Transthoracic echocardiographic Doppler metrics in evaluating bioprosthetic tricuspid valve dysfunction.

PURPOSE: There is currently limited information on the utility of transthoracic echocardiography (TTE)-derived Doppler parameters for assessing bioprosthetic tricuspid valve (BTV) dysfunction. Our study aimed to establish the precision and appropriate reference ranges for routinely collected transthoracic Doppler parameters in the assessment of BTV dysfunction. METHODS: We retrospectively evaluated 100 BTV patients who underwent TTE. Based on redo surgical confirmation or more than 2 repeat TTE or transesophageal echocardiography (TEE) examinations, patients were allocated to normal (n = 61), regurgitant (n = 24), or stenotic (n = 15) BTV group. Univariate and multivariate binary logistic regression were performed to identify TTE Doppler parameters that detected BTV dysfunction. RESULTS: The VTI ratio (VTITV/VTILVOT) was the most accurate Doppler parameter for detecting BTV dysfunction, with a ratio of >2.8 showing 84.6% sensitivity and 90.2% specificity. VTI ratio > 3.2, mean gradient (MGTV) > 6.2 mmHg and pressure half-time > 218 ms detected significant BTV stenosis, with sensitivities of 100%, 93.3% and 93.3% and specificities of 82.4%, 75.3% and 87.1%, respectively. After multivariate analysis, the VTI ratio > 2.8 (OR = 9.00, 95% CI = 2.13-41.61, p = .003) and MGTV > 5.1 mmHg (OR = 6.50, 95% CI = 1.69-27.78, p = .008) were the independent associations of BTV dysfunction. With these cutoff values, 75.0%-92.2% of normal and 62.5%-96.0% of dysfunctional BTV were identified. CONCLUSIONS: Doppler parameters from TTE can accurately identify BTV dysfunction, particularly with VTI ratio > 2.8 and MGTV > 5.1 mmHg, to assess the need for additional testing with TEE.

Phytoremediation of Pb-polluted soil using bermudagrass: Effect of mowing frequencies.

Plant lead (Pb) tolerance and accumulation are key characteristics affecting phytoremediation efficiency. Bermudagrass is an excellent candidate for the remediation of Pb-polluted soil, and it needs to be mowed regularly. Here, we explored the effect of different mowing frequencies on the remediation of Pb-contaminated soil using bermudagrass. Mowing was found to decrease the biomass and photosynthetic efficiency of bermudagrass under Pb stress, thereby inhibiting its growth. Although mowing exacerbated membrane peroxidation, successive mowing treatments alleviated peroxidation damage by regulating enzymatic and nonenzymatic systems. A comprehensive evaluation of Pb tolerance revealed that all the mowing treatments reduced the Pb tolerance of bermudagrass, and a once-per-month mowing frequency had a less negative effect on Pb tolerance than did more frequent mowing. In terms of Pb enrichment, mowing significantly increased the Pb concentration, total Pb accumulation, translocation factor (TF), and bioenrichment factor (BCF) of bermudagrass. The total Pb accumulation was greatest under the once-a-month treatment, while the TF and BCF values were greatest under the three-times-a-month mowing treatment. Additionally, the decrease in soil pH and DOC were significantly correlated with the soil available Pb content and plant Pb accumulation parameters. The results showed that changes in the rhizosphere are crucial factors regulating Pb uptake in bermudagrass during mowing. Overall, once-a-month mowing minimally affects Pb tolerance and maximizes Pb accumulation, making it the optimal mowing frequency for soil Pb remediation by bermudagrass. This study provides a novel approach for the remediation of Pb-contaminated soil with bermudagrass based on mowing.

Exploring the nurses' experiences in recognising and managing clinical deterioration in emergency patients: A qualitative study.

BACKGROUND: Emergency Department (ED) patients are particularly at a high risk of deterioration. The frontline nurses are key players in identifying and responding to deterioration events; however, few studies have sought to explore the whole process of recognition and management of clinical deterioration by emergency nurses. OBJECTIVES: The aim of this study was to explore the experiences of emergency nurses and provide a whole picture of how they recognise and manage clinical deterioration. METHODS: A qualitative descriptive study involving 11 senior nurses and seven junior nurses was conducted in the ED of a 3000-bed tertiary general hospital using semistructured interviews. The interviews were transcribed and thematically analysed. FINDINGS: Four salient themes emerged from the data analysis. The first, 'early recognition and response', revealed the importance of vital signs assessment in recognising and responding to clinical deterioration. The second, 'information transfer', depicted the skills and difficulties of transferring information in escalations of care. The third, 'abilities, education, and training', presented the abilities that emergency nurses should have and their perspectives on training. The fourth, 'support culture', described the major role of senior nurses in collaboration with colleagues in the ED. CONCLUSIONS: This study explored the experiences of emergency nurses in recognising and managing clinical deterioration. The findings illuminate the need to support the critical role of emergency nurses, with an emphasis on their abilities and continuous interprofessional collaboration training to improve the recognition and management of clinical deterioration.

The Synergistic Mechanism of Photosynthesis and Antioxidant Metabolism between the Green and White Tissues of Ananas comosus var. bracteatus Chimeric Leaves.

Ananas comosus var. bracteatus (Ac. bracteatus) is a typical leaf-chimeric ornamental plant. The chimeric leaves are composed of central green photosynthetic tissue (GT) and marginal albino tissue (AT). The mosaic existence of GT and AT makes the chimeric leaves an ideal material for the study of the synergistic mechanism of photosynthesis and antioxidant metabolism. The daily changes in net photosynthetic rate (NPR) and stomatal conductance (SCT) of the leaves indicated the typical crassulacean acid metabolism (CAM) characteristic of Ac. bracteatus. Both the GT and AT of chimeric leaves fixed CO2 during the night and released CO2 from malic acid for photosynthesis during the daytime. The malic acid content and NADPH-ME activity of the AT during the night was significantly higher than that of GT, which suggests that the AT may work as a CO2 pool to store CO2 during the night and supply CO2 for photosynthesis in the GT during the daytime. Furthermore, the soluble sugar content (SSC) in the AT was significantly lower than that of GT, while the starch content (SC) of the AT was apparently higher than that of GT, indicating that AT was inefficient in photosynthesis but may function as a photosynthate sink to help the GT maintain high photosynthesis activity. Additionally, the AT maintained peroxide balance by enhancing the non-enzymatic antioxidant system and antioxidant enzyme system to avoid antioxidant damage. The enzyme activities of reductive ascorbic acid (AsA) and the glutathione (GSH) cycle (except DHAR) and superoxide dismutase (SOD), catalase (CAT), and peroxidase (POD) were enhanced, apparently to make the AT grow normally. This study indicates that, although the AT of the chimeric leaves was inefficient at photosynthesis because of the lack of chlorophyll, it can cooperate with the GT by working as a CO2 supplier and photosynthate store to enhance the photosynthetic ability of GT to help chimeric plants grow well. Additionally, the AT can avoid peroxide damage caused by the lack of chlorophyll by enhancing the activity of the antioxidant system. The AT plays an active role in the normal growth of the chimeric leaves.

The application of infrared thermography technology in flap: A perspective from bibliometric and visual analysis.

The application of infrared thermography technology (IRT) in flap has become a major focus of research, as it provides a non-invasive, real-time, and quantitative approach for monitoring flap perfusion. In this regard, we conducted a comprehensive visualization and scientometric analysis to systematically summarize and discuss the current state of research in this field. We systematically reviewed publications on the application of IRT in flap procedures from 1999 to 2022, using the Web of Science Core Collection (WoSCC). Through scientometric analysis, we examined annual trends, affiliations, countries, journals, authors, and their relationships, providing insights into current hotspots and future developments in this area. We analysed 522 English studies and found a steady increase in annual publications. The United States and Germany had the highest publication rates, with Beth Israel Deaconess Medical Center and Shanghai Jiaotong University being leading institutions. Notably, Lee BT and Alex Keller emerged as influential authors in this field. Compared to existing techniques, infrared-based technology offers significant advantages for non-invasive monitoring of flap perfusion, including simplicity of operation and objective results. Future trends should focus on interdisciplinary collaborations to develop new infrared devices and achieve intelligent image processing, enabling broader application in various clinical scenarios. This bibliometric study summarizes the progress and landscape of research on 'the Application of infrared thermography technology in flap' over the past two decades, providing valuable insights and serving as a reliable reference to drive further advancements and spark researchers' interest in this field.

Using NEWS2 to triage newly admitted patients with COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has spread globally and caused a major worldwide health crisis. Patients who are affected more seriously by COVID-19 usually deteriorate rapidly and need further intensive care. AIM: We aimed to assess the performance of the National Early Warning Score 2 (NEWS2) as a risk stratification tool to discriminate newly admitted patients with COVID-19 at risk of serious events. DESIGN: We conducted a retrospective single-centre case-control study on 200 unselected patients consecutively admitted in March 2020 in a public general hospital in Wuhan, China. METHODS: The following serious events were considered: mortality, unplanned intensive care unit (ICU) admission, and non-invasive ventilation treatment. Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to quantify the association between outcomes and NEWS2. RESULTS: There were 12 patients (6.0%) who had serious events, where 7 patients (3.5%) experienced unplanned ICU admissions. The area under the ROC curve (AUROC) and cut-off of NEWS2 for the composite outcome were 0.83 and 3, respectively. For patients with NEWS2 ≥ 4, the odds of being at risk for serious events was 16.4 (AUROC = 0.74), while for patients with NEWS2 ≥ 7, the odds of being at risk for serious events was 18.2 (AUROC = 0.71). CONCLUSIONS: NEWS2 has an appropriate ability to triage newly admitted patients with COVID-19 into three levels of risk: low risk (NEWS2 = 0-3), medium risk (NEWS2 = 4-6), and high risk (NEWS2 ≥ 7). RELEVANCE TO CLINICAL PRACTICE: Using NEWS2 may help nurses in early identification of at-risk COVID-19 patients and clinical nursing decision-making. Using NEWS2 to triage new patients with COVID-19 may help nurses provide more appropriate level of care and medical resources allocation for patients safety.

Development and validation of an instrument for measuring junior nurses' recognition and response abilities to clinical deterioration (RRCD).

BACKGROUND: Nurses of all levels are expected to be competent in managing clinical deterioration. Given their limited experience and basic-level knowledge, there is a concern about junior nurses' clinical and patient management skills. However, junior nurses' abilities to recognise and respond to clinical deterioration have not been adequately explored because of the absence of a comprehensive tool. OBJECTIVES: The aim of this study was to develop a new self-assessment scale to assess the junior nurses' recognition and response abilities to clinical deterioration and to examine its reliability and validity. METHODS: Scale items were based on literature reviews and interviews. The preliminary scale was generated through two rounds of expert review. A panel of five experts evaluated content validity. After a pilot study, the questionnaire was distributed to 168 junior nurses via convenience sampling. Subsequent statistical analysis of results included construct validity, internal consistency, and test-retest reliability. RESULTS: Six factors were included, and 69.310% of the total variance was explained by the 25 items comprising the scale. The Cronbach's alpha coefficient was 0.905 (95% confidence interval [CI]: 0.812-0.979) for the overall scale and 0.655-0.838 for its subscales. The Guttman split-half reliability was 0.856 (95% CI: 0.806-0.894). The test-retest reliability of the scale was 0.878 (95% CI: 0.836-0.911). CONCLUSION: We developed a scale for measuring the abilities of junior nurses to recognise and respond to clinical deterioration and confirmed its reliability and validity. More experimental studies are needed to further evaluate this instrument.

Tanshinone IIA increased amniotic fluid volume through down-regulating placental AQPs expression via inhibiting the activity of GSK-3ß.

The mechanism of idiopathic oligohydramnios is still uncertain, and there is no effective and targeted treatment for it. Placental aquaporins (AQPs) were associated with idiopathic oligohydramnios. This study aimed to investigate the effect of tanshinone IIA on amniotic fluid volume (AFV) and its underlying molecular mechanisms related to placental AQPs (AQP1, AQP3, AQP8, AQP9). Results showed that compared with the women with normal AFV, placental AQP1, AQP3, AQP8, and AQP9 protein expressions were decreased in women with idiopathic oligohydramnios. Immunohistochemistry revealed localization of AQP1, AQP3, AQP8, and AQP9 mainly in trophoblast cells within labyrinth zone of mouse placenta. Also, AQP1 was located in fetal vascular endothelial cells. Pregnant mice were administered with tanshinone IIA (10 mg/kg or 50 mg/kg, n = 8, respectively) or vehicle (n = 8) from 9.5 to 18.5 gestational day (GD). Tanshinone IIA markedly increased the AFV in pregnant mice, without the effects on embryo numbers per litter, atrophic embryo rate, fetal weight, and placental weight, as well as increased the expressions of AQPs and inhibited the activity of GSK-3ß in mice placenta. In JEG-3 cells, tanshinone IIA downregulated AQP1, AQP3, AQP8, AQP9 expressions and inhibited the activity of GSK-3ß. Activating GSK-3ß with MK-2206 eliminated these alterations. Thus, tanshinone IIA could increase AFV in pregnant mice, possibly through downregulating placental AQP1, AQP3, AQP8, and AQP9 expression via inhibiting the activity of GSK-3ß. Tanshinone IIA may be optional for the treatment of idiopathic oligohydramnios.

Differential effects of delayed cord clamping on bilirubin levels in normal and diabetic pregnancies.

The purpose of the study is to investigate the effects of delayed cord clamping on bilirubin levels and phototherapy rates in neonates of diabetic mothers. This was a prospective study that enrolled pregnant women without pregnancy complications and those with diabetes. Their neonates were randomized in a 1:1 ratio to delayed cord clamping. The main outcomes were the neonatal transcutaneous bilirubin values on 2-4 days postpartum and the rate of requiring phototherapy in infants. A total of 261 pregnant women were included in the final analysis (132 women with diabetic pregnancies and 129 women with normal pregnancies). In diabetic pregnancies, neonatal bilirubin levels on the 2-4 days postpartum and phototherapy rates were significantly higher in the delayed cord clamping group than in the immediate cord clamping group (7.65 ± 1.83 vs 8.25 ± 1.96, P = 0.039; 10.35 ± 2.23 vs 11.54 ± 2.56, P = 0.002; 11.54 ± 2.94 vs 12.83 ± 3.07 P = 0.024, 18.2% vs 6.3%, P = 0.042), while in normal pregnancies, there was no statistical difference in bilirubin values and phototherapy rates between the delayed cord clamping group and the immediate cord clamping group (P > 0.05). After receiving delayed cord clamping, bilirubin levels on the third postnatal day and the rate of requiring phototherapy in infants were higher in the diabetic pregnancy group than in the normal pregnancy group (10.35 ± 2.23 vs 11.54 ± 2.56, P = 0.013). CONCLUSION: Delayed cord clamping increased the risk of jaundice in newborns born to diabetic mothers, but had no effect in newborns from mothers with normal pregnancies. DCC may be a risk factor for increased bilirubin in infants of diabetic mothers. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04369313; date of registration: April 27, 2020 (retrospectively registered). WHAT IS KNOWN: • Delayed cord clamping had significant benefits for newborns by increasing neonatal hemoglobin levels and reducing the risk of neonatal anemia, etc. • Delayed cord clamping may lead to neonatal hyperemia, erythrocytosis, and hyperbilirubinemia, which increases the risk of neonatal jaundice. WHAT IS NEW: • Our trial focused on the differential effects of delayed cord clamping on jaundice in full-term newborns between diabetic pregnancies and normal pregnancies. And newborns of diabetic mothers who received delayed cord clamping had a significantly increased risk of jaundice compared to newborns with normal pregnancy. • Delayed cord clamping may be a risk factor for increased bilirubin levels in neonates of diabetic mothers.

Labor characteristics and intrapartum interventions in women with vaginal birth after cesarean section.

BACKGROUND: With the development of China's two-child-policy, vaginal birth after cesarean section (VBAC) has aroused public concern. It is important to understand the labour characteristics and intrapartum management of women attempting VBAC to enhance the rates of successful VBAC. The purpose of our research was to investigate the differences in the characteristics of labor, intervention measures and perinatal outcomes between women who had a VBAC and primiparas or multiparas not undergoing VBAC, providing clinical references of intrapartum management for women who are planning a VBAC. MATERIAL AND METHODS: This observational retrospective study enrolled all women who laboured spontaneously and who had a VBAC (n = 139) at the Second Affiliated Hospital of Wenzhou Medical University in China between 2016 and 2019. They were allocated into VBAC group A (the previous cesarean section was performed before dilation of the cervix) and VBAC group B (the previous cesarean section was performed after dilation of the cervix). The primipara control group included 149 primiparae, and the multipara control group included 155 multiparae with second vaginal birth. Durations of labor, intervention measures and perinatal outcomes were compared among the groups. RESULTS: The durations of labor, intrapartum interventions and maternal and neonatal outcomes in VBAC group A were similar to those of the VBAC group B. However, all women who had a VBAC and those in VBAC group A had shorter first, second and the total stages of labor than primiparae. All women with VBAC and those in VBAC group B had longer second stage of labor, but shorter third stage of labor than multiparae. Oxytocin, labor analgesia and artificial rupture of membranes were administered less often in women with VBAC than in primiparae, while phloroglucinol was administered more often in women with VBAC than in multiparae. Women who had a VBAC were more likely to receive episiotomy and had higher incidences of postpartum hemorrhage than primipara and multipara women. CONCLUSIONS: Labor characteristics, intrapartum interventions and perinatal outcomes in women who had a VBAC with cervical dilation were similar to those in women who had a VBAC without cervical dilation before the previous cesarean section, but differed significantly from those of multiparae and primiparae who did not undergo VBAC.

Associations between prepregnancy body mass index, gestational weight gain, and pregnancy outcomes in women with twin pregnancies: A five-year prospective study.

BACKGROUND: The purpose of this project was to investigate the relationship between prepregnancy body mass index (ppBMI), gestational weight gain (GWG), and pregnancy outcomes in women with twin pregnancies. METHODS: A prospective cohort of 369 women with dichorionic diamniotic twin pregnancies was recruited from 2016 to 2020. According to ppBMI using Chinese BMI classifications, they were categorized into the underweight (BMI < 18.5 kg/m2 ), normal (BMI 18.5-23.9 kg/m2 ), and overweight and obese (BMI ≥ 24 kg/m2 ) groups. In each ppBMI group, they were divided into two subgroups based on the presence or absence of the complications such as gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and small for gestational age (SGA). The outcomes including GDM, HDP, and SGA were compared among three ppBMI groups, and the associations of GWG with these outcomes within each ppBMI category were analyzed. RESULTS: Twin-pregnant women with overweight and obesity were at increased risks of HDP (aOR = 4.417 [95% CI = 1.826-9.415]) and SGA (2.288 [1.102-4.751]), whereas underweight women were prone to deliver SGA newborns (2.466 [1.157-5.254]). Women with GDM gained less weight during pregnancy than those without GDM within each ppBMI category. For overweight and obese women, greater GWG increased the incidence of HDP (1.235 [1.016-1.500]) and decreased the risk of SGA (0.818 [0.702-0.953]). CONCLUSIONS: Both ppBMI and GWG in twin-pregnant women were strongly associated with HDP and SGA, but not GDM.

Effect of later cord clamping on umbilical cord blood gas in term neonates of diabetic mothers: a randomized clinical trial.

OBJECTIVE: To evaluate the effect of later cord clamping (LCC) on umbilical arterial blood gas in neonates of diabetic mothers. METHODS: This prospective study included a group of 160 diabetic mothers (DM) whose neonates were randomized to immediate cord clamping (ICC) (≤ 15 s after birth) or LCC (≥ 30 s after birth), and a group of 208 non-diabetic mothers (NDM) whose neonates were randomized to ICC or LCC as a reference. Cord arterial pH, base excess (BE), bicarbonate (HCO3-), partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), lactate, hemoglobin, hematocrit and glucose were compared among groups. RESULTS: In neonates of DM, there was no significant difference in cord arterial pH between the ICC and LCC group. LCC of ≥ 30 s decreased umbilical arterial HCO3- and BE and increased lactate (ICC versus LCC, HCO3-: 24.3 (22.7, 25.8) versus 23.7 (22.3, 24.7) mmol/L, P = 0.01; BE: -2.70 (-4.80, -1.50) versus - 3.72 (-5.66, -2.36) mmol/L, P = 0.006; lactate: 2.1 (1.6, 3.7) versus 2.7 (2.1, 4.3) mmol/L, P = 0.005), without the alterations of pCO2, pO2, hemoglobin, hematocrit and glucose. Similar results were found in neonates of NDM (ICC versus LCC, HCO3-: 24.3 (23.1, 25.7) versus 23.5 (22.3, 24.8) mmol/L, P = 0.01; BE: -2.39 (-3.73, -1.51) versus - 3.40 (-4.73, -1.91) mmol/L, P = 0.001; lactate: 2.2 (1.9, 3.3) versus 2.5 (2.0, 4.3) mmol/L, P = 0.01), except for the higher level of hemoglobin in the LCC group. The majority of diabetic mothers (ICC: 92.0%; LCC: 91.8%) had good blood glucose control. No differences were observed in acid-base status and glucose between neonates of DM and neonates of NDM in both ICC and LCC, but hemoglobin and hematocrit were elevated after ICC in neonates of DM compared to neonates of NDM. CONCLUSIONS: Later cord clamping of ≥ 30 s resulted in a tendency towards metabolic acidosis of umbilical arterial blood in neonates of DM and NDM. Umbilical arterial blood gas parameters at birth were similar in neonates of DM and NDM. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04369313 ; date of registration: 30/04/2020 (retrospectively registered).

Low-molecular-weight organic acid-mediated tolerance and Pb accumulation in centipedegrass under Pb stress.

Lead (Pb) is one of the most harmful, toxic pollutants to the ecological environment and humans. Centipedegrass, a fast-growing warm-season turfgrass, is excellent for Pb pollution remediation. Exogenous low-molecular-weight organic acid (LMWOA) treatment is a promising approach for assisted phytoremediation. However, the effects of this treatment on the tolerance and Pb accumulation of centipedegrass are unclear. This study investigated these effects on the physiological growth response and Pb accumulation distribution characteristics of centipedegrass. Applications of 400 µM citric acid (CA), malic acid (MA) and tartaric acid (TA) significantly reduced membrane lipid peroxidation levels of leaves and improved biomass production of Pb-stressed plants. These treatments mainly increased peroxidase (POD), catalase (CAT) and ascorbate peroxidase (APX) activities and enhanced free protein (Pro), ascorbic acid (AsA) and phytochelatins (PCs) contents, ultimately improving the Pb tolerance of centipedegrass. Their promoting effects decreased as follows: TA>CA>MA. All the treatments decreased root Pb concentrations and increased stem and leaf Pb concentrations, thus increasing total Pb accumulation and TF values. MA had the best and worst effects on Pb accumulation and Pb transportation, respectively. CA had the best and worst effects on Pb transportation and Pb accumulation, respectively. TA exhibited strong effects on both Pb accumulation and transport. Furthermore, all treatments changed the subcellular Pb distribution patterns and distribution models of the chemical forms of Pb in each tissue. The root Pb concentration was more highly correlated with the Pb subcellular fraction distribution pattern, while the stem and leaf Pb concentrations were more highly correlated with the distribution models of the chemical forms of Pb. Overall, TA improved plant Pb tolerance best and promoted both Pb absorption and transportation well and is considered the best candidate for Pb-contaminated soil remediation with centipedegrass. This study provides a new idea for Pb-contaminated soil remediation with centipedegrass combined with LMWOAs.

Comparison of the Performance of 24 Early Warning Scores with the Updated National Early Warning Score (NEWS2) for Predicting Unplanned Intensive Care Unit (ICU) Admission in Postoperative Brain Tumor Patients: A Retrospective Study at a Single Center.

BACKGROUND There have been few studies to evaluate early warning score (EWS) systems, or track and trigger systems (TTS), to identify early clinical deterioration in patients following brain tumor surgery who are admitted to the Intensive Care Unit (ICU). The National Early Warning Score (NEWS2) is an established method used in the U.K. National Health Service to improve care for in-hospital patients. This retrospective study from a single center aimed to compare the performance of NEWS2 with 24 other types of EWS to evaluate unplanned ICU admissions within 72 h after brain tumor surgery. MATERIAL AND METHODS A total of 326 patients with brain tumors were included in the study. Patients who experienced unplanned ICU transfer after surgery (69 cases) were diagnostically matched with patients who did not require intensive care (257 controls). We collected the physiological variables to calculate the area under the receiver operator characteristic curve (AUROC), sensitivity, specificity, Youden index values, cutoff values, positive predictive values, and negative predictive values. RESULTS The NEWS2 identified postoperative brain tumor patients with AUROC (0.860, p=0.000). The Patient-At-Risk (PAR) score was higher than NEWS2 in terms of AUROC value (0.870, P=0.000), Youden index (0.589 vs 0.542). CONCLUSIONS The findings showed that although the NEWS 2 performed well when used to evaluate unplanned ICU admissions within 72 h of postoperative brain tumor patients, the PAR score was also an accurate EWS.

Triage practice in emergency departments in tertiary hospitals across China: A multicenter national descriptive survey.

Triage procedure remains at a developing stage in mainland China, and few studies have reported the current status. This study aimed to explore the triage practices presently implemented in emergency departments in mainland China. A descriptive online national survey was administered to nurses with experience in emergency department triage who worked in 64 hospitals in 2019. A total of 361 participants completed the survey. Only 210 nurses (58.2%) used triage systems. Approximately 5% of the participants reported that no nurse was allocated to triage during the evening and night shifts in their emergency departments. Most participants had fewer than 5 years of nursing experience (47%) and emergency nursing experience (58.2%) before fulfilling the triage role. This study shows the variability in triage guidelines as well as the inconsistency between different hospitals in nurses' entry qualifications to triage, in hospital workforce arrangements, and in triage training. These problems underscore the need to unify triage guidelines and to establish reasonable entry qualifications and appropriate workforce arrangements for triage nurses that ensure high triage quality and high levels of patient safety.

Application of "family member-like" care strategies among COVID-19 patients in an isolation ward. / "家属"ç §æŠ¤ç­–ç•¥åœ¨éš”ç¦»ç— æˆ¿çš„2019å† çŠ¶ç— æ¯’ç— æ‚£è€ ä¸­çš„åº”ç”¨.

OBJECTIVES: To control the pandemic of coronavirus disease 2019 (COVID-19) effectively, strict isolation measures have been taken in China. Suspected patients must be isolated, and the confirmed patients specifically are isolated in negative-pressure isolation rooms. During the isolation, patients face difficulty in adapting to their surrounding environment, worry about the prognosis of the disease, lack confidence in treatment, separate from their families, and have a sense of distance from medical staff. Isolated patients may possess the feelings of negativity, including loneliness, anxiety, depression, insomnia, and despair. Hence, to reduce the risk of adverse psychological outcomes, "family member-like" care strategies were developed and implemented to solve problems associated with the COVID-19 pandemic. This study aims to examine whether using "family member-like" care strategies can improve psychological resilience and reduce depression, anxiety, and stress symptoms among patients with COVID-19 in an isolation ward. METHODS: A quasi-experimental design was used to evaluate the "family member-like" care strategies for adult patients with COVID-19 in an isolation ward. COVID-19 patients in the Xiangya ward of the West District of the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology in Wuhan, Hubei province, were included in this study from February 9 to March 20, 2020. Healthcare providers who volunteered as family members were assigned to patients. They practiced one-to-one care and provided continuous and whole care for the patients who were from admission to discharge. Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Depression Anxiety Stress Scale-21 (DASS-21) were used to evaluate the resilience and psychological status of COVID-19 inpatients upon hospital admission, 2 weeks after admission, and at their discharge from the hospital. RESULTS: The questionnaire response rate of the "family member-like" strategies was 100%. Of the 60 patients, 39 (65.0%) were male, and 21 (35%) were female. The hospital stay was (27.5±3.5) days. All the 60 patients were cured and discharged without any death and serious complications. The total scores for CD-RISC were 8.83±6.86 at admission, 29.13±5.42 at 2 weeks after admission, and 33.87±6.14 at discharge, which were significantly improved at the 2 follow-ups (F=404.564, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant improvements in tenacity (F=360.839, P<0.001), strength (F=368.217, P<0.001), and optimism (F=328.456, P<0.001) at the 2 follow-ups. The total scores of DASS-21 were 49.27±11.30 at admission, 30.77±16.71 at 2 weeks after admission, and 4.17±11.03 at discharge, and the scores were significantly decreased at the 2 follow-ups (F=270.536, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant decreases in depression (F=211.938, P<0.001), anxiety (F=285.592, P<0.001), and stress (F=287.478, P<0.001) at the 2 follow-ups. CONCLUSIONS: "Family member-like" strategies had positive effects on improving psychological resilience and reducing the symptoms of anxiety and depression of COVID-19 patients. It might be an effective care method for COVID-19 patients. It should be incorporated into emergency care management to improve care quality during public health emergencies of infectious diseases.

Severe pneumonia in Chinese patients with systemic lupus erythematosus.

OBJECTIVE: This study aimed to investigate the clinical characteristics and risk factors associated with severe pneumonia in systemic lupus erythematosus (SLE) patients from China. METHOD: We performed a retrospective study in 112 hospitalized SLE patients who had had pneumonia for 8 years. The primary outcome was severe pneumonia, followed by descriptive analysis, group comparison and bivariate analysis. RESULTS: A total of 28 SLE patients were diagnosed with severe pneumonia, with a ratio of 5:23 between men and women. The mean age at diagnosis was 44.36 ± 12.389 years. The median disease duration was 72 months, and the median SLE Disease Activity Index 2000 (SLEDAI 2K) score was 8. The haematological system was the most affected, with an incidence of anaemia in 85.7% of cases and thrombocytopenia in 75% of cases, followed by lupus nephritis in 50% of cases and central nervous system involvement in 10.71% of cases. Cultured sputum specimens were positive in 17 (68%) SLE patients with severe pneumonia, of whom nine (36%) were cases of fungal infection, five (20%) were cases of bacterial infection and three (12%) were cases of mixed infection. Using multivariate logistic regression analysis, we concluded that a daily dosage of prednisone (>10 mg; odds ratio (OR) = 3.193, p = 0.005), a low percentage of CD4+ T lymphocytes (OR = 0.909, p = 0.000), a high SLEDAI 2K score (OR = 1.182, p = 0.001) and anaemia (OR = 1.182, p = 0.001) were all independent risk factors for pneumonia in SLE patients, while a low percentage of CD4+ T lymphocytes (OR = 0.908, p = 0.033), a daily dose of prednisone of >10 mg (OR = 35.67, p = 0.001) were independent risk factors for severe pneumonia in SLE patients. CONCLUSION: Severe pneumonia is not rare in lupus, and is associated with high mortality and poor prognosis. Monitoring CD4+ T-cell counts and giving a small dose of glucocorticoids can reduce the occurrence of severe pneumonia and improve the prognosis of patients with lupus.

Development of the National Early Warning Score-Calcium Model for Predicting Adverse Outcomes in Patients With Acute Pancreatitis.

INTRODUCTION: This study aimed to develop a new model on the basis of the National Early Warning Score to predict intensive care unit admission and the mortality of patients with acute pancreatitis. METHODS: Patients diagnosed with acute pancreatitis in the emergency department were enrolled. The values of the National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis in predicting intensive care unit admission and mortality of patients with acute pancreatitis were evaluated. RESULTS: A total of 379 patients with acute pancreatitis were enrolled; 77 patients (20.3%) were admitted to the intensive care unit and 14 (3.7%) died. The National Early Warning Score and calcium level were identified as independent risk factors of intensive care unit admission. Serum calcium exhibited a moderate correlation with National Early Warning Score (r = -0.46; P < 0.001), Modified Early Warning Score (r = -0.37; P < 0.001), and Bedside Index of Severity in Acute Pancreatitis (r = -0.39; P < 0.001). A new model called National Early Warning Score-calcium was developed by combining National Early Warning Score and calcium blood test result, which had larger areas under the curve for predicting intensive care unit admission and mortality than the other 3 scoring systems. DISCUSSION: A new model developed by combining National Early Warning Score and calcium exhibited better value in predicting the prognosis of acute pancreatitis than the models involving National Early Warning Score, Modified Early Warning Score, and Bedside Index of Severity in Acute Pancreatitis alone.

Effect of low tidal volume with PEEP on respiratory function in infants undergoing one-lung ventilation.

BACKGROUND: An increasing number of studies have shown that low tidal volume (TV) with positive end-expiratory pressure (PEEP) offers lung protection during one-lung ventilation (OLV). Considering the unique physiological characteristics of infants, we aimed to determine the feasibility and effect of low TV with PEEP in infants undergoing OLV during thoracoscopy. PATIENTS AND METHODS: We randomized 60 infants to a conventional group (group I: TV, 8-10 ml/kg; RR, 23-45 bpm; PEEP, 0 cmH2O) or a low TV with PEEP group (group II: TV, 5-7 ml/kg; RR, 23-45 bpm; PEEP, 4-6 cmH2O). Arterial blood gas analyses were performed at four time points: 5 min of two-lung ventilation (TLV, T0), and 20 min, 40 min, and 60 min of OLV (T1, T2, T3); hemodynamic parameters (heart rate, mean blood pressure), temperature, as well as gas exchange (SpO2 and PETCO2) and ventilation parameters (FiO2, PEEP, Pmax) were recorded simultaneously. Lung compliance and shunt were also calculated. RESULT: No significant difference was found between both groups at T0. Compared with T0, PETCO2, Pmax, PaCO2, lactic acid, and intrapulmonary shunt volume (Qs/Qt) were increased while PaO2 and respiratory system compliance (Cdyx) were decreased noticeably in both groups at T1, T2, and T3. At T1, T2, and T3, Pmax and Qs/Qt were much lower while PETCO2, PaCO2, and Cdyx were higher in group II than in group I. There was no significant difference in lactic acid and PaO2 measurements between the two groups at T1, T2, and T3. CONCLUSION: Low TV with PEEP could be an effective intraoperative ventilation strategy for infants undergoing OLV during video-assisted thoracoscopic surgery and may reduce the risk of lung injury. However, this strategy, as well as the influence of intraoperative hypercapnia on infants, needs further investigation.

Physiological analyses indicate superoxide dismutase, catalase, and phytochelatins play important roles in Pb tolerance in Eremochloa ophiuroides.

Phytoremediation is considered to be a promising approach to restore or stabilize soil contaminated by lead (Pb). Turfgrasses, due to their high biomass yields, are considered to be suitable for use in phytoextraction of soil contaminated with heavy metal. It has been demonstrated that centipedegrass (Eremochloa ophiuroides (Munro) Hack., Poaceae) is a good turfgrass for restore of soil contaminated by Pb. However, the enhanced tolerant mechanisms in metallicolous (M) centipedegrass accessions remain unknown. In this study, we made a comparative study of growth performance, Pb accumulation, antioxidant levels, and phytochelatin concentrations in roots and shoots from M and nonmetallicolous (NM) centipedegrass accessions. Results showed that turf quality and growth rate were less repressed in M accessions than in NM accession. Pb stress caused generation of reactive oxygen species in centipedegrass with relatively lower levels in M accessions. Antioxidant activity analysis indicated that superoxide dismutase and catalase played important roles in Pb tolerance in M accessions. M accessions accumulated more Pb in roots and shoots. Greatly increased phytochelatins and less repressed sulfur contents in roots and shoots of M accessions indicated that they correlated with Pb accumulation and tolerance in centipedegrass.