相位角(PhA)作为一种机体成分评估指标,能够反映细胞完整性、细胞内外空间水分的分布及肌肉和脂肪质量,近年来在危重病领域受到越来越多的关注.PhA由生物电阻抗分析(BIA)测得的全身电阻数据计算而来,可在床旁便携使用,无侵入性,使用成本低廉,且可靠性高.本文旨在总结和探讨PhA在危重症患者中的临床价值和在不同疾病中的应用进展及目前临床亟待解决的问题,以期为未来研究提供参考.

脓毒症被定义为宿主对感染反应失调引起的危及生命的器官功能障碍[1]，具有较高的发病率和病死率，严重影响危重期患者的生命健康，增加患者的心理及经济负担，导致远期预后不良。据《全球疾病负担研究》估计，2017年脓毒症导致的死亡占全球可预防死亡的近20%[2]。其中，肾脏是脓毒症最常累及的器官之一，大约有60%的脓毒症患者伴发急性肾损伤（acute kidney injury，AKI）。当合并AKI时，脓毒症患者的病死率显著升高[3-4]。同时，与其他原因引起的AKI相比，脓毒症相关急性肾损伤（sepsis associated acute kidney injury，S-AKI）往往预后更差[5]。如未及时识别和处理S-AKI，患者将有可能发展成慢性肾脏病，增加心血管并发症的风险[6]。

随着病原学检测技术的不断发展和新型检测技术在临床上的广泛应用，病毒感染在脓毒症中越来越常见。基于病毒这一特定感染病原体，病毒性脓毒症被定义为宿主对病毒性感染反应失调所导致的危及生命的器官功能障碍。近年来，随着流行性感冒病毒、冠状病毒等感染的全球或区域流行，尤其是2019年至今的新型冠状病毒感染的全球流行，病毒性脓毒症逐渐被认识，相关研究越来越深入。现总结病毒性脓毒症的病原学、病理生理机制、高炎症反应与免疫抑制过程、病原学新型标志物研究、新型抗病毒药物等方面的最新进展，并对未来研究提出设想。

Background:Severe community-acquired pneumonia (SCAP) is the main cause of mortality in immunocompromised patients. Compared with conventional microbiological tests (CMT), metagenomic next-generation sequencing (mNGS) can quickly and simultaneously detect a wide array of bacteria, viruses, and fungi in an unbiased manner. It is increasingly used for severe respiratory infectious diseases, especially for immunocompromised patients. However, the effects of mNGS-based antimicrobial treatment procedures on clinical outcomes in immunocompromised patients with SCAP have not been evaluated.Methods/Design:The MATESHIP study is a prospective, multicenter, parallel-group, open-label, randomized controlled trial from 20 ICUs in university hospitals and academic teaching hospitals across Shandong Province, China. We will enroll 342 immunocompromised patients with early onset SCAP who are admitted to an intensive care unit (ICU). Participants will be randomly allocated to an mNGS-guided treatment group or a conventional treatment group (guided by CMT), according to centrally computer-based block randomization stratified by participating centers. Participants will undergo CMT tests using appropriate lower respiratory tract (LRT) and other necessary specimens, with or without mNGS tests using LRT specimens. The primary outcomes will be: (1) The relative change in Sequential Organ Failure Assessment (SOFA) score from randomization to day 5, day 7, day 10, or the day of ICU discharge/death; and (2) the consumption of antimicrobial agents during ICU stay (expressed as defined daily doses). The secondary outcome measures will be: days from randomization to initiation of definitive antimicrobial treatment; overall antimicrobial agent use and cost; total cost of hospitalization; length of ICU stay; 28- and 90-day mortality; and clinical cure rate. This study hypothesizes that mNGS-guided treatment will decrease the degree of organ dysfunction/failure, the consumption of antimicrobial agents, and mortality, while the cure rate will be increased, and the time to initiation of appropriate therapy will be advanced.Discussion:The MATESHIP study will evaluate for the first time whether mNGS-guided antimicrobial therapy improves the outcomes of SCAP in an immunocompromised population, and provide high-level evidence on the application of mNGS in the management of this population.Clinical Trial Registration:[ClinicalTrials.gov], identifier [NCT05290454].

Objective:To study the ultrasound manifestations,its diagnosis value and misdiagnostic causes of liver tuberculosis. Methods:11 cases of misdiagnostic patients with liver tuberculosis were examined by ultrasound and the mainfestations of liver tuberculosis were analysed. Results:The liver tuberculosis were classified into diffuse,serosal,abscess,tuberculoma and mixed according to the manisfestios of ultrasound. Conclusion:Short of knowledge of liver tuberculosis,neglectfulness of illness history and clinical manifestations and despite of liver puncture guided by ultrasound were main causes of misdiagnosis,Type B ultrasound could be a screen examination of choice at first in the patient with high risk factors of liver tuberculosis.