Hyperreflective foci (HRF) were defined as well-circumscribed and scattered dots with hyperreflective signals in optical coherence tomography (OCT). HRF can be seen in the vitreous cavity as well as the retinal and choroidal layers. Different OCT examination equipment and modes have differences in HRF detection results, and HRF counting methods gradually develop from manual counting to semi-automatic counting and automatic counting. HRF may be lens fragments, inflammatory cells, migrating photoreceptor complexes, exuded proteins or lipids, activated microglia, degenerated photoreceptor cells, migrating retinal pigment epithelial cells, and degraded lipofuscin deposits. The number and distribution of HRF are associated with the progression and the prognosis of a variety of ocular diseases, such as diabetic retinopathy, age-related macular degeneration, central serous chorioretinopathy, retinal dystrophy, etc. HRF are clinically important in guiding the personalized treatment of patients.

Objective To systematically summarize the best evidence for the prevention of peripherally inserted central venous catheter(PICC)-associated infection,and provide evidence-based basis for healthcare workers to for-mulate management strategies for the prevention of PICC-associated infection.Methods According to the"6S"model of the evidence pyramid,relevant literatures on the prevention of PICC-related infection were systematically retrieved from top to bottom from UpToDate,websites of World Health Organization,Centers for Disease Control and Prevention,Infusion Nurses Society,Registered Nurses' Association of Ontario,New South Wales Agency for Clinical Innovation,National Health Commission of the People'Republic of China,Medlive,PubMed,Web of Sci-ence,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),Wanfang,VIP,and SinoMed Database.The types of included literatures were clinical decision-making,guidelines,consensus,evidence summa-ries,and systematic reviews.The retrieval search window was from the establishment of the database to August 2024.Two researchers independently evaluated the quality of literatures and extracted evidence.Results A total of 19 papers were included in the analysis,including 2 clinical decisions,9 guidelines,6 expert consensuses,1 evi-dence summary,and 1 systematic review.Ultimately,28 pieces of evidence covering 6 topics including manage-ment,tools,catheterization,maintenance,infusion,and removal were formed.Conclusion This study summarizes the best evidence for preventing PICC-related infection,and recommends that clinical healthcare workers apply rele-vant evidence rationally and prudently,so as to reduce the incidence of PICC-related infections.

Objective To systematically summarize the best evidence for the prevention of peripherally inserted central venous catheter(PICC)-associated infection,and provide evidence-based basis for healthcare workers to for-mulate management strategies for the prevention of PICC-associated infection.Methods According to the"6S"model of the evidence pyramid,relevant literatures on the prevention of PICC-related infection were systematically retrieved from top to bottom from UpToDate,websites of World Health Organization,Centers for Disease Control and Prevention,Infusion Nurses Society,Registered Nurses' Association of Ontario,New South Wales Agency for Clinical Innovation,National Health Commission of the People'Republic of China,Medlive,PubMed,Web of Sci-ence,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),Wanfang,VIP,and SinoMed Database.The types of included literatures were clinical decision-making,guidelines,consensus,evidence summa-ries,and systematic reviews.The retrieval search window was from the establishment of the database to August 2024.Two researchers independently evaluated the quality of literatures and extracted evidence.Results A total of 19 papers were included in the analysis,including 2 clinical decisions,9 guidelines,6 expert consensuses,1 evi-dence summary,and 1 systematic review.Ultimately,28 pieces of evidence covering 6 topics including manage-ment,tools,catheterization,maintenance,infusion,and removal were formed.Conclusion This study summarizes the best evidence for preventing PICC-related infection,and recommends that clinical healthcare workers apply rele-vant evidence rationally and prudently,so as to reduce the incidence of PICC-related infections.

Hyperreflective foci (HRF) were defined as well-circumscribed and scattered dots with hyperreflective signals in optical coherence tomography (OCT). HRF can be seen in the vitreous cavity as well as the retinal and choroidal layers. Different OCT examination equipment and modes have differences in HRF detection results, and HRF counting methods gradually develop from manual counting to semi-automatic counting and automatic counting. HRF may be lens fragments, inflammatory cells, migrating photoreceptor complexes, exuded proteins or lipids, activated microglia, degenerated photoreceptor cells, migrating retinal pigment epithelial cells, and degraded lipofuscin deposits. The number and distribution of HRF are associated with the progression and the prognosis of a variety of ocular diseases, such as diabetic retinopathy, age-related macular degeneration, central serous chorioretinopathy, retinal dystrophy, etc. HRF are clinically important in guiding the personalized treatment of patients.

Objective To explore the effect of training mode based on action learning on improving the practicing ability of hospital pharmacists.Methods Thirty pharmacists who received training from September 2022 to December 2023 at Panzhihua Central Hospital were randomly divided into an education reform group(16 cases)and a routine group(14 cases).The education reform group adopted a routine teaching method based on action learning,while the routine group adopted a routine teaching method.The differences between the two groups of pharmacists in theoretical knowledge,practical operation,pharmaceutical services,emergency response,and comprehensive quality were compared.Results The pharmacists in the education reform group were better than the routine group in prescription review,clinical medication analysis,pharmaceutical services,emergency response,andcomprehensive quality.The difference was statistically significant(P＜0.05).Conclusion The teaching model based on action learning can effectively enhance the higher order thinking ability of pharmacists and help them better apply medical knowledge and skills to serve patients and physicians.

The subretinal space is a potential area between the retinal pigment epithelium layer and the photoreceptor layer.Subretinal injection is a way of drug administration to the subretinal space.Compared with intravitreal injection,subretinal injection allowed drugs to take more direct and effective action on retinal photoreceptor cells and retinal pigment epithelial cells.In recent years,thanks to advances in medical technology and surgical instrumentation subretinal injection realizes a gradually expanded clinical application,becoming an important drug delivery method for gene therapy and cell therapy of various fundus oculi diseases and playing an increasingly prominent role in vitreoretinal surgery.This article will explore the indications,techniques,potential risks,and complications of subretinal injection.

Objective:To explore the mediating effect of coping style between family function and psychological resilience in patients with diabetes retinopathy (DR) .Methods:From September 2021 to August 2022, 310 DR patients who visited the First Affiliated Hospital of Zhengzhou University were selected as the study subject by convenience sampling. Patients were surveyed using the General Information Questionnaire, Simplified Coping Style Questionnaire (SCSQ) , Family Assessment Device (FAD) , and Connor-Davidson Resilience Scale (CD-RISC) . Pearson correlation was used to analyze the correlation between coping style, family function, and psychological resilience in DR patients. AMOS 21.0 software was used to establish structural equation models and verify mediating effects. A total of 310 questionnaires were distributed, and 297 valid questionnaires were collected, and the effective response rate of the questionnaire was 95.81% (297/310) .Results:Among 297 DR patients, the positive coping dimension score in SCSQ was (14.79±3.58) , while the negative coping dimension score was (16.37±4.02) . the FAD score was (169.28±23.34) . The total score of CD-RISC was (65.62±11.52) . The score of the positive coping dimension was negatively correlated with the FAD score ( P<0.05) , and positively correlated with the total score and each dimension score of CD-RISC ( P<0.05) . The score of negative coping dimension was positively correlated with the score of FAD ( P<0.05) , and negatively correlated with the total score and each dimension score of CD-RISC ( P<0.05) . The FAD score was negatively correlated with the total score and each dimension score of CD-RISC ( P<0.05) . Coping styles played a partial mediating effect between family function and psychological resilience, with the mediating effect accounting for 53.65% of the total effect. Conclusions:DR patients have poor family functional and moderate psychological resilience, and their coping styles tend to be negative. Medical and nursing staff should pay attention to and improve the family function of patients, promote their positive response to diseases, and enhance their family function and psychological resilience.

OBJECTIVE: To explore the diagnostic yield of bronchoscopic rapid on-site evaluation (B-ROSE) in patients with severe invasive bronchopulmonary aspergillosis (IBPA) and provide evidence for starting antifungal treatment before microbiological results were available. METHODS: A prospective cohort study was conducted to select patients with severe pneumonia suspected of IBPA admitted to the respiratory intensive care unit (RICU) in the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June 2022, and those who were primarily infected with other pathogens (such as bacteria, Mycobacterium tuberculosis) at admission were excluded. Whether the antifungal treatment was initiated or not on the basis of the bedside B-ROSE, the B-ROSE was administered as soon as possible within 24 hours after admission to RICU. The current international definition of invasive aspergillosis was used as the gold diagnostic standard, the diagnostic accordance rate, the sensitivity and specificity of B-ROSE were calculated respectively, and the receiver operator characteristic curve (ROC curve) was also plotted, to evaluate the predictive value in diagnosing IBPA. RESULTS: A total of 176 patients with severe pneumonia suspected of IBPA were included in the study. According to international diagnostic standards, there were 81 cases of IBPA and 95 cases of non-IBPA. According to the early diagnosis of B-ROSE, there were 89 cases of IBPA and 87 cases of non-IBPA. The diagnostic accordance rate of B-ROSE was 84.09% (148/176), the area under the ROC curve for B-ROSE in diagnosing severe IBPA was 0.844, the 95% confidence interval (95%CI) was 0.782-0.905, the sensitivity was 87.65%, the specificity was 81.05%, the positive predictive value was 79.78%, the negative predictive value was 88.51%, the rate of underdiagnosis was 12.35% (10/81), and the rate of misdiagnosis was 18.95% (18/95). Compared with the true negative group, the proportion of long-term (≥ 14 days) use of glucocorticoid [70.0% (7/10) vs. 9.1% (7/77), P < 0.01] and the proportion of cases with diabetes [40.0% (4/10) vs. 10.4% (8/77), P < 0.05] were significantly higher in the false negative group (underdiagnosis group). However, B-ROSE of both groups showed mucosal bleeding, congestion and edema [100.0% (10/10) vs. 94.8% (73/77), P > 0.05], indicating that acute mucosal inflammation was non-characteristic. Compared with the true positive group, the proportion of long-term (≥ 14 days) use of glucocorticoid in the false positive group (misdiagnosis group) was significantly reduced [33.3% (6/18) vs. 60.6% (43/71), P < 0.05]. The B-ROSE results showed the proportion of cases with mucosal white spots, black plaques and pseudomembrane was significantly reduced [16.7% (3/18) vs. 52.1% (37/71), P < 0.01] in the misdiagnosed group, which suggest that cases of long-term use of glucocorticoid and cases with B-ROSE showing mucosal white spots, black plaques and pseudomembrane were less likely to be misdiagnosed. The main diseases that were easily misdiagnosed as IBPA included pulmonary tuberculosis (38.9%, 7/18), inflammatory lung adenocarcinoma (27.8%, 5/18) and pulmonary vasculitis (16.7%, 3/18). CONCLUSIONS Before obtaining microbiological evidence, B-ROSE can assist in decision-making of early anti-aspergillus treatment for severe IBPA. This method is prompt, simple, and has high accuracy and reliability. If B-ROSE lacks characteristic manifestations, especially for severe pneumonia in patients with long-term use of glucocorticoid or diabetes, attention should be paid to the underdiagnosis of IBPA. Diseases such as lung tuberculosis, inflammatory lung adenocarcinoma and lung vasculitis should be vigilant against misdiagnosis as IBPA.
Humans ; Prospective Studies ; Antifungal Agents ; Glucocorticoids ; Rapid On-site Evaluation ; Reproducibility of Results ; Pulmonary Aspergillosis ; Pneumonia ; Diabetes Mellitus ; Adenocarcinoma of Lung ; Vasculitis ; Retrospective Studies

Objective:To explore the risk factors and event characteristics of unplanned removal of peripherally inserted central catheters (PICCs) in patients with chest tumors.Methods:The convenience sampling method was used to select chest cancer patients treated in a hospital in Shanghai between March 2018 and December 2021. Logistic regression analysis was used to identify the risk factors of unplanned removal in these patients.Results:A total of 242 patients were included in this study, of whom 42 (17.3%) experienced unplanned removal. The most common causes of unplanned removal in descending order were catheter related dermatitis, catheter slippage, catheter occlusion, catheter related thrombosis, and local or catheter related infections. Logistic multivariate regression analysis showed that a history of radiation therapy ( OR=0.295, 95% CI: 0.108 to 0.806, P=0.017) and a history of surgery ( OR=0.247, 95% CI: 0.076 to 0.799, P=0.020) were protective factors for preventing unplanned removal. Catheterization during spring or autumn ( OR=8.771, 95% CI: 2.828 to 27.204, P<0.001), catheter-related dermatitis ( OR=12.404, 95% CI: 4.176 to 36.845, P<0.001), catheter slippage ( OR=25.105, 95% CI: 7.040 to 89.523, P<0.001), occlusion ( OR=6.155, 95% CI: 1.713 to 22.111, P=0.005), and catheter related thrombosis ( OR=17.817, 95% CI: 2.848 to 111.479, P=0.002) were independent risk factors of unplanned removal. Unplanned removal may occur anytime when the patient had the catheter inserted, but is less likely to happen in the early stage and more likely in the first month after catheterization. Besides, catheter related complications demonstrated seasonality, with catheter related thrombosis and occlusion more frequent in autumn and winter, compared with dermatitis and catheter slippage showing no difference in incidence around the year. Conclusions:The incidence of unplanned removal is high in chest tumor patients with PICC. Nursing staff should familiarize themselves with the risk factors, event characteristics, and the seasonality of catheter related complications, and improve the evaluation and early intervention of complications, to reduce the incidence of unplanned removal and improve the patient's experience of living with catheters.

The suprachoroidal space is a potential space between the sclera and choroid. Suprachoroidal spacedrug delivery is becoming an applicable method to the ocular posterior segment diseases. Because it targets the choroid, retinal pigment epithelium and retina with high bioavailability and safety, while maintaining low levels elsewhere in the eye. In recent years, new discoveries has been carried out in different areas of interest, such as drug delivery methods, pharmacokinetics and clinical trials. Clinical trials with suprachoroidal space injection of triamcinolone acetonide are executed with promising findings for patients with noninfectious uveitis and diabetic macular edema. Suprachoroidal space triamcinolone acetonide injectable suspension is the first and currently the only agent specifically approved for uveitic macular edema by Food and Drug Administration. Nowadays, many clinical trails with suprachoroidal space drug delivery have been explored, although there are still many risks and uncertainties. With the development of technology in the future, suprachoroidal space drug delivery appears to be a promising treatment modality for ocular posterior segment diseases.