Objective To improve the compliance of nurses in ICU standard specimen collection of blood culture by six sigma quality management method, so as to improve the quality of blood culture sample submission, to ensure the accuracy of inspection results. Methods A total of 158 nurses in ICU from February 2016 to January 2017 were selected as the research objects. The six sigma quality management method was used to analyze the operation of blood culture samples collected by ICU nurses,and the improvement plan was worked out and implemented. The compliance rate of blood culture samples collected by nurses before and after implementation and the feedback information of laboratory about blood culture specimen quality were compared. Results Before the application of six sigma quality management method, the compliance rate of blood culture specimens collected by ICU nurses was 54.1％(152/281), and the compliance rate after improvement was 88.6％(271/306), and the difference was statistically significant (χ2=86.45, P<0.01). Among the factors influencing nurses' blood culture,the importance of blood culture was not enough, the operation process was not mastered, the relevant knowledge of blood culture was not mastered, and the allocation of related consumables was unreasonable. After implementation,the composition ratio was reduced from 50.4％(65/129), 24.0％(31/129), 45.7％(59/129), 21.7％(28/129) to 17.1％(6/35), 8.6％(3/35), 25.7％(9/35), 2.9％(1/35), and the difference was statistically significant (χ2=4.00- 12.39, P<0.01 or 0.05). The contamination rate of blood culture specimens after six sigma management was 6.2％(19/306) and significantly lower than that of 16. 4％(46/281) before implementation,and the difference was statistically significant (χ2=15.36, P<0.01). Conclusions The six sigma quality management method can improve the nurses' attention to the correct collection of blood culture samples, reveal the defects in the operation, and reduce the irregular behavior of blood culture process. Therefore, the compliance of ICU nurses with standardized blood culture samples is improved, and the contamination rate of blood culture specimens is effectively reduced.

Objective To observe the application effect of procedural sedation and analgesia solution that aiming at shallow sedation in critical patients with mechanical ventilation. Methods Totally 160 patients with mechanical ventilation who accepted endotracheal intubation and without cerebral organic lesions in intensive care unit ( ICU) of our hospital from February 2014 to February 2015 were assigned to the observation group and the control group at random. Patients in the control group received drug sedation and analgesia treatment and the dosage was regulated according to the medication orders; patients in the observation group received the procedural sedation and analgesia solution that aiming at shallow sedation. Doctors made plans and aim of sedation and analgesia, and nurses dynamically evaluated the standard situation of sedation and analgesia and regulated the dosage according to the assessment results. We compared the dosage of sedation drugs, the time of mechanical ventilation, ICU time and the incidence of delirium between two groups.Results The dosage of sedation drugs in the observation group were:disoprofol,(5 690±618.610) mg;dexmedetomidine, (1 642.5± 317.330) μg;the mechanical ventilation time was (4.77±0.740) d, and the ICU time was (5.78±0.750) d. Those data were all lower than the control group (t=9.587,9.523,6.291,6.260;P<0.05). The incidence of delirium was 13.75% in the observation group, and was 26.25% in the control group (χ2=3.91,P<0.05). Conclusions The procedural sedation and analgesia solution that aiming at shallow sedation could effectively reduce the dosage of sedation drugs, shorten the mechanical ventilation time, reduce the incidence of delirium and is worth to popularization and application.

Objective To explore the effects of nutritional risk assessment combined with individual enteral nutrition management process among critically ill patients.Methods A total of 220 critically ill patients were selected in ICU at Ningbo First Hospital of Zhejiang Province from January 2016 to January 2017. They were coded according to the order of being admitted and were divided into observation group (n=110) and control group (n=110) with the method of random number table. Patients in control group received routine nutritional support following the doctor's advice involving adopting total protein enteral nutrition powder, evaluating gastric residual volume of patients by nurses at four hours interval, increasing dose of nutritive medium according to patients' conditions. Patients in observation group accepted nutritional risk screening with the evaluation standards of nutrition risk screening 2002 (NRS 2002) after being admitted to department along with gastrointestinal function assessment. And then, the individual enteral nutrition management process was carried out. In this process, doctors were responsible for establishing objectives and schemes of nutritional support including nutrition time, types of nutritive medium and nutritional goal. Besides, nurses executed enteral nutrition schemes, and evaluated the tolerance of enteral nutrition dynamically, and adjusted the velocity and quantity of enteral nutrition liquid. Finally, this research compared the indexes of nutrition and amynology, incidences of gastrointestinal dysfunction and infectious complications and time of being admitted to ICU of patients in two groups.Results There were no statistically significant differences in the indexes of nutrition and amynology on the first day of being admitted of patients in two groups (P>0.05). The indexes of nutrition and amynology including total serum protein (57.06±3.31)g/L, blood albumin (32.12±1.49)g/L, hemoglobin (118.34±9.34)g/L, IgA (3.24±0.50)g/L, IgG (2.96±0.38)g/L, IgM (1.92±0.17)g/L of patients in observation group were higher than those in control group with significant differences on the seventh day (t=4.01, 3.59, 2.39, 6.06, 4.05, 6.19;P<0.05). The incidences of gastrointestinal dysfunction and infectious complications were 21.81％ and 12.72％ in observation group significantly lower than those in control group (χ2=11.89, 8.91;P<0.05). The time of being admitted to ICU was (10.01±2.28) d in observation group and (13.99±1.91) d in control group with a significant difference (t=9.91,P<0.05).Conclusions The nutritional risk assessment combined with individual enteral nutrition management process can enhance the overall nutritional level, and effectively improve the nutrition of patients, and reduce the incidence of complications related to enteral nutrition, and promote the rehabilitation of patients. It is worth to be used widely in clinical application.

Human epidermal growth factor receptor 2 (HER2)-targeted therapy has greatly improved the prognosis of HER2-positive breast cancer. HER2-targeted therapy combined with chemotherapy dominated by trastuzumab+ pertuzumab is important in the neoadjuvant therapy, postoperative adjuvant therapy and late-stage standard treatment for HER2-positive breast cancer. Antibody-drug conjugates (ADCs) and tyrosine kinase inhibitors (TKIs) have further improved the efficacy of therapy. However, advanced breast cancer will eventually get a recurrence or drug resistance. HER2-positive breast cancer is characterized by moderate immunogenicity with the presence of large tumor-infiltrating lymphocytes (TILs), which provides a theoretical basis for immunotherapy. The application of HER2-targeted cancer vaccines and immune checkpoint inhibitors is promising and would offer more treatment options for the patients.

Objective:To explore the relationship between white matter integrity and cognitive function in first-episode children and adolescents with schizophrenia by diffusion tensor imaging (DTI).Methods:Totally 84 children and adolescents with first-episode schizophrenia who were hospitalized in the Department of Child and Adolescent Psychiatry at the Second Affiliated Hospital of Xinxiang Medical University from September 2017 to June 2021 were selected as the study group, and 35 healthy children and adolescents matched with the study group were selected as the control group. Positive and negative symptom scale (PANSS) was used to assess the patient's mental symptoms. Diffusion tensor imaging (DTI) scans were performed, and the structural integrity of white matter fibers in the brain was measured by tract-based spatial statistics (TBSS), with the indicators including fractional anisotropy (FA). The Chinese version of measurement and treatment research to improve cognition in schizophrenia consensus cognitive battery (MCCB) and the Stroop color-word test were used to evaluate the cognitive function of all subjects. SPSS 26.0 software was used to analyse the data by analysis of variance, independent sample t-test, Mann Whitney U-test and Pearson correlation analysis. Results:(1)The FA values of the right superior longitudinal tract (MNI: x=49, y=-40, z=31) and the left corticospinal tract (MNI: x=-27, y=-22, z=-19) in the study group were higher than those in the control group(both P<0.05). The FA values of the bilateral cingulate gyrus (MNI: x=-7, y=25, z=14; x=20, y=-50, z=25) and the occipital part of the corpus callosum radiation line (MNI: x=-19, y=-50, z=21) in the study group were lower than those in the control group(both P<0.05).(2)The trail making test score of the study group was higher than that of the control group( t=4.344, P<0.01), and the scores of the symbol coding, Hopkins verbal learning test-revised( HVLT-R), brief visuospatial memory test-revised(BVMT-R), word fluency test, number span, maze, Stroop word, Stroop color and Stroop color words were lower than those in the control group( t=-13.041--3.204, all P<0.05). (3) The FA value of right cingulate gyrus (hippocampus) was negatively correlated with the number span ( r=-0.269, P=0.023).The FA value in occipital part of the corpus callosum radiation line was positively correlated with the symbol code ( r=0.237, P=0.047).The FA value of the left lower longitudinal bundle was negatively correlated with the Stroop color and maze ( r=-0.289, -0.275; P=0.010, 0.020).The FA value of the right inferior longitudinal fasciculus was negatively correlated with the score of maze ( r=-0.254, P=0.032). The FA value of occipital part of the corpus callosum radiation line was positively correlated with positive symptom score ( r=0.170, P=0.040). Conclusion:Cognitive dysfunction in children and adolescent with first-episode schizophrenia may be related to abnormal white matter integrity in the brain.

Objective To observe the impact of semi-solidification enteral nutrition on feeding tolerance,nutritional and infection related indicators,and prognosis in neurocritical patients.Methods Adopting the prospective research method,the neurocritical patients who were admitted to the department of intensive care unit(ICU)of the First Affiliated Hospital of Ningbo University from December 2021 to May 2022 and had to stay in the nasogastric tube for enteral nutrition were selected as the study subjects,pectin was added to achieve the semi-solidification of enteral nutrition,and the patients were divided into pectin group and control group according to the principle of randomized control,with 25 cases in each group.Enteral nutrition was started within 24-48 hours of admission to the ICU in all patients,and pectin plus continuously pumped enteral nutrition preparation was given in the pectin group and continuously pumped enteral nutrition preparation in the control group,all of which was used continuously for more than 7 days.Differences in albumin,prealbumin,Glasgow coma scale(GCS),acute physiology and chronic health evaluation Ⅱ(APACHEⅡ),sequential organ failure assessment(SOFA),procalcitonin(PCT),interleukin-6(IL-6)and C-reactive protein(CRP)were compared between the two groups before and after 7 days of treatment,and enteral nutrition compliance rates at 3 days and 7 days of treatment,as well as the incidence of enteral nutrition intolerance(including vomiting,diarrhea,constipation,aspiration and bloating),along with the length of ICU stay and 28 days prognosis were observed.Results There were no statistically significant differences between the two groups in general clinical data[including gender,age and body mass index(BMI)]and pre-treatment GCS score,APACHEⅡ score,SOFA score,albumin,prealbumin,PCT,IL-6 and CRP levels.The incidence of vomiting,diarrhea,constipation,and bloating during enteral nutrition was significantly lower in the pectin group than those in the control group[vomiting:4.0％(1/25)vs.24.0％(6/25),diarrhea:8.0％(2/25)vs.32.0％(8/25),constipation:20.0％(5/25)vs.65.0％(13/25),bloating:12.0％(3/25)vs.36.0％(9/25),all P<0.05],but the difference in the incidence of aspiration compared with the control group was not statistically significant[4.0％(1/25)vs.16.0％(4/25),P>0.05].Caloric compliance with enteral nutrition was significantly higher in the pectin group than in the control group at both 3 days and 7 days of treatment[3 days of treatment:48.0％(12/25)vs.20.0％(5/25),7 days of treatment:88.0％(22/25)vs.60.0％(15/25),both P<0.05],and the prealbumin level was significantly higher in the pectin group than in the control group at the end of 7 days treatment(mg/L:248.08±43.99 vs.221.64±33.95,P<0.05).There was no statistically significant difference in the comparison of GCS score,APACHEⅡ score,SOFA score,PCT,IL-6,CRP,length of ICU stay,and 28 days mortality between the two groups after treatment.Conclusion The administration of semi-solidification enteral nutrition reduces the incidence of enteral nutrition intolerance,improves caloric intake and nutritional status in neurocritical patients,but has no significant effect on infection indicators and prognosis.

Objective To analyze the risk factors of enteral nutrition intolerance in elderly patients with severe pneumonia(SP)in intensive care unit(ICU)and construct its prediction model.Methods A total of 140 elderly patients with severe pneumonia in ICU ward of the First Affiliated Hospital of Ningbo University from January 2021 to December 2022 were selected.According to the tolerance of enteral nutrition,they were divided into tolerance group(n=82)and intolerance group(n=58).Univariate and multivariate Logistic regression analysis was used to analyze the risk factors of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU.The risk prediction model was constructed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the prediction effect of the model.Results Multivariate Logistic regression analysis showed that acute gastrointestinal injury(AGI),intra-abdominal pressure(IAP),and the use of antibiotics≥2 were independent influencing factors of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU(P<0.05).The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the fitting effect of the equation.The area under the curve was 0.867(95%CI:0.750-0.984),the sensitivity was 87.8%,and the specificity was 85.1%.Conclusion The risk prediction model constructed in this study can effectively predict the risk of enteral nutrition intolerance in elderly patients with severe pneumonia in ICU.

Objective: To evaluate the relationship between-590C/T polymorphisms of interleukin-4 gene and periodontitis by meta-analysis. Methods: Databases including PubMed, EMbase, Web of Science, CBM, CNKI, Wanfang and VIP, were searched from their establishment to December 31, 2016. Only case-control studies on the association between -590C/ T polymorphisms of interleukin-4 gene and periodontitis were selected, and the references of those selected studies were searched by hand. Assessment and data extraction were conducted by 2 reviewers independently, and the meta-analysis was performed with the R 3.3.1 software. Results : The meta-analysis showed that there was no association between the IL-4-590C/T polymorphism and periodontitis susceptibility (T vs C: OR=1.19, 95%CI=0.81~1.76, P =0.37). Subgroup analysis showed that the IL-4 -590 TT was associated with periodontitis in Caucasians (TT vs CT: OR=1.75, 95%CI=1.10 ~ 2.78, P = 0.02), but no significant association in Asians (P =0.63). Meanwhile, IL-4 gene polymorphisms were not significantly associated with the susceptibility of chronic periodontitis (CP) or aggressive periodontitis (AgP) ( e. g. T vs C, CP: P=0.45; AgP: P =0.45). Conclusion Based on current evidence, the polymorphisms of IL-4-590C/T are associated with the increased risk of periodontitis in Caucasians.