ObjectiveTo clarify the application value of nutritional scoring in patients with sepsis and explore the impact of the modified Nutritional Risk in Critically Ill （mNUTRIC） score on the in-hospital fatality of sepsis patients in the emergency intensive care unit （EICU）. MethodsA retrospective analysis was conducted on the clinical data and laboratory examination results of 436 sepsis patients treated in the EICU of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2021 to May 2024. The patients were divided into survival group （298 cases） and death group （138 cases） according to whether they died or not during hospital treatment， and then compared the two groups’ data. Logistic multi-factor regression analysis was used to analyze the risk factors for in-hospital death and the ROC curve to evaluate the predictive value of each risk factor for the prognosis of sepsis patients. ResultsThe death group exhibited higher Acute Physiology and Chronic Health EvaluationⅡ（APACHE Ⅱ） score， Nutritional Risk Screening 2002 （NRS 2002） score， mNUTRIC score， Sequential Organ Failure Assessment （SOFA） score， Padua Prediction Score for Venous Thromboembolism， the proportions of chronic kidney failure and pneumonia patients， C-reactive protein （CRP） level， lactate concentration and neutrophil count， but lower prognostic nutritional index， cholinesterase level， cholinesterase-albumin ratio and lymphocyte count than the survival group， with statistical significance （all P<0.05）. Logistic regression analysis revealed that the mNUTRIC score ［OR=1.254， 95%CI （1.109，1.417）］， CRP ［OR=1.004， 95%CI （1，1.007）］， and pneumonia ［OR=1.82， 95%CI （1.017， 3.257）］ were independent risk factors for in-hospital death in sepsis patients. ROC curve analysis showed that the area under the curve （AUC） of the mNUTRIC score for predicting in-hospital death in sepsis patients was 0.683 ［95%CI （0.623，0.742）］， with a sensitivity of 83% and a specificity of 49.3%. The AUC for CRP and pneumonia were 0.602 ［95%CI （0.533， 0.671）］， and 0.582 ［95%CI （0.516，0.647）］. ConclusionThe mNUTRIC score is an independent predictive indicator for in-hospital death in sepsis patients in the EICU.

Abstract In recent years, the prevalence of overweight and obesity among children and adolescents has risen rapidly, posing a serious threat to their physical and mental health. To provide scientific, systematic, and standardized weight management guidance for overweight and obese children and adolescents, the study focuses on the core concept of healthy lifestyle intervention, integrates multidisciplinary expert opinions and research findings,and proposes a comprehensive multidisciplinary intervention framework covering scientific exercise intervention, precise nutrition and diet, optimized sleep management, and standardized psychological support. It calls for the establishment of a multi agent collaborative management mechanism led by the government, implemented by families, fostered by schools, initiated by individuals, optimized by communities, reinforced by healthcare, and coordinated by multiple stakeholders. Emphasizing a child and adolescent centered approach, the consensus advocates for comprehensive, multi level, and personalized guidance strategies to promote the internalization and maintenance of a healthy lifestyle. It serves as a reference and provides recommendations for the effective prevention and control of overweight and obesity, and enhancing the health level of children and adolescents.

Objective To investigate whether modification with IL-21 and CCL19 enhances killing and tumor-infiltrating efficiency of NKP30 CAR-T cells in lung cancer.Methods The modified IL-21-CCL19 NKP30 CAR-T cells expressing IL-21 and CCL19 fusion gene was constructed based on NKP30 CAR-T cells and stimulated with CD3CD28 antibodies and IL-2.The immunophenotype and migration of the cells in the presence of IL-21 were investigated using flow cytometry and migration experiments.Lactate dehydrogenase(LDH)release and sphere formation assays were used to assess the killing and infiltration capabilities of CAR-T cells,and the secretion levels of IFN-γ,IL-21 and CCL19 were determined with enzyme-linked immunospot assay(ELISPOT)and ELISA.A zebrafish model bearing HCG-27 cell xenograft was established by microinjection of the tumor cells into the yolk sac followed 24 h later by injection of the immune cells at the same site,and the fluorescence signals were captured using a fluorescent microscopy.Results The NKP30 ligand B7H6,which was almost undetectable in normal tissues and blood cells,was highly expressed(over 90%)in lung cancer cells.Compared with NKP30 CAR-T cells and conventional T cells,IL-21-CCL19 NKP30 CAR-T cells exhibited stronger proliferative and migration capabilities with the formation of central memory T cells.The reduced expressions of CTLA4 and PD1 in the constructed cells resulted in enhanced killing efficiency against lung cancer cells accompanied by significantly increased production of IFN-γ,IL-21 and CCL19.In the zebrafish models,CAR-T cells exhibited stronger cytotoxicity and proliferative abilities than typical T cells,but these differences were not statistically significant between the two CAR-T cells.Conclusion Modification of NKP30 CAR-T cells with IL-21 and CCL19 facilitates their access into solid tumors for more effective tumor cell killing while producing a large number of memory T cells.

Objective:To investigate the value of implantable cardiac monitor (ICM) in the diagnosis and treatment of patients over 60 years old with unexplained syncope.Methods:This was a multi-center, prospective cohort study. Between June 2018 and April 2021, patients over the age of 60 with unexplained syncope at Beijing Hospital, Fuwai Hospital, Beijing Anzhen Hospital and Puren Hospital were enrolled. Patients were divided into 2 groups based on their decision to receive ICM implantation (implantation group and conventional follow-up group). The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up. Kaplan‐Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups. A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope.Results:A total of 198 patients with unexplained syncope, aged (72.9±8.25) years, were followed for 558.0 (296.0,877.0) d, including 98 males (49.5%). There were 100 (50.5%) patients in the implantation group and 98 (49.5%) in the conventional follow-up group. Compared with conventional follow-up group, patients in the implantation group were older, more likely to have comorbidities, had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram, and had a lower body mass index (all P<0.05). During the follow-up period, positive cardiac arrhythmia events were recorded in 58 (58.0%) patients in the ICM group. The diagnosis rate (42.0% (42/100) vs. 4.1% (4/98), P<0.001) and the intervention rate (37.0% (37/100) vs. 2.0% (2/98), P<0.001) of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group (all P<0.001). Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group ( HR=11.66, 95% CI 6.49-20.98, log-rank P<0.001). Multivariate analysis indicated that ICM implantation, previous atrial fibrillation, diabetes mellitus or first degree atrioventricular block in baseline electrocardiogram were independent predictors for cardiogenic syncope (all P<0.05). Conclusions:ICM implantation improves the diagnosis and intervention rates in patients with unexplained syncope, and increases diagnostic efficiency in patients with unexplained syncope.

Objective To investigate whether modification with IL-21 and CCL19 enhances killing and tumor-infiltrating efficiency of NKP30 CAR-T cells in lung cancer.Methods The modified IL-21-CCL19 NKP30 CAR-T cells expressing IL-21 and CCL19 fusion gene was constructed based on NKP30 CAR-T cells and stimulated with CD3CD28 antibodies and IL-2.The immunophenotype and migration of the cells in the presence of IL-21 were investigated using flow cytometry and migration experiments.Lactate dehydrogenase(LDH)release and sphere formation assays were used to assess the killing and infiltration capabilities of CAR-T cells,and the secretion levels of IFN-γ,IL-21 and CCL19 were determined with enzyme-linked immunospot assay(ELISPOT)and ELISA.A zebrafish model bearing HCG-27 cell xenograft was established by microinjection of the tumor cells into the yolk sac followed 24 h later by injection of the immune cells at the same site,and the fluorescence signals were captured using a fluorescent microscopy.Results The NKP30 ligand B7H6,which was almost undetectable in normal tissues and blood cells,was highly expressed(over 90%)in lung cancer cells.Compared with NKP30 CAR-T cells and conventional T cells,IL-21-CCL19 NKP30 CAR-T cells exhibited stronger proliferative and migration capabilities with the formation of central memory T cells.The reduced expressions of CTLA4 and PD1 in the constructed cells resulted in enhanced killing efficiency against lung cancer cells accompanied by significantly increased production of IFN-γ,IL-21 and CCL19.In the zebrafish models,CAR-T cells exhibited stronger cytotoxicity and proliferative abilities than typical T cells,but these differences were not statistically significant between the two CAR-T cells.Conclusion Modification of NKP30 CAR-T cells with IL-21 and CCL19 facilitates their access into solid tumors for more effective tumor cell killing while producing a large number of memory T cells.

Objective To observe the effects of different surgical approaches on the complications and tumor markers of patients undergoing radical resection of esophageal cancer.Method A prospective study was conducted on 100 patients with esophageal cancer who underwent radical surgery in our hospital from October 2019 to October 2022.They were randomly divided into an observation group and a control group using a random number table method,with 50 patients in each group,he right thoracic approach was used in the observation group and the left thoracic approach was used in the control group.Perioperative indexes,inflammatory factors[Substance P(SP),hypersensitive C-reactive protein(hs-CRP),interleukin6(IL-6)],tumor markers[cytokeratin 19 fragment antigen(CYFRA21-1),squamous cell carcinoma antigen(SCC-Ag)and carbohydrate antigen 199(CA199)]and lung function of the two groups were compared before and after surgery Indicators[vital capacity(VC),forced vital capacity(FVC),and forced expiratory volume in the first second(FEV1)]and complication rate.Result The operating time,blood loss,indwelling time,hospitalization time,and number of lymph node dissection in the observation group were(247.65±27.33)minutes,(211.82±25.49)ml,(6.97±2.12)days,(16.11±3.81)days,and(19.67±5.21),respectively,which were higher than those in the control group[(217.63±23.69)minutes,(175.67±22.13)ml,(5.43±1.80)days,(12.68±3.24)days,(15.45±4.12)](P＜0.05).On average,there was a significant increase in SP,hs CRP,and IL-6 levels in both groups 3 days after surgery(P＜0.05).The levels of SP,hs CRP,and IL-6 in the observation group were(273.96±35.45)ng/L,(11.35±2.12)mg/L,and(8.19±1.67)p.g/ml,respectively,which were lower than the control group[(298.33±38.42)ng/L,(14.29±2.68)mg/L,(10.35±1.82)pg/ml](P＜0.05);One month after surgery,there was a significant decrease in CYFRA21-1,SCC-Ag,and CA199 in both groups(P＜0.05),and in the observation group,the data of CYFRA21-1,SCC-Ag,and CA199 were(2.59±0.37)μg/L,(45.62±6.18)pg/L and(59.37±6.12)U/ml,respectively,which were lower than those in the control group[(3.12±0.43)μg/L,(60.27±7.35)pig/L,(63.28±6.49)U/ml](P＜0.05);One month after surgery,there was a significant decrease in VC,FVC,and FEV1 in both groups(P＜0.05).However,the VC,FVC,and FEV1 in the observation group were(67.21±8.69)％,(70.33±9.41)％,and(72.88±10.12)％,respectively,which were higher than those in the control group[(54.35±8.27)％,(61.65±8.79)％,(65.37±9.24)％](P＜0.05).There was no significant difference in the incidence of complications between the two groups(P＞0.05).Conclusion Both approaches can effectively treat esophageal cancer.Among them,the right chest approach can significantly improve the effect of lymph node dissection,inhibit inflammatory reactions,reduce tumor marker levels,and have less impact on lung function,without significantly increasing the risk of complications.However,the surgical time,bleeding volume,and postoperative recovery time are relatively long.Therefore,a suitable approach should be selected in clinical practice based on the patient's actual situation.

BACKGROUND:Diabetic foot patients with wound infections constitute a large patient population,and there is currently no satisfactory treatment approach. OBJECTIVE:To investigate the clinical efficacy of a modified tibial cortex transverse transport combined with antibiotic-loaded bone cement for treating refractory diabetic foot ulcers. METHODS:A total of 46 diabetic foot ulcers patients,27 males and 19 females,with an average age of 64.37 years,were selected from Beijing Chaoyang Hospital,Capital Medical University and Beijing Chaoyang Integrative Medicine Rescue and First Aid Hospital from January 2020 to January 2023.All of them underwent the modified tibial cortex transverse transport combined with antibiotic-loaded bone cement treatment.Ankle-brachial index,WIFi(Wound/Ischemia/Foot infection)classification,pain visual analog scale score,and ulcer area were recorded before and 3 months after surgery. RESULTS AND CONCLUSION:(1)The mean ulcer healing time for the 46 patients was(58.07±24.82)days.At 3 months postoperatively,there were significant improvements in ankle-brachial index,pain visual analog scale score,ulcer area,and WIFi classification in 46 patients,as compared to the preoperative values,with statistically significant differences(P<0.05).Two patients experienced pin-tract infections,without infection or ulcer recurrence during the follow-up period.(2)These findings indicate that the modified tibial cortex transverse transport combined with antibiotic-loaded bone cement effectively alleviates patients'pain,improves lower limb circulation,controls infections,and promotes ulcer healing.

Objective To explore the effects of dexmedetomidine combined with desflurane anesthesia on cerebral oxygen metabolism,sedation depth and cerebral function in liver cancer patients undergoing partial hepatic lobectomy.Methods A total of 30 liver cancer patients undergoing partial hepatic lobectomy at the Affiliated Cancer Hospital of Zhengzhou University from March to September 2022 were selected as the research subjects,they were divided into control group(n=15)and observation group(n=15)according to different anesthesia methods.Patients in both groups underwent partial open hepatectomy,and they were given the same anesthesia induction method.The patients in the control group received desflurane for anesthesia mainte-nance,while patients in the observation group received dexmedetomidine combined with desflurane for anesthesia maintenance.The anesthesia recovery indexes including the postoperative recovery time,recovery time of spontaneous breathing,eye-opening time of patients between the two groups were compared.The arterial oxygen saturation(SaO2),cervical vein oxygen saturation(SjvO2),arterial partial pressure of oxygen(PaO2)and partial pressure of venous oxygen of patients were detected by blood gas analyzer before anesthesia induction(T0),at the completion of anesthesia induction(T,),at 10 minutes after hepatic portal occlusion(T2),after hepatic lobectomy(T3)and after surgery(T4),and arterio-venous oxygen content difference(AVDO2)and cerebral oxygen extraction rate(CEO2)were calculated.The sedation depth of patients was evaluated by bispectral index(BIS)and patient state index(PSI)at T0,T1,T2,T3 and T4.The cerebral function of patients was evaluated by the Glasgow-Pittsburgh cerebral performance category scale at 3 months after surgery.The incidence of postoperative adverse reactions of patients between the two groups was compared.Results The postoperative recovery time,recovery time of sponta-neous breathing and eye-opening time of patients in the observation group were significantly shorter than those in the control group(P＜0.05).There was no significant difference in SaO2 of patients between the two groups at different time points(P＞0.05).At T2 and T3,SjvO2,AVDO2 and CEO2 of patients in the observation group were significantly lower than those in the control group(P＜0.05),but there was no significant difference in SjvO2,AVDO2 and CEO2 of patients between the two groups at the other time points(P＞0.05).At T2,T3 and T4,BIS and PSI of patients in the observation group were significantly lower than those in the control group(P＜0.05),but there was no significant difference in BIS and PSI of patients between the two groups at T0 and T1(P＞0.05).In the control group,there were 11 patients with postoperative brain function in grade 1,3 patients in grade Ⅱ and 1 patient in grade Ⅲ;in the observation group,there were 12 patients in grade Ⅰ and 3 patients in gradeⅡ.There was no significant difference in postoperative grading of brain function between the two groups(x2=1.044,P＞0.05).There was no significant difference in the total incidence of postoperative adverse reactions between the control group and observation group[20.00％(3/15)vs 26.67％(4/15),x2=0.186,P＞0.05].Conclusion Dexmedetomidine combined with desflurane anesthesia can shorten anesthesia recovery time,improve anesthesia depth and reduce cerebral oxygen metabolism in patients undergoing liver cancer surgery,which has no effect on cerebral function,showing good safety.

Diabetic peripheral neuropathy is a common diabetic complication.Presently,our understanding of its pathogenesis is incomplete,and there are no effective treatment options.In-depth research requires the use of animal experiments.The criteria for modeling success and the evaluation method for peripheral nerve function recovery are critical for carrying out animal experiments into type 2 diabetic peripheral neuropathy.However,but there has been a lack of systematic interrogation and analysis of the evaluation method used with type 2 diabetic peripheral neuropathy models.Therefore,the author reviewed the recent data,summarized and analyzed the evaluation method used for animal models of type 2 diabetic peripheral neuropathy of small and large nerve fibers,and proposed future directions for development,providing a reference for related research.

Objective:To analyze the significance of systemic immune inflammatory index (SII) combined with neutrophil lymphocyte ratio (NLR) in the treatment of advanced gastric cancer with PD-1/PD-L1 inhibitors.Methods:The clinical data of 90 patients with stage Ⅳ gastric adenocarcinoma who received immunotherapy from January 2020 to January 2023 were retrospectively analyzed, including 70 males and 20 females, aged from 36 to 80 years, with an average age of (53.76±15.58) years. The clinicopathological features and follow-up data were collected. SPSS 26.0 software was used to conduct statistical analysis. The critical values of NLR, SII, PLR and MLR were calculated, and the overall survival (OS) and progression free survival (PFS) of patients with different levels of markers were analyzed. The independent predictive factors of PFS and OS were determined, and the predictive value of risk factors for PFS and OS in patients with gastric cancer was evaluated.Results:The median follow-up time of all patients was 27.3 months, and the median PFS and OS were 10.0 months and 17.7 months, respectively. The area under the curve (AUC) of NLR and SII for predicting PFS and OS were>0.7, the critical values NLR were 4.75 and 3.85, and SII were 1154.67 and 887.90, respectively. PFS and OS in patients with high NLR, high MLR, high PLR and high SII were lower than those in patients with low levels. ECoG PS≥ 1, high NLR and high SII were independent influencing factors of disease progression or death. The AUC of the combination of NLR, ECoG PS and SII was 0.761, which was higher than that of any single factor. The fewer the number of risk factors, the longer the PFS and OS.Conclusions:NLR and SII are effective predictors of PFS and OS in patients with advanced gastric cancer receiving immunotherapy. Pre treatment detection of NLR and SII can provide reliable guidance for immunotherapy of advanced gastric cancer.