Sepsis-associated acute kidney injury（SA-AKI）is a frequently encountered critical-care syndrome that complicates 40%-50% of sepsis cases and carries a markedly higher mortality than sepsis alone，representing a major threat to human health. Zinc finger protein A20，also known as tumor necrosis factor alpha-induced protein 3（TNFAIP3），is an important ubiquitin-editing enzyme. It was originally identified as a gene induced by tumor necrosis factor alpha and can negatively regulate the nuclear factor- κB（NF-κB）signaling pathway，serving as a key“brake”molecule in cell death and inflammatory responses. A20 encoded by the TNFAIP3 gene is a key negative regulator of inflammation, which is essential for regulating cell apoptosis and suppressing inflammatory cascades. Its protective role in SA-AKI is increasingly recognized. This review delineates the structural features，and biological functions，expression regulation of A20 ，summarizes current mechanistic insights into its renoprotective actions in SA-AKI ，and outlines emerging A20-targeted therapeutic strategies together with their prospects for clinical translation，aiming to provide novel therapeutic avenues for SA-AKI.
Objective To systematically analyze the current status，risk factors and root causes of protocol deviation（PD）in drug clinical trials，and construct risk control strategies to reduce the incidence of PD and improve the quality of clinical trials. Methods A retrospective collection was conducted on PD reports（351 cases in total）from 105 drug clinical trial projects carried out in Zhongda Hospital Affiliated to Southeast University from January to December 2024.Pareto chart was used to identify the main types of PD and responsible subjects，and fishbone diagram was applied to trace and analyze multi-dimensional causes including personnel ，processes and mechanisms. Results The main responsible subjects of PD were subjects（52.99%）and investigators（29.06%）. The primary types of PD included window violations（30.20%），examination/visit-related deviations（28.21%）and medication-related deviations（17.38%）. The root causes were concentrated in insufficient personnel compliance（lack of subject cognition and weak Good Clinical Practice awareness of investigators），process defects（absence of standardization）and unreasonable design by sponsors.Conclusion Based on the multi-dimensional causes of PD，a whole-process risk control strategy featuring“subject-centered，investigator-focused and clinical research coordinator-supported”is proposed. By optimizing protocol design，strengthening compliance management and improving quality control mechanisms，the incidence of PD can be significantly reduced，so as to ensure the authenticity of trial data and the safety of subjects.
Objective To investigate the relationship between serum malondialdehyde(MDA),endotoxin,peripheral blood mean platelet volume(MPV)to platelet count(PLT)ratio and early acute kidney injury in patients with severe acute pancreatitis(SAP),and to provide a reference for predicting kidney injury in patients with SAP.Methods A total of 90 patients with SAP admitted to Jiamusi Central Hospital from February 2021 to March 2024 were enrolled.According to the occurrence of early acute kidney injury,patients were divided into a kidney injury group and a non-kidney injury group.Serum MDA,endotoxin,and peripheral blood MPV/PLT ratio were compared between the two groups.Multivariate logistic regression was used to analyze independent risk factors for early acute kidney injury in SAP patients.Receiver operating characteristic(ROC)curves were constructed to evaluate the predictive efficacy of the three indicators.Results Of the 90 patients,37(41.11％)developed early acute kidney injury(kidney injury group),and the remaining 53(58.89％)did not(non-kidney injury group).Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,CRP,MDA,endotoxin,and MPV/PLT ratio were significantly higher,while urine volume and serum calcium(Ca2+)were significantly lower in the kidney injury group compared to in the non-kidney injury group(P＜0.05).Multivariate logistic regression analysis showed that high levels of MDA(OR=7.870,95％CI:1.669-37.108),endotoxin(OR=1.260,95％CI:4.814-34.034),and MPV/PLT ratio(OR=4.424,95％CI:1.408-13.897)were independent risk factors for early acute kidney injury in SAP patients(P＜0.05).ROC curve analysis showed that the area under the ROC curve(AUC)of endotoxin was 0.884,with a sensitivity of 78.38％and a specificity of 90.57％;the AUC of MDA was 0.874,with a sensitivity of 91.89％and a specificity of 69.81％;the AUC of MPV/PLT ratio was 0.875,with a sensitivity of 78.38％and a specificity of 92.45％.Conclusion MDA,endotoxin,and MPV/PLT ratio are closely related to the occurrence of early kidney injury in patients with SAP.These three all have high predictive efficacy for early kidney injury in patients with SAP.
Glioblastoma（GBM）is one of the most common primary brain tumors in adults，characterized by rapid progression and extremely poor prognosis. Cholesterol metabolism reprogramming occurs in GBM cells，involving the processes of cholesterol uptake，transport and esterification. Tumor cells can use cholesterol as an energy source，construct cell membranes and mediate signal molecules to promote their proliferation，progression and adaptation to the tumor microenvironment. Recent studies have shown that cholesterol metabolism in GBM cells is closely related to patient prognosis，and therapies targeting its regulatory pathways can significantly improve survival time. This review summarizes the phenomenon of cholesterol metabolism reprogramming in GBM，the roles of sterol regulatory element-binding proteins，liver X receptors，3-hydroxy-3-methylglutaryl coenzyme A reductase（HMGCR）and others in the regulation of cholesterol metabolism，and interpret the latest advances in targeted therapies related to cholesterol metabolism and its regulatory pathways.
Objective To systematically evaluate the predictive efficacy of four nutritional assessment tools for hypoglycemia risk in hospitalized patients with type 2 diabetes mellitus(T2DM),explore the independent association between malnutrition and hypoglycemia,and construct a hypoglycemia risk prediction model.Methods A total of 3 864 T2DM patients hospitalized in the Affiliated Hospital of Qingdao University from January 2014 to December 2023 were retrospectively enrolled and grouped according to fasting plasma glucose(FPG)levels at admission:patients with FPG≤3.9 mmol/L were defined as the hypoglycemia group(n=1 273),and those with FPG between 4.0 and 6.0 mmol/L were defined as the euglycemia group(n=2 591).Four nutritional assessment tools,including Prognostic Nutritional Index(PNI),Nutritional Risk Index(NRI),Controlling Nutritional Status(CONUT)score,and Nutritional Risk Screening 2002(NRS2002),were used to determine nutritional status,and their predictive abilities for hypoglycemia were compared.Least absolute shrinkage and selection operator(LASSO)regression was applied to screen characteristic variables,a multivariate logistic regression model was established,a nomogram was drawn,and the predictive performance of the model was evaluated using receiver operating characteristic(ROC)curve and Bootstrap method.Results ROC curve analysis showed that among the four nutritional tools,NRS2002 had the optimal predictive ability for hypoglycemia[area under the curve(AUC)=0.697,sensitivity=49.10％,specificity=90.04％],while the AUC values of NRI,PNI,and CONUT were 0.612,0.590,and 0.587,respectively,indicating limited overall predictive efficacy of nutritional tools.Multivariate logistic regression analysis revealed that malnutrition assessed by NRS2002 had the largest odds ratio(OR)for hypoglycemia risk,at 2.68(95％CI:2.39-3.01).PNI and NRI were not included in the final multivariate logistic regression model after LASSO regression variable screening,suggesting their limited applicability in this population.The final constructed regression equation was as follows:logit(P)=-1.418+0.842 × NRS2002+0.343 × disease duration+0.233 × oral hypoglycemic agents alone+1.778 × insulin monotherapy+1.839 × combined oral hypoglycemic agents and insulin-0.662 × history of coronary heart disease-0.441 × prealbumin-0.229 × estimated glomerular filtration rate.The model exhibited good ability to predict hypoglycemia occurrence in T2DM,with an AUC of 0.846 on the ROC curve;a sensitivity of 77.5％and a specificity of 80.1％.Conclusion Malnutrition is independently associated with hypoglycemia in hospitalized T2DM patients.The nomogram model has better predictive efficacy than commonly used nutritional tools and good clinical practicability,providing new ideas for the integrated application of clinical nutritional risk screening tools in blood glucose management.
Objective To explore the differences in homocysteine(HCY)levels and Age Shock Index(Age-SI)among elderly spontaneous intracerebral hemorrhage(SICH)patients with different prognoses,and to analyze their relationship with prognosis.Methods A total of 404 elderly patients with SICH admitted to the Department of Neurosurgery,Affiliated Hospital of North China University of Science and Technology from December 2021 to December 2024 were selected and divided into a good prognosis group(155 cases)and a poor prognosis group(249 cases)according to their 90-day prognosis.General data,Glasgow Coma Scale(GCS)score,admission vital signs,laboratory examination indicators and other clinical data were compared between the two groups.Logistic regression analysis was used to explore the prognostic factors of elderly patients with SICH,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of HCY combined with Age-SI on the prognosis of elderly patients with SICH.Results After a 90-day follow-up,the systolic blood pressure and GCS score in the poor prognosis group were significantly lower than those in the good prognosis group,while the age,heart rate,D-dimer,HCY,plasma thrombin time,blood glucose,Age-SI and the proportion of ventricular rupture were significantly higher than those in the good prognosis group(P＜0.05).Logistic regression analysis revealed that the increased HCY level(OR=1.220,95％CI:1.133-1.314,P＜0.01),increased Age-SI(OR=1.241,95％CI:1.178-1.306,P＜0.01)were independently associated with poor prognosis in elderly SICH patients.ROC curve analysis showed that the area under the curve(AUC)for predicting 90-day prognosis in elderly SICH patients was 0.769(95％CI:0.725-0.813)for HCY,0.878(95％CI:0.845-0.912)for Age-SI,and 0.920(95％CI:0.894-0.946)for their combination,with the combination being superior.The sensitivity and specificity were 80.72％and 89.67％,respectively.Conclusion HCY combined with Age-SI can predict the 90-day prognosis of elderly patients with SICH.
Objective To investigate the predictive value of preoperative CT signs and imaging parameters for the spread through air spaces(STAS)in pT1a-pT1c stage lung adenocarcinoma,and to provide a reference for designing reasonable surgical plans for lung cancer patients.Methods Patients with pT1a-pT1c stage lung adenocarcinoma who were admitted to Shijiazhuang People's Hospital from December 2021 to December 2024 were selected.They were divided into STAS-positive and STAS-negative groups based on postoperative pathological diagnosis results.The clinical data,preoperative CT signs,and imaging parameters of the two groups were compared,and the relationship of preoperative CT signs and imaging parameters with STAS was analyzed.An XGBoost model was constructed based on preoperative CT signs and imaging parameters.The predictive value of the XGBoost model was evaluated using calibration curves,receiver operating characteristic(ROC)curves,and decision curve analysis(DCA);additionally,103 patients with pT1a-pT1c stage lung adenocarcinoma from the same period were selected as the external validation set for external validation.Results Ultimately,237 patients with lung adenocarcinoma were included as study subjects,including 55 cases in the STAS positive group and 182 cases in the STAS negative group.A significant difference was observed in the clinical T-stage between the two groups(P＜0.05).In the STAS-positive group,the incidence of lobulated sign,spiculated sign,vascular convergence sign,bronchial air bronchogram,and tumor diameter,solid component diameter,chord-arc distance/chord length ratio,and net increase in arterial phase were higher than those in the STAS-negative group(P＜0.05),and the above CT signs and imaging parameters were positively correlated with STAS(P＜0.05).The XGBoost algorithm identified six factors to construct a predictive model,ranked in order of importance as follows:chord-arc distance/chord length ratio,solid component diameter,vascular convergence sign,net increase in arterial phase,spiculated sign,and bronchial air bronchogram.The calibration curve indicated that the calibration degree of the XGBoost model for preoperative CT signs and imaging parameters was 0.871,with a consistency index of 0.884,suggesting high predictive accuracy of the model.The ROC curve showed that the area under the curve(AUC)of the XGBoost model for predicting STAS was 0.899(95％CI:0.860-0.937),indicating good predictive performance of the model.The DCA curve demonstrated that when the threshold probability range was between 10％and 100％,the XGBoost model for predicting STAS had a high net benefit.The sensitivity,specificity,and Kappa value of the XGBoost model for predicting STAS in the external validation set were 87.50％,93.67％,and 0.789(95％CI:0.596-0.982),respectively,indicating high consistency with clinical actual results(P＜0.05).Conclusion The XGBoost model,constructed based on preoperative CT features including the diameter of solid components,vascular convergence sign,chord-arc distance/chord length ratio,net increase in arterial phase,bronchial air bronchogram,and spiculation sign,exhibits high application value for predicting STAS in pT1a-pT1c stage lung adenocarcinoma,and can provide guidance information for clinical surgical planning.
Objective Based on the 2021 Global Burden of Disease Study（GBD 2021）data，this study aims to quantify the spatiotemporal distribution characteristics of early-onset dementia among individuals aged 40-64 from 1990 to 2021，predict the disease development trend up to 2050，and identify health inequalities and modifiable risk factors.Methods Integrating epidemiological data from 204 countries/regions in the GBD 2021 database，the long-term trends of incidence，prevalence，mortality，and disability-adjusted life years（DALYs）were analyzed using age-standardized rates，joinpoint regression models，and Bayesian age-period-cohort（BAPC）models. The contribution of population growth，aging and epidemiological changes was evaluated by decomposition analysis，and the socio-demographic index（SDI）related health inequality was quantified by slope index of inequality and concentration index. Results From 1990 to 2021，the estimated annual percentage changes（EAPC）of the age-standardized incidence rate（ASIR），age-standardized prevalence rate（ASPR），and age-standardized DALYs rate（ASR-DALYs）for early-onset dementia worldwide continued to rise（EAPC of ASIR = 0.17，EAPC of ASPR = 0.08，and EAPC of ASR-DALYs = 0.07），with the most significant increase in burden observed among people aged 55-59（EAPC of ASIR = 1.52）. Women had higher incidence rates compared to men（69.27/100 000 vs 57.69/100 000），but men showed a faster growth rate（with an average annual growth rate 1.6 times that of women）. Middle-high SDI regions（e.g.，East Asia and Southeast Asia）reported the highest incidence（70.57/100 000）and prevalence（387.58/100 000）with rapid increases（EAPC of ASIR=0.30 and EAPC of ASPR=0.21），while low SDI regions faced widening relative inequalities in mortality and ASR - DALYs. Risk factors demonstrated gender specificity：high fasting plasma glucose（FPG）and high body mass index（BMI）dominated in women，whereas smoking and high FPG jointly influenced men. Projections indicated that global incidence and prevalence would rise to 76.92/100 000 and 403.95/100 000 by 2050，respectively. Conclusion This study reveals the global increasing trend of early - onset dementia and the patterns of health inequality，emphasizing the need to strengthen metabolic health management for high-risk populations in middle-high SDI regions，expand surveillance of modifiable risk factors（such as education and lifestyle），and improve disease diagnostic capacity in low SDI regions，in order to reduce the future disease burden and promote health equity.
Objective To explore the levels of soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK)and forkhead box protein M1(FOXM1)in the serum of patients with severe pneumonia(SP)complicated with respiratory failure(RF)and their relationship with prognosis.Methods From February 2024 to February 2025,193 SP patients complicated with RF and 185 patients with simple SP in Hebei Chest Hospital were enrolled as SP complicated with RF group and SP group,respectively.According to the 28-day prognosis,SP complicated with RF patients were classified into survival group(n=151)and death group(n=42).Serum sTWEAK and FOXM1 were measured by enzyme-linked immunosorbent assay.Pearson correlation coefficient was used for correlation analysis.The factors influencing the prognosis of SP patients complicated with RF were analyzed using multivariate Cox regression.The predictive value of serum sTWEAK and FOXM1 for the prognosis of these patients was analyzed using receiver operating characteristic(ROC)curves.Results The SP complicated with RF group had significantly higher serum sTWEAK and FOXM1 compared to SP group(t=14.888,18.028,P＜0.05).Compared with the survival group,the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,white blood cell count(WBC),and the serum levels of sTWEAK and FOXM1 in the death group were significantly higher(t=11.900,6.431,7.160,7.534,P＜0.05).Pearson correlation analysis showed that the serum sTWEAK and FOXM1 levels were positively correlated with the APACHE Ⅱ score and WBC count in SP patients complicated with RF(P＜0.05);the APACHE Ⅱ score,WBC,serum levels of sTWEAK and FOXM1 were all prognostic factors for these patients(HR=1.839,1.465,1.618,1.657,P＜0.05).The sensitivity and specificity of the combination of serum sTWEAK and FOXM1 for predicting 28-day mortality in SP patients complicated with RF were 90.48％and 81.46％,respectively,and the area under the curve(AUC)was 0.886.Conclusion The serum levels of sTWEAK and FOXM1 in SP patients complicated with RF are relatively high.Moreover,the combination of serum sTWEAK and FOXM1 has higher predictive efficacy for their prognosis,which can provide certain reference for clinical diagnosis and treatment.
Septic acute lung injury（SALI）is one of the common complications of sepsis，with a high incidence and closely related to the high mortality of patients in the intensive care unit. The pathophysiological mechanism of SALI is complex and involves multiple aspects such as dysfunction of the pulmonary vascular endothelial barrier. Endothelial glycocalyx（EG），a polysaccharide-protein complex covering the surface of vascular endothelial cells，plays a key role in maintaining vascular integrity，regulating inflammatory responses and coagulation functions. Recent studies have demonstrated that the damage of EG plays an important role in the occurrence and progression of SALI. This article reviews the structural and functional basis of EG，and focuses on discussing the molecular mechanism of EG damage in sepsis and its role in SALI，aiming to provide a theoretical basis for the exploration of therapeutic targets and the development of related drugs for SALI.
Objective To explore the effects of different doses of muscle relaxants on intraoperative body motor response,respiratory mechanics,and postoperative spontaneous breathing recovery in patients undergoing gynecological hysteroscopic surgery,and to provide a reference for the clinical dose selection of cisatracurium besilate.Methods A retrospective study was conducted on 180 patients who underwent hysteroscopic surgery at the Affiliated Chuzhou Hospital of Anhui Medical University from January 2021 to December 2021.All patients received intravenous general anesthesia.During anesthesia induction,60 patients received 0.05 mg/kg cisatracurium besilate as the low-dose group,60 patients received 0.15 mg/kg cisatracurium besilate as the normal-dose group,and 60 patients did not receive cisatracurium besilate as the control group.The following indicators were collected and compared:hemodynamic parameters including heart rate(HR),systolic blood pressure(SBP),and diastolic blood pressure(DBP)before anesthesia induction(T0),10 min after anesthesia induction(T1),at laryngeal mask airway insertion(T2),and 10 min after laryngeal mask airway insertion(T3);respiratory mechanical parameters including partial pressure of end-tidal carbon dioxide(PetCO2),lung compliance,and airway pressure at 5 and 10 min after laryngeal mask airway insertion;body movement response,success rate of first-attempt laryngeal mask airway insertion,and time from drug withdrawal to spontaneous breathing recovery.Results There were statistically significant inter-time effects,inter-group effects,and interaction effects on HR,SBP,DBP,and lung compliance among the three groups(P＜0.05).At time points T2 and T3,HR,SBP,and DBP in the normal-dose group and low-dose group were more stable than those in the control group(P＜0.05).At 5 and 10 minutes after laryngeal mask airway insertion,there were no statistically significant difference in airway pressure and PetCO2 among the three groups(P＞0.05),while lung compliance in the normal-dose group and low-dose group was higher than that in the control group(P＜0.05).There were statistically significant differences in body movement response(0,1.67％,15.00％;x2=10.179,P＜0.05),first-time success rate of laryngeal mask airway insertion(96.67％,95.00％,81.67％;x2=11.523,P＜0.01),and time from drug discontinuation to spontaneous respiration recovery[(20.43±2.20)min,(8.12±1.14)min,(5.07±1.18)min;F=1 588.011,P＜0.01]among the normal-dose group,low-dose group and control group.The body movement response in the normal-dose group and low-dose group was lower than that in the control group(P＜0.05),while the first-time success rate of laryngeal mask airway insertion was higher than that in the control group(P＜0.05).The time from drug discontinuation to spontaneous respiration recovery in the normal-dose group was longer than that in the low-dose group and control group(P＜0.05).Conclusion Low-dose cisatracurium besilate for anesthesia induction in gynecological hysteroscopic surgery is beneficial to improve lung compliance and reduce airway resistance,thereby increasing the success rate of first laryngeal mask airway insertion.At the same time,it can reduce movement response,and the time from drug withdrawal to spontaneous breathing recovery is relatively short,which has no adverse effect on postoperative recovery.
Objective To investigate the levels of serum chemokine CX3C ligand 1(CX3CL1)and galectin-3(Gal-3)in persistent pulmonary hypertension of newborn(PPHN)and their relationship with the disease condition and prognosis,and to provide a reference for the assessment and prognostic prediction of PPHN.Methods A total of 196 newborns with secondary PPHN admitted to the Second Hospital of Shanxi Medical University from February 2021 to December 2024 were regarded as the study subjects(case group).And the newborns were separated into severe group(n=65),moderate group(n=71),and mild group(n=60)according to the severity of the disease condition.Another 196 normal newborns who were delivered at full term during the same period were regarded as the control group.Enzyme-linked immunosorbent assay(ELISA)was applied to detect serum levels of CX3CL1 and Gal-3.Spearman correlation coefficient was applied to analyze the relationship between serum levels of CX3CL1 and Gal-3 and the severity of PPHN in infants.Multivariate logistic regression model was applied to analyze the factors affecting the prognosis of newborns with PPHN.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum CX3CL1 and Gal-3 for the prognosis of infants with PPHN.Results The serum levels of CX3CL1 and Gal-3 in the case group were higher than those in the control group(P＜0.05).The serum levels of CX3CL1 and Gal-3 decreased sequentially in the severe,moderate,and mild groups(P＜0.05).Serum levels of CX3CL1 and Gal-3 were positively correlated with the severity of PPHN in newborns(r=0.516,0.493,P＜0.05).The proportions of oxygenation index≥16,serum CX3CL1 and Gal-3 levels in the death group(n=33)showed significant differences compared to the survival group(n=163)(P＜0.01).An oxygenation index ≥16 and elevated serum levels of CX3CL1 and Gal-3 were independent risk factors for 30-day mortality in infants with PPHN(P＜0.05).The area under the curve(AUC)of serum CX3CL1 and Gal-3 in combination for predicting the prognosis of newborns with PPHN was 0.873(95％CI:0.791-0.931),with a sensitivity of 90.91％and a specificity of 80.60％.The AUC of combined detection of the two was higher than that of CX3CL1 and Gal-3 alone(Z=2.159,P=0.032;Z=2.037,P=0.045).Conclusion The elevated levels of serum CX3CL1 and Gal-3 in newborns with PPHN are positively correlated with the severity of condition,and the combined detection of these two has high predictive value for the 30-day prognosis of newborns.
Objective To investigate the serum levels of T-cell immunoglobulin and mucin-containing molecule-3(TIM-3),paraoxonase-1(PON-1),and growth differentiation factor-15(GDF-15)in elderly sepsis patients and their relationship with poor prognosis.Methods A total of 128 elderly sepsis patients who visited the First People's Hospital of Lianyungang between October 2022 and October 2024 were retrospectively selected as the research subjects(sepsis group).All patients were assigned into a simple sepsis group(n=50)and a septic shock group(n=78)based on the disease severity.According to the survival status after 28 days,the patients were assigned into a survival group(n=77)and a death group(n=51).In the same period,119 individuals who experienced physical examination were included as the healthy control group.Enzyme-linked immunosorbent assay was used to detect serum TIM-3,PON-1,and GDF-15 in sepsis group patients within 24 hours of admission and in the healthy control group on the day of physical examination.Multivariate logistic regression analysis was used to screen for influencing factors.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of indicators for prognosis.The area under the curve(AUC)was compared using Z-test.Results The serum levels of TIM-3 and GDF-15 in sepsis group were higher than those in healthy control group,while the PON-1 was lower than that in healthy control group(P＜0.01).The serum TIM-3 and GDF-15 in septic shock group were higher than those in normal sepsis group,and the PON-1 was lower than that in normal sepsis group(P＜0.01).Compared with the survival group,the Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,the level of TIM-3,and GDF-15 were higher(P＜0.05),PON-1 was lower(P＜0.05)in death group.Increased TIM-3 and GDF-15 were independent risk factors for death in elderly sepsis patients(OR=3.167,95％CI:1.604-6.252,P=0.001;OR=2.942,95％CI:1.411-6.135,P=0.004),while increased PON-1 was a protective factor for death in elderly sepsis patients(OR=0.756,95％CI:0.631-0.905,P=0.002).The AUC of TIM-3,PON-1,and GDF-15 alone and combined to predict death were 0.830,0.826,0.828,and 0.950,respectively.The combined AUC surpassed the individual AUC(P＜0.05).Conclusion Serum levels of TIM-3,PON-1,and GDF-15 are factors influencing death in elderly patients with sepsis,and combined detection has high predictive value for their death risk.
Sepsis-associated encephalopathy（SAE）is a common neurological complication in sepsis，with an incidence rate of 70% in the intensive care unit，and approximately half of the patients suffer from long-term cognitive dysfunction.Currently，clinical treatment mainly focuses on anti-infection and supportive therapy，lacking specific intervention measures targeting core pathological processes such as neuroinflammation，blood-brain barrier disruption，mitochondrial dysfunction，and oxidative stress. This study systematically reviews the latest progress in the treatment of cognitive dysfunction in SAE and its transition from basic research to clinical practice，providing new strategies for the clinical treatment plan of SAE.
Objective To investigate the predictive efficacy of combined indexes based on soluble thrombomodulin(sTM)for acute kidney injury(AKI)in patients with sepsis,and to provide a reference for the early identification of AKI in clinical practice.Methods A retrospective study was conducted to collect clinical data of 364 patients with sepsis admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January to December 2024.According to the occurrence of AKI during hospitalization[based on the diagnostic criteria proposed by Kidney Disease:Improving Global Outcomes(KDIGO)],the patients were divided into AKI group(171 cases)and non-AKI group(193 cases).The clinical data of the two groups were compared.Multivariate logistic regression analysis was used to screen the risk factors for AKI in sepsis patients.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of combined indicators based on sTM for AKI in sepsis patients.Results The incidence of sepsis-associated AKI was 46.98％.Compared with the non-AKI group,the AKI group exhibited significantly higher Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,28-day mortality,and incidence rates of shock,respiratory failure,and liver injury(P＜0.05).Levels of sTM,C-reactive protein(CRP),interleukin-6,procalcitonin,prothrombin time,and activated partial thromboplastin time were also significantly higher,whereas platelet count was significantly lower(P＜0.05).Multivariate logistic regression analysis identified shock(OR=3.304,95％CI:2.001-5.457,P＜0.01),liver injury(OR=2.442,95％CI:1.399-4.265,P=0.002),high APACHE Ⅱ score(OR=1.050,95％CI:1.016-1.085,P=0.004),high sTM(OR=1.039,95％CI:1.018-1.060,P＜0.01),and high CRP(OR=1.003,95％CI:1.001-1.006,P=0.034)as independent risk factors for AKI in patients with sepsis.The combined use of sTM,shock,and APACHE Ⅱ score yielded an area under the curve(AUC)of 0.804(95％CI:0.759-0.850)for predicting AKI,with a sensitivity of 0.754 and a specificity of 0.762.Conclusion sTM is an independent risk factor for AKI in sepsis patients,and has certain predictive value for AKI in sepsis patients.The predictive value is more significant when combined with shock and APACHE Ⅱ score.
Objective To investigate the risk factors for hyperbilirubinemia(HB)in critically infected patients treated with tigecycline,thereby providing a reference for the safe and rational clinical use of this drug.Methods A retrospective review was conducted on 205 critically infected patients who received tigecycline in Suzhou Municipal Hospital from January 2018 to December 2024.Patients were stratified into an HB(n=40)group and non-HB(n=165)group based on the occurrence of HB after treatment.General data,clinical histories,tigecycline dosing regimens,and laboratory parameters of the two groups were collected.Risk factors were identified using multivariate logistic regression.Receiver operating characteristic(ROC)curve was plotted,and the area under the curve(AUC)was used to evaluate the value of these factors for predicting HB occurrence.Results The incidence of HB was 19.5％(40/205).Univariate analysis showed statistically significant differences between the two groups in underlying diseases(renal disease,liver disease),high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),platelet count(PLT),activated partial thromboplastin time(APTT),prothrombin time(PT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),and albumin levels(P＜0.05).Multivariate logistic regression analysis showed that combined liver disease(OR=3.817,95％CI:1.467-9.933),elevated APTT(OR=1.084,95％CI:1.028-1.142),increased PCT(OR=1.093,95％CI:1.021-1.170)and decreased PLT(OR=0.994,95％CI:0.989-0.999)were independent risk factors for tigecycline-related HB(P＜0.05).ROC curve analysis showed that the AUC of the combination of APTT,PCT and PLT in predicting HB was 0.867(95％CI:0.800-0.934),with a sensitivity of 77.5％and a specificity of 84.2％.Conclusion Combined liver disease,elevated APTT,elevated PCT,and decreased PLT are high-risk factors for HB in critically infected patients treated with tigecycline.Clinicians should exercise heightened vigilance when tigecycline is used for anti-infective treatment,and enhance monitoring of these parameters in high-risk patients to mitigate the risk of this adverse reaction.
Objective To provide a scientific basis for understanding the disease mechanism and achieving precise diagnosis and treatment of sepsis-induced acute respiratory distress syndrome(ARDS)related to immune imbalance by identifying immune regulation-related differentially expressed genes(IRDEGs).Methods Based on sepsis alone and sepsis-induced ARDS samples gained from the Gene Expression Omnibus(GEO)database,IRDEGs were screened and subjected to Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses.Weighted gene co-expression network analysis(WGCNA)was used to obtain co-expression module genes.Combined with logistic regression,random forest,and LASSO regression,an ARDS diagnostic model was constructed.Meanwhile,CIBERSORT was employed to analyze immune infiltration.Peripheral blood samples from patients with sepsis-induced ARDS and sepsis alone(n=10,each),treated at the First Affiliated Hospital of Harbin Medical University in 2024,were collected to validate the protein expression of model genes via enzyme-linked immunosorbent assay(ELISA).Results A total of 34 IRDEGs and 4 model genes[tumor necrosis factor superfamily member 10(TNFSF10),[32-microglobulin(B2M),semaphorin 7A(SEMA7A),and cluster of differentiation 200(CD200)]were identified.An effective diagnostic model for ARDS was subsequently constructed.Immune infiltration analysis revealed extensive enrichment of immune cells and significant correlations in ARDS,such as a strong positive correlation between follicular helper T cells and resting dendritic cells(r=0.765,P＜0.05).Model genes were associated with immune cell infiltration;for example,B2M was negatively correlated with naive B cells(r=-0.383,P＜0.05).ELISA confirmed that serum levels of CD200 and SEMA7A were significantly higher in patients with sepsis-induced ARDS compared to those with sepsis alone(P＜0.01).Conclusion The ARDS diagnostic model constructed using TNFSF10,B2M,SEMA 7A,and CD200 exhibit good performance.There are significant correlations between the model genes and immune cells,as well as among various immune cells themselves.ELISA confirms that serum levels of CD200 and SEMA7A are significantly elevated in patients with septic ARDS,suggesting that they are potential diagnostic biomarkers.
Objective To investigate the correlation between systemic immune-inflammation index(SII)and respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and the predictive efficiency of SII for respiratory failure in AECOPD patients.Methods Clinical data of 102 AECOPD patients admitted to Anhui No.2 Provincial People's Hospital from November 2023 to February 2025 were retrospectively collected.The patients were divided into the observation group(n=48)and the control group(n=54)according to the presence or absence of respiratory failure.Levels of C-reactive protein(CRP),D-dimer(D-D),albumin(ALB),fibrinogen(FIB),neutrophil count(NEU),platelet count(PLT),lymphocyte count(LYM),red blood cell distribution width(RDW),mean platelet volume(MPV),plateletcrit(PCT),platelet distribution width(PDW),SII,neutrophil-to-lymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR)were compared between the two groups.Logistic regression was used to analyze influencing factors of respiratory failure secondary to AECOPD,and receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of SII for respiratory failure.Results Compared with the control group,CRP,NEU,NLR,PLR,SII,and FIB were significantly higher(P＜0.05),while ALB and LYM were significantly lower in the observation group(P＜0.05).Multivariate logistic regression showed that high SII(OR=1.003,95％CI:1.001-1.005),high CRP(OR=1.016,95％CI:1.000-1.030),and low ALB(OR=0.861,95％CI:0.753-0.983)were independent risk factors for respiratory failure in AECOPD patients(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of SII in predicting respiratory failure in AECOPD patients was 0.809.Conclusion SII can be used as an effective indicator for predicting respiratory failure in AECOPD patients.
Objective To investigate the effect of ultrasound-guided fluid resuscitation combined with esmolol on oxygen metabolism indicators and inflammatory levels in patients with septic shock.Methods A total of 122 patients with septic shock admitted to Affiliated Hospital of Hebei University of Engineering from June 2021 to June 2023 were selected and randomly divided into a control group and a treatment group,with 61 cases in each group.All patients received conventional treatments including fluid resuscitation for anti-shock,application of vasoactive drugs,anti-infection,immune regulation,and organ function support.The control group was treated with ultrasound-guided fluid resuscitation,while the treatment group was additionally treated with esmolol based on the control group.Oxygen metabolism indicators[oxygen consumption(VO2),oxygen delivery(DO2)],inflammatory factors[interleukin-6(IL-6),C-reactive protein(CRP)],6-hour lactate clearance rate,mortality rate during treatment,hemodynamic indicators[mean arterial pressure(MAP),central venous pressure(CVP)],and myocardial related indicators[creatine kinase-MB(CK-MB),brain natriuretic peptide(BNP),cardiac troponin I(cTnI)]were compared between the two groups.Results After treatment,the levels of IL-6,CRP,CK-MB,BNP,and cTnI decreased in both groups,and those in the treatment group were significantly lower than those in the control group(P＜0.05).The levels of VO2,DO2,MAP,and CVP increased in both groups,and those in the treatment group were significantly higher than those in the control group(P＜0.05).The 6-hour lactate clearance rate in the treatment group was significantly higher than that in the control group[(86.21±9.35)％vs(81.52±8.69)％,t=2.870,P=0.005].There was no significant difference in mortality rate during treatment between the two groups(P＞0.05).Conclusion Ultrasound-guided fluid resuscitation combined with esmolol can effectively improve oxygen supply-consumption balance,enhance tissue oxygen delivery capacity,stabilize hemodynamics,inhibit the release of inflammatory factors,reduce systemic inflammatory response,and improve myocardial function in patients with septic shock,which has clinical application value.
Objective To observe the clinical value of the HA380 hemoperfusion combined with Xuebijing injection for patients with sepsis,and analyze the effect of this regimen on the serum levels of interleukin(IL)-17 and soluble leukocyte differentiation antigen 14 subtype(Presepsin)in patients.Methods A total of 120 sepsis patients admitted to Cangzhou Central Hospital between December 2021 and June 2023 were enrolled prospectively,and randomly divided into two groups:the Xuebijing group(n=60)and the combined group(n=60)using a random number table.During the study,15 cases were excluded due to dropout,resulting in 52 cases in the Xuebijing group and 53 cases in the combined group.The Xuebijing group received intravenous Xuebijing injection,while the combined group received Xuebijing injection combined with HA380 hemoperfusion therapy.The treatment course for both groups lasted one week.The blood indicators and relevant scores of the two groups of patients before treatment and after one week of treatment,as well as the clinical efficacy and adverse reactions after one week of treatment were observed.Results After one week of treatment,the total effective rate was significantly higher in the combined group than that in the Xuebijing group(94.34％ vs 80.77％,x2=4.456,P=0.035).Serum levels of IL-17,tumor necrosis factor-α(TNF-α),procalcitonin(PCT),Presepsin,serum creatinine,blood urea nitrogen,and arterial partial pressure of carbon dioxide(PaCO2),as well as Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ)score and Sequential Organ Failure Assessment(SOFA)score,were significantly reduced in both groups(P＜0.05),with the combined group showing significantly lower levels than the Xuebijing group(P＜0.05).Conversely,arterial oxygen saturation(SaO2)levels and pondus hydrogenii(pH)values were significantly increased in both groups(P＜0.05),with significantly higher levels in the combined group than in the Xuebijing group(P＜0.05).The incidence of adverse reactions was significantly lower in the combined group than in the Xuebijing group(5.66％vs 19.23％,x2=4.456,P=0.035).Conclusion The combination of HA380 hemoperfusion and Xuebijing has significant therapeutic effects on sepsis patients,which can improve the prognosis of patients and reduce the levels of serum IL-17 and Presepsin.
