Objective To analyze the risk factors for the development of chronic critical illness(CCI)in septic shock patients in the intensive care unit(ICU).Methods A retrospective analysis was conducted on 102 sepsis shock patients admitted to the ICU of the hospital from August 2018 to May 2023.According to their clinical dates,they were divided into CCI group(n=60)and rapid recovery(RR)group(n=42).Multi-ple logistic regression analysis was perform to identify independent risk factors for developing CCI in septic shock patients,and construct their receiver operating characteristic(ROC)curves to evaluate their predictive value for CCI.Results The prolonged duration of hypernatremia(OR=1.770,95％CI:1.147-2.731,P=0.010)and low acute physiology and chronic health(APACHEⅡ)scores(OR=1.212,95％CI:1.025-1.433,P=0.025)were independent risk factors for CCI in ICU septic shock patients.The occurrence of acute gastrointestinal injury(OR=0.060,95％CI:0.011-0.341,P=0.002)and peak blood sodium levels during ICU(OR=0.812,95％CI:0.662-0.995,P=0.044)were protective factors.Conclusion For septic shock pa-tients,special attention should be paid to its related independent risk factors and protective factors to improve the prognosis of septic shock patients.

Objective To investigate the diagnostic value of serum carcinoembryonic antigen-related cell adhesion molecule 6(CEACAM6)in pancreatic cancer.Methods A total of 188 patients admitted to the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from May to December 2024 were consecutively enrolled,including 112 patients in the pancreatic cancer group and 76 patients in the benign pancreatic disease group(43 with pancreatitis and 33 with benign pancreatic tumors).Additional-ly,76 healthy individuals were included in the health control group.Serum CEACAM6 and carbohydrate antigen 19-9(CA19-9)levels were detected by ELISA and chemiluminescence immunoassay(CLIA),respectively.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of serum CEACAM6 for pancreatic cancer.The positive rate of serum CEACAM6 in CA19-9-negative pancreatic cancer patients was also investigated.Results The levels of serum CEACAM6 in the pancreatic cancer group(20.3[11.1,34.0]ng/mL)were significantly higher than those in the benign pancreatic disease group(6.2[2.6,10.5]ng/mL,Z=64.1,P＜0.001)and healthy control group(0.8[0.4,4.4]ng/mL,Z=131.6,P＜0.001).The areas under the ROC curve(AUCROC),sensitivity,and specificity of CEACAM6 and CA19-9 in the diagnosis of pancreatic cancer were 0.889(95%CI:0.854-0.924)and 0.819(95%CI:0.761-0.863),81.3%and 65.2%,and 84.9%and 86.2%,respectively.The AUCROC,sensitivity,and specificity of the combined detection of the two reached 0.916(95%CI:0.875-0.946),91.1%,and 82.2%,respectively,which were better than any single indicator(P＜0.05).In addition,the positive rate of serum CEACAM6 in CA19-9-negative pancreatic canc-er patients was 83.3%,significantly higher than CEA and CA125(P＜0.01).Conclusion The detection of serum CEACAM6 is help-ful to the diagnosis of pancreatic cancer,and its combination with serum CA19-9 can improve the diagnostic efficacy of pancreatic cancer.

Objective To investigate the diagnostic value of serum carcinoembryonic antigen-related cell adhesion molecule 6(CEACAM6)in pancreatic cancer.Methods A total of 188 patients admitted to the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from May to December 2024 were consecutively enrolled,including 112 patients in the pancreatic cancer group and 76 patients in the benign pancreatic disease group(43 with pancreatitis and 33 with benign pancreatic tumors).Additional-ly,76 healthy individuals were included in the health control group.Serum CEACAM6 and carbohydrate antigen 19-9(CA19-9)levels were detected by ELISA and chemiluminescence immunoassay(CLIA),respectively.The receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of serum CEACAM6 for pancreatic cancer.The positive rate of serum CEACAM6 in CA19-9-negative pancreatic cancer patients was also investigated.Results The levels of serum CEACAM6 in the pancreatic cancer group(20.3[11.1,34.0]ng/mL)were significantly higher than those in the benign pancreatic disease group(6.2[2.6,10.5]ng/mL,Z=64.1,P＜0.001)and healthy control group(0.8[0.4,4.4]ng/mL,Z=131.6,P＜0.001).The areas under the ROC curve(AUCROC),sensitivity,and specificity of CEACAM6 and CA19-9 in the diagnosis of pancreatic cancer were 0.889(95%CI:0.854-0.924)and 0.819(95%CI:0.761-0.863),81.3%and 65.2%,and 84.9%and 86.2%,respectively.The AUCROC,sensitivity,and specificity of the combined detection of the two reached 0.916(95%CI:0.875-0.946),91.1%,and 82.2%,respectively,which were better than any single indicator(P＜0.05).In addition,the positive rate of serum CEACAM6 in CA19-9-negative pancreatic canc-er patients was 83.3%,significantly higher than CEA and CA125(P＜0.01).Conclusion The detection of serum CEACAM6 is help-ful to the diagnosis of pancreatic cancer,and its combination with serum CA19-9 can improve the diagnostic efficacy of pancreatic cancer.

ObjectiveTo explore the distribution of pharyngeal microbiota in coal miners exposed to dust. Methods Eight coal miners who had been engaged in occupational dust exposure for more than 20 years were selected as the dust-exposed group, and four coal miners who were not exposed to dust at work were selected as the control group using the judgment sampling method. Pharyngeal secretions of the coal miners were collected with throat swabs, and its pharyngeal microbiota was analyzed. The diversity, abundance and evenness of the microbiota were analyzed by gene sequencing using the 16sRNA gene high-throughput sequencing technology. Results A total of 254 operational taxonomic units of pharyngeal microbiota were detected in the coal miners in the control group, which was 210 more than that in the dust-exposed group. The Chao1 index, Shannon index, PD-tree index and Pielou index of pharyngeal microbiota in the dust-exposed group decreased compared with the control group (all P<0.01). The abundance of Bacteroidetes and Clostridum, at the phylum level, in the pharynx of coal miners in the dust-exposed group was higher than that in the control group (all P<0.05). The abundance of Prevotella, Neisseria, and Monas, at the genus level, in the pharynx of coal miners in the dust-exposed group was higher than that in the control group(all P<0.05), while the abundance of Lactobacillus decreased (P<0.05). The analysis results of the receiver operating characteristic curve showed that Lactobacillus, Fusobacterium and Rothia may play a role for pharyngeal microbiota imbalance prediction in dust-exposed workers, and the area under the curves were all 1.00±0.00. Conclusion The species diversity and evenness of pharyngeal microbiota in coal miners exposed to dust are decreased, which may be related to the continuous inhalation of coal dust that disrupts the microbial environment of the throat.

Objective Based on the multi-software visual analysis of the literature on the effect of Janus kinase(JAK)/signal transducer and activator of transcription(STAT)signaling pathway on rheumatoid arthritis in the past decade,the development trend and research hotspot in this field are summarized.To provide researchers with new directions and ideas to promote the innovative development of the field.Methods The literatures related to JAK/STAT signaling pathway in rheumatoid arthritis were collected from the Web of Science Core Collection database from 2013 to 2023.CiteSpace and VOSviewer software were used to analyze the number of publications,countries,authors and keywords of 354 articles retrieved.Results The number of published papers in this field continues to increase.According to the author's research direction,the presentation of high-frequency words,and the attention to the preface and hot topics,it is suggested that this field focuses on gene expression,immune mechanism,inflammatory mechanism,pathway inhibitors,drug therapy,etc.Future research will focus on the safety,mechanism and controlled trials of pathway inhibitors and antirheumatic drugs.Conclusion The effect of JAK/STAT signaling pathway on rheumatoid arthritis has attracted much attention in the past,present and future.There are differences in the research of different teams in this field,and the regional development is unbalanced,suggesting that we should strengthen cooperation and exchanges,focus on the international frontier,and carry out more high-quality research to promote the development and progress of this field,and provide clinical basis.

Gastric cancer is one of the most common malignant tumors in the world, and its incidence and mortality are among the top of malignant tumors in China. Since Kitano et al com-plete the first laparoscopic radical gastrectomy for gastric cancer in the world in 1992, the laparos-copic technology has developed rapidly. After more than 30 years of exploration and practice, the clinical diagnosis and treatment of gastric cancer in China has also made considerable progress. A large number of clinical studies at home and abroad have confirmed that laparoscopic radical gas-trectomy is no less effective than traditional open surgery in the short and long term. Laparoscopic radical gastrectomy has the characteristics of less trauma, faster recovery of gastrointestinal func-tion, less postoperative pain, and shorter average hospital stay. It has gradually replaced open surgery as the mainstream surgical method for gastric cancer. As the concept of surgical treatment for gastric cancer continues to update, emerging minimally invasive technologies continue to emerge, including robotic surgery systems and indocyanine green tracing technology, which are increasingly used in gastric cancer surgery, making gastric cancer surgery more minimally invasive and accurate, the quality of perigastric lymph node dissection and the domestic gastric cancer surgery technology further improving. Based on the relevant research at home and abroad, the authors review and summarize the latest progress in recent years with the topic of minimally invasive surgery for gastric cancer, aiming to systematically describe the current situation and future prospects of gastric cancer surgery. It is believed that in the future, the clinical diagnosis and treatment of gastric cancer in China will be more standardized, minimally invasive and accurate, more high-quality multicenter clinical research will be carry out and the diagnosis and treatment of gastric cancer will be further improved in China.

Objective:To identify the effective concentrations of Ropivacaine in the modified fascial iliac compartment block(FICB)that would not affect the movement of the affected limb but would offer effective pain relief after total knee arthroplasty(TKA)in elderly patients.In addition, adverse reactions within 24 hours of FICB were examined.Methods:This study was a prospective, single-arm sequential trial.Forty-five elderly patients treated with TKA at the First Affiliated Hospital of Soochow University between September 2021 and March 2022 were selected, with an American Society of Anesthesiologists(ASA)score of Ⅰ or Ⅱ.All patients were given ultrasound-guided FICB on the surgical side under general anesthesia and 10 minutes before the operation, and the injection volume was 30 ml.According to preliminary experiments and relevant literature, the initial concentration of Ropivacaine was 0.1%, and the concentration for the next patient was determined using a modified Dixon sequential method.If the quadriceps femoris muscle strength score of the first patient was ≥4, there was no resting pain[visual analogue scale(VAS)score ≤1], and the VAS score during activity was ≤3, the concentration for the next patient would be reduced.Conversely, the concentration would be increased.The Ropivacaine concentration was increased or decreased by 0.01% each time and the trial would be stopped after 12 reentries.The median effective concentration(ED50), 95% effective concentration(ED95)and corresponding 95% confidence interval(CI)of ropivacaine were calculated using the probit model.Meanwhile, adverse reactions within 24 hours of FICB were monitored.Results:Of 43 elderly patients who completed the trial, the intervention was effective in 23 and ineffective in 20.While ensuring that postoperative limb movement in elderly patients was not affected, a single injection of 30 ml ropivacaine through FICB was able to effectively inhibit postoperative pain, and the ED50 and ED95 of ropivacaine were 0.072%(95% CI: 0.065%-0.078%)and 0.093%(95% CI: 0.084%-0.124%), respectively.Within 24 hours of FICB, 2 patients had lower limb weakness and could not get out of bed and walk, and 5 patients had severe pain and needed additional analgesics.No other adverse reactions were found. Conclusions:The effective ED50 and ED95 of Ropivacaine for postoperative pain relief in elderly patients after TKA are 0.072% and 0.093%, respectively.And the incidence of adverse reactions is low.

Background Diagnosis of pneumoconiosis by radiologist reading chest X-ray images is affected by many factors and is prone to misdiagnosis/missed diagnosis. With the rapid development of artificial intelligence in the field of medical imaging, whether artificial intelligence can be used to read images of pneumoconiosis deserves consideration. Objective Three deep learning models for identifying presence of pneumoconiosis were constructed based on deep convolutional neural network. An optimal model was selected by comparing diagnostic efficiency of the three models. Methods Digital radiography (DR) chest images were collected between June 2017 and December 2020 from 7 hospitals and standard radiograph quality control protocol was also followed. The DR chest images with positive results were classified into the positive group, while those without pneumoconiosis were classified into the negative group. The collected chest radiographs were labeled by experts who had passed the assessment of reading radiographs,and the experts were constantly assessed for consistency in the labeling process based on an expectation-maximization algorithm. The labeled data were cleaned, archived, and preprocessed, and then were grouped into a training set and a verification set. Three deep convolutional neural network models TMNet, ResNet-50, and ResNeXt-50 were constructed and trained by ten-fold cross-validation method to obtain an optimal model. Five hundred cases of DR chest radiographs that were not included in the training set and the validation set were collected, and identified by five senior experts as the gold standard, named the test set. The accuracy rate, sensitivity, specificity, area under curve (AUC), and other indexes of the three models were derived after testing, and the efficiency of the three models was evaluated and compared. Results A total of 24867 DR chest radiographs of the training set and the validation set were collected in this study, including 6978 images in the positive group and 17889 images in the negative group. There were 312 cases of pulmonary abnormalities such as pneumothorax and pulmonary tuberculosis. A total of nine experts labeled the chest radiographs, the labeling consistency rate of pneumoconiosis (non-staging) was above 88%, and the labeling consistency rate of pneumoconiosis staging ranged from 84.68% to 93.66%. The diagnostic accuracy, sensitivity, specificity, and AUC of TMNet were 95.20%, 99.66%, 88.61%, and 0.987, respectively. The indicators of ResNeXt were 87.00%, 89.93%, 82.67%, and 0.911, respectively. Those of ResNet were 84.00%, 85.91%, 81.19%, and 0.912, respectively. All these indexes of TMNet were higher than those of ResNeXt-50 and ResNet-50 models. The AUC differences between TMNet and the other two models were both statistically significant (P<0.001). Conclusion All the three convolutional neural network models can effectively diagnose the presence of pneumoconiosis, among which TMNet provides the best efficiency.

Objective:To explore the relationship between input and output of occupational health funds, and to provide basis for relevant departments to make decisions.Methods:In September 2018, a state-owned iron ore in Hebei Province (mining history of more than 10 years, which can represent the general type of iron ore) was selected as the research object. Through the investigation and collection of enterprise general situation, occupational health input, loss and output related indicators, the iron mine occupational health expenditure input-output table and model were established, and the digital relationship between the investment and output was solved by MATLAB software.Results:The labor consumption in the departments of underground mining, open pit mining, crushing and rock discharging, transportation, tailings and mineral processing (taking labor wages as reference) were 756.46, 1.281.78, 987.61, 1 570.71, 50.956 and 18.9116 million yuan/year respectively. The output value of each sector is 11 207.19, 18 989.95, 15 176.40, 25 294.00, 7.704.94 and 280.1797 million yuan/year respectively. The ratio of health input to total output was 0.004 5, and the ratio of occupational health input to output was 1/0.046.Conclusion:The input-output table model of occupational health in iron mine can reflect the relationship between input and output of occupational health funds. The input situation of the coal mine is poor, and the input does not bring obvious occupational health benefits.