Objective:To investigate the prognostic value of the combined use of central venous-arterial carbon dioxide partial pressure difference/arterial-central venous oxygen content difference ratio (Pv-aCO 2/Ca-vO 2) combined with peripheral perfusion index (PI) for prognosis in middle-aged and elderly patients with acute heart failure (AHF) complicated by hypoperfusion. Methods:A case-control study was conducted, enrolling middle-aged and elderly AHF patients with tissue hypoperfusion admitted to the Emergency Intensive Care Unit of Nanjing First Hospital from May 2022 to May 2024. The primary endpoint was 28-day all-cause mortality. Patients were divided into survival and death groups based on prognosis. Baseline characteristics and clinical data were compared between groups. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of risk factors. Stratified analysis based on optimal cutoff values was performed, and Kaplan-Meier survival curves were used to compare prognostic differences between subgroups.Results:A total of 70 patients with AHF and hypoperfusion were enrolled, with 36 deaths (28-day mortality rate: 51.43%). No significant differences were observed in baseline characteristics, N-terminal B-type natriuretic peptide precursor, creatine kinase, creatine kinase-myocardial band, cardiac troponin I,central venous pressure, or left ventricular ejection fraction between groups(all P>0.05). Compared with the survival group, the death group exhibited significantly higher APACHEⅡ scores, lactate levels, and Pv-aCO 2/Ca-vO 2 ratios, along with lower PI values (all P<0.05). The area under the ROC curve (AUCs) for PI, Pv-aCO 2/Ca-vO 2, and their combination in predicting 28-day mortality were 0.804 (95% CI: 0.701-0.908), 0.848 (95% CI: 0.758-0.938), and 0.922 (95% CI: 0.859-0.985), respectively. The optimal cutoff value for PI was 1.17 (sensitivity 83.3% and specificity 67.6%), and for Pv-aCO 2/Ca-vO 2 was 1.59 (sensitivity 77.8% and specificity 79.4%). Stratified analysis revealed that the PI≤1.17 group had a significantly higher 28-day mortality rate than the PI>1.17 group ( P<0.01), and the Pv-aCO 2/Ca-vO 2>1.59 group had a markedly higher mortality rate than the Pv-aCO 2/Ca-vO 2≤1.59 group ( P<0.01) ,consistent with Kaplan-Meier survival analysis. Conclusion:Early assessment of Pv-aCO 2/Ca-vO 2 combined with PI demonstrates superior predictive performance for prognosis in AHF patients with hypoperfusion.

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.

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai, China. A total of 173 235 patients with type 2 diabetes in 2017 were included in the analysis. Profiles of risk factors and intermediate outcomes were determined. The patients had a mean age of 66.43 ± 8.12 (standard deviation (SD)) years and a mean diabetes duration of 7.95 ± 5.53 (SD) years. The percentage of patients who achieved the target level for HbA_1c (< 7.0%) was 48.6%. Patients who achieved the target levels for blood pressure (BP) < 130/80 mmHg and low-density lipoprotein-cholesterol (LDL-c) < 2.6 mmol/L reached 17.5% and 34.0%, respectively. A total of 3.8% achieved all three target levels, and the value increased to 6.8% with an adaptation of the BP target level (< 140/90 mmHg) for those over 65 years. Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels: male, young age, short diabetes duration, low body mass index, macrovascular complications, no microvascular complications, prescribed with lipid-lowering medication, and no prescription of antihypertensive medication. In conclusion, nearly 50% and one-third of the patients with diabetes met the target levels for HbA_1c and LDL-c, respectively, with a low percentage achieving the BP target level. The percentage of patients who achieved all three target levels needs significant improvement.
Aged ; Blood Pressure ; China/epidemiology* ; Cholesterol, LDL/therapeutic use* ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2/drug therapy* ; Glycated Hemoglobin A/analysis* ; Humans ; Male ; Middle Aged

Objective To systematically evaluate the clinical effect of surgery combined with adjuvant therapy (postoperative chemoradiotherapy or chemotherapy) and single surgery for resectable pancreatic cancers.Methods Literatures were researched using PubMed,Embase,Science Citation Index Expanded,Cochrane Central Register of Controlled Trials and China Biology Medicine disc with the key words including "pancreatic cancer,adjuvant therapy,chemoradiotherapy,radiochemotherapy,chemotherapy,radiotherapy,胰腺癌,辅助治疗,化学治疗and放射治疗”from the time of database building to October 2016.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.All the patients undergoing surgery combined with adjuvant chemoradiotherapy,surgery combined with adjuvant chemotherapy and single surgery were respectively allocated into the first treatment group,second treatment group and control group.The inverse variance was used for mergering hazard ratio (HR) and related statistic data.HR and 95％ confidence interval (CI) were used for assessing the overall survival time and disease-free survival time.The median survival time and 1-,2-,5-year survival rates were evaluated by the relative risk (RR) and 95％CI.The heterogeneity of the studies was analyzed using the I2 test.Results Eleven randomized controlled trials (RCTs) of 9 literatures were retrieved,and the total sample size was 1 482 patients,including 238 patients in the first treatment group,545 in the second treatment group and 699 in the control group.Results of Meta analysis:① overall survival time:there was no significant difference in overall survival time between the first treatment group and control group (HR =0.87,95％ CI:0.56-1.17,P＞ 0.05).There was a significant difference in overall survival time between the second treatment group and control group (HR =0.68,95 ％ CI:0.55-0.80,P＜ 0.05).② Disease-free survival time:there was no significant difference in disease-free survival time between the first treatment group and control group (HR=0.78,95％CI:0.53-1.03,P＞0.05).There was a significant difference in disease-free survival time between the second treatment group and control group (HR=0.56,95％CI:0.45-0.67,P＜0.05).③ Median survival time:there were significant differences in median survival time between the first treatment group and control group (RR=1.82,95％CI:1.35-2.45,P＜0.05) between the second group and control group (RR=1.32,95％CI:1.07-1.62,P＜0.05).④ One-,2-,5-year survival rates:there was no significant difference in 1-,2-,5-year survival rates between the first treatment group and control group (RR=1.24,2.47,1.15,95％ CI:0.72-2.12,0.82-7.41,0.71-1.84,P＞0.05).One-year survival rate in the second treatment group was compared with that in the control group,with no significant difference (RR=1.15,95％CI:0.99-1.34,P＞0.05).There were significant differences in 2-and 5-year survival rates between the second treatment group and control group (RR=1.24,1.73,95％CI:1.01-1.50,1.32-2.27,P＜0.05).Conclusions Compared with single surgery,surgery combined with postoperative chemoradiotherapy cannot significantly improve the overall survival time and disease-free survival time of patients.However,surgery combined with adjuvant chemotherapy can prolong the overall survival time and disease-free survival time of patients.

Objective To evaluate the clinical application value of modified CURB-65 score for assessing severity of community-acquired pneumonia (CAP) in emergency patients.Methods During the period from May 2011 to May 2012,198 emergency patients with CAP enrolled in this study were evaluated by CURB-65 score and modified CURB-65 score,respectively.Based on the severity of CAP,patients were divided into mild pneumonia group (Group A,n =107) and severe pneumonia group (Group B,n =91).The clinical status and biomarkers (the white blood cell count,procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses) were recorded and compared with t test.Group B was divided into survived-subgroup (n =62) and death-subgroup (n =29).The differences in CURB-65 score and modified CURB-65 scere between the two groups were compared with t test.The correlation of CURB-65 score and modified CURB-65 score with procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses were determined with Pearson rank correlation method.Results The procalcitonin,pneumonia severity index,hospitalization days,hospitalization expenses,modified CURB-65 score and CURB-65 score in Group B were significantly higher than those in Group A [(3.70 ± 0.83) vs.(1.27±0.24),t=28.91,P＜0.01; (121.33±16.74) vs.(73.79±9.21),t=25.23,P＜0.01;(25.79±10.13) vs.(14.85 ±6.83),t=9.02,P＜0.01; (22.71 ±3.84) vs.(9.83 ±1.24),t=32.76,P＜0.01; (3.69±1.03) vs.(3.32±1.06),t=2.48,P＜0.05; (4.21±1.13) vs.(3.41±0.96),t =5.39,P＜0.01],while no significant difference was observed in the white blood cell count between GroupA and B (17.58 ±5.99 vs.16.86±4.41,t =0.97,P＞0.05).For Group B,the modified CURB-65 score of death-subgroup was significantly higher than that of survived-subgroup [(4.75± ± 1.17) vs.(4.01 ± 1.09),t =2.95,P ＜ 0.01],whilc no significant difference was observed in the CURB-65 score between the death-subgroup and survived-subgroup (4.01 ± 1.15 vs.3.58 ±0.97,t =1.86,P ＞ 0.05).The CURB-65 score positive correlated with the procalcitonin (r =-0.803,P =0.025),and had no obvious correlation with the pneumonia severity index,hospitalization days,and hospitalization expenses (r=0.621,P=0.320; r=0.701,P=0.231; r=0.675,P=0.256); The modified CURB-65 score significantly positively correlated with the procalcitonin,pneumonia severity index,hospitalization days,and hospitalization expenses (r =0.951,P =0.003 ; r =0.965,P =0.002 ; r =0.947,P =0.004 ; r =0.961,P =0.002).Conclusions Compared with the CURB-65 score,the modified CURB-65 score is more efficient in evaluating the severity and prognoses of CAP for emergency patients.

Objective To investigate the effects of Shenfu injection ( SF,a Chinese herbal medicine preparation made of Codonopsis pilosula and Aconitum carmichaeli) on the cell apoptosis of focal cerebral ischemic-reperfusion injured rats and the expression of heme oxygenase-1 (HO-1). Methods Forty-two male Sprague-Dawley rats used for producing unilateral brain ischemia reperfusion model were randomly divided into three groups:sham operation group ( Sham group),ischemia reperfusion group ( IR group),and SF Injection group (SF group).The model of focal cerebral ischemia-reperfusion injury was induced by transient occlusion of middle cerebral artery (ischemia for 2 h,and reperfusion for 3,6 h respectively).In SF group,SF ( 10 mg/kg) was intraperitoneally injected duri(n)g reperfusion.Cell apoptosis rate in brain tissue was detected by the technique of Annexin-V-PI double staining and was counted in flow cytometer.Expression of HO-1 in brain was measured by RT-PCR,while the pathological and ultra structure changes of cerebral tissue were also observed.Results Cell apoptosis rate of brain tissue were significantly higher in IR group than that in Sham group (P ＜0.01 ),while SF group had less significant changes in cell apoptosis rate, HO-1 level of brain tissue than IR group (P ＜ O.01 ).The ultra structure change of brain tissue was less in SF group than that in IR group.Conclusions During early stage of brain IR injury,SF inhibits cellular apoptosis and in turn protects the brain from injury which is attributed to the increase in HO-1 expression induced by SF.

Objective To investigate the effects of naloxone (Na) on pneumocyte apoptosis and expression of heme oxygenase-1 (HO-1) during ischemia reperfusion injury of lung in rats. Method Forty-two male Sprague-Dawley rats were made models of ischemia reperfusion injury of unilateral lung, and were randomly( random number) divided into three groups: sham operation group (Sh group), ischemia reperfusion group (IR group) and naloxone group (Na group). The hilus of lung was clamped for 45 minutes and the clamp was taken off to build the I/R model. After 3-6 hours reperfusion, naloxone in dose of 1 mg/kg was injected intra-peritoneally in rats of Na group. The rate of cell apoptosis in lung tissue was detected with the way of Annexin-V-PI in flow cy-tometer. The wet to dry weight ratio (W/D) of lung tissue was measured. The expression of HO-1 in lung was measured by using RT-PCR and the ultra-structure change of lung tissue was observed under electron microscope. Results The rate of pneumocyte apoptosis and W/D ratio of lung tissue were significantly higher in IR group than in Sh group (P < 0.01), and the rate of pneumocyte apoptosis and W/D ratio of lung tissue were negatively correlated with the expression of HO-1 mRNA in lung tissue. Compared with IR group, the rate of cell apoptosis and W/D ratio were lower and the expression of HO-1 mRNA was higher in Na group (P < 0.01). The ultra- structure changes of lung tissue were lessened in Na group than in IR group. Conclusions During early period of lung IR injury, HO-1 induced by naloxone can inhibit the cellular apoptosis and protect the lung tissue.