Objective:To evaluate the effect of fiberoptic endoscopic evaluation of swallowing (FEES) on clinical functional outcomes of patients with intensive care unit-acquired swallowing disorders (ICU-ASD).Methods:This retrospective cohort study analyzed clinical data of patients diagnosed with post-extubation dysphagia (PED) in the intensive care unit (ICU) and respiratory intensive care unit (RICU) of the Affiliated Hospital of Inner Mongolia Medical University from February 2020 to February 2025. Patients were categorized into a FEES group of 60 cases [34 males, 26 females, aged 37-80 years (median age 62 years)] and a control group without FEES of 58 cases [32 males, 26 females, aged 39-77 years (median age 61 years)].The patients in two groups received swallowing function and feeding training based on the results of the FEES assessment and the Volume-Viscosity Swallow Test-Clinical Version (VVST-CV), respectively. Clinical functional outcome measures included pneumonia incidence, clinical pulmonary infection score (CPIS), pneumonia severity index (PSI), Functional Oral Intake Scale (FOIS), and dietary method at discharge. χ2 test, Mann-Whitney U test, and Wilcoxon signed-rank test, were employed for statistical analysis of the outcome measures. Results:Compared with the control group, the FEES group had significantly lower aspiration pneumonia incidence at discharge [3.3% (2/60) vs 15.5% (9/58), χ2=5.179, P=0.023]. Regarding dietary methods,a significantly higher proportion of patients in the FEES group achieved complete oral feeding compared with the control group [75.0% (45/60) vs 67.3% (39/58), χ2=8.065, P<0.05]. After training, the FEES group had higher median FOIS scores than the control group (7.00 vs 6.00, Z=-2.370, P=0.018), and lower CPIS scores (2.50 vs 5.00, Z=-2.216, P=0.027) and PSI scores (59.00 vs 73.00, Z=-2.251, P=0.024). Within-group comparisons revealed that FOIS scores significantly improved post-training in both groups (both P<0.001). Conclusion:Early FEES examination for ICU patients with acquired swallowing disorders is associated with a lower incidence of pneumonia, improved swallowing function, and superior clinical functional outcomes.

Objective:To explore the clinical value of multi-parameter combined monitoring in guiding low-molecular-weight heparin (LMWH) therapy for intensive care unit (ICU) patients.Methods:A retrospective case-control study was conducted. A total of 381 patients who received LMWH therapy with anti-Ⅹa activity monitoring in the ICU of West China Hospital, Sichuan University between January 31st, 2022, and November 30th, 2023, were enrolled in this study. The cohort comprised 264 males and 117 females, with the age of 58 (48, 71) years old. Clinical data and relevant laboratory parameters were collected, including anti-Ⅹa activity, antithrombin activity (AT), thrombin-antithrombin complex (TAT), plasmin-antiplasmin complex (PIC), conventional coagulation parameters such as activated partial thromboplastin time (APTT), and indicators of hepatic/renal impairment such as alanine aminotransferase (ALT) and creatinine( CREA). Patients were stratified into three groups based on thrombotic event: thrombosis-controlled, progressive thrombosis, and bleeding group. Single-factor and adjusted multifactorial Logistic regression analysis were used to identify independent predictors of anti-xa activity levels.Results:Among 381 patients, thrombosis was controlled in 213 (55.9%) patients, progressed in 81 (21.3%) patients , and bleeding events occurred in 87 (22.8%) patients. The patients whose anti-Ⅹa activity levels lay entirely within the target range(0.2-0.4 IU/ml): Only 35 (16.4%) cases in the thrombosis-controlled group, 16 (19.7%) cases in the progressive thrombosis group, and 16 (18.4%) in the bleeding group. No significant differences in anti-Ⅹ a levels activity among the three groups ( H=1.678, P=0.432). Both single-factor and adjusted multifactorial Logistic regression identified low AT activity as an independent risk factor for failure to achieve target anti-Ⅹ a activity levels (AT nadir, OR=1.031,95% CI 1.016-1.046, P<0.05). Compared with the progressive thrombosis and bleedinggroup, the thrombosis-controlled group exhibited significantly higher proportion of TAT values below the cut-off value ( H=8.519, P=0.014), and a higher proportion of TAT/PIC ratios below the cut-off ( H=15.56, P<0.001). Patients with bleeding demonstrated significantly lower AT activity ( H=14.968, P=0.001), prolonged APTT ( H=6.815, P=0.033), higher ALT ( H=13.774, P=0.001), and higher CREA ( H=14.068, P=0.001) compared with the thrombosis-controlled or progressive thrombosis group. Conclusion:Laboratory monitoring is required for low-molecular-weight heparin (LMWH) therapy in ICU patients. While anti-Ⅹa activity reflects the anticoagulant effect of LMWH, the utility of anti-Ⅹ a activity for predicting thrombotic or hemorrhagic risks in LMWH treated ICU patients is limited. Reductions in TAT levels and TAT/PIC ratios are associated with a lower risk of thrombotic progression. Furthermore, abnormalities in conventional coagulation tests and standard hepatic/renal function parameters occur more frequently in patients experiencing hemorrhagic events.

Objective:To explore the clinical value of multi-parameter combined monitoring in guiding low-molecular-weight heparin (LMWH) therapy for intensive care unit (ICU) patients.Methods:A retrospective case-control study was conducted. A total of 381 patients who received LMWH therapy with anti-Ⅹa activity monitoring in the ICU of West China Hospital, Sichuan University between January 31st, 2022, and November 30th, 2023, were enrolled in this study. The cohort comprised 264 males and 117 females, with the age of 58 (48, 71) years old. Clinical data and relevant laboratory parameters were collected, including anti-Ⅹa activity, antithrombin activity (AT), thrombin-antithrombin complex (TAT), plasmin-antiplasmin complex (PIC), conventional coagulation parameters such as activated partial thromboplastin time (APTT), and indicators of hepatic/renal impairment such as alanine aminotransferase (ALT) and creatinine( CREA). Patients were stratified into three groups based on thrombotic event: thrombosis-controlled, progressive thrombosis, and bleeding group. Single-factor and adjusted multifactorial Logistic regression analysis were used to identify independent predictors of anti-xa activity levels.Results:Among 381 patients, thrombosis was controlled in 213 (55.9%) patients, progressed in 81 (21.3%) patients , and bleeding events occurred in 87 (22.8%) patients. The patients whose anti-Ⅹa activity levels lay entirely within the target range(0.2-0.4 IU/ml): Only 35 (16.4%) cases in the thrombosis-controlled group, 16 (19.7%) cases in the progressive thrombosis group, and 16 (18.4%) in the bleeding group. No significant differences in anti-Ⅹ a levels activity among the three groups ( H=1.678, P=0.432). Both single-factor and adjusted multifactorial Logistic regression identified low AT activity as an independent risk factor for failure to achieve target anti-Ⅹ a activity levels (AT nadir, OR=1.031,95% CI 1.016-1.046, P<0.05). Compared with the progressive thrombosis and bleedinggroup, the thrombosis-controlled group exhibited significantly higher proportion of TAT values below the cut-off value ( H=8.519, P=0.014), and a higher proportion of TAT/PIC ratios below the cut-off ( H=15.56, P<0.001). Patients with bleeding demonstrated significantly lower AT activity ( H=14.968, P=0.001), prolonged APTT ( H=6.815, P=0.033), higher ALT ( H=13.774, P=0.001), and higher CREA ( H=14.068, P=0.001) compared with the thrombosis-controlled or progressive thrombosis group. Conclusion:Laboratory monitoring is required for low-molecular-weight heparin (LMWH) therapy in ICU patients. While anti-Ⅹa activity reflects the anticoagulant effect of LMWH, the utility of anti-Ⅹ a activity for predicting thrombotic or hemorrhagic risks in LMWH treated ICU patients is limited. Reductions in TAT levels and TAT/PIC ratios are associated with a lower risk of thrombotic progression. Furthermore, abnormalities in conventional coagulation tests and standard hepatic/renal function parameters occur more frequently in patients experiencing hemorrhagic events.

Objective:To evaluate the effect of fiberoptic endoscopic evaluation of swallowing (FEES) on clinical functional outcomes of patients with intensive care unit-acquired swallowing disorders (ICU-ASD).Methods:This retrospective cohort study analyzed clinical data of patients diagnosed with post-extubation dysphagia (PED) in the intensive care unit (ICU) and respiratory intensive care unit (RICU) of the Affiliated Hospital of Inner Mongolia Medical University from February 2020 to February 2025. Patients were categorized into a FEES group of 60 cases [34 males, 26 females, aged 37-80 years (median age 62 years)] and a control group without FEES of 58 cases [32 males, 26 females, aged 39-77 years (median age 61 years)].The patients in two groups received swallowing function and feeding training based on the results of the FEES assessment and the Volume-Viscosity Swallow Test-Clinical Version (VVST-CV), respectively. Clinical functional outcome measures included pneumonia incidence, clinical pulmonary infection score (CPIS), pneumonia severity index (PSI), Functional Oral Intake Scale (FOIS), and dietary method at discharge. χ2 test, Mann-Whitney U test, and Wilcoxon signed-rank test, were employed for statistical analysis of the outcome measures. Results:Compared with the control group, the FEES group had significantly lower aspiration pneumonia incidence at discharge [3.3% (2/60) vs 15.5% (9/58), χ2=5.179, P=0.023]. Regarding dietary methods,a significantly higher proportion of patients in the FEES group achieved complete oral feeding compared with the control group [75.0% (45/60) vs 67.3% (39/58), χ2=8.065, P<0.05]. After training, the FEES group had higher median FOIS scores than the control group (7.00 vs 6.00, Z=-2.370, P=0.018), and lower CPIS scores (2.50 vs 5.00, Z=-2.216, P=0.027) and PSI scores (59.00 vs 73.00, Z=-2.251, P=0.024). Within-group comparisons revealed that FOIS scores significantly improved post-training in both groups (both P<0.001). Conclusion:Early FEES examination for ICU patients with acquired swallowing disorders is associated with a lower incidence of pneumonia, improved swallowing function, and superior clinical functional outcomes.

To evaluate the advantages of using PBL case library in teaching circulatory system diseases to clinical medicine undergraduate students, a PBL case library was established and applied in teaching practice in the reform of circulatory system teaching. The PBL case library achieved the characteristics of combining theories with cases, morphology with functions, and basic knowledge with clinical knowledge. The PBL case library also realized the informatization, query, and update of cases. Preliminary application showed that the median practical score of students in the case library group was 94.00 points, which was significantly higher than the 92.00 points in the control group ( P=0.005). The average lesson preparation time for teachers in the case library group was (5.00±1.00) hours, which was significantly shorter than the (6.89±0.42) hours in the control group ( P<0.001). The difficulty score for lesson preparation among teachers in the case library group was significantly lower than that of the control group [(1.89±1.05) vs. (3.22±0.44), P<0.001]. However, there were no significant difference in theoretical scores and student satisfaction with teachers and courses. These results suggest that the construction of case library can improve practical teaching effectiveness and enhance the efficiency of lesson preparation for teachers.

BACKGROUND: The burden of esophageal cancer varies across different regions of the world. The aim of this study is to analyze the current burden of esophageal cancer in 185 countries in 2022 and to project the trends up to the year 2050. METHODS: We extracted data on primary esophageal cancer cases and deaths from the GLOBOCAN 2022 database, which includes data from 185 countries. Age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 person-years were calculated by stratifying by Human Development Index (HDI) levels and regions. Considering changes in population size and age structure, we assumed that the risks of incidence and mortality remain constant at the levels of 2022 to forecast the number of new cases and deaths from esophageal cancer globally by 2050. RESULTS: In 2022, an estimated 511,054 people were diagnosed with esophageal cancer globally, and 445,391 died from the disease. The global ASIR and ASMR for esophageal cancer were 5.00 and 4.30 per 100,000, respectively. The highest rates were observed in East Africa (7.60 for incidence, 7.20 for mortality per 100,000), East Asia (7.60 for incidence, 5.90 for mortality per 100,000), Southern Africa (6.30 for incidence, 5.90 for mortality per 100,000), and South Central Asia (5.80 for incidence, 5.50 for mortality per 100,000). Among the 185 countries worldwide, esophageal cancer was among the top five causes of cancer incidence in 18 countries and among the top five causes of cancer mortality in 25 countries. In 2022, China had 224,012 new cases and 187,467 deaths from esophageal cancer, accounting for approximately 43.8% and 42.1% of the global total, respectively, which is higher than the proportion of China's population to the global population (17.9%). ASIR was 8.30 per 100,000, and ASMR was 6.70 per 100,000. The highest burden of esophageal cancer was in high HDI countries, with new cases and deaths accounting for 51.3% and 50.0% of the global total, respectively. The ASIR and ASMR were highest in the high HDI group (6.10 and 5.10 per 100,000, respectively), also exceeding the global averages. There was a trend of decreasing mortality to incidence ratio with increasing HDI, but no correlation was observed between HDI and ASIR or ASMR. In all regions worldwide, the incidence and mortality rates were higher in males than in females (with a male-to-female ASR ratio ranging from 1.10 to 28.7). Compared to 2022, it is projected that by 2050, the number of new esophageal cancer cases will increase by approximately 80.5%, and deaths will increase by 85.4% due to population growth and aging. CONCLUSIONS The burden of esophageal cancer remains heavy. Adopting a healthy lifestyle, including reducing tobacco and alcohol intake, avoiding moldy foods, and increasing intake of fresh fruits and vegetables, can help reduce the risk of stomach and esophageal cancer. In addition, the development and implementation of evidence-based and effective public health policies are critical to reducing the global disease burden of esophageal cancer.
Esophageal Neoplasms/mortality* ; Humans ; Male ; Incidence ; Female ; Middle Aged ; Global Health ; Aged ; Adult

Objective:To analyze the risk factors of unfavourable treatment outcomes in patients with rifampicin-sensitive pulmonary tuberculosis（PTB）.Methods:Clinical data of 726 patients with rifampicin-sensitive PTB admitted in Quzhou Hospital Affiliated to Wenzhou Medical University from January 2020 to December 2021 were retrospectively analyzed，including 628 cases with favourable treatment outcomes（favourable group）and 98 cases with unfavourable treatment outcomes（unfavourable group）. After excluding the lost to follow-up cases and non-tuberculosis-related death cases，there were 659 survival cases（survival group）and 16 cases of tuberculosis-related death（fatal group）. Univariate and multivariate Logistic regression were used to analyze the related risk factors.Results:Among 98 cases with unfavourable treatment outcomes，42 cases died from non-tuberculosis causes，32 cases lost follow-up，16 cases died from tuberculosis and 8 cases had failed treatment. Multivariate Logistic regression analysis showed that age≥60（ OR=2.515，95% CI 1.461-4.330），retreatment of tuberculosis（ OR=2.502，95% CI 1.255-4.989），chronic obstructive pulmonary disease（ OR=2.796，95% CI 1.607-4.865），respiratory failure（ OR=6.373，95% CI 2.320-17.506），hypoproteinemia（ OR=3.149，95% CI 1.876-5.286）and elevated C-reactive protein（ OR=1.007，95% CI 1.002-1.012）were independent risk factors for unfavorable treatment outcomes in rifampicin-sensitive PTB patients（all P<0.01）；retreated pulmonary tuberculosis（ OR=4.542，95% CI 1.182-17.449），complicated respiratory failure（ OR=14.186，95% CI 3.038-66.252）and body mass index<18.5 kg/m 2（ OR=5.179，95% CI 1.333-20.119）were independent risk factors for poor prognosis in rifampicin-sensitive PTB patients（ P<0.05 or <0.01）. Conclusion:The older age，low BMI，hypoproteinemia，elevated C-reactive protein，comorbidities and retreatment are risk factors for unfavorable treatment outcomes and poor prognosis in patients with rifampicin-sensitive PTB.

Objective:To analyze the risk factors of unfavourable treatment outcomes in patients with rifampicin-sensitive pulmonary tuberculosis（PTB）.Methods:Clinical data of 726 patients with rifampicin-sensitive PTB admitted in Quzhou Hospital Affiliated to Wenzhou Medical University from January 2020 to December 2021 were retrospectively analyzed，including 628 cases with favourable treatment outcomes（favourable group）and 98 cases with unfavourable treatment outcomes（unfavourable group）. After excluding the lost to follow-up cases and non-tuberculosis-related death cases，there were 659 survival cases（survival group）and 16 cases of tuberculosis-related death（fatal group）. Univariate and multivariate Logistic regression were used to analyze the related risk factors.Results:Among 98 cases with unfavourable treatment outcomes，42 cases died from non-tuberculosis causes，32 cases lost follow-up，16 cases died from tuberculosis and 8 cases had failed treatment. Multivariate Logistic regression analysis showed that age≥60（ OR=2.515，95% CI 1.461-4.330），retreatment of tuberculosis（ OR=2.502，95% CI 1.255-4.989），chronic obstructive pulmonary disease（ OR=2.796，95% CI 1.607-4.865），respiratory failure（ OR=6.373，95% CI 2.320-17.506），hypoproteinemia（ OR=3.149，95% CI 1.876-5.286）and elevated C-reactive protein（ OR=1.007，95% CI 1.002-1.012）were independent risk factors for unfavorable treatment outcomes in rifampicin-sensitive PTB patients（all P<0.01）；retreated pulmonary tuberculosis（ OR=4.542，95% CI 1.182-17.449），complicated respiratory failure（ OR=14.186，95% CI 3.038-66.252）and body mass index<18.5 kg/m 2（ OR=5.179，95% CI 1.333-20.119）were independent risk factors for poor prognosis in rifampicin-sensitive PTB patients（ P<0.05 or <0.01）. Conclusion:The older age，low BMI，hypoproteinemia，elevated C-reactive protein，comorbidities and retreatment are risk factors for unfavorable treatment outcomes and poor prognosis in patients with rifampicin-sensitive PTB.

Objective:To analyze the influencing factors related to false-negative results of interferon-γ release assay (IGRA) QFT-GIT in patients with confirmed pulmonary tuberculosis.Methods:Clinical data of 389 patients with bacteriologically confirmed pulmonary tuberculosis who underwent QFT-GIT in Quzhou Hospital Affiliated to Wenzhou Medical University between January 1 and December 31 2020 were retrospectively analyzed. Univariate and multivariate logistic regression were used to analyze the influencing factors related to the false-negative results of QFT-GIT.Results:Among 389 confirmed patients, 347 cases had positive QFT-GIT results and 42 cases had negative results. Univariate analysis showed that the false-negative results of QFT-GIT were associated with low BMI, reduced CD4 + T lymphocyte count, decreased lymphocyte count, increased C-reactive protein, negative sputum smear, anemia, diabetes mellitus, malignant tumor and sepsis ( P<0.05 or P<0.01). Multivariate conditional logistic regression analysis showed that BMI <18.5 kg/m 2( OR=1.585, 95% CI 1.076-2.336), complicated with diabetes( OR=5.157, 95% CI 2.340-11.365), malignant tumors ( OR=5.596, 95% CI 2.048-15.295)and sepsis ( OR=4.141, 95% CI 1.042-16.459) were independent risk factors for the false-negative results of QFT-GIT ( P<0.05 or P<0.01). Conclusion:When the pulmonary tuberculosis patients are extreme emaciation, complicated with diabetes, malignant tumor or sepsis, the QFT-GIT results will be false negative.

Objective To evaluate the damage of longitudinal mechanical parameters of left ventricular myocardium by ultrasonic layer‐specific strain imaging in patients with systemic lupus erythematosus ( SLE ) without conventional evidence of cardiovascular system involvement . Methods Seventy‐eight patients suffered from SLE without conventional evidence of cardiovascular system involvement ( SLE group ) and 48 healthy volunteers with age and sex matched ( control group ) were selected for this study . T he left ventricular conventional structure and functional parameters were measured by conventional echocardiography . T hen layer‐specific strain imaging was performed in both groups to obtain left ventricular endocardial myocardial global longitudinal strain ( GLSendo ) ,mid‐myocardial GLS ( GLSmid) ,epicardial GLS ( GLSepi) and basal segment ,middle segment and apex longitudinal strain ( LS) of all three layers of the myocardium . T hen the transmural difference of the GLS ( ΔLS ＝ GLSendo －GLSepi) were calculated . T he related parameters between these two groups were compared for difference and correlation analysis of related mechanical parameters were also made . Results ① T here was no significant difference in the left ventricular ejection fraction ( LVEF ) and left ventricular stroke volume ( LVSV ) between the two groups ( all P ＞0 .05 ) ; Compared with the control group ,the mean E/e in the SLE group was increased and the E/A ,E ,e were decreased ( all P ＜0 .05) ; however ,the incidence of left ventricular diastolic dysfunction in the SLE group ( 2/78 ) was not significantly different from that in the control group ( 0/48 ) ( P ＞0 .05 ) . ② T he myocardial global longitudinal strain( GLS ) of the two groups were decreased from endocardial to epicardial gradient ; the values of GLS and segmental LS of all three layers in the SLE group were decreased ( all P ＜0 .05) ; the ΔLS of the SLE group was decreased compared with the control group ( P ＜ 0 .05 ) ; the value of peak strain dispersion ( PSD ) were increased in SLE patients ( P ＜ 0 .05 ) . ③ T he correlation analysis showed the GLS of each layer of myocardium in SLE patients were negatively correlated with disease duration ( rs ＝ －0 .34～ －0 .36 ,all P ＜ 0 .05 ) and SLE disease activity index ( SLEDAI) ( rs ＝ －0 .25～ －0 .30 ,all P ＜0 .05 ) . Conclusions T he ultrasonic layer‐specific strain imaging can quantitatively detect the damage of mechanical parameters of left ventricle in SLE patients ,w hich is more sensitive than the conventional echocardiography in evaluating left ventricular systolic function . It may provide visual evidence for early diagnosis of cardica dysfunction in SLE patients .