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Importance of timely and adequate source control in sepsis and septic shock

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Journal of Intensive medicine 2024年第3期4卷 281-286页

作者： Jan J.De Waele department of Intensive Care medicine Ghent University HospitalGhentBelgium department of internal medicine and Pediatrics Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium

Source control is defined as the physical measures undertaken to eliminate the source of infection and control ongoing contamination, as well as restore anatomy and function at the site of infection. It is a key component of the management of patients with sepsis and septic shock and one of the main determinants of the outcome of infections that require source control. While not all infections may require source control, it should be considered in every patient presenting with sepsis;it is applicable and necessary in numerous infections, not only those occurring in the abdominal cavity. Although the biological rationale is clear, several aspects of source control remain under debate. The timing of source control may impact outcome;early source control is particularly relevant for patients with abdominal infections or necrotizing skin and soft tissue infections, as well as for those with more severe disease. Percutaneous procedures are increasingly used for source control;nevertheless, surgery—tailored to the patient and infection—remains a valid option for source control. For outcome optimization, adequate source control is more important than the strategy used. It should be acknowledged that source control interventions may often fail, posing a challenge in this setting. Thus, an individualized, multidisciplinary approach tailored to the infection and patient is preferable.

关键词： Sepsis Septic shock Source control Drainage Debridement

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

Ten- year follow- up investigation of stroke risk in systemic lupus erythematosus

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Stroke & Vascular Neurology 2024年第1期9卷 1-7页

作者： Jin-An Huang Ching-Heng Lin Ming-Ju Wu Yi-Hsing Chen Kuo-Cheng Chang Chung-Wei Hou Division of Neurology Neurological InstituteTaichung Veterans General HospitalTaichungTaiwan department of Health Business Administration Hungkuang UniversityTaichungTaiwan department of Medical research Taichung Veterans General HospitalTaichungTaiwan Division of Nephrology Department of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan School of medicine Chung Shan Medical UniversityTaichungTaiwan College of medicine National Chung Hsing UniversityTaichungTaiwan Division of Allergy Immunology and RheumatologyDepartment of Internal MedicineTaichung Veterans General HospitalTaichungTaiwan School of medicine National Yang-Ming Chiao Tung UniversityTaichungTaiwan

Background and purpose To analyse the long-term risk of ischaemic stroke and the clinical effects of antithrombotics on the risk of haemorrhagic stroke in patients with systemic lupus erythematosus(SLE).Methods A retrospective cohort study was conducted using a population-based database taken from Taiwan National Health Insurance research *** with SLE between 2000 and 2008 were registered and matched with two controls by the index date,age,gender and Charlson Comorbidity Index(CCI).These subjects were followed until either stroke event or 31 December *** HRs(aHRs)for strokes were estimated with Cox regression models,and the cumulative incidence of ischaemic stroke was analysed by log-rank test and Kaplan-Meier survival *** In total,8310 patients with SLE and 16620 patients without SLE were *** general,patients with SLE had higher rates of ischaemic stroke(5.4%vs 3.3%)and haemorrhagic stroke(1.5%vs 0.6%)than in *** multivariate analysis adjusted to age,gender,CCI,urbanisation level and antithrombotics uses,aHRs of all strokes,ischaemic stroke and haemorrhagic stroke were 1.73(95%CI:1.54 to 1.94),1.65(95%CI:1.45 to 1.87)and 2.24(95%CI:1.71 to 2.95),respectively,in patients with *** with SLE were significantly more likely to suffer ischaemic stroke than patients without SLE,even 10 years after SLE diagnosis(6.12%vs 3.50%,p<0.001).Antiplatelet use increased the risk of haemorrhagic stroke in SLE group(aHR=1.74,95%CI:1.18 to 2.57).Conclusions Patients with SLE are at greater risk of developing ischaemic stroke that lasts for 10 *** should be carefully administered to prevent cardiovascular events in patients with SLE due to the risk of haemorrhagic stroke.

关键词： erythematosus diagnosis likely

Obstructive sleep apnea:Overlooked comorbidity in patients with diabetes

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World Journal of Diabetes 2024年第7期15卷 1448-1460页

作者： Eric D Tenda Joshua Henrina Jin H Cha Muhammad R Triono Ersananda A Putri Dahliana J Aristy Dicky L Tahapary Division of Respirology and Critical Care Department of Internal MedicineFaculty of Medicine Universitas Indonesia-Cipto Mangunkusumo HospitalDKI JakartaJakarta Pusat 10430Indonesia Head of research Group Artificial Intelligence and Digital Health Indonesian Medical Education and Research InstituteFaculty of Medicine University of IndonesiaDKI JakartaJakarta Pusat 10430Indonesia Division of Endocrinology Metabolism and DiabetesDepartment of Internal MedicineFaculty of Medicine Universitas Indonesia-Cipto Mangunkusumo HospitalDKI JakartaJakarta Pusat 10430Indonesia

In this review article,we explore the interplay between obstructive sleep apnea(OSA)and type 2 diabetes mellitus(T2DM),highlighting a significant yet often overlooked *** delve into the pathophysiological links between OSA and diabetes,specifically how OSA exacerbates insulin resistance and disrupts glucose *** research examines the prevalence of OSA in diabetic patients and its role in worsening diabetes-related *** the importance of comprehensive management,including weight control and positive airway pressure therapy,the study advocates integrated approaches to improve outcomes for patients with T2DM and *** review underscores the necessity of recognizing and addressing OSA in diabetes care to ensure more effective treatment and better patient outcomes.

关键词： Obstructive sleep apnea Type 2 diabetes mellitus Macrovascular Microvascular Weight loss Positive airway pressure

Organic Integration of Traditional Chinese and Western medicines—Future of Clinical Practice Guidelines of Integrated Traditional Chinese and Western medicines

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Chinese Journal of Integrative medicine 2024年第4期30卷 359-365页

作者： XIE Ying-lan HAN Fei JIN Ying-hui DING Yan-bing GUO Jing JI Dong-xiao ZHANG Teng CHENXiao-min SHANG Hong-cai department of Traditional Chinese medicine Encephalopathy Hubei Provincial Hospital of Traditional Chinese MedicineWuhan(430074)China department of Traditional Chinese medicine Encephalopathy Hubei Province Traditional Chinese Medicine Research InstituteWuhan(430074)China Xuanwu Hospital of Traditional Chinese medicine Beijing(100000)China Center for Evidence-Based and Translational medicine Zhongnan Hospital of Wuhan UniversityWuhan(430074)China College of Acupuncture and Massage College of Health and RehabilitationNanjing University of Chinese MedicineNanjing(210023)China department of Ophthalmology Huaihe Hospital of Henan UniversityKaifengHenan Province(475000)China Ministry of Education and Beijing Key Laboratory of internal medicine of Traditional Chinese medicine Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine/Ministry of Education and Beijing Key Laboratory of Internal Medicine of Traditional Chinese MedicineBeijing(100700)China

The transformation and implementation of clinical practice guidelines for integrated traditional Chinese medicine(TCM)and Western medicine(WM)is crucial to the adoption of medical science and technological findings and is an important way for TCM to be made available to the ***,clinical practice guidelines(CPGs)of TCM and WM integration in recent years was analyzed to clarify the current situation and problems in the existing guidelines according to the following four perspectives:(1)perspective of TCM and WM integration in guidelines,(2)diagnosis Using integrated TCM and WM,(3)integration of TCM and WM treatment,(4)promoting TCM and WM ***,the information and quality evaluation of CPGs for integrated Chinese and Western medicine in 2020–2022 were analyzed to explore the degree and methods of integration of Chinese and Western medicine *** last this study aimed to lay a foundation for the further establishment of Chinese characteristic,repeatable,and calculable clinical practice guidelines of TCM and WM integration.

关键词： clinical practice guidelines integrated traditional Chinese and Western medicine organic integration

Regulatory effects of the p38 mitogen-activated protein kinase-myosin light chain kinase pathway on the Intestinal Epithelial Mechanical Barrier and the mechanism of modified Pulsatilla decoction(加味白头翁汤) in the treatment of ulcerative colitis

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Journal of Traditional Chinese medicine 2024年

作者： WU Tingting YANG Xin ZHU Huiping GUO Jinwei ZHU Hui ZHANG Peipei WANG Meng LIANG Guoqiang SUN Hongwen department of internal medicine Suzhou TCM Hospital Affiliated to Nanjing University of Chinese medicine department of internal medicine The Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University Suzhou Academy of Wumen Chinese medicine Suzhou TCM Hospital Affiliated to Nanjing University of Chinese medicine

OBJECTIVE: To investigate the mechanism of the protective effect of modified Pulsatilla decoction (加味白头翁汤， MPD) on the mechanical barrier of the ulcerative colitis (UC) intestinal epithelium in vitro and in ***: We established an intestinal epithelial crypt cell line-6 cell barrier injury model by using lipopolysaccharide (LPS). The model was then treated with p38 mitogen-activated protein kinase-myosin light chain kinase (p38MAPK-MLCK) pathway inhibitors， p38MAPK-MLCK pathway silencing genes (si-p38MAPK， si-NF-κB， and si-MLCK)， and MPD respectively. Transepithelial electronic resistance (TEER) measurements and permeability assays were performed to assess barrier function. Immunofluorescence staining of tight junctions (TJ) was performed. In in vivo experiment， dextran sodium sulfate-induced colitis rat model was conducted to evaluate the effect of MPD and mesalazine on UC. The rats were scored using the disease activity index based on their clinical symptoms. Transmission electron microscopy and hematoxylin-eosin staining were used to examine morphological changes in UC rats. Western blotting and real-time quantitative polymerase chain reaction were performed to examine the gene and protein expression of significant differential molecules. RESULTS: In in vitro study， LPS-induced intestinal barrier dysfunction was inhibited by p38MAPK-MLCK pathway inhibitors and p38MAPK-MLCK pathway gene silencing. Silencing of p38MAPK-MLCK pathway genes decreased TJ expression. MPD treatment partly restored the LPS-induced decreased in TEER and increase in permeability. MPD increased the gene and protein expression of TJ， while down-regulated the LPS-induced high expression of p-p38MAPK and p-MLC. In UC model rats， MPD could ameliorate body weight loss and disease activity index， relieve colonic pathology， up-regulate TJ expression as well as decrease the expression of p-p38MAPK and p-MLC in UC rat colonic mucosal tissue. CONCLUSIONS: The p38MAPK-MLCK signaling pathway can

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Anoctamin 4 defines glucose-inhibited neurons in the ventromedial hypothalamus

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Neural Regeneration research 2024年第6期19卷 1177-1178页

作者： Longlong Tu Yanlin He Yong Xu Children's Nutrition research Center Department of Pediatrics Baylor College of Medicine department of Molecular and Cellular Biology Section of Endocrinology Diabetes and Metabolism Department of Medicine Baylor College of Medicine Brain Glycemic and Metabolism Control department Pennington Biomedical Research Center Louisiana State University

Glucose is the primary fuel source of the brain,and therefore glucose levels need to be tightly regulated and maintained within a small physiological ***,the body necessitates a stable supply of energy mainly provided by glucose for various bodily *** or low blood glucose levels would impair the physiological functions of various organs of the *** high blood glucose(i.e.,

关键词： HYPOGLYCEMIA

Understanding the molecular crossroads in acute liver failure:A pathway to new therapies

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World Journal of Gastroenterology 2024年第23期30卷 2931-2933页

作者： Chun-Yao Cheng Wen-Rui Hao Tzu-Hurng Cheng department of Medical Education National Taiwan University HospitalTaipei 100225Taiwan Division of Cardiology Department of Internal MedicineShuang Ho HospitalMinistry of Health and WelfareTaipei Medical UniversityNew Taipei 23561Taiwan Division of Cardiology Department of Internal MedicineSchool of MedicineCollege of MedicineTaipei Medical UniversityTaipei 11002Taiwan department of Biochemistry School of MedicineCollege of MedicineChina Medical UniversityTaichung 404333Taiwan

In this editorial we comment on the article published in a recent issue of the World Journal of *** liver failure(ALF)is a critical condition characterized by rapid hepatocellular injury and organ dysfunction,and it often necessitates liver transplant to ensure patient *** research has eluci-dated the involvement of distinct cell death pathways,namely ferroptosis and pyroptosis,in the pathogenesis of *** is driven by iron-dependent lipid peroxidation,whereas pyroptosis is an inflammatory form of cell death;both pathways contribute to hepatocyte death and exacerbate tissue *** comprehensive review explores the interplay between ferroptosis and pyroptosis in ALF,highlighting the role of key regulators such as silent information regulator sirtuin *** from clinical and preclinical studies provide valuable perspectives on the dysregulation of cell death pathways in ALF and the therapeutic potential of targeting these *** across multiple disciplines is essential for translating the experimental insights into effective treatments for this life-threatening condition.

关键词： Silent information regulator sirtuin 1 Ferroptosis Pyroptosis P53/glutathione peroxidase 4/gasdermin D Acute liver failure

Atrial fibrillation and prediabetes:A liaison that merits attention!

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World Journal of Diabetes 2024年第7期15卷 1645-1647页

作者： Akash Batta Juniali Hatwal department of Cardiology Dayanand Medical College and HospitalLudhiana 141001PunjabIndia department of internal medicine Post Graduate Institute of Medical Education&ResearchChandigarh 160012India

Atrial fibrillation(AF)and prediabetes share common pathophysiological mechanisms with endothelial dysfunction and inflammation playing a key *** resultant vicious cycle which sets in culminates in a higher atherogenicity and thermogenicity of the vascular system resulting in increased major adverse cardiac or cerebrovascular event(MACCE)***,the same has not convincingly been verified in real-world *** the recent retrospective study by Desai et al amongst AF patients being admitted to hospitals following MACCE,prediabetes emerged as an independent risk factor for MACCE after adjusting for all confounding ***,certain questions like the role of metformin,quantifying the risk for MACCE amongst prediabetes compared to diabetes,the positive impact of reversion to normoglycemia remain *** provide our insights and give future directions for dedicated research in this area to clarify the exact relationship between the two.

关键词： Atrial fibrillation Major adverse cardiac or cerebrovascular event Prediabetes Diabetes Stroke Heart failure Dysglycemia Metformin