Objective:To explore the expression of CD14 in peripheral blood monocytes to predict the prognosis of patients with severe COPD complicated with pulmonary infection.Methods:A total of 122 patients with severe COPD and pulmonary infection diagnosed and treated in East Lianyungang Hospital from January 2019 to February 2022 were selected as co-infection group,127 pa-tients with severe COPD were selected as COPD group,and 62 healthy subjects in physical examination during the same period were selected as control group.After 30 days of follow-up,patients in co-infected group were divided into death group(n=16)and survival group(n=106)according to prognosis during hospitalization.Membrane CD14(mCD14)related parameters of control group,COPD group and co-infected group were compared.Dynamic changes of mCD14 related parameters were compared between death group and survival group at day 1,3,5,7 and 14 after diagnosis.Cox proportional hazard regression was used to analyze the independent risk factors of death in patients with severe COPD complicated with pulmonary infection after 30 days.Predictive values of CD14%,CD14MFI and CD14IND on prognostic death were analyzed by ROC curve,and the area under the curve(AUC)was compared.Ka-plan-Meier method was used to draw survival curve to compare the survival of patients with different CD14IND levels.Results:Com-pared with control group,CD14%,CD14MFI and CD14IND in COPD group and co-infection group were significantly decreased;com-pared with COPD group,CD14%,CD14MFI and CD14IND in co-infection group were significantly decreased,the differences were statistically significant(P<0.05).Expression of mCD14 in survival group increased steadily during the whole monitoring process,while expression in death group fluctuated at a low level.COPD grade,forced expiratory volume in 1 second/forced vital capacity(FEV1/FVC),forced expiratory volume in 1 second as a percentage of predicted value(FEV1%pred),CD14%,CD14MFI,CD14IND were all risk factors for death in patients with severe COPD complicated with pulmonary infection(P<0.05).CD14%,CD14MFI and CD14IND were negatively correlated with mortality and COPD grade in patients with severe COPD complicated with pulmonary infec-tion,while were positively correlated with FEV1%pred and FEV1/FVC(P<0.001).With CD14IND≤74.36 as cut-off value,the sensi-tivity and specificity of predicting death reached 91.22%and 95.51%respectively.The 30-day survival rate of high-risk group was 68.42%(26/38),which was significantly lower than 95.24%(80/84)of low-risk group(log-rank χ2=10.067,P=0.002).Conclusion:mCD14-related parameters are expected to be the prognostic markers of death in patients with severe COPD complicated with pulmo-nary infection,and the sensitivity and specificity of CD14IND are better than those of CD14%and CD14MFI.

Objective To investigate the expression of non-receptor protein tyrosine phosphatase 18(PT-PN18)and RNA binding protein FOX2(RBFOX2)in endometrial cancer(EC),and to analyze their relation-ship with clinicopathological features and prognostic significance.Methods A total of 122 EC patients treated in Hainan Women and Children's Medical Center from January 2020 to June 2021 were collected.The expres-sion of PTPN18 and RBFOX2 protein was detected by immunohistochemistry.The expressions of PTPN18 mRNA and RBFOX2 mRNA were detected by real-time fluorescence quantitative PCR.Pearson correlation a-nalysis was used to analyze the correlation between PTPN18 mRNA and RBFOX2 mRNA expression in EC.Kaplan-Meier curve and multivariate Cox regression model were used to analyze the effect of PTPN18 mRNA and RBFOX2 mRNA expression on the prognosis of EC patients.Results Compared with adjacent tissues,PTPN18 protein expression(2.53±0.67 vs.0.56±0.14)was higher and RBFOX2 protein expression(0.74±0.22 vs.3.11±0.63)was lower in EC cancer tissues,and the difference was statistically significant(t=31.790,39.229,P<0.001).Compared with adjacent tissues,PTPN18 mRNA expression(3.15±0.76 vs.0.78±0.23)was higher and RBFOX2 mRNA expression(1.14±0.34 vs.3.87±0.80)was lower in EC cancer tissues,and the difference was statistically significant(t=32.976,34.689,P<0.001).There was a negative correlation between the expression of PTPN18 mRNA and RBFOX2 mRNA in EC(r=-0.674,P<0.001).The expression of PTPN18 mRNA was higher and RBFOX2 mRNA was lower in FIGO stage Ⅲ EC patients with lymph node metastasis(P<0.05).There was no significant difference in 3-year overall survival rate between PTPN18 mRNA high expression group and low expression group,and between RBFOX2 mRNA high expression group and low expression group(P>0.05).The 3-year progression-free survival rate of the PTPN18 mRNA high expression group was lower than that of the low expression group,and the 3-year pro-gression-free survival rate of the RBFOX2 mRNA high expression group was higher than that of the low ex-pression group,and the differences were statistically significant(P<0.001).FIGO stage Ⅲ,lymph node me-tastasis and PTPN18 mRNA were risk factors for progression-free survival in EC patients,and RBFOX2 mR-NA was a protective factor(P<0.05).Conclusion PTPN18 expression is increased and RBFOX2 expression is decreased in EC,which is related to FIGO stage and lymph node metastasis.PTPN18 is a tumor marker for evaluating the prognosis of EC.

Central venous lesions are challenging in the maintenance of hemodialysis vascular access, with endovascular therapy as the preferred treatment. Coated stent grafts, with superior primary patency rates and the ability to mitigate the risk of vascular rupture and bleeding, have become one of the clinical options. However, they pose a risk of occluding important tributary veins. This report describes a case of right innominate vein occlusion treated with a small-caliber coated stent graft, resulting in postoperative symptoms of intracranial venous hypertension. This case highlights the need to pay attention to neurological symptoms caused by central venous lesions and conduct a more meticulous assessment of contralateral venous return before placing coated stent grafts, to avoid irreversible neurological symptoms.

This study analyzed the epidemiological characteristics and trends of respiratory syncytial virus (RSV) infections among inpatients with acute respiratory infections (ARI) in a children′s hospital in Shenzhen City inpatients from 2020 to 2023. From January 2020 to December 2023, multiple reverse transcription polymerase chain reaction (RT-PCR) combined with capillary electrophoresis fragment analysis technology was used to detect the nucleic acids of 12 respiratory pathogens, including RSV, in hospitalized children diagnosed with ARI. The patients were divided into six age groups: 0 to <6 months, 6 months to <1 year, 1 to <2 years, 2 to <5 years, 5 to <10 years, and 10 to <18 years. A total of 53 033 children were tested, including 6 830 RSV positive cases, with an overall positivity rate of 12.88%. The annual RSV positivity rates from 2020 to 2023 were 20.04%, 16.18%, 4.89%, and 13.33%, respectively, with statistically significant differences between the years ( χ2=1 185.994, P<0.001). The positive rate of RSV detection decreased with increasing age across all years (all P trend<0.05). From 2020 to 2023, the proportion of RSV-positive cases aged 2 to 5 years and older showed an increasing trend ( P trend<0.001 for all years). Compared to 2023, the median age of RSV-infected children was lower in 2020 ( Z=7.826, P<0.001) and 2021 ( Z=6.106, P<0.001). The proportion of severe infections requiring ICU admission did not change significantly across all years ( χ2=0.179, P=0.981). The RSV epidemic season in 2020 mainly occurred during 28-43 weeks, and in 2021, it spanned from 22-43 weeks. However, in 2022, the season was delayed until the 49th week and lasted for three weeks. In 2023, the seasonal epidemic appeared earlier, starting in the 14th week and lasting for 28 weeks. From 2020 to 2023, the rate of RSV co-infections with other pathogens (mycoplasma pneumoniae, human parainfluenza virus, human bocavirus, human coronavirus, human metapneumovirus, and influenza A) significantly increased (all P trend<0.01). In conclusion, the epidemiological characteristics of RSV infections in Shenzhen Children′s Hospital changed from 2020 to 2023. In 2022, there were only delayed, low-intensity and short-lived seasonal epidemics. However, in 2023, there was an earlier and prolonged epidemic, with increased infections in children aged 2 to 5 years and older and a rise in co-infections, while the proportion of severe infections requiring ICU admission remained unchanged.

Objective To compare the short-term efficacy and safety of transanal natural orifice specimen extraction surgery(Ta-NOSES)and conventional laparoscopic surgery in left-sided colon cancer.Methods A retrospective analysis was conducted on the clinical data of 35 patients with left-sided colon cancer admitted to the anorectal department of the hospital from January 2018 to December 2019.According to the different surgical methods,the patients were divided into experimental group(15 cases)and control group(20 cases).The observation group underwent Ta-NOSES,and the control group underwent conventional laparoscopic surgery.The perioperative related indicators,postoperative complications,postoperative pain scores,postoperative defecation control,short-term postoperative quality of life scores and 5-year postoperative follow-up of the two groups of patients were compared.Results There was no statistically significant difference in the intraoperative blood loss,stoma status and the number of lymph node dissections between the two groups of patients(P>0.05).Moreover,no permanent stoma occurred in either group of patients.The operation time of the experimental group was longer than that of the control group,the first time to get out of bed and move around,the time of the first anal exhaust,the time of the first diet intake and the hospital stay were shorter than those of the control group,the hospitalization cost was significantly lower than that of the control group,the differences were statistically significant(P<0.05).On 1 and 3 days after operation,the VAS scores of the experimental group were significantly lower than those of the control group.At 3 days after operation,the VAS scores of the two groups were significantly lower than those at 1 day after operation,and the differences were statistically significant(P<0.05).There was a statistically significant difference in postoperative Kirwan anal function grading between two groups of patients(P<0.05),with the experimental group having a better grading(higher proportion of grade Ⅰ),the control group had poor grading(with a higher proportion of grades Ⅱ,Ⅲ,and Ⅳ).There was no statistically significant difference in postoperative complications between the two groups of patients(P>0.05).The scores of each item on the Short Form-36(SF-36)in the experimental group were higher than those in the control group at 10 and 20 days after surgery(P<0.05).There was no statistically significant difference in the scores of each item on the SF-36 between the two groups at 30 days after surgery(P>0.05).The distant recurrence rate after surgery in the experimental group was 26.7％,compared with 25.0％in the control group,the difference was not statistically significant(P>0.05).There were no tumor recurrence cases with the original incision site,rectal and intestinal cavity,pelvic cavity and other specimen removal routes in both groups.The 5-year survival rate of the experimental group was 73.3％,which was not statistically significantly different from that of the control group(70.0％)(P>0.05).Conclusion Ta-NOSES in the treatment of left-sided colon cancer can alleviate postoperative pain compared with conventional laparoscopic surgery,promote the recovery of postoperative gastrointestinal function,improve the utilization rate of medical resources,reduce the economic burden of patients,improve the short-term quality of life after surgery,and does not increase the risks of postoperative complications and tumor metastasis and recurrence.It is worthy of clinical promotion and application.

Objective:To evaluate the clinical efficacy of a novel surgical approach of debridement, antibiotics, and implant retention (DAIR) with flap transfer, for treating chronic implant infections in bone tumor patients.Methods:A retrospective review was conducted on nine consecutive patients [6 males, 3 females; median age 35(27, 51) years, range 9-71] who underwent a modified procedure of DAIR plus flap transfer between November 2022 and January 2024. The cohort included six cases of chronic periprosthetic joint infection and three cases of chronic plate and screw infection. Tumor diagnoses included seven primary malignant tumors (osteosarcoma=5, undifferentiated pleomorphic sarcoma of bone=1, synovial sarcoma=1) and two bone metastasis of renal cell carcinoma. The procedure involved wide, radical debridement, meticulous removal of biofilm from implants and surrounding soft tissue, followed by the transfer of a well vascularized musculocutaneous flap to fully envelope the contaminated interface. Pre-operative clinicopathological data, surgical details, postoperative complications and infection recurrence were analyzed.Results:The median interval between initial implantation and debridement was 10.0(3.3, 14.8) months. Median follow-up after debridement was 15.9(15.4, 18.2) months. All nine surgeries were completed as planned: six musculocutaneous flaps, two fasciocutaneous flaps and one muscle-only flap. Implants were preserved in six patients; two required subsequent removal for recurrent infection, and one patient later underwent amputation for tumor recurrence. Infection-free implant survival at 3, 6 and 12 months was 88.9%, 87.5% and 87.5%, respectively. Major complications included one donor-site hematoma, one donor-site sensory deficit and one wound healing delay. All the complications were well management. Both reinfections occurred in proximal tibial prostheses, likely due to limited flap coverage options and local anatomical constraints.Conclusion:Although reinfections happened in two cases DAIR with flap transfer provides promising short-term infection control in patients with chronic implant-associated infections following bone tumor surgery.

Objective:To evaluate the characteristic manifestations of lumbar fusion following oblique lateral interbody fusion (OLIF), determine the specific incidence of these patterns, and the identify factors associated with fusion characteristics.Methods:This retrospective study analyzed 209 patients who underwent OLIF surgery at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between July 2017 and September 2023. The cohort had a mean age of 64.2±9.8 years and included 125 males and 84 females. A total of 338 lumbar segments were assessed, comprising 159 segments treated with stand-alone OLIF (OLIF-SA) and 179 segments treated with OLIF combined with posterior pedicle screw fixation (OLIF-PSF). Inclusion criteria were: patients aged 18-80 years who underwent OLIF with complete radiographic records. Surgical parameters, including fixation method, number of fused segments, surgical approach, and cage dimensions (height and width), were obtained from operative records. Radiographic evaluation included preoperative osteophytes, Hounsfield unit (HU) values of endplates, and cage positioning. Fusion rate, fusion pattern (lateral vs. central), cage subsidence, and related influencing factors were assessed. Clinical outcomes were measured via the Oswestry disability index (ODI) and visual analog scale (VAS) preoperatively, immediately postoperatively, and at 1-year follow-up. Results:The overall fusion rate was 98.2% (332/338), with a non-union rate of 1.8% (6/338). The incidence of lateral fusion was 40.2% (136/338). In the OLIF-SA group, lateral and central fusion rates were 50.3% (80/159) and 49.7% (79/159), respectively, with no cases of non-union. In the OLIF-PSF group, lateral fusion occurred in 31.3% (56/179), central fusion in 65.4% (117/179), and non-union in 3.3% (6/179), with statistically significant differences between groups ( P<0.05). Preoperative osteophytes and higher endplate HU values were significantly associated with lateral fusion ( P<0.05). However, cage dimensions and cage position (anterior-posterior and lateral placement) were not significantly associated with fusion pattern ( P>0.05). Overall, 61.5% (208/338) of segments showed no cage subsidence; 24.5% (83/338) had settling, and 14.0% (47/338) had grade 1 or higher subsidence. Among lateral fusion cases, the rates of no subsidence, anchoring, grade 1, grade 2, and grade 3 subsidence were 67.6%, 21.3%, 7.4%, 3.9%, and 0.7%, respectively. In the central fusion group, these rates were 59.2%, 27.6%, 9.2%, 2.5%, and 1.3%, respectively. In the non-union group, grade 2 and 3 subsidence occurred in 50% (3/6) each, significantly higher than in the other fusion groups ( P<0.05). Post hoc analysis confirmed that grade 2 and 3 subsidence rates were significantly elevated in the non-union group compared to the lateral and central fusion groups, while other subsidence categories showed no significant differences across groups. Clinically, patients showed significant improvements in ODI and VAS scores following surgery ( P<0.05). Conclusions:Lateral fusion occurred in 40.2% of OLIF cases. The OLIF-SA technique, preoperative osteophytes, and elevated preoperative HU values were significantly associated with lateral fusion. In contrast, surgical approach, number of fused segments, cage height, width, and cage positioning did not significantly influence the occurrence of lateral fusion.

OBJECTIVE: To determine whether the glutamatergic neurons in the paraventricular nucleus of the thalamus (PVT) is involved in the change of consciousness induced by propofol through a combination of behavioral and electroencephalography (EEG) recordings. METHODS: Healthy male VGluT2-IRES-Cre mice aged 8-12 weeks were used in this experiment. (1) The glutamatergic neurons in the PVT was selectively damaged, and its effect on propofol anesthesia induction and recovery times as well as the energy of EEG in different frequency bands were observed. (2) Optogenetics was utilized to selectively activate or inhibit glutamatergic neurons in the PVT to assess their influence on anesthesia induction and recovery times under propofol as well as the energy of EEG in different frequency bands. RESULTS: (1) Selective ablation of glutamatergic neurons in the PVT significantly delayed recovery from propofol anesthesia with statistical difference as compared with the control group (s: 409.43±117.49 vs. 273.71±51.52, P < 0.05), but had no significant effect on anesthesia induction time. During the recovery phase of propofol, selective ablation of glutamatergic neurons in the PVT exhibited higher α-wave (1-4 Hz) power and reduced β-wave (12-15 Hz) power as compared with the control group. (2) Optogenetic activation of glutamatergic neurons in the PVT significantly prolonged anesthesia induction time under propofol (s: 161.67±29.09 vs. 119.33±18.98, P < 0.05) while significantly shortening the recovery time from propofol anesthesia (s: 208.67±57.19 vs. 288.83±34.52, P < 0.05). During the induction phase of propofol, activation of glutamatergic neurons in PVT reduced α-wave and α-wave (8-12 Hz) power, while during the recovery phase, α-wave power significantly increased as compared with the control group. (3) Optogenetic inhibition of glutamatergic neurons in the PVT delayed recovery from propofol anesthesia (s: 403.50±129.06 vs. 252.83±45.31, P < 0.05), but had no significant effect on induction time. During both the induction phase and recovery phase of propofol, the optogenetic inhibition of glutamatergic neurons in the PVT exhibited increased α-wave power. CONCLUSION Glutamatergic neurons in the PVT are involved in the regulation of propofol anesthesia recovery process.
Animals ; Propofol/pharmacology* ; Mice ; Neurons/physiology* ; Male ; Electroencephalography ; Wakefulness ; Midline Thalamic Nuclei ; Optogenetics

Activating transcription factor 5 (ATF5) is a member of the activating transcription factor/cyclic adenosine monophosphate response element binding protein (ATF/CREB) family. As a stress-induced transcription factor, ATF5 plays a crucial role in cellular inflammatory stress responses. Under cellular inflammatory stress conditions, ATF5 maintains cell homeostasis and survival by regulating key genes in the mitochondrial unfolded protein response (UPR^mt) and endoplasmic reticulum stress (ERS). As a key regulator in UPR^mt, ATF5 senses mitochondrial stress and translocate to the nucleus to activate the transcription of UPR^mt-related genes, thereby promoting mitochondrial function recovery. Meanwhile, in ERS, ATF5 maintains endoplasmic reticulum homeostasis by regulating the expression of genes related to protein folding, degradation, and apoptosis, determining cell survival or death. ATF5 plays a vital role in various cellular inflammatory stress responses. In infectious inflammation, ATF5 plays an important role in alleviating neuroinflammation and maintaining intestinal barrier function by regulating UPR^mt. In inflammation related to degenerative diseases, ATF5 improves intervertebral disc degeneration and delays the progression of osteoarthritis by regulating UPR^mt. In metabolic inflammation such as diabetes and obesity, ATF5 regulates UPR^mt and ERS to maintain the function of pancreatic β-cells, controlling their survival or inducing apoptosis, thus influencing the progression of diabetes. ATF5 protects mitochondria in the kidneys, adipose tissue, and pancreas, slows the progression of diabetic nephropathy, and improves insulin sensitivity. Furthermore, in immune-related inflammation, ATF5 alleviates glomerulonephritis and promotes tissue repair by enhancing immune tolerance in dendritic cells. In summary, ATF5, as a key regulator in cellular inflammatory stress responses, maintains cell homeostasis through regulating UPR^mt and ERS and determines cell fate. Its critical regulatory role in cellular inflammatory stress responses makes ATF5 a potential clinical therapeutic target. This article summarizes the structural features and translational regulatory mechanisms of ATF5, focusing on its role in cellular inflammatory stress responses, particularly its regulatory mechanisms in UPR^mt and ERS, aiming to provide a theoretical basis for understanding ATF5's role in cell and organ protection and to offer new insights into the treatment of related inflammatory diseases.
Humans ; Endoplasmic Reticulum Stress ; Inflammation/metabolism* ; Activating Transcription Factors/metabolism* ; Unfolded Protein Response ; Mitochondria/metabolism* ; Apoptosis ; Animals

Critical care emphasizes critical thinking, focuses on the triggers that lead to disease progression, and attaches great importance to early diagnosis of diseases and assessment of the compensatory capacity of vital organs. Pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) is relatively rare in the intensive care unit (ICU). Most cases occur within 10 weeks after delivery. Severe cases can be life-threatening. It characterized by microangiopathic hemolytic anemia, decreased platelet count (PLT), and acute kidney injury (AKI). Early clinical diagnosis is difficult due to its similarity to various disease manifestations. On January 28, 2024, a 26-year-old pregnant woman at 26⁺³ weeks gestation was transferred to the ICU 19 hours post-vaginal delivery due to abdominal pain, reduced urine output, decreased PLT, elevated D-dimer, tachycardia, increased respiratory rate and declined oxygenation. On the day of ICU admission, the critical care physician identified the causes that triggered the acute respiratory and circulatory events based on the "holistic and local" critical care thinking. The condition was stabilized rapidly by improving the capacity overload. In terms of etiological diagnosis, under the guidance of the "point and face" critical care thinking, starting from abnormality indicators including a decrease in hemoglobin (Hb) and PLT and elevated D-dimer and fibrin degradation product (FDP) without other abnormal coagulation indicators, the critical care physician ultimately determined the diagnosis direction of thrombotic microangiopathy (TMA) by delving deeply into the essence of the disease and formulating a laboratory examination plan in a reasonable and orderly manner. In terms of in-depth diagnosis, combining the disease development process, family history, and past history, applying the two-way falsification thinking of "forward and reverse" as well as "questioning and hypothesis", the diagnosis possibilities of preeclampsia, HELLP syndrome [including hemolysis (H), elevated liver function (EL) and low platelet count (LP)], thrombotic thrombocytopenic purpura (TTP), typical hemolytic uremic syndrome (HUS), and autoimmune inflammatory diseases inducing the condition was ruled out. The diagnosis of complement activation-induced P-aHUS was finally established for the patient, according to the positive result of the complement factor H (CFH). Active decision was made in the initial treatment. The plasma exchange was initiated early. "Small goals" were formulated in stages. The "small endpoints" were dynamically controlled in a goal-oriented manner to achieve continuous realization of the overall treatment effect through phased "small goals". On the 5th day of ICU treatment, the trend of microthrombosis in the patient was controlled, organ function damage was improved, and the patient was transferred out of the ICU. It is possible to reach a favorable clinical outcome for critically ill patients by applying a critical care mindset to quickly integrate diagnostic and therapeutic strategies, accurately identifying the triggers and causes that led to the progression of the disease, and using critical care medical techniques for early and effective intervention.
Humans ; Female ; Pregnancy ; Adult ; Atypical Hemolytic Uremic Syndrome/therapy* ; Intensive Care Units ; Pregnancy Complications, Hematologic/therapy* ; Critical Care