Objective To analyze the current application status,research hotspots and develop-ment trends of sedation strategies from both domestic and international perspectives in mechanically ventilated patients in the intensive care unit(ICU).Methods Relevant literature on the application of sedation strategies in mechanically ventilated patients from 2014 to 2024 was retrieved from data-bases including China National Knowledge Infrastructure(CNKI),Wanfang and Web of Science.Visual analysis of publication volume and keywords was conducted using CiteSpace 6.2.R3 software.Results A total of 475 Chinese-language articles and 405 English-language articles were included.Significant differences were observed in publication volume between domestic and international re-search,with early domestic activity followed by a decline,while international research had demonstra-ted robust and sustained growth over the past five years.International studies primarily emphasized protocol-driven sedation processes and standardized strategies,whereas domestic research focused on optimizing the concept of comfort-oriented sedation management and exploring postoperative sedation strategies.Analysis of research hotspots revealed that precise pharmacological regulation,the development of disease-specific sedation strategies,and the establishment of multidisciplinary collaborative protocols were key areas of focus in sedation strategies for ICU mechanically ventilated patients.Conclusion Future research should prioritize shortening the update cycle of clinical guidelines,enhancing the transla-tion of evidence-based practices into clinical settings,establishing clear application standards for disease-specific sedation strategies,improving multicenter collaborative research capabilities,and developing artificial intelligence-based sedation monitoring technologies.

Objective To investigate the effect of extracellular heat shock protein(HSP)22 on Toll-like receptor(TLR)4/nuclear factor-κB(NF-κB)signaling pathway in oxidative-low-density lipoprotein(ox-LDL)-induced inflammatory damage in coronary endothelial cells(HCAECs).Methods HCAECs were cul-tured in vitro and pretreated with ox-LDL to establish a model of high-lipid-induced endothelial cell injury.Re-combinant human HSP22(rhHSP22)was exogenously treated.The effects of rhHSP22 on the expression of inflammation-related proteins such as interleukin(IL)-8,vascular cell adhesion molecule(VCAM)-1 and NF-κB in endothelial cells and endothelial cell apoptosis were observed.The relationship between HSP22 and TLR4/NF-κB signaling pathway was investigated under the action of TLR4 inhibitor E5564.Western blot was used to detect the expression of IL-8,VACM-1 and NF-κB proteins,and flow cytometry was used to detect the apoptosis of endothelial cells in each group.Results Compared with the CNT group,the relative expression levels of IL-8,VACM-1 and NF-κB protein in the rhHSP22 group,rhHSP22+ox-LDL group,rhHSP22+E5564 group and rhHSP22+E5564+ox-LDL group were significantly increased,and the differences were sta-tistically significant(P<0.05).Compared with the rhHSP22 group,the relative expression levels of IL-8,VACM-1 and NF-κB protein in the rhHSP22+ox-LDL group were significantly increased,and the differences were statistically significant(P<0.05).Compared with the rhHSP22+ox-LDL group,the relative expression levels of IL-8 and VACM-1 in the rhHSP22+E5564+ox-LDL group were decreased,and the differences were statistically significant(P<0.05).Compared with the CNT group,the apoptosis rate in the rhHSP22 group,rhHSP22+ox-LDL group and rhHSP22+E5564+ox-LDL group was significantly increased,and the differ-ence was statistically significant(P<0.05).Compared with the rhHSP22 group,the apoptosis rate in the rhHSP22+ox-LDL group was increased,and the difference was statistically significant(P<0.05).Compared with the rhHSP22+ox-LDL group,the apoptosis rate in the rhHSP22+E5564+ox-LDL group was de-creased,and the difference was statistically significant(P<0.05).Conclusion In ox-LDL-induced inflamma-tory damage of HCAECs,extracellular HSP22 induces the expression of IL-8,VACM-1 and NF-κB proteins by activating the TLR4/NF-κB signaling pathway,and promotes endothelial cell apoptosis.

Objective:To study the feasibility and safety of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ.Methods:Clinical data of 60 patients with liver tumors treated at Jinhua Central Hospita from January 2018 to September 2022 were retrospectively collected, including 40 males and 20 females, aged (51.5±4.5) years. Perioperative data on operative time, intraoperative blood loss, postoperative time of ambulation, postoperative time to flatulate, duration of hospital stay, pathological type, complications (bile leakage, pleural effusion, etc.) were analyzed. Postoperative follow-ups were conducted through telephone reviews, outpatient visits.Results:Of 57 patients (95.0%) successfully underwent the surgery, while three cases (5.0%) were converted to open surgery due to excessive intraoperative bleeding. The operative time was (210.5±20.5) min. The intraoperative blood loss was (220.5±50.5) ml. The postoperative time of ambulation was (1.5±0.5) d, and the postoperative time to flatulate was (2.0±0.8) d. The postoperative hospital stay was (7.2±1.5) d. Bile leakage occurred in four cases (6.7%) after surgery, which was managed by conservative treatment, and pleural effusion occurred in eight cases (13.3%), which recovered after puncture and drainage. Postoperative pathology included 40 cases (66.7%) of hepatocellular carcinoma, three cases (5.0%) of intrahepatic cholangiocarcinoma, five cases (8.3%) of liver metastases, seven cases (11.7%) of hepatic hemangioma, two case (3.3%) of angiomyolipoma, and three case (5.0%) of focal hepatic nodular hyperplasia. No tumor recurrence was observed during follow-up (median 26 months; range 18-40 months).Conclusion:The application of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ is safe and feasible.

Objective:To study the comprehensive surgical treatment of brucellosis with chest wall cysts as the main manifestation.Methods:Retrospective analysis was made on the general information epidemiological characteristics, clinical manifestations, laboratory examinations, imaging examinations, treatment and outcomes of five patients with brucellosis mainly manifested by chest wall cysts admitted to the 948 Hospital of the People's Liberation Army from July 2019 to June 2022.Results:Among the 5 patients, there were 4 males and 1 female, aged between 23 and 64 years old, with a clear history of contact with cattle and sheep. The main clinical manifestation was painless cystic masses on the chest wall. Both the serum tiger red plate agglutination test (RBPT) and the test tube agglutination test (SAT) were positive. Four cases were infected with Brucella and one case was infected with Actinobacillus pleuropneumoniae (considered as Brucella infection based on the overall condition). All patients exhibited abnormal chest wall signals (manifesting as hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging) on magnetic resonance imaging(MRI), and were ultimately diagnosed with brucellosis presenting predominantly as chest wall cysts. After complete removal of the chest wall cyst through surgery, a combination treatment of rifampicin capsules and doxycycline hyclate tablets was given for 6 weeks. There were no significant adverse reactions and the wound healed in one stage. During the postoperative follow-up period of 11 - 40 months, MRI reexamination demonstrated no evidence of chest wall cyst recurrence, and all SAT results were negative. Conclusions:Patients with brucellosis presenting as chest wall cysts are clinically rare and lack specific symptoms. Surgical resection of the affected lesion combined with early, standardized, combined, and full course antimicrobial therapy results in a good prognosis for the patient.

Objective:To study the comprehensive surgical treatment of brucellosis with chest wall cysts as the main manifestation.Methods:Retrospective analysis was made on the general information epidemiological characteristics, clinical manifestations, laboratory examinations, imaging examinations, treatment and outcomes of five patients with brucellosis mainly manifested by chest wall cysts admitted to the 948 Hospital of the People's Liberation Army from July 2019 to June 2022.Results:Among the 5 patients, there were 4 males and 1 female, aged between 23 and 64 years old, with a clear history of contact with cattle and sheep. The main clinical manifestation was painless cystic masses on the chest wall. Both the serum tiger red plate agglutination test (RBPT) and the test tube agglutination test (SAT) were positive. Four cases were infected with Brucella and one case was infected with Actinobacillus pleuropneumoniae (considered as Brucella infection based on the overall condition). All patients exhibited abnormal chest wall signals (manifesting as hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging) on magnetic resonance imaging(MRI), and were ultimately diagnosed with brucellosis presenting predominantly as chest wall cysts. After complete removal of the chest wall cyst through surgery, a combination treatment of rifampicin capsules and doxycycline hyclate tablets was given for 6 weeks. There were no significant adverse reactions and the wound healed in one stage. During the postoperative follow-up period of 11 - 40 months, MRI reexamination demonstrated no evidence of chest wall cyst recurrence, and all SAT results were negative. Conclusions:Patients with brucellosis presenting as chest wall cysts are clinically rare and lack specific symptoms. Surgical resection of the affected lesion combined with early, standardized, combined, and full course antimicrobial therapy results in a good prognosis for the patient.

Objective:To study the feasibility and safety of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ.Methods:Clinical data of 60 patients with liver tumors treated at Jinhua Central Hospita from January 2018 to September 2022 were retrospectively collected, including 40 males and 20 females, aged (51.5±4.5) years. Perioperative data on operative time, intraoperative blood loss, postoperative time of ambulation, postoperative time to flatulate, duration of hospital stay, pathological type, complications (bile leakage, pleural effusion, etc.) were analyzed. Postoperative follow-ups were conducted through telephone reviews, outpatient visits.Results:Of 57 patients (95.0%) successfully underwent the surgery, while three cases (5.0%) were converted to open surgery due to excessive intraoperative bleeding. The operative time was (210.5±20.5) min. The intraoperative blood loss was (220.5±50.5) ml. The postoperative time of ambulation was (1.5±0.5) d, and the postoperative time to flatulate was (2.0±0.8) d. The postoperative hospital stay was (7.2±1.5) d. Bile leakage occurred in four cases (6.7%) after surgery, which was managed by conservative treatment, and pleural effusion occurred in eight cases (13.3%), which recovered after puncture and drainage. Postoperative pathology included 40 cases (66.7%) of hepatocellular carcinoma, three cases (5.0%) of intrahepatic cholangiocarcinoma, five cases (8.3%) of liver metastases, seven cases (11.7%) of hepatic hemangioma, two case (3.3%) of angiomyolipoma, and three case (5.0%) of focal hepatic nodular hyperplasia. No tumor recurrence was observed during follow-up (median 26 months; range 18-40 months).Conclusion:The application of left semiprone position in 3D laparoscopic liver resection for tumor in segment Ⅶ is safe and feasible.

Objective To analyze the publication profile and research hotspots of studies at home and abroad on postoperative cognitive dysfunction by bibliometric methods. Methods Literatures related to postoperative cognitive dysfunction published in the China National Knowledge Infrastructure (CNKI) and Web of Science databases from 2013 to 2023 were included, and statistical analysis was conducted by CiteSpace software. Results A total of 2 705 Chinese literatures and 2 412 English core literatures were included. The number of literatures on postoperative cognitive dysfunction showed an annual increase from 2013 to 2023; China was the country with the highest number of publications internationally, with Capital Medical University ranking the top among Chinese institutions; domestically, postoperative cognitive dysfunction researches predominantly focused on clinical studies, while overseas researches emphasized pathological mechanisms and basic investigations. Research hotspot analysis revealed an enhanced interest in the inflammatory mechanisms and anesthetic aspects of postoperative cognitive dysfunction. Conclusion From 2013 to 2023, the overall research at home and abroad interest in postoperative cognitive dysfunction has shown an upward trend, yet its pathophysiological mechanisms need further exploration. The risk factors for postoperative cognitive impairment and their correlations with anesthesia and mortality are being actively explored, and new methods for prevention and treatment such as percutaneous electrical stimulation are gradually emerging.

Objective To investigate the safety and clinical efficacy of the combined gallbladder plate approach using Laennec membrane based on APR triangle in laparoscopic anaphylactic right lobe hepatectomy.Methods Clinical data of 27 patients underwent laparoscopic anaphylactic of right lobe hepatectomy based on the APR triangle combined with the gallbladder plate approach using Laennec membrane were collected from January 2021 to December 2023.The relevant data of patients were statistically analyzed,including operation time,intraoperative blood loss,postoperative complications,and postoperative hospital stay.Results All the 27 patients underwent laparoscopic anatomic hepatectomy,and no perioperative death occurred.Among them,segment Ⅴ was resected in 4 cases,segment Ⅵ in 3 cases,segment Ⅴ+Ⅷ in 6 cases,segment Ⅴ+Ⅵ in 4 cases,segment Ⅵ+Ⅶin 5 cases,segment Ⅴ+Ⅵ+Ⅶ in 3 cases,and segment Ⅴ+Ⅵ+Ⅷ in 2 cases.All cases belonged to the China Liver Cancer(CNLC)clinical staging,stage Ⅰa in 15 cases,stage Ⅰb in 8 cases and stage Ⅱa in 4 cases.The operative time was(258.3±62.3)min,the intraoperative blood loss was(168.8±48.1)mL,and there was no transfusion.The patients were given liquid diet on the first day after surgery,and were active in bed on the second day after surgery.The mean postoperative length of hospital stay was(6.5±1.7)d after removal of abdominal drainage tube.There were 5 cases of Clavien-Dindo Ⅰ and Ⅱ complications(3 cases of abdominal effusion,1 case of pleural effusion,1 case of pulmonary infection),and no complications such as bile leakage and abdominal hemorrhage occurred.Postoperative pathology:21 cases of hepatocellular carcinoma,4 cases of hepatociliary duct carcinoma,2 cases of liver metastasis.Patients with liver malignant tumor were followed up for 2 months to 2 years,and all patients survived during the follow-up period without tumor recurrence.Conclusion The gallbladder plate approach based on APR triangle combined with Laennec membrane is a safe and effective surgical method for laparoscopic anaphylactic right lobe hepatectomy,which is worthy of clinical application.

Objective To develop and validate a prediction model for extended hospitalisation in patients with ischemic stroke.Methods A total of 318 patients with ischemic stroke hospitalised between November 2021 and May 2023 in a Grade ⅢA hospital in Changzhou were selected as study objects with a convenience sampling method.The modelling group consisted 212 patients and the validation group included 106 patients.The patients in the modelling group were divided into a group of extended hospital stay and a group of normal hospital stay.Binary logistic regression analysis was conducted to develop the prediction model,and data from the 106 patients in the validation group were then incorporated into the developed prediction model.The prediction performance and goodness-of-fit of the model were accessed using the area under the curve(AUC)of the receiver operation characteristic(ROC)curve and the Hosmer-Lemeshow test.Results Multivariate logistic analysis showed that comorbid diabetes,number of complications during hospitalisation,a Braden score less than 18,and a white blood cell count greater than 3.5×109/L or more than 9.5×109/L were the risk factors of extended hospitalisation in patients with cerebral ischemic stroke.Based on the factors,a prediction model was developed with following formula:P=1/[1+exp(-Z)].Hosmer-Lemeshow test for the prediction model yielded χ 2=7.430,P=0.191.AUC of the prediction model was 0.818(95％CI:0.754-0.883,P<0.001)with Jordon index of 0.51 and the optimal cut-off value of 0.268,sensitivity of 78.9％and specificity of 72.3％The results of the validation of independent data model showed a sensitivity of 75.0％,specificity of 74.4％,and accuracy of 74.5％.Conclusion Comorbid diabetes,Braden score at admission,white blood cell count and the number of complications during hospitalisation are the significant factors that affect the length of hospital stay in the patients with ischemic stroke.The prediction model for extended hospitalisation of the patients with ischemic stroke exhibits good predictive value and can provide reference in clinical decision-making.

Objective This research assessed the impact of incorporating choledochoscopy with laparoscopic left hepatectomy on stress response and bile duct stone removal in patients presenting with complex intrahepatic biliary stones.Methods Clinical data of 194 patients with complex intrahepatic biliary stones from June 2020 to June 2024 were retrospectively analyzed.The patients were divided into control group (n=97) and observation group (n=97) according to different operation methods.The control group received laparoscopic left hepatectomy,while the observation group received choledochoscopic lithotomy combined with laparoscopic left hepatectomy.The changes of stress indexes[cortisol (Cor),adrenaline (AD)],inflammatory factors[C-reactive protein (CRP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α)]in the two groups before and 3 days after operation were compared.The liver function indexes[alanine transaminase (ALT),total bilirubin (TBiL),glutamyl transferase (GGT)]of the two groups before and 7 days after operation were compared.The treatment effect levels of the two groups were evaluated 3 months after operation.The incidence of postoperative complications (bile leakage,infection,residual stones and pleural effusion) was recorded and compared between the two groups.Results Three days before and after operation,the levels of Cor,AD,CRP,IL-6 and TNF-α in the two groups had no significant difference (P>0.05),but the postoperative level in two groups were significantly higher than those before surgery,and the differences were statistically significant (P<0.05).Before operation,there was no significant difference in ALT,TBiL and GGT between the two groups (P>0.05).On the 7th day after operation,ALT,TBiL and GGT of the two groups decreased,and the observation group was lower than those of the control group (P<0.05).There was no significant difference in visual analogue scale (VAS),postoperative anal exhaust time and postoperative ambulation time between the two groups (P>0.05).The hospitalization time of the observation group was shorter than that of the control group,the difference was statistically significant (P<0.05).The therapeutic effect of the observation group at 3 months after operation was significantly better than that of the control group,the difference was statistically significant (P<0.05).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group,the difference was statistically significant (P<0.05).Conclusion The combination of laparoscopic left hepatectomy and choledochoscopy effectively addresses complex intrahepatic biliary stones,minimally impacting patient stress responses,enhancing liver function,and reducing complication risks,thereby holding promising clinical applicability.