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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%,P<0.001).The 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%,P<0.001),and dialysis due to 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

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Blood metal concentrations and cardiac structure and function in total joint arthroplasty patients

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World Journal of Orthopedics 2024年第8期15卷 773-782页

作者： Peter C Brennan Stephanie M Peterson Thomas J O'Byrne Mariana L Laporta Cody C Wyles Paul J Jannetto Garvan C Kane Maria Vassilaki Hilal Maradit Kremers Department of Orthopedic Surgery Mayo ClinicRochesterMN 55905United States Department of Quantitative Health Sciences Mayo ClinicRochesterMN 55905United States Department of Anesthesiology and Perioperative Medicine Mayo ClinicRochesterMN 55905United States Department of Laboratory Medicine and Pathology Mayo ClinicRochesterMN 55905United States Department of Cardiovascular Diseases Mayo ClinicRochesterMN 55905United States

BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)*** To determine the association of commonly used implant metals with echocardiographic measures in TJA *** The study comprised 110 TJA patients who had a recent history of high chromium,cobalt or titanium *** underwent two-dimensional,three-dimensional,Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal *** and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations(exposure)with echocardiographic measures(outcome).RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume(estimate 5.09;95%CI:0.02-10.17)as well as left atrial and right ventricular dilation,particularly in men but no changes in cardiac *** titanium concentrations were associated with a reduction in left ventricle global longitudinal strain(estimate 0.38;95%CI:0.70 to 0.06)and cardiac index(estimate 0.08;95%CI,-0.15 to-0.01).CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some *** studies are warranted to better understand the systemic effects of metals in TJA patients.

关键词： Total joint arthroplasty Metal-on-metal Cardiotoxicity Heart failure Echocardiography Cobalt

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Advances in clinical applications of bioceramics in the new regenerative medicine era

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World Journal of clinical Cases 2024年第11期12卷 1863-1869页

作者： Noha Elshazly Fayza Eid Nasr Ayat Hamdy Safa Saied Mohamed Elshazly Tissue Engineering Laboratory Faculty of DentistryAlexandria UniversityAlexandria 21526Egypt Department of Biochemistry Faculty of ScienceAlexandria UniversityAlexandria 21526Egypt Public Dental clinic Central Administration of DentistryMinistry of Health and PopulationAlexandria 21554Egypt Department of Surgery Faculty of Veterinary MedicineAlexandria 21526Egypt

In this editorial,we comment on the hard and soft tissue applications of different ceramic-based scaffolds prepared by different mechanisms such as 3D printing,sol-gel,and *** new concept of regenerative medicine relies on biomaterials that can trigger in situ tissue regeneration and stem cell recruitment at the defect site.A large percentage of these biomaterials is ceramic-based as they provide the essential requirements of biomaterial principles such as tailored multisize porosity,antibacterial properties,and angiogenic *** these previously mentioned properties put bioceramics on top of the hierarchy of biomaterials utilized to stimulate tissue regeneration in soft and hard tissue *** clinical applications registered the use of these materials in triggering soft tissue regeneration in healthy and diabetic patients such as bioactive glass *** results were promising and opened new frontiers for utilizing these materials on a larger *** same results were mentioned when using different forms and formulas of bioceramics in hard defect *** bioceramics were used in combination with other polymers and biological scaffolds to improve their regenerative and mechanical *** this progress will enable a larger scale of patients to receive such services with ease and decrease the financial burden on the government.

关键词： Regenerative medicine Bioceramics Chronic wounds Bone defects clinical applications

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Recent advances in treatment of follicular lymphoma: efficacy of PI3Kα/δ inhibitor (TQ-B3525)

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Signal Transduction and Targeted Therapy 2024年第6期9卷 2341-2343页

作者： Takuya Watanabe Department of Internal Medicine and Gastroenterology Watanabe Internal Medicine Aoyama ClinicNiigata-city 9502002Japan

The commented study reports the results of monotherapy using TQ-B3525,a novel phosphatidylinositol-3 kinase(PI3K)inhibitor developed in China,in patients with refractory/relapsed follicular lymphoma(r/r FL).

关键词： PI3K lymphoma treatment

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Adenovirus F40/41 Gastroenteritis-Associated Emphysematous Gastritis:A Case Report

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Infectious Diseases & Immunity 2024年第2期4卷 93-95页

作者： Maulik K.Lathiya Abigail T.La Nou Maria E.Linnaus Susan M.Cullinan Emergency Department Mayo Clinic Health SystemEau Claire 54703WIUSA Critical Care Medicine Mayo Clinic Health SystemEau Claire 54703WIUSA General Surgery Department Mayo Clinic Health SystemEau Claire 54703WIUSA

Emphysematous gastritis(EG)is a rare form of gastritis characterized by gastric wall *** is associated with a high mortality *** case report describes a patient with a history of atrial fibrillation treated with apixaban,prior stroke,and schizoaffective disorder who showed epigastric tenderness on ***,no peritonitis signs were recorded,and laboratory values revealed high lactate levels and the presence of adenovirus F40/*** computed tomography scan showed extensive portal venous gas in the left hepatic lobe of the liver,as well as pneumatosis involving the entire stomach,indicating *** diagnosis was histologically confirmed and initially managed medically,which proved inefficacious,necessitating surgical intervention in the form of a laparotomy and esophagojejunostomy with Roux-en-Y *** case report suggests a potential association between EG and adenovirus F40/41–induced gastroenteritis,thereby emphasizing the challenging nature of *** underscores the need for comprehensive research to enhance our understanding of its underlying causes and effective treatment strategies.

关键词： Emphysema Gastritis Human adenovirus F40/41 Immunocompromised

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Toward less invasive coloproctology: The future is out there

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World Journal of Gastroenterology 2024年第3期30卷 199-203页

作者： Sameh Hany Emile Jonathan Ragheb Department of Colorectal Surgery Cleveland Clinic FloridaWestonFL 33331United States Department of Gastroenterology and Hepatology Cleveland Clinic FloridaWestonFL 33331United States

Medical care has undergone remarkable improvements over the past few *** of the most important innovative breakthroughs in modern medicine is the advent of minimally and less invasive *** trend towards employing less invasive treatment has been vividly shown in the field of gastroenterology,particularly *** to foregut interventions,colorectal surgery has shifted towards a minimally invasive ***,including both medical and surgical management of colorectal diseases,has undergone a remarkable paradigm *** treatment of both benign and malignant colorectal conditions has gradually transitioned towards more conservative and less inva-sive *** interesting paradigm shift was the trend to avoid the need for radical resection of rectal cancer altogether in patients who showed complete response to neoadjuvant *** trend of adopting less invasive appro-aches to treat various colorectal conditions does not seem to be stopping soon as further research on novel,more effective and safer methods is ongoing.

关键词： Toward Less invasive Minimally invasive Coloproctology Future Colorectal surgery

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Effects of Tai Chi in diabetes patients: Insights from recent research

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World Journal of Diabetes 2024年第1期15卷 1-10页

作者： Hidetaka Hamasaki Department of Endocrinology and Metabolism Internal MedicineHamasaki ClinicKagoshima 890-0046Japan

Tai Chi,a practice that combines elements of both exercise and mindfulness,offers a wide range of health *** body of evidence concerning the impact of Tai Chi on diabetes has recently been *** editorial aims to provide a concise summary of the current state of evidence for Tai Chi's effects on individuals with type 2 diabetes(T2D).The review includes 3 randomized controlled trials(RCTs)and 5 systematic reviews and meta-analyses,all of which investigate the effectiveness of Tai Chi on various health outcomes in individuals with *** Chi demonstrates a significant effect to enhance glycemic control,lower blood pressure,improve serum lipid profiles,reduce insulin resistance,positively influence obesity-related indices,and improve overall quality of life in individuals with ***,it is noteworthy that recent RCTs have reported inconsistent findings regarding the effects of Tai Chi on glycemic control and insulin *** author also delves into potential mechanisms by which Tai Chi may exert its influence on the human ***,the editorial highlights the critical issues that warrant further exploration in the future.

关键词： Type 2 diabetes Tai Chi Exercise Mind-body exercise Chinese traditional exercise Randomized controlled trial Systematic review and meta-analysis

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Generation of brain vascular heterogeneity:recent advances from the perspective of angiogenesis

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Neural Regeneration Research 2025年第7期20卷 2013-2014页

作者： Nathanael J.Lee Ryota L.Matsuoka Department of Neurosciences Lerner Research InstituteCleveland ClinicClevelandOHUSA Department of Molecular Medicine Cleveland Clinic Lerner College of MedicineCase Western Reserve UniversityClevelandOHUSA

Heterogeneous proper t i es of vascular endothelial cells in the brain:The brain displays large energy dynamics and consumption,and this high level of metabolic demands is fulfilled by a continuous supply of glucose and oxygen through its vascular *** vasculature consists of highly divergent blood vessel branches,giving rise to a dense network of capillaries that supply blood to all cells across the *** elaborated vascular network is thought to develop via angiogenesis,a process in which new blood vessels grow from pre-existing *** capillaries exhibit organotypic features distinct from other tissues and are formed primarily by two major endothelial cell(EC)types:those that form the semi-permeable blood-brain barrier(BBB)and those that develop highly permeable pores known as fenestrae(Matsuoka et al.,2022).The structural and functional differences between BBB and fenestrated vascular ECs represent a fundamental feature of brain vasculature and form the foundation for both brain function and homeostasis.

关键词： angiogenesis homeostasis network

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Esophageal inserted subclavian catheter:a rare complication

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World Journal of Emergency Medicine 2024年第3期15卷 243-245页

作者： DilberÜçöz Kocaşaban SertaçGüler Emergency Medicine clinic Health Sciences University Ankara Training and Research HospitalAnkara 06930Turkey

Central venous catheterization(CVC) is an invasive procedure for administering fluids,nutrients,and drugs;monitoring central venous pressure;performing pulmonary artery catheterization;and placing transvenous pacemakers in intensive care units and all specialties,from anesthesia to emergency medicine,for the treatment of trauma and hemodynamically unstable pediatric and adult patients.[1,2]Complications have been observed in more than 15% of patients who underwent ***,infectious,and thrombotic complications have been reported in 5%–19%,5%–26%,and 2%–26% of patients,respectively.[3] Malposition,on the other hand,is common in subclavian catheter insertion and is usually associated with an initially misplaced guidewire.[4]

关键词： unstable insertion initially

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Topic highlight on texture and color enhancement imaging in gastrointestinal diseases

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World Journal of Gastroenterology 2024年第14期30卷 1934-1940页

作者： Osamu Toyoshima Toshihiro Nishizawa Keisuke Hata Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Gastroenterology Nihonbashi Muromachi Mitsui Tower Midtown ClinicTokyo 103-0022Japan

Olympus Corporation developed texture and color enhancement imaging(TXI)as a novel image-enhancing endoscopic *** topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting.A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate(ADR)and the mean number of adenomas per procedure(MAP)of TXI compared with those of white-light imaging(WLI)observation(58.7%vs 42.7%,adjusted relative risk 1.35,95%CI:1.17-1.56;1.36 vs 0.89,adjusted incident risk ratio 1.48,95%CI:1.22-1.80,respectively).A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI(1.5 vs 1.0,adjusted odds ratio 1.4,95%CI:1.2-1.6;58.2%vs 46.8%,1.5,1.0-2.3,respectively).A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure(0.29 vs 0.30,difference for non-inferiority-0.01,95%CI:-0.10 to 0.08).A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis.A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI(0.71%vs 0.29%).A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI(69.2%vs 52.5%and 85.3%vs 78.7%,res-pectively).In conclusion,TXI can improve gastrointestinal lesion detection and qualitative ***,further studies on the efficacy of TXI in clinical practice are required.

关键词： Endoscopy Texture and color enhancement imaging White-light imaging Narrow-band imaging Colorectal neoplasm Gastric cancer Adenoma Ulcerative colitis Helicobacter infections Colonoscopy

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