Objective To systematically evaluate the application effect of virtual reality exposure in children undergoing surgeiy,providing guidance for clinical practice.Methods A systematic search of PubMed,Web of Science,Cochrane Library,Embase,CNKI,VIP,WanFang Data and CBM was conducted for randomised controlled trials on the effects of virtual reality exposure in children undergoing surgeiy.The search time was limited to March 21,2024.There were 2 researchers who independently screened the literature,extracted data and evaluated quality.Meta-analysis was performed using RevMan 5.4 software.Results A total of 9 studies with 900 children were included.The results of Meta-analysis showed that the level of preoperative anxiety in the experimental group was lower than that in the control group,and the difference was statistically significant[SMD=-0.65,95％CI(-0.95,-0.35),P＜0.001].The caregiver satisfaction in the experimental group was higher than that in the control group,and the difference was statistically significant[SMD=0.40,95％CI(0.10,0.70),P=0.010].However,there was no statistically significant difference when comparing the level of postoperative pain between the 2 groups[SMD=-1.16,95％CI(-2.83,0.51),P=0.180].Subgroup analyses showed that the preoperative anxiety levels of the children were lower when the intervention was performed with gamified interactive virtual reality videos compared with ordinary virtual reality videos and ordinary interactive virtual reality videos[SMD=-0.96,95％CI(-1.36,-0.56),P＜0.001].Compared with ≤4 min,children had lower levels of preoperative anxiety when the length of the intervention was 5 mnin[SSMD=-0.96,95％CI(-1.36,-0.56),P＜0.001].Conclusion The implementation of virtual reality exposure was effective in relieving preoperative anxiety and improving caregiver satisfaction,but further research is needed to investigate the effect on the children's postoperative pain levels.

Objective To systematically evaluate the application effect of virtual reality exposure in children undergoing surgeiy,providing guidance for clinical practice.Methods A systematic search of PubMed,Web of Science,Cochrane Library,Embase,CNKI,VIP,WanFang Data and CBM was conducted for randomised controlled trials on the effects of virtual reality exposure in children undergoing surgeiy.The search time was limited to March 21,2024.There were 2 researchers who independently screened the literature,extracted data and evaluated quality.Meta-analysis was performed using RevMan 5.4 software.Results A total of 9 studies with 900 children were included.The results of Meta-analysis showed that the level of preoperative anxiety in the experimental group was lower than that in the control group,and the difference was statistically significant[SMD=-0.65,95％CI(-0.95,-0.35),P＜0.001].The caregiver satisfaction in the experimental group was higher than that in the control group,and the difference was statistically significant[SMD=0.40,95％CI(0.10,0.70),P=0.010].However,there was no statistically significant difference when comparing the level of postoperative pain between the 2 groups[SMD=-1.16,95％CI(-2.83,0.51),P=0.180].Subgroup analyses showed that the preoperative anxiety levels of the children were lower when the intervention was performed with gamified interactive virtual reality videos compared with ordinary virtual reality videos and ordinary interactive virtual reality videos[SMD=-0.96,95％CI(-1.36,-0.56),P＜0.001].Compared with ≤4 min,children had lower levels of preoperative anxiety when the length of the intervention was 5 mnin[SSMD=-0.96,95％CI(-1.36,-0.56),P＜0.001].Conclusion The implementation of virtual reality exposure was effective in relieving preoperative anxiety and improving caregiver satisfaction,but further research is needed to investigate the effect on the children's postoperative pain levels.

Objective:To investigate the clinical features and prognostic influencing factors of toxic epidermal necrolysis (TEN).Methods:A retrospective observational study was conducted. From January 2008 to March 2019, a total of 46 TEN patients who met the inclusion criteria were admitted to Guangdong Provincial People's Hospital. The gender, age, and hospital admission diagnosis of the 46 patients, the category of department admitted of patients complicated with sepsis, death ratio of the sepsis patients with or without treatment history in intensive care unit (ICU)/department of burns and wound repair, and the cause of death of the deceased patients were recorded. Depending on whether complicated with sepsis, the patients were divided into sepsis group (32 cases) and non-sepsis group (14 cases). According to whether died or not, the patients were divided into death group (9 cases) and survival group (37 cases). The specific conditions of suspected pathogenic agents and combined underlying diseases, the abnormality of transaminase/bilirubin, creatinine, and platelet count in blood on admission, and the detection of pathogenic microorganisms and drug resistance during the course of disease of patients were recorded in both sepsis group and non-sepsis group. The gender, age, lesion area, severity of illness score for TEN (SCORTEN) system score, combined underlying diseases on admission, and blood microbial culture positivity, hormone use, and gamma globulin use during the course of disease of patients between sepsis group and non-sepsis group, death group and survival group were compared respectively. Data were statistically analyzed with chi-square test, Fisher's exact probability test, and Mann-Whitney U test. The factors with statistically significant differences between sepsis group and non-sepsis group, death group and survival group were selected for binary multivariate logistic regression analysis, so as to screen the independent risk factors affecting sepsis and death in TEN patients. Results:Of the 46 TEN patients, 30 were male and 16 were female, aged from 8 months to 92.0 years, with 11 cases (23.91%) of epidermolysis bullosa, 9 cases (19.57%) of exfoliative dermatitis, 9 cases (19.57%) of TEN, 7 cases (15.22%) of epidermolysis bullosa, 6 cases (13.04%) of Stevens-Johnson syndrome, and 4 cases (8.70%) of severe drug rash for hospital admission diagnosis. The patients complicated with sepsis were admitted to 11 departments, and the death ratio of patients with treatment history in ICU/department of burns and wound repair was similar to that of patients without such department treatment history ( P>0.05). All the deceased patients were complicated with sepsis, which was also the main cause of death. On admission, the suspected pathogenic agents of patients in sepsis group were mainly allopurinol (8 cases) and non-steroidal anti-inflammatory drugs (4 cases), while those in non-sepsis group were allopurinol (3 cases) and psychotropic drugs (3 cases). Patients in sepsis group combined as many as 10 underlying diseases, while those in non-sepsis group combined only 4 underlying diseases. The proportions of patients with increased creatinine ( χ2=13.349, P<0.01) and decreased platelet count ( P<0.01) in sepsis group were significantly higher than those in non-sepsis group, while the transaminase/bilirubin abnormality was similar to that in non-sepsis group ( P>0.05). A wide variety of pathogens were detected in the blood, respiratory tract secretions, and skin secretions of 21 patients in sepsis group, and 14 patients were infected with drug-resistant bacteria; among the 9 strains cultured from the blood samples, 8 were drug-resistant bacteria and 6 were Gram-positive bacteria. In non-sepsis group, pathogens were detected in blood, respiratory tract secretions, and skin secretions of 8 patients, with fewer species, and 6 patients were infected with drug-resistant bacteria. The gender, age, lesion area, blood microbial culture positivity, hormone use, and gamma globulin use of patients in sepsis group were similar to those in non-sepsis group ( P>0.05). The proportion of patients combined with underlying diseases ( χ2=4.493, P<0.05) and the proportion of patients with SCORTEN system score of 4-6 points ( P<0.01) of patients in sepsis group were significantly higher than those in non-sepsis group. The gender, combined underlying diseases, lesion area, blood microbial culture positivity, hormone use, and gamma globulin use of patients were similar between survival group and death group ( P>0.05). The proportion of patients with age≥60 years and the proportion of patients with SCORTEN system score of 4-6 points of patients in death group were significantly higher than those in survival group ( χ2=4.412, 11.627, P<0.05 or P<0.01). The SCORTEN system score was an independent risk factor affecting sepsis and death in TEN patients (odds ratio=3.025, 2.757, 95% confidence interval=1.352-6.769, 1.244-6.110, P<0.05 or P<0.01). Conclusions:The diagnosis of TEN is difficult on admission. Male population is susceptible to TEN, and allopurinol is the common pathogenic agent. The proportion of patients combined with underlying diseases is high in TEN patients complicated with sepsis, with mainly drug-resistant bacteria and mostly Gram-positive bacteria in blood-borne infections. The deceased patients are older than the survived, and the main cause of death is sepsis. The SCORTEN system score is an independent risk factor affecting sepsis and death in TEN patients.

Objective Evaluating the effect of Shugan-Jieyu capsule combined with pramipexole on depressive symptoms in parkinson's disease(PD) patients.MethodsAccording to the criteria of including and excluding, we collected 63 PD depression cases who visited doctors at neurological outpatient room between June 2014 and April 2016.35 cases only treated with pramipexole, designed as pramipexole group, and 28 cases treated with pramipexole and Shugan-Jieyu capsule, designed as combined treatment group.The Hamilton depression scale(HAMD), activities of daily living scale(ADL) and unified Parkinson's disease rating scale-part III(UPDRS-III) were assessed at baseling, week 6 and week 9.ResultsAt week 9, HAMD was (17.71±6.78) in pramipexole group versus (14.32±4.81) in combined treatment group, there was significant difference between the two groups(P=0.029), As for HAMDΔ9, analysis did show a significant difference(pramipexole group (-11.06±3.27) vs combined group (-14.93±6.24);P=0.002).Analysis showed a significant difference as for ADLΔ6(pramipexole group (-2.37±1.31) vs combined group (-3.57±2.04);P=0.006) at week 6.There was no significant difference between groups for the reduction in total UPDRS-III scale.No serious adverse event was recorded during treatment of depression.ConclusionShugan-Jieyu capsule combined with pramipexole did have significant effects versus pramipexole on depressive symptoms in PD patients.

Adolescent ; Adult ; Child ; Deubiquitinating Enzyme CYLD ; Female ; Humans ; Male ; Neoplastic Syndromes, Hereditary ; genetics ; Pedigree ; Skin Neoplasms ; genetics ; Tumor Suppressor Proteins ; genetics ; Young Adult

Objective To observe the effect of Shenfu injection on fluid intake volume of resuscitation therapy for patients with septic shock. Methods The clinic data of 36 patients with septic shock admitted to Department of Critical Care Medicine of the Affiliated Hospital of Hangzhou Normal University from June 2010 to June 2013 were retrospectively analyzed. All the patients were treated with western conventional medicine. Twenty cases treated with western medicine combined with Shenfu injection (intravenous drip 100 mL once daily, half of a month was a therapeutic course) were defined as Shenfu group; the rest 16 cases treated with western medicine only were assigned as control group. The following data after treatment for 6, 24, and 72 hours in the two groups were compared:liquid intake and urine volumes, system vascular resistance index (SVRI), mean arterial pressure (MAP), cardiac index (CI), and case fatality rate in 28 days. Results There were no significant differences in the liquid intake volume in 6 hours after treatment (mL:3 101±219 vs. 3 329±295, P>0.05), the urine volumes in 6, 24 and 72 hours after treatment (mL, 6 hours:701±229 vs. 651±292, 24 hours:1 870±566 vs. 1 697±618, 72 hours:7 396±2 546 vs. 5 987±2 497), and the levels of SVRI in 24 hours after treatment between Shenfu group and control group (kPa·s·L-1·m-2:802±158 vs. 741±106, all P>0.05). The total liquid intake volumes (mL) in 24 hours and 72 hours after treatment in Shenfu group were significantly less than those in the control group (24 hours:4 544±425 vs. 4 996±396, 72 hours:10 985±891 vs. 11 612±807, both P<0.05). The SVRI, MAP, and CI in 72 hours of Shenfu group were significantly higher than those of control group [SVRI (kPa·s·L-1·m-2): 1 361±182 vs. 1 163±183, MAP (mmHg, 1 mmHg = 0.133 kPa): 76.2±6.1 vs. 71.8±6.3, CI (mL·s-1·m-2):76.2±7.5 vs. 70.8±7.2, all P<0.05], and the 28-day mortality rate in Shenfu group was significantly lower than that of control group [25.0%(5/20) vs. 62.5%(10/16), P<0.05]. Conclusion The application of Shenfu injection was favorable to the reduction of liquid intake volume in 72 hours after treatment that may be beneficial to the fluid limitation management in the course of treatment for septic shock.

Objective To report on the clinical presentations of patients with colonic angiodysplasia and the results of electrocoagulation under the guide of colonoscopy. Methods Study on the clinical and endoscopic manifestation of patient with colonic angiodysplasia and follow-up study for the risk of bleeding in asymptomatic AD and in those after electrocoagulation. Results Totally 10 200 cases were involved in colonoscopy, among them 126(1. 24%) cases of CAD were found. Prevalence rate in asymptomatic group was 0. 89%, in bleeding group 2. 62%, and in nonbleeding group 0. 82%. In 9 asymptomatic AD cases no bleeding occurred in a period of 3-year follow-up. However, most of the bleeding AD patients have bleeding relapsed within 3 years. The curative effect of electrocoagulation during 1 year is significant the relapse rate of bleeding, 18% as compared to 54% in patients with bleeding without electrocoagilation P