As the largest microbial community in the human body,the intestinal microecology plays a pivotal role in the health and disease progression of the host.As part of the human symbiotic system,the metabolites of the intestinal microecology have a profound impact on the physiological and pathological states of the host.Hospi-tal-acquired infections(HAIs),as a common health problem among hospitalized patients,involve complex necha-nisms influenced by multiple factors.In recent years,with the advancement of technologies such as 16S rRNA and shotgun sequencing,researchers have gradually recognized that the intestinal microecology plays an important role in the occurrence and development of HAIs.In the intensive care unit,the treatment of primary diseases,sec-ondary infections,and the use of clinical treatment methods often lead to intestinal microecological imbalance.This article reviews the characteristics of changes in the intestinal microecology of critically ill patients after admission and explores the relationship between these changes and HAIs,aiming to deeply explore the possible mechanisms of the intestinal microorganisms in affecting the hospital-associated infections and provide theoretical support for developing prevention and treatment strategies.

Objective To explore the predictive value of heparin-binding protein(HBP)combined with soluble growth-stimulated gene 2 protein(sST2)for the prognosis of elderly patients with acute heart failure(AHF).Methods A total of 338 elderly AHF patients who were treated in the Affiliated Hospital of Xuzhou Medical University and Kuitun Hospital of Ili Kazakh Autonomous Prefecture from April 2021 to March 2022 were selected as the research subjects.The patients were followed up for 1 year.According to whether the ma-jor adverse cardiovascular and cerebrovascular events(MACE)occurred during the follow-up period,they were divided into the MACE group and the non-MACE group,respectively.The baseline characteristics of the patients were recorded,laboratory indicators were detected,transthoracic color Doppler ultrasound examina-tion was completed,the risk factors affecting the prognosis of elderly patients with AHF,as well as the predic-tive value of HBP and sST2 for the prognosis of elderly patients with AHF were analyzed.Results Among the 338 elderly AHF patients,101 patients experienced MACE,and 237 patients did not.The levels of serum creatinine,NT-proBNP,troponin T,white blood cell count(WBC),left ventricular end-diastolic diameter(LVEDD),HBP,and sST2 in the MACE group were higher than those in the non-MACE group,while the left ventricular ejection fraction(LVEF)was lower than that in the non-MACE group,and the differences were statistically significant(P＜0.05).LVEF was a protective factor for the occurrence of MACE(HR＜1,P＜0.05)and age,diabetes mellitus,creatinine,NT-proBNP,troponin T,LVEF,WBC,HBP,and sST2(HR≥1,P＜0.05)were the influencing factors for the occurrence of MACE.The optimized model(Model 5)has the highest predictive efficiency for the prognosis of elderly patients with AHF,with an area under the curve(AUC)of 0.976(95％CI:0.962-0.990).Conclusion Both HBP and sST2 are independent risk factors for the occurrence of MACE in elderly AHF patients.The predictive model established by combining HBP and sST2 has a high predictive value.

As the largest microbial community in the human body,the intestinal microecology plays a pivotal role in the health and disease progression of the host.As part of the human symbiotic system,the metabolites of the intestinal microecology have a profound impact on the physiological and pathological states of the host.Hospi-tal-acquired infections(HAIs),as a common health problem among hospitalized patients,involve complex necha-nisms influenced by multiple factors.In recent years,with the advancement of technologies such as 16S rRNA and shotgun sequencing,researchers have gradually recognized that the intestinal microecology plays an important role in the occurrence and development of HAIs.In the intensive care unit,the treatment of primary diseases,sec-ondary infections,and the use of clinical treatment methods often lead to intestinal microecological imbalance.This article reviews the characteristics of changes in the intestinal microecology of critically ill patients after admission and explores the relationship between these changes and HAIs,aiming to deeply explore the possible mechanisms of the intestinal microorganisms in affecting the hospital-associated infections and provide theoretical support for developing prevention and treatment strategies.

Objective To explore the therapeutic effect of high adsorption hemoperfusion on hypertriglyceridemic acute pancreatitis (HLAP). Methods A retrospective study was conducted. HLAP patients who received high adsorption hemoperfusion treatment in the Department of Critical Care Medicine,Tongling People's Hospital from May 1,2020 to July 31,2023 were selected as the research objects. The patients were divided into the HA380 high adsorption hemoperfusion group and the HA330 ordinary adsorption hemoperfusion group according to different hemoperfusion devices used. The changes in vital signs before and after treatment with the HA380 high adsorption hemoperfusion device were observed,and the differences in triglyceride (TG) and blood amylase levels before and after hemoperfusion were compared between the HA380 high adsorption hemoperfusion group and the HA330 ordinary adsorption hemoperfusion group. Results A total of 26 patients were included,with 16 cases in the HA380 high adsorption hemoperfusion group and 10 cases in the HA330 ordinary hemoperfusion group. With the increase in the number of hemoperfusion sessions,the heart rate,body temperature,and respiratory rate of the patients in the HA380 high adsorption hemoperfusion group gradually decreased[heart rate (bpm):105.38±21.44,95.31±17.56 vs. 119.93±21.06,body temperature (℃):37.31±0.88,37.22±0.69 vs. 37.99±1.17,respiratory rate (times/min):19.44±5.12,17.00±4.83 vs. 21.94±5.12,all P<0.05],and the systolic blood pressure gradually increased[mmHg (1 mmHg≈ 0.133 kPa):106.81±11.04,120.13±9.14 vs. 97.44±8.23,both P<0.05]. The TG and blood amylase levels in both the HA380 high adsorption hemoperfusion group and the HA330 ordinary adsorption hemoperfusion group gradually decreased after hemoperfusion,reaching the lowest level after the second hemoperfusion,and the TG and blood amylase levels in the HA380 high adsorption hemoperfusion group were significantly lower than those in the HA330 ordinary adsorption hemoperfusion group[TG (mmol/L):9.63±2.57 vs. 15.52±4.07,blood amylase (U/L):759.63±153.29 vs. 973.90±125.94,both P<0.05]. Conclusion The use of hemofiltration combined with high adsorption hemoperfusion in HLAP can rapidly relieve symptoms,reduce blood lipid levels,and alleviate the severity of pancreatitis.

Objective To explore the therapeutic effect of high adsorption hemoperfusion on hypertriglyceridemic acute pancreatitis (HLAP). Methods A retrospective study was conducted. HLAP patients who received high adsorption hemoperfusion treatment in the Department of Critical Care Medicine,Tongling People's Hospital from May 1,2020 to July 31,2023 were selected as the research objects. The patients were divided into the HA380 high adsorption hemoperfusion group and the HA330 ordinary adsorption hemoperfusion group according to different hemoperfusion devices used. The changes in vital signs before and after treatment with the HA380 high adsorption hemoperfusion device were observed,and the differences in triglyceride (TG) and blood amylase levels before and after hemoperfusion were compared between the HA380 high adsorption hemoperfusion group and the HA330 ordinary adsorption hemoperfusion group. Results A total of 26 patients were included,with 16 cases in the HA380 high adsorption hemoperfusion group and 10 cases in the HA330 ordinary hemoperfusion group. With the increase in the number of hemoperfusion sessions,the heart rate,body temperature,and respiratory rate of the patients in the HA380 high adsorption hemoperfusion group gradually decreased[heart rate (bpm):105.38±21.44,95.31±17.56 vs. 119.93±21.06,body temperature (℃):37.31±0.88,37.22±0.69 vs. 37.99±1.17,respiratory rate (times/min):19.44±5.12,17.00±4.83 vs. 21.94±5.12,all P<0.05],and the systolic blood pressure gradually increased[mmHg (1 mmHg≈ 0.133 kPa):106.81±11.04,120.13±9.14 vs. 97.44±8.23,both P<0.05]. The TG and blood amylase levels in both the HA380 high adsorption hemoperfusion group and the HA330 ordinary adsorption hemoperfusion group gradually decreased after hemoperfusion,reaching the lowest level after the second hemoperfusion,and the TG and blood amylase levels in the HA380 high adsorption hemoperfusion group were significantly lower than those in the HA330 ordinary adsorption hemoperfusion group[TG (mmol/L):9.63±2.57 vs. 15.52±4.07,blood amylase (U/L):759.63±153.29 vs. 973.90±125.94,both P<0.05]. Conclusion The use of hemofiltration combined with high adsorption hemoperfusion in HLAP can rapidly relieve symptoms,reduce blood lipid levels,and alleviate the severity of pancreatitis.

γ-butyrolactone is a colorless transparent liquid used in the production of drugs such as cyclopropylamine and pyrrolidone, and is also used as an industrial solvent, diluent, curing agent, etc., and is listed as the third category of precursor chemicals control. There is less clinical exposure to γ-butyrolactone and insufficient studies on its withdrawal response. This article reports a case of severe life-threatening rhabdomyolysis in a patient with γ-butyrolactone withdrawal. After active treatment, the patient eventually recovered. The clinical characteristics and treatment methods of γ-butyrolactone withdrawal reaction were summarized, suggesting that severe withdrawal reaction may occur in γ-butyrolactone.

Objective:To screen out the potential key genes of sepsis-associated acute kidney injury (AKI), and provide theoretical and experimental evidence for the treatment of sepsis-associated AKI.Methods:① Bioinformatics analysis: two gene expression datasets (GSE30718 and GSE53773) were downloaded for bioinformatics analysis from the Gene Expression Omnibus (GEO). These two datasets recorded mRNA microarray data from kidney biopsies before and after kidney transplantation, and a subset of patients developed AKI after kidney transplantation. Differential analysis was conducted, and the genes with the same differential expression and a higher area under the receiver operator characteristic curve (AUC) in both databases were used as the target gene for subsequent cell experiments. ② Cell validation experiment: human proximal renal tubular cells HK2 were cultured in vitro, and lipopolysaccharide (LPS) was used for establishing LPS-HK2 cell model (LPS 10 mg/L for 6 hours, LPS model group), and the blank control group was set. Then, small interfering RNA (siRNA) technology was used to knock down the target gene obtained by bioinformatics analysis in LPS-HK2 cells (gene knockdown group), and a gene negative control group was set. The real-time fluorescent quantitative reverse transcription-polymerase chain reaction (RT-qPCR) technique was used to detect the expression of the target gene in HK2 cells. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of inflammatory factors in the cell supernatants. Western blotting was used to detect the expressions of key apoptosis proteins. Results:① Results of bioinformatics analysis: 325 genes in the two datasets showed the same expression trend, of which 144 were significantly down-regulated and 181 were significantly up-regulated, while the expression difference of secretory leukocyte protease inhibitor (SLPI) in the two datasets was both statistically significant. Further receiver operator characteristic curve (ROC curve) analysis confirmed that the SLPI expression in GSE30718 and GSE53773 datasets had a high diagnostic efficiency for AKI, with AUC of 0.83 and 0.92, respectively. Therefore, SLPI was selected as the target gene for subsequent cell validation experiment. ② Cell validation experiment: the RT-qPCR analysis showed that the expression of SLPI in LPS-HK2 cells of the LPS model group was significantly higher than that of the blank control group (2 -ΔΔCT: 1.80±0.14 vs. 1.00±0.11, P < 0.01), and the change trend was the same with the results of bioinformatics analysis. Furthermore, knockdown SLPI gene analysis showed that the levels of inflammatory factors in LPS-HK2 cells supernatants in the gene knockdown group were significantly higher than those in the negative control group [Interleukin-6 (IL-6, ng/L): 509.58±27.08 vs. 253.87±75.83, IL-1β (ng/L): 490.99±49.52 vs. 239.67±26.97, tumor necrosis factor-α (TNF-α, ng/L): 755.22±48.66 vs. 502.06±10.92, all P < 0.01]. The above results indicated that SLPI could inhibit the inflammatory response of HK2 cells induced by LPS. The expressions of key apoptosis proteins Bax and caspase-3 in LPS-HK2 cells in the gene knockdown group were significantly higher than those in the negative control group [Bax protein (Bax/GAPDH): 1.38±0.12 vs. 1.00±0.10, caspase-3 protein (caspase-3/GAPDH): 1.44±0.15 vs. 1.00±0.11, both P < 0.05], and Bcl-2 expression was significantly decreased (Bcl-2/GAPDH: 0.83±0.08 vs. 1.00±0.05, P < 0.05), the above results indicated that SLPI could inhibit the apoptosis of cells in the inflammatory response. Conclusion:SLPI can inhibit the inflammatory response and apoptosis of HK2 cells induced by LPS, which may be involved in the protective mechanism of renal tubular cells in the response to sepsis, and is a potential target for the treatment of sepsis-associated AKI.

γ-butyrolactone is a colorless transparent liquid used in the production of drugs such as cyclopropylamine and pyrrolidone, and is also used as an industrial solvent, diluent, curing agent, etc., and is listed as the third category of precursor chemicals control. There is less clinical exposure to γ-butyrolactone and insufficient studies on its withdrawal response. This article reports a case of severe life-threatening rhabdomyolysis in a patient with γ-butyrolactone withdrawal. After active treatment, the patient eventually recovered. The clinical characteristics and treatment methods of γ-butyrolactone withdrawal reaction were summarized, suggesting that severe withdrawal reaction may occur in γ-butyrolactone.

Objective To study the surgical indications and effectiveness of short segment pedicle screw fixation plus pecutaneous vertebroplasty (PVP) for single thoracolumbar fracture combined with Kümmell disease.Methods Between June 2012 and June 2014,a prospective case series analysis was made on the clinical data of 15 selected cases of single thoracolumbar fracture patients who were combined with Kümmell disease.There were three males and 12 females,with an average age of 62.5 years (range,48-80 years).The iujured vertebrae were located at T11 in 3 cases,at T12in 4,at L1 in 5 and at L2 in 3.All the patients were treated by short segment fixation plus PVP.Operative time,surgery-related complications and adjacent vertebral fracture during follow-up were recorded.The effectiveness of the treatment was appraised by visual analogue scale (VAS),Oswestry Disability Index (ODI),Cobb angle of operative segment,which were recorded preoperatively,one week post-operatively and at final follow-up.One-way ANOVA (Analysis of Variance) was employed for statistical analysis.Results The operative time was 0.8-2 hours (mean,1.35 hour).There was no observation of incision infection,nerve injury,cement leakage or other related operative complications.A total of 15 patients were followed up for 16-36 months (mean,22.4 months),which showed solid fusion and bone bridges in all patients,with no fracture of adjacent vertebra observed.VAS was improved from preoperative (5.93 ± 0.62) points to (1.80±0.64) points one week postoperatively and (2.60 ± 0.53) points at final follow-up.ODI was improved from preoperative 61.53 ± 4.30 to 19.93 ±3.26 one week postoperatively and 23.07 ± 4.06 at final follow-up.Cobb angle of operative segment was improved from preoperative (17.40 ± 6.73) ° to (9.53 ± 3.12) o one week postoperatively and (11.00 ± 3.20) ° at final follow-up.There was significant difference of all the indexes namely,VAS,ODI and Cobb angle,between preoperative and one week postoperative status as well as between preoperative and final follow-up (P ＜ 0.05 or 0.01).However,there was no significant difference between ODI and Cobb angle in one week postoperatively and at last follow-up (P ＞ 0.05).Conclusion For single thoracolumbar fracture with Kümmell disease,short segment fixation plus PVP can shorten the surgery time,reduce the rate of complications,relieve pain,recover the function and avoid loss of kyphosis correction,as is worthy of clinical recommendation.

Coma ; chemically induced ; Humans ; Nitriles ; adverse effects ; Pyrethrins ; adverse effects