Objective To evaluate the effect of prone ventilation in children with severe pneumonia at high altitude.Methods By convenience sampling method,80 children with severe pneumonia hospitalized in intensive care department of a tertiary A children's hospital in Xining,Qinghai Province from June 2021 to June 2023 were selected as the study subjects,and the regional randomization group method was used to divide into a test group and a control group with 40 cases in each group.On the basis of routine care,the test group received prone ventilation once a day for 6 to 12 h;the control group received supine ventilation.Respiratory mechanical parameters(oxygenation index,oxygen saturation,arterial oxygen partial pressure,arterial CO2 partial pressure),mechanical ventilation duration and safety parameters(incidence of unplanned extubation,stress injury)at 6 h and 12 h of mechanical ventilation were compared.Results There were no shedding cases.The interaction between oxygenation index,blood oxygen saturation and arterial oxygen partial pressure(P＜0.05)in the 2 groups was compared(P＞0.05).The results of simple effect analysis showed that at 6 h,the oxygen saturation and oxygenation index in the test group were higher than those in the control group,and the difference was statistically significant(P＜0.05).At 12 h of mechanical ventilation,the oxygenation index,blood oxygen saturation and arterial oxygen partial pressure in the test group were higher than those in the control group,and the difference was statistically significant(P＜0.05).The time of mechanical ventilation in the test group was102.00(60.00,153.00)h and 126.00(108.00,156.00)h in the control group,and the difference was statistically significant(P=0.013).The incidence of unplanned extubation and pressure injury were compared,and the differences in 2 groups were not significant(P＞0.05).Conclusion Prone ventilation in children with severe pneumonia at high altitude is safe and feasible,which is helpful to improve the respiratory function and shorten the time of mechanical ventilation.

Objective:To evaluate the efficacy and safety of mild hypothermia for patients with severe traumatic brain injury (sTBI).Methods:PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Disc, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, and VIP Database were searched for prospective randomized controlled researches on mild hypothermia and normothermia for patients with sTBI. The search time was from the establishment of the databases to February 2023. RevMan 5.3 software was used for Meta-analysis. The evaluation indicators included literature search results, basic characteristics and quality of the literature, poor prognosis rate and mortality at 6 and 12 months after treatment, incidence of pulmonary infection, arrhythmia, thrombocytopenia, intracranial infection, renal insufficiency, gastrointestinal ulcer/bleeding and electrolyte disorder during the treatment, and publication bias.Results:A total of 16 papers involving 2 640 patients were included, comprising 1 381 patients in the mild hypothermia group and 1 259 patients in the normothermia group. The poor prognosis rate in the mild hypothermia group was significantly lower than that in the normothermia group at 6 and 12 months after treatment ( RR=0.81, 95% CI 0.69, 0.95, P<0.01; RR=0.65, 95% CI 0.51, 0.84, P<0.01). There was no significant difference in the mortality between the two groups at 6 and 12 months after treatment ( RR=0.81, 95% CI 0.61, 1.08, P>0.05; RR=0.69, 95% CI 0.47, 1.03, P>0.05). In contrast with the the normothermia group, in the mild hypothermia group the incidence of pulmonary infection was significantly different ( RR=1.18, 95% CI 1.04, 1.34, P<0.01); the incidence of arrhythmia was not significantly different ( RR=1.35, 95% CI 0.73, 2.49, P>0.05); the incidence of thrombocytopenia was significantly different ( RR=1.78, 95% CI 1.34, 2.37, P<0.01); the incidence of intracranial infection was not significantly different ( RR=1.32, 95% CI 0.54, 3.23, P>0.05); the incidence of renal insufficiency was not significantly different ( RR=1.22, 95% CI 0.71, 2.09, P>0.05); the incidence of gastrointestinal ulcer/bleeding was not significantly different ( RR=0.98, 95% CI 0.73, 1.31, P>0.05); the incidence of electrolyte disorders was not significantly different ( RR=1.39, 95% CI 1.00, 1.94, P>0.05). The funnel plot was approximately symmetrical and the scattered points were concentrated in the narrow area in the upper part of the funnel plot, suggesting no publication bias. Conclusions:In comparison with normothermia for sTBI, mild hypothermia can not reduce the mortality at 6 and 12 months after treatment, but it can reduce the incidence of poor prognosis at 6 and 12 months after treatment. Moreover, mild hypothermia has no obvious effect on the incidence of arrhythmia, intracranial infection, renal insufficiency, gastrointestinal ulcer/bleeding, and electrolyte disorder, but it can increase the incidence of pulmonary infection and thrombocytopenia.

Ethical sensitivity is a behavioral concept emerging in recent years, which has attracted high attention from all sectors of society. Ethical sensitivity not only affects the clinical decision-making, doctor-patient relationship and medical quality of medical staff, but also provides the possibility to identify, predict and solve ethical problems in clinical. Combined with previous studies, this paper analyzed the current situation of ethical sensitivity of medical personnel in China, and took pediatric medical staff as an example to analyze the factors affecting the ethical sensitivity of medical staff from clinical practice and related theories, including age, working years, occupational categories, education level, work environment, empathy ability, etc. At the same time, this paper analyzed the causes of the ethical sensitivity of medical staff from the perspective of clinical practice and related systems, and put forward corresponding countermeasures, so as to improve the ethical sensitivity of medical staff and help to build a harmonious doctor-patient relationship.

The occurrence of benign prostate hyperplasia(BPH)was related to disrupted sex steroid hormones,and metformin(Met)had a clinical response to sex steroid hormone-related gynaecological disease.How-ever,whether Met exerts an antiproliferative effect on BPH via sex steroid hormones remains unclear.Here,our clinical study showed that along with prostatic epithelial cell(PEC)proliferation,sex steroid hormones were dysregulated in the serum and prostate of BPH patients.As the major contributor to dysregulated sex steroid hormones,elevated dihydrotestosterone(DHT)had a significant positive rela-tionship with the clinical characteristics of BPH patients.Activation of adenosine 5'-monophosphate(AMP)-activated protein kinase(AMPK)by Met restored dysregulated sex steroid hormone homeostasis and exerted antiproliferative effects against DHT-induced proliferation by inhibiting the formation of androgen receptor(AR)-mediated Yes-associated protein(YAP1)-TEA domain transcription factor(TEAD4)heterodimers.Met's anti-proliferative effects were blocked by AMPK inhibitor or YAP1 over-expression in DHT-cultured BPH-1 cells.Our findings indicated that Met would be a promising clinical therapeutic approach for BPH by inhibiting dysregulated steroid hormone-induced PEC proliferation.

By consulting the ancient and modern literature， the name， origin， quality evaluation， harvesting and processing methods of Curculiginis Rhizoma（CR） were systematically combed and verified， in order to provide a basis for the development and utilization of famous classical formulas containing CR. The results of herbal textual research showed that the name Xianmao was first recorded in Leigong Paozhilun， the name of CR was used in all dynasties and this name came from its efficacy and morphological characteristics， the mainstream source for CR of the past dynasties was the rhizome of Curculigo orchioides or C. capitulata， since modern times， C. orchioides has been the main source of commodities. In ancient times， most of the places of origin of the description were the western regions and southwest China， while in modern times， Sichuan and Guizhou were regarded as genuine places. Since modern times， its quality has been summarized as the best with thick roots， firm texture and black-brown surface， the harvesting and processing methods recorded in the past dynasties are mainly sun drying after harvest in the second， eighth and ninth months of the lunar calendar， and most of them are harvested in autumn and winter in modern times. In ancient times， there were many processing methods of CR， mainly in processing with rice swill， while in modern times， stir-frying with wine was the main processing method. The nature， taste， meridian tropism， functions and indications of CR are basically consistent from ancient to modern times， the taboos for taking are to avoid iron， cow's milk， and beef. Although there are some differences in the understanding of the toxicity of CR in the past dynasties， most of the materia medica are clear that it has a certain toxicity. Based on the research conclusion， it is suggested that the rhizome of C. orchioides of Lycoris family should be used as its source in the famous classical formulas， and the corresponding processing method should be selected according to the processing requirements in the formulas， while the raw products is recommended to be selected as medicine if the processing requirement is not specified.

The"biographical disruption"theory aims at explain the crises and conflicts in human development,as well as explore how to restore or rebuild an individual's identity and values.From the perspective of the"biographical disruption"theory,this paper analyzed the dilemmas and causes of children with epilepsy from four aspects,including disruption of physical and mental health,cognitive,social relationships,and family life.Based on these,the following suggestions were proposed to enhance the quality of life of children with epilepsy,including adjusting living habits and improving treatment compliance;formulating early rehabilitation training plans to develop language and thinking abilities;understanding and caring about their psychological state and correctly cultivating their sense of self-worth;providing personalized education programs and enhancing their leisure time;offering professional psychological counseling and strengthening the understanding and support of all sectors;establishing self-cognition groups and empowering children with a sense of control over the disease;changing the misunderstandings and prejudices about epilepsy;removing stigmatization of epilepsy patients;encouraging children to actively participate in social activities and providing a safe and positive social environment;encouraging social workers to actively intervene to restore and enhance family cohesion;actively seeking social support and resources and improving their social security system.

Objective:To translate and culturally adjust Decisional Fatigue Scale (DFS) , and test its reliability and validity.Methods:The Chinese version of DFS was formed through the method of double translation, back translation and expert consultation. Using the convenient sampling method, 247 medical staffs from 16 departments in 76 wards of Xiangyang No.1 People's Hospital Affiliated to Hubei University of Medicine were selected as the research objects. Content validity, criterion validity and structure validity were used for validity evaluation, and internal consistency reliability, split half reliability and retest reliability were used for reliability evaluation. A total of 247 questionnaires were sent out in this study and 247 were effectively received, with effective recovery of 100.00%.Results:The total Cronbach's α coefficient of Chinese DFS was 0.933, the half-reliability coefficient was 0.849 and the retest reliability coefficient was 0.838 ( P<0.01) . Both the item content validity index and scale content validity index were 1.00, and the correlation coefficient with the total score of SRF-S was 0.729 ( P<0.01) . One common factor was extracted by exploratory factor analysis and 65.64% of the variation was explained cumulatively, which was consistent with the dimensions of the original scale. Confirmatory factor analysis showed that all fitting indexes were up to standard and the fitting degree was good. Conclusions:The reliability and validity of the Chinese version of DFS in medical staffs is good, which can be used to evaluate the degree of decision-making fatigue of Chinese medical staffs.

Spinal muscular atrophy (SMA) is a common fatal disease in children, which can cause muscle weakness, muscle atrophy, and affect respiratory system, attracting attention from scholars both domestically and internationally. This article elaborates on the concept, application status of family management strategies, and management status for SMA patients, and proposes a concept of family management strategies for SMA patients, providing reference for constructing a suitable family management model for SMA patients.

Objective:To explore the effect of teach-back method combined with motivational interviewing in diabetic patients.Methods:From June 2018 to June 2021, 188 diabetic patients admitted to Henan Provincial People's Hospital were selected as subjects by convenience sampling. The subjects were divided into the intervention group and the control group, with 94 cases in each group, according to the number of visits to the hospital at the time of admission. The patients in the control group were given routine diabetes health education, and the patients in the intervention group received the teach-back method combined with motivational interviewing. The blood glucose, knowledge, attitude and practice, self-management ability and quality of life were compared between the two groups before and after the intervention.Results:The fasting blood glucose, 2-hour postprandial blood glucose of the two groups of patients after intervention were lower than those before intervention, and the fasting blood glucose, 2-hour postprandial blood glucose of the intervention group after intervention were lower than those of the control group, and the differences were all statistically significant ( P<0.05) . The knowledge, attitude, practice scores and total scores of the two groups after intervention were higher than those before intervention, and the knowledge, attitude, practice scores and total score of the intervention group after intervention were higher than those of the control group, and the differences were statistically significant ( P<0.05) . The dimension scores of self-management ability of the two groups after the intervention were higher than those before the intervention, and the dimension scores of self-management ability of the intervention group after intervention were higher than those of the control group, with statistical differences ( P<0.05) . The dimension scores and total score of quality of life in the two groups after intervention were lower than those before intervention, and the dimension scores and total score of quality of life in the intervention group after intervention were lower than those in the control group, with statistical differences ( P<0.05) . Conclusions:The teach-back method combined with motivational interviewing can effectively improve the knowledge, attitude, practice and self-management ability of diabetic patients, which is beneficial to the improvement of blood glucose control and quality of life, and is worthy of clinical promotion.

Objective:To systematically evaluate the risk prediction model of anastomotic leakage in colorectal cancer patients after surgery.Methods:The research related to the risk prediction model of anastomotic leakage after colorectal cancer surgery was comprehensively searched in Chinese and English databases such as China National Knowledge Infrastructure (CNKI) , Wanfang Data, VIP, Chinese Biomedical Literature Database, PubMed, Embase, Wed of Science and Cochrane Library. The retrieval time limit was from the establishment of the database to November 30, 2021. Two researchers independently screened the article and extracted information, and used the bias risk and applicability assessment tools of the prediction model study to assess the risk bias.Results:A total of 10 articles were included. The predictors with high frequency in the prediction model included were gender, tumor location, body mass index, preoperative albumin and new adjuvant therapy. The area under the receiver operator characteristic curve of the prediction model was 0.63 to 0.98. The risk of bias in the included studies was mainly caused by the type of study and data analysis.Conclusions:The study on the risk prediction model of anastomotic leakage after colorectal cancer surgery is still in the development stage. Future researchers can refer to the common predictive factors summarized in this study and select appropriate methods to develop and verify the prediction model of anastomotic leakage in combination with clinical practice, so as to identify the risk of anastomotic leakage of patients as early as possible and give targeted preventive measures.