Objective To evaluate the effect of different doses of esketamine combined with propofol medium and long chain fat emulsion in painless gastroenteroscopy.Methods 144 patients who were scheduled to receive painless gastroenteroscopy from January 2022 to December 2023 were randomly divided into four groups with 36 cases in each group.The load dose of esketamine in group A,group B and group C was 0.2,0.3 and 0.4 mg/kg respectively,and group D was treated with equivalent normal saline instead of esketamine as the control.All the patients were administrated with propofol medium and long chain fat emulsion during the examination.Heart rate(HR),mean arterial pressure(MAP)and percutaneous arterial oxygen saturation(SpO2)were recorded immediately after electrocardiograph monitoring was established(T0),immediately before examination(T1),immediately after gastroscopy placement(T2),immediately before colonoscopy(T3),immediately after colonoscopy implantation(T4)and immediately after examination(T5).The dosage of propofol medium and long chain fat emulsion,recovery time and discharge time were compared among the four groups.Patients were assessed with quality of recovery-40 questionnaire(QoR-40)at T0 and at wake time(T6).The adverse reactions of the four groups were compared.Results There were statistically significant differences in the temporal effects of HR,MAP and SpO2 among the 4 groups(F=3.91,21.65,6.17,P＜0.05);There were statistically significant differences in the intergroup effects of HR,MAP and SpO2 among the 4 groups(F=14.57,7.14,30.34,P＜0.05).The variation trend of SpO2 in groups A,B,C and D was statistically significant(F=2.88,P＜0.05).The first and total dosage of propofol medium and long chain fat emulsion,and the recovery time of the four groups were statistically significant(P＜0.05).The initial dosage and total dosage of propofol medium and long chain fat emulsion in group A,group B and group C were significantly lower than those in group D(P＜0.05),and group B and group C were significantly lower than group A(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The recovery time of group A and group B were significantly shorter than that of group C and group D(P＜0.05),and group C was significantly longer than that of group D(P＜0.05),and there was no significant difference between group A and group B(P＞0.05).There was no significant difference in the time of get discharged from the hospital among the four groups(P＞0.05).The total scores of QoR-40 in four group at T6 were significantly lower than those at T0 respectively(P＜0.05).T6 QoR-40 total score:group B was significantly higher than group A,Group C and group D(P＜0.05),group A and group C were significantly higher than group D(P＜0.05),and there was no significant difference between group A and group C(P＞0.05).There were significant differences in the incidence of hypoxemia,hypotension,bradycardia,tachycardia,body movement and dizziness among the four groups(P＜0.05).The incidence of hypoxemia,hypotension and bradycardia in group B and group C was significantly lower than that in group D(P＜0.083),and the incidence of dizziness in group C was significantly higher than that in group D(P＜0.0083).Among them,1 case in group A and 3 cases in group D needed mask pressure ventilation due to hypoxemia.There was no significant difference in the incidence of nausea and vomiting among the four groups(P＞0.05).Conclusion During painless gastroenteroscopy,the application of 0.3 mg/kg esketamine combined with propofol medium and long chain fat emulsion can help maintain the hemodynamic stability,alleviate the respiratory and circulatory inhibition caused by propofol medium and long chain fat emulsion,accelerate recovery,and reduce adverse reactions in patients.

OBJECTIVE To establish and verify the risk prediction models for postoperative multidrug-resistant or-ganisms(MDROs)infections in the liver transplantation patients based on the machine learning algorithms so as to provide bases for identification of the population at high risk of postoperative MDROs infections.METHODS The liver transplantation patients who were retrospectively collected from intensive care Ⅳ database(MIMIC-Ⅳ)and eICU collaborative research database(eICU)were recruited as the research subjects,meanwhile,the patients who underwent liver transplantation in the First Hospital of Shanxi Medical University from Jan.2021 to Jul.2024 were assigned as the external verification group.The variables were selected by Lasso regression,and the models were established based on 7 types of machine learning algorithms such as extreme gradient boosting algorithm and random forest.The predictive performances of the models were evaluated by comparing the areas under receiver operating characteristic(ROC)curves and the accuracy,the characteristic variables were interpreted by Shapley additive explanations(SHAP),and the risk prediction calculator was established.RESULTS A total of 637 pa-tients were finally enrolled in the study,and the incidence of postoperative MDROs infections was 35.79％.Total-ly 15 variables were finally selected for construction of the model.The area under the receiver operating character-istic curve of XGBoost model was 0.82 for the internal test set,0.78 for the external test set;the predictive per-formance of XGBoost model was better than that of the rest of 6 models.SHAP algorithm indicated that the top 5 important predictive factors were as follows:hepatic encephalopathy,length of intensive care unit(ICU)stay,albumin,model of end-stage liver disease(MELD)and total length of hospital stay.CONCLUSION The risk pre-diction models that are established based on the machine learning algorithms have remarkable effect on prediction of the postoperative MDROs infections and can accurately identify the liver transplantation patients at high risk of postoperative MDROs infections,which may provide guidance for the identification of high-risk population and the development of prevention and treatment measures for infections.

OBJECTIVE To establish and verify the risk prediction models for postoperative multidrug-resistant or-ganisms(MDROs)infections in the liver transplantation patients based on the machine learning algorithms so as to provide bases for identification of the population at high risk of postoperative MDROs infections.METHODS The liver transplantation patients who were retrospectively collected from intensive care Ⅳ database(MIMIC-Ⅳ)and eICU collaborative research database(eICU)were recruited as the research subjects,meanwhile,the patients who underwent liver transplantation in the First Hospital of Shanxi Medical University from Jan.2021 to Jul.2024 were assigned as the external verification group.The variables were selected by Lasso regression,and the models were established based on 7 types of machine learning algorithms such as extreme gradient boosting algorithm and random forest.The predictive performances of the models were evaluated by comparing the areas under receiver operating characteristic(ROC)curves and the accuracy,the characteristic variables were interpreted by Shapley additive explanations(SHAP),and the risk prediction calculator was established.RESULTS A total of 637 pa-tients were finally enrolled in the study,and the incidence of postoperative MDROs infections was 35.79％.Total-ly 15 variables were finally selected for construction of the model.The area under the receiver operating character-istic curve of XGBoost model was 0.82 for the internal test set,0.78 for the external test set;the predictive per-formance of XGBoost model was better than that of the rest of 6 models.SHAP algorithm indicated that the top 5 important predictive factors were as follows:hepatic encephalopathy,length of intensive care unit(ICU)stay,albumin,model of end-stage liver disease(MELD)and total length of hospital stay.CONCLUSION The risk pre-diction models that are established based on the machine learning algorithms have remarkable effect on prediction of the postoperative MDROs infections and can accurately identify the liver transplantation patients at high risk of postoperative MDROs infections,which may provide guidance for the identification of high-risk population and the development of prevention and treatment measures for infections.

Objective To evaluate the effect of different doses of esketamine combined with propofol medium and long chain fat emulsion in painless gastroenteroscopy.Methods 144 patients who were scheduled to receive painless gastroenteroscopy from January 2022 to December 2023 were randomly divided into four groups with 36 cases in each group.The load dose of esketamine in group A,group B and group C was 0.2,0.3 and 0.4 mg/kg respectively,and group D was treated with equivalent normal saline instead of esketamine as the control.All the patients were administrated with propofol medium and long chain fat emulsion during the examination.Heart rate(HR),mean arterial pressure(MAP)and percutaneous arterial oxygen saturation(SpO2)were recorded immediately after electrocardiograph monitoring was established(T0),immediately before examination(T1),immediately after gastroscopy placement(T2),immediately before colonoscopy(T3),immediately after colonoscopy implantation(T4)and immediately after examination(T5).The dosage of propofol medium and long chain fat emulsion,recovery time and discharge time were compared among the four groups.Patients were assessed with quality of recovery-40 questionnaire(QoR-40)at T0 and at wake time(T6).The adverse reactions of the four groups were compared.Results There were statistically significant differences in the temporal effects of HR,MAP and SpO2 among the 4 groups(F=3.91,21.65,6.17,P＜0.05);There were statistically significant differences in the intergroup effects of HR,MAP and SpO2 among the 4 groups(F=14.57,7.14,30.34,P＜0.05).The variation trend of SpO2 in groups A,B,C and D was statistically significant(F=2.88,P＜0.05).The first and total dosage of propofol medium and long chain fat emulsion,and the recovery time of the four groups were statistically significant(P＜0.05).The initial dosage and total dosage of propofol medium and long chain fat emulsion in group A,group B and group C were significantly lower than those in group D(P＜0.05),and group B and group C were significantly lower than group A(P＜0.05),but there was no significant difference between group B and group C(P＞0.05).The recovery time of group A and group B were significantly shorter than that of group C and group D(P＜0.05),and group C was significantly longer than that of group D(P＜0.05),and there was no significant difference between group A and group B(P＞0.05).There was no significant difference in the time of get discharged from the hospital among the four groups(P＞0.05).The total scores of QoR-40 in four group at T6 were significantly lower than those at T0 respectively(P＜0.05).T6 QoR-40 total score:group B was significantly higher than group A,Group C and group D(P＜0.05),group A and group C were significantly higher than group D(P＜0.05),and there was no significant difference between group A and group C(P＞0.05).There were significant differences in the incidence of hypoxemia,hypotension,bradycardia,tachycardia,body movement and dizziness among the four groups(P＜0.05).The incidence of hypoxemia,hypotension and bradycardia in group B and group C was significantly lower than that in group D(P＜0.083),and the incidence of dizziness in group C was significantly higher than that in group D(P＜0.0083).Among them,1 case in group A and 3 cases in group D needed mask pressure ventilation due to hypoxemia.There was no significant difference in the incidence of nausea and vomiting among the four groups(P＞0.05).Conclusion During painless gastroenteroscopy,the application of 0.3 mg/kg esketamine combined with propofol medium and long chain fat emulsion can help maintain the hemodynamic stability,alleviate the respiratory and circulatory inhibition caused by propofol medium and long chain fat emulsion,accelerate recovery,and reduce adverse reactions in patients.

Objective To construct a prediction model for the long-term prognosis of elderly pa-tients heart failure with preserved ejection fraction(HFpEF)based on two-dimensional speckle tracking technology.Methods A total of 312 elderly HFpEF patients admitted in our hospital from January 2017 to December 2018 were prospectively enrolled,and then randomly divided into a training set(218 cases)and a validation set(94 cases)in a ratio of 7∶3.After 5 years of follow-up,they were divided into a death group(n=128)and a survival group(n=184)according to having experienced cardiovascular death events or not.The main clinical characteristics were com-pared between the two groups,and the risk factors for cardiovascular death events were analyzed.A clinical prediction model was constructed based on the relevant risk factors with R4.0.3 statisti-cal software.Results The age,age ≥80 years,atrial fibrillation,chronic obstructive pulmonary disease(COPD),and early strain rate of global systole(GSRs)in the death group were signifi-cantly higher than those in the survival group,with statistical significances[(76.68±8.73)years vs(70.98±7.74)years,P＜0.01;34.4％vs 20.7％,P＜0.01;25.0％vs 11.4％,P＜0.01;26.6％vs 9.2％,P＜0.01;(-0.84±0.24)/s vs(-1.24±0.31)/s,P＜0.01].Multivariate logistic regression analysis showed that age ≥80 years,atrial fibrillation,COPD and GSRs＞-1.035 1/s were inde-pendent risk factors for cardiovascular death events(RR=2.196,95％CI:1.217-3.962,P=0.009;RR=2.242,95％CI:1.136-4.424,P=0.020;RR=3.631,95％CI:1.787-7.377,P=0.000;RR=6.199,95％CI:3.624-10.602,P=0.000).The AUC value of the training set was 0.822(95％CI:0.765-0.879),and that of the validation set was 0.790(95％CI:0.698-0.882).Conclusion Our constructed nomogram prediction model has high predictive value and reliability in predicting cardiovascular death events.

Temporomandibular joint (TMJ) diseases are common clinical conditions. The number of patients with TMJ diseases is large, and the etiology, epidemiology, disease spectrum, and treatment of the disease remain controversial and unknown. To understand and master the current situation of the occurrence, development and prevention of TMJ diseases, as well as to identify the patterns in etiology, incidence, drug sensitivity, and prognosis is crucial for alleviating patients′suffering.This will facilitate in-depth medical research, effective disease prevention measures, and the formulation of corresponding health policies. Cohort construction and research has an irreplaceable role in precise disease prevention and significant improvement in diagnosis and treatment levels. Large-scale cohort studies are needed to explore the relationship between potential risk factors and outcomes of TMJ diseases, and to observe disease prognoses through long-term follw-ups. The consensus aims to establish a standard conceptual frame work for a cohort study on patients with TMJ disease while providing ideas for cohort data standards to this condition. TMJ disease cohort data consists of both common data standards applicable to all specific disease cohorts as well as disease-specific data standards. Common data were available for each specific disease cohort. By integrating different cohort research resources, standard problems or study variables can be unified. Long-term follow-up can be performed using consistent definitions and criteria across different projects for better core data collection. It is hoped that this consensus will be facilitate the development cohort studies of TMJ diseases.

Rheumatoid arthritis （RA） is an autoimmune disease involving symmetrical small joints， with clinical manifestations such as small joint swelling， morning stiffness， progressive pain， and even joint deformity and loss of function. Due to the complex immune mechanism， the pathogenesis of RA remains unclear. However， studies have shown that the pathogenesis of RA is related to abnormal immune mechanism， increased synovial inflammatory response， abnormal biological behavior of RA fibroblast-like synoviocytes （RA-FLSs）， and abnormal degradation of extracellular matrix. Mitogen-activated protein kinase （MAPK） plays a key role in the regulation of cell growth， proliferation， differentiation， and apoptosis. It is involved in the abnormal release and activation of inflammatory mediators in RA， the abnormal proliferation， migration， and invasion of RA-FLSs， synovial angiogenesis， bone erosion， and cartilage destruction. The thousands of years of practical experience show that Chinese medicine can effectively mitigate the clinical symptoms such as joint swelling， morning stiffness， and pain and delay the occurrence of joint deformity in RA patients. Moreover， the Chinese medicine treatment has the advantages of overall regulation， personalized treatment， multiple pathways and targets， high safety， few adverse reactions， and stable quality. Modern studies have confirmed that Chinese medicine can play a role in the prevention and treatment of RA by interfering in the MAPK signaling pathway， reducing pro-inflammatory cytokines， inhibiting the abnormal proliferation， migration， and invasion of RA-FLSs， regulating the apoptosis of RA-FLSs， and protecting extracellular matrix. This article elaborates on the key role of MAPK signaling pathway in the development of RA and reviews the latest research results of Chinese medicine intervention in MAPK signaling pathway for the prevention and treatment RA， aiming to provide a basis for the development of new drugs and the clinical application of Chinese medicine in the prevention and treatment of RA.

Background and aims:Liver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery(BS).This study aimed to explore the outcome of BS in patients with unexpected cirrhosis,focusing on postoperative complications and the progression of liver disease. Methods:A retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted,with follow-up for one year after BS.The primary outcome was the safety of BS in patients with unexpected cirrhosis,while the secondary outcome was the metabolic efficacy of BS in this group postoperatively. Results:A total of 47 patients met the study criteria,including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B.Pathological examination confirmed nodular cirrhosis in 21 patients(44.68％),pseudolobule formation in 1 patient(2.13％),lipedema degeneration with inflammatory cell infiltration in 3 patients(6.38％),and chronic hepatitis in 1 patient(2.13％).The average percentage of total weight loss was 29.73±6.53％at one year postoperatively.During the 30-day postoperative period,the complication rate was 6.38％,which included portal vein thrombosis,gastrointestinal bleeding,and intra-abdominal infection.Moreover,no cases of liver decompensation or mortality were reported during the follow-up period.The remission rates of comorbidities among 41 patients one year after surgery were as fol-lows:dyslipidemia 100％,type 2 diabetes 82.61％,hypertension 84.62％,and obstructive sleep apnea syndrome 85.71％. Conclusions:BS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease,with low postoperative morbidity and no mortality observed during one-year follow-up.

【Objective】 To investigate the knowledge acquisition status for blood transfusion of transfusion related medical staff in underdeveloped cities in western China and explore its influencing factors. 【Methods】 A questionnaire consisted of blood transfusion laws and regulations, clinical blood transfusion theory and blood transfusion technology was designed, randomly distributed to medical staff and blood transfusion departmenttechnicians of 17 secondary/tertiary hospitals in Wuwei and then collected on the spot. The knowledge acquisition of blood transfusion of each group was compared using statistical description method, and its influencing factors were analyzed by multivariate logistic regression analysis. 【Results】 A total of 507 questionnaires were issued, and 498 valid questionnaires (98.22%) were collected. The scores of transfusion related laws and regulations, blood transfusion theory and blood transfusion technology of doctor group(n=158), nurse group(n=239) and transfusion technician group(n=101)were 4.56-5.97(5.06±0.73)(P<0.01) vs 4.23-5.87(4.98±1.24)(P<0.01) vs 3.71-0.78 (4.15±1.34), 3.67-5.02(4.27±1.02) vs 3.76-5.12(4.06±0.75) vs 4.71-5.98(5.16±0.64)(P<0.01) and 3.41-5.76(3.82±0.56) vs 3.78-5.24(4.01±0.56) vs 3.77-5.46(3.82±0.59). Among the seven departments, blood transfusion department(n=51) won the highest score of above three types of knowledge [4.91-5.97(5.28±0.43) vs 5.03-5.92(5.36±0.59) vs 4.39-5.77(4.97±0.79)(P<0.01) ]. Univariate logistic regression analysis showed that age, occupation, professional titles, training times and hospital grade had an impact on the degree (score) of blood transfusion knowledge acquisition (P<0.05), and multivariate unconditional logistic regression analysis indicated that training times was an important influencing factor(P<0.01). 【Conclusion】 This survey revealed that the level of knowledge acquisition for blood transfusion among medical staff in Wuwei is generally low, and there is a significant difference between staff from hospitals of different grade and different departments. It is urgent to strengthen the training of blood transfusion for medical staff in western China.

Objective:To analyze the changes in plasma endothelin-1 (ET-1) concentrations in the patients with acute respiratory distress syndrome (ARDS).Methods:Fourteen patients with ARDS induced by trauma, 8 males and 6 females, aged 19-80 yr, were studied. The severity of ARDS was graded according to the Berlin definition of ARDS after admission to intensive care unit (ICU). Venous blood samples were obtained on 1st, 3rd and 5th days after admission to ICU, the plasma ET-1 concentrations were measured by radioimmunoassay, the pulmonary vascular permeability index (PVPI) was determined by PiCCO technique, and multiple organ dysfunction (MOD) score and lung injury score (LIS) were assessed. Spearman correlation of plasma ET-1 concentrations with MOD score, LIS and PVPI was analyzed.Results:MOD score, LIS, PVPI and plasma ET-1 concentrations were significantly decreased in mild ARDS patients ( n=5) as compared with moderate ARDS patients ( n=9, P<0.05). The plasma ET-1 concentration was positively correlated with MOD score, LIS and PVPI ( r=0.69, 0.76, 0.62, P<0.001). Conclusions:Plasma ET-1 concentrations can reflect the pulmonary vascular permeability and even the severity of the disease in the early stage of ARDS, so it is necessary to carry out dynamic monitoring in the patients.