Kawasaki disease has replaced rheumatic fever as the most common acquired heart disease in childhood,but its etiology remains unknown. The development and analyses of animal models will help us under-stand KD and find new and effective therapeutic strategies for it. Among these existing animal models, mouse modelof coronary artery inflammation induced by a single intraperitoneal injection of lactobacillus casei cell wall extract is a relatively mature model. In this review,we present an overview of how this model established and some progress in research of the mouse model.

Objective:To explore the application effect of optimizing the anti-epileptic drug (AED) administration nursing procedure for patients with severe epilepsy at the first time after ICU admission.Methods:A quasi-experiment study was conducted by convenience sampling. The 44 patients with severe status epilepticus admitted in our department from January 2016 to December 2017 were selected as the control group .The 44 patients with status epilepticus admitted in our department from January 2018 to December 2019 were selected as the experimental group .The experimental group was implemented the optimized administration procedure after ICU admission. The control group was implemented the routine administration procedure after ICU admission. Some data of the two groups were compared, including baseline data, first administration time after admission, administration step time, AED dose reserve, and seizures at different time periods and so on.Results:Comparative analysis of the time of the first drug administration after admission into the two groups .The administration time of the control group was 31.0 (10.0-69.0) min, which was significantly longer than that of the experimental group, 25.0 (16.0-31.8) min ( χ2 value was -2.760, P<0.05). Comparison and analysis of the time taken for each step of drug administration: The time taken for step 1(Patient admission—medical order confirmation) in the control group was significantly greater than that in the experimental group ( χ2 value was -2.811, P<0.05); step 2 (medical order confirmation—Prepare medicines)in the control group was significantly greater than that in the experimental group ( χ2 value was -4.327, P<0.05).There was no significant difference in the time taken for step 3(Prepare medicines—Drug delivery to complete)between the two groups ( χ2 value was -1.137, P>0.05). Control group AED reserve ratio 63.6% (28/44), experimental group AED reserve was 100.0% (44/44), and the difference was statistically significant ( χ2 value was 19.556, P<0.05). Epilepsy control in two groups of patients: the total control rate after the first administration of the experimental group was 93.2% (41/44), which was significantly higher than 61.4% (27/44) of the control group ( Z value was -3.445, P<0.001). Conclusion:It can shorten the time to first give AED and improve the patient's clinical symptoms that optimizing the first drug administration procedure for patients with status epilepticus after admission.

Objective To evaluate the efficacy of systemic glucocorticoids and intravenous immunoglobulin (IVIG)for the treatment of toxic epidermal necrolysis (TEN). Methods Clinical data on TEN inpatients treated with systemic glucocorticoids alone or in combination with IVIG were collected from the Department of Dermatology, First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2012. Therapeutic outcomes were evaluated in these patients. Statistical analysis was carried out by using a multiple linear regression analysis, binary logistic regression analysis and Cox regression analysis with the SPSS 16.0 software. Results A total of 48 inpatients with TEN were included in this study. Multiple linear regression analysis showed that the maximum daily dose of glucocorticoids for disease control was decreased gradually over years (β=-0.461, P=0.004). However, binary logistic regression analysis revealed no obvious changes in the frequency of administration of IVIG over years. Cox regression analysis showed that both hospitalization duration (RR=0.351, 95.0%CI:0.150-0.825)and the time required for the control of skin lesions (RR=0.492, 95.0%CI:0.245-0.986)decreased with the increase in the frequency of IVIG administration. In addition, with the increase in the maximum daily dose of glucocorticoids for disease control, the time required for the control of skin lesions was also shortened (RR=0.997, 95.0%CI:0.994 -1.000), while no obvious changes were observed in hospitalization duration. Conclusions IVIG shows superiority in controlling lesions, reducing complications and improving the prognosis of TEN. Compared with systemic glucocorticoids, IVIG shows better therapeutic efficacy and less adverse effects, and may be preferentially selected.

Objective: To discuss the correlation between different muscle strength of lower extremitiess and the formation of deep vein thrombosis (DVT) in neurological ICU patients, and to provide evidence for effective nursing intervention. Methods: A questionnaire was developed to investigate the factors related to lower extremities DVT in patients with neurological ICU.By collecting clinical data of 195 patients from neurological ICU in Xuanwu Hospital of Capital Medical University, using the UK Medical Research Council(MRC) scale of freehand muscle strength for grading evaluation, patients were divided into a muscle strength grade 4-5 group (at least one extremities muscle strength grade 4) and a muscle strength grade 0-3 group (both lower extremities muscle strength grade 3).Gender, age, deep venous catheterization, Glasgow Coma Scale(GCS) score, bed time, fibrinogen value, D-dimer value were compared between the two groups.The main influencing factors of lower extremities DVT with different muscle strength were analyzed, and the incidence of lower extremities DVT with different muscle strength was compared. Results: The comparison between muscle strength grade 4-5 group and muscle strength grade 0-3 group in neurological ICU patients showed that bed time, GCS score, and D-dimer of the 0-3 muscle strength group were 18.96(14.00, 27.00) d, 9.00(6.00, 10.15), and 2.15(1.24, 3.58) mg/L, while those of the 4-5 muscle strength group were 13.50(5.75, 22.00)d, 13.50(10.00, 15.00), 1.52(0.76, 2.99) mg/L, the difference was statistically significant (Z=-3.767, -5.811, -2.296, P<0.01 or 0.05).While gender, catheterization, fibrinogen, anticoagulant use and age had no statistical significance (P > 0.05). Grouping comparison of unilateral lower extremities muscle strength showed that the left lower extremities muscle strength group,the incidence of thrombosis in grade 0-3 group was 26.9%(32/119), and that in grade 4-5 group was 14.5%(11/76), the incidence of left lower extremities DVT had statistical significance (χ²=4.160, P<0.05),and the right lower extremities muscle strength group,the incidence of thrombosis was 32.8%(41/125) in the 0-3 group and 15.7%(11/70) in the 4-5 group, the incidence of right lower extremities DVT had statistical significance (χ²=6.698, P<0.05). Conclusions Patients with grade 0-3 lower extremities muscle strength in neurological ICU have more factors influencing DVT.The incidence of DVT is high in the lower extremities with unilateral extremities muscle strength grade 0-3, and early monitoring of lower extremities DVT should be strengthened to prevent the occurrence of lower extremities DVT.

This article reviews the nursing care of recent years to assist neurotic patients to turn over to prevent pressure sore. The present situation of nursing research on the prevention effect of pressure sore with different turn over method, different turn over angle, different turn over interval time combined with the nature of mattress and patient's condition were introduced, and the effect of preventing pressure sore with different turn over auxiliary appliance was introduced in order to provide a reference for the development of individual nursing guidelines for neurocritical patients.

Elderly stroke patients often suffer from different types of urinary incontinence due to injuries in different parts of the brain. Urinary incontinence not only affects the prognosis of these patients, but also imposes a workload on clinical caregivers. There are many urinary incontinence care devices in clinical practice, including built-in catheters, absorbent products, and external urine collection devices, and each type of care device has its own characteristics. The proper use of nursing devices according to the patient's characteristics of disease, type of urinary incontinence and lifestyle can effectively prevent the occurrence of complications such as incontinence-associated dermatitis, infection and skin damage, and is conducive to the recovery of bladder function. This article analyzes the characteristics and effects of urinary incontinence care devices use in clinical practice for elderly stroke patients, and provides a basis for nursing staff to apply urinary incontinence care tools, so that they can properly select urinary incontinence care devices for elderly stroke patients and improve patients' quality of life in clinical nursing work.

Objective:To explore the establishment of a cluster intervention strategy by multi-criteria decision analysis (MCDA) to provide a basis for the early removal of indwelling catheters in severe neurological patients.Methods:Through literature retrieval and MCDA, the catheter cluster intervention strategy was constructed, and the expert consultation was adopted to finally form 7 item cluster intervention strategies. The convenience sampling method was used to select 122 patients with severe neurological diseases as the research objects. A total of 61 patients with indwelling catheters from November 2018 to April 2019 were selected as the control group, and routine nursing care was performed according to indwelling catheters. A total of 61 patients with indwelling catheters from May 2019 to October 2019 were selected as the intervention group to compare the success rate of removing catheters, the number of days of indent catheters and the incidence of catheter-associated urinary tract infection ( CAUTI) in the two groups, as well as to analyze the indicators related to indent catheters in the intervention group with different diagnoses. Results:CAUTI incidence, successful catheter removal rate, indwelling days of catheter in the intervention group were 39.3% (24/61), 32.79% (20/61), 17 (14,22) days, which were significantly higher than 59.0% (36/61), 8.19% (5/61), 21 (15, 27) days in the control group, and the difference was statistically significant (χ 2 values were 4.723, 11.775, Z value was -9.211, P<0.05 or 0.01); In the intervention group, stroke patients′ indwelling time of catheter were 7-20 days, and the highest success rate of removing urinary catheters 36.6% (15/41), compared with other diseases, the difference was statistically significant ( Z values were -2.448, -2.109, P<0.05). Conclusion:MCDA construction of early catheter removal strategy can significantly shorten the indwelling time of the catheter in patients with severe neurological diseases, improve the success rate of early catheter extubation, reduce the CAUTI rate, to provide evidence-based basis for clinical nursing.

As the severe neurological patients have special disease characteristics such as disorder of consciousness, respiratory dysfunction and dysfunction of autonomic nervous system, patients could not cooperated with weakly coughing and increasing oral secretion in patients, so it is difficult to collect sputum specimens in clinic and easily to obtain unqualified sputum specimens. According to the disease characteristics of severe neurological patients, this paper summarizes the key process of collecting sputum samples, to provide guidance for clinical nursing work, and improve the quality of sputum specimens so that provide accurate diagnostic bases for clinical treatment.

Objective The causes of unsuccessful nasointestinal tube placement in 9 patients with severe brain injury and gastric retention were analyzed and corrected. Methods The 9 cases of unsuccessful nasointestinal tube placement were analyzed from the aspects of disease, sedative drug use, mechanical ventilation, weakened bowel sounds and so on. Blind intubation was used to correct the defect, and the depth and time consumed of blind intubation and ultrasonic catheterization were compared. Results All 9 patients had gastric emptying disorders, decreased gastrointestinal peristalsis, and increased gastric residue, which affected the entrance of the catheter to the pylorus. Among them, 5 patients were given 3 or more sedative drugs in the state of drug sedation, and 2 patients had gastric emptying disorder due to the location of the disease damage. Therefore, ultrasound-guided nasointestinal tube placement was unsuccessful. Finally the 9 patients are successful to be inserted nasointestinal tubes by the blind placement plus air injection method. The average time of blind intubation was (28.89±13.80) min, which was lower than that of ultrasonic catheterization (84.44±20.07) min, and the difference was statistically significant (t=6.842, P＜ 0.01). Conclusions The failure of ultrasound-guided nasointestinal tube placement in patients with severe brain injury and gastric retention is related to the severity of the patient, the use of sedatives, mechanical ventilation, gastric retention and other causes of gastrointestinal peristalsis weakened or disappeared. Clinical nurses are required to give accurate assessment. Patients with severe brain injury and massive gastric retention are advised to use the blind placement plus air injection method for nasointestinal tube placement. In the case of ultrasound-guided nasointestinal tube placement, gastric motility drugs need to be used in advance.

Objective? To explore the preventive effects of different application time of intermittent pneumatic compression devices (IPC) on deep vein thrombosis (DVT) of lower extremities in patients with severe stroke. Methods? Totally 154 stroke patients from the Neurological Intensive Care Unit, Xuanwu Hospital, Capital Medical University were selected by convenient sampling from September 2017 to August 2018. Totally 77 patients admitted from September 2017 to February 2018 were included into the control group, while another 77 patients admitted from March to August 2018 were included into the intervention group. IPC was applied to patients in the control group twice a day and for 1 h each time, while it was applied to patients in the intervention group consecutively for 12 h each day. The incidence rate and time of DVT was compared between the two groups. Results? A total of 20 (26.0%) cases with DVT were found in the intervention group, while 22 (28.6%) cases were found in the control group, and there was no statistically significant difference in the incidence rate of DVT between the two groups (χ2=0.131, P＞0.05). The median incidence time of DVT in the intervention group was 9.00 d, while that in the control group was 3.50 d, and there was statistically significant difference in the incidence time of DVT between the two groups (Z=-2.344, P＜0.05). Conclusions? Prolonged use of IPC in patients with severe stroke may delay the incidence time of DVT, though it cannot reduce its incidence rate.