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.

BACKGROUND:Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. Elderly individuals (≥65 years of age) constitute a particularly vulnerable population comprised by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. The review is expected to promote improvements in the diagnosis and treatment of SAE in elderly patients, ultimately achieving more standardized and efficient SAE management. METHODS:We performed a literature search in four databases-PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang-from inception to April 2025 using bilinguals (Chinese and English). RESULTS:The diagnostic criteria for SAE in elderly individuals include the following: (1) sepsis; (2) new-onset neurological dysfunction; and (3) exclusion of other causes of neurological dysfunction. Physicians should develop tailored empiric anti-infective plans for elderly SAE patients, considering comorbidities, organ function, infection site, local bacterial spectrum, and resistance. The treatment protocol can be adjusted once the pathogen is identified. Stabilizing hemodynamics and ensuring cerebral perfusion are two fluid resuscitation strategies used in elderly SAE patients. An individualized approach to fluid resuscitation using restrictive fluid volumes should be employed. Supportive treatment for elderly SAE patients focuses on improving tissue perfusion/oxygenation, controlling blood glucose levels, and correcting internal imbalances. Early rehabilitation, nutritional support, cognitive training, and family-based emotional support are important components of comprehensive care. CONCLUSION:The diagnosis and management of SAE in elderly patients support early recognition and timely intervention.

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.

Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of the nervous system resulting from sepsis originating outside the central nervous system. The elderly (≥65 years of age) are a particularly vulnerable population, and the emergency department is typically the first point of contact following onset of SAE. Clinical symptoms in elderly patients with SAE are often atypical, compounded by a high burden of underlying diseases and complications, which frequently leads to underdiagnosis or misdiagnosis. These patients are at increased risk of long-term or permanent central nervous system impairment, making rapid and accurate diagnosis and treatment especially critical. Currently, there are no standardized diagnostic or treatment guidelines tailored specifically to geriatric SAE. This expert consensus, grounded in evidence-based medicine and clinical experience, offers recommendations on the risk factors, clinical characteristics, diagnosis, and treatment of geriatric SAE. The goal is to standardize care, improve diagnostic accuracy, reduce mortality, and enhance patient outcomes.

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.

Efferocytosis, the process of engulfing and removing apoptotic cells, plays an essential role in preserving tissue health and averting undue inflammation. While macrophages are primarily known for this task, dendritic cells (DCs) also play a significant role. This review delves into the unique contributions of various DC subsets to efferocytosis, highlighting the distinctions in how DCs and macrophages recognize and handle apoptotic cells. It further explores how efferocytosis influences DC maturation, thereby affecting immune tolerance. This underscores the pivotal role of DCs in orchestrating immune responses and sustaining immune equilibrium, providing new insights into their function in immune regulation.

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.

Common carotid artery (CCA) pseudoaneurysm is a rare clinical disorder. CCA pseudoaneurysm that occurs with a carotid-esophageal fistula and causes massive upper gastrointestinal bleeding is especially uncommon but can be life-threatening. Accurate diagnosis and prompt managements are essential to save lives. Here, we report a case of a 58-year-old female who presented with dysphagia and throat pain after accidental ingestion of a chicken bone. The patient presented with active upper gastrointestinal bleeding which quickly developed into hemorrhage shock. Imaging studies confirmed a diagnosis of right CCA pseudoaneurysm and carotid-esophageal fistula. The patient had a satisfactory recovery after a right CCA balloon occlusion, right CCA pseudoaneurysm excision, and right CCA and esophageal repairs. We present and discuss this case here to remind physicians to rule out rare causes of upper gastrointestinal bleeding. A multidisciplinary approach is commonly required to achieve satisfactory outcomes in these cases.

依据 2023 年国家卫生健康委员会、教育部、科技部、国家中医药管理局联合发布的《涉及人的生命科学和医学研究伦理审查办法》,为优化伦理审查流程,为临床研究人员减负,提出了部分符合条件的情况下可以"免除伦理审查".这是国家在伦理审查管理办法中首次针对"免除伦理审查"的一个突破进展.回顾梳理了国内外关于免除审查的相关情况,重点针对免除审查的四种情况进行分析探讨,尤其是对免除审查中关于匿名化和个人敏感信息的理解进行讨论分析,并针对四种情况提出实践的建议,并结合伦理审查工作的实际情况,探讨建立关于免除审查的实践标准和流程,为相关医疗机构实施免除伦理审查提供参考.

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: This study aimed to explore the changes of programmed death-ligand 1 (PD-L1) and programmed death-1 (PD-1) expression on antigen-presenting cells (APCs) and evaluate their association with organ failure and mortality during early sepsis. METHODS:In total, 40 healthy controls and 198 patients with sepsis were included in this study.Peripheral blood was collected within the first 24 h after the diagnosis of sepsis.The expression of PD-L1 and PD-1 was determined on APCs, such as B cells, monocytes, and dendritic cells (DCs), by flow cytometry.Cytokines in plasma, such as interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-4 (IL-4), IL-6, IL-10, and IL-17A were determined by Luminex assay.RESULTS: PD-1 expression decreased significantly on B cells, monocytes, myeloid DCs (mDCs), and plasmacytoid DCs (pDCs) as the severity of sepsis increased.PD-1 expression was also markedly decreased in non-survivors compared with survivors.In contrast, PD-L1 expression was markedly higher on mDCs, pDCs, and monocytes in patients with sepsis than in healthy controls and in non-survivors than in survivors.The PD-L1 expression on APCs (monocytes and DCs) was weakly related to organ dysfunction and infl ammation.The area under the receiver operating characteristic curve (AUC) of the PD-1 percentage of monocytes (monocyte PD-1%)+APACHE II model (0.823) and monocyte PD-1%+SOFA model (0.816) had higher prognostic value than other parameters alone.Monocyte PD-1% was an independent risk factor for 28-day mortality. CONCLUSION:The severity of sepsis was correlated with PD-L1 or PD-1 over-expression on APCs.PD-L1 in monocytes and DCs was weakly correlated with infl ammation and organ dysfunction during early sepsis.The combination of SOFA or APACHE II scores with monocyte PD-1% could improve the prediction ability for mortality.

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:探讨新冠肺炎疫情防控常态化背景下,加强导医人员服务质量管理,强化防疫措施的规范化培训,提升专业服务水平及增强服务意识教育.方法:随机抽取北京市某三级甲等医院2020年4月和5月门诊患者各300名作为实施强化服务质量管理和规范化防疫措施培训前后的观察对象,分别对导医服务满意度进行问卷调查,并整理分析实施强化服务质量管理和规范化防疫措施培训前后各3个月期间医院接待患者投诉工单中涉及导医服务的占比变化.结果:与2020年4月比较,5月份调查患者对导医服务的整体满意率由77.7％显著提升至92.3％(P＜0.05);同时,涉及导医服务类投诉工单占比由13.6％下降至7.09％(P＜0.05).结论:医院加强对导医人员服务质量管理,并强化防疫措施的规范化培训,既可以保证各项疫情防控措施的严格落实,同时也提升了患者对导医服务的满意度,降低患者投诉率,为广大患者提供了良好的就医体验.

Purpose To investigate the antimicrobial activity of berberine and the mechanism by which it combats methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from patients with bloodstream infections. Methods Fifteen clinical MRSA isolates were collected, and their Multi-locus Sequence Types (MLST) were examined. The minimum inhibitory concentration (MIC) and combined antibacterial activity of berberine alone, and when combined with clindamycin and rifampicin separately, were determined. Additionally, two MRSA strains (ST239 and ST5) were selected to perform the time-killing assay and biofilm formation test. Cell wall alterations and cell membrane integrity were measured by confocal laser scanning microscopy (CLSM) and electron microscopy to assess the influence on cell morphology. Results Our data showed berberine was effective against MRSA at MIC values varying from 256 to 64 mg*L−1 for different MLST types. Berberine alone, and when combined with clindamycin and rifampicin separately, displayed excellent antibacterial activity which reduced the bacterial counts by 2lgCFU*mL within 24h and significantly weakened biofilm formation compared with control strain. Additionally, bacterial cytological profiling indicates that berberine destroyed the structure of the cell walls, membrane integrity and further changed the cell morphology with concentration increased. Conclusion In our study, berberine has excellent anti-MRSA activities and has synergistic antibacterial property when combined with clindamycin and rifamycin separately, and the mechanism of activities involves the destruction of cell wall and membrane.

Shuai Xia,1 Liyan Ma,2 Guoxing Wang,1 Jie Yang,1 Meiying Zhang,3 Xuechen Wang,1 Jianrong Su,2 Miaorong Xie1 1Department of Emergency and Critical Care Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 2Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 3Department of Emergency Center, Peking University First Hospital, Peking University, Beijing, 100050, People’s Republic of ChinaCorrespondence: Miaorong Xie, Department of Emergency and Critical Care, Center, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, 100050, People’s Republic of China, Email xiemiao27@126.com View the original paper by Mr Xia and colleagues This is in response to the Letter to the Editor

文章以北京市4家社会组织作为研究对象,对其在新冠肺炎疫情防控期间慈善捐赠采取的做法与措施、取得的创新和成效进行了分析、总结和思考.结果表明:社会组织依法有序参与疫情防控的慈善捐赠工作,已然成为应对新冠肺炎疫情不可或缺的重要力量.通过总结和分析社会组织在新冠肺炎疫情防控期间捐赠的管理实践和经验,对于提高包括社会组织在内的全社会应对突发公共卫生事件的反应能力有着十分重要的意义.

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.

Objectives Rapid changes in glucocorticoid (GC) levels and adrenal insufficiency are related to the development of post-cardiac arrest (CA) syndrome. However, GC receptor (GR) expression changes have not been studied. Hence, this study aimed to investigate the association of early changes in GR expression and prognosis and immune response in patients who experienced CA.Design Prospective observational study.Setting Emergency department.Participants Patients (85) in the early period of return of spontaneous circulation (ROSC) after CA were admitted between October 2018 and October 2019. After a physical examination, age-matched and sex-matched healthy individuals (40) were recruited for the control group.Primary and secondary outcome measures GR expression and cell counts of circulatory T and B lymphocytes, natural killer cells and regulatory T (Treg) cells were assessed. Plasma total cortisol and adrenocorticotrophic hormone (ACTH) levels were also tested.Results All cell counts were lower, and plasma total cortisol levels were higher (p<0.001) in patients who experienced CA than in the healthy control group. GR expression in Treg cells and CD3+CD4+ T lymphocytes were not significantly different, but the mean fluorescence intensity and GR expression in other cells were lower in patients who experienced CA (p<0.05) than in the healthy control group. ACTH levels were not different. There were no significant differences between survivors and non-survivors.Conclusions This study revealed that GR expression and cell counts rapidly decreased, whereas plasma total cortisol levels increased in the early period after ROSC among patients who experienced CA. Our findings provide important information about GR level and function, and immunosuppressive status in these patients. Assessing GR expression in patients who experienced CA may help screening for those who are more sensitive to GC therapy.

目的 探究盐酸小檗碱单药及联合应用对金黄色葡萄球菌的体外抗菌活性.方法 收集首都医科大学附属北京友谊医院2020年4月至2021年3月临床分离的金黄色葡萄球菌28株,采用琼脂稀释法测定盐酸小檗碱对金黄色葡萄球菌的最低抑菌浓度,采用棋盘法检测盐酸小檗碱与左氧氟沙星、环丙沙星、甲氧苄啶、克林霉素、利福平、万古霉素和庆大霉素的联合抑菌活性,对分离株进行MLST分型,选取优势ST型(ST5,ST188,ST239)进行时间-杀菌实验和生物膜形成实验.结果 盐酸小檗碱对82.1％金黄色葡萄球菌的最低抑菌浓度(MIC)为128 mg/L,10.7％菌株的MIC为64 mg/L,7.1％菌株的MIC为256 mg/L;对MRSA和MSSA的体外抑菌活性差异无统计学意义(P>0.05).盐酸小檗碱与克林霉素、左氧氟沙星、环丙沙星、万古霉素、庆大霉素、甲氧苄啶和利福平联合应用时,分别有82.14％、78.57％、96.43％、96.43％、67.86％、17.86％和71.43％的菌株表现协同作用;盐酸小檗碱能显著抑制细菌数量和生物膜的形成,且随着药物浓度升高,抑制能力逐渐增强.结论 盐酸小檗碱在体外对金黄色葡萄球菌具有良好的抑菌活性,而且与万古霉素、克林霉素、利福平、氟喹诺酮和氨基糖苷类药物具有良好的协同抑菌作用.