Predicting Severity in Hypertriglyceridemia-Induced Acute Pancreatitis: The Role of Neutrophils, Calcium, and Apolipoproteins.

BACKGROUND Hypertriglyceridemia-induced acute pancreatitis (HTG-AP), representing 10% of all acute pancreatitis cases, is characterized by younger onset age and more severe progression, often leading to higher ICU admission rates. This condition poses a significant challenge due to its rapid progression and the potential for severe complications, including multiple organ failure. HTG-AP is distinct from other forms of pancreatitis, such as those caused by cholelithiasis or alcohol, in terms of clinical presentation and outcomes. It's essential to identify early markers that can predict the severity of HTG-AP to improve patient management and outcomes. MATERIAL AND METHODS This study divided 127 HTG-AP patients into mild acute pancreatitis (MAP, n=71) and moderate-to-severe acute pancreatitis (MSAP/SAP, n=56) groups. Blood biological indicators within the first 24 hours of admission were analyzed. Risk factors for HTG-AP progression were determined using binary logistic regression and ROC curves. RESULTS Elevated levels of HCT, NLR, TBI, DBI, AST, Cre, and AMS were noted in the MSAP/SAP group, with lower levels of LYM, Na⁺, Ca²âº, ApoA, and ApoB compared to the MAP group (p<0.05). NEUT%, Ca²âº, ApoA, and ApoB were significantly linked with HTG-AP severity. Their combined ROC analysis yielded an area of 0.81, with a sensitivity of 61.8% and specificity of 90%. CONCLUSIONS NEUT%, Ca²âº, ApoA, and ApoB are significant risk factors for progressing to MSAP/SAP in HTG-AP. Their combined assessment provides a reliable predictive measure for early intervention in patients at risk of severe progression.

Effectiveness of a Teach-Back Education Program on Perioperative Pain in Patients With Lung Cancer: An Intervention Study Using Behavior Change Wheel.

OBJECTIVE: To assess the effect of a teach-back educational intervention using Behavior Change Wheel (BCW) framework on perioperative pain among patients with lung cancer. METHODS: A prospective quasi-experimental study was conducted in 88 patients with lung cancer from a tertiary hospital in China. According to the order of admission, they were allocated to either control group or intervention group, with 44 patients in each group. Patients in the control group received routine nursing care, while patients in the intervention group were given a teach-back education program based on BCW framework. The visual analog scale (VAS) was adopted to evaluate patients' pain on the day of surgery (T0), 1 (T1), 2 (T2), and 3 (T3) days after surgery. We also recorded the use of patient-controlled analgesia (PCA), the length of hospital stay, and the degree of patients' satisfaction. RESULTS: Rest pain, pain when coughing, and pain during activity that patients in the intervention group experienced were significantly less severe than those in the control group on T0 and T1. The pain when coughing in the intervention group was also significantly milder on T2 and T3. In addition, the number of self-control time, use duration, and total dose of PCA were significantly lower in the intervention group. Moreover, patients' satisfaction of nursing service was significantly higher in the intervention group. CONCLUSION: A teach-back education program based on BCW framework was effective in pain management among the perioperative patients with lung cancer. This study demonstrates the application of teach-back method and the BCW in the development of patient education intervention to mitigate perioperative pain.

The knowledge and attitude on the prevention of pressure ulcers in Chinese nurses: A cross-sectional study in 93 tertiary and secondary hospitals.

Although pressure ulcers are related to substantial health burdens, they may be preventable. Since nurses play a fundamental role in pressure ulcer prevention, their knowledge and attitude are of great importance. This study aims to investigate the current situation and associated factors of nurses' knowledge and attitude on the prevention of pressure ulcers from both tertiary and secondary hospitals. A total of 11 347 nurses were recruited including 7108 nurses (62.6%) from tertiary hospitals and 4239 nurses (37.4%) from secondary hospitals. The median (interquartile range) of the pressure ulcer knowledge score was 51% (38%, 90%) for all the participants with the lowest scores on prevention of pressure ulcers (51.33%). The mean (standard deviation) of attitude towards pressure ulcer prevention was 39.64 (4.65) with the lowest scores on personal competency to prevent pressure ulcers (mean 3.09). The results of multivariate linear regression showed that hospital level, nurses' age, years of work experience, initial education level at work and time of last training significantly associated with nurses' knowledge of pressure ulcer prevention. Meanwhile, hospital level, job title, previous training, time of last training and subjective needs for further training had significant association with nurses' attitude towards pressure ulcer prevention (all p < 0.05). Results showed inadequate knowledge but relative positive attitudes in nurses indicating the importance to deliver continuing education and training regarding pressure ulcer prevention in practice to improve the quality of care.

The experiences of ethical conflict among critical care professionals in China: A qualitative study.

BACKGROUND: Ethical conflict is embedded in healthcare and is common in critical care setting. However, there is a paucity of research on the nature of ethical conflict in China. Ethical conflict has cultural and context sensitivity. Therefore, evidence is needed from different backgrounds to help discuss this issue across borders. AIM: This study aimed to qualitatively identify the experience of ethical conflict in critical care professionals in China. STUDY DESIGN: From December 2021 to February 2022, we performed semi-structured, face-to-face interviews with 21 critical care professionals from five intensive care units in a tertiary general hospital in China. A thematic analysis approach was used to analyse the data. RESULTS: Five themes and 14 sub-themes emerged from the data. Critical care professionals probably felt unable to navigate uncertainty, torn by family issues, outraged by unprofessional behaviours of medical staff, being trapped in a socioeconomic dilemma when having experience of ethical conflict. In addition, they also perceived that they could turn struggle into growth. CONCLUSIONS: The experience of ethical conflict in critical care professionals involved a mixture of feelings. This study builds a comprehensive understanding of how ethical conflict affected their perceptions of themselves and their profession and provides implications to develop effective coping strategies. RELEVANCE TO CLINICAL PRACTICE: The identification of critical care professionals' experience of ethical conflict would help identify what might trigger the ethical issues and what would be the potential target to optimize in critical practice.

Ethical conflict in nursing: A concept analysis.

AIMS AND OBJECTIVES: The purpose of this paper was to clarify the concept of ethical conflict in nursing and highlight the importance of tackling this issue. BACKGROUND: Ethical conflict is on the rise in the nursing context. It is associated with the compromise of nurses' well-being and patient care. However, there is no thorough conceptual understanding of this concept. DESIGN: Concept analysis. METHODS: Databases (PubMed, PsycINFO, CINAHL, Scopus, Embase, Web of Science and SocINDEX) were searched for studies between 1984 and 2021. Both quantitative and qualitative studies related to ethical conflict in nursing were included. Walker and Avant's method of concept analysis was used to identify the defining attributes, antecedents and consequences of the concept of ethical conflict in nursing. We followed the PRISMA-ScR checklist to report the study. RESULTS: Thirty studies were included for conceptualization. Defining attributes were divided into four categories: (1) emotional responses, (2) incompatible values, (3) competing interests and (4) ambiguous obligations. The antecedents were (1) ethical sensitivity, (2) negative ethical climate, (3) insufficient authority, (4) unrealistic expectations, (5) poor collaboration and (6) inadequate resources. The consequences were identified as (1) moral residue, (2) loss of identity, (3) professional burnout and (4) poor patient care. CONCLUSIONS: A unified conceptual model of ethical conflict in nursing shed light on the ethical issues nurses might come across in practice. Despite the fact that ethical conflict is inherently negative, we conceptualised this concept as a neutral fact and an opportunity for nursing action. The construct identification provides basis for both the development of practice and the development of staff support and education. RELEVANCE TO CLINICAL PRACTICE: A clearer understanding of such an important facet of nursing practice helps nurses raise awareness of ethical conflict and implement effective coping strategies to improve their well-being and patient care. NO PATIENT OR PUBLIC CONTRIBUTION: This is a review article conducted by the researchers, so there is no patient or public contribution.

The experiences of intensive care nurses coping with ethical conflict: a qualitative descriptive study.

BACKGROUND: The critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear. AIMS: This study aims to explore the experience of intensive care nurses coping with ethical conflict in China. METHODS: From December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study. RESULTS: Two distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features. CONCLUSION: This study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue.

The relationships of ethical climate, physician-nurse collaboration and psychological empowerment with critical care nurses' ethical conflict in China: A structural equation model.

AIMS: To explore the relationships of ethical climate, physician-nurse collaboration and psychological empowerment with ethical conflict in critical care nurses. BACKGROUND: Ethical conflict is a major ethical issue in nursing practice. Little research has been done on the associated factors from both organizational and personal perspectives, especially in China. METHODS: From October 2021 to March 2022, we collected the data from 342 critical care nurses in three tertiary general hospitals in China via questionnaires about four variables (ethical climate, physician-nurse collaboration, psychological empowerment and ethical conflict). Data were analysed using Spearman's correlation and a structural equation model through statistical product and service solutions (SPSS) and analysis of moment structure (AMOS). RESULTS: Critical care nurses' ethical conflict showed a negative correlation with ethical climate (r = -0.351), physician-nurse collaboration (r = -0.347) and psychological empowerment (r = -0.259) (all p < 0.001). Physician-nurse collaboration partially mediated the relationship between ethical climate and ethical conflict. Additionally, physician-nurse collaboration and psychological empowerment served as sequential mediators in the association. CONCLUSIONS: These findings suggested that negative ethical climate can lead to poor physician-nurse collaboration and ultimately ethical conflict. The intermediary role of psychological empowerment and physician-nurse collaboration was also identified. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should use the study as a fundamental basis to evaluate factors that can affect nurses' ethical conflict and develop effective strategies to mitigate this issue, which may help improve nurses' wellbeing and quality of patient care.

Psychometric properties of the ethical conflict in nursing questionnaire critical care version among Chinese nurses: a cross-sectional study.

BACKGROUND: Ethical conflicts are common in the critical care setting, and have compromised job satisfaction and nursing care quality. Using reliable and valid instruments to measure the ethical conflict is essential. This study aimed to translate the Ethical Conflict in Nursing Questionnaire - Critical Care Version into Chinese and determine the reliability and validity in the population of Chinese nurses. METHODS: Researchers obtained permission and followed the translation-backward method to develop the Chinese version of the Ethical Conflict in Nursing Questionnaire - Critical Care Version (ECNQ-CCV-C). Relevant psychometric properties were selected according to the Consensus-based standards for the selection of health status measurement instruments checklist. Critical care nurses were recruited from two tertiary public hospitals in Hangzhou, Zhejiang Province, and Kunming, Yunnan Province. Of the 264 nurses we approached, 248 gave their consent and completed the study. RESULTS: The ECNQ-CCV-C achieved Cronbach's alphas 0.902 and McDonald's omega coefficient 0.903. The test-retest reliability was satisfactory within a 2-week interval (intraclass correlation coefficient = 0.757). A unidimensional structure of the ECNQ-CCV-C was determined. Confirmatory factor analysis supported acceptable structure validity. Concurrent validity was confirmed by a moderate relation with a measure for hospital ethical climate (r = - 0.33, p < 0.01). The model structure was invariant across different gender groups, with no floor/ceiling effect. CONCLUSIONS: The ECNQ-CCV-C demonstrated acceptable reliability and validity among Chinese nurses and had great clinical utility in critical care nursing.

Systematic review of physical exercise for patients with idiopathic inflammatory myopathies.

Idiopathic inflammatory myopathies (IIM) are systemic autoimmune connective tissue diseases. The safety and effectiveness of exercise for patients with idiopathic inflammatory myopathies remains unclear. This study aimed to systematically review the evidence for physical exercise among patients with idiopathic inflammatory myopathies. Relevant experimental studies were identified through searching the PubMed, Cochrane, Embase, Scopus, and CINAHL databases, and studies involving any type of physical exercise for ≥1 month were considered. The primary outcome was muscle strength, and the secondary outcomes included aerobic fitness, functional performance, health status, quality of life, activities of daily living, pain, and fatigue. Eight randomized controlled trials and thirteen nonrandomized uncontrolled trials were reviewed. Physical exercise appeared safe, with several positive effects. However, selection or allocation biases and small sample sizes affected the certainty of the evidence. While physical exercise appeared safe for patients with idiopathic inflammatory myopathies with several positive effects, studies of a higher methodological quality and involving patients with active disease are needed. Furthermore, to design optimal exercise programs, consistent and sensitive outcome measures are needed to facilitate comparisons of results from different studies.

Long noncoding RNA NEAT1 sponges miR-129 to modulate renal fibrosis by regulation of collagen type I.

The long noncoding RNA nuclear enriched abundant transcript 1 (NEAT1) has been reported to promote liver fibrosis progression. However, its molecular mechanism in renal fibrosis was not elucidated. In the present study, an in vitro model of renal fibrosis was established with HK-2 and HKC-8 cells treated with transforming growth factor-ß1. C57BL/6 mice were used for the in vivo model with unilateral ureteral obstruction. Our results indicated that NEAT1 and collagen type I levels were significantly upregulated, whereas miR-129 was obviously downregulated, in the progression of renal fibrosis. Meanwhile, NEAT1 knockdown or miR-129 overexpression inhibited collagen type I deposition, the epithelial-mesenchymal transition process, and the inflammation response to suppress renal fibrosis. NEAT1 directly targeted miR-129, and miR-129 directly bound to collagen type I. Downregulation of miR-129 reversed inhibition of renal fibrosis induced by NEAT1 silencing, and upregulation of collagen type I also reversed inhibition of renal fibrosis caused by miR-129 overexpression. NEAT1 knockdown alleviated renal fibrosis in mice subjected to unilateral ureteral obstruction. In conclusion, NEAT1 sponged miR-129 to modulate the epithelial-mesenchymal transition process and inflammation response of renal fibrosis by regulation of collagen type I. Our study indicates a novel role in the regulation of renal fibrosis and provides a new potential treatment target for renal fibrosis.

Ponicidin induces apoptosis via JAK2 and STAT3 signaling pathways in gastric carcinoma.

Ponicidin has a variety of biological effects such as immunoregulatory and anti-inflammatory functions as well as anti-viral functions especially in the upper respiratory tract infection. This study was aimed to elucidate the antitumor effect of ponicidin in gastric carcinoma MKN28 cells and the possible molecular mechanism involved. Cell viability was measured by the Cell Count Kit-8 (CCK8). Cell apoptosis was assessed by flow cytometry as well as cell cycle and reactive oxygen species (ROS) analysis. Western blot analysis was used to detect the active form of caspase-3 as well as Bax and B-cell lymphoma-2 (Bcl-2) expressions after cells were treated with different concentrations of ponicidin. The results revealed that ponicidin could inhibit the growth of MKN28 cells significantly in both a time- and dose-dependent manner. The cell cycle was blocked and ROS generation was increased after the cells were treated with ponicidin. Bcl-2 expression was down-regulated remarkably while Bax expression and the active form of caspase-3 were increased after apoptosis occurred. We therefore conclude that ponicidin exhibited significant growth inhibition of gastric carcinoma cell line MKN28 and induced apoptosis of MKN28 cells via the signaling pathway regulated by Janus kinase 2 (JAK2) and signal transducers and activators of transcription 3 (STAT3). Ponicidin may serve as a potential therapeutic agent for gastric carcinoma.

Feasibility and acceptability of a home-based virtual group exercise program in global Asian adult population: Baseline characteristics of a cohort study.

BACKGROUND: To determine the potential influence of a home-based virtual group exercise on people's long-term overall health consequences in global Asian population. METHODS: We recruited 1021 participants from more than 7 regions across the globe including Taiwan, Malaysia, Singapore, Hong Kong, United States, Canada, Europe, and other regions. All the participants attended the virtual group Qigong exercise 60-minute bi-weekly with instructors for 6 months from June 2022 to December 2022. The physical, mental, and social well-being and other variables were measured via online questionnaires. RESULTS: The majority were 51 to 65 (50.6%) years old, female (90.2%), married (68.5%), and came from Taiwan (48.9%). Older adults had higher scores on measures of overall health and exercise adherence, and lower scores on measures of sleep quality and depressive symptoms compared with younger counterparts (P < .05). Most of them (95.3%) acknowledged that the improvement of health status was their motivating factor for exercise. Eighty nine percent of the participants believed that social media played an important role in this exercise program. CONCLUSION: This study will suggest such approach has great potential to reduce health disparities and can be implemented to underserved population who has limited recourses to join in-person exercise program.

Perspectives of Chinese New Nurses Regarding Successful Transition: A Qualitative Study.

BACKGROUND: Transition issues have been discussed for many decades, yet little is known about successful transition expectations in the context of Chinese culture. PURPOSE: This article was designed to describe the expectations of newly graduated nurses in China regarding successful transition. METHODS: A qualitative, descriptive study design was employed, and a purposive sampling method was used to recruit interviewees. All of the one-to-one conversations were held in a quiet room to ensure privacy. All of the interviews were transcribed and then analyzed using thematic analysis. RESULTS: Nineteen new nurses were recruited from seven tertiary hospitals and participated in the in-depth interview process. Transition success, that is, "professional metamorphosis," was revealed through the four themes of "being competent in nursing work," "establishing a professional identity," "establishing comfortable interpersonal relationships," and "achieving balance between work and life." CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Chinese new nurses expect their successful transition to achieve a professional metamorphosis in many aspects. A successful transition is not only a journey of professionalization but also a process of socialization. New nurses expect to achieve both maturity in their work and wisdom in life. The results of this study provide a greater understanding of transition issues in the context of Chinese culture. Thus, support and strategies cannot be limited to interventions designed to improve working competence but should be individualized to help new nurses achieve a smooth transition.

Surface molecularly imprinted polymer/covalent organic framework/silica composite material with specific recognition ability and excellent chromatographic performance.

Facing with the difficulty of specific chromatographic separation of nucleoside drugs, this study prepared a surface molecularly imprinted polymer (SMIP) modified covalent organic framework (COF) coated silica stationary phase based on the specificity of molecular imprinting technology and the powerful chromatographic separation performance of COF. This novel SMIP-COF@SiO2 stationary phase can not only specifically identify template molecule and structural analogs, but can also be used to separate multiple types of analytes, such as B vitamins, sulfonamides, alkylbenzenes, phenyl ketones, polycyclic aromatic hydrocarbons and environmental endocrine disruptors, which satisfies the need for complex sample separation. Various retention mechanisms have been investigated and multiple interactions between the SMIP-COF@SiO2 stationary phase and the analytes are discovered. The chromatographic performance of SMIP-COF@SiO2 is far superior to that of the SMIP@SiO2 and COF@SiO2. Furthermore, the SMIP-COF@SiO2 stationary phase can be successfully used to analyze polycyclic aromatic hydrocarbons in the environmental water sample and detect whitening ingredient in skincare product, indicating its great potential for application in various fields.

Temperature-Dependent Spontaneous Resolution of a Tetrahedral Chiral-at-Nickel(II) Complex under Supramolecular Control.

Although stereochemical control of carbon centers is a well-established technique in modern synthetic chemistry, that of tetrahedral metal complexes with a stereogenic metal center remains difficult due to the dynamic nature of their coordination bonds. Here we report the synthesis of a tetrahedral d8 high-spin chiral-at-nickel(II) complex composed exclusively of achiral ligands and the supramolecular control of its temperature-dependent spontaneous resolution in crystals. Under certain conditions, complex molecules with the same absolute configuration of the nickel(II) center grow into conglomerate crystals with a helically arranged structure due to intermolecular hydrogen bonding. This process is highly spontaneous, does not require any chiral sources, and is closely related to the origin of homochirality in biological systems. The obtained enantiopure nickel(II) complex will be a new type of redox-active chiral source for asymmetric synthetic chemistry.

Ionic liquid/covalent organic framework/silica composite material: Green synthesis and chromatographic evaluation.

BACKGROUND: Due to their large surface area and distinctive adsorption affinity, covalent organic frameworks (COFs) appear to be good candidates as liquid chromatographic separation materials with good application prospect. The development of COF materials in chromatographic science is currently in an exploratory stage. Especially, the practicability of COF@silica composite materials as liquid chromatographic stationary phases needs further exploration. Reasonably integrating a functional component such as ionic liquid (IL) into the COF@silica composite materials may provide customized functionality to achieve the purpose of synthesizing multi-functional COF based stationary phases. RESULTS: In this study, an IL modified COF bonded silica composite material (IL-COF@SiO2) was successfully synthesized by using an environmentally friendly deep eutectic solvent as the reaction medium instead of the frequently-used organic solvent. The synthesized IL-COF@SiO2 composite material combines the excellent separation ability of COF and the excellent mass transfer function of spherical porous silica microsphere, and meanwhile, the introduction of IL endows COF@SiO2 with preferable separation performance. The slurry-packed IL-COF@SiO2 liquid chromatographic column could be applied to effectively separate hydrophobic and hydrophilic compounds with preferable separation selectivity and high column efficiency. By investigating the retention behavior and influencing factors, a mixed-mode retention mechanism was found. Multiple interaction forces endow the IL-COF@SiO2 with a hydrophilic-hydrophobic balance performance, demonstrating a good application prospect as a versatile liquid chromatographic separation material. SIGNIFICANCE: In this study, a new strategy is proposed for greenly synthesizing a novel IL-COF@SiO2 composite material under mild conditions, which expands the potential application of COF materials in chromatographic science. One particular point to note is that the reaction medium in each step of the preparation process is low toxic and degradable deep eutectic solvent, which conforms to the concept of green chemistry.

Sleep quality after stroke: A systematic review and meta-analysis.

BACKGROUND: Sleep-related problems are debilitating and long-lasting conditions in individuals with stroke. We aimed to estimate the prevalence of poor sleep quality after stroke by conducting a systematic review and meta-analysis. METHODS: Five databases (PubMed, Embase, Web of Science, Scopus, and CINHAL) were searched for literature published before November 2022. Studies recruiting participants with stroke, using a validated scale to measure sleep quality and in English were included. We used the Agency for Healthcare Research and Quality Scale and Newcastle-Ottawa Scale to assess the quality of eligible studies. Pooled prevalence and subgroup analyses were performed to understand the variation in sleep quality among studies. We followed the PRISMA checklist to report the study. RESULTS: Thirteen studies were included for analysis (n = 3886). The pooled prevalence of poor sleep quality was 53% (95% CI 41-65%). Studies using PSQI with a cutoff point of 7 had a prevalence of 49% (95% CI 26-71%), whereas those with a cutoff point of 5 had a higher prevalence of 66% (95% CI 63-69%) (P = .13). Geographical location could explain the prevalence variation between studies. The majority of included studies had a medium level quality of evidence (10/13). CONCLUSION: Poor sleep quality appears to be common in patients with stroke. Considering its negative impact on health, effective measures should be taken to improve their quality of sleep. Longitudinal studies should be conducted to examine the contributing factors and investigate the mechanisms that lead to poor sleep quality.

Occurrence, fate, and risk assessment of antibiotics in typical pharmaceutical manufactories and receiving water bodies from different regions.

This study aimed to investigate the presence and persistence of antibiotics in wastewater of four typical pharmaceutical manufactories in China and receiving water bodies and suggest the removal of antibiotics by the wastewater treatment process. It also evaluated the environmental impact of antibiotic residues through wastewater discharge into receiving water bodies. The results indicated that thirteen antibiotics were detected in wastewater samples with concentrations ranging from 57.03 to 726.79 ng/L. Fluoroquinolones and macrolides were the most abundant antibiotic classes found in wastewater samples, accounting for 42.5% and 38.7% of total antibiotic concentrations, respectively, followed by sulfonamides (16.4%) and tetracyclines (2.4%). Erythromycin-H2O, lincomycin, ofloxacin, and trimethoprim were the most frequently detected antibiotics; among these antibiotics, the concentration of ofloxacin was the highest in most wastewater samples. No significant difference was found in different treatment processes used to remove antibiotics in wastewater samples. More than 50% of antibiotics were not completely removed with a removal efficiency of less than 70%. The concentration of detected antibiotics in the receiving water bodies was an order of magnitude lower than that in the wastewater sample due to dilution. An environmental risk assessment showed that lincomycin and ofloxacin could pose a high risk at the concentrations detected in effluents and a medium risk in their receiving water bodies, highlighting a potential hazard to the health of the aquatic ecosystem. Overall, The investigation was aimed to determine and monitor the concentration of selected antibiotics in 4 typical PMFs and their receiving water bodies, and to study the removal of these substances in PMFs. This study will provide significant data and findings for future studies on antibiotics-related pollution control and management in water bodies.

Spatial Distribution and Risk Assessment of Antibiotics in 15 Pharmaceutical Plants in the Pearl River Delta.

Pharmaceutical plants are an essential source of antibiotics emitted into the aqueous environment. The monitoring of target antibiotics in pharmaceutical plants through various regions is vital to optimize contaminant release. The occurrence, distribution, removal, and ecological risk of 30 kinds of selected antibiotics in 15 pharmaceutical plants in the Pearl River Delta (PRD) were investigated in this study. Lincomycin (LIN) showed the highest concentration (up to 56,258.3 ng/L) in the pharmaceutical plant influents from Zhongshan city. Norfloxacin (NFX) showed a higher detection frequency than other antibiotics. In addition, the spatial distribution of antibiotics in pharmaceutical plants showed significant differences, with higher concentrations of total antibiotics found in pharmaceutical plant influents in Shenzhen City than those of different regions in PRD. The treatment processes adopted by pharmaceutical plants were commonly ineffective in removing antibiotics, with only 26.7% of antibiotics being effectively removed (average removal greater than 70%), while 55.6% of antibiotics had removal rates of below 60%. The anaerobic/anoxic/oxic (AAO)-membrane bioreactor (MBR) combined process exhibited better treatment performance than the single treatment process. Sulfamethoxazole (SMX), ofloxacin (OFL), erythromycin-H2O (ETM-H2O), sulfadiazine (SDZ), sulfamethazine (SMZ), norfloxacin (NFX), and ciprofloxacin (CIP) in pharmaceutical plant effluents posed high or moderate ecological risk and deserve particular attention.

[Effects of recruitment maneuver in prone position on hemodynamics in patients with severe pulmonary infection].

OBJECTIVE: To evaluate effects of recruitment maneuver in prone position on hemodynamics in patients with severe pulmonary infection, based on the protective pulmonary ventilation strategy. METHODS: Ninety-seven cases with severe pulmonary infection admitted to intensive care unit (ICU) of Ganzhou City People's Hospital undergoing mechanical ventilation were involved. Volume controlled ventilation mode with small tidal volume (8 ml/kg) and positive end-expiratory pressure (PEEP) of 6 cm H(2)O [1 cm H(2)O = 0.098 kPa] was conducted. Each patient underwent recruitment maneuver in supine position and then in prone position [PEEP 20 cm H(2)O+pressure control (PC) 20 cm H(2)O]. Heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation [SpO(2)] and blood gas analysis data were recorded before and after recruitment maneuver in either position. A double-lumen venous catheter was inserted into internal jugular vein or subclavian vein, and a pulse index contour cardiac output (PiCCO) catheter was introduced into femoral artery. Cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), intra-thoracic blood volume index (ITBVI), extra vascular lung water index (EVLWI), global end-diastolic volume index (GEDVI), global ejection fraction (GEF), stroke volume variation (SVV) and central vein pressure (CVP) were monitored. RESULTS: (1) Compared with data before recruitment maneuver, there were no significant differences in HR and MAP after supine position and prone position recruitment maneuver, but significant differences in SpO(2) were found between before and after recruitment maneuver when patients' position was changed (supine position: 0.954 ± 0.032 vs. 0.917 ± 0.025, P < 0.05; prone position: 0.982 ± 0.028 vs. 0.936 ± 0.039, P < 0.05). SpO(2) was higher in prone position recruitment maneuver (P < 0.05). (2) Compared with data before recruitment maneuver, CI [L×min(-1)×m(-2)], SVI (ml/m(2)), GEDVI (ml/m(2)) and GEF were decreased significantly during recruitment maneuver (supine position: CI 3.2 ± 0.4 vs. 3.8 ± 0.6, SVI 32.4 ± 5.6 vs. 38.8 ± 6.5, GEDVI 689 ± 44 vs. 766 ± 32, GEF 0.267 ± 0.039 vs. 0.305 ± 0.056; prone position: CI 3.1 ± 0.5 vs. 3.6 ± 0.4, SVI 31.2 ± 5.8 vs. 37.3 ± 5.0, GEDVI 678 ± 41 vs. 758 ± 36, GEF 0.268 ± 0.040 vs. 0.288 ± 0.053, all P < 0.05), and CVP [cm H(2)O] and SVV were significantly increased [supine position: CVP 10.7 ± 1.5 vs. 8.2 ± 2.5, SVV (11.2 ± 3.3)% vs. (8.3 ± 4.7)%; prone position: CVP 10.3 ± 1.8 vs. 8.1 ± 2.5, SVV (12.7 ± 3.4)% vs. (9.1 ± 3.6)%, all P < 0.05], but they returned to the level of that before recruitment maneuver soon after termination of recruitment maneuver. There were no significant differences in SVRI, ITBVI and EVLWI between before and after recruitment maneuver in both positions. There were also no significant differences in above parameters between two positions. CONCLUSIONS: Based on the lung protective ventilation strategy of small tidal volume with PEEP, oxygenation was improved and SpO(2) was increased significantly when prone position ventilation combined with lung recruitment method was used in severe pulmonary infection patients. The effect of recruitment maneuver during prone position on hemodynamics was slight, except a temporary decrease of SVI and GEF just during recruitment maneuver.