Objective To compare the application values of the Ranson score,Bedside Index for Severity in Acute Pancreatitis(BISAP),CT Severity Index(CTSI)and Oxford Acute Severity of Illness Score(OA-SIS)in forecasting the new onset organ failure in the patients with severe acute pancreatitis(SAP).Methods The study was a retrospective analysis.A total of 126 cases of SAP receiving by the intensive care unit(ICU)and emergency ICU(EICU)of the Second Affiliated Hospital of Chongqing Medical University from January 2015 to June 2023 served as the study subjects.The clinical data of the patients were collected.The first time OASIS score,Ranson score,BISAP score and CTSI score were calculated within 48 h after the patients ente-ring ICU.The new onset organ failure served as the clinical outcome.The random forest and least absolute shrinkage and selection operator(LASSO)regression were used to screen the risk factors for new onset organ failure.The multivariate logistic regression was adopted to analyze the correlation between the four scoring systems and new onset organ failure in the SAP patients.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were adopted to analyze the predictive efficiency of 4 kinds of scoring sys-tems.Results The age in the organ failure group was higher than that in the non-organ failure group(P=0.039).The OASIS,Ranson,BISAP and CTSI scores in the organ failure group all were higher than those in the non-organ failure group(P＜0.05).The random forest and LASSO regression analysis results showed that Lac,Cr and myoglobin were the most important variables affecting the new onset organ failure in SAP pa-tients.The OASIS score(OR=1.27,95％CI:1.06-1.51,P=0.009)and Ranson score(OR=1.88,95％CI:1.03-3.43,P=0.040)were the independent influencing factors for predicting the new onset organ fail-ure in SAP patients.The ROC curve results showed that the area under the curve(AUC)of the OASIS score was the highest(AUC=0.830,95％CI:0.743-0.916).Conclusion The OASIS score is an independent risk factor for predicting the new onset organ failure in SAP patients,moreover has the highest predictive efficiency in predicting the new onset organ failure.

Objective:To investigate the clinical characteristics of first-episode and recurrent acute hypertriglyceridemic pancreatitis (HTGP).Methods:The retrospective cohort study was con-ducted. The clinical data of 313 patients with HTGP admitted to 26 medical centers in China in the Chinese Acute Pancreatitis Clinical Research Group (CAPCTG)-PERFORM database from November 2020 to December 2021 were collected. There were 219 males and 94 females, aged 38(32,44)years. Of the 313 patients, 193 patients with first-episode HTGP were allocated into the first-episode group and 120 patients with recurrent HTGP were allocated into the recurrent group. Observation indica-tors: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) comparison of severity and prognosis in the course of disease within 14 days between the two groups; (3) the association between recurrent HTGP and the risk of persistent organ failure (POF); (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Wilcoxon rank sum test. The Kaplan-Meier method was used to plot the cumulative recurrence rate curve and Log-Rank test was used for survival analysis. The Logistic regression model was used for multivariate analysis, and continuous variables were converted into categorical variables according to the mean value or common criteria. Propensity score matching was performed by 1∶1 nearest neighbor matching method, with caliper value of 0.02. Paired t test or Wilcoxon rank sum test and McNemar′s test were used for comparison between matched groups. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 313 patients,208 cases were successfully matched, including 104 cases in the first-episode group and 104 cases in the recurrent group. After propensity score matching, there was no significant difference in demographic characteristics, severity of illness scores and laboratory test between the two groups ( P>0.05). The elimination of gender, acute physiology and chornic health evaluation (APACHE) Ⅱ score, computed tomography severity index score, systemic inflammatory response syndrome score, sequential organ failure assessment score, apolipoprotein E, C-reactive protein, creatinine, lactic acid dehydrogenase, procal-citonin confounding bias ensured comparability between the two groups. (2) Comparison of severity and prognosis in the course of disease within 14 days between the two groups. There were signifi-cant differences in POF and local complications between the first-episode group and the recurrent group ( P<0.05). (3) The association between recurrent HTGP and the risk of POF. Results of uncor-rected univariate analysis showed that there was no association between recurrent HTGP and the risk of POF ( odds ratio=0.78, 95% confidence interval as 0.46-1.30, P>0.05). Results of multivariate analysis after adjusting for covariates such as gender, age, APACHE Ⅱ score, C-reactive protein, triglyceride and total cholesterol showed that compared with first-episode HTGP, recurrent HTGP was associated with a higher risk of POF ( odds ratio=2.22, 95% confidence interval as 1.05-4.71, P<0.05). Results of subgroup analysis showed that age<40 years was associated with an increased risk of POF ( odds ratio=3.31, 95% confidence interval as 1.09-10.08, P<0.05). (4) Follow-up. Twelve of the 313 patients died during hospitalization, including 9 cases in the first-episode group and 3 cases in the recurrent group. The rest of 301 surviving patients, including 184 cases in the first-episode group and 117 cases in the recurrent group, were followed up for 19.2(15.5, 21.9)months. Results of follow-up showed that for 184 survived patients of the first-episode group, 164 cases were followed up and 24 cases experienced recurrence, for 117 survived patients of the recurrent group,29 cases experienced recurrence, showing a significant difference between the two groups ( χ2=4.67, P<0.05). Conclusion:Compared with first-episode HTGP, patients with recurrent HTGP are more prone to POF and local complications, and are more prone to recurrence after discharge. The risk of POF in recurrent HTGP patients is 2.22 times that of those with first-episode, and the risk is higher in patients with age <40 years.

Objective To investigate the effect of whole-course empowerment health intervention on the psychological resilience and self-care ability of older patients with severe pneumonia.Methods A total of 210 older patients with severe pneumonia admitted to Sichuan Provincial People's Hospital between January 2020 and December 2023 were enrolled.The patients were sequentially numbered according to the order of admission.Then,they were assigned to a conventional care group(105 cases)and a whole-course empowerment group(105 cases)by a 1∶1 ratio using a random number table.The conventional care group received conventional clinical intervention,while the whole-course empowerment group received the whole-course empowerment health intervention regimen in addition to the intervention administered in the conventional care group.Psychological resilience was assessed with the Connor-Davidson Resilience Scale(CD-RISC),self-care ability with Exercise of Self-Care Agency Scale(ESCA),and quality of life with the World Health Organization Quality of Life Brief Version(WHOQOL-BREF).The evaluation results obtained before and after the interventions were compared.Results After intervention,the scores for all dimensions of CD-RISC in the whole-course empowerment group were higher than those in the conventional care group(t=10.326,P＜0.001;t=6.386,P＜0.001;t=9.581,P＜0.001).The scores for all dimensions of ESCA after intervention were higher in whole-course empowerment group than those in the conventional care group(t=1 1.599,P＜0.001;t=9.072,P＜0.001;t=4.353,P＜0.001;t=16.646,P＜0.001).After intervention,the scores for all dimensions of WHOQOL-BREF in the whole-course empowerment group were higher than those in the conventional care group(t=9.164,P＜0.001;t=13.809,P＜0.001;t=5.001,P＜0.001;t=6.695,P＜0.001).Conclusion Whole-course empowerment health intervention significantly enhances psychological resilience,self-care capacity,and quality of life in older patients with severe pneumonia.

Wasp sting is a common emergency in mountainous areas of China, with rapid onset and progression, high mortality rate, and serious harm to public health. Wasp sting can cause mild local reactions in mild cases, and Anaphylaxis or even multiple organ dysfunction in severe cases, of which Acute kidney injury (AKI) is the most common and serious. Blood purification treatment is commonly used for wasp sting patients to maintain renal function, eliminate toxins, and maintain Internal environment stability. The commonly used clinical methods are Hemoperfusion (HP), plasma exchange (PE), and continuous renal replacement therapy (CRRT). At present, there is no clear recommendation for the blood purification treatment mode of wasp sting in China, and there is no clear guidance for its combined treatment mode. This article will review the single and combined use of blood purification treatment models for wasp stings, based on the latest clinical research.

Objective:To explore the therapeutic mechanism of Mongolian medicine Sendeng-4 decoction for rheumatoid arthritis by 99Tc m-hydrazinonicotinamide-(polyethylene glycol) 4-E[(polyethylene glycol) 4-c((Arg-Gly-Asp)fk)] 2 (3PRGD 2) imaging. Methods:A total of 200 female SD rats (age: 6-7 weeks) were divided into collagen-induced arthritis (CIA) group ( n=176) and blank control group ( n=24). Rats in the CIA group were divided into Sendeng-4 decoction treatment group ( n=24), etanercept treatment group ( n=24), and negative control group ( n=24) by simple random sampling method. 99Tc m-3PRGD 2 SPECT/CT imaging was performed before and after modeling and treatment. The differences of target/non-target (T/NT) ratio and serological, pathological, and immunohistochemical results among groups were compared by one-way analysis of variance or Kruskal-Wallis rank sum test. The correlation was analyzed by Pearson correlation or Spearman correlation analysis. Results:There were 95 (95/176) CIA models successfully established. The T/NT ratios of Sendeng-4 decoction treatment group and etanercept treatment group were lower than that of negative control group (0.260± 0.094, 0.238±0.099, 0.766±0.144 ; F=163.00, P<0.001), while there was no significant difference between the two drug treatment groups ( P>0.05). After drug treatment, serum levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α) and α vβ 3 were significantly lower than those of negative control group ( F values: 49.43-92.36, all P<0.001), pathological score was also lower than that of negative control group ( H=34.25, P<0.001), and levels of immunohistochemical makers (VEGF, TNF-α, α vβ 3, CD31, CD34) were also lower than those of negative control group ( H values: 13.51-26.84, all P<0.001), while there were no significant differences between the two drug treatment groups (all P>0.05). The T/NT ratios were positively correlated with above indictors in Sendeng-4 decoction treatment group ( r values: 0.56-0.59, rs values: 0.49-0.69), etanercept treatment group ( r values: 0.50-0.55, rs values: 0.46-0.70) and negative control group ( r values: 0.55-0.80, rs values: 0.58-0.86, P<0.001 or P<0.05). Conclusion:Verified by 99Tc m-3PRGD 2 SPECT/CT imaging and molecular pathology, Mongolian medicine Sendeng-4 decoction can inhibit neovascularization by down-regulating vascular factors such as VEGF, resulting in delaying the progression of the disease and improving clinical symptoms.

Objective: To observe the uptake of ⁹⁹Tc^m-3 polyethylene glycol Arg-Gly-Asp dimer (3PRGD₂) in rat models of rheumatoid arthritis (RA), in order to provide theoretical foundation for early diagnosis of RA. Methods: The healthy female SD rats were divided into collagen induced arthritis (CIA) group (n=100), osteoarthritis (OA) group (n=20) and control group (n=20). Bovine collagen type Ⅱ emulsion was used for arthritis induction to establish CIA models. OA models were established by injection of L-cysteine and papain. Gamma imaging was performed before and 15 d, 30 d after the model establishment. The mediastinum was selected as non-target (NT) area and the target (T)/NT ratios were calculated. The serum levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α), α_Vβ₃ before and after the model establishment were measured. Pathological and immunohistochemical detection were performed. One-way analysis of variance, Pearson and Spearman correlation analyses were used to analyze the data. Results: There were 58 CIA models successfully established. Before the model establishment, T/NT ratios of CIA group, OA group and control group were 0.215±0.049, 0.210±0.050, 0.209±0.051, respectively (F=0.093, P>0.05). The T/NT ratios of the above three groups were 0.405±0.230, 0.223±0.045, 0.211±0.049 (F=12.601, P<0.05) 15 d post-model establishment, and those were 0.572±0.182, 0.238±0.045, 0.212±0.055 (F=65.147, P<0.05) 30 d post-model establishment. T/NT ratios of CIA group were positively correlated with the levels of serum VEGF, TNF-α, α_Vβ₃, pathological score and the levels of immunohistochemical markers (VEGF, TNF-α, α_Vβ₃, CD31, CD34; r values: 0.391-0.721, r_s values: 0.365-0.669, all P<0.05). Conclusion ⁹⁹Tc^m-3PRGD₂ can be specifically up-taken by RA lesions in rat models, thus has the potential in early synovial neovascularization imaging of RA.

Objective To synthesize 11 C-methyldopamine (MDA) and to explore its feasibility as an agent for cardiac sympathetic nerve imaging.Methods 11 C-MDA was synthesized by direct N-methylation method and purified by semi-preparation reverse HPLC.Thirty Kunming mice were divided into five groups by random number table.The mice were respectively sacrificed at 2,5,10,20 and 30 min after injection of 7.4 MBq 11C-MDA.The lung,liver,spleen,kidney,stomach,intestine,brain,muscle,bone tissues and blood of mice were removed and weighed before radioactive γ-counting.The ％ID/g was calculated.Six Chinese mini-swine were divided into normal group (n=3) and inhibition group (n =3) for myocardial imaging.Mini-swine of inhibition group were injected with 10 mg/kg imipramine hydrochloride at 30 min before 11C-MDA (370 MBq) injection.The data were analyzed with SPSS 15.0 software.Results The synthesis of 11 C-MDA took 45 min with radiochemical yields of (20±3)％.The solution of11 C-MDA was colorless and the pH value was 6.5.The radiochemical purity was more than 98％ and the specific activity was 50 GBq/mmol.The myocardial uptake reached the peak value of (8.78± 1.18) ％ID/g at 2 min after injection of 11 C-MDA in mice.11C-MDA was mainly metabolized through liver and kidney.PET/CT imaging showed that 11 C-MDA was highly uptaken in swine myocardium and could be blocked by imipramine hydrochloride.Conclusions 11C-MDA can be synthesized by a simple and economic method.The high uptake rate of 11 C-MDA in the heart suggests it may be a potential agent for cardiac nerve imaging.