Lung ultrasound score evaluation of the effect of pressure-controlled ventilation volume-guaranteed on patients undergoing laparoscopicassisted radical gastrectomy

BACKGROUND Laparoscopic-assisted radical gastrectomy(LARG)is the standard treatment for early-stage gastric carcinoma(GC).However,the negative impact of this proce-dure on respiratory function requires the optimized intraoperative management of patients in terms of ventilation.AIM To investigate the influence of pressure-controlled ventilation volume-guaranteed(PCV-VG)and volume-controlled ventilation(VCV)on blood gas analysis and pulmonary ventilation in patients undergoing LARG for GC based on the lung ultrasound score(LUS).METHODS The study included 103 patients with GC undergoing LARG from May 2020 to May 2023,with 52 cases undergoing PCV-VG(research group)and 51 cases undergoing VCV(control group).LUS were recorded at the time of entering the operating room(T0),20 minutes after anesthesia with endotracheal intubation(T1),30 minutes after artificial pneumoperitoneum(PP)establishment(T2),and 15 minutes after endotracheal tube removal(T5).For blood gas analysis,arterial partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))were observed.Peak airway pressure(P_(peak)),plateau pressure(Pplat),mean airway pressure(P_(mean)),and dynamic pulmonary compliance(C_(dyn))were recorded at T1 and T2,1 hour after PP establishment(T3),and at the end of the operation(T4).Postoperative pulmonary complications(PPCs)were recorded.Pre-and postoperative serum interleukin(IL)-1β,IL-6,and tumor necrosis factor-α(TNF-α)were measured by enzyme-linked immunosorbent assay.RESULTS Compared with those at T0,the whole,anterior,lateral,posterior,upper,lower,left,and right lung LUS of the research group were significantly reduced at T1,T2,and T5;in the control group,the LUS of the whole and partial lung regions(posterior,lower,and right lung)decreased significantly at T2,while at T5,the LUS of the whole and some regions(lateral,lower,and left lung)increased significantly.In comparison with the control group,the whole and regional LUS of the research group were reduced at T1,T2,and T5,with an increase in PaO_(2),decrease in PaCO_(2),reduction in P_(peak) at T1 to T4,increase in P_(mean) and C_(dyn),and decrease in Pplat at T4,all significant.The research group showed a significantly lower incidence of PPCs than the control group within 3 days postoperatively.Postoperative IL-1β,IL-6,and TNF-αsignificantly increased in both groups,with even higher levels in the control group.CONCLUSION LUS can indicate intraoperative non-uniformity and postural changes in pulmonary ventilation under PCV-VG and VCV.Under the lung protective ventilation strategy,the PCV-VG mode more significantly improved intraop-erative lung ventilation in patients undergoing LARG for GC and reduced lung injury-related cytokine production,thereby alleviating lung injury.

Lipid levels and insulin resistance markers in patients with colorectal cancer:Propensity score matching analysis

BACKGROUND Colorectal cancer(CRC)is a prevalent malignant neoplasm characterized by subtle early manifestations.AIM To investigate the correlation among serum lipid profiles,the triglyceride-glucose(TyG)index,and the atherosclerotic index(AI)in patients with CRC.Furthermore,it explored the clinical diagnostic utility of combining serum lipids with cancer antigens in the context of CRC.METHODS A retrospective analysis encompassed 277 patients with CRC and 1034 healthy individuals.RESULTS Following propensity score matching,patients with CRC exhibited significantly reduced levels of serum triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol,and low-density lipoprotein cholesterol(LDL-C),as well as a diminished TyG index.Conversely,they displayed elevated AI levels compared to their healthy counterparts.Patients in advanced stages exhibited lower serum levels of TG,TC,and LDL-C compared to those in early stages.Patients with positive lymph node metastasis demonstrated reduced levels of TG,LDL-C,and the TyG index.Receiver operating characteristic analysis revealed that the combination of the TyG index,carcinoembryonic antigen,and carbohydrate antigen 19-9 yielded the highest positive prediction rate for CRC at 75.3%.CONCLUSION Preoperative serum lipid profiles exhibit a robust association with patients with CRC.The concurrent assessment of multiple serum lipids and cancer antigens effectively enhances the diagnostic accuracy for CRC.

Coagulation indices and fibrinogen degradation products as predictive biomarkers for tumor-node-metastasis staging and metastasis in gastric cancer

BACKGROUND Gastric cancer(GC)is a prevalent malignancy with a substantial health burden and high mortality rate,despite advances in prevention,early detection,and treatment.Compared with the global average,Asia,notably China,reports disproportionately high GC incidences.The disease often progresses asymptoma-tically in the early stages,leading to delayed diagnosis and compromised out-comes.Thus,it is crucial to identify early diagnostic biomarkers and enhance treatment strategies to improve patient outcomes and reduce mortality.METHODS Retrospectively analyzed the clinical data of 148 patients with GC treated at the Civil Aviation Shanghai Hospital between December 2022 and December 2023.The associations of coagulation indices-partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen,fibrinogen degradation products(FDP),fasting blood glucose,and D-dimer(D-D)with TNM stage and distant metastasis were examined.RESULTS Prolongation of APTT,PT,and TT was significantly correlated with the GC TNM stage.Hence,abnormal coagulation system activation was closely related to disease progression.Elevated FDP and D-D were significantly associated with distant metastasis in GC(P<0.05),suggesting that increased fibrinolytic activity contributes to increased metastatic risk.CONCLUSION Our Results reveal coagulation indices,FDPs as GC biomarkers,reflecting abnormal coagulation/fibrinolysis,aiding disease progression,metastasis prediction,and helping clinicians assess thrombotic risk for early intervention and personalized treatment plans.

Obesity paradox in patients with community-acquired pneumonia:Have you fully considered the confounding factors?

There exists a notion that there is an obesity paradox in the prognosis of community-acquired pneumonia.In other words,obese individuals with communityacquired pneumonia have a better prognosis.The study by Wang et al supports this claim,but we believe that the obesity paradox should not be proposed hastily as it is influenced by numerous subjective and objective confounding factors.

Improving postoperative outcomes in patients with pancreatic cancer:Inflammatory and nutritional biomarkers

This editorial assesses the prognostic value of preoperative inflammatory and nutritional biomarkers in patients undergoing surgical resection for pancreatic cancer.Lu et al evaluated the ability of seven biomarkers to predict postoperative recovery and long-term outcomes.These biomarkers were albumin-to-globulin ratio,prognostic nutritional index(PNI),systemic immune-inflammation index,neutrophil-to-lymphocyte ratio,platelet-to-lymphocyte ratio,nutritional risk index,and geriatric nutritional risk index.The PNI was found to be a strong predictor of both overall and recurrence-free survival,underscoring its clinical relevance in managing patients with pancreatic cancer.

Persistent alterations in gray matter in COVID-19 patients experiencing sleep disturbances:a 3-month longitudinal study

Sleep disturbances are among the most prevalent neuropsychiatric symptoms in individuals who have recovered from severe acute respiratory syndrome coronavirus 2 infections.Previous studies have demonstrated abnormal brain structures in patients with sleep disturbances who have recovered from coronavirus disease 2019(COVID-19).However,neuroimaging studies on sleep disturbances caused by COVID-19 are scarce,and existing studies have primarily focused on the long-term effects of the virus,with minimal acute phase data.As a result,little is known about the pathophysiology of sleep disturbances in the acute phase of COVID-19.To address this issue,we designed a longitudinal study to investigate whether alterations in brain structure occur during the acute phase of infection,and verified the results using 3-month follow-up data.A total of 26 COVID-19 patients with sleep disturbances(aged 51.5±13.57 years,8 women and 18 men),27 COVID-19 patients without sleep disturbances(aged 47.33±15.98 years,9 women and 18 men),and 31 age-and gender-matched healthy controls(aged 49.19±17.51 years,9 women and 22 men)were included in this study.Eleven COVID-19 patients with sleep disturbances were included in a longitudinal analysis.We found that COVID-19 patients with sleep disturbances exhibited brain structural changes in almost all brain lobes.The cortical thicknesses of the left pars opercularis and left precuneus were significantly negatively correlated with Pittsburgh Sleep Quality Index scores.Additionally,we observed changes in the volume of the hippocampus and its subfield regions in COVID-19 patients compared with the healthy controls.The 3-month follow-up data revealed indices of altered cerebral structure(cortical thickness,cortical grey matter volume,and cortical surface area)in the frontal-parietal cortex compared with the baseline in COVID-19 patients with sleep disturbances.Our findings indicate that the sleep disturbances patients had altered morphology in the cortical and hippocampal structures during the acute phase of infection and persistent changes in cortical regions at 3 months post-infection.These data improve our understanding of the pathophysiology of sleep disturbances caused by COVID-19.

Impact of disease severity on gastric residual volume in critical patients

AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were enrolled. Sequential Organ Failure Assessment (SOFA) score was assessed immediately preceding the start of the study. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded on the first, fourth, seventh, and fourteenth day of the study period. GRV was measured every 4 h during enteral feeding. The relationship be-tween mean daily GRV and SOFA scores and the correlation between mean daily GRV and mean APACHE Ⅱ score of all patients were evaluated and compared. RESULTS: Of the 61 patients, 43 patients were survivors and 18 patients were non-survivors. The mean daily GRV increased as SOFA scores increased (P < 0.001, analysis of variance). Mean APACHE Ⅱ scores of all patients correlated with mean daily GRV (P = 0.011, Pearson correlation) during the study period. Patients with decreasing GRV in the first 2 d had better survival than patients without decreasing GRV (P = 0.017, log rank test). CONCLUSION: GRV is higher in more severely ill medical ICU patients. Patients with decreasing GRV had lower ICU mortality than patients without decreasing GRV.

Effects of high-volume hemofiltration on alveolar- arterial oxygen exchange in patients with refractory septic shock

BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS：A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A, n=41）, and fluid resuscitation plus high-volume hemofiltration （group B, n=48）, The levels of O2 content of central venous blood （CcvO2）, arterial oxygen content （CaO2）, alveolar-arterial oxygen pressure difference P（A-a）DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/ PAO2）, respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0, 24, 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2：0.60±0.24 vs, 0.72±0.28, P〈0.05; CaO2：0.84±0.43 vs. 0.94±0.46, P〈0.05）. The level of oxygen extraction rate （O2ER） in group A on the 7th day was significantly higher than that in group B （ 28.7±2.4 vs. 21.7±3.4, P〈0.01）. The levels of P（A-a）DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A （P〈0.05 or P〈0.01）. The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A （8.2±3.8 vs. 17.2±6.8, P〈0.01）. HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.

A sludge volume index (SVI) model based on the multivariate local quadratic polynomial regression method

In this study, a multivariate local quadratic polynomial regression(MLQPR) method is proposed to design a model for the sludge volume index(SVI). In MLQPR, a quadratic polynomial regression function is established to describe the relationship between SVI and the relative variables, and the important terms of the quadratic polynomial regression function are determined by the significant test of the corresponding coefficients. Moreover, a local estimation method is introduced to adjust the weights of the quadratic polynomial regression function to improve the model accuracy. Finally, the proposed method is applied to predict the SVI values in a real wastewater treatment process(WWTP). The experimental results demonstrate that the proposed MLQPR method has faster testing speed and more accurate results than some existing methods.

Extrapancreatic necrosis volume:A new tool in acute pancreatitis severity assessment?

BACKGROUND Many scores have been suggested to assess the severity of acute pancreatitis upon onset.The extrapancreatic necrosis volume is a novel,promising score that appears to be superior to other scores investigated so far.AIM To evaluate the discriminatory power of extrapancreatic necrosis volume to identify severe cases of acute pancreatitis.METHODS A total of 123 patients diagnosed with acute pancreatitis at Institute of Gastroenterology and Hepatology,St Spiridon Hospital between January 1,2017 and December 31,2019 were analyzed retrospectively.Pancreatitis was classified according to the revised Atlanta classification(rAC)as mild,moderate,or severe.Severity was also evaluated by computed tomography and classified according to the computed tomography severity index(CTSI)and the modified CTSI(mCTSI).The results were compared with the extrapancreatic volume necrosis to establish the sensitivity and specificity of each method.RESULTS The CTSI and mCTSI imaging scores and the extrapancreatic necrosis volume were highly correlated with the severity of pancreatitis estimated by the rAC(r=0.926,P<0.001 and r=0.950,P<0.001;r=0.784,P<0.001,respectively).The correlation of C-reactive protein with severity was positive but not as strong,and was not significant(r=0.133,P=0.154).The best predictor for the assessment of severe pancreatitis was the extrapancreatic necrosis volume[area under the curve(AUC)=0.993;95%confidence interval(CI):0.981-1.005],with a 99.5%sensitivity and 99.0%specificity at a cutoff value of 167 mL,followed by the mCTSI 2007 score(AUC=0.972;95%CI:0.946-0.999),with a 98.0%sensitivity and 96.5%specificity,and the CTSI 1990 score(AUC=0.969;95%CI:0.941-0.998),with a 97.0%sensitivity and 95.0%specificity.CONCLUSION Radiological severity scores correlate strongly and positively with disease activity.Extrapancreatic necrosis volume shows the best diagnostic accuracy for severe cases.

Dosimetric Comparison of Volumetric Modulated Arc Therapy (VMAT), 5F Intensity Modulated Radiotherapy (IMRT) and 3D Conformal Radiotherapy (3DCRT) in Rectal Carcinoma Receiving Neoadjuvant Chemoradiotherapy

Objective: To investigate better dosimetric distribution of volumetric modulated arc therapy (VMAT) vs. 5F intensity modulated radiotherapy (IMRT) and 3D conformal radiotherapy (3DCRT) in patients with locally advanced rectal cancer (LARC) when treated with neoadjuvant chemoradiotherapy. Methods: 3D-CRT, 5F-IMRT and VMAT plans for preoperative radiotherapy were 66011designed in 12 patients with locally advanced rectal cancer. The conformity index (CI) and homogeneity index (HI) in target volume, and the dose and volume of the organs at risk (OAR) irradiated including small bowel, bladder and bilatera1 femoral heads were compared among the three plans. Results: The CI for planning target volume (PTV) 2 and HI for PTV1 of VMRT and 5F-IMRT were superior to 3D-CRT. The CI of VMAT, 5F-IMRT and 3D-CRT plans were 0.71, 0.69 and 0.62 (p = 0.011 and p = 0.019, respectively). The HI of the VMAT and 5F-IMRT plans were both 1.04 and 3D-CRT planning was 1.06 (p = 0.022 and p = 0.006, respectively). The V35 - V45 of small bowel in VMAT were significantly less than in 5F-IMRT and 3D-CRT. V35 was 47.0, 56.4, and 72.8 cm3 for VMAT, 5F-IMRT, and 3D-CRT (p = 0.021 and p = 0.034, respectively), while V40 was 30.5, 35.5, 45.1 cm3 (p = 0.024 and p = 0.032, respectively) and V45 was 15.1, 18.1, 30.0 cm3 (p = 0.033 and p = 0.032, respectively). The D5, V30 and V50 of bladder in 3D-CRT were less than in VMAT and 5F-IMRT planning (p = 0.034, 0.004, 0.002 and p = 0.027, 0.003, 0.002, respectively). The Dmean of left femoral head in VMAT and 5F-IMRT were less than in 3D-CRT planning (p = 0.028 and p = 0.022, respectively) and the Dmean, V30 of right femoral head in VMAT and 5F-IMRT were better than in 3D-CRT planning (p = 0.044, 0.036 and p = 0.023, 0.028, respectively). Conclusions: Dosimetric analyses demonstrated that IMRT is superior to 3D-CRT in the conformity and homogeneity of dose distribution to the target volume, and provide a better protection to OARs sparing in patients with locally advanced rectal cancer for preoperative radiotherapy. With similar target coverage, VMRT is superior to 5F-IMRT in normal tissue sparing.

Left Atrial Volume Index in Patients with Dilated Cardiomyopathy—Correlation with Left Ventricular Function

Background: The aim of this study was to determine the relation of left atrial (LA) volume and LA volume index with left ventricular function and to determine the association of duration of symptoms and left atrial volume index in patients with dilated cardiomyopathy. Materials and Methods: This was an observational, single centre study conducted in India. A total of 50 patients who were admitted to department of cardiology from July, 2008 to February, 2009 with diagnosis of dilated cardiomyopathy and an ejection fraction of <40% were included. Results: Of the 50 patients, 34 (68%) were males. 27 (54%) patients were in NYHA class II and 23 (46%) patients were in NYHA class III. LA volume was found to be ≥40 ml in all patients. LV function and LA volume were found to be correlated (r = -0.789, p < 0.01). Similarly, there was a correlation between LV function and LA volume index (r = -0.826, p < 0.01). There was no correlation between LA volume index and duration of symptoms (r = 0.04). Conclusion: It can be concluded that there is a strong inverse correlation between LA volume and left ventricular function and also between LA volume index and left ventricular function. The patients with NYHA class III were having larger left atrial volume than those with NYHA class II. Moreover, the duration of symptoms has no correlation with left atrial volume index.

Thermo-mechanical properties of bowl-shaped grinding wheel and machining error compensation for grinding indexable inserts

In order to meet the technical requirements of grinding the circumferential cutting edge of indexable inserts, thermo-mechanical properties of bowl-shaped grinding wheel in high speed grinding process and the influence of dimension variations of the grinding wheel on machining accuracy were investigated. Firstly, the variation trends of the dimension due to centrifugal force generated in different wheel speeds were studied and the effect of stress stiffening and spin softening was presented. Triangular heat flux distribution model was adopted to determine temperature distribution in grinding process. Temperature field cloud pictures were obtained by the finite element software. Then, dimension variation trends of wheel structure were acquired by considering the thermo-mechanical characteristic under combined action of centrifugal force and grinding heat at different speeds. A method of online dynamic monitoring and automatic compensation for dimension error of indexable insert was proposed. By experimental verification, the precision of the inserts satisfies the requirement of processing.