Objective:To investigate the pathogen distribution characteristics and related risk factors for postoperative infection in liver transplant recipients.Method:A retrospective analysis was conducted on the clinical data of 153 recipients who underwent liver transplantation and received postoperative treatment in the intensive care unit (ICU) of China-Japan Friendship Hospital from January 2019 to December 2023. According to whether postoperative infection occurred, the recipients were divided into the infection group (33 cases) and the non-infection group (120 cases). Pathogen-related data were collected from multiple postoperative body fluid sites of liver transplant recipients. Univariate analysis and multivariate logistic regression analysis were performed to identify independent risk factors.Result:Among the 153 recipients, 105 were male and 48 were female, with a mean age of (52.2 ± 9.5) years. During the ICU stay after liver transplantation, 33 recipients developed infections, including 15 cases of single-pathogen infection and 18 cases of mixed-pathogen infection. The most common site of infection was the lung, accounting for 22 cases (66.67%). Eleven recipients (33.33%) in the infection group died, with septic shock being the leading cause of death (7 cases, 63.63%), and the median survival time was 14 days. Infected recipients had Gram-negative bacteria (171 strains), mainly Stenotrophomonas maltophilia[54 strains (31.57%)] and Pseudomonas aeruginosa[52 strains (30.41%)]. Gram-positive bacteria (47 strains) were dominated by Enterococcus faecalis[25 strains (53.19%)]. Multivariate regression analysis showed that postoperative mechanical ventilation for more than 48 hours was an independent risk factor for infection in liver transplant recipients ( OR=10.878, 95% CI: 3.632-32.580, P<0.001). Conclusion:It is necessary to prevent ventilator-associated pneumonia in liver transplant recipients. Early removal of the tracheal tube and strengthening hospital infection prevention and control are of great significance in reducing the risk of postoperative infection in liver transplant recipients.

PURPOSE: End-stage knee osteoarthritis (OA) patients are the primary candidates for total knee arthroplasty (TKA). However, most morphological refinements of TKA prosthesis are based on anatomical data from the knees of healthy individuals. This study aimed to determine whether differences exist in key bony morphological characteristics of the distal femur and proximal tibia between osteoarthritic knees and healthy knees. METHODS: This was a retrospective cross-sectional observational study with a case-control design. Patients who were aged ≥ 50 years, had no history of trauma, fracture, or surgery in the studied knee, and had no obvious knee flexion contracture were included in this study by CT scans. Patients who met the American College of Rheumatology clinical criteria for knee OA were included in the study group. Kellgren-Lawrence grade III or IV knees were studied (for bilateral cases, the more severely affected knee was chosen). Patients who presented with unilateral knee pain or trauma were included in the control group, with CT scans from the opposite (asymptomatic) knee used for analyzing. The studied knee had a Kellgren-Lawrence grade of 0 or I and showed no abnormalities upon physical examination. Archived knee CT scans from 160 patients were divided into 2 groups: the study group (80 moderate-to-severe OA knees) and the control group (80 healthy knees). After 3-dimensional reconstruction and virtual cutting using a CT workstation, 13 morphological parameters of the distal femur and proximal tibia were compared between the 2 groups using independent-samples t-tests. RESULTS: No significant group differences in the femoral anteroposterior dimension (p = 0.797), height of the lateral femoral condyle (p = 0.268), posterior condylar angle (p = 0.240), tibial anteroposterior dimension (p = 0.536), or tibial lateral anteroposterior dimension (p = 0.702) were observed. However, the femoral mediolateral dimension (p = 0.002), distal femoral aspect ratio (femoral mediolateral dimension/femoral anteroposterior dimension) (p < 0.001), height of the femoral trochlear groove (p < 0.001), height of the medial femoral condyle (p < 0.001), tibial mediolateral dimension (p = 0.001), proximal tibial aspect ratio (tibial mediolateral dimension/tibial anteroposterior dimension) (p = 0.004), tibial medial anteroposterior dimension (p = 0.005), and tibial asymmetry ratio (tibial medial anteroposterior dimension/tibial lateral anteroposterior dimension) (p = 0.006) were all significantly greater in the study group. CONCLUSION Knees with moderate-to-severe OA are significantly wider than healthy knees, and OA is a risk factor for increased tibial platform asymmetry. When refining the morphological parameters of TKA prostheses, the specific bony morphological characteristics of OA knees should be taken into account to reduce the potential risk of femoral or tibial component underhang and facilitate optimal balance between tibial component fit and rotational alignment.
Humans ; Osteoarthritis, Knee/pathology* ; Male ; Female ; Cross-Sectional Studies ; Retrospective Studies ; Arthroplasty, Replacement, Knee ; Middle Aged ; Aged ; Case-Control Studies ; Prosthesis Design ; Knee Prosthesis ; Femur/anatomy & histology* ; Tibia/anatomy & histology* ; Tomography, X-Ray Computed ; Knee Joint/diagnostic imaging*

Objective To explore the impact of enteral nutrition formula containing slow-release starch on blood glucose variability and prognosis in patients with severe acute pancreatitis(SAP).Methods A total of 204 SAP patients were enrolled and randomly divided into control group and ob-servation group using a random number table method,with 102 patients in each group.The control group received early enteral nutrition support with a standard enteral nutrition formula,while the ob-servation group received early enteral nutrition support with an enteral nutrition formula containing slow-release starch.Blood glucose variability indicators[largest amplitude of glycemic excursions(LAGE),standard deviation of blood glucose(SDBG),blood glucose coefficient of variation(BGCV),mean blood glucose(MBG),mean amplitude of glycemic excursions(MAGE),and time in range(TIR)]were compared between the two groups after treatment,along with clinical indicators during hospitalization,inflammatory markers[procalcitonin,C-reactive protein,interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)],and nutritional indicators(albumin,prealbumin)levels.Kaplan-Meier analysis was conducted to assess the prognosis of the two groups,and multivariate Cox regression analysis was performed to identify factors influencing prognosis.Results After treat-ment,the observation group exhibited lower levels of MBG,LAGE,SDBG,BGCV,MAGE,and a higher TIR compared with the control group(P＜0.05).During hospitalization,the observation group had a shorter duration of enteral nutritiontherapy,lower insulin usage,and lower incidence rates of multiple organ failure and infectious pancreatic necrosis compared with the control group(P＜0.05).After treatment,the observation group had lower levels of procalcitonin,C-reactive protein,IL-6,and TNF-α compared with the control group(P＜0.05);however,there were no statistically significant differences in albumin and prealbumin levels between the two groups(P＞0.05).Kaplan-Meier analysis showed that the cumulative mortality rate in the observation group was 12.75％,which was lower than the 17.65％in the control group(Log-rank x2=4.361,P=0.037).Multivariate Cox regression analysis revealed that TIR after treatment(HR=0.920;95％CI,0.869 to 0.974)was an independent protective factor for prognosis in SAPpatients(P＜0.05),while infectious pancreatic necrosis(HR=4.269;95％CI,1.922 to 9.482)was an inde-pendent risk factor for prognosis in SAP patients(P＜0.05).Conclusion Enteral nutrition formu-la containing slow-release starch helps stabilize blood glucose variability,control inflammatory mark-er levels,improve nutritional status,and prognosis in SAP patients.Both TIR and infectious pancre-atic necrosis are closely related to the prognosis of SAP patients.

Objective:To investigate the pathogen distribution characteristics and related risk factors for postoperative infection in liver transplant recipients.Method:A retrospective analysis was conducted on the clinical data of 153 recipients who underwent liver transplantation and received postoperative treatment in the intensive care unit (ICU) of China-Japan Friendship Hospital from January 2019 to December 2023. According to whether postoperative infection occurred, the recipients were divided into the infection group (33 cases) and the non-infection group (120 cases). Pathogen-related data were collected from multiple postoperative body fluid sites of liver transplant recipients. Univariate analysis and multivariate logistic regression analysis were performed to identify independent risk factors.Result:Among the 153 recipients, 105 were male and 48 were female, with a mean age of (52.2 ± 9.5) years. During the ICU stay after liver transplantation, 33 recipients developed infections, including 15 cases of single-pathogen infection and 18 cases of mixed-pathogen infection. The most common site of infection was the lung, accounting for 22 cases (66.67%). Eleven recipients (33.33%) in the infection group died, with septic shock being the leading cause of death (7 cases, 63.63%), and the median survival time was 14 days. Infected recipients had Gram-negative bacteria (171 strains), mainly Stenotrophomonas maltophilia[54 strains (31.57%)] and Pseudomonas aeruginosa[52 strains (30.41%)]. Gram-positive bacteria (47 strains) were dominated by Enterococcus faecalis[25 strains (53.19%)]. Multivariate regression analysis showed that postoperative mechanical ventilation for more than 48 hours was an independent risk factor for infection in liver transplant recipients ( OR=10.878, 95% CI: 3.632-32.580, P<0.001). Conclusion:It is necessary to prevent ventilator-associated pneumonia in liver transplant recipients. Early removal of the tracheal tube and strengthening hospital infection prevention and control are of great significance in reducing the risk of postoperative infection in liver transplant recipients.

Objective To construct a risk prediction model for ventilator-associated pneumonia(VAP)in trauma patients and evaluate its efficacy.Methods A single-center retrospective study was conducted,trauma patients admitted to the department of emergency intensive care unit(EICU)of Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine from January 1,2018 to January 1,2023 were selected as the study subjects,and the patients were divided into VAP group and non-VAP group.Differences between the two groups in variables including demographic characteristics,clinical data,and clinical scores.To prevent overfitting,differences between the groups were reduced using LASSO regression.Multifactor Logistic regression was used to identify risk factors for VAP in trauma patients and construct a risk prediction model.The model's discrimination was evaluated using the receiver operator characteristic curve(ROC curve)and area under the curve(AUC).The calibration curve was drawn and Hosmer-Lemeshow test were performed to evaluate the calibration degree of the model.Decision curve analysis(DCA)and clinical impact curve(CIC)were used to analyse the model's net benefit at different probability thresholds.Results A total of 888 trauma patients were included,among which 166 cases(18.7%)were diagnosed with VAP.Compared to the non-VAP group,the VAP group showed a significant increase in age,age-adjusted Charlson comorbidity index(aCCI)scores,white blood cell count(WBC),sequential organ failure assessment(SOFA)scores,length of ICU stay,and the proportion of patients with chest trauma,traumatic brain injury,and spinal cord injury.In contrast,hemoglobin(Hb),Glasgow coma scale(GCS)scores,and body mass index(BMI)were significantly lower in the VAP group(all P<0.05).Using LASSO regression,four variables were identified as important predictors for the occurrence of VAP in trauma patients:length of ICU stay,aCCI,WBC,and SOFA score.Multivariate Logistic regression showed that length of ICU stay[odds ratio(OR)and 95%confidence interval(95%CI)was 1.094(1.070-1.117)],aCCI[OR(95%CI)was 1.135(1.065-1.210)],WBC[OR(95%CI)was 1.139(1.104-1.176)],and SOFA score[OR(95%CI)was 1.137(1.080-1.197)]were independent risk factors for the occurrence of VAP in trauma patients(all P<0.05).Based on these influencing factors,a predictive model for VAP occurrence was constructed.ROC curve analysis showed that the AUC for predicting VAP occurrence in trauma patients was 0.876,with a 95%CI was 0.850-0.903,a sensitivity of 86.14%,and a specificity of 75.17%,indicating that the model has a high discriminative ability.Hosmer-Lemeshow test:χ2=7.7,P=0.2,Cox&Snell R2=0.236,Nagelkerke R2=0.387,the calibration curve was very close to the diagonal,and the mean absolute error(MAE)=0.03,indicating the model's predictions were highly consistent with actual clinical observations.The DCA and CIC curves indicate that within the threshold probability of<70%,using this model to identify high-risk groups for VAP in trauma patients and making clinical decisions can provide benefits in clinical practice.Conclusion The risk prediction model of VAP in trauma patients constructed in this study has high discrimination and calibration,which can provide reference for medical personnel to identify high-risk groups of VAP among trauma patients at an early stage and provide targeted intervention measures.

Pyroptosis,as the main mechanism of host defense,is the key link between innate immunity and adaptive immunity.Pyroptosis is accompanied by membrane rupture,and the cells release a large number of inflammatory mediators,which recruit inflam-matory cells and activate the inflammatory response.Tumor immunotherapy utilizes the natural defense mechanism of the host to ad-minister certain immunomodulators,antibodies or stimulation-adjusted immune cells to obtain stronger anti-tumor effects.Recent stud-ies have shown that pyroptosis has a positive regulatory effect on tumor immunotherapy,including immune checkpoint inhibitors and chimeric antigen receptor T-cell immunotherapy,etc.In this paper,based on the published experimental studies,the mechanism of pyroptosis and its correlation with tumor immunotherapy.In this paper,based on the published experimental studies,the mechanism of cellular apoptosis in tumor immunity is elucidated on the basis of the mechanism of apoptosis and the correlation between tumor im-munotherapy,in order to provide new ideas for the basic and clinical research of malignant tumors.

Objective:To construction the risk factors associated with prolonged hospitalization in patients with severe acute pancreatitis (SAP) and develop a prediction model for assessing these risks.Methods:SAP patients admitted to the department of emergency of Hebei Province Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2015 to December 2023 were retrospectively selected as the study subjects. The 75% of hospital stay was used as the cut-off point, and the patients were categorized into a normal group and an extended group. Clinical indicators of patients were collected, and independent risk factors for prolonged hospital stay in SAP patients were analyzed using multifactor Logistic regression. A prediction model was established, and a nomogram was created. The efficiency of the prediction model was evaluated using a receiver operator characteristic curve (ROC curve). The accuracy of the model was assessed using Hosmer-Lemeshow goodness-of-fit test. Decision curve analysis (DCA) was employed to evaluate the clinical applicability of the model. Finally, internal validation of the model was conducted using Bootstrap method.Results:A total of 510 patients with SAP were included, and the length of hospital stay was 18 (6, 44) days, including 400 cases in the normal group (<24 days) and 110 cases in the extended group (≥24 days). Multivariate Logistic regression analysis showed that abdominal effusion [odds ratio ( OR) = 4.163, 95% confidence interval (95% CI) was 2.105-8.234], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ; OR = 1.320, 95% CI was 1.185-1.470), C-reactive protein (CRP; OR = 1.006, 95% CI was 1.002-1.011), modified CT severity index (MCTSI; OR = 1.461, 95% CI was 1.213-1.758), procalcitonin (PCT; OR = 1.303, 95% CI was 1.095-1.550) and albumin ( OR = 0.510, 95% CI was 0.419-0.622) were independent risk factors for prolonged hospital stay in SAP patients (all P < 0.01). ROC curve analysis showed that the area under the curve (AUC) of the model was 0.922 (95% CI was 0.896-0.947), the optimal cut-off value was 0.726, the sensitivity was 87.3%, and the specificity was 85.3%. Hosmer-Lemeshow test showed that χ 2 = 5.79, P = 0.671. It showed that the prediction model had good prediction efficiency and fit degree. The DCA curve showed that the prediction probability of the model could bring more clinical benefits to patients at 0.1 to 0.7. Bootstrap internal verification showed that the model had a high consistency (AUC = 0.916). Conclusions:Abdominal effusion, high APACHEⅡ score, high CRP, high MCTSI, high PCT and low albumin level are significantly associated with prolonged hospital stay in SAP patients. The prediction model can help clinicians make more scientific clinical decisions for SAP patients.

Objective:To investigate whether end-tidal carbon dioxide (etCO 2) is associated with acute kidney injury (AKI) after liver transplantation. Methods:Clinical data of 83 patients undergoing classic allogeneic liver transplantation were retrospectively collected. Patients were divided into AKI group and non AKI group based on changes in serum creatinine levels within 48 hours after surgery, and differences in baseline data, intraoperative etCO 2 decrease rate [ΔetCO 2(%)], and postoperative creatinine values were analyzed between the groups. Results:The incidence of AKI within 48 hours after liver transplantation in 83 patients was 56.6%(47/83). The proportion of male patients in the AKI group was higher ( P=0.003), and the ΔetCO 2(%) in the anhepatic phase of AKI group patients was higher than that of non AKI patients [(0.26±0.08)% vs (0.22±0.07)%, P=0.024]. There was no statistically significant difference in ΔetCO 2(%) between the two groups during pre liver, inferior vena cava (IVC) occlusion, and new liver phase (all P>0.05). On the 7th day after surgery, the creatinine value in the AKI group was significantly higher than that in the non AKI group [68.7(55.4, 92.6)]μmol/L vs 52.7(44.1, 69.3)μmol/L, P<0.001], at a 3-month follow-up, creatinine levels in 43 patients (91.5%) in the AKI group returned to normal. Conclusions:The decrease in ΔetCO 2(%) during the anhepatic phase of liver transplantation reflects to some extent the severe fluctuations in circulation during the operation, which may be related to the occurrence of AKI within 48 hours after surgery.

Objective To construct a risk prediction model for ventilator-associated pneumonia(VAP)in trauma patients and evaluate its efficacy.Methods A single-center retrospective study was conducted,trauma patients admitted to the department of emergency intensive care unit(EICU)of Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine from January 1,2018 to January 1,2023 were selected as the study subjects,and the patients were divided into VAP group and non-VAP group.Differences between the two groups in variables including demographic characteristics,clinical data,and clinical scores.To prevent overfitting,differences between the groups were reduced using LASSO regression.Multifactor Logistic regression was used to identify risk factors for VAP in trauma patients and construct a risk prediction model.The model's discrimination was evaluated using the receiver operator characteristic curve(ROC curve)and area under the curve(AUC).The calibration curve was drawn and Hosmer-Lemeshow test were performed to evaluate the calibration degree of the model.Decision curve analysis(DCA)and clinical impact curve(CIC)were used to analyse the model's net benefit at different probability thresholds.Results A total of 888 trauma patients were included,among which 166 cases(18.7%)were diagnosed with VAP.Compared to the non-VAP group,the VAP group showed a significant increase in age,age-adjusted Charlson comorbidity index(aCCI)scores,white blood cell count(WBC),sequential organ failure assessment(SOFA)scores,length of ICU stay,and the proportion of patients with chest trauma,traumatic brain injury,and spinal cord injury.In contrast,hemoglobin(Hb),Glasgow coma scale(GCS)scores,and body mass index(BMI)were significantly lower in the VAP group(all P<0.05).Using LASSO regression,four variables were identified as important predictors for the occurrence of VAP in trauma patients:length of ICU stay,aCCI,WBC,and SOFA score.Multivariate Logistic regression showed that length of ICU stay[odds ratio(OR)and 95%confidence interval(95%CI)was 1.094(1.070-1.117)],aCCI[OR(95%CI)was 1.135(1.065-1.210)],WBC[OR(95%CI)was 1.139(1.104-1.176)],and SOFA score[OR(95%CI)was 1.137(1.080-1.197)]were independent risk factors for the occurrence of VAP in trauma patients(all P<0.05).Based on these influencing factors,a predictive model for VAP occurrence was constructed.ROC curve analysis showed that the AUC for predicting VAP occurrence in trauma patients was 0.876,with a 95%CI was 0.850-0.903,a sensitivity of 86.14%,and a specificity of 75.17%,indicating that the model has a high discriminative ability.Hosmer-Lemeshow test:χ2=7.7,P=0.2,Cox&Snell R2=0.236,Nagelkerke R2=0.387,the calibration curve was very close to the diagonal,and the mean absolute error(MAE)=0.03,indicating the model's predictions were highly consistent with actual clinical observations.The DCA and CIC curves indicate that within the threshold probability of<70%,using this model to identify high-risk groups for VAP in trauma patients and making clinical decisions can provide benefits in clinical practice.Conclusion The risk prediction model of VAP in trauma patients constructed in this study has high discrimination and calibration,which can provide reference for medical personnel to identify high-risk groups of VAP among trauma patients at an early stage and provide targeted intervention measures.

OBJECTIVE To establish the estimation model for the exposure of mycophenolic acid （MPA） in early renal transplant recipients [calculated by the area under the plasma concentration-time curve with 12 h （AUC0－12 h）]. METHODS Twenty kidney transplant recipients， who received triple immunosuppressive therapy of mycophenolate mofetil （MMF）+tacrolimus+ methylprednisolone， were selected and given MMF dispersible tablets （750 mg， q12 h） on the 15th day after the operation； the blood samples were collected from the patients before and 0.5， 1.0， 1.5， 2.0， 3.0， 4.0， 6.0， 8.0， 12.0 hours after the administration， respectively. The blood concentration of MPA was determined， and the pharmacokinetic parameters of MPA were calculated. The multivariate linear stepwise regression analysis method was used to fit an estimation formula for the finite sampling method suitable for MPA-AUC0－12 h of the recipients. Bland-Altman analysis was used to evaluate the agreement between the estimation formula and the classical pharmacokinetic method. RESULTS The main pharmacokinetic parameters of MPA in 20 renal transplant recipients： c0 was （1.53±0.84） μg/mL， cmax was （12.07±5.97） μg/mL， t1/2 was （5.41±3.67） h， tmax was （1.58±0.75） h， and the average AUC0－12 h calculated by the classical pharmacokinetic method was （33.95±13.40） μg·h/mL. MPA-AUC0－12 h was estimated with sampling points of “4.0， 8.0， 12.0 h”； the simplified calculation formula was AUC0－12 h＝12.058+2.819c4.0+7.045c8.0+ 3.879c12.0 （R 2＝0.934）. The predicted value had a good correlation and consistency with the measured value， and 95.0% of predicted values did not exceed the x±1.96SD （standard deviation） range. CONCLUSIONS The estimation model is established successfully for the exposure of MPA in early renal transplant recipients； the model has better prediction accuracy and fewer sampling points.