Cheng Zheng

A ROS-responsive mPEG- b -PPS nanoplatform enables controlled curcumin delivery to suppress LPS-induced systemic inflammation.

Objective: This study assessed the accuracy, clinical effectiveness, and utility of continuous glucose monitoring compared with conventional methods in critically ill patients with sepsis. Methods: From July 2023 to July 2025, 60 patients with sepsis (mean age, 75.6 ± 27.107 years; mean body mass index, 22.4 ± 2.960 kg/m ² ) were randomized to the continuous glucose monitoring (FreeStyle Libre II system) or conventional monitoring group in this prospective randomized trial. Conventional monitoring (self-monitoring of blood glucose using a glucometer with fingertip capillary samples, plus arterial/venous measurements) was applied in the control group, whereas the intervention group additionally received continuous glucose monitoring. Outcomes included glucose measurement results, protocol adherence, efficiency, and accuracy, assessed using correlation analysis, the Diabetes Technology Society error grid, and International Standardization Organization conformity. Results: Continuous glucose monitoring demonstrated a high correlation (r = 0.986, p < 0.001), a low mean absolute relative deviation (11.44%), and 100% of readings fell within the clinically acceptable Zones A (91.9%) and B (8.1%) on the Diabetes Technology Society error grid analysis. The continuous glucose monitoring group showed significantly higher glycemic protocol adherence (73.91% vs. 48.16%, p < 0.001) and a shorter measurement time (41.33 vs. 63.67 s). Continuous glucose monitoring detected more hypoglycemic events (2.46% vs. 0.28%, p < 0.001) and fewer hyperglycemic events (44.38% vs. 50.88%, p < 0.001), with a higher time in the target range (33.23% vs. 26.26%). Conclusions: Continuous glucose monitoring is an accurate and clinically feasible method for real-time glucose monitoring in critically ill patients with sepsis in the intensive care unit. It enhances protocol adherence, improves dysglycemia detection, reduces nursing workload, and enables more precise insulin titration. Larger multicenter studies are warranted to confirm its long-term effects and cost-effectiveness.

Background: Cerebral fat embolism syndrome (CFES) usually occurs within fat embolism syndrome, classically characterized by hypoxemia, neurological abnormalities, and petechial rash. Pulmonary-sparing CFES is uncommon and may delay diagnosis. Case presentation: A 23-year-old man sustained multiple lower-extremity long-bone fractures after a traffic accident. After emergency orthopedic surgery, he was fully conscious with preserved oxygenation. Approximately 12 h after injury, he developed lethargy; at that time, oxygen saturation was normal, and head CT, chest CT, and CT pulmonary angiography showed no intracranial, pulmonary parenchymal, or pulmonary embolic abnormality. Two hours later, generalized seizures with vomiting were followed by desaturation and intubation, indicating that the subsequent respiratory failure was temporally more consistent with aspiration than primary pulmonary fat embolism. After ICU admission, brain MRI demonstrated the characteristic “starfield” pattern. Day-1 resting right-heart contrast echocardiography showed no definite right-to-left shunt. Management was mainly supportive, including airway protection, mechanical ventilation, continuous EEG monitoring, antiseizure therapy, targeted temperature management, organ support, infection control, and staged orthopedic treatment. Outcomes: Despite comprehensive treatment, the patient developed refractory status epilepticus, septic shock, rhabdomyolysis, acute kidney injury, hepatic dysfunction, and coagulopathy. Serial early neuron-specific enolase levels remained normal. He remained in an unresponsive wakefulness syndrome at 1 month and had a severe disorder of consciousness with a Glasgow Coma Scale score of 6 at 15 months. Conclusion: Severe CFES may occur despite normal early pulmonary imaging and oxygenation. Early brain MRI is essential after unexplained neurological deterioration following long-bone fractures. In this case, normal early NSE did not exclude devastating neurological injury.

Objective: To compare the clinical outcomes and prognosis of regional citrate anticoagulation and systemic heparin anticoagulation in patients with sepsis-associated acute kidney injury undergoing continuous renal replacement therapy. Methods: This retrospective cohort study (2020–2024) included 168 adults with sepsis-associated acute kidney injury who received continuous renal replacement therapy at the intensive care unit of Taizhou Municipal Hospital. Kaplan–Meier curves and multivariable Cox regression were used to evaluate 14- and 28-day mortality, with subgroup analyses performed to assess effect modification. Results: Among 168 eligible patients, 1:1 propensity score matching yielded 42 well-balanced pairs (regional citrate anticoagulation, n = 42; systemic heparin anticoagulation, n = 42) with comparable baseline characteristics. Hospital mortality was lower with regional citrate anticoagulation (59.5%) than with systemic heparin anticoagulation (71.4%); however, the difference did not reach statistical significance ( P = 0.251). The 14-day comparison demonstrated a higher survival probability with regional citrate anticoagulation (log-rank P = 0.043; hazard ratio, 2.10; 95% confidence interval: 1.01–4.39), and a similar benefit persisted at 28 days (log-rank P = 0.042; hazard ratio, 1.76; 95% confidence interval: 1.01–3.05). Subgroup analysis further indicated that the survival benefit of regional citrate anticoagulation on 28-day mortality was most pronounced among patients with pre-existing hypertension (hazard ratio, 2.75; 95% confidence interval: 1.32–5.71; P = 0.007; interaction P = 0.028). Conclusions: In patients with sepsis-associated acute kidney injury requiring continuous renal replacement therapy, regional citrate anticoagulation may confer better short-term (14- and 28-day) survival than systemic heparin anticoagulation; however, no clear difference in overall hospital mortality was observed. This potential benefit may be more pronounced among patients with hypertension, meriting further evaluation of tailored anticoagulation approaches.

Objective: To investigate the clinical characteristics and identify risk factors for severe Pneumocystis jirovecii pneumonia (PJP) in human immunodeficiency virus (HIV) -negative patients. Methods: This retrospective study included 39 non-HIV PJP patients diagnosed by next-generation sequencing (NGS) of bronchoalveolar lavage fluid (BALF) at Taizhou Municipal Hospital between June 2019 and March 2025. Patients were divided into severe (n=18) and non-severe (n=21) groups based on disease severity. Continuous variables were analyzed using Student’s t-test or Mann-Whitney U test, while categorical variables were compared with Fisher’s exact test. Variables showing statistical significance (PP < 0.001). Serum procalcitonin (PCT) [0.285 (0.113, 0.643) vs. 0.070 (0.045, 0.110) ng/mL; P = 0.003] and lactate dehydrogenase (LDH) [554.00 (465.25, 702.00) vs. 269.00 (246.50, 378.00) IU/L; P < 0.001] levels were significantly elevated in the severe group compared with the non-severe group. BALF-based NGS detected co-infections in 76.92% (30/39) of cases, predominantly bacteria (35.90%, 14/39) and Cytomegalovirus (CMV) (30.77%, 12/39) infections. The severe group showed significantly higher CMV co-infection rates than the non-severe group (55.56% vs. 9.52%, P = 0.006). Multivariable logistic regression analysis revealed that elevated LDH levels (OR = 1.863, 95% CI 1.153-3.009; P = 0.011) and CMV co-infection (OR = 11.477, 95% CI 1.186-111.109; P = 0.035) were independent risk factors for severe PJP. Conclusions: Pneumocystis jirovecii pneumonia in non-HIV demonstrated a substantial case-fatality rate. BALF-based NGS may facilitate the detection of co-infections. Elevated LDH levels and CMV co-infection emerged as independent predictors of progression to severe PJP.

Allergic bronchopulmonary aspergillosis (ABPA), a hypersensitivity lung disease mediated by Aspergillus fumigatus , represents a frequently overlooked diagnosis in pediatric practice. We describe an 11-year-old girl with difficult-to-treat asthma and recurrent pneumonias (three episodes within one year) in whom comprehensive evaluation revealed borderline total IgE (678 IU/mL), Aspergillus -specific IgE of 5.81 kUA/L, high-resolution CT demonstrating bilateral infiltrates with scattered nodules, and Aspergillus fumigatus identification via bronchoalveolar lavage fluid culture and targeted next-generation sequencing (tNGS). Initiation of systemic corticosteroids plus itraconazole produced rapid clinical resolution within three weeks, decreased total IgE by 29% (to 479 IU/mL) at one month, and achieved marked radiographic improvement by four months. This case highlights the need to consider ABPA in children with difficult-to-treat asthma and recurrent pulmonary infections, suggests Aspergillus -specific IgE screening in difficult-to-treat asthma, while diagnosis should rely on integrated clinical, immunologic, radiologic, and microbiologic assessment.

In patients with a known diagnosis of lung cancer, a new intracranial space-occupying lesion is most frequently interpreted as a brain metastasis. However, distinguishing it from an independent double primary brain tumor is critical, as treatment strategies and prognoses differ substantially. We report a rare case of primary glioblastoma occurring approximately two years after surgery for anaplastic lymphoma kinase (ALK)-positive lung adenocarcinoma. A 63-year-old female underwent radical resection for stage IA lung adenocarcinoma (ALK-positive) and received adjuvant ensartinib. Two years postoperatively, brain magnetic resonance imaging (MRI) revealed a solitary lesion in the right centrum semiovale, which was clinically misdiagnosed as a brain metastasis. The patient was subsequently treated with lorlatinib combined with stereotactic radiotherapy. Despite these interventions, she developed progressive left-sided limb weakness, and imaging demonstrated continuous lesion progression. Subsequent surgical resection and pathological examination confirmed primary glioblastoma, strongly supporting a diagnosis of metachronous double primary cancers (DPCs). The patient died 10 months after the glioblastoma diagnosis. This case highlights that during long-term follow-up of patients with malignancies, a new intracranial lesions may warrant consideration of a second primary cancer (SPC), particularly when the treatment response is not consistent with the expected biology of the original tumor. Timely pathological confirmation and multidisciplinary review may help reduce diagnostic delay and improve treatment selection.

Furazolidone is a nitrofuran antibiotic commonly used in the treatment of Helicobacter pylori infection. Although gastrointestinal symptoms are well-documented adverse effects, furazolidone-associated drug-induced interstitial lung disease is extremely rare. Herein, we report a case of a 54-year-old Chinese woman who developed fever, dry cough, and dyspnea on day 4 of furazolidone-containing quadruple therapy. Chest computed tomography revealed diffuse bilateral interlobular septal thickening and small pleural effusions. An extensive workup excluded other causes. The Naranjo adverse drug reaction probability scale score was 6, indicating a probable association with furazolidone. Discontinuation of the drug and initiation of glucocorticoid therapy resulted in rapid clinical and radiological improvement. This case highlights that furazolidone can cause drug-induced interstitial lung disease and that early recognition and intervention are crucial for a favorable outcome.

Background: Left ventricular (LV) thrombus is a catastrophic complication during veno arterial-extracorporeal membrane oxygenation (VA-ECMO) support for cardiogenic shock, arising from a confluence of hemodynamic stasis, a prothrombotic state, and potential limitations of conventional anticoagulation monitoring. Case presentation: A 42-year-old man with acute inferior-wall ST-elevation myocardial infarction developed refractory cardiogenic shock during percutaneous coronary intervention, necessitating VA-ECMO initiation. Dual antiplatelet therapy and systemic heparinization (targeting an activated partial thromboplastin time of 50–80 s) were maintained. Results: Despite therapeutic anticoagulation, serial echocardiography documented the formation of a massive LV thrombus occupying >90% of the cavity within a 14 h interval on the fourth day of ECMO support. The patient subsequently deteriorated into refractory multi-organ failure, leading to withdrawal of care. Conclusion: This case underscores the rapidity and severity of LV thrombus formation in VA-ECMO patients with severe ventricular dysfunction. It highlights the critical need for proactive management, including multimodal anticoagulation monitoring and aggressive, individualized LV unloading strategies that may require escalation beyond intra-aortic balloon pump support to more direct decompression methods.

Objective: The clinical characteristics of Klebsiella pneumoniae liver abscess (KPLA) and Klebsiella pneumoniae bloodstream infection (KP-BSI) are often reported, while the risk factors for KPLA combined with KP bloodstream infection (KPLA/KP-BSI) among KPLA are largely unknown. Therefore, this study aimed to investigate the clinical characteristics, risk factors, and outcomes of patients with KPLA complicated by KP-BSI. Methods: A retrospective study from May 2013 to October 2020 at a tertiary hospital compared KPLA patients with and without KP-BSI, analyzing clinical data. Results: Among all liver abscess cases during the study period, Klebsiella pneumoniae was the most common pathogen, accounting for 76.0% of isolates. Of 233 KPLA patients, 68.7% were male with a median age of 60.5 years. KPLA/KP-BSI occurred in 27.9%. Patients with KPLA/KP-BSI had higher male prevalence, abdominal surgery history, and higher APACHE II, SOFA, and CCI scores (p 10 cm reduced the risk (aOR 0.144). KPLA/KP-BSI was associated with worse outcomes, including higher septic shock, acute kidney injury, transfusion rates, organ dysfunction, pneumonia, longer hospital stays, and higher mortality (all p10 cm is protective. KPLA/KP-BSI is associated with significantly higher rates of septic shock, organ dysfunction, and in-hospital mortality, warranting heightened clinical attention.