OBJECTIVE To investigate the levels of high-mobility group box 1(HMGB1)protein,soluble fms-like tyrosine kinase 1(sFLT-1)and lactate-to-albumin ratio(LAR)in patients with severe pulmonary infection-associ-ated sepsis undergoing continuous renal replacement therapy(CRRT),and their correlation with 28-day clinical outcomes.METHODS A total of 102 patients with severe pulmonary infection-associated sepsis undergoing CRRT admitted to the People's Hospital of Nanchuan Chongqing from Jul.2021 to Jul.2024 were enrolled.Based on 28-day clinical outcomes,they were divided into a favorable prognosis group(71 cases)and a poor prognosis group(31 cases).The levels of HMGB1,sFLT-1,lactate,albumin and LAR were compared between the two groups.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of HMGB1,sFLT-1 and LAR for 28-day clinical outcomes in patients with severe pulmonary infection-associated sepsis undergoing CRRT.RESULTS Gram-negative bacteria were the predominant pathogens in patients with se-vere pulmonary infection-associated sepsis undergoing CRRT.The poor prognosis group had higher lactate levels(4.01±1.07 mmol/L)and lower albumin levels(27.46±4.15 g/L)than the favorable prognosis group(P＜0.05).The levels of HMGB1(62.66±15.66 ng/ml),sFLT-1(0.71±0.17 ng/ml)and LAR(14.59±3.64％)in the poor prognosis group were significantly higher than those in the favorable prognosis group(P＜0.05).The combined detection of HMGB1,sFLT-1 and LAR yielded an area under the curve(AUC)of 0.949 for predicting poor 28-day mortality in patients with severe pulmonary infection-associated sepsis undergoing CRRT,superior to the single detection of the indexes(P＜0.05),with a sensitivity of 93.55％and specificity of 87.32％.CONCLUSIONS In patients with severe pulmonary infection-associated sepsis undergoing CRRT,gram-negative bacteria are the predominant pathogens.Patients with poor prognosis exhibit abnormally elevated levels of HMGB1,sFLT-1 and LAR,and the combined detection of these three markers demonstrates high predictive value for 28-day mortality.

OBJECTIVE To investigate the levels of high-mobility group box 1(HMGB1)protein,soluble fms-like tyrosine kinase 1(sFLT-1)and lactate-to-albumin ratio(LAR)in patients with severe pulmonary infection-associ-ated sepsis undergoing continuous renal replacement therapy(CRRT),and their correlation with 28-day clinical outcomes.METHODS A total of 102 patients with severe pulmonary infection-associated sepsis undergoing CRRT admitted to the People's Hospital of Nanchuan Chongqing from Jul.2021 to Jul.2024 were enrolled.Based on 28-day clinical outcomes,they were divided into a favorable prognosis group(71 cases)and a poor prognosis group(31 cases).The levels of HMGB1,sFLT-1,lactate,albumin and LAR were compared between the two groups.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of HMGB1,sFLT-1 and LAR for 28-day clinical outcomes in patients with severe pulmonary infection-associated sepsis undergoing CRRT.RESULTS Gram-negative bacteria were the predominant pathogens in patients with se-vere pulmonary infection-associated sepsis undergoing CRRT.The poor prognosis group had higher lactate levels(4.01±1.07 mmol/L)and lower albumin levels(27.46±4.15 g/L)than the favorable prognosis group(P＜0.05).The levels of HMGB1(62.66±15.66 ng/ml),sFLT-1(0.71±0.17 ng/ml)and LAR(14.59±3.64％)in the poor prognosis group were significantly higher than those in the favorable prognosis group(P＜0.05).The combined detection of HMGB1,sFLT-1 and LAR yielded an area under the curve(AUC)of 0.949 for predicting poor 28-day mortality in patients with severe pulmonary infection-associated sepsis undergoing CRRT,superior to the single detection of the indexes(P＜0.05),with a sensitivity of 93.55％and specificity of 87.32％.CONCLUSIONS In patients with severe pulmonary infection-associated sepsis undergoing CRRT,gram-negative bacteria are the predominant pathogens.Patients with poor prognosis exhibit abnormally elevated levels of HMGB1,sFLT-1 and LAR,and the combined detection of these three markers demonstrates high predictive value for 28-day mortality.

Objective:To observe the effect of personalized airway clearance therapy on extubation of patients with trache-otomy in intensive rehabilitation care unit. Method:Totally 62 patients who met the inclusion criteria were divided into the control group and experimen-tal group,with 31 patients in each group.During the experimental period,one patient in the control group and experimental group dropped off.The control group was given the posture drainage combined with back tap-ping on the basis of routine rehabilitation,while the experimental group was given the personalized airway clearance therapy(including cough training,active cycles of breathing techriques,posture drainage,etc.)on the basis of routine rehabilitation.The observation period was 6 weeks,and the sputum volume,extubation time,extubation success rate and clinical pulmonary infection score were compared between the two groups. Result:After 6 weeks of training,the average sputum volume in the experimental group was significantly high-er than that in the control group(P＜0.05).At the first week of training,there was no significant difference in the average daily sputum volume between the two groups(P＞0.05),but at the second,fourth and sixth weeks,the average daily sputum volume in the experimental group was significantly lower than that in the control group(P＜0.05).Before training,there was no statistically significant difference in CPIS scores between the two groups(P＞0.05),but at the first,third and sixth weeks,CPIS scores in the experimental group were significantly lower than that in the control group(P＜0.05).The results of repeated measure ANOVA showed that the time effect,inter-group effect and interaction effect of daily expectoration volume and CPIS score in the two groups were statistically significant(P＜0.05).The extubation time in the experimental group was significantly shorter than that in the control group(P＜0.05),and the success rate of extubation in the ex-perimental group was 93.3％,which was significantly higher than 70.0％in the control group(P＜0.05). Conclusion:Personalized airway clearance technology can improve the pulmonary infection of patients with tra-cheotomy in ICU more effectively,shorten the time of tracheal tube removal,and improve the success rate of extubation.

Objective:To observe the effect of abdominal electrical stimulation combined with airway clearance on cough ability and success rate of extubation in patients with severe tracheotomy. Method:A randomized,double-blind,controlled trial was conducted.52 patients with tracheotomy who met the inclusion criteria were divided into a control group and an experimental group,with 26 cases in each group.The experimental group was treated with abdominal electrical stimulation on the basis of airway clear-ance technique.The observation period was 6 weeks.Before and after treatment,involuntary cough peak flow rate(ICPF),clinical pulmonary infection score(CPIS),tracheal tube extubation time and extubation success rate were used to compare the differences in clinical efficacy. Result:Before the training,there was no significant difference in ICPF between the two groups(P＞0.05),but at l,3 and 6 weeks,the ICPF score of the experimental group was significantly higher than that of the con-trol group(P＜0.05).Before training,there was no significant difference in CPIS score between the two groups(P＞0.05),but after 1,3 and 6 weeks,the CPIS score of the experimental group was significantly lower than that of the control group,and the difference was statistically significant(P＜0.05).Before training,there was no significant difference in abdominal muscle thickness between the two groups(P＞0.05).At the 3rd and 6th week,the abdominal muscle thickness of the experimental group was significantly higher than that of the control group,and the difference was statistically significant(P＜0.05).The extubation time of the experimental group was significantly shorter than that of the control group(P＜0.05).The success rate of extu-bation in the experimental group was 92％,which was significantly higher than that in the control group(76％),and the difference was statistically significant(P＜0.05). Conclusion:Abdominal electrical stimulation combined with airway clearance can significantly improve the cough ability of patients with severe tracheotomy,shorten the time of tracheal cannula removal,and improve the success rate of extubation.

Objective To observe the effectiveness of plasma exchange(PE)combined with the double plasma molecular adsorption system(DPMAS)in managing liver failure complicated by severe hyperbilirubinemia.Methods A total of 120 patients with liver failure who received artificial liver therapy were selected in Mianyang Central Hospital from June 2023 to June 2024 were as study objects.These patients were divided into an observation group and a control group,with 60 cases in each group.The control group received standard medical treatment,while the observation group underwent PE+DPMAS therapy in addition to the standard regimen,concrete method:firstly,low molecular weight heparin sodium at 25000 U was added to the 0.9%physiological saline(NS)1 750 mL pre flushing tube;Secondly,low molecular weight heparin sodium at 12 500 U and 0.9%NS at 500 mL were administered,and finally 0.9%NS 500 mL was used for flushing pipes,based on the patient's coagulation function,low molecular weight heparin sodium at 12500 U and 0.9%NS at 500 mL can be sequentially moved forward,after the pre flushing was completed,it can be connected to the catheter and wait for it to be loaded onto the machine.The circulating flow rate for the first 30 minutes after starting the machine was 1 800-2000 mL/h,with a flow rate of 125-140 mL per minute,blood is drawn out from the arterial terminals and separated by a plasma separator,the separated plasma was adsorbed by a series of AR-350 bilirubin columns and YTS-200 hemoperfusion apparatus before flowing into the venous circuit tube and returning to the body.The differences of clinical symptoms and laboratory indicators,including liver function indicators[aspartate transaminase(AST),alanine transaminase(ALT),alkaline phosphatase(ALP),γ-glutamyl transferase(GGT),total bile acid(TBA),total bilirubin(TBil),direct bilirubin(DBil),albumin(ALB)],kidney function indicators[creatinine(Cr)],coagulation function indicators[prothrombin time(PT)and prothrombin activity(PTA)]before and after treatment between the two groups were compared,and clinical efficacy and adverse reactions of the two groups were observed.Results Following treatment,both groups exhibited significant reductions in AST,ALT,ALP,TBA,TBil,and DBil levels compared to before treatment,the levels of total AST,ALT,TBA and TBil after treatment in the observation group were significantly lower than those in the control group[AST(U/L):84.2±69.3 vs.158.3±130.2,ALT(U/L):119.3±112.1 vs.145.9±124.7,TBA(μmol/L):59.1±48.3 vs.158.3±130.2,TBil(μmol/L):101.3±56.4 vs 145.9±124.7,all P<0.05];ALB increased significantly in the both groups after treatment compared to before treatment(g/L:the observation group was 35.1±3.7 vs.32.1±4.6,the control group was 33.1±3.1 vs.31.8±3.5,both P<0.05),however,there was no significantly difference between the two groups(P>0.05).In the observation group,PT shortened significantly after treatment(s:13.6±1.4 vs.14.5±2.1,P<0.05),while PTA increased significantly after treatment[(95.1±19.5)%vs.(83.2±21.1)%,P<0.05];moreover,the time required to achieve 30%,50%,and 70%reductions in TBil was markedly shorter in the observation group than in the control group[time required to achieve 30%reductions in TBil(days):6.1±4.3 vs.9.7±4.8,time required to achieve 50%reductions in TBil(days):9.3±5.1 vs.11.9±6.2,time required to achieve 70%reductions in TBil(days):13.2±5.9 vs.18.1±6.9,all P<0.05].The total effective rate of observation group was significantly higher than that of control group[93.3%(56/60)vs.68.3%(41/60),P<0.05].Both groups completed the treatment without deaths.During the treatment,5 cases experienced allergic reactions and 3 cases experienced a decrease in blood pressure,after symptomatic treatment,all patients continued to complete the treatment.Conclusion PE combined with DPMAS shows considerable clinical benefits for patients with liver failure and severe hyperbilirubinemia by effectively lowering bilirubin levels and accelerating recovery,thus shortening the disease course.

Objective To observe the effectiveness of plasma exchange(PE)combined with the double plasma molecular adsorption system(DPMAS)in managing liver failure complicated by severe hyperbilirubinemia.Methods A total of 120 patients with liver failure who received artificial liver therapy were selected in Mianyang Central Hospital from June 2023 to June 2024 were as study objects.These patients were divided into an observation group and a control group,with 60 cases in each group.The control group received standard medical treatment,while the observation group underwent PE+DPMAS therapy in addition to the standard regimen,concrete method:firstly,low molecular weight heparin sodium at 25000 U was added to the 0.9%physiological saline(NS)1 750 mL pre flushing tube;Secondly,low molecular weight heparin sodium at 12 500 U and 0.9%NS at 500 mL were administered,and finally 0.9%NS 500 mL was used for flushing pipes,based on the patient's coagulation function,low molecular weight heparin sodium at 12500 U and 0.9%NS at 500 mL can be sequentially moved forward,after the pre flushing was completed,it can be connected to the catheter and wait for it to be loaded onto the machine.The circulating flow rate for the first 30 minutes after starting the machine was 1 800-2000 mL/h,with a flow rate of 125-140 mL per minute,blood is drawn out from the arterial terminals and separated by a plasma separator,the separated plasma was adsorbed by a series of AR-350 bilirubin columns and YTS-200 hemoperfusion apparatus before flowing into the venous circuit tube and returning to the body.The differences of clinical symptoms and laboratory indicators,including liver function indicators[aspartate transaminase(AST),alanine transaminase(ALT),alkaline phosphatase(ALP),γ-glutamyl transferase(GGT),total bile acid(TBA),total bilirubin(TBil),direct bilirubin(DBil),albumin(ALB)],kidney function indicators[creatinine(Cr)],coagulation function indicators[prothrombin time(PT)and prothrombin activity(PTA)]before and after treatment between the two groups were compared,and clinical efficacy and adverse reactions of the two groups were observed.Results Following treatment,both groups exhibited significant reductions in AST,ALT,ALP,TBA,TBil,and DBil levels compared to before treatment,the levels of total AST,ALT,TBA and TBil after treatment in the observation group were significantly lower than those in the control group[AST(U/L):84.2±69.3 vs.158.3±130.2,ALT(U/L):119.3±112.1 vs.145.9±124.7,TBA(μmol/L):59.1±48.3 vs.158.3±130.2,TBil(μmol/L):101.3±56.4 vs 145.9±124.7,all P<0.05];ALB increased significantly in the both groups after treatment compared to before treatment(g/L:the observation group was 35.1±3.7 vs.32.1±4.6,the control group was 33.1±3.1 vs.31.8±3.5,both P<0.05),however,there was no significantly difference between the two groups(P>0.05).In the observation group,PT shortened significantly after treatment(s:13.6±1.4 vs.14.5±2.1,P<0.05),while PTA increased significantly after treatment[(95.1±19.5)%vs.(83.2±21.1)%,P<0.05];moreover,the time required to achieve 30%,50%,and 70%reductions in TBil was markedly shorter in the observation group than in the control group[time required to achieve 30%reductions in TBil(days):6.1±4.3 vs.9.7±4.8,time required to achieve 50%reductions in TBil(days):9.3±5.1 vs.11.9±6.2,time required to achieve 70%reductions in TBil(days):13.2±5.9 vs.18.1±6.9,all P<0.05].The total effective rate of observation group was significantly higher than that of control group[93.3%(56/60)vs.68.3%(41/60),P<0.05].Both groups completed the treatment without deaths.During the treatment,5 cases experienced allergic reactions and 3 cases experienced a decrease in blood pressure,after symptomatic treatment,all patients continued to complete the treatment.Conclusion PE combined with DPMAS shows considerable clinical benefits for patients with liver failure and severe hyperbilirubinemia by effectively lowering bilirubin levels and accelerating recovery,thus shortening the disease course.

Objective To observe the clinical efficacy of artificial liver plasma bilirubin adsorption for treatment of patients with severe viral hepatitis B (HBV). Methods A retrospective study was conducted, the 120 patients with severe HBV B and their historical data of having undergone treatment of artificial liver plasma bilirubin adsorption admitted to Department of Respiration of Mianyang Central Hospital from August 2015 to August 2017 were collected, and there were 68 cases in the cirrhotic group and 52 cases in the non-cirrhotic group. The indexes of liver function and coagulation function before and after the treatment of artificial liver plasma bilirubin adsorption were collected; the differences of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamine transferase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total protein (TP), albumin (Alb), globulin (Glo), prothrombin time (PT), prothrombin activity (PTA), total bilirubin (TBil) and indirect bilirubin (IBil), total bile acid (TBA), etc were compared between cirrhotic group and the severe hepatitis B non-cirrhotic group. Results The levels of ALT, AST, ALP, LDH after artificial liver plasma bilirubin adsorption therapy were lower than those before the treatment [ALT (U/L): 138.8±26.2 vs. 993.4±185.2, AST (U/L): 121.7±119.9 vs. 798.7±226.8, ALP (U/L): 129.7±8.1 vs. 178.9±14.1, LDH (μmol·L-1·s-1·L-1): 4.50±0.32 vs. 8.15 ±1.75, all P < 0.05], PTA was higher than that before the treatment [(43.2±25.6)% vs. (30.0±16.1)%, P < 0.05]. After the treatment, the decline rate of ALP, TBil, and TBA of non-cirrhotic group was higher than those in cirrhotic group (ALP: 34.20% vs. 17.80%, TBil: 39.10% vs. 18.10%, TBA:30.70% vs. 5.00%, P < 0.05), the elevation rate of PTA in non-cirrhotic group was also higher than that in cirrhotic group (52.50% vs. 25.10%, P < 0.05). Conclusion Artificial liver plasma bilirubin adsorption therapy is effective for treatment of patients with severe HBV B, particularly the effect being good on the early severe viral HBV B non-cirrhotic group.

Objective To compare the clinical effect of Multiloc nailing and Philos locking plate for treating proximal humerus fracture.Methods A retrospective analysis of 34 surgery treated proximal humeral fractures patients in Department of Orthopedics,Beijing Haidian Hospital and Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University from January 2015 to June 2016,in which 3 cases of high-energy injury and multiple fractures andonecase of humerus head replacement and onecase of non-surgical treatment were excluded.Finally,29 patients were included and clinical followed up to 12 months after surgery.The 29 paients were divided into the locking plate group (n =13) and intramedullary nail group (n =16),The operative time,volume of intraoperative blood loss,preoperative to postoperative 24 patients were compared between the locking plate group and intramedullary nail group underwent open reduction and internal fixation with philos locking plate hemoglobin changes,24 h postoperative visual analogue scale and 3,6,12 months postoperative Constant-Murley shoulder function score.SPSS13.0 statistical software was used to analyze the data.Measurement data were expressed as ((x) ± s).Comparison of groups used independent samples t test,repeated measurement data used repeated measures analysis of variance.Results The age of the locking plate group was (65.7 ± 9.3) years,and the age of the intramedullary nailing group was (65.6 ± 11.1) years.In the locking plate group,the operation time was (150 ± 17) minutes,the intraoperative blood volume was (300 ± 53) ml,the change of blood pigment between before surgery to 24 hours after surgery was (26 ± 8) mg/L,and the vision algetic standard of 24 hours after surgery was (3.4 ± 0.8) scores.In intramedullary nailing group,the operation time was (119 ± 13) minutes,the intraoperative blood volume was (130 ± 25) ml,and the change of blood pigment between before surgery to 24 hours after surgery was (11 ± 5) g/L,the vision algetic standard of 24 hours after surgery was (2.3 ± 0.5) scores.No serious postoperative complications occurred in either group,including infection,internal fixationfailure,and humeral head necrosis.In locking plate group,for the Constant-Murley shoulder joint function score,3 months after surgery was (76.0 ± 11.6) scores,6 months was (78.0 ± 13.4) scores,12 months was (88.0 ± 12.1) score.In intramedullary nailing group 3 months was (85.0 ± 9.7) scores,6 months was (87.0 ± 8.9) scores,12 months was (89.0 ± 10.3) scores.There were no statistical difference between the two groups at incidence of serious complications after surgery,postoperative 12 months Constant-Murley shoulder joint function score.Muhiloc intramedullary nailing group was better than Philos locking plate group in the operation time,the intraoperative blood volume,etc.Conclusion Multiloc intramedullary nail is an effective method for treating proximal humerus fracture,and it has the advantages of less surgical injury and early postoperativesatisfactory than the locking plate.

Objective To compare the intubating conditions between dexmedetomidine and remifentanil when combined with sevoflurane-nitrous oxide (N2O) for anesthesia induction in the pediatric patients.Methods A total of 122 pediatric patients,aged 4-10 yr,of American Society of Anesthesiologists physical status Ⅰ,undergoing elective plastic surgery,were randomly divided into dexmedetomidine group (group D,n =61) and remifentanil group (group R,n=61).Eight percent sevoflurane and 60％ N2O were inhaled for induction of anesthesia,and the fresh gas flow was set at 6 L/min.After disappearance of eyelash reflex,dexmedetomidine 1 μg/kg and remifentanil 1 μg/kg were intravenously injected over 50-60 s in D and R groups,respectively,and 1 min later tracheal intubation was performed.The intubating conditions were graded,and the satisfactory intubating conditions and successful intubation were recorded.The development of adverse cardiovascular reactions and complications such as hyoxemia and laryngospasm before and after intubation and postoperative pharyngodynia was recorded.Results Compared with group D,no significant change was found in the success rate of intubation,rate of satisfactory intubation,intubating condition grade or incidence of postoperative pharyngodynia (P＞ 0.05),and the incidence of hypertension and sinus tachycardia after intubation was significantly increased in group R (P＜0.05).No pediatric patients developed hyoxemia,laryngospasn or sinus tachycardia in two groups.Conclusion When 8％ sevoflurane and 60％ N2O are inhaled for anesthesia induction,combing with dexmedetomidine 1 μg/kg produces better clinical efficacy than combing with remifentanil 1 μg/kg in improving the intubating conditions for pediatric patients.

Objective To evaluate and compare the efficacy and safety of sedative and analgesic anesthesia in surgical patients with supine and prone position .Methods Sixty female patients, American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged from 18 -53 years, scheduled for elective plastic operations under sedative and analgesic anesthesia combined with local anesthesia were divided into two groups according to their surgical positions: supine group ( n=30 ) and prone group ( n=30 ) .All patients received Ⅳ dexmedetomidine ( DEX) 1 μg/kg over 15 min followed by 0.4 -0.7 μg/kg/h infusion. Both groups were administered Ⅳ midazolam 0.04 mg/kg and a continuous infusion of remifentanil of 0.1 μg/kg/min at the beginning of anesthesia .Heart rate ( HR) , mean arterial pressure (MAP), pulse oximetry (SpO2), respiratory rate (RR), bispectral index (BIS) and Ramsay sedation scores ( RSS) were recorded at the following time points: before anesthesia ( T0 ) , 5 min after induction with midazolam ( T1 ) , 10 min after induction of midazolam ( T2 ) , immediately after induction with DEX( T3 ) , the beginning of local anesthesia ( T4 ) , the beginning of surgery ( T5 ) , 30 min after anesthesia induction ( T6 ) , 60 min after anesthesia induction ( T7 ) , immediately after turning off DEX infusion (T8), the end of surgery (T9).Incidences of respiratory depression, incidences of apnea, oxygen supplementation by facial mask and jaw-thrust, frequencies of body movements and additional rescue medication were also recorded .After surgery , recall of events during surgery , the visual analogue scales (VAS) for pain in PACU, the satisfaction levels of patients and surgeons were also assessed .Results No significant differences were found in MAP , SpO2 , RR, BIS, RSS scores at any time point between two groups (all P >0.05).There were no significant differences in incidences of respiratory depression , frequencies of body movements and additional rescue medication during surgery between groups ( all P>0. 05).Neither were recall of events during surgery , the visual analogue scales (VAS) for pain and the satisfaction levels of patients and surgeons after surgery (all P>0.05).The HR at time points of T0, T1, T2 in prone group were significantly higher than those in supine group (all P<0.05).Compared with the supine group , the incidences of apnea , oxygen supplementation by facial mask and jaw-thrust in prone group were significantly lower .Conclusions Sedative and analgesic anesthesia is effective and safe for patients with prone surgical position and has a lower incidence of upper airway obstruction during surgery than patients in supine surgical position .