BACKGROUND: Serum osmolality is a prognostic indicator in critically ill patients. This study aimed to evaluate the association between high osmolality and 28-day mortality in patients with cardiac arrest (CA) admitted to the intensive care unit (ICU). METHODS: Baseline data of adult patients with CA who were admitted to the ICU from 2008 to 2019 were collected from the Medical Information Mart for Intensive Care (MIMIC)-IV. Patients were divided into survivor and non-survivor groups according to the 28-day prognosis. Serum concentrations of sodium, potassium, glucose, and urea nitrogen on the first day of ICU admission were used to determine serum osmolarity. The primary endpoint of this study was 28-day all-cause mortality. Propensity score matching (PSM) analysis was performed to reduce bias between the survivor and non-survivor groups. RESULTS: Among the 798 included CA patients, the high osmolarity on the first day of ICU admission remained significantly associated with increased 28-day mortality (62.0% vs. 35.5%, P<0.001) and reduced cumulative survival (log-rank P<0.05) after PSM. Cox regression identified the high osmolarity on the first day of ICU admission as an independent predictor. High serum osmolarity on the first day of ICU admission effectively predicted 1-, 3-, 7-, and 28-day all-cause mortality, with the strongest predictive performance for 1-day mortality both before and after PSM (all P<0.05). CONCLUSION: In this study, elevated serum osmolarity on the first day of ICU admission was independently associated with increased 28-day mortality in CA patients and could serve as a prognostic marker.

BACKGROUND Individualized positive end-expiratory pressure (PEEP) titration is a crucial technique in mechanical ventilation therapy for acute respiratory distress syndrome (ARDS) patients with intra-abdominal hypertension (IAH). This study aimed to evaluate the effectiveness of electrical impedance tomography (EIT)-guided PEEP titration in this population. METHODS: This prospective study enrolled 36 ARDS patients, including 22 patients with IAH and 14 without IAH. All the patients underwent EIT-guided PEEP titration at the intersection point between alveolar overdistension and collapse during a decremental PEEP trial. The changes in pulmonary ventilation distribution, respiratory mechanics and hemodynamics during the titration process were observed. RESULTS: After EIT-guided PEEP titration was performed, the PEEP, peak inspiratory pressure and plateau pressure increased significantly (P<0.05). Furthermore, no significant differences were observed in respiratory system compliance, tidal volume, driving pressure, or the 4*DP+RR index between the two groups (P>0.05). The mechanical power increased in the non-IAH (NIAH) group after PEEP titration (P<0.05). Ventilation in gravity-dependent lung regions significantly increased (P<0.05), and the oxygenation index (PaO2/FiO2) improved significantly (P<0.05) in both groups. However, blood pressure, heart rate, respiratory rate, central venous pressure, and lactate levels did not significantly change. In the IAH group, the PaO2/FiO2 ratio improved less than that in the NIAH group did (P<0.05). CONCLUSION: In our study, individualized PEEP titration guided by EIT improved oxygenation in ARDS patients with concomitant IAH without significantly affecting hemodynamics. The presence of IAH may limit the improvement of oxygenation during EIT-guided PEEP titration.

Oral squamous cell carcinoma (OSCC) is a common head and neck malignancy. Approximately 50% to 60% of patients with OSCC are diagnosed at a locally advanced stage (clinical staging III-IVa). Even with comprehensive and sequential treatment primarily based on surgery, the 5-year overall survival rate remains below 50%, and patients often suffer from postoperative functional impairments such as difficulties with speaking and swallowing. Programmed death receptor-1 (PD-1) inhibitors are increasingly used in the neoadjuvant treatment of locally advanced OSCC and have shown encouraging efficacy. However, clinical practice still faces key challenges, including the definition of indications, optimization of combination regimens, and standards for efficacy evaluation. Based on the latest research advances worldwide and the clinical experience of the expert group, this expert consensus systematically evaluates the application of PD-1 inhibitors in the neoadjuvant treatment of locally advanced OSCC, covering combination strategies, treatment cycles and surgical timing, efficacy assessment, use of biomarkers, management of special populations and immune related adverse events, principles for immunotherapy rechallenge, and function preservation strategies. After multiple rounds of panel discussion and through anonymous voting using the Delphi method, the following consensus statements have been formulated: 1) Neoadjuvant therapy with PD-1 inhibitors can be used preoperatively in patients with locally advanced OSCC. The preferred regimen is a PD-1 inhibitor combined with platinum based chemotherapy, administered for 2-3 cycles. 2) During the efficacy evaluation of neoadjuvant therapy, radiographic assessment should follow the dual criteria of Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and immune RECIST (iRECIST). After surgery, systematic pathological evaluation of both the primary lesion and regional lymph nodes is required. For combination chemotherapy regimens, PD-L1 expression and combined positive score need not be used as mandatory inclusion or exclusion criteria. 3) For special populations such as the elderly (≥ 70 years), individuals with stable HIV viral load, and carriers of chronic HBV/HCV, PD-1 inhibitors may be used cautiously under the guidance of a multidisciplinary team (MDT), with close monitoring for adverse events. 4) For patients with a poor response to neoadjuvant therapy, continuation of the original treatment regimen is not recommended; the subsequent treatment plan should be adjusted promptly after MDT assessment. Organ transplant recipients and patients with active autoimmune diseases are not recommended to receive neoadjuvant PD-1 inhibitor therapy due to the high risk of immune related activation. Rechallenge is generally not advised for patients who have experienced high risk immune related adverse events such as immune mediated myocarditis, neurotoxicity, or pneumonitis. 5) For patients with a good pathological response, individualized de escalation surgery and function preservation strategies can be explored. This consensus aims to promote the standardized, safe, and precise application of neoadjuvant PD-1 inhibitor strategies in the management of locally advanced OSCC patients.

Objective: To study the association between ankyloglossia and sagittal mandibular development impairment as well as lower anterior dental crowding, providing a reference for clinical practice. Methods: This study was approved by the hospital&#39;s Medical Ethics Committee. A total of 100 patients aged 7-13 years were enrolled from January 2024 to January 2025, comprising 50 patients with ankyloglossia (case group) and 50 individuals with a healthy lingual frenulum (normal group). Clinical examination was performed to assess lingual frenulum length, Kotlow classification, and the simplified Hazelbaker assessment tool for lingual frenulum function (HATLFF) score. Cephalometric radiographs were used to measure the A-point-nasion-B-point (ANB) angle, sella-nasion-B-point (SNB) angle, and mandibular total length (condylion-gnathion [Co-Gn]). Dental cast analysis was conducted to evaluate lower anterior teeth crowding. Data were compared between the two groups. Pearson correlation analysis was used to examine the relationships between the lingual frenulum length, simplified HATLFF score, and cephalometric/dental cast parameters (ANB, SNB, Co-Gn, lower anterior crowding). The diagnostic value of ankyloglossia for mandibular development and lower anterior crowding was analyzed using receiver operating characteristic (ROC) curves. Results: Ankyloglossia was significantly associated with mandibular development and lower anterior crowding (P<0.05). The case group showed significantly lower values for the lingual frenulum length, simplified HATLFF score, SNB angle, and Co-Gn, while the ANB angle and lower anterior crowding index were significantly higher compared to the normal group (P<0.05). The lingual frenulum length and simplified HATLFF score were negatively correlated with the ANB angle and lower anterior crowding index, and positively correlated with the SNB angle and Co-Gn (P<0.05). ROC curve analysis indicated that the area under the curve (AUC) for the simplified HATLFF score, and ankyloglossia in predicting mandibular development deficiency and lower anterior crowding was greater than 0.700, demonstrating good diagnostic value. Conclusion A significant correlation exists between ankyloglossia and both mandibular development deficiency and lower anterior crowding.

[摘 要] 目的：探讨iSEND免疫评分联合肺癌免疫治疗预后指数（LIPI）在评估非小细胞肺癌（NSCLC）接受免疫治疗预后中的价值。方法：通过回顾性分析2018年2月至2023年2月期间100例接受免疫治疗的晚期NSCLC患者的临床资料，收集并整理患者的iSEND免疫评分和LIPI数据，根据iSEND免疫评分和LIPI分别将患者分为3组（不良组、中等组和良好组），运用Kaplan-Meier方法绘制生存曲线分析所有患者和不同组别患者的无进展生存期（PFS），运用Cox回归分析评估影响患者预后的风险因素。结果：在接受免疫治疗后，NSCLC患者的ORR为42.00%（42/100），DCR为82.00%（82/100）。iSEND免疫评分和LIPI不良组ORR和DCR均最低，良好组均最高，不同组别ORR和DCR比较均有统计学意义（均P < 0.01）。100例NSCLC患者的中位PFS为7.63个月[95% CI（7.23, 8.05）]，iSEND免疫评分不良组、中等组和良好组的中位PFS分别为4.69、6.58和8.99个月，iSEND免疫评分良好组的PFS最长，其次为中等组，不良组最短（χ2=125.391，P < 0.000 1）。LIPI不良组、中等组和良好组的中位PFS分别为4.54、6.39和8.49个月，以LIPI良好组的PFS最长，其次为中等组（χ2 = 115.707，P < 0.000 1）。Cox多因素分析提示，ECOG PS > 1、远处转移、iSEND免疫评分≥ 2分和LIPI ≥ 2分是影响患者独立预后的风险因素。结论：iSEND免疫评分和LIPI可作为评估NSCLC免疫治疗预后的良好指标，具有一定的临床价值。

Objective To establish an individualized nomogram model and evaluate its efficacy to provide a possible evaluation basis for the prognosis of lower third and abdominal part of oesophageal adenocarcinoma (EAC). Methods Lower third and abdominal part of EAC patients from 2010 to 2015 were chosen from the SEER Research Plus Database (17 Regs, 2022nov sub). The patients were randomly allocated to the training cohort and the internal validation cohort with a ratio of 7∶3 using bootstrap resampling. The Cox proportional hazards regression analysis was used to determine significant contributors to overall survival (OS) in EAC patients, which would be elected to construct the nomogram prediction model. C-index, calibration curve and receiver operating characteristic (ROC) curve were performed to evaluate its efficacy. Finally, the efficacy to evaluate the OS of EAC patients was compared between the nomogram prediction model and TNM staging system. Results In total, 3945 patients with lower third and abdominal part of EAC were enrolled, including 3475 males and 470 females with a median age of 65 (57-72) years. The 2761 patients were allocated to the training cohort and the remaining 1184 patients to the internal validation cohort. In the training and the internal validation cohorts, the C-index of the nomogram model was 0.705 and 0.713, respectively. Meanwhile, the calibration curve also suggested that the nomogram model had a strong capability of predicting 1-, 3-, and 5-year OS rates of EAC patients. The nomogram also had a higher efficacy than the TNM staging system in predicting 1-, 3-, and 5-year OS rates of EAC patients. Conclusion This nomogram prediction model has a high efficiency for predicting OS in the patients with lower third and abdominal part of EAC, which is higher than that of the current TNM staging system.

Objective To investigate the necessity of further surgery for patients with locally advanced esophageal squamous cell carcinoma following treatment with the programmed cell death-1 (PD-1) inhibitor combined with chemotherapy, and to assess its impact on survival. Methods Patients with stage ⅡA to ⅢB esophageal squamous cell carcinoma who received immunotherapy combined with chemotherapy at our hospital from January 2020 to June 2022 were selected for this study. Based on whether they underwent surgery after receiving PD-1 inhibitor combined with chemotherapy, patients were divided into a surgery group and a non-surgery group. We compared the general clinical data, side effects, clinical complete response rates, progression-free survival (PFS), and overall survival (OS) between the two groups. Results A total of 58 patients were included in the study, comprising 45 males and 13 females, with an average age of (65.5±6.9) years. There were no statistical differences in general clinical data or adverse reactions between the two groups. Univariate analysis revealed that the objective response rate and surgery were significantly associated with PFS (P<0.05). Binary logistic regression analysis showed that surgery was the only independent risk factor for PFS (P=0.003). Kaplan-Meier survival analysis showed that the PFS and OS in the surgery group were significantly higher than those in the non-surgery group (HR=0.13, 95%CI 0.036 to 0.520, P＜0.001; HR=0.17, 95%CI 0.045 to 0.680, P=0.004). Conclusion After treatment with the PD-1 inhibitor combined with chemotherapy, patients with locally advanced esophageal squamous cell carcinoma still require surgical intervention to achieve improved PFS and OS.

Objective To investigate the discovery and disposal process and epidemiological characteristics of the first confirmed case of mpox (formerly named monkeypox) in Huai&#39;an, Jiangsu Province, and to provide reference for the prevention and control of key infectious diseases in this region. Methods The on-site epidemiological investigation data of the first confirmed case of mpox on June 21, 2023, as well as the results of nucleic acid detection and gene sequencing of laboratory specimens were analyzed retrospectively. Possible sources of infection were explored. Results The first confirmed case of mpox was an AIDS patient, men who had sex with men (MSM), who had no history of travel abroad or outside the city within 21 days before the onset of the disease, but had interacted with some people outside the city, and the epidemiological trajectory was complex. The detection of mpox virus nucleic acid was positive (BioGerm reagent: Ct value 21.8, ZhuoCheng reagent: Ct value 21.2). According to genetic sequencing, the first confirmed case was classified as C.1.1 lineage of clade IIb. During the investigation on the source of infection of the first confirmed case, one new asymptomatic infected person was found. Based on the epidemiological investigation and laboratory results, the first confirmed case was believed to be caused by local infection, however, the source of infection was unclear. Although there was an epidemiological association with asymptomatic infected people, the direct evidence of mutual infection was insufficient, and it could not be ruled out that there was still a hidden transmission chain between regions. The source of infection of the asymptomatic infected person was presumed to be the first confirmed case or an unidentified person with whom he had high-risk sex and caused anal bleeding. Conclusion The first confirmed case is caused by local infection. Awareness of case diagnosis and reporting in medical institutions should be improved, and publicity and education should be provided to key exposed populations, especially those men who have sex with men, to prevent the occurrence of large-scale local epidemic.

Objective To investigate the correlation between insulin resistance and interleukin-6 (IL-6), chemerin, total cholesterol (TC)/high density lipoprotein cholesterol (HDL-C) ratio, triglyceride (TG)/HDL-C ratio, low density lipoprotein cholesterol (LDL-C)/HDL-C ratio and insulin resistance in obese patients with type 2 diabetes mellitus (T2DM), and to provide scientific basis for T2DM prevention and control. Methods A total of 355 obese T2DM patients in Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine were selected from January 2021 to December 2023. IL-6, chemerin and lipids were detected, and the assessment of insulin resistance was conducted through the homeostasis model assessment of insulin resistance (HOMA-IR). Results Among the 355 obese T2DM patients, there were 280 cases of insulin resistance, with the incidence rate of 78.87%. The BMI, IL-6, chemerin, TC/HDL-C, LDL-C/HDL-C, and TG/HDL-C in the insulin resistance group were higher than those in the non-insulin resistance group (P<0.05). The above insulin resistant patients were divided into 4 subgroups by means of insulin resistance, and there were significant differences in BMI, IL-6, chemerin, and TG/HDL-C among the subgroups (P<0.05). IL-6, chemerin, and TG/HDL-C were positively correlated with HOMA-IR in obese T2DM patients (P<0.05), while TC/HDL-C and LDL-C/HDL-C had no significant correlation with HOMA-IR (P>0.05). BMI, IL-6, chemerin, and TG/HDL-C were all influencing factors of insulin resistance in obese T2DM patients (P<0.05). Conclusion IL-6, chemerin and TG/HDL-C are correlated with insulin resistance in obese patients with T2DM and are influencing factors for the occurrence of insulin resistance.

Objective To understand the epidemiological and genotypic characteristics of norovirus (NoV) in Jingzhou area，and to design primers and probes covering the variant genomes in the NoV gene library. Methods A total of 556 fecal samples were collected from suspected NoV patients from the First People&#39;s Hospital of Jingzhou from January 2022 to May 2023. The positive rate of NoV nucleic acid in fecal samples was detected by commercial kits. The differences in positive rates among different seasons and five age groups were statistically analyzed. Primers covering the NoV variant genome were designed to genotype some positive specimens. Results The detection rate of NoV nucleic acid in the tested samples was 30.04% (167/556). The detection rate in spring and winter was higher than that in summer and autumn (χ²=20.411，P<0.01). There were statistical differences in the positive rates among the five age groups of <1 year, 1-5 years, 6-10 years, 11-19 years, and >19 years (χ²=17.192，P<0.01), and the positive rate in young children (1~5 years old) was the highest (39.29%, 88/224). In addition, all the positive samples were NoV GII. Conclusion The epidemic situation of NoV is serious in winter and spring in Jingzhou area, with a high infection rate in young children (1-5 years old), and NoV GII is the main prevalent genotype. The primers designed in this study can be used for genotyping of NoV GI and GII.