSIONS: The disturbance of the circadian rhythm of melatonin and cortisol secretion was associated with the development of delirium in ICU patients. Clinical staff should pay more attention to the importance of maintaining patients' normal circadian rhythms in the ICU. TRIAL REGISTRATION: The study was registered with the US National Institutes of Health ClinicalTrials.gov(NCT05342987) (25/04/2022).

The relationships between organizational culture and thriving at work among nurses: The mediating role of affective commitment and work engagement.

AIM: Guided by the social embeddedness model of thriving at work, this paper explores how nursing organizational culture, work engagement and affective commitment affect nurses' thriving at work. BACKGROUND: Thriving at work has implications for better employee and organization outcomes. The antecedents of thriving at work among the nursing population needs to be expanded by analysing the cross-level impact of organizational and individual characteristics. METHODS: A cross-sectional design was used to collect data from 1437 frontline nurses in a tertiary teaching hospital in China between April and May 2020 through an online survey about perceived nursing culture, work engagement, affective commitment and thriving at work. Data were analysed using SPSS, and a structural equation model was established using the PROCESS macro. RESULTS: Our results showed that work engagement and affective commitment mediated the relationship between nurses' perceived nursing culture and their thriving at work. Among nurses, work engagement was positively correlated to affective commitment. CONCLUSION: Our study confirmed the social embeddedness model of thriving at work by showing that both contextual and dispositional factors can influence nurses' thriving at work. Nurse leaders can foster nursing staff's thriving at work by building an inclusive work environment and by providing adequate resources to staff. Future research is needed to elaborate on employee and organizational outcomes associated with thriving at work. IMPACT: Nurse leaders should be the advocate for nurses to improve their organizational identification, fostering their thriving at work. Individual nurses can also take an active role in developing work-related resources to sustain their thriving through self-adaption processes. Collective thriving in the nursing workforce is needed to overcome adversity and hardship in the ever-changing and increasingly demanding health care industry and to further contribute to the vitality of the broader social and public environments. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.

The beliefs and attitudes of intensive care unit nurses and patient families regarding an open visitation policy in China.

AIMS: To investigate the beliefs and attitudes of intensive care unit (ICU) nurses and patients' family members towards an open visitation policy in the ICU in China and to explore the reasons that promote or hinder open visitation to improve visitation policy. BACKGROUND: Open visitation policies are widely recommended in many countries. However, there are gaps between evidence and practice. Most ICUs in China still use a restrictive policy for family visits, which raises controversy. There are limited visiting times, and family visitors are not allowed to enter the ICU. STUDY DESIGN: A multicentre survey was conducted in seven hospitals in China. The Beliefs and Attitudes towards Visitation in the Intensive Care Unit Questionnaire (BAVIQ) was administered to ICU nurses and patient families from 11 the ICUs of seven hospitals. A total of 275 questionnaires were completed and returned by ICU nurses and 139 by patients' family members. RESULTS: Among nurses, the belief scale score was 2.87 ± 0.33 (range 2-4), and the attitude scale score was 5.53 ± 1.12 (range 2.33-7). The belief scale was divided into three subscales: nurses, patients, and patients' families. The subscale score for patients' families was the highest, and the nurses' subscale score was the lowest. Most (84.0%) of the nurses were satisfied with the current ICU visitation policy. The belief and attitude scores were 3.13 ± 0.39 (range 1.96-4) and 6.18 ± 1.20 (range 1.67-7), respectively, for family members. The scores of the three subscales, that is, patients, patients' families and nurses, were 3.13 ± 0.40, 3.26 ± 0.43, and 3.04 ± 0.49, respectively. CONCLUSION: Nurses' beliefs and attitudes towards implementing an open visitation policy in China are at a less positive level than those of patient family members. RELEVANCE TO CLINICAL PRACTICE: The beliefs and attitudes of nurses towards open visitation policy in China need to be improved. The question of how to mobilize nurses' enthusiasm for an open visitation policy poses a challenge for ICU management.

External use of Mirabilite combined with Lactulose improves postoperative gastrointestinal mobility among older patients undergoing abdominal surgery.

AIMS: To evaluate the feasibility and efficacy of Mirabilite combined with Lactulose in older patients after abdominal surgery. DESIGN: It is a retrospective observational cohort study with a pre and post intervention group. METHODS: Medical records were retrospectively reviewed of postoperative Intensive Care patients with postoperative gastrointestinal tract dysfunction (aged >60 years) in the Surgical Intensive Care Unit from January 2017-December 2018. RESULTS: One hundred and sixty-seven post-surgical Intensive Care patients with postoperative gastrointestinal tract dysfunction were analysed; 74 patients received Mirabilite + Lactulose treatment and 93 patients received Lactulose treatment. The recovery rate of bowel sounds was better in the Mirabilite + Lactulose group (62.16%) compared with the Lactulose group (37.63%) after 3-day treatment (p = 0.002) and the relative risk (RR) was 1.65 (95% CI, 1.20, 2.27). Moreover 70.27% patients in the Mirabilite + Lactulose group finally had flatus or defecation compared with 46.24% patients in Lactulose group (p = 0.003) and the RR was 1.52 (1.17, 1.98). The abdominal girth and Inter Abdominal Pressure in Mirabilite + Lactulose group showed significantly greater decrease over a 3-day period compared with Lactulose group (4.86 vs. 3.46 cm, p = 0.027; 4.80 vs. 3.11 mmHg, p = 0.002 respectively). The pain score had greater decrease from the baseline in Mirabilite + Lactulose group than in Lactulose group (2.40 vs. 1.11; p < 0.01). Patients in the Mirabilite + Lactulose group had shorter hospital stay than the Lactulose group 12.5 (SD 3.51) versus 13.9 (SD 5.14), p = 0.05. CONCLUSIONS: This study demonstrated that external use of Mirabilite combined with Lactulose can be considered as an easy intervention to improve postoperative gastrointestinal mobility in older intensive care patients who suffer from postoperative gastrointestinal tract dysfunction after surgery. IMPACT: Our results provide a great option to alleviate the sufferings of postoperative patients. The externally use Mirabilite is a painless and safe interventions that is easy to implement by ICU nurses.

Incidence and risk factors of PostopeRativE delirium in intensive care unit patients: A study protocol for the PREDICt study.

AIM: The aims of this study are: (a) to determine the incidence of postoperative delirium (POD) among surgical intensive care unit (ICU) patients in China and identify risk factors, especially, which are modifiable and have value for developing a prediction model; (b) to develop and validate a prediction model of delirium to recognize high-risk patients in surgical ICUs; (c) to investigate the short- and long-term outcomes of delirious patients and identify the predictors of patient outcomes. DESIGN: A single-centre prospective cohort study. METHODS: Patients will be enrolled from three surgical ICUs in a tertiary teaching hospital. Delirium assessment and perioperative data will be collected throughout the hospitalization. Delirious patients will be followed up for 2 years. The study was approved by the ethics committee in May 2018 and was funded by the clinical research grant from Zhongshan hospital, Fudan University, Shanghai. DISCUSSION: Developing POD can be a burden to patients both for the short- and long-term period. Due to the lack of effective treatments for POD, prevention remains the best strategy. This study will provide an effective tool for early screening of high-risk patients of POD and provide a better understanding of the aetiology and outcome of delirium. IMPACT: In clinical practice, a prediction model will offer an effective tool for ICU nurses to assess high-risk patients, which can support them to implement preventive strategies at the early stages to targeted patients. The follow-up results will help us better understand the impact of delirium on patients' long-term outcome.

Separation and purification of 9,10-dihydrophenanthrenes and bibenzyls from Pholidota chinensis by high-speed countercurrent chromatography.

Stilbenoids are the main components of leaves and stems of Pholidota chinensis. In the present investigation, high-speed counter-current chromatography was used for the separation and purification of two classes of stilbenoids, namely, bibenzyls and 9,10-dihydrophenanthrenes, on a preparative scale from whole plants of P. chinensis with different solvent systems after silica gel column chromatography fractionation. n-Hexane/ethyl acetate/methanol/water (1.2:1:1:0.8, v/v/v/v) was selected as the optimum solvent system to purify 1-(3,4,5-trimethoxyphenyl)-1',2'-ethanediol (1), coelonin (2), 3,4'-dihydroxy-5,5'-dimethoxybibenzyl (3), and 2,​7-​dihydroxy-​3,​4,​6-​trimethoxy-​9,​10-​dihydrophenanthrene (4). While 2,7-dihydroxy-3,4,6-trimethoxy-​9,​10-​dihydrophenanthrene (5), batatasin III (6), orchinol (7), and 3'-O-methylbatatasin III (8) were purified by n-hexane/ethyl acetate/methanol/water (1.6:0.8:1.2:0.4, v/v/v/v). After the high-speed counter-current chromatography isolation procedure, the purity of all compounds was over 94% assayed by ultra high performance liquid chromatography. The chemical structure identification of all compounds was carried out by mass spectrometry and (1)H and (13)C NMR spectroscopy. To the best of our knowledge, the current investigation is the first study for the separation and purification of bibenzyls and 9,10-dihydrophenanthrenes by high-speed counter-current chromatography from natural resources.

Separation and purification of five alkaloids from Aconitum duclouxii by counter-current chromatography.

C19 -diterpenoid alkaloids are the main components of Aconitum duclouxii Levl. The process of separation and purification of these compounds in previous studies was tedious and time consuming, requiring multiple chromatographic steps, thus resulted in low recovery and high cost. In the present work, five C19 -diterpenoid alkaloids, namely, benzoylaconine (1), N-deethylaconitine (2), aconitine (3), deoxyaconitine (4), and ducloudine A (5), were efficiently prepared from A. duclouxii Levl (Aconitum L.) by ethyl acetate extraction followed with counter-current chromatography. In the process of separation, the critical conditions of counter-current chromatography were optimized. The two-phase solvent system composed of n-hexane/ethyl acetate/methanol/water/NH3 ·H2 O (25%) (1:1:1:1:0.1, v/v) was selected and 148.2 mg of 1, 24.1 mg of 2, 250.6 mg of 3, 73.9 mg of 4, and 31.4 mg of 5 were obtained from 1 g total Aconitum alkaloids extract, respectively, in a single run within 4 h. Their purities were found to be 98.4, 97.2, 98.2, 96.8, and 96.6%, respectively, by ultra-high performance liquid chromatography analysis. The presented separation and purification method was simple, fast, and efficient, and the obtained highly pure alkaloids are suitable for biochemical and toxicological investigation.

Systematic separation and purification of iridoid glycosides and crocetin derivatives from Gardenia jasminoides Ellis by high-speed counter-current chromatography.

INTRODUCTION: Iridoid glycosides and crocetin derivatives are the main bioactive components of Gardenia. The processes of separation of these compounds reported in much of the literature are tedious, time consuming and require multiple chromatographic steps, which results in lower recovery and higher costs. OBJECTIVE: To develop a high-speed counter-current chromatography (HSCCC) method for the systematic separation and purification of iridoid glycosides and crocetin derivatives on a preparative scale from Gardenia. METHODS: After fractionation using HPD100 column chromatography, n-butanol:ethanol:water (10:1:10, v/v) was selected to purify gardenoside, 6ß-hydroxy geniposide and geniposidic acid from fraction A; ethyl acetate:n-butanol:water (2:1.5:3, v/v) was used to isolate geniposide from fraction B; crocin-1, crocin-2, crocin-3 and crocin-4 were purified by hexane:ethyl acetate:n-butanol:water (1:2:1:5, v/v) from fraction C. The head-to-tail elution mode was used with a flow rate of 8.0 mL/min and a rotary speed of 600 rpm. RESULTS: After HSCCC isolation, 151.1 mg of gardenoside, 52.2 mg of 6ß-hydroxy geniposide and 24.5 mg of geniposidic acid were obtained from 800 mg of fraction A; 587.2 mg of geniposide was obtained from 800 mg of Fraction B; 246.2 mg of crocin-1, 34.2 mg of crocin-2, 24.4 mg of crocin-3 and 24.7 mg of crocin-4 were obtained from 1000mg of fraction C. Their purities were found by UPLC analysis to be 91.7%, 93.4%, 92.5%, 98.2%, 94.1%, 96.3%, 94.1% and 98.9% respectively. CONCLUSION: The present results demonstrates that the main iridoid glycosides and crocetin derivatives in Gardenia can be obtained efficiently from extracts using HSCCC.

Genomic analysis of Cobetia sp. D5 reveals its role in marine sulfur cycling.

Dimethylsulfoniopropionate (DMSP) is one of the most abundant sulfur-containing organic compounds on the earth, which is an important carbon and sulfur source and plays an important role in the global sulfur cycle. Marine microorganisms are an important group involved in DMSP metabolism. The strain Cobetia sp. D5 was isolated from seawater samples in the Yellow Sea area of Qingdao during an algal bloom. There is still limited knowledge on the capacity of DMSP utilization of Cobetia bacteria. The study reports the whole genome sequence of Cobetia sp. D5 to understand its DMSP metabolism pathway. The genome of Cobetia sp. D5 consists of a circular chromosome with a length of 4,233,985 bp and the GC content is 62.56%. Genomic analysis showed that Cobetia sp. D5 contains a set of genes to transport and metabolize DMSP, which can cleave DMSP to produce dimethyl sulphide (DMS) and 3-Hydroxypropionyl-Coenzyme A (3-HP-CoA). DMS diffuses into the environment to enter the global sulfur cycle, whereas 3-HP-CoA is catabolized to acetyl CoA to enter central carbon metabolism. Thus, this study provides genetic insights into the DMSP metabolic processes of Cobetia sp. D5 during a marine algal bloom, and contributes to the understanding of the important role played by marine bacteria in the global sulfur cycle.

Prediction models for postoperative delirium after cardiac surgery: Systematic review and critical appraisal.

BACKGROUND: Many studies have developed or validated prediction models to estimate the risk of delirium after cardiac surgery, but the quality of the model development and model applicability remain unknown. OBJECTIVES: To systematically review and critically evaluate currently available prediction models for delirium after cardiac surgery. DATA SOURCES: PubMed, EMBASE, and MEDLINE were systematically searched. This systematic review was registered in PROSPERO (Registration ID: CRD42021251226). STUDY SELECTION: Prospective or retrospective cohort studies were considered eligible if they developed or validated prediction models or scoring systems for delirium in the ICU. We included studies involving adults (age ≥18 years) undergoing cardiac surgery and excluded studies that did not validate a prediction model. DATA EXTRACTION: Data extraction was independently performed by two authors using a standardized data extraction form based on the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies checklist. Quality of the models was assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST). DATA SYNTHESIS: Of 5469 screened studies, 13 studies described 10 prediction models. The postoperative delirium incidence varied from 11.3 % to 51.6 %. The most frequently used predictors were age and cognitive impairment. The reported areas under the curve or C-statistics were between of 0.74 and 0.91 in the derivation set. The reported AUCs in the external validation set were between 0.54 and 0.90. All the studies had a high risk of bias, mainly owing to poor reporting of the outcome domain and analysis domain; 10 studies were of high concern regarding applicability. CONCLUSIONS: The current models for predicting postoperative delirium in the ICU after cardiac surgery had a high risk of bias according to the PROBAST. Future studies should focus on improving current prediction models or developing new models with rigorous methodology.

Two-stage prediction model for postoperative delirium in patients in the intensive care unit after cardiac surgery.

OBJECTIVES: Postoperative delirium is a common severe complication in patients in the intensive care unit after cardiac surgery. We developed a two-stage prediction model and quantified the risk of developing postoperative delirium to assist in early prevention before and after surgery. METHODS: We conducted a prospective cohort study and consecutively recruited adult patients after cardiac surgery. The Confusion Assessment Method for patients in the intensive care unit was used to diagnose delirium 5 days postoperatively. The stage I model was constructed using patient demographics, health conditions and laboratory results obtained preoperatively, whereas the stage II model was built on both pre- and postoperative predictors. The model was validated internally using the bootstrap method and externally using data from an external cohort. RESULTS: The two-stage model was developed with 654 patients and was externally validated with 214 patients undergoing cardiac surgery. The stage I model contained 6 predictors, whereas the stage II model included 10 predictors. The stage I model had an area under the receiver operating characteristic curve of 0.76 (95% confidence interval: 0.68-0.81), and the stage II model's area under the receiver operating characteristic curve increased to 0.85 [95% confidence interval (CI): 0.81-0.89]. The external validation resulted in an area under the curve of 0.76 (95% CI: 0.67-0.86) for the stage I model and 0.78 (95% CI: 0.69-0.86) for the stage II model. CONCLUSIONS: The two-stage model assisted medical staff in identifying patients at high risk for postoperative delirium before and 24 h after cardiac surgery. This model showed good discriminative power and predictive accuracy and can be easily accessed in clinical settings. TRIAL REGISTRATION: The study was registered with the US National Institutes of Health ClinicalTrials.gov (NCT03704324; registered 11 October 2018).

The Diagnostic Accuracy of Critical Care Pain Observation Tool (CPOT) in ICU Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The critical care pain observation tool (CPOT) has been widely used to assess pain in ICU patients, and its validity and reliability have been tested in various contexts. OBJECTIVE: To determine the diagnostic accuracy of the CPOT in critically ill patients, a systematic review of diagnostic studies was performed. METHODS: A database search (PubMed, Medline, CINAHL, ProQuest, EMBASE, Cochrane Library, CNKI, Wanfang, COVIP, CBM) was conducted, as was the manual identification of eligible papers from citations. Eligible studies were published between 2006 and February 2020. Quality appraisal of the studies was carried out with the QUADAS-2 checklist, and data extraction was performed in alignment with STARD 2015. Open Meta Analyst was used for the statistical analysis. RESULTS: In total, 25 articles involving 1920 subjects with 3493 experimental results were included. Most of the studies were of fair quality. A high degree of heterogeneity (I2 = 57.2%, P < 0.001) was discovered. The Youden index values were 1.56 and 1.55 when the CPOT threshold was set at two and three, respectively. The diagnostic performance of the CPOT was affected by the reference standard. The CPOT had a higher diagnostic odds ratio of 11.52 (95% CI: 7.42-17.87) during nociceptive procedures compared with 9.14 (95% CI: 5.38-15.53) at rest or during non-nociceptive procedures. CONCLUSION: CPOT has moderate diagnostic parameters with a threshold of two or three, suggesting that it is a fair but not excellent tool. More research on the validity of the CPOT in specific subgroups is needed to broaden its applicability in critical care.

The efficacy of e-health in the self-management of chronic low back pain: A meta analysis.

BACKGROUND: Globally, more than half a billion people are suffering from chronic low back pain, which results in poor quality of life for patients and major welfare cost for society. Currently, e-Health has been considered as a potential strategy to deliver self-management programs for chronic low back pain, but its effects are uncertain. OBJECTIVES: To assess the efficacy on pain intensity and disability of e-Health based self-management programs on chronic low back pain. DESIGN: Systematic review and meta-analysis DATA SOURCES: Searches of Pubmed, the Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature, Elsevier, Physiotherapy Evidence Database and ProQuest from inception through 2nd April 2019. REVIEW METHODS: Randomized controlled trials were screened and selected if they examined e-Health based self-management programs on chronic low back pain and assessed pain intensity and disability as primary outcomes. Risks of bias were assessed by two independent reviewers. Evidence quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Meta-analyses were performed to investigate the effects of e-Health based self-management programs on pain intensity and disability for chronic low back pain. Subgroup analyses were conducted. RESULTS: Eight randomized controlled trials were included. For pain intensity, moderate-quality evidence indicated there was a clinically important effect of e-Health based self-management programs for relieving pain both at immediate and short-term follow-ups. For disability, moderate-quality evidence showed there was a clinically important effect of e-Health based self-management programs for improving disability at immediate follow-up, and low-quality of evidence showed no significant difference at short-term follow-ups, but with a favorable trend. The results of subgroup analyses indicated that m-Health based self-management programs showed better immediate effects on both pain and disability than web-Health based programs, and programs with durations ≤ 8 weeks demonstrated a better immediate effect on pain than those with durations >8 weeks, but not on disability. CONCLUSIONS: Generally, e-Health based self-management programs may play a positive role in improving pain and disability within short-term period for chronic low back pain patients. More rigorous trials are warranted to determine the optimal delivery mode, duration, and long-term effect of e-Health based self-management programs.

Clinical outcome of standardized oxygen therapy nursing strategy in COVID-19.

BACKGROUND: Novel coronavirus pneumonia (COVID-19) has become a global pandemic. However, a technical standard for oxygen therapy nursing, as well as how this would improve clinical outcomes and symptoms, is yet to be explored. METHODS: From February 9, 2020, to March 31, 2020, 58 patients of confirmed COVID-19 were admitted to the 20th ward of the Eastern Branch, Renmin Hospital of Wuhan University. Fifteen patients who did not receive oxygen therapy and 13 patients who were transferred from other hospitals were excluded. The rest of the 30 patients that received standardized oxygen therapy in our unit were included in the study. Baseline characteristics, symptoms, and finger pulse oxygen saturation were collected during hospitalization. RESULTS: Clinical outcomes of the 30 patients were as follows: 27 patients (90.00%) were cured and discharged; 3 patients (10.00%) who continued to stay in hospital were stabilized with symptoms relieved. The fingertip oxygen saturation was 94.80%±3.49% at ICU admission and 97.8%±1.27% when transferred out of ICU after standardized oxygen therapy (P<0.005). The symptoms of dyspnea, fatigue, and muscle aches of the patients were improved when transferred out of ICU, compared with their condition when admitted to ICU (P<0.05). CONCLUSIONS: The standardized oxygen therapy nursing strategy for patients with COVID-19 emphasizes the nursing measurement, which focuses on the patient's oxygenation. It is led by nurses and starts oxygen therapy at an earlier stage. It not only improves the clinical outcomes of critical patients but also effectively reduces the infection risk of medical staff while emphasizing nursing quality management.

Stress, Burnout, and Coping Strategies of Frontline Nurses During the COVID-19 Epidemic in Wuhan and Shanghai, China.

Background: Nurses at the frontline of caring for COVID-19 patients might experience mental health challenges and supportive coping strategies are needed to reduce their stress and burnout. The aim of this study was to identify stressors and burnout among frontline nurses caring for COVID-19 patients in Wuhan and Shanghai and to explore perceived effective morale support strategies. Method: A cross-sectional survey was conducted in March 2020 among 110 nurses from Zhongshan Hospital, Shanghai, who were deployed at COVID-19 units in Wuhan and Shanghai. A COVID-19 questionnaire was adapted from the previous developed "psychological impacts of SARS" questionnaire and included stressors (31 items), coping strategies (17 items), and effective support measures (16 items). Burnout was measured with the Maslach Burnout Inventory. Results: Totally, 107 (97%) nurses responded. Participants mean age was 30.28 years and 90.7% were females. Homesickness was most frequently reported as a stressor (96.3%). Seven of the 17 items related to coping strategies were undertaken by all participants. Burnout was observed in the emotional exhaustion and depersonalization subscales, with 78.5 and 92.5% of participants presenting mild levels of burnout, respectively. However, 52 (48.6%) participants experienced a severe lack of personal accomplishment. Participants with longer working hours in COVID-19 quarantine units presented higher emotional exhaustion (OR = 2.72, 95% CI 0.02-5.42; p = 0.049) and depersonalization (OR = 1.14, 95% CI 0.10-2.19; p = 0.033). Participants with younger age experienced higher emotional exhaustion (OR = 2.96, 95% CI 0.11-5.82; p = 0.042) and less personal accomplishment (OR = 3.80, 95% CI 0.47-7.13; p = 0.033). Conclusions: Nurses in this study experienced considerable stress and the most frequently reported stressors were related to families. Nurses who were younger and those working longer shift-time tended to present higher burnout levels. Psychological support strategies need to be organized and implemented to improve mental health among nurses during the COVID-19 pandemic.

Preoperative cardiac function parameters as valuable predictors for nurses to recognise delirium after cardiac surgery: A prospective cohort study.

BACKGROUND: Delirium is a common postoperative complication after cardiac surgery. The relationship between delirium and cardiac function has not been fully elucidated. AIMS: The aim of this study was to identify the association between preoperative cardiac function and delirium among patients after cardiac surgery. METHODS: We prospectively recruited 635 cardiac surgery patients with a planned cardiac intensive care unit admission. Postoperative delirium was diagnosed using the confusion assessment method for the intensive care unit. Preoperative cardiac function was assessed using N-terminal prohormone of brain natriuretic peptide (NT-proBNP), New York Heart Association functional classification and left ventricular ejection fraction. RESULTS: Delirium developed in 73 patients (11.5%) during intensive care unit stay. NT-proBNP level (odds ratio (OR) 1.24, 95% confidence interval (CI) 1.01-1.52) and New York Heart Association functional classification (OR 2.34, 95% CI 1.27-4.31) were both independently associated with the occurrence of delirium after adjusting for various confounders. The OR of delirium increased with increasing NT-proBNP levels after the turning point of 7.8 (log-transformed pg/ml). The adjusted regression coefficients were 1.19 (95% CI 0.95-1.49, P=0.134) for NT-proBNP less than 7.8 (log-transformed pg/ml) and 2.78 (95% CI 1.09-7.12, P=0.033) for NT-proBNP greater than 7.8 (log-transformed pg/ml). No association was found between left ventricular ejection fraction and postoperative delirium. CONCLUSION: Preoperative cardiac function parameters including NT-proBNP and New York Heart Association functional classification can predict the incidence of delirium following cardiac surgery. We suggest incorporating an early determination of preoperative cardiac function as a readily available risk assessment for delirium prior to cardiac surgery.

Prevalence, Predictors, and Early Outcomes of Post-operative Delirium in Patients With Type A Aortic Dissection During Intensive Care Unit Stay.

Objectives: The aim of this study was to investigate the prevalence and explore the predictors and early outcomes of post-operative delirium (POD) in patients with type A aortic dissection (AAD) during intensive care unit (ICU) stays. Methods: We retrospectively reviewed the records of 301 patients with AAD who underwent surgical treatment in our institution from January 2017 to December 2018. Results: Delirium developed in 73 patients (24.25%) during the ICU stay. Patients with lower estimated glomerular filtration rates [odds ratio (OR) 0.84, 95% CI 0.74-0.94, p = 0.003], post-operative midazolam use (OR 2.37, 95% CI 1.33-4.23, p = 0.004), and post-operative morphine use (OR 1.87, 95% CI 1.07-3.29, p = 0.029) were more susceptible to developing POD. Patients who developed POD had a longer ICU stay (11.52 vs. 7.22 days, p < 0.001) and hospital stay (23.99 vs. 18.91, p = 0.007) with higher hospitalization costs (48.82 vs. 37.66 thousand dollars, p < 0.001) than those without POD. The in-hospital mortality rate was higher in the delirium group, but the difference was not significant (6.85 vs. 4.82%, p = 0.502). Conclusions: The incidence of POD in patients with AAD was high and was associated with renal dysfunction and the use of midazolam and morphine. POD was associated with poor early outcomes, suggesting the importance of early screening, such as for renal dysfunction, and prevention by using sedation scales to minimize the use of midazolam and morphine in these patients.

Ethanol extract of gardenia fruit alleviates renal interstitial fibrosis induced by unilateral ureteral obstruction in rats.

Gardenia fruit has been used in traditional Chinese medicine for thousands of years. A previous study by the present authors indicated that the ethanol extract of gardenia fruits (EEG) primarily contains eight constituents. In the present study, the potential effects of EEG on unilateral ureteral obstruction (UUO)-induced renal interstitial fibrosis were observed in rats. A total of 30 rats were randomly divided into three groups (n=10 each): Sham group, UUO group, and EEG group, which were administered with EEG (200 mg/kg/day) or the same volume of distilled water as a vehicle. UUO were established by ligating left ureter at two points and cut between the ligatures. All rats were sacrificed at 14 days after UUO operation. the present results demonstrated that EEG significantly elevated the expressions of vascular endothelial growth factor and E-cadherin induced by UUO (both P<0.05), and reduced levels of hypoxia-inducible factor-1α, transforming growth factor-ß1, connective tissue growth factor and α-smooth muscle actin (all P<0.05). The present findings suggest that EEG is a potential novel renoprotective compound for renal fibrosis through inhibiting epithelial-to-mesenchymal transition.

Comparative Evaluation of Hepatoprotective Activities of Geniposide, Crocins and Crocetin by CCl4-Induced liver Injury in Mice.

Iridoid glycosides (mainly geniposide) and crocetin derivatives (crocins) are the two major active constituents in Gardenia jasminoides Ellis. In the present study, geniposide, crocins, crocin-1 and crocetin were separated from gardenia chromatographically. Then, mice were orally administrated with geniposide (400 mg/kg b.w.), crocins (400 mg/kg b.w.), crocin-1 (400 mg/kg b.w.) and crocetin (140 mg/kg b.w.) once daily for 7 days with CCl4. Hepatoprotective properties were evaluated by biochemical parameters: Administration of geniposide, crocins, crocin-1and crocetin significantlylowered serum alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase (ALP) levels in CCl4-treated mice. The reduced glutathione (GSH) levels and antioxidant enzymes (SOD and CAT) activities were also increased by geniposide, crocins, crocin-1 and crocetin. Histopathological examination of livers showed that these components reduced deformability, irregular arrangement and rupture of hepatocyte in CCl4-treated mice. These biochemical results and liver histopathological assessment demonstrated that geniposide, crocetin derivatives and crocetin show comparative beneficialeffects on CCl4-induced liver damage via induction of antioxidant defense. Therefore, contents of geniposide and crocetin derivatives should be both considered for hepatoprotective efficacyof Gardenia jasminoides Ellis.

Effects of minocycline on learning and memory of mice following ischemic-hypoxic cerebral injuries.

An ischemic-hypoxic animal model was established using right common carotid artery occlusions and inhalation of low concentrations of oxygen in mice. At 10 days after the ischemic-hypoxic injuries, saline-treated mice exhibited significantly prolonged escape latencies in water-maze tests and significantly shorter memory latencies and more mistakes in step-down tests. In contrast, mice treated with 5 mg/kg minocycline exhibited significant reversals of each of these effects compared with the saline-treated control mice. Moreover, we found that minocycline can relieve brain water content and morphological changes in mice following ischemic-hypoxic cerebral injuries. Accordingly, our findings indicate that minocycline provides some protections against the deleterious effects of these injuries in mice.