BackgroundFruit and vegetable consumption is linked to oral health in later life, but whether consumption frequency is associated with subsequent tooth-loss transitions across baseline dentition stages remains unclear. We examined these associations in older Chinese adults.MethodsWe used Chinese Longitudinal Healthy Longevity Survey data from 2008, 2011, 2014, and 2018. Participants aged ≥65 years were grouped by baseline dentition; the outcome was incident edentulism in the 1–19-teeth stratum and transition to fewer than 20 teeth in the 20–24 and 25–32-teeth strata. Models mutually adjusted fruit and vegetable consumption frequency. Target-population interpretation prioritised a full baseline-eligible cohort competing-outcome analysis treating death as a competing outcome; additional analyses addressed alternative exposure definitions, differential inclusion, and competing survival.ResultsIn the full baseline-eligible cohort competing-outcome analysis among participants with 1–19 baseline teeth, more frequent vegetable consumption showed an attenuated inverse association with incident edentulism after accounting for death as a competing outcome (HR 0.88, 95% CI 0.73–1.04). In the observed-outcome sample with follow-up tooth counts, the corresponding vegetable estimate was stronger (HR 0.83, 95% CI 0.69–0.99), whereas fruit consumption was not associated with incident edentulism (HR 0.97, 95% CI 0.86–1.09). Associations in the 20–24 and 25–32 baseline-teeth strata were weaker and less consistent.ConclusionAmong older Chinese adults with 1–19 baseline natural teeth, higher vegetable consumption frequency showed only a weak inverse association with incident edentulism when the full baseline-eligible cohort and competing death were considered, whereas fruit consumption remained near null. The stronger estimate from the observed-outcome sample may overstate the association in the target population and should not be interpreted as evidence of an independent protective effect.

Glioblastoma (GBM) is an extremely aggressive and diverse type of brain tumor that is associated with a poor prognosis. Immunogenic cell death (ICD) is a particular form of cellular demise that is closely linked to antineoplastic immune responses. However, it is important to note that the function of ICD in GBM is not yet fully understood. Utilizing single-cell analysis, AddModuleScore, and weighted gene co-expression network analyses (WGCNA), ICD-related genes were identified at both the bulk transcriptome and single-cell levels. Based on these newly identified ICD-related genes, a novel signature for GBM was developed employing three machine learning methods: LASSO, XGBoost, and RandomForest. This prognostic model comprises four characteristic genes: G0S2, NEUROD1, SERPINE2, and LZTS1. The overall survival was significantly lower for the high-risk group compared to the low-risk group in the TCGA-GBM cohort (P < 0.001), CGGA693 cohort (P < 0.001), CGGA325 cohort (P < 0.001), and CGGA301 cohort (P < 0.001). This dichotomy indicates that the riskscore encapsulates a spectrum of tumor microenvironment phenotypes, ranging from immune-permissive (high-risk group) to immune-excluded (low-risk group), with direct implications for therapeutic response. Tumor microenvironment profiling has revealed that the high-risk patients display elevated stromal and immune scores, alongside reduced tumor purity, indicative of a densely infiltrated, macrophage-rich microenvironment. By elucidating the interaction between ICD and macrophage biology, this study establishes a robust prognostic model that surpasses traditional clinical parameters, offering insights into tumor microenvironment immunity and therapeutic vulnerabilities in GBM.

Lung adenocarcinoma (LUAD), a prevalent type of non-small cell lung cancer (NSCLC), was known for its diversity and intricate tumor microenvironment (TME). Comprehending the interaction among human immune-related genes (IRGs) and the TME is vital in the creation of accurate predictive models and specific treatments. We created a risk score based on IRGs and designed a nomogram to predict the prognosis of LUAD accurately. This involved a thorough examination of TME and the infiltration of immune cells in both high-risk and low-risk LUAD groups. Furthermore, the examination of the association between characteristic genes (BIRC5 and BMP5) and immune cells, along with immune checkpoints in the TME, was also conducted. The findings of our research unveiled unique immune profiles and interactions among individuals in the high- and low-risk categories, which contribute to variations in prognosis. LUAD demonstrated significant associations between BIRC5, BMP5, immune cells, and checkpoints, suggesting their involvement in disease advancement and resistance to medication. Furthermore, by correlating our findings with a multidrug database, we identified specific LUAD patient subsets that might benefit from tailored treatments. Our study establishes a groundbreaking prognostic model for LUAD, which not only underscores the importance of the immune context in LUAD but also paves the way for advancing precision medicine strategies in this complex malignancy.

Objective·To assess the effect of veno-arterial extracorporeal membrane oxygenation(VA-ECMO)treatment on the mortality rate of patients suffering from cardiogenic shock and cardiac arrest in hospital.Methods·A total of 19 patients with cardiogenic shock or cardiac arrest who were treated with VA-ECMO treatment in Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine from September 2017 to March 2022 were included in the retrospective study.Patients were divided into extracorporeal cardiopulmonary resuscitation(ECPR)group(n=9)and VA-ECMO for cardiogenic shock(E-CS)group(n=10)according to whether cardiac arrest had occurred.The general demographic data,clinical data,Sequential Organ Failure Assessment(SOFA)scores,postoperative complications and prognostic indicators of the two groups of patients were collected.Univariate and multivariate Cox proportional hazard regression analyses were used to evaluate the correlation between each covariate and hospital mortality.Results·Among the included patients,there were 15 males(78.9％),with an average age of 46.5(34.5,61.6)years.The incidence of postoperative complications was as follows:bleeding(47.4％),AKI(36.8％),infection(31.6％),limb ischemia(15.8％)and cerebrovascular accident(5.3％).The duration of VA-ECMO was 4.0(2.0,6.8)days,and the intensive care duration was 11.5(5.8,26.2)days;the ECMO withdrawal success rate was 63.2％,and the hospital mortality was 63.2％.The results of univariate Cox proportional hazard regression analysis showed that AKI(prior to VA-ECMO initiation),postoperative complications of infection and limb ischemia were correlated with the hospital mortality of patients(all P＜0.05).The results of multivariate Cox proportional hazard regression analysis showed that AKI(prior to VA-ECMO initiation),postoperative complications of infection and limb ischemia were also independent risk factors for the hospital mortality of patients(all P＜0.05).Conclusion·For patients with cardiogenic shock and cardiac arrest treated with VA-ECMO,AKI(prior to VA-ECMO initiation),postoperative infection and limb ischemia are independently associated with higher hospital mortality.

目的 探讨纤维支气管镜肺泡灌洗治疗重症肺炎伴呼吸衰竭患者的治疗效果.方法 选取2019年4月—2022年4月苏州市吴中人民医院收治的70例重症肺炎伴呼吸衰竭患者,以抽签法将患者随机分为两组,各35例.对照组以常规方案治疗,观察组增加纤支镜下肺泡灌洗治疗.对比两组患者疗效、血清炎性反应介质因子、血气指标变化.结果 观察组治疗总有效率为91.43％(32/35),高于对照组的71.43％(25/35),差异有统计学意义(χ2=4.629,P＜0.05).治疗后,观察组CRP、PCT降至(46.91±9.41)mg/L、(2.19±1.13)μg/L,低于对照组的(73.56±11.82)mg/L、(3.76±1.47)μg/L,差异有统计学意义(t=10.436、5.010,P＜0.001);PaO2 升至(80.16±6.41)mmHg,高于对照组的(75.54±6.50)mmHg,PaCO2 降至(39.62±4.61)mmHg,低于对照组的(44.46±5.20)mmHg,差异有统计学意义(t=2.994、4.120,P＜0.05).结论 常规治疗基础上联合纤支镜肺泡灌洗,在重症肺炎伴呼吸衰竭患者的治疗中疗效出众,可加速肺部炎症吸收,改善患者换气功能.

目的 分析行局部枸橼酸抗凝连续床边血液净化期间,不同滤器后游离钙浓度的应用效果.方法 以2021年1月-2022年12月医院收治的63例行连续床边血液净化患者为研究对象,根据滤器后游离钙浓度目标值及组间性别、年龄、急性生理与慢性健康(APACHE Ⅱ)评分、既往基础病史等基线资料均衡可比的原则进行分组.对照组(31 例)以 0.36～0.50mmpl/L为目标值,观察组(32 例)目标值为 0.20～0.35mmol/L,对比两组的滤器后游离钙离子浓度、凝血相关指标、滤器使用寿命以及不良反应发生情况.结果 经对应治疗后,观察组患者的滤器后游离钙浓度较对照组更低,且滤器使用寿命更长久,组间差异有统计学意义(P<0.05);两组患者的活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、血肌酐(Scr)、尿素氮(BUN)水平均较治疗前有所改善,但治疗后两组患者上述各项生化指标比较,差异无统计学意义(P>0.05).观察组患者的总不良反应发生率(6.25%)较对照组(29.03%)更低,组间差异有统计学意义(P<0.05).结论 在局部枸橼酸抗凝的连续床边血液净化期间,不同滤器后游离钙浓度均可取得满意效果,且较低滤器后游离钙浓度可延长滤器使用时间,降低不良反应风险.

目的 探讨间羟胺、去甲肾上腺素治疗脓毒性休克的疗效并分析对肾功能的影响.方法 选取2019年1月—2022年4月吴中人民医院收治的72例脓毒性休克患者为研究对象,按照治疗方案分为对照组和观察组,各36例.对照组以去甲肾上腺素治疗,观察组以间羟胺治疗.对比两组患者生理指标、血清学指标、肾功能指标.结果 治疗后,两组患者HR均下降,MAP上升,差异无统计学意义(P＞0.05);治疗后,两组患者PCT、CRP、LA均下降,差异无统计学意义(P＞0.05);治疗后,观察组每小时尿量、CCr 升至(65.12±15.52)mL/h、(52.16±6.82)mL/min,高于对照组的(41.37±15.91)mL/h、(39.46±6.50)mL/min,BUN、SCr降至(12.31±3.16)、(97.16±12.56)μmol/L,低于对照组的(17.62±3.42)、(131.26±14.20)μmol/L,差异有统计学意义(P＜0.05).结论 间羟胺、去甲肾上腺素在治疗脓毒性休克时均能改善患者心率、血压,促进血清炎性反应缓解,但间羟胺在预防肾功能损伤方面更具优势.

Objective To investigate the efficacy of cefoperazone sodium and sulbactam sodium（CSSS） combined with tigacycline（TG） in the treatment of severe pneumonia caused by multidrug-resistant bacteria. Methods A total of 72patients with severe pneumonia admitted to Suzhou Wuzhong People’s Hospital from January 2020 to June 2022 were randomly divided into two groups, with 36 patients in each group. The control group was treated with antibacterial CSSS alone, and the observation group was treated with antibacterial TG on the basis of the control group. Symptom improvement, therapeutic efficacy, antibacterial effect and adverse reactions were compared between the two groups.Results The total effective rate of observation group was 91.67%, which was higher than that of control group（66.67%）, the difference was statistically significant（χ~2=6.821,P＜0.05）. The clearance rate of observation group was 80.56%, which was higher than that of control group（58.33%）, the difference was statistically significant（χ~2=4.189,P＜0.05）. In the observation group, the body temperature returned to normal, the chest radiograph was normal, the rales disappeared, the length of hospitalization was（5.49±1.92） d,（12.58±3.92） d,（10.83±2.71） d,（16.71±5.16） d, lower than the control group（7.27±2.36） d,（16.14±4.23） d,（13.41±2.76） d,（20.67±5.47） d, the difference was statistically significant（t=3.510, 3.704, 4.000, 3.160,P＜0.05）. The incidence of adverse reactions was 8.33% in the observation group and 5.56% in the control group,the difference was not statistically significan（P＞0.05）. Conclusion CSSS combined with TG has good curative effect and antibacterial effect in the treatment of severe pneumonia with multidrugresistant bacteria, which can shorten the course of the disease of patients. Meanwhile, the safety of combined medication can be guaranteed with low risk of adverse reactions.

Background Oxidative stress (OS) can either lead to leukemogenesis or induce tumor cell death by inflammation and immune response accompanying the process of OS through chemotherapy. However, previous studies mainly focus on the level of OS state and the salient factors leading to tumorigenesis and progression of acute myeloid leukemia (AML), and nothing has been done to distinguish the OS-related genes with different functions. Method First, we downloaded single-cell RNA sequencing (scRNAseq) and bulk RNA sequencing (RNAseq) data from public databases and evaluated the oxidative stress functions between leukemia cells and normal cells by the ssGSEA algorithm. Then, we used machine learning methods to screen out OS gene set A related to the occurrence and prognosis of AML and OS gene set B related to treatment in leukemia stem cells (LSCs) like population (HSC-like). Furthermore, we screened out the hub genes in the above two gene sets and used them to identify molecular subclasses and construct a model for predicting therapy response. Results Leukemia cells have different OS functions compared to normal cells and significant OS functional changes before and after chemotherapy. Two different clusters in gene set A were identified, which showed different biological properties and clinical relevance. The sensitive model for predicting therapy response based on gene set B demonstrated predictive accuracy by ROC and internal validation. Conclusion We combined scRNAseq and bulk RNAseq data to construct two different transcriptomic profiles to reveal the different roles of OS-related genes involved in AML oncogenesis and chemotherapy resistance, which might provide important insights into the mechanism of OS-related genes in the pathogenesis and drug resistance of AML.

BACKGROUND:Myocardial calcification is a rare complication in critically ill patients. The prognosis of myocardial calcifications in critically ill patients is very poor if not treated in a timely manner. We describe a rare case of acute extensive myocardial calcifications due to acute myocarditis after receiving extracorporeal membrane oxygenation (ECMO) support.CASE SUMMARY:We report a 17-year-old male patient who developed extensive myocardial calcifications while receiving prolonged ECMO support for severe myocarditis and cardiogenic shock. Extensive myocardial calcifications were confirmed by chest computed tomography (CT). Myocardial calcifications were observed in the left ventricle walls on CT examination 10 days after admission. The patient was then discharged with heart function class II on the NYHA classification. Two years later, the patient was still alive with adequate quality of life. We then included this patient and 7 other cases retrieved from the PubMed, Cochrane Library, EMBASE, and MEDLINE databases in our study, in order to provide a reference for the clinical diagnosis and treatment of this disease.CONCLUSION:Multiple causes including prolonged hemodynamic failure, profound acidosis, high vasopressor doses, and acute renal failure may jointly lead to extensive myocardial calcifications. The precise role of ECMO support in the timing and frequency of acute myocardial calcifications deserves further investigation.

脓毒症(sepsis)目前研究是一种因机体感染导致所在宿主反应失控,进而演变成致命器官功能障碍的急危重症,多见于一些合并严重疾病、外伤、昏迷等情况的急危重症患者,机体的病情若进一步严重时便进展为脓毒症休克/感染性休克,其致死率高,是目前急危重症患者的可能主要死亡原因之一.脓毒症属于一种涉及到宿主、免疫和炎症、凝血功能、微循环和代谢以及细胞功能等多种机制的全身性炎症反应综合征(SIRS),病情若持续发展,则会导致患者则发生休克、严重休克、MODS(MOF)、甚至可能死亡.脓毒症的治疗也是临床需要面临的难题之一,但目前现有临床上常规的治疗方法一般只能控制患者的病情,总体上来说治疗效果仍欠佳.本文将对脓毒症的病理生理的机制、诊断以及治疗等方面作一综述.

目的 系统评价艾司洛尔控制心室率对脓毒性休克患者血流动力学及预后的影响.方法 计算机检索PubMed、Cochrane library、EMBASE、MEDLINE、OVID、中国生物医学文献数据库、中国知网、万方数字化期刊全文数据库和维普数据库自建库至2020年6月有关艾司洛尔治疗脓毒症患者临床疗效的随机对照试验,由2名评价者独立选择实验、提取资料和评估方法学质量,采用stata 12.0软件进行Meta分析.结果 共纳入9项随机对照实验研究,共计795例受试者(实验组398例,对照组397例).Meta分析结果提示:与使用常规方案治疗脓毒症病人相比,艾司洛尔够明显降低患者28天的病死率[RR=0.67,95％CI(0.56,0.79),P<0.05],降低患者的心率[SMD=-1.94,95％CI(-2.82,-1.05),P<0.05],降低患者平均动脉压[SMD=-1.56,95％CI(-2.86,-0.25),P=0.049],以及改善患者全心舒张末期血容积指数[SMD=0.81,95％CI(0.37,1.25),P<0.01].结论 现有临床结论显示艾司洛尔可以降低脓毒性休克患者的28天病死率、心率、平均动脉压,改善全心脏舒张末期血容积指数.对中心静脉血氧饱和度、血乳酸、心脏指数、心脏每搏指数等影响不大,仍需长期随访的大样本随机对照试验予以评价.

目的 分析重症超声为基础的医疗行为转换在规培生中的应用研究意义.方法 分析2020年1月-2021年8月上海交通大学医学院附属苏州九龙医院ICU收治需要应用PICCO动脉穿刺置管的共计43例的患者的资料,随机分为对照组(n=22)和试验组(n=21),规培医生未应用重症超声导引的PICCO动脉穿刺置管的为对照组,规培医生规范化培训后再应用重症超声导引的PICCO动脉穿刺置管为试验组.观察两组置管总时间、一次性置管成功率、需要上级医师干预的例数、即时并发症(穿刺损伤静脉)例数、远期并发症(导管感染)例数等指标.结果 经过规范化培训重症超声技术及PICCO动脉穿刺置管技术以后,试验组的置管总时间缩短,一次性置管成功率增加,需要上级医师干预的例数相应减少,差异有统计学差异(P<0.05),但在即刻并发症(穿刺损伤静脉)例数、远期并发症(导管感染)例数上无统计学差异(P>0.05).结论 建议在规范化培训的医生入ICU轮转期间,需要进行医疗行为转换,以重症超声技术为基础,规范化进行PICCO动脉穿刺置管的培训及重症超声导引技术培训后再进行PICCO动脉穿刺置管,可以使得置管总时间缩短,一次性置管成功率增加,需要上级医师干预的例数相应减少,以便进一步提高需要住院医师规范化培训医生的在ICU的工作效率,更多次的可独立完成ICU的血管穿刺技术.

目的 分析改良后重症超声流程在多发伤(ISS>16分)患者中的应用价值.方法 分析2020年4月至2020年12月期间急诊收治的60例多发伤(ISS>16分)的患者的资料,排除急诊死亡的患者6例,其余随机分为试验组(n=27)和对照组(n=27),应用改良后的重症超声流程的为试验组,未应用改良后的重症超声流程的为对照组,对照组由医生根据临床经验进行胸片、CT或超声科普通超声筛查.观察患者的住ICU时间,住院时间,抢救成功人数,死亡人数,致残人数,住ICU费用,住院费用等指标.结果 启动创伤中心的多发伤患者应用改良后年的重症超声流程组的住ICU时间,住院时间,住ICU费用,住院费用差异无统计学意义(P>0.05),但在抢救成功人数,死亡人数,致残人数上有统计学差异,应用改良后的重症超声流程组优于常规对照组(P<0.05).结论 建议在急诊ICU收治创伤患者中,全面推行改良后的重症超声流程,又称集束化重症超声技术流程,以期提高多发伤(ISS>16分)患者的抢救成功率,降低病死率和致残率.

目的 回顾性分析不同置管方式下的IABP患者相关指标对比及预后分析.方法 采用回顾性方法,分析笔者所在医院2016年01月至2020年12月,共5年期间收治的18例应用IABP患者的相关资料.分为超声引导下IABP组(n=9)和常规IABP组(n=9),随后进行器官保护下的器官支持,观察患者行IABP置管时间、即刻并发症(误入股静脉)、28天病死率等指标.结果 两组患者在28天病死率上无统计学差异(P>0.05),但IABP置管所用时间、即刻并发症(误入股静脉)上有统计学差异,超声引导下IABP组的置管时间显著快于常规IABP组,且穿刺即刻并发症(误入股静脉)少于常规IABP组(P<0.05).结论 建议在ICU的需要IABP的患者中,超声引导下进行IABP能够缩短IABP置管时间,减少IABP时穿刺损伤并发症,以便更好的救治患者.

目的 简要分析临床病例ECPR抢救成功率及并发症发生率.方法 分析2017年12月至2020年12月期间我院重症医学科收治的12例常规ECMO与ECPR的患者的资料.分为常规ECMO组(n=7)和ECPR组(n=5),两组患者常规给与重症超声置管后上机,重症超声实时监测进行器官支持和器官保护等,观察患者行ECMO术时间(置管时血管穿刺至ECMO成功运转的时间)、并发症(消化道出血及血流感染)、生存率(存活及死亡)等指标.结果 两组患者在并发症(消化道出血及血流感染)上,两组无统计学差异(P>0.05),但两组在行ECMO术时间、生存率上有统计学差异,常规ECMO组优于ECPR组(P<0.05).结论 建议在ICU收治重症患者中,需要尽早评估ECMO指征,充分评估后若患者有ECMO指征则尽早进行ECMO术,以便提高患者的抢救成功率.

目的 探讨降钙素原、C反应蛋白、血小板计数检测及急性胰腺炎严重程度床边指数评分(BISAP)对急性胰腺炎病情程度的预测价值.方法 选取2014年1月至 2018年10月本院诊治的急性胰腺炎(AP)患者132例作为研究对象,根据AP的病情严重程度分为轻症急性胰腺炎(MAP)组(n=78)和重症急性胰腺炎(SAP)组(n=54),比较两组患者各指标的差异,并应用Logistic回归模型和ROC曲线分析降钙素原、C反应蛋白、血小板计数和BISAP评分对AP的预测价值.结果 与MAP组相比,SAP组的PCT、C反应蛋白和BISAP评分均显著提高,而血小板显著降低,差异具有统计学意义(P<0.05).Logistic回归模型和 ROC 曲线结果 显示以上指标均是急性胰腺炎病情程度的独立因素和预测因子(P<0.05).结论 降钙素原、C反应蛋白、血小板计数检测及BISAP评分可作为急性胰腺炎病情严重程度的评价指标之一.

目的 分析ICU临床治疗在90例重度颅脑损伤患者中的临床疗效.方法 将2017年9月至2019年8月间我院ICU病房收治的90例重度颅脑损伤患者进行分组,即:对照组(常规治疗)和实验组(ICU临床治疗),比较临床疗效.结果 实验组患者的并发症发生率低于对照组的并发症发生率,两组患者的并发症发生率对比差异具有统计学意义(P<0.05);针对两组患者实施不同的治疗方式后,实验组患者治疗总有效率显著比对照组要高,差异较大(P<0.05).结论 ICU临床治疗能够有效提高重度颅脑损伤患者的临床疗效,可在临床中进一步应用推广.