OBJECTIVE: To systematically summarize and analyze the project applications and funding in the field of Emergency and Critical Care Medicine by the Medical Science Department of the National Natural Science Foundation of China (NSFC) from 2010 to 2024, and to identify research hotspots and developmental trends, providing scientific references for the high-quality development of the Emergency and Critical Care Medicine in China. METHODS: Data on all project applications and funding in the field of Emergency and Critical Care Medicine (application code H16) from 2010 to 2024 were collected from the NSFC Grants System, including project application numbers, funding numbers and amounts, project categories, regional and affiliated institutions distributions. Keyword co-occurrence analysis was conducted using VOSviewer software to identify research hotspots, and results were presented using bar charts, pie charts, and Sankey diagrams. RESULTS: Over the past 15 years, the Emergency and Critical Care Medicine field of NSFC received 13 747 project applications and funded 1 781 projects, with a cumulative funding amount of 8.064 99 billion RMB. The annual number of applications increased from 296 in 2010 to 1 971 in 2024, representing an average annual growth rate of 40.42%. Similarly, the number of funded projects grew from 45 in 2010 to 175 in 2024, with an average annual growth rate of 20.63%, while annual funding rose from 20.01 million RMB in 2010 to 74.20 million RMB in 2024, reflecting an average annual growth rate of 19.34%. The majority of funded projects belonged to the General Program (774 projects), Young Scientists Fund (754 projects), and Regional Science Fund (163 projects), collectively accounting for 94.95% of total funded projects (1 691/1 781). Funding was concentrated in two primary research areas: Organ Dysfunction and Support (H1602, 751 projects) and Sepsis (H1601, 612 projects), together comprising 76.53% of total funded projects (1 363/1 781). The total number of funded projects (1 781 projects) in Emergency and Critical Care Medicine was fewer than the average across the subfields of Medical Science Department (4 181 projects). Shanghai (305 projects, 17.1%), Guangdong (222 projects, 12.5%), Jiangsu (154 projects, 8.6%), Zhejiang (149 projects, 8.4%), and Beijing (134 projects, 7.5%) ranked as the top five regions in terms of funded projects. Keyword co-occurrence analysis revealed that sepsis, organ injury, pulmonary injury and poisoning, and cardiopulmonary resuscitation were the main research hotspots in the field of Emergency and Critical Care Medicine over the past 15 years. CONCLUSION From 2010 to 2024, the NSFC funding for the field of Emergency and Critical Care Medicine has shown a significant upward trajectory, providing vital support for the rapid advancement of basic and applied research. This growth has played a crucial role in facilitating the high-quality development of Emergency and Critical Care Medicine in China.
China ; Critical Care/economics* ; Emergency Medicine/economics* ; Humans ; Foundations

Although the understanding of sepsis has evolved from "sepsis 1.0" to "sepsis 3.0", and the consensus on clinical management of sepsis has been continuously updated, the incidence rate and mortality of sepsis remain high. Therefore, in-depth investigation of the pathogenesis and related influencing factors of sepsis is of great significance for revealing the nature of sepsis and improving the clinical outcome of sepsis patients. This review will focus on the key issues in the basic research of sepsis, and summarize the recent advances and challenges in this field, mainly including genetic polymorphism, microorganisms, high-mobility group box 1 (HMGB1), endothelial dysfunction, immunotherapy, and biomarkers, aiming to provide new insights for the diagnosis and treatment of sepsis.

Sepsis-related organ dysfunction is associated with increased morbidity and mortality. Previous studies have found that the endothelium plays crucial roles in maintaining the vascular permeability during sepsis, as well as in regulating inflammation and thrombosis. During sepsis, endothelial cells may release cytokines, chemokines, and pro-coagulant factors, as well as express adhesion molecules. In general, endothelial responses during sepsis typically inhibit bacterial transmission and coordinate leukocyte recruitment to promote bacterial clearance. However, excessive or prolonged endothelial activation can lead to impaired microcirculation, tissue hypoperfusion, and organ dysfunction. Given the structural and functional heterogeneity of endothelial cells in different organs, there are potential differences in endothelial responses by organ type, and the risk of organ damage may vary accordingly. This article reviews the endothelial response observed in sepsis and its effects on organ function, summarizes current progress in the development of therapeutic interventions targeting the endothelial response, and discusses future research directions to serve as a reference for researchers in the field.
Sepsis/complications* ; Humans ; Multiple Organ Failure/etiology* ; Endothelium, Vascular/physiopathology* ; Endothelial Cells/metabolism* ; Cytokines/metabolism* ; Animals

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective To explore the value of modified early warning score (MEWS) in clinical status assessment and outcome prediction of heat stroke patients.Methods The clinical data of 46 heat stroke patients were collected.According to the severity,the subjects were divided into mild group and severe group;and alternatively,according to the treatment outcomes,the subjects were also divided into survival group and death group.The MEWS at admission was employed for comparison of the differences in severity and outcome of heat stroke between groups.Receiver operating characteristic curve (ROC curve) was used to evaluate the accuracy of MEWS used at admission in assessing severity and predicting outcome of heat stroke patients.Results The results of MEWS calculated at admission in mild and severe heat stroke patients showed significant difference between them (3.00 ± 1.70 vs.6.85 ± 3.03,P =0.004).The area under the ROC curve (AUC) of MEWS got at admission for the diagnosis of severe heat stroke was 0.864 ± 0.056.The results of MEWS obtained at admission in survived and died heat stroke patients were 5.13 ± 2.96 and 9.25 ± 2.05,respectively (P =0.037).The AUC of MEWS used at admission for predicting the death of heat stroke patients was 0.867 ± 0.061.Conclusions The initial MEWS is useful to accurately assess and predict the outcome of heat stroke patients.Heat stroke patients with higher level of MEWS used at admission than 4.5 could be diagnosed as severe heat stroke,and whereas the value of MEWS got at admission higher than 7.5 could be the indicator of the poor prognosis.

Objective To investigate the effect of epinephrine combined with methoxamedrine on rate of successful cardiopulmonary resuscitation (CPR) in rabbit model of sudden cardiac arrest by the method of clamping the trachea to asphyxia.Methods Twenty-seven rabbits were randomly (random number)divided into methoxamedrine group,epinephrine group and epinephrine combined with methoxamedrine group.After the modeling,rabbits in the three groups were treated methoxamedrine,epinephrine,and epinephrine combined with methoxamedrine respectively by intravenous injection during CPR.The change of heart rate (HR),mean arterial pressure (MAP) and electrocardiogram (ECG),restoration of spontaneous circulation (ROSC) and mortality within 2 hours of each experimental group were recorded before suffocation and 15 min,30 min,60 min,120 min after the success of the resuscitation.The pathological changes of myocardium were observed under optical and electronic microscope.Results The number of ROSC rabbits in methoxamedrine group,epinephrine group and epinephrine combined with methoxamedrine group were 1,6,5 respectively.The heart rate and mean arterial pressure of the rabbits after ROSC were lowered compared with those before suffocation significantly (P ＜0.05).The levels of mean arterial pressure at 15 minutes and 30 minutes after ROSC in combined treatment group were higher than those of epinephrine group significantly (P ＜ 0.05).The myocardial structure of rabbits after ROSC observed by optical and electronic microscope showed an acute injury,however,the damage degree of myocardium in combined treatment group was slighter.Conclusions Epinephrine combined with methoxamedrine has no apparently additional effect on ROSC during CPR compare with epinephrine used alone,but this combination of two agents can be benefit for stabilizing hemodynamic at early post-ROSC stage,and methoxamedrine can reduce the damage of myocardium during CPR.

Objective To establish a long-term culture system for mouse spermatogonial stem cells(SSCs). Methods Testis cells from 4-6 days postpartum male transgenic BALB/C mice were collected by a modified two-step enzymatic digestion method.After three differential adherence selections,the enriched germ cells were finally suspended in StemPro-34 SFM medium supplemented with other nutrients factors and plated on mouse embryonic fibroblast(MEF)feeder layer.20 ng/ml Glial cell line-derived neurotrophic factor,10 ng/ml basic fibroblast growth factor and 200 ng/ml GDNF-family receptor al were added to the serum-free medium to promote SSCs proliferation.Aduh male BALB/C mice,4-5 weeks old,underwent intraperitoneal injection of 40 mg/kg busulfan as recipient mice.Cultured SSCs were also injected into the seminiferous tubules of the left recipient testis through micromanipulator and right testis as self-control.Testes of recipient mice were observed by a fluorescence stereomicroscope and HE stains at 2 months after transplantation. Results By improved digestion method,the vitality of isolated testis cells was more than 98%and the stem cells was enriched about 18.5 fold. 1-2 days after transferred to MEF feeder, the round germ cells started to proliferate and had the shape of paired or aligned undifferentiated spermatogonia connected by cytoplasmic bridges. After 3-4 days, SSCs proliferated continuously and formed typical colonies. SSCs from BALB/c mice could be cultured and passaged in a steady state for 3 months. Cryostat section through the transplanted testis showed that most of seminiferous tubules were filled with germ cells expressing EGFP.HE staining further showed clearly that seminiferous tubules contained complete spermatogenesis.Conclusions SSCs from BALB/c mice could be cultured in an improved culture system for 3 months.The culture system could facilitate understanding the regulatory mechanism that governs SSCs and might provide an opportunity for the cure of infertility.

The targeted agents of metastatic renal cell carcinoma include the inhibitor of the VHL- HIF-VEGF pathway(sunitinib、 sorafenib、 bevacizumab、 Axitinib) and the mTOR pathway (Temsirolimus, Everoli-mus). These targeted chugs suggest the onset of a new therapeutic era for patients with metastatic renal cell car-cinoma. It is necessary to pay more attention to the side effect. The therapeutic scheme choice of patients and the treatment effect of the non-clear cell carcinomal need further studies.

OBJECTIVE:To study the spermicidal and antibacterial effects of tannic acid from Chinese gall.METHODS:Human sperm samples of 20 subjects were taken for spermicidal tests in vitro in accordance with the standard method recommended by WTO.The minimum inhibitory concentration and minimum bactericidal concentration(MIC and MBC)of tannic acid from Chinese gall on bacterium coli and staphylococcus aureus were detected.RESULTS:The lowest effective spermicidal concentration of tannic acid at 20s was 20mg? mL-1.The MIC and MBC of tannic acid against bacterium coli(3 strains)were 0.195～ 0.390mg? mL-1 and 0.390～ 0.780 mg? mL-1 respectively,against staphylococcus aureus(2 strains)were 0.049～ 0.098mg? mL-1 and 0.195～ 0.390mg? mL-1 respectively.CONCLUSION:Tannic acid from Chinese gall showed potent coagulating effect on spermatines and remarkable antibacterial effect,and which is expected to be an effective and safe vaginal spermicidal and antibacterial agent,further study on which remains to be carried out.

BACKGROUND:It is accepted that the best method for spermatogonial stem cells separation is using artificial cryptorchism model combined with surface makers.OBJECTIVE:To explore the feasibility of separation spermatogonial stem cells with ?6-integrin and c-kit as specific surface markers.DESIGN,TIME AND SETTING:The randomized control experiment was performed at the Renmin Hospital of Wuhan University from May to December 2006.MATERIALS:Forty adult,white Kunming mice with 6 weeks old were randomly divided into cryptorchidism and control groups,with 20 animals in each group.METHODS:Artificial cryptorchidism model was prepared by made an incision at the median of abdomen,and testis was pulled into abdominal cavity,which was fixed at the each side of lateral abdominal wall.There was no treatment in the control group.The single cell suspension of seminiferous epithelium was obtained by traditional two step enzyme digestion at 2-3 months after operation.FITC-conjugated anti-?6-intergrin antibody and PE-conjugated anti-c-kit antibodies were added.Then the cells with low side scatter light-scattering properties were sorted and positively stained for ?6-intergrin and negative c-kit expression.Meanwhile,the viability of the isolated cells was assessed by trypan blue staining.MAIN OUTCOME MEASURES:The morphological changes of cryptorchidism,and the sorting results of spermatogonial stem cells.RESULTS:Cell distribution in seminiferous tubule was disorder with reduced numbers.The layer and lumens were disappeared,and cell division phase could be seen in the center of tubules.Compared to the control group,the testicular cells in the cryptorchidism group were increased in the side scatterlow,Forward scatterhi areas,with figure left-upward displacement.The distribution of ?6-integrin+ and c-kit cells were deviated each other,it named that most ?6-integrin+ cell were not spermatogonial stem cells,so do the c-kit-cells.Only 2.8% of testicular cells exhibited side scatterlow,?6-integrin+,and c-kit-,which were spermatogonial stem cells in the cryptorchidism group.And trypan blue staining showed that over 95% of them were viable.CONCLUSION:Using the two surface markers to sort spermatogonial stem cells can advance the purity of the spermatogonial stem cells in cell suspension,but the specificity is insufficient.