Objective:To develop evaluation indicators for care ability of caregivers in home-based palliative care based on the Farran caregiver skills model.Methods:Based on the Farran caregiver skills model, a preliminary evaluation index system was constructed through theoretical analysis, literature review, and semi-structured interviews. From July to October 2024, experts in the field were selected to conduct expert consultations, revise and improve the index system, and determine the weight of the indicators through the analytic hierarchy process.Results:A total of two rounds of expert consultations were conducted. The effective response rates for the first and second rounds of expert consultation questionnaires were 90.00% (18/20) and 100.00% (18/18), respectively. In the two rounds of expert consultations, 15 experts (83.33%) and 3 experts (16.67%) respectively proposed revision suggestions. In the two rounds of consultation, the expert authority coefficients were 0.931 and 0.936, respectively, and the Kendall coefficient of concordance were 0.152~0.283、0.183~0.269 ( P<0.05). The final evaluation indicators for care ability of caregivers in home-based palliative care included four first-level indicators, 12 second-level indicators, and 45 third-level indicators. Conclusions:The evaluation indicators for care ability of caregivers in home-based palliative care developed are highly scientific and reliable, and can provide a reference for the evaluation of family caregiver care ability and the formulation of training programs.

Objective:To develop evaluation indicators for care ability of caregivers in home-based palliative care based on the Farran caregiver skills model.Methods:Based on the Farran caregiver skills model, a preliminary evaluation index system was constructed through theoretical analysis, literature review, and semi-structured interviews. From July to October 2024, experts in the field were selected to conduct expert consultations, revise and improve the index system, and determine the weight of the indicators through the analytic hierarchy process.Results:A total of two rounds of expert consultations were conducted. The effective response rates for the first and second rounds of expert consultation questionnaires were 90.00% (18/20) and 100.00% (18/18), respectively. In the two rounds of expert consultations, 15 experts (83.33%) and 3 experts (16.67%) respectively proposed revision suggestions. In the two rounds of consultation, the expert authority coefficients were 0.931 and 0.936, respectively, and the Kendall coefficient of concordance were 0.152~0.283、0.183~0.269 ( P<0.05). The final evaluation indicators for care ability of caregivers in home-based palliative care included four first-level indicators, 12 second-level indicators, and 45 third-level indicators. Conclusions:The evaluation indicators for care ability of caregivers in home-based palliative care developed are highly scientific and reliable, and can provide a reference for the evaluation of family caregiver care ability and the formulation of training programs.

OBJECTIVE: To evaluate and summarize the relevant evidence of anticoagulation and bleeding risk management in patients with extracorporeal membrane oxygenation (ECMO), and provide the evidence-based basis for the management of anticoagulation and bleeding during ECMO treatment. METHODS: According to the evidence "6S" pyramid model, all evidence on ECMO anticoagulation management and bleeding risk was searched in relevant databases, organizations and guideline websites at home and abroad. Evidence types included guidelines, expert consensus, systematic evaluation, Meta-analysis and original study. The search time limit was from May 31, 2012 to May 31, 2022. Two researchers with evidence-based research background conducted independent literature quality evaluation of the retrieved evidence, and the evidence that met the quality standards was extracted and summarized based on the opinions of industry experts. RESULTS: A total of 315 articles were retrieved, and 13 articles were included, including 3 guidelines, 6 expert consensus, and 4 Meta-analysis. A total of 27 best evidences were summarized from 7 aspects, including the selection of ECMO anticoagulation, anticoagulation in priming, anticoagulation in operation, anticoagulation monitoring, bleeding and treatment, thrombosis and treatment, and prevention and management of terminal limb ischemia. CONCLUSIONS This study provides evidence-based basis for bleeding prevention and anticoagulant management in ECMO patients. It is recommended to selectively apply the best evidence after evaluating the clinical environmental conditions of medical institutions, so as to improve the prognosis of ECMO patients.
Humans ; Extracorporeal Membrane Oxygenation/adverse effects* ; Blood Coagulation ; Hemorrhage/etiology* ; Anticoagulants/adverse effects* ; Thrombosis/prevention & control* ; Retrospective Studies

Objective:To evaluate and summarize the best evidence for early rehabilitation of adults with veno-venous extracorporeal membrane oxygenation (VV-ECMO).Methods:Evidence on early rehabilitation of adult VV-ECMO patients was searched by computer from 7 English literature databases [PubMed database, cumulative index to nursing and allied health literature (CINAHL), Embase database, Cochrane library database, UpToDate clinical consultant, BMJ best clinical practice, JBI database], 5 Chinese literature databases (China biomedical literature database, China Yimai Tong, China national knowledge infrastructure, Wanfang data, VIP database), 5 guideline networks [National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), China Guide Network] and 2 professional association websites [Extracorporeal Life Support Organization (ELSO), Chinese Association of Rehabilitation Medicine]. The search period is from January 2011 to December 2021. The appraisal of guidelines for research and evaluation Ⅱ (AGREE ) and JBI 2014 quality assessment tools were used to evaluate the quality of inclusion guidelines, systematic reviews, expert consensus and original studies, respectively, and to extract and summarize the best evidence for early rehabilitation of adults with VV-ECMO.Results:A total of 2 guidelines, 2 expert consensuses, 2 systematic reviews and 8 original studies [including 1 randomized controlled trial (RCT), 1 non-randomized controlled study, 3 cohort studies and 3 case reports] were included. The evidence was summarized from 9 aspects including the necessity of early rehabilitation, rehabilitation initiation time, rehabilitation location, pre-rehabilitation preparation, pre-rehabilitation assessment, rehabilitation method, rehabilitation frequency and duration, rehabilitation process monitoring and effect evaluation,and finally 24 pieces of the best evidence were summarized.Conclusion:Early rehabilitation of adults with VV-ECMO is safe and feasible. The summary of the best evidence can provide evidence-based guidance for clinical medical staff to reasonably carry out early rehabilitation.

Objective:To summarize the establishment and management experience of extracorporeal membrane oxygenation (ECMO) rapid response team, and explore a more efficient rescue mode.Methods:From January 2015 to September 2020, 85 patients treated with ECMO in Affiliated Hospital of Qingdao University were selected as the research objects. Thirty-eight patients treated with conventional ECMO from January 2015 to December 2019 were selected as the control group, and 47 patients treated with ECMO rapid response team from January 2020 to September 2020 were selected as the experimental group. The differences in team preparation time, catheterization time, treatment success rate, incidence of complications and equipment failure frequency between the two groups were compared.Results:There were no significant differences in gender, age or disease types between the two groups. The team preparation time and catheterization time of the experimental group were significantly shorter than those of the control group [team preparation time (minutes): 31.79±6.10 vs. 67.16±30.49, catheterization time (minutes): 40.62±7.13 vs. 84.89±19.29], and the incidence of complications was significantly lower than that of the control group [4.3% (2/47) vs. 21.1% (8/38)], and the differences were statistically significant (all P < 0.05). Conclusion:ECMO rapid response team can shorten the rescue preparation time, reduce the occurrence of complications, improve the team treatment efficiency, and provide ideas for emergency and critical patients.

Objective ToexploretheeffectofTIPS+GCVEcombinedwithPSEonhemodynamicsinpatientswithlivercirrhosis,portal hypertensionandsplenomegaly.Methods 56patientswereincludedfromJanuary2015toDecember2016 whounderwentTIPS+GCVEcombinedwithPSE.Patientswerefollowed-upon1month,3months,6monthsand1yearaftersurgery,andstatisticanalysis weredoneonportalveinhemodynamicindex:portalveintrunkdiameter(PVD),portalveinvelocity(PVV),portalvenousbloodflow (PVF),splenicveintrunkdiameter(SVD)andvelocityofbloodflowinsplenicvein(SVV).Results Thereweresignificantdifferencesinportal veinpressurebeforeandafterthebypassinall56patients.PVDandPVV weresignificantlydifferentbetween3and6 monthsafter surgeryandpre-surgery.PVF wassignificantlydifferentcomparing6 monthsand1yearaftersurgery withpre-surgery.SVDand SVV weresignificantlydifferentbetween3 months,6 monthsand1yearaftersurgeryandpre-surgery.Conclusion TIPS+GCVE combinedwithPSEcouldeffectivelyreduceportalveinpressure,improveportalveinandspleenveinbloodflow,increaseportalvenousblood flow,andimprovepatients’liverfunction.

AIM:To investigate the effect of ionizing radiation on epithelial-mesenchymal transition in lung cancer cell line A549 and its possible mechanism.METHODS:The lung cancer A549 cells were irradiated with different doses (0 Gy, 1 Gy, 2 Gy, 4 Gy and 8 Gy) of X-ray for different time.The morphological changes of the cells were observed under inverted microscope at time points of 12 h, 24 h and 48 h.The expression of vimentin, N-cadherin, E-cadherin and transcription factor c-Myc was detected by Western blot at the time points of 12 h and 24 h.RESULTS:After ionizing radiation, the contours of the A549 cells were unclear, the protrusions increased, and the edges were irregular, with fried egg-like collapses.The mesenchymal morphology of the A549 cells was most obvious after irradiation at 8 Gy for 48 h.Compared with 0 Gy irradiation group, the expression of vimentin was down-regulated seemingly 12 h after irradiation, but up-regulated in 2 Gy, 4 Gy and 8 Gy irradiation groups for 24 h, and the most obvious effect was observed in 2 Gy irradiation group (P<0.01).Compared with 0 Gy irradiation group, the expression of N-cadherin was up-regulated in 1 Gy, 2 Gy and 4 Gy irradiation groups for 24 h (P<0.05), while the expression of E-cadherin was not influenced.The up-regulation of vimentin expression in lung cancer cell line A549 was positively correlated with c-Myc expression.CONCLUSION:Ionizing radiation may promotes epithelial-mesenchymal transition in the lung cancer cell line A549 by up-regulating the c-Myc expression.

[Objective]To investigate the expression and the clinical significance of macrophage migration inhibitory factor (MIF)in the serum and lung tissues of the patients with non-small cell lung cancer(NSCLC).[Methods]Eighty-eight eligible inpatients were confirmed by pathology of lung tissues ,including 66 patients with NSCLC and 22 patients with benign lung lesions. ELISA was performed to measure serum concentration of MIF of these patients ,which was compared with 30 healthy individuals. Meanwhile,immunohistochemistry(IHC)was performed to examine the expression of MIF in the lung tissues of the two groups. MIF expression level was compared between two groups and among different subgroups of NSCLC. The correlationship between serum MIF level and high expression rate in lung tissues was also analyzed. All the data were analyzed by SPSS17.0.[Results]The serum concentration of MIF in NSCLC group was significantly higher than that in healthy control(14.79 ng/mL vs 10.69 ng/mL,P=0.001), and was slightly higher but not significantly different from benign lung lesions group(14.79 ng/mL vs 13.68 ng/mL,P=0.580). The comparison among subgroups of NSCLC showed that the serum MIF level was not only correlated with the histological grade and clini?cal stage of the cancer,but also correlated with the gender and smoking history of the host. Immunohistochemistry showed that the MIF high expression rate in the lung tissues of NSCLC was markedly higher than that of benign lung lesions group(30.3%vs 4.5%, P=0.014). Among the subgroups of NSCLC,IHC showed MIF high expression rate was correlated with the histopathologic types and clinical stage of the cancer. Simultaneously ,the serum MIF level showed a positive correlation with MIF expression rate in the lung tissues in all patients and NSCLC group(P<0.05).[Conclusion]MIF was strongly related to the clinicopathological characteristics of NSCLC. It could be helpful for the diagnosis and clinical evaluation of NSCLC.

Objective To study infection of the lung tissue by bronchoalveolar lavage for BALF and explore whether GM can help improve the he diagnosis efficiency in patients without granulocyte deficiency with IPA, and find the threshold of GM values. Methods Between January 2011 and December 2011, 173 cases of patients were considered possible invasive pulmonary aspergillosis in parallel BALF GM detection in the center of the respiratory endoscopic examination.. According to the diagnostic criteria at home and abroad, all the cases were divided into four groups, including group of IPA, group of tuberculosis, group of bacterial pneumonia and group of non-infection. Using ELISA method for determination of serum and BALF GM. The diagnostic value was made by statistical methods in BALF GM detection without patients of granulocyte deficiency with IPA. Results There were 11 cases in the group of IPA, 23 cases in the group of tuberculosis, 90 cases in the group of bacterial pneumonia and 49 cases in the group of non-infection. In patients without granulocyte deficiency with IPA,BALF GM value was higher comparing with the patients without IPA. There were significant difference between the two groups; Comparing the GM value in the serum, the detection of BALF GM was higher in IPA. ROC curve analysis found that when the BALF GM test value was 0.95 or higher, there was highest possible with IPA. Conclusion BALF GM testing is beneficial to patients of invasive pulmonary aspergillosis without granulocyte deficiency in early identification with IPA. This study found that BALF GM best value is 0.95 or higher.

AIM: To investigate the protective effect of anti-macrophage migration factor monoclonal antibody (anti-MIF MAb) on oleic-acid-induced acute lung injury (ALI) rats and its influence on the expression level of MIF and intercellular adhesion molecule-1(ICAM-1). METHODS: The rats were subjected to injection of oleic acid (oleic acid group) or saline solution (control group). One hours before administration of oleic acid, the rats were intraperitoneally injected with anti-MIF antibody (5 mg/kg) as the treatment group. After injecting oleic acid or saline for 4 hours, the PaO_2, lung permeability index (LPI), the number of macrophage and the level of soluble ICAM-1 (sICAM-1) in the bronchial alveolar lavage fluid (BALF) were measured. The expression level of MIF mRNA and ICAM-1 mRNA in the lung were detected by in situ hybridization, and the degree of macrophage infiltration and the expression of MIF were evaluated by double staining immunocytochemistry. RESULTS: The PaO_2 of the oleic acid group was far lower than those of the control and treatment group (P