We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.
Humans ; Consensus ; Critical Care/methods* ; Intensive Care Units ; Pain/drug therapy* ; Analgesics/therapeutic use* ; Delirium/therapy* ; Critical Illness

This study was aimed to understand the current status of the antimicrobial resistance and molecular distribution of Campylobacter in various poultry in Jiaodong area,to provide a basis for effective prevention and control of the Campy-lobacter risk to poultry products and human health.Campylobacter was isolated and identified from 565 cloacal samples collect-ed in the Jiaodong area from August to October 2021 through conventional bacterial isolation and culture,mass spectrometry,microbroth dilution and multilocus sequence typing(MLST).The drug resistance and molecular typing of 131 representative strains(67 Campylobacter jejuni and 64 Campylobacter coli)were studied separately.Antimicrobial resistance analysis indica-ted that 131 isolates were highly resistant to ciprofloxacin,nalixic acid and tetracycline,with resistance rates of 96.21％,96.21％and 95.45％,respectively.Except for 2 strains,62 strains of C.coli were completely resistant to these three drugs(100％).A total of 65 strains of 131 strains were multidrug re-sistant,and the overall multidrug resistance rate was 49.62％,among which 11 strains(16.42％)of C.jejuni were resistance to 3-5 antibiotics,and 54 strains(84.38％)of C.coli were re-sistance to 3-6 antibiotics.Among the isolates from different poultry sources,waterfowl isolates were the most resistant,fol-lowed by broiler isolates.The MLST typing results revealed 72 alleles and 35 sequence types obtained from 67 strains of C.je-juni,and the distribution was relatively dispersed,without a dominant ST type and homologous complex.A total of 27 alleles and 19 sequence types were obtained from 64 strains of C.coli.Moreover,59.38％(38/64)strains were homologous complex CC-828,in which the ST-1586 sequence type was most frequent,followed by ST-825.ST-1586,ST-9944 and ST-3735 were the main sources of C.coli in broilers,and ST-825 and ST-1586 were the main sources of C.coli in waterfowl.Differences in C.jejuni and C.coli carriage were observed among poultry in the Jiaodong area.Carriage of the two bacteria was more common in laying hens than in broilers and waterfowl.C.jejuni from poultry in the Jiaodong area was highly resistant to ciprofloxacin,nalixic acid and tetracycline,but had good sensitivity to other drugs.C.coli was highly resistant to a variety of antibiotics,and multiple drug resistance was common.St-type dispersal of C.jejuni showed high genetic diversity.C.coli was cloned and transmitted mainly by ST-1586 in broiler chickens and waterfowl.Poultry carry C.jejuni,which can cause serious diseases in humans.Therefore,dynamic monitoring of Campylobacter from poultry should be strengthened.

Objective: To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. Methods: From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by t-test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). Results: The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ²=4.00, P=0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (P>0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ²=5.06, P=0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio (OR)=0.95, 0.97; 95%CI: 0.92~0.97, 0.95~0.99; both P<0.05) and epinephrine dosage (OR=0.87 and 0.79, 95%CI: 0.76-1.00 and 0.69-0.89, respectively; both P<0.05). Conclusions: There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.
Cardiopulmonary Resuscitation ; Child ; Child, Preschool ; Female ; Heart Arrest/therapy* ; Heart Defects, Congenital/therapy* ; Humans ; Intensive Care Units, Pediatric ; Male ; Retrospective Studies

【Objective】To investigate the expression of FosB in invasive breast cancer and its correlation to the ultrasound findings and clinical significance.【Methods】Immunohistochemical and ultrasound examination were performed for 155 cases with invasive breast cancer，36 cases with paracancerous tissue and 30 cases with normal breast tissue. To investigate the correlations between the different expression of FosB with histological grade ，lymph nodes，and ultrasound findings.【Results】①The expression of FosB in paracancerous tissue and normal breast tissue was higher than that in invasive breast cancer（P＜0.01）. ②Based on immunohistochemical staining，high positive expression rate of FosB was associated with low histological grade，ER positive and PR positive（P＜0.05）. There was no correlation between FosB and age，tumor diameter，lymph nodes，Her2 and clinical stages（P＞0.05）③The expression of FosB was higher in microcalcification positive and lymph nodes bigger tissues（P＜0.05）. There was no correlation between FosB and tumor size， regular shape，boundary，posterior attenuation ratio and blood flow（P＞0.05）.【Conclusion】The expression of FosB in invasive breast cancer was lower than that in paracancerous tissue and normal breast tissue. The different expression of FosB was correlated with histological grade，ER positive and PR positive. To study the expression of FosB in invasive breast cancer may be helpful for differential diagnosis and targeted treatment. The different expression of FosB was correlated with microcalcification，lymph nodes，and combined FosB with ultrasound findings may contribute to prognostic evaluation of breast cancer.

Resveratrol (3,5,4'-trihydroxystilbene, RSV) has been widely used in mammalian cells, but whether it can be used during freezing boar semen is still unknown. The effects of RSV treatment during boar semen freezing on its anti-freezing ability, apoptosis, and possible apoptotic pathways were observed in this study. Sperm motility, mitochondrial membrane potential (ΔΨ), adenosine triphosphate (ATP) content, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end labeling (TUNEL)-positive apoptotic state, and messenger RNA (mRNA) expression levels of apoptotic genes involved in different apoptotic pathways after freezing with or without RSV treatment were tested. The results showed that: (1) Compared with fresh sperm, the motility, normal acrosome rate, and plasma membrane integrity rate of frozen boar sperm decreased significantly (P<0.05), and RSV did not significantly increase the sperm motility (0.44 vs. 0.40, P>0.05), but it did significantly improve the normal acrosome rate (57.65% vs. 47.00%, P<0.05) and plasma membrane integrity rate (46.67% vs. 38.85%, P<0.05). (2) After freezing, most boar sperm showed low mitochondrial ΔΨ. RSV treatment could increase the rate of high mitochondrial ΔΨ of boar sperm. (3) RSV treatment significantly decreased reactive oxygen species (ROS) levels (58.65% vs. 88.41%, P<0.05) and increased the ATP content (0.49 μmol/L vs. 0.25 μmol/L, P<0.05) of boar sperm during freezing. (4) The apoptotic rate of the freezing group (80.41%) with TUNEL detection increased significantly compared to the fresh group (9.70%, P<0.05), and RSV treatment greatly decreased the apoptotic rate (68.32%, P<0.05). (5) Real-time polymerase chain reaction (RT-PCR) showed that not only the genes from the death receptor-mediated apoptotic pathway (tumor necrosis factor-α (TNF-α), Fas ligand (FasL), and Caspase-8), but also the genes from the mitochondria-mediated apoptotic pathway (manganese superoxide dismutase (MnSOD), B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), and Caspase-9) were both significantly changed after freezing. RSV treatment during freezing greatly changed their expression levels. Although RSV treatment during boar semen freezing did not significantly increase motility after thawing, it still played an efficient antioxidant role, which could enhance the mitochondrial function and decrease the apoptotic level induced by both the death receptor- and mitochondria-mediated apoptotic pathways.

Objective: Based on response surface methodology, HPLC was applied to quantitatively determine the optimal processing technology of Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (GRRPM) from the perspective of multi-index and comprehensive evaluation. Methods: HPLC was used for quantitative analysis, and the content of liquiritin, liquiritigenin, licochalcone A and glycyrrhetinic acid was used as inspection indexes. Response surface methodology was used to investigate the effects of the adding amount of honey, steaming and soaking time, frying temperature and frying time on the processing technology of GRRPM, and to optimize the optimal processing technology of GRRPM. Results: The chromatographic column was Diamonsil C18 (2) (4.6 mm × 200 mm, 5 μm); mobile phase was acetonitrile-0.1% phosphate aqueous solution, gradient eluting: 0-20 min, 12%-32% acetonitrile; 20-45 min, 32%-70% acetonitrile; 45-75 min, 70%-97% acetonitrile, with detection wavelength of 260 nm, column temperature of 20 ℃, and flow rate of 1 mL/min; Using liquiritin as internal standard, the relative correction factors of glycyrrhizin, licochalcone A, glycyrrhizinic acid and their relative correction factors were determined and calculated to be 0.56, 0.64 and 1.42, respectively. The optimum processing process of GRRPM was as follows: the amount of honey was 1/4, the soaking time was 15 min, frying pan bottom temperature was 160 ℃, and frying time was 13 min. Conclusion: The results of systematic adaptability investigation of the experimental content determination method meet the requirements. The best processing scheme of GRRPM optimized by response surface methodology is feasible and provides scientific basis for formulating quality standards and modern research of GRRPM.

Objective: To establish the HPLC fingerprint and multicomponents determination of Potentillae Chinensis Herba, and provide a scientific basis for the improvement of its quality standards. Methods: The separation was performed on a chromatographic Diamonsil C18 column (250 mm × 4.6 mm, 5 μm), with acetonitrile-0.1% phosphoric acid as the mobile phase for gradient elution. Volume flow rate was 1.0 mL/min. Column temperature was 25 ℃. Injection was 10 μL and the detection wavelength was 260 nm. The fingerprints of 10 batches of Potentillae Chinensis Herba were established and evaluated by the similarity evaluation system of TCM (version 2004A), which were divided into two categories by clustering analysis. Meanwhile, the content of galic acid, quercetin, and kaempferol was determined. Results: The fingerprint of Potentillae Chinensis Herba was established. There were 12 common peaks in the fingerprint. Galic acid, quercetin, and kaempferol were separated with good linearity relationships (r > 0.999). The average recovery rates of the investigated compounds were 97.44%, 97.64%, and 99.19%, respectively. Conclusion: The established fingerprint and multicomponents determination method of Potentillae Chinensis Herba have strong specificity and good repeatability, which can effectively control the internal quality of Potentillae Chinensis Herba and provide reference for improving the quality evaluation method of Potentillae Chinensis Herba.

【Objective】ToinvestigatetheexpressionandclinicalsignificanceofJunDinmolecularsubtypesofinva⁃ sivebreastcarcinoma，benignandmalignantbreastlesions.【Methods】Immunohistochemicalexaminationwasperformed for160patientswithinvasivebreastcarcinoma，191patientswithbreastintraductalproliferativelesionsand20patients withnormalbreasttissue.【Results】①ComparisonwithothersubtypesshowedthattheexpressionofJunDwassignificantly increasedinTBNCsubtype（P＜0.05）anddifferencesbetweenothersubtypeswerenotstatisticallysignificant（P＞0.05） . ②TheexpressionofJunDininvasivebreastcarcinomawaslowerthanthatinbreastintraductalproliferativelesionsand normalbreasttissuse（P <0.01） .③Basedonimmunohistochemicalstaining，highpositiveexpressionrateofJunDwas associatedwithlowhistologicalgrade（P <0.01）.ThereisnocorrelationbetweenJunDandtumordiameter，age，lymph nodes，ER，PRandhistologicalgrade（P >0.05） .【Conclusions】TheexpressionofJunDwassignificantlyincreasedin TBNCsubtype.TostudytheexpressionofJunDinTBNCsubtypeofinvasivebreastcarcinomamayprovideanevaluation intargetedtreatment.ThedifferentexpressionofJunDinbenignandmalignantbreastlesionsmaybehelpfulfortheir differentialdiagnosis.

Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia, with a high incidence and many complications. It has become an increasingly serious public health problem in the world, and has seriously affected the quality of life. Phosphatidylinositol-3-kinases (PI3K)/protein kinase B (Akt) signaling pathway is the main pathway of insulin signal transmission and the main signal channel for regulating blood glucose. The abnormal signal molecule of PI3K/Akt may cause abnormal signal transduction pathway, so as to impact the proliferation, apoptosis, metastasis and invasion of the corresponding tissues and organs, and lead to the occurrence of disease. Study of PI3K/Akt signal channel has a positive significance for investigating whether traditional Chinese medicine(TCM) has a definite and stable hypoglycemic effect. Currently, there are many TCM and Western medicines to treat diabetes, however, most drugs, especially Western medicines, have a relatively poor effect in controlling complications. To understand the progress of TCM in treatment of diabetes, in expectation of better studying the comprehensive therapeutic effect and mechanism of TCM on diabetes, and further developing the multi-target, multi-way and multi-channel advantages and features of TCM in the treatment of diabetes, this paper focuses on a systematic analysis on the progress of in vivo and in vitro studies on DM based on PI3K/Akt signaling channel in recent years, including the effect of the signaling channel on insulin secretion, the three main target organs of insulin (liver, skeletal muscle and fat), and its effect on the four main complications of diabetes (brain, kidney, heart, testis), and also provides certain ideas and guidance for the study of hypoglycemic mechanism of TCM monomer, TCM and compound medicine.

To provide a scientific basis for the selection and optimization of the modern drying processing method for Angelicae Sinensis Radix (ASR). Three phenolic acids (esters), 6 phthalides were determined by using UPLC-PDA while polysaccharides were determined by UV-Vis spectrophotometry. Then the effects of drying methods on the inner qualities of ASR were evaluated through principle components analysis (PCA) combined with the appearance properties after drying. Results showed that the contents of chlorogenic acid and ferulic acid in samples obtained with controlled temperature and humidity drying (CTHD), medium and shortwave infrared drying (MSID) and microwave vacuum drying (MVD) methods were significantly higher than those with primary drying processing(PDP) method and the fresh samples. Multivariate statistical analysis showed that samples processed with CTHD had more similar general chemical properties with those processed with PDP, suggesting that CTHD was appropriate for the modern primary drying processing of ASR. With samples processed with traditional PDP method as reference, the CTHD method was further optimized in the processing parameters for ASR by orthogonal experiment design. Considering the consumption of drying power and time and other parameters, the modern drying parameters for the primary drying processing of ASR were finally optimized as follows: controlled temperature and humidity drying at 40-45 ℃, relative humidity below 25% and target moisture content about 50% in the first stage of drying process, tempering for 12-24 h, and then drying under the conditions of temperature at 50-60 ℃, relative humidity below 20% and fan frequency at 30-40 Hz in the second stage. The study provided the scientific evidence for the selection of appropriate drying method and suitable parameters for the modern primary drying processing of ASR, as well as the beneficial exploration and practice on the formation of technical standard of primary drying processing for roots and rhizomes types herbal medicines.