This study aimed to investigate the clinicopathological and immunophenotypic significance of Claudin18.2 (CLDN18.2) in pulmonary invasive mucinous adenocarcinoma (IMA), with particular focus on its association with gastric-type differentiation and potential implications for diagnosis and targeted therapy. Immunohistochemistry for CLDN18.2, MUC5AC, MUC6, and PD-L1 (22C3-TPS) was performed in 117 surgically resected lung IMAs. Associations with clinicopathological parameters and overall survival were analysed. Correlation analyses among CLDN18.2, MUC5AC, and MUC6 expression were conducted using Spearman’s rank coefficients to assess the relationship between CLDN18.2 and gastric-type mucin phenotype. CLDN18.2 expression was detected in 71 of 117 tumors (60.7

Empathy and effective communication are core competencies in emergency care, yet structured training explicitly targeting these skills is uncommon in undergraduate curricula. We evaluated whether a Nonviolent Communication (NVC) curriculum, a structured framework centered on observation, feelings, needs, and requests, improves empathy and observed communication performance in undergraduate medical students. We conducted a single-center, parallel-group randomized controlled educational intervention among fourth-year medical students at Nantong University (2024–2025). Participants were randomized to an NVC-based training program (n = 100) or a time- and dose-matched standard curriculum control (active control, n = 98). Empathy was measured using the Jefferson Scale of Physician Empathy (JSPE; primary outcome), and observed communication performance was assessed using the simplified Calgary–Cambridge–Guided communication checklist (SCCG; secondary outcome) in OSCE-style role-play encounters. Primary analyses used linear mixed-effects models with a group-by-time interaction. All 198 randomized students completed baseline and post-course assessments. In the primary mixed-effects models, NVC training produced a significantly larger increase in JSPE than control (group-by-time interaction β = 16.95; 95

Background:The fibrinogen-albumin ratio (FAR) is recognized as a prognostic biomarker in several diseases, but its role in sepsis remains controversial. To elucidate the relationship between FAR and mortality risk in a large cohort of patients with sepsis. Methods:In this retrospective cohort study, we analyzed clinical data from the Medical Information Mart for Intensive Care IV Database (version 2.2) to investigate the mortality of sepsis patients. We employed restricted cubic spline curves and Cox regression models to evaluate the effect of FAR on mortality and conducted subgroup analyses to verify the consistency of our primary findings. Results:In our analysis of 4,615 sepsis patients, we observed that mortality risk initially decreased with increasing FAR values, reaching a minimum at approximately 94.5*10-3, before rising again. Cox regression analysis revealed differing hazard ratios (HRs) for FAR quartiles relative to the second quartile (Q2). At 28 days, adjusted HRs were 1.23 (95% CI: 1.03-1.46) for Q1, 1.14 (0.96-1.36) for Q3, and 1.11 (0.93-1.33) for Q4. By 90 days, these HRs adjusted to 1.25 (1.07-1.46) for Q1, 1.21 (1.04-1.41) for Q3, and 1.21 (1.03-1.42) for Q4. This pattern persisted at 1-year mortality, with HRs of 1.16 (1.00-1.33) for Q1, 1.22 (1.06-1.39) for Q3, and 1.24 (1.07-1.43) for Q4. Conclusion:FAR exhibited a nonlinear, U-shaped association with mortality risk at 28 days, 90 days, and 1 year in patients with sepsis. These findings suggest that FAR may serve as a practical prognostic biomarker to support early risk stratification and clinical decision-making in sepsis care.

Previous studies have demonstrated a significant correlation between immune cells and thyroid cancer (TC). Nevertheless, there remains uncertainty regarding whether this association indicates a causal relationship. We performed a bidirectional Mendelian randomization (MR) analysis to explore the causal relationship between 731 immune phenotypes and thyroid cancer. Our primary analytical method was the inverse variance weighting technique, complemented by supporting analyses using weighted median, MR-Egger, simple mode, and weighted mode. Our results were also robustly assessed using sensitivity analyses to account for heterogeneity and potential horizontal pleiotropy. The results from the inverse variance weighting analysis, which examined 7 groups of immune cells in their antithyroid cancer effects, indicated that 11 immune cell traits were positively correlated with the occurrence and progression of thyroid cancer (odds ratio [OR] > 1, P < .05), while 22 immune cell traits showed a negative correlation (OR < 1, P < .05). In the reverse MR analysis, thyroid cancer was positively associated with 2 immune cell phenotypes (P < .05, OR > 1) and negatively associated with 1 immune cell phenotype (P < .05, OR < 1). None of these findings displayed evidence of heterogeneity, horizontal pleiotropy, or reverse causality (P > .05). This research offers a perspective on the biological mechanisms between thyroid cancer and immune cells, contributing to the exploration of early intervention and treatment options.

Abstract Background The causal relationship between immune cell phenotypes and their interactions with sepsis remains partially understood, with several aspects subject to debate. Our objective was to bidirectionally investigate specific immune cell phenotypes and their association with sepsis. Methods We performed bidirectional Mendelian randomization (MR) analysis using publicly available genome-wide association study (GWAS) summary statistics to investigate the causal links between 731 immunophenotypes and sepsis. We conducted comprehensive sensitivity analyses to ensure robustness and consistency and assess for possible horizontal pleiotropy of our results. Results The analysis, adjusted for multiple comparisons using the Bonferroni method, revealed that increased levels of CD66b + + myeloid cells (Odds Ratio [OR] = 0.945, 95% Confidence Interval [CI]: 0.916–0.974, P = 0.0002, PBonferroni= 0.0089), BAFF-R on IgD- CD38br B cells (OR = 0.919, 95% CI: 0.873–0.966, P = 0.001, PBonferroni = 0.0365), and CD39 on CD39 + CD8br regulatory T cells (OR = 0.927, 95% CI: 0.890–0.966, P = 0.0003, PBonferroni = 0.0116) play a protective role against sepsis, as determined by the inverse variance weighted (IVW) method. Our findings did not reveal any significant impacts of sepsis on immunophenotypes. Conclusions This study highlights the potential protective roles of CD66b + + myeloid cells, BAFF-R on IgD- CD38br B cells, and CD39 on CD39 + CD8br regulatory T cells against sepsis. These insights advance our understanding of the immune system's interaction with sepsis risk and propose new avenues for immunotherapy-oriented interventions.

BACKGROUND:Postoperative acute kidney injury (AKI) after lung transplantation (LTx) is an important factor affecting the short-term outcomes. The focus item of transplantation centers is how to improve the incidence of AKI through optimal management during the perioperative period. OBJECTIVE:The purpose of the study is to investigate the influence of perioperative volume in the development of early AKI following LTx. METHOD:The study involved patients who had undergone LTx between October 2018 to December 2021 at China-Japan Friendship Hospital in Beijing. The patients were monitored for AKI occurring within 72 hours after LTx, as well as the renal outcomes within 30 days. The perioperative volumes were compared and analyzed to determine the impact on various clinical outcomes. RESULTS:248 patients were enrolled in the study ultimately, with almost half of them (49.6 %) experiencing AKI. 48.8 % of AKI patients received continuous renal replacement therapy (CRRT), with 57.7 % recovered by the end of the 30-day follow-up period. A J-shaped relationship was demonstrated between perioperative volume and AKI incidence. Moreover, maintaining a positive fluid balance would increase the 30-day mortality and lead to poor renal outcomes. CONCLUSION:Perioperative volume is an independent risk factor of early AKI after LTx. Positive fluid balance increases the risk of AKI, 30-day mortality, and adverse renal prognosis. The LTx recipients may benefit from a relatively restrict fluid strategy during and after the lung transplantation.

目的 构建并验证基于决策树的急性创伤性脑损伤(traumatic brain injury,TBI)患者早期死亡风险分诊模型,为急诊分诊提供准确、直观的新工具.方法 回顾性收集某院急性TBI患者 2287 例的临床数据,构建早期死亡风险的分诊模型,采用十字交叉验证,并与改良早期预警评分(modified early waring score,MEWS)、修正创伤评分(revised trauma score,RTS)、改良快速急诊医学评分(the modified rapid emergency medicine score,mREMS)及损伤机制格拉斯哥年龄血压评分(mechanism,Glasgow coma scale,age and arterial pressure score,MGAP)比较预测效能.结果 2287 例急性TBI患者中,24 h内发生死亡者 166 例.决策树共3 层,15 个节点,筛选出 6 个解释变量,分别是瞳孔反应性、RTS、MGAP、MEWS、血氧饱和度及收缩压.决策树模型的受试者工作特征曲线下面积为 0.917,高于MEWS、RTS、MGAP评分和mREMS,差异均有统计学意义(均P＜0.05).结论 基于决策树构建的急性TBI患者早期死亡风险分诊模型能准确预测急性TBI患者 24h内死亡风险,可作为医护人员分诊的决策依据.

目的:分析影响脓毒症患者预后的相关因素,构建预后预测模型.方法:脓毒症患者263例,按照患者入院28 d时临床结局分为存活组210例和死亡组53例.收集患者入院24小时内临床相关参数,多因素Logistic回归分析影响脓毒症患者预后的独立危险因素,使用R软件构建列线图预测模型.应用受试者工作特征曲线(receiver operating characteristic curve,ROC)评估列线图模型的区分度,绘制Hosmer-Lemeshow拟合度曲线、递减曲线分析(decline curveanalysis,DCA)评估模型的有效性.结果:呼吸频率、休克、动脉血乳酸、白蛋白、肌酐、总胆红素为脓毒症患者预后不良的独立影响因素.列线图模型预测脓毒症患者预后的ROC曲线下面积为0.824(95％CI 0.755～0.893).列线图模型预测脓毒症患者预后的校正曲线趋近于理想曲线,Hosmer-Lemeshow拟合优度检验结果显示,列线图模型预测脓毒症患者死亡风险的一致性良好,DCA曲线在两条极端曲线之上.结论:呼吸频率、休克、动脉血乳酸、白蛋白、肌酐、总胆红素为脓毒症患者入院28天时死亡的独立危险因素,据此建立的预测模型对脓毒症患者预后的预测具有良好的准确性、区分度及一致性.

Systemic immune-inflammation index (SII) has been identified as a prognostic biomarker for various diseases. Our study aimed to investigate the association between SII and mortality risk in critically ill patients with sepsis, thus exploring possible tools for rapid screening. This retrospective cohort study was conducted using clinical data extracted from the Medical Information Mart for Intensive Care Database. The study included only patients diagnosed with sepsis admitted to the intensive care unit for the first time. We used the restricted cubic splines to explore the relationship between SII and 28-day mortality. Kaplan-Meier curve and Cox regression models were performed to evaluate the association between SII and mortality. Subgroup analysis was performed to explore the stability of the primary results. A total of 16,007 patients with sepsis were eligible in the final analysis. We found a J-shaped relationship between SII and mortality risk. The SII level associated with the lowest mortality risk was 774.46*109/L. Compared with the reference group (second SII quartile), the 28-day mortality was increased in the highest quartile and third quartile groups of SII levels; fully adjusted HRs were 1.16 (1.02 to 1.32) and 1.40 (1.23 to 1.58), respectively. However, although the lower SII (Q1 group) also showed a trend toward a higher hazard of 28-day mortality, there was no statistical difference, with a fully adjusted HR of 1.05 (0.92 to 1.21). In the population of critically ill patients with sepsis, low and high SII levels were associated with an increased risk of short-term mortality. The 28-day mortality risk was lowest at SII levels of 774.46*109/L.

目的 探讨入院时血糖水平与脓毒症患者预后的相关性.方法 选取2016年4月—2021年10月在南通大学附属医院急诊科住院的290例脓毒症患者,根据入院时血糖水平分为正常血糖组(血糖值4.0～7.7 mmol/L)116例、轻度高血糖组(血糖值＞7.7～11.0 mmol/L)95例、严重高血糖组(血糖值＞11.0 mmol/L)79例,并排除了低血糖组.采用限制性立方样条曲线分析血糖水平与28 d死亡率的关系;采用Logistic回归模型分析血糖等级与28 d死亡率的相关性;根据既往是否存在高血压和糖尿病进行亚组分析.结果 290例患者中,28 d内死亡70例(24.1％).与存活组(n=220)比较,死亡组患者年龄更大、序贯器官衰竭评分(SOFA)和急性生理学与慢性健康状况评分系统(APACHE Ⅱ)评分更高,差异有统计学意义(P＜0.05).正常血糖组、轻度高血糖组、严重高血糖组的基线特征资料比较显示,随着高血糖严重程度加剧,高血压和糖尿病的既往患病率更高,差异有统计学意义(P=0.01、P＜0.01),凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)有缩短趋势,差异有统计学意义(P＜0.01);3组28 d死亡率分别为18.1％、22.1％、35.4％,差异有统计学意义(P=0.02).随着血糖水平的增加,患者28 d死亡率的风险升高,二者呈线性关系(非线性检验P=0.856);单因素Logistic回归分析发现,年龄增加、SOFA得分增高、APACHE Ⅱ得分增高、血糖升高程度与28 d死亡率相关(P＜0.05);在多因素回归分析构建的模型1和模型2中,严重高血糖均与28 d死亡率独立相关[OR(95％CI)=2.48(1.25～4.95)、3.38(1.50～7.63)];对既往是否存在高血压和糖尿病进行亚组分析,未发现显著交互作用(P＞0.05).结论 脓毒症患者入院时严重高血糖与28 d死亡风险升高相关,应引起临床医生的重视.

Aluminium phosphide (ALP) and aluminium zinc phosphide (ZnP), the two main ingredients of fumigation drugs, are commonly used to kill insects or rodents in grain. When exposed to water, highly toxic phosphine gas is released and absorbed through the respiratory or digestive tract. Phosphine gas could non-selectively block cytochrome oxidase, inhibit electron transfer and suppress oxidative phosphorylation, leading to cellular hypoxia and organ dysfunction. The characteristic clinical manifestations are refractory shock and metabolic acidosis with high mortality. However, patients with ALP poisoning have a chance to be cured. Here, we report a case of oral ALP poisoning that was successfully treated by extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) during frequent ventricular fibrillation and cardiac dysfunction.

Objectives This study aimed to evaluate the effectiveness of the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate and Systolic blood pressure score (TRIAGES) in predicting 24-hour in-hospital mortality among patients aged 65 years and older with isolated traumatic brain injury (TBI). Design A retrospective, single-centre cohort study. Setting This study was conducted at a government-run tertiary comprehensive hospital. Participants This study included 982 patients aged 65 years or older with isolated TBI, who were admitted to the emergency department between 1 January 2020 and 31 December 2021. Interventions None. Primary outcome 24-hour in-hospital mortality was the primary outcome. Results Among the 982 patients, 8.75% died within 24 hours of admission. The non-survivors typically had higher TRIAGES and lower GCS scores. Logistic regression showed significant associations of both TRIAGES and GCS with mortality; the adjusted ORs were 1.98 (95% CI 1.74 to 2.25) for TRIAGES and 0.72 (95% CI 0.68 to 0.77) for GCS. Receiver operating characteristic (ROC) analysis indicated an area under the ROC curve of 0.86 for GCS and 0.88 for TRIAGES, with a significant difference (p=0.012). However, precision-recall curve (PRC) analysis revealed an area under the PRC of 0.38 for GCS and 0.47 for TRIAGES, without a significant difference (p=0.107). Conclusions The TRIAGES system is a promising tool for predicting 24-hour in-hospital mortality in older patients with TBI, demonstrating comparable or slightly superior efficacy to the GCS. Further multicentre studies are recommended for validation.

为激发规培生的学习兴趣,提高"急诊医学"课程教学质量,文章概述了OBE教育理念和BOPPPS教学模式,提出了基于OBE理念的BOPPPS教学模式在"急诊医学"课程教学中的应用,包括教学改革总体思路、基于OBE理念的BOPPPS教学模式的分析与设计、教学改革的发展策略.

目的 基于基因表达数据库(GEO)分析大鼠中暑神经损伤的基因表达差异,探讨lncRNA-miRNA-mRNA共表达调控网络(ceRNA网络)参与中暑神经损伤的作用.方法 通过GEO数据库检索中暑相关数据集GSE64778获得差异表达基因(differential expression genes,DEGs),结合GeneCards和CTD数据库检索中暑相关靶基因,取交集筛选获得候选靶基因.采用R语言对中暑相关候选靶基因进行GO和KEGG富集分析;进一步STRING数据库构建靶基因的交互作用网络图,并对关键基因进行相关性分析获得核心基因.通过RNAInter、miRWalk及RAID2数据库对候选靶基因的上游miRNA进行预测,再利用miRDB数据库预测与lncRNA靶向结合的miRNA,筛选并构建lncRNA-miRNA-mRNA共表达调控通路.结果 GSE64778数据集的SRA数据筛选,共获得1 178个DEGs,其中322个上调,856个下调.GeneCards数据库筛选到2 914个基因,CTD数据库筛选到2 377个基因.将GSE64778数据集差异表达排名前300的基因,与GeneCards和CTD数据库检索结果取交集,最终筛出25个候选DEGs.GO功能注释结果表明靶基因主要参与细胞凋亡、应激反应以及细胞过程的负调控,在蛋白质二聚化和蛋白结合等过程中发挥功能.KEGG富集分析提示候选靶基因主要富集在PI3K-Akt信号通路.蛋白-蛋白交互作用(PPI)网络分析Hsp90aa1是degree值最高的枢纽基因,且在PI3K-Akt信号通路中富集.对Hsp90aa1基因的上游miRNA以及候选lncRNA的靶miRNA进行预测,锁定3个lncRNAs、8个miRNAs和1个mRNA,DIANA TOOLS数据库通路富集和相关性分析得到LOC102547734与miR-206-3p、miR-206-3p与Hsp90aa1存在靶向结合位点.结论 基于生物信息学分析,中暑神经损伤与细胞凋亡、应激反应以及细胞过程的负调控相关;LOC102547734-miR-206-3p-Hsp90aa1调控网络可能抑制中暑神经损伤的发生.

Objective:To search for genes related to nerve injury in heat stroke (HS) by bioinformatics, the possible molecular mechanism of nerve injury in HS was explored and preliminarily verified.Methods:(1) Taking April 2022 as the time cut-off, the expression profile datas of nerve inject-related genes in thermal radiation disease were screened based on GEO and other databases, and differentially expressed genes (DEGs) were obtained by retrieving datas set GSE64778, combined with GeneCards and CTD databases to retrieve HS related target genes, and the candidate target genes were obtained by intersection screening. The "ClusterProfiler" package in R language was used to perform GO and KEGG enrichment analysis for HS related target genes; STRING database was further used to construct the interaction network map of target genes and correlation analysis of key genes to obtain core genes. (2) Peripheral blood of patients with HS treated in Nantong First People's Hospital of Jiangsu Province from June 2022 to August 2022 were collected, and the expression of core genes were verified by PCR technology.Results:(1) SRA datas screening of the GSE64778 dataset yielded 1178 DEGs, of which 322 were up-regulated and 856 were down-regulated. 2914 genes were screened in the GeneCards database and 2377 genes were screened in the CTD database. The top 300 differentially expressed genes in the GSE64778 dataset were intersected with the search results of GeneCards and CTD databases, and 25 candidate DEGs were finally screened. (2) GO functional annotation results indicated that the target genes were mainly involved in apoptosis, stress response and negative regulation of cellular processes, and functioned in processes such as protein dimerization and protein binding. KEGG pathway enrichment analysis suggested that the candidate target genes were mainly enriched in PI3K-Akt signaling pathway. PPI network analysis suggested that Hsp90AA1 was the hub gene with the highest Degree value and enriched in PI3K-Akt signaling pathway. (3) qRT-PCR confirmed that the expression of Hsp90AA1 in the patients with nerve injury in the early stage of HS was consistent with the results of bioinformatics analysis.Conclusion:Hsp90AA1 may be the main affecting gene of nerve injury in HS, which is related to apoptosis, stress response and negative regulation of cellular processes.

Following the publication of this paper, it was drawn to the Editors' attention by a concerned reader that, for the western blots showing the CtBP1 and SOX2 bands in Fig. 5C on p. 74, the data were in fact the same, but flipped horizontally; moreover, two pairs of overlapping data panels were identified comparing between the cell invasion and assay data images shown in Figs. 3E and 6C, such that these were likely to have been derived from the same original sources even though they were intended to show the results from differently performed experiments; similarly, the 'shSOX2 / 24 h' and 'shCtBP1 / 24  h' data panels in Fig. 6B showing the results of differently performed scratch‑wound assay experiments appeared to be overlapping, albeit with one of the panels being slightly rotated relative to the other. Finally, there were erroneous calculations included for the CtBP1 expression data shown in Table III.  Given the large number of apparent errors that were made during the assembly of various of the figures and Table III in this paper, the Editor of Oncology Reports has decided that this paper should be retracted from the Journal due to an overall lack of confidence in the presented data. After contacting the authors, they accepted the decision to retract this paper. The Editor apologizes to the readership for any inconvenience caused. [Oncology Reports 42: 67‑78, 2019; DOI: 10.3892/or.2019.7142].

目的 通过分析重症中暑患者的临床特征,探讨热射病(heat stroke,HS)辅助诊断的早期敏感临床指标,以期及早干预病情.方法 选择南通大学第二附属医院收治的70例重症中暑住院患者为研究对象,根据患者中暑的严重程度,分为热痉挛与热衰竭组(n=28)、劳力型热射病(exertional heat stroke,EHS)组(n=24)、经典型热射病(classic heat stroke,CHS)组(n=18).记录患者的一般资料及入院24 h的临床检验指标,比较各组患者临床指标的差异,进一步绘制热痉挛与热衰竭组和HS组的受试者工作特征曲线(ROC).结果 70例患者中男性46例,女性24例;平均年龄(65.72±16.64)岁.最高体温(39.66±1.08)℃,住院时间(15.58±14.49)d.61例病情好转,9例死亡.3组患者入院24 h内多项临床指标差异有统计学意义(P＜0.05).其中:EHS组及CHS组的体温高于热痉挛与热衰竭组(P＜0.05),但EHS组、CHS组的体温差异无统计学意义(P＞0.05);EHS组的D-二聚体(DD)、降钙素原(PCT)高于热痉挛与热衰竭组、CHS组(P＜0.05);EHS组的血小板(PLT)、超敏C反应蛋白(CRP)、血钠(Na)、静脉血糖(GLU)、APACHEⅡ低于热痉挛与热衰竭组、CHS组(P＜0.05),PLT的降低最为显著;CHS组糖化血红蛋白(HbA1C)高于热痉挛与热衰竭组、EHS组(均P＜0.05).各指标在热痉挛与热衰竭组、HS组患者间的受试者工作特征曲线显示:各指标均无法同时达到较高的特异度和敏感度;而串联DD、PCT、PLT三者后的AUC上升至0.838(95％CI:0.731～0.916),敏感度为71.43％,特异度为85.71％,该联合指标的诊断效能高于任何单一指标.结论 PLT的显著下降、PCT和DD的增高可能是HS的早期敏感指标,三者联合检测可作为HS早期诊断以及病情危重的参考依据.

Objective:To investigate the predictive value of mechanism Glasgow age blood pressure score (MGAPS), revised trauma score (RTS) and modified rapid emergency medicine score (mREMS) in predicting the mortality risk of patients with acute traumatic brain injury (TBI) within 24 hours.Methods:A case control study was performed for clinical data of 1 156 patients with acute TBI admitted to Affiliated Hospital of Nantong Hospital from January to December of 2020, including 745 males and 411 females; aged 18-100 years [(59.9±15.1)years]. Glasgow coma score (GCS) was 3-15 points [15(9, 15)points]. The patients were divided into death group ( n=87) and survival group ( n=1 069) according to death or not within 24 hours. Vital signs, general data, MGAPS, RTS and mREMS were documented at emergency visit. Differences in the specific scores and severity levels of the patients using the three scoring systems were compared between the two groups. Receiver operating characteristic (ROC) curve was plotted for the three scoring systems based on the specific scores and severity levels of the patients. While the area under the curve (AUC), sensitivity, specificity, optimal threshold and Youden index were determined to estimate the value of the three scoring systems in predicting death risk in patients with acute TBI within 24 hours. Results:Death group showed significantly decreased scores in MGAPS [17(12, 19)points] and RTS [5.0(4.1, 6.0)points] and significantly increased score in mREMS [9(7, 12)points] when compared with survival group (all P<0.01). The proportion of moderate- and high-risk patients for MGAPS and proportion of high-risk patients for RTS and mREMS in death group were significantly higher than those in survival group (all P<0.01). As indicated by the ROC curve plotted based on the specific scores, mREMS had the maximum AUC (0.88), followed by MGAPS (0.86) and RTS (0.86); the sensitivity of mREMS, MGAPS and RTS was similar (80.5%, 86.2% and 82.8%, respectively), while mREMS showed the highest specificity (83.4%) compared to MGAPS (78.0%) and RTS (82.3%); the optimum threshold of mREMS, MGAPS and RTS, was 6 points, 6.08 points and 20 points; the Youden index of MGAPS, RTS and mREMS was 0.64, 0.64 and 0.65. As indicated by the ROC curve plotted based on the injury severity, MGAPS had the highest AUC (0.84), followed by RTS (0.70) and mREMS (0.59); MGAPS also had the highest sensitivity (92.0%), higher than RTS (47.1%) and RTS (18.4%); when mREMS showed the highest specificity(98.8%) compared to RTS (93.7%) and MGAPS (68.8%); the optimal threshold of MGAPS, RTS and mREMS was 22 points, 4 points and 13 points; the Youden index of MGAPS, RTS and mREMS was 0.61, 0.41 and 0.17. Conclusions:MGAPS, RTS and mREMS can be predictive in assessing the mortality risk of patients with acute TBI within 24 hours. mREMS has the highest prediction value, with an optimal threshold of 6 points when the risk assessment is made in accordance with specific scores of the patients. MGAPS has the highest prediction value when the risk assessment is assessed by the injury severity.

Objective:To investigate the effects of levosimendan on renal function in patients with septic cardiomyopathy.Methods:Patients admitted to the Emergency Intensive Care Unit (EICU) of Affiliated Hospital of Nantong University from May 2018 to April 2020 diagnosed with septic cardiomyopathy assessed by pulse-indicator continuous cardiac output (PiCCO) and bedside echocardiograpy and renal ultrasound were retrospectively enrolled and divided into levosimendan group (combined levosimendan with traditional treatment) and control group (traditional treatment). The cardiac index (CI) and other hemodynamic indicators were measured by the PiCCO instrument, the left ventricular ejection fraction (LVEF) and other indicators were measured by bedside echocardiography, and renal blood flow grading and renal resistance index (RRI) were evaluated by bedside renal ultrasound. Changes of hemodynamic indexes and cardiac and renal function at 7 days after treatment were evaluated. The incidence of acute kidney injury (AKI) and the proportion and duration of patients receiving continuous renal replacement therapy (CRRT) for AKI during hospitalization were compared between the two groups, and the clinical outcomes of patients were followed up at 28 days.Results:A total of 56 patients were enrolled, including 25 patients in levosimendan group and other 31 patients in control group. There was no significant difference in baseline characteristics between the two groups (all P>0.05). After 7 days of treatment, compared with the control group, in the levosimendan group, CI was significantly higher [4.5 (3.5, 5.3) L·min -1·m -2 vs. 5.7 (4.6, 7.4) L·min -1·m -2, P=0.004], the LVEF was also significantly higher [40.0 (31.0, 49.0) % vs. 51.0 (39.0, 57.0) % vs, P=0.015], the renal blood flow grading was higher ( P=0.020), and the RRI was significantly lower [0.67 (0.62, 0.74) vs. 0.62 (0.56, 0.69), P=0.034]. There was no significant difference in the proportion of AKI and the proportion of CRRT required between the two groups during hospitalization (all P>0.05); However, the duration of CRRT treatment for AKI in levosimendan group was significantly shorter than that in the control group (56h vs. 73h, P=0.009). There was no significant difference in mortality between levosimendan group and control group at 28 days of follow-up (24.0% vs. 22.6%, P=1.000). Conclusion:In patients with septic cardiomyopathy, levosimendan treatment can improve cardiac function and renal blood flow, and then promote renal function recovery and successful withdrawal of CRRT for those complicating AKI on the treatment of CRRT.