[Feasibility and safety study of building a friendly management model for elderly critically ill patients based on geriatric intensive care unit: a prospective controlled study].

OBJECTIVE: To explore the feasibility and safety of integrating the geriatric intensive care unit (GICU) into the friendly management model of the elderly critically ill patients. METHODS: A prospective controlled study was conducted. Patients with elderly critically ill admitted to the GICU and the general intensive care unit (ICU) of Jintan First People's Hospital of Changzhou from December 2021 to May 2023 were enrolled. Patients in the ICU group received the traditional intensive care and nursing mode. In addition to the ICU group basic medical care measures, the patients in the GICU group were treated with friendly management models such as flexible visitation, diagnosis and treatment environment optimization, caring diagnosis and treatment, and family participation in hospice care according to their condition assessment. The gender, age, main diagnosis, and acute physiology and chronic health evaluation II (APACHE II) at admission were recorded and compared between the two groups. During the treatment period, the incidence of nosocomial infection, unplanned extubation, falling out of bed/fall, unexpected readmission to ICU/GICU, and ICU/GICU mortality, the incidence of post-intensive care syndrome (PICS), the satisfaction rate of patients/families with medical care, and the satisfaction rate of patients/families with diagnosis and treatment environment were recorded and compared between the two groups. RESULTS: According to the admission criteria for ICU and GICU, as well as the willingness of the patients and/or their families, a total of 59 patients were finally included in the ICU group, and 48 patients were enrolled in the GICU group. There were no significantly differences in gender, age, main diagnosis and APACHE II score between the two groups, and there were comparability. There were no significantly differences in the incidence of adverse events such as nosocomial infection [13.6% (8/59) vs. 12.5% (6/48)], unplanned extubation [5.1% (3/59) vs. 6.2% (3/48)], falling out of bed/fall [3.4% (2/59) vs. 0% (0/48)], unexpected readmission to ICU/GICU [8.5% (5/59) vs. 10.4% (5/48)], and ICU/GICU mortality [6.8% (4/59) vs. 6.2 (3/48)] between the ICU group and GICU group (all P > 0.05). Compared with the ICU group, the incidence of PICS in GICU group was significantly lower [8.3% (4/48) vs. 25.4% (15/59), P < 0.05], the satisfaction rate of patients/families with medical care [89.6% (43/48) vs. 74.6% (44/59)] and satisfaction rate of patients/families with diagnosis and treatment environment [87.5% (42/48) vs. 67.8% (40/59)] were significantly increased (both P < 0.05). CONCLUSIONS: The use GICU as a friendly management model for elderly critically ill patients is feasible and safe, and it is worthy of further exploration and research.

Astilbin exerts a neuroprotective effect by upregulating the signaling of nuclear NF-E2-related factor 2 in vitro.

Objective: The present study aims to evaluate the impact of Astilbin (AST) on cortical neuron survival in vitro under conditions of oxygen-glucose deprivation and reoxygenation (OGD/R) and determine the role of NF-E2-related factor 2 (Nrf2) in this process. Methods: Primary neurons were pre-treated with various concentrations of AST for 8 h before OGD induction. Cell viability and lactate dehydrogenase (LDH) leakage were assessed to determine the optimal concentration. Biomarkers related to oxidative stress, antioxidant enzyme activities, and apoptosis were evaluated at 24 h post-OGD/R. To investigate the involvement of Nrf2 in AST-mediated neuroprotection, we conducted molecular docking and microscale thermophoresis analyses, as well as examined the expression levels of Nrf2 and its regulatory genes including heme oxygenase-1(HO-1), (NAD(P)H: quinone oxidoreductase 1 (NQO-1), and peroxiredoxin 1 (Prdx1). Additionally, lentivirus-mediated knockdown of Nrf2 and overexpression of Nrf2 with L-sulforaphane (SFN) were performed, followed by an assessment of cell viability, oxidative stress, antioxidant enzyme activities and apoptosis. Results: Pre-treatment with AST reduced oxidative stress levels while increasing antioxidant enzyme activities and mitigating neuronal apoptosis. After OGD/R exposure, AST upregulated nuclear Nrf2 expression and increased the expression of HO-1, NQO-1 and Prdx1 in the cytoplasm. However, the knockdown of Nrf2 abolished the antioxidative and protective effects exerted by AST treatment. Conversely, combining AST with the Nrf2 agonist SFN demonstrated an enhancement in the protective effects provided by AST. These results demonstrate that Nrf2-dependent antioxidant responses contribute to AST-induced tolerance against neuronal injury caused by OGD/R injury. Conclusions: Overall findings support the ability of AST to protect primary neurons from OGD/R-induced damage through activation of Nrf2-dependent antioxidant responses.