Construction of continuous nursing program for children with congenital imperforate anus based on 5W1H analysis / 中国实用护理杂志

Objective:Based on the framework of 5W1H analysis, to establish the continuous nursing project by delphi expert consultation method for children with congenital imperforate anus after discharge.Methods:This study is observational. Through the literature review, qualitative interview and group discussion to establish the expert correspondence questionnaire from April 2021 to March 2022. Delphi consultation was applied to experts for two rounds of expert consultation, to evaluate the initiative, authority and coordination of expert opinions.Results:Two rounds of expert consultation were carried out with 20 experts.The response rates of two rounds of expert questionnaires were 19/20 and 20/20 respectively, the expert authority coefficients were 0.873 and 0.893 respectively, and the Kendall′s coefficients were 0.311 and 0.405 respectively. The coordination of expert opinions was statistically significant ( P<0.05); After two rounds of expert consultation, it was finally determined that the continuing care plan for children with anal atresia included three first-level indicators (composition and responsibilities of continuing care personnel, implementation methods of continuing care, and implementation content of continuing care), 23 second-level indicators, and 46 third-level indicators. Conclusions:This study have high enthusiasm and authority of experts, and concentrated expert opinions on various indicators. The results are reliable, scientific and comprehensive, which will provide a basis for clinical medical staff to carry out the continuous nursing of children with congenital imperforate anus.

Protective effect of berberine against ionizing radiation injury in rats and its mechanism of action / 中国辐射卫生

Objective To investigate the protective effect of berberine (BBR) against ionizing radiation injury in rats and its mechanism of action. Methods Sprague-Dawley rats were divided into seven groups: normal control group, 1-Gy radiation group, 1-Gy radiation plus low-dose BBR (50 mg/kg) group, 1-Gy radiation plus high-dose BBR (150 mg/kg) group, 3-Gy radiation group, 3-Gy radiation plus low-dose BBR (50 mg/kg) group, and 3-Gy radiation plus high-dose BBR (150 mg/kg) group. All the groups except the normal control group were exposed to external irradiation with a medical electron linear accelerator, followed by BBR administration by gavage for consecutive ten days. The serum levels of superoxide dismutase (SOD), reduced glutathione (GSH), and malondialdehyde (MDA) were measured by using the micromethod. The pathological changes of the bone marrow and small intestine were observed with HE staining. Results Compared with the normal control group, the radiation groups showed significantly increased MDA levels (P < 0.05), significantly decreased SOD and GSH levels (P < 0.05), and more severe pathological damage of the bone marrow and small intestine. Compared with the radiation groups, the BBR groups showed significantly decreased MDA levels (P < 0.05), significantly increased SOD and GSH levels (P < 0.05), and reduced pathological damage to the bone marrow and small intestine, which were more marked in the high-dose BBR group. Conclusion BBR has a certain protective effect against radiation injury in rats, which may be through increasing the activity of antioxidant substances, enhancing free radical clearance, and thereby alleviating free radicals-caused oxidative damage.

Norcantharidin induces apoptosis through autophagosome accumulation in breast cancer MDA-MB-231 cells / 中国药科大学学报

@#The aim of this study was to investigate the effect of norcantharidin (NCTD) on the proliferation and apoptosis of triple-negative breast cancer cell line MDA-MB-231.Western blot was used to detect the effect of NCTD on the expression levels of apoptosis-related proteins Bax/Bcl-2, cleaved-PARP/PARP/PARP, cleved-caspase-9, cleaved-caspase-3 and MCL-1 in MDA-MB-231 cells.Also, the expression levels of autophagy-related proteins LC3-II/LC3-I, Parkin and PINK1 in MDA-MB-231 cells were measured by Western blot.Flow cytometry was used to measure the effect of NCTD on the changes of mitochondrial membrane potential and mitochondrial reactive oxygen species (ROS).The effect of NCTD on autophagy flow in cells expressing mCherry-EGFP-LC3 was detected by a confocal microscope.Moreover, the effects of NCTD combined with chloroquine (CQ) or 3-methyladenine (3-MA) on the apoptosis of MDA-MB-231 cells were detected by flow cytometry.The results showed that NCTD significantly increased the expression levels of Bax/Bcl-2, cleaved-PARP/PARP, cleaved-caspase-9, cleasved-caspase-3 and LC3-II/LC3-I proteins, and promoted the mitochondrial translocation of Parkin, and blocked the autophagic flow in MDA-MB-231 cells. Moreover, NCTD combined with CQ accelerated apoptosis, while NCTD combined with 3-MA decreased apoptosis.These results suggest that NCTD can induce autophagy accumulation and lead to apoptosis of MDA-MB-231 cells.

Clinical value of pulse pressure/central venous pressure ratio in low cardiac output syndrome after cardiac surgery / 中华危重病急救医学

Objective:To explore the relationship between the pulse pressure/central venous pressure (PP/CVP) ratio and the cardiac output (CO) of patients after cardiac surgery from the basic principles of hemodynamics, and to further evaluate the predictive value of PP/CVP ratio in patients with secondary low cardiac output syndrome (LCOS) after cardiac surgery.Methods:A retrospective study was conducted, and patients who received pulse indicator continuous cardiac output (PiCCO) monitoring were enrolled at the department of critical care medicine of Peking Union Medical College Hospital from January 1, 2016, to September 1, 2021. Patients were divided into two groups: the LCOS group [cardiac index (CI) < 33.34 mL·s -1·m -2, 25 cases] and the non-LCOS group (CI ≥ 33.34 mL·s -1·m -2, 125 cases) according to the CI at 6 hours after surgery. The general clinical data and hemodynamic parameters were collected. Correlations between PP/CVP ratio and PiCCO monitoring indicators were performed with Pearson or Spearman correlation test. Receiver operator characteristic curve (ROC curve) analysis was carried out to evaluate the predictive value of the parameters in patients with LCOS after cardiac surgery. Results:A total of 150 patients with PiCCO monitoring after cardiac surgery were included. There were no differences in baseline characteristics between the two groups, while PP in the LCOS group was lower than that in the non-LCOS group [mmHg (1 mmHg ≈ 0.133 kPa): 40 (37, 44) vs. 55 (46, 64)], CVP was higher than that in the non-LCOS group [mmHg: 12 (11, 14) vs. 10 (8, 12)], and PP/CVP ratio in the LCOS group was lower than that in the non-LCOS group [3.3 (2.9, 3.7) vs. 5.5 (4.6, 6.8)], with significant differences (all P < 0.05). Correlation analysis results showed that PP/CVP ratio was positively correlated with CI, CO, and stroke volume index (SVI), respectively ( rs = 0.660, 0.592, 0.600, all P < 0.001). CI was negatively correlated with PP ( rs = 0.509, P < 0.001) and positively correlated with CVP ( rs = -0.297, P < 0.001). ROC curve analysis revealed that compared with PP, CVP, SVI and cardiac function index (CFI), PP/CVP ratio was the best predictor of LCOS after cardiac surgery [area under the ROC curve (AUC) was 0.94±0.02, P < 0.001], when the optimum cut-off value was 4.41, the sensitivity was 80.00%, and the specificity was 96.00%. Conclusion:PP/CVP ratio was moderately positively correlated with CO after cardiac surgery, and PP/CVP ratio could be used as a prognostic predictor for LCOS after cardiac surgery.

Differential diagnosis of vasovagal syncope in children / 国际儿科学杂志

Vasovagal syncope(VVS) is a common clinical reflex syncope, which is easy to occur repeatedly.Although there is no direct life risk, it causes varying degrees of physical injury and psychological disorders to children, affects their daily life and study, and also causes anxiety of parents.At present, the diagnosis of VVS mainly depends on the vertical tilt table test.With the development of translational medicine, identifying VVS and other types of syncope by other methods has achieved important clinical value, which will be more convenient for primary hospital to carry out the related work of syncope diagnosis and treatment.This paper will review the related progress in the differential diagnosis of VVS.

Risk factors and prognosis in critical patients with sepsis-related cardiomyopathy / 中华内科杂志

Objective:To explore the risk factors and prognosis of sepsis-related cardiomyopathy.Methods:Patients with sepsis and septic shock admitted to the Critical Care Medicine Department at Peking Union Medical College Hospital from October 2017 to February 2021 were enrolled. Echocardiographic parameters including left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE) and cardiac index (CI) were obtained within 24 h after admission. Hemodynamic parameters including heart rate, mean arterial pressure and central venous pressure were also collected. The risk factors of 45-day mortality were analyzed using Cox regression analysis. Kaplan-Meier survival analysis was performed to compare 45-day mortality among patients with normal left ventricle (LV) systolic function group, sepsis-related takotsubo cardiomyopathy (ST) and septic cardiomyopathy (SC) group as well as between patients with normal right ventricular (RV) function and patients with RV dysfunction.Results:According to LV systolic function, patients were categorized into three groups: normal group [174 (66.9%)], SC group [66 (25.4%)] and ST group [66 (25.4%)]. In comparison with those in normal group, patients in SC group and ST group had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score ( P<0.05). No difference was found between SC group and ST group regarding APACHE Ⅱ score and SOFA score( P>0.05). ST group had lower LVEF [33(28, 41)% vs. 45(38, 48)%, P<0.05], CI [2.29 (1.99, 2.53)L·min -1·m -2 vs. 3.04(2.61, 3.61) L·min -1·m -2, P<0.05] higher TAPSE [18.6(16.0, 21.2)mm vs. 15.1(12.5, 19.0)mm, P<0.05] than SC group. A Cox regression survival analysis showed that right ventricular dysfunction (RVD) was an independent predictor of 45-day mortality ( HR=1.992, 95% CI 1.088-3.647, P=0.025). A Kaplan-Meier analysis revealed no significant difference regarding 45-day mortality among ST group [25.0%(5/20)], SC group [30.3%(20/66)] and normal group 18.4%(32/174)( P=0.158). RVD patients [38.0%(30/79)] had significantly higher 45-day mortality than patients with normal RV function [14.9%(27/181), P<0.001]. Conclusions:In comparison with SC patients, ST patients tend to have worse LV systolic function, lower cardiac output and better RV function. However, neither ST nor SC is associated with 45-day mortality. RVD is a risk predictor of 45-day mortality, which should be monitored in septic patients.

The quality control standards and principles of the application and training of critical ultrasonography / 中华内科杂志

Critical ultrasonography is widely used in ICU and has become an indispensable tool for clinicians. However, besides operator-dependency of critical ultrasonography, lack of standardized training mainly result in the physicians′ heterogenous ultrasonic skill. Therefore, standardized training as well as strict quality control plays the key role in the development of critical ultrasonography. We present this quality control standards to promote better development of critical ultrasonography.

Resuscitation fluids as drugs: targeting the endothelial glycocalyx / 中华医学杂志(英文版)

Fluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.

High Central Venous Pressure and Right Ventricle Size Are Related to Non-decreased Left Ventricle Stroke Volume After Negative Fluid Balance in Critically Ill Patients: A Single Prospective Observational Study.

Background: Optimal adjustment of cardiac preload is essential for improving left ventricle stroke volume (LVSV) and tissue perfusion. Changes in LVSV caused by central venous pressure (CVP) are the most important concerns in the treatment of critically ill patients. Objectives: This study aimed to clarify the changes in LVSV after negative fluid balance in patients with elevated CVP, and to elucidate the relationship between the parameters of right ventricle (RV) filling state and LVSV changes. Methods: This prospective cohort study included patients with high central venous pressure (CVP) (≥8 mmHg) within 24 h of ICU admission in the Critical Medicine Department of Peking Union Medical College Hospital. Patients were classified into two groups based on the LVSV changes after negative fluid balance. The cutoff value was 10%. The hemodynamic and echo parameters of the two groups were recorded at baseline and after negative fluid balance. Results: A total of 71 patients included in this study. Forty in VI Group (LVOT VTI increased ≥10%) and 31 in VNI Group (LVOT VTI increased <10%). Of all patients, 56.3% showed increased LVSV after negative fluid balance. In terms of hemodynamic parameters at T0, patients in VI Group had a higher CVP (p < 0.001) and P(v-a)CO2 (p < 0.001) and lower ScVO2 (p < 0.001) relative to VNI Group, regarding the echo parameters at T0, the RVD/LVD ratio (p < 0.001), DIVC end-expiratory (p < 0.001), and ΔLVOT VTI (p < 0.001) were higher, while T0 LVOT VTI (p < 0.001) was lower, in VI Group patients. The multifactor logistic regression analysis suggested that a high CVP and RVD/LVD ratio ≥0.6 were significant associated with LVSV increase after negative fluid balance in critically patients. The AUC of CVP was 0.894. A CVP >10.5 mmHg provided a sensitivity of 87.5% and a specificity of 77.4%. The AUC of CVP combined with the RVD/LVD ratio ≥0.6 was 0.926, which provided a sensitivity of 92.6% and a specificity of 80.4%. Conclusion: High CVP and RVD/LVD ratio ≥0.6 were significant associated with RV stressed in critically patients. Negative fluid balance will not always lead to a decrease, even an increase, in LVSV in these patients.

Antimicrobial resistance profiling and molecular typing of ruminant-borne isolates of Clostridium perfringens from Xinjiang, China.

OBJECTIVES: Clostridium perfringens (C. perfringens) can cause intestinal diseases in livestock and humans, which seriously threatens the healthy development of animal husbandry and human food safety. Here, the characteristics of antimicrobial resistance and molecular typing of ruminant-borne strains of C. perfringens in Xinjiang, China were explored and profiled. METHODS: A total of 307 clinical feces collected from ruminants (cattle and sheep) with diarrheal symptoms were screened for C. perfringens. The recovered isolates were characterized in respect to their antimicrobial resistance pattern and molecular typing. RESULTS: A total of 109 isolates of C. perfringens were isolated from 307 clinical feces of ruminants, most of which displayed the multidrug resistance (MDR) phenotype. Demonstration of the quinolone-resistance gene was the highest among the isolates (70.6%). The multiplex PCR typing based on toxin genes showed that type A and type D strains made up 82.6% (90/109) and 17.4% (19/109), among which, the isolates carrying ß2 gene occupied 43.3% (39/90) of type A strains and 31.6% (6/19) of type D strains. These isolates were divided into 6 genotypes (I-VI) by enterobacterial repetitive intergenic consensus sequence-based PCR (ERIC-PCR) method. A total of 33 ST types (ST1-ST33) were identified by multilocus sequence typing (MLST) method. CONCLUSION: C. perfringens isolates with multidrug resistance (MDR) were frequent and circulating in ruminants. Among them, type A-Ⅰ-ST19 was the dominant genotype of C. perfringens, displaying obvious genetic diversity. This study provided important epidemiological data for the risk assessment of food safety associated with ruminant-borne C. perfringens in Xinjiang, China.

Correlation between nutritional status and dietary behavior of college students in a medical college in Guangzhou / 中国学校卫生

Objective@#To evaluate the nutritional status, food intake, eating behavior and physical activity level of college students in a medical college in Guangzhou, and to explore its association with dietary behavior.@*Methods@#A total of 263 students selected using stratified random sampling method from a medical college in Guangzhou were investigated by questionnaire from October to December in 2019. Chi square test and Wilcoxon test were used to analyze group differences. Multivariate Logistic regression was used to analyze associated factors with thinness, overweight and obesity.@*Results@#The rate of thinness was 25.5%, and the rate of overweight and obesity was 11.8%. The intake of cereals, fruits, eggs, livestock, fried foods and carbonated drinks varied significantly by gender (U=3 278.00，5 224.50，5 981.00，6 663.00，5 460.00，3 873.00，P＜0.05). There was significant difference in total physical activity level in different grades (U=4 239.50，P＜0.05). Multivariate analysis showed that egg intake was negatively correlated with emaciation (OR=0.20, P＜0.01). Picky eating and partial eating were positively correlated with emaciation (OR=2.96, P＜0.01). Eating fast was positively correlated with overweight and obesity (OR=5.35, P＜0.05).@*Conclusion@#The detection rate of malnutrition among college students in this college is relatively high, and dietary behavior is associated with thinness, overweight and obesity.

Functional mitral regurgitation combined with increased early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio is associated with a poor prognosis in patients with shock / 中华医学杂志(英文版)

BACKGROUND@#Functional mitral regurgitation (FMR) is common in critically ill patients and may cause left atrial (LA) pressure elevation. This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.@*METHODS@#We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017. The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio (E/e') ≥ 4 within 6 h of shock on the prognosis of patients were evaluated. Finally, the synergistic effect of FMR and E/e' were assessed by combination, grouping, and trend analyses.@*RESULTS@#Forty-four patients (33.8%) had FMR, and 15 patients (11.5%) had E/e' elevation. A multivariate analysis revealed FMR and E/e' as independent correlated factors for 28-day mortality (P = 0.043 and 0.028, respectively). The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR (χ2 = 7.672, P = 0.006) and between the E/e' ≥ 14 and E/e' < 14 groups (χ2 = 19.351, P < 0.010). Twenty-eight-day mortality was significantly different among the four groups (χ2 = 30.141, P < 0.010). The risk of 28-day mortality was significantly higher in group 4 (E/e' ≥ 14 with FMR) compared with groups 1 (E/e' < 14 without FMR) and 2 (E/e' < 14 with FMR) (P = 0.001 and 0.046, respectively).@*CONCLUSIONS@#Patients with shock can be identified by the presence of FMR. FMR and E/e' are independent risk factors for a poor prognosis in these patients, and prognosis is worst when FMR and E/e' ≥ 14 are present. It may be possible to improve prognosis by reducing LA pressure and E/e'.@*TRIAL REGISTRATION@#ClinicalTrials.gov, NCT03082326.

Impact of point-of-care cardiopulmonary ultrasound on treatment change in critically ill patients: assessment of 1 913 cases in a multicentric, prospective study / 中华超声影像学杂志

Objective:To describe the features of point-of-care cardiopulmonary ultrasound (POCUS) in the critically ill patients and analyze the independent factors associated with treatment changes after POCUS assessment.Methods:This was a prospective multicentric observational study from January to December 2018 in 13 intensive care units (ICU) in China. Consecutive patients admitted to the ICU were enrolled, POCUS were performed within the first 24 h of admission. The POCUS parameters included acute or chronic cardiac abnormality, diameter of inferior vena cava (IVC) at end-expiration, right ventricular systolic function, systolic and diastolic function of left ventricle (LV) and lung ultrasound score. The general features of patients and performers were recorded. Based on the treatment proposed by the performer before and after POCUS assessment, the patients were divided into treatment changed and unchanged groups. Factors associated with treatment changes were identified by multiple logistic regression analysis.Results:Totally 1 913 patients were enrolled including 322 (16.8%) patients with shock, 638 (33.3%) patients with respiratory failure, 139 (7.3%) patients with both shock and respiratory failure and 814 (42.6%) perioperative patients. POCUS had contributed to treatment changes in 1 204 (62.9%) patients, including 867 (72.0%) cases involved fluid management. Univariate analysis showed that there were significant differences in general characteristics of patients, performers and POCUS parameters between groups(all P<0.05). Logistic regression analysis showed that independent factors of treatment changes included ministry of education or university affiliated teaching hospitals (vs.general hospitals, OR=1.891, 95% CI=1.314-2.722, P<0.001 and OR=1.644, 95% CI=1.152-2.347, P=0.006 separately), middle and senior title performers (vs.primary title, OR=2.112, 95% CI=1.358-3.284, P=0.001, OR=3.271, 95% CI=2.129-5.025, P<0.001 separately), mechanical ventilation (vs.without, OR=0.488, 95% CI 0.381-0.626, P<0.001), IVC diameter ≤1 cm (vs.1-2 cm, OR=0.317, 95% CI 0.231-0.434, P<0.001), LV ejecting fraction <50% (vs.≥50%, OR=0.328, 95% CI=0.210-0.512, P<0.001), lung ultrasound score of 6-12 and >12 points(vs.score ≤ 6 points, OR=0.237, 95% CI=0.178-0.315, P<0.001 and OR=0.619, 95% CI=0.457-0.837, P=0.002 separately). Conclusions:POCUS assessment contributes to treatment changes, most of which involves fluid management strategy, in 62.9% critical patients. The independent influencing factors associated with POCUS parameters includes IVC diameter at end-expiratory, LV systolic function and lung ultrasound score. The performers′ title and hospital grade also have a noticeable effect.

Understanding the phase separation characteristics of nucleocapsid protein provides a new therapeutic opportunity against SARS-CoV-2

The ongoing coronavirus disease 2019 (COVID-19) pandemic has raised an urgent need to develop effective therapeutics against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As a potential antiviral drug target, the nucleocapsid (N) protein of SARS-CoV-2 functions as a viral RNA chaperone and plays vital and multifunctional roles during the life cycle of coronavirus1-3. In this study, we discovered that the N protein of SARS-CoV-2 undergoes liquid-liquid phase separation (LLPS) both in vitro and in vivo, which is further modulated by viral RNA. In addition, we found that, the core component of the RNA-dependent RNA polymerase (RdRp) of SARS-CoV-2, nsp12, preferentially partitions into the N protein condensates. Moreover, we revealed that, two small molecules, i.e., CVL218 and PJ34, can be used to intervene the N protein driven phase separation and loosen the compact structures of the condensates of the N-RNA-nsp12 complex of SARS-CoV-2. The discovery of the LLPS-mediated interplay between N protein and nsp12 and the corresponding modulating compounds illuminates a feasible way to improve the accessibility of antiviral drugs (e.g., remdesivir) to their targets (e.g., nsp12/RdRp), and thus may provide useful hints for further development of effective therapeutic strategies against SARS-CoV-2.

Effect of Brucea javanica oil emulsion on proliferation inhibition of multi-drug resistant K562/VCR cell line of human leukemia / 中国医师进修杂志

Objective:To investigate the inhibitory effect of Brucea javanica oil emulsion on the proliferation of human leukemia multi-drug resistant K562/VCR cell line.Methods:Methyl thiazolyl tetrazolim (MTT) colorimetric method was used to detect the proliferation inhibition rate of K562/VCR cells in vitro after intervention with Brucea javanica oil emulsion.Results:With the increasing concentration of Brucea javanica oil emulsion (125,250,500,750,1 000 mg/L), the inhibition ratio to K562 cells continued to increase ( P<0.05), and with the increasing duration of Brucea javanica oil emulsion(24,48,72 h), the inhibition ratio to K562 cells continued to increase ( P<0.05). With the increasing concentration of Brucea javanica oil emulsion(500,750,1 000,1 500,2 000 mg/L), the inhibition ratio of K562/VCR cells continued to increase ( P<0.05), and with the increasing action time of Brucea javanica oil emulsion (24,48,72 h), the inhibition ratio of K562/VCR cells continued to increase ( P<0.05). With the increasing concentration of Brucea javanica oil emulsion(blank control group , Brucea javanica oil emulsion group for 500,750,1 000,1 500 mg/L), the G 0/G 1 ratio in K562/VCR cell cycle continued to increase, while the S ratio and G 2/M ratio continued to decrease ( P<0.05). After injection of Brucea javanica oil emulsion, ADM concentration (fluorescence intensity) in the cells increased significantly(161.4 ± 10.9 vs. 95.9 ± 8.1)( P<0.05). Conclusions:Brucea javanica oil emulsion can inhibit the proliferation of multi-drug resistant K562/VCR cell lines and induce the arrest of multi-drug resistant cell cycle. Brucea javanica oil emulsion increasesd the accumulation of chemotherapeutic agents in multi-drug resistant K562/VCR cell lines.

Critical care ultrasonography: the development and clinical practise in ICU nursing / 中国实用护理杂志

Objective:To establish a practical framework for critical ultrasonography to provide a basis for clinical practice.Methods:With reference to domestic and foreign literature, expert interviews and research groups developed a preliminary draft of the practice framework for critical ultrasonography, and conducted two rounds of consultation using the Delphi method.Results:A practical framework for critical ultrasonography was developed, including 5 primary indicators and 20 secondary indicators. In the two rounds of expert consultation, the expert′s positive coefficient was 100% and the authoritative coefficient was 0.836.Conclusions:Expert opinion has good coordination and high authority, which can provide clinical basis for ICU nurses to carry out ultrasound examination.

Critical care ultrasonography: the development and clinical practise in ICU nursing / 中国实用护理杂志

Objective@#To establish a practical framework for critical ultrasonography to provide a basis for clinical practice.@*Methods@#With reference to domestic and foreign literature, expert interviews and research groups developed a preliminary draft of the practice framework for critical ultrasonography, and conducted two rounds of consultation using the Delphi method.@*Results@#A practical framework for critical ultrasonography was developed, including 5 primary indicators and 20 secondary indicators. In the two rounds of expert consultation, the expert′s positive coefficient was 100% and the authoritative coefficient was 0.836.@*Conclusions@#Expert opinion has good coordination and high authority, which can provide clinical basis for ICU nurses to carry out ultrasound examination.

Analysis of the duration of Noravirus shedding among infected kindergarten children during an outbreak / 中国学校卫生

Objective@#To investigate the duration of Norovirus (NoV) shedding among infected school children during a NoV outbreak in a kindergarten,and to provide scientitic basis for epidemic prevention and control.@*Methods@#Specimens and epidemiological data were collected from suspected cases, and specimens were detected using real-time RT-PCR to determine whether or not infecting with NoV. Specimens were collected every 3-7 days from NoV-infected children until specimens became negative for NoV.@*Results@#A total of 14 suspected cases were reported, and 12 of them were infected with NoV. The average duration of NoV shedding was (26.58±17.94)d. The specimens among 9 from 12 Nov-infected cases were positive at 7 days, 8 NoV-intected cased remained positive at 14 days and 7 Non-infected cased at least 21 days.@*Conclusion@#Since NoV shedding duration among NoV-infected children tends to longer than their isolation time during outbreaks, reinforcement of hygiene practices among these school children is especially necessary to reduce the risk of virus secondary transmissions after their return to school.

Recommendations for the treatment of severe coronavirus disease 2019 based on critical care ultrasound / 中华内科杂志

Severe patients with coronaviras disease 2019 (COVID-19) are characterized by persistent lung damage, causing respiratory failure, secondary circulatory changes and multiple organ dysfunction after virus invasion. Because of its dynamic, real-time, non-invasive, repeatable and other advantages, critical ultrasonography can be widely used in the diagnosis, assessment and guidance of treatment for severe patients. Based on the recommendations of critical care experts from all over the country who fight against the epidemic in Wuhan, this article summarizes the guidelines for the treatment of COVID-19 based on critical ultrasonography, hoping to provide help for the treatment of severe patients. The recommendations mainly cover the following aspects: (1) lung ultrasound in patients with COVID-19 is mainly manifested by thickened and irregular pleural lines, different types of B-lines, shred signs, and other consolidation like dynamic air bronchogram; (2) Echocardiography may show right heart dysfunction, diffuse cardiac function enhancement, stress cardiomyopathy, diffuse cardiac depression and other multiple abnormalities; (3) Critical ultrasonography helps with initiating early treatment in the suspect patient, screening confirmed patients after intensive care unit admission, early assessment of sudden critical events, rapid grading assessment and treatment based on it; (4) Critical ultrasonography helps to quickly screen for the etiology of respiratory failure in patients with COVID-19, make oxygen therapeutic strategy, guide the implementation of lung protective ventilation, graded management and precise off-ventilator; (5) Critical ultrasonography is helpful for assessing the circulatory status of patients with COVID-19, finding chronic cardiopulmonary diseases and guiding extracorporeal membrane oxygenation management; (6) Critical ultrasonography contributes to the management of organs besides based on cardiopulmonary oxygen transport; (7) Critical ultrasonography can help to improve the success of operation; (8) Critical ultrasonography can help to improve the safety and quality of nursing; (9) When performing critical ultrasonography for patients with COVID-19, it needs to implement three-level protection standard, pay attention to disinfect the machine and strictly obey the rules from nosocomial infection. (10) Telemedicine and artificial intelligence centered on critical ultrasonography may help to improve the efficiency of treatment for the patients with COVID-19. In the face of the global spread of the epidemic, all we can do is to share experience, build a defense line, We hope this recommendations can help COVID-19 patients therapy.

The value of renal resistance index and urine oxygen pressure for prediction of acute kidney injury in patients with septic shock / 中华内科杂志

Objective To explore the value of renal resistance index (RI) and urine oxygen pressure for early prediction of acute kidney injury (AKI) in patients with septic shock.Methods Patients with septic shock were enrolled from August 2018 to November 2018 in intensive care unit (ICU) at Peking Union Medical College Hospital.Subjects' general information and AKI characteristics were assessed.Area under the receiver operating characteristic (ROC) curve was used to analyze the predictive value of RI,urine oxygen pressure,or combination of RI on the occurrence of AKI.Results A total of 72 septic shock patients were enrolled including 29 patients with AKI and 43 without.Logistic regression analysis of AKI risk factors found that RI (OR=1.139,95％CI 1.029-1.261,P=0.012) and urine oxygen pressure (OR=0.957,95％CI 0.923-0.991,P=0.014) at admission were independent risk factors for AKI in patients with septic shock.The sensitivity and specificity of dual RI and urine oxygen pressure in predicting AKI were 65.5％and 76.7％ respectively (AUCROC 0.772,Youden index 0.423).We selected the cut-off value of RI as 0.70,and urine oxygen pressure as 48 mmHg (1 mmHg=0.133 kPa).According to this two cut-off values patients were divided into four groups,those with RI≥0.70 and urine oxygen pressure≤48 mmHg showed the highest incidence of AKI (75％).There was no statistically difference in 28-day survival rate between the four groups (P=0.197).Conclusion High RI and low urine oxygen pressure are independent risk factors for the development of AKI in patients with septic shock.The predictive cut-off values are 0.70 for RI and 48 mmHg for urine oxygen pressure.Combination of RI and urine oxygen pressure has a practical predictive value for AKI in patients with septic shock.