Objective To explore the relationship between blood glucose variability, disease severity and prognosis of the patients with acute pancreatitis. Methods Total of 242 patients with acute pancreatitis admitted to the department of emergency from January 2019 to December 2019 were enrolled. The organ failure was evaluated according to Marshall's score, the severity of the disease was evaluated according to Atlanta's score, and the blood glucose indexes of three groups of patients with mild acute pancreatitis, moderate severe acute pancreatitis and severe acute pancreatitis were compared within seven days after admission. The relationship between blood glucose index and disease severity in different patients with acute pancreatitis was analyzed. Taking whether a puncture was performed at admission, whether the patient was admitted to the intensive care unit (ICU), and whether the patient died as endpoint events as classification factors, the relationship between blood glucose indicators and disease prognosis of patients with acute pancreatitis was analyzed using the One-Way ANOVA, Kruskal-Wallis test, Mann-Whitney U test, receiver operating characteristic curve (ROC curve), etc. Results Of the 242 patients, 70 cases (28.9%) were mild acute pancreatitis, 71 cases (29.3%) with moderate severe acute pancreatitis, 101 cases (41.7%) with severe acute pancreatitis. There was no statistically significant difference in the coefficient of variation of blood glucose among the three groups within 7 days of admission. The mean, standard deviation, maximum, minimum value and difference between maximum and minimum value of venous blood glucose in severe acute pancreatitis group were higher than those in moderate severe acute pancreatitis group, while those in moderate severe acute pancreatitis group were higher than those in mild acute pancreatitis group. The mean value of blood glucose of invasive operation group (IOP) (n=55) was higher than that of non-invasive operation (NOP) group(n=187). Conclusions The blood glucose level and fluctuation range of patients with acute pancreatitis within seven days after admission, are of great significance for the judgment of the severity and prognosis of the disease.

Humans ; China/epidemiology* ; SARS-CoV-2 ; COVID-19

At present,although the mortality of most patients undergoing major surgery is very low,the increase of so-called high-risk surgery patients with high risk of postoperative complications and death brings new challenges to perioperative safety management.The efficient collaboration of multidisciplinary professional teams based on patient-centered and value-based medicine is a new measure to ensure perioperative safety.Among them,the critical care medical professional team plays a key role in risk assessment,perioperative organ protection,close monitoring and specific early intervention for high-risk patients,so as to achieve timely prevention,early identification and effective treatment of postoperative complications,and to reduce the risk of death and improve the postoperative quality of life.

Objective Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment in patients with Carbapenem-resistant Klebsiella pneumoniae bloodstream infections(CRKP-BSI).Methods Retrospective analysis of the clinical characteristics of 81 CRKP-BSI patients in our intensive care unit from July 2016 to June 2020,to indentify the risk factors of death and treatment effects of different antibiotic regimens.Results In 81 CRKP-BSI cases,the majority source were from abdominal and respiratory,accounting for 56.79%(46 cases)and 22.22%(18 cases),respectively.The 28-day mortality and hospitalization mortality of CRKP-BSI were 54.32%(44 cases)and 65.43%(53 cases).Multivariate regression analysis suggested that biliary tract disease before admission(P=0.026)and increased SOFA score at the onset of BSI(P=0.006)were independent risk factors for 28-day mortality.There was no statistically significant difference in 28-day mortality between the groups of antibiotic treatment based on tigecycline(44 cases)and polymyxin B(26 cases)[56.82%(25/44)vs.57.69%(15/26),P=0.943].Patients were evaluated based on their age(≤65 years vs.>65 years),gender,body mass index(≤25 kg/m2 vs.>25 kg/m2),and APACHEⅡ score(≤20 vs.>20),the use of renal replacement therapy and mechanical ventilation,there was no difference in the mortality among each subgroup.Conclusions Biliary tract disease before admission and SOFA score were independent risk factors for 28-day mortality.There was no significant difference outcomes between tigecycline-and polymyxin B-based therapy.

Nutritional support is one of the comprehensive treatments for the patients with novel coronavirus infection, especially for critically ill patients. Nutritional therapy needs to follow the standard process, which includes nutritional risk screening, assessment, intervention and monitoring. Nutrition intervention is recommended to follow the principle of "five-step" of nutritional therapy. Appropriated diet and evidence-based nutritional support should be given to improve the nutritional status and immunologic function of the patients, and to get best of overall clinical outcomes.

Sepsis associated-acute kidney injury (SA-AKI) is a common complication of sepsis, which has a high incidence and is closely related to a poor prognosis. However, delayed diagnosis and non-specific treatments make it difficult to systematically manage SA-AKI. Based on massive clinical data, machine learning could build prediction models, which provide alarms and suggestions for the clinical decision support system. Although there are still many challenges such as poor interpretability, it has shown clinical application value in SA-SKI risk prediction, imaging diagnosis, subtype identification, prognosis assessment, and so on. Based on a brief introduction of machine learning, this article reviews the application, limitations, and future directions of machine learning in the diagnosis and treatment of SA-AKI, and explores the possibility of machine learning in the medical field, in order to promote the development of precision medicine and intelligent medicine.

Objective:To explore the protective effect and its mechanism of vitamin C on septic renal injury induced by lipopolysaccharide (LPS).Methods:Renal tubular epithelial cells HK-2 were induced with 10 mg/L LPS for 8 hours and 12 hours, respectively, and then 0.5 mmol/L and 1 mmol/L vitamin C were added, respectively. Cell viability was measured using cell proliferation and toxicity assay cell counting kit-8 (CCK-8) to determine suitable condition for subsequent experiments. HK-2 cells were divided into control group, LPS group and LPS+vitamin C group (LPS+VC group). The contents of necrosis factors phosphorylated mixed lineage kinase domain-like protein (p-MLKL) and phosphorylated receptor-interacting protein kinase 3 (p-RIPK3) were measured by Western blotting. The contents of inflammatory factors interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA) in each group. Differences among the groups were compared.Results:CCK-8 showed that 1 mmol/L vitamin C improved the survival rate of HK-2 cells to 86% after 12 hours of LPS induction, so this condition was selected for subsequent experiments. After 12 hours LPS induction in HK-2 cells, the expressions of p-MLKL and p-RIPK3 were significantly higher than those of the control group, and the levels of IL-1β and TNF-α were also significantly higher than those of the control group [IL-1β (ng/L): 23.2±1.4 vs. 12.8±3.9, TNF-α (ng/L): 36.4±3.9 vs. 11.6±1.8, both P < 0.05], indicating the co-existence of cell necrosis and inflammation. Compared with LPS group, 1 mmol/L vitamin C significantly decreased the protein expression of p-MLKL and p-RIPK3, and also significantly decreased the levels of IL-1β and TNF-α [IL-1β (ng/L): 19.8±0.7 vs. 23.2±1.4, TNF-α (ng/L): 17.4±5.8 vs. 36.4±3.9, both P < 0.05]. Conclusion:Vitamin C can alleviate LPS-induced HK-2 cell damage, and reduce the expressions of necrotic factors and inflammatory factors.

Sepsis is defined as a life-threatening organ dysfunction caused by the dysregulated host response to infection, and is one of the main causes of death in intensive care unit (ICU) patients. Coagulation dysfunction runs through the pathophysiological progress of sepsis whose severity should be closely related to the prognosis of sepsis. Neutrophil extracellular traps (NETs) is a three-dimensional network structure with DNA as the skeleton and inlaid with various protein components. The excessive production of NETs can lead to sepsis-induced coagulopathy (SIC) by activating the coagulation system, inhibiting the anticoagulation system, resisting fibrinolysis, damaging vascular endothelial cells and the interaction of platelets. At present, the treatment of SIC is mainly symptomatic treatment, and there is no recognized effective anticoagulation strategy. Interventions for NETs and their components, and drugs for antiplatelets are expected to become new directions for disease treatment.

Trauma center is an important link of trauma treatment, which is beneficial for professional integrated treatment of trauma patients and reduction of disability and death rate. The establishment of trauma rescue and treatment system is conducive to improving the regional trauma treatment capacity, rationalizing the layout of medical resources and standardizing the trauma treatment. Making full use of geographic information system (GIS) to analyze the big data such as the number of trauma patients, population, ground traffic situation and geographic information in the region and scientifically plan the number and location of trauma centers in the region is crucial to further optimize the geographic layout of trauma treatment centers, coordinate regional trauma treatment resources and improve the overall treatment capacity and is conducive to optimizing trauma treatment resources, improving regional trauma treatment capacity and reducing the disability and death rate of trauma patients. Based on domestic and foreign literature researches, the authors discuss how to use GIS to optimize the trauma rescue and treatment system in China in order to provide a useful reference for construction of regional trauma rescue and treatment system.