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ObjectiveTo explore the impact of an airway stepwise management strategy in the treatment of hospital acquired pneumonia (HAP) in the ultra elderly critically ill patients.MethodsClinical data on the ultra eldely(≥80 years old) HAP patients at the department of Critied Care Medicine, Peking Union Medical College Hospital from January 2021 to April 2023 was retrospective collected, and the enrolled patients were divided into an observation group (January 2022-April 2023) and control group (January 2021-December 2021) according to the airway stepwise management strategy. In the control group, conventional airway manage- ment was used, and in the observation group, an airway stepwise management strategy from simple to complex and from noninvasive to invasive was used. The oxygenation indices before and after airway interventiont, tracheal intubation/tracheostomy rate, and invasive ventilator usage rate was compared in both groups.ResultsA total of 61 HAP patients who met the inclusion and exclusion criteria were selected, including 31 in the observation group and 30 in the control group. Compared with before airway intervention, the arterial partial pressure of carbon dioxide gradually decreased, arterial partial pressure of oxygen and oxygenation index gradually increased at 12 h, 48 h and 72 h of airway intervention(all P < 0.05). Compared with the control group, the observation group had lower arterial partial pressure of carbon dioxide, and higher arterial partial pressure of oxygen and oxygenation index(all P < 0.05), and the rate of tracheal intubation/incision (35.5% vs. 66.7%, P=0.015) and the rate of invasive ventilator use (41.9% vs. 73.3%, P=0.013) were lower in the observation group at 48 h of airway intervention.ConclusionsThe application of an airway stepwise management strategy in the ultra elderly HAP patients can significantly improve oxygenation status and reduce iatrogenic trauma.

Objective To investigate the relationship between Oxygen extraction ratio(ERO2) and prognosis of septic shock patients in the early stage of resuscitation. Methods The data of the patients with septic shock admitted to the department of Critical Care Medicine of Peking Union Medical College Hospital from January 2016 to July 2021 were retrospectively collected. The patients were divided into the survival group and the death group according to the prognosis of the ICU. The baseline data, and Oxygen metabolism indexes including Oxygen delivery (DO2), Oxygen consumption(VO2), ERO2 and lactate(Lac) of the two groups were collected. Risk factors for ICU death in patients with septic shock were analyzed using multifactorial Logistic regression, and the predictive value of each indicator for ICU death in patients with septic shock was assessed using receiver operating characteristic (ROC) curves. Results A total of 73 patients with septic shock who met the inclusion and exclusion criteria were enrolled, including 21 cases in the death group and 52 cases in the survival group. The differences in acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores and sequential organ failure assessment (SOFA) scores between the two groups were statistically significant (all P < 0.05). Compared with the survival group, 6 h after resuscitation in the death group, Lac [5.6(4.2, 10.0)mmol/L vs. 3.4(2.1, 6.9)mmol/L, P=0.009], VO2[(165±95) mL/(min·m2) vs. (106±58)mL/(min·m2), P=0.012], ERO2[(56.56±19.48)% vs.(33.71±13.24)%, P=0.000] were elevated, and there was no significant difference in DO2 between the two groups[266 (214, 384) mL/(min·m2) vs. 300 (250, 396)mL/(min·m2), P=0.159]. The results of multifactorial Logistic regression analysis showed that ERO2 was an independent risk factor for ICU death in patients with septic shock (OR=1.126, 95% CI: 1.053-1.203, P=0.000). The ROC curve showed that the area under the curve (AUC) of ERO2 for predicting ICU death in septic shock patients was 0.833, with an optimal threshold of 45.93%, sensitivity of 76.19%, specificity of 94.23%, and its predictive efficacy was superior to that of the APACHEⅡ scores(AUC: 0.704), SOFA score(AUC: 0.778), and Lac(AUC: 0.668). Conclusion ERO2 in the early stage of septic shock resuscitation is an independent risk factor for ICU prognosis, which has a good predictive value for the prognosis of septic shock.

Objective To explore the relationship between the post-operative peak value of central venous pressure (CVPp) and the incidence of acute kidney injury (AKI) in patients who had undergone cardiopulmonary bypass surgery (CBS). Methods Clinical data were retrospectively collected from 1 May 2016 to 1 May 2018 from all patients undergoing CBS in the Department of Intensive Care Medicine, Peking Union Medical College Hospital. The CVP values immediately after transfer to ICU (CVP 0h) and at 6 h(CVP 6h), and CVPp within 48 h(CVPp 48h) of transfer to ICU, the incidence of AKI after 48 h of transfer to ICU and in-hospital mortality were recorded. The receiver operating characteristic (ROC) curve was used to evaluate the clinical value of CVP-related indicators in predicting AKI after CBS and determine the optimal threshold. The risk factors for AKI and in-hospital mortality after CBS were analysed using single factor and multifactorial Logistic regression. Results A total of 485 patients after CBS who met the inclusion and exclusion criteria were enrolled, with an incidence of AKI after 48 h of transfer to ICU of 25.2% (122/485) and an in-hospital mortality rate of 2.5% (12/485). The ROC curve analysis showed that the area under the curve (AUC) for CVPp 48h to predict AKI after CBS was 0.634 (95% CI: 0.577-0.692, P < 0.001), with an optimal threshold value of 14 mm Hg, sensitivity of 49.6% and specificity of 63.5%. Multifactorial logistic regression analysis showed that hypertension(OR=2.505, 95% CI: 1.581-3.969, P < 0.001), pulmonary hyperten-sion(OR=2.552, 95% CI: 1.573-4.412, P < 0.001), prolonged aortic block time(OR=1.009, 95% CI: 1.004-1.014, P=0.001), and CVPp 48h≥14 mm Hg(OR=1.613, 95% CI: 1.030-2.526, P=0.037) were independent risk factors for AKI after CBS; CVPp 48h≥14 mm Hg was an independent risk factor for in-hospital death(OR=8.044, 95% CI: 1.579-40.979, P=0.012). Conclusions CVPp 48h is associated with AKI in patients who have undergone CBS. The monitoring and management of CVP might be a way to improve the prognosis of these patients.

This year marks the 10th anniversary of the Belt and Road Initiative, and relevant theme indexes have attracted market attention. As a characteristic policy of China’s foreign trade, it is of great significance to study the development situation of its related stocks for the progress and future development of the Belt and Road. In this paper, EMD method and ARMA model are adopted. Taking the SSE One Belt & One Road Index as the representative of the Belt and Road Theme Index, the paper analyzes the price influencing factors of the Belt and Road theme stocks and predicts the future trend of their volatility. It believes that the price of the Belt and Road theme index is mainly affected by three parts: market supply relationship, short-term common influencing factors and long-term major event impact. Making EMDARMA prediction on its volatility and finds it to be more accurate than using the ARMA model directly.r load forecasting is very important for power dispatching. Accurate load forecasting is of great significance for saving energy, reducing generating cost and improving social and economic benefits. In order to accurately predict the power load, based on BP neural network theory, combined with the advantages of Clementine in dealing with big data and preventing overfitting, a neural network prediction model for large data is constructed.

Aiming at the problems of difficult adjustment of resonant frequency and difficult debugging in traditional atomizing circuit, a new atomizing circuit with multi-frequency and multi-circuit controlled by program is designed.The circuit uses STM32 as the main controller, and generates a frequency-adjustable external driving signal by frequency synthesizer based on AD9833 programming.The switching function of the MOS tube is driven to control the input of the external signal, so as to excite the oscillator oscillation.Sampling feedback circuit is used to find the optimum resonant frequency, which improves the stability of atomization circuit, realizes the real-time frequency adjustment, simplifies the circuit structure and reduces the difficulty of debugging.

An all-solid waveguide array fiber (WAF) is one kind of special microstructured optical fiber in which the higher-index rods are periodically distributed in a low-index silica host to form the transverse two-dimensional photonic crystal. In this paper, one kind of multidimensional microstructured optical fiber photonic device is proposed by using electric arc discharge method to fabricate periodic tapers along the fiber axis. By tuning the applied magnetic field intensity, the propagation characteristics of the all-solid WAF integrated with magnetic fluid are periodically modulated in both radial and axial directions. Experimental results show that the wavelength changes little while the transmission loss increases for an applied magnetic field intensity range from 0 to 500 Oe. The magnetic field sensitivity is 0.055 dB/Oe within the linear range from 50 to 300 Oe. Meanwhile, the all-solid WAF has very similar thermal expansion coefficient for both high- and low-refractive index glasses, and thermal drifts have a little effect on the mode profile. The results show that the temperature-induced transmission loss is

Variations from equilibrium Young's angle, known as contact angle hysteresis (CAH), are frequently observed upon droplet deposition on a solid surface. This ubiquitous phenomenon indicates the presence of multiple local surface energy minima for the sessile droplet. Previous research primarily explains CAH via considering macroscopic roughness, such as topographical defects, which alter the effective interfacial energy between the fluid phase and the solid phase, thereby shifting the global surface energy minimum. One typical example is the classic Cassie–Baxter–Wenzel theory. Here, we propose an alternative microscopic mechanism that emphasizes the complexity of molecular rearrangements at the fluid–solid interface, treating their interfacial tensions as variables, which results in multiple local surface energy minima. Our theoretical framework demonstrates that CAH can occur even on chemically homogeneous and mechanically smooth-flat substrates, aligning with previously unexplained experimental observations. In addition, we explore the interplay between macroscopic and microscopic roughness in influencing CAH and clarify the contrasting wetting behaviors—the lotus effect and the rose petal effect—on hierarchical roughness from a thermodynamic perspective. This work provides valuable insights into surface tension determination by restoring the natural physical properties of interfaces and illuminates the multifaceted mechanisms underlying the everyday occurrences of CAH. [ABSTRACT FROM AUTHOR]