Objective To observe the effects of cinepazide maleate and nimodipine in improving the neurological function in patients with hypertensive cerebral hemorrhage after microtraumatic craniopuncture.Methods Seventy-eight patients with hypertensive cerebral hemorrhage were randomly divided into 2 groups,cinepazide maleate group (39 patients)and nimodipine group(39 patients).After 3 days operated with the microtraumatic craniopuncture,cinepazide maleate group used the amount 160mg cinepazide maleate mixed with sodium chloride injection(500ml,concentration 0.9%),and the nimodipine group uesd nimodipine(4mg)mixed with the same injection.Both the patients of the 2 groups were given intravenous drip once a day,then after continuous 14 days,the general information and the improvement of nerve were observeed.Results The total improvement rate and the improvement rate of nervous symptom was 87.2%and 61.5%respectively,in comparison,the nimodipine group was 64.1%and 39.9%.Conclusion Cinepazide maleate was better than nimodipine in improving chnical symptoms and the neurological deficit of the patients with hypertensive cerebral hemorrhage after microtraumatic craniopuncture.

OBJECTIVETo investigate the rationality and feasibility of primary closure of the common bile duct after choledochotomy for common bile duct calculi.

METHODSFrom January 1990 to June 2001, 386 patients with the evidence of stones in the common bile duct underwent choledochotomy. Among them, 215 received primary closure of the common bile duct (group A) and 171 T-tube drainage (group B). The patients with emergency operations were excluded. Intraoperative choledochoscopy or cholangiography was routinely performed to rule out the possibility of retained stones. The duct was meticulously stitched using 0/3 to 0/5 absorbent sutures for primary closure. A T-tube was placed in the subhepatic space in the patients of both groups.

RESULTSPostoperative bile leakage was seen in 9 patients of group A and in 5 of group B, respectively (P > 0.05), and no reoperations were necessary. After surgery, the average time and volume of transfusion was 4.9 days and 9.1 liters in group A, versus 7.3 days and 12.8 liters in group B (P < 0.01). The patients in group B had a longer postoperative hospital stay than the those in group A (average 17.6:10.0 days, P < 0.01). T-tube removal resulted in bile peritonitis in 5 patients at day 16, 17, 19, 21 and 22 after surgery in group B, and 3 patients required repeated surgery.

CONCLUSIONSPrimary closure of the common bile duct after choledochotomy is safe, effective, and inexpensive in selected patients with common bile duct calculi, and should be regarded as an alternative procedure.

Adult ; Aged ; Biliary Tract Surgical Procedures ; methods ; Choledocholithiasis ; surgery ; Common Bile Duct ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective:To review the influencing factors of position change frequency in adult Intensive Care Unit (ICU) patients, so as to provide reference basis for formulating position change plans for adult ICU patients.Methods:Under the guidance of the scoping review guidelines of the Joanna Briggs Institute in Australia, relevant literature was systematically searched in PubMed, ProQuest, CINAHL, China National Knowledge Infrastructure (CNKI), WanFang Data, VIP, and China Biomedical Literature Database. The search period was from database establishment to October 26, 2022. We extracted and summarized data from the included literature.Results:A total of 23 articles were included. Factors affecting the frequency of position change in adult ICU patients included patient activity ability, mobility ability, perception, moisture, nutrition, friction and shear forces, fever, skin condition, age, weight, past history, consciousness, hemodynamic status, respiration, oxygen demand, hygiene self-care ability, support surface used, patient skin response to position change frequency, and pain during position change, whether it was the final/near death stage, sleep, overall disease status, overall treatment goals, and perspective of position change.Conclusions:Nurses should fully consider relevant influencing factors when formulating a position change plan for adult ICU patients, in order to improve the prevention effect of pressure injury, promote patient recovery, and increase the cost-effectiveness of position change.

Objective To search and summarize the de-implementation strategy of low-value care and describe the specific elements of de-implementation strategies.Methods PubMed,ProQuest,CINAHL,China Biomedical Literature Service System database,CNKI,Wanfang and VIP database were searched until May 10,2023.Literature of de-implementation strategies was screened.Specific elements of the de-implementation strategies(i.e.,actors,actions,temporality,dose,action target,affected implementation outcome and justification)were extracted.Results A total of 20 pieces of the literature were included,of which 18 used multiple strategies and 2 used single strategy.A total of 65 strategies were extracted,and the education strategy was applied 15 times,the assessment and feedback strategy were applied 14 times,and the specific elements of only 3 strategies were fully described.Conclusion Education,assessment and feedback strategies are commonly used in de-implementation of low-value care studies.Future studies should clearly describe the specific elements of de-implementation strategies,in order to promote replication,improvement,and clinical application of strategies.

Objective To further update the evidence-based medicine evidence of clinical efficacy and safety of butylphthalide soft capsules in the treatment of Parkinson disease(PD). Methods Randomized controlled trials(RCT) on Butylphthalide soft capsules for PD was collected from PubMed,Embase,Cochrane Library,CNKI,Wanfang and CBM,the retrieval time was from inception to August 2021.The literature selection,data collection were conducted. Meta-analysis was performed by RevMan 5.3 software. Results A total of 28 studies were included and 2463 patients were included. Compared with control group,butylphthalide soft capsules could reduce UPDRS score (MD=-9.52,95%CI -11.23~-7.82,P<0.05),increase MMSE score (MD=3.40,95%CI 2.74~4.06,P<0.05) and MoCA score (MD=3.31,95%CI 3.04~3.57,P<0.05). It also could reduce CRP levels (MD=-2.37,95%CI -2.49~-2.24,P<0.05) and PARK-7 level (MD=-9.39,95%Cl -10.56~-8.22,P<0.05),increase NT-3 levels (MD=8.04,95%CI 7.01~9.07,P<0.05). However,there was no statistical difference in the number of adverse events between the treatment and control groups (RR=1.21,95%CI 0.75~1.94,P=0.43). Conclusion Butylphthalide soft capsules can improve cognitive dysfunction and other complications in Parkinson's patients,by reducing PARK-7,CRP levels and increase NT-3 levels,No serious adverse events have been observed.

Objective:To investigate the clinical efficacy of local injection of platelet-rich plasma (PRP) combined with double-layer artificial dermis in treating wounds with exposed tendon on extremity.Methods:A retrospective observational study was conducted. From December 2017 to October 2022, 16 patients were admitted to Department of Orthopaedic Trauma of the Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, and 32 patients were admitted to Department of Burns and Plastic Surgery of Guiyang Steel Factory Staff Hospital. All the patients had wounds with exposed tendon on extremity caused by various reasons and met the inclusion criteria. There were 39 males and 9 females, aged 26 to 58 years. The patients were divided into PRP alone group, artificial dermis alone group, and PRP+artificial dermis group, with 16 patients in each group. The wounds were treated with autologous PRP, double-layer artificial dermis, or thei combination of autologous PRP and double-layer artificial dermis, followed by autologous split-thickness scalp grafting after good growth of granulation tissue. On the 7 th day after the secondary surgery, the autograft survival was observed, and the survival rate was calculated. The wound healing time and length of hospital stay of patients were recorded. At 3 and 6 months after wound healing, the Vancouver scar scale (VSS) was used to score the pigmentation, height, vascularity, and pliability of scars, and the total score was calculated. Adverse reactions during the entire treatment process were recorded. Data were statistically analyzed with chi-square test, Fisher's exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, Nemenyi test, and Bonferroni correction. Results:On the 7 th day after the secondary surgery, there was no statistically significant difference in the autograft survival rate of patients among PRP alone group, artificial dermis alone group, and PRP+artificial dermis group ( P>0.05). The wound healing time and length of hospital stay of patients in PRP+artificial dermis group were (20.1±3.0) and (24±4) d, respectively, which were significantly shorter than (24.4±5.5) and (30±8) d in PRP alone group ( P<0.05) and (24.8±4.9) and (32±8) d in artificial dermis alone group ( P<0.05). At 3 and 6 months after wound healing, the pliability scores of patients in PRP+artificial dermis group were significantly lower than those in PRP alone group (with Z values of 12.91 and 15.69, respectively, P<0.05) and artificial dermis alone group (with Z values of 12.50 and 12.91, respectively, P<0.05). There were no statistically significant differences in pigmentation, vascularity, height scores, and total score of scar of patients among the three groups ( P>0.05). In artificial dermis alone group, one patient experienced partial liquefaction and detachment of the double-layer artificial dermis due to local infection of Staphylococcusepidermidis, which received wound dressing change, second artificial dermis transplantation, and subsequent treatment as before. No adverse reactions occurred in the remaining patients during the whole treatment process. Conclusions:Local injection of PRP combined with double-layer artificial dermis is effective in treating wounds with exposed tendon on extremity, which can not only significantly shorten wound healing time and length of hospital stay, but also improve scar pliability after wound healing to some extent in the long term. It is a clinically valuable treatment technique that is worth promoting and applying.

【Objective】 To explore the characteristics of esophageal motility and reflux of endoscopic-negative heartburn patients based on the Lyon Consensus Diagnostic Criteria and discuss the differential diagnosis value of the mean nocturnal baseline impedance （MNBI） and the postreflux swallow-induced peristaltic wave （PSPW） index for reflux hypersensitivity （RH） and functional heartburn （FH） patients. 【Methods】 We enrolled 132 patients with heartburn as the main symptom who visited the Gastroenterology Department of our hospital from January 2017 to June 2021， including 24 in the non-erosive reflux disease （NERD） group， 24 in the RH group， and 84 in the FH group. All the patients completed gastroscopy， esophageal high-resolution manometry and 24h-pH impedance monitoring. We analyzed and compared the related indexes of esophageal motility and reflux. The receiver operating characteristic （ROC） curve was used to analyze the esophageal proximal MNBI， distal MNBI， and PSPW indexes for the differential diagnosis of RH and FH. 【Results】 The lower esophageal sphincter （LES） average resting pressure， LES residual pressure and intact relaxation pressure （IRP） in NERD were lower than those in RH and FH （P<0.05）. The number of acid reflux， the upright acid exposure time （AET）， the supine position AET， the total AET， and the DeMeester score were higher in NERD than in RH and FH （P<0.05）. The non-acid reflux， distal MNBI and PSPW indexes were lower in NERD than in RH and FH （P<0.05）. The distal MNBI and PSPW indexes were lower in RH than in FH （P<0.05）. However， there was no significant difference in proximal MNBI among the three groups （P>0.05）. When the proximal MNBI， distal MNBI， and PSPW indexes were used alone respectively to diagnose RH， the area under the ROC curve was 0.480， 0.810， 0.682， respectively， with the sensitivities being 87.5%， 100% and 91.7%， and the specificities being 26.2%， 66.7% and 51.2%， respectively. 【Conclusion】 NERD patients have obvious abnormal esophageal dynamics， mainly manifested as LES relaxation， which further aggravates the pathological acid reflux， while patients with RH and FH are mainly exposed to physiological acid or non-acid reflux. In patients with endoscopic negative heartburn， distal MNBI value can improve the clinical diagnosis rate of RH and help distinguish RH from FH.