Objective To investigate the prognostic value of the platelet-to-lymphocyte ratio(PLR)at different early time points in adult patients undergoing veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective study was conducted,selecting 55 adult patients who underwent VA-ECMO treatment at the First Hospital of Jiaxing from June 2020 to October 2022 as the study subjects.Then,the patients'gender,age,past history[including hypertension,diabetes,heart disease,chronic obstructive pulmonary disease(COPD)],and the reason for extracorporeal membrane pulmonary oxygenation(ECMO)adjuvant therapy[including severe myocarditis,acute myocardia infarction,in-hospital and out-of-hospital cardiac arrest,severe closed craniocerebral injury,severe pneumonia,pelvic fracture,other(pulmonary embolism,electrocution,traumatic hepatic rupture,post-partum hemorrhage,severe acute pancreatitis,crush syndrome)],acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)at the time of admission,and ECMO peripheral blood tests[creatinine,alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood lactate acid(Lac),white blood cell count(WBC),neutrophil count(NEU),lymphocyte count(LYM),hemoglobin(Hb),and platelet count(PLT)]and the last time prior to ECMO assistance,24 hours prior to the occurrence of acute kidney injury(AKI),and 24 hours after the occurrence of AKI.PLR levels at 24 hours ECMO,and the proportion of continuous renal replacement therapy(CRRT).The patients were divided into a death group and a survival group based on their 30-day prognosis and further categorized into a CRRT group and a non-CRRT group based on whether CRRT was administered.Clinical indicators of patients with different prognosis and the differences in PLR levels between CRRT and non-CRRT groups were compared.Logistic regression analysis was used to identify independent risk factors affecting the 30-day prognosis of VA-ECMO patients.The receiver operator characteristic(ROC curves)were plotted to evaluate the prognostic predictive value of each risk factor.Results Compared to the survival group,the death group had significantly higher APACHEⅡscores,SOFA scores,LYM and proportion receiving CRRT[APACHEⅡscore:34.00(28.50,36.00)vs.25.00(14.75,34.00),SOFA score:5.00(4.00,6.50)vs.3.00(2.00,5.25),LYM(×109/L):3.40±1.97 vs.2.24±2.11,proportion receiving CRRT:91.30%(21/23)vs.62.50%(20/32)],and a significantly lower level of the last PLR prior to ECMO adjuvant[30.00(21.06,48.17)vs.58.82(41.80,145.72)],and the differences were statistically significant(all P<0.05).Logistic regression analysis showed that the levels of the last PLR before ECMO assistance[odds ratio(OR)=0.965,95%confidence interval(95%CI)was 0.938-0.993,P=0.013],APACHEⅡscore at the time of admission(OR=1.121,95%CI was 1.018-1.234,P=0.020),and CRRT(OR=7.734,95%CI was 1.042-57.401,P=0.045)were independent risk factors affecting the prognosis of the VA-ECMO patients at 30 days after adjuvant;the ROC curve analysis showed that APACHEⅡscore,CRRT and the last PLR level before ECMO assistance had a predictive value for the prognosis of VA-ECMO patients 30 days after assistance,in which the APACHEⅡscore+the last PLR level before ECMO assistance had the greatest predictive value in predicting the prognosis of the patients,with area under the curve(AUC)of 0.846,with a sensitivity of 62.5%and a specificity of 95.7%.Higher early PLR levels were associated with better prognosis.In the CRRT group,PLR levels at 24 hours before ECMO initiation,24 hours before AKI onset,and 24 hours after AKI onset were significantly lower than those in the non-CRRT group(all P<0.05).Conclusion Early PLR levels and CRRT administration have significant predictive value for the prognosis of patients undergoing VA-ECMO therapy.

With the development of the economy in our country,trauma has already become a major medical burden in society,traffic injury has already become a major type of trauma,and the trauma of lower limbs is relatively much more.Since patients with lower extremity trauma have limited mobility,postoperative dressing changes need to be done at the bedside.At present,in the process of lower limb dressing change,it is necessary for family members or medical staff to help elevate the affected limb,which is unstable and difficult to adhere to.The dressing change process not only increases the pain of patients,but also affects the sight line and comfort of medical staff during operation,resulting in incomplete wound exposure and affecting the effect of dressing change.The washing solution and disinfectant in the dressing change process are easy to contaminate the sheets,which increases the difficulty of ward management.This dressing change method is unscientific,irregular and inconvenient to operate.Therefore,the medical staff of department of emergency of the First Hospital of Jiaxing City developed a mobile treatment vehicle for leg care for debridement and dressing change of patients with lower limb trauma,this device has been granted the National Utility Model Patent of China(patent numbeer:ZL 2021 2 0647636.0),which makes bedside debridement and dressing change more scientific,convenient and normative.The utility model relates to a mobile treatment vehicle for leg care,which is composed of a base,a support seat,a leg support plate,a support rod,a fixed plate and a smart trash can.The angle of the leg support plate can be adjusted 360 °by loosening the bolt,and the height can be adjusted by sliding up and down.Adequate rotation flexibility and high adjustment space can effectively solve problems of bedside debridement and dressing change for patients with lower limb trauma,provide scientific,simple and operable auxiliary tools for trauma medical staff,improve the comfort of patients and operators,and improve the quality of ward management in emergency trauma ward.

Objective:Multivariate logistic regression analysis was performed to analyze the risk factors for intensive care unit-acquired weakness (ICU-AW) in critically ill patients.Methods:A total of 220 critically ill patients who were admitted to Intensive Care Unit, The First Hospital of Jiaxing from January 2020 to January 2022 were included in this study. The incidence of ICU-AW was recorded. Univariate analysis was conducted to investigate the factors related to ICU-AW, while multiple logistic regression analysis was performed to identify independent risk factors for ICU-AW in critically ill patients.Results:Among the 220 critically ill patients, 64 developed ICU-AW, resulting in an incidence of 29.1% (64/220). There were no significant differences in sex, age, history of alcoholism, history of smoking, marital status, hypertension, diabetes, or use of glucocorticoid (methylprednisolone sodium succinate for injection) between the ICU-AW group and the non-ICU-AW group (all P > 0.05). The proportion of patients with sepsis in the ICU-AW group was higher than that in the non-ICU-AW group [46.9% (30/64) vs. 15.4% (24/156)]. The proportion of patients who were immobilized in the ICU-AW group was higher than that in the non-ICU-AW group [89.1% (37/64) vs. 64.1% (100/156)]. The use of nerve blocker (vecuronium bromide for injection) was more prevalent in the ICU-AW group than that in the non-ICU-AW group [57.8% (37/64) vs. 23.1% (36/156)]. The Acute Physiology And Chronic Health Evaluation Ⅱ score in the ICU-AW group was higher than that in the non-ICU-AW group [16 (11, 23) vs. 12 (8, 17)]. The duration of mechanical ventilation in the ICU-AW group was longer than that in the non-ICU-AW group [8 (4, 13) days vs. 4 (3, 6) days]. The length of hospital stay in the ICU-AW group was longer than that in the non-ICU-AW group [10 (7, 17) days vs. 7 (5, 11) days]. The blood lactate level in the ICU-AW group was higher than that in the non-ICU-AW group [2 (1, 2) mmol/L vs. 1 (1, 2) mmol/L]. All differences were statistically significant ( χ2 = 24.30, 13.83, 24.70, Z = 3.83, 4.59, 3.97, 2.70, all P < 0.05). The results of the univariate analysis, when included in the multivariate logistic regression analysis, showed that sepsis, immobilization, duration of mechanical ventilation, blood lactate level, and Acute Physiology And Chronic Health Evaluation Ⅱ score were independent risk factors for ICU-AW (all P < 0.05). Conclusions:The incidence of ICU-AW is high and the risk factors for ICU-AW are complex. Therefore, targeted control of high-risk factors should be actively performed to prevent and treat ICU-AW.

Objective To investigate the prognostic value of the platelet-to-lymphocyte ratio(PLR)at different early time points in adult patients undergoing veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective study was conducted,selecting 55 adult patients who underwent VA-ECMO treatment at the First Hospital of Jiaxing from June 2020 to October 2022 as the study subjects.Then,the patients'gender,age,past history[including hypertension,diabetes,heart disease,chronic obstructive pulmonary disease(COPD)],and the reason for extracorporeal membrane pulmonary oxygenation(ECMO)adjuvant therapy[including severe myocarditis,acute myocardia infarction,in-hospital and out-of-hospital cardiac arrest,severe closed craniocerebral injury,severe pneumonia,pelvic fracture,other(pulmonary embolism,electrocution,traumatic hepatic rupture,post-partum hemorrhage,severe acute pancreatitis,crush syndrome)],acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)at the time of admission,and ECMO peripheral blood tests[creatinine,alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood lactate acid(Lac),white blood cell count(WBC),neutrophil count(NEU),lymphocyte count(LYM),hemoglobin(Hb),and platelet count(PLT)]and the last time prior to ECMO assistance,24 hours prior to the occurrence of acute kidney injury(AKI),and 24 hours after the occurrence of AKI.PLR levels at 24 hours ECMO,and the proportion of continuous renal replacement therapy(CRRT).The patients were divided into a death group and a survival group based on their 30-day prognosis and further categorized into a CRRT group and a non-CRRT group based on whether CRRT was administered.Clinical indicators of patients with different prognosis and the differences in PLR levels between CRRT and non-CRRT groups were compared.Logistic regression analysis was used to identify independent risk factors affecting the 30-day prognosis of VA-ECMO patients.The receiver operator characteristic(ROC curves)were plotted to evaluate the prognostic predictive value of each risk factor.Results Compared to the survival group,the death group had significantly higher APACHEⅡscores,SOFA scores,LYM and proportion receiving CRRT[APACHEⅡscore:34.00(28.50,36.00)vs.25.00(14.75,34.00),SOFA score:5.00(4.00,6.50)vs.3.00(2.00,5.25),LYM(×109/L):3.40±1.97 vs.2.24±2.11,proportion receiving CRRT:91.30%(21/23)vs.62.50%(20/32)],and a significantly lower level of the last PLR prior to ECMO adjuvant[30.00(21.06,48.17)vs.58.82(41.80,145.72)],and the differences were statistically significant(all P<0.05).Logistic regression analysis showed that the levels of the last PLR before ECMO assistance[odds ratio(OR)=0.965,95%confidence interval(95%CI)was 0.938-0.993,P=0.013],APACHEⅡscore at the time of admission(OR=1.121,95%CI was 1.018-1.234,P=0.020),and CRRT(OR=7.734,95%CI was 1.042-57.401,P=0.045)were independent risk factors affecting the prognosis of the VA-ECMO patients at 30 days after adjuvant;the ROC curve analysis showed that APACHEⅡscore,CRRT and the last PLR level before ECMO assistance had a predictive value for the prognosis of VA-ECMO patients 30 days after assistance,in which the APACHEⅡscore+the last PLR level before ECMO assistance had the greatest predictive value in predicting the prognosis of the patients,with area under the curve(AUC)of 0.846,with a sensitivity of 62.5%and a specificity of 95.7%.Higher early PLR levels were associated with better prognosis.In the CRRT group,PLR levels at 24 hours before ECMO initiation,24 hours before AKI onset,and 24 hours after AKI onset were significantly lower than those in the non-CRRT group(all P<0.05).Conclusion Early PLR levels and CRRT administration have significant predictive value for the prognosis of patients undergoing VA-ECMO therapy.

With the development of the economy in our country,trauma has already become a major medical burden in society,traffic injury has already become a major type of trauma,and the trauma of lower limbs is relatively much more.Since patients with lower extremity trauma have limited mobility,postoperative dressing changes need to be done at the bedside.At present,in the process of lower limb dressing change,it is necessary for family members or medical staff to help elevate the affected limb,which is unstable and difficult to adhere to.The dressing change process not only increases the pain of patients,but also affects the sight line and comfort of medical staff during operation,resulting in incomplete wound exposure and affecting the effect of dressing change.The washing solution and disinfectant in the dressing change process are easy to contaminate the sheets,which increases the difficulty of ward management.This dressing change method is unscientific,irregular and inconvenient to operate.Therefore,the medical staff of department of emergency of the First Hospital of Jiaxing City developed a mobile treatment vehicle for leg care for debridement and dressing change of patients with lower limb trauma,this device has been granted the National Utility Model Patent of China(patent numbeer:ZL 2021 2 0647636.0),which makes bedside debridement and dressing change more scientific,convenient and normative.The utility model relates to a mobile treatment vehicle for leg care,which is composed of a base,a support seat,a leg support plate,a support rod,a fixed plate and a smart trash can.The angle of the leg support plate can be adjusted 360 °by loosening the bolt,and the height can be adjusted by sliding up and down.Adequate rotation flexibility and high adjustment space can effectively solve problems of bedside debridement and dressing change for patients with lower limb trauma,provide scientific,simple and operable auxiliary tools for trauma medical staff,improve the comfort of patients and operators,and improve the quality of ward management in emergency trauma ward.

Objective:Multivariate logistic regression analysis was performed to analyze the risk factors for intensive care unit-acquired weakness (ICU-AW) in critically ill patients.Methods:A total of 220 critically ill patients who were admitted to Intensive Care Unit, The First Hospital of Jiaxing from January 2020 to January 2022 were included in this study. The incidence of ICU-AW was recorded. Univariate analysis was conducted to investigate the factors related to ICU-AW, while multiple logistic regression analysis was performed to identify independent risk factors for ICU-AW in critically ill patients.Results:Among the 220 critically ill patients, 64 developed ICU-AW, resulting in an incidence of 29.1% (64/220). There were no significant differences in sex, age, history of alcoholism, history of smoking, marital status, hypertension, diabetes, or use of glucocorticoid (methylprednisolone sodium succinate for injection) between the ICU-AW group and the non-ICU-AW group (all P > 0.05). The proportion of patients with sepsis in the ICU-AW group was higher than that in the non-ICU-AW group [46.9% (30/64) vs. 15.4% (24/156)]. The proportion of patients who were immobilized in the ICU-AW group was higher than that in the non-ICU-AW group [89.1% (37/64) vs. 64.1% (100/156)]. The use of nerve blocker (vecuronium bromide for injection) was more prevalent in the ICU-AW group than that in the non-ICU-AW group [57.8% (37/64) vs. 23.1% (36/156)]. The Acute Physiology And Chronic Health Evaluation Ⅱ score in the ICU-AW group was higher than that in the non-ICU-AW group [16 (11, 23) vs. 12 (8, 17)]. The duration of mechanical ventilation in the ICU-AW group was longer than that in the non-ICU-AW group [8 (4, 13) days vs. 4 (3, 6) days]. The length of hospital stay in the ICU-AW group was longer than that in the non-ICU-AW group [10 (7, 17) days vs. 7 (5, 11) days]. The blood lactate level in the ICU-AW group was higher than that in the non-ICU-AW group [2 (1, 2) mmol/L vs. 1 (1, 2) mmol/L]. All differences were statistically significant ( χ2 = 24.30, 13.83, 24.70, Z = 3.83, 4.59, 3.97, 2.70, all P < 0.05). The results of the univariate analysis, when included in the multivariate logistic regression analysis, showed that sepsis, immobilization, duration of mechanical ventilation, blood lactate level, and Acute Physiology And Chronic Health Evaluation Ⅱ score were independent risk factors for ICU-AW (all P < 0.05). Conclusions:The incidence of ICU-AW is high and the risk factors for ICU-AW are complex. Therefore, targeted control of high-risk factors should be actively performed to prevent and treat ICU-AW.

Vaccines are among the most effec-tive measures for preventing infectious diseases and play a crucial role in controlling the spread of these diseases.Adjuvants,serving as auxiliary com-ponents in vaccines,are indispensable in the vac-cine development process.Ideal adjuvants not only enhance the immune response,enabling the body to achieve optimal protective immunity but also play important roles in reducing the dosage of im-munogens and lowering vaccine production costs.To meet the demands of novel vaccines,many new types of adjuvants have been developed.However,there is still a lack of adjuvants that are safe,effec-tive,easy to prepare,highly pure,and suitable for a variety of vaccines in clinical settings.This article categorizes adjuvants and summarizes their mecha-nisms of action and characteristics,focusing on tra-ditional aluminum salt adjuvants and more modern lipid-based and nucleic acid-based adjuvants.The summary is based on a computer search of data-bases including PubMed,Embase,The Cochrane Li-brary,CNKI(China National Knowledge Infrastruc-ture),VIP Database,and Wanfang Database,using English search keywords such as Adjuvants,Vac-cine,Vaccine Adjuvant,aluminum salts,MF59,AS03,Toll-like receptor agonist,etc.,and corre-sponding Chinese search terms.The aim is to pro-vide references for the development and applica-tion of adjuvants.

Acute ischemic stroke(AIS)is associated with a high mortality and disability rate.Endovascular therapy(EVT)has emerged as a primary treatment method for achieving vascular reperfusion in large vessel occlusion AIS patients.The cerebral hemodynamic status of patients undergoing reperfusion therapy is closely linked to the extent of cerebral vascular reperfusion and improvement in the ischemic penumbra at the site of injury.Transcranial Doppler(TCD)ultrasound offers non-invasive,reliable,and convenient advantages for evaluating intracranial vessel occlusion or stenosis,guiding treatment decisions,and predicting patient outcomes.The authors reviewed the application progress of TCD in AIS patients.

Objective To assess the impact of statins combined with sorafenib(SRF)therapy on survival outcomes in patients with metastatic renal cell carcinoma(mRCC).Methods Clinical data of mRCC patients treated in the 908th Hospital of the Joint Security Force from November 2019 to November 2023 were retrospectively analyzed.They were categorized into statin group and non-statin group according to whether they used statins or not,and the differences in the primary endpoint of overall survival(OS),secondary endpoints of progression-free survival(PFS),objective response rate(ORR),and disease control rate(DCR)were compared between the two groups.Results A total of 80 patients were included in the study,with 27 in the statin group and 53 in the non-statin group.There were no statistically significant differences in partial remission,stable disease,disease progression,and DCR between the two groups(P＞0.05);complete remission and ORR were significantly higher in the statin group than in the non-statin group(P＜0.05).Kaplan-Meier analysis showed that,compared with the non-statin group,the median PFS and OS of the statin group were prolonged,and the difference in median PFS between the two groups was statistically significant(P＜0.05).In terms of safety,the incidence of other adverse events was similar in both groups(P＞0.05).Conclusion Statins combined with SRF treatment regimen can improve ORR and DCR and prolong median PFS and OS in patients with mRCC.

Objective:The study aimed to analyze the risk variables influencing the prognosis of patients with sepsis-associated delirium (SAD) in the Intensive Care Unit (ICU) and build a prediction nomogram.Methods:This was a retrospective cohort study that includes patients with SAD in the Medical Information Mart for Intensive CareⅢ database (MIMIC-Ⅲ) database as training cohort, and patients who were hospitalized in the First Hospital of Jiaxing from January 2021 to September 2022 as validation cohort. Inclusion criteria: (1) age≥18 years old; (2) being admitted to the ICU for the first time; (3) the length of ICU stay≥24 h; (4) consistent with the diagnosis of sepsis; (5) the diagnosis of delirium was identified by CAM-ICU questionnaire. The general information, vital signs, past medical history and laboratory examination results of the patients were collected, and the outcome was 28-day mortality. Multiple logistic regression was used to identify independent influencing factors and the nomogram was constructed. The validity of the prediction model was determined using multiple indicators, including calibration curve, the area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), and Hosmer-Lemeshow test.Results:A total of 250 patients were included in the training cohort and 154 patients were in the validation cohort. The multiple logistic regression demonstrated that age ( OR=1.057, 95% CI: 1.030-1.084, P<0.001), respiratory frequency ( OR=1.117, 95% CI: 1.037-1.202, P=0.003), lactic acid ( OR=1.137, 95% CI:1.011-1.279, P=0,032), hemoglobin ( OR=0.983, 95% CI: 0.970-0.997, P=0.020), SOFA score ( OR=1.184, 95% CI: 1.070-1.309, P=0.001) were independent risk factors associated with the 28-day mortality of patients with SAD. The AUC of the nomogram created by the five factors above was 0.773 (95% CI: 0.705-0.841), and the Hosmer-Lemeshow test showed that the model was a good fit ( P=0.875). The DCA curve indicates that the model has potential net benefit. The AUC was 0.864 (95% CI: 0.799-0.928) in the validation cohort, and the Hosmer-Lemeshow test showed that the model was a good fit ( P=0.488). The DCA curve indicates that the model of the validation cohort had potential net benefit. Conclusion:The prediction model based on age, respiratory frequency, lactate, hemoglobin, and SOFA scores shows valuable capability of predicting the prognosis of patients with SAD, which could help clinicians identify risk factors at first time and make earlier intervention.