To address the limitations of convolutional neural networks in global context modeling and the complexity of secondary computation in Transformer's self attention mechanism,an improved multi-direction-MambaUNet(MD-MambaUNet)based on MambaUNet is proposed.This network integrates with multi directional selective scanning module to extract spatial features from multiple directions of CT images,significantly improving the global context modeling capability.By introducing partial convolution and constructing a lightweight hybrid convolution module,the model's parameter count is significantly reduced,enabling the processing of large-scale medical image data at lower computational costs while maintaining high-level performance.Experiments are conducted on the LiTS2017 and 3DIRCADB public datasets.Compared with MambaUNet on the LiTS2017 dataset,MD-MambaUNet improves the Dice similarity coefficient for liver and tumor segmentation by 3.32%and 4.77%,reaching 95.36%and 76.93%,and increases intersection over union by 4.18%and 4.92%,reaching 91.43%and 69.74%,respectively.Compared with MambaUNet on the 3DIRCADB dataset,MD-MambaUNet improves the Dice similarity coefficient for liver and tumor segmentation by 2.08%and 2.21%,reaching 93.81%and 64.68%,and increases intersection over union by 0.79%and 3.13%,reaching 87.23%and 57.65%,respectively.Meanwhile,the parameter count is 13.71 M less than MambaUNet,making it possible for the model to be deployed in clinical scenarios.

To address the limitations of convolutional neural networks in global context modeling and the complexity of secondary computation in Transformer's self attention mechanism,an improved multi-direction-MambaUNet(MD-MambaUNet)based on MambaUNet is proposed.This network integrates with multi directional selective scanning module to extract spatial features from multiple directions of CT images,significantly improving the global context modeling capability.By introducing partial convolution and constructing a lightweight hybrid convolution module,the model's parameter count is significantly reduced,enabling the processing of large-scale medical image data at lower computational costs while maintaining high-level performance.Experiments are conducted on the LiTS2017 and 3DIRCADB public datasets.Compared with MambaUNet on the LiTS2017 dataset,MD-MambaUNet improves the Dice similarity coefficient for liver and tumor segmentation by 3.32%and 4.77%,reaching 95.36%and 76.93%,and increases intersection over union by 4.18%and 4.92%,reaching 91.43%and 69.74%,respectively.Compared with MambaUNet on the 3DIRCADB dataset,MD-MambaUNet improves the Dice similarity coefficient for liver and tumor segmentation by 2.08%and 2.21%,reaching 93.81%and 64.68%,and increases intersection over union by 0.79%and 3.13%,reaching 87.23%and 57.65%,respectively.Meanwhile,the parameter count is 13.71 M less than MambaUNet,making it possible for the model to be deployed in clinical scenarios.

Objective To explore the application effect of the Roy adaptation model in continuing care for patients with acute-ST segment elevation myocardial infarction(STEMI)after interventional treatment.Methods A total of 120 STEMI patients who received emergency percutaneous coronary intervention at Henan Chest Hospital from March 2020 to February 2022 were selected as the research subjects.Patients were randomly divided into the observation group and the control group by using a random number table method,with 60 patients in each group.After discharge,patients in the control group received routine continuing care intervention,while patients in the observation group received continuing care based on Roy's adaptation model.Before and at 1 year of intervention,the posttraumatic growth level of patients in the two groups was evaluated by using the posttraumatic growth inventory(PTGI),the adherence to antiplatelet and anticoagulant medication of patients in the two groups was evaluated with the medication adherence questionnaire(MAQ),and the quality of life of patients in the two groups was evaluated with the China questionnaire of quality of life in patients with cardiovascular diseases(CQQC).Patients in the two groups were followed up for 1 year.The major adverse cardiac events(MACE)that occurred within 1 year were recorded.Results The proportion of patients with strong adherence in the observation group was significantly higher than that in the control group(x2=9.969,P＜0.05).Before the intervention,there was no significant difference in the PTGI and CQQC scores of patients between the observation group and the control group(P＞0.05).At 1 year of intervention,the PTGI and CQQC scores of patients in both groups were significantly higher than those before intervention,and the PTGI and CQQC scores of patients in the observation group were significantly higher than those in the control group(P＜0.05).The total incidence of MACE in the control group and the observation group was 23.33％(14/60)and 8.33％(5/60),respectively.The total inci-dence of MACE in the observation group was significantly lower than that in the control group(P＜0.05).Conclusion The Roy adaptation model can significantly improve the patient's posttraumatic growth level and secondary preventive medication adherence in continuing care after STEMI intervention treatment,reducing the occurrence of MACE and improving the quality of life.

As a classic prescription for invigorating spleen and replenishing qi, Sijunzi Decoction has a good clinical efficacy in the treatment of gastric cancer. It can improve chemotherapy resistance, reduce the toxic and side effects of chemotherapy, promote postoperative recovery, enhance immunity, improve the nutritional status of patients, improve the quality of life of patients and prevent precancerous lesions. Network pharmacology studies have shown that Sijunzi Decoction exerts anti-gastric cancer effects through multiple active ingredients, multiple targets and multiple pathways, and quercetin may be the main active component in Sijunzi Decoction to exert anti-gastric cancer effects. The main mechanisms of Sijunzi Decoction in the treatment of gastric cancer include regulating the expression of cell cycle and apoptosis-related gene proteins, and inhibiting the proliferation, migration, invasion and gastric cancer stem cell characteristics of gastric cancer cells.

Prehospital emergency care is the primary stage in the treatment of critically ill patients, where efficient and accurate monitoring methods are crucial for patient survival and prognosis. End-tidal carbon dioxide (EtCO₂) monitoring is a real-time, non-invasive method that can sensitively capture the status of respiratory, circulatory, and metabolic functions, particularly in the urgent and complex pre-hospital environment, a immediate detection and non-invasive method, can sensitively capture the respiratory, circulatory, and metabolic status of patients. It provides valuable guidance for rapid decision-making and precise interventions. This is particularly valuable in the complex and urgent prehospital environment, providing critical data for rapid decision-making and precise intervention. This paper systematically reviews the advancements in the application of EtCO₂ monitoring across various fields, including sepsis identification, trauma assessment, cardiac arrest, respiratory critical care, endotracheal intubation confirmation, and management of metabolic diseases, aiming to explore its application value and prospects in pre-hospital emergency care.
Humans ; Emergency Medical Services/methods* ; Carbon Dioxide/analysis* ; Monitoring, Physiologic/methods* ; Critical Illness ; Capnography/methods*

AimTo study the anti-inflammatory effect of astragalosides(AST) and its mechanisms of action. Methods The exudate volume, neutrophil count and protein content in exudate were measuredinthe carrageenan-induced air pounch model in rats. The content of PGE2 was assayed by radioimmunoassay,the activity of PLA2 by microacid titration assay, IL-8 by ELISA, and NO by nitrate reductase assay. The production of O2 in neutrophil was determined by cytochrome C assay. Results AST(40, 80 mg· kg -1) could markedly reduce the exudate volume, neutrophil count, protein content, the content of IL-8, and the production of O2.AST lowered PLA2 activity of neutrophil and accellular component in exudate, and it also decreased the contents of PGE2 and NO in exudate. Conclusion AST has an obvious anti-inflammatory effect on carrageenan-induced acute inflammation.Its mechanisms may be related to the inhibition of vascular permeability and leukocyte migration, as well as to the suppression of PLA2 activity and the reduction of IL-8, PGE2, NO and O2 production.

0.05).61 patients received no sedatives nor analgesics showed significantly higher incidence of SUE compared with those patients received either sedatives or analgesics(73.8% vs 37.3%,P

Objective Post-operative hypoxemia occurred frequently after extubation in patients who underwent orthotopic liver transplantation (OLT) in ICU. This study is to investigate the efficiency of hyperoxia solution in improving oxygenation. Methods Ten OLT cases, who post-operatively manifested hypoxemia after extubation, were enrolled in this study. Hyperoxia Ringer's solution (500ml) prepared by Jing-Shu-Yang (an apparatus of oxygen supply, Vanform Co., Shandong) was infused at a rate of 200ml/hr. Hemodynamic parameters, blood gas, and blood lactate were determined at the beginning, end of infusion, and 1 hour after the infusion, with recording of the following data: heart rate (HR), mean arterial pressure (MAP), pulmonary arterial pressure (PAP), and pulmonary capillaries wedged pressure (PCWP). Results Compared with the levels at the beginning of infusion, SpO2 and SvO2 increased significantly at the end of the infusion of 500 ml hyperoxia Ringer's solution, and they returned to the baselines 1 hour later, although regular Ringer′s solution was coutinuously given by the same infusion rate. HR, MAP and PCWP were kept stable with the solution infusion. Notably, PAP was decreased markedly at the end of infusion, and blood lactate level remained unchanged after the intervention. Conclusion Hyperoxia Ringer's solution infusion improved oxygenation in OLT patients who suffered from acute lung injury with hypoxemia postoperatively. PAP decreased markedly as hypoxemia was corrected.

Objective To investigate morbidity and analyze high risk factors of nosocomial infection in patients who underwent orthotopic liver transplantation (OLT) in our ICU, in order to draft possible preventive strategies. Methods The clinical data of 56 OLT patients from Apr 2002 to Dec 2004 were analyzed. Results Significantly high APACHE Ⅱ scores and total plasma bilirubin, low platelet count were found in patients with nosocomial infection. The number of patients who had received an additional operation and broad-spectrum antibiotics before OLT were greater in nosocomial infection (NI) group than in none-nosocomial infection (NNI) group. Notably, the longer the broad-spectrum antibiotics used before OLT, the higher the morbidity rate of nosocomial infection. No significant difference was found in age, Child-Pugh grade and plasma albumin level between the two groups. In addition, APACHE Ⅱ scores and total bilirubin level were significantly higher in patients acquired enterococcal infection than in those infected with other pathogenic microorganisms. Conclusions High APACHE Ⅱ score, high total bilirubin level, low platelet count and length of use of broad-spectrum antibiotics before OLT were closely associated with nosocomial infection. As an important indicator, change in total bilirubin level not only represented the liver function ,but also was one of the high risk factors to nosocomial infection in patients undergoing OLT.