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Vitamin C is an essential micronutrient for human and its deficiency will lead to scurvy. In recent years, as a new therapeutic strategy, high dose intravenous vitamin C(HDIVC) has been widely studied in critical cared diseases. In this review, we summarized the progress of HDIVC in sepsis, including its research history, rationality of usage, controversy and prospect, problems and outlook. The application of HDIVC in critical cared diseases underwent three periods: early, preheating and outbreaking period. Given the reduction of vitamin C in critical diseases, it requires rapid intravenous supplementation. We confirmed the therapeutic efficacy of HDIVC in COVID-19 and severe acute pancreatitis respectively. It is well known that HDIVC has effect of suppressing inflammatory responses, stabilizing the circulation and improving the immunity. But the application of HDIVC in critical cared diseases is still controversial, for the opposing findings in multiple large-scale randomized controlled trials. Future studies should be better to pay further attention on the dose and time of vitamin C and vitamin C plasma concentration monitoring.

Acute pancreatitis (AP) is a common cause of emergent patients and common severe disorders of hospital admission. This review includes the characteristic of inflammatory reaction from AP, the pattern and the aetiology of AP with infection, the necessity of preventive use of antibacterials, antimicrobial treatment of AP with infection, use of antibacterials for extra-pancreatic infections, surgical intervention of anti-infective treatment. Related recognition and clinical experience in treatment of AP were provided. Extra-pancreatic infections appeared in the patients with AP indicating the increase in disease severity. Compared to the patients with aseptic necrosis, the patients with extra-pancreatic infections might have organ failure, increasing in rescue risk for into intensive care unit, and with mortality increasing. Early diagnosis, infection control and proper treatment with antibacterials will be the footing and base for the treatment of AP combined infection.

Acute lung injury (ALI) is a devastating human malignancy characterized by excessively uncontrolled inflammation and lung endothelial dysfunction. Non-coding RNAs play essential roles in endothelial protections during the pathological processes of ALI. The precise functions and molecular mechanisms of the lncRNA-NORAD-mediated endothelial protection remain obscure. This study reports NORAD was significantly induced in human pulmonary microvascular endothelial cells (HPMECs) under lipopolysaccharide (LPS) treatment. Silencing NORAD effectively protected HPMECs against the LPS-induced cell dysfunction. In addition, RNA pull-down and luciferase assay validated that NORAD sponged miR-30c-5p, which showed reverse functions of NORAD in the LPS-induced cell injury of HPMECs. Furthermore, the glucose metabolism of HPMECs was significantly elevated under LPS stimulation which promoted the glucose consumption and extracellular acidification rate (ECAR) of HPMECs. Inhibiting NORAD or overexpressing miR-30c-5p suppressed glucose metabolism in HPMECs, leading to protective effects on HPMECs under LPS stimulation. The glycolysis key enzyme, lactate dehydrogenase-A (LDHA), was subsequently identified as a direct target of miR-30c-5p. Finally, recovery of miR-30c-5p in NORAD-overexpressing HPMECs effectively overrode the NORAD-promoted glycolysis and impaired endothelial dysfunction under LPS stimulation by targeting LDHA. Summarily, we demonstrated a NORAD-miR-30c-5p-LDHA-glycolysis axis in the LPS-induced HPMECs dysfunction in vitro and in vivo, contributing to the development of anti-ALI therapeutic approaches.

Purpose: New-onset atrial fibrillation (NOAF) and sepsis-induced coagulopathy (SIC) are severe complications in septic patients. However, the relationship between NOAF and SIC score has not been clearly defined. This study aims to investigate the association between SIC score and NOAF, as well as their effect on mortality in sepsis. Patients and Methods: This study was a two-center retrospective analysis. Medical data were collected from patients diagnosed with sepsis. The patients were divided into NOAF and non-NOAF groups, and the SIC score was calculated for each group. Univariable and multivariable logistic regression analyses were performed to explore the relationship between the SIC score and NOAF, as well as their effects on mortality. The Kaplan-Meier curve was used to assess the survival rate. Results: A total of 2,280 septic patients were included, with 132 (5.7%) suffering from NOAF. Multivariable logistic regression analyses indicated that age, gender, the Acute Physiology and Chronic Health Evaluation II score (APACHE II), heart rate, renal failure, stroke, chronic obstructive pulmonary disease (COPD), and the SIC score were independent risk factors for NOAF in sepsis. Moreover, NOAF was associated with an increased risk of in-hospital mortality, 28-day mortality, and 90-day mortality. These results were consistent across subgroup analyses. Conclusion: The SIC score was an independent risk factor for NOAF in septic patients, and NOAF was an independent risk factor for predicting mortality. [ABSTRACT FROM AUTHOR]

Objective To establish the nomogram and predict the risk factors of wound complication in patients with emergent abdominal surgery via a midline vertical incision. Methods The clinical data of 247 patients treated in Department of Surgery Ruijin Hospital including 68 cases with wound complication and 139 cases without wound complication were collected and analyzed. Risk predictors were selected from the items of clinical strategies by the least absolute shrinkage and selection operator (LASSO) regression model and multivariable logistic regression analysis was performed with incorporated items. C-index and calibration plot were used to evaluate the discrimination and calibration of prediction model. Results Six items including age ≥60 years, smoking and history of abdominal surgery, preoperative lower albumin in serum and increase in C-reactive protein level, and both continuous and interrupted suture of abdominal incision were included in the prediction model. The prediction model showed better discrimination and calibration with a C-index of 0.747 (95%Cl: 0.678-0.816). Conclusions The established nomogram can be used to predict the risk of wound complication in patients with emergent abdominal surgery via abdominal midline vertical incision.

Objective To understand the characteristics of patients in the emergency observation room, analyze the factors influencing death, and provide orientation for improving the level of emergency treatment in the hospital. Methods The data of all patients discharged from the emergency observation room in a tertiary hospital in Shanghai from January 1 to December 31, 2019 were collected. The patients were divided into the death group and the survival group based on their outcome. The clinical data of two groups were compared, and the characteristics of death cases were analyzed. Results In 2019, there were 2 211 patients discharged from the emergency observation room, including 125 deaths and 2 086 survivors. Among the surviving patients, 1 183 were discharged (accounting for 56.71%), and 903 were admitted to specialized departments for further treatment (accounting for 43.28%). The median (25th, 75th percentile) observation time was 2.50 (1.00, 9.00) days, and 1 076 patients (accounting for 48.67%) had an observation time longer than 72 h. The average age was (67.81 ± 18.87) years, and males accounted for 57.98% (1 282 cases). The death group had a higher incidence of respiratory system diseases and malignant tumors than the survival group, while the survival group had a higher incidence of nervous system diseases (P < 0.01). The frequencies of using non-invasive ventilators and electrocardiogram monitoring in the death group were higher than those in the survival group (P < 0.01). The peak period of death occurrence was mainly in the winter. The multivariate logistic regression analysis showed that the risk of death increased to 1 . 057 and 1 . 013 times for every 1 year increment of age and every 1 day increment of staying in observation time, respectively (P < 0.001); the risk of death for patients with two or more diagnosed diseases was 3.873 times that of patients with one diagnosis (P < 0.001); compared with patients from the clinic, the risk of death for patients from the rescue room increased to 2.877 times (P < 0.001). Conclusions The hospital should standardize the triage and treatment of critically ill and complicated patients, allocate and distribute emergency resources reasonably, and strengthen the observation of the condition. Effective prevention and treatment strategies should be formulated based on high-risk factors such as old age, respiratory system diseases, tumors, and seasonal variations to improve the efficiency and quality of emergency treatment. [ABSTRACT FROM AUTHOR]

Background: To identify the factors influencing the early encapsulation of peripancreatic fluid/necrosis collections via contrast-enhanced computed tomography (CECT) and to determine the clinical significance of early encapsulation for determining the prognosis of acute pancreatitis (AP) patients. Methods: AP patients who underwent CECT between 4 and 10 days after disease onset were enrolled in this study. Early encapsulation was defined as a continuous enhancing wall around peripancreatic fluid/necrosis collections on CECT. Univariate and multivariate logistic regression analyses were performed to assess the associations between the variables and early encapsulation. Clinical outcomes were compared between the non-encapsulation and early encapsulation groups with 1:1 propensity score matching. Results: A total of 289 AP patients were enrolled. The intra-observer and inter-observer agreement were considered good (kappa statistics of 0.729 and 0.614, respectively) for identifying early encapsulation on CECT. The ratio of encapsulation increased with time, with a ratio of 12.5% on day 5 to 48.7% on day 9. Multivariate logistic regression analysis revealed that the longer time from onset to CECT examination (OR 1.55, 95% CI 1.23–1.97), high alanine aminotransferase level (OR 0.98, 95% CI 0.97–0.99), and high APACHE II score (OR 0.89, 95% CI 0.81–0.98) were found to be independent factors associated with delayed encapsulation. The incidence of persistent organ failure was significantly lower in the early encapsulation group after matching (22.4% vs 6.1%, p = 0.043). However, there was no difference in the incidence of infected pancreatic necrosis, surgical intervention, or in-hospital mortality. Conclusions: AP patients without early encapsulation of peripancreatic fluid/necrosis collections have a greater risk of persistent organ failure. In addition to longer time, the high APACHE II score and elevated alanine aminotransferase level are factors associated with delayed encapsulation. [ABSTRACT FROM AUTHOR]

Objective of this study is to evaluate the association between NTIS and DIC, as well as their impacts on the mortality in adults with sepsis.Patients and methods: A total of 1219 septic patients in two Chinese academic centers from October 2012 and October 2022 were enrolled in analysis. We conduct logistic regression models to analyze the independent risk factors for DIC. Modified Poisson regression models are used to estimate the relative risk (RR) of NTIS on the 28 days mortality in septic patients with DIC. Correlation analysis between thyroid function parameters and coagulation parameters is performed with Pearson coefficient be reported.Results: DIC is diagnosed on 388 (31.8%) of all the 1219 enrolled septic patients within 72 hours after admission. In multivariate logistic regression models, NTIS (OR 3.19; CI 2.31– 4.46; p< 0.001) is a statistically significant independent risk factor for DIC after adjustment for potential confounders. Twenty-eight days mortality is significantly higher in DIC patients complicated with NTIS compared with the other DIC patients (23.2% vs 14.0%, p=0.024). This result is also robust in different modified Poisson regression models (Model 1: RR 1.46; CI 1.25– 1.70; p< 0.001; Model 2: RR 1.35; CI 1.14– 1.60; p< 0.001; Model 3: RR 1.18; CI 1.02– 1.37; p=0.026). Correlation analysis reveals that the thyroid function parameters of FT3, FT4 and TSH only have weak correlations with coagulation parameters of platelet count, fibrinogen, FDP, D-dimers, PT, APTT and INR in sepsis.Conclusion: NTIS is an independent risk factor for DIC in adults with sepsis. DIC patients complicated with NTIS have significantly higher severity and higher rate of mortality. [ABSTRACT FROM AUTHOR]