Construction of a graded post management indicator system for specialist nurses in medical institutions / 中华医院管理杂志

Objective:To establish a graded post management system for specialist nurses in medical institutions, so as to provide a reference for the selection, stratification, employment, and promotion of specialist nurses in China.Methods:Through literature review and brainstorming, the primary screening indicators of the graded post indicator management system for specialist nurses were constructed. Two rounds of Delphi method were used to consult 25 experts to construct the graded post management system for specialist nurses.Results:The effective recovery rates for two rounds of consultation were 100% and 96%, respectively, with expert authority coefficients of 0.86 and 0.89, and Kendall harmony coefficients of 0.31 and 0.54. The final establishment of a specialist nurses graded post management indicator system included 8 first level indicators, 31 second level indicators.Conclusions:The graded post management indicator system for specialist nurse could provide theoretical support for the management of specialist nurse. It was conducive to clarifying the admission standards and hierarchical framework for specialist nurses, standardizing the establishment of positions and responsibilities, and improving the competition and incentive mechanism.

Trend test on the "dose-effect" relationships of social support to Internet addiction among left-behind middle school students / 四川精神卫生

ObjectiveTo understand the status and relationship between social support level and Internet addiction among left-behind middle school students， so as to provide references for the targeted intervention and risk reduction of Internet addiction. MethodsStratified cluster random sampling method was used to recruit 3 532 middle school students from six middle schools in a county of Southeast Chongqing， including 1 945 （55.07%） left-behind students and 1 587 （44.93%） non-left behind students. All the selected students were assessed using self-designed general situation questionnaire， Diagnostic Scale of Internet Addiction for Middle School Students （DSIA-MSS） and Adolescent Social Support Rating Scale （ASSRS）， then the trend test was performed on relationships of social support to Internet addiction. Results① The detection rate of Internet addiction in the left behind group was higher than that in the non-left behind group （22.98% vs. 16.13%， χ2=25.732， P<0.01）. ② ASSRS score in the left behind group was lower than that in the non-left behind group ［（66.81±15.92） vs. （68.19±16.18）， t=2.544， P=0.011］. ③ Among three different living states of students （non-left behind， one-parent working outside， both-parents working outside）， the detection rate of Internet addiction demonstrated significant differences among students with different social support levels （χ2=35.220， 37.662， 31.434， P<0.01）. ④ A "dose-effect" relationship of social support to Internet addiction was found， indicating that students with higher social support levels suffered a lower risk of Internet addiction （P<0.01）. ConclusionLeft-behind middle school students develop a prominent problem of Internet addiction， which is closely related to their social support level， and the two aspects display a negative "dose-effect" relationship.

Pendelluft volume during double-triggered asynchronous breaths under pressure support ventilation: a prospective physiological study / 中华危重病急救医学

Objective:To investigate the relationship between double-triggering and abnormal movement of air in the lungs (pendelluft phenomenon) under pressure support ventilation (PSV).Methods:A prospective observational study was conducted, postoperative patients admitted to department of critical care medicine of Beijing Tiantan Hospital, Capital Medical University from April 1, 2019 to August 31, 2020 and received invasive mechanical ventilation with PSV mode were enrolled. Electrical impedance tomography (EIT) monitoring was performed. Airway pressure-time, flow-time, global and regional impedance-time curves were synchronously collected and analyzed offline. The volume of abnormal movement of air in the lungs at the beginning of inspiration was measured and defined as pendelluft volume. Double-triggered breaths were identified by trained researchers. Pendelluft volume during double-triggering was measured including the first triggered breath, the double-triggered breath, and the breath immediately following the double-triggered breath. Pendelluft volume was also measured for normal breath during the study. According to the frequency of double-triggering, patients were divided into severe (≥1 time/min) and non-severe double-triggering group. Pendelluft volume, parameters of respiratory mechanics, and clinical outcomes between the two groups were compared.Results:In 40 enrolled patients, a total of 9 711 breaths [(243±63) breaths/patient] were collected and analyzed, among which 222 breaths (2.3%) were identified as double-triggering. The Kappa of interobserver reliability to detect double-triggering was 0.964 [95% confidence interval (95% CI) was 0.946-0.982]. In 222 double-triggered breaths, pendelluft volume could not be measured in 7 breaths (3.2%), but the pendelluft phenomenon did exist as shown by opposite regional impedance change at the beginning of double-triggered inspiration. Finally, pendelluft volume was measured in 215 double-triggered breaths. Meanwhile, 400 normal breaths (10 normal breaths randomly selected for each patient) were identified as control. Compared with normal breath, pendelluft volume significantly increased in the first breath, the double-triggered breath, and the following normal breath [mL: 3.0 (1.4, 6.4), 8.3 (3.6, 13.2), 4.3 (1.9, 9.1) vs. 1.4 (0.7, 2.8), all P < 0.05]. Patients in severe double-triggering, pendelluft volume of normal breath and double-triggered breath were significantly higher than those in non-severe double-triggering group [mL: 1.8 (0.9, 3.2) vs. 1.1 (0.5, 2.1), P < 0.001; 8.5 (3.9, 13.4) vs. 2.0 (0.6, 9.1), P = 0.008]. Patients in severe double-triggering group had significantly higher respiratory rate than that in the non-severe double-triggering group (breaths/min: 20.9±3.5 vs. 15.2±3.7, P < 0.001). There were no significant differences in other respiratory mechanics parameters and main clinical outcomes between the two groups. Conclusions:During PSV, the abnormal movement of air in the lungs (pendelluft phenomenon) was more likely to occur in double-triggering especially in double-triggered breath. The more frequent the double-triggering occurred, the more serious the pendelluft phenomenon was. A higher pendelluft volume of normal breath and a higher respiratory rate were related to severity of double-triggering.

Assisting Scalable Diagnosis Automatically via CT Images in the Combat against COVID-19

Introductory paragraphThe pandemic of coronavirus Disease 2019 (COVID-19) caused enormous loss of life globally. 1-3 Case identification is critical. The reference method is using real-time reverse transcription PCR (rRT-PCR) assays, with limitations that may curb its prompt large-scale application. COVID-19 manifests with chest computed tomography (CT) abnormalities, some even before the onset of symptoms. We tested the hypothesis that application of deep learning (DL) to the 3D CT images could help identify COVID-19 infections. Using the data from 920 COVID-19 and 1,073 non-COVID-19 pneumonia patients, we developed a modified DenseNet-264 model, COVIDNet, to classify CT images to either class. When tested on an independent set of 233 COVID-19 and 289 non-COVID-19 patients. COVIDNet achieved an accuracy rate of 94.3% and an area under the curve (AUC) of 0.98. Application of DL to CT images may improve both the efficiency and capacity of case detection and long-term surveillance.

Feasibility of using esophageal balloon pressure-volume curve to calibrate esophageal pressure during assisted mechanical ventilation / 中华危重病急救医学

Objective:To evaluate the feasibility of esophageal pressure (Pes) calibration by the esophageal balloon pressure-volume (P-V) curve during assisted mechanical ventilation.Methods:A prospective study was conducted. The postoperative patients admitted to intensive care unit of Beijing Tiantan Hospital Affiliated to Capital Medical University from June 2017 to January 2019 who needed pressure support ventilation by tracheal intubation and Pes monitoring with stable breath were enrolled. The Pes monitoring was performed by the esophageal balloon with a small geometric volume (2.8 mL). ① Balloon volume tests of esophageal balloon were performed by inflating intermittently 0.5 mL increments up to 2.5 mL, the end-expiratory and end-inspiratory Pes were recorded to obtain end-expiratory and end-inspiratory P-V curves. The intermediate section in end-expiatory P-V curve that showed linear correlation was identified (as intermediate linear section), whose volume range was balloon working volume ( Vwork) and slope was esophageal wall elastance (Ees), the balloon volume with the largest difference between end-expiratory and end-inspiratory Pes was the best balloon volume ( Vbest), and the product of Ees and Vbest was esophageal wall recoil pressure reacting to balloon filling. To minimize the effect of esophageal wall on Pes, the calibrated Pes was the difference of Pes and esophageal wall recoil pressure. The consistency of calibrated Pes obtained by balloon volume at Vbset and other Vwork were analyzed. ② For the convenience of clinical application, a simplified method was introduced to calibrate Pes. Based on all Vwork of patients located in 0.5-1.5 mL, the difference of end-expiratory Pes between balloon volume at 0.5 mL and 1.5 mL divided by 1.0 mL was used to estimate Ees, and the Pes among 0.5-1.5 mL was calibrated by Ees obtained by the simple method. The consistency of calibrated Pes obtained by the simple method and standard method were observed. Results:Totally 30 patients were enrolled, all end-expiratory and end-inspiratory P-V curves existed the intermediate linear section, the calibrated Pes at Vwork did not increase with the balloon being inflated and had a good consistency with the calibrated Pes at Vbest, mean difference and 95% confidence interval (95% CI) was -0.02 (-1.50-1.50) cmH 2O (1 cmH 2O = 0.098 kPa). The Ees and calibrated Pes estimated by the simple method had a good agreement with the standard method, mean difference and 95% CI was -0.2 (-1.0-0.6) cmH 2O/mL and 0.2 (-1.1-1.4) cmH 2O, respectively. Conclusions:During assisted mechanical ventilation, the use of a small geometric volume esophageal balloon to monitor Pes and balloon P-V curve to calibrate Pes is feasible. The simple method can be used for simplifying clinical application, that's only by monitoring Pes at balloon volume at 0.5, 1.0 and 1.5 mL to evaluate the Ees and calibrate Pes.

Research status of mechanical power in ventilator-induced lung injury / 中华危重病急救医学

The ventilator-induced lung injury (VILI) was centered on the "static" characteristics of the mechanical ventilation in early phases (tidal volume, plateau pressure, positive end-expiratory pressure and driving pressure). But the "dynamic" characteristics of ventilation must not be ignored (respiratory rate and flow). Mechanical energy and mechanical power (the pace of performing energy load) regarding all factor have won wide spread attention. The energy generated by mechanical ventilation is mainly used to expand respiratory system and overcome resistance, a fraction of energy acts on lung tissues probably inducing "heat" and inflammation that is related to lung injury. The review described recent conceptual advances regarding the mechanical energy and power, and the relationship with VILI, hoping to help further understanding the risk factors for VILI.

Research status of mechanical power in ventilator-induced lung injury / 中华危重病急救医学

The ventilator-induced lung injury (VILI) was centered on the "static" characteristics of the mechanical ventilation in early phases (tidal volume, plateau pressure, positive end-expiratory pressure and driving pressure). But the "dynamic" characteristics of ventilation must not be ignored (respiratory rate and flow). Mechanical energy and mechanical power (the pace of performing energy load) regarding all factor have won wide spread attention. The energy generated by mechanical ventilation is mainly used to expand respiratory system and overcome resistance, a fraction of energy acts on lung tissues probably inducing "heat" and inflammation that is related to lung injury. The review described recent conceptual advances regarding the mechanical energy and power, and the relationship with VILI, hoping to help further understanding the risk factors for VILI.

Detection and clinical significance of differentially expressed microRNAs in chronic hepatitis B patients before being treated with pegylated interferon / 中华实验和临床病毒学杂志

Objective@#To detect differentially expressed microRNAs in chronic hepatitis B (CHB) before being treated with pegylated interferon (PegIFN) and the relationship between their target genes and HBsAg loss.@*Methods@#Pretreatment differentially expressed microRNAs between different response groups were screened using high throughput microarrays and validated by quantitative reverse-transcription polymerase chain reaction (RT-qPCR). Bioinformatics analysis was performed to determine their target genes potential mechanistic roles.@*Results@#A total of 417 microRNA were differentially expressed between different response groups, among which 342 were up-regulated and 75 were down-regulated. miR-3960, miR-126-3p, miR-23 a-3p and miR-335-5p were verified to be down-regulated by RT-qPCR result in HBsAg loss group. Bioinformatic analysis result show that the relevant pathways of microRNAs include AMPK signal pathway, NOD-like signal pathway, NF-kappa B signal pathway and mTOR signal pathway.@*Conclusions@#HBsAg loss is probably achieved as the result of genes expression regulated in association with immune response, further enhance the immune response of HBV elimination and acquire HBsAg loss.

Inhibitory effect of anti interleukin-8 monoclonal antibodies on cervical cancer / 肿瘤研究与临床

Objective To investigate the inhibitory effect of anti interleukin(IL)-8 monoclonal antibodies on the growth and metastasis of cervical cancer. Methods Involved cervical cells included CaSki cells with high expression of IL-8 and SiHa cell lines with IL-8 plasmid transfected (pcDNA3.1-IL-8-SiHa). Cervical cancer animal model was established on nude mice. Boyden method was used in vitro study to observe the effects of anti IL-8 antibodies on the chemotaxis of high-expressed IL-8 cervical cancer cells. The effect of anti IL-8 antibodies on the growth of cervical cancer cells and nude mice transplantation tumor was observed by the experiment in vivo through reverse transcription-polymerase chain reaction (RT-PCR), enzyme linked immunosorbent assay (ELISA), TUNEL method. Cell line (CaSki and pcDNA3.1-IL-8-SiHa) modeled nude mice were divided into 5 groups with 5 animals in each group. The blank control group (group Ⅰ) was given the equal volume of phosphate buffer solution (PBS). Negative control group (group Ⅱ) was injected with IgG at the same volume of IgG. Treatment group (group Ⅲ) was injected with anti IL-8 antibodies at dose of 100 μg for once and intervals for once 2 days. Treatment group (group Ⅳ) was injected with anti IL-8 antibodies at dose of 500 μg for once and intervals for once 3 days. Treatment group (group V) was injected with anti IL-8 antibodies at dose of 1 000 μg for once and intervals for once 1 week.Results Experiments in vitro showed that the cell chemotaxis ability of anti IL-8 antibody in CaSki cells and pcDNA3.1-IL-8-SiHa cells was lower than that in the blank control group(CaSki cells:F=289.6,P =0.000; pcDNA3.1-IL-8-SiHa cells:F=79.0,P=0.005).GroupⅣwas taken as the example for its best anti-tumor effect in experiments in vivo. The tumor weight in groupⅣwas lower than that in groupⅠ[CaSki cells: (0.172±0.031) g vs. (0.735± 0.015) g, P＜ 0.05; pcDNA3.1-IL-8-SiHa cells: (0.400±0.029) g vs. (1.430±0.199) g, P＜ 0.05]. The tumor volume in groupⅣwas less than that in groupⅠ[CaSki cells:(0.049±0.028)cm3vs.(0.214±0.016) cm3,P＜0.05;pcDNA3.1-IL-8-SiHa cells:(0.063±0.022)cm3vs.(0.600±0.072)cm3,P＜0.05].The tumor growth curve also showed that tumor growth was slow, and the time of tumor formation as well as survival time was prolonged in anti IL-8 antibody treated group. The expression of mRNA in IL-8 in group IV was lower than that in group Ⅰ (CaSki cells: 0.58±0.06 vs. 1.15±0.13, P＜ 0.05; pcDNA3.1-IL-8-SiHa cells: 0.69±0.08 vs. 1.16±0.13,P＜0.05).The protein expression of IL-8 in groupⅣwas lower than that in groupⅠ(CaSki cells:126±29 vs.411±112,P＜0.05;pcDNA3.1-IL-8-SiHa cells:134±47 vs.327±69,P＜0.05).Apoptotic index in groupⅣwas higher than that in groupⅠ(CaSki cells:81.8±3.0 vs.26.0±5.6,P＜0.05;pcDNA3.1-IL-8-SiHa cells: 84.4±3.6 vs. 32.0±4.9, P＜0.05). Conclusion Anti IL-8 antibody can inhibit cell migration of human cervical cancer in vitro, inhibit growth and metastasis of transplantation tumor in vivo, and promote apoptosis and necrosis with a dose-dependent way in vivo.

Research advances in the role of long non-coding RNA in diabetic kidney disease / 中国糖尿病杂志

Objective Long non-coding RNA(lncRNA),with more than 200 nucleotides in length,is closely related to many endocrine and metabolic diseases as a functional RNA.Researches has shown that lncRNA can regulate gene expression in multiple levels,including participation in chromatin imprints,in combination with apparent modified complexes or transcription factors to play a transcriptional regulation,and binding with miRNA,mRNA or protein to play the role of post-transcriptional regulation.The disorder of lncRNA expression and the mutation of the primary sequence or variation of the secondary structure are associated with many human diseases.The study of lncRNA in diabetic kidney disease is still in its infancy.In addition,since some lncRNA can be detected in human body fluid and have good specificity and accessibility,it is speculated that lncRNA can be used as a new potential biomarker for the diagnosis and prognosis of diabetic kidney disease.

Application of injection test in confirming the ideal position of esophageal balloon catheter / 中华危重病急救医学

Objective To evaluate the safety and feasibility of injection test which is used to locate esophageal balloon catheter.Methods A prospective study was conducted. The patients undergoing invasive mechanical ventilation (MV) admitted to general intensive care unit (ICU) of Beijing Tiantan Hospital Affiliated to Capital Medical University from May 2015 and March 2017 were enrolled. The commercially available esophageal balloon catheter was modified to perform injection test. The catheter was withdrawn step by step and the injection test was repeated until the presence disturbance wave presented, which indicated that the balloon had just entered the esophagus. The position where disturbance wave appears was named 0 cm. End-expiratory occlusions were performed at the positions of+15,+10,+5, 0, -5, -10 and -15 cm, respectively, and the changes of esophageal pressure (Pes) and airway pressures (Paw) were measured in the spontaneous breathing and passive ventilation, and the ratio between the changes (ΔPes/ΔPaw) was calculated.Results A total of 20 patients were enrolled, of which 15 patients finished both the spontaneous and the passive ventilation parts, and 2 patients finished only the spontaneous part and 3 patients finished only passive part. ① Disturbance waves could be induced by injection test in all patients. The average depth of disturbance wave in spontaneous breathing was deeper than that in passive ventilation (cm: 42.4±3.8 vs. 41.8±3.3), but there was no significant difference between the two ventilation settings (P = 0.132). No adverse events occurred during the study period. ② Pes increased with the stepwise withdraw of esophageal catheter, reached the maximal value at+5 cm, and then decreased when the catheter was further withdrawn, no matter in the spontaneous or the passive ventilation. In spontaneous breathing, the ΔPes/ΔPaw was within the ideal range (0.8-1.2) at the positions of 0, -5 and -10 cm. The ΔPes/ΔPaw was closest to unity at the positions of 0 cm (0.98±0.15). The ΔPes/ΔPaw at -15 cm (0.66±0.26) was significantly lower than that at 0 cm (P < 0.05). For passive ventilation, the ΔPes/ΔPaw was within the ideal range at the positions of -5 cm and -10 cm, and the ΔPes/ΔPaw was closest to unity at the positions of-10 cm (0.94±0.12). The ΔPes/ΔPaw at 0 cm and -5 cm was significantly higher than that at -10 cm (1.43±0.31 and 1.12±0.14, respectively); while the ΔPes/ΔPaw at -15 cm (0.68±0.23) was significantly lower than that at -10 cm (allP < 0.01).Conclusions Ideal position of the esophageal balloon catheter could be determined quickly and easily by using injection test. The method is safe and clinically feasible.Clinical Trial Registration Clinical Trials, NCT02446938.

Effects of hepatitis B virus on liver function, liver fibrosis and liver pathological staging at different ALT stages / 西安交通大学学报(医学版)

Objective To evaluate the effects of hepatitis B virus on liver function,liver fibrosis,and liver pathological staging at different immune stages.Methods We made a retrospective analysis of 657 patients with chronic hepatitis B diagnosed in the First Hospital of Lanzhou University.Their liver function parameters,liver fibrosis parameters,and hepatitis B virus load were measured by automatic biochemical analyzer,automatic gammaradiation immunity analyzer,and quantitative PCR analyzer,respectively.Effects of hepatitis B virus on liver function,liver fibrosis in different immune stages were analyzed by variance analysis.Effects of hepatitis B virus on liver pathological staging at different immune stages were analyzed by linear trend chi square test analysis.Results In ALT normal chronic hepatitis B patients group,viral load had mild effects on liver function and liver fibrosis parameters.However,in ALT abnormal chronic hepatitis B patients group,viral load had a significant effect on liver function and liver fibrosis parameters,and the effect was most obvious in ALT＞double upper limit of normal group.The specific manifestation was that with viral load increasing,liver function parameters including ALT,AST,TBiL,DBiL,and IBiL increased,while TP and ALB decreased.Liver fibrosis parameters HA,LN,PcⅢ,and CIV all increased (P＜0.05).In ALT normal chronic hepatitis B patients group,viral load had no relationship with liver pathological staging.However,in ALT abnormal chronic hepatitis B patients group,especially ALT≥double upper limit of normal group,viral load was significantly related to liver pathological staging.Conclusion The effects of hepatitis B virus on patients' liver function at different immune stages were different,thus providing evidence-based medicine support for clinical antiviral treatment.

Clinical Study on Dahuang Xiaozhi Suppository Combined with Tetracycline in Treating Type Ⅲ Prostatitis Infected with Nano-bacteria / 中国中医药信息杂志

Objective To investigate the clinical efficacy of Dahuang Xiaozhi Suppository combined with tetracycline in treating type Ⅲ prostatitis infected with nano-bacteria. Methods Totally 120 patients of type Ⅲprostatitis infected with nano-bacteria were randomly divided into treatment group and control group, with 60 cases in each group. Both groups were disabled anti-infective drugs and other preparations for diet and life intervention. Both groups received tetracycline, once a tablet, twice a day, orally. The treatment group received Dahuang Xiaozhi Suppository, once a capsule, once a day, placing in the anus 3-4 cm. 10 d was a treatment course, for 3 courses. The clinical efficacy, major symptoms improving time, NIH-CPSI, leukocyte count and ecithin corpuscles in expressed prostatic secretion (EPS), urinary flow rate, and cytokine content of TNF-α, IL-6, IL-8, were evaluated. Results The total effective rate was 100.0% (60/60) in treatment group and 83.3% (50/60) in the control group, and treatment group was higher than the control group (P<0.05). Pelvic pain, urinary symptom, and scrotum wet improvement time of treatment group were lower than the control group (P<0.05). Compared with before the treatment, the NIH-CPSI pain scores, urinary symptom scores, life quality score, leukocyte count and TNF-α, IL-6, IL-8 content of EPS in both groups were significantly lower after treatment (P<0.05), and the cases with lecithin corpuscles +++ - ++++ in both groups significantly increased after treatment (P<0.05). The urinary peak flow rate and mean flow rate in both groups were higher after treatment (P<0.05). There was statistical significance in the scores of NIH-CPSI pain, urinary symptom and life quality, leukocyte count and TNF-α, IL-6, IL-8 content of EPS, and the cases with lecithin corpuscles ++++ between the two groups (P<0.05). Conclusion Dahuang Xiaozhi Suppository can improve the efficacy of treating type Ⅲ prostatitis infected with nano-bacteria. Combining Dahuang Xiaozhi Suppository with tetracycline can reduce prostate inflammation, with obvious efficacy.

Persistent intestinal motility disorder after transient intestinal nematode infection in rats / 北京大学学报(医学版)

Objective: To investigate the intestinal motor function (distal colonic manometry and gastrointestinal transit time) after T. spiralis infection in rats. Methods: Sprague Dawley rats were infected by administering T. spiralis larvae. Rats were studied on 14, 42, and 56 days post infection (PI). Age matched non infected animals served as controls. All rats underwent colonic manometry and gastrointestinal transit time test. Results: (1) The small intestinal inflammation became the most severe on day 14 PI, and returned to normal on day 56. (2) The distal colonic manometry showed significantly active motility in acute infected rats either at rest or upon balloon stimulating. (3) Rat colonic motility parameters were not different from those of the control rats either at rest or upon small volume (1mL) balloon stimulating on day 42 and day 56 PI. But when the balloon was inflated with 2 mL of air, the colonic activity increased significantly compared with that of the control. (4) Gastrointestinal transit time was slower in acute and PI rats than that in the control group. Conclusion: Intestinal motility function was abnormal persistently after transient intestinal nematode infection in rats either in distal colonic manometry or in gastrointestinal transit time.