OBJECTIVE: To observe the effects of enhanced rehabilitation on the prognosis of critically ill patients in the intensive care unit (ICU). METHODS: A single-center retrospective historical controlled study was conducted, patients admitted to the ICU of Peking University First Hospital from May 1, 2020, to April 30, 2021, and from October 1, 2021, to September 30, 2022 were enrolled. According to the different rehabilitation treatment strategies during different periods, patients were divided into the conventional rehabilitation group (patients receiving conventional rehabilitation treatment from May 1, 2020, to April 30, 2021) and the enhanced rehabilitation group (patients receiving the therapy of multidisciplinary team, ie medical care-rehabilitation-nursing care from October 1, 2021, to September 30, 2022). General data, acute physiology and chronic health evaluation II (APACHE II), and study endpoints were collected. Primary endpoints included rehabilitation-therapy rate, intervention time for rehabilitation, rehabilitation-related adverse events, and prognostic indicators such as (length of stay in hospital, length of stay in the ICU, and duration of mechanical ventilation). Secondary endpoints included incidence of deep vein thrombosis and hospital mortality. Kaplan-Meier curves were used to analyze cumulative discharge rates within 50 days. RESULTS: A total of 539 ICU patients were enrolled, with 245 in the conventional rehabilitation group and 294 in the enhanced rehabilitation group; 322 patients had an APACHE II score ≤ 15, while 217 patients had an APACHE II score > 15. Compared to the conventional rehabilitation group, the enhanced rehabilitation group demonstrated significantly higher rehabilitation-therapy rate [51.70% (152/294) vs. 11.43% (28/245)], earlier intervention time for rehabilitation [days: 2.00 (1.00, 3.00) vs. 4.00 (3.00, 7.00)]; shorter length of stay in hospital [days: 18.00 (12.00, 30.00) vs. 21.00 (13.00, 36.00)] and lower incidence of DVT [17.01% (50/294) vs. 24.08% (59/245)]. The differences were all statistically significant (all P < 0.05). There were no rehabilitation-related adverse events occurred in either group. Kaplan-Meier analysis demonstrated a significantly higher cumulative discharge rate within 50 days in the enhanced rehabilitation group compared to the conventional rehabilitation group [86.7% (255/294) vs. 82.9% (203/245); Log-Rank test: χ² = 4.262, P = 0.039]. Subgroup analysis showed that for patients with APACHE II score ≤ 15, the enhanced rehabilitation subgroup had higher rehabilitation-therapy rate [44.32% (78/176) vs. 6.16% (9/146), P < 0.05]. For patients with APACHE II score > 15, compared to the conventional rehabilitation group, the enhanced subgroup demonstrated higher rehabilitation-therapy rate [62.71% (74/118) vs. 19.19% (19/99), P < 0.05] and shorter length of stay in hospital [days: 20.50 (12.00, 31.25) vs. 26.00 (16.00, 43.00), P < 0.05]. CONCLUSIONS Enhanced rehabilitation therapy with medical care, rehabilitation and nursing care, improved rehabilitation-therapy rate, advanced time of rehabilitation treatment, reduced length of stay in hospital and incidence of deep vein thrombosis in critically ill patients, particularly benefited those with APACHE II score > 15. The enhanced rehabilitation was beneficial to the patient in the intensive care unit with safety and worth more investigation.
Humans ; Retrospective Studies ; Critical Illness/rehabilitation* ; Intensive Care Units ; Prognosis ; Length of Stay ; APACHE ; Historically Controlled Study ; Male ; Female ; Middle Aged ; Aged

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To observe the clinical efficacy of Dan Qi Yishen Prescription in treating diabetic nephropathy(DN)and explore its renal protective mechanism.Methods A total of 150 patients with DN of qi-yin deficiency complicated with blood stasis syndrome who admitted to Sanya Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from October 2021 to April 2023 were divided into a control group and an observation group according to the random number table method,with 75 patients in each group.Both groups were given conventional therapies such as dietary treatment,blood glucose control,blood pressure control,lipid-lowering treatment and treatment of complications.Additionally,the control group was given intravenous injection of reduced glutathione,while the observation group was given oral use of the decoction of Dan Qi Yishen Prescription and ionic introduction of Dan Qi Yishen Prescription in renal region.Thirty days constituted one course of treatment,and both groups were treated for three courses.Before and after treatment,the scores of traditional Chinese medicine(TCM)syndrome,and the levels of renal function indicators,renal hemodynamic indicators,coagulation and fibrinolysis indicators,and vascular endothelial function indicators in the two groups were observed.Results(1)After treatment,the scores of TCM symptoms such as fatigue and weakness,palpitations and shortness of breath,dizziness and tinnitus,spontaneous sweating and night sweating,restlessness and insomnia,and thirst with preference for drinks in the two groups were decreased compared with those before treatment(P<0.01),and the decrease in the observation group was significantly superior to that in the control group(P<0.01).(2)After treatment,the levels of renal function indicators such as blood urea nitrogen(BUN),serum creatinine(SCr),collagen Ⅳ(CⅣ),and plasma laminin(LN)of patients in the two groups were improved compared with those before treatment(P<0.01),and the improvement in the observation group was significantly superior to that in the control group(P<0.01).(3)After treatment,the levels of renal hemodynamic indicators such as systolic maximum blood flow velocity(Vsmax)and diastolic minimum blood flow velocity(Vdmin)of the main renal artery(MRA)and interlobar artery(IRA)in the two groups were increased compared with those before treatment(P<0.05 or P<0.01),while the resistance index(RI)and pulsatility index(PI)of MRA and RI of IRA in the two group as well as PI of IRA in the observation group were decreased compared with those before treatment(P<0.05 or P<0.01).The increase of Vsmax and Vdmin of MRA and IRA as well as the decrease of RI and PI of MRA and IRA in the observation group was significantly superior to that in the control group(P<0.05 or P<0.01).(4)After treatment,the levels of coagulation and fibrinolysis indicators such as prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D),and fibrinogen(FIB)in the two groups were improved compared with those before treatment(P<0.01),and the improvement in the observation group was significantly superior to that in the control group(P<0.01).(5)The analysis of vascular endothelial function indicators showed that after treatment,the serum vasohibin 1(VASH-1)level in the two groups was increased compared with that before treatment(P<0.01),and the serum vascular endothelial growth factor(VEGF)and endothelin 1(ET-1)levels were decreased compared with those before treatment(P<0.01),and the increase of serum VASH-1 level as well as the decrease of serum VEGF and ET-1 levels in the observation group was significantly superior to that in the control group(P<0.01).Conclusion Dan Qi Yishen Prescription exerts good clinical efficacy in treating patients with DN of qi-yin deficiency complicated with blood stasis syndrome,and it has protective effect on renal function probably by improving the coagulation and fibrinolysis system and vascular endothelial function of the patients.

Objective To explore the safety of Yttrium-90 resin microsphere selective internal radiation therapy (⁹⁰Y-SIRT) on malignant liver tumors. Methods A retrospective analysis was conducted on 64 patients with malignant liver tumors who underwent ⁹⁰Y-SIRT from February 2023 to November 2024 at Weifang People’s Hospital. The clinical characteristics of the patients and the occurrence of adverse reactions after treatment were analyzed to assess the safety of ⁹⁰Y-SIRT. Results Among the 64 patients, there were 52 males (81.25%) and 12 females (18.75%); the average age was (56.29±11.08) years. Seven patients (10.94%) had tumors with maximum diameter of less than 5 cm, 38 patients (59.38%) had tumors with maximum diameter of 5-10 cm, and 19 patients (29.68%) had tumors with maximum diameter of greater than 10 cm. There were 47 cases (73.44%) of solitary lesions and 17 cases (26.56%) of multiple lesions; 53 cases (82.81%) were primary liver cancers and 11 cases (17.19%) were metastatic liver cancers. Of the 64 patients, 63 successfully completed the Technetium-99m macroaggregated albumin (^99mTc-MAA) perfusion test and received the ⁹⁰Y-SIRT; one patient received ⁹⁰Y-SIRT after the second ^99mTc-MAA perfusion test due to a work error. The most common adverse reactions included grade 1 alanine aminotransferase (ALT) elevation in 26 cases (40.62%) and grade 2 in 2 cases (9.37%), grade 1 aspartate aminotransferase (AST) elevation in 27 cases (42.18%) and grade 2 in 7 cases (10.93%); grade 1 nausea in 17 cases (26.56%) and grade 2 in 6 cases (9.37%); grade 1 abdominal pain in 12 cases (18.75%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%); grade 1 vomiting in 11 cases (17.18%), grade 2 in 5 cases (7.81%), and grade 3 in 1 case (1.56%). Conclusion The adverse reactions of ⁹⁰Y-SIRT for treating malignant liver tumors are mild, indicating good safety.

Objective To establish an experimental autoimmune thyroiditis(EAT)mouse model using mouse thyroglobulin(mTg)immunization and investigate kidney injury presence and characteristics in order to explore the underlying mechanisms of renal injury in autoimmune thyroiditis(AIT).Methods To induce EAT,female CBA/J mice were immunized with mTg,while control mice received subcutaneous injections of distilled water.Serum and kidney homogenate levels of Tg-specific autoantibodies(TgAbs)were measured using enzyme-linked immunosorbent assay(ELISA).The thyroid tissue was analyzed using hematoxylin and eosin(HE)staining.Urine protein levels were assessed at post-immunization weeks three and four.Kidney tissues were examined using HE staining and electron microscopy.Direct and indirect immunofluorescence was used to detect immune complex deposition and serum anti-kidney tissue autoan-tibodies,respectively.Results EAT mice exhibited significantly increased serum TgAb levels,mononuclear cell infiltration in the thyroid tissues,and increased urine protein levels.Light microscopy revealed glomerular hypercellularity and narrowed lumen.Electron microscopy unraveled electron-dense subendothelial deposits in the glomeruli.IgG immune complexes and TgAbs were detected in the glomeruli and kidney homogenates,respectively.Serum samples from EAT mice contained IgG antibodies targeting kidney tissue antigens.Conclusion TgAb-Tg immune complex depositions in the glomeruli might be a key mechanism of renal injury in AIT,while cross-reac-tive autoimmune responses to shared thyroid and kidney antigens could also contribute to kidney damage.

Objective:To investigate the mechanism by which lycopene prevents and alleviates ionizing radiation-induced intestinal injury.Methods:Forty specific pathogen-free male C57BL/6 mice were randomly divided into 4 groups: control group (gavage with an equal volume of corn oil), radiation group (gavage with an equal volume of corn oil and exposed to a single dose of 12 Gy X-ray irradiation on day 3), lycopene group (gavage with lycopene), and lycopene + radiation group (gavage with lycopene and irradiated with 12 Gy X-ray on day 3). All gavage treatments continued for 7 days after irradiation. On day 7 post-irradiation, intestinal tissues were collected. Hematoxylin and eosin (HE), Masson's trichrome, and Sirius red staining were used to assess intestinal injury and fibrosis. Immunohistochemistry was used to detect the expression of α-smooth muscle actin (α-SMA). Immunofluorescence staining was performed to assess the expression of transforming growth factor-β (TGF-β) and connective tissue growth factor (CTGF) in intestinal tissues. Serum levels of malondialdehyde (MDA), total superoxide dismutase (T-SOD), total antioxidant capacity (T-AOC), and glutathione peroxidase (GSH-PX) were measured to evaluate oxidative stress. mRNA expression of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-1β, and CD68 in intestinal tissue was quantified using real-time quantitative PCR (RT-qPCR). Western blot was used to detect the expression of apoptosis-related proteins. One-way ANOVA was used to compare differences among groups.Results:Compared with the radiation group, the lycopene + radiation group showed significantly reduced radiation-induced intestinal injury index, fibrosis, and expression of α-SMA, TGF-β, and CTGF (all P<0.05). Oxidative stress assays showed that serum MDA levels were decreased, while T-SOD, T-AOC, and GSH-PX activities were significantly increased in the lycopene + radiation group (all P<0.05). The mRNA expression of inflammatory cytokines such as TNF-α and IL-6 was significantly downregulated (all P<0.05), while pro-apoptotic protein expression was reduced and anti-apoptotic protein expression was upregulated (all P < 0.05) in the lycopene + radiation group. Conclusions:Lycopene significantly alleviates ionizing radiation-induced intestinal injury through its antioxidant, anti-inflammatory, and anti-apoptotic effects, making it a promising agent for the prevention and treatment of radiation-induced intestinal injury.

Objective To elucidate how the overexpression of cystathionine-β-synthase(CBS)plays an antihypertensive role by affecting peroxisome proliferator-activated receptor γ coactivator-1α(PGC-1α)expression.Methods The adeno-associated viruses(AAVs),ones that overexpressed CBS,and another knocked down PGC-1α,were injected into the hypothalamic paraventricular nucleus(PVN)of spontaneously hypertensive rats(SHRs).The rats'blood pressure was monitored,and the level of norepinephrine(NE)was examined by ELISA;PVN inflammatory response,oxidative stress and tyrosine hydroxylase(TH)expression were detected with RT-qPCR and immunofluorescence.Results PVN overexpression of CBS could increase the transcription level of CBS(by 3.8 times,P＜0.05)and PGC-1α(by 1.6 times,P＜0.05)in PVN of SHR.PVN overexpression of CBS could reduce blood pressure in SHR(from 177.81 mmHg to 128.77 mmHg,P＜0.001),but PVN knockdown of PGC-1αweakened such effect(from 128.77 mmHg to 152.79 mmHg,P＜0.05).PVN overexpression of CBS could alleviate PVN inflammatory response and oxidative stress,but this effect was weakened or even eliminated when knocking down PGC-1α was performed at the same time.Conclusion PVN overexpression of CBS can reduce blood pressure in SHR,and this effect may be achieved by increasing the transcriptional level of PGC-1α,alleviating PVN inflammatory response,oxidative stress,and improving sympathetic nerve excitation.

Background and Aims:Polycystic ovary syndrome(PCOS)is a common endocrine disorder among obese women,often accompanied by psychological issues such as anxiety and depression.Laparoscopic sleeve gastrectomy(LSG)is an effective treatment for obesity and its related metabolic conditions,and has shown clear benefits in improving weight and metabolic profiles in PCOS patients.However,the potential mechanisms by which psychological status may affect weight loss outcomes remain unclear.This study aimed to evaluate the psychological characteristics of obese patients with PCOS and explore their impact on postoperative weight loss outcomes,in order to provide evidence for individualized intervention strategies.Methods:Female obese patients scheduled for LSG between November 2020 and September 2022 were enrolled and divided into PCOS and non-PCOS groups.Standardized psychological scales were used to assess anxiety,depression,self-esteem,and eating behaviors.Weight loss outcomes were recorded at 6 and 12 months postoperatively.Propensity score matching was used to control for confounding factors such as age and body mass index(BMI),and correlation analysis was conducted to explore the relationship between psychological status and weight loss outcomes.Results:A total of 314 patients were included,with 130 cases(41.4％)in the PCOS group.Before matching,the PCOS group had significantly worse psychological indicators and lower weight loss outcomes compared to the non-PCOS group(all P＜0.05);after matching,these differences were no longer statistically significant(all P＞0.05).Emotional eating was positively correlated with 12-month weight loss outcomes in the PCOS group,while anxiety and internalized weight stigma were associated with weight loss outcomes in the non-PCOS group(P＜0.05).Additionally,among patients with moderate and extreme obesity,weight loss outcomes in the PCOS group were superior to those in the non-PCOS group(P＜0.05).BMI was negatively correlated with self-esteem,eating behaviors,and quality of life(all P＜0.05).Conclusion:Obese patients with PCOS exhibit notable psychological distress.However,after controlling for BMI and age,their psychological status and weight loss outcomes are comparable to those of non-PCOS patients.BMI may serve as an important confounding factor,and psychological factors may influence weight loss indirectly through eating behaviors.Preoperative psychological screening and intervention are recommended.

Zebrafish is a relatively new experimental animal model with unique characteristics that enable its wide use in research on many human diseases.The exploration of anti-tumor drugs and other clinical treatments remain the focus of current research on cancer.Zebrafish characteristics,including rapid development,ease of observation,high genetic homology,and low-cost gene editing,make them highly useful for tumor research.By covering the applications of zebrafish in anti-tumor drug research and clinical studies,this review aims to provide valuable insights for the further utilization of zebrafish in cancer drug screening,assessment of drug activity and toxicity,and clinical research.

Objective To establish an experimental autoimmune thyroiditis(EAT)mouse model using mouse thyroglobulin(mTg)immunization and investigate kidney injury presence and characteristics in order to explore the underlying mechanisms of renal injury in autoimmune thyroiditis(AIT).Methods To induce EAT,female CBA/J mice were immunized with mTg,while control mice received subcutaneous injections of distilled water.Serum and kidney homogenate levels of Tg-specific autoantibodies(TgAbs)were measured using enzyme-linked immunosorbent assay(ELISA).The thyroid tissue was analyzed using hematoxylin and eosin(HE)staining.Urine protein levels were assessed at post-immunization weeks three and four.Kidney tissues were examined using HE staining and electron microscopy.Direct and indirect immunofluorescence was used to detect immune complex deposition and serum anti-kidney tissue autoan-tibodies,respectively.Results EAT mice exhibited significantly increased serum TgAb levels,mononuclear cell infiltration in the thyroid tissues,and increased urine protein levels.Light microscopy revealed glomerular hypercellularity and narrowed lumen.Electron microscopy unraveled electron-dense subendothelial deposits in the glomeruli.IgG immune complexes and TgAbs were detected in the glomeruli and kidney homogenates,respectively.Serum samples from EAT mice contained IgG antibodies targeting kidney tissue antigens.Conclusion TgAb-Tg immune complex depositions in the glomeruli might be a key mechanism of renal injury in AIT,while cross-reac-tive autoimmune responses to shared thyroid and kidney antigens could also contribute to kidney damage.