Objective To investigate the difference between single lumen endotracheal intubation of thoracoscope and traditional double lumen endotracheal intubation of thoracoscope in process of thymectomy. Methods From January 2010 to June 2014, clinical data of 30 cases with thymectomy under single lumen endotracheal intubation of thoracoscope (group A) and 30 cases with thymectomy under traditional double lumen endotracheal intubation thora-coscope (group B) were analyzed. Results There were no death patients in both groups. Group A:endotracheal intu-bation time (2.67 ± 0.72) min, surgery time (48.37 ± 4.64) min, the bleeding (26.17 ± 9.62) ml; Group B:endotracheal intubation time (5.55 ± 0.71) min, surgery time (52.10 ± 5.68) min, the bleeding (33.00 ± 7.94) ml. Conclusion Compared with traditional double lumen endotracheal intubation under thoracoscope, the single lumen endotracheal intubation of thoracoscope showed that intubation time was significantly shorter, and reduced the oc-currence of postoperative complications, the operative field was exposed more completely, reduced operation time and blood loss.

Objective:To investigate the metabolic disorder of gut microbiota and short-chain fatty acids (SCFAs) in patients with hypertensive intracerebral hemorrhage and their correlations with the poor outcomes.Methods:Thirty-eight patients with hypertensive intracerebral hemorrhage within 7 d of onset and 32 healthy controls were enrolled prospectively. Fecal samples were collected for 16S rRNA sequencing and SCFAs levels detection. The outcome was evaluated by the modified Rankin Scale at 90 d after the onset, and >2 points were defined as a poor outcome. Multivariate logistic regression model was used to determine the correlations between the gut microbiota and the fecal SCFAs levels and outcomes. Results:The gut microbiota of patients with hypertensive intracerebral hemorrhage was significantly different from that of healthy control group. It is manifested as a decrease in α diversity, a difference in β diversity, an increase in the abundance of potential undesirable bacteria, a decrease in the abundance of common SCFA-producing bacteria and a decrease in the fecal SCFAs levels. In patients with hypertensive intracerebral hemorrhage, compared with the good outcome group, the α diversity of the gut microbiota, the abundance of SCFA-producing bacteria such as Lacetospirillum and Bacteroides, and the total SCFAs, acetic acid and propionic acid levels decreased in the poor outcome group. Multivariate logistic regression analysis showed that after adjusting for potential confounding factors, the decrease of fecal SCFAs levels after log2 conversion was significantly and independently correlated with the poor outcomes. Conclusion:Patients with hypertensive intracerebral hemorrhage have gut microbiota and SCFAs metabolic disorder, the latter is significantly correlated with the poor outcomes. Gut microbiota and SCFAs may become an outcome marker and treatment target for patients with hypertensive intracerebral hemorrhage

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

Objective To investigate the risk factors of in-hospital mortality and establish a risk prediction model for patients receiving venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods We retrospectively collected the data of 302 patients receiving VA-ECMO in ICU of 3 hospitals in Guangdong Province between January,2015 and January,2022 using a convenience sampling method.The patients were divided into a derivation cohort(201 cases)and a validation cohort(101 cases).Univariate and multivariate logistic regression analyses were used to analyze the risk factors for in-hospital death of these patients,based on which a risk prediction model was established in the form of a nomogram.The receiver operator characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the discrimination ability,calibration and clinical validity of this model.Results The in-hospital mortality risk prediction model was established based the risk factors including hypertension(OR=3.694,95%CI:1.582-8.621),continuous renal replacement therapy(OR=9.661,95%CI:4.103-22.745),elevated Na2+ level(OR=1.048,95%CI:1.003-1.095)and increased hemoglobin level(OR=0.987,95%CI:0.977-0.998).In the derivation cohort,the area under the ROC curve(AUC)of this model was 0.829(95%CI:0.770-0.889),greater than those of the 4 single factors(all AUC<0.800),APACHE Ⅱ Score(AUC=0.777,95%CI:0.714-0.840)and the SOFA Score(AUC=0.721,95%CI:0.647-0.796).The results of internal validation showed that the AUC of the model was 0.774(95%CI:0.679-0.869),and the goodness of fit test showed a good fitting of this model(χ2=4.629,P>0.05).Conclusion The risk prediction model for in-hospital mortality of patients on VA-ECMO has good differentiation,calibration and clinical effectiveness and outperforms the commonly used disease severity scoring system,and thus can be used for assessing disease severity and prognostic risk level in critically ill patients.

In China, patients with hepatocellular carcinoma (HCC) are usually with late stage and long medical history when diagnosed, resulting in a lower 5-year survival rate. For advanced HCC, guidelines from different countries have different indications for local treatment. The applica-tion of hepatic artery chemoembolization has brought new treatment opportunities to patients with advanced HCC. Due to tumor heterogeneity, the response to immunotherapy is different in patients with intrahepatic recurrent lesions and extrahepatic metastatic lesions of primary hepatic carcinoma. Therefore, hepatic artery chemoembolization combined with systemic treatment is beneficial to prolong the survival of patients. The authors introduce the clinical experience of a patient with recurrent advanced HCC combined with abdominal lymph node metastasis who was treated with hepatic artery chemoembolization combined with atezolizumab plus bevacizumab. The results show that tumor is controlled in a short period with a good clinical effect.