Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Septic shock is the primary cause of mortality in sepsis, with its core pathophysiological mechanism being severe ischemia and hypoxia in critical units—composed of microcirculation and the mitochondria of functional cells—resulting from disruptions in blood flow and oxygen flow following a dysregulated host response. Due to the systemically convergent yet clinically heterogeneous nature of the host response, current understanding and management strategies for hemodynamics remain inconsistent, often leading to inadequate resuscitation or overtreatment. To improve the quality of care, based on a systematic review of the "blood flow-oxygen flow" theory, an expert panel emphasizes reevaluating septic shock from an integrated perspective of blood flow and oxygen flow, and has formulated the Expert Consensus on Blood Flow and Oxygen Delivery Phenotyping and Clinical Management of Septic Shock (2025). The consensus proposes that clinical typing of blood flow-oxygen flow should comprehensively consider cardiac function, vascular tone, oxygen flow utilization status in critical units, and disease trajectory, while optimizing subtype identification by integrating host response phenotypes and artificial intelligence technologies. It advocates establishing a continuous assessment system through multi-site oxygen flow monitoring for organ perfusion, peripheral perfusion monitoring, and critical care ultrasound. Under the framework of the "critical care triangle", the consensus promotes the implementation of individualized, bundled management strategies, providing guidance for multiple management points to restore blood flow-oxygen flow matching, reduce the risk of organ failure, and decrease patient mortality.

Addressing the challenge of traditional physical/semi physical simulation methods being difficult to achieve full process and full element simulation of extravehicular activities,virtual reality technology is utilized to break through the limitations of physical environments and establish a virtual reality simulation system for extravehicular activities.Based on the application characteristics of space station extravehicular activity engineering,with the goal of improving system practicality and usability,integrating the visual immersion of virtual images,the ontology of real operation,and the consistency of virtual and real space perception,a three-dimensional scene simulation,multi-mode joystick interaction paradigm,continuous operation actions simulation of extravehicular operations,and interactive operation virtual/real space consistency method that were proposed and designed for the realistic visual perception and extravehicular operation.The system has been successfully applied to astronaut training,program validation,joint exercise,and flight control support for sixteen extravehicular activities from SZ-12 to SZ-18.The results showed that the complete reproduction of the static/dynamic realistic comprehensive scene was achieved on the ground for the human-machine operation in the entire process of extravehicular activity,and the system is an essential and important means of ground simulation for extravehicular activity.

Objective:To investigate the application value of self-pulling and latter transection (SPLT) technique in double anti-reflux double-tract reconstruction of totally laparoscopic proximal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 103 patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction in clinical stage Ⅰ-Ⅱ who were admitted to Shanxi Cancer Hospital from January 2018 to January 2020 were collected. There were 65 males and 38 females, aged from 45 to 79 years, with a median age of 59 years. Of 103 patients, 49 cases undergoing totally laparoscopic proximal gastrectomy with double-tract reconstruction of SPLT were assigned into the SPLT group, 54 cases undergoing totally laparoscopic proximal gastrectomy with conventional double-tract reconstruction were assigned into the traditional group. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination and telephone inter-view to detect postoperative reflux esophagitis of patients up to December 2021. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and the Wilcoxon test was used for comparison between groups. Count data were described as absolute numbers or percentages, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Results:(1) Intraoperative situations: the operation time, digestive tract reconstruction time, volume of intraoperative blood loss, the number of inferior mediastinal lymph nodes dissected, cases with auxiliary incisions for the SPLT group were (261±48)minutes, (26±4)minutes, (114±42)mL, 8.0(6.5,9.5), 1, respectively. The above indicators were (244±42)minutes, (30±6)minutes, (118±46)mL, 5.5(4.0,8.0), 9 for the traditional group, respectively. There were significant differences in the digestive tract reconstruction time, the number of inferior mediastinal lymph nodes dissected and cases with auxiliary incisions between the two groups ( t=-3.34, Z=-4.05, χ2=4.72, P<0.05). There was no significant difference in the operation time or volume of intraoperative blood loss between the two groups ( t=1.87, -0.47, P>0.05). (2) Postoperative situations: duration of postopera-tive hospital stay and cases with postoperative complications were (11.5±2.7)days and 4 for the SPLT group, versus (12.5±4.3)days and 9 for the traditional group, showing no significant difference between the two groups ( t=-1.47, χ2=1.68, P>0.05). There were 13 of 103 patients with postopera-tive complications, including 5 cases of left pleural effusion, 4 cases of anastomotic leakage, 2 cases of mild pneumonia, 1 case of incision infection, 1 case of chylous leakage. Four patients had anasto-motic leakage at the esophagojejunostomy, the abdominal esophagus of whom was invaded by more than 1 cm. During the operation, mediastinal drainage tubes were placed through the abdominal wall. The 4 patients were cured after enteral and parenteral nutrition support and adequate drainage, and the remaining patients with complications were cured after symptomatic treatment. (3) Follow-up: of 49 patients in the SPLT group, 43 cases were followed up for (18±4)months. During the follow-up, 1 case showed reflux esophagitis by gastroscopy, with the incidence of 2.33%(1/43). Of 54 patients in the traditional group, 53 cases were followed up for (17±4)months. During the follow-up, 4 cases showed reflux esophagitis by gastroscopy, with the incidence of 7.55%(4/53). There was no significant difference in the incidence of reflux esophagitis between the two groups ( χ2=0.47, P>0.05). Conclusions:SPLT technology is feasible for double anti-reflux double-tract reconstruction of proximal gastrectomy. Compared with traditional double-tract reconstruction of totally laparos-copic proximal gastrectomy, SPLT technology can reduce the auxiliary incisions, increase the number of lower mediastinal lymph nodes dissected, and shorten the digestive tract reconstruction time.

Objective: Schizophrenia (SCZ) is one of the most common and severe mental disorders. Modified electroconvulsive therapy (MECT) is the most effective therapy for all kinds of SCZ, and the underlying molecular mechanism remains unclear. This study is aim to detect the molecule mechanism by constructing the transcriptome dataset from SCZ patients treated with MECT and health controls (HCs). Methods: Transcriptome sequencing was performed on blood samples of 8 SCZ (BECT: before MECT; AECT: after MECT) and 8 HCs, weighted gene co-expression network analysis (WGCNA) was used to cluster the different expression genes, enrichment and protein-protein interaction (PPI) enrichment analysis were used to detect the related pathways. Results: Three gene modules (black, blue and turquoise) were significantly associated with MECT, enrichment analysis found that the long-term potentiation pathway was associated with MECT. PPI enrichment p-value of black, blue, turquoise module are 0.00127, <1×10-16 and 1.09×10-13, respectively. At the same time, EP300 is a key node in the PPI for genes in black module, which got from the transcriptome sequencing data. Conclusion It is suggested that the long-term potentiation pathways were associated with biological mechanism of MECT.

Objective: Schizophrenia (SCZ) is one of the most common and severe mental disorders. Modified electroconvulsive therapy (MECT) is the most effective therapy for all kinds of SCZ, and the underlying molecular mechanism remains unclear. This study is aim to detect the molecule mechanism by constructing the transcriptome dataset from SCZ patients treated with MECT and health controls (HCs). Methods: Transcriptome sequencing was performed on blood samples of 8 SCZ (BECT: before MECT; AECT: after MECT) and 8 HCs, weighted gene co-expression network analysis (WGCNA) was used to cluster the different expression genes, enrichment and protein-protein interaction (PPI) enrichment analysis were used to detect the related pathways. Results: Three gene modules (black, blue and turquoise) were significantly associated with MECT, enrichment analysis found that the long-term potentiation pathway was associated with MECT. PPI enrichment p-value of black, blue, turquoise module are 0.00127, <1×10-16 and 1.09×10-13, respectively. At the same time, EP300 is a key node in the PPI for genes in black module, which got from the transcriptome sequencing data. Conclusion It is suggested that the long-term potentiation pathways were associated with biological mechanism of MECT.

Objective : The purpose of this study was to investigate the relevant social and environmental factors affecting the occurrence of periodontal diseases during pregnancy in pregnant women and to analyze the influence of the periodontal status of women in the second trimester of pregnancy on small for gestational age (SGA) delivery. Methods: A total of 215 pregnant women were enrolled in this study in the Department of Periodontology of the West China Hospital of Stomatology of Sichuan University from May 2015 to May 2018. Periodontal parameters, such as bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL), were recorded at 16-24 weeks of gestational age. Subjects were divided into the periodontitis (n=32) group, gingivitis (n=171) group and periodontally healthy (n=12) group according to their periodontal conditions. With the patient′s informed consent, the patient decided whether to receive periodontal treatment. Basic and socioeconomic information was collected through questionnaires. After delivery, subjects were divided into the SGA group and non-SGA group according to their birth results. The periodontal clinical indicators, questionnaire results and delivery results were compared among the groups. Results : The mean PD (P=0.005, r=-0.192) and BOP% (P=0.003, r=-0.199) were negatively correlated with economic income. The family income in the periodontitis group was significantly lower than that in the healthy group and the gingivitis group (P < 0.05). The flossing use rate was significantly higher in the healthy group than that in the gingivitis group (P < 0.05). A total of 106 pregnant women received scaling and root planing, while 109 patients only received oral hygiene instruction. After delivery, SGA occurred in 23 cases (10.7%), and there were no significant difference in SGA incidence among the three groups (P > 0.05). PD ≥ 5 mm% and PD ≥ 4 mm% (P < 0.05) were significantly higher in the SGA group than in the non-SGA group. There was no significant difference in SGA incidence between the treated group and the untreated group (P > 0.05). Conclusion Family income and dental flossing use have an impact on the incidence of periodontal diseases during pregnancy. The severity of periodontitis in pregnant women is correlated with the incidence of SGA.

Objective:To understand the perceptions, attitudes and treatment selection of Chinese surgeons for proximal gastrectomy (PG) and digestive tract reconstruction.Methods:A cross-sectional survey was used in this study. Selection of subjects: (1) Domestic public grade IIIA (provincial and prefecture-level) tumor hospitals or general hospitals possessing the diagnosis and treatment qualifications for gastric cancer.(2) Surgeons with senior attending physician, associate chief physician and chief physician. The "Questionnaire Star" platform was used to design a questionnaire about cognition, attitude and treatment choice of "proximal gastrectomy and digestive tract reconstruction". The questionnaire contained 32 questions, such as the basic information of surgeons, the current status of gastric cancer surgery, the selection and management of surgical methods and related details for proximal gastric cancer, the choice of proximal gastrectomy and reconstruction of digestive tract, the related complications and nutritional status monitoring after proximal gastrectomy. A total of 76 questionnaires were linked to the respondents via WeChat between July 29 and August 25, 2019. Statistical analysis was performed using Chi-square test or Kruskal-Wallis test for categorical variables.Results:A total of 47 grade IIIA hospitals were included, and 76 questionnaires were sent out. The proportions of recovered and valid questionnaires were both 100%. For early and middle stage adenocarcinoma of esophagogastric junction (AEG), especially those smaller than 4 cm, 72.37% (55/76) of surgeons preferred proximal gastrectomy, while 22.37% (17/76) of surgeons chose total gastrectomy. For early AEG, 90.79% (69/76) of surgeons thought that endoscopic submucosal dissection (ESD) or proximal gastrectomy could be considered. For AEG below T3 stage and shorter than 4 cm, 60.53% (46/76) of surgeons gave priority to proximal gastrectomy, and 60.53% (46/76) of the surgeons believed that the advanced AEG with a higher radical cure should be treated with proximal gastrectomy, and the residual stomach should not be less than half stomach. Considering anti-reflux effect, postoperative weight recovery, clinical efficacy, wide application and easy popularization, surgeons preferred double-tract reconstruction. The surgeons in tumor hospitals had a higher approval rate for the application of proximal gastrectomy and the fact that the Kamikawa anastomosis was the most difficult to promote than the surgeons in provincial/municipal general hospitals. The surgeons with an annual surgical volume of more than 200 were more likely to choose proximal gastrectomy for early and middle stage AEG patients and the proportion was as high as 8/9. From the perspective of good clinical results, wide range of application, and easy popularization, the surgeons with a higher ratio (60.00%, 15/25) of double-tract reconstruction were those surgeons with 50-100 operations per year.Conclusions:The general level of cognition and acceptability of Chinese surgeons for proximal gastrectomy and reconstruction of digestive tract is suboptimal. In the future, it is urgent to promote the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy" so as to guide and optimize treatment in proximal gastric cancer.

Objective:To understand the perceptions, attitudes and treatment selection of Chinese surgeons for proximal gastrectomy (PG) and digestive tract reconstruction.Methods:A cross-sectional survey was used in this study. Selection of subjects: (1) Domestic public grade IIIA (provincial and prefecture-level) tumor hospitals or general hospitals possessing the diagnosis and treatment qualifications for gastric cancer.(2) Surgeons with senior attending physician, associate chief physician and chief physician. The "Questionnaire Star" platform was used to design a questionnaire about cognition, attitude and treatment choice of "proximal gastrectomy and digestive tract reconstruction". The questionnaire contained 32 questions, such as the basic information of surgeons, the current status of gastric cancer surgery, the selection and management of surgical methods and related details for proximal gastric cancer, the choice of proximal gastrectomy and reconstruction of digestive tract, the related complications and nutritional status monitoring after proximal gastrectomy. A total of 76 questionnaires were linked to the respondents via WeChat between July 29 and August 25, 2019. Statistical analysis was performed using Chi-square test or Kruskal-Wallis test for categorical variables.Results:A total of 47 grade IIIA hospitals were included, and 76 questionnaires were sent out. The proportions of recovered and valid questionnaires were both 100%. For early and middle stage adenocarcinoma of esophagogastric junction (AEG), especially those smaller than 4 cm, 72.37% (55/76) of surgeons preferred proximal gastrectomy, while 22.37% (17/76) of surgeons chose total gastrectomy. For early AEG, 90.79% (69/76) of surgeons thought that endoscopic submucosal dissection (ESD) or proximal gastrectomy could be considered. For AEG below T3 stage and shorter than 4 cm, 60.53% (46/76) of surgeons gave priority to proximal gastrectomy, and 60.53% (46/76) of the surgeons believed that the advanced AEG with a higher radical cure should be treated with proximal gastrectomy, and the residual stomach should not be less than half stomach. Considering anti-reflux effect, postoperative weight recovery, clinical efficacy, wide application and easy popularization, surgeons preferred double-tract reconstruction. The surgeons in tumor hospitals had a higher approval rate for the application of proximal gastrectomy and the fact that the Kamikawa anastomosis was the most difficult to promote than the surgeons in provincial/municipal general hospitals. The surgeons with an annual surgical volume of more than 200 were more likely to choose proximal gastrectomy for early and middle stage AEG patients and the proportion was as high as 8/9. From the perspective of good clinical results, wide range of application, and easy popularization, the surgeons with a higher ratio (60.00%, 15/25) of double-tract reconstruction were those surgeons with 50-100 operations per year.Conclusions:The general level of cognition and acceptability of Chinese surgeons for proximal gastrectomy and reconstruction of digestive tract is suboptimal. In the future, it is urgent to promote the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy" so as to guide and optimize treatment in proximal gastric cancer.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective: To evaluate the clinical efficacy of two different digestive tract reconstruction methods in the Siewert Ⅱ or Ⅲ adenocarcinoma of esophagogastric junction underwent proximal gastrectomy and piggyback jejunal interposition. Methods: A total of 84 patients with Siewert Ⅱ or Ⅲ AEG who underwent proximal gastrectomy and interposition jejunal anastomosis were enrolled prospectively according to the exclusion criteria, from October 2015 to August 2017 at Department of Digestive Minimally Invasive Surgery, Shanxi Cancer Hospital. There were 61 male and 23 female patients, aged 48-69 years with an average age of 59.7 years. They were divided into single-tract reconstruction group (n=41) and double-tract reconstruction group (n=43) according to random number table. Both groups underwent proximal gastrectomy and piggyback jejunal interposition. After side-to-side anastomosis of the remnant stomach and jejunum was performed in the single-tract group, jejunum 3 cm below the anastomosis was ligated or closed. The jejunum in the double-tract group was not treated during the operation. Relevant nutritional indicators were collected at 3 months and 6 months after operation. The data were analyzed by repeated measurement of variance analysis to determine the nutritional status. Results: There was no significant difference in preoperative general condition between single-tract reconstruction group and double-tract reconstruction group (P>0.05). There was no significant difference in perioperative related indicators (P>0.05). Nutritional indicators in single-channel reconstruction group were higher than those in double-channel reconstruction group (hemoglobin: F=23.374, P=0.000; albumin: F=6.149, P=0.003; total protein: F=18.362, P=0.000; weight: F=74.255, P=0.000). The quality of life was compared half year after operation, there was no significant difference in the incidence of subjective symptoms such as reflux, heart burning, nausea and vomiting, dysphagia and sternum discomfort in the two groups (P>0.05), as well as the results of QLQ-STO22 score (27.0±3.8 vs. 27.6±3.3, t=-0.688, P=0.494). The results of gastroscopy showed that the incidence and degree of the two groups were almost the same whether in the incidence of reflux esophagitis (2/41 vs. 2/43, P=1) or in the contrast of reflux degree (Z=-1.528, P=0.127). Conclusion For patients with type Siewert Ⅱ or Ⅲ esophagogastric junction adenocarcinoma who underwent proximal gastrectomy and piggyback jejunal operation, single tract reconstruction is ideal.