BACKGROUND:Sepsis is a prevalent and severe condition, with microcirculation disruptions playing a crucial role in its progression. Endothelial cell (EC) injury is the primary factor behind microcirculatory issues. This review is to outline the pathomechanism, organ heterogeneity, biomarkers, and therapeutic implications of endothelial dysfunction in sepsis, offering references and insights for the clinical management of sepsis. METHODS:A systematic search of Web of Science and PubMed from inception to June 10, 2025, limited to English publications, was conducted. Two reviewers independently identified studies on EC injury in patients with septic microcirculatory dysfunction. Duplicate articles based on multiple search criteria were excluded. RESULTS:Fifty-nine articles, including cell, animal, and clinical studies, were included. These studies reported the effects of EC injury on the microcirculation in sepsis, including changes in vascular permeability, coagulation dysfunction, vasomotor regulation, and inflammatory responses. These pathways interact and ultimately lead to septic microcirculation disorders. CONCLUSION:Sepsis-induced endothelial dysfunction involves various interconnected mechanisms, which collectively compromise ECs and impede microcirculatory perfusion. Future research should enhance current understanding of endothelial injury mechanisms, develop synergistic multi-target strategies to disrupt this cycle, and facilitate the clinical application of endothelial markers for early intervention and dynamic assessment.

OBJECTIVE:This study investigated the effectiveness and accuracy of hands-free carotid ultrasound (CADFlow, Continuous Auto Doppler Flow, Sensus Medical, Suzhou, China) for monitoring carotid blood flow in assessing the return of spontaneous circulation (ROSC), in comparison to manual palpation of major arterial pulses. METHODS:A total of 341 adult patients with in-hospital cardiac arrest were enrolled from five affiliated teaching hospitals of medical universities. Chest compression rate and depth were monitored using the Prehospital Advanced Life Support Manual Cardiopulmonary Resuscitation (PALMCPR, SunLife Science, Suzhou, China) system. In the CADFlow group, hands-free carotid ultrasound was used to monitor carotid pulsation, while the control group relied on manual palpation of the carotid artery to assess ROSC. The groups were compared in terms of ROSC success rates, time to ROSC determination, and ROSC misjudgment rates. Additionally, the relationships between chest compression parameters (depth and rate) and carotid blood flow were analyzed. RESULTS:The ROSC success rate was non-significantly higher in the CADFlow group than in the control group (43% vs. 33%, P = 0.053), corresponding to a 10-percentage-point absolute increase The mean time required to assess carotid pulsation was significantly shorter in the CADFlow group (2.9 (SD 0.8) s vs. 7.2 (SD 1.3) s, P < 0.001). Strong correlations were observed between chest compression depth and CADFlow parameters, suggesting that the system can effectively assess Cardiopulmonary Resuscitation (CPR) compression quality. CONCLUSIONS:The CADFlow hands-free carotid Doppler ultrasound system improves ROSC detection, shortens assessment time, and provides real-time feedback for CPR quality optimisation. TRIAL REGISTRATION:This clinical trial is registered with the Chinese Clinical Trial Registry (ChiCTR), with the registration number ChiCTR2200064633. The trial was registered on October 13, 2022. The full trial protocol is available upon request from the corresponding author.

Emergency department crowding (EDC) is a global public health crisis associated with adverse patient- and physician-related events. Currently, a reliable EDC assessment tool is lacking in China, as existing international models cannot be directly adapted owing to differences in healthcare systems, data accessibility constraints, and national policy contexts. The issue is multifactorial, data are difficult to obtain, and EDC varies regionally and temporally. Therefore, we developed a crowding assessment index system for tertiary hospital emergency departments in China, aiming to support the development of quantitative models suited to local conditions and formulation of related policies. This study used two rounds of Delphi surveys involving a multidisciplinary expert panel from China, with expertise in emergency care crowding research and management. Experts rated 96 presumptive assessment indicators. The index system’s reliability was assessed by evaluating the experts’ enthusiasm, degree of authority, and degree of consistency and coordination in their opinions. The core EDC indicators were screened and optimised based on the boundary value method, with decision rules including coefficient of variation < 0.25 and full-score ratio ≥ 50

Despite advances in post-cardiac arrest (CA) care, mortality rates remain high. Intestinal dysfunction following CA is associated with adverse clinical outcomes. While laxatives might be a potential therapeutic strategy for restoring intestinal function, there is currently a lack of evidence. This study aims to explore the safety and efficacy of laxatives as therapeutic agents for intestinal function recovery in CA, while further assessing the most suitable types of laxatives for this clinical context. Utilizing the MIMIC-IV database, we conducted a retrospective cohort study categorizing patients into laxative and non-laxative groups. Propensity score matching (PSM) was applied to balance baseline characteristics. We classified confounders into prehospital and hospitalization categories, establishing three hierarchical adjustment models. Through multivariable Cox and logistic regression analyses, we assessed 30-day and extended mortality risks while evaluating laxative-associated safety outcomes. Time-dependent Cox regression analysis was utilized to assess the time-varying effect of laxative administration. Furthermore, we also comparatively analyzed the risk–benefit profiles of commonly used laxatives. 2604 patients were eligible for this study. After PSM, a total of 898 patients were average divided into two groups. Patients in the laxative group demonstrated a statistically significant reduction in 30-day mortality risk compared to the non-laxative group (HR = 0.686, 95

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.

Background: Sepsis management in elderly populations presents unique challenges due to age-related physiological changes and comorbidities. Current guidelines remain conflicted regarding optimal antibiotic timing. We conducted a retrospective, multicenter study to evaluate the association between antibiotic administration timing and short-term and long-term outcomes in elderly sepsis patients. Methods: This retrospective cohort study analyzed data from the MIMIC-IV (v3.1) database. Patients were categorized into the early group (antibiotics initiated within 1 h) and the late group (antibiotics initiated >1 h after diagnosis). Further analyses were stratified by shock status (septic shock vs non-septic shock) and pathogen type (Gram-positive vs Gram-negative bacteria). Multivariable Cox regression assessed associations between antibiotic administration timing and 28-/180-/365-day hospital mortality. Restricted cubic spline models evaluated dose-response relationships. The primary outcome was 28-day hospital mortality. Secondary outcomes included 180-day and 365-day mortality rates, along with the incidence of continuous renal replacement therapy (CRRT) and mechanical ventilation requirements. Results: A total of 12,425 patients met the inclusion criteria from the MIMIC-IV database. The multivariable-adjusted analysis demonstrated that delayed antibiotics administration was significantly associated with a 35% increased risk of 28-day all-cause hospital mortality (HR = 1.35, 95% CI 1.22-1.52; P < 0.001), a 43% elevated 180-day hospital mortality risk (HR = 1.43, 95% CI 1.30-1.56; P < 0.001), and a 45% higher 365-day mortality risk (HR = 1.45, 95% CI 1.33-1.56; P < 0.001). Stratified analyses revealed mortality benefits persisted in non-shock patients (28-day HR = 1.31, P < 0.001) and Gram-positive infections (28-day HR = 1.63, P < 0.001), whereas no significant associations emerged in septic shock (28-day HR = 0.82, 95%CI 0.65-1.03; P = 0.081) or Gram-negative infections (HR = 1.04, 95%CI 0.87-1.24; P = 0.692). A linear relationship was observed between antibiotic delay and mortality (Nonlinear P = 0.88). Conclusions: Early antibiotic administration improves survival in elderly sepsis patients, particularly non-shock cases and Gram-positive infections. These insights advocate the importance of individualized selection based on patients' clinical context in critical care practice.

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.

OBJECTIVE:Qishen Huoxue Granule (QHG), a classical Traditional Chinese Medicine prescription, can reduce septic cardiomyopathy in the clinic. However, the mechanism of QHG remains unclear. This study aims to investigate the mechanism and effect of QHG-contained serum (QHG-CS) on sepsis-induced cardiomyopathy (SICM). METHODS:QHG was administered to Wistar rats via gavage to obtain QHG-CS. The chemical constituents of QHG-CS were identified via UPLC-Q-TOF-MS. In vitro, rat cardiomyocytes H9c2 cells isolated from embryonic BD1X rat heart tissue, and septic myocardial injury model was established by inducing H9c2 cells with lipopolysaccharide (LPS). Cell viability was assessed through CCK-8. Protein expression was determined using western blot, and gene expression was measured using real-time quantitative PCR. Cell autophagy was investigated by detecting LC3 expression using flow cytometry and immunofluorescence. In addition, three inhibitors, A779 (MasR), wortmannin (PI3K) and rapamycin (mTOR) were used to focus the potential therapeutic targets. RESULTS:QHG-CS significantly improved the survival of septic cardiomyocytes (p<0.0001). The expression of autophagy-related markers Beclin1, ATG5, and LC3II/I was increased in LPSinduced cardiomyocytes, which could be inhibited by QHG-CS. QHG-CS upregulated the mRNA expression of MasR, PI3K, and AKT, as well as the phosphorylation of PI3K, AKT, and mTOR. Moreover, A779 markedly lowered mRNA levels of MasR, PI3K, and mTOR, while wortmannin decreased mRNA levels of PI3K and mTOR, whereas rapamycin only suppressed mTOR phosphorylation. CONCLUSIONS:By inhibiting excessive autophagy through upregulation of the MasR/PI3K-AKTmTOR pathway, QHG can alleviate sepsis-induced cardiomyocyte damage. This study provides novel perspectives for the management of sepsis-induced cardiac damage.

To determine therapeutic effect of Qishen Huoxue Granule (QHG) on the myocardial injury in sepsis and whether it is through the inhibition of excessive autophagy by using network pharmacological analysis and in vitro.120 SPF male Wistar rats were divided into 6 groups. Firstly, the function of the heart were evaluated through echocardiography, and pathological changes of myocardial tissue was observed by Hematoxylin-eosin (H&E) and Transmission electron microscopy (TEM). Subsequently, enzyme-linked immunosorbent assay (ELISA) was employed to measure the levels of myocardial injury markers (cTnT and BNP) and inflammatory cytokines (TNF-α and IL-1β). Finally, the expression of proteins associated with the MasR/PI3K-AKT-mTOR pathway and autophagy-related proteins was evaluated using immunohistochemistry, immunofluorescence, RT-qPCR, and Western blot analysis.The results demonstrated that QHG significantly improved systolic function in rats, reduced levels of myocardial injury markers and inflammatory cytokines, and downregulated autophagy-related genes (ATG5, LC3, and Beclin1). However, when QHG was combined with inhibitors of the MasR/PI3K-AKT-mTOR pathway, the mRNA and protein expression levels of pathway components were reduced. Concurrently, the mRNA and protein expressions of autophagy indicators were upregulated, counteracting the inhibitory effect of QHG on excessive autophagy.QHG ameliorated the myocardial injury in sepsis rats by inhibiting the excessive autophagy in myocardial cells via activating the MasR/PI3K-AKT-mTOR pathway.

We develop and validate a clinical guideline-integrated LLM for enhanced sepsis mortality prediction. Using MIMIC-IV data from 24,237 ICU sepsis patients, we fine-tuned a large language model with Low-Rank Adaptation, embedding clinical guidelines into the training process. The model's predictive performance was evaluated using accuracy, F1-score, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Ablation studies assessed the specific contributions of clinical guideline integration. The guideline-enhanced fine-tuned LLM demonstrated moderately higher performance across all evaluation metrics including predictive accuracy (0.819), F1-score (0.815), sensitivity (0.815), specificity (0.822), and AUC (0.852) in predicting mortality risk for septic patients compared to traditional machine learning (highest accuracy: 0.774, AUC: 0.850) and deep learning methods (highest accuracy: 0.762, AUC: 0.841). Ablation experiments demonstrated that explicit integration of clinical guideline knowledge substantially improved performance over both direct prompting (accuracy: 0.709, AUC: 0.706) and fine-tuning without clinical guidelines (accuracy: 0.786, AUC: 0.801). These findings demonstrate that incorporating clinical guidelines into the fine-tuning of large language models outperforms both traditional and deep learning baselines across multiple metrics in sepsis mortality prediction, highlighting the value of explicit domain knowledge integration for clinical AI's robustness.

Objective To analyze the clinical characteristics of pyogenic liver abscess（PLA）, to review the risk factors for sepsis caused by pyogenic liver abscess（PLA） and the laboratory indicators that can predict the occurrence of sepsis at an early stage. Methods The clinical data of 131 patients with PLA in Beijing Friendship Hospital, Capital Medical University from January 2019 to December 2020 were retrospectively analyzed. Patients meeting the inclusion criteria were divided into a sepsis group（45 cases） and a non-sepsis group（86 cases）. SPSS 26.0 statistical software was used to analyze the clinical data of patients in the two groups, and the risk factors of sepsis caused by PLA were determined by univariate and logistic multivariate analysis. Receiver operating characteristic curve（ROC curve） was used to analyze the diagnostic value of neutrophil ratio, serum creatinine and glucose on admission for the sepsis caused by PLA. Results The sepsis group had a higher percentage of males and symptoms of chills, and higher neutrophil percentage, hemoglobin, C-reactive protein, glutamic-pyruvic transaminase, total bilirubin, direct bilirubin, creatinine and glucose levels on admission than the non-sepsis groups, while platelets, sodium and carbon dioxide levels were lower than the non-sepsis group（all P＜0.05）. Logistic regression analysis showed that the higher percentage of neutrophil, creatinine and glucose at admission were the risk factors for sepsis caused by bacterial liver abscess（all P＜0.05）. ROC curve analysis showed that serum neutrophil ratio and creatinine at admission had better diagnostic value for PLA progressing to sepsis, and the AUC values were 0.815（95% CI: 0.743-0.886） and 0.760（95% CI: 0.667-0.854）, respectively. When the neutrophil ratio is ≥85.8% and creatinine ≥79.75 μmol/L, one needs to be alert for the progression of PLA to sepsis. Conclusion The neutrophil ratio is a good predictor of PLA-induced sepsis. In PLA patients, if the neutrophil ratio is ≥85.8% on admission, it is necessary to prevent the progression of sepsis.

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:To summarize the clinical characteristics of patients with acute cholangitis and analyze the early warning factors of death.Methods:The clinical data of patients with acute cholangitis treated in the emergency department of Beijing Friendship Hospital from May 1, 2019 to December 5, 2020 were prospectively selected. The age, gender, vital signs, basic diseases, inflammatory indexes, organ function indexes, coagulation indexes, etiology, emergency drainage and prognosis of cholangitis were analyzed to understand the clinical characteristics of acute cholangitis and find out the strongest early warning factor of 28 day death.Results:A total of 274 patients with acute cholangitis attending the emergency department were examined, which included 265 survival patients (survival group) and 9 deaths (death group). In the death group, the proportion of diabetic patients, white blood cell counts, C-reactive protein, creatinine, international standardized ratio, D-dimer, lactate dehydrogenase, fibrinogen degradation products, Sequential Organ Failure Assessment (SOFA) score were significantly higher than those in the survival group, while the albumin level and Glasgow Coma Scale (GCS) score were significantly lower than those in the survival group (all P<0.05). Multivariate logistic regression analysis showed that GCS score, creatinine level, white blood cell counts and international standardized ratio were the risk factors of death in patients with acute cholangitis (all P<0.05). Conclusions:GCS score, creatinine level, white blood cell counts and international standardized ratio are early warning factors to judge the death of patients with acute cholangitis. GCS score is the strongest predictor of death in patients with cholangitis.

目的 探讨还原型谷胱甘肽(GSH)联合肠内免疫微生态营养对重症急性胰腺炎(SAP)患者内毒素及肝功能的影响.方法 选取2018年5月至2021年4月首都医科大学附属北京友谊医院急诊科收治的SAP患者175例,按照干预方法不同分为对照组(87例)和研究组(88例).两组患者均给予SAP规范化治疗,对照组在SAP规范化治疗基础上辅以肠内免疫微生态营养治疗;研究组在对照组基础上辅以GSH治疗(1.2 g/d,每日1次),两组均治疗1周.比较两组的临床疗效,治疗前后的内毒素、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(γ-GT)]、炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]、氧化指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]水平,以及并发症发生率.结果 研究组总有效率高于对照组[93.18％(82/88)比77.01％(67/87)](χ2=9.043,P=0.003).治疗后1周,研究组内毒素水平低于对照组[(3.8±1.0)ng/L比(5.2±1.1)ng/L](t=12.153,P<0.001).治疗前,两组肝功能指标(ALT、AST、γ-GT)、炎症因子(IL-6、CRP、TNF-α)、氧化指标(MDA、SOD)比较差异无统计学意义(P>0.05);治疗后,两组上述指标均低于治疗前,且研究组低于对照组(P<0.01).两组总并发症发生率比较差异无统计学意义(P>0.05).结论 GSH联合肠内免疫微生态营养治疗SAP患者的临床效果显著,可降低内毒素水平,保护肝脏,且抗炎、抗氧化作用显著,同时具有较好的安全性.

目的 探讨血小板减少在急性胆管炎患者中的提示意义.方法 回顾性分析2020年6月至2021年6月于首都医科大学附属北京友谊医院急诊科收治的77例急性胆管炎患者的临床资料.77例急性胆管炎患者根据血小板指标是否≥125×109/L分为两组,即血小板正常组(≥125×109/L)患者59例和血小板减少组(<125×109/L)患者18例.观察两组患者血象指标(包括白细胞计数、中性粒细胞绝对值、血红蛋白计数、血小板计数)、生化指标[包括天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素、直接胆红素、间接胆红素、乳酸脱氢酶、淀粉酶)]、感染指标(包括C-反应蛋白、降钙素原)、是否存在休克、是否应用血管活性药物治疗、是否存在精神神经症状、住院天数等指标.结果 血小板减少组患者在白细胞升高(33.33％vs.20.34％)、中性粒细胞升高(38.89％vs.37.29％)、血红蛋白减低(33.33％vs.23.73％)、ALT升高(88.89％vs.81.36％)、总胆红素升高(94.44％vs.76.27％)、直接胆红素升高(100.0％vs.77.97％)、间接胆红素升高(83.33％vs.72.88％)、C-反应蛋白升高(94.44％vs.79.66％)、降钙素原升高(73.33％vs.57.69％)、乳酸脱氢酶升高(38.89％vs.25.42％)、淀粉酶升高(44.44％vs.29.31％)、存在精神神经症状(5.56％vs.1.69％)等方面的比率高于血小板正常组患者,但差异无统计学意义(P>0.05);血小板减少组患者在AST升高(94.44％vs.66.10％)、出现休克(33.33％vs.1.69％)、应用血管活性药物治疗(22.22％vs.1.69％)等的比率均高于血小板正常组患者,差异均有统计学意义(P<0.05).血小板减少组患者AST、C-反应蛋白及降钙素原高于血小板正常组患者(170.65 U/L vs.49.00 U/L、111.67±85.19 mg/L vs.68.70±68.93 mg/L、3.18 ng/mL vs.0.65 ng/mL),差异均有统计学意义(P<0.05).结论 对于急性胆管炎患者,出现血小板减少时,需要警惕存在感染的可能.血小板减少也提示着疾病可能更加凶险.

Dear editor, Herpes B virus (BV), also known as Macacine herpesvirus 1 (family: Herpesviridae, subfamily: Alphaherpesvirinae, genus: Simplexvirus), officially designated by the International Committee on the Taxonomy of Viruses, exhibits serologic cross-reactivity with other members of the genus Simplexvirus, namely HSV type 1 (HSV-1), the causative agent of oral herpetic ulcers (cold sores) in humans and HSV type 2 (HSV-2), the agent of human genital herpes.[1] BV infection in macaques is life-long, with periodic reactions, sometimes causing HSV-like symptoms; however, it may cause fatal encephalomyelitis in humans.

目的 分析生大黄保留灌肠联合乌司他丁对脓毒症合并多器官功能障碍综合征(MODS)患者免疫内稳态及炎症水平的影响.方法 收集2018年1月至2020年12月首都医科大学附属北京友谊医院收治的145例脓毒症合并MODS患者的临床资料进行回顾性分析.按照治疗方法不同分为对照组(72例)和观察组(73例).其中,对照组在常规治疗的基础上给予乌司他丁治疗,将100000 U的药物溶于500 ml的氯化钠注射液中,静脉滴注,每次静滴时间为1～2 h,每日3次;观察组在对照组的基础上给予生大黄保留灌肠治疗,两组均治疗1周.比较两组患者治疗前后的急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA),炎症因子[白细胞介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平,免疫功能指标(CD4+、CD8+、CD4+/CD8+)和心功能指标[左心室射血分数(LVEF)、N端脑钠肽前体(NT-proBNP)]变化,以及并发症发生情况.结果 不同时点间、组间APACHEⅡ、SOFA的主效应差异有统计学意义(P<0.01);时点间与组间存在交互作用(P<0.01).与治疗前相比,治疗后两组的APACHEⅡ、SOFA均降低,且观察组低于对照组(P<0.05).不同时点间、组间IL-6、CRP、TNF-α水平的主效应差异有统计学意义(P<0.01);时点间与组间存在交互作用(P<0.01).与治疗前相比,治疗后两组的IL-6、CRP、TNF-α水平均降低,且观察组低于对照组(P<0.05).不同时点间、组间CD4+、CD8+、CD4+/CD8+水平的主效应差异有统计学意义(P<0.01);时点间与组间存在交互作用(P<0.01).与治疗前相比,治疗后两组的CD4+、CD8+、CD4+/CD8+水平均升高,且观察组高于对照组(P<0.05).不同时点间、组间LVEF、NT-proBNP水平的主效应差异有统计学意义(P<0.01);时点间与组间存在交互作用(P<0.01).与治疗前相比,治疗后两组的LVEF均升高,且观察组高于对照组(P<0.05);NT-proBNP水平均降低,且观察组低于对照组(P<0.05).两组的总并发症发生率比较差异无统计学意义(P>0.05).结论 生大黄保留灌肠联合乌司他丁治疗脓毒症合并MODS能明显控制患者病情进展,减轻机体炎症反应程度,提高免疫功能和心功能,同时具有较好的安全性.

目的 探讨血清铁蛋白显著升高在急诊发热患者中的提示意义.方法 回顾性分析2020年1月至2021年1月于首都医科大学附属北京友谊医院急诊科收治的25例完善血清铁蛋白检测且经过专科会诊诊断为"噬血细胞综合征"的发热患者的临床信息.根据血清铁蛋白指标是否≥10000μg/L分为2组,即血清铁蛋白显著升高组(≥10000μg/L,n=13)和血清铁蛋白升高组(306～10000μg/L,n=12).观察指标包括患者性别、年龄、体温、血清铁蛋白水平、血象指标、肝功能指标、甘油三酯水平、纤维蛋白原水平、乳酸脱氢酶、C-反应蛋白、降钙素原、是否存在脾大、入院是否存在休克、是否应用血管活性药物治疗、是否需要急诊输血治疗等.结果 患者血清铁蛋白范围为391～73376μg/L,中位血清铁蛋白水平为10326μg/L.血清铁蛋白显著升高组患者在血象减低(76.92％vs.58.33％)、天门冬氨酸氨基转移酶升高(84.62％vs.58.33％)、丙氨酸氨基转移酶升高(76.92％vs.58.33％)、总胆红素水平升高(53.85％vs.25.00％)、直接胆红素水平升高(61.54％vs.33.33％)、间接胆红素水平升高(30.77％vs.8.33％)、甘油三酯升高(77.78％vs.0.00％)、纤维蛋白原减低(46.15％vs.25.00％)、乳酸脱氢酶升高(100％vs.90.91％)、存在脾大(92.31％vs.66.67％)、出现休克(23.08％vs.0.00％)、应用血管活性药物治疗(23.08％vs.0.00％)、需要急诊输血治疗(69.23％vs.33.33％)等方面的比率均高于血清铁蛋白升高组患者.血清铁蛋白显著升高组患者白细胞低于血清铁蛋白升高组,差异有统计学意义(P=0.039);血清铁蛋白显著升高组患者甘油三酯明显高于血清铁蛋白升高组,差异有统计学意义(P=0.001).结论 对于急诊发热患者,血清铁蛋白显著升高时,需要考虑并警惕噬血细胞综合征的可能.血清铁蛋白显著升高也提示疾病可能更加凶险.

目的 探讨伊伐布雷定在脓毒症合并急性心力衰竭易损期患者中应用的疗效与安全性.方法 纳入脓毒症合并急性心力衰竭患者共140例,按不同治疗方式分为伊伐布雷定组(n=73)和对照组(n=67).比较两组患者一般资料,治疗前后平均动脉压、心率、NT-proBNP、院内死亡、再发急性心力衰竭及12个月全因死亡和心力衰竭再入院发生率.随访计量资料采取一般线性模型重复测量的方差分析,Kaplan-Meier法绘制生存曲线.结果 伊伐布雷定组住ICU时间(d:6.99±3.04 vs.8.75±3.13,P=0.001)和住院时间(d:9.08±3.67 vs.11.09±3.79,P=0.002)明显低于对照组.两组患者院内病死率(11.0％vs.13.4％)和12个月全因病死率(19.2％vs.23.9％)差异无统计学意义.伊伐布雷定组12个月心力衰竭再入院率明显低于对照组(11.0％vs.23.9％,P=0.043).重复测量的方差分析显示,两组患者心率、NT-proBNP均随时间明显降低(P<0.001).简单效应分析显示,心率、NT-proBNP与时间和使用伊伐布雷定存在明显交互效应(P<0.001).KM曲线显示,伊伐布雷定组12个月心力衰竭再入院率明显低于对照组(P=0.046).结论 脓毒症合并急性心力衰竭患者易损期应用伊伐布雷定可以明显降低患者心率、NT-proBNP及12个月心力衰竭再入院率.