As the search for effective treatments for COVID-19 continues, the high mortality rate among critically ill patients in Intensive Care Units (ICU) presents a profound challenge. This study explores the potential benefits of traditional Chinese medicine (TCM) as a supplementary treatment for severe COVID-19. A total of 110 critically ill COVID-19 patients at the Intensive Care Unit (ICU) of Vulcan Hill Hospital between Feb., 2020, and April, 2020 (Wuhan, China) participated in this observational study. All patients received standard supportive care protocols, with a subset of 81 also receiving TCM as an adjunct treatment. Clinical characteristics during the treatment period and the clinical outcome of each patient were closely monitored and analysed. Our findings indicated that the TCM group exhibited a significantly lower mortality rate compared with the non-TCM group (16 of 81 vs 24 of 29; 0.3 vs 2.3 person/month). In the adjusted Cox proportional hazards models, TCM treatment was associated with improved survival odds (P < 0.001). Furthermore, the analysis also revealed that TCM treatment could partially mitigate inflammatory responses, as evidenced by the reduced levels of proinflammatory cytokines, and contribute to the recovery of multiple organic functions, thereby potentially increasing the survival rate of critically ill COVID-19 patients.
Humans ; COVID-19 ; Medicine, Chinese Traditional ; SARS-CoV-2 ; Critical Illness ; Treatment Outcome

Objective: To explore the effects of short-term exposure to four air pollutants, namely fine particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2) and ozone (O3), on death and years of life lost (YLL). Methods: Air pollutants and meteorological data in Jindong District and Wucheng District of Jinhua City, Zhejiang Province from 2014 to 2021 were collected through Jinhua Environmental Monitoring Center and Jinhua Meteorological Bureau. Death data of residents during the same period was collected through Zhejiang Province Chronic Disease Monitoring Information Management System. The effects of short-term exposure to four air pollutants on death and YLL were analyzed using a generalized additive model. Results: The results of single-pollutant model analysis showed that the lagged effect of short-term exposure to PM2.5 on death and YLL was the largest at cumulative lags of 2 days, with effect size of 1.064% (95%CI: 0.450%-1.682%) and 2.084 (95%CI: 1.003-3.165) person-years, respectively; the effect of short-term exposure to SO2 on YLL was the largest on the same day, with an effect size of 2.432 (95%CI: 0.610-4.254) person-years; short-term exposure to NO2 and O3 had no statistically significant effects on death and YLL (both P>0.05). The results of gender- and age-stratified analysis showed that short-term exposure to PM2.5 had significant lagged effects on death and YLL among females and residents aged 65 years and above at cumulative lags of 2 days; short-term exposure to SO2 had significant effects on YLL among females and residents aged 65 years and above on the same day (both P<0.05). The results of dual-pollutant model analysis showed that after the inclusion of NO2 in PM2.5 and SO2, the effects on death and YLL were statistically significant, with the effect size being higher compared to the single-pollutant model; after the inclusion of SO2 or O3 in PM2.5, the effects on death and YLL were statistically significant, with the effect size being lower compared to the single-pollutant model (all P<0.05). Conclusion Short-term exposure to PM2.5 may increase the risk of death and YLL, and short-term exposure to SO2 may increase the risk of YLL among residents, with more significant impacts on female and residents aged 65 years and above.

Objective:To evaluate the efficacy and safety of oliceridine for treatment of moderate to severe pain after surgery with general anesthesia in patients.Methods:The patients with moderate to severe pain (numeric pain rating scale ≥4) after abdominal surgery with general anesthesia from 14 hospitals between July 6, 2021 and November 9, 2021 were included in this study. The patients were assigned to either experiment group or control group using a random number table method. Experiment group received oliceridine, while control group received morphine, and both groups were treated with a loading dose plus patient-controlled analgesia and supplemental doses for 24 h. The primary efficacy endpoint was the drug response rate within 24 h after giving the loading dose. Secondary efficacy endpoints included early (within 1 h after giving the loading dose) drug response rates and use of rescue medication. Safety endpoints encompassed the development of respiratory depression and other adverse reactions during treatment.Results:After randomization, both the full analysis set and safety analysis set comprised 180 cases, with 92 in experiment group and 88 in control group. The per-protocol set included 170 cases, with 86 in experiment group and 84 in control group. There were no statistically significant differences between the two groups in 24-h drug response rates, rescue analgesia rates, respiratory depression, and incidence of other adverse reactions ( P>0.05). The analysis of full analysis set showed that the experiment group had a higher drug response rate at 5-30 min after giving the loading dose compared to control group ( P<0.05). The per-protocol set analysis indicated that experiment group had a higher drug response rate at 5-15 min after giving the loading dose than control group ( P<0.05). Conclusions:When used for treatment of moderate to severe pain after surgery with general anesthesia in patients, oliceridine provides comparable analgesic efficacy to morphine, with a faster onset.

Objective:To investigate the relationship between intracerebral high-density foci and progressive stroke (PS) morbidity by using dual-energy CT, which can quantify the intracerebral high-density foci of patients with acute ischemic stroke after endovascular treatment.Methods:Ninety-two patients with acute ischemic stroke who received interventional treatment in Gaozhou People′s Hospital from May 2019 to August 2020, and underwent dual-energy CT scan immediately after intervention, were analyzed. The patients were divided into PS group ( n=35) and non-PS group ( n=57) according to the National Institutes of Health Stroke Scale (NIHSS) score, and the patients whose NIHSS score increased≥4 points within 72 hours of stroke were included in the PS group, while the patients whose NIHSS score increased<4 points were included in the non-PS group. The clinical data, volume of high-density foci and CT values were compared between the 2 groups. Logistic regression analysis was used to adjust for confounding factors and screen for risk factors. The correlations of the admission NIHSS score, presence and volume of high-density lesions, maximum CT (CTmax) value and average CT (CTave) value with the onset of PS were analyzed, and the receiver operating characteristic curve was used to screen predictive indicators of PS. Results:In the PS group, the NIHSS score (18.80±8.50 vs 14.40±9.58, t=2.229, P=0.028), proportion of high-density foci [29/35(82.9%) vs 32/57 (56.1%), χ 2=6.928, P=0.008], high-density focal volume [13.23 (39.33) cm 3vs 0.76 (9.82) cm 3, U=1 440.000, P<0.001], CTmax value [80.00 (92.00) HU vs 65.00 (87.50) HU, U=1 337.000, P=0.005] and CTave value [53.48 (23.79) HU vs 45.94 (55.11) HU, U=1 345.000, P=0.004] were higher than those in the non-PS group. The NIHSS score ( OR=1.054, 95% CI 1.004-1.106, P=0.033; rs=0.255, 95% CI 0.051-0.447, P=0.014), presence of high-density foci ( OR=3.776, 95% CI 1.358-10.503, P=0.011; rs=0.274, 95% CI 0.093-0.460, P=0.008), high-density focal volume ( OR=1.026, 95% CI 1.003-1.049, P=0.027; rs=0.381, 95% CI 0.183-0.560, P<0.001), CTmax value ( OR=1.006, 95% CI 1.001-1.011, P=0.014; rs=0.292, 95% CI 0.088-0.475, P=0.005) and CTave value ( OR=1.021, 95% CI 1.007-1.035, P=0.004; rs=0.299, 95% CI 0.092-0.484, P=0.004) were all risk factors affecting PS morbidity and were positively correlated with PS morbidity. The area under the receiver operating characteristic curve of NIHSS score, high-density lesion volume, CTmax value, and CTave value to predict the onset of PS was 0.652, 0.722, 0.670 and 0.674, respectively. The volume of high-density lesions had moderate predictive value for the onset of PS. Conclusions:For AIS patients, CT examination should be performed immediately after interventional operation. The volume, CTmax value and CTave value of high-density lesions newly appeared in the ischemic area are positively correlated with the onset of PS. Quantifying the volume of high-density lesions can help to predict the onset of PS.

Objective: To construct air quality health index (AQHI) in Jinhua City, Zhejiang Province based on the exposure-response relationship between air pollutants and years of life lost (YLL), and evaluate the health risk associated with air quality. Methods: Air pollutants and meteorological data in Jindong District and Wucheng District of Jinhua City from 2014 to 2021 were collected through Jinhua Environmental Monitoring Center and Jinhua Meteorological Bureau. Non-accidental death data of residents during the same period was collected through Zhejiang Chronic Disease Monitoring Information Management System. The exposure-response relationship between major air pollutants and YLL was analyzed using a generalized additive model (GAM), and major pollutants were screened for calculating AQHI. The exposure-response relationship between AQHI and YLL was analyzed using GAM. Results: The results of single-pollutant model analysis showed that the lagged effect of PM2.5 on YLL was the largest at lag of 1 day, and the effect of SO2 on YLL was the largest on the same day. The results of dual-pollutant model analysis showed that the impact of PM2.5 on YLL was statistically significant when other pollutants were included at a lag of 1 day, and the impact of SO2 on YLL was statistically significant when NO2 was included on the same day (all P<0.05). The average daily mass concentration of O3 exceeded the standard by a relatively high rate of 42.27% from 2014 to 2021. Based on the analysis results of single-pollutant and two-pollutant models, excessive pollutant condition and relevant research findings, PM2.5, SO2, NO2 and O3 were selected as the major pollutants for calculating the AQHI. The median AQHI value of 1.40 (interquartile range, 1.13) from 2014 to 2021. According to the AQHI classification standard, 94.55% was the time was at low risk, and 4.93% of the time was at medium risk. With an increase in AQHI by one interquartile range, the YLL among the entire population, males, females, <65-year-old and ≥65-year-old populations would increase 6.21, 3.26, 6.46, 4.24 and 10.57 person-years, respectively. Conclusions The air quality health risk in Jinhua City was low at most of the time from 2014 to 2021. An increase in AQHI was associated with an increased risk of YLL among population.

Objective To investigate the diagnostic value of skeletal muscle and diaphragm muscle in the extremities,as assessed by bedside ultrasound,for ICU-acquired weakness in elderly patients.Methods A total of 47 elderly patients with severe illness,admitted to the intensive care unit(ICU)of the Second People's Hospital of Yuhang District from March 2023 to April 2024,were included in this study.The average age of the patients was 74.51 years.Medical Research Council(MRC)scores were assessed twice within a 24-hour interval.Among them,when MRC score＜48,20 cases were classified into the ICU-AW group,while the remaining 27 cases formed the non-ICU-AW group with MRC score≥48.Ultrasound measurements for lower extremity skeletal muscle thickness and diaphragm parameters were conducted on the first day,third day,and seventh day after ICU admission.The rate of shrinkage in upper and lower extremity skeletal muscle thickness at different time points was calculated.Differ-ences in ultrasound parameters between the two groups were compared,and ROC curve analysis was performed to evaluate the diagnostic value of upper and lower extremity skeletal muscle as well as diaphragm parameters for ICU-AW.Results Significant differences were observed in gender,age,BMI,APACHEⅡ score,SOFA score,number of mechanical ventilation cases,and number of sepsis cases between the two groups(P＜0.05).Compared to the non-ICU-AW group,the ICU-AW group exhibited higher rates of atrophy in quadriceps femoris(RF)and total quad-riceps femoris(QF)on day 3 and a lower degree of diaphragm displacement(DE)(P＜0.05).On day 7,the ICU-AW group showed higher rates of atrophy in quadriceps femoris[rectus femoris(RF),intermedius femoris(VI),and total quadriceps femoris(QF)]along with lower diaphragm parameters[diaphragm displacement degree(DE)and diaphragm thickness fraction(DTF)](P＜0.05).According to ROC curve analysis,the critical value of ICU-AW predicted by ΔRF-MLT atrophy rate on day 7 was 9.9%,AUC was 0.743,sensitivity was 75.0%and specificity was 77.8%.On day 7,the critical value of ICU-AW was 5.69%,AUC was 0.828,sensitivity was 80.0%,and speci-ficity was 77.8%.On day 7,the critical value of ICU-AW was 16.96%,AUC was 0.835,sensitivity was 60.0%,and specificity was 88.9%.On day 7,DE predicted that the critical value of ICU-AW was 1.67 cm,AUC was 0.818,sensitivity was 75.0%,and specificity was 85.2%.On day 7,DTF predicted that the critical value of ICU-AW was 33.96%,AUC was 0.889,sensitivity was 80.0%,and specificity was 85.2%.On day 7,the AUC of ICU-AW was 0.976,the sensitivity was 80.0%,and the specificity was 100%.Conclusion The quadriceps atrophy rate and diaphragm parameters measured by bedside ultrasound can identify and diagnose ICU-AW as early as possible.

Objective To observe the impact of cold circulation liquid temperature on ablation focus morphology of microwave ablation(MWA)for in vitro porcine liver tissue.Methods Twenty in vitro fresh porcine liver blocks were randomly divided into ice water circulation group(group A)and normal temperature circulation group(group B),respectively.Ten target ablations in each subgroups in group A and group B,i.e.A1 and B1(50 W,1 min),A2 and B2(50 W,5 min),A3 and B3(60 W,1 min),A4 and B4(60 W,5 min),A5 and B5(70 W,1 min)as well as A6 and B6(70 W,5 min)subgroups were performed using different ablation power(50,60,70 W)and ablation time(1,5 min),respectively.Then the morphology indexes of ablation foci,including longitudinal diameter(LD),transverse diameter(TD),roundness index(RI)and volume(V)were compared between subgroups in group A and B,also among subgroups within group A and B.Results Under the same ablation power and time,LD of ablation foci in subgroups of group A were all smaller than those of group B(all P＜0.05).Significant differences of RI of ablation foci were found between A1 and B1,A2 and B2,A4 and B4,A5 and B5 as well as A6 and B6 subgroups(all P＜0.05),but not between A3 and B3 subgroups(P＞0.05).However,the main effect of cold circulation liquid temperature on ablation focus TD(F=1.125)nor V(F=3.332)was not significant(both P≥0.05).Under the same cold circulation liquid temperature,significant differences of the morphology indexes of ablation foci were detected between A1 and A2,A3 and A4 as well as A5 and A6 subgroups,also between corresponding subgroups in group B(all P＜0.05).Conclusion During MWA for in vitro porcine liver tissue under constant ablation power and time,taken ice water as the cold circulation liquid was benefit to ablation focus shaped spherically.With the extension of ablation time,the larger the ablation focus,the higher the RI.

Objective·To systematically integrate relevant influencing factors of advanced cancer patients'engagement behavior in advance care planning(ACP).Methods·The systematic search of Chinese and English literature on factors influencing ACP engagement behavior in advanced cancer patients from inception to December 2022 in China National Knowledge Infrastructure(CNKI),Wanfang,China Biomedical Literature Database(Sinomed),PubMed,Cochrane Library,Embase,CINAHL,and PsycINFO was conducted.After the literature quality evaluation,content extraction and summary were conducted by two researchers,and the data of quantitative research and qualitative research were extracted and integrated respectively.The final influencing factors of ACP engagement behavior of advanced cancer patients were obtained.With the help of the theoretical domain,they were mapped to the capability,opportunity,motivation-behavior(COM-B)model step by step.Results·A total of 21 studies were included and 27 factors were summarized,including 9 theoretical domains.Mapping to the COM-B model included 9 capability factors(knowledge of ACP,education level,accurate knowledge of prognosis,knowledge of the time of disease diagnosis,prior experience,subjective life expectancy,age,cancer site,and disease symptom burden),13 opportunity factors(gender,marital status,race/ethnicity,religious belief,dependent children,family economic condition,place of living,housing type,family support,social support,doctor-patient relationship,acculturation,and whether or not to establish a hospice service center)and 5 motivational factors(ACP attitude,ACP belief,ACP motivation,anxiety and depression,and death attitude).Among them,doctor-patient relationship,religious belief,ACP attitude,educational level,marital status,family support,knowledge of ACP,accurate knowledge of prognosis,age,place of living,attitude toward death,prior experience,and race/ethnicity were more influential factors on ACP engagement behavior.Conclusion·Based on the COM-B model,the influencing factors of ACP engagement behavior in advanced cancer patients can be comprehensively summarized.Future studies can use the above factors as an entry point to design continuous,multifaceted,and comprehensive interventions based on the COM-B model to promote the practice of ACP engagement behavior in advanced cancer patients.

Objective To observe area of coagulation necrosis after microwave ablation(MWA)of rabbit liver showed on contrast-enhanced ultrasound(CEUS)in comparison with pathological findings.Methods Twenty-five healthy male experimental rabbits were equally randomly divided into L0,M0,H0,M7 and M14 groups.MWA was achieved with different power and time,and then CEUS and pathological examinations were performed,respectively.Four target areas of rabbit liver were ablated under 20 W for 1 min in L0 group,under 30 W for 1 min in M0 group and under 30 W for 3 min in H0 group,and the ablated areas were observed on the same day after MWA,while 2 target areas of rabbit liver were ablated under 30 W for 1 min in M7 and M14 groups,and the ablated areas were observed 7 days and 14 days after MWA,respectively.The ablated foci and ablated foci+edema band(inflammatory reaction band,IRB)showed on CEUS and pathology were compared,and their differences and changes with time going were analyzed.Results On the day of ablation,the extent of ablation foci,ablation foci+IRB as well as IRB in L0,M0 and H0 groups showed on CEUS were all larger than pathological findings under light microscopy(all P＜0.05),and the difference value of the length of the ablation foci between 2 methods increased sequentially among group L0,M0 and H0(all adjusted P＜0.05).Seven days after ablation,the area of ablation foci measured with CEUS in M 7 group was slightly larger than that measured with pathology(adjusted P=0.045),but no significant difference of the length nor the short diameter was found(both adjusted P＞0.05).Fourteen days after ablation,no significant difference of the length,the short diameter nor the area of ablation foci was detected between 2 methods in M14 group(all adjusted P＞0.05).The length,short diameter and area of ablation foci in M0 group measured with CEUS or pathology were all smaller than those in M 7 and M14 groups(all adjusted P＜0.05),while no significant difference was found between the latter 2 groups(all adjusted P＞0.05).Conclusion On the day of MWA of rabbit liver with different power and time settings,the areas of ablation foci,ablation foci+IRB and IRB showed on CEUS were larger than pathological findings.The range of ablation foci showed on CEUS 7 days after ablation was basically in line with pathology,indicating that CUES should be reexamined 7 days after ablation to evaluate the actual extent of coagulation and necrosis of ablation foci.

Objective:To evaluate the clinical value of CD4 + T lymphocyte subsets such as helper Th2 in patients with recurrent uveitis (BU) in Beh?et′s disease (BD). Methods:The clinical data of 153 hospitalized patients diagnosed with Beh?et′s disease from January 1, 2020 to June 30, 2023 in the Second Hospital of Shanxi Medical University were retrospectively analyzed. The subsets of CD4 + T lymphocytes were measured, including helper T cells (Th cells) such as Th1, Th2, Th17 and regulatory T cells (Treg cells), biochemical lipid indexes (TC, TG, etc.), the frequency of oral ulcers in the past 1 year, the frequency of genital ulcers in the past 1 year, and drug use before admission;According to whether there was ocular involvement and uveitis, 153 cases of BD were divided into Beh?et non-uveitis group (non-BU group) and Beh?et uveitis group (BU group). The above indexes and independent correlation factors of recurrent BU were compared between BU group and non-BU group;The above indexes and independent correlation factors of recurrent BU were compared between BU group and non-BU group. The levels of cytokines and ICBD total score, the correlation between ICBD total score and various cytokines, and the diagnostic performance of Th2 cells were compared between BU group and non-BU group.The statistical methods were Mann-Whitney U test, independent sample t test, Chi-square test, multiple logistic regression analysis, Pearson correlation analysis and receiver operating characteristic curve (ROC) analysis. Results:①The levels of Th1, Th2, Th17 cells, TC and TG in BU group were higher than those in non-BU group [133.87 (93.38, 229.87)/μl vs. 102.51(64.25, 149.23)/μl] and [9.43 (5.84, 14.13)/μl vs. 6.78(4.23, 9.44)/μl], [15.53 (9.36, 25.27)/μl vs. 9.83(5.46, 14.76)/μl], [4.21 (3.89, 4.90) mmol/L vs. 3.89(3.37, 4.34)mmol/L)], [1.43(1.00, 2.21)mmol/L vs. 0.96(0.69, 1.38)mmol/L], The differences were statistically significant ( Z=-3.24, Z=-3.05, Z=-3.94, Z=-2.25, Z=-3.47; all P<0.05); There was no statistical significance in Chi-square test between the two groups ( χ2=5.69, P>0.05).②The levels of IL-2, IL-10 and total ICBD score in BU group were higher than those in non-BU group, with statistical significance ( Z=-2.12, Z=-2.29, t=-6.48; all P<0.05). ③ The results of multiple logistic regression analysis showed that Th2 was an independent correlation factor for BU [ OR value (95% CI) was 1.143(1.007, 1.298), P=0.039]. The total score of BU patients was correlated with Th2 and Th17 cells. ROC analysis showed that the sensitivity of Th2 in diagnosing BU was 68.8%, the specificity was 49.5% and the area under the curve (95% CI) was 0.697 (0.585, 0.809) (P=0.001). Conclusion:CD4 + T lymphocyte subsets such as the absolute number of Th2 cells are related to BU, which is an important indicator to observe the severity of disease progression in BU patients, and has certain clinical value in evaluating the recurrence of BU in BD patients.