Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20250317-00157
Yu Luo, Yongping Xu, Li Chen, Xuefeng Ding
Severe acute pancreatitis (SAP) is a condition with high mortality, characterized by persistent (>48 hours) organ dysfunction. Fluid therapy serves as the cornerstone of acute-phase management in SAP, crucial for reducing morbidity and mortality. In recent years, significant research progress has been made in the treatment concepts, methods, and strategies of fluid management for SAP patients, contributing to improved patient outcomes. Based on an understanding of the pathophysiological characteristics of SAP, it is important to recognize the significance of individualized fluid management strategies and to reasonably select the appropriate types and treatment methods of fluids for resuscitation. To achieve precise volume management, the fluid therapy for SAP patients requires the comprehensive integration of monitoring parameters, including clinical signs, laboratory markers, and invasive hemodynamic indicators, enabling dynamic assessment to avoid fluid overload. This approach is essential for continuously enhancing the efficacy and safety of fluid therapy in SAP. This review systematically summarizes recent advances in fluid management for SAP. It covers the pathophysiological mechanisms of fluid loss, individualized fluid management strategies, the selection of resuscitation fluid types and timing, goal-directed therapy, and monitoring methods. It aims to elucidate how optimized fluid resuscitation strategies can enhance organ perfusion while mitigating the risks of fluid overload and related complications, thereby providing a theoretical framework for precise, and individualized SAP fluid management protocols.
{"title":"[Research advances in fluid therapy for severe acute pancreatitis].","authors":"Yu Luo, Yongping Xu, Li Chen, Xuefeng Ding","doi":"10.3760/cma.j.cn121430-20250317-00157","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20250317-00157","url":null,"abstract":"<p><p>Severe acute pancreatitis (SAP) is a condition with high mortality, characterized by persistent (>48 hours) organ dysfunction. Fluid therapy serves as the cornerstone of acute-phase management in SAP, crucial for reducing morbidity and mortality. In recent years, significant research progress has been made in the treatment concepts, methods, and strategies of fluid management for SAP patients, contributing to improved patient outcomes. Based on an understanding of the pathophysiological characteristics of SAP, it is important to recognize the significance of individualized fluid management strategies and to reasonably select the appropriate types and treatment methods of fluids for resuscitation. To achieve precise volume management, the fluid therapy for SAP patients requires the comprehensive integration of monitoring parameters, including clinical signs, laboratory markers, and invasive hemodynamic indicators, enabling dynamic assessment to avoid fluid overload. This approach is essential for continuously enhancing the efficacy and safety of fluid therapy in SAP. This review systematically summarizes recent advances in fluid management for SAP. It covers the pathophysiological mechanisms of fluid loss, individualized fluid management strategies, the selection of resuscitation fluid types and timing, goal-directed therapy, and monitoring methods. It aims to elucidate how optimized fluid resuscitation strategies can enhance organ perfusion while mitigating the risks of fluid overload and related complications, thereby providing a theoretical framework for precise, and individualized SAP fluid management protocols.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"106-110"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Objective: </strong>To investigate the predictive value of different pediatric critical illness scores for the prognosis of children with refractory shock receiving extracorporeal membrane oxygenation (ECMO) auxiliary treatment.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted. Pediatric patients admitted to the pediatric cardiac and thoracic surgery intensive care unit (ICU) at Henan Children's Hospital from January 2019 to December 2023 who received veno-arterial ECMO support for refractory shock were included. Clinical data were collected. The Pediatric Critical Illness Score (PCIS), PEdiatric Logistic Organ Dysfunction-2 (PELOD-2), and Pediatric Multiple Organ Dysfunction Score (P-MODS) were calculated based on vital signs and laboratory results at 24 hours before ECMO as well as 6 hours and 12 hours of ECMO. Pediatric patients were categorized into death and survival groups according to discharge outcomes. Differences in clinical data and the three scores between groups were compared. Receiver operator characteristic curve (ROC curve) analysis was used to assess the predictive value of the three scores for in-hospital death in ECMO-treated pediatric patients with shock. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the predictive accuracy of the three scoring systems for death.</p><p><strong>Results: </strong>A total of 35 pediatric patients with shock were ultimately included. Among them, 23 (66%) successfully weaned off ECMO. At discharge, 18 cases survived (51%), while 17 died (49%). As the duration of ECMO treatment increased, both the survival and death groups showed a gradual increase in PCIS scores, while PELOD-2 and P-MODS scores tended to decrease. Pediatric patients in the death group had lower PCIS scores than the survival group at all the time points before and on ECMO (24 hours before ECMO: 72.00±1.87 vs. 78.22±1.87, 6 hours of ECMO: 75.53±2.15 vs. 81.89±1.35, 12 hours of ECMO: 77.76±1.35 vs. 85.00±1.53, all P<0.05), and PELOD-2 scores were higher than those in the survival group [24 hours before ECMO: 13.00 (10.50, 17.50) vs. 8.50 (6.00, 11.25), 6 hours of ECMO: 13.00 (8.50, 17.00) vs. 9.00 (7.75, 10.75), 12 hours of ECMO: 8.00 (7.00, 13.50) vs. 6.00 (5.00, 8.00), all P<0.05]. Pediatric patients in the death group had higher P-MODS scores at 6 hours and 12 hours of ECMO as compared with the survival group (6 hours of ECMO: 7.94±0.52 vs. 5.61±0.55, 12 hours of ECMO: 5.29±0.71 vs. 3.22±0.44, both P<0.05). The differences in the three scores between 6 hours and 12 hours of ECMO were not statistically significant between groups. ROC curve analysis indicated that the PCIS, PELOD-2, P-MODS scores at 6 hours and 12 hours of ECMO had predictive value for in-hospital death in pediatric patients with shock receiving ECMO support. The 6-hour P-MODS score and 12-hour PELOD-2 score demonstrated the highest predictive accuracy, with combined use of all three scoring systems yielding
{"title":"[Prognostic value of dynamic monitoring of different pediatric critical illness scales in children with extracorporeal membrane oxygenation assisted shock treatment].","authors":"Yingying Xue, Wanyu Jia, Xue Zhang, Xueli Quan, Peng Li, Chunlan Song, Jie Wang, Yibing Cheng","doi":"10.3760/cma.j.cn121430-20241114-00933","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20241114-00933","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the predictive value of different pediatric critical illness scores for the prognosis of children with refractory shock receiving extracorporeal membrane oxygenation (ECMO) auxiliary treatment.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted. Pediatric patients admitted to the pediatric cardiac and thoracic surgery intensive care unit (ICU) at Henan Children's Hospital from January 2019 to December 2023 who received veno-arterial ECMO support for refractory shock were included. Clinical data were collected. The Pediatric Critical Illness Score (PCIS), PEdiatric Logistic Organ Dysfunction-2 (PELOD-2), and Pediatric Multiple Organ Dysfunction Score (P-MODS) were calculated based on vital signs and laboratory results at 24 hours before ECMO as well as 6 hours and 12 hours of ECMO. Pediatric patients were categorized into death and survival groups according to discharge outcomes. Differences in clinical data and the three scores between groups were compared. Receiver operator characteristic curve (ROC curve) analysis was used to assess the predictive value of the three scores for in-hospital death in ECMO-treated pediatric patients with shock. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate the predictive accuracy of the three scoring systems for death.</p><p><strong>Results: </strong>A total of 35 pediatric patients with shock were ultimately included. Among them, 23 (66%) successfully weaned off ECMO. At discharge, 18 cases survived (51%), while 17 died (49%). As the duration of ECMO treatment increased, both the survival and death groups showed a gradual increase in PCIS scores, while PELOD-2 and P-MODS scores tended to decrease. Pediatric patients in the death group had lower PCIS scores than the survival group at all the time points before and on ECMO (24 hours before ECMO: 72.00±1.87 vs. 78.22±1.87, 6 hours of ECMO: 75.53±2.15 vs. 81.89±1.35, 12 hours of ECMO: 77.76±1.35 vs. 85.00±1.53, all P<0.05), and PELOD-2 scores were higher than those in the survival group [24 hours before ECMO: 13.00 (10.50, 17.50) vs. 8.50 (6.00, 11.25), 6 hours of ECMO: 13.00 (8.50, 17.00) vs. 9.00 (7.75, 10.75), 12 hours of ECMO: 8.00 (7.00, 13.50) vs. 6.00 (5.00, 8.00), all P<0.05]. Pediatric patients in the death group had higher P-MODS scores at 6 hours and 12 hours of ECMO as compared with the survival group (6 hours of ECMO: 7.94±0.52 vs. 5.61±0.55, 12 hours of ECMO: 5.29±0.71 vs. 3.22±0.44, both P<0.05). The differences in the three scores between 6 hours and 12 hours of ECMO were not statistically significant between groups. ROC curve analysis indicated that the PCIS, PELOD-2, P-MODS scores at 6 hours and 12 hours of ECMO had predictive value for in-hospital death in pediatric patients with shock receiving ECMO support. The 6-hour P-MODS score and 12-hour PELOD-2 score demonstrated the highest predictive accuracy, with combined use of all three scoring systems yielding ","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"79-84"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20240425-00210
Lei Wang, Yiming Shen, Qiang Peng, Xin Chu, Peng Gu, Yi Zhang, Baofeng Zhu
<p><strong>Objective: </strong>To investigate the molecular mechanism of microRNA-206-3p (miR-206-3p) regulating heat shock protein 90αA1 (HSP90αA1) in neuroinflammation and mitochondrial dysfunction.</p><p><strong>Methods: </strong>(1) In vivo experiment: male Wistar rats (7 weeks old) were randomly divided into normal control group (n=10) and heat stroke model group (n=10). The rats in the normal control group were routinely fed and received no treatment. In the heat stroke model group, the heat stroke model was established by exposing rats to a controlled environment [temperature (40.0±0.5)centigrade, humidity (40±1)%]. Neurological function was assessed using modified Neurological Severity Score (mNSS) and brain water content was measured. Neuronal morphology was observed by Golgi staining. Inflammatory factors in the brain were detected by enzyme-linked immunoadsordent assay (ELISA). The localization of miR-206-3p and HSP90αA1 mRNA in the brain was determined using fluorescence in situ hybridization (FISH). (2) In vitro experiment: rat hippocampal neuronal cell line HT-22 was cultured in vitro, and the cells were divided into an empty vector control group [co-transfected with miR-206-3p mimic negative control (NC) and HSP90αA1 overexpressing empty virus (HSP90αA1 OE-NC)], a miR-206-3p overexpressing group (co-transfected with miR-206-3p mimic and HSP90αA1 OE-NC), a HSP90αA1 overexpressing group (co-transfected with miR-206-3p mimic-NC and HSP90αA1 OE), and a co-overexpressing group (co-transfected with miR-206-3p mimic and HSP90αA1 OE). Cleaved caspase-3/caspase-3 ratio and protein expressions of Bax and Bcl-2 were detected by Western blotting. Mitochondrial morphology was observed by transmission electron microscopy. Mitochondrial DNA (mtDNA) copy number was quantified by real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR). Reactive oxygen species (ROS) levels were measured using fluorescent probe method. Adenosine triphosphate (ATP) levels were determined by bioluminescence assay.</p><p><strong>Results: </strong>(1) In vivo experiment results: with prolonged heat exposure, mNSS scores, brain water content and levels of interleukins (IL-1β, IL-6, IL-10, IL-13, IL-17A) and tumor necrosis factor-α (TNF-α) in brain tissue were gradually increased in the heat stroke model group with peaking at 6 hours, and there was a statistically significant difference compared with the normal control group [mNSS score: 12.70±1.57 vs. 2.00±0.67, brain water content: (82.37±1.88)% vs. (70.69±1.75)%, IL-1β (ng/L): 5.56±0.64 vs. 1.00±0.13, IL-6 (ng/L): 6.70±0.84 vs. 1.00±0.10, IL-10 (ng/L): 4.92±0.58 vs. 1.00±0.11, IL-13 (ng/L): 4.55±0.53 vs. 1.00±0.09, IL-17A (ng/L): 3.83±0.44 vs. 1.00±0.11, TNF-α (ng/L): 6.70±0.72 vs. 1.00±0.09, all P<0.05]. Golgi staining revealed that with prolonged heat stroke injury, the number of dendritic branches in rat neurons gradually decreased. FISH experiment showed that miR-206-3p and HSP90αA1 were co-
目的：探讨microRNA-206-3p （miR-206-3p）调节热休克蛋白90αA1 （HSP90αA1）在神经炎症和线粒体功能障碍中的分子机制。方法：(1)体内实验：雄性Wistar大鼠（7周龄）随机分为正常对照组（n=10）和中暑模型组（n=10）。正常对照组按常规喂养，不作任何处理。中暑模型组将大鼠置于受控环境[温度（40.0±0.5）℃，湿度（40±1）%]中建立中暑模型。采用改良神经系统严重程度评分（mNSS）评估神经功能，并测量脑含水量。高尔基染色观察神经元形态。采用酶联免疫吸附试验（ELISA）检测脑内炎症因子。采用荧光原位杂交法（FISH）检测miR-206-3p和HSP90αA1 mRNA在脑组织中的定位。(2)体外实验：体外培养大鼠海马神经元细胞系HT-22，将细胞分为空载体对照组（共转染miR-206-3p模拟物阴性对照（NC）和过表达HSP90αA1空病毒（HSP90αA1 OE-NC））、过表达组（共转染miR-206-3p模拟物和HSP90αA1 OE-NC）、过表达组（共转染miR-206-3p模拟物-NC和HSP90αA1 OE）、过表达组（共转染miR-206-3p模拟物-NC和HSP90αA1 OE）。和共过表达组（共转染miR-206-3p mimic和HSP90αA1 OE）。Western blotting检测caspase-3/caspase-3比值及Bax、Bcl-2蛋白表达。透射电镜观察线粒体形态。实时定量逆转录聚合酶链反应（RT-qPCR）测定线粒体DNA （mtDNA）拷贝数。采用荧光探针法检测活性氧（ROS）水平。生物发光法测定三磷酸腺苷（ATP）水平。结果：(1)体内实验结果：随着热暴露时间的延长，热休克模型组大鼠mNSS评分、脑含水量及脑组织白介素（IL-1β、IL-6、IL-10、IL-13、IL-17A）、肿瘤坏死因子-α (TNF-α)水平逐渐升高，并在6 h达到峰值，与正常对照组比较差异有统计学意义[mNSS评分：12.70±1.57比2.00±0.67，脑含水量：（82.37±1.88）%比（70.69±1.75）%,IL-1β (ng/L)；5.56±0.64 vs 1.00±0.13,IL-6 (ng/L): 6.70±0.84 vs 1.00±0.10,IL-10 (ng/L): 4.92±0.58 vs 1.00±0.11,IL-13 (ng/L): 4.55±0.53 vs 1.00±0.09,IL-17A (ng/L): 3.83±0.44 vs 1.00±0.11,TNF-α (ng/L): 6.70±0.72 vs 1.00±0.09，均得出结论：mir - 2063p通过靶向HSP90αA1参与中热卒中诱导的中枢神经系统损伤，抑制细胞凋亡，损害线粒体功能。
{"title":"[MicroRNA-206-3p targeting heat shock protein 90αA1 in neuroinflammation and mitochondrial dysfunction in a rat model of heat stroke].","authors":"Lei Wang, Yiming Shen, Qiang Peng, Xin Chu, Peng Gu, Yi Zhang, Baofeng Zhu","doi":"10.3760/cma.j.cn121430-20240425-00210","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240425-00210","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the molecular mechanism of microRNA-206-3p (miR-206-3p) regulating heat shock protein 90αA1 (HSP90αA1) in neuroinflammation and mitochondrial dysfunction.</p><p><strong>Methods: </strong>(1) In vivo experiment: male Wistar rats (7 weeks old) were randomly divided into normal control group (n=10) and heat stroke model group (n=10). The rats in the normal control group were routinely fed and received no treatment. In the heat stroke model group, the heat stroke model was established by exposing rats to a controlled environment [temperature (40.0±0.5)centigrade, humidity (40±1)%]. Neurological function was assessed using modified Neurological Severity Score (mNSS) and brain water content was measured. Neuronal morphology was observed by Golgi staining. Inflammatory factors in the brain were detected by enzyme-linked immunoadsordent assay (ELISA). The localization of miR-206-3p and HSP90αA1 mRNA in the brain was determined using fluorescence in situ hybridization (FISH). (2) In vitro experiment: rat hippocampal neuronal cell line HT-22 was cultured in vitro, and the cells were divided into an empty vector control group [co-transfected with miR-206-3p mimic negative control (NC) and HSP90αA1 overexpressing empty virus (HSP90αA1 OE-NC)], a miR-206-3p overexpressing group (co-transfected with miR-206-3p mimic and HSP90αA1 OE-NC), a HSP90αA1 overexpressing group (co-transfected with miR-206-3p mimic-NC and HSP90αA1 OE), and a co-overexpressing group (co-transfected with miR-206-3p mimic and HSP90αA1 OE). Cleaved caspase-3/caspase-3 ratio and protein expressions of Bax and Bcl-2 were detected by Western blotting. Mitochondrial morphology was observed by transmission electron microscopy. Mitochondrial DNA (mtDNA) copy number was quantified by real-time quantitative reverse transcription-polymerase chain reaction (RT-qPCR). Reactive oxygen species (ROS) levels were measured using fluorescent probe method. Adenosine triphosphate (ATP) levels were determined by bioluminescence assay.</p><p><strong>Results: </strong>(1) In vivo experiment results: with prolonged heat exposure, mNSS scores, brain water content and levels of interleukins (IL-1β, IL-6, IL-10, IL-13, IL-17A) and tumor necrosis factor-α (TNF-α) in brain tissue were gradually increased in the heat stroke model group with peaking at 6 hours, and there was a statistically significant difference compared with the normal control group [mNSS score: 12.70±1.57 vs. 2.00±0.67, brain water content: (82.37±1.88)% vs. (70.69±1.75)%, IL-1β (ng/L): 5.56±0.64 vs. 1.00±0.13, IL-6 (ng/L): 6.70±0.84 vs. 1.00±0.10, IL-10 (ng/L): 4.92±0.58 vs. 1.00±0.11, IL-13 (ng/L): 4.55±0.53 vs. 1.00±0.09, IL-17A (ng/L): 3.83±0.44 vs. 1.00±0.11, TNF-α (ng/L): 6.70±0.72 vs. 1.00±0.09, all P<0.05]. Golgi staining revealed that with prolonged heat stroke injury, the number of dendritic branches in rat neurons gradually decreased. FISH experiment showed that miR-206-3p and HSP90αA1 were co-","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"63-71"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20250212-00086
Yunlong Li, Guanghui Xiu, Bin Ling
The incidence of ICU-acquired weakness (ICU-AW) in patients with sepsis is relatively high, which can lead to symmetrical atrophy of skeletal muscle, loss of strength and abnormal muscle regeneration and repair. In severe cases, it can cause diaphragmatic involvement, seriously affecting respiratory function and thus the short-term and long-term prognosis of patients. The pathogenesis of ICU-AW in patients with sepsis is complex, mainly involving dysregulation of inflammatory response, neuromuscular conduction disorder, abnormal muscle protein production and decomposition, and reduction of muscle satellite cell (MuSC). There are multiple risk factors, including the patient's own condition, sepsis-induced inflammatory response and multiple organ failure, mechanical ventilation, sedation and analgesia, glucocorticoids, antibacterial drugs, etc. Diagnosis mainly relies on subjective and objective assessment of skeletal muscle and diaphragm, including manual muscle strengthen testing (MMT), handgrip dynamometry (HGD), physical function ICU test (PFIT), muscle electrophysiological examination, muscle ultrasound examination, etc. The treatment usually involves a comprehensive approach including controlling sepsis, early rehabilitation activities, bundle management, neuromuscular electrical stimulation, nutritional support, etc. Integrated traditional Chinese and Western medicine has also shown efficacy. This article reviews the research progress on ICU-AW in patients with sepsis in terms of pathogenesis, risk factors, diagnosis and treatment, aiming to emphasize the value and limitations of ICU-AW in the early clinical diagnosis and treatment of patients with sepsis.
{"title":"[Research progress on ICU-acquired weakness in patients with sepsis].","authors":"Yunlong Li, Guanghui Xiu, Bin Ling","doi":"10.3760/cma.j.cn121430-20250212-00086","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20250212-00086","url":null,"abstract":"<p><p>The incidence of ICU-acquired weakness (ICU-AW) in patients with sepsis is relatively high, which can lead to symmetrical atrophy of skeletal muscle, loss of strength and abnormal muscle regeneration and repair. In severe cases, it can cause diaphragmatic involvement, seriously affecting respiratory function and thus the short-term and long-term prognosis of patients. The pathogenesis of ICU-AW in patients with sepsis is complex, mainly involving dysregulation of inflammatory response, neuromuscular conduction disorder, abnormal muscle protein production and decomposition, and reduction of muscle satellite cell (MuSC). There are multiple risk factors, including the patient's own condition, sepsis-induced inflammatory response and multiple organ failure, mechanical ventilation, sedation and analgesia, glucocorticoids, antibacterial drugs, etc. Diagnosis mainly relies on subjective and objective assessment of skeletal muscle and diaphragm, including manual muscle strengthen testing (MMT), handgrip dynamometry (HGD), physical function ICU test (PFIT), muscle electrophysiological examination, muscle ultrasound examination, etc. The treatment usually involves a comprehensive approach including controlling sepsis, early rehabilitation activities, bundle management, neuromuscular electrical stimulation, nutritional support, etc. Integrated traditional Chinese and Western medicine has also shown efficacy. This article reviews the research progress on ICU-AW in patients with sepsis in terms of pathogenesis, risk factors, diagnosis and treatment, aiming to emphasize the value and limitations of ICU-AW in the early clinical diagnosis and treatment of patients with sepsis.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"111-116"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20250227-00161
Zhengguang Wang, Xiaoyan Chen, Guobin Wang, Rong Huang, Shaopeng Zheng
<p><strong>Objective: </strong>To explore the diagnostic model of sepsis based on Medical Information Mart for Intensive Care-IV (MIMIC-IV).</p><p><strong>Methods: </strong>The clinical data of septic patients admitted to intensive care unit (ICU) with MIMIC-IV database, including demographic characteristics, disease severity scores [Simplified Acute Physiology Score II (SAPS II), Logistic Organ Failure Score (LODS), Oxford Acute Disease Severity Score (OASIS), Sequential Organ Failure Assessment (SOFA)], vital signs and laboratory indicators (blood routine, serum electrolytes, blood gas analysis, blood glucose, liver and kidney function, coagulation function, blood culture results) at ICU admission, underlying disease, site of infection and whether shock was combined were retrospectively analyzed. The primary outcome indicator was 28-day death. The patients were divided into survival group and death group according to 28-day prognosis. The differences in various indicators between the two groups were compared, and the indicators with differences between the two groups were incorporated into the classification tree model to screen out the top 5 indexes of importance for predicting the 28-day death in septic patients, which were enrolled in the diagnostic model of sepsis. Receiver Operator characteristic curve (ROC curve) was used to screened out the scoring system with the greatest predictive value for 28-day death in septic patients from four disease severity scores, which was enrolled in the diagnosis model of sepsis.</p><p><strong>Results: </strong>A total of 12 743 patients were enrolled in the study finally, including 7 411 males (58.157%) and 5 332 females (41.843%), aged from 18 to 100 years old, age (65.38±16.16) years. There were 9 097 patients (71.388%) in the 28-day survival group and 3 646 patients (28.612%) in the death group. Age, four disease severity scores, vital signs and most laboratory indicators at ICU admission [body temperature, heart rate (HR), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (SpO<sub>2</sub>), white blood cell count (WBC), platelets count (PLT), hemoglobin (Hb), K<sup>+</sup>, Na<sup>+</sup>, Cl<sup>-</sup>, HCO<sub>3</sub><sup>-</sup>, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), activated partial thromboplastin time (APTT), blood urea nitrogen (BUN), serum creatinine (SCr)] and ratio of positive blood culture, infection site and combined with shock were statistically significant differences between the two groups (all P<0.05). The 28-day death risk factors classification tree model for septic patients was consisted of 4 layers and 25 nodes, among which there were 10 terminal nodes. The top 5 variables in terms of importance were combined with shock or not, age, combined with metastatic tumor or not, infection site, and blood culture results. Except for age, which had an insignificant warning effect,
{"title":"[Study on the diagnosis model of sepsis based on Medical Information Mart for Intensive Care-IV database].","authors":"Zhengguang Wang, Xiaoyan Chen, Guobin Wang, Rong Huang, Shaopeng Zheng","doi":"10.3760/cma.j.cn121430-20250227-00161","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20250227-00161","url":null,"abstract":"<p><strong>Objective: </strong>To explore the diagnostic model of sepsis based on Medical Information Mart for Intensive Care-IV (MIMIC-IV).</p><p><strong>Methods: </strong>The clinical data of septic patients admitted to intensive care unit (ICU) with MIMIC-IV database, including demographic characteristics, disease severity scores [Simplified Acute Physiology Score II (SAPS II), Logistic Organ Failure Score (LODS), Oxford Acute Disease Severity Score (OASIS), Sequential Organ Failure Assessment (SOFA)], vital signs and laboratory indicators (blood routine, serum electrolytes, blood gas analysis, blood glucose, liver and kidney function, coagulation function, blood culture results) at ICU admission, underlying disease, site of infection and whether shock was combined were retrospectively analyzed. The primary outcome indicator was 28-day death. The patients were divided into survival group and death group according to 28-day prognosis. The differences in various indicators between the two groups were compared, and the indicators with differences between the two groups were incorporated into the classification tree model to screen out the top 5 indexes of importance for predicting the 28-day death in septic patients, which were enrolled in the diagnostic model of sepsis. Receiver Operator characteristic curve (ROC curve) was used to screened out the scoring system with the greatest predictive value for 28-day death in septic patients from four disease severity scores, which was enrolled in the diagnosis model of sepsis.</p><p><strong>Results: </strong>A total of 12 743 patients were enrolled in the study finally, including 7 411 males (58.157%) and 5 332 females (41.843%), aged from 18 to 100 years old, age (65.38±16.16) years. There were 9 097 patients (71.388%) in the 28-day survival group and 3 646 patients (28.612%) in the death group. Age, four disease severity scores, vital signs and most laboratory indicators at ICU admission [body temperature, heart rate (HR), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (SpO<sub>2</sub>), white blood cell count (WBC), platelets count (PLT), hemoglobin (Hb), K<sup>+</sup>, Na<sup>+</sup>, Cl<sup>-</sup>, HCO<sub>3</sub><sup>-</sup>, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), activated partial thromboplastin time (APTT), blood urea nitrogen (BUN), serum creatinine (SCr)] and ratio of positive blood culture, infection site and combined with shock were statistically significant differences between the two groups (all P<0.05). The 28-day death risk factors classification tree model for septic patients was consisted of 4 layers and 25 nodes, among which there were 10 terminal nodes. The top 5 variables in terms of importance were combined with shock or not, age, combined with metastatic tumor or not, infection site, and blood culture results. Except for age, which had an insignificant warning effect, ","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"29-35"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20240426-00217
Feng Xiong, Hongfeng Yang, Jun Yan, Chun Wang, Lu Bai, Qiguang Du
<p><strong>Objective: </strong>To evaluate the right ventricular function in patients with sepsis and to analyze the association between right ventricular dysfunction and 30-day mortality.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted. The clinical data from 196 adult patients with sepsis admitted to the department of critical care medicine of the Affiliated People's Hospital of Jiangsu University from January 2020 to December 2023 were collected, including age, gender, mean arterial pressure (MAP), oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>), heart rate (HR), urine output, continuous renal replacement therapy (CRRT), presence of acute renal failure, Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, Elixhauser comorbidity index (ECI) score, blood lactic acid (Lac), fluid resuscitation volume, vasoactive drug dose, mechanical ventilation status, echocardiographic parameters within 24 hours after admission, and 30-day outcomes. Demographic, clinical, and echocardiographic features were compared between survivors and non-survivors. The prevalence and death risk of ventricular dysfunction subtypes in patients with sepsis were analyzed. Multivariate Logistic regression analysis was used to identify independent risk factors for short-term death risk.</p><p><strong>Results: </strong>Among 196 patients with sepsis, 157 survived for 30 days and 39 died. Compared with the survival group, the patients in the non-survival group had less urine output, a higher proportion of patients receiving CRRT, higher APACHE II score, higher Lac, higher doses of vasoactive drugs, and a higher proportion of requiring mechanical ventilation. Echocardiography showed that the patients in the non-survival group had lower tricuspid annular peak systolic excursion (TAPSE), right ventricular fractional area change, and left ventricular ejection fraction (LVEF) as compared with those in the survival group [TAPSE (mm): 16.0±3.6 vs. 19.3±4.4, right ventricular fractional area change: (30.23±8.14)% vs. (33.69±7.81)%, LVEF: 0.575±0.129 vs. 0.637±0.069, all P<0.05], and higher right ventricular end-systolic area and ratio of left ventricular early diastolic mitral flow velocity to mitral annular motion velocity [E/E'; right ventricular end-systolic area (cm<sup>2</sup>): 15.75±4.45 vs. 14.27±3.39, left ventricular E/E' ratio: 9.18±4.43 vs. 7.74±3.12, both P<0.05]. Among 196 patients with sepsis, 136 patients (69.4%) developed ventricular dysfunction, including isolated right ventricular dysfunction in 50 (25.5%), isolated left ventricular systolic dysfunction in 33 (16.8%), isolated left ventricular diastolic dysfunction in 7 (3.6%), combined left ventricular systolic dysfunction and right ventricular dysfunction in 25 (12.8%), combined right ventricular dysfunction and left ventricular diastolic dysfunction in 1 (0.5%), and combined left ventricular systolic dysfunction, left vent
目的：评价脓毒症患者的右心室功能，分析右心室功能障碍与30天死亡率的关系。方法：采用回顾性队列研究。收集2020年1月至2023年12月江苏大学附属人民医院重症医学系收治的196例成年脓毒症患者的临床资料，包括年龄、性别、平均动脉压（MAP）、氧合指数（PaO2/FiO2）、心率（HR）、尿量、持续肾替代治疗（CRRT）、是否存在急性肾功能衰竭、急性生理与慢性健康评估II （APACHE II）评分、入院后24小时内的顺序器官衰竭评估（SOFA）评分、Elixhauser合并症指数（ECI）评分、血乳酸（Lac）、液体复苏量、血管活性药物剂量、机械通气状态、超声心动图参数和30天结局。比较幸存者和非幸存者的人口学、临床和超声心动图特征。分析败血症患者脑室功能障碍亚型的患病率和死亡风险。采用多因素Logistic回归分析确定短期死亡风险的独立危险因素。结果：196例败血症患者中，157例存活30天，39例死亡。与生存组相比，非生存组患者尿量更少，接受CRRT的患者比例更高，APACHE II评分更高，Lac更高，血管活性药物剂量更高，需要机械通气的比例更高。超声心动图显示，与生存组相比，非生存组患者有较低的三尖瓣环收缩峰值偏移（TAPSE）、右室分数面积变化和左室射血分数（LVEF） [TAPSE (mm): 16.0±3.6 vs. 19.3±4.4，右室分数面积变化：（30.23±8.14）% vs.(33.69±7.81)%,LVEF: 0.575±0.129 vs. 0.637±0.069，所有P2): 15.75±4.45 vs. 14.27±3.39，左室E/E'比值：9.18±4.43 vs. 7.74±3.12，均P-1×min-1): 1.1 (0.2, 2.1) vs. 0.7(0.2, 2.0)，需要机械通气的比例：18.8% (18/96)vs. 15.0%(15/100)， 30天死亡率：40.6% (39/96)vs. 21.0%(21/100)，均p结论：右室功能障碍在早期脓毒症患者中常见，是30天死亡的独立危险因素。
{"title":"[Association between right ventricular function and short-term death risk in patients with sepsis].","authors":"Feng Xiong, Hongfeng Yang, Jun Yan, Chun Wang, Lu Bai, Qiguang Du","doi":"10.3760/cma.j.cn121430-20240426-00217","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240426-00217","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the right ventricular function in patients with sepsis and to analyze the association between right ventricular dysfunction and 30-day mortality.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted. The clinical data from 196 adult patients with sepsis admitted to the department of critical care medicine of the Affiliated People's Hospital of Jiangsu University from January 2020 to December 2023 were collected, including age, gender, mean arterial pressure (MAP), oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>), heart rate (HR), urine output, continuous renal replacement therapy (CRRT), presence of acute renal failure, Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, Elixhauser comorbidity index (ECI) score, blood lactic acid (Lac), fluid resuscitation volume, vasoactive drug dose, mechanical ventilation status, echocardiographic parameters within 24 hours after admission, and 30-day outcomes. Demographic, clinical, and echocardiographic features were compared between survivors and non-survivors. The prevalence and death risk of ventricular dysfunction subtypes in patients with sepsis were analyzed. Multivariate Logistic regression analysis was used to identify independent risk factors for short-term death risk.</p><p><strong>Results: </strong>Among 196 patients with sepsis, 157 survived for 30 days and 39 died. Compared with the survival group, the patients in the non-survival group had less urine output, a higher proportion of patients receiving CRRT, higher APACHE II score, higher Lac, higher doses of vasoactive drugs, and a higher proportion of requiring mechanical ventilation. Echocardiography showed that the patients in the non-survival group had lower tricuspid annular peak systolic excursion (TAPSE), right ventricular fractional area change, and left ventricular ejection fraction (LVEF) as compared with those in the survival group [TAPSE (mm): 16.0±3.6 vs. 19.3±4.4, right ventricular fractional area change: (30.23±8.14)% vs. (33.69±7.81)%, LVEF: 0.575±0.129 vs. 0.637±0.069, all P<0.05], and higher right ventricular end-systolic area and ratio of left ventricular early diastolic mitral flow velocity to mitral annular motion velocity [E/E'; right ventricular end-systolic area (cm<sup>2</sup>): 15.75±4.45 vs. 14.27±3.39, left ventricular E/E' ratio: 9.18±4.43 vs. 7.74±3.12, both P<0.05]. Among 196 patients with sepsis, 136 patients (69.4%) developed ventricular dysfunction, including isolated right ventricular dysfunction in 50 (25.5%), isolated left ventricular systolic dysfunction in 33 (16.8%), isolated left ventricular diastolic dysfunction in 7 (3.6%), combined left ventricular systolic dysfunction and right ventricular dysfunction in 25 (12.8%), combined right ventricular dysfunction and left ventricular diastolic dysfunction in 1 (0.5%), and combined left ventricular systolic dysfunction, left vent","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"50-55"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20241203-00573
Zhixiong Li, Yue Zhang, Shuai Liu, Nanning Ou, Jun Wu, Xianglin Liu, Xiaojun Hu, Lingyan Liu, Dan He
<p><strong>Objective: </strong>To analyze the epidemiological characteristics of septic shock and identify high risk factors influencing the prognosis based on the eICU Collaborative Research Database.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted. Data of patients with septic shock from 2014 to 2015 in the eICU Collaborative Research Database were collected, including demographic information, general information of intensive care unit (ICU) and hospital, severity scores of illness, comorbidities, primary infection site, vital signs, interventions, serum lactic acid, and outcome measures. Epidemiological characteristics of the septic shock population were analyzed, as well as the ICU mortality, in-hospital mortality, and ICU readmission rate. Multivariate Logistic regression analysis was used to identify independent risk factors for ICU death in patients with septic shock.</p><p><strong>Results: </strong>A total of 5 564 patients with septic shock were enrolled, comprising 2 903 males and 2 661 females. The age was (66.31±15.84) years (ranged 18-91 years), and body mass index (BMI) was (28.84±9.34) kg/m<sup>2</sup> (ranged 10.72-121.67 kg/m<sup>2</sup>). The majority were first admitted to a medical ICU [79.31% (4 413/5 564)], and a higher proportion were hospitals with ≥250 beds [63.93% (3 557/5 564)]. The Sequential Organ Failure Assessment (SOFA) score was 8.51±3.83 (ranged 2-23), Acute Physiology Score III (APS III) was 67.73±29.89 (ranged 7-200), and Acute Physiology And Chronic Health Evaluation IV (APACHE IV) score was 81.57±30.85 (ranged 9-205). Common comorbidities included cardiovascular and cerebrovascular diseases [35.14% (1 955/5 564)], diabetes [31.99% (1 780/5 564)], and liver/kidney diseases [23.89% (1 329/5 564)]. The main primary infection site was pulmonary [34.38% (1 913/5 564)] and urinary tract infections [21.53% (1 198/5 564)]; 14.41% (802/5 564) had two or more concurrent infections. 55.10% (3 066/5 564) received vasopressors, 5.66% (315/5 564) received renal replacement therapy (RRT), and 72.09% (4 011/5 564) received invasive mechanical ventilation. Within the entire eICU population, septic shock patients accounted for 3.310 3% (6 649/200 859) of the total ICU admissions, and accounted for 24.869% (6 649/26 736) of the sepsis patients. The ICU mortality for septic shock patients was 21.30% (1 416/6 649), the in-hospital mortality was 29.39% (1 954/6 649), and the ICU readmission rate was 16.30% (1 084/6 649). Multivariate Logistic regression analysis identified 16 independent risk factors associated with ICU death in patients with septic shock, including female [odds ratio (OR)=1.209, 95% confidence interval (95%CI) was 1.035-1.411, P=0.016], advanced age (OR=1.018, 95%CI was 1.186-1.329, P<0.001), low BMI (OR=0.950, 95%CI was 0.907-0.995, P=0.030), admission in community hospital (OR=1.548,95%CI was 1.321-1.814, P<0.001), higher SOFA score (OR=1.110, 95%CI was 1.081-1.140, P<0.001), higher A
{"title":"[Analysis of epidemiological features and prognostic risk factors in septic shock].","authors":"Zhixiong Li, Yue Zhang, Shuai Liu, Nanning Ou, Jun Wu, Xianglin Liu, Xiaojun Hu, Lingyan Liu, Dan He","doi":"10.3760/cma.j.cn121430-20241203-00573","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20241203-00573","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the epidemiological characteristics of septic shock and identify high risk factors influencing the prognosis based on the eICU Collaborative Research Database.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted. Data of patients with septic shock from 2014 to 2015 in the eICU Collaborative Research Database were collected, including demographic information, general information of intensive care unit (ICU) and hospital, severity scores of illness, comorbidities, primary infection site, vital signs, interventions, serum lactic acid, and outcome measures. Epidemiological characteristics of the septic shock population were analyzed, as well as the ICU mortality, in-hospital mortality, and ICU readmission rate. Multivariate Logistic regression analysis was used to identify independent risk factors for ICU death in patients with septic shock.</p><p><strong>Results: </strong>A total of 5 564 patients with septic shock were enrolled, comprising 2 903 males and 2 661 females. The age was (66.31±15.84) years (ranged 18-91 years), and body mass index (BMI) was (28.84±9.34) kg/m<sup>2</sup> (ranged 10.72-121.67 kg/m<sup>2</sup>). The majority were first admitted to a medical ICU [79.31% (4 413/5 564)], and a higher proportion were hospitals with ≥250 beds [63.93% (3 557/5 564)]. The Sequential Organ Failure Assessment (SOFA) score was 8.51±3.83 (ranged 2-23), Acute Physiology Score III (APS III) was 67.73±29.89 (ranged 7-200), and Acute Physiology And Chronic Health Evaluation IV (APACHE IV) score was 81.57±30.85 (ranged 9-205). Common comorbidities included cardiovascular and cerebrovascular diseases [35.14% (1 955/5 564)], diabetes [31.99% (1 780/5 564)], and liver/kidney diseases [23.89% (1 329/5 564)]. The main primary infection site was pulmonary [34.38% (1 913/5 564)] and urinary tract infections [21.53% (1 198/5 564)]; 14.41% (802/5 564) had two or more concurrent infections. 55.10% (3 066/5 564) received vasopressors, 5.66% (315/5 564) received renal replacement therapy (RRT), and 72.09% (4 011/5 564) received invasive mechanical ventilation. Within the entire eICU population, septic shock patients accounted for 3.310 3% (6 649/200 859) of the total ICU admissions, and accounted for 24.869% (6 649/26 736) of the sepsis patients. The ICU mortality for septic shock patients was 21.30% (1 416/6 649), the in-hospital mortality was 29.39% (1 954/6 649), and the ICU readmission rate was 16.30% (1 084/6 649). Multivariate Logistic regression analysis identified 16 independent risk factors associated with ICU death in patients with septic shock, including female [odds ratio (OR)=1.209, 95% confidence interval (95%CI) was 1.035-1.411, P=0.016], advanced age (OR=1.018, 95%CI was 1.186-1.329, P<0.001), low BMI (OR=0.950, 95%CI was 0.907-0.995, P=0.030), admission in community hospital (OR=1.548,95%CI was 1.321-1.814, P<0.001), higher SOFA score (OR=1.110, 95%CI was 1.081-1.140, P<0.001), higher A","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"21-28"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20241217-00607
Zhen Liang, Song Yang, Luying Zhang, Rui Shao, Xingsheng Wang, Le An, Chenchen Hang, Ziren Tang
<p><strong>Objective: </strong>To establish an oxygen-glucose deprivation/restoration (OGD/R) model of cardiomyocytes to simulate myocardial ischemia reperfusion injury induced by cardiac arrest, and to explore the potential mechanism of hypothermia protective effect on cardiomyocytes.</p><p><strong>Methods: </strong>H9C2 cardiomyocytes in logarithmic growth phase were selected to establish the OGD/R model by selecting the most appropriate oxygen-glucose deprivation (OGD) and reoxygenation time combined with the results of the preliminary experiment. The cells were divided into four groups: blank control group without OGD treatment, 37 centigrade room temperature culture. The OGD group was subjected to OGD for 12 hours without restoration of glucose and oxygen. The OGD/R with normal temperature groups were subjected to OGD for 12 hours followed by reoxygenation for 4, 8, and 12 hours at 37 centigrade, respectively. The OGD/R hypothermia groups were subjected to OGD for 12 hours followed by reoxygenation for 4, 8, and 12 hours at 34 centigrade, respectively. Trypan blue staining was used to detect cell viability. Flow cytometry was used to analyze the change in mitochondrial membrane potential (Δ ψm). Western blotting was used to detect the protein expression of apoptosis-related protein (cleaved caspase-3/caspase-3 ratio), autophagy-related proteins [microtubule-associated protein 1 light chain 3B-II/I (LC3B-II/I), p62] and PTEN-induced kinase 1/E3 ubiquitin ligase (PINK1/Parkin) pathway proteins (PINK1, Parkin) and mitochondrial outer membrane pore protein [voltage-dependent anion channel 3 (VDAC3)] were detected.</p><p><strong>Results: </strong>Compared with the blank control group, the cell survival rate was significantly decreased in the OGD group and OGD/R groups, and the cleaved caspase-3/caspase-3 ratio, LC3B-II/I ratio and the protein expression of VDAC3 were increased, indicating that OGD and OGD/R could cause cell apoptosis and induce autophagy. In addition, OGD/R resulted in a decrease in Δψm and up-regulation of PINK1/Parkin pathway proteins. These results suggested that reoxygenation could aggravate myocardial cell injury induced by OGD, and the mechanism might be related to the PINK1/Parkin pathway. In the OGD/R groups, compared with normothermia, the survival rate of cardiomyocytes in hypothermia was increased at each time point [4 hours: (65.46±0.81)% vs. (60.26±0.71)%, 8 hours: (72.76±0.23)% vs. (62.93±0.37)%, 12 hours: (77.72±0.43)% vs. (70.75±0.61)%, all P<0.05], the decreased-Δ ψm lowed at 12 hours (green/red fluorescence intensity ratio of JC-1: 0.120±0.005 vs. 0.250±0.011, P<0.05), cleaved caspase-3/caspase-3 ratio decreased at 8 hours and 12 hours (8 hours: 0.96±0.06 vs. 1.08±0.07, 12 hours: 0.91±0.06 vs. 1.23±0.08, both P<0.05), the LC3B-II/I ratio was increased at 8 hours and 12 hours (8 hours: 1.40±0.08 vs. 1.16±0.08, 12 hours: 1.51±0.11 vs. 1.12±0.07, both P<0.05), the p62 expression was increased at 12 hours (p62/GAPDH
{"title":"[Effect and mechanism of hypothermia on apoptosis and autophagy of cardiomyocytes after oxygen-glucose deprivation/restoration injury].","authors":"Zhen Liang, Song Yang, Luying Zhang, Rui Shao, Xingsheng Wang, Le An, Chenchen Hang, Ziren Tang","doi":"10.3760/cma.j.cn121430-20241217-00607","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20241217-00607","url":null,"abstract":"<p><strong>Objective: </strong>To establish an oxygen-glucose deprivation/restoration (OGD/R) model of cardiomyocytes to simulate myocardial ischemia reperfusion injury induced by cardiac arrest, and to explore the potential mechanism of hypothermia protective effect on cardiomyocytes.</p><p><strong>Methods: </strong>H9C2 cardiomyocytes in logarithmic growth phase were selected to establish the OGD/R model by selecting the most appropriate oxygen-glucose deprivation (OGD) and reoxygenation time combined with the results of the preliminary experiment. The cells were divided into four groups: blank control group without OGD treatment, 37 centigrade room temperature culture. The OGD group was subjected to OGD for 12 hours without restoration of glucose and oxygen. The OGD/R with normal temperature groups were subjected to OGD for 12 hours followed by reoxygenation for 4, 8, and 12 hours at 37 centigrade, respectively. The OGD/R hypothermia groups were subjected to OGD for 12 hours followed by reoxygenation for 4, 8, and 12 hours at 34 centigrade, respectively. Trypan blue staining was used to detect cell viability. Flow cytometry was used to analyze the change in mitochondrial membrane potential (Δ ψm). Western blotting was used to detect the protein expression of apoptosis-related protein (cleaved caspase-3/caspase-3 ratio), autophagy-related proteins [microtubule-associated protein 1 light chain 3B-II/I (LC3B-II/I), p62] and PTEN-induced kinase 1/E3 ubiquitin ligase (PINK1/Parkin) pathway proteins (PINK1, Parkin) and mitochondrial outer membrane pore protein [voltage-dependent anion channel 3 (VDAC3)] were detected.</p><p><strong>Results: </strong>Compared with the blank control group, the cell survival rate was significantly decreased in the OGD group and OGD/R groups, and the cleaved caspase-3/caspase-3 ratio, LC3B-II/I ratio and the protein expression of VDAC3 were increased, indicating that OGD and OGD/R could cause cell apoptosis and induce autophagy. In addition, OGD/R resulted in a decrease in Δψm and up-regulation of PINK1/Parkin pathway proteins. These results suggested that reoxygenation could aggravate myocardial cell injury induced by OGD, and the mechanism might be related to the PINK1/Parkin pathway. In the OGD/R groups, compared with normothermia, the survival rate of cardiomyocytes in hypothermia was increased at each time point [4 hours: (65.46±0.81)% vs. (60.26±0.71)%, 8 hours: (72.76±0.23)% vs. (62.93±0.37)%, 12 hours: (77.72±0.43)% vs. (70.75±0.61)%, all P<0.05], the decreased-Δ ψm lowed at 12 hours (green/red fluorescence intensity ratio of JC-1: 0.120±0.005 vs. 0.250±0.011, P<0.05), cleaved caspase-3/caspase-3 ratio decreased at 8 hours and 12 hours (8 hours: 0.96±0.06 vs. 1.08±0.07, 12 hours: 0.91±0.06 vs. 1.23±0.08, both P<0.05), the LC3B-II/I ratio was increased at 8 hours and 12 hours (8 hours: 1.40±0.08 vs. 1.16±0.08, 12 hours: 1.51±0.11 vs. 1.12±0.07, both P<0.05), the p62 expression was increased at 12 hours (p62/GAPDH","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"56-62"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20250614-00333
Jiayue Zhang, Zhijie Du, Jianxiang Wang, Min Li
<p><strong>Objective: </strong>To apply latent class analysis (LCA) to explore the latent classes of ICU-acquired weakness (ICU-AW) in mechanically ventilated patients and to analyze their influencing factors.</p><p><strong>Methods: </strong>A prospective observational study was conducted. From June 2024 to April 2025, 360 mechanically ventilated patients admitted to the intensive care unit (ICU) of the First People's Hospital of Kunming were enrolled. Consciousness was assessed using the Richmond Agitation-Sedation Scale (RASS). Muscle strength of six muscle groups (shoulder abductors, elbow flexors, wrist extensors, hip flexors, knee extensors, and ankle dorsiflexors) was evaluated using the Medical Research Council (MRC) score across, with a total score<48 indicating ICU-AW. Clinical data were collected via a self-designed ICU-AW risk factor scale, covering 21 items: demographic characteristics (gender, age), clinical interventions (total length of ICU stay, norepinephrine use or not, mechanical ventilation duration, immobilization time, neuromuscular blocker use duration, sedative/analgesic use or not, pre-ICU mechanical ventilation duration, invasive blood pressure monitoring or not, aminoglycoside use or not), underlying diseases and complications [combined with multiple organ dysfunction syndrome (MODS) or not, combined with sepsis or not, diabetes or not, hypertension or not, Acute Physiology And Chronic Health Evaluation II (APACHE II) score], and laboratory indicators (blood oxygen saturation, calcium, albumin, lactic acid, glucose). LCA was used to optimize the number of classes. The optimal model was selected based on the minimization of Akaike information criterion (AIC), Bayesian information criterion (BIC), and adjusted Bayesian information criterion (aBIC), an entropy value > 0.8, and significant results from the Lo-Mendell-Rubin test and the Bootstrap likelihood ratio test. Patients were classified and named based on LCA results. Univariate analysis and unordered multivariate Logistic regression analysis were used to identify influencing factors of latent class of ICU-AW in mechanically ventilated patients.</p><p><strong>Results: </strong>After deleting entries with missing values for both total length of ICU stay and pre-ICU mechanical ventilation duration exceeding 50%, latent class modeling was ultimately performed based on 19 risk factor variables. The results showed that when the number of classes was 3, AIC (9 179), BIC (9 455), and aBIC (9 467) were all superior to other class numbers, achieving a better balance between goodness of fit and complexity. Additionally, the entropy value (0.937) was higher than that of other class numbers, indicating the highest classification accuracy. Therefore, the final number of classes was determined to be 3. Based on the conditional probability distribution of risk factors for ICU-AW patients, combined with the clinical significance of the variables, the three potential categories were n
{"title":"[Latent class analysis of ICU-acquired weakness in mechanically ventilated patients and its influencing factors].","authors":"Jiayue Zhang, Zhijie Du, Jianxiang Wang, Min Li","doi":"10.3760/cma.j.cn121430-20250614-00333","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20250614-00333","url":null,"abstract":"<p><strong>Objective: </strong>To apply latent class analysis (LCA) to explore the latent classes of ICU-acquired weakness (ICU-AW) in mechanically ventilated patients and to analyze their influencing factors.</p><p><strong>Methods: </strong>A prospective observational study was conducted. From June 2024 to April 2025, 360 mechanically ventilated patients admitted to the intensive care unit (ICU) of the First People's Hospital of Kunming were enrolled. Consciousness was assessed using the Richmond Agitation-Sedation Scale (RASS). Muscle strength of six muscle groups (shoulder abductors, elbow flexors, wrist extensors, hip flexors, knee extensors, and ankle dorsiflexors) was evaluated using the Medical Research Council (MRC) score across, with a total score<48 indicating ICU-AW. Clinical data were collected via a self-designed ICU-AW risk factor scale, covering 21 items: demographic characteristics (gender, age), clinical interventions (total length of ICU stay, norepinephrine use or not, mechanical ventilation duration, immobilization time, neuromuscular blocker use duration, sedative/analgesic use or not, pre-ICU mechanical ventilation duration, invasive blood pressure monitoring or not, aminoglycoside use or not), underlying diseases and complications [combined with multiple organ dysfunction syndrome (MODS) or not, combined with sepsis or not, diabetes or not, hypertension or not, Acute Physiology And Chronic Health Evaluation II (APACHE II) score], and laboratory indicators (blood oxygen saturation, calcium, albumin, lactic acid, glucose). LCA was used to optimize the number of classes. The optimal model was selected based on the minimization of Akaike information criterion (AIC), Bayesian information criterion (BIC), and adjusted Bayesian information criterion (aBIC), an entropy value > 0.8, and significant results from the Lo-Mendell-Rubin test and the Bootstrap likelihood ratio test. Patients were classified and named based on LCA results. Univariate analysis and unordered multivariate Logistic regression analysis were used to identify influencing factors of latent class of ICU-AW in mechanically ventilated patients.</p><p><strong>Results: </strong>After deleting entries with missing values for both total length of ICU stay and pre-ICU mechanical ventilation duration exceeding 50%, latent class modeling was ultimately performed based on 19 risk factor variables. The results showed that when the number of classes was 3, AIC (9 179), BIC (9 455), and aBIC (9 467) were all superior to other class numbers, achieving a better balance between goodness of fit and complexity. Additionally, the entropy value (0.937) was higher than that of other class numbers, indicating the highest classification accuracy. Therefore, the final number of classes was determined to be 3. Based on the conditional probability distribution of risk factors for ICU-AW patients, combined with the clinical significance of the variables, the three potential categories were n","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"92-98"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.3760/cma.j.cn121430-20240904-00432
Yongtian Luo, Zhigui Jiang, Zhen Yang, Tingting Pan, Ju Zhang, Dinghong Pu, Dazhong Wang, Hui Sun
<p><strong>Objective: </strong>To evaluate the value of the Phoenix Sepsis Score (PSS), pediatric Sequential Organ Failure Assessment (pSOFA) and PEdiatric Logistic Organ Dysfunction-2 (PELOD-2) in assessing disease severity and prognosis in children with sepsis.</p><p><strong>Methods: </strong>A retrospective observational study was conducted. A total of 226 pediatric patients with sepsis admitted to pediatric intensive care unit (PICU) of the Affiliated Hospital of Guizhou Medical University from June 2021 to April 2024 were enrolled. The gender, age, body mass index (BMI), site of infection, mechanical ventilation requirement, length of PICU stay, and clinical outcome were extracted, together with the physiological variables required by PSS, pSOFA and PELOD-2 scoring systems. The three critical scores were calculated with the worst values of physiological indicators obtained within 24 hours after PICU admission. According to the 2024 international consensus, children were classified as sepsis (without shock) or septic shock depending on the presence of cardiovascular dysfunction. They were further divided into survivors and non-survivors based on the outcome during PICU hospitalization. Clinical characteristics were compared between the two groups. Receiver operator characteristic curve (ROC curve) was used to assess the ability of the three scoring systems to predict death risk during PICU hospitalization in sepsis without shock and in septic shock, as well as progression from sepsis without shock to septic shock. Decision curve analysis (DCA) was employed to examine the clinical utility of the three scoring systems for predicting death risk during PICU hospitalization in children with sepsis without shock and in those with septic shock, as well as progression from sepsis without shock to septic shock.</p><p><strong>Results: </strong>A total of 226 pediatric patients with sepsis were ultimately included; 188 (83.2%) survived during PICU hospitalization and 38 (16.8%) died. No significant differences were observed between survivors and non-survivors in gender, age, BMI, site of infection, or length of PICU stay. Non-survivors exhibited higher rates of septic shock and mechanical ventilation, together with higher PSS, pSOFA and PELOD-2 scores, than survivors [septic shock: 84.2% (32/38) vs. 23.4% (44/188), mechanical ventilation: 97.4% (37/38) vs. 24.5% (46/188), PSS score: 7.0 (5.0, 8.3) vs. 3.0 (2.0, 3.0), pSOFA score: 8 (5, 12) vs. 3 (2, 5), PELOD-2 score: 6 (5, 9) vs. 2 (0, 4), all P<0.05]. ROC curve analysis showed that the area under the ROC curve (AUC) of PSS, pSOFA, and PELOD-2 scores for predicting death risk during PICU hospitalization in the pediatric patients with sepsis without shock was 0.924 [95% confidence interval (95%CI) was 0.831-1.000], 0.666 (95%CI was 0.438-0.894), and 0.915 (95%CI was 0.818-1.000), respectively. The AUC of PSS, pSOFA, and PELOD-2 scores for predicting death risk during PICU hospitalization in the pediatri
{"title":"[Predictive value of three scoring systems for pediatric sepsis prognosis: a receiver operator characteristic curve and decision curve analysis].","authors":"Yongtian Luo, Zhigui Jiang, Zhen Yang, Tingting Pan, Ju Zhang, Dinghong Pu, Dazhong Wang, Hui Sun","doi":"10.3760/cma.j.cn121430-20240904-00432","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240904-00432","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the value of the Phoenix Sepsis Score (PSS), pediatric Sequential Organ Failure Assessment (pSOFA) and PEdiatric Logistic Organ Dysfunction-2 (PELOD-2) in assessing disease severity and prognosis in children with sepsis.</p><p><strong>Methods: </strong>A retrospective observational study was conducted. A total of 226 pediatric patients with sepsis admitted to pediatric intensive care unit (PICU) of the Affiliated Hospital of Guizhou Medical University from June 2021 to April 2024 were enrolled. The gender, age, body mass index (BMI), site of infection, mechanical ventilation requirement, length of PICU stay, and clinical outcome were extracted, together with the physiological variables required by PSS, pSOFA and PELOD-2 scoring systems. The three critical scores were calculated with the worst values of physiological indicators obtained within 24 hours after PICU admission. According to the 2024 international consensus, children were classified as sepsis (without shock) or septic shock depending on the presence of cardiovascular dysfunction. They were further divided into survivors and non-survivors based on the outcome during PICU hospitalization. Clinical characteristics were compared between the two groups. Receiver operator characteristic curve (ROC curve) was used to assess the ability of the three scoring systems to predict death risk during PICU hospitalization in sepsis without shock and in septic shock, as well as progression from sepsis without shock to septic shock. Decision curve analysis (DCA) was employed to examine the clinical utility of the three scoring systems for predicting death risk during PICU hospitalization in children with sepsis without shock and in those with septic shock, as well as progression from sepsis without shock to septic shock.</p><p><strong>Results: </strong>A total of 226 pediatric patients with sepsis were ultimately included; 188 (83.2%) survived during PICU hospitalization and 38 (16.8%) died. No significant differences were observed between survivors and non-survivors in gender, age, BMI, site of infection, or length of PICU stay. Non-survivors exhibited higher rates of septic shock and mechanical ventilation, together with higher PSS, pSOFA and PELOD-2 scores, than survivors [septic shock: 84.2% (32/38) vs. 23.4% (44/188), mechanical ventilation: 97.4% (37/38) vs. 24.5% (46/188), PSS score: 7.0 (5.0, 8.3) vs. 3.0 (2.0, 3.0), pSOFA score: 8 (5, 12) vs. 3 (2, 5), PELOD-2 score: 6 (5, 9) vs. 2 (0, 4), all P<0.05]. ROC curve analysis showed that the area under the ROC curve (AUC) of PSS, pSOFA, and PELOD-2 scores for predicting death risk during PICU hospitalization in the pediatric patients with sepsis without shock was 0.924 [95% confidence interval (95%CI) was 0.831-1.000], 0.666 (95%CI was 0.438-0.894), and 0.915 (95%CI was 0.818-1.000), respectively. The AUC of PSS, pSOFA, and PELOD-2 scores for predicting death risk during PICU hospitalization in the pediatri","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 1","pages":"72-78"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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