OBJECTIVE:To analyze the occurrence and clinical characteristics of poor inguinal incision healing after weaning in patients undergoing peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and to explore its risk factors and clinical management strategies. METHODS:A retrospective case-control study was conducted to select VA-ECMO patients admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from February 2022 to February 2025 as the study objects. All patients were weaned from ECMO under open surgery and were divided into normal incision healing group and poor incision healing group according to the healing of the inguinal incision on the side of ECMO catheterization after weaning. The basic data, clinical parameters and laboratory indicators between the two groups were compared, and the risk factors of poor inguinal incision healing after weaning in patients undergoing VA-ECMO were analyzed by univariate and multivariate Logistic regression analyses. RESULTS:Finally, 41 patients undergoing VA-ECMO were enrolled, including 23 males and 18 females. Among the 41 patients, 27 patients had normal inguinal incision healing, 14 patients had poor inguinal incision healing, and the incidence of poor incision healing was 34%. There were statistically significant differences between the two groups of patients in terms of ECMO catheterization location and ECMO catheterization protocol (both P<0.05). The patients in the poor incision healing group often completed ECMO intubation in the operating room, and most of them chose the unilateral semi-incision catheterization protocol. Compared with the normal incision healing group, the length of ICU stay, the duration of mechanical ventilation and the duration of continuous application of vasoactive drugs in the poor incision healing group were longer [length of ICU stay (days): 29.0 (21.0, 39.0) vs. 15.0 (10.0, 19.0), duration of mechanical ventilation (hours): 454.0 (170.0, 789.0) vs. 134.0 (45.0, 269.0), duration of continuous application of vasoactive drugs (days): 18.5 (6.5, 24.3) vs. 5.0 (2.0, 12.0), all P<0.05], 3-day accumulated fluid balance overload after ECMO weaning [mL: 616.5 (-249.3, 2 148.0) vs. -878.0 (-1 603.0, -387.0), P<0.05], suggesting that the poor healing of inguinal incision after VA-ECMO weaning was related to the above factors. The results of univariate Logistic regression analysis showed that unilateral semi-incision catheterization [odds ratio (OR)=21.000, 95% confidence interval (95%CI) was 2.868-153.754, P=0.003], length of ICU stay>10 days (OR=5.571, 95%CI was 1.042-29.790, P=0.045) and positive 3-day accumulated fluid balance after ECMO weaning (OR=16.133, 95%CI was 3.244-80.224, P=0.001) were the risk factors for poor inguinal incision healing after weaning in patients undergoing VA-ECMO. The variables with statistical significance in univariate Logistic regression analysis were incorporated into the binary multivariate Logistic regression model. The analysis results showed that unilateral semi-incision catheterization (OR=13.203, 95%CI was 1.295-134.632, P=0.029) and positive 3-day accumulated fluid balance after ECMO weaning (OR=14.178, 95%CI was 1.985-101.245, P=0.008) were independent risk factors for poor inguinal incision healing after weaning in patients undergoing VA-ECMO. Fourteen patients with poor healing of inguinal incisions presented with massive exudate from the incision (12 cases), delayed incision healing (7 cases), non-healing of the incision (7 cases), incision infection (4 cases), lymphatic leakage (4 cases), and incision dehiscence (3 cases). In addition to routine dressing change, 12 cases underwent negative pressure sealed drainage (VSD), 7 cases underwent reoperation for debridement, and 2 cases underwent flap repair. Four patients died in the ICU with unhealed incisions, 2 patients had unhealed incisions at the time of discharge referral, and the remaining patients' groin incisions eventually healed. CONCLUSIONS:The incidence of poor healing of inguinal incisions after weaning from VA-ECMO is relatively high, mainly manifested as excessive exudate from the incision, delayed incision healing, non-healing of the incision, incision infection, lymphatic leakage, and incision dehiscence. Unilateral semi-incision catheterization and positive 3-day accumulated fluid balance after ECMO weaning are independent risk factors for poor inguinal incision healing in patients undergoing VA-ECMO. Early application of VSD is an effective solution for treating poor incision healing accompanied by a large amount of exudate.

Airway foreign-body aspiration in adults is uncommon but can be life-threatening.Flexible bronchoscopy is the standard first-line therapy,but critically ill patients may need extracorporeal life support.This study aims to characterize the diagnosis,management,and outcomes of adult airway foreign-body cases treated at a single center over nearly 12 years to inform a standardized clinical pathway.A single-center retrospective observational study of consecutive patients aged ≥14 years with confirmed airway foreign body who were treated at a tertiary hospital in China were conducted.Medical records of consecutive adolescent and adult patients diagnosed with airway foreign-body aspiration and admitted to the hospital from 01/01/ 2014-30/11/2025 were reviewed.Data included demographics,imaging,extraction method, respiratory support and so on.Descriptive statistics were reported as medians with interquartile ranges or counts and percentages.A total of 41 patients were included,with a median age of 59.5 years(interquartile ranges 51-72) and 65.85% male.Flexible bronchoscopy was attempted as the primary intervention in 38 patients(92.68%) and succeeded in 81.58%(31/38) to remove airway foreign body.Most patients(78.05%) required only nasal cannula oxygen,while nine patients(21.95%) needed advanced support including mechanical ventilation (14.63%),high-flow oxygen(4.88%),and extracorporeal life support (2.44%).At discharge,most survivors had a good neurological outcome,with 36 patients(87.80%) having a Cerebral Performance Categories score of 1.The 28-day survival rate was 92.68%.These findings show that flexible bronchoscopy is an effective first-line therapy,and rigid bronchoscopy or surgery is useful when flexible bronchoscopy fails.In unstable cases,timely extracorporeal life support can bridge to definitive removal.These results support a tiered,multidisciplinary approach incorporating early chest computed tomography,flexible bronchoscopy,and escalation to advanced airway or extracorporeal support.

Purpose:Failure to wean from mechanical ventilation can lead to prolonged hospital stays, increased incidence of ventilator-associated pneumonia, and higher mortality rates. This study aimed to explore the effectiveness of the diaphragm contraction pressure index (DCPI) in predicting weaning outcomes in patients undergoing mechanical ventilation, providing a scientific basis for successful weaning in clinical practice. Patients and Methods:This prospective observational study included 286 individuals in the derivation cohort and 104 patients in the validation cohort, all of whom completed the spontaneous breathing trial (SBT). During SBT, ultrasound was used to quantify the right hemidiaphragm excursion (DE), diaphragm thickness (DTF) after inspiration and expiration, and DCPI. MIP values were gathered from the mechanical ventilator when the patients breathed peacefully. The derivation cohort determined the cut-off value of DCPI and compared these ultrasound diaphragm parameters. The validation cohort contributes to verifying the accuracy of DCPI. Results:The weaning success group's DCPI in the derivation cohort was significantly higher than that of the weaning failure group (36.67% ± 7.02% vs 24.03% ± 5.78%, P < 0.001). While the area under the receiver operating characteristic curve (ROC) (AUC) of DE, DTF, and MIP was 0.698 (95% CI, 0.615-0.771, P < 0.001), 0.770 (95% CI, 0.693-0.837, P < 0.01), and 0.811 (95% CI, 0.737-0.872, P < 0.001), the ROC of DCPI was 0.954 (95% CI, 0.905-0.982, P < 0.001), indicating good predictive performance for weaning success. The DCPI had a sensitivity of 94.1% and a specificity of 90.8%, with the ideal cut-off value set at ≥30.0%. Similarly, in the validation cohort, the AUC of DCPI for the predicted value is 0.952 (95% CI, 0.854-0.992, P < 0.001). Conclusion:Compared with DTF, DE, and MIP, DCPI dramatically improves the accuracy of predicting successful weaning. Trial Registration:No. ChiCTR2100052470, Registered 28 October 2021.

BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening systemic inflammatory disorder characterized by cytokine storm, coagulation abnormalities, and pancytopenia, which can rapidly progress to multi-organ failure. Although acute respiratory distress syndrome (ARDS) is a less common but severe complication of HLH, veno-venous extracorporeal membrane oxygenation (VV-ECMO) can serve as a lifesaving intervention in cases unresponsive to standard treatments. Emerging case reports indicate that, when appropriately indicated, VV-ECMO can offer substantial clinical benefits. CASE REPORT A 45-year-old woman presented with 1 week of high-grade fever, fatigue, anorexia, and progressive dyspnea. Initial workup showed thrombocytopenia (platelets 30×10⁹/L), elevated C-reactive protein, and bilateral ground-glass opacities on chest computed tomography. Despite lung-protective settings, her PaO₂/FiO₂ ratio stayed below 80 mmHg. VV-ECMO was started on day 2 in the Intensive Care Unit, promptly restoring SpO₂ and reducing vasopressor needs. Further evaluation met HLH-2004 criteria: hyperferritinemia, high soluble CD25, splenomegaly, bone marrow hemophagocytosis, and elevated EBV DNA. Under ECMO support, she received high-dose methylprednisolone (1 g/day×5 days), a prednisone taper, and etoposide on day 18. She was weaned from ECMO on day 8, extubated on day 20, and discharged on day 45, with normalized laboratory values. At the 4-year follow-up, she remained in complete remission. CONCLUSIONS Early VV-ECMO can be life-saving in adult patients with HLH-associated ARDS by providing a window for targeted immunosuppression and chemotherapy. Rapid HLH recognition, multidisciplinary management, and timely ECMO initiation are essential. Further studies should refine patient selection, timing, and integrated treatment protocols.

Acute compartment syndrome (ACS) is a critical condition resulting from increased intra-compartmental pressure, causing tissue ischemia and necrosis. ACS following cardiovascular surgery is rare but catastrophic. Postoperative sedation and analgesia often obscure classic symptoms, delaying diagnosis. This underscores the importance of vigilance and early detection, particularly in high-risk scenarios such as prolonged extracorporeal circulation and femoral artery cannulation. Enhanced monitoring, including tissue oxygen saturation and transcutaneous oxygen pressure, may facilitate timely diagnosis. We report a 56-year-old male who developed ACS after valve replacement surgery involving femoral artery cannulation for cardiopulmonary bypass. Approximately 12 h postoperatively, the patient exhibited severe lower limb swelling, mottling, and diminished dorsalis pedis pulse. Laboratory findings revealed elevated myoglobin and creatine kinase levels. Diagnosis was confirmed via clinical and ultrasound evaluation, prompting emergent fasciotomy. Postoperative management included wound care, renal replacement therapy, and skin flap reconstruction. At 6 months follow-up, the patient achieved complete functional recovery of the affected limb. ACS is a rare but severe complication of cardiovascular surgery. This case highlights the necessity for heightened vigilance, early recognition, and timely intervention to mitigate adverse outcomes. Further studies are needed to validate and establish standardized monitoring protocols and management strategies, including early use of distal perfusion techniques, to improve surgical safety and patient outcomes.

BACKGROUND:Neoadjuvant chemotherapy with paclitaxel and cisplatin (TP regimen) is a cornerstone of treatment for locally advanced laryngeal squamous cell carcinoma. While effective, this regimen can, in rare instances, induce multiple adverse events, including a life-threatening fulminant myocarditis. Characterized by sudden and severe cardiac inflammation leading to cardiogenic shock and arrhythmias, this complication carries a high mortality rate. Its non-specific initial symptoms often mimic more common conditions like acute coronary syndrome, posing significant diagnostic and therapeutic challenges for oncologists and critical care teams. CASE PRESENTATION:We describe the case of a 59-year-old male with laryngeal cancer who, after completing three cycles of neoadjuvant TP chemotherapy and undergoing a total laryngectomy, presented with acute-onset dyspnea and chest pain. His condition rapidly deteriorated into profound cardiogenic shock, characterized by severe hypotension refractory to maximal vasopressor support, and a third-degree atrioventricular block necessitating temporary cardiac pacing. Diagnostic investigations revealed a severely depressed left ventricular ejection fraction (< 30%) with global hypokinesis on echocardiography and exceptionally high serum high-sensitivity troponin I levels (> 27 ng/mL). The patient developed multi-organ failure, including acute kidney and liver injury requiring continuous renal replacement therapy. After emergent coronary angiography ruled out obstructive coronary artery disease and extensive microbiological screenings were negative, a diagnosis of chemotherapy-induced fulminant myocarditis was established. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was promptly initiated to provide biventricular support and restore end-organ perfusion, alongside high-dose corticosteroids and intravenous immunoglobulin. The patient's myocardial function substantially improved over eight days, leading to successful weaning from VA-ECMO. He was subsequently discharged with complete cardiac and renal function recovery. CONCLUSION:This case describes fulminant myocarditis with cardiogenic shock and high-grade atrioventricular block following neoadjuvant paclitaxel-cisplatin chemotherapy for laryngeal cancer. Early initiation of VA-ECMO, together with intensive supportive care and immunosuppressive therapy, was associated with complete recovery of cardiac and renal function. This case underscores the need to consider severe myocarditis in patients receiving TP chemotherapy who present with acute cardiac symptoms, and illustrates that timely use of VA-ECMO can provide an effective bridge to recovery in selected patients.

Background: Peritoneal and intra-abdominal infections (IAIs) are a major cause of morbidity and mortality in surgical patients, with rising antimicrobial resistance (AMR) threatening surgical safety. This study mapped global and regional patterns in IAI burden and resistant pathogens to inform evidence-based surgical practice. Methods: Global IAI deaths, disability-adjusted life years, and distributions of key AMR pathogens were analysed from 1990 to 2021 across 21 Global Burden of Disease (GBD) regions using the Measuring Infectious Causes and Resistance Outcomes for Burden Estimation (MICROBE) database, with future projections through 2050. Results: IAI-related deaths rose from 394,500 (95% Uncertainty Intervals [UI] 361,200 to 427,800) in 1990 to 646,359 (95% UI 585,349 to 707,369) in 2021, with mortality rates increasing from 7.4 (95% UI 6.8 to 8.0) to 8.2 (95% UI 7.4 to 9.0) per 100,000 population. By 2050, global deaths are projected to decrease slightly by 0.6% to 642,485 (95% UI 552,824 to 750,367). However, this decrease is not seen in all regions. The death count is predicted to rise in Latin America and the Caribbean, while substantial declines are projected for South Asia and Central/Eastern Europe and Central Asia. Escherichia coli was the leading global pathogen, with regional variation: Klebsiella pneumoniae predominated in Sub-Saharan Africa, while Staphylococcus aureus (S. aureus) was most frequent in high-income regions. In 2021, AMR-related deaths approached 329,000 worldwide, with the death rate rising from 3.79 to 4.17 per 100,000. Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae showed the most rapid increases. Methicillin-resistant S. aureus mortality remained stable, while efforts to control vancomycin-resistant Enterococcus faecium were less effective. Conclusion: The rising and regionally diverse burden of IAIs, exacerbated by increasing AMR, demands robust surgical antimicrobial stewardship and targeted infection control strategies. Tailoring perioperative antibiotics to local resistance patterns and prioritizing effective source control are essential to optimizing surgical outcomes worldwide.

OBJECTIVE:To investigate the clinical effectiveness of an early mobilization protocol based on the ICU mobility scale (IMS) movement model in intensive care unit (ICU) patients with difficult weaning from mechanical ventilation. METHODS:A quasi-experimental study design was adopted. Patients with difficult weaning admitted to the department of critical care medicine, the First Affiliated Hospital of Wannan Medical College, from February 2022 to February 2023 were assigned to the control group, while those admitted from March 2023 to March 2024 were allocated to the experimental group, all meeting predefined inclusion and exclusion criteria. The control group received conventional early rehabilitation activities, whereas the experimental group received an IMS model-based early mobilization protocol in addition to standard care. General demographic data, Medical Research Council (MRC), Barthel index score, and generalized anxiety disorder-7 (GAD-7) score at the time of enrollment and discharge, diaphragmatic ultrasound parameters (including diaphragm thickness, diaphragm thickening fraction, and diaphragm excursion) at the time of enrollment and 24 hours after extubation, and outcomes-related indicators of each group of patients were collected and compared. RESULTS:A total of 52 patients with difficult weaning were enrolled, including 25 in the control group and 27 in the experimental group. No significant differences were observed between the two groups in terms of gender, age, or other baseline characteristics, indicating comparability. There were no statistically significant differences in MRC scores or Barthel index scores between the groups at enrollment. However, at ICU discharge, the experimental group showed significantly higher MRC scores (44.41±2.61 vs. 35.32±2.75) and Barthel index scores [45 (35, 45) vs. 40 (35, 45), both P < 0.05]. Regarding diaphragmatic ultrasound parameters, no significant differences were found between groups at baseline in diaphragm thickness, diaphragm thickening fraction, or diaphragm excursion. At discharge, the experimental group exhibited a significantly higher diaphragm thickening fraction 24 hours after extubation (%: 26.53 ± 3.74 vs. 24.31±3.71, P < 0.05) and greater diaphragm excursion (cm: 1.80±0.40 vs. 1.52±0.57, P < 0.05). In terms of anxiety status, there was no significant difference in GAD-7 scores between groups at enrollment; however, at discharge, the experimental group had a significantly lower GAD-7 score [12.0 (8.5, 17.0) vs. 16.0 (15.0, 17.0), P < 0.05]. For clinical outcomes, the experimental group had significantly shorter durations of mechanical ventilation (MV) [hours: 144.00 (116.00, 304.00) vs. 396.00 (240.50, 606.50)] and ICU length of stay [days: 12.00 (8.00, 24.00) vs. 24.00 (18.00, 41.50)], both P < 0.05. No significant differences were observed between the two groups in total hospital stay, 48-hour reintubation rate, 48-hour ICU readmission rate, or total hospitalization cost. The overall safety profile during the implementation of the mobilization protocol was favorable. CONCLUSIONS:The early mobilization protocol based on the IMS model for ICU patients with difficulty in weaning can effectively enhance exercise capacity, improve diaphragmatic function, elevate self-care capacity, alleviate anxiety, and shorten the duration of MV and ICU length of stay.

BACKGROUND:Sepsis, characterized by dysregulated host responses to infection, remains a critical global health concern, with high morbidity and mortality rates. The gastrointestinal tract assumes a pivotal role in sepsis due to its dual functionality as a protective barrier against injurious agents and as a regulator of motility. Dexmedetomidine, an α2-adrenergic agonist commonly employed in critical care settings, exhibits promise in influencing the maintenance of intestinal barrier integrity during sepsis. However, its impact on intestinal motility, a crucial component of intestinal function, remains incompletely understood. METHODS:In this study, we investigated dexmedetomidine's multifaceted effects on intestinal barrier function and motility during sepsis using both in vitro and in vivo models. Sepsis was induced in Sprague-Dawley rats via cecal ligation and puncture. Rats were treated with dexmedetomidine post-cecal ligation and puncture, and various parameters were assessed to elucidate dexmedetomidine's impact. RESULTS:Our findings revealed a dichotomous influence of dexmedetomidine on intestinal physiology. In septic rats, dexmedetomidine administration resulted in improved intestinal barrier integrity, as evidenced by reduced mucosal hyper-permeability and morphological alterations. However, a contrasting effect was observed on intestinal motility, as dexmedetomidine treatment inhibited both the frequency and amplitude of contractions in isolated intestinal strips and decreased the distance of ink migration in vivo. Additionally, dexmedetomidine suppressed the secretion of pro-motility hormones while having no influence on hormones that inhibit intestinal peristalsis. CONCLUSION:The study revealed that during sepsis, dexmedetomidine exhibited protective effects on barrier integrity, although concurrently it hindered intestinal motility, partly attributed to its modulation of pro-motility hormone secretion. These findings underscore the necessity of a comprehensive understanding of dexmedetomidine's impact on multiple facets of gastrointestinal physiology in sepsis management, offering potential implications for therapeutic strategies and patient care.

Acetaminophen is a commonly used analgesic after surgery, and its impact on prognosis in patients with acute respiratory distress syndrome (ARDS) has not been studied. This study explores the association between the use of acetaminophen and the risk of mortality in patients with ARDS. In this retrospective cohort study, 3,227 patients with ARDS who had or had not received acetaminophen were obtained from the Medical Information Mart for Intensive Care IV, patients were divided into acetaminophen and non- acetaminophen groups. In-hospital mortality of ARDS patients was considered as primary end point. We used univariate and multivariate Cox regression analyses to assess the relationship of acetaminophen use and in-hospital mortality in patients with ARDS. Subgroup analysis was performed according to age, gender, and severity of ARDS. Of the total patients, 2,438 individuals were identified as acetaminophen users. The median duration of follow-up was 10.54 (5.57, 18.82) days. The results showed that the acetaminophen use was associated with a decreased risk of in-hospital mortality [hazard ratio (HR) = 0.67, 95

BACKGROUND:Sepsis-induced cardiomyopathy (SICM), is defined as a global but reversible dysfunction of both the left and right sides of the heart, which plays a significant role in the pathogenesis of sepsis. Lymphatic vessels are crucial for maintaining tissue fluid balance and regulating inflammatory responses. However, the role of lymphatics in SICM is still unknown. METHODS:The SICM model was established by intraperitoneal injection of lipopolysaccharide (LPS) for 12 h. To evaluate the effects of VEGF-C on LPS-induced SICM, the mice were treated with VEGFC-156S (0.1 mg/kg) via tail vein injection 6 h after LPS challenged and sacrificed 6 h after being treated with VEGFC. To evaluate the effects of the VEGF-C-VEGFR-3 signaling pathway in SICM. MAZ51, a specific inhibitor of VEGFR-3, was given intraperitoneally once daily for a total of 30 days before challenge with LPS. RESULTS:We found that cardiac function was impaired in SICM, along with a significant reduction in the area of lymphatic vessels. Then, we revealed that stimulation of cardiac lymphangiogenesis with vascular endothelial growth factor C (VEGFC) effectively improved cardiac function and promoted neutrophil clearance. Meanwhile, lymphatic inhibition by MAZ51, a specific inhibitor of VEGFR3, could further exacerbate cardiac dysfunction during SICM. Furthermore, the protective effect of VEGFC on SICM could be blocked by MAZ51. Finally, combined with transcriptomics sequencing, we found that VEGFC effectively inhibited the mitogen-activated protein kinase (MAPK) signaling pathway to protect the septic heart. CONCLUSIONS:Our data show that effective lymphatic vessels are necessary for cardiac function and inflammation resolution in SICM. Our findings offer a novel therapeutic approach to SICM by promoting lymphatic function.

OBJECTIVE:To investigate the incidence and risk factors of hypothermia in patients with acute renal injury (AKI) receiving continuous renal replacement therapy (CRRT), and to compare the effects of different heating methods on the incidence of hypothermia in patients with CRRT. METHODS:A prospective study was conducted. AKI patients with CRRT who were admitted to the department of critical care medicine of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from January 2020 to December 2022 were enrolled as the study subjects. Patients were divided into dialysate heating group and reverse-piped heating group according to randomized numerical table method. Both groups were provided with reasonable treatment mode and parameter setting by the bedside physician according to the patient's specific condition. The dialysis heating group used the AsahiKASEI dialysis machine heating panel to heat the dialysis solution at 37 centigrade. The reverse-piped heating group used the Barkey blood heater from the Prismaflex CRRT system to heat the dialysis solution, and the heating line temperature was set at 41 centigrade. The patient's temperature was then continuously monitored. Hypothermia was defined as a temperature lower than 36 centigrade or a drop of more than 1 centigrade from the basal body temperature. The incidence and duration of hypothermia were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the influencing factors of hypothermia during CRRT in AKI patients. RESULTS:A total of 73 patients with AKI treated with CRRT were eventually enrolled, including 37 in the dialysate heating group and 36 in the reverse-piped heating group. The incidence of hypothermia in the dialysis heating group was significantly lower than that in the reverse-piped heating group [40.5% (15/37) vs. 69.4% (25/36), P < 0.05], and the hypothermia occurred later than that in the reverse-piped heating group (hours: 5.40±0.92 vs. 3.35±0.92, P < 0.01). Patients were divided into hypothermic and non-hypothermic groups based on the presence or absence of hypothermia, and a univariate analysis of all indicators showed a significant decrease in mean arterial pressure (MAP) in hypothermic patients (n = 40) compared with the non-hypothermic patients [n = 33; mmHg (1 mmHg ≈ 0.133 kPa): 77.45±12.47 vs. 94.42±14.51, P < 0.01], shock, administration of medium and high doses of vasoactive drug (medium dose: 0.2-0.5 μg×kg-1×min-1, high dose: > 0.5 μg×kg-1×min-1) and CRRT treatment were significantly increased [shock: 45.0% (18/40) vs. 6.1% (2/33), administration of medium and high doses of vasoactive drugs: 82.5% (33/40) vs. 18.2% (6/33), administration of CRRT (mL×kg-1×h-1): 51.50±9.38 vs. 38.42±10.97, all P < 0.05], there were also significant differences in CRRT heating types between the two groups [in the hypothermia group, the main heating method was the infusion line heating, which was 62.5% (25/40), while in the non-hypothermia group, the main heating method was the dialysate heating, which was 66.7% (22/33), P < 0.05]. Including the above indicators in a binary multivariate Logistic regression analysis, it was found that shock [odds ratio (OR) = 17.633, 95% confidence interval (95%CI) was 1.487-209.064], mid-to-high-dose vasoactive drug (OR = 24.320, 95%CI was 3.076-192.294), CRRT heating type (reverse-piped heating; OR = 13.316, 95%CI was 1.485-119.377), and CRRT treatment dose (OR = 1.130, 95%CI was 1.020-1.251) were risk factors for hypothermia during CRRT in AKI patients (all P < 0.05), while MAP was protective factor (OR = 0.922, 95%CI was 0.861-0.987, P < 0.05). CONCLUSIONS:AKI patients have a high incidence of hypothermia during CRRT treatment, and the incidence of hypothermia can be effectively reduced by heating CRRT treatment fluids. Shock, use of medium and high doses of vasoactive drug, CRRT heating type, and CRRT treatment dose are risk factors for hypothermia during CRRT in AKI patients, with MAP is a protective factor.

The upper lip bite test (ULBT) is considered an effective method for predicting difficult airways, but data on the ULBT for predicting difficult tracheal intubation are lacking. This study aimed to examine the clinical utility of the ULBT in predicting difficult endotracheal intubation. We conducted an observational case-cohort study of adult patients undergoing elective surgery and requiring endotracheal intubation for general anesthesia. Difficult airway assessment was performed on the recruited patients before the operation, including the ULBT, mouth opening, thyromental distance, modified Mallampati test, and body mass index. The primary outcome was the incidence of difficult tracheal intubation. The receiver operating characteristic curve analysis was used to compare the performance of variables in predicting difficult tracheal intubation. We successfully recruited 2522 patients for analysis and observed 64 patients with difficult tracheal intubation. When predicting difficult tracheal intubation, grade 2 ULBT had a sensitivity of 0.75 and a specificity of 0.54, and grade 3 had a sensitivity of 0.28 and a specificity of 0.75. Compared with mouth opening, the area under the receiver operating characteristic curve of the ULBT was lower in predicting difficult tracheal intubation (0.69 [95% confidence interval: 0.67–0.71] vs. 0.84 [95% confidence interval: 0.82–0.87], P < 0.05). Clinical Trials Registry : ChiCTR-ROC-16009050, principal investigator: Weidong Yao.

目的 探讨静脉-动脉体外膜氧合(VA-ECMO)联合主动脉球囊反搏(IABP)治疗对重症心源性休克(CS)患者临床预后的影响.方法 回顾性分析2019年4月—2021年12月本院因CS接受VA-ECMO联合IABP治疗的15例患者的临床资料,主要收集指标:心功能、动脉血气和血管活性药使用.次要收集指标:肝肾功能、血常规和凝血功能等.结果 15例患者中男6例(40％),年龄(54.1±15.4)岁,APACHEⅡ评分12-39分,SOFA评分10-26分.VA-ECMO联合IABP治疗时间中位数(四分位数)为6(4,8)天,10例(66.7％)患者存活.与治疗前比较,主要指标:左室射血分数明显改善;肌钙蛋白Ⅰ降低;平均动脉压明显升高;去甲肾上腺素、肾上腺素使用量明显下降;动脉血乳酸降低;PH值升高,差异有统计学意义(P<0.05);次要指标:血小板降低,差异有统计学意义(P<0.05).存活组B型钠尿肽、血红蛋白、肌钙蛋白Ⅰ总体趋势低于死亡组,乳酸持续下降,而平均动脉压及血小板总体趋势高于死亡组.结论 VA-ECMO联合IABP治疗对于CS患者是一种新的治疗手段,提高了治愈率,减少了血管活性药的用量,改善脏器灌注.

OBJECTIVE:To investigate the effect of lateral prone position ventilation in patients with acute respiratory distress syndrome (ARDS). METHODS:A prospective control study was conducted. A total of 75 patients with moderate to severe ARDS admitted to the department of critical care medicine of Jingxian Hospital in Anhui province from January 2020 to December 2022 were selected as the research objects. According to the envelope method, the patients were divided into the lateral prone position ventilation group (38 cases) and the traditional prone position ventilation (PPV) group (37 cases), using lateral prone position ventilation and traditional PPV, respectively. The mechanical ventilation parameters were set according to the ARDS treatment guidelines and lung protective ventilation requirements in both groups, and the time of prone position for the first 3 times was not less than 16 hours per day. General data of patients were recorded, including heart rate (HR), mean arterial pressure (MAP), airway resistance and lung static compliance (Cst) before prone position (T0), 1 hour (T1), 4 hours (T2), 8 hours (T3), and before the end of prone position (T4), oxygenation index (PaO2/FiO2) before the first prone position (t0) and 12 hours (t1), 24 hours (t2), 48 hours (t3), and 72 hours (t4) after the intensive care unit (ICU) admission, as well as the incidence of pressure injury (PI) and vomiting, tracheal intubation time, and mechanical ventilation time. Repeated measures analysis of variance was used to compare the effects of different prone positions on patients before and after the prone position. RESULTS:There were no significant differences in age, gender, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II), underlying diseases, HR, MAP, pH value, PaO2/FiO2, blood lactic acid (Lac), arterial blood pressure of carbon dioxide (PaCO2) and other general information between the two groups. The HR (intergroup effect: F = 0.845, P = 0.361; time effect: F = 1.373, P = 0.247; interaction: F = 0.245, P = 0.894), MAP (intergroup effect: F = 1.519, P = 0.222; time effect: F = 0.169, P = 0.954; interaction: F = 0.449, P = 0.773) and airway resistance (intergroup effect: F = 0.252, P = 0.617; time effect: F = 0.578, P = 0.679; interaction: F = 1.467, P = 0.212) of T0-T4 between two groups showed no significant difference. The Cst of T0-T4 between the two groups showed no significant difference in the intergroup effect (F = 0.311, P = 0.579) and the interaction (F = 0.364, P = 0.834), while the difference in the time effect was statistically significant (F = 120.546, P < 0.001). The PaO2/FiO2 of t0-t4 between the two groups showed no significant difference in the intergroup effect (F = 0.104, P = 0.748) and the interaction (F = 0.147, P = 0.964), while the difference in the time effect was statistically significant (F = 17.638, P < 0.001). The group factors and time factors were tested separately, and there were no significant differences in the HR, MAP, airway resistance, Cst, PaO2/FiO2 between the two groups at different time points (all P > 0.05). The Cst at T1-T4 and PaO2/FiO2 at t1-t4 in the two groups were significantly higher than those at T0/t0 (all P < 0.05). There were no significant differences in the tracheal intubation time [days: 6.75 (5.78, 8.33) vs. 7.00 (6.30, 8.45)] and mechanical ventilation time [days: 8.30 (6.70, 9.20) vs. 7.40 (6.80, 8.75)] between the lateral prone position ventilation group and the traditional PPV group (both P > 0.05). However, the incidences of PI [7.9% (3/38) vs. 27.0% (10/37)] and vomiting [10.5% (4/38) vs. 29.7% (11/37)] in the lateral prone position ventilation group were significantly lower than those in the traditional PPV group (both P < 0.05). CONCLUSIONS:Both lateral prone position ventilation and traditional PPV can improve Cst and oxygenation in patients with moderate to severe ARDS. The two types of prone position have little influence on HR, MAP and airway resistance of patients, and there is no difference in the influence on tracheal intubation time and mechanical ventilation time of patients. However, the lateral prone position ventilation mode can reduce the incidence of PI and vomiting, and is worthy of clinical promotion and application.

Vanadium is a transition metal that naturally occurs in the environment and has a variety of biological and physiological impacts on humans. Sodium orthovanadate (SOV), a well-known chemical compound of vanadium, has shown notable anti-cancer activity in various types of human malignancies. However, the effect of SOV on stomach cancer is yet undetermined. Furthermore, only a few studies have investigated the association of SOV and radiosensitivity with stomach cancer. Our study has investigated the ability of SOV to increase the sensitivity of gastric cancer cells to radiation. To detect autophagy triggered by ionizing radiation and the influence of SOV on cell radiosensitivity, the Cell Counting Kit-8 (CCK8) test, EDU staining experiment, colony formation assay, and immunofluorescence were performed. The possible synergistic effects of SOV and irradiation were examined in vivo using a xenograft mouse model of stomach cancer cells. Both in vitro and in vivo studies showed that SOV markedly reduced the growth of stomach cancer cells and improved their radiosensitivity. Our results showed that SOV increased gastric cancer cells' radiosensitivity, thereby blocking the radiation-induced autophagy-related protein, ATG10. Thus, SOV can be considered a potential agent for radiosensitizing gastric cancer.

BackgroundThe anatomical characteristics of difficult airways can be analysed geometrically. This study aims to develop and validate a geometry-assisted difficult airway screening method (GADAS method) for difficult tracheal intubation.MethodsIn the GADAS method, a geometric simulated model was established based on computer graphics. According to the law of deformation of the upper airway on laryngoscopy, the expected visibility of the glottis was calculated to simulate the real visibility on laryngoscopy. Validation of the new method: Approved by the Ethics Committee of Yijishan Hospital of Wannan Medical College. Adult patients who needed tracheal intubation under general anaesthesia for elective surgery were enrolled. The data of patients were input into the computer software to calculate the expected visibility of the glottis. The results of tracheal intubation were recorded by anaesthesiologists. The primary observation outcome was the screening performance of the expected visibility of the glottis for difficult tracheal intubation.ResultsThe geometric model and software of the GADAS method were successfully developed and are available for use. We successfully observed 2068 patients, of whom 56 patients had difficult intubation. The area under the receiver operating characteristic curve of low expected glottis visibility for predicting difficult laryngoscopy was 0.96 (95% confidence interval [CI]: 0.95-0.96). The sensitivity and specificity were 89.3% (95% CI: 78.1-96.0%) and 94.3% (95% CI: 93.2%-95.3), respectively.ConclusionsIt is feasible to screen difficult-airway patients by applying computer techniques to simulate geometric changes in the upper airway.

低氧血症是指血液中氧分压的明显下降,造成呼吸困难,损害重要器官的功能,导致临床预后不良.氧气疗法是一种常用的支持治疗手段,用于纠正低氧血症和缓解呼吸困难,传统低流量氧疗受到氧气浓度不恒定和湿化不足的限制,难以满足临床救治的需求,因此目前经鼻高流量氧疗常被用于治疗低氧血症.本研究综述了低氧血症成人患者经鼻高流量氧疗新进展,旨在为低氧血症患者的治疗提供指导.