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 explore related influencing factors for postoperative delirium in elderly patients, to provide a reference for the prevention and treatment. Methods Fifty-four patients with delirium after surgery were used as observa?tion group, and a total of 150 subjects with no delirium after surgery during the same period were selected as the control group. Data of age, gender, malnutrition, disorders of water and electrolyte metabolism, postoperative mechanical ventilation, postoperative hypoxemia, severe infection and postoperative pain degree, and the combination of basic diseases were com?pared and analysed between two groups. The binary logistic regression analysis was used to analyse the influencing factors of postoperative delirium. The outcome and prognosis were observed and analyzed in observation group. Results The average age was significantly higher in observation group than that of control group (P<0.05). The percentages of postoperative hy?poxemia and severe infection were significantly higher in observation group than those of control group ( P<0.05). Patients with higher age, postoperative hypoxemia and severe infection were risk factors for postoperative delirium. In observation group,1 case died of lung infection, 1 case died of multiple organ failure, the remaining 52 patients were improved and dis?charged from hospital after three months. Conclusion For patients with higher age, postoperative hypoxemia and severe in?fection are the risk factors for occurrence of postoperative delirium. More attention should be paid to clinical preoperative and postoperative periods.

Objective To explore the application effects of the innovative nursing practice in the patients with the uterine fibroid surgery based on the concept of homogeneous medical treatment was investigated in the study.Methods Two hundred and twenty patients with the uterine fibroid surgery in our hospital before (from October 201 4 to March 201 5 ) and after (from April 201 5 to September 201 5 ) the practice of homogeneous innovative nursing were included as the objects.The patients before the practice was included into control group (1 1 0 patients ) and the patients after the practice was included into experimental group (1 1 0 patients).The patients in the control group accepted the conventional nursing of the uterine fibroid surgery,while the patients in the experimental group accepted the innovative nursing based on the concept of homogenous medical treatment. The anxiety state, the mastery of health knowledge, the incidence of complications,the quality of life,the satisfaction rate of nursing of patients before and after the intervention were compared between two groups.Results The nursing effects (the anxiety state,the grasp of health knowledge, the incidence of complications)in the patients of the experimental group were significantly better than that in the control group (P <0.05).Three months after the intervention,the quality of life including social life,vigor, sleep,somatic movement,emotional response and pain in the experimental group was significantly better than that in the control group (P <0.05).Three months after the intervention,the satisfaction rate was 96.36% in the experimental group,which was significantly higher than that in the control group (86.36%)(P <0.05). Conclusions The nursing effects,the quality of life and the satisfaction rate are significantly improved when the innovative nursing model based on the concept of homogenous medical treatment is applied in the nursing practice of the patients with the uterine fibroid surgery.

Objective To analyze the application effect of pretreatment system for the risk factors of dysfunction in hemodialysis patients with arteriovenous fistula. Methods The pretreatment system for the risk factors of dysfunction was used in the maintenance practice of hemodialysis patients with arteriovenous fistula in our hospital since June 2014. Totally 50 patients undergoing maintenance hemodialysis from June 2013 to May 2014 in our hospital were selected as the control group, and 46 patients with similar practice from June 2014 to May 2015 were selected as the experimental group. The differences in related indexes between two groups after intervention were compared. Results The incidence of complications related to arteriovenous fistula, and the dysfunction rate of internal fistula in the experimental group were significantly lower than the control group. However, the score of quality of life in the experimental group was higher than that in the control group ( P<0. 05) . Conclusions The application of pretreatment system for the risk factors of dysfunction in hemodialysis patients with arteriovenous fistula can significantly reduce the incidence of complications and the risk of fistula dysfunction, and improve patients′quality of life.

The nitrate-N content in KNO3 solution and soil was rapidly predicted using techniques of mid-infrared spectroscopy, in which 15 NO-3 and 14 NO-3 were distinguished and predicted. The results showed that the characteristic band of nitrate in solution and soil was 1200-1500 cm-1 , and compared with 14 NO-3 , the red shift of characteristic band of 15 NO-3 was about 35 cm-1 . In the characteristic band of nitrate, absorption band increased with the nitrate nitrogen concentration with less interference absorption. The linear regression was made between the first principal component of characteristic band and nitrate-N content, and correlation coefficient was more than 0 . 9840 , indicating that the technique of mid-infrared attenuated total reflectance spectroscopy could be applied for rapid monitoring of nitrate in solution and soil. Meanwhile, based on the red shift characteristic of 15 NO-3 absorption band, the method of partial least squares were involved to predict the nitrate-N of different N-isotope labeled in solution and soil, resulting that all the prediction models reached excellent levels. For 14 NO3-N and 15 NO3-N in solution, the correlation coefficients ( R2 ) were 0. 9980 and 0. 9982 respectively, and ration performance to standard deviations ( RPD ) were 6. 44 and 4. 76, respectively. While for 14 NO3-N and 15 NO3-N in soil, the correlation coefficients ( R2 ) were 0. 9794 and 0. 9679, and RPD were 5. 75 and 4. 78, respectively. Therefore, the technique of mid-infrared attenuated total reflectance spectroscopy can be applied for rapid monitoring different N-isotope labeled nitrate in solution and soil, to provide a new in situ and fast time method to study nitrification process in soil.