Objective:To analyze the effectiveness of multi-layer silicone foam dressing in preventing pressure injury of sacrococcygeal and heel by systematic evaluation.Methods:Randomized controlled studies on the effectiveness of multi-layer silicone foam dressings in preventing stress injury of sacrococcygeal and heel of hospitalized patients in CNKI, Wanfang, VIP, CBM, PubMed, Embase, The Cochrane Library and Web of Science were systematically reviewed. The retrieval time was from January 2012 to January 2023, and the Meta were screened and extracted by two researchers respectively. After evaluating the bias risk of the included studies, they were conducted by RevMan 5.4 software.Results:Eight randomized controlled studies involving 4 725 patients were included. Meta-analysis showed that multilayer silicone foam dressing could reduce the incidence of sacrococcygeal stage I pressure injury ( RR=0.18, 95% CI 0.09-0.35, P<0.01), and reduce the incidence of the first-stage heel pressure injury ( RR=0.29, 95% CI 0.13-0.66, P<0.05). It could reduce the incidence of sacrococcygeal stage Ⅱ and more serious pressure injury ( RR=0.42, 95% CI 0.31-0.58, P<0.01), but the influence on the incidence of the second-stage heel pressure injury and more serious heel pressure injury was not clear ( RR=0.52, 95% CI 0.27-0.99, P=0.05) Conclusions:Multi-layer silicone foam dressing can effectively reduce the incidence of sacrococcygeal pressure injury and reduce the incidence of first-stage pressure injury in heel, but the impact on the incidence of second-stage and more serious pressure injury in heel is still unclear.

Objective To explore the effects and mechanism of Baitouweng Decoction in intestinal mucosal healing in mice with ulcerative colitis(UC)based on RIPK1/RIPK3/MLKL signaling pathway.Methods Totally 30 C57BL/6 male mice were randomly divided into control group,model group,Baitouweng Decoction group,infliximab group and combination group(Baitouweng Decoction+infliximab),with 6 mice in each group.A mouse model of UC was established by free administration of 3.5%sodium gluconate sulfate solution for 7 days.After modeling,Baitouweng Decoction group was given 8 g/kg Baitouweng Decoction solution by gavage daily,while the infliximab group was given 5 mg/kg infliximab intraperitoneal injection,the combination group was given synchronous gastric and intraperitoneal injection,while the control group and model group were given equal volume of normal saline by gavage for 7 consecutive days.The body mass of mice was recorded daily,fecal characteristics were observed,and disease activity index(DAI)score was performed,colon length was measured after intervention,ELISA was used to detect the contents of serum interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α),RT-qPCR was used to detect mRNA expressions of RIPK1,RIPK3 and MLKL in colon tissue,Western blot and immunofluorescence staining were used to detect the expressions of RIPK1,RIPK3 and MLKL protein in colon tissue.Results Compared with the control group,the model group mice showed a decrease in body mass(P<0.01),an increase in DAI score(P<0.01),a shortened colon length(P<0.01),and an increase in serum IL-6 and TNF-α content(P<0.01);colonic mucosal was destructed,with disappearance of crypts and glandular structures,extensive infiltration of inflammatory cells,and increased pathological score of colon tissue(P<0.01);the mRNA and protein expressions of RIPK1,RIPK3 and MLKL in colon tissue increased(P<0.01,P<0.05).Compared with the model group,the body mass of mice in each treatment group increased(P<0.01),and the DAI score decreased(P<0.01),colon length increased(P<0.01),and the contents of serum IL-6 and TNF-α decreased(P<0.05,P<0.01);the destruction of the colonic mucosal barrier was reduced,the pathological score of colon tissue was reduced(P<0.05);the expressions of RIPK1,RIPK3 and MLKL mRNA and protein in colon tissue decreased(P<0.05,P<0.01).Conclusion Baitouweng Decoction can alleviate intestinal mucosal damage and inflammation in UC mice,and its mechanism may be related to the inhibition of the RIPK1/RIPK3/MLKL signaling pathway.

The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
Humans ; Consensus ; Prone Position ; Wakefulness ; China ; Dyspnea

Objective: To explore the commonalities and differences between primary school students and teachers in beliefs of myopia prevention and control, in order to provide a theoretical basis for the education programs of myopia prevention and control. Methods: Convenient sampling method was used to select 14 students and 16 teachers from grades 3 and 4 in two elementary schools in Hangzhou for one to one in depth interviews, and the results were coded and analyzed by using Nvivo 11.0 software. Results: There were commonalities in the perceived severity, benefits and barriers of myopia prevention and control beliefs among students and teachers, and the common keywords had been mentioned for 114 times, the commonalities of perceived severity, benefits and barriers were more obvious among them; there were differences in the specific attributions of perceived susceptibility, severity and barriers among students and teachers，the difference keywords had been mentioned for 63 times, the differences of perceived susceptibility, severity and barriers were more obvious among them. Conclusion There were commonalities in the perceived susceptibility, severity, benefits and barriers of myopia prevention and control beliefs between students and teachers; there were differences in the aspects of perceived susceptibility, severity and barriers between students and teachers. Adverse health outcomes of myopia and associated prevention knowledge should be enhanced among students. schools should carry out health education activities to improve the ability of teachers and students to prevent and control myopia; the government should implement the "double reduction" policy and improve the safety insurance system for outdoor activities.

Objective: To study the clinicopathologic features of intraductal papillary neoplasm of the bile duct(IPNB) and to analyze the diagnostic and therapeutic patterns. Methods: The data of 46 patients with IPNB undergoing surgery in Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to November 2017 were retrospectively analyzed.There were 23 males and 23 females with age of (64±8)years.Patients were followed up by clinics and telephone inquiry.Categorical data were compared with χ² test or Fisher′s exact test. Results: Abdominal pain(in 31 patients), fever (in 15 patients) and jaundice (in 11 patients) were the most common symptoms.Twenty-five patients were accompanied with cholangiolithiasis and 25 were accompanied with liver atrophy.Preoperative laboratory examination was mainly manifested as the abnormal liver function caused by biliary obstruction.Typical imaging findings included bile duct dilation (in 45 patients) and mass within bile duct (in 22 patients). All the patients were diagnosed as IPNB histopathologically.Among them, high-grade intraepithelial neoplasia and related adenocarcinoma were more common in mucus-hypersecretion IPNB ((13/15 vs. 51.6%(16/31))(χ²=5.331, P=0.021). Hepatectomy was performed in 25 patients, hepatectomy combined with biliary resection and reconstruction in 12 cases, biliary resection and reconstruction in 3 cases, pancreatoduodenectomy in 3 cases, hepatopancreaticoduodenectomy in 1 case, liver transplantation in 1 case and radiofrequency ablation in 1 case.Forty-one patients were followed up with a median of 30 (12, 41) months.Seven patients suffered recurrence and 6 died. Conclusion IPNB is a rare disease with limited knowledge currently.Images are the main diagnositc means and surgery is the first choice.

Objective:To investigate the improvement effects of duodenal-jejunal bypass (DJB)on the blood glucose homeostasis,insulin resistance and inflammation of the obese type 2 diabetic (T2DM)ZDF rats,and to discuss its possible mechanism.Methods:A total of 20 ZDF rats were randomly divided into DJB operation group and sham operation group (n = 10).There were 8 rats survived in each group after operation.The level of blood glucose (FBG)was detected by Roche glucose meter at 1 week before operation,2 weeks,4 weeks and 6 weeks after operation;the fasting serum insulin level of the rats was measured by ELISA kit;the insulin sensitivity index (HOMA-ISI)and insulin resistance index (HOMA-IR)were calculated.The rats were executed 6 weeks after operation.HE staining was used to observe the morphology of the inflammatory cells in BP limb of the rats;the expression levels of AMPK and pAMPK in BP lamb of the rats were observed by immunohistochemical staining;the expression levels of interleukin 1β(IL-1β),interleukin 6 (IL-6),tumor necrosis factorα(TNF-α),nuclear factorκB (NF-κB),and interleukin 10 (IL-10)mRNA of the rats were detected by QRT-PCR method.Results:From the 2nd week after operation,compared with before operation,the FBG levels of the rats in DJB operation group were decreased (t=3.798,P <0.05);compared with sham operation group,the FBG level of the rats in DJB operation group was decreased (t=3.205,P <0.05).Six weeks after operation,compared with sham operation group,the HOMA-IR of the rats in DJB operation group was significantly decreased (t=4.441,P <0.05)and the HOMA-ISI was significantly increased (t=-8.65,P < 0.05).The HE staining results showed that compared with sham operation group,the morphology of the inflammatory cells in BP limb of the rats in DJB operation group was significantly improved.The QRT-PCR results showed that the expression levels of IL-1β,IL-6,TNF-αand NF-κB of the rats in DJB operation group was significantly decreased compared with sham operation group (P < 0.05), while the expression level of IL-10 was significantly increased (P < 0.05).The immunohistochemical test results showed that the expression levels of AMPK and pAMPK in BP lamb of the rats in DJB operation group were increased compared with sham operation group.Conclusion:DJB can significantly improve the blood glucose homeostasis and insulin resistance in the T2DM rats,and its mechanism may be related to the decreased expressions of inflammatory factors and the activation of AMPK molecules in BP lamb of the T2DM rats.

Objective To study doctor-nurse associated pain intervention effect on postoperative patient-controlled analgesia of patients with lower limb fractures and their negative emotions.Methods One hundred and twenty patients with lower limb fractures who used the postoperative fentanyl patient-controlled analgesia method in the author's hospital from June 2015 to June 2016 were selected with a convenience sampling method. The patients from June 2015 to December 2015 were included into the control group (n=60). The patients from January 2016 to June 2016 were included into the observation group (n=60). The patients in the control group were cared with the postoperative routine nursing. The patients in the observation group were cared with the postoperative doctor-nurse associated pain nursing intervention. The visual analogue pain (VAS) and the Ramasy sedation score of patients in the two groups who were at admission,6 h,24 h,48 h and 72 h after surgery,discharged from hospital were evaluated and compared. The negative emotions of patients in the two groups one day before operation and three days after operation were evaluated with the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS). The complications during patient-controlled analgesia in the two groups were recorded.Results The VAS score and the Ramasy sedation score of patients were significantly different at different time points(Ftime=145.263,132.561;P<0.05). The VAS score and the Ramasy sedation score of patients were significantly different between the two groups(Fgroup=122.451,98.126;P<0.05). There was a significant effect between time and group (Finteraction=102.454,118.259;P<0.05). The SAS score and the SDS score were significantly lower in the observation group compared to the control group (P<0.05). The incidence of nausea and vomiting,the incidence of dizziness and the amount of sufentanil after surgery in the observation group were significantly lower than those in the control group (P<0.05). The satisfaction score of the patients in the observation group was higher compared to the control group (P<0.05). Conclusions The doctor-nurse associated pain intervention can improve postoperative anxiety and depression of patients with lower limb fractures,reduce the postoperative pain,contribute to the postoperative sedation, reduce the dose of postoperative anesthesia medication and complications,enhance patient-controlled analgesia pump effects and patients' satisfaction.

Objective To examine the brain metabolic changes in WD patients receiving copper chelation by us?ing 1H-MRS. Method Thirty-nine patients with WD was randomly divided into four groups: non-brain type group (18 cases), brain type prior-treatment group and short-term treatment group (21 cases), long-term treatment group (20 cases) from short-term treatment group, and 20 healthy volunteers served as a control group. 1H-MRS and MRI were performed on patients on 1.5/MR/MRS system to detect these above-mentioned items before and after treatment. Result The mean of NAA/Cr was significantly lower in the left putamen and head of the caudate nucleus than in the left basal ganglion in the 39 patients with WD. The mean of NAA/Cr and Cho/Cr in the left putamen and basal ganglion was significantly lower in non-brain type group than in control group(P<0.01). The mean of NAA/Cr Cho/Cr and NAA/Cho in the left putamen,head of the caudate nucleus and basal ganglion were significantly lower in brain type group than in control group(P<0.01 or P<0.05). The mean of NAA/Cr in the left putamen was much lower in brain type group than in non-brain type group (P<0.01). The mean of NAA/Cr, Cho/Cr and NAA/Cho of short-term treatment group in the left putamen, head of the caudate nucleus and basal ganglion was not significantly different between brain type group and short-term treatment group(P>0.05). The mean of NAA/Cr and NAA/Cho in the left putamen and basal ganglion was much higher in long-term treatment group than in brain type group(P<0.01 or P<0.05). The mean of Cho/Cr in the left head of caudate nucleus were much higher after treatment compared with prior-treatment group(P<0.05). The mean of NAA/Cr in the left putamen, head of the left caudate nucleus and basal ganglion in all groups was negatively correlated with course of the disease. Conclusion There are significant differences in brain metabolism among different type of WD. The long-term but not short-term copper chelation significantly improves brain metabolism. NAA/Cr may be used as a non-invasive indicator to examine the efficacy of treatment.

Objective To evaluate whether the predictive value of admission hyperglycemia for mortality differs between diabetics and non-diabetics with acute coronary syndrome (ACS).Methods A total of 1534 consecutive patients admitted with ACS to Central Control Unit of Beijing Friendship Hospital were analyzed.Among these patients,1332 patients who had a venous plasma glucose record at admission were retrospectively enrolled and were stratified according to admission glucose levels with or without diabetes.The primary end point was in-hospital and 2-year all-cause mortality.Results In patients without a history of diabetes,649 patients had glucose level ≤7.8 mmol/L(group A),204 patients with 7.8-11.0 mmol/L (group B) and 142 patients ＞ 11.0 mmol/L (group C).Of those with diabetes,124 patients were in group A,142 in group B and 126 in group C.By Cox regression analysis,admission hyperglycemia (group B,HR 1.48,P =0.05 ; group C,HR 2.78,P ＜ 0.001) was an independent predictor of long-term all-cause mortality in patients without diabetes.In patients with diabetes,blood glucose ＞ 11.0 mmol/L (group C,HR 2.68,P ＜ 0.001) also independently predicted long-term all-cause mortality.Conclusions Compared with the diabetic patients,elevation of blood glucose at admission is common in ACS patients without definite history of diabetes.Admission hyperglycemia should be considered as a risk factor strongly correlated with in-hospital and 2-year all-cause mortality in patients with ACS.

Objective To investigate the effect of methylene blue(MB)on liver ischemia-reperfusion (I/R) injury in rabbits.Methods Twenty-four healthy New Zealand white rabbits of both sexes welshins 2.0-2.3 kg were randomly divided into 3 groups (n=8 each):group Ⅰ sham operation(group s);group Ⅱ I/R and group Ⅲ methylene blue (group MB).The animals were anesthetized with intravenous 2% pentobarbital 30 mg/kg.Liver I/R was produced by occlusion of hepatic blood flow for 40 min followed by 60 min repeffusion.In group MB methylene blue 5 mg/kg was injected iv at 20 min before liver ischemia.Femoral artery was carmulated for MAP monitoring and blood sampling.MAP and HR were recorded immediately before(T1,baseline)and at 20 and 40 min of ischemia (T2,3) and 1,5,30,60 min(T4-7)of repedusion.Blood samples were collected at T1,T5,T6 and T7 for measurement of seruln TNF-α and IL-6 concentrations.Plasma AST and ALT activities were measured at T1,T6 and T7.Liver specimens were obtained at the end of experiment for determination of SOD activity and MDA content.Results In group I/R MAP was significantly decreased at T4-7 during reperfusion and HR at T7 as compared with the baseline at T1;while in group MB no significant change in MAP and HR Was observed during ischemia and reperfusion as compared with the baseline.The gerum TNF-α and IL-6 concentrations and the plasma ALT and AST activities were significantly increased during reperfusion as compared with the baseline immediately before ischemia in group I/R and MB and were significantly lower in group MB than in group. I/R. The SOD activity was significantly higher while MDA content was significantly lower in group MB than in group I/R. Microscopic examination showed that liver damage was less severe in group MB than in group I/R. Conclusion The administration of MB can maintain hemodynamic stability and attenuate liver I/R injury in rabbits.