This study summarized the nursing experience of midline catheter insertion in 12 patients with a body mass index≥50,providing clinical references.Key nursing interventions included:pre-insertion patient positioning was adjusted to semi-Fowler's or sitting position based on respiratory status.The puncture sites were chosen at the middle or distal third of the upper arm with elbow flexion.The widened tourniquets and extended-length needles/catheter sheaths were used according to vascular depth and puncture angle.The modified pre-insertion length measurement and real-time ultrasound-guided vascular puncture were applied.The catheter with crisscross elastic bandage was secured post-insertion.All 12 patients successfully underwent catheterization,with devices removed after completing intravenous therapy and blood sampling.

OBJECTIVE To investigate the current status of etiological submission for hospitalized patients in hospi-tals of a city before the antimicrobial treatment so as to provide basis for the etiological submission.METHODS From Jan.2022 to Dec.2022,a questionnaire survey was conducted for the status of etiological submission before antimicrobial treatment in 32 secondary and tertiary medical institutions of Huaian by Huaian Nosocomial Infection Management Quality Control Center.RESULTS The data from 28 hospitals were analyzed.Less awareness of sub-mission of healthcare workers and incomplete items for etiological test were the major influencing factors for the etiological submission.85.71％(24)of the hospitals have embedded the common names of antimicrobial drugs in-to the medical order system,and only 42.86％of the hospitals had the prompts for etiological submission in the information systems.A great deal of hospitals failed to execute the etiological submission and capture time for use of antibiotics according to national standards,only 5 hospitals met the standards for the capture[executing by scanning on personal digital assistant(PDA)].The majority of the hospitals only carried out'microbial culture and drug susceptibility testing',and there was deficiency in the test items.The diagnosis-related etiological submission rate of the tertiary hospitals was(87.49±10.77)％,higher than(64.45±30.59)％of the secondary hospitals(t=-2.250,P=0.036).The etiological submission rate before the antimicrobial treatment and the etiological submis-sion rate before the combined use of key drugs were higher in the tertiary hospitals than in the secondary hospi-tals,and there were no significant differences.CONCLUSIONS The hospitals vary in degree of execution of etiolog-ical submission before the antimicrobial treatment,and the secondary hospitals achieve lower effect on manage-ment than the tertiary hospitals.It is necessary for the medical institutions to carry out the etiological submission scientifically according to the standards so as to facilitate the reasonable use of antibiotics.

OBJECTIVE To investigate the current status of etiological submission for hospitalized patients in hospi-tals of a city before the antimicrobial treatment so as to provide basis for the etiological submission.METHODS From Jan.2022 to Dec.2022,a questionnaire survey was conducted for the status of etiological submission before antimicrobial treatment in 32 secondary and tertiary medical institutions of Huaian by Huaian Nosocomial Infection Management Quality Control Center.RESULTS The data from 28 hospitals were analyzed.Less awareness of sub-mission of healthcare workers and incomplete items for etiological test were the major influencing factors for the etiological submission.85.71％(24)of the hospitals have embedded the common names of antimicrobial drugs in-to the medical order system,and only 42.86％of the hospitals had the prompts for etiological submission in the information systems.A great deal of hospitals failed to execute the etiological submission and capture time for use of antibiotics according to national standards,only 5 hospitals met the standards for the capture[executing by scanning on personal digital assistant(PDA)].The majority of the hospitals only carried out'microbial culture and drug susceptibility testing',and there was deficiency in the test items.The diagnosis-related etiological submission rate of the tertiary hospitals was(87.49±10.77)％,higher than(64.45±30.59)％of the secondary hospitals(t=-2.250,P=0.036).The etiological submission rate before the antimicrobial treatment and the etiological submis-sion rate before the combined use of key drugs were higher in the tertiary hospitals than in the secondary hospi-tals,and there were no significant differences.CONCLUSIONS The hospitals vary in degree of execution of etiolog-ical submission before the antimicrobial treatment,and the secondary hospitals achieve lower effect on manage-ment than the tertiary hospitals.It is necessary for the medical institutions to carry out the etiological submission scientifically according to the standards so as to facilitate the reasonable use of antibiotics.

This study summarized the nursing experience of midline catheter insertion in 12 patients with a body mass index≥50,providing clinical references.Key nursing interventions included:pre-insertion patient positioning was adjusted to semi-Fowler's or sitting position based on respiratory status.The puncture sites were chosen at the middle or distal third of the upper arm with elbow flexion.The widened tourniquets and extended-length needles/catheter sheaths were used according to vascular depth and puncture angle.The modified pre-insertion length measurement and real-time ultrasound-guided vascular puncture were applied.The catheter with crisscross elastic bandage was secured post-insertion.All 12 patients successfully underwent catheterization,with devices removed after completing intravenous therapy and blood sampling.

Capsular warning syndrome (CWS) is a rare clinical syndrome characterized by recurrent and transient episodes of focal neurological deficits. Patients with CWS are at high risk of developing infarction. However, the exact physiological mechanism of CWS remains unclear. This paper presents an imaging assessment of penetrating arteries in the context of CWS using advanced time-of-flight magnetic resonance angiography and high resolution magnetic resonance imaging. This case reveals atherosclerosis of the lenticulostriate artery as a potential etiological factor contributing to CWS.

Objective To investigate the current status of off-label drug use(OLDU)management in tertiary hospitals of Guizhou province and to provide baseline evidence for developing a unified administration regulation for OLDU in Guizhou province.Methods In line with the relevant policies and regulations,a questionnaire including basic information about the person filling out the form,basic information about the hospitals,and information about OLDU was developed.The questionnaire was sent to 84 tertiary hospitals in Guizhou province through the Wenjuanxing.Results A total of 84 questionnaires were distributed and recovered,with a response rate of 100.00%.Of the 84 hospitals,77 had OLDU,of which 68(88.31%)had established a management system for OLDU.Among the 77 hospitals with OLDU,65(84.42%),42(54.55%),58(75.32%),36(46.75%),15(19.48%),and 21(27.27%)hospitals respectively,required approval from the Committee on Drug Administration and Pharmacotherapy before OLDU,restricted the qualifications of doctors prescribing OLDU,required informed consent from patients or their families before OLDU,recorded the matters and reasons in the medical records of patients treated with OLDU,followed up patients in their files and evaluated the reasonableness of the OLDU,and carried out special reviews for OLDU.Only 30(38.96%)hospitals have set up a catalogue of OLDUs,and 58(75.32%)hospitals have urgent needs to set up a unified provincial catalogue of OLDUs.Conclusion The pharmacy administration level of OLDU in tertiary hospitals of Guizhou province is relatively low,so there is an urgent need to establish a unified OLDU management system and medication catalog.

Objective To investigate the appropriate venous access for obese patients undergoing metabolic and bariatric surgery by comparing the clinical outcomes of different lengths of peripheral intravenous catheters.Methods Inpatients who underwent bariatric surgery in a tertiary hospital in Zhejiang from August 2022 to December 2022 were selected as the study population using a fixed-point continuous convenience sampling method.A stratified block randomisation method was used to divide the group into an experimental group 1(mini-midline catheters),an experimental group 2(midline catheters)and a control group(short peripheral intravenous catheters,Short PIVCs).The incidence of catheter-related complications,the rate of extubation due to complications,the duration of catheter retention,the time to first catheter-related complication were compared in the 3 groups.Results A total of 186 patients were included,with 62 patients in each group.The overall incidence of catheter-related complications in experimental group 1,experimental group 2,and control group were 25.81％,8.06％,and 58.06％.The extubation rates due to complications were 19.35％,4.84％,and 41.94％,and the duration of catheter retention was 7.00(6.00,7.00)d,7.00(6.00,7.00)d,6.00(3.00,6.25)d.The differences were statistically different(P＜0.05)when comparing the 3 groups.Among them,the differences in the overall incidence of catheter-related complications and the rate of extubation due to complications were statistically significant when comparing experimental group 1 with the control group,experimental group 2 with the control group,and experimental group 1 with experimental group 2(P＜0.017);the duration of catheter retention in both experimental group 1 and experimental group 2 were higher than it in the control group,and the differences were statistically different(P＜0.017).Conclusion The complication rate of mini-midline catheters and midline catheters is lower than that of short ones,and the indwelling time is consistent with the perioperative period of metabolic and bariatric surgery,which is suitable for use in patients undergoing metabolic and bariatric surgery.

Aminopeptidase A (Pep A) is a metal-dependent enzyme that specifically hydrolyze peptides with the N-terminal amino acids glutamic acid (Glu) and aspartic acid (Asp). A possible application of PepA is the hydrolysis of Glu/Asp-rich food proteins such as wheat gluten and casein, increasing the flavor and solubility of food protein. In the present study, the gene encoding a Pep A from Lactococcus lactis ssp. lactis IL1403 was synthesized and introduced into Pichia pastoris GS115 (His4). Lc-Pep A was successfully expressed and secreted to the culture medium, followed by identification and purification to homogeneity. Characteristics study demonstrated that Lc-Pep A could specifically hydrolyze the substrates Glu-pNA and Asp-pNA with similar catalytic activity, and this was further confirmed by the kinetics parameters measured. Additionally, Lc-Pep A showed a broad thermostability and pH stability with an optimum temperature of 60 ℃ and an optimum pH of 8.0. The enzyme activity of Lc-Pep A was activated by metal ions Co²⁺, Mn²⁺, and Zn²⁺ but was strongly inhibited by Ni²⁺and Cu²⁺. The routine proteinase inhibitor had no effect on the activity of Lc-Pep A. However, Lc-Pep A was strongly inhibited by the metallopeptidase inhibitor, EDTA, and disulfide bond-reducing agents. The study may facilitate production and application of Lc-Pep A.
Glutamyl Aminopeptidase ; Lactococcus lactis/genetics* ; Biological Transport ; Culture Media ; Glutamic Acid

Objective:To analyze the clinical characteristics of monkeypox patients.Methods:The clinical data and laboratory findings of 4 patients with monkeypox patients diagnosed at Yiwu Central Hospital in July 2023 were analyzed. Herpes fluid and skin tissue samples were collected, the viruses were isolation and cultured in African green monkey kidney cells (Vero) and identified with whole gene sequencing.Results:All four patients were male, aged 24-35 years. All patients had male-to-male behavior within 21 days before onset of the disease. Among them, one patient has AIDS and one patient has syphilis. Four patients presented with perineal skin lesions with itching, and 3 patients were found to have enlarged lymph nodes upon admission. Laboratory testing: lymphocyte abnormality (4.57×10 9/L) in 1 case; increased procalcitonin (0.25 ng/mL) in 1 case; elevated IL-10 levels ( 7.11 ng/L and 9.42 ng/L) in 2 cases; increased IL-6 (66 ng/L) and IL-4 (3.24 ng/L) in 1 case, respectively. One case had abnormal myocardial zymogram with a elevated lactate dehydrogenase level of 313 U/L. The monkeypox virus was isolated from lesion tissue and herpes fluid, and the whole gene sequencing identified it as the B. 1.3 subtype of the IIb evolutionary branch, exhibiting typical pathological effects on Vero cells. Conclusion:The clinical manifestations of the 4 monkeypox patients confirmed in Zhejiang province are mild, patients had a definitive history of male-to-male sexual behavior and the virus strains belong to the B. 1.3 lineage of the IIb evolutionary branch.

Acetaminophen (APAP) overdose is a major cause of liver injury. Neural precursor cell expressed developmentally downregulated 4-1 (NEDD4-1) is an E3 ubiquitin ligase that has been implicated in the pathogenesis of numerous liver diseases; however, its role in APAP-induced liver injury (AILI) is unclear. Thus, this study aimed to investigate the role of NEDD4-1 in the pathogenesis of AILI. We found that NEDD4-1 was dramatically downregulated in response to APAP treatment in mouse livers and isolated mouse hepatocytes. Hepatocyte-specific NEDD4-1 knockout exacerbated APAP-induced mitochondrial damage and the resultant hepatocyte necrosis and liver injury, while hepatocyte-specific NEDD4-1 overexpression mitigated these pathological events both in vivo and in vitro. Additionally, hepatocyte NEDD4-1 deficiency led to marked accumulation of voltage-dependent anion channel 1 (VDAC1) and increased VDAC1 oligomerization. Furthermore, VDAC1 knockdown alleviated AILI and weakened the exacerbation of AILI caused by hepatocyte NEDD4-1 deficiency. Mechanistically, NEDD4-1 was found to interact with the PPTY motif of VDAC1 through its WW domain and regulate K48-linked ubiquitination and degradation of VDAC1. Our present study indicates that NEDD4-1 is a suppressor of AILI and functions by regulating the degradation of VDAC1.