With the continuous advancement and innovation in medical equipment technology, the transition between high-flow oxygen therapy, non-invasive ventilation, and invasive ventilation can be easily achieved by adjusting the ventilation mode of ventilators. During the weaning phase for tracheotomized patients, it is necessary to disconnect the ventilator circuit, change the ventilator mode, and gradually extend the weaning time to achieve complete ventilator liberation. During the weaning process, due to patients' excessive dependence on the ventilator, there may be situations where respiratory endpoints and Y-connectors of the ventilator are reconnected for invasive ventilation. However, during the weaning process, the Y-connector and expiratory end connectors are exposed to the air, which cannot ensure the tightness of the ventilator circuit, easily increasing the probability of ventilator circuit contamination and subsequently the risk of ventilator-associated pneumonia (VAP). To overcome these issues, the research team of department of critical care medicine of Zhongda Hospital Southeast University has designed a ventilator circuit interface protective device for weaning and has obtained a National Utility Model Patent of China (ZL 2023 2 1453385.8). The main body of the protective device is a Y-connector plug, consisting of multiple components, including a sealing piece, a protective cover, a sealing plug, an interface 1 (connects with the patient's tracheal tube), an interface 2 (connects with the respiratory branch of the ventilator), and an interface 3 (connects with the expiratory branch of the ventilator), featuring a unique design and easy operation. During the patient's weaning training process, the interface 1 and interface 2 is disconnected from the patient's tracheal tube and respiratory branch, respectively. The interface 1 is plugged with a stopper, and the interface 2 is covered with a protective cover to ensure the tightness of the expiratory branch and Y-connector of the ventilator. During the period when the patient is using the ventilator, the protective cover and plug are removed, and connecting them together ensures the tightness of the device itself, reducing the incidence of VAP caused by ventilator circuit contamination, avoiding nosocomial infections, and shortening the prolonged use of invasive ventilation, increased complication rate, extended hospital stay, and increased medical cost associated with weaning.
Humans ; Ventilator Weaning/methods* ; Equipment Design ; Ventilators, Mechanical ; Respiration, Artificial/instrumentation* ; Pneumonia, Ventilator-Associated/prevention & control*

Objective To analyze the characteristics of TCM symptoms of aging in female insomnia patients;To provide syndrome differentiation evidence for clinical prevention and treatment of female aging.Methods A cross-sectional study method was used to include female insomnia patients who attended outpatient clinics at Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing Changping District Hospital of Traditional Chinese Medicine,and the Third Affiliated Hospital of Beijing University of Chinese Medicine from August 2021 to July 2024.The patients'clinical information was collected,and frequency analysis,factor analysis,and clustering analysis of the relevant clinical information of the 107 female insomnia patients were conducted,which,together with the experts'opinions,resulted in characteristics of TCM syndrome elements and syndrome distribution of aging in female insomnia patients.Results Totally 20 core items were screened and 7 common factors were obtained from the factor analysis.There were 5 types of syndrome elements of disease location associated with aging symptoms in female patients with insomnia,including heart,liver,spleen,kidney and lung;and there were 7 types of syndrome elements of disease property,including qi deficiency,yin deficiency,qi stagnation,blood deficiency,heat,phlegm,and dampness.There were 4 types of syndromes were obtained from the systematic clustering,including heart-kidney disharmony syndrome,heart-liver stagnation syndrome,spleen deficiency and qi stagnation syndrome,lung-spleen qi deficiency syndrome.Conclusion By analyzing the TCM syndrome characteristics of aging symptoms in female patients with insomnia,four types of syndromes are obtained.The heart-kidney disharmony syndrome is the common syndrome.The internal relationship between insomnia and aging process in female patients with insomnia is revealed from the perspective of pathogenesis,which can provide a research basis for the clinical practice of TCM anti-aging guided by syndrome differentiation and treatment in the future.

Objective:To investigate relationship between expression of ADGRG5 and clinical prognosis and immune response in pancreatic adenocarcinoma(PAAD).Methods:ADGRG5 expression in PAAD and normal tissues were compared by Wilcoxon rank sum test.Diagnostic value of ADGRG5 was evaluated by ROC curve in PAAD.Kaplan-Meier method and Cox regres-sion analysis were used to evaluate prognostic factors.Gene set enrichment analysis(GSEA)and immune infiltration analysis were applied to annotate biological function of ADGRG5.Results:ADGRG5 expression in PAAD was significantly higher than normal tissue(P=2.8e-32).ADGRG5 had significant diagnostic and prognostic ability for PAAD(AUC=0.866).High ADGRG5 expression predicted a good progress free interval(PFI)(P=0.01),and expression of ADGRG5 was independently associated with PFI(HR:0.656,95%CI:0.433～0.972,P=0.035).ADGRG5 expression was related to regulation of immunomodulatory pathway and function of some types of immune infiltrating cells.Conclusion:Increased ADGRG5 may be a potential biomarker for PAAD diagnosis and prognosis,which affects prognosis of PAAD patients and significantly correlated with immune infiltration.

Objective:To investigate the levels of social support, self-disclosure, and demoralization in postoperative patients with chronic osteomyelitis, and to explore the mediating effect of social support between self-disclosure and demoralization.Methods:This cross-sectional study used convenience sampling to select 390 postoperative patients with chronic osteomyelitis who were treated at the Trauma Center of the Affiliated Provincial Hospital of Shandong First Medical University from June 2022 to October 2023. The General Information Questionnaire, Distress Disclosure Index (DDI), Social Support Rating Scale (SSRS), and the Mandarin Version of the Demoralization Scale (DS-MV) were used to survey the patients. Structural equation modeling was used to analyze the mediating mechanism of social support between self-disclosure and demoralization.Results:A total of 390 questionnaires were distributed, with 380 valid responses (effective response rate was 97.44%). Among the 380 patients, the DDI score was (33.88±14.57), SSRS score was (34.83±8.90), and DS-MV score was (47.27±4.23). Both self-disclosure and social support directly and negatively predicted demoralization ( P<0.05). Social support partially mediated the relationship between self-disclosure and demoralization, with an indirect negative effect of -0.600, accounting for 64.45% of the total effect. Conclusions:Social support serves as a mediating variable between self-disclosure and demoralization in postoperative patients with chronic osteomyelitis. Clinical healthcare providers should encourage patients to express their feelings, enhance their self-disclosure, and strengthen their social support systems to reduce demoralization.

Objective To investigate the cardiac protective effect of Taohong Tongluo granules on coronary microvascular dysfunction(CMD)rats.Methods SD rats were randomly assigned to sham-operated group,CMD group,nicorandil group(5 mg/kg),or Taohong Tongluo granule group(50 mg/kg).Animals were administered corresponding drugs for 7 d according to the grouping,and the CMD model was prepared 2 h after the last administration.The rat CMD model was induced by injecting embolization microspheres(diameter 40-120 μm,approximately 1 000 microspheres)into the left ventricular cavity.Twenty-four hours after modeling,echocardiography was performed to measure the left ventricular ejection fraction(EF),fractional shortening(FS),and end-diastolic volume(EDV).The damaged myocardial area was assessed by 2,3,5-triphenyltetrazolium chloride(TTC)staining.Myocardial morphological changes were observed by hematoxylin-eosin(H-E)staining.The protein expression levels of NOD-like receptor family pyrin domain containing protein 3(NLRP3),apoptosis-associated speck-like protein(ASC),and cysteine aspartic acid specific protease(caspase)-1 in rat myocardial tissue were detected by immunohistochemical staining and Western blotting.Results Echocardiography showed that the EF and FS values in the Taohong Tongluo granule group,CMD group,and nicorandil group were significantly lower than those in the sham-operated group(all P＜0.001).The EF and FS values in the Taohong Tongluo granule group and nicorandil group were significantly higher than those in the CMD group(all P＜0.01).However,there were no significant differences in EDV among the groups(all P＞0.05).H-E staining showed no abnormalities in the myocardium in the sham-operated group.The CMD group exhibited microsphere embolism in the myocardium,myocardial cell dissolution and rupture,and inflammatory infiltration.The lesions in the nicorandil group and the Taohong Tongluo granule group were relatively milder,and the number of thrombi in both groups was lower than that in the CMD group(both P＜0.01).The results of TTC staining indicated that the areas of damaged myocardial regions in both the nicorandil group and the Taohong Tongluo granule group were smaller than that in the CMD group(P＜0.05 or P＜0.01).Moreover,the area in the Taohong Tongluo granule group was smaller than that in the nicorandil group(P＜0.05).The results of immunohistochemical staining showed that in the CMD model,the expression of ASC and caspase-1 proteins,as well as the number of positive cells for these proteins,was increased and was distributed in myocardial and interstitial cells.The numbers of ASC and caspase-1 positive cells in the Taohong Tongluo granule group were lower than that in the CMD group(both P＜0.01).The Western blotting showed that the expression levels of NLRP3,ASC,and caspase-1 proteins in the Taohong Tongluo granule group were all lower than those in the CMD group(all P＜0.05).Conclusion Taohong Tongluo granules can improve cardiac function,ameliorate hemodynamic parameters,and reduce myocardial infarction area in rats with CMD induced by microsphere embolism.The mechanism is related to the inhibition of myocardial inflammasome activation,thereby attenuating the myocardial injuries.

Objective:To investigate the levels of social support, self-disclosure, and demoralization in postoperative patients with chronic osteomyelitis, and to explore the mediating effect of social support between self-disclosure and demoralization.Methods:This cross-sectional study used convenience sampling to select 390 postoperative patients with chronic osteomyelitis who were treated at the Trauma Center of the Affiliated Provincial Hospital of Shandong First Medical University from June 2022 to October 2023. The General Information Questionnaire, Distress Disclosure Index (DDI), Social Support Rating Scale (SSRS), and the Mandarin Version of the Demoralization Scale (DS-MV) were used to survey the patients. Structural equation modeling was used to analyze the mediating mechanism of social support between self-disclosure and demoralization.Results:A total of 390 questionnaires were distributed, with 380 valid responses (effective response rate was 97.44%). Among the 380 patients, the DDI score was (33.88±14.57), SSRS score was (34.83±8.90), and DS-MV score was (47.27±4.23). Both self-disclosure and social support directly and negatively predicted demoralization ( P<0.05). Social support partially mediated the relationship between self-disclosure and demoralization, with an indirect negative effect of -0.600, accounting for 64.45% of the total effect. Conclusions:Social support serves as a mediating variable between self-disclosure and demoralization in postoperative patients with chronic osteomyelitis. Clinical healthcare providers should encourage patients to express their feelings, enhance their self-disclosure, and strengthen their social support systems to reduce demoralization.

Objective:To investigate relationship between expression of ADGRG5 and clinical prognosis and immune response in pancreatic adenocarcinoma(PAAD).Methods:ADGRG5 expression in PAAD and normal tissues were compared by Wilcoxon rank sum test.Diagnostic value of ADGRG5 was evaluated by ROC curve in PAAD.Kaplan-Meier method and Cox regres-sion analysis were used to evaluate prognostic factors.Gene set enrichment analysis(GSEA)and immune infiltration analysis were applied to annotate biological function of ADGRG5.Results:ADGRG5 expression in PAAD was significantly higher than normal tissue(P=2.8e-32).ADGRG5 had significant diagnostic and prognostic ability for PAAD(AUC=0.866).High ADGRG5 expression predicted a good progress free interval(PFI)(P=0.01),and expression of ADGRG5 was independently associated with PFI(HR:0.656,95%CI:0.433～0.972,P=0.035).ADGRG5 expression was related to regulation of immunomodulatory pathway and function of some types of immune infiltrating cells.Conclusion:Increased ADGRG5 may be a potential biomarker for PAAD diagnosis and prognosis,which affects prognosis of PAAD patients and significantly correlated with immune infiltration.

Objective To analyze the characteristics of TCM symptoms of aging in female insomnia patients;To provide syndrome differentiation evidence for clinical prevention and treatment of female aging.Methods A cross-sectional study method was used to include female insomnia patients who attended outpatient clinics at Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing Changping District Hospital of Traditional Chinese Medicine,and the Third Affiliated Hospital of Beijing University of Chinese Medicine from August 2021 to July 2024.The patients'clinical information was collected,and frequency analysis,factor analysis,and clustering analysis of the relevant clinical information of the 107 female insomnia patients were conducted,which,together with the experts'opinions,resulted in characteristics of TCM syndrome elements and syndrome distribution of aging in female insomnia patients.Results Totally 20 core items were screened and 7 common factors were obtained from the factor analysis.There were 5 types of syndrome elements of disease location associated with aging symptoms in female patients with insomnia,including heart,liver,spleen,kidney and lung;and there were 7 types of syndrome elements of disease property,including qi deficiency,yin deficiency,qi stagnation,blood deficiency,heat,phlegm,and dampness.There were 4 types of syndromes were obtained from the systematic clustering,including heart-kidney disharmony syndrome,heart-liver stagnation syndrome,spleen deficiency and qi stagnation syndrome,lung-spleen qi deficiency syndrome.Conclusion By analyzing the TCM syndrome characteristics of aging symptoms in female patients with insomnia,four types of syndromes are obtained.The heart-kidney disharmony syndrome is the common syndrome.The internal relationship between insomnia and aging process in female patients with insomnia is revealed from the perspective of pathogenesis,which can provide a research basis for the clinical practice of TCM anti-aging guided by syndrome differentiation and treatment in the future.

Background::Pancreatic ductal adenocarcinoma (PDAC) is one of the main types of malignant tumor of the digestive system, and patient prognosis is affected by difficulties in early diagnosis, poor treatment response, and a high postoperative recurrence rate. Carbohydrate antigen 19-9 (CA19-9) has been widely used as a biomarker for the diagnosis and postoperative follow-up of PDAC patients. Nevertheless, the production mechanism and potential role of CA19-9 in PDAC progression have not yet been elucidated.Methods::We performed single-cell RNA sequencing on six samples pathologically diagnosed as PDAC (three CA19-9-positive and three CA19-9-negative PDAC samples) and two paracarcinoma samples. We also downloaded and integrated PDAC samples (each from three CA19-9-positive and CA19-9-negative patients) from an online database. The dynamics of the proportion and potential function of each cell type were verified through immunofluorescence. Moreover, we built an in vitro coculture cellular model to confirm the potential function of CA19-9. Results::Three subtypes of cancer cells with a high ability to produce CA19-9 were identified by the markers TOP2A, AQP5, and MUC5AC. CA19-9 production bypass was discovered on antigen-presenting cancer-associated fibroblasts (apCAFs). Importantly, the proportion of immature ficolin-1 positive (FCN1+) macrophages was high in the CA19-9-negative group, and the proportion of mature M2-like macrophages was high in the CA19-9-positive group. High proportions of these two macrophage subtypes were associated with an unfavourable clinical prognosis. Further experiments indicated that CA19-9 could facilitate the transformation of M0 macrophages into M2 macrophages in the tumor microenvironment. Conclusions::Our study described CA19-9 production at single-cell resolution and the dynamics of the immune atlas in CA19-9-positive and CA19-9-negative PDAC. CA19-9 could promote M2 polarization of macrophage in the pancreatic tumor microenvironment.

Objective:To assess the prevalence of dentinal hypersensitivity (DH) and related factors in urban adults in China.Methods:The study was designed as an observational, cross-sectional epidemiological study carried out in adults aged 18-69 years old in seven cities (Beijing, Shanghai, Wuhan, Chengdu, Xi′an, Guangzhou, and Harbin) of China. The study was conducted from March 2021 to May 2023. Patients were required to complete a questionnaire regarding the subjects′ socio-economic factors, dietary behavior, oral health behavior and personal antecedent factors. DH was clinically diagnosed by judging whether the tooth cold air stimulation provoked DH or not, and recorded by investigator pain rating Schiff score. Compare the findings of six cities (Harbin excluded) with a similar study conducted in 2008.Results:In total, 11 622 subjects from seven cities in China participated the study. Fifty two point two percent (6 072/11 622) of subjects reported DH in questionnaire, 36.7% (4 266/11 622) of subjects reported experiencing DH in response to cold air stimulation for at least one study tooth. Risk factors including age, sex, city, toothbrush method and acid reflux showed marked associations with DH ( P<0.05). The prevalence of DH of urban residents in six cities (Harbin excluded) was 33.7% (3 335/9 882), higher than that in 2008 [29.7%(2 354/7 939)]. Conclusions:Overall, DH was common among urban adults in China and the prevalence increased in recent years. Better understanding of DH and its associated factors should be considered in its prevention and management by dental professionals.