Acute carbon monoxide poisoning (ACMP) is one of the most common gas poisonings in the emergency department, with tens of thousands of people seeking medical attention for carbon monoxide (CO) poisoning each year. The severity of poisoning is dependent upon environmental and human factors, with hypoxia and oxidative stress being important mechanisms of cardiac toxicity induced by CO. Myocardial involvement is common in moderate to severe ACMP, including myocardial injury, myocardial infarction, arrhythmia, and sudden death, which are associated with a high risk of death. Ferroptosis is a cell death mechanism caused by iron-dependent lipid peroxidation (LPO), although ferroptosis has been shown to play a critical role in various cardiovascular diseases, the potential mechanism by which it contributes to ACMP-induced myocardial injury is unclear. This review discusses the established link between ferroptosis and cardiovascular disease and summarizes the potential role of ferroptosis in ACMP-induced myocardial injury and the detrimental effects of ACMP on the heart. Elucidating these mechanisms could guide the development of novel therapeutic strategies that target ferroptosis to mitigate ACMP-induced myocardial injury. This review aims to provide a theoretical foundation for future research on the potential use of ferroptosis as a therapeutic target for ACMP-induced myocardial injury.
Humans ; Carbon Monoxide Poisoning/complications* ; Ferroptosis ; Lipid Peroxidation ; Myocardium/pathology* ; Oxidative Stress

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective To investigate the efficacy of indobuprofen combined with nicodil for the treatment of acute coronary syndromes(ACS)and the effects of percutaneous coronary intervention on patients Effects of myocardial injury markers,platelet function and inflammatory factors after intervention(PCI).Method A total of 150 patients with ACS admitted to the hospital from January 2021 to December 2022 were divided into groups according to different treatment methods.The control group(n=75)was given nicodil combined with antiplatelet therapy,and the study group(n=75)was given indobufen combined with nicodil combined with antiplatelet therapy.Both groups were treated for 2 weeks.The clinical efficacy of the two groups was compared,the changes of myocardial injury markers,platelet function and inflammatory factors before and after treatment were monitored,and the total incidence of adverse reactions was recorded.Results The total effective rate of the group treated with nicodil combined with indobufen was 98.67%higher than that of the control group treated with nicodil alone,90.67%(χ2=4.754,P<0.05).The levels of myocardial injury markers such as cTnI and CK-MB in the study group after treatment were lower than those in the control group(t=15.492,3.250,P<0.05).The levels of platelet function indexes such as CD62p,CD63,GPⅡb/Ⅲa in the study group after treatment were lower than those in the control group(t=2.034,3.257,2.221,P<0.05).The levels of CRP,TNF-α,IL-6 and other inflammatory factors in the study group were lower than those in the control group after treatment(t=21.862,3.378,2.131,P<0.05).The total incidence of adverse reactions after treatment was 4.00%in the study group and 2.67%in the control group(P>0.05).Conclusion The efficacy of indobufien combined with nicodil in the treatment of ACS is better than that of nicodil alone,and it can improve myocardial injury and platelet function after PCI,inhibit the release of inflammatory factors,and the incidence of adverse reactions is lower.

Objective:To investigate the safety and therapeutic effect of split liver transplantation (SLT) in clinical application.Methods:This is a retrospective case-series study. The clinical data of 203 consecutive SLT, 79 living donor liver transplantation (LDLT) and 1 298 whole liver transplantation (WLT) performed at the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to July 2023 were retrospectively analyzed. Two hundred and three SLT liver grafts were obtained from 109 donors. One hundred and twenty-seven grafts were generated by in vitro splitting and 76 grafts were generated by in vivo splitting. There were 90 adult recipients and 113 pediatric recipients. According to time, SLT patients were divided into two groups: the early SLT group (40 cases, from July 2014 to December 2017) and the mature SLT technology group (163 cases, from January 2018 to July 2023). The survival of each group was analyzed and the main factors affecting the survival rate of SLT were analyzed. The Kaplan-Meier method and Log-rank test were used for survival analysis.Results:The cumulative survival rates at 1-, 3-, and 5-year were 74.58%, 71.47%, and 71.47% in the early SLT group, and 88.03%, 87.23%, and 87.23% in the mature SLT group, respectively. Survival rates in the mature SLT group were significantly higher than those in the early SLT group ( χ2=5.560, P=0.018). The cumulative survival rates at 1-, 3- and 5-year were 93.41%, 93.41%, 89.95% in the LDLT group and 87.38%, 81.98%, 77.04% in the WLT group, respectively. There was no significant difference among the mature SLT group, the LDLT group and the WLT group ( χ2=4.016, P=0.134). Abdominal hemorrhage, infection, primary liver graft nonfunction,and portal vein thrombosis were the main causes of early postoperative death. Conclusion:SLT can achieve results comparable to those of WLT and LDLT in mature technology liver transplant centers, but it needs to go through a certain time learning curve.

Objective To compare the predictive value of controlling nutritional status score(CO-NUT),prognostic nutritional index(PNI)and prognostic inflammation and nutritional index(PINI)for se-vere stroke complicating lung infection(SCLI),and to analyze the risk factors for severe SCLI occurrence.Methods A retrospective analysis on the clinical data of 98 cases of severe stroke firstly visited and treated in the nervous intensive care unit(NICU)of this hospital from August 2022 to August 2023 was performed.The patients were divided into the SCLI group and non-SCLI group according to whether or not SCLI occurring during the hospitalization.Logistic regression was used to analyze the independent risk factors influencing se-vere SCLI.The sensitivity,specificity,Youden index and Kappa value of the three tools in predicting severe SCLI were calculated,and the area under the receiver operating characteristic(ROC)curve(AUC)was plot-ted.Results Among 98 cases,there were 35 cases(35.71％)of SCLI occurrence during hospitalization.The multivariate logistic regression analysis results showed that the mechanical ventilation use(OR=1.33,95％CI:1.06-2.76),nasogastric tube use(OR=1.42,95％CI:1.25-2.68),high CONUT(OR=2.74),95％CI:2.02-3.69),low PNI(OR=0.70,95％CI:0.51-0.96)and low PINI(OR=2.51,95％CI:1.78-3.62)were the independent risk factors for severe SCLI(P＜0.05).AUC of the ROC curve of CONUT,PNI and PINI for predicting SCLI was 0.729,0.723 and 0.697 respectively.The sensitivity was 0.707,0.685 and 0.631,and the specificity was 0.872,0.764 and 0.712,respectively.The Youden index was 0.579,0.449 and 0.343 respectively,and the Kappa value was 0.621,0.534 and 0.432 respectively.Conclusion CONUT,PNI and PINI all are correlated with the SCLI risk.CONUT has the highest predictive value for SCLI.

Objective To explore the effect of sleep duration and body mass index(BMI)on hypertension.Methods The data was collected from the database of the China Health and Retirement Longitudinal Study(CHARLS),and the data of the 2015 National Longitudinal Study were selected.A total of 8,889 subjects were included in this study.Questionnaires,health status,physical examination and laboratory information were collect-ed.The interactive effect of sleep duration and BMI on hypertension was analyzed by multiplicative model and addi-tive model.Results The prevalence rate of hypertension was 28.86%.Logistic regression results showed that night sleep duration＜6 h(OR=1.138,95%CI:1.024-1.265)and＞8 h(OR=1.1365,95%CI:1.167-1.598);overweight(OR=1.736,95%CI:1.557-1.936)and obesity(OR=2.076,95%CI:1.973-2.710)were all risk factors for hypertension(P＜0.05).Stratified results showed that the risk of hypertension in the normal group was 1.193(95%CI:1.023-1.393)times and 1.555(95%CI:1.244-1.943)times of those with sleep du-ration 6-8 h,respectively.The risk of hypertension was 1.392(95%CI:1.066-1.818)times higher than that of sleep duration 6-8 h.The interaction showed that night sleep duration and BMI had a multiplicative interaction(OR=2.120,95%CI:1.767-2.543)and a additive interaction on hypertension[RERI=1.242(95%CI:0.326-2.157),SI=3.697(95%CI:2.658-5.143),AP=0.460(95%CI:0.324-0.595)].Conclusions Insufficient and excessive sleep duration at night and BMI both increase the risk of hypertension,and have a mul-tiplicative and additive interaction.Reasonable adjustment of nighttime sleep duration and BMI may prevent the occurrence of hypertension.

Objective To investigate the effect of different doses of esketamine combined with hydromorphone postoperative patient-controlled intravenous analgesia(PCIA)on depression in elderly pa-tients undergoing total knee arthroplasty.Methods A total of 180 elderly patients,44 males and 136 fe-males,aged 65-80 years,BMI 18.5-35.0 kg/m2,ASA physical status Ⅱ or Ⅲ,undergoing total knee arthroplasty(TKA)under elective general anesthesia combined with adductor block from J uly 2023 to Sep-tember 2023.Patients were divided into three groups by random number table method;control group(group C),esketamine 0.5 mg/kg group(group E1),and esketamine 1.0 mg/kg group(group E2),60 patients in each group.After operation,groups C,E1 and E2 were given hydromorphone 0.2 mg/kg,esketamine 0.5 mg/kg combined with hydromorphone 0.2 mg/kg,and esketamine 1.0 mg/kg combined with hydromor-phone 0.2 mg/kg to receive PCIA,respectively,and the three groups were diluted to 100 ml with normal saline.Parameters were set as follows.The background infusion rate was 1.5 ml/h,and the single press dose was 1.5 ml,and the locking time was 15 minutes.If the VAS pain score at rest was greater than or equal to 4 points and the analgesic effect of pressing the PCIA pump was not effective,then intramuscular injection of tramadol 0.1 g was used for remedial analgesia.Hamilton depression scale(HAMD)score was performed 1 day,3 and 7 days after surgery.Depressive state was classified as having HAMD score ≥ 8 points.VAS pain scores at rest were performed 1 day,3 and 7 days after surgery.The number of depression within 7 days after surgery,the number of effective(D1)and total(D2)pump compressions and D1/D2 within 3 days after surgery,the number of rescue analgesia,the occurrence of adverse reactions such as tra-madol dosage,dizziness,headache,multiple dreams,hallucinations,nausea and vomiting were recorded.Results Twenty-one patients(35％)in group C experienced depression,7 patients(12％)in group E1,and 8 patients(13％)in group E2 during 3 days after surgery.Eight patients(13％)in group C experi-enced depression,1 patients(2％)in group E1,and 2 patients(3％)in group E2 during 7 days after sur-gery.Compared with group C,the incidence of depression 3 and 7 days after surgery,rescue analgesia rate in group E1 were significantly decreased,the incidence of depression 3 and 7 days after surgery,dizziness,headache,and dreaminess within 3 days after surgery in group E2 were significantly decreased(P＜0.05).There were no significant differences in the incidence of depression and VAS pain scores between group El and group E2 at 1,3,and 7 days after surgery.Conclusion Esketamine 0.5 and 1.0 mg/kg for PCIA in elderly patients after TKA can improve postoperative depression,while esketamine 1.0 mg/kg can reduce the incidence of postoperative dizziness,headache,and multiple dreams.

Objective:On the basis of post evaluation,the hospital pharmacy posts are scientifically classified and stratified,and the performance evaluation standard of pharmacy posts is constructed.Methods:The hospital pharmacy posts are classified and stratified by factor comparison method and the post value coefficient is determined.Delphi method and analytic hierarchy process are used to construct the performance evaluation index system of pharmaceutical posts and determine the performance evaluation standards.Results:Pharmacy posts in hospitals are divided into 5 categories,including clinical pharmacists,research pharmacists,static pharmacists,dispensing pharmacists and purchasing pharmacists.The indexes and weights of pharmaceutical post performance evaluation are determined from 4 dimensions:service,process,quality and cost,and the evaluation standard of pharmaceutical post performance oriented to rational drug use is established.Conclusion:The construction of pharmaceutical performance evaluation system meets the requirements of the reform of public hospitals for the transformation and development of pharmaceutical services,which is conducive to enhancing the enthusiasm of pharmaceutical personnel and improving the efficiency and benefit of pharmaceutical services.

【Objective】 To establish a blood quality monitoring indicator system, in order to continuously improve blood quality and standardized management. 【Methods】 Based on the research of literature and standards, and guided by the key control points of blood collection and supply process, the blood quality monitoring indicator system was developed. Through two rounds of Delphi expert consultation, the indicator content was further revised and improved according to expert opinions after six months of trial implementation. The indicator weight was calculated by questionnaire and analytic hierarchy process. 【Results】 A blood quality monitoring indicator system covering the whole process of blood collection and supply was constructed, including five primary indicators, namely blood donation service, blood component preparation, blood testing, blood supply and quality control, as well as 72 secondary indicators, including definitions, calculation formulas, etc. Two rounds of expert consultation and two rounds of feasibility study meeting were held to revise 17 items and the weight of each indicator was obtained through the analytic hierarchy process. After partial adjustments, a blood quality monitoring indicator system was formed. 【Conclusion】 A blood quality monitoring indicator system covering the whole process of blood collection and supply has been established for the first time, which can effectively evaluate the quality management level of blood banks and coordinate blood quality control activities of blood banks in Shandong like pieces in a chess game, thus improving the standardized management level