Abstract Background and aims To establish artificial intelligence-derived, Magnetic Resonance Imaging (MRI)-based etiological subtypes of cerebral small vascular disease (CSVD). Methods A multicenter, cohort study that enrolled 1,036 adults with mild cognitive impairment before September 31, 2025 with the first month follow-up was completed. MRI radiomic features were extracted using an artificial intelligence driven segmentation and clustering framework for etiological subtyping. The primary outcome was the clinical risks of the imaging-driven MCI subtypes. Results The analysis revealed three CSVD subtypes based on seven imaging features: a lacune-specific subtype, characterized by severe lacunes, was associated with lower high-density lipoprotein cholesterol (HDL-C) (mean [SD], 0.9 [0.2] mmol/L; OR, 3.27; 95% CI, 1.41-5.60), higher systolic blood pressure (SBP), and lower apolipoprotein A1 (mean [SD], 1.2 [0.3] g/L; OR, 1.01; 95% CI, 1.01-1.71); a white matter hyperintensities (WMHs)-specific subtype, marked by more severe WMHs, was associated with elevated SBP, normal HDL-C (mean [SD], 1.1 [0.2] mmol/L), and apolipoprotein A1 (mean [SD], 1.3 [0.2] g/L) levels; and a hippocampal-atrophy subtype, marked by significant hippocampal atrophy, was associated with fewer vascular risk factors (HDL-C, mean [SD], 1.2 [0.4] mmol/L; apolipoprotein A1, mean [SD], 1.3 [0.3] g/L). Visuospatial and language deficits were prominent in the lacune- and WMHs-specific subtypes. These clusters were validated in 1130 patients from the ADNI database. Abnormal HDL-C metabolism was linked to specific gene mutations. Conclusions This study identified and validated three distinct imaging subtypes of CSVD, providing a framework for precise diagnosis and targeted therapeutic strategies. Conflict of interest Jinjie Liu. nothing to disclose Figure 1 - belongs to Methods Table 1 - belongs to Results

Background:Alzheimer's disease and other dementias (ADOD) pose a significant global health challenge, with projected annual increases. The growing elderly population exacerbates burdens, underscoring the need for interventions. Methods:Using data from the Global Burden of Disease Study 2021, we analysed global ADOD trends from 1990 to 2021 among adults aged 65+ and projected to 2050. Average annual percentage change (AAPC) in the age-standardised prevalence, mortality and disability-adjusted life years (DALYs) rates of ADOD were calculated to quantify the temporal trends. Results:Globally, the number of adults aged 65 years or older living with ADOD increased from 18.1 (95% uncertainty interval [UI] 14.4-22.5) million in 1990 to 49.1 (38.7-61.3) million in 2021 (AAPC 0.09%). While mortality rates remained relatively stable (AAPC 0%), DALYs increased by 176% (AAPC 0.02%). Females consistently exhibited a higher age-standardised prevalence (7,603 [95% UI 6,023-9,469] cases per 100,000 population) vs. 5,744 [4,486-7,205]) and mortality (304 [78 to 782] vs. 225 [54-626]) rate compared to males, with notable regional variations. From 1990 to 2021, the age-standardised prevalence of ADOD increased only in East Asia and High-income Asia Pacific (AAPC 0.79% and 0.16%). High fasting plasma glucose, high body-mass index, and smoking were identified as primary risk factors. Projections indicate a 50.1% increase in age-standardised prevalence by 2050, with an estimated 191 (52-330) million cases, and a predicted death toll of 6.8 (2.4-11.3) million. Conclusion:The global number of people living with dementia nearly tripled from 1990 to 2021, mainly due to increases in population ageing and growth. The findings emphasize the need for comprehensive strategies to address ADOD, including prevention, early diagnosis, and effective management, with a focus on gender and regional disparities.

INTRODUCTION:For patients with severe liver failure, citrate administration during plasma exchange (PE) may be associated with accumulation and increases the risk of death in the critically ill. To reduce this risk, we created a self-anticoagulation protocol, using predilution plasma exchange (pre-PE) with exogenous plasma and the included citrate. METHODS:Severe liver failure patients who met inclusion criteria were prospectively enrolled in our study from ICUs of two hospitals. Multiple PE treatments in enrolled patients were divided into two groups; the pre-PE group and the post-dilution plasma exchange (post-PE) group, using random table method. Therefore, anticoagulation for our PE was either included citrate (4%) within exogenous donated plasma at 750 mL/h in the pre-PE or citrate (4%) infusion at 120 mL/h and donated plasma at 1,000 mL/h routinely used in the post-PE group. Parameters such as bilirubin, coagulation function, and electrolytes were measured for analysis. RESULTS:A total of 13 patients were included in this study, and 46 PE treatments assigned as pre-PE, n = 22, and post-PE, n = 24. At the end of the PE, the incidence of citrate accumulation (tCa/iCa>2.5) in the pre-PE group was significantly lower than that in the post-PE group (13.6% vs. 62.5%, p < 0.001). This study showed that the clearance of bilirubin each session in the pre-PE group was 17.23% lower than that in the post-PE group (567.79 ± 155.16 µmol vs. 685.99 ± 181.03 µmol, p = 0.022). The reduction rate of bilirubin in the pre-PE group was significantly lower than that in the post-PE group (16.49 ± 5.00 µmol/L vs. 26.00 ± 10.60 µmol/L, p < 0.0001). CONCLUSION:This new method of pre-PE has higher safety than post-PE using exogenous donated plasma and a 4% citrate infusion, although it decreases the solute clearance efficiency slightly. It is most suitable for patients with severe liver failure.

Background:The objective was to provide standardized, comprehensive, and updated estimates of the global, regional, and national burdens of and risk factors for ischaemic stroke (IS) in adults aged 20 years and older. Methods:This was a population-based study (Global Burden of Disease, Injuries and Risk Factors Study 2021). Adults aged 20 years and older from 204 countries and territories and 811 subnational locations from 1990 to 2021 were included. The primary outcomes were IS-related age-standardized prevalence, mortality, disability-adjusted life years (DALYs), average annual percentage change (AAPC), and risk factors associated with DALYs. Results:From 1990 to 2021, the global age-standardized prevalence of IS decreased from 1,309 (95% UI 1,151 to 1,481) to 1,266 (95% UI 1,120 to 1,423) cases per 100,000 population, with an average annual decrease of -0.12%. However, the prevalence increased notably in the middle sociodemographic index (SDI) regions and East Asia but remained stable in Southeast Asia. The total number of IS cases still increased significantly from 33.2 million to 68.4 million. During the same period, the overall age-standardized mortality for IS decreased from 116 to 70 cases per 100,000 population, with an average annual change of -1.60%. Similarly, the overall age-standardized DALYs for IS decreased by 35%, with an average annual change of -1.36%. The decrease in both the age-standardized mortality and DALY rates was correlated with the SDI, with the most rapid decrease occurring in high-SDI regions. Conversely, in subregions of southern sub-Saharan Africa, an increase was observed. Males consistently faced a greater burden of IS across all subgroups. High systolic blood pressure and high low-density lipoprotein cholesterol (LDL-C) levels consistently represented the most significant risk factors contributing to DALYs from 1990 to 2021. Conclusion:Globally, the total IS caseload has increased. Targeted strategies, such as metabolic risk control in high-SDI regions, low-cost interventions in middle-/low-SDI regions, and improved neuroimaging infrastructure in sub-Saharan Africa, are needed. Future research should focus on subtype-specific burdens, the legacy effects of COVID-19, and intervention cost effectiveness to guide policymakers in developing efficient strategies to combat the global burden of ischaemic stroke.

BackgroundDementia, a progressive neurological disorder, is a leading cause of disability and death globally, often underdiagnosed in its early stages. Early diagnosis, prevention, and treatment are crucial for mitigating its impact on individuals and society.ObjectiveThis study aimed to predict the exact conversion time from normal cognition (NC) to mild cognitive impairment (MCI), and to provide insights for early diagnosis and treatment of dementia.MethodsA novel dual attention convolutional network model was proposed to handle high-dimensional features and limited patients' records in short-sequence time series data. It integrated feature and temporal attention modules to capture dependencies and used a custom loss function to enhance clinical interpretability.ResultsThe model significantly reduced mean squared error (MSE) by 9.67% and mean absolute error (MAE) by 26.24%, while increasing the r-square (R2) by 16.71% compared to a basic convolutional model. It effectively predicted NC to MCI conversion, offering valuable guidance for early intervention.ConclusionsThe dual attention convolutional network model effectively predicted NC to MCI conversion, providing a valuable tool for early dementia diagnosis and treatment.

OBJECTIVE:The goal was to analyze the progression of cerebral edema post-endovascular thrombectomy (EVT) in large infarcts and its association with functional outcomes. METHODS:A secondary analysis of the Endovascular Therapy in Acute Anterior Circulation Large Vessel Occlusive Patients with a Large Infarct Core trial was conducted in patients with large ischemic cores randomized to receive either EVT or medical management (MM) alone. Patients who had follow-up imaging within 7 days post-randomization were involved. The primary outcome was midline shift (MLS). Mediation analysis was performed with EVT as the independent variable, MLS as the mediator, and modified Rankin scale scores at 90 days served as the endpoint. An exploratory analysis was conducted on the progression of net water uptake (ΔNWU). RESULTS:Of 434 patients, median age was 66.0 years (standard deviation [SD], 9.9), with 61.3% (266) being males. EVT was associated with an early increase in MLS at 24 (±12) hours after randomization (mean [SD], 3.0 [4.2] vs 2.4 [3.6]mm; p = 0.03) compared with the MM group, partially mediating poorer functional outcomes post-EVT (mediation proportion, -25%; 95% CI, -46.54 to -4.10), but did not negate the overall efficacy of thrombectomy. The progression of NWU remained slower after EVT throughout 7 days, inconsistent with MLS. INTERPRETATION:In patients with large infarct cores, EVT was associated with an early increased mass effect compared with MM, potentially mediating poorer functional outcomes. Despite the evident overall benefits from thrombectomy, accurate prediction and effective anti-edema interventions for the early mass effect post-EVT may further improve outcomes. The complex relationship between NWU and cerebral edema progression warrants further investigation. ANN NEUROL 2025;98:258-269.

White matter hyperintensities (WMHs), a major neuroimaging biomarker of cerebral small vessel disease (CSVD), are increasingly recognized as predictors of dementia risk. The subregional distribution and diverse imaging phenotypes of WMHs, including spatial distribution patterns, morphological characteristics, signal intensity, and concomitant lesions, are correlated with distinct mechanisms and aetiologies. This systematic review synthesizes evidence from 31 studies identified through comprehensive searches of PubMed, Embase, Web of Science and the Cochrane Library, following PRISMA guidelines. A key finding is that frontal/deep confluent WMHs with lacunes in the deep white matter are associated with mixed dementia characterized by CSVD and amyloid-β (Aβ) deposition. In contrast, posterior periventricular WMHs coexisting with hippocampal and temporal lobe atrophy and co-localized Aβ deposition serve as early biomarkers of Alzheimer’s disease. Cerebral amyloid angiopathy related WMHs are characterized by juxtacortical multispot patterns and lobar microbleeds, resulting from vascular Aβ deposition and glymphatic system dysfunction. These findings highlight the etiological heterogeneity of WMHs, where spatial distribution patterns and associated imaging features provide critical insights into underlying pathological mechanisms. The identification of these phenotype-specific correlations offers a framework for improving early diagnosis and developing targeted interventions for dementia subtypes.

BackgroundComplicated intra-abdominal infections (cIAIs), often caused by multidrug-resistant bacteria such as carbapenem-resistant A. baumannii (CRAB) and carbapenem-resistant Enterobacteriaceae (CRE) are a critical challenge in ICUs. Owing to their high mortality and treatment failure rates, there is an urgent need for effective therapies. This trial will compare eravacycline to tigecycline for treating cIAIs in patients in the ICU, aiming to provide a superior treatment option.MethodsThis is a multicenter, single-blind, parallel randomized controlled trial. Adult patients in the ICU with complex abdominal infections who meet the eligibility criteria will be included. The main outcome is the all-cause 30-day mortality of patients in clinically evaluable and microbiologically evaluable populations. Secondary outcomes include the proportion of total responsive patients in the clinically evaluable population at the end of treatment and test of cure visits; the proportion of total responsive patients in the microbiologically evaluable population at the end of treatment and test of cure visits; and ICU hospitalization time and costs. Safety assessments include the incidence of various adverse events and changes in clinical laboratory test results. The subjects will be randomly assigned to receive treatment with either eravacycline or tigecycline at a 1:1 ratio. The all-cause mortality rates of patients treated with eravacycline and TGC were 17.7 and 18.7%, respectively, with an estimated actual mortality rate of 0.95. A total sample size of 262 subjects is required to reach 80% power with an α of 0.05. Considering a 10% loss rate, 292 patients will be enrolled and randomly assigned to the three groups in equal proportions.Ethics and communicationThis trial was approved by the Ethics Committee of Ansteel Group General Hospital. The communication plan includes presentations at scientific conferences, scientific publications, and presentations to the public through nonprofessional media.Clinical trial registrationhttps://clinicaltrials.gov/, ChiCTR2300078646.

Delirium in critical ill patients is a complex and common neurological syndrome in the intensive care unit (ICU) that is caused by a range of structural or functional abnormalities. ICU Delirium is associated with reduced compliance, prolonged hospital stays, greater use or delayed withdrawal of sedatives, higher rates and durations of mechanical ventilation, and higher rates of mortality. The aetiology and pathogenesis of ICU delirium are unclear, and the lack of better prediction, prevention, and treatment measures leads to a non-standardized control of delirium. By searching the relevant literature, we aim in this narrative review to describe progress in the pathogenesis, predictive biomarkers, diagnosis, and treatment of ICU delirium.

Background The relationship between post-endovascular thrombectomy (EVT) blood pressure (BP) and outcomes in patients with acute ischemic stroke (AIS) remains contentious. We aimed to explore whether this association differs with different cerebral perfusion statuses post-EVT. Methods In a multicenter observational study of patients with AIS with large vessel occlusion who underwent EVT, we enrolled those who accepted CT perfusion (CTP) imaging within 24 hours post-EVT. We recorded post-EVT systolic (SBP) and diastolic BP. Patients were stratified into favorable perfusion and unfavorable perfusion groups based on the hypoperfusion intensity ratio (HIR) on CTP. The primary outcome was good functional outcome (90-day modified Rankin Scale score of <= 3). Secondary outcomes included early neurological deterioration, infarct size growth, and symptomatic intracranial hemorrhage. Results Of the 415 patients studied (mean age 62 years, 75% male), 233 (56%) achieved good functional outcomes. Logistic regression showed that post-EVT HIR and 24-hour mean SBP were significantly associated with functional outcomes. Among the 326 (79%) patients with favorable perfusion, SBP <140 mmHg was associated with a higher percentage of good functional outcomes compared with SBP >= 140 mmHg (68% vs 52%; aOR 1.70 (95% CI 1.00 to 2.89), P=0.04). However, no significant difference was observed between SBP and functional outcomes in the unfavorable perfusion group. There was also no discernible difference between SBP and secondary outcomes across the different perfusion groups. Conclusions In patients with favorable perfusion post-EVT, SBP <140 mmHg was associated with good functional outcomes, which underscores the need for further investigations with larger sample sizes or a more individualized BP management strategy.

BackgroundPrevious studies mainly focused on risk factors in patients with mild cognitive impairment (MCI) or dementia. The aim of the study was to provide basis for preventing MCI in cognitive normal populations.MethodsThe data came from a longitudinal retrospective study involving individuals with brain magnetic resonance imaging scans, clinical visits, and cognitive assessment with interval of more than 3 years. Multiple machine-learning technologies, including random forest, support vector machine, logistic regression, eXtreme Gradient Boosting, and naïve Bayes, were used to establish a prediction model of a future risk of MCI through a combination of clinical and image variables.ResultsAmong these machine learning models; eXtreme Gradient Boosting (XGB) was the best classification model. The classification accuracy of clinical variables was 65.90%, of image variables was 79.54%, of a combination of clinical and image variables was 94.32%. The best result of the combination was an accuracy of 94.32%, a precision of 96.21%, and a recall of 93.08%. XGB with a combination of clinical and image variables had a potential prospect for the risk prediction of MCI. From clinical perspective, the degree of white matter hyperintensity (WMH), especially in the frontal lobe, and the control of systolic blood pressure (SBP) were the most important risk factor for the development of MCI.ConclusionThe best MCI classification results came from the XGB model with a combination of both clinical and imaging variables. The degree of WMH in the frontal lobe and SBP control were the most important variables in predicting MCI.

Background: With regard to the treatment of massive pulmonary embolism (MPE) with circulatory and respiratory collapse and thrombolytic contraindications, current guidelines and researches usually give the priority to veno-arterial extracorporeal membrane oxygenation (V-A ECMO). However, the objective of this clinical case report is to highlight the effective use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) in a 35-year-old pregnant woman with MPE complicated by hemorrhage, persistent hypoxia and multiple cardiac arrests. Case Description: A 35-year-old pregnant woman with gestational mellitus suddenly presented with complaints of nausea, vomiting and dyspnea after going to the toilet, combined with increasing heart rate (HR) of 150 bpm, decreasing pulse oxygen saturation (SpO2) of 94%, larger right heart and the growing D-dimer at 11.2 mu g/mL, who was considered as the pulmonary embolism. Unpredictable cardiac arrest occurred repeatedly before and after the cesarean section. Although cardiopulmonary resuscitation (CPR) was started timely and successfully, the maintenance of blood pressure still depended on high-dose pressor drugs, even terribly, the oxygenation was unstable under the assistance of mechanical ventilation with pure oxygen. Thus, V-V ECMO supporting was commenced following by gradual recovering in haemodynamics and respiratory function. And the diagnosis of MPE was ascertained again through computed tomographic pulmonary angiography (CTPA) and pulmonary angiography. Directing at the pathogeny, thrombolysis infusion catheters and anticoagulant therapy were initiated after bilateral uterine artery embolism for postpartum haemorrhage, later the patient discharged from hospital after recovery and had a good prognosis. Conclusions: V-V ECMO could be effective for some patients with MPE who suffer from successful CPR after cardiac arrest while still combined with severe hypotension and refractory hypoxemia.

Background:Agitation is very common in the intensive care unit (ICU). The causes include pain, delirium, underlying disease, withdrawal syndrome, and some drug treatments. The practical goal of ICU treatment is to find an appropriate sedation regimen to reduce pain, restlessness, and delirium. Previous trials have examined the use of dexmedetomidine, but no trials have evaluated the efficacy and safety of ciprofol, a new sedative drug.Methods:This study was a multicenter, single-blind, 3-arm parallel randomized controlled trial. ICU patients aged ≥ 18 years with agitation and delirium who met the eligibility criteria were included. The main outcome was the proportion of patients who needed additional study medication or midazolam due to agitation within 4 h after the first intravenous injection of the study medication. The secondary outcomes included the pass rate as indicated by a Richmond Agitation-Sedation Scale (RASS) score < +1, the effectiveness rate of improving delirium symptoms, the number of recurrences of agitation within 24 h, the incidence of rescue treatment, the dose and cost of analgesic and sedative drugs, the length and cost of ICU stay, and the 30-day survival period. The safety evaluation included the incidence of adverse events (hypotension, bradycardia, hypoxia, etc.) and the rate of endotracheal intubation. The subjects were randomly assigned to receive ciprofol, dexmedetomidine, or normal saline at a ratio of 1:1:1. The rates of additional drug administration within 4 h after the first injection of the study drug in the three groups were 40, 50, and 90%, respectively. A total sample size of 81 subjects was required to reach 90% power and an α of 0.05. Considering a 20% loss rate, 102 patients were enrolled and randomly assigned to the three groups in equal proportions.Ethics and communication:This trial was approved by the Ethics Committee of Dalian Municipal Central Hospital. The communication plan includes presentations at scientific conferences, scientific publications, and presentations to the public through non-professional media.Clinical trial registration:www.ClinicalTrials.gov, identifier ChiCTR220006 2799.

Cardiac surgery can provoke an acute cytokine storm that may contribute to the development of postoperative multiple organ dysfunction syndrome. We prospectively observed patients undergoing cardiac surgery and divided them into two groups: the severe group and the mild group. Healthy individuals were enrolled acting as the control group for comparison. Plasma samples and clinical data were recorded at the initiation of cardiac-pulmonary bypass (CPB) and 3, 6, 12, 24, and 48 h after initiation of CPB. Cytokine levels were detected using the Luminex® technique. Thirty-nine adults were enrolled in this study (14 in the severe group, 15 in the mild group, and 10 in the control group). Cytokine concentrations were significantly higher in the severe group. Principal component analysis was used to establish a cytokine storm intensity curve, which represented the overall trend of 10 cytokines. The peak concentrations of interleukin (IL)-6, IL-10, and IL-16 were 425.1, 198.5, and 623.0 pg/mL, which were more than 1,200, 1,800, and 240 times the normal level, respectively. The maximum cytokine storm intensity predated the maximum Vasoactive-Inotropic Score (VIS) and Sequential Organ Failure Assessment (SOFA) score in the severe group. Cytokine storm response to cardiac surgery occurred early and was associated with disease severity. Interventions to cytokine storm should be initiated early as guided by cytokine storm biomarkers such as IL-6, IL-10, and IL-16 in severe patients undergoing cardiac surgery. Clinical Trial Registration: ChiCTR1900021351.

BackgroundThe optimal control thresholds for systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with white matter hyperintensity (WMH) are still unclear.MethodA longitudinal retrospective study of patients with brain magnetic resonance imaging (MRI) scans with intervals of more than 3 years was conducted. Blood pressure records during hospitalization and from outpatient visits between baseline and the last MRI scan were collected. The outcome was the change in total WMH from baseline to the final visit.ResultsAmong the 965 patients with MRI scans, 457 patients with detailed longitudinal blood pressure records were ultimately included and classified into the WMH absent group (n = 121), mild WMH group (n = 126), and moderate to severe WMH group (n = 210). Both baseline and longitudinal mean SBP, DBP, and SBP SD were significantly associated with WMH severity (p < 0.05). An average SBP of 130-140 mmHg [vs. <130 mmHg, aOR, 1.80, (95% CI, 1.05–3.07), p = 0.03] was associated with a higher risk of WMH progression. DBP ≥ 90 mmHg [vs. <80 mmHg, OR, 1.81, (95% CI, 0.88–3.74), p = 0.02, aOR, 1.54, (95% CI, 0.66–3.53), p = 0.32] was associated with a higher risk of WMH progression, but was not after adjusted for other covariates. Longitudinal BP variability was not significantly associated with WMH progression.ConclusionBoth SBP and DBP had a stronger relationship with the severity of WMH. A target mean SBP of <130 mmHg and mean DBP of <80 mmHg was associated with a lower risk of WMH progression.

Background: As an atypical antipsychotic drug, olanzapine is one of the most commonly used drugs for delirium control. There are no systematic evaluations or meta-analyses of the efficacy and safety of olanzapine for delirium control in critically ill adults. Objectives: In this meta-analysis, we evaluated the efficacy and safety of olanzapine for delirium control in critically ill adults in the intensive care unit (ICU). Data Sources and Methods: From inception to October 2022, 12 electronic databases were searched. We retrieved randomized controlled trials (RCTs) and retrospective cohort studies of critically ill adults with delirium that compared the effects of olanzapine and other interventions, including routine care (no intervention), nonpharmaceutical interventions and pharmaceutical interventions. The main outcome measures were the (a) relief of delirium symptoms and (b) a decrease in delirium duration. Secondary outcomes were ICU and in-hospital mortality, ICU and hospital length of stay, incidence of adverse events, cognitive function, sleep quality, quality of life, mechanical ventilation time, endotracheal intubation rate and delirium recurrence rate. We applied a random effects model. Results: Data from 10 studies (four RCTs and six retrospective cohort studies) involving 7076 patients (2459 in the olanzapine group and 4617 in the control group) were included. Olanzapine did not effectively relieve delirium symptoms (OR = 1.36, 95% CI [0.83, 2.28], p = 0.21), nor did it shorten the duration of delirium [standardized mean difference (SMD) = 0.02, 95% CI [−1.04, 1.09], p = 0.97] when compared with other interventions. Pooled data from three studies showed that the use of olanzapine reduced the incidence of hypotension (OR = 0.44, 95% CI [0.20, 0.95], p = 0.04) compared with other pharmaceuticals. There was no significant difference in other secondary outcomes, including ICU or hospital length of stay, in-hospital mortality, extrapyramidal reactions, QTc interval prolongation, or overall incidence of other adverse reactions. The number of included studies was not sufficient for performing a comparison between olanzapine and no intervention. Conclusion: Compared with other interventions, olanzapine has no advantage in alleviating delirium symptoms and shortening delirium duration in critically ill adults. However, there is some evidence that the rate of hypotension was lower in patients who received olanzapine than in those who received other pharmaceutical interventions. There was a nonsignificant difference in the length of ICU or hospital stay, in-hospital mortality, and other adverse reactions. This study provides reference data for delirium research and clinical drug intervention strategies in critically ill adults. Registration: Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42021277232).

Background: The efficacy and safety of dexmedetomidine and olanzapine for delirium control in elderly critically ill patients without ventilation or surgery are unknown.Method: In this retrospective cohort of elderly critically ill patients, the efficacy and safety of dexmedetomidine or olanzapine for controlling delirium were evaluated by drug dosage/duration, sedation level, adverse effects, intubation during sedation and prognosis.Result: From 439 screened patients, average RASS scores, drug use duration and sedative combination rates were lower, adverse effect and intubation rates were higher, and hospital stay length was longer with dexmedetomidine than olanzapine. Mortality rates, long-term cognitive function, and delirium recurrence rates were similar across groups. Age, severe cardiopulmonary disease, APACHE II scores, dexmedetomidine dosage, minimum RASS score and sedative combination rates were associated with adverse effects of dexmedetomidine.Conclusion: Dexmedetomidine was more effective in delirium control but had a higher rate of adverse effects than olanzapine.Funding Statement: This work was supported by the Open Project Program of Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education [grant numbers 2019GDND03] and Youth Research Project of Dalian Municipal Central Hospital [grant numbers No. 2018A08].Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the ethics committee of the Dalian Central Municipal Hospital.

目的 探究低频电刺激治疗仪与下肢压力泵对预防外伤患者下肢静脉血栓形成中的应用效果.方法 选取2018年3月至2019年11月于本院接受治疗的外伤患者80例,按照随机数字表法分为A组与B组,各40例.A组采用低频电刺激治疗仪以预防下肢静脉血栓形成,B组则采用下肢压力泵.比较两组干预前后的血小板最大聚集率(maximal platelet aggregation rate,MPAR)、凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial prothrombin time,APTT)与干预开始后的静脉血栓形成状况.结果 干预后,两组MPAR均低于干预前,PT、APTT均短于干预前,差异有统计学意义(P<0.05);干预后,两组MPAR、PT、APTT比较差异无统计学意义;干预后,两组均未见下肢静脉血栓形,但A组中有1例患者出现上肢静脉血栓.结论 低频电刺激治疗仪与下肢压力泵在预防外伤患者下肢静脉血栓形成方面均有较高的应用价值,均能有效抑制血小板聚集,改善血液高凝状态.