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Hypoperfusion context as a predictor of 28-d all-cause mortality in septic shock patients:A comparative observational study

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World Journal of Clinical Cases 2023年第16期11卷 3765-3779页

作者： Sahil Kataria Omender Singh Deven Juneja Amit Goel Madhura Bhide Devraj Yadav institute of Critical Care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India

BACKGROUND As per the latest Surviving sepsis Campaign guidelines,fluid resuscitation should be guided by repeated measurements of blood lactate levels until ***,raised lactate levels should be interpreted in the clinical context,as there may be other causes of elevated lactate ***,it may not be the best tool for real-time assessment of the effect of hemodynamic resuscitation,and exploring alternative resuscitation targets should be an essential research priority in *** To compare the 28-d mortality in two clinical patterns of septic shock:hyperlactatemic patients with hypoperfusion context and hyperlactatemic patients without hypoperfusion *** This prospective comparative observational study carried out on 135 adult patients with septic shock that met sepsis-3 definitions compared patients with hyperlactatemia in a hypoperfusion context(Group 1,n=95)and patients with hyperlactatemia in a non-hypoperfusion context(Group 2,n=40).Hypoperfusion context was defined by a central venous saturation less than 70%,central venousarterial PCO_(2)gradient[P(cv-a)CO_(2)]≥6 mmHg,and capillary refilling time(CRT)≥4 *** patients were observed for various macro and micro hemodynamic parameters at regular intervals of 0 h,3 h,and 6 ***-cause 28-d mortality and all other secondary objective parameters were observed at specified *** categorical data were compared using theχ^(2)or Fisher’s exact *** distributed continuous variables were compared using the Mann-Whitney U *** operating characteristic curve analysis with the Youden index determined the cutoff values of lactate,CRT,and metabolic perfusion parameters to predict the 28-d all-cause mortality.A P value of<0.05 was considered *** Patient demographics,comorbidities,baseline laboratory,vital parameters,source of infection,baseline lactate levels,and lactate clearance at 3 h and 6 h,Sequential Organ Failure scores,need for inv

关键词： Capillary refill time Central venous saturation Hypoperfusion Lactate Mortality PCO_(2)gap Septic shock

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Is Regular Probiotic Practice Safe for Management of sepsis?

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Chinese Journal of Integrative Medicine 2022年第2期28卷 185-192页

作者： Rishabh Kumar Alok Shiomurti Tripathi Nidhi Sharma Gaaminepreet Singh Lucy Mohapatra Department of Pharmacology ISF College of PharmacyMoga(Punjab)India Department of Pharmacology Amity Institute of PharmacyAmity UniversityLucknow(UP)India

For decades,the gut has been thought to play an important role in sepsis *** is a serious life-threatening,chronic condition of an infection caused by dysregulated host immune response in most of the intensive care unit *** have dual roles in polymicrobial sepsis *** may induce sepsis in many cases and may prevent its prognosis in many *** evidence from both pre-clinical and clinical studies have demonstrated that probiotic therapy ameliorates various inflammatory mediators such as tumor necrosis factor,interleukin-10(IL-10),IL-6,etc.,in *** addition,probiotic use was also found to reduce the severity of pathological conditions associated with irritable bowel disorder and prevent development of endocarditis in *** contrary,probiotic therapy in neonatal and athymic adult mice fail to provide any beneficial effects on mortality and sepsis-induced ***,in few clinical trials probiotic use was found to aggravate sepsis by promoting inflammatory cascade rather than suppressing *** review discusses various studies regarding the beneficial or harmful effects associated with probiotic therapy in sepsis.

关键词： sepsis probiotics microbial flora immune system

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Efficacy of infliximab in acute severe ulcerative colitis:A single-centre experience

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World Journal of Gastroenterology 2013年第7期19卷 1091-1097页

作者： Stephen J Halpin P John Hamlin Daniel P Gree Lisa Warren Alexander C Ford Leeds Gastroenterology institute St.James's University HospitalLeedsWest Yorkshire LS9 7TFUnited Kingdom Leeds Gastroenterology institute St.James's University HospitalLeedsWest Yorkshire LS9 7TFUnited Kingdom r Leeds institute of Molecular Medicine University of LeedsLeedsWest Yorkshire LS9 7TFUnited Kingdom

AIM:To suggest infliximab(IFX) is effective for acute severe ulcerative colitis,from real-life clinical ***:All patients receiving IFX for the treatment of acute severe ulcerative colitis in a single centre were *** were extracted from clinical records in order to assess response to IFX *** primary endpoint was colectomy-free survival,and secondary outcomes included glucocorticosteroid-free remission and safety,which was evaluated by recording deaths and adverse *** and clinical characteristics of those who underwent colectomy and those who were colectomy-free,both at discharge from their index admission,and during follow-up after an initial response to IFX were ***:Forty-four patients(16 females,mean age 36 years) received IFX between May 2006 and January 2012 for acute severe ulcerative *** median duration of follow-up post-first infusion was 396 d(interquartile range = 173-828 d).There were 21(47.7%) patients with 2 years of follow-up post-first infusion of ***,35(79.5%) responded to IFX,avoiding colectomy during their index admission,29(65.9%) were colectomyfree at last point of follow-up(median follow-up 396 d),and 25(56.8%) were in glucocorticosteroid-free remission at end of *** was one death from post-operative sepsis,20 d after a single IFX *** rates were generally lower among those "bridging" to *** 18 patients "bridged" to thiopurine therapy,17(94.4%) were colectomyfree,and 15(83.3%) were in glucocorticosteroid-free remission at study *** predictors of response were ***:IFX is effective for acute severe ulcerative colitis in real-life clinical ***-thirds of patients avoided colectomy,and more than 50% were in glucocorticosteroid-free remission.

关键词： Ulcerative colitis Severe Azathioprine Infliximab Remission

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Immune Dysfunction in Cirrhosis

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Journal of Clinical and Translational Hepatology 2017年第1期5卷 50-58页

作者： Mohd Talha Noor Piyush Manoria Department of Gastroenterology Sri Aurobindo Medical College and Post Graduate InstituteIndoreIndia

Cirrhosis due to any etiology disrupts the homeostatic role of liver in the ***-associated immune dysfunction leads to alterations in both innate and acquired immunity,due to defects in the local immunity of liver as well as in systemic ***-associated immune dysfunction is a dynamic phenomenon,comprised of both increased systemic inflammation and immunodeficiency,and is responsible for 30%*** also plays an important role in acute as well as chronic *** paralysis can accompany it,which is characterized by increase in antiinflammatory cytokines and suppression of proinflammatory *** is also presence of increased gut permeability,reduced gut motility and altered gut flora,all of which leads to increased bacterial *** increased bacterial translocation and consequent endotoxemia leads to increased blood stream bacterial infections that cause systemic inflammatory response syndrome,sepsis,multiorgan failure and *** gut microbiota of cirrhotic patients has more pathogenic microbes than that of noncirrhotic individuals,and this disturbs the homeostasis and favors gut *** diagnosis and treatment of such infections are necessary for better *** have reviewed the various mechanisms of immune dysfunction and its consequences in *** the exact pathophysiology of immune dysfunction will help treating clinicians in avoiding its complications in their patients and can lead to newer therapeutic interventions and reducing the morbidity and mortality rates.

关键词： Cirrhosis Immune dysfunction Inflammation Liver disease

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Lipopolysaccharide decreasing albumin expression in rat hepatocytes

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Hepatobiliary & Pancreatic Diseases International 2005年第3期4卷 410-415页

作者： Research institute of General Surgery, Jinling Hospital, Nanjing 210002, China (Wang XY, Li WQ, Li N and Li JS) and Department of Orthopaedics, Zhongda Hospital, Nanjing 210009, China (Lu J) Research institute of General Surgery Jinling Hospital Nanjing 210002 China. wxinying@***

The relations of the severity of hypoalbu-minemia to morbidity and mortality of patients with critical illness illustrate the need for better understanding of molecular mechanism of hypoalbuminemia. This study was undertaken to investigate the response of albumin synthesis to lipopolysaccharide(LPS)in rat hepatocytes in vitro in early acute phase of sepsis. METHODS:Hepatocytes were cultured at an initial cell density of 1.5×106 cells/well in 3 ml culture medium. There were two groups of samples which received either normal saline or 1 μg/L LPS randomly. Albumin mRNA in hepatocytes was assessed by reverse transcription-poly-merase chain reaction(RT-PCR) and albumin level in the supernatant was measured by ELISA at 0,2,8,12,24 hours after exposure. Meanwhile, the albumin precursor was evaluated at the same time points by flow cytometry. RESULTS:The quantitative changes of mRNA, albumin precursor and its protein were analogous. All of them tended to decline at 12 hours post-treatment and did not decrease significantly until 24 hours after LPS exposure. Meanwhile, albumin mRNA decreased about 30% and the levels of albumin precursor and albumin reduced approximately 50%. CONCLUSIONS: LPS can inhibit albumin synthesis in rat hepatocytes by prevention of albumin transcription. Moreover, the response of hepatic albumin synthesis to LPS changes with the stage of sepsis process. The results show that albumin metabolism in sepsis is a complicated process and further studies are required to understand the molecular mechanism of LPS-induced hypoalbuminemia in sepsis.

关键词： lipopolysaccharide hepatocyte albumin hypoalbuminemia signal transduction sepsis

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Study on delay two-phase multiple organ dysfunction syndrome

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Chinese Medical Journal 1998年第2期000卷 5-12页

作者：胡森盛志勇周宝桐郭振荣陆江阳薛丽波晋桦孙晓庆孙世荣黎君友吕艺 Burn institute 304th Hospital Beijing 100037 China

This research was supported by a grant from the Ministry of Health, General Logistic Department of PLA (the Eighth Five Year Key Project), ***. Objective To study the injury factors, pathogenic process and clinical features of delay two phase multiple organ dysfunction syndrome (MODS) in severe burned patients and to replicate a standardized animal model that would accurately imitate the clinical features of MODS. Methods Forty five human patients with burn size larger than 30% total body surface area (TBSA) were analyzed. All of them underwent severe burn shock in early stage and sepsis in late stage. Thirty two goats were randomly divided into three groups: 1) hemorrhagic shock (group H, n=6); 2) endotoxemia (group E, n=6); and 3) hemorrhagic shock plus endotoxemia (group M, n=20). Hemorrhagic shock was produced according to the method of Wigger (6.7 kPa for an hour, 1 kPa=7.5 mmHg). Endotoxin (E. coli O 111 B 4) was given via the portal vein 24 hours after the resuscitation of hemorrhagic shock, in a dose of 30 ng/kg/min for 5 consecutive days. During the observation period of 10 days, all animals were hemodynamically monitored, given standard metabolic support and due cardiac and pulmonary support according to human intensive care. Results All the patients showed burn shock at 1 3 days and hyperdynamic circulation, hypermetabolism and systemic inflammatory responses over two weeks post injury. Thirteen cases were found to develop MODS according to the prevailing diagnostic criteria, and 10 of them died with a mortality of 77%. Eighteen animals died in group M with a mortality of 90%, 12 of the 18 developed MODS, with overall incidence of 60%. Most animals in group M showed changes similar to that observed in human cases. The experimentation proved that in the pathogenic process of MODS, there was a two hit phenomenon in the dvelopment of the syndrome. To prevent the development of MODS, it therefore was imperative to blunt th

关键词：胡森 delay multiple two-phase organ dysfunction syndrome Study 郭振荣盛志勇

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Diagnostic use of superb microvascular imaging in evaluating septic arthritis of the manubriosternal joint:A case report

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World Journal of Clinical Cases 2023年第18期11卷 4397-4405页

作者： Goda Seskute Dominyka Kausaite Ana Chalkovskaja Egle Bulotaite Irena Butrimiene Clinic of Rheumatology Orthopaedics Traumatologyand Reconstructive SurgeryCentre of RheumatologyInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Clinic of Internal Diseases Family Medicine and OncologyInstitute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius 01513Lithuania Department of Radiology Nuclear Medicine and Medical PhysicsInstitute of Biomedical SciencesFaculty of MedicineVilnius UniversityVilnius 01513Lithuania

BACKGROUND Septic arthritis of the manubriosternal joint is a diagnostic challenge due to its rarity and anatomical *** ultrasound,plain radiographs,and computed tomography are not able to confirm or even suspect arthritis *** microvascular imaging is a new advanced Doppler technique in evaluating low-flow microvascular *** higher sensitivity for increased perisynovial vascularity helps to suspect septic arthritis and forms a methodical approach to using magnetic resonance imaging(MRI).CASE SUMMARY A 34-year-old immunocompetent woman presented with a fever and a dull ache in the chest radiating to the right *** injury and the most common respiratory and cardiac disorders were ruled *** cultures came back positive for Staphylococcus aureus,and sepsis was confirmed.A small lump was noted on the chest during the first week of *** microvascular imaging was performed and septic arthritis of the manubriosternal joint was *** confirmed the diagnosis and showed septic arthritis of the manubriosternal joint with several localized abscesses behind the *** patient was treated for three weeks with intravenous antibiotics and the outcome was favorable:Inflammatory markers became normal,and the lump *** months later,the patient was examined for a new episode of mild pain in the sternum and was diagnosed with persistent perichondritis by ultrasound in comparison with *** Superb microvascular imaging is a useful tool for the early diagnosis of septic arthritis of the manubriosternal joint and following-up.

关键词： Power Doppler Superb microvascular imaging Ultrasound Septic arthritis Manubriosternal joint Case report

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Nomogram for predicting the prognosis of tumor patients with sepsis after gastrointestinal surgery

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World Journal of Gastrointestinal Oncology 2022年第9期14卷 1771-1784页

作者： Ren-Xiong Chen Zhou-Qiao Wu Zi-Yu Li Hong-Zhi Wang Jia-Fu Ji ICU Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing)Peking University Cancer Hospital&InstituteBeijing 100142China Department of Gastrointestinal Surgery Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing)Peking University Cancer Hospital&InstituteBeijing 100142China

BACKGROUND There were few studies on the prognosis of tumor patients with sepsis after gastrointestinal surgery and there was no relevant nomogram for predicting the prognosis of these *** To establish a nomogram for predicting the prognosis of tumor patients with sepsis after gastrointestinal surgery in the intensive care unit(ICU).METHODS A total of 303 septic patients after gastrointestinal tumor surgery admitted to the ICU at Peking University Cancer Hospital from January 1, 2013 to December 31, 2020 were analysed retrospectively. The model for predicting the prognosis of septic patients was established by the R software *** The most common infection site of sepsis after gastrointestinal surgery in the ICU was abdominal infection. The 90-d all-cause mortality rate was 10.2% in our study group. In multiple analyses, we found that there were statistically significant differences in tumor type, septic shock, the number of lymphocytes after ICU admission, serum creatinine and total operation times among tumor patients with sepsis after gastrointestinal surgery(P sepsis after gastrointestinal surgery.

关键词： Tumor Surgery sepsis Gastrointestinal Nomogram

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Current management of liver diseases and the role of multidisciplinary approach

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World Journal of Hepatology 2022年第11期14卷 1920-1930页

作者： Nouhoum Bouare Department of Assurance Quality and Biosafety/Biosecurity National Institute of Public HealthBamako 1771Mali

Liver is an organ having extremely diversified functions,ranging from metabolic and synthetic to detoxification of harmful *** multifunctionality of the liver in principle requires the multidisciplinary and pluralistic interventions for its *** studies have investigated liver function,dysfunction and *** editorial work discusses new ideas,challenges and perspectives of current research regarding multidisciplinary and pluralistic management of liver *** one hand the discussions have carried out on the involvement of extracellular vesicles,Na^(+)/H^(+) exchangers,severe acute respiratory syndrome coronavirus 2 and Epstein–Barr virus infections,Drug-induced liver injury,sepsis,pregnancy,and food supplements in hepatic *** the other hand this study has discussed hepatocellular carcinoma algorithms and new bio-chemical and imaging experiments pertaining to liver *** articles with an impact index value">0"from reference citation analysis,which is an open multidisciplinary citation analysis database based on artificial intelligence technology,have served for the study’s *** work may be a useful tool for the clinical practice and research in managing and investigating liver disorders.

关键词： Liver management Liver function Liver dysfunction Liver clinic Liver diagnosis Multidisciplinary approach

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Novel assays for quality evaluation of XueBiJing:Quality variability of a Chinese herbal injection for sepsis management

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Journal of Pharmaceutical Analysis 2022年第4期12卷 664-682页

作者： Xuan Yu Wei Niu Ya-Ya Wang Olajide E.Olaleye Jia-Nan Wang Meng-Yuan Duan Jun-Ling Yang Rong-Rong He Zi-Xuan Chu Kai Dong Gui-Ping Zhang Chang-Xiao Liu Chen Cheng Chuan Li State Key Laboratory of Drug Research Shanghai Institute of Materia MedicaChinese Academy of SciencesShanghai201203China School of Pharmacy University of Chinese Academy of SciencesBeijing100049China Graduate School Tianjin University of Traditional Chinese MedicineTianjin300193China Research institute Tianjin Chasesun Pharmaceutical Co.Ltd.Tianjin301700China State Key Laboratory of Drug Delivery Technology and Pharmacokinetics and Tianjin Key Laboratory of Quality-Marker of Traditional Chinese Medicines Tianjin Institute of Pharmaceutical ResearchTianjin300193China

XueBiJing is an intravenous five-herb injection used to treat sepsis in *** study aimed to develop a liquid chromatography-tandem mass spectrometry(LC-MS/MS)-or liquid chromatography-ultraviolet(LC-UV)-based assay for quality evaluation of *** development involved identifying marker constituents to make the assay therapeutically relevant and building a reliable one-point calibrator for monitoring the various analytes in *** marker constituents from the five herbs were selected based on XueBiJing's chemical composition,pharmacokinetics,and pharmacodynamics.A selectivity test(for“similarity of response”)was developed to identify and minimize interference by nontarget ***,an intercept test was developed to fulfill“linearity through zero”for each analyte(absolute ratio of intercept to C response,<2%).Using the newly developed assays,we analyzed samples from 33 batches of XueBiJing,manufactured over three years,and found small batch-to-batch variability in contents of the marker constituents(4.1%-14.8%),except for senkyunolide I(26.5%).

关键词： XueBiJing Chinese herbal medicine Quality variability Quality marker One-point calibration

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