Narrative medicine as a teaching strategy for nursing students to developing professionalism, empathy and humanistic caring ability: a randomized controlled trial.

BACKGROUND: Narrative medicine has become a solution to cultivate medical students' ability of empathy and humanistic care. However, the role of narrative medicine is lacking in the study of professionalism. The aim of this study was to analyze the effects of narrative medical theory learning and narrative writing on professionalism, empathy and humanistic care ability of nursing students. METHODS: This cluster randomized controlled trial was conducted between June 2021 and June 2022 in two universities in Jiangsu, China. The participants of this study were 85 nursing students who were randomly divided into the intervention group (n = 43) or the control group (n = 42). Participants in the intervention group were trained in narrative medical theory learning and narrative writing based on a Web-based platform, while those in the control group were not. Self-report questionnaires of professionalism, empathy and humanistic care ability were used before and after intervention. RESULTS: The results showed that the professionalism score of the intervention group was (68.7 ± 6.8 vs. 64.5 ± 7.5; P = 0.005), empathy (99.4 ± 15.7 vs. 92.2 ± 14.6; P = 0.014) and humanistic care ability (127.6 ± 20.0 vs. 113.3 ± 18.8; P = 0.004) were better than the control group. CONCLUSION: The results of this quantitative study suggest that narrative medical theory education and narrative writing based on the network platform can promote the development of professionalism, empathy and humanistic care ability of nursing undergraduates.

'It turned my life upside down': Parents' emotional experience of the transition with their preterm infant from birth to discharge Home-A qualitative study.

BACKGROUND: A smooth transition from the neonatal intensive care unit (NICU) to home is critical for establishing parents' competence as primary caregivers and ensuring infant health. In the clinical context with a restrictive visiting policy, family-centred care is challenging to implement, prohibiting a smooth transition of care for the families. According to Meleis' Transition Theory, parents might experience emotional change initiated by critical events during this transition. OBJECTIVES: The aim of this study was to understand parents' emotional experience of their preterm infant's birth to discharge home from the NICU to facilitate the care transition better. METHODS: This qualitative descriptive study using semistructured interviews was conducted between June and August 2020. Purposive sampling was used to recruit 17 parents (6 fathers and 11 mothers) from the NICU of a tertiary hospital in eastern China. Data were analysed using content analysis. RESULTS: The following three situational themes characterised by three-phase emotions related to 16 critical events were obtained from the data and were used to describe parents' experiences during the transition: Theme 1, Life falling apart; Theme 2, Feeling anxious and struggling with uncertainty; and Theme 3, Feeling both hopeful and inadequate at discharge. CONCLUSIONS: Parents of preterm infants have distinctive emotional experiences in each phase during their infants' transition from the NICU to home. Awareness of parents' critical events and emotional experiences in each phase could help NICU staff anticipate and provide timely and targeted support for parents. The next step is to develop a family-centred intervention for healthcare providers to better prepare parents for the transition from the NICU to home.

Knowledge about neonatal danger signs and associated factors among mothers of children aged 0-12 months in a rural county, Southwest of China: a cross-sectional study.

BACKGROUND: Delay in care seeking is one of the causes for neonatal death. Mothers' knowledge of neonatal danger signs is imperative to promote early recognition of neonatal illness and reduce the delay in care seeking. Currently, no study has been conducted on the knowledge about neonatal danger signs in China, especially in economically less developed areas. This study aimed to examine the knowledge of neonatal danger signs and risk factors of poor knowledge among mothers in a rural county of southwest of China. METHODS: A cross-sectional study was conducted in Wenshan, a rural county of southwest of China. A total of 112 respondents were included from November 2020 to February 2021 among women who had babies aged 0-12 months and brought their babies to health care centers for immunization within the study period. A questionnaire with 18-item key neonatal danger signs was used to measure their knowledge about these signs. Mothers who scored above average were considered to have relatively good knowledge whereas those who scored below average were considered to have relatively poor knowledge. Independent predictors of mothers' knowledge were identified by multivariable logistic regression analysis. RESULTS: The mean knowledge score of neonatal danger signs of mothers was 18.1 (SD = 8.6). Fifty-eight percentage of mothers (65/112) had poor knowledge of neonatal danger signs. Danger signs of "bluish or pale skin", "chest indrawing", and "convulsion" were mostly recognized, whereas danger signs of "not able to feed since birth, or stopped feeding well", "excessive crying" and "eyes draining pus" were recognized poorly. Less than four antenatal visits [AOR = 4.348], younger than 25 years old [AOR = 3.839], ethnic minority [AOR = 3.956] and family financial difficulty [AOR = 4.944] were significant indicators of relatively poor knowledge. CONCLUSIONS: Mothers' knowledge about neonatal danger signs in rural China is poor even though the coverage of maternal and child health care services are expanded. Existing efforts should be enhanced for antenatal care visits, avoiding early marriage as well as early childbearing. More attention should be paid to low-income ethnic minority mothers. Educating and training should be strengthened for danger signs, especially those who are predicted to have insufficient knowledge.

Analysis of Symptom Characteristics, Influencing Factors, and Their Predictive Value for Posttraumatic Stress Disorder in Nurses: A Cross-Sectional Questionnaire Study.

ABSTRACT: Nurses often face a variety of nursing-related stresses, making them more prone to symptoms of posttraumatic stress disorder (PTSD). We aimed to explore symptom characteristics, influencing factors, and their predictive value for PTSD in nurses, so as to prevent the occurrence of PTSD in nurses. This was a cross-sectional study conducted in two tertiary hospitals in Yangzhou. A total of 1290 valid questionnaires were received in our study, and 190 nurses (14.7%) were positive for PTSD symptoms. The results show that individuals with higher scores on the Perceived Stress Scale-10 (PSS-10), Patient Health Questionnaire-15 (PHQ-15), Generalized Anxiety Disorder Scale-7 (GAD-7), and maladaptive cognitive emotion regulation strategies questionnaire (maladaptive CERS) were more likely to experience PTSD symptoms, whereas those with lower scores on the Perceived Social Support Scale (PSSS) were more likely to experience PTSD symptoms. Compared with the PSS-10, PHQ-15, and PSSS, GAD-7 and maladaptive CERS had higher predictive value. This study provided the optimal threshold of relevant factors that may have a positive effect on the prevention of PTSD symptoms. This has guiding implications for active prevention and intervention in some institutions.

The effects of combined spinal-epidural analgesia and epidural anesthesia on maternal intrapartum temperature: a randomized controlled trial.

BACKGROUND: Labor epidural analgesia has been suggested to be associated with intrapartum fever. We designed this study to investigate the effects of epidural analgesia and combined spinal-epidural analgesia on maternal intrapartum temperature. METHODS: Four hundred healthy nullipara patients were randomly assigned to receive either epidural analgesia (EA group) or combined spinal-epidural analgesia (CSEA group). Maternal temperature was measured hourly after analgesia administration. The primary outcome was the incidence of maternal fever, and the secondary outcomes were the duration of analgesia, analgesia to full cervical dilation and analgesia to delivery. Neonatal outcomes and other basic labor events were also recorded. RESULTS: Maternal temperature gradually increased with time in both analgesia groups during labor. However, the CSEA group had a lower incidence of maternal fever, and a lower mean maternal temperature at 5 h, 6 h, and 9 h after analgesia. In addtion, the CSEA group also had a shorter time of analgesia duration, analgesia to full cervical dilation, analgesia to delivery, and less dose of epidural local anesthetic than the EA group. CONCLUSION: Our findings suggest that combined spinal-epidural analgesia is associated with a lower risk of intrapartum fever than epidural analgesia. TRIAL REGISTRATION: ChiCTR1900026606 . Registered on 16/10/2019.

Current status of unplanned readmission of neonates within 31 days after discharge from the neonatal intensive care unit and risk factors for readmission. / 新生儿重症监护室患儿出院31 då† éžè®¡åˆ’å†å ¥é™¢çŽ°çŠ¶åŠå½±å“å› ç´ åˆ†æž.

OBJECTIVES: To investigate the current status of unplanned readmission of neonates within 31 days after discharge from the neonatal intensive care unit (NICU) and risk factors for readmission. METHODS: A retrospective analysis was performed on the medical data of 1 561 infants discharged from the NICU, among whom 52 infants who were readmitted within 31 days were enrolled as the case group, and 104 infants who were not readmitted after discharge during the same period of time were enrolled as the control group. Univariate analysis and multivariate logistic regression analysis were performed to identify the risk factors for readmission. RESULTS: Among the 1 561 infants, a total of 63 readmissions occurred in 52 infants, with a readmission rate of 3.33%. hyperbilirubinemia and pneumonia were the main causes for readmission, accounting for 29% (18/63) and 24% (15/63) respectively. The multivariate logistic regression analysis showed that that gestational age <28 weeks, birth weight <1 500 g, multiple pregnancy, mechanical ventilation, and length of hospital stay <7 days were risk factors for readmission (OR=5.645, 5.750, 3.044, 3.331, and 1.718 respectively, P<0.05). CONCLUSIONS: Neonates have a relatively high risk of readmission after discharge from the NICU. The medical staff should pay attention to risk factors for readmission and formulate targeted intervention measures, so as to reduce readmission and improve the quality of medical service.

Tocilizumab for treating COVID-19: a systemic review and meta-analysis of retrospective studies.

OBJECTIVES: COVID-19 has become a global epidemic, and effective therapies have not been discovered up to now. We conducted this study to explore the effectiveness and safety of tocilizumab recently used for treating COVID-19. METHOD: A comprehensive search was conducted (up to September 27, 2020), and 19 eligible records were identified according to the inclusion and exclusion criteria. The data of the studies were extracted by 2 independent reviewers and were analyzed to evaluate the safety and availability of tocilizumab for treating COVID-19. RESULTS: Thirteen retrospective case-control studies (n = 2285 patients) and 6 retrospective single-armed studies (n = 208) were retrieved in this study. In the comparison of tocilizumab treatment group (TCZ) and standard treatment group (ST), significant associations with a lower risk of admission to ICU, use of ventilation, and mortality (OR, 95% CI: 0.53, 0.26~1.09; 0.66, 0.46~0.94; 0.44, 0.36~0.55) were found in the tocilizumab treatment group. What is more, patients treated with tocilizumab had better clinical improvement compared with the patients treated with ST (OR, 1.24; 95% CI, 0.96~1.62). After taking tocilizumab, the patients had lower C-reactive protein (CRP), white blood cell count (WBC), aspartate aminotransferase (AST) (WMD, 95% CI: - 99.66, - 156.24~- 43.09; - 0.95, - 1.8~- 0.11; - 12.58, - 18.88~-6.29) but higher troponin (WMD, 7.61; 95% CI, 3.06~12.15) than before. In addition, tocilizumab did not have significant influence on patients' neutrophil count (Neut), lymphocyte count (Lymp), platelet count (Plt), alanine aminotransferase (ALT), and creatine (WMD, 95% CI: - 0.29, - 2.91~2.33; 0.42, - 0.23~1.07; 5.2, - 2.85~13.25; 22.49, - 2.73~47.7; - 44.78, - 93.37~3.81). CONCLUSION: Tocilizumab may have potential effectiveness to treat COVID-19 according to the results of this study. However, more large-scale studies are needed for more accurate conclusions.

Tacrolimus ameliorates thrombocytopenia in an ITP mouse model.

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by lower platelet count resulting from immune cells-mediated platelet clearance. Tacrolimus is an immunosuppressive agent which selectively inhibits T cell activation. Whether tacrolimus plays a role in ITP remains unclear. This study aimed to investigate the effect of tacrolimus on ITP in mice. An ITP mouse model was established by injection of rat anti-mouse integrin GPIIb/CD41 immunoglobulin and treated with tacrolimus followed by isolation of peripheral blood mononuclear cells and plasma. The mRNA expression of T-bet, GATA3, and Foxp3 was measured by RT-PCR, and level of IFN-γ, IL-12p70, IL-4, IL-13, and TGF-ß in plasma was measured by ELISA. Tacrolimus inhibited antiplatelet antibody-mediated platelet clearance in ITP mouse model. Meanwhile, tacrolimus-treated ITP mice displayed a significant decrease in the mRNA expression of T-bet and plasma level of IFN-γ and IL-12p70 compared with ITP mice but without differences when compared with normal mice. Furthermore, the expression of GATA3, Foxp3, and plasma level of IL-4 and TGF-ß were upregulated in tacrolimus-treated ITP mice without significant differences to normal mice (except TGF-ß). Tacrolimus prevents antiplatelet antibody-mediated thrombocytopenia in ITP mice possibly through regulating T cell differentiations, suggesting it might be a novel approach for preventing ITP.

Chemical Vapor Deposition-Assisted Fabrication of Self-Assembled Co/MnO@C Composite Nanofibers as Advanced Anode Materials for High-Capacity Li-Ion Batteries.

Constructing the nanostructure of transition metal oxides for high energy density lithium-ion batteries has been widely studied recently. Prompted by the idea that the transition metal can serve as a catalyzer influence on the reversibility of solid-electrolyte interphase films, Co/MnO@C composite nanofibers were designed by electrospinning and chemical vapor deposition methods. The Co/MnO@C electrode showed superior electrochemical performance with a large capacity increase for the first 400 cycles and a high rate performance of 1345 mA h g-1 at 1000 mA g-1. There was no obvious decay of capacity over the whole 1000 cycles, demonstrating the excellent cycling stability of the samples. The new design and synthesis of the anodic materials may offer a prototype for high-performance and strong-stability batteries.

Preparation and High Photocurrent Generation Enhancement of Self-Assembled Layered Double Hydroxide-Based Composite Dye Films.

Understanding photocurrent conversion of layered double hydroxide (LDH) materials will be a key step in the future application of these materials to light-capturing molecular devices. In the present study, ultrathin nickel-iron layered double hydroxide/dye (NF-LDH/dye) Langmuir-Blodgett (LB) semiconductor films were prepared using an LB device and deposited on an indium tin oxide (ITO) substrate as a photoanode. The photoelectric conversion efficiency of the prepared LB semiconductor film materials was tested. A comparative experiment was performed to effectively explore the photoelectric conversion performances of the LB semiconductor film materials. Specifically, the NF-LDH cast film electrode, the dye cast film electrode, and an ultrathin composite LB film electrode were used as typical samples to explore photoelectric conversion performances. The electrochemical workstation was used to study the photocurrent density, linear scanning voltammetry curve, and electrochemical impedance spectroscopy of LB film electrodes with different layers. The results show that the film electrode cast by LDH alone or dye alone produces weak photocurrent. The photoelectric conversion efficiency of the LB film electrode is enhanced due to the different dyes' molecular structures and/or aggregations on the surface of LDH with various morphological patterns. The combined NF-LDH/dye composite LB film photoelectrode can generate a photocurrent that is 2-5 times stronger than the raw material, and the stable use efficiency is more than 92%. Present obtained composite LB films demonstrated a uniform morphology and good photoelectric conversion ability. This work provides a useful reference for the field of LDH semiconductor optoelectronic devices and solar cells.

Expression and subcellular analyses of CCR8a/b genes with the identification of response to SGIV viral infect in orange-spotted grouper (Epinephelus coioides).

Chemokine receptors are a superfamily of seven transmembrane domain G-coupled receptors, and they play important roles in immune surveillance, inflammation, and development. Recently, nine CC chemokine receptors (CCRs) were identified and cloned from orange-spotted grouper (Epinephelus coioides) and annotated by phylogenetic and syntenic analyses. We detected mRNA transcripts for CCRs in healthy tissues of E. coioides, and CCR genes were highly expressed in the immune-relevant tissues. Analysis of gene expression after Singapore grouper iridovirus (SGIV) infection indicated that CCR genes are regulated in a gene-specific manner. CCR8a and CCR8b were significantly upregulated in the spleen and liver of resistant fish, indicating potential roles in immunity against the pathogen. Fluorescence microscopy revealed that CCR8a and CCR8b were expressed predominantly in the cytoplasm. Overexpression of CCR8a and CCR8b in grouper cells significantly inhibited the replication of SGIV, demonstrating that they delayed the occurrence of cytopathic effects induced by SGIV infection and inhibited viral gene transcription. CCR8a and CCR8b overexpression also significantly increased the expression of interferon (IFN)-related cytokines and activated IFN response element and IFN promoter activities. These results demonstrated that CCR8a and CCR8b might have an antiviral function against SGIV infect.

Fabrication of hierarchical SrTiO3@MoS2 heterostructure nanofibers as efficient and low-cost electrocatalysts for hydrogen-evolution reactions.

The construction of low-cost, high-performance electrocatalysts instead of platinum catalysts is critical to solving the energy crisis. Here, using simple electrospinning and hydrothermal methods, new MoS2 nanosheets on SrTiO3 nanofibers (NFs) and 2D SrTiO3@MoS2 heterostructure NFs are synthesized. In addition, SrTiO3@MoS2 heterostructure NFs are compared with bare SrTiO3 NFs and MoS2 nanosheets. Importantly, the prepared SrTiO3@MoS2 heterostructure shows better hydrogen-evolution reaction performance than other MoS2-based electrocatalysts with an overpotential of 165 mV at 10 mA cm-2, a Tafel slope of 81.41 mV dec-1, and long-term electrochemical durability of 3000 cycles. Therefore, the present work strongly demonstrates the positive synergy between SrTiO3 NFs and layered MoS2, and also provides a strategy for preparing low-cost and high-activity water-decomposition electrocatalysts.

Morinda citrifolia (Noni) fruit juice promotes vascular endothelium function in hypertension via glucagon-like peptide-1 receptor-CaMKKß-AMPK-eNOS pathway.

Morinda citrifolia (Noni) is extensively used in herbal remedies to prevent and treat various diseases, including hypertension. The purpose of this study was to investigate the vascular effects of noni fruit juice and characterize the upstream signaling pathways. We measured the systolic blood pressure, diastolic blood pressure, 24-hr urinary nitric oxide (NO) metabolite excretion, bodyweight (BW), and urine examination in SHR.Cg-Leprcp/NDmcr (SHR/cp) rats after 6 weeks noni juice (15 ml/kg) treatment. Noni juice significantly decreased blood pressure and 24-hr urinary NO metabolite without change of BW or urine volume. Furthermore, the noni juice extract (NJE) promoted endothelial vasorelaxation in rat aorta rings and NO product through an increase in phosphorylation of endothelial nitric oxide synthase (eNOS) in human umbilical vein endothelial cells (HUVECs). NJE might act on a glucagon like peptide-1 receptor (GLP-1R) via Ca2+ /calmodulin-dependent protein kinase kinase ß (CaMKKß)-AMPK signaling with pretreatment of their inhibitors or antagonist in HUVECs. Deacetylasperulosidic acid (DAA) was an active compound in noni juice to improve NO release through same pathway in HUVECs. These results suggested that noni is a novel dietary plant that probably regulates GLP-1R-induced CaMKKß-AMPK-eNOS pathway to improve endothelium-dependent relaxation, thus reduce the blood pressure probably via one of its responsible ingredient DAA.

Facile preparation of self-assembled hydrogels constructed from poly-cyclodextrin and poly-adamantane as highly selective adsorbents for wastewater treatment.

Self-assembled hydrogel materials constructed from cyclodextrin polymer (P-CD)/adamantane-modified poly acrylic acid (PAA-Ad) were designed and prepared via host-guest interactions. It was observed that the prepared supramolecular hydrogels had an interconnected three-dimensional porous network. In addition, the obtained hydrogels showed a recovery performance and it was confirmed that the host-guest interactions between ß-cyclodextrin and adamantane were the main driving force for the formation of the hydrogels. The mechanical properties of the hydrogels could be adjusted by varying the concentrations of PAA-Ad. In particular, the prepared supramolecular hydrogels exhibited superior performances in water purification. The results demonstrated that the hydrogels possessed different mechanisms in the adsorption of the four typical poisonous organic dye molecules used, including bisphenol A (BPA), 4-aminoazobenzene (N-Azo), methylene blue (MB), and rhodamine B (RhB). The hydrogels mainly adsorbed N-Azo by host-guest interaction and adsorbed BPA by host-guest interaction and hydrogen bond synergy. They also adsorbed MB and RhB by hydrogen bonding and electrostatic interaction.

Qiwei granules alleviates podocyte lesion in kidney of diabetic KK-Ay mice.

BACKGROUND: Chinese medicine comprised of all natural herbs is widespread used in the treatment of diabetic nephropathy (DN). Podocyte contributes to the integrity of glomerular filtration barrier whose injury plays an important role in the initiation and progression of DN. Our study aimed to investigate the effect of Qiwei granules on podocyte lesion in diabetic KK-A(y) mice kidney and its underlying mechanism. METHODS: Twelve-week-old male KK-A(y) mice were randomly divided in vehicle group and Qiwei granules group, while C57BL/6J mice were used as normal control. The mice were gavage with 1.37 g/kg/day Qiwei granules or water for 10 weeks. We measured water, food intake and body weight (BW) and fasting blood glucose (FBG) every 2 weeks, and urine protein every 4 weeks. At the end of the experiment, all surviving mice were sacrificed. The kidney weight and serum renal parameters were measured, and the renal morphology was observed. To search the underlying mechanism, we examined the podocyte positive marker, slit diaphragm protein expression and some involved cell signal pathway. RESULTS: Qiwei granules treatment significantly improved the metabolic parameters, alleviated the urinary protein, and protected renal function in KK-A(y) mice. In addition, the glomerular injuries and podocyte lesions were mitigated with Qiwei granules treatment. Furthermore, Qiwei granules increased expression of nephrin, CD2AP, and integrin alpha3beta1 in the podocytes of KK-A(y) mice. Qiwei granules improved the phosphoration of Akt and inhibited cleaved caspase-3 protein expression. CONCLUSION: These finding suggest that Qiwei granules protects the podocyte from the development of DN via improving slit diaphragm (SD) molecules expression and likely activating Akt signaling pathway in KK-A(y) mice.

Supramolecular assembly and nanostructures of a series of luminol derivatives with aromatic/alkyl substituted groups in Langmuir-Blodgett films.

A series of functional luminol derivatives with aromatic and alkyl substituted groups has been designed and synthesized from the reaction of the corresponding chloride precursors with luminol. These compounds can be spread on water surface to form stable Langmuir films at the air-water interface. It has been found that UV and IR spectra confirmed the characteristic aromatic segment, imide group, and aromatic/alkyl substituted groups. In addition, for the interfacial assembly process of compounds with alkyl substituted groups, there are obvious spectral changes for the alkyl chains. AFM results indicated that various different aggregated domains may be fabricated in the transferred LB films. For all cases, the substituted groups in molecular structures have an important effect in regulating the aggregation mode and spectral changes in organized molecular films. The present results showed that the modified luminol derivatives may have potential application in functional material fields such as ECL sensor, which may give some insight to study the relationship between the molecular structures and supramolecular aggregation of amphiphiles in organized molecular films.

Isoquercitrin activates the AMP-activated protein kinase (AMPK) signal pathway in rat H4IIE cells.

BACKGROUND: Isoquercitrin, a flavonoid compound that is widely distributed in medicinal and dietary plants, possesses many biological activities, including inhibition of adipocyte differentiation. In this study, we investigated the effect of isoquercitrin on lipid accumulation and its molecular mechanisms in rat hepatoma H4IIE cells. METHODS: To investigate the effect of isoquercitrin on lipid accumulation, H4IIE cells were induced by FFA and the total lipid levels were detected by Oil Red O staining. Furthermore, The protein levels of AMPK and acetyl-CoA carboxylase (ACC), the gene expressions of transcriptional factor, lipogenic genes, and adiponectin receptor 1 (AdipoR1) were analyzed by Western blotting and quantitative real-time PCR. To further confirm the pathway of isoquercitrin-mediated hepatic lipid metabolism, H4IIE cells were treated with an AMPK inhibitor and AdipoR1 siRNA. RESULTS: Isoquercitrin significantly enhances AMPK phosphorylation, downregulates sterol regulatory element binding protein transcription factor 1 (SREBP-1) and fatty acid synthase (FAS) gene expressions. Pretreatment with AMPK inhibitor, significantly decreased the AMPK phosphorylation and increased FAS expression stimulated by isoquercitrin. Isoquercitrin might also upregulate the expression of AdipoR1 dose-dependently via AMPK in the presence of an AMPK inhibitor and AdipoR1 siRNA. CONCLUSIONS: Isoquercitrin appears to regulate AMPK activation, thereby enhancing AdipoR1 expression, suppressing SREBP-1 and FAS expressions, and resulting in the regulation of lipid accumulation. These results suggest that isoquercitrin is a novel dietary compound that can be potentially be used to prevent lipid metabolic disorder and nonalcoholic fatty liver disease.

[Practice on the data normalization of medical device adverse event reporting and exploration on improving the quality of the reports].

On the basis of real working practices in data normalization, the case reports from the monitoring system were studied, non-standard reports were summarized and the reasons were analyzed, the methods of data normalization and improving the reporting quality were discussed. The standard databases and the rule databases were created, they were capable of automatic completion of the standardization work of new cases.

Chloroprocaine 3% for anesthesia during cesarean section in a patient with dopa-responsive dystonia: A case report.

RATIONALE: Dopa-responsive dystonia (DRD) is a rare autosomal dominant hereditary disorder with a prevalence of 0.5 per million population. The disease is characterized by onset of dystonia in childhood, progressive aggravation of the dystonia with diurnal fluctuation, and complete or near complete alleviation of symptoms with low-dose oral levodopa. The incidence of DRD is low, and only a few publications have described this disorder connected with anesthesia. PATIENT CONCERNS: We present a case involving a pregnant woman with DRD who continued levodopa/benserazide throughout the pregnancy. The perioperative anesthesia management was described. We used chloroprocaine 3% for epidural anesthesia during cesarean section. DIAGNOSES: Dopa-responsive dystonia. INTERVENTIONS: Levodopa/benserazide. OUTCOMES: In summary, levodopa/benserazide was continued throughout our patient's pregnancy with a good obstetric outcome, and chloroprocaine was safely used in epidural anesthesia without deterioration of her dystonic symptoms. LESSONS: Chloroprocaine was safely used in epidural anesthesia without deterioration of her dystonic symptoms.

Association between dietary inflammation index and cataract: a population-based study from NHANES 2005-2008.

Importance: Various studies have widely explored the association between index of dietary inflammation (DII) and occurrence of diseases. Accumulating evidence have revealed that a lower DII seems to be protective against a variety of diseases. Nevertheless, the association between DII and age-related cataract remains unclear. Objective: To investigate the correlation between DII and age-related cataract in a representative sample of the American population. Design setting and participants: This cross-sectional population-based study comprised 6,395 participants from the National Health and Nutrition Examination Survey (NHANES) conducted in cycles from 2005 to 2008. DII was calculated using dietary recall information, with higher scores indicating greater inflammatory potential of the diet. Age-related cataract was evaluated using cataract surgery as a surrogate measure. Covariates included sociodemographic factors, lifestyle factors, physical measures, and comorbidities. Logistic regression models were employed to assess the association between DII and cataract. The presence of a non-linear relationship was examined using restricted cubic spline analysis. Subgroup analysis was conducted to explore potential interaction effects. Data analysis was performed from September 1 to December 30, 2022. Main outcomes and measures: Age-related cataract assessed through cataract surgery information obtained from a self-reported questionnaire. Results: A total of 6,395 participants were included, with a mean (standard deviation, SD) age of 48.7 (15.3) years. Of these, 3,115 (48.7%) were male, 3,333 (52.1%) were non-Hispanic white, and 683 (10.7%) had cataract. The mean (SD) DII was -4.78 (1.74). After adjusting for all included covariates, DII showed a positive association with cataract, both as a continuous variable (odds ratio (OR): 1.054, 95% confidence interval (CI): 1.007-1.103, p = 0.023) and in quartiles, with the highest quartile compared to the lowest (OR: 1.555, 95% CI: 1.233-1.967, p < 0.001). Restricted cubic spline analysis revealed no evidence of a non-linear relationship (p for non-linearity 0.085). Subgroup analysis indicated no interaction effects among the studied covariates. Conclusions and relevance: These findings suggest that a pro-inflammatory diet serves as a risk factor for the occurrence of cataracts.