In the clinical stage, suspected hemolytic plasma may cause hemolysis illness, manifesting as symptoms such as heart failure, severe anemia, etc. Applying a deep learning method to plasma images significantly improves recognition accuracy, so that this paper proposes a plasma quality detection model based on improved "You Only Look Once" 5th version (YOLOv5). Then the model presented in this paper and the evaluation system ‌were introduced‌ into the plasma datasets, and ‌the average accuracy of the final classification reached 98.7%‌. The results of this paper's experiment were obtained through the combination of several key algorithm modules including‌ omni-dimensional dynamic convolution, pooling with separable kernel attention, residual bi-fusion feature pyramid network, ‌and‌ re-parameterization convolution. The method of this paper‌ obtains the feature information of spatial mapping efficiently, and enhances the average recognition accuracy of plasma quality detection. This paper presents a high-efficiency detection method for plasma images, aiming to provide a practical approach to prevent hemolysis illnesses caused by external factors.
Algorithms ; Humans ; Hemolysis ; Plasma ; Deep Learning ; Image Processing, Computer-Assisted/methods*

Objective:To explore the effect of the Nurse-Mini-CEX assessment method combined with PBL teaching mode in the cultivation of core competencies of undergraduate nursing students during ICU internships.Methods:A total of 64 nursing students interning in the ICU of a Third-grade Class-A hospital in Wuhu City from Sep 2022 to Aug 2023 were selected and randomly divided into 8 groups(8 students in each group).Using cluster sampling,4 groups(32 students)were assigned to the experimental group,receiving training via Nursing-Mini-CEX combined with PBL,while the remaining 4 groups(32 students)served as the control group,undergoing traditional clinical teaching.All students completed a 2-month pre-ICU clinical internship,followed by a 4-week ICU internship.Results:Compared to the control group,the experimental group showed significantly higher scores in five dimensions of nursing competency:nursing consultation,nursing physical examination,nursing diagnosis,nursing interventions,and holistic evaluation(P＜0.05).Additionally,the experimental group outperformed the control group in core competencies,including clinical nursing skills,leadership,interpersonal communication,professional development,critical thinking and research ability(P＜0.05).Self-efficacy in learning ability and behavior,as well as scores in personal accomplishment,depersonalization,and emotional exhaustion,were also higher in the experimental group(P＜0.05).Furthermore,the experimental group reported greater satisfaction with training content,teaching effectiveness,clinical skill development,teamwork cultivation,and overall satisfaction(P＜0.05).Conclusions:Nursing-Mini-CEX assessment combined with PBL teaching mode effectively enhances core competencies and self-efficacy,reduces burnout among ICU nursing interns,and achieve good clinical results,providing a theoretical and practical basis for the teaching and training of nursing students in ICU.However,as a single-center study,further validation and broader studies are warranted.

Objective:To explore the effect of the Nurse-Mini-CEX assessment method combined with PBL teaching mode in the cultivation of core competencies of undergraduate nursing students during ICU internships.Methods:A total of 64 nursing students interning in the ICU of a Third-grade Class-A hospital in Wuhu City from Sep 2022 to Aug 2023 were selected and randomly divided into 8 groups(8 students in each group).Using cluster sampling,4 groups(32 students)were assigned to the experimental group,receiving training via Nursing-Mini-CEX combined with PBL,while the remaining 4 groups(32 students)served as the control group,undergoing traditional clinical teaching.All students completed a 2-month pre-ICU clinical internship,followed by a 4-week ICU internship.Results:Compared to the control group,the experimental group showed significantly higher scores in five dimensions of nursing competency:nursing consultation,nursing physical examination,nursing diagnosis,nursing interventions,and holistic evaluation(P＜0.05).Additionally,the experimental group outperformed the control group in core competencies,including clinical nursing skills,leadership,interpersonal communication,professional development,critical thinking and research ability(P＜0.05).Self-efficacy in learning ability and behavior,as well as scores in personal accomplishment,depersonalization,and emotional exhaustion,were also higher in the experimental group(P＜0.05).Furthermore,the experimental group reported greater satisfaction with training content,teaching effectiveness,clinical skill development,teamwork cultivation,and overall satisfaction(P＜0.05).Conclusions:Nursing-Mini-CEX assessment combined with PBL teaching mode effectively enhances core competencies and self-efficacy,reduces burnout among ICU nursing interns,and achieve good clinical results,providing a theoretical and practical basis for the teaching and training of nursing students in ICU.However,as a single-center study,further validation and broader studies are warranted.

Objective To explore the targets and mechanism of Jiegengbai Powder in the treatment of lung adenocarcinoma based on network pharmacology and animal experiments.Methods The targets of effective components of Jiegengbai Powder were obtained from TCMSP,the targets of lung adenocarcinoma were screened from GeneCards,PharmGKB,DrugBank,TTD,OMIM databases,and the intersection targets were obtained.The protein-protein interaction(PPI)network and active components of Chinese materia medica-target network were constructed by using Cytoscape 3.8.0 software,and the key components and core targets were screened out.The intersection targets were analyzed by GO and KEGG enrichment analysis.PyMOL and AutoDockTools 1.5.6 software were used to verify the molecular docking between the key components and core targets.The lung cancer mice model was established.The mice were randomly divided into blank group,model group,cisplatin group,Jiegengbai Powder combined with cisplatin group,Jiegengbai Powder low-,medium-and high-dosage groups.After 14 days of intervention,the tumor inhibition rate was calculated,and the morphology of tumor tissues was observed by HE staining.The gene and protein expressions of PI3K,PTEN,Akt and mTOR in tumor tissues were detected by RT-qPCR and Western blot.Results The core targets of Jiegengbai Powder in the treatment of lung adenocarcinoma such as TP53,CASP3,BCL2L1 and AKT1 were screened by network pharmacology.The key pathways of enrichment were PI3K-Akt signaling pathway and so on.Jiegengbai Powder can inhibit the growth of tumor effectively.Compared with the model group,the mRNA expressions of PI3K,Akt and mTOR decreased in the Jiegengbai Powder medium-and high-dosage groups,and PTEN mRNA expression increased,the ratio of p-PI3K/PI3K,p-Akt/Akt and p-mTOR/mTOR decreased,and the expression of PTEN protein increased(P<0.05,P<0.01).Conclusion Jiegengbai Powder has the characteristics of multi-level and multi-target in the treatment of lung adenocarcinoma.It may promote tumor cell apoptosis and autophagy by regulating PI3K/Akt/mTOR signaling pathway,so as to achieve the anti-tumor effect of inhibiting tumor cell growth.

Objective:To integrate the best evidence for early rehabilitation of mechanically ventilated ICU-acquired weakness (ICU-AW) patients using evidence-based methods, providing evidence-based basis for standardized evaluation and intervention of early exercise therapy for mechanically ventilated ICU-AW patients.Methods:A systematic search was conducted on the American Thoracic Society (ATS) Clinical Practice Guidelines, Registered Nurses' Association of Ontario (RNAO), Guidelines International Network (GIN), Canadian Medical Association Clinical Practice Guideline Library (CMACPGL), BMJ Clinical Evidence, UpToDate, Scottish Intercollegiate Guidelines Network (SIGN), PubMed, Cochrane Library, National Guideline Clearinghouse (NGC), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), UM-library, Physiotherapy Evidence Database (PEDro), National Institute for Health and Care Excellence (NICE), New Zealand Guidelines Group (NZGG), Chinese Medical Pulse Guidelines Website, CNKI and Wanfang data and other Chinese and English databases, professional team websites, and guideline websites for expert consensus, guidelines, randomized collected trial (RCT), systematic reviews and other evidence on early exercise rehabilitation for mechanically ventilated ICU-AW patients. The search time limit was from the establishment of the database to December 31, 2023. Literature search, screening, evaluation, information extraction was independently conducted by two evaluators with cross checking, and quality evaluation of the included literature was conducted.Results:A total of 21 literatures were enrolled, including 5 guidelines, 5 systematic reviews, 4 expert consensuses, and 7 RCT, all of which with high evidence level and all were enrolled. They were summarized into seven aspects with assessment screening, exercise safety standards, precautions, setting of exercise time, exercise intensity, exercise sequence, and recommended exercise content as the core, and 32 best evidences.Conclusions:The evidence summarized can provide evidence-based basis for standardized assessment and intervention of early exercise rehabilitation in mechanically ventilated ICU-AW patients. ICU medical practitioners need to combine the actual clinical environment, individual differences and rehabilitation goals of patients, to provide targeted health guidance and intervention for the prevention of ICU-AW in mechanically ventilated patients.

Objective:To explore the application effect of ICU nursing sub-specialty management model in the clinical treatment of ICU patients.Methods:Based on the actual needs of ICU patients,a precise and systematic management plan including organizational structure,workflow,linkage mechanism,quality control system,dynamic follow-up,and scientific research transformation was formulated,to construct a working model of multi-linkage,multi-direction supplement and coordinated development of two-way feedback mechanism in sub-specialty nursing.The control group was set before the implementation of ICU nursing sub-specialty management mode(Jan 1 to Dec 31,2021),and the intervention group was set after the implementation of ICU nursing sub-specialty management model(Jan 1 to Dec 31,2022).The core competence,specialty,sensitive indicators,satisfaction,and impact on patients were compared before and after implementation.Results:After the implementation of the ICU nursing sub-specialty management model,the core competence of nurses was improved,and the hospitalization time and mechanical ventilation time of patients were reduced,the incidence of re-entry ICU,acquired weakness,acquired dysphagia and incontinence dermatitis was decreased,the proportion of unplanned extubation was decreased,and the satisfaction of patients,nurses,doctors and students was improved(P＜0.05).Conclusion:The construction of ICU nursing sub-specialty management model can effectively promote the construction of ICU nursing sub-specialty,improve the core competence of nurses,reshape the connotation of nursing,improve the prognosis of patients,and ultimately promote the benign and sustainable development of hospital nursing.

OBJECTIVE: To explore the predictive value of diaphragmatic thickening fraction (DTF) combined with Medical Research Council-score (MRC score) on the outcome of weaning from mechanical ventilation in ICU-acquired weakness (ICU-AW) patients. METHODS: A retrospective case-control study was conducted. The clinical data of mechanically ventilated patients with an MRC score of less than 48 admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College from January 2022 to March 2023 were collected, including general information, ultrasound indicators, MRC scores, main clinical outcomes, and weaning outcomes. Patients were divided into successful weaning group and failed weaning group according to whether the patient could maintain effective autonomous breathing for at least 48 hours without using an invasive or non-invasive ventilator. The clinical data of the two groups were compared. Receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of DTF and MRC score alone or in combination for successful weaning of patients. RESULTS: A total of 87 patients were enrolled, of which 58 were successful weaning and 29 were failed weaning. There were no statistically significant differences in general data such as gender, age, underlying disease, heart rate (HR), mean arterial pressure (MAP), pH value, blood lactic acid (Lac), oxygenation index (PaO₂/FiO₂), and severity scores between the two groups. Compared with the failed weaning group, the DTF and MRC scores of patients in the successful weaning group were significantly increased [DTF: (26.02±2.68)% vs. (22.79±5.40)%, MRC score: 38.90±2.78 vs. 33.24±3.78, both P < 0.05]. The duration of mechanical ventilation and the length of ICU stay of patients in the successful weaning group were significantly shorter than those in the failed weaning group [duration of mechanical ventilation (hours): 102.21±32.60 vs. 113.14±41.34, length of ICU stay (days): 6.48±2.18 vs. 10.11±4.01, both P < 0.05], and the re-intubation rate and ICU hospitalization cost were significantly lowered [re-intubation rate: 6.90% (4/58) vs. 27.59% (8/29), ICU hospitalization cost (10 000 RMB): 4.99±0.87 vs. 7.85±2.45, both P < 0.05]. ROC curve analysis showed that the area under the ROC curve (AUC) of DTF and MRC score for predicting successful weaning in ICU-AW mechanical ventilation patients was 0.839 [95% confidence interval (95%CI) was 0.746-0.931] and 0.799 (95%CI was 0.701-0.899), respectively. Using DTF ≥ 25.01% as the optimal cut-off value to predict successful weaning, the sensitivity was 82.76%, and the specificity was 72.41%. Predicting successful weaning based on an optimal cut-off value of MRC score of ≥ 35.50 had a sensitivity of 79.31% and a specificity of 70.69%. Based on the DTF ≥ 25.01% combined with MRC score ≥ 35.50, it was predicted that the weaning would be successful, with an AUC of 0.887 (95%CI was 0.812-0.962), sensitivity increased to 89.70%, and specificity increased to 79.30%. CONCLUSIONS The DTF and MRC score have good guiding value for the selection of weaning timing and predicting the weaning outcomes in ICU-AW patients. Compared with independent DTF and MRC score, the combination of DTF and MRC score improves the predictive value of successful weaning in ICU-AW patients.
Humans ; Respiration, Artificial ; Ventilator Weaning ; Case-Control Studies ; Retrospective Studies ; Intensive Care Units

Objective:To systematically review the qualitative researches on patients′ lived experiences of being mechanically ventilated in intensive care unit.Methods:The Cochrane Library, PubMed, Web of Science, Ovid, CNKI, VIP and Wanfang database were searched to collect qualitative studies on patients′ lived experiences of being mechanically ventilated in intensive care unit, from October 2009 to October 2019. Two reviewers independently screened the literature against the pre-determined inclusion and exclusion criteria, extracting the data, and evaluated the included studies according to JBI Critical Appraisal Tool for qualitative studies in Australia.Results:A total of fourteen studies were included. Thirty-eight complete results were grouped according to their similarities to form seven categories. These categories led to three synthesized findings: results 1: patients suffered from both physical and mental distress; results 2: they were eager for supports; results 3: patients achieved personal growth through self-adjustment and reflection.Conclusion:Discomfort experience during mechanical ventilation reduces patients′ comfort, and to a certain extent, has negative impacts on their physical or mental health and clinical outcome. As the main caregiver of patients with mechanical ventilation, not only should nurses alleviate patients′ physical distress by strengthening communication but also give them adequate psychological support. Eventually, promote the physical and mental recovery of patients.

Objective    To systematically evaluate the risk factors of acute kidney injury after surgery for acute type A aortic dissection. Methods    We searched the CNKI, Wanfang Database, VIP, PubMed, Web of science, Cochrane Library (from inception to January 2019) to identify studies about the risk factors of acute kidney injury after surgery for acute type A aortic dissection. Quality of the included studies was evaluated by Kars-Ottawa scale. The meta-analysis was performed by RevMan 5.3 software. Results    A total of 16 case-control studies were included  involving 1 728 patients. The results of meta-analysis showed that gender (OR=1.58, 95% CI 1.31 to 1.89, P<0.001), body mass index (OR=1.05, 95%  CI 0.66 to 1.45, P<0.001), hypertension (OR=1.58, 95% CI 1.10 to 2.26, P=0.010), smoking history (OR=1.71, 95% CI 1.12 to 2.61, P=0.010), preoperative serum creatinine level (OR=30.26, 95% CI 20.17 to 40.35, P<0.000 01), preoperative white blood cell (OR=1.73, 95% CI 0.26 to 3.20, P=0.020), extracorporeal circulation time (OR=25.60, 95% CI 21.13 to 30.08, P<0.000 01), aortic occlusion time (OR=13.24, 95% CI 10.27 to 16.22, P<0.001), deep hypothermic circulatory arrest (DHCA) time (OR=2.58, 95% CI 0.86 to 4.29, P=0.003), arch replacement (OR=2.31, 95% CI 1.31 to 4.07, P=0.004), intraoperative blood transfusion (OR=1.27, 95% CI 0.29 to 2.24, P=0.010), postoperative mean arterial pressure (OR=–2.41, 95% CI –4.59 to –0.24, P=0.030), reoperation due to postoperative hemorrhage (OR=4.19, 95% CI 2.04 to 8.63, P<0.001), postoperative acute respiratory insufficiency (OR=6.61, 95% CI 3.21 to 13.60, P<0.001), postoperative mechanical ventilation time (OR=48.51, 95% CI 21.94 to 75.09, P<0.001) were associated with acute kidney injury after surgery for acute type A aortic dissection. Conclusion    Current evidence shows that gender, body mass index, hypertension, smoking history, preoperative serum creatinine level, preoperative white blood cell, extracorporeal circulation time, aortic occlusion time, deep hypothermic circulatory arrest (DHCA) time, arch replacement, intraoperative blood transfusion, postoperative mean arterial pressure, postoperative hemorrhage reoperation, postoperative acute respiratory insufficiency and postoperative mechanical ventilation time were risk factors for acute kidney injury after surgery for type A aortic dissection. Medical staff can strengthen perioperative management of patients with acute type A aortic dissection combined with the above factors, so as to reduce the incidence of acute kidney injury after operation and improve the clinical prognosis of patients.

Objective    To systematically evaluate the risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting (CABG). Methods    PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang and VIP Database were electronically searched to collect case-control and cohort studies about the risk factors for perioperative blood transfusion in patients undergoing CABG from inception to February 2020. Two reviewers screened and evaluated the literatures according to the inclusion and exclusion criteria, and meta-analysis was performed by using RevMan 5.3 software. Results    A total of 26 articles were collected, involving 84 661 patients. The results of meta-analysis showed that age (OR=1.06, 95%CI 1.03 to 1.08, P<0.001), age≥70 years (OR=2.14, 95%CI 1.77 to 2.59, P<0.001), female (OR=1.85, 95%CI 1.55 to 2.22, P<0.001), body mass index (OR=0.94, 95%CI 0.90 to 0.98, P=0.003), weight (OR=0.95, 95%CI 0.93 to 0.96, P<0.001), body surface area (OR=0.19, 95%CI 0.10 to 0.39, P<0.001), smoking (OR=0.80, 95%CI 0.69 to 0.93, P=0.003), diabetes (OR=1.15, 95%CI 1.09 to 1.20, P<0.000 01), chronic heart failure (OR=1.59, 95%CI 1.26 to 1.99, P<0.001), number of diseased coronary arteries (OR=1.17, 95%CI 1.01 to 1.35, P=0.030), reoperation (OR=2.12, 95%CI 1.79 to 2.51, P<0.001), preoperative hemoglobin level (OR=0.60, 95%CI 0.43 to 0.84, P=0.003), preoperative ejection fraction <35% (OR=2.57, 95%CI 1.24 to 5.34, P=0.010), emergency surgery (OR=4.09, 95%CI 2.52 to 6.63, P<0.001), urgent operation (OR=2.28, 95%CI 1.25 to 4.17, P=0.007), intra-aortic balloon pump (OR=3.86, 95%CI 3.35 to 4.44, P<0.001), cardiopulmonary bypass (OR=4.24, 95%CI 2.95 to 6.10, P<0.001), cardiopulmonary bypass time (OR=1.01, 95%CI 1.01 to 1.01, P<0.000 01) and minimum hemoglobin during cardiopulmonary bypass (OR=0.42, 95%CI 0.23 to 0.77, P=0.005) were the risk factors for perioperative blood transfusion in patients undergoing CABG. Conclusion    Current evidence shows that age, age≥70 years, female, body mass index, weight, body surface area, smoking, diabetes, chronic heart failure, number of diseased coronary arteries, reoperation, preoperative hemoglobin level, preoperative ejection fraction<35%, emergency surgery, urgent operation, intra-aortic balloon pump, cardiopulmonary bypass, cardiopulmonary bypass time and minimum hemoglobin during cardiopulmonary bypass are risk factors for perioperative blood transfusion in patients who undergo CABG. Medical staff should formulate and improve the relevant perioperative blood management measures according to the above risk factors, in order to reduce the perioperative blood utilization rate and improve the clinical prognosis of patients.