Objective To develop a scale suitable for assessing work stressors among intensive care unit (ICU) nurses and to examine its reliability and validity. Methods The initial questionnaire of the ICU Nurses' Work Stressors Scale was constructed through literature review, ICU nurse interviews, and Delphi expert consultation. A total of 434 ICU nurses were selected as the validation subjects using the convenient sampling method. Item analysis, exploratory factor analysis, and confirmatory factor analysis were conducted to finalize the version of the ICU Nurses' Work Stressors Scale and evaluate its reliability and validity. Results The ICU Nurses' Work Stressors Scale included six dimensions and 34 items. Exploratory factor analysis extracted six common factors with a cumulative variance contribution rate of 77.8%. The results of confirmatory factor analysis demonstrated good model fit. The scale-level content validity index of the scale was 0.965, with item-level content validity index ranging from 0.850 to 1.000. The overall Cronbach's α coefficient of the questionnaire was 0.958, and the test-retest reliability was 0.986. In a survey of 434 ICU nurses testing with the scale, the total score ranged from 22.0-160.0 (82.6±20.6) points. The scores of each dimension including nursing profession, workload, working environment, patient care, family factors and interpersonal relationship were (14.5±4.2), (21.9±5.8), (7.0±2.1), (14.1±4.2), (6.3±2.5) and (18.8±5.7) points, respectively. Conclusion ICU Nurses' Work Stressors Scale demonstrates good reliability and validity and can serve as an effective tool for evaluating work stress among ICU nurses.

With the continuous advancement and innovation in medical equipment technology, the transition between high-flow oxygen therapy, non-invasive ventilation, and invasive ventilation can be easily achieved by adjusting the ventilation mode of ventilators. During the weaning phase for tracheotomized patients, it is necessary to disconnect the ventilator circuit, change the ventilator mode, and gradually extend the weaning time to achieve complete ventilator liberation. During the weaning process, due to patients' excessive dependence on the ventilator, there may be situations where respiratory endpoints and Y-connectors of the ventilator are reconnected for invasive ventilation. However, during the weaning process, the Y-connector and expiratory end connectors are exposed to the air, which cannot ensure the tightness of the ventilator circuit, easily increasing the probability of ventilator circuit contamination and subsequently the risk of ventilator-associated pneumonia (VAP). To overcome these issues, the research team of department of critical care medicine of Zhongda Hospital Southeast University has designed a ventilator circuit interface protective device for weaning and has obtained a National Utility Model Patent of China (ZL 2023 2 1453385.8). The main body of the protective device is a Y-connector plug, consisting of multiple components, including a sealing piece, a protective cover, a sealing plug, an interface 1 (connects with the patient's tracheal tube), an interface 2 (connects with the respiratory branch of the ventilator), and an interface 3 (connects with the expiratory branch of the ventilator), featuring a unique design and easy operation. During the patient's weaning training process, the interface 1 and interface 2 is disconnected from the patient's tracheal tube and respiratory branch, respectively. The interface 1 is plugged with a stopper, and the interface 2 is covered with a protective cover to ensure the tightness of the expiratory branch and Y-connector of the ventilator. During the period when the patient is using the ventilator, the protective cover and plug are removed, and connecting them together ensures the tightness of the device itself, reducing the incidence of VAP caused by ventilator circuit contamination, avoiding nosocomial infections, and shortening the prolonged use of invasive ventilation, increased complication rate, extended hospital stay, and increased medical cost associated with weaning.
Humans ; Ventilator Weaning/methods* ; Equipment Design ; Ventilators, Mechanical ; Respiration, Artificial/instrumentation* ; Pneumonia, Ventilator-Associated/prevention & control*

OBJECTIVE T o explore the value of targeted next-generation sequencing(t-NGS)in diagnosis of respir-atory tract pathogens through meta-analysis so as to provide reference for clinical application.METHODS PubMed database,Web of Science database,Wanfang database,CNKI database and Sinomed database were retrieved,and the time period of retrieval ranged from Jan.2010 to May 2024.The literatures were screened out based on the es-tablished standards.The quality was assessed by QU ADAS-2,the risk of bias graph was drawn by Revman 5.4,and the statistical analysis was performed by Stata 16.0.RESULTS A total of 9 literatures were included in the study.The result of meta-analysis showed that the heterogeneity test Q for sensitivity was 268.21,P＜0.01,I2=97.02％,with the heterogeneity test Q for specificity 210.04,P＜0.01,I2=96.19％,the combined sensitivity 0.88(95％CI:0.62 to 0.97),combined specificity 0.68(95％CI:0.41 to 0.86),combined positive likelihood ratio 2.72(95％CI:1.44 to 5.15),combined negative likelihood ratio 0.18(95％CI:0.06 to 0.53),combined diagno-sis score 2.74(95％CI:1.68 to 3.80),and combined diagnostic odds ratio 15.44(95％CI:5.34 to 44.66).The area under synthesize receiver operating characteristic(SROC)curve(AUC)was 0.85(95％CI:0.82 to 0.88).The result of Deeks funnel plot showed that P was 0.99,indicating that there was no obvious publication bias.CONCLUSIONS The sensitivity of tNGS is high in detection of the pathogens causing acute respiratory tract infection,the specificity needs to be improved,but its comprehensive ability is satisfactory.It has certain val-ue in early clinical diagnosis.

OBJECTIVE T o explore the value of targeted next-generation sequencing(t-NGS)in diagnosis of respir-atory tract pathogens through meta-analysis so as to provide reference for clinical application.METHODS PubMed database,Web of Science database,Wanfang database,CNKI database and Sinomed database were retrieved,and the time period of retrieval ranged from Jan.2010 to May 2024.The literatures were screened out based on the es-tablished standards.The quality was assessed by QU ADAS-2,the risk of bias graph was drawn by Revman 5.4,and the statistical analysis was performed by Stata 16.0.RESULTS A total of 9 literatures were included in the study.The result of meta-analysis showed that the heterogeneity test Q for sensitivity was 268.21,P＜0.01,I2=97.02％,with the heterogeneity test Q for specificity 210.04,P＜0.01,I2=96.19％,the combined sensitivity 0.88(95％CI:0.62 to 0.97),combined specificity 0.68(95％CI:0.41 to 0.86),combined positive likelihood ratio 2.72(95％CI:1.44 to 5.15),combined negative likelihood ratio 0.18(95％CI:0.06 to 0.53),combined diagno-sis score 2.74(95％CI:1.68 to 3.80),and combined diagnostic odds ratio 15.44(95％CI:5.34 to 44.66).The area under synthesize receiver operating characteristic(SROC)curve(AUC)was 0.85(95％CI:0.82 to 0.88).The result of Deeks funnel plot showed that P was 0.99,indicating that there was no obvious publication bias.CONCLUSIONS The sensitivity of tNGS is high in detection of the pathogens causing acute respiratory tract infection,the specificity needs to be improved,but its comprehensive ability is satisfactory.It has certain val-ue in early clinical diagnosis.

Prone position ventilation(PPV)is a lung protective ventilation strategy widely used in patients with acute respiratory distress syndrome(ARDS)to improve ventilation and oxygenation of the lungs by changing the patient's position.During PPV treatment,patients may face a variety of complications and risks,such as pressure injury,brachial plexus injury,corneal injury and unplanned extubation,which aggravate the patient's pain,increase medical costs and affect the prognosis of the disease.To this end,medical staff at Zhongda Hospital Southeast University jointly designed a PPV patient care kit pillow and obtained a National Utility Model Patent of China(patent number:ZL 202221128961.7).The PPV patient care kit pillow is composed of head pad,chest pad,hip pad and lower limb pad,with gel on its surface,which can reduce friction force and shear force;grooves are set on the middle of head pad,two sides above chest pad,middle of chest pad,middle of hip pad and lower limb pad,which can effectively avoid compression of corresponding parts and reduce the risk of pressure injury;and air bags are set on both sides below head pad,hip pad and lower limb pad,which can be inflated unilaterally or bilaterally at the same time and used for deflecting or elevating the body;in addition,a tube limiting groove is set on the outside of head pad,which can effectively fix the tracheal tube and reduce the risk of tube displacement and unplanned extubation.The overall structure of the pillow of this PPV patient care kit conforms to the angle of human mechanics and has strong versatility,which can improve the comfort,safety and effectiveness of PPV therapy for patients and reduce the work burden of medical staff,and has good application value.

Prone position ventilation(PPV)is a lung protective ventilation strategy widely used in patients with acute respiratory distress syndrome(ARDS)to improve ventilation and oxygenation of the lungs by changing the patient's position.During PPV treatment,patients may face a variety of complications and risks,such as pressure injury,brachial plexus injury,corneal injury and unplanned extubation,which aggravate the patient's pain,increase medical costs and affect the prognosis of the disease.To this end,medical staff at Zhongda Hospital Southeast University jointly designed a PPV patient care kit pillow and obtained a National Utility Model Patent of China(patent number:ZL 202221128961.7).The PPV patient care kit pillow is composed of head pad,chest pad,hip pad and lower limb pad,with gel on its surface,which can reduce friction force and shear force;grooves are set on the middle of head pad,two sides above chest pad,middle of chest pad,middle of hip pad and lower limb pad,which can effectively avoid compression of corresponding parts and reduce the risk of pressure injury;and air bags are set on both sides below head pad,hip pad and lower limb pad,which can be inflated unilaterally or bilaterally at the same time and used for deflecting or elevating the body;in addition,a tube limiting groove is set on the outside of head pad,which can effectively fix the tracheal tube and reduce the risk of tube displacement and unplanned extubation.The overall structure of the pillow of this PPV patient care kit conforms to the angle of human mechanics and has strong versatility,which can improve the comfort,safety and effectiveness of PPV therapy for patients and reduce the work burden of medical staff,and has good application value.

Objective:To evaluate the retinal differentiation ability of human induced pluripotent stem cells (hiPSCs) from various somatic cell sources.Methods:The hiPSCs lines BC1- green fluorescent protein (GFP) and Gibco obtained by blood cell reprogramming and the hiPSCs line UE017 obtained by urine cell reprogramming were used to induce retinal differentiation.The morphogenesis and development of retina were recorded with an optical microscope, and the expression of specific molecular markers of various cell subclasses in the retina was detected by immunofluorescence, and the efficiency of retinal differentiation of different cell lines was analyzed and compared.Results:All three hiPSC lines derived from blood and urine cells were able to be induced into three-dimensional (3D) retinal organoids, including neuroretina and retinal pigment epithelial cells.Retinal organoids simulated the development process of retina in vivo and gradually differentiated into all cell subtypes of retina, including retinal ganglion cells, photoreceptor cells, amacrine cells, horizontal cells, bipolar cells, Müller cells, and even formed lamellar structures.However, in terms of the efficiency of acquiring retinal organoids, the hiPSCs derived from blood were more efficient than those derived from urine. Conclusions:hiPSCs from both blood and urine somatic cells can differentiate into 3D retinal organoids, including all subtypes of retinal cells.The differentiation efficiency among lines is different.

Objective To investigate the effect of high-frequency oscillatory ventilation (HFOV) on inflammatory responses in lung tissues of dogs with severe acute respiratory distress syndrome (ARDS).Methods Healthy mongrel dogs of both sexes,weighing 13.7-16.2 kg,in which severe ARDS was induced by intravenous infusion of the mixture of oleic acid 0.2 ml/kg and autologous blood (equal to the volume of oleic acid).Twenty-four dogs with severe ARDS were randomly divided into 4 groups (n=6 each) using a random number table:conventional mechanical ventilation with low tidal volume group (group CMV),HFOV-9 Hz group,HFOV-12 Hz group and HFOV-15 Hz group.In HFOV-9 Hz,HFOV-12 Hz and HFOV-15 Hz groups,the frequency was 9,12,and 15 Hz,respectively,mean airway pressure 20 cmH2O,oscillation pressure 70 cmH2O,and inspired oxygen fraction ratio 1.0.In group CMV,the animals were mechanically ventilated in volume-controlled mode,with positive end-expiratory pressure 5 cmH2O,tidal volume 6 ml/kg,respiratory rate 30 breaths/min,inspiratory/expiratory ratio 1:2,and inspired oxygen fraction ratio 1.0.At 4 h of ventilation,the animals were sacrificed,and lungs were removed for determination of wet/dry weight (W/D) ratio,contents of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and IL-10 (by enzyme-linked immunosorbent assay),and expression of vascular endothelial (VE)-Cadherin (by Western blot) and for microscopic examination.Lung injury scores were assessed.Results Compared with group CMV,the lung injury scores,W/D ratio,and contents of TNF-α and IL-6 were significantly decreased,the content of IL-10 was significantly increased,and the expression of VE-Cadherin was significantly up-regulated in the other three groups (P＜0.05).Compared with group HFOV-9Hz,the lung injury scores,W/D ratio and contents of TNF-α and IL-6 were significantly decreased,the content of IL-10 was significantly increased,and the expression of VE-Cadherin was significantly up-regulated in group HFOV-15 Hz,and the content of IL-6 was significantly decreased in group HFOV-12 Hz (P＜0.05).Conclusion HFOV can significantly inhibit inflammatory responses in lung tissues of dogs with severe ARDS as compared with mechanical ventilation with low tidal volume,which may be involved in the mechanism of lung-protective ventilation effect.

Objective To evaluate the role of endoplasmic reticulum stress in ketamine-induced apoptosis in rat neurons.Methods Rat adrenal pheochromocytoma cell line (PC12 cells) was seeded in the culture dishes 100 mm in diameter (10 ml/dish) or in 6-well plates (2 ml/well) at a density of 5 × 105 cells/ml.PC12 cells were divided into 4 groups (n =6 each) using a random number table:control group (group C);ketamine group (group K);endoplasmic reticulum stress inhibitor salubrinal group (group S);ketamine + salubrinal group (group K+S).In group C,the cells were cultured in the plain culture medium.In group K,1.5 mmol/L ketamine was added.In group S,30 mmol/L salubrinal was added.In group K + S,1.5 mmol/L ketamine and 30 mmol/L salubrinal were added.At 24 h of incubation,the cell morphology was observed under light microscope,the expression of Bip and caspase-12 in PC12 cells was detected by Western blot,and the cell apoptosis was measured by flow cytometry.The apoptosis rate was calculated.Results Compared with group C,the expression of Bip and caspase-12 was significantly upregulated,and the apoptosis rate was increased in K and K + S groups (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group S (P＞ 0.05).Compared with group K,the expression of Bip and caspase-12 was significantly down-regulated,and the apoptosis rate was decreased in group K+S (P＜0.05).The degree of damage to PC12 cells was more serious in group K than in group C..The degree of damage to PC12 cells in group K+S was significantly mnilder than that in group K and more serious than that in group C.Conclusion The mechanism by which ketamine induces neuronal apoptosis is related to the enhancement of endoplasmic reticulum stress in rats.

BACKGROUND:Elderly hypertensive patients often associated with organ and tissue ischemia. Al kinds of risks are easy to appear in the process of undergoing arthroplasty. To ensure the smooth operation and to improve the safety of the surgery treatment, it is needed to choose an appropriate mode of anesthesia.
OBJECTIVE:To explore the application security of epidural combined with smal dose of intravenous anesthesia in total knee arthroplasty in elderly hypertensive patients.
METHODS:A total of 64 elderly hypertensive patients with arthroplasty in the Third Hospital of Hebei Medical University from December 2013 to December 2014 were selected and were divided into control group (32 cases) and observation group (32 cases). They were given total intravenous anesthesia and epidural block combined with smal dose of intravenous anesthesia. Systolic blood pressure, diastolic blood pressure, heart rate, blood oxygen saturation and changes in respiratory rate were detected before anesthesia, after anesthesia induction, 10 minutes after anesthesia, 10 minutes after use of bone cement, and at the end of arthroplasty in both groups. The usage of vasoactive drugs (including ephedrine and dopamine) during arthroplasty and adverse events after arthroplasty were recorded. RESULTS AND CONCLUSION:Compared with pre-anesthesia, systolic blood pressure and diastolic blood pressure were significantly reduced and blood oxygen saturation was increased at 10 minutes after anesthesia and 10 minutes after the application of bone cement in both groups (P<0.05). In the end of arthroplasty, systolic blood pressure, diastolic blood pressure and respiratory rate were significantly higher in the control group than in the observation group (P<0.05). A total of 3 cases in the observation group and 15 cases in the control group used vasoactive drugs (including ephedrine and dopamine), and there was a significant difference in its usage (P<0.05). Moreover, five patients in the control group experienced respiratory insufficiency, which was apparently improved after given the short-term ventilator support. These results confirm that compared with the total intravenous anesthesia, epidural block combined with smal dose of intravenous anesthesia showed a high safety during total knee arthroplasty in elderly hypertensive patients.