Objective:To develop and validate a clinical prediction model for assessing the risk of postoperative pulmonary complications (PPCs) in elderly patients undergoing surgery with general anesthesia.Methods:This prospective observational study enrolled patients aged ≥65 years who underwent general anesthesia with mechanical ventilation duration >3 hours across six tertiary hospitals between December 2022 and August 2023. Based on follow-up outcomes (until discharge or postoperative day 7), patients were categorized into a non-PPCs group and a PPCs group. Detailed records included baseline patient characteristics, preoperative comorbidities, surgical information (type, duration), and bedside lung ultrasound scores (LUS) assessed within 24 hours postoperatively using a standardized 12-zone protocol. Predictor selection was performed using LASSO regression. Significant predictors identified were incorporated into a multivariate logistic regression analysis to build the prediction model, visualized as a nomogram. Internal validation was conducted via bootstrap resampling (1 000 repetitions). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) for discrimination, calibration curves for calibration accuracy, and decision curve analysis (DCA) for clinical utility.Results:A total of 130 eligible elderly surgical patients were included. PPCs occurred in 17 patients (incidence rate: 13.1%). Multivariate analysis identified LUS ( OR=1.248, 95% CI: 1.099-1.417, P=0.001) and elective surgery type ( OR=0.206, 95% CI: 0.043-0.988, P=0.048) as independent predictors of PPCs. The nomogram model demonstrated an AUC of 0.867 (95% CI: 0.775-0.959) upon initial testing. Internal validation confirmed good discrimination (AUC=0.863, 95% CI: 0.778-0.972). Calibration curves indicated excellent agreement between predicted probabilities and observed outcomes. Decision curve analysis demonstrated significant clinical net benefit across a wide range of threshold probabilities (0.03-0.89). Conclusions:The clinical prediction model, developed using early postoperative LUS scores and surgical type, effectively predicts the risk of postoperative pulmonary complications in elderly patients following surgery under general anesthesia. The model exhibits strong discrimination, calibration, and clinical utility, providing clinicians with a reliable tool for individualized risk assessment to support clinical decision-making and potentially reduce PPC incidence.

Young management talents are the driving force behind the refined management of hospitals and the future and hope of high-quality development.In the context of the new era,high-quality development has become the main theme of reform and development in public hospitals,which puts forward new and higher requirements for the cultivation of young management tal-ents in hospitals.Based on literature research,this article systematically summarizes and explores the concept and characteristics of young management talents in hospitals.Taking Jiangsu Provincial People's Hospital as an example,it actively supports and serves the growth and development of young management talents through specific practices such as optimizing organizational man-agement,improving training systems,strengthening incentive mechanisms,and smoothing development channels.These practices have achieved good results and aim to provide references for the cultivation and development of young management talents in pub-lic hospitals in China.

Young management talents are the driving force behind the refined management of hospitals and the future and hope of high-quality development.In the context of the new era,high-quality development has become the main theme of reform and development in public hospitals,which puts forward new and higher requirements for the cultivation of young management tal-ents in hospitals.Based on literature research,this article systematically summarizes and explores the concept and characteristics of young management talents in hospitals.Taking Jiangsu Provincial People's Hospital as an example,it actively supports and serves the growth and development of young management talents through specific practices such as optimizing organizational man-agement,improving training systems,strengthening incentive mechanisms,and smoothing development channels.These practices have achieved good results and aim to provide references for the cultivation and development of young management talents in pub-lic hospitals in China.

Objective:To evaluate the effect of CD47-overexpressed mesenchymal stem cells (MSCs) on fatty liver ischemia-reperfusion (I/R) injury and the role of signal regulatory protein alpha (SIRPα) in mice.Methods:MSCs from C57 mouse bone marrow were isolated and purified using the density gradient centrifugation, and then CD47 recombinant adenovirus was transfected into MSCs. SPF 4-week-old C57 mice were fed a high-fat diet to induce moderate liver steatosis and then 70% liver I/R model was established. Mice were divided into 4 groups ( n=6 each) using a random number table method: sham operation group (S group), liver I/R group (I/R group), CD47-overexpressed MSCs group (CD47+ I/R group) and CD47-overexpressed MSCs+ SIRPα inhibitor group (CD47+ RRx+ I/R group). MSCs were injected via the tail vein at 24 h before surgery. SIRPα inhibitor RRx-001 1 mg/kg was injected through the tail vein at 48 h before surgery. The mice were anesthetized and sacrificed at 6 h of reperfusion. Blood samples were collected from the inferior vena cava for determination of serum concentrations of alanine transaminase (ALT) and aspartate transaminase (AST). Liver tissues were obtained for examination of the pathological changes and for determiation of the expression of cleaved-caspase 1 (c-caspase-1), gasdermin (GSDM) and PYD domains-containing protein 3 (NLRP3) (by Western blot). Results:Compared with S group, the serum concentrations of ALT and AST were significantly increased, the expression of c-caspase-1, GSDM and NLRP3 in liver tissues was up-regulated ( P<0.05), and the histo-pathological changes of the liver tissue were aggravated in I/R group. Compared with I/R group, the serum concentrations of ALT and AST were significantly decreased, the expression of c-caspase-1, GSDM and NLRP3 in liver tissues was down-regulated ( P<0.05), and the histo-pathological changes of the liver tissue were significantly attenuated in CD47+ I/R group. Compared with CD47+ I/R group, the serum concentrations of ALT and AST were significantly increased, the expression of c-caspase-1, GSDM and NLRP3 in liver tissues was up-regulated ( P<0.05), and the histo-pathological changes of the liver tissue were aggravated in CD47+ RRx+ I/R group. Conclusions:CD47-overexpressed MSCs can alleviate fatty liver I/R injury in mice, and activation of SIRPα and subsequent inhibition of pyroptosis are involved in the process.

Objective To investigate the appropriate venous access for obese patients undergoing metabolic and bariatric surgery by comparing the clinical outcomes of different lengths of peripheral intravenous catheters.Methods Inpatients who underwent bariatric surgery in a tertiary hospital in Zhejiang from August 2022 to December 2022 were selected as the study population using a fixed-point continuous convenience sampling method.A stratified block randomisation method was used to divide the group into an experimental group 1(mini-midline catheters),an experimental group 2(midline catheters)and a control group(short peripheral intravenous catheters,Short PIVCs).The incidence of catheter-related complications,the rate of extubation due to complications,the duration of catheter retention,the time to first catheter-related complication were compared in the 3 groups.Results A total of 186 patients were included,with 62 patients in each group.The overall incidence of catheter-related complications in experimental group 1,experimental group 2,and control group were 25.81％,8.06％,and 58.06％.The extubation rates due to complications were 19.35％,4.84％,and 41.94％,and the duration of catheter retention was 7.00(6.00,7.00)d,7.00(6.00,7.00)d,6.00(3.00,6.25)d.The differences were statistically different(P＜0.05)when comparing the 3 groups.Among them,the differences in the overall incidence of catheter-related complications and the rate of extubation due to complications were statistically significant when comparing experimental group 1 with the control group,experimental group 2 with the control group,and experimental group 1 with experimental group 2(P＜0.017);the duration of catheter retention in both experimental group 1 and experimental group 2 were higher than it in the control group,and the differences were statistically different(P＜0.017).Conclusion The complication rate of mini-midline catheters and midline catheters is lower than that of short ones,and the indwelling time is consistent with the perioperative period of metabolic and bariatric surgery,which is suitable for use in patients undergoing metabolic and bariatric surgery.

Objective:To analyze the occurrence and clinical features of liver injury induced by dandelion, a food-medicine homologous traditional Chinese medicine.Methods:The patients with liver injury caused by taking dandelion, who were admitted to the Department of Infectious Diseases, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 1, 2017 to December 31, 2023, were enrolled in this study. The electronic medical records of the patients were retrieved, and the patients′ general information, using of dandelion, combined medication, clinical manifestations, and liver biochemical test results were recorded. The causal relationship between dandelion and the liver injury were evaluated, and the clinical manifestations, classification, severity, treatment and prognosis of liver injury were analyzed.Results:A total of 13 patients were enrolled in the study, including 8 females and 5 males. The age ranged from 29 to 78 years. Nine patients took dandelion by themselves, and 4 according to the doctor′s advice. The administration methods included dandelion root tea drink, whole herb tea drink, and powder drink mixed in water. Most patients′ liver injury occurred within 90 days after taking dandelion. The main clinical manifestations were yellowish staining of skin and sclera, dark urine, abdominal distension, abdominal pain, loss of appetite, etc. The laboratory tests showed that serum aminotransferase and bilirubin increased in 13 patients, alkaline phosphatase increased in 12 patients, and plasma ammonia increased in 5 patients. The causality evaluation results showed "probable related" in 8 cases and "highly probable related" in 5 cases. The clinical classification showed that 11 patients were of hepatocellular type and 2 of mixed type. The severity was mainly grade 2 (8 of 13 patients). Two patients with grade 3 and 2 patients with grade 4 developed liver failure. After symptomatic treatments, 11 patients′ liver function returned to normal or were improved; 2 patients′ condition progressed, of which 1 patient survived after liver transplantation and 1 patient died.Conclusions:Dandelion can cause liver injury, mostly occurring within 90 days after administration, with moderate severity. After stopping dandelion and giving symptomatic treatments, most patients have a good prognosis, but there is a risk of liver failure and death.

Objective:To evaluate the effect of CD47-overexpressed mesenchymal stem cells (MSCs) on fatty liver ischemia-reperfusion (I/R) injury and the role of signal regulatory protein alpha (SIRPα) in mice.Methods:MSCs from C57 mouse bone marrow were isolated and purified using the density gradient centrifugation, and then CD47 recombinant adenovirus was transfected into MSCs. SPF 4-week-old C57 mice were fed a high-fat diet to induce moderate liver steatosis and then 70% liver I/R model was established. Mice were divided into 4 groups ( n=6 each) using a random number table method: sham operation group (S group), liver I/R group (I/R group), CD47-overexpressed MSCs group (CD47+ I/R group) and CD47-overexpressed MSCs+ SIRPα inhibitor group (CD47+ RRx+ I/R group). MSCs were injected via the tail vein at 24 h before surgery. SIRPα inhibitor RRx-001 1 mg/kg was injected through the tail vein at 48 h before surgery. The mice were anesthetized and sacrificed at 6 h of reperfusion. Blood samples were collected from the inferior vena cava for determination of serum concentrations of alanine transaminase (ALT) and aspartate transaminase (AST). Liver tissues were obtained for examination of the pathological changes and for determiation of the expression of cleaved-caspase 1 (c-caspase-1), gasdermin (GSDM) and PYD domains-containing protein 3 (NLRP3) (by Western blot). Results:Compared with S group, the serum concentrations of ALT and AST were significantly increased, the expression of c-caspase-1, GSDM and NLRP3 in liver tissues was up-regulated ( P<0.05), and the histo-pathological changes of the liver tissue were aggravated in I/R group. Compared with I/R group, the serum concentrations of ALT and AST were significantly decreased, the expression of c-caspase-1, GSDM and NLRP3 in liver tissues was down-regulated ( P<0.05), and the histo-pathological changes of the liver tissue were significantly attenuated in CD47+ I/R group. Compared with CD47+ I/R group, the serum concentrations of ALT and AST were significantly increased, the expression of c-caspase-1, GSDM and NLRP3 in liver tissues was up-regulated ( P<0.05), and the histo-pathological changes of the liver tissue were aggravated in CD47+ RRx+ I/R group. Conclusions:CD47-overexpressed MSCs can alleviate fatty liver I/R injury in mice, and activation of SIRPα and subsequent inhibition of pyroptosis are involved in the process.

Objective:To analyze the occurrence and clinical features of liver injury induced by dandelion, a food-medicine homologous traditional Chinese medicine.Methods:The patients with liver injury caused by taking dandelion, who were admitted to the Department of Infectious Diseases, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 1, 2017 to December 31, 2023, were enrolled in this study. The electronic medical records of the patients were retrieved, and the patients′ general information, using of dandelion, combined medication, clinical manifestations, and liver biochemical test results were recorded. The causal relationship between dandelion and the liver injury were evaluated, and the clinical manifestations, classification, severity, treatment and prognosis of liver injury were analyzed.Results:A total of 13 patients were enrolled in the study, including 8 females and 5 males. The age ranged from 29 to 78 years. Nine patients took dandelion by themselves, and 4 according to the doctor′s advice. The administration methods included dandelion root tea drink, whole herb tea drink, and powder drink mixed in water. Most patients′ liver injury occurred within 90 days after taking dandelion. The main clinical manifestations were yellowish staining of skin and sclera, dark urine, abdominal distension, abdominal pain, loss of appetite, etc. The laboratory tests showed that serum aminotransferase and bilirubin increased in 13 patients, alkaline phosphatase increased in 12 patients, and plasma ammonia increased in 5 patients. The causality evaluation results showed "probable related" in 8 cases and "highly probable related" in 5 cases. The clinical classification showed that 11 patients were of hepatocellular type and 2 of mixed type. The severity was mainly grade 2 (8 of 13 patients). Two patients with grade 3 and 2 patients with grade 4 developed liver failure. After symptomatic treatments, 11 patients′ liver function returned to normal or were improved; 2 patients′ condition progressed, of which 1 patient survived after liver transplantation and 1 patient died.Conclusions:Dandelion can cause liver injury, mostly occurring within 90 days after administration, with moderate severity. After stopping dandelion and giving symptomatic treatments, most patients have a good prognosis, but there is a risk of liver failure and death.

Humans ; Asthma/diagnosis* ; HMGB1 Protein

Objective:To evaluate the effect of patent foramen ovale (PFO) on the perioperative complications and survival rate in pediatric patients undergoing living donor liver transplantation.Methods:The medical records from pediatric patients of either sex with biliary atresia, aged<18 yr, who underwent living donor liver transplantation from January 2020 to January 2022, were retrospectively collected. The pediatric patients were divided into PFO group and non-PFO group according to the results of echocardiography before operation. The postreperfusion syndrome, acute lung injury, acute kidney injury, postoperative delirium and 1-year survival rate were recorded.Results:There was no significant difference in the incidence of postreperfusion syndrome, acute lung injury, acute kidney injury, postoperative delirium and one-year survival rate between PFO group and non-PFO group ( P>0.05). Conclusions:PFO has no obvious effect on the incidece of intraoperative and early postoperative complications and 1-year survival rate in pediatric patients undergoing living donor liver transplantation.