Objective:To explore the efficacy and safety of sivelestat sodium in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU).Methods:Sixty patients with ARDS admitted to the ICU of the Fuyang Hospital Affiliated to Anhui Medical University from August 1, 2023 to November 1, 2024 were selected and divided into the control group (conventional treatment, 30 cases) and the sivelestat sodium group (treated with sivelestat sodium in addition to conventional treatment, 30 cases) by the random number table method. The clinical data such as inflammatory factors, blood gas analysis indicators, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and Sequential Organ Failure Assessment (SOFA) score of the two groups of patients before treatment and 3 days after treatment were compared. The prognostic indicators such as mechanical ventilation time, ICU stay time, total hospital stay time, 28-day mortality rate and clinical efficacy of the two groups of patients were compared.Results:Before treatment, there were no statistically significant differences in inflammatory factors, blood gas analysis indicators, APACHE Ⅱ score and SOFA score between the two groups of patients (all P>0.05). After 3 days of treatment, the improvement degrees of APACHE Ⅱ score, SOFA score, arterial partial pressure of oxygen (PaO 2), oxygenation index (PaO 2/FiO 2), procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) in the sivelestat sodium group were all greater than those in the control group. The differences were all statistically significant (all P<0.05); The mechanical ventilation time [(5.31±4.12) d vs (7.17±2.32)d] and ICU stay [(6.31±3.42)d vs (8.93±5.26)d] of patients in the sivelestat sodium group were significantly shorter than those in the control group, and the differences were statistically significant (all P<0.05). There was no statistically significant difference in the 28-day mortality rate between the sivelestat sodium group [20.00%(6/30)] and the control group [43.33%(13/30)] ( P>0.05). The total effective rate of treatment in the sivelestat sodium group was significantly higher than that in the control group [80.00%(24/30) vs 56.67%(17/30)], and the difference was statistically significant (χ 2=4.167, P=0.041). Conclusions:Sivelestat sodium is helpful in improving the physiological parameters of patients with ARDS, effectively reducing the levels of inflammatory factors in the body, shortening the duration of mechanical ventilation and ICU stay, but has no significant effect on the 28-day mortality rate.

Objective:To explore the efficacy and safety of sivelestat sodium in patients with acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU).Methods:Sixty patients with ARDS admitted to the ICU of the Fuyang Hospital Affiliated to Anhui Medical University from August 1, 2023 to November 1, 2024 were selected and divided into the control group (conventional treatment, 30 cases) and the sivelestat sodium group (treated with sivelestat sodium in addition to conventional treatment, 30 cases) by the random number table method. The clinical data such as inflammatory factors, blood gas analysis indicators, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score and Sequential Organ Failure Assessment (SOFA) score of the two groups of patients before treatment and 3 days after treatment were compared. The prognostic indicators such as mechanical ventilation time, ICU stay time, total hospital stay time, 28-day mortality rate and clinical efficacy of the two groups of patients were compared.Results:Before treatment, there were no statistically significant differences in inflammatory factors, blood gas analysis indicators, APACHE Ⅱ score and SOFA score between the two groups of patients (all P>0.05). After 3 days of treatment, the improvement degrees of APACHE Ⅱ score, SOFA score, arterial partial pressure of oxygen (PaO 2), oxygenation index (PaO 2/FiO 2), procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) in the sivelestat sodium group were all greater than those in the control group. The differences were all statistically significant (all P<0.05); The mechanical ventilation time [(5.31±4.12) d vs (7.17±2.32)d] and ICU stay [(6.31±3.42)d vs (8.93±5.26)d] of patients in the sivelestat sodium group were significantly shorter than those in the control group, and the differences were statistically significant (all P<0.05). There was no statistically significant difference in the 28-day mortality rate between the sivelestat sodium group [20.00%(6/30)] and the control group [43.33%(13/30)] ( P>0.05). The total effective rate of treatment in the sivelestat sodium group was significantly higher than that in the control group [80.00%(24/30) vs 56.67%(17/30)], and the difference was statistically significant (χ 2=4.167, P=0.041). Conclusions:Sivelestat sodium is helpful in improving the physiological parameters of patients with ARDS, effectively reducing the levels of inflammatory factors in the body, shortening the duration of mechanical ventilation and ICU stay, but has no significant effect on the 28-day mortality rate.

Objective:To investigate the risk factors for early allograft dysfunction (EAD) following deceased donor liver transplantation in pediatric recipients.Method:A retrospective analysis was conducted on 390 pediatric liver transplant recipients who underwent deceased donor liver transplantation at Tianjin First Central Hospital between January 1, 2018, and December 31, 2023. Patients were categorized into the EAD group (152 cases) and the non-EAD group (238 cases) based on the presence or absence of EAD. Patient and graft survival rates were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent risk factors for EAD. A nomogram was constructed and validated using receiver operating characteristic (ROC) curves to assess predictive performance.Result:Among the 390 pediatric liver transplant recipients, 152 cases (38.97%) developed EAD. Postoperative intensive care unit (ICU) stay and duration of ventilatory support were significantly longer in the EAD group compared to the non-EAD group ( P<0.05). The 1-month (90.8% vs. 97.1%) and 3-month (90.7% vs. 95.4%) cumulative graft survival rates were significantly lower in the EAD group than in the non-EAD group ( χ2=4.36, P=0.037). However, the 1-month (93.4% vs. 97.9%) and 3-month (92.8% vs. 96.6%) cumulative recipient survival rates showed no statistically significant difference between the two groups ( χ2=3.15, P=0.076). Multivariate logistic regression analysis identified recipient weight ( P=0.0091), preoperative blood lactate level ( P=0.0065), donor age ( P=0.0434), operative duration ( P<0.01), cold ischemia time ( P<0.01), and portal venous flow (PVF) before abdominal closure ( P=0.0241) as independent risk factors for EAD. The combination of these factors demonstrated good predictive performance for EAD, with an area under the curve (AUC) of 0.75 (95% CI: 0.70~0.80, P<0.05) . Conclusion:Recipient weight, preoperative blood lactate levels, donor age, operative duration, cold ischemia time, and PVF before abdominal closure are significantly associated with the development of EAD in pediatric recipients undergoing deceased donor liver transplantation. Optimizing preoperative donor and recipient assessment, as well as refining surgical procedures, may help reduce the incidence of EAD and improve post-transplant outcomes.

Objective:To investigate the risk factors for early allograft dysfunction (EAD) following deceased donor liver transplantation in pediatric recipients.Method:A retrospective analysis was conducted on 390 pediatric liver transplant recipients who underwent deceased donor liver transplantation at Tianjin First Central Hospital between January 1, 2018, and December 31, 2023. Patients were categorized into the EAD group (152 cases) and the non-EAD group (238 cases) based on the presence or absence of EAD. Patient and graft survival rates were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent risk factors for EAD. A nomogram was constructed and validated using receiver operating characteristic (ROC) curves to assess predictive performance.Result:Among the 390 pediatric liver transplant recipients, 152 cases (38.97%) developed EAD. Postoperative intensive care unit (ICU) stay and duration of ventilatory support were significantly longer in the EAD group compared to the non-EAD group ( P<0.05). The 1-month (90.8% vs. 97.1%) and 3-month (90.7% vs. 95.4%) cumulative graft survival rates were significantly lower in the EAD group than in the non-EAD group ( χ2=4.36, P=0.037). However, the 1-month (93.4% vs. 97.9%) and 3-month (92.8% vs. 96.6%) cumulative recipient survival rates showed no statistically significant difference between the two groups ( χ2=3.15, P=0.076). Multivariate logistic regression analysis identified recipient weight ( P=0.0091), preoperative blood lactate level ( P=0.0065), donor age ( P=0.0434), operative duration ( P<0.01), cold ischemia time ( P<0.01), and portal venous flow (PVF) before abdominal closure ( P=0.0241) as independent risk factors for EAD. The combination of these factors demonstrated good predictive performance for EAD, with an area under the curve (AUC) of 0.75 (95% CI: 0.70~0.80, P<0.05) . Conclusion:Recipient weight, preoperative blood lactate levels, donor age, operative duration, cold ischemia time, and PVF before abdominal closure are significantly associated with the development of EAD in pediatric recipients undergoing deceased donor liver transplantation. Optimizing preoperative donor and recipient assessment, as well as refining surgical procedures, may help reduce the incidence of EAD and improve post-transplant outcomes.

Objective:To investigate the effect of early protein supplementation on the clinical outcomes of elderly ICU patients with critically ill.Methods:The study was a post-hoc analysis of a multicenter, cluster randomized controlled trial (NEED trial), which aimed to evaluate the impact of feeding protocol on nutritional implementation and outcomes in ICU patients. It was planned to include elderly patients aged ≥70 years from the NEED trial, and patients who had not started nutritional therapy by the Day 3 after enrolment, stayed in the ICU less than 7 days, missing the primary outcome were excluded. The primary outcome of this study was 28-day mortality of enrolment. Patients were categorized into Q1 (<0.6 g/kg/d), Q2 (0.6-0.83 g/kg/d), and Q3 (≥0.83 g/kg/d) groups according to the tertiles of protein supply. The log-rank test was used to compare the Kaplan-Meier survival curves for 28-day mortality. The associations between different protein groups and 28-day mortality were tested by Cox proportional hazards regression models. Subgroup analysis was conducted in patients with high (mNUTRIC score≥5) nutritional risk or patients with baseline acute kidney injury.Results:A total of 789 elderly (≥70 years) patients was included in the study, with a mean protein amount of 0.69 (0.53, 0.91) g/(kg·d) during days 3-7 after ICU admission, and mean protein amounts in the Q1 low-protein group, the Q2 medium-protein group, and the Q3 high-protein group were 0.46 (0.36, 0.53), 0.69 (0.63, 0.76), and 1.03 (0.91, 1.23) g/(kg·d), respectively. The results showed that the medium protein group associated with lower 28-day mortality compared to the high protein group, and the association between the medium protein group and lower 28-day mortality still held after controlling for possible confounders by Cox multivariate regression analysis. In the high-nutritional risk subgroup (mNUTRIC≥5), a significant association was also found between the medium protein group and lower 28-day mortality.Conclusions:Early high protein supply are not beneficial for elderly ICU patients by this large sample size post-hoc analysis, and medium protein supply associate with lower 28-day mortality compared with the high protein group. This study may provide a theoretical basis for the optimal dose of early protein supply in elderly ICU patients, as well as a reference for clinical implementation.

Humans ; Angina, Stable ; COVID-19 ; Risk Factors ; Patients

Objective: To investigate the incidence and associated factors of spinal curvature disorders among primary and middle school students in Hohhot, so as to provide reference for relevant prevention strategies. Methods: According to the monitoring and intervention work of students common diseases in Inner Mongolia Autonomous, 13 586 primary and middle school students in Hohhot were selected by random sampling method to carry out scoliosis examination in September 2021. Results: A total of 538( 4.0% ) students were found to have spinal curvature disorder. Multivariate Logistic regression analysis showed that monitoring site, phases of studying, and persistent back pain in the past 1 month were associated of spinal curvature disorder in primary and middle school students ( OR =0.33, 1.74, 1.28, 1.51, P <0.05). Conclusion Spinal curvature disorder is relatively common in primary and middle school students in Hohhot. Effective measures should be taken to reduce the burden of spinal curvature disorders in primary and middle school students.

Objective: To analyze the prevalence and trend of myopia among children and adolescents in Inner Mongolia from 2019 to 2021，so as to provide a reference for making scientific and effective prevention and controlling measures of myopia. Methods: By using the stratified random cluster sampling method, 555 093 children and adolescents were selected from 12 professional institutions in league cities of the whole region for remote vision examination and refractive examination. The refraction test was carried out under the condition of non-Ciliary muscle paralysis using a desktop automatic computer optometer. Chi-squared test and multivariate Logistic regression were used to analyze the myopia status of children and adolescents and its influencing factors. Results: From 2019 to 2021, the myopia rate of children and adolescents was 53.30%, 58.65% and 54.82%, respectively, the difference was statistically significant ( χ 2=991.70, P <0.01). The overall female myopia rate(58.82%) was higher than that of male (51.52%), and the differece was statistical significant ( χ 2=3 295.66, P <0.05). The myopia rates of boys and girls by year were 49.44% and 57.30%, 54.76% and 62.60%, 51.23% and 57.62%, respectively, and the differences were statistically significant ( χ 2=1 197.02, 922.31, 1 172.09, P <0.01). The overall myopia rate of urban students (59.42%) was higher than that of suburban counties (53.61%), and the difference was statistically significant ( χ 2=1 565.03, P <0.05). The myopia rates of children and adolescentss in urban and suburban counties were 59.20% and 50.79%, 60.26% and 57.88%, 58.95% and 53.36%, and the differences were statistically significant ( χ 2=1 150.80, 74.10, 529.25, P <0.01). The children and adolescents of learning stages were of statistical significance ( χ 2=92 402.39, P <0.05), and the overall myopia rate of senior school students was the highest, accounting for 83.57%. The difference of overall myopia rates of different age groups was of statistical significance ( χ 2=121 881.67, P <0.05), and the students in age group of 17 ranked the first (83.32%), those in age group of 5 ranked the last(15.52%). Conclusion From 2019 to 2021, the myopia rate of children and adolescents in the Inner Mongolia Autonomous Region increase first and then decrease, and the myopia rate in 2020 and 2021 is higher than that in 2019. The high incidence and low age of myopia are intensifying. The prevention and controlling of myopia among children and adolescents should be strengthened, so as to reduce the occurance of myopia.

Objective:To explore the reconstruction strategy and technical selection of S3 hepatic vein with middle hepatic vein confluence in pediatric liver transplantation(LT)using living donor left lateral segment to lower the risk of vascular complications caused by variant grafts.Methods:From January 2015 to June 2021, retrospective analysis is performed for 840 consecutive cases of pediatric living donor LT using left lateral segment(LLS).There are 32 cases of S3 hepatic vein with middle hepatic vein confluence with an overall incidence of 3.81%.Individualized reconstruction strategies are implemented according to the specific conditions of variation and different interposition vessels available: group I unification venoplasty technique with interposition vein graft is employed for reconstructing HV from grafts, prolonged S3 is formed into a single opening with S2 and then anastomosed with recipient(21 cases); group Ⅱ dual HV reconstructions were performed(11 cases); venoplasty of recipients'LHV, MHV and inferior vena cava(IVC)is performed for creating a large orifice for anastomosis with S2 HV from graft and S3 is anastomosed with stump of recipient right HV directly or interposed blood vessels.Clinical features and prognosis of two groups, the incidence, treatment and prognosis of HVOO and the incidence of HVOO between variant and non-variant groups were compared.Results:The median follow-up time of variant group(32 cases)is 23.8 month with an incidence of HVOO at 15.6%.During the same period, the non-variant group incidence of HVOO is 4.5%.There is inter-group statistical difference( P=0.014).The only statistical difference between groups Ⅰ and Ⅱ is ultrasonic blood flow velocity of S3 HV at 14 POD [(39.15±16.37)vs(20.05±8.52)cm/s, P=0.001].HVOO occurred in 7 cases and 6 cases respectively in groupⅠ and group Ⅱ.There is no statistical difference( P=0.310).There are no intractable vascular complications.Long-term vascular patency of allogeneic and autologous interposition vein is satisfactory and there is no graft failure or mortality related to HVOO. Conclusions:Selecting strategies and techniques for reconstructing S3 hepatic vein with middle hepatic vein confluence at our center are reasonable, safe and effective.And the overall treatment efficacy is satisfactory.Reasonable selection of multidimensional reconstruction methods and accurate application of various technologies are conducive to improving patient prognosis.

Objective:To explore the relationship between serum lactate level and early prognosis after liver transplantation (LT) in children.Methods:Between January 1, 2018 and December 31, 2020, 675 pediatric LT recipients were recruited. Clinical data were retrospectively reviewed, early postoperative serum lactate level and clearance rate recorded and receiver operating characteristic (ROC) curve plotted for determining optimal cut-off values. The inter-group differences in early postoperative complications and patient/graft survival rates were compared.Results:According to ROC, blood lactate levels >1.99 mmol/L at 12 h postoperatively were associated with early postoperative graft loss (AUC 0.73, 95% CI: 0.62-0.84, P=0.01). Age and weight of recipients in high-level group were 7.17(5.70-10.40) month and 7.00(6.00-8.60) kg and both were significantly lower than those in low-level group [7.80(6.21-13.58) month and 7.20(6.45-9.00) kg]. The inter-group differences were statistically significant ( P=0.017, P=0.034). Blood plasma transfusion volume, red blood cell transfusion volume, portal vein pressure pre-closure, postoperative intensive care unit (ICU) stay, ventilator use time, early allograft dysfunction rate, early postoperative pulmonary infection rate and recipient mortality rate in high-level group were 400 (200-400) ml, 2.00 (2.00-4.00) U, (15.71±4.44) mmHg, 2.50(2.00-3.00) day, 3.81(2.47-8.50) hour, 22.95%(42/185), 16.76%(31/185) and 6.49%(12/185) respectively. The above values were significantly higher than those in low-level group 200(100-400) ml, 2.00 (2.00-3.00) U, (14.69±4.68) mmHg, 2.00(2.00-3.00) day, 3.53(2.34-6.12) hour, 14.69%(72/490), 11.02%(54/490) and 1.43%(7/490) respectively. The inter-group differences were statistically significant ( P<0.001, P=0.014, P=0.015, P=0.037, P=0.043, P=0.011, P=0.045 & P<0.001). The incidence of early postoperative acute cellular rejection was significantly lower in high-level group than that in low-level group [11.89%(22/185) vs 22.86%(112/490)]. The inter-group difference was statistically significant ( P=0.01). The 1/3-month cumulative survival rates of patient/graft were 94.6%, 94.1% and 92.4%, 91.4% in high-level group versus 99.2%, 98.6% and 99.0%, 98.4% in low-level group. There were significant inter-group differences ( P=0, P<0.000 1). With a rising level of lactate at 12 h postoperatively, risk of early graft loss and early recipient mortality spiked markedly ( P<0.05). Conclusions:Serum lactate level post-operation is a valid predictor of early prognosis after LT in children.