Zhonghua wei zhong bing ji jiu yi xue最新文献

{"title":"[Impact of active surveillance for carbapenem-resistant organisms on healthcare-associated infections and clinical prognosis of patients in intensive care unit: a propensity score-matching historical cohort study].","authors":"Huawei Kou, Xiaoyu Li, Yuhui Geng, Hui Wang, Qinfu Liu, Danmei Zhang, Baozhong Yang","doi":"10.3760/cma.j.cn121430-20260605-00271","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20260605-00271","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of active surveillance for carbapenem-resistant organisms (CRO) on healthcare-associated infections and clinical prognosis of patients in intensive care unit (ICU), and to provide real-world clinical evidence for developing scientific CRO active surveillance protocols in medical institutions.</p><p><strong>Methods: </strong>A prospective intervention study with a post-hoc retrospective historical control cohort design was conducted. ICU inpatients at the General Hospital of Ningxia Medical University from January 1, 2024 to December 31, 2025 were enrolled. The routine testing group comprised patients hospitalized from January 1 to December 31, 2024, who underwent routine microbiological testing with only retrospective chart review (690 cases). The CRO active surveillance group comprised patients hospitalized from January 1 to December 31, 2025, who received active CRO surveillance within 24 hours of ICU admission (608 cases). The active surveillance protocol involved collecting nasal swabs, rectal swabs, sputum specimens, and secretions or drainage fluids from existing wounds or drainage sites, which were inoculated onto chromogenic media. Patients with positive CRO results were considered colonized or infected with CRO and placed under contact precautions; those with negative results continued to receive standard precautions. Propensity score matching (PSM) at a 1 : 1 ratio was used to control for confounding factors including age, sex, acute physiology and chronic health evaluation II(APACHE II), severity of surgical insult (surgical grade×number of surgeries), and durations of mechanical ventilation, central venous catheterization, and urinary catheterization, with a caliper value of 0.02. After matching, the two groups were compared for CRO healthcare-associated infection incidence and clinical outcomes (in-ICU mortality, treatment abandonment rate, and improvement-to-discharge rate).</p><p><strong>Results: </strong>A total of 634 patients in the CRO active surveillance group underwent active surveillance (608 of whom met inclusion criteria), with a CRO positivity rate of 22.4% (142/634). A total of 1 298 patients were enrolled, including 690 in the routine testing group and 608 in the CRO active surveillance group. After PSM, 477 pairs were successfully matched, with 477 cases in the routine testing group and 477 cases in the CRO active surveillance group. After matching, baseline characteristics were well balanced and comparable between the two groups [all standardized mean differences (SMD)<0.1, all P>0.05]. After PSM, there was no statistically significant difference in CRO nosocomial infection incidence between the CRO active surveillance group and the routine testing group [2.3% (11/477) vs. 2.5% (12/477), both P>0.05]. However, the CRO active surveillance group had significantly lower in-ICU mortality [2.1% (10/477) vs. 4.6% (22/477)] and treatment abandonment rate [8.6% (41/477) vs","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"789-793"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Research progress on the role of geniohyoid muscle ultrasound in the assessment of swallowing function in critically ill elderly patients].","authors":"Liming Wang, Tao Song, Guanrong Chen, Qiuyi Wang","doi":"10.3760/cma.j.cn121430-20260401-00152","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20260401-00152","url":null,"abstract":"<p><p>Swallowing dysfunction severely affects the quality of life in elderly individuals. In China, the prevalence of dysphagia among people aged 80 years or older is 41%, with even higher rates seen in critically ill elderly patients. Currently, available methods for assessing swallowing function are complex to perform and inconvenient for bedside evaluation. However, this functional disorder, which is common and has a significant impact on prognosis in critically ill elderly patients, has not received widespread attention from intensivists. With the increasing use of ultrasound in critical care, identifying a convenient and reliable ultrasound method for evaluating swallowing function will offer more tools for precise monitoring, scientific intervention, therapeutic assessment, and prognostic evaluation of swallowing function in critically ill patients. Atrophy of the geniohyoid muscle is an important factor in reduced swallowing safety and aspiration in the elderly. Using ultrasound to measure the cross-sectional area, movement, and muscle quality changes of the geniohyoid muscle in the sagittal plane to evaluate swallowing function has demonstrated good accuracy and operability. This article summarizes the pathogenesis of swallowing dysfunction, the role of the geniohyoid muscle in swallowing, the progress of research on ultrasound detection of the geniohyoid muscle, and the methods of ultrasound measurement of the geniohyoid muscle. The aim is to provide a reference for research and application of ultrasound evaluation of swallowing function in critically ill elderly patients.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"877-880"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Interferon regulatory factor 7 participates in hepatic ischemia-reperfusion injury via modulating non-classical pyroptosis pathway in mice].","authors":"Tao Chen, Jing Hou, Yuzhe Gao, Dewen Deng, Jianjun Zhang, Zhongyang Shen","doi":"10.3760/cma.j.cn121430-20251029-00532","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20251029-00532","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore the role and mechanism of interferon regulatory factor 7 (IRF7) in regulating caspase-11-mediated non-canonical pyroptosis in mice hepatic ischemia-reperfusion injury (HIRI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;(1) Animal experiments: Thirty male 4- to 6-week-old C57BL/6 mice were randomly divided into a sham operation (Sham) group and reperfusion 2, 6, 12, and 24 hours groups, with six mice in each group. The reperfusion 2, 6, 12, and 24 h groups underwent a 70% hepatic ischemia-reperfusion (IR) model, which involved clamping the middle and left hepatic lobes with an arterial clamp for 1.5 hours, followed by blood flow reperfusion at 2, 6, 12, and 24 hours time points after releasing the clamp. The Sham group mice underwent laparotomy without vessel clamping. Liver tissue and serum were collected at 2, 6, 12, and 24 hours of reperfusion, and the mice were sacrificed. Transcriptomic sequencing and data analysis of liver tissue from the Sham group and reperfusion 6 hours group were performed using the Illumina sequencing platform. Immunohistochemical staining was followed by light microscopy to observe the positive expression of IRF7 in each group. Transmission electron microscopy was used to observe the ultrastructural changes in liver tissue cells in each group. Western blotting was used to detect the protein expression of IRF7, caspase-11, gasdermin D (GSDMD), GSDMD-N terminal domain (GSDMD-N), and interleukin-1β (IL-1β) in liver tissue from each group. (2) Cell experiments: The mouse AML-12 hepatocyte cell line was transfected with IRF7 overexpression plasmid, knockdown IRF7 plasmid (shIRF7), and corresponding empty vector (NC), respectively. The cells were then subjected to hypoxia/reoxygenation (H/R) treatment, and divided into the following groups: shIRF7 NC+H/R group, shIRF7+H/R group, IRF7 overexpression NC+H/R group, and IRF7 overexpression+H/R group. Western blotting was used to detect the protein expression of IRF7, caspase-11, GSDMD, GSDMD-N, and IL-1β in each group of cells. Immunofluorescence double staining was followed by inverted fluorescence microscopy to observe the co-expression of caspase-11 and GSDMD in each group of cells. Inverted microscopy was used to observe the survival of cells in each group; the content of IL-1β in the supernatant of each group of cells was measured.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;(1) Animal experiments: Preliminary findings from transcriptomics sequencing revealed that the expression of IRF7 mRNA in the 6-hour reperfusion group was significantly upregulated compared to the Sham group. Light microscopy showed that IRF7 was mainly localized in the cytoplasm and nucleus; at various time points during reperfusion, the expression of IRF7 in mouse liver tissue cells was upregulated compared to the Sham group, with the highest expression at 6 hours of reperfusion [IRF7 (A value): 0.59±0.04 vs. 0.04±0.01, P&lt;0.05]. Transmission electron microscopy revealed that at vario","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"832-839"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Role of secrum albumin-to-creatinine ratio in assessing the prognosis of sepsis].","authors":"Zhiyuan Bao, Peng Li, Lin Zhang","doi":"10.3760/cma.j.cn121430-20260318-00127","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20260318-00127","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the role of serum albumin-to-creatinine ratio (sACR) in prognostic assessment of patients with sepsis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was conducted. Patients with newly diagnosed sepsis admitted to the emergency intensive care unit (ICU) and comprehensive ICU of the Fourth Affiliated Hospital of Anhui Medical University from October 2023 to October 2024 were enrolled. Baseline data and laboratory parameters within 24 hours of admission, including white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), serum albumin, and creatinine, were collected, and sACR was calculated. The Acute Physiology and Chronic Health Evaluation II(APACHE II) and Sequential Organ Failure Assessment (SOFA) were recorded at admission. The 28-day survival status and survival time were documented. Patients were divided into sepsis group and septic shock group according to sepsis severity, and further divided into survivor group and non-survivor group based on 28-day outcomes. The above parameters were compared between groups. Cox proportional hazards regression analysis was used to identify independent prognostic factors for 28-day mortality. Receiver operator characteristic curves (ROC curves) were plotted to evaluate the predictive value of each indicator, and the areas under the curves (AUCs) were compared using DeLong's test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 177 patients with newly diagnosed sepsis were included, comprising 66 in the sepsis group and 111 in the septic shock group; 94 survived and 83 died within 28 days. Significant differences were observed between the sepsis and septic shock groups in age, WBC, CRP, PCT, APACHE II score, SOFA score, and sACR (all P&lt;0.05), with sACR being higher in the sepsis group [2.98 (1.82, 4.10) vs. 2.26 (1.19, 3.08)]. Significant differences were also found between survivors and non-survivors in WBC, CRP, PCT, APACHE II score, SOFA score, and sACR (all P&lt;0.05), with sACR being higher in survivors [3.17 (1.87, 4.20) vs. 1.80 (0.95, 2.25)]. Cox regression analysis showed that CRP (HR=1.004, 95%CI was 1.001-1.007, P=0.043), APACHE II score (HR=1.078, 95%CI was 1.049-1.108, P&lt;0.001), and SOFA score (HR=1.105, 95%CI was 1.027-1.189, P=0.008) were independent risk factors for 28-day all-cause mortality, while sACR was an independent protective factor (HR=0.795, 95%CI was 0.646-0.978, P=0.030). ROC curve analysis revealed that CRP, APACHE II score, SOFA score, and sACR had certain predictive value for 28-day prognosis; the AUC of sACR was 0.765, with an optimal cut-off value of 2.446, yielding a sensitivity of 66.0% and specificity of 77.1%. DeLong's test indicated that the predictive performance of sACR was similar to that of SOFA score, superior to CRP, but inferior to APACHE II score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;As a novel composite biomarker, sACR has potential adjunctive value in assessing disease severity and predictin","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"806-811"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Correlation between glycemic variability coefficient and sepsis-induced coagulopathy and analysis of risk factors].","authors":"Luyue Zhang, Xiujuan Liu","doi":"10.3760/cma.j.cn121430-20260331-00150","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20260331-00150","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the association between glycemic variability coefficient (CV) and sepsis-induced coagulopathy (SIC), analyze the related risk factors for SIC in septic patients, and further explore the clinical value of glycemic CV as a potential predictor for SIC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective case-control study was conducted. General data, laboratory findings, therapeutic interventions, and disease severity scores of septic patients admitted to the Department of Critical Care Medicine of the First Hospital of Qinhuangdao from July 2021 to June 2024 were collected. Blood glucose CV within 24 hours of admission was used as the exposure variable, and SIC served as the primary outcome. Patients were divided into Q&lt;sub&gt;1&lt;/sub&gt;, Q&lt;sub&gt;2&lt;/sub&gt;, Q&lt;sub&gt;3&lt;/sub&gt;, and Q&lt;sub&gt;4&lt;/sub&gt; groups according to quartiles of glycemic CV within 24 hours of intensive care unit (ICU) admission, with Q&lt;sub&gt;1&lt;/sub&gt; as the reference. Baseline clinical characteristics were compared among the four groups. Multivariate logistic regression was performed to analyze the effect of glycemic CV on SIC occurrence after adjusting for various confounders. Subgroup analyses were used to explore potential interaction effects and further verify the robustness of the results. A restricted cubic spline model was applied to examine the dose-response relationship between glycemic CV and SIC. Patients were divided into SIC and non-SIC groups based on the presence of SIC. Univariate analysis was used to identify risk factors for SIC, and significant variables were entered into binary logistic regression to determine independent risk factors. Receiver operator characteristic curve (ROC curve) was plotted to assess the predictive value of glycemic CV for SIC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 440 patients with sepsis were enrolled, including 110 in Q&lt;sub&gt;1&lt;/sub&gt; (glycemic CV&lt;19.5%), 109 in Q&lt;sub&gt;2&lt;/sub&gt; (19.5%≤glycemic CV&lt;26.0%), 111 in Q&lt;sub&gt;3&lt;/sub&gt; (26.0%≤glycemic CV&lt;31.5%), and 110 in Q&lt;sub&gt;4&lt;/sub&gt; (glycemic CV≥31.5%). Multivariate logistic regression showed that after adjustment for confounders, each 10% increase in glycemic CV was associated with an increased risk of SIC [odds ratio (OR)=1.049, 95% confidence interval (95%CI) was 1.024-1.074, P&lt;0.001]. Compared with Q&lt;sub&gt;1&lt;/sub&gt;, the risk of SIC remained significantly higher in Q&lt;sub&gt;4&lt;/sub&gt; (OR=2.739, 95%CI was 1.427-5.255, P=0.002). Restricted cubic spline (RCS) analysis revealed a linear dose-response relationship between glycemic CV and SIC risk (overall P&lt;0.001, nonlinear P=0.828), with the risk increasing linearly as glycemic CV rose. Subgroup analyses showed no significant interaction between glycemic CV and sex, age, diabetes, Acute Physiology and Chronic Health Evaluation II(APACHE II), Sequential Organ Failure Assessment (SOFA), use of vasoactive agents, use of corticosteroids, or anticoagulant therapy, consistently supporting elevated glycemic CV as a risk factor for SIC. ","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"794-805"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Successful treatment of myocardial infarction complicated with thyroid crisis using extracorporeal membrane oxygenation: a case report and literature review].","authors":"Liang Zhang, Yihua Piao, Xianji Piao","doi":"10.3760/cma.j.cn121430-20260207-00078","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20260207-00078","url":null,"abstract":"<p><p>Thyroid crisis is caused by an excess of thyroid hormones in the body, leading to a hypermetabolic state and a series of pathological and physiological changes. Clinical manifestations are often non-specific, and in severe cases, it can manifest as multiple organ dysfunction. Acute myocardial infarction combined with thyroid crisis is dangerous and has a high mortality rate. Timely identification and combination of mechanical circulatory support and antithyroid drug treatment are key to improving prognosis. On January 28, 2021, a 49-year-old female patient was admitted to Yanbian University Affiliated Hospital due to \"altered mental status for 4 hours, cardiopulmonary during this period\". After cardiopulmonary resuscitation, her vital signs were extremely unstable, and electrocardiogram and myocardial enzymes showed acute non-ST-segment elevation myocardial infarction with severe heart function decline (ejection fraction 26%). On the third day of admission, she underwent veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support, and on the sixth day, she underwent percutaneous coronary stent implantation. After surgery, the patient continued to experience recurrent persistent hyperpyrexia and profuse diaphoresis. Screening revealed a significant increase in thyroid hormones and inhibition of thyroid-stimulating hormone. Combined with thyroid ultrasound and Burch-Wartofsky score>45 points, the diagnosis was confirmed to be hyperthyroidism and thyroid crisis. Subsequently, treatment was given with propylthiouracil, propranolol, and hydrocortisone. On the 9th day of admission, extracorporeal membrane oxygenation (ECMO) was successfully withdrawn, cardiac function recovered (ejection fraction of 60%), consciousness improved, and finally the patient was weaned off the ventilator and transferred to a primary hospital for rehabilitation. After 3 months of follow-up, normal life and work were resumed. This case study suggests that early application of ECMO combined with antithyroid therapy can significantly improve the prognosis of patients with refractory cardiogenic shock and thyroid crisis. Even without a clear history of hyperthyroidism, acute coronary events may trigger crisis, and clinical vigilance should be maintained.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"860-865"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Development and validation of a predictive model for high-flow nasal cannula oxygen therapy failure in patients with type I respiratory failure].","authors":"Fei Ma, Yali Chao, Linyan Xu, Ziwen Wang","doi":"10.3760/cma.j.cn121430-20260423-00202","DOIUrl":"10.3760/cma.j.cn121430-20260423-00202","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore the independent risk factors for failure of high-flow nasal cannula oxygen therapy (HFNC) in patients with type I respiratory failure, and to establish and validate an effective risk prediction model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective observational study was conducted, Patients with type I respiratory failure who received HFNC treatment in the intensive care unit (ICU) of the Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2024 were selected as the research subjects. Clinical data within 24 hours after admission to the ICU were collected, including demographic information and general conditions, underlying diseases, early acute organ dysfunction, vital signs, laboratory examinations, disease severity scores, and treatment measures. Patients were divided into the HFNC success group and the HFNC failure group based on whether HFNC failure (endotracheal intubation and/or death during treatment) occurred. The overall cohort was randomly divided at a ratio of 7 : 3 into a training set and a validation set. Multivariate logistic regression analysis was used to screen independent predictors of HFNC failure, and a nomogram prediction model was constructed accordingly. The receiver operator characteristic curve (ROC curve), Hosmer-Lemeshow goodness-of-fit test, calibration curve, and decision curve analysis (DCA) were used to evaluate the model's discrimination, calibration, and clinical utility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 700 patients with type I respiratory failure were included, of whom 601 experienced HFNC success and 99 experienced HFNC failure, with a failure rate of 14.1%. Compared with the HFNC success group, patients in the HFNC failure group had lower height, proportion of coronary heart disease, serum sodium, oxygenation index, Glasgow Coma Score (GCS), and proportion of patients receiving human albumin, while exhibiting significantly higher incidence of acute kidney injury (AKI), heart rate, respiratory rate, blood urea nitrogen level, serum creatinine level, blood lactate level, Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II(APACHE II) score, as well as longer prothrombin time (all P&lt;0.05). Multivariate logistic regression analysis showed that the presence of AKI [odds ratio (OR)=2.113, 95% confidence interval (95%CI) was 1.159-3.854, P=0.015] and elevated blood lactate level (OR=1.148, 95%CI was 1.027-1.283, P=0.015) were independent risk factors for HFNC failure, while elevated oxygenation index (OR=0.973, 95%CI was 0.963-0.983, P&lt;0.001) and higher GCS score (OR=0.815, 95%CI was 0.760-0.874, P&lt;0.001) were independent protective factors. Based on these four independent predictors, a nomogram prediction model was established. The ROC curves showed that the area under the curve (AUC) of the training set and validation set were 0.844 (95%CI was 0.794-0.895) and 0.794 (95%CI was 0.706-0.8","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"812-818"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Tsutsugamushi disease with left heart failure as the main manifestation complicated by multiple organ dysfunction: a case report and literature review].","authors":"Xia Zhang, Junjie Yang, Ming Yang, Kejiao Long, Miao He, Jing Mao, Yanping Zhong, Xu Lei, Juan Wang, Xuan Dong, Huabing Tan","doi":"10.3760/cma.j.cn121430-20260219-00096","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20260219-00096","url":null,"abstract":"<p><p>Tsutsugamushi disease (TD) is a zoonotic and naturally focal infectious disease caused by Orientia tsutsugamushi (Ot), transmitted between humans and rodents through the bite of chigger mites. On August 17, 2025, a patient with TD complicated by acute left sided heart failure and multiple organ dysfunction was admitted to Wuhan Jinyintan Hospital. The patient presented to the emergency department with a 10 day history of fever, palpitations, dyspnea, and cough, and had a history of outdoor exposure. Physical examination revealed a temperature of 39.2 centigrade, a heart rate of 79 beats/min (showing relative bradycardia), an eschar of 0.5 cm×0.6 cm at the intersection of the right mid axillary line and the umbilical horizontal line, and a truncal rash. Laboratory findings showed an eosinophil count of 0, troponin T 1.31 μg/L, N terminal pro B type natriuretic peptide 2 912.60 ng/L, and elevated procalcitonin. Electrocardiography revealed prolonged Q T and Q Tc intervals, and chest CT demonstrated bilateral interstitial pulmonary edema and bilateral pleural effusion. Next generation sequencing of blood detected Ot nucleic acid fragments, and serum Ot immunoglobulin M (IgM) antibody was positive, confirming the diagnosis of TD complicated by myocarditis, acute left sided heart failure, and multiple organ dysfunction. The patient was treated with doxycycline combined with rifampicin for anti infection, along with symptomatic and supportive care, as well as local interventions including thoracentesis drainage and bronchoalveolar lavage. Subsequently, the patient's body temperature normalized, cardiac function improved, pulmonary edema and pleural effusion resolved, and myocardial enzymes returned to normal levels; the patient was discharged with clinical cure. This case indicates that TD can affect the cardiovascular system, presenting as acute left sided heart failure and myocarditis. For patients with fever, relative bradycardia, and multiple organ dysfunction, TD should be considered in the differential diagnosis, and early recognition of the eschar together with prompt initiation of etiological therapy are crucial for improving prognosis.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"866-870"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Application of a spontaneous breathing trial based on high-flow oxygen therapy in weaning of mechanically ventilated patients].","authors":"Liheng Zhang, Meng Deng, Hailiang Li, Gang Wu, Zhi Wang, Wenchun Wang, Shanshan Meng, Weiwei Chen, Dongxing Zhang, Congshan Yang, Jie Chen","doi":"10.3760/cma.j.cn121430-20260408-00165","DOIUrl":"10.3760/cma.j.cn121430-20260408-00165","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the application efficacy of a spontaneous breathing trial (SBT) based on high-flow oxygen therapy (HFOT) during the weaning process in mechanically ventilated patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A randomized controlled trial was conducted. A total of 163 patients undergoing invasive mechanical ventilation admitted to the Department of Critical Care Medicine, Zhongda Hospital, Southeast University, from September 2024 to July 2025 were enrolled and randomly assigned to the HFOT group (80 cases) or the pressure support ventilation (PSV) group (83 cases). The HFOT group received SBT based on HFOT, while the PSV group received SBT based on PSV. Baseline data were collected and compared between the two groups, and adverse events during SBT were recorded. The primary outcome was the success rate of extubation within 48 hours. Secondary outcomes included vital signs, sputum grade, arterial blood gas parameters measured before SBT and 30 minutes after SBT initiation, SBT success rate, and prognostic outcomes [duration of mechanical ventilation, length of intensive care unit (ICU) stay, hospitalization costs, ICU mortality, in-hospital mortality, and 28-day mortality].&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 163 mechanically ventilated patients were included, with 80 in the HFOT group and 83 in the PSV group. There were no statistically significant differences in baseline data or prognostic outcomes between the two groups. The SBT success rates were 100% (80/80) in the HFOT group and 98.8% (82/83) in the PSV group, and the 48-hour extubation success rates were 87.5% (70/80) and 80.5% (66/82), respectively, with no statistically significant differences (both P&gt;0.05). At 30 minutes after SBT initiation, the heart rate (HR&lt;sub&gt;0.5&lt;/sub&gt;) and the decrease in HR (ΔHR&lt;sub&gt;0.5&lt;/sub&gt;) in the HFOT group were significantly lower than those in the PSV group [HR&lt;sub&gt;0.5&lt;/sub&gt;: 87.10±12.73 vs. 94.28±13.60; ΔHR&lt;sub&gt;0.5&lt;/sub&gt;: 0.0 (-3.0, 2.0) vs. -1.0 (-5.0, 1.0); both P&lt;0.05]. No significant differences were observed in other vital signs, sputum grade, or arterial blood gas parameters between the two groups. No safety events occurred in either group during the trial, indicating good safety. Subgroup analysis showed statistically significant interactions between intervention modality and both age and duration of mechanical ventilation (both P&lt;0.05). In patients aged≥65 years, the ICU length of stay in the HFOT group was significantly shorter by a mean of 83.12 hours [95% confidence interval (95%CI) was -151.28 to -14.96] compared with the PSV group. In patients with mechanical ventilation duration≥24 hours, the ICU length of stay in the HFOT group was significantly shorter by a mean of 157.40 hours (95%CI was -254.60 to -60.20) compared with the PSV group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;SBT based on HFOT is safe for weaning mechanically ventilated patients and offers certain physiological advantages in improving H","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"819-825"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Research progress on the mechanisms and assessment indicators of abnormal vaccine immune responses in sepsis survivors].","authors":"Weiqing Yao, Zhongyi Miao, Bin Qiu, Dong Liu","doi":"10.3760/cma.j.cn121430-20260107-00017","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20260107-00017","url":null,"abstract":"<p><p>Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Although advances in early recognition and standardized management have improved in-hospital survival, sepsis survivors remain at increased risk of reinfection, readmission, functional decline, and long-term mortality after discharge. Growing evidence indicates that post-sepsis immune abnormalities do not represent a simple linear transition from inflammatory activation to immunosuppression. Rather, they reflect a persistent and heterogeneous state of immune reprogramming characterized by the coexistence of ongoing inflammation and immunosuppression, with concurrent impairment of both innate and adaptive immunity. The major features of this state include reduced antigen-presenting capacity of myeloid cells, innate immune hyporesponsiveness, persistent lymphopenia with T-cell dysfunction, remodeling of humoral immunity and immune memory, and the coexistence of persistent inflammation and immunosuppression. These alterations may disrupt multiple steps required for effective vaccine responses, including antigen presentation, T-cell help, germinal center formation, functional antibody generation, and maintenance of immune memory, thereby leading to reduced vaccine immunogenicity, insufficient protective efficacy, or shortened durability of protection. Direct clinical evidence regarding vaccination in sepsis survivors remains limited. However, available studies suggest that absolute lymphocyte count (ALC), monocyte human leukocyte antigen-DR (mHLA-DR) expression, and programmed cell death protein 1/programmed death ligand 1 (PD-1/PD-L1) related phenotypes may help identify individuals at high risk of poor vaccine response and inform post-vaccination reassessment and long-term follow-up. This narrative review summarizes the immune status of sepsis survivors, the potential mechanisms underlying abnormal vaccine immune responses in different immune states, and the current approaches to predicting and evaluating vaccine responsiveness, with the aim of informing precision immunoprophylaxis and future prospective study design in this special population.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"38 9","pages":"871-876"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}