Kidney is one of the most vulnerable organs in sepsis, resulting in sepsis-associated acute kidney injury (SA-AKI), which brings about not only morbidity but also mortality of sepsis. Ferroptosis is a new kind of death type of cells elicited by iron-dependent lipid peroxidation, which participates in pathogenesis of sepsis. The aim of this study was to verify the occurrence of ferroptosis in the SA-AKI pathogenesis and demonstrate that post-treatment with irisin could restrain ferroptosis and alleviate SA-AKI via activating the SIRT1/Nrf2 signaling pathway. We established a SA-AKI model by cecal ligation and puncture (CLP) operation and an in vitro model in LPS-induced HK2 cells, respectively. Our result exhibited that irisin inhibited the level of ferroptosis and ameliorated kidney injury in CLP mice, as evidenced by reducing the ROS production, iron content, and MDA level and increasing the GSH level, as well as the alteration of ferroptosis-related protein (GPX4 and ACSL4) expressions in renal, which was consistent with the ferroptosis inhibitor ferrostatin-1 (Fer-1). Additionally, we consistently observed that irisin inhibited ROS accumulation, iron production, and ameliorated mitochondrial dysfunction in LPS-stimulated HK-2 cells. Furthermore, our result also revealed that irisin could activate SIRT1/Nrf2 signaling pathways both in vivo and vitro. However, the beneficial effects of irisin were weakened by EX527 (an inhibitor of SIRT1) in vivo and by SIRT1 siRNA in vitro. In conclusion, irisin could protect against SA-AKI through ferroptotic resistance via activating the SIRT1/Nrf2 signaling pathway.

Background: An outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 infection occurred in Wuhan, China, in December 2019. To date, the analysis of fatal cases and the risk factors for death have rarely been reported. Methods: In this study, 220 adult patients with confirmed and suspected COVID-19 were enrolled. Clinical characteristics, laboratory data, treatments, and complications were compared between 168 survivors and 52 nonsurvivors. Univariable analysis and multivariable logistic regression were used to investigate the risk factors for mortality. Results: A total of 220 patients (168 were discharged and 52 died in the hospital) were enrolled in the study. The median age of all patients was 59.5 (47.0-69.0) years, and the median age of patients who died was significantly older than that of patients who survived (70.5 vs 56.0 years, respectively; P < .001). According to multivariate logistic regression, older age (odds ratio: 1.09, 95% CI: 1.03-1.15; P = .001), initial Sequential Organ Failure Assessment (SOFA) score >2 (37.4, 9.4-148.0; P = .011), and respiratory rate >24 per minute (10.89, 1.47-80.67; P = .019) were independent risk factors for mortality. Conclusion: Clinical and laboratory parameters predicting poor prognosis including older age, baseline SOFA score >2, and respiratory rate >24 per minute were identified.

Background Carbapenem antibiotics are widely used in intensive care units (ICU), and the prevalence of carbapenem-resistant microorganisms (CRO) has increased, forming a major threat to inpatients that urgently requires improved surveillance. This study aimed to assess the role of individualized active surveillance of carbapenem resistance genes on CRO risk. Methods A total of 3,765 patients were admitted to the ICU of Zhongnan Hospital of Wuhan University between 2020 and 2022 (March 2020 to February 2021 in the first period and March 2021 to February 2022 in the second period). The presence of carbapenem resistance genes were monitored using Xpert Carba-R, and CRO incidence was assigned as the investigated outcome. Results Of 3,765 patients, 390 manifested the presence of CRO, representing a prevalence of 10.36%. Active surveillance was associated with a lower CRO risk (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.62–0.95; P = 0.013), especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa (OR: 0.79; 95%CI: 0.62–0.99; P = 0.043), carbapenem-resistant Klebsiella pneumoniae (OR: 0.56; 95%CI: 0.40–0.79; P = 0.001), and carbapenem-resistant Enterobacteriaceae (OR: 0.65; 95%CI: 0.47–0.90; P = 0.008). However, active surveillance was not associated with risk of carbapenem-resistant Acinetobacter (P = 0.140), carbapenem-resistant Pseudomonas aeruginosa (P = 0.161), carbapenem-resistant Enterobacteriaceae (except CRKP) (P = 0.259), or ICU stay (P = 0.743). Moreover, there were significant differences between positive and negative active surveillance in high-risk patients with a CRO-positive culture (P < 0.001) or microorganism-positive culture (P < 0.001), time between ICU admission and CRO positivity (P < 0.001), length of hospital stay before surveillance (P = 0.002), carbapenem antibiotic use in the 90 days before surveillance (P = 0.001), corticosteroid use in the 90 days prior to surveillance (P = 0.028), and surgery in the 90 days before surveillance (P = 0.003). Conclusions Individualized active surveillance using Xpert Carba-R may be associated with a reduction in the overall CRO incidence in the ICU, especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae. Further prospective studies should be performed to verify these conclusions and guide further management of patients in the ICU.

Carbapenem antibiotics are widely used in ICU, and the prevalence of carbapenem-resistant microorganisms (CRO) has increased. This study aimed to assess the role of individualized active surveillance using Xpert Carba-R of carbapenem resistance genes on CRO risk. A total of 3,765 patients were admitted to the ICU of Zhongnan Hospital of Wuhan University between 2020 and 2022. The presence of carbapenem resistance genes were monitored using Xpert Carba-R, and CRO incidence was assigned as the investigated outcome. Of 3,765 patients, 390 manifested the presence of CRO, representing a prevalence of 10.36%. Active surveillance using Xpert Carba-R was associated with a lower CRO risk (odds ratio [OR]: 0.77; 95% confidence interval [CI] 0.62–0.95; P = 0.013), especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa (OR: 0.79; 95% CI 0.62–0.99; P = 0.043), carbapenem-resistant Klebsiella pneumoniae (OR: 0.56; 95% CI 0.40–0.79; P = 0.001), and carbapenem-resistant Enterobacteriaceae (OR: 0.65; 95% CI 0.47–0.90; P = 0.008). Individualized active surveillance using Xpert Carba-R may be associated with a reduction in the overall CRO incidence in ICU. Further prospective studies should be performed to verify these conclusions and guide further management of patients in ICU.

Objectives: Left ventricular diastolic dysfunction can be detected in the early stage of essential hypertension. Previous studies have used Ganau configuration classification with the European population criterion rather than Chinese population. In this study, we evaluate the energy loss and vortex circulation in diastolic left ventricle in patients with essential hypertension under the criterion of Chinese population and explore the relationship between intracardiac blood flow change and diastolic function. Methods: Collect the structural and hemodynamic information in left ventricular diastolic period by echocardiography. Measure the energy loss and vortex circulation in left ventricle at different phases by VFM on the offline station. Results: 63 patients with essential hypertension and 23 volunteers as controls are included. Compared to the controls, the energy loss and vortex circulation is significantly increased in hypertension which has a correlation with the diastolic function. The subgroups under the European criterion which find no significant difference in energy loss, have significant difference in ratio from that of Chinese criterion. Conclusions: The study shows the different results under two criterions and indicates the Chinese criterion can acquire a better reflection of the left ventricular energy loss in hypertension patients. VFM technology can be used to analyze the left ventricular flow in patients with hypertension, providing a new method to evaluate diastolic function.