Objective To explore the effectiveness of a tracheal intubation training system based on virtual reality(VR)technology in cultivating the clinical practice abilities of resident physicians.Methods Twenty-five first-year resident physicians who were enrolled in the residency programme at Peking University Third Hospital from August 2024 to February 2025 were recruited for this study.All participants completed a questionnaire after receiving VR-based intensive care unit(ICU)emergency tracheal intubation training,to share their experiences with the VR technology-based ICU emergency tracheal intubation training and the shortcomings encountered during the process.Results ① General information:a total of 25 resident physician questionnaires were distributed in this study and received 25 valid responses(response rate 100%).Among the 25 residents,there were 15 males(60%)and 10 females(40%),with an average age of(25.3±0.8)years.Clinical experience was categorised as≤1 year 4 residents(16%),>1-3 years 8 residents(32%),>3-<5 years 5 residents(20%)and≥5 years 8 residents(32%).Among them,3 residents(12%)had no prior tracheal intubation experience,while 11(44%)had performed>10 intubations.Prior to this training,3 residents(12%)had received other forms of virtual tracheal intubation training,whereas 22(88%)had not.During traditional tracheal intubation training,18 residents(72%)reported that they monitored heart rate and blood pressure,whereas 7(28%)did not.In real-world emergency tracheal intubation scenarios,21 residents(84%)experienced role confusion.Additionally,23 residents(92%)believed that opportunities for tracheal intubation practice were too limited,17(68%)thought traditional training provided more guidance from instructors,and 15(60%)valued practical operation opportunities more in tracheal intubation training.②VR-based ICU emergency tracheal intubation training experience:23 residents(92%)considered the VR-based ICU emergency tracheal intubation training effective,with 13(52%)believing it to be more effective than traditional training.Furthermore,23 residents(92%)felt that the VR-based training created a more relaxed learning atmosphere,heightened their interest in learning tracheal intubation,and had better future prospects;22 residents(88%)believed that VR technology facilitated a better understanding of the laryngeal structure;24 residents(96%)thought that VR-based training reduced practical operation risks and better simulated real-world conditions;16 residents(64%)were highly satisfied with the VR-based ICU emergency tracheal intubation operating system;24 residents(96%)considered the case scenarios in the VR-based training reasonable.17 residents(68%)believed that VR-based training offered more learning opportunities,and 19 residents(76%)thought it reduced anxiety during the intubation process.③ Disadvantages of VR-based ICU emergency tracheal intubation:9 residents(36%)tended to overlook obtaining family consent before emergency tracheal intubation prior to the training.Regarding interactivity,5 residents(20%)rated it as excellent,9(36%)as average,and 11 residents(44%)believe that the interactivity was poor;22 residents(88%)felt a lack of tactile feedback during practical operations;20 residents(80%)recommended adding more simulated scenarios;11 residents(44%)believed that,compared to traditional training,VR training lacked practical operation opportunities.Additionally,17 residents(68%)experienced discomfort such as dizziness during the operation.Conclusion VR-based intubation training effectively enhances technical proficiency and psychological preparedness in ICU clinicians,particularly in anatomical visualization and risk-controlled rehearsal.

Objective To evaluate the effectiveness of standardized video teaching mode in cardiopulmonary resuscitation(CPR)skill training.Methods A total of 357 freshmen from a senior high school in Hexi District,Tianjin,were selected as the research objects.The training mode combining standardized video teaching and on-site demonstration was adopted for CPR skill training.The training content included 4 modules:assessment and call for help,compression,breathing,and external defibrillation.The training process was as follows:standardized video learning(20 minutes),on-site demonstration(20 minutes),group practical training(60 minutes).A self-designed questionnaire assessed pre-and post-training knowledge and attitudes,practical skills,willingness to perform CPR,satisfaction and suggestions.Results Compared with before training,the average knowledge score increased significantly after training(12.22±1.51 vs.7.67±1.84,P<0.05),while there was no statistically significant difference in attitude scores between before and after training(9.18±1.33 vs.9.80±0.62,P>0.05).After training:95.5%(341/357)of students performed compressions satisfactorily,88.5%(316/357)performed breathing,99.7%(356/357)believed the course helpful for understanding CPR knowledge and skills,and all students thought the training was helpful for mastering CPR skills.When investigating students'willingness to perform CPR on different victims,the results showed that 97.2%(347/357)of students would perform CPR on relatives and friends,and 91.9%(328/357)were will to perform CPR on strangers.In the satisfaction survey,students expressed the highest satisfaction with the instructors at 89.6%,followed by satisfaction with the teaching content at 86.8%.Satisfaction with both teaching mode and teaching environment exceeds 80.0%.The survey on suggestions for skill training indicated that 93.3%(333/357)of students preferred to further improve CPR skill training in future sessions,and 85.7%(306/357)hoped to enhance CPR on-site practice and training.Conclusion A standardized video teaching mode can effectively improve the CPR knowledge level and operational skills,with high training satisfaction,which is worthy of popularization and application.

Objective To analyze the misdiagnosis issues and its contributing factors in 2 cases of failed rescue from severe acute methanol poisoning.Methods Clinical data of the 2 patients who died despite emergency treatment were retrospectively reviewed.Misdiagnosis-related problems were summarized and their root causes were investigated.Results Major misdiagnoses included:① Incomplete and insufficient inquiry of medical history;②Insufficient knowledge of methanol-toxic manifestations;③Failure to scientifically properly interpret arterial blood gas analysis in auxiliary examinations;④Unfamiliarity with methanol poisoning because of its rarity at primary hospitals.The primary causes of misdiagnosis were:①Patients and their families failed to promptly provide a history of methanol poisoning ingestion in a timely manner;② Although the 2 patients were poisoned at the same time,they visited the hospital separately with a time interval of up to 24 hours;③Physicians lacked vigilance and in-depth understanding of the systemic disease mainly characterized by central nervous system damage,visual impairment and metabolic acidosis;④ Physicians made subjective assumptions,had narrow thinking,and lacked the ability to comprehensively analyze the condition.Conclusions Correct diagnosis is the key to reducing the misdiagnosis in the emergency management of severe acute methanol poisoning.Emergency physicians must master the diagnostic criteria of acute methanol poisoning proficiently,and strive for early diagnosis and treatment to improve the prognosis of patients.In addition,public education on poisoning prevention should be strengthened to raise public awareness and reduce the incidence of methanol poisoning.

Objective To analyze the academic literature on sepsis-related microRNA(miRNA)at worldwide,and to dentify thematic hotspots and future research trends.Methods A bibliometric analysis was employed to retrieve the literature on sepsis-related miRNA published in the core collection of China National Knowledge Infrastructure(CNKI),and Web of Science(WOS)databases from January 1,2010,to January 1,2025,which met the article inclusion criteria,and used CiteSpace 6.3.1 software to perform the co-occurrence analysis of keywords,keyword emergence analysis,and cluster analysison;on the basis of these analyses,the keywords were sorted according to time to generate clustering time line figure to explore the current status and hotspot evolution process of sepsis-related miRNA.Results A total of 135 and 1 278 articles were retrieved from CNKI and the core collection of WOS databases,respectively.The frequency and centrality of keywords such as sepsis,prognosis,microRNA,acute lung injury,acute kidney injury,etc.were high in 135 documents in CNKI;in 1 278 documents in WOS core collection,the frequency and centrality of keywords such as expression,sepsis,inflammation,cells,micrornas,etc.were high;The top 10 keywords in the CNKI database in terms of burst intensity were:microRNA,inflammatory response,inflammatory factor,interleukin-10,tumor necrosis factor-α,acute respiratory distress syndrome,interleukin-35,septic shock,rat,tiny microRNA-155(miR-155);the top 10 keywords in the core collection of the WOS database in terms of burst intensity were:expression,NF-κB,microRNA,cells,induction,pathway,mechanisms,septic shock,mortality,cancer.Representative clustering tags in the CNKI are#0 prognosis,#1 miRNA,#2 septic shock;The representative clustering labels in the core collection of WOS database are#0 acute lung injury,#1 cancer,#2 septic shock,and so on.In CNKI and WOS core databases,the early keywords mainly revolve around the study of inflammatory factors and related mechanisms of sepsis,and the research center gradually shifts to the clinical physiological injuries as well as complications and mortality in the later stage,miRNA-126,AMP-activated protein kinase,interleukin-35 and other keywords have emerged.Among the top 10 most-cited English literature,researchers have paid particular attention to studying various miRNA as potential biomarkers of sepsis,including miR-146a,miR-223 and miR-146.Conclusions There are similarities and differences in the direction and hotspots of sepsis-related miRNA research in China and abroad.The research paradigm of sepsis has gradually shifted from the early clinical observation focusing on the overall complications and prognosis of patients to the basic research centered on the molecular mechanisms of inflammatory factors and signaling pathways.In this context,the study of miRNA as novel biomarkers for sepsis has been increasingly emphasized,and miRNA represent a promising direction for sepsis research,with potential applications both in basic research and clinical treatment.

Objective To investigate the effect and mechanism of Ginkgo biloba extract(EGB761)on acute lung injury(ALI)induced by sepsis in mice.Methods Fifty male Kunming mice were selected,they were randomly divided into sham operation group(intraperitoneal injection of equal amount of normal saline after operation),model group(intraperitoneal injection of equal amount of normal saline after operation),low-dose EGB761 group(intraperitoneal injection of 20 mg/kg EGB761 immediately after operation)and high-dose EGB761 group(intraperitoneal injection of 50 mg/kg EGB761 immediately after operation)and high-dose EGB761+nuclear factor E2-related factor 2(Nrf2)inhibitor ML385 group(intraperitoneal injection of ML385 30 mg/kg 1 hour before modeling and 50 mg/kg EGB761 immediately after operation),with 10 mice in each group.ALI model of sepsis was established by cecal ligation and puncture(CLP),and the sham operation group only underwent open-closed abdominal surgery.Serum and lung tissue were taken at 12 hours after operation,and the pathological changes of lung tissue were observed under light microscope after hematoxylin-eosin(HE)staining,and the lung injury score was made.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of interleukin(IL-6,IL-1β)and tumor necrosis factor-α(TNF-α)in serum of mice in each group.Western blotting test and real-time fluorescence quantitative reverse transcription-polymerase chain reaction(qRT-PCR)were used to detect the protein expression levels of glutathione peroxidase 4(GPX4),Nrf2,member 11 of solute carrier family 7(SLC7A11)and the mRNA expression levels of Nrf2 and GPX4 mRNA the lung tissues of mice in each group.The content of malondialdehyde(MDA)in the lung tissues of mice in each group was detected by the thiobarbituric acid method.The activity of superoxide dismutase(SOD)in the lung tissues of mice in each group was detected by xanthine oxidase method.Results Compared with the sham operation group,in the model group,a large number of inflammatory cells infiltrated in the lung tissue,the alveolar structure was destroyed,the lung injury score was significantly increased(3.71±0.29 vs.0.33±0.10),and serum pro-inflammatory factors IL-1β,IL-6,TNF-α and the content of oxidation index MDA in lung tissue all increased significantly[IL-1β(ng/L):0.410±0.002 vs.0.351±0.007,IL-6(ng/L):0.650±0.010 vs.0.560±0.010,TNF-α(ng/L):0.320±0.010 vs.0.290±0.002,MDA(nmol/mg):2.49±0.31 vs.1.77±0.02,all P<0.05],while SOD activity in lung tissue decreased significantly(U/mg:20.20±4.61 vs.61.47±8.10,P<0.05),the expression levels of Nrf2,GPX4,SLC7A11 protein,GPX4,and Nrf2 mRNA all decreased[NRF2 protein expression(Nrf2/β-actin):0.33±0.11 vs.0.63±0.17,GPX4 protein expression(GPX4/β-actin):1.19±0.08 vs.2.50±0.17,SLC7A11 protein expression(SLC7A11/β-actin):0.41±0.03 vs.0.67±0.08;GPX4 mRNA(2-ΔΔCt):0.32±0.00 vs.1.02±0.21,NRF2 mRNA(2-ΔΔCt):0.44±0.04 vs.1.01±0.20,all P<0.05].Compared with the model group,the degree of lung injury in the low-dose EGB761 group and the high-dose EGB761 group was reduced to varying degrees,and the lung injury score in the high-dose EGB761 group was significantly reduced(0.96±0.40 vs.3.71±0.29,P<0.05).The contents of MDA in lung tissue and serum proinflammatory factors IL-1β,IL-6 and TNF-α were significantly decreased[MDA(nmol/mg):1.53±0.09 vs.2.49±0.31,IL-1β(ng/L):0.350±0.004 vs.0.410±0.002,TNF-α(ng/L):0.280±0.003 vs.0.320±0.010,all P<0.05],SOD activity,proteins of Nrf2,GPX4 and SLC7A11,and expression levels of GPX4 and Nrf2 mRNA all increased significantly[SOD activity(U/mg):63.78±8.74 vs.20.20±4.61,the expression of Nrf2 protein(NRF2/β-actin):0.71±0.06 vs.0.33±0.11,the expression of GPX4 protein(GPX4/β-actin):2.03±0.10 vs.1.19±0.08,and the expression of SLC7A11 protein(SLC7A11/β-actin)0.65±0.07 vs.0.41±0.03;GPX4 mRNA(2-ΔΔCt):0.80±0.10 vs.0.32±0.00,NRF2 mRNA(2-ΔΔCt):0.84±0.07 vs.0.44±0.04,all P<0.05].Compared with high-dose EGB761 group,Nrf2 inhibitor ML385 can obviously reverse the above-mentioned effects of high-dose EGB761 after intervention.Conclusion Ginkgo biloba extract EGB761 can improve the sepsis ALI induced by CLP in mice,and it may play a protective role by activating Nrf2 and up-regulating SLC7A11 to inhibit ferroptosis.

Objective To investigate the impact of lower inspiratory peak flow rates on airway peak pressure when using a ventilator to maintain respiratory function during the advanced life support phase of in-hospital cardiopulmonary resuscitation(CPR).Methods A prospective study was conducted,30 patients who underwent CPR for more than 20 minutes admitted to Lishui Municipal Central Hospital between September 2021 and December 2023 were enrolled as the study subjects.Volume controlled ventilation(VCV)with a descending flow waveform was used,while other preset parameters remained unchanged.Airway peak pressure was measured at different peak flow rates(55,50,45,and 40 L/min).The influence of varying flow rates on peak pressure was analyzed.Results During CPR,patients were in a continuous state of chest compressions.When the ventilator parameters were set conventionally,alarms for high airway pressure,low tidal volume(VT),and high respiratory rate often occurred,which affected the effectiveness of ventilatory support.There was a significant variation in airway peak pressure among different patients.As the peak flow rate increased from 40 L/min to 55 L/min,the airway peak pressure gradually increased.During the process of reducing the peak flow rate,the pulse oxygen saturation(SpO2)of all patients remained stable without significant changes.The 40 L/min group had significantly lower peak pressures than the 50 and 55 L/min groups,whereas the 55 L/min group had significantly higher pressures than all others[cmH2O(1 cmH2O≈0.098 kPa):41.20±9.06 vs.47.90±9.04 and 53.70±7.96,all P<0.05].When comparing patients with peak flow rates of 40 L/min and 50 L/min,as well as 45 L/min and 55 L/min,the average airway peak pressure increased significantly with each 10 L/min increment in inspiratory peak flow rate.However,the SpO2 remained essentially unchanged or slightly increased as the peak flow rate decreased.There were no statistically significant differences in SpO2 among patients at different peak flow rate levels.When the peak flow rate was set at 55,50,45,and 40 L/min,the proportions of patients with airway peak pressure>40 cmH2O were 100.0%,83.3%,63.3%,and 53.3%,respectively.Among them,the proportions of patients with airway peak pressure>50 cmH2O were 66.7%,40.0%,16.6%,and 16.6%,respectively.As the peak flow rate decreased,the proportion of patients with airway peak pressure>40 cmH2O gradually decreased.If the peak flow rate was set at 45 L/min or lower,the number of patients with airway peak pressure>50 cmH2O during CPR was less than 50.0%of the total number of cases.Conclusions During mechanical ventilation in CPR,using volume-controlled ventilation(VCV)mode with a decelerating waveform,improper peak flow rate settings can easily trigger high airway pressure alarms and result in low tidal volume(VT),leading to poor synchrony between the ventilator and the patient.Compared to peak flow rates of 55 L/min and above,selecting an inspiratory peak flow rate of 40 L/min and setting the high-pressure alarm at 50 cmH2O is suitable for the mechanical ventilation needs of most patients and does not affect oxygenation levels.This is a more appropriate choice.

Objective To analyze the distribution characteristics of comorbid diseases in patients with atrial fibrillation(AF)and the current status of their medical intervention.Methods A retrospective cohort study was conducted using clinical data from AF patients at the AF center of Hainan Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine between October 2020 and September 2022.The data included information on hospitalizations,diagnoses and treatments,health assessments,physical examinations,tests,laboratory results,and medication treatments.Descriptive research methods were used to analyze the clinical distribution characteristics,comorbid diseases,and stroke intervention status.A Logistic regression model was employed to analyze the impact of comorbid diseases on the type of AF.Receiver operator characteristic curve(ROC curve)analysis was performed to evaluate the predictive value of comorbid diseases in AF for the development of persistent AF.Results Among the 667 AF patients,89.21%(595 cases)had comorbidities,with a total of 64 different comorbidity combinations observed.These combinations consisted of AF coexisting with 1-5 diseases,72.44%had 1-2 comorbidities.The top 5 most frequent comorbidity patterns,in descending order,were hypertension,hypertension and chronic heart failure,hypertension and coronary heart disease and chronic heart failure,hypertension and coronary heart disease,hypertension and diabetes.These 5 patterns accounted for 49.41%(294/595)of the total cases.All 8 diseases were associated with high abnormality rates in four key indicators:the CHA2DS2-VASc score,brain natriuretic peptide/N-terminal pro-brain natriuretic peptide(BNP/NT-proBNP),creatinine clearance rate(CCr),and left atrial diameter.The highest medication rates were observed for anticoagulants in valvular heart disease(84.62%),for antiarrhythmics in thyroid disease(70.97%),and for blood pressure control agents across all other diseases.For the 4 disease comorbidity combinations,the monitoring rates were highest for hypertension(100.00%)and lowest for diabetes mellitus(83.12%).The treatment rates were as follows:hypertension(highest 63.16%,lowest 60.91%),coronary heart disease(CHD,highest 73.96%,lowest 44.44%),diabetes mellitus(highest 75.29%,lowest 64.94%),chronic heart failure(highest 67.63%,lowest 62.50%).For stroke intervention in the 4 disease comorbidity combinations,the proportion of high-stroke-risk population was highest in patients with diabetes(98.46%)and lowest in those with chronic heart failure(92.18%).The anticoagulation therapy rate was highest in the chronic heart failure(56.25%)and lowest in the diabetes(46.88%).The proportion of patients with high bleeding risk was highest in the diabetes group(44.53%)and lowest in the chronic heart failure group(32.59%).Multivariate binary Logistic regression analysis revealed that AF comorbid with coronary heart disease[odds ratio(OR)=1.499,95%confidence interval(95%CI)was 1.016-2.214,P=0.042],valvular heart disease(OR=3.362,95%CI was 1.473-7.674,P=0.004),and chronic heart failure(OR=1.903,95%CI was 1.309-2.767,P=0.001)were all independent risk factors for the development of persistent AF.ROC curve analysis showed that coronary heart disease,valvular heart disease,and chronic heart failure all had certain predictive value for persistent AF,with areas under the curve(AUC)of 0.538,0.536,and 0.572,respectively.Combined assessment demonstrated an AUC of 0.654(95%CI was 0.610-0.698,P<0.001),sensitivity 54.50%,and specificity 69.20%.Conclusions The distribution of high-frequency comorbidity combinations in AF patients is highly clustered and warrants focused attention.In this center,patients with comorbidities exhibited high abnormality rates in comorbid disease detection and elevated stroke risk scores,yet targeted interventions remain insufficient and require optimization.AF combined with coronary artery disease,valvular heart disease,and chronic heart failure were identified as independent risk factors for persistent AF.

Objective To analyze the clinical characteristics of patients with coronary heart disease complicated by gastrointestinal hemorrhage and explore the independent prognostic factors.Methods The clinical data of patients with coronary heart disease complicated by gastrointestinal hemorrhage who were treated in the department of emergency of the First Affiliated Hospital of Zhejiang University School of Medicine from January 1,2022 to December 31,2023 were collected,including general information:gender,age,smoking history,drinking history,gastrointestinal hemorrhage-related symptoms(hematemesis,melena,hematochezia,hematemesis combined with melena)or positive fecal occult blood test,past medical history[hypertension,diabetes,atrial fibrillation,liver cirrhosis,malignancy,prior gastrointestinal hemorrhage],coronary heart disease treatment history(history of coronary stent implantation,history of coronary artery bypass grafting),history of antithrombotic drugs,vital signs on admission[body temperature,pulse rate,systolic blood pressure,pulse oxygen saturation(SpO2)],laboratory tests[random blood glucose,white blood cell count(WBC),hemoglobin(Hb),platelet count(PLT),C-reactive protein(CRP),serum creatinine(SCr),blood urea nitrogen(BUN),serum albumin(Alb),alanine aminotransferase(ALT),aspartate aminotransferase(AST),MB isoenzyme of creatine kinase(CK-MB),troponin I(TNI),brain natriuretic peptide(BNP),fibrinogen(Fib),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer,ejection fraction(EF)],treatment process[gastrointestinal hemorrhage management(gastrointestinal endoscopy examination or treatment,vascular interventional therapy),blood transfusion volume(red blood cells,plasma),ICU admission rate and admission time,hospital stay],the causes of gastrointestinal hemorrhage comprehensively inferred from imaging and gastrointestinal endoscopy.According to the treatment outcome,the patients were divided into the cured group and the death group,and the differences in clinical data between the two groups were compared.Multivariate Logistic regression analysis was used to identify the independent influencing factors of death outcome.The receiver operating characteristic(ROC)curves were plotted to compare the predictive value of each factor for prognosis.Results A total of 526 patients were enrolled,including 486 in the cured group and 40 in the death group.The causes of death were multiple organ dysfunction syndrome(22 cases),acute myocardial infarction(7 cases),malignant arrhythmia(2 cases),respiratory failure(2 cases),infection(2 cases),hemorrhagic shock(3 cases),acute cerebral infarction(1 case),and cerebral hemorrhage(1 case).No statistically significant differences were found between the two groups in terms of gender,age,smoking history,excessive drinking history,symptoms(hematemesis,hematochezia,positive fecal occult blood test,hematemesis combined with melena),past medical history(hypertension,atrial fibrillation,liver cirrhosis,tumor history,prior gastrointestinal hemorrhage),coronary heart disease treatment history,antithrombotic drug history,body temperature,pulse rate,SpO2,random blood glucose,WBC,Hb,PLT,ALT,AST,CK-MB,TNI,Fib,APTT,EF,gastrointestinal hemorrhage management,causes of gastrointestinal hemorrhage,red blood cell/plasma transfusion volume,and hospital stay(all P>0.05).Compared with the cured group,the death group had a lower rate of melena as the initial symptom,systolic blood pressure,and serum Alb level[melena rate:32.50%(13/40)vs.66.26%(322/486),systolic blood pressure(mmHg,1 mmHg≈0.133 kPa):104.71±8.52 vs.122.52±22.59,Alb(g/L):30.80(27.60,33.70)vs.34.70(32.65,39.05),all P<0.05],and a higher prevalence of diabetes,higher levels of CRP,SCr,BUN,BNP,PT,D-dimer,a higher ICU admission rate,and a longer ICU stay[diabetes prevalence:70.00%(28/40)vs.29.42%(143/486),CRP(mg/L):94.91(30.69,125.56)vs.2.95(1.17,24.31),SCr(μmol/L):200.0(123.0,407.0)vs.82.5(66.8,112.0),BUN(mmol/L):15.81(14.00,22.21)vs.7.61(5.00,14.49),BNP(ng/L):2 970.50(1 504.25,6 193.50)vs.442.00(141.25,1 590.25),PT(s):13.50(12.60,22.50)vs.12.25(11.58,13.30),D-dimer(μg/L):5601(4115,11352)vs.609(267,1350),ICU admission rate:67.50%(27/40)vs.6.99%(34/486),ICU stay(days):3(2,16)vs.0(0,0),all P<0.05].With clinical outcomes(death,cure)as the dependent variable,variables with statistical significance in univariate analysis were included in the multivariate Logistic regression analysis.The results showed that systolic blood pressure and serum Alb were independent protective factors for death outcome[odds ratio(OR)=0.960,0.818;95%confidence interval(95%CI)was 0.933-0.987,0.719-0.932;P=0.004,0.002;respectively],while CRP and SCr were independent risk factors for death outcome[OR=1.013,1.004;95%CI was 1.006-1.020,1.002-1.006,all P<0.001].Taking death outcome as the state variable and serum Alb,systolic blood pressure,SCr,and CRP as the test variables respectively,the ROC curves were plotted.The results indicated that serum Alb,systolic blood pressure,SCr,CRP and their combined detection all had high predictive efficacy for the death outcome[area under the curve(AUC)=0.825,0.775,0.862,0.819,0.928;95%CI was 0.766-0.885,0.729-0.820,0.818-0.905,0.703-0.934,0.891-0.965;sensitivity was 78.6%,92.8%,85.7%,85.7%,92.9%;specificity was 72.7%,72.5%,78.8%,83.8%,77.8%,all P<0.001].The combined detection of the 4 factors had the highest predictive efficacy(all P<0.05).Conclusions Systolic blood pressure,serum Alb,CRP,and SCr were independent influencing factors for the in-hospital death outcome of patients with coronary heart disease complicated by gastrointestinal hemorrhage.The Logistic regression model constructed based on these factors had better predictive efficacy for death outcome than single factor analysis.

Objective To explore the clinical application value of respiratory function rehabilitation training combined with traditional Chinese medicine acupuncture therapy in the weaning and extubation of critically ill patients with respiratory failure.Methods A total of 82 patients with critical respiratory failure who had been treated with endotracheal intubation and ventilator therapy in the department of critical care of the Third Affiliated Hospital of Gansu University of Traditional Chinese Medicine from August 2021 to August 2024 were enrolled.The patients were divided into control group(40 cases)and observation group(42 cases)according to different treatment methods.The control group was treated with the original underlying disease according to the condition,and was given symptomatic support and other active rescue treatment when there was an acute progressive exacerbation of respiratory failure and heart failure.On the basis of the treatment of the control group,the observation group was trained by a professional respiratory function rehabilitation therapist to conduct respiratory rehabilitation training on the patients.Acupuncture treatment was performed by acupuncturists specializing in traditional Chinese medicine who have undergone special training.The differences of general data[including gender,age,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)],laboratory tests indicators[including white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT),oxygenation index(PaO2/FiO2)],prognosis(including the success rate of weaning and extubation,28-day respiratory failure recurrence rate,90-day mortality,incidence of lung infection,and incidence of right heart failure)between the two groups were compared.Results There were no significant differences in gender,age,APACHE Ⅱ score,WBC,CRP,PCT,and PaO2/FiO2 between the two groups(all P>0.05).After treatment,WBC,CRP,and PCT in both groups were significantly lower than before treatment,while PaO2/FiO2 was significantly higher than before treatment,compared with the control group,the observation group showed significantly decreased WBC,CRP and PCT,and significantly increased PaO2/FiO2 after treatment[WBC(×109/L):8.09±4.28 vs.14.63±5.07,CRP(mg/L):79.11±51.22 vs.117.49±49.24,PCT(μg/L):5.46±4.29 vs.10.56±8.64,PaO2/FiO2(mmHg,1 mmHg≈0.133 kPa):193.12±2.88 vs.190.83±3.90,all P<0.05],the success rate of weaning extubation in the observation group was significantly increased[57.1％(24/42)vs.35.0％(14/40)],and the 28-day respiratory failure recurrence rate,90-day mortality,the incidence of lung infection,and the incidence of right heart failure were significantly reduced[28-day respiratory failure recurrence rate:23.8％(10/42)vs.45.0％(18/40),and the 90-day mortality:28.6％(12/42)vs.50.0％(20/40),incidence of pulmonary infection:23.8％(10/42)vs.45.0％(18/40),incidence of right heart failure:14.3％(6/42)vs.35.0％(14/40),all P<0.05].Conclusion Through respiratory rehabilitation training combined with acupuncture treatment,it is possible to improve the blood oxygen supply to the vital organs of patients with critical respiratory failure who are on mechanical ventilation,reduce inflammatory responses,and thereby improve the prognosis of the patients.

Objective To analyze the role and mechanism of Xiaoqinglong decoction in alleviating the pathological process of pulmonary arterial hypertension(PAH),and to observe the effect of Xiaoqinglong decoction on endothelial-mesenchymal transition(EMT)in human pulmonary arterial endothelial cell(HPAEC)and the involvement of the Toll-like receptor/nuclear factor-κB/hypoxia-inducible factor-1α(TLR/NF-κB/HIF-1α)pathway in this mechanism.Methods Thirty-six male Sprague Dawley(SD)rats and HPAEC were randomly divided into control group,model group,Xiaoqinglong decoction plus Earthworm group,Bosentan tablet group,dimethyl sulfoxide(DMSO)group,and monophosphoryl lipid A(MPL)group.PAH rat models and HPAEC models were established by hypoxic exposure.The Xiaoqinglong decoction plus Earthworm group received intragastric administration Xiaoqinglong decoction plus Earthworm(5 g·kg-1·d-1)or cultured with 10%corresponding drug serum,the Bosentan group received Bosentan(100 mg·kg-1·d-1)by gavage or cultured with 10%corresponding drug serum,the MPL group received 1 μg MPL,and the DMSO group received an equivalent volume of the DMSO and corn oil mixed solvent as a negative control for the MPL group.The hemodynamic parameters,including mean pulmonary arterial pressure(mPAP),right ventricular systolic pressure(RVSP),and the maximum rate of right ventricular pressure(+dp/dt max),were measured via right heart catheterization.After euthanasia,lung and heart tissues were collected to assess the right ventricular hypertrophy index(RVHI);hematoxylin-eosin(HE)staining was used to observe the degree of right ventricular cardiomyocyte hypertrophy and to calculate the average intima-media thickness(IMT)in small pulmonary arteries;Western blotting was used to detect the protein expression levels of proliferating cell nuclear antigen(PCNA),CD68,TLR4,NF-κB,HIF-1α,vascular endothelial cadherin,and vimentin;cell counting kit-8(CCK-8),Transwell,and scratch assays were used to observe cell proliferation and migration;Enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of interleukins(IL-8,IL-6),tumor necrosis factor-α(TNF-α),endothelin-1(ET-1),and nitric oxide(NO).Results Compared with the model group,the Xiaoqinglong decoction plus Earthworm group showed significant reductions in mPAP,RVSP,RVHI,and IMT in PAH rats[mPAP(mmHg,1 mmHg≈0.133 kPa):22.17±1.94 vs.42.00±4.90,RVSP(mmHg):34.67±3.20 vs.52.83±3.76,RVHI:0.402±0.057 vs.0.822±0.101,IMT:(37.85±2.49)%vs.(62.06±4.52)%,all P<0.05],and a significant increase in+dP/dT max(mmHg/s:2 730.83±137.89 vs.1 718.33±148.36,P<0.05).Western blotting and ELISA results showed that compared with the model group,the Xiaoqinglong decoction plus Earthworm group had significantly lower protein expression of PCNA and CD68 in lung tissue,and levels of inflammatory factors(IL-6,IL-8,TNF-α)in rat serum[lung tissue:PCNA protein expression(PCNA/GAPDH)was 1.56±0.08 vs.2.20±0.26,CD68 protein expression(CD68/GAPDH):1.46±0.09 vs.2.60±0.23;serum:IL-8(ng/L)was 39.67±6.28 vs.149.17±7.49,IL-6(ng/L):81.00±6.63 vs.211.00±25.31,TNF-α(ng/L):213.17±24.86 vs.799.50±43.51,all P<0.05].In vitro experiments,compared with the model group,Xiaoqinglong decoction plus Earthworm inhibited abnormal proliferation(A value:2.052±0.087 vs.2.242±0.057,P<0.05)and migration[number of migrating cells(per field):101.33±12.01 vs.226.67±17.56,P<0.05]of HPAEC,and reversed the EMT process,manifested as upregulation of vascular endothelial cadherin protein expression levels(vascular endothelial cadherin/GAPDH:0.39±0.06 vs.0.12±0.03,P<0.05)and downregulation of vimentin protein expression(vimentin/GAPDH:4.96±0.33 vs.7.89±0.44,P<0.05).Western blotting results indicated that compared with the model group,the protein expression levels of TLR4,the ratio of phosphorylated p65 to total p65,and HIF-1α in both lung tissue and HPAEC were significantly reduced in the Xiaoqinglong decoction plus Earthworm group[lung tissue:TLR4 protein expression(TLR4/GAPDH)was 3.13±0.20 vs.4.38±0.30,p-p65/p65 ratio:7.11±0.81 vs.12.73±1.80,HIF-1α protein expression(HIF-1α/GAPDH):2.37±0.32 vs.4.45±0.34;HPAEC:TLR4 protein expression(TLR4/GAPDH)was 1.42±0.03 vs.2.43±0.05,p-p65/p65 ratio:6.01±1.84 vs.11.28±1.06,HIF-1α protein expression(HIF-1α/GAPDH)was 3.24±0.17 vs.5.50±0.44,all P<0.05],accompanied by upregulated vascular endothelial cadherin protein expression(vascular endothelial cadherin/GAPDH:0.66±0.03 vs.0.49±0.03,P<0.05)and downregulated vimentin protein expression(vimentin/GAPDH:1.81±0.12 vs.2.47±0.10,P<0.05),indicating that Xiaoqinglong decoction plus Earthworm inhibits the EMT process in endothelial cells by suppressing the activation of the TLR/NF-κB/HIF-1α pathway.Experiments with a TLR agonist further confirmed that activation of the TLR pathway reverses the protective effects of Xiaoqinglong decoction plus Earthworm,as shown by the MPL group compared to the DMSO group having significantly increased protein expression of the p-p65/p65 ratio and HIF-1α[p-p65/p65 ratio:2.17±0.35 vs.1.08±0.14,HIF-1α/GAPDH:3.96±0.25 vs.1.03±0.10,both P<0.05],further decreased vascular endothelial cadherin protein expression(vascular endothelial cadherin/GAPDH:0.66±0.04 vs.0.99±0.02,P<0.05),further increased vimentin protein expression(vimentin/GAPDH:1.53±0.12 vs.0.93±0.07,P<0.05),along with enhanced cell migration capacity[number of migrating cells(per field):176.67±17.50 vs.107.00±11.14;cell migration rate in scratch assay:(34.32±2.82)%vs.(22.71±2.49)%,both P<0.05]and increased proliferation activity(48 hours A value:2.156±0.044 vs.1.810±0.088,P<0.05).Conclusions Xiaoqinglong decoction combined with Pheretima not only significantly reduces pulmonary artery pressure,improves cardiac function and mitigates pulmonary vascular fibrosis in PAH rats,but also alleviates pulmonary vascular remodeling by inhibiting inflammatory responses and EMT.It can further decrease the content of ET-1,increase the level of NO,and ameliorate vascular stenosis.This result further indicates that exterior-relieving medicines exert a significant dilating and supporting effect on the narrowed meridians and collaterals.