Objective To systematically evaluate the risk prediction models for postoperative pulmonary infection in patients with esophageal cancer, providing an objective basis for clinical selection and optimization of models. Methods A systematic search was conducted in Chinese and English databases such as VIP, Wanfang, CNKI, CBM, PubMed, Cochrane Library, Embase, and Web of Science for studies related to the risk prediction models of postoperative pulmonary infection in patients with esophageal cancer from the inception to September 30, 2024. The PROBAST tool was used to assess the quality of prognostic model research, and the RevMan 5.4 software was used for meta-analysis of predictive factors. Results A total of 17 articles were included, containing 26 pulmonary infection risk prediction models. The area under the receiver operating characteristic curve (AUC) ranged from 0.627 to 0.942, among which 21 models had good predictive performance (AUC>0.7). Quality assessment through the PROBAST tool revealed that all 17 articles had a high risk of bias. Meta-analysis results showed that common predictive factors for postoperative pulmonary infection in esophageal cancer included smoking history (OR=1.97), smoking index ≥200 (cigarettes-years) (OR=4.38), smoking index ≥400 (cigarettes-years) (OR=2.00), age (OR=1.27), comorbid diabetes (OR=2.13), comorbid emphysema or chronic obstructive pulmonary disease (OR=1.55), low plasma albumin levels (OR=1.17), prognostic nutritional index (OR=4.45), history of related lung diseases (OR=2.10), tumor location (OR=2.32), surgical approach (OR=2.21), operation time (OR=1.73), preoperative serum procalcitonin levels (OR=3.06), anastomotic leakage (OR=3.39), reduced forced expiratory volume in the first second/forced vital capacity ratio (OR=0.86), and hoarseness (OR=2.23). Conclusion At present, the risk prediction models for postoperative pulmonary infection in esophageal cancer are still in the stage of continuous development and optimization, and their research quality needs to be further improved. Future research can refer to the predictive factors summarized in this study based on meta-analysis, combined with clinical practice, to select appropriate methods to construct and validate the risk prediction models for postoperative pulmonary infection in esophageal cancer, thus providing early targeted preventive strategies for high-risk patients.

Objective:To investigate the effect of extracorporeal membrane oxygenation (ECMO) in assisting neonates with complex congenital heart diseases (CHD) and the survival rate of the patients.Methods:A retrospective case-control study was made on 22 newborns with complex CHD assisted by ECMO during the perioperative period in Fuwai Central China Cardiovascular Hospital from January 2018 to June 2024.There were 19 males and 3 females in the newborns included, with an average age of (10.4±8.7) days (range: 1-26 days) and an average weight of (3.1±0.3) kg.Complex CHD included total anomalous pulmonary venous connection in 9 cases (40.9%), interrupted aortic arch and coarctation in 8 cases (36.4%), transposition of great arteries in 3 cases (13.6%), double outlet right ventricle in 1 case (4.5%) and cardiac tumor in 1 case (4.5%).The patients were divided into the <5 d group, 5-12 d group, and >12 d group according to the duration of ECMO support.Data were compared using the t-test or χ2 test. Results:There were 8 cases (36.4%) successfully weaned from ECMO support and 6 cases (27.3%) survived.ECMO support was used routinely in 15 cases (68.2%), and for extracorporeal cardiopulmonary resuscitation in 7 cases (31.8%).The duration of ECMO support was (5.9±3.7) days.There were no statistically differences in age, weight, gender, disease composition, operation time, cardiopulmonary bypass time, cross-clamp time, assistant time, blood routine, liver and kidney function and other biochemical indicators, preoperative cardiac ejection fraction value, procalcitonin, C-reactive protein and other infection indicators between the death group and the survival group (all P>0.05).The highest lactate values 24 hours before [(8.1±5.4) mmol/L] and after ECMO support [(10.5±7.1) mmol/L] in the survival group were significantly lower than those in the death group [(18.7±9.2) mmol/L, (21.3±8.6) mmol/L] ( t=2.606, P=0.018; t=2.729, P=0.013).It was found that the survival rate was 0/9 (0) in the <5 d group, 6/12 (50.0%) in the 5-12 d group, and 0/1 (0) in the >12 d group.The survival rate of the 5-12 d group was the highest, which was significantly higher than that of the <5 d group ( χ2=6.300, P=0.012). Conclusions:ECMO support is an effective treatment for severe circulatory failure in neonates with complex CHD in the perioperative period.The highest lactate levels 24 hours before and after ECMO support affect the survival rate.Patients receiving 5-12 d ECMO support can achieve the highest survival rate.

Objective To explore the scheme for the deployment and withdrawal of the surgical module of the new-type tent hospital system.Methods A set of standardized scheme for deploying and withdrawing the surgical module of the new-type tent hosital system was proposed and implemented in terms of labor division,operation precedure,operation technique and precaution.The operating time,number of operational errors and number of equipment damages were recorded for each of the five deployment and withdrawal operations before and after the program was executed,and the team members'immediate heart rate,percentage of maximum heart rate(MHR)and rating of perceived exercise(RPE)at the end of the operation were recorded after the program was implemented.SPSS 26.0 software was used for statistical analysis.Results The standardized scheme had the deployment time shortened from(85.15±11.430)min to(58.23±8.513)min,withdrawal time decreased from(65.36±9.369)min to(48.92±7.129)min,with the differences being statistically significant(P＜0.05);the numbers of operatio-nal errors and equipment damages were both reduced when compared with those before the implementation of the schemce;the immediate heart rate of the team members at the end of the operation ranged from 43 to 157 beats/min,with an average value of 151.1 beats/min,the individual MHR percentages were from 75％to 87％,with an average value of 81.1％,and the RPE scores were from 14 to 17,with an average value of 15.3,which all could be categorized as moderate-operation intensity.Condusion The standardized deployment and withdrawal scheme for the surgical module meets the needs of actual combat and training assessment,and thus is worthy promoting in medical institutions equipped with the surgical module of the new-type tent hosital system.[Chinese Medical Equipment Journal,2025,46(2):74-79]

Objective To explore the early clinical manifestations,random cortisol levels,and management of late-onset circulatory collapse(LCC)in preterm infants.Methods Preterm infants with LCC from October to December 2023 at the Affiliated Suzhou Hospital of Nanjing Medical University were included.Maternal perinatal factors and infants'early clinical symptoms,signs,random serum cortisol levels,treatment,and outcomes were retrospectively analyzed.Results Seven preterm infants with LCC were included,with gestational ages of 25 weeks+2 days to 29 weeks and birth weights of 800-1 150 g.At 3 weeks of age,abnormal weight gain[gain rate:21-28.5 g/(kg·d)],generalized edema,low serum sodium(129.5-135.2 mmol/L),and decreased random serum cortisol concentrations(13.6-44.6 nmol/L)were observed.After 1-2 weeks of hydrocortisone treatment,edema subsided and serum sodium increased.Conclusions In clinically stable preterm infants,early manifestations of LCC include abnormal weight gain,generalized edema,recurrent hyponatremia,and decreased random serum cortisol concentrations.Hydrocortisone treatment effectively improves symptoms.

Objective:To analyze the reasons for the low results obtained by the determination of isosorbide dini-trate tablets content using the methods in the Chinese Pharmacopoeia and to improve the content determination method.Methods:The content of isosorbide dinitrate in 10 tablets was determined by high-performance liquid chromatography(HPLC)using a Phenomenex Luna C18 column(4.6 mm ×250 mm,5 μm)for separation,with a mobile phase of methanol-water(54∶46),a flow rate of 1.0 mL·min-1,and a UV detector set at a wavelength of 230 nm.The average content of 10 tablets was taken as the result of the content determination.Results:Isosor-bide dinitrate showed good linearity in the range of 49.22 to 1 230.5 μg·mL-1(r=0.999 96);the relative stand-ard deviation was 0.11％,the recovery rate was 96.0％,and the RSD was 1.5％(n=9).Conclusion:This method simplifies the experimental operations and steps,can eliminate the interference factors introduced by the original method,and improves the accuracy of the detection results.

Objective:To investigate whether intermittent fasting alleviates insulin resistance in a polycystic ovary syndrome(PCOS) mouse model through the regulation of autophagy.Methods:Fifty 3-week-old female C57BL/6J mice were randomly assigned into the following groups using a random number table: normal control(NC) group( n=10), maintained on a standard chow diet; high-fat diet(HFD) group( n=10) fed a diet with 60% of calories derived from fat; and PCOS model group( n=30), established by combining a HFD with dehydroepiandrosterone(DHEA) administration. Successful modeling was confirmed by disrupted estrous cycles, hyperandrogenism, and polycystic ovarian morphology. The PCOS model mice were further divided into three groups: PCOS group( n=9), PCOS with intermittent fasting group(PCOS+ IF, n=9), and PCOS with intermittent fasting plus the autophagy inhibitor 3-methyladenine(3-MA) group(PCOS+ IF+ 3-MA, n=9). Autophagy levels were assessed by detecting markers LC3 and p62 and observing autophagosomes via transmission electron microscopy. Glucose tolerance test(GTT) and insulin tolerance test(ITT) were performed, and the area under the curve(AUC) was calculated to evaluate insulin resistance. Western blotting was used to detect phosphorylation levels of phosphatidylinositol 3-kinase(PI3K), protein kinase B(Akt), mammalian target of rapamycin(mTOR), and p70S6 kiase(p70S6K). Results:Compared with the NC group, the PCOS model group showed absent estrous cycles, significantly elevated serum testosterone, sex hormone binding globulin, and luteinizing hormone(LH) levels( P<0.001), and polycystic ovarian changes on hematoxylin-eosin staining, confirming successful model establishment. Immunohistochemistry, transmission electron microscopy, and Western blotting demonstrated that autophagy levels were increased in the PCOS+ IF group compared with the PCOS group, while 3-MA administration reduced the intermittent fasting - induced autophagy. The AUC values for both GTT and ITT were significantly lower in the PCOS+ IF group than those in the PCOS group( P<0.001, P=0.003), but increased in the PCOS+ IF+ 3-MA group compared to the PCOS+ IF group( P<0.001, P=0.020). Western blotting analysis showed that phosphorylation levels of PI3K, Akt, mTOR, and p70S6K were significantly decreased in the PCOS+ IF group compared with the PCOS group( P=0.002, P=0.001, P=0.001, and P<0.001, respectively), and increased in the PCOS+ IF+ 3-MA group compared with the PCOS+ IF group( P=0.021, P=0.041, P=0.047, and P=0.024, respectively). Conclusions:Intermittent fasting alleviates insulin resistance in a PCOS mouse model through inhibitiing PI3K/Akt/mTOR signaling pathway and promoting autophagy.

Objective To explore the predictive value of coronary artery calcium score(CACS)combined with C-X-C motif chemokine ligand 12(CXCL12)and soluble CD40 ligand(sCD40L)for major adverse cardiovascular events(MACE)within 5 years in patients with stable coronary artery disease(SCAD).Methods A total of 206 elderly SCAD patients admitted in our depart-ment from March 2015 to November 2018 were recruited,and according to whether MACE occurred within 5 years of follow-up,they were divided into MACE group(42 cases)and control group(164 cases).Multivariate logistic regression analysis was performed to identify the inde-pendent predictors of MACE.ROC curve analysis was applied to evaluate the predictive value of the combined model,and its area under curve(AUC)value was calculated.Results Compared with the control group,the MACE group had significantly older age,larger proportions of hyper-tension and diabetes mellitus,higher CACS,and elevated CXCL12 and sCD40L levels(P＜0.05,P＜0.01).Multivariate logistic regression analysis revealed that age,hypertension,diabetes melli-tus,CACS,CXCL12 and sCD40L were independent risk factors for MACE in the elderly SCAD patients within 5 years(P＜0.05,P＜0.01).ROC curve analysis indicated that the AUC value of CACS,CXCL12,sCD40L,and these three indicators combined together in predicting MACE in elderly SCAD patients within 5 years was 0.872(95％CI:0.819-0.915),0.768(95％CI:0.704-0.824),0.726(95％CI:0.660-0.786),and 0.935(95％CI:0.893-0.965),respectively,with the value of the combination obviously higher than that of each indicator alone(P＜0.01).Conclusion Increased CACS,CXCL12 and sCD40L have predictive value for MACE in elderly SCAD patients,and the combination of the three indicators has obvious advantages in the prediction.

Objective To investigate the role of cathepsin K(CTK)and secreted frizzled-related protein 2(sFRP2)in ventricular remodeling in very old patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI),and analyze the correlation.Methods A total of 192 very old AMI patients undergoing PCI in our department from January 2020 to December 2023 were recruited,and based on clinical outcomes at 6 months after surgery,they were assigned into a ventricular remodeling group(74 cases)and a non-ventricular remodeling group(118 cases).The clinical data and postoperative biochemical indicators were collected in the two groups.Multivariate logistic regression analysis was performed to assess the correlation between CTK and sFRP2 levels and ventricular remodeling.ROC curves were plotted to analyze the predictive value of CTK and sFRP2 in ventricular remodeling.Results The ventricular remodeling group had significantly longer length of hospital stay,larger left ventricular end-diastolic diameter,and higher levels of CTK,sFRP2,C-reactive protein(CRP)and IL-6,but lower left ventricular ejection fraction than the non-ventricular remodeling group(P＜0.05,P＜0.01).Multivariate logistic regression analysis suggested that CTK and sFRP2 were independent risk factors for postoperative ventricular remodeling in very old AMI patients(P＜0.01).ROC curve analysis manifested that the area under curve value of CTK,sFRP2,CRP and IL-6 combined together in predicting ventricular remodeling in very old AMI patients after PCI was 0.892,with a sensitivity of 79.73％and a specificity of 88.14％(P＜0.01).Conclusion CTK and sFRP2 are significantly increased in ventricular remodeling in very old AMI patients after PCI,and are closely related to the occurrence of ventricular remodeling.They can be used as potential biomark-ers in the prediction of ventricular remodeling and provide important reference for clinical diagno-sis and treatment.

Objective To explore the early clinical manifestations,random cortisol levels,and management of late-onset circulatory collapse(LCC)in preterm infants.Methods Preterm infants with LCC from October to December 2023 at the Affiliated Suzhou Hospital of Nanjing Medical University were included.Maternal perinatal factors and infants'early clinical symptoms,signs,random serum cortisol levels,treatment,and outcomes were retrospectively analyzed.Results Seven preterm infants with LCC were included,with gestational ages of 25 weeks+2 days to 29 weeks and birth weights of 800-1 150 g.At 3 weeks of age,abnormal weight gain[gain rate:21-28.5 g/(kg·d)],generalized edema,low serum sodium(129.5-135.2 mmol/L),and decreased random serum cortisol concentrations(13.6-44.6 nmol/L)were observed.After 1-2 weeks of hydrocortisone treatment,edema subsided and serum sodium increased.Conclusions In clinically stable preterm infants,early manifestations of LCC include abnormal weight gain,generalized edema,recurrent hyponatremia,and decreased random serum cortisol concentrations.Hydrocortisone treatment effectively improves symptoms.

Objective:To analyze the reasons for the low results obtained by the determination of isosorbide dini-trate tablets content using the methods in the Chinese Pharmacopoeia and to improve the content determination method.Methods:The content of isosorbide dinitrate in 10 tablets was determined by high-performance liquid chromatography(HPLC)using a Phenomenex Luna C18 column(4.6 mm ×250 mm,5 μm)for separation,with a mobile phase of methanol-water(54∶46),a flow rate of 1.0 mL·min-1,and a UV detector set at a wavelength of 230 nm.The average content of 10 tablets was taken as the result of the content determination.Results:Isosor-bide dinitrate showed good linearity in the range of 49.22 to 1 230.5 μg·mL-1(r=0.999 96);the relative stand-ard deviation was 0.11％,the recovery rate was 96.0％,and the RSD was 1.5％(n=9).Conclusion:This method simplifies the experimental operations and steps,can eliminate the interference factors introduced by the original method,and improves the accuracy of the detection results.