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Comparison of fungal vs bacterial infections in the medical intensive liver unit:Cause or corollary for high mortality?

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World Journal of Hepatology 2024年第3期16卷 379-392页

作者： Sarah Khan Hanna Hong Stephanie Bass Yifan Wang Xiao-Feng Wang Omar t Sims Christine E Koval Aanchal Kapoor christina C Lindenmeyer Department of Internal Medicine Cleveland ClinicClevelandOH 44195United States Cleveland Clinic Lerner College of Medicine Cleveland ClinicClevelandOH 44195United States Department of Pharmacy Cleveland ClinicClevelandOH 44195United States Department of Quantitative Health Sciences/Biostatistics Section Cleveland ClinicClevelandOH 44195United States Department of Gastroenterology Hepatology and NutritionCleveland ClinicClevelandOH 44195United States Department of Infectious Disease Cleveland ClinicClevelandOH 44195United States Department of Critical Care Medicine Cleveland ClinicClevelandOH 44195United States

BACKGROUND Due to development of an immune-dysregulated phenotype,advanced liver disease in all forms predisposes patients to sepsis acquisition,including by opportunistic pathogens such as *** data exists on fungal infection within a medical intensive liver unit(MILU),particularly in relation to acute on chronic liver *** to investigate the impact of fungal infections among critically ill patients with advanced liver disease,and compare outcomes to those of patients with bacterial *** From our prospective registry of MILU patients from 2018-2022,we included 27 patients with culture-positive fungal infections and 183 with bacterial *** compared outcomes between patients admitted to the MILU with fungal infections to bacterial *** was extracted through chart *** All fungal infections were due to Candida species,and were most frequently blood *** among patients with fungal infections was significantly worse relative to the bacterial cohort(93%vs 52%,Pthe majority of the fungal cohort developed grade 2 or 3 acute on chronic liver failure(ACLF)(90%vs 64%,P=0.02).Patients in the fungal cohort had increased use of vasopressors(96%vs 70%,P=0.04),mechanical ventilation(96%vs 65%,Pto acute kidney injury(78%vs 52%,P=0.014).On MILU admission,the fungal cohort had significantly higher Acute Physiology and Chronic Health Evaluation(108 vs 91,P=0.003),Acute Physiology Score(86 vs 65,P=0.003),and Model for End-Stage Liver Disease-Sodium scores(86 vs 65,P=0.041).there was no significant difference in the rate of central line use preceding culture(52%vs 40%,P=0.2).Patients with fungal infection had higher rate of transplant hold placement,and lower rates of transplant;however,differences did not achieve statistical *** Mortality was worse among patients with fungal infections,likely attributable to severe ACLF *** studies examinin

关键词： Fungal Infection Sepsis Acute on chronic liver failure Intensive care

the effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation:A randomized,physiological,crossover study

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Journal of Intensive Medicine 2024年第2期4卷 202-208页

作者： Elena Lytra Stelios Kokkoris Ioannis Poularas Dimitrios Filippiadis Demosthenes Cokkinos Dimitrios Exarhos Spyros Zakynthinos christina Routsi 1st Department of Intensive Care Medical SchoolNational and Kapodistrian University of AthensEvangelismos HospitalAthensGreece Radiology Department Evangelismos HospitalAthensGreece 2nd Radiology Department Medical SchoolNational and Kapodistrian University of AthensAttikon HospitalAthensGreece

Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOt)through the nasal cannulae has demonstrated clinical *** data exist on whether such effects are also present in HFOt through ***,we aimed to examine the short-term effects of HFOt through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical *** A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical *** patients underwent a 30-min spontaneous breathing trial(SBt)and received oxygen either via t-piece or by HFOt through tracheostomy,followed by a washout period of 15-min breathing through the t-piece and receipt of 30-min oxygen with the other modality in a randomized crossover *** the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(Vt)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle *** Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied *** were randomly assigned to start the SBt with a t-piece(n=10 sessions)or with HFOt(n=9 sessions).With HFOt,Vt and minute ventilation(VE)significantly increased during SBt(from[465±119]mL to[549±134]mL,Pto[13.1±4.2]L/min,Ptively),but they did not change significantly during SBt with t-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/Vt decreased during HFOt(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),Pt it did not change significantly during SBt with t-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(m

关键词： Diaphragm Diaphragm ultrasonography High-flow oxygen Prolonged mechanical ventilation tracheostomy

Aging impairs the osteocytic regulation of collagen integrity and bone quality

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Bone Research 2024年第1期12卷 78-94页

作者： Charles A.Schurman Serra Kaya Neha Dole Nadja M.Maldonado Luna Natalia Castillo Ryan Potter Jacob P.Rose Joanna Bons christina D.King Jordan B.Burton Birgit Schilling Simon Melov Simon tang Eric Schaible tamara Alliston Department of Orthopaedic Surgery University of CaliforniaSan FranciscoCA 94143USA UC Berkeley/UCSF Graduate Program in Bioengineering San FranciscoCA 94143USA Buck Institute for Research on Aging NovatoCA 94945USA Washington University in St Louis Department of OrthopedicsSt.LouisMO 63130USA Advanced Light Source Lawrence Berkeley National LaboratoryBerkeleyCA 94720USA

Poor bone quality is a major factor in skeletal fragility in elderly *** molecular mechanisms that establish and maintain bone quality,independent of bone mass,are unknown but are thought to be primarily determined by *** hypothesize that the age-related decline in bone quality results from the suppression of osteocyte perilacunar/canalicular remodeling(PLR),which maintains bone material *** examined bones from young and aged mice with osteocyte-intrinsic repression of tGFβsignaling(tβRII^(ocy−/−))that suppresses *** control aged bone displayed decreased tGFβsignaling and PLR,but aging did not worsen the existing PLR suppression in male tβRII^(ocy−/−)*** relationship impacted the behavior of collagen material at the nanoscale and tissue scale in macromechanical *** effects of age on bone mass,density,and mineral material behavior were independent of osteocytic tGFβ.We determined that the decline in bone quality with age arises from the loss of osteocyte function and the loss of tGFβ-dependent maintenance of collagen integrity.

关键词： maintain primarily integrity

Hepatic ischemia-reperfusion syndrome and its effect on the cardiovascular system: the role of treprostinil, a synthetic prostacyclin analog

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世界胃肠外科杂志:英文版(电子版) 2023年第9期15卷 1858-1870页

作者： christina Mouratidou Efstathios t Pavlidis Georgios Katsanos Serafeim-Chrysovalantis Kotoulas Eleni Mouloudi Georgios tsoulfas Ioannis N Galanis theodoros E Pavlidis Intensive Care Unit Hippokration General HospitalThessaloniki 54642Greece 2^(nd)Propedeutic Department of Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Department of transplantation Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece

Hepatic ischemia-reperfusion syndrome has been the subject of intensive study and experimentation in recent decades since it is responsible for the outcome of several clinical entities,such as major hepatic resections and liver *** addition to the organ’s post reperfusion injury,this syndrome appears to play a central role in the dysfunction of distant tissues and ***,continuous research should be directed toward finding effective therapeutic options to improve the outcome and reduce the postoperative morbidity and mortality *** is a synthetic analog of prostaglandin I2,and its experimental administration has shown encouraging *** has already been approved by the Food and Drug Administration in the United States for pulmonary arterial hypertension and has been used in liver transplantation,where preliminary encouraging results showed its safety and feasibility by using continuous intravenous administration at a dose of 5 ng/kg/*** improves renal and hepatic function,diminishes hepatic oxidative stress and lipid peroxidation,reduces hepatictoll-like receptor 9 and inflammation,inhibits hepatic apoptosis and restores hepatic adenosine triphosphate(AtP)levels and AtP synthases,which is necessary for functional maintenance of *** exhibits vasodilatory properties and antiplatelet activity and regulates proinflam-matory cytokines;therefore,it can potentially minimize ischemia-reperfusion ***,it may have beneficial effects on cardiovascular parameters,and much current research interest is concentrated on this compound.

关键词： Hepatic ischemia-reperfusion syndrome Myocardial damage Prostaglandins treprostinil Liver transplantation Hepatectomy

Spinal cord infarction attributed to SARS-CoV-2, with post-acute sequelae of COVID-19: A case report

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World Journal of Clinical Cases 2023年第36期11卷 8542-8550页

作者： christina V Oleson Andrew C Olsen Suzanna Shermon Department of Physical Medicine and Rehabilitation Case Western Reserve UniversityMetroHealth Rehabilitation InstituteClevelandOH 44109United States

BACKGROUND While stroke and lower extremity venous thromboemboli have been commonly reported following acute infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),spinal cord infarction or ischemia has been extremely *** of long coronavirus disease(COVID)in this select population have not been *** SUMMARY We present the case of a 70-year-old female with sudden onset of trunk and lower extremity sensorimotor loss due to spinal cord infarction,attributed to acute infection with *** work up confirmed a t3 complete(ASIA impairment Scale A)paraplegia resulting from a thrombotic *** reported myalgias,neuropathic pain,spasticity,bladder spasms,and urinary tract infections exceeded the frequency and severity of many spinal cord injury(SCI)individuals of similar age and degree of neurologic *** her first year after contracting COVID-19,she underwent 2 separate inpatient rehabilitation courses,but also required acute hospitalization 6 additional times for subsequent infections or uncontrolled *** other complications of complete non-traumatic SCI(NtSCI),including neurogenic bowel and temperature hypersens-itivity,were mild,and pressure injuries were *** has now transitioned from the acute to chronic phase of spinal cord injury care,with subsequent development of post-acute sequelae of SARS-CoV-2 infection(PASC).CONCLUSION this individual experienced significant challenges with the combined effects of acute t3 NtSCI and acute COVID-19,with subsequent progression to *** tip:Although stroke and venous thromboembolism have been frequently observed with acute coronavirus disease 2019(COVID-19),spinal cord infarction leading to paraplegia has rarely been *** report a case of spinal cord infarction shortly following infection with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Consequently,this individual has experienced severe neurologic disability,with subsequent developme

关键词： Spinal cord infarction Paraplegia COVID-19 SARS-CoV-2 Post-acute

Epigastric hernias in children and the use of ultrasound in its diagnosis

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World Journal of Pediatric Surgery 2023年第2期6卷 92-96页

作者： tatjana t König Laura S Oerters Ljuba Spiller Martin Schwind Mark Born christina Oetzmann von Sochaczewski Andreas C Heydweiller Klinik und Poliklinik für Kinderchirurgie Universitätsmedizin der Johannes Gutenberg-Universität MainzMainzGermany Sektion Kinderchirurgie der Klinik und Poliklinik für Allgemein- Viszeral-Thorax-und GefächirurgieUniversität sklinikum BonnBonnGermany Sektion Kinderradiologie der Klinik für Diagnostische und Interventionelle Radiologie Universitätsklinikum BonnBonnGermany

Introduction there is a paucity of clinical data on pediatric epigastric hernias despite them accounting for up to 6%of all hernia repairs in *** aimed to provide additional data to supplement those 117 cases of a recent systematic review and to further clarify the role of ultrasound in diagnosing pediatric epigastric *** We retrospectively included all 60 patients treated for epigastric hernias in children in two tertiary pediatric surgical departments within 12 *** were tested via point-biserial correlation *** Epigastric hernias primarily affected preschool children with a median age of 39 *** vast majority of patients(88%)presented with swelling that was occasionally(30%)accompanied by *** defects could be found during clinical examination in 45%of patients with a median size of 5 mm(95%CI 3 to 10).Smaller defects were less likely to be palpable(r=-0.44,95%CI-0.08 to-0.7,p=0.021).Likewise,ultrasound was used more frequently with smaller fascial defect sizes(r=-0.51,95%Cl-0.16 to-0.74,p=0.007).Laparoscopic repair was used in 11 patients(19%)and more often(4/11)in combination with another simultaneous procedure than open repair(11/48).Conclusions Epigastric hernias are primarily a condition of the preschool *** can be beneficial if the diagnosis cannot be made clinically;otherwise,it is abdicable if it does not change the management of the patient's epigastric *** repairs might be beneficial for children with multiple defects or simultaneous procedures.

关键词： diagnosis primarily otherwise

Characteristics and distinct prognostic determinants of individuals with hepatosplenic t-cell lymphoma over the past two decades

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World Journal of Clinical Oncology 2024年第6期15卷 745-754页

作者： Ayrton Bangolo Pierre Fwelo Shraboni Dey tanni Sethi Sowmya Sagireddy Jawaria Chatta Ashish Goel Sneha Nagpaul Eric Pin-Shiuan Chen Chiranjeeve Saravanan Sheeja Gangan Joel thomas Sarah Potiguara Vignesh K Nagesh Daniel Elias Charlene Mansour Prajakta H Ratnaparkhi Priyanshu Jain Midhun Mathew taylor Porter Shadiya Sultan Shailaja Abbisetty Linh tran Megha Chawla Abraham Lo Simcha Weissman christina Cho Department of Internal Medicine Palisades Medical CenterNorth BergenNJ 07047United States Department of Epidemiology Human Geneticsand Environmental SciencesUTHealth School of Public HealthHoustonTX 77030United States Department of Medicine Palisades Medical CenterNorth BergenNJ 07047United States Stem Cell transplantation and Cellular therapy John Theurer Cancer CenterHackensackNJ 07601United States

BACKGROUND Hepatosplenic t-cell lymphoma(HStCL)is a rare and aggressive peripheral t-cell lymphoma with historically dismal outcomes,representing less than one percent of non-Hodgkin *** its rarity,the true incidence of HStCL is unknown and most data have been extrapolated through case *** the best of our knowledge,the largest and most up to date study addressing the epidemiology and outcomes of patients with HStCL in the United States covered a period from 1996 to 2014,with a sample size of 122 *** to paint the most updated epidemiological picture of *** A total of 186 patients diagnosed with HStCL,between 2000 and 2017,were ultimately enrolled in our study by retrieving data from the Surveillance,Epidemiology,and End Results *** analyzed demographics,clinical characteristics,and overall mortality(OM)as well as cancer-specific mortality(CSM)of *** with a P valuethe univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors,with a hazard ratio of greater than 1 representing adverse prog-nostic *** Overall,the outlook for this rare malignancy is very *** this retrospective cohort study of the United States population,non-Hispanic blacks and the elderly had a higher *** data highlights the need for larger prospective studies to investigate factors associated with worse prognosis in one ethnic group,such as treatment delays,which have been shown to increase mortality in this racial/ethnic group for other cancers.

关键词： Extra nodal lymphoma Mortality Survival Racial disparity Age

Singing therapy Improving Peak Flow, Speech and Eating Abilities in Adults with Cerebral Palsy

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Open Journal of therapy and Rehabilitation 2022年第4期10卷 158-178页

作者： Jessica Pingel christina t. Andersen Peter Raffalt Camilla Kowalczyk Department of Neuroscience University of Copenhagen Copenhagen Denmark the Elsass Foundation Charlottenlund Denmark Department of Biology University of Southern Denmark Odense Denmark

Introduction: Individuals with cerebral palsy (CP) often suffer from speech impairments and dysphagia due to impaired motor control of the tongue and lips. Aim: to investigate the effect of singing on peak flow, speech- and swallowing abilities in individuals with CP. Method: ten adults with CP received one-to-one singing lessons by a professional singing teacher for one hour twice a week for 6 months. Methods: the peak flow, swallowing-, speech-, and eating abilities were investigated pre, and after 3 months and 6 months of singing. Results: the meal analysis revealed that an average of eleven factors was improved after 6 months of singing. Nine out of ten participants improved their pronunciation of the letter “N” and seven participants improved their pronunciation of the letter “G”. the singing lessons increased the peak flow significantly (p = 0.02;Pre = 246 ± 36, 3 months = 287 ± 34, and 6 months = 336 ± 48). Self-reported difficulties on a 1 - 10 scale reduced significantly for both swallowing (p = 0.039) and speaking (p = 0.049). Conclusion: 6 months of singing lessons improve the peak flow, speech-, swallowing- and eating abilities in adults with CP. the present study indicates that singing is a very promising intervention for the treatment of speech and eating impairments in individuals with CP.

关键词： Singing Cerebral Palsy Pronunciation Eating Swallowing Mealtime

Integrating insulin-like growth factor 1 and sex hormones into neuroprotection:Implications for diabetes

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World Journal of Diabetes 2017年第2期8卷 45-55页

作者： Jacob Huffman christina Hoffmann George t taylor Behavioral Neuroscience Program Department of Psychological SciencesUniversity of MissouriSt. Interfakultare Biomedizinische Forschung-seinrichtung der Universitat Heidelberg

Brain integrity and cognitive aptitude are often impaired in patients with diabetes mellitus, presumably a result of the metabolic complications inherent to the disease. However, an increasing body of evidence has demonstrated the central role of insulin-like growth factor 1(IGF1) and its relation to sex hormones in many neuroprotective processes. Both male and female patients with diabetes display abnormal IGF1 and sexhormone levels but the comparison of these fluctuations is seldom a topic of interest. It is interesting to note that both IGF1 and sex hormones have the ability to regulate phosphoinositide 3-kinase-Akt and mitogen-activated protein kinases-extracellular signal-related kinasesignaling cascades in animal and cell culture models of neuroprotection. Additionally, there is considerable evidence demonstrating the neuroprotective coupling of IGF1 and estrogen. Androgens have also been implicated in many neuroprotective processes that operate on similar signaling cascades as the estrogen-IGF1 relation. Yet, androgens have not been directly linked to the brain IGF1 system and neuroprotection. Despite the sex-specific variations in brain integrity and hormone levels observed in diabetic patients, the IGF1-sex hormone relation in neuroprotection has yet to be fully substantiated in experimental models of diabetes. taken together, there is a clear need for the comprehensive analysis of sex differences on brain integrity of diabetic patients and the relationship between IGF1 and sex hormones that may influence brain-health outcomes. As such, this review will briefly outline the basic relation of diabetes and IGF1 and its role in neuroprotection. We will also consider the findings on sex hormones and diabetes as a basis for separately analyzing males and females to identify possible hormone-induced brain abnormalities. Finally, we will introduce the neuroprotective interplay of IGF1 and estrogen and how androgen-derived neuroprotection operates through similar si

关键词： Diabetes Androgens Estrogen Insulin Insulin-like growth factor 1 Neuroprotection Brain integrity Cognition