The invasive arterial blood pressure(ABP)monitoring technique is widely utilized in the management of critically ill patients,providing medical professionals with real-time,continuous,and dynamic blood pressure data that plays a crucial role in guiding patient treatment.However,current traditional methods for arterial catheter blood collection and zero setting and measurement technology for ABP and central venous pressure(CVP)present certain issues such as complex operation procedures,inaccurate zero setting,and the inability to simultaneously monitor both ABP and CVP.Additionally,these methods may increase the risk of bloodstream infection and occupational exposure.Therefore,the department of critical care medicine at Tianjin Medical University General Hospital has developed a vascular access convenient blood collection device which has been granted a National Utility Model Patent(patent number:ZL 202322581247.4).This device includes a connecting tube,a specimen collection structure,a blood suction structure,a multifunctional pressure measurement device with laser emission structure,a pressure measurement conversion structure,and an efficient vascular access blood collection device.By optimizing the blood collection procedure and simplifying the manometry process,this design reduces the risk of bloodstream infection for patients and minimizes occupational exposure for medical staff.The device ensures accurate zero point adjustment of pressure measurements while guaranteeing the authenticity and reliability of collected data.Additionally,it supports synchronous monitoring of ABP and CVP,thereby saving medical consumables and reducing workload for healthcare professionals.This simple yet safe and efficient device meets clinical requirements effectively and is highly recommended for widespread use.

Objective:To investigate the predictive value of refeeding syndrome (RFS) and its influencing factors for 30-day intensive care unit (ICU) readmission in critically ill patients.Methods:A prospective cohort study was conducted. Critically ill patients admitted to the department of critical care medicine, department of respiratory and critical care medicine, and department of neurology at Tianjin Medical University General Hospital from January to April in 2025 were enrolled. Patients were assessed for RFS according to the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria. General information within 24 hours of ICU admission was collected via the electronic medical record system. Treatment details and 30-day ICU readmission status were dynamically recorded. Participants were divided into readmission and non-readmission groups based on whether ICU readmission occurred within 30 days. Intergroup comparisons were performed to identify differences. Multivariate Logistic regression was used to analyze the relationship between RFS and its influencing factors with 30-day ICU readmission. Receiver operator characteristic curve (ROC curve) was plotted to evaluate the predictive performance of risk factors.Results:A total of 196 critically ill patients were enrolled, among whom 25 (12.76%) were readmitted to ICU within 30 days and 171 (87.24%) were not. Significant differences were observed in the readmission group compared with the non-readmission group, including significantly higher rates of nasogastric decompression, higher acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, a higher incidence of RFS, and a longer duration of nasogastric decompression. Multivariate Logistic regression analysis showed that RFS was an independent risk factor for 30-day ICU readmission [odds ratio ( OR) = 5.756, 95% confidence interval (95% CI) was 1.603-20.670, P = 0.007]. APACHEⅡ score showed a positive correlation trend with 30-day ICU readmission ( OR = 1.057, 95% CI was 0.991-1.127, P = 0.092). ROC curve analysis showed that the combined prediction model incorporating RFS and APACHEⅡ score had an area under the ROC curve (AUC) of 0.766 (95% CI was 0.668-0.864), with a sensitivity of 88.0% and a specificity of 62.0%, which was significantly superior to a single indicator (the AUC of RFS and APACHEⅡ score was 0.639 and 0.624, respectively). Conclusions:RFS significantly increases the risk of 30-day ICU readmission in critically ill patients. A combined model incorporating RFS and APACHEⅡ score demonstrates good predictive efficacy for 30-day ICU readmission in critically ill patients.

The invasive arterial blood pressure(ABP)monitoring technique is widely utilized in the management of critically ill patients,providing medical professionals with real-time,continuous,and dynamic blood pressure data that plays a crucial role in guiding patient treatment.However,current traditional methods for arterial catheter blood collection and zero setting and measurement technology for ABP and central venous pressure(CVP)present certain issues such as complex operation procedures,inaccurate zero setting,and the inability to simultaneously monitor both ABP and CVP.Additionally,these methods may increase the risk of bloodstream infection and occupational exposure.Therefore,the department of critical care medicine at Tianjin Medical University General Hospital has developed a vascular access convenient blood collection device which has been granted a National Utility Model Patent(patent number:ZL 202322581247.4).This device includes a connecting tube,a specimen collection structure,a blood suction structure,a multifunctional pressure measurement device with laser emission structure,a pressure measurement conversion structure,and an efficient vascular access blood collection device.By optimizing the blood collection procedure and simplifying the manometry process,this design reduces the risk of bloodstream infection for patients and minimizes occupational exposure for medical staff.The device ensures accurate zero point adjustment of pressure measurements while guaranteeing the authenticity and reliability of collected data.Additionally,it supports synchronous monitoring of ABP and CVP,thereby saving medical consumables and reducing workload for healthcare professionals.This simple yet safe and efficient device meets clinical requirements effectively and is highly recommended for widespread use.

Objective:To investigate the predictive value of refeeding syndrome (RFS) and its influencing factors for 30-day intensive care unit (ICU) readmission in critically ill patients.Methods:A prospective cohort study was conducted. Critically ill patients admitted to the department of critical care medicine, department of respiratory and critical care medicine, and department of neurology at Tianjin Medical University General Hospital from January to April in 2025 were enrolled. Patients were assessed for RFS according to the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria. General information within 24 hours of ICU admission was collected via the electronic medical record system. Treatment details and 30-day ICU readmission status were dynamically recorded. Participants were divided into readmission and non-readmission groups based on whether ICU readmission occurred within 30 days. Intergroup comparisons were performed to identify differences. Multivariate Logistic regression was used to analyze the relationship between RFS and its influencing factors with 30-day ICU readmission. Receiver operator characteristic curve (ROC curve) was plotted to evaluate the predictive performance of risk factors.Results:A total of 196 critically ill patients were enrolled, among whom 25 (12.76%) were readmitted to ICU within 30 days and 171 (87.24%) were not. Significant differences were observed in the readmission group compared with the non-readmission group, including significantly higher rates of nasogastric decompression, higher acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, a higher incidence of RFS, and a longer duration of nasogastric decompression. Multivariate Logistic regression analysis showed that RFS was an independent risk factor for 30-day ICU readmission [odds ratio ( OR) = 5.756, 95% confidence interval (95% CI) was 1.603-20.670, P = 0.007]. APACHEⅡ score showed a positive correlation trend with 30-day ICU readmission ( OR = 1.057, 95% CI was 0.991-1.127, P = 0.092). ROC curve analysis showed that the combined prediction model incorporating RFS and APACHEⅡ score had an area under the ROC curve (AUC) of 0.766 (95% CI was 0.668-0.864), with a sensitivity of 88.0% and a specificity of 62.0%, which was significantly superior to a single indicator (the AUC of RFS and APACHEⅡ score was 0.639 and 0.624, respectively). Conclusions:RFS significantly increases the risk of 30-day ICU readmission in critically ill patients. A combined model incorporating RFS and APACHEⅡ score demonstrates good predictive efficacy for 30-day ICU readmission in critically ill patients.

Objective:To summarize the best evidence for exercise intervention in elderly patients with sarcopenia in intensive care unit (ICU) through literature search, and provide a reference for clinical implementation of early exercise intervention in this population through evidence-based practice.Methods:① Summary of best evidence: relevant literature on exercise intervention for elderly patients with sarcopenia in ICU, including guideline, evidence summary, expert consensus, systematic review, and original study [quasi-experiment and randomized controlled trial (RCT)] from UpToDate Clinical Advisor, Ovid database, National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed/Medline, SinoMed, CNKI, Wanfang Database, VIP, and Yimai Tong Guideline Network were systematically searched. The search period covered from the establishment of these databases up to August 24, 2023. The quality of the literature was evaluated by two researchers with methodological expertise in evidence-based medicine, and the evidences were extracted and summarized. ② Evidence-based practice: the elderly patients with high risk of sarcopenia who had been hospitalized in the ICU for more than 7 days from January to April 2024 were enrolled as the research subjects, and they were divided into a control group and an intervention group using convenience sampling method. The control group received routine intensive care nursing. The intervention group implemented exercise intervention based on the actual situation of the patients, the baseline review was conducted before evidence application, and the effectiveness of evidence application at 7 days and 14 days was evaluated.Results:① A total of 19 pieces of literature were included, including 4 guidelines, 1 summary of evidence, 4 expert consensuses, 4 systematic reviews, and 6 original studies (1 quasi-experiment, 5 RCT). After literature quality evaluation, all 19 articles were enrolled. Finally, 31 pieces of best evidence were extracted from eight aspects, including assessment and diagnosis, multidisciplinary cooperation, indication, preparation before intervention, intervention program, safety monitoring, post-intervention evaluation, and special task. ② Finally, a total of 30 patients were enrolled in the intervention group, of which 17 completed 14 days of rehabilitation exercise, and 13 completed 7 days of rehabilitation exercise. Twenty-seven patients were enrolled in the control group, of which 17 completed 14 days of monitoring, and 10 completed 7 days of monitoring. Clinical evidence application results showed that the patients in the intervention group did not experience adverse events such as increased heart rate, extubation, or physical discomfort. The skeletal muscle mass index (SMI) in both groups was gradually decreased with the prolongation of intervention duration, but the 7-day SMI in the intervention group was significantly higher than that in the control group (kg/m 2: 8.61±2.66 vs. 6.65±1.50, P < 0.01). Conclusion:By summarizing the best evidence and evidence-based practice of exercise intervention for elderly patients with sarcopenia in ICU, this study confirmed the feasibility due to safe and effective of implementing early exercise intervention for elderly sarcopenia patients in ICU.

Objective:To investigate and analysis of the occurrence and influencing factors of sarcopenia in elderly critically ill patients in the intensive care unit (ICU).Methods:A prospective cohort study was conducted. Elderly patients (aged ≥ 60 years) admitted to the ICU of Tianjin Medical University General Hospital from November 2023 to June 2024 were enrolled. Clinical records were collected, and conduct muscle mass and strength measurements, as well as upper arm circumference and calf circumference were measured. Appendicular skeletal muscle index (ASMI) of less than 7.0 kg/m 2 for males and less than 5.7 kg/m 2 for females was defined as reduced muscle mass, grip strength of less than 28 kg for males and less than 18 kg for females was defined as decreased muscle strength, patients meeting both low muscle mass and low muscle strength criteria were diagnosed with sarcopenia. According to the diagnostic criteria for sarcopenia, patients were divided into sarcopenia group and non-sarcopenia group. Multivariate Logistic regression analysis was applied to identify risk factors for sarcopenia in the elderly and to develop a predictive model for the occurrence of sarcopenia. The predictive value of various risk factors for sarcopenia in elderly critically ill patients were evaluated by receiver operator characteristic curve (ROC curve). The Kaplan-Meier curve for the length of ICU stay of two groups patients were drawn. Results:Finally, 540 elderly critically ill patients were included, including 43 patients with sarcopenia, and the incidence of sarcopenia was 8.0%. Univariate analysis showed that there were significantly differences in body mass index (BMI), number of hospitalizations in the past year, the length of ICU stay, ventilation mode, duration of mechanical ventilation, pre-admission exercise habits, nutritional support methods, upper arm circumference, calf circumference, and albumin infusion between the sarcopenia group and the non-sarcopenia group. Multivariate Logistic regression analysis showed that BMI [odds ratio ( OR) = 0.79, 95% confidence interval (95% CI) was 0.67-0.93, P = 0.004], calf circumference ( OR = 0.64, 95% CI was 0.54-0.76, P < 0.001), and duration of mechanical ventilation ( OR = 1.06, 95% CI was 1.01-1.12, P = 0.034) were associated with an increased risk of sarcopenia in elderly critically ill patients. The ROC curve results showed that the area under the curve (AUC) and 95% CI of BMI, calf circumference, and duration of mechanical ventilation for predicting sarcopenia in elderly critically ill patients were 0.828 (0.767-0.888), 0.889 (0.844-0.933), and 0.397 (0.299-0.496), respectively, with cut-off values of 22.95 kg/m 2, 28.25 cm, and 50.50 days, respectively. The Kaplan-Meier curve showed that the cumulative survival rate of patients with sarcopenia was significantly lower than that of the non-sarcopenia group (Log-Rank test: χ 2 = 5.619, P = 0.018). Conclusion:Lower BMI, smaller calf circumference, and longer duration of mechanical ventilation are associated with an increased risk of sarcopenia in critically ill elderly patients.

Objective:To investigate the treatment efficacy of adjuvant anti-VEGF/VEGFR targeted therapy in patients with non-metastatic (cM 0) non-clear cell renal cell carcinoma and tumor thrombus (nccRCC-VTT). Methods:This retrospective study enrolled 26 patients who underwent radical nephrectomy combined with inferior vena cava tumor thrombectomy at Peking University Third Hospital from January 2014 to July 2021. Patients were divided into adjuvant therapy group (10 cases) and control group (16 cases)based on the use of postoperative targeted therapy. The distribution of baseline clinical characteristics in the adjuvant therapy group and the control group were as follows: gender (6 males and 4 females in the adjuvant therapy group, 12 males and 4 females in the control group, P=0.66), age (56.2±18.5 years old in the adjuvant therapy group; 54.6±14.5 years old in the control group; P=0.80), BMI(24.0±3.5 in the adjuvant therapy group; 24.3±3.3 in the control group; P=0.80), presence of clinical symptoms (8 cases in the adjuvant therapy group; 15 cases in the control group; P=0.54), tumor laterality(6 cases on the left and 4 cases on the right in the adjuvant therapy group; 6 cases on the left and 10 cases on the right in the control group; P=0.42), location of tumor thrombus (2 cases with renal vein tumor thrombus and 8 cases with inferior vena cava tumor thrombus in the adjuvant therapy group; 2 cases with renal vein tumor thrombus and 14 cases with inferior vena cava tumor thrombus in the control group; P=0.67), ASA classification (2 cases in ASA class 1 and 8 cases in ASA class 2 in the adjuvant therapy group; 2 cases in ASA class 1 and 14 cases in ASA class 2 in the control group; P=0.63), surgical approach (7 minimally invasive surgeries and 3 open surgeries in the adjuvant therapy group; 9 minimally invasive surgeries and 7 open surgeries in the control group; P=0.68), conversion to open surgery (2 cases in the adjuvant therapy group; 2 cases in the control group; P=0.63), operation time [287.5(222.2, 456.0) minutes in the adjuvant therapy group; 344.0(287.8, 482.5) minutes in the control group; P=0.34), blood loss [400.0(250.0, 600.0)ml in the adjuvant therapy group; 575.0(175.0, 800.0)ml in the control group; P=0.63), Clavien-Dindo classification of postoperative complications (8 cases with no postoperative complications, 2 cases with level 1-2 complications, and 0 cases with level ≥3 complications in the adjuvant therapy group; 10 cases with no postoperative complications, 4 cases with level 1-2 complications, and 2 cases with level ≥3 complications in the control group; P=0.68), postoperative hospital stay (8.5 [5.5, 11.5] days in the adjuvant therapy group; 7.5 [6.0, 13.0] days in the control group; P=1.00), maximum tumor diameter[ (9.2±2.7)cm in the adjuvant therapy group; (8.9±3.3)cm in the control group; P=0.81], sarcomatoid differentiation (0 cases in the adjuvant therapy group; 1 case in the control group; P=1.00), perinephric fat invasion (2 cases in the adjuvant therapy group; 7 cases in the control group; P=0.40), tumor necrosis (6 cases in the adjuvant therapy group; 5 cases in the control group; P=0.23), pathological subtype (1 case of PRCC type 1, 6 cases of PRCC type 2, and 3 cases of TFE3 rearrangement RCC in the adjuvant therapy group; 2 cases of PRCC type 1, 10 cases of PRCC type 2, and 1 case each of oncocytic PRCC, TFE3 rearrangement RCC, FH-deficient RCC, and unclassified RCC in the control group; P=0.72), WHO/ISUP nuclear grade (10 cases of grades 3-4 in the adjuvant therapy group; 4 cases of grades 1-2 and 12 cases of grades 3-4 in the control group; P=0.14), invasion of tumor thrombus into the vessel wall (5 cases in the adjuvant therapy group; 5 cases in the control group; P=0.43), T stage (1 case of T 3a, 3 cases of T 3b, 5 cases of T 3c, and 1 case of T 4 in the adjuvant therapy group; 1 case of T 3a, 4 cases of T 3b, 10 cases of T 3c, and 1 case of T 4 in the control group; P=1.00), and positive lymph nodes metastasis(3 cases in the adjuvant therapy group; 0 cases in the control group; P<0.05). The recommended doses for sunitinib, axitinib, and pazopanib are 50mg qd, 5mg q12h, and 800mg qd, respectively. The primary endpoint of this study was disease-free survival (DFS), and the secondary endpoint was overall survival (OS). Statistical analyses were performed using R v4.2.2. Confounding factors were adjusted using propensity score weighting. Results:The median follow-up time for DFS was 29 months in the adjuvant therapy group and not reached in the control group, while median follow-up time for OS was 28 and 26 months, respectively. In the univariate Cox regression analysis, there were no statistically significant difference in the impact of all baseline characteristics and exposure factors on DFS and OS between the two groups. In survival analysis, there were no significant difference between DFS and OS curves of patients in the adjuvant therapy group and the control group (DFS, P=0.62; OS, P=0.74). The median DFS of patients in the adjuvant therapy group and the control group were 17 and 19 months, respectively, while the median OS was 43 and 27 months. After adjusting for confounding factors, the median DFS of patients in the adjuvant therapy group and the control group were 26 and 12 months, respectively, and the median OS remained 43 and 27 months, with no significant difference (DFS, P=0.81; OS, P=0.40). Conclusion:There is currently a lack of definitive evidence for survival benefit from adjuvant anti-VEGF/VEGFR targeted therapy in patients with cM0 nccRCC-VTT after surgery.

This article introduces the contents of the latest edition Risk of Bias in Non-randomized Studies-of Exposure (ROBINS-E) published in June 2022 [ROBINS-E (2022)], and gives some examples about its usage. ROBINS-E is a tool for assessing the risk of bias in non-randomized studies-of exposure. Compared with ROBINS-E (2019), ROBINS-E (2022) adds more bias for observational studies, covers a more comprehensive range of bias, and adds the assessment of the external authenticity of the study. ROBINS-E (2022) adds a preliminary evaluation process to improve the efficiency of evaluation. In addition, ROBINS-E (2022) visualizes and instrumentalizes the use of signal problems in the form of path graph, making it more convenient to use. ROBINS-E (2022), although more consideration has been given to the issue of co-exposure, still does not address the problem of effect modification in co-exposure, and there is still room to expand the applicable research.

Objective:To explore new methods to assist the diagnosis of glucose transporter type 1 deficiency syndrome (GLUT1-DS).Methods:Sixteen children with epilepsy and/or movement disorder carrying the SLC2A1 mutation who admitted to Department of Pediatrics, the First Medical Center, Chinese People′s Liberation Army General Hospital and Department of Nutrition, Shanghai Deji Hospital from October 2019 to October 2020 were retrospectively analyzed.GLUT1-DS was diagnosed based on clinical phenotype, glucose level in CSF and/or genetic testing results.Forty-four healthy children who underwent physical examination in the First Medical Center, Chinese People′s Liberation Army General Hospital during the same period were selected as healthy control group.Glucose transporter 1 (GLUT1) level on the membrane surface of peripheral red blood cells and erythrocyte glucose uptake rate were measured by flow cytometry and glucose oxidase method, respectively.Their differences between groups were compared by the rank sum test.The receiver operating cha-racteristic (ROC) curve was plotted to assess their diagnostic value. Results:Sixteen children were diagnosed as GLUT1-DS.GLUT1 levels of 16 children with GLUT1-DS were significantly lower than those of healthy control group [17.96% (13.43%, 22.12%) vs.27.93% (24.76%, 34.30%), Z=5.249, P<0.001]. Area under curve (AUC) was 0.946, and weighted Kappa was 0.791 ( P<0.001). The erythrocyte glucose uptake was measured in 12 children with GLUT1-DS, which was significantly lower than that of healthy control group [23.14% (14.80%, 26.45%) vs.27.40% (24.61%, 32.82%), Z=2.366, P=0.018]. AUC and weighted Kappa were 0.724 and 0.344, respectively ( P<0.001), showing a poor consistency. Conclusions:GLUT1 level on the surface of human erythrocyte membrane measured by flow cytometry may be a new method to assist the diagnosis of GLUT1-DS.The erythrocyte glucose uptake rate test requires stricter experimental conditions and needs further investigation.

Objective:To understand the sleep quality and mental health status of nurses in public health emergencies, and analyze the correlation between them.Methods:A total of 128 first-line nursing staff participating in public health emergencies on February 22-23, 2020 in Tianjin Beichen Hospital, Tianjin First Central Hospital, Tianjin Fourth Central Hospital were investigated by the general data questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Symptom Checklist 90 (SCL-90).Results:70.3%(90/128) of nursing staff had poor sleep quality, and the total score of PSQI was (9.71±4.01) points, which was statistically significant compared with the domestic norm ( t value was 16.479, P<0.01). The total score of SCL-90 was 1.59±0.52, which was statistically significant compared with the domestic norm ratio ( t value was 4.505, P<0.01). One-way ANOVA showed that the nursing staff's age had a significant impact on sleep quality, and the difference was statistically significant ( F value was 4.092, P<0.05). Pearson correlation analysis showed that the Pittsburgh sleep quality scale index scores and symptom self-assessment scale and somatization, force, sensitive interpersonal relationship, depression, anxiety, hostile, terrorist, paranoia, and psychosis were positively correlated( r values were 0.292-0.444, P< 0.01). Conclusions:The sleep quality and mental health status of nurses in public health emergencies are poor, and the sleep quality is correlated with mental health status.