OBJECTIVE: To explore the association between blood glucose trajectories within 7 days of intensive care unit (ICU) admission and mortality in patients with sepsis-associated acute respiratory distress syndrome (ARDS). METHODS: Based on the MIMIC-IV database, sepsis-associated ARDS patients with daily blood glucose monitoring data within 7 days of ICU admission were selected. Blood glucose trajectories were analyzed using group-based trajectory modeling (GBTM), and the optimal number of groups was determined based on the minimum Akaike information criterion (AIC), Bayesian information criterion (BIC), average posterior probability (AvePP), odds of correct classification (OCC), and proportion of group membership (Prop). Baseline characteristics including demographics, comorbidities, severity scores, vital signs, laboratory indicators within the first 24 hours of ICU admission, and treatments were collected. Kaplan-Meier survival curves were used to compare 28-day and 1-year survival across trajectory groups. Multivariate Logistic regression was performed to evaluate the associations between glucose trajectory groups and in-hospital mortality, ICU mortality. The incidence of hypoglycemia within 7 days in the ICU was analyzed among different groups. RESULTS: A total of 3 869 patients with sepsis-associated ARDS were included, with a median age of 63.52 (52.13, 73.54) years; 59.6% (2 304/3 869) were male. Based on glucose levels within 7 days, patients were categorized into three groups: persistent hyperglycemia group (glucose maintained at 10.6-13.1 mmol/L, n = 894), moderate glucose group (7.8-8.9 mmol/L, n = 1 452), and low-normal glucose group (6.1-7.0 mmol/L, n = 1 523). There were statistically significant differences in 28-day mortality and 1-year mortality among low-normal glucose group, moderate glucose group, and persistent hyperglycemia group [28-day mortality: 11.42% (174/1 523), 19.83% (288/1 452), 25.50% (228/894), χ ² = 82.545, P < 0.001; 1-year mortality: 23.31% (355/1 523), 33.75% (490/1 452), 39.49% (353/894), χ ² = 77.376, P < 0.001]. Kaplan-Meier analysis showed that higher glucose trajectories were associated with significantly lower 28-day and 1-year cumulative survival rates (Log-rank test: χ ² were 83.221 and 85.022, both P < 0.001). There were statistically significant differences in in-hospital mortality and ICU mortality among the low-normal glucose group, moderate glucose group, and persistent hyperglycemia group [in-hospital mortality: 9.65% (147/1 523), 19.70% (286/1 452), 24.50% (219/894), χ ² = 102.020, P < 0.001; ICU mortality: 7.22% (110/1 523), 16.05% (233/1 452), 20.13% (180/894), χ ² = 93.050, P < 0.001]. Logistic regression confirmed that, using the persistent hyperglycemia group as the reference, the low-normal glucose group had significantly lower risks of in-hospital mortality and ICU mortality after multiple factor adjustment. Although the moderate glucose group showed a trend toward lower mortality, the differences were not statistically significant. Using the moderate glucose group as a reference, the low-normal glucose group had 43.1% lower in-hospital mortality [odds ratio (OR) = 0.569, 95% confidence interval (95%CI) was 0.445-0.726, P < 0.001] and 42.0% lower ICU mortality (OR = 0.580, 95%CI was 0.439-0.762, P < 0.001). There was no statistically significant difference in the incidence of hypoglycemia within 7 days of ICU admission among low-normal glucose group, moderate glucose group, and persistent hyperglycemia group [2.82% (43/1 523), 2.69% (39/1 452), 3.02% (27/894), χ ² = 0.226, P = 0.893]. CONCLUSIONS Blood glucose trajectories during ICU stay are closely associated with prognosis in patients with sepsis-associated ARDS. Persistent hyperglycemia (10.6-13.1 mmol/L) is linked to significantly higher short- and long-term mortality.
Humans ; Respiratory Distress Syndrome/etiology* ; Sepsis/blood* ; Intensive Care Units ; Male ; Female ; Middle Aged ; Blood Glucose/metabolism* ; Hospital Mortality ; Aged

OBJECTIVE To optimize the venipuncture disinfection procedures for the patients with psoriasis by modifying the skin pretreatment,number of times of disinfection and action time,evaluate the disinfection effects before and after the modification and observe the impact on skin barrier function.METHODS A total of 78 patients with psoriasis who were hospitalized in Air Force Medical Center of Special Medicine from Jan.2024 to Mar.2025 were enrolled in the study and were randomly divided into the control group and the study group,with 39 cases in each group.Both groups were disinfected with povidone iodine swabs.The control group was treated with a single clockwise spiral wipe centered on the puncture site,and the total time of embrocation and drying time was 60 s;the study group was treated with the modified disinfection method'pretreatment-bidirectional disinfec-tion-120-second drying',which was unidirectional wiping of puncture site skin of hand back with sterile swab in-filtrating with normal saline,a single clockwise spiral wipe centered on the puncture site,counter-clockwise wipe for two times,the total time of embrocation and drying 120 s in total.The skin specimens were collected from the puncture sites for culture and identification of pathogens before the disinfection and after the drying,and the trans-epidermal water loss(TEWL)volume was detected by TewameterTM 300 instrument.RESULTS Totally 16 types of pathogens were isolated from the two groups of patients before the disinfection,among which Staphylococcus spp was dominant.The bacterial colony counts were[26.00(8.00,74.00)]CFU/cm2 in the study group before the disinfection,[41.00(13.00,94.00)]CFU/cm2 in the control group,and there was no significant difference(P=0.081).The bacterial colony counts of the two groups were lower after the disinfection and drying than before the disinfection(P＜0.001),and the bacterial colony counts of the study group were[0.00(0.00,1.00)]CFU/cm2,lower than[1.00(0.00,4.00)]CFU/cm2 of the control group(P=0.042).The TEWL value of the two groups was greater after the disinfection than before the disinfection(P＜0.001),however,there was no between-group difference(P=0.933).CONCLUSION The modified disinfection procedure has more advantages in eradicating pathogens without increasing damage to skin barrier,it provides safer disinfection plans for the patients with psoriasis and is worthy to be promoted in the hospital.

OBJECTIVE To optimize the venipuncture disinfection procedures for the patients with psoriasis by modifying the skin pretreatment,number of times of disinfection and action time,evaluate the disinfection effects before and after the modification and observe the impact on skin barrier function.METHODS A total of 78 patients with psoriasis who were hospitalized in Air Force Medical Center of Special Medicine from Jan.2024 to Mar.2025 were enrolled in the study and were randomly divided into the control group and the study group,with 39 cases in each group.Both groups were disinfected with povidone iodine swabs.The control group was treated with a single clockwise spiral wipe centered on the puncture site,and the total time of embrocation and drying time was 60 s;the study group was treated with the modified disinfection method'pretreatment-bidirectional disinfec-tion-120-second drying',which was unidirectional wiping of puncture site skin of hand back with sterile swab in-filtrating with normal saline,a single clockwise spiral wipe centered on the puncture site,counter-clockwise wipe for two times,the total time of embrocation and drying 120 s in total.The skin specimens were collected from the puncture sites for culture and identification of pathogens before the disinfection and after the drying,and the trans-epidermal water loss(TEWL)volume was detected by TewameterTM 300 instrument.RESULTS Totally 16 types of pathogens were isolated from the two groups of patients before the disinfection,among which Staphylococcus spp was dominant.The bacterial colony counts were[26.00(8.00,74.00)]CFU/cm2 in the study group before the disinfection,[41.00(13.00,94.00)]CFU/cm2 in the control group,and there was no significant difference(P=0.081).The bacterial colony counts of the two groups were lower after the disinfection and drying than before the disinfection(P＜0.001),and the bacterial colony counts of the study group were[0.00(0.00,1.00)]CFU/cm2,lower than[1.00(0.00,4.00)]CFU/cm2 of the control group(P=0.042).The TEWL value of the two groups was greater after the disinfection than before the disinfection(P＜0.001),however,there was no between-group difference(P=0.933).CONCLUSION The modified disinfection procedure has more advantages in eradicating pathogens without increasing damage to skin barrier,it provides safer disinfection plans for the patients with psoriasis and is worthy to be promoted in the hospital.

Myocardial ischemia/reperfusion injury(MIRI)occurs after cardiopulmonary bypass open heart surgery,cardiovascular intervention and thrombolytic therapy,which is the most important cause of cardiac insufficiency,heart fail-ure,and even death in patients after treatment.In recent years,studies have found that the release of endogenous active peptides can alleviate the production of MIRI,and regulating the function and action of endogenous peptides may be one of the most effective ways to treat MIRI.Dipeptidyl peptidase 4(DPP4)is an important serine protease in mammals,with enzymatic activity to hydrolyze endogenous peptides.Its primary physiological function is to metabolize short peptides,in-cluding growth factors,hormones,etc.This review aims to better understand and search for effective therapeutic targets by elucidating the impact of DPP4 on the hydrolysis of endogenous peptides in MIRI,and ultimately provide new ideas for the therapeutic effects of MIRI.

Objective: To describe the prevalence and association of dietary rhythm and depressive symptoms among adolescents, so as to provide a basis for improving unhealthy behavioral habits,and to promote adolescent physical and mental health. Methods: From October to December 2021, a total of 22 868 students were selected from one middle school and high school in urban and rural areas of eight cities, namely, Shenyang, Xuzhou, Shenzhen, Taiyuan, Nanchang, Zhengzhou, Chongqing, and Kunming cities, China, using a combination of purposive sampling and stratified cluster random sampling. A self administered questionnaire was used to assess adolescents dietary rhythm, and the Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. Binary Logistic regression model was employed to analyze the associations between adolescent dietary rhythm and depressive symptoms, while the associations between adolescent dietary rhythm and depressive symptoms across gender and physical activity levels were stratified by gender and physical activity levels. Results: The detection rate of depressive symptoms in adolescents was 44.4%. The respective differences in the detection rates of depressive symptoms among adolescents of different genders, physical activity levels, and dietary rhythm disorders were statistically significant ( χ 2=157.51, 105.02, 3 282.50, P <0.01). Taking the low disordered dietary rhythm group as the reference, binary Logistic regression analyses showed that after adjusting for confounding factors such as age, gender，family location, family economic situation, whether only child, parental education level, and learning burden, physical activity levels, depressive symptoms were positively correlated with adolescents in the moderate disordered dietary rhythm group ( OR=2.63, 95%CI =2.45-2.83) and the high disordered dietary rhythm group ( OR=6.38, 95%CI = 5.93- 6.86). In addition, after stratifying by gender, dietary rhythm were positively correlated with depressive symptoms. The moderate disordered group (male: OR=2.62, 95%CI =2.37-2.89, female: OR=2.67, 95%CI =2.40-2.97) and the highly disordered group (male: OR=5.74, 95%CI =5.19-6.35, female: OR=7.11, 95%CI =6.40-7.89) were positively correlated with depressive symptoms. After stratification by physical activity levels, low, moderate and above physical activity levels among adolescents in the disordered dietary rhythm group (low physical activity: OR=2.91, 95%CI =2.58-3.29, moderate and above physical activity: OR= 2.50, 95%CI =2.28-2.74), high disordered group (low physical activity: OR=6.51, 95%CI =5.94- 7.13 , moderate and higher physical activity: OR=6.18, 95%CI =5.47-6.97) were positively associated with depressive symptoms ( P <0.01). There was an interaction between dietary rhythm and physical activity levels in regard to the development of depressive symptoms in adolescents, taking the group with moderate and above physical activity levels and low disordered dietary rhythm as the reference,the detection rate of which was higher in adolescents with low levels of physical activity and those in the moderate or high disordered dietary rhythm group ( OR=1.50, 3.90, 95%CI=1.39-1.61, 3.63-4.19, P <0.01). Conclusions Dietary rhythm disorders were found to be positively associated with depressive symptoms in adolescents. Regular dietary behaviors and increased physical activity play an important positive role in promoting adolescent mental health.

Objective To evaluate the application efficacy of low-dose test method combined with variable helical pitch(VHP)technology in computed tomography angiography(CTA)of lower extremity arteries.Methods Eighty patients with CTA imaging of bilateral lower extremity arteries were selected and divided into group A and group B on average.VHP technology was used in group A,and conventional fixed pitch scanning was used in group B.The objective and subjective image quality of the two groups were compared,and the radiation dose and contrast agent dosage of the two groups were recorded and compared.Results The subjective image quality evaluation of group A was significantly better than that of group B,and the difference was statistically significant(Kappa test,P<0.05).In the objective image quality evaluation,the CT value and signal-to-noise ratio(SNR)value of the common iliac artery,popliteal artery and anterior tibial artery in group A were higher than those in group B at the same level,and the differences were statistically significant(P<0.05);The effective dose(ED)value in group A was(6.74±1.20)mSv,and that in group B was(7.93±1.78)mSv(P<0.05).The dosage of contrast agent in group A was significantly lower than that in group B[(73.97±12.15)mL in group A,(82.50±2.61)mL in group B](P<0.05).Conclusion Low-dose test method combined with VHP technology not only can reduce the radiation dose and contrast agent dosage,but also can effectively improve the success rate and image quality of lower extremity arteries examination,which is worthy of clinical application.

Objective:To investigate the value of mDixon-Quant imaging combined with blood cell parameters in assessing lymphovascular invasion (LVI) and lymph node metastasis (LNM) in rectal cancer (RC). Methods:Clinical and magnetic resonance imaging (MRI) data were retrospectively collected from 62 patients with pathologically confirmed RC at North China University of Science and Technology Affiliated Hospital from November 2022 to June 2024. We calculated the ratio of blood cell parameters and measured the mDixon-Quant parameters,including fat fraction (FF),R2* value,and T2* value,of the lesions. We compared these metrics across groups and performed multiple Lo-gistic regression analyses to identify risk factors associated with LVI and LNM. Additionally,we calculated the area under the curve (AUC) of the receiver operating characteristic (ROC) to evaluate predictive efficacy. Smooth curve fitting and Spearman correlation analysis were used to evaluate the relationship between imaging and blood cell parameters. Results:The R2* value,neutrophil to lymphocyte ratio (NLR),sys-temic immune-inflammation index (SII),and systemic inflammatory response index (SIRI) were significantly higher in the LVI-positive group compared to those in the negative group. Similarly,the LNM-positive group showed higher R2* value,FF value,NLR,platelet to lymphocyte ratio (PLR),SII,and SIRI than the negative group,with all differences being statistically significant (P<0.05). R2* and SII were identified as in-dependent risk factors for LVI,with AUCs of R2*,SII,and R2*+SII being 0.752,0.802,and 0.883,respectively. R2*,FF,and SII were independ-ent risk factors for LNM,and the AUCs of R2*,FF,SII,R2*+FF,and R2*+FF+SII were 0.733,0.702,0.778,0.825 and 0.857,respectively. Cor-relation analysis indicated a positive relationship between FF and several blood cell parameters,including NLR,monocyte to lymphocyte ra-tio (MLR),SII,and SIRI (r=0.534,0.451,0.353,0.468,P<0.05). Conclusions:Both mDixon-Quant imaging and blood cell parameters are effect-ive for assessing LVI and LNM status in RC. In addition,the correlation between FF and various blood cell parameters highlights the potential role of abnormal lipid metabolism and inflammatory responses in the development of RC,suggesting new avenues for developing clinically tailored treatment protocols.

Objective:To provide evidence for the prevention and control of pulmonary bulla by analyzing the clinical feature and risk factors of pulmonary bulla in military pilots.Methods:With a retrospective analysis, 61 hospitalized military pilots who were diagnosed as pulmonary bulla in Air Force Medical Center from 2021 to 2023 were selected as the case group, and 67 pilots without pulmonary bulla were randomly selected during the same period as the control group, and their medical records were collected. The clinical features of pulmonary bulla were analyzed and the independent risk factors of pulmonary bulla were explored by using multivariate Logistic regression analysis.Results:Among 61 cases of military pilots with pulmonary bulla, 59.02% pathogenic site was located at right lung and 96.72% was at upper lobe , the proportion of multiple pulmonary bulla was 85.25%; 39.34% of the patients with pulmonary bulla experienced thoracic adhesions and located at the top of the chest mostly, and 22.95% of the patients with pulmonary bullae had other pulmonary diseases; the diameter of pulmonary bulla was ranged from 8 mm to 71 mm. From 2021 to 2023, the detection rate of pulmonary bulla among military pilots was 0.91%, 1.65% and 1.73% respectively, which increased year by year. The operative time ranged from 25 min to 260 min, with the median of [45.00 (35.00, 60.00)] min. A total of 68.85% of the military pilots were qualified in aeromedical assessment, and the time of observation was 21-204 d, with an average of (126.55±47.27) d. Multivariate Logistic analysis results showed that flying high performance fighter aircraft ( OR=5.545, 95% CI:1.425-23.560), long total flying hours ( OR=17.864, 95% CI:3.029-136.205), low body mass index ( OR=0.592, 95% CI:0.420-0.789), suffering from other lung diseases ( OR=0.261, 95% CI:0.069-0.770) and long weekly aerobic exercise time ( OR=10.204, 95% CI:1.624-138.146) were independent risk factors of pulmonary bulla in military pilots. Conclusions:The pulmonary bulla of military pilots is mainly at upper lung and right lobe, with a large diameter, and the proportion of incidence is increasing year by year. The operation time is short and the effect is good. The pulmonary bulla of military pilots is related to flying high performance fighter aircraft, long total flying hours, low body mass index, other lung diseases and long weekly aerobic exercise time. Targeted prevention and control measures should be taken according to some of these risk factors to reduce the detection rate of pulmonary bulla in military pilots.

Objective:To investigate the value of mDixon-Quant imaging combined with blood cell parameters in assessing lymphovascular invasion (LVI) and lymph node metastasis (LNM) in rectal cancer (RC). Methods:Clinical and magnetic resonance imaging (MRI) data were retrospectively collected from 62 patients with pathologically confirmed RC at North China University of Science and Technology Affiliated Hospital from November 2022 to June 2024. We calculated the ratio of blood cell parameters and measured the mDixon-Quant parameters,including fat fraction (FF),R2* value,and T2* value,of the lesions. We compared these metrics across groups and performed multiple Lo-gistic regression analyses to identify risk factors associated with LVI and LNM. Additionally,we calculated the area under the curve (AUC) of the receiver operating characteristic (ROC) to evaluate predictive efficacy. Smooth curve fitting and Spearman correlation analysis were used to evaluate the relationship between imaging and blood cell parameters. Results:The R2* value,neutrophil to lymphocyte ratio (NLR),sys-temic immune-inflammation index (SII),and systemic inflammatory response index (SIRI) were significantly higher in the LVI-positive group compared to those in the negative group. Similarly,the LNM-positive group showed higher R2* value,FF value,NLR,platelet to lymphocyte ratio (PLR),SII,and SIRI than the negative group,with all differences being statistically significant (P<0.05). R2* and SII were identified as in-dependent risk factors for LVI,with AUCs of R2*,SII,and R2*+SII being 0.752,0.802,and 0.883,respectively. R2*,FF,and SII were independ-ent risk factors for LNM,and the AUCs of R2*,FF,SII,R2*+FF,and R2*+FF+SII were 0.733,0.702,0.778,0.825 and 0.857,respectively. Cor-relation analysis indicated a positive relationship between FF and several blood cell parameters,including NLR,monocyte to lymphocyte ra-tio (MLR),SII,and SIRI (r=0.534,0.451,0.353,0.468,P<0.05). Conclusions:Both mDixon-Quant imaging and blood cell parameters are effect-ive for assessing LVI and LNM status in RC. In addition,the correlation between FF and various blood cell parameters highlights the potential role of abnormal lipid metabolism and inflammatory responses in the development of RC,suggesting new avenues for developing clinically tailored treatment protocols.

Objective:To provide evidence for the prevention and control of pulmonary bulla by analyzing the clinical feature and risk factors of pulmonary bulla in military pilots.Methods:With a retrospective analysis, 61 hospitalized military pilots who were diagnosed as pulmonary bulla in Air Force Medical Center from 2021 to 2023 were selected as the case group, and 67 pilots without pulmonary bulla were randomly selected during the same period as the control group, and their medical records were collected. The clinical features of pulmonary bulla were analyzed and the independent risk factors of pulmonary bulla were explored by using multivariate Logistic regression analysis.Results:Among 61 cases of military pilots with pulmonary bulla, 59.02% pathogenic site was located at right lung and 96.72% was at upper lobe , the proportion of multiple pulmonary bulla was 85.25%; 39.34% of the patients with pulmonary bulla experienced thoracic adhesions and located at the top of the chest mostly, and 22.95% of the patients with pulmonary bullae had other pulmonary diseases; the diameter of pulmonary bulla was ranged from 8 mm to 71 mm. From 2021 to 2023, the detection rate of pulmonary bulla among military pilots was 0.91%, 1.65% and 1.73% respectively, which increased year by year. The operative time ranged from 25 min to 260 min, with the median of [45.00 (35.00, 60.00)] min. A total of 68.85% of the military pilots were qualified in aeromedical assessment, and the time of observation was 21-204 d, with an average of (126.55±47.27) d. Multivariate Logistic analysis results showed that flying high performance fighter aircraft ( OR=5.545, 95% CI:1.425-23.560), long total flying hours ( OR=17.864, 95% CI:3.029-136.205), low body mass index ( OR=0.592, 95% CI:0.420-0.789), suffering from other lung diseases ( OR=0.261, 95% CI:0.069-0.770) and long weekly aerobic exercise time ( OR=10.204, 95% CI:1.624-138.146) were independent risk factors of pulmonary bulla in military pilots. Conclusions:The pulmonary bulla of military pilots is mainly at upper lung and right lobe, with a large diameter, and the proportion of incidence is increasing year by year. The operation time is short and the effect is good. The pulmonary bulla of military pilots is related to flying high performance fighter aircraft, long total flying hours, low body mass index, other lung diseases and long weekly aerobic exercise time. Targeted prevention and control measures should be taken according to some of these risk factors to reduce the detection rate of pulmonary bulla in military pilots.