The American Heart Association(AHA)/American Stroke Association(ASA)published the"2024 Guidelines for Primary Stroke Prevention"in the Stroke journal on October 21,2024.This document summarized the clinical research and epidemiological data since the publication of the previous version of the guidelines in 2014,providing strategies and recommendations for stroke prevention across the entire lifecycle.The guidelines emphasized the importance of pharmacological treatment,routine screenings,and lifestyle changes,with updated and refined recommendations.This article dissects the newly revised sections of the guidelines,with a special focus on the management of blood pressure,blood glucose,and blood lipids levels,as well as customized advice for particular populations and patient subgroups.Furthermore,it explores health behavior management strategies,including diet and exercise,by intergarting the knowledge from the previous version of the primary stroke prevention guidelines with pertinent domestic and international materials.The ultimate objective is to offer valuable insights and guidance to China in advancing primary stroke prevention efforts and formulating coherent guidelines and consensuses within this critical domain.

The American Heart Association(AHA)/American Stroke Association(ASA)published the"2024 Guidelines for Primary Stroke Prevention"in the Stroke journal on October 21,2024.This document summarized the clinical research and epidemiological data since the publication of the previous version of the guidelines in 2014,providing strategies and recommendations for stroke prevention across the entire lifecycle.The guidelines emphasized the importance of pharmacological treatment,routine screenings,and lifestyle changes,with updated and refined recommendations.This article dissects the newly revised sections of the guidelines,with a special focus on the management of blood pressure,blood glucose,and blood lipids levels,as well as customized advice for particular populations and patient subgroups.Furthermore,it explores health behavior management strategies,including diet and exercise,by intergarting the knowledge from the previous version of the primary stroke prevention guidelines with pertinent domestic and international materials.The ultimate objective is to offer valuable insights and guidance to China in advancing primary stroke prevention efforts and formulating coherent guidelines and consensuses within this critical domain.

Objective:To investigate the role and mechanism of vitamin D(VD)in renal ischemia-reperfusion(I/R group)injury.Methods:Forty-eight male C57BL/6J mice were divided into four groups:Sham operation group(Sham group),active VD analog alfacalcidol treatment group(VD group),renal ischemia-reperfusion injury group(I/R group)and alfacalcidol treated I/R group(I/R+VD group).After 24 h renal I/R injury,mice in each group were sacrificed,and peripheral blood was collected to detect the levels of blood urea nitrogen(BUN),serum creatinine(SCr)and inflammatory factors IL-1β,IL-18 and tumor necrosis factor-α(TNF-α).The renal tissues of mice in each group were collected,the apoptosis level of renal tissues was detected by TUNEL staining,and the positive expression rate of NLRP3 was detected by IHC.Western blot was used to detect the NLRP3 inflammasome associated factors NLRP3,GSDMD-N,cleaved Caspase-1,IL-1β and NF-κB p65,IκBα in renal tissues of mice in each group.Results:Com-pared with Sham group,there was no significant difference in serum BUN,SCr,IL-1β,IL-18 and TNF-α levels in VD group(P>0.05),significantly increased in I/R group and I/R+VD group(P<0.05).Compared with I/R group,BUN,SCr,IL-1β,IL-18 and TNF-α were significantly decreased in I/R+VD group(P<0.05).Compared with Sham group,the positive rate of TUNEL and NLRP3 expression in renal tissues of mice in VD group had no significant difference(P>0.05),the positive rate of TUNEL and NLRP3 expres-sion in renal tissues of mice in I/R group and I/R+VD group were significantly increased(P<0.01),while the positive rate of TUNEL and NLRP3 expression in I/R+VD group were significantly decreased(P<0.05).Western blot results showed that compared with Sham group,there was no significant difference in protein expression levels of NLRP3,GSDMD-N,cleaved Caspase-1,IL-1β,NF-κB P65,IκBα in VD group(P>0.05).The protein expression of IκBα in I/R group and I/R+VD group was significantly decreased(P<0.05),while the other protein expression levels were significantly increased(P<0.05).Compared with the I/R group,the expression levels of NLRP3,GSDMD-N,cleaved Caspase-1,IL-1β and NF-κB p65 were significantly decreased in the I/R+VD group(P<0.05),while the expression level of IκBα was significantly decreased(P<0.05).Conclusion:VD plays a protective role in I/R injury by inhibiting NF-κB mediated activation of NLRP3 inflammasome.

Objective:To explore the effectiveness of the Shewhart control chart-based assessment and early warning system in prevention of medical device-related pressure injury(MDRPI).Methods:152 critically ill patients admitted to Hebei Central Hospital from January 2020 to December 2021 were selected and divided into a control group and an observation group based on different methods of assessing MDRPI risk,with 76 cases in each group.The control group adopted the Braden scale to assess the risk of MDRPI.The observation group adopted a safety early warning system based on Shewhart control charts to assess the risk of MDRPI in patients.Nursing measures were undertaken according to MDRPI risk grade in both groups.The occurrence of adverse events of MDRPI,nursing safety quality and nursing comprehensive quality were compared between the two groups.Results:The incidence rate of head,neck and face adverse events of MDRPI and the total incidence of adverse events of MDRPI of the patients in the observation group were lower than those in the control group(x2=4.802,5.758,P<0.05).The safety quality and comprehensive quality of nursing of 20 nurses in the observation group were higher than those in the control group(t=6.654,7.172,P<0.05).Conclusion:The application of assessment and early warning system based on Shewhart control chart in clinical nursing management can effectively reduce the incidence of MDRPI adverse events and improve the quality of nursing safety and comprehensive nursing.

In order to strengthen the supervision of the use of drugs in hospitals，the Sichuan Academy of Medical Sciences· Sichuan Provincial People’s Hospital took the lead in compiling the Principles for the Rational Use of National Key Monitoring Drugs （the Second Batch） with a number of experts from multiple medical units in accordance with the Second Batch of National Key Monitoring Rational Drug Use List （hereinafter referred to as “the List”） issued by the National Health Commission. According to the method of the WHO Guidelines Development Manual， the writing team used the Delphi method to unify expert opinions by reading and summarizing the domestic and foreign literature evidence of related drugs， and applied the evaluation， formulation and evaluation method of recommendation grading （GRADE） to evaluate the quality of evidence formed， focusing on more than 30 drugs in the List about the evaluation of off-label indications of drugs， key points of rational drug use and key points of pharmaceutical monitoring. It aims to promote the scientific standardization and effective management of clinical medication， further improve the quality of medical services， reduce the risk of adverse drug reactions and drug abuse， promote rational drug use， and improve public health.

Objective:To investigate the efficacy and safety of cedilanid in the treatment of severe pneumonia in infants and the value of preventing heart failure.Methods:A total of 80 children with severe pneumonia admitted to Dezhou Maternal and Child Health Hospital from January 2019 to December 2020 were selected and randomly divided into the control group and the observation group, with 40 cases in each group. The control group received comprehensive treatment, while the observation group was treated with cedilanid (0.01 mg/kg, one-time intravenous injection) on the basis of the control group. The efficacy of both groups was observed after 5 d of treatment. The incidence of heart failure, correction time of heart failure, improvement time of symptoms and signs, and length of hospitalization time were compared between the two groups; the inflammatory markers, myocardial markers and arterial blood gas indexes were compared between the two groups before and after the treatment.Results:The total effective rate in the observation group was higher than that in the control group, and the incidence of heart failure in the observation group was lower than that in the control group: 90.0% (36/40) vs. 72.5% (29/40), 32.5%(13/40) vs. 10.0%(4/40), the differences were statistically significant ( χ2 = 4.02, 4.10, P<0.05). The improvement time of symptoms and signs (restlessness elimination, respiratory improvement, heart rate improvement and disappearance of rhonchus in lung) in the observation group were less than those in the control group ( P<0.05). The levels of procalcitonin (PCT) and N-terminal pro-brain natriuretic peptide (NT-ProBNP), myocardial troponin I(cTnI), and creatine kinase isoenzyme (CK-MB) in the observation group after treatment were lower than those in the control group: (6.15 ± 1.03) μg/L vs. (10.85 ± 2.12) μg/L, (112.02 ± 30.09) ng/L vs. (215.39 ± 55.08) ng/L, (0.68 ± 0.17) μg/L vs. (1.12 ± 0.34) μg/L, (19.05 ± 6.11) U/L vs. (28.97 ± 7.82) U/L, P<0.05. The levels of oxygen partial pressure (PaO 2), blood oxygen saturation (SaO 2) and oxygenation index (PaO 2/FiO 2) in the observation group after treatment were higher than those in the control group: (6.15 ± 1.03) μg/L vs. (10.85 ± 2.12) μg/L, (112.02 ± 30.09) ng/L vs. (215.39 ± 55.08) ng/L, (0.68 ± 0.17) μg/L vs. (1.12 ± 0.34) μg/L, (19.05 ± 6.11) U/L vs. (28.97 ± 7.82) U/L, P<0.05. Conclusions:Early application of small dose of cedilanid in infants with severe pneumonia can effectively reduce the occurrence of heart failure, improve the clinical symptoms and blood gas indicators, with significant curative effect, which is worthy of promotion.

Objective: This study aimed to explore the existing knowledge about midwives' views and experiences of providing care for women in the context of task shifting.Methods: We conducted a qualitative systematic review using meta-ethnography to describe the views and experiences of midwives on providing care in the context of task shifting. Comparative textual analysis of published qualitative studies involved translation of first-order key concepts and meanings from included studies to generate second-and third-order concepts. A grid was made to identify core findings and compare them reciprocally. Results: Thirty-six qualitative studies met the inclusion criteria. The literature comprised of 32 first key concepts. Eight second-order constructs emerged, and three third-order interpretations were generated. The three overarching themes were: (1) midwives perceived themselves as providing culturally competent and high quality women-centered care; (2) they valued their profession but saw it as complex and challenging; (3) as health professionals, they reported a variety of organizational, cultural, and professional barriers to providing women-centered care. Conclusions: While performing a specific task in the task shifting context, midwives perceived their crucial roles and responsibilities, along with achieved value and reward. However, due to a range of existing barriers, the caring task posed great challenges in completely implementing women-centered care. It is essential for systems to identify and eliminate these barriers early, to consider midwives' emotional well-being, and to develop overall strategies to better support the midwifery workforce. Policy makers and administrators should establish a supportive environment to facilitate midwives to perform women-centered caring tasks in more effective and efficient ways.

A 50-year-old male patient with agitated depression and hyperlipemia received oral amoxicillin and clavulanate potassium 0.5 g once daily and 2 lopinavir and ritonavir tablets twice daily for novel coronavirus infection, based on previous drugs including quetiapine, clonazepam, and atorvastatin calcium. After 3 days, lopinavir and ritonavir was changed to oral arbidol 200 mg, thrice daily due to suspicious drug interaction. After taking arbidol for 3 days, the patient developed red papules on the whole body. Considering that it might be related to amoxicillin and clavulanate potassium, the drug was stopped and loratadine was given. But the rashes were aggravated. Considering that the drug eruption was caused by arbidol, arbidol was discontinued and the rashes subsided in a large area the next day. Then vitamin C injection, calcium gluconate injection, and ribavirin were added. After 5 days, the rashes subsided completely. After 17 days, the patient recovered from pneumonia.

A 50-year-old male patient with agitated depression and hyperlipemia received oral amoxicillin and clavulanate potassium 0.5 g once daily and 2 lopinavir and ritonavir tablets twice daily for novel coronavirus infection, based on previous drugs including quetiapine, clonazepam, and atorvastatin calcium. After 3 days, lopinavir and ritonavir was changed to oral arbidol 200 mg, thrice daily due to suspicious drug interaction. After taking arbidol for 3 days, the patient developed red papules on the whole body. Considering that it might be related to amoxicillin and clavulanate potassium, the drug was stopped and loratadine was given. But the rashes were aggravated. Considering that the drug eruption was caused by arbidol, arbidol was discontinued and the rashes subsided in a large area the next day. Then vitamin C injection, calcium gluconate injection, and ribavirin were added. After 5 days, the rashes subsided completely. After 17 days, the patient recovered from pneumonia.

OBJECTIVE: To explore the suitable process for prenatal screening and diagnosis for women with advanced maternal age. METHODS: From January 2014 to November 2017, the indications and distributions of prenatal diagnosis for women with advanced maternal age only or accompanying with positive maternal serum test screening and non-invasive prenatal testing (NIPT), abnormal fetal ultrasound, one harboring chromosomal abnormalities or anomalous reproductive history were analyzed. The rate of fetal chromosomal abnormalities was compared between different groups. RESULTS: The 351 pregnant women with fetal chromosomal abnormalities have included 196 cases with advanced maternal age, 26 with positive maternal serum test, 96 with high-risk by NIPT, 14 with abnormal fetal ultrasound, 15 with one partner harboring chromosomal abnormalities, and 4 with anomalous reproductive history. Assuming that all pregnant women had undergone maternal serum test screening or NIPT without amniocentesis, the detection rate of fetal chromosome abnormality would be 51.0% and 69.2%, respectively. However, should these women have received both tests, the detection rate would be as high as 84.6%. Should those with one partner harboring chromosomal abnormalities undergone maternal serum test screening or NIPT without amniocentesis, the detection rate of fetal chromosomal abnormality would only be 6.7%. CONCLUSION Should pregnant women with advanced maternal age undergo both maternal serum test and NIPT, the detection rate of fetal chromosomal abnormality will be higher than those receiving only maternal serum test screening or NIPT. Couples with one partner harboring chromosomal abnormalities should undergo prenatal diagnosis by amniocentesis.
Amniocentesis ; Chromosome Aberrations ; Chromosome Disorders ; Female ; Humans ; Maternal Age ; Pregnancy ; Prenatal Diagnosis