The metabolic response to stress plays a key role in the adaptive response during critical illness.Multiple mechanisms including the stimulation of the sympathetic nervous system,inflammation,and immune responses were involved.Insulin resistance is one of the main features in metabolic response to stress.Metabolic response to stress was manifested by disorders of energy consumption,such as glucose,lactic acid,lipids,and proteins.The decrease in fat-free body mass and cell mass,relative excess of adipose tissues,and increased extracellular fluid volumes were also involved.Therapeutic interventions,including hormone supplementation,enhanced protein intake,and early mobilization,are considered for prevention and therapy of metabolic response to stress.The review aims to summarize the pathophysiological mechanisms,clinical consequences,and therapeutic implications of metabolic response to stress in critical illness.

Sepsis is a leading cause of death in critically ill patients.The definitions of sepsis and septic shock were introduced in 1991 and last revised in 2001.Since considerable advances had occurred to its pathophysiology and management,an update definitions for sepsis and septic shock were released in February 2016 by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.This article is to review the development and limitations of previous versions of sepsis definition,and summarize the sepsis 3.0 definition and its clinical diagnosis criteria.These updated definitions and clinical criteria will play vital roles in providing important reference frame for clinical trials,and facilitating early recognition and timely management of patients with sepsis.

During sepsis, circulating leukocytes are in a hyper inflammatory state, and with the progress of the inflammation, immune cells may become tolerated. Glycolysis and pentose phosphate pathway are up-regulated but oxidative phosphorylation is suppressed in hyper inflammatory cells, whereas during immune tolerance, glycolysis is often down-regulated. In this review, we will summarize the changes of cellular metabolic pathways in monocytes and macrophages during sepsis. We also review how the metabolism of glucose, amino acids, and fatty acids affect the function of monocytes and macrophages in sepsis. Current literature indicated that metabolism plays a significant role in regulating the functions of immune cells in sepsis, which might be a potential therapy for sepsis and deserved further research.

Medical record writing may open up the clinical intern's clinical field of vision his,raise clinical thought,and improve his medical comprehensive ability.The clinical intern in medical record writing has the following questions:the delayedwriting,unstandard language and the unreal content and so on.Through the centralizing teaching,teachers'prompt counsel and interns'initiation and so on,clinical interns'medical record writing quality may be enhanced.

The article introduces the experience of Clinical teaching of anesthesiological undergraduate under "3+2" pattern.We have enhanced the teaching effect by making the detailed teaching plan for overall situation,strengthening clinical guidance and teaching of one by one,educing the students subjective initiative and utilizing kinds of methods to raise the students' comprehensive capacity.

Immunosuppression plays a vital role in the pathophysiological mechanism of sepsis, and it is the main cause of death in patients with sepsis during the later phase. Sepsis induced immunosuppression is gradually recognized. Its underlying mechanisms involve immune cell apoptosis, autophagy, cell metabolism reprogramming, endotoxin tolerance, central nervous system regulation, and epigenetic regulation. New approaches that target the host immune response and reconstruct the immune balance are the keys to improve the prognosis of patients with sepsis. With the help of immune status monitor, novel immunomodulatory agents, such as thymosin α1, γ- interferon (IFN-γ), interleukin-7 (IL-7), granulocyte-macrophage colony stimulating factor (GM-CSF) and anti-programmed death receptor 1 (PD-1) antibody, are expected to become a new strategy for the treatment of sepsis in future.

In order to effectively prevent infection or severe acute respiratory syndrome coronavirus 2 transmission among medical staff during tracheal intubation in patients with suspected or confirmed coronavirus disease 2019(COVID-19), and to ensure the safety of personnel who will perform the endotracheal intubation, we made a literature review to analyze the airway management for SARS patients from China and abroad in 2003. Relevant documents, consensus of diagnosis and therapy for patients with COVID-19 from the National Health Commission, and guidelines of relevant academic societies were also reviewed.Thus, we provide suggestions on infection control for performing endotracheal intubation in patients with COVID-19 mainly as follows.Medical staff should fully understand the infection risk of COVID-19 and strengthen the training before the procedure.It is suggested that the indication of endotracheal intubation should be properly defined, and the need for intubation as emergent or elective should be evaluated early with preparation made in advance.During the implementation of endotracheal intubation, the procedure should be completed by the most experienced personnel in airway management using the tools they master best, and a rapid sequential induction of endotracheal intubation is recommended.

Perioperative cardiac arrest is a significant cause of perioperative mortality in patients.The first clinical practice recommendation dedicated to the management of perioperative cardiac arrest was published in 2021 and contains 22 specific recommendations.This clinical practice recommendation includes indicators to monitor during treatment, the sequence of defibrillation and chest compressions, the use of epinephrine and antiarrhythmic drugs, treatment strategies for specific types of perioperative cardiac arrest, the use of adjunctive therapies such as ultrasound to assist in treatment, setting appropriate hemodynamic and respiratory parameters, and temperature management.This clinical practice recommendation is essential for effective management of perioperative cardiac arrest and will also provide guidance for further exploration of the management of perioperative cardiac arrest in the future.

Sepsis is defined as life-threatening organ dysfunction secondary to a dysregulated host response to infection.It is considered a major cause of death and health loss worldwide.Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021, released in October 2021, included 93 total statements, which addressed screening and initial resuscitation, infection, hemodynamics, ventilation, additional therapies, and goals of care and long-term outcomes.This review interpreted the content ofthe guidelines and also analyzed the underlying issues.The guidelines provide a more accurate framework and guidance for the diagnosis and treatment of sepsis, and may also provide an opportunity to urge researchers in the field of sepsis worldwide to implement further individualized research.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, of which the pathogenesis is complex and the mortality rate is high. However, current basic research is facing the dilemma of high heterogeneity and difficult translation to clinical practice. In-depth basic research is one of the most important ways to break through the "bottleneck" of clinical diagnosis and treatment of sepsis. The purpose of this review is to analyze the current progress and challenges in the field of basic research on sepsis, and look forward to the potential research directions in the future. Cell function, energy metabolism, microbiota, epigenetics and recovery period of sepsis may be the research priorities.