Objective To investigate the expression and clinical significance of serum calcium/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ) and phospholipase D2(PLD2) in patients with severe acute pancreatitis(SAP) complicated by sepsis. Methods A total of 105 patients with SAP complicated by sepsis admitted to the Intensive Care Unit, First Affiliated Hospital of Xinjiang Medical University, from January 2021 to January 2025 were prospectively enrolled as the sepsis group.According to disease severity, they were divided into the general sepsis subgroup(n = 45) and the septic shock subgroup(n =60). Based on 90-day outcomes, patients were further divided into the death subgroup(n = 41) and survival subgroup(n = 64).Another 105 SAP patients without sepsis, matched 1 ∶1 during the same period, were included as the non-sepsis group. Serum Ca MKⅡ and PLD2 levels were measured by enzyme-linked immunosorbent assay. The relationship between serum Ca MKⅡand PLD2 levels and disease severity in SAP patients with sepsis was analyzed using point-biserial correlation analysis. Multivariate logistic regression analysis was used to analyze the influencing factors of prognosis and death in patients with SAP complicated with sepsis. Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive efficacy of serum Ca MKⅡ and PLD2 levels on the prognosis and death of patients with SAP complicated with sepsis. Results Serum Ca MKⅡ and PLD2 levels were significantly higher in the sepsis group than in the non-sepsis group(t/P = 10.109/<0.001 and9.100/<0.001, respectively). Patients in the septic shock subgroup had higher serum Ca MKⅡ and PLD2 levels than those in the general sepsis subgroup(t/P = 5.458/<0.001 and 5.503/<0.001, respectively). Point-biserial correlation analysis revealed that serum Ca MKⅡ and PLD2 levels were positively correlated with disease severity in SAP patients with sepsis(r/P = 0.574/<0.001 and 0.563/<0.001, respectively). The death subgroup had higher proportions of septic shock, sequential organ failure assessment(SOFA) scores, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores, and serum Ca MKⅡ and PLD2 levels than the survival subgroup(t/P = 3.622/<0.001, 3.355/0.001, 12.005/<0.001, 6.036/<0.001, and 5.419/<0.001, respectively). Multivariate logistic regression identified septic shock, higher SOFA and APACHE Ⅱ scores, and elevated Ca MKⅡ and PLD2 levels as independent risk factors for mortality in SAP patients with sepsis [OR(95%CI) = 4.708(1.076-20.599), 1.436(1.097-1.880), 1.237(1.088-1.405), 1.037(1.016-1.059), and 1.046(1.016-1.077), respectively]. The areas under the ROC curves(AUCs) for serum Ca MKⅡ, PLD2, and their combination in predicting mortality were 0.795, 0.782,and 0.907, respectively. The combined detection showed significantly higher predictive performance than either marker alone(Z/P = 2.990/0.003 and 3.141/0.002). Conclusion Elevated serum Ca MKⅡ and PLD2 levels are closely associated with disease progression in SAP patients complicated by sepsis. The combined measurement of serum Ca MKⅡ and PLD2 provides high predictive value for mortality in these patients.

Objective To analyze the relationship between serum levels of CBP/p300 interacting transactivator 2(CITED2), brain and muscle Arnt-like 1(BMAL1), and NOP2/Sun RNA methyltransferase 3(NSUN3) and the condition of patients with sepsis complicated by acute kidney injury(AKI), and their impact on prognosis. Methods A total of 123 patients with sepsis complicated by AKI admitted to the Department of Critical Care Medicine at Tangdu Hospital, Air Force Medical University, between February 2023 and March 2025 were selected as the sepsis-AKI group. According to AKI staging criteria, cases were classified into stage I(45 cases), stage Ⅱ(40 cases), and stage Ⅲ(38 cases). Patients were divided into a survival subgroup(81 cases) and a mortality subgroup(42 cases) based on 28-day survival status. Additionally, 115 patients with uncomplicated sepsis admitted during the same period were selected as the sepsis group, and 123 healthy volunteers constituted the healthy control group. ELISA was used to detect serum CITED2 levels. Quantitative real-time PCR(qRT-PCR)was used to detect the relative expression levels of serum BMAL1 m RNA and NSUN3 m RNA. Pearson correlation analysis was used to examine relationships between variables. Multivariate Cox proportional hazards analysis was performed to identify factors associated with poor prognosis. Receiver operating characteristic(ROC) curve analysis was used to evaluate the predictive value of these biomarkers for poor prognosis in patients with sepsis complicated by AKI. Results Serum CITED2 and NSUN3 m RNA levels progressively increased across the healthy control, sepsis, and sepsis-AKI groups, while serum BMAL1m RNA levels progressively decreased(F = 544.535, 728.950, 478.098; all P <0.001). Serum CITED2 and NSUN3 m RNA levels progressively increased across stages I, Ⅱ, and Ⅲ, while serum BMAL1 m RNA levels progressively decreased(F =33.532, 22.012, 72.544; all P < 0.001). The mortality subgroup exhibited significantly higher serum CITED2 and NSUN3m RNA levels, higher APACHE Ⅱ scores, higher SOFA scores, and higher serum creatinine levels compared to the survival subgroup, while serum BMAL1 m RNA levels were significantly lower(t/χ2= 7.514, 7.639, 7.732, 9.627, 6.264, all P <0.001).Serum CITED2 was positively correlated with APACHE Ⅱ and SOFA scores(r = 0.512, 0.508, both P <0.001); serum NSUN3m RNA was positively correlated with APACHE Ⅱ and SOFA scores(r = 0.506, 0.513, both P <0.001); and serum BMAL1m RNA was negatively correlated with APACHE Ⅱ and SOFA scores(r =-0.527,-0.519, both P <0.001). Elevated CITED2,NSUN3 m RNA, APACHE Ⅱ score, and SOFA score were independent risk factors for poor prognosis [HR(95%CI) = 2.078(1.353-3.192), 2.343(1.458-3.765), 2.436(1.763-3.366), 2.651(1.777-3.954)], while elevated BMAL1 m RNA was an independent protective factor [HR(95%CI) = 0.314(0.172-0.572)]. The AUC values for predicting poor prognosis in sepsis-associated AKI patients using serum CITED2, BMAL1 m RNA, NSUN3 m RNA individually and in combination were 0.794,0.814, 0.810, and 0.916, respectively. The combined assessment demonstrated superior predictive value compared to individual markers(Z = 2.780, 2.084, 2.435; P = 0.005, 0.037, 0.015). Conclusion Patients with sepsis-associated AKI exhibit elevated serum levels of CITED2 and NSUN3 alongside decreased BMAL1 levels. These three markers correlate with disease severity and poor prognosis, potentially serving as biomarkers for predicting 28-day mortality in patients with sepsis-associated AKI.

Objective To investigate the characteristics of serum neutrophil extracellular traps(NETs) in patients with septic shock and their predictive value for the risk of developing multiple organ dysfunction syndrome(MODS). Methods This prospective observational study included 212 patients with septic shock treated at our hospital between May 2023 and May 2025. The patients were divided into a MODS group and a non-MODS group based on whether MODS occurred during hospitalization. Basic clinical characteristics, septic shock features, treatment details, and serum NETs markers at admission were collected and compared between the two groups. Multivariate logistic regression analysis was used to identify independent factors associated with MODS in septic shock patients. The predictive efficacy of individual and combined NETs markers for MODS in septic shock patients was evaluated using receiver operating characteristic(ROC) curves and the area under the curve(AUC). Results The MODS group had higher age, proportion of diabetes comorbidity, proportion of mixed infections, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) scores at the first diagnosis of septic shock after admission, Sequential Organ Failure Assessment(SOFA) scores, and serum levels of circulating free DNA(cfDNA), citrullinated histone H3(CitH3), myeloperoxidase(MPO), and neutrophil elastase(NE) compared to the non-MODS group(t/χ2/P =2.342/0.020, 4.707/0.030, 4.222/<0.001, 5.131/<0.001, 3.630/<0.001, 3.512/0.001, 3.728/<0.001, 3.210/0.002). Diabetes comorbidity, mixed infections, higher APACHE Ⅱ scores, higher SOFA scores, and elevated serum levels of cf DNA, Cit H3, MPO,and NE were identified as risk factors for MODS in septic shock patients [OR(95%CI) = 2.187(1.007-4.750), 2.123(1.031-4.373), 1.178(1.055-1.315), 1.615(1.226-2.127), 1.010(1.001-1.020), 1.035(1.014-1.056), 1.045(1.022-1.067), 1.012(1.004-1.035)]. The AUCs for serum cf DNA, Cit H3, MPO, NE, and their combination in predicting MODS risk in septic shock patients were 0.628, 0.642, 0.610, 0.600, and 0.806, respectively. The combined prediction of the four NETs markers demonstrated the highest efficacy(Z = 4.056, 3.816, 4.720, 4.814, all P <0.001). Conclusion Serum levels of NETs markers,including cf DNA, Cit H3, MPO, and NE, are significantly elevated in septic shock patients who develop MODS and are independent risk factors for MODS. The combined detection of NETs markers provides a new approach for the early clinical prediction of MODS risk in septic shock patients.

Objective To investigate the relationship between serum pyruvate kinase M2(PKM2) and serpin family A member 3(SERPINA3) levels and white matter degeneration and cognitive impairment in patients with lacunar cerebral infarction. Methods A total of 193 patients with lacunar cerebral infarction admitted to the Department of Neurology, the Third Hospital of Heilongjiang Province from May 2020 to May 2025 were selected as the lacunar cerebral infarction group. According to the Fazekas score, patients were divided into a subgroup without leukoaraiosis(89 cases) and a subgroup with leukoaraiosis(104 cases). According to the Montreal Cognitive Assessment(MoCA) score, patients were divided into a normal cognition subgroup(95 cases) and a cognitive impairment subgroup(98 cases). In addition, 193 healthy subjects from the same period were randomly selected as the healthy control group. Serum PKM2 and SERPINA3 levels were detected by enzymelinked immunosorbent assay. Spearman rank correlation analysis was used to analyze the correlation between serum PKM2,SERPINA3 levels and the degree of white matter degeneration and cognitive impairment. Multivariate logistic regression analysis was used to identify factors influencing cognitive impairment in patients with lacunar cerebral infarction. Receiver operating characteristic(ROC) curve analysis was used to evaluate the diagnostic value of serum PKM2 and SERPINA3 levels for cognitive impairment in patients with lacunar cerebral infarction. Results Serum PKM2 and SERPINA3 levels were significantly higher in the lacunar infarction group than in the healthy control group(t/P = 15.776/<0.001, 23.092/<0.001). With increasing severity of white matter degeneration, serum PKM2 and SERPINA3 levels progressively increased across mild, moderate, and severe white matter degeneration subgroups(F/P = 22.141/<0.001, 52.482/<0.001). Serum PKM2 and SERPINA3 levels were positively correlated with the degree of white matter degeneration(rs/P = 0.621/<0.001, 0.597/<0.001). Serum PKM2 and SERPINA3 levels were significantly higher in the cognitive impairment subgroup than in the normal cognition subgroup(t/P = 10.812/<0.001, 8.986/<0.001). Serum PKM2 and SERPINA3 levels were positively correlated with the degree of cognitive impairment(rs/P = 0.708/<0.001, 0.692/<0.001). Age, elevated homocysteine(Hcy), white matter degeneration, elevated PKM2, and elevated SERPINA3 were independent risk factors for cognitive impairment in patients with lacunar infarction [OR(95%CI) = 1.432(1.193-1.718), 2.863(1.517-5.403), 2.241(1.406-3.573), 1.865(1.334-2.607), 2.071(1.367-3.138)]. The AUCs for PKM2, SERPINA3, and their combination in diagnosing cognitive impairment were 0.802, 0.825, and0.907, respectively. The combined diagnostic value was significantly greater than that of either marker alone(Z/P = 2.804/0.001, 2.290/0.004). Conclusion Serum PKM2 and SERPINA3 expression is upregulated in patients with lacunar cerebral infarction and is associated with white matter degeneration and cognitive impairment. Early combined detection of these markers may assist in the clinical diagnosis of cognitive impairment.

Objective To investigate the predictive value of serum NOD-like receptor thermal protein domain associated protein 3(NLRP3) and NOD-like receptor family CARD domain containing 4(NLRC4) levels for short-term prognosis after surgery in patients with hypertensive basal ganglia intracerebral hemorrhage(HBGH). Methods A total of 182 HBGH patients(HBGH group) who underwent minimally invasive hematoma evacuation in the Department of Neurosurgery, Yulin First Hospital, from January 2022 to May 2025, and 125 healthy controls(healthy control group) during the same period were enrolled. Serum levels of NLRP3 and NLRC4 were measured by enzyme-linked immunosorbent assay. Based on disease severity, HBGH patients were categorized into mild(n = 34), moderate(n = 45), moderately severe(n = 47), and severe(n = 56)subgroups. The correlation between serum NLRP3, NLRC4 levels and disease severity was analyzed using Spearman correlation. According to 3-month prognosis, HBGH patients were divided into poor prognosis and good prognosis subgroups. Multivariate logistic regression analysis was used to identify factors influencing short-term postoperative poor prognosis; ROC curve analysis was employed to assess the value of serum NLRP3 and NLRC4 levels in predicting short-term postoperative poor prognosis. Results Serum NLRP3 and NLRC4 levels were significantly higher in the HBGH group than in the healthy control group(t/P = 21.239/<0.001, 16.528/<0.001). Serum NLRP3 and NLRC4 levels increased progressively across the mild,moderate, moderately severe, and severe HBGH subgroups(F/P = 396.166/<0.001, 487.216/<0.001). A positive correlation was observed between serum NLRP3, NLRC4 levels and disease severity in HBGH patients(rs/P = 0.826/<0.001, 0.878/<0.001).The poor prognosis rate among the 182 HBGH patients was 33.52%(61/182). NLRP3 and NLRC4 levels were significantly higher in the poor prognosis subgroup than in the good prognosis subgroup(t/P = 7.020/<0.001, 7.727/<0.001). Severe HBGH,larger hematoma volume, elevated NLRP3, and elevated NLRC4 were identified as independent risk factors for short-term postoperative poor prognosis, while higher Glasgow Coma Scale(GCS) score was an independent protective factor [OR(95%CI) = 13.097(2.009-85.400), 1.128(1.057-1.203), 3.027(1.648-5.561), 1.080(1.039-1.123), 0.646(0.529-0.790)]. The AUCs for serum NLRP3 level, NLRC4 level, and their combination in predicting short-term postoperative poor prognosis were0.781, 0.793, and 0.860, respectively. The combined predictive value was superior to that of either biomarker alone(Z/P =2.914/0.004, 2.736/0.006). Conclusion Elevated serum NLRP3 and NLRC4 levels in HBGH patients are associated with increased disease severity and short-term postoperative poor prognosis. The combination of these two biomarkers demonstrates high predictive value for short-term postoperative prognosis in HBGH patients.