Objective To investigate current management of external auditory canal irrigation among the nurses in otolaryngology in Guangdong Province,and to provide a reference for development and promotion of a standardised procedure.Methods From January to February in 2022,a total of 48 head nurses or nursing backbone in otolaryngology department of 48 hospitals from 21 major cities in Guangdong Province were selected by convenience sampling.A questionnaire proposed by Otolaryngology Nursing Committee of Guangdong Nursing Association was used to investigate the knowledge,operation procedure and training management in external auditory canal irrigation.Results A total of 48 head nurses or nursing backbone responded to the survey.The survey revealed that 34(70.8%)of the participants had mastered the knowledge of external auditory canal irrigation and 38(79.2%)of them had mastered the knowledge on the irrigation indications.In terms of operation procedure,syringe was applied as irrigator in 43(89.6%)hospitals,disposable irrigation needle was applied as flushing connector in 24(50.0%)hospitals,body surface temperature test of operator or patient was carried out in 24(50.0%)hospitals and adjusted flushing pressure was applied according to patients'feedback in 37(77.1%)hospitals.Regarding the training of external auditory canal irritation,35(72.9%)hospitals did not ask patients to sign an informed consent before,29(60.4%)hospitals required qualifications for operator and 45(93.7%)hospitals had the training programs.Conclusions The knowledge of external auditory canal irrigation of otolaryngology nurses in Guangdong province needs to be improved.The management of procedure and training of external auditory canal irrigation shall be standardised.It is suggested that the profession should draw up the external auditory canal irrigation standard,and all hospitals strengthen the management and training in order to promote the standardisation of specialised nursing together.

Objective To investigate the clinical efficacy and safety of 1 565 nm non-ablative fractional laser combined with topical minoxidil and oral finasteride in the treatment of patients with androgenetic alopecia(AGA).Methods Seventy-five male AGA patients with Norwood-Hamilton classification grade Ⅱ-Ⅲ,were randomly assigned into three groups:the control group 1,the control group 2 and the experimental group,with 25 cases in each group.Patients in the control group 1 received topical 5%minoxidil(1 mL,twice daily).Patients in the control group 2 were treated with both topical 5%minoxidil and oral finasteride(1 mg,once daily).Patients in the experimental group received a combined therapy of 1 565 nm non-ablative fractional laser in addition to topical 5%minoxidil and oral finasteride.Hair overall efficacy was evaluated using a 7-point rating scale after 24 weeks of treatment.Hair diameter and density were measured using a dermoscope.Patient satisfaction was assessed post-treatment,and adverse reactions were recorded.Results The overall efficacy of hair in the experimental group was superior to the control group 1 and the control group 2.There were no significant differences in hair density and hair diameter before treatment between the three groups(P＞0.05).After treatment,hair diameter and density increased in all three groups compared to baseline values(P＜0.05),and the hair diameter and hair density of the experimental group were higher than those of the control group 1 and the control group 2(P＜0.05).Patient satisfaction in the experimental group was higher than that in the control group 1 and the control group 2(P＜0.05).Patients in the experimental group experienced tolerable pain and burning sensations during laser treatment,and the symptoms were self-alleviated within a few hours.There were no serious adverse reactions reported in any group.Conclusion The combination therapy of 1 565 nm non-ablative fractional laser,5%minoxidil,and finasteride demonstrates significantly better efficacy in the treatment of AGA than minoxidil and finasteride alone drug therapy.

Objective:To summarize the best evidence for external auditory canal irrigation in patients with cerumen embolism.Methods:The clinical decisions, guidelines, systematic reviews, expert consensus, group standards, evidence summaries, and randomized controlled trials regarding external auditory canal irrigation in patients with cerumen embolism were retrieved from databases and websites such as BMJ Best Practice, UpToDate, Guidelines International Network, National Institute for Health and Clinical Excellence, Joanna Briggs Institute Evidence-Based Health Care Center Database, PubMed, Embase, China National Knowledge Infrastructure, WanFang data, and China Biology Medicine disc. The search period was from database establishment to February 15, 2023. Six researchers screened the literature, evaluated the methodological quality, and extracted and summarized the best evidence for external auditory canal irrigation in patients with cerumen embolism.Results:A total of nine articles were included, including one clinical decision, two guidelines, two systematic reviews, one group standard, and three randomized controlled trials. Sixteen pieces of evidence were summarized from six aspects of operators: pre-operation evaluation and preparation, operation process, post-operation handling, health education, and adverse reactions during operation.Conclusions:This paper summarizes the best evidence for external auditory canal irrigation in patients with cerumen embolism. Medical and nursing staff should carefully select and apply evidence based on clinical scenarios and patient's wishes.

Objective:To investigate the current situation of insomnia in patients with acute coronary syndrome (ACS), and analyze the influencing factors of insomnia in the ACS patients, so as to provide information on the development of new strategies for the treatment of insomnia in ACS patients.Methods:This is a multicenter and prospective observational study. A total of 771 ACS patients who met the criteria were selected from March 2013 to June 2015. The baseline social demographic information, sleep quality questionnaire, general anxiety disorder scale-7(GAD-7),patient health questionnaire-9(PHQ-9), short-form 12 health survey questionnaire(SF-12), and enhancing recovery in coronary heart disease patients social inventory(ESSI) were completed within 7 days after admission. Logistic regression analyses were used to analyze the influencing factors of insomnia in ACS patients.Results:A total of 741 subjects with valid questionnaires were collected, including 510 males (68.8%) and 231 females (31.2%). Among them, 487 (65.7%) subjects had at least one insomnia symptom: 308 (41.6%) subjects had difficulty in falling asleep, 369 (49.8%) subjects were easy to wake at night, 116 (15.7%) subjects woke up earlier than they expected, 74 (10.0%) subjects experienced both woke up earlier and difficulty in falling asleep, and 53 (7.2%) subjects woke up earlier, woke up at night and had difficulty in falling asleep at the same time. Logistic regression analyses showed that before admission physical activity ( OR =0.636, 95% CI 0.411-0.984), depression ( OR=1.908, 95% CI 1.101-3.305) and low social support ( OR=0.278, 95% CI 1.198-3.301) were independent factors of insomnia in ACS patients. Conclusions:Nearly 2/3 ACS patients have symptoms of insomnia. Difficulty in falling asleep and easy to wake up at night are the most common manifestations. Physical activity, depression and social support independently are associated with insomnia.

Objective:To form the consensus of nursing experts in accelerated rehabilitation surgery in perioperative period of chronic rhinosinusitis in order to promote the standardized development of accelerated rehabilitation surgery nursing in perioperative period of chronic rhinosinusitis in China.Methods:By consulting the literature evidence and combining with the clinical practice experience, the consensus draft was formed by more than 5 nurses in charge of nursing. According to the Grading of Recommendations Assessment, Development and Evaluation System, (GRADE), the evidence quality and recommendation grade of each item were evaluated.Results:The consensus covered 4 aspects of pre-hospital care guidance, including preoperative care, postoperative care, and discharge care for chronic rhinosinusitis, with a total of 12 items, including health education, individualized treatment guidance, network platform use, adaptive training, diet management, activity guidance, pain management, and discharge follow-up.Conclusions:The content of this consensus covers all aspects of accelerated rehabilitation surgery nursing during perioperative period of chronic rhinosinusitis, which is scientific, rigorous and authoritative, and can provide reference and guidance for accelerated rehabilitation surgery nursing in the perioperative period of chronic rhinosinusitis.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective? ?To?analyze?the?risk?factors?of?delirium?in?patients?in?cardiac?surgery?intensive?care?unit?(CSICU).? Methods? A?prospective?observational?study?was?performed.?Patients?admitted?to?CSICU?of?Fujian?Medical?University?Union?Hospital?from?March?to?August?in?2017?were?enrolled.?The?combination?of?the?Richmond?agitation?sedation?scale?(RASS)?and?the?ICU-confusion?assessment?method?(CAM-ICU)?were?used?to?evaluate?delirium.?The?patient?was?assessed?on?the?second?day?after?CSICU?admission,?twice?a?day,?the?evaluation?was?stopped,?and?the?follow-up??observation?was?terminated?after?the?patient?was?discharged?from?CSICU.?The?patients?were?divided?into?two?groups?according?to?whether?delirium?occurred?in?CSICU.?The?general?and?clinical?treatment?data?(including?condition,?operation,?anesthesia?and?CSICU?treatment)?of?the?two?groups?were?compared.?The?related?factors?of?delirium?were?identified?by?univariate?analysis?and?multifactor?Logistic?regression?analysis.? Results? A?total?of?318?cases?were?included?in?this?study.?Among?them,?93?cases?had?delirium?and?the?incidence?of?delirium?was?29.2%.?It?was?shown?by?univariate?analysis?that?age,?history?of?hypertension,?type?of?surgery,?surgical?procedure,?American?Society?of?Anesthesiologists?(ASA)?anesthesia?classification,?usage?of?propofol,?plasma?transfusion,?red?blood?cells,?platelet?transfusion,?blood?loss,?operative?time,?cardiopulmonary?bypass?(CPB)?time,?myocardial?block?time,?acute?physiology?and?chronic?health?evaluation?Ⅱ?(APACHEⅡ),?duration?of?mechanical?ventilation,?the?length?of?intensive?care?unit?(ICU)?stay,?postoperative?usage?of?diazepam,?midazolam,?fentanyl,?morphine,?chlorpromazine,?etc.?which?were?related?to?delirium,?and?occupation?? (on-the-job?or?self-employed),?medical?insurance?(city?or?provincial?medical?insurance),?education?(primary?to?junior?high?school,?high?school?or?above)?could?reduce?the?risk?of?delirium.?Colinearity?diagnosis?was?performed?on?variables?with?statistically?significant?differences,?and?variables?with?variance?expansion?factor?(VIF)?

Objective To translate the English vcrsion of Intensive Care Unit Environment Stressor Questionnaire (ESQ) into Chinese,and test the reliability and validity of the Chinese version of Intensive Care Unit Environment Stressor Questionnaire (ESQ-C).Methods The ESQ-C was translated from the ESQ and back-translated,Delphi tcchnique was used to conduct cultural adaption.The reliability and validity of ESQ-C were tested in 313 cardiac surgery ICU patients.Results The ESQ-C contained 42 items.Eight factors that explained 51.803％ of the variance were extracted after exploratory factor analysis.The Cronbach's α coefficient of the questionnaire was 0.851,the odd-even split-half reliability was 0.888.Conclusion ESQ-C was proved to be valid and reliable.It's a valuablc tool to assess the environment stressors of ICU patients in China.

Aim To establish depression rat model with kidney-yang deficiency and evaluate the related parameters.Methods A total of 24 adult SD rats were divided into control group,mod-el group and self-healing group by body weight.Model group and self-healing group were injected hydrocortisone for 21 days, meanwhile the control group was injected sodium chloride.After modeling,the related indexs detection were taken out:open-field test,sucrose preference test and forced swim test.Then the orbital blood was taken to detect 5-HT,DA and NE by LC-MS/MS.And liver,kidney,spleen,thymus,adrenal gland,testis and epididymis were taken to calculate organ index.Results Compared with the control group,model rats displayed depres-sion and kidney yang deficiency syndrome such as dry hairs, chills,back arched and so on. Correspondingly, the body weight increased slowly.Immobility in FST was significantly in-creased. Sucrose preference, horizontal scores and vertical scores was significantly decreased.Organ index decreased in liv-er,kidney,spleen,adrenal,testis and epididymis.The level of 5-HT and NE was significantly high.Compared with the model group,5-HT,NE and DA were significantly reduced,5-HT and DA were even lower than those of the control group.Conclusion Depression rat model with kidney-yang deficiency could be in-duced by continuous injection of hydrocortisone.

Objective Based on the previous research that the ethanolic extract from traditional Chinese medicine fructus forsythiae (Lianqiao) can obviously inhibit cancer cells in vitro, the article aimed to investigate the anti-proliferation effects of dammar-24-ene-3β-acetate-20S-ol (DM) extracted from fructus forsythiae on gastric cancer cells and its mechanism.Methods MTT assay was used to assess the anti-proliferation effects of DM on gastric cancer cells including SGC-7901, BGC-823, and MKN-45 in vitro.There were MKN-45 control group and its low dose and high dose groups, BGC-823 control group and its low dose and high dose groups, SGC-7901 control group and its low dose and high dose groups in the experiment.Flow cytometry was used to analyze the cell apoptosis rate.Cellquest software was used to analyze the results and record the ratio of cells at different cycles.DCFH-DA probe was applied to detect the ROS levels of blank control group, docetaxol group and DM group.The reaction system of microtubule assembly test was set with 10?mol/L docetaxol, 50 or 100 μmol/L DM final density and no medicine in blank control group.The readings of UV spectrophotometer were recorded.Microtubule assembly assay and microtubule immunofluorescence staining were applied to investigate the effects of DM on microtubule system.Results The inhibition ratio of 50 μg/L DM on the proliferation three gastric cell lines were all above 80%, with IC50s of MKN-45 11.72±1.35 μg/mL, BGC-823 17.19±0.82 μg/mL, SGC-7901 7.55±0.79 μg/mL.8 days′ low density culturing at 48 hours after 2 μg/mL DM treatment, compared with control group, the number of cell clones significantly reduced without much change in clone size, while 48 hours after 10 μg/mL DM treatment, besides a few clones of BGC-823, there were just several megascopic clones of SGC-7901 and MKN-45.In comparison with apoptotic cell ratio in MKN-45 control group[(21.1±2.5)%], its low dose group and high dose group resulted in significant rise of apoptotic cell ratio[(25.1±1.3)% and (55.2±2.3)%] (P<0.01).Compared with apoptotic cell ratio in BGC-823 control group[(13.2±2.5)%], its low dose group and high dose group resulted in significant rise of apoptotic cell ratio[(18.2±2.1)% and (41.8±2.1)%] (P<0.01).Compared with apoptotic cell ratio in SGC-7901 control group[(10.5±1.8)%], significant rise was observed in its high dose group[(41.8±2.1)%] (P<0.05) while no statistical significance was found in its low dose group[(12.3±1.6)%] (P>0.05).In comparison with MKN-45 control group, the ratio of cells at S phase decreased in its low dose group[(14.5±2.7)% vs (12.3±3.3)%,P>0.05].In comparison with BGC-823 control group, the ratio of cells at S phase increased in its low dose group[(12.2±5.4)% vs (20.2±2.1)%,P<0.05].In comparison with SGC-7901 control group, the ratio of cells at S phase increased in its low dose group[(21.5±3.8)% vs (31.3±2.6)%,P<0.05].From the detection of intracellular active oxygen after DM treatment, dose-dependent ROS level increased in all three cell lines 48 hours after 10μg/mL and 50μg/mL DM treatment.From the results of microtubule immunofluorescence staining, 48 hours after the treatment of IC50 docetaxol and 10μg/mL DM, the fluorescence signals were in local concentration and disorder.Conclusion Dammar-24-ene-3β-acetate-20S-ol demonstrated anti-proliferation effects due to the apoptosis induced by cell cycle arrest at S phase.