Objective To investigate the predictive value of systemic immune-inflammation index(SII)and N-terminal pro-brain natriuretic peptide(NT-proBNP)level in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)developing contrast-induced acute kidney injury(CIAKI)after PCI.Methods A total of 1085 elderly STEMI patients undergoing emergency PCI in the Affiliated Hospital of Xuzhou Medical University from January 2018 to March 2023 were consecutively recruited as a training set,and another 287 elderly STEMI pa-tients receiving emergency PCI in the East Branch of the Affiliated Hospital from January 2021 to June 2023 were included as a verification set.According to the diagnostic criteria of CIAKI,they were divided into CIAKI group(n=95)and non-CIAKI group(n=990).Based on the results of restricted cubic spline(RCS)analysis,the patients from the training set were assigned into low-risk subgroup(n=292),moderate-risk group(n=515)and high-risk group(n=278).Multivari-ate logistic regression analysis was used to analyze the independent risk factors of CIAKI in elder-ly STEMI patients after PCI,and ROC curve was plotted to analyze the predictive value of combi-nation of SII and NT-proBNP.The risk of CIAKI was compared among the patients at different risk grades.Results Age,SII,baseline serum creatinine,NT-proBNP,fasting blood glucose and use of diuretics were independent risk factors for CIAKI after primary PCI in elderly STEMI patients(P＜0.05,P＜0.01).The AUC value of SII combined with NT-proBNP in predicting CIAKI was 0.801(95％CI:0.761-0.842,P＜0.01),with a sensitivity of 83.2％and a specificity of 67.5％,both superior to that of SII or NT-proBNP alone.RCS analysis revealed an increased risk of CIAKI at SII ≥1084.97 × 109/L and NT-proBNP ≥296.12 ng/L.The incidence of CIAKI was increased with the increase of risk grades(1.71％vs 6.41％vs 20.50％).Conclusion SII and NT-proBNP are independent risk factors for CIAKI after emergency PCI in elderly STEMI pa-tients.And their combination has better predictive value for CIAKI.

Objective:To explore the current status of barriers to participation in phaseⅡcoronary artery bypass grafting (CABG) patients and the factors influencing them, and to provide new ideas for reducing barriers to participation in rehabilitation and improving the participation rate in cardiac rehabilitation.Methods:For this study, a cross-sectional survey research method was utilized. The study included 334 patients who underwent CABG and were admitted to the Second Hospital of Hebei Medical University between June 2022 and May 2023. These patients were selected using the convenience sampling method. A General Information Questionnaire, the Cardiac Rehabilitation Barriers Scale (CRBS-C/M), and a Questionnaire on the Knowledge of Information Related to Cardiac Rehabilitation were used to conduct the survey. Multiple linear regression was used to analyze the independent influencing factors on barriers to participation in phase Ⅱ cardiac rehabilitation in post-CABG patients.Results:Out of 334 patients, 248 were males and 86 were females with age (54.74 ± 7.61) years old. The total average score of CRBS-C/M in patients after CABG surgery was 3.20 ± 0.43, with the highest external logistic factors score of 3.42 ± 0.58. The knowledge status score of information related to cardiac rehabilitation was 42.11 ± 7.94. Multiple linear regression analysis revealed that the following factors independently influenced post-CABG patients′ barriers to participating in phaseⅡcardiac rehabilitation: marital status, whether or not they had completed phase I cardiac rehabilitation,number of other comorbidities, knowledge of cardiac rehabilitation information. All of these differences were statistically significant ( t values were -4.87-3.35, all P<0.05). Conclusions:The barriers to participation in phase Ⅱ cardiac rehabilitation in post-CABG patients are at an intermediate to high level, and healthcare professionals should emphasize the assessment of barrier factors in these patients, and target the development and implementation of phase Ⅱ cardiac rehabilitation in terms of the influencing factors.

Objective:To investigate the factors contributing to frailty in very elderly patients with multimorbidity.Methods:This cross-sectional study enrolled 119 very elderly patients with multimorbidity who were hospitalized in the Department of Geriatrics of Huadong Hospital Affiliated to Fudan University from August 2022 to March 2023.The study aimed to understand the basic status of multimorbidity by collecting general information, the number and types of diseases, and frailty status.The subjects were divided into frail and non-frail groups through comprehensive geriatric assessment.Various factors including gender, age, Tinetti balance gait score, risk of sarcopenia, dementia, depression, risk of deep vein thrombosis, dysphagia, comorbidity index, medication count, Basic Activities of Daily Living(BADL)score, Instrumental Activities of Daily Living(IADL)score, Nutritional Risk Screening 2002(NRS-2002)score, Norton pressure injury risk assessment score, and Social Support Rating Scale(SSRS)score were compared.The correlation between each factor and the occurrence of frailty was analyzed using univariate analysis and multivariate Logistic regression analysis.Results:A total of 119 elderly inpatients with multimorbidity, with an average age of 90.8±5.9 years old, were included in the study.The incidence of frailty was 68.9%(82 cases).Univariate analysis revealed significant statistical differences between the frail group and the non-frail group in various factors including age( t=-3.131, P=0.002), Tinetti score( Z=-5.544, P<0.001), risk of sarcopenia( χ2=39.205, P<0.001), dysphagia( χ2=5.937, P=0.015), Charlson comorbidity index( Z=-2.565, P=0.010), medication count( Z=-3.325, P<0.001), BADL( Z=-5.871, P<0.001), IADL( Z=-5.062, P<0.001), Norton score( Z=-5.922, P<0.001), and SSRS social support( Z=-2.637, P=0.008).Multivariate logistic regression analysis showed that the Tinetti score( OR=0.843, 95% CI: 0.737-0.966, P=0.014), decreased muscle strength( OR=11.226, 95% CI: 2.157-58.432, P=0.004), sarcopenia( OR=18.084, 95% CI: 2.041-106.211, P=0.009), Norton score( OR=0.462, 95% CI: 0.254-0.838, P=0.011), and medication count( OR=1.153, 95% CI: 1.000-1.329, P=0.049)were independently associated with frailty. Conclusions:In very elderly patients with multimorbidities, the occurrence of frailty is notably increased.Frailty is linked to multiple risks including falls, muscle weakness/sarcopenia, pressure ulcer risk, and polypharmacy, and these risks are independent of other factors.

Objective:To investigate the current status of early nutritional support treatment in patients with severe acute pancreatitis complicated with intestinal fistula,and analyze the impact on the clinical outcomes of patients.Methods:Retrospective analysis was used to select the relevant data of 60 ICU admission patients with severe acute pancreatitis complicated with intestinal fistula of a tertiary hospital in Nanjing from May 2022 to May 2023,the statistics analysis of the patients'early nutritional support treatment were carried out,and explored the impact on clinical outcomes of patients.Results:A total of 45(75％)and 57(95％)patients started EN and PN treatment within 48 h of admission.The EEN calorie compliance rate after admission of 1 week was 44.2％.There was a difference in mechanical ventilation time and hospitalization expenses between the early enteral nutrition calorie group and non-compliance group,but no significant difference in the length of ICU stay(P＞0.005).Conclusion:The early enteral nutrition compliance rate of patients with severe acute pancreatitis combined with intestinal fistula is slightly lower.Compared with the early enteral nutrition non-compliance group,the enteral nutrition standard group has shorter mechanical ventilation time and lower total hospitalization costs,which can improve the clinical outcome of patients.

Worldwide, the incidence of cancer is greatest in China. Tumor screening is effective to achieve early diagnosis, improve prognosis, increase the quality of life, and reduce mortality among cancer patients. Positron emission tomography/computed tomography (PET/CT) imaging provides metabolic data to support initial staging, treatment planning, and response evaluation in tumor screening, as well as tumor follow-up. The progressive integration of PET/CT imaging in radiotherapy has its basic principle in the biological heterogeneity of inter- and intra-tumor malignant lesions, and the radiation dose is required to be adjusted to achieve effective local tumor control among cancer patients. In addition, PET/CT imaging provides data on the biological features of tumor lesions, such as metabolism, hypoxia, and proliferation, which is useful to identify radiation-resistant regions and optimize treatment plans. These data are effective to reduce the uncertainty and variability in the anatomic description of tumor sites. This review summarizes the application of PET/CT imaging in common tumors.

OBJECTIVE: To discuss the development of a multifunctional and multipoint fixed support drainage device for the digestive tract, as well as the effect of its application on animal experimental models and patients. METHODS: The digestive tract multifunctional and multipoint fixed support drainage device is designed according to the requirements of the various gastrointestinal surgery and interventional procedures. It has metal flaps and airbags to achieve multi point fixation. The cuffs and shears are used to achieve endoscopic removal. And through different tube diameters and lengths, surgeons can achieve different surgical purposes. RESULTS: A multifunctional and multipoint fixed support drainage device for the digestive tract was successfully designed and developed. The application experiment of the winged pancreatico-intestinal supporting drainage tube on animal models and patients, showed lower drainage fluid amylase level, faster amylase recovery speed, and better perioperative safety. CONCLUSIONS The support drainage device has the characteristics of simple operation, firm fixation, and good controllability of removal. It is an ideal choice among support drainage tubes in gastrointestinal surgery and interventional operations.
Drainage ; Gastrointestinal Tract ; Endoscopy

The combination of conventional single-photon emission computed tomography (SPECT) and computed tomography (CT) may display the morphological changes of lesions and distribution of imaging agents, which is effective to improve the imaging sensitivity and specificity of tumors and non-tumor diseases. SPECT/CT is feasible to analyze the anatomical structure and metabolic status through displaying multi-site lesions with single imaging, thereby improving differential diagnosis and diagnostic accuracy of diseases. In addition, the novel mixed SPECT/CT device shortens the duration of image acquisition and provides precise attenuation correction and fusion imaging, which provides a scientific basis for rational selection of treatment regimens in clinical practice. This review describes the advances in clinical application of SPECT/CT.

Objective:To explore the effects and mechanism of annexin A1 ( ANXA1)-overexpressing human adipose-derived mesenchymal stem cells (AMSCs) in the treatment of mice with acute respiratory distress syndrome (ARDS). Methods:The experimental study method was adopted. After the adult AMSCs were identified by flow cytometry, the 3 rd passage cells were selected for the follow-up experiments. According to the random number table (the same grouping method below), the cells were divided into ANXA1-overexpressing group transfected with plasmid containing RNA sequences of ANXA1 gene and no-load control group transfected with the corresponding no-load plasmid. The other cells were divided into ANXA1-knockdown group transfected with plasmid containing small interfering RNA sequences of ANXA1 gene and no-load control group transfected with the corresponding no-load plasmid. At post transfection hour (PTH) 72, the fluorescence expression was observed under a fluorescence microscope imaging system, and the protein and mRNA expressions of ANXA1 were detected by Western blotting and real-time fluorescence quantitative reverse transcription polymerase chain reaction respectively (with the sample numbers being 3). Fifty male C57BL/6J mice aged 6-8 weeks were divided into sham injury group, ARDS alone group, normal cell group, ANXA1-overexpressing group, and ANXA1-knockdown group, with 10 mice in each group. Mice in the last 4 groups were treated with endotoxin/lipopolysaccharide to make ARDS lung injury model, and mice in sham injury group were simulated to cause false injury. Immediately after injury, mice in sham injury group and ARDS alone group were injected with normal saline through the tail vein, while mice in normal cell group, ANXA1-overexpressing group, and ANXA1-knockdown group were injected with normal AMSCs, ANXA1-overexpressing AMSCs, and ANXA1-knockdown AMSCs, correspondingly. At post injection hour (PIH) 24, 5 mice in each group were selected, the Evans blue staining was performed to observe the gross staining of the right lung tissue, and the absorbance value of bronchoalveolar lavage fluid (BALF) supernatant of left lung was detected by microplate reader to evaluate the pulmonary vascular permeability. Three days after injection, the remaining 5 mice in each group were taken, the right lung tissue was collected for hematoxylin-eosin staining to observe the pathological changes and immunohistochemical staining to observe the CD11b and F4/80 positive macrophages, and the levels of tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and IL-1β in BALF supernatant of left lung were determined by enzyme-linked immunosorbent assay. Data were statistically analyzed with paired sample t test, one-way analysis of variance, and least significant difference test. Results:At PTH 72, AMSCs in both ANXA1-overexpressing group and ANXA1-knockdown group expressed higher fluorescence intensity than AMSCs in corresponding no-load control group, respectively. At PTH 72, compared with those in corresponding no-load control group, the protein and mRNA expressions of ANXA1 in ANXA1-overexpressing group were significantly increased (wth t values of 249.80 and 6.56, respectively, P<0.05), while the protein and mRNA expressions of ANXA1 in ANXA1-knockdown group were significantly decreased (wth t values of 176.50 and 18.18, respectively, P<0.05). At PIH 24, compared with those in sham injury group (with the absorbance value of BALF supernatant being 0.041±0.009), the lung tissue of mice in ARDS alone group was obviously blue-stained and the absorbance value of BALF supernatant (0.126±0.022) was significantly increased ( P<0.05). Compared with those in ARDS alone group, the degree of blue-staining in lung tissue of mice was significantly reduced in normal cell group or ANXA1-overexpressing group, and the absorbance values of BALF supernatant (0.095±0.020 and 0.069±0.015) were significantly decreased ( P<0.05), but the degree of blue-staining in lung tissue and the absorbance value of BALF supernatant (0.109±0.016, P>0.05) of mice in ANXA1-knockdown group had no significant change. Compared with that in normal cell group, the absorbance value of BALF supernatant of mice in ANXA1-overexpressing group was significantly decreased ( P<0.05). Three days after injection, the lung tissue structure of mice in ARDS alone group was significantly damaged compared with that in sham injury group. Compared with those in ARDS alone group, hemorrhage, infiltration of inflammatory cells, alveolar collapse, and interstitial widening in the lung tissue of mice were significantly alleviated in normal cell group and ANXA1-overexpressing group, while no significant improvement of above-mentioned lung tissue manifestation was observed in ANXA1-knockdown group. Three days after injection, the numbers of CD11b and F4/80 positive macrophages in the lung tissue of mice in ARDS alone group were significantly increased compared with those in sham injury group. Compared with those in ARDS alone group, the numbers of CD11b and F4/80 positive macrophages in lung tissue of mice in normal cell group, ANXA1-overexpressing group, and ANXA1-knockdown group reduced, with the most significant reduction in ANXA1-overexpressing group. Three days after injection, compared with those in sham injury group, the levels of TNF-α, IL-6, and IL-1β in BALF supernatant of mice in ARDS alone group were significantly increased ( P<0.05). Compared with those in ARDS alone group, the levels of TNF-α, IL-6, and IL-1β in BALF supernatant of mice in normal cell group and ANXA1-overexpressing group, as well as the level of IL-1β in BALF supernatant of mice in ANXA1-knockdown group were significantly decreased ( P<0.05). Compared with that in normal cell group, the level of TNF-α in BALF supernatant of mice was significantly decreased in ANXA1-overexpressing group ( P<0.05) but significantly increased in ANXA1-knockdown group ( P<0.05). Conclusions:Overexpression of ANXA1 can optimize the efficacy of AMSCs in treating ARDS and enhance the effects of these cells in inhibiting inflammatory response and improving pulmonary vascular permeability, thereby alleviating lung injury of mice with ARDS.

Aging refers to the process by which the structural degeneration and functional decline over time, eventually leading to dysfunction of multiple organs and systems, even death. Stem cells are gradually applied to the field of anti-aging due to their multiple differentiation and paracrine functions, and adipose-derived mesenchymal stem cell (ADSC) arise our attention for the characteristic of easy to access and low immunogenicity. This lecture elaborates the ability of ADSC to fight aging in various systems, reflecting their important prospects in the anti-aging field.

Aging refers to the process by which the structural degeneration and functional decline over time, eventually leading to dysfunction of multiple organs and systems, even death. Stem cells are gradually applied to the field of anti-aging due to their multiple differentiation and paracrine functions, and adipose-derived mesenchymal stem cell (ADSC) arise our attention for the characteristic of easy to access and low immunogenicity. This lecture elaborates the ability of ADSC to fight aging in various systems, reflecting their important prospects in the anti-aging field.