PURPOSE: Early mortality in major trauma has decreased, but MODS remains a leading cause of poor outcomes, driven by trauma-induced cytokine storms that exacerbate injuries and organ damage. METHODS: This prospective cohort study included 79 major trauma patients (ISS >15) treated in the National Center for Trauma Medicine, Peking University People's Hospital, from September 1, 2021, to July 31, 2023. Patients (1) with ISS >15 (according to AIS 2015), (2) aged 15-80 years, (3) admitted within 6 h of injury, (4) having no prior treatment before admission, were included. Exclusion criteria were (1) GCS score <9 or AIS score ≥3 for TBI, (2) confirmed infection, infectious disease, or high infection risk, (3) pregnancy, (4) severe primary diseases affecting survival, (5) recent use of immunosuppressive or cytotoxic drugs within the past 6 months, (6) psychiatric patients, (7) participation in other clinical trials within the past 30 days, (8) patients with incomplete data or missing blood samples. Admission serum inflammatory cytokines and pathophysiological data were analyzed to develop machine learning models predicting MODS within 7 days. LR, DR, RF, SVM, NB, and XGBoost were evaluated based on the area under the AUROC. The SHAP method was used to interpret results. RESULTS: This study enrolled 79 patients with major trauma, and the median (Q₁, Q₃) age was 51 (35, 59) years (52 males, 65.8%). The inflammatory cytokine data were collected for all participants. Among these patients, 35 (44.3%) developed MODS, and 44 (55.7%) did not. Additionally, 2 patients (2.5%) from the MODS group succumbed. The logistic regression model showed strong performance in predicting MODS. Ten key cytokines, IL-18, Eotaxin, MCP-4, IP-10, CXCL12, MIP-3α, MCP-1, IL-1RA, Cystatin C, and MRP8/14 were identified as critical to the trauma-induced cytokine storm and MODS development. Early elevation of these cytokines achieved high predictive accuracy, with an AUROC of 0.887 (95% CI 0.813-0.976). CONCLUSION Trauma-induced cytokine storms are strongly associated with MODS. Early identification of inflammatory cytokine changes enables better prediction and timely interventions to improve outcomes.
Humans ; Prospective Studies ; Middle Aged ; Male ; Female ; Adult ; Aged ; Cytokine Release Syndrome/etiology* ; Adolescent ; Young Adult ; Aged, 80 and over ; Wounds and Injuries/complications* ; Cytokines/blood* ; Multiple Organ Failure/diagnosis* ; Machine Learning

Objective To investigate the role of lncRNA SNHG1 in homocysteine-induced pyroptosis of podocyte.Methods Cbs+/-mice were randomly divided into two groups:a normal diet group(ND)and a high me-thionine diet group(HMD).Western blotting was used to detect the protein expression levels of Caspase-1,Cleaved Caspase-1,and NLRP3.Mouse renal glomerular podocytes were cultured in vitro,and then assigned into a control group(Control,0 μmol/L Hcy)and a homocysteine intervention group(Hcy,80 μmol/L Hcy).Western blotting was used to detect the protein expression levels of Caspase-1,Cleaved Caspase-1,and NLRP3.Mouse renal glomerular podocyion group(OE-NC + Hcy)and the lncSNHG1 overexpression + homocysteine intervention group(OE-SNHG1 + Hcy)were also established.After 48 hours of intervention,Real-time fluorescence quantita-tive PCR was used to detect the expression of lncSNHG1 in podocytes after Hcy intervention.Western blot was used to detect the expressions of Caspase-1,Cleaved Caspase-3 and NLRP3.Immunofluorescence was used to de-tect the expression levels of GSDMD and GSDMD-N.ELISA was used to detect the contents of IL-1β and IL-18.Results(1)In the animal experiments,the expression levels of pyroptosis-related proteins Caspase-1,Cleaved Caspase-1,NLRP3,GSDMD,and GSDMD-N were all increased in the HMD group compared with the ND group.(2)In the cellular experiments,the expression levels of Caspase-1,Cleaved Caspase-1,NLRP3,GSDMD,and GSDMD-N were all increased in the Hcy group compared with the Control group,and the contents of pyroptosis-mediated inflammatory factors IL-1β and IL-18 were increased as well.(3)In the cellular experiments,the expres-sion of lncSNHG1 was increased in the Hcy group compared with the control group.After transduction with lnc-SNHG1 lentivirus,the expression of lncSNHG1 was increased in the OE-SNHG1 group,compared with the control group and the OE-NC group.(4)In the cellular experiments,the expressions of pyroptosis-related proteins Cas-pase-1,Cleaved Caspase-1,NLRP3,GSDMD,and GSDMD-N were increased compared with the OE-NC+Hcy group,and the contents of pyroptosis-mediated inflammatory factors IL-1β and IL-18 were increased in the OE-SNHG1+Hcy group.Conclusion These results indicate that lncSNHG1 may play a role in promoting Hcy induced podocytepyroptosis.

Objective:To quantitatively analyze the hospital infectious disease prevention and control policy texts in China, providing reference for optimizing the formulation of hospital infectious disease prevention and control policies and enhancing the public health risk management capabilities of infectious diseases.Methods:With the " hospital" " epidemic" " public health" " risk management" as keywords, relevant policy documents issued from October 2017 to December 2023 were searched on the official websites of the State Council and the National Health Commission. Based on the perspective of public health risk governance for infectious diseases, the content analysis method was used to quantitatively analyze policy texts from three dimensions: policy tools (supply oriented, demand oriented, and environmental oriented), policy objects (hospitals and medical staff as internal objects, grassroots medical and health institutions, disease prevention and control institutions, and health administrative authorities as external objects), and risk management lifecycle (risk identification, risk assessment, risk control, and risk management effectiveness evaluation).Results:A total of 98 hospital infectious disease prevention and control policies were included, with a total of 539 codes obtained. Among them, there were 134, 179, and 226 policy items for supply, demand, and environment oriented, respectively. There were 239, 25, 24, 26, and 225 policy items for hospitals, medical staffs, grassroots medical and health institutions, disease prevention and control institutions, and health administrative authorities, respectively. In the stages of risk identification, risk assessment, risk control, and risk management effectiveness evaluation, there were 117, 34, 326, and 62 policy items, respectively. Three dimensional cross analysis revealed that in the risk identification stage, environmental policy tools were often used to strengthen the responsibilities of hospitals (29/117) and health administrative authorities (23/117); The main policy tools used in the risk assessment stage were demand based tools for the health administrative authorities (6/34); During the risk control stage, three types of policy tools were used to propose requirements for each policy object; The evaluation stage of risk management effectiveness mainly used environmental policy tools to regulate the main responsibility of health administrative authorities (33/62), which was not reflected in grassroots medical and health institutions, medical staffs, and disease prevention and control institutions.Conclusions:In China′s hospital infectious disease prevention and control policies, there were differences in the design and application of various policy tools and risk management policies at different stages, and the division of responsibility for policy objects still needed to be optimized. Policy makers should make reasonable use of policy tools, strengthen the full lifecycle management and policy coverage of infectious disease risks from the perspective of public health governance, clarify the division of responsibilities among various policy objects, and improve the hospital′s ability to manage infectious disease public health risks.

Objective:To review the current research and existing problems of symptom cluster sentinel symptoms in cancer patients both domestically and internationally, so as to provide reference for future research.Methods:The literature on sentinel symptoms of cancer symptom clusters, from the establishment of the database until November 8, 2023, was electronically searched on platforms such as China National Knowledge Infrastructure, WanFang Data, VIP, China Biomedical Database, PubMed, Web of Science, Cochrane Library, Embase and so on. Descriptive statistical analysis was conducted.Results:Sixteen articles were included, with an overall upward trend in publication volume, including 10 Chinese articles and 6 English articles. The sentinel symptom hotspots of cancer patients' symptom clusters mainly included: (1) the number of symptoms included in the analyzed symptom clusters was 3 to 13, the number of symptom clusters was 1 to 8, and the number of sentinel symptoms explored in each literature was 1 to 8; (2) Identification and dynamic changes of sentinel symptoms in symptom clusters; (3) Differences in sentinel symptoms among different symptom groups of cancer patients; (4) Analyzing specific sentinel symptoms of symptom groups based on different statistical methods; (5) Intervention based on sentinel symptoms of symptom clusters.Conclusions:In recent years, the symptom cluster sentinel symptoms of cancer patients have received attention from researchers at home and abroad, but there are problems such as uneven development and inconsistent research methods. High quality identification research is needed to make the included population specific and the methods scientifically unified, and to focus on the impact and mechanism of symptom cluster sentinel symptoms on patient outcomes in symptom clusters, so as to investigate potential mechanisms and promote effective symptom management.

Anaplastic lymphoma kinase (ALK) fusions represent the second most common oncogenic driver mutation in non-small cell lung cancer (NSCLC). As the new class of 3rd generation of ALK tyrosine kinase inhibitor (TKI), lorlatinib has shown robust potency and brain-penetrant clinical activity against a wide spectrum of multiple resistance mutations within the ALK domain detected during crizotinib and 2nd generation ALK TKI treatment. Lorlatinib is generally well-tolerated with unique adverse drug reaction/adverse event, including hyperlipidemia and central nervous system effects, which are mostly mild to moderate severity and manageable through dosage modifications and/or standard medical intervention. For advanced NSCLC with ALK positivity, patients should be evaluated for baseline characteristics and pre-existing medication, informed of the potential toxicities, and periodically monitored to balance benefits and risks. Moreover, a multidisciplinary group of experts is essential to establish a comprehensive diagnostic and therapeutic strategy.
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Aminopyridines ; Carcinoma, Non-Small-Cell Lung/pathology* ; China ; Consensus ; Drug Resistance, Neoplasm/genetics* ; Drug-Related Side Effects and Adverse Reactions/drug therapy* ; Humans ; Lactams ; Lactams, Macrocyclic/adverse effects* ; Lung Neoplasms/pathology* ; Protein Kinase Inhibitors/adverse effects* ; Protein-Tyrosine Kinases/genetics* ; Pyrazoles

Objective:To investigate the value of paraffin-embedded section of cell block in the diagnosis of lung adenocarcinoma in bloody pleural effusion.Methods:The data of 60 patients with lung adenocarcinoma diagnosed by bloody pleural effusion and confirmed by pathological biopsy in the First Affiliated Hospital of Xi'an Jiaotong University from June 2018 to June 2019 were retrospectively analyzed. Cell smears and paraffin-embedded sections of cell blocks using removed red blood cells sedim entation method were used to make cytological examination in bloody pleural effusion. The expressions of carcinoembryonic antigen (CEA), cytokeratin 7 (CK7), NapsinA, thyroid transcription factor 1 (TTF-1), cytokeratin 5/6 (CK5/6), calretinin, P63 and P40 in the specimens were detected by using immunohistochemistry. The results of histopathological examination were used as the gold standard, and the diagnostic values of cell block paraffin-embedded sections and cell smears for lung adenocarcinoma in bloody pleural effusion were evaluated and compared.Results:The cell block sections had a clear background, clear and easy to distinguish cell morphology, and can be made into permanent specimens. The bloody pleural effusion cell smears results of 60 cases of lung adenocarcinoma showed that 21 cases were diagnosed as atypical cells, 39 cases were diagnosed as adenocarcinoma, and the coincidence rate with the diagnosis of adenocarcinoma by histopathological examination results was 65% (39/60); the immunohistochemistry results of cell block paraffin-embedded sections of bloody pleural effusion showed that CK7, NapsinA, TTF-1 and CEA were positive, and P40, P63, CK5/6 and calretinin were negative, all 60 cases were diagnosed as adenocarcinoma according to the results, and the coincidence rate with the diagnosis of adenocarcinoma by histopathological examination results was 100% (60/60), which was significantly higher than that of cytological smears ( χ2 = 23.088, P < 0.01). Conclusions:The technique of paraffin-embedded section of cell block using removed red blood cells sedim entation method has a high diagnostic rate for lung adenocarcinoma in bloody pleural effusion, and it has a high coincidence rate with histopathological diagnosis. It can improve the accuracy of diagnosis of lung adenocarcinoma in bloody pleural effusion, and it also has a good reference value for cytological typing.

【Objective】 To observe the inactivation effect of a new low-temperature plasma air disinfector on microorganisms in the natural environment and artificial contaminated environment so as to further determine the minimum effective processing parameters. 【Methods】 First， in 0.5 m³ of super clean workbench and 1.05 m³ airtight organic glass cavity in the body， the new low-temperature plasma air disinfector developed was used to inactivate the natural bacteria in the air under different parameters. Then in 1.05 m³ airtight organic glass cavity in the body， the new low-temperature plasma air disinfector was used to treat the Staphylococcus aureus and Escherichia coli under the condition of artificial bacteria spraying. Last， the plate counting method was used to evaluate the inactivation effect of the disinfector on natural bacteria and artificial bacteria in the air. 【Results】 For the low-temperature plasma air disinfector in 0.5 m³ and 1.05 m³ confined space， the lowest effective treatment parameters for inactivated natural bacteria were 13 kV， 5 min or 12 kV， 10 min. For the low-temperature plasma air disinfection machine in 13 kV discharge voltage treatment of different time， compared with before treatment， the killing rate of Escherichia coli and Staphylococcus aureus increased significantly after treatment for 20 min （P<0.000 1）. Both could meet the requirements of disinfection specifications ［100%， （99.98±0.01）%≥99.90%］. 【Conclusion】 The inactivation of natural bacteria and artificial bacteria by the new low-temperature plasma air disinfector has reached the qualified standard of disinfection stipulated in Technical Specifications for Disinfection.

Objective To investigate the related factors and preventive measures of delayed gastric emptying after operation for esophageal and cardiac carcinoma.Methods A total of 45 patients with delayed gastric emptying after operation for esophageal and cardiac carcinoma were selected as observation group,and 45 patients without delayed gastric emptying after operation for esophageal and cardiac carcinoma were selected as control group.Differences in the relevant factors were compared between the two groups.Results Single factor analysis showed that older age,high body mass index,short time education,malnutrition,poor mental state,rural residence,surgical incision,blood loss,long operation time,postoperative analgesia pump application,and the large amount of fluid volume were related risks of delayed gastric emptying (P ＜ 0.05).The Logistic regression analysis showed that older age (OR =4.15,95 ％ CI:1.89 ～ 26.30),bad psychological reaction (OR =3.96,95％ CI:1.38 ～ 25.38),long operation time (OR =3.40,95％ CI:1.11 ～ 20.28) and malnutrition (OR =3.02,95％ CI:1.09 ～ 19.35) were independent factors of delayed gastric emptying.Conclusion Delayed gastric emptying is one of the common complications after operation for esophageal and cardiac carcinoma,and the influencing factors are complex.

Objective To investigate the related factors and preventive measures of delayed gastric emptying after operation for esophageal and cardiac carcinoma.Methods A total of 45 patients with delayed gastric emptying after operation for esophageal and cardiac carcinoma were selected as observation group,and 45 patients without delayed gastric emptying after operation for esophageal and cardiac carcinoma were selected as control group.Differences in the relevant factors were compared between the two groups.Results Single factor analysis showed that older age,high body mass index,short time education,malnutrition,poor mental state,rural residence,surgical incision,blood loss,long operation time,postoperative analgesia pump application,and the large amount of fluid volume were related risks of delayed gastric emptying (P ＜ 0.05).The Logistic regression analysis showed that older age (OR =4.15,95 ％ CI:1.89 ～ 26.30),bad psychological reaction (OR =3.96,95％ CI:1.38 ～ 25.38),long operation time (OR =3.40,95％ CI:1.11 ～ 20.28) and malnutrition (OR =3.02,95％ CI:1.09 ～ 19.35) were independent factors of delayed gastric emptying.Conclusion Delayed gastric emptying is one of the common complications after operation for esophageal and cardiac carcinoma,and the influencing factors are complex.

Purpose To explore the role of cell blocks combined with immunohistochemical examination in the diagnosis and differential diagnosis of malignant pleural effusion,and to explore the role of pleural effusion cell blocks in lung adenocarcinoma molecular pathology examination.Methods 142 cases of malignant pleural effusion based cytology,cell blocks of HE staining and immunohistochemical staining by EnVision twostep were retrospectively analysed,the tumor classification was made through analyzing the characteristics of the cells combined with antibody expression.The detection of epidermal growth factor receptor (EGFR) gene mutation of 40 cases of lung adenocarcinoma diagnosed after immunohistochemical staining were used by ARMS-PCR method.Results Among 142 cases of malignant pleural effusion,there were 99 cases caused by lung adenocarcinoma,4 cases of lung small cell carcinoma,3 cases of lung squamous cell carcinoma,13 cases of breast carcinoma,9 cases of ovarian carcinoma,2 cases of gastric carcinoma,1 case of thyroid carcinoma,1 case of endometrial carcinoma,5 cases of mesothelioma,3 cases of lymphoma,1 case of malignant melanoma,1 case of synovial sarcoma.In 40 cases of lung adenocarcinoma pleural effusion cell block,there were 20 cases with EGFR mutations,9 cases of 19del mutations and 11 cases L858R mutations.Conclusion The pleural effusion cell blocks combined immunohistochemistry are useful to improve the accuracy of diagnosis of patients with pleural effusion,and helpful for the determination of classification and the primary site of tumor,assessment of prognosis.Pleural dffusion cell block may used to detect EGFR mutations of lung adenocarcinoma,which provide new source of specimen for the gene detection of lung adenocarcinoma.