Nafamostat mesylate versus regional citrate anticoagulation for continuous renal replacement therapy in patients at high risk of bleeding: a retrospective single-center study.

PURPOSE: The choice of continuous renal replacement therapy (CRRT) anticoagulation program for patients at high risk of bleeding has always been a complex problem in clinical practice. Clinical regimens include regional citrate anticoagulation (RCA) and nafamostat mesylate (NM). This study aimed to evaluate the efficacy and safety of these two anticoagulants for CRRT in patients at high risk of bleeding to guide their clinical use better. PATIENTS AND METHODS: Between January 2021 and December 2022, 307 patients were screened for this study. Forty-six patients were finally enrolled: 22 in the regional citrate anticoagulation group and 24 in the nafamostat mesylate group. We collected patients' baseline characteristics, laboratory indicators before CRRT, and CRRT-related data. We then performed a statistical analysis of the data from both groups of patients. RESULTS: In our study, the baseline characteristics did not differ significantly between the two groups; the baseline laboratory indicators before CRRT of patients in the two groups were not significantly different. The duration of CRRT was 600 min in the regional citrate anticoagulation (RCA) group, 615 min in the nafamostat mesylate (NM) group; the success rate was 90.7% in the RCA group, and 85.6% in the NM group, the anticoagulant efficacy between the two groups was comparable. There was no significant difference in the safety of anticoagulation between the two groups. We used Generalized Estimating Equations (GEE) to test whether different anticoagulation methods significantly affected the success rate of CRRT and found no statistical difference between RCA and NM. CONCLUSION: Our study suggests that nafamostat mesylate's anticoagulant efficacy and safety are not inferior to regional citrate anticoagulation for continuous renal replacement therapy in patients at high risk of bleeding.

Aggressive alternative splicing events discovered in cecum ligation and puncture induced lung injury.

AIMS: Acute lung injury (ALI) induced by sepsis and its complications have high morbidity and mortality rates globally. The objective of this study was to enhance our understanding of the underlying mechanism of ALI by identifying potential splicing events that are regulated in this condition. MATERIALS AND METHODS: The CLP mouse model was utilized for mRNA sequencing, and the expression and splicing data were analyzed. Verification of the changes in expression and splicing induced by CLP was conducted using qPCR and RT-PCR. RESULTS: Our results showed that splicing-related genes were regulated, suggesting that splicing regulation may be a key mechanism in ALI. We also found that more than 2900 genes displayed alternative splicing in the lungs of mice with sepsis. Using RT-PCR, we verified that TLR4 and other genes had differential splicing isoforms in the lungs of mice with sepsis. We confirmed the presence of TLR4-s in the lungs of mice with sepsis using RNA-fluorescence in situ hybridization. CONCLUSION: Our results suggest that sepsis-induced ALI can significantly alter splicing in the lungs of mice. The list of DASGs and splicing factors is valuable for further study in the search for new treatment approaches for sepsis-induced ALI.

Knowledge, Attitude, and Perceived Barriers of Newly Graduated Registered Nurses Undergoing Standardized Training in Intensive Care Unit Toward Early Mobilization of Mechanically Ventilated Patients: A Qualitative Study in Shanghai.

Aim: To explore the knowledge and attitudes of newly graduated registered nurses, who have undergone standardized training in the intensive care unit, about the early mobilization of mechanically ventilated patients and identify perceived barriers to the application of early mobilization. Background: Early mobilization of mechanically ventilated patients has been gradually gaining attention, and its safety and effectiveness have also been verified. Nurses in intensive care units are the implementers of early mobilization, and the quality of their care is closely related to patient prognosis. However, the knowledge and attitude of newly graduated registered nurses undergoing standardized training, in intensive care units, on the early mobilization of mechanically ventilated patients and the obstacles they face in clinical implementation are still unclear. Methods: This qualitative study utilized the phenomenological method to explore the experiences of 15 newly graduated registered nurses undergoing standardized training in intensive care units in a 3rd hospital in Shanghai, China. Semi-structured face-to-face interviews were conducted in June 2020. The Colaizzi seven-step framework was used for data analysis. Findings: A total of 15 new nurses comprised the final sample after data saturation. Three main themes emerged from the analysis and seven subthemes: perceived importance, low implementation rate, and perceived barriers. Conclusions: Newly graduated registered nurses undergoing standardized training in intensive care units have a high level of awareness of the importance of early mobilization of mechanically ventilated patients and are willing to implement it. However, there is a lack of relevant knowledge and other obstacles that restrict clinical implementation. Early mobilization should be included in the standardized training of new nurses in intensive care units.