Objective:Efficacy of prothrombin complex concentration (PCC) and analysis of prognostic factors in patients with traumatic trauma-induced coagulopathy (TIC).Methods:A retrospective study was conducted on patients with TIC admitted to 11 hospitals from January to December 2021. The data included baseline characteristics, injury information, blood product transfusions (including PCC treatment), laboratory examination at admission and 24 hour-after admission, treatment measure, pre-hospitalization time, and clinical outcomes (improvement at discharge, length of hospital stay). The patients were divided into a conventional group and a PCC group according to whether they were treated with PCC. Propensity score matching method was used to match the patients at a 1:1 ratio, and the differences in different indicators between the groups were compared. Univariate and multivariate logistic regression analyses were performed to identify prognostic factors for TIC patients.Results:After propensity score matching, 103 patients were identified in both the PCC and conventional groups. Univariate logistic regression analysis revealed no significant differences in age, gender, Glasgow Coma Scale (GCS) score, injury severity score, acute physiology and chronic health evaluation score, underlying diseases, pre-hospitalization time, injury type and site, and treatment measure (use of vasoactive drugs, calcium agents, tranexamic acid, and emergency surgery) between the two groups (all P>0.05). Compared with the conventional group, the PCC group exhibited lower 24-hour white blood cell counts, lactate level, prothrombin time, and international normalized ratio (INR) (all P<0.05), whereas hemoglobin level and pH value were higher (both P<0.05). The PCC group also had a shorter hospital stay (13 d vs. 15 d, P<0.05). However, there was no significant difference in the rate of improvement at discharge between the two groups ( P=0.308). Multivariate logistic regression revealed that age (>68 years), GCS score (<5 points), fibrinogen (FIB) level (after 24 h, <2.04 g/L), and INR (after 24 h, >1.455) were independent risk factors affecting the prognosis of TIC patients, and the AUCs were 0.632, 0.702, 0.733, and 0.752, respectively. Conclusions:Treatment with PCC in TIC patients can correct coagulation dysfunction and reduce hospital stay. Age, GCS score, FIB level and INR after 24 h affect the clinical prognosis of TIC patients, which requires special attention.

The setting and adjustment of ventilator parameters need to rely on a large amount of clinical data and rich experience. This paper explored the problem of difficult decision-making of ventilator parameters due to the time-varying and sudden changes of clinical patient's state, and proposed an expert knowledge-based strategies for ventilator parameter setting and stepless adaptive adjustment based on fuzzy control rule and neural network. Based on the method and the real-time physiological state of clinical patients, we generated a mechanical ventilation decision-making solution set with continuity and smoothness, and automatically provided explicit parameter adjustment suggestions to medical personnel. This method can solve the problems of low control precision and poor dynamic quality of the ventilator's stepwise adjustment, handle multi-input control decision problems more rationally, and improve ventilation comfort for patients.
Humans ; Ventilators, Mechanical ; Respiration, Artificial ; Neural Networks, Computer

Objective:To explore the efficacy and safety of anti-B cell maturation antigen (BCMA) chimeric antigen receptor T-cell (CAR-T) for the retreatment of relapsed and refractory multiple myeloma (RRMM).Methods:The clinical data of 10 RRMM patients who received anti-BCMA CAR-T therapy for the second time (CART2) in Henan Province Hospital of Traditional Chinese Medicine due to failure or recurrence after their first anti-BCMA CAR-T (CART1) therapy from January 2017 to June 2021 were retrospectively analyzed. The treatment, efficacy and adverse events of patients receiving CART2 therapy were summarized; and the objective response rate (ORR), median duration of response (DOR) and incidence of adverse reactions were compared between CART1 and CART2.Results:Among 10 patients, 8 were males and 2 were females, with a median age of 57 years (41-70 years). Patients' 3-month ORR after CART1 therapy was 90%, and the median DOR was 16.0 months (3.0-27.0 months). CART2 used human-derived anti-BCMA CAR-T to treat 6 cases and mouse-derived anti-BCMA CAR-T to treat 4 cases. The 3-month ORR of patients receiving CART2 therapy was 40%, and the median DOR was 8.5 months (3.0-11.0 months). Among 9 patients who received mouse-derived anti-BCMA CAR-T in CART1 therapy, 4 of them received the same product again and none of them showed curative effect. Among 6 patients retreated with human-derived anti-BCMA CAR-T, 4 patients (66.7%) of them achieved partial remission (PR) or better. During CART1 therapy, 10 patients developed grade 1-2 cytokine release syndrome (CRS), and 7 patients developed different degrees of decrease in leukocyte, neutrophil absolute count (ANC) and platelet. Among patients who achieved effective outcomes after receiving CART2 therapy, 4 patients of them developed grade 1-2 CRS, and different degrees of decrease in white blood cell, ANC and thrombocytopenia. Immune effector cell-related neurotoxicity syndrome was not observed.Conclusions:Anti-BCMA CAR-T is effective and safe to retreat RRMM. The ORR and DOR of patients receiving CART2 therapy are lower than those of patients receiving CART1 therapy. CRS and cytopenia are common adverse reactions.

ObjectiveTo explore the effect of Youguiwan on the rats with adriamycin-induced nephrotic syndrome （NS） and its mechanism. MethodSD rats were randomly divided into a normal group， a model group， three Youguiwan low， medium， and high-dose groups， and a prednisone group. Rats in the model group were intravenously injected with adriamycin in the tail vein to induce the NS model. Rats in the Youguiwan low， medium， and high-dose groups were given 2.8， 5.6， 11.2 g·kg^-1·d^-1 of crude drugs， respectively， and rats in the prednisone group were given 6.3 mg·kg^-1·d^-1 of prednisone acetate. Each administration group was given continuous medicine for 6 weeks， and the normal group and model group were given an equal volume of normal saline. Bicinchoninic acid （BCA） assay was used to detect 24 h urine protein （24 h UP）. Automatic biochemical analyzer was used to detect serum urea nitrogen （BUN）， creatinine （SCr）， albumin （ALB）， total cholesterol （TC）， and triglyceride （TG） levels. Hematoxylin-eosin （HE） staining was used to observe renal tissue morphology， and kit was used to detect serum advanced oxidized protein products （AOPPs） and reactive oxygen species （ROS）. Western blot was used to detect the receptor of advanced glycation endproducts （RAGE） of renal tissue， nuclear factor-κB （NF-κB） phosphorylation levels， Wnt， and β-catenin protein expression. ResultAs compared with the normal group， 24 h UP， serum BUN， SCr， TC， TG， AOPPs， and ROS levels in the model group increased significantly （P<0.01）， whereas ALB decreased （P<0.01）. There were typical pathological injuries in the renal tissue， and the expressions of RAGE， phosphorylation（p）-NF-κB， Wnt1， and β-catenin protein were significantly increased （P<0.01）. As compared with the model group， the 24 h UP， serum BUN， SCr， TC， TG， AOPPs， and ROS levels of rats in the Youguiwan low， medium， and high-dose groups significantly reduced （P<0.01）， and ALB significantly increased （P<0.01）. The renal tissue damage was reduced， and the expressions of RAGE， p-NF-κB， Wnt1， and β-catenin protein were significantly decreased （P<0.01） in a dose-dependent manner. ConclusionYouguiwan improves the kidney injury of rats with adriamycin-induced NS. The mechanism may be related to the reduction of AOPPs level， inhibition of RAGE/ROS/NF-κB axis， and activation of Wnt/β-catenin signal.

Objective:To investigate the effects of TNF-α knockout on liver and spleen neutrophil responses to Vibrio vulnificus bloodstream infection in a mouse model. Methods:(1) TNF-α-knockout (TNF-α -/-) and wild-type (WT) C57BL/6J mice aged 6-8 weeks were randomly divided into four groups with six in each group: uninfected WT group, infected WT group, uninfected TNF-α -/- group and infected TNF-α -/- group. The mouse model of bloodstream infection was constructed by intraperitoneal injection of Vibrio vulnificus CGMCC1.1758 (2×10 8 CFU/200 μl), while the mice in the uninfected groups were injected intraperitoneally with equal amount of PBS. (2) Liver immune cells and splenocytes were isolated 4 h after infection and subjected to analyze the percentages and numbers of neutrophils, and the changes in cell viability, cellular reactive oxygen species (ROS) level and phagocytosis by flow cytometry. In addition, effects of Vibrio vulnificus bloodstream infection on mTOR signaling pathway in murine neutrophils were evaluated in vivo. Results:(1)Compared with the uninfected WT group, the percentages and numbers of neutrophils in liver and spleen tissues of the infected WT group increased significantly. The percentage and number of liver neutrophils were significantly higher in the infected TNF-α -/- group than in the infected WT group, but no significant difference in spleen neutrophils was detected between the two groups. (2) Compared with the infected WT group, the phagocytosis of liver neutrophils rather than that of spleen neutrophils was enhanced in the infected TNF-α -/- group. (3) The survival rates of neutrophils in both liver and spleen were decreased, while the cellular ROS level was significantly increased in the infected WT group compared with those of the uninfected WT group. Compared with the infected WT group, the infected TNF-α -/- group had increased survival rates of both liver and spleen neutrophils, but decreased level of ROS. (4) The levels of p-AKT (S473) in liver and spleen neutrophils of the infected WT group were lower than those of the uninfected WT group. Compared with the infected WT group, the infected TNF-α -/- group had lower level of p-AKT (S473) in liver neutrophils, but higher p-AKT (S473) level in spleen neutrophils. There were no significant differences in p-4E-BP1(T37/46) levels between the uninfected WT group and the infected WT group. The p-4E-BP1 (T37/46) level in liver neutrophils was lower in the infected TNF-α -/- group than in the infected WT group, but no significant difference in p-4E-BP1 (T37/46) levels in spleen neutrophils was observed between the two groups. Conclusions:TNF-α had different effects on the neutrophils in spleen and liver tissues of mice with Vibrio vulnificus bloodstream infection. It played a critical role in regulating the recruitment, phagocytic function and mTOR signaling of liver neutrophils after Vibrio vulnificus infection in vivo.

Objective: To evaluate the effect of dexmedetomidine on pyroptosis during lung ischemia-reperfusion (I/R) in rats. Methods: Adult male Sprague-Dawley rats, weighing 250-320 g, were used in this study.The model of isolated lung perfusion was established using an IL-2 Isolated Perfused Rat or Guinea Pig Lung System after the rats were anesthetized.Thirty lungs in which an ex vivo lung perfusion model was successfully established were divided into 3 groups (n=10 each) by a random number table method: control group (C group), I/R group and dexmedetomidine group (DEX group). The lungs were continuously perfused with K-H solution for 150 min in C group.After 15 min of perfusion, lungs were subjected to 60-min suspension of ventilation and perfusion, followed by 75 min of reperfusion and ventilation to establish the model of lung I/R injury in I/R and DEX groups.In DEX group, dexmedetomidine 10 nmol/L was added to K-H solution at the beginning of reperfusion.Lung tissues were obtained for determination of wet/dry weight ratio (W/D ratio) and for examination of pathological changes (with a light microscope) and ultrastructure (using an electron microscope), and the alveolar damage rate (IAR) was calculated.The expression of pyroptosis-related factors including NOD-like receptor family protein 3 (NLRP3), caspase-1, interleukin-1β (IL-1β), IL-18 and gasdermin D (GSDMD) protein and mRNA was detected by Western blot or by real-time polymerase chain reaction. Results: Compared with C group, the W/D ratio and IAR in lung tissues were significantly increased, and the expression of NLRP3, caspase-1, IL-1β, IL-18 and GSDMD protein and mRNA was up-regulated in I/R and DEX groups (P<0.05). Compared with I/R group, the W/D ratio and IAR in lung tissues were significantly decreased, the expression of NLRP3, caspase-1, IL-1β, IL-18 and GSDMD protein and mRNA was down-regulated (P<0.05), and the pathological changes were significantly attenuated in DEX group. Conclusion The mechanism by which dexmedetomidine reduces isolated rat lung I/R injury may be related to inhibiting pyroptosis.

Objective To evaluate the effect of sevoflurane on unfolded protein response-related cell apoptosis during acute lung injury in rats undergoing cardiopulmonary bypass ( CPB) . Methods For-ty-eight clean-grade healthy adult male Sprague-Dawley rats, aged 6-8 weeks, weighing 250-300 g, were allocated into 3 groups ( n=16 each) using a random number table method: sham operation group ( Sham group) , CPB group and sevoflurane group ( Sev group) . Left common carotid artery and right internal jugu-lar vein were only cannulated in group Sham. After establishing CPB, the flow rate was gradually adjusted to the maximum (100 ml·kg-1·min-1) and maintained for 60 min in group CPB. Two percent sevoflurane was inhaled for 30 min, and 15 min later the model of CPB was established in Sev group. Rats were sacri-ficed at 1 h after the end of CPB, lungs were removed and lung tissues were obtained. The pathological changes and ultrastructure of lung tissues were examined with a light microscope and with an electron micro-scope, respectively. The wet to dry weight ratio ( W∕D ratio) , apoptosis in lung cells ( by TUNEL assay) , expression of glucose-regulated protein 78 ( GRP78) , CCAAT∕enhancer-binding protein homologous protein (CHOP), c-Jun N-terminal kinase (JNK) and caspase-12 mRNA was determined by real-time polymerase chain reaction. The expression of GRP78, CHOP, phosphorylated JNK (p-JNK) and caspase-12 was de-tected by Western blot. The index of quantitative assessment of histologic lung injury ( IQA) was measured, and apoptotic index ( AI) was calculated. Results Compared with Sham group, the W∕D ratio, IQA and AI were significantly increased, the expression of GRP78, CHOP, JNK and caspase-12 was up-regulated ( P<0. 05) , and the pathological changes of lung tissues were accentuated in CPB group. Compared with CPB group, the W∕D ratio, IQA and AI were significantly decreased, the expression of GRP78, CHOP, JNK and caspase-12 was down-regulated ( P<0. 05) , and the pathological changes of lung tissues were sig-nificantly attenuated in Sev group. Conclusion The mechanism by which sevoflurane mitigates acute lung injury induced by CPB is related to inhibiting unfolded protein response related cell apoptosis in lung tissues of rats.

Objective To evaluate the effect of multimodal warming regimen on the postoperative outcomes and cost-effectiveness in the patients undergoing resection of liver cancer.Methods Sixty Ameri-can Society of Anesthesiologists physical status ⅠorⅡ patients of both sexes, aged 35-64 yr, with body mass index of 18-24 kg∕m2, of liver function Child-Pugh grade A, scheduled for elective resection of liver cancer, were divided into 2 groups(n=30 each)using a random number table: routine warming group (group R)and multimodal warming group(group M). Quilts were covered on the body exposed before in-duction of anesthesia, and the abdominal cavity was washed with the room-temperature peritoneal lavage flu-id during operation in group R.In group M, the lower body was covered using the forced-air warming system at 30 min before induction of anesthesia, and the temperature was maintained at 38℃ until the end of oper-ation; the solution used for infusion was warmed to 42 ℃ using a fluid-warming device during operation;the abdominal cavity was washed with 0.9% sodium chloride injection which was prewarmed to 37℃ during operation.The rectal temperature was recorded after anesthesia induction and before tracheal intubation (T1), at 30, 60, 90, 120 and 150 min after anesthesia and at the end of operation(T2-7). The parame-ters of thrombelastogram were measured before induction of anesthesia(T0), at T7and at 12 h after opera-tion(T8).At T0, T7, T8and 24 and 48 h after operation(T9,10), blood samples were taken from the in-ternal jugular vein for determination of plasma interleukin-6 concentrations by enzyme-linked immunosorbent assay.The extubation time, duration of post-anesthesia care unit stay, intraoperative blood loss, blood transfusion, requirement for allogeneic blood transfusion, length of hospitalization, occurrence of postoper-ative shivering, occurrence of hypothermia, volume of drainage on 1st and 3rd days after operation, neu-trophil count, cost of general anesthesia and total cost of hospitalization were recorded.Results Compared with group R, the extubation time and duration of post-anesthesia care unit stay were significantly short-ened, the intraoperative blood loss, volume of blood transfused, and volume of drainage on 1st day after operation were reduced, length of hospitalization was shortened, the requirement for allogeneic blood trans-fusion and incidence of postoperative shivering and hypothermia were decreased, the body temperature was increased at T2-7, R and K were shortened at T7, α angle was enlarged, the neutrophil count on 1st day af-ter operation was reduced, the concentration of plasma interleukin-6 was decreased at T8and T9, the cost of anesthesia was increased, and the total cost of hospitalization was reduced in group M(P<0.05). Con-clusion Multimodal warming regimen can not only promote postoperative outcomes but also improve the cost-effectiveness in the patients undergoing resection of liver cancer.

Objective To observe the impatcts of health care follow-up after chronic heart failture on cardiovascular events and qualigy of life.Methods One hundred and sixty-six patients who were confirmed to have chronic heart failture in our hospital during February 2007 and December 2008 were enrolled in this investigation.The patients were then assigned to the health management group (n=65) or the non-health management group (n=101) and followed up for 5 years.All-cause mortality,readmission for heart failture and quality of life (SF-36 score) were evaluated.Results There was no significant difference of all-cause mortalitv between the two groups (health management group:12.30％ (8/65); non-health management group:14.85％ (15/101; x2=0.22,P＞0.05),although a statistically significant difference of readmission rate was found between the two groups (health management group:12.30％ (9/65); non-health management group:35.64％ (36/101; x2=9.51,P＜0.05).In health management group,the scores of SF-36 were significantly increased at 3 (114.11 ±2.76) or 5 years (116.07± 15.43) when compared with baseline (91.37 ± 2.62) (x2 =102.39,P＜0.05).For the non-health management group,the scores of SF-36 were significantly decreased from 92.65±3.65 at baseline to 90.09±5.12 at 3 years or 89.08±5.71 at 5 years (x2=102.39,P＜0.05).Conclusion Health care follow-up after chronic heart failture may not decrease all-cause mortality,although can decrease readmission rate and improve quality of life of the patients.

ObjectiveTo quantitative evaluate the alterations of cardiac morphology and function in gestational impaired glucose tolerance(GIGT) fetuses.MethodsFetal echocardiograms were performed on 68 GIGT fetuses with gestation age between 21 ～ 40 weeks for evaluation of cardiac morphology and function.Fetal cardiac morphology,systolic and diastolic functions of 68 GIGT fetuses were compared with 81 control group fetuses using conventional two-dimensional,M-mode,pulsed Doppler echocardiography and myocardial tissue Doppler imaging.ResultsComprehensive fetal echocardiography data analysis showed no significant differences in cardiac morphology and function between two groups (P＞0.05).Conclusions The alterations of cardiac morphology and function in GIGT fetuses can be accurately and objectively evaluated using quantitative evaluation in fetal echocardiography and will help to offer consultation.