Background:The mechanisms underlying ceftazidime-avibactam resistance in carbapenem-resistant Klebsiella pneumoniae (CRKPCZA-R) remain to be elucidated. Methods:CRKPCZA-R isolates were screened from non-repetitive CRKP isolates at our hospital from January 1, 2018 to October 30, 2021. The antimicrobial susceptibility and molecular characteristics of CRKPCZA-R were analyzed by broth microdilution method and next-generation sequencing, respectively. Results:In total, 67 of 623 CRKP isolates (10.8%) were identified as CRKPCZA-R. The susceptibility rates of CRKPCZA-R to polymyxin B, tigecycline, aztreonam-avibactam, and cefiderocol were 97.0% (65/67), 83.6% (56/67), 100.0% (67/67), and 94.0% (63/67), respectively. The most prevalent resistance gene was bla NDM-1 (44.8%, 30/67), followed by bla IMP-4 (9.0%, 6/67), bla NDM-5 (7.5%, 5/67), and bla NDM-4 (1.5%, 1/67). Furthermore, 37.3% (25/67) of the CRKPCZA-R isolates co-harbored more than two carbapenemase-encoding genes, mainly bla NDM-1 and bla KPC-2 (31.3%, 21/67). The enzyme inhibitor enhancement method detected carbapenemase activity with high sensitivity, except for isolates carrying two or more carbapenemases. Notably, 21 KL64-ST11 CRKPCZA-R isolates presented bla NDM-1, bla KPC-2, and ompk36 deletion, and 17 co-harbored two or more high virulence gene markers. Patients infected with these 21 isolates were older and experienced more serious illness compared to those infected with other drug-resistant isolates. Conclusion:The detection rate of CRKPCZA-R was relatively high due to the metallo-β-lactamase-producing isolates. Although enzyme inhibitor enhancement method can detect carbapenemases with high sensitivity and specificity, and provide an important reference for drug selection, it is not as effective for isolates carrying two or more carbapenemases. Patients infected with CRKPCZA-R co-harboring both bla KPC-2 and bla NDM-1 should be closely monitored.

Non-neonatal tetanus continues to pose a public health challenge in low- and middle-income regions. This study aimed to describe the decade-long profile of non-neonatal tetanus in Guangdong, China, from 2011 to 2021—a period marked by rapid economic development and healthcare system strengthening. Multicenter, retrospective study. The study was conducted across 159 hospitals in Guangdong, China. We included patients with a clinical diagnosis of tetanus admitted between 2011 and 2021. A total of 2,567 cases (median age 53 years; 62.1

Osteosarcoma (OS) is a bone tumor characterized by a high recurrence rate and poor prognosis. Arjunolic acid (AA), the most abundant triterpene component in Cyclocarya paliurus, is reported to have anti-tumor effects. Its specific role in OS is still unknown, which we aim to investigate in our study. An OS mouse model was established to investigate the effects of AA. Subsequently, M2 macrophages and M0 macrophages pretreated with AA were co-cultured with OS cells. The impact of AA on OS cell behavior (proliferation, apoptosis, migration, and invasion) was evaluated via EdU staining, flow cytometry, and Transwell assays. Concurrently, the expression of M1- and M2-associated genes (CD86, CD163, IL-6, Arg1) was quantified to assess AA’s regulatory role in macrophages within the tumor microenvironment (TME). Knockdown or overexpression of Wnt3a in AA-treated M0 macrophages to determine whether AA modulates Wnt3a-mediated M2 polarization, which was further validated in vivo. In vivo, AA inhibited tumor progression in OS mice. Concurrently, AA-treated macrophages inhibited OS cell malignant behavior, and AA inhibited OS cell-mediated macrophage M2-type polarization. Mechanistically, AA inhibits the malignant behavior of OS cells and inhibits tumor progression in OS mice by suppressing Wnt3a-mediated macrophage M2 polarization. Additionally, AA-induced macrophage conversion to a pro-inflammatory phenotype in the TME of OS mice. Our experiment demonstrated that AA from Cyclocarya paliurus inhibits Wnt3a-mediated M2 macrophage polarization to suppress the progression of osteosarcoma, providing a pharmacological foundation for developing therapies against OS.

Pressure ulcers are a common complication of prone orthopaedic surgery, causing pain and inconvenience to patients. This study aimed to evaluate a comprehensive nursing intervention for pressure ulcer formation in these patients. A total of 120 patients undergoing prone orthopaedic surgery were randomly divided into two groups. The study group (60 patients) received a comprehensive nursing intervention, whereas the control group (60 patients) received a routine nursing intervention. After 2 weeks, the comprehensive nursing intervention significantly reduced the incidence and degree of pressure sores and led to a shorter recovery time than the routine nursing intervention (p < 0.05). The incidence of postoperative wound complications was decreased, and patient satisfaction was significantly improved (p < 0.05). The Hamilton Anxiety Scale, Hamilton Depression Scale and visual analogue scale scores of the study group were significantly lower than those of the control group, and the Short Form 36 Health Survey Questionnaire scores were higher than those of the control group (p < 0.05). A comprehensive nursing intervention can significantly reduce the incidence and degree of pressure ulcers, accelerate recovery time, reduce postoperative wound complications and improve the quality of life and satisfaction of patients undergoing prone orthopaedic surgery.

The development of intensive care medicine is inseparable from the diversified monitoring data. Intensive care medicine has been closely integrated with data since its birth. Critical care research requires an integrative approach that embraces the complexity of critical illness and the computational technology and algorithms that can make it possible. Considering the need of standardization of application of big data in intensive care, Intensive Care Medicine Branch of China Health Information and Health Care Big Data Society, Standard Committee has convened expert group, secretary group and the external audit expert group to formulate Chinese Experts’ Consensus on the Application of Intensive Care Big Data (2022). This consensus makes 29 recommendations on the following five parts: Concept of intensive care big data, Important scientific issues, Standards and principles of database, Methodology in solving big data problems, Clinical application and safety consideration of intensive care big data. The consensus group believes this consensus is the starting step of application big data in the field of intensive care. More explorations and big data based retrospective research should be carried out in order to enhance safety and reliability of big data based models of critical care field.

Background: While central venous pressure (CVP) measurement is used to guide fluid management for high-risk surgical patients during the perioperative period, its relationship to patient prognosis is unknown. Methods: This single-center, retrospective observational study enrolled patients undergoing high-risk surgery from February 1, 2014 to November 31, 2020, who were admitted to the surgical intensive care unit (ICU) directly after surgery. Patients were divided into the following three groups according to the first CVP measurement (CVP1) after admission to the ICU: low, CVP1 <8 mmHg; moderate, 8 mmHg <= CVP1 <= 12 mmHg; and high, CVP1 >12 mmHg. Perioperative fluid balance, 28-day mortality, length of stay in the ICU, and hospitalization and surgical complications were compared across groups. Results: Of the 775 high-risk surgical patients enrolled in the study, 228 were included in the analysis. Median (interquartile range) positive fluid balance during surgery was lowest in the low CVP1 group and highest in the high CVP1 group (low CVP1: 770 [410, 1205] mL; moderate CVP1: 1070 [685, 1500] mL; high CVP1: 1570 [1008, 2000] mL; all P <0.001). The volume of positive fluid balance during the perioperative period was correlated with CVP1 (r= 0.336, P <0.001). The partial arterial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO(2)) ratio was significantly lower in the high CVP1 group than in the low and moderate CVP1 groups (low CVP1: 400.0 [299.5, 443.3] mmHg; moderate CVP1: 362.5 [330.0, 434.9] mmHg; high CVP1: 335.3 [254.0, 363.5] mmHg; all P <0.001). The incidence of postoperative acute kidney injury (AKI) was lowest in the moderate CVP1 group (low CVP1: 9.2%; moderate CVP1: 2.7%; high CVP1: 16.0%; P=0.007). The proportion of patients receiving renal replacement therapy was highest in the high CVP1 group (low CVP1: 1.5%; moderate CVP1: 0.9%; high CVP1: 10.0%; P= 0.014). Logistic regression analysis showed that intraoperative hypotension and CVP1 >12 mmHg were risk factors for AKI within 72 h after surgery (adjusted odds ratio[aOR]= 3.875, 95% confidence interval[CI]: 1.378-10.900, P= 0.010 and aOR=1.147, 95%CI: 1.006-1.309, P=0.041). Conclusions: CVP that is either too high or too low increases the incidence of postoperative AKI. Sequential fluid therapy based on CVP after patients are transferred to the ICU post-surgery does not reduce the risk of organ dysfunction caused by an excessive amount of intraoperative fluid. However, CVP can be used as a safety limit indicator for perioperative fluid management in high-risk surgical patients.

Background: Neonatal tetanus is a severe yet preventable acute infectious disease that threatens the life of newborns. We aimed to assess the disease burden and epidemiological trends of neonatal tetanus at global, regional, and country levels from 1990 to 2019. Methods: Data on neonatal tetanus was retrieved from the Global Burden of Disease Study 2019. In this study, we reported the incidence and mortality of neonatal tetanus at the global, regional, and national levels. We further explored the sex and sociodemographic index (SDI) distribution of neonatal tetanus disease burden. The average annual percentage changes (AAPCs) were calculated to assess the trends of incidence and mortality. Spearman’s correlation analysis and frontier analysis were performed to evaluate the correlation between incidence and SDI. Findings: From 1990 to 2019, the global incident cases of neonatal tetanus decreased by 92.67% from 370,885 to 27,171, and the global deaths of neonatal tetanus decreased by 91.53% from 168092 to 14229. In general, the incidence and mortality of neonatal tetanus were significantly higher in low-SDI countries than in high-SDI countries, and Spearman rank correlation analysis verified the negative correlation between incidence, mortality, and SDI. In 2019, low SDI regions had 14,196 incident cases of neonatal tetanus, accounting for 52.25% of all tetanus cases. Additionally, low-middle SDI regions had 9,713 incident cases, accounting for 35.75% of all tetanus cases. Western Sub-Saharan Africa, South Asia, and Eastern Sub-Saharan Africa had the highest incidence and mortality of neonatal tetanus in 2019. Age distribution showed that most neonatal tetanus cases occurred in the early neonatal period (0-6 days). Frontier analysis indicated that there was still great potential for improvement of neonatal tetanus in most low and low-middle SDI countries.Interpretation: From 1990 to 2019, the global burden of neonatal tetanus has improved significantly. However, neonatal tetanus remains a severe public health problem, especially in low and low-middle SDI regions. Therefore, it is necessary and significant to improve tetanus vaccination coverage, childbirth hygiene practice, public prevention awareness, and surveillance in high-burden regions.Funding: The National Natural Science Foundation of China (82072441) and the Hunan Provincial Natural Science Outstanding Youth Fund (2022JJ10095) supported this study.Declaration of Interest: The authors declare no competing interests

BACKGROUND:It is unclear whether the magnitude and duration of elevated central venous pressure (ECVP) greater than ten mmHg has the same impact on mortality in sepsis patients.METHODS:Critically ill patients with sepsis were identified from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The duration and the magnitude of ECVP were calculated. Normalized ECVP load was defined as the ECVP load (the sum of ECVP value times its duration) divided by the total duration of ECVP. The primary endpoint was 28-day mortality. Kaplan-Meier survival analysis was used to compare survival between patients with high or low normalized ECVP load.RESULTS:A total of 1071 sepsis patients were included. Higher normalized ECVP load was associated with higher mortality rate; in contrast, the duration of ECVP was not associated with mortality. A linear relationship between normalized ECVP load and mortality was identified. Patients with higher normalized ECVP load had less urine output and more positive fluid balance.CONCLUSION:The magnitude, but not the duration of ECVP, is associated with mortality in sepsis patients. ECVP should be considered as a valuable and easily accessible safety parameter during fluid resuscitation.

Craniotomy is an invasive operation with great trauma and many complications, and patients undergoing craniotomy should enter the ICU for monitoring and treatment. Based on electronic medical records (EMR), the discovery of high-risk multi-biomarkers rather than a single biomarker that may affect the length of ICU stay (LoICUS) can provide better decision-making or intervention suggestions for clinicians in ICU to reduce the high medical expenses of these patients and the medical burden as much as possible. The multi-biomarkers or medical decision rules can be discovered according to some interpretable predictive models, such as tree-based methods. Our study aimed to develop an interpretable framework based on real-world EMRs to predict the LoICUS and discover some high-risk medical rules of patients undergoing craniotomy. The EMR datasets of patients undergoing craniotomy in ICU were separated into preoperative and postoperative features. The paper proposes a framework called Rules-TabNet (RTN) based on the datasets. RTN is a rule-based classification model. High-risk medical rules can be discovered from RTN, and a risk analysis process is implemented to validate the rules discovered by RTN. The performance of the postoperative model was considerably better than that of the preoperative model. The postoperative RTN model had a better performance compared with the baseline model and achieved an accuracy of 0.76 and an AUC of 0.85 for the task. Twenty-four key decision rules that may have impact on the LoICUS of patients undergoing craniotomy are discovered and validated by our framework. The proposed postoperative RTN model in our framework can precisely predict whether the patients undergoing craniotomy are hospitalized for too long (more than 15 days) in the ICU. We also discovered and validated some key medical decision rules from our framework.

Objectives: Tetanus is a serious infectious disease. In recent decades, the epidemiology and disease char-acteristics of tetanus have been reported by many medical workers, but these studies usually have limited sample sizes.Methods: We retrieved all the epidemiological data related to tetanus from the Global Burden of Dis-ease Study 2019, and a secondary analysis was performed to report the global epidemiology and disease burden of tetanus.Results: From 1990 to 2019, the incidence and death rate of tetanus decreased worldwide. In general, high sociodemographic index (SDI) countries have lower age-standard incidence rates and age-standard death rates than low SDI countries. Moreover, in low SDI regions, newborns were the highest-risk group for tetanus. In high SDI areas, half of the tetanus cases occurred in the 70 + years age group. The disease burden of tetanus was significantly higher in males than in females. Conclusion: The disease burden of tetanus decreased significantly worldwide from 1990 to 2019. Neonatal tetanus is serious in low SDI areas, whereas the proportion of elderly tetanus is the highest in high SDI areas. The containment of tetanus in all age groups and sex still requires effort from all sectors.(c) 2023 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Aims To evaluate the clinical and genetic virulence characteristics of critically ill patients with hypervirulent Klebsiella pneumoniae (hvKP) and classic KP (cKP) infection. Methods and Results The patients included in this retrospective study (n = 225) were grouped according to their hvKP (n = 114) or cKP (n = 111) status, and their clinical characteristics were analysed and compared. Cox multivariate analysis was conducted to determine the risk factors for hvKP infection. Length of hospital stay, length of intensive care unit stay, duration of mechanical ventilation and 28-day survival rate were similar between the groups. However, the incidence of septic shock was higher in the hvKP group (16.7%) than in the cKP group (8.1%). Conclusions There was a high rate of hvKP infection in this population. Compared to patients with cKP infection, those with hvKP infection showed a higher probability of having septic shock; nevertheless, survival and length of hospital stay were similar between the groups. Risk factors for hvKP infection included hospital-acquired infection and renal insufficiency. Significance and Impact of the Study This study presents relevant information on the characteristics of hvKP infection in a Chinese population, and this promotes early diagnosis and supports the view that the prevalence of hvKP is high in China.

Objective To establish an early warning scoring system for septic shock in patients with digestive tract perforation (DTP) and evaluate its diagnostic efficacy. Methods Patients with surgically confirmed or clinically diagnosed DTP admitted to the Department of Intensive Care Medicine of Fujian Provincial Hospital from June 2012 to October 2021 were retrospectively analyzed. General demographic characteristics, perforation-related information, vital signs, common laboratory indicators, and common ICU scores (Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation-II score,Sequential Organ Failure Assessment score) were collected. The patients were divided into shock group and non-shock group according to whether the patients had septic shock during hospitalization. The risk factors of septic shock were screened by basic statistical analysis and multivariate Logistic regression analysis. The receiver operating characteristic curve was drawn to determine the cut-off value of the continuous indicators and discretized with reference to clinic, and the corresponding score was set according to the β regression coefficient of each variable. Results A total of 176 patients with DTP were included. The average age of the patients was 64.13 ± 14.67 years old, and 74.40% were males. The incidence of septic shock was 30.11% (53/176). Multivariate Logistic regression analysis showed that the highest heart rate≥105 beats/min, Glasgow Coma Scale score≤14 points, lactic acid≥5.75 mmol/L, procalcitonin≥41.47 ug/L, C-reactive protein≥222.5 mg/L were independent risk factors for septic shock in patients with DTP. The total score of clinical diagnostic scoring system of septic shock in patients with DTP was 6 points, including the highest heart rate≥105 beats/min (1 point), lactic acid≥5.75 mmol/L (two points), procalcitonin≥41.47 ug/L (one point), C-reactive protein≥222.5 mg/L (1 point), and Glasgow Coma Scale score≤14 points (1 point). The area under ROC curve (AUC) of this scoring system was 0.789 and the 95% confidence interval was 0.717–0.860 (P < 0.001); when the optimal cut-off value was 2.5, the sensitivity and specificity were 54.70 and 87.80%, respectively. Conclusion This new score system has its certain clinical value and has important guiding significance for clinicians to judge the prognosis of patients with DTP in time.

Objectives We aimed to predict the mortality of patients with craniotomy in ICU by using predictive models to extract the high-risk factors leading to the death of patients from a retrospective a study. Methods Five machine-learning (ML) algorithms were applied for training on mortality predictive models with the data from a surgical intensive care unit (ICU) database of the Fujian Provincial Hospital in China. The accuracy, precision, recall, f1 score and the area under the receiver operator characteristic curve (AUC) were used to evaluate the performance of different models, and the calibration of the model was evaluated by brier score. Results We demonstrated that eXtreme Gradient Boosting (XGBoost) was more suitable for the task, demonstrating a AUC of 0.84. We analyzed the feature importance with the Local Interpretable Model-agnostic Explanations (LIME) analysis and further identified the high-risk factors of mortality in ICU through this study. Conclusions This study established the mortality predictive model of patients who had undergone craniotomy in ICU. Identification of the factors that had great influence on mortality has the potential to provide auxiliary decision support for clinical medical staff on their practices.

Craniotomy is a kind of operation with great trauma and many complications, and patients undergoing craniotomy should enter the ICU for monitoring and treatment. Based on the electronic medical records (EMR), the discovery of high-risk multi-biomarkers rather than a single biomarker that may affect the length of ICU stay (LoICUS) can provide better decision-making or intervention suggestions for clinicians in ICU to reduce the high medical expenses of these patients and the medical burden as much as possible. The multi-biomarkers or medical decision rules can be discovered according to some interpretable predictive models such as ensembling methods. Our study aims to develop an interpretable framework based on the real-world EMRs to predict the LoICUS and discover some high-risk medical rules of patients undergoing craniotomy. The EMR data sets of patients undergoing craniotomy in ICU are separated into pre-operative features and post-operative features. The paper proposes a framework called Rules-TabNet (RTN) based on the data sets. It is a rule-based classification model and the high-risk medical rules can be discovered from RTN, and a risk analysis process is implemented to validate the rules discovered by RTN. The performance of post-operative model is significantly better than that of pre-operative model. The post-operative RTN model has the best performance compared with other baseline models, and it achieves 0.93 accuracy and 0.98 AUC for the task. Seventeen key decision rules that may have impact on the LoICUS of patients undergoing craniotomy are discovered and validated by our framework. The proposed post-operative RTN model in our framework can precisely predict whether the patients undergoing craniotomy are hospitalized for too long (more than 12 days) in ICU. We also discover and validate some key medical decision rules from our framework.

Purpose: Cardiac dysfunction has been rarely reported in patients with traumatic brain injury (TBI). The study aimed to compare clinical outcomes in patients admitted in intensive care unit (ICU) with normal cardiac function versus cardiac dysfunction after TBI. Moreover, the association of risk factors and hospital mortality ICU or hospital length of stay was investigated. Methods: A retrospective study was conducted from December 2011 to April 2018 on TBI patients admitted without pre-existing cardiac diseases. Patients with TBI were grouped into secondary cardiac dysfunction (n = 112) and normal cardiac function (n = 160) groups according to the presence of abnormal echocardiography after ICU admission. Univariate and multivariate analyses were performed. Results: Elevated BNP and troponin levels were found in the group with cardiac dysfunction. Patients with cardiac dysfunction had significantly higher hospital mortality (16.96% vs. 8.13%), longer ICU length of stay (16.34 vs. 10.99 d) than those without cardiac events. Cardiac dysfunction was an independent predictor of hospital mortality (p

Background. Tetanus is a life-threatening disease in developing countries and is accompanied by a high mortality rate. Although China is the world’s largest developing country, there have been few clinical studies on tetanus in China. The purpose of this study was to investigate the epidemiology, incidence, and management of tetanus in Fujian Province and to understand the current treatment and prognosis of tetanus patients. Methods. This was a retrospective, multicenter observational study of patients who presented with a clinical diagnosis of tetanus at 5 general hospitals in Fujian from January 2008 to December 2018. Data were analyzed using a computer software system. Results. A total of 95 patients were recruited, including 6 newborns. The average age of the adult tetanus patients was 55.53±15.39 years old. None of the patients knew their previous history of tetanus immunization. The rate of having received human tetanus immunoglobulin (HTIG) was 9.47%. A total of 73 (76.84%) patients were cured, 17 (17.89%) patients had an unknown prognosis, and 5 (5.26%) patients died. Age, severity of illness, and complications all increased the total duration of hospitalization. Compared with endotracheal intubation, tracheotomy increased the length of stay in the ICU (Intensive Care Unit) but did not affect the total hospital length of stay for mechanical ventilation. Conclusions. With the promotion of nationwide immunization against tetanus and the development of critical care medicine, morbidity and mortality rates of tetanus in Fujian are low. It is important to increase awareness among local physicians and staff in charge of tetanus immunization programs and with regard to neonatal tetanus and drug-induced tetanus. The prevention and treatment of tetanus in developing countries should arouse widespread concern in society.

Sesamin is a major component in lignans of sesame seeds, has been described to possess a lot of biological activity. The main objective of our study was to investigate the inhibitory effect and novel molecular mechanisms of sesamin on carrageenan-induced lung inflammation in rats. Here we showed that sesamin can obviously reduce polymorphonuclear neutrophils infiltration and exudate volume. Further studies exhibited sesamin can inhibit cytokines release, polymorphonuclear neutrophils markers production and the degree of lung tissues injury. Western blot analysis revealed that sesamin can inhibit the TRAF6 expression and NF-κB pathway activation in lung tissue. We found that sesamin can increase the expression of A20 and TAX1BP1 in lung tissues, and the interaction between the two molecules. In conclusion, all these results demonstrated that sesamin can attenuate carrageenan-induced lung inflammation, the mechanisms that may be related to upregulation of the novel target A20 and TAX1BP1 which can negative regulation for NF-κB pathway. Importantly, this is the first evidence showing that TAX1BP1 can be as a novel regulatory target to attenuate the lung inflammation.

Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, Fujian 350001, China Department of Critical Care Medicine, Mindong Hospital of Ningde City, Ningde, Fujian 355000, China Department of Infectious Diseases, Chaoyang District of Affiliated Zhangzhou Municipal Hospital of Fujian Medical University, Zhangzhou, Fujian 363000, China Department of Critical Care Medicine, Jinjiang Municipal Hospital, Jinjiang, Fujian 362200, China Department of Critical Care Medicine, Affiliated Nanping First Hospital of Fujian Medical University, Nanping, Fujian 353000, China

LPS-induced septic cardiomyopathy has been found to be connected with mitochondrial stress through unknown mechanisms. Mitochondrial fission is an early event in mitochondrial dysfunction. The aim of our study was to determine the role and regulatory mechanism of mitochondrial fission in the progression of LPS-induced septic cardiomyopathy, with a particular focus on Mst1 and F-actin. Our data demonstrated that Mst1 expression was rapidly upregulated in LPS-treated hearts and that increased Mst1 promoted cardiomyocyte death by inducing mitochondrial stress. Mechanistically, elevated expression of Mst1 upregulated Drp1, and the latter initiated mitochondrial fission. Excessive mitochondrial fission caused mitochondrial oxidative injury, mitochondrial membrane potential reduction, mitochondrial proapoptotic element translocation into the cytoplasm/nucleus, mitochondrial energy dysfunction and mitochondrial apoptosis activation. Inhibition of mitochondrial fission sustained mitochondrial function and favored cardiomyocyte survival. Furthermore, we identified F-actin degradation as an apparent downstream event of mitochondrial fission activation in the context of LPS-induced septic cardiomyopathy. Stabilization of F-actin attenuated fission-mediated cardiomyocyte death. Altogether, our results define the Mst1/Drp1/mitochondrial fission/F-actin axis as a new signaling pathway that mediates LPS-related septic cardiomyopathy by inducing mitochondrial stress and cardiomyocyte death. Therefore, Mst1 expression, mitochondrial fission modification and F-actin stabilization may serve as potential therapeutic targets for sepsis-related myocardial injury.

Background. Urosepsis and septic shock are a critical situation leading to a mortality rate up to 30% in patients with obstructive diseases of the urinary tract. Aim. To analyze the bacterial distribution and drug resistance of pathogenic bacteria in patients with urosepsis and to provide a basis for the rational application of antibacterial drugs in clinical practice. Methods. A retrospective analysis of 94 hospitalized patients with urosepsis for 6 years was performed. The strain composition, resistance characteristics, and the antibiogram of common bacteria from positive blood and midstream urine culture were analyzed. Results. A total of 87 strains were isolated, including 65 strains (74.71%) of Gram-negative bacilli, 14 strains (16.09%) of Gram-positive cocci, and 8 strains (9.20%) of fungi. The Gram-negative bacilli included 42 strains of Escherichia coli (E. coli) (64.62%), among which 34 strains (80.95%) were producing ESBLs, and 14 strains (21.84%) of Klebsiella pneumoniae (K. pneumoniae), among which nine strains (64.29%) were producing ESBLs. The most common pathogenic bacteria, ESBL+ E. coli and K. pneumoniae strains, showed sensitivity towards imipenem, ertapenem, piperacillin/tazobactam, amikacin, and cefotetan, but were highly resistant to quinolones. The cure rate of urosepsis was 88.30%, and the susceptibility rate of septic shock was 45.47%. Significance. Gram-negative bacterial infections are the main cause of urosepsis. The mild patient group showed more E. coli (ESBL-) infections, and the number of ESBL producing E. coli isolated from the mild group showed higher drug resistance rates for aztreonam and levofloxacin compared with isolates from the severe group.