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Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom

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Journal of intensive medicine 2024年第1期4卷 62-72页

作者： Hongling Zhang Youdong Xu Xin Huang Shunyin Yang Ruiting Li Yongran Wu Xiaojing Zou Yuan Yu You Shang Department of Critical care medicine Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei430022China Department of intensive care Unit Affiliated Lu’an HospitalAnhui Medical UniversityLu’anAnhui237000China

Sepsis and septic shock remain the leading causes of death in intensive care *** patients with sepsis fail to respond to routine treatment and rapidly progress to refractory respiratory and circulatory failure,necessitating extracorporeal membrane oxygenation(ECMO).However,the role of ECMO in adult patients with sepsis has not been fully *** to existing studies,ECMO may be a viable salvage therapy in carefully selected adult patients with *** choice of venovenous,venoarterial,or hybrid ECMO modes is primarily determined by the patient’s oxygenation and hemodynamics(distributive shock with preserved cardiac output,septic cardiomyopathy(left,right,or biventricular heart failure),or right ventricular failure caused by acute respiratory distress syndrome).Veno-venous ECMO can be used in patients with sepsis and severe acute respiratory distress syndrome when conventional mechanical ventilation fails,and early application of veno-arterial ECMO in patients with sepsis-induced refractory cardiogenic shock may be critical in improving their chances of *** ECMO is indicated,the choice of an appropriate mode and determination of the optimal timing of initiation and weaning are critical,particularly in an experienced ECMO ***,some special issues,such as ECMO flow,anticoagulation,and antibiotic therapy,should be noted during the management of ECMO support.

关键词： Extracorporeal membrane oxygenation Sepsis Shock Acute respiratory distress syndrome(ARDS) Septic cardiomyopathy Mod

Potential impact of specific therapy on pregnant women with pulmonary arterial hypertension without cardiac shunt:a descriptive study in northern China

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Emergency and Critical care medicine 2024年第2期4卷 60-66页

作者： Weida Lu Min Li Fuqing Ji Hua Feng Guo Li Qiushang Ji Hongyu Zhang Xiaopei Cui Department of Geriatric medicine&Shandong Key laboratory Cardiovascular Proteomics Qilu Hospital of Shandong UniversityJinanShandongChina intensive care Unit of Cardiac Surgery Shandong Provincial Qianfoshan Hospitalthe First Hospital Affiliated with Shandong First Medical UniversityAffiliated Hospital of Shandong UniversityJinanShandongChina Department of Cardiology Linyi Central HospitalLinyiShandongChina Department of Gastroenterology Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityJinanShandongChina Department of Pulmonary and Critical care medicine the Affiliated Hospital of Qingdao UniversityQingdaoShandongChina Department of Cardiology Qilu Hospital of Shandong UniversityJinanShandongChina

Background:Pregnancy in women with pulmonary arterial hypertension(PAH)is a fatal condition,despite the effectiveness of PAH-specific *** coverage status and effect of specific therapies in pregnant patients with PAH without cardiac shunts in China remain *** investigate this issue,we conducted a multicenter retrospective study in northern ***:The study included 85 patients who were admitted to 4 clinical centers in Shandong Province between October 2010 and August *** endpoint events included(1)maternal death and/or(2)major adverse cardiac events,both occurring during pregnancy or within 6 weeks ***:Although the overall mortality rate was encouraging(11.8%),the number of patients receiving PAH-specific therapies was extremely low(28.2%).Moreover,only 15.3%of patients received adequate duration of PAH-specific therapy(≥4 weeks)before delivery,and this subgroup showed the lowest major adverse cardiac events rate(7.7%)compared with that in the untreated(19.7%)and short-time treated groups(<4 weeks;54.5%).Conclusion:Pregnant patients with PAH without cardiac shunts face significantly increased mortality ***-term PAH-specific therapy does not guarantee favorable maternal *** screening,early identification,and timely intervention are expected to improve maternal outcomes in pregnant women with PAH.

关键词： Major adverse cardiac events Maternal mortality Pregnancy outcome Pulmonary arterial hypertension Specific therapy

Risk Factors for Mortality in Acute Kidney Injury in intensive care Units in Togo

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Open Journal of Nephrology 2024年第1期14卷 37-47页

作者： Eyram Makafui Yoan Yawo Amekoudi Kossi Akomola Sabi Marcel David Keoula Badomta Dolaama Sarakawabalo Assenouwe Tabana Mouzou Department of Nephrology Kara University Hospital University of Kara Kara Togo Department of Nephrology and Haemodialysis Sylvanus Olympio University Hospital University of Lome Lomé Togo Department of Anaesthesia and intensive care University Hospital of Kara University of Kara Kara Togo

Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.

关键词： AKI intensive care Unit Dialysis Epidemiology Togo

Natural long-chain saturated fatty acids doped LNPs enabling spleen selective mRNA translation and potent cancer immunotherapy

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Nano Research 2024年第3期17卷 1804-1817页

作者： Fazhan Wang Meng Zhang Meiling Tian Jia Lou Longze Pan Xiaoke Gao Lijing Zhang Xiaohan Lou Linyu Zhu Yuqiao Sheng Ming Wang Rui Xue Wenjing Deng Shuai Shao Zhihai Qin Medical Research Center The First Affiliated Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhou 450052China Translational Medical Center The First Affiliated Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhou 450052China Department of Neuro-intensive care Unit The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Academy of Medical Sciences Zhengzhou UniversityZhengzhou 450052China

Rationally tailored lipid nanoparticles(LNPs)with efficient and tunable delivery of mRNA in vivo are crucial for mRNA *** expression of antigenic protein in lymphoid tissues/organs could improve the immunostimulatory efficacy and safety of LNPs-based mRNA *** by the metabolic behavior that long-chain saturated fatty acids tending to enter lymphoid tissue rather than the liver,we developed fatty acid-doped LNPs capable of mediating differential protein expressions in the liver and spleen when administered *** the molar ratio of saturated fatty acid located 60%–70%,the doped LNPs achieved the spleen selective mRNA *** mechanism could be attributed to the different cellular uptake behaviors of saturated fatty acids in *** with a model antigen(ovalbumin)mRNA-loaded spleen selective LNPs,we observed enhanced antigen-specific T cell immune responses,and potent immunotherapeutic and immunoprophylactic efficacy in the mouse lymphoma *** natural long-chain saturated fatty acids metabolic characteristics-inspired design of LNPs for spleen-selective mRNA vaccines delivery will provide references for designing mRNA vaccines with high efficacy and safety for tumor immunotherapy.

关键词： mRNA vaccine lipid nanoparticles spleen long-chain saturated fatty acid cancer immunotherapy

Role of mitochondrial dysfunction in kidney disease:Insights from the cGAS-STING signaling pathway

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Chinese Medical Journal 2024年第9期137卷 1044-1053页

作者： Lu Li Fei Liu Chunyue Feng Zhenjie Chen Nan Zhang Jianhua Mao Department of Nephrology Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouZhejiang 310052China Department of Pediatric intensive care Unit Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouZhejiang 310052China

Over the past decade,mitochondrial dysfunction has been investigated as a key contributor to acute and chronic kidney ***,the precise molecular mechanisms linking mitochondrial damage to kidney disease remain *** recent insights into the cyclic guanosine monophosphate-adenosine monophosphate(GMP-AMP)synthetase(cGAS)-stimulator of interferon gene(STING)signaling pathway have revealed its involvement in many renal *** of these findings is that mitochondrial DNA(mtDNA)induces inflammatory responses via the cGAS-STING ***,we provide an overview of the mechanisms underlying mtDNA release following mitochondrial damage,focusing specifically on the association between mtDNA release-activated cGAS-STING signaling and the development of kidney ***,we summarize the latest findings of cGAS-STING signaling pathway in cell,with a particular emphasis on its downstream signaling related to kidney *** review intends to enhance our understanding of the intricate relationship among the cGAS-STING pathway,kidney diseases,and mitochondrial dysfunction.

关键词： Mitochondrial dysfunction Mitochondrial DNA cGAS-STING pathway Kidney diseases Chronic kidney disease

Minimally invasive pelvic exenteration for primary or recurrent locally advanced rectal cancer:A glimpse into the future

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 1960-1964页

作者： Dimitrios Kehagias Charalampos Lampropoulos Ioannis Kehagias Department of General Surgery General University Hospital of PatrasPatras 26504Greece intensive care Unit Saint Andrew’s General HospitalPatras 26335Greece Division of Bariatric and Metabolic Surgery Department of SurgeryUniversity of PatrasPatras 26504Greece

Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer(LARC)for many *** main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative ***,pelvic exenteration(PE)with or without neoadjuvant treatment is a curative treatment when negative resection margins are *** traditional open approach has been favored by many ***,the technological advancements in minimally invasive surgery have radically changed the surgical *** studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE.A recent retrospective study entitled“Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review”was published in the World Journal of Gastrointestinal *** we read this article with great interest,we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for ***,the small number of suitable patients,limited surgeon experience,and steep learning curve are hindering the establishment of minimally invasive PE.

关键词： Locally advanced rectal cancer Pelvic exenteration Multivisceral resection Minimally invasive surgical procedures Robotic surgical procedures

Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance

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Journal of intensive medicine 2024年第3期4卷 355-361页

作者： Vasiliki Tsolaki Kyriaki Parisi George E.Zakynthinos Efrosini Gerovasileiou Nikitas Karavidas Vassileios Vazgiourakis Epaminondas Zakynthinos Demosthenes Makris intensive care Unit University Hospital of LarissaUniversity of Thessaly Faculty of MedicineLarissaGreece Third Cardiology Clinic University of AthensSotiria HospitalAthensGreece Respiratory Department University Hospital of LarissaUniversity of Thessaly Faculty of MedicineLarissaGreece

Background Sepsis is a life-threatening organ dysfunction,and septic cardiomyopathy(SCM)may complicate the course of the *** with multidrug-resistant(MDR)pathogens has been linked with worse *** study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant *** This retrospective study included patients with sepsis/septic shock,hospitalized,and intubated in the intensive care unit of the University Hospital of Larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection *** patients were divided into two groups:non-MDR-SCM group and MDR-SCM *** cardiac function was compared between the two *** A total of 62 patients were included in the ***-four patients comprised the MDR-SCM and 18 the non-MDR-SCM ***-six patients(41.9%)presented with left ventricular(LV)systolic dysfunction,and≤35%right ventricular fractional area change(RVFAC)was present in 56.4%.LV systolic function was more severely impaired in the non-MDR-SCM group(left ventricular ejection fraction,35.8%±4.9%vs.45.6%±2.4%,P=0.049;LV outflow tract velocity time integral,[10.1±1.4]cm vs.[15.3±0.74]cm,P=0.001;LV-Strain,–9.02%±0.9%vs.–14.02%±0.7%,P=0.001).The MDR-SCM group presented with more severe right ventricular(RV)dilatation(right ventricular end-diastolic area/left ventricular end-diastolic area,0.81±0.03 vs.0.7±0.05,P=0.042)and worse RV systolic function(RVFAC,32.3%±1.9%vs.39.6%±2.7%,P=0.035;tricuspid annular plane systolic excursion,[15.9±0.9]mm vs.[18.1±0.9]mm,P=0.165;systolic tissue Doppler velocity measured at the lateral tricuspid annulus,[9.9±0.5]cm/s vs.[13.1±0.8]cm/s,P=0.002;RV-strain,–11.1%±0.7%vs.–15.1%±0.9%,P=0.002).Conclusion SCM related to MDR infection presents with RV systolic dysfunction predominance,while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.

关键词： Septic cardiomyopathy Multidrug-resistant pathogen Left ventricular failure Right ventricular dysfunction Left/right ventricular longitudinal strain Ventriculoarterial Coupling

Nursing effect of narrative nursing intervention on postoperative patients with severe lung cancer

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World Journal of Clinical Cases 2024年第1期12卷 76-85页

作者： Bin Wen Ying Liu Xiao-Xia Min An-Qi Wang Department of intensive care Tongren Hospital of Wuhan University and Wuhan Third HospitalOptics Valley BranchWuhan 430074Hubei ProvinceChina The First Department of Thoracic Oncology Hubei Cancer Hospital Affiliated to Tongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430079Hubei ProvinceChina Department of Emergency medicine Taizhou First People's HospitalTaizhou 318020Zhejiang ProvinceChina

BACKGROUND Lung cancer is a common disease with high mortality,and psychological support is very important in the diagnosis and treatment of postoperative patients with cancer *** To explore the application effect of the narrative nursing method in postoperative lung cancer patients in the intensive care *** A total of 120 patients diagnosed with lung cancer and experiencing cancer-related pain were randomly allocated into two groups:an observation group and a control group,each consisting of 60 *** control group was given routine analgesic and psychological care,while the research group applied the five-step narrative nursing method based on routine care,comparing the visual analogue scale scores,sleep status,anxiety and depression status,and quality of life of the two groups of patients before and after the *** The pain scores,anxiety scores,and depression scores of the study group were lower than those of the control group after the intervention using the narrative nursing method,and the difference was statistically significant(P<0.05).CONCLUSION Using narrative nursing methods to intervene in patients with lung cancer combined with cancerous pain can help patients to correctly recognize their disease,adjust their mentality,establish confidence,alleviate patients'subjective pain feelings,and improve their adverse emotions.

关键词： Narrative care Lung cancer care unit Pain Quality of life

Predictive model for postpartum hemorrhage requiring hysterectomy in a minority ethnic region

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World Journal of Clinical Cases 2024年第22期12卷 4865-4872页

作者： Ling Wang Jun-Yu Pan intensive care Unit People's Hospital of Qiandongnan Miao and Dong Autonomous PrefectureKaili 556000Guizhou ProvinceChina

BACKGROUND Postpartum hemorrhage(PPH)is a leading cause of maternal mortality,and hysterectomy is an important intervention for managing intractable *** predicting the need for hysterectomy and taking proactive emergency measures is crucial for reducing mortality *** To develop a risk prediction model for PPH requiring hysterectomy in the ethnic minority regions of Qiandongnan,China,to help guide clinical *** The study included 23490 patients,with 1050 having experienced PPH and 74 who underwent *** independent risk factors closely associated with the necessity for hysterectomy were analyzed to construct a risk prediction model,and its predictive efficacy was subsequently *** The proportion of hysterectomies among the included patients was 0.32%(74/23490),representing 7.05%(74/1050)of PPH *** number of deliveries,history of cesarean section,placenta previa,uterine atony,and placenta accreta were identified in this population as independent risk factors for requiring a *** operating characteristic curve analysis of the prediction model showed an area under the curve of 0.953(95%confidence interval:0.928-0.978)with a sensitivity of 90.50%and a specificity of 90.70%.CONCLUSION The model demonstrates excellent predictive power and is effective in guiding clinical decisions regarding PPH in the ethnic minority regions of Qiandongnan,China.

关键词： Region Ethnicity Postpartum hemorrhage Hysterectomy Risk factors Prediction