Purpose. To explore the effect of rational emotional intervention combined with hierarchical management mode on improving the psychological stress of emergency nurses and trainee nurses. Methods. 50 emergency nurses who worked or practiced in our hospital from June 2019 to May 2021 were selected as the research object. From June 2019 to May 2020, our hospital adopted the traditional management mode. From June 2020 to May 2021, our hospital adopted the rational emotional intervention combined with hierarchical management mode. The psychological state, work stress, stress response, job burnout, and sleep quality of emergency nurses were compared before and after intervention. Results. Compared with before intervention, the scores of self-rating anxiety scale and self-rating depression scale, the work stress scores, the Maslach burnout inventory score, the Pittsburgh sleep quality index score of emergency nurses decreased after intervention ( P < 0.05 ). Compared with before intervention, the stress coping scores of emergency nurses increased after intervention ( P < 0.05 ). Conclusion. The rational emotional intervention combined with hierarchical management mode can improve the psychological pressure of emergency nurses and trainee nurses, reduce job burnout, improve stress coping ability, and improve sleep quality.
Background: Nonalcoholic fatty liver disease (NAFLD) has become one of the leading etiologies of hepatocellular carcinoma (HCC), but risk factors for NAFLD-related HCC occurrence have not been defined. NAFLD is often complicated by metabolic abnormalities, and there is a bidirectional association of metabolic abnormalities with NAFLD progression. This study aimed to systematically evaluate the relationship between metabolic traits and HCC occurrence in patients with NAFLD. Method: This study reviewed eight eligible studies that included 297,956 participants, to determine the relationship between metabolic traits and the occurrence of HCC in patients with NAFLD. Results: Presence of diabetes mellitus (DM) was associated with increased risk of HCC (HR: 2.65, 95%CI: 2.02 ~ 3.49, P heterogeneity = 0.589, I 2 = 0.0%). Stratified analysis revealed that this risk was higher in NAFLD patients with advanced fibrosis/cirrhosis (HR: 4.55, 95%CI: 2.34 ~ 8.87, P heterogeneity = 0.870, I 2 = 0.0%). Nonetheless even in patients without cirrhosis, DM remained a high risk factor for HCC incidence (HR: 1.80, 95%CI: 1.05 ~ 3.06, P heterogeneity = 0.291, I 2 = 10.4%). Overweight/obesity had a slight correlation with increased risk of HCC occurrence in NAFLD patients (HR: 1.31, 95%CI: 1.00 ~ 1.71, P heterogeneity = 0.888, I 2 = 0.0%), while presence of hypertension and dyslipidemia had no correlation. Conclusion: DM and overweight/obesity are high risk factors for NAFLD-related HCC. In particular, DM increases 4-fold the risk of HCC incidence in NAFLD patients with advanced fibrosis/cirrhosis. There is a need to strengthen surveillance for HCC in NAFLD patients with DM, especially in those with advanced fibrosis/cirrhosis.
Background & AimBile acids, as hydrophilicity/ hydrophobic molecules and natural ligands of bile acids receptors, are involved in the pathogenesis of liver injury and metabolic disorders. Cholestyramine acts as a bile acid chelating agent and is used to reduce cholesterol in clinic, but its hepatotoxicity and effects on metabolism are still unclear.MethodsApoE-/- mice were continuously administered with low fat diet with or without 2% cholestyramine 12 weeks to determine the hepatotoxicity and metabolic influences of cholestyramine on these mice. Serum transaminases, liver histological features and hepatic inflammatory markers expression were used to assess cholestyramine hepatotoxicity. Body weight, liver weight, serum lipids profile and liver lipid metabolism related genes expression were used to evaluate effects of cholestyramine on metabolism. Differences of endogenous bile acids composition, bile acids metabolism related genes and intestinal flora structure between groups were also analyzed by an ultraperformance liquid chromatography coupled to tandem mass spectrometry system, quantitative real time PCR and 16S rDNA sequencing.ResultsAfter 12 weeks of dietary intervention, although cholestyramine decreased ApoE-/- mice serum cholesterol level, it significantly increased the body and liver weight of these mice, and caused severe liver injury: increased serum transaminases levels, promoted liver vesicular steatosis and inflammatory cells infiltration, and enhanced the expression of lipid synthesis gene: FASN and inflammatory markers genes: TNF-α 、MCP-1、F4/80 and CD68. Moreover, cholestyramine administration caused hydrophobic transformation of bile acids pool and severe gut dysbiosis, which were characterized by decreased hydrophilic bile acids: muricholic acid (MCA) and ursodeoxycholic acid (UDCA), and increased abundance of potential pathogenic bacteria: s_Bacteroide_vulgatus.ConclusionThis study revealed that cholestyramine had the ability to induce severe liver injury and metabolic disorders. These effects might be attributed to inducing hydrophobic transformation of bile acids pool and gut dysbiosis by cholestyramine. Furthermore, our study provided a warning of hepatotoxicity and metabolic disorders for clinical application of cholestyramine, and suggested that cholestyramine was not a good scavenging tool to study the role of bile acids alternations in diseases progression.
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