Aims To evaluate the clinical and genetic virulence characteristics of critically ill patients with hypervirulent Klebsiella pneumoniae (hvKP) and classic KP (cKP) infection. Methods and Results The patients included in this retrospective study (n = 225) were grouped according to their hvKP (n = 114) or cKP (n = 111) status, and their clinical characteristics were analysed and compared. Cox multivariate analysis was conducted to determine the risk factors for hvKP infection. Length of hospital stay, length of intensive care unit stay, duration of mechanical ventilation and 28-day survival rate were similar between the groups. However, the incidence of septic shock was higher in the hvKP group (16.7%) than in the cKP group (8.1%). Conclusions There was a high rate of hvKP infection in this population. Compared to patients with cKP infection, those with hvKP infection showed a higher probability of having septic shock; nevertheless, survival and length of hospital stay were similar between the groups. Risk factors for hvKP infection included hospital-acquired infection and renal insufficiency. Significance and Impact of the Study This study presents relevant information on the characteristics of hvKP infection in a Chinese population, and this promotes early diagnosis and supports the view that the prevalence of hvKP is high in China.

神经外科中枢神经系统感染(neurosugical central nervous system infections,NCNSIs)的流行病学及发病机制有别于社区获得性中枢神经系统感染.本综述分析了NCNSIs在现行诊断标准下存在的临床及病原学诊断阳性率低的困境,并介绍了脑脊液降钙素原、乳酸及肝素结合蛋白等提示感染的生物标志物的研究现状,以及二代宏基因组测序技术等快速病原学诊断方法.

Purpose: Cardiac dysfunction has been rarely reported in patients with traumatic brain injury (TBI). The study aimed to compare clinical outcomes in patients admitted in intensive care unit (ICU) with normal cardiac function versus cardiac dysfunction after TBI. Moreover, the association of risk factors and hospital mortality ICU or hospital length of stay was investigated. Methods: A retrospective study was conducted from December 2011 to April 2018 on TBI patients admitted without pre-existing cardiac diseases. Patients with TBI were grouped into secondary cardiac dysfunction (n = 112) and normal cardiac function (n = 160) groups according to the presence of abnormal echocardiography after ICU admission. Univariate and multivariate analyses were performed. Results: Elevated BNP and troponin levels were found in the group with cardiac dysfunction. Patients with cardiac dysfunction had significantly higher hospital mortality (16.96% vs. 8.13%), longer ICU length of stay (16.34 vs. 10.99 d) than those without cardiac events. Cardiac dysfunction was an independent predictor of hospital mortality (p

Background : The outbreak of coronavirus disease 2019 (COVID-19) has posed a huge threat to human health. However, little is known regarding the risk factors associated with COVID-19 severity. We aimed to explore early-stage disease risk factors associated with eventual disease severity. Methods : This study enrolled 486 hospitalized, non-intensive care unit (ICU)-admitted adult patients with COVID-19 (age ≥ 18 years) treated at Wuhan Jinyintan Hospital, who were divided into three groups according to disease severity. The demographic, clinical, and laboratory data at admission and clinical outcomes were compared among severity groups, and the risk factors for disease severity were identified by multiple regression analysis. Results : Of 486 patients with COVID-19, 405 (83.33%) were discharged, 33 (6.71%) died outside of the ICU, and 48 (7.20%) were still being treated in the ICU by the time the study period ended. Significant differences in age, lymphocyte counts, and the levels of procalcitonin, aspartate aminotransferase, and D-dimer (P < 0.001 for all) among the three groups. Further analysis showed that older age, decreased lymphocyte counts, and increased procalcitonin, aspartate aminotransferase, and D-dimer levels were significantly associated with disease progression. Conclusion : Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may impair the immune system, the blood coagulation system, and hepatic and cardiac function. Some clinical characteristics and laboratory findings can help identify patients with a high risk of disease severity, which can be significant for appropriate resource allocation during the COVID-19 pandemic.

Objective:To study the changes of hemodynamic status, intracranial pressure and cerebral oxygen metabolism in acute respiratory distress syndrome (ARDS) pig models of cranial hypertension with different blood volume status, before and after increasing positive end-expiratory pressure (PEEP).Methods:A total of 12 male adult Bama miniature pigs, which were purchased from Beijing Real Genesis Company, were randomly divided into two groups: low blood volume group and normal blood volume group. To induce ARDS, 0.1 mol/L hydrochloride solution (4 ml/kg) was instilled. An intracranial water balloon was used to establish intracranial hypertension. The initial PEEP was 5 cmH 2O (1 cmH 2O=0.098 kPa) and was gradually increase by 5 cmH 2O each time until 25 cmH 2O. Repeated measures analysis of variance was used, and the Sidak method was used for multiple comparisons between different PEEP levels and correction of P values. Results:With the gradual increase of PEEP, the ICP of the normal blood volume group gradually increased, and the ICP of the hypovolemia group gradually decreased. When PEEP were 5, 10, 15 cmH 2O, the ICP of the two groups were (25.83±1.47) mmHg (1 mmHg=0.133 kPa) vs. (27.00±1.63) mmHg, (27.33±1.75) mmHg vs. (27.67±2.21) mmHg, (28.83±1.72) mmHg vs. (27.50±2.06) mmHg, with no statistical difference ( t=0.793, 0.227, 0.906, P>0.05). When PEEP were 20 cmH 2O and 25 cmH 2O, the ICP of the two groups were (31.33±2.07) mmHg vs. (26.50±3.35) mmHg and (31.67±2.94) mmHg vs. (25.83±3.67) mmHg, respectively, showing statistical differences ( t=3.284, 3.964, P<0.01). As PEEP gradually increased, PtiO 2 in both groups decreased gradually, with the hypovolemia group decreasing more significantly. At each PEEP level, the PtiO 2 between the two groups were (19.83±2.64) mmHg vs. (14.33±3.50) mmHg, (18.67±2.50) mmHg vs. (12.33±3.88) mmHg, (17.67±3.88) mmHg vs. (10.67±3.88) mmHg, (15.33±2.34) mmHg vs. (9.17±3.54) mmHg, (13.67±3.61) mmHg vs. (6.67±2.73) mmHg, all with statistical difference ( t=2.333, 3.319, 3.668, 3.231, 3.668, all P<0.05). Conclusion:The effects of PEEP on hemodynamics, intracranial pressure, and brain metabolism are affected by different volume states. In the state of hypovolemia, as PEEP gradually increases, its cardiac output, blood pressure and PtiO 2 decreased more significantly.

Background The lateral abdominal wall muscles are recruited with active expiration, as may occur with high breathing effort, inspiratory muscle weakness, or pulmonary hyperinflation. The effects of critical illness and mechanical ventilation on these muscles are unknown. This study aimed to assess the reproducibility of expiratory muscle (i.e., lateral abdominal wall muscles and rectus abdominis muscle) ultrasound and the impact of tidal volume on expiratory muscle thickness, to evaluate changes in expiratory muscle thickness during mechanical ventilation, and to compare this to changes in diaphragm thickness. Methods Two raters assessed the interrater and intrarater reproducibility of expiratory muscle ultrasound (n = 30) and the effect of delivered tidal volume on expiratory muscle thickness (n = 10). Changes in the thickness of the expiratory muscles and the diaphragm were assessed in 77 patients with at least two serial ultrasound measurements in the first week of mechanical ventilation. Results The reproducibility of the measurements was excellent (interrater intraclass correlation coefficient: 0.994 [95% CI, 0.987 to 0.997]; intrarater intraclass correlation coefficient: 0.992 [95% CI, 0.957 to 0.998]). Expiratory muscle thickness decreased by 3.0 ± 1.7% (mean ± SD) with tidal volumes of 481 ± 64 ml (P < 0.001). The thickness of the expiratory muscles remained stable in 51 of 77 (66%), decreased in 17 of 77 (22%), and increased in 9 of 77 (12%) patients. Reduced thickness resulted from loss of muscular tissue, whereas increased thickness mainly resulted from increased interparietal fasciae thickness. Changes in thickness of the expiratory muscles were not associated with changes in the thickness of the diaphragm (R2 = 0.013; P = 0.332). Conclusions Thickness measurement of the expiratory muscles by ultrasound has excellent reproducibility. Changes in the thickness of the expiratory muscles occurred in 34% of patients and were unrelated to changes in diaphragm thickness. Increased expiratory muscle thickness resulted from increased thickness of the fasciae. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Mitochondrial fission is associated with cardiomyocyte death and myocardial depression, and suppressor of ras val-2 (SRV2) is a newly discovered pro-fission protein. In this study, we examined the mechanisms of SRV2-mediated mitochondrial fission in septic cardiomyopathy. Western blotting, ELISA, and immunofluorescence were used to evaluate mitochondrial function, oxidative balance, energy metabolism and caspase-related death, and siRNA and adenoviruses were used to perform loss- and gain-of-function assays. Our results demonstrated that increased SRV2 expression promotes, while SRV2 knockdown attenuates, cardiomyocyte death in LPS-induced septic cardiomyopathy. Mechanistically, SRV2 activation promoted mitochondrial fission and physiological abnormalities by upregulating oxidative injury, ATP depletion, and caspase-9-related apoptosis. Our results also demonstrated that SRV2 promotes mitochondrial fission via a Mst1-Drp1 axis. SRV2 knockdown decreased Mst1 and Drp1 levels, while Mst1 overexpression abolished the mitochondrial protection and cardiomyocyte survival-promoting effects of SRV2 knockdown. SRV2 is thus a key novel promotor of mitochondrial fission and Mst1-Drp1 axis activity in septic cardiomyopathy.

OBJECTIVE:To explore the significance of multimodal monitoring in the monitoring and treatment of neurocritical care patients. METHODS:104 neurocritical care patients admitted to the department of Critical Care Medicine of Fujian Provincial Hospital from March 2019 to January 2020 were enrolled. Patients were randomly assigned into two groups, with 52 in each group. In the routine monitoring treatment group, heart rate, blood pressure, respiratory rate and the changes in consciousness and pupils were monitored after operation. The patients were treated with routine medicine to reduce intracranial pressure (ICP), maintain proper cerebral perfusion pressure (CPP), balance fluid intake and output, and maintain the airway clear. Patients in the multimodal monitoring treatment group were treated with invasive ICP monitoring, ultrasound to assess brain structure, ultrasound to measure optic nerve sheath diameter (ONSD), transcranial color doppler (TCCD), internal jugular venous blood oxygen saturation monitoring, near-infrared spectroscopy (NIRS), non-invasive cerebral blood oxygen saturation monitoring and quantitative electroencephalogram monitoring. According to the monitoring results, the patients were given targeted treatment with the goal of controlling ICP and improving brain metabolism. The length of intensive care unit (ICU) stay, the incidences of neurological complications (secondary cerebral infarction, cerebral hemorrhage, high intracranial pressure, etc.), and the incidences of poor prognosis [6 months after the onset of Glasgow outcome score (GOS) 1 to 3] were compared between the two groups. Spearman rank correlation analysis of the correlation between invasive ICP and the ICP value which was calculated by TCCD. The receiver operating characteristic (ROC) curve of invasive ICP and pulsatility index of middle cerebral artery (PIMCA) were used to predict poor prognosis. RESULTS:The length of ICU stay in the multimodal monitoring treatment group was significantly shorter than that of the routine monitoring treatment group (days: 6.27±3.81 vs. 9.61±5.09, P < 0.01), and the incidence of neurological complications was significantly lower than that in the routine monitoring treatment group (9.62% vs. 25.00%, P < 0.05). In the multimodal monitoring treatment group, 37 cases had a good prognosis and 15 cases had a poor prognosis, while the routine monitoring treatment group had a good prognosis in 27 cases and a poor prognosis in 25 cases. The incidence of poor prognosis in the multimodal monitoring treatment group was lower than that of the routine monitoring treatment group (28.85% vs. 48.08%, P < 0.05). In the multimodal monitoring treatment group, the invasive ICP and PIMCA of patients with good prognosis were significantly lower than those of patients with poor prognosis [invasive ICP (mmHg, 1 mmHg = 0.133 kPa): 16 (12, 17) vs. 22 (20, 24), PIMCA: 0.90±0.33 vs. 1.39±0.58, both P < 0.01]. There was no significant difference in resistance index of the middle cerebral artery (RIMCA) between the good prognosis group and the poor prognosis group (0.63±0.12 vs. 0.66±0.15, P > 0.05). There was a positive correlation between the invasive ICP and the ICP value which was calculated by TCCD (r = 0.767, P < 0.001). ROC curve analysis showed that the area under ROC curve (AUC) of invasive ICP for poor prognosis prediction was 0.906, the best cut-off value was ≥ 18 mmHg, the sensitivity was 86.49%, and the specificity was 86.67%. The AUC of PIMCA for poor prognosis prediction was 0.759, the best cut-off value was ≥ 1.12, the sensitivity was 81.08%, and the specificity was 60.00%. The AUC of invasive ICP was greater than PIMCA (Z = 2.279, P = 0.023). CONCLUSIONS:Comprehensive analysis of multimodal monitoring indicators for neurocritical care patients to guide clinical treatment can reduce the length of hospital stay, and reduce the risk of neurosurgery complications and disability; invasive ICP can predict poor prognosis of neurocritical care patients.

Background It is essential to assess the patients’ volume responsiveness before fluid infusion in patients with circulatory failure. The hypothesis is that the combining of end-tidal carbon dioxide (EtCO2) and pulse pressure variability (PPV) measurements can non-invasively predict fluid responsiveness during passive leg raising (PLR) test. Methods Pulse indicates continuous cardiac output, right radial artery blood pressure, and EtCO2 were monitored in 71 septic shock patients with mechanical ventilation. A standard PLR test was performed; cardiac index (CI), arterial pressure, stroke volume variability (SVV), PPV, and EtCO2 were measured before and after the PLR test. Patients with an increase in CI greater than 15% after the PLR test were defined as fluid responders. Receiver-operating characteristics (ROC) curve analysis was carried out to assess the predictive performance of the measured parameters. Results PPV, △EtCO2 and △EtCO2 variation ratio (△EtCO2%) in fluid-responders were significantly greater than those in the non-responders. The AUC of △EtCO2% was 0.884 (95% CI, 0.785 to 0.948) with a cut-off value of > 5.88%; yielded a sensitivity of 91.89% (95% CI, 78.1–98.3%) and aspecificity of 76.47% (95% CI, 58.8–89.3%). The AUC of PPV was 0.852 (95% CI, 0.748 to 0.925) with a cut-off value of > 10%; yielded a sensitivity of 81.1% (95% CI, 64.8–92%) and specificity of 79.41% (95% CI, 62.1–91.3%). The AUC of PPV-△EtCO2% combination was 0.942 (95% CI, 0.86 to 0.984) with a cut-off value of > 0.666; yielded a sensitivity of 83.8% (95% CI, 68–93.8%) and aspecificity of 94.1% (95% CI, 80.3–99.3%). The AUC of PPV-△EtCO2% combination was significantly greater than either △EtCO2% or PPV. Conclusion The combination of PPV and △EtCO2 can better predict fluid responsiveness during PLR.

LPS-induced septic cardiomyopathy has been found to be connected with mitochondrial stress through unknown mechanisms. Mitochondrial fission is an early event in mitochondrial dysfunction. The aim of our study was to determine the role and regulatory mechanism of mitochondrial fission in the progression of LPS-induced septic cardiomyopathy, with a particular focus on Mst1 and F-actin. Our data demonstrated that Mst1 expression was rapidly upregulated in LPS-treated hearts and that increased Mst1 promoted cardiomyocyte death by inducing mitochondrial stress. Mechanistically, elevated expression of Mst1 upregulated Drp1, and the latter initiated mitochondrial fission. Excessive mitochondrial fission caused mitochondrial oxidative injury, mitochondrial membrane potential reduction, mitochondrial proapoptotic element translocation into the cytoplasm/nucleus, mitochondrial energy dysfunction and mitochondrial apoptosis activation. Inhibition of mitochondrial fission sustained mitochondrial function and favored cardiomyocyte survival. Furthermore, we identified F-actin degradation as an apparent downstream event of mitochondrial fission activation in the context of LPS-induced septic cardiomyopathy. Stabilization of F-actin attenuated fission-mediated cardiomyocyte death. Altogether, our results define the Mst1/Drp1/mitochondrial fission/F-actin axis as a new signaling pathway that mediates LPS-related septic cardiomyopathy by inducing mitochondrial stress and cardiomyocyte death. Therefore, Mst1 expression, mitochondrial fission modification and F-actin stabilization may serve as potential therapeutic targets for sepsis-related myocardial injury.

Background: Sepsis combined with myocardial injury is an important cause of septic shock and multiple organ failure. However, the molecular mechanism of sepsis-induced myocardial dysfunction has not yet been thoroughly studied. Resveratrol has been an important research topic due its organ-protection function, but the specific mechanism is unclear. The purpose of this study was to explore the mechanism of organ injury in sepsis and to investigate the molecular mechanism of resveratrol in myocardial protection in sepsis. Material/Methods: A classical Sprague-Dawley rat model of sepsis peritonitis was constructed for further experiments. The PI3K inhibitor LY294002 and resveratrol were used to intervene in a rat model of cardiomyopathy. HE staining was used to observe pathological changes. Cardiomyocyte apoptosis was detected by TUNEL assay. Western blot analysis was used to detect the level of maker proteins. Results: The PI3K inhibitors could promote cardiac abnormalities and apoptosis, but resveratrol showed the opposite effect. The upregulation function of the PI3K inhibitor on the expression of NF-kappa B, IL-6, IL-1 beta, and TLR4 in LPS rats was not obvious, but the expression of TNF-alpha in LPS+LY294002 rats was increased by 22.85% compared with that in LPS rats (P<0.05). Compared with the LPS group, the expression of NF-kappa B, TNF-alpha, IL-6, IL-1 beta, and TLR4 in the LPS+resveratrol group was decreased. The expression of p-PI3K, p-AKT, and p-mTOR in LPS+LY294002 was reduced. The expression p-PI3K, p-AKT, and p-mTOR in the myocardium of the LPS+resveratrol group was increased. Conclusions: Resveratrol can protect the myocardium in sepsis by activating the PI3K/AKT/mTOR signaling pathway and inhibiting the NF-kB signaling pathway and related inflammatory factors.

目的 通过对比重型颅脑损伤(TBI)患者是否存在心肌损伤两组患者的特征和临床指标,分析TBI患者发生心肌损伤的影响因素.方法 本文采用回顾性研究的方法,收集从2011年11月至2018年4月在我院外科ICU中住院的颅脑外伤患者的资料,根据入ICU后的心电图和超声心动图检查结果,被分为无心肌损伤组(n=158)和心肌损伤组(n=110,包括心电图改变、心律失常、心肌缺血和心功能衰竭),并将两组患者的特征和临床指标进行对比.BNP及肌钙蛋白I用于评估心脏事件中心功能的情况,其他多项指标如GCS评分、死亡率及ICU住院天数用于评估患者预后.结果 发生心脏事件患者的心电图改变、心律失常、心肌缺血、心功能衰竭、BNP、肌钙蛋白I高于正常水平,该组患者对比未发生心脏事件的患者死亡率上升(13.21％ vs 7.12％),ICU住院天数增加(16.31 vs.10.97).院内死亡率风险(OR 6.66,95％CI 2.39～18.61,P＜0.001)和ICU住院天数{Exp (B)0.132,95％CI0.08～0.19,P＜0.001｝是患者预后的独立预测因素.住院死亡率与患者心功能相关(OR=3.17,95％CI 1.44～6.95,P=0.004).住院天数的相关因素则包括年龄{Exp (B) =0.36,95％CI-0.01～0.71,P=0.043｝、GCS评分{Exp(B)=-1.97,95％CI-3.16～0.78,P＜0.001}和使用机械通气{Exp (B)=21.89,95％CI4.59～39.18,P=0.013｝.GCS评分{Exp (B)=-1.49,95％CI-2.09～-0.89,P＜0.001}和使用血管活性药物{Exp (B)=-33.42,95％CI-60.97～-0.86,P=0.018｝.结论 重型颅脑外伤患者并发心肌损伤是患者预后的不良因素,是TBI患者治愈率下降和住院天数延长的独立预测因素.

Cardiomyocyte function and viability are highly modulated by mammalian Ste20‐like kinase 1 (Mst1)‐Hippo pathway and mitochondria. Mitophagy, a kind of mitochondrial autophagy, is a protective program to attenuate mitochondrial damage. However, the relationship between Mst1 and mitophagy in septic cardiomyopathy has not been explored. In the present study, Mst1 knockout mice were used in a lipopolysaccharide (LPS)‐induced septic cardiomyopathy model. Mitophagy activity was measured via immunofluorescence, Western blotting, and enzyme‐linked immunosorbent assay. Pathway blocker and small interfering RNA were used to perform the loss‐of‐function assay. The results demonstrated that Mst1 was rapidly increased in response to LPS stress. Knockout of Mst1 attenuated LPS‐mediated inflammation damage, reduced cardiomyocyte death, and improved cardiac function. At the molecular levels, LPS treatment activated mitochondrial damage, such as mitochondrial respiratory dysfunction, mitochondrial potential reduction, mitochondrial ATP depletion, and caspase family activation. Interestingly, in response to mitochondrial damage, Mst1 deletion activated mitophagy which attenuated LPS‐mediated mitochondrial damage. However, inhibition of mitophagy via inhibiting parkin mitophagy abolished the protective influences of Mst1 deletion on mitochondrial homeostasis and cardiomyocyte viability. Overall, our results demonstrated that septic cardiomyopathy is linked to Mst1 upregulation which is followed by a drop in the protective mitophagy.

Background. Urosepsis and septic shock are a critical situation leading to a mortality rate up to 30% in patients with obstructive diseases of the urinary tract. Aim. To analyze the bacterial distribution and drug resistance of pathogenic bacteria in patients with urosepsis and to provide a basis for the rational application of antibacterial drugs in clinical practice. Methods. A retrospective analysis of 94 hospitalized patients with urosepsis for 6 years was performed. The strain composition, resistance characteristics, and the antibiogram of common bacteria from positive blood and midstream urine culture were analyzed. Results. A total of 87 strains were isolated, including 65 strains (74.71%) of Gram-negative bacilli, 14 strains (16.09%) of Gram-positive cocci, and 8 strains (9.20%) of fungi. The Gram-negative bacilli included 42 strains of Escherichia coli (E. coli) (64.62%), among which 34 strains (80.95%) were producing ESBLs, and 14 strains (21.84%) of Klebsiella pneumoniae (K. pneumoniae), among which nine strains (64.29%) were producing ESBLs. The most common pathogenic bacteria, ESBL+ E. coli and K. pneumoniae strains, showed sensitivity towards imipenem, ertapenem, piperacillin/tazobactam, amikacin, and cefotetan, but were highly resistant to quinolones. The cure rate of urosepsis was 88.30%, and the susceptibility rate of septic shock was 45.47%. Significance. Gram-negative bacterial infections are the main cause of urosepsis. The mild patient group showed more E. coli (ESBL-) infections, and the number of ESBL producing E. coli isolated from the mild group showed higher drug resistance rates for aztreonam and levofloxacin compared with isolates from the severe group.

Respiratory system elastance (ERS) is an important determinant of the responsiveness of intracranial pressure (ICP) to positive end-expiratory pressure (PEEP). However, lung elastance (EL) and chest wall elastance (ECW) were not differentiated in previous studies. We tested the hypothesis that patients with high ECW or a high ECW/ERS ratio have greater ICP responsiveness to PEEP.

目的 总结多途径置负压双套管在腹部外科术后肠瘘治疗中的应用经验.方法 2013年1月1日至2017年12月31日行多途径置负压双套管治疗腹部外科术后肠瘘共106例,根据患者具体病情及影像学表现,采用不同途径置入腹腔负压双套管进行引流,如直接更换普通引流管为双套管、导丝引导下更换双套管、经切口置入双套管、床边小切口直接或经导丝引导置双套管和开腹手术置双套管等.结果 106例患者好转或治愈95例,好转治愈率89.6％,死亡5例,自动出院6例.结论 多途径置负压双套管引流可以达到充分引流肠瘘的目的,在肠瘘的治疗中起到关键作用.

Objective To evaluate the diagnostic values of endothelial cell specific molecule-1 (ESM-1),procalcitonin (PCT),C reactive protein (CRP),interleukin-6 (IL-6) in patients with sepsis.Methods This study totally enrolled 90 patients who were admitted to our hospital from July 2014 to February 2016 were divided into sepsis group (n =32),and common infection group (n =58).Serum levels of ESM-1 were detected by enzyme-linked immunosorbent assay (ELISA);The levels of PCT and IL-6 were measured by automatic electrochemiluminescene (ECL) analyzer;The levels of CRP were measured by rate immunonephelometric analyzer.The diagnostic powers of this four biomarkers were constructed by receiver operating characteristic (ROC) curve.Results The values of ESM-1,PCT,IL-6 and CRP in sepsis group were 3.93 ng/ml,4.05 ng/ml,83.20 mg/L,61.80 ng/L,respectively;The values of ESM-1,PCT,IL-6 and CRP in common infection group were 0.69 ng/ml,0.41 ng/ml,64.35 mg/L,17.20 ng/L,respectively;P =0.001,0.001,0.003,0.001,respectively;there were statistically significant differences.The area under the ROC curve (AUC) of ESM-1,PCT,CRP,IL-6 were 0.911,0.893,0.667,0.760;The AUC of ESM-1 was higer than that of CRP (P =0.001);The AUC of ESM-1 was higer than that of IL-6 (P =0.003);The AUC of PCT was higer than that of CRP (P =0.001);The AUC of PCT was higer than that of IL-6 (P =0.002);There was no significant difference in ESM-1 and the PCT.As an early diagnostic indicator of sepsis,the cut-off value of ESM-1 was 2.215 ng/ml,with sensitivity of 81.3％,specificity of 93.1％,Youden index was 0.744,positive predictive value was 0.867,negative predictive value was 0.900,positive likelihood ratio was 11.781,negative likelihood ratio was 0.201.As an early diagnostic indicator of sepsis,the cut-off value of PCT was 1.875 ng/ml,with sensitivity of 84.4％,specificity of 82.8％,Youden index was 0.672,positive predictive value was 0.730,negative predictive value was 0.906,positive likelihood ratio was 4.894,negative likelihood ratio was 0.189.Conclusion ESM-1,PCT as early biomarkers for sepsis are superior to CRP,IL-6,both have high value for the early diagnosis of the patients with sepsis.

OBJECTIVE To explore the risk factors for acute respiratory distress syndrome (ARDS) in children receiving surgeries for critical and complex congenital heart disease (CCHD). METHODS According to the 2011's Berlin definition of ARDS, the clinical data were collected from 75 children without ARDS (group I) and 80 children with ARDS (group II) following surgeries for CCHD performed in the Department of Cardiac Surgery of our hospital from January, 2009 to May, 2014. Univariate analyses and logistic regression were used to analyze the risk factors contributing to the occurrence of ARDS following the surgeries. RESULTS In the 80 patients who developed ARDS postoperatively in group II, 27 had mild ARDS, 25 had moderate ARDS, and 28 had severe ARDS; death occurred in 17 (21%) cases. Univariate analyses showed that 23 parameters were significantly different between groups I and II (P<0.05), including weight; preoperative PCO2, left ventricular ejection fraction, pulmonary artery pressure, pulmonary infection, and coagulation abnormalities; early postoperative serum globulin; intraoperative aortic cross clamp (ACC) time; cardiopulmonary bypass (CPB) time; operation time; blood loss and blood transfusion amount intraoperatively and during the first 8 h after operation; lactic acid level immediately after the operation and its maximum increasing rate within 24 h postoperatively; postoperative serum levels of albumin and creatinine; serum levels of B-type natriuretic peptide, procalcitonin, C-reactive protein, and prealbumin 24 h after operation; and age. Logistic regression analyses showed that intraoperative ACC time, CPB time, the maximum increasing rate of lactic acid within 24 h after operation, serum procalcitonin 24 h after operation and intraoperative blood loss were independent risk factors for postoperative ARDS. CONCLUSION The risk factors of ARDS identified in these children can predict the occurrence of ARDS following the surgeries and timely interventions can improve the success rate in treatment of postoperative ARDS in children with CCHD.

INTRODUCTION:There are concerns that the use of positive end-expiratory pressure (PEEP) in patients with brain injury may potentially elevate intracranial pressure (ICP). However, the transmission of PEEP into the thoracic cavity depends on the properties of the lungs and the chest wall. When chest wall elastance is high, PEEP can significantly increase pleural pressure. In the present study, we investigate the different effects of PEEP on the pleural pressure and ICP in different respiratory mechanics.METHODS AND ANALYSIS:This study is a prospective, single-centre, physiological study in patients with severe brain injury. Patients with acute respiratory distress syndrome with ventricular drainage will be enrolled. An oesophageal balloon catheter will be inserted to measure oesophageal pressure. Patients will be sedated and paralysed; airway pressure and oesophageal pressure will be measured during end-inspiratory occlusion and end-expiratory occlusion. Elastance of the chest wall, the lungs and the respiratory system will be calculated at PEEP levels of 5, 10 and 15 cm H2O. We will classify each patient based on the maximal ΔICP/ΔPEEP being above or below the median for the study population. 2 groups will thus be compared.ETHICS AND DISSEMINATION:The study protocol and consent forms were approved by the Institutional Review Board of Fujian Provincial Hospital. Study findings will be disseminated through peer-reviewed publications and conference presentations.TRIAL REGISTRATION NUMBER:NCT02670733; pre-results.

Objective To assess whether bedside ultrasound can accurately evaluate intracranial hemorrhage in patients with decompressive craniectomy.Method 256 patients admitted to the third department of critical care medicine of Fujian Provincial Hospital who underwent decompressive craniectomy were studied. We used ultrasound to exam the intracranial lesions through the bone defect of craniectomy windows, and the result was compared with that of CT at the same time.Result Ultrasound found 35 cases of parenchymal hemorrhage,11 cases of the basal ganglia hematoma,8 cases of temporal lobe hematoma,6 cases of frontal lobe hematoma,4 cases of cerebellar hematoma,3 cases of parietal lobe hematoma and 3 cases of occipital lobe hematoma. Linear regression equations for the longitudinal diameter, the sagittal diameter,the coronal diameter,and the volume of the hematoma measured by ultrasound and CT are(Y=-0.016+0.988X;Y=-0.105+1.033X;Y=0.136+0.961X;Y=-0.037+0.986X). Mean of hematoma volume difference value is 0.24 and 95% consistency limit is -1.13 to 1.61. Conclusion Bedside ultrasound can accurately evaluate early intracranial hemorrhage and it's progress. The longitudinal diameter, the sagittal diameter, the corona diameter and the volume of hematoma measured by ultrasound correlate well with CT measurement.