Objective Patients with chronic liver diseases often exhibit unique hemodynamic abnormalities and metabolic disorders.Postoperative fluid management presents numerous challenges,especially for critically ill patients admitted to the intensive care unit(ICU)after surgery.This study aimed at exploring the relationship between postoperative fluid therapy and prognosis.Methods Based on 2 414 patients with chronic liver diseases who underwent surgical treatment and were subsequently transferred to the ICU in the MIMIC-IV database,a retrospective cohort study was conducted on the final 2 143 patients after our inclusion and exclusion criteria.Multivariate adjusted logistic regression model was used to analyze the association between fluid therapeutic regimens on the first day after ICU admission and the risk of 7-day death after surgery.Restricted cubic spline(RCS)was applied to analyze the dose-response relationship.Results Multivariate analysis indicated that restrictive fluid resuscitation was an independent protective factor.Compared with the non-restrictive fluid resuscitation group,restrictive fluid resuscitation significantly reduced the 7-day postoperative mortality rate(6.4％vs 12.4％,OR=0.44,95％CI:0.22～0.88,P=0.021),decreased the use of mechanical ventilation(42.9％vs 72.3％,OR=0.29,95％CI:0.24～0.35,P<0.001),and shortened the ICU stay(1.86 vs 3.47 d,OR=0.81,95％CI:0.78～0.84,P<0.001).RCS curve showed that the fluid intake on the first postoperative day and the 7-day postoperative mortality risk presented a J-shaped curve relationship,with an inflection point at 1 850 mL.Beyond this threshold,the 7-day postoperative mortality risk was increased.Subgroup analysis results indicated that the protective effect of restrictive fluid resuscitation was consistent across different age and comorbidity groups.Conclusion For patients with chronic liver diseases,adopting a restrictive fluid therapy on the first day after surgery can effectively reduce the risk of short-term death.Moreover,there is a non-linear dose-effect relationship between the fluid intake and the 7-day mortality risk.When the fluid intake exceeds 1 850 mL,the risk of death significantly increases.

Objective To identify risk factors for postoperative respiratory failure(PORF)in cardiovascular surgery patients using machine learning algorithms and to construct a specific risk prediction model.Methods A retrospective cohort was conducted on 1 623 patients undergoing cardiovascular surgery between 2011 and 2020 from the INSPIRE database.Following data quality analysis,multiple imputation was employed to handle missing data,and the Boruta algorithm was used for feature selection.Eight machine learning models were constructed based on the selected features,including Gradient Boosting Machine(GBM),Generalized Linear Model(GLM),Extreme Gradient Boosting(XGBoost),K-Nearest Neighbors(KNN),Neural Network(NNET),Naive Bayes(NB),Support Vector Machine(SVM),and Random Forest(RF).Model performance was evaluated using metrics including the area under the curve(AUC),sensitivity,and specificity.Variables significantly influencing PORF were identified using the permutation importance algorithm.Results The overall incidence of PORF was 27.05％(439/1 623).The in-hospital mortality rate was significantly higher in the PORF group than the non-PORF group(12.98％vs 1.60％,P<0.001).Among the developed models,the SVM model demonstrated the best performance,achieving an AUC of 0.705 in the testing set,with a sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of 0.481,0.825,0.504,and 0.812,respectively.Based on feature importance analysis,the top 10 variables most predictive of PORF were anesthesia duration,arterial partial pressure of carbon dioxide(PaCO?),calcium level,lymphocyte percentage,cardiopulmonary bypass duration,intraoperative blood loss,age,creatinine level,aspartate aminotransferase(AST)level,and activated partial thromboplastin time(aPTT).Conclusion A predictieon model for PORF following cardiovascular surgery is successfully developed.This model can identify high-risk patients and estimate their probability of developing respiratory failure,thereby facilitating data-driven clinical decision-making.

Objective To investigate the clinical characteristics and related risk factors of severe Mycoplasmal pneumoniae pneumonia(SMPP)in children.Methods Analysis of clinical data of 240 children with Mycoplasmal pneumoniae pneumonia admitted to Guangxi Hospital Division of the First Affiliated Hospital,Sun Yat-sen University from October 2023 to March 2024.According to the severity of the disease,they were divided into SMPP group and general Mycoplasmal pneumoniae pneumonia(GMPP)group,multivariate Logistic regression analysis was used to analyze the risk factors related to the occurrence of SMPP.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of each independent risk factor of SMPP.Results Compared the data during hospitalisation between GMPP group and SMPP group,the SMPP group had longer fever course,hospitalization time,azithromycin treatment time,and glucocorticoid use time(P＜0.05).The proportion of patients with unilateral lung lesions and large patchy shadows in SMPP group were significantly higher than those in GMPP group(P＜0.05).The levels of C-reactive protein,interleukin(IL)-6,and D-dimer in SMPP group were significantly higher than those in GMPP group,while the peripheral blood lymphocyte count was significantly lower than that in GMPP group(P＜0.05).The results of multiple Logistic regression analysis showed that the duration of fever,D-dimer,IL-6,and large patchy shadows in the lungs were independent risk factors for SMPP.The ROC curve results showed that fever duration ≥ 6.5 days,D-dimer≥0.495mg/L,IL-6≥11.05pg/ml,and large patchy shadows in the lungs had good application value in distinguishing SMPP and GMPP children.Conclusion Prolonged fever duration(≥6.5 days),significantly elevated levels of D-dimer and IL-6,and large patchy shadows in the lungs are the main clinical features of children with SMPP,which may be independent risk factors for predicting SMPP.

Objective To investigate the clinical characteristics and related risk factors of severe Mycoplasmal pneumoniae pneumonia(SMPP)in children.Methods Analysis of clinical data of 240 children with Mycoplasmal pneumoniae pneumonia admitted to Guangxi Hospital Division of the First Affiliated Hospital,Sun Yat-sen University from October 2023 to March 2024.According to the severity of the disease,they were divided into SMPP group and general Mycoplasmal pneumoniae pneumonia(GMPP)group,multivariate Logistic regression analysis was used to analyze the risk factors related to the occurrence of SMPP.The receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of each independent risk factor of SMPP.Results Compared the data during hospitalisation between GMPP group and SMPP group,the SMPP group had longer fever course,hospitalization time,azithromycin treatment time,and glucocorticoid use time(P＜0.05).The proportion of patients with unilateral lung lesions and large patchy shadows in SMPP group were significantly higher than those in GMPP group(P＜0.05).The levels of C-reactive protein,interleukin(IL)-6,and D-dimer in SMPP group were significantly higher than those in GMPP group,while the peripheral blood lymphocyte count was significantly lower than that in GMPP group(P＜0.05).The results of multiple Logistic regression analysis showed that the duration of fever,D-dimer,IL-6,and large patchy shadows in the lungs were independent risk factors for SMPP.The ROC curve results showed that fever duration ≥ 6.5 days,D-dimer≥0.495mg/L,IL-6≥11.05pg/ml,and large patchy shadows in the lungs had good application value in distinguishing SMPP and GMPP children.Conclusion Prolonged fever duration(≥6.5 days),significantly elevated levels of D-dimer and IL-6,and large patchy shadows in the lungs are the main clinical features of children with SMPP,which may be independent risk factors for predicting SMPP.

OBJECTIVE To elucidate the mechanisms responsible for the inhibitory effects of limonene on the proliferation of non-small cell lung cancer(NSCLC) by non-targeted metabolomics and additional approaches. METHODS The CCK-8 assay was utilized to evaluate the inhibitory effects of limonene on NSCLC A549 cell viability and to ascertain the IC50. In vitro experiments, encompassing colony formation, flow cytometry, iron content assessment, and mitochondrial staining, were conducted to assess the anti-lung cancer and iron-induced cell death effects of limonene. Metabolomic analysis was employed to identify potential pathways influenced by limonene, and Western blotting was carried out to validate pivotal proteins within these pathways. RESULTS In comparison to the control group, the limonene-treated group demonstrated a significant, dose-dependent reduction in A549 cell proliferation and colony formation. Optical microscopy revealed cellular detachment and pronounced changes in cellular morphology following exposure to limonene. Limonene induced apoptosis in A549 cells and arrested them in the G0-G1 phase of the cell cycle. Confocal microscopy unveiled diminished mitochondrial fluorescence and an augmented intracellular iron content, indicative of the classical phenomenon of ferroptosis. Metabolomic investigations unveiled divergent metabolic pathways, including glutathione(GSH) metabolism, arginine biosynthesis, D-glutamine and D-glutamate metabolism, as well as cysteine and methionine metabolism, with many of them intricately linked to intracellular GSH synthesis. Western blotting experiments underscored a marked reduction in the levels of SLC40A1, SLC7A11(xCT), and GPX4 proteins within the cells post-limonene treatment. CONCLUSION Limonene may induce ferroptosis in lung cancer cells by reducing GSH synthesis and increasing Fe2+ levels.

Objective:To evaluate the efficacy and safety of pembrolizumab plus nab-paclitaxel and platinum as first-line treatment in patients with recurrent or metastatic head and neck squamous-cell carcinoma (R/M HNSCC).Methods:This was a prospective, single-arm, open label, phase 2 clinical study enrolling patients at the Cancer Hospital of the Chinese Academy of Medical Sciences with R/M HNSCC treated with pembrolizumab plus nab-paclitaxel and cisplatin or carboplatin. After six cycles of treatment, patients received pembrolizumab as maintenance therapy until disease progression or intolerable toxicity or completion of 35 cycles of treatment. The primary endpoint was objective response rate, and secondary endpoints included overall survival, progression-free survival, and safety profile. Efficacy was evaluated according to the response evaluation criteria in solid tumors 1.1, survival analysis was performed using the Kaplan-Meier method, and adverse events were assessed using the America National Cancer Institute Common Terminology Criteria for Adverse Events 5.0.Results:A total of 30 patients with R/M HNSCC were enrolled from 23 April 2021 to 22 March 2023, including 28 males and 2 females, with a median age of 67 years. The median follow-up time was 14.5 months, the objective response rate was 70.0%, the disease control rate was 96.7%, and the median progression-free survival and overall survival of all patients were 11.6 months and 18.8 months, respectively. Median duration of response was up to 17.3 months. Grade≥3 treatment-related adverse events were leukopenia (26.7%), neutropenia (26.7%), peripheral neurotoxicity (3.3%), rash (3.3%), hyperalgesia (3.3%), and immune-related pneumonitis (3.3%). The most common immune-related adverse event was hypothyroidism (40.0%).Conclusion:Pembrolizumab combined with nab-paclitaxel and platinum shows encouraging antitumor activity accompanied with a manageable safety profile in untreated R/M HNSCC patients in China.

Objective:To determine the external bremsstrahlung doses and doses to radiation workers in selective internal radiation therapy using 90Y resin microspheres ( 90Y-SIRT). Methods:Using an AT1123 X-ray and gamma radiation dosimeter, the ambient dose equivalent rates of bremsstrahlung at distances of 30 and 100 cm from the 90Y drug with and without lead shielding were measured. The attenuation factors of 90Y bremsstrahlung attributed to lead cans and lead aprons were calculated. Furthermore, the dose rates at corresponding sites were theoretically estimated using formula. Finally, the annual doses to radiation workers were estimated based on estimated and measured bremsstrahlung doses. Results:The measured dose rates of 90Y bremsstrahlung ranged from 0.19 to 0.26 μSv·h -1·GBq -1 at a distance of 1 m from the surface of the lead shield and from 1.00 to 1.60 μSv·h -1·GBq -1 at a distance of 1 m from the surface of the unshielded penicillin bottle, plexiglass transport container, injection delivery box, and the patient. The deviations between the calculated and measured bremsstrahlung doses were mostly close to or less than ±20%. Under conditions of 200 patients treated annually, 3 GBq for each bottle of 90Y resin microspheres, and a maximum dose of 2 GBq per patient, the estimated annual effective doses to nuclear medicine technologists, interventional injection physicians, and ward-round physicians were 2.24, 1.04 and 0.22 mSv, respectively, and the annual equivalent doses to their hands were 49.9, 25.5 and 2.06 mSv, respectively. The measured attenuation factors of 90Y bremsstrahlung attributed to the lead can of 6.4 mmPb equivalent and the lead apron of 0.5 mmPb equivalent ranged from 0.13 to 0.15 and from 0.45 to 0.50, respectively. Conclusions:Under normal working conditions, the annual effective doses to the radiation workers in 90Y-SIRT will not exceed 5 mSv. Wearing personal protective equipment (PPE) or covering the injection sites of patients using a lead apron during 90Y injection can reduce the doses to the workers by approximately 50%.

Objective:To determine the external bremsstrahlung doses and doses to radiation workers in selective internal radiation therapy using 90Y resin microspheres ( 90Y-SIRT). Methods:Using an AT1123 X-ray and gamma radiation dosimeter, the ambient dose equivalent rates of bremsstrahlung at distances of 30 and 100 cm from the 90Y drug with and without lead shielding were measured. The attenuation factors of 90Y bremsstrahlung attributed to lead cans and lead aprons were calculated. Furthermore, the dose rates at corresponding sites were theoretically estimated using formula. Finally, the annual doses to radiation workers were estimated based on estimated and measured bremsstrahlung doses. Results:The measured dose rates of 90Y bremsstrahlung ranged from 0.19 to 0.26 μSv·h -1·GBq -1 at a distance of 1 m from the surface of the lead shield and from 1.00 to 1.60 μSv·h -1·GBq -1 at a distance of 1 m from the surface of the unshielded penicillin bottle, plexiglass transport container, injection delivery box, and the patient. The deviations between the calculated and measured bremsstrahlung doses were mostly close to or less than ±20%. Under conditions of 200 patients treated annually, 3 GBq for each bottle of 90Y resin microspheres, and a maximum dose of 2 GBq per patient, the estimated annual effective doses to nuclear medicine technologists, interventional injection physicians, and ward-round physicians were 2.24, 1.04 and 0.22 mSv, respectively, and the annual equivalent doses to their hands were 49.9, 25.5 and 2.06 mSv, respectively. The measured attenuation factors of 90Y bremsstrahlung attributed to the lead can of 6.4 mmPb equivalent and the lead apron of 0.5 mmPb equivalent ranged from 0.13 to 0.15 and from 0.45 to 0.50, respectively. Conclusions:Under normal working conditions, the annual effective doses to the radiation workers in 90Y-SIRT will not exceed 5 mSv. Wearing personal protective equipment (PPE) or covering the injection sites of patients using a lead apron during 90Y injection can reduce the doses to the workers by approximately 50%.

Objective:To observe the effect of well-designed board sanding training on the upper extremity motor functioning of hemiplegic stroke survivors.Methods:Sixty stroke survivors with hemiplegia were randomly divided into an observation group (30 cases) and a control group (30 cases). All received conventional rehabilitation. The observation group′s training involved intelligent board sanding, while the control group′s training involved traditional sanding.Results:After the treatment, significant improvement was observed in the Fugl-Meyer upper extremity scores, modified Barthel index scores and reported shoulder pain in both groups, with the observation group′s averages significantly better than those of the control group. After the intervention, the average scores of both groups on the modified Ashforth scale had also improved significantly.Conclusions:Supplementing conventional rehabilitation treatment with intelligent board sanding can significantly improve upper extremity motor function and ability in the activities of daily living of stroke survivors with hemiplegia while somewhat relieving shoulder pain. The effect is better than with traditional board sanding.

Objective To study the clinical use of microwave scalpel in hepatectomy for hepatocellular carcinoma without hepatic vascular inflow occlusion.Methods A retrospective study was conducted on the clinical data of 126 consecutive patients with hepatocellular carcinoma who were treated at the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Sun Yat-sen University from December 2015 to August 2018.The patients included 111 males and 15 females,with ages which ranged from 25 to 75 years.These patients were divided into two groups by the different surgical resection methods:the microwave scalpel hepatectomy (MSH) group which employed microwave scalpels to perform hepatectomy (n =42),and the ultrasound scalpel hepatectomy (USH) group which employed ultrasound scalpels (n =84).The perioperative conditions which included baseline data,amount of intraoperative bleeding,liver function after operation,and morbidity of postoperative complications were compared.Results There were no significant differences in the preoperative indexes which included tumor diameter,number of tumors,levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) between the 2 groups (all P ＞ 0.05).In the MSH group,the amount of intraoperative bleeding was 100.0 (100.0,200.0) ml,which was significantly lower than the 300.0 (100.0,400.0) ml in the USH group (P ＜ 0.05).Compared with the USH group,the levels of AST and ALT on postoperative day 1,3,7 after operation in the MSH group were significantly lower (all P ＜ 0.05),and the corresponding albumin levels were significantly higher than the USH group (P ＜0.05).The incidence of complications was 4.8％ (2/42) in the MSH group which was significantly lower than that of 20.2％ (17/84) in the USH group (P ＜ 0.05).Conclusion Microwave scalpel significantly reduced intraoperative bleeding and postoperative complications,and led to less liver functional injury.