搜索结果：Zhonghua wei zhong bing ji jiu yi xue

To investigate the association between acute kidney injury (AKI) and the gut microbiota by integrating 16S sequencing analysis with mendelian randomization (MR). 1) MR analysis: The genome-wide association study (GWAS) dataset for AKI from the FinnGen consortium and the GWAS dataset for gut microbiota composition from the Dutch Microbiome Project were selected to screen single nucleotide polymorphism (SNP) associated with AKI as instrumental variable (IV) for genetic variation, using AKI as the exposure factor. Potential causal associations between AKI and gut microbiota were analyzed using a two-sample, one-way MR analysis with the primary analysis method of inverse variance weighted (IVW). Heterogeneity analysis was performed using the Cochran Q test. Potential pleiotropy was assessed using the MR-Egger intercept test. Sensitivity analysis was performed using the leave-one-out test. 2) Clinical cohort study: Consecutive patients admitted to the intensive care unit (ICU) of Qingdao Municipal Hospital between December 2024 and March 2025 were prospectively enrolled. Patients were classified into the AKI group or the non-AKI group based on the occurrence of AKI during their ICU stay, according to the diagnostic criteria from Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines (2012). Baseline clinical data were collected within 48 hours of ICU admission, including gender, age, height, weight, body mass index (BMI), major comorbidities, vital signs, serum creatinine (SCr), blood routine, C-reactive protein (CRP), interleukin-6 (IL-6), etc. Anal swabs were collected from patients within 48 hours of ICU admission for 16S rDNA high-throughput sequencing. Significant difference analysis and linear discriminant analysis effect size (LEfSe) were performed to characterize the gut microbiota profile in AKI patients and to further validate the findings from the MR analysis. 1) MR analysis results: Using the GWAS summary statistics for gut microbiota and AKI, the MR analysis revealed that the genetic liability to AKI was associated with decreased abundance in six gut microbial taxa and increased abundance in one taxon. IVW analysis showed that at the genus level, genetic susceptibility to AKI was associated with lower abundance of Collinsella (β=-0.144, P=0.029), Lachnospiraceaenoname (β=-0.131, P=0.040), Roseburia (β=-0.126, P=0.047), and Parasutterella (β=-0.198, P=0.023). At the species level, AKI genetic susceptibility was linked to reduced abundance of Parasutterellaexcrementihominis (β=-0.197, P=0.024) and Roseburia unclassified (β=-0.280, P=0.012), while being associated with increased abundance of Bacteroidesintestinalis (β=0.358, P=0.013). Cochran Q test showed no heterogeneity, MR-Egger intercept test revealed no pleiotropy, and leave-one-out analysis verified the robustness of the results. 2) Clinical cohort study results: A total of 129 patients were initially enrolled. After excluding 25 patients with incomplete clinical data and 10 whose samples failed to generate sufficient 16S rDNA gene amplification for sequencing, 94 patients were included in the final analysis comprising 72 cases in the AKI group and 22 cases in the non-AKI group. Apart from higher SCr levels in the AKI group than those in the non-AKI group, no statistically significant differences were observed in other baseline clinical characteristics between the two groups. 16S rDNA high-throughput sequencing yielded 6 868 647 high-quality reads, which were clustered into 13 025 amplicon sequence variant (ASV). Significant difference analysis at the species level showed that, compared with the non-AKI group, patients in the AKI group had a relative enrichment of Streptococcus anginosus and Novosphingobium sp. B0.09-8. Conversely, the relative abundances of uncultured Prevotellasp., Alistipesshahii, uncultured Coprococcussp., Collinsellatanakaei, Streptococcus equinus, Alistipesindistinctus, Klebsiellasp. GRB36, and uncultured Oscillospirasp. were significantly lower in the AKI group. LEfSe analysis identified Veillonella unclassified, Ligilactobacillus unclassified, Collinsellatanakaei, Atopobium unclassified, and Streptococcus anginosus as potential biomarkers for the AKI group, whereas Alistipesshahii, uncultured Prevotella sp., and Agathobacter unclassified were more characteristic of the patients in the non-AKI group. The MR analysis suggests that the occurrence of AKI exerts an influence on the gut microbiota profile, characterized by a reduction in the abundance of the genus Collinsella. Findings from the real-world study further indicate significant differences in gut microbiota composition between patients with and without AKI. Overall, the gut microbiota of AKI patients is characterized by an enrichment of pro-inflammatory bacteria and a depletion of commensal symbionts. The genus Collinsellamay may serve as a potential biomarker for AKI.

To explore the interventional effects of a targeted diaphragmatic function exercise bundle strategy, guided by ultrasound assessment, on nutritional status, diaphragmatic function, muscle strength, and hospital stay of mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated by type II respiratory failure. A randomized controlled study was conducted. Patients with AECOPD complicated by type II respiratory failure who received mechanical ventilation in the Department of Critical Care Medicine, the Second Hospital of Tianjin Medical University from January to December 2024 were enrolled. Using a random number table, patients were divided into an experimental group and a control group. The control group received routine intensive care unit (ICU) treatment and nursing care. On the basis of routine care, the experimental group received a targeted diaphragmatic function exercise bundle strategy based on ultrasound assessment, including limb function exercises and respiratory function training. The duration and intensity of the exercises were adjusted according to the patient's vital signs, clinical condition, tolerance, and daily improvement in diaphragmatic function. The following indicators were compared between the two groups before the intervention and on the 7th day of intervention: nutritional indicators [albumin, total protein, hemoglobin, body mass index (BMI), Nutritional Risk Screening 2002 (NRS2002) score]; diaphragmatic function (diaphragmatic excursion, diaphragmatic thickness); blood gas analysis indicators (pH value, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, base excess, lactate, alveolar-arterial oxygen gradient); and muscle strength. The duration of mechanical ventilation, length of ICU stay, and total hospital stay were also compared between the two groups. A total of 134 patients were finally enrolled, including 66 in the experimental group and 68 in the control group. There were no statistically significant differences in baseline data including gender, age, Acute Physiology and Chronic Health Evaluation II, nutritional indicators, blood gas analysis parameters, diaphragmatic excursion, diaphragmatic thickness, and muscle strength between the two groups (all P>0.05). Compared with before intervention, both groups showed varying degrees of improvement in diaphragmatic function indicators, blood gas analysis indicators, and muscle strength on the 7th day of intervention, but nutritional indicators decreased. On the 7th day of intervention, the experimental group had better nutritional indicators (albumin, total protein, hemoglobin, and BMI) than the control group [albumin (g/L): 27.49&#xb1;3.78 vs. 26.03&#xb1;3.76, total protein (g/L): 55.84&#xb1;6.17 vs. 53.42&#xb1;6.22, hemoglobin (g/L): 105.10&#xb1;24.74 vs. 96.80&#xb1;21.17, BMI (kg/m2): 24.84&#xb1;2.55 vs. 24.12&#xb1;1.13, all P<0.05]. The improvements in diaphragmatic excursion and diaphragmatic thickness were greater in the experimental group than in the control group [difference in diaphragmatic excursion before and after intervention (cm): 0.182&#xb1;0.030 vs. 0.104&#xb1;0.020; difference in diaphragmatic thickness before intervention and after intervention (cm): 0.023&#xb1;0.004 vs. 0.014&#xb1;0.002, both P<0.05], and muscle strength was enhanced in the experimental group compared with the control group (&#x3c7; 2=21.860, P=0.001), whereas there were still no statistically significant differences in blood gas analysis indicators between the two groups (all P>0.05). Compared with the control group, the experimental group had a significantly shorter duration of mechanical ventilation [hours: 137.5 (90.8, 202.2) vs. 162.5 (92.5, 263.8)], shorter length of ICU stay [days: 9.0 (5.8, 14.5) vs. 11.0 (7.0, 18.0)], shorter total hospital stay [days: 12.0 (7.0, 20.0) vs. 17.0 (10.0, 23.5)], and a higher weaning success rate (89% vs. 76%), with all differences being statistically significant (all P<0.05). Implementation of the targeted diaphragmatic function exercise bundle strategy based on ultrasound assessment can effectively improve nutritional status and diaphragmatic function, enhance muscle strength, and shorten the duration of mechanical ventilation and hospital stay in mechanically ventilated patients with AECOPD complicated by type II respiratory failure. It can serve as an effective adjunctive treatment for these patients.

To investigate the relationship between changes in serum thyroid hormone levels and postoperative acute kidney injury (AKI) as well as the severity of AKI in patients with acute type A aortic dissection (ATAAD), and to evaluate their predictive value for in-hospital mortality. A retrospective study was conducted. Patients who underwent surgery for ATAAD and received treatment in the Department of Intensive Care Medicine of Nanjing Hospital Affiliated to Nanjing Medical University from January 2021 to December 2023 were enrolled. General information, thyroid function, biochemical indicators, blood routine, procalcitonin, coagulation function and other data were collected. Patients were divided into AKI group and non-AKI group based on whether AKI occurred after surgery. In addition, patients were divided into NTIS group and non-NTIS group based on whether they developed non-thyroidal illness syndrome (NTIS). The factors associated with AKI and the impact of thyroid hormone levels on the stage of AKI were analyzed. The predictive value of thyroid hormone and serum creatinine (SCr) for in-hospital mortality was analyzed using the receiver operator characteristic curve (ROC curve). A total of 176 postoperative ATAAD patients were enrolled. AKI occurred in 105 patients (59.7%), including 46 cases (26.1%) of stage 1 AKI, 32 cases (18.2%) of stage 2 AKI, and 27 cases (15.3%) of stage 3 AKI. NTIS occurred in 113 patients (64.2%), the incidence of NTIS in the non-AKI group and in patients with stage 1, stage 2, and stage 3 AKI was 54.9% (39/71), 56.5% (26/46), 84.4% (27/32), and 77.8% (21/27), respectively. Compared with the non-AKI group, the AKI group had higher body mass index, proportion of vasopressors and cardiac stimulants used, incidence of pulmonary infection and NTIS, blood transfusion, reoperation, and continuous renal replacement therapy (CRRT), higher predicted mortality and actual mortality, as well as longer total hospital stay and the length of intensive care unit stay, and lower levels of free tri-iodothyronine (FT3), total tri-iodothyronine (TT3), and free thyroxine (FT4), and there were statistically significant differences in SCr, uric acid, blood sodium, alanine transaminase, aspartate transaminase, creatine kinase, MB isoenzyme of creatine kinase, white blood cell count, procalcitonin, platelet count, prothrombin time, activated partial thromboplastin time, and fibrinogen between the two groups (all P<0.05). The NTIS group had higher postoperative day 1, 3, and 5 SCr levels, overall AKI incidence, and incidences of stage 2 and stage 3 AKI than the non-NTIS group (all P<0.05). FT3, TT3, FT4, and total thyroxine (TT4) decreased with increasing severity of AKI stage (all P<0.05), while TSH slightly increased with increasing severity of AKI stage (P>0.05). ROC curve analysis showed that the area under the curve (AUC) and 95% confidence interval (95%CI) of FT3, TT3, and postoperative day 1 SCr for predicting in-hospital mortality were 0.770 (0.636-0.904), 0.812 (0.708-0.916), and 0.719 (0.597-0.840), respectively. The combination of the three had the highest AUC, which was 0.838 (0.732-0.944). The incidence of AKI is relatively high in patients following ATAAD surgery. The decline in FT3 and FT4 levels may contribute to the occurrence and progression of AKI. The lower the thyroid hormone levels, the more severe AKI and the worse the prognosis. FT3 and TT3 combined with postoperative day 1 SCr may serve as auxiliary predictors of in-hospital mortality in ATAAD patients.

To identify the risk factors of critical illness-related corticosteroid insufficiency (CIRCI) in patients with sepsis and to construct a nomogram model for predicting the occurrence of CIRCI in septic patients. A case-control study was conducted. A total of 50 patients with sepsis complicated by CIRCI who were admitted to Henan Provincial People's Hospital from January 2018 to December 2023 were enrolled as the CIRCI group. Meanwhile, 150 patients with sepsis but without CIRCI admitted during the same period were randomly selected as the control group. Baseline characteristics, etiologies of sepsis, vital signs, adrenal function indicators, serological parameters, intervention measures, disease severity scores, and prognosis-related outcomes were collected and compared between the two groups. Multivariate Logistic regression and inverse probability of treatment weighting (IPTW) regression analyses were performed to evaluate the correlation between various factors and the occurrence of CIRCI, screen out the influencing factors of CIRCI in septic patients, and construct a nomogram prediction model. The receiver operator characteristic curve (ROC curve) and calibration curve were used to assess the discrimination of the model. The Bootstrap method (with 1 000 repeated samplings) was adopted for internal validation, and the calibration curve was plotted to evaluate the calibration of the model. Decision curve analysis (DCA) was performed to assess the clinical validity of the model. After adjusting for confounding factors, univariate Logistic regression analysis showed that older age, history of type 2 diabetes mellitus, higher white blood cell count (WBC), higher procalcitonin (PCT) level, higher serum K+ level, higher Acute Physiology and Chronic Health Evaluation II (APACHE II), and higher Sequential Organ Failure Assessment (SOFA) were associated with an increased risk of CIRCI, whereas higher serum sodium (Na+) level was associated with a decreased risk of CIRCI (all P<0.05). In addition, CIRCI was associated with longer ICU length of stay, longer duration of mechanical ventilation, as well as higher rates of 28-day mortality and ICU mortality (all P<0.05). Multivariate Logistic regression and IPTW regression analyses revealed that history of type 2 diabetes mellitus [odds ratio (OR)=1.574, 95% confidence interval (95%CI) was 0.558-4.437, P=0.022], elevated PCT level (OR=4.271, 95%CI was 1.637-11.139, P=0.003), elevated serum K+ level (OR=2.115, 95%CI was 0.909-4.921, P=0.044), elevated APACHE II score (OR=1.258, 95%CI was 1.071-1.478, P=0.006), and elevated SOFA score (OR=1.236, 95%CI was 1.049-1.456, P=0.012) were independent risk factors for CIRCI. A nomogram prediction model was constructed based on the above 5 indicators. The ROC curve demonstrated that the model achieved an area under the curve (AUC) of 0.965 (95%CI was 0.942-0.989) for predicting the occurrence of CIRCI. The optimal cut-off value was 0.201, yielding a sensitivity of 92.0% and a specificity of 87.3%, indicating excellent discriminative performance. The calibration curve revealed a C-index of 0.966 and a Dxy statistic of 0.933 in the training cohort, reflecting very high predictive accuracy and strong discriminative ability. The standard error of the C-index was 0.028, supporting the reliability of this estimate. Furthermore, the calibration curve showed excellent agreement with the ideal reference line. DCA curve indicated that the model provided positive net benefit across a predefined threshold probability range of 0.05-0.50 (with the 95%CI based on 1 000 Bootstrap resamples not crossing zero). Notably, at threshold probabilities exceeding the event rate (approximately 0.25), the model outperformed both the treat-all and treat-none strategies. History of type 2 diabetes mellitus, elevated PCT, elevated K+, elevated APACHE II score and elevated SOFA score may be independent risk factors for CIRCI in septic patients. The constructed nomogram prediction model has high accuracy and effectiveness, which can be used for early identification and intervention of CIRCI, and is conducive to improving the prognosis of sepsis patients.

To analyze the occurrence and clinical characteristics of poor inguinal incision healing after weaning in patients undergoing peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO), and to explore its risk factors and clinical management strategies. A retrospective case-control study was conducted to select VA-ECMO patients admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital) from February 2022 to February 2025 as the study objects. All patients were weaned from ECMO under open surgery and were divided into normal incision healing group and poor incision healing group according to the healing of the inguinal incision on the side of ECMO catheterization after weaning. The basic data, clinical parameters and laboratory indicators between the two groups were compared, and the risk factors of poor inguinal incision healing after weaning in patients undergoing VA-ECMO were analyzed by univariate and multivariate Logistic regression analyses. Finally, 41 patients undergoing VA-ECMO were enrolled, including 23 males and 18 females. Among the 41 patients, 27 patients had normal inguinal incision healing, 14 patients had poor inguinal incision healing, and the incidence of poor incision healing was 34%. There were statistically significant differences between the two groups of patients in terms of ECMO catheterization location and ECMO catheterization protocol (both P<0.05). The patients in the poor incision healing group often completed ECMO intubation in the operating room, and most of them chose the unilateral semi-incision catheterization protocol. Compared with the normal incision healing group, the length of ICU stay, the duration of mechanical ventilation and the duration of continuous application of vasoactive drugs in the poor incision healing group were longer [length of ICU stay (days): 29.0 (21.0, 39.0) vs. 15.0 (10.0, 19.0), duration of mechanical ventilation (hours): 454.0 (170.0, 789.0) vs. 134.0 (45.0, 269.0), duration of continuous application of vasoactive drugs (days): 18.5 (6.5, 24.3) vs. 5.0 (2.0, 12.0), all P<0.05], 3-day accumulated fluid balance overload after ECMO weaning [mL: 616.5 (-249.3, 2 148.0) vs. -878.0 (-1 603.0, -387.0), P<0.05], suggesting that the poor healing of inguinal incision after VA-ECMO weaning was related to the above factors. The results of univariate Logistic regression analysis showed that unilateral semi-incision catheterization [odds ratio (OR)=21.000, 95% confidence interval (95%CI) was 2.868-153.754, P=0.003], length of ICU stay>10 days (OR=5.571, 95%CI was 1.042-29.790, P=0.045) and positive 3-day accumulated fluid balance after ECMO weaning (OR=16.133, 95%CI was 3.244-80.224, P=0.001) were the risk factors for poor inguinal incision healing after weaning in patients undergoing VA-ECMO. The variables with statistical significance in univariate Logistic regression analysis were incorporated into the binary multivariate Logistic regression model. The analysis results showed that unilateral semi-incision catheterization (OR=13.203, 95%CI was 1.295-134.632, P=0.029) and positive 3-day accumulated fluid balance after ECMO weaning (OR=14.178, 95%CI was 1.985-101.245, P=0.008) were independent risk factors for poor inguinal incision healing after weaning in patients undergoing VA-ECMO. Fourteen patients with poor healing of inguinal incisions presented with massive exudate from the incision (12 cases), delayed incision healing (7 cases), non-healing of the incision (7 cases), incision infection (4 cases), lymphatic leakage (4 cases), and incision dehiscence (3 cases). In addition to routine dressing change, 12 cases underwent negative pressure sealed drainage (VSD), 7 cases underwent reoperation for debridement, and 2 cases underwent flap repair. Four patients died in the ICU with unhealed incisions, 2 patients had unhealed incisions at the time of discharge referral, and the remaining patients' groin incisions eventually healed. The incidence of poor healing of inguinal incisions after weaning from VA-ECMO is relatively high, mainly manifested as excessive exudate from the incision, delayed incision healing, non-healing of the incision, incision infection, lymphatic leakage, and incision dehiscence. Unilateral semi-incision catheterization and positive 3-day accumulated fluid balance after ECMO weaning are independent risk factors for poor inguinal incision healing in patients undergoing VA-ECMO. Early application of VSD is an effective solution for treating poor incision healing accompanied by a large amount of exudate.

Sepsis-induced multiple organ dysfunction syndrome (MODS) is the leading cause of mortality in critically ill patients, and widespread disruption of the vascular endothelial barrier represents the central pathological event. The integrity of the endothelial barrier is crucial for maintaining microcirculatory homeostasis. In sepsis, the dysregulated inflammatory response leads to a dramatic increase in microvascular permeability through multiple mechanisms, including endothelial cell activation, oxidative stress, disruption of intercellular junctions, degradation of the glycocalyx, and the promotion of immunothrombosis, ultimately driving organ failure. This review systematically elaborates on the mechanisms underlying vascular endothelial barrier injury across different organs (e.g., the lung, heart, intestine, kidney, and brain) in sepsis, with a particular focus on methodological advances in assessing barrier function, aiming to provide optimal detection strategies for various organs. By detailing universal techniques such as transendothelial electrical resistance (TEER) measurement, fluorescent tracer permeability assays, Evans Blue leakage, and intravital microscopy imaging, it further summarizes specific assessments for key target organs, including the lung, intestine, kidney, and brain. The importance of employing a multi-technique approach and multi-level validation for the comprehensive evaluation of barrier function is emphasized. Finally, this review synthesizes the methods for detecting the vascular endothelial barrier from different perspectives and discusses future directions for technological innovation and clinical translation. The overall goal of this review is to provide a systematic methodological reference and conceptual framework for in-depth research into the pathological mechanisms and therapeutic strategies targeting vascular endothelial dysfunction in sepsis-induced organ injury.

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) serves as an advanced extracorporeal life support modality capable of totally or partially substituting pulmonary gas exchange function. It is indicated for severe acute respiratory distress syndrome, chronic obstructive pulmonary disease, and bridging therapy prior to lung transplantation. Currently, the fixation of the internal jugular vein catheter for ECMO mainly relies on transparent dressings supplemented by secondary securing with ties. However, this method has drawbacks such as insecure fixation, susceptibility to catheter displacement, and the risk of inducing device related pressure injuries. To address the aforementioned issues, research team from the Department of Critical Care Medicine, Zhongda Hospital, Southeast University, developed a novel neck catheter fixation device for ECMO, which was granted a national utility model patent (Patent number: ZL 2021 2 1130686.8). The device consists of two main components: a head fixation strap and a catheter fixation device. The head immobilization strap comprises a frontoparietal strap, a circumferential fronto-occipital strap, and a mandibular strap. These components utilize Velcro to achieve three-dimensional force equilibrium, thereby preventing overall slippage. The tube fixation module consists of a fixation patch and an anti-slip silicone pad. By employing a hook and loop fastener in combination with the anti slip silicone pad and wrapping the catheter with a fold back locking strap, the device achieves effective fixation of the catheter. The catheter fixation unit is positioned posteroinferior to the auricle and is equipped with a dual-locking structure (U-shaped strap combined with an anti-slip silicone clip). This design allows bidirectional fixation of the catheter, helping to prevent catheter dislodgement, alleviate local skin compression, and reduce the risk of catheter related bloodstream infection. The device is easy to operate, can be repeatedly disinfected and reused, and demonstrates good clinical application prospects.

To establish a predictive model for acute kidney injury (AKI) in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR), and to evaluate and validate its predictive value. A multicenter retrospective cohort study was conducted. 1) The clinical data of the patients undergoing ECPR during cardiopulmonary resuscitation (CPR) admitted to the First Hospital of Jiaxing between January 2016 and August 2024 were collected as the modeling cohort. The clinical data included patient characteristic information, relevant treatment information during ECPR, post-extracorporeal membrane oxygenation (ECMO) operation parameters, and ECMO-related variable information. The patients were divided into an AKI group and a non-AKI group according to the occurrence of AKI during ECMO support. The differences in clinical characteristics between the two groups were compared. Multivariate Logistic regression analysis was used to screen independent risk factors for AKI during ECMO therapy, and a nomogram model was established. The predictive value of the model was evaluated by receiver operator characteristic curve (ROC curve). Internal validation of the model was performed using the Bootstrap method with 1 000 resamplings. The predictive performance of the nomogram model was verified using calibration curves and the Hosmer-Lemeshow test, and the clinical utility of the model was assessed by decision curve analysis (DCA). 2) The clinical data of the patients who received ECPR during CPR admitted to the First People's Hospital of Tongxiang and the First People's Hospital of Pinghu from May 2024 to June 2025 were selected for external validation. The predictive efficacy of the model was evaluated by ROC curve analysis. 1) A total of 108 ECPR patients were finally enrolled in the modeling cohort, among whom 78 developed AKI during ECMO treatment and 30 did not, with an AKI incidence of 72.2%. Compared with the non-AKI group, the patients in the AKI group had higher Sequential Organ Failure Assessment (SOFA) score, serum creatinine (SCr), blood lactic acid, lower procalcitonin (PCT), and longer hypoperfusion time (all P<0.05). There were no significant differences in other clinical data between the two groups. Multivariate Logistic regression analysis showed that increased SOFA score [odds ratio (OR)=1.288, 95% confidence interval (95%CI) was 1.055-1.571, P=0.013], SCr (OR=1.010, 95%CI was 1.002-1.018, P=0.015) and blood lactic acid (OR=1.151, 95%CI was 1.036-1.279, P=0.009), and prolonged hypoperfusion time (OR=1.059, 95%CI was 1.007-1.114, P=0.026) were independent risk factors for AKI during ECMO in ECPR patients. A nomogram prediction model was constructed based on the above independent risk factors. ROC curve analysis showed that the area under the ROC curve (AUC) of the nomogram model for predicting AKI in ECPR patients was 0.858 (95%CI was 0.782-0.934, P<0.001), with a sensitivity of 71.8% and a specificity of 83.3%. After 1 000 Bootstrap resamplings, the C-index was 0.822. The Hosmer-Lemeshow test and calibration curve showed good fitness between the predicted and ideal probabilities (&#x3c7;2=6.402, P=0.602), indicating favorable model performance. DCA results suggested that using the nomogram model achieved higher net benefit for most patients. 2) A total of 31 patients who received ECPR were enrolled for external validation. There were no significant differences in baseline data such as gender, age, or underlying diseases as well as four core independent risk factors for constructing a nomogram predictive model between the external validation cohort and the primary cohort, meeting the requirements of external validation design. ROC curve analysis showed that the AUC of the nomogram model for predicting AKI in ECPR patients was 0.833 (95%CI was 0.654-1.000, P<0.001), with a sensitivity of 70.0% and a specificity of 85.7%. A nomogram model for predicting AKI in ECPR patients is established based on hypoperfusion time combined with SOFA score, SCr, and blood lactic acid. The model has been confirmed to possess good predictive value through both internal and external validation.

To investigate the predictive value of ultrasound evaluation of intercostal muscle combined with diaphragmatic function for weaning and extubation outcomes in neurocritically ill patients. A retrospective case-control study was performed. Clinical data of patients receiving invasive mechanical ventilation via tracheal intubation admitted to the neurology intensive care unit (ICU) of The First Affiliated Hospital of Wannan Medical University (Yijishan Hospital of Wannan Medical University) from April 2023 to April 2025 were collected. Patients were divided into a weaning failure group and a weaning success group according to weaning and extubation outcomes. General baseline data, eye opening and motor reaction scores before extubation, air leakage volume of tracheal intubation cuff leak test, cough ability before extubation, routine blood test and blood biochemical indicators within 48 hours before extubation, and basic vital signs, respiratory mechanics parameters, arterial blood gas analysis results as well as intercostal muscle function indicators [intercostal muscle thickness at the end of inspiration (ICMTei), intercostal muscle thickness at the end of expiration (ICMTee), thickening fraction of intercostal muscle (TFic)] and diaphragmatic function indicators [diaphragmatic excursion (DE), diaphragmatic thickness at the end of inspiration (DTei), diaphragmatic thickness at the end of expiration (DTee), diaphragmatic thickening fraction (DTF)] assessed by ultrasound at the end of spontaneous breathing trial (SBT) were compared between the two groups. Meanwhile, the inpatient outcome indicators of patients were collected. Binary multivariate Logistic regression analysis was used to screen the influencing factors of weaning and extubation outcomes in neurocritically ill patients undergoing invasive mechanical ventilation via tracheal intubation. Receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of the combination of TFic, DE and DTF for weaning and extubation outcomes in neurocritically ill patients undergoing invasive mechanical ventilation via tracheal intubation. A total of 233 neurocritically ill patients undergoing invasive mechanical ventilation via tracheal intubation were initially enrolled. After excluding 40 patients aged<18 years or &#x2265;80 years, 55 patients with treatment abandonment or voluntary discharge, 11 patients with unclear ultrasound images, 5 patients undergoing tracheotomy before extubation and 11 patients with incomplete clinical data, 111 patients were finally included in the analysis, including 32 cases in the weaning failure group and 79 cases in the weaning success group. Univariate analysis showed that there were statistically significant differences in Glasgow Coma Scale (GCS) score at admission, eye opening and motor action scores before extubation, air leakage volume of tracheal intubation cuff leak test, cough ability before extubation, rapid shallow breathing index (RSBI) at the end of SBT (all P<0.05). At the end of SBT, TFic in the weaning failure group was higher than that in the weaning success group [15.76% (13.12%, 21.24%) vs. 10.00% (8.33%, 13.33%), P<0.05], while DE and DTF were lower than those in the weaning success group [DE (cm): 1.10 (1.05, 1.20) vs. 1.36 (1.25, 1.45), DTF: 18.75% (16.85%, 24.75%) vs. 27.27% (22.73%, 31.58%), both P<0.05]. Multivariate Logistic regression analysis showed that elevated TFic [odds ratio (OR)=0.731, 95% confidence interval (95%CI) was 0.583-0.917, P=0.007], elevated DE (OR=4.494, 95%CI was 1.663-12.146, P=0.003) and elevated DTF (OR=1.381, 95%CI was 1.078-1.770, P=0.011) were independent influencing factors for successful weaning and extubation in neurocritically ill patients undergoing invasive mechanical ventilation via tracheal intubation. ROC curve analysis showed that TFic, DE and DTF alone had certain predictive value for successful weaning in neurocritically ill patients undergoing invasive mechanical ventilation via tracheal intubation, and the combined application of the three indicators achieved the highest predictive value, with an area under the ROC curve (AUC) of 0.972 (95%CI was 0.948-0.997, P<0.001), a sensitivity of 88.6% and a specificity of 96.9%. Analysis of hospital outcome indicators showed that length of ICU stay, total length of hospital stay and total mechanical ventilation duration in the weaning failure group were longer than those in the weaning success group [length of ICU stay (days): 31.00 (18.25, 49.25) vs. 20.00 (8.00, 32.00), total length of hospital stay (days): 34.50 (22.00, 50.00) vs. 25.00 (16.00, 37.00), total mechanical ventilation duration (days): 18.50 (12.00, 30.25) vs. 8.00 (3.00, 10.00), all P<0.05]. Ultrasound assessment of TFic combined with DE and DTF has high application value in predicting successful weaning and extubation in neurocritically ill patients.

To investigate the ameliorative effect of irisin on sepsis-associated acute kidney injury (SA-AKI) by inhibiting ferroptosis through the regulation of the nuclear factor E2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway. Sixty C57BL/6 mice were divided into four groups using a random number table method: control group, lipopolysaccharide (LPS) group, LPS+irisin group, and LPS+irisin+ML385 (Nrf2 inhibitor) group, with 15 mice in each group. The SA-AKI model was established by intraperitoneal injection of LPS at a dose of 10 mg/kg, while the control group received an equal volume of normal saline. In the LPS+irisin group, irisin (1 &#x3bc;g/kg) was intravenously injected 30 minutes prior to LPS administration. In the LPS+irisin+ML385 group, ML385 (30 mg/kg) was intraperitoneally injected 60 minutes before LPS injection, followed by irisin injection 30 minutes before LPS. All mice were anesthetized and sacrificed 24 hours after modeling. Blood samples were collected from the eyeballs for serum creatinine (SCr) and blood urea nitrogen (BUN) measurement using an automatic biochemical analyzer. Renal tissues were harvested for the following assessments: the levels of interleukin-6 (IL-6) and tumor necrosis factor-&#x3b1; (TNF-&#x3b1;) were measured by enzyme linked immunosorbent assay (ELISA); histopathological changes were observed under light microscope after hematoxylin-eosin (HE) staining; mitochondrial morphology was observed under transmission electron microscope after uranium acetate staining; protein expressions of glutathione peroxidase 4 (GPX4), acyl-CoA synthetase long-chain family member 4 (ACSL4), Nrf2, and HO-1 were detected by Western blotting; the contents of Fe2+, malondialdehyde (MDA), reduced glutathione (GSH), and relative fluorescence intensity of reactive oxygen species (ROS) were also measured in renal tissues. 1) The levels of SCr, BUN, IL-6, and TNF-&#x3b1; in the LPS, LPS+irisin, and LPS+irisin+ML385 groups were higher than those in the control group (all P<0.05). Compared with the LPS group, the LPS+irisin group showed decreased levels of SCr, BUN, IL-6, and TNF-&#x3b1; [SCr (&#x3bc;mol/L): 31.70&#xb1;3.94 vs. 65.75&#xb1;7.02, BUN (mmol/L): 11.03&#xb1;2.25 vs. 29.23&#xb1;2.58, IL-6 (ng/L): 239.96&#xb1;14.93 vs. 1 080.40&#xb1;20.06, TNF-&#x3b1; (ng/L): 105.85&#xb1;14.92 vs. 299.12&#xb1;19.94, all P<0.05]. However, the levels of these indicators in the LPS+irisin+ML385 group were higher than those in the LPS+irisin group (all P<0.05). 2) Light microscopy revealed that compared with the control group, the LPS, LPS+irisin, and LPS+irisin+ML385 groups exhibited varying degrees of renal tubular dilation, tubular cell shedding, cellular vacuolization, and intratubular cast formation, with the most severe damage observed in the LPS group and the mildest damage in the LPS+irisin group. 3) Transmission electron microscopy showed that compared with the control group, the other three groups displayed varying degrees of mitochondrial enlargement, rounding and swelling, sparse and dissolved matrix, and reduced cristae, with the most pronounced changes in the LPS group, while mitochondrial morphology was only mildly altered in the LPS+irisin group. 4) Compared with the control group, the protein expression of GPX4 was decreased, while the protein expressions of Nrf2, HO-1, and ACSL4 were increased in the LPS, LPS+irisin, and LPS+irisin+ML385 groups (all P<0.05). Compared with the LPS group, the LPS+irisin group exhibited increased expression of GPX4, Nrf2, and HO-1, and decreased expression of ACSL4 (GPX4/GAPDH: 0.68&#xb1;0.07 vs. 0.49&#xb1;0.03, Nrf2/Lamin B: 1.03&#xb1;0.04 vs. 0.82&#xb1;0.06, HO-1/GAPDH: 0.93&#xb1;0.02 vs. 0.66&#xb1;0.04, ACSL4/GAPDH: 0.69&#xb1;0.02 vs. 0.93&#xb1;0.07, all P<0.05). Compared with the LPS+irisin group, the LPS+irisin+ML385 group showed decreased expressions of GPX4, Nrf2, and HO-1, and increased expression of ACSL4 (all P<0.05). 5) Compared with the control group, the levels of MDA, ROS, and Fe2+; were increased, while the level of GSH was decreased in the LPS, LPS+irisin, and LPS+irisin+ML385 groups (all P<0.05). Compared with the LPS group, the LPS+irisin group exhibited decreased levels of MDA, ROS, and Fe2+, and increased level of GSH [MDA (nmol/mg): 9.35&#xb1;2.07 vs. 15.65&#xb1;4.03, ROS (relative fluorescence intensity): 584.26&#xb1;74.48 vs. 1 655.68&#xb1;405.71, Fe2+ (nmol/mg): 9.24&#xb1;3.82 vs. 26.99&#xb1;7.95, GSH (nmol/mg): 91.50&#xb1;7.99 vs. 43.13&#xb1;11.85, all P<0.05]. Compared with the LPS+irisin group, the LPS+irisin+ML385 group showed increased levels of MDA, ROS, and Fe2+, and decreased level of GSH (all P<0.05). Irisin ameliorates LPS-induced SA-AKI in mice by inhibiting ferroptosis through the Nrf2/HO-1 signaling pathway, suggesting that irisin may serve as a potential therapeutic strategy for organ protection in sepsis.

To investigate the protective effect of kynurenine 3-monooxygenase (KMO) inhibitor GSK180 against trauma-induced sepsis (TIS)-induced acute kidney injury (AKI) and to explore its underlying mechanism. Male SPF healthy Sprague-Dawley (SD) rats were randomly divided into groups using a random number table. (1) A normal control group, a sham-operated (Sham) group, and TIS groups at 12, 24, and 48 hours were established, and 6 surviving rats were finally retained in each group for statistical analysis. The normal control group received no treatment. The Sham group was subjected only to laparotomy exploration and gentle cecal palpation followed by abdominal closure, and 40 mL/kg normal saline was injected subcutaneously for fluid resuscitation after surgery until the rats recovered voluntary movement. TIS groups were treated with combined injury to establish the TIS-induced AKI model, and postoperative management was identical to that of the Sham group. Samples were collected at each time point to detect inflammatory indicators such as white blood cell count (WBC), tumor necrosis factor-&#x3b1; (TNF-&#x3b1;), interleukin-6 (IL-6), and C-reactive protein (CRP), as well as serum creatinine (SCr) and blood urea nitrogen (BUN) to evaluate inflammatory response and renal injury. Based on the severity of renal injury, renal tissues of the corresponding groups were harvested for proteomic analysis to screen candidate target proteins for related mechanistic intervention experiments. (2) In the KMO inhibitor intervention experiment, rats were randomly divided into the Sham group, TIS group, and KMO inhibitor intervention group, with 6 surviving rats retained in each group for statistical analysis. Procedures in the Sham and TIS groups were the same as described above; the KMO inhibitor intervention group was intraperitoneally injected with the KMO inhibitor GSK180 (10 mg/kg) at 2 hours after model establishment, while the Sham and TIS groups were intraperitoneally injected with an equal volume of normal saline. The above inflammatory and renal function indicators were detected at 24 hours after surgery. Periodic acid-Schiff (PAS) staining was used to observe histopathological changes of renal tissues. Terminal-deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL) staining was adopted to observe cell apoptosis in renal tissues. Mitochondrial ultrastructure changes were examined by transmission electron microscopy. Mitochondrial reactive oxygen species (ROS) and membrane potential were detected by flow cytometry. Western blotting was performed to determine the expression of KMO, mitochondrial dynamics-related proteins [dynamin-related protein 1 (DRP1) and its phosphorylated form at Ser616 (p-DRP1 Ser616), mitofusin 2 (MFN2), optic atrophy protein 1 (OPA1)], and the apoptosis-inducing protein Bcl-2-associated X protein (BAX). (1) Compared with the normal control group, significant inflammatory response and renal function injury were observed in TIS groups at all-time points, and peaked at the 24 hours, indicating the most severe renal injury at this time point. Proteomic analysis showed that KMO expression was upregulated in renal tissues of the TIS 24-hour group compared with the normal control group, which was thus selected as the target for subsequent intervention. (2) The KMO inhibitor intervention experiment showed that compared with the Sham group, the rats in the TIS group exhibited systemic inflammatory response and renal dysfunction. Pathological observations revealed aggravated renal damage, increased cell apoptosis, and ultrastructural damage. The level of intracellular ROS was elevated, mitochondrial membrane potential was decreased, and mitochondrial dynamics were imbalanced. Compared with the TIS group, KMO inhibition could improve both systemic inflammatory response and renal function, the levels of WBC, TNF-&#x3b1;, IL-6, CRP, SCr, and BUN were decreased [WBC (&#xd7;109/L): 9.87&#xb1;2.74 vs. 25.10&#xb1;3.55, TNF-&#x3b1; (ng/L): 213.61&#xb1;81.47 vs. 820.59&#xb1;105.13, IL-6 (ng/L): 986.98&#xb1;105.54 vs. 2 376.28&#xb1;211.80, CRP (ng/L): 1 149.55&#xb1;405.60 vs. 3 355.76&#xb1;439.79, SCr (&#x3bc;mol/L): 57.67&#xb1;12.36 vs. 129.67&#xb1;10.52, BUN (mmol/L): 11.63&#xb1;2.60 vs. 21.53&#xb1;4.31, all P<0.05], alleviated histopathological changes in the kidney, ameliorated mitochondrial ultrastructural damage in renal cells, reduced mitochondrial ROS levels and stabilized membrane potential, and both cell apoptosis and mitochondrial dynamics balance had been improved, the phosphorylation level of DRP1 Ser616 and BAX expression were both decreased [p-DRP1 Ser616 protein (p-DRP1 Ser616/DRP1): 0.88&#xb1;0.15 vs. 1.63&#xb1;0.13, BAX protein (BAX/GAPDH): 1.24&#xb1;0.13 vs. 2.40&#xb1;0.26, both P<0.05], accompanied by upregulated expression of MFN2 and OPA1 [MFN2 protein (MFN2/GAPDH): 1.09&#xb1;0.08 vs. 0.64&#xb1;0.03, OPA1 protein (OPA1/GAPDH): 1.13&#xb1;0.07 vs. 0.74&#xb1;0.14, both P<0.05]. KMO is upregulated in TIS-induced AKI and serves as a key factor mediating renal injury. The KMO inhibitor GSK180 exerts renal protective effects by inhibiting DRP1-mediated mitochondrial fission, promoting MFN2/OPA1-dependent mitochondrial fusion, improving mitochondrial function, and alleviating inflammation, oxidative stress and cell apoptosis.

Sepsis is a critical illness induced by infection and characterized by dysregulated inflammatory responses. Neutrophils (Neu) are not only key effector cells that directly combat pathogenic microbial infections, but also crucial regulators of immune responses, thus playing a double-edged sword role in sepsis. Interleukin-18 (IL-18) is a classical inflammasome-associated potent pro-inflammatory factor, and plays an imperative role in the migration and activation of neutrophils. Therefore, this article summarizes the roles of neutrophils and IL-18 in sepsis, aiming to provide a theoretical basis for further in-depth exploration of the pathogenesis of sepsis, the development of IL-18 related biological agents, and the formulation of targeted therapeutic strategies.

To explore the clinical application effect of the improved three-level fixation method in percutaneous extracorporeal membrane oxygenation (ECMO) catheter fixation. A retrospective cohort research method was conducted. Clinical data of patients who underwent percutaneous ECMO catheterization treatment and were admitted to the Extracorporeal Life Support Center of Fuwai Huazhong Cardiovascular Hospital from June 2021 to June 2025 were collected. Patients were divided into a traditional fixation method group and a modified fixation method group based on different ways of catheter fixation. The incidence of catheter dislodgement, bleeding at the catheterization site, and skin injury-related infections in patients receiving different ECMO catheter fixation methods was statistically analyzed. A questionnaire survey was conducted to assess the comfort level of conscious patients undergoing different ECMO catheter fixation methods and the satisfaction of nurses in caring for patients with different ECMO catheter fixation methods. A total of 586 patients undergoing percutaneous ECMO catheterization were enrolled, including 214 in the traditional fixation group and 372 in the modified fixation group. There were no statistically significant differences in gender, age, disease type, proportion of awake ECMO patients, proportion of ECMO operations performed outside the hospital, and duration of ECMO operation between the two groups. The modified fixation group had lower rates of catheter dislodgement, bleeding at the catheterization site, and skin injury-related infections compared to the traditional fixation group [catheter dislodgement: 0% (0/372) vs. 1.4% (3/214), bleeding at the catheterization site: 5.3% (20/372) vs. 15.8% (34/214), skin injury-related infections: 4.0% (15/372) vs. 22.4% (48/214), all P<0.05]. The comfort level of awake patients and the satisfaction of nursing staff in the modified fixation group were higher than those in the traditional fixation group [comfort level of awake patients: 68.7% (22/32) vs. 23.5% (4/17), satisfaction of nursing staff: 89.2% (332/372) vs. 63.5% (136/214), both P<0.05]. The improved "three-level" fixation method can significantly reduce the incidence of catheter dislodgement, bleeding at the catheterization site, and skin injury-related infections in percutaneous puncture ECMO catheter fixation, and can be used as one of the effective measures for continuous improvement of ECMO quality control. It can also significantly improve the comfort level of conscious patients and the satisfaction of nursing staff in clinical work, and is recommended for clinical promotion and application.

The fiberoptic bronchoscope, when fully integrated with imaging systems, enables real-time observation of airway structures. It can assist in procedures such as clearing respiratory secretions, tracheal intubation assistance, and bronchoalveolar lavage. It is widely used in various settings, including intensive care unit (ICU), emergency department, anesthesiology, and critical care respiratory department. However, the fiberoptic bronchoscope currently used in clinical practice faces clinical issues such as susceptibility to accidental touch, low operational efficiency, and difficulty in adjusting height. To address these issues, medical staff from the department of critical care medicine of Zhongda Hospital Affiliated to Southeast University have designed a dedicated support stand for fiberoptic bronchoscopy and obtained a National Utility Model Patent of China (ZL 2020 2 3282155.9). The dedicated support stand for fiberoptic bronchoscopy comprises two core components: a telescoping vertical frame and a multifunctional articulating support structure. The apparatus incorporates a telescoping pole system to adapt its height to different operators and integrates multiple functional modules, including a display fixation unit (secured by limit grooves), a bronchoscope temporary storage component (&#x3a9; -shaped elastic clamps), and partitioned consumable management, thereby optimizing procedural workflows. A foot-pedal-operated non-contact waste bin ensures safe disposal of medical waste, mitigating cross-contamination risks. The modular design, combined with a 360degree angle rotatable bracket, enables flexible adjustment of operational angles to reduce operator musculoskeletal fatigue. This device was designed to fully consider the convenience of clinical use, aiming to simplify preoperative preparation procedures and enhance operational safety, which helps reduce the risk of scope slippage and contamination. Its structural features make it suitable for various clinical scenarios such as the ICU and emergency department, demonstrating strong potential for practicality.

To evaluate the predictive value of the Vasoactive Inotropic Score (VIS) for 28-day mortality in intensive care unit (ICU) patients with atrial fibrillation (AF)-related hemodynamic deterioration, to determine its optimal cutoff value, and to analyze its independent association with 28-day mortality risk. A retrospective cohort study was conducted. Patients with AF-related hemodynamic deterioration treated in the Department of Critical Care Medicine of Sichuan Provincial People's Hospital from September 2020 to May 2025 were enrolled. General clinical data, laboratory indices at ICU admission, arterial blood gas analysis and vital signs at AF onset, and the peak VIS within 48 hours of AF onset were collected through the electronic medical record system. According to the 28-day outcome, the patients were divided into a survivor group and a non-survivor group. Clinical data were compared between the two groups. Receiver operator characteristic curve (ROC curve) analysis was performed to evaluate the predictive value of VIS for 28-day mortality and to determine its optimal cutoff value. After stratifying patients by VIS using the optimal cut off value, variables with statistically significant differences in univariate analysis were entered into a multivariable logistic regression model to identify independent predictors of 28-day mortality. An ROC curve was further plotted to evaluate the predictive performance of the combined predictive model. A total of 123 ICU patients who met the definition of AF-related hemodynamic deterioration were identified through retrospective review of continuous electrocardiographic monitoring records and expert adjudication. Among them, 68 died and 55 survived within 28 days. Univariate analysis showed that, compared with the survivor group, patients in the non-survivor group were older, had higher proportions of diabetes mellitus, sepsis, and severe pneumonia, were more likely to receive continuous renal replacement therapy (CRRT), and had a lower proportion of postoperative cardiac surgery patients. The levels of the VIS, Acute Physiology and Chronic Health Evaluation II(APACHE II), Sequential Organ Failure Assessment (SOFA), CHA2DS2-VASc score, HAS-BLED score, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and lactic acid (Lac) at AF onset were higher in the non-survivor group than in the survivor group. In contrast, the proportion of patients receiving anticoagulation therapy, bicarbonate (HCO3-) levels at AF onset, and mean arterial pressure (MAP) at AF onset were lower, while the total length of hospital stay was shorter (all P<0.05). ROC curve analysis showed that VIS had good predictive performance for 28-day mortality, with an area under the curve (AUC) of 0.801 [95% confidence interval (95%CI) was 0.722-0.880, P<0.001]. When the optimal cutoff value of VIS was 129.705, the sensitivity was 61.8%, the specificity was 92.7%, and the Youden index was 0.545. Multivariable logistic regression analysis showed that VIS&#x2265;129.705 was an independent risk factor for 28-day mortality [odds ratio (OR)=70.532, 95%CI was 10.043-495.320, P<0.001], whereas anticoagulation therapy was an independent protective factor (OR=0.073, 95%CI was 0.006-0.870, P=0.038). Variables including age, history of diabetes mellitus, cardiac surgery, and CRRT were not significantly associated with 28-day mortality (all P>0.05). The combined prediction of anticoagulation and VIS&#x2265;129.705 achieved an AUC of 0.938 (95%CI was 0.898-0.977, P<0.001), with a sensitivity of 92.6% and a specificity of 81.8%, indicating good predictive performance. VIS can effectively predict 28-day mortality in ICU patients with AF-related hemodynamic deterioration. The optimal cutoff value was 129.705, and VIS&#x2265;129.705 was an independent risk factor for 28-day mortality in this population. The combined predictive model based on VIS exhibited favorable predictive performance and may serve as a bedside reference tool for early identification of high-risk patients, facilitating clinical risk stratification and individualized therapeutic optimization.

To investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR) combined with glycosylated hemoglobin A1c (HbA1c) for bloodstream infection in patients with pyogenic liver abscess (PLA). A retrospective cohort study was conducted. Patients with PLA admitted to Linyi Central Hospital from January 2020 to June 2024 were enrolled. Clinical data, comorbidities, clinical symptoms, signs, admission laboratory parameters, imaging data, and blood culture results were collected. Patients were divided into a bloodstream infection group (blood culture-positive) and a non-bloodstream infection group (blood culture-negative) according to their blood culture results, and differences in various indicators were compared between two groups. Multivariate Logistic regression analysis was used to identify independent risk factors for bloodstream infection. The receiver operator characteristic curve (ROC curve) was employed to evaluate the predictive value of NLR combined with HbA1c for bloodstream infection in patients with PLA. A total of 124 patients with PLA were enrolled, among whom 48 had positive blood cultures, yielding a positivity rate of 45.2%. The proportion of patients with diabetes, as well as levels of procalcitonin (PCT), HbA1c, and NLR, were higher in the bloodstream infection group than in the non-bloodstream infection group [diabetes proportion: 41.1% vs. 11.8%, PCT (ng/L): 18.98&#xb1;12.16 vs. 14.19&#xb1;11.85, HbA1c: 0.939&#xb1;0.056 vs. 0.053&#xb1;0.027, NLR: 28.08&#xb1;13.64 vs. 21.69&#xb1;11.37, all P<0.05]. Multivariate Logistic regression analysis revealed that elevated HbA1c at admission [odds ratio (OR)=1.289, 95% confidence interval (95%CI) was 1.097-1.513, P=0.002] and elevated NLR (OR=1.041, 95%CI was 1.007-1.075, P=0.016) were independent risk factors for bloodstream infection in patients with PLA. ROC curve analysis demonstrated that the combination of NLR and HbA1c predicted bloodstream infection with an area under the curve (AUC) of 0.824 (95%CI was 0.753-0.896, P<0.001); when the optimal cut-off value of 0.298, the sensitivity was 0.929 and the specificity was 0.603. The combination of NLR and admission HbA1c has predictive value for bloodstream infection in patients with PLA.

To search, evaluate and summarize evidence for the prevention and management of brain injury in patients supported by extracorporeal membrane oxygenation (ECMO), and to provide evidence-based basis for the prevention and management of brain injury during ECMO support. A systematic search was conducted in the following databases and resources for clinical decision support tools, guidelines, expert consensus, systematic reviews and high-quality original studies related to the prevention and management of brain injury in ECMO-supported patients: UpToDate, BMJ Best Practice, JBI evidence-based Health Care Center Database, the Cochrane Library, the National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN), the National Guideline Clearinghouse (NGC), Yimaitong, Extracorporeal Life Support Organization (ELSO), the American College of Cardiology (ACC), PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), China Biomedical Literature Service System (SinoMed), CNKI, Wanfang Database, VIP Database and other Chinese and English databases, professional team websites, and guideline websites. The search time range is from the establishment of the database to May 2025. Two researchers with systematic training backgrounds in evidence-based nursing methods independently evaluated the quality of the literature, and extracted and summarized the evidence from the literature that met the quality standards. A total of 18 publications were ultimately included, comprising 4 guidelines, 3 expert consensuses, 4 systematic reviews, and 7 original studies [including 1 randomized controlled trial (RCT), 4 cohort studies, and 2 case studies]. Through synthesis, 31 pieces of best evidence for the prevention and management of brain injury in ECMO-supported patients were formulated, covering five major themes: risk factors of brain injury, protective factors of brain injury, assessment and monitoring during treatment, prevention of brain injury, and treatment measures for brain injury. This evidence provides the best evidence-based basis for the prevention and management of brain injury during ECMO treatment. It is recommended to selectively apply the best evidence in combination with the actual clinical environment of medical institutions and individual differences of patients, and to prevent and manage brain injury in ECMO-supported patients in a personalized and reasonable manner.

Due to their unique pathophysiological states, neurocritical care patients are at a significantly increased risk of acute pulmonary embolism. Typical symptoms are frequently masked by neurological deficits, resulting in delayed diagnosis. Furthermore, clinical management is highly challenging owing to the concurrent high risk of intracranial hemorrhage. On February 26, 2025, Linyi People's Hospital admitted a 67-year-old male patient who developed neurogenic stress cardiomyopathy (NSC) and acute submassive pulmonary embolism following surgery for a ruptured aneurysm. The patient presented with a chief complaint of "sudden onset headache accompanied by loss of consciousness for 6 hours." Physical examination revealed a deep coma with a Glasgow Coma Scale (GCS) score of 3 (E1V1M1), a Hunt-Hess grade of IV, and a modified Fisher grade of 4. Both pupils were 2.5 mm in diameter and reactive to light, and nuchal rigidity was positive. Cerebral computed tomography angiography (CTA) demonstrated an anterior communicating artery aneurysm, subarachnoid hemorrhage, and extensive intraventricular hemorrhage. Based on the medical history, clinical manifestations, and imaging findings, the patient was diagnosed with a ruptured anterior communicating artery aneurysm complicated by subarachnoid hemorrhage and secondary intraventricular hemorrhage. Emergent stent-assisted coil embolization of the anterior communicating artery aneurysm, cerebral angiography, and bilateral external ventricular drainage were performed under general anesthesia. Postoperatively, the patient was transferred to the neurosurgical intensive care unit (ICU) with endotracheal intubation and high-dose vasoactive support. Upon admission, concurrent NSC and severe hemodynamic instability were confirmed via bedside ultrasound and laboratory tests. Following one week of comprehensive management, including the control of inappropriate stress responses, clearance of bloody cerebrospinal fluid, management of intracranial hypertension, and optimization of vasoactive agents, the patient's hemodynamics stabilized, and vasoactive drugs were successfully discontinued. However, during the second postoperative week, the patient's condition deteriorated. Bedside echocardiography detected characteristic signs of right ventricular overload [right ventricle-to-left ventricle diameter ratio (RV/LV ratio) >1, "Notch sign," and "McConnell's sign"] that were highly suggestive of acute pulmonary embolism. This was immediately confirmed by computed tomography pulmonary angiography (CTPA). Following thorough deliberation by a multidisciplinary team (MDT) and careful balancing of the hemorrhagic and thrombotic risks, an individualized anticoagulation regimen was implemented. After three weeks of intensive intervention, the patient's condition stabilized, and he was successfully transferred out of the neurosurgical intensive care unit. At the 6-month postoperative follow-up, the patient's modified Rankin Scale (mRS) score was 3. Neurocritical care patients represent a high-risk population for acute pulmonary embolism. Bedside ultrasound facilitates the early identification of pulmonary embolism in these high-risk individuals. Utilizing an MDT to formulate individualized clinical intervention strategies is crucial for balancing the management of intermediate-to-high-risk pulmonary embolism with the risk of intracranial hemorrhage.

Monitoring the quality of cardiopulmonary resuscitation (CPR) in patients with cardiac arrest remains challenging in emergency and resuscitation processes. Achieving seamless integration between different links in the chain of survival and maintaining high-quality chest compressions while rapidly assessing the perfusion status of vital organs is crucial for evaluating the effectiveness of CPR and predicting patient outcomes. Current CPR quality monitoring primarily includes the assessment of CPR technique and the monitoring of circulation in patients with cardiac arrest. However, the indicators of compression effectiveness do not objectively reflect peripheral perfusion status. In the fast-paced environment of emergency care, quickly assessing the effectiveness of CPR and related tissue perfusion and accurately identifying the patient's status of spontaneous circulation is of significant importance. To address this, the medical staff of The First Affiliated Hospital of Huzhou Normal University has designed a brachial artery blood flow cuff during CPR and has obtained a National Utility Model Patent of China (ZL 2019 2 1478870.4). The brachial artery blood flow cuff during CPR comprises a blood pressure monitoring cuff, a dual fixation mechanism, an ultrasound blood flow measurement probe, and an integrated signal acquisition and display system. Its velcro-and-hook dual-fixation design ensures stability and reliability of cuff during emergency procedures. The long probe covers the antecubital fossa, enabling rapid and accurate acquisition of blood flow signals. The signal receiver and display screen provide real-time visualization of the blood flow waveform, which can, to some extent, indirectly reflect intracranial arterial hemodynamics. The brachial artery blood flow cuff during CPR can monitor CPR-related forward blood flow and perfusion of vital organs, thereby guiding high-quality CPR and rapidly assessing the patient's circulatory status during resuscitation. It offers the advantages of rapid and secure fixation, easy operation, and clear interpretation of results, showing good clinical application value.