ObjectiveTo construct a nomogram prediction model for non-valvular persistent atrial fibrillation （PeAF） patients with left ventricular hypertrophy （LVH） ， followed by prognostic analysis through follow-up. MethodsThis study retrospectively enrolled 949 patients with newly diagnosed and hospitalized non-valvular PeAF. Among them， 403 patients presented with LVH. The cohort was randomly stratified into a training set （n=665） and a validation set （n=284）. Univariate and multivariate Logistic regression analyses were employed to identify independent risk factors for PeAF complicated by LVH. A nomogram prediction model was subsequently constructed and evaluated for discriminative ability， calibration， and clinical utility using receiver operating characteristic （ROC） curve analysis， calibration plots， and decision curve analysis （DCA）. ResultsSeven independent risk factors were ultimately identified and included in the prediction model： female sex， hypertension， diabetes， red blood cell distribution width-SD （RDW-SD）， body mass index （BMI）， left atrial diameter （LAD）， and left ventricular ejection fraction （LVEF）. The area under the ROC curve （AUC） in the training set was 0.862 （95% CI： 0.834-0.890）， and in the validation set， it was 0.870 （95% CI： 0.829-0.911）， demonstrating excellent predictive performance. ConclusionIndependent risk factors for LVH in PeAF patients include female， hypertension， diabetes， RDW-SD， BMI， LAD， and LVEF. The prediction model built based on this can help early identification of PeAF patients with high risk of LVH. At the same time， the incidence of major adverse cardiovascular events （MACE） is higher in PeAF patients with LVH. Patients with atrial fibrillation combined with LVH may benefit from catheter ablation.

Objective Explore the correlation among difference of skin temperature(ΔT)between proximal and distal ends,peripheral serum indicators and cardiac function,to screen the influencing factors of the main syndrome of"reverse coldness of limbs"in Sini decoction.Methods The clinical data of 134 critically ill patients who visited the emergency department of the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2022 to September 2023 were collected,including echocardiographic indicators[ejection fraction(EF),anterior-posterior diameter of the aortic sinus,left atrial anterior-posterior diameter,right ventricle left-right diameter,right atrial left-right diameter,left ventricular diastolic end anterior-posterior diameter,interventricular septum thickness,left ventricular posterior wall thickness,left ventricular posterior wall movement amplitude,main pulmonary artery inner diameter,pulmonary artery valve flow velocity,aortic valve flow velocity,mitral valve flow velocity,pulmonary artery systolic pressure],blood routine[white blood cell count(WBC),red blood cell count(RBC),platelet count(PLT),hemoglobin(Hb)],myocardial markers[troponin(cTnI,cTnT),MB isoenzyme of creatine kinase(CK-MB),myoglobin(MYO),N-terminal pro-brain natriuretic peptide(NT-proBNP)],D-dimer,blood gas analysis[pH value,arterial oxygen partial pressure(PaO2),arterial partial pressure of carbon dioxide(PaCO2),lactic acid(Lac),arterial oxygen saturation(SaO2)],coagulation function indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),international normalized ratio(INR),fibrinogen(Fib)],infection indicators[C-reactive protein(CRP),procalcitonin(PCT)],biochemical indicators[K+,Na+,Cl-,Ca2+,P3+,total protein(TP),albumin(Alb),aspartate aminotransferase(AST),creatine kinase(CK),α-hydroxybutyrate dehydrogenase(α-HBDH),lactate dehydrogenase(LDH),urea,creatinine(Cr),uric acid(UA)],mean arterial pressure(MAP),and the top 10 disease types.These data were used as independent variables,and the ΔT value was used as the dependent variable for univariate linear regression analysis.Variables with statistically significant differences in the univariate analysis were subjected to multivariate linear regression analysis to identify the influencing factors causing an increase in the ΔT value.Results The univariate analysis analysis showed that variables such as shock,MAP,WBC,MYO,Lac,PT,APTT,TT,CRP,K+,P3+,Alb,urea,Cr,right ventricular left-right diameter,left ventricular posterior wall motion amplitude,main pulmonary artery diameter,pulmonary artery valve velocity,and aortic valve velocity were all risk factors influencing the increase of ΔT between the left axilla and the left hand in critically ill patients(all P<0.05);shock,respiratory failure,MAP,WBC,cTNI,MYO,Lac,PT,APTT,TT,CRP,Ca2+,P3+,Alb,urea,Cr,right ventricular left-right diameter,interventricular septum motion amplitude,left ventricular posterior wall motion amplitude,and main pulmonary artery inner diameter were all risk factors influencing the increase of ΔT between the left axilla and the left foot in critically ill patients(all P<0.05).Multivariate linear regression analysis showed that APTT,Lac,right ventricular left and right diameters,and urea were independent risk factors for the increase of ΔT in the left axilla and left hand[95%confidence interval(95%CI)was 0.016-0.036,0.024-0.095,-0.031 to-0.003,0.002-0.029,respectively;P values were 0.000,0.001,0.015,0.028,respectively],while PT,right ventricular left and right diameters,interventricular septal motion amplitude,and MYO were independent risk factors for the increase of ΔT left axilla and left foot(95%CI was 0.023-0.178,-0.103 to-0.019,0.031-0.245,0.000-0.002,respectively;P values were 0.012,0.006,0.013,0.015,respectively).Conclusion APTT,PT,Lac,MYO,urea,the right ventricular diameter and interventricular septal motion amplitude are key factors affecting the ΔT value of critically ill patients,which can cause reverse coldness of limbs.

Objective To explore the application effect of midazolam combined with oxycodone in fiberoptic bronchoscope intubation of burn patients with difficult airway.Methods 80 burn patients with difficult airway who underwent fiberoptic bronchoscope intubation from March 2023 to March 2024 were included as the study subjects.They were assigned into two groups based on anesthesia medication:the control group(40 cases)was given midazolam anesthesia,and the combined group(40 cases)was given midazolam combined with oxycodone anesthesia.The one-time success rate of intubation,hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP),and percutaneous arterial oxygen saturation(SpO2)],Ramsay sedation score,and adverse reactions were compared between the two groups.Results The success rate of intubation in the combined group(95.00%)was higher than that in the control group(72.50%),the difference was statistically significant(P<0.05).The HR and MAP of both groups decreased after administration(T1),1 min after intubation(T2),and 5 min after intubation(T3)compared to before administration(T0),and the HR of the combined group was lower than that of the control group,while the MAP was higher than that of the control group,the differences were statistically significant(P<0.05).The SpO2 at T1,T2 and T3 time points in the control group was significantly lower than T0 time point,the SpO2 of the combined group was higher than that of the control group at T1 and T2 time points,the differences were statistically significant(P<0.05);The Ramsay sedation score at T2 and T3 time points was lower than that of the control group,the difference was statistically significant(P<0.05).The total incidence of adverse reactions in the combined group(12.50%)showed no obvious difference compared to the control group(7.50%)(P>0.05).Conclusion The combination of midazolam and oxycodone has a good healing effect in fiberoptic bronchoscope intubation of burn patients with difficult airway,with a higher success rate of intubation,better sedation,and can maintain hemodynamic stability.It also has high medication safety.

OBJECTIVE To quantitatively evaluate the effect on decolonization of gram-negative bacteria(GNB)and carbapenem-resistant gram-negative bacteria(CRGNB)in water sinks of neonatal wards and compare the decoloni-zation effects among the 500 mg/L,1000 mg/L of chlorine-containing disinfectants and 3％hydrogen peroxide so-lution.METHODS A total of 15 water sinks were chosen from West China Second University Hospital of Sichuan University as the research subjects,which were randomly divided into the 500 mg/L chlorine-containing disinfect-ant group,the 1000 mg/L chlorine-containing disinfectant group and the 3％hydrogen peroxide solution group.The bacterial colony counts of GNB and CRGNB as well as microbial diversity at the drain outlets were ob-served and compared before the intervention and after the disinfectants were continuously poured for 7 days.RESULTS There were GNB and CRGNB colonized at the drain outlets of water sinks in the neonatal wards under the mode of regular rinsing with 500 mg/L of chlorine-containing disinfectant,with Pseudomonadaceae dominant.There were no significant differences in the bacterial colony counts of GNB/CRGNB,Alpha diversity(Shannon index)and Beta diversity(Bray-Curtis distance)among the three types of disinfectants after the inter-vention for 7 days.CONCLUSIONS There are still large quantity of GNB and CRGNB colonized at the drain outlets of water sinks of neonatal wards after daily conventional treatment with 500 mg/L of chlorine-containing disinfect-ant.Neither the disinfectant with the concentration of chlorine increasing to 1000 mg/L nor 3％hydrogen peroxide solution can remarkably reduce the colonization or alter the microbial diversity.The optimal disinfection strategy should be formulated based on compound disinfectant,physical intervention and project reconstruction.

OBJECTIVE: To observe the effects of Tongdu Tiaoshen acupuncture (acupuncture for unblocking the obstruction in the governor vessel and regulating the spirit) on the depression-like behavior and the hippocampal neuronal ferroptosis mediated by solute carrier family 7 member 11 (SLC7A11)/glutathione peroxidase 4 (GPX4) pathway in depression rats, and explore the mechanism of this therapy for depression. METHODS: Of 30 male SD rats of SPF grade, 24 rats were selected. According to the random number table, they were divided into a normal group (n=8) and a modeling group (n=16). The rats in the modeling group were subjected to chronic unpredictable mild stress (CUMS) for 28 consecutive days to establish depression model. After modeling, 16 successfully-modeled rats were randomly divided into a model group and an acupuncture group, 8 rats in each one. In the acupuncture group, Tongdu Tiaoshen acupuncture was applied to "Dazhui"(GV14), "Shuigou" (GV26), "Baihui" (GV20) and "Shenting" (GV24). This intervention measure was deliveredonce a day, continuously for 6 days. The intervention discontinued on day 7, and was completed in 4 weeks. Before and after modeling, and after intervention completion, the behavioristics detection was performed using sucrose preference experiment and open field experiment. After intervention, using hematoxylin-eosin (HE) and Nissl staining, the morphology of hippocampal neurons was observed; with Western blot method, the protein expression of GPX4, SLC7A11, Ferritin and acyl-CoA synthetase long-chain family 4 (ACSL4) in hippocampal tissues was detected; with the real-time fluorescence quantitative PCR adopted, the mRNA expression of GPX4, SLC7A11, Ferritin and ACSL4 was detected; and using colorimetry, the hippocampal iron content was determined. RESULTS: After modeling, the sucrose preference rates, the total distance of movement, the standing times and the boxes of horizontal crossing in the model group and the acupuncture group were lower than those in the normal group (P<0.01). After the intervention, the sucrose preference rates, the total distance of movement, the standing times and the boxes of horizontal crossing in the acupuncture group were higher than those in the model group (P<0.01, P<0.05). Compared with the normal group, the number of necrotic cells increased and the number of Nissl bodies decreased in the model group; and when compared with the model group, the neuronal pyknosis and necrosis were ameliorated, the cells were arranged more regularly, the neuronal structure was clear, the matrix was dense, the blood vessels were enriched and the number of Nissl bodies increased in the acupuncture group. In comparison with the normal group, the relative expression of protein and mRNA of hippocampal GPX4, SLC7A11 decreased (P<0.01), it increased in the expression of hippocampal Ferritin and ACSL4 (P<0.01) in the model group. When compared with the model group, in the acupuncture group, the relative expression of protein and mRNA of hippocampal GPX4, SLC7A11 was elevated (P<0.01, P<0.05), it was dropped for hippocampal Ferritin and ACSL4 (P<0.01). In the model group, the hippocampal iron content was elevated when compared with that in the normal group (P<0.01); and it was reduced in the acupuncture group when compared with that in the model group (P<0.05). CONCLUSION Tongdu Tiaoshen acupuncture attenuates depression-like behaviors in the depression rats, which may be related to regulating SLC7A11/GPX4 pathway and inhibiting neuronal ferroptosis in the hippocampus.
Animals ; Ferroptosis ; Male ; Hippocampus/cytology* ; Rats, Sprague-Dawley ; Rats ; Depression/enzymology* ; Phospholipid Hydroperoxide Glutathione Peroxidase/genetics* ; Acupuncture Therapy ; Neurons/metabolism* ; Humans ; Acupuncture Points ; Amino Acid Transport System y+/genetics* ; Glutathione Peroxidase/genetics*

Objective To explore the application effect of midazolam combined with oxycodone in fiberoptic bronchoscope intubation of burn patients with difficult airway.Methods 80 burn patients with difficult airway who underwent fiberoptic bronchoscope intubation from March 2023 to March 2024 were included as the study subjects.They were assigned into two groups based on anesthesia medication:the control group(40 cases)was given midazolam anesthesia,and the combined group(40 cases)was given midazolam combined with oxycodone anesthesia.The one-time success rate of intubation,hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP),and percutaneous arterial oxygen saturation(SpO2)],Ramsay sedation score,and adverse reactions were compared between the two groups.Results The success rate of intubation in the combined group(95.00%)was higher than that in the control group(72.50%),the difference was statistically significant(P<0.05).The HR and MAP of both groups decreased after administration(T1),1 min after intubation(T2),and 5 min after intubation(T3)compared to before administration(T0),and the HR of the combined group was lower than that of the control group,while the MAP was higher than that of the control group,the differences were statistically significant(P<0.05).The SpO2 at T1,T2 and T3 time points in the control group was significantly lower than T0 time point,the SpO2 of the combined group was higher than that of the control group at T1 and T2 time points,the differences were statistically significant(P<0.05);The Ramsay sedation score at T2 and T3 time points was lower than that of the control group,the difference was statistically significant(P<0.05).The total incidence of adverse reactions in the combined group(12.50%)showed no obvious difference compared to the control group(7.50%)(P>0.05).Conclusion The combination of midazolam and oxycodone has a good healing effect in fiberoptic bronchoscope intubation of burn patients with difficult airway,with a higher success rate of intubation,better sedation,and can maintain hemodynamic stability.It also has high medication safety.

OBJECTIVE To quantitatively evaluate the effect on decolonization of gram-negative bacteria(GNB)and carbapenem-resistant gram-negative bacteria(CRGNB)in water sinks of neonatal wards and compare the decoloni-zation effects among the 500 mg/L,1000 mg/L of chlorine-containing disinfectants and 3％hydrogen peroxide so-lution.METHODS A total of 15 water sinks were chosen from West China Second University Hospital of Sichuan University as the research subjects,which were randomly divided into the 500 mg/L chlorine-containing disinfect-ant group,the 1000 mg/L chlorine-containing disinfectant group and the 3％hydrogen peroxide solution group.The bacterial colony counts of GNB and CRGNB as well as microbial diversity at the drain outlets were ob-served and compared before the intervention and after the disinfectants were continuously poured for 7 days.RESULTS There were GNB and CRGNB colonized at the drain outlets of water sinks in the neonatal wards under the mode of regular rinsing with 500 mg/L of chlorine-containing disinfectant,with Pseudomonadaceae dominant.There were no significant differences in the bacterial colony counts of GNB/CRGNB,Alpha diversity(Shannon index)and Beta diversity(Bray-Curtis distance)among the three types of disinfectants after the inter-vention for 7 days.CONCLUSIONS There are still large quantity of GNB and CRGNB colonized at the drain outlets of water sinks of neonatal wards after daily conventional treatment with 500 mg/L of chlorine-containing disinfect-ant.Neither the disinfectant with the concentration of chlorine increasing to 1000 mg/L nor 3％hydrogen peroxide solution can remarkably reduce the colonization or alter the microbial diversity.The optimal disinfection strategy should be formulated based on compound disinfectant,physical intervention and project reconstruction.

Objective Explore the correlation among difference of skin temperature(ΔT)between proximal and distal ends,peripheral serum indicators and cardiac function,to screen the influencing factors of the main syndrome of"reverse coldness of limbs"in Sini decoction.Methods The clinical data of 134 critically ill patients who visited the emergency department of the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2022 to September 2023 were collected,including echocardiographic indicators[ejection fraction(EF),anterior-posterior diameter of the aortic sinus,left atrial anterior-posterior diameter,right ventricle left-right diameter,right atrial left-right diameter,left ventricular diastolic end anterior-posterior diameter,interventricular septum thickness,left ventricular posterior wall thickness,left ventricular posterior wall movement amplitude,main pulmonary artery inner diameter,pulmonary artery valve flow velocity,aortic valve flow velocity,mitral valve flow velocity,pulmonary artery systolic pressure],blood routine[white blood cell count(WBC),red blood cell count(RBC),platelet count(PLT),hemoglobin(Hb)],myocardial markers[troponin(cTnI,cTnT),MB isoenzyme of creatine kinase(CK-MB),myoglobin(MYO),N-terminal pro-brain natriuretic peptide(NT-proBNP)],D-dimer,blood gas analysis[pH value,arterial oxygen partial pressure(PaO2),arterial partial pressure of carbon dioxide(PaCO2),lactic acid(Lac),arterial oxygen saturation(SaO2)],coagulation function indicators[prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),international normalized ratio(INR),fibrinogen(Fib)],infection indicators[C-reactive protein(CRP),procalcitonin(PCT)],biochemical indicators[K+,Na+,Cl-,Ca2+,P3+,total protein(TP),albumin(Alb),aspartate aminotransferase(AST),creatine kinase(CK),α-hydroxybutyrate dehydrogenase(α-HBDH),lactate dehydrogenase(LDH),urea,creatinine(Cr),uric acid(UA)],mean arterial pressure(MAP),and the top 10 disease types.These data were used as independent variables,and the ΔT value was used as the dependent variable for univariate linear regression analysis.Variables with statistically significant differences in the univariate analysis were subjected to multivariate linear regression analysis to identify the influencing factors causing an increase in the ΔT value.Results The univariate analysis analysis showed that variables such as shock,MAP,WBC,MYO,Lac,PT,APTT,TT,CRP,K+,P3+,Alb,urea,Cr,right ventricular left-right diameter,left ventricular posterior wall motion amplitude,main pulmonary artery diameter,pulmonary artery valve velocity,and aortic valve velocity were all risk factors influencing the increase of ΔT between the left axilla and the left hand in critically ill patients(all P<0.05);shock,respiratory failure,MAP,WBC,cTNI,MYO,Lac,PT,APTT,TT,CRP,Ca2+,P3+,Alb,urea,Cr,right ventricular left-right diameter,interventricular septum motion amplitude,left ventricular posterior wall motion amplitude,and main pulmonary artery inner diameter were all risk factors influencing the increase of ΔT between the left axilla and the left foot in critically ill patients(all P<0.05).Multivariate linear regression analysis showed that APTT,Lac,right ventricular left and right diameters,and urea were independent risk factors for the increase of ΔT in the left axilla and left hand[95%confidence interval(95%CI)was 0.016-0.036,0.024-0.095,-0.031 to-0.003,0.002-0.029,respectively;P values were 0.000,0.001,0.015,0.028,respectively],while PT,right ventricular left and right diameters,interventricular septal motion amplitude,and MYO were independent risk factors for the increase of ΔT left axilla and left foot(95%CI was 0.023-0.178,-0.103 to-0.019,0.031-0.245,0.000-0.002,respectively;P values were 0.012,0.006,0.013,0.015,respectively).Conclusion APTT,PT,Lac,MYO,urea,the right ventricular diameter and interventricular septal motion amplitude are key factors affecting the ΔT value of critically ill patients,which can cause reverse coldness of limbs.

Objective To enhance the quality of medical services in the intensive care unit(ICU)of provincial traditional Chinese medicine(TCM)hospitals.Methods In November 2023,Sichuan Provincial Critical Care Medicine Quality Control Center of TCM launched the"quality control supervision project scoring standard for critical care medicine of TCM"to conduct quality control evaluation and business guidance for all TCM hospitals with independent ICU.The survey covered structural indicators,control indicators,participation of TCM,development of new technologies,and diagnosis and treatment programs for dominant diseases.Results In terms of structural indicators:a total of 110 TCM hospitals in the province have independent ICU,an increase of 1.12 times compared with 2019.The control indicators showed that the ICU patients admission rate was higher than that of the national ICU admission rate in 2017,and the admission rate of patients with acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score≥15 points increased.However,the mortality of ICU exceeded the national average.The implementation of core indicators had been significantly improved,but the incidence of outcome indicators such as ICU ventilator-associated pneumonia(VAP),ICU intravascular catheter-related bloodstream infection(CRBSI),and ICU catheter-related urinary tract infection(CAUTI)had increased since 2019,mainly in secondary hospitals.The average number of new technologies was about(5.5±3.4),the participation rate of TCM decreased,and the dominant diseases increased compared with 2019,mainly sepsis,respiratory failure and hemorrhagic stroke.Conclusions The number of ICU units in TCM hospitals at all levels in Sichuan province has grown rapidly,and key performance indicators have also improved compared to previous periods.However,greater efforts are still needed in preventing the occurrence rates of VAP,CRBSI,and CAUTI.There is a shortage of medical resources allocation,and the imbalance in regional medical resources and professional training remains an urgent issue to be addressed.Additionally,the participation rate of TCM and the dominant diseases need further enhancement.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.