OBJECTIVE: To investigate the feasibility and prognostic implications of assessing volume status during early fluid resuscitation in septic patients based on estimated plasma volume status (ePVS). METHODS: A prospective study was conducted. Patients with sepsis admitted to intensive care unit (ICU) of the First Affiliated Hospital of Kunming Medical University from March to December in 2023 were enrolled. The general information and laboratory indicators at ICU admission were recorded, and ePVS, sequential organ failure assessment (SOFA) score, acute physiology and chronic health status evaluation II (APACHE II) score were calculated. The vital signs, arterial blood gas analysis and volume status related indicators before liquid resuscitation (T0h) and 3 hours (T3h) and 6 hours (T6h) of fluid resuscitation were recorded. The diameter and variability of the inferior vena cava (IVC) were measured by ultrasound, and ePVS, percentage change value of estimated plasma volume status (ΔePVS%), difference in central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO₂), and lactate clearance rate (LCR) were calculated. Patients were divided into sepsis group and septic shock group based on the diagnosis at ICU admission, and septic patients were subdivided into survival group and death group based on their 28-day survival status. The differences in clinical data between the groups were compared. The correlation between ePVS or ΔePVS% and volume status related indicators during early liquid resuscitation was analyzed by Spearman rank sum correlation test. The predictive value of each variable for 28-day survival in patients with sepsis was analyzed by receiver operator characteristic curve (ROC curve), and 28-day death risk factors were analyzed by Logistic regression method. RESULTS: Fifty-four septic patients were enrolled in the final analysis, including 17 with sepsis and 37 with septic shock; 34 survived at 28 days and 20 died, with a 28-day survival rate of 63.0%. Compared with the sepsis group, the septic shock group had a lower venous ePVS at ICU admission [dL/g: 4.96 (3.67, 7.15) vs. 7.55 (4.36, 10.07), P < 0.05]. Compared with the death group, the survival group had higher T6h arterial and venous ΔePVS%, and albumin [Alb; T6h arterial ΔePVS% (%): 11.57% (-1.82%, 31.35%) vs. 0.48% (-5.67%, 6.02%), T6h venous ΔePVS%: 9.62% (3.59%, 25.75%) vs. 1.52% (-9.65%, 7.72%), Alb (g/L): 27.57±4.15 vs. 23.77±6.97, all P < 0.05], lower SOFA score, APACHE II score, AST, T0h Lac, and T3h and T6h norepinephrine dosage [SOFA score: 9.00 (8.00, 10.00) vs. 11.50 (9.25, 14.50), APACHE II score: 18.00 (14.75, 21.25) vs. 25.50 (21.00, 30.00), AST (U/L): 34.09 (23.20, 56.64) vs. 79.24 (25.34, 196.59), T0h Lac (mmol/L): 1.75 (1.40, 2.93) vs. 3.25 (2.33, 5.30), norepinephrine dosage (mg): 0.98 (< 0.01, 3.10) vs. 4.60 (1.05, 8.55) at T3h, 1.82 (0.38, 5.30) vs. 8.20 (2.80, 17.73) at T6h, all P < 0.05]. While there were no significantly differences in other basic data and ePVS at all of the time points before and after resuscitation between the two groups. Correlation analysis showed that T6h venous ePVS was significantly positively correlated with T6h IVC variability in septic patients (r = 0.360, P < 0.05), T0h arterial ePVS was significantly negatively correlated with T3h and T6h liquid intake volume (r₁ = -0.367, r₂ = -0.280, both P < 0.05), and venous ePVS at ICU admission was significantly positively correlated with NT-proBNP at ICU admission (r = 0.409, P < 0.05). T6h venous ΔePVS% was significantly positively correlated with T3h liquid intake volume and T6h LCR (r₁ = 0.286, r₂ = 0.286, both P < 0.05), and significantly negatively correlated with T6h urine volume and T6h change value of Pcv-aCO₂ (ΔPcv-aCO₂; r₁ = -0.321, r₂ = -0.371, both P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of T6h venous ΔePVS% for predicting 28-day survival in septic patients was 0.726 [95% confidence interval (95%CI) was 0.578-0.875, P = 0.006], with a sensitivity of 82.4%, a specificity of 60.0%, and an optimal cut-off value of 3.09%. Binary multifactorial Logistic regression analysis showed that an increase in T6h venous ΔePVS% was a protective factor for 28-day death in patients with sepsis on early fluid resuscitation [odds ratio (OR) = 0.900, 95%CI was 0.834-0.972, P = 0.007]. CONCLUSIONS ePVS may have potential for assessing the volume status of septic patients during early fluid resuscitation. The ΔePVS% during early fluid resuscitation may help to identify septic patients with a poor prognosis.
Humans ; Prognosis ; Fluid Therapy ; Sepsis/physiopathology* ; Prospective Studies ; Plasma Volume ; Intensive Care Units ; Resuscitation ; Male ; Female ; Middle Aged ; Shock, Septic/therapy*

The discipline of allied health sciences provides vital support to clinical diagnosis and treatment while promoting the translation of medical research into practice.As the integration of medicine and engineering deepens,talent cultivation in allied health faces new opportunities and challenges.Herein,we reviewed representative cases from domestic and international universities that have implemented interdisciplinary training in fields related to allied health,including exploration and practices concerning the development of cross-disciplinary platform,dual-degree programs,and collaborative education mechanisms involving the academia,industry,and research.We highlight the efforts of the School of Allied Health,West China School of Medicine,Sichuan University,which has continuously improved its disciplinary system and training programs through top-level planning and platform construction.The School of Allied Health Sciences has accelerated platform construction and established a new model for multidisciplinary collaborative education.At the practical level,the school has promoted curriculum reform through initiatives in ideological and political theories education,instructional system design,and the development of textbook systems.The school has created courses focused on the integration of medicine and engineering,interdisciplinary project-based modules,and specialized project-based curricula.These initiatives aim to strengthen the foundation for training high-level interdisciplinary professionals in allied health sciences under the evolving landscape of medicine-engineering integration.This articile also highlights other prospects,such as establishing a collaborative education model integrating medicine and engineering through industry-university-research collaboration,optimizing academic program structures,and enhancing professional certification systems,to inform policy-making and optimize practice.

Colorectal cancer (CRC) is one of the most common clinical malignancies, its morbidity and mortality are still on the rise. Colorectal tumorous polyp is the main precancerous lesion of CRC. The morbidity and mortality of colorectal neoplasms in men are higher than those in women, and exogenous estrogen supplementation can reduce the incidence of CRC in women, which suggests that estrogen may play a protective role in the occurrence and development of colorectal neoplasms. This article reviewed the research progress on the relationship between estrogen and colorectal neoplasms.

Objective To investigate the clinical and laboratory features of male patients with anti-phospholipid syndrome (APS).Methods Thirty-three male APS patients admitted to Peking University People's Hospital from January 2003 to April 2015 were enrolled.One hundred and fourteen female APS patients were selected as controls.Female patients with thrombosis were analyzed.x2 test, Fisher's exact test and t test were used for statistical analysis.Results Among male patients, 39.4％ were primary APS and 60.6％ were secondary APS.Compare with female patients,the prevalence of venous thrombosis was significantly higher than that in male APS (72.7％ vs 29.8％,x2=19.719, P=0.000).The male APS patients experienced more episodes of thrombosis (75.8％ vs 22.8％, x2=31.669, P=0.000) and not less than two locations of thrombosis than female (69.7％ vs 22.8％, x2=25.321, P=0.000), there was still significant difference between male patients and female patients with thrombosis.There was no difference of antiphopholipid antibodies between the two groups.Conclusion Male patients with antiphospholipid syndrome are more prone to have thrombosis.More clinical interventions should be implemented in male patients with APS.