BACKGROUND Bacteremia,which is a major cause of mortality in patients with acute cholangitis,induces hyperactive immune response and mitochondrial dysfunction.Presepsin is responsible for pathogen recognition by innat...BACKGROUND Bacteremia,which is a major cause of mortality in patients with acute cholangitis,induces hyperactive immune response and mitochondrial dysfunction.Presepsin is responsible for pathogen recognition by innate immunity.Acylcarnitines are established mitochondrial biomarkers.AIM To clarify the early predictive value of presepsin and acylcarnitines as biomarkers of severity of acute cholangitis and the need for biliary drainage.METHODS Of 280 patients with acute cholangitis were included and the severity was stratified according to the Tokyo Guidelines 2018.Blood presepsin and plasma acylcarnitines were tested at enrollment by chemiluminescent enzyme immunoassay and ultra-high-performance liquid chromatography-mass spectrometry,respectively.RESULTS The concentrations of presepsin,procalcitonin,short-and medium-chain acylcarnitines increased,while long-chain acylcarnitines decreased with the severity of acute cholangitis.The areas under the receiver operating characteristic curves(AUC)of presepsin for diagnosing moderate/severe and severe cholangitis(0.823 and 0.801,respectively)were greater than those of conventional markers.The combination of presepsin,direct bilirubin,alanine aminotransferase,temperature,and butyryl-L-carnitine showed good predictive ability for biliary drainage(AUC:0.723).Presepsin,procalcitonin,acetyl-L-carnitine,hydroxydodecenoyl-Lcarnitine,and temperature were independent predictors of bloodstream infection.After adjusting for severity classification,acetyl-L-carnitine was the only acylcarnitine independently associated with 28-d mortality(hazard ratio 14.396;P<0.001)(AUC:0.880).Presepsin concentration showed positive correlation with direct bilirubin or acetyl-L-carnitine.CONCLUSION Presepsin could serve as a specific biomarker to predict the severity of acute cholangitis and need for biliary drainage.Acetyl-L-carnitine is a potential prognostic factor for patients with acute cholangitis.Innate immune response was associated with mitochondrial metabolic dysfunction in acute cholangitis.展开更多
BACKGROUND:This study aimed to explore the changes of programmed death-ligand 1(PDL1)and programmed death-1(PD-1)expression on antigen-presenting cells(APCs)and evaluate their association with organ failure and mortal...BACKGROUND:This study aimed to explore the changes of programmed death-ligand 1(PDL1)and programmed death-1(PD-1)expression on antigen-presenting cells(APCs)and evaluate their association with organ failure and mortality during early sepsis.METHODS:In total,40 healthy controls and 198 patients with sepsis were included in this study.Peripheral blood was collected within the first 24 h after the diagnosis of sepsis.The expression of PDL1 and PD-1 was determined on APCs,such as B cells,monocytes,and dendritic cells(DCs),by flow cytometry.Cytokines in plasma,such as interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),IL-6,IL-10,and IL-17A were determined by Luminex assay.RESULTS:PD-1 expression decreased significantly on B cells,monocytes,myeloid DCs(mDCs),and plasmacytoid DCs(pDCs)as the severity of sepsis increased.PD-1 expression was also markedly decreased in non-survivors compared with survivors.In contrast,PD-L1 expression was markedly higher on mDCs,pDCs,and monocytes in patients with sepsis than in healthy controls and in non-survivors than in survivors.The PD-L1 expression on APCs(monocytes and DCs)was weakly related to organ dysfunction and infl ammation.The area under the receiver operating characteristic curve(AUC)of the PD-1 percentage of monocytes(monocyte PD-1%)+APACHE II model(0.823)and monocyte PD-1%+SOFA model(0.816)had higher prognostic value than other parameters alone.Monocyte PD-1%was an independent risk factor for 28-day mortality.CONCLUSION:The severity of sepsis was correlated with PD-L1 or PD-1 over-expression on APCs.PD-L1 in monocytes and DCs was weakly correlated with infl ammation and organ dysfunction during early sepsis.The combination of SOFA or APACHE II scores with monocyte PD-1%could improve the prediction ability for mortality.展开更多
BACKGROUND Biliary decompression is well known to greatly decrease the risks of mortality in acute cholangitis(AC).Although early biliary drainage is recommended by the treatment guidelines for AC,the best time for pe...BACKGROUND Biliary decompression is well known to greatly decrease the risks of mortality in acute cholangitis(AC).Although early biliary drainage is recommended by the treatment guidelines for AC,the best time for performing this procedure is yet to be established.Furthermore,since the clinical outcomes of patients with severe AC vary dramatically,screening for patients that could benefit the most from early drainage would be more beneficial than the drainage performed based on the severity grade criteria.AIM To investigate the optimal drainage timing for AC patients with each disease severity grade and organ dysfunction.METHODS In this retrospective monocenter cohort analysis,we reviewed 1305 patients who were diagnosed with AC according to the Tokyo guidelines 2018 at a Chinese tertiary hospital between July 2016 and December 2020.Demographic characteristics including age and sex,clinical and laboratory characteristics,and imaging findings of each patient were obtained from electronic medical records.We investigated the all-cause in-hospital mortality(IHM),hospital length of stay(LOS),and hospitalization costs associated with the timing of biliary drainage according to the severity grading and different dysfunctioning organs and predictors[age,white blood cell(WBC)count,total bilirubin,albumin,lactate,malignant obstruction,and Charlton comorbidity index(CCI)].RESULTS Biliary drainage within 24 or 48 h in Grade Ⅲ AC patients could dramatically decrease IHM(3.9%vs 9.0%,P=0.041;4%vs 9.9%,P=0.018,respectively),while increasing LOS and hospitalization costs.Multivariate logistic analysis revealed that neurological,respiratory,renal,and cardiovascular dysfunctions,hypoalbuminemia,and malignant obstruction were significantly associated with IHM(odds ratio=5.32,2.541,6.356,4.021,5.655,and 7.522;P<0.001,P=0.016,P<0.001,P=0.012,P<0.001,and P<0.001;respectively).Biliary decompression performed within 12 h of admission significantly decreased the IHM in AC patients with neurological dysfunction(0%vs 17.3%,P=0.041)or with serum lactate>2 mmol/L(0%vs 5.4%,P=0.016).In the subgroup of AC patients with renal dysfunction,abnormal WBC count,hyperbilirubinemia,or hypoalbuminemia,early drainage(<24 h)reduced the IHM(3.6%vs 33.3%,P=0.004;1.9%vs 5.8%,P=0.031;1.7%vs 5.0%,P=0.019;0%vs 27%,P=0.026;respectively).The IHM was lower in patients with AC combined with hepatic dysfunction,malignant obstruction,or a CCI>3 who had undergone biliary drainage within 48 h(2.6%vs 20.5%,P=0.016;3.0%vs 13.5%,P=0.006;3.4%vs 9.6%,P=0.021;respectively).CONCLUSION Biliary drainage within 12 h is beneficial for AC patients with neurological or cardiovascular dysfunction,while complete biliary decompression within 24 h of admission is recommended for treating patients with Grade Ⅲ AC.展开更多
BACKGROUND: Venous thromboembolism(VTE), including both deep vein thrombosis(DVT) and pulmonary embolism(PE), is a common, lethal disorder that affects hospitalized and nonhospitalized patients. This study aimed to re...BACKGROUND: Venous thromboembolism(VTE), including both deep vein thrombosis(DVT) and pulmonary embolism(PE), is a common, lethal disorder that affects hospitalized and nonhospitalized patients. This study aimed to review the progress in the research into VTE.DATA SOURCES: We reviewed the studies about VTE and verified different genetic polymoriphisms of VTE.RESULTS: The pathogenesis of VTE involves hereditary and acquired factors. Many studies indicated that the disorder of coagulation and fibirnolytic system is of utmost importance to this disease. Genetic polymoriphism-related VTE demonstrated significant differences among geographies and ethnicities.CONCLUSION: VTE has many risk factors, but genetic factors play an important role.展开更多
BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum leve...BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.展开更多
BACKGROUND:The study aimed to explore the effects of hypothermia state induced by4 ℃ normal saline(NS) on liver biochemistry,enzymology and morphology after restoration of spontaneous circulation(ROSC) by cardiopulmo...BACKGROUND:The study aimed to explore the effects of hypothermia state induced by4 ℃ normal saline(NS) on liver biochemistry,enzymology and morphology after restoration of spontaneous circulation(ROSC) by cardiopulmonary resuscitation(CPR) in swine.METHODS:After 4 minutes of ventricular fibrillation(VF),standard CPR was carried out.Then the survivors were divided into two groups:low temperature group and normal temperature group.The low temperature(LT) group(n-5) received continuously 4 °C NS at the speed of 1.33 mL/kg per minute for 22 minutes,then at the speed lowering to 10 mL/kg per hour.The normal temperature(NT) group(n-5) received NS with normal room temperature at the same speed of the LT group.Hemodynamic status and oxygen metabolism were monitored and the levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST) and lactate dehydrogenase(LDH) were measured in blood samples obtained at baseline and at 10 minutes,2 hours and 4 hours after ROSC.At 24 hours after ROSC,the animals were killed and the liver was removed to determine the Na^+-K^+-ATPase and Ca^(2+)-ATPase enzyme activities and histological changes under a light or electron microscope.RESULTS:Core temperature was decreased in the LT group(P<0.05),while HR,MAP and CPP were not significantly decreased(P>0.05) compared with the NT group(P>0.05).The oxygen extraction ratio was lower in the LT group than in the NT group(P<0.05).The serum levels of ALT,AST and LDH increased in both groups but not significantly in the LT group.The enzyme activity of liver ATP was much higher in the LT group(Na^+-K^+-ATP enzyme:8.64±3.32 U vs.3.28±0.71 U;Ca^(2+)-ATP enzyme:10.92±2.12 U vs.2.75±0.78 U,P<0.05).The LT group showed less cellular edema,inflammation and few damaged mitochondria as compared with the NT group.CONCLUSION:These data suggested that infusing 4 °C NS continuously after ROSC could quickly lower the core body temperature,while maintaining a stable hemodynamic state and balancing oxygen metabolism,which protect the liver in terms of biochemistry,enzymology and histology after CPR.展开更多
BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery re...BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme(ACE)2-angiotensin(Ang)(1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor(AT1)axis(ACE2/ACE axes)ratio on pulmonary artery lesion after return of spontaneous circulation(ROSC).METHODS:To establish a porcine massive APE with CA model,autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg(1 mmHg=0.133 kPa).Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation.Pigs were divided into four groups of five pigs each:control group,APE-CA group,ROSC-saline group,and ROSC-captopril group,to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril.RESULTS:Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells.Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor(VEGF)in the APE-CA group compared with the control group.Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC.Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax)ratio and decreasing cleaved caspase-3 expression.CONCLUSION:Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.展开更多
1.Introduction Sudden cardiac death(SCD)refers to sudden death due to a variety of cardiac causes.It is manifested as a sudden loss of consciousness,cardiac arrest,and respiratory arrest and generally shows early symp...1.Introduction Sudden cardiac death(SCD)refers to sudden death due to a variety of cardiac causes.It is manifested as a sudden loss of consciousness,cardiac arrest,and respiratory arrest and generally shows early symptoms that are atypical and not easily detected[1].According to a recent study,nearly 544000 patients suffer from SCD every year in China[2].展开更多
BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsi...BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.展开更多
BACKGROUND: Cardiac arrest(CA) is a critical condition that is a concern to healthcare workers. Comparative studies on extracorporeal cardiopulmonary resuscitation(ECPR) and conventional cardiopulmonary resuscitation(...BACKGROUND: Cardiac arrest(CA) is a critical condition that is a concern to healthcare workers. Comparative studies on extracorporeal cardiopulmonary resuscitation(ECPR) and conventional cardiopulmonary resuscitation(CCPR) technologies have shown that ECPR is superior to CCPR. However, there is a lack of studies that compare the protective effects of these two resuscitative methods on organs. Therefore, we aim to perform experiments in swine models of ventricular fibrillation-induced CA to study whether the early application of ECPR has advantages over CCPR in the lung injury and to explore the protective mechanism of ECPR on the post-resuscitation pulmonary injury.METHODS: Sixteen male swine were randomized to CCPR(CCPR;n=8;CCPR alone) and ECPR(ECPR;n=8;extracorporeal membrane oxygenation with CCPR) groups, with the restoration of spontaneous circulation at 6 hours as an endpoint. RESULTS: For the two groups, the survival rates between the two groups were not statistically significant(P>0.05), the blood and lung biomarkers were statistically significant(P<0.05), and the extravascular lung water and pulmonary vascular permeability index were statistically significant(P<0.01). Compared with the ECPR group, electron microscopy revealed mostly vacuolated intracellular alveolar type II lamellar bodies and a fuzzy lamellar structure with widening and blurring of the blood-gas barrier in the CCPR group.CONCLUSIONS: ECPR may have pulmonary protective effects, possibly related to the regulation of alveolar surface-active proteins and mitigated oxidative stress response postresuscitation.展开更多
BACKGROUND Acute cholangitis is caused by bacterial infection and has high morbidity and mortality risk.The grade of cholangitis can guide clinical treatment from single antibiotic treatment to biliary drainage.With t...BACKGROUND Acute cholangitis is caused by bacterial infection and has high morbidity and mortality risk.The grade of cholangitis can guide clinical treatment from single antibiotic treatment to biliary drainage.With the introduction of white blood cell(WBC)count,C-reactive protein(CRP),and total bilirubin(T-Bil)into the diagnostic criteria and severity grading for acute cholangitis,the diagnosis rate and grading have significantly improved.However,early risk stratification assessments are challenging in the emergency department.Therefore,we hope to find an ideal predictive biomarker for cholangitis grade.Presepsin is a promising biomarker for the early diagnosis,severity,and prognosis of acute bacterial infections.AIM To assess the grading value of presepsin in patients with acute cholangitis.METHODS This clinical study was conducted at the Beijing Friendship Hospital,a 2000-bed teaching hospital with approximately 200000 emergency admissions per year.In this prospective observational study,336 patients with acute cholangitis meeting the Tokyo Guidelines 2018 diagnostic criteria in the emergency department from May 2019 to December 2020 were analyzed.WBC count,CRP,procalcitonin(PCT),presepsin,T-Bil,and blood culture results were collected.The values were compared using the Pearsonχ2 test,Fisher’s exact test,or Mann-Whitney U test.The area under the receiver operating characteristic curve(AUC)of the value was examined using the Delong test.The correlations among the key research indicators were determined using Pearson correlation.RESULTS In total,336 patients were examined,which included 107,106,and 123 patients classified as having mild,moderate,and severe cholangitis,respectively.WBC count,CRP,PCT,presepsin,T-Bil,direct bilirubin,and sequential organ failure assessment scores of moderate and severe cholangitis patients were higher than those of mild cholangitis patients(P=0.000).The AUC of presepsin in predicting moderate acute cholangitis was 0.728,which was higher than that of CRP(0.631,P=0.043)and PCT(0.585,P=0.002),and same as that of WBC count(0.746,P=0.713)and T-Bil(0.686,P=0.361).The AUC of presepsin in predicting severe acute cholangitis was 0.715,which was higher than that of WBC count(0.571,P=0.008),CRP(0.590,P=0.009),PCT(0.618,P=0.024),and T-Bil(0.559,P=0.006).The presepsin levels in the positive blood culture group were higher(2830.8pg/mLvs1987.8pg/mL,P=0.000),and the AUC of presepsin(0.688)proved that it was a good biomarker for predicting positive bacterial culture.CONCLUSION Presepsin can predict positive blood culture in patients with acute cholangitis.It is superior to WBC count,CRP,PCT,and T-Bil for the risk stratification of acute cholangitis.展开更多
BACKGROUND:This study aimed to determine the potential protective effect of inducing hypertransfusion to the gastrointestinal tract following a porcine model of cardiac arrest and cardiopulmonary resuscitation(CPR) by...BACKGROUND:This study aimed to determine the potential protective effect of inducing hypertransfusion to the gastrointestinal tract following a porcine model of cardiac arrest and cardiopulmonary resuscitation(CPR) by evaluating the influence of gastrointestinal ultrastructure,ATPase and serum diamine oxidase.METHODS:Ventricular fibrillation was induced by programmed electrical stimulation in 16 male domestic pigs(n=8/group).Four minutes after ventricular fibrillation,CPR was performed.The pigs that successfully restored spontaneous circulation received intravenous infusion of either norepinephrine to maintain the mean arterial pressure at 130%of the baseline before ventricular fibrillation or normal saline.Serum diamine oxidase and gastrointestinal ATPase activity were determined,and histopathological examination of the gastrointestinal tract was performed by light and electron microscopy.RESULTS:CPR caused significant injury to the gastrointestinal tract,elevating serum diamine oxidase and causing destruction of intestinal microvillus in control animals.Na^+-K^+ ATPase and Ca^(2+)ATPase activity in gastric tissue were significantly elevated in animals receiving hypertransfusion treatment compared with the control animals.Hypertransfusion also significantly reduced serum diamine oxidase to below control levels after CPR.Moreover,severe injury sustained by the gastrointestinal tissue was markedly ameliorated under hypertransfusion conditions compared with the control animals.CONCLUSIONS:Gastrointestinal injury and abnormal energy metabolism were strikingly evident following CPR.Hypertransfusion inducing hypertension can improve energy metabolism and ameliorate gastrointestinal mucosal injury,indicating that hypothermia significantly ameliorates gastrointestinal injury sustained following cardiac arrest.展开更多
BACKGROUND Acute pancreatitis(AP) is an inflammatory disorder of the pancreas with an unpredictable course of illness. A major challenge of AP is the early identification of patients at high-risk for organ failure and...BACKGROUND Acute pancreatitis(AP) is an inflammatory disorder of the pancreas with an unpredictable course of illness. A major challenge of AP is the early identification of patients at high-risk for organ failure and death. However, scoring systems are complicated and time consuming, and the predictive values for the clinical course are vague.AIM To determine whether the dynamic changes in presepsin levels can be used to evaluate the severity of disease and outcome of AP.METHODS In this multicentric cohort study, 133 patients with AP were included. Clinical severity was dynamically evaluated using the 2012 revised Atlanta Classification. Blood presepsin levels were measured at days 1, 3, 5 and 7 after admission by chemiluminescent enzyme immunoassay.RESULTS The median concentration of presepsin increased and the clearance rate of presepsin decreased with disease severity and organ failure in AP patients. The presepsin levels on days 3, 5 and 7 were independent predictors of moderately severe and severe AP with time-specific area under the curve(AUC) values of 0.827, 0.848 and 0.867, respectively. The presepsin levels positively correlated with bedside index of severity in AP, Ranson, acute physiology and chronic health evaluation II, computed tomography severity index and Marshall scores. Presepsin levels on days 3, 5 and 7 were independent predictors of 28-d mortality of AP patients with AUC values of 0.781, 0.846 and 0.843, respectively.CONCLUSION Blood presepsin levels within 7 d of admission were associated with and may be useful to dynamically predict the severity of disease course and 28-d mortality in AP patients.展开更多
Carbon nanofibers(CNFs)have been extensively studied as anode materials for sodium-ion batteries due to their high conductivity,large aspect ratio and good electrochemical stability.The low specific capacity and low f...Carbon nanofibers(CNFs)have been extensively studied as anode materials for sodium-ion batteries due to their high conductivity,large aspect ratio and good electrochemical stability.The low specific capacity and low first cycle efficiency of CNFs,however,have hindered its practical application.Herein,we present a facile strategy to synthesize a novel CNFs decorated with Cu/CuO nanoparticles(Cu-CNFs)using magnetron sputtering method.Cu/CuO nanoparticles were uniformly distributed on the surface of CNFs.According to the density functional theory(DFT)calculation,Cu/CuO nanoparticles d-orbitals and CNFs p-orbitals present hybridization states,and the Na~+adsorption energy of the modified CNFs decreases from-2.14 to-2.97 eV.The Cu-CNFs composites exhibit excellent sodium storage properties,presenting a desirable initial Coulombic efficiency of 76%and a high specific reversible capacity of 300 mAh·g^(-1)at 0.1 A·g^(-1)after 400 cycles.Cu-CNFs anode has excellent cycling stability under high current density,maintaining a high capacity of 150 mAh·g^(-1)at 1 A·g^(-1)after 6000 cycles.Using magnetron sputtering to regulate the electronic structure provides a new thought for improving the electrochemical performance of carbon materials.展开更多
Objective： Sepsis remains a leading cause of death in many Intensive Care Units worldwide, lmmunosuppression has been a primary locus of sepsis research as a key pathophysiological mechanism. Given the important role...Objective： Sepsis remains a leading cause of death in many Intensive Care Units worldwide, lmmunosuppression has been a primary locus of sepsis research as a key pathophysiological mechanism. Given the important role of the negative costimulatory molecules programmed cell death-1 （PD-1） and programmed death-ligand 1 （PD-LI） in the occurrence of immunosuppression during sepsis, we reviewed literatures related to the PD-1/PD-L 1 pathway to examine its potential as a new target for sepsis treatment. Data Sources： Studies of the association between PD-I/PD-LI and sepsis published tip to January 31, 2017, were obtained by searching tile PubMed database. Study Selection： English language studies, including those based on animal models, clinical research, and reviews, with data related to PD- 1/PD-L I and sepsis, were evaluated. Results： lmmunomodulatory therapeutics could reverse the deactivation of immune cells caused by sepsis and restore immune cell activation and function. Blockade of＇the PD-1/PD-LI pathway could reduce the exhaustion ofT-cells and enhance the proliferation and activation ofT-cells. Conclusions： The anti-PD- I/PD-L 1 pathway shows promise as a new target for sepsis treatment. This review provides a basis for clinical trials and Iiiture studies aimed at revaluating the efficacy and safety of this targeted approach.展开更多
Background:Acute heart failure(AHF)is the most common disease in emergency departments(EDs).However,clinical data exploring the outcomes of patients presenting AHF in EDs are limited,especially the long-term outcomes....Background:Acute heart failure(AHF)is the most common disease in emergency departments(EDs).However,clinical data exploring the outcomes of patients presenting AHF in EDs are limited,especially the long-term outcomes.The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective,multicenter,cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1,2011 and September 23,2012.Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4%and 49.6%,respectively.The median overall survival was 34 months.Independent predictors of 5-year mortality were patient age(hazard ratio[HR]:1.027,95 confidence interval[CI]:1.023-1.030),body mass index(BMI)(HR:0.971,95%CI:0.958-0.983),fatigue(HR:1.127,95%CI:1.009-1.258),ascites(HR:1.190,95%CI:1.057-1.340),hepatic jugular reflux(HR:1.339,95%CI:1.140-1.572),New York Heart Association(NYHA)class III to IV(HR:1.511,95%CI:1.291-1.769),heart rate(HR:1.003,95%CI:1.001-1.005),diastolic blood pressure(DBP)(HR:0.996,95%CI:0.993-0.999),blood urea nitrogen(BUN)(HR:1.014,95%CI:1.008-1.020),B-type natriuretic peptide(BNP)/N-terminal pro-B-type natriuretic peptide(NT-proBNP)level in the third(HR:1.426,95%CI:1.220-1.668)or fourth quartile(HR:1.437,95%CI:1.223-1.690),serum sodium(HR:0.980,95%CI:0.972-0.988),serum albumin(HR:0.981,95%CI:0.971-0.992),ischemic heart diseases(HR:1.195,95%CI:1.073-1.331),primary cardiomyopathy(HR:1.382,95%CI:1.183-1.614),diabetes(HR:1.118,95%CI:1.010-1.237),stroke(HR:1.252,95%CI:1.121-1.397),and the use of diuretics(HR:0.714,95%CI:0.626-0.814),(3-blockers(HR:0.673,95%CI:0.588-0.769),angiotensin-converting enzyme inhibitors(ACEIs)(HR:0.714,95%CI:0.604-0.845),angiotensin-II receptor blockers(ARBs)(HR:0.790,95%CI:0.646-0.965),spironolactone(HR:0.814,95%CI:0.663-0.999),calcium antagonists(HR:0.624,95%CI:0.531-0.733),nitrates(HR:0.715,95%CI:0.631-0.811),and digoxin(HR:0.579,95%CI:0.465-0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF.Age,BMI,fatigue,ascites,hepatic jugular reflux,NYHA class III to IV,heart rate,DBP,BUN,BNP/NT-proBNP level in the third or fourth quartile,serum sodium,serum albumin,ischemic heart diseases,primary cardiomyopathy,diabetes,stroke,and the use of diuretics,P-blockers,ACEIs,ARBs,spironolactone,calcium antagonists,nitrates,and digoxin were independently associated with 5-year all-cause mortality.展开更多
Background： Shen-Fu injection （SFI） can attenuate ischemia-reperfusion injury, protect cardiac function, and improve microcirculation during cardiopulmonary resuscitation. We hypothesized that SFI may also have an ...Background： Shen-Fu injection （SFI） can attenuate ischemia-reperfusion injury, protect cardiac function, and improve microcirculation during cardiopulmonary resuscitation. We hypothesized that SFI may also have an influence on myocardial metabolism during ventrictdar fibrillation （VF）. In this study, we used SFI pretreatment prior to VF to discuss the changes of myocardial metabolism and catecholamine （CA） levels during untreated VF, trying to provide new evidence to the protection of SFI to myocardiurn. Methods： Twenty-four pigs were divided into three groups： Saline group （SA group）, SFI group, and SHAM operation group （SHAM group）. Thirty minutes prior to the induction of VF, the SFI group received 0.24 mg/ml SFI through an intravenous injection： the SA group received an equal amount of sodium chloride solution. The interstitial fluid from the left ventricle （LV） wall was collected through the microdialysis tubes during VF. Adenosine diphosphate （ADP）, adenosine triphosphate （ATP）, and Na^＋-K^＋-ATPase and Ca2^＋-ATPase enzyme activities were measured after untreated VF. Peak-to-trough VF amplitude and median frequency were analyzed for each of these 5-s intervals. Results： The levels of glucose and glutamate were lower after VF in both the SA and SFI groups, compared with baseline, and the levels in the SFI group were higher than those in the SA group. Compared with baseline, the levels of lactate and the lactate/pyruvate ratio increased after VF in both SA and SFI groups, and the levels in the SFI group were lower than those in the SA group. In both the SA and SFI groups, the levers of dopamine, norepinephrine, and epinephrine increased significantly. There were no statistical differences between the two groups. The content of ATE ADE and phosphocreatine in the SF1 group was higher than those in the SA group. The activity ofLV Na^＋-K^＋-ATPase was significantly higher in the SFI group than in the SA group. Amplitude mean spectrum area （AMSA） was significantly lower in the SA and SFI groups at 8- and 12-min compared with 4-min. The AMSA in the SFI group was higher than that in the SA group at each time point during untreated VF. Conclusions： SFI pretreatment can improve myocardial metabolism and reduce energy exhaustion during VF, and it does not aggravate the excessive secretion of endogenous CAs.展开更多
Background：Morbidity and mortality after resuscitation largely depend on the recovery of brain function.Ventricular fibrillation cardiac arrest （VFCA） and asphyxial cardiac arrest （ACA） are the two most prevalent...Background：Morbidity and mortality after resuscitation largely depend on the recovery of brain function.Ventricular fibrillation cardiac arrest （VFCA） and asphyxial cardiac arrest （ACA） are the two most prevalent causes of sudden cardiac death.Up to now,most studies have focused on VFCA.However,results from the two models have been largely variable.So,it is necessary to characterize the features of postresuscitation cerebral metabolism of both models.Methods：Forty-four Wuzhishan miniature inbred pigs were randomly divided into three groups：18 for VFCA group,ACA group,respectively,and other 8 for sham-operated group （SHAM）.VFCA was induced by programmed electric stimulation,andACA was induced by endotracheal tube clamping.After 8 min without treatment,standard cardiopulmonary resuscitation （CPR） was initiated.Following neurological deficit scores （NDS） were evaluated at 24 h after achievement of spontaneous circulation,cerebral metabolism showed as the maximum standardized uptake value （SUVmax） was measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography.Levels of serum markers of brain injury,neuron specific enolase （NSE）,and S100β were quantified with an enzyme-linked immunosorbent assay.Results：Compared with VFCA group,fewer ACA animals achieved restoration of spontaneous circulation （61.1% vs.94.4%,P 〈 0.01） and survived 24-h after resuscitation （38.9% vs.77.8%,P 〈 0.01） with worse neurological outcome （NDS：244.3 ± 15.3 vs.168.8 ± 9.71,P 〈 0.01）.The CPR duration of ACA group was longer than that of VFCA group （8.1 ± 1.2 min vs.4.5 ± 1.1 min,P 〈 0.01）.Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA （P 〈 0.05 or P 〈 0.01）.Higher serum biomarkers of brain damage （NSE,S100β） were found inACA than VFCA after resuscitation （P 〈 0.01）.Conclusions：Compared with VFCA,ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse neurological outcome.展开更多
Background:Retroperitoneal fibrosis (RPF) is an uncommon disease that is characterized by development of fibrosclerotic tissues involving retroperitoneal structures.This study aimed to investigate the clinical feature...Background:Retroperitoneal fibrosis (RPF) is an uncommon disease that is characterized by development of fibrosclerotic tissues involving retroperitoneal structures.This study aimed to investigate the clinical features of 30 patients with RPF in a single center in Beijing in a 10-year period.Methods:We retrospectively analyzed clinical data on demographic characteristics,clinical manifestations,laboratory findings,radiological findings,modalities of treatments,outcomes and prognosis of 30 patients with RPF.Patients were treated in Beijing Chao-Yang Hospital between January 2003 and December 2013.Results:The mean age of patients with RPF was 56.7 ± 14.4 years.Twenty-three patients were men and seven patients were women.Acute phase reactants were elevated in most patients.Rheumatic factor was positive in 4/25 (16.0％) patients,and antinuclear antibody was positive in 6/22 (27.3％) patients.Elevation of IgG4 was observed in 9/22 (40.9％) patients.The most common type was I + Ⅲ (n =13),followed by Ⅰ + Ⅱ +Ⅲ (n =12).Five patients undertook an 18F-fluoro-deoxy-D-glucose positron emission tomography examination and increased uptake was detected in four patients.Eight patients received combination therapy with glucocorticoids and tamoxifen.Surgical intervention treatments included intraureteral double-J stent implantation (n =26),percutaneous nephrostomy (n =2),open ureterolysis and intraperitonealization of the ureters (n =5) and Iaparoscopic ureterolysis and intraperitonealization of the ureters (n =5).Three patients underwent hemodialysis because of renal failure.Conclusions:Clinical characteristics of RPF patients in our study are similar to those previously reported.Steroids and immunosuppressive therapy combined with ureterolysis could be a viable choice of treatment for RPF.More prospective,multi-center studies with a longer follow-up are warranted.展开更多
Background： Sepsis is one of the main canses of mortality in critically ill patients following progression to septic shock. To investigate the pathophysiologic changes of sepsis, we developed a novel porcine model of...Background： Sepsis is one of the main canses of mortality in critically ill patients following progression to septic shock. To investigate the pathophysiologic changes of sepsis, we developed a novel porcine model of septic shock induced by acute respiratory distress syndrome （ARDS） due to methicillin-resistant Staphylococcus aureus （MRSA） pneumonia. Methods： Twenty-six male Landraces （Lvyuanweiye, Beijing, China） weighing 30 - 2 kg were divided into lbur groups： sham gronp （SH： n = 5）; cotton smoke inhalation group （SM; n = 6）; MRSA pneumonia group （MR; n = 6）; and septic shock group with cotton smoke inhalation ＋ MRSA pneumonia （SS; n = 9）. Extensive hemodynamics, oxygen dynamics, and lung function were monitored for 24 11 following the injury or until death. Tissues were collected, and histopathology evaluations were carried out. Results： Blood cultures from 6 of 9 animals in the SS group were positive for MRSA. Two hours following the injury, decreased mean arterial blood pressure （60 70 mmHg） and cardiac index （〈2 L-rain -＇m --） were observed in the animals in the SS group, while systemic vascular resistance index was increased. The hemodynamic characteristics of septic shock were only observed in the SS group but not significant in the other groups, The PO_JFiO2 in the SM and SS groups decreased to 300 and 100, respectively. In the SS group, extravascular lung water index increased to 20 ml/kg, whereas thoracopulmonary compliance decreased to 10 ml/H2O after injury. Deterioration of pulmonary function in the SS group was more serious than the SM and MR groups. Severe lung injury in the SS group was confinaaed by the histopathology evaluations. The lung injury confirmed by high-resolution thin-section computed tomography and histopathology in the SS group was more serious than those of other groups. Conclusions： In the present study, we developed a novel porcine model of septic shock induced by ARDS due to severe MRSA pneumonia with characteristic hyperdynamic and hypodynamic phases in 24 h, which mimicked the hemodynamic changing of septic shock in human.展开更多
基金National Natural Science Foundation of China,No.81773931Beijing Municipal Administration of Hospitals’ Youth Program,No.QML20170105Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support "Yangfan" Project,No.ZYLX201804
文摘BACKGROUND Bacteremia,which is a major cause of mortality in patients with acute cholangitis,induces hyperactive immune response and mitochondrial dysfunction.Presepsin is responsible for pathogen recognition by innate immunity.Acylcarnitines are established mitochondrial biomarkers.AIM To clarify the early predictive value of presepsin and acylcarnitines as biomarkers of severity of acute cholangitis and the need for biliary drainage.METHODS Of 280 patients with acute cholangitis were included and the severity was stratified according to the Tokyo Guidelines 2018.Blood presepsin and plasma acylcarnitines were tested at enrollment by chemiluminescent enzyme immunoassay and ultra-high-performance liquid chromatography-mass spectrometry,respectively.RESULTS The concentrations of presepsin,procalcitonin,short-and medium-chain acylcarnitines increased,while long-chain acylcarnitines decreased with the severity of acute cholangitis.The areas under the receiver operating characteristic curves(AUC)of presepsin for diagnosing moderate/severe and severe cholangitis(0.823 and 0.801,respectively)were greater than those of conventional markers.The combination of presepsin,direct bilirubin,alanine aminotransferase,temperature,and butyryl-L-carnitine showed good predictive ability for biliary drainage(AUC:0.723).Presepsin,procalcitonin,acetyl-L-carnitine,hydroxydodecenoyl-Lcarnitine,and temperature were independent predictors of bloodstream infection.After adjusting for severity classification,acetyl-L-carnitine was the only acylcarnitine independently associated with 28-d mortality(hazard ratio 14.396;P<0.001)(AUC:0.880).Presepsin concentration showed positive correlation with direct bilirubin or acetyl-L-carnitine.CONCLUSION Presepsin could serve as a specific biomarker to predict the severity of acute cholangitis and need for biliary drainage.Acetyl-L-carnitine is a potential prognostic factor for patients with acute cholangitis.Innate immune response was associated with mitochondrial metabolic dysfunction in acute cholangitis.
文摘BACKGROUND:This study aimed to explore the changes of programmed death-ligand 1(PDL1)and programmed death-1(PD-1)expression on antigen-presenting cells(APCs)and evaluate their association with organ failure and mortality during early sepsis.METHODS:In total,40 healthy controls and 198 patients with sepsis were included in this study.Peripheral blood was collected within the first 24 h after the diagnosis of sepsis.The expression of PDL1 and PD-1 was determined on APCs,such as B cells,monocytes,and dendritic cells(DCs),by flow cytometry.Cytokines in plasma,such as interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),IL-6,IL-10,and IL-17A were determined by Luminex assay.RESULTS:PD-1 expression decreased significantly on B cells,monocytes,myeloid DCs(mDCs),and plasmacytoid DCs(pDCs)as the severity of sepsis increased.PD-1 expression was also markedly decreased in non-survivors compared with survivors.In contrast,PD-L1 expression was markedly higher on mDCs,pDCs,and monocytes in patients with sepsis than in healthy controls and in non-survivors than in survivors.The PD-L1 expression on APCs(monocytes and DCs)was weakly related to organ dysfunction and infl ammation.The area under the receiver operating characteristic curve(AUC)of the PD-1 percentage of monocytes(monocyte PD-1%)+APACHE II model(0.823)and monocyte PD-1%+SOFA model(0.816)had higher prognostic value than other parameters alone.Monocyte PD-1%was an independent risk factor for 28-day mortality.CONCLUSION:The severity of sepsis was correlated with PD-L1 or PD-1 over-expression on APCs.PD-L1 in monocytes and DCs was weakly correlated with infl ammation and organ dysfunction during early sepsis.The combination of SOFA or APACHE II scores with monocyte PD-1%could improve the prediction ability for mortality.
文摘BACKGROUND Biliary decompression is well known to greatly decrease the risks of mortality in acute cholangitis(AC).Although early biliary drainage is recommended by the treatment guidelines for AC,the best time for performing this procedure is yet to be established.Furthermore,since the clinical outcomes of patients with severe AC vary dramatically,screening for patients that could benefit the most from early drainage would be more beneficial than the drainage performed based on the severity grade criteria.AIM To investigate the optimal drainage timing for AC patients with each disease severity grade and organ dysfunction.METHODS In this retrospective monocenter cohort analysis,we reviewed 1305 patients who were diagnosed with AC according to the Tokyo guidelines 2018 at a Chinese tertiary hospital between July 2016 and December 2020.Demographic characteristics including age and sex,clinical and laboratory characteristics,and imaging findings of each patient were obtained from electronic medical records.We investigated the all-cause in-hospital mortality(IHM),hospital length of stay(LOS),and hospitalization costs associated with the timing of biliary drainage according to the severity grading and different dysfunctioning organs and predictors[age,white blood cell(WBC)count,total bilirubin,albumin,lactate,malignant obstruction,and Charlton comorbidity index(CCI)].RESULTS Biliary drainage within 24 or 48 h in Grade Ⅲ AC patients could dramatically decrease IHM(3.9%vs 9.0%,P=0.041;4%vs 9.9%,P=0.018,respectively),while increasing LOS and hospitalization costs.Multivariate logistic analysis revealed that neurological,respiratory,renal,and cardiovascular dysfunctions,hypoalbuminemia,and malignant obstruction were significantly associated with IHM(odds ratio=5.32,2.541,6.356,4.021,5.655,and 7.522;P<0.001,P=0.016,P<0.001,P=0.012,P<0.001,and P<0.001;respectively).Biliary decompression performed within 12 h of admission significantly decreased the IHM in AC patients with neurological dysfunction(0%vs 17.3%,P=0.041)or with serum lactate>2 mmol/L(0%vs 5.4%,P=0.016).In the subgroup of AC patients with renal dysfunction,abnormal WBC count,hyperbilirubinemia,or hypoalbuminemia,early drainage(<24 h)reduced the IHM(3.6%vs 33.3%,P=0.004;1.9%vs 5.8%,P=0.031;1.7%vs 5.0%,P=0.019;0%vs 27%,P=0.026;respectively).The IHM was lower in patients with AC combined with hepatic dysfunction,malignant obstruction,or a CCI>3 who had undergone biliary drainage within 48 h(2.6%vs 20.5%,P=0.016;3.0%vs 13.5%,P=0.006;3.4%vs 9.6%,P=0.021;respectively).CONCLUSION Biliary drainage within 12 h is beneficial for AC patients with neurological or cardiovascular dysfunction,while complete biliary decompression within 24 h of admission is recommended for treating patients with Grade Ⅲ AC.
文摘BACKGROUND: Venous thromboembolism(VTE), including both deep vein thrombosis(DVT) and pulmonary embolism(PE), is a common, lethal disorder that affects hospitalized and nonhospitalized patients. This study aimed to review the progress in the research into VTE.DATA SOURCES: We reviewed the studies about VTE and verified different genetic polymoriphisms of VTE.RESULTS: The pathogenesis of VTE involves hereditary and acquired factors. Many studies indicated that the disorder of coagulation and fibirnolytic system is of utmost importance to this disease. Genetic polymoriphism-related VTE demonstrated significant differences among geographies and ethnicities.CONCLUSION: VTE has many risk factors, but genetic factors play an important role.
文摘BACKGROUND:Hyperglycemia has been detected in many critically ill patients in the department of emergency medicine.But its mechanism and prognosis have not been well elucidated.In this study,we measured the serum level of glycated hemoglobin A1C(HbA1c) in critically ill patients to evaluate the effects of hyperglycemia on the prognosis of the patients.METHODS:A total of 826 critically ill patients,who had been treated at the Department of Emergency Medicine of Chaoyang Hospital during October 2006 and November 2007,were divided into a diabetes mellitus group(n=184) and a non-diabetes mellitus group(642) according to whether they had diabetes mellitus.Fasting glucose and HbA1 c were measured in all patients.Those in the diabetes mellitus group were further assigned to a drug therapy subgroup and a non-drug therapy subgroup;the serum level of HbA1 c and its relationship with short-term outcome were evaluated.RESULTS:Fasting glucose increased in 78.8% of the patients(88.6%in the diabetes mellitus group,and 75.9%in the non-diabetes mellitus group,P<0.05),and HbA1 c was elevated in 45.5% of the patients(78.3% in the diabetes mellitus group,and 36.1%in the non-diabetes mellitus group,P<0.01).Fasting glucose,HbA1 c and 28-day mortality were improved more significantly(P<0.01) in the drug therapy subgroup than in the non-drug therapy subgroup.The 28-day mortality was more significantly different in patients with fasting blood glucose >8.33 mmol/L than in those with fasting blood glucose <8.33 mmol/L.CONCLUSIONS:Hyperglycemia of critically ill patients could not totally attribute to stress response,especially in those who have no history of diabetes mellitus.Prognosis of hyperglycemia may vary among critically ill patients.
文摘BACKGROUND:The study aimed to explore the effects of hypothermia state induced by4 ℃ normal saline(NS) on liver biochemistry,enzymology and morphology after restoration of spontaneous circulation(ROSC) by cardiopulmonary resuscitation(CPR) in swine.METHODS:After 4 minutes of ventricular fibrillation(VF),standard CPR was carried out.Then the survivors were divided into two groups:low temperature group and normal temperature group.The low temperature(LT) group(n-5) received continuously 4 °C NS at the speed of 1.33 mL/kg per minute for 22 minutes,then at the speed lowering to 10 mL/kg per hour.The normal temperature(NT) group(n-5) received NS with normal room temperature at the same speed of the LT group.Hemodynamic status and oxygen metabolism were monitored and the levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST) and lactate dehydrogenase(LDH) were measured in blood samples obtained at baseline and at 10 minutes,2 hours and 4 hours after ROSC.At 24 hours after ROSC,the animals were killed and the liver was removed to determine the Na^+-K^+-ATPase and Ca^(2+)-ATPase enzyme activities and histological changes under a light or electron microscope.RESULTS:Core temperature was decreased in the LT group(P<0.05),while HR,MAP and CPP were not significantly decreased(P>0.05) compared with the NT group(P>0.05).The oxygen extraction ratio was lower in the LT group than in the NT group(P<0.05).The serum levels of ALT,AST and LDH increased in both groups but not significantly in the LT group.The enzyme activity of liver ATP was much higher in the LT group(Na^+-K^+-ATP enzyme:8.64±3.32 U vs.3.28±0.71 U;Ca^(2+)-ATP enzyme:10.92±2.12 U vs.2.75±0.78 U,P<0.05).The LT group showed less cellular edema,inflammation and few damaged mitochondria as compared with the NT group.CONCLUSION:These data suggested that infusing 4 °C NS continuously after ROSC could quickly lower the core body temperature,while maintaining a stable hemodynamic state and balancing oxygen metabolism,which protect the liver in terms of biochemistry,enzymology and histology after CPR.
基金supported by grants from the National Natural Science Foundation of China(81773931 and 81374004)the Beijing Municipal Administration of Hospitals’Youth Program(QML20170105)+1 种基金the Natural Science Foundation of Beijing Municipality(7173253)the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support“Yangfan”Project(ZYLX201802)。
文摘BACKGROUND:Acute pulmonary embolism(APE)with cardiac arrest(CA)is characterized by high mortality in emergency due to pulmonary arterial hypertension(PAH).This study aims to determine whether early pulmonary artery remodeling occurs in PAH caused by massive APE with CA and the protective effects of increasing angiotensin-converting enzyme(ACE)2-angiotensin(Ang)(1-7)-Mas receptor axis and ACE-Ang II-Ang II type 1 receptor(AT1)axis(ACE2/ACE axes)ratio on pulmonary artery lesion after return of spontaneous circulation(ROSC).METHODS:To establish a porcine massive APE with CA model,autologous thrombus was injected into the external jugular vein until mean arterial pressure dropped below 30 mmHg(1 mmHg=0.133 kPa).Cardiopulmonary resuscitation and thrombolysis were delivered to regain spontaneous circulation.Pigs were divided into four groups of five pigs each:control group,APE-CA group,ROSC-saline group,and ROSC-captopril group,to examine the endothelial pathological changes and expression of ACE2/ACE axes in pulmonary artery with or without captopril.RESULTS:Histological analysis of samples from the APE-CA and ROSC-saline groups showed that pulmonary arterioles were almost completely occluded by accumulated endothelial cells.Western blotting analysis revealed a decrease in the pulmonary arterial ACE2/ACE axes ratio and increases in angiopoietin-2/angiopoietin-1 ratio and expression of vascular endothelial growth factor(VEGF)in the APE-CA group compared with the control group.Captopril significantly suppressed the activation of angiopoietin-2/angiopoietin-1 and VEGF in plexiform lesions formed by proliferative endothelial cells after ROSC.Captopril also alleviated endothelial cell apoptosis by increasing the B-cell lymphoma-2(Bcl-2)/Bcl-2-associated X(Bax)ratio and decreasing cleaved caspase-3 expression.CONCLUSION:Increasing the ACE2/ACE axes ratio may ameliorate pulmonary arterial remodeling by inhibiting the apoptosis and proliferation of endothelial cells after ROSC induced by APE.
基金Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2019-I2M-5-023)Hainan Provincial Science and Technology Major Project(No.ZDKJ201804)+2 种基金National Natural Science Foundation of China(No.81871611)National Natural Science Foundation of China(No.81760352)Project of Hainan Provincial Department of Education(No.Hnjg2019ZD-16)
文摘1.Introduction Sudden cardiac death(SCD)refers to sudden death due to a variety of cardiac causes.It is manifested as a sudden loss of consciousness,cardiac arrest,and respiratory arrest and generally shows early symptoms that are atypical and not easily detected[1].According to a recent study,nearly 544000 patients suffer from SCD every year in China[2].
文摘BACKGROUND:The aim of this study is to investigate the diagnostic and prognostic value of neutrophil CD64(nCD64)as a novel biomarker in sepsis patients.METHODS:One hundred fifty-one adult patients diagnosed with sepsis and 20 age-matched healthy controls were enrolled in the study.Patients with sepsis were further subdivided into a sepsis group and a septic shock group.nCD64 expression,serum procalcitonin(PCT)level,C-reactive protein(CRP)level,and white blood cell(WBC)count were obtained for each patient,and Sequential Organ Failure Assessment(SOFA)scores were calculated.RESULTS:nCD64 expression was higher in the sepsis group with confirmed infection than in the control group.The receiver operating characteristic(ROC)curve of nCD64 was higher than those of SOFA score,PCT,CRP and WBC for diagnosing infection.The area under the curve(AUC)of nCD64 combined with SOFA score was the highest for all parameters.The AUC of nCD64 for predicting 28-day mortality in sepsis was signifi cantly higher than those of PCT,CRP,and WBC,but slightly lower than that of SOFA score.The AUC of nCD64 or PCT combined with SOFA score was signifi cantly higher than that of any single parameter for predicting 28-day mortality.CONCLUSION:nCD64 expression and SOFA score are valuable parameters for early diagnosis of infection and prognostic evaluation of sepsis patients.
文摘BACKGROUND: Cardiac arrest(CA) is a critical condition that is a concern to healthcare workers. Comparative studies on extracorporeal cardiopulmonary resuscitation(ECPR) and conventional cardiopulmonary resuscitation(CCPR) technologies have shown that ECPR is superior to CCPR. However, there is a lack of studies that compare the protective effects of these two resuscitative methods on organs. Therefore, we aim to perform experiments in swine models of ventricular fibrillation-induced CA to study whether the early application of ECPR has advantages over CCPR in the lung injury and to explore the protective mechanism of ECPR on the post-resuscitation pulmonary injury.METHODS: Sixteen male swine were randomized to CCPR(CCPR;n=8;CCPR alone) and ECPR(ECPR;n=8;extracorporeal membrane oxygenation with CCPR) groups, with the restoration of spontaneous circulation at 6 hours as an endpoint. RESULTS: For the two groups, the survival rates between the two groups were not statistically significant(P>0.05), the blood and lung biomarkers were statistically significant(P<0.05), and the extravascular lung water and pulmonary vascular permeability index were statistically significant(P<0.01). Compared with the ECPR group, electron microscopy revealed mostly vacuolated intracellular alveolar type II lamellar bodies and a fuzzy lamellar structure with widening and blurring of the blood-gas barrier in the CCPR group.CONCLUSIONS: ECPR may have pulmonary protective effects, possibly related to the regulation of alveolar surface-active proteins and mitigated oxidative stress response postresuscitation.
基金by National Natural Science Foundation of China,No.81773931Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support“Yanfan”Project,No.ZYLX201802.
文摘BACKGROUND Acute cholangitis is caused by bacterial infection and has high morbidity and mortality risk.The grade of cholangitis can guide clinical treatment from single antibiotic treatment to biliary drainage.With the introduction of white blood cell(WBC)count,C-reactive protein(CRP),and total bilirubin(T-Bil)into the diagnostic criteria and severity grading for acute cholangitis,the diagnosis rate and grading have significantly improved.However,early risk stratification assessments are challenging in the emergency department.Therefore,we hope to find an ideal predictive biomarker for cholangitis grade.Presepsin is a promising biomarker for the early diagnosis,severity,and prognosis of acute bacterial infections.AIM To assess the grading value of presepsin in patients with acute cholangitis.METHODS This clinical study was conducted at the Beijing Friendship Hospital,a 2000-bed teaching hospital with approximately 200000 emergency admissions per year.In this prospective observational study,336 patients with acute cholangitis meeting the Tokyo Guidelines 2018 diagnostic criteria in the emergency department from May 2019 to December 2020 were analyzed.WBC count,CRP,procalcitonin(PCT),presepsin,T-Bil,and blood culture results were collected.The values were compared using the Pearsonχ2 test,Fisher’s exact test,or Mann-Whitney U test.The area under the receiver operating characteristic curve(AUC)of the value was examined using the Delong test.The correlations among the key research indicators were determined using Pearson correlation.RESULTS In total,336 patients were examined,which included 107,106,and 123 patients classified as having mild,moderate,and severe cholangitis,respectively.WBC count,CRP,PCT,presepsin,T-Bil,direct bilirubin,and sequential organ failure assessment scores of moderate and severe cholangitis patients were higher than those of mild cholangitis patients(P=0.000).The AUC of presepsin in predicting moderate acute cholangitis was 0.728,which was higher than that of CRP(0.631,P=0.043)and PCT(0.585,P=0.002),and same as that of WBC count(0.746,P=0.713)and T-Bil(0.686,P=0.361).The AUC of presepsin in predicting severe acute cholangitis was 0.715,which was higher than that of WBC count(0.571,P=0.008),CRP(0.590,P=0.009),PCT(0.618,P=0.024),and T-Bil(0.559,P=0.006).The presepsin levels in the positive blood culture group were higher(2830.8pg/mLvs1987.8pg/mL,P=0.000),and the AUC of presepsin(0.688)proved that it was a good biomarker for predicting positive bacterial culture.CONCLUSION Presepsin can predict positive blood culture in patients with acute cholangitis.It is superior to WBC count,CRP,PCT,and T-Bil for the risk stratification of acute cholangitis.
文摘BACKGROUND:This study aimed to determine the potential protective effect of inducing hypertransfusion to the gastrointestinal tract following a porcine model of cardiac arrest and cardiopulmonary resuscitation(CPR) by evaluating the influence of gastrointestinal ultrastructure,ATPase and serum diamine oxidase.METHODS:Ventricular fibrillation was induced by programmed electrical stimulation in 16 male domestic pigs(n=8/group).Four minutes after ventricular fibrillation,CPR was performed.The pigs that successfully restored spontaneous circulation received intravenous infusion of either norepinephrine to maintain the mean arterial pressure at 130%of the baseline before ventricular fibrillation or normal saline.Serum diamine oxidase and gastrointestinal ATPase activity were determined,and histopathological examination of the gastrointestinal tract was performed by light and electron microscopy.RESULTS:CPR caused significant injury to the gastrointestinal tract,elevating serum diamine oxidase and causing destruction of intestinal microvillus in control animals.Na^+-K^+ ATPase and Ca^(2+)ATPase activity in gastric tissue were significantly elevated in animals receiving hypertransfusion treatment compared with the control animals.Hypertransfusion also significantly reduced serum diamine oxidase to below control levels after CPR.Moreover,severe injury sustained by the gastrointestinal tissue was markedly ameliorated under hypertransfusion conditions compared with the control animals.CONCLUSIONS:Gastrointestinal injury and abnormal energy metabolism were strikingly evident following CPR.Hypertransfusion inducing hypertension can improve energy metabolism and ameliorate gastrointestinal mucosal injury,indicating that hypothermia significantly ameliorates gastrointestinal injury sustained following cardiac arrest.
基金Supported by Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support “Yangfan” Project,No.ZYLX201802Beijing Municipal Administration of Hospitals’ Youth Program,No.QML20170105National Natural Science Foundation of China,No.81374004 and 81773931
文摘BACKGROUND Acute pancreatitis(AP) is an inflammatory disorder of the pancreas with an unpredictable course of illness. A major challenge of AP is the early identification of patients at high-risk for organ failure and death. However, scoring systems are complicated and time consuming, and the predictive values for the clinical course are vague.AIM To determine whether the dynamic changes in presepsin levels can be used to evaluate the severity of disease and outcome of AP.METHODS In this multicentric cohort study, 133 patients with AP were included. Clinical severity was dynamically evaluated using the 2012 revised Atlanta Classification. Blood presepsin levels were measured at days 1, 3, 5 and 7 after admission by chemiluminescent enzyme immunoassay.RESULTS The median concentration of presepsin increased and the clearance rate of presepsin decreased with disease severity and organ failure in AP patients. The presepsin levels on days 3, 5 and 7 were independent predictors of moderately severe and severe AP with time-specific area under the curve(AUC) values of 0.827, 0.848 and 0.867, respectively. The presepsin levels positively correlated with bedside index of severity in AP, Ranson, acute physiology and chronic health evaluation II, computed tomography severity index and Marshall scores. Presepsin levels on days 3, 5 and 7 were independent predictors of 28-d mortality of AP patients with AUC values of 0.781, 0.846 and 0.843, respectively.CONCLUSION Blood presepsin levels within 7 d of admission were associated with and may be useful to dynamically predict the severity of disease course and 28-d mortality in AP patients.
基金financially supported by the National Natural Science Foundation of China (Nos.52271011 and 52102291)。
文摘Carbon nanofibers(CNFs)have been extensively studied as anode materials for sodium-ion batteries due to their high conductivity,large aspect ratio and good electrochemical stability.The low specific capacity and low first cycle efficiency of CNFs,however,have hindered its practical application.Herein,we present a facile strategy to synthesize a novel CNFs decorated with Cu/CuO nanoparticles(Cu-CNFs)using magnetron sputtering method.Cu/CuO nanoparticles were uniformly distributed on the surface of CNFs.According to the density functional theory(DFT)calculation,Cu/CuO nanoparticles d-orbitals and CNFs p-orbitals present hybridization states,and the Na~+adsorption energy of the modified CNFs decreases from-2.14 to-2.97 eV.The Cu-CNFs composites exhibit excellent sodium storage properties,presenting a desirable initial Coulombic efficiency of 76%and a high specific reversible capacity of 300 mAh·g^(-1)at 0.1 A·g^(-1)after 400 cycles.Cu-CNFs anode has excellent cycling stability under high current density,maintaining a high capacity of 150 mAh·g^(-1)at 1 A·g^(-1)after 6000 cycles.Using magnetron sputtering to regulate the electronic structure provides a new thought for improving the electrochemical performance of carbon materials.
文摘Objective： Sepsis remains a leading cause of death in many Intensive Care Units worldwide, lmmunosuppression has been a primary locus of sepsis research as a key pathophysiological mechanism. Given the important role of the negative costimulatory molecules programmed cell death-1 （PD-1） and programmed death-ligand 1 （PD-LI） in the occurrence of immunosuppression during sepsis, we reviewed literatures related to the PD-1/PD-L 1 pathway to examine its potential as a new target for sepsis treatment. Data Sources： Studies of the association between PD-I/PD-LI and sepsis published tip to January 31, 2017, were obtained by searching tile PubMed database. Study Selection： English language studies, including those based on animal models, clinical research, and reviews, with data related to PD- 1/PD-L I and sepsis, were evaluated. Results： lmmunomodulatory therapeutics could reverse the deactivation of immune cells caused by sepsis and restore immune cell activation and function. Blockade of＇the PD-1/PD-LI pathway could reduce the exhaustion ofT-cells and enhance the proliferation and activation ofT-cells. Conclusions： The anti-PD- I/PD-L 1 pathway shows promise as a new target for sepsis treatment. This review provides a basis for clinical trials and Iiiture studies aimed at revaluating the efficacy and safety of this targeted approach.
基金grants from the Capital Health Development Research Fund(No.2009-SHF04)Beijing Municipal Commission of Health and Family,Beijing,China.
文摘Background:Acute heart failure(AHF)is the most common disease in emergency departments(EDs).However,clinical data exploring the outcomes of patients presenting AHF in EDs are limited,especially the long-term outcomes.The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective,multicenter,cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1,2011 and September 23,2012.Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4%and 49.6%,respectively.The median overall survival was 34 months.Independent predictors of 5-year mortality were patient age(hazard ratio[HR]:1.027,95 confidence interval[CI]:1.023-1.030),body mass index(BMI)(HR:0.971,95%CI:0.958-0.983),fatigue(HR:1.127,95%CI:1.009-1.258),ascites(HR:1.190,95%CI:1.057-1.340),hepatic jugular reflux(HR:1.339,95%CI:1.140-1.572),New York Heart Association(NYHA)class III to IV(HR:1.511,95%CI:1.291-1.769),heart rate(HR:1.003,95%CI:1.001-1.005),diastolic blood pressure(DBP)(HR:0.996,95%CI:0.993-0.999),blood urea nitrogen(BUN)(HR:1.014,95%CI:1.008-1.020),B-type natriuretic peptide(BNP)/N-terminal pro-B-type natriuretic peptide(NT-proBNP)level in the third(HR:1.426,95%CI:1.220-1.668)or fourth quartile(HR:1.437,95%CI:1.223-1.690),serum sodium(HR:0.980,95%CI:0.972-0.988),serum albumin(HR:0.981,95%CI:0.971-0.992),ischemic heart diseases(HR:1.195,95%CI:1.073-1.331),primary cardiomyopathy(HR:1.382,95%CI:1.183-1.614),diabetes(HR:1.118,95%CI:1.010-1.237),stroke(HR:1.252,95%CI:1.121-1.397),and the use of diuretics(HR:0.714,95%CI:0.626-0.814),(3-blockers(HR:0.673,95%CI:0.588-0.769),angiotensin-converting enzyme inhibitors(ACEIs)(HR:0.714,95%CI:0.604-0.845),angiotensin-II receptor blockers(ARBs)(HR:0.790,95%CI:0.646-0.965),spironolactone(HR:0.814,95%CI:0.663-0.999),calcium antagonists(HR:0.624,95%CI:0.531-0.733),nitrates(HR:0.715,95%CI:0.631-0.811),and digoxin(HR:0.579,95%CI:0.465-0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF.Age,BMI,fatigue,ascites,hepatic jugular reflux,NYHA class III to IV,heart rate,DBP,BUN,BNP/NT-proBNP level in the third or fourth quartile,serum sodium,serum albumin,ischemic heart diseases,primary cardiomyopathy,diabetes,stroke,and the use of diuretics,P-blockers,ACEIs,ARBs,spironolactone,calcium antagonists,nitrates,and digoxin were independently associated with 5-year all-cause mortality.
基金This work was supported b-y grants from the National Natural Science Foundation of China （No. 81372025） and the Beijing Natural Science Foundation （No. 7132092）.
文摘Background： Shen-Fu injection （SFI） can attenuate ischemia-reperfusion injury, protect cardiac function, and improve microcirculation during cardiopulmonary resuscitation. We hypothesized that SFI may also have an influence on myocardial metabolism during ventrictdar fibrillation （VF）. In this study, we used SFI pretreatment prior to VF to discuss the changes of myocardial metabolism and catecholamine （CA） levels during untreated VF, trying to provide new evidence to the protection of SFI to myocardiurn. Methods： Twenty-four pigs were divided into three groups： Saline group （SA group）, SFI group, and SHAM operation group （SHAM group）. Thirty minutes prior to the induction of VF, the SFI group received 0.24 mg/ml SFI through an intravenous injection： the SA group received an equal amount of sodium chloride solution. The interstitial fluid from the left ventricle （LV） wall was collected through the microdialysis tubes during VF. Adenosine diphosphate （ADP）, adenosine triphosphate （ATP）, and Na^＋-K^＋-ATPase and Ca2^＋-ATPase enzyme activities were measured after untreated VF. Peak-to-trough VF amplitude and median frequency were analyzed for each of these 5-s intervals. Results： The levels of glucose and glutamate were lower after VF in both the SA and SFI groups, compared with baseline, and the levels in the SFI group were higher than those in the SA group. Compared with baseline, the levels of lactate and the lactate/pyruvate ratio increased after VF in both SA and SFI groups, and the levels in the SFI group were lower than those in the SA group. In both the SA and SFI groups, the levers of dopamine, norepinephrine, and epinephrine increased significantly. There were no statistical differences between the two groups. The content of ATE ADE and phosphocreatine in the SF1 group was higher than those in the SA group. The activity ofLV Na^＋-K^＋-ATPase was significantly higher in the SFI group than in the SA group. Amplitude mean spectrum area （AMSA） was significantly lower in the SA and SFI groups at 8- and 12-min compared with 4-min. The AMSA in the SFI group was higher than that in the SA group at each time point during untreated VF. Conclusions： SFI pretreatment can improve myocardial metabolism and reduce energy exhaustion during VF, and it does not aggravate the excessive secretion of endogenous CAs.
基金Beijing Natural Science Foundation （No.7132092）.
文摘Background：Morbidity and mortality after resuscitation largely depend on the recovery of brain function.Ventricular fibrillation cardiac arrest （VFCA） and asphyxial cardiac arrest （ACA） are the two most prevalent causes of sudden cardiac death.Up to now,most studies have focused on VFCA.However,results from the two models have been largely variable.So,it is necessary to characterize the features of postresuscitation cerebral metabolism of both models.Methods：Forty-four Wuzhishan miniature inbred pigs were randomly divided into three groups：18 for VFCA group,ACA group,respectively,and other 8 for sham-operated group （SHAM）.VFCA was induced by programmed electric stimulation,andACA was induced by endotracheal tube clamping.After 8 min without treatment,standard cardiopulmonary resuscitation （CPR） was initiated.Following neurological deficit scores （NDS） were evaluated at 24 h after achievement of spontaneous circulation,cerebral metabolism showed as the maximum standardized uptake value （SUVmax） was measured by 18F-fluorodeoxyglucose positron emission tomography/computed tomography.Levels of serum markers of brain injury,neuron specific enolase （NSE）,and S100β were quantified with an enzyme-linked immunosorbent assay.Results：Compared with VFCA group,fewer ACA animals achieved restoration of spontaneous circulation （61.1% vs.94.4%,P 〈 0.01） and survived 24-h after resuscitation （38.9% vs.77.8%,P 〈 0.01） with worse neurological outcome （NDS：244.3 ± 15.3 vs.168.8 ± 9.71,P 〈 0.01）.The CPR duration of ACA group was longer than that of VFCA group （8.1 ± 1.2 min vs.4.5 ± 1.1 min,P 〈 0.01）.Cerebral energy metabolism showed as SUVmax in ACA was lower than in VFCA （P 〈 0.05 or P 〈 0.01）.Higher serum biomarkers of brain damage （NSE,S100β） were found inACA than VFCA after resuscitation （P 〈 0.01）.Conclusions：Compared with VFCA,ACA causes more severe cerebral metabolism injuries with less successful resuscitation and worse neurological outcome.
文摘Background:Retroperitoneal fibrosis (RPF) is an uncommon disease that is characterized by development of fibrosclerotic tissues involving retroperitoneal structures.This study aimed to investigate the clinical features of 30 patients with RPF in a single center in Beijing in a 10-year period.Methods:We retrospectively analyzed clinical data on demographic characteristics,clinical manifestations,laboratory findings,radiological findings,modalities of treatments,outcomes and prognosis of 30 patients with RPF.Patients were treated in Beijing Chao-Yang Hospital between January 2003 and December 2013.Results:The mean age of patients with RPF was 56.7 ± 14.4 years.Twenty-three patients were men and seven patients were women.Acute phase reactants were elevated in most patients.Rheumatic factor was positive in 4/25 (16.0％) patients,and antinuclear antibody was positive in 6/22 (27.3％) patients.Elevation of IgG4 was observed in 9/22 (40.9％) patients.The most common type was I + Ⅲ (n =13),followed by Ⅰ + Ⅱ +Ⅲ (n =12).Five patients undertook an 18F-fluoro-deoxy-D-glucose positron emission tomography examination and increased uptake was detected in four patients.Eight patients received combination therapy with glucocorticoids and tamoxifen.Surgical intervention treatments included intraureteral double-J stent implantation (n =26),percutaneous nephrostomy (n =2),open ureterolysis and intraperitonealization of the ureters (n =5) and Iaparoscopic ureterolysis and intraperitonealization of the ureters (n =5).Three patients underwent hemodialysis because of renal failure.Conclusions:Clinical characteristics of RPF patients in our study are similar to those previously reported.Steroids and immunosuppressive therapy combined with ureterolysis could be a viable choice of treatment for RPF.More prospective,multi-center studies with a longer follow-up are warranted.
文摘Background： Sepsis is one of the main canses of mortality in critically ill patients following progression to septic shock. To investigate the pathophysiologic changes of sepsis, we developed a novel porcine model of septic shock induced by acute respiratory distress syndrome （ARDS） due to methicillin-resistant Staphylococcus aureus （MRSA） pneumonia. Methods： Twenty-six male Landraces （Lvyuanweiye, Beijing, China） weighing 30 - 2 kg were divided into lbur groups： sham gronp （SH： n = 5）; cotton smoke inhalation group （SM; n = 6）; MRSA pneumonia group （MR; n = 6）; and septic shock group with cotton smoke inhalation ＋ MRSA pneumonia （SS; n = 9）. Extensive hemodynamics, oxygen dynamics, and lung function were monitored for 24 11 following the injury or until death. Tissues were collected, and histopathology evaluations were carried out. Results： Blood cultures from 6 of 9 animals in the SS group were positive for MRSA. Two hours following the injury, decreased mean arterial blood pressure （60 70 mmHg） and cardiac index （〈2 L-rain -＇m --） were observed in the animals in the SS group, while systemic vascular resistance index was increased. The hemodynamic characteristics of septic shock were only observed in the SS group but not significant in the other groups, The PO_JFiO2 in the SM and SS groups decreased to 300 and 100, respectively. In the SS group, extravascular lung water index increased to 20 ml/kg, whereas thoracopulmonary compliance decreased to 10 ml/H2O after injury. Deterioration of pulmonary function in the SS group was more serious than the SM and MR groups. Severe lung injury in the SS group was confinaaed by the histopathology evaluations. The lung injury confirmed by high-resolution thin-section computed tomography and histopathology in the SS group was more serious than those of other groups. Conclusions： In the present study, we developed a novel porcine model of septic shock induced by ARDS due to severe MRSA pneumonia with characteristic hyperdynamic and hypodynamic phases in 24 h, which mimicked the hemodynamic changing of septic shock in human.
