Objective:This study used data-independent acquisition (DIA) proteomics to analyze plasma protein expression in sepsis-induced coagulopathy (SIC), identify key biomarkers, and develop a diagnostic model.Methods:This prospective study included 46 adult sepsis patients from the intensive care unit. Patients were categorized into a general sepsis group ( n=26) and an SIC group ( n=20) based on established SIC criteria. Plasma samples underwent proteomic and bioinformatics analyses to identify differentially expressed protein (DEP) using LASSO regression and Random Forest. A diagnostic model was constructed and assessed via receiver operating characteristic (ROC) curve analysis. Results:The baseline data revealed that SIC patients exhibited longer prothrombin times, lower platelet counts, and higher D-dimer, fibrin degradation products, blood lactate, SOFA scores, and APACHE Ⅱ scores compared with general sepsis patients ( P<0.05). DIA proteomics identified 2 637 proteins, with 240 DEP meeting the criteria (fold change >1.5, P<0.05), including 81 upregulated and 159 downregulated DEP. Subcellular localization analysis revealed that DEPs were predominantly extracellular and nuclear. Gene ontology (GO) annotation showed that DEP were mainly involved in cellular physiology, biological regulation, and stress response processes in biological processes. Domain annotation revealed a predominance of immunoglobulin V regions in DEP, which are crucial for antigen recognition and binding. KEGG enrichment analysis showed significant enrichment of DEP in pathways related to natural killer cell-mediated cytotoxicity, glycosylphosphatidylinositol anchor biosynthesis, tumor necrosis factor signaling, and NF-κB signaling. LASSO regression identified angiogenin and C-type lectin domain family 10 member A as key DEP. The SIC diagnostic nomogram showed an area under the curve of 0.896, with 0.731 specificity and 0.900 sensitivity. Conclusion:The nomogram incorporating angiogenin and C-type lectin domain family 10 member A provides an accurate tool for SIC diagnosis.

Objective:This study used data-independent acquisition (DIA) proteomics to analyze plasma protein expression in sepsis-induced coagulopathy (SIC), identify key biomarkers, and develop a diagnostic model.Methods:This prospective study included 46 adult sepsis patients from the intensive care unit. Patients were categorized into a general sepsis group ( n=26) and an SIC group ( n=20) based on established SIC criteria. Plasma samples underwent proteomic and bioinformatics analyses to identify differentially expressed protein (DEP) using LASSO regression and Random Forest. A diagnostic model was constructed and assessed via receiver operating characteristic (ROC) curve analysis. Results:The baseline data revealed that SIC patients exhibited longer prothrombin times, lower platelet counts, and higher D-dimer, fibrin degradation products, blood lactate, SOFA scores, and APACHE Ⅱ scores compared with general sepsis patients ( P<0.05). DIA proteomics identified 2 637 proteins, with 240 DEP meeting the criteria (fold change >1.5, P<0.05), including 81 upregulated and 159 downregulated DEP. Subcellular localization analysis revealed that DEPs were predominantly extracellular and nuclear. Gene ontology (GO) annotation showed that DEP were mainly involved in cellular physiology, biological regulation, and stress response processes in biological processes. Domain annotation revealed a predominance of immunoglobulin V regions in DEP, which are crucial for antigen recognition and binding. KEGG enrichment analysis showed significant enrichment of DEP in pathways related to natural killer cell-mediated cytotoxicity, glycosylphosphatidylinositol anchor biosynthesis, tumor necrosis factor signaling, and NF-κB signaling. LASSO regression identified angiogenin and C-type lectin domain family 10 member A as key DEP. The SIC diagnostic nomogram showed an area under the curve of 0.896, with 0.731 specificity and 0.900 sensitivity. Conclusion:The nomogram incorporating angiogenin and C-type lectin domain family 10 member A provides an accurate tool for SIC diagnosis.

Objective:To observe any effect of oscillating positive expiratory pressure training on the airway clearing ability of postoperative esophageal cancer patients after neoadjuvant chemotherapy.Methods:Forty postoperative esophageal cancer patients undergoing neoadjuvant chemotherapy were enrolled and randomized into a control group and an experimental group, each of 20. Both groups received conventional postoperative rehabilitation starting on the first postoperative day, while the experimental group additionally underwent oscillating positive expiratory pressure training (3 sets/day, 30 breaths/set) for five consecutive days. Peak cough flow was measured using a peak flow meter before and 1, 3 and 5 days after the operation. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) were also measured on the 5th day after the operation using spirometry. Any postoperative pulmonary complications were recorded.Results:On the 1st day after the operation, peak cough flow had decreased significantly in both groups compared to preoperative levels. However, it had increased significantly on days 3 and 5 in both groups, with the average increase in the experimental group significantly greater than in the control group. On day 5 the average FEV1, forced vital capacity and PEF in both groups were significantly lower than the preoperative values, while the experimental group demonstrated significantly higher average FEV1s (2.22±0.51L) and PEFs (5.09±1.26L/s) compared to the control group.Conclusions:Early postoperative oscillating positive expiratory pressure training can improve the peak cough flow and airway clearing ability of esophageal cancer patients after neoadjuvant chemotherapy, promoting the recovery of their lung function.

Objective:To observe any effect of oscillating positive expiratory pressure training on the airway clearing ability of postoperative esophageal cancer patients after neoadjuvant chemotherapy.Methods:Forty postoperative esophageal cancer patients undergoing neoadjuvant chemotherapy were enrolled and randomized into a control group and an experimental group, each of 20. Both groups received conventional postoperative rehabilitation starting on the first postoperative day, while the experimental group additionally underwent oscillating positive expiratory pressure training (3 sets/day, 30 breaths/set) for five consecutive days. Peak cough flow was measured using a peak flow meter before and 1, 3 and 5 days after the operation. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF) were also measured on the 5th day after the operation using spirometry. Any postoperative pulmonary complications were recorded.Results:On the 1st day after the operation, peak cough flow had decreased significantly in both groups compared to preoperative levels. However, it had increased significantly on days 3 and 5 in both groups, with the average increase in the experimental group significantly greater than in the control group. On day 5 the average FEV1, forced vital capacity and PEF in both groups were significantly lower than the preoperative values, while the experimental group demonstrated significantly higher average FEV1s (2.22±0.51L) and PEFs (5.09±1.26L/s) compared to the control group.Conclusions:Early postoperative oscillating positive expiratory pressure training can improve the peak cough flow and airway clearing ability of esophageal cancer patients after neoadjuvant chemotherapy, promoting the recovery of their lung function.

Objective To investigate the prognostic value of plasma thrombomodulin(TM)in patients with septic shock.Methods A retrospective analysis was conducted on the clinical data of 180 patients with septic shock admitted to the intensive care unit of the 908th Hospital from May 2018 to November 2022.The patients were divided into survival group(106 cases)and death group(74 ca-ses)based on the 30-day follow-up outcomes.Propensity score matching(PSM)was used to match 57 surviving patients with 57 de-ceased patients in a 1∶1 ratio,based on confounding factors such as age,gender,underlying diseases,primary infection site,laborato-ry results and disease severity scores.TM and other coagulation molecular markers were compared between the two groups,and logistic regression,receiver operating characteristic(ROC)curve,survival and correlation analyses were performed.Results After PSM,the TM levels in the death group(18.3[13.2,22.3]TU/mL)were significantly higher than those in the survival group(13.7[9.0,18.3]TU/mL)(P＜0.05).Multivariate logistic regression analysis showed that TM was an independent risk factor for 30-day mortality in the patients with septic shock(OR=1.137,95％CI:1.023-1.262,P＜0.005).ROC curve analysis revealed that the areas under the curve(AUCs)for predicting 30-day mortality were 0.665,0.627 and 0.600 for TM,Acute Physiology and Chronic Health EvaluationⅡ(APACHE Ⅱ)and Sequential Organ Failure Assessment(SOFA)scores,respectively.Kaplan-Meier survival analysis stratified by the optimal TM cut-off value(17.9 TU/mL)showed that the 30-day survival rate of the TM＜17.9 TU/mL group was 1.56 times that of the TM≥17.9 TU/mL group(Log-Rank test,P＜0.000 1).Spearman correlation analysis demonstrated that TM levels were positively correlated with APACHE Ⅱ(r=0.10,P＜0.005)and SOFA scores(r=0.35,P＜0.005).Conclusion Plasma TM has showed a good predictive value for assessing the prognosis of patients with septic shock and may serve as a potential biomarker for determining the prognosis of septic shock.

Objective To investigate the clinical values of heparinase-modified thromboelastography(hmTEG)in heparin monitoring during continuous renal replacement therapy.Methods A total of 97 cases who were undergoing continuous renal replacement therapy(CRRT)in the intensive care unit of the 94th People's Liberation Army Hospital from Jan 2014 to Jun 2019 were enrolled in this stud-y.The patients were divided into TEG group and APTT group according to different means of heparin monitoring during continuous renal replacement therapy.In total,278 hemofilters were used in all the blood purification therapies.Complication of bleeding,CRRT time,total heparin dose and SOFA(sequential organ failure assessment)score of the patients were compared between the TEG and APTT groups.The filter life span and survival time in hospital were also compared using Kaplan-Meier analysis.Rusults Compared with APTT group,the total heparin dose in TEG group were significantly higher(P＜0.05).The CRRT time of patients and the average filter life span in TEG group were significantly longer than those of APTT group(P＜0.05).Compared to APTT group,the 28-day SOFA in TEG group was significantly lower(P＜0.05).Survival analysis showed that the 28-day risk of death in the patients of APTT group was 2.01 times higher than that in TEG group(P＜0.05).The 72-hour filter life of TEG group was significantly longer than that of APTT group(P＜0.05).Conclusion The use of hmTEG for monitoring heparin in blood purification should be superior in terms of safety and efficacy with longer filter life span and higher survival rate of patients.

Objective:To investigate the relationship between sarcopenia and the maximum diaphragm excursion(Dmax)observed on ultrasound in the elderly.Methods:Elderly volunteers(age≥60 years)were recruited from family members of patients at Guangdong Provincial People's Hospital.Their Dmax during forced inhalation was measured via ultrasound.The parameters for the diagnosis of sarcopenia included the appendicular skeletal muscle mass index(ASMI), handgrip strength and usual gait speed.We compared the differences in physical characteristics, pulmonary ventilation, physical performance and Dmax between patients with and without sarcopenia, and evaluated the relationship between sarcopenia and DEmax in the elderly via linear regression.Results:A total of 145 elderly volunteers[age(69.47±5.15)years]were included, and 28(19.31%)were diagnosed with sarcopenia.Body weight, ASMI, maximum inspiratory pressure(Pinmax), maximal power output(Wmax)and Dmax of patients with sarcopenia were significantly lower than those of patients without sarcopenia(all P<0.05).Dmax in the elderly was correlated with sex, height, ASMI, handgrip strength, usual gait speed, Pinmax and Wmax( r=0.181, 0.130, 0.322, 0.373, 0.401, 0.134, and 0.388, P=0.012, 0.037, 0.009, 0.002, 0.022, 0.009, and 0.002, respectively).After adjusting for sex, age, height and forced vital capacity(FVC), there was still a negative correlation between sarcopenia and Dmax in the elderly( β=-0.310, P=0.021). Conclusions:Dmax is related to Pinmax and physical performance in the elderly, and sarcopenia increases the risk of decline in the maximum diaphragm excursion in the elderly as observed on ultrasound.

Objective:To investigate the clinical significance of plasma thrombin-antithrombin complex (TAT) levels in patients with sepsis-induced cardiomyopathy(SIC).Methods:One hundred and seven sepsis patients who were admitted to intensive care units (ICU) of the 908th Hospital of Chinese PLA Logistical Support Force were enrolled in the study. Patients were divided into sepsis group ( n=79) and the sepsis-induced cardiomyopathy group ( n=28) according to whether the cardiac ultrasound examination in 2 hours after admission, and the differences of each indicators between the two groups were compared including acute physiological and chronic health score (APACHEⅡ), lactate, blood routine, liver and kidney function, cardiac troponin I, N-terminal?pro-brain?natriuretic?peptide (NT-pro BNP), conventional coagulation tests and molecular markers of coagulation [tissue plasminogen activator-inhibitor complex (t-PAIC), thrombomodulin (TM), TAT, plasmin-α2-plasmin inhibitor complex (PIC)].Logistical?regression?was?used?to analyze the?risk?factors?for sepsis-induced cardiomyopathy and the receiver operating characteristic (ROC) curve was to analyze their cut-off values. The effect of low-molecular-weight heparin anticoagulation therapy on sepsis patients with TAT>8.26 ng/ml was evaluated by Kaplan-Meier analysis. Results:Compared with the cardiac troponin I[0.02(0.01, 0.09) ng/ml], NT-proBNP [1 118.09 (333.25, 2687.00) pg/ml], lactate[1.35(0.90, 2.60) mmol/L], TAT[6.50(3.94, 12.14) ng/ml], PIC[1.256 (0.668, 2.045) μg/ml] and t-PAIC[10.50 (6.70, 21.30) ng/ml] in sepsis group, the cardiac troponin I [0.75(0.01, 6.02) ng/ml], NT-proBNP[12 125.14(4 185.89, 33 611.62) pg/ml], lactate[2.35(1.43, 4.34) mmol/L], TAT[19.85 (9.08, 45.78) ng/ml], PIC[2.115 (0.878, 4.114) μg/ml] and t-PAIC [22.03(15.61,33.20) ng/ml] levels in the sepsis-induced cardiomyopathy group were significantly increased ( P<0.05). Logistical regression showed that positive NT-pro BNP and elevated TAT levels were independent risk factors for sepsis-induced cardiomyopathy. ROC curve analysis showed that the area under the curve of plasma TAT level for predicting sepsis-induced cardiomyopathy was 0.78. The sensitivity and specificity at the cut-off value of plasma TAT level with 8.26 ng/ml were 0.82 and 0.63, respectively. Conclusions:The elevated TAT level was an independent risk factor for the development of sepsis-induced cardiomyopathy. Low-molecular-weight heparin anticoagulation therapy can improve the 28-day survival rate of sepsis patients with TAT>8.26 ng/ml.

Objective:To investigate the correlation between the muscle mass loss and severe postoperative pulmonary complications(PPC)in elderly patients with non-small cell lung cancer(NSCLC).Methods:Elderly patients with NSCLC undergoing lobectomy at the Lung Cancer Institute and the Department of Thoracic Surgery of Guangdong Provincial People's Hospital were recruited from Feb.2019 to Dec.2019.Data of the body composition, lung function, respiratory muscle strength test, cardiopulmonary exercise test were collected before operation.All patients were grouped into two groups: with versus without severe PPC at 30 d after operation.The differences of the above parameters were compared between the two groups.A multiple logistic regression analysis was used to analyze the risk factors for severe PPC.Results:In this study, 120 elderly NSCLC patients undergoing lobectomy were recruited, All evaluations were completed in 113 patients(aged 68.13±7.01 years)in whom, 21(18.58%, 21/113)patients had serious PPC.Compared with patients without PPC, patients with severe PPC had a lower appendicular skeletal muscle mass index(ASMI)(5.67±0.90 kg/m 2vs.7.71±1.40 kg/m 2, t=3.900, P=0.001), a lower forced expiratory volume in 1 second(FEV 1)(1.85±0.40 L vs.2.12±0.57 L, t=2.412, P=0.027), a lower maximal mid-expiratory flow(MMF)(1.40±0.69 L/s vs.2.11±1.09 L/s, t=2.502, P=0.021), a lower maximum inspiratory pressure(Pimax)(55.13±32.52 cmH 2O vs.64.71±20.60, t=0.778, P=0.047, 1 cmH 2O=0.098 kPa), a lower maximal oxygen consumption(Vo 2max)(1.14±0.41 L/min vs.1.40±0.34 L/min, t=0.779, P=0.046), a lower peak O 2 consumption(Vo 2max@kg)(20.00±1.91 L·min -1·kg -1vs.22.33±2.37 L·min -1·kg -1, t=0.813, P=0.041). Multiple logistic regression analysis showed that in addition to FEV 1( OR=2.824, 95% CI: 1.127-5.158, P=0.001)and Vo 2max@kg( OR=3.149, 95%CI: 1.829-6.592, P<0.001), ASMI was also an independent risk factor for serious PPC( OR=1.919, 95% CI: 1.604-3.466, P=0.006), in which the best cut-off value was 6.295 kg/m 2, the sensitivity and specificity were 0.816 and 0.818 respectively, and the area under the receiver operating characteristic(ROC)curve(AUC)was 0.887(95% CI: 0.793-0.981, P<0.0001). Conclusions:Muscle mass loss can increase the risk for the occurrence of severe PPC within 30 days after lobectomy in elderly patients with NSCLC.

Objective To investigate the displacement characteristics of intraoperative and postoperative positions of electrodes on CT imaging for bilateral subthalamic nucleus-deep brain stimulation (STN-DBS) in Parkinson's disease (PD).Methods A retrospective analysis on preoperative MR imaging,intraoperative and postoperative CT images of 35 patients with PD treated with STN-DBS in our hospital from January 2014 to June 2018 was performed.A three-dimensional coordinate system was established based on preoperative MR imaging.MR imaging/CT fusion technique was used to fuse intraoperative and postoperative CT images with preoperative MR imaging to locate intraoperative and postoperative electrode positions.The displacement characteristics of intraoperative and postoperative electrodes were analyzed.Results The spatial distance between intraoperative and postoperative positions of bilateral electrodes was about 1 mm,and the depth displacement was minimal.The postoperative position of the first side electrode on lateral axis was shifted outwardly from intraopemtive position,and the second side electrode was shifted internally with a small degree;on anterior-posterior axis,the first side electrode obviously shifted backward,and the second side electrode slightly shifted backward.For bilateral electrodes,corresponding coordinate deviation of three axis between intraoperative electrode-preoperative target and postoperative electrode-preoperative target,showed a significant positive linear correlation,therefore,leading out the coordinate deviation regression function model.Conclusions The displacement of electrodes between intraoperative and postoperative positions has obvious rules after STN-DBS in PD,which can guide the adjustment of intraoperative electrode position and predict the postoperative position of electrode.