Sepsis is a life-threatening organ dysfunction due to dysregulation of the body's response to infection. The immunosuppressive phase of sepsis is also an important cause of high morbidity and mortality in patients with advanced sepsis. Myeloid-derived suppressor cell (MDSC), as a heterogeneous population of Gr1 +CD11b + immature cells, play a pivotal role in the immune process of advanced sepsis together with programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) with immunosuppressive properties. This review summarized the research progress of PD-1/PD-L1 pathway-mediated mechanism of MDSC in septic immunosuppression in recent years. The mechanism of action of PD-1/PD-L1 pathway in the immunosuppressive stage, the effects of PD-1/PD-L1 pathway on the "dual-signaling" model of MDSC through the signaling pathway and cytokines, as well as the time course of PD-1/PD-L1 pathway mediation in sepsis were described.

Objective:To investigate the static and dynamic trends of scientific research efficiency of the critical care medicine in hospitals affiliated S university during the 13th Five-Year Plan period.Methods:Based on the scientific research data of 16 hospitals affiliated to Beijing S University from 2014 to 2020, the scientific research investment funds and the number of physicians involved in scientific research were selected as input evaluation indexes, and the number of science citation index (SCI) papers, Chinese science citation database (CSCD) papers, and the number of masters and doctors trained were selected as output evaluation indexes, and the evaluation index system of scientific research efficiency of critical care medicine was constructed. SPSS version 23.0 software was used for descriptive data statistics, and data envelopment analysis (DEA)-BCC model and DEA-Malmquist index model of DEAP 2.1 software were used for static and dynamic evaluation of its scientific research efficiency from 2016 to 2020, respectively.Results:① The scientific research technical efficiency (TE) of critical care medicine in 16 hospitals affiliated with S universities varied greatly from 2016 to 2020, but pure technical efficiency (PTE) and scale efficiency (SE) were at a good level, and 6-11 affiliated hospitals in critical care medicine kept DEA effective for 5 consecutive years. ② Dynamic analysis of their total factor productivity (TFP) of scientific research from 2016 to 2020 showed a trend of rising and then falling and then rising again. The mean value was 0.985. The technical efficiency change (TEC) showed a decreasing and then increasing trend, and the technical progress change (TC) showed a slow increasing and then decreasing trend, with a mean value of 0.953. While the mean values of TEC, pure technical efficiency change (PTEC) and scale efficiency change (SEC) were above 1, which showed that the growth of total factor productivity index of research and innovation depended more on the technical efficiency index.Conclusions:The "gain effect" and "catch-up effect" of scientific research efficiency in the specialty of critical care medicine in hospitals affiliated S universities are obvious, but the "growth effect" is not obvious. "Although the research efficiency of the 13th Five-Year Plan period has been significantly improved, there is still much room for improvement in scientific and technological innovation and international academic influence.

Objective:To explore the preventive measures of nasal pressure injury in patients with preserved nasal endotracheal intubation after oral and maxillofacial neoplasms resection and simultaneous free tissue flap transplantation.Methods:Using the convenient sampling method, a total of 520 patients who underwent oral and maxillofacial neoplasms resection and simultaneous free tissue flap transplantation in Peking University Hospital of Stomatology were selected as the research objects from August 2018 to December 2019. According to the random number table method, they were divided into the experimental group and the control group. Patients in the control group received routine care, while in the experimental group, silk surgical tape was used to re-fix the endotracheal intubation tube away from the original position, and the special-shaped inflatable balloon was used to support the remote end of the tube. The incidence of nasal pressure injury, medical adhesive-related skin injury (MARSI) and the occurrence of complications caused by the fixation of tracheal intubation of patients were compared between the two groups. In the end, 246 patients in the experimental group and 248 patients in the control group completed the study.Results:No stage 3 or above nasal pressure injury occurred in the two groups. The incidence of nasal pressure injury related to nasotracheal tube in the experimental group was 2.85% (7/246) , lower than 12.10% (30/248) in the control group (χ 2=15.254, P<0.001) . There was no statistically significant difference in the incidence of MARSI of patients between the two groups ( P>0.05) . No complications caused by endotracheal intubation fixation occurred in both groups. Conclusions:The use of silk surgical tape to re-fix the endotracheal intubation and the combination of special inflatable balloon to support the end of the endotracheal intubation can prevent nasal pressure injury, and the safety is better.

Acute respiratory distress syndrome (ARDS) is an important cause of death in critically ill patients. Prone ventilation is one of the effective treatment methods for ARDS, but the current clinical implementation rate is not high, which is mainly due to the occurrence of serious complications such as tracheal tube and venous pipeline disconnection, pressure sores, hemodynamic instability and so on, and requires adequate personal and cooperation. The medical staff of the department of critical care medicine of Beijing Shijitan Hospital Affiliated to Capital Medical University designed a kind of support bracket for human body carrying and turning over which can help the critically ill patients to easily complete the position conversion during prone position ventilation, and has obtained the national utility model patent (Patent Number: ZL 2017 2 1847759.9). The support bracket is simple in design, composed of stent, rotating shaft and bandage. It is reliable and easy to operate. It can significantly reduce the difficulty of prone position ventilation, avoid the occurrence of related complications, reduce the labor load of medical staff, and improve the treatment quality of patients.

To establish septic myocardial inhibition rat model by echocardiography. Methods Twenty adult male Sprague-Dawley (SD) rats were divided into control group and model group according to the random number table method, with 10 rats in each group. The rat model of septic myocardial inhibition was reproduced by intraperitoneal injection of 10 mg/kg lipopolysaccharide, while the control group was given the same volume of saline. The left ventricular end-diastolic diameter (LVDd), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic diameter (LVDs), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), right ventricular end-diastolic diameter (RVDd), right ventricular end-systolic diameter (RVDs), heart rate (HR), positive pulmonary artery flow rate and aortic flow rate were measured at 8 hours after model establishment by echocardiography. Then the rats were sacrificed to harvest serum and myocardial tissue. The levels of serum tumor necrosis factor-α(TNF-α), nuclear factor-κB (NF-κB), interleukin-1 (IL-1), cardiac troponin I (cTnI) and B-type brain natriuretic peptide (BNP) were measured by enzyme linked immunosorbent assay (ELISA). The mRNA expressions of TNF-α, IL-1 and NF-κB in myocardium were detected by real-time polymerase chain reaction (real-time PCR). The pathological changes of myocardium were observed by hematoxylin-eosin (HE) staining under light microscope. Results Compared with control group, myocardial inhibition was obviously observed in model group, manifesting as enlargement of overall shape of heart, and prominent increase of HR (bpm: 449.0±21.1 vs. 356.7±23.3, P < 0.01); left ventricular and right ventricular functions were affected, LVDd, LVDs, LVEDV, LVESV were enlarged [LVDd (mm):10.03±0.95 vs. 7.04±0.71, LVDs (mm): 5.95±0.71 vs. 3.07±0.05, LVEDV (mL): 2.11±0.53 vs. 0.81±0.21, LVESV (mL): 0.51±0.16 vs. 0.07±0.01, all P < 0.05], LVEF was significantly decreased (0.760±0.046 vs. 0.901±0.025, P < 0.01), RVDd was significantly increased (mm: 4.48±0.58 vs. 3.22±0.20, P < 0.05), and positive pulmonary artery velocity was significantly decreased (cm/s: 64.2±9.3 vs. 89.0±0.8, P < 0.05). Compared with control group, the levels of serum NF-κB, TNF-α, IL-1, BNP and cTnI in model group were significantly increased [NF-κB (ng/L):103.84±6.55 vs. 57.29±41.34, TNF-α (ng/L): 1 198.32±164.07 vs. 835.45±24.01, IL-1 (ng/L): 1 089.90±221.96 vs. 746.19±165.83, BNP (ng/L): 1 097.36±293.84 vs. 454.71±197.79, cTnI (ng/L): 6 938.59±1 400.21 vs. 3 731.90±1 349.31, all P < 0.01], the mRNA expressions of TNF-α, NF-κB and IL-1 in myocardial tissue were significantly increased (2-ΔΔCT: 1.50±0.42 vs. 0.71±0.40, 1.10±0.17 vs. 0.63±0.06, 1.77±0.67 vs. 0.10±0.03, all P < 0.05). It was shown by HE staining that the structure of myocardial tissue in control group was distinct, the arrangement of myocardial fibers was neat, and transverse was clear; the structure of myocardial tissue in model group was loose, blurred, and the cells were swollen, with obvious pathological changes. Conclusions Cardiac function was assessed by echocardiography, expression of inflammatory factors, myocardial markers and pathological changes. It was verified that intraperitoneal injection of 10 mg/kg endotoxin could successfully prepare a rat model of septic myocardial inhibition.

Objective To assess the predictive value of early phrase echocardiography and cardiac biomarkers in patients with severe sepsis. Methods A retrospective analysis of severe septic patients (patients with acute coronary syndrome and end stage renal disease were excluded) in department of intensive care unit of Capital Medical University Affiliated Beijing Shijitan Hospital from January 2013 to December 2017 was conducted. The acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB) within 6 hours after admission, and bedside echocardiography indexes [left ventricular ejection fraction (LVEF), the ratio of the peak blood flow velocity in the early stage of the mitral valve and the peak blood flow rate of the mitral valve (E/A ratio)] within 6 hours after diagnosis were recorded. The differences of indexes between patients with decreased contractile function (LVEF < 0.50) group and normal group, and the difference between dead group and survival group within 28-day were compared. Receiver operating characteristic (ROC) curve and Logistic regression analysis were conducted to assess the early detected prognostic value in severe sepsis patients. Results ① A total of 316 patients were enrolled in the survey period. Decreased cardiac systolic function (LVEF < 0.50) was found in 89 cases (28.2%), and cardiac diastolic function impaired (E/A ratio < 1) in 269 cases (85.1%); while 79 cases (25.0%) had both systolic function and diastolic function impairment. ② NT-proBNP and cTnI were statistically different between cardiac systolic function impaired group and normal group. Further Logistic regression analysis showed that only NT-proBNP was significantly correlated with LVEF [β=-1.311, odds ratio (OR) = 0.269, P < 0.001]. ③ Eighty-two of 316 cases were died in 28-day, and the 28-day mortality rate was 25.9%. Compared with the survival group, the ratio of E/A < 1, APACHEⅡ score, NT-proBNP, cTnI, MYO, CK and CK-MB were significantly increased in death group. The ROC curve analysis showed that the above indexes had diagnosed value for prognosis in severe sepsis patient, among which NT-proBNP and cTnI had higher predictive value [the area under ROC curve (AUC) were 0.920 and 0.901 respectively, both P < 0.001]. Multivariate Logistic regression analysis showed that APACHEⅡ score (β= 0.282, OR = 1.326, P < 0.001) and NT-proBNP (β= 0.402, OR = 1.261, P < 0.001) were independent risk factors for prognosis in patients with severe sepsis. Conclusions The LVEF values measured by echocardiography in early phrase were unrelated to 28-day prognosis. APACHEⅡ score, E/A ratio, NT-proBNP, cTnI, MYO, CK and CK-MB were related to 28-day prognosis. APACHEⅡ scores and NT-proBNP were independent prognostic factors in severe sepsis patient.

Objective To evaluate the effect of combination therapy with milrinone and esmolol on hemodynamics and cardiac function in patients with septic myocardial depression. Methods From October 2010 to October 2013,after the hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output (PICCO),74 sepsispatients withCI < 2.2 L/min · m2 after fluid resuscitation were enrolled in the study and were divided into group A with intravenous injection of dobutamine hydrochloride ,and group B with intravenous injection of milrinone and esmolol,with 37 cases in each group. The patients'PICCO indicators, echocardiography and cardiac biomarker(CK,CK-MB,MYO,cTnI and ProBNP)in two groups were compared before and after 3-day treatment. Results (1)CI and GEF were significantly increased in group B after 3-day treatment when compared with those in group A.(2)Compared with those in group A,early diastolic mitral flow velocity/end diastolic mitral velocity (E/A) and right ventricular diastolic diameter(RVD) in group B had statistical significance.(3) CK-MB,cTnI and ProBNP decreased significantly in group B when compared with those in group A. Conclusion Combination therapy with milrinone and esmolol can increase cardiac ejection function,slow down the heart rate,reduce the heart blood and vascular preload,lessen the injury of myocardial and improve heart function.

Objective To investigate the effects of volatile oil from artemisia dracunculus on myocardial injury caused by viral myocarditis in mice and explore its possible mechanism.Methods Totally 160 adult male BALB/c mice were randomly divided into normal control group (10) and viral myocarditis group (150).Viral myocarditis mice models were reproduced by intraperitoneal inoculation with a solution of coxsackievirus B3 (CVB3),a viral strain with affinity to myocardium,and then randomly divided into model,astragalus group,and low-,medium-,and high-dose volatile oil from artemisia dracunculus groups.After 1 hour of viral infection,normal control group and model group mice were given normal saline by intragastric administration,astragalus group mice were injected with astragalus 0.1 mL in each mouse by intraperitoneal injection,and the mice in other three groups were given low,medium and high dose (2％,5％,10％) 0.3 mL volatile oil from artemisia dracunculus in each mouse by intragastric administration,respectively,once a day for one week consecutively.The mortality,heart/body weight ratio,the activity of natural killer cells (NK cell),virus titer in myocardial homogenate,serum cardiac troponin Ⅰ (cTnI) level and myocardial pathological changes were observed.Results ① Mortality:the mortality of model group was higher than that of the normal control group,astragalus group,low and medium dose volatile oil from artemisia dracunculus groups (60.0％ vs.0％,23.3％,20.0％,28.7％),and the difference in the mortality being of no statistical significance between model group and that of high-dose volatile oil from artemisia dracunculus group (60.0％ vs.47.6％,P ＞ 0.05);the mortality of astragalus group was obviously lower than that of high-dose volatile oil from artemisia dracunculus group (P ＜ 0.01),and the differences in comparisons between the mortalities of astragalus intervention group,and medium-and low-dose volatile oil groups were not statistically significant (all P ＞ 0.05),and the comparison of mortality between low-and medium-dose volatile oil groups were also not statistically significant (P ＞ 0.05).② Immunization parameters:on the 8th day after modeling,the activity of NK cells in the model group was significantly lower than that in the normal control group [(15.91 ± 3.87)％ vs.(38.50 ± 2.32)％],the activities of NK cells in astragalus group,medium-and low-dose volatile oil from artemisia dracunculus groups were significantly higher than that in model group [(19.38 ± 3.27)％,(18.54 ± 3.09)％,(18.36 ± 2.64)％ vs.(15.91 ± 3.87)％,all P ＜ 0.05].None of virus was detected in the myocardial homogenate in the normal control group,and the virus titers in astragalus group,low and medium dose volatile oil from artemisia dracunculus groups were significantly lower than the titer of the model group (10-9/mL:1.96 ± 0.44,1.95 ± 0.46,1.95 ± 0.48 vs.2.41 ± 0.51,all P ＜0.01).③ Myocardial injury parameters:the level of cTnI in the normal control group was less than 0.1 μg/L,obviously lower than that in the model group [(15.84 ± 3.89) μg/L],as well as the ratio of heart/body weight in model group was also significantly higher than that in normal control group (× 10-4:8.3 ± 1.3 vs.4.6 ± 0.1),and the cTnI and the ratio of heart/body weight of astragalus intervention group,low and medium dose volatile oil from artemisia dracunculus groups were markedly lower than those of model group [cTnI (mg/L):10.03 ± 2.35,10.81 ± 2.56,11.10 ± 1.89 vs.15.84 ± 3.89,ratio of heart/body weight (× 10-4):7.2 ± 0.8,7.3 ± 1.0,7.3 ± 0.6 vs.8.3 ± 1.3].In the normal control group,there were no inflammatory cell infiltration and necrosis in myocardial tissue,the scores of myocardial pathological changes were 0.In the model group,the scores of inflammatory cell infiltration (3.25 ± 0.45) and of necrosis (2.91 ± 0.51) were markedly higher than those in the normal control group.And the above scores in astragalus group,low and medium dose volatile oil from artemisia dracunculus groups were significantly lower than those of the model group (infiltration score:2.92 ± 0.39,2.95 ± 0.35,2.95 ± 0.37 vs.3.25 ± 0.45,necrosis score:2.46 ± 0.50,2.50 ± 0.51,2.54 ± 0.50 vs.2.91 ± 0.51,all P ＜0.05).Conclusions Volatile oil from artemisia dracunculus can protect cardiomyocytes by removing the virus and regulating the immune function in the body.But the protective effects of volatile oil from artemisia dracunculus is related to the dosage,and the effects of low and medium dose are better.

Objective To investigate the expression of procalcitonin (PCT) and C-reactive protein (CRP),and endotoxin in bloodstream infection with different microorganisms,so as to assess the value of these inflammatory cytokines in early diagnosis of sepsis in bloodstream infections patients.Methods Data of 152 septic bloodstream infected patients with 90 male and 62 female aged from 62 to 102 years and 79.2 ± 16.3 years in average admitted from January 2012 to December 2013 were analyzed retrospectively.According to the results of blood culture,the microorganisms could be categorized into gram-negative bacteria,gram-positive bacteria and fungus groups,and the levels of serum CRP,PCT,and endotoxin were compared among these groups of bloodstream infections patients within 24 hours after admission.Results (1) A total of 152 strains of microorganisms were surveyed including 92 gram-negative strains (61.18％),43 gram-positive strains (28.29％),and 16 fungal strains (10.53％).In the gram-negative strains,Klebsiella pneumoniae (n =29),Acinetobacter baumannii (n =24),Escherichia coli (n =23),Burkholderia cepacia (n =9) and Pseudomonas aeruginosa (n =4) were the most common isolates.In the Gram-positive strains,13 strains of Staphylococcus aureus were isolated.(2) In the gram-negative bacterial bloodstream infections group,there were 60 (64.52％) patients with endotoxin positive,and there were no endotoxin positive cases with detected gram-positive bacteria and fungal bloodstream infections.The median levels of PCT were significantly different among the three groups [gram-negative strains group:7.760 (3.365,28.585) ng/mL,gram-positive strains group:0.705 (0.265,3.225) ng/mL,fungal infection group:1.245 (0.543,1.998) ng/mL].In the fungal bloodstream infection group,the mean level of CRP was higher than that in other two groups [gram-negative strains group:(126.01 ± 66.53) mg/L,gram-positive strains group:(77.58 ±54.21) mg/L,fungal infection group:(140.14 ±71.21) mg/L].(3) The receiver operating characteristic (ROC) curve of inflammatory cytokines was made for the diagnostic value in bloodstream infections.ROC curve used to distinguish between gram-positive bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP =0.791.When PCT cut-off value was 0.92 ng/mL,and CRP cut-off value was 68.00 mg/L,the sensitivity was 50％ and the specificity was 95.5％.ROC curve used to distinguish between the gram-negative bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.16 ng/mL and CRP cutoff value was 94.10 mg/L,and endotoxin was positive,the sensitivity was 82.8％ and the specificity was 100％.ROC curve used to distinguish between gram-negative bacterial bloodstream infections group and gram-positive bacterial group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.68 ng/ mL,CRP cut-off value was 106.5 mg/L,endotoxin was positive,the sensitivity was 74.2％ and the specificity was 97.7％.Conclusions Gram-negative bacteria were the most common microorganisms in bloodstream infections in ICU patients.Compared with single inflammatory cytokine,the serum concentrations of PCT,CRP and endotoxin used together could provide more sensitivity and specificity for the early diagnosis of bloodstream infection with different microorganisms.

Objective To discuss the differences of inflammatory parameters such as procalcitonin ( PCT ), C-reactive protein ( CRP ), endotoxin, white blood cell ( WBC ), neutrophil ratio ( Neut%) in blood of septic patients caused by bacterial bloodstream infection, and their correlation with the severity of disease. Methods 292 septic patients with positive blood culture were enrolled in Beijing Shijitan Hospital Affiliated to Capital Medical University from February 2012 to March 2015, and their gender, age, acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score, bacterial species and other general information were retrospectively collected. The differences in inflammatory parameters ( PCT, CRP, endotoxin, WBC, Neut%) in septic patients caused by bacterial bloodstream infection were compared, their correlations with APACHEⅡ scores within 24 hours were analyzed, and their diagnostic efficacies were also analyzed. Results ①It was shown by Pearson correlation coefficients that positively statistical correlation was found between PCT ( r=0.638 ), CRP ( r=0.620 ), endotoxin ( r=0.284 ), WBC ( r=0.209 ) and APACHEⅡscore ( all P=0.000 ) in bacterial bloodstream infective patients ( n=292 ), and positively statistical correlation was found between PCT ( r=0.626 ), CRP ( r=0.616 ), Neut%( r=0.297 ) and APACHEⅡscore ( all P<0.01 ) in Gram positive bacterial ( G+) group ( n = 86 ), and positively statistical correlation was shown between PCT ( r=0.631 ), CRP ( r=0.616 ), endotoxin ( r=0.301 ), WBC ( r=0.226 ) and APACHEⅡscore ( all P<0.01 ) in Gram negative bacterial ( G-) group ( n=206 ).②It was shown that PCT and CRP of both G+/G-bacterial severe sepsis and septic shock subgroup were significantly higher than those of sepsis subgroup, respectively [ G+ group: PCT (μg/L ):0.92 ( 0.38, 4.75 ) vs. 0.43 ( 0.22, 1.00 ), CRP ( mg/L ):118.45±62.60 vs. 57.97±32.41;G-group:PCT (μg/L ):6.92 ( 1.94, 25.90 ) vs. 1.28 ( 0.27, 4.12 ), CRP ( mg/L ):130.99±60.18 vs. 49.18±26.87, all P<0.01 ], and the endotoxin and WBC in G-bacterial severe sepsis and septic shock subgroup were significantly higher than those of sepsis subgroup [ endotoxin ( ng/L ): 19.40 ( 9.62, 33.87 ) vs. 10.00 ( 5.00, 18.52 ), WBC ( ×109/L ): 12.13±6.72 vs. 9.61±5.01, both P<0.01 ]. The PCT and endotoxin in G-bacterial severe sepsis and septic shock subgroup were significantly higher than those in G+severe sepsis and septic shock subgroup [ PCT (μg/L ):6.92 ( 1.94, 25.90 ) vs. 0.92 ( 0.38, 4.75 ), endotoxin ( ng/L ):19.40 ( 9.62, 33.87 ) vs. 2.56 ( 1.11, 4.01 ), both P<0.01 ].③The diagnostic efficacy of inflammatory parameters for severe sepsis and septic shock subgroup were: PCT area under receiver operating characteristic ( ROC ) curve ( AUC ) = 0.683, the cut-off point = 0.55 μg/L, sensitivity 63.2%, specificity 69.0%; CRP AUC = 0.802, the cut-off point = 92.25 mg/L, sensitivity 73.7%, specificity 86.2%; WBC AUC = 0.614, the cut-off point = 7.35×109/L, sensitivity 75.4%, specificity 48.3%; Neut% AUC = 0.622, the cut-off point = 0.882, sensitivity 43.9%, specificity 79.3%in G+group. At the same time, it was shown that PCT AUC=0.780, the cut-off point=6.80μg/L, sensitivity 51.0%, specificity 93.9%; CRP AUC = 0.907, the cut-off point = 90.10 mg/L, sensitivity 73.2%, specificity 95.9%;endotoxin AUC=0.694, the cut-off point=17.54 ng/L, sensitivity 57.3%, specificity 75.5%;WBC AUC=0.611, the cut-off point = 10.54×109/L, sensitivity 54.1%, specificity 69.4%; Neut% AUC = 0.621, the cut-off point = 0.843, sensitivity 65.6%, specificity 61.2%in G-group. Conclusions The plasma PCT and CRP have the best correlation between inflammatory parameters and severity of disease in bloodstream infective sepsis patients. CRP has the best diagnostic effect in severe sepsis/septic shock patients with bloodstream infection.