Objective:To explore the value of bedside lung ultrasound in the early diagnosis and severity assessment of ventilator-associated pneumonia (VAP).Methods:A prospective observational study was conducted in 60 patients with VAP (VAP group) and 62 patients without VAP (control group) who were admitted to department of intensive care unit of General Hospital of Ningxia Medical University from September 2018 to July 2020. The gender, age and underlying diseases of non-VAP group were matched with VAP group. The general clinical data such as gender, age, underlying diseases, department source of the patient, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score were recorded. The body temperature, white blood cell count (WBC), procalcitonin (PCT), oxygenation index (PaO 2/FiO 2), alveolar artery oxygen differential pressure (P A-aDO 2) were recorded. During mechanical ventilation, the patient's body temperature, WBC, sputum characteristics, and the change of the lung ultrasound were dynamically observed. With or without dynamic air bronchogram, lung ultrasound was considered to be positive as long as there were small subpleural consolidation or tissue-like sign. Ventilator-associated pneumonia lung ultrasound score (VPLUS) and lung ultrasound score (LUSS) were performed, and chest CT scan was completed on the same day. Use positive chest CT scan as the standard to evaluate the diagnostic efficacy of lung ultrasound, VPLUS score, and the combination of the two with PCT for VAP. LUSS was used to assess the severity of disease in patients with VAP. The correlation between LUSS and PaO 2/FiO 2, P A-aDO 2, APACHEⅡscore and SOFA score were analyzed. Results:① General information: compared with non-VAP group, VAP group had more emergency surgery patients [51.7% (31/60) vs. 33.9% (21/62), P = 0.047], APACHEⅡ score and SOFA score were significantly higher (APACHEⅡscore: 15.4±5.7 vs. 13.4±3.4, P = 0.021; SOFA score: 8.8±4.2 vs. 6.3±3.3, P < 0.001), body temperature tended to rise (℃: 38.3±0.8 vs. 38.0±0.9, P = 0.054), more patients had airway purulent secretions [65.0% (39/60) vs. 41.9% (26/62), P = 0.011], and mechanical ventilation time and length of ICU stay were longer [mechanical ventilation time (days): 10.5 (6.6, 15.0) vs. 4.3 (3.0, 6.0), P < 0.001; length of ICU stay (days): 14.8 (9.0, 18.0) vs. 6.0 (4.0, 9.1), P < 0.001], 28-day mortality rate was higher [31.7% (19/60) vs. 9.7% (6/62), P = 0.003].② Diagnostic efficacy evaluation: when lung ultrasound was positive, VPLUS≥3 and PCT > 0.5 μg/L were used separately for the diagnosis of VAP, the sensitivity was 73.3%, 75.0%, 61.7%, respectively; the specificity was 80.6%, 58.1% and 59.7%, respectively; the 95% confidence interval (95% CI) was 0.685-0.842, 0.574-0.748, 0.514-0.694, respectively, all P < 0.05, positive lung ultrasound had good sensitivity and specificity. When positive lung ultrasound or VPLUS≥3 were combined with PCT > 0.5 μg/L for tandem test, the specificity of VAP diagnosis was increased to 95.2% and 83.9%, respectively; but the specificity of VAP diagnosis of positive lung ultrasound combined with PCT > 0.5 μg/L was higher than VPLUS ≥3 combined with PCT > 0.5 μg/L (95.2% vs. 83.9%, P < 0.05).③ Correlation analysis: LUSS showed a significant positive correlation with APACHEⅡ and SOFA score ( r values were 0.407, 0.399, P values were 0.001, 0.002, respectively), LUSS had no relation with PaO 2/FiO 2 and P A-aDO 2 ( r values were 0.189, -0.064, P values were 0.629, 0.149, respectively). Conclusions:Lung ultrasound can early detect VAP , and its diagnostic specificity is significantly improved when combined with PCT > 0.5 μg/L. LUSS is closely related to the severity of disease in VAP patients, therefore, lung ultrasound may be an effective method for early diagnosis and efficacy evaluation of VAP patients.

Abstract Objective　To explore the clinical status and correlation of ruminant thinking and sleep quality in isolated population during the COVID-19 epidemic. Methods　Insomnia Severity Index Scale （ISI） and Rumination Thinking Scale （RRS） were used to investigate 107 persons in a centralized isolation site in Deyang，Sichuan. Results　The detection rate of insomnia among isolated personnel was 37.4%. Correlation analysis showed that the total score of the RRS was positively correlated with the ISI （r=0.468，P<0.05）；the repeated deep thinking was positively correlated with the ISI （r=0.35，P<0.05）；the compulsive thinking dimension was positively correlated with the sleep ISI （r=0.382，P<0.05）；the depression-related dimension was positively correlated with the ISI （r=0.468，P<0.05）. Multivariate Logistic regression analysis showed that marriage was a risk factor for sleep disturbance （P<0.05）；however，increasing age was a protective factor （P<0.05）. Conclusion　Quarantined people are prone to sleep disorders during the epidemic，and ruminant thinking is strongly positively related to sleep disorders. For public health emergencies，improving ruminant thinking may have important research value for regulating sleep disorders.

Objective: Toexplore work process-oriented theory nursing ward round, research work process-oriented theory nursing ward round on critical thinking capacity of nursing undergraduates. Methods: Totally 80 Elective nursing ward round courses of nursing undergraduates were divided into the experimental A group and the experimental b group with 40 cases in each group. The experimental A group select the beginning of 9 weeks on Until, the experimental B group select the after of 9 weeks on Until. The nursing undergraduates were assessed by CTDI-CV on first, ninth, eighteenth weeks to evaluate the effect of the two groups. Results: Main effect of group factor and time factor of CTDI-CV had statistical significance (P<0.05) . There were significant interaction in the scores of CTDI-CV. Simple effect analysis demonstrated the scores of CTDI-CV in the experimental A group were higher than those of the experimental b group after the intervention (P<0.05) . Two groups of on first, ninth, eighteenth weeks measured values compared the effect of amount of F_B<F_A, the experimental group A intervention effect was better than in the experimental group B intervention. Conclusions For nursing undergraduates guided based on the working process of the curriculum of nursing ward round the critical thinking ability had good practice guidance, and on the start time to choose university grade three semester two on 9 weeks before commencement of nursing undergraduates promotes higher critical thinking ability.

Objective To observe the effect of sequential therapy of butylphthalide injection and soft capsules for acute cerebral infarction and its influence on plasma lipoprotein phospholipase A2.Methods 120 patients with cerebral infarction were selected in the study,and they were divided into observation group (64 cases) and control group(56 cases) according to the digital table.The control group received conventional therapy plus placebo,the observation group received the sequential administration of butylphthalide injection and butylphthalide soft capsule treatment based on the conventional treatment.Before and after treatment,the plasma lipoprotein phospholipase A2 of the two groups was detected,and the National Institutes of Health Stroke Scale (NIHSS) was evaluated,compared neurological deficit improvement between the two groups and recorded adverse drug reactions of the two groups.Results There were no significant differences in NIHSS score and plasma lipoprotein phospholipase A2 level between the two groups before treatment(all P ＞ 0.05).After treatment,the NIHSS score of neurological impairment,plasma lipoprotein phospholipase A2 level in the observation group were (6.40 ± 5.22) points,(203.26 ± 29.33) ng/mL,those in the control group were (8.59 ± 6.22) points,(253.10 ± 52.99) ng/mL,the differences were statistically significant(t =-1.36,-2.089,P =0.039,0.000).The total effective rate of the observation group was 90.6％,which was higher than 67.9％ of the control group,the difference was statistically significant (x2 =9.676,P =0.002).The incidence rate of adverse reactions was similar in the two groups (P ＞ 0.05).Conclusion Sequential therapy of butylphthalide for acute cerebral infarction can improve the neurological function,decrease the level of plasma lipoprotein phospholipase A2,inhibit the inflammation of blood vessels,improve the prognosis of patients.

Objective To investigate the molecular mechanism of the inhibitory effects of rhizoma coptidis on multi-drug resistant uropathogenic Escherichia coli.Methods High-throughput RNA sequencing ( RNA-seq ) was performed to investigate the transcriptome in a multi-drug resistant uropathogenic Escherichia coli strain (NB8) treated with water decoction of rhizoma coptidis .Agar dilution test was used to determine the minimal inhibitory concentration ( MIC) of water decoction of rhizoma coptidis against the NB 8 strain.A growth curve was drawn to evaluate the effects of water decoction of rhizoma coptidis on the growth of NB8 strain.Total RNAs were extracted from the NB 8 strain after treated with the water decoction of rhizo-ma coptidis for 30 minutes and then synthetized to cDNA by reverse transcription after screening out the rRNAs.The HiSeq 2000 sequencing system was used for transcriptome sequencing .The TopHat software was used to map and analyze the RNA-Seq reads, and then Cufflinks was run to assemble transcripts and es-timate their abundances .The differential expression , GO enrichment and KEGG metabolic pathway were fur-ther analyzed .The NB8 strain dealt with normal saline was used as negative control .Results The MIC of water decoction of rhizoma coptidis to NB 8 strain was 12.5 mg/ml.There were 3665 genes expressed in NB8 strain treated with water decoction of rhizoma coptidis and 3430 genes expressed in NB8 strain treated with normal saline .The number of differentially expressed genes was 1428 including 921 up-regulated genes and 507 down-regulated genes .Those differentially expressed genes mainly enriched in the modules of binding and catalysis.The genes concerning cell adhesion , apoptosis and multicellular process were up-regulated, while those concerning the regulation of enzyme activities were down-regulated.Results of the KEGG meta-bolic pathway enrichment analysis showed that the genes concerning synthetic pathway of LPS were signifi -cantly up-regulated as well as those encoding the repair polymerase Ⅲthat was involved in DNA replication . However , the genes concerning fatty acid metabolism , histidine metabolism , thiamine metabolism , folate metabolism and iron carrier in ribosome synthesis showed overall down-regulation.Conclusion The tran-scriptome in uropathogenic Escherichia coli strain treated with rhizoma coptidis was profiled .The main mo-lecular mechanism of the inhibitory effects of rhizoma coptidis on uropathogenic Escherichia coli was to de-stroy the cell wall of Escherichia coli, affect the replication of DNA and regulate the transcription and transla-tion of proteins .This study illustrated that the inhibitory effects of rhizoma coptidis on uropathogenic Esche-richia coli were achieved in multiple levels .

Objective To analyze the clinical manifestations of familial acute necrotizing encephalopathy (ANE)and to improve the recognition of this disease. Methods The clinical data of a 25 - month - old girl with fa-milial and recurrent ANE with evidence of mutation in the RANBP2 gene were collected and analyzed,and the gene examination of their family members was performed. Results A previously healthy girl experienced recurrent ANE epi-sodes at the ages of 8 months,18 months and 25 months,respectively. At each beginning of each episodes the patient presented with lethargy and tremor of limbs following febrile illness of 3 - 4 days,even developed coma and convulsions in the last time. Brain magnetic resonance imaging showed bilateral and high T2 signal changes in thalamus,cerebellum and hippocampus. Abnormal signals also appeared in the brainstem,claustrum,corpus scallosum and cortex(temporal, parietal and cingulate)also appeared abnormal signals. Spinal MRI showed spinal cord involvement. The girl recovered after her first episode;she could speak but could not walk steadily after the second time;after the third episode,al-though she regained consciousness from coma,she could no longer speak or walk. The patient's sister died of encephali-tis at the age of 18 months. Her paternal uncle had suffered from dysnoesia from meningitis at his 17 months of age. The patient and her grandmother,father,uncle and one of her aunts harbored a mutation(c. 1754C ﹥ T)in RANBP2 gene. Conclusions Familial ANE has typical clinical manifestations and characteristic MRI findings. The patient with recur-rent history,especially with positive family history,should have the mutation in RANBP2 gene detected earlier in order to clarify the diagnosis of ANE.

Adolescent ; Adult ; Female ; Fusion Proteins, bcr-abl ; genetics ; Gene Expression ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; genetics ; Leukemia, Myeloid ; genetics ; Male ; Oncogene Proteins, Fusion ; genetics ; Retrospective Studies

BACKGROUNDSignificant efforts have been made to identify factors that differentiate patients treated with novel therapies, such as bortezomib in multiple myeloma (MM). The exact expression pattern and prognostic value of the cancer/testis antigen preferentially expressed antigen of melanoma (PRAME) in MM are unknown and were explored in this study.

METHODSThe transcript level of PRAME was detected in bone marrow specimens from 100 newly diagnosed MM patients using real-time quantitative polymerase chain reaction, and the prognostic value of PRAME was determined through retrospective survival analysis. PRAME expression higher than the upper limit of normal bone marrow was defined as PRAME overexpression or PRAME (+).

RESULTSSixty-two patients (62.0%) overexpressed PRAME. PRAME overexpression showed no prognostic significance to either overall survival (n = 100) or progression-free survival (PFS, n = 96, all P > 0.05) of patients. The patients were also categorized according to regimens with or without bortezomib. PRAME overexpression tended to be associated with a lower two-year PFS rate in patients treated with non-bortezomib-containing regimens (53.5% vs. 76.9%, P = 0.071). By contrast, it was not associated with the two-year PFS rate in patients with bortezomib-containing regimens (77.5% vs. 63.9%, P > 0.05). When the patients were categorized into PRAME (+) and PRAME (-) groups, treatment with bortezomibcontaining regimens predicted a higher two-year PFS rate in PRAME (+) patients (77.5% vs. 53.5%, P = 0.027) but showed no significant effect on two-year PFS rate in PRAME (-) patients (63.9% vs. 76.9%, P > 0.05).

CONCLUSIONPRAME overexpression might be an adverse prognostic factor of PFS in MM patients treated with non-bortezomib-containing regimens. Bortezomib improves PFS in patients overexpressing PRAME.

Adult ; Aged ; Aged, 80 and over ; Antigens, Neoplasm ; metabolism ; Boronic Acids ; therapeutic use ; Bortezomib ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; drug therapy ; metabolism ; mortality ; Pyrazines ; therapeutic use ; Real-Time Polymerase Chain Reaction ; Young Adult

ABSTRACT:Objective To discuss the risk factors of ICU patients with catheter-associate-durinary tract infection (CAUTI)so as to provide scientific basis for effective nursing measures. Methods ICU patients from April 2012 to March 2014 in our hospital were monitored,and in-dwelling catheter chances,indwelling catheter days,maintenance of urinary catheter,perineum nursing,the urine property,urine culture results were observed.Results 92 cases of urinary tract infection occurred in 1421 urinary catheter indwelling patients.Patients in emergency department with indwelling catheter more than 7 days and perineum nursing less than 2 times a day had more risk factors of urinary tract infection (P <0.05).A total of 153 pathogenic bacteria were separated in 92 patients.Among these pathogenic bacteria,23 cases were multiple drug-resistant bacteria. The top three pathogens were 17.65% of klebsiella,15.69% of candidaalbicans and 9.80% of es-cherichia coli.Conclusion Effective nursing strategies are to shorten the urine tube indwelling time,improve the technique of emergency patients with catheter,correctly maintain urine tube,en-sure the drainage device sealability,strengthen the perineum nursing,apply multiple drug-resis-tant bacteria isolation measures so as to prevent catheter-associated urinary tract infection.

ABSTRACT:Objective To discuss the risk factors of ICU patients with catheter-associate-durinary tract infection (CAUTI)so as to provide scientific basis for effective nursing measures. Methods ICU patients from April 2012 to March 2014 in our hospital were monitored,and in-dwelling catheter chances,indwelling catheter days,maintenance of urinary catheter,perineum nursing,the urine property,urine culture results were observed.Results 92 cases of urinary tract infection occurred in 1421 urinary catheter indwelling patients.Patients in emergency department with indwelling catheter more than 7 days and perineum nursing less than 2 times a day had more risk factors of urinary tract infection (P <0.05).A total of 153 pathogenic bacteria were separated in 92 patients.Among these pathogenic bacteria,23 cases were multiple drug-resistant bacteria. The top three pathogens were 17.65% of klebsiella,15.69% of candidaalbicans and 9.80% of es-cherichia coli.Conclusion Effective nursing strategies are to shorten the urine tube indwelling time,improve the technique of emergency patients with catheter,correctly maintain urine tube,en-sure the drainage device sealability,strengthen the perineum nursing,apply multiple drug-resis-tant bacteria isolation measures so as to prevent catheter-associated urinary tract infection.