ObjectiveTo evaluate the utility of the NMF standards—comprising intraoperative norepinephrine dosage, preoperative MELD-Na score, and total intraoperative fluid intake—in determining the optimal timing for initiating renal replacement therapy (RRT) in patients with acute kidney injury (AKI) following liver transplantation.MethodsThe NMF standards were developed and validated in two studies: (1) a retrospective cohort study (2018–2023, 189 patients with KDIGO stage 2 AKI) stratified by NMF status and RRT timing into four groups (A, B, C, D); and (2) a historically controlled cohort study (2024–2025, 76 NMF-guided patients vs. 189 historical controls managed by clinical judgment). The primary outcomes included renal function indicators, hospital stay, CKD incidence, and long-term RRT dependence.ResultsThe NMF standards have been validated as a robust clinical tool: intraoperative norepinephrine ≥6.5 μg·kg−1·h−1, preoperative MELD-Na ≥15.5, and total fluid intake ≥6,600 ml. In the retrospective cohort, patients meeting NMF standards who received timely RRT exhibited significantly better renal function, lower blood ammonia, shorter hospital stay, and lower rates of CKD and long-term RRT dependence than those with delayed or no RRT. For patients not meeting the NMF standards, early RRT did not show significant long-term benefits in this small subgroup, but was associated with an increased risk of catheter-related bloodstream infection. In the historically controlled cohort study, NMF-guided RRT significantly improved 7-day creatinine (64.5 vs. 72.2 μmol/L), shortened hospital stay (24.0 vs. 27.5 days), and reduced CKD (14.5% vs. 24.5%) and long-term RRT dependence (7.9% vs. 18.5%) compared with clinically guided RRT.ConclusionsThe NMF standards, integrated with a user-friendly WeChat mini-program, provide a validated and practical framework for optimizing RRT timing in AKI post-liver transplantation. This tool enhances clinical decision-making, reduces complications, and improves long-term renal outcomes.

The study investigates the link between the venous-to-arterial carbon dioxide gap (Pv-aCO2) and cardiac output (CO), as well as the venous-to-arterial carbon dioxide gap to arterial-venous oxygen content difference (Pv-aCO2/Ca-vO2) ratio and the oxygen delivery to oxygen consumption (DO2/VO2) ratio in septic shock patients, with myocardial dysfunction as a secondary subgroup analysis. A retrospective observational study was conducted in intensive care units (ICUs) from July 1, 2018, to March 31, 2024, focusing on patients with septic shock. Participants were divided into two groups for subgroup analysis: those with myocardial dysfunction and those without, based on ejection fraction (EF). The study collected fundamental data, baseline clinical variables, and prognostic indicators to compare the two groups. The study also examined the correlations between Pv-aCO2 and CO, Pv-aCO2/Ca-vO2 and DO2/VO2 in the overall cohort and subgroups. The study involved 597 septic shock patients. In the overall cohort, a negative correlation was found between Pv-aCO2 and CO (r = - 0.63, P < 0.01) and between Pv-aCO2/Ca-vO2 and DO2/VO2 (r = - 0.71, P < 0.01). In subgroup analysis, 127 patients had myocardial dysfunction, and 470 did not. No significant differences were noted in basic data, lactate, and other indicators (P > 0.05). However, significant differences were observed in intubation rate, CO, EF, vasoactive inotropic score (VIS), C-reactive protein (CRP), DO2, Pv-aCO2/Ca-vO2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE-II) score, and 28-day mortality rate (P < 0.05) between groups. In myocardial dysfunction subgroup, Pv-aCO2 negatively correlated with CO (r = - 0.57, P < 0.01), and Pv-aCO2/Ca-vO2 negatively correlated with DO2/VO2 (r = - 0.80, P < 0.01). Similarly, in non-myocardial dysfunction subgroup, Pv-aCO2 negatively correlated with CO (r = - 0.62, P < 0.01), and Pv-aCO2/Ca-vO2 negatively correlated with DO2/VO2 (r = - 0.68, P < 0.01). The correlation of Pv-aCO2/Ca-vO2 with DO2/VO2 was significantly stronger in myocardial dysfunction subgroup (P = 0.008), while the Pv-aCO2-CO correlation was similar between subgroups (P = 0.44). In septic shock patients, Pv-aCO2 and Pv-aCO2/Ca-vO2 correlate well with CO and DO2/VO2, indicating they could be surrogate markers for these parameters. As a secondary finding, the correlation of Pv-aCO2 and Pv-aCO2/Ca-vO2 is stronger in patients with myocardial dysfunction.

Background: Tissue hypoperfusion can persist despite meeting early goal-directed therapy targets, while excessive resuscitation poses risks. The study focuses on the utility of central venous-arterial CO 2 gap to arterial-central venous O 2 content difference ratio (P v-a CO 2 /C a-v O 2 ) can serve as a valuable tool for guiding fluid resuscitation in patients with septic shock. Methods: A prospective study was conducted in a Chinese intensive care unit from July 1, 2020 to March 31, 2025. The study cohort comprised individuals who have been diagnosed with septic shock. The patients were allocated into 2 groups: control group: after receiving early goal directed therapy target fluid resuscitation for 6h, no additional fluid replacement was required; experimental group: fluid resuscitation should be continued until P v-a CO 2 /C a-v O 2 ≤ 1.8 mm Hg/mL. The fundamental data, clinical characteristics, prognostic factors, and complications were comprehensively collected and analyzed. Finally, the reliability of P v-a CO 2 /C a-v O 2 as parameter for determining fluid resuscitation targets in septic shock patients was evaluated. Results: A total of 321 patients were enrolled in the study. There were no significant differences in fundamental data and clinical characteristics among the 2 groups. At baseline, no significant differences were observed between the control and experimental groups regarding the total decannulation rate, duration of mechanical ventilation, and length of stay in the intensive care unit ( P >.05). However, the experimental group exhibited a significantly lower 28-day mortality rate compared to the control group ( P <.05). Furthermore, the length of hospital stay was significantly reduced in the experimental group relative to the control group ( P <.05). The incidence of heart failure or pulmonary edema, hepatic insufficiency, gastrointestinal bleeding, cerebrovascular accidents, and coronary heart disease or myocardial ischemia did not differ significantly between the 2 groups ( P >.05). Nonetheless, the incidence of renal insufficiency or the requirement for renal replacement therapy was significantly lower in the experimental group than in the control group ( P <.05). In terms of the total fluid replacement volume at time point T6, no statistically significant differences were identified between the control and experimental groups ( P >.05). However, at time points T12 and T24, the total fluid replacement volume was significantly higher in the experimental group compared to the control group ( P <.05). Conclusions: P v-a CO 2 /C a-v O 2 may serve as a reliable parameter for determining the fluid resuscitation target in patients with septic shock.

Occupational burnout is highly prevalent among physicians working in intensive care units (ICUs), with male clinicians being a particularly vulnerable yet understudied subgroup. However, the evidence base for investigating modifiable, non-stigmatizing protective factors against burnout—such as specific leisure-time activities—remains weak. This national study seeks to quantify the protective effect of sports spectating behavior against burnout and to elucidate the influencing factors and psychological pathways involved, thereby providing an evidence base for developing accessible mental health promotion strategies. A nationwide cross-sectional survey was conducted among 1,002 male ICU physicians in China between April and October 2025. Independent risk and protective factors for burnout were identified using multivariable logistic regression. The associations of these factors with burnout severity and its distinct dimensions (Emotional Exhaustion-EE, Depersonalization-DP, and Personal Accomplishment-PA), as well as population heterogeneity, were further analyzed using ordinal logistic regression and stratified multiple linear regression models. Multivariable logistic regression was performed to identify independent factors associated with burnout after adjusting for potential confounders. The results, visually summarized in a forest plot, identified attending physician title (OR = 1.643, 95

The objective of this study is to investigate the involvement of creatine phosphate (CP) in sepsis-induced myocardial dysfunction (SIMD) among patients. A retrospective analysis was conducted to gather data on patients with SIMD. Based on the administration of CP, the patients were categorized into 2 groups: the observation group and the control group. The study recorded fundamental demographic information including age, gender, and factors contributing to infection, as well as various clinical indices. Additionally, measurements of vasoactive infusion score (VIS), lactate, N-terminal pro-B-type natriuretic peptide (NT-proBNP), cardiac troponin-I (cTnI), central venous-arterial CO2 gap (GAP), and central venous-arterial CO2 gap to arterial-central venous O2 content difference ratio (Pv-aCO2/Ca-vO2) (GAP ratio) were taken before treatment, as well as at 24-hour and 72-hour intervals post-treatment. Furthermore, the study documented the patients' 28-day survival rate, tracheal intubation extubation rate, duration of mechanical ventilation, length of stay in the intensive care unit (ICU), and overall length of hospitalization. A total of 572 patients were ultimately selected for inclusion in the study, with 299 cases assigned to the observation group and 273 cases assigned to the control group. No statistically significant differences were observed between the 2 groups in terms of age, gender, cause of infection, body mass index, cardiac index, Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II, and premedication clinical indices. After 24 hours of treatment, there were no statistically significant differences between the 2 groups in VIS, lactic acid, cTnI, and GAP ratio, but significant differences were observed in NT-proBNP and GAP. At the 72-hour mark following treatment, the observation group exhibited superior results in VIS, lactate, NT-proBNP, GAP, and GAP ratio compared to the control group. However, there was no statistically significant difference in cTnI levels. Furthermore, the observation group demonstrated significant improvements in the 28-day survival rate, tracheal intubation extubation rate, mechanical ventilation, and ICU stay time, and 28-day all-cause mortality risk Kaplan-Meier curve when compared to the control group. The sustained administration of CP for a duration exceeding 3 days has been observed to enhance the oxygen delivery and systemic perfusion in patients with SIMD, leading to improved cardiac function and cardioprotection. Additionally, this intervention has demonstrated the potential to enhance the patient's 28-day survival rate, tracheal intubation extubation rate, while reducing the need for mechanical ventilation and length of stay in ICU.

Aeromonas hydrophila (A. hydrophila), a Gram-negative bacterium commonly found in aquatic environments, has the capacity to be transmitted to humans through consumption of contaminated fish, water, or seafood. In this study, we present a case report concerning a 77-year-old female patient who experienced an acute exacerbation of chronic heart failure, subsequently developing severe septic shock due to necrotizing fasciitis caused by A. hydrophila. Infections caused by A. hydrophila are more prevalent during warmer months, particularly in regions characterized by dense aquaculture or the presence of natural water bodies. The excessive use of antibiotics in aquaculture has contributed to the emergence of antibiotic-resistant A. hydrophila strains. The proliferation of multidrug-resistant A. hydrophila presents a significant challenge for clinicians. In the context of atypical bacterial infections, the initial empiric therapy typically involves the use of third-generation cephalosporins in conjunction with quinolone antibiotics. In the present case, the patient's successful recovery was achieved through the administration of a combination of cefoperazone/sulbactam and levofloxacin, as determined by sensitivity testing. This case study underscores the critical importance of considering A. hydrophila infection in patients with septic shock who present with necrotizing fasciitis.

To Explore the correlation between Continuous Renal Replacement Therapy (CRRT) and the prognostic outcomes of patients with Severe Acute Pancreatitis (SAP); to analyze the impact of CRRT initiation time on the final prognosis of SAP patients; to evaluate factors affecting the therapeutic effect of CRRT in SAP patients without absolute indications for CRRT, and to develop a multi-factorial predictive model for the efficacy of CRRT in treating SAP. This retrospective cohort study analyzed clinical data from SAP patients admitted to The Affiliated LiHuili Hospital of Ningbo University (2015–2024), collecting baseline characteristics (demographics, disease severity scores), CRRT parameters (initiation timing, laboratory values), and clinical outcomes. We stratified patients by prognosis and CRRT status, and performed subgroup analyses for CRRT-treated cases. After excluding patients with definitive CRRT indications, we randomly allocated cases to training (80

Endothelial progenitor cells (EPCs) are undifferentiated cells with the capacity to mature into endothelial cells (ECs). EPCs have garnered considerable attention in the fields of regenerative medicine and cardiovascular therapy, owing to their pivotal role in neovascularization and vascular repair. Nonetheless, numerous challenges and questions persist regarding the translational research and practical application of EPCs. This review aims to examine the varying definitions of EPCs, their classification, extraction methods, and sources. It will also address the optimization of cultivation techniques for EPCs and the reprogramming of EPCs into induced pluripotent stem cells (iPSCs). Furthermore, the review will delve into the role of EPCs in cardiovascular diseases (CVD), septic shock, and rheumatic immune conditions, as well as their implications in connective tissue diseases (CTDs) and skin soft tissue regeneration. Finally, the article will discuss future research prospects for EPCs, aiming to engage and inspire readers.

Synaptopodin 2 (SYNPO2) plays a pivotal role in regulating tumor growth, development and progression in bladder urothelial Carcinoma (BLCA). However, the precise biological functions and mechanisms of SYNPO2 in BLCA remain unclear. Based on TCGA database‑derived BLCA RNA sequencing data, survival analysis and prognosis analysis indicate that elevated SYNPO2 expression was associated with poor survival outcomes. Notably, exogenous SYNPO2 expression significantly promoted tumor invasion and migration by upregulating vimentin expression in BLCA cell lines. Enrichment analysis revealed the involvement of SYNPO2 in humoral immune responses and the PI3K/AKT signaling pathway. Moreover, increased SYNPO2 levels increased the sensitivity of BLCA to PI3K/AKT pathway‑targeted drugs while being resistant to conventional chemotherapy. In in vivo BLCA mouse models, SYNPO2 overexpression increased pulmonary metastasis of 5637 cells. High SYNPO2 expression led to increased infiltration of innate immune cells, particularly mast cells, in both nude mouse model and clinical BLCA samples. Furthermore, tumor immune dysfunction and exclusion score showed that patients with BLCA patients and high SYNPO2 expression exhibited worse clinical outcomes when treated with immune checkpoint inhibitors. Notably, in the IMvigor 210 cohort, SYNPO2 expression was significantly associated with the population of resting mast cells in BLCA tissue following PD1/PDL1 targeted therapy. In conclusion, SYNPO2 may be a promising prognostic factor in BLCA by modulating mast cell infiltration and exacerbating resistance to immune therapy and conventional chemotherapy.

Objective. To determine prognostic role of endothelial progenitor cells (EPCs) in intensive care patients with acute myocardial infarction (AMI). Materials and Methods. From December 2018 to July 2021, a total of 91 eligible patients with AMI were consecutively examined in a single intensive care unit (ICU) in China. Patients with a history of acute coronary artery disease were excluded from the study. Samples were collected within 24 hr of onset of symptoms. EPCs, defined as coexpression of CD34+/CD133+ cells or CD133+/CD34+/KDR+, were studied using flow cytometry and categorized by quartiles. Based on the 28-days mortality outcome, the patients were further divided into two groups: death and survival. The study incorporated various variables, including cardiovascular risk factors such as body mass index, hypertension, diabetes, hypercholesterolemia, atherosclerotic burden, and medication history, as well as clinical characteristics such as APACHEⅡscore, central venous-arterial carbon dioxide difference (GAP), homocysteine, creatinine, C-reactive protein, HbAlc, and cardiac index. Cox regression analysis was employed to conduct a multivariate analysis. Results. A total of 91 patients with AMI who were admitted to the ICU were deemed eligible for inclusion in the study. Among these patients, 23 (25.3%) died from various causes during the follow-up period. The counts of EPCs were found to be significantly higher in the survival group compared to the death group (P<0.05). In the univariate analysis, it was observed that the 28-days mortality rate was associated with the several factors, including the APACHEⅡscore (P=0.00), vasoactive inotropic score (P=0.03), GAP (P=0.00), HCY (P=0.00), creatinine (P=0.00), C-reactive protein (P=0.00), HbAlc (P=0.00), CI (P=0.01), quartiles of CD34+/CD133+ cells (P=0.00), and quartiles of CD34+/CD133+/KDR+ cells (P=0.00). CD34+/CD133+/KDR+ cells retained statistical significance in Cox regression models even after controlling for clinical variables (HR: 6.258 × 10−10 and P=0.001). Nevertheless, no significant correlation was observed between CD34+/CD133+ cells and all-cause mortality. Conclusions. The decreased EPCs levels, especially for CD34+/CD133+/KDR+ cells subsets, were an independent risk factor for 28-days mortality in AMI patients.

Objective:To investigate the early prognostic value of central venous-arterial carbon dioxide tension (GAP) combined with GAP to arterial-central venous oxygen content ratio (GAP ratio) in patients with septic shock.Methods:A total of 571 ICU patients with septic shock in Ningbo Medical Centre Lihuili Hospital from January 2018 to April 2022 were selected as the research objects for the retrospective study. According to the GAP and GAP ratio at the time of admission, patients were divided into four groups: group A (180 cases): GAP ≤6 mmHg (1 mmHg=0.133 kPa) and GAP ratio ≤1.8; group B (35 cases): GAP>6 mmHg and GAP ratio ≤1.8; group C (113 cases): GAP ≤6 mmHg and GAP ratio>1.8; group D (243 cases): GAP>6 mmHg and GAP ratio>1.8. According to 28-day mortality, the patients were divided into survival group (339 cases) and death group (232 cases). The basic data, clinical and prognostic indicators of patients in each group were recorded and analyzed. Binary Logistic regression was used to analyze the risk factors influencing the prognosis of patients with septic shock. The receiver operating characteristic curve (ROC) was drawn to analyze the early prognostic value of GAP and GAP ratio for septic shock.Results:There were significant differences in lactate, cardiac output (CO), vasoactive-inotropic score (VIS), acute physiology and chronic health evaluation (APACHE-Ⅱ), sequential organ failure assessment (SOFA), extubation rate, and 28-day mortality among different groups ( Z=18.89, F=101.29, Z=131.58, F=24.19, F=24.82, χ2=197.19, χ2=191.58, all P<0.001). The levels of CO in group A and group C were (5.2±1.5) L/min and (4.8±1.5) L/min, respectively, which were higher than that in group D with significant differences ( t=15.87 and 13.80, both P<0.001). The VIS, APACHE-Ⅱ, SOFA and 28-day mortality rate in group D were 20.8(10.9, 33.5), (23.8±9.1), (13.4±7.0) and 72.0%, respectively, which were higher than those in the other three groups with significant differences ( Z=11.76, 5.46 and 5.41; t=8.21, 3.70 and 3.86; t=8.54, 3.69 and 4.46; χ2=191.05, 37.38 and 42.34; all P<0.05). The extubation rate in group D was 24.7%, which was lower than those in the other three groups with significant differences ( χ2=172.55, 47.56 and 56.92, all P<0.001). Binary Logistic regression analysis showed that lactate, VIS, GAP, and GAP ratio were independent risk factors for death with OR values of 1.14, 1.12, 1.42 and 6.51, respectively. ROC curve analysis showed that the Youden index of GAP was 0.53, the area under the curve (AUC) for predicting death in patients with septic shock was 0.84(95% CI: 0.81-0.88), and the cut-off value was 6.48 mmHg with the sensitivity of 76.3% and the specificity of 76.4%. The Youden index of GAP ratio was 0.62, the AUC was 0.88(95% CI: 0.86-0.91), and the cut-off value was 2.11 with the sensitivity of 76.3% and the specificity of 85.8%. The Youden index of GAP combined with GAP ratio was 0.70, which had a good predictive value with the AUC of 0.94(95% CI: 0.92-0.96), the sensitivity of 83.2%, and the specificity of 86.7%. Conclusions:GAP combined with GAP ratio has a good clinical application value in the early prognostic evaluation of patients with septic shock.

Hypervirulent Klebsiella pneumoniae (HvKp) is a dynamic pathotype characterized by heightened mucoviscosity and virulence, typically afflicting individuals within the community, who commonly exhibit good health. We presented a case study of a 65-year-old male with diabetes who developed community acquired pneumonia, septic shock, and intracranial infection. The diagnosis was established through cranial magnetic resonance imaging (MRI), typical clinical presentation, and biological culture. The presence of HvKp infection was confirmed by cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) and blood culture. Treatment consisted of Amikacin 0.8 g qd in combination with meropenem 2.0 g q8h, based on drug sensitivity testing. The patient experienced symptom relief, with the CSF becoming clear and the elimination of the pathogen, ultimately resulting in a successful recovery. The clinical data, diagnosis, and treatment of the patient were documented, and a review of the literature was conducted to offer clinical guidance regarding the intracranial infection resulting from community-acquired HvKp.

Introduction When COVID-19 patients develop hypoxaemic respiratory failure, they often undergo early intubation. Such a potentially aerosol-generating approach places caregivers at increased risk of contracting COVID-19. This protocol aims to evaluate the clinical efficacy and safety of a high-flow nasal cannula (HFNC) for the treatment of COVID-19 patients with acute hypoxaemic respiratory failure. Methods and analysis We intend to search MEDLINE, Embase, Web of Science and Cochrane Library to identify all randomised controlled trials (RCTs) on the use of HFNC in COVID-19 patients with acute respiratory failure. We will screen the RCTs against eligibility criteria for inclusion in our review. Two reviewers will independently undertake RCT selection, data extraction and risk of bias assessment. Primary outcome will be the rate of intubation, and secondary outcomes will be intensive care unit (ICU)/hospital mortality, ICU/hospital length of stay and risks of infection transmission. We will conduct meta-analyses to determine the risk ratio for dichotomous data and the mean difference (MD) or standardised MD for continuous data. Subgroup analyses will be performed based on the different quality of studies, different levels of disease severity, and the age and sex of participants. Ethics and dissemination Ethical approval is not required for this study considering this is a systematic review protocol that uses only published data. The findings of this study will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number CRD42021236519.

目的 探讨低磷血症与急性呼吸窘迫综合征患者预后的关系.方法 回顾性分析本院重症监护治疗病房(ICU)?2020年1月至2021年11月收治的急性呼吸窘迫综合征患者,按照血磷水平分为低磷血症组与非低磷血症组,低磷血症组则分为轻度低磷血症组和中重度低磷血症组,记录年龄、性别、体质量指数、氧合指数、急性生理与慢性健康状况评价Ⅱ(APACHEⅡ)等基础资料;记录主要预后指标:28?d死亡率和拔管成功率,次要预后指标:机械通气持续时间、ICU住院持续时间和总住院持续时间.结果 最终入选235例,其中低磷血症组79例、非低磷血症组156例;两组基础资料、ICU住院时间与总住院治疗持续时间的比较,差异无统计学意义(P>0.05),机械通气持续时间和拔管成功率比较,差异有统计学意义(P<0.05).79例低磷血症组中,轻度低磷血症组31例(39.24％),中重度低磷血症组48例(60.76％).非低磷血症组、轻度低磷血症组与中重度低磷血症组三组预后指标对比,机械通气持续时间、ICU住院持续时间和总住院持续时间,差异无统计学意义(P>0.05),28?d死亡率增加,拔管成功率降低(P<0.05).结论 低磷血症可预示急性呼吸窘迫综合征(ARDS)疾病的加重,对预测ICU?ARDS患者预后具有重要的价值.

目的 探讨外周血内皮祖细胞(EPCs)在脓毒性休克患者早期预后中的评估价值.方法 选择91例脓毒性休克患者为研究组,根据28 d预后分为死亡组和存活组,另选45例健康成人为对照组.检测外周血EPCs的相对数量,同时记录研究对象基本资料,入科第1、3和7天的体温、C-反应蛋白(CRP)、前降钙素(PCT)、血白细胞(WBC)、白介素-6(1L-6)、白介素-10(IL-10)、机械通气时间和ICU平均住院时间.分析影响患者预后的危险因素,以及EPCs对患者预后的评估价值.结果 死亡组EPCs少于对照组和存活组,存活组与对照组EPCs差异无统计学意义.死亡组入科第1天IL-6高于存活组,第1、3和7天PCT高于存活组.EPCs和APACHE Ⅱ评分是脓毒性休克患者死亡的独立危险因素.ROC曲线分析发现,EPCs约登指数为0.508,具有中等预测价值,曲线下面积(AUC)为0.79(95％CI=0.68～0.89),最佳临界值为0.108％时,敏感性77.2％,特异性73.5％.结论 外周血EPCs对脓毒性休克患者早期预后具有较好的评估价值.

A 24- year-old man who lived in Ningbo was admitted to hospital with sudden onset twitching of the extremities. His family reported that the patient was previously healthy and did not have any history of epilepsy; however, the patient was a pet lover who owned three dogs, and came into contact with stray dogs and cats. His temperature was 38.0 degrees C, blood pressure 154/84 mmHg (without vasopressor support) and he had a regular pulse at 117/ min. Examination revealed unconsciousness (Glasgow coma scale of 6), and a few inconspicuous maculopapular erythematous rashes on and around his neck (3-5 mm diameter). There were no focal neurological findings or neck stiffness. A routine blood test revealed a left shift with a high percentage of polymorphonuclear leukocytes (83.6%). The C-reactive protein level was 92.7 mg/litre (normal range 0-8 mg/litre), and the procalcitonin level was 0.229 ng/ml (normal range 0-0.046 ng/ml). Lumbar puncture was performed and the CSF was clear and colourless with a cell count of 8 cells/mu l (two lymphocytes, six neutrophils), protein level 0.325 g/litre ( normal range 0.15- 0.45 g/litre), and glucose level 3.6 mmol/litre (normal range 2.5-4.5 mmol/litre). CSF and blood cultures were also performed, and no microorganisms were detected upon Gram staining or during routine culture. Serological testing and polymerase chain reaction for suspected microorganisms (such as Escherichia coli, Vibrio cholerae, Rickettsia and Salmonella spp.) were also conducted but provided no significant clues. A plain computed tomography scan of the head and a chest radiograph were normal. Renal function test values, liver function test values, and electrolyte levels were within the normal ranges. Treatment was initiated using valproate to treat status epilepticus and piperacillin-tazobactam combined with levofloxacin for suspected CNS infection. On the second day of intensive care unit admission, the patient's CSF sample underwent metagenomic next-generation sequencing analysis. This identified eight sequence reads that uniquely corresponded to the R. felis genome, with 0.023% coverage. After removal of human reads, R. felis reads accounted for 0.8% of the microorganisms. R. felis DNA was further verified in the CSF using real- time polymerase chain reaction followed by Sanger sequencing. Based on these results and the past exposure to stray dogs and cats, the patient was diagnosed with R. felis encephalopathy. Oral doxycycline (0.1 g every 12 hours) was prescribed to replace piperacillin-tazobactam and levofloxacin. Subsequently the patient's fever gradually reduced, as did his limb twitches. He emerged from the coma on the fourth day of his intensive care unit admission and was discharged home 6 days later with no further limb twitches.

目的 探讨阿托伐他汀钙在老年脓毒性休克患者炎症控制中的作用.方法 采用前瞻性随机对照研究的方法,将2019年1月-2019年12月宁波市医疗中心李惠利医院东部院区重症医学科(intensive care unit,ICU)收治的老年脓毒性休克患者,随机分为他汀组和对照组,对照组采用常规综合支持治疗,他汀组在对照组的基础上加用阿托伐他汀钙.记录2组患者的年龄、性别、病因、急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)等基本资料;观察并记录患者治疗前及治疗后第1天、第3天、第7天的C反应蛋白、前降钙素、体温波动、白细胞计数、中心静脉-动脉二氧化碳分压差[P(v-a)CO2,GAP]和中心静脉-动脉二氧化碳分压差/动脉-中心静脉氧含量差[P(v-a)CO2/C(a-v)O2,GAP ratio]等临床指标;记录2组患者28d存活率、机械通气时间、ICU平均住院时间、总住院天数等预后指标.结果 最终研究纳入86例患者,2组基本资料差异无统计学意义.在治疗前和治疗后第1天,2组临床指标对比无差异;在治疗后第3,7天,他汀组临床指标的改善均优于对照组(P＜0.05);并且随着时间的推移,2组不同组间与检测时间点对各临床指标的改善均存在交互作用(P＜0.05),提示越早应用阿托伐他汀钙,患者临床指标的改善越明显.2组预后对比,他汀组患者28 d存活率、机械通气时间、ICU平均住院和总住院时间均优于对照组.结论 应用阿托伐他汀钙可以改善老年脓毒性休克患者的炎症和全身灌注情况,可提高患者28d存活率,减少机械通气时间、ICU平均住院时间和总住院时间,且越早应用获益越多.

Acute kidney injury (AKI) is a severe kidney disease defined by partial or abrupt loss of renal function. Emerging evidence indicates that non-coding RNAs (ncRNAs), particularly long non-coding RNAs (lncRNAs), function as essential regulators in AKI development. Here we aimed to explore the underlying molecular mechanism of the lncRNA H19/miR-130a axis for the regulation of inflammation, proliferation, and apoptosis in kidney epithelial cells. Human renal proximal tubular cells (HK-2) were induced by hypoxia/reoxygenation to replicate the AKI model in vitro. After treatment, the effects of LncRNA H19 and miR-130a on proliferation and apoptosis of HK-2 cells were investigated by CCK-8 and flow cytometry. Meanwhile, the expressions of LncRNA H19, miR-130a, and inflammatory cytokines were detected by qRT-PCR, western blot, and ELISA assays. The results showed that downregulation of LncRNA H19 could promote cell proliferation, inhibit cell apoptosis, and suppress multiple inflammatory cytokine expressions in HK-2 cells by modulating the miR-130a/BCL2L11 pathway. Taken together, our findings indicated that LncRNA H19 and miR-130a might represent novel therapeutic targets and early diagnostic biomarkers for the treatment of AKI.