ObjectiveTo establish a reasonable risk evaluation tool in order to guide the clinical prevention of accidental extubation. MethodsWe collected all the tube types in our hospital, and according to the extubation consequence severity and risks, we designed the extubation risk factor items and formed the professional tables for scoring. Sixteen medical experts and 16 nursing experts were chosen to determine the scores for two rounds following the "Delphi" method. Five patients that had extubation accidentally were selected for evaluation, and 56 clinical cases provided feedbacks after evaluation. Then, the risk was set into 3 ranks:light (≤ 8 points), medium (9-12 points) and high (≥ 13 points). Finally, literature review and collection of the prevention measures were carried out, and the final "Accidental Extubation Risk Evaluation Table" was completed. ResultsAltogether, 283 patients were evaluated using the table in 23 departments of the hospital, among whom 121 were at mild risk, 76 were at medium risk and 86 were at high risk. Measures were taken accordingly, and no accidental extubation occurred. ConclusionThe evaluation table is reasonable, with which accidental extubation risk evaluation is standardized, and the safety of catheter nursing is enhanced.
睡眠呼吸暂停低通气综合征( OSAHS) 是一种常见的全身性慢性疾病, 主要表现为呼吸暂停和低通气, 反复发生低氧血症、高碳酸血症和睡眠结构紊乱, 导致白天嗜睡、情绪异常、神经认知功能障碍、心脑血管疾病等。这些异常对患者的日常生活、社会功能、工作效率及认知功能等方面都有不同程度的损害, 使患者生活质量明显下降。多项研究提示 OSAHS患者生活质量与抑郁、白天嗜睡、社会支持等密切相关, OSAHS 相关的生活质量评估量表不仅能关注多导睡眠图( PSG) 无法反映的主观症状如嗜睡、困倦等, 而且反映OSAHS 导致的器官功能损害及其严重程度。本文主要就用于评价OSAHS患者生活质量主要的相关量表及其应用, 以及目前一些治疗措施对生活质量的影响作一综述。
ObjectiveTo investigate the role of the p38 MAPK signaling pathway in sTREM-1 expression of RAW264.7 cells induced by lipopolysaccharide (LPS). MethodsMacrophage cell line RAW264.7 cells were cultured in vitro and induced with the same concentration of LPS at different time. The protein expressions of p38 MAPK and phosphorylation of p38 MAPK(p-p38 MAPK) were detected by Western blot. The mRNA expression of p38 MAPK was detected by RT-PCR. The level of sTREM-1 was detected by enzyme linked immunosorbent assay method.The RAW264.7 cells were treated by SB203580 at different concentration,the changes of above indexes were observed. ResultsThe p-p38 MAPK and p38 MAPK mRNA could be inducted by LPS in a time-dependent manner. The p-p38 MAPK and p38 MAPK mRNA could be inhibited by SB203580. After SB203580 blocking p38 MAPK signal transduction pathway,the sTREM-1 expression was significantly inhibited in a dose dependent manner. ConclusionLPS can induce sTREM-1 expression in RAW264.7 cells by activating the p38 MAPK signaling pathway.
Objective To investigate the changes and clinical significance of cytokines and inflammatory species in exhaled breath condensate (EBC) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Thirty AECOPD patients admitted in the Department of Respiratory Medicine from March 2015 to August 2016 (smokers and passive smokers) and 21 healthy volunteers (non-smokers) were recruited in this prospective study. General information and EBC were collected from each subject. The concentrations of interleukin-17 (IL-17), IL-10, and 8-isoprestane (8-iso-PG) in EBC were measured by enzyme-linked immunosorbent assay, meanwhile lung function test was performed in the AECOPD patients. Results Both IL-17 (ng/L) and 8-iso-PG (ng/L) levels increased significantly in the AECOPD patients before and after treatment compared with the healthy controls (10.74±1.02 and 5.65±0.88 vs. 3.36±0.61, 12.35±2.25 and 9.65±1.22 vs. 6.93±1.15, P<0.05). However, IL-10 level significantly decreased in the AECOPD patients before and after treatment compared with the healthy controls (1.68±0.17 and 2.59±0.31 vs. 2.85±0.43, P<0.05). Both IL-17 and 8-iso-PG levels in the AECOPD patients were significantly lower after treatment than those before treatment (5.65±0.88 vs. 10.74±1.02, 9.65±1.22 vs. 12.35±2.25, P<0.05), but IL-10 level were significantly higher aftertreatment than those before treatment (2.59±0.31 vs. 1.68±0.17, P<0.05). FEV1, FVC, and FEV1%pred improved significantly after treatment (P<0.01). FEV1, FEV1/FVC and FEV1%pred were not significantly correlated with IL-17, IL-10 or 8-is-PG levels. Conclusion IL-17, IL-10 and 8-iso-PG may be involved in the pathogenesis of COPD, and may be important biomarkers in monitoring airway inflammation and oxide stress during the treatment of AECOPD patients.
ObjectiveTo investigate the role of interleukin-25 (IL-25) and its receptor during allergen challenge test in allergic asthmatics as well as its underlining mechanism.MethodsFifteen allergic asthmatic patients with dual response in allergen challenge test were enrolled and blood samples were collected before and after challenge test. The expression levels of IL-25 receptor on the surface of eosinophils, plasma and intracellular IL-25 levels were measured by flow cytometry and enzyme-linked immunosorbent assay. Besides, the function of eosinophils from these patients was evaluated through the expression of type 2 cytokines, degranulation and chemotaxis after stimulation with IL-25.ResultsUpon allergen challenge, the expression of IL-17RB on the surface of eosinophils were increased from (7 426±2 824)/106 white blood cells to (19 446±5 593)/106 white blood cells (P<0.001). The expression of IL-17RA/RB on eosinophils were significantly increased from (4 508±1 360)/106 white blood cells to (9 025±3 166)/106 white blood cells (P<0.001). The plasma level of IL-25 increased from (650±45) pg/ml to (851±43) pg/ml (7 hours after allergen challenge) and (813±56) pg/ml (24 hours after allergen challenge) (P<0.001). The intracellular IL-25 expression of eosinophils was also upregulated from (10 398±1 909)/106 white blood cells to (147 684±46 222)/106 white blood cells (P<0.05). In vitro study, IL-25 (1 ng/ml) stimulated eosinophils for 2 hours promoted its expression of peroxidase [(12.5±4.2) ng/ml compared to control (1.26±0.4) ng/ml, P<0.05). The intracellular expression of IL-5 and IL-13 in eosinophils were also increased after stimulated by IL-25. IL-25 (1 pg/ml) stimulation compared to control could increase eosinophil migration in eotaxin [(36±3) vs. (69±5), P<0.05).ConclusionIL-25 and its receptor play a critical role in eosinophilic aggregation, activation and mobilization during allergic inflammation in allergic asthmatics.
ObjectiveTo explore the prevalence of anxiety symptoms and its related factors among the family caregivers of the disabled elderly. MethodsA cross-sectional survey based on convenience sampling was conducted among family caregivers between November and December, 2013 in Dongcheng district in Beijing. The Self-rating Anxiety Scale (SAS) and the Social Support Rating Scale (SSRS) were used to evaluate caregivers' anxious symptoms and social support status respectively. The degree of functional impairment of the elderly was measured by Barthel index. ResultsA total of 243 family caregivers took part in the study including 88 males and 155 females. The average age of the family caregivers was (60±1.7) years old, ranging from 25 to 85. The prevalence rate of anxiety was 29.2% reported by family caregivers. The average score of SAS was 35.6±8.6. The risk factors of caregivers' anxiety included Barthel index score ≤20 (OR=1.51), SSRS score ≤33 (OR=4.56), no time to relax (OR=1.57) and poor health status caregivers feeling (OR=3.48). ConclusionA relative high level of anxiety exists in family caregivers for the disabled elderly. Caregiver anxiety is a complex process, influenced by diverse care receiver and caregiver characteristics.
Objective To investigate the factors influencing the medication adherence among patients with diabetes signing family doctor service contract in Beijing urban areas, and provide the basis for improving the level of medication adherence. Methods A total of 320 patients with diabetes from four community health service centers in Beijing urban areas were selected to answer the questionnaires using convenient sampling from June to September 2015. Univariate analysis and binary logistic regression were used for the influencing factors analysis. Results A total of 320 questionnaires were distributed, and 317 valid questionnaires were recovered, in which the rate of high medication adherence was 54.6%. The results of logistic regression showed that the main impact factors on medication adherence were age [odds ratio (OR)=1.918, P=0.011)], degree of education (OR=2.462, P=0.008), knowledge related to diabetes (OR=1.773, P=0.027), adopting of family doctor service or not (OR=2.521, P=0.029) and social function status (P=0.003). Conclusions The family doctor service team should implement the practice of the family doctor service to ensure that the contracted residents can make full use of the family doctor services; and strengthen the follow-up and interventions for patients less aged or with low degree of education. For those with poor social function, more attention should be paid to their self-health management behavior to improve the level of patients’ compliance. As a result, the levels of blood glucose will be well controlled to reduce possibilities of complications and improve their health status and quality of life.
ObjectiveTo explore the value of transthoracic echocardiography (TTE) to monitor and evaluate aortic insufficiency (AI) within one year after the implantation of the left ventricular assist device (LVAD).MethodsWe retrospectively collected and analyzed the TTE data of 12 patients who received LVAD implantation from 2018 to 2020 in our hospital. All patients were males, with an average age of 43.3±8.6 years. We analyzed temporal changes in the aortic annulus (AA), aortic sinus (AoS), ascending aorta (AAo), the severity of AI and the opening of aortic valve before operation and 1 month, 3 months, 6 months and 12 months after LVAD implantation.ResultsAll 12 patients survived within 1 year after LVAD implantation. One patient was bridged to heart transplantation 6 months after implantation, and two patients did not receive TTE after 3 and 6 months. Compared to pre-implantation, AoS increased at 1 month after implantation (31.58±5.09 mm vs. 33.83±4.69 mm). The inner diameters of AA, AoS and AAo increased at 3, 6 and 12 months after LVAD implantation compared to pre-implantation (P<0.05), but all were within the normal range except for one patient whose AoS slightly increased before operation. After LVAD pump speed was adjusted, the opening of aortic valve improved. The severity of AI increased at 6 and 12 months after LVAD implantation compared to pre-implantation, and increased at 12 months compared to 6 months after LVAD implantation (P<0.05).ConclusionTTE can evaluate aortic regurgitation before and after LVAD implantation and monitor the optimization and adjustment of LVAD pump function, which has a positive impact on the prognosis after LVAD implantation.
ObjectiveTo evaluate the diagnostic accuracy and efficacy of X-ray for evaluating the tip position of umbilical venous catheterization (UVC). MethodsThe PubMed, Embase, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect diagnostic tests for UVC tip localisation from inception to 1 May 2023. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality of the studies using the QUADAS-2 tool. Then, meta-analysis was performed by using Stata 16.0 software. Results Twelve articles involving 1 055 patients were included. The sensitivity and specificity of Negar Yazdani’s study were both 100%. The results of the meta-analysis (the remaining eleven articles, n=951) indicated a pooled sensitivity of 0.7 (95%CI 0.6 to 0.8), a pooled specificity of 0.8 (95%CI 0.7 to 0.9), a positive likelihood ratio of 4.0 (95%CI 2.0 to 8.1), a negative likelihood ratio of 0.4 (95%CI 0.2 to 0.6) and a diagnostic odds ratio of 11 (95%CI 3 to 36) with an area under the cumulative receiver operating characteristic curve of 0.8 (95%CI 0.8 to 0.9). A subgroup analysis was performed according to the different methods of judging X, the 8th–9th thoracic, the 9th–10th thoracic and combined judgement of the diaphragmatic plane + the vertebral body + the heart shadow. The sensitivities of the 3 groups were 0.8 (95%CI 0.5 to 0.9), 0.5 (95%CI 0.4 to 0.7) and 0.8 (95%CI 0.6 to 0.9); the specificities of the 3 groups were 0.8 (95%CI 0.6 to 0.9), 0.76 (95%CI 0.6 to 0.9) and 0.91 (95%CI 0.79 to 0.96). The areas under the cumulative receiver operating characteristic curve were 0.9 (95%CI 0.8 to 0.9), 0.7 (95%CI 0.6 to 0.7) and 0.92 (95%CI 0.89 to 0.94). ConclusionSome error is present when determining the catheter tip position by X-ray, in which the evaluation of the umbilical vein catheter tip position through a comprehensive evaluation of the diaphragmatic plane, the heart margin and the vertebral body is more powerful than the evaluation of the vertebral body alone.