Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients.

AIM: To evaluate and summarize the evidence for prevention and management of enteral feeding intolerance in critically ill patients and provide reference for clinical practice. DESIGN: This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing. METHODS: Current literatures were systematically searched for the best evidence for prevention and management of enteral feeding intolerance in critically ill patients. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries and cohort studies. DATA SOURCES: UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Scottish Intercollegiate Guidelines Network, the Cochrane Library, Embase, PubMed, Sinomed, Web of Science, Yi Maitong Guidelines Network, DynaMed, MEDLINE, CNKI, WanFang database, Chinese Medical Journal Full-text Database, European Society for Clinical Nutrition and Metabolism website, the American Society for Parenteral and Enteral Nutrition website were searched from January 2012 to April 2023. RESULTS: We finally identified 18 articles that had high-quality results. We summarized the 24 pieces of best evidence from these articles, covering five aspects: screening and assessment of the risk of enteral nutritional tolerance; formulation of enteral nutrition preparations; enteral nutritional feeding implementation; feeding intolerance symptom prevention and management; and multidisciplinary management. Of these pieces of evidence, 19 were 'strong' and 5 were 'weak', 7 pieces of evidence were recommended in level one and 4 pieces of evidence were recommended in level two. CONCLUSION: The following 24 pieces of evidence for prevention and management of enteral feeding intolerance in critically ill patients were finally recommended. However, as these evidences came from different countries, relevant factors such as the clinical environment should be evaluated before application. Future studies should focus on more specific symptoms of feeding intolerance and more targeted prevention design applications. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: The clinical medical staffs are recommended to take evidence-based recommendations for the implementation of standardized enteral nutrition to improve patient outcomes and decrease gastrointestinal intolerance in critically ill patients. IMPACT: The management of enteral nutrition feeding intolerance has always been a challenge and difficulty in critically ill patients. This study summarizes 24 pieces of the best evidence for prevention and management of enteral nutrition feeding intolerance in critically ill patients. Following and implementing these 24 pieces of evidence is beneficial to the prevention and management of feeding intolerance in clinical practice. The 24 pieces of evidence include five aspects, including screening and assessment of the risk of enteral nutritional tolerance, formulation of enteral nutrition preparations, enteral nutritional feeding implementation, feeding intolerance symptom prevention and management and multidisciplinary management. These five aspects constitute a good implementation process. Screening and assessment of enteral nutritional tolerance throughout intervention are important guarantees for developing a feasible nutrition program in critically ill patients. This study will be benefit to global medical workers in the nutritional management of critically ill patients. REPORTING METHOD: This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute (JBI). The reporting specifications include problem establishment, literature retrieval, literature screening, literature evaluation, the summary and grading of evidence and the formation of practical suggestions. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing, the register name is 'Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients', the registration number is 'ES20231823'.

New DNA-hydrolyzing DNAs isolated from an ssDNA library carrying a terminal hybridization stem.

DNA-hydrolyzing DNAs represent an attractive type of DNA-processing catalysts distinctive from the protein-based restriction enzymes. The innate DNA property has enabled them to readily join DNA-based manipulations to promote the development of DNA biotechnology. A major in vitro selection strategy to identify these DNA catalysts relies tightly on the isolation of linear DNAs processed from a circular single-stranded (ss) DNA sequence library by self-hydrolysis. Herein, we report that by programming a terminal hybridization stem in the library, other than the previously reported classes (I & II) of deoxyribozymes, two new classes (III & IV) were identified with the old selection strategy to site-specifically hydrolyze DNA in the presence of Zn2+. Their representatives own a catalytic core consisting of ∼20 conserved nucleotides and a half-life of ∼15 min at neutral pH. In a bimolecular construct, class III exhibits unique broad generality on the enzyme strand, which can be potentially harnessed to engineer DNA-responsive DNA hydrolyzers for detection of any target ssDNA sequence. Besides the new findings, this work should also provide an improved approach to select for DNA-hydrolyzing deoxyribozymes that use various molecules and ions as cofactors.

Catalytic DNA-Assisted Mass Production of Arbitrary Single-Stranded DNA.

Synthetic single-stranded (ss) DNA is a cornerstone for life and materials science, yet the purity, quantity, length, and customizability of synthetic DNA are still limiting in various applications. Here, we present PECAN, paired-end cutting assisted by DNAzymes (DNA enzymes or deoxyribozymes), which enables mass production of ssDNA of arbitrary sequence (up to 7000 nucleotides, or nt) with single-base precision. At the core of PECAN technique are two newly identified classes of DNAzymes, each robustly self-hydrolyzing with minimal sequence requirement up- or down-stream of its cleavage site. Flanking the target ssDNA with a pair of such DNAzymes generates a precursor ssDNA amplifiable by pseudogene-recombinant bacteriophage, which subsequently releases the target ssDNA in large quantities after efficient auto-processing. PECAN produces ssDNA of virtually any terminal bases and compositions with >98.5 % purity at the milligram-to-gram scale. We demonstrate the feasibility of using PECAN ssDNA for RNA in situ detection, homology-directed genome editing, and DNA-based data storage.

Programming CircLigase Catalysis for DNA Rings and Topologies.

Circular single-stranded (ss) DNA is an essential element in rolling circle amplification and many DNA nanotechnology constructions. It is commonly synthesized from linear ssDNA by a ligase, which nevertheless suffers from low and inconsistent efficiency due to the simultaneous formation of concatemeric byproducts. Here, we design an intramolecular terminal hybridization strategy to program the ring formation catalytic process of CircLigase, a thermostable RNA ligase 1 that can ligate ssDNA in an intramolecular fashion. With the enthalpy gained from the programmed hybridization to override disfavored entropic factors associated with end coupling, we broke the limit of natural CircLigase on circularization of ssDNA, realizing over 75% yields of byproduct-free monomeric rings on a series of hundred-to-half-kilo-based linear DNAs. We found that this hybridization strategy can be twisted from intra- to intermolecular to also program CircLigase to efficiently and predominantly join one ssDNA strand to another. We focused on DNA rings premade by CircLigase and demonstrated their utility in elevating the preparation, quantity, and quality of DNA topologies. We expect that the new insights on engineering CircLigase will further promote the development of nucleic acid biotechnology and nanotechnology.

A Full-Spectrum Registration Method for Zhuhai-1 Satellite Hyperspectral Imagery.

Accurate registration is an essential prerequisite for analysis and applications involving remote sensing imagery. It is usually difficult to extract enough matching points for inter-band registration in hyperspectral imagery due to the different spectral responses for land features in different image bands. This is especially true for non-adjacent bands. The inconsistency in geometric distortion caused by topographic relief also makes it inappropriate to use a single affine transformation relationship for the geometric transformation of the entire image. Currently, accurate registration between spectral bands of Zhuhai-1 satellite hyperspectral imagery remains challenging. In this paper, a full-spectrum registration method was proposed to address this problem. The method combines the transfer strategy based on the affine transformation relationship between adjacent spectrums with the differential correction from dense Delaunay triangulation. Firstly, the scale-invariant feature transform (SIFT) extraction method was used to extract and match feature points of adjacent bands. The RANdom SAmple Consensus (RANSAC) algorithm and the least square method is then used to eliminate mismatching point pairs to obtain fine matching point pairs. Secondly, a dense Delaunay triangulation was constructed based on fine matching point pairs. The affine transformation relation for non-adjacent bands was established for each triangle using the affine transformation relation transfer strategy. Finally, the affine transformation relation was used to perform differential correction for each triangle. Three Zhuhai-1 satellite hyperspectral images covering different terrains were used as experiment data. The evaluation results showed that the adjacent band registration accuracy ranged from 0.2 to 0.6 pixels. The structural similarity measure and cosine similarity measure between non-adjacent bands were both greater than 0.80. Moreover, the full-spectrum registration accuracy was less than 1 pixel. These registration results can meet the needs of Zhuhai-1 hyperspectral imagery applications in various fields.

[Reflectance characteristics of rare earth solution with different concentrations].

In the present paper, ten aqueous samples which contain-different concentrations of REE were collected in south Jiangxi province, and the reflectance spectra and the concentrations of REE were measured by analytical spectral devices (ASD) FieldSpec-3 reflectance spectroscopy and inductively coupled plasma mass spectrometry (ICP-MS), respectively. The results show that the spectra presented mix characteristics of pure water and rare earth oxide. In addition, six diagnostic absorption features caused by REE in visible and near-infrared wavelengths were detected. Then, relative absorption depths of the six absorption wavelength were calculated by the ratio spectra of sample spectra and pure water spectra. Finally, concentrations of total REE of ten samples and relative absorption depths of the six absorption wavelength were selected as two factors, and their relationship was perfectly described using linear regression analysis in which correlation coefficient was up to 96%-97%. The study provides a new method for quantitative estimation of different concentrations of dissolved REE in aqueous media, and strengthens theoretical basis for hyperspectral information extraction of REE.

Modelling, mapping and monitoring of forest cover changes, using support vector machine, kernel logistic regression and naive bayes tree models with optical remote sensing data.

The present study is designed to monitor the spatio-temporal changes in forest cover using Remote Sensing (RS) and Geographic Information system (GIS) techniques from 1990 to 2017. Landsat data from 1990 (Thematic mapper [TM]), 2000 and 2010 (Enhanced Thematic Mapper [ETM+]), and 2013 to 2017 (Operational Land Imager/Thermal Infrared Sensor [OLI/TIRS]) were classified into the classes termed snow, water, barren land, built-up area, forest, and vegetation. The method was built using multitemporal Landsat images and the machine learning techniques Support Vector Machine (SVM), Naive Bayes Tree (NBT) and Kernel Logistic Regression (KLR). According to the results, forest area was decreased from 19,360 km2 (26.0%) to 18,784 km2 (25.2%) from 1990 to 2010, while forest area was increased from 18,640 km2 (25.0%) to 26,765 km2 (35.9%) area from 2013 to 2017 due to "One billion tree Project". According to our findings, SVM performed better than KLR and NBT on all three accuracy metrics (recall, precision, and accuracy) and the F1 score was >0.89. The study demonstrated that concurrent reforestation in barren land areas improved methods of sustaining the forest and RS and GIS into everyday forestry organization practices in Khyber Pakhtun Khwa (KPK), Pakistan. The study results were beneficial, especially at the decision-making level for the local or provincial government of KPK and for understanding the global scenario for regional planning.

[The application of spectral geological profile in the alteration mapping].

Geological section can help validating and understanding of the alteration information which is extracted from remote sensing images. In the paper, the concept of spectral geological profile was introduced based on the principle of geological section and the method of spectral information extraction. The spectral profile can realize the storage and vision of spectra along the geological profile, but the spectral geological spectral profile includes more information besides the information of spectral profile. The main object of spectral geological spectral profile is to obtain the distribution of alteration types and content of minerals along the profile which can be extracted from spectra measured by field spectrometer, especially for the spatial distribution and mode of alteration association. Technical method and work flow of alteration information extraction was studied for the spectral geological profile. The spectral geological profile was set up using the ground reflectance spectra and the alteration information was extracted from the remote sensing image with the help of typical spectra geological profile. At last the meaning and effect of the spectral geological profile was discussed.

The Association Between General Self-Efficacy and Depressive Symptoms in People with Type 2 Diabetes Mellitus: The Mediating Role of Coping Styles Preference.

Background: Depressive symptoms are prevalent in persons with type 2 diabetes mellitus and related with poor disease outcomes. Both general self-efficacy and coping style are associated with depressive symptoms. A model about proactive coping indicates that coping style plays a mediation role between general self-efficacy and depressive symptoms. But, empirical evidence is missing about this potential mediation relationship which may be a barrier of taking precise strategies for relieving depressive symptoms. Objective: This study aims to investigate the prevalence of elevated depressive symptoms in persons with type 2 diabetes mellitus and explore whether coping style preference mediates the association between general self-efficacy and depressive symptoms. Methods: This was a secondary data analysis of a cross-sectional survey (June-July 2017) among 721 persons with type 2 diabetes mellitus (45.4% male and 54.6% female) aged from 22 to 96 years old. Data on general self-efficacy, coping style preference and depressive symptoms were collected using validated questionnaires in hospital setting. The mediation model was tested using the bootstrapping (K=5000) in the MPlus program version 7.4. The results were reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: The prevalence of elevated depressive symptoms was 58% (n = 418) among persons with type 2 diabetes mellitus at hospital setting. A higher level of general self-efficacy was related to less depressive symptoms via positive coping preference (p < 0.01). Discussion: About two-thirds of persons with type 2 diabetes mellitus experienced elevated depressive symptoms during hospitalization. The intervention elements, including strengthening general self-efficacy and promoting positive coping, are promising to decrease their depressive symptoms.

Does the Association of Sedentary Time or Fruit/Vegetable Intake with Central Obesity Depend on Menopausal Status among Women?

(1) Background: The prevalence of central obesity is growing rapidly among women, and the prevalence differs by menopausal status. Longer sedentary time and less fruit/vegetable (F/V) intake increased the risk of central obesity. Among women of different menopausal statuses, controversy surrounds the association between sedentary time or F/V intake and central obesity. This study aimed to explore whether the independent and joint associations between sedentary time or F/V intake and menopausal status are correlated with central obesity, respectively. (2) Methods: This cross-sectional study was conducted in Hunan, China. Self-reported questionnaires were used to gather information on demographic characteristics, menopausal status, sedentary time, and F/V intake. Waist circumference was measured at the study site. Binary logistic regression and multiple interaction models were used to explore the independent and joint associations of menopausal status and the above two lifestyle variables with central obesity. (3) Results: A total of 387 women with a mean age of 47.7 ± 6.6 years old participated in the study. The prevalence of central obesity was 52.8%. Peri- and post-menopause statuses and not taking five servings of F/V per day were risk factors of central obesity (p < 0.05), whereas no significant association was found between sedentary time and central obesity (p > 0.05). Among peri-menopausal (mutual odds ratio (OR): 2.466, 95% confidence interval [CI]: 0.984−6.182; p < 0.05) and post-menopausal women (mutual OR: 2.274, 95% CI: 1.046−4.943; p < 0.05), more than 4 h of sedentary time per day was associated with a high risk of central obesity. Among pre-menopausal women, the consumption of five servings of F/V per day was associated with a low risk of central obesity (mutual OR: 0.444, 95%CI: 0.236−0.837, p < 0.05). (4) Conclusions: More than half of women in the central south of China presented with central obesity, spent >4 h of sedentary time per day, or did not engage in recommended F/V intake. Healthier lifestyle intervention is warranted to prevent central obesity development, including reducing the sedentary time to <4 h per day for peri- and post-menopausal women, while increasing taking five servings of F/V per day for pre-menopausal women.

Assessment of urban environmental change using multi-source remote sensing time series (2000-2016): A comparative analysis in selected megacities in Eurasia.

Excessive urban growth has led to an urban environmental degradation in megacities in less developed countries. Using fine particulate matter (PM2.5) concentration, land surface temperature (LST), and normalized difference vegetation index (NDVI) data obtained by satellite remote sensing, we analysed the inter-annual variations and trends in the urban environment of 17 megacities in Eurasia from 2000 to 2016. Taking the average environmental condition for all the megacities in 2000 as the baseline, the urban environmental conditions were evaluated by a Comprehensive Environmental Index (CEI) from 2001 to 2016. The variation and trends analysis of CEI revealed that the overall environmental conditions in Chennai, Dhaka, Kolkata and Tianjin showed significant deterioration trends. Environmental qualities in newly developed urban areas experienced degradation in Bangalore, Beijing, and Mumbai. The area of environmentally deteriorated urban land has been expanding in Bangalore, Chennai, Delhi, Kolkata, and Mumbai in India and Dhaka in Bangladesh since 2001. By contrast, the area of environmentally degraded urban land in Chinese megacities expanded to the largest extent in the period of 2007-2009 and decreased afterwards. The result suggests that greening and strong emission control strategies significantly contributed to urban environmental quality enhancement in rapidly developing megacities.