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Applications of mPCR testing reduced initial antibiotic use and duration of mechanical ventilation in virus-infected children with severe community-acquired pneumonia admitted to the PICU

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World Journal of Pediatrics 2022年第6期18卷 449-452页

作者： Chao-Nan Fan Bo-Liang Fang Heng-Miao Gao Ru-Bo Li Guo-Yun Su Yi-Yang Mao Yu-Shan He Yue Wang Xiao-He Zhou Liang-Ming Cai Ye-Qing wang Jennifer A.Blumenthal Su-Yun Qian Pediatric Intensive care Unit Beijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthNo.56 Nan-Li-Shi RoadBeijing100045China division of critical care medicine/bader 6 Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s Hospital and Harvard Medical School300 Longwood AvenueBostonMA02115USA

Community-acquired pneumonia(CAP)remains the leading cause of morbidity and mortality among children *** is critical for these patients to select and timely initiate appropriate empirical antimicrobial therapy against the causative pathogens[1].However,conventional pathogen-detecting methods,such as culture and serology,have no prospect of altering empiric therapy owing to their time delay in obtaining results and to their lower detection rates[2].Recent advances in molecular diagnostic assays,such as multiplex polymerase chain reaction PCR(mPCR)methods,have been used to detect multiple pathogens in CAP simultaneously within two hours and have dramatically improved the ability to diagnose respiratory pathogens[3].However,whether this molecular diagnosis method can reduce the use of antibiotics and can improve prognosis in severe CAP children,especially those less than 5 years old,remains to be explored.

关键词： admitted pneumonia diagnosis

Late immune consequences of combat trauma: A review of trauma-related immune dysfunction and potential therapies

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Military Medical Research 2019年第4期6卷 340-353页

作者： Kelly B.Thompson Luke T.Krispinsky Ryan J.Stark division of critical care medicine Department of PediatricsVanderbilt University School of Medicine2200 Children’s WayNashvilleTN 37232USA division of Pediatric critical care medicine Department of PediatricsUniformed Services UniversityNaval Medical Center PortsmouthPortsmouthVA 23708USA

With improvements in personnel and vehicular body armor,robust casualty evacuation capabilities,and damage control resuscitation strategies,more combat casualties are surviving to reach higher levels of care throughout the casualty evacuation *** such,medical centers are becoming more accustomed to managing the deleterious late consequences of combat trauma related to the dysregulation of the immune *** this review,we aim to highlight these late consequences and identify areas for future research and therapeutic *** leads to the dysregulation of both the innate and adaptive immune responses,which places the injured at risk for several late consequences,including delayed wound healing,late onset sepsis and infection,multi-organ dysfunction syndrome,and acute respiratory distress syndrome,which are significant for their association with the increased morbidity and mortality of wounded *** mechanisms by which these consequences develop are complex but include an imbalance of the immune system leading to robust inflammatory responses,triggered by the presence of damage associated molecules and other immune-modifying agents following *** strategies to improve outcomes have been difficult to develop as the immunophenotype of injured personnel following trauma is variable,fluid and difficult to *** more information regarding the triggers that lead to immune dysfunction following trauma is elucidated,it may be possible to identify the immunophenotype of injured personnel and provide targeted treatments to reduce the late consequences of trauma,which are known to lead to significant morbidity and mortality.

关键词： Trauma Sepsis Compensatory anti-inflammatory response syndrome Persistent inflammationimmunosuppression and catabolism syndrome Immune dysfunction

Diffuse cystic lung diseases

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Frontiers of medicine 2013年第3期7卷 316-327页

作者： Jay H.Ryu Xinlun Tian Misbah Baqir Kaifeng Xu division of Pulmonary and critical care medicine Mayo ClinicRochesterMN 55905USA division of Respiratory medicine Peking Union Medical College HospitalBeijing 100730China

Diffuse cystic lung diseases are uncommon but can present a diagnostic challenge because increasing number of diseases have been associated with this *** in the lung is defined as a round parenchymal lucency with a well-defined thin wall(<2 mm thickness).Focal or multifocal cystic lesions include blebs,bullae,pneumatoceles,congenital cystic lesions,traumatic lesions,and several infectious processes such as coccidioidomycosis,Pneumocystis jiroveci pneumonia,and hydatid disease.“Diffuse”distribution in the lung implies involvement of all *** lung involvement with cystic lesions can be seen in pulmonary lymphangioleiomyomatosis,pulmonary Langerhans’cell histiocytosis,lymphoid interstitial pneumonia,Birt-Hogg-Dubésyndrome,amyloidosis,light chain deposition disease,honeycomb lung associated with advanced fibrosis,and several other rare causes including metastatic ***-resolution computed tomography of the chest helps define morphologic features of the lung lesions as well as their distribution and associated features such as intrathoracic *** the tempo of the disease process and clinical context with chest imaging findings serve as important clues to defining the underlying nature of the cystic lung disease and guide diagnostic evaluation as well as management.

关键词： cyst lung disease interstitial lung disease lymphangioleiomyomatosis Langerhans’cell histiocytosis Birt-Hogg-Dubésyndrome

Glycemic targets in critically ill adults: A mini-review

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World Journal of Diabetes 2021年第10期12卷 1719-1730页

作者： Kay Choong See division of Respiratory and critical care medicine Department of MedicineNational University HospitalSingapore 119228Singapore

Illness-induced hyperglycemia impairs neutrophil function,increases pro-inflammatory cytokines,inhibits fibrinolysis,and promotes cellular *** turn,these mechanisms lead to pneumonia and surgical site infections,prolonged mechanical ventilation,prolonged hospitalization,and increased *** optimal glucose control,blood glucose measurements need to be done accurately,frequently,and *** choosing glycemic targets,one should keep the glycemic variability<4 mmol/L and avoid targeting a lower limit of blood glucose<4.4 mmol/*** upper limit of blood glucose should be set according to casemix and the quality of glucose control.A lower glycemic target range(i.e.,blood glucose 4.5-7.8 mmol/L)would be favored for patients without diabetes mellitus,with traumatic brain injury,or who are at risk of surgical site *** avoid harm from hypoglycemia,strict adherence to glycemic control protocols and timely glucose measurements are *** contrast,a higher glycemic target range(i.e.,blood glucose 7.8-10 mmol/L)would be favored as a default choice for medical-surgical patients and patients with diabetes *** targets may be modified if technical advances for blood glucose measurement and control can be achieved.

关键词： Brain injuries Traumatic critical care Diabetes mellitus Glycemic control Insulin infusion systems Sepsis

High-dose dexamethasone regulates microglial polarization via the GR/JAK1/STAT3 signaling pathway after traumatic brain injury

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Neural Regeneration Research 2025年第9期20卷 2611-2623页

作者： Mengshi Yang Miao Bai Yuan Zhuang Shenghua Lu Qianqian Ge Hao Li Yu Deng Hongbin Wu Xiaojian Xu Fei Niu Xinlong Dong Bin Zhang Baiyun Liu Beijing Tiantan Hospital Capital Medical UniversityBeijingChina Department of Neurology The First Hospital of Tsinghua UniversityBeijingChina Department of Neurotrauma and Beijing Key Laboratory of Central Nervous System Injury Beijing Neurosurgical InstituteCapital Medical UniversityBeijingChina Department of critical care medicine Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Center for Nerve Injury and Repair Beijing Institute of Brain DisordersChina National Clinical Research Center for Neurological DiseasesBeijingChina

Although microglial polarization and neuroinflammation are crucial cellular responses after traumatic brain injury,the fundamental regulatory and functional mechanisms remain insufficiently *** potent anti-inflammato ry agents,the use of glucoco rticoids in traumatic brain injury is still controversial,and their regulatory effects on microglial polarization are not yet *** the present study,we sought to determine whether exacerbation of traumatic brain injury caused by high-dose dexamethasone is related to its regulatory effects on microglial polarization and its mechanisms of *** vitro cultured BV2 cells and primary microglia and a controlled cortical impact mouse model were used to investigate the effects of dexamethasone on microglial ***,dexamethasone,RU486(a glucocorticoid receptor antagonist),and ruxolitinib(a Janus kinase 1 antagonist)were ***-sequencing data obtained from a C57BL/6 mouse model of traumatic brain injury were used to identify potential targets of *** Morris water maze,quantitative reverse transcription-polymerase chain reaction,western blotting,immunofluorescence and confocal microscopy analysis,and TUNEL,Nissl,and Golgi staining were performed to investigate our ***-throughput sequencing results showed that arginase 1,a marker of M2 microglia,was significantly downregulated in the dexamethasone group compared with the traumatic brain injury group at3 days post-traumatic brain *** dexamethasone inhibited M1 and M2 microglia,with a more pronounced inhibitory effect on M2microglia in vitro and in *** receptor plays an indispensable role in microglial polarization after dexamethasone treatment following traumatic brain ***,glucocorticoid receptor activation increased the number of apoptotic cells and neuronal death,and also decreased the density of dendritic spines.A possible downstream receptor signaling mechanism is th

关键词： apoptosis BV2 microglia dexamethasone glucocorticoid receptor glucocorticoids innate immune system microglial polarization neuroinflammation primary microglia traumatic brain injury

Obesity paradox in patients with community-acquired pneumonia:Have you fully considered the confounding factors?

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World Journal of Clinical Cases 2025年第9期13卷 53-55页

作者： Jin-Ke Sun Hui Tian Department of Pulmonary and critical care medicine Affiliated Hospital of Shandong University of Traditional Chinese MedicineJinan 250000Shandong ProvinceChina Department of critical care medicine Liaocheng People’s HospitalLiaocheng 252000Shandong ProvinceChina

There exists a notion that there is an obesity paradox in the prognosis of community-acquired *** other words,obese individuals with communityacquired pneumonia have a better *** study by Wang et al supports this claim,but we believe that the obesity paradox should not be proposed hastily as it is influenced by numerous subjective and objective confounding factors.

关键词： Community-acquired pneumonia Mortality Body mass index Overweight Obesity paradox

Procalcitionin as a diagnostic marker to distinguish upper and lower gastrointestinal perforation

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World Journal of Gastroenterology 2017年第24期23卷 4422-4427页

作者： Yang Gao Kai-Jiang Yu Kai Kang Hai-Tao Liu Xing Zhang Rui Huang Jing-Dong Qu Si-Cong Wang Rui-Jin Liu Yan-Song Liu Hong-Liang Wang Department of critical care medicine the Second Affiliated Hospital of Harbin Medical University Department of critical care medicine the Cancer Hospital of Harbin Medical University Institute of critical care medicine in Sino Russian Medical Research Center of Harbin Medical University Department of critical care medicine the First Affiliated Hospital of Harbin Medical University

AIM To assess the accuracy of serum procalcitionin(PCT)as a diagnostic marker in verifying upper and lower gastrointestinal perforation(GIP).METHODS This retrospective study included 46 patients from the surgical intensive care unit(ICU)of the Second Affiliated Hospital of Harbin Medical University who were confirmed to have GIP between June 2013 and December *** and clinical patient data were recorded on admission to *** were divided into upper(n=19)and lower(n=27)GIP groups according to the perforation site(above or below Treitz ligament).PCT and WBC count was obtained before laparotomy and then compared between ***,the diagnostic accuracy of PCT was *** Patients with lower GIP exhibited significantly higher APACHE II score,SOFA score and serum PCT level than patients with upper GIP(P=0.017,0.004,and0.001,respectively).There was a significant positive correlation between serum PCT level and APACHE II score or SOFA score(r=0.715 and r=0.611,respectively),while there was a significant negative correlation between serum PCT level and prognosis(r=-0.414).WBC count was not significantly different between the two groups,and WBC count showed no significant correlation with serum PCT level,APACHE II score,SOFA score or *** area under the receiver operating characteristic curve of PCT level to distinguish upper or lower GIP was *** with a serum PCT level above 17.94 ng/d L had a high likelihood of lower GIP,with a sensitivity of 100%and a specificity of 42.1%.CONCLUSION Serum PCT level is a reliable and accurate diagnostic marker in identifying upper or lower GIP before laparotomy.

关键词： Procalcitionin White blood cell count Gastrointestinal perforation Sepsis APACHE II score SOFA score

Hepatoprotective actions of melatonin:Possible mediation by melatonin receptors

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World Journal of Gastroenterology 2010年第48期16卷 6087-6097页

作者： Alexander M Mathes Department of Anesthesiology Critical Care and Pain MedicineSaarland University Hospital

Melatonin,the hormone of darkness and messenger of the photoperiod,is also well known to exhibit strong direct and indirect antioxidant properties. Melatonin has previously been demonstrated to be a powerful organ protective substance in numerous models of injury; these beneficial effects have been attributed to the hormone's intense radical scavenging capacity. The present report reviews the hepatoprotective potential of the pineal hormone in various models of oxidative stress in vivo,and summarizes the extensive literature showing that melatonin may be a suitable experimental substance to reduce liver damage after sepsis,hemorrhagic shock,ischemia/reperfusion,and in numerous models of toxic liver injury. Melatonin's influence on hepatic antioxidant enzymes and other potentially relevant pathways,such as nitric oxide signaling,hepatic cytokine and heat shock protein expression,are evaluated. Based on recent literature demonstrating the functional relevance of melatonin receptor activation for hepatic organ protection,this article finally suggests that melatonin receptors could mediate the hepatoprotective actions of melatonin therapy.

关键词： Antioxidant enzymes Hemorrhagic shock Hepatoprotection Ischemia Liver Liver function Melatonin Melatonin receptor Ramelteon Reperfusion Sepsis Toxic liver injury

Gut-brain axis in traumatic brain injury: impact on neuroinflammation

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Neural Regeneration Research 2022年第5期17卷 1007-1008页

作者： Marta Celorrio Stuart H.Friess division of critical care medicine Department of PediatricsWashington University in St.Louis School of MedicineSt.LouisMOUSA Perspective

The gastrointestinal track is inhabited by tens of trillions of microorganisms. The gut microbiota is involved in gut motility, nutrient absorption and synthesis of metabolites that influence hmeostasis, metabolism and immunefunction. Given the influence gut microbiota has on health, there is a growing body of literature describing the gut microbiota's impact on brain and behavior.

关键词： metabolism inflammation stasis