Background Although current evidence suggests a link between outdoor air pollution and depressive symptoms, the effect of solid fuel use (a significant indoor air pollutant) on depressive symptoms in China's rural middle-aged and elderly population remains poorly understood. Objective To explore the association between solid fuel use for cooking and depressive symptoms among middle-aged and elderly people in rural areas of China, and to provide a basis for the prevention and control of depressive symptoms among residents in rural areas. Methods Data were obtained from the 2020 China Family Panel Studies (CFPS), depressive symptoms were assessed using 8-item Center for Epidemiologic Studies Depression Scale (CES-D), and cooking fuel type was self-reported. Subsequently, two-level binary unconditional logistic regression models were fitted to assess the impact of solid fuel use for cooking on depressive symptoms. Results A total of 7991 participants aged 45 years and older [mean age (58.52±9.18) years] were included in the study, with a mean CES-D score of 6.07±4.48 and a mean positive depressive symptoms rate of 34% (40.54% in the solid fuel group and 30.81% in the clean fuel group, χ²=74.40, P<0.001). After controlling for potential confounding covariates, rural middle-aged and elderly residents in the solid fuel group had a higher risk of reporting depressive symptoms than those in the clean fuel group (OR=1.36, 95%CI: 1.20-1.54), an association that was unaffected by participant characteristics and was positive across age and gender groups. Conclusion There is a positive association between solid fuel use for cooking and depressive symptoms in middle-aged and elderly people in rural areas of China. It is recommended that rural areas promote the upgrading of stoves through the installation of ventilation equipment or the switch from solid cooking fuel to clean fuel. This approach is directed toward reducing exposure to household air pollution, alleviating the prevalence of depression among middle-aged and elderly residents in vast rural areas, and enhancing their mental health.

Objective:The association between air pollutants and the risk of sudden cardiac death (SCD) remains controversial. This study aimed to investigate the relationship between five air pollutants—PM 2.5, PM 2.5–10, PM 10, NO 2, and NO?—and the risk of SCD. Methods:We analyzed data from 460 862 participants in the UK Biobank cohort, all enrolled between 2006 and 2010, with no baseline SCD. Follow-up continued until the study endpoint. Annual average concentrations of the five pollutants were assessed. Associations between pollutants and SCD were evaluated using Cox proportional hazards models, followed by Mendelian randomization (MR) to assess causality.Results:Over a mean follow-up of 12.4 years, 2 662 SCD cases were recorded. After adjusting for confounders, no significant associations were found between air pollutants and SCD risk: PM 2.5 ( HR 1.03, 95% CI 0.99–1.07, P = 0.14), PM 2.5–10 ( HR 1.04, 95% CI 1.00–1.08, P = 0.08), PM 10 ( HR 1.01, 95% CI 0.99–1.03, P = 0.26), NO? ( HR 1.00, 95% CI 0.99–1.00, P = 0.26), and NO x ( HR 1.00, 95% CI 1.00–1.01, P = 0.19). MR analysis further supported the absence of causal relationships: PM 2.5 ( β = -0.149, P = 0.90), PM 2.5–10 ( β = 0.387, P = 0.62), PM 10 ( β = -0.994, P = 0.62), NO? ( β = –0.005, P = 0.99), and NO 2 ( β = –0.827, P = 0.25). Conclusions:This study found no evidence linking PM 2.5, PM 2.5–10, PM 10, NO?, or NO 2 to an increased risk of SCD. Mendelian randomization confirmed the lack of causal associations between these pollutants and SCD.

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) in acute myocardial infarction (AMI) with in-hospital cardiac arrest (IHCA).Methods:The data of 70 patients with AMI-IHCA-ECPR in extracorporeal life support center of the first affiliated hospital of Nanjing medical university from January 2017 to December 2024 were retrospectively analyzed. The patients were grouped by Survival/death at 90 days, with/without combined intra-aortic balloon pump (IABP). Age, sex, Charlson comorbidity index, initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO treatment time, 90-day survival rate were analyzed.Results:Among the 70 patients with AMI-IHCA-ECPR, 22 (31.4%) patients survived at 90 days, of whom 19 (86.4%) patients had good neurological outcomes. About 50% of AMI-IHCA-ECPR patients had severe multi-vessel coronary artery lesions, and there was no significant difference in survival outcomes among different vascular lesions. In the IABP group, the success rate of ECMO withdrawal was low, the duration of ECMO treatment was long, and the combination of IABP did not reduce the mortality. Compared with the death group, the 90-day survival group had a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value.Conclusions:AMI-IHCA-ECPR combined with IABP did not show significant survival benefits, and about 50% of patients had severe lesions of multiple coronary arteries. It is difficult to evaluate the prognosis based on a single offender vessel. It is recommended to evaluate the outcome of patients by quantification of the severity of coronary artery lesions by Gensini score.

Objective:To investigate the perioperative safety and survival benefits of two-stage operation in the treatment of esophageal malignancies.Methods:This is a retrospective case series study. The clinical data of 70 patients who underwent two-stage operation for esophageal malignancies from January 2015 to January 2023 in the Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. There were 58 males and 12 females. The age ( M(IQR)) was 61 (22) years (range: 9 to 79 years), and 51.4% (36/70) of the patients were older than 65 years. All patients underwent the first operation to remove esophageal tumor and the second operation to complete digestive tract reconstruction. The reasons for two-stage operation were summarized, complications and treatment results were recorded, and the prognosis was calculated using Kaplan-Meier curve. Results:The interval between the two stages was 49 (35) days (range: 32 to 82 days). The follow-up perrod was 28(50) months (range: 1 to 69 months). The 30-day fatality rate after the first operation was 4.3% (3/70) and the 30-day fatality rate after the second operation was 0(0/63). The total complication rate of first operation was 55.7% (39/70), the respiratory complication rate was 10.0% (7/70) and the cardiovascular complication rate was 5.7% (4/70) The incidence of anastomotic leakage was 11.1% (9/63). The overall survival rate at 2, 3 and 5 years was 35.7%, 30.0% and 15.7%, respectively.Conclusion:Two-stage operation in the treatment of complex esophageal malignancies is feasible and yields satisfaetory results.

Objective:To investigate the time characteristics from extracorporeal cardiopulmonary resuscitation (ECPR) initiation to termination.Methods:The data of ECPR patients in extracorporeal life support center of the First Affiliated Hospital of Nanjing Medical University from April 2015 to October 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, in-hospital/out-of-hospital cardiac arrest (IHCA/OHCA), daytime/evening initiation, and procedural/non-procedural termination. Data on age, sex, Charlson comorbidity index, interhospital transport, initial rhythm, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECPR initiation/termination and ECMO treatment time, 90-day survival rate and so on were analyzed.Results:200 ECPR patients were enrolled, the cardiogenic etiologies were accounted for 70.5%, more men than women, 68 (34.0%) patients survived at 90 days, of whom 61 (89.7%) patients had good neurological outcomes. The 90-day survival group had a significantly lower of no-flow time, a higher proportion of IHCA and initial shockable heart rhythm, with a higher ECPR initial blood gas pH and a lower lactic acid value than those in the death group. 3. The no flow time in OHCA group was significantly longer than that in IHCA group, with a lower ECPR initial blood gas pH and a higher lactic acid value, 77.4% were non-procedural termination and the 90-day survival rate was 16.1%. ECPR were initiated in all time periods, IHCA-ECPR initiated at random, OHCA-ECPR were rare in the early morning, and the initiation time had no significant effect on ECPR outcomes. There were 75.5% of ECPR terminated at the daytime, 56.8% death cases were occurred within 3 days after ECPR, and 19.0% of patients in the procedural termination group died due to a combination of factors.Conclusions:ECPR had a potentially high benefit for patients with IHCA, initial shockable rhythm, and a short no-flow time. The ECPR initiation time were irregular and had no effect on ECPR outcomes. Death events tend to occur in the early days after ECPR, and ECPR terminated is mostly during the daytime working hours. The construction of full-time ECPR team should be strengthened.

Objective:To evaluate the prognostic value of coagulofibrinolytic changes in survivors of adult extracorporeal cardiopulmonary resuscitation (ECPR) in Chinese.Methods:133 cardiac arrest (CA) patients whose blood samples were collected after establishment of extracorporeal membrane oxygenation between January 2018 and April 2023 in Emergency Department of the First Affiliated Hospital of Nangjing Medical University were enrolled in this single-center study. The following were examined: platelet counts (PLT), prothrombin time (PT), activated partial thrombin time (APTT), thrombin time (TT), fibrinogen (Fib), and D-dimer (D-D). The prognostic values of these coagulation-related indicators in predicting poor outcomes (Cerebral Performance Category 3-5) were analyzed.Results:Among the 133 patients involved, 96 (72.2%) had poor outcomes after ECPR treatment. In the poor-outcome group, PLT and Fib were significantly decreased, while PT and APTT were significantly prolonged (all P < 0.05). ECPR survivors had a significantly higher risk of poor neurological outcomes in the high-level group than those in the low-level group for PT ( HR=1.87, 95% CI:1.17-2.99, P=0.009), APTT ( HR=1.95, 95% CI:1.26-3.00, P=0.003), and D-D levels ( HR=5.18, 95% CI:2.06-13.03, P<0.001). The risk of poor neurological outcomes was significantly lower in the high-level group for PLT ( HR=0.55, 95%CI:0.35-0.84, P=0.007). Conclusion:Coagulofibrinolytic changes can be promising tools to assess poor neurological outcomes in adult ECPR survivors.

Objective:To observe the effects of early energy intake and early enteral nutrition on prognosis of patients during extracorporeal membrane oxygenation (ECMO).Methods:Patients who received ECMO treatment in the emergency intensive care unit (EICU) of the Jiangsu Provincial Hospital (First Affiliated Hospital of Nanjing Medical University) from January 2021 to June 2022 were selected as subjects to summarize the early energy intake of ECMO patients. Logistic regression analysis and restricted cubic spline (RCS) analysis were used to determine the relationship between early energy intake and prognosis of ECMO patients. According to the results of RCS analysis, the patients were divided into energy-deficient group and energy-sufficient group. And according to whether early enteral nutrition (EEN) was initiated, the patients were divided into EEN group and non-EEN group. The differences of clinical outcomes between energy-deficient group and energy-sufficient group, EEN group and non-EEN group were compared.Results:There was no significant difference in age, sex, BMI, primary disease and ECMO pattern between energy-deficient group and energy-sufficient group, EEN group and non-EEN group. The ECMO conversion time (days) and hospitalization time (days) in the energy-deficient group were significantly lower than those in the energy-sufficient group, and the survival rate in the energy-deficient group was significantly lower than that in the energy-sufficient group [43.2% (19/44) vs. 66.0% (31/47), P=0.029]. Kaplan-Meier survival analysis showed that the 28-day survival rate in the energy-deficient group was significantly lower than that in the energy-sufficient group, and the risk of death was 2.595 times higher than that in the energy-sufficient group. The conversion time (days), hospital stay (days) and average daily energy intake [kcal/(kg·d)] in the EEN group were higher than those in the non-EEN group ( P<0.05), and the survival rate in the non-EEN group was significantly higher than that in the non-EEN group [66.1% (41/62) vs. 31.0% (9/29), P<0.002]. Kaplan-Meier survival analysis showed that the 28-day survival rate in the non-EEN group was significantly lower than that in the EEN group, and the risk of death was 2.981 times higher than that in the EEN group ( P<0.001). Conclusions:The energy intake of patients with ECMO above 16.94 kcal/ (kg·d) is a protective factor for prognosis. EEN helps to increase early energy intake and improve prognosis in patients during ECMO.

Objective:To investigate the effect of Early infarct growth rate(EIGR) on the prognosis of patients with acute large vessel occlusive ischemic stroke.Methods:A total of 164 patients with acute large vessel occlusive ischemic stroke were enrolled in the emergency department of the First Affiliated Hospital of Nanjing Medical University from January 1, 2020 to December 31, 2022.According to the change of the National Institutes of Health Stroke Scale (NIHSS) score at admission and 72 h after treatment, the patients were divided into good prognosis group and poor prognosis group. The basic clinical data of the two groups were observed and compared. The risk factors of poor prognosis were analyzed by univariate regression. The effect of EIGR on prognosis after age stratification was further analyzed.Results:Comparing the clinical data of the two groups, there was no difference in EIGR (mL/h) (7.67 vs. 8.24, P=0.211) between the two groups. The product between EIGR and age was included as the interaction term, and the result of the interaction term in the model was statistically significant ( OR=1.002, 95% CI: 1.000-1.003, P=0.032) .Moreover, the result was still statistically significant after adjusting for relevant variables (gender, history of hypertension, history of atrial fibrillation, history of diabetes, history of coronary heart disease, and history of stroke) ( OR=1.002, 95% CI:1.000-1.003, P=0.027). Subgroup analysis was performed according to the median age (71 years). In the elderly group, the proportion of poor prognosis was higher with fast core infarction growth rate defined by 25 mL/h and 15 mL/h ( P < 0.05).In the younger age group, there was no significant difference in the proportion of poor prognosis in the fast core infarction growth rate compared with the slow type ( P > 0.05). Conclusions:EIGR can predict the early clinical outcome early in elderly patients with large vessel occlusive ischemic stroke.

Objective:To analyze the feasibility and safety of laparoscopic radical resection of hilar cholangiocarcinoma (HCCA).Methods:Clinical data of 72 patients with HCCA undergoing radical resection at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to January 2022 were retrospectively analyzed, including 36 males and 36 females, aged 57(47, 63) years old. According to surgical approach, patients were divided into the laparoscopic group ( n=39) and open group ( n=33). The surgical safety, tumor radicality, postoperative recovery, complications and survival time were compared between the two groups. Results:Operative time was comparable between the two groups [(6.4±2.6) h vs. (6.3±2.4) h, P>0.05], while the intraoperative blood loss was lower in the laparoscopic group [(531.9±273.3) ml vs. (674.6±330.0) ml]. Data were also comparable between the two groups in terms of R0 resection rate [92.3% (36/39) vs. 93.9% (31/33)], the number of lymph node dissection (7.7±2.6 vs. 7.6±2.4), and the incidence of postoperative complications [20.5% (8/39) vs. 18.2% (6/33)] (all P>0.05). However, the laparoscopic group was superior to the open group in terms of postoperative analgesia time [(2.0±0.7)d vs. (2.8±0.9)d], postoperative resumption of feeding time [(1.6±0.5)d vs. (3.9±0.9)d], and postoperative hospitalization time [(8.6±1.5)d vs. (12.8±2.2)d] ( t=4.04, 8.23, 9.47, respectively, all P<0.001). Postoperative cumulative survival was comparable between the two groups ( χ2=0.50, P=0.480). Conclusion:Laparoscopic radical resection of HCCA has similar efficacy to open surgery and has the advantage of less invasiveness and enhanced recovery.