This article discusses the innovative practice and development path of the intelligent ward medical service model in primary hospitals, and focuses on the research content under the national key research and development program of "active health and scientific response to population aging". In view of the medical needs of the elderly disabled population, the project constructed a theoretical model of "three-dimensional demand response", designed an intelligent ward system from the three dimensions of patients, institutions and regions, and integrated intelligent monitoring, robot assistance and artificial intelligence (AI) diagnosis and treatment technologies to achieve the "four-low" characteristics of low power consumption, low dependence, low threshold and low cost. Innovative service models include 5G-augmented reality (AR) remote collaborative diagnosis and treatment, intelligent robot care and data-driven precision medicine, which significantly improve the diagnosis and treatment efficiency and the collaboration ability of primary hospitals. Through the practice of 30 demonstration hospitals, the project will verify the feasibility of standardized construction process and sustainable operation mechanism, provide reproducible experience for the intelligent transformation of primary medical care, and help achieve the goal of healthy aging.

To explore the mechanism of Toll-like receptors (TLRs)/nuclear factor-kappaB (NF-κB) signaling pathway mediated by speckle-type POZ protein (SPOP) on lung tissue injury in rats with pneumonia.

Thirty Sprague Dawley rats were divided into a pneumonia group, an inhibitor group and a control group, with 10 rats in each group. A rat model of pneumonia was constructed, and the histopathological changes of lung tissue were observed. The lung tissue injury degree score and lung wet/dry specific gravity were calculated. The protein expression levels of SPOP, TLR4, TLR9, NF-κB and myeloid differentiation factor 88 (MyD88) were detected by western-blotting. The levels of serum interleukin-1 beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) were detected by enzyme-linked immunosorbent assay.

The lung tissue structure of the rats in the control group was normal, without obvious lesions. In the pneumonia group, some alveolar walls were thickened, and inflammatory cell infiltration could be observed. The degree of alveolar destruction was greater, and the range and degree of inflammatory cell infiltration were more severe in the inhibitor group than in the pneumonia group. There were statistically significant differences in the lung tissue injury degree score, wet/dry specific gravity, protein expression levels of SPOP, TLR4, TLR9, NF-κB and MyD88 in lung tissue, and levels of serum IL-1β, IL-6 and TNF-α among the three groups (F = 178.049, 8.557, 15.489, 36.935, 37.490, 35.152, 91.250, 89.687, 361.539, 16.319; all P < 0.001). Further pairwise comparisons revealed that the lung tissue injury degree score, wet/dry specific gravity, and protein expression levels of SPOP, TLR4, TLR9, NF-κB, and MyD88 in lung tissue, as well as serum levels of IL-1β, IL-6 and TNF-α, in the pneumonia group and inhibitor group were all higher than those in the control group (all P < 0.05). Moreover, the lung tissue injury degree score, wet/dry specific gravity, and protein expression levels of TLR4, TLR9, NF-κB and MyD88 in lung tissue, as well as the levels of serum IL-1β, IL-6 and TNF-α, in the inhibitor group were all higher than those in the pneumonia group, while the protein expression of SPOP was lower (all P < 0.05).

SPOP regulates the TLRs/NF-κB signaling pathway through the interaction with MyD88, which in turn affects the inflammatory response of lung tissue in rats with pneumonia.

To investigate the protective effects of different doses of ulinastatin on sepsis-induced lung injury in rats and their influence on the activation of the NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome.

Seventy-two Sprague Dawley rats were divided into a sham group, a sepsis group, a low-dose group, and a high-dose group, with 18 rats in each group. The sepsis, low-dose, and high-dose groups underwent cecal ligation and puncture (CLP) to establish a sepsis model, while the sham group underwent laparotomy without ligation. After modeling, rats in the low-dose and high-dose groups received intraperitoneal injections of ulinastatin (50 000 or 100 000 U/kg, respectively), whereas rats in the sham and sepsis groups received an equal volume of isotonic NaCl solution. Ten rats in each group were monitored for 7-day survival status. At 24 h post-modeling, the remaining eight rats in each group were euthanized for sample collection. Arterial blood was drawn from the abdominal aorta to measure the partial pressure of oxygen. Lung tissue was collected for histopathological examination (hematoxylin-eosin staining and injury scoring), for enzyme-linked immunosorbent assay (ELISA) to quantify interleukin-1 beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α) levels, for western-blotting to assess NLRP3, caspase-1 and apoptosis-associated speck-like protein (ASC) expression, and for immunofluorescence to determine the percentage of NLRP3 positive cells.

There was a statistically significant difference in the 7-day survival status of rats among the four groups (Log-rank test: χ² = 7.727, P = 0.005). The 7-day survival status of the sepsis group was significantly worse than that of the low-dose and high-dose groups (both P < 0.05). The lung injury scores, arterial partial pressure of oxygen, levels of IL-1β, IL-6 and TNF-α in lung tissue, expression of NLRP3, caspase-1 and ASC proteins, and percentage of NLRP3 positive cells were compared among the four groups, and the differences were statistically significant (F = 30.691, 11.787, 13.042, 6.669, 18.953, 52.539, 46.265, 61.609, 39.339; all P < 0.05). Further pairwise comparisons revealed that compared with the sham group, the arterial partial pressure of oxygen in the sepsis group was significantly reduced, while the lung tissue injury score, levels of IL-1β, IL-6 and TNF-α, expression of NLRP3, caspase-1 and ASC proteins, and percentage of NLRP3 positive cells were significantly increased (all P < 0.05). Compared with the sepsis group, the arterial partial pressure of oxygen in the low-dose and high-dose groups increased significantly after administration of ulinastain, and the increase was more pronounced in the high-dose group (all P < 0.05). The lung tissue injury score, levels of IL-1β, IL-6 and TNF-α, expression of NLRP3, caspase-1 and ASC proteins, and percentage of NLRP3 positive cells were significantly lower in the low-dose and high-dose groups than in the sepsis group, with the high-dose group showing a more significant decrease (all P < 0.05).

Ustutidine may improve survival status and lung injury in septic rats by inhibiting the activation of NLRP3 inflammasome.

To explore the application of central venous-to-arterial carbon dioxide difference to arterial-to-central venous oxygen content difference ratio (Pcv-aCO₂/Ca-cvO₂) and lactate clearance rate (LCR) in fluid resuscitation for patients with traumatic shock.

From April 2022 to April 2024, 100 patients with traumatic shock admitted to the Department of Emergency Medicine of the 908th Hospital of PLA Logistical Support Force were selected and divided into an experimental group and a control group according to the single-blind random number table method, with 50 patients in each group. Patients in the control group underwent non-invasive ultrasound cardiac output monitoring for fluid resuscitation, while patients in the experimental group were monitored for fluid resuscitation with Pcv-aCO₂/Ca-cvO₂ and LCR on the basis of the control group. The clinical indicators, acute physiology and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure assessment (SOFA) score, Glasgow coma scale (GCS) score, hemodynamic indicators, complications and 28-day mortality were compared between the two groups. Meanwhile, the Kaplan-Meier survival curve was used to compare the survival conditions of the two groups.

Compared with the control group, the fluid infusion volume at 6 and 48 hours and the dosage of vasoactive drugs at 48 hours in the experimental group were much lower, and the mechanical ventilation time, ICU stay time and total hospital stay time were much shorter (all P < 0.05). There were statistically significant differences in the APACHEⅡ score (F = 5.594, P = 0.020), SOFA score (F = 4.631, P = 0.034), GCS score (F = 460.414, P < 0.001), mean arterial pressure (MAP) (F = 12.064, P < 0.001), heart rate (F = 4.233, P = 0.040) and central venous oxygen saturation (ScvO₂) (F = 7.541, P = 0.008) before and after resuscitation in the two groups. Compared with those before resuscitation, the APACHEⅡ score, SOFA score and heart rate of patients in the two groups at 6 and 24 hours after resuscitation were significantly decreased, while the GCS score, MAP and ScvO₂ were significantly increased (all P < 0.05). Moreover, the APACHEⅡ score, SOFA score, GCS score, MAP, heart rate and ScvO₂ in the experimental group were better than those in the control group (all P < 0.05). The incidence of complications [6% (3/50) vs. 20% (10/50), χ² = 4.332, P = 0.037] and the 28-day mortality rate [10% (5/50) vs. 26% (13/50), χ² = 4.336, P = 0.037] in the experimental group were much lower than those in the control group. The Kaplan-Meier survival curve showed that the survival curve of patients in the experimental group was markedly better than that in the control group (χ² = 3.900, P = 0.048).

The application of Pcv-aCO₂/Ca-cvO₂ and LCR in fluid resuscitation of traumatic shock has a good clinical effect, which can effectively stabilize hemodynamics, promote disease improvement, reduce the incidence of complications and improve prognosis.

To investigate the association between different doses of norepinephrine and the implementation of enteral nutrition, and to analyze the risk factors and predictors of prognosis in septic shock patients receiving enteral nutrition.

Fifty-seven septic shock patients admitted to the ICU of the Second Affiliated Hospital of Nanjing Medical University between December 2021 and August 2022 were selected and divided into a low-dose group (n = 38) and a high-dose group (n = 19) according to a norepinephrine equivalent dose (NEQ) < 0.14 μg·kg^-1·min^-1 or ≥ 0.14 μg·kg^-1·min^-1. General data of patients were collected, and the differences in superior mesenteric artery (SMA) Doppler parameters on the first and fifth days of enteral nutrition application were compared between the two groups. Factors associated with hemodynamic differences in the SMA were analyzed using multiple linear regression on the fifth day of enteral nutrition application. Septic shock patients were divided into survival (n = 41) and death (n= 16) groups according to 28-d mortality, and the Cox proportional hazard regression model was used to analyze independent risk factors affecting the outcome of septic shock patients who received enteral nutrition. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of mean arterial pressure (MAP) /NEQ for the outcome of patients with septic shock. Kaplan-Meier survival curves were used to compare the survival condition of patients with septic shock in the high MAP/NEQ and low MAP/NEQ groups.

The peak systolic velocity (PSV), end-diastolic velocity (EDV), and blood flow (Q) of patients in the low-dose group on the fifth day of enteral nutrition increased significantly compared to the first day (all P < 0.05). The EDV and Q of patients in the high-dose group increased significantly on the fifth day compared to the first day, while the pulsatility index (PI) decreased significantly (all P < 0.05). The 28-d mortality and feeding intolerance in the high-dose group increased significantly compared to the low-dose group, while the length of ICU stay shortened significantly (all P < 0.05). Multiple linear regression analysis showed that NEQ and MAP/NEQ were negatively correlated with PSV and EDV, and positively correlated with PI (all P < 0.05). MAP/NEQ was an independent protective factor affecting the prognosis of septic shock patients receiving enteral nutrition [hazard ratio (HR) = 0.9995, 95% confidence interval (CI) (0.9991, 0.9999), P = 0.047]. The area under the curve for MAP/NEQ obtained by the ROC curve was 0.716 [95%CI (0.582, 0.828)], and the optimal cutoff value was 1 116.667 mmHg/(μg·kg^-1·min^-1). According to this value, 57 patients with septic shock were divided into a high MAP/NEQ group [MAP/NEQ > 1 116.667 mmHg/(μg·kg^-1·min^-1), 36 cases] and a low MAP/NEQ group [MAP/NEQ ≤ 1 116.667 mmHg/(μg·kg^-1·min^-1), 21 cases]. The sequential organ failure assessment score, heart rate, NEQ, nutrition risk screening 2002 score, and 28-d mortality of patients in the high MAP/NEQ group were significantly lower than those in the low MAP/NEQ group, while the ICU stay was significantly longer (all P < 0.05). The Kaplan-Meier survival curve showed that the 28-d cumulative survival rate of the high MAP/NEQ group was significantly higher than that of the low MAP/NEQ group (χ² = 14.300, P < 0.001).

MAP/NEQ is an independent protective factor affecting the outcome of septic shock patients who receive enteral nutrition. MAP/NEQ > 1 116.667 mmHg/(μg·kg^-1·min^-1) may improve their prognosis.

To investigate the predictive value of inflammatory and nutritional indicators for severe human rhinovirus (HRV) pneumonia in children.

A total of 975 children with HRV pneumonia admitted to the Department of Respiratory Medicine of Capital Center for Chlidren's Health, Capital Medical University from January 2019 to December 2023 were divided into a mild pneumonia group (829 cases) and a severe pneumonia group (146 cases) according to the diagnostic criteria for severe pneumonia. The clinical characteristics, along with inflammatory and nutritional indicators, were compared between the two groups. Logistic regression was used to analyze the influencing factors of severe pneumonia in children with HRV, and the receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of each influencing factor.

Compared with the mild pneumonia group, the age (t = 0.535, P < 0.001), neutrophils (t = 0.261, P = 0.033), C-reactive protein (CRP) (Z = 5.293, P < 0.001), lactate dehydrogenase (LDH) (t = 0.417, P = 0.008), creatinine (t = 0.339, P < 0.001), systemic immune-inflammation index (SII) (Z = 5.569, P < 0.001), neutrophil-to-lymphocyte ratio (NLR) (Z = 6.156, P < 0.001), platelet-to-lymphocyte ratio (PLR) (t = 4.624, P < 0.001), monocyte-to-lymphocyte ratio (MLR) (Z = 2.444, P = 0.015), neutrophil-to-monocyte ratio (NMR) (Z = 2.973, P = 0.003), systemic inflammation response index (SIRI) (Z = 2.318, P = 0.020) and red cell distribution width-to-lymphocyte ratio (RLR) (Z = 2.845, P = 0.004) were higher, while the proportion of males (χ² = 0.227, P = 0.012), lymphocytes (t = 0.373, P < 0.001), red blood cells (t = 0.079, P < 0.001), albumin (t = 0.865, P < 0.001) and prognostic nutritional index (PNI) (Z = 0.317, P < 0.001) were lower in the severe pneumonia group. The univariate and multivariate logistic regression revealed that age [odds ratio (OR) = 1.204, 95% confidence interval (CI) (1.109, 1.307), P < 0.001], white blood cells [OR = 1.103, 95%CI (1.022, 1.191), P = 0.012], CRP [OR = 1.029, 95%CI (1.020, 1.039), P < 0.001], LDH [OR = 1.004, 95%CI (1.002, 1.006), P < 0.001] and SIRI [OR = 1.219, 95%CI (1.038, 1.432), P = 0.016] were risk factors influencing the occurrence of severe pneumonia in children with HRV, while the albumin [OR = 0.837, 95%CI (0.788, 0.889), P < 0.001] and PNI [OR = 0.986, 95%CI (0.978, 0.994), P < 0.001] were protective factors. The ROC curve indicated that the area under the curve (AUC) of the multi-factor combined model was the highest [AUC = 0.904, 95%CI (0.878, 0.930), P < 0.001], followed by albumin [AUC = 0.819, 95%CI (0.781, 0.857), P < 0.001] and PNI [AUC = 0.763, 95%CI (0.728, 0.798), P < 0.001].

Age, white blood cell count, CRP, LDH and SIRI are risk factors affecting the occurrence of severe pneumonia in children with HRV, while albumin and PNI are protective factors. They have the potential to be used as early warning indicators for severe pneumonia in children with HRV.