To explore the protective effect of sulforaphane (SFN) on septic myocardial injury (SMI) rats.

Sixty male wistar rats were randomly divided into a sham operation group, an SMI group, and an SFN group, with 20 rats in each group. Rats in the SMI group were prepared by cecum ligation and puncture (CLP), rats in the sham operation group were only exposed to the cecum by laparotomy, and rats in the SFN group were injected with 5 mg/kg SFN infusion 6 hours after CLP. Ten rats were selected from each group and observed for 48 hours after the operation; the mortality of rats at each time point was recorded. The hemodynamics of the remaining rats in each group were monitored by intraventricular catheterization through the right common carotid artery 24 hours after the operation, including heart rate, mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), maximal rate of left ventricular pressure rise during systole (+dp/dtmax), and maximum negative rate of left ventricular pressure decline (-dp/dtmax). The serum levels of cardiac troponin I (cTnI) and lactate dehydrogenase (LDH) and the myocardial tissue levels of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β), nitric oxide (NO) and reactive oxygen species (ROS) were measured by the enzyme-linked immunosorbent assay (ELISA). The protein expression levels of Toll-like receptor 4 (TLR4) and nuclear factor E2-related factor 2 (Nrf2) in myocardial tissue were determined by western-blotting.

There was a statistically significant difference in the survival time among the three groups (χ² = 23.720, P < 0.001), but there was no statistically significant difference in the survival time between the SMI group and the SFN group (P = 0.084). The expression levels of heart rate, LVSP, LVEDP, +dp/dtmax, -dp/dtmax, cTnI, LDH, TNF-α, IL-1β, NO, and ROS among the three groups showed statistically significant differences (F = 54.901, 95.190, 94.335, 111.104, 76.477, 1 263.532, 57.782, 1 130.698, 338.950, 155.727, 342.914; all P < 0.001). Compared with the sham operation group, the heart rate, LVSP, +dp/dtmax, and -dp/dtmax in the SMI group and SFN group were significantly decreased, and the above indicators in the SMI group were lowest (all P < 0.05); the levels of LVEDP, cTnI, LDH, TNF-α, IL-1β, NO, and ROS in both the SMI group and the SFN group were significantly increased, and the above indicators in the SMI group were highest (all P < 0.05). Western-blotting showed that there were statistically significant differences in the expression levels of Nrf2 and TLR4 in myocardial tissues among the three groups (F = 26.294, 32.667; both P < 0.001). Compared with the SMI group, the expression of Nrf2 in the SFN group was significantly increased, and the expression of TLR4 was significantly decreased (both P < 0.05).

SFN can alleviate septic myocardial inflammation and oxidative stress in rats and has a certain protective effect on SMI. Its mechanism of action may be related to the inhibition of TLR4 and the enhancement of the Nrf2 signaling pathway.

To evaluate the impact of phosphate supplementation therapy on the in-hospital mortality in septic patients with hypophosphatemia, and to identify the optimal serum phosphorus threshold for sepsis management.

The relevant clinical data of patients with sepsis were collected from the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database and Electronic Intensive Care Unit-Collaborative Research Database. The logistic regression model was used to assess the effect of phosphate supplementation therapy on in-hospital mortality in septic patients with hypophosphatemia. The blood phosphorus level was divided into six intervals, including significant hypophosphatemia (< 15 mg/L), mild hypophosphatemia (15-25 mg/L), normal low value (> 25-35 mg/L), normal high value (> 35-45 mg/L), mild hyperphosphatemia (> 45-55 mg/L), and significant hyperphosphatemia (> 55 mg/L). The proportion of exposure time of septic patients in each blood phosphorus interval was calculated by the time-weighted method, and the optimal blood phosphorus threshold was determined by the logistic regression model.

A total of 29 729 patients with sepsis were included, 250 856 blood phosphorus test data were analyzed, and 4 849 patients developed hypophosphatemia (serum phosphorus < 27 mg/L). Logistic regression analysis showed that septic patients with hypophosphatemia who received phosphate supplementation were significantly associated with a higher in-hospital mortality rate [odds ratio (OR) = 1.509, 95% confidence interval (CI) (1.203, 1.895), P < 0.001]. In the subgroups excluding patients with acute kidney injury (AKI) and/or refeeding syndrome (RFS), this association remained significant (all P < 0.05). There were 24 051 septic patients who had at least one recorded blood phosphorus test every 24 hours during the ICU period. Logistic regression analysis showed that septic patients with mild hypophosphemia [OR = 0.574, 95%CI (0.473, 0.697), P < 0.001] and those in the normal low value range [OR = 0.411, 95%CI (0.352, 0.480), P < 0.001] had a significantly reduced risk of in-hospital mortality.

Phosphate supplementation therapy cannot improve the prognosis of septic patients with hypophosphatemia. The optimal serum phosphorus level for septic patients is 15-35 mg/L, which is lower than the traditional reference range.

To explore prognostic factors of patients with sepsis complicated with immunocompromised status and to construct a predictive model.

A retrospective analysis was conducted on the clinical data of ICU patients with sepsis in the Affiliated Suzhou Hospital of Nanjing Medical University from April 2023 to February 2025. The general data and laboratory index of patients were analyzed. The statistically significant indicators in the univariate analysis were included in the multivariate logistic regression analysis, and a model of the regression equation was constructed. The model fitting degree was evaluated by the Omnibus test and the Hosmer-Lemeshow test, and the prognosis prediction value of each index was evaluated by drawing receiver operating characteristic (ROC) curves.

In total, 203 sepsis patients were combined with immunocompromised status, including 109 patients (53.7%) in the survival group and 94 patients (46.3%) in the death group. Univariate analysis showed that sequential organ failure assessment (SOFA), lactic acid (Lac), C-reactive protein (CRP), lymphocyte count (LYM), albumin and C-reactive protein/albumin ratio (CAR) were influencing factors of 28-day prognosis in sepsis patients with immune impairment (all P < 0.05). The above indicators were included in the multivariate logistic regression analysis. The research results showed that the SOFA score [odds ratio (OR) = 1.101, 95% confidence interval (CI) (1.004, 1.207), P = 0.041], Lac level [OR = 1.225, 95%CI (1.016, 1.478), P = 0.034] and CAR [OR = 1.183, 95%CI (1.063, 1.317), P = 0.002] were independent risk factors affecting the 28-day prognosis of patients. The logistic regression model was established, and the regression equation was: Logit (P) = 0.096X₁ + 0.203X₂ + 0.168X₃ - 1.854, with X₁, X₂ and X₃ representing the SOFA, Lac and CAR. The Omnibus test and the Hosmer-Lemeshow test suggested that the model was well fitting. The area under the curve of the prediction model was 0.690 [95%CI (0.618, 0.762), P < 0.001], the sensitivity was 60.6%, the specificity was 72.5%, and the Youden index was 0.331.

The SOFA score, Lac and CAR are the influencing factors for the 28-day prognosis of immunocompromised patients with sepsis. The prediction model constructed based on the SOFA score, Lac and CAR can effectively predict the 28-day prognosis of immunocompromised patients with sepsis.

To investigate the protective effect of sivelestat sodium, a neutrophil elastase (NE) inhibitor, on acute lung injury (ALI) after cardiopulmonary bypass (CPB) by regulating alveolar macrophages (AMs) polarization and to analyze its impact on clinical outcomes.

A prospective study was conducted on 65 patients with ALI after CPB admitted to the Department of Critical Care Medicine of the Shaoxing People's Hospital between April 2023 and April 2025. Patients were randomly divided into a Sivel group (n = 32) and a Ctrl group (n = 33) using a single-blind group random number table. The basic information, 30-day mortality, stroke incidence, and the utilization rate of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were collected. The changes of bilateral pulmonary exudation after CPB, ventricular arrhythmia, lactate elevation > 48 h, new-onset atrial fibrillation, mechanical ventilation time, ICU stay time, and the oxygenation index, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), white blood cell (WBC) and neutrophil (Neu) ratio at the time of ICU admission and on the 1st, 3rd and 5th days after surgery were observed. On the 1st day after surgery, bronchoalveolar lavage fluid (BALF) was collected to measure tumor necrosis factor-alpha (TNF-α), IL-10, and high mobility group box 1 (HMGB1) levels. AMs were cultured, and the messenger RNA (mRNA) expression levels of M1 polarization markers [inducible nitric oxide synthase (iNOS), TNF-α, and IL-1β] and M2 polarization marker [arginase-1 (Arg1)] were quantified using real-time fluorescence quantitative PCR. Immunofluorescence was used to assess iNOS and CD206 expression in AMs.

There were no significant differences in the 30-day mortality, ECMO utilization, stroke incidence, or CRRT utilization between the Sivel group and the Ctrl group (all P > 0.05). However, the Sivel group showed significant improvement in reduced bilateral pulmonary exudative changes [28.12% (9/32) vs. 54.55% (18/33), χ² = 5.909, P = 0.015], lower incidence of new-onset atrial fibrillation [6.25% (2/32) vs. 24.24% (8/33), χ² = 4.040, P = 0.044], shorter mechanical ventilation time [(3.7 ± 2.1) d vs. (5.2 ± 2.5) d, χ² = 3.727, P = 0.014], and shorter ICU stay [(75 ± 47) h vs. (97 ± 25) h, χ² = 2.257, P = 0.031] compared with the Ctrl group. In the Sivel group, the oxygenation index improved on the 1st day after surgery, while PCT and CRP levels improved on the 3rd and 5th days as compared with the Ctrl group (all P < 0.05). BALF analysis on the first postoperative day revealed lower TNF-α and HMGB1 levels but higher IL-10 levels in the Sivel group than in the Ctrl group (all P < 0.05). AMs studies showed increased Arg1 mRNA expression and decreased iNOS, TNF-α, and IL-1β mRNA expression in the Sivel group as compared with the Ctrl group (all P < 0.05). Immunofluorescence confirmed increased CD206 positive cells and decreased iNOS positive cells in the Sivel group.

Sivelestat sodium may protect against CPB-induced ALI and improve clinical outcomes by promoting M2 macrophage polarization and reducing inflammation.

To investigate the clinical characteristics, pathogen spectrum, and epidemic patterns of severe pneumonia patients, and to analyze the association between different pathogen spectrum infections and severe pneumonia with respiratory failure.

This study systematically reviewed all hospitalized children diagnosed with severe pneumonia at Changzhou Children's Hospital from December 2020 to March 2024. By extracting medical history, we described the basic characteristics, age distribution, pathogen spectrum, and comorbid respiratory failure of children with severe pneumonia, compared the differences in respiratory failure among children infected with different pathogens, and used multiple logistic regression analysis to explore the impact of different pathogen spectra on respiratory failure in children with severe pneumonia.

During the study period, 2 177 children with severe pneumonia were included. Among them, 319 (14.65%) had respiratory failure. Compared with the period before 2023, the number of children hospitalized with severe pneumonia has increased sharply since 2023, with rises observed across different pathogens and age groups. Notably, the increase was most pronounced for severe pneumonia patients caused by Mycoplasma pneumoniae (MP), which accounted for 51.92% (962/1 853) of all severe pneumonia patients since 2023. Among 319 children with severe pneumonia complicated with respiratory failure, MP infection accounted for 17.55% (56/319), and 49.22% (157/319) were infants aged ≤ 1 year. Multivariate analysis identified age, low birth weight, spring season, bacterial-bacterial co-infection, and bacterial-viral co-infection as risk factors for respiratory failure in children with severe pneumonia (all P < 0.05).

During the 2023-2024 period, the number of severe pneumonia patients caused by various pathogens increased significantly, with MP being the main cause. However, severe pneumonia due to MP infection rarely leads to respiratory failure. Infants under one year old are likely to be a high-risk group for severe pneumonia with respiratory failure. Additionally, bacterial-bacterial and bacterial-viral co-infections may be important risk factors for this complication in children.

To systematically review the prevalence and influencing factors of ICU-acquired weakness (ICU-AW).

The nine databases of Cochrane Library, Embase, Web of Science, PubMed, CINAHL, CNKI, WanFang, VIP, and CBM were searched to retrieve literature on the prevalence and influencing factors of ICU-AW. The retrieval period was from inception to October 31, 2024. After literature screening and data extraction were completed by two researchers, a meta-analysis of the included literature was conducted using RevMan 5.4 and Stata 18.0 software.

A total of 48 articles were selected, involving 13 176 ICU patients. The meta-analysis showed that the prevalence of ICU-AW was 41% [95% confidence interval (CI) (33%, 48%), Z = 10.630, P < 0.000 01]. The influencing factors of ICU-AW included advanced age, female gender, combined sepsis, combined multiple organ dysfunction syndrome, use of glucocorticoid drugs, use of neuromuscular blockers, use of sedative and analgesic drugs, elevated blood glucose, elevated lactate, prolonged mechanical ventilation time, parenteral nutrition, prolonged ICU stay, immobilization, and increased acute physiology and chronic health evaluation Ⅱ score (all P < 0.05).

The prevalence of ICU-AW is relatively high, and the influencing factors cover multiple aspects. Therefore, medical staff should attach importance to the early screening of ICU-AW and carry out comprehensive intervention measures.