Objective To determine the effects of dexmedetomidine(Dex)in anesthesia on brain function,cerebral oxygen uptake rate(CERO2),difference in glucose content between cerebral ar-terial and venous blood(A-VDG)and jugular bulb oxygen saturation(SjvO2)and stress response in elderly patients with hypertensive cerebral hemorrhage.Methods A total of 96 elderly patients with hypertensive cerebral hemorrhage admitted to our hospital from January 2021 to June 2024 were recruited,and according to different anesthesia schemes,they were divided into the group A(propofol,remifentanil,sevoflurane combined with rocuronium anesthesia,48 cases)and group B(same anesthesia regimen as group A plus Dex).Glasgow coma(GCS)score and restlessness-sedation score 48 h after operation,postoperative recovery,stress indexes and cerebral glucose and oxygen metabolism before(T1)and at the end of operation(T2),and adverse reactions during the study were compared between the two groups.Results When compared with the group A,the group B had significantly higher GCS score 48 after surgery(13.95±0.28 vs 12.89±0.41,P＜0.01),and shorter awakening time,time to regain spontaneous breathing,extubation time and response time(P＜0.01).At T2,the levels of CERO2,A-VDG and SjvO2 were notably higher,while levels of cortisol,norepinephrine and epinephrine,and activity of renin were remarkably lower in the group B than the group A(P＜0.01).At T2,the both groups obtained increased levels of cortisol,norepinephrine,epinephrine and renin activity and SjvO2,while decreased CERO2 and A-VDG levels than the corresponding levels at T1(P＜0.05).The incidences of nausea and vomiting,cough,chills,restlessness and delirium was obviously lower in the group B than the group A(P＜0.05,P＜0.01).Conclusion For elderly patients with hypertensive cerebral hemorrhage,application of Dex in anesthesia can improve cerebral glucose and oxygen metabo-lism,reduce stress response,maintain the stability of perioperative vital signs,decrease the severi-ty of coma and incidences of delirium,nausea and vomiting,cough,chills,restlessness and other adverse reactions,and thus promote postoperative recovery.

Objective To determine the effects of dexmedetomidine(Dex)in anesthesia on brain function,cerebral oxygen uptake rate(CERO2),difference in glucose content between cerebral ar-terial and venous blood(A-VDG)and jugular bulb oxygen saturation(SjvO2)and stress response in elderly patients with hypertensive cerebral hemorrhage.Methods A total of 96 elderly patients with hypertensive cerebral hemorrhage admitted to our hospital from January 2021 to June 2024 were recruited,and according to different anesthesia schemes,they were divided into the group A(propofol,remifentanil,sevoflurane combined with rocuronium anesthesia,48 cases)and group B(same anesthesia regimen as group A plus Dex).Glasgow coma(GCS)score and restlessness-sedation score 48 h after operation,postoperative recovery,stress indexes and cerebral glucose and oxygen metabolism before(T1)and at the end of operation(T2),and adverse reactions during the study were compared between the two groups.Results When compared with the group A,the group B had significantly higher GCS score 48 after surgery(13.95±0.28 vs 12.89±0.41,P＜0.01),and shorter awakening time,time to regain spontaneous breathing,extubation time and response time(P＜0.01).At T2,the levels of CERO2,A-VDG and SjvO2 were notably higher,while levels of cortisol,norepinephrine and epinephrine,and activity of renin were remarkably lower in the group B than the group A(P＜0.01).At T2,the both groups obtained increased levels of cortisol,norepinephrine,epinephrine and renin activity and SjvO2,while decreased CERO2 and A-VDG levels than the corresponding levels at T1(P＜0.05).The incidences of nausea and vomiting,cough,chills,restlessness and delirium was obviously lower in the group B than the group A(P＜0.05,P＜0.01).Conclusion For elderly patients with hypertensive cerebral hemorrhage,application of Dex in anesthesia can improve cerebral glucose and oxygen metabo-lism,reduce stress response,maintain the stability of perioperative vital signs,decrease the severi-ty of coma and incidences of delirium,nausea and vomiting,cough,chills,restlessness and other adverse reactions,and thus promote postoperative recovery.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective To investigate the best evidence application of exercise prescription in patients with chronic heart failure in clinical practice and evaluate its effectiveness.Methods The best evidence of exercise prescription for patients with chronic heart failure was summarized,and the evidence-based practice plan was developed,and it was implemented in the cardiology department of a tertiary hospital in Zhejiang Province from August to October,2022.Nurses'exercise prescription knowledge-attitude-practice level,implementation rate of review indicators,the length of hospital stay,exercise endurance,daily living ability and grip strength of both groups before and after the intervention were compared.Results After the application of the best evidence,the score of knowledge dimension was(9.34±0.98)points;the score of attitude dimension was(63.29±1.37)points;the score of practice dimension was(25.49±1.51)points,which were statistically significant compared with the scores before the application of evidence(P<0.05).After the application of the best evidence,the implementation rate of 16 review indicators was higher than that before the application of evidence(P<0.001).The length of hospital stay in the evidence application group was shorter than that in the baseline examination group(Z=-2.610,P<0.001).After intervention,the exercise endurance,daily living ability and grip strength of patients in the evidence application group were improved compared with the baseline review group,and the difference was statistically significant(P<0.05).Conclusion After the application of the best evidence of exercise prescription in patients with chronic heart failure,it can improve the level of knowledge,attitude and practice of nurses on exercise prescription,standardize the compliance of nurses'exercise prescription,reduce the number of days in the hospital,and improve patients'exercise endurance,daily living ability and grip strength.

To summarize the nursing experience of postoperative arrhythmia after transcatheter aortic valve replacement in an elderly patient with severe aortic stenosis.The key points of nursing include:implementing nurse led triple pre-rehabilitation,goal oriented hemodynamic monitoring and volume management,prevention and management of postoperative complications,psychological adaptation adjustment under the guidance of dual heart medicine,early and gradual rehabilitation training,and follow-up specialist guidance for extended care in the hospital.The patient was discharged from hospital with both stable physical and psychological condition after careful treatment and nursing care by the team in 12 days after operation.

A number of research has shown that the plant polyphenol resveratrol,one of the most prominent small molecules,has beneficial protective effects in multiple organisms,including worms,flies,and killifish.To understand the effects of resveratrol on lifespan,we evaluated its effects in the silkworm Bombyx mori.In this study,we found that lifespan was significantly prolonged in both female and male silkworms treated with resveratrol.Silkworm larval weight was significantly increased from day 3 of the 5th larval instar(L5D3) to day 7 of the 5th larval instar (L5D7).However,the weight of the pupa,cocoon,and total cocoon was not significantly different in female silkworms with resveratrol treatment than that in controls.Meanwhile,resveratrol significantly improved the thermotolerance of the silkworms,which enhanced their survival rate.Moreover,antioxidant activity was increased by resveratrol in both female and male silkworms.Furthermore,an antioxidant-related signalling pathway,SIRT7-FoxO-GST,was activated in silkworms with resveratrol treatment.Collectively,these results help us to understand the molecular pathways underlying resveratrol induced pro-longevity effects and indicate that silkworm is a promising animal model for evaluating the effects of lifespan-extending drugs.

Chronic obstructive pulmonary disease (COPD) is well known as a chronic lung disease. In recent years, with the deepening of its understanding, various complications of COPD, especially pulmonary hypertension(PH) have received more and more attention. COPD patients with PH have an increased fatality rate and a poor prognosis, which seriously affects the quality of life of the patients, and the treatment of the disease lacks effective drugs. In order to fully understand the current status of the treatment of the disease, the research progress of the drug treatment of COPD combined with PH was reviewed. The results show that for patients with COPD and PH, the best treatment should be given to their underlying diseases. The use of statins and fasudil may be beneficial, but the effect of targeted drugs is still controversial. In the future, more large randomized controlled trials need to be carried out to further clarify the efficacy of various drugs on COPD.

Objective To investigate the problems existing in hospital transfusion records,analyze unreasonable factors,and improve the quality of blood transfusion.Methods Investigation of our hospital from January 2016 to January 2017 with blood transfusion medical records,according to hospitalization number,900 cases were selected,using random number table.Investigating blood transfusion records on each record integrity,according toGuidelines for Surgical and Traumatic Blood Transfusion and Internal medicine transfusion guide in clinical blood transfusion technical specifications.The common blood components such as red blood cells,plasma and cryoprecipitate infusion and rationality evaluation.Results There were 583 surgical departments and 557 non-surgical departments.There was a significant difference between the surgical department and the non-surgical department.The reasonable rate of non-operation department was higher than that of the operation department (x2 =7.723,P=0.021).The rational rate of the department was 93.8％,while the operation department was only 88.0％;900 blood transfusion records of four kinds of blood components of the rationality of the difference was statistically significant (x2=214.767,P＜0.001).Non-surgical department of erythrocyte,plasma,cold precipitate reasonable rate than the surgical department;900 medical records in 55 records failed,mainly after the assessment of incomplete blood transfusion,no recorded blood transfusion reaction.There were significant differences in the failure rate between the surgical department and the non-surgical department (x2 =4.613,P=0.032).Conclusion Some physicians transfusion indications,for evaluation before and after blood transfusion blood insufficient attention to curative effect evaluation,blood transfusion is not reasonable,and in the operation department,do not take the blood transfusion medical record writing,hospitals should strengthen the blood transfusion blood transfusion continuously improve the scientific and normative management.

Background and objective Epidermal growth factor receptor (EGFR)-activating mutation predicts excellent response to EGFR tyrosine kinase inhibitors (TKIs). However, lung cancer patients are otfen with unknown EGFR mutation status because there are little tumor specimen to determine. TKIs induce tumor cell apoptosis which associates with several apoptosis-related genes. To explore the association between GNAS1 T393C polymorphism and therapeutic effcacy of TKI in pretreated advanced non-small cell lung cancer (NCSLC) with unknown EGFR mutation status. Methods A total of 116 patients were recruited for the study from Zhejiang Cancer Hospital, all of whom were treated with geiftinib or erlotinib atfer failure to prior chemotherapy. We detected the genotype of peripheral blood lymphocytes of patients with GNAS1 T393C polymorphism through polymerase chain reaction (PCR). Statistical analysis was performed by SPSS version 18.0. Results hTe overall response rate was 29.3%. No signiifcant associations were found among GNAS1 T393C polymorphism and the objective response rate. hTe disease control rate of patients with GNAS1 T393C CC genotype was lower than that of patients with variant genotype (TT or CT) (46.2%vs 73.8%, P=0.039). Univariate analysis identiifed gender, smoking history, histol-ogy and GNAS1 T393C polymorphism as predictive marker of PFS (P=0.04, P<0.001, P<0.001 and P=0.005). Multivariate analysis of factors, including smoking history, performance status score, histology, GNAS1 T393C polymorphism demonstrat-ed that GNAS1 T393C polymorphism was correlated independently with PFS (P=0.007). Conclusion Our data suggest the role of GNAS1 T393C CC genotype as a poor predictive marker both of DCR and PFS in advanced NSCLC patients treated with tyrosine kinase inhibitor.