Objective:To investigate the diagnostic efficacy of artificial intelligence(AI)software combined with contrast-enhanced ultrasound(CEUS)on portal hypertension of cirrhosis.Methods:A retrospective analysis was conducted on 106 patients with cirrhosis who admitted to Handan Communicable Disease Hospital from January 2024 to June 2024 and were confirmed by surgical pathology.In them,60 cases with positive portal hypertension were included in positive group,and 46 cases with negative portal hypertension were included in negative group.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic values of ultrasound characteristics via preoperative AI quantization,enhanced ultrasound mode and the combination of them for portal hypertension of cirrhosis.Results:The mean peak intensity,mean vessel density and branching morphology index of AI software were respectively 201.23±10.18,0.62±0.11 and 1.23±0.24 in diagnosing portal hypertension of positive group,all of which were significantly higher than those of negative group(t=8.551,3.707,2.054,P<0.05).However,the mean peak reaching time,uniformity of flow perfusion,mean flow velocity and uniformity of microcirculation perfusion of the positive group were respectively(18.22±2.18)seconds,(75.22±5.46)%,(10.09±2.22)cm/s,(80.78±5.11)%,all of which were significantly lower than those in the negative group(t=3.729,5.237,4.969,4.491,P<0.05).The enhancement speed and degree of liver parenchyma,the enhancement speed of portal vein,and the enhancement speed and degree of spleen in CEUS of positive group were significantly higher than those of negative group,and the differences were significant(t=4.770,12.781,7.313,5.501,4.645,7.513,P<0.05).ROC curve analysis showed that the area under curve(AUC)value of CEUS combined with AI algorithm was 0.926 in diagnosis,which was significantly better than single CEUS and single AI analysis(0.853,0.925).Conclusion:CEUS technique combines with AI software can show higher diagnostic efficacy in the diagnosis for portal hypertension of cirrhosis,which diagnostic effect was better than single either of two methods.

This paper reviews the current application status of big language model in nursing, the needs for information technology development in critical care nursing, the current application status of and future development direction of big language model in critical care nursing, as well as the risks and challenges faced, with a view to providing a reference for promoting the application of big language model in critical care nursing.

This paper reviews the current application status of big language model in nursing, the needs for information technology development in critical care nursing, the current application status of and future development direction of big language model in critical care nursing, as well as the risks and challenges faced, with a view to providing a reference for promoting the application of big language model in critical care nursing.

Objective:To investigate the diagnostic efficacy of artificial intelligence(AI)software combined with contrast-enhanced ultrasound(CEUS)on portal hypertension of cirrhosis.Methods:A retrospective analysis was conducted on 106 patients with cirrhosis who admitted to Handan Communicable Disease Hospital from January 2024 to June 2024 and were confirmed by surgical pathology.In them,60 cases with positive portal hypertension were included in positive group,and 46 cases with negative portal hypertension were included in negative group.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic values of ultrasound characteristics via preoperative AI quantization,enhanced ultrasound mode and the combination of them for portal hypertension of cirrhosis.Results:The mean peak intensity,mean vessel density and branching morphology index of AI software were respectively 201.23±10.18,0.62±0.11 and 1.23±0.24 in diagnosing portal hypertension of positive group,all of which were significantly higher than those of negative group(t=8.551,3.707,2.054,P<0.05).However,the mean peak reaching time,uniformity of flow perfusion,mean flow velocity and uniformity of microcirculation perfusion of the positive group were respectively(18.22±2.18)seconds,(75.22±5.46)%,(10.09±2.22)cm/s,(80.78±5.11)%,all of which were significantly lower than those in the negative group(t=3.729,5.237,4.969,4.491,P<0.05).The enhancement speed and degree of liver parenchyma,the enhancement speed of portal vein,and the enhancement speed and degree of spleen in CEUS of positive group were significantly higher than those of negative group,and the differences were significant(t=4.770,12.781,7.313,5.501,4.645,7.513,P<0.05).ROC curve analysis showed that the area under curve(AUC)value of CEUS combined with AI algorithm was 0.926 in diagnosis,which was significantly better than single CEUS and single AI analysis(0.853,0.925).Conclusion:CEUS technique combines with AI software can show higher diagnostic efficacy in the diagnosis for portal hypertension of cirrhosis,which diagnostic effect was better than single either of two methods.

Multiple sclerosis (MS) is a neuroinflammatory demyelinating disease, mediated by pathogenic T helper 17 (Th17) cells. However, the therapeutic effect is accompanied by the fluctuation of the proportion and function of Th17 cells, which prompted us to find the key regulator of Th17 differentiation in MS. Here, we demonstrated that the triggering receptor expressed on myeloid cells 2 (TREM-2), a modulator of pattern recognition receptors on innate immune cells, was highly expressed on pathogenic CD4-positive T lymphocyte (CD4⁺ T) cells in both patients with MS and experimental autoimmune encephalomyelitis (EAE) mouse models. Conditional knockout of Trem-2 in CD4⁺ T cells significantly alleviated the disease activity and reduced Th17 cell infiltration, activation, differentiation, and inflammatory cytokine production and secretion in EAE mice. Furthermore, with Trem-2 knockout in vivo experiments and in vitro inhibitor assays, the TREM-2/zeta-chain associated protein kinase 70 (ZAP70)/signal transducer and activator of transcription 3 (STAT3) signal axis was essential for Th17 activation and differentiation in EAE progression. In conclusion, TREM-2 is a key regulator of pathogenic Th17 in EAE mice, and this sheds new light on the potential of this therapeutic target for MS.
Animals ; Humans ; Mice ; CD4-Positive T-Lymphocytes/pathology* ; Cell Differentiation ; Encephalomyelitis, Autoimmune, Experimental/metabolism* ; Mice, Inbred C57BL ; Multiple Sclerosis ; Th1 Cells/pathology*

Hemorrhagic shock (HS) is one of the leading causes of death among young adults worldwide. Multiple organ dysfunction in HS is caused by an imbalance between tissue oxygen supply and demand, which is closely related to the poor prognosis of patient. Mitochondrial dysfunction is one of the key mechanisms contributing to multiple organ dysfunction in HS, while mitochondrial quality control regulates mitochondrial function through a series of processes, including mitochondrial biogenesis, mitochondrial dynamics, mitophagy, mitochondrial-derived vesicles, and mitochondrial protein homeostasis. Modulating mitochondrial quality control can improve organ dysfunction. This review aims to summarize the effects of mitochondrial dysfunction on organ function in HS and discuss the potential mechanisms of mitochondrial quality control, providing insights into the injury mechanisms underlying HS and guiding clinical management.

The World Health Organization (WHO) classification serves as the internationally recognized standard for diagnosing and classifying hematopoietic and lymphoid tissue tumors(WHO-HEAM). Since 2001, it has undergone multiple upgrades and revisions, updating, clarifying, and refining previous tumor diagnostic and classification standards while incorporating numerous new genetic and molecular biological subtypes. In 2022, two classification proposals emerged due to a wealth of clinical and scientific research results: the fifth edition of the WHO hematopoietic and lymphoid tissue classification (WHO-HAEM5), published in Leukemia journal; and the International Consensus Classification (ICC), published in Blood journal. These two schemes differ in their approach to classifying hematopoietic and lymphoid tissue tumors, posing challenges for clinical laboratory diagnosis and treatment.

OBJECTIVE: To evaluate and summarize the relevant evidence of anticoagulation and bleeding risk management in patients with extracorporeal membrane oxygenation (ECMO), and provide the evidence-based basis for the management of anticoagulation and bleeding during ECMO treatment. METHODS: According to the evidence "6S" pyramid model, all evidence on ECMO anticoagulation management and bleeding risk was searched in relevant databases, organizations and guideline websites at home and abroad. Evidence types included guidelines, expert consensus, systematic evaluation, Meta-analysis and original study. The search time limit was from May 31, 2012 to May 31, 2022. Two researchers with evidence-based research background conducted independent literature quality evaluation of the retrieved evidence, and the evidence that met the quality standards was extracted and summarized based on the opinions of industry experts. RESULTS: A total of 315 articles were retrieved, and 13 articles were included, including 3 guidelines, 6 expert consensus, and 4 Meta-analysis. A total of 27 best evidences were summarized from 7 aspects, including the selection of ECMO anticoagulation, anticoagulation in priming, anticoagulation in operation, anticoagulation monitoring, bleeding and treatment, thrombosis and treatment, and prevention and management of terminal limb ischemia. CONCLUSIONS This study provides evidence-based basis for bleeding prevention and anticoagulant management in ECMO patients. It is recommended to selectively apply the best evidence after evaluating the clinical environmental conditions of medical institutions, so as to improve the prognosis of ECMO patients.
Humans ; Extracorporeal Membrane Oxygenation/adverse effects* ; Blood Coagulation ; Hemorrhage/etiology* ; Anticoagulants/adverse effects* ; Thrombosis/prevention & control* ; Retrospective Studies

Hemorrhagic shock, a life-threatening organ hypoperfusion caused by rapid, massive blood loss, is the leading cause of traumatic death in peacetime and wartime. The vascular endothelial glycocalyx (vEG) plays an important role in maintaining microcirculatory homeostasis. Severe ischemia and hypoxia of hemorrhagic shock can damage the vEG, leading to endothelial dysfunction and exacerbated microcirculatory and organ impairments. Therefore, early prevention and treatment of vEG damage in hemorrhagic shock can improve microcirculation dysfunction, which is of paramount importance for therapeutic efficacies and outcomes. There have been many studies on the prevention and treatment of vEG damage in hemorrhagic shock, but none is based on the management of vEG damage. The authors reviewed the progress on the mechanism and preventive and therapeutic strategies of vEG damage caused by hemorrhagic shock, hoping to provide reference for the further research of hemorrhagic shock-induced vEG damage.

Objective:To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with maintenance hemodialysis (MHD) in Jiangsu province during SARS-CoV-2 pandemic in China from December 7, 2022 to January 27, 2023, and to analyze the influencing factors of all-cause death.Methods:It was a multi-center cross-sectional investigation. Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center (room) as investigators. Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System. MHD patients from hemodialysis centers (rooms) at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included, and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results:Questionnaire surveys and data analysis on 57 278 patients in 407 hemodialysis centers (rooms) were completed, accounting for 90.41% of the total number of MHD patients (63 357 cases) in Jiangsu province during the same period. There were 24 038 cases (41.97%) of SARS-CoV-2 infection and 14 805 cases (25.85%) of suspected infection, which were widely distributed in all dialysis centers in Jiangsu province. After clinical classification of 38 843 confirmed and suspected SARS-CoV-2 infection cases, 3 662 cases were severe and critical cases, accounting for 9.43% of the infected and suspected cases. Among the patients who had completed the questionnaires, there were 1 812 all-cause deaths, with an all-cause mortality rate of 3.16%. Multivariate logistic regression analysis showed that elderly (taking ≤50 years as a reference, 51-59 years: OR=1.583, 95% CI 1.279-1.933, P=0.001; 60-69 years: OR=3.972, 95% CI 3.271-4.858, P<0.001; 70-79 years: OR=7.236, 95% CI 5.917-8.698, P<0.001; ≥80 years: OR=11.738, 95% CI 9.459-14.663, P<0.001), male ( OR=1.371, 95% CI 1.229-1.529, P<0.001), and co-infection with hepatitis B virus (HBV) (positive serum HBV surface antigen, OR=0.629, 95% CI 0.484-0.817, P<0.001) were independent influencing factors for all cause mortality. Receiver-operating characteristic curve analysis showed that the area under the curve for male, age and current HBV infection prediction of all-cause death was 0.529 ( P<0.001), 0.724 ( P<0.001) and 0.514 ( P=0.042), respectively, and the cut-off value for age prediction of all-cause death was 65.5 years old. Compared with patients without HBV infection, MHD patients with HBV infection significantly reduced the proportion of severe and critically ill patients, all-cause hospitalizations and all cause deaths when infected with SARS-CoV-2 (4.99% vs. 6.41%, χ2=6.136, P=0.013; 8.90% vs. 11.44%, χ2=11.662, P<0.001; 2.01% vs. 3.37%, χ2=10.713, P=0.001, respectively). Conclusion:The MHD patients in Jiangsu province are susceptible to SARS-CoV-2. Elderly age and male gender are independent risk factors for death in MHD patients during the epidemic, while the HBV infection may be a protective factor for death of MHD patients infected with SARS-CoV-2.