To investigate the efficacy of amiodarone and lidocaine in cardiac arrest patients.

To analyze the clinical characteristics of acute diquat poisoning complicated by central nervous system injury (CNSI) and identify early risk factors, aiming to provide a theoretical basis for reducing mortality in diquat poisoning with CNSI.

Objective To describe the clinical characteristics of acute dichlorvos poisoning and analyzed the risk factors affecting patient prognosis,in order to provide important treatment guidance and theoretical reference for reducing the mortality of patients with acute dichlorvos poisoning.Methods A retrospective study method was conduct to collect the clinical data of patients admitted to the department of emergency of Fuyang People's Hospital from November 2019 to November 2023 and analyze the clinical poisoning characteristics.The patients were divided into death group and survival group according to the prognosis to compare the differences in the clinical characteristics of patients with different outcomes.This study conducted binary multifactor Logistic regression analysis of statistically significant indicators to select the independent risk factors affecting the prognosis of patients,and drew the receiver operator characteristic(ROC)curve to predict value of the risk factors on the prognosis.Results In 82 patients,22(26.83%)died,39(47.56%)developed capillary leak syndrome(CLS),31(37.80%)had acute respiratory failure,and 35(42.68%)had shock.Compared with the survival group,patients in the death group were older(years:57.73±17.67 vs.44.25±13.74),the proportion of gastric lavage,cholinesterase activity,Glasgow coma scale(GCS),albumin,pH value were all significantly decreased[proportion of gastric lavage:81.82%(18/22)vs.100.00%(60/60),cholinesterase activity(U/L):235.96(200.00,401.67)vs.450.00(240.26,739.25),GCS scores:4.00(3.00,6.00)vs.12.00(4.00,15.00),albumin(g/L):39.35±12.02 vs.45.21±4.51,pH value:7.14(7.04,7.26)vs.7.38(7.28,7.40)],dichlorvos concentration,dipterex concentration,sequential organ failure assessment(SOFA),acute physiology and chronic health evaluationⅡ(APACHEⅡ),alanine transaminase(ALT),blood urea nitrogen(BUN),serum creatinine(SCr),MB isoenzyme of creatine kinase(CK-MB),blood lactate acid(Lac),and concurrent acute respiratory failure,shock,CLS ratio were significantly increased[dichlorvos concentration(μg/L):271.00(49.25,908.25)vs.64.00(16.75,211.00),dipterex concentration(μg/L):1 337.50(397.25,3 614.00)vs.494.00(71.00,1 679.80),SOFA score:12.50(9.00,15.50)vs.2.00(0.00,6.75),APACHEⅡscore:28.50(23.00,32.50)vs.6.50(2.25,19.00),ALT(U/L):40.40(17.28,66.33)vs.19.65(13.70,34.68),BUN(mmol/L):6.30±2.78 vs.5.05±1.48,SCr(μmol/L):87.59±39.67 vs.58.87±14.85,CK-MB(U/L):164.80(86.13,284.85)vs.116.05(81.65,160.60),Lac(mmol/L):3.00(1.68,9.15)vs.1.20(1.00,2.40),the proportion of concurrent acute respiratory failure:95.45%(21/22)vs.33.33%(20/60),proportion of concurrent shock:100.00%(22/22)vs.21.67%(13/60),proportion of concurrent CLS:95.45%(21/22)vs.30.00%(18/60)],the differences were statistically significant(all P<0.05).The binary multivariate Logistic regression analysis showed that age,SOFA score,and CLS were independent risk factors affecting the prognosis of dichlorvos poisoning[age:odds ratio(OR)=1.090,95%credibility interval(95%CI)was 1.019-1.167;SOFA score:OR=1.454,95%CI was 1.159-1.825;CLS:OR=122.473,95%CI was 7.954-1 885.787,all P<0.05].The ROC curve analysis shows that the age,SOFA score and CLS had a certain predictive value for the prognosis of patients with acute dichlorvos poisoning[area under the curve(AUC)were 0.752,0.864,0.827,95%CI were 0.622-0.881,0.767-0.960,0.735-0.919,the Youden index were 0.453,0.681,0.655,sensitivity were 63.6%,86.4%,95.5%,specific features were 81.7%,81.6%,70.0%,all P<0.05].Conclusions Age,SOFA score,and CLS are independent risk factors affecting the prognosis of patients with acute dichlorvos poisoning.In particular,CLS is the most important risk factor affecting the prognosis of patients.When managing acute dichlorvos poisoning,it is crucial to closely monitor the occurrence of CLS and administer prompt,proactive treatment.

BACKGROUND:Sepsis is one of the main causes of mortality in intensive care units(ICUs).Early prediction is critical for reducing injury.As approximately 36%of sepsis occur within 24 h after emergency department(ED)admission in Medical Information Mart for Intensive Care(MIMIC-IV),a prediction system for the ED triage stage would be helpful.Previous methods such as the quick Sequential Organ Failure Assessment(qSOFA)are more suitable for screening than for prediction in the ED,and we aimed to find a light-weight,convenient prediction method through machine learning. METHODS:We accessed the MIMIC-IV for sepsis patient data in the EDs.Our dataset comprised demographic information,vital signs,and synthetic features.Extreme Gradient Boosting(XGBoost)was used to predict the risk of developing sepsis within 24 h after ED admission.Additionally,SHapley Additive exPlanations(SHAP)was employed to provide a comprehensive interpretation of the model's results.Ten percent of the patients were randomly selected as the testing set,while the remaining patients were used for training with 10-fold cross-validation. RESULTS:For 10-fold cross-validation on 14,957 samples,we reached an accuracy of 84.1%±0.3%and an area under the receiver operating characteristic(ROC)curve of 0.92±0.02.The model achieved similar performance on the testing set of 1,662 patients.SHAP values showed that the five most important features were acuity,arrival transportation,age,shock index,and respiratory rate. CONCLUSION:Machine learning models such as XGBoost may be used for sepsis prediction using only a small amount of data conveniently collected in the ED triage stage.This may help reduce workload in the ED and warn medical workers against the risk of sepsis in advance.

OBJECTIVE: To explore the genetic etiology of a child with D bifunctional protein deficiency (DBPD) born to a consanguineous pedigree. METHODS: A child with DBPD who was admitted to the First Affiliated Hospital of Hainan Medical College on January 6, 2022 due to hypotonia and global developmental delay was selected as the study subject. Clinical data of her pedigree members were collected. Peripheral blood samples of the child, her parents and elder sisters were collected and subjected to whole exome sequencing. Candidate variant was validated by Sanger sequencing and bioinformatic analysis. RESULTS: The child, a 2-year-and-9-month-old female, had featured hypotonia, growth retardation, unstable head lift, and sensorineural deafness. Serum long-chain fatty acids were elevated, and auditory brainstem evoked potentials had failed to elicit V waves in both ears with 90 dBnHL stimulation. Brain MRI revealed thinning of corpus callosum and white matter hypoplasia. The child's parents were secondary cousins. Their elder daughter had a normal phenotype and no clinical symptoms related to DBPD. Elder son had frequent convulsions, hypotonia and feeding difficulties after birth, and had died one and a half month later. Genetic testing revealed that the child had harbored homozygous c.483G>T (p.Gln161His) variants of the HSD17B4 gene, for which both of her parents and elder sisters were carriers. Based on the guidelines from the American College of Medical Genetics and Genomics, the c.483G>T (p.Gln161His) was rated as a pathogenic variant (PM1+PM2_Supporting+PP1+PP3+PP4). CONCLUSION The homozygous c.483G>T (p.Gln161His) variants of the HSD17B4 gene caused by the consanguineous marriage probably underlay the DBPD in this child.
Female ; Humans ; Pedigree ; Muscle Hypotonia ; Hearing Loss, Sensorineural ; Protein Deficiency ; Mutation

Objective:To analyse the changes in color Doppler and contrast-enhanced ultrasound (CEUS) blood flow parameters in patients with septic acute kidney injury (AKI) from the perspective of macroscopic circulation and microscopic circulation perfusion, in order to explore the value of clinical application of ultrasound in this disease.Methods:A total of 53 ICU-admitted patients diagnosed with septic AKI at the Second Affiliated Hospital of Soochow University from January 2021 to May 2022 were selected.Patients with septic AKI were classified into stages 1-3 according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) AKI diagnostic criteria, with stage 1 being the mild group(17 cases), stages 2 and 3 being the severe group(21 cases), and septic patients without AKI in the same period being the control group(15 cases). The ultrasound parameters such as the relative blood flow(RBF) and time-averaged velocity(TAV) of the renal artery as well as the cardiac output (CO) and cardiac index (CI) in the macroscopic circulation were measured, and the time-intensity curve was analysed by the CEUS analysis software to calculate the microscopic parameters such as time to peak(TTP), rise time(RT), fall half time(FHT) and mean transit time(MTT), and the cardiac output and cardiac index were also measured. The differences in ultrasound Doppler and CEUS parameters among the various groups were compared. The diagnostic effectiveness of each parameter for severe AKI was assessed using ROC curve analysis.Results:①In macrocirculation, the renal blood flow (RBF) and time-averaged velocity (TAV) gradually decreased ( P=0.004, P<0.001) as the disease progressed in AKI patients. But the difference of CO and CI among the three groups were not statistically significant in each group ( P=0.17, 0.12). ②In microcirculation, the renal interlobar artery Doppler parameters pulsatility index (PI), resistance index (RI), and systolic/diastolic flow ratio (S/D) gradually increase in patients with septic AKI ( P<0.05) and the CEUS parameters TTP, RT, FHT and MTT were prolonged ( P<0.001, P=0.003, P=0.004, P=0.009). ③The combined diagnosis of RI and TTP was more beneficial in diagnosing septic AKI in critically ill patients [AUC=0.93(0.85-1.00)]. Conclusions:Color Doppler ultrasound combined with CEUS can detect reduced macroscopic and microscopic circulation in patients with septic AKI, especially in those with severe AKI, and this is independent of changes in CO or CI.

Objective:To investigate the effects of Bcl3 gene knockout on the composition of spleen immune cells and antitumor ability of mice.Methods:Bcl3 gene knockout mice (Bcl3 -/-) were established by CRISPR/Cas9 genome editing technology. Blood routine test and flow cytometry were used to detect the immune cell composition in Bcl3 -/- mice. Lung metastasis models were established by injecting mice with B16F10 melanoma cells. The number of tumor nodules in lung and the survival time of mice were used to assess the antitumor ability of wild-type (WT) and Bcl3 -/- mice. Results:Bcl3 -/- mice were successfully bred to a strain with normal growth rate and normal breeding performance. Furthermore, no embryonic death occurred. Compared with WT mice, Bcl3 -/- mice showed splenomegaly and a significant increase in the number of spleen immune cells ( P<0.05). The counts and percentages of platelets and neutrophils in Bcl3 -/- mice were significantly lower than those in WT mice. The proportion of CD19 + B cells showed no significant change, while the proportions of CD3 + T cells and T cell subsets (CD4 + , CD8 + , Treg) increased significantly ( P<0.05). The proportions of NK cells (NK1.1 + ) and neutrophils (Gr1 + ) decreased ( P<0.05), while no significant change in the proportion of DC (CD11b + ) was observed. There were a large number of tumor nodules formed by melanoma cells in the lung of Bcl3 -/- tumor bearing mice, and their survival time was shortened dramatically. Conclusions:Knockout of Bcl3 gene affected the development, differentiation and function of immune cells, thereby reducing the antitumor ability of mice.

A 77-years-old female patient presented gross hematuria for one week, and CT showed a mass in the left kidney. Ureteroscopy detected a left renal mass. Laparoscopic nephroureterectomy was performed and pathology showed the tumor was mainly located in the renal parenchyma, with glomeruli around the tumor cells. Urothelium showed no obvious dysplasia or clear migration of tumor cells. Considering both the clinical symptoms, and squamous cell carcinoma not detecting in other locations of the patient, primary renal parenchyma was confirmed. Three months after surgery, CT detected recurrence in the operating area, with metastasis to the adjacent abdominal cavity and aorta lymph node.

The coronavirus disease 2019 (COVID-19) pandemic is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is spread primary via respiratory droplets and infects the lungs. Currently widely used cell lines and animals are unable to accurately mimic human physiological conditions because of the abnormal status of cell lines (transformed or cancer cells) and species differences between animals and humans. Organoids are stem cell-derived self-organized three-dimensional culture in vitro and model the physiological conditions of natural organs. Here we showed that SARS-CoV-2 infected and extensively replicated in human embryonic stem cells (hESCs)-derived lung organoids, including airway and alveolar organoids which covered the complete infection and spread route for SARS-CoV-2 within lungs. The infected cells were ciliated, club, and alveolar type 2 (AT2) cells, which were sequentially located from the proximal to the distal airway and terminal alveoli, respectively. Additionally, RNA-seq revealed early cell response to virus infection including an unexpected downregulation of the metabolic processes, especially lipid metabolism, in addition to the well-known upregulation of immune response. Further, Remdesivir and a human neutralizing antibody potently inhibited SARS-CoV-2 replication in lung organoids. Therefore, human lung organoids can serve as a pathophysiological model to investigate the underlying mechanism of SARS-CoV-2 infection and to discover and test therapeutic drugs for COVID-19.
Adenosine Monophosphate/therapeutic use* ; Alanine/therapeutic use* ; Alveolar Epithelial Cells/virology* ; Antibodies, Neutralizing/therapeutic use* ; COVID-19/virology* ; Down-Regulation ; Drug Discovery ; Human Embryonic Stem Cells/metabolism* ; Humans ; Immunity ; Lipid Metabolism ; Lung/virology* ; RNA, Viral/metabolism* ; SARS-CoV-2/physiology* ; Virus Replication/drug effects*

Objective To investigate the clinicopathological characteristics and prognosis of patients with Borrmann type Ⅳ gastric cancer. Methods A cohort retrospective analysis of 2386 patients with gastric cancer who underwent radical surgery was used to screen out Borrmann type Ⅳ patients, and analyze their clinical features and prognostic factors. Results Among 2386 patients with gastric cancer, 363 cases (15.21%) were Borrmann type Ⅳ. Compared with non-Borrmann type Ⅳ gastric cancer patients, Borrmann type Ⅳ patients had higher rates of simultaneous liver metastasis, metachronous liver metastasis, lymph node metastasis and vascular infiltration. Moreover, the age of onset tended to be younger and the pathological type tended to be poorly differentiated-undifferentiated (all P < 0.05). The 5-year OS of the entire group was 49.32% and the 5-year DFS was 44.61%. There were significant differences in 5-year OS and DFS between Borrmann type Ⅳ and non-Borrmann type Ⅳpatients (all P < 0.001). The subgroup analyses showed that there were statistically significant differences in 5-year OS and DFS of gastric cancer patients between Borrmann type Ⅳ and non-Borrmann type Ⅳ in pT2-pT4a and pN0-pN3a stages (all P < 0.005). Multivariate analysis showed that the poorly differentiated-undifferentiated tumor, the T4a-pT4b stage of tumor invasion depth, lymph node metastasis, the ⅢA-ⅢC pTNM stage of the tumor, postoperative liver metastasis and peritoneal metastasis were independent risk factors affecting the prognosis of Borrmann type Ⅳ gastric cancer patients (all P < 0.05). Conclusion Borrmann type Ⅳ gastric cancer is prone to liver metastasis, lymph node metastasis, peritoneal metastasis and poor prognosis, and it's prognosis is affected by a variety of independent risk factors.