OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Objective: To understand and grasp the current situation and actual demands of China’s pharmaceutical industry, in order to provide a basis for the establishment of the chemometrics guideline in the Chinese Pharmacopoeia.
Methods: Online questionnaire was adopted to investigate the chemometrics backgrounds and demands of pharmaceutical industry practitioners.
Results: The practitioners of China’s pharmaceutical industry had certain expectations and demands for the chemometrics guideline, but the situation of talent reserves was not that optimistic.
Conclusions: It is extremely urgent to develop the chemometrics guideline, as general chapters of the Chinese Pharmacopoeia, which serve as the legal basis to guide the data quality control, the establishment of analytical methods and the verification of analytical methods in analytical practice, so as to ensure the scientific of multivariate analysis methods and reliability of analytical results, and will be conducive to promoting the improvement of China’s pharmaceutical level.

Objective To investigate the effect of a three-tier delirium care management process in patients with acute stroke in neurology intensive care unit(NICU).Methods A total of 50 patients with acute stroke admitted to the NICU of the Fourth Hospital of Changsha from May to September 2021 were assigned to the control group.The patients in the control group received routine NICU nursing care to prevent delirium.Another 50 patients with acute stroke admitted to the NICU from December 2021 to April 2022 were assigned to the trial group.They were managed with the three-tier delirium nursing management process on top of the routine NICU nursing care for the control group.The incidence of ICU delirium(DICU),duration of DICU,length of stay in NICU and the incidence of delirium-related adverse events were compared between the two groups.The degree of delirium and cognitive function before and after the intervention were compared between the two groups as well.Results The trial group had significantly shorter duration of DICU and NICU stay(both P<0.05)and lower incidence rate of delirium-related adverse events(P<0.05)compared to the control group.After the intervention,the trial group showed significantly lower scores on the intensive care delirium screening checklist(ICDSC)and significantly higher scores of cognitive function compared to those of the control group(both P<0.05).Conclusion The three-tier delirium nursing management process can lower the occurrence of delirium in NICU patients with acute stroke,shorten the NICU stay,reduce the safety risk in nursing,and improve the cognitive function.

Objective:To investigate the predictive factors of early neurological deterioration (END) in patients with single subcortical infarction (SSI).Methods:Consecutive patients with SSI within 12 h of onset admitted to the Department of Neurology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University from January 2016 to December 2021 were included retrospectively. The clinical and imaging data of the END and non-END groups were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Results:A total of 1 060 patients with SSI were included, of which 268 (25.28%) developed END. There were statistically significant differences in the infarct involving internal capsule on diffusion-weighted imaging, SSI classification, maximum diameter and classification of the infarcts, and the number of infarct layers between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that the infarct involved the internal capsule (odds ratio [ OR] 1.52, 95% confidence interval [ CI] 1.27-1.96; P=0.015), the maximum diameter of the infarct ( OR 1.33, 95% CI 1.12-1.42; P=0.023), proximal SSI ( OR 1.49, 95% CI 1.28-1.92; P=0.018), and the number of infarct layers (compared to 1 layer, 3 layers: OR 15.01, 95% CI 4.12-12.45, P=0.013; ≥ 4 layers: OR 15.42, 95% CI 5.67-18.43, P=0.004) were independent risk factors for END. Conclusion:Infarct involved internal capsule on diffusion-weighted imaging, larger diameter of the infarct, proximal SSI, and ≥3 layers of infarct may be predictive factors of the occurrence of END in patients with SSI.

DNMT3A encodes a DNA methyltransferase involved in development, cell differentiation, and gene transcription, which is mutated and aberrant-expressed in cancers. Here, we revealed that loss of DNMT3A promotes malignant phenotypes in lung cancer. Based on the epigenetic inhibitor library synthetic lethal screening, we found that small-molecule HDAC6 inhibitors selectively killed DNMT3A-defective NSCLC cells. Knockdown of HDAC6 by siRNAs reduced cell growth and induced apoptosis in DNMT3A-defective NSCLC cells. However, sensitive cells became resistant when DNMT3A was rescued. Furthermore, the selectivity to HDAC6 inhibition was recapitulated in mice, where an HDAC6 inhibitor retarded tumor growth established from DNMT3A-defective but not DNMT3A parental NSCLC cells. Mechanistically, DNMT3A loss resulted in the upregulation of HDAC6 through decreasing its promoter CpG methylation and enhancing transcription factor RUNX1 binding. Notably, our results indicated that HIF-1 pathway was activated in DNMT3A-defective cells whereas inactivated by HDAC6 inhibition. Knockout of HIF-1 contributed to the elimination of synthetic lethality between DNMT3A and HDAC6. Interestingly, HIF-1 pathway inhibitors could mimic the selective efficacy of HDAC6 inhibition in DNMT3A-defective cells. These results demonstrated HDAC6 as a HIF-1-dependent vulnerability of DNMT3A-defective cancers. Together, our findings identify HDAC6 as a potential HIF-1-dependent therapeutic target for the treatment of DNMT3A-defective cancers like NSCLC.

Objective:To construct a Discharge Preparation Service Demand Assessment Scale for Psychiatric Patients with Depression.Methods:Convenience sampling was used to select 25 experts from fields such as psychiatric nursing, psychiatric management, and rehabilitation treatment as the subject of the consultation. On the basis of literature review and clinical experience, the research group used the Delphi method to conduct two rounds of consultation with 25 experts, forming a Discharge Preparation Service Demand Assessment Scale for Psychiatric Patients with Depression. The enthusiasm of experts was evaluated using the effective response rate of the questionnaires. The authority level of experts was assessed using an authority coefficient. The concentration of expert opinions was evaluated using the mean of item importance assignment and coefficient of variation. The degree of coordination of expert opinions was represented by the Kendall coordination coefficient.Results:The effective response rates of the two rounds of consultation questionnaires were all 100%, with expert authority coefficients of 0.890 and 0.904, and the Kendall coordination coefficients of expert opinions of 0.247 and 0.203 ( P<0.05) . The Discharge Preparation Service Demand Assessment Scale for Psychiatric Patients with Depression was constructed, which included 10 dimensions and 38 items. Conclusions:The Discharge Preparation Service Demand Assessment Scale for Psychiatric Patients with Depression is scientific and reliable, which can provide a basis for clinical nurses to evaluate the discharge preparation service demands of psychiatric patients with depression.

Objective:To investigate the efficacy and safety of tirofiban in patients with acute ischemic stroke (AIS) with early neurological deterioration (END).Methods:Consecutive patients with AIS who had END and did not receive reperfusion treatment admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University within 24 h of onset from January 2017 to December 2022 were retrospectively included. END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale score within 72 h after onset compared at admission, or an increase of 1 in motor function. The tirofiban group was given tirofiban within 2 h after the occurrence of END, while the control group was given aspirin+clopidogrel. A score of ≤2 on the modified Rankin Scale at 90 d after onset was considered as a good outcome.Results:A total of 502 patients with AIS who had END were enrolled; including 322 males (64.14%) aged 65 ± 9 years. There was no statistically significant difference in baseline characteristics between the tirofiban group ( n=252) and the control group ( n=250). The good outcome rate of the tirofiban group at 90 d was significantly higher than that of the control group (60.32% vs. 42.00%; P<0.05), while there were no statistically significant differences in the incidence of symptomatic hemorrhagic transformation, asymptomatic hemorrhagic transformation, death and serious adverse events within 90 d. There were statistically significant differences in diabetes, atrial fibrillation, use of tirofiban, and the classification of stroke etiology between the good outcome group and the poor outcome group ( P<0.05). Multivariate logistic regression analysis showed that the use of tirofiban was an independent correlated factor for good outcome (odds ratio 0.33, 95% confidence interval 0.22-0.48; P<0.001). Conclusion:Tirofiban has good efficacy and safety for END in patients with AIS who did not received reperfusion therapy.

Neuroblastoma is the most common extracranial solid tumor for infants and young children.About 50% of patients have extensive metastasis before diagnosis, and the neuroblastoma can metastasize to bone marrow, bone, lymph node, orbit, liver and skin.Bone marrow is the most common site of neuroblastoma metastasis and recurrence.Once neuroblastoma metastasize or relapse, their survival rate will reduce significantly.The mechanism of neuroblastoma bone marrow metastasis has not been elucidated.The drug resistance of tumor cells, the interaction of bone marrow microenvironment, and the regulation of cell signaling pathways may play important roles in regulating tumor cell bone marrow metastasis.This review summarizes the research progress of bone marrow metastasis in neuroblastoma, which helps us to better understand the mechanism of interaction between neuroblastoma and the bone marrow microenvironment, and to provide new ideas for the diagnosis and treatment of patients.

Objective:To investigate the correlation between fibrinogen and lipoprotein (a) and early neurological deterioration (END) in acute ischemic stroke patients with diabetes.Methods:From January 2017 to December 2020, patients with acute ischemic stroke admitted to the Department of Neurology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University within 48 h of onset were enrolled retrospectively. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 d after onset increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Demographic and baseline clinical data were collected. Multivariate logistic regression analysis was used to identify the independent risk factors for END in general and diabetic patients with acute ischemic stroke. Results:A total of 1 504 patients with acute ischemic stroke were enrolled. Two hundred and fifty-two (16.76%) patients had END. The age, baseline NIHSS score, random blood glucose, fibrinogen, lipoprotein (a) levels, and the proportion of patients with diabetes in the END group were higher than those in the non-END group. There were also significant differences in various stroke etiologic subtypes between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that fibrinogen and lipoprotein (a) levels were not the independent risk factors for END in patients with acute ischemic stroke. Three hundred and thirty-seven patients also had diabetes mellitus, of which 85 had END (25.22%). The levels of fibrinogen and lipoprotein (a) in the END group were significantly higher than those in the non-END group ( P<0.05). Multivariate logistic regression analysis showed that fibrinogen (odds ratio 2.23, 95% confidence interval 1.75-4.54; P=0.002) and lipoprotein (a) (odds ratio 1.98, 95% confidence interval 1.57-3.65; P=0.003) were the independent risk factors for END in acute ischemic stroke patients with diabetes. Conclusion:Higher fibrinogen and lipoprotein (a) levels are associated with END in acute ischemic stroke patients with diabetes.

Objective To understand the training effect and discuss psychiatric nurse specialists training′s influence on the core competence and scientific research ability by investigating the working status of psychiatric nurse specialists with the Chinese Nursing Association certification, and in order to improve the quality of the psychiatric nurse specialists training experience. Methods 100 nurses who participated in the Chinese Nursing Association psychiatric nurse specialists training from 2010 to 2014 were chosen by random number table method. Surveyed with their core competence and scientific research ability after training to understand their working status. Results Eighty-eight valid questionnaires were recovered. Scores in core competence of nurses after training were 2.78 ± 0.55, which in the medium level;education background was the main influencing factor of core competence (t=-2.891, P<0.01). Average scientific research ability scores were 1.74 ± 0.88, which was in low level;education background and title were main influencing factors of scientific research ability (t=-3.310, F=5.922, P<0.01). After training, 62.5%(55/88) psychiatric specialist nurses undertook clinical and nursing work the night shift. 82.9%(73/88) of specialist nurse after back to the unit to undertake the teaching work. 52.2% (46/88) psychiatric specialist nurses carried out the scientific research work, and a total of 33 articles published. 79.5%(70/88) of specialist nurses thought hospital for junior nurses more seriously, 35.2% (31/88) of psychiatric specialist nurses′ units carried out the follow-up training. 6.8% (6/88) of hospital tilted in wages reward about nurse specialist, 18.2% (16/88) of hospital tilted in the cut about nurse specialist. Conclusions After training,psychiatric nurses play an important role in clinical care, research, teaching and other work, but their core competencies and research capabilities should to be improved by the further training of the hospital. Although the hospital attaches great importance to specialist nurses, but in the wage awards and title do not tilt.