Objective:To explore the ethical issues in liver cirrhosis and hepatic encephalopathy and integratet-hem into health education. Methods:36 patients with hepatic encephalopathy and their family members were car-ried out medical ethics education and adopted relevant nursing care. Results:It was proved that integrating medi-cal ethical knowledge into health education could greatly relieve patients′pressure and emotion swing, so as to ob-tain better treatment effect. Conclusion:Through carrying out effective ethics education for the patients with liver cirrhosis and hepatic encephalopathy, strictly complying with the principle of medical ethics that keeping secret for patients, protecting the subjects maximally, holding the issues between ethics and medical moral and cooperating with comprehensive treatment and nursing care, the death rate of hepatic encephalopathy can be largely reduced and relationship between doctors, nurses and patients can be improved.

OBJECTIVE To systematically evaluate the efficacy and safety of the sedative effect of remimazolam in endoscopy and to compare it with propofol and midazolam. METHODS Search PubMed, Embase, Cochrane Library, Wanfang database, CNKI and other databases to collect the literature of randomized controlled trials of remimazolam for sedation in endoscopy. The search period was from 2018 onwards when remimazolam was approved for clinical trials until April 2022. The search strategy included the following variable keywords: remimazolam, gastroscopy, bronchoscopy, and colonoscopy. The quality of the included literature was assessed and the collected data were subjected to meta-analysis by RevMan 5.4 software. RESULTS Ten relevant RCTs involving midazolam and propofol, involving a total of 2 076 patients were included in the analysis. The results showed that the sedative effect of remimazolam was significantly higher than that of midazolam [OR=0.03, 95%CI(0.02, 0.05), I2=0%, P<0.000 01]; but lower than that of propofol [OR=11.32, 95%CI(2.12, 60.56), I2=0%, P=0.005]. The onset time of remimazolam was longer than that of propofol, but shorter than that of midazolam; the recovery time was faster than that of propofol and midazolam. Compared with midazolam, there was no significant difference in the incidence of adverse reactions. Compared with propofol, remimazolam was associated with lower rates of hypotension, slowed heart rate, hypoxemia, and injection pain, but higher risk ratio of nausea, with no difference invomiting. CONCLUSION The sedative effect and onset of action of remimazolam are better than midazolam but less than propofol when used for endoscopy. Wake-up time is faster than that of propofol and midazolam. The incidence of respiratory and circulatory depression is lower with remimazolam than with propofol, and there are no significant differences in adverse effects compared with midazolam.

Objective:To observe the emulsification of silicone oil in eyes with rhegmatogenous retinal detachment (RRD) after silicone oil filling surgery, and to preliminarily analyze the possible clinical factors related to it.Methods:A cross-sectional clinical study. From January 2019 to April 2022, 50 eyes of 50 patients with RRD who underwent pans plana vitrectomy (PPV) combined with silicone oil filling surgery in Eye and ENT Hospital of Fudan University were included in the study. Among them, there were 25 males with 25 eyes and 25 females with 25 eyes; the age was 54.86±11.79 years old. The retina was in place 3 months after surgery. Before silicone oil removal surgery, intraocular pressure >21 mm Hg (1 mm Hg=0.133 kPa) or treated with≥1 anti-glaucoma drug (high intraocular pressure) in 20 eyes; intraocular pressure ≤21 mm Hg and no anti-glaucoma drug treatment in 30 eyes (normal intraocular pressure). During follow-up after surgery, silicone oil emulsification was found and those who met the indications for silicone oil removal were subjected to silicone oil removal surgery. The first 2 ml of lavage fluid was collected immediately after removal of the silicone oil, and the particle diameter and number of emulsified silicone oil were measured using a Multisizer ? 3 particle/cell counter and particle size analyzer. The measuring range was 0.4-12.0 μm, and the diameter is accordingly divided into 0.4-<1.0, 1.0-<3.0, 3.0-<5.0, 5.0-<7.0, 7.0-12.0 μm. Each sample was measured 3 times and the average value was taken. Spearman correlation analysis and multiple linear regression analysis were used to analyze the correlation between the number of emulsified silicone oil particles and clinical factors. Results:The number of emulsified silicone oil particles was (1.74±2.94)×10 7/ml (0.96×10 7-14.11×10 7/ml), of which the diameter of 0.4-<1.0 μm emulsified silicone oil particle was (1.25±2.41)×10 7/ml, accounted for (64.26±12.70)% [(1.25±2.41)×10 7/(1.74±2.94)×10 7]. The results of correlation analysis showed that there was no correlation between the total particle number of emulsified silicone oil and various clinical factors ( P>0.05). The number of emulsified silicone oil particles with a diameter of 7.0-12.0 μm was negatively correlated with age ( r=-0.298, P=0.036), and positively correlated with axial length ( r=0.325, P=0.021). There was no correlation between the previous ocular trauma, choroidal detachment and different lens states and the number of emulsified silicone oil particles ( P>0.05). Multiple linear regression analysis showed that eye axis ( β=1 570.868, P=0.023) and age ( β=-316.128, P=0.039) were the risk predictors of silicone oil emulsification into large diameter particles (7-<12 μm). The number of emulsified silicone oil particles with a diameter of 7-12 μm in the patients with high intraocular pressure was significantly higher than that in the patients with normal intraocular pressure, and the difference was statistically significant ( U=195.00, P=0.037). Conclusions:Most of the emulsified silicone oil particles in the eyes of RRD patients after silicone oil filling surgery are small-diameter particles; the silicone oil emulsification is more serious in young patients and patients with long ocular axis, and young patients are more prone to high intraocular pressure.