Abstract:Objective To investigate the short-term efficacy of the early rehabilitation protocol after enhanced suture repair surgery of ankle lateral collateral ligament under arthroscopy.Methods A total of 75 patients with lateral ankle ligament injuries who underwent arthroscopic suture-augmented lateral ankle ligament repair at the General Hospital of Northern Theater Command from January 2022 to December 2022 were enrolled in this study.The cohort included 70 males and 5 females,with a mean age of 26.9±6.0 years.Based on postoperative rehabilitation protocols,patients were divided into conventional rehabilitation group(n=39)and early rehabilitation group(n=36).Patients in the conventional rehabilitation group initiated standard exercises including ankle pump training,straight leg raises,and quadriceps isometric contractions immediately after drain removal.The early rehabilitation group received additional interventions,rehabilitation specialists conducted joint assessments and implemented guided rehabilitation(including traditional Chinese medicine directional drug penetration therapy and joint mobilization techniques)continuing through the first postoperative week.After the first postoperative week,both groups underwent further rehabilitation at the rehabilitation department.Outcome measures included visual analog scale(VAS)for pain,limb symmetry index(LSI),American Orthopaedic Foot and Ankle Society(AOFAS)score,and Berg balance scale at one and three months postoperatively,along with adverse event monitoring.Results The patients in this study were followed up for three to seven months,with a follow-up time of(5.1±1.1)months.During the follow-up period,no adverse reactions such as infection,lower limb thrombosis,or nail detachment occurred.There were no statistically significant differences in VAS scores,LSI,AOFAS scores and Berg balance scale scores between the two groups before and at three months after the surgery(P＞0.05).The VAS score,LSI and AOFAS score of the early rehabilitation group were better than those of the conventional rehabilitation group at one month after the surgery,and the differences were statistically significant(P＜0.05).Conclusion The application of early rehabilitation protocol after enhanced suture repair surgery of ankle lateral collateral ligament under arthroscopy can reduce the early pain of patients,and is beneficial to the early rehabilitation exercise of ankle joint function.

Abstract:Objective To investigate the effect of intermittent θ pulse stimulation(iTBS)combined with continuous passive exercise training on the rehabilitation outcomes of patients with anterior cruciate ligament(ACL)injuries after surgery.Method A total of 80 patients with ACL injuries who underwent arthroscopic ligament reconstruction surgery at the jiujiang 171 hospital,from January 2021 to July 2024 were selected.There were 60 male patients and 20 female patients,with an average age of(31.1±6.5)years old,ranging from 19 to 51 years old.According to different rehabilitation methods after surgery,they were divided into the control group(n=39)and the observation group(n=41).The control group received continuous passive movement training,while the observation group received additional iTBS intervention on the basis of the control group.Both groups were continuously intervened for 6 weeks to determine the intervention effect.The early postoperative pain degree,knee joint proprioception before and after intervention,and knee joint function of the two groups were compared.Results Both groups of patients did not experience severe pain.The proportion of patients with moderate pain in the control group was higher than that in the observation group,and the difference was statistically significant(P＜0.05).Before the intervention,there was no statistically significant difference in the 30° and 60° passive angulation errors of the affected knees between the two groups(P＞0.05);after 6 weeks of intervention,the passive angulation errors of the affected knees in both groups decreased,and the passive angulation error of the affected knee in the observation group was smaller than that in the control group,with a statistically significant difference(P＜0.05).Before the intervention,there was no statistically significant difference in the hospital for special surgery knee score(HSS)scores between the two groups(P＞0.05);after 6 weeks of intervention,the HSS scores of both groups increased compared to before the intervention,and the HSS score of the observation group was higher than that of the control group,with a statistically significant difference(P＜0.05).Conclusion The combination of iTBS and continuous passive exercise training can alleviate early postoperative pain in patients with ACL injuries,improve knee proprioception,and promote knee joint function recovery.

Abstract:Objective This study aims to explore the risk factors influencing the occurrence of deep vein thrombosis(DVT)in patients with sepsis.Methods This study was a retrospective case-control study,a total of 160 patients with sepsis were selected from Xiang'an Hospital of Xiamen University from April 2019 to June 2024,including 71 males and 89 females,aged(72.4±6.4)years old,ranging form 61 to 82 years old.Based on whether the patients subsequently developed DVT,they were divided into the DVT group(n=50)and the non-DVT group(n=110).Univariate and multivariate Logistic regression analyses were conducted to identify the risk factors affecting the occurrence of DVT in sepsis patients.The diagnostic efficacy of each risk factor and the combined indicators was analyzed using the receiver operating characteristic curve.Results Logistic regression results indicated that diabetes(OR=3.009,95%CI:1.191 to 7.604),lower limb dysfunction(OR=6.790,95%CI:2.740 to 16.828),elevated D-dimer(OR=6.173,95%CI:2.606 to 14.625),and surgery during hospitalization(OR=2.379,95%CI:1.034 to 5.471)were independent risk factors for the occurrence of DVT in sepsis(P＜0.05).Each of the above four factors had a high impact on diagnostic efficacy,the combined detection had an even higher diagnostic efficacy(P＜0.05).Conclusion Diabetes,lower limb dysfunction,elevated D-dimer,and surgery during hospitalization are independent risk factors affecting the occurrence of DVT in sepsis patients and have high diagnostic efficacy,with combined detection outperforming individual assessments.

Abstract:Objective To develop a 7-day mortality risk prediction model for patients with cancers in the intensive care unit(ICU)based on logistic regression(LR),support vector machine(SVM),random forest(RF),gradient boosting decision tree(GBDT),extreme gradient boosting(XGBoost)and light gradient boosting machine(LightGBM).Methods A total of 4 102 cancer patients in the ICU were selected from the Medical Information Mart for Intensive Care Ⅳ database,including 2 412 males and 1 690 females,with the age of(68.4±12.8)years old,ranging from 20 to 100 years old.The cohort was randomly divided into a training set(n=3 281)and an internal validation set(n=821)at an 8∶2 ratio.In addition,932 cancer patients in the ICU of the Third Affiliated Hospital of Naval Medical University between December 2016 and December 2024 were enrolled as the external validation set,consisting of 699 males and 233 females,with the age of(61.8±11.4)years old,ranging from 19 to 90 years old.Clinical baseline characteristics,vital signs,laboratory parameters and supportive treatment data of the patients were collected and preprocessed.7-day mortality risk prediction models for ICU cancer patients were established based on LR,SVM,RF,GBDT,XGBoost and LightGBM algorithms,and the model performance was evaluated by area under the receiver operating characteristic curve.Results The LightGBM model exhibited the optimal performance,with the area under curve of 0.730(95%CI:0.679 to 0.785)in the internal validation set and 0.806(95%CI:0.736 to 0.866)in the external validation set.Conclusion The LightGBM model demonstrates satisfactory predictive ability for the 7-day mortality risk of cancer patients in the ICU.

Abstract:Objective To investigate the correlation between serum cold-inducible RNA-binding protein(CIRP)and the severity of trauma in patients with severe trauma.Methods A total of 32 patients with severe trauma admitted to the General Hospital of Northern Theater Command from November 2018 to October 2019 were selected,including 26 males and 6 females,aged(49.8±10.5)years old,ranging from 31 to 70 years old.The probability of survival was calculated according to the trauma and injury severity score(TRISS).Patients with the probability of survival≥0.5 were defined as the low-risk group,and patients with the probability of survival＜0.5 were defined as the high-risk group.The baseline data of patients were collected after admission,and the expression levels of CIRP,tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)in serum of patients with severe trauma were determined.Pearson correlation study was used to analyze the correlation between CIRP and the severity of trauma in patients with severe trauma.Results The acute physiology and chronic health score Ⅱ(APACHE Ⅱ),injury severity score and CIRP level of the high-risk group were higher than those of the low-risk group,and the Glasgow coma score(GCS),modified trauma score(RTS),Ps(TRISS)were lower than those of the low-risk group,and the differences were statistically significant(P＜0.05).Pearson results showed that CIRP level in severe trauma patients was positively correlated with APACHE Ⅱ(r=0.392,P=0.027),and was positively correlated with GCS(r=-0.486,P=0.005),RTS(r=-0.532,P=0.002)and Ps(TRISS)(r=-0.666,P＜0.001).Conclusion Serum CIRP level in patients with severe trauma is correlated with the severity of trauma,which can be used as a new trauma assessment index for early identification of high-risk patients,so as to take timely intervention measures to improve the prognosis.

Abstract:Objective To investigate the predictive value of serum miR-126,a disintegrin and a metalloprotease 9(ADAM9)expression for recurrence and metastasis of gastric cancer after radical surgery.Methods From June 2019 to August 2020,a total of 120 gastric cancer patients admitted to the Chongming Hospital Affiliated to Shanghai Health Medical University were selected as the gastric cancer group.This group comprised 66 males and 54 females,with a mean age of(58.2±8.2)years and an age range of 45 to 70 years.Additionally,120 healthy individuals undergoing routine physical examinations during the same period were selected as the healthy control group.QRT-PCR was applied to detect serum miR-126 level.ELISA method was applied to detect serum ADAM9 level.Pearson correlation was applied to analyze the correlation between serum miR-126 and ADAM9 expression levels.Logistic regression was applied to analyze the factors affecting the recurrence and metastasis of gastric cancer patients after radical gastrectomy.Receiver operating characteristic curve was applied to evaluate the predictive value of serum miR-126 and ADAM9 for postoperative recurrence and metastasis of gastric cancer patients undergoing radical surgery.Results The serum miR-126 expression level in the gastric cancer group was lower,and the serum ADAM9 expression level was higher(P＜0.05).There was an obvious difference in the degree of differentiation between the recurrent metastasis group and the non recurrent metastasis group(P＜0.05).Pearson correlation analysis showed a negative correlation between serum miR-126 and ADAM9 expression levels in gastric cancer patients(r=-0.454,P＜0.001).Multivariate Logistic regression analysis showed that serum miR-126 was a protective factor for postoperative recurrence and metastasis in gastric cancer patients undergoing radical surgery,and ADAM9 was a risk factor(P＜0.05).The combined prediction of serum miR-126 and ADAM9 for postoperative recurrence and metastasis of gastric cancer was obviously higher than that of miR-126 alone and ADAM9 alone(P＜0.05).Conclusion The serum miR-126 expression is low and ADAM9 expression is high in patients with recurrence and metastasis of gastric cancer after radical surgery,which is related to the recurrence and metastasis of gastric cancer patients after radical surgery.

Abstract:Objective To explore the risk factors for secondary multiple organ dysfunction syndrome(MODS)in patients with severe pneumonia complicated by acute respiratory distress syndrome(ARDS)and to construct a predictive model.Methods A total of 346 patients with severe pneumonia complicated by ARDS admitted to the Second Affiliated Hospital of Naval Medical University between January 2021 and December 2023 were enrolled,including 181 males and 165 females,aged(62.5±10.8)years old,ranging from 28 to 89 years old.According to the occurrence of MODS,the patients were divided into an occurrence group(n=52)and a non-occurrence group(n=294).Univariate analysis and multivariate Logistic regression analysis were used to screen for risk factors,and a prediction model was constructed accordingly.The area under the receiver operating characteristic curve(AUC)was used to evaluate the discrimination of the model,the Hosmer-Lemeshow test and calibration curves were used to assess calibration,and decision curve analysis(DCA)was used to evaluate clinical net benefit.To further validate the model's generalization ability,150 patients meeting the same inclusion and exclusion criteria from January to December 2024 were collected as an independent validation set for external validation.Results Multivariate logistic regression analysis revealed that advanced age,elevated levels of CRP,elevated procalcitonin,elevated blood lactate,and higher APACHE Ⅱ score were risk factors for secondary MODS(P<0.05).Based on these factors,the prediction model achieved an AUC of 0.874(95％CI:0.831 to 0.917)in the development set,with a sensitivity of 87.06％and a specificity of 83.74％.In the external validation set,the AUC was 0.852(95％CI:0.791 to 0.913),with a sensitivity of 84.62％and a specificity of 80.61％.The Hosmer-Lemeshow test indicated good calibration in both the development set(χ²=1.909,P=0.984)and the validation set(χ²=7.324,P=0.502).DCA demonstrated that the model provided high clinical net benefit across a wide range of threshold probabilities.Conclusion The model constructed based on logistic regression analysis has a high predictive value for secondary MODS in patients with severe pneumonia complicated by ARDS and can be used to predict the risk of secondary MODS in such patients.

Abstract:Objective To investigate the expression of serum lncRNA UCA1 and miR-331-3p in severe infections and their relationship with the severity of the condition and prognosis.Methods A total of 84 critically infected patients admitted to the Jianli People's Hospital from January 2023 to January 2024 were selected,including 39 males and 45 females,aged(49.8±8.1)years old,ranging from 43 to 59 years old.Patients were divided into sepsis group(n=47)and septic shock group(n=37)based on the severity of severe infection.Another 40 healthy individuals who underwent physical examinations at the People's Hospital of Jianli City,Hubei Province during the same period were selected as the health group,with 19 males and 21 females,aged(51.0±8.7)years old,ranging from 42 to 60 years old.Collect general information(age,gender,body mass index,comorbidities,site of infection)and clinical data[C-reactive protein(CPR),white blood cell count,platelet count,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score]of all participants,and record the survival status of severely infected patients one month later as prognosis.Detect the expression levels of serum lncRNA UCA1 and miR-331-3p in the enrolled individuals,predict the interaction between serum lncRNA UCA1 and miR-331-3p,and further study the relationship between various indicators and prognosis in critically infected patients.Results Bioinformatics prediction revealed that there is a targeted binding site between serum lncRNA UCA1 and miR-331-3p.One month later,54 critically infected patients survived and 30 died.Logistic regression analysis showed that APACHEⅡ score and elevated lncRNA UCA1 were independent risk factors for patient prognosis,while elevated miR-331-3p was an independent protective factor for patient prognosis(P<0.05).The results of the subject operating characteristic curve showed that the area under the curve for predicting the prognosis of critically infected patients by combining serum lncRNA UCA1 and miR-331-3p was higher than that predicted by serum lncRNA UCA1 and miR-331-3p alone(P<0.05).Conclusion The expression levels of serum lncRNA UCA1 and miR-331-3p can be used to determine the severity of severe infections,and the combined prediction effect of the two is better than predicting them separately.

Abstract:Objective To investigate the relationship between serum levels of NOD-like receptor protein 3(NLRP3),soluble growth stimulation expressed gene 2 protein(sST2),macrophage migration inhibitory factor(MIF)and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)complicated with heart failure.Methods A total of 155 patients with AECOPD complicated with heart failure in Zhenjiang First People's Hospital from December 2022 to December 2024 were selected,including 104 males and 51 females,aged(64.7±6.6)years old,with an age range of 50 to 80 years old.The incidence of poor 28-day prognosis after admission was counted.Logistic regression was used to analyze the adverse prognostic factors.Smooth curve fitting was used to analyze the linear relationship between NLRP3,sST2,MIF and prognosis in patients with AECOPD combined with heart failure.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of NLRP3,sST2 and MIF in patients with AECOPD combined with heart failure.Results There were 50 cases of poor prognosis in 155 patients with AECOPD combined with heart failure,accounting for 32.26%.Logistic regression analysis showed that blood oxygen saturation,N-terminal pro-brain natriuretic peptide(NT-proBNP),NLRP3,sST2 and MIF were independent prognostic factors for AECOPD patients with heart failure(P<0.05).The results of smoothing curve fitting showed that serum NLRP3,sST2 and MIF were linearly positively correlated with the risk of poor prognosis in patients with AECOPD combined with heart failure(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of NLRP3,sST2 and MIF in predicting poor prognosis in AECOPD patients with heart failure was slightly higher than that of NT-proBNP and blood oxygen saturation,but the difference was not statistically significant(P>0.05).The AUC of serum NLRP3,sST2 and MIF combined to predict the poor prognosis of AECOPD patients with heart failure was 0.898,which was significantly higher than that of serum NLRP3,sST2,MIF,NT-proBNP and oxygen saturation alone(P<0.05).Conclusion Serum NLRP3,sST2 and MIF are independent predictors of prognosis in patients with AECOPD complicated with heart failure.The prediction model constructed by the three shows good predictive efficacy and has certain clinical transformation potential.

Abstract:Objective To explore the application value of lung ultrasound score combined with Ultrasound cardiac output monitor in the weaning of invasive mechanical ventilation for elderly patients in the ICU.Methods A total of 60 elderly patients receiving mechanical ventilation admitted to Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University between April 2023 and June 2024 were selected,including 36 males and 24 females,with an average age of(71.81±8.19)years,ranging from 65 to 89 years.the weaning outcomes were recorded 48 hours after extubation.Based on the weaning results,the patients were divided into a extubation success group and a extubation failure group.The differences in lung ultrasound scores and Ultrasound cardiac output monitor examination indicators(such as cardiac output,cardiac index,and Smith-Madigan inotropic index)between the extubation success group and the extubation failure group were compared.The receiver operating characteristic curve was used to evaluate the predictive value of lung ultrasound scores and Ultrasound cardiac output monitor examination indicators(such as cardiac output,cardiac index,and Smith-Madigan inotropic index)for the weaning outcomes of elderly mechanically ventilated patients.Results Among the 60 patients,the extubation success group comprised 42 cases,while the extubation failure group included 18 cases.The lung ultrasound score in the extubation success group was significantly lower than that in the extubation failure group,with a statistically significant difference(P<0.05).The cardiac index and Smith-Madigan inotropic index in the extubation success group were significantly higher than those in the extubation failure group,with statistically significant differences(P<0.05).However,there was no statistically significant difference in cardiac output between the two groups(P>0.05).The receiver operating characteristic curve was used to evaluate the predictive efficacy of lung ultrasound score,cardiac index,and Smith-Madigan inotropic index for weaning.The AUC value for lung ultrasound score was 0.785,with a cutoff value of 16.5 points,a sensitivity of 77.8%,and a specificity of 71.4%.The AUC value for cardiac index was 0.700,with an optimal cutoff value of 2.15,a sensitivity of 44.4%,and a specificity of 92%.The AUC value for Smith-Madigan inotropic index was 0.817,with a cutoff value of 1.15,a sensitivity of 83.3%,and a specificity of 64.3%.The combined AUC value for the three indicators was 0.893,with a sensitivity of 78.6%and a specificity of 94.4%.Further comparison showed no statistically significant difference in AUC values between the combined assessment of the three indicators and the Smith-Madigan inotropic index alone(P>0.05).However,the AUC value of the combined assessment was significantly higher than those of the lung ultrasound score and cardiac index individually,with statistically significant differences(P<0.05).Conclusion Lung ultrasound scores,along with cardiac index and Smith-Madigan inotropic index measured by ultrasonic cardiac output monitoring,all hold high predictive value for successful extubation in elderly patients undergoing invasive mechanical ventilation,the predictive efficacy of combining these three indicators does not show a clear advantage compared to Smith-Madigan inotropic index alone.

Abstract:Objective To investigate the relationship between prognostic nutrition index(PNI)and the prognosis of patients with acute ischemic stroke,and to establish a nomograph prediction model.Methods A total of 217 patients with acute ischemic stroke diagnosed and treated in Shengjing Hospital of China Medical University from Jan 2016 to Jan 2020 were selected as the research subjects.There were 144 male cases and 73 female cases,with an age range of(67.1±8.1)years old,ranging from 40 to 80 years old.Collect the basic clinical characteristics,laboratory test results and treatment conditions of all patients.The influencing factors of prognosis in patients with acute ischemic stroke were analyzed through the Cox regression model,and a nomogram prediction model was constructed based on the influencing factors of prognosis.Results The best cut-off value of PNI was 46.32,the sensitivity was 63.6%,and the specificity was 82.1%.The 1-year,2-year and 3-year disease-free survival rates were 84.4%,78.2%and 67.9%respectively.According to the PNI cut-off value,it was divided into a low-value group and a high-value group.The 1-year,2-year and 3-year disease-free survival rates in the low-value PNI group were lower than those in the high-value group,and the difference was statistically significant(P<0.05).Multivariate Cox regression analysis showed that age>65 years old,history of hypertension,NIHSS score,early psychological care,and PNI were all independent influencing factors for the prognosis of patients with acute ischemic stroke.The C-index of the nomogram prediction model constructed based on the above independent influencing factors is 0.818.Conclusion PNI can be used as an important index to evaluate the prognosis of patients with acute ischemic stroke.The nomogram prediction model based on PNI can help clinicians to accurately evaluate the survival and prognosis of patients.

Abstract:Objective To explore the relationship between platelet-to-lymphocyte ratio(PLR)and CVD cardiovascular disease(CVD)morality in elderly patients undergoing peritoneal dialysis(PD).Methods This is a retrospective cohort study.We analyzed the clinical data of elderly patients who underwent PD catheterization in our hospital from January 2013 to September 2021.Among the 209 patients,including 95 male and 114 female,aged(69.5±6.5)years old,ranging from 65 to 86 years old.According to the receiver operator characteristic(ROC)curve,we determined the basis for grouping PLR.We divided the subjects into low PLR and high PLR groups.We used Kaplan Meier method to calculate the survival rate and we used Log-rank method to compare the incidence of CVD between the two groups.We use multivariate Cox regression proportional risk model to analyze risk factors that affect prognosis.Results Kaplan-Meier survival curve analysis showed that the incidence of CVD morality in patients with high PLR was higher than that in patients with low PLR(Log-rank χ2=11.374,P=0.001).Multivariate Cox regression analysis showed that PLR(HR=1.002,95%CI:1.000 to 1.004,P=0.011)may be influencing factors for CVD morality in elderly PD patients.Elevated body mass index(HR=0.860,95%CI:0.787 to 0.940,P=0.001)an high serum albumin level(HR=0.950,95%CI:0.903 to 0.999,P=0.047)may serve as protective factors against this adverse outcome.Conclusion Higher PLR may be associated with the risk of CVD morality in elderly PD patients.

Abstract:Objective To compare the effects of aspirin combined with clopidogrel and aspirin combined with ticagrelor on the 5-year prognosis after coronary artery bypass grafting(CABG).Methods A total of 194 patients who underwent elective CABG at the First Affiliated Hospital of Naval Medical University from October 2017 to June 2020 were selected.Among them,129 were male and 65 were female,with an average age of(66.8±5.1)years,and the age range was 50 to 78 years.The patients were randomly divided into the clopidogrel group(n=100)and the ticagrelor group(n=94)using the block randomization method.Within 6 hours after CABG,the groups were initiated and dual antiplatelet therapy(DAPT)was started.1 year after CABG,both groups were switched to long-term single antiplatelet therapy with aspirin.5 years after CABG,the occurrence of major adverse cardiovascular event(MACE),bleeding event(BE),and the patency of the bypass vessel were observed.Results Two patients in the clopidogrel group died,and 3 patients in the ticagrelor group died.The incidence of MACE in the clopidogrel group[12.0%(12/100)]was not statistically different from that in the ticagrelor group[16.0%(15/94)](P>0.05).The incidence of BE in the clopidogrel group[25.0%(25/100)]was not statistically different from that in the ticagrelor group[27.7%(26/94)](P>0.05).The patency rate of the great saphenous vein(GSV)in the clopidogrel group[79.2%(179/226)]was lower than that in the ticagrelor group[86.7%(176/203)],and the difference was statistically significant(P<0.05).The patency rate of the left internal mammary artery in the clopidogrel group[91.7%(88/96)]was lower than that in the ticagrelor group[92.1%(82/89)],but the difference was not statistically significant(P>0.05).Conclusion From the perspective of GSV patency rate,there are significant differences between the two different DAPT intensification treatment strategies after CABG.Aspirin combined with ticagrelor is superior to aspirin combined with clopidogrel.

Abstract:Objective To construct a nomogram model for predicting the risk of post-traumatic chronic disorders of consciousness(pDoC)in patients with severe craniocerebral injury(SCI).Methods A total of 168 patients with severe craniocerebral injury,including 87 males and 81 females,aged(48.2±3.3)years old,rangingfrom 35 to 60 years old,were admitted to the Second Affiliated Hospital of the Air Force Medical University between June 2020 and June 2023 were enrolled.The occurrence of pDoC was assessed.Logistic regression analysis was used to identify influencing factors for pDoC development in these patients.The predictive performance of these factors was evaluated using receiver operating characteristic(ROC)curve analysis.A nomogram prediction model was constructed based on the identified factors.The predictive accuracy of the nomogram model was validated using ROC curves and calibration curves.Results Among the 168 patients with severe craniocerebral injury,121(72.0%)developed pDoC,while 47(28.0%)had normal postoperative consciousness.Logistic regression analysis identified older age,≥2 injury sites,admission GCS score of 3 to 5,presence of neurological complications,occurrence of electrolyte disturbances,and underlying diseases as independent risk factors for pDoC following severe craniocerebral injury(P<0.05).ROC curve analysis demonstrated that age,number of injury sites,admission GCS score,neurological complications,electrolyte disturbances,and underlying diseases had good predictive value for pDoC occurrence in severe craniocerebral injury patients.The nomogram model underwent bootstrap resampling 1000 times to generate a calibration curve,indicating good model discrimination(C-index=0.929).The nomogram model of ROC curve was drawn to evaluate the occurrence of pDoC in patients with severe craniocerebral injury,and it had a high predictive accuracy for the occurrence of pDoC in patients with severe craniocerebral injury(area under curve=0.929,95%CI:0.883 to 0.975).Conclusion Independent risk factors for post-traumatic chronic disorders of consciousness in severe craniocerebral injury patients are older age,≥2 injury sites,admission GCS score of 3 to 5,presence of neurological complications,occurrence of electrolyte disturbances,and underlying diseases.The constructed nomogram model has high reference value and predictive efficacy.

Abstract:Objective To investigate the risk factors for postoperative massive gastrointestinal hemorrhage in type A aortic dissection(TAAD).Methods A total of 204 patients who underwent TAAD surgery in the General Hospital of Eastern Theater Command from January 2012 to December 2022 were selected,including 167 males and 37 females,with an age of(48.3±11.6)years old,ranging from 23 to 82 years old.Compare the preoperative,intraoperative and postoperative relevant indicators between patients who have experienced massive gastrointestinal bleeding and those who have not.Univariate analysis and multivariate Logistic regression analysis were used to explore the risk factors of postoperative massive gastrointestinal bleeding in TAAD patients.Results Logistic regression analysis indicated that preoperative involvement of the celiac trunk or mesenteric artery by the dissection and postoperative implementation of continuous renal replacement therapy were independent risk factors for massive gastrointestinal bleeding(P<0.05).Conclusion Dissection involving celiac trunk or mesenteric artery and postoperative CRRT are independent risk factors for postoperative massive gastrointestinal bleeding in TAAD patients.

Abstract:Objective To investigate the effects of platycodin D on the proliferation,apoptosis,migration,and AKT activity of hypertrophic scar fibroblasts.Methods Hypertrophic scar fibroblasts were treated with 0 μ mol/L,20 μmol/L,40 μmol/L,or 80 μmol/L platycodin D.Cell proliferation was assessed via MTT assay.Cell cycle distribution was analyzed by PI staining after 24-hour treatment,and apoptosis was detected using Annexin V-PI staining.Cell migration was evaluated using the Transwell assay.Western blotting was performed to examine the expression of Cyclin D1,Bcl-2,MMP-2,phospho-AKT(P-AKT),and total AKT proteins.For further analysis,cells were divided into four groups:control(0 μmol/L),platycodin D(40 μmol/L),LY294002 alone(10 μmol/L),and platycodin D(40 μmol/L)+LY294002(10 μmol/L).Cell proliferation,migration,and P-AKT activation were assessed by MTT,Transwell assays,and western blotting.Result The MTT assay results indicated that platycodon-D at different concentrations significantly inhibited cell proliferation,and the inhibitory effect became more pronounced with increasing drug concentration and treatment duration.Cell cycle analysis showed that platycodon-D at different concentrations upregulated the proportion of cells in the G1 phase and downregulated the proportion of cells in the S phase.Annexin V-PI staining results indicated that platycodon-D at different concentrations significantly promoted apoptosis.The transwell assay results showed that platycodon-D at different concentrations significantly inhibited cell migration.Western blot demonstrated that platycodon-D downregulated the expression of Cyclin D1,Bcl-2,MMP2,and P-AKT proteins.Pretreatment with LY294002 did not further enhance the inhibitory effects of platycodon-D on proliferation,migration,and P-AKT activation.Conclusion Platycodin D can inhibit the activation of P-AKT and downregulate the protein expression of Cyclin D1,Bcl-2,and MMP2,thereby suppressing the growth and migration of hypertrophic scar fibroblasts.

Abstract:Objective To explore the application value of monitoring the level of small and dense low-density lipoprotein cholesterol(sdLDL-C)in patients with acute ischemic stroke(AIS)for the prognosis of antiplatelet therapy.Methods A total of 120 AIS patients were selected from January 2022 to January 2023 in Nanjing Jiangbei Hospital,including 68 males and 52 females,aged(71.3±8.0)years old,ranging from 45 to 87 years old.All of whom were treated with dual antiplatelet therapy,and the changes in sdLDL-C levels during antiplatelet therapy were monitored.According to the prognosis criteria of recurrence after 1 year of dual antiplatelet therapy,they were divided into patients with poor prognosis and patients with good prognosis.The clinical data,laboratory indexes before treatment and sdLDL-C levels before treatment,1 month,2 months and 3 months after treatment were compared between patients with poor prognosis and patients with good prognosis.Logistic regression analysis was used to explore the prognostic factors of antiplatelet therapy in AIS patients.The receiver operator characteristic(ROC)curve was used to analyze the predictive value of sdLDL-C level in evaluating the prognosis of antiplatelet therapy.Results There were significant differences in age,infarct size,baseline NIHSS score,sdLDL-C before treatment,sdLDL-C after 1 month of treatment,sdLDL-C after 2 months of treatment and sdLDL-C after 3 months of treatment between patients with good prognosis and patients with poor prognosis(P<0.05).The results of Logistic regression analysis showed that age,sdLDL-C level and large area infarction were independent risk factors for the prognosis of antiplatelet therapy in AIS patients(P<0.05).ROC curve results showed that sdLDL-C levels before treatment,1 month,2 months and 3 months after treatment could be used to evaluate the prognosis of antiplatelet therapy in AIS patients(P<0.05).Conclusion During antiplatelet therapy for AIS patients,the level of sdLDL-C gradually decreases,and its level change is related to prognosis.

Abstract:Objective To construct the Nomogram prediction model based on the new intensive care unit(ICU)critical illness score scale and traditional score scale for the death of the patients in ICU.Methods A total of 1 200 patients in ICU of our Hospital from December 2019 to December 2023 were selected.Among the patients,there were 743 males and 457 females,with an average age of(62.5±8.3)years old,ranging from 51 to 74 years old.The patients were randomly divided into the modeling group(n=840)and validation group(n=360).A new critical illness score scale(hereinafter referred to as the'Table')was created by using the baseline data from the modeling group.Basing on the Table score,modified early warning score(MEWS),acute physiology and chronic health evaluation Ⅱ score(APACHEⅡ),sequential organ failure score(SOFA),Tilburg frailty indicator.Nomogram prediction model for the death of the patients in ICU was constructed and verified.Results High Table,MEWS,APACHEⅡ,and SOFA scores were independent risk factors affecting the death rate in the modeling group(P<0.05).Nomogram model was constructed based on the 4 predictive factors mentioned above.The model had good consistency and could provide clinical net benefits.Area under the curve predicted by the model for death in the modeling group and validation group were 0.883 and 0.874,respectively.Receiver operating characteristic curves of the two groups were well fitted(P>0.05).Conclusion The prediction performance of Nomogram model based on the new Table and traditional score scales for the death of the patients in ICU can meet the clinical requirements.The application of it can provide some reference for reducing the death rate of the patients.

Abstract:Objective To compare the efficacy and safety of ciprofol and propofol in induction of general anesthesia for acute Stanford type A aortic dissection surgery.Methods From February 2023 to December 2023,60 patients with acute Stanford type A aortic dissection were selected from the General Hospital of Northern Theater Command,including 33 males and 27 females,aged(67.8±9.1)years old,ranging from 58 to 75 years old.The patients were randomly divided into two groups:Ciprofol group(n=30)and Propofol group(n=30).Anesthesia was induced by intravenous injection of ciprofol 0.4 mg/kg or propofol 2.0 mg/kg,respectively.The effectiveness indexes[the success rate of general anesthesia induction,the time of successful induction,the time of disappearance of eyelash reflex,the number of additional cases,the number of additional times)and security indexs(the systolic blood pressure(SBP)、mean arterial pressure(MAP)、diastolic blood pressure and heart rate at T0(before anesthesia),T1(eyelash reflex disappeared),T2(intubation succeeded),T3(1 min after intubation),T4(2 min after intubation),T5(3 min after intubation),the occurrence of adverse reactions such as hypotension,hypertension,bradycardia,tachycardia,cough,body movement,injection pain and hypoxemia]were recorded.Results The induction success rate of general anesthesia in both groups was 100%.Compared with the propofol group,there was no significant difference in the time of successful induction,the time of disappearance of eyelash reflex,the number of additional cases and the number of additional times in the ciprofol group(P>0.05).SBP and MAP were higher in the ciprofol group than in the propofol group at T1,T2 and T3(both groups were lower than baseline),and the difference was statistically significant(P<0.05).The incidence of hypotension and injection pain in the ciprofol group was significantly lower than that in the propofol group(P<0.05).There was no significant difference in the incidence of hypertension,bradycardia,tachycardia,cough,body movement and hypoxemia between the two groups(P>0.05).Conclusion Ciprofol is effective and safe for induction of general anesthesia in patients undergoing acute Stanford type A aortic dissection surgery.It has the advantages of stable hemodynamics,less injection pain and less dosage.

Abstract:Objective To identify the risk factors associated with poor prognosis in patients with pancreatitis and to evaluate the predictive performance of these factors.Methods A total of 190 patients with pancreatitis admitted to The Fifth Hospital of Xiamen between June 2020 and June 2024 were enrolled in this study,including 107 males and 83 females,aged 48.67±4.38 years old,ranging from 32 to 68 years old.Clinical data were collected,severity of pancreatitis,blood tests parameters,scoring systems,and prognosis.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for poor prognosis.The predictive performance of individual and combined indicators was assessed using receiver operator characteristic(ROC)curve analysis.Results Logistic regression analysis identified high ultrasound score,high CT score,elevated APACHEⅡscore,prolonged intensive care unit stay,elevated lactate dehydrogenase and amylase levels,and decreased albumin as independent predictors of poor prognosis(P<0.05).ROC curve analysis demonstrated that ultrasound score,CT score,APACHEⅡscore,and their combined models had good predictive performance,with combined models showing superior accuracy(P<0.05).The combination of ultrasound score and APACHE Ⅱ score had better predictive performance than the combination of CT score and APACHEⅡscore(P<0.05).Conclusion Elevated ultrasound,APACHEⅡ,and CT scores are independent risk factors for poor prognosis in patients with pancreatitis.These scoring systems can be effectively used to predict patient outcomes,with the combination of ultrasound and APACHEⅡ scores providing the highest predictive value.