Post-cardiac arrest brain injury (PCABI) remains the main cause of death and poor prognosis in patients after resuscitation. In June 2024, the International Liaison Committee on Resuscitation (ILCOR) released a scientific statement on improving the prognosis of PCABI based on relevant research progress. The statement proposed the pathological mechanism of PCABI, explored the reasons why previous preclinical data could not be translated into clinical practice, and outlined possible future directions for advancement. This article interprets the key content of the 2024 ILCOR scientific statement on improving the prognosis of PCABI, hoping to provide reference and assistance for domestic medical staff to understand and apply this scientific statement.
Humans ; Heart Arrest/therapy* ; Brain Injuries/therapy* ; Cardiopulmonary Resuscitation ; Prognosis ; Resuscitation

OBJECTIVE: To develop a method for identifying high-risk patients among septic populations requiring mechanical ventilation, and to conduct phenotypic analysis based on this method. METHODS: Data from four sources were utilized: the Medical Information Mart for Intensive Care (MIMIC-IV 2.0, MIMIC-III 1.4), the Philips eICU-Collaborative Research Database 2.0 (eICU-CRD 2.0), and the Anhui Medical University Second Affiliated Hospital dataset. The adult patients in intensive care unit (ICU) who met Sepsis-3 and received invasive mechanical ventilation (IMV) on the first day of first admission were enrolled. The MIMIC-IV dataset with the highest data integrity was divided into a training set and a test set at a 6:1 ratio, while the remaining datasets were served as validation sets. The demographic information, comorbidities, laboratory indicators, commonly used ICU scores, and treatment measures of patients were extracted. Clinical data collected within first day of ICU admission were used to calculate the sequential organ failure assessment (SOFA) score. K-means clustering was applied to cluster SOFA score components, and the sum of squared errors (SSE) and Davies-Bouldin index (DBI) were used to determine the optimal number of disease subtypes. For clustering results, normalized methods were employed to compare baseline characteristics by visualization, and Kaplan-Meier curves were used to analyze clinical outcomes across phenotypes. RESULTS: This study enrolled patients from MIMIC-IV dataset (n = 11 166), MIMIC-III dataset (n = 4 821), eICU-CRD dataset (n = 6 624), and a local dataset (n = 110), with the four datasets showing similar median ages and male proportions exceeding 50%; using 85% of the MIMIC-IV dataset as the training set, 15% as the test set, and the rest dataset as the validation set. K-means clustering based on the six-item SOFA score was performed to determine the optimal number of clusters as 3, and patients were finally classified into three phenotypes. In the training set, compared with the patients with phenotype II and phenotype III, those with phenotype I had the more severe circulatory and respiratory dysfunction, a higher proportion of vasoactive drug usage, more obvious metabolic acidosis and hypoxia, and a higher incidence of congestive heart failure. The patients with phenotype II was dominated by respiratory dysfunction with higher visceral injury. The patients with phenotype III had relatively stable organ function. The above characteristics were consistent in both the test and validation sets. Analysis of infection-related indicators showed that the patients with phenotype I had the highest SOFA score within 7 days after ICU admission, initial decreases and later increases in platelet count (PLT), and higher counts of neutrophils, lymphocytes, and monocytes as compared with those with phenotype II and phenotype III, their blood cultures had a higher positivity rates for Gram-positive bacteria, Gram-negative bacteria and fungi as compared with those with phenotype II and phenotype III. The Kaplan-Meier curve indicated that in the training, test, and validation sets, the 28-day cumulative mortality of patients with phenotype I was significantly higher than that of patients with phenotypes II and phenotype III. CONCLUSIONS Three distinct phenotypes in septic patients receiving IMV based on unsupervised machine learning is derived, among which phenotype I, characterized by cardiorespiratory failure, can be used for the early identification of high-risk patients in this population. Moreover, this population is more prone to bloodstream infections, posing a high risk and having a poor prognosis.
Humans ; Machine Learning ; Sepsis/therapy* ; Respiration, Artificial ; Intensive Care Units ; Organ Dysfunction Scores ; Male ; Female ; Middle Aged ; Adult

Objective To conduct an analysis on objective data of tongue manifestations and complexions among college students with yang deficiency constitution and balanced constitution,thus to explore the correlation between yang deficiency constitution and the objective data of tongue manifestations and complexions among college students.Methods From August 2023 to January 2024,data collection was carried out in 325 cases of yang deficiency constitution(yang deficiency group)and 175 cases of balanced constitution(balanced group)from college students of Hunan University of Chinese Medicine,Central South University,Hunan Normal University,Hunan University and Changsha University of Science and Technology in Hunan Province.YM-MA-Ⅰ digital detection system for tongue manifestations and complexions of traditional Chinese medicine(TCM)was utilized for data collection and image analysis,and the differences in the Lab parameters of tongue color,tongue shape,tongue coating color,complexions,and lip color were compared between yang deficiency group and balanced group.Of the Lab parameters,letter"L"stands for luminance,which expresses the luminance from absolute black to absolute white,and takes the value of 0-100;letter"a"and letter"b"stand for two color channels,letter"a"represents the color from dark green to grey then to bright pink,and takes a value from-128 to 127,and letter"b"represents the color from bright blue to grey then to yellow,and also takes a value from-128 to 127.Results(1)The analysis of tongue manifestations showed that in comparison with the balanced group,enlarged tongue(72.62％),tooth-marked tongue(83.69％),and greasy coating(59.38％)were frequently seen in the yang deficiency group,and the differences were all statistically significant(P＜0.05 or P＜0.01).(2)The analysis of complexions showed that in comparison with the balanced group,lusterless complexion(79.08％)and pale lip(42.15％)were frequently seen in the yang deficiency group,with statistically significant differences(P＜0.01).(3)The yang deficiency group had higher L value of tongue color,L value of tongue coating color,L value of complexions,and L and b values of lip color than the balanced group,and the differences were all statistically significant(P＜0.05),indicating that the tongue color,complexions,and lip color of the yang deficiency group were all pale.Conclusion The objective data and image analysis of tongue manifestations and complexions can accurately identify the population of yang deficiency constitution from college students,and the results will provide approaches and references for the identification of other TCM constitutions from the population.

Objective To explore the mechanisms of"treating different diseases with the same method"for chronic obstructive pulmonary disease(COPD)and diabetes mellitus(DM)with Shen-ling Baizhu San based on network pharmacology and molecular docking.Methods Comprehensive databases were searched to collect the active ingredients and targets of Shenling Baizhu San,which were then performed standardized process.Relevant targets for COPD and DM were collected from data platforms such as GeneCards and Online Mendelian Inheritance in Man(OMIM).The intersection tar-gets of the drug and diseases were identified using Venn software,imported into the STRING database to construct a protein-protein interaction(PPI)network,and performed visualized analysis using Cyto-scape software.Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analysis were performed using R software.Molecular doc-king and visualization analysis were conducted using the CB-Dock2 platform.Results After screening,215 potential targets of Shenling Baizhu San were obtained.Venn diagram analysis showed that there were 70 potential intersection targets for the treatment of COPD and DM with Shenling Baizhu San.Key active ingredients included quercetin,stigmasterol,kaempferol,sitosterol,and luteolin,while core targets included tumor necrosis factor(TNF),interleukin-6(IL-6),interleukin-β(IL-1 β),prostaglandin-endoperoxide synthase 2(PTGS2),and tumor protein p53(TP53).GO functional en-richment analysis yielded 2,599 biological process terms,49 cellular component terms,and 230 molecular function terms.The main pathways obtained from KEGG pathway enrichment analysis in-cluded lipid and atherosclerosis,interleukin-17(IL-17)signaling pathway,TNF signaling pathway,and human cytomegalovirus infection.Molecular docking results showed that stigmasterol had the best docking activity with PTGS2.Conclusion Shenling Baizhu San may achieve the"treatment of different diseases with the same method"for COPD and DM through multiple components,multiple targets,and multiple pathways,and there is a certain correlation in the treatment mechanisms of two diseases,providing a theoretical basis and direction for subsequent research.

BACKGROUND:Lower limb peri-knee muscle strength training and neuromuscular electrical stimulation are generally safe and effective rehabilitation methods for patellofemoral joint pain,but the mechanism of their intervention is still unclear. OBJECTIVE:To determine the effect of muscle strength training combined with neuromuscular electrical stimulation on pain,lower extremity function and biomechanical characteristics in patients with patellofemoral pain. METHODS:Thirty-seven patients with patellofemoral pain were randomly divided into muscle strength training combined with electrical stimulation group(trial group,n=19)and muscle strength training group(control group,n=18).Both groups underwent intervention training for 6 weeks,three times a week.The visual analog scale and anterior knee pain scale were used to evaluate the pain level and functional level of the knee.Kinematic and kinetics data during running were collected by using an infrared motion capture system and a three-dimensional force platform simultaneously.A two-way analysis of variance with repeated measures(group*time)was applied to analyze the data. RESULTS AND CONCLUSION:(1)After the intervention,the visual analog scale scores of the trial group and the control group were significantly decreased(P<0.001),and the anterior knee pain scale scores were significantly increased(Ptrial group<0.001,Pcontrol group=0.001)in the trial group and control group.The anterior knee pain scale scores of the trial group were significantly higher compared to the control group after the intervention(P=0.001).(2)The peak knee flexion angle(P=0.011),peak knee extension moment(P<0.001),the peak knee internal rotation moment(P=0.008),the peak patellofemoral stress(P<0.001)and the peak patellofemoral contact force(P<0.001)were significantly decreased in the trial and control groups during running after the intervention compared with those before the intervention.(3)In conclusion,both muscle strength training and muscle strength training combined with electrical stimulation training are helpful to improve the subjective pain and lower limb function of patellofemoral pain patients,enhance the movement pattern during running and reduce the stress of the patellofemoral joint.Compared with muscle strength training alone,muscle strength training combined with electrical stimulation can improve lower limb function more significantly.

Objective:To evaluate the effect of individualized positive end-expiratory pressure (PEEP) titration based on open-lung strategy on the intraoperative thoracic fluid content (TFC) in elderly patients undergoing transurethral ultrasound-guided laser-induced prostatectomy (TULIP).Methods:Eighty-six American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, patients, aged 65-80 yr, with body mass index of 18-28 kg/m 2, scheduled for elective TULIP, were divided into 2 groups ( n=43 each) by the random number table method: fixed PEEP group (group C) and individualized PEEP titration group (group P). PEEP was set at 4 cmH 2O after routine mechanical ventilation in group C. Patients underwent pulmonary recruitment maneuvers combined with individualized PEEP titration during surgery in group P. TFC was measured using a non-invasive cardiac output monitor at 5 min after tracheal intubation (T 0), 30 min after PEEP titration and ventilation (T 1), 5 min before surgery (T 2), and 5 min before leaving the recovery room (T 3). Cardiac output, oxygenation index and stroke volume index were recorded from T 0-T 2, arterial blood gas analysis was simultaneously performed to record peak airway pressure and dynamic lung compliance, and oxygenation index was calculated. The duration of postanesthesia care unit stay, pulmonary complications within 7 days after surgery, and length of hospital stay were also recorded. Results:Eighty-three patients were finally included, with 42 in group C and 41 in group P. Compared with group C, TFC was significantly decreased at T 1-T 3, cardiac index, cardiac output and stroke volume index were decreased at T 1, dynamic lung compliance, PaO 2 and oxygenation index were increased at T 1 and T 2, PaCO 2 was decreased, the incidence of postoperative pulmonary complications was reduced, and the duration of postanesthesia care unit stay and postoperative length of hospital stay were shortened in group P ( P<0.05). Conclusions:Individualized PEEP titration based on open-lung strategy can effectively decrease TFC and improve intraoperative oxygenation and prognosis in elderly patients undergoing TULIP.

Abstract Psychological stress is a significant contributing factor for the decline in male sperm quality. In terms of the psychological mechanism, the decline of sperm quality due to psychological stress is associated with increased perceived stress and different coping strategies. External sources of stress can elevate stress perception, then affect sperm quality, while coping strategies may modulate the impact of stress perception on sperm quality. In terms of the physiological mechanism, psychological stress disrupts the normal functioning of the sympathoadrenal system, hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-gonadal axis, leading to disturbances in the essential endocrine environment for sperm production. This review synthesizes the psychological and physiological mechanisms through which psychological stress influences male sperm quality, providing insights into the prevention and treatment of male infertility.

This study proposed the use of the minimum slip force as an indicator to measure the clamping ability of microsurgical forceps.By analyzing the minimum slip forces of four typical tooth types of microsurgical forceps,the clamping capacity of each type was evaluated.Among the existing tooth forms,the staggered tooth type exhibited a relatively large minimum slip force.Consequently,a new tooth-shaped structure for microsurgical forceps-the hemispherical convex structure was proposed.Simulation and experimental studies demonstrated that this new dental structure could achieve stable and reliable clamping.

Objective:To investigate the clinical features and prognosis of testicular relapse in pediatric acute lymphoblastic leukemia (ALL).Methods:Clinical data including the age, time from initial diagnosis to recurrence, relapse site, and therapeutic effect of 37 pediatric ALL with testicular relapse and treated in Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences between November 2011 and December 2022 were analyzed retrospectively. Patients were grouped according to different clinical data. Kaplan-Meier analysis was used to evaluate the overall survival (OS) rate and event free survival (EFS) rate for univariate analysis, and Cox proportional-hazards regression model was used to evaluate the influencing factors of OS rate and EFS rate for multivariate analysis.Results:The age at initial diagnosis of 37 pediatric testicular relapse patients was (5±3) years and the time from initial diagnosis to testicular recurrence was (37±15) months. The follow-up time was 43 (22, 56) months. Twenty-three patients (62%) were isolated testis relapse. The 5-year OS rate and EFS rate of the 37 relapsed children were (60±9) % and (50±9) % respectively. Univariate analysis showed that the 2-year EFS rate in the group of patients with time from initial diagnosis to testicular recurrence >28 months was significantly higher than those ≤28 months ((69±10)% vs. (11±11)%, P<0.05), 2-year EFS rate of the isolated testicular relapse group was significantly higher than combined relapse group ((66±11)% vs. (20±13) %, P<0.05), 2-year EFS rate of chimeric antigen receptor T (CAR-T) cell treatment after relapse group was significantly higher than without CAR-T cell treatment after relapse group ((78±10)% vs. (15±10)%, P<0.05). ETV6-RUNX1 was the most common genetic aberration in testicular relapsed ALL (38%, 14/37). The 4-year OS and EFS rate of patients with ETV6-RUNX1 positive were (80±13) % and (64±15) %, respectively. Multivariate analysis identified relapse occurred≤28 months after first diagnosis ( HR=3.09, 95% CI 1.10-8.72), combined relapse ( HR=4.26, 95% CI 1.34-13.52) and CAR-T cell therapy after relapse ( HR=0.15,95% CI 0.05-0.51) were independent prognostic factors for 2-year EFS rate (all P<0.05). Conclusions:The outcome of testicular relapse in pediatric ALL was poor. They mainly occurred 3 years after initial diagnosis. ETV6-RUNX1 is the most common abnormal gene.Patients with ETV6-RUNX1 positive often have a favorable outcome. Early relapse and combined relapse indicate unfavorable prognosis, while CAR-T cell therapy could significantly improve the survival rate of children with testicular recurrence.

Objective:To investigate the clinical characteristics and long-term prognostic factors of relapsed pediatric acute lymphoblastic leukemia (ALL).Methods:Clinical data including the age, time from initial diagnosis to relapse, relapse site, and molecular biological features of 217 relapsed ALL children primarily treated by the Chinese Children's Leukemia Group (CCLG)-ALL 2008 protocol in Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences between April 2008 and April 2015 were collected and analyzed in this retrospective cohort study. Kaplan-Meier analysis was used to evaluate the overall survival (OS) rate and event free survival (EFS) rate for univariate analysis, and Cox proportional-hazards regression model was used to evaluate the influencing factors of OS rate and EFS rate for multivariate analysis.Results:The age at initial diagnosis of 217 relapsed patients was 5 (3, 7) years. There were 135 males and 82 females. The time from initial diagnosis to relapse of 217 children was 22 (10, 39) months. After relapse, 136 out of 217 children (62.7%) received treatment and the follow-up time was 65 (47, 90) months. The 5-year OS rate and EFS rate of the 136 relapsed children were (37±4) % and (26±4) %, respectively. The predicted 10-year OS rate and EFS rate were (35±5) % and (20±4) %, respectively. Univariate analysis showed that the 5-year OS rate in the group of patients with late relapse (43 cases) was significantly higher than those with very early (54 cases) and early relapse (39 cases) ((72±7)% vs. (16±5)%, (28±8)%, χ2=35.91, P<0.05), 5-year OS rate of the isolated extramedullary relapse group (20 cases) was significantly higher than isolated bone marrow relapse group (102 cases) and combined relapse group (14 cases) ((69±11)% vs. (31±5)%, (29±12)%, χ2=9.14, P<0.05), 5-year OS rate of high-risk group (80 cases) was significantly lower than standard-risk group (10 cases) and intermediate-risk group (46 cases) ((20±5)% vs. (90±10)%, (54±8)%, χ2=32.88, P<0.05). ETV6::RUNX1 was the most common fusion gene (13.2%, 18/136). The predicted 10-year OS rate of relapsed children with positive ETV6::RUNX1 was significantly higher than those without ETV6::RUNX1 (118 cases) ((83±9)% vs. (26±5)%, χ2=14.04, P<0.05). The 5-year OS for those accepted hematopoietic stem cell transplantation (HSCT) after relapse (42 cases) was higher than those without HSCT (94 cases) ((56±8)% vs. (27±5)%, χ2=15.18, P<0.05). Multivariate analysis identified very early/early relapse ( HR=3.91, 95% CI 1.96-7.79; HR=4.15, 95% CI 1.99-8.67), bone marrow relapse including isolated bone marrow relapse and combined relapse ( HR=6.50, 95% CI 2.58-16.34; HR=5.19, 95% CI 1.78-15.16), with ETV6::RUNX1 ( HR=0.23, 95% CI 0.07-0.74) and HSCT after relapse ( HR=0.24, 95% CI 0.14-0.43) as independent prognostic factors for OS (all P<0.05). Conclusions:Relapsed pediatric ALL mainly occurs very early and often affects bone marrow, which confer poor outcome. ETV6::RUNX1 is the most common genetic aberration with a favorable outcome. HSCT could rescue the outcome of relapsed children, though the survival rate is still poor.