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Background The high prevalence of caesarean section (CS) is a global concern. Relaparotomy is needed when conservative managements are not effective in CS complications. This study aimed to systematically review and meta-analyze the mortality rate and risk factors of relaparotomy after CS. Methods Based on a pre-registered protocol, we searched 11 databases. The MOOSE guideline was followed, and the reporting was in accordance with the PRISMA statement. A Freeman-Tukey double arcsine transformation was used to transform the raw data, and a random-effects meta-analytic model was applied. The quality of the evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results The qualities of the pooled results were assessed to be “very low” based on the inclusion of observational studies. A total of 40 studies were retrieved. The mortality rate in patients after relaparotomy was 7.24% (95%CI 4.10-11.03%). Significant gap existed between high-resources and low-resources countries. In developed areas this rate was 0.56% and in places of low resources this rate was 16.90%. Higher CS rate correlated with higher mortality. Over 70% of the relaparotomies followed emergent CS. Risk factors associated with relaparotomy included higher maternal age, CS performed in the second stage of labor, twin pregnancy, preterm birth (OR 2.72, 95%CI 1.87–3.95) and preeclampsia (OR 3.24, 95%CI 1.47–7.14). Conclusion Our findings demonstrated the high mortality rate in patients who had relaparotomy after CS. Interpretation of the results should be with caution due to GRADE evidence level. During a time when there is an imbalance in medical resources in different countries, interventions to reduce CS rate, good prenatal care and intensified post-operative management are important. Trial registration PROSPEROCRD42021265325.

BackgroundSecondary infection is an important factor affecting mortality and quality of life in patients with severe acute pancreatitis. The characteristics of secondary infection, which are well known to clinicians, need to be re-examined in detail, and their understanding among clinicians needs to be updated accordingly.AimThis study aims to investigate the characteristics and drug resistance of pathogens causing severe acute pancreatitis (SAP) secondary infection, to objectively present infection situation, and to provide reference for improved clinical management.MethodsA retrospective analysis was performed on 55 consecutive patients with SAP who developed secondary infection with an accurate evidence of bacterial/fungal culture from 2016 to 2018. The statistics included the spectrum and distribution of pathogens, the drug resistance of main pathogens, and associations between multiple infectious parameters and mortality.ResultsA total of 181 strains of pathogens were isolated from (peri)pancreas; bloodstream; and respiratory, urinary, and biliary systems in 55 patients. The strains included 98 g-negative bacteria, 58 g-positive bacteria, and 25 fungi. Bloodstream infection (36.5%) was the most frequent infectious complication, followed by (peri)pancreatic infection (32.0%). Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Stenotrophomonas maltophilia were predominant among gram-negative bacteria. Gram-positive bacterial infections were mainly caused by Enterococcus faecium and Staphylococcus spp. Fungal infections were predominantly caused by Candida spp. The drug resistance of pathogens causing SAP secondary infection was generally higher than the surveillance level. Patients in the death group were older (55 ± 13 years vs. 46 ± 14 years; p = 0.039) and had longer intensive care unit (ICU) stay (14 vs. 8; p = 0.026) than those in the survival group. A. baumannii infection (68.4% vs. 33%; p = 0.013), number of pathogens ≥ 4 (10 vs. 6; p = 0.005), pancreatic infection (14 vs. 15, p = 0.024), and urinary infection (8 vs. 5; p = 0.019) were significantly associated with mortality.ConclusionGram-negative bacteria are the main pathogens causing SAP secondary infection, in which nosocomial infections play a major role. The drug resistance profile of gram-negative bacteria is seriously threatening, and the commonly used antibiotics in SAP are gradually losing their effectiveness. Much attention should be paid to the rational use of antibiotics, and strategies should be established for infection prevention in SAP.

Trueperella pyogenes is an opportunistic pathogen that causes suppurative infections in animals. The development of new anti-biofilm drugs will improve the current treatment status for controlling T. pyogenes infections in the animal husbandry industry. Luteolin is a naturally derived flavonoid compound with antibacterial properties. In this study, the effects and the mechanism of luteolin on T. pyogenes biofilm were analyzed and explored. The MBIC and MBEC of luteolin on T. pyogenes were 156 μg/mL and 312 μg/mL, respectively. The anti-biofilm effects of luteolin were also observed by a confocal laser microscope and scanning electron microscope. The results indicated that 312 μg/mL of luteolin could disperse large pieces of biofilm into small clusters after 8 h of treatment. According to the real-time quantitative PCR detection results, luteolin could significantly inhibit the relative expression of the biofilm-associated genes luxS, plo, rbsB and lsrB. In addition, the in vivo anti-biofilm activity of luteolin against T. pyogenes was studied using a rat endometritis model established by glacial acetic acid stimulation and T. pyogenes intrauterine infusion. Our study showed that luteolin could significantly reduce the symptoms of rat endometritis. These data may provide new opinions on the clinical treatment of luteolin and other flavonoid compounds on T. pyogenes biofilm-associated infections.

Objective The purpose of this study was to translate the Vicarious Posttraumatic Growth Inventory (VPTGI) into Chinese and to assess its reliability and validity in Nurses, Additionally, it explored the correlations between vicarious posttraumatic growth (VPTG), Secondary Traumatic Stress (STS) and demographic variables. Methods The Brislin translation model was used to translate the VPTGI into Chinese. Validity analysis involved exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and assessments of convergent validity, discriminant validity, and content validity. Reliability analysis included split-half reliability, internal consistency reliability, and test-retest reliability. Item analysis employed the Critical Ratio Decision Value (CR) method, item-total correlation method, and reliability change method. Single-factor analysis was conducted to examine the relationship between demographic variables and VPTG, while correlation analysis explored the association between STS and VPTG. Results The Chinese version VPTGI demonstrated robust content validity (I-CVI: 0.83-1, S-CVI: 0.97), supported by EFA (KMO: 0.933) and significant Bartlett’s test ( p  < 0.001). Four factors explained 67.82% variance, CFA confirmed the model fit (χ2/df = 2.255, RMSEA = 0.079, IFI = 0.931, TLI = 0.914, CFI = 0.930, NFI = 0.882). The Chinese version VPTGI demonstrated high internal consistency (Cronbach’s α = 0.951), with dimensions’ Cronbach’s α ranging from 0.806 to 0.912. Overall, nurses demonstrated a moderate to low level of VPTG and a severe level of STS. Furthermore, there was a significant negative correlation between STS and VPTG. Conclusion The Chinese version of VPTGI demonstrated satisfactory reliability, validity, and factor structure, making it a reliable tool to assess VPTG in Chinese nurses. These findings underscore the importance of promoting VPTG and addressing STS among healthcare professionals. Further research in this area is warranted to better understand and support the psychological well-being of nurses.

Wood dust produced in medium-density fiberboard (MDF) processing is a major occupational hazard in wood industry and may damage processing equipment. In many wood processing factories, dust collecting systems need to be optimized for the distributional and morphological characteristics of dust in the workshop so that economical and efficient dust control can be achieved. In this study, weighting, image analysis and scanning electron microscopy (SEM) were applied to explore the effects of different cutting speeds on the distribution and morphology of dust generated in MDF milling. The results showed that most dust particles were less than 100 μm and that the aspect ratios (AR) were between 0.6 and 0.7. There was significant difference in particle number size distribution (PNSD) between the dust at different sampling positions. Less amount of dust was located close to cutting center, and fine dust was more likely to appear far away from cutting center. Cutting speed was associated with PNSD, but had little effect on AR. The findings provide spatial distribution characteristics of MDF dust during milling, which can be helpful for optimizing cutting parameters and locating dust collecting hoods to minimize dust exposure.

Background Nurses face high levels of occupational stress due to direct and indirect trauma exposure, resulting in psychological challenges such as anxiety, depression, and secondary traumatic stress. However, vicarious posttraumatic growth (VPTG), a positive outcome of trauma exposure, can improve resilience and professional satisfaction. Understanding the factors affecting VPTG is key to developing strategies that enhance nurse well-being. This study sought to explore the various factors that affect VPTG among clinical nurses, using a cross-sectional design. Methods A cross-sectional survey was performed during the period from September to November 2023, involving 1,025 nurses from 13 tertiary and secondary hospitals across China. The study utilized various validated scales, including the Chinese adaptation of the Vicarious Posttraumatic Growth Inventory, the Coping Style Questionnaire, the Perceived Social Support Scale, the Event Related Rumination Inventory, the Interpersonal Reactivity Index, and the Core Beliefs Inventory. Statistical analysis, including Pearson correlation and stepwise multiple regression, was performed using SPSS 27.0 to identify key factors influencing VPTG. Results The average VPTG score was 105.02 (SD = 15.75), with 70.1% of nurses exhibiting low to moderate levels of VPTG. Positive coping (β = 0.358), social support (β = 0.266), core beliefs (β = 0.186), age (β = 0.083), and empathy (β = 0.066) were significant positive predictors of VPTG, while intrusive rumination (β =-0.078) negatively impacted VPTG. Receiving psychological trauma training also contributed positively (β = 0.046). These factors explained 49.8% of the variance in VPTG. Conclusions Positive coping strategies, social support, core beliefs, and empathy play pivotal roles in enhancing VPTG among nurses. Tailored interventions focusing on these areas could significantly promote VPTG, thereby improving nurse resilience and patient care quality. What is known? • Nurses serve as vital links in healthcare but face significant occupational stress stemming from direct and vicarious trauma, resulting in psychological issues like anxiety, depression, secondary traumatic stress (STS), and post-traumatic stress disorder (PTSD). • VPTG among nurses can lead to personal growth, improved resilience, job satisfaction, and enhanced care quality, but research shows moderate to low levels of VPTG, indicating a need for further exploration of its influencing factors. • Cohen and Collens’ VPTG framework provides a solid theoretical basis for understanding how indirect trauma exposure and empathetic engagement with patients can lead to cognitive restructuring and personal growth among nurses. What is new? • The research employed the Vicarious Posttraumatic Growth Inventory (VPTGI) to assess nurses’ VPTG levels, providing an accurate reflection of their current status. The VPTGI serves as an essential tool for researchers and practitioners, offering a reliable framework for measuring the nuances of VPTG in nursing contexts, particularly given the tendency of previous studies to conflate post-traumatic growth (PTG) with VPTG. • This study identifies significant predictors of VPTG among nurses, including positive coping strategies, social support, core beliefs, and empathy. These findings highlight the vital role these factors play in fostering growth among nurses exposed to indirect trauma from patient care, addressing gaps in previous research that lacked comprehensive theoretical frameworks. • Results indicate that demographic factors, particularly age and years of nursing experience, significantly influence VPTG scores. Notably, nurses aged 41–50 and those professionals with over 30 years of experience display higher VPTG levels. This suggests that as nurses advance in their careers, they develop greater emotional resilience and coping mechanisms, which are crucial for navigating the complexities of their roles, an aspect often overlooked in earlier studies.

Background and objective The efficacy and safety of L-carnitine supplementation on non-alcoholic fatty liver disease (NAFLD) are unclear. This systematic review and meta-analysis aimed to assess the efficacy and safety of L-carnitine supplementation on NAFLD. Methods We searched in four databases (PubMed, Embase, Cochrane Library, and Web of Science) from inception to 1 November 2022 (updated on March 20, 2023) for potentially relevant records without language restrictions. We collected information on the first author, publication year, country, setting, study design, population characteristics, duration of follow-up, outcome variables of interest, and sources of funding. We used a modified Cochrane risk of bias tool to assess the risk of bias, used GRADE to assess the certainty of evidence, and used the Credibility of Effect Modification Analyses (ICEMAN) tool to assess the credibility of any apparent subgroup effect. Results This systematic review and meta-analysis included eight eligible randomized controlled trials (RCTs). Compared to placebo, low certainty evidence show that L-carnitine supplementation significantly changes (reduced) more in AST levels and ALT levels (MD: − 26.38, 95%CI: − 45.46 to − 7.30), and moderate certainty evidence show that L-carnitine supplementation significantly changes (reduced) more in HDL cholesterol levels (MD: 1.14, 95%CI: 0.21 to 2.07) and triglyceride levels (MD: − 6.92, 95%CI: − 13.82 to − 0.03). Moderate credibility of ICEMAN results shows that L-carnitine supplementation has no difference in changes of AST and ALT levels in younger ones (MD: 0.5, 95%CI: − 0.70 to 1.70) but has significant changes (reduced) in adults (MD: − 20.3, 95%CI: − 28.62 to − 12.28) compared to placebo. Conclusion L-carnitine supplementation may improve liver function and regulate triglyceride metabolism in patients with NAFLD, and with no significant adverse effects.

Purposes Secondary traumatic stress (STS) poses a substantial concern within nursing, affecting nurses’ well-being and clinical care quality. While empathy, rumination, and STS are connected, research on their interplay among nurses is limited. The current study investigates how intrusive and purposive rumination mediates the link between empathy and STS in nursing professionals. Patients and methods A cross-sectional survey involving 784 nurses from China was undertaken using convenience sampling. Data collection involved three scales: the Secondary Traumatic Stress Scale, Event-Related Rumination Inventory, and Interpersonal Reactivity Index Scale. The analysis utilized SPSS 25.0 and AMOS 26.0, employing various statistical methods including descriptive statistics, t-tests, ANOVA, Pearson correlation, multiple linear regression and structural equation model. STROBE guidelines were followed. Results This study found moderate empathy and rumination levels among nurses, highlighting a significant prevalence of secondary traumatic stress. Positive correlations were observed between STS, empathy, and rumination. Linear regression revealed intrusive rumination, empathy, and purposive rumination as primary predictors of STS, explaining 33% of the variance. Empathy’s impact on STS (β = 0.328) included both direct (β = 0.157) and indirect effects (β = 0.171) through intrusive and purposive rumination, with the indirect effect comprising 52.13% of the total. Invasive rumination can exacerbate STS, while purposive rumination can mitigate STS. Conclusion Intrusive and purposive rumination sequentially mediate the association between empathy and secondary traumatic stress. Therefore, hospital administrators should monitor nurses’ empathy levels and implement personalized interventions to reduce intrusive rumination and enhance purposive rumination, thereby alleviating STS. Significance What is already known about the topic? • During their professional responsibilities, nurses often experience STS as a consequence of their frequent interactions with patients who have undergone trauma. • Empathy and rumination in nurses are each related to secondary traumatic stress, but the internal connections among these three factors have not been investigated. What this paper adds? • A notable majority of participants indicated severe to extreme levels of STS, highlighting its significant presence among nurses. • The presence of invasive rumination and heightened empathy may exacerbate STS among nurses. • Purposive rumination has been found to mitigate levels of STS among nurses. • Invasive and purposive rumination mediates between empathy and STS.

The massive amounts of dust formed during bamboo CNC milling presents serious risks to human health and equipment. The present study aimed to determine the particle size distribution (PSD) and shape characteristics of bamboo milling dust derived from different average chip thicknesses. Spindle speed and feed rate were varied in combination, in setting up two experimental groups having the same average chip thicknesses. Sieving and flatbed scanning image analyses were collectively utilized for the morphological analysis of bamboo dust. The results showed that less than 5% of the particles were below 100 μm in terms of mass, but represented more than 83% in number. Average chip thickness was positively correlated with a mass proportion of bamboo dust with large size, which was preferably generated when reducing spindle speed instead of increasing feed rate. Spindle speed and feed rate individually affected the particle size and particle size distribution instead of average chip thickness. The aspect ratio, roundness and convexity of bamboo milling dust were augmented with a reduction in particle size, indicating that bamboo milling dust with smaller size had more a regular shape, a smoother profile and fewer corners. These findings provide a theoretical basis for better understanding bamboo milling dust and its related control in the bamboo processing industry.

Background Breast cancer is a global health problem that cannot be underestimated. Many studies have shown that breast cancer is related to pathogenic mutations in hereditary predisposition genes. Clinical practice guidelines play a vital role in guiding the selection of breast cancer screening. Little is known about the quality and consistency of guidelines’ recommendations and their changes over these years. Methods We reviewed the existing screening guidelines for genetic susceptibility to breast cancer and assessed the methodological quality, and summarized the recommendations to aid clinicians to make decisions. We conducted a systematic search in PubMed, Embase, Web of Science, and guideline‐specific databases, aiming to find the guidelines of breast cancer due to hereditary predisposition. The necessary information was exacted by Excel. We also summarized different evidence grading systems. The qualities of the guidelines were assessed by the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument. Results A total of 54 recommendations from 13 guidelines were extracted. Generally speaking, the recommendations were consistent, mainly focusing on mammography and MRI. Conclusions The recommendations differ in details. Moreover, different guidelines are based on different grading systems, and some guidelines are not divided for age limits, which may limit the promotion and implementation of the guidelines. It is suggested that improvement can be made in this regard in the future. Systematic and comprehensive search of breast cancer gene mutation screening guidelines, and summarize and analyze the recommendations, to find out the current problems