Objective:To retrieve, evaluate, and summarize the best evidence on ultrasound-guided placement and tip confirmation of peripherally inserted central catheter (PICC) in neonates.Methods:Based on the "6S" evidence pyramid model, literature on ultrasound-guided placement and tip confirmation of PICC in neonates was sequentially searched on guideline websites, professional society websites, and journal databases. The search period was from database establishment to September 30, 2024. Two researchers used uniform criteria for independent quality assessment and evidence extraction from the literature, and the extracted evidence was integrated and summarized.Results:A total of ten articles were included, including five guidelines, one clinical decision, two expert consensus, one Meta-analysis, and one evidence summary. Thirty pieces of evidence were developed in six aspects: personnel qualification and training, catheter selection, assessment of placement veins, ultrasound-guided PICC puncture in neonates, PICC tip confirmation in neonates, and prevention and management of malposition.Conclusions:This study summarizes the best evidence for ultrasound-guided placement and tip confirmation of PICC in neonates. It is recommended that evidence be selected and applied to develop a standardized process for neonatal PICC placement in conjunction with the resource environment of the department and the skill level of the healthcare professionals to improve the quality of nursing and to ensure the safe and effective use of the PICC in clinical practice.

Objective:To develop a pre-processing workflow of real world data (RWD) derived from multicenter clinical laboratories so that the level of data standardization can be improved, and subsequently to produce more robust real world evidence (RWE).Methods:Purpose sampling was used to invite senior experts with experience in clinical research utilizing RWD, covering the fields of clinical laboratory, epidemiology, biostatistics, and clinical medicine. In-depth, semi-structured individual interviews were conducted and thematic analysis was used to analyze the collected data.Results:The in-depth interviews were completed in 16 experts. The experts unanimously agreed that pre-processing RWD derived from multicenter clinical laboratories is necessary prior to its application in research. Based on experts' insights, a comprehensive pre-processing workflow for RWD was constructed, comprising six key steps: ①developing a variable list based on research questions and distributing it to each clinical laboratory; ②conducting an initial quality assessment of RWD based on existing quality control results in clinical laboratories; ③cleaning the data; ④determining whether RWD (including categorical and continuous variables) is heterogeneity among different clinical laboratories; ⑤exploring potential sources of heterogeneity;⑥pre-processing RWD based on identified causes contributing to heterogeneity.Conclusion:The pre-processing workflow of RWD was established, to provide a methodological reference for controlling systematic errors in RWD derived from multicenter clinical laboratories, thereby enhancing the validity of RWE.

Objective To construct and implement a swallowing disorder assessment and management program for tracheal intubated patients after extubation based on the 4R crisis management theory,providing standardized and scientific interventions for oral feeding.Methods Utilizing the expert meeting method with the 4R crisis management theory framework,a swallowing disorder assessment and management program was developed for post-extubation tracheal intubated patients.A convenience sampling method was employed to select patients with tracheal intubations treated from July to December 2023 in the emergency ICU,central ICU,and cardiovascular surgery ICU of a tertiary hospital in Zhejiang Province.The patients treated from October to December were assigned to an experimental group(n=68),while those treated from July to September were designated as a control group(n=58).The experimental group received the 4R crisis management-based intervention,whereas the control group received standard ICU assessment and management.Outcomes indicators included the incidence of post-extubation swallowing disorders,time to first oral intake,incidence of aspiration during initial feeding,nasogastric and nasointestinal tube placement duration,incidence of aspiration pneumonia during hospitalization,re-intubation rates,ICU readmission rates,ICU stay duration,and total hospitalization days.Results Of the initially recruited subjects,68 in the experimental group and 54 in the control group were included in the final analysis.After the intervention,the experimental group exhibited significantly lower rates of post-extubation swallowing disorders,shorter time to first liquid oral intake,aspiration incidence during first feeding,shorter durations of nasogastric and nasointestinal tube placement,aspiration pneumonia,ICU readmission compared to the control group(P＜0.05).No significant differences were observed between the groups in time to first regular oral intake,re-intubation rates(P＞0.05).Conclusion The risk management program for dysphagia following tracheal extubation based on the 4R crisis management theory is scientifically robust and safe,offering a valuable reference for clinical assessments and management of swallowing and eating post-extubation in tracheal intubated patients.

Objective:To develop a pre-processing workflow of real world data (RWD) derived from multicenter clinical laboratories so that the level of data standardization can be improved, and subsequently to produce more robust real world evidence (RWE).Methods:Purpose sampling was used to invite senior experts with experience in clinical research utilizing RWD, covering the fields of clinical laboratory, epidemiology, biostatistics, and clinical medicine. In-depth, semi-structured individual interviews were conducted and thematic analysis was used to analyze the collected data.Results:The in-depth interviews were completed in 16 experts. The experts unanimously agreed that pre-processing RWD derived from multicenter clinical laboratories is necessary prior to its application in research. Based on experts' insights, a comprehensive pre-processing workflow for RWD was constructed, comprising six key steps: ①developing a variable list based on research questions and distributing it to each clinical laboratory; ②conducting an initial quality assessment of RWD based on existing quality control results in clinical laboratories; ③cleaning the data; ④determining whether RWD (including categorical and continuous variables) is heterogeneity among different clinical laboratories; ⑤exploring potential sources of heterogeneity;⑥pre-processing RWD based on identified causes contributing to heterogeneity.Conclusion:The pre-processing workflow of RWD was established, to provide a methodological reference for controlling systematic errors in RWD derived from multicenter clinical laboratories, thereby enhancing the validity of RWE.

Objective To construct and implement a swallowing disorder assessment and management program for tracheal intubated patients after extubation based on the 4R crisis management theory,providing standardized and scientific interventions for oral feeding.Methods Utilizing the expert meeting method with the 4R crisis management theory framework,a swallowing disorder assessment and management program was developed for post-extubation tracheal intubated patients.A convenience sampling method was employed to select patients with tracheal intubations treated from July to December 2023 in the emergency ICU,central ICU,and cardiovascular surgery ICU of a tertiary hospital in Zhejiang Province.The patients treated from October to December were assigned to an experimental group(n=68),while those treated from July to September were designated as a control group(n=58).The experimental group received the 4R crisis management-based intervention,whereas the control group received standard ICU assessment and management.Outcomes indicators included the incidence of post-extubation swallowing disorders,time to first oral intake,incidence of aspiration during initial feeding,nasogastric and nasointestinal tube placement duration,incidence of aspiration pneumonia during hospitalization,re-intubation rates,ICU readmission rates,ICU stay duration,and total hospitalization days.Results Of the initially recruited subjects,68 in the experimental group and 54 in the control group were included in the final analysis.After the intervention,the experimental group exhibited significantly lower rates of post-extubation swallowing disorders,shorter time to first liquid oral intake,aspiration incidence during first feeding,shorter durations of nasogastric and nasointestinal tube placement,aspiration pneumonia,ICU readmission compared to the control group(P＜0.05).No significant differences were observed between the groups in time to first regular oral intake,re-intubation rates(P＞0.05).Conclusion The risk management program for dysphagia following tracheal extubation based on the 4R crisis management theory is scientifically robust and safe,offering a valuable reference for clinical assessments and management of swallowing and eating post-extubation in tracheal intubated patients.

Objective:To retrieve, evaluate, and summarize the best evidence on ultrasound-guided placement and tip confirmation of peripherally inserted central catheter (PICC) in neonates.Methods:Based on the "6S" evidence pyramid model, literature on ultrasound-guided placement and tip confirmation of PICC in neonates was sequentially searched on guideline websites, professional society websites, and journal databases. The search period was from database establishment to September 30, 2024. Two researchers used uniform criteria for independent quality assessment and evidence extraction from the literature, and the extracted evidence was integrated and summarized.Results:A total of ten articles were included, including five guidelines, one clinical decision, two expert consensus, one Meta-analysis, and one evidence summary. Thirty pieces of evidence were developed in six aspects: personnel qualification and training, catheter selection, assessment of placement veins, ultrasound-guided PICC puncture in neonates, PICC tip confirmation in neonates, and prevention and management of malposition.Conclusions:This study summarizes the best evidence for ultrasound-guided placement and tip confirmation of PICC in neonates. It is recommended that evidence be selected and applied to develop a standardized process for neonatal PICC placement in conjunction with the resource environment of the department and the skill level of the healthcare professionals to improve the quality of nursing and to ensure the safe and effective use of the PICC in clinical practice.

Objective To explore the value of CT derived fractional flow reserve(CT-FFR)combined with pericoronary adipose tissue(PCAT)fat attenuation index(FAI)in predicting major adverse cardiac events(MACE)in patients with obstructive coronary heart disease(CHD).Methods A total of 149 patients with obstructive CHD who underwent coronary computed tomography angiography(CCTA)examination were analyzed retrospectively.The patients were divided into MACE group and non-MACE group according to the occurrence of MACE.The clinical data,CCTA characteristics,CT-FFR,PCAT volume and FAI differences between the two groups were compared.Multiple logistic regression analysis was used to screen the independent predictors of MACE.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was used to evaluate the efficiency of a single independent predictor and its joint prediction of MACE.Results CT-FFR≤0.8 and right coronary artery(RCA)FAI(RCA-FAI)were independent risk factors for MACE in patients with obstructive CHD.The AUC of CT-FFR≤0.8 and RCA-FAI to predict MACE in patients with obstructive CHD were 0.773 and 0.766,respectively,while of their combination was 0.865.Conclusion Compared with single imaging parameters,the combined imaging parameters of CT-FFR and RCA-FAI can significantly improve the predictive efficiency of MACE in patients with obstructive CHD.

Objective To investigate the impacts of polysaccharide from Ganoderma lucidum(PSG-1)on intestinal barrier function and Wnt/β-catenin signal pathway in rats with short bowel syndrome(SBS).Methods Fifty male SD rats were randomly divided into sham operation group,low dose PSG-1 group(25 mg?kg-1?d-1),medium dose PSG-1 group(50 mg?kg-1?d-1)and high dose PSG-1 group(100 mg?kg-1?d-1).SBS rat model was built,intestinal permeability of rats was detected,intestinal histopathology was observed with HE staining,and the bacterial translocation rate was calculated,the contents of inflammatory cytokines such as interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)were measured by ELISA,immunofluorescence was used to detect the expression and distribution of tight junction protein in ileum,Western blot was used to detect the expression of Wnt and β-catenin.Results Compared with the control group,the villi of ileum in SBS group were sparse,and the villi length,recess depth,Fluorescein isothiocyanate-dextran(FD-40)concentration,bacterial translocation rate(MLN,liver,spleen),levels of IL-6 and TNF-α were significantly increased,the levels of IL-10,Wnt,β-catenin,and the fluorescence densities and protein levels of claudin-1 and occludin were significantly decreased;compared with rats in SBS group,the FD-40 concentration,bacterial translocation rate(MLN,liver,spleen),levels of IL-6 and TNF-α in PSG-1 low,middle and high dose groups were significantly reduced,the villus length,recess depth,the levels of IL-10,Wnt,β-catenin,and the fluorescence densities and protein levels of claudin-1 and occludin were significantly increased.Conclusion PSG-1 may reduce inflammatory reaction and intestinal permeability and improve intestinal barrier dysfunction by activating the expression of Wnt/β-catenin pathway protein in SBS rats.

Objective To investigate the impacts of polysaccharide from Ganoderma lucidum(PSG-1)on intestinal barrier function and Wnt/β-catenin signal pathway in rats with short bowel syndrome(SBS).Methods Fifty male SD rats were randomly divided into sham operation group,low dose PSG-1 group(25 mg?kg-1?d-1),medium dose PSG-1 group(50 mg?kg-1?d-1)and high dose PSG-1 group(100 mg?kg-1?d-1).SBS rat model was built,intestinal permeability of rats was detected,intestinal histopathology was observed with HE staining,and the bacterial translocation rate was calculated,the contents of inflammatory cytokines such as interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)were measured by ELISA,immunofluorescence was used to detect the expression and distribution of tight junction protein in ileum,Western blot was used to detect the expression of Wnt and β-catenin.Results Compared with the control group,the villi of ileum in SBS group were sparse,and the villi length,recess depth,Fluorescein isothiocyanate-dextran(FD-40)concentration,bacterial translocation rate(MLN,liver,spleen),levels of IL-6 and TNF-α were significantly increased,the levels of IL-10,Wnt,β-catenin,and the fluorescence densities and protein levels of claudin-1 and occludin were significantly decreased;compared with rats in SBS group,the FD-40 concentration,bacterial translocation rate(MLN,liver,spleen),levels of IL-6 and TNF-α in PSG-1 low,middle and high dose groups were significantly reduced,the villus length,recess depth,the levels of IL-10,Wnt,β-catenin,and the fluorescence densities and protein levels of claudin-1 and occludin were significantly increased.Conclusion PSG-1 may reduce inflammatory reaction and intestinal permeability and improve intestinal barrier dysfunction by activating the expression of Wnt/β-catenin pathway protein in SBS rats.

The goal of this study was to investigate the regulatory effect of angiotensin converting enzyme 2 (ACE2) on cellular inflammation caused by avian infectious bronchitis virus (IBV) and the underlying mechanism of such effect. Vero and DF-1 cells were used as test target to be exposed to recombinant IBV virus (IBV-3ab-Luc). Four different groups were tested: the control group, the infection group[IBV-3ab-Luc, MOI (multiplicity of infection)=1], the ACE2 overexpression group[IBV-3ab Luc+pcDNA3.1(+)-ACE2], and the ACE2-depleted group (IBV-3ab-Luc+siRNA-ACE2). After the cells in the infection group started to show cytopathic indicators, the overall protein and RNA in cell of each group were extracted. real-time quantitative polymerase chain reaction (RT-qPCR) was used to determine the mRNA expression level of the IBV nucleoprotein (IBV-N), glycoprotein 130 (gp130) and cellular interleukin-6 (IL-6). Enzyme linked immunosorbent assay (ELISA) was used to determine the level of IL-6 in cell supernatant. Western blotting was performed to determine the level of ACE2 phosphorylation of janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3). We found that ACE2 was successfully overexpressed and depleted in both Vero and DF-1 cells. Secondly, cytopathic indicators were observed in infected Vero cells including rounding, detaching, clumping, and formation of syncytia. These indicators were alleviated in ACE2 overexpression group but exacerbated when ACE2 was depleted. Thirdly, in the infection group, capering with the control group, the expression level of IBV-N, gp130, IL-6 mRNA and increased significantly (P < 0.05), the IL-6 level was significant or extremely significant elevated in cell supernatant (P < 0.05 or P < 0.01); the expression of ACE2 decreased significantly (P < 0.05); protein phosphorylation level of JAK2 and STAT3 increased significantly (P < 0.05). Fourthly, comparing with the infected group, the level of IBV-N mRNA expression in the ACE2 overexpression group had no notable change (P > 0.05), but the expression of gp130 mRNA, IL-6 level and expression of mRNA were elevated (P < 0.05) and the protein phosphorylation level of JAK2 and STAT3 decreased significantly (P < 0.05). In the ACE2-depleted group, there was no notable change in IBV-N (P > 0.05), but the IL-6 level and expression of mRNA increased significantly (P < 0.05) and the phosphorylation level of JAK2 and STAT3 protein decreased slightly (P > 0.05). The results demonstrated for the first time that ACE2 did not affect the replication of IBV in DF-1 cell, but it did contribute to the prevention of the activation of the IL-6/JAK2/STAT3 signaling pathway, resulting in an alleviation of IBV-induced cellular inflammation in Vero and DF-1 cells.
Animals ; Chlorocebus aethiops ; Humans ; Interleukin-6/genetics* ; Janus Kinase 2/pharmacology* ; Infectious bronchitis virus/metabolism* ; STAT3 Transcription Factor/metabolism* ; Angiotensin-Converting Enzyme 2/pharmacology* ; Cytokine Receptor gp130/metabolism* ; Vero Cells ; Signal Transduction ; Inflammation ; RNA, Messenger