Objective To investigate the application value of BIS monitoring and Ramsay score in the prevention of unplanned tracheal extubation in ICU patients.Methods 93 patients were enrolled in this study,they were divided into the experimental group(47 cases)and the control group(46 cases) using random number method.They received sedation regimens with BIS monitoring and Ramsay score or Ramsay score respectively.Occurrence rate of unplanned extubation was compared between the two groups.Results The occurrence rate of unplanned extubation was significantly lower in the experimental group than that of the control group.Conclusions BIS monitoring and Ramsay score is a suitable ways for the management of sedation of intubated patients.

High-risk neuroblastoma (NB) is highly aggressive and has poor prognosis. Treatment of NB mainly includes comprehensive therapies, of which radiotherapy serves as a part of consolidation therapy. For patients who receive complete resection of the primary lesion, usually an irradiation dose of 21-23.4 Gy is given; for patients with incomplete resection, further study focused on radiation dose is necessary. Recurrence is most commonly observed in the bone lesions involved at presentation. Currently, the principle of irradiation to the metastatic sites is to treat lesions where metaio-dobenzylguanidine (MIBG) uptake remains positive after induction chemotherapy, or those become negative uptake but still at high risk of recurrence. On the premise of lacking of MIBG imaging, positron emission tomography CT (PET-CT) may assist in screening for metastatic sites requiring irradiation. The late side effects of radiotherapy are mainly mild musculoskeletal abnormalities. No significant increase is observed in the incidence of second primary tumor during short-term follow-up.

Objective To evaluate the application effect of the situation-background-assessment-recommendation(SBAR) communication mode in the intensive care unit in the department of neurosurgery (NSICU).Methods From January 2015, the SBAR communication mode was carried out in the shifting of duty for the nurses in the intensive care unit in the department of neurosurgery. The SBAR communication standard of patients' condition was initiated in the communication between nurses and doctors. The implementation effect of the mode was evaluated by the comparisons of the time of the nurses' shifting of duty, the incidence of adverse events, the average hospital stay of patients, the satisfaction of patients between before the implementation (the year of 2014) and after the implementation(the year of 2015).Results After implementing the SBAR communication mode, the incidence of pressure sores decreased from 2.64% to 0.39% significantly (χ2=4.252, P<0.05). The incidence of extubation decreased from 1.76% to 0% significantly (χ2=4.531,P<0.05). The satisfaction of patients increased from 91.4% to 97.7% significantly (χ2=4.714,P<0.05). The handover time of the nurses was shortened from (8.7±2.1)min every time to(6.1±1.9)min every time significantly (t=2.045, P<0.05). The average hospital stay in the NSICU was shortened from (13.2±2.5)day to(10.5±2.1)day significantly (t=2.057,P<0.05).Conclusions The implementation of the SBAR communication mode is helpful to standardize the shifting of duty and the communication process of doctors and nurses, ensure the safety of patients and improve the satisfaction, which is worth promotion and reference.

Objective To evaluate life quality of Graves orbitopathy (GO) patients using Graves orbitopathy quality-of-life questionnaire (GO-QOL) and explore the influence factors of the quality of life of GO patients.Methods This was a cross-sectional study conducted at The Third Affiliated Hospital of Southern Medical University including 145 newly diagnosed GO patients.All the patient answered the GO-QOL and underwent ophthalmic and endocrine assessments.The main outcome measures were the scores on GO-QOL 2 subscales:visual functioning and appearance.Based on the classification in the guideline of European Group on Graves Orbitopathy (EUGOGO),the patients were divided into two groups:mild and moderate to severe groups.Then the scales between these two groups were compared and influencing factors were analyzed.Finally,the floor and ceiling effects were assessed.Results The GO-QOL scores for the subscales of visual functioning and appearance were 70.91±27.83 and 61.29±26.37 respectively in 145 GO patients.Visual functioning and appearance were lower in moderate to severe group (62.71 ±28.77 and 57.52 ± 26.49,respectively) than in mild group (85.58 ± 18.77 and 68.02 ±24.99,respectively).The GO-QOL scores for the visual functioning subscale were significantly correlated with age (P =0.002),clinical active score (P =0.011) and the degree of diplopia (P =0.00,R2=0.373).The GO-QOL scores for the appearance were significantly correlated with sex (P =0.05) and thyroid-stimulating hormone levels (P =0.001,R2 =0.231).No significant ceiling or floor effects were observed for either subscale of the GO-QOL.Conclusions With the aggravation of the disease,the quality of life of GO patients is getting worse and worse.The main influencing factors of the quality of life of GO patients include age,gender,diplopia,clinical active score and thyroid-stimulating hormone levels.Close attention needs to be paid to the quality of life of GO patients.

Objective To establish a young nurse standardized training system and evaluate its practical effectiveness in the “young nurses ’ quality improvement action”.Methods Using cluster sampling method, 202 new hiring graduate nurses in Wuxi No .2 people’ s hospital were enrolled from October 2010 to December 2011.Standardized training plan was set and several training bases were established according to training goal.Taking periodic quantitative training , night self-study, one-on-one tutor teaching and a combination training of reality and scene simulation to strengthen young nurse ’s basic theory, basic knowledge, basic skills, to improve interpersonal communication ability , as well as to foster the clinical observation and critical thinking ability.Finally evaluating and examining the effect of the standardized training plan .Results Through “young nurses’ quality improvement action”, self-efficacy and core competence of young nurses were improved .Self-efficacy were significantly higher after training (2.69 ±0.40) than training before (1.73 ±0.51) ( t=3.59, P<0.01).Total score of nurses ’ core ability after training was increased from ( 118.53 ±19.28 ) to (137.21 ±25.42), the difference was statistically significant (t=5.87,P<0.01).Theory and skill scores were increased respectively from (81.18 ±6.12),(81.58 ±3.22) before to (89.36 ±4.34),(87.98 ±5.52) after(t =3.37,2.86,respectively;P <0.01).General nursing satisfaction rate rose sharply from 2011’ s 87.6%to 94.95%in 2012(χ2 =5.86,P<0.01).Young nurses’ clinical comprehensive ability was improved through the combination of reality and scene simulation training .Conclusions The implementation system of young nurses ’ quality improvement action can improve young nurses ’ comprehensive ability through careful design, reasonable implementation and scientific evaluation .It is a kind of training method which worth popularization and application .

Objective:To explore relationship between serum 25-hydroxy vitamin D ( 25OHD ) level and ketosis-prone in patients with newly-diagnosed type 2 diabetes mellitus(T2DM).Methods:One hundred and thirty-four patients with newly diagnosed T2DM (103 males, 31 females) admitted in The Third Affiliated Hospital, Southern Medical University from January 2017 to January 2019 were enrolled into this study, including 36 patients with ketosis-prone (KPDM group) and 98 patients without ketosis(NKPDM group). Clinical characteristics, including height, weight, and history of hypertensive disease were collected. Serum 25OHD levels, lipid profile, islet function and glycosylated hemoglobin (HbA 1C)levels, ICA, IAA, GAD-Ab, etc., were measured. Results:Among the 134 patients, the patients with vitamin D deficiency, insufficiency, and sufficiency were 71 cases(52.99%), 52 cases(38.81%), and 11 cases(8.20%), respectively. KPDM group had significantly lower serum 25OHD level than NKPDM group[(44.12±9.77) nmol/L vs (55.35±15.31) nmol/L, P<0.01]. The rate of vitamin D deficiency was significantly higher in KPDM group compared to that in NKPDM group [(77.78% vs 43.88%), P<0.01]. The prevalence of KPDM varied significantly in different vitamin D status groups( P<0.01). Logistic regression analysis suggested that low serum 25OHD, younger age, high HbA 1C, and triglyceride were risk factors to ketosis-prone in newly diagnosed T2DM( P<0.01). Conclusion:Vitamin D deficiency is a common problem in newly diagnosed T2DM, especially in KPDM. Low serum 25OHD level seems to be an independent risk factor for ketosis-prone in patients with newly diagnosed T2DM.

Background The United Kingdom (UK) adopts active surveillance and passive surveillance to jointly collect occupational injury data, and builds a relatively complete occupational injury surveillance system, which can provide reference for the construction of China's occupational injury surveillance system. Objective To compare the results of active surveillance and passive surveillance of occupational injuries in the UK, and to explore the joint application value of active and passive surveillance methods in the field of occupational injury prevention and control. Methods The non-fatal occupational injury active surveillance data from Labor Force Survey were used to calculate indicators such as number of reported cases, reporting rate, lost workdays per year, lost workdays per capita, and average lost workdays per case. The fatal passive surveillance data reported by the employers were used to calculate number of reported deaths, reported mortality, and other indicators. Join-point regression was used to estimate the reported trends of fatal and non-fatal occupational injuries from 2004 to 2020, and the annual percentage change (APC) and average annual percentage change (AAPC) were calculated. Results The active surveillance data showed that from 2004 to 2020, the number of reported cases of absenteeism ≥0 d due to occupational injury decreased from 89.7 (95%CI: 85.2, 94.2) per ten thousand to 44.1 (95%CI: 39.1, 49.2) per ten thousand, and the reporting rate of occupational injury decreased from 32100/100000 (95%CI: 3050/100000, 3370/100000) to 1410/100000 (95%CI: 1250/100000, 1570/100000), showing a linear downward trend (both APC and AAPC were −3.88%, P<0.05); the average lost workdays per case in 2019 was 9.1 (95%CI: 6.8, 11.5) d. The passive surveillance data showed that from 2004 to 2020, the number of reported deaths due to occupational injury decreased from 223 to 142, and the reporting rate of occupational injury decreased from 0.78/100000 to 0.44/100000, showing a linear downward trend (both APC and AAPC were −4.59%, P<0.05). Conclusion The reporting rates of fatal and non-fatal occupational injuries in the UK are showing a linear downward trend. The active surveillance method based on Labor Force Survey provides more surveillance indicators for non-fatal occupational injuries, and the passive surveillance method based on employer report has more advantages in assessment of fatal occupational injuries. Jointly applying the two surveillance modalities and the combination of trend analysis indicators, such as AAPC, provide a more comprehensive picture of the epidemiological characteristics of occupational injuries.

Objective To explore the mechanism by which soybean isoflavone(SI)reduces calcium overload induced by cerebral ischemia-reperfusion(I/R).Methods Forty-eight SD rats were randomized into 4 groups to receive sham operation,cerebral middle artery occlusion for 2 h followed by 24 h of reperfusion(I/R model group),or injection of adeno-associated virus carrying Frizzled-2 siRNA or empty viral vector into the lateral cerebral ventricle after modeling.Western blotting was used to examine Frizzled-2 knockdown efficiency and changes in protein expressions in the Wnt/Ca2+signaling pathway.Calcium levels and pathological changes in the ischemic penumbra(IP)were measured using calcium chromogenic assay and HE staining,respectively.Another 72 SD randomly allocated for sham operation,I/R modeling,or soy isoflavones pretreatment before modeling were examined for regional cerebral blood flow using a Doppler flowmeter,and the cerebral infarct volume was assessed using TTC staining.Pathologies in the IP area were evaluated using HE and Nissl staining,and ROS level,Ca2+level,cell apoptosis,and intracellular calcium concentration were analyzed using immunofluorescence assay or flow cytometry;the protein expressions of Wnt5a,Frizzled-2,and P-CaMK II in the IP were detected with Western blotting and immunohistochemistry.Results In rats with cerebral I/R,Frizzled-2 knockdown significantly lowered calcium concentration(P<0.001)and the expression levels of Wnt5a,Frizzled-2,and P-CaMK II in the IP area.In soy isoflavones-pretreated rats,calcium concentration,ROS and MDA levels,cell apoptosis rate,cerebral infarct volume,and expression levels of Wnt/Ca2+signaling pathway-related proteins were all significantly lower while SOD level was higher than those in rats in I/R model group.Conclusion Soy isoflavones can mitigate calcium overload in rats with cerebral I/R by inhibiting the Wnt/Ca2+signaling pathway.

Objective To explore the mechanism by which soybean isoflavone(SI)reduces calcium overload induced by cerebral ischemia-reperfusion(I/R).Methods Forty-eight SD rats were randomized into 4 groups to receive sham operation,cerebral middle artery occlusion for 2 h followed by 24 h of reperfusion(I/R model group),or injection of adeno-associated virus carrying Frizzled-2 siRNA or empty viral vector into the lateral cerebral ventricle after modeling.Western blotting was used to examine Frizzled-2 knockdown efficiency and changes in protein expressions in the Wnt/Ca2+signaling pathway.Calcium levels and pathological changes in the ischemic penumbra(IP)were measured using calcium chromogenic assay and HE staining,respectively.Another 72 SD randomly allocated for sham operation,I/R modeling,or soy isoflavones pretreatment before modeling were examined for regional cerebral blood flow using a Doppler flowmeter,and the cerebral infarct volume was assessed using TTC staining.Pathologies in the IP area were evaluated using HE and Nissl staining,and ROS level,Ca2+level,cell apoptosis,and intracellular calcium concentration were analyzed using immunofluorescence assay or flow cytometry;the protein expressions of Wnt5a,Frizzled-2,and P-CaMK II in the IP were detected with Western blotting and immunohistochemistry.Results In rats with cerebral I/R,Frizzled-2 knockdown significantly lowered calcium concentration(P<0.001)and the expression levels of Wnt5a,Frizzled-2,and P-CaMK II in the IP area.In soy isoflavones-pretreated rats,calcium concentration,ROS and MDA levels,cell apoptosis rate,cerebral infarct volume,and expression levels of Wnt/Ca2+signaling pathway-related proteins were all significantly lower while SOD level was higher than those in rats in I/R model group.Conclusion Soy isoflavones can mitigate calcium overload in rats with cerebral I/R by inhibiting the Wnt/Ca2+signaling pathway.

Background The severity of occupational injury in countries such as the United Kingdom, the United States, and Germany is usually analyzed using lost workdays, but in existing occupational injury surveillance research in China, the application of this index is rare. Objective To evaluate the application value of lost workdays in non-fatal occupational injury surveillance, and provide a reference for the construction of occupational injury surveillance index system. Methods The public data of European Statistics on Accidents at Work (ESAW) from 2010 to 2019 on non-fatal injury accidents in 27 member states of the European Union were used. Non-fatal occupational injury is defined as an injury event during occupational activities or at work resulting a victim's absence from work for ≥4 d. According to the European Statistics on Accidents at Work-Summary methodology, the lost workdays were divided into 8 categories (4-6 d, 7-13 d, 14-20 d, 21-30 d, 31-91 d, 92-182 d, 183 d and above, and unknown). Annual percentage change (APC) and the average annual percentage change (AAPC) were used to evaluate the overall trend changes in the incidence rate of non-fatal occupational injury accidents in different lost workdays from 2010 to 2019, and the non-fatal occupational injury accidents in key industries. The characteristics of the occurrence of non-fatal occupational injuries were analyzed in conjunction with the changes in non-fatal occupational injuries in different lost workdays in the industry. Results From 2010 to 2019, the overall incidence of non-fatal occupational injury accidents in the European Union showed a downward trend, and the AAPC was −1.0% (P<0.05). The accident rates of lost workdays of 4-6 d and 92-182 d showed an upward trend, and the AAPC were 7.9% and 5.8% respectively (P<0.05). The average annual accident rates of non-fatal occupational injuries (≥4 d) in Categories C (manufacturing industry), E (water supply, sewage treatment, waste management and remediation), and F (construction industry) showed a linear downward trend, and the AAPC were −3.0%, −2.5%, and −1.5%, respectively (P<0.05). However, among them, the rate of non-fatal occupational injury accidents with 92-182 d of lost workdays in the manufacturing industry showed a significant upward trend, with an AAPC of 3.7% (P<0.001). Conclusion Using lost workdays combined with APC and AAPC by Join-point linear regression analysis can measure the severity and trend changes of non-fatal occupational injury accidents in different industries and different lost workdays. This indicator has an important practical significance in evaluating the effectiveness of occupational injury prevention and control strategies adopted by countries and enterprises.