Objective To evaluate the efficacy of traditional Chinese medicine which eliminating necrotic tissues and promoting granulation on pressure ulcer of Ⅲ to Ⅳstage using Meta analysis.Methods RCTstudies of therapy of eliminating necrotic tissues and promoting granulation traditional Chinese medicine for stage Ⅲ～Ⅳ pressure ulcer were searched,in which the control groups used routine methods,while the experimental groups adopted necrotic tissues and promoting granulation traditional Chinese medicine.Two reviewers assessed the documents'quality separately and completed data extraction.The statistical analysis was performed using the Cochrance collaborations' Rev Man 5.1 software.Results The cure rates for pressure ulcers of the experimental groups were higher than the control groups.The time of recovery of the experimental groups were shorter than the controls.The dressing change frequency of the experimental groups was less than the controls.Conclusions Traditional Chinese medicines which eliminating necrotic tissues and promoting granulation can significantly improve the cure rate,shorten the therapeutic time and reduce the frequency of dressing change.

Objective To develop a kind of new machine for making animal model for pressure ulcer,and inspect its effect through experiments,in order to lay the foundation for the research of pressure ulcer experiments on animals.Methods This study developed the machine after reviewing the domestic and foreign literature,making full use of the existing experimental platform of our university.Then 55 Sprague Dawley(SD) rats were selected,after anesthesia and the skin preparation,the researchers imposed certain pressure with 70 mmHg/cm2 (1 mmHg=0.133 kPa) on the skin and muscle tissue on the inner left thigh of SD rats by using self-designed machine,pressing for 2 h,then reperfusion for 30 min,3 times a day,a total of 7 days.Results The authors developed a kind of new machine for making animal model for pressure ulcer,and successfully prepared Ⅲ phase pressure ulcers model in SD rats with success rate of 98.2％(54/55).Conclusion This machine can prepare Ⅲ phase pressure ulcers model on animals,it's easy to use and efficient,it can be used for researches in the field of prevention and cure of pressure ulcers.

BACKGROUND: Constipation, especially that caused by spleen insufficiency in transportation, often not responses to common purgatives, however,the therapy to strengthen the spleen and regulate qi so as to promote transportation and dredge stasis may be an ideal way to resolve the problem.OBJECTIVE: To investigate the effect of zhizhu decoction, a classic famous prescription, on gastric motility of mice with spleen insufficiency constipationDESIGN: A randomized controlled trial.SETTING: Department of Traditional Chinese Medicine (TCM) of Guangdong Medical College and Spleen-stomach Institute of Guangzhou University of Traditional Chinese Medicine.MATERIALS: The experiment was completed from June to December2002 at Spleen-stomach Institute of Guangzhou University of Traditional Chinese Medicine. Totally 328 NIH mice of general grade were chosen.METHODS: Mouse models with spleen insufficiency constipation were set up by irregular diet and overstrain combined with water deprivation. The influence of zhizhu decoction in large, middle and small doses on defecation in both spleen insufficiency mice and normal mice was investigated, taking Chinese patent drug bianmi tong (bowel-relaxing) as a positive control. In observation of normal mice defecation, there were five groups of large dose,middle dose and small dose of zhizhu decoction, bianmi tong and normal control. In observation of defecation of spleen insufficiency constipation mice, there were six groups: the above five and a natural recovering. In observation of loading mice trial, besides the above five groups, there was an atropine group. After administration, the time when the mice first defecated dark stool, the number of stool grains and the stool quantity were observe;and the percentage of small intestine advance was calculated.MAIN OUTCOME MEASURES: [1] Observation of the effect of zhizhu decoction on the defecation in both normal and spleen insufficiency mice.[2] The influence of zhizhu decoction on bowel advance in both normal and atropine loading miceRESULTS: Totally 328 mice were involved in the trial and 319 entered into the final result analysis, the other 9 died because of mistake in administration by gavage. The effect of zhizhu decoction on the defecation: [1] For normal mice, compared with the distilled group, in the zhizhu decoction groups of various doses the time when the mice first defecated dark stool was obviously reduced, and the number of stool grains and stool quantity were obviously increased, but the effect in the large and middle dose groups was best. [2] Compared with the normal group, in the model group the time when the mice first defecated dark stool was obviously increased, and the number of stool grains and stool quantity were obviously decreased. Zhizhu decoction in large and middle doses could obviously reduce the time when the mice first defecated dark stool, and increase the number of stool grains and stool quantity, the effect was better than that of the control drug bianmi tong. The influence ofzhizhu decoction on intestinal advance in mice: [1]Zhizhu decoction in various doses could obviously increase the rate of intestinal advance compared with distilled water group for normal mice. [2]Adding atropine load could reduce the rate of intestinal advance compared with the normal control group, and the percentage in all zhizhu decoction groups was obviously increased compared with the atropine group.CONCLUSION: Zhizhu decoction can reduce the time when the mice first defecated dark stool, increase the number of stool grains and stool quantity were obviously increased to both normal mice and mice with spleen insufficiency mice; it can also increase the intestinal advance rate in normal mice, and had a good antagonism against the inhibition of atropine to intestinal advance. In the trials the effect of zhizhu decoction in large and middle doses was more obvious, with a certain dose-effect relationship, the effect was better than that of the control drug bianmi tong.

Objective To systematically analyze and evaluate the intervention effect of foreign and domestic research about needlestick injuries in medical staffs and provide the basis for reducing the rate of occupational exposure of medical staffs.Methods The intervention study of needlestick injuries in medical staffs between 1981 and 2013 were collected in CNKI,VIP,Wanfang and PubMed databases,Metaanalysis was conducted for the included studies by RevMan5.2 software.According to I2 and P value heterogeneity was determined,choose a fixed or random effect model to analyze and merge the data to measure the effect of the intervention by OR and 95％ confidence intervals (C I).Results The total of included studies was 19,the number of the intervention group and the control group was 20 592 and 19 855,the OR and 95％ CI of intervention effect as shown below:comprehensive intervention OR=0.40,CI 95％ (0.27～0.59),education and training OR=0.24,CI 95％ (0.11～0.55),safety management OR=0.09,CI 95％ (0.06～0.13),engineering intervention OR=0.30,CI 95％ (0.16～0.55),safe operation OR=0.15,CI 95％ (0.09～0.26).The intervention group and the control group were statistically significant on reducing the incidence of needlestick injuries.Conclusions Education and training,safety management,engineering intervention,and safe operation can reduce the incidence of needlestick injuries,improve the quality of life of medical staffs.

Objective To assess the effectiveness and safety of heat moisture exchangers (HMEs) on the artificial airway humid-ification in the mechanically ventilated patients .Methods The related literature in the Cochrane Library ,PubMed ,Embase ,CNKI , VIP ,WanFang database and CBM from the establishment to March 2012 were retrieved ,then included the randomized controlled trial(RCT) and quasi-RCT on the effect of HMEs for the artificial airway humidification in the mechanically ventilated patients were performed the meta analysis by using RevMan 5 .1 .2 software .Results 19 RCT were included(involving 2 960 patients) , which were the random parallel controlled trials .The meta analysis results showed that HMEs could not reduce the incidence rate of ventilator-associated pneumonia(VAP)(RR=0 .78 ,95% CI 0 .61-1 .01 ,P=0 .06) ,also could not decrease the hospitalization mor-tality(RR=0 .94 ,95% CI 0 .83-1 .08 ,P=0 .40) ,the length of ICU stay(MD= -0 .32 ,95% CI -3 .13 -2 .50 ,P=0 .82) and the occurrence rate of catheter occlusion (RR=0 .65 ,95% CI 0 .22 -1 .93 ,P= 0 .44) ,the differences between the two groups had no statistical significance .But 5 RCT reported that using HMEs could reduce the patient′s costs .Conclusion HMEs can not reduce the incidence rate of VAP ,mortality ,length of ICU stay ,occurrence rate of airway occlusion ,but can cut down the patient′s cost . Due to the risk of bias existing in all included RCT and the low quality of the obtained evidences ,more strictly designed and imple-mented RCTs are needed to further verify thse evidences .

Hyperoxia is very common in critical patients, which causes varying degrees of pathophysiological damage. Hyperoxia is one of the main reasons for increasing mortality, prolonged hospital stay and poor prognosis of critical patients. Therefore, it is critical to carry out the standardized oxygen therapy. In this paper, we discussed the harmful effects of hyperoxemia to critically ill patients by reviewing the effect of hyperoxemia on cardiovascular and cerebrovascular, hyperoxia-induced lung injury, and the association of hyperoxemia with ventilator-associated pneumonia (VAP) and acute renal kidney injury (AKI). Meanwhile, we provided some management suggestions about standardized clinical oxygen therapy, oxygen therapy related research and clinical management of oxygen therapy, aimed at providing reference and research direction for standardizing clinical oxygenation process, reducing the occurrence of hyperoxemia, and making reasonable method for hyperoxemia prevention.

OBJECTIVETo compare and estimate the diagnostic value and characteristic of different diagnostic methods (blood laboratory test, histological analysis, synovial fluid cytological test and microbiological examination) in detecting the presence of periprosthetic joint infection.

METHODSData of 52 patients underwent hip or knee joint revision in Peking University People's Hospital Arthritis Clinic and Research Center between July 2013 and March 2015 were analyzed retrospectively. For each patient, results of blood laboratory tests(peripheral-blood white blood cell, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (Hs-CRP)), histological analysis, synovial fluid white cell count (SWCC), microbiological examinations (synovial fluid, tissue and prosthetic joint sonication fluid) were collected. Data were analyzed by t-test, independent sample median test or χ(2) test, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for each method were calculated and compared by receiver operating characteristic curve.

RESULTSThere were 30 female and 22 male patients. Twenty-one patients (40.4%) were diagnosed as PJI. The levels of CRP, ESR, IL-6 and Hs-CRP in patients with PJI were higher than that in aseptic failure patients (Z=23.084, 13.499, 5.796, 17.045, all P<0.05). The sensitivities of CRP, ESR, IL-6 and Hs-CRP were 90.5%, 81.0%, 95.0% and 90.0%. The sensitivities of histological analysis and SWCC were 55.0% and 70.6%, while they had high specificity as 89.7% and 85.7%. The sensitivity of sonication fluid culture was 90.0%, which was higher than that of tissue culture (71.4%) and synovial fluid culture (65.0%) (χ(2) = 5.333, 6.400, all P<0.05).

CONCLUSIONSThe tests of CRP, ESR, IL-6 and Hs-CRP have good value in detecting PJI preoperatively. Histological analysis and SWCC have high specificity, which could help to exclude PJI. Sonication fluid culture has a higher sensitivity than tissue culture and synovial fluid culture.

Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Blood Sedimentation ; C-Reactive Protein ; metabolism ; Female ; Humans ; Interleukin-6 ; blood ; Knee Joint ; Male ; Prosthesis-Related Infections ; diagnosis ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Synovial Fluid ; cytology

Objective To investigate the effects of chemokine like factor 1 (CKLF1) gene on the proliferative activities and osteogenic potentials of hip ligaments of ankylosing spondylitis (AS) in situ and in vitro. Methods Normal and AS hip ligament specimens were collected from 6 patients with femoral neck fracture and 4 AS patients with severe hip deformities. Ligament specimens were exposed to type Ⅱ colla-genase and obtained a single cell suspension, while phase contrast microscopy and anti-vimentin immuno- fluorescence staining (IFC) were applied to observe the cells. The specimens and fibroblasts were divided and cultured in situ and in vitro respectively, and the recombinant adeno-associated virus (rAAV)-lacZ (E. coli beta-galactosidase gene)and rAAV-hCKLF1 (human CKLF1 cDNA cloned in rAAV-lacZ in place of lacZ) were transduced for 21 days. Cell proliferation (cellularity), secretion of pro-inflammatory cytokines, expression of CKLF1 and CCR4 genes were detected by the water-soluble tetrazolium (WST-1) assay and Hoechst 33258 test (DNA content), enzyme-linked immunosorbent assay (ELISA), IFC test and fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR), respectively. Statistical analysis significance was conducted using the Student's t test and one-way analysis of variance (ANOVA) (LSD) test where appropriate. Results The second passage of normal and AS cells were positive for anti-vimentin, indicating that the cells were fibroblasts. After transducing with rAAV-hCKLF1 for 21 days, cellularity, WST-1 and Hoechst 33258 assays illustrated that CKLF1 gene transfer promoted cell proliferation (compared with the non-viral transduction and lacZ groups, F=6.98, 64.32, 115.91, P<0.05 or P<0.01). Overexpression of CKLF1 gene enhanced the secretion of pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor-alpha) and the expression of bone-specific extracellular matrix proteins (osteopontin and osteocalcin) (F=34.57, 8.89, P<0.05 or P<0.01). Similar results were observed in fluorescent quantitative RT-PCR test. Conclusion Overexpression of CKLF1 promotes the proliferation of fibroblasts, the secretion of pro-inflammatory cytokines and the expression of osteogenic related target genes, suggesting that CKLF1 might be involved in the pathological ossification of AS.

Objective:To conduct a scope review on the application of ICU diaries in critically ill patients, laying the foundation for further exploration and construction of ICU diary patterns and frameworks that were in line with the national conditions and tailored to different regions and cultural backgrounds.Methods:The Joanna Briggs Institute Reviewer′s Manual was used as the methodological framework, and a computer search was conducted in nine domestic and international databases, including China National Knowledge Infrastructure, Wanfang Database, China Biomedical Literature Database, Cochrane Library, PubMed, and Embase, etc. The search period was from the inception of the databases until March 13, 2023. The included literature was screened, summarized, and analyzed.Results:A total of 19 articles were included. ICU diaries were commonly recorded using a combination of text and visuals, with the involvement of both healthcare professionals and family members. Most patients received ICU diaries approximately one month after their transfer from the ICU. Out of the 15 studies, ICU diaries were found to be effective, while 4 studies indicated no significant improvement in patients′ psychological issues. However, ICU diaries were still considered acceptable by patients and their families.Conclusions:The application of ICU diaries has shown positive significance in critically ill patients, but further research and exploration are needed to investigate its impact on issues such as post-traumatic stress disorder, anxiety, depression, and quality of life. In the future, a combination of multiple forms and high-quality research designs with large samples, long periods, and structured approaches should be employed to explore its application effects and long-term outcomes on psychological problems.