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Early prediction and prevention of infected pancreatic necrosis

World Journal of Gastroenterology 2024年第9期30卷 1005-1010页

作者： Cheng Lv Zi-Xiong Zhang Lu Ke Department of critical care Medicine Jinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210000Jiangsu ProvinceChina Research institute of critical care Medicine and Emergency Rescue Nanjing UniversityNanjing 210000Jiangsu ProvinceChina

Approximately 20%-30%of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis(IPN),a highly morbid and potentially lethal complication.Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes.In the past two decades,several markers and predictive tools have been proposed and evaluated for this purpose.Conventional biomarkers like C-reactive protein,procalcitonin,lymphocyte count,interleukin-6,and interleukin-8,and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN.On the other hand,scoring systems like the Acute Physiology and Chronic Health Evaluation II and Pancreatitis Activity Scoring System have also been tested,and the results showed that they may provide better accuracy.For early prevention of IPN,several new therapies were tested,including early enteral nutrition,anti-biotics,probiotics,immune enhancement,etc.,but the results varied.Taken together,several evidence-supported predictive markers and scoring systems are readily available for predicting IPN.However,effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition.In this editorial,we summarize evidence concerning early prediction and prevention of IPN,providing insights into future practice and study design.A more homo-geneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN,thereby achieving individualized treatment.

关键词： Acute pancreatitis Infected pancreatic necrosis Biomarker Scoring system Nutrition therapy Selective digestive decontamination Probiotics Antibiotics Immune enhancement therapy

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Early systemic anticoagulation reduces hospital readmission in acute necrotizing pancreatitis patients:A retrospective cohort study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 77-82页

作者： Wen-Jian Mao Jing Zhou Guo-Fu Zhang Fa-Xi Chen Jing-Zhu Zhang Bai-Qiang Li Lu Ke Wei-Qin Li Department of critical care Medicine Jinling HospitalNanjing Medical UniversityNanjing 210002China Department of critical care Medicine Jinling HospitalMedical School of Nanjing UniversityNanjing 210002China National institute of Healthcare Data Science Nanjing UniversityNanjing 210010China

Background:Early systemic anticoagulation(SAC)is a common practice in acute necrotizing pancreatitis(ANP),and its impact on in-hospital clinical outcomes had been assessed.However,whether it affects long-term outcomes is unknown.This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients.Methods:During January 2013 and December 2018,ANP patients admitted within 7 days from the onset of abdominal pain were screened.The primary outcome was 90-day readmission after discharge.Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission.Results:A total of 241 ANP patients were enrolled,of whom 143 received early SAC during their hospitalization and 98 did not.Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis(SVT)[risk ratio(RR)=0.40,95%CI:0.26-0.60,P<0.01]and lower 90-day readmission with an RR of 0.61(95%CI:0.41-0.91,P=0.02)than those who did not.For the quality of life,patients who received early SAC had a significantly higher score in the subscale of vitality(P=0.03)while the other subscales were all comparable between the two groups.Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57(95%CI:0.34-0.96,P=0.04).Mediation analysis showed that SVT mediated 37.0%of the early SAC-90-day readmission causality.Conclusions:The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients,and reduced SVT incidence might be the primary contributor.

关键词： Anticoagulation Splanchnic venous thrombosis Acute necrotizing pancreatitis Readmission Long-term outcomes

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Neuroprotective effects of chaperone-mediated autophagy in neurodegenerative diseases

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Neural Regeneration Research 2024年第6期19卷 1291-1298页

作者： Qi Jia Jin Li Xiaofeng Guo Yi Li You Wu Yuliang Peng Zongping Fang Xijing Zhang Department of Anesthesiology and Perioperative Medicine and Department of Intensive care Unit Xijing Hospital The Fourth Military Medical University Department of critical care Medicine Translational Research institute of Brain and Brain-Like Intelligence Shanghai Fourth People's Hospital School of Medicine Tongji University

Chaperone-mediated autophagy is one of three types of autophagy and is characterized by the selective degradation of proteins. Chaperone-mediated autophagy contributes to energy balance and helps maintain cellular homeostasis, while providing nutrients and support for cell survival. Chaperone-mediated autophagy activity can be detected in almost all cells, including neurons. Owing to the extreme sensitivity of neurons to their environmental changes, maintaining neuronal homeostasis is critical for neuronal growth and survival. Chaperone-mediated autophagy dysfunction is closely related to central nervous system diseases. It has been shown that neuronal damage and cell death are accompanied by chaperone-mediated autophagy dysfunction. Under certain conditions, regulation of chaperone-mediated autophagy activity attenuates neurotoxicity. In this paper, we review the changes in chaperone-mediated autophagy in neurodegenerative diseases, brain injury, glioma, and autoimmune diseases. We also summarize the most recent research progress on chaperone-mediated autophagy regulation and discuss the potential of chaperone-mediated autophagy as a therapeutic target for central nervous system diseases.

关键词： chaperone-mediated autophagy neurodegenerative disease neuronal homeostasis neuroprotection

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Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy:a meta-analysis

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World Journal of Emergency Medicine 2024年第3期15卷 181-189页

作者： Zeyu Yang Huiruo Liu Dazhou Lu Shengchuan Cao Feng Xu Chuanbao Li Department of Emergency Medicine Qilu Hospital of Shandong UniversityJinan 250012China Shandong Provincial Clinical Research Center for Emergency and critical care Medicine Institute of Emergency and Critical Care Medicine of Shandong UniversityChest Pain CenterQilu Hospital of Shandong UniversityJinan 250012China Key Laboratory of Emergency and critical care Medicine of Shandong Province Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceShandong Provincial Engineering Laboratory for Emergency and Critical Care MedicineQilu Hospital of Shandong UniversityJinan 250012China Shandong Key Laboratory:Magnetic Field-free Medicine&Functional Imaging(MF) Qilu Hospital of Shandong UniversityJinan 250012China National Medical Products Administration(NMPA)Key Laboratory for Clinical Research and Evaluation of Innovative Drug Qilu Hospital of Shandong UniversityJinan 250012China

BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.

关键词： Acute coronary syndrome High-dose Glucose-insulin-potassium treatment Reperfusion therapy Meta-analysis

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Cytomegalovirus infection in non-immunocompromised critically ill patients:A management perspective

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World Journal of Virology 2024年第1期13卷 38-50页

作者： Madhura Bhide Omender Singh Prashant Nasa Deven Juneja institute of critical care Medicine Max Super Speciality HospitalSaketNew Delhi 110017India Department of critical care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates

critically ill patients are a vulnerable group at high risk of developing secondary infections.High disease severity,prolonged intensive care unit(ICU)stay,sepsis,and multiple drugs with immunosuppressive activity make these patients prone to immuneparesis and increase the risk of various opportunistic infections,including cytomegalovirus(CMV).CMV seroconversion has been reported in up to 33%of ICU patients,but its impact on patient outcomes remains a matter of debate.Even though there are guidelines regarding the management of CMV infection in immunosuppressive patients with human immunodeficiency virus/acquired immuno deficiency syndrome,the need for treatment and therapeutic approaches in immunocompetent critically ill patients is still ambiguous.Even the diagnosis of CMV infection may be challenging in such patients due to non-specific symptoms and multiorgan involvement.Hence,a better understanding of the symptomatology,diagnostics,and treatment options may aid intensive care physicians in ensuring accurate diagnoses and instituting therapeutic interventions.

关键词： Cytomegalovirus critically ill Immunocompetent Intensive care unit Virus

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Alterations in nasal microbiota of patients with amyotrophic lateral sclerosis

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Chinese Medical Journal 2024年第2期137卷 162-171页

作者： Kaixiong Liu Qifu Guo Ying Ding Li Luo Jianchai Huang Qijie Zhang Department of Respiratory and critical care Medicine The First Affiliated HospitalFujian Medical UniversityFuzhouFujian 350005China Department of Respiratory and Critical Care MedicineNational Regional Medical CenterBinhai Campus of The First Affiliated HospitalFujian Medical UniversityFuzhouFujian 350212China Department of Neurology Fujian Institute of NeurologyThe First Affiliated HospitalFujian Medical UniversityFuzhouFujian 350005China Department of NeurologyNational Regional Medical CenterBinhai Campus of The First Affiliated HospitalFujian Medical UniversityFuzhouFujian 350212China

Background:Links between alterations in gut microbiota composition and amyotrophic lateral sclerosis(ALS)have previously been reported.This study aimed to examine the microbiota in the nasal cavity of ALS.Methods:Sixty-six ALS patients and 40 healthy caregivers who live in close proximity with patients were enrolled.High throughput metagenomic sequencing of the 16S ribosomal deoxyribonucleic acid(rDNA)gene V3-V4 region of nasal microbiota was used to characterize the alpha and beta diversity and relative abundance of bacterial taxa,predict function,and conduct correlation analysis between specific taxa and clinical features.Results:The nasal microbiome of ALS patients showed lower alpha diversity than that of corresponding healthy family members.Genera Gaiella,Sphingomonas,Polaribacter_1,Lachnospiraceae_NK4A136_group,Klebsiella,and Alistipes were differentially enriched in ALS patients compared to controls.Nasal microbiota composition in ALS patients significantly differed from that in healthy subjects(unweighted UniFrac P=0.001),while Linear discriminant analysis Effect Size(LEfSe)analysis indicated that Bacteroidetes and Firmicutes dominated healthy nasal communities at the phylum level,whereas Actinobacteria was the predominant phylum and Thermoleophilia was the predominant class in ALS patients.Genus Faecalibacterium and Alistipes were positively correlated with ALS functional rating scale revised(ALSFRS-R;r_(s)=0.349,P=0.020 and r_(s)=0.393,P=0.008),while Prevotella-9 and Bacteroides operational taxonomic units(OTUs)were positively associated with lung function(FVC)in ALS patients(r_(s)=0.304,P=0.045,and r_(s)=0.300,P=0.048,respectively).Prevotella-1 was positively correlated with white blood cell counts(WBC,r_(s)=0.347,P=0.021),neutrophil percentage(Neu%,r_(s)=0.428,P=0.004),and neutrophil-to-lymphocyte ratio(NLR,r_(s)=0.411,P=0.006),but negatively correlated with lymphocyte percentage(Lym%,r_(s)=-0.408,P=0.006).In contrast,Streptococcus was negatively associated with Neu%(r_(s)=-0.445,P=0.003)and NLR(r_(s)

关键词： Amyotrophic lateral sclerosis Nasal microbiota Dysbiosis Inflammation

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Prediabetes in children and adolescents:A ticking bomb!

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World Journal of Clinical Pediatrics 2024年第2期13卷 11-15页

作者： Anju Gupta Nitin Choudhary Nishkarsh Gupta Department of Anesthesiology Pain Medicine and Critical CareAll India Institute of Medical ScienceNew Delhi 110076India Department of Onco-Anesthesiology and Palliative Medicine All India Institute of Medical ScienceNew Delhi 110029India

Prediabetes in children and adolescents is on the rise which has drawn significant attention over the past decade.It is an early warning sign of the underlying pathophysiological changes which in due course of time might compound into type II diabetes mellitus.The incidence of prediabetes in adolescents ranges from 4%-23%which is alarmingly high and requires active intervention from the system.We have discussed early identification of high-risk patients,prompt screening and active intervention to manage this growing problem.

关键词： Prediabetes Children Adolescents Glucose metabolism Complications

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Steroids in acute respiratory distress syndrome:A panacea or still a puzzle?

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World Journal of critical care Medicine 2024年第2期13卷 93-105页

作者： Sharmili Sinha Rohit Patnaik Srikant Behera Department of critical care Medicine Apollo HospitalsBhubaneswar 751005OdishaIndia Department of critical care Medicine Medeor 24x7 HospitalAl Danah 40330Abu DhabiUnited Arab Emirates Department of Internal Medicine and critical care All India Institute of Medical SciencesBhubaneswar 751019OdishaIndia

Acute respiratory distress syndrome(ARDS)is a unique entity marked by various etiologies and heterogenous pathophysiologies.There remain concerns regarding the efficacy of particular medications for each severity level apart from respiratory support.Among several pharmacotherapies which have been examined in the treatment of ARDS,corticosteroids,in particular,have demonstrated potential for improving the resolution of ARDS.Nevertheless,it is imperative to consider the potential adverse effects of hyperglycemia,susceptibility to hospital-acquired infections,and the development of intensive care unit acquired weakness when administering corticosteroids.Thus far,a multitude of trials spanning several decades have investigated the role of corticosteroids in ARDS.Further stringent trials are necessary to identify particular subgroups before implementing corticosteroids more widely in the treatment of ARDS.This review article provides a concise overview of the most recent evidence regarding the role and impact of corticosteroids in the management of ARDS.

关键词： Acute respiratory distress syndrome Corticosteroids Septic shock Community acquired pneumonia COVID-19 Randomized controlled trials

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Multifunctional photon conversion materials for enhancing silicon solar cells

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Light(Science & Applications) 2024年第4期13卷 598-601页

作者： Yiyan Zhang Guanying Chen MIIT Key Laboratory of critical Materials Technology for New Energy Conversion and Storage School of Chemistry and Chemical EngineeringHarbin Institute of Technology150001 HarbinChina

A type of multifunctional erbium(Er^(3+))and ytterbium(Yb^(3+))codoped NaY(WO4)2 phosphors,with simultaneous photon upconversion,photon quantum cutting,and luminescence ratiometric temperature sensing abilities,have b... 详细信息

关键词： photon luminescence quantum

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Circle-map profiling of extrachromosomal circular DNA as diagnostic biomarkers for lung cancer

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Precision Clinical Medicine 2024年第1期7卷 90-92页

作者： Yongfeng Yang Tingting Song Sha Liu Zhiqiang Liu Xuehui Wang Yi Li Dan Liu Department of Respiratory and critical care Medicine Institute of Respiratory HealthCenter of Precision MedicineWest China HospitalSichuan UniversityChengdu610041China

Dear Editor:Lung cancer has the highest incidence rate among malignancies and remains the primary contributor to cancer-related mortality on a global scale[1].Early detection is the most efficacious approach for enhancing the prognosis and mitigating the mortality of patients with lung cancer[2].Currently,diagnosis of lung cancer is mainly by different types of imaging including low-dose spiral computed tomography(LDCT)combined with pathological assessment of biopsy,but prevalence of false-positive results and associated expenses may impede its becoming a standard screening technique[3].

关键词： mortality lung diagnosis

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