Objective To explore the relationship between serum silent information regulator 2 related en-zyme(SIRT)3,SIRT6,and sepsis complicated with acute respiratory distress syndrome(ARDS)and progno-sis.Methods Sixty-eight patients with sepsis complicated with ARDS admitted to the Baoding First Central Hospital from March 2020 to February 2022 were selected as the study objects,and were divided into mild group,moderate group and severe group according to the criteria of mild,moderate and severe ARDS.Accord-ing to the prognosis within 28 days,the patients were divided into survival group and death group.The levels of serum SIRT3 and SIRT6 were detected by enzyme-linked immunosorbent assay.The sequential organ fail-ure assessment(SOFA)scores,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)scores,the levels of serum SIRT3 and SIRT6 in each group were compared.The clinical data of patients were collected,the influencing factors of mortality in patients with sepsis complicated with ARDS was analyzed by univariate and multivariate Logistic regression.The predictive value of serum SIRT3 and SIRT6 of mortality in patients with sepsis complicated with ARDS was analyzed by receiver operating characteristic(ROC)curve.Results The levels of serum SIRT3 and SIRT6 in moderate group and severe group were lower than those in mild group,the scores of SOFA and APACHE Ⅱ were higher than those in mild group,the levels of serum SIRT3 and SIRT6 in severe group were lower than those in moderate group,and the scores of SOFA and APACHE Ⅱwere higher than those in moderate group,with statistical significance(P＜0.05).There were statistically significant differences in age,mechanical ventilation time,lactate,arterial oxygenation index[arterial partial pressure of oxygen(PaO2)/inhaled oxygen concentration(FiO2)],C reactive protein(CRP),interleukin(IL)-6,SIRT3,SIRT6,SOFA score and APACHE Ⅱ score between the two groups(P＜0.05).Longer mechanical ventilation time,higher lactic acid,higher CRP,higher IL-6,higher SOFA score and higher APACHE Ⅱ score were all risk factors for death in sepsis complicated with ARDS within 28 days,while larger PaO2/FiO2,high-er SIRT3 and higher SIRT6 were protective factors(P＜0.05).ROC curve results showed that the area under the curve and 95％CI of serum SIRT3,SIRT6 levels,SOFA score and APACHE Ⅱ score were 0.706(0.493-0.922),0.722(0.497-0.954),0.753(0.570-0.922),0.710(0.442-0.952)and 0.872(0.761-0.976),respectively when applied alone and in combination.Conclusion Serum SIRT3 and SIRT6 levels are decreased in patients with sepsis complicated with ARDS,and the lower the serum SIRT3 and SIRT6 levels are as the disease worsens,the two can help predict the prognosis of patients with sepsis complicated with ARDS.

Objective:To explore the early coagulation function changes of penetrating intestinal firearm injury of pig in high-altitude environments.Methods:Twenty healthy long white piglets were selected and divided into the plain group and the high-altitude group using the random number table method, with 10 pigs in each group. Pigs in the plain group were placed in a plain environment at an altitude of 800 meters, while pigs in the high-altitude group were placed in an experimental chamber simulating an altitude of 6 000 meters for 48 hours. Both groups received pistol gunshot to have firearm penetrating wounds to the abdominal intestinal tract and then returned to the plain observation room. At 0, 2, 4, 8, 12 and 24 hours after injury, coagulation in the peripheral blood and fibrinolytic indexes [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fbg), D-dimer (D-D), and fibrinogen degradation product (FDP)], thromboelastogram (TEG) [reaction time (R), clotting time (K), clot formation rate (α), maximum amplitude (MA) and coagulation composite index (CI) ], platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR)] in the two groups were detected separately.Results:The PT values at 0 and 2 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours than those in the plain group ( P<0.01); there was no significant difference at 4 hours between the two groups ( P>0.05). The APTT values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The TT values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.01); there was no significant difference at 8 hours after injury between the two groups ( P>0.05). The Fbg, D-D and FDP values at 0, 2, 4, 8, 12 and 24 hours after injury were higher in the high-altitude group than those in the plain group ( P<0.01). The R values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The K values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The α angles at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The MA values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The CI values at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The PLT values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The MPV values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.01). The PDW values at 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.05 or 0.01), while there was no significant difference in PDW at 0 hour after injury between the two groups ( P>0.05). The P-LCR values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were all significantly higher than those in the plain group ( P<0.01). Conclusion:Compared with the plain environments, pig intestinal firearm penetrating injury in the high-altitude environments is more prone to early hypercoagulable state accompanied by mild hyperfibrinolysis, and faster to reach a hypocoagulable state accompanied by obvious hyperfibrinolysis.

Objective:To explore the short-term outcomes of 3D-printing stand-alone artificial vertebral body(AVB)in the surgical procedure of anterior cervical corpectomy and fusion(ACCF).Methods:Following the proposal of IDEAL(idea,development,exploration,assessment,and long-term follow-up)framework,we designed and conducted this single-armed,retrospective cohort study.The patients with cervical spondylotic myelopathy were recruited,and these patients exclusively received the surgical procedure of single-level ACCF in our single center.After the process of corpectomy,the size was tailored using different trials and the most suitable stand-alone AVB was then implanted.This AVB was manufactured by the fashion of 3D-printing.Two pairs of screws were inserted in an inclined way into the adjacent vertebral bodies,to stabilize the AVB.The participants were regularly followed-up after the operation.Their clinical data were thoroughly reviewed.We assessed the neurological status according to Japanese Orthopedic Association(JOA)scale.We determined the fusion based on imaging examination six months after the operation.The recorded clinical data were analyzed using specific software and they presented in suitable styles.Paired t test was employed in comparison analysis.Results:In total,there were eleven patients being recruited eventually.The patients were all followed up over six months after the operation.The mean age of the cohort was(57.2±10.2)years.The mean operation time was(76.1±23.1)min and the median bleeding volume was 150(100,200)mL.The postoperative course was uneventful for all the cases.Dysphagia,emergent hematoma,and deterioration of neurological func-tion did not occur.Mean JOA scores were 13.2±2.2 before the operation and 16.3±0.8 at the final follow-up,which were significantly different(P＜0.001).The mean recovery rate of neurological func-tion was 85.9％.By comparing the imaging examinations postoperatively and six months after the opera-tion,we found that the average subsidence length was(1.2±1.1)mm,and that there was only one ca-ses(9.1％)of the severe subsidence(＞3 mm).We observed significant improvement of cervical lor-dosis after the operation(P=0.013).All the cases obtained solid fusion.Conclusion:3D-printing stand-alone AVB presented favorable short-term outcome in one-level ACCF in this study.The fusion rate of this zero-profile prosthesis was satisfactory and the complication rate was relatively low.

To explore the impact of an airway stepwise management strategy in the treatment of hospital acquired pneumonia (HAP) in the ultra elderly critically ill patients.

Objective:To investigate the predictive value of Doppler ultrasonography combined with cytokeratin fragment 19 (Cyfra21-1) and soluble interleukin-2 receptor (sIL-2R) in cervical lymph node metastasis of thyroid micropapillary carcinoma.Methods:102 patients with minimal papillary carcinoma of thyroid confirmed by surgery and pathology admitted to Ultrasound Department, Shanxi Cancer Hospital from Aug. 2020 to Aug. 2023 were selected and treated with thyroidectomy plus central region and at least one cervical lymph node dissection. Among them, There were 24 cases in the LLNM group and 78 cases in the non-LLNM group.Results:There were significant differences in age, shape, nodular and capsule contact area, tumor shape aspect ratio > 1, blood flow, microcalcification, serum Cyfra21-1 and serum sIL-2R levels between the two groups (Cyfra21-1: P<0.001, sIL-2R: P=0.001). Logistic regression analysis showed that age ≥50 years old ( OR=0.443, 95% CI: 0.217-0.904), microcalcification ( OR=2.787, 95% CI: 1.491-5.208), Cyfra21-1>3.3ng/ml ( OR=3.117, 95% CI: 1.404-6.922) and sIL-2R > 110.45pmol/L ( OR=3.408, 95% CI: 1.473-7.884) were independent risk factors for cervical lymph node metastasis in PTMC patients ( P < 0.05). The ROC curve results showed that the area under the curve of cervical lymph node metastasis predicted by Doppler ultrasound combined with Cyfra21-1 and sIL-2R was 0.82, and the sensitivity and specificity were 83.67% and 70.56%, respectively. Conclusions:The calcification features of Doppler ultrasound and the elevation of serum Cyfra21-1 and sIL-2R are closely related to cervical lymph node metastasis of thyroid micropapillary carcinoma. The combination of Doppler ultrasound with serum Cyfra21-1 and sIL-2R has important reference value in predicting cervical lymph node metastasis.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the indoor radon concentrations and to analyze their seasonal variations in urban and rural residential dwellings in Ningxia province.Methods:From March 2022 to March 2023, based on the administrative region division and population distribution in Ningxia, a total of 143 typical residential dwellings, including 82 urban houses and 61 rural houses, were selected to measure indoor radon concentration by CR-39 solid nuclear track detectors for 1 year in Ningxia, with detectors changed every 3 months.Results:The annual average indoor radon concentration in Ningxia was 88 Bq/m 3, range 39-226 Bq/m 3. The annual average indoor radon concentration was below 100 Bq/m 3 for 69.9% of the measured dwellings, and below 300 Bq/m 3 for all of surveyed dwellings. Indoor radon concentrations in rural areas were much higher than those in urban areas ( Z=5.85, P<0.05). Indoor radon concentration varied significantly with the seasons, higher in autumn and winter, but lower in spring and summer, in total ( χ2=63.97, P<0.05), urban ( χ2=24.74, P<0.05), and rural ( χ2=43.15, P<0.05). Conclusion:The annual average indoor radon concentrations in all the measured dwellings are below the reference level of 300 Bq/m 3 recommended by Indoor Air Quality Standard (GB/T 18883-2022) in China.

To define the concept of digital-intelligent pharmacy from three aspects:digital technology,digital intelligence,and data intelligence.By sorting out the development process of hospital pharmacy from informatization to digitalization and then to intelligence in recent years,and combining with the practical experience of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology in the field of digital pharmacy,this paper discussed the meaning of digital pharmacy and provided new ideas and new assistance for the transformation of hospital pharmacy.Digital pharmacy refers to pharmacists with digital intelligence,who apply digital technology to hospital pharmacy scenarios,combining their own pharmaceutical knowledge,to obtain and produce data intelligence,and realize the digital transformation of hospital pharmacy.Digital pharmacy has become an emerging interdisciplinary subject in hospital pharmacy,which can promote the high-quality development of hospital pharmacy in the future and is a new productive force in hospital pharmacy.

Background and purpose:Lung adenocarcinoma has the characteristics of difficult early detection,rapid tumor progression and low surgical resection rate.Although studies on immunotherapy alone and immunotherapy combined with chemotherapy have shown initial success in improving prognosis and overcoming drug resistance,the majority of lung adenocarcinoma patients still receive limited benefits.Therefore,there is an urgent need to identify novel biomarkers with relatively high sensitivity and specificity to improve the prognosis of lung adenocarcinoma.Cell division cycle protein 20(CDC20)is involved in the occurrence and development of various tumors,but its biological role and mechanism in lung adenocarcinoma remain unclear.The aim of this study was to investigate the expression of CDC20 in lung adenocarcinoma and its predictive value for the prognosis of patients with lung adenocarcinoma,and to further explore the effects of CDC20 on the proliferation and invasion capabilities of lung adenocarcinoma cells.Methods:Utilizing immunohistochemistry(IHC)to detect the expression of CDC20 in lung adenocarcinoma tissues,we analyzed its correlation with poor prognosis in combination with bioinformatics and clinicopathological parameters.Kaplan-Meier survival curves were employed to illustrate the impact of CDC20 on postoperative survival rates in lung adenocarcinoma patients.COX multivariate regression analysis was conducted to identify independent prognostic factors influencing postoperative survival rates.Additionally,receiver operating characteristic(ROC)curves were applied to assess the diagnostic value of CDC20 expression in lung adenocarcinoma patients.Real-time fluorescence quantitative polymerase chain reaction(RTFQ-PCR)and Western blot were used to measure the expression levels of CDC20 in normal human lung epithelial cells(BEAS-2B)and human lung adenocarcinoma cells(A549 and H1299).In cellular experiments,CDC20 was knocked down in lung adenocarcinoma cells,which were divided into three groups:si-NC(control group),si-CDC20#1(knockdown group 1)and si-CDC20#2(knockdown group 2).Cell counting kit-8(CCK-8),colony formation,transwell and wound healing assays were conducted to assess cell proliferation,migration and invasion capabilities.Functional enrichment analysis using Geng Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathways was conducted to explore the biological roles of CDC20 in lung adenocarcinoma.Finally,gene set enrichment analysis(GSEA)was employed to investigate potential regulatory pathways of CDC20 in lung adenocarcinoma.This study was approved by the Ethics Committee of Hebei Chest Hospital(Number:2022051).Results:The results of both bioinformatics analysis and IHC demonstrated a significantly high expression of CDC20 in lung adenocarcinoma tissues(P＜0.05).Both bioinformatics analysis and clinical parameter evaluation revealed a correlation between high CDC20 expression and poor patient prognosis.Kaplan-Meier survival analysis and COX regression analysis consistently indicated a significant negative correlation between CDC20 expression and postoperative survival rates in patients(P＜0.05).Additionally,the expression levels of CDC20 were higher in human lung adenocarcinoma cell lines A549 and H1299 compared with BEAS-2B(P＜0.05).Knockdown of CDC20 effectively inhibited the proliferation,migration and invasion of lung adenocarcinoma cells(P＜0.05).The results of GO,KEGG pathways and GSEA consistently pointed to a relationship between CDC20 and cell cycle regulation.Conclusion:CDC20 is highly expressed in lung adenocarcinoma.High expression of CDC20 is an independent risk factor for poor prognosis of lung adenocarcinoma patient.CDC20 can promote the proliferation,migration and invasion of lung adenocarcinoma cells.

Objective To investigate the effect of T helper cell 17(Th17)on the progression of B cell-acute lymphoblastic leukemia(B-ALL)and its possible mechanism.Methods We established the B-ALL mouse model and detected the proportion of Th17 cells in peripheral blood,bone marrow,spleen and lymph nodes by flow cytometry.Further,we used cytokine microarray to analyze the expression of cytokine in peripheral blood of B-ALL mice,and used ELISA to verify the IL-17A expression in peripheral blood of B-ALL mice.Th17 cells were co-cultured with leukemia cells,and the apoptosis ratio of Ki-67 positive cells and B-ALL cells was detected by flow cytometry,the recruitment effect of B-All cells on Th17 cells was analyzed.The expression of apoptosis-related proteins was detected by Western blot.The development of B-ALL by secreting IL-17A from Th17 cells was evaluated in vivo in a mouse model of human acute leukemia.Results Th17 cells were increased in peripheral blood(P<0.0001),bone marrow(P<0.0001),spleen(P<0.0001)and lymph nodes(P<0.0001)of B-ALL mice.The expression of IL-17A was increased in peripheral blood of B-ALL model mice(P<0.0001),and Th17 cells promoted the proliferation of B-All cells and inhibited their apoptosis through IL-17A(P<0.0001).B-All cells recruit Th17 cells through CXCL16(P<0.0001).The animal experiments showed that IL-17A treatment significantly increased the proportion of leukemia cells in peripheral blood,bone marrow and spleen of B-ALL mice,and shortened their survival time.Conclusion The proportion of Th17 cells in B-ALL increases,B-All cells recruit Th17 cells through CXCL16,and Th17 cells secrete IL-17A to promote B-All progression.