OBJECTIVE: To investigate the current status of early pain and agitation management in critically ill patients in Guizhou Province. METHODS: A retrospective study was performed using data collected from a quality control activity conducted between April and June 2021 in non-provincial public hospitals with general intensive care unit (ICU) in Guizhou Province. Hospital-level data included hospital name and grade, ICU staffing, and number of ICU beds. Patient-level data included characteristics of patients treated in the general ICU on the day of the survey (e.g., age, sex, primary diagnosis), as well as pain and agitation assessments and the types of analgesic and sedative medications administered within 24 hours of ICU admission. RESULTS: A total of 947 critically ill ICU patients from 145 hospitals were included, among which 104 were secondary-level hospitals and 41 were tertiary-level hospitals. Within 24 hours of ICU admission, 312 (32.9%) critically ill patients received pain assessments, and 277 (29.3%) received agitation assessments. Among the pain assessment tools, the critical care pain observation tool (CPOT) was used in 44.2% (138/312) of critically ill ICU patients, with a significantly higher usage rate in tertiary hospitals compared to secondary hospitals [52.3% (69/132) vs. 38.3% (69/180), P < 0.05]. The Richmond agitation-sedation scale (RASS) was used in 93.8% (260/277) of critically ill ICU patients for agitation assessment, with no significant difference between hospital levels. Among the 947 critically ill patients, 592 (62.5%) received intravenous analgesics within 24 hours, with remifentanil being the most commonly used [42.9% (254/592)]; 510 (53.9%) received intravenous sedatives, with midazolam being the most frequently used [60.8% (310/510)]. Mechanical ventilation data were available for 932 critically ill patients, of whom 579 (62.1%) received mechanical ventilation and 353 (37.9%) did not. Compared with non-ventilated patients, ventilated patients had significantly higher rates of analgesic and sedative use [analgesics: 77.9% (451/579) vs. 38.8% (137/353); sedatives: 71.8% (416/579) vs. 25.8% (91/353); both P < 0.05]. In terms of analgesic selection, ventilated patients were more likely to receive strong opioids than non-ventilated patients [85.8% (95/137) vs. 69.3% (387/451), P < 0.05]. For sedatives, ventilated patients preferred midazolam [66.6% (277/416)], whereas non-ventilated patients more often received dexmedetomidine [45.1 (41/91)]. Blood pressure within 24 hours of ICU admission were available for 822 critically ill patients, of whom 245 (29.8%) had hypotension and 577 (70.2%) did not. Compared with non-hypotensive patients, hypotensive patients had significantly higher rates of analgesic and sedative use [analgesics: 74.7% (183/245) vs. 59.8% (345/577); sedatives: 65.7% (161/245) vs. 51.3% (296/577); both P < 0.05], but there was no significant difference in the choice of analgesic or sedative agents between the two groups. CONCLUSIONS The proportion of critically ill ICU patients in Guizhou Province who received standardized pain and agitation assessments was relatively low. The most commonly used assessment tools were CPOT and RASS, while remifentanil and midazolam were the most frequently used analgesic and sedative agents, respectively. Secondary-level hospitals had a lower rate of using standardized pain assessment tools compared to tertiary-level hospitals. Mechanical ventilation and hypotension were associated with the use of analgesic and sedative medications.
Humans ; Critical Illness ; Intensive Care Units ; Analgesics/therapeutic use* ; Hypnotics and Sedatives/therapeutic use* ; Retrospective Studies ; China ; Pain Measurement ; Pain Management ; Female ; Male ; Critical Care ; Middle Aged

Objective The aim of this study was to investigate the impact and mechanisms of emodin on oxidative stress response in lipopolysaccharide(LPS)-induced murine mononuclear macrophages(RAW264.7).Methods Involved the use of LPS,RAW264.7 cells,and emodin.Experimental groups included a control group,LPS(1 μg/mL)group,and LPS(1 μg/mL)+emodin(15 μmmol/L)pretreatment group.Aldehyde malondialdehyde(MDA)content,intracellular reactive oxygen species(ROS)levels,and silent information regulator 2(Sirt2)expression were evaluated at 6,12,and 18 hours after LPS exposure.Additionally,RAW264.7 cells were pretreated with Sirt2 inhibitor AGK2(20 μmol/L)followed by LPS stimulation,and the above-mentioned parameters were assessed at 6 hours.Results Compared to the control group,MDA content,ROS levels,Sirt2 mRNA,and protein expression in RAW264.7 cells in the LPS group increased at all time points(all P<0.05).At 6 and 18 hours,MDA content and ROS levels in RAW264.7 cells in the LPS+emodin group decreased significantly(all P<0.05),while at 12 hours,ROS levels were lower in the LPS group compared to the LPS+emodin group(P<0.05).Sirt2 mRNA and protein levels significantly increased at all time points(all P<0.05)compared to the LPS group.In the LPS+emodin+AGK2 group,Sirt2 mRNA and protein levels decreased,and MDA content and ROS levels increased compared to the LPS+emodin group(all P<0.05).Conclusion LPS-induced oxidative stress in RAW264.7 cells and emodin attenuate LPS-induced oxidative stress in RAW264.7 cells through Sirt2.

ObjectiveTo detect the flexibility differences of Plasmodium berghei K173 （PbK173）-infected red blood cells with varying degrees of sensitivity to artemisinin-based drugs and to preliminarily explore the underlying mechanisms of the differences. MethodA total of 102 specific-pathogen-free （SPF） male C57BL/6 mice were randomly divided into three groups， with 30 mice each in the control group and PbK173-resistant （PbK173-R） group， and 42 mice in the PbK173-sensitive （PbK173-S） group. Except for the control group， the rest groups were vaccinated with 1×10⁷ PbK173-S/PbK173-R infected red blood cells to establish a mouse malaria model. During the administration and recovery periods （control group， PbK173-R/PbK173-S）， dihydroartemisinin （DHA， 40 mg·kg^-1） and malaridine （MD， 6 mg·kg^-1） were administered continuously for four days. Peripheral blood was taken from the PbK173-S/PbK173-R groups with an infection rate equal to or greater than 20%. Peripheral blood and each organ were taken on the first day at the end of administration （dosing period） and on the fifth day at the end of administration （recovery period）， and blood parameters and organ indices of each group were examined. The osmotic fragility of peripheral blood red blood cells in each group was detected using the red blood cell osmotic fragility test. Western blot was applied to determine the levels of Piezo1 and Band3 proteins in the red blood cell membrane. ResultDuring the administration and recovery periods， there were no significant differences between the PbK173-S MD group and the DHA group. During the administration period， there were no significant differences in hematological parameters between PbK173-S and PbK173-R in the MD group. However， during the recovery period， the red blood cell count， hemoglobin concentration and hematocrit of the PbK173-R group were significantly higher than those of the PbK173-S group （P<0.05） in the MD group. Compared with that of the control group， the osmotic fragility of the PbK173-S/PbK173-R groups was significantly enhanced （P<0.01）， and the osmotic fragility of the PbK173-S group was significantly stronger than that of the PbK173-R group （P<0.01）. The osmotic fragility of red blood cells in the PbK173-S group during the administration period was significantly stronger than that in the control group and PbK173-R group during the administration period （P<0.01）. The osmotic fragility of red blood cells in the PbK173-R group during the recovery period was significantly higher than that in the control group during the administration period and the PbK173-S group during the recovery period （P<0.05）. Compared with those in the control group， the Piezo1 protein and Band3 protein in the red blood cell membrane of the PbK173-S group were significantly reduced （P<0.01）. Compared with those in the PbK173-R group， the Piezo1 protein and Band 3 protein in the red blood cell membrane of the PbK173-S group were significantly reduced. ConclusionThe flexibility of PbK173-infected red blood cells with different sensitivities to artemisinins differed. Plasmodium-infected red blood cells significantly reduced the levels of Piezo1 and Band3 proteins in the red blood cell membrane， and the erythrocyte flexibility exhibited a decreasing trend in the following order： normal group， PbK173-R group， and PbK173-S group.

Transient receptor potential vanilloid-1(TRPV1) channel is a non-selective ligand-gated cationic channel with multiple activation mechanisms in the transient receptor potential subfamily. In recent years, a large number of studies have found that TRPV1 plays an important role in the field of cardiovascular diseases such as hypertension and atherosclerosis. With the in-depth study of traditional Chinese medicine, it has been found that Chinese medicine monomers and their active components can activate or inhibit TRPV1 channels, which has certain potential in the study of cardiovascular diseases. In this paper, the role of TRPV1 channel in cardiovascular diseases and the research progress of traditional Chinese medicine prevention and treatment of cardiovascular diseases based on TRPV1 channel are reviewed, in order to provide new ideas for prevention and treatment of cardiovascular system diseases.

Objective:To analyze effects of tectorigenin on improving cognitive deficits in rats with vascular dementia(VD)by regulating Toll-like receptor 4(TLR4)/myeloid differentiation factor 88(MyD88)/nuclear factor-κB(NF-κB)signaling pathway.Methods:A total of 72 rats were randomly divided into sham operation group,model group,low,medium and high doses[25,50,100 mg/(kg·d)]tectorigenin groups and positive control group[piracetam 324 mg/(kg·d)],with 12 rats in each group.Except for sham operation group,VD models were replicated in other groups.After successful modeling,different doses tectorigenin groups and positive control group were administered intragastrically with different doses of tectorigenin and piracetam,while other groups were administered intragastrically with same volume of normal saline for 28 d.Spatial learning and memory ability were detected by Morris water maze.Neurotransmitter levels in hippocampus interstitial fluid were detected by high performance liquid chromatography-electro-chemical.Brain-derived neurotrophic factor(BDNF)and tyrosine kinase receptor b(TrkB)expressions in hippocampus were detected by RT-qPCR and Western blot.TLR4/MyD88/NF-κB pathway-related proteins in hippocampus were detected by Western blot.Results:Compared with sham operation group,escape latency was longer,while stay time in target area and times of crossing platform were lower in model group(P<0.05).Compared with model group,escape latency was shorter,while stay time in target area and times of crossing platform were higher in medium and high doses tectorigenin groups(P<0.05).NE,DA,5-HT and 5-HIAA levels in model group were lower than those in sham operation group(P<0.05),which were higher in medium and high doses tectorigenin groups than model group(P<0.05).Compared with sham operation group,BDNF and TrkB mRNA and proteins levels were lower,while TLR4,MyD88 and p-NF-κB p65/NF-κB p65 proteins levels were higher in model group(P<0.05).Compared with model group,BDNF and TrkB mRNA and proteins levels were higher,while TLR4,MyD88 and p-NF-κB p65/NF-κB p65 proteins levels were lower in medium and high doses tectorigenin groups(P<0.05).Conclusion:Tectorigenin can improve cognitive deficits in VD rats,which may be related to regulating TLR4/MyD88/NF-κB signaling pathway.

Objective:This study aimed to investigate the correlation between serum chitinase-3 like-protein-1(YKL-40), matrix metalloproteinase-9(MMP-9), and imaging markers in middle-aged and elderly patients with cerebral small vessel disease(CSVD).It also sought to elucidate the mechanism underlying the onset and development of CSVD.Methods:A case-control study was conducted with 130 CSVD patients and 20 age-matched controls admitted to the Department of Neurology of the Second Affiliated Hospital of Zhengzhou University between December 2020 and November 2022.Based on their white matter hyperintensity(WMH)and enlarged perivascular spaces(EPVS)scores, CSVD patients were categorized into mild, moderate, and severe groups.Cerebral microbleeds(CMBs)were classified into non-lacunar, lacunar, non-CMBs, and CMBs groups.Patients' general data were collected, and serum levels of YKL-40 and MMP-9 were measured using ELISA.Results:The results showed 34 cases in the severe WMH group, 35 cases in the EPVS severe group, 90 cases in the group with lacunar and 65 cases in the group with CMBs.Statistically significant differences(both P<0.05)in serum YKL-40 and MMP-9 in WMH severe groups compared to age control group.Statistically significant differences(both P<0.05)in serum YKL-40 and MMP-9 in EPVS severe groups compared to age control group.The increase of serum YKL-40 and MMP-9 levels was an independent risk factor for the severity of WMH( OR=1.25, 95% CI: 0.164-0.289, P<0.05)( OR=1.13, 95% CI: 0.090-0.160, P<0.05)and EPVS( OR=1.05, 95% CI: 0.021-0.076, P<0.05)( OR=1.02, 95% CI: 0.006-0.026, P<0.05).There was no significant different in the serum YKL-40 and MMP-9 levels between lacunar group and non-lacunar group( P>0.05).The serum YKL-40 and MMP-9 levels in the group with CMBs were significantly higher than those in the group without CMBs( P<0.05).The ROC curve showed that the optimal cutoff point of YKL-40 was 0.38, the area under the curve was 0.669(95% CI: 0.569-0.768, P<0.01), the optimal cutoff point of MMP-9 was 0.40, and the area under the curve was 0.746(95% CI: 0.644-0.848, P<0.01). Conclusions:Changes in serum YKL-40 and MMP-9 levels in middle-aged and elderly patients with CSVD were found to be associated with various imaging markers, potentially contributing to the onset and development of CSVD.These findings may aid in early CSVD diagnosis and provide insights for potential interventions.

As an integral part of worldwide healthcare,nursing still has a big task to make in conducting implementation research.Addressing the pressing challenges of closing the gap between evidence and nursing practice,and effectively disseminating and applying evidence within the nursing discipline,remains a top priority.This paper presents a compilation of the status of evidence implementation in clinical nursing from an implementation science perspective,including the theoretical framework of barriers to evidence implementation,common research methodologies,and research progress of related factors in the field of nursing.The goal of this work is to bring more insights to further advance the implementation of evidence in nursing.

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.

Purpose: To construct an index system to evaluate the competencies of nurses in enhanced recovery after surgery (ERAS) programs and provide a scientific foundation for their training and assessment. Methods: Utilizing a literature review and semi-structured interviews, a preliminary indicator system was constructed. Based on the preliminary indicator system, a Delphi questionnaire was developed and utilized to achieve consensus among experts in two rounds of Delphi studies. The indicators were selected based on a mean importance score greater than 4 and a coefficient of variation less than .25. The weights of the indicators were calculated using the Analytic Hierarchy Process. Results: The study developed a system that evaluates the competencies of nurses involved in ERAS programs, offering a reference for their training and evaluation. The final index system includes 7 primary indicators, 20 secondary indicators, and 66 tertiary indicators. The primary indicators consist of competencies in the following components: 1) Direct clinical practice (20 items); 2) Expert coaching and guidance (9 items); 3) Consultation (6 items); 4) Research (7 items); 5) Leadership (11 items); 6) Collaboration (8 items); and 7) Ethical decision-making (5 items). Conclusion The developed competency evaluation index system is reliable and can serve as a foundation for the selection, training, and assessment of ERAS nurses.