Neurophysiological Correlates of Fatigue in Multiple Sclerosis

Examining fatigue may be beneficial for nurse practitioners to intervene in the care of patients with multiple sclerosis (MS). We measured the relationship of fatigue severity with event-related potentials during electroencephalogram and diffusion basis spectrum imaging/magnetic resonance imaging in 11 participants with relapsing-remitting MS and 5 healthy controls. Data were analyzed to measure brain activity during event-related potentials to responses to cue (correct response) and distractor (incorrect response) using a cognitive performance task. Nurse practitioners caring for patients with MS have an important role in monitoring fatigue severity.     

降尿酸治疗对脑梗死患者血管内皮功能的影响

目的:研究高尿酸血症的急性脑梗死患者降尿酸治疗对血管内皮功能及血压的影响。方法:搜集同一中心共138例患者入选该研究。高尿酸血症并急性脑梗死者入选92例,随机（随机数字法）分为实验组46例,对照组46例,同时入选同期血尿酸正常的急性脑梗死患者46例,实验组口服别嘌醇3个月治疗高尿酸血症。对这些人群进行抽血化验,记录治疗前后血尿酸、血脂及hs-CRP,同时检测患者血压、体质量指数（BMI）,并采用超声无创血流介导的血管舒张功能（FMD）进行血管内皮功能评估,治疗前后各组之间比较并进行统计学分析。结果:别嘌醇治疗3个月后实验组血尿酸[(479.7±49.0) μmol/L vs. (381.2±76.7)μmol/L]、hs-CRP[(8.1±6.7) mg/L vs. (5.1±4.6) mg/L]、收缩压[(124.7±26.3) mmHg vs. (97.4±13.5) mmHg]明显降低( P<0.05),FMD[(7.6±3.5%) vs. (11.2±3.9%)]明显升高( P<0.05),FMD升高的程度与血尿酸降低的程度呈正相关( r=0.463, P<0.01),多元回归分析显示血尿酸是FMD的独立影响因子（ β=-0.229, P=0.035)。 结论:高尿酸血症的急性脑梗死患者中降尿酸治疗可明显改善患者的血管内皮功能,改善炎症状态,降低患者血压,进一步印证了高尿酸血症导致血管内皮功能紊乱,促进动脉粥样硬化的发生与发展。     

The development and psychometric evaluation of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients scale

BackgroundValidated measures of ward nurses' safety cultures in relation to escalations of care in deteriorating patients are lacking.ObjectivesThis study aimed to develop and evaluate the psychometric properties of the Clinicians' Attitudes towards Responding and Escalating care of Deteriorating patients (CARED) scale for use among ward nurses.MethodsThe study was conducted in two phases: scale development and psychometric evaluation. The scale items were developed based on a systematic literature review, informant interviews, and expert reviews (n = 15). The reliability and validity of the scale were examined by administering the scale to 617 registered nurses with retest evaluations (n = 60). The factor structure of the CARED scale was examined in a split-half analysis with exploratory and confirmatory factor analyses. The internal consistency, test–retest reliability, convergent validity, and known-group validity of the scale were also analysed.ResultsA high overall content validity index of 0.95 was obtained from the validations of 15 international experts from seven countries. A three-factor solution was identified from the final 22 items: ‘beliefs about rapid response system’, ‘fears about escalating care’, and ‘perceived confidence in responding to deteriorating patients’. The internal consistency reliability of the scale was supported with a good Cronbach's alpha value of 0.86 and a Spearman-Brown split-half coefficient of 0.87. An excellent test–retest reliability was demonstrated, with an intraclass correlation coefficient of 0.92. The convergent validity of the scale was supported with an existing validated scale. The CARED scale also demonstrated abilities to discriminate differences among the sample characteristics.ConclusionsThe final 22-item CARED scale was tested to be a reliable and valid scale in the Singaporean setting. The scale may be used in other settings to review hospitals' rapid response systems and to identify strategies to support ward nurses in the process of escalating care in deteriorating ward patients.     

Evaluation of the relationship between linezolid exposure and hyponatremia

IntroductionAims of this study were (a) to assess the development ratio of hyponatremia during treatment with linezolid and (b) to evaluate the relationship between the risk of hyponatremia and linezolid exposure and patient background.MethodClinical data including linezolid serum concentrations and serum sodium values were collected at Toyama University Hospital and Kyorin University Hospital. Data from 89 patients were used for the analysis, and a nadir serum sodium level ≤130 mmol/L during the treatment with linezolid was defined as hyponatremia. Mann-Whitney's U test was used to evaluate the effects of the area under the time-concentration curve (AUC) of linezolid at the nadir sodium level, clinical characteristics (e.g. laboratory data), and baseline serum sodium levels on the development of hyponatremia.ResultsThe hyponatremia was occurred in 21 of 89 patients (23.6%). Data are compared for baseline and nadir serum sodium levels of patients with and without hyponatremia. In both groups, nadir serum sodium levels were significantly different from those of the baseline values (P < 0.05). The values of AUC_0-12, accumulated AUC, baseline serum sodium levels and age were significantly different between patients with and without hyponatremia (P < 0.05).ConclusionsLinezolid exposure, age, and baseline sodium levels were detected as the risk factors for linezolid-related hyponatremia. Our findings suggest that regular monitoring of serum sodium levels is desirable during treatment with linezolid, especially for the elderly and patients with low serum sodium levels before the start of linezolid administration.     

儿童反复呼吸道感染影响因素分析

目的探讨儿童反复呼吸道感染(RRTIs)的相关影响因素,为儿童RRTIs的有效防治提供依据和策略。方法选择183例RRTIs患儿纳入病例组,85例同期门诊体检健康儿童纳入对照组,对以上所有儿童可能导致RRTIs的相关因素进行临床资料调查,并对血清微量元素铁、锌、钙、铜,血清25-羟维生素D[25-(OH)-D]水平及肺炎支原体(MP)-IgM抗体进行检测,并对两组儿童的结果进行对比,对RRTIs的相关影响因素进行多因素Logistic回归分析。结果病例组中剖宫产、母乳喂养、湿疹、变应性鼻炎、哮喘、被动吸烟、多次使用抗菌药物儿童所占百分比与对照组比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,哮喘、被动吸烟、多次使用抗菌药物为儿童RRTIs的危险因素,母乳喂养为儿童RRTIs的保护因素。病例组血清微量元素铁、锌、钙及血清25-(OH)-D水平均明显低于对照组,MP-IgM抗体阳性率明显高于对照组,差异有统计学意义(P<0.05)。结论积极控制儿童哮喘,远离被动吸烟,避免抗菌药物滥用,尽量母乳喂养,及时合理补充微量元素铁、锌、钙及维生素D制剂,均衡营养,警惕MP感染,并积极规范治疗,对儿童RRTIs的有效防治非常重要。     

胃肠道手术患者氧化应激反应对胃肠道功能恢复、切口愈合的影响及相关机制

目的探讨胃肠道手术患者氧化应激反应对胃肠道功能恢复、切口愈合的影响及相关机制。方法选取2018年8月至2019年8月在广西中医药大学第一附属医院外科行胃肠道手术的患者137例为手术组,另选取73例健康体检者为对照组。检测两组血清活性氧自由基(ROS)、D-乳酸、内毒素水平。比较手术组术前与对照组,以及术后不同胃肠道功能评分和切口愈合分级患者的血清ROS、D-乳酸、内毒素水平。分析血清ROS水平与D-乳酸和内毒素水平的相关性。结果手术组术前血清ROS、D-乳酸和内毒素水平均高于对照组,差异均有统计学意义(P<0.05)。随着胃肠道功能评分的增加,患者血清ROS、D-乳酸和内毒素水平逐渐升高,差异均有统计学意义(P<0.05)。与甲级切口愈合患者比较,乙、丙级切口愈合患者的血清ROS、D-乳酸、内毒素水平明显升高,差异均有统计学意义(P<0.05);与乙级切口愈合患者比较,丙级切口愈合患者的血清ROS、D-乳酸、内毒素水平明显升高,差异均有统计学意义(P<0.05)。术后胃肠道功能评分1、2、3分及乙、丙级切口愈合患者的血清ROS水平与D-乳酸、内毒素水平均呈正相关(P<0.05)。结论胃肠道手术患者发生的氧化应激反应会延缓胃肠道功能恢复,影响手术切口愈合。     

Cytotoxicity induced by abamectin exposure in haemocytes of Chinese mitten crab,Eriocheir sinensis

Abamectin is widely utilized in both agricultural and aquaculture areas in China for pest control. However, information about toxic effects of abamectin on non-target aquatic organisms is still incomplete. The Chinese mitten crab, Erocheir sinensis has been extensively bred in the rice-crab co-culture system for years, resulting in the frequent exposure to pesticides including abamectin. In the present study, a primary haemocyte culture model was established to investigate the immune response under exposure of abamectin. The results showed that medium osmolarity ranging from 360 to 480 mOsM/Kg was optimal for primary haemocyte culture from E. sinensis. Abamectin could induce significant decrease of cell viability, inhibition of phagocytic activity, as well as decline of acid phosphatase (ACP) and alkaline phosphatase (AKP) activities. All parameters decreased in time- and dose- dependent manners throughout the experiment, indicating the remarkable immunosuppression of abamectin on E. sinensis and also the sensitivity of the cytotoxicology model of haemocytes in vitro under abamectin exposure. In addition, a dose dependent increase of intracellular reactive oxygen species (ROS) was found after 6 h exposure. It revealed that excessive generation of ROS may a main reason to the degradation of cell viability, and moreover, the decrease in immune function.