Sepsis-associated liver injury (SALI) is a common complication of sepsis, which is characterized by systemic immune disorders induced by sepsis leading to liver damage. Currently, there are no effective treatments for SALI, which is related to its complex pathophysiological mechanisms. In recent years, the disorder of intestinal environment after sepsis has been considered as an important factor for SALI, but the specific molecular mechanism of the above process is still unclear. This article will review the pathological role and molecular mechanisms between intestinal environmental disturbance and SALI, aiming to analyze the potential research direction of SALI and identify potential therapeutic targets for its treatment.

Objective:This study aimed to investigate the correlation between the levels of serum amyloid A protein (SAA) and apolipoprotein A-Ⅰ (ApoA-Ⅰ) with the severity and prognosis of septic patients, in order to find new clinical prognostic markers for sepsis patients.Methods:This study prospectively included patients admitted to the intensive care unit of Northern Jiangsu People's Hospital from September 2021 to February 2022. Patients were diagnosed with sepsis according to the Sepsis-3 criteria and aged between 18 and 80 years old. Peripheral venous blood samples were collected at 0 h, 24 h, and 72 h after inclusion in the study, measured the levels of ApoA-Ⅰ and SAA, and the 72 h ΔSAA and 72 h ΔApoA-Ⅰwere calculated.. Patient demographics, laboratory parameters, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores, sequential organ failure assessment scores, etc., were recorded. Patients were divided into survival and death groups based on outcomes, and were divided into shock and non-shock groups based on the presence of shock. Logistic regression was used to combine ApoA-I and SAA to establish a new combined index. Receiver Operating Characteristic curve analysis was performed to evaluate the predictive value of SAA, ApoA-Ⅰ, 72 h ΔApoA-Ⅰ, 72 h ΔSAA and the combined SAA and ApoA-Ⅰ for the prognosis of sepsis patients.Results:A total of 108 patients were included in the analysis, with 48 cases in the non-septic shock group and 60 cases in the septic shock group; 77 cases in the survival group and 31 cases in the death group. There were statistically significant differences in SAA and ApoA-Ⅰ levels at each time point between the shock and non-shock groups (all P<0.05), as well as between the death and survival groups (all P<0.05). SAA levels at each time point were positively correlated with APACHEⅡ scores (all P<0.001), while ApoA-Ⅰ levels at each time point were negatively correlated with APACHEⅡ scores (all P<0.01). SAA levels could predict the risk of death in sepsis patients, with the highest area under curve (AUC) value at 24 h SAA (AUC=0.713, P=0.001), sensitivity was 65.3%, and specificity was 72.7% for predicting 28-day mortality in sepsis. ApoA-Ⅰ levels at each time point could also predict the risk of death in sepsis patients, with the highest AUC value at 72 h ApoA-Ⅰ (AUC=0.743, P<0.001), sensitivity was 69.4%, and specificity was 77.1% for predicting 28-day survival in sepsis. The combined detection of 24 h SAA and 72 h ApoA-Ⅰ increased the AUC value (AUC=0.758, P<0.05), but the Z test showed that the prediction of death risk in patients with sepsis was not significantly higher than that of a single index ( P>0.05). Conclusions:Serum levels of SAA and ApoA-Ⅰ could reflect the severity of sepsis in patients and serve as independent indicators for predicting the prognosis of sepsis patients. The overall diagnostic efficacy of the combined SAA and ApoA-Ⅰ was not significantly different from that of a single index.

Objective:To investigate the risk factors and prognosis of early septic shock-related thrombocytopenia.Methods:Retrospective analysis of clinical data of patients with septic shock admitted to the department of intensive care unit (ICU) of Northern Jiangsu People's Hospital from June 2016 to November 2020 was conducted. According to the lowest platelet count (PLT) in the early stage of septic shock (within 24 hours of using vasoactive drugs), the patients were divided into mild thrombocytopenia group [PLT (50-100)×10 9/L], severe thrombocytopenia group (PLT < 50×10 9/L) and normal platelet group (PLT > 100×10 9/L). The differences in general information, laboratory indicators, mechanical ventilation time, length of ICU stay, in-hospital stay, and 28-day mortality among the three groups were analyzed. Multivariate Logistic regression was used to analyze the influencing factors of thrombocytopenia, and the 28-day Kaplan-Meier survival curve of patients with different PLT levels was drawn. Results:A total of 486 patients with septic shock were enrolled, including 123 patients with mild thrombocytopenia, 75 patients with severe thrombocytopenia and 288 patients with normal platelets. Patients with diabetes ( χ2 = 30.460, P < 0.001), abdominal infection ( χ2 = 15.024, P = 0.001), urinary tract infection ( χ2 = 36.633, P < 0.001), bloodstream infection ( χ2 = 7.755, P = 0.022), Gram negative (G -) bacilli infection ( χ2 = 19.569, P < 0.001), hyperlactic acidemia ( H = 23.404, P < 0.001), elevated procalcitonin (PCT, H = 43.368, P < 0.001), high acute physiology and chronic health evaluation Ⅱ (APACHEⅡ, F = 11.122, P < 0.001) and high sequential organ failure assessment (SOFA, F = 84.328, P < 0.001) were more likely to have thrombocytopenia within 24 hours of septic shock. Multivariate Logistic regression analysis of early septic shock-related thrombocytopenia showed that, diabetes [odds ratio ( OR) = 0.19, 95% confidence interval (95% CI) was 0.08-0.42, P < 0.001], urinary tract infection ( OR = 0.33, 95% CI was 0.13-0.83, P = 0.018), G - bacilli infection ( OR = 0.20, 95% CI was 0.07-0.58, P = 0.003), hyperlactic acidemia ( OR = 1.25, 95% CI was 1.07-1.46, P = 0.005) and high APACHEⅡ score ( OR = 0.85, 95% CI was 0.78-0.92, P < 0.001) were independent risk factors for platelets < 50×10 9/L. Abdominal infection was an independent risk factor for PLT (50-100)×10 9/L ( OR = 0.56, 95% CI was 0.34-0.95, P = 0.03). High SOFA score was an independent risk factor for PLT ≤ 100×10 9/L [PLT < 50×10 9/L: OR = 2.03, 95% CI was 1.65-2.52, P < 0.001; PLT (50-100)×10 9/L: OR = 1.31, 95% CI was 1.16-1.48, P < 0.001]. There were no significant differences in mechanical ventilation time, length of ICU stay, and in-hospital stay among the three groups ( H values were 0.142, 2.134, and 3.990, respectively, all P > 0.05). The 28-day mortality of septic shock patients increased with the severity of thrombocytopenia ( χ2 = 40.406, P < 0.001), and the 28-day mortality of severe thrombocytopenia group and mild thrombocytopenia group was significantly higher than those of the normal platelet group [66.7% (50/75), 43.1% (53/123) vs. 27.8% (80/288), both P < 0.05]. Kaplan-Meier survival curve analysis showed that the 28-day survival rate gradually decreased with the decrease of PLT, and the 28-day survival rate was higher in the normal platelet group (Log-Rank test: χ2 = 80.667, P < 0.001). Conclusions:Diabetes, abdominal infection, urinary tract infection, G - bacilli infection, hyperlactic acidemia, high APACHEⅡ score, and high SOFA score are independent risk factors for early septic shock-related thrombocytopenia. Early thrombocytopenia in patients with septic shock indicates a high risk of 28-day death.

Objective:To investigate the standardized construction of critical care departments in different cities and counties of Guizhou province to promote the homogenization development of critical care medicine in Guizhou Province.Methods:Using research methods such as field investigation and data collection, the public hospitals of 88 counties and urban areas in 9 prefectures and cities of Guizhou province were divided into five routes: southeast, northeast, northwest, southwest, and Guiyang. To design the survey form for the standardized construction of ICU, the e-form was sent to the director of ICU or his/her designated personnel by email or wechat 2-3 days in advance. Check the authenticity of data item by item on site, and leave the hospital after checking the receipt form.Results:From April to July 2021, the survey and research data collection was completed for 146 public hospitals (excluding provincial hospitals) with intensive care departments in 88 counties and cities of 9 dizhou cities in Guizhou Province, including 24 Grade-Ⅲ Level A hospitals. 122 Grade-Ⅱ and above hospitals (including 8 Grade-Ⅲ Level B hospitals, 11 Grade-Ⅲ comprehensive hospitals, 97 Level-Ⅱ A hospitals, 3 Level-Ⅱ B hospitals, and 3 Level-Ⅱ comprehensive hospitals). 146 public hospitals have a total of 80 983 beds and 104 017 open beds. The department of Critical Care has 2 035 beds. The ratio of actual beds in ICU to total beds in hospital was 2.51%. From 1999 to 2010, 18 (12.33%) established departments, and from 2011 to 2021, 128 (87.67%) established departments. The total area of the discipline is 113 355.48 m 2, with an average bed area of 55.70 m 2. There were 97 hospitals with 1.5-2.0 m bed spacing, accounting for 66.44%, and 49 hospitals with 2.1- > 2.5 m spacing, accounting for 33.56%. The number of negative pressure wards: 1 in each of 43 hospitals, accounting for 29.45%; 103 hospitals did not have, accounting for 70.55%. The number of single rooms: 288 in 140 hospitals, accounting for 95.89%; 6 hospitals did not have, accounting for 4.11%. Central oxygen supply: 138 hospitals have (94.52%); 8 hospitals did not have, accounting for 5.48%. Natural ventilation: in 129 hospitals with 88.36%; 17 hospitals did not have, accounting for 11.64%. Specialized ICU construction: 66 hospitals, accounting for 45.21%; none in 80 hospitals, accounting for 54.79%. There are 3 712 doctors and nurses in 146 public hospitals. The total number of doctors was 1 041, and the ratio of doctors to beds was 0.51∶1. The total number of nurses was 2 675, and the ratio of nurses to beds was 1.31∶1. Conclusions:All 88 counties and districts in 9 prefectures and cities of Guizhou province have established intensive care medicine departments. The standardization of the discipline construction has been significantly improved. Lack of talents is still an important factor restricting the rapid development of the discipline.

Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.

Objective? To?observe?the?effects?of?enteral?nutrition?(EN)?emulsion?with?different?components?on?nutritional?index,?blood?glucose,?inflammatory?reaction,?gastrointestinal?tolerance?and?prognosis?in?patients?with?severe?traumatic?brain?injury?(sTBI).? Methods? Patients?with?sTBI?[Glasgow?coma?scale?(GCS)??0.05].? Conclusion? For?patients?with?sTBI,?short?peptide?EN?preparations?(Baipuli)?is?much?better?in?gastrointestinal?tolerance?but?it?can?cause?fluctuations?of?blood?glucose;?the?whole?protein?EN?containing?ω-3?fatty?acid?(Ruineng,?Ruisu)?has?relatively?less?fluctuation?on?blood?glucose,?the?duration?of?MV?and?the?length?of?ICU?stay?can?be?shortened?by?Ruineng,?therefore?it?is?more?suitable?to?be?applied?for?such?patients.

Objective To approach the value of red cell distribution width (RDW) on the prognostic assessment of patients with abdominal sepsis. Methods The clinical data of adult patients with abdominal sepsis admitted to intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to September 2017 were retrospectively analyzed. The patients were divided into survival group and death group according to ICU prognosis. The levels of serum lactate (Lac), procalcitonin (PCT), RDW, and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score within 24 hours were recorded. Receiver operating characteristic (ROC) curve was plotted to analyze the prognostic value of Lac, PCT, RDW and APACHE Ⅱ score. Results 162 patients with abdominal sepsis were enrolled, 132 survived, and 30 died. Compared with survival group, the Lac, PCT, APACHE Ⅱ score, and RDW in death group were significantly increased [Lac (mmol/L): 4.21±2.42 vs. 2.27±1.51, PCT (mg/L): 32.08±12.95 vs. 11.87±8.81, APACHEⅡ score: 30.13±6.42 vs. 23.36±5.29, RDW: (16.64±1.38)% vs. (13.49±2.03)%, all P < 0.01]. ROC curve analysis showed that all indicators could be used to predict the prognosis of abdominal sepsis, with the maximum predictive value of RDW. The area under the ROC curve (AUC) was 0.888, it was greater than that of APACHE Ⅱ score (AUC = 0.787), Lac (AUC = 0.767) and PCT (AUC = 0.696). When threshold value of RDW was 15.40%, the sensitivity was 83.3%, and the specificity was 85.6%. Conclusion RDW can evaluate the prognosis of patients with abdominal sepsis, and its predictive value is greater than traditional evaluation parameters such as APACHEⅡscore, Lac, and PCT.

Objective To observe the effect of hydrogen-rich water on the chondriosome damage and cytokines change in brain tissue of rats with traumatic brain injury (TBI). Methods Fifty-four health male Sprague-Dawley (SD) rats were divided into three groups by random number table: sham group, trauma group (TBI group), and trauma+hydrogen-rich water group (TBI+HW group), the rats in each group were subdivided into 1, 3 and 7 days subgroups according to the time points after trauma, with 6 rats in each subgroup. The TBI model was reproduced by using a modified Feency method for free fall impact, and the rats in sham group were not given brain impact after craniotomy. The rats in TBI+HW group were given intraperitoneal injection of hydrogen-rich water (5 mL/kg) after TBI model reproduction, and then once a day until being sacrificed; and the rats in sham group and TBI group were given the same amount of normal saline. The neurological severity scores (NSS) for neurologic deficits were calculated at corresponding time points, and then the rats were sacrificed to harvest brain tissue at 3 mm around lesion boundary. The cytokines including tumor necrosis factor-α (TNF-α) and interleukin-1β(IL-1β) were determined by enzyme linked immunosorbent assay (ELISA); the protein expressions of Bax, Bcl-2 were determined by Western Blot; the RFU of reactive oxygen species (ROS), mitochondrial membrane potential (MMP) and mitochondrial membrane permeability (MPTP) were determined by fluorescence and enzyme sign method. Results TBI and TBI+HW groups appeared obvious neurologic damage after injury in rats. NSS scores in TBI and TBI+HW groups showed a decreased tendency with time prolongation after TBI. NSS scores in TBI+HW group at 3 days and 7 days were significantly lower than those of TBI group (NSS score: 9.67±0.82 vs. 11.17±1.17, 6.83±0.75 vs. 8.50±1.04, both P < 0.05). Compared with sham group, the expressions of TNF-α, IL-1β, RFU of ROS in chondriosome, protein expression of Bax in brain tissue in TBI group and TBI+HW group were significantly increased, peaked at 1 day, then they gradually declined. Each time point of RFU of MMP, MPTP in chondriosome and protein expression of Bcl-2 were significantly decreased, and gradually increased after one-day valley value. Compared with TBI group, the expressions of TNF-α, IL-1β, RFU of ROS in chondriosome and protein expression of Bax in brain tissue were all declined at corresponding time points [TNF-α(ng/L): 54.14±1.11 vs. 81.49±2.76, IL-1β(ng/L):74.53±1.75 vs. 119.44±3.56, ROS (RFU): 92.30±2.46 vs. 121.33±6.57, Bax: 0.89±0.01 vs. 1.10±0.01, all P <0.01]; RFU of MMP, MPTP in chondriosome and the protein expression of Bcl-2 were all increased at corresponding time points [MMP (RFU): 99.28±3.97 vs. 74.72±3.00, MPTP (RFU): 188.82±4.44 vs. 160.01±2.04, Bcl-2: 0.52±0.02 vs. 0.30±0.02, all P < 0.01]. Conclusions The high expressions of cytokines and chondriosome damage were involved in the early TBI. Early treatment with an intraperitoneally injection of hydrogen-rich water can reduce chondriosome damage and inflammation factor release, reduce the nerve cell apoptosis after TBI, and protect brain function.

Objective To compare the effect of 0.9％ NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution (ASPMCG solution) on internal environment in patients with septic shock receiving early fluid resuscitation.Methods A prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital were enrolled. All eligible patients were randomly divided into 0.9％ NaCl solution group (group N), Ringer solution group (group L) and ASPMCG solution group (group P) with random number table. In all patients, catheters were placed in the right internal jugular vein or subclavian vein and were infused with 30 mL/kg of corresponding crystalloid within 3 hours after admission. According to fluid responsiveness, the rehydration rate and fluid volume were determined by the researcher within 6 hours. Other treatments were based on the 2012 Surviving Sepsis Campaign (SSC) guidelines during the study. In this study, 6-hour or 24-hour fluid volume and 7-day exogenous insulin use were recorded. The changes in arterial blood pH, base excess (BE), blood glucose (Glu), lactic acid (Lac), and serum Na+, K+, Cl-, Ca2+ were observed at 0, 3, 6, 24 hours, and 3 days and 7 days of resuscitation.Results In this study, a total of 1082 patients were admitted to the ICU, and patients who did not meet the diagnostic criteria for septic shock, death or discharge within 24 hours of ICU admission were excluded. Finally, 280 patients with septic shock were enrolled in the analysis, with 94 patients in group N, 94 patients in group L and 92 patients in group P. There was [Abstract] Objective To compare the effect of 0.9％ NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution (ASPMCG solution) on internal environment in patients with septic shock receiving early fluid resuscitation.Methods A prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital were enrolled. All eligible patients were randomly divided into 0.9％ NaCl solution group (group N), Ringer solution group (group L) and ASPMCG solution group (group P) with random number table. In all patients, catheters were placed in the right internal jugular vein or subclavian vein and were infused with 30 mL/kg of corresponding crystalloid within 3 hours after admission. According to fluid responsiveness, the rehydration rate and fluid volume were determined by the researcher within 6 hours. Other treatments were based on the 2012 Surviving Sepsis Campaign (SSC) guidelines during the study. In this study, 6-hour or 24-hour fluid volume and 7-day exogenous insulin use were recorded. The changes in arterial blood pH, base excess (BE), blood glucose (Glu), lactic acid (Lac), and serum Na+, K+, Cl-, Ca2+ were observed at 0, 3, 6, 24 hours, and 3 days and 7 days of resuscitation.Results In this study, a total of 1082 patients were admitted to the ICU, and patients who did not meet the diagnostic criteria for septic shock, death or discharge within 24 hours of ICU admission were excluded. Finally, 280 patients with septic shock were enrolled in the analysis, with 94 patients in group N, 94 patients in group L and 92 patients in group P. There was no significant difference in the amount of crystalloid, colloidal fluid, total fluid within 6 hours or 24 hours or exogenous insulin dose within 7 days among the three groups. After fluid resuscitation, blood Cl- concentration in the three groups was increased in different degrees, peaked at 24 hours, but it in group N was significantly higher than that in group L and group P (mmol/L: 107.5±5.6 vs. 106.1±4.8, 105.1±4.2, bothP ﹤ 0.05). Moreover, blood Ca2+concentration also showed an increased tendency, it was significantly lower at 3 hours and 6 hours in group N than that in group L and group P (mmol/L: 1.10±0.08 vs. 1.15±0.09, 1.12±0.10 at 3 hours, 1.12±0.10 vs. 1.16±0.08, 1.15±0.09 at 6 hours, all P < 0.05). There was no significant difference in blood Cl- or Ca2+between groups L and P (bothP > 0.05). Arterial blood pH, BE, Glu, Lac, Na+, or K+at each time point during fluid resuscitation also showed no difference among the three groups.Conclusion Among patients with septic shock receiving early fluid resuscitation, compared with Ringer solution and ASPMCG solution, 0.9％ NaCl solution may cause hyperchloremia and hypocalcemia, but has no significant effect on acid-base balance.Clinical Trial Registration Chinese Clinical Trial Registry, ChiCTR-IOR-16009176.

Objective To analyze the pathogenic factors, clinical features and treatment measures of critically ill pregnant women so as to provide experience for improving the success rate of treatment. Methods The clinical data of 167 cases of critically ill pregnant women who admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from January 2013 to December 2017 were collected, and the disease distribution of patients, the causes of postpartum hemorrhage, the treatment situation and the results. Patients were divided into obstetrical complications group, pregnancy complicated with basic diseases group and other complicated diseases group according to disease types, and the treatment status of each group was analyzed. Results Among 167 critically ill pregnant women, 118 cases (70.6%) were in the obstetric complications group, 26 cases (15.6%) were in the pregnancy complicated with basic diseases group, and 23 cases (13.8%) were in the other complicated diseases group. Nine cases died in 167 critically ill pregnant women, with a mortality rate of 5.4%. Postpartum hemorrhage was the major obstetric complication (35.3%), and the coagulation function of 59 patients with postpartum hemorrhage was significantly improved 48 hours after active hemostasis and reasonable blood transfusion [compared to entering the ICU, prothrombin time (PT, s): 14.49±4.66 vs. 23.39±8.11, activated partial thromboplastin time (APTT, s): 52.94±36.36 vs. 87.35±74.69, fibrinogen (Fib, g/L): 2.91±1.03 vs. 1.03±0.65, platelet count (PLT, ×109/L): 94.85±30.09 vs. 43.15±24.07, all P < 0.01]. Compared with pregnancy complicated basic diseases group and other complicated diseases group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores was reduced significantly in obstetrical complications group (10.41±4.85 vs. 16.46±13.87, 16.90±8.82, both P < 0.05), the length of ICU stay was significantly reduced (hours: 57.83±34.67 vs. 79.64±36.01, 278.30±83.72, both P < 0.05). Compared with other complicated diseases group, the mechanical ventilation time [hours :14 (6, 38) vs. 43 (12, 396)] and mortality (0.8% vs. 13.0%) were significantly decreased in obstetrical complications group (both P < 0.05). Conclusions Observe the changes of the condition closely, necessary hemodynamic treatment, respiratory support, and organ function support with critically ill pregnant women can improve the rescue success rate and prognosis.