Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Objective:To analyze the effects of exposure to life events and social support levels during different stages of pregnancy on low birth weight in offspring.Methods:From 2021 to 2023, pregnant women in early pregnancy who were registered with health cards in Linping District, Hangzhou City, were recruited and followed up. The Life Events Scale for Pregnant Women (LESPW) and Social Support Rating Scale (SSRS) were used to evaluate the exposure to life events and social support levels of pregnant women in early, middle and late pregnancy, respectively. A generalized linear model was used to analyze the impact and critical period of exposure to prenatal life events and social support levels on the risk of low birth weight in offspring.Results:A total of 3 663 pregnant women with ages M ( Q1, Q3) of 29.18 (26.59, 32.21) years were included in this study. 116 cases (3.17%) of infants with low birth weight were delivered. Generalized linear model analysis showed no correlation between the level of social support in early, middle and late pregnancy and low birth weight in offspring (all P>0.05). The risk of low birth weight in offspring of pregnant women with high exposure to early pregnancy life events was 1.78 times higher than that of the low exposure group ( RR=1.78, 95% CI: 1.13-2.73, P=0.010), and there was no association in the middle and late stages of pregnancy (both P>0.05). Pregnant women with high exposure to early life events and low levels of social support had a 2.08-fold higher risk of low birth weight in their offspring compared to the low exposure group ( RR=2.08, 95% CI: 1.17-6.78, P=0.010), while this situation was not associated with high social support stratification. Conclusion:Exposure to life events during pregnancy has an early window effect on birth weight. Increased exposure to life events during early pregnancy is associated with a higher risk of low birth weight in offspring. This association is more pronounced in pregnant women with low social support.

Objective:To analyze the effects of exposure to life events and social support levels during different stages of pregnancy on low birth weight in offspring.Methods:From 2021 to 2023, pregnant women in early pregnancy who were registered with health cards in Linping District, Hangzhou City, were recruited and followed up. The Life Events Scale for Pregnant Women (LESPW) and Social Support Rating Scale (SSRS) were used to evaluate the exposure to life events and social support levels of pregnant women in early, middle and late pregnancy, respectively. A generalized linear model was used to analyze the impact and critical period of exposure to prenatal life events and social support levels on the risk of low birth weight in offspring.Results:A total of 3 663 pregnant women with ages M ( Q1, Q3) of 29.18 (26.59, 32.21) years were included in this study. 116 cases (3.17%) of infants with low birth weight were delivered. Generalized linear model analysis showed no correlation between the level of social support in early, middle and late pregnancy and low birth weight in offspring (all P>0.05). The risk of low birth weight in offspring of pregnant women with high exposure to early pregnancy life events was 1.78 times higher than that of the low exposure group ( RR=1.78, 95% CI: 1.13-2.73, P=0.010), and there was no association in the middle and late stages of pregnancy (both P>0.05). Pregnant women with high exposure to early life events and low levels of social support had a 2.08-fold higher risk of low birth weight in their offspring compared to the low exposure group ( RR=2.08, 95% CI: 1.17-6.78, P=0.010), while this situation was not associated with high social support stratification. Conclusion:Exposure to life events during pregnancy has an early window effect on birth weight. Increased exposure to life events during early pregnancy is associated with a higher risk of low birth weight in offspring. This association is more pronounced in pregnant women with low social support.

Objective : To investigate the 90 day prognosis of acute ischemic stroke patients treated with mechanical thrombectomy in the real world and analyze the related factors of prognosis． Methods: A total of 1 033 acute ischemic stroke patients treated with mechanical thrombectomy in tertiary hospitals of Anhui province were retrospectively investigated．The 90 day modified Rankin Scale (mRS) score was evaluated by follow-up telephone，0 ～2 points were good prognosis and 3 ～6 points were poor prognosis. Results : A total of 770 patients were followed up，with an average age of (67. 7 ± 11. 8) years．The good prognosis rate was 32. 1% and the mortality rate was 31. 8% . With the increase of age，the good prognosis rate showed a downward trend while the mortality rate showed an upward trend．The best cut-off value for age prediction of 90-day mortality was 69 years old．There was no gender difference in the good prognosis rate between women (70. 6 ± 10. 6) years and men (65. 6 ± 12. 2) years，but females experienced a higher mortality than males (37. 1% vs 27. 9% ) before adjusting for age． Comparison was made among provincial，municipal and county hospitals，only the good prognosis rate of provincial hospitals was significantly higher than that of county hospitals (37．2% vs 15. 6% ) ．In the grouping of annual number of endovascular treatment cases，the good prognosis rate of only ≥40 cases group was significantly higher．There was no significant difference in mortality among the groups． Conclusion At present，the good prognosis is low and the mortality is high for the whole acute ischemic stroke patients treated with mechanical thrombectomy．Age was positively correlated with poor prognosis and mortality．The higher mortality rate in women than in men is due to the higher average age of onset in women．The good prognosis rate of provincial hospitals and hospitals with annual number of endovascular treatment ≥40 cases is higher than that of other hospitals.

The physical trauma and psychological stress brought by awake surgery will lead to many negative outcomes. Virtual reality (VR) technology can effectively relieve the pain and anxiety of patients undergoing awake surgery by taking advantage of its advantages of immersion, interactivity and imagination. This paper summarizes the types and application effects of VR head-mounted displays, analyzes the shortcomings of VR and points for attention in application, so as to provide reference for future research and clinical practice.

Objective:To improve the awareness of primary myeloid sarcoma.Methods:The clinical data of one primary myeloid sarcoma patient with first symptom involving nasopharynx who was admitted to the Second Affiliated Hospital of Anhui Medical University in June 2017 were retrospectively analyzed, and the related literature was reviewed.Results:The patient presented with nasal congestion with tinnitus; it took half a year for the myeloid sarcoma diagnosis to be clear with biopsy and immunohistochemical examinations for many times. The patient was treated with chemotherapy regimens for acute myeloid leukemia (AML). Isolated myeloid sarcoma relapsed with skin masses after remission for more than 2 years. Further improvement of the bone marrow-related examinations showed that the bone marrow was not involved, and it was still isolated myeloid sarcoma. The skin mass disappeared completely after the induction chemotherapy of AML. Six months after the recurrence, the patient was in stable condition and was still under follow-up treatment.Conclusions:The primary nasopharyngeal myeloid sarcoma lacks specificity and is easy to be misdiagnosed. The prognosis of isolated myeloid sarcoma is better than that of AML. Isolated recurrence after chemotherapy remission is rare, and usually progresses to the leukemia stage quickly. Early and correct diagnosis is very important for the prognosis, and clinicians should improve the awareness of primary myeloid sarcoma.

[Abstract]? Objective? To investigate the current situation of negative leadership behavior in hospital nursing management, analyze the relationship and influence between negative leadership behavior and nurses' sense of professional mission and patients' satisfaction, and provide theoretical basis for reducing negative leadership behavior in nursing management and improving nurses' sense of professional mission and nursing quality. Methods? From January 2017 to July 2018, 260 clinical nurses from three hospitals in Hangzhou were selected by convenience sampling method. General Information Questionnaire, Negative Leadership Scale, Professional Mission Questionnaire and Nursing Job Satisfaction Scale were used in the questionnaire survey. The negative leadership behavior in hospital nursing management and its influence on nurses' sense of professional mission and patients' satisfaction were analyzed. A total of 271 questionnaires were distributed to the nursing staff and 260 valid questionnaires were retrieved. Results? Among the 260 nurses surveyed, 22.69% encountered autocratic and selfish leadership, 30.77% encountered unfaithful leadership, 55.00% experienced constructive leadership, and the total average score of items in Negative Leadership Scale was (1.58±0.76). Autocratic and selfish leadership behavior was negatively correlated with nurses' sense of professional mission and nursing quality (P＜ 0.01), unfaithful leadership behavior was negatively correlated with nurses' sense of professional mission and nursing quality (P＜ 0.01), and constructive leadership behavior was positively correlated with nurses' sense of professional mission and nursing quality (P＜0.01). Conclusions? There are some arbitrary, selfish and unfaithful negative leadership behaviors in hospital management, which have a negative impact on nurses' sense of professional mission and patients' satisfaction. Effective measures should be taken to intervene.

Objective: To explore the application of the 3D precise digital technology in restoring structural defects of the orbital region. Methods: Structural defects of the orbital region concerning on osseous structure and soft tissue were restored in one stage or stages using EH composite artificial bone prosthesis with complex three-dimensional structure. The fabrication of EH composite artificial bone prosthesis was based on CT scanning and 3D reconstruction of the skull with computer aided data analysis and design. The appearance, degree of satisfaction and the complications were evaluated in postoperative regular follow-up. Results: Five cases of structural defects in the orbital regions presenting bone defect and soft tissue abnormality, received treatments in the department from January 2016 to September 2017. The cases consist of one patient with dysplasia following surgical treatment, three with post-traumatic and one with Treacher-Collins syndrome. With the application of individualized EH composite artificial bone fabricated by aforementioned method, all the repair materials presented the ideal three-dimensional structure and coincided well with the defects, and soft tissue restoration of 2 cases was performed in one stage or by stages. Appearance and symmetry of the 5 cases was significantly improved, without complications of infection, rejection, exposure or graft tissue necrosis. All the patients were satisfied with the results. Conclusions In consideration of the capacity to fabricate accurate individualized repair materials, the three-dimensional digital technology plays an important role in the treatment of structural defects in the orbital region, especially the reconstruction of the bony contour. The simple orbital deformities can be treated with the repair materials and correction of soft tissue. For special orbital deformities, attention should be paid to bone structure repair, eye socket reconstruction and filling of orbital contents sequentially.

Objective: The aim of this study was to describe the distribution of neck-shoulder symptoms among middle school students, and to explore its influence factors. Methods: A cross-sectional survey was conducted on 24 middle schools in Shenyang, Zhengzhou and Shenzhen by purposive sampling method. In each middle school, 3 to 4 classes were selected from each grade all the students in the selected class would be recruited to the survey to investigate the demographic characteristics, neck-shoulder symptoms, physical exercise time, academic stress, screen behavior, sedentary behavior and other information by questionnaire. A total of 10 566 questionnaires were issued and 10 270 valid questionnaires were withdrawn. The prevalence of neck-shoulder symptoms among students were compared by different characteristics. Logistic regression models were applied to examine influencing factors associated with neck-shoulder symptoms. Results: The prevalence of neck-shoulder symptoms among middle school students was 19.2% (1 968/10 270), while it was 22.6% (1 137/5 039) among girls and 15.9% (831/5 231) among boys; the difference showed statistical significance (P<0.001). The prevalence of neck-shoulder symptoms was separately 13.3% (253/1 901) in seventh grade, 16.8% (326/1 942) in eighth grade, 18.5% (299/1 617) in ninth grade, 21.8% (417/1 915) in sophomore, 21.4% (345/1 611) in junior, 25.5% (328/1 284) in senior; the difference showed statistical significance (P<0.001). The multivariate logistic regression analysis showed that in the last 3 months, students who always playing mobile phone ≥40 min continuously (OR=4.66, 95%CI: 3.95-5.49), watching TV ≥40 min continuously (OR=4.01, 95%CI: 3.39-4.73), using computer ≥40 min continuously (OR=3.61, 95%CI: 3.09-4.23), doing homework ≥60 min continuously (OR=3.25, 95%CI: 2.79-3.79), the average daily sitting time ≥10 h (OR=4.95, 95%CI: 4.25-5.77), and always sitting ≥90 min continuously (OR=5.18, 95%CI: 4.42-6.06) were risk factors of neck-shoulder symptoms. Conclusion The prevalence of neck-shoulder symptoms was high among middle school students in China, especially girls in senior grades. Long time, high frequency video behaviors and sedentary behaviors were related to the occurrence of neck-shoulder symptoms among middle school students.

Objective: To examine the relationship between the prevalence of self-reported myopia and outdoor activities among middle school students and to explore the influence factors of the self-reported myopia. Methods: A total of 12 979 participants were recruited from junior and senior middle school students in in Shenzhen, Nanchang, Zhengzhou and Shenyang by random cluster sampling method between December 2015 and March 2016. All participants completed an anonymous questionnaire to collect the information of demographic characteristics, self-reported myopia, outdoor activities, etc. 12 603 out of 12 979 copies of questionnaire were valid. The prevalence of self-reported myopia was compared among middle school students with different characteristics. Logistic regression models were used to analyze the relationship between myopia and outdoor activities. Results: The prevalence of self-reported myopia among middle school students was 69.6% (8 766/12 603); which was separately 52.1% (1 216/2 335) in seventh grader, 61.6% (1 459/2 369) in eighth grader, 69.0%(1 470/2 129) in ninth grader, 80.0% (1 812/2 265) in freshmen, 79.4% (1 622/2 042) in sophomore, and 81.1%(1 187/1 463) in junior. The prevalence of self-reported myopia showed an increasing trend with the increase of grade (χ²=639.67, P<0.001). The prevalence of self-reported myopia was separately 63.5%(4 927/7 756) in non-myopic parents group, 78.0%(2 664/3 415)in either myopic parent group, and 82.1%(1 175/1 432) in both myopic parents group(χ²=328.28, P<0.001). Outdoor activities were associated with self-reported myopia. Binary logistic regression analysis showed that the risk of self-reported myopia was significantly increased by always staying at home in extracurricular time among the middle school students (OR=1.58, 95%CI: 1.36-1.82). The risk of self-reported myopia were significantly decreased by always physical exercise and recreational activities after school among middle school students: the ORs were separately 0.67 (95%CI: 0.57-0.78) for physical exercise and 0.77 (95%CI: 0.64-0.92) for recreational activities. After stratified analysis by the parents' myopia status, in non-myopic parents group, exercise and recreational activities after school among middle school students decreased the risk of myopia: the ORs were separately 0.68 (95%CI: 0.55-0.82) for physical exercise and 0.76 (95%CI: 0.61-0.95) for recreational activities; in either myopic parent group, OR(95%CI) were separately 0.65 (0.47-0.90) and 0.68 (0.47-0.98). Conclusion Outdoor activities was negatively associated with self-reported myopia among middle school students. However, the parents' myopia status may affect the protective effect.