Objective To study the efficacy of transcutaneous prostaglandin E 1( PGE 1) cream in relaxing the vascular spasm in rabbits, to find an ideal vascular dilation drug. Methods Sixty rabbits were randomly divided into six groups:experiment group 1(using 0.1% transcutaneous PGE 1 cream),experiment group 2(using 0.2% transcutaneous PGE 1 cream),experiment group 3(using 0.4% transcutaneous PGE 1 cream), experiment group 4( using 0.8% transcutaneous PGE 1 cream),PGE 1 control group (without using transcutaneous PGE 1 cream, but using PGE 1 cream only),control group(withous using PGE 1). 0.1% adrenlin was injected to the root of the rabbite ear to induce a model of vascular spasm. After a typical vascular spasm appeared,transcutaneou PGE 1 cream or PGE 1 cream was used on the skin of the ear. The vascular diameter and blood folw rate of the ear were determined before adrenalin injection, 10min after vascular spasm and 10,15,30,60,90 and 120 min after the drugs were used. Results The vascular diameters and blood flow rate were recovered to the levels of before adrenalin injection in experimental group 3, 4 after topical used of transcutaneous PGE 1 cream, and those parameters were significamly increased compared with other 4 groups(P0.05). Conclusions Tramscutameou PGE 1 cream can effectively relax the vascular spasm caused be adrenalin injection.The effect of vascular dilation is related to the dosage of the drug. Transcutaneous PGE 1 cream as a topical vascular dilation drug has advantages snch as wide indications,taking effect quick and enduring, and less side effect. So it might be a new simple, safe and effective drug for the treatment of vascular spasm.

Objective: To investigate the effects of acupuncture on the number of associated phosphorylated proteins in brain tissues of middle cerebral artery occlusion (MCAO) rats, based on the protein microarray technique. Methods: The MCAO model was prepared according to the modified occlusion method using occlusion lines. Forty healthy Sprague-Dawley (SD) rats were randomly divided into 4 groups using the lottery method: a sham operation group, a model group, a control point group and an acupoint group, with 10 rats in each group. Rats in the sham operation group and the model group only received binding without acupuncture. Rats in the acupoint group received acupuncture at Dazhui (GV 14), Baihui (GV 20) and Shuigou (GV 25); rats in the control point group received acupuncture at non-acupoint control points. The needle was twisted once for 1 min after insertion and another time in the middle of the 30 min needle retaining. Acupuncture was conducted once every 12 h for 6 consecutive times. At the end of the experiment, the neurological impairment score was collected, and cells of the ischemic brain tissues were extracted. The protein phosphorylation of the related signaling was detected using the 720 phosphorylated antibody microarray technique, and the differentially expressed proteins between groups were screened. Results: The neurological impairment scores after 72 h of treatment: compared with the sham operation group, the scores of the model group, the control point group and the acupoint group were significantly increased (P<0.01); compared with the model group, the scores of the acupoint group and the control point group were significantly decreased (P<0.01,P<0.05); the score of the acupoint group was better than that of the control point group (P<0.05). The results of the protein microarray: compared with the sham operation group, 48 proteins showed up-regulated phosphorylation (≥1.5 times) in the model group and the down-regulated was 28; compared with the model group, 35 proteins showed up-regulated phosphorylation in the control point group, and the down-regulated was 24. There were 29 proteins showing up-regulated phosphorylation in the acupoint group and the down-regulated was 51. The numbers of proteins involved in the function and signal transduction pathways were also different. Conclusion: Acupuncture at Dazhui (GV 14), Baihui (GV 20) and Shuigou (GV 25) can effectively repair brain injury. The ischemic injury of brain tissue may be caused by imbalance of a variety of proteins, and acupuncture can promote brain tissue repair by multi-functional and multi-channel regulation of the protein disorders.

Objective:To explore the effect of improving oral care based on cluster management in ventilator-associated pneumonia (VAP).Methods:Totally 126 VAP patients from February 2019 to February 2020 in our hospital were selected. The patients admitted from February 2019 to August 2019 were the control group, and the patients from September 2019 to February 2020 were the observation group, 63 cases in each group. The control group was treated with cluster nursing, and the observation group was treated with cluster nursing with improved oral care. The EICU hospitalization time, mechanical ventilation time, plaque index, pathogen infection, oral cleaning score, oral bleeding ulcer and aspiration were compared between the two groups.Results:After nursing, the EICU hospitalization time and mechanical ventilation time in the observation group were (18.34±4.15), (8.56±2.14) days, which were shorter than (23.56±4.82), (12.04±3.10) days in the control group ( t value was -6.514, -7.333, P<0.05). During the nursing process, the incidence of bleeding ulcer and aspiration in the observation group were 12.70% (8/63), 6.35% (4/63), which were lower than 30.16% (19/63), 20.63% (13/63) in the control group ( χ 2 values were 5.704, 5.508, P<0.05). After nursing, the plaque index of the two groups was lower than that before nursing ( t values were 12.516, 6.654, P<0.05), and the plaque index of the observation group was lower than that of the control group ( t value was -6.860, P<0.05). During the nursing process, the incidence of pathogenic bacteria infection in the observation group was 28.57% (18/63), which was lower than 49.21% (31/63) in the control group ( χ 2 value was 5.644, P<0.05). After nursing, the oral cleaning score of the two groups was lower than that before nursing ( t values were 11.118, 6.240, P<0.05), and the score of the observation group was (14.38±3.60) points, which was lower than (18.20±4.11) points of the control group ( t value was -5.549, P<0.05). Conclusion:Auricular pressure therapy can effectively improve the constipation symptoms, shorten the time required to take effect for the main symptoms, and improve the quality of life of schizophrenic patients.

Visual hallucination(VH)is a common symptom of schizophrenia,the underlying mechanism has not been fully elucidated.It has been found that the dysfunction of dopamine(DA)system,the overactivation of α-amino-3-hydroxy-5-methyl-4-isoxazole-propionate(AMPA)receptor in glutamate system and the dysfunction of γ-aminobutyric acid(GABA)ergic neurons can induce VH in patients with schizophrenia.In addition,abnormalities in brain structural and functional networks and visual networks are also closely related to the occurrence of VH.The purpose of this paper is to review the neurochemistry and nerve injury mechanism of VH in schizophrenic patients to deeply understand the characteristics of VH,and make more accurate judgment in the early diagnosis,condition evaluation and treatment plan of schizophrenic patients.

Objective To determine the safety criteria for early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in intensive care unit (ICU) by systematic review.Methods Randomized controlled trails (RCTs) and cohort studies about early goal-oriented rehabilition exercise in patients undergoing mechanical ventilation in ICU were retrieved in CBM,CNKI,Wanfang Data,PubMed,Cochrane Library and Web of Science from their foundation to March 2018,and other sources as supplement was also retrieved.The intervention program of RCT study was ICU routine nursing in control group,early activity in observation group,and early activity in cohort study without control group.Early activities included active and passive activities on the bed,sitting upright,bed-chair transfer,standing and walking.Literature screening and data extraction were performed independently by two researchers.Variables or parameters.related to cardiovascular,respiratory,nervous,orthopedic and other systems were collected for safety criteria.Variables or parameters used in at least three literatures were collected for each system.Cochrane 5.1.0 was used to evaluate the quality of RCT study,and Newcastle-Ottawa scale (NOS) was used to evaluate the quality of cohort study.Results A total of 24 articles about early activity of patients undergoing mechanical ventilation in ICU were enrolled,involving 4647 patients,including 11 RCT studies involving 1 031 patients,509 in control group and 522 in observation group;13 cohort studies including 3616 patients.It was shown by systematic review that safety criteria for early activity in patients undergoing mechanical ventilation in ICU involved five systems,20 variables or parameters.The cardiovascular system included 8 variables or parameters,such as 40 bpm ＜ heart rate (HR) ＜ 130 bpm (n =4),hemodynamic stability (n =5),no myocardial infarction (n =3),no arrhythmia (n =4),no vascular active drugs (n =4),90 mmHg ＜ systolic blood pressure (SBP) ＜ 200 mmHg (1 mmHg =0.133 kPa,n =4),65 mmHg ≤ mean arterial pressure (MAP) ≤ 110 mmHg (n =3),no history of cardiopulmonary resuscitation (CPR,n =5).The respiratory system included 4 variables or parameters,involving 5 times/min ＜ respiratory rate (RR) ＜ 40 times/min (n =5),fraction of inspired oxygen (FiO2) ≤ 0.60 and positive end-expiratory pressure (PEEP) ≤ 10 cmH2O (1 cmH2O =0.098 kPa,n =4),FiO2 ＜ 0.60 or PEEP ＜ 10 cmH2O (n =3),pulse blood oxygenation (SpO2) ＞ 0.88 (n =5).The nervous system included 4 variables,including no neuromuscular disease (n =7),no increase in intracranial pressure (n =7),no coma (n =4),understand and do the right thing (n =4).The orthopedic system included 2 variables,including no fracture (n =3),no unstable fracture (n =8).Other factors included 2 variables,including no open abdomen wound (n =4),and no palliative care (n =3).Conclusions This study identified safety criteria for early goal-directed rehabilition exercise in patients undergoing mechanical ventilation in ICU included five systems of cardiovascular,respiratory,neurological,orthopedic,and other systems,in which cardiovascular and respiratory systems were the most frequently cited variables or parameters.The consistency of each system security criteria or variables reported by different literatures was high,but the parameters need to be further verified by high-quality study.

Objective:To compare the biomechanical properties of dynamic hip screw (DHS), traditional cannulated compression screw (CCS) configuration, traditional CCS configuration+medial locking plate and compression buttress screw (CBS) in the treatment of femoral neck fracture by finite element analyses.Methods:A simulation model of Pauwels type Ⅲ femoral neck fracture with discontinuous medial cortex was established by the finite element method. The maximum displacement, maximum principal stress, normal form equivalent stress, hip varus angle and fracture end stress were compared between DHS (group A), traditional CCS configuration (group B), traditional CCS configuration+medial locking plate (group C) and CBS (group D) in the simulation model.Results:In the internal fixation model in groups A, B, C and D, respectively, the maximum displacement of the femur was 0.41 mm, 2.04 mm, 0.94 mm and 0.30 mm; the maximum displacement of internal fixation 0.34 mm, 1.18 mm, 0.84 mm and 0.22 mm; the peak normal form stress of internal fixation 83.6 MPa, 231.4 MPa, 259.8 MPa and 194.8 MPa; the maximum principal stress of internal fixation 52.3 MPa, 216.3 MPa, 151.7 MPa and 74.6 MPa; the maximum normal form stress of the femur 101.1 MPa, 282.3 MPa, 100.5 MPa and 181.2 MPa; the maximum principal stress 99.7 MPa, 201.0 MPa, 60.9 MPa and 56.1 MPa; the axis angle of the femoral neck after loading 179.55°, 176.97°, 179.66° and 179.64°; the normal form equivalent stress at the fracture end ranged from 42.0 to 50.0 MPa, from 258.7 to 282.3 MPa, from 50.8 to 58.1 MPa, and from 45.3 to 60.4 MPa.Conclusion:Considering stability, stress distribution and prevention of hip varus and femoral neck shortening, CBS may be a choice treatment for femoral neck fracture because it is comparable to DHS in mechanical stability.

Objective:To investigate the cognitive impairment after intensive care unit (ICU) discharge and provide theoretical basis for prevention and intervention.Methods:Studies about cognitive impairment after ICU discharge were retrieved in PubMed, Embase, Cochrane Library, Web of Science, Wanfang data, CNKI and SinoMed from their foundation to December 2019. The literature screening and data extraction were performed by two researchers independently, and the quality of different types of researches was evaluated using Cochrane Handbook 5.1.0, Newcastle-Ottawa scale (NOS) and agency for healthcare research and quality criteria (AHRQ). The Meta-analysis was performed by Stata 13.0 software. Sensitivity analysis was used to determine the reliability of the combined effect values. Funnel plot and Egger test were used to analyze publication bias. The non-parametric clipping was used to evaluate the impact of publication bias on the results.Results:A total of 35 studies were enrolled, including 27 prospective cohort studies, 4 retrospective cohort studies, 2 randomized controlled trial (RCT) studies, 1 case-control study, and 1 cross-sectional study. Three literatures were published in Chinese and 32 were in English, which covered 13 countries, and a total of 102 504 ICU survivors were followed up successfully. Literature quality evaluation results showed that the NOS scores of 31 cohort studies were between 6 and 9, of which the case-control study scored 9. The quality grade of 2 RCT studies were both B. According to the AHRQ criteria, 1 cross-sectional study's design was scientifically rigorous and of high quality. Thirty-five studies reported that the overall incidence of cognitive impairment after ICU discharge ranged from 2.47% to 66.07%. For the multiple follow-ups studies, the first survey data was selected for Meta-analysis, and the results showed that the pooled incidence was 38.44% [95% confidence interval (95% CI) was 29.32-47.55]. Each study was removed for sensitivity analysis and the pooled results did not change much, which indicated that the results were reliable. The sub-group analysis was performed on different evaluation methods for cognitive impairment after ICU discharge, different types of ICU patients, and different follow-up time. The results showed that the pooled incidence of studies using neuropsychological test to evaluate cognitive impairment after ICU discharge was 31.42% (95% CI was 21.82-41.02), the pooled incidence of studies using questionnaires or scales was 38.75% (95% CI was 29.54-47.96), and the difference between the two groups was statistically significant ( P < 0.01). The pooled incidence of cognitive impairment after ICU discharge in general ICU patients was 43.42% (95% CI was 30.88-55.95), acute respiratory distress syndrome (ARDS) patients' pooled incidence was 34.40% (95% CI was 23.02-45.79), and the pooled incidence of elderly ICU patients was 12.93% (95% CI was 8.48-17.37), the difference among the three groups was statistically significant ( P < 0.01). The incidences of cognitive impairment < 1 year, 1 to 4 years, ≥ 5 years after ICU discharge were 43.30% (95% CI was 29.47-57.13), 34.21% (95% CI was 26.70-41.72), and 20.22% (95% CI was 4.89-35.55), respectively, and the differences among the three groups were statistically significant ( P < 0.01). The funnel plot showed that the distribution of all studies was asymmetric, and the Egger test result also suggested that there might be publication bias ( P < 0.05). The non-parametric clipping was used to estimate the impact of publication bias on the results, and the result showed that the difference in the incidence of cognitive impairment after ICU discharge before and after non-parametric clipping was large, suggesting that publication bias might influence the stability of the research results. Conclusions:The incidence of cognitive impairment after ICU discharge is relatively high and persistent for a long time, but diagnostic criteria of cognitive impairment and follow-up time are quite different. It is necessary to develop consistent evaluation criteria and rigorous designed research in the further.

Objective:To construct an immersive cognitive training intervention scheme for patients with subcortical ischemic vascular cognitive impairment (SIVCI) to provide references for the development of cognitive training.Methods:Through literature research, theoretical analysis, group discussion and clinical investigation, the immersive cognitive training intervention scheme for SIVCI patients was constructed. Using the Delphi expert consultation method, 12 experts were selected to conduct 2 rounds of Delphi expert consultation, and finally an immersive cognitive training intervention scheme for SIVCI patients was established.Results:The recovery rate of the two rounds of expert consultation questionnaire was 100.00% (12/12) . In the second round of consultation, the coefficient of variation of each item was 0 to 0.14, the importance value was 4.67 to 5.00, the expert authority coefficient was 0.92 and Kendall coefficient of concordance was 0.67 ( P<0.05) . Finally, an immersive cognitive training intervention scheme for SIVCI patients was formed. Conclusions:The immersive cognitive training intervention scheme for SIVCI patients constructed in this study is scientific and practical, which can provide a reference for cognitive intervention of patients.

Objective:To develop an expert consensus on safety management of inpatients with Alzheimer's disease (AD) (referred to as the " Consensus") and standardize safety management strategies for AD inpatients. Methods:The evidence on safety management of AD inpatients was searched, evaluated, and summarized, with a search period from database establishment to July 31, 2023. This study conducted methodological quality evaluation and evidence extraction on the included article to form a consensus draft. A total of 24 experts from 15 hospitals across the country were selected for two rounds of Delphi expert consultation to analyze, revise, and improve their opinions, forming the final draft of the Consensus. Results:The positive coefficients for both rounds of expert consultation were 100.00% (24/24). In the second round of consultation, the expert judgment basis coefficient was 0.925, familiarity level was 0.846, authority coefficient was 0.886, Kendall harmony coefficient was 0.044 ( P<0.01). The Consensus elaborated on five common safety problems (loss, falling, aspiration/choking, self-injury/other injury, and medication errors in AD inpatients) from three aspects (assessment, identification of risk factors, and nursing strategies) . Conclusions:The Consensus is scientific and practical to a certain extent, providing guidance and reference for the safety management practice of AD inpatients.