BackgroundAcquired immunodeficiency syndrome (AIDS) complicated by Pneumocystis pneumonia (PCP) is characterized by an insidious onset, rapid progression, and a critical clinical course. Severe complications, such as respiratory failure and pneumothorax, may occur in the absence of timely and effective intervention, resulting in increased mortality. Extracorporeal membrane oxygenation (ECMO) can serve as a salvage therapy by temporarily and effectively replacing cardiopulmonary function.ObjectiveWe aimed to summarize the clinical experience of veno-venous extracorporeal membrane oxygenation (V-V ECMO) support in four patients with AIDS complicated by PCP.MethodsClinical data from four patients with AIDS who were complicated by PCP and received ECMO support at Beijing Ditan Hospital, Capital Medical University, were retrospectively analyzed. The timing of ECMO initiation, mode selection, mechanical ventilation (MV) management, sedation and analgesia strategies, prognosis, and clinical experience were evaluated, and treatment experience was summarized.ResultsAll four patients were definitively diagnosed with AIDS complicated by PCP and respiratory failure. All patients received ventilatory support and developed barotrauma. Pneumothorax occurred in cases 1, 2, and 4, whereas pneumomediastinum was detected in case 3. All patients received V-V ECMO support, which improved clinical conditions in all cases. Finally, cases 1 and 2 died, whereas cases 3 and 4 recovered and were discharged. Among them, awake ECMO was successfully implemented in case 3.ConclusionFor patients with AIDS complicated by PCP, particularly for those with concomitant barotrauma, early initiation of ECMO support may rapidly improve systemic oxygenation and lower the intensity of MV. This approach may decrease ventilator-induced lung injury (VILI), facilitate lung rest and lung protection, and provide a therapeutic window for treating the underlying disease. Clinicians should comprehensively evaluate disease reversibility, immune recovery potential, and the severity of lung injury. Withholding ECMO therapy solely due to HIV infection status should be avoided.

The prognostic role of the albumin-corrected anion gap (ACAG) in cirrhotic patients with invasive fungal infection (IFI) remains unclear. This retrospective cohort study aimed to investigate the association between ACAG and 28-/90-day mortality in this high-risk population. A retrospective cohort study was conducted at Beijing Ditan Hospital, including patients with cirrhosis complicated by IFI who were admitted between January 2009 and December 2021. ACAG was calculated using initial anion gap and albumin measurements within 24 h of admission. Patients were stratified into high and normal ACAG groups by an ACAG cutoff of 20 mmol/L. The primary outcomes were 28-day and 90-day all-cause mortality. Cox proportional hazards regression models and Kaplan-Meier survival analysis were employed to assess the association between ACAG levels and mortality outcomes. Subgroup analyses were performed to explore the consistency of the association. The prognostic value of ACAG was assessed by receiver operating characteristic (ROC) curve analysis. A total of 313 cirrhotic patients with IFI were enrolled. Patients with high ACAG (≥ 20 mmol/L) had significantly higher 28-day (36.44

Background:Sepsis accounts for a significant proportion of global deaths and has limited treatment options. Cancer patients are at a higher risk of sepsis and experience worse outcomes, highlighting the complex interplay between sepsis and cancer on immune cell function and clinical prognosis. Methods:Between July and December 2023, we prospectively enrolled 30 sepsis patients and 10 healthy controls, categorizing the patients into sepsis with non-cancer and sepsis with cancer based on established clinical diagnostics. Multi-color flow cytometry was used to monitor changes in the expression of surface molecules of monocyte and neutrophil subsets, phagocytic activity and cytokine-producing capacity. Results:Compared with sepsis with non-cancer, the sepsis with cancer group demonstrated elevated 28-day mortality rates, increased CD177+ activated band neutrophil and HLA-DRlowCCR2low classical monocyte, and attenuated phagocytic activity of immature neutrophil and monocyte. Further, HLA-DRlowCCR2low classical monocytes and CD177+ myelocytes may serve as immunological predictors of adverse outcomes in sepsis. The HLA-DRlowCCR2low classical monocyte and CD177+ myelocytes exhibit significant correlations with internal environment and coagulation markers. Conclusion:In septic patients, particularly those patients with cancer, attenuated phagocytic activity of immature neutrophil (myelocytes, metamyelocytes, band neutrophils) and monocyte, and HLA-DRlowCCR2low classical monocyte and CD177+ myelocytes may serve as immunological predictors of poor prognosis.

Background Severe fever with thrombocytopenia syndrome (SFTS) is a life-threatening tick-borne viral disease with high mortality and limited treatment options. Understanding its transmission routes is essential for effective prevention and control. Case presentation: We report a case of a 55-year-old woman who developed high fever, malaise and diarrhea five days after being bitten by a Mustela sibirica (Siberian weasel). SFTS was diagnosed on day 12 via metagenomic next-generation sequencing (mNGS) of peripheral blood. Despite timely antiviral and supportive treatment, the patient rapidly progressed to multiple organ dysfunction and had a poor prognosis. She had no known exposure to ticks or other animals, raising strong suspicion of SFTSV transmission through the weasel bite. Conclusion This is the first reported case of SFTS possibly linked to a M. sibirica bite, offering novel insight into potential alternative zoonotic transmission routes of SFTSV. These findings highlight the urgent need for surveillance of animal hosts in endemic regions to better understand transmission pathways.

Abstract Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) pose significant threats to patient prognosis, often leading to multiple organ dysfunction syndrome (MODS), which is characterized by simultaneous dysfunction of two or more organ systems and significantly heightens the risk of mortality. Standard strategies for managing organ complications in critical illness may not always be suitable for patients with liver failure (LF).This study aims to investigate the outcomes of MODS in patients with ALF and ACLF in China, while also identifying factors influencing mortality and prognosis. We conducted a retrospective cohort study at a specialized tertiary hospital for liver diseases in Beijing, China, spanning from June 1, 2009, to May 31, 2022.Risk factors were assessed through univariate and multivariate analyses using logistic regression. Cumulative 90-day mortality rates between the ACLF and ALF groups were compared using Cox Analysis. 195 patients with ALF and 318 patients with ACLF were included in this study. The primary outcome of interest was 90-day mortality. This study enrolled a total of 513 patients. Of these, 119 patients (61%) with ALF and 140 patients (44%) with ACLF experienced MODS. Patients with ALF exhibited a higher number of organ failures compared to those with ACLF (2 vs. 1, P = 0.006). Additionally, patients with ALF demonstrated higher median admission critical illness scores.Multivariate logistic analysis indicated that GIB (OR = 3.112, 95% CI 1.4–6.916, P = 0.005), MELD-Na scores (OR = 1.079, 95% CI 1.033–1.127, P = 0.001), Age (OR = 1.056, 95% CI 1.025–1.088, P < 0.001), NLR (OR = 1.073, 95% CI 1.014–1.132, P = 0.014), ICU admission (OR = 4.319, 95% CI 1.347–13.851, P = 0.014), and Clif-SOFA (OR = 1.147, 95% CI 1.022–1.287, P = 0.02) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.881. Multivariate logistic analysis revealed that SOFA score (OR = 1.255, 95% CI 1.166–1.351, P = 0.001), GCS scores (OR = 0.674, 95% CI 0.606–0.881, P = 0.001), Age (OR = 1.048, 95% CI 1.022–1.076, P < 0.001), and ICU admission (OR = 0.258, 95% CI 0.075–0.885, P = 0.031) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.872.Cox analysis for cumulative 90-day mortality indicated that patients with ALF had higher mortality rates compared to those with ACLF (33.8% vs. 27%, P = 0.026) and compared to patients with cirrhosis ACLF and non-cirrhosis ACLF (33.8% vs. 31% vs. 25.9%, P = 0.018).Patients with ALF exhibited a higher incidence of MODS and consequently had a poorer 90-day prognosis.

Background: Respiratory failure in acquired immunodeficiency syndrome (AIDS) patients was the leading cause of intensive care unit (ICU) admission in our center. We aimed to describe the pulmonary infections and outcomes for respiratory failure in AIDS patients.Methods: A retrospective study was conducted on AIDS adult patients with respiratory failure who were admitted to the ICU in Beijing Ditan hospital, China, from January 2012 to December 2021. We investigated pulmonary infections complicated by respiratory failure in AIDS patients. The primary outcome was ICU mortality, and a comparison between survivors and nonsurvivors was performed. Multiple logistic regression analysis was used to identify predictors of ICU mortality. The Kaplan-Meier curve and Log rank test were used for survival analysis.Results: A total of 231 AIDS patients were admitted to ICU with respiratory failure over a 10-year period with a male predominance (95.7%). Pneumocystis jirovecii pneumonia was the main etiology of pulmonary infections (80.1%). The ICU mortality was 32.9%. In multivariate analysis, ICU mortality was independently associated with invasive mechanical ventilation (IMV) [odds ratio (OR), 27.910; 95% confidence interval (CI, 8.392-92.818; p = 0.000) and the time before ICU admission (OR, 0.959; 95% CI, 0.920-0.999; p = 0.046). In the survival analysis, patients with IMV and later admission to ICU had a higher probability of mortality.Conclusion: Pneumocystis jirovecii pneumonia was the primary etiology for respiratory failure in AIDS patients admitted to the ICU. Respiratory failure remains a severe illness with high mortality, and ICU mortality was negatively associated with IMV and later admission to ICU.

Background: Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. Methods: We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF were enrolled and randomly assigned in a 1:1 ratio to receive either high-flow nasal cannula (HFNC) oxygen therapy or non-invasive ventilation (NIV) immediately after randomization. The primary outcome was the need for endotracheal intubation on day 28. Results: 120 AIDS patients were enrolled and 56 patients in the HFNC group and 57 patients in the NIV group after secondary exclusion. Pneumocystis pneumonia (PCP) was the main etiology for ARF (94.7%). The intubation rates on day 28 were similar to HFNC and NIV (28.6% vs. 35.1%, p = 0.457). Kaplan–Meier curves showed no statistical difference in cumulative intubation rates between the two groups (log-rank test 0.401, p = 0.527). The number of airway care interventions in the HFNC group was fewer than in the NIV group (6 (5–7) vs. 8 (6–9), p < 0.001). The rate of intolerance in the HFNC group was lower than in the NIV group (1.8% vs. 14.0%, p = 0.032). The VAS scores of device discomfort in the HFNC group were lower than that in the NIV group at 2 h (4 (4–5) vs. 5 (4–7), p = 0.042) and at 24 h (4 (3–4) vs. 4 (3–6), p = 0.036). The respiratory rate in the HFNC group was lower than that in the NIV group at 24 h (25 ± 4/min vs. 27 ± 5/min, p = 0.041). Conclusions: Among AIDS patients with ARF, there was no statistical significance of the intubation rate between HFNC and NIV. HFNC had better tolerance and device comfort, fewer airway care interventions, and a lower respiratory rate than NIV. Clinical Trial Number: Chictr.org (ChiCTR1900022241).

Objective:To investigate the clinical efficacy of high-flow nasal cannula (HFNC) oxygen therapy as the respiratory support for severe coronavirus disease 2019 (COVID-19) patients, and to analyze the risk factors of HFNC oxygen therapy failure in the treatment of severe COVID-19.Methods:A retrospective analysis was performed on the clinical data of patients who received HFNC oxygen therapy and met the criteria for severe COVID-19 in the Department of Intensive Care Medicine, Beijing Ditan Hospital, Capital Medical University from January 2020 to June 2020. Patients were divided into HFNC success group and HFNC failure group according to applying non-invasive/invasive positive pressure ventilation or not in the following treatment. T test or chi-square test were used to compare the differences between the two groups in basic data, APACHEII score, laboratory data, basic oxygenation index, time from onset to HFNC usage, baseline ROX index, and respiratory rate, oxygenation index and ROX index at 2, 4 and 12 hours after HFNC treatment. The risk factors of HFNC treatment failure were then analyzed.Results:A total of 40 patients were enrolled in the clinical study. Twenty-one patients (52.5%) successed in HFNC treatment and 19 patients (47.5%) failed. There were no significant differences between the success group and failure group in basic data, laboratory data, basal oxygenation index, time from onset to HFNC use, baseline ROX index, respiratory rate and oxygenation index at 2 h, 4 h and 12 h after HFNC treatment ( P>0.05). There were significant differences between the two groups in APACHEII score and ROX index at 2h, 4h and 12h after HFNC treatment ( P<0.05). Logistic regression analysis showed that APACHEII score and ROX index were independent risk factors for HFNC treatment failure. Conclusions:HFNC can be used as the respiratory support for severe COVID-19, and ROX index monitoring was a key factor in evaluating the success of HFNC treatment.

BACKGROUND The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients’ hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. After the modified Fontan operation, circulation is different from that of patients who are not subjected to the procedure. This paper describe a successful case using ECMO in curing influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The special cardiac structure and circulatory characteristics are explored in this case. CASE SUMMARY We report a successful case using ECMO in curing influenza A infection in a 23-year-old man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The man was admitted to the intensive care unit with severe acute respiratory distress syndrome as a result of influenza A infection. He was initially treated by veno-venous (VV) ECMO, which was switched to veno-venous-arterial ECMO (VVA ECMO) 5 d later. As circulation and respiratory function gradually improved, the VVA ECMO equipment was removed on May 1, 2018. The patient was successfully withdrawn from artificial ventilation on May 28, 2018 and then discharged from hospital on May 30, 2018. CONCLUSION After the modified Fontan operation, circulation is different compared with that of patients who are not subjected to the procedure. There are certainly many differences between them when they receive the treatment of ECMO. Due to the special cardiac structure and circulatory characteristics, an individualized liquid management strategy is necessary and it might be better for them to choose an active circulation support earlier.

Abstract Background: Pneumocystis pneumonia is a major cause of death in immunocompromised patients. Many risk factors for poor prognosis have been reported, but few studies have created predictive models with these variables to calculate the death rate accurately. This study created nomogram models for the precise prediction of mortality risk in non-human immunodeficiency virus (NHIV)- and human immunodeficiency virus (HIV)-infected patients with Pneumocystis jirovecii pneumonia (PJP).Methods: A retrospective study was performed over a 10-year period to evaluate the clinical characteristics and outcomes of NHIV-PJP at Beijing Chaoyang Hospital and HIV-PJP at Beijing Ditan Hospital in China from 2010 to 2019. Univariate and multivariate logistic regression analyses were used to screen out mortality risk factors to create the nomograms. Nomogram models were evaluated by using a bootstrapped concordance index, calibration plots and receiver operating characteristic (ROC) curves.Results: A total of 167 NHIV-PJP patients and 193 HIV-PJP patients were included in the study. Pneumothorax, febrile days after admission, CD4+ T cells ≤100/µl and sulfa combined with caspofungin (CAS) treatment were identified as independent risk factors for death that could be combined to accurately predict mortality risk in NHIV-PJP patients. We created a nomogram for mortality by using these variables. The area under the curve was 0.865 (95% confidence interval 0.799-0.931). The nomogram had a C-index of 0.865 and was well calibrated. The independent risk factors for death in HIV-PJP patients included in the nomogram were pneumothorax, platelet (PLT) ≤80×109/L, haemoglobin (HGB) ≤90 g/L, albumin (ALB), cytomegalovirus (CMV) coinfection and sulfa combined with CAS treatment. The nomogram showed good discrimination, with a C-index of 0.904 and excellent calibration. The area under the curve was 0.910 (95% confidence interval 0.850-0.970).Conclusions: Our nomograms were useful tools for the precise prediction of mortality in NHIV-PJP and HIV-PJP patients.

目的:人感染猕猴α疱疹病毒1型是罕见的人畜共患病，2021年4月，在中国北京一位实验动物饲养员出现发热、皮疹、行走无力等症状，后被诊断为人感染猕猴α疱疹病毒1型，病毒性脑脊髓炎，为我国首例人感染猕猴α疱疹病毒1型病患。这名患者在入院前出现心脏呼吸骤停，诊断为缺血缺氧性脑病并出现坏死性病毒性脑脊髓炎，住院期间脑功能损害逐渐加重，临床判定脑死亡，在患者入院39 d，病程第51 d，家属撤除治疗。

目的 探讨免费医学定向生专业承诺对职业成熟度的影响机制,为提升免费医学定向生的职业成熟度提供理论依据.方法 采用大学生专业承诺量表、情绪量表和大学生职业成熟度量表,对370名免费医学定向生进行调查.结果 免费医学定向生专业承诺与情绪智力、职业成熟度两两变量之间均呈正相关(P<0.05),情绪智力在免费医学定向生专业承诺与职业成熟度间起部分中介作用.结论 提高并践行免费医学定向生的专业承诺,注重其情绪智力的培养与教育,有利于提升免费医学定向生的职业成熟度.

新型冠状病毒肺炎( COVID-19 )疫情在国内已经得到有效控制,但其他国家和地区仍呈增长态势[1].目前研究[2]显示,COVID-19 疫情的病原体新型冠状病毒主要损伤肺部,同时也可造成全身多脏器损伤,表现出广泛损伤的特点.急性胰腺炎( acute pancrea-titis,AP)是消化系统常见的危重疾病,发病率逐年升高,已成为严重危及我国人民健康和生命的重大疾病之一.尽管目前新型冠状病毒肺炎病例数量巨大,但目前仅有少量的报道[3]观察到合并急性胰腺炎.在COVID-19大流行中,首都医科大学附属北京地坛医院收治了北京市首例重症新型冠状病毒肺炎合并急性胰腺炎病例,经治疗后痊愈出院.为总结经验,提高救治水平,现将本例患者资料报道如下.

We reported that the complete genome sequence of SARS-Coronavirus-2 (SARS-CoV-2) was obtained from a cerebrospinal fluid (CSF) sample by ultrahigh-depth sequencing. Fourteen days after onset, seizures, maxillofacial convulsions, intractable hiccups and a significant increase in intracranial pressure developed in an adult coronavirus disease 2019 patient. The complete genome sequence of SARS-CoV-2 obtained from the cerebrospinal fluid indicates that SARS-CoV-2 can invade the central nervous system. In future, along with nervous system assessment, the pathogen genome detection and other indicators are needed for studying possible nervous system infection of SARS-CoV-2.

Background: Pneumocystis pneumonia is a major cause of death in immunocompromised patients. Many risk factors for poor prognosis have been reported, but few studies have created predictive models with these variables to calculate the death rate accurately. This study created nomogram models for the precise prediction of mortality risk in non-human immunodeficiency virus (NHIV)- and human immunodeficiency virus (HIV)-infected patients with Pneumocystis jirovecii pneumonia (PJP).Methods: A retrospective study was performed over a 10-year period to evaluate the clinical characteristics and outcomes of NHIV-PJP at Beijing Chaoyang Hospital and HIV-PJP at Beijing Ditan Hospital in China from 2010 to 2019. Univariate and multivariate logistic regression analyses were used to screen out mortality risk factors to create the nomograms. Nomogram models were evaluated by using a bootstrapped concordance index, calibration plots and receiver operating characteristic (ROC) curves.Results: A total of 167 NHIV-PJP patients and 193 HIV-PJP patients were included in the study. Pneumothorax, febrile days after admission, CD4+ T cells ≤100/µl and sulfa combined with caspofungin (CAS) treatment were identified as independent risk factors for death that could be combined to accurately predict mortality risk in NHIV-PJP patients. We created a nomogram for mortality by using these variables. The area under the curve was 0.865 (95% confidence interval 0.799-0.931). The nomogram had a C-index of 0.865 and was well calibrated. The independent risk factors for death in HIV-PJP patients included in the nomogram were pneumothorax, platelet (PLT) ≤80×109/L, haemoglobin (HGB) ≤90 g/L, albumin (ALB), cytomegalovirus (CMV) coinfection and sulfa combined with CAS treatment. The nomogram showed good discrimination, with a C-index of 0.904 and excellent calibration. The area under the curve was 0.910 (95% confidence interval 0.850-0.970).Conclusions: Our nomograms were useful tools for the precise prediction of mortality in NHIV-PJP and HIV-PJP patients.

Background : This study was to create nomogram models for precise prediction of mortality risk of NHIV-PJP and HIV-PJP cases. Methods : A retrospective study was performed over a 10-year period to evaluate the clinical characteristics and outcomes of NHIV-PJP at Beijing Chaoyang Hospital and HIV-PJP at Beijing Ditan Hospital in China from 2010 to 2019. Univariate and multivariate logistic regression analysis were used to screen out mortality risk factors for creating nomograms. Nomogram models were evaluated by using a bootstrapped concordance index, calibration plots and receiver operating characteristics (ROCs) curve. Results : A total of 167 NHIV-PJP cases and 193 HIV-PJP cases were included in the study. Pneumothorax, febrile days after admission, CD4+ T cells≤100cells/ul and sulfa combine CAS treatment were identified as independent risk factors that could be combined for accurate prediction of mortality result in NHIV-PJP group. We created a nomogram for mortality risk by using these variables. The area under the curve was 0.865 (95% confidence interval 0.799-0.931). The nomogram had a C-index of 0.865 and was well calibrated. Independent risk factors contained in the nomogram in HIV-PJP group included pneumothorax, PLT≤80×10 9 /L, HGB≤90g/L, ALB, CMV co-infection and sulfa combine CAS treatment. The nomogram showed good discrimination, with a C-index of 0.904 and good calibration. The area under the curve was 0.910 (95% confidence interval 0.850-0.970). Conclusions : Our nomograms were useful tools for evaluating the poor prognosis in both NHIV-PJP and HIV-PJP cases.

Objective:To evaluate the application value of serum amyloid A (SAA) and C-reactive protein (CRP) in the monitoring the status of coronavirus disease 2019 (COVID-19).Methods:The clinical data of COVID-19 patients admitted to the Department of Intensive Medicine and Infection Center of Beijing Ditan Hospital affiliated to Capital Medical University from January 20 to June 29, 2020 were retrospective analyzed, including 147 cases in mild group and 75 cases in severe group. The differences between SAA and CRP at each time point between the two groups and the prediction value for severe COVID-19 were analyzed.Results:The average ages of the severe and mild cases were 57.2±16.8 and 35.9±17.4 years old, respectively and the difference was statistically significant ( P<0.05). The proportions of male cases in severe and mild groups were 62.7% and 48.3%, respectively and the difference was statistically significant ( P<0.05). For underlying diseases, the proportion of patient with diabetes in severe and mild groups were 25.3% and 2.7%, respectively and the difference was statistically significant ( P<0.05); the proportion of patient with hypertension in severe and mild groups were 37.3% and 17.0%, respectively and the difference was statistically significant ( P<0.05). The average hospitalization time in severe and mild groups were 31.5±10.2 days and 24.5±13.8 days, respectively and the difference was statistically significant ( P<0.05). The levels of CRP and SAA at the 0, 3, 7 and 14 days after admission in severe were higher than those in mild group. In ROC analyses of the prediction values, the area under curve (AUC) of CPR at the 0, 3, 7 and 14 days after admission for severe COVID-19 were 0.923, 0.918, 0.945 and 0.776 respectively, while AUCs of SAA at the above time points were 0.807, 0.795, 0.864 and 0.762, respectively. CRP level above 27.85mg/dL at 0 day and 45.25mg/dL at 3 days after admission can predict the occurrence of severe illness in patients. SAA level above 66.0mg/dL at 0 day and 267.35 mg/dL at 3 days after hospitalization can predict the occurrence of severe illness in patients. Conclusions:Regular testing of SAA and CRP would be helpful for the judgment of disease severity and the prediction of disease development and can be applied in clinical practice.

Background: SARS-Coronavirus-2 (SARS-CoV-2), the pathogen of coronavirus disease 2019 (COVID-19), not only infects the respiratory tract, but also other organs. About a third of the inpatients of COVID-19 have neurological symptoms and in vitro experiments revealed that SARS-CoV-2 could infect human neural progenitor cells and brain organoids. However, the traditional test often reports negative owing to the low number of virus in the cerebrospinal fluid. To date, timely diagnosis of central nervous system infection of SARS-CoV-2 remains a challenge. Case presentation: On day 14 of COVID-19, seizures , maxillofacial convulsions, intractable hiccups and significant increase in intracranial pressure developed in a 56-year-old man. The RT-PCR of SARS-CoV-2 was negative. SARS-CoV-2 nucleic acid were detected in cerebrospinal fluid (CSF) by ultrahigh depth sequencing. The patient was successfully treated after 14 days of mechanical ventilation and treatment of pneumonia and neurological dysfunction. Conclusions: This case suggests SARS-CoV-2 can invade the central nervous system and relevant examinations with CSF including ultrahigh depth sequencing of SARS-CoV-2 are needed among COVID-19 patients with neurological dysfunction.

Abstract Background Acute kidney injury (AKI) is a common complication among human immunodeficiency virus (HIV)-infected patients resulting in increased morbidity and mortality. Continuous renal replacement therapy (CRRT) is a useful method and instrument in critically ill patients with fluid overload and metabolic disarray, especially in those who are unable to tolerate the intermittent hemodialysis. However, the epidemiology, influence factors of CRRT and mortality in patients with HIV/AIDS are still unclear in China. This study aims to study the HIV-infected patients admitted in Intensive Care Unit (ICU) and explore the influence factors correlated with CRRT and their prognosis. Methods We performed a retrospective case-control study in the ICU of the Beijing Ditan Hospital Capital Medical University. From June 1, 2005 to May 31, 2017, 225 cases were enrolled in this clinical study. Results 122 (54.2%) patients were diagnosed with AKI during their stay in ICU, the number and percentage of AKI stage 1, 2 and 3 were 38 (31.1%), 21(17.2%) and 63(51.7%), respectively. 26.2% of AKI patients received CRRT during the stay of ICU. 56.25% CRRT patients died in ICU. The 28-day mortality was 62.5%, and the 90-day mortality was 75%. By univariate logistics analysis, it showed that higher likelihood of diagnosis for respiratory failure (OR = 7.333,95% CI 1.467–36.664, p = 0.015), higher likelihood of diagnosis for septic shock (OR = 1.005,95% CI 1.001–1.01, p = 0.018), and higher likelihood to use vasoactive agents (OR = 10.667,95% CI 1.743–65.271, p = 0.001), longer mechanical ventilation duration (OR = 1.011,95% CI 1.002–1.019, p = 0.011), higher likelihood for diagnosis for PCP (OR = 7.50,95% CI 1.288–43.687, p = 0.025), higher SOFA score at ICU admission (OR = 1.183,95% CI 1.012–1.383, p = 0.035), longer duration of CRRT (OR = 1.014,95% CI 1.001–1.028, p = 0.034) contributed to a higher mortality at ICU. The Cox Analysis for the cumulative survival of AKI 3 patients between the CRRT and non-CRRT groups shows no significant differences (p = 0.595). Conclusions There is a high incidence of AKI in HIV-infected patients admitted in our ICU. Patients with severe AKI were more prone to be admitted for CRRT and have a consequent poor prognosis.

To evaluate the efficacy and safety of covered stent placement for the treatment of hepatic artery pseudoaneurysm (HAP). Between March 2006 and March 2019, 17 consecutive patients underwent emergency covered stent placement for treatment of HAP. There were 12 men and 5 women aged 24–71 years, with an average age of 49.4 years. Eleven patients had undergone Whipple procedure, 3 had hepatic abscess following hepatectomy, 2 had undergone hepatectomy under extracorporeal circulation, and 1 had received surgical exploration after a car accident. The average interval from surgical intervention to massive bleeding was 15.3 days (range: 6–35 days). After HAP was confirmed by angiography, 1–3 covered stent grafts (3–8 mm in diameter and 13 mm–5 cm in length) were implanted. Adequate drainage, anti-infection treatment, and symptomatic treatment were offered after stent placement, and no anticoagulation or antiplatelet drug was used. The interventions were successful in all 17 patients. Angiography revealed pseudoaneurysms in common hepatic artery in 16 patients (in gastroduodenal artery stumps in 4 patients) and hemorrhage from a ruptured right hepatic artery in 1 patient. All patients were successfully implanted with 1–3 covered stent grafts. Bleeding was completely controlled in 12 patients (stent diameter: 4.5–8 mm). Four patients (stent diameter: 3–4.5 mm) experienced bleeding recurrence 1 h to 3 days after stent implantation, and type 1 endoleaks were identified during second angiography. Finally, these 4 patients died of multiple organ failure 2–10 days after embolization/blockage. The remaining patient suffered from abdominal hemorrhage again 2 weeks after stent implantation, and second angiography showed hemorrhage from a branch of the superior mesenteric artery; no bleeding occurred after embolization. Thirteen patients survived at discharge, and the average length of hospital stay was 26.53 days (range: 11–58 days). The average follow-up time was 23 months (range: 16–37 months), during which 6 patients died of tumor progression. No bleeding recurred during the follow-up period, and routine color Doppler ultrasound revealed that the common hepatic artery was patent and the blood flow was smooth at the stent implantation site. Covered stent placement is a safe and effective alternative for treating HAP patients with high risk of severe complications after hepatic artery embolization. Larger stent grafts (> 4 mm in diameter) may achieve better prognosis.