There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery. This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained. A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2–19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2–3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353–0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008–0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient – 0.002, 95% CI – 0.008 to − 0.001; p = 0.024) and male gender (coefficient – 0.144, 95% CI – 0.203 to − 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2–3 was associated with lower EN proportion (coefficient – 0.206, 95% CI – 0.273 to − 0.139; p < 0.001). The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.

Coronavirus disease 2019 (COVID-19), which is caused by severe acute res piratory syndrome coronavirus 2, poses a significant threat to public health worldwide, and diabetes is considered a risk factor for the rapid progression and poor prognosis of COVID-19. Limited immune function is a clinical feature of COVID-19 patients, and diabetes patients have defects in innate and adaptive immune functions, which may be an important reason for the rapid progression and poor prognosis of COVID-19 in patients with diabetes. We review the possible multiple effects of immune impairment in diabetic patients on the immune responses to COVID-19 to provide guidance for the diagnosis and treatment of diabetic patients with COVID-19.

BACKGROUND Klebsiella variicola (K. variicola ) is a member of the Klebsiella genus and is often misidentified as Klebsiella pneumoniae . In this report, we present a rare case of invasive liver abscess caused by K. variicola . CASE SUMMARY We report a rare case of liver abscess due to K. variicola . A 57-year-old female patient presented with back pain for a month. She developed a high-grade fever associated with chills, and went into a coma and developed shock. The clinical examinations and tests after admission confirmed a diagnosis of primary liver abscess caused by K. variicola complicated by intracranial infection and septic shock. The patient successfully recovered following early percutaneous drainage of the abscess, prompt appropriate antibiotic administration, and timely open surgical drainage. CONCLUSION This is a case of successful treatment of invasive liver abscess syndrome caused by K. variicola , which has rarely been reported. The findings of this report point to the need for further study of this disease.

Background: The well-established scientific observation has shown that the process of sensing and making adaptive response to external stimuli in bacteria is regulated by the two-component signal-transduction systems (TCSTSs). Typical TCSTSs are composed of two different types of proteins, a histidine kinase (HK) and a response regulator (RR). This review focuses on the influence of TCSTSs on the virulence, competence, biofilm formation and antibiotic resistance, and further discusses the value of TCSTSs for the new drug targets. Methods and findings: The HK protein is responsible for response to external stimuli by autophosphorylation, subsequently transfering this phosphate group to the RR protein, so then activating a series of biological processes. Loss of function or genetic mutation of these systems has been reported to study the function of the two component systems. It suggests that this system can regulate the expression of virulence factors, control the competence for transformation, modulate biofilm formation and cell envelope stress response, and influence the susceptibility to antibiotics. Conclusion: The homologies of HK and RR proteins in different genera of bacteria are highly conserved respectively, especially in the residues located near active sites. Moreover the signal transduction in mammals has an entirely different mechanism compared with bacteria. Altogether, this system may be very suited as a good potential drug target for the development of novel antibacterial.

高甘油三酯血症性急性胰腺炎(hypertriglyceridemic acute pancreatitis, HTG-AP)日渐增多, 且呈年轻化、重症化态势, 已成为我国急性胰腺炎的第二大病因. 已有的研究证实高甘油三酯血症的严重程度与急性胰腺炎的严重程度相关. 但当前对其HTG及HTG-AP的发病机制尚不明了. HTG-AP治疗手段包括: 低热卡喂养, 胰岛素, 肝素, 降脂药物及血液净化等. 这些治疗手段, 尤其以血浆置换为代表的血液净化措施尽管在降低血脂水平方面的作用已得到证实, 但其对于改善HTG-AP的预后尚需高质量的RCT研究证实. 基因诊断与基因治疗在HTG-AP的诊治中的价值越来越受到重视, 可能是今后HTG-AP研究的重要方向.