BackgroundAtypical antipsychotics have been widely used in patients with chronic schizophrenia， and aripiprazole and risperidone are the most commonly used drugs. The mechanism of action of the two is different， while previous studies have provided insufficient credible evidence from multiple perspectives to support the comparative efficacy of the two drugs in improving symptoms in patients with chronic schizophrenia. ObjectiveTo compare the efficacy of aripiprazole and risperidone on the improvement of symptoms， prepulse inhibition （PPI）， cognitive functioning and neurotrophic factors in patients with chronic schizophrenia， so as to provide effective treatment regimens for these patients. MethodsA total of 86 patients with chronic schizophrenia attending the psychiatry department of the Third People's Hospital of Fuyang from March 2021 to March 2023 and fulfilling the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） were enrolled and grouped using random number table method， each with 43 cases. Aripiprazole group was given oral aripiprazole once daily at an initial dose of 5 mg for one week and then gradually increased to a maximum dose of 25 mg. Risperidone group received oral risperidone twice daily at an initial dose of 0.5 mg for one week and then gradually increased to a maximum dose of 3 mg. Treatment in both groups lasted 3 months. Before treatment and 3 months after treatment， Patients were required to complete Positive and Negative Symptom Scale （PANSS）， detection of both strong and weak PPIs in a startle modification passive attention paradigm， Wisconsin Card Sorting Test （WCST） and the measurement of neurotrophic factors at baseline and after treatment. The adverse reactions were recorded. Analysis of covariance was used to test the difference between the PANSS score， PPI， WCST and neurotrophic factor levels of the groups， with the pretest used as the covariate. Results3 months after treatment， no statistical difference was found in the scores of PANSS general psychopathology subscale， positive symptom subscale， negative symptom subscale and total score between two groups after treatment （F=0.621， 0.815， 0.743， 0.752， P>0.05）. There were no statistically significant differences between the two groups in PPI inhibition rate， single intense stimulus amplitude， single intense stimulus latency， prepulse inhibition amplitude， or prepulse inhibition latency （F=0.174， 0.001， 0.183， 0.171， 0.001， P>0.05）. There was no statistically significant difference in the total number of WCST tests between two groups （F=0.512， P>0.05）， whereas aripiprazole group reported significantly larger total numbers of categories completed and correct responses as well as smaller total numbers of random errors and perseverative errors compared to risperidone group （F=3.737， 4.621， 4.892， 5.130， P<0.05）. A significant increase in brain-derived neurotrophic factor （BDNF） and nerve growth factor （NGF） along with a reduction in glial fibrillary acidic protein （GFAP） were documented in risperidone group when compared to risperidone group （F=4.414， 3.781， 6.319， P<0.05）. No significant difference was demonstrated in the incidence of adverse reactions between the two groups （χ²=0.261， P>0.05）. ConclusionAripiprazole may be more beneficial than risperidone in improving cognitive functioning and neurotrophic factor levels in patients with chronic schizophrenia. ［Funded by Scientific Research Project of Fuyang Municipal Health Commission in 2021 （number， FY2021-147）］

Objective To evaluate the anticoagulation efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) in patients with high-risk atrial fibrillation (AF) undergoing transcatheter aortic valve implantation (TAVI). Methods A computer-based search was conducted on PubMed, EMbase, The Cochrane Library, CNKI, SinoMed, and VIP databases to identify studies on the application of NOACs and VKAs in high-risk AF patients after TAVI. The search period was from database inception to January 2023. The quality of the included studies was assessed using the Cochrane risk assessment tool and the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4 software. Results A total of 7 studies involving 24 592 patients were included. The meta-analysis results showed that compared to patients using VKAs, those treated with NOACs had a significantly lower risk of all-cause mortality [RR=0.74, 95%CI (0.58, 0.94), P=0.01]. Subgroup analysis indicated that when the follow-up period was less than 1 year, there was no significant difference in all-cause mortality between the NOAC and VKA groups [RR=0.57, 95%CI (0.17, 1.88), P=0.35]; however, when the follow-up period was ≥1 year, the VKA group had a higher all-cause mortality rate than the NOAC group, with a statistically significant difference [RR=0.73, 95%CI (0.57, 0.95), P=0.02]. No significant differences were found between the two groups regarding early stroke [RR=0.50, 95%CI (0.19, 1.28), P=0.15], stroke during follow-up [RR=1.04, 95%CI (0.88, 1.22), P=0.64], bleeding [RR=0.94, 95%CI (0.73, 1.21), P=0.61], major or life-threatening bleeding [RR=0.80, 95%CI (0.49, 1.31), P=0.38], or acute kidney injury [RR=0.51, 95%CI (0.16, 1.59), P=0.24]. Conclusion Compared to VKAs, the use of NOACs in patients with high-risk AF undergoing TAVI may reduce the risk of all-cause mortality, especially during long-term anticoagulation therapy, potentially offering greater benefits. However, further evidence from randomized controlled trials is needed to confirm these findings.

Objective:To design and develop a cone-beam CT imaging system for small animals with continuously adjustable spatial resolution.Methods:The imaging system used an X-ray source with a focal spot size of 30 μm and a flat panel detector with a pixel size of 100 μm. On this premise, a " stepping-focusing-rotating" image acquisition mode was proposed, in which the " focusing" and " stepping" systems were sequentially embedded in the " rotating" system. In this acquisition mode, the X-ray source and flat panel detector were relatively stationary to form the " focusing" system. When the " stepping" system accurately transported the object to the scanning position, the " focusing" system could achieve adjustable spatial resolution by making linear motion around the object to be scanned according to different experimental requirements. Finally the " rotating" system achieve high-quality imaging.Results:The variable spatial resolution of small animal CBCT ranges from 35.7 μm to 71.4 μm, and the FOV ranges from 39.6 mm to 108.0 mm. The conversion time for the limit spatial resolution is 19.125 s, which allowed accurate 3D reconstruction of normal mice at different resolutions with high reproducibility.Conclusions:A cone-beam CT suitable for small animals has been developed, whose spatial resolution and FOV can be adjusted arbitrarily within a certain range, which can meet the different imaging requirements in rodent experiments.

Objective:To design and develop a cone-beam CT imaging system for small animals with continuously adjustable spatial resolution.Methods:The imaging system used an X-ray source with a focal spot size of 30 μm and a flat panel detector with a pixel size of 100 μm. On this premise, a " stepping-focusing-rotating" image acquisition mode was proposed, in which the " focusing" and " stepping" systems were sequentially embedded in the " rotating" system. In this acquisition mode, the X-ray source and flat panel detector were relatively stationary to form the " focusing" system. When the " stepping" system accurately transported the object to the scanning position, the " focusing" system could achieve adjustable spatial resolution by making linear motion around the object to be scanned according to different experimental requirements. Finally the " rotating" system achieve high-quality imaging.Results:The variable spatial resolution of small animal CBCT ranges from 35.7 μm to 71.4 μm, and the FOV ranges from 39.6 mm to 108.0 mm. The conversion time for the limit spatial resolution is 19.125 s, which allowed accurate 3D reconstruction of normal mice at different resolutions with high reproducibility.Conclusions:A cone-beam CT suitable for small animals has been developed, whose spatial resolution and FOV can be adjusted arbitrarily within a certain range, which can meet the different imaging requirements in rodent experiments.

As technology advances, current evidence supports the use of devices for valvular heart disease interventions, including transcatheter aortic valve implantation, transcatheter mitral or tricuspid valve repair, and transcatheter mitral valve implantation. These procedures require antithrombotic therapy to prevent thromboembolic events during the perioperative period, and these therapies are associated with an increased risk of bleeding complications. To date, there are challenges and controversies regarding how to balance the risk of thrombosis and bleeding in these patients, and therefore the optimal antithrombotic regimen remains unclear. In this review, we summarize the current evidence for antithrombotic therapy after transcatheter intervention in patients with valvular heart disease and highlight the importance of an individualized approach in targeting these patients.

Enhanced recovery after surgery (ERAS) has been proven to reduce surgical injuries, promote recovery, and improve postoperative outcomes in different types of surgeries. A core principle of ERAS is to provide programmatic evidence-based perioperative interventions. An international multidisciplinary expert group provided a statement on clinical practice in each thematic area of ERAS by obtaining a list of potential ERAS elements, and reviewing literature. The version 2024 of "Perioperative care in cardiac surgery: A joint consensus statement by the Enhanced Recovery After Surgery (ERAS) Cardiac Society, ERAS International Society, and the Society of Thoracic Surgeons (STS)" is developed from the version 2019 of "Guidelines for perioperative care in cardiac surgery: Enhanced Recovery after Surgery Society recommendations". The consensus statement group was composed of multidisciplinary experts such as cardiac surgeons, anesthesiologists, intensive care physicians, and nurses, based on personal ERAS knowledge and experience. This article interprets the changes and new statements in the 2024 consensus, which can provide a foundation for the best perioperative practices for adult cardiac surgery patients.

Objective:To construct an evaluation model of safety efficiency of medical equipment in diagnosis and treatment on the basis of special management model of software-hardware-environment-liveware (SHEL),and to discuss its application value in improving the safety effectiveness of medical equipment in diagnosis and treatment of anesthesiology department. Methods:Based on the management system,equipment and facilities,diagnosis and treatment areas and medical personnel,a safety effectiveness evaluation model was constructed with four levels:management,operation,condition and operational efficiency. The geometric average method was used to calculate the index weight to comprehensively evaluate the safety efficacy of equipment in diagnosis and treatment. Special management measures,including standardized training,risk management,information upgrades,and preventive maintenance,were formulated for equipment management. A total of 115 medical equipment in clinical use in the Department of Anesthesiology of the No.2 Hospital of Baoding from 2020 to 2023 were selected. From January 2020 to December 2021,104 medical equipment were managed using the conventional management mode,and from January 2022 to December 2023,108 equipment were managed using the special management mode. The safety efficacy scores and safety management quality of the two management modes were compared,and the satisfaction of 12 doctors,18 nurses,5 technicians and 6 engineers with the clinical use of the two management modes were compared. Results:The average scores of management efficacy,running efficacy,conditional efficacy and operational efficacy of medical equipment in anesthesiology using a special management mode were (89.09±4.79) points,(91.08±4.21) points,(90.58±3.87) points and (92.25±3.36) points,respectively,all of which were higher than those of conventional management mode. The differences were statistically significant (Z=2.344,2.457,3.498,2.601,P<0.05). The average safety risk ratio of anesthesia equipment,monitoring equipment,first aid equipment,treatment equipment and other auxiliary equipment using special management mode were (1.45±0.69)％,(1.62±0.61)％,(1.15±0.39)％,(1.22±0.38)％ and (1.84±0.53)％,respectively. These ratios were all lower than those using the conventional management mode,and the differences were statistically significant (Z=2.686,3.149,3.236,3.640,3.323,P<0.05). The satisfactions of doctors,nurses,technicians and engineers with the clinical use of medical equipment in anesthesiology using the special management mode were (91.29±3.47) points,(92.34±2.28) points,(93.80±3.01) points and (90.07±3.73) points,respectively,all of which were higher than those using the conventional management mode. The differences were statistically significant (Z=2.207,2.705,2.554,3.069,P<0.05),respectively. Conclusion:The special management mode of evaluation model of safety efficiency of medical equipment in diagnosis and treatment under SHEL model can improve the safety efficiency of equipment in usage,and reduce safety risk of equipment operation,and improve the quality of equipment in clinical service.

Objective:To construct an evaluation model of safety efficiency of medical equipment in diagnosis and treatment on the basis of special management model of software-hardware-environment-liveware (SHEL),and to discuss its application value in improving the safety effectiveness of medical equipment in diagnosis and treatment of anesthesiology department. Methods:Based on the management system,equipment and facilities,diagnosis and treatment areas and medical personnel,a safety effectiveness evaluation model was constructed with four levels:management,operation,condition and operational efficiency. The geometric average method was used to calculate the index weight to comprehensively evaluate the safety efficacy of equipment in diagnosis and treatment. Special management measures,including standardized training,risk management,information upgrades,and preventive maintenance,were formulated for equipment management. A total of 115 medical equipment in clinical use in the Department of Anesthesiology of the No.2 Hospital of Baoding from 2020 to 2023 were selected. From January 2020 to December 2021,104 medical equipment were managed using the conventional management mode,and from January 2022 to December 2023,108 equipment were managed using the special management mode. The safety efficacy scores and safety management quality of the two management modes were compared,and the satisfaction of 12 doctors,18 nurses,5 technicians and 6 engineers with the clinical use of the two management modes were compared. Results:The average scores of management efficacy,running efficacy,conditional efficacy and operational efficacy of medical equipment in anesthesiology using a special management mode were (89.09±4.79) points,(91.08±4.21) points,(90.58±3.87) points and (92.25±3.36) points,respectively,all of which were higher than those of conventional management mode. The differences were statistically significant (Z=2.344,2.457,3.498,2.601,P<0.05). The average safety risk ratio of anesthesia equipment,monitoring equipment,first aid equipment,treatment equipment and other auxiliary equipment using special management mode were (1.45±0.69)％,(1.62±0.61)％,(1.15±0.39)％,(1.22±0.38)％ and (1.84±0.53)％,respectively. These ratios were all lower than those using the conventional management mode,and the differences were statistically significant (Z=2.686,3.149,3.236,3.640,3.323,P<0.05). The satisfactions of doctors,nurses,technicians and engineers with the clinical use of medical equipment in anesthesiology using the special management mode were (91.29±3.47) points,(92.34±2.28) points,(93.80±3.01) points and (90.07±3.73) points,respectively,all of which were higher than those using the conventional management mode. The differences were statistically significant (Z=2.207,2.705,2.554,3.069,P<0.05),respectively. Conclusion:The special management mode of evaluation model of safety efficiency of medical equipment in diagnosis and treatment under SHEL model can improve the safety efficiency of equipment in usage,and reduce safety risk of equipment operation,and improve the quality of equipment in clinical service.

Acute respiratory distress syndrome (ARDS) continues to be one of the most life-threatening conditions for patients in the intensive care unit (ICU). The 2023 European Society of Intensive Care Medicine guidelines on ARDS: definition, phenotyping and respiratory support strategies (2023 Guideline) update the 2017 An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with ARDS (2017 Guideline), including 7 aspects of 3 topics of definitions, phenotyping, and respiratory support strategies [including high flow nasal cannula oxygen (HFNO), non-invasive ventilation (NIV), neuromuscular blocking agents (NMBA), extracorporeal life support (ECLS), positive end-expiratory pressure (PEEP) with recruitment maneuvers (RM), tidal volume (VT), and prone positioning]. 2023 Guideline review and summarize the literature since the publication of the 2017 Guideline, covering ARDS and acute hypoxemic respiratory failure, as well as ARDS caused by novel coronavirus infection. Based on the most recent medical evidence, the 2023 Guideline provide clinicians with new ideas and approaches for nonpharmacologic respiratory support strategies for adults with ARDS. This article provides interpretation of the new concepts, the new approaches, the new recommended grading and new levels of evidence for ARDS in the 2023 Guideline.
Adult ; Humans ; COVID-19 ; Respiration, Artificial ; Positive-Pressure Respiration ; Respiratory Distress Syndrome/therapy* ; Noninvasive Ventilation

Objective To explore the impact of dexmedetomidine (Dex) on the apoptosis of rat hippocampal neurons induced by β-amyloid (Aβ) 1-42 via mitogen-activated protein kinase (MAPK)/signal transduction and transcriptional activators 3 (STAT3) pathway. Metuods The patients were randomly divided into sham operation group,Aβ1-42、Dex(Dex-L)、Dex(Dex-H)、Dex-H+Anisomycin、Dex-H+colivelin group.The experimental observation was carried out after different treatment of administration.Results In the Aβ1-42 group,the neuronal structure of the hippocampus of rats in the Aβ1-42 group was lost,the cell body morphology was abnormal,and the Aβ deposition was severe,the escape latency,the levels of inflammatory factors (IL-1β,IL-6,TNF-α),the number of apoptotic cells,the expressions of p-p38 MAPK/p38 MAPK,p-STAT3/STAT3,and cleaved caspase-3 were unusually higher than those in the sham operation group,the times of crossing the original platform and the expression of Bcl-2 were unusually lower (P<0.05);the above indicators could be reversed after intervention with different doses of Dex (P<0.05);MAPK pathway activators and STAT3 activators could alleviate the protective effect of Dex on AD rats (P<0.05). Conclusion Dex can reduce the levels of inflammatory factors and Aβ deposition to reduce cell damage and apoptosis,and protect rat hippocampal neurons,which may be related to the inhibition of MAPK/STAT3 pathway.