OBJECTIVE:To systematically evaluate the effectiveness and safety of escitalopram and duloxetine in the treatment of depression, and provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed, Wanfang database,VIP,CNKI and CBM,randomized controlled trials (RCTs) about escitalopram (trial group) and duloxetine (control group) in the treatment of depression were collected. Meta-analysis was conducted by using Rev Man 5.3 software after data extraction and quality evaluation according to bias risk assessment tool recommended by system evaluator manual 5.3. RESULTS:Finally 25 RCTs were included,involving 2621 patients. The results of Meta-analysis showed that there was no statistical significance in total response rate between 2 groups after 1,2,4,6,8 weeks of treatment or cure rate between 2 groupsafter 4,6,8 weeks of treatment (P>0.05). There was no statistical significance in total response rate [RR=0.96,95％CI(0.88, 1.05),P=0.42] or cure rate [RR=0.91,95％CI(0.78,1.06),P=0.24] of female patients,as well as total response rate [RR=0.96, 95％CI(0.84,1.11),P=0.61] or cure rate [RR=0.90,95％CI(0.54,1.49),P=0.69] of elderly patients between 2 groups. The incidence of constipation [RR=0.59,95％CI (0.42,0.81),P=0.001],dry mouth [RR=0.65,95％CI(0.51,0.82),P=0.0004], nausea [RR=0.68,95％CI(0.56,0.83),P=0.0002] and decreased appetite [RR=0.74,95％CI(0.55,0.99),P=0.04] in trial group were significantly lower than control group,with statistical significance. CONCLUSIONS:The effectiveness of escitalopram is similar to duloxetine in the treatment of depression,but the safety of escitalopram is better than duloxetine.

Objective:To analyze the nursing management information system in China based on bibliometric analysis so as to provide a reference for further research.Methods:This study retrieved literatures on nursing management information system in Chinese National Knowledge Infrastructure (CNKI) , WanFang Data and VIP from 2000 to 2018 and carried out the bibliometric analysis.Results:A total of 421 literatures were included. The number of literatures showed a trend of rising. There were 1 461 authors from 30 province-level regions and 287 research institutions focused on hospitals. Province-level regions with literature number in the top 10 mainly were distributed in east of China. Journals with literature number in the top 10 were statistical source or core journals publishing 192 (47.29%) literatures. The average time cited per paper was 5.04. There were 29.69% of literatures with the program fund. The study focused on nursing quality involving the nursing human resource, nursing teaching, nursing administration and nursing research.Conclusions:Nursing management information system is one of the research hotspots in China. We should increase the research depth, literature recognition and fund support, and concentrated on nursing quality improvement, and accelerate to build the nursing standardized language of China so as to promote the development of nursing information construction in China.

Objective:To construct the continuous nursing health empowerment program for chronic heart failure (CHF) patients based on health empowerment theory so as to improve the participation and self-management of CHF patients in continuous nursing.Methods:From January to June 2019, we initially established the continuous nursing health empowerment program for CHF patients based on literature search combined with qualitative interview results. From July to August 2019, we selected 15 experts in cardiovascular medical nursing, geriatric nursing, community nursing and nursing management for two rounds of Delphi expert consultations by purposive sampling to construct the continuous nursing health empowerment program for CHF patients.Results:The recovery rate of two rounds of expert consultation questionnaires was 100% (15/15) , and the expert authority coefficient was 0.90. The results of the first round showed that the modification rate of experts was 66.67% (10/15) , adding 22 items, modifying 10 items, merging 13 items and deleting 7 items. The results of the second round showed that the modification rate of experts was 20.00% (3/15) , adding 1 item and modifying 2 items. After two rounds of Delphi expert consultations, we determined 5 first-level items, 18 second-level items and 75 third-level items.Conclusions:Construction of continuous nursing health empowerment program for CHF patients based on Delphi expert consultation help improve the participation and self-management of patients with CHF and improve the effectiveness of continuous nursing.

Objective:To apply the best evidence of exercise rehabilitation during hospitalization for patients with acute myocardial infarction after percutaneous coronary intervention (PCI) in clinical practice, in order to standardize the management of exercise rehabilitation of patients by medical staff and promote the practice of cardiac rehabilitation.Methods:By using the clinical evidence practice application system of Joanna Briggs Institute (JBI) Evidence-Based Health Care Center, the literatures related to the subject were systematically retrieved and quality evaluation was conducted. A total of 20 best evidences were collected, and 16 evidence-based quality review standards were developed in combination with the clinical context. The implementation of nurses' review indicators, the score of Cardiac Rehabilitation Knowledge Test and the score of Exercise Fear Scale before and after the application of evidence were compared respectively on the nurses and patients with acute myocardial infarction after PCI from February 1 to March 30, 2020 and from May 1 to July 3, 2020.Results:Except for index 1 and index 2, the implementation rates of all review indexes before and after the application of evidence were all increased, and the differences were statistically significant ( P<0.01) . The score of Cardiac Rehabilitation Knowledge Test was (91.14±14.05) after the application of evidence, which was higher than (80.00±10.41) before the application of evidence, and the difference was statistically significant ( t=-2.682, P<0.05) . After the application of evidence, the score of Exercise Fear Scale for Patients with Heart Disease was (43.43±10.93) , which was not statistically significantly different from the score (44.19±8.58) before the application of the evidence ( t=0.280, P>0.05) . Conclusions:The application of the best evidence of exercise rehabilitation during hospitalization in patients with acute myocardial infarction after PCI can improve the management and cognition of medical staff on exercise rehabilitation of patients and reduce the influence of exercise fear avoidance of patients.

This article summarizes the application of cardiac rehabilitation from the aspects of the generation, demand and feasibility, application status and effects of cardiac rehabilitation, so as to provide a basis for the development of cardiac rehabilitation in our country.

Objective To develop a self-assessment scale for medication literacy in patients with coronary heart disease comorbidity diabetes and to test its reliability and validity.Methods According to medication literacy theory model,the initial scale was formed through literature review,the qualitative interview and expert inquiry.Cognitive interview was used to optimize the expression of item text.421 patients with coronary heart disease comorbidity diabetes in a tertiary hospital in Zhejiang province from November 2022 to April 2023 were selected to investigate the reliability and validity of the scale by convenience sampling.Results The self-assessment scale of drug literacy for coronary heart disease comorbidity diabetes mellitus included 23 items in 5 dimensions including acquisition,understanding,communication,evaluation and calculation.The total Cronbach's α coefficient of the scale was 0.911;the retest reliability was 0.948;the average content validity index was 0.997;the correlation coefficients between each dimension and total score of the scale and the calibration scale ranged from 0.485 to 0.926.The exploratory factor analysis was employed to extract 5 common factors,and the cumulative variance contribution rate was 73.753％.Confirmatory factor analysis showed that the scale factor structure was stable.Conclusion The scale has good reliability and validity,and it can be used as an effective tool to evaluate the self-rated medication literacy level of patients with coronary heart disease comorbidity diabetes.

Objective To develop a self-assessment scale of home volume management for patients with chronic heart failure(CHF),and to test its reliability and validity.Methods With the self-care theory as the theoretical framework,the initial scale was developed through literature analysis,qualitative interview and expert consultation.A questionnaire survey was conducted on 598 patients with CHF who were treated or reviewed in a tertiary hospital in Hangzhou from September 2022 to January 2023 to test the reliability and validity of the scale.Results The exploratory factor analysis extracted 4 common factors with the cumulative variance contribution rate of 61.268％.The results of confirmatory factor analysis showed that the main evaluation indicators were all within the acceptable range of the judgment standard.The item-level content validity index ranged from 0.853 to 1.000;the scale-level content validity index/average was 0.951.The Cronbach's a coefficient,half reliability and retest reliability of the overall scale were 0.930,0.723 and 0.867,respectively.Conclusion The self-rating scale of home volume management for CHF patients has good reliability and validity,and it can effectively assess the level of home volume management for CHF patients.

Objective:To observe the characteristics and differences of gut microbiota in asthma patients with different inflammatory types through metagenomic analysis.Methods:Adults aged ≥18 years who visited the Respiratory Clinic of Peking University Third Hospital from August 1, 2021 to August 31, 2022 and were primarily diagnosed with asthma were selected as the study subjects. Finally, 29 patients with stable asthma were included. Fresh fecal samples were collected and the fecal DNA was extracted for high-throughput 16sRNA sequencing of gut microbiota. The diversity and community structure of gut microbiota in different groups of asthma patients were compared, and the species differences were analyzed through random forest and LEfSe analysis.Results:There were sex-based differences in asthma patients with different types of inflammation, and the proportion of female patients was higher in neutrophilic asthma patients ( χ2=4.14, P=0.042). There was no significant intergroup difference in the alpha diversity of gut microbiota among asthma patients with different inflammatory types, but there were significant differences in the microbiome. Patients with neutrophilic asthma had higher relative abundance of Bacillales ( P=0.029) and Oscillospiraceae ( P=0.015). In species LEfSe analysis, patients with eosinophilic asthma had a higher relative abundance of fungi. Conclusion:There are intergroup differences in the gut microbiota of asthma patients with different inflammation types, and fungi are biomarkers that distinguish the differences in gut microbiota between patients with eosinophilic asthma and neutrophilic asthma.

Objective:To explore the clinical effects of free anterolateral thigh perforator flap (ALTPF) with modified cross-leg vessel bridging in reconstruction of infected wounds in the lower leg combined with major vessel defects.Methods:A retrospective observational study was conducted on 7 patients who admitted to the Department of Trauma Orthopaedics, the 521 Hospital of Norinco Group from January 2020 to December 2021 for treatment of large infected wounds in lower leg with soft tissue defect by reconstructive surgery of flap transfer. The patients were 5 males and 2 females, aged 23-50 years old with an average age of 37 years old. The causes of injury were: 5 patients were of car accidents, 1 of machinery compression and 1 of heavy object crush. The wounds were reconstructed after debridement and infection control with sensitive antibiotics, where the soft tissue defects were found at 11.0 cm×15.0 cm to 20.0 cm×32.0 cm in size. All patients underwent vascular angiography or CDU examinations and it was confirmed that the affected calf had only an anterior tibial artery as the vessel left for blood supply in 6 patients and a posterior tibial artery as the blood supply vessel in one patient. Therefore application of vascular end-to-side anastomosis in free flap reconstruction of limb defects was impossible due to the damaged artery could not be salvaged as a blood supply artery for the transferred flap. Therefore, a modified cross-leg vessel bridging to the freed ALTPF in the affected lower leg was applied. The donor site of the pedicle was covered with VSD while the pedicle of the flap was anastomosed. It was remained until the posterior tibial artery and the tubular flap were ready for replantation after disconnection of the pedicle. The sizes of flap were 13.0 cm×17.0 cm to 22.0 cm×32.0 cm (unilateral ALTPFs for 6 patients and bilateral ALTPFs for 1 patient). Two donor sites in low tension were direct closed, and the rest of 5 donor sites that had great tensions and could not be directly sutured were reconstructed by skin grafting. The survival and complications of flaps were observed in the scheduled postoperative follow-ups at outpatient visits, WeChat reviews and home visits, etc.Results:All 7 patients were successfully treated and had 12-24 months postoperative follow-up, with an average of 16 months. All flaps survived, with primary healing in 6 patients and 1 patient had partial flap necrosis with surface infection, which healed after dressing changes. The wound healing time was 14-36 days with an average of 17.9 days. The time for disconnection of the cross-leg vessel bridging pedicle was 3-4 weeks with the flap transfer, with an average of 3.6 weeks. The donor sites of ALTPFs and vessel pedicles all healed well. CDU confirmed the patency of the contralateral posterior tibial artery. Satisfactory functional recovery was achieved in the affected lower limb and there was a good function of the contralateral healthy lower leg.Conclusion:Application of the transfer of a free ALTPF with modified cross-leg vessel bridging in reconstruction of infected wounds with major vessel defects in the lower leg has shown excellent clinical outcomes. It is a practical and effective method in treatment of large infective defect in lower leg.

Objective:To deliver understanding of the latest research progress on clinical trials and approval of dermatological drugs in China in 2020.Methods:A registration and information disclosure platform for drug clinical studies and a query system for domestic and imported drugs in the National Medical Products Administration of China were searched for registered clinical trials and approved dermatological drugs, respectively. The number and stages of clinical trials, indications and classification of involved products, and listed dermatological drugs in 2020 were summarized and depicted.Results:There were 157 dermatological drug trials registered in China in 2020, accounting for 6.16% of all the 2 548 clinical drug trials, including 127 (80.9%) initiated by Chinese pharmaceutical enterprises and 25 (15.9%) international multicenter trials. Among the 127 drug trials initiated by Chinese pharmaceutical enterprises, bioequivalence trials were mostly common, accounting for 55.9% (71/127) . Compared with global pharmaceutical enterprises, domestic pharmaceutical companies initiated significantly decreased proportions of international multicenter trials (1.9% [3/157] vs. 14.0% [22/157], P < 0.001) , but significantly increased proportions of phaseⅠclinical trials and bioequivalence trials (24.4% [31/127] vs. 10.0% [3/30], 55.9% [71/127] vs. 0, respectively, both P < 0.001) . Totally, 90 kinds of dermatological drug were involved in all the trials, psoriasis, atopic dermatitis and melanoma were the most common indications, and innovative drugs accounted for 53.3% (48/90) ; the proportion of innovative drugs was significantly lower in domestic pharmaceutical companies than in global pharmaceutical companies (43.2% [32/74] vs. 16/16, P < 0.001) . In addition, 28 dermatological drugs developed by 22 pharmaceutical companies were approved in China in 2020, of which 21 drugs were developed by domestic pharmaceutical companies. Conclusion:Clinical drug trials carried out by domestic pharmaceutical companies mostly focus on generic drugs, and it is still necessary for domestic pharmaceutical companies to further improve the innovation ability.