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Blood–brain barrier dysfunction in intensive care unit

Journal of intensive Medicine 2023年第4期3卷 303-312页

作者： Loic Le Guennec Nicolas Weiss Département de neurologie Sorbonne UniversitéAP-HP Sorbonne UniversitéHôpital de la Pitié-SalpêtrièreUnitéde Médecine Intensive Réanimationàorientation neurologiqueParis 75013France Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE(GRC-RESPIRE)Sorbonne Université Paris 75013France Brain liver Pitié-Salpêtrière(BLIPS)Study Group INSERM UMR_S 938Centre de recherche Saint-AntoineMaladies métaboliquesBiliaires et fibro-inflammatoire du foieInstitute of Cardiometabolism and Nutrition(ICAN)Paris 75013France

The central nervous system is characterized by a peculiar vascularization termed blood–brain barrier(BBB),which regulates the exchange of cells and molecules between the cerebral tissue and the whole *** dysfunction is a life-threatening condition since its presence corresponds to a marker of severity in most diseases encountered in the intensive care unit(ICU).During critical illness,inflammatory response,cytokine release,and other phenomena activating the brain endothelium contribute to alterations in the BBB and increase its permeability to solutes,cells,nutrients,and ***,patients in the ICU are often old,with underlying acute or chronic diseases,and overly medicated due to their critical condition;these factors could also contribute to the development of BBB *** accurate diagnostic approach is critical for the identification of the mechanisms underlying BBB alterations,which should be rapidly managed by *** methods were developed to investigate the BBB and assess its ***,in humans,exploration of the BBB requires the use of indirect *** and biochemical methods can be used to study the abnormal passage of molecules through the *** this review,we describe the structural and functional characteristics of the BBB,present tools and methods for probing this interface,and provide examples of the main diseases managed in the ICU that are related to BBB dysfunction.

关键词： Blood–brain barrier ICU hepatic encephalopathy Delirium Extracorporeal membrane oxygenation(ECMO) Acute bacterial meningitis

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Clinical Epidemiology,Illness Profiles,and the Implication of COVID-19 Before and After the Nationwide Omicron Outbreak During the Winter of 2022

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Infectious Diseases & Immunity 2023年第4期3卷 176-185页

作者： Yuming Guo Zhe Xu Wen-Xin Wang Cheng Zhen Jinhua Hu Jinsong Mu Chengcheng Ji Xin Yuan Ruonan Xu Lei Huang Lei Shi Fanping Meng Junliang Fu Shuangnan Zhou Siyu Wang Fengyi Li Bo Tu Dawei Zhang Huihuang Huang Yufeng Mao Wen Xu Chao Zhang Xiuying Mu Jun Zhao Bo Jin Haibin Su Yinying Lu Yongqian Cheng Dong Ji Shaoli You Jinghui Dong Changchun Liu Mengmeng Zhang Yuanyuan Li Tianjun Jiang Yonggang Li Fu-Sheng Wang Senior Department of Infectious Diseases the Fifth Medical Center of Chinese People's Liberation Army(PLA)General HospitalNational Clinical Research Center for Infectious DiseasesBeijing 100039China Senior Department of Hepatology the Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China Institute of intensive Care unit the Fifth Medical Center of Chinese PLA HospitalBeijing 100039China Comprehensive liver Cancer the Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China Department of Geriatrics the Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China Department of Radiology the Fifth Medical Center of Chinese PLA General HospitalBeijing 100039China

*** this study,we aimed to investigate the clinical characteristics and outcomes of patients with coronavirus disease 2019(COVID-19)in the Beijing ***:In this retrospective study,we enrolled inpatients admitted for COVID-19 in the Fifth Medical Center of Chinese PLA General Hospital in Beijing between November 10,2022,and January 30,*** and clinical features and treatment outcomeswere comprehensively *** used logistic regression and linear regression analyses to explore the risk factors associated with disease severity and time of nucleic acid conversion,***:A total of 1010 hospitalized patients with COVID-19 were *** median age was 43.0 years(interquartile range,28.0–63.0),and patients aged7 pg/mL,lactic dehydrogenase level>245 U/L,cough,and fever at ***≥80 years and chronic lung diseasewere independent risk factors in the nonmild group in elderly *** addition,the duration for nucleic acid to turn negativewas approximately 5.0 d(interquartile range,3.0–7.0).Prolonged time of nucleic acid conversion was associated with age≥60 years,serum urea nitrogen level>8

关键词： Beijing COVID-19 Disease severity Elderly Nucleic acid conversion Omicron variant

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Molecular mechanism and therapeutic targeting of necrosis,apoptosis,pyroptosis,and autophagy in cardiovascular disease

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Chinese Medical Journal 2021年第22期134卷 2647-2655页

作者： Pan Li Xiao-Rong Dong Bei Zhang Xin-Tong Zhang Jing-Zhuo Liu De-Sheng Ma Li Ma Department of Emergency Hong Hui HospitalXi’an Jiaotong UniversityXi’anShaanxi 710054China Department of Emergency intensive Care unit Lanzhou University of Second HospitalLanzhouGansu 730030China

Cell death occurs in various tissues and organs in the *** is a physiological or pathological process that has different *** is of great significance in maintaining the morphological function of cells and clearing abnormal ***,apoptosis,and necrosis are all modes of cell death that have been studied extensively by many experts and scholars,including studies on their effects on the liver,kidney,the heart,other organs,and even the whole *** heart,as the most important organ of the body,should be a particular *** review summarizes the mechanisms underlying the various cell death modes and the relationship between the various mechanisms and heart *** current research status for heart therapy is discussed from the perspective of pathogenesis.

关键词： Cell death Apoptosis Necrosis Pyroptosis Autophagy Pathogenesis Treatment

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Biomarkers of Metabolic(Dysfunction)-associated Fatty liver Disease:An Update

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Journal of Clinical and Translational Hepatology 2022年第1期10卷 134-139页

作者： Jawaher Alharthi Mohammed Eslam Storr liver Centre Westmead Institute for Medical ResearchWestmead Hospital and University of SydneySydneyNSWAustralia Department of Biotechnology Faculty of ScienceTaif UniversityTaifSaudi Arabi

The prevalence of metabolic(dysfunction)-associated fatty liver disease(MAFLD)is rapidly increasing and affects up to two billion individuals globally,and this has also resulted in increased risks for cirrhosis,hepatocellular carcinoma,and liver *** addition,it has also been linked to extrahepatic consequences,such as cardiovascular disease,diabetes,and various types of ***,only a small proportion of patients with MAFLD develop these ***,the identification of high-risk patients is *** fibrosis is the major determinant in developing these ***,liver biopsy is still considered the gold standard for the assessment of patients with *** of its invasive nature,among many other limitations,the search for noninvasive biomarkers for MAFLD remains an area of intensive *** this review,we provide an update on the current and future biomarkers of MAFLD,including a discussion of the associated genetics,epigenetics,microbiota,and *** also touch on the next wave of multiomic-based biomarkers.

关键词： Biomarkers Metabolic(dysfunction)-associated fatty liver disease Scores

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Anabolic steroid-induced cardiomyopathy underlying acute liver failure in a young bodybuilder

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World Journal of Gastroenterology 2009年第23期15卷 2920-2922页

作者： Miguel Bispo Ana Valente Rosário Maldonado Rui Palma Helena Glória Joo Nóbrega Paula Alexandrino intensive Care unit of Gastroenterology and Hepatology Santa Maria University Hospital 1069-166 Lisbon Portugal Department of Gastroenterology Egas Moniz Hospital 1349-019 Lisbon Portugal Coronary Care unit Santa Maria University Hospital 1069-166 Lisbon Portugal

Heart failure may lead to subclinical circulatory disturbances and remain an unrecognized cause of ischemic liver injury. We present the case of a previously healthy 40-year-old bodybuilder, referred to our intensive-Care unit of Hepatology for treatment of severe acute liver failure, with the suspicion of toxic hepatitis associated with anabolic steroid abuse. Despite the absence of symptoms and signs of congestive heart failure at admission, an anabolic steroid-induced dilated cardiomyopathy with a large thrombus in both ventricles was found to be the underlying cause of the liver injury. Treatment for the initially unrecognized heart failure rapidly restored liver function to normal. To our knowledge, this is the f irst reported case of severe acute liver failure due to an unrecognized anabolic steroid-induced cardiomyopathy. Awareness of this unique presentation will allow for prompt treatment of this potentially fatal cause of liver failure.

关键词：肝功能衰竭蛋白合成类固醇心肌病急性健美充血性心力衰竭无法识别

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Prevalence, diagnosis, treatment, and associated factors of hepatitis C in the united States from 1999 to 2018: A population-based cross- sectional study

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liver Research 2022年第4期6卷 284-288页

作者： Congnan Zhang Jiahui Lu Yajing Zhang Pengyuan He Jinyu Xia Mingxing Huang Department of Infectious Diseases The Fifth Affiliated Hospital of Sun Yat-sen UniversityZhuhaiGuangdongChina intensive Care unit Jiangmen Central HospitalJiangmenGuangdongChina Sino-French Institute of Nuclear Engineering and Technology Sun Yat-sen UniversityGuangzhouGuangdongChina Office of the Dean The Third People's Hospital of ZhuhaiZhuhaiGuangdongChina

Background and aim:Hepatitis C virus(HCV)infection is one of the major global health challenges,leading to a significant increase in rates of hepatic fibrosis,cirrhosis and hepatocellular carcinoma.A comprehensive nationwide survey of trends in prevalence and associated factors could facilitate pre-ventive behavioral ***,we sought to determine prevalence,diagnosis,treatment,and risk factors for HCV infection in the general united States(US)***:This was a secondary analysis of the publicly available data from the US National Health and Nutrition Examination Survey(NHANES).The prevalence of HCV-RNA-positive(HCV-RNAþ)was weighted using patient serum sample data collected from 1999 to 2018.A propensity score matching model was used due to the imbalance in the number of HCV-RNAþand HCV-RNA-negative(HCV-RNA?)*** variables included gender,age,educational level,marital status,language,household size,alcohol consumption,smoking,number of family members and family income to poverty ***:The weighted prevalence of HCV-RNAþwas 1.11%(95%confidence interval(CI):1.02e1.20),1.58%(95%CI:1.42e1.74)for men and 0.67%(95%CI:0.57e0.77)for women aged 20 years or older in the US from 1999 to *** weighted prevalence of HCV-RNAþincreased from 0.87%(95%CI:0.62e1.12)in 2013e2014,0.95%(95%CI:0.68e1.22)in 2015e2016 to 1.00%(95%CI:0.72e1.28)in 2017e2018,*** propensity-matched analysis,patients with HCV-RNAþwere more likely to be non-Hispanic black,and have had drug use and blood ***,the weighted diagnostic and treatment rates were 56.27%(95%CI:50.90e61.64)and 35.40%(95%CI:27.64e43.16)from 1999 to 2018,***:Active HCV infection rate increased between 2013 and 2018,varied by demographic and risk *** the direct-acting antiviral era,affordable treatment and universal screening have the potential to improve overall national health.

关键词： Hepatitis C virus(HCV) Epidemiology Risk factors united States HCV-RNA

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Perioperative thromboprophylaxis in liver transplant patients

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World Journal of Gastroenterology 2018年第27期24卷 2931-2948页

作者： Lesley De Pietri Roberto Montalti Daniele Nicolini Roberto Ivan Troisi Federico Moccheggiani Marco Vivarelli Division of Anaesthesiology and intensive Care unit Department of General SurgeryAUSL Reggio Emilia-IRCCSReggio Emilia 42123Italy Hepatobiliary and Abdominal Transplantation Surgery Department of Experimental and Clinical MedicinePolytechnic University of MarcheAncona 60126Italy Department of General Hepatobiliary and Liver Transplantation SurgeryGhent University Hospital Medical SchoolGhent 185 3K3 9000Belgium

Improvements in surgical and anesthetic procedures have increased patient survival after liver transplantation(LT). However, the perioperative period of LT can still be affected by several complications. Among these, thromboembolic complications(intracardiac thrombosis, pulmonary embolism, hepatic artery and portal vein thrombosis) are relatively common causes of increased morbidity and mortality. The benefit of thromboprophylaxis in general surgical patients has already been established, but it is not the standard of care in LT recipients. LT is associated with a high bleeding risk, as it is performed in a setting of already unstable hemostasis. For this reason, the role of routine perioperative prophylactic anticoagulation is usually restricted. However, recent data have shown that the bleeding tendency of cirrhotic patients is not an expression of an acquired bleeding disorder but rather of coexisting factors(portal hypertension, hypervolemia and infections). Furthermore, in cirrhotic patients, the new paradigm of ‘‘rebalanced hemostasis' ' can easily tip towards hypercoagulability because of the recently described enhanced thrombin generation, procoagulant changes in fibrin structure and platelet hyperreactivity. This new coagulation balance, along with improvements in surgical techniques and critical support, has led to a dramatic reduction in transfusion requirements, and the intraoperative thromboembolic-favoring factors(venous stasis, vessels clamping, surgical injury) have increased the awareness of thrombotic complications and led clinicians to reconsider the limited use of anticoagulants or antiplatelets in the postoperative period of LT.

关键词： Anticoagulation liver transplantation Antiplatelets Thrombosis Coagulation Heparin Thromboelastography Thromboprophylaxis Hepatic artery thrombosis Portal vein thrombosis

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Invasive fungal infection before and after liver transplantation

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World Journal of Gastroenterology 2020年第47期26卷 7485-7496页

作者： Alberto Ferrarese Annamaria Cattelan Umberto Cillo Enrico Gringeri Francesco Paolo Russo Giacomo Germani Martina Gambato Patrizia Burra Marco Senzolo Multivisceral Transplant unit Padua University HospitalPadua 35128Italy Tropical and Infectious Disease unit Padua University HospitalPadua 35128Italy Padua University Hospital Hepatobiliary Surgery and Liver Transplant CenterPadua 35128Italy

Invasive infections are a major complication before liver transplantation(LT)and in the early phase after *** has been an increasing prevalence of invasive fungal disease(IFD),especially among the sickest patients with decompensated cirrhosis and acute-on-chronic liver failure,who suffer from a profound state of immune dysfunction and receive intensive care *** such patients,who are listed for LT,development of an IFD often worsens hepatic and extra-hepatic organ dysfunction,requiring a careful evaluation before *** the post-transplant setting,the burden of IFD has been reduced after the clinical advent of antifungal prophylaxis,even if several major issues still remain,such as duration,target population and drug type(s).Nevertheless,the development of IFD in the early phase after surgery significantly impairs graft and patient *** review outlines presentation,prophylactic and therapeutic strategies,and outcomes of IFD in LT candidates and recipients,providing specific considerations for clinical practice.

关键词： Acute-on-chronic liver failure Sepsis Cirrhosis Candidemia Acute liver failure Invasive fungal infection

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Acute renal dysfunction in liver diseases

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世界胃肠病学杂志：英文版 2007年第42期13卷 5552-5559页

作者： Alex P Betrosian Banwari Agarwal Emmanuel E Douzinas Third Department of Critical Care Athens University Evgenidion Hospital Papadiamantopoulou 20 Athens 11528 Greece intensive therapy unit Royal Free Hospital London United Kingdom

Renal dysfunction is common in liver diseases,either as part of multiorgan involvement in acute illness or secondary to advanced liver *** presence of renal impairment in both groups is a poor prognostic *** failure is often multifactorial and can present as pre-renal or intrinsic renal *** or post renal dysfunction only rarely complicates liver *** syndrome(HRS)is a unique form of renal failure associated with advanced liver disease or cirrhosis,and is characterized by functional renal impairment without significant changes in renal *** of the type of renal failure,renal hypoperfusion is the central pathogenetic mechanism,due either to reduced perfusion pressure or increased renal vascular *** expansion,avoidance of precipitating factors and treatment of underlying liver disease constitute the mainstay of therapy to prevent and reverse renal *** vasoconstrictor agents,such as terlipressin,along with volume expansion,and early placement of transjugular intrahepatic portosystemic shunt(TIPS)may be effective in improving renal function in *** renal replacement therapy(CRRT)and molecular absorbent recirculating system(MARS)in selected patients may be life saving while awaiting liver transplantation.

关键词：肝病急性肾机能障碍肝肾综合征肝衰竭

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Cholangiojejunostomy for multiple biliary ducts in living donor liver transplantation: A case report

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World Journal of Clinical Cases 2021年第11期9卷 2649-2654页

作者： Fei Xiao Li-Ying Sun Lin Wei Zhi-Gui Zeng Wei Qu Ying Liu Hai-Ming Zhang Zhi-Jun Zhu liver Transplantation Center National Clinical Research Center for Digestive DiseasesBeijing Friendship HospitalCapital Medical UniversityBeijing 100050China Department of Organ Transplantation Liao Cheng People's HospitalLiaocheng 252000Shandong ProvinceChina Clinical Center for Pediatric liver Transplantation Capital Medical UniversityBeijing 100050China Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation Capital Medical UniversityBeijing 100050China Department of intensive Care unit Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China liver Transplantation Center National Clinical Research Center for Digestive DiseasesCapital Medical UniversityBeijing 100050China

BACKGROUND Laparoscopic living donor hepatectomy(LLDH)has been successfully carried out in several transplant *** reconstruction is key in living donor liver transplantation(LDLT).Reliable biliary reconstruction can effectively prevent postoperative biliary stricture and *** preoperative magnetic resonance cholangiopancreatography and intraoperative indocyanine green cholangiography have been shown to be helpful in determining optimal division points,biliary variability and limitations associated with LLDH,multiple biliary tracts are often encountered during surgery,which inhibits biliary reconstruction.A reliable cholangiojejunostomy for multiple biliary ducts has been utilized in *** procedure provides a reference for multiple biliary reconstructions after *** SUMMARY A 2-year-old girl diagnosed with ornithine transcarbamylase deficiency required liver *** to the scarcity of deceased donors,she was put on the waiting list for *** father was a suitable donor;however,after a rigorous evaluation,preoperative magnetic resonance cholangiopancreatography examination of the donor indicated the possibility of multivessel variation in the biliary ***,a laparoscopic left lateral section was performed on the donor,which met the estimated graft-to-recipient weight *** intraoperative indocyanine green cholangiography,4 biliary tracts were confirmed in the *** was difficult to reform the intrahepatic bile ducts due to their openings of more than 5 mm.A reliable cholangiojejunostomy was,therefore,utilized:Suture of the jejunum to the adjacent liver was performed around the bile duct openings with 6/0 absorbable *** the last follow-up(1 year after surgery),the patient was *** Intrahepatic cholangiojejunostomy is reliable for multiple biliary ducts after LLDH in LDLT.

关键词： Cholangiojejunostomy Living donor liver transplantation Laparoscopic left lateral section Multiple biliary ducts Treatment Case report

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