Objective:To explore the correlations of sleep quality and architecture with heart rate variability (HRV) in patients with stenoses of vertebrobasilar artery system and internal carotid artery system.Methods:A retrospective study was performed; 72 patients with stenosis or occlusion of the head and neck arteries (not resulting in cerebral infarction) admitted to Department of Neurology, Second Affiliated Hospital of Zhengzhou University from June 2023 to June 2024 were chosen, including 33 patients with moderate-to-severe stenosis or occlusion of the vertebrobasilar system (VB group) and 39 patients with moderate-to-severe stenosis or occlusion of the internal carotid artery system (ICA group). Pittsburgh sleep quality index (PSQI) and polysomnography (PSG) were used to evaluate the sleep quality and architecture, respectively; and 24-hour ambulatory electrocardiogram was used to assess the HRV. Differences in PSQI score, PSG and HRV parameters between the two groups were compared; partial correlation analysis was used to explore the correlations of HRV parameters with PSQI scores and PSG parameters; multivariate linear regression was used to analyze the independent influencing factors for HRV.Results:(1) Compared with the ICA group, the VB group exhibited significantly higher PSQI scores, spontaneous arousal index (SAI), ratio of time of stage 1 non-rapid eye movement sleep/total sleep time (T N1/T t), and apnea-hypopnea index (AHI), while significantly lower ratio of time of rapid eye movement sleep/total sleep time (T R/T t), spindle wave density in stage 2 non-rapid eye movement sleep (N2), lowest blood oxygen saturation, standard deviation of normal to normal intervals (SDNN) of all sinus beats, low-frequency power (LF), and high-frequency power (HF, P<0.05). (2) In both VB group and ICA group, SDNN was negatively correlated with PSQI score ( r=-0.461, P=0.020; r=-0.378, P=0.036). In the VB group, SDNN was negatively correlated with T N1/T t ( r=-0.467, P=0.019) and SAI ( r=-0.551, P=0.004), and positively correlated with ratio of time of stage 3 non-rapid eye movement sleep/total sleep time (T N3/T t, r=0.686, P<0.001) and spindle wave density in N2 ( r=0.518, P=0.008); LF and HF were negatively correlated with SAI ( r=-0.481, P=0.015; r=-0.564, P=0.003). In the ICA group, HF was negatively correlated with spindle wave density in N2 ( r=-0.369; P=0.041). (3) Multivariate linear regression results indicated that T N3/T t (β=0.348, P=0.018), SAI (β=-0.330, P=0.018), and spindle wave density in N2 (β=0.286, P=0.013) were independent influencing factors for Ln_SDNN in patients with moderate-to-severe stenosis or occlusion of the vertebrobasilar system. Conclusion:Patients with stenosis or occlusion of the vertebrobasilar system exhibit poorer subjective sleep quality, increased light sleep, heightened arousal, and reduced sleep stability compared with those with stenosis or occlusion of the internal carotid artery system, which may be caused by the imbalance of autonomic nerve function.

Objective To compare the efficacy and safety of bridging therapy and direct thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion within 4.5 h.Methods Retrospective consecutive patients with acute basilar artery occlusion stroke within 4.5 h of onset admitted to five centers from January 2018 to August 2024 were included and divided into a bridging therapy(intravenous thrombolysis with alteplase given prior to emergency endovascular treatment)group and a direct thrombectomy group according to the treatment modality.Baseline and clinical data were collected from patients,including age,sex,systolic and diastolic blood pressure on admission,past history(including history of hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,hyperlipidemia,and history of stroke),history of smoking,pre-morbid modified Rankin scale(mRS)scores,National Institutes of Health stroke scale(NIHSS)score on admission,posterior circulation Alberta stroke program early CT score on admission,basilar artery CT angiography score,history of pre-procedural antiplatelet aggregation medications,history of pre-procedural anticoagulant medications,choice of arterial puncture access(via femoral or radial artery),site of vascular occlusion(proximal basilar artery,mid-basilar artery,distal basilar artery),trial of Org 10172 in acute stroke treatment(TOAST)classification,American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation classification,time from onset to admission,time from admission to puncture,time from puncture to revascularization,time from onset to revascularisation,type of embolisation procedure(stenting,aspiration,and combined),immediate post-procedure extended thrombolysis in cerebral infarction(eTICI)classification,and intra-procedural related complications(arterial entrapment,distal occlusion and arterial perforation).The main efficacy indicators(good prognosis[mRS score 0-3 90 d postoperatively],death[mRS score 6 90 d postoperatively],and good recanalisation[eTICI grade ≥2b50]within the immediate postoperative period)and safety indicators(incidence of symptomatic intracranial haemorrhage[sICH]within 7 days post-procedure)were compared between the two groups.The two groups were matched 1∶1 using propensity score matching(PSM)to compare differences in effectiveness and safety indices before and after PSM.Variables with P＜0.05 in the baseline and clinical data comparison between the two groups were included in multifactorial Logistic regression analysis for correction,the differences in safety and efficacy between the two groups were compared before and after correction.Results A total of 206 patients with acute ischemic stroke caused by basilar artery occlusion within 4.5 h of onset were included,comprising 151 males and 55 females.The age ranged from 26 to 93 years old,with an average of(65±13)years old.Among them,101 patients(49.0％)were in the bridging therapy group and 105(51.0％)in the direct thrombectomy group.After 1∶1 PSM,each group consisted of 69 patients.(1)The differences in the proportion of patients with atrial fibrillation between the bridging therapy group and the direct thrombectomy group(16.8％[17/101]vs.28.6％[30/105]),the distribution of pre-morbid mRS scores,and the distribution of TOAST subtypes were statistically significant(all P＜0.05);the differences in the residual baseline and clinical data of the two groups were not statistically significant(all P＞0.05).After 1∶1 PSM,the differences in all baseline and clinical data between the two groups were not statistically significant(all P＞0.05).(2)No statistically significant differences were observed between the bridging therapy group and direct thrombectomy group in the good prognosis rate at 90 d postoperatively,morbidity and mortality rates at 90 d postoperatively,or good revascularization rate in the immediate postoperative period(all P＞0.05).However,the risk of sICH at 7 d postoperatively was higher in the bridging therapy group(9.5％[10/105]vs.19.8％[20/101];OR,2.346,95％CI 1.038-5.299,P=0.037).After correcting for variables with statistically significant differences in baseline and clinical data between the direct thrombectomy group and bridging therapy groups(atrial fibrillation,pre-onset mRS score,and TOAST classification)using a multifactorial Logistic regression model,the results showed no statistically significant differences in the effectiveness and safety metrics between the two groups(all P＞0.05).(3)The results after 1∶1 PSM showed that the bridging therapy group had a higher risk of sICH(11.6％[8/69]vs.26.1％[18/69];OR,2.691,95％CI 1.081-6.700,P=0.033).No statistically significant differences were observed between the two groups in terms of good prognosis rate at 90 d postoperatively,disease-related mortality rate at 90 d postoperatively,or rate of good revascularization in the immediate postoperative period(all P＞0.05).Conclusions In patients with acute basilar artery occlusion stroke within 4.5 h of onset,the effectiveness of bridging therapy and direct thrombectomy was similar,but the incidence of sICH was higher with bridging therapy.The results of this study still need further validation through prospective studies with larger sample sizes.

Objective To compare the efficacy and safety of bridging therapy and direct thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion within 4.5 h.Methods Retrospective consecutive patients with acute basilar artery occlusion stroke within 4.5 h of onset admitted to five centers from January 2018 to August 2024 were included and divided into a bridging therapy(intravenous thrombolysis with alteplase given prior to emergency endovascular treatment)group and a direct thrombectomy group according to the treatment modality.Baseline and clinical data were collected from patients,including age,sex,systolic and diastolic blood pressure on admission,past history(including history of hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,hyperlipidemia,and history of stroke),history of smoking,pre-morbid modified Rankin scale(mRS)scores,National Institutes of Health stroke scale(NIHSS)score on admission,posterior circulation Alberta stroke program early CT score on admission,basilar artery CT angiography score,history of pre-procedural antiplatelet aggregation medications,history of pre-procedural anticoagulant medications,choice of arterial puncture access(via femoral or radial artery),site of vascular occlusion(proximal basilar artery,mid-basilar artery,distal basilar artery),trial of Org 10172 in acute stroke treatment(TOAST)classification,American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation classification,time from onset to admission,time from admission to puncture,time from puncture to revascularization,time from onset to revascularisation,type of embolisation procedure(stenting,aspiration,and combined),immediate post-procedure extended thrombolysis in cerebral infarction(eTICI)classification,and intra-procedural related complications(arterial entrapment,distal occlusion and arterial perforation).The main efficacy indicators(good prognosis[mRS score 0-3 90 d postoperatively],death[mRS score 6 90 d postoperatively],and good recanalisation[eTICI grade ≥2b50]within the immediate postoperative period)and safety indicators(incidence of symptomatic intracranial haemorrhage[sICH]within 7 days post-procedure)were compared between the two groups.The two groups were matched 1∶1 using propensity score matching(PSM)to compare differences in effectiveness and safety indices before and after PSM.Variables with P＜0.05 in the baseline and clinical data comparison between the two groups were included in multifactorial Logistic regression analysis for correction,the differences in safety and efficacy between the two groups were compared before and after correction.Results A total of 206 patients with acute ischemic stroke caused by basilar artery occlusion within 4.5 h of onset were included,comprising 151 males and 55 females.The age ranged from 26 to 93 years old,with an average of(65±13)years old.Among them,101 patients(49.0％)were in the bridging therapy group and 105(51.0％)in the direct thrombectomy group.After 1∶1 PSM,each group consisted of 69 patients.(1)The differences in the proportion of patients with atrial fibrillation between the bridging therapy group and the direct thrombectomy group(16.8％[17/101]vs.28.6％[30/105]),the distribution of pre-morbid mRS scores,and the distribution of TOAST subtypes were statistically significant(all P＜0.05);the differences in the residual baseline and clinical data of the two groups were not statistically significant(all P＞0.05).After 1∶1 PSM,the differences in all baseline and clinical data between the two groups were not statistically significant(all P＞0.05).(2)No statistically significant differences were observed between the bridging therapy group and direct thrombectomy group in the good prognosis rate at 90 d postoperatively,morbidity and mortality rates at 90 d postoperatively,or good revascularization rate in the immediate postoperative period(all P＞0.05).However,the risk of sICH at 7 d postoperatively was higher in the bridging therapy group(9.5％[10/105]vs.19.8％[20/101];OR,2.346,95％CI 1.038-5.299,P=0.037).After correcting for variables with statistically significant differences in baseline and clinical data between the direct thrombectomy group and bridging therapy groups(atrial fibrillation,pre-onset mRS score,and TOAST classification)using a multifactorial Logistic regression model,the results showed no statistically significant differences in the effectiveness and safety metrics between the two groups(all P＞0.05).(3)The results after 1∶1 PSM showed that the bridging therapy group had a higher risk of sICH(11.6％[8/69]vs.26.1％[18/69];OR,2.691,95％CI 1.081-6.700,P=0.033).No statistically significant differences were observed between the two groups in terms of good prognosis rate at 90 d postoperatively,disease-related mortality rate at 90 d postoperatively,or rate of good revascularization in the immediate postoperative period(all P＞0.05).Conclusions In patients with acute basilar artery occlusion stroke within 4.5 h of onset,the effectiveness of bridging therapy and direct thrombectomy was similar,but the incidence of sICH was higher with bridging therapy.The results of this study still need further validation through prospective studies with larger sample sizes.

Objective:To explore the correlations of sleep quality and architecture with heart rate variability (HRV) in patients with stenoses of vertebrobasilar artery system and internal carotid artery system.Methods:A retrospective study was performed; 72 patients with stenosis or occlusion of the head and neck arteries (not resulting in cerebral infarction) admitted to Department of Neurology, Second Affiliated Hospital of Zhengzhou University from June 2023 to June 2024 were chosen, including 33 patients with moderate-to-severe stenosis or occlusion of the vertebrobasilar system (VB group) and 39 patients with moderate-to-severe stenosis or occlusion of the internal carotid artery system (ICA group). Pittsburgh sleep quality index (PSQI) and polysomnography (PSG) were used to evaluate the sleep quality and architecture, respectively; and 24-hour ambulatory electrocardiogram was used to assess the HRV. Differences in PSQI score, PSG and HRV parameters between the two groups were compared; partial correlation analysis was used to explore the correlations of HRV parameters with PSQI scores and PSG parameters; multivariate linear regression was used to analyze the independent influencing factors for HRV.Results:(1) Compared with the ICA group, the VB group exhibited significantly higher PSQI scores, spontaneous arousal index (SAI), ratio of time of stage 1 non-rapid eye movement sleep/total sleep time (T N1/T t), and apnea-hypopnea index (AHI), while significantly lower ratio of time of rapid eye movement sleep/total sleep time (T R/T t), spindle wave density in stage 2 non-rapid eye movement sleep (N2), lowest blood oxygen saturation, standard deviation of normal to normal intervals (SDNN) of all sinus beats, low-frequency power (LF), and high-frequency power (HF, P<0.05). (2) In both VB group and ICA group, SDNN was negatively correlated with PSQI score ( r=-0.461, P=0.020; r=-0.378, P=0.036). In the VB group, SDNN was negatively correlated with T N1/T t ( r=-0.467, P=0.019) and SAI ( r=-0.551, P=0.004), and positively correlated with ratio of time of stage 3 non-rapid eye movement sleep/total sleep time (T N3/T t, r=0.686, P<0.001) and spindle wave density in N2 ( r=0.518, P=0.008); LF and HF were negatively correlated with SAI ( r=-0.481, P=0.015; r=-0.564, P=0.003). In the ICA group, HF was negatively correlated with spindle wave density in N2 ( r=-0.369; P=0.041). (3) Multivariate linear regression results indicated that T N3/T t (β=0.348, P=0.018), SAI (β=-0.330, P=0.018), and spindle wave density in N2 (β=0.286, P=0.013) were independent influencing factors for Ln_SDNN in patients with moderate-to-severe stenosis or occlusion of the vertebrobasilar system. Conclusion:Patients with stenosis or occlusion of the vertebrobasilar system exhibit poorer subjective sleep quality, increased light sleep, heightened arousal, and reduced sleep stability compared with those with stenosis or occlusion of the internal carotid artery system, which may be caused by the imbalance of autonomic nerve function.

With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective: To investigate the changes of microorganisms and metabolites in joint effusion of patients with Rheumatoid arthritis(RA), Osteoarthritis(OA) and Urarthritis(UA). To provide new ideas for the study of the effect of microbiota on the pathogenesis of arthritis. Methods: Joint effusion samples were collected from 20 patients with RA, 20 patients with OA, and 20 patients with UA. 16S rRNA gene sequencing and untargeted ultra-high performance Liquid chromatography-mass spectrometry(LC-MS) were used to explore the differences in microorganisms and metabolites among the three groups. Pearson correlation analysis was used to detect the correlation between effusion microbiota and metabolites. Results: There were differences in microbial diversity and microbiota composition among the three groups. Combined with VIP>1 from OPLS-DA andP<0.05 from two-tailed Students t-test, 45 differential metabolites(Between RA and OA groups), 38 differential metabolites(Between UA and OA groups) and 16 differential metabolites(Between RA and UA groups), were identified. GO analysis and KEGG pathway analysis showed that the differential metabolic pathways among the three groups were mainly concentrated in citric acid cycle(TCA cycle), nucleotide metabolism, amino acid metabolism and glycolysis pathway. Correlation analysis of joint effusion microbiota and metabolites suggested that bacteria enriched in the three groups of joint effusion, such asPrevotella,Clostridium ruminosus,Prevotellaceae＿UCG-001, were related to many key metabolites such as lysozyme, uric acid, glucose, and L-glutamine. Conclusion This study shows that there are a variety of bacterial flora in joint cavity effusion of RA, OA, and UA patients, and the differential metabolites produced by them are involved in the pathogenesis of the three types of arthritis by affecting a variety of metabolic pathways.

Objective To investigate the relationship between the expression levels of long non-coding RNA(lncRNA)metastasis-associated lung adenocarcinoma transcript 1(MALAT1)and leptin levels in the patients with multiple myeloma,as well as the role in the diagnosis and prognosis of multiple myeloma.Meth-ods A total of 60 patients with newly diagnosed multiple myeloma in this hospital from January 2018 to Oc-tober 2020 were selected as the patient group.Additionally,60 healthy individuals during the same period were recruited as the control group.The levels of serum lncRNA MALAT1 and leptin in the test population were detected.The correlation between the two and thier ratio as well as their role in disease prognosis were invest-gated.Results The expression levels of serum lncRNA MALAT1 and leptin in the patients group were signif-icantly higher than those in the control group,and the difference was statistically significant(P＜0.05).A-mong the various stages of Durie-Salmon(DS)staging,the expression levels of lncRNA MALAT1 and leptin from stage I,stage Ⅱ and stage Ⅲ were in turn from high to low,and the differences were statistically signifi-cant(P＜0.05).Among different immune types,the expression level of lncRNA MALAT1 in the patients with light chain type was highest,which in those with non-secretory type was lowest.The leptin levels in the patients with light chain type,IgG type,IgA type and non-secretory type were in turn from high to low,and the differences were statistically significant(P＜0.05).Furthermore,the expression level of lncRNA MAL-AT1 was positively correlated with leptin(r=0.41,P＜0.05).There were statistically significant differences in the expression levels of lncRNA MALAT1,leptin levels,and lncRNA MALAT1/leptin ratio between before and after treatment in the patients with treatment effect(P＜0.05).However,there was no statistically sig-nificant difference in these two indices between before and after treatment in the patients with no treatment effect(P＞0.05).After treatment,the median survival time for the patients with serum lncRNA MALAT1/leptin ratio＜3 was 27 months(95％CI:21.949-27.120),while which for the patients with serum lncRNA MALAT1/leptin ratio 3 was 14 months(95％CI:12.076-22.199),and the difference was statistically sig-nificant(P=0.014).Conclusion lncRNA MALAT1 and leptin exhibit a certain extent of synergistic effect in the de-velopment and progression of multiple myeloma.The ratio of these two could be used to evaluate the prognosis of the patients.

Objective To construct secretory IgA(sIgA)based on the previously screened IgG neutralizing antibody ZW2G10 against SARS-CoV-2,evaluate its activity and find out about the biodistribution of sIgA in ICR mice after nasal administration.Methods After expression,purification,and identification,sIgA was evaluated for its binding and neutralizing activity through ELISA and pseudovirus-based neutralization assays.SIgA was coupled with Alexa Fluor 750 dye and administered to mice via nasal administration.In vivo imaging was used to observe the biodistribution of sIgA.After dissection of the mice,the biodistribution of sIgA in various tissues and organs was observed.Results Compared with IgG,sIgA retained the binding ability to SARS-CoV-2 S proteins,and its neutralizing ability was enhanced.After nasal administration of a single dose of 1 mg/kg,sIgA could be retained in the lungs of mice for more than 72 hours.SIgA could be detected only in the nasal cavity and gastrointestinal tract within 8 h of administration,but not in the heart,liver,kidney,spleen,brain,bladder or blood.Conclusion In this study,a universal and efficient sIgA expression system has been established.sIgA can effectively target the respiratory tract and lungs after nasal administration.SIgA is expected to become a potential drug that provides immediate passive immune protection.

Neck dissection(ND)is one of the main treatment methods for oral and maxillofacial malignancies.Although ND type is in con-stant improvement,but intraoperative peal-pull-push injury of the accessory nerve,muscle,muscle membrane,fascia and ligament induced shoulder syndrome(SS)is still a common postoperative complication,combined with the influence of radiochemotherapy,not only can cause pain,stiffness,numbness,limited dysfunction of shoulder neck and arm,but also may have serious impact on patient's life quality and phys-ical and mental health.At present,there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors.Based on the previous clinical practice and the current available evidence,refer to the relevant lit-erature at home and abroad,the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss,modify and reach a consenusus on the etiology,assessment diagnosis,differential diagnosis,rehabilitation strategy and prevention of SS,in order to provide clinical reference.

Objective:To investigate the implementation status of sepsis hour-1 bundle strategy for patients with septic shock in emergency department.Methods:A total of 116 septic shock patients admitted to the emergency department from January 2020 to December 2020 were included in this prospective study, and the implementation of sepsis bundles and the clinical outcomes of patients were recorded.Results:Among 116 patients, 20 cases (17.2%) had lactic acid monitored within 1 h, 20 cases (17.2%) had blood culture before antibiotics, 82 cases (70.1%) received broad-spectrum antibiotics, 16 cases (13.8%) received fluid resuscitation ≥30 ml/kg, and 57 cases (49.1%) received vasoactive drugs during resuscitation. Finally, the sepsis hour-1 bundle strategy was fully implemented only in 13 cases (11.2%). Compared with the group with incomplete implementation of sepsis hour-1 bundle strategy, the volume of fluid recovery in the group with full implementation was significantly increased [33.7 (30.0,37.5) vs. 8.9(7.3,10.8) ml/kg, Z=-4.78, P<0.001], mean artery blood pressure significantly increased [70.0 (70.0,76.7) vs. 67.7 (61.7,76.7)mmHg(1 mmHg=0.133 kPa) , Z=-2.00, P<0.001], and lactic acid significantly decreased [3.0 (2.0,3.2) vs. 4.4 (3.7,7.2) mmol/L, Z=-2.76, P=0.006]. However, there were no significant differences in ICU mortality, in-hospital mortality and 28-day mortality between the two groups ( P>0.05). Conclusions:Septic shock patients in emergency department have poor compliance with the implementation of sepsis hour-1 bundle strategy, and relevant management training should be strengthened.