Objective To evaluate the association between hypomagnesemia and in-hospital all-cause mortality in elderly patients with sepsis. Methods A retrospective analysis was performed on elderly patients (60–80 years old) with sepsis admitted to the Department of Critical Care Medicine of our hospital from August 2022 to July 2024. Eligible patients were divided into the hypomagnesemia group (serum magnesium < 1.46 mg/dL) and the normal magnesium group based on their serum magnesium levels at admission. The mortality difference between the two groups was compared, and univariate analysis was first conducted followed by multivariate Logistic regression to identify independent risk factors for in-hospital mortality. Results A total of 255 elderly patients were included, with 99 in the hypomagnesemia group. The mortality rate of the hypomagnesemia group was 34.3%, which was significantly higher than that of the normal magnesium group (9.0%), with a statistically significant difference (p < 0.05). High Sequential Organ Failure Assessment (SOFA) score, mechanical ventilation, and hypomagnesemia were independent risk factors for in-hospital all-cause mortality in elderly patients with sepsis (OR = 2.63, 2.14, 3.01, all p < 0.05). Conclusion Hypomagnesemia is an independent risk factor for in-hospital all-cause mortality in elderly patients with sepsis. Attention should be paid to maintaining normal serum magnesium levels during the management of these patients.

Objective: To evaluate the efficacy and safety of electroacupuncture as an adjunct to standard intensive care unit (ICU) care for gastrointestinal recovery in patients with grade II-III acute gastrointestinal injury (AGI). Methods: This single-center, randomized, sham-controlled trial enrolled 60 ICU patients with grade II or III AGI. Participants were randomly assigned in a 1:1 ratio to a treatment group or a control group. The control group received standard care plus sham electroacupuncture, whereas the treatment group received standard care plus electroacupuncture at bilateral Zusanli (ST36), Shangjuxu (ST37), and Tianshu (ST25) for 7 consecutive days. The primary outcome was the change in intestinal peristaltic frequency from day 1 to day 7, assessed by abdominal ultrasonography. Results: The treatment group showed a significantly greater increase in intestinal peristaltic frequency from day 1 to day 7 than that in the control group (1.9 +/- 0.6 vs 0.9 +/- 0.3 counts/2 min, P < 0.001). Compared with the control group, the treatment group showed significantly greater improvements on days 3 and 7 in inflammatory biomarkers, stress hormone levels, abdominal ultrasonographic indices, and contrast-enhanced gastrointestinal ultrasonographic parameters (all P < 0.05). No significant between-group differences were observed in vital signs at any time point (all P > 0.05). The incidence of adverse events was comparable between the two groups (P = 0.704). Conclusion: Electroacupuncture, when added to standard ICU care, safely and effectively promotes gastrointestinal motility recovery in patients with grade II-III AGI.

Background . Inhalation of particles with a diameter of less than 2.5  μ m (PM2.5) among air pollutants may cause lung damage. Gu-Ben-Zhi-Ke-Zhong-Yao (GBZK) is a traditional Chinese medicine prescription that has a beneficial effect on the treatment of chronic obstructive pulmonary disease (COPD). However, the effect of GBZK on PM2.5-induced lung injury remains to be elucidated. Methods . We constructed a mice lung injury model through PM2.5 stimulation and simultaneously performed GBZK gavage treatment. After 4 weeks, the lung tissues of the mice were collected for pathological staining to analyze the degree of damage. The activities of myeloperoxidase (MPO), malondialdehyde (MDA), and oxidative stress-related factors (superoxide dismutase, SOD; glutathione peroxidase, GSH-Px) were detected by commercial kit in lung tissue. Furthermore, the number of neutrophils and related inflammatory factors (interleukin-1, IL-1 β ; tumor necrosis factor α , TNF- α ; interleukin-6, IL-6) in bronchoalveolar lavage fluid (BALF) and serum were collected and tested to evaluate the effect of GBZK on inflammation. Masson staining was used to detect the level of lung fibrosis in mice. The activation of HMGB1 (high-mobility group protein 1) and NF κ Bp65 (nucleus factor kappa B) in lung tissue was evaluated by immunohistochemistry and western blot. Results . The result revealed that PM2.5 induces lung damage, and GBZK gavage treatment could reduce the degree of injury in a concentration-dependent manner in mice. After GBZK treatment, the MPO activity, MDA content, and oxidative stress level in the lung tissues of mice decreased. And after GBZK treatment, the expression levels of inflammatory cytokines in BALF and blood were decreased. GBZK treatment also improved pulmonary fibrosis in mice. In addition, we also found that GBZK prevented the up-regulation of the HMGB1/NF- κ B axis in the lungs of mice. Conclusion . These results indicated that GBZK might protect mice from PM2.5-induced lung injury by inhibiting the HMGB1/NF κ B pathway, thus repressing inflammation and pulmonary fibrosis.

目的:评价改良NUTRIC(mNUTRIC)评分对成人脓毒性休克患者病死率的预测价值。方法:回顾性研究2018年1月至2020年12月中日友好医院重症监护室(ICU)收治的成人脓毒性休克患者124例。使用受试者工作特征(ROC)曲线确定一个可预测成年脓毒性休克患者预后的mNUTRIC评分。结果:124例患者中，死亡组46例，存活组78例。死亡组急性生理和慢性健康评估(APACHE Ⅱ)、序贯器官衰竭评估(SOFA)、mNUTRIC评分均高于存活组(均 P<0.05)。mNUTRIC评分越高，28 d病死率越高，mNUTRIC评分与28 d病死率呈正相关( r＝0.318， P<0.001)。在mNUTRIC评分的ROC曲线中，最佳截断值为4分。mNUTRIC评分预测28 d病死率的曲线下面积(AUC)为0.664(95% CI：0.574，0.746)。 结论:mNUTRIC评分是一种良好的脓毒性休克患者营养风险评估工具。mNUTRIC评分在预测脓毒性休克患者28 d病死率方面表现良好。

目的:探讨血清中介素对脓毒症合并肝损伤患者预后的影响.方法:选择2017年1月～2020年6月中日友好医院收治的90例脓毒症合并肝损伤患者作为研究对象,另选择40例单纯脓毒症患者和40例健康体检者作为对照.比较各组的中介素水平.根据入院后28d内的生存状态将患者分为死亡组和生存组,采用多因素回归分析脓毒症合并肝损伤患者预后的影响因素.结果:脓毒症合并肝损伤组的中介素水平显著高于脓毒症组(P＜0.05).血清中介素水平在轻度、中度和重度肝损伤脓毒症组的差异均有统计学意义(P＜0.05).死亡组的重度肝损伤程度和意识障碍的发生率、中介素水平和APACHE Ⅱ评分均显著高于生存组,BMI显著低于生存组.重度肝损伤、意识障碍、高中介素水平、高APACHE Ⅱ评分是脓毒症合并肝损伤患者死亡的危险因素(P＜0.01).结论:血清中介素水平与脓毒症合并肝损伤患者临床预后密切相关,可作为评估预后的潜在指标.

Background. Inhalation of particles with a diameter of less than 2.5 μm (PM2.5) among air pollutants may cause lung damage. Gu-Ben-Zhi-Ke-Zhong-Yao (GBZK) is a traditional Chinese medicine prescription that has a beneficial effect on the treatment of chronic obstructive pulmonary disease (COPD). However, the effect of GBZK on PM2.5-induced lung injury remains to be elucidated. Methods. We constructed a mice lung injury model through PM2.5 stimulation and simultaneously performed GBZK gavage treatment. After 4 weeks, the lung tissues of the mice were collected for pathological staining to analyze the degree of damage. The activities of myeloperoxidase (MPO), malondialdehyde (MDA), and oxidative stress-related factors (superoxide dismutase, SOD; glutathione peroxidase, GSH-Px) were detected by commercial kit in lung tissue. Furthermore, the number of neutrophils and related inflammatory factors (interleukin-1, IL-1β; tumor necrosis factor α, TNF-α; interleukin-6, IL-6) in bronchoalveolar lavage fluid (BALF) and serum were collected and tested to evaluate the effect of GBZK on inflammation. Masson staining was used to detect the level of lung fibrosis in mice. The activation of HMGB1 (high-mobility group protein 1) and NFκBp65 (nucleus factor kappa B) in lung tissue was evaluated by immunohistochemistry and western blot. Results. The result revealed that PM2.5 induces lung damage, and GBZK gavage treatment could reduce the degree of injury in a concentration-dependent manner in mice. After GBZK treatment, the MPO activity, MDA content, and oxidative stress level in the lung tissues of mice decreased. And after GBZK treatment, the expression levels of inflammatory cytokines in BALF and blood were decreased. GBZK treatment also improved pulmonary fibrosis in mice. In addition, we also found that GBZK prevented the up-regulation of the HMGB1/NF-κB axis in the lungs of mice. Conclusion. These results indicated that GBZK might protect mice from PM2.5-induced lung injury by inhibiting the HMGB1/NFκB pathway, thus repressing inflammation and pulmonary fibrosis.

Abstract Purpose The application of point of care ultrasound (PoCUS) in medical education is a relatively new course. There are still great differences in the existence, quantity, provision, and depth of bedside ultrasound education. The left ventricular outflow tract velocity time integral (LVOT‐VTI) has been successfully used in several studies as a parameter for hemodynamic management of critically ill patients, especially in the evaluation of fluid responsiveness. While LVOT‐VTI has been broadly used, valuable applications using artificial intelligence (AI) in PoCUS is still limited. We aimed to identify the degree of correlation between auto LVOT‐VTI and the manual LVOT‐VTI acquired by PoCUS trained ICU doctors. Methods Among the 58 ICU doctors who attended PoCUS training from 1 September 2019 to 30 November 2020, 46 ICU doctors who trained for more than 3 months were enrolled. At the end of PoCUS training, each of the enrolled ICU doctors acquired echocardiography parameters of a new ICU patient in 2 h after new patient was admitted. One of the two bedside expert sonographers would take standard echocardiogram of new ICU patients within 24 h. For ICU doctors, manual LVOT‐VTI was obtained for reference and auto LVOT‐VTI was calculated instantly by using an AI software tool. Based on the image quality of the auto LVOT‐VTI, ICU patients was separated into ideal group (n = 31) and average group (n = 15). Results Left ventricular end‐diastolic dimension (LVEDd, p = 0.1028), left ventricular ejection fraction (LVEF, p = 0.3251), left atrial dimension (LA‐d, p = 0.0962), left ventricular E/A ratio (p = 0.160), left ventricular wall motion (p = 0.317) and pericardial effusion (p = 1) had no significant difference between trained ICU doctors and expert sonographer. ICU patients in average group had greater sequential organ failure assessment (SOFA) score (7.33 ± 1.58 vs. 4.09 ± 0.57, p = 0.022) and lactic acid (3.67 ± 0.86 mmol/L vs. 1.46 ± 0.12 mmol/L, p = 0.0009) with greater value of LVEDd (51.93 ± 1.07 vs. 47.57 ± 0.89, p = 0.0053), LA‐d (39.06 ± 1.47 vs. 35.22 ± 0.98, p = 0.0334) and percentage of decreased wall motion (p = 0.0166) than ideal group. There were no significant differences of δLVOT‐VTI (|manual LVOT‐VTI – auto LVOT‐VTI|/manual VTI*100%) between the two groups (8.8% ± 1.3% vs. 10% ± 2%, p = 0.6517). Statistically, significant correlations between manual LVOT‐VTI and auto LVOT‐VTI were present in the ideal group (R2 = 0.815, p = 0.00) and average group (R2 = 0.741, p = 0.00). Conclusions ICU doctors could achieve the satisfied level of expertise as expert sonographers after 3 months of PoCUS training. Nearly two thirds of the enrolled ICU doctors could obtain the ideal view and one third of them could acquire the average view. ICU patients with higher SOFA scores and lactic acid were less likely to acquire the ideal view. Manual and auto LVOT‐VTI had statistically significant agreement in both ideal and average groups. Auto LVOT‐VTI in ideal view was more relevant with the manual LVOT‐VTI than the average view. AI might provide real‐time guidance among novice operators who lack expertise to acquire the ideal standard view.

目的:评价R-R差异能否预测房颤射频消融术后左心收缩功能的改善.方法:回顾研究2019年7月～2021年7月在阜阳市第五人民医院行射频消融成功的房颤患者.术后左室射血分数升高＞7.5％定义为心功能改善.根据心功能变化将患者分为改善组和非改善组.对比分析2组的临床特点、心电图及超声心动图.采用多变量回归分析,筛选心功能改善的相关因素.结果:在纳入的80例患者中,改善组患者46例(57.5％).2组在高血压及睡眠呼吸暂停综合征合并症率、心电图的R-R差异、超声心动图的左室舒张末及收缩末内径上差异均有统计学意义(P＜0.05).多变量回归分析显示,R-R差异度越高的患者,心功能改善可能性更高(OR=2.12,95％CI 1.82～2.71).结论:高R-R差异与房颤射频消融术后左心收缩功能改善可能相关.

Objective: We aimed to evaluate the effects of hemodynamic monitoring using the pulse index continuous cardiac output (PiCCO) system with critically ill patients. Methods: In total, 292 patients with primary physiological abnormalities of hypotension (n = 180) or hypoxemia (n = 112) were evaluated. The attending physicians completed a questionnaire before each catheterization. After each catheterization, the attending physicians reviewed each chart to determine the possibility of altering the therapy. Results: In the hypotension subgroup, the attending physicians showed less accuracy in predicting the global end-diastolic index values (23.9%, 43/180), with a significant difference, and more accuracy in predicting the extravascular lung water index values (58.9%, 66/112), without a significant difference from the patients in the hypoxemia subgroup. In the hypotension patients, the lactate clearance rate within 6 h was significantly higher (36.4 ± 9.6 vs 21.3 ± 9.5; P<0.0001) when the hemodynamic monitoring led to therapeutic changes. Conclusions: The hemodynamic variables obtained using the PiCCO system improved the accuracy of the bedside evaluations and led to alterations in the therapeutic plans, particularly among the hypotension patients. The therapy changes showed no improvement in the overall mortality but were associated with improved tissue perfusion among the hypotension patients.

妊娠期及围生期孕妇常见有体重增加、水肿、气短、乏力等的妊娠期不适[1～4],有4％的孕妇出现心血管并发症[5],包括妊娠期高血压、子痫、HELLP综合征(hemolysis,elevated liver enzymes and low platelet count syndrome)、围生期心肌病(peripartum cardiomyopathy,PPCM)[6],妊娠同时可暴露隐匿的遗传性心肌病如扩张型心肌病(dilated cardiomyopathy,DCM)[7,8]或爆发潜伏的病毒性心肌炎.妊娠期不适与PPCM临床表现重叠,较难区别,因此了解正常妊娠期生理变化以及PPCM的病理生理显得尤为重要.本文还对PPCM诊断、治疗、预后的最新进展进行了综述.

Objective:To investigate the short term outcomes and postoperative respiratory complications of patients with chronic thromboembolic pulmonary hypertension(CTEPH) treated by pulmonary endarterectomy(PEA).Methods:45 consecutive CTEPH patients underwent PEA between December 2017 and January 2020 in our institution were enrolled, including 25 females and 20 males. The mean age of operation was 51.2(25-70) years old. 24(53.5%) patients were in New York Heart Association(NYHA) functional class Ⅲ-Ⅳ. The mean PVR before operation was 923(461-2 711) dyn·s·cm -5. All patients’ data were entered in a prospective database, divieded into patients with respiratory complications group(WRC)and without respiratory complications group(WORC). To assess risk factors for postoperative respiratory complications and its effect on short term outcomes. Results:There was a significant reduction in mPAP(from 37 mmHg to 20 mmHg) and PVR(from 923 dyn·s·cm -5 to 293 dyn·s·cm -5) in the entire group. The in-hospital mortality rate was 4.4%(2 cases), died due to postoperative cardiogenic circulatory failure, even with VA-ECMO treatment and mediastinal infection, respectively. Postoperative respiratory complications occurred in 32 patients(71.1%). The most common complications were reperfusion pulmonary edema 44.4%(20 cases) and residual pulmonary hypertension 11.1%(5 cases). The WRC group showed a tendency to have longer periods of mechanical ventilation, longer ICU stays and more ICU costs. Independent predictors of postoperative respiratory complications were time from symptom onset to PEA>36 months( OR=12.2, 95% CI: 2.1-70.7, P=0.005)and six-minute walking distance<300 m( OR=12.6, 95% CI: 1.1-138.0, P=0.0038). Conclusion:Pulmonary endarterectomy is an effective and safe treatment for CTEPH. Postoperative respiratory complications were mainly determined by symptom onset time and pre-operative status. Patients with CTEPH should consider PEA surgery early.

目的:明确白细胞介素17A(IL-17A)是细颗粒物(PM2.5)导致的肺损伤过程中的重要炎症因子,并探究此过程中产生IL-17A的关键细胞类型.方法:准备30只C57BL/6J小鼠和15只IL-17A基因敲除(IL-17A-/-)C57BL/6J小鼠,将15只野生型小鼠作为对照组,另外15只野生型小鼠和15只IL-17A-/-小鼠作为实验组,用2mg/ml浓度的PM2.5气管内滴注造模,持续9d.对照组和实验组中各5只小鼠分别在模型构建的第3d、6d、9d处死,将其肺组织和肺泡灌洗液进行形态学、流式、PCR和ELISA检测.结果:实验组野生型小鼠和对照组在第3d、6d、9d时γδT和Th17细胞的增加有显著差异(P＜0.05).ELISA检测,与实验组IL-17A-/-小鼠相比,实验组野生型小鼠第9d IL-1β、TNF-α水平有显著差异(均P＜0.05),且第9d的HE染色提示实验组IL-17A-/-小鼠比实验组野生型小鼠肺组织中的炎性细胞浸润明显减少.结论:PM2.5可通过诱导小鼠γδT和Th17细胞分泌IL-17A,从而加剧肺部炎症反应.

Stress-induced cardiomyopathy is expected that with the wide application of critical ultrasound, ICU doctors will find more cases, particularly among pregnant patients. Patients can actually survive the acute period of excessive stress, and their cardiac function can recover as long as effective treatment measures are taken.

Fine particulate matter (PM2.5) is the primary air pollutant that is able to induce airway injury. Compelling evidence has shown the involvement of IL‐17A in lung injury, while its contribution to PM2.5‐induced lung injury remains largely unknown. Here, we probed into the possible role of IL‐17A in mouse models of PM2.5‐induced lung injury. Mice were instilled with PM2.5 to construct a lung injury model. Flow cytometry was carried out to isolate γδT and Th17 cells. ELISA was adopted to detect the expression of inflammatory factors in the supernatant of lavage fluid. Primary bronchial epithelial cells (mBECs) were extracted, and the expression of TGF signalling pathway‐, autophagy‐ and PI3K/Akt/mTOR signalling pathway‐related proteins in mBECs was detected by immunofluorescence assay and Western blot analysis. The mitochondrial function was also evaluated. PM2.5 aggravated the inflammatory response through enhancing the secretion of IL‐17A by γδT/Th17 cells. Meanwhile, PM2.5 activated the TGF signalling pathway and induced EMT progression in bronchial epithelial cells, thereby contributing to pulmonary fibrosis. Besides, PM2.5 suppressed autophagy of bronchial epithelial cells by up‐regulating IL‐17A, which in turn activated the PI3K/Akt/mTOR signalling pathway. Furthermore, IL‐17A impaired the energy metabolism of airway epithelial cells in the PM2.5‐induced models. This study suggested that PM2.5 could inhibit autophagy of bronchial epithelial cells and promote pulmonary inflammation and fibrosis by inducing the secretion of IL‐17A in γδT and Th17 cells and regulating the PI3K/Akt/mTOR signalling pathway.

Purpose: As a well-known cardioprotective factor, the relevance of adiponectin (APN) to heart function following sepsis remains largely unknown. The present study evaluated the effects of plasma APN levels on heart function and 28-day mortality in sepsis patients. Materials and methods: This was a prospective study that was performed with 98 patients with sepsis and 32 controls. Left ventricular systolic dysfunction (LVSD) was defined as a left ventricular ejection fraction (LVEF) <= 45% based on echocardiography. The effects of APN on the development of sepsis-related LVSD and prediction of 28day mortality were evaluated. Results: Plasma APN levels significantly decreased in sepsis patients compared with controls, with rising severity of illness, and positively correlated with the LVEF and stroke volume index. Sepsis patients with LVSD had lower APN levels than patients without LVSD. According to the receiver operating characteristic curve, plasma APN levels had the comparable value in prediction of LVSD incidence than those conditional factors, including brain natriuretic peptide (BNP) and highly sensitive cardiac troponin T (hsTnT). Twenty-three of the 98 sepsis patients (23.47%) died at 28 days. Adiponectin levels were an independent predictive factor for 28-day mortality. Conclusions: Low APN levels were associated with the incidence of LVSD and 28-day mortality in sepsis patients. Adiponectin may be a novel factor that may be useful for the diagnosis of LVSD. (C) 2020 Elsevier Inc. All rights reserved.

Severe pneumonia is a common disease in intensive care unit (ICU), which is characterized by acute onset, poor prognosis, and can cause multiple systems dysfunction. For critical ill patients, in a state of stress, catabolism is increased, and nutritional risk is extremely high. Proper nutrition treatment can reduce the decomposition of own tissues in the stress period and supplement the protein and energy needed by the body′s metabolism. Therefore, the nutritional treatment of severe pneumonia patients is particularly important. This paper mainly reviews the nutritional literatures of severe pneumonia and critical ill patients in recent years, in order to provide more appropriate nutritional treatment for severe pneumonia patients.

目的 探讨血栓弹力图对重症颅脑损伤手术患者预后的预测价值.方法 根据患者术后28d预后情况,选取2018年1月至2019年12月入住中日友好医院外科重症医学科(SICU)的66例颅脑手术术后患者,分为存活组(44例)和死亡组(22例).比较两组患者的基线资料、实验室指标、用药详情和疾病严重程度评分,包括急性生理与慢性健康评分(APACHEⅡ评分)、格拉斯哥昏迷评分(GCS),以及血栓弹力图各指标,包括凝血反应时间(R值),血凝块形成时间及速率(K值),血凝块生成率(α角),血凝块最大强度和硬度(MA值),通过多因素COX回归探讨血栓弹力图对颅脑损伤术后患者28d死亡的影响因素.结果 死亡组患者在APACHEⅡ评分、血管活性药应用、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白(原)降解产物(FDP)上明显高于存活组;GCS评分、血小板计数均明显低于存活组.死亡组中血栓弹力图R值、K值较存活组均明显延长,而α角、MA值较存活组均显著降低.血栓弹力图各指标与凝血功能指标均存在相关性,多因素COX回归结果提示:APACHEⅡ评分{HR=1.127,95％CI(1.059,1.198),P=0.03},血栓弹力图中MA值＜50mm {HR=3.502,95％CI (1.818,12.142),P=0.04},为重症颅脑损伤患者术后28d死亡的影响因素.结论 APACHEⅡ评分和血栓弹力图MA值降低对重症颅脑手术患者28d预后具有一定的预测价值.