FBD were more common and severe among rotating shift nurses. The FBD symptom score was positively and independently correlated with the sleep disturbance score, suggesting that poor sleep might be associated with increased FBD symptoms in rotating shift nurses.

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Ventilator-associated pneumonia (VAP) is a common complication and cause of death in neonates on mechanical ventilation. However, it is difficult to define the causes of VAP. To understand the causes of VAP, we undertook a prospective study based on the diversity of the microflora in VAP. The experimental group consisted of newborns who suffered from respiratory distress syndrome (RDS) and VAP, while the control group suffered from RDS without VAP. Sputa were collected within 1, 3, and 5 days of ventilation and were divided into six groups. DNA was extracted from the samples, and the 16S rDNA was PCR amplified, separated using denaturing gradient gel electrophoresis (DGGE), cloned and sequenced. The resulting sequences were compared using BLAST. The DGGE pictures were measured, and the richness, Shannon-Wiener index, and cluster maps were analyzed. No differences were found regarding the constituent ratio of any genus between the Non-VAP and VAP group within 1 day after intubation. After 1 to 3 days, the constituent ratios of Klebsiella sp., Acinetobacter sp., and Streptococcus sp. in the VAP group were higher than those in the Non-VAP group, and the ratios of Serratia sp. and Achromobacter sp. were lower. After 3 to 5 days, the ratios of Klebsiella sp., Acinetobacter sp., Serratia sp., and Achromobacter sp. were lower than those in the Non-VAP group. The richness and Shannon-Wiener index of the Non-VAP group were higher than those of the VAP group from 1 to 3 days after intubation, while no differences were found within 1 day and from 3 to 5 days. We conclude that during the first three days of intubation, the microflora diversity in the lower respiratory tract was reduced due to VAP, and the greater constituent ratios of Klebsiella sp., Acinetobacter sp., and Streptococcus sp. in the sputum may be indicators of VAP.

SUMMARYHumans display a trait-like response to sleep loss. However, it is not known whether this trait-like response can be captured by a mathematical model from only one sleep-loss condition to facilitate neurobehavioural performance prediction of the same individual during a different sleep-loss condition. In this paper, we investigated the extent to which the recently developed unified mathematical model of performance (UMP) captured such trait-like features for different sleep-loss conditions. We used the UMP to develop two sets of individual-specific models for 15 healthy adults who underwent two different sleep-loss challenges (order counterbalanced; separated by 2-4 weeks): (i) 64 h of total sleep deprivation (TSD) and (ii) chronic sleep restriction (CSR) of 7 days of 3 h nightly time in bed. We then quantified the extent to which models developed using psychomotor vigilance task data under TSD predicted performance data under CSR, and vice versa. The results showed that the models customized to an individual under one sleep-loss condition accurately predicted performance of the same individual under the other condition, yielding, on average, up to 50% improvement over nonindividualized, group-average model predictions. This finding supports the notion that the UMP captures an individual's trait-like response to different sleep-loss conditions. IN TROD UCTI ONInsufficient sleep impairs alertness and neurobehavioural performance. Results from Van Dongen et al. (2004) and Rupp et al. (2012) showed that substantial interindividual variability exists with regard to response to sleep loss. More importantly, both studies also showed that this response was trait-like. Van Dongen et al. (2004) evaluated the same 21 individuals under three separate total sleep deprivation (TSD) challenges of 36 h each and observed that the neurobehavioural deficits resulting from sleep loss were stable within individuals across the three challenges. Rupp et al. (2012) showed that an individual's neurobehavioural response to 64 h of TSD was correlated positively with that individual's response to chronic sleep restriction (CSR) [seven consecutive days of 3 h nightly time in bed (TIB)]. In both studies, they quantified individual response to sleep loss by averaging neurobehavioural performance [i.e. psychomotor vigilance task (PVT) data] over the last 12-24 h of the sleep-loss condition, and used the intraclass correlation coefficient (ICC) to assess the extent to which an individual's vulnerability rank among a group of individuals was preserved across sleep-loss conditions. Large ICC values observed in the two studies suggest a high degree of trait preservation. In other words, performance on the last day of a particular sleep-loss challenge can predict accurately the relative rank of an individual for a subsequent sleep-loss challenge. However, such analyses provide little or no information regarding the temporal dynamics of an individual's performance, which is critical in operational settings.In the past, many biomathematical m...

Background In recent years, short segment internal fixation combined with vertebroplasty (SSF + VP) has provided a new option for the treatment of Kummell disease (KD). The purpose of this study is to evaluate the efficacy of percutaneous kyphoplasty (PKP) and SSF + VP, to provide evidence-based medical support for the decision-making process when treating KD patients without neurological deficits. Methods Databases including MEDLINE (PubMed) and EMBASE (Ovid) (1947 to April 6, 2019) were searched for PKP and short-segmental fixation combined with vertebroplasty (SSF + VP) to treat Kummell disease in randomized controlled trials (RCTs) or cohort studies. Two investigators independently evaluated the eligibility of the studies retrieved from the databases based on the predetermined selection criteria. The postoperative evaluation indexes included operation time, bleeding volume, visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, local vertebral Cobb angle, and cement leakage. When the data were significant, a random-effects model was used for analysis. In contrast, when the results showed no statistical heterogeneity, a fixed-effects model was used to estimate the overall effect sizes. Results Three retrospective case-control studies were included in the final analysis. The differences in the bleeding volume and operation time were statistically significant, and the combined weighted mean differences (WMDs) (95% CI) were − 0.204.46 (− 210.97, − 197.93) and − 98.98 (− 141.63, 56.32), respectively. The combined data showed that the differences in VAS score, ODI score, local vertebral Cobb angle, and cement leakage were not statistically significant. Conclusions This analysis demonstrates that the PKP and SSF + VP methods are safe and effective in treating Kummell disease patients without neurological symptoms. However, PKP can shorten the operation time and reduce the volume of blood loss.

AIM:To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation. METHODS:Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography. Second injections were performed 5 d after the initial injection. All patients were followed up for 6-18 mo. A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy. RESULTS:Successful puncture was obtained in all patients. The overall efficacy was 91.4%; the outcome was the excellent in 37 cases (63.8%), good in 16 cases (27.6%) and fair/poor in 5 cases (8.6%) according to the Macnab criteria. No severe complications were found throughout this study. CONCLUSION:

Background/Aims:This study aimed to verify the reliability of the alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index (ANI) for distinguishing ALD in patients with hepatic steatosis from NAFLD, and to investigate whether ANI combined with γ-glutamyl transferase (GGT) would enhance the accuracy of diagnosis in China.Methods:A hundred thirty-nine cases of fatty liver disease (FLD) were divided into two groups of ALD and NAFLD. The ANI was calculated with an online calculator. All indicators and ANI values were analyzed using statistical methods.Results:ANI was significantly higher in patients with ALD than in those with NAFLD (7.11 ± 5.77 vs. –3.09 ± 3.89, p < 0.001). With a cut-off value of –0.22, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of diagnosed ALD cases was 87.1%, 92.5%, and 0.934 (95% confidence interval [CI], 0.879 to 0.969), respectively. The corresponding values for aspartate aminotransferase (AST)/alanine transaminase (ALT), mean corpuscular volume (MCV), and GGT were 75.29%, 72.94%, and 0.826 (95% CI, 0.752 to 0.885); 94.34%, 83.02%, and 0.814 (95% CI, 0.739 to 0.875) and 80.23%, 79.25%, and 0.815 (95% CI, 0.740 to 0.876), respectively. ANI AUROC was significantly higher than the AST/ALT, MCV, or GGT AUROCs (all p < 0.001), moreover, ANI showed better diagnostic performance. The combination of ANI and GGT showed a better AUROC than ANI alone (0.976 vs. 0.934, p = 0.016). The difference in AUROCs between AST/ALT, MCV, and GGT was not statistically significant (all p > 0.05).Conclusions:ANI can help distinguish ALD from NAFLD with high accuracy; when ANI was combined with GGT, its effectiveness improved further.

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