ObjectiveTo explore the common syndrome elements of cerebral ischemic stroke （CIS） complicated with obstructive sleep apnea-hypopnea syndrome （OSAHS）， reveal the characteristics of traditional Chinese medicine （TCM） syndromes of the disease， clarify the syndrome differentiation and syndrome types， provide evidence for clinical syndrome differentiation， and provide reference for establishing the TCM syndrome type standards of CIS complicated with OSAHS. MethodThe clinical information form of CIS complicated with OSAHS formulated by the research group was used for syndrome survey， and the four-examination information of 300 patients with CIS complicated with OSAHS was collected. The four-examination information of patients was analyzed by latent structure method and comprehensive cluster analysis， and the common syndrome elements of CIS complicated with OSAHS were extracted by combining the TCM basic theory and clinical experience. On this basis， the characteristics of TCM syndromes and the syndrome types in line with reality were summarized. ResultThe top five syndrome elements in patients with CIS and OSAHS are sleep snoring， open mouth breathing， physical obesity， night awakening and dizziness. The top five tongue and pulse manifestations are enlarged tongue， slippery pulse， slippery coating， thick and white coating and purple tongue. The disease locations are the lung， spleen， stomach， kidney， liver and brain. The nature of disease includes deficiency， depression， blood stasis， phlegm， dampness and fire. The clinical syndrome types include the syndrome of stagnation of phlegm and dampness， syndrome of phlegm-dampness blocking the mind， syndrome of spleen deficiency with dampness， syndrome of Yin deficiency leading to fire hyperactivity， syndrome of Qi depression blocking collaterals， syndrome of liver depression and blood stasis， syndrome of Qi deficiency with dampness， and syndrome of Yang deficiency induced water retention. ConclusionIn addition to the common phlegm-， dampness- and blood stasis-related syndromes in patients with CIS and OSAHS， there are also depression- and deficiency-related syndromes. The main etiology and pathogenesis is the disturbance of Qi movement. In clinical practice， attention should be paid to the specific situation of individual patients to differentiate between deficiency and excess， and the treatment should be performed by the method of soothing and reinforcing， or unblocking and clearing， or both.

The core of diagnosing and treating diseases in traditional Chinese medicine lies in syndrome differentiation. The eight principles of syndrome differentiation serve as guidance for syndrome differentiation. As one of the eight principles of syndrome differentiation， the differentiation of deficiency and excess is the basic and critical method. Ischemic stroke is currently the leading cause harming the health of Chinese residents. Although the hypotheses about the cause of ischemic stroke have evolved from external wind to the later internal wind and to the modern theory of toxin damaging the brain collaterals， they all believe that this disease is rooted in internal deficiency and external excess. According to available studies， although stroke is characterized by complex pathogenesis and rapid progression of syndromes， the key cause evolution has a regularity， that is， from excess to deficiency. This article analyzes the historical evolution of the etiology， pathogenesis， and syndrome differentiation schemes of stroke. There are diverse schemes for the syndrome differentiation of stroke， which make it difficult to choose in clinical practice. In view of this problem， this paper puts forward a new approach of staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess according to the evolution law of the key cause of stroke. Furthermore， we conducted a randomized controlled study on 100 patients with ischemic stroke to evaluate this new approach. The results showed that the staging sequential treatment of ischemic stroke based on the differentiation of deficiency and excess demonstrated definite clinical efficacy. In addition， this article reviews the previous research results of our team and the research achievements of other teams to preliminarily explore the relationship between stroke syndromes and biomarkers， aiming to provide an objective basis for unveiling the pathogenesis of stroke. In summary， according to the key cause evolution （from excess to deficiency）， the treatment of ischemic stroke by stages based on differentiation of deficiency and excess can facilitate the rapid intervention and improve the clinical efficacy on ischemic stroke.

Objective:To explore the influencing factors for hypoglycemia in elderly patients during peri-colonoscopy, construct and validate a risk prediction model.Methods:The factors influencing hypoglycemia in elderly patients during the peri-colonoscopy period were identified through a literature review and semi-structured interviews. After two rounds of Delphi expert consultation, the survey questionnaire was determined. From January to September 2023, convenience sampling was used to select elderly patients who underwent colonoscopy in the Department of Gastroenterology at the Affiliated Hospital of Qingdao University as participants for a questionnaire survey. Univariate and multivariate Logistic regression was used to explore the influencing factors of hypoglycemia in elderly patients during the peri-colonoscopy period, and a nomogram model of hypoglycemia risk in elderly patients during the peri-colonoscopy period was drawn. The area under the receiver operating characteristic curve ( AUC) of the subjects and the Hosmer-Lemeshow goodness of fit test were used to evaluate the model's predictive performance. The clinical decision curve of DCA was implemented to evaluate the model's clinical benefit ability. Results:A total of 558 questionnaires were distributed (392 for the modeling group and 166 for the validation group) and 558 valid questionnaires were collected, with a valid response rate of 100.00%. Among 558 elderly patients, a total of 130 cases (89 in the modeling group and 41 in the validation group) experienced hypoglycemia during the peri-colonoscopy period, with an incidence of 23.30%. Multivariate Logistic regression analysis showed that serum albumin, age, previous hypoglycemia frequency, insulin use, fasting time, and nutritional risk were independent influencing factors (all P<0.05). The AUCs of the modeling and validation groups were 0.933 and 0.899, respectively. Hosmer Lemeshow test showed that the model had good calibration accuracy, and the DCA curve indicated that the model had good clinical effectiveness. Conclusions:The nomogram model has good predictive performance and can intuitively and concisely predict the risk of hypoglycemia in elderly patients during the peri-colonoscopy period, providing reference for medical and nursing staff.

Peri-anesthetic dental trauma(PADT)occurs during anesthesia,which may obstruct eating,affect postoperative recovery and even mental health of patients.Natural aging decreases the stability of teeth and periodontal tissue.As the percentage of elderly sur-gical patients increases year by year,anesthesiologists are confronted with tricky situations during oral tracheal intubation frequently,which poses a new challenge for anesthesiologists.In recent years,dental protection has received increasing attention in perioperative medicine and many protective products have been introduced.This article reviews the causes of damage,treatment of the complications,protective measures and innovative evaluation in PADT,so as to assist clinical practice.

Objective To explore the regulatory effect and mechanism of Zhongfeng Xinglou Tongfu Capsule on the brain inflammatory response of mice with cerebral hemorrhage through cholecystokinin octapeptide(CCK-8)mediated the interleukin 10(IL-10)/signal transduction and transcriptional activator 3(STAT3)signaling pathway.Methods A total of 110 C57BL/6 mice were divided into sham operation group,cerebral hemorrhage group,Zhongfeng Xinglou Tongfu Capsule low-,medium-,and high-dose groups according to the random number table method,with 22 mice in each group.The intracerebral hemorrhage model was established by collagenase method.At 2 hours after the establishment of the model,Zhongfeng Xinglou Tongfu Capsule suspension was intragastrically administered at a dose of 10 mL·kg-1.The sham operation group and the cerebral hemorrhage group were intragastrically administered with the same dose of normal saline.The neurofunctional score and left-turn rate of the mice were recorded.The dry and wet weight method was used to detect brain water content on the 72 h after surgery,and the Western Blot method was used to detect tumor necrosis factor-α(TNF-α),interleukin 1β(IL-1β),interleukin 6(IL-6),interleukin 10(IL-10),and the relative expression levels of JAK-1,STAT3,and p-STAT3 pathway proteins around the hematoma of mice at 72 h after surgery.On the 3rd and 5th day after surgery,Elisa method was used to detect the relative expression level of CCK-8,qPCR method was used to detect the expression levels of IL-10 and STAT3 mRNA.Results Compared with the cerebral hemorrhage group,the NDS scores of mice in the low-,medium-,and high-dose groups of Zhongfeng Xinglou Tongfu Capsules were significantly reduced on the 3rd and 5th days after intervention treatment(P＜0.01).And the left-turn rate in the low-dose group on the 3rd and 5th days after intervention treatment was reduced(P＜0.05),the left-turn rate in the medium-dose group was reduced on the 3rd day(P＜0.05)and the 5th day(P＜0.01).Furthermore,the left-turn rate was obviously reduced on the 3rd and 5th day in the high-dose group(P＜0.01).The brain water content of mice in the low-dose group was reduced(P＜0.05),and the brain water content of mice in the medium-and high-dose groups was significantly reduced(P＜0.01).In the low-dose group,the expressions of pro-inflammatory factors TNF-α,IL-6 and JAK-1,STAT3,and p-STAT3 pathway proteins were significantly reduced(P＜0.01),while the expression of IL-1β was reduced(P＜0.05),the expression of IL-10 increased significantly(P＜0.01).The expression of pro-inflammatory factors TNF-α,IL-1β,IL-6,as well as JAK-1,STAT3,and p-STAT3 pathway proteins in the medium-and high-dose groups was significantly reduced(P＜0.01),the expression of anti-inflammatory factor IL-10 increased significantly(P＜0.01).The content of CCK-8 in the low-dose group was increased on the 3rd day after treatment(P＜0.05),and the content increased significantly on the 5th day(P＜0.01).The content of CCK-8 in the medium-and high-dose groups obviously increased on the 3rd and the 5th day after treatment(P＜0.01).The relative expression level of IL-10 mRNA was significantly increased after treatment(P＜0.01),but the relative expression level of STAT3 mRNA was significantly decreased after treatment(P＜0.01).Conclusion Zhongfeng Xinglou Tongfu Capsule can target the content of brain-gut peptide CCK-8 and regulate the IL-10/STAT3 signaling pathway to reduce the secondary inflammatory reaction and cytotoxic brain edema after cerebral hemorrhage.

Objective:To analyze and interpret the literature on intestinal preparation during colonoscopy in the elderly in China, and explore the research hotspots and development frontiers in this field, so as to provide theoretical reference for relevant institutions and researchers.Methods:Bibliometrics CiteSpace Ⅴ software was used to search CNKI, Wanfang Database, VIP, Chinese biomedical journal database, Chinese biomedical literature database from January 1, 2000 to April 30, 2022, and then statistical analysis was made on the number of published papers, distribution of institutions and regions, authors, journals, funding, and the maps of high-frequency keywords, clustering, and cooperation of authors, institutions and burst words were drawn.Results:A total of 281 literatures were included, and the characteristics of intestinal preparation, the effect of intestinal preparation for colonoscopy and nursing intervention of intestinal preparation for colonoscopy in the elderly were extracted as the research focus.Conclusions:The visualization analysis showed the research hotspots and trend of intestinal preparation during colonoscopy in the elderly. Intestinal preparation and comprehensive nursing intervention are still the focus of future research, and the cooperation among researchers and quality of published literature should be improved based on the research hotspots in the future.

During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results: A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.

Objective:To evaluate the application method and effect of standardized scenario simulation teaching based on Kirkpatrick model in vocational protection education for nursing students.Methods:A historical controlled trial study was designed. Practical nursing students enrolled in 2018-2019 and 2017-2018 were selected into the experimental group ( n=203) and control group ( n=196), respectively. The experimental group adopted standardized scenario simulation teaching in the prevention and control education of needlestick injuries, and the control group adopted traditional classroom lecture. Using the Kirkpatrick model, the teaching effect of needlestick injuries protection for nursing students were compared between the 2 groups from such 4 levels as in reaction level, learning level, behavior level and results level. Results:There was no significant difference in the baseline data between the two groups in terms of age, gender, educational background and test scores of nursing professional knowledge as compared to that before practice. In reaction level: the nursing students' satisfaction of experimental group in teaching methods ( t=25.149, P<0.001) and teaching environment ( t=12.827, P<0.001) are higher than that of the control group, with statistical significance. In learning level: the test scores of needlestick injury knowledge in experimental group were significantly higher than those in control group ( t=8.221, P<0.001). In behavior level: the level of needlestick injury protection behavior in the experimental group was significantly higher than that in the control group ( t=9.250, P<0.001), and the knowledge conversion rate in the experimental group was higher than that in the control group ( t=6.054, P<0.001). In results level: the needlestick injuries incidence of experimental group was significantly lower than that of the control group ( χ2=15.815, P<0.001), the reported rate of needlestick injuries of experimental group was significantly lower than that of the control group ( χ2=14.185, P<0.001). Conclusion:The implementation of standardized scenario simulation teaching can effectively improve the effectiveness of vocational protection learning and reduce the incidence of needlestick injuries.

Objective:To explore the real experience of "shadow" nurses acting as family members of hospitalized patients and provide references for improving patients' medical experience.Methods:From October to November 2019, a total of 19 "shadow" nurses from the the Affiliated Hospital of Qingdao University were given semi-structured interviews with the guidance of service quality gap model using the purposive sampling method and qualitative research. The phenomenological analysis method and Nvivo 11.0 Chinese software were applied to assist the data analysis.Results:The real experience of "shadow" nurses acting as family members of inpatients can be summarized into five thematic groups. Firstly, there was a gap between patients' and nurses' cognition of nursing service. Second, some current system standards could not meet the needs of patients. Third, nursing services didn't fully implement the established rules and systems. Fourth, there was a difference between patient perception and nursing services. The fifth theme was feelings and reflections.Conclusions:The "shadow" nurse experience activity can explore the medical experience and needs of inpatients, analyze the problems in nursing services and improve the medical experience of patients and meet their needs in a targeted manner.