Objective:To investigate the heterogeneity of peripheral blood neutrophils in sepsis and provide reference for the diagnosis of sepsis.Methods:Twenty-four male C57BL/6 mice were divided into two groups, control and sepsis groups, with 12 mice in each group using a completely randomized design. The mice in the control group were injected with 100 μl saline through the tail vein, while the mice in the sepsis group were injected with an equal amount of Escherichia coli solution (3.33 McFarland turbidity standards) through the tail vein to establish the sepsis model. Peripheral blood samples were collected, and the proportions of neutrophils expressing different surface markers were detected using mass cytometry. GO and KEGG analyses were performed on neutrophil subsets with high CD62L expression, and public datasets were used for verification. The protein-protein interaction networks of CD62L were investigated to assess the value of neutrophil heterogeneity in the diagnosis of sepsis. Results:There were significant differences in the expression of markers in peripheral blood samples between the sepsis group and the control group. CD62L + neutrophil subsets were found in mice with sepsis. GO and KEGG analyses showed that CD62L + neutrophil subsets were associated with multiple biological processes and signaling pathways such as cell adhesion, migration, surface receptor activation, and immune regulation. Clinical results confirmed the correlation of neutrophil CD62L expression with the severity and prognosis of sepsis. The number of subpopulations expressing CD62L in peripheral blood neutrophils in the sepsis group was higher than that in the control group, but the expression level of CD62L in single cells in the sepsis group was significantly lower than that in the control group ( P<0.01). Protein-protein interaction network analysis showed strong interaction between CD62L and multiple important proteins such as P-selectin, P-selectin ligand, E-selectin, and vascular cell adhesion molecule-1. Conclusion:There is heterogeneity in the surface markers of neutrophils between sepsis mice and control mice, which may be a potential indicator for the diagnosis of sepsis.

Objective:To investigate the heterogeneity of peripheral blood neutrophils in sepsis and provide reference for the diagnosis of sepsis.Methods:Twenty-four male C57BL/6 mice were divided into two groups, control and sepsis groups, with 12 mice in each group using a completely randomized design. The mice in the control group were injected with 100 μl saline through the tail vein, while the mice in the sepsis group were injected with an equal amount of Escherichia coli solution (3.33 McFarland turbidity standards) through the tail vein to establish the sepsis model. Peripheral blood samples were collected, and the proportions of neutrophils expressing different surface markers were detected using mass cytometry. GO and KEGG analyses were performed on neutrophil subsets with high CD62L expression, and public datasets were used for verification. The protein-protein interaction networks of CD62L were investigated to assess the value of neutrophil heterogeneity in the diagnosis of sepsis. Results:There were significant differences in the expression of markers in peripheral blood samples between the sepsis group and the control group. CD62L + neutrophil subsets were found in mice with sepsis. GO and KEGG analyses showed that CD62L + neutrophil subsets were associated with multiple biological processes and signaling pathways such as cell adhesion, migration, surface receptor activation, and immune regulation. Clinical results confirmed the correlation of neutrophil CD62L expression with the severity and prognosis of sepsis. The number of subpopulations expressing CD62L in peripheral blood neutrophils in the sepsis group was higher than that in the control group, but the expression level of CD62L in single cells in the sepsis group was significantly lower than that in the control group ( P<0.01). Protein-protein interaction network analysis showed strong interaction between CD62L and multiple important proteins such as P-selectin, P-selectin ligand, E-selectin, and vascular cell adhesion molecule-1. Conclusion:There is heterogeneity in the surface markers of neutrophils between sepsis mice and control mice, which may be a potential indicator for the diagnosis of sepsis.

Objective: To summarize the measures and experience of treatment in mass extremely severe burn patients. Methods: The clinical data and treatment of 8 extremely severe burn patients in August 2 Kunshan factory aluminum dust explosion accident who were admitted in the 100th Hospital of PLA on August 2nd, 2014, were retrospectively analyzed. There were 4 males and 4 females, aging 22-45 (34±7) years, with total burn area of 55%-98% [(89±15)%] total body surface area (TBSA) and full-thickness burn area of 45%-97% [(80±21)%] TBSA. All the 8 patients were accompanied with severe shock, inhalation injury, and blast injury. According to the requirements of former PLA General Logistics Department and Nanjing Military Command, a treatment team was set up including a special medical unit and a special care unit, with Chai Jiake from the First Affiliated Hospital of PLA General Hospital as the team leader, Zheng Qingyi from the 175th Hospital of PLA (the Affiliated Dongnan Hospital of Xiamen University) as the deputy leader, the 100th Hospital of PLA as the treatment base, and burn care, respiratory, nephrology, nursing specialists from the First Affiliated Hospital of PLA General Hospital, and the burn care experts and nursing staff from the 180th Hospital of PLA, 118th Hospital of PLA, 98th Hospital of PLA, and 175th Hospital of PLA, and nurses from the 85th Hospital of PLA, 455th Hospital of PLA, 101th Hospital of PLA, 113th Hospital of PLA as team members. Treatment strategies were adopted as unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns. With exception of one patient who received deep vein catheterization before admission, the other 7 patients were treated with deep vein catheterization 0.5 to 3.0 hours after admission to correct hypovolemic shock as soon as possible. Eight patients received tracheotomy, and 7 patients were treated with mechanical ventilation by ventilator in protective ventilation strategy with low tide volume and low volume pressure to assist breathing. Fiberoptic bronchoscopy was done one to three times for all the 8 patients to confirm airway injuries and healing status. Escharectomy and Meek dermatoplasty in the extremities of all the 8 patients were performed 3 to 6 days after injury for the first time. Escharectomy, microskin grafting, and covering of large pieces of allogeneic skin on the trunks of 4 patients were performed 11 to 16 days after injury for the second time. The broad-spectrum antibiotics were uniformly used at first time of anti-infective therapy, and then the antibiotics species were adjusted in time. The balance of internal environment was maintained and the visceral functions were protected. One special care unit was on responsibility of only one patient. Psychological intervention was performed on admission. The rehabilitative treatment was started at early stage and in company with the whole treatment. Results: Acute renal injury occurred in 5 patients within 36 hours after injury and their renal function was restored to normal 4 days after injury due to active adjustment of fluid resuscitation program. No pulmonary complications, such as severe pulmonary infection and ventilator-associated pneumonia, occurred in the survived patients. One of the 8 patients died, and the other 7 patients were cured successfully. The wounds were basically healed in 2 patients in 26 or 27 days by 2 or 3 times of operation, and in 5 patients by 4 or 5 times of operation. The basic wound healing time was 26-64 (48±15) days for all the 7 patients. Conclusions Treatment strategies of unified coordination by the superior, unified responsibility of team leader, division of labor and cooperation between team members, and multidisciplinary cooperation led by department of burns are the bases to successful treatment. Correcting shock as soon as possible is the prerequisite and closing wound as soon as possible is the key to successful treatment. Comprehensive treatment measures, such as maintaining and regulating the function of viscera, improving the body immunity, and preventing and treating the complications, are the important components to successful treatment. It is emphasized that in the treatment of mass extremely severe burn patients, specialist burn treatment should always be in the dominant position, and other related disciplines may play a part in auxiliary function.