Transarterial radioembolization (TARE) is a widely utilized therapeutic approach for hepatocellular carcinoma (HCC), however, the clinical implementation is constrained by the stringent preparation conditions of radioembolization agents. Herein, we incorporated the superstable homogeneous iodinated formulation technology (SHIFT), simultaneously utilizing an enhanced solvent form in a carbon dioxide supercritical fluid environment, to encapsulate radionuclides (such as ¹³¹I,¹⁷⁷Lu, or ¹⁸F) with lipiodol for the preparation of radiolipiodol. The resulting radiolipiodol exhibited exceptional stability and ultra-high labeling efficiency (≥99%) and displayed notable intratumoral radionuclide retention and in vivo stability more than 2 weeks following locoregional injection in subcutaneous tumors in mice and orthotopic liver tumors in rats and rabbits. Given these encouraging findings, ¹⁸F was authorized as a radiotracer in radiolipiodol for clinical trials in HCC patients, and showed a favorable tumor accumulation, with a tumor-to-liver uptake ratio of ≥50 and minimal radionuclide leakage, confirming the feasibility of SHIFT for TARE applications. In the context of transforming from preclinical to clinical screening, the preparation of radiolipiodol by SHIFT represents an innovative physical strategy for radionuclide encapsulation. Hence, this work offers a reliable and efficient approach for TARE in HCC, showing considerable promise for clinical application (ChiCTR2400087731).

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) on the treatment of sudden cardiac death (SCD).Methods:The data of 120 adults with SCD-ECPR in emergency department of the first affiliated hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by Survival/death at 90 days, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), with/without acute myocardial infarction (AMI) and divided according to 60 min of the time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time). Age, sex, Charlson comorbidity index, IHCA/OHCA, initial rhythm, no-flow time, CA-Pump On time, ECMO evacuation success rate, 90-day survival rate, ECMO treatment time were analyzed.Results:①Total of 114 adult patients with SCD-ECPR were enrolled, and 45 (39.5%) patients survived at 90 days, of whom 40 (88.9%) patients had good neurological outcomes.②Age and no-flow time were significantly lower in the 90-day survival group than that in death group, and the proportion of IHCA and shockable initial rhythm was higher. ③The no flow time in IHCA group was significantly lower than that in OHCA group, and the 90-day survival rate was higher. ④OHCA and regional interhospital transport prolonged CA-Pump On time and reduced the 90-day survival rate. ⑤The AMI group was older with a higher Charlson comorbidity index, and the 90-day survival rate was significantly lower than that in non-AMI group.Conclusions:ECPR improves the prognosis of patients with SCD, there are high benefits in patients with long healthy life expectancy, IHCA, shockable initial rhythm, and short no flow time. The smooth life-saving chain of SCD-ECPR improves survival rate, by screening high benefit candidates in patients with OHCA, delayed initiation of ECPR or requiring interhospital transport, despite CA-Pump On time > 60 min, there is still survival potential.

Objective:To investigate the major adverse kidney events (MAKE) in acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:The data of 75 patients with AMI-ECPR in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, with/without renal replacement therapy (RRT), and whether to initiate RRT because of acute kidney injury (AKI). age, sex, Charlson comorbidity index, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO and RRT treatment time, 90-day survival rate were analyzed. Moreover, the renal function of the survivors was followed up.Results:① Total of 68 AMI-ECPR patients were enrolled, 22 (32.4%) patients survived at 90 days, 54 (79.4%) combined with RRT, and 48 (70.6%) MAKE within 90 days. ②Compared with the death group, the 90-day survival group had a higher proportion of initial shockable heart rhythm, a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value. ③The severity of coronary artery disease, ECPR initial acidosis and hyperlactacemia in the RRT group was significantly higher than that in the non-RRT group, and all the non-RRT group patients survived. ④ There was no difference between the AKI-RRT group and the non-AKI-RRT group. Of 21 patients with stage 1 AKI initiating RRT, 5 survived, one of them still needs RRT for 90 days, and 7 patients with stage 2 to 3 AKI initiating RRT died.Conclusions:The 90-day MAKE rate in AMI-ECPR patients was as high as 70.6%, and the 90-day renal insufficiency rate in AMI-ECPR survivors with AKI was as high as 20.0%. Active initiation of RRT to avoid AKI or early initiation of RRT may improve the prognosis of AMI-ECPR patients.

Objective:To investigate the time characteristics from extracorporeal cardiopulmonary resuscitation (ECPR) initiation to termination.Methods:The data of ECPR patients in extracorporeal life support center of the First Affiliated Hospital of Nanjing Medical University from April 2015 to October 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, in-hospital/out-of-hospital cardiac arrest (IHCA/OHCA), daytime/evening initiation, and procedural/non-procedural termination. Data on age, sex, Charlson comorbidity index, interhospital transport, initial rhythm, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECPR initiation/termination and ECMO treatment time, 90-day survival rate and so on were analyzed.Results:200 ECPR patients were enrolled, the cardiogenic etiologies were accounted for 70.5%, more men than women, 68 (34.0%) patients survived at 90 days, of whom 61 (89.7%) patients had good neurological outcomes. The 90-day survival group had a significantly lower of no-flow time, a higher proportion of IHCA and initial shockable heart rhythm, with a higher ECPR initial blood gas pH and a lower lactic acid value than those in the death group. 3. The no flow time in OHCA group was significantly longer than that in IHCA group, with a lower ECPR initial blood gas pH and a higher lactic acid value, 77.4% were non-procedural termination and the 90-day survival rate was 16.1%. ECPR were initiated in all time periods, IHCA-ECPR initiated at random, OHCA-ECPR were rare in the early morning, and the initiation time had no significant effect on ECPR outcomes. There were 75.5% of ECPR terminated at the daytime, 56.8% death cases were occurred within 3 days after ECPR, and 19.0% of patients in the procedural termination group died due to a combination of factors.Conclusions:ECPR had a potentially high benefit for patients with IHCA, initial shockable rhythm, and a short no-flow time. The ECPR initiation time were irregular and had no effect on ECPR outcomes. Death events tend to occur in the early days after ECPR, and ECPR terminated is mostly during the daytime working hours. The construction of full-time ECPR team should be strengthened.

Childhood obesity has become a global public health problem, and its incidence and development are closely related to the exposure to risk factors in early life. In recent years, more and more epidemiological research evidences have shown that breastfeeding has the modification effect on early life risk factors of childhood obesity, such as high genetic risk of obesity, maternal gestational diabetes mellitus, macrosomia and other factors. This paper reviews the research results in this field, and summarizes the modification effect of breastfeeding on childhood obesity heredity and early life environmental risk factors associated with childhood obesity, to provide a reference for the evaluation of positive effect of breastfeeding on prevention and control of obesity in specific risk groups for taking targeted measure to reduce the risk for childhood obesity.

Objective:Early identification of ischemic stroke patients with large vessel occlusion can improve referral efficiency and shorten reperfusion time. The purpose of this study was to analyze the characteristics of patients with large vessel occlusion and identify factors that could predict large vessel occlusion.Methods:The clinical data of 432 patients with ischemic stroke treated through emergency green channel were retrospectively analyzed, and the differences between the large vessel occlusion group (LVO group) and the non-large vessel occlusion group (non-LVO group) were compared, and two independent risk factors of the LVO group were screened out by logistics regression analysis: baseline NIHSS score and D-dimer value. The predicted cutoff values of NIHSS score and D-dimer were further determined by the receiver operating characteristic (ROC) curve.Results:A total of 432 patients with ischemic stroke had complete imaging data, with a mean age of 68.5±12.4 years, including 275 (63.7%) males, and 245 (56.7%) in the LVO group and 187 (43.3%) in the non-LVO group. Age, hemorrhagic transformation, thrombolytic therapy, endovascular treatment, atrial fibrillation, baseline NIHSS score [14.0 (6.0-20.0) vs. 3.0 (1.0-6.0), P<0.05], and D-dimer value at admission [0.9(0.4-2.3) mg/L vs. 0.3 (0.2-0.5)mg/L, P<0.05] were statistically significant different between the two groups. Multivariate Logistic regression analysis showed that higher baseline NIHSS score( OR=1.22,95% CI: 1.17-1.27)and higher D-dimer value( OR=3.10,95% CI: 2.14-4.47)were independent risk factors for large vessel occlusion. Baseline NIHSS score combined with D-dimer value was a good predictor of large vessel occlusion(AUC 0.85 [0.81-0.89]). ROC curve suggested that NIHSS score >6.5 and D-dimer >0.57 mg/L were the cutoff values for predicting large vessel occlusion. Conclusions:Higher baseline NIHSS score and D-dimer value are valuable for early prediction of large vessel occlusion, patients with NIHSS score >6.5 points and D-dimer >0.57 mg/L should be promptly transported to an advanced stroke center for treatment.

Objective:To investigate the safety of early whole body computed tomography (WBCT) combined with coronary angiography (CAG) in patients with extracorporeal cardiopulmonary resuscitation (ECPR) and its application value in the diagnosis of cardiac arrest and complications of cardiopulmonary resuscitation (CPR).Methods:This was a retrospective study. Patients who underwent ECPR in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were enrolled in this research. Patients younger than 18 years or with incomplete clinical data were excluded. The results of WBCT and CAG examinations after ECPR were collected.Results:A total of 89 patients with ECPR, aged (47±17) years, were enrolled in the study, all underwent WBCT examination, and no adverse events such as ECMO and tracheal tube shedding occurred. WBCT found 7 cases of pulmonary embolism, 3 cases of aortic dissection and 2 cases of cerebral hemorrhage. WBCT identified CPR-related complications in 42 cases, including rib fractures ( n=20), pneumothorax ( n=5), mediastinal emphysema ( n=5), subcutaneous emphysema ( n=6), and hematoma or swelling at puncture site ( n=6). Fifty-five patients underwent CAG examination, the most common culprit vessels were the left anterior descending branch disease (58.2%) followed by the left circumflex branch disease (27.3%), the right coronary artery disease (21.8%) and left main artery disease (12.7%). Conclusions:Early WBCT and CAG examinations are of great significance and safety for the guidance of treatment in ECPR patients.

Objective:To investigate the prognostic value of early lactate in patients with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A retrospective analysis was performed on the clinical data of patients with ECPR in the Emergency Medicine Department of The First Affiliated Hospital of Nanjing Medical University from March 2015 to August 2021. The age, sex, etiology, initial rhythm, prognosis, blood lactate and pH of patients with ECPR were collected, and their difference between the deceased and survived patients was compared.Results:Totally 95 patients were enrolled, with an average age of 47 years; male accounted for 69.5%, and the survival rate was 29.5%. There was no significant difference in age and sex ratio between the deceased and survived patients. However, the deceased patients had a significant lower rate of shockable rhythms (31.3% vs. 60.8%), a higher level of lactate [16.4 (11.2, 19.1) vs. 9.2 (3.2, 15.0), mmol/L], and a lower pH [7.01 (6.88, 7.23) vs. 7.37 (7.10, 7.43)] than the survived patients. Multivariate binary logistic regression analysis showed that shockable rhythm [odds ratio ( OR) = 0.295, 95% confidence interval ( CI): 0.118-0.739), lactate ( OR=1.159, 95% CI: 1.068-1.258) and pH ( OR= 0.017, 95% CI: 0.002-0.157) were independent risk factors for poor prognosis. Furthermore, a lactate level >24 mmol/L was the best threshold to predict mortality with a specificity of 100%. Combined application, the cutoff point was lactate level>16 mmol/L and pH <6.828. Conclusions:Shockable rhythm, higher early lactate and lower pH value are independent risk factors for prognosis in patients with ECPR. Early lactate > 24 mmol/L or lactate > 16 mmol/L companied with pH < 6.828 are novel indicators of the termination of ECPR.

Objective:To investigate the predictive value of platelet dynamics on the prognosis of 28-day in patients with extracorporeal membrane oxygenation (ECMO).Methods:From January 2017 to December 2020, 60 patients from the Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University received ECMO for life support. The baseline data of the patients were collected, the minimum value of platelets on day 1-7 of the machine was calculated, and the platelet change value and change rate were calculated. The patients were divided into the survival group and death group according to the 28-day survival status after ECMO was installed, and the receiver operating curve (ROC) was drawn based on the platelet change value and change rate to evaluate its predictive value for prognosis.Results:Among patients receiving VV-ECMO, the platelet change value and change rate on day 7 had the best prediction effect on the patient's 28-day outcome ( AUCΔPLT7=0.772, P=0.016; AUCΔPLT7%=0.764, P=0.020), when the platelet change value was 4×10 9/L as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99% as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99%. The sensitivity was 0.643 with a specificity of 0.846. In patients receiving VA-ECMO, the platelet change rate on day 6 predicted the best effect on the patient's 28-day outcome ( AUCΔPLT6%= 0.707, P = 0.045). When the platelet change rate was -26.19% as the critical value, the sensitivity was 0.842 and the specificity was 0.643. Conclusions:Platelet dynamic changes of platelets are correlated with the 28-day prognosis of patients receiving ECMO, and the combination of platelet change value and the critical value of change rate can better predict the poor prognosis of patients in both ECMO modes.

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) in the treatment of out-of-hospital cardiac arrest (OHCA) in adults.Methods:The data of 40 adults with OHCA-ECPR in Emergency Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2022 were retrospectively analyzed. The patients were grouped by discharge survival/in-hospital death, with/without bystander resuscitation, and with/without interhospital transport. Age, sex, Charlson comorbidity index, initial rhythm, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO evacuation success rate, survival rate, ECMO treatment time, time-to-death, and length of hospital stay were analyzed.Results:①Among the 40 patients with OHCA-ECPR, 9 patients (22.5%) survived upon discharge, 7 (77.8%) of whom had good neurological outcomes.②The no-flow time in the survival group was significantly shorter than that in the death group, and the proportion of shockable initial rhythm was higher.③Bystander resuscitation greatly shortened the no-flow time.④The regional OHCA-ECPR interhospital transport extended the CA-Pump On time, without affecting patients’ prognosis.Conclusions:ECPR improves the prognosis of patients with OHCA. Bystander resuscitation greatly shortens the no-flow time. ECPR is significantly effective in patients with short no-flow time and shockable initial rhythm. Regional interhospital transport ECPR is recommended to benefit more patients with OHCA.