Objective To describe the self-management behaviors and self-efficacy in patients with chronic low back pain (CLBP) and to explore the relationship between them. Methods The Chronic Disease Self-Management Study Measures and the Chronic Disease Self-Efficacy Scale were used to investigate a total of 113 patients with chronic low back pain. Results The average score of self-management behavior of CLBP patients was 21.42 ± 8.11. The average time for exercise was (168.72 ± 148.97) min/week;the average level of cognitive symptoms management practice and communication with physicians were 1.70 ± 0.74 and 2.10 ± 1.05 respectively. The self-efficacy was achieved the average level of 7.10 ± 1.88. There was a positive and significant correlation between the self-management behaviors and self-efficacy (P<0.05 or 0.01). Conclusions The self-management behaviors among patients with chronic low back pain was poor and was related with self-efficacy. Individualized health education was needed for improving self-efficacy, which would be benefit for self-management behaviors.

Objective Based on active monitoring MRSA carriage for hospitalized patients, the relationship between colonization pressure and MRSA cross transmission in wards without rigorous contactisolation measures was analyzed, and the role of colonization pressure in predicting MRSA cross transmission was further evaluated. Methods From March to December 2009, active MRSA colonization screening was performed for 240 hospitalized patients in emergency ward and 94 cases in RICU in our hospital. rep-PCR method was employed to do homology analysis on MRSA strains obtained in this study. MRSA weekly colonization pressure, threshold colonization pressure ,cross transmission rate were calculated respectively. RR of MRSA cross transmission under higher level of colonization pressure and lower level of colonization pressure was analyzed. Results MRSA carriage rates on admission for patients in emergency wards and RICU were 6. 25% (15/2A0) and 13. 83 % (13/94) ,and MRSA cross transmission occurred in 13 weeks and 14 weeks in above two units, respectively. Threshold colonization pressures for above two units were 6. 49%and 17. 66%, respectively. For emergency ward, the MRSA cross transmission rate under higher level of colonization pressure was significantly higher than that under lower level of colonization pressure (x2 = 7. 10,P＜0. 01), the RR of MRSA transmission was 9. 61 (95% CI:1. 25-74.00). For RICU, the MRSA cross transmission rate under higher level of colonization pressure was significantly higher than that under lower level of colonization pressure(x2 = 12. 60, P＜0. 01 ), the RR of MRSA transmission was 15.87 (95% CI:2. 06-122. 10). Conclusions Higher level of colonization pressure is an important risk factor for MRSA transmission, and average colonization pressure can be used as a prediction index for MRSA transmission and strengthening prevention and control measures.

Objective To investigate the effect of pre - washing without heparin on adequacy of hemodialysis. Methods Using self-control method, fifty hemodialysis patients received pre-washing with heparin in normal saline and normal saline. Then we tested Kt/v by online clearance monitoring and observed clotting condition of dialyzer and hemodialysis tubes. Results There were no difference of Kt/v between two methods. After hemodialysis, no clotting phenomenon was found in dialyzer. There was a little pot of coagulation in artery and vein pot, but no significant difference between two methods. Conclusions Pre-washing with normal saline alone can not only ensure the adequacy of hemodialysis, but also reduce the risk of cross infection and reduce the amount of heparin, simplify operational procedures, so it should be promoted.

Objective To construct a prokaryotic plasmid expressing the recombinant protein of enterohemorrhagic Escherichia coli(EHEC) effector NleB1 and to prepare the polyclonal antibody of mouse anti-NleB1.Methods The nleB1 (990 bp) gene was amplified from the genome EHEC O157∶H7 and cloned into the expression plasmid pET24a to construct the recombinant plasmid pET24a-nleB1 that was transformed into E.coli BL21(DE3).After induction with isopropylthio-gelactoside( IPTG) , the His-tag fusion proteins were purified by Ni+affinity chromatography and gel slices.The polyclonal antibody was prepared by immunizing BALB/c mice with purified recombinant proteins and analyzed by Western blotting and ELISA.Results The pET24a-nleB1 recombinant plasmid was successfully constructed, the fusion protein was ex-pressed and purified,and the polyclonal antibody was obtained by immunizing mice with purified fusion protein.Western blotting and ELISA staining demonstrated that the polyclonal antibody was successfully obtained.Conclusion The prepara-tion of the polyclonal antibody against EHEC O157∶H7 NleB1 will be of help for further studies on the function of NleB1 protein.

In order to remove the endotoxin from the blood of endotoxemia patients, we prepared a new adsorbent with heparin space arm and polymyxin B (PMB) ligand. The carrier of chloromethyl polystyrene resin was activated and heparin space arm was grafted, and then PMB ligand was immobilized onto adsorbent with glutaraldehyde. We employed in vitro FITC-lipopolysaccharide (FITC-LPS) static adsorption to characterize the adsorption properties on the adsorbent, and conducted in vitro lipopolysaccharide (LPS) static adsorption to measure quantitavely the adsorption capacity and rate, and then evaluated the blood compatibility. The in vitro static adsorption indicated that the adsorbent had the removal rate of LPS above 70% with the adsorption equilibrium time for 2 hours. Blood compatibility experiment showed that the adsorbent had little negative effects on blood cells and plasma protein, and their adsorption rates were less than 10% for hemocytes and 20% for plasma protein respectively. This adsorbent exhibited high selectivity, high adsorption capacity and good biocompatibility, and presented a promising clinical application in the treatment of endotoxemia.
Adsorption ; Endotoxemia ; therapy ; Endotoxins ; isolation & purification ; Hemofiltration ; instrumentation ; methods ; Heparin ; chemistry ; Humans ; Ion Exchange Resins ; chemistry ; Ligands ; Polymyxin B ; chemistry ; Sorption Detoxification ; methods

Objective:To comprehensively understand the basic construction of intensive care unit (ICU) in the secondary and tertiary hospitals in Xinjiang Uygur Autonomous Region, and to provide a theoretical basis for the development direction of critical care medicine and the rational allocation of medical resources in our region.Methods:On the March 14th, 2020, a cross-sectional survey of 147 ICU in 122 hospitals in Xinjiang Uygur Autonomous Region was conducted using an online questionnaire. The survey included 6 modules: the basic conditions of the hospital, ICU profile, ICU human resources status, equipment allocation, technology development, and ICU quality control.Results:Among the 147 ICUs, there were 69 ICUs in tertiary hospital and 78 ICUs in secondary hospital. 75.51% (111/147) were comprehensive ICU and 24.49% (36/147) were specialized ICU. The total number of ICU beds was 1 818, accounted about 2.43% (1 818/74 912) of the total number of hospital beds. In ICU terms of human resourse, physicians/beds ratio was 0.54∶1, and nurses/beds ratio was 1.55∶1. Physicians/beds ratio in the secondary hospitals was 0.52∶1, and nurses/beds was 1.45∶1; physicians/beds ratio in the tertiary hospital was 0.56∶1, and nurses/beds ratio was 1.79∶1. The ICU management model was mainly closed management (82.99%, 122/147), and the proportion of closed management in tertiary hospitals was 88.41% (61/69), which was higher than that in secondary hospitals (78.21%, 61/78). In aspect of ICU equipment, the invasive ventilator/bed ratio, enteral nutrition infusion pump/bed ratio, and blood purifier/bed ratio in the tertiary hospitals were significantly higher than those in the secondary hospitals [0.70 (0.46, 1.00) vs. 0.45 (0.33, 0.67), 0.18 (0.00, 0.56) vs. 0.00 (0.00, 0.13), 0.08 (0.00, 0.13) vs. 0.00 (0.00, 0.10), respectively, all P < 0.01]. In the tertiary hospital, the chest sputum excretion device, blood gas analyzer, blood purification instrument, transport ventilator, fiber bronchoscope, enteral nutrition infusion pump, bedside ultrasound machine, continuous hemodynamics and oxygen metabolism monitor, electroencephalogram bispectral index monitor, bedside electroencephalography machine and extracorporeal membrane oxygenation (ECMO) were also superior to the secondary hospitals. ICU technologies, such as deep venipuncture, jejunal nutrition tube placement, percutaneous tracheotomy, invasive blood pressure monitoring, invasive hemodynamic monitoring, bedside ultrasound examination, continuous blood purification, fiber bronchoscopy, high frequency ventilation, intra-aortic balloon counterpulsation (IABP), and ECMO had also performed better than secondary hospitals. In the management of ICU medical quality control, in tertiary hospitals, the proportions of single or isolated room for patients with drug-resistant bacteria, 1-hour bundle and hemodynamic monitoring for patients with septic shock, routine prone position ventilation and lung recruitment for patients with acute respiratory distress syndrome (ARDS), common analgesic, and use of personal digital assistant (PDA) for pre-operation scan code by nurses and electronic medical record for routine rounds were significantly higher than those in secondary hospitals (91.30% vs. 85.90%, 68.12% vs. 48.72%, 85.51% vs. 70.51%, 28.99% vs. 12.82%, 85.51% vs. 61.54%, 76.81% vs. 61.54%, 71.01% vs. 29.49, 49.28% vs. 28.21%, respectively), and the differences were statistically significant (all P < 0.05). 89.74% (70/78) ICU in secondary hospitals and 89.86% (62/69) of tertiary hospitals used acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) to evaluate the severity of critically ill patients; in terms of sequential organ failure assessment (SOFA), the difference between the secondary hospitals and the tertiary hospitals was not statistically significant (51.28% vs. 62.32%, χ2 = 1.814, P = 0.178). Conclusions:Although the ICU construction of the tertiary hospitals in Xinjiang Uygur Autonomous Region is more complete than secondary hospitals, there is a big gap between the requirements of the national guidelines and the developed regions in the east. The ICU's investment in human resource, equipment and supporting facilities allocation, promotion of suitable technology, and medical quality control management should be increased to promote the development of critical care medicine in Xinjiang Uygur Autonomous Region.

Objective:To evaluate the efficacy of remimazolam combined with low-dose propofol for sedation during induction of anesthesia.Methods:A total of 228 patients of both sexes, aged 18-64 yr, with body mass index of 19-35 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic cholecystectomy, were divided into 2 groups ( n=114 each) by a random number table method: remimazolam combined with low-dose propofol group (group R) and propofol group (group P). Anesthesia was induced with intravenous injection of sufentanil 0.3 μg/kg, remimazolam 0.3 mg/kg, propofol 0.5 mg/kg and micuronium 0.2 mg/kg in group R, and sufentanil 0.3 μg/kg, propofol 2 mg/kg and micuronium 0.2 mg/kg in group P. Endotracheal intubation was performed when bispectral index value ≤ 50.Before induction (T 0), immediately before intubation (T 1), at 1 min (T 2) and 3 min (T 3) after intubation, mean arterial pressure (MAP) and heart rate (HR) were recorded.The anesthesia induction time and the incidence of hypotension and bradycardia were recorded in the two groups. Results:There was no significant difference in MAP and HR at T 0 between the two groups ( P>0.05). Compared with the value at T 0, MAP in two groups and HR were significantly decreased at T 1-3 in group P ( P<0.01). Compared with group P, the anesthesia induction time was significantly prolonged, and hypotension and bradycardia was decreased in group R ( P<0.05). Conclusion:The combination of remimazolam and low-dose propofol exerts better efficacy for sedation during induction of anesthesia than propofol alone.

Objective:To develop and test the reliability and validity of the assessment scale for patients with persistent vegetative state (PVS) or minimally conscious state (MCS) discharge from the anesthesia recovery room after operation.Methods:From September 2018 to October 2020, three dimensions and 17 item pools were determined through literature review and discussion among the project members. Two rounds of expert consultation were conducted to determine the respiratory (R), circulatory (C), oxygenation (O), bispectral index (B) and neuromuscular monitoring (N) scale (RCOBN scale), the reliability and validity were tested. 87 patients with PVS or MCS after operation Affiliated Sichuan Bayi Rehabilitation Center of Chengdu University of Traditional Chinese Medicine were selected to verify the effectiveness.Results:In the first round, 23 questionnaires were distributed. The total score of experts was 50 ± 3, F=9.24, CV were 0.00-0.43. The Cronbach α coefficient of each dimension was 0.782-0.846, and the Cronbach α coefficient of the total scale was 0.813. In the second round, 10 questionnaires were distributed. The item-level content validity index was 0.7-1.0, the probability of random consistency ( Pc) was 0.001-0.117, the adjusted kappa value ( k*) was 0.567-1.000, and the sum of the index scores corresponding to k* > 0.74 was 8. The scale-level content validity index of the overall consistency was 0.87. The ratio of patients transferred out of PACU by two rounds of evaluation method was 100 : 96.55, and the difference was not statistically significant ( χ2=3.05, P>0.05). The time of the first round of assessment was significantly longer than that of the second round, which were (197 ± 52) s and (58 ± 14) s respectively. The difference was statistically significant ( t=26.52, P < 0.01). Conclusions:The RCOBN scale has high reliability and validity. It can be used as an assessment scale for patients with PVS or MCS to transfer out of PACU after surgery, and those with a total score of 8 can be transferred out of PACU.

Objective:To evaluate the efficay of different doses of remimazolam for anesthesia induction during reoperation in asthenic patients with tracheotomy.Methods:One hundred and twenty patients of both sexes, aged 19-64 yr, with a modified frailty index score ≥3, of American Society of Anesthesiologists physical status Ⅳ, scheduled for reoperation after tracheotomy, were divided into 4 groups ( n=30 each)using a random number table method: propofol group (group C) and different doses of remimazolam groups (R 1, R 2 and R 3 groups). Anesthesia was induced with intravenous sufentanil 5 μg, propofol 1.5 mg/kg in group C and with remimazolam 0.1, 0.2 and 0.3 mg/kg in R 1, R 2 and R 3 groups, respectively.The tracheotomy cannula was replaced with a reinforced endotracheal intubation (ID=6.0 mm) when bispectral index value ≤ 65.Mean arterial pressure and heart rate were recorded before induction (T 0), immediately before replacement of the tube (T 1) and immediately after replacement of the tube (T 2). The onset time of anesthesia and adverse reactions such as hypotension, bradycardia and bucking during replacement of the tube, and requirement for rescue sedation were recorded. Results:Compared with group C, mean arterial pressure was significantly increased at T 1, 2 in group R 1 and group R 2, the onset time of anesthesia was significantly prolonged, the incidence of hypotension and bradycardia was decreased in R 1, R 2 and R 3 groups, and the requirement for rescue sedation in group R 1 and incidence of bucking in group R 1 and group R 2 were increased ( P<0.05 or 0.01). Compared with group R 1, heart rate at T 2 was significantly decreased, the onset time of anesthesia was shortened, and the requirement for rescue sedation and incidence of bucking were decreased in C, R 2 and R 3 groups, and the incidence of hypotension was significantly increased in group R 3 ( P<0.05 or 0.01). Compared with group R 2, the onset time of anesthesia was significantly shortened in group R 3 ( P<0.05). Conclusions:Remimazolam 0.2 mg/kg provides good efficacy when used for anesthesia induction with fewer side effects during reoperation in asthenic patients with tracheotomy.

Objective:To investigate the effect and molecular mechanism of tumor necrosis factor-α-inducible protein 8-like 2(TIPE2)on lipopolysaccharide(LPS)or interleukin-4(IL-4)-induced phenotypic switch of adipose tissue macrophages(ATM).Methods:The expression levels of TIPE2, inducible nitric oxide synthase(iNOS), monocyte chemoattractant protein 1(MCP-1), CD206, and arginase 1(Arg-1)in the visceral adipose tissue of obese mice, TIPE2-knockout(KO)mice, and control mice were detected by immunohistochemistry, Western blotting, and real-time PCR(RT-qPCR). Peritoneal macrophages isolated from KO and wild-type mice and RAW 264.7 mouse macrophage cell line were cultured, and then stimulated with LPS(100 ng/mL)or IL-4(20 ng/mL)for 6 hours. The expression levels of TIPE2, iNOS, MCP-1, CD206, and Arg-1 were detected by Western blotting and RT-qPCR.Results:Obese mice showed down-regulated TIPE2 expression, up-regulated pro-inflammatory markers iNOS and MCP-1 expressions, and down-regulated anti-inflammatory markers CD206 and Arg-1 expressions. LPS decreased the expression of TIPE2 in RAW 264.7 cells and peritoneal macrophages from mice, increased the expression of the classically activated macrophages(M1 phenotype)markers iNOS and MCP-1, and decreased the expression of the substituting activated macrophages(M2 phenotype)markers CD206 and Arg-1. IL-4 increased the expression of TIPE2 in RAW 264.7 cells and peritoneal macrophages, decreased the expression of iNOS and MCP-1, and increased the expression of CD206 and Arg-1. During the M1 polarization of macrophages, LPS increased toll-like receptor(TLR4)expression as well as nuclear transcription factor κBα suppressor protein(IκBα) and NF-κB phosphorylations in macrophages. Knockout of TIPE2 further increased the expression of the TLR4/IκBα/NF-κB signaling pathway and M1 macrophage markers, and further reduced the expression of the M2 macrophage markers.Conclusion:TIPE2 regulates ATM phenotypic transformation through inhibition of the TLR4/IκBα/NF-κB signaling pathway, which ameliorates adipose tissue inflammation in obese states.