To identify factors that affect the prognosis of patients with acute myocardial infarction (AMI) combined with cardiogenic shock (CS), in order to provide reference for predicting prognosis and propose possible measures to improve prognosis in such patients.

A retrospective analysis was performed on the clinical data of patients with AMI and CS who visited the Department of Emergency Medicine of the Second Hospital of Hebei Medical University from December 2018 to December 2021, including gender, age, body mass index (BMI); past history of smoking, coronary heart disease, arrhythmia, diabetes, hypertension, hyperlipidemia, and cerebrovascular disease; APACHE Ⅱ score, highest vasoactive-inotropic score (VIS) within 24 hours of admission, and fastest heart rate within 24 hours of admission; the worst auxiliary examination values within 24 hours after admission: blood lactate, white blood cell count (WBC), cardiac troponin I (cTnI) , alanine aminotransferase (ALT), total bilirubin (TBil), creatinine (Cr), serum potassium, left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction(LVEF); whether to use continuous renal replacement therapy (CRRT), intra-aortic balloon counterpulsation (IABP), or extracorporeal membrane oxygenation (ECMO), etc. The patients were divided into either a survival group or a death group based on the prognosis after 30 days of onset. Univariate analysis was used to compare the differences in the above indicators between the two groups. Logistic regression analysis was used to identify independent risk factors affecting the prognosis of patients with AMI combined with CS, and receiver operating characteristic (ROC) curves were drawn to evaluate the predictive value of the identified risk factors on patient prognosis. According to whether ECMO or IABP was used, the patients were divided into a non-ECMO group and an ECMO group, or a non-IABP group and an IABP group, and the differences in APACHE Ⅱ score and VIS were compared between groups.

Among 97 patients, 62 (63.9%) survived for 30 days and 35 (36.1%) died. Compared with the survival group, the APACHE Ⅱ score, VIS, WBC, and blood lactate in the death group were significantly increased, and the proportion of patients using IABP in the death group was significantly increased. Logistic regression analysis showed that WBC and blood lactate were independent risk factors affecting the 30-day prognosis of AMI patients with CS [odds ratio (OR)=1.137, 95% confidence interval (CI): 1.012-1.278, P<0.05; OR=1.166, 95%CI: 1.025-1.326, P<0.05]. ROC curve analysis showed that, using a cutoff value of 15.35×10⁹/L, the AUC of WBC in predicting prognosis was 0.710, with a sensitivity of 60.0% and specificity of 77.4%. When the cutoff value was 6.05 mmol/L, the AUC of blood lactate is 0.756, with a sensitivity of 85.7% and specificity of 67.7%. Compared with the non-ECMO group, the APACHE Ⅱ score and VIS in the ECMO group were significantly increased. Compared with the non-IABP group, the VIS of the IABP group was significantly higher (P<0.05).

WBC and blood lactate are independent risk factors affecting the prognosis of patients with AMI combined with CS. The highest WBC >15.35×10⁹/L and the highest lactate value >6.05 mmol/L within 24 hours of admission indicate a poor prognosis. Due to the fact that AMI patients with CS supported by IABP and ECMO are more critical, these support measures cannot improve their prognosis.

To determine the current situation regarding emergency rescue training among Chinese college students, in order to provide insight for future training programs.

Questionnaires were collected online from college students in different regions of China (excluding Hong Kong, Macao, and Taiwan). Measurement data are expressed as the mean±standard deviation, and counting data are expressed as percentages (%). Binary and multiple logistic regression models were used to analyze the passing rate of emergency rescue training and the influencing factors of training effect.

A total of 2037 questionnaires were collected, of which 2032 were valid. The student training rate reached 73.9%. Among the students who did not receive training, 63.4% reported that the school did not organize such training program, 34.5% did not have time to attend the training, 31.7% did not pay attention to the training, and 2.1% believed that the training was meaningless. Under the premise of mastering first aid knowledge and skills, 73.0% of students reported that they were willing to rescue strangers and 83.0% were willing to rescue people that they knew. Of the students who did not want to provide help, 84.0% were worried about their ability, 44.0% worried about taking responsibility, 13.0% worried about infectious diseases, 14.0% were afraid of touching "dead people", and other reasons accounted for 4.0%. The passing rate of training reached 94.0%, and training effect and grade were influencing factors on the the passing rate. Among the students who received training, 49.0% believed that the training effect was good, with major and retraining being the influencing factors of training effect. Satisfaction with training content was lowest in the "retraining process" and highest in the "practicability of training knowledge and skills". With regard to first aid knowledge and skill proficiency, "cardiopulmonary resuscitation" was the highest, and "infant cardiopulmonary resuscitation", "infant airway foreign body obstruction exclusion", and "snake bite" were lower.

The training rate, passing rate, rescue intention, and training intention of Chinese college students are high, and the training effect is good, but some knowledge and skills of emergency rescue need to be strengthened.

Heparin-binding protein (HBP) is a kind of granule protein produced by neutrophils in response to external stimuli. It plays a crucial role in increasing vascular permeability, chemotaxis, and regulating inflammatory response In recent years, studies have found that HBP can be used as an early predictor of sepsis. In addition, it has been confirmed that HBP can be used to evaluate the disease severity and prognosis in sepsis patients. This review focuses on the clinical value of HBP in sepsis.

To investigate the value of antibiotic administration based on dynamic monitoring of serum amyloid A (SAA) in the treatment of severe pneumonia by electronic bronchoscopy combined with pulmicort.

A total of 60 children with severe pneumonia who were treated at our hospital from January 2020 to January 2021 were selected and divided into three groups according to the treatment method used, and were given pulmicort aerosol inhalation plus antibiotic treatment (control group), pulmicort aerosol inhalation plus electronic bronchoscopy plus conventional antibiotic treatment (observation group 1), and pulmicort aerosol inhalation plus electronic bronchoscopy plus antibiotic treatment based on SAA monitoring (observation group 1). The clinical efficacy of the three groups was compared, blood gas indexes and the incidence of adverse reactions were observed and counted, IL-6 and PCT were determined by enzyme-linked immunosorbent assay, SAA level was determined by colloidal gold immunochromatographic assay, and CRP level was detected by immunoturbidimetry.

After treatment, the levels of PaO₂/FiO₂, SaO₂, PaO₂, FVC, PEF, and FEV₁ were significantly increased, and the levels of PaO₂/FiO₂, SaO₂, PaO₂, FVC, PEF, and FEV1 in the observation group 2 were significantly higher than those in the control group and the observation group 1 (P＜0.05). After treatment, SAA level in the observation group 1 and observation group 2 decreased over time, and SAA level in the observation group 2 was significantly lower than that in the control group and observation group 1 (P＜0.05). The levels of CRP, IL-6, and PCT in children after treatment decreased, and the levels of CRP, IL-6, and PCT in the observation group 2 were significantly lower than those in the control group and observation group 1 (P＜0.05). The time to disappearance of lung wet rales and cough, and the duration of hospital stay were shortened after treatment, and these indexes in group 2 were signficantly shorter than those in the control group and observation group 1 (P＜0.05). The total effective rate in the observation group 2 (95.00%) was significantly higher than those of the control group (60.00%) and observation group 1 (85.00%) (P＜0.05). The total incidence of adverse reactions in the observation group 1 (30.00%) was higher than that in the control group (10.00%) and observation group 2 (20.00%), but there was no statistical difference (P＞0.05).

Antibiotic administration based on dynamic monitoring of SAA has anti-inflammatory effects, improves blood gas condition, and shortens the treatment duration and hospitalization time in the treatment of severe pneumonia by electronic bronchoscopy combined with pulmicort. Dynamic monitoring of SAA level can assess the severity and prognosis of infection, which can help relieve the clinical symptoms and improve the lung function significantly.

To create a training outline for intensive care unit (ICU) specialist nurses and assess its clinical application value.

The literature analysis and semi-structured interview methods were used to form the ICU specialist nurse training outline, the Delphi method was used for expert consultation and certification, and the ICU specialist training outline and rules were made. Finally, the weight of each training item was recorded by the analytic hierarchy process and expert scoring method. Twelve nurses in the ICU specialist department in our hospital were chosen as the research subjects, and the six-dimensional (6-D) scale was used to compare the work ability of these ICU nurses before and after training.

The results of weight analysis showed that the weights of the first-level indicators of job knowledge, professionalism, and interpersonal relationship in the ICU training outline were 0.517, 0.262, and 0.221 respectively. The weight range of second-level indicators such as training content was 0.036~0.201, and the weight range of third-level indexes was 0.0039~0.016. The effective recovery rate of the two rounds of consultation were 92.00% and 98.00%, and the proportion of experts who proposed the consultation were 76.00% and 70.00%, respectively. The expert authority coefficient was 0.72~1.00, with an average value of 0.89. The scores of ICU nurses' leadership, teaching and cooperation, critical patient monitoring, plan evaluation, communication, and professional dimensions of the 6-D scale after training were significantly higher than those before training (P＜0.05).

The training outline for ICU specialist nurses developed by semi-structured interviews and expert consultation is complete, which can help to improve the competence of ICU nurses.

High-density lipoprotein (HDL) can bind and neutralize the endotoxin of Gram-negative bacteria and lipoteichoic acid of Gram-positive bacteria through apolipoprotein A-I (ApoA-I) during sepsis. The expression of serum amyloid A (SAA) is significantly increased in sepsis, and ApoA-I in HDL is replaced by SAA, resulting in a significant reduction in plasma HDL levels, an independent risk factor for sepsis. HDL has dysfunction during sepsis, and the exact mechanism of SAA in altering HDL structure and function is not clear. This paper reviews the change trend of HDL, ApoA-I, and SAA during sepsis, the interaction between them, and the clinical application of various indexes, to provide a theoretical basis for the further study of lipoproteins and related apolipoproteins in sepsis.

To investigate the clinical significance of cardiac function parameters in intensive care unit (ICU) patients with early stage acute cerebral disease.

Seventy-one patients with acute cerebral disease treated in the ICU from January 2009 to December 2014 were retrospective reviewed. All the patients underwent PICCO catherization to monitor hemodynamic parameters, especially cardiac function parameters, within six hours. Information about age, sex, APACHE Ⅱ score, Glasgow coma scale (GCS) score, and outcome at 28 days was collected. The clinical diagnostic data on the type of cerebral disease, hypertension, coronary heart disease, and heart failure were also collected. Cardiac function parameters were measured with PULSION PiCCO plus, including cardiac function index (CFI), global ejection fraction (GEF), left ventricular contractility index (dpmax), and cardiac index (CI). The patients were divided into either a death group or a survival group according to the outcome at 28 days. Then cardiac function parameters were analyzed in the two groups.

There was a significant difference in GCS score between the two groups (P=0.02). There was a higher dpmax level in the death group on the 2nd, 3rd, 4^th, and 7th day after the onset of the disease (P=0.012, 0.016, 0.025, and 0.029, respectively), but there was a lower CI on the 3rd day and SVI level on the 7th day in the death group after the onset of the disease (P=0.013 and 0.015, respectively). Further correlation analysis showed that there were significant correlations between most of the cardiac function parameters measured by PiCCO, though there was no significant correlation between dpmax and GEF (r=0.02, P= 0.75) or SVI (r=-0.02, P=0.622). Except CI (r=-0.07, P=0.133), other cardiac function parameters were all significantly correlated with GCS score. Partial correlation analysis showed that there was no correlation between the cardiac function parameters and the number of days of onset in both the overall patients and the patients in the survival group or the death group. Further survival analysis showed that CFI on the 2nd day, CFI on the 3rd day, dpmax on the 2nd day, dpmax on the 3rd day, and CI on the 1st day had significant effects on 28-day survival (P=0.038, 0.019, 0.035, 0.020, and 0.019, respectively). The survival rate of patients with reduced CFI and CI and patients with normal dpmax decreased significantly.

After the onset of acute cerebral disease, there are cardiac function changes, which is related to the 28-day survival rate.

A novel coronavirus that emerged in late 2019 has rapidly spread around the world. Pre-hospital emergency care is currently serving as the front line for initial detection, management, evaluation, and transport of COVID-19 patients during the COVID-19 epidemic. Therefore, the emergency staff is presently facing unprecedented challenges. This article analyzes the impact of COVID-19 on the pre-hospital emergency system and summarizes the experience of prevention and control, with an aim to provide reference for the reform of emergency medical system and the formulation of infection prevention strategies by the full-time staff under the normal epidemic prevention and control.

Linkage of hospital and police is a community of destiny and responsibility. This paper discusses the application status of pre-hospital first aid based on linkage mechanism of hospital and police in China, analyzes the limitations of pre-hospital first aid, and proposes coping strategies, in order to provide reference for the construction and optimization of pre-hospital first aid system.

To explore the effect of early analgesia on the prognosis of patients with multiple trauma receiving prehospital care.

A total of 168 patients with multiple trauma recently admitted to the department of emergency of our hospital were randomly divided into either an analgesia group or a non-analgesia group. Both groups were given Advanced Trauma Life Support. In addition, patients in the analgesic group were given analgesic therapy with remifentanil during the stage of prehospital emergency, and those in the non-analgesic group were given an equal volume of saline using the same method. Then, the first vital signs, the first laboratory examination indexes, the consumption of clinical resources, and hospital mortality were compared between the two groups.

Since hospital admission, the first result of respiratory rate was significantly lower and that of PCO₂ was significantly higher in the analgesia group than in the non-analgesia group. Red blood cell distribution width was significantly lower in the analgesia group than in the non-analgesia group (P＜0.01). Compared with the non-analgesic group, the ICU and hospital stay time were both significantly shortened and the rate of mechanical ventilation was significantly reduced in the analgesic group (P＜0.01). In subgroup analysis, all of the differences observed above existed in the subgroup of severe multiple trauma (ISS score＞25) (P＜0.01), but not in the subgroups characterized by mild (ISS≤16) and moderate (16＜ISS＜25) multiple trauma. Moreover, in the subgroup of severe multiple trauma, analgesic therapy can reduce the in-hospital mortality (P=0.03).

Remifentanil can be used for analgesic treatment of patients with severe multiple trauma during the stage of prehospital rescue with high safety. It can significantly shorten ICU and hospital stay time and may improve the hospital survival rate of patients. All of these benefits make prehospital analgesia be a potential clinical treatment under the background of emergency medicine.

To systematically evaluate the effect of pre-hospital care on therapeutic effect and prognosis in patients with acute myocardial infarction (AMI), in order to help suitable treatment in clinical practice.

According to Shekelle's clinical evidence evaluation criteria, PubMed, OVID, Medline, Chinese Biomedicine database (CBMdisc), VIP Database for Chinese Technical Periodicals, Wanfang Data, and China National Knowledge Internet (CNKI) were searched for relevant randomized controlled trials. Data extraction and assessment of methodologic quality were performed independently by two reviewers. Patients receiving pre-hospital emergency treatment were included in the observation group, and patients who were hospitalized by themselves or did not receive pre-hospital emergency treatment were included in the control group. Meta-analysis was performed with RevMan 5.3 software.

Thirteen papers (including 1168 patients) were identified. Age and weight were similar in the two groups. The cure rate was higher in the observation group than in the control group (84.97% vs 64.19%, P＜0.01), and the mortality was lower than that of the control group (9.61% vs 27.47%, P＜0.01). The rate of complications in the observation group was lower than that of the control group (10.03% vs 35.90%, P＜0.01). Time from onset to entering emergency room and thrombolysis time were shorter in the observation group than in the control group (P＜0.01).

Pre-hospital care has great influence on the therapeutic effect and prognosis in patients with AMI. It can improve the cure rate, reduce the mortality rate, and reduce the occurrence of cardiogenic shock, heart failure, arrhythmia, and other serious complications. For AMI patients with chest pain outside the hospital, pre-hospital care is preferred.

To explore the role of thromboelastography (TEG) parameters in the diagnosis and prognosis evaluation of disseminated intravascular coagulation (DIC) in patients with sepsis.

From January 1, 2021 to December 31, 2021, 100 patients with sepsis meeting Sepsis 3.0 criteria, who underwent thromboelastography on the day of admission and were screened for sepsis by the DIC early warning system, were collected at the Department of Critical Care Medicine, Shanghai Pudong New Area People's Hospital. The general and clinical data of the patients, including age, gender, peripheral blood parameters on the day of admission (initial blood lactate, white blood cell count, platelet count, C-reactive protein, hemoglobin, albumin, D-dimer, fibrinogen concentration, prothrombin time, international normalized ratio, and partial thromboplastin time), and thromboelastography parameters [reaction time, clot formation time and rate of formation (alpha angle), and maximum amplitude (MA)], as well as SOFA score, APACHE II score, and 90-day survival status were recorded. According to the presence of DIC or not, the patients were divided into either a DIC group or a non-DIC group. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of thromboelastometry for DIC in patients with sepsis, and the Kaplan-Meier curve was used to explore its impact on the prognosis of patients with sepsis.

Comparing the coagulation indexes of the two groups, it was found that PT (P=0.011) and INR (P＜0.001) were prolonged in the DIC group. Regarding the thromboelastography parameters, reaction time (P＜0.001) and clot formation time (P＜0.001) were significantly prolonged in the DIC group, while α angle (P=0.001) and MA (P＜0.001) were significantly decreased. ROC curve analysis showed that the areas under the curves of reaction time and clot formation time for the diagnosis of DIC were 0.928 (95% confidence interval [CI]: 0.875~0.982) and 0.752 (95%CI: 0.638~0.866), respectively, while those of the alpha angle and MA for excluding DIC were 0.720 (95%CI: 0.602~0.837) and 0.930 (95%CI: 0.878~0.979), respectively. ROC analysis of thromboelastography parameters for predicting 90-day survival in patients with sepsis revealed that the area under the curve for MA was 0.707 (95%CI: 0.578~0.836), while reaction time, clot formation time, and alpha angle were not predictive. Kaplan-Meier survival curve analysis also demonstrated that MA value was a good predictor of 90-day survival in patients with sepsis (P=0.001).

TEG parameters can be used as an effective method to diagnose and exclude DIC. MA value can be used as a good indicator to predict the 90-day survival rate of sepsis patients.

To identify the factors related to thrombocytopenia in patients with sepsis, and to construct a Bayesian network model of thrombocytopenia in those patients to explore the network relationship between thrombocytopenia and its related factors and to reflect the extent of influence of various factors on thrombocytopenia in patients with sepsis by network model reasoning.

Ninety-eight patients with sepsis admitted to the intensive care unit (ICU) of Shanghai Sixth People's Hospital from January 2019 to December 2020 were selected. Among them, there were 53 males and 45 females, with an age of (59.37±4.28) years. The occurrence of thrombocytopenia in all patients during ICU stay was statistically analyzed and the patients were divided into either an occurrence group or a non-occurrence group according to the occurrence of thrombocytopenia or not. Baseline data questionnaire was designed to collect baseline data of the two groups. Logistic regression analysis was used to screen the influencing factors of thrombocytopenia in patients with sepsis, and the relationship between each influencing factor and thrombocytopenia in patients with sepsis was analyzed using the Bayesian network model.

Among the 98 patients with sepsis, 33 had thrombocytopenia (33.67%). Fungal infection, septic shock, interleukin-6 (IL-6) level, and maximum amplitude of thromboelastogram (MA) differed significantly between the two groups (P＜0.05 for all), but there was no statistical significant difference in other data between the two groups (P＞0.05 for all). Logistic regression analysis demonstrated that fungal infection (odds ratio [OR]=7.185, 95% confidence interval [CI]:1.168-44.184), septic shock (OR=4.024, 95%CI:1.081-14.983), and overexpression of serum IL-6 (OR=9.360, 95%CI:2.283-38.379) were risk factors for thrombocytopenia in patients with sepsis (P＜0.05 for all), while elevation of MA value (OR=0.814, 95%CI:0.734-0.902) was a protective factor for thrombocytopenia (P＜0.05). Directed acyclic Bayesian network structure graph showed that fungal infection, septic shock, IL-6, and MA value were associated with thrombocytopenia in patients with sepsis.

The occurrence of thrombocytopenia in patients with sepsis may be related to fungal infection, septic shock, high IL-6 level, and low MA value

To assess the value of blood ammonia and serum lactic acid (LAC) and β₂-microglobulin (β₂-MG) in predicting the prognosis of patients with sepsis caused by infection in emergency department, so as to provide a basis for its clinical diagnosis and treatment.

A total of 90 patients with sepsis who were admitted to the Emergency Intensive Care Unit of Affiliated Hospital of North Sichuan Medical College from March 2020 to March 2021 were selected as the study subjects. Their survival within 28 days after diagnosis was analyzed retrospectively, and they were divided into either a death group (21 cases)or a survival group (69 cases) according to their prognosis. The basic data and laboratory indexes at the day of diagnosis were compared between the two groups, and the factors related to the prognosis were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to assess their value in predicting the prognosis of the patients.

The proportions of patients with diabetes and chronic kidney disease and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score at the day of diagnosis were 42.86% (9/21), 47.62% (10/21), and (26.72±5.34) in the death group, respectively, which were significantly higher than the corresponding values in the survival group (P＜0.05). Blood ammonia and serum LAC, β₂-MG, and procalcitonin (PCT) levels were (115.56±38.17) μmol/L,(3.87±0.92) mmol/L, (6.91±1.32) mg/L, and (3.96±0.66)μg/L in the death group, respectively, which were higher than the corresponding values in the survival group (P＜0.05). Logistic multiple regression analysis showed that APACHE Ⅱ score, blood ammonia, and serum LAC and β₂-MG at the day of diagnosis were independent risk factors for the death of patients with sepsis (P＜0.05). The area under the ROC curve (AUC^ROC) values of APACHE Ⅱ score, blood ammonia, and serum LAC and β₂-MG in predicting the prognosis of the patients with sepsis were 0.705, 0.827, 0.663, and 0.815, respectively (P＜0.05), of which the AUC^ROC of blood ammonia was the highest, under the best boundary value, β₂-MG had the highest sensitivity, and LAC had the highest specificity.

Serum ammonia and serum LAC and β₂-MG have appreciated auxiliary values for early prediction of the prognosis of patients with sepsis caused by infection in emergency department. Clinicians should flexibly use a variety of markers according to their respective advantages to increase the prediction efficiency so as to improve the prognosis of such patients.

To investigate the etiological characteristics and risk factors of hospital acquired pneumonia (HAP) in respiratory intensive care unit (RICU).

One hundred and sixty patients admitted to the RICU of Second Affiliated Hospital of Anhui Medical University from March 2018 to August 2021, and 54 patients complicated with HAP were selected. The pathogenic bacteria of HAP were isolated and identified using the microbial identification system. The paper method was used to test drug sensitivity. Univariate analysis was used to identify the influencing factors of HAP. Multivariate Logistic regression was used to identify the independent risk factors for HAP.

Among the 54 HAP patients, 81 strains of pathogenic bacteria were isolated, including 62 Gram-negative bacteria, 6 Gram-positive bacteria, and 13 fungi. The drug resistance rates of Klebsiella pneumoniae to ceftazidime (85.19%) and cefazolin (77.78%) were high. Pseudomonas aeruginosa had high resistance rates to ceftazidime (94.74%) and cefoperazone/sulbactam (78.95%). Univariate analysis showed that there were no significant differences in gender, body mass index, smoking history, or hypertension history between the HAP group and non-HAP group (P＞0.05), but there were statistically significant differences in age, diabetes history, mechanical ventilation time, oral cleanliness, albumin level, pulmonary disease, hospital stay, and broad-spectrum antibiotic application between the two groups (P＜0.05). Multivariate Logistic regression analysis showed that age＞70 years, mechanical ventilation time＞7 d, history of diabetes mellitus, oral cleanliness, albumin＜30 g/L, pulmonary disease, length of hospital stay, and broad-spectrum antibiotic use were the independent risk factors for HAP among RICU patients.

Gram-negative bacteria are the main pathogenic bacteria of HAP among RICU patients. Age, mechanical ventilation time, diabetes history, oral cleanliness, albumin level, pulmonary disease, hospital stay, and broad-spectrum antibiotic use are the independent risk factors for HAP among RICU patients.

To study the effect of ulinastatin (UTI) on acute kidney injury (AKI) in septic rats and explore the possible mechanism involved.

Thirty-two SD rats were randomly divided into four groups: blank control group, lipopolysaccharide group (LPS group), ulinastatin treatment group (LPS+UTI group), and p38 MAPK blocker intervention group (LPS+SB group). A rat model of sepsis was induced by LPS. The expression of TNF-α and TGF-β1 in renal tissues was detected by ELISA, and the expression of phosphorylated p38 MAPK protein in renal tissues was detected by Western blot. The pathomorphological changes of glomeruli and renal tubules were observed by light microscopy and electron microscopy.

Compared with the blank control group, the LPS group showed glomerular hyperemia and swelling, renal balloon dilation, obvious swelling of proximal convoluted renal tubule epithelial cells, weak nuclear staining, partial nuclear concentration, breakage, and even dissolution, renal interstitial hyperemia, edema, and a large amount of inflammatory cell infiltration. Electron microscopy showed that the endothelial cells of glomerular capillaries disappeared or were occluded, the basement membrane partially fractured and disappeared, the foot processes of podiocytes extensively fused and disappeared, and the mitochondria in the epithelial cytoplasm of proximal convoluted renal tubules were disorganized, with a fuzzy structure, marked swelling, and vacuolated phenomenon. The expression of TNF-α, TGF-β1, and p38 MAPK proteins in renal tissues increased significantly. Compared with the LPS group, the expression of TNF-α, TGF-β1, and p38 MAPK proteins in the LPS+UTI group was decreased compared with the LPS group [TNF-α (pg/ml): 4915.00±267.06 vs 8836.00±739.51; TGF-β1 (pg/ml): 257.71±23.88 vs 354.39±29.44; P-p38 MAPK/β-actin: 0.158±0.022 vs 0.300±0.044, P＜0.05]. The expression of TNF-α, TGF-β1, and p38 MAPK proteins in the LPS+SB group was decreased compared with the LPS group [TNF-α (pg/ml): 4856.75±167.23 vs 8836.00±739.51; TGF-β1 (pg/ml): 249.56±23.42 vs 354.39±29.44; P-p38 MAPK/β-actin: 0.136±0.017 vs 0.300±0.044, P＜0.05], but there was no significant difference between the LPS+UTI group and LPS+SB group (P＞0.05).

Ulinastatin protects against septic acute kidney injury possibly by inhibiting the TGF-β1/p38 MAPK signal transduction pathway.

To explore the surgical management for bile duct injury during laparoscopic cholecystectomy.

From January 2001 to December 2017, 3695 cases of laparoscopic cholecystectomy were performed at the Department of Surgery, Peking University First Hospital, of which 11 (0.3%) suffered from bile duct injury. Five cases of non-transected bile duct injury underwent suture repair, and T-tube drainage was placed in four cases. Six cases of bile duct transection injury were treated either by end-to-end biliary anastomosis with T-tube drainage (n=3) or by Roux-en-Y choledochojejunostomy (n=3).

T-tubes in seven patients were removed 6~12 months after operation. The 11 patients with bile duct injury were followed for 18~60 months, with an average of 44.8 months. Balloon dilatation under a choledochoscope was performed in two cases of anastomotic stricture of the bile duct and jejunum, and no biliary stricture was found in the remaining nine cases.

Suture repair of the bile duct, end-to-end biliary anastomosis, and roux-en-Y choledochojejunostomy are all effective means for surgical treatment of bile duct injury. Balloon dilatation under a choledochoscope can be selected for bile duct stenosis after repair of bile duct injury, and reoperation can be performed if necessary.

Long-term chronic hypoxia can promote microangiogenesis through a variety of mechanisms to enhance the effective exchange of blood and tissue fluid and ensure oxygen transport, which is a physiological mechanism for the body to adapt to hypoxic environment. However, when the body suffers from various stresses such as severe trauma, infection, and hypoxia, microvascular hyperplasia may play adverse roles, and hypovolemic shock may occur in the early stage of the disease. With the development of the disease and inappropriate medical intervention, it is easy to develop capillary leakage and organ and tissue edema, thus aggravating the disease. At this time, the body may have special pathophysiology. This paper describes the physiological mechanism of microangiogenesis in chronic hypoxic environment and discusses its possible pathophysiological and clinical characteristics, which is beneficial to the accurate implementation of clinical treatment.

To investigate the relationship between maternal and neonatal 25-hydroxy vitamin D₃ [25(OH)D] levels and neonatal respiratory distress syndrome (NRDS) among woman with gestational diabetes mellitus (GDM).

A total of 148 pregnant women with GDM at Fuyang Hospital Affiliated to Anhui Medical University from March 2018 to September 2020 were selected. The incidence of postpartum NRDS was recorded. The blood was collected at 28 to 36 weeks of gestation and at birth of the newborn, and the serum 25-(OH)D levels were detected. Binary Logistic regression model was used to analyze the independent influence factors of NRDS in pregnant women with GDM. The value of maternal and neonatal 25-(OH)D for predicting NRDS was evaluated by receiver operating characteristic (ROC) curve analysis.

There were 28 cases of NRDS in the 148 newborns, with an incidence of 18.92%. There were statistically significant differences between the NRDS group and the non-NRDS group in Apgar scores at 1 min and 5 min, amniotic fluid inhalation, premature rupture of membranes, prenatal glucocorticoid treatment, and maternal and neonate 25(OH)D₃ levels (P＜0.05). Logistic regression analysis showed that Apgar scores at 1 min (odds ratio [OR]=2.243, 95% confidence interval [CI]: 1.795-2.803) and 5 min (OR=3.662, 95%CI: 2.074-6.466), amniotic fluid inhalation (OR=2.893, 95%CI: 1.325-6.317), neonatal 25(OH)D₃ (OR=0.483, 95%CI: 0.271-0.861), and maternal 25(OH)D₃ (OR=0.501, 95%CI: 0.282-0.890) were independent influence factors for postpartum NRDS (P＜0.05). ROC analysis results showed that the AUC of neonatal 25(OH)D₃ in predicting NRDS was 0.741, with a sensitivity and specificity of 86.7% and 54.6%, respectively. The AUC of maternal 25(OH)D₃ in predicting NRDS was 0.648, and the sensitivity and specificity were 89.2% and 35.7%, respectively. The prediction model was established based on the results of Logistic multi-factor analysis: logit(P)=0.119+0.808X₁+1.298X₂+1.062X₃-0.728X₄-0.691X₅ [1 min Apgar score=X₁, 5 min Apgar score=X₂, inhalation of amniotic fluid=X₃, newborn 25(OH)D₃=X₄, and maternal 25(OH)D₃=X₅]. ROC analysis showed that the AUC value of the prediction model for diagnosing NRDS was 0.844 (SE=0.041, 95%CI: 0.764-0.924, P＜0.001), with a sensitivity of 0.929 and specificity od 0.675.

Maternal and neonatal 25(OH)D₃ levels in GDM woman are independent influencing factors of NRDS. It is helpful for early screening of NRDS and guiding clinical practice to monitor the maternal and neonatal 25(OH)D₃ levels in GDM woman.

To identify the risk factors for urinary sepsis after transurethral ureteropyeloscopic holmium laser lithotripsy (URSL).

Clinical data of patients with upper urinary calculi treated by URSL at Peking University Shougang Hospital from June 2015 to December 2020 were retrospectively analyzed, and the patients were divided into either a postoperative sepsis group (21 cases) or a non-sepsis group (1086 cases) according to the development of postoperative sepsis or not. Gender, age, body mass index (BMI), diabetes, calculus location, calculus size, CT value, operation time, preoperative indwelling of ureteral stents, preoperative urinary tract infection, preoperative obstructive pyelonephritis, preoperative urine bacterial culture, and surgical methods were compared between the two groups to identify the risk factors for urosepsis after URSL.

A total of 1107 patients were enrolled, of whom 21 (21/1107) met the diagnostic criteria for urinary sepsis. Compared with the non-sepsis group, there were statistically significant differences in BMI, stone size, operation time, preoperative obstructive pyelonephritis, preoperative urine bacterial culture, and surgical methods in the sepsis group (P＜0.05). Multivariate Logistic regression analysis showed that operative time, preoperative obstructive pyelonephritis, and positive preoperative urine bacterial culture were risk factors for postoperative urinary sepsis (OR=1.157, 95% CI: 1.026~1.305, P=0.018; OR=4.733, 95%CI: 1.274~17.573, P=0.020; OR=5.287, 95%CI: 1.408~19.857, P=0.014).

For patients with obstructive pyelonephritis and positive urine bacterial culture caused by upper urinary calculi before surgery, and patients with long operation time, we should be alert to the risk of urinary sepsis after URSL.