Objective·To explore the value of combined diaphragm and intercostal muscle ultrasound assessment compared with conventional diaphragm ultrasound in predicting the weaning outcome in mechanically ventilated patients with sepsis.Methods·Mechanically ventilated patients with sepsis,consecutively admitted to the Department of Critical Care Medicine of Affiliated Hospital of Nantong University from October 2022 to December 2023,were selected.During the peri-weaning period,after the patient's sepsis condition improved and the patient passed the spontaneous breathing trial(SBT),ultrasound evaluation of respiratory muscles was performed by ultrasound qualified personnel with ultrasound qualification and experience in bedside ultrasound examination.Diaphragm excursion(DE),thickening fraction of diaphragm(TFD),and thickening fraction of intercostal muscle(TFic)were measured,respectively.The patients were divided into a successful weaning group(n=114)and a failed weaning group(n=24)according to the weaning results.Receiver operating characteristic(ROC)curves were used to analyze the value of diaphragm ultrasound and intercostal muscle ultrasound,alone and in combination,in predicting ventilator weaning outcome.Results·TFic and TFic/TFD were significantly higher in the failed weaning group during SBT than in the successful weaning group(all P<0.05).The areas under the ROC curve(AUROC)of DE,TFD,and TFic to predict weaning failure in mechanically ventilated patients with sepsis during the period of SBT were 0.689(0.591?0.776),0.657(0.557?0.747),and 0.769(0.676?0.846),respectively,whereas the combined indexes TFic/TFD and TFic&TFD_mix had AUROCs of 0.867(0.786?0.925)and 0.860(0.778?0.920),respectively.TFic/TFD with a cutoff value of>0.95 had a sensitivity of 86.7%and a specificity of 75.3%in predicting weaning failure,and TFic&TFD_mix with a cutoff value of>0.13 had a sensitivity of 86.6%and a specificity of 80.9%in predicting weaning failure.Moreover,the intercostal muscle ultrasonography method had an intra-observer intraclass correlation coefficient(ICC)of 0.890 and an extra-observer ICC of 0.876 for measurement reliability,which were both rated as good(P<0.001).Conclusion·Combined diaphragm and intercostal muscle ultrasonography provides a more comprehensive picture of the patient's overall respiratory muscles,and has a higher guiding value in predicting the weaning outcomes in mechanically ventilated patients with sepsis than diaphragm ultrasound alone.

Objective:To investigate the association between metabolic dysfunction-associated steatotic liver disease(MASLD)and the risk of adverse pregnancy outcomes,and to analyze the impact of the type and severity of cardiometabolic risk factor(CMRF)abnormalities on this association.Methods:A retrospective cohort study was conducted among primiparous women with singleton pregnancies who had registered at Beijing Friendship Hospital from March 10,2020,to December 31,2022.A total of 2 623 women were included.Basic characteristics and delivery outcomes were documented,liver ultrasound and relevant prenatal examinations were performed,and adverse pregnancy outcomes were diagnosed.Modi-fied Poisson regression models were used to analyze the association between MASLD and adverse pregnan-cy outcomes.The relationship between the type or severity of CMRF abnormalities in MASLD and the risk of adverse pregnancy outcomes was also explored.Results:After adjusting for confounding factors including age,gestational weight gain,and education level,MASLD was associated with an increased risk of cesarean section(RR=1.531,95％CI:1.304-1.799,P＜0.001),gestational diabetes melli-tus(GDM;RR=2.409,95％CI:1.948-2.979,P＜0.001),pregnancy-associated hypertension(PAH;RR=3.062,95％CI:2.069-4.533,P＜0.001),preterm birth(RR=2.145,95％CI:1.342-3.429,P=0.001),and large for gestational age(LGA;2.224,95％CI:1.599-3.095,P＜0.001).However,no significant associations were found for small for gestational age or postpartum hemorrhage.After adjusting for other CMRF abnormalities,the risk of adverse pregnancy outcomes varied among MASLD pregnant women with different CMRF abnormalities:the body mass index abnormal group had higher risks of cesarean section,GDM,PAH,preterm birth,and LGA;the glucose abnormal group had an increased risk of GDM;the blood pressure abnormal group had a higher risk of PAH;the high density lipoprotein cholesterol abnormal group had higher risks of cesarean section,GDM,and PAH;and the tri-glyceride abnormal group was associated with higher risks of GDM and preterm birth.Additional,as the severity of CMRF abnormalities increased,the risks of cesarean section(RR=1.199,95％CI:1.112-1.292,P＜0.001),GDM(RR=1.478,95％CI:1.345-1.624,P＜0.001),PAH(RR=1.626,95％CI:1.367-1.934,P＜0.001),preterm birth(RR=1.384,95％CI:1.120-1.710,P=0.003),and LGA(RR=1.422,95％CI:1.224-1.650,P＜0.001)continued to rise.Conclusion:MASLD during pregnancy is associated with an increased risk of multiple adverse pregnancy outcomes,and the type and severity of CMRF abnormalities significantly influence this association.These results suggest that attention should be paid to the specific CMRF abnormalities when diagnosed MASLD,as this may help to facilitate targeted interventions and reduce the risk of adverse pregnancy outcomes.

Objective·To explore the value of combined diaphragm and intercostal muscle ultrasound assessment compared with conventional diaphragm ultrasound in predicting the weaning outcome in mechanically ventilated patients with sepsis.Methods·Mechanically ventilated patients with sepsis,consecutively admitted to the Department of Critical Care Medicine of Affiliated Hospital of Nantong University from October 2022 to December 2023,were selected.During the peri-weaning period,after the patient's sepsis condition improved and the patient passed the spontaneous breathing trial(SBT),ultrasound evaluation of respiratory muscles was performed by ultrasound qualified personnel with ultrasound qualification and experience in bedside ultrasound examination.Diaphragm excursion(DE),thickening fraction of diaphragm(TFD),and thickening fraction of intercostal muscle(TFic)were measured,respectively.The patients were divided into a successful weaning group(n=114)and a failed weaning group(n=24)according to the weaning results.Receiver operating characteristic(ROC)curves were used to analyze the value of diaphragm ultrasound and intercostal muscle ultrasound,alone and in combination,in predicting ventilator weaning outcome.Results·TFic and TFic/TFD were significantly higher in the failed weaning group during SBT than in the successful weaning group(all P<0.05).The areas under the ROC curve(AUROC)of DE,TFD,and TFic to predict weaning failure in mechanically ventilated patients with sepsis during the period of SBT were 0.689(0.591?0.776),0.657(0.557?0.747),and 0.769(0.676?0.846),respectively,whereas the combined indexes TFic/TFD and TFic&TFD_mix had AUROCs of 0.867(0.786?0.925)and 0.860(0.778?0.920),respectively.TFic/TFD with a cutoff value of>0.95 had a sensitivity of 86.7%and a specificity of 75.3%in predicting weaning failure,and TFic&TFD_mix with a cutoff value of>0.13 had a sensitivity of 86.6%and a specificity of 80.9%in predicting weaning failure.Moreover,the intercostal muscle ultrasonography method had an intra-observer intraclass correlation coefficient(ICC)of 0.890 and an extra-observer ICC of 0.876 for measurement reliability,which were both rated as good(P<0.001).Conclusion·Combined diaphragm and intercostal muscle ultrasonography provides a more comprehensive picture of the patient's overall respiratory muscles,and has a higher guiding value in predicting the weaning outcomes in mechanically ventilated patients with sepsis than diaphragm ultrasound alone.

Objective:To investigate the association between metabolic dysfunction-associated steatotic liver disease(MASLD)and the risk of adverse pregnancy outcomes,and to analyze the impact of the type and severity of cardiometabolic risk factor(CMRF)abnormalities on this association.Methods:A retrospective cohort study was conducted among primiparous women with singleton pregnancies who had registered at Beijing Friendship Hospital from March 10,2020,to December 31,2022.A total of 2 623 women were included.Basic characteristics and delivery outcomes were documented,liver ultrasound and relevant prenatal examinations were performed,and adverse pregnancy outcomes were diagnosed.Modi-fied Poisson regression models were used to analyze the association between MASLD and adverse pregnan-cy outcomes.The relationship between the type or severity of CMRF abnormalities in MASLD and the risk of adverse pregnancy outcomes was also explored.Results:After adjusting for confounding factors including age,gestational weight gain,and education level,MASLD was associated with an increased risk of cesarean section(RR=1.531,95％CI:1.304-1.799,P＜0.001),gestational diabetes melli-tus(GDM;RR=2.409,95％CI:1.948-2.979,P＜0.001),pregnancy-associated hypertension(PAH;RR=3.062,95％CI:2.069-4.533,P＜0.001),preterm birth(RR=2.145,95％CI:1.342-3.429,P=0.001),and large for gestational age(LGA;2.224,95％CI:1.599-3.095,P＜0.001).However,no significant associations were found for small for gestational age or postpartum hemorrhage.After adjusting for other CMRF abnormalities,the risk of adverse pregnancy outcomes varied among MASLD pregnant women with different CMRF abnormalities:the body mass index abnormal group had higher risks of cesarean section,GDM,PAH,preterm birth,and LGA;the glucose abnormal group had an increased risk of GDM;the blood pressure abnormal group had a higher risk of PAH;the high density lipoprotein cholesterol abnormal group had higher risks of cesarean section,GDM,and PAH;and the tri-glyceride abnormal group was associated with higher risks of GDM and preterm birth.Additional,as the severity of CMRF abnormalities increased,the risks of cesarean section(RR=1.199,95％CI:1.112-1.292,P＜0.001),GDM(RR=1.478,95％CI:1.345-1.624,P＜0.001),PAH(RR=1.626,95％CI:1.367-1.934,P＜0.001),preterm birth(RR=1.384,95％CI:1.120-1.710,P=0.003),and LGA(RR=1.422,95％CI:1.224-1.650,P＜0.001)continued to rise.Conclusion:MASLD during pregnancy is associated with an increased risk of multiple adverse pregnancy outcomes,and the type and severity of CMRF abnormalities significantly influence this association.These results suggest that attention should be paid to the specific CMRF abnormalities when diagnosed MASLD,as this may help to facilitate targeted interventions and reduce the risk of adverse pregnancy outcomes.

To analyze the disease burden of Alzheimer′s disease (AD) in China from 1990 to 2021 and its trend of change, providing evidence for targeted interventions to reduce the burden of AD. A descriptive analysis of AD and its main risk factors among males and females of different ages in China from 1990 to 2021 was conducted using the Global Burden of Disease (GBD) 2021 database. The evaluation indicators were incidence rate, prevalence rate, mortality rate, and disability-adjusted life years (DALYs). The risk factors included high body mass index (BMI), high fasting plasma glucose, and smoking. The results showed that in 2021, the number of AD incidence among the Chinese population was 2 914 112 (204.8/100 000), the number of prevalence was 16 990 827 (1 194.2/100 000), the number of DALYs was 10 072 477 (708.0/100 000), and the number of deaths was 491 773 (34.6/100 000), which increased by 242.7%, 249.1%, 208.2%, and 239.4% respectively compared with 1990. In 2021, the AD incidence rate (264.4/100 000), prevalence rate (1 558.9/100 000), DALYs rate (935.8/100 000), and mortality rate (47.3/100 000) were all higher in women than in men. All rates showed a clear age-dependent trend. In 2021, the DALYs attributable to smoking, high BMI, and high fasting plasma glucose in the AD population in China were 602 501.1 (42.3/100 000), 466 728.7 (32.8/100 000), and 1 204 039.4 (84.6/100 000), respectively, with death tolls of 24 897.3 (1.7/100 000), 20 856.3 (1.5/100 000), and 58 838.2 (4.1/100 000). The proportion of DALYs attributable to high BMI showed an upward trend during 1990-2021, while the proportion of DALYs attributable to smoking showed a gradual decrease. The difference in the attributable risk factors between the genders was significant. In 2021, the highest risk among men was attributed to smoking, with DALYs rate and mortality rate of 68.3/100 000 and 2.7/100 000, respectively. In contrast, the highest risk among women was attributed to high fasting blood sugar, with DALYs rate and mortality rate of 111.1/100 000 and 5.6/100 000, respectively. In conclusion,the disease burden of AD is still increasing, and targeted interventions should be taken for both males and females to reduce the burden of AD by reducing unhealthy lifestyles.

Objective:Through the bibliometrics analysis and visual analysis of Chinese and English literature related to pneumoconiosis through CiteSpace, to understand the research situation, research trend and hotspots of pneumoconiosis, so as to provide reference for further research.Methods:In August 2022, CNKI (China National Knowledge Infrastructure) data baseand Web of Science core collection database were used as data sources for literature retrieval. Cite Space.5.8.R3c software was used to analyze the cooperation between authors and institutions, keyword co-occurrence analysis, keyword clustering analysis and keyword emergence analysis.Results:A total of 4726 Chinese literature and 2490 English literature related to pneumoconiosis were included; The annual publication volume of Chinese literature shows a fluctuating downward trend, while the annual publication volume of English literature shows a fluctuating upward trend. The Institute of Labor Health and Occupational Disease of the Chinese Academy of Preventive Medical Sciences and the Institute of Occupational Health and Poisoning Control of the Chinese Center for Disease Control and Prevention have the highest publication volume (55 articles) in the institutional cooperation network; The National Institute for Occupational Safety and Health (NIOSH) in the United States has the highest publication volume (153 articles) in the institutional collaboration network. The results of keyword co-occurrence, clustering, and prominence analysis show that Chinese literature focuses more on clinical research on pneumoconiosis, while English literature focuses more on experimental research related to the pathogenesis of pneumoconiosis.Conclusion:In the related field of pneumoconiosis research, the experimental research and clinical research on the pathogenesis are the main research hotspots.

Objective:To discuss the effect of mangiferin(MGF)on the healing of hip fracture in the rats by regulating the Wnt/β-catenin signaling pathway,and to clarify the mechanism.Methods:The hip fracture model in the SD rats was established.After successful modeling,the rats were divided into model group,MGF group,and MGF+XAV-939(Wnt/β-catenin signaling pathway inhibitor)group,and sham operation group was set up,and there were 15 rats in each group.From the first day after surgery,the rats in each group received MGF or XAV-939 interventions every two days,totally for 14 times.Lane-Sandhu X-ray scoring method was used to detect the fracture healing in the second and fourth weeks after surgery;micro CT was used to detect the microstructural parameters of the bone,such as bone volume(BV),number of bone trabeculae(Tb.N),bone volume fraction(BV/TV),and bone trabecular thickness(Tb.Th);HE staining was used to observe the morphology of callus tissue of the rats in various groups;enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of osteogenic markers bone alkaline phosphatase(BALP)and type Ⅰ procollagen N-terminal propeptide(PINP)and bone resorption markers tartrate resistant acid phosphatase-5b(TRACP-5b)and Carboxy-terminal terminalpeptide of type Ⅰcollagen(CTX)in serum of the rats in various groups;Western blotting method was used to detect the expression levels of β-catenin,Runt-associated transcription factor 2(Runx2),and bone morphogenetic protein-2(BMP-2)in callus tissue of the rats in various groups.Results:Compared with sham operation group,the rats in model group showed distinct fracture lines,an abundance of fibrous tissue at the fracture site,and no bony callus at the 2nd and 4th weeks after fracture,the Lane-Sandhu X-ray scores and microstructural parameters BV,Tb.N,BV/TV,and Tb.Th of the rats in model group were decreased(P＜0.05),the serum level of BALP was decreased(P＜0.05),while the levels of PINP,TRACP-5b,and CTX were increased(P＜0.05),and the expression levels of β-catenin,Runx2,and BMP-2 proteins in callus tissue were decreased(P＜0.05).Compared with model group,the rats in MGF group showed significantly increased new bone callus at 2nd weeks after fracture,almost no visible fracture line at the 4th weeks,faster fracture healing,and replacement of fibrous tissue by bone tissue at the fracture site,the Lane-Sandhu X-ray scores and microstructural parameters BV,Tb.N,BV/TV,and Tb.Th of the rats in MGF group were increased(P＜0.05),the serum level of BALP was increased(P＜0.05),the levels of PINP,TRACP-5b,and CTX were decreased(P＜0.05),and the expression levels of β-catenin,Runx2,and BMP-2 proteins in callus tissue were increased(P＜0.05).Compared with MGF group,the rats in MGF+XAV-939 group showed only a small amount of new bone callus at the fracture site at 2nd and 4th weeks after fracture,with no formation of the marrow cavity,and the Lane-Sandhu X-ray scores and microstructural parameters BV,Tb.N,BV/TV,and Tb.Th of the rats in MGF+XAV-939 group were decreased(P＜0.05),the serum level of BALP was decreased(P＜0.05),the levels of PINP,TRACP-5b,and CTX were increased(P＜0.05),and the expression levels ofβ-catenin,Runx2,and BMP-2 proteins in callus tissue were decreased(P＜0.05).Conclusion:MGF can promote the healing of hip fracture in the rats,and its mechanism may be related to activation of Wnt/β-catenin signaling pathway.

Objective:Through the bibliometrics analysis and visual analysis of Chinese and English literature related to pneumoconiosis through CiteSpace, to understand the research situation, research trend and hotspots of pneumoconiosis, so as to provide reference for further research.Methods:In August 2022, CNKI (China National Knowledge Infrastructure) data baseand Web of Science core collection database were used as data sources for literature retrieval. Cite Space.5.8.R3c software was used to analyze the cooperation between authors and institutions, keyword co-occurrence analysis, keyword clustering analysis and keyword emergence analysis.Results:A total of 4726 Chinese literature and 2490 English literature related to pneumoconiosis were included; The annual publication volume of Chinese literature shows a fluctuating downward trend, while the annual publication volume of English literature shows a fluctuating upward trend. The Institute of Labor Health and Occupational Disease of the Chinese Academy of Preventive Medical Sciences and the Institute of Occupational Health and Poisoning Control of the Chinese Center for Disease Control and Prevention have the highest publication volume (55 articles) in the institutional cooperation network; The National Institute for Occupational Safety and Health (NIOSH) in the United States has the highest publication volume (153 articles) in the institutional collaboration network. The results of keyword co-occurrence, clustering, and prominence analysis show that Chinese literature focuses more on clinical research on pneumoconiosis, while English literature focuses more on experimental research related to the pathogenesis of pneumoconiosis.Conclusion:In the related field of pneumoconiosis research, the experimental research and clinical research on the pathogenesis are the main research hotspots.

To analyze the disease burden of Alzheimer′s disease (AD) in China from 1990 to 2021 and its trend of change, providing evidence for targeted interventions to reduce the burden of AD. A descriptive analysis of AD and its main risk factors among males and females of different ages in China from 1990 to 2021 was conducted using the Global Burden of Disease (GBD) 2021 database. The evaluation indicators were incidence rate, prevalence rate, mortality rate, and disability-adjusted life years (DALYs). The risk factors included high body mass index (BMI), high fasting plasma glucose, and smoking. The results showed that in 2021, the number of AD incidence among the Chinese population was 2 914 112 (204.8/100 000), the number of prevalence was 16 990 827 (1 194.2/100 000), the number of DALYs was 10 072 477 (708.0/100 000), and the number of deaths was 491 773 (34.6/100 000), which increased by 242.7%, 249.1%, 208.2%, and 239.4% respectively compared with 1990. In 2021, the AD incidence rate (264.4/100 000), prevalence rate (1 558.9/100 000), DALYs rate (935.8/100 000), and mortality rate (47.3/100 000) were all higher in women than in men. All rates showed a clear age-dependent trend. In 2021, the DALYs attributable to smoking, high BMI, and high fasting plasma glucose in the AD population in China were 602 501.1 (42.3/100 000), 466 728.7 (32.8/100 000), and 1 204 039.4 (84.6/100 000), respectively, with death tolls of 24 897.3 (1.7/100 000), 20 856.3 (1.5/100 000), and 58 838.2 (4.1/100 000). The proportion of DALYs attributable to high BMI showed an upward trend during 1990-2021, while the proportion of DALYs attributable to smoking showed a gradual decrease. The difference in the attributable risk factors between the genders was significant. In 2021, the highest risk among men was attributed to smoking, with DALYs rate and mortality rate of 68.3/100 000 and 2.7/100 000, respectively. In contrast, the highest risk among women was attributed to high fasting blood sugar, with DALYs rate and mortality rate of 111.1/100 000 and 5.6/100 000, respectively. In conclusion,the disease burden of AD is still increasing, and targeted interventions should be taken for both males and females to reduce the burden of AD by reducing unhealthy lifestyles.

Objective:To explore the effect of long-chain fat emulsion in parenteral nutrition therapy on the perioperative nutritional status of patients with low rectal cancer.Methods:A total of 204 patients who underwent rectal cancer surgery in the Third Hospital of Shanxi Medical University from January 2017 to June 2020 were retrospectively analyzed. The patients were divided into two groups according to the specific nutritional treatment methods, 100 cases in the study group used long-chain fat emulsion for parenteral nutrition support, and 104 cases in the control group used medium- and long-chain fat emulsion injection. After admission, the nutritional status of patients were evaluated according to the results of Scored Patient-Generated Subjective Global Assessment (PG-SGA) and related laboratory tests. At 7th day before the operation, the patients were treated with nutrition and electrolyte support. Parenteral nutrition and enteral nutrition combined treatment and early enteral nutrition were given after the operation. The albumin, prealbumin, retinol-binding protein, total cholesterol and body mass index (BMI) at 7th day before the operation, 1st day after the operation and 7th day after the operation and the patient's first exhaust time after surgery, occurrence of postoperative complications, postoperative fever and total hospital stay were recorded and compared between the two groups.Results:Postoperative first exhaust time [(42±11) h vs. (54±10) h], fever time [(48±8) h vs. (57±7) h], total hospital stay [(16.0±0.7) d vs. (18.0±0.9) d)], resting energy expenditure at the 7th day after surgery [(5 326±589) kJ/d vs. (5 840±599) kJ/d] and total cholesterol at the 7th day after surgery [(4.8±0.3) mmol/L vs. (5.0± 0.4) mmol/L] in the study group were lower than those in the control group, and albumin [(33±3) g/L vs. (28± 3) g/L], prealbumin [(0.189±0.041) g/L vs. (0.164±0.037) g/L] and retinol-binding protein [(0.039±0.016) g/L vs. (0.032±0.013) g/L] at the 7th day after surgery in the study group were higher than those in the control group, and the differences between the two groups were statistically significant (all P < 0.05). There was no statistical difference in other detection indexes between the two groups (all P > 0.05). Conclusion:The use of long-chain fat emulsion in low rectal cancer patients with malnutrition during the perioperative period may be more conducive to the recovery of the body.