Platelet glycoprotein (GP) IIb/IIIa antagonists have been employed in selective patients after endovascular therapy (EVT) for acute ischemic stroke (AIS), yet application in patients without EVT is debated. This meta-analysis of randomized controlled studies on AIS patients without EVT assessed the effectiveness and safety of platelet GP IIb/IIIa antagonists compared with traditional antiplatelet or thrombolysis therapy. Articles were retrieved from databases, including PubMed, Web of Science, EMBASE, and Cochrane. The risk of bias and certainty level of evidence were assessed. Fifteen studies were included. GP IIb/IIIa antagonists increased the proportion of patients with modified Rankin Scale (mRS) 0-1 (odd ratio [OR] 1.37, 95% confidence interval [CI] 1.04-1.81, p = 0.03), mRS 0-2 (OR 1.27, 95% CI 1.12-1.46, p = 0.0004), and Barthel Index (BI) 95-100 (OR 1.25, p = 0.005); decreased the proportion of stroke progression within 5 days (OR 0.66, p = 0.006); and lowered the mean mRS score at 90 days (mean difference [MD] -0.43, p = 0.002) and the National Institute of Health stroke scale score at 7 days (MD -1.64, p < 0.00001) compared with conventional treatment. Proportions of stroke recurrence within 90 days (OR 1.20, p = 0.60), any intracranial hemorrhage (aICH) (OR 1.20, p = 0.12), symptomatic intracranial hemorrhage (sICH) (OR 0.91, p = 0.88), and death (OR 0.87, p = 0.25) had no statistical difference between both groups. This meta-analysis finds that compared with traditional antiplatelet or thrombolysis therapy, GP IIb/IIIa antagonists administered within 24-96 h of ischemic stroke onset significantly improve functional prognosis of patients with AIS not receiving EVT, as indicated by mRS and BI at 90 days, and do not increase the incidence of aICH, sICH, and death.

Abstract Objective To develop a nomogram for predicting the occurrence of sepsis-associated delirium (SAD). Materials and methods Data from a total of 642 patients were retrieved from the Medical Information Mart for Intensive Care (MIMIC III) database to build a prediction model. Multivariate logistic regression was performed to identify independent predictors and establish a nomogram to predict the occurrence of SAD. The performance of the nomogram was assessed in terms of discrimination and calibration by bootstrapping with 1000 resamples. Results Multivariate logistic regression identified 4 independent predictors for patients with SAD, including Sepsis-related Organ Failure Assessment(SOFA) (p = 0.004; OR: 1.131; 95% CI 1.040 to 1.231), mechanical ventilation (P < 0.001; OR: 3.710; 95% CI 2.452 to 5.676), phosphate (P = 0.047; OR: 1.165; 95% CI 1.003 to 1.358), and lactate (P = 0.023; OR: 1.135; 95% CI 1.021 to 1.270) within 24 h of intensive care unit (ICU) admission. The area under the curve (AUC) of the predictive model was 0.742 in the training set and 0.713 in the validation set. The Hosmer − Lemeshow test showed that the model was a good fit (p = 0.471). The calibration curve of the predictive model was close to the ideal curve in both the training and validation sets. The DCA curve also showed that the predictive nomogram was clinically useful. Conclusion We constructed a nomogram for the personalized prediction of delirium in sepsis patients, which had satisfactory performance and clinical utility and thus could help clinicians identify patients with SAD in a timely manner, perform early intervention, and improve their neurological outcomes.

Objective:To evaluate the effect of immersive virtual reality(IVR) combined with high simulation makeup technology in the training of emergency medical rescue in disaster scene.Methods:From April 2021 to December 2021, a total of 97 undergraduates from five-year program of clinical medicine enrolled in 2018 in Jiaxing University College of Medicine received the training of emergency medical rescue in disaster scene .They were divided into traditional teaching group (49 students) and IVR teaching group (48 students). PBL method was adopted in the traditional teaching group and IVR combined with high simulation makeup technology was adopted in the IVR teaching group .By the end of the course, the teaching effect has been evaluated by the final exam results of the two groups and the questionnaire survey of the IVR teaching group. The final results between the two groups were compared using the t-test or the chi-square test. Results:The questionnaire survey in IVR teaching group showed that 93.6% (44/47) students recognized the teaching method of IVR combined with high simulation makeup technology which provided a good environmental experience in disaster scene, 83.0% (39/47) students believed that this teaching method had a good sensory experience and 83.0% (39/47) of them experienced encouragement to their active learning. The average exam score related to emergency medical rescue in IVR teaching group were significantly higher than that in the traditional teaching group [(9.10±2.36) vs. (7.11±1.65), P<0.001]. Conclusions:IVR combined with high simulation makeup technology can improve students' environmental experience and sensory experience in the training of emergency medical rescue in disaster scene, which meet the needs from students and thus improve the quality of teaching.

Objective:To investigate the value of regional collaborative multi-hospital teamwork (MHT) in the treatment of patients with hemodynamically unstable pelvic fracture.Methods:A retrospective analysis was performed on 78 patients with hemodynamically unstable pelvic fractures treated by Jiaxing Regional Advanced Trauma Center from January 2018 to June 2021, including 40 patients treated by MHT mechanism as MHT group and 38 patients treated by multi-disciplinary teamwork (MDT) as MDT group. The general information, main injury mechanism, severity of trauma, main laboratory results, time nodes, hospitalization indicators and prognosis of the two groups were observed and compared.Results:There were no significant differences in gender, age, TI score and ISS score between two groups (P>0.05). Traffic accident was the main injury mechanism in both groups (42.5%vs60.5%), and the difference was not statistically significant (χ2=3.899, P>0.05). The proportion of patients who underwent surgery and operation treatment in both groups had no statistical significance (P>0.05). Compared with MDT group, MHT group had lower blood HGB (87.7±21.9 g/L vs 110.3±28.5 g/L), but Lac level (3.5±2.1 mmol/L vs 5.3±3.4 mmol/L) was also lower; the differences were statistically significant (P<0.05). There was no significant difference in BE and PT between the two groups (P>0.05). In MHT group, the time from admission to check-up was (19.5±7.7 min vs. 33.8±18.0 min), the time from decision to operation [25(18.3, 36.0)min vs 31(20.0, 41.3)min], and the stay time in the emergency room [45(31.3, 63.3)min vs 78(52.8, 92.5) min] were significantly shortened compared with MDT group, and the difference was statistically significant (P<0.05). There were no significant differences in length of hospital stay and ICU cost between the two groups, and the mortality rates were 15.0% and 15.8%, respectively, with no statistical significance (P>0.05).Conclusion:Regional collaborative MHT integrated treatment can improve the treatment level of patients with hemodynamically unstable pelvic fractures.