[Attention should be paid to sleep disorders in critically ill patients and its recognition and intervention]

The sleep deficiency and sleep disturbance of critically ill patients may result in adverse outcomes, negative effects on early rehabilitation, and may persist well beyond the intensive care unit (ICU). It has been paid more and more attention in clinical practice. The sleep problems of critically ill patients are associated with suffered critical illness, ICU environments, and coexisting sleep disorders before critical illness. Poor sleep quality, insufficient sleep duration, severe sleep fragmentation and irregular circadian rhythms during critical care illness have been extensively described. In addition, ICU patients have been specifically shown to experience atypical sleep and pathologic wakefulness. So the sleep in critical ill patients should be evaluated. Sleep can be evaluated by both subjective assessment and objective measurements, including polysomnography and actigraphy. According to individual situation, comprehensive, interdisciplinary, and personalized interventions, which include treating critical illness, improving ICU environment to reduce interference to sleep, nonpharmacological treatment to relax and stabilize sleep, and treating coexisting sleep disorders, should be taken to improve the patient's sleep and then to promote the early rehabilitation of critically ill patients.

A retrospective cohort study evaluating the improvement of medical records management based on whole-process control

BACKGROUND

Whole-process management is a novel approach widely applied in industry and commerce; however, it is not widely used in the management of medical records in hospitals.

OBJECTIVE

The purpose of this study is to investigate the application of whole-process control in the administration of a hospital's medical records department to achieve refined management of medical records.

METHODS

Whole-process control is a management measure that begins with process conception and implementation and includes control over all processes. The control group included medical records that were created prior to the implementation of whole-process control, i.e., those created between June 1 and December 31, 2020. The observation group included medical records that were created after the implementation of whole-process control. The behavior of the medical records staff (in terms of medical record collection, sorting, entry, inquiry, and supply) and the final quality of the medical records (the number of grade-A medical records and their front-page quality) were compared between the two groups, and subjective judgments related to staff satisfaction were reviewed.

RESULTS

The implementation of whole-process control improved the behavior of the medical records staff. The final quality of the medical records was also improved, as was the job satisfaction of the medical records staff.

CONCLUSION

Implementing whole-process control improved the management of medical records and quality of medical records.

[Correlation analysis of age and microbial characteristics in saliva and feces of high-risk population of upper gastrointestinal cancer]

Objective: To explore the correlation between age and diversity and microbial composition in saliva and feces microbiota in high-risk population of upper gastrointestinal cancer. Methods: Based on the national project on early diagnosis and early treatment of upper gastrointestinal cancer, 38 participants were enrolled in Linzhou in Henan province in August 2019. The participant information was collected by questionnaire. Saliva and feces specimens were collected from each participant for 16S rRNA sequencing and bioinformatics analysis. Spearman rank correlation was used to analyze the correlation between age and α diversity (Observed ASVs and Shannon index) and relative abundance of microbiota (phyla, genera, and species) in saliva and feces. Results: The median age (age range) of 38 participants was 54 (43-60) years old, and there were 16 males (42.1%). The Observed ASVs of saliva was negatively correlated with age (r_s=-0.35, P<0.05), but the observed ASVs of feces was not correlated with age. In saliva, the relative abundance of Treponema (r_s=‒0.44, P<0.05), Alloprevotella (r_s=‒0.42, P<0.05), and Porphyromonas (r_s=‒0.41,P<0.05) were significantly negatively correlated with age. At the species level, the relative abundance of Porphyromonas endodontalis, Alloprevotella tannerae, Haemophilus influenza, Moraxella bovoculi, Prevotella sp.oral clone ID019, and Prevotella sp.oral clone ASCG10 in saliva were significantly negatively correlated with age, and the r_s values were -0.50, -0.40, -0.38, -0.35, -0.33 and -0.33 (P<0.05), respectively. In feces, the relative abundance of Enterobacteria (r_s=-0.35, P<0.05), Escherichia (r_s=-0.33, P<0.05), and Bifidobacteria (r_s=0.33, P<0.05) were correlated with age. At the species level, the relative abundance of Romboutsia sedimentorum, Citrobacter murliniae, and bacteroides uniformis in feces were correlated with age, and the r_s values were -0.42, -0.37 and 0.36 (P<0.05), respectively. Conclusion: Age of the high-risk population of upper gastrointestinal cancer is correlated with the relative abundance of microbiota in saliva and feces.

Modified Zhibai Dihuang pill, a traditional Chinese medicine formula, on steroid withdrawal in systemic lupus erythematosus: A systematic review and meta-analysis

BACKGROUND

Zhibai Dihuang pill (ZBDH), a Chinese herbal formula, has been widely used as an adjunctive therapy to help reduce the patient's steroid dose and maintain low disease activity in systemic lupus erythematosus (SLE).

OBJECTIVE

This systematic review evaluates the therapeutic effect of modified ZBDH in reducing steroid use in patients with SLE.

SEARCH STRATEGY

A systematic literature search was carried out using seven databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, Chinese VIP Information and Wanfang Database, from their inception to June 1st, 2019. The search terms included "systemic lupus erythematosus," "Chinese medicine" and "clinical trial," and their synonyms. Subject headings matching the above terms were also used.

INCLUSION CRITERIA

This meta-analysis included randomized controlled trials that evaluated the reduction of steroid dose in patients with SLE. Traditional Chinese medicine (TCM) formulas in experimental group should be prescribed based on ZBDH and used as adjunctive therapy and the comparator should contain steroids.

DATA EXTRACTION AND ANALYSIS

Two authors independently conducted database search, study selection, data extraction and quality assessment. The extracted information contained study design, sample size, recruitment mode, diagnostic criteria, inclusion and exclusion criteria, participant characteristics, TCM patterns, TCM formulas and treatment outcomes. The primary outcome was the change of steroid dose. Secondary outcomes included SLE Disease Activity Index (SLEDAI), biomarkers of disease activity and clinical response rate. STATA 15.0 was used to analyze the pooled effects reported as weighted mean difference (WMD) or odds ratio, with a 95% confidence interval (CI).

RESULTS

In total, 20 trials involving 1470 SLE patients were included. The pooled result showed that modified ZBDH taken in combination with standard care led to a larger reduction in steroid dose, compared to standard care alone (WMD: 3.79; 95% CI: 2.58-5.01; P < 0.001). Favorable outcomes were also seen in secondary outcome criteria, such as SLEDAI and complement 3. The modified ZBDH treatments were well tolerated without increasing adverse effects.

CONCLUSION

The systematic review provided preliminary evidence supporting the use of ZBDH as a co-therapy to aid steroid dose reduction in patients with SLE. However, more rigorous studies should be conducted to validate these findings, and explore the mechanisms of ZBDH's relevant bioactive constituents.

[Study on the related factors of esophageal cancer and precancerous lesions in rural residents aged 40-69 years in Shandong Province]

Objective: To analyze the related factors of esophageal squamous cell carcinoma and precancerous lesions among residents aged 40-69 years old in rural areas of Shandong Province. Methods: In October 2018, 300 villages in 13 counties of the Shandong upper gastrointestinal cancerearly diagnosis and treatment projectin 2017 were selected as research areas, and 30 400 residents aged 40-69 were recruited in this study. The demographic characteristics, health status and lifestyle information were collected through the questionnaire survey, and endoscope iodine staining and indicative biopsy methods were used for cancer screening among eligible people.The multivariate logistic regression model was used to analyze the risk factors for esophageal cancer and precancerous lesions. Results: The subjects in this study were (56.42±7.24) years old, including 13 193 males (43.40%).There were 936 cases of esophageal cancer and precancerous lesions (3.08%), including 521 males and 415 females.Compared with women, 40-49 years old, high level education, drinking tap water, regular intake of meat, eggs and milk, and family average annual income more than 30 000 RMB, men (OR=1.90, 95%CI: 1.65-2.19), 60-69 years old (OR=5.28, 95%CI: 4.11-7.30), primary school education or below (OR=1.50, 95%CI: 1.20-1.89), drinking groundwater (OR=1.71, 95%CI: 1.38-2.13), never eating meat, eggs and milk (OR=1.48, 95%CI: 1.22-1.80), and family average annual income less than 30 000 RMB (OR=1.41, 95%CI: 1.16-1.70) would increase the risk of esophageal cancer and precancerous lesions. Conclusion: The gender, age, educational level, annual household income, drinking water source, the frequency of eating meat, egg and milk were related to the occurrence of esophageal cancer and precancerous lesions among 40-69 years old residents in rural areas of Shandong Province.

Why hasn't this woman been screened for breast and cervical cancer? - Evidence from a Chinese population-based study

OBJECTIVE

Less than half of eligible Chinese rural women have been screened for breast and cervical cancer. The objective of this study was to describe individual-level reasons for attending or not attending 'two cancers' screening using Andersen's Behavioral Model of Health Services Use.

STUDY DESIGN

Cross-sectional study.

METHODS

The study sample was from the Health Services Survey in 2013 in Jiangsu, China. A total of 6520 rural women aged 36-65 years answered the questions on 'two cancers' screening participation and were included in the final analysis, which consisted of univariate and multivariate logistic regression.

RESULTS

In the results of multivariate logistic regression, factors significantly associated with having 'two cancers' screening included educational level (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.65-0.92), per capita household income (OR = 0.65, 95% CI = 0.58-0.73), availability of female medical faculty in township facilities (OR = 0.35, 95% CI = 0.28-0.42), quality of life (OR = 0.72, 95% CI = 0.58-0.90), being nulliparous (OR = 3.21, 95% CI = 1.96-5.26), and multiparous (OR = 1.91, 95% CI = 1.68-2.16).

CONCLUSION

To reduce inadequate screening service utilization of breast and cervical cancer in rural areas, efforts should be made not only to target the vulnerable rural women with lower income, lower educational level, and lower health conditions but also to further improve access to female primary-care providers. Strategies are also urgently needed to focus on nulliparous and multiparous women.

[Effect of the Chinese Herbal Medicinal Ingredients in Huoxiang Zhengqi Liquid on Alcohol Metabolism in Rats]

OBJECTIVES

To study the changes of alcohol content and pharmacokinetic parameter in rats after taking Huoxiang Zhengqi liquid.

METHODS

The rats were randomly divided into three groups and given with white alcohol at the dose of 3.0 mL/kg, low-dose and high-dose Chinese medicine liquor, respectively. The blood was collected before administration and 5 min, 10 min, 15 min, 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, 6 h and 8 h after administration by cutting rats' tails. The concentrations of alcohol in blood were detected by headspace-gas chromatography method. The main pharmacokinetic parameters were calculated by DAS 2.0, and then analyzed by SPSS 17.0.

RESULTS

The difference of maximum blood concentrations between high-dose Chinese medicine alcohol group and white alcohol group was statistically significant （P<0.05）. There was no significant difference in other pharmacokinetic parameters among three groups （P>0.05）.

CONCLUSIONS

The Chinese herbal medicinal ingredients in the Huoxiang Zhengqi liquid has no effect on the metabolism and elimination of ethanol in rats. The research provides useful reference for the qualitative assessment and processing of traffic accident cases involved in Huoxiang Zhengqi liquid and the studies related to drug-interaction.

[Study on the serum 25-hydroxyvitamin D levels of benign paroxysmal positional vertigo patients]

Objective:To study whether serum 25-hydroxy vitamin D can be used as an independent indicator of prognosis in patients with benign paroxysmal positional vertigo. Method:Two hundred and two patients with BPPV were collected and divided into vitamin D deficiency group and control group according to their serum 25-OHD level. The severity of the symptoms and the recurrence rate were compared between the two groups. Result:Compared with the control group, patients with vitamin D deficiency group showed severer symptoms, either in longer duration of vertigo, lower success rate of repositioning maneuver treatment at the first time, or higher recurrence rate within six months. Conclusion:Serum 25-OHD level was negatively correlated with the severity and prognosis of BPPV, and could be used as an important index to evaluate the prognosis of BPPV.

Fast formation and growth of high-density Sn whiskers in Mg/Sn-based solder/Mg joints by ultrasonic-assisted soldering: Phenomena, mechanism and prevention

A universally applicable method for promoting the fast formation and growth of high-density Sn whiskers on solders was developed by fabricating Mg/Sn-based solder/Mg joints using ultrasonic-assisted soldering at 250 °C for 6 s and then subjected to thermal aging at 25 °C for 7 d. The results showed that the use of the ultrasonic-assisted soldering could produce the supersaturated dissolution of Mg in the liquid Sn and lead to the existence of two forms of Mg in Sn after solidification. Moreover, the formation and growth of the high-density whiskers were facilitated by the specific contributions of both of the Mg forms in the solid Sn. Specifically, interstitial Mg can provide the persistent driving force for Sn whisker growth, whereas the Mg2Sn phase can increase the formation probability of Sn whiskers. In addition, we presented that the formation and growth of Sn whiskers in the Sn-based solders can be significantly restricted by a small amount of Zn addition (≥3 wt.%), and the prevention mechanisms are attributed to the segregation of Zn atoms at grain or phase boundaries and the formation of the lamellar-type Zn-rich structures in the solder.

Genetic variability and diversity of the main resources of lily assessed via phenotypic characters, pollen morphology, and ISSR markers

Lily (Lilium spp), which belongs to Lilium, is one kind of monocotyledon. As a perennial ornamental plant with extremely high esthetic, edible, and medicinal value, lily has gained much favor due to its mostly showy flowers of various colors and elegant shape. In this research, we studied experimental materials in a sample of 49 individuals including 40 cultivars, nine species of wild lily, and their variants. The collection of 40 cultivars covered all six hybrids in the genus, i.e., Asiatic hybrids, Oriental hybrids, Longiflorum hybrids, LA hybrids, LO hybrids, and OT hybrids. Genetic diversity and inter-relationships were assessed through analysis of phenotypic characteristics, pollen morphology, and ISSR molecular markers. Quantitative characters were selected to analyze phenotypic variation, with results indicating greater variability in petiole length as compared to other characters. Pollen morphological observations suggested that the largest variation coefficient between all hybrids and wild species was the lumina. ISSR makers demonstrated that both cultivars and wild species possess a high level of genetic diversity. Specifically, the genetic diversity of wild lily was higher than cultivars.

Influence of grape seed proanthocyanidin extract in broiler chickens: effect on chicken coccidiosis and antioxidant status

Grape seed proanthocyanidin extract (GSPE) has been widely used as a human food supplement for health promotion and disease prevention. However, there was little information regarding its application in animal nutrition. The aim of the current study is to determine the effect of GSPE at different concentrations on chicken performance, and the status of antioxidant/oxidant system after the Eimeria tenella infection. In the first experiment, GSPE incorporated in the diet at 5, 10, 20, 40, and 80 mg/kg significantly decreased mortality and increased weight gain after the E. tenella infection, and the protective effect of GSPE was dose-dependent. The lowest mortality and the greatest growth gains were recorded in the group of birds fed with GSPE between 10 to 20 mg/kg. In the second experiment, 12 mg/kg of GSPE supplementation in the diet significantly reduced the mortality and lesion scores in birds after the infection with 5 x 10(4) and 1 x 10(5) oocysts of E. tenella. The weight gains also improved significantly. After the oral infection with 5 x 10(4) and 1 x 10(5) of E. tenella, analysis of the status of antioxidant/oxidant system revealed that plasma NO increased significantly from 7.11 to 21.31 micromol/L, plasma superoxide dismutase (SOD) decreased from 126.55 to 111.14 U/mL, and malondiadehyde increased, suggesting oxidative stress was increased in circulation. However, supplementation of 12 mg/kg GSPE reduced the level of plasma NO from 21.31 to 14.73 micromol/L and increased plasma SOD activities from 111.14 to 133.27 U/mL. The effects of incorporation of GSPE into the poultry diet on the concentration of plasma NO, malondiadehyde, and SOD indicated that the lower concentration of dietary GSPE was able to restore the balance of antioxidant/oxidant system that was exerted by the oxidative stress after the parasite infection. The current results suggested GSPE can act as an antioxidant in diet to improve the performance of broiler chickens and remedy the clinical symptoms caused by the oxidative stress of E. tenella infection.

Gestational diabetes mellitus in Chinese women

OBJECTIVE

To determine whether foreign diagnostic criteria for the diagnosis of gestational diabetes mellitus (GDM) are suitable for Chinese pregnant women.

METHODS

The study participants were 340 pregnant women receiving obstetric care at the Shanghai Jiaotong University-Affiliated Sixth People's Hospital in Shanghai, China. The normal-pregnancy group comprised 190 women with no risk factor for GDM and the high-risk pregnancy group comprised 150 women who had at least one high-risk factor for GDM. All women took the diagnostic 100-g, 3-h oral glucose tolerance test (100-g 3-h OGTT) between 24 and 28 weeks of pregnancy. The results of the 100-g 3-h OGTT were classified according to three different sets of diagnostic criteria: (1) new, "Chinese" diagnostic criteria based on the results from the 100-g 3-h OGTT performed in the 190 healthy participating women; (2) the Carpenter and Coustan criteria; and (3) the National Diabetes Data Group (NDDG) criteria. Venous plasma glucose (VPG) was measured by the glucose oxidase method. A consistency check was used for analysis. Obstetric and neonatal outcomes were recorded.

RESULTS

With 97.5% as the statistical cutoff value for the 100-g 3-h OGTT, the new diagnostic criteria for this study, based on data obtained from the 100-g 3-h OGTT performed on the 190 participating healthy pregnant women, were 5.2, 10.3, 8.9, and 7.7 mmol/L at 0, 60, 120, and 180 min. The e value was 0.83 for the new criteria vs. the Carpenter and Coustan criteria (P<0.001) and 0.70 for the new criteria vs. the NDDG criteria (P<0.001). In women with GDM and gestational-impaired glucose tolerance (GIGT), the incidence rates of macrosomia by the new criteria and the Carpenter and Coustan criteria were similar, but higher than the rates calculated with the NDDG criteria (P<0.05).

CONCLUSION

With venous plasma glucose level measured by the glucose oxidase method, the Carpenter and Coustan criteria are applicable to Chinese pregnant women for diagnosis of GDM.

[Mechanical efficacy of different internal fixation devices in the treatment of thoracolumbar fractures]

To know the efficacy of different internal fixation devices used in the treatment of thoracolumbar fractures, specimens of 15 adult cadaveric (T-8 to L-4) were prepared and were divided into 5 groups for comparative study. Except the control group, the vertebra of T-12 of every specimen in other 4 groups was artificially fractured, imitating flexion fracture dislocation, with standard technic. Then, they were fixed in each group, with Luque's rod, Dick's screw, pedicle screw plate or Dunn's device respectively. The stress distribution and yielding stress under load and dimensional motions in each group were recorded and compared among the groups and with the control. In the experimental groups, Dunn's device gave the strongest support, against load on the anterior and middle columns. Dick's screw and pedicle screw plate could theoretically fix the anterior, middle and posterior columns rigidly; however, because of the weakness persisted in the connection of their components, their fixation effectiveness was reduced. Luque's rod acted though effectively against bending on every direction, it could not stand much axial load. It is obvious that each of these 4 devices has its own advantages and could be used to prevent horizontal displacement of the fixed fracture, but fail to control torsional stress.