Intravascular large B-cell lymphoma(IVLBCL) is a rare and aggressive type of lymphoma with diverse and nonspecific clinical manifestations, often leading to misdiagnosis. This article reports a case of IVLBCL in a middle-aged male patient who initially presented with pulmonary arterial hypertension(PAH). The patient exhibited progressive hypoxemia and PAH, showing poor response to standard PAH therapy. Laboratory tests indicated a hyperinflammatory state and significantly elevated lactate dehydrogenase levels, while imaging revealed diffuse bilateral lung lesions. Random skin biopsy identified atypical B lymphocytes within subcutaneous capillaries, confirming the diagnosis of IVLBCL. Following treatment with the ZR-CHOP regimen, the patient's symptoms and laboratory parameters improved markedly. By reviewing relevant literature, this article systematically outlines the diagnostic and therapeutic process of this case, aiming to provide insights for the clinical recognition of such rare presentations.

Doxorubicin (DOX)-induced cardiotoxicity and sepsis-induced myocardial injury (SIMI) represent significant clinical challenges in patients undergoing chemotherapy, sharing a common pathological basis of oxidative stress and mitochondrial dysfunction. Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, has recently been shown to play a critical role in DOX-induced cardiotoxicity and lipopolysaccharide (LPS)-induced SIMI. This article systematically reviews the mechanisms underlying myocardial injury caused by DOX and sepsis, identifying ferroptosis as a central common pathway. DOX triggers a burst of reactive oxygen species within mitochondria and inhibits glutathione peroxidase 4 (GPX4) activity through redox cycling of its quinone group and high-affinity accumulation in mitochondrial cardiolipin. LPS, by activating pattern recognition receptors and related inflammatory signaling pathways, provokes a cytokine storm and mitochondrial dysfunction. Both can disrupt the core regulatory axis of cysteine-glutathione (GSH)-GPX4, synergistically promoting ferroptosis in cardiomyocytes. Moreover, epigenetic regulation plays a key role in DOX- and LPS-induced cardiomyocyte ferroptosis and may serve as a promising therapeutic target. A deeper understanding of the ferroptosis mechanism and its epigenetic regulatory network in the synergistic injury induced by DOX and sepsis is of great importance for developing novel strategies to mitigate chemotherapy-related cardiotoxicity and improve outcomes in cancer patients with concurrent infections.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Based on network pharmacology,molecular docking technology and experimental valida-tion to explore the therapeutic efficacy and mechanism of action of baicalin(BC)on kidney injury caused by Klebsiella pneumoniae(KP)infection.The inhibitory activity of BC against KP was de-termined by in vitro experiments;a mouse kidney injury model was established,and the therapeu-tic effect was preliminarily verified by ophthalmoscopy and pathological histology;three pro-in-flammatory factors,namely,TNF-α,IL-10,and IL-1β,were detected by ELISA;and the cyber-pharmacology technology was utilized by PubChem,TCMSP,STRING,Cytoscape,AutoDocks and other databases and software to construct the PPI network as well as to perform GO function and KEGG enrichment analyses;and molecular docking technology was used to assess the binding ac-tivity of the drugs to the core targets and to speculate on the signaling pathways of the drug action.The results showed that BC had a better inhibitory effect on KP in the in vitro experiments;path-ological histology showed a significant therapeutic effect of BC;compared with the infected group,the content of pro-inflammatory factors TNF-α,IL-10,and IL-1β in the baicalin treatment group were significantly decreased(P≤0.05).Twenty-four core targets and 11 pathways of action were screened by network pharmacology,and BC docked stably with the acquired core targets TP53,PTGS2,MAPK1,MAPK8,TNF,BCL2,and IGF1 molecules,and it was speculated that BC might exert its antibacterial and anti-inflammatory effects through the signaling pathways of PI3K-Akt,MAPK,HIF-1,and NF-kappa B,etc.This study lays the foundation for further research on the mechanism of action of baicalin on renal injury.

Based on network pharmacology,molecular docking technology and experimental valida-tion to explore the therapeutic efficacy and mechanism of action of baicalin(BC)on kidney injury caused by Klebsiella pneumoniae(KP)infection.The inhibitory activity of BC against KP was de-termined by in vitro experiments;a mouse kidney injury model was established,and the therapeu-tic effect was preliminarily verified by ophthalmoscopy and pathological histology;three pro-in-flammatory factors,namely,TNF-α,IL-10,and IL-1β,were detected by ELISA;and the cyber-pharmacology technology was utilized by PubChem,TCMSP,STRING,Cytoscape,AutoDocks and other databases and software to construct the PPI network as well as to perform GO function and KEGG enrichment analyses;and molecular docking technology was used to assess the binding ac-tivity of the drugs to the core targets and to speculate on the signaling pathways of the drug action.The results showed that BC had a better inhibitory effect on KP in the in vitro experiments;path-ological histology showed a significant therapeutic effect of BC;compared with the infected group,the content of pro-inflammatory factors TNF-α,IL-10,and IL-1β in the baicalin treatment group were significantly decreased(P≤0.05).Twenty-four core targets and 11 pathways of action were screened by network pharmacology,and BC docked stably with the acquired core targets TP53,PTGS2,MAPK1,MAPK8,TNF,BCL2,and IGF1 molecules,and it was speculated that BC might exert its antibacterial and anti-inflammatory effects through the signaling pathways of PI3K-Akt,MAPK,HIF-1,and NF-kappa B,etc.This study lays the foundation for further research on the mechanism of action of baicalin on renal injury.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

INTRODUCTIONAcute fatty liver of pregnancy (AFLP) frequently causes liver failure in pregnant women. A better understanding of the clinical characteristics, management, outcomes and risk factors of AFLP is required, given its relatively high mortality rate. We aimed to describe the characteristics of AFLP, and further assess its outcomes and potential risk factors from the perspectives of the mother and fetus.

METHODSThis was a retrospective cohort study of 133 patients with AFLP hospitalised at four tertiary hospitals in China between January 2009 and April 2014.

RESULTSAmong 133 patients, AFLP was diagnosed in the postpartum period for 13 (9.8%) patients. Potential factors influencing adverse maternal outcome were male fetus (p = 0.04), postpartum diagnosis of AFLP (p < 0.01), intrauterine fetal death (p = 0.04), disseminated intravascular coagulation (p < 0.01), prothrombin time (p < 0.01) and activated partial thromboplastin time (p = 0.04). The frequency of fetal distress (p = 0.03) and activated partial thromboplastin time (p < 0.05) were significantly higher in pregnancies with dead fetuses than in those where the fetuses survived. Independent risk factors for perinatal maternal mortality were history of legal termination of pregnancy (odds ratio [OR] 1.958, 95% confidence interval [CI] 1.133-3.385), total bilirubin (OR 1.009, 95% CI 1.003-1.014) and serum creatinine (OR 1.010, 95% CI 1.003-1.017).

CONCLUSIONCompared with total bilirubin and serum creatinine, history of legal termination of pregnancy appeared to be a greater risk factor for maternal mortality among patients with AFLP.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

Adult ; Anemia, Hemolytic ; diagnosis ; drug therapy ; Anti-Bacterial Agents ; therapeutic use ; Humans ; Male ; Mycoplasma pneumoniae ; pathogenicity ; Pneumonia, Mycoplasma ; diagnosis ; drug therapy