Objective To explore the feasibility and safety of CT guided indocyanine green(ICG)injection for localization of small pulmonary nodules in thoracoscopy surgery.Methods Thoracoscopic resection of pulmonary nodules was performed in 96 cases with a total of 124 pulmonary nodules from September 2021 to June 2023.Within 1 day before surgery,under the CT guidance,we firstly confirmed that the needle tip was less than 10 mm from the nodule,and then 0.04 ml of ICG solution was injected for pulmonary nodule localization,followed by thoracoscopic resection of pulmonary nodules.Results A total of 124 nodules were successfully located in the 96 patients.The average nodule size was 8 mm(range,5-10 mm),and the average positioning time was 11 min(range,9-20 min).The duration of fluorescence development lasted for over 22 h.Postoperative pathology showed 45 lesions of adenocarcinomas in situ,17 lesions of atypical hyperplasia,and 62 lesions of adenocarcinomas(including 53 microinvasive adenocarcinomas and 9 invasive adenocarcinomas).Among them,8 patients had mild pneumothorax and 3 patients had blood in sputum,all of which did not require special treatment.Conclusion CT guided ICG injection has high accuracy,safety,and effectiveness for localization of small pulmonary nodules.

Objective:To investigate the effect of conventional coronary CT angiography (CCTA) bolus injection of contrast agent on the diameter and angle of the left main coronary artery (LMA) bifurcation area, and to provide a basis for the application of CCTA to accurately measure the coronary artery.Methods:In Cangzhou Central Hospital of Hebei Province from January to December 2020, the clinical data of 54 patients with suspected coronary heart disease who underwent coronary artery calcification score (CACS) and CCTA with conventional bolus injection of contrast agent were retrospectively analyzed. Two physicians measured middle lumen diameter of LMA (d1), proximal lumen diameter of left anterior descending (LAD) (d2), proximal lumen diameter of left circumflex (LCX) (d3) and bifurcation angle between LAD and LCX (∠1). The consistency of 2 physicians was compared, and the results of CACS and CCTA were compared.Results:The consistency analysis result showed that only d3 measured by CCTA had a moderate consistency (intra-group correlation coefficient = 0.717), and the remaining indexes were in good agreement (intra-group correlation coefficient >0.75). There were no statistical differences in indexes measured results between CACS and CCTA ( P>0.05). According to the degree of left coronary artery stenosis, 54 patients were divided into 2 groups: LMA and branches normal or stenosis degree < 50% group (25 cases) and LMA and branches 1 or more branches stenosis degree≥50% group (29 cases). There were no statistical differences in indexes measured results between CACS and CCTA in patients with different disease severity ( P>0.05). Conclusions:In the CCTA examination, the conventional bolus injection of contrast agent does not affect the diameter and angle of the lumen of the LMA bifurcation area of the coronary artery.

Objective To evaluate the differentiation of mouse tracheal epithelial cells ( MTEC) at an air-liquid interface and to investigate the influences of influenza virus on the cystic fibrosis transmem-brane conductance regulator ( CFTR) in primary cultured MTEC for further elucidating the possible mecha-nism of imbalanced fluid and salt transportation in respiratory system caused by influenza virus infection . Methods The morphology of primarily cultured MTEC was observed under inverted microscope .Trans epi-thelial electrical resistance ( TEER) was measured by a resistance meter to evaluate the integrity of cultured MTEC.An Ussing chamber apparatus was used to record the short-circuit current of primary cultured MTEC . Results The primarily cultured MTEC clustered together and had a tight pavement-like appearance under light microscope .The TEER was greater than 1000 Ωafter 6 days of culture .Influenza virus could reduce the short-circuit current of CFTR to (52.77±10.30)％in intact cell membrane and to (41.50±1.09)％in monolayer MTEC after increasing the permeability of basement membrane .It had been proved that CFTR was essential to maintaining the balance of fluid and salt transportation in respiratory system.Conclusion Mouse MTEC are efficiently cultured at a air-liquid interface and the primarily cultured cells are highly simi-lar to those in a normal physiologic state .Influenza virus may block the secretion of anions through inhibiting the function of CFTR , which may induce the development of chronic obstructive pulmonary disease and the incidence of asthma .

Objective To investigate the effects of inverse ratio ventilation on pulmonary function and ce-rebral oxygen saturation in elderly patients with single lung ventilation.Methods Sixty patients scheduled for elec-tive radical resection of esophageal cancer were divided into 2 groups(n=30 for each group)using a random num-ber table:the experiment group(group A)and the control group(group B). During the two lung ventilation,the ventilator parameters were set as tidal volume(VT)7 mL/kg,inspiratory to expiratory ratio 1:2. During one lung ventilation,the I:E ratio was 1.5:1 in the group A and 1:2 in the group B. At 15 min after two lung ventilation (T1),20 min after one lung ventilation(T2),60 min after one lung ventilation(T3)and 15 min after restarting two-lung ventilation(T4),the blood gas analysis was measured and recorded for the hemodynamics,respiratory me-chanics index and cerebral oxygen saturation respectively. Results Compared with the B group,the Ppeak and VD/VT at T2~T4in the group A were lower while PaO2,Pmean and Cdyn were higher(P<0.05).During one lung ventilation,the incidence of rSO2< 50% or rSO2decreased more than 20% in the group A was lower than that in the group B(P<0.05).The PaO2,Cdyn and rSO2of the two groups at T2~T4were significantly lower and Ppeak, Pmean,PaCO2,VD/VT were significantly higher than the baseline(T1)(P < 0.05). Conclusion During one-lung ventilation,prolonged inspiratory time can improve pulmonary function and lung compliance without increas-ing peak airway pressure,reduce the decline of rSO2 at the same time.

Objective:To construct and validate a nomogram model for predicting the risk of 28-day mortality in sepsis patients.Methods:A retrospective cohort study was conducted. 281 sepsis patients admitted to the department of intensive care unit (ICU) of the 940th Hospital of the Joint Logistics Support Force of PLA from January 2017 to December 2022 were selected as the research subjects. The patients were divided into a training set (197 cases) and a validation set (84 cases) according to a 7∶3 ratio. The general information, clinical treatment measures and laboratory examination results within 24 hours after admission to ICU were collected. Patients were divided into survival group and death group based on 28-day outcomes. The differences in various data were compared between the two groups. The optimal predictive variables were selected using Lasso regression, and univariate and multivariate Logistic regression analyses were performed to identify factors influencing the mortality of sepsis patients and to establish a nomogram model. Receiver operator characteristic curve (ROC curve), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the nomogram model.Results:Out of 281 cases of sepsis, 82 cases died with a mortality of 29.18%. The number of patients who died in the training and validation sets was 54 and 28, with a mortality of 27.41% and 33.33% respectively. Lasso regression, univariate and multivariate Logistic regression analysis screened for 5 independent predictors associated with 28-day mortality. There were use of vasoactive drugs [odds ratio ( OR) = 5.924, 95% confidence interval (95% CI) was 1.244-44.571, P = 0.043], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ: OR = 1.051, 95% CI was 1.000-1.107, P = 0.050), combined with multiple organ dysfunction syndrome (MODS: OR = 17.298, 95% CI was 5.517-76.985, P < 0.001), neutrophil count (NEU: OR = 0.934, 95% CI was 0.879-0.988, P = 0.022) and oxygenation index (PaO 2/FiO 2: OR = 0.994, 95% CI was 0.988-0.998, P = 0.017). A nomogram model was constructed using the independent predictive factors mentioned above, ROC curve analysis showed that the AUC of the nomogram model was 0.899 (95% CI was 0.856-0.943) and 0.909 (95% CI was 0.845-0.972) for the training and validation sets respectively. The C-index was 0.900 and 0.920 for the training and validation sets respectively, with good discrimination. The Hosmer-Lemeshoe tests both showed P > 0.05, indicating good calibration. Both DCA and CIC plots demonstrate the model's good clinical utility. Conclusions:The use of vasoactive, APACHEⅡ score, comorbid MODS, NEU and PaO 2/FiO 2 are independent risk factors for 28-day mortality in patients with sepsis. The nomogram model based on these 5 indicators has a good predictive ability for the occurrence of mortality in sepsis patients.