To explore the efficacy and safety of oral isavuconazole in the treatment of invasive pulmonary aspergillosis (IPA) through a retrospective study. The clinical and laboratory data of patients admitted to the Respiratory Intensive Care Unit (RICU) of Huaian No.1 People’s Hospital from 1 March 2023 to 29 February 2024, clinically diagnosed with IPA, and treated with oral isavuconazole were retrospectively analyzed. A total of 31 patients were involved, including 10 dead and 21 survivors at 42 days. The average hospitalization time was 21.81 ± 8.03 days. The average usage time of isavuconazole was 25.10 ± 12.87 days, while the survival group was greater than the death group (28.62 ± 12.56 days vs 17.70 ± 10.56 days) (P = 0.025). The average time frame between hospitalization and isavuconazole administration was 9.97 ± 7.08 days. The survival group was significantly shorter than the death group (7.86 ± 4.51 days vs 14.4 ± 9.47 days) (P = 0.013). Among the surviving patients, the average hospitalization time for early use was shorter than that for late use (16.33 ± 2.65 days vs 25.83 ± 5.87 days) (P < 0.001). Laboratory parameters including coagulation function, serum electrolytes, liver and kidney function, and blood routine were not significantly affected by oral isavuconazole (all P > 0.05), and no patient was required to discontinue isavuconzole use due to an adverse event. Early oral administration of isavuconazole may reduce mortality rates and hospitalization time, with fewer adverse reactions and a high level of safety.

Objective:To investigate the association between coffee consumption and hypertension risk. Methods:Using data from the 2005-2020 National Health and Nutrition Examination Survey (NHANES) on 41,685 adults, multivariable logistic regression models examined the relationship between categorical coffee intake (none, >0 to < 1, ≥1 to < 2, ≥2 to < 3, ≥3 to < 4, and ≥4 cups/day) and hypertension, with stratified and curve-fitting analyses. Results:Compared to non-consumers, moderate daily intake of 1-3 cups was significantly associated with lower hypertension odds (OR 0.829-0.869, p < 0.05), more prominently in those < 60 years (OR 0.957, 95% CI 0.940-0.975). Curve fitting revealed a U-shaped association between coffee consumption and hypertension risk. Conclusion:While a moderate coffee intake (1-3 cups/day) was associated with a lower prevalence of hypertension, especially among adults under 60 years, this cross-sectional study cannot establish causality. Further prospective studies are needed to confirm these findings.

Osteosarcoma (OS) is the most common malignant tumor of the bone. This paper aimed to explore the mechanism of macrophage polarization and glycolysis in OS. Gene expression microarray GSE42572 for OS was downloaded from the GEO database and validated in TCGA-SARC. CDKN2A expression in OS cell lines and normal human bone osteoblasts was detected. Saos2 cells were transfected with siRNA-CDKN2A, and U2OS were transfected with pcDNA3.4-CDKN2A to knock down or upregulate CDKN2A expression to explore the role in malignant behaviors. Extracellular acidification rate, oxygen consumption rate, and glycolysis-related proteins were detected. Saos2 cells were co-incubated with THP-1 cells, and CD206 and CD86 levels were detected. The secretion of IL-10 and IL-12 by macrophages was measured. CDKN2A upstream regulatory elements were predicted by online databases, and the binding of TCF19 to the CDKN2A promoter was validated. Xenograft OS was established to verify the effect of TCF19 knockdown on OS growth in mice. CDKN2A was highly expressed in OS tissues and cell lines. CDKN2A knockdown inhibited the proliferation, migration, and invasion of Saos2 cells and promoted apoptosis and glycolysis. After CDKN2A knockdown in Saos2 cells and co-incubation with macrophages, CD206-positive cells decreased, CD86-positive cells increased, IL-10 decreased, and IL-12 increased. TCF19 was enriched on the CDKN2A promoter and promoted CDKN2A expression. Upregulation of CDKN2A by TCF19 promoted glycolysis and M2 polarization. TCF19 downregulation inhibited OS growth, metabolic reprogramming, and CDKN2A expression in OS mice. TCF19 is enriched in the CDKN2A promoter and enhances its expression, which in turn activates glycolysis and M2 polarization, ultimately promoting OS progression.

This study aimed to investigate explore the role of tRF16-ALKBH5 in osteoarthritis (OA). Differential expression of tRF in normal and OA tissues was analyzed using sequencing. OA rats model was established by destabilization of the medial meniscus and anterior cruciate ligament transaction surgeries. The tRF-16 inhibitor or mimic was injected into OA rats and OA symptoms were analyzed. We analyzed the m6A levels in tRF16 inhibitor-treated rat cartilage tissues, ALKBH5 levels, and the binding relationship between tRF16 and ALKBH5. The effect of ALKBH5 on OA rats was analyzed using specific antagonists. Chondrocytes were extracted to establish an OA cell model using IL-1β induction. The effects of tRF16, ALKBH5, and downstream genes on chondrocyte viability were verified. tRF-16 was overexpressed in OA patients and rat models. tRF16 inhibitor improved the symptoms of OA rats and inhibited autophagy and extracellular matrix degradation in IL-1β-induced chondrocytes. tRF16 reduced ALKBH5 expression by targeting ALKBH5, decreased NFKBIA mRNA stability, and activated the NF-kB pathway, thus exacerbating OA progression. Collectively, by binding to ALKBH5, tRF16 promotes the degradation of ALKBH5 and impairs the maintenance of NFKBIA mRNA stability by ALKBH5, promotes the nuclear translocation of phos-p65, leads to the secretion of inflammatory factors, exacerbates OA symptoms.

OBJECTIVES:Pulse transit time (PTT) is used to assess vascular elasticity. We aim to investigate whether respiratory event-related PTT metrics can predict left ventricular (LV) impairment in obstructive sleep apnea (OSA). METHODS:This retrospective study included OSA patients without pre-existing LV impairment who underwent polysomnography from January 2014 to May 2017 at Affiliated Huai'an No.1 People's Hospital and The First Affiliated Hospital of Nanjing Medical University. LV impairment was assessed via echocardiography and blood tests from December 2023 to May 2024. Respiratory event-related PTT metrics (drop rate, magnitude, index, nadir, area) were measured using SOMNOscreen + polysomnographic system. Cox models estimated hazard ratios for LV impairment, and receiver operating characteristic (ROC) curves assessed the predictive value. RESULTS:The sample included 517 individuals (82.8 % male) with a median age of 53.0 years (IQR: 43.0-63.0). Over a median follow-up of 8.3 years, 112 patients (21.7 %) were diagnosed with LV hypertrophy (LVH) and 249 (48.2 %) with LV diastolic dysfunction (LVDD), none had systolic dysfunction. Patients in the fourth quartile of the PTT drop rate had adjusted hazard ratios of 2.49 [95 % CI, 1.38-4.49] for LVH and 3.84 [95 % CI, 2.49-5.92] for LVDD, and 0.53 ng/ml [95 % CI, 0.33-0.73] higher cardiac troponin T than those in the first quartile. No consistent associations were found with other PTT metrics. In ROC analysis, the PTT drop rate showed greater accuracy than traditional metrics in predicting LVDD. CONCLUSIONS:A high respiratory event-related PTT drop rate, reflecting vascular hyperactivity, may help stratify LV impairment risk in OSA.

BACKGROUND:Use of sedatives and analgesics is associated with the occurrence of delirium in critically ill patients receiving mechanical ventilation. Dexmedetomidine reduces the occurrence of delirium but may cause hypotension, bradycardia, and insufficient sedation. This substudy aims to determine whether the combination of esketamine with dexmedetomidine can reduce the side effects and risk of delirium than dexmedetomidine alone in mechanically ventilated patients. METHODS:This single-center, randomized, active-controlled, superiority trial will be conducted at The First Affiliated Hospital of Nanjing Medical University. A total of 134 mechanically ventilated patients will be recruited and randomized to receive either dexmedetomidine alone or esketamine combined with dexmedetomidine, until extubation or for a maximum of 14 days. The primary outcome is the occurrence of delirium, while the second outcomes include the number of delirium-free days; subtype, severity, and duration of delirium; time to first onset of delirium; total dose of vasopressors and antipsychotics; duration of mechanical ventilation; ICU and hospital length of stay (LOS); accidental extubation, re-intubation, re-admission; and mortality in the ICU at 14 and 28 days. DISCUSSION:There is an urgent need for a new combination regimen of dexmedetomidine due to its evident side effects. The combination of esketamine and dexmedetomidine has been applied throughout the perioperative period. However, there is still a lack of evidence on the effects of this regimen on delirium in mechanically ventilated ICU patients. This substudy will evaluate the effects of the combination of esketamine and dexmedetomidine in reducing the risk of delirium for mechanically ventilated patients in ICU, thus providing evidence of this combination to improve the short-term prognosis. The study protocol has obtained approval from the Medical Ethics Committee (ID: 2022-SR-450). TRIAL REGISTRATION:ClinicalTrials.gov: NCT05466708, registered on 20 July 2022.

BackgroundPost-thrombectomy intraparenchymal hyperdensity (PTIH) in patients with acute anterior circulation large vessel occlusion is a common CT sign associated with a higher incidence of futile reperfusion (FR). We aimed to develop a nomogram to predict FR specifically in patients with PTIH.MethodsWe retrospectively collected information on patients with acute ischemic stroke who underwent endovascular thrombectomy (EVT) at two stroke centers. A total of 398 patients with PTIH were included to develop and validate the nomogram, including 214 patients in the development cohort, 92 patients in the internal validation cohort and 92 patients in the external validation cohort. The nomogram was developed according to the independent predictors obtained from multivariate logistic regression analysis, including clinical factors and CT texture features extracted from hyperdense areas on CT images within half an hour after EVT. The performance of the nomogram was evaluated with integrated discrimination improvement (IDI), category-free net reclassification improvement (NRI), the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, and decision curve analyses for discrimination, calibration ability, and clinical net benefits, respectively.ResultsOur nomogram was constructed based on three clinical factors (age, NIHSS score and ASPECT score) and two CT texture features (entropy and kurtosis), with AUC-ROC of 0.900, 0.897, and 0.870 in the development, internal validation, and external validation cohorts, respectively. NRI and IDI further validated the superior predictive ability of the nomogram compared to the clinical model. The calibration plot revealed good consistency between the predicted and the actual outcome. The decision curve indicated good positive net benefit and clinical validity of the nomogram.ConclusionThe nomogram enables clinicians to accurately predict FR specifically in patients with PTIH within half an hour after EVT and helps to formulate more appropriate treatment plans in the early post-EVT period.

Poly-L-lactic acid (PLLA), a well-established biostimulator that induces collagenases, is widely used among clinical practice to treat skin aging. However, the precise regulatory effect of PLLA on different dermal cell subsets beyond fibroblast has not been fully elucidated. In this study, we constructed in vivo PLLA injection and in vitro PLLA-adipocyte co-culture models to analyze the regulatory effects of PLLA on the volume, differentiation, lipolysis, and thermogenic capacity of dermal adipocyte. We found that PLLA injection significantly reduced the thickness of dermal fat in mice. In co-culture assay, PLLA showed no effect on adipogenesis, but stimulated the lipolysis activity. Interestingly, PLLA also enhanced the differentiation of fat cells into beige fat cells, which possess higher thermogenic capacity. In mechanical study, we blocked adipocyte lactate uptake with a monocarboxylate transporter (MCT1/4) inhibitor and found that the regulatory effect of PLLA on dermal adipocyte relies on its metabolite lactate. In summary, our results suggest that PLLA has complex regulatory effects on the dermal cells, and its ability to improve skin aging is not fully attributed to stimulating collagen synthesis, but also partially involves adipocytes. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Chondrocyte degeneration and classically activated macrophage (AM)-related inflammation play critical roles in osteoarthritis (OA). Here, we explored the effects of astaxanthin and Rspo2 on OA in vitro and in vivo. We observed that the Rspo2 gene was markedly elevated in synovial tissues of OA patients compared with healthy controls. In 2D cultures, Rspo2 and inflammatory factors were enhanced in AMs compared with nonactivated macrophages (NMs), and the protein expression levels of Rspo2, β-catenin, and inflammatory factors were increased, and anabolic markers were reduced in osteoarthritic chondrocytes (OACs) compared to normal chondrocytes (NCs). Astaxanthin reversed these changes in AMs and OACs. Furthermore, Rspo2 shRNA significantly abolished inflammatory factors and elevated anabolic markers in OACs. In NCs cocultured with AM, and in OACs cocultured with AMs or NMs, astaxanthin reversed these changes in these coculture systems and promoted secretion of Rspo2, β-catenin and inflammatory factors and suppressed anabolic markers compared to NCs or OACs cultured alone. In AMs, coculture with NCs resulted in a slight elevation of Rspo2 and AM-related genes, but not protein expression, compared to culture alone, but when cocultured with OACs, these inflammatory mediators were significantly enhanced at both the gene and protein levels. Astaxanthin reversed these changes in all the groups. In vivo, we observed a deterioration in cartilage quality after intra-articular injection of Rspo2 associated with medial meniscus (DMM)-induced instability in the OA group, and astaxanthin was protective in these groups. Our results collectively revealed that astaxanthin attenuated the process of OA by abolishing Rspo2 both in vitro and in vivo.

Chondrocyte degeneration and classically activated macrophage (AM)-related inflammation play critical roles in osteoarthritis (OA). Here, we explored the effects of astaxanthin and Rspo2 on OA in vitro and in vivo. We observed that the Rspo2 gene was markedly elevated in synovial tissues of OA patients compared with healthy controls. In 2D cultures, Rspo2 and inflammatory factors were enhanced in AMs compared with nonactivated macrophages (NMs), and the protein expression levels of Rspo2, l3-catenin, and inflammatory factors were increased, and anabolic markers were reduced in osteoarthritic chondrocytes (OACs) compared to normal chondrocytes (NCs). Astaxanthin reversed these changes in AMs and OACs. Furthermore, Rspo2 shRNA significantly abolished inflammatory factors and elevated anabolic markers in OACs. In NCs cocultured with AM, and in OACs cocultured with AMs or NMs, astaxanthin reversed these changes in these coculture systems and promoted secretion of Rspo2, l3-catenin and inflammatory factors and suppressed anabolic markers compared to NCs or OACs cultured alone. In AMs, coculture with NCs resulted in a slight elevation of Rspo2 and AM-related genes, but not protein expression, compared to culture alone, but when cocultured with OACs, these inflammatory mediators were significantly enhanced at both the gene and protein levels. Astaxanthin reversed these changes in all the groups. In vivo, we observed a deterioration in cartilage quality after intra-articular injection of Rspo2 associated with medial meniscus (DMM)-induced instability in the OA group, and astaxanthin was protective in these groups. Our results collectively revealed that astaxanthin attenuated the process of OA by abolishing Rspo2 both in vitro and in vivo.

目的 探讨老年患者大肠埃希菌血流感染的早期临床识别及预后不良的影响因素.方法 回顾性分析2012年6月至2020年10月首次入住首都医科大学附属北京世纪坛医院且生物学标本培养为大肠埃希菌的232例老年患者的临床资料,其中血培养为大肠埃希菌者84例,其他标本培养为大肠埃希菌者148例,结合老年患者的早期临床特征,采用多因素Logistic回归法进行大肠埃希菌血流感染的早期临床识别分析;并根据患者住院期间的预后情况,采用多因素Logistic回归法进行预后不良的危险因素分析.结果 232例老年患者共检出527株大肠埃希菌,其中血培养阳性的84例患者共培养出167株大肠埃希菌,痰培养阳性的62例共培养出137株,尿培养阳性的59例共培养出63株,其他标本培养阳性的78例共培养出160株.与非血流感染组相比,大肠埃希菌血流感染组女性患者更多〔66.7％(56/84)比48.6％(72/148),P<0.05〕,患者年龄更小(岁:67.9±17.8比73.9±17.6,P<0.05),基础疾病中冠心病比例更高〔25.0％(21/84)比35.8％(53/148),P<0.05〕,?且入院时体温及炎症指标C-反应蛋白(CRP)、降钙素原(PCT)更高〔体温(℃):37.1±1.1比36.9±1.0,CRP(mg/L):123.7±78.2比99.0±76.0,PCT(ng/L):6.4(0.6,25.8)比1.5(0.3,1.8),均P<0.05〕;多因素Logistic回归分析显示,患者的性别〔优势比(OR)=2.903,95％可信区间(95％CI)为1.438～5.862,P=0.003〕、年龄(OR=0.975,95％CI为0.956～0.994,P=0.009)和入院时PCT(OR=1.028,95％CI为1.010～1.046,P=0.002)均是影响老年患者发生大肠埃希菌血流感染的独立危险因素.232例患者住院期间预后良好161例,预后不良71例.以预后不良为结局变量进行单因素分析,结果显示,与预后良好组比较,预后不良组年龄更大?(岁:78.7±15.4比68.7±18.1,P<0.05),基础疾病中高血压、糖尿病、冠心病、慢性肾功能不全的比例均较高〔分别为57.7％(41/71)比46.0％(74/161)、45.1％(32/71)比26.7％(43/161)、43.7％(31/71)比26.7％(43/161)、26.8％(19/71)比11.2％(18/161),均P<0.05〕、手术率和体温降低〔手术率:19.7％(14/71)比34.2％(55/161),体温(℃):36.8±1.0比37.1±1.0,均P<0.05〕、呼吸频率(RR)加快(次/min:25.2±7.8比22.5±6.1,P<0.05),提示年龄、高血压、糖尿病、冠心病、慢性肾功能不全及手术、体温、RR均可能与老年患者预后不良有关;多因素Logistic回归分析显示,年龄(OR=1.039,95％CI为1.016～1.062,P=0.001)、入院时体温(OR=0.619,95％CI为0.438～0.875,P=0.007)、RR(OR=1.062,95％CI为1.013～1.113,P=0.012)及既往存在慢性肾功能不全(OR=2.239,95％CI为1.004～4.995,P=0.049)是影响大肠埃希菌感染老年患者预后不良的独立危险因素.结论 性别、年龄及入院时PCT是老年患者发生大肠埃希菌血流感染的独立危险因素,而年龄、入院时低体温、RR及慢性肾功能不全则是大肠埃希菌感染老年患者预后不良的重要因素.

Background Poststroke depression and anxiety, independent predictor of poor functional outcomes, are common in the acute phase of stroke. Up to now, there is no fast-onset antidepressive and anxiolytic agents suitable for the management of acute stroke. ZL006-05, a dual-target analgesic we developed, dissociates nitric oxide synthase from postsynaptic density-95 while potentiates α2-containing γ-aminobutyric acid type A receptor. This study aims to determine whether ZL006-05 can be used as an antistroke agent with fast-onset antidepressant and anxiolytic effects. Methods Photothrombotic stroke and transient middle cerebral artery occlusion were induced in rats and mice. Infarct size was measured by TTC(2,3,5-Triphenyltetrazolium chloride) staining or Nissl staining. Neurological defects were assessed by four-point scale neurological score or modified Neurological Severity Scores. Grid-walking, cylinder and modified adhesive removal tasks were conducted to assess sensorimotor functions. Spatial learning was assessed using Morris water maze task. Depression and anxiety were induced by unpredictable chronic mild stress. Depressive behaviours were assessed by tail suspension, forced swim and sucrose preference tests. Anxiety behaviours were assessed by novelty-suppressed feeding and elevated plus maze tests. Pharmacokinetics, toxicokinetics and long-term toxicity studies were performed in rats. Results Administration of ZL006-05 in the acute phase of stroke attenuated transient and permanent ischaemic injury and ameliorated long-term functional impairments significantly, with a treatment window of 12 hours after ischemia, and reduced plasminogen activato-induced haemorrhagic transformation. ZL006-05 produced fast-onset antidepressant and anxiolytic effects with onset latency of 1 hour in the normal and CMS mice, had antidepressant and anxiolytic effects in stroke mice. ZL006-05 crossed the blood–brain barrier and distributed into the brain rapidly, and had a high safety profile in toxicokinetics and long-term toxicological studies. Conclusion ZL006-05 is a new neuroprotectant with fast-onset antidepressant and anxiolytic effects and has translational properties in terms of efficacy, safety and targeting of clinical issues.

Abstract Background Assessment of the patient’s respiratory effort is essential during assisted ventilation. We aimed to evaluate the accuracy of airway pressure (P aw)-based indices to detect potential injurious inspiratory effort during pressure support (PS) ventilation. Methods In this prospective diagnostic accuracy study conducted in four ICUs in two academic hospitals, 28 adult acute respiratory failure patients undergoing PS ventilation were enrolled. A downward PS titration was conducted from 20 cmH2O to 2 cmH2O at a 2 cmH2O interval. By performing an end-expiratory airway occlusion maneuver, the negative P aw generated during the first 100 ms (P 0.1) and the maximal negative swing of P aw (∆P occ) were measured. After an end-inspiratory airway occlusion, P aw reached a plateau, and the magnitude of change in plateau from peak P aw was measured as pressure muscle index (PMI). Esophageal pressure was monitored and inspiratory muscle pressure (P mus) and P mus–time product per minute (PTPmus/min) were used as the reference standard for the patient’s effort. High and low effort was defined as P mus > 10 and < 5 cmH2O, or PTPmus/min > 200 and < 50 cmH2O s min−1, respectively. Results A total of 246 levels of PS were tested. The low inspiratory effort was diagnosed in 145 (59.0%) and 136 (55.3%) PS levels using respective P mus and PTPmus/min criterion. The receiver operating characteristic area of the three P aw-based indices by the respective two criteria ranged from 0.87 to 0.95, and balanced sensitivity (0.83–0.96), specificity (0.74–0.88), and positive (0.80–0.91) and negative predictive values (0.78–0.94) were obtained. The high effort was diagnosed in 34 (13.8%) and 17 (6.9%) support levels using P mus and PTPmus/min criterion, respectively. High receiver operating characteristic areas of the three P aw-based indices by the two criteria were found (0.93–0.95). A high sensitivity (0.80–1.00) and negative predictive value (0.97–1.00) were found with a low positive predictive value (0.23–0.64). Conclusions By performing simple airway occlusion maneuvers, the P aw-based indices could be reliably used to detect low inspiratory efforts. Non-invasive and easily accessible characteristics support their potential bedside use for avoiding over-assistance. More evaluation of their performance is required in cohorts with high effort.

Abstract Background: Hypoalbuminemia is a common complication in patients with heart disease, which is closely related to the treatment of patients. Especially for patients in department of cardiac surgery, failure to timely intervene in the treatment of hypoproteinemia can easily lead to deterioration of the condition, increase the risk of surgery, and affect the prognosis of patients. Methods: The subjects of this experimental study were patients who underwent cardiac surgery in Nanjing Drum Tower Hospital, China, from October.2020 to October. 2022 .It was a retrospective study. Those patients were excluded from this study, including pregnant patients, patients aged<18 or>80 years, non thoracotomy patients, and patients with preoperative infection and unknown clinical data. A total of 421 patients were included in the study. The preoperative serum albumin level and prognosis of patients undergoing cardiac surgery and admitted to the intensive care unit were retrospectively analyzed. Collect clinical data of patients, as well as serum albumin level, brain natriuretic peptide level, preoperative left ventricular ejection fraction, surgical duration, extracorporeal circulation duration, intraoperative blood transfusion and bleeding volume, postoperative invasive mechanical ventilation time, postoperative brain natriuretic peptide level, postoperative left ventricular ejection fraction, new renal injury rate, new infection rate, secondary intubation rate, secondary thoracotomy rate, icu stay time Data such as total hospitalization time and hospital mortality. To analyze the impact of preoperative hypoproteinemia on the prognosis of patients undergoing cardiac surgery. Results: Of the 421 patients included, 380 were non hypoproteinemia patients before operation, and 41 were patients with hypoproteinemia before operation, accounting for 9.7% of the total number of patients in the group. Except for hypertension, diabetes and chronic renal insufficiency, there was no significant difference between the two groups (P<0.05). The duration of surgery, cardiopulmonary bypass, postoperative mechanical ventilation, and stay time in the intensive care unit in the hypoproteinemia group were significantly longer than those in the normal group (P<0.05). The level of brain natriuretic peptide increased significantly after surgery (P<0.05), and the amount of intraoperative blood transfusion and bleeding in the hypoproteinemia group were significantly higher than those in the normal group (P<0.05). There was no clear correlation between preoperative hypoproteinemia and the occurrence of new infections (P>0.05). At the same time, there was no significant difference between the two groups in terms of new renal injury, secondary intubation, secondary thoracotomy, postoperative left ventricular ejection fraction, and hospital mortality (P>0.05). The above results suggest that preoperative hypoproteinemia can lead to the prolongation of the condition of patients undergoing cardiac surgery, but there was no statistical significance in the incidence of postoperative adverse events. By analyzing the impact of postoperative albumin content on prognosis, it was found that hypoalbuminemia significantly increased the incidence of adverse events in patients within 24 hours after surgery and prolonged the recovery time. There were significant differences between the two groups of patients in terms of new infection rate (53 (29.0%) vs. 38 (16.0%), P=0.001), new kidney injury (45 (24.6%) vs. 35 (14.7%), P=0.010), secondary thoracotomy (7 (3.8%) vs. 0, P=0.002), secondary intubation (10 (5.5%) vs. 4 (1.7%), P=0.032), hospitalization duration （20（16,25） vs. 16（14,20），P=0.000）, and ICU stay duration （72（48,120）vs. 50（45,72），P=0.000）. Conclusion: 1. Preoperative hypoproteinemia can affect the duration of surgery, cardiopulmonary bypass, and icu stay in patients undergoing cardiac surgery. 2. Preoperative hypoproteinemia can lead to increased surgical bleeding and blood transfusion in patients undergoing cardiac surgery, as well as increased brain natriuretic peptide levels after surgery. 3. Preoperative hypoproteinemia had no significant impact on postoperative new infections, renal injury, secondary thoracotomy, mortality, and secondary intubation. 4. Hypoalbuminemia significantly increases the incidence of postoperative adverse events in patients within 24 hours after surgery and prolongs the recovery time.

消化道早癌的及时发现和干预是避免其向进展期癌症发展的关键,其早期发现高度依赖消化内镜的筛查,而传统白光内镜对早癌筛查存在一定的局限性.目前越来越多新的内镜成像技术出现,使得消化道早癌的精准筛查成为可能.

Abstract Background Postoperative pneumonia (PP) is one of the most common complications after cardiac surgery. This study was designed to access the diagnostic value of interleukin-6 (IL-6) for pneumonia within the first 5 days after cardiac surgery in adults. Method This prospective observational study enrolled 694 patients who admitted to our center from 10 October 2020 to 30 June 2021. Blood samples were collected after admission and on five consecutive days after surgery to measure IL-6, procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC) respectively. Combined with clinical data, we assessed the diagnostic performance of different biomarkers using univariate and multifactorial analyses as well as receiver operating characteristic curves (ROC) and the area under the curve (AUC). Result Finally, 68 patients were diagnosed with PP (PP Group). In addition, 626 cases were assigned to the control group (Non-PP Group). From postoperative day 1 (POD1) to day 5, IL-6 and PCT levels showed higher diagnostic value (P < 0.001, P < 0.05, respectively); meanwhile, there was no difference in white blood cell counts between the two groups; CRP showed some value from POD2 onwards (P < 0.001). Among these biomarkers, IL-6 on POD1 [AUC: 0.78, 95% confidence interval (CI): 0.71–0.83], IL-6 on POD2 (AUC: 0.77, 95% CI: 0.71–0.82) and CRP levels on POD3 (AUC: 0.77, 95% CI: 0.70–0.84) had the highest diagnostic value. Multivariate analysis found that smoking status [odds ratio(OR): 7.79, 95% CI: 3.05, 19.88, p < 0.001], drinking status (OR: 22.68, 95% CI: 9.29, 55.37, p < 0.001) and hypertension (OR: 2.85, 95% CI: 1.28, 6.35, p = 0.011), IL-6 on POD2 (OR: 1.01, 95% CI: 1.00, 1.01, p = 0.018), mechanical ventilation time (OR: 1.03, 95% CI: 1.00, 1.05, p = 0.040) and intensive care unit stay time (OR: 1.01, 95% CI: 1.00, 1.02, p < 0.001) were independent risk factors for postoperative pneumonia. Conclusion Smoking, drinking, hypertension, prolonged duration of mechanical ventilation and intensive care unit stay, and IL-6 on POD2 were independent risk factors for pneumonia after cardiovascular surgery. IL-6 level on POD2 may serve as a promising indicator, better than WBC, PCT and CRP.

目的 探讨匀浆膳的使用是否能够降低脑卒中合并脓毒症患者腹泻的发生率.方法 本研究采用回顾性分析276例接受肠内营养治疗的脑卒中合并脓毒症患者,匀浆膳采用3次/d的顿服,而商品化要素类肠内营养制剂采用持续泵入,在肠内营养治疗期间每天评估有无腹泻的发生,直至肠内营养第8d;主要观察指标为在观察期间首次出现腹泻的时间;采用Cox回归分析2组腹泻的发生率是否存在差异.结果 其中132例脑卒中合并脓毒症患者肠内营养治疗使用匀浆膳,144例使用商品化要素类肠内营养制剂;生存分析提示匀浆膳组腹泻的发生率明显降低(P=0.000).在多因素分析当中与商品化的要素类肠内营养制剂比较,匀浆膳的使用明显降低了腹泻的发生风险(风险比=0.383,95％ 可信区间=0.248～0.591,P=0.000).结论 匀浆膳的使用能够降低脑卒中合并脓毒症患者肠内营养治疗过程中腹泻的发生率.

目的 探讨ICU重症肺炎老年患者呼吸道菌群特征及临床意义.方法 纳入重症医学科的60岁以上气管插管重症肺炎患者.入院时即予以气管插管的重症社区获得性肺炎(CAP)患者35例为对照组(A组);入院48 h后予以气管插管重症院内获得性肺炎(HAP)患者45例为研究组(B组).比较两组患者急性生理与慢性健康评估(APACHE)Ⅱ评分、C反应蛋白(CRP)、降钙素原(PCT)等指标.经气管插管留取深部痰液,进行细菌DNA提取.通过Ion S5 XL平台进行高通量测序,对测序结果进行生物信息学分析.结果 A组APACHEⅡ评分、CRP、PCT水平明显高于B组(P<0.05);B组MV时间、CAR时间明显高于A组(P<0.05).在门水平,A组下呼吸道菌群多样性显著高于B组下呼吸道(P<0.05);两组拟杆菌门、厚壁菌门、变形菌门存在明显差异(P<0.05),在属水平,两组不动杆菌属、窄食单胞菌属、链球菌属、棒状杆菌属等存在明显差异(P<0.05).A组肺炎链球菌、类白喉杆菌、乳杆菌、松卟啉单胞菌、牙周梭杆菌、产黑素普雷沃菌占比明显高于B组(P<0.05);B组中鲍曼不动杆菌、嗜麦芽窄食单胞菌占比明显高于A组(P<0.05).结论 HAP患者下呼吸道菌群多样性较CAP下降,HAP患者下呼吸道病原菌以鲍曼不动杆菌、嗜麦芽窄食单胞菌为主,CAP下呼吸道病原菌以口腔定植菌为主.

Purpose Simultaneous occurrence of hypertension and excessive daytime sleepiness (EDS) is very common in obstructive sleep apnea syndrome (OSAS), although no study has specifically addressed this issue. The present study explored the risk factors for co-occurrence of OSAS-related EDS and hypertension. Patients and Methods A total of 161 OSAS patients were studied after undergoing an eight-hour in-laboratory polysomnography for one night. The OSAS severity assessment depends on the number of breathing disturbances per hour of sleep. EDS was defined using the Epworth Sleepiness Scale (ESS) scores of ≥13. Hypertension was defined according to direct cuff blood pressure (BP) measurements. Beat-to-beat R-R interval data were incorporated in polysomnography for heart rate variability analysis. The low-frequency/high-frequency band ratio was used to reflect sympathovagal balance. The study participants were divided into four groups based on the presence of EDS and/or hypertension: EDS with hypertension (n = 53), EDS without hypertension (n = 27), no EDS with hypertension (n = 38), and no EDS or hypertension (n = 43). Clinical, polysomnographic and heart rate data were compared and studied among the four groups. Plasma acetylcholine (ACh) levels were assessed to explore the effects of the non-neuronal cholinergic system and the co-occurrence of EDS and hypertension. Results Patients with EDS and hypertension had more severe OSAS severity indices compared to control patients. Increased cardiac sympathovagal imbalance and nocturnal hypoxemia regulated the presence of EDS and hypertension. Further plasma biomarker analysis revealed that both ESS scores and BP levels were associated with significantly elevated plasma norepinephrine, interleukin-6 and superoxide dismutase levels and significantly decreased ACh levels. Logistic regression analyses showed that ACh was the only factor significantly associated with co-occurrence of EDS and hypertension after controlling for confounders using odds ratio of 0.932, with a 95% confidence interval of 0.868 to 1.000 (P = 0.049). Conclusion The results suggested that OSAS coupled with both EDS and hypertension is a more severe phenotype of the respiratory disorder. The presence of EDS and hypertension was accompanied by sympathovagal imbalance, and co-occurrence of these two conditions may be related to decreased plasma ACh levels.