Clinical Influence of Nursing Intervention Under FOCUS-Plan-Do-Check-Act Cycle Management Model on Preventing and Controlling Central Line-associated Bloodstream Infections in Patients in ICU.

Background: Central venous catheterization is an invasive procedure that may lead to central line-associated bloodstream infection, affecting the patient's prognosis and recovery. Thus, it is essential to master the right interventions for the prevention and control of central line-associated bloodstream infections. FOCUS-Plan-Do-Check-Act (PDCA) cycle management model, also known as Deming circle management model, is a programmed and scientific management method. Objective: We attempted to clarify the impact of nursing intervention on preventing and controlling central line-associated bloodstream infection under the FOCUS- PDCA cycle management model, in order to effectively deplete central line-associated bloodstream infection in each intensive care unit, facilitate early recovery of patients. Design: Our study retrospectively analyzed the clinical data of intensive care unit patients before and after implementation of nursing intervention under the FOCUS-PDCA cycle management model. This study was a retrospective study. Setting: This study was performed in the Department of Infection Management, Taihe County People's Hospital. Participants: A total of 214 intensive care unit patients with indwelling central venous catheters before implementation of nursing intervention under the FOCUS-PDCA cycle management model in our hospital in 2021 were selected as the control group. A total of 220 ICU patients with indwelling CVC after nursing intervention under the FOCUS-PDCA cycle management model in 2022 were included in the experimental group. All patients met the inclusion criteria of patients with CVC puncture catheterization for ≥ 2 days. Interventions: The control group underwent conventional nursing, including (1) nurses observing aseptic technique; (2) nurses regularly inspected and replaced dressings; (3) nurses timely handled abnormal situations at the puncture site; (4) nurses provided relevant education and psychological counseling to patients and their families. The experimental group adopted nursing intervention under the FOCUS-PDCA cycle management model on the basis of that of the control group. Primary Outcome Measures: (1) central venous catheterization puncture status (2) central venous catheterization application status (3) central line-associated bloodstream infection status, and (4) hospitalization status. Results: The one-time success rate of puncture and success rate of puncture in the experimental group exhibited elevation relative to those in the control group (P < .05). The central venous catheterization application rate in the experimental group exhibited depletion relative to that in the control group (P < .05). The daily infection rate of CLABSI in the experimental group exhibited depletion relative to that in the control group, but without statistical significance (P > .05), indicating that nursing intervention under the FOCUS-PDCA cycle management model had no obvious inhibitory effect on the daily infection rate of CLABSI. The time of central line-associated bloodstream infection occurrence in the experimental group was later than that in the control group (P < .05). The hospitalization time and hospitalization expenses in the experimental group exhibited depletion relative to those in the control group (P < .05). Conclusion: Nursing intervention under the FOCUS-PDCA cycle management model can effectively deplete central line-associated bloodstream infection in each intensive care unit, facilitate early recovery of patients, and shorten hospital stay, which is worthy of promotion. Our study provide a clinical nursing reference for the preventing and controlling central line-associated bloodstream infections in patients in each intensive care unit.

Carbon nanocage-based nanozyme as an endogenous H2O2-activated oxygenerator for real-time bimodal imaging and enhanced phototherapy of esophageal cancer.

Intelligent phototherapy by theranostic nanosystems that can be activated by a tumor microenvironment has high sensitivity and specificity. However, hypoxia and low drug accumulation in tumors greatly limit its clinical application. Herein, we have designed a cage-like carbon-manganese nanozyme, which effectively relieves tumor hypoxia and delivers numerous photosensitizers (PSs) to the tumor site, for real-time imaging and enhanced phototherapy of esophageal cancer. Specifically, bovine serum albumin (BSA) was used as a template and reducing agent for preparing a BSA-MnO2 nanozyme; then a BSA-MnO2/IR820@OCNC (BMIOC) nanosystem was successfully synthesized by crosslinking BSA-MnO2 on the surface of IR820-loaded carboxylated carbon nanocages (OCNCs). Abundant PSs were successfully delivered to tumor sites via hollow OCNCs, and the final loading rate of IR820 reached 42.8%. The intratumor BMIOC nanosystem can be initiated by a tumor microenvironment to switch on its magnetic resonance (MR) imaging signal, and photothermal therapy (PTT) and photodynamic therapy (PDT) functions. Notably, the BSA-MnO2 nanozyme, with intrinsic catalase (CAT)-like activity, catalyzed endogenous H2O2 for oxygen generation to overcome tumor hypoxia and enhance PDT, thereby leading to more efficient therapeutic effects in combination with OCNC-elevated PTT. In addition, the H2O2-activated and acid-enhanced properties enable our nanosystem to be specific to tumors, protecting normal tissues from damage. By integrating a high drug loading capacity, a hypoxia regulation function, an enlarged phototherapy effect, and bimodal imaging into a nanozyme-mediated nanoreactor, this work realizes a "one for all" system and represents promising clinical translation for efficient esophageal cancer theranostics.

Passion fruit-like exosome-PMA/Au-BSA@Ce6 nanovehicles for real-time fluorescence imaging and enhanced targeted photodynamic therapy with deep penetration and superior retention behavior in tumor.

Exosomes (Exos) of approximately 30-150 nm in diameters are the promising vehicles for therapeutic drugs. However, several challenges still exist in clinical applications, such as unsatisfied yield of exosomes, complicated labeling procedure and low drug loading efficiency. In this work, the gram-scale amount of high-purity urinary exosomes can be obtained from gastric cancer patients by non-invasive method. Passion fruit-like Exo-PMA/Au-BSA@Ce6 nanovehicles were fabricated by considerable freshly-urinary Exos loaded efficiently with multi-functionalized PMA/Au-BSA@Ce6 nanoparticles via instant electroporation strategy. In this system, prepared Exo-PMA/Au-BSA@Ce6 nanovehicles could be internalized into cancer cells effectively, and could delay the endocytosis of macrophages and prolong blood circulation time owing to its membrane structure and antigens. Under 633 nm laser irradiation and acidic condition, the structures of nanovehicles would be collapsed and tremendous PMA/Au-BSA@Ce6 nanoparticles could be released inside cancer cells, produced considerable singlet oxygen, inhibiting growth of tumor cells. In vivo experiment of MGC-803 tumor-bearing nude mice showed that prepared Exo-PMA/Au-BSA@Ce6 nanovehicles could target tumor cells with deep penetration and superior retention performance in tumors. This work reports a reliable conjugation-free labeling strategy for tracking exosomes harvested from human urine. Moreover, the integration of multifunctional nanoparticles with urinary Exos paves a versatile road for the development of cancer-targeted photodynamic therapy.

Carbon-gold hybrid nanoprobes for real-time imaging, photothermal/photodynamic and nanozyme oxidative therapy.

Rationale: Recently, there is one-fifth of human deaths caused by cancer, leading to cancer treatment remains a hard nut to crack in the medical field. Therefore, as an emerging diagnostic technology, mesoporous nanomaterials-based drug delivery systems integrated diagnosis and therapy have aroused tremendous interest owing to visually targeting effect and superior therapy efficacy compared with traditional cancer treatment. Methods: In this work, we have successfully synthesized mesoporous carbon-gold hybrid nanozyme nanoprobes, whereby mesoporous carbon nanospheres were doped with small gold nanoparticles (OMCAPs) and further stabilized with a complex of reduced serum albumin and folic acid (rBSA-FA). After loading IR780 iodide, the OMCAPs@ rBSA-FA@IR780 nanoprobes were finally accomplished for real-time imaging, photothermal/photodynamic and nanozyme oxidative therapy. Results: Herein, acid oxidized MCAPs possessed large surface area and numerous -COOH groups, which could be used to surface chemically modify numerous targeting molecules and load abundant NIR dye IR780, as well as be acted as photothermal reagents to enhance photothermal therapy effect. In addition, the small Au NPs embedded in OMCAPs were utilized as nanozyme to catalyze H2O2 located in tumor cells to generate ·OH for intracellular oxidative damage of tumor. Besides, as a commonly used near-infrared (NIR) fluorescence dye, the loaded IR780 iodide could not only apply for real-time imaging, but also effectively enhance photo-thermal therapy (PTT) upon the 808 nm laser irradiation. Moreover, FA molecules could enhance the targeted efficiency of the nanoprobes to the gastric tumor site. According to the systematical study in vitro and in vivo, our fabricated nanoprobes based on carbon-gold hybrid (OMCAPs@ rBSA-FA@IR780) revealed excellent tumor targeting efficacy, long tumor retention and favorably therapeutic effect for tumor. Conclusion: All the results demonstrated that here synthesized probes exhibited excellently diagnostic and therapeutic performance, indicating our technology may potentially offer an outstanding strategy for tumor-targeting theranostics.

Extraction optimization, characterization and immunity activity of polysaccharides from Fructus Jujubae.

The versatile Fructus Jujubae is widely used in Chinese and Korean traditional medicine. In this study, the extraction optimization, characterization and immunostimulatory activities of polysaccharides from Fructus Jujubae were investigated. Based on a four-variable-three-level Box-Behnken statistical design, the optimal extraction parameters were optimized as follows: extraction temperature 90 °C, extraction time 3.23 h, water to raw material ratio 33:1 and extraction 3 times. Under these conditions, the experimental yield of polysaccharides was 6.47 ± 0.26%, which was close to the predicted yield value (6.54%). The crude Fructus Jujubae polysaccharide was further purified by DEAE-cellulose chromatography repeatedly, and two homogenous fractions, designated as RQP1d and RQP2d with molecular weight of 83.8 and 123.0 kDa respectively, were obtained. Their structures were determined by chemical analysis, Fourier transform infrared (FT-IR) spectroscopy and scanning electron microscopy (SEM). Finally, preliminary immunological tests indicated that both RQP1d and RQP2d significantly stimulated NO production in RAW264.7 macrophages, and promoted LPS-induced splenocyte proliferation. These data implied Fructus Jujubae polysaccharides had the potential to be explored as novel natural immunostimulant for using in functional foods or medicine.

Variation in antioxidant activities of polysaccharides from Fructus Jujubae in South Xinjiang area.

The Fructus Jujubae has been widely used as favorable food and folk medicine in China and Russia. In this study, we compared the carbohydrate constituents and antioxidative effects of Fructus Jujubae polysaccharides from five different production areas in South Xinjiang. Results demonstrated that the average annual temperature (r=0.590) and frost-free period (r=0.779) were well correlated to the uronic acid content, while the neutral carbohydrate content showed negative correlation with precipitation amount (r=-0.567). Antioxidative tests indicated that Fructus Jujubae polysaccharides could scavenge chemicals-induced reactive oxygen species in a dose-dependent manner. In addition, these polysaccharides could rescue H2O2-induced HUVEC death. The antioxidative activity of polysaccharides from the Fructus Jujubae might contribute to their diverse medicinal and nutritional values.

Antioxidative properties of crude polysaccharides from Inonotus obliquus.

The mushroom Inonotus obliquus has been widely used as a folk medicine in Russia, Poland and most of the Baltic countries. In this study, water-soluble and alkali-soluble crude polysaccharides (IOW and IOA) were isolated from I. obliquus, and the carbohydrate-rich fractions IOW-1 and IOA-1 were obtained respectively after deproteination and depigmentation. Their contents, such as neutral carbohydrate, uronic acid and protein, were measured. Their antioxidant properties against chemicals-induced reactive species (ROS) including 1,1'-Diphenyl-2-picrylhydrazyl (DPPH) radical, hydroxyl radical and superoxide anion radical, as well as their protective effects on H(2)O(2)-induced PC12 cell death were investigated. Results showed that I. obliquus polysaccharides can scavenge all ROS tested above in a dose-dependent manner. IOA and its product IOA-1 could rescue PC12 cell viability from 38.6% to 79.8% and 83.0% at a concentration of 20µg/mL. Similarly, IOW and its product IOW-1 at the same dose, can also increase cell viability to 84.9% and 88.6% respectively. The antioxidative activities of water-soluble and alkali-soluble polysaccharide constituents from I. obliquus might contribute to diverse medicinal and nutritional values of this mushroom.