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Objective To investigate and analyze the geriatric nurses’ guideline-based practice of suctioning for elderly patients, and to provide reference for clinical nursing practice and management. Methods A cross-sectional survey was conducted and a total of 200 operations were observed with 76 nurses from geriatric wards. Furthermore, this study statistically analyzed the situations that did not match the guides and standards, and discussed the correlation between negative pressure range, duration, several basic information, and incidence of suction complications, the probability of suctioning all sputum at once. Results More than half of the nurses had three or more irregular behaviors during sputum suction operations. Before suctioning, 62. 00%(124/200) of nurses did not wash their hands, 61. 00%(122/200) of nurses failed to evaluate the signs, 23. 50%(47/200) of nurses had contaminated gloves and 36. 00%(72/200) of nurses did not check the negative pressure. The negative pressure value and duration of sputum suction used by nurses this time were greater than the values recommended in the guides. For every 1 mm Hg increase in negative sputum suction pressure, the probability of suctioning all sputum at once increased by 1. 90% (P＜0. 05). For every 1 second increase duration of intratracheal suctioning, the probability of suctioning all sputum at once increased by 3. 50% (P＜0. 05), while the incidence of related complications increased by 1. 90% (P＜0. 05). Conclusion There was a low consistent rate between nurses’ behavior and clinical guidelines. Nursing managers should improve quality issues in response to irregular nursing behavior, guide nurses to control the duration of an intratracheal sputum suction time and appropriately increase the negative pressure of phlegm suction in order to find the best suctioning effect. (目的 了解和分析老年病房护士在临床实际工作中践行吸痰护理实践指南及规范的现况, 为临床护理实践和管理提供参考。方法 采用横断面调查, 观察并记录某三甲医院76名老年病房护士的200次吸痰操作, 将其中与指南和规范不符的情况进行统计分析, 并探讨吸痰选取的负压范围、持续时长及几项基本信息与吸痰并发症发生率和一次吸净痰液率的相关性。结果 超过半数护士在吸痰操作中发生三种及以上的不规范行为, 62. 00%(124/200)的护士吸痰前未洗手, 61. 00%(122/200)的护士在吸痰前未评估吸痰指征, 23. 50%(47/200)的护士吸痰前手套污染, 36. 00%(72/200)的护士在吸痰前未检查负压, 本次护士所采取的吸痰负压值和吸痰持续时间均大于指南中推荐数值。此外, 吸痰负压每增加1 mm Hg, 一次吸净痰液的成功率就会提高1. 90%(P＜0. 05); 一次气管内吸痰时间每增加1 s, 一次吸净痰液率就会提高3. 50%(P＜0. 05), 同时相关并发症的发生率增加1. 90%(P＜0. 05)。结论 护士实施吸痰操作时存在较多与指南和规范不符的行为, 护理管理者需要针对不规范的护理行为进行质量问题改善, 同时指导护士控制一次气管内吸痰时间, 适当增大吸痰负压, 以寻求最佳吸痰效果。)

Post-traumatic stress disorder (PTSD) is a severe and heterogenous psychiatric disorder that was first defined as a mental disorder in 1980. Currently, the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and the International Classification of Diseases 11th Edition (ICD-11) offer the most widely accepted diagnostic guidelines for PTSD. In both diagnostic categories, experiencing a traumatic event (TE) is the necessary criterion for diagnosing PTSD. The TEs described in the DSM-5 include actual or threatened death, serious injury, sexual violence, and other extreme stressors, either directly or indirectly. More than 70% of adults worldwide are exposed to a TE at least once in their lifetime, and approximately 10% of individuals develop PTSD after experiencing a TE. The important features of PTSD are intrusion or re-experiencing fear memories, pervasive sense of threat, active avoidance, hyperarousal symptoms, and negative alterations of cognition and mood. Individuals with PTSD have high comorbidities with other psychiatric diseases, including major depressive disorder, generalized anxiety disorder, and substance use disorder. Multiple lines of evidence suggest that the pathophysiology of PTSD is complex, involving abnormal neural circuits, molecular mechanisms, and genetic mechanisms. A combination of both psychotherapy and pharmacotherapy is used to treat PTSD, but has limited efficacy in patients with refractory PTSD. Because of the high prevalence, heavy burden, and limited treatments, PTSD is a psychiatric disorder that requires urgent attention. In this review, we summarize and discuss the diagnosis, prevalence, TEs, pathophysiology, and treatments of PTSD and draw attention to its prevention.

Objective To analyze the risk factors for heart failure in hospitalized patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI) and establish a personalized risk prediction model for heart failure after PCI. Methods The clinical data of 640 patients with CHD who were hospitalized and underwent PCI in our department from January 2017 to December 2018 were collected and retrospectively analyzed. The subjects were divided into heart failure group (n=44) and non-heart failure group (n=596) according to the occurrence of postoperative heart failure. Logistic multivariate regression analysis and R software were used respectively to screen the independent predictors and plot the nomogram prediction model of heart failure risk. Then, consistency index (C-index), area under the receiver operating characteristic (ROC) curve and calibration curve were subsequently adopted to evaluate the prediction efficiency of the model. Results Multivariate analysis showed that left ventricular ejection fraction (LVEF), age, contrast agent dosage, concomitant cerebral infarction, and grade of New York Heart Association (NYHA) functional classification were independent predictors of heart failure after PCI (P < 0.05). The C-index of the nomogram for predicting heart failure risk was 0.796 (95%CI: 0.723~0.869), and the area under the ROC curve was 0.797 after internal validation (95%CI: 0.726~0.861). Hosmer-Lemeshow test and calibration curves indicated that the nomogram had good prediction consistency (Chi-square=12.360, P=0.135). Conclusion The nomogram model for predicting heart failure risk is successfully constructed, which can assist the medical staff to screen out the population with high risk of heart failure after PCI, and then to implement targeted intervention measures.

Adenosine-to-inosine (A-to-I) RNA editing is an important post-transcriptional modification mediated by the adenosine deaminases acting on RNA (ADAR) family of enzymes, expanding the transcriptome by altering selected nucleotides A to I in RNA molecules. Recently, A-to-I editing has been explored for correcting disease-causing mutations in RNA using therapeutic guide oligonucleotides to direct ADAR editing at specific sites. Humans have two active ADARs whose preferences and specificities are not well understood. To investigate their substrate specificity, we introduced hADAR1 and hADAR2, respectively, into Schizosaccharomyces pombe (S. pombe), which lacks endogenous ADARs, and evaluated their editing activities in vivo. Using transcriptome sequencing of S. pombe cultured at optimal growth temperature (30 °C), we identified 483 A-to-I high-confident editing sites for hADAR1 and 404 for hADAR2, compared with the non-editing wild-type control strain. However, these sites were mostly divergent between hADAR1 and hADAR2-expressing strains, sharing 33 common sites that are less than 9% for each strain. Their differential specificity for substrates was attributed to their differential preference for neighboring sequences of editing sites. We found that at the -3-position relative to the editing site, hADAR1 exhibits a tendency toward T, whereas hADAR2 leans toward A. Additionally, when varying the growth temperature for hADAR1- and hADAR2-expressing strains, we observed increased editing sites for them at both 20 and 35 °C, compared with them growing at 30 °C. However, we did not observe a significant shift in hADAR1 and hADAR2's preference for neighboring sequences across three temperatures. The vast changes in RNA editing sites at lower and higher temperatures were also observed for hADAR2 previously in budding yeast, which was likely due to the influence of RNA folding at these different temperatures, among many other factors. We noticed examples of longer lengths of dsRNA around the editing sites that induced editing at 20 or 35 °C but were absent at the other two temperature conditions. We found genes' functions can be greatly affected by editing of their transcripts, for which over 50% of RNA editing sites for both hADAR1 and hADAR2 in S. pombe were in coding sequences (CDS), with more than 60% of them resulting in amino acid changes in protein products. This study revealed the extensive differences in substrate selectivity between the two active human ADARS, i.e., ADAR1 and ADAR2, and provided novel insight when utilizing the two different enzymes for in vivo treatment of human genetic diseases using the RNA editing approach. [ABSTRACT FROM AUTHOR]

Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) and Spodoptera litura (Fabricius) are the main pests on corn (Poaceae: Gramineae). The performance of the larval wasp, Microplitis pallidipes Szépligeti (Hymenoptera: Braconidae), was reported on S. frugiperda and S. litura. In this study, we evaluated host selectivity, constructed an age–stage, 2-sex life table, and assessed the pest control potential of M. pallidipes against these 2 pests under laboratory conditions. In a 2-choice host preference experiment, M. pallidipes exhibited a stronger preference for S. frugiperda over S. litura and a distinct preference for second instars. We also investigated the parasitism of females that were either unfed or fed with 10% honey–water solution under different host densities and found that the highest parasitism rate was observed when M. pallidipes were fed with honey–water solution on the first day after mating and a presented female wasp:host ratio of 1:90. In a nonselective assay, M. pallidipes successfully completed a full generation on both hosts. However, the parasitoids exhibited higher fitness and population growth potential when reared on S. frugiperda , with a net reproductive rate (R 0) of 24.24, an intrinsic rate of increase (r) of 0.20 per day, a finite rate of increase (λ) of 1.23 per day, and a mean generation time (T) of 15.69 days. This study elucidates the performance of M. pallidipes on 2 Spodoptera host species and offers insights into its biological control potential on lepidopteran pests. [ABSTRACT FROM AUTHOR]

Clustered regularly interspaced short palindromic repeats (CRISPR)-Cas9 editing of immune checkpoint genes could improve the efficacy of T cell therapy, but the first necessary undertaking is to understand the safety and feasibility. Here, we report results from a first-in-human phase I clinical trial of CRISPR-Cas9 PD-1-edited T cells in patients with advanced non-small-cell lung cancer (ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT02793856?term=NCT02793856&draw=2&rank=1)). Primary endpoints were safety and feasibility, and the secondary endpoint was efficacy. The exploratory objectives included tracking of edited T cells. All prespecified endpoints were met. PD-1-edited T cells were manufactured ex vivo by cotransfection using electroporation of Cas9 and single guide RNA plasmids. A total of 22 patients were enrolled; 17 had sufficient edited T cells for infusion, and 12 were able to receive treatment. All treatment-related adverse events were grade 1/2. Edited T cells were detectable in peripheral blood after infusion. The median progression-free survival was 7.7 weeks (95% confidence interval, 6.9 to 8.5 weeks) and median overall survival was 42.6 weeks (95% confidence interval, 10.3-74.9 weeks). The median mutation frequency of off-target events was 0.05% (range, 0-0.25%) at 18 candidate sites by next generation sequencing. We conclude that clinical application of CRISPR-Cas9 gene-edited T cells is generally safe and feasible. Future trials should use superior gene editing approaches to improve therapeutic efficacy. In a first-in-human phase I trial of patients with advanced lung cancer, infusions of autologous T cells edited to delete the PD-1 gene via CRISPR-Cas9 were well tolerated and did not lead to severe treatment-related adverse events., Author(s): You Lu [sup.1] , Jianxin Xue [sup.1] , Tao Deng [sup.2] , Xiaojuan Zhou [sup.1] , Kun Yu [sup.2] , Lei Deng [sup.3] , Meijuan Huang [sup.1] , Xin [...]