Abstract: Pulmonary hypertension (PH) causes right heart failure (RHF), leading to an unfavorable prognosis. This prospective single-arm study evaluated the acute effects of levosimendan in 105 patients with RHF secondary to PH. Levosimendan was administered as a continuous infusion at a rate of 0.1 μg/kg/min over 24 hours. The primary end point was improvement in WHO Functional Class (WHO-FC) at day 7, with secondary end points including the Borg dyspnea scores, systolic pulmonary artery pressure (SPAP), and echocardiographic parameters. Treatment resulted in significant clinical and hemodynamic improvements by day 7. WHO-FC decreased from a median of 4.00 (3.00, 4.00) to 3.00 (2.00, 3.00) ( P < 0.001) and Borg dyspnea scores improved from 8.00 (6.00, 8.00) to 4.00 (4.00, 5.00) ( P < 0.001). SPAP decreased significantly from 57.51 (51.24, 68.00) mm Hg to 50.16 (44.55, 59.83) mm Hg ( P = 0.002). Echocardiography showed favorable changes, including reduced left ventricular end-systolic volume and tricuspid regurgitation velocity, alongside increased left ventricular fractional shortening. In a subgroup with left heart disease, left ventricular ejection fraction increased from 33.10% (27.58, 47.20) to 36.50% (30.63, 49.50) ( P = 0.025). Patients with heart failure with preserved ejection fraction also showed reduced SPAP and tricuspid regurgitation velocity. The findings suggest that levosimendan provides acute physiological benefits in PH-related RHF, with potential anti-inflammatory, hepatoprotective, and glycemic-modulating properties. Patient-specific medical history and concomitant medications may influence treatment response. This study offers preliminary evidence supporting the acute physiological effects and tolerability of levosimendan in this population.

Cardiomyopathy accounts for worse clinical outcome and higher mortality rate during sepsis globally. Here we assessed whether post-operative administration of I-C-F-6, a small molecule oligo-peptide (Gly-Ala-Gly-Pro-His-Gly-Gly) derived from Carapax trionycis, protected against septic cardiomyopathy in mice. Male adult mice were exposed to cecal ligation and puncture (CLP) and I-C-F-6 was administered intravenously (0.4 mg/kg or 4.0 mg/kg) 30 min following surgery. Administration of I-C-F-6 extended survival period and decreased sepsis severity score in septic mice. Furthermore, administration of I-C-F-6 mitigated cardiac atrophy and preserved cardiac function in septic mice. Mechanistically, I-C-F-6 inhibited inflammation and promoted M2 polarization in myocardium of septic mice. In addition, I-C-F-6 activated nuclear factor erythroid 2-related factor 2 (Nrf2)/haem oxygenase-1 (HO-1)/glutathione peroxidase 4 (GPX4) pathway, mitigated oxidative damage and inhibited ferroptosis in myocardium of septic mice. In conclusion, post-operative administration of I-C-F-6 in mice exposed to CLP improved survival and mitigated myocardial impairment. Our work established a clear therapeutic potential of I-C-F-6 for sepsis-induced cardiomyopathy.

Anemia is a common sepsis complication with poor long-term outcomes, and accurate risk stratification tools are critical for clinical management. We conducted a multicenter retrospective observational study to develop and validate a nomogram for anemia in Chinese Han sepsis patients, enrolling 723 eligible patients from two tertiary hospitals. Lasso regression for parameter screening and binary logistic regression identified age, gender, APACHE Ⅱ scores, albumin (Alb), procalcitonin (PCT), and cholinesterase (ChE) as independent predictors. Based on multifactorial results of the binary logistic regression analysis in the training cohort, a nomogram was established to predict the anemia risk in sepsis patients. The nomogram exhibited excellent discriminative performance [ AUC: 0.911 (95% CI, 0.880-0.936) in the training set, 0.896 (95% CI, 0.843-0.936) internally, 0.876 (95% CI, 0.801-0.931) externally] and good calibration. These findings provide a highly accurate nomogram for anemia risk prediction in this population, offering a reliable tool for clinical decision-making

BACKGROUND:Aquaporin 2 (AQP2), a vasopressin-sensitive water channel in the renal collecting ducts, maintains body water homeostasis. Sepsis reduces AQP2 and vasopressin receptor 2 (V2R) levels, contributing to acute kidney injury. In a heritable nephrogenic diabetes insipidus mouse model with V2R mutation, Wnt-5a, a ligand for frizzled receptors (Fzds), enhances AQP2 expression and translocation through calcium/calmodulin/calcineurin signaling. However, the mechanism by which Wnt-5a reduces sepsis-induced AQP2 inhibition remains unclear. We assessed this mechanism and whether Wnt-5a alleviates sepsis-induced downregulation of renal AQP2. METHODS:Our study used in vitro and in vivo approaches. To study AQP2 trafficking, lipopolysaccharide (LPS) was applied to mouse inner medullary collecting duct 3 (mIMCD3) cells in vitro; subsequently, phosphorylated AQP2 and apical AQP2 expression as well as calcineurin activity and its upstream regulators (endogenous Wnt-5a, Fzds, and intracellular calcium intensity) were examined. In vivo, cecal ligation and puncture (CLP) mice were used to assess AQP2 levels and urine osmolality as indicators of urinary concentration. RESULTS:In mIMCD3 cells, LPS application was associated with reduced V2R expression, a vasopressin-irreversible reduction in AQP2, and increased Fzds turnover and Wnt-5a-stimulated intracellular calcium, enhancing calcineurin signaling. Subsequent application of Wnt-5a to LPS-exposed mIMCD3 cells prevented AQP2 reduction. Moreover, it increased phosphorylated AQP2 at residue Ser269 (Ser269-pAQP2) and decreased at Ser261-pAQP2 without affecting Ser256-pAQP2. These effects were reversed by the calcineurin inhibitor cyclosporin A. In CLP mice, Wnt-5a injection was associated with increased renal AQP2 and urine osmolality. CONCLUSION:Wnt-5a attenuates sepsis-induced AQP2 downregulation through the calcineurin signaling pathway.

ABSTRACT:Background: Sepsis is caused by the invasion of the bloodstream by microorganisms from local sites of infection, leading to high mortality. This study aimed to compare the predictive ability of the biomarkers presepsin, procalcitonin (PCT), and C-reactive protein for bacteraemia. Methods: In this retrospective, multicentre study, a dataset of patients with sepsis who were prospectively enrolled between November 2017 and June 2021 was analyzed. The performances of the biomarkers for predicting positive blood cultures and infection with specific pathogens were assessed by the areas under the receiver operating characteristic curves (AUCs). The independent effects of the pathogen and foci of infection on presepsin and PCT levels were assessed by linear logistic regression models. Results: A total of 577 patients with 170 positive blood cultures (29.5%) were enrolled. The AUC achieved using PCT levels (0.856) was significantly higher than that achieved using presepsin (0.786, P = 0.0200) and C-reactive protein (0.550, P < 0.0001) levels in predicting bacteraemia. The combined analysis of PCT and presepsin levels led to a significantly higher AUC than the analysis of PCT levels alone for predicting blood culture positivity (0.877 vs. 0.856, P = 0.0344) and gram-negative bacteraemia (0.900 vs. 0.875, P = 0.0216). In a linear regression model, the elevated concentrations of presepsin and PCT were both independently related to Escherichia coli , Klebsiella species, Pseudomonas species, and Streptococcus species infections and Sequential Organ Failure Assessment score. Presepsin levels were also associated with Acinetobacter species and abdominal infection, and PCT levels were positively associated with other Enterobacteriaceae and negatively associated with respiratory infection. Combined analysis of presepsin and PCT levels provided a high sensitivity and specificity in identifying E. coli or Klebsiella species infection. Conclusions: Presepsin and PCT were promising markers for predicting bacteraemia and common pathogens at the time of sepsis onset with a synergistic effect.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.[1,2]Septic shock,the most severe form of sepsis,is characterized by circulatory and cellular/metabolic abnormalities,and can increase mortality to＞40％.[1-3]Early recognition and risk stratification of septic shock are crucial but challenging because of the heterogeneity of its presentation and progression.Although blood culture is recognized as the gold standard for detecting sepsis,it usually takes several days to obtain result,which may delay the diagnosis.Therefore,with the advantage of rapid screening of pathogens,bedside biomarker detection has been widely used for identifying high-risk patients.Procalcitonin(PCT),C-reactive protein(CRP)and presepsin are the most commonly used biomarkers for sepsis.[4]However,there has been no research comparing the predictive value of presepsin,PCT and CRP for septic shock and risk stratification.Therefore,this study aimed to compare the accuracy of presepsin,PCT and CRP in identifying septic shock and assessing organ dysfunction in a large sample of septic patients.

ABSTRACT:Background: Pulmonary sepsis and abdominal sepsis have pathophysiologically distinct phenotypes. This study aimed to compare their clinical characteristics and predictors of mortality. Methods: In this multicenter retrospective trial, 1,359 adult patients who fulfilled the Sepsis-3 criteria were enrolled and classified into the pulmonary sepsis or abdominal sepsis groups. Plasma presepsin was measured, and the scores of Acute Physiology and Chronic Health Evaluation (APACHE) II, Mortality in Emergency Department Sepsis (MEDS), and Simplified Acute Physiology Score (SAPS) II were calculated at enrollment. Data on 28-day mortality were collected for all patients. Results: Compared with patients with abdominal sepsis (n = 464), patients with pulmonary sepsis (n = 895) had higher 28-day mortality rate, illness severity scores, incidence of shock and acute kidney injury, and hospitalization costs. Lactate level and APACHE II and MEDS scores were independently associated with 28-day mortality in both sepsis types. Independent predictors of 28-day mortality included Pa o2 /F io2 ratio (hazard ratio [HR], 0.998; P < 0.001) and acute kidney injury (HR, 1.312; P = 0.039) in pulmonary sepsis, and SAPS II (HR, 1.037; P = 0.017) in abdominal sepsis. A model that combined APACHE II score, lactate, and MEDS score or SAPS II score had the best area under the receiver operating characteristic curve in predicting mortality in patients with pulmonary sepsis or abdominal sepsis, respectively. Interaction term analysis confirmed the association between 28-day mortality and lactate, APACHE II score, MEDS score, SAPS II score, and shock according to the sepsis subgroups. The mortality of patients with pulmonary sepsis was higher than that of patients with abdominal sepsis among patients without shock (32.9% vs. 8.8%; P < 0.001) but not among patients with shock (63.7 vs. 48.4%; P = 0.118). Conclusions: Patients with pulmonary sepsis had higher 28-day mortality than patients with abdominal sepsis. The study identified sepsis subgroup-specific mortality predictors. Shock had a larger effect on mortality in patients with abdominal sepsis than in those with pulmonary sepsis.

BACKGROUND:Bacteremia, which is a major cause of mortality in patients with acute cholangitis, induces hyperactive immune response and mitochondrial dysfunction. Presepsin is responsible for pathogen recognition by innate immunity. Acylcarnitines are established mitochondrial biomarkers.AIM:To clarify the early predictive value of presepsin and acylcarnitines as biomarkers of severity of acute cholangitis and the need for biliary drainage.METHODS:Of 280 patients with acute cholangitis were included and the severity was stratified according to the Tokyo Guidelines 2018. Blood presepsin and plasma acylcarnitines were tested at enrollment by chemiluminescent enzyme immunoassay and ultra-high-performance liquid chromatography-mass spectrometry, respectively.RESULTS:The concentrations of presepsin, procalcitonin, short- and medium-chain acylcarnitines increased, while long-chain acylcarnitines decreased with the severity of acute cholangitis. The areas under the receiver operating characteristic curves (AUC) of presepsin for diagnosing moderate/severe and severe cholangitis (0.823 and 0.801, respectively) were greater than those of conventional markers. The combination of presepsin, direct bilirubin, alanine aminotransferase, temperature, and butyryl-L-carnitine showed good predictive ability for biliary drainage (AUC: 0.723). Presepsin, procalcitonin, acetyl-L-carnitine, hydroxydodecenoyl-L-carnitine, and temperature were independent predictors of bloodstream infection. After adjusting for severity classification, acetyl-L-carnitine was the only acylcarnitine independently associated with 28-d mortality (hazard ratio 14.396; P < 0.001) (AUC: 0.880). Presepsin concentration showed positive correlation with direct bilirubin or acetyl-L-carnitine.CONCLUSION:Presepsin could serve as a specific biomarker to predict the severity of acute cholangitis and need for biliary drainage. Acetyl-L-carnitine is a potential prognostic factor for patients with acute cholangitis. Innate immune response was associated with mitochondrial metabolic dysfunction in acute cholangitis.

目的 研究定量CT骨密度(QCT-BMD)对骨质疏松性椎体压缩骨折(OVCFs)患者经皮椎体成形术(PVP)后椎体压缩骨折复发的预测价值.方法 回顾性分析PVP手术治疗的OVCFs患者108例(骨折复发组15例,骨折未复发组93例).比较两组患者年龄、性别、体重指数(BMI)、病程、伤椎上位、下位椎体QCT-BMD、骨水泥注入量、骨水泥渗漏.采用logistic回归筛选PVP术后骨折复发独立危险因素.AUC分析QCT-BMD对骨折复发预测准确性.Kaplan-Meier生存分析、Cox比例风险回归模型分析QCT-BMD对3年椎体压缩骨折复发的预测价值.结果 骨折复发组伤椎上位和下位椎体QCT-BMD均明显低于骨折未复发组(P＜0.01).上位椎体QCT-BMD是PVP术后患者骨折复发的独立预测因素(OR=0.945,P=0.006).AUC为0.802,特异度为100.0％,敏感度为59.3％.上位椎体QCT-BMD≤59.15 mg Ca-HA/mL患者3年骨折复发风险明显升高(P=0.002).风险比(HR)为0.951(95％CI 0.916～0.987,P=0.008).结论 QCT-BMD值对于PVP术后患者骨折复发具有早期预测价值.

Objective:To evaluate the risk factors of mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:A total of 97 patients with AECOPD in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from January 2018 to January 2019 were prospectively selected and followed up for 2.5 years. According to the prognosis, they were divided into survival group (82 cases) and death group (15 cases). Logistic regression analysis was used to screen the independent risk factors for death. The area under receiver operating characteristic curve (AUC) was used to analyze the prediction accuracy. Kaplan-Meier survival analysis and Cox proportional hazards regression model were used to analyze the predictive value of the prediction model for 2.5-year mortality in AECOPD patients.Results:Drinking history ( OR=4.975, P=0.046), past long-term β receptor blockers ( OR=5.486, P=0.029) and creatine kinase isoenzyme (CK-MB) level ( OR=2.008, P=0.049) were independent risk factors for death in patients with AECOPD. The AUC was 0.729, 0.715 and 0.710 respectively. The weight values of the three in the prediction model were 5, 5 and 1 respectively and the AUC was 0.834. Kaplan Meier survival analysis showed that 8 points of the prediction model could predict the 2.5-year survival rate in AECOPD patients (Log Rank P<0.001). The risk of death in AECOPD patients with score >8 was significantly higher than that of patients with score ≤8 ( HR=12.471, 95% CI: 3.735-41.643, P<0.001). Conclusions:Drinking history, past long-term β receptor blockers and CK-MB levels are independent risk factors for 2.5-year mortality in patients with AECOPD. The combination of these three factors has high predictive value for the prognosis of patients.

Objective Acute pancreatitis in pregnancy (APIP) is a rare and serious complication during pregnancy. It has acute onset and is difficult to diagnose and treat. The aim of the present study was to describe the etiology, clinical manifestations, and maternofetal outcomes of APIP. Methods We retrospectively reviewed 32 pregnant women who were treated at three tertiary care hospitals in Beijing, China. The correlation between the causes of APIP, severity, laboratory indices, and outcomes was analyzed. Results The most common causes of APIP were hypertriglyceridemia (56.2%,18/32) and gallstones (28.1%, 9/32). Hypertriglyceridemia-induced APIP was associated with a higher rate of severe acute pancreatitis ( P = 0.025). Serum level of triglycerides showed a positive correlation with the severity of APIP ( P = 0.039). The most frequent presentation of APIP was abdominal pain (93.7%, 30/32). There were no maternal or fetal deaths in our study. Apgar scores at 1 min, 5 min, and 10 min of the premature neonates was correlated with the severity of APIP of the mother ( P = 0.022; 0.002; 0.002). Conclusion High level of triglycerides may serve as a useful marker of the severity of APIP. The severity of APIP was associated with higher risk of neonate asphyxia. Appropriate timing of termination of pregnancy is a key imperative for APIP patients.

BACKGROUND Acute pulmonary embolism (APE) with cardiac arrest (CA) is characterized by high mortality in emergency due to pulmonary arterial hypertension (PAH). This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme (ACE) 2-angiotensin (Ang) (1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor (AT1) axis (ACE2/ACE axes) ratio on pulmonary artery lesion after return of spontaneous circulation (ROSC). METHODS To establish a porcine massive APE with CA model, autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg (1 mmHg=0.133 kPa). Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation. Pigs were divided into four groups of five pigs each: control group, APE-CA group, ROSC-saline group, and ROSC-captopril group, to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril. RESULTS Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells. Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor (VEGF) in the APE-CA group compared with the control group. Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC. Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2 (Bcl-2)/Bcl-2-associated X (Bax) ratio and decreasing cleaved caspase-3 expression. CONCLUSION Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.

BACKGROUND:Acute pancreatitis (AP) is an inflammatory disorder of the pancreas with an unpredictable course of illness. A major challenge of AP is the early identification of patients at high-risk for organ failure and death. However, scoring systems are complicated and time consuming, and the predictive values for the clinical course are vague.AIM:To determine whether the dynamic changes in presepsin levels can be used to evaluate the severity of disease and outcome of AP.METHODS:In this multicentric cohort study, 133 patients with AP were included. Clinical severity was dynamically evaluated using the 2012 revised Atlanta Classification. Blood presepsin levels were measured at days 1, 3, 5 and 7 after admission by chemiluminescent enzyme immunoassay.RESULTS:The median concentration of presepsin increased and the clearance rate of presepsin decreased with disease severity and organ failure in AP patients. The presepsin levels on days 3, 5 and 7 were independent predictors of moderately severe and severe AP with time-specific area under the curve (AUC) values of 0.827, 0.848 and 0.867, respectively. The presepsin levels positively correlated with bedside index of severity in AP, Ranson, acute physiology and chronic health evaluation II, computed tomography severity index and Marshall scores. Presepsin levels on days 3, 5 and 7 were independent predictors of 28-d mortality of AP patients with AUC values of 0.781, 0.846 and 0.843, respectively.CONCLUSION:Blood presepsin levels within 7 d of admission were associated with and may be useful to dynamically predict the severity of disease course and 28-d mortality in AP patients.

目的:分析急性心肌梗死(AMI)患者心理弹性水平与生活质量、焦虑抑郁和医学应对方式的相关性.方法:选取2019年3月～2020年8月期间我院收治的AMI患者142例.分别采用心理弹性量表(CD-RISC)、生活质量自评量表(WHOQOL-BREF)、Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)、医学应对方式问卷(MCMQ)评估所有患者的心理弹性水平、生活质量、焦虑抑郁情况和医学应对方式,并与国内常模对比.采用Pearson相关性分析心理弹性评分与生活质量评分、焦虑抑郁评分和医学应对方式评分的相关性.结果:AMI患者力量、坚韧性、乐观性各维度评分及CD-RISC总分均较国内常模低(P＜0.05).AMI患者心理、生理、社会关系、环境以及WHOQOL-BREF平均分均低于国内常模(P＜0.05).AMI患者SAS、SDS评分均高于国内常模(P＜0.05).AMI患者回避、屈服评分较国内常模高,面对评分低于国内常模(P＜0.05).Pearson相关性分析结果显示:CD-RISC总分与WHOQOL-BREF平均分、面对评分呈正相关,而与SAS、SDS、回避、屈服评分呈负相关(P＜0.05).结论:AMI患者心理弹性水平与焦虑抑郁、生活质量和医学应对方式相关,治疗时应采取相应措施提高患者应对疾病的能力,通过提高AMI患者的心理弹性,缓解其焦虑、抑郁情绪,进而提高生活质量.

Introduction: Long-term use of antibiotics for septic patients leads to bacterial resistance, increased mortality, and hospital stay. In this study, we investigated an emerging biomarker presepsin-guided strategy, which can be used to evaluate the shortening of antibiotic treatment in patients with sepsis without risking a worse outcome. Methods: In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days and mortality at 28 and 90 days. Secondary endpoints were the percentage of patients with a recurrent infection, length of stay in ICU and hospital, hospitalization costs, days of first episode of antibiotic treatment, percentage of antibiotic administration and multidrug-resistant bacteria, and SOFA score. Results: Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n = 327) or the control group (n = 329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs. 11.01 days [SD 7.73]; P< 0.001). Mortality in the presepsin group showed no difference to that in the control group at days 28 (17.7% vs. 18.2%; P = 0.868) and 90 (19.9% vs. 19.5%; P = 0.891). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects. There were no differences in the rate of recurrent infection and multidrug-resistant bacteria and the SOFA score tendency between the two groups. Conclusions: Presepsin guidance has potential to shorten the duration of antibiotic treatment in patients with sepsis without risking worse outcomes of death, recurrent infection, and aggravation of organ failure.

Background: Long-term use of antibiotics for septic patients leads to antibiotic resistance. This study aimed at assessing the benefit and safety of an emerging biomarker presepsin on guiding antibiotic courses for patients with sepsis. Methods: In this multicenter prospective cohort trial, patients were assigned to the presepsin or control groups. In the presepsin group, antibiotics were ceased based on predefined cut-off ranges of presepsin concentrations. The control group stopped antibiotics according to international guidelines. The primary endpoints were the number of days without antibiotics within 28 days (superiority analysis) and mortality at 28 and 90 days (non-inferiority analysis). The margin of non-inferiority was 10%. Results: Overall, 656 out of an initial 708 patients were eligible and assigned to the presepsin group (n=327) or the control group (n=329). Patients in the presepsin group had significantly more days without antibiotics than those in the control group (14.54 days [SD 9.01] vs 11.01 days [SD 7.73]; absolute difference 3.64 days, p =0.000). Mortality in the presepsin group was non-inferior to that in the control group at days 28 (17.7% vs 18.2%; absolute difference -0∙5%, 90% CI -5.4 to 4.4) and 90 (19.9% vs 19.5%; 0.4%, -4.7 to 5.5). Patients in the presepsin group had a significantly shorter mean length of stay in the hospital and lower hospitalization costs than control subjects. Conclusions: Presepsin guidance reduces the duration of antibiotic treatment in patients with sepsis without increasing mortality. Trial registration: ChiCTR, ChiCTR1900024391. Registered 9 July 2019. Retrospectively registered.

Acute biliary tract infection is a common digestive system emergency, which is prone to complications and high risk of death. Therefore, paying attention to the early identification of the severity of the disease in patients with acute biliary tract infection and taking appropriate intervention measures for complications will help to improve the survival rate of patients and shorten the length of hospital stay. Six articles in this column introduced the early severity identification and diagnosis methods of acute cholangitis and the clinical characteristics of common complications such as liver abscess and sepsis myocardial injury, and elaborated the treatment effect from the perspective of Western medicine and traditional Chinese medicine.

Digestive tract is one of the biggest contact surfaces between human body and environmental factors.It has a large number of microorganisms from the environment.Once bacteria transfer and release into the blood,it will cause sepsis and endanger life.Therefore,we should pay more attention to the infectious diseases of digestive system.This paper reviews six articles published in this journal,and expounds the etiology and early recognition methods of severity of three common infectious diseases of acute digestive system,namely,acute diarrhea,acute cholangitis and acute pancreatitis,and puts forward potential targets for the treatment of sepsis from the perspective of neurohumoral and integrated traditional Chinese and western medicine.Therefore,we should pay attention to the early recognition of the severity of infectious diseases of digestive system and the treatment of integrated traditional Chinese and western medicine.

Acute pulmonary embolism (APE) with cardiac arrest (CA) is associated with a high mortality rate. Even upon return of the spontaneous circulation (ROSC), APE-CA survivors are prone to myocardial cell apoptosis, a key cellular mechanism that induces heart failure. A recent study by our group discovered a post-resuscitation imbalance in the serum angiotensin-converting enzyme (ACE)2/ACE axis of the renin-angiotensin system (RAS), as well as regressive cardiac function in a porcine model of APE-CA. However, it has remained elusive how this imbalance in the ACE2/ACE axis affects myocardial cell apoptosis. In the present study, western blot and immunohistochemical analyses demonstrated that the RAS was only activated in the left myocardium, as evidenced by a decreased ACE2/ACE ratio following APE-CA and ROSC, but not the right myocardium. Ultrastructural analysis confirmed myocardial apoptosis in the left and right myocardium. Furthermore, B-cell lymphoma 2 (Bcl-2)-associated X protein (Bax) and caspase-3 levels were elevated and Bcl-2 levels were decreased in the left myocardium following APE-CA and ROSC. Treatment with the ACE inhibitor captopril for 30 min after initiation of ROSC prevented the increase in Bax and the decrease in Bcl-2 in the left myocardium compared with that in saline-treated pigs. Captopril also inhibited the activation of extracellular signal-regulated kinase (ERK)1/2 in the left myocardium. The results of the present study suggest that an imbalance in the ACE2/ACE axis has an important role in myocardial apoptosis following APE-CA, which may be attributed to decreased ERK1/2 activation. In addition, it was indicated that captopril prevents apoptosis in the left myocardium after ROSC.