Self-Appraisal of Clinical Competence in Echocardiography of Chinese Intensivists Post Basic Echocardiography Training

Objectives To learn the echocardiography skills of intensivists after receiving a basic critical care echocardiography training course,and investigate factors that may influence their performance.Methods We completed a web-based questionnaire that assessed the skills in ultrasound scanning techniques of intensivists who took a training course on basic critical care echocardiography held in 2019 and 2020.MannWhitney test was used to analyze the factors which might affect their performance on image acquisition,recognizing clinical syndrome,and measuring the diameter of inferior vena cava,left ventricular ejection fraction and left ventricular outflow tract velocity-time integral.Results We enrolled 554 physicians from 412 intensive care units across China.Among them,185(33.4%)reported that they had 10%-30%chance of being misled by critical care echocardiography when making therapeutic decision,and 34(6.1%)reported that the chance was greater than 30%.Intensivists who performed echocardiography under the guidance of a mentor and finished ultrasound scanning more than 10 times per week reported significant higher scores in image acquisition,clinical syndrome recognition,and quantitative measurement of inferior vena cava diameter,left ventricular ejection fraction and left ventricular outflow tract velocity-time integral than those without mentor and performing echocardiography 10 times or less per week respectively(all P 0.05).Conclusion The skills in diagnostic medical echocardiography of Chinese intensivists after a basic echocardiographic training course remain low,and further quality assurance training program is clearly warranted.

腹腔镜下胃癌根治术患者术后发生医院感染的病原菌分布及危险因素分析

背景腹腔镜下手术治疗已经是胃癌根治术的首选方法,医院感染是术后常见并发症之一,严重影响患者术后恢复.目前国内关于腹腔镜手术感染的研究报道较多,但是对整体医院感染的临床特点研究较少.本研究对在我院行腹腔镜下胃癌根治术患者发生医院感染的病原菌分布及危险因素进行分析,以为临床诊疗和护理提供客观依据.目的腹腔镜下胃癌根治术患者术后发生医院感染的病原菌分布及危险因素分析.方法选择2016-10/2019-10在浙江省义乌市中心医院住院治疗胃癌根治术患者175例为研究对象,均于腹腔镜下手术治疗.认真详细记录所有患者一般资料,如性别,年龄,病理类型,胃癌分期,术前住院时间,腹腔镜治疗时间,有创性操作,糖尿病史,吸烟史,饮酒史等指标以及是否发生医院感染.结果175例胃癌患者术后有20例(占11.43%)发生医院感染.其中肺部感染11例(占6.29%),其次是腹腔感染6例(占3.43%),再者是切口感染和尿路感染,分别2例(占1.14%)和1例(占0.57%).发生医院感染的20例患者共分离培养出24株病原菌,其中革兰阴性菌较多,共15株(占62.5%),革兰阳性菌9株(占37.5%).单因素分析表明,年龄,胃癌分期,手术时间,糖尿病史,吸烟史等因素是术后发生医院感染的影响因素,差异有统计学意义(P<0.05,或P<0.01);而性别,病理类型,术前住院时间,术中出血量,饮酒史等因素比较,差异无统计学意义.通过多元回归分析发现,年龄≥70岁,胃癌分期≥Ⅲ期,手术时间≥3 h,有糖尿病史及吸烟史是术后发生医院感染的独立危险因素(P<0.01).结论年龄、胃癌分期、手术时间、糖尿病史及吸烟史是腹腔镜下胃癌根治术患者术后发生医院感染的独立风险因素,在工作中对于具有上述危险因素时,要积极采取措施预防发生医院感染.

Continuous Positive Airway Pressure Effectively Alleviates Arrhythmias in Patients with Obstructive Sleep Apnea:Possible Relationship with Counteracting Oxidative Stress

This work is aimed at exploring the clinical efficacy of continuous positive airway pressuie(CPAP)in treatment of patients with arrhythmias combined with obstructive sleep apnea(OSA).Through evaluating serum native thiol,malonaldehyde(MDA)and nicotinamide adenine dinucleotide phosphate oxidase(NADPH oxidase)in these patients and describing the effects on oxidative parameters of CPAP therapy for 3 months,we confirmed the impact of oxidative stress on arrhythmias.A total of 64 patients with OSA combined with arrhythmias were collected from April 2014 to April 2017 with full clinical information.Patients were divided into two groups(paired experiment design):32 patients in group A(control group),who received unchanged anti-arrhythmia treatment and 32 patients in group B,who were subjected to unchanged pharmacological anti-arrhythmia therapy combined with CPAP.OSA related parameters were compared between the two groups after 3-month therapy.And the levels of parameters of oxidative stress in patients were measured before and after CPAP therapy.After 3 months of CPAP therapy,compared with the control group,the percentage of sage N3(NREM 3)and stage R(REM)in total sleep time was significantly increased,while apnea-hypopnea index(AHI)and the Epworth Sleepiness Scale(ESS)score were evidently decreased.Meanwhile,the lowest oxygen saturation(LSpCh)was also elevated after CPAP treatment for 3 months.The CPAP therapy significantly prevented the occurrence of arrhythmias(P<0.05).Both the MDA level and NADPH oxidase levels were significantly lower in the group B than in the group A(P<0.05).But serum native thiol was improved by CPAP treatment(P<0.05).In conclusion,proper use of CPAP therapy provides significant benefits for the treatment of arrhythmia in patients with OSA.

Respiratory and Cardiac Characteristics of ICU Patients Aged 90 Years and Older:A Report of 12 Cases

Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit(ICU)patients.Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study.We retrospectively collected all patients' clinical data through medical record review.The basic demographics,primary cause for admission,the condition of respiratory and circulatory support,as well as prognosis were recorded.Shock patients and pneumonia patients were specifically analyzed in terms of clinical manifestations,laboratory variables,echocardiography,and lung ultrasound results.Results The mean age of the included patients was 95 years with a male predominance(8 to 4,66.7%).Regarding the reasons for admission,6(50.0%) patients had respiratory failure,1(8.3%) patient had shock,while 5(41.7%) patients had both respiratory failure and shock.Of the 6 patients who suffered from shock,only 1 was diagnosed with distributive shock,5 with cardiogenic shock.Of the 5 cardiogenic shock patients,1 was diagnosed with acute coronary syndrome.The rest 4 cardiogenic shock patients were diagnosed with Takotsubo cardiomyopathy.The patient with ST-segment elevation myocardial infarction died within 24 hours.Of the 4 Takotsubo patients,1 died on day-6 and the other 3 patients were transferred to ward after heart function recovered in 1 to 2 weeks.Of the 10 pneumonia patients,3 were diagnosed as community acquired pneumonia,and 7 as hospital acquired pneumonia.Only 3 patients were successfully weaned from ventilator.The others required long-term ventilation complicated with heart failure,mostly with diastolic heart failure.Lung ultrasound of 6 patients with diastolic dysfunction showed bilateral B-lines during spontaneous breathing trial.Conclusions Elderly patients in shock tend to develop Takotsubo cardiomyopathy.Diastolic heart dysfunction might be a major contributor to difficult weaning from ventilator in elderly patients.Bedside lung ultrasonography and echocardiography could help decide the actual cause of respiratory failure and shock more accurately and effectively.

Bloodstream Infection with Carbapenem-resistant Klebsiella Pneumoniae and Multidrug-resistant Acinetobacter Baumannii:a Case Report

IN the presence of septic shock,every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality.This is especially true for neutropenic patients with septic shock.1 As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients,the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous

Development of “Parameter space screening”-based single-wavelength anomalous diffraction phasing and structure determination pipeline

In this paper, we present a highly efficient structure determination pipeline software suite(X^2 DF) that is based on the "Parameter space screening" method, by combining the popular crystallographic structure determination programs and high-performance parallel computing. The phasing method employed in X^2 DF is based on the single-wavelength anomalous diffraction(SAD) theory. In the X^2 DF, the choice of crystallographic software, the input parameters to this software and the results display layout, are all parameters which users can select and screen automatically. Users may submit multiple structure determination jobs each time, and each job uses a slightly different set of input parameters or programs. Upon completion, the results of the calculation performed can be displayed, harvested, and analyzed by using the graphical user interface(GUI) of the system. We have applied the X^2 DF successfully to many cases including the cases that the structure solutions fail to be yielded by using manual approaches.

Early initiation renal replacement therapy for fluid management to reduce central venous pressure is more conducive to renal function recovery in patients with acute kidney injury

Background:Acute kidney injury (AKI) is a serious complication in critically ill patients with septic shock treated in the intensive care unit. Renal replacement therapy (RRT) is a treatment for severe AKI;however, the time of initiation of RRT and factors that affect the recovery of kidney function remains unclear. This study was to explore whether early initiation of RRT treatment for fluid management to reduce central venous pressure (CVP) can help to improve patients5 kidney function recovery. Methods: A retrospective analysis of septic patients who had received RRT treatment was conducted. Patients received RRT either within 12 h after they met the diagnostic criteria of renal failure (early initiation) or after a delay of 48 h if renal recovery had not occurred (delayed initiation). Parameters such as patients5 renal function recovery at discharge, fluid balance, and levels of CVP were assessed. Results: A total of 141 patients were eligible for enrolment: 40.4% of the patients were in the early initiation group (57 of 141 patients), and 59.6% were in the delayed initiation group (84 of 141 patients). There were no significant differences in the characteristics at baseline between the two groups, and there were no differences in 28-day mortality between the two groups (χ^2 = 2.142, P = 0.143);however, there was a significant difference in the recovery rate of renal function between the two groups at discharge (χ^2 = 4.730, P < 0.001). More importantly, early initiation of RRT treatment and dehydration to reduce CVP are more conducive to the recovery of renal function in patients with AKI. Conclusion: Compared with those who received delayed initiation RRT, patients who received early-initiation RRT for dehydration to reduce CVP have enhanced kidney function recovery.

Delirium in Intensive Care Unit Patients： Ten Important Points of Understanding

INTRODUCTION Delirium is a significant independent indicator of poor prognoses for critically ill patients （including in-hospital mortality, prolonged hospitalization, increased medical costs, and long-term cognitive impairment）. Intensive care medicine experts have been paying attention to and carried out research on delirium for better prediction, prevention, management, and treatment, and even better prognosis of patients in critical condition. Based on the latest findings of theoretical research and in combination with clinical experience, literature on delirium has been reviewed and ten points of basic understanding of delirium in critically ill patients have been identified.

Infection management strategy based on prevention and control of nosocomial infections in intensive care units

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection,which is clinical problem often faced by intensive care units (ICU) doctors.Without positive treatment,the incidence and mortality of sepsis are high.^[1]As hospital infection control plays an essential role in treating the nosocomial infections in the ICU,and according to the clinical presentation of critically ill patients,the biological characteristics of pathogenic microorganisms and the ICU environment,this article put forward a strategy for the nosocomial infections in the ICU.

Induction and deduction in sepsis-induced cardiomyopathy: five typical categories

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.The heart is one of the most important oxygen delivery organs,and dysfunction significantly increases the mortality of the body.Hence,the heart has been studied in sepsis for over half a century.However,the definition of sepsis-induced cardiomyopathy is not unified yet,and the conventional conception seems outdated:left ventricular systolic dysfunction(LVSD)along with enlargement of the left ventricle,recovering in 7 to 10 days.With the application of echocardiography in intensive care units,not only LVSD but also left ventricular diastolic dysfunction,right ventricular dysfunction,and even diffuse ventricular dysfunction have been seen.The recognition of sepsis-induced cardiomyopathy is gradually becoming complete,although our understanding of it is not deep,which has made the diagnosis and treatment stagnate.In this review,we summarize the research on sepsis-induced cardiomyopathy.Women and young people with septic cardiomyopathy are more likely to have LVSD,which may have the same mechanism as stress cardiomyopathy.Elderly people with ischemic cardiomyopathy and hypertension tend to have left ventricular diastolic dysfunction.Patients with mechanical ventilation,acute respiratory distress syndrome or other complications of increased right ventricular afterload mostly have right ventricular dysfunction.Diffuse cardiac dysfunction has also been shown in some studies;patients with mixed or co-existing cardiac dysfunction are more common,theoretically.Thus,understanding the pathophysiology of sepsis-induced cardiomyopathy from the perspective of critical care echocardiography is essential.

Role of Combining Peripheral with Sublingual Perfusion on Evaluating Microcirculation and Predicting Prognosis in Patients with Septic Shock

Background： Measurement of general microcirculation remains difficult in septic shock patients. The peripheral perfusion index （PI） and sublingual microcirculation monitoring are thought to be possible methods. This study was pertbrmed to determine whether assessing microcirculation by PI and a new parameter, proportion of perfusion vessel change rate （APPV） from sublingual microcirculation monitoring, can be associated with patients＇ outcome. Methods： A prospective observational study was carried out, including 74 patients with septic shock in a mixed intensive care unit. Systemic hemodynamic variables were obtained at TO and 6 h after （T6）. PI and sublingual microcirculation indicators were obtained using a bedside monitor and a sidestream dark-field device, respectively. The t-test, analysis of variance, Mann-Whitney U-test, Kruskal- Wallis test, receiver operating characteristic curve analysis with the Hanley-McNeil test, survival curves using the Kaplan-Meier method, and the log-rank （Mantel-Cox） test were used to statistical analysis. Results： Systemic hemodynamics and microcirculation data were obtained and analyzed. Patients were divided into two groups based on whether the first 6 h lactate clearance （LC） was 〉20%; PI and APPV were lower at T6 in the LC 〈20% group compared with LC ≥20% （PI： 1.52 [0.89, 1.98] vs. 0.79 [0.44, 1,81], Z = -2.514, P - 0.012; APPV： 5.9 ±15.2 vs. 17.9 ± 20.0, t = -2.914, P = 0.005）. The cutoff values of PI and APPV were 1.41% and l 2.1%, respectively. The cutoff value of the combined indicators was 1.379 according to logistic regression. Area under the curve demonstrated 0.709 （P 〈 0.05）, and the sensitivity and specificity of using combined indicators were 0.622 and 0.757, respectively. Based on the PI and APPV cutoff; all the participants were divided into the following groups： （1） high PI and high APPV group, （2） high PI and low APPV group, （3） low PI and high zXPPV group, and （4） low PI and low APPV group. The highest Sequential Organ Failure Assessment score （14.5 ± 2.9） was in the low P1 and low APPV group （F = 13.7, P 〈 0.001）. Post hoc tests showed significant differences in 28-day survival rates among these four groups （log rank [Mantel-Cox], 20.931 ; P 〈 0.05）. Conclusion： Pl and APPV in septic shock patients are related to 6 h LC, and combining these two parameters to assess microcirculation can predict organ dysfunction and 28-day mortality in patients with septic shock.

Venovenous extra-corporeal membrane oxygenation for severe acute respiratory distress syndrome: a matched cohort study

Background:Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing,the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear.Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.Methods:We conducted a multi-center,retrospective,cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018.Patients with severe ARDS who received W-ECMO support were included.The detailed demographic data and physiologic data were used to match ARDS patients without ECMO.The primary endpoint was the 28-day mortality.Results:Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study.The acute physiology and chronic health evaluation Ⅱ score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P =0.1195).The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P =0.0848).The 28-day mortality of patients with ECMO support was 39.4%,and that of the control group was 55.6%.The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P =0.0097).Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]:1.006;95% confidence interval [CI]:1.001-1.013;P =0.030) and duration of mechanical ventilation before ECMO (HR:3.299;95% CI:1.264-8.609;P =0.034).Conclusions:This study showed that ECMO improved the survival of patients with severe ARDS.The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.

Placement of a Jejunal Feeding Tube via an Ultrasound-Guided Antral Progressive Water Injection Method

Background： Jejunal feeding tube allows the nutrition of critical care patients more easy and safe. However, its placement remains a challenge. This study aimed to introduce a jejunal feeding tube through an ultrasound-guided antral progressive water injection method and subsequently to examine its efficacy. Methods： Between April 2016 and April 2017, 54 patients hospitalized in the Department of Critical Care Medicine, Peking Union Medical College Hospital, China who needed nutritional support through a jejunal feeding tube were recruited for this study. Patients who applied ultrasound-guided antral progressive water injection method were classified into the experimental group. Patients who applied conventional method were registered as control group. Results： No significant differences were found in age, body mass index, and Acute Physiology and Chronic Health Evaluation score, but a significant difference in operation time was found between the experimental group and the control group. Of the 24 individuals in the control group, 17 displayed clear catheter sound shadows once the tube entered the esophagus. In comparison, of the 30 individuals in the experimental group, all harbored catheter sound shadows through the esophageal gas injection method. Subsequent observation revealed that in the control group （via ultrasonographic observation）, 15 individuals underwent successthl antral tube entry, for a success rate of 63%. In the experimental group （via antral progressive water injection）, 27 individuals underwent successful antral tube entry, for a success rate of 90%. There was a significant difference between the success rates of the two groups （x2 = 5.834, P= 0.022）. Conclusion： The antral progressive water injection method for the placement of a jejunal feeding tube is more effective than the traditional ultrasonic placement method.

Critical hemodynamic therapy oriented resuscitation helping reduce lung water production and improve survival

Background: Increased extravascular lung water (EVLW) in shock is common in the critically ill patients. This study ai explore the effect of cardiac output (CO) on EVLW and its relevant influence on prognosis. Methods: The hemodynamic data of 428 patients with pulse-indicated continuous CO catheterization from Department of Critical Care Medicine, Peking Union Medical College Hospital were retrospectively collected and analyzed. The patients were assigned to acute respiratory distress syndrome group, cardiogenic shock group, septic shock group, and combined shock (cardiogenic and septic) group according to their symptoms. Information on 28-day mortality and renal function was also collected. Results: The CO and EVLW index (EVLWI) in the cardiogenic and combined shock groups were lower than those in the other groups (acute respiratory distress syndrome group vs. cardiogenic shock group vs. septic shock group vs. combined shock group: CO, 5.1 [4.0, 6.2] vs. 4.7 [4.0, 5.7] vs. 5.5 [4.3, 6.7] vs. 4.6 [3.5, 5.7] at 0 to 24 h, P=0.009;4.6 [3.8, 5.6] vs. 4.8 [4.1, 5.7] vs. 5.3 [4.4, 6.5] vs. 4.5 [3.8, 5.3] at 24 to 48 h, P=0.048;4.5 [4.1, 5.4] vs. 4.8 [3.8, 5.5] vs. 5.3 [4.0, 6.4] vs. 4.0 [3.2, 5.4] at 48 to 72 h, P=0.006;EVLWI, 11.4 [8.7,19.1] vs. 7.9 [6.6,10.0] vs. 8.8 [7.4,11.0] vs. 8.2 [6.7,11.3] at 0 to 24 h, P<0.001;11.8 [7.7,17.2] vs. 7.8 [6.3,10.2] vs. 8.7 [6.6,12.2] vs, 8.0 [6.6,11.1] at 24 to 48 h,P< 0.001;and 11.3 [7.7,18.7] vs. 7.5 [6.3,10.0] vs. 8.8 [6.3,12.2] vs. 8.4 [6.4,11.2] at 48 to 72 h, P< 0.001. The trend of the EVLWI in the septic shock group was higher than that in the cardiogenic shock group (P<0.05). Moreover, there existed some difference in the pulmonary vascular permeability index among the cardiogenic shock group, the septic shock group, and the combined shock group, without statistical significance (P> 0.05). In addition, there was no significant difference in tissue perfusion or renal function among the four groups during the observation period (P>0.05). However, the cardiogenic shock group had a higher 28-day survival rate than the other three groups [log rank (Mantel-Cox)= 31.169, P< 0.001]. Conclusion: Tissue-aimed lower CO could reduce the EVLWI and achieve a better prognosis.

A cross-sectional study of acute cor pulmonale in acute respiratory distress syndrome patients in China

Background:Increased right ventricle afterload during acute respiratory distress syndrome(ARDS)may induce acute cor pulmonale(ACP),which is associated with a poor clinical outcome.Echocardiography is now considered as a rapid and non-invasive tool for diagnosis of ACP.The aims of this study were to investigate the morbidity and mortality rates of ACP in ARDS patients in intensive care units(ICUs)across the mainland of China and to determine the severity and prognosis of ACP in ARDS patients through an ultrasound protocol(TRIP).And the association between ACP related factors and the ICU mortality will be revealed.Methods:This study is a multicenter and cross-sectional study in China which will include ICU participants when diagnosed as ARDS.The ultrasound protocol,known as the TRIP,is proposed as severity assessment for ACP,which includes tricuspid regurgitation velocity(T),right ventricular size(R),inferior vena cava diameter fluctuation(I),and pulmonary regurgitation velocity(P).The 28-day mortality,ICU/hospital mortality,the length of stay in ICU,mechanical ventilation days,hemodynamic parameters and lab parameters of liver function and kidney function are all recorded.Discussion:This large-scale study would give a sufficient epidemic investigation of ACP in ARDS patients in China.In addition,with the TRIP protocol,we expect that we could stratify ACP with more echocardiography parameters.

Efficacy and Safety of Esmolol in Treatment of Patients wi Septic Shock

Background： Previous studies have suggested that β1-receptor blockers benefit septic shock patients. This study aimed to determine whether β1-receptor blockers benefit tissue perfusion in sepsis and to identify parameters to reduce the risk of this drug in sepsis. Methods： Consecutive septic shock patients were recruited from the Intensive Care Unit of Peking Union Medical College Hospital within 48 h of diagnosis. All patients were hemodynamically stable and satisfactorily sedated with a heart rate （HR） 〉100 beats/rain. Esmolol therapy achieved the target HR of 10-15% lower than the baseline HR. Clinical and physiological data of patients were collected prospectively within 1 h prior to esmolol therapy and 2 h after achieving the targeted HR. Results： Sixty-three patients were recruited. After esmolol therapy, blood pressure was unaltered, whereas stroke volume （SV） was increased compared with betbre esmolol therapy （43.6 ± 22.7 vs. 49.9 ±23.7 ml, t = -2.3, P = 0.047）. Tissue perfusion, including lactate levels （1.4 ± 0.8 vs. 1.1 ± 0.6 mmol/L, t = 2.6, P = 0.015） and the central venous-to-arterial carbon dioxide difference （5.6 ±3.3 vs. 4.3 ± 2.2 mmHg, t - 2.6 P = 0.016）, was also significantly decreased after esmolol therapy. For patients with increased SV （n = 42）, cardiac efficiency improved, and esmolol therapy had a lower risk for a decrease in cardiac output （CO）. Therefore, pretreatment cardiac systolic and diastolic parameters with （n = 42）/without 01 = 21 ） an increase in SV were compared. Mitral lateral annular plane systolic excursion （MAPSEIat） in patients with increased SV was significantly higher than that in those without increased SV （1.3 ±0.3 vs. 1.1 ± 0.2 cm, t = 2.4, P = 0.034）. Conclusions： SV of septic shock patients is increased is llowing esmolol therapy. Although CO is also decreased with HR, tissue perfusion is not worse.

Clarifications on Continuous Renal Replacement Therapy and Hemodynamics

Objective： Continuous renal replacement therapy （CRRT） is a continuous process of bedside blood purification which is widely used in the treatment of acute kidney injury （AKI） and for fluid management. However, since AKI and fluid overload are often found to be associated with hemodynamic abnormalities, determining the relationship between CRRT and hemodynamics remains a challenge in the treatment of critically ill patients. The aim of this review was to summarize key points in the relationship between CRRT and hemodynamics and to understand and monitor renal hemodynamics in critically ill patients, especially those with AK1. Data Sources： This review was based on data in articles published in the PubMed databases up to January 30, 2017, with the following keywords： ＂continuous renal replacement therapy,＂ ＂Hemodynamics,＂ and ＂＇Acute kidney injury.＂ Study Selection： Original articles and critical reviews on CRRT were selected for this review. Results： CRRT might treat AKI by hemodynamic therapy, and it was an important form of hemodynamic therapy. The targets of hemodynamic therapy should be established when using CRRT. Therefore, hemodynamic management and stability were very important during CRRT. Most studies suggested that renal hemodynamics should be clearly identified. Conclusions： CRRT is not only a replacement for organ function, but an important form of hemodynamic therapy, lmproved hemodynamic management of critically ill patients can be achieved by establishing specific therapeutic hemodynamic targets and maintaining circulatory stability during CRRT. Over the long term, observation of renal hemodynamics will provide greater opportunities for the progression of CRRT hemodynamic therapy.

Left Ventricular Longitudinal Systolic Function in Septic Shock Patients with Normal Ejection Fraction： A Case-control Study

Background： Septic cardiomyopathy is a common finding in septic shock patients. The accepted definition of septic cardiomyopathy is often based on the left ventricular ejection traction （LVEF）. The aim of this study was to determine whether the left ventricular longitudinal systolic function was more sensitive than the LVEF in heart function appraisal of septic shock patients. Methods： This was a case-control study conducted at a 40-bed Intensive Care Unit （ICU） of Peking Union Medical College Hospital. Septic shock patients admitted to the ICU were consecutively enrolled in the study group from March I, 2016 to September 1,2016. The control group was selected from nonsepsis patients who were admitted to the ICU and were comparable to the study group. Transthoracic echocardiography was perfon-ned to obtain the LVEF measurement, mitral annular plane systolic excursion （MAPSE）, tissue Doppler velocity measurement of mitral annulus （Sa）, and tricuspid annular plane systolic excursion. Results： The study group consisted ot＇45 septic shock patients. Another 45 nonsepsis patients were selected as the control group. There was no difference in the LVEF between the two groups （64.6% vs. 67.2%, t = -1.426, P ： 0.161 ）. MAPSE in the study group was much lower than in the control group （1.2 cm vs. 1.5 cm, t - -4.945, P 〈 0.001）. Sa in the study group was also lower than in the control group （I0.2 cm/s vs. I 1.8 cm/s, t -2.796, P = 0.014）. Conclusions： Compared to the LVEF, longitudinal systolic function might be more sensitive in the detection of cardiac depression in septic shock patients. In the heart function appraisal of septic shock patients with a normal ejection fraction, more attention should be given to longitudinal function parameters such as MAPSE and Sa.

Vimentin modulates apoptosis and inflammatory cytokine release by a human monocytic cell line (THP-1) in response to lipopolysaccharides in vitro

Background:It has recently been recognized that serum vimentin is elevated in infectious diseases,and that vimentin plays a role in regulating neutrophils and macrophages associated inflammation.However,the mechanisms are unclear.This study was designed to explore the role of vimentin in regulating monocyte survival or apoptosis as well as inflammatory cytokine secretion in response to lipopolysaccharides (LPSs).Methods:A human monocytic leukemia cell line (THP-1) was transfected with vimentin-specific small interfering RNA (siRNA) or vimentin over-expressing plasmid.Apoptosis was assessed by TdT-mediated dUTP Nick-End Labeling (TUNEL) and DNA content assay.Immunoblotting was performed to detect apoptosis-associated proteins.Cytokines (interleukin [IL]-6,IL-10,and tumor necrosis factor α [TNF-α]) were measured by enzyme-linked immuno sorbent assay.Two-way analysis of variance followed by Student's t test was used to compare means between different groups.Results:Suppression of vimentin in THP-1 cells resulted in increased apoptotic response in the presence of LPS,while overexpression of vimentin could prevent the cells from apoptosis in response to LPS.LPS alone or suppression of vimentin resulted in significant up-regulation of caspase-3 (1.42 ± 0.20 of LPS alone and 1.68 ± 0.10 of vimentin suppression vs.control,t =5.21 and 10.28,respectively,P < 0.05).In addition,pro-inflammatory cytokines (IL-6 and TNF-α) was significantly increased (IL-6:577.90 ± 159.90 pg/day/105 cells vs.283.80 ± 124.60 pg/day/105 cells of control,t=14.76,P < 0.05;TNF-α:54.10 ± 5.80 vs.17.10 ± 0.10 pg/day/105 cells of control,t =6.71,P < 0.05),while anti-inflammatory cytokine (IL-10) was significantly up-regulated in the THP-1 cells that over-expressed vimentin (140.9 ± 17.2 pg/day/105 cells vs.undetectable in control cells).Contusions:In summary,the vimentin may regulate innate immunity through modulating monocytes viability as well as inflammatory response in sepsis through shifting the balance of pro-inflammatory and anti-inflammatory cytokines.

Serum microtubule-associated protein light chain 3 typeⅡlevels correlate with aggravation and multi-organ dysfunction in septic patients

Sepsis involves the early activation of both pro-and antiinflammatory responses,but is also accompanied by major changes in nonimmunologic pathways.[1]Autophagy is the lysosome-dependent process of removing damaged proteins and organelles.[2]Accumulating evidence from in vitro and in vivo studies reveals that autophagy may have a protective effect on sepsis,and the late-stage suppression of autophagy is associated with a poor outcome.[3]Thus,reversal of late-stage autophagy may be a good therapeutic strategy for sepsis.Accordingly,the identification of biomarker,which could inform the clinical diagnosis of autophagic impairment,will be essential for guiding the management of septic patients.