The purpose of this study was to investigate the residue elimination of ceftiofur hydrochloride in milk of postpartum cows after intramammary infusing at dry-off. An ultra-high performance liquid chromatography-tandem...The purpose of this study was to investigate the residue elimination of ceftiofur hydrochloride in milk of postpartum cows after intramammary infusing at dry-off. An ultra-high performance liquid chromatography-tandem mass spectrometry （UPLC-MS/ MS） method was developed and validated to detect ceftiofur hydrochloride residue in milk. Through preprocessing, ceftiofur hydrochloride was derivatized into a more stable compound dedfuroyl ceftiofur acetamide （DCA） for further analysis. The linear range of DCA was 0.1 to 50 μg kg-1. Average recoveries of DCA were 82.52-105.86％. The intra-day and interday coefficients of variation （CV） were 2.95-9.82 and 6.41-7.43％, respectively. The limit of detection （LOD） and limit of quantitation （LOQ） scores were 0.05 and 0.1 μg kg-1, respectively. These parameters showed this method was reliable and valid. Twelve cows were administrated 10 mL ceftiofur hydrochloride by intramammary infusion （corresponding to 500 mg ceftiofur） to each udder after the last milking before the dry-off period. Milk was collected from each udder of cow at 12, 24, 36, 48, 60 and 72 h after calving and was mixed for each time point and each cow, then subjected to UPLC-MS/MS analysis. The results showed, the DCA concentrations in all milk samples were less than LOQ and the maximum residue limit （MRL） 100 μg kg-1, which suggested the withdrawal time of ceftiofur hydrochloride intramammary infusion used for preventing and curing mastitis in dry cows was 0 day. The study provided guidance for the clinical applications of ceftiofur hydrochloride intramammary infusion （dry cow）.展开更多
Lubricant infused surface(LIS)always displays efficient anti-fouling performance.However,the inherent liquid properties of infused lubricants often lead to their rapid depletion in harsh conditions such as water flush...Lubricant infused surface(LIS)always displays efficient anti-fouling performance.However,the inherent liquid properties of infused lubricants often lead to their rapid depletion in harsh conditions such as water flushing,thereby reducing the antifouling capability of LIS.Herein,we reported a thermal-responsive lubricant infused surface(TLIS)based on composite phase change materials(CPCMs),exhibiting durable and efficient anti-scaling performance.During multicycle scalingdescaling test,the anti-scaling efficiencies of TLIS based on paraffin and vaseline can be increased to 91.4%±0.5% for first cycle and 85.3%±3.3% for sixth cycle.The paraffin acts as solid scaffolds for structural stability while the vaseline acts as liquid lubricants for anti-scaling enhancement.The universality of this surface can be revealed by suppressing various scales(e.g.,CaCO_(3),CaSO_(4),CaC_(2)O_(4),and MgCO_(3))and varying CPCMs types(e.g.,n-alkanes,ionic liquids,and fatty acids).Therefore,this study presents a promising strategy that enhances the durability of anti-scaling capability and potentially applys in heat exchange systems.展开更多
This experiment was conducted to investigate the effects of infusing milk precursors into the external pudic artery on rumen fermentation in lactating dairy cows. Eight multiparous Holstein cows were randomly assigned...This experiment was conducted to investigate the effects of infusing milk precursors into the external pudic artery on rumen fermentation in lactating dairy cows. Eight multiparous Holstein cows were randomly assigned to Group A(experimental group) and Group B(control group) with 4 cows each. A2×4 complex factor crossover design was used. Cows in Group A were fed corn straw as the only roughage, and cows in Group B were fed mixed roughage. The experiment was divided into two periods.In the first period, cows in Group A, received treatments: 1) a basal infusate as a control(CSC); 2) a milk fat precursor infusion including C16:0, C18:0, C18:1 c9, C18:2 c6, C18:3 n3, acetic acid(CSF); 3) a milk protein precursor infusion including 16 amino acids(CSA); 4) the mixed infusion of milk fat and protein precursors(CSFA). And meanwhile, cows in Group B were infused the basal infusate as a control group. In the second period, the cows in both Groups A and B were crossed over, which cows in Group A were named as Group B and the cows originally in Group B were in Group A. The experimental results showed that cows in experimental group had higher ruminal pH compared with the control, and ruminal pH in CSC, CSF, CSA were significantly higher than those in their respective control group(P < 0.05). The concentration of ammonia nitrogen(NH_3-N) was significantly higher in CSA and CSFA compared with Group B(P < 0.05). We also observed that the infusion of mixed amino acids significantly increased the bacterial protein(BCP) content in rumen(P < 0.05) and influenced the rumen acetic acid concentration as well as the acetic to propionic ratio(P < 0.05). Milk fat precursors infusion significantly affected butyric acid concentration(P < 0.05). In addition, the content of lipopolysaccharide(LPS) in CSA was significantly higher than that in the control group(P < 0.05). It is concluded that the milk precursors infused into external pudic artery caused feedback effects on ruminal fermentation under the corn straw roughage conditions. The milk protein precursor increased the ruminal pH, the contents of BCP and acetic acid, which adjust rumen fermentation and improve milk performance.展开更多
BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion...BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.展开更多
Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation ...Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.展开更多
Forecasting landslide deformation is challenging due to influence of various internal and external factors on the occurrence of systemic and localized heterogeneities.Despite the potential to improve landslide predict...Forecasting landslide deformation is challenging due to influence of various internal and external factors on the occurrence of systemic and localized heterogeneities.Despite the potential to improve landslide predictability,deep learning has yet to be sufficiently explored for complex deformation patterns associated with landslides and is inherently opaque.Herein,we developed a holistic landslide deformation forecasting method that considers spatiotemporal correlations of landslide deformation by integrating domain knowledge into interpretable deep learning.By spatially capturing the interconnections between multiple deformations from different observation points,our method contributes to the understanding and forecasting of landslide systematic behavior.By integrating specific domain knowledge relevant to each observation point and merging internal properties with external variables,the local heterogeneity is considered in our method,identifying deformation temporal patterns in different landslide zones.Case studies involving reservoir-induced landslides and creeping landslides demonstrated that our approach(1)enhances the accuracy of landslide deformation forecasting,(2)identifies significant contributing factors and their influence on spatiotemporal deformation characteristics,and(3)demonstrates how identifying these factors and patterns facilitates landslide forecasting.Our research offers a promising and pragmatic pathway toward a deeper understanding and forecasting of complex landslide behaviors.展开更多
Schwann cells are essential for the maintenance and function of motor neurons,axonal networks,and the neuromuscular junction.In amyotrophic lateral sclerosis,where motor neuron function is progressively lost,Schwann c...Schwann cells are essential for the maintenance and function of motor neurons,axonal networks,and the neuromuscular junction.In amyotrophic lateral sclerosis,where motor neuron function is progressively lost,Schwann cell function may also be impaired.Recently,important signaling and potential trophic activities of Schwann cell-derived exosomal vesicles have been reported.This case report describes the treatment of a patient with advanced amyotrophic lateral sclerosis using serial intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles,marking,to our knowledge,the first instance of such treatment.An 81-year-old male patient presented with a 1.5-year history of rapidly progressive amyotrophic lateral sclerosis.After initial diagnosis,the patient underwent a combination of generic riluzole,sodium phenylbutyrate for the treatment of amyotrophic lateral sclerosis,and taurursodiol.The patient volunteered to participate in an FDA-approved single-patient expanded access treatment and received weekly intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles to potentially restore impaired Schwann cell and motor neuron function.We confirmed that cultured Schwann cells obtained from the amyotrophic lateral sclerosis patient via sural nerve biopsy appeared impaired(senescent)and that exposure of the patient’s Schwann cells to allogeneic Schwann cell-derived exosomal vesicles,cultured expanded from a cadaver donor improved their growth capacity in vitro.After a period of observation lasting 10 weeks,during which amyotrophic lateral sclerosis Functional Rating Scale-Revised and pulmonary function were regularly monitored,the patient received weekly consecutive infusions of 1.54×1012(×2),and then consecutive infusions of 7.5×1012(×6)allogeneic Schwann cell-derived exosomal vesicles diluted in 40 mL of Dulbecco’s phosphate-buffered saline.None of the infusions were associated with adverse events such as infusion reactions(allergic or otherwise)or changes in vital signs.Clinical lab serum neurofilament and cytokine levels measured prior to each infusion varied somewhat without a clear trend.A more sensitive in-house assay suggested possible inflammasome activation during the disease course.A trend for clinical stabilization was observed during the infusion period.Our study provides a novel approach to address impaired Schwann cells and possibly motor neuron function in patients with amyotrophic lateral sclerosis using allogeneic Schwann cell-derived exosomal vesicles.Initial findings suggest that this approach is safe.展开更多
This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy...This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.展开更多
Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a...Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a promising modality for treating advanced HCC,particularly in Asian clinical practice,its adoption in Western medicine remains limited due to a lack of large-scale randomized controlled trials.This editorial reviews and comments on the meta-analysis conducted by Zhou et al,which evaluates the efficacy and safety of HAIC and its combination strategies for advanced HCC.The authors performed a comprehensive meta-analysis of various clinical trials and cohort studies comparing HAIC and its combinations to other first-line treatments,such as sorafenib and transarterial chemoembolization(TACE).In this work,HAIC showed significantly better results regarding overall survival and progression-free survival compared to sorafenib or TACE alone and their combination.HAIC in combination with lenvatinib,ablation,programmed cell death 1 inhibitors,and radiotherapy further enhanced patient outcomes,indicating a synergistic effect.This editorial focuses on the critical role of multimodal treatment strategies in managing advanced HCC.It advocates for a paradigm shift towards integrated treatment approaches to enhance survival rates and improve the quality of life in patients with advanced HCC.展开更多
This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinom...This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.展开更多
Objective:To observe the guiding role of image navigation technology in the treatment of patients with tuberculosis.Methods:A total of 188 patients with multidrug-resistant tuberculosis(MDR-TB)and rifampin-resistant t...Objective:To observe the guiding role of image navigation technology in the treatment of patients with tuberculosis.Methods:A total of 188 patients with multidrug-resistant tuberculosis(MDR-TB)and rifampin-resistant tuberculosis(RR-TB)who were hospitalized in the hospital from September 2023 to September 2024 were included.After random equal division,94 patients were included in the control group and received systemic anti-tuberculosis chemotherapy;94 patients were included in the treatment group.Based on systemic anti-tuberculosis treatment,digital subtraction angiography(DSA)technology was used to inject targeted drugs into the bronchial lumen through bronchoscopy to complete anti-tuberculosis treatment.The changes in sputum bacteria and imaging were observed in the two groups.Results:The sputum negative conversion rate in the treatment group was significantly higher than that in the control group(86.2%;70.2%)(u=2.74,P<0.01).The absorption rate of CT imaging lesions(significant absorption)was significantly higher than that of the control group(83.0%;50%)(u=2.45,P<0.05).The closure rate of chest CT cavities was significantly higher than that of the control group(74.2%;39.1%)(u=2.20,P<0.05).During the treatment process,the improvement of clinical symptoms was significantly higher than that of the control group,and the difference was statistically significant.There was no statistically significant difference in the incidence of adverse reactions between the two groups(x^(2)=0.434,P>0.05).Conclusion:Based on DSA,targeted drug infusion within the bronchoscope can significantly improve the efficacy of the disease,with mild adverse reactions that patients can tolerate.It is worthy of promotion and application.展开更多
BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic c...BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.展开更多
Hepatic arterial infusion chemotherapy (HAIC) is an advanced targeted therapeuticapproach for hepatocellular carcinoma (HCC), the most common type ofprimary liver cancer. HAIC has demonstrated significant potential in...Hepatic arterial infusion chemotherapy (HAIC) is an advanced targeted therapeuticapproach for hepatocellular carcinoma (HCC), the most common type ofprimary liver cancer. HAIC has demonstrated significant potential in managingadvanced HCC, particularly in regions with high prevalence rates. Despite itspromise, several challenges and areas for future research remain. Clinical studieshave substantiated the efficacy of HAIC in enhancing survival outcomes forpatients with advanced hepatic carcinoma. Notably, combination therapiesinvolving immune checkpoint inhibitors, such as lenvatinib and programmeddeath-1 inhibitors, have shown substantial improvements in median overallsurvival and progression-free survival compared to systemic chemotherapy.These combination therapies have also exhibited superior response rates anddisease control, with manageable and often less severe adverse events relative tosystemic treatments. This article is based on the review by Zhou et al and aims todiscuss the current status and future directions in the treatment of HCC, emphasizingthe role of HAIC and its integration with novel therapeutic agents.展开更多
Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metast...Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.展开更多
BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach t...BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach to initially reach appropriate pain control,while potentially achieving sedation goals concurrently.Our system employs a guideline-based ICU sedation order-set that features an electronic medical record(EMR)integrated ICU checklist that combines analgesia and sedation.AIM To identify systems-based factors that are associated with the use of continuous midazolam infusion administration in mechanically ventilated patients.METHODS We extracted EMR data from patients who received mechanical ventilation between January 1,2021,and December 31,2023.Subjects included were 18 years or older who received mechanical ventilation.“R”version 4.3.2 was used for data processing and statistical analysis.We performed a multivariable regression analysis to predict the administration of a continuous midazolam infusion with modified Sequential Organ Failure Assessment score,Charlson comorbidity index,and critical care medicine(CCM)primary service.RESULTS Of 3805 patients that underwent mechanical ventilation,62%were male,with a mean age of 66.9 years.3429 patients were treated by a provider team with a CCM attending,and 376 patients were managed by a non-CCM primary team with CCM consultative services.A midazolam infusion was used in 187 of 3429(5%)patients with CCM as primary and in 166 of 376(56%)patients with non-CCM primary(χ2598.23,P<0.001).Of the patients who received continuous midazolam,117(21%)died vs 236(7%)survived hospitalization.Continuous midazolam was associated with more days with coma and more days with delirium(P<0.0001).CONCLUSION Continuous midazolam infusion was more likely in patients admitted to the ICU under an open unit with a non-CCM physician with an intensivist consult available,despite guided order-sets and checklists integrated into the EMR.展开更多
In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using networ...In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy in China,primarily diagnosed at advanced stages,which limits treatment options and increases mortality rates.Conversion therapy,which includes systemic...BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy in China,primarily diagnosed at advanced stages,which limits treatment options and increases mortality rates.Conversion therapy,which includes systemic and locoregional treatments,aims to render unresectable tumors resectable.Nonetheless,research is scant on the risks of disease progression during the temporary cessation of targeted drugs and immune checkpoint inhibitors before surgery.CASE SUMMARY This report describes a 58-year-old male with HCC who developed lung meta-stases following the discontinuation of lenvatinib and tislelizumab,revealing the necessity for further investigation into the management of HCC patients during the perioperative period,particularly concerning the timing and duration of tar-geted therapy and immunotherapy.CONCLUSION Our study highlights the complex challenges in managing advanced HCC and emphasizes the critical need for ongoing research to refine treatment strategies and improve patient outcomes.展开更多
The rapid evolution of systemic therapies for hepatocellular carcinoma(HCC),one of the most common types of liver cancer,has attracted significant attention especially to hepatic arterial infusion chemotherapy(HAIC)as...The rapid evolution of systemic therapies for hepatocellular carcinoma(HCC),one of the most common types of liver cancer,has attracted significant attention especially to hepatic arterial infusion chemotherapy(HAIC)as a highly promising treatment approach.This method,which delivers chemotherapy directly into the liver's arterial supply,is designed to maximize the concentration of anti-cancer drugs at the tumor site while minimizing systemic side effects.Despite the potential and the encouraging results observed in various studies,HAIC has not yet achieved widespread acceptance and utilization.Sorafenib is a widely used systemic therapy that targets multiple pathways involved in tumor growth and angiogenesis,while transarterial chemoembolization(TACE)is a locoregional therapy that combines arterial embolization with chemotherapy.These treatments have been the mainstay of HCC management,yet they have limitations that HAIC may potentially overcome.This article specifically comments on the network meta-analysis that examined the current research status of HAIC,highlighting its effectiveness and safety profile in comparison to established standard treatments such as Sorafenib and TACE.Through an extensive review of existing studies,the authors conclude that patients receiving HAIC often experience better survival rates and longer periods without disease progression compared to those receiving Sorafenib or TACE.展开更多
Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long c...Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long catheters in the hospital from March 2024 to March 2025 were selected and randomly divided into a control group and an observation group,with 45 patients in each group.The control group received routine nursing intervention,while the observation group received clinical nursing pathway intervention.The nursing risk events,catheter indwelling time,and nursing satisfaction were evaluated in both groups.Results:The observation group had a shorter catheter indwelling time,fewer risk events during intravenous therapy(total incidence rate of 2.22%),and higher nursing satisfaction.Additionally,negative emotional feedback was reduced,and the SAS score(31.02±1.12)was lower in the observation group compared to the control group.There were significant differences between the two groups in all indicators(P<0.05).Conclusion:Applying the clinical nursing pathway during intravenous therapy via peripheral mid-long catheters can help ensure infusion safety,improve unstable emotional states,and promote high-quality service standards.展开更多
BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).Howeve...BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).However,it is unclear whether this is also the case for patients with type 2 diabetes mellitus(T2DM).AIM To compare insulin dosage requirements between CSII and MDI in T2DM,iden-tifying influencing factors associated with both therapeutic modalities.METHODS A total of 954 patients with T2DM were divided into two groups:CSII and MDI groups.The total daily insulin dose(TDD),TDD per kilogram per day(TDD/kg),and ratio of total basal insulin dose to TDD(%TBa)required to achieve the target blood glucose levels were compared between the two groups.In addition,factors affecting insulin dosage were analyzed in both groups of patients.RESULTS Compared to the CSII group,the MDI group required a higher TDD[median(interquartile)]:30.00(24.00,38.00)U/day vs 26.40(21.60,32.40)U/day;P<0.01,TDD/kg and%TBa.In the MDI group and CSII groups,an increase in TDD was independently associated with an increase in body mass index(BMI),waist circumference(WC),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).The pathophysiology of type 2 diabetes mellitus(T2DM)mainly involves insulin resistance and progressiveβ-cell failure,which leads to increased blood glucose levels(hyperglycemia)[1-3].Treatment for T2DM includes antidiabetic medications and insulin therapy[4,5].Patients with T2DM withβ-cell failure usually require insulin therapy[6-8].Continuous subcutaneous insulin infusion(CSII)and multiple daily injections(MDIs)are two major insulin therapies for controlling hyperglycemia in these patients.However,excessive insulin therapies may cause problems such as hypoglycemia,weight gain,and iatrogenic hyperinsulinemia[9].Therefore,attention should be paid to the dosage of insulin used.The establishment of insulin regimens for CSII and MDI therapies is primarily guided by physicians’empirical judgment.To date,there have been few clear guidelines or recommendations on the appropriate insulin dose during CSII and MDI treatment for T2DM[10].Yang et al[11]studied insulin doses and related factors in the CSII treatment of patients with T2DM[12].However,these studies did not cover the dose setting and related factors in MDI treatment.Previous studies have shown that patients with type 1 diabetes mellitus treated with CSII require less insulin than those treated with MDIs[13-15].However,it is unclear whether patients with T2DM on CSII also require less insulin than patients on MDI.Therefore,the present study determined the difference in insulin dosages between CSII and MDI therapies and evaluated the related factors in patients with T2DM.It also systematically analyzed the insulin dose characteristics of MDI and CSII in 954 hospitalized patients with T2DM,aiming to optimize the insulin dosage regimen and provide clinical references for guiding the application of CSII and MDI in patients with T2DM.展开更多
基金supported by the Beijing Diary Industry Innovation Team,Chinathe Special Fund of the Chinese Academy of Agricultural Sciences Innovation Project (CAAS-FRI-06)
文摘The purpose of this study was to investigate the residue elimination of ceftiofur hydrochloride in milk of postpartum cows after intramammary infusing at dry-off. An ultra-high performance liquid chromatography-tandem mass spectrometry （UPLC-MS/ MS） method was developed and validated to detect ceftiofur hydrochloride residue in milk. Through preprocessing, ceftiofur hydrochloride was derivatized into a more stable compound dedfuroyl ceftiofur acetamide （DCA） for further analysis. The linear range of DCA was 0.1 to 50 μg kg-1. Average recoveries of DCA were 82.52-105.86％. The intra-day and interday coefficients of variation （CV） were 2.95-9.82 and 6.41-7.43％, respectively. The limit of detection （LOD） and limit of quantitation （LOQ） scores were 0.05 and 0.1 μg kg-1, respectively. These parameters showed this method was reliable and valid. Twelve cows were administrated 10 mL ceftiofur hydrochloride by intramammary infusion （corresponding to 500 mg ceftiofur） to each udder after the last milking before the dry-off period. Milk was collected from each udder of cow at 12, 24, 36, 48, 60 and 72 h after calving and was mixed for each time point and each cow, then subjected to UPLC-MS/MS analysis. The results showed, the DCA concentrations in all milk samples were less than LOQ and the maximum residue limit （MRL） 100 μg kg-1, which suggested the withdrawal time of ceftiofur hydrochloride intramammary infusion used for preventing and curing mastitis in dry cows was 0 day. The study provided guidance for the clinical applications of ceftiofur hydrochloride intramammary infusion （dry cow）.
基金supported by the Beijing Natural Science Foundation(No.JQ23008)the National Natural Science Foundation of China(Nos.22275203 and 22035008)Beijing Outstanding Young Scientist Program(No.JWZQ20240102014).
文摘Lubricant infused surface(LIS)always displays efficient anti-fouling performance.However,the inherent liquid properties of infused lubricants often lead to their rapid depletion in harsh conditions such as water flushing,thereby reducing the antifouling capability of LIS.Herein,we reported a thermal-responsive lubricant infused surface(TLIS)based on composite phase change materials(CPCMs),exhibiting durable and efficient anti-scaling performance.During multicycle scalingdescaling test,the anti-scaling efficiencies of TLIS based on paraffin and vaseline can be increased to 91.4%±0.5% for first cycle and 85.3%±3.3% for sixth cycle.The paraffin acts as solid scaffolds for structural stability while the vaseline acts as liquid lubricants for anti-scaling enhancement.The universality of this surface can be revealed by suppressing various scales(e.g.,CaCO_(3),CaSO_(4),CaC_(2)O_(4),and MgCO_(3))and varying CPCMs types(e.g.,n-alkanes,ionic liquids,and fatty acids).Therefore,this study presents a promising strategy that enhances the durability of anti-scaling capability and potentially applys in heat exchange systems.
文摘This experiment was conducted to investigate the effects of infusing milk precursors into the external pudic artery on rumen fermentation in lactating dairy cows. Eight multiparous Holstein cows were randomly assigned to Group A(experimental group) and Group B(control group) with 4 cows each. A2×4 complex factor crossover design was used. Cows in Group A were fed corn straw as the only roughage, and cows in Group B were fed mixed roughage. The experiment was divided into two periods.In the first period, cows in Group A, received treatments: 1) a basal infusate as a control(CSC); 2) a milk fat precursor infusion including C16:0, C18:0, C18:1 c9, C18:2 c6, C18:3 n3, acetic acid(CSF); 3) a milk protein precursor infusion including 16 amino acids(CSA); 4) the mixed infusion of milk fat and protein precursors(CSFA). And meanwhile, cows in Group B were infused the basal infusate as a control group. In the second period, the cows in both Groups A and B were crossed over, which cows in Group A were named as Group B and the cows originally in Group B were in Group A. The experimental results showed that cows in experimental group had higher ruminal pH compared with the control, and ruminal pH in CSC, CSF, CSA were significantly higher than those in their respective control group(P < 0.05). The concentration of ammonia nitrogen(NH_3-N) was significantly higher in CSA and CSFA compared with Group B(P < 0.05). We also observed that the infusion of mixed amino acids significantly increased the bacterial protein(BCP) content in rumen(P < 0.05) and influenced the rumen acetic acid concentration as well as the acetic to propionic ratio(P < 0.05). Milk fat precursors infusion significantly affected butyric acid concentration(P < 0.05). In addition, the content of lipopolysaccharide(LPS) in CSA was significantly higher than that in the control group(P < 0.05). It is concluded that the milk precursors infused into external pudic artery caused feedback effects on ruminal fermentation under the corn straw roughage conditions. The milk protein precursor increased the ruminal pH, the contents of BCP and acetic acid, which adjust rumen fermentation and improve milk performance.
文摘BACKGROUND Propofol has been widely used in bidirectional gastrointestinal endoscopy sedation;however,it frequently leads to cardiovascular adverse events and respiratory depression.Propofol target-controlled infusion(TCI)can provide safe sedation but may require higher dosages of propofol.On the contrary,etomidate offers hemodynamic stability.AIM To evaluate the effect of different dose etomidate added to propofol TCI sedation during same-visit bidirectional endoscopy.METHODS A total of 330 patients from Fujian Provincial Hospital were randomly divided into three groups:P,0.1EP,and 0.15EP.Patients in the P group received propofol TCI only,with an initial effect-site concentration of the propofol TCI system of 3.0 mg/mL.Patients in the 0.1EP and 0.15EP groups received 0.1 and 0.15 mg/kg etomidate intravenous injection,respectively,followed by propofol TCI.RESULTS Patients in the 0.15EP group had higher mean blood pressure after induction than the other groups(P group:78 mmHg,0.1EP group:82 mmHg,0.15EP group:88 mmHg;P<0.05).Total doses of propofol consumption significantly decreased in the 0.15EP group compared with that in the other groups(P group:260.6 mg,0.1EP group:228.1 mg,0.15EP group:201.2 mg;P<0.05).The induction time was longer in the P group than in the other groups(P group:1.9±0.7 minutes,0.1EP group:1.2±0.4 minutes,0.15EP group:1.1±0.3 minutes;P<0.01).The recovery time was shorter in the 0.15EP group than in the other groups(P group:4.8±2.1 minutes,0.1EP group:4.5±1.6 minutes,0.15EP group:3.9±1.4 minutes;P<0.01).The incidence of hypotension(P group:36.4%,0.1EP group:29.1%,0.15EP group:11.8%;P<0.01)and injection pain was lower in the 0.15EP group than in the other groups(P<0.05).Furthermore,the incidence of respiratory depression was lower in the 0.15EP group than in the P group(P<0.05).Additionally,the satisfaction of the patient,endoscopist,and anesthesiologist was higher in the 0.15EP group than in the other groups(P<0.05).CONCLUSION Our findings suggest that 0.15 mg/kg etomidate plus propofol TCI can significantly reduce propofol consumption,which is followed by fewer cardiovascular adverse events and respiratory depression,along with higher patient,endoscopist,and anesthesiologist satisfaction.
文摘Sedation practices in gastrointestinal endoscopy have evolved considerably,driven by patient demand for comfort and the need to minimize cardiopulmonary complications.Recent guidelines emphasize personalized sedation strategies,risk assessment,and vigilant hemodynamic monitoring to ensure that sedation depth aligns with each patient’s comorbidities and procedural requirements.Within this landscape,the trial by Luo et al highlights the value of adding etomidate to propofol target-controlled infusion,demonstrating significantly reduced hypotension,faster induction,and fewer respiratory complications in typical American Society of Anesthesiologists I-III candidates.These findings align with broader recommendations from both European and American societies advo-cating sedation regimens that preserve stable circulation.Etomidate’s favorable hemodynamic profile,coupled with propofol’s reliability,suggests potential applications in advanced endoscopic interventions such as endoscopic retrograde cholangiopancreatography,interventional endoscopic ultrasound,and endoscopic submucosal dissection,where deeper or more sustained sedation is often required.Remimazolam,a novel short-acting benzodiazepine,has similarly been associated with reduced cardiovascular depression and faster recovery,partic-ularly in high-risk populations,although direct comparisons between etomidate-propofol and remimazolam-based regimens remain limited.Further investig-ations into these sedation strategies in higher-risk cohorts,as well as complex the-rapeutic endoscopy,will likely inform more nuanced,patient-specific protocols aimed at maximizing both safety and procedural efficiency.
基金supported by the Postdoctoral Fellowship Program of CPSF(Grant No.GZB20230685)the National Science Foundation of China(Grant No.42277161).
文摘Forecasting landslide deformation is challenging due to influence of various internal and external factors on the occurrence of systemic and localized heterogeneities.Despite the potential to improve landslide predictability,deep learning has yet to be sufficiently explored for complex deformation patterns associated with landslides and is inherently opaque.Herein,we developed a holistic landslide deformation forecasting method that considers spatiotemporal correlations of landslide deformation by integrating domain knowledge into interpretable deep learning.By spatially capturing the interconnections between multiple deformations from different observation points,our method contributes to the understanding and forecasting of landslide systematic behavior.By integrating specific domain knowledge relevant to each observation point and merging internal properties with external variables,the local heterogeneity is considered in our method,identifying deformation temporal patterns in different landslide zones.Case studies involving reservoir-induced landslides and creeping landslides demonstrated that our approach(1)enhances the accuracy of landslide deformation forecasting,(2)identifies significant contributing factors and their influence on spatiotemporal deformation characteristics,and(3)demonstrates how identifying these factors and patterns facilitates landslide forecasting.Our research offers a promising and pragmatic pathway toward a deeper understanding and forecasting of complex landslide behaviors.
基金support from the Miami Project to Cure Paralysis,the Buoniconti Fund,and the Interdisciplinary Stem Cell Institute(to AK,WDD,JDG,and ADL)the unconditional support of Dean Henri Ford of the Leonard M.Miller School of Medicine at the University of Miami.
文摘Schwann cells are essential for the maintenance and function of motor neurons,axonal networks,and the neuromuscular junction.In amyotrophic lateral sclerosis,where motor neuron function is progressively lost,Schwann cell function may also be impaired.Recently,important signaling and potential trophic activities of Schwann cell-derived exosomal vesicles have been reported.This case report describes the treatment of a patient with advanced amyotrophic lateral sclerosis using serial intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles,marking,to our knowledge,the first instance of such treatment.An 81-year-old male patient presented with a 1.5-year history of rapidly progressive amyotrophic lateral sclerosis.After initial diagnosis,the patient underwent a combination of generic riluzole,sodium phenylbutyrate for the treatment of amyotrophic lateral sclerosis,and taurursodiol.The patient volunteered to participate in an FDA-approved single-patient expanded access treatment and received weekly intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles to potentially restore impaired Schwann cell and motor neuron function.We confirmed that cultured Schwann cells obtained from the amyotrophic lateral sclerosis patient via sural nerve biopsy appeared impaired(senescent)and that exposure of the patient’s Schwann cells to allogeneic Schwann cell-derived exosomal vesicles,cultured expanded from a cadaver donor improved their growth capacity in vitro.After a period of observation lasting 10 weeks,during which amyotrophic lateral sclerosis Functional Rating Scale-Revised and pulmonary function were regularly monitored,the patient received weekly consecutive infusions of 1.54×1012(×2),and then consecutive infusions of 7.5×1012(×6)allogeneic Schwann cell-derived exosomal vesicles diluted in 40 mL of Dulbecco’s phosphate-buffered saline.None of the infusions were associated with adverse events such as infusion reactions(allergic or otherwise)or changes in vital signs.Clinical lab serum neurofilament and cytokine levels measured prior to each infusion varied somewhat without a clear trend.A more sensitive in-house assay suggested possible inflammasome activation during the disease course.A trend for clinical stabilization was observed during the infusion period.Our study provides a novel approach to address impaired Schwann cells and possibly motor neuron function in patients with amyotrophic lateral sclerosis using allogeneic Schwann cell-derived exosomal vesicles.Initial findings suggest that this approach is safe.
文摘This editorial comments on a study by Zuo et al.The focus is on the efficacy of he-patic arterial infusion chemotherapy combined with camrelizumab and apatinib(the TRIPLET regimen),alongside microwave ablation therapy,in treating advanced hepatocellular carcinoma(HCC).The potential application of this combination therapy for patients with advanced HCC is evaluated.
文摘Hepatocellular carcinoma(HCC)is a leading cause of cancer-related mortality worldwide,with advanced stages posing significant treatment challenges.Al-though hepatic arterial infusion chemotherapy(HAIC)has emerged as a promising modality for treating advanced HCC,particularly in Asian clinical practice,its adoption in Western medicine remains limited due to a lack of large-scale randomized controlled trials.This editorial reviews and comments on the meta-analysis conducted by Zhou et al,which evaluates the efficacy and safety of HAIC and its combination strategies for advanced HCC.The authors performed a comprehensive meta-analysis of various clinical trials and cohort studies comparing HAIC and its combinations to other first-line treatments,such as sorafenib and transarterial chemoembolization(TACE).In this work,HAIC showed significantly better results regarding overall survival and progression-free survival compared to sorafenib or TACE alone and their combination.HAIC in combination with lenvatinib,ablation,programmed cell death 1 inhibitors,and radiotherapy further enhanced patient outcomes,indicating a synergistic effect.This editorial focuses on the critical role of multimodal treatment strategies in managing advanced HCC.It advocates for a paradigm shift towards integrated treatment approaches to enhance survival rates and improve the quality of life in patients with advanced HCC.
文摘This study examines the pivotal findings of the network meta-analysis of Zhou et al,which evaluated the efficacy of hepatic arterial infusion chemotherapy and combination therapies for advanced hepatocellular carcinoma(HCC).This meta-analysis suggests that therapeutic combinations have greater efficacy than do standard treatments.The article highlights the key insights that have the potential to shift current clinical practice and enhance outcomes for patients with advanced HCC.Additionally,this article discusses further research that can be conducted to optimize these treatments and achieve personalized care for patients with HCC.
基金Science and Education Department Harbin Health Committee Project。
文摘Objective:To observe the guiding role of image navigation technology in the treatment of patients with tuberculosis.Methods:A total of 188 patients with multidrug-resistant tuberculosis(MDR-TB)and rifampin-resistant tuberculosis(RR-TB)who were hospitalized in the hospital from September 2023 to September 2024 were included.After random equal division,94 patients were included in the control group and received systemic anti-tuberculosis chemotherapy;94 patients were included in the treatment group.Based on systemic anti-tuberculosis treatment,digital subtraction angiography(DSA)technology was used to inject targeted drugs into the bronchial lumen through bronchoscopy to complete anti-tuberculosis treatment.The changes in sputum bacteria and imaging were observed in the two groups.Results:The sputum negative conversion rate in the treatment group was significantly higher than that in the control group(86.2%;70.2%)(u=2.74,P<0.01).The absorption rate of CT imaging lesions(significant absorption)was significantly higher than that of the control group(83.0%;50%)(u=2.45,P<0.05).The closure rate of chest CT cavities was significantly higher than that of the control group(74.2%;39.1%)(u=2.20,P<0.05).During the treatment process,the improvement of clinical symptoms was significantly higher than that of the control group,and the difference was statistically significant.There was no statistically significant difference in the incidence of adverse reactions between the two groups(x^(2)=0.434,P>0.05).Conclusion:Based on DSA,targeted drug infusion within the bronchoscope can significantly improve the efficacy of the disease,with mild adverse reactions that patients can tolerate.It is worthy of promotion and application.
基金Supported by Shenzhen Clinical Research Center for Gastroenterology(Gastrointestinal Surgery),No.LCYSSQ20220823091203008.
文摘BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is an aggressive malignancy with limited treatment options and a poor prognosis,particularly in unresectable or metastatic cases.Tri-modal strategies combining systemic chemotherapy,targeted therapies,and immune checkpoint inhibitors have demonstrated synergistic effects in converting unresectable ICC to resectable status and improving patient survival.CASE SUMMARY A 39-year-old male presented with unresectable stage IIIB ICC(cT3N1M0),abdominal pain,and elevated carbohydrate antigen(CA)19-9 levels.He received tri-modal therapy consisting of gemcitabine-oxaliplatin hepatic arterial infusion chemotherapy(GEMOX-HAIC),lenvatinib(8 mg daily),and toripalimab(160 mg every three weeks).After five cycles,significant tumor shrinkage and normalization of CA19-9 levels enabled a left hepatectomy.Complications,including biliary stenosis and liver abscesses,were managed with biliary stenting and percutaneous drainage,which allowed for the continuation of chemotherapy.Postoperative pathological examination confirmed a pathological complete response.At the last follow-up,the patient had maintained 29 months of diseasefree survival post-resection and was continuing postoperative therapy.CONCLUSION This case highlights the potential of a tri-modal therapy combining GEMOX-HAIC,lenvatinib,and toripalimab to convert unresectable ICC to a resectable status,thereby potentially improving patient survival by surgical resection.Further clinical trials investigating this regimen are warranted.
文摘Hepatic arterial infusion chemotherapy (HAIC) is an advanced targeted therapeuticapproach for hepatocellular carcinoma (HCC), the most common type ofprimary liver cancer. HAIC has demonstrated significant potential in managingadvanced HCC, particularly in regions with high prevalence rates. Despite itspromise, several challenges and areas for future research remain. Clinical studieshave substantiated the efficacy of HAIC in enhancing survival outcomes forpatients with advanced hepatic carcinoma. Notably, combination therapiesinvolving immune checkpoint inhibitors, such as lenvatinib and programmeddeath-1 inhibitors, have shown substantial improvements in median overallsurvival and progression-free survival compared to systemic chemotherapy.These combination therapies have also exhibited superior response rates anddisease control, with manageable and often less severe adverse events relative tosystemic treatments. This article is based on the review by Zhou et al and aims todiscuss the current status and future directions in the treatment of HCC, emphasizingthe role of HAIC and its integration with novel therapeutic agents.
文摘Hepatic arterial infusion(HAI)chemotherapy,first introduced in the 1980s,has gained recognition as an effective locoregional treatment for colorectal liver metastasis(CRLM).Initially used for unresectable liver metastases,HAI’s app-lication has expanded to the adjuvant setting following hepatic resection,with early studies indicating improved hepatic disease-free survival.Recent research demonstrates that combining HAI with modern systemic therapies enhances conversion to resectability and prolongs both recurrence-free and overall survival,even in heavily pretreated patients with diverse RAS mutational statuses.Person-alization through approaches like microsatellite instability status and dose mo-difications further optimize outcomes.However,the complexity of HAI requires expertise across multidisciplinary teams,limiting its widespread adoption to specialized centers.Ongoing clinical trials continue to investigate HAI’s role in CRLM management,highlighting its potential to become a cornerstone of liver-directed therapy.We explore how HAI chemotherapy,in combination with personalized medicine,can advance treatment strategies for metastatic colorectal cancer.
文摘BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach to initially reach appropriate pain control,while potentially achieving sedation goals concurrently.Our system employs a guideline-based ICU sedation order-set that features an electronic medical record(EMR)integrated ICU checklist that combines analgesia and sedation.AIM To identify systems-based factors that are associated with the use of continuous midazolam infusion administration in mechanically ventilated patients.METHODS We extracted EMR data from patients who received mechanical ventilation between January 1,2021,and December 31,2023.Subjects included were 18 years or older who received mechanical ventilation.“R”version 4.3.2 was used for data processing and statistical analysis.We performed a multivariable regression analysis to predict the administration of a continuous midazolam infusion with modified Sequential Organ Failure Assessment score,Charlson comorbidity index,and critical care medicine(CCM)primary service.RESULTS Of 3805 patients that underwent mechanical ventilation,62%were male,with a mean age of 66.9 years.3429 patients were treated by a provider team with a CCM attending,and 376 patients were managed by a non-CCM primary team with CCM consultative services.A midazolam infusion was used in 187 of 3429(5%)patients with CCM as primary and in 166 of 376(56%)patients with non-CCM primary(χ2598.23,P<0.001).Of the patients who received continuous midazolam,117(21%)died vs 236(7%)survived hospitalization.Continuous midazolam was associated with more days with coma and more days with delirium(P<0.0001).CONCLUSION Continuous midazolam infusion was more likely in patients admitted to the ICU under an open unit with a non-CCM physician with an intensivist consult available,despite guided order-sets and checklists integrated into the EMR.
文摘In this manuscript,we comment on the article by Zhou et al,who assessed the efficacy of hepatic arterial infusion chemotherapy(HAIC)and its combination strategies for advanced hepatocellular carcinoma(HCC)using network metaanalysis methodology.We focus specifically on the potential advantages and role of HAIC in the treatment algorithm for advanced HCC.However,there remains numerous knowledge gaps before the role of HAIC can be established.There is significant heterogeneity of HAIC regimes with difficult interpretation of the clinical outcomes.Additionally,there is a lack of direct comparative data between HAIC,systemic chemotherapy,novel immunotherapies and targeted therapies.The underlying biochemical mechanisms that might explain the efficacy of HAIC and its effect on the HCC microenvironment requires further research.In the developing era of nanotechnology and targeted drug delivery systems,there is potential for integration of HAIC with novel technologies to effectively treat advanced HCC whilst minimising systemic complications.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a prevalent malignancy in China,primarily diagnosed at advanced stages,which limits treatment options and increases mortality rates.Conversion therapy,which includes systemic and locoregional treatments,aims to render unresectable tumors resectable.Nonetheless,research is scant on the risks of disease progression during the temporary cessation of targeted drugs and immune checkpoint inhibitors before surgery.CASE SUMMARY This report describes a 58-year-old male with HCC who developed lung meta-stases following the discontinuation of lenvatinib and tislelizumab,revealing the necessity for further investigation into the management of HCC patients during the perioperative period,particularly concerning the timing and duration of tar-geted therapy and immunotherapy.CONCLUSION Our study highlights the complex challenges in managing advanced HCC and emphasizes the critical need for ongoing research to refine treatment strategies and improve patient outcomes.
文摘The rapid evolution of systemic therapies for hepatocellular carcinoma(HCC),one of the most common types of liver cancer,has attracted significant attention especially to hepatic arterial infusion chemotherapy(HAIC)as a highly promising treatment approach.This method,which delivers chemotherapy directly into the liver's arterial supply,is designed to maximize the concentration of anti-cancer drugs at the tumor site while minimizing systemic side effects.Despite the potential and the encouraging results observed in various studies,HAIC has not yet achieved widespread acceptance and utilization.Sorafenib is a widely used systemic therapy that targets multiple pathways involved in tumor growth and angiogenesis,while transarterial chemoembolization(TACE)is a locoregional therapy that combines arterial embolization with chemotherapy.These treatments have been the mainstay of HCC management,yet they have limitations that HAIC may potentially overcome.This article specifically comments on the network meta-analysis that examined the current research status of HAIC,highlighting its effectiveness and safety profile in comparison to established standard treatments such as Sorafenib and TACE.Through an extensive review of existing studies,the authors conclude that patients receiving HAIC often experience better survival rates and longer periods without disease progression compared to those receiving Sorafenib or TACE.
文摘Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long catheters in the hospital from March 2024 to March 2025 were selected and randomly divided into a control group and an observation group,with 45 patients in each group.The control group received routine nursing intervention,while the observation group received clinical nursing pathway intervention.The nursing risk events,catheter indwelling time,and nursing satisfaction were evaluated in both groups.Results:The observation group had a shorter catheter indwelling time,fewer risk events during intravenous therapy(total incidence rate of 2.22%),and higher nursing satisfaction.Additionally,negative emotional feedback was reduced,and the SAS score(31.02±1.12)was lower in the observation group compared to the control group.There were significant differences between the two groups in all indicators(P<0.05).Conclusion:Applying the clinical nursing pathway during intravenous therapy via peripheral mid-long catheters can help ensure infusion safety,improve unstable emotional states,and promote high-quality service standards.
基金Supported by the National Key R and D Program of China,No.2021YFC2501700 and No.2021YFC2501705and the National Natural Science Foundation of China,No.82171580 and No.81672646.
文摘BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).However,it is unclear whether this is also the case for patients with type 2 diabetes mellitus(T2DM).AIM To compare insulin dosage requirements between CSII and MDI in T2DM,iden-tifying influencing factors associated with both therapeutic modalities.METHODS A total of 954 patients with T2DM were divided into two groups:CSII and MDI groups.The total daily insulin dose(TDD),TDD per kilogram per day(TDD/kg),and ratio of total basal insulin dose to TDD(%TBa)required to achieve the target blood glucose levels were compared between the two groups.In addition,factors affecting insulin dosage were analyzed in both groups of patients.RESULTS Compared to the CSII group,the MDI group required a higher TDD[median(interquartile)]:30.00(24.00,38.00)U/day vs 26.40(21.60,32.40)U/day;P<0.01,TDD/kg and%TBa.In the MDI group and CSII groups,an increase in TDD was independently associated with an increase in body mass index(BMI),waist circumference(WC),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).The pathophysiology of type 2 diabetes mellitus(T2DM)mainly involves insulin resistance and progressiveβ-cell failure,which leads to increased blood glucose levels(hyperglycemia)[1-3].Treatment for T2DM includes antidiabetic medications and insulin therapy[4,5].Patients with T2DM withβ-cell failure usually require insulin therapy[6-8].Continuous subcutaneous insulin infusion(CSII)and multiple daily injections(MDIs)are two major insulin therapies for controlling hyperglycemia in these patients.However,excessive insulin therapies may cause problems such as hypoglycemia,weight gain,and iatrogenic hyperinsulinemia[9].Therefore,attention should be paid to the dosage of insulin used.The establishment of insulin regimens for CSII and MDI therapies is primarily guided by physicians’empirical judgment.To date,there have been few clear guidelines or recommendations on the appropriate insulin dose during CSII and MDI treatment for T2DM[10].Yang et al[11]studied insulin doses and related factors in the CSII treatment of patients with T2DM[12].However,these studies did not cover the dose setting and related factors in MDI treatment.Previous studies have shown that patients with type 1 diabetes mellitus treated with CSII require less insulin than those treated with MDIs[13-15].However,it is unclear whether patients with T2DM on CSII also require less insulin than patients on MDI.Therefore,the present study determined the difference in insulin dosages between CSII and MDI therapies and evaluated the related factors in patients with T2DM.It also systematically analyzed the insulin dose characteristics of MDI and CSII in 954 hospitalized patients with T2DM,aiming to optimize the insulin dosage regimen and provide clinical references for guiding the application of CSII and MDI in patients with T2DM.
