In cases where a tracheal injury exceeds half the length of the adult trachea or one-third of the length of the child trachea, it becomes difficult to perform end-to-end anastomosis after tracheal resection due to excessive tension at the anastomosis site. In such cases, tracheal replacement therapy is required. Advances in tissue engineering technology have led to the development of tissue engineering tracheal substitutes, which have promising applications. Hydrogels, which are highly hydrated and possess a good three-dimensional network structure, biocompatibility, low immunogenicity, biodegradability, and modifiability, have had wide applications in the field of tissue engineering. This article provides a review of the characteristics, advantages, disadvantages, and effects of various hydrogels commonly used in tissue engineering trachea in recent years. Additionally, the article discusses and offers prospects for the future application of hydrogels in the field of tissue engineering trachea.

OBJECTIVE: To explore whether hydrocortisone can improve the prognosis of patients with severe community-acquired pneumonia (sCAP) by Meta-analysis. METHODS: Randomized controlled trial (RCT) on hydrocortisone in the treatment of sCAP were extracted from the database including PubMed, Cochrane library, Web of Science, and Embase, and the search time was up to April 29, 2023. The patients in the standard treatment group received standard treatment such as antibiotics and supportive care, while those in the hydrocortisone group received hydrocortisone treatment on the basis of standard treatment. Meta-analysis was used to compare the mortality, duration of mechanical ventilation, mechanical ventilation rate and incidence of adverse reactions (hyperglycemia, gastrointestinal bleeding, secondary infection) between the two groups. The risk of literature bias was assessed. The studies that might have publication bias were corrected by the subtraction and complementation method. At the same time, trial sequential analysis (TSA) was conducted. RESULTS: A total of 5 RCTs involving 1 031 patients were finally enrolled, including 494 patients in the standard treatment group and 537 patients in the hydrocortisone group. Among the 5 studies, the research site of 2 studies was in the mixed ward. Considering the inclusion characteristics of the study population, there was doubt whether its research object was sCAP patients, which might have a certain impact on the results and introduce potential bias. Meta-analysis showed that the mortality in the hydrocortisone group was significantly lower than that in the standard treatment group [6.0% vs. 14.0%; odds ratio (OR) = 0.38, 95% confidence interval (95%CI) was 0.25-0.59, P < 0.01; I² = 9%]. The studies that were asymmetric were corrected by the reduction and supplementation method. Even after filling the missing studies, hydrocortisone could still reduce the death risk of the patient (OR = 0.49, 95%CI was 0.32-0.73, P < 0.01; I² = 31%). TSA showed that the average mortality of the standard treatment group was about 14.0%, and that of the hydrocortisone group was about 6.0%, with a relative risk reduction (RRR) = 57%. The calculated sample size was 699 cases, and the actual sample size was 1 031 cases. The actual sample size exceeded the required sample size, and the Z-curve crossed the O'Brien-Fleming boundary and the curve corresponding to P = 0.05, it meant that hydrocortisone could effectively reduce the mortality of sCAP. Compared with the standard treatment group, no statistical difference in the duration of mechanical ventilation was found in the hydrocortisone group [mean difference (MD) = -3.26, 95%CI was -6.72-0.21, P = 0.07; I² = 0%], but the 8-day mechanical ventilation rate was significantly lowered (19.5% vs. 55.4%; OR = 0.24, 95%CI was 0.12-0.45, P < 0.01; I² = 0%), and also no significantly difference was found in the incidence of hyperglycemia (54.3% vs. 44.6%, OR = 1.26, 95%CI was 0.56-2.84, P = 0.58; I² = 61%), gastrointestinal bleeding (2.5% vs. 3.6%; OR = 0.70, 95%CI was 0.34-1.46, P = 0.34; I² = 0%) and secondary infection (9.2% vs. 11.5%; OR = 0.46, 95%CI was 0.06-3.35, P = 0.45; I² = 53%). CONCLUSION Hydrocortisone can reduce the mortality rate of sCAP patients, decrease their need for mechanical ventilation, and does not increase the risk of hyperglycemia, gastrointestinal bleeding, or secondary infections.
Humans ; Hydrocortisone/therapeutic use* ; Community-Acquired Infections/drug therapy* ; Pneumonia/drug therapy* ; Randomized Controlled Trials as Topic ; Respiration, Artificial ; Community-Acquired Pneumonia

AIM: To investigate the potential causal relationship between gut microbiota(GM)and primary open-angle glaucoma(POAG)based on a two-sample Mendelian randomization(MR)analysis.METHODS: The exposure data was derived from the Genome-Wide Association Studies(GWAS)of GM at the University of Bristol, while the outcome data for POAG was sourced from the MRC Integrative Epidemiology Unit(IEU)Open GWAS database. In this study, inverse variance weighted(IVW), MR Egger, weighted median(WM), Simple Mode, and Weighted Mode were analyzed to investigate the potential causal relationships between GM and POAG. IVW was used as the primary method for this study, and sensitivity analysis was conducted to assess the reliability of the MR analysis.RESULTS: The IVW analysis revealed that Butyrivibrio(OR=1.170, 95%CI: 1.057-1.295, P=0.002), Howardella(OR=1.188, 95%CI: 1.043-1.355, P=0.010), and LachnospiraceaeUCG001(OR=1.229, 95%CI: 1.016-1.485, P=0.033)were correlated with the risk of POAG. Conversely, Candidatus Soleaferrea(OR=0.810, 95%CI: 0.670-0.981, P=0.031), Ruminococcustorquesgroup(OR=0.656, 95%CI: 0.453-0.950, P=0.026), and RuminococcaceaeUCG013(OR=0.770, 95%CI: 0.598-0.990, P=0.041)were protective factors for POAG. Sensitivity analysis showed that there were no heterogeneity and pleiotropy among the instrumental variables.CONCLUSION: The MR study indicated a causal relationship between GM and POAG. Given the sight-threatening characteristic of POAG, early identification and intervention in the relative factors was significant for the prognosis of POAG.

Objective To analyze the current research application status and hotspots of nanoparticles in the treatment of non-small cell lung cancer (NSCLC) and predict the future development trend. Methods The Web of Science database was searched for literatures on nanoparticles use in the treatment of NSCLC from inception to November 2022. CiteSpace, VOSviewer and literature measurement analysis online platform (https://bibliometric.com/) were used for the visual analysis of the number of documents, source journals, authors, organizations, countries and keywords. Results A total of 742 English literatures were included. The results showed that the number of published literatures increased year by year from 2011 and reached the peak in 2020. Researches on nanoparticles and NSCLC treatment were mainly concentrated in China, the United States, India and Japan. China is a major research country in this field, but it lacked cooperation with other countries and related institutions. Among numerous research institutions, the Chinese Academy of Sciences was the authoritative and backbone force in this research field, with the number of published literatures ranking first and the research achievements outstanding. The keyword analysis found that "poly lactic-co-glycolic acid nanoparticles (PLGA NPs)" and "photothermal therapy" had become the latest breakout words since 2018. Moreover, the occurrence frequency of related keywords such as "drug delivery" increased significantly, indicating that the application of PLGA NPs in photothermal therapy might be the current research hotspot and future development trend of NSCLC treatment. Conclusion Currently, the domestic research on the treatment of nanoparticles and NSCLC is in a leading position in the world. The organic combination of nanoparticles with different materials and other NSCLC therapies is expected to improve the prognosis of NSCLC patients. In the future, attempts to develop nanoparticles with different sources and structures and combined with photothermal therapy for the treatment of NSCLC may become a research hotspot of nanoparticles in the treatment of NSCLC.

Objective To analyze the current development of researches on biomarkers for predicting the efficacy of immunotherapy in non-small cell lung cancer and to provide reference for subsequent studies. Methods Studies on biomarkers for predicting the efficacy of immunotherapy for non-small cell lung cancer indexed in the Web of Science Core Collection from 2017 to 2021 were searched by computer. The annual distribution, journals, authors, countries, institutions, and keywords of studies were visualized and analyzed by CiteSpace. Results A total of 426 studies were collected, including 298 articles and 128 reviews. The average number of published studies was about 85, and increased year by year. PD-L1 expression, tumor mutational burden, tumor microenvironment and liquid biopsy were hot keywords in this field. Conclusion In the future, combination of biomarkers in the liquid biopsy and tumor microenvironment with radiomics analysis will be the research hotspot and frontier in this field for more accurate assessment with tumor-related signatures such as lymphocytic immune status and characteristics of tumor lesions in non-small cell lung cancer patients.

Objective To investigate the effect of integrated in-hospital and discharge care model based on the health empowerment theory in patients with knee osteoarthritis after intra-articular injection. Methods A total of 160 patients undergoing knee joint puncture treatment were selected as the study objects, and were divided into control group (80 cases) and observation group (80 cases) according to random number table method. The control group received traditional nursing care, while the observation group received an integrated in-hospital and discharge care model based on the health empowerment theory in addition to the traditional care. The health empowerment level (Chronic Disease Health Empowerment Scale for the Elderly), self-care ability [Exercise of Self-Care Agency (ESCA) Scale] and knee pain severity [Visual Analogue Scale (VAS) and Lysholm score] were compared between the two groups. The incidence of complications after treatment was compared between the two groups. Results The scores for the dimensions of support acquisition, responsibility belief, participation in treatment, knowledge enhancement as well as self-reconstruction and the total score of the health empowerment scale were significantly higher in the observation group than those in the control group (P < 0.05). After treatment, VAS scores in two groups were significantly lower than before treatment, and observation group was significantly lower than the control group (P < 0.05); the Lysholm scores in two groups were significantly higher than before treatment, and the observation group was significantly higher than the control group (P < 0.05). The self-care ability scores after 1 course, 2 and 3 courses of treatment were significantly higher in the observation group than those in the control group (P < 0.05). The overall incidence of complications after treatment was significantly lower in the observation group than that in the control group (P < 0.05). Conclusion The integrated in-hospital and discharge care model based on the health empowerment theory can improve patients' health empowerment levels and self-care abilities, enhance knee function, relieve knee pain, and decrease the incidence of complications after treatment.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common and serious complication following cardiac surgical procedures. The conventional diagnostic methods relying on serum creatinine and urine output changes often exhibit delayed responsiveness. Therefore, there is an urgent need for highly sensitive and specific biomarkers to detect and identify high-risk patients with CSA-AKI at an early stage, allowing for timely intervention and improved clinical outcomes. In this paper, the relevant biomarkers of CSA-AKI were reviewed in order to provide valuable information for the subsequent research on CSA-AKI.

Objective To investigate the application value of point-of-care lung ultrasound (POC-LUS) scoring in selecting respiratory support treatment modalities for neonatal infectious pneumonia (NIP). Methods A total of 89 NIP patients were selected as the study subjects and divided into control group (no assisted ventilation) with 46 cases, noninvasive group (noninvasive assisted ventilation) with 28 cases, and invasive group (invasive mechanical ventilation) with 15 cases based on the degree of dyspnea and blood gas analysis results. The POC-LUS scores of the three groups were compared, and the correlations of POC-LUS scores with arterial oxygen partial pressure [p_a(O₂)] and arterial carbon dioxide partial pressure [p_a(CO₂)] were analyzed. Receiver operating characteristic (ROC) curves were plotted to assess the predictive efficacy of POC-LUS scores for the need for noninvasive assisted ventilation or invasive mechanical ventilation in NIP patients. Results The POC-LUS scores of the noninvasive group and the invasive group were (31.7±7.3) and (42.1±8.0), respectively, which were higher than (21.5±7.3) of the control group. Additionally, the score of the invasive group was higher than that of the noninvasive group (P < 0.05). Correlation analysis revealed a significant negative correlation between POC-LUS scores and p_a(O₂) (r=-0.802, P < 0.05), and a significant positive correlation with p_a(CO₂) (r=0.807, P < 0.05). ROC curve analysis showed that the area under the curve (AUC) of POC-LUS scores for predicting the need for noninvasive assisted ventilation and invasive mechanical ventilation were 0.918 (95%CI, 0.862 to 0.973) and 0.938 (95%CI, 0.889 to 0.987), respectively. The sensitivity was 0.767 and 0.933, and the specificity was 0.935 and 0.824, with optimal cutoff values of 29.5 and 31.5, respectively. Conclusion POC-LUS scoring can quantitatively assess the severity of lung lesions in NIP patients and serves as a guiding tool for clinicians in selecting assisted ventilation treatment modalities.

Objective To investigate the effects of different deflation methods of endotracheal tube cuff on coughing response and hemodynamics during extubation. Methods Ninety patients undergoing elective surgery for endotracheal intubation under general anesthesia were selected as study subjects and randomly divided into study group and control group, with 45 patients in each group. In the study group, the cuff end of the endotracheal tube cuff was connected to a syringe and a non-liquid pressure gauge through a three-way stopcock. Before extubation, the cuff was aspirated to decrease the cuff pressure at a rate of 3 cmH₂O/s. In the control group, the gas in cuff was rapidly deflated by aspirating all the gas inside with a syringe during extubation. The incidence and severity of coughing response during extubation were recorded in both groups. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction of general anesthesia (T₀), before cuff deflation (T₁), immediately after cuff deflation (T₂), 1 minute after extubation (T₃), 3 minutes after extubation (T₄), and 5 minutes after extubation (T₅). Adverse events were also recorded in both groups. Results The coughing response during extubation started immediately after cuff deflation in both groups. The incidence and severity of coughing response were lower in the study group than in the control group (P < 0.05). Compared with the control group, values of MAP were lower at T₂ to T₄ and values of HR were lower at T₂ to T₅ in the study group (P < 0.05). The incidence of post-extubation pharyngeal discomfort was 6.67 % in the study group, which was lower than 26.67 % in the control group (P < 0.05). There was no significant difference in the incidence of post-extubation hypoventilation between the two groups (P>0.05). Conclusion The method of slowly reducing the pressure of the endotracheal tube cuff at a constant rate can reduce the incidence and severity of coughing, decrease postoperative extubation complications, and stabilize hemodynamics, with better effects than the method of rapidly aspirating all the gas inside the cuff at once.

In response to the problem that the traditional lower limb rehabilitation scale assessment method is time-consuming and difficult to use in exoskeleton rehabilitation training, this paper proposes a quantitative assessment method for lower limb walking ability based on lower limb exoskeleton robot training with multimodal synergistic information fusion. The method significantly improves the efficiency and reliability of the rehabilitation assessment process by introducing quantitative synergistic indicators fusing electrophysiological and kinematic level information. First, electromyographic and kinematic data of the lower extremity were collected from subjects trained to walk wearing an exoskeleton. Then, based on muscle synergy theory, a synergistic quantification algorithm was used to construct synergistic index features of electromyography and kinematics. Finally, the electrophysiological and kinematic level information was fused to build a modal feature fusion model and output the lower limb motor function score. The experimental results showed that the correlation coefficients of the constructed synergistic features of electromyography and kinematics with the clinical scale were 0.799 and 0.825, respectively. The results of the fused synergistic features in the K-nearest neighbor (KNN) model yielded higher correlation coefficients ( r = 0.921, P < 0.01). This method can modify the rehabilitation training mode of the exoskeleton robot according to the assessment results, which provides a basis for the synchronized assessment-training mode of "human in the loop" and provides a potential method for remote rehabilitation training and assessment of the lower extremity.
Humans ; Exoskeleton Device ; Reproducibility of Results ; Walking/physiology* ; Lower Extremity ; Algorithms ; Stroke Rehabilitation/methods*