Septic shock, a prevalent critical condition in intensive care units (ICU) and a major cause of patient mortality, is fundamentally attributed to microcirculatory dysfunction. Traditional macrocirculatory parameters are often insufficiently sensitive to reflect microcirculatory status. Consequently monitoring peripheral microcirculatory function holds crucial significance for assessing disease progression and evaluating therapeutic efficacy in septic shock. The peripheral perfusion index (PPI), obtained from a standard pulse oximeter, is based on photoplethysmography (PPG). It calculates the differential absorption of red and infrared light emitted by the sensor between pulsatile arterial blood and non-pulsatile tissue, enabling real-time reflection of peripheral perfusion and thus providing non-invasive, continuous monitoring of microcirculatory function. Although often overlooked compared to other ICU monitoring parameters, PPI has demonstrated notable clinical advances in septic shock management. Specifically, in early identification, PPI combined with sequential organ failure assessment (SOFA) predicts disease progression, with its dynamic changes further aiding prognosis assessment. During fluid resuscitation, it guides fluid responsiveness evaluation and serves as a therapeutic target to optimize strategies. In circulatory support, it assists in determining vasoactive drug initiation timing and dosage titration. Additionally, PPI aids mechanical ventilation weaning and organ dysfunction evaluation. This article reviews the principles, influencing factors, and clinical application advances of PPI in septic shock, aiming to provide clinicians with a basis for individualized intervention, improved patient outcomes, and the advancement of precision medicine in septic shock management.
Humans ; Shock, Septic/therapy* ; Microcirculation ; Perfusion Index ; Prognosis ; Photoplethysmography

Objective:To explore differences in the clinical and pathological features and postoperative survival after radical resection of biliary tract cancer in different locations such as intrahepatic cholangiocarcinoma,perihilar cholangiocarcinoma,distal cholangiocarcinoma,and gallbladder cancer.Methods:This is a retrospective case series study. The clinical and pathological data of 4 852 patients with biliary tract cancer admitted to the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi ′an Jiaotong University from January 2013 to December 2022 were retrospectively analyzed. Among them, 2 110(43.49%%) patients were male and 2 742(56.51%) patients were female,aged from 26 to 88 years with age of (61.3±10.8) years. Observation indicators: (1) The distribution,diagnosis and treatment of patients with biliary tract cancer; (2) Comparison of clinical and pathological features of patients with biliary tract cancer after curative-intent resection; (3) Survival analysis of patients with biliary tract cancer after curative-intent resection; (4) Analysis of effect on adjuvant therapy for patients with biliary tract cancer after curative-intent resection. One-way analysis of variance,Kruskal-Wallis H test and χ 2 test were used for among-group comparisons,respectively. Survival univariate analysis was performed using the Kaplan-Meier method and Log-rank test. Results:Among the 4 852 patients with biliary tract cancer,there were 2 303 cases (47.46%) of gallbladder cancer,952 cases (19.62%) of intrahepatic cholangiocarcinoma,892 cases (18.38%) of perihilar cholangiocarcinoma,and 705 cases(14.53%) of distal cholangiocarcinoma. From the perspective of the year of diagnosis and treatment,the overall number of patients diagnosed and treated for biliary tract cancer has shown an upward trend. From the perspective of diagnosis and treatment,the curative-intent resection rate was 33.37%(1 619/4 852),and the curative-intent resection rate of distal cholangiocarcinoma was higher than that of other biliary tract cancer ( χ2=23.897, P<0.01). Univariate analysis showed that there were statistical differences in gender,age,bile duct stones,total bilirubin at admission,carcinoembryonic antigen,CA19-9,CA125,the degree of pathological differentiation,vascular invasion,microvascular invasion,perineural invasion,surgical margins,pT staging,and pN staging among patients for biliary tract cancer in different locations (all P<0.05). Survival comparison analysis showed that recurrence-free survival and overall survival of patients with gallbladder cancer after curative-intent resection were significantly better than those of intrahepatic cholangiocarcinoma,perihilar cholangiocarcinoma,and distal cholangiocarcinoma ( χ 2=87.780,83.717,both P<0.01). Comparing the postoperative prognosis of patients with biliary tract cancer between the two periods of 2013 to 2017 and 2018 to 2022, the results showed that recurrence-free survival and overall survival of patients with biliary tract cancer from 2018 to 2022 were significantly better than those from 2013 to 2017 ( χ 2=31.202,25.615, both P<0.01),and the proportion of early recurrence and short-term death after curative-intent resection was significantly reduced ( χ 2=21.588,9.623, both P<0.01),with gallbladder cancer being the most significant ( P<0.01). Postoperative adjuvant therapy for patients with biliary tract cancer can effectively prolong recurrence-free survival and overall survival ( χ 2=5.033,11.273,both P<0.05). Conclusions:Gallbladder cancer remains the most common biliary tract cancer with a relatively favorable prognosis after radical resection. There are significant differences in the clinical and pathological features of biliary tract cancer in different locations,and patients with adjuvant therapy effectively improving prognosis.

Objective:To explore differences in the clinical and pathological features and postoperative survival after radical resection of biliary tract cancer in different locations such as intrahepatic cholangiocarcinoma,perihilar cholangiocarcinoma,distal cholangiocarcinoma,and gallbladder cancer.Methods:This is a retrospective case series study. The clinical and pathological data of 4 852 patients with biliary tract cancer admitted to the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi ′an Jiaotong University from January 2013 to December 2022 were retrospectively analyzed. Among them, 2 110(43.49%%) patients were male and 2 742(56.51%) patients were female,aged from 26 to 88 years with age of (61.3±10.8) years. Observation indicators: (1) The distribution,diagnosis and treatment of patients with biliary tract cancer; (2) Comparison of clinical and pathological features of patients with biliary tract cancer after curative-intent resection; (3) Survival analysis of patients with biliary tract cancer after curative-intent resection; (4) Analysis of effect on adjuvant therapy for patients with biliary tract cancer after curative-intent resection. One-way analysis of variance,Kruskal-Wallis H test and χ 2 test were used for among-group comparisons,respectively. Survival univariate analysis was performed using the Kaplan-Meier method and Log-rank test. Results:Among the 4 852 patients with biliary tract cancer,there were 2 303 cases (47.46%) of gallbladder cancer,952 cases (19.62%) of intrahepatic cholangiocarcinoma,892 cases (18.38%) of perihilar cholangiocarcinoma,and 705 cases(14.53%) of distal cholangiocarcinoma. From the perspective of the year of diagnosis and treatment,the overall number of patients diagnosed and treated for biliary tract cancer has shown an upward trend. From the perspective of diagnosis and treatment,the curative-intent resection rate was 33.37%(1 619/4 852),and the curative-intent resection rate of distal cholangiocarcinoma was higher than that of other biliary tract cancer ( χ2=23.897, P<0.01). Univariate analysis showed that there were statistical differences in gender,age,bile duct stones,total bilirubin at admission,carcinoembryonic antigen,CA19-9,CA125,the degree of pathological differentiation,vascular invasion,microvascular invasion,perineural invasion,surgical margins,pT staging,and pN staging among patients for biliary tract cancer in different locations (all P<0.05). Survival comparison analysis showed that recurrence-free survival and overall survival of patients with gallbladder cancer after curative-intent resection were significantly better than those of intrahepatic cholangiocarcinoma,perihilar cholangiocarcinoma,and distal cholangiocarcinoma ( χ 2=87.780,83.717,both P<0.01). Comparing the postoperative prognosis of patients with biliary tract cancer between the two periods of 2013 to 2017 and 2018 to 2022, the results showed that recurrence-free survival and overall survival of patients with biliary tract cancer from 2018 to 2022 were significantly better than those from 2013 to 2017 ( χ 2=31.202,25.615, both P<0.01),and the proportion of early recurrence and short-term death after curative-intent resection was significantly reduced ( χ 2=21.588,9.623, both P<0.01),with gallbladder cancer being the most significant ( P<0.01). Postoperative adjuvant therapy for patients with biliary tract cancer can effectively prolong recurrence-free survival and overall survival ( χ 2=5.033,11.273,both P<0.05). Conclusions:Gallbladder cancer remains the most common biliary tract cancer with a relatively favorable prognosis after radical resection. There are significant differences in the clinical and pathological features of biliary tract cancer in different locations,and patients with adjuvant therapy effectively improving prognosis.

Brain Injuries, Traumatic ; China ; Critical Care ; Cross-Sectional Studies ; Female ; Humans ; Intensive Care Units ; Male ; Renal Insufficiency

Objective:To investigate the correlation of 25-hydroxyvitamin D [25(OH)D], parathyroid hormone(PTH)and bone turnover markers with the glomerular filtration rate(GFR)in elderly male patients with type 2 diabetes mellitus.Methods:The study included a total of 426 non-dialyzed male T2DM patients with a disease course of more than 10 years, of whom 206 aged 60-86 years(the elderly group, 69.8±5.7 years old)and 220 aged 40-59 years(the middle-aged group, 50.1±5.3 years old). According to the estimated GFR(eGFR)calculated using the CKD-EPI formula, patients in each group were divided into four subgroups: Group 1(at CKD1 stage), Group 2(at CKD2 stage), Group 3(at CKD3 stage)and Group 4(at CKD4/5 stage). Levels of 25(OH)D, parathyroid hormone(PTH), procollagen type 1 N-terminal propeptide(P1NP), and C-terminal telopeptide of type Ⅰ collagen(β-CTX)in each group were measured.Results:The median level of 25(OH)D was 17.10(11.30-21.60) μg/L in 426 patients, of whom 292(68.5%)showed vitamin D deficiency.The level of 25(OH)D decreased significantly in the elderly group compared with the middle-aged group(15.10 μg/L vs. 17.15 μg/L, Z=-2.165, P=0.030), while the proportions of patients with vitamin D deficiency were similar in the two groups(68.4% vs. 68.6%, χ2=0.002, P=0.966). With decreasing eGFR, the proportion of patients with vitamin D deficiency gradually increased in the elderly.In the elderly cases, compared with the Group 1 and Group 2, the level of 25(OH)D in Group 3 dropped significantly (10.85 μg/L vs. 16.80 μg/L, Z=-2.808, P=0.005; 10.85 μg/L vs. 15.60 μg/L, Z=-2.099, P=0.044), and Group 4 showed an even more pronounced decrease than Group 3(6.65 μg/L vs. 10.85 μg/L, Z=-1.956, P=0.048). The level of 25(OH)D decreased significantly in the middle-aged patients at the CKD4/5 stage.The levels of PTH and β-CTX were negatively correlated with the 25(OH)D level( r=-0.348 and -0.263, P<0.001), and the level of negative correlation was affected by eGFR. Conclusions:In non-dialysis elderly male patients with T2DM, PTH and bone turnover marker β-CTX levels are negatively correlated with the 25(OH)D level, and the negative correlations are affected by eGFR.

Objective To investigate the predictive value of bedside echocardiographic assessment of the inferior vena cava variability ( ΔIVC ) in the weaning of patients with mechanical ventilation before spontaneous breathing test ( SBT ) . Methods Eighty-two mechanical ventilation patients admitted to the department of critical care medicine in our hospital from June to December 2017 and ready to wean from the mechanical ventilation were successively included . SBT was performed by T-tube mode after screening and the success of weaning is defined that the spontaneous breathing time exceeds 48 h after extubated . According to the outcomes of weaning ,the patients were divided into the weaning success group( 61 cases) and the weaning failure group(21 cases) ,the successful rate of weaning was 76 .1％ . The basic clinical characteristics of the patients ,including age ,sex ,acute physiology and chronic health score II ,heart rate , respiratory rate ,mean arterial pressure ,central venous pressure ( CVP) and the level of lactic acid were recorded ,and the inferior vena cava variability ( ΔIVC ) were measured before SBT with bedside echocardiography . The ΔIVC differences between the patients in the weaning success group and the weaning failure group were compared ,and the predicted value of ΔIVC for the weaning results was evaluated by ROC curve ,expressed as the area under the curve ( AUC) . Results The CVP of the weaning failure group was higherthanthatintheweaningsuccessgroup[(10.0±3.2)mmHgvs(7.2±2.8)mmHg(1mmHg =0 .133 kPa) , P =0 .01] . There was no significant difference in other basic clinical characteristics( all P >0 .05) . The ΔIVC of the weaning success group was significantly higher than that of the weaning failure group[(67.1±25.8)％ vs(33.8±23.2)％ ,P =0.001].TheAUCofthe ΔIVC predicted the weaning result before SBT was 0 .76 . The sensitivity of ΔIVC>50％ predicting successful weaning was 81 .8％ and the specificity was 79 .2％ . Conclusions Echocardiographic assessment of the inferior vena cava variability in patients with mechanical ventilation before SBT can predict the weaning outcome and guide fluid management clinically .

Objective To systematically evaluate the effect of different administration methods of hydrocortisone on blood glucose in patients with septic shock. Methods The Cochrane Library, PubMed, Web of Science, Embase, CNKI, CBM, Wanfang, and VIP databases were searched from foundation to December 31st, 2017 for the randomized controlled trials (RCTs) about hydrocortisone on blood glucose of different drug-deliver ways in patients with septic shock. In addition, the citation retrievals were performed by the literature references. Then the quality evaluation and data extraction was conducted by two researchers independently according to the Cochrane systematic review methods. RevMan 5.3 software was utilized to perform meta-analysis on the influences of the two different administration methods of the continuously pumping hydrocortisone group (experimental group) vs. the intermittently dripping hydrocortisone group (control group) on the mean blood glucose (MBG), largest amplitude of glycemic excursion (LAGE), glucose variability (GV), hyperglycemia time window in patients with septic shock. Results 1 203 relevant articles were preliminarily searched. Then the duplications were removed, reviews, and non-RCTs and articles evidently not accordant with the inclusion criteria were excluded by titles and abstracts. Eventually a total of 5 well-designed RCTs (404 cases) were incorporated, including 201 cases in the experimental group and 203 cases in the control group. The results of meta-analysis showed that compared with the control group, MBG was significantly decreased in the experimental group [mean difference (MD) = -0.99, 95% confidence interval (95%CI) = -1.53 to -0.45, P < 0.05], LAGE was decreased (MD = -5.66, 95%CI =-6.92 to -4.41, P < 0.05), GV was reduced (MD = -0.67, 95%CI = -0.82 to -0.53, P < 0.05), and hyperglycemia time window was shortened (MD = -7.68, 95%CI = -9.03 to -6.33, P < 0.05). The funnel chart revealed that there was publication bias in the MBG, hyperglycemia time window of the articles, and the publication bias was lower in the LAGE and GV. Conclusion Compared with intermittent administration method, the continuous pumping hydrocortisone method can stabilize the blood glucose of septic shock patients, shorten the duration of hyperglycemia and reduce the peak value of blood glucose.

Objective To explore the relationship between the disease uncertainty and information demand in preoperative patients with aortic dissection. Methods A total of 100 preoperative patients with aortic dissection were investigated from January 2012 to January 2014 with Mishel′s uncertainty in illness scale ( MUIS) , Hamilton anxiety scale ( HAMA) and self-designed information collection table, and the correlations were analysed. Results The total score of MUIS was (112. 32 ± 9. 66), and the number of patients in middle level was 90 (91. 8%). The score of ambiguity was (42. 32 ± 4. 54), and the number of patients in middle level was 85 (86. 7%). The score of complexity was (22. 43 ± 3. 63), and the number of patients in middle level was 68 (69. 4%). The score of lack of information was (19. 32 ± 2. 75), and the number of patients in middle level was 65 (66. 3%). The score of unpredictability was (15. 43 ± 2. 78), and the number of patients in middle level was 60 (61. 2%). The total score of HAMA was (13. 65 ± 11. 64), and the number of patients in middle level was 60 (61. 2%). The score of information requirements was (141. 34 ± 14. 56), and the number of patients in middle level was 65 (66. 3%). The score of disease and treatment was (62. 32 ± 4. 54), and the number of patients in middle level was 65 (66. 3%). The score of health was (32. 43 ± 3. 63), and the number of patients in middle level was 68 (69. 4%). The score of mental health was (17. 43 ± 2. 78), and the number of patients in middle level was 60 (61. 2%). The score of family health was (9. 64 ± 2. 65), and the number of patients in middle level was 65 (66. 3%). The score of social health was (7. 34 ± 2. 56), and the number of patients in middle level was 60 (61. 2%). The different dimensions of disease uncertainty were positively correlated to anxiety, treatment of disease, physical health, mental health, family health, social health and information demand (P<0. 05). Conclusions Preoperative patients with aortic dissection have the medium level of disease uncertainty and are affected by anxiety. They have a high level of demand for the disease and treatment information, and health information. The information demands significantly affect the patient′s disease uncertainty.

Objective To investigate the curative effect and safety of percutaneous intradiscal injection of ozone combined with epidural injection of collagenase for the treatment of prominent lumbar disc protrusion.Methods A total of 541 patients with lumbar disc protrusion were included in this study.All the patients fulfilled the following criteria:the fibrous ring was broken,the protruded extent of nucleus pulposus was less than 10 mm and the dura sac and/or nerve root was compressed.The intradiscal injection of ozone combined with epidural injection of collagenase was performed in all patients.The patients were followed up through further consultation,letters,telephone or other ways.Five hundred and forty-one cases were followed up for 2-3 months(short-term),312 cases for 4-12 months(medium-term)and 115 cases for 13-18 months(ling-term).The short-term,medium-term and long-term curative effects were evaluated with unified curative criteria,and the results were compared with that obtained with the treatment of epidural injection of collagenase only. Results The short-term, medium-term and long-term effective rate of selected cases was 95.9%(519/541),90.4%(489/541)and 87.2%(472/541),respectively.When combined application of two methods was performed,different degree of shrinkage of the protruded nucleus pulposus was obviously observed,with a mean shrinkage degree of 30.5%.The short-term,medium-term and long-term effective rate of simple collagenase chemonucleolysis was 89.5%,82.4%and 80.4%,respectively.Conclusion Intradiscal injection of ozone combined with epidural injection of collagenase is an effective treatment for lumbar disc protrusion when the fibrous ring is broken,the protruded extent of nucleus pulposus is less than 10 mm and the dura sac and/or nerve root is compressed. Its curative effect is superior to simple collagenase chemonucleolysis. Ozone is of clinical significance for producing the shrinkage of the nucleus pulposus.

To optimize program of bovine somatic nuclear transfer, we used two different enucleation procedures (by Spindle-view system & Hoechst 33342 staining), two different procedures to introduce donor nuclei (by ooplasm microinjection & electrofusion), and three different group electrofusion parameters (group 1: 1.9 kV/cm, 10 micros, two; group 2: 1.5 kV/cm, 25 micros, two; group 3: 0.6 kV/cm, 100 micros, one) to reconstruct bovine cloned embryos. The cleavation rates and blastocyst development rates of cloned embryos were used to assess the efficiency of different operational procedure. Finally, the best combination of operational procedure, that the spindle-viewer system was used for oocytes enucleating, and donor cell was electrofused into ooplasm by electrical pulse (1.9 kV/cm, 10 micros, two) to reconstruct bovine cloned embryos. Then the excellent blastocysts were transferred to fosters for producing cloned cattle 80 high-quality cloned blastocysts were transferred into 33 fosters, two cloned calves were produced. According to the results, the optimized program could be used to produce cloned cattle.
Animals ; Cattle ; Cell Nucleus ; physiology ; Cloning, Organism ; veterinary ; Embryo Transfer ; methods ; Embryo, Mammalian ; cytology ; physiology ; Female ; Microinjections ; Nuclear Transfer Techniques ; veterinary ; Oocytes ; cytology ; physiology