Re-evaluating the Morse Fall Scale in obstetrics and gynecology wards and determining optimal cut-off scores for enhanced risk assessment: A retrospective survey.

OBJECTIVE: This study aims to examine the validity of the MFS by analyzing the electronic medical records on fall risk in obstetrics and gynecology wards and determine the optimal cut-off score of the Morse Fall Scale. DESIGN: A retrospective survey. METHODS: The research was conducted in an Obstetrics and Gynecology Hospital and a general hospital. The sample included 136 fall inpatients and 120 no-fall inpatients recruited from January 1st, 2020, to July 10th, 2022. The Morse Fall Scale was analyzed using the gold standard of patients who fell while hospitalized, assessing the area under the Receiver Operating Characteristic curve, sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Kappa. RESULTS: At cut-off scores of 40, 45,50, and 55, the area under the Receiver Operating Characteristic curve was 0.772, 0.761, 0.749, and 0.763, respectively. The Youden index was 0.543, 0.521, 0.498, and 0.525, while Kappa values were 0.540, 0.518, 0.490, and 0.515. Sensitivity was 0.735, 0.713, 0.640, and 0.625; specificity was 0.808, 0.808, 0.858, and 0.900. The positive predictive values were 0.813, 0.808, 0.837, and 0.876, and the negative predictive values were 0.729, 0.713, 0.678, and 0.679. Accuracy were 0.770, 0.758, 0.742, and 0.754. CONCLUSIONS: The Morse Fall Scale demonstrates good predictive performance for assessing fall risk in gynecology and obstetrics wards. The optimal cut-off score is 40.

Systematic review and meta-analysis: Evaluating the influence of intrahepatic cholestasis of pregnancy on obstetric and neonatal outcomes.

BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a serious liver conditions that negatively impacts obstetric and neonatal outcomes. Elevated levels of bile acid, particularly glycine conjugate, may compromise blood flow and cause functional hypoxia-ischemia. AIMS: This meta-analysis aims to assess the association between ICP and key pregnancy outcomes including emergency caesarian sections (C-sections), preeclampsia, hemorrhage, preterm birth, small for gestational age, admission rate to neonatal intensive care union (NICU), gestational age, and stillbirth. MATERIALS AND METHODS: Literature search across five databases (PubMed, Embase, Web of Science) was done to detect relevant studies published up until June 2023. Meta-analysis of the identified studies was done using a random-effects model, and the results presented as Odds ratio (OR). RESULTS: A literature search identified 662 studies. Of them, 21 met the inclusion criteria. There was a significant association between ICP and odds of C-section (OR: 1.42, p <0.001), preeclampsia (OR: 2.64, p <0.001), NICU admission (OR: 2.1, p <0.001), and pre-term birth (OR: 2.64, p <0.001). ICP was not associated with postpartum hemmorhage (OR: 1.31, p = 0.13), small for gestational age (OR: 0.87, p = 0.07), stillbirth (OR: 1.49, p = 0.29). CONCLUSIONS: Our results confirm the adverse effects of ICP on co-existing pregnancy complications, obstetric and neonatal outcomes. ICP in associated with severe complications including increased rates of preeclampsia, emergency C-sections, preterm births, l gestational periods and higher rates of NICU admissions. These results may assist healthcare professionals in formulating comprehensive care guidelines for expectant mothers and newborns.

Effect of Nursing Intervention on Pregnancy Outcomes, Blood Pressure, Postpartum Self-efficacy, and Quality of Life in Patients with Preeclampsia: An Observational Study.

Objective: To analyze the intervention effects of targeted nursing based on goal management theory on pregnancy outcomes, blood pressure, postpartum self-efficacy, and quality of life in patients with preeclampsia. Methods: We retrospectively analyzed 90 cases of preeclampsia admitted to Huzhou Maternity & Child Health Care Hospital from January 2022 to June 2023. All patients met the complete inclusion criteria. They were divided into 2 groups based on different nursing interventions: the control group (n = 45) received routine nursing interventions, and the observation group (n = 45) received targeted nursing based on goal management theory. Pregnancy outcomes, blood pressure, postpartum self-efficacy, and quality of life were compared between the 2 groups. Results: The incidence of adverse pregnancy outcomes was 28.89% in the control group and was significantly lower in the observation group at 11.11% (P < .001). Before intervention, there were no significant differences in systolic blood pressure and diastolic blood pressure between the 2 groups (P > .05). After intervention, the systolic blood pressure and diastolic blood pressure were significantly lower in the observation group than in the control group (P < .001). Before intervention, there was no significant difference in Breastfeeding Self-Efficacy Scale scores between the 2 groups (P > .05). After intervention, the Breastfeeding Self-Efficacy Scale scores were significantly higher in the observation group than in the control group (P < .001). Before intervention, there was no significant difference in the Short Form 36 Health Survey scores between the 2 groups (P > .05). After intervention, the Short Form 36 Health Survey scores were significantly higher in the observation group than in the control group (P < .001). Conclusion: Compared with routine nursing, targeted nursing based on goal management theory had superior intervention effects on preeclampsia. It can further alleviate patients' blood pressure, promote postpartum self-efficacy, improve quality of life, and reduce the risk of adverse pregnancy outcomes. It is worthy of clinical application and promotion.

Impact of hypertensive disorders of pregnancy on maternal and neonatal outcomes of twin gestation: a systematic review and meta-analysis.

Background: The impact of hypertensive disorders of pregnancy (HDP) on outcomes of twin gestations is not clear. We aimed to collate data via this meta-analysis to examine how HDP alters maternal and neonatal outcomes of twin gestations. Methods: Studies comparing pregnancy outcomes of twin gestations based on HDP and published on the databases of PubMed, CENTRAL, Scopus, Web of Science, and Embase between 1 January 2000 to 20 March 2023 were eligible for inclusion. Results: Twelve studies were included. A cumulative of 355,129 twin gestations were analyzed in the current meta-analysis. The pooled analysis found that the presence of HDP increases the risk of preterm birth (OR: 1.86 95% CI: 1.36, 2.55 I2 = 99%) and cesarean section in twin gestations (OR: 1.36 95% CI: 1.20, 1.54 I2 = 89%). Meta-analysis showed a significantly increased risk of low birth weight (OR: 1.30 95% CI: 1.10, 1.55 I2 = 97%), small for gestational age (OR: 1.30 95% CI: 1.09, 1.55 I2 = 96%) and neonatal intensive care unit admissions (OR: 1.77 95% CI: 1.43, 2.20 I2 = 76%) with HDP in twin gestations. There was no difference in the incidence of 5-min Apgar scores <7 (OR: 1.07 95% CI: 0.87, 1.38 I2 = 79%) but a lower risk of neonatal death (OR: 0.39 95% CI: 0.25, 0.61 I2 = 62%) with HDP. Conclusion: HDP increases the risk of preterm birth, cesarean sections, low birth weight, SGA, and NICU admission in twin gestations. Contrastingly, the risk of neonatal death is reduced with HDP. Further studies are needed to corroborate the current results. Systematic Review Registration: PROSPERO (CRD42023407725).

Nurse managers' experience during the COVID-19 pandemic in China: A qualitative study.

AIMS: The aim of the study was to explore the experiences of female new nurse managers during the COVID-19 pandemic. DESIGN: This was a phenomenological study, and qualitative descriptive analysis was used. METHODS: New nurse managers were defined as new nurse managers with less than 3 years of management experience in this study. During November and December of 2021, 18 female new nurse managers were interviewed face-to-face with a semi-structured interview guide in three municipal hospitals. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for evaluating qualitative research reports. Data analysis was performed using Colaizzi's seven-step method. RESULTS: Four main themes and 10 sub-themes were extracted from the collected data. The four major themes were as follows: (1) a shift in stress; (2) work-related physical and psychological discomfort; (3) reflection on the cause; (4) coping and struggles. CONCLUSIONS: New nurse managers were experiencing great stress and exhaustion in their roles. It is important that they are helped to handle situations. Providing them with readily accessible support, addressing their psychosocial needs and addressing exhaustion is necessary. Considering their short management time, the hospital should provide adequate support in human, financial and material areas and provide training to help new nurse managers better adapt to their new roles. In addition, nurse directors should create a culture of mutual respect, identify workplace bullying and create a harmonious and cooperation-oriented work environment for new nurse managers. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Prospective analysis of the prognostic value of prenatal MRI measurement of cystic volume ratio in fetal congenital cystic adenomatoid malformation.

BACKGROUND: The cystic volume ratio (CVR) has been used to predict the prognosis of fetal lung disease, but most of them are reported on ultrasound. The purpose of this study was to investigate the prognostic value of prenatal magnetic resonance imaging (MRI) measurement of CVR in fetal congenital cystic adenomatoid malformation (CCAM). METHODS: To collect follow-up data on postnatally confirmed CCAM fetuses. According to the size of CVR, they were divided into a CVR ≥1.26 group and a CVR <1.26 group. The lesions were divided into macrocystic (diameter ≥5 mm) and microcystic (diameter <5 mm) types according to the size of cysts in the lesions. The collected contents also included the location of the lesions, prenatal symptoms, postpartum clinical prognosis, and pregnancy outcomes. RESULTS: In all, 51 cases were collected. Of these, 11 were placed into the CVR ≥1.26 group, and 40 were placed into the CVR <1.26 group; meanwhile 34 were classified as macrocystic lesions and 17 as microcystic lesions; 7 cases involved a terminated pregnancy. In the CVR ≥1.26 group, 81.82% (9/11) and 36.36% (4/11) had displacement of large vessels/heart and increased amniotic fluid, respectively; meanwhile, in the CVR <1.26 group, these phenomena occurred in 35.00% (14/40) and 2.50% (1/40) of cases (P=0.006, 0.010). Additionally, 83.33% (5/6) of live infants in the CVR ≥1.26 group had dyspnea, a significantly higher proportion than the 21.05% (8/38) in the CVR <1.26 group (P=0.011). Moreover, 45.45% (5/11) of the cases in the CVR ≥1.26 group were terminated pregnancies, a significantly higher proportion than the 5.26% (2/38) in the CVR <1.26 group (P=0.001). Finally, the CVR of macrocystic lesions was 0.55 (0.34-1.31), which was significantly greater than the 0.34 (0.17-0.57) of microcystic lesions (P=0.022). Logistical regression analysis identified that CVR is an independent factor associated with the postpartum prognosis of CCAM. CONCLUSIONS: Prenatal symptoms and postpartum prognosis were worse than CVR <1.26 when fetal CVR ≥1.26 measured by prenatal MRI; and the measurement of CVR of CCAM through prenatal MRI has considerable practical value in prenatal consultation, evaluation, and postpartum treatment.

Increasing the targeting scope and efficiency of base editing with Proxy-BE strategy.

Base editors (BEs) are widely used in precise gene editing due to their simplicity and versatility. However, their efficiencies are hindered by various obstacles. Considering the chromatin microenvironment as a possible obstacle, here, we demonstrate a further development of the proxy-clustered regularly interspaced short palindromic repeats strategy, termed Proxy-BE, to increase gene editing efficiency. Specifically, a nuclease-dead Cas9 (dCas9) was bound to the sequence about 20-30 base pair away from the target site, potentially improving access to the DNA and, thus, providing a better editing microenvironment for base editors. Our findings confirm that nuclease-dead Streptococcus pyogenes Cas9 can assist the base editors SaKKH-BE3 and dCpf1-BE to double their canonical base editing efficiency. This work provides a new approach to enhance base editing, extending its scope for biological research and gene therapy.

Reactive Oxygen Species-Mediated Tumor Microenvironment Transformation: The Mechanism of Radioresistant Gastric Cancer.

Radioresistance is one of the primary causes responsible for therapeutic failure and recurrence of cancer. It is well documented that reactive oxygen species (ROS) contribute to the initiation and development of gastric cancer (GC), and the levels of ROS are significantly increased in patients with GC accompanied with abnormal expressions of multiple inflammatory factors. It is also well documented that ROS can activate cancer cells and inflammatory cells, stimulating the release of a variety of inflammatory cytokines, which subsequently mediates the tumor microenvironment (TME) and promotes cancer stem cell (CSC) maintenance as well as renewal and epithelial-mesenchymal transition (EMT), ultimately resulting in radioresistance and recurrence of GC.