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Tian R, Li R, Chen Y, Liu D, Li Y, He S, Pan T, Qu H, Tan R. Shenfu injection ameliorates endotoxemia-associated endothelial dysfunction and organ injury via inhibiting PI3K/Akt-mediated glycolysis. JOURNAL OF ETHNOPHARMACOLOGY 2024; 335:118634. [PMID: 39089657 DOI: 10.1016/j.jep.2024.118634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 07/05/2024] [Accepted: 07/26/2024] [Indexed: 08/04/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Microcirculatory dysfunction is one of the main characteristics of sepsis. Shenfu Injection (SFI) as a traditional Chinese medicine is widely applied in clinical severe conditions. Recent studies have shown that SFI has the ability to ameliorate sepsis-induced inflammation and to improve microcirculation perfusion. AIM OF THE STUDY This study aims to investigate the underlying mechanism of SFI for ameliorating sepsis-associated endothelial dysfunction and organ injury. MATERIALS AND METHODS Side-stream dark-field (SDF) imaging was used to monitor the sublingual microcirculation of septic patients treated with or without SFI. Septic mouse model was used to evaluate the effects of SFI in vivo. Metabolomics and transcriptomics were performed on endothelial cells to identify the underlying mechanism for SFI-related protective effect on endothelial cells. RESULTS SFI effectively abolished the disturbance and loss of sublingual microcirculation in septic patients. Twenty septic shock patients with or without SFI administration were enrolled and the data showed that SFI significantly improved the levels of total vessel density (TVD), perfused vessel density (PVD), microvascular flow index (MFI), and the proportion of perfused vessels (PPV). The administration of SFI significantly decreased the elevated plasma levels of Angiopoietin-2 (Ang2) and Syndecan-1, which are biomarkers indicative of endothelial damage in sepsis patients. In the mouse septic model in vivo, SFI inhibited the upregulation of endothelial adhesion molecules and Ly6G + neutrophil infiltration while restored the expression of VE-Cadherin in the vasculature of the lung, kidney, and liver tissue. Additionally, SFI reduced the plasma levels of Ang2, Monocyte Chemoattractant Protein-1(MCP1), and Interleukin-6 (IL6), and alleviated liver and kidney injury in septic mice. Moreover, SFI significantly inhibited the inflammatory activation and increased permeability of endothelial cells induced by endotoxins in vitro. By performing metabolomics and transcriptomics, we identified the activation of PI3K/Akt-mediated glycolysis as the underlying mechanism for SFI-related protective effect on endothelial cells. CONCLUSIONS Our findings revealed that SFI may improve microcirculation perfusion and endothelial function in sepsis via inhibiting PI3K/Akt-mediated glycolysis, providing theoretical evidence for the clinical application of SFI.
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Affiliation(s)
- Rui Tian
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Ranran Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Yang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Di Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Yinjiaozhi Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Shiyuan He
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Ruoming Tan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.
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Su QY, Chen WJ, Zheng YJ, Shi W, Gong FC, Huang SW, Yang ZT, Qu HP, Mao EQ, Wang RL, Zhu DM, Zhao G, Chen W, Wang S, Wang Q, Zhu CQ, Yuan G, Chen EZ, Chen Y. Development and external validation of a nomogram for the early prediction of acute kidney injury in septic patients: a multicenter retrospective clinical study. Ren Fail 2024; 46:2310081. [PMID: 38321925 PMCID: PMC10851832 DOI: 10.1080/0886022x.2024.2310081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/21/2024] [Indexed: 02/08/2024] Open
Abstract
Background and purpose: Acute kidney injury (AKI) is a common serious complication in sepsis patients with a high mortality rate. This study aimed to develop and validate a predictive model for sepsis associated acute kidney injury (SA-AKI). Methods: In our study, we retrospectively constructed a development cohort comprising 733 septic patients admitted to eight Grade-A tertiary hospitals in Shanghai from January 2021 to October 2022. Additionally, we established an external validation cohort consisting of 336 septic patients admitted to our hospital from January 2017 to December 2019. Risk predictors were selected by LASSO regression, and a corresponding nomogram was constructed. We evaluated the model's discrimination, precision and clinical benefit through receiver operating characteristic (ROC) curves, calibration plots, decision curve analysis (DCA) and clinical impact curves (CIC) in both internal and external validation. Results: AKI incidence was 53.2% in the development cohort and 48.2% in the external validation cohort. The model included five independent indicators: chronic kidney disease stages 1 to 3, blood urea nitrogen, procalcitonin, D-dimer and creatine kinase isoenzyme. The AUC of the model in the development and validation cohorts was 0.914 (95% CI, 0.894-0.934) and 0.923 (95% CI, 0.895-0.952), respectively. The calibration plot, DCA, and CIC demonstrated the model's favorable clinical applicability. Conclusion: We developed and validated a robust nomogram model, which might identify patients at risk of SA-AKI and promising for clinical applications.
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Affiliation(s)
- Qin-Yue Su
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Jie Chen
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan-Jun Zheng
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Shi
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang-Chen Gong
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shun-Wei Huang
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-tao Yang
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong-Ping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - En-Qiang Mao
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui-Lan Wang
- Department of Emergency Medicine, Shanghai First People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Du-Ming Zhu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Gang Zhao
- Department of Emergency Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Chen
- Department of Critical Care Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sheng Wang
- Department of Critical Care Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qian Wang
- Department of Emergency Medicine, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chang-Qing Zhu
- Department of Emergency Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gao Yuan
- Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Er-Zhen Chen
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ru X, Chen S, Chen D, Shao Q, Shao W, Ye Q. Simulating the clinical manifestations and disease progression of human sepsis: A monobacterial injection approach for animal modeling. Virulence 2024; 15:2395835. [PMID: 39219264 PMCID: PMC11370922 DOI: 10.1080/21505594.2024.2395835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, with great clinical heterogeneity, high morbidity, and high mortality. At the same time, there are many kinds of infection sources, the pathophysiology is very complex, and the pathogenesis has not been fully elucidated. An ideal animal model of sepsis can accurately simulate clinical sepsis and promote the development of sepsis-related pathogenesis, treatment methods, and prognosis. The existing sepsis model still uses the previous Sepsis 2.0 modelling standard, which has some problems, such as many kinds of infection sources, poor repeatability, inability to take into account single-factor studies, and large differences from clinical sepsis patients. To solve these problems, this study established a new animal model of sepsis. The model uses intravenous tail injection of a single bacterial strain, simplifying the complexity of multibacterial infection, and effectively solving the above problems.
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Affiliation(s)
- Xuanwen Ru
- Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Simiao Chen
- Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Danlei Chen
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qingyi Shao
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenxia Shao
- Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Ye
- Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Franco Palacios CR, Hoxhaj R, Thigpen C, Jacob J. Factors associated with post-hospitalization dialysis dependence in ECMO patients who required continuous renal replacement therapy. Ren Fail 2024; 46:2343810. [PMID: 38655876 PMCID: PMC11044754 DOI: 10.1080/0886022x.2024.2343810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE This single center retrospective study aimed to describe the variables associated with outpatient dialysis dependence in extracorporeal membrane oxygenation (ECMO) patients who needed continuous renal replacement therapy (CRRT) for acute kidney injury (AKI) during their hospitalization. METHODS Retrospective study of patients who required ECMO-CRRT. RESULTS Between the years of 2016 and 2022, 202 patients required ECMO-CRRT. One hundred and six patients (52.5%) survived their hospitalization and were followed up for a median of 391 [133, 1005] days. Eighty-one patients (76.5%) recovered kidney function and were dialysis-free before hospital discharge. Twenty-five patients (23.5%) were hemodialysis-dependent after hospitalization. On multivariate regression analysis, hyperlipidemia (odds ratio, OR 6.08 [1.67-22]) and CRRT duration (OR 1.09 [1.03-1.15]) were associated with the need for dialysis post-hospitalization. In this group, 16 patients eventually became dialysis-free, after a median of 49 [34.7, 78.5] days. These patients had a higher median baseline glomerular filtration rate (GFR) compared to those who never recovered renal function (93 mL/min/1.73 m2 [82.4, 104.3] vs. 63.8 mL/min/1.73 m2 [37.9, 83], p = .009). Their follow-up GFR was lower compared to those who recovered renal function before hospital discharge; (87 mL/min/1.73 m2 [68.2, 98.9] vs. 99 mL/min/1.73 m2 [79, 118], p = .07). CONCLUSIONS AKI requiring CRRT was associated with high mortality in patients receiving ECMO. Nonetheless, most ECMO survivors became dialysis-free before hospital discharge. Variables associated with the need for outpatient dialysis included hyperlipidemia and prolonged need for CRRT during hospitalization.
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Affiliation(s)
| | - Rudiona Hoxhaj
- Internal Medicine, WellStar Health System, Marietta, GA, USA
| | - Catlyn Thigpen
- Internal Medicine, WellStar Health System, Marietta, GA, USA
| | - Jeffrey Jacob
- Internal Medicine, WellStar Health System, Marietta, GA, USA
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Wang B, Xu M, Fu S, Wang Y, Ling H, Li Y, Li B, Liu X, Ouyang Q, Zhang X, Li A, Zhang X, Liu M. Tiny clue reveals the general trend: a bibliometric and visualized analysis of renal microcirculation. Ren Fail 2024; 46:2329249. [PMID: 38482598 PMCID: PMC10946277 DOI: 10.1080/0886022x.2024.2329249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Renal microcirculation plays a pivotal role in kidney function by maintaining structural and functional integrity, facilitating oxygen and nutrient delivery, and waste removal. However, a thorough bibliometric analysis in this area remains lacking. Therefore, we aim to provide valuable insights through a bibliometric analysis of renal microcirculation literature using the Web of Science database. METHODS We collected renal microcirculation-related publications from the Web of Science database from January 01, 1990, to December 31, 2022. The co-authorship of authors, organizations, and countries/regions was analyzed with VOSviewer1.6.18. The co-occurrence of keywords and co-cited references were analyzed using CiteSpace6.1.R6 software to generate visualization maps. Additionally, burst detection was applied to keywords and cited references to forecast research hotspots and future trends. RESULTS Our search yielded 7462 publications, with the American Journal of Physiology-Renal Physiology contributing the most articles. The United States, Mayo Clinic, and Lerman Lilach O emerged with the highest publication count, indicating their active collaborations. 'Type 2 diabetes' was the most significant keyword cluster, and 'diabetic kidney disease' was the largest cluster of cited references. 'Cardiovascular outcome' and 'diabetic kidney diseases' were identified as keywords in their burst period over the past three years. CONCLUSION Our bibliometric analysis illuminates the contours of nephrology and microcirculation research, revealing a landscape ripe for challenges and the seeds of future scientific innovation. While the trends discerned from the literature emerging opportunities in diagnostic innovation, renal microcirculation research, and precision medicine interventions, their translation to clinical practice is anticipated to be a deliberate process.
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Affiliation(s)
- Bing Wang
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Mengting Xu
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sunjing Fu
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingyu Wang
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Ling
- Department of Radiology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Yuan Li
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bingwei Li
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xueting Liu
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qin Ouyang
- Department of Pathology, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Xiaoyan Zhang
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ailing Li
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Zhang
- Laboratory of Electron Microscopy, Ultrastructural Pathology Center, Peking University First Hospital, Beijing, China
| | - Mingming Liu
- Institute of Microcirculation, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- International Center of Microvascular Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Diabetes Research Center, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Wright SW, Ekchariyawat P, Sengyee S, Phunpang R, Dulsuk A, Saiprom N, Thiansukhon E, Pattanapanyasat K, Korbsrisate S, West TE, Chantratita N. Dysfunctional host cellular immune responses are associated with mortality in melioidosis. Emerg Microbes Infect 2024; 13:2380822. [PMID: 39008280 PMCID: PMC11293272 DOI: 10.1080/22221751.2024.2380822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/04/2024] [Accepted: 07/12/2024] [Indexed: 07/16/2024]
Abstract
Melioidosis is a tropical infection caused by the intracellular pathogen Burkholderia pseudomallei, an underreported and emerging global threat. As melioidosis-associated mortality is frequently high despite antibiotics, novel management strategies are critically needed. Therefore, we sought to determine whether functional changes in the host innate and adaptive immune responses are induced during acute melioidosis and are associated with outcome. Using a unique whole blood stimulation assay developed for use in resource-limited settings, we examined induced cellular functional and phenotypic changes in a cohort of patients with bacteremic melioidosis prospectively enrolled within 24 h of positive blood culture and followed for 28 days. Compared to healthy controls, melioidosis survivors generated an IL-17 response mediated by Th17 cells and terminally-differentiated effector memory CD8+ T cells (P < .05, both), persisting to 28 days after enrolment. Furthermore, melioidosis survivors developed polyfunctional cytokine production in CD8+ T cells (P < .01). Conversely, a reduction in CCR6+ CD4+ T cells was associated with higher mortality, even after adjustments for severity of illness (P = 0.004). Acute melioidosis was also associated with a profound acute impairment in monocyte function as stimulated cytokine responses were reduced in classical, intermediate and non-classical monocytes. Impaired monocyte cytokine function improved by 28-days after enrolment. These data suggest that IL-17 mediated cellular responses may be contributors to host defense during acute melioidosis, and that innate immune function may be impaired. These insights could provide novel targets for the development of therapies and vaccine targets in this frequently lethal disease.
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Affiliation(s)
- Shelton W. Wright
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Peeraya Ekchariyawat
- Department of Microbiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Sineenart Sengyee
- Department of Microbiology and Immunology, Reno School of Medicine, University of Nevada, Reno, NV, USA
| | - Rungnapa Phunpang
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Adul Dulsuk
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Natnaree Saiprom
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Kovit Pattanapanyasat
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Center of Excellence for Microparticle and Exosome in Diseases, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunee Korbsrisate
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - T. Eoin West
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Narisara Chantratita
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Fan Q, Chang H, Tian L, Zheng B, Liu R, Li Z. Methane saline suppresses ferroptosis via the Nrf2/HO-1 signaling pathway to ameliorate intestinal ischemia-reperfusion injury. Redox Rep 2024; 29:2373657. [PMID: 39023011 PMCID: PMC11259071 DOI: 10.1080/13510002.2024.2373657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVES Intestinal ischemia-reperfusion (I/R) injury is a multifactorial and complex clinical pathophysiological process. Current research indicates that the pathogenesis of intestinal I/R injury involves various mechanisms, including ferroptosis. Methane saline (MS) has been demonstrated to primarily exert anti-inflammatory and antioxidant effects in I/R injury. In this study, we mainly investigated the effect of MS on ferroptosis in intestinal I/R injury and determined its potential mechanism. METHODS In vivo and in vitro intestinal I/R injury models were established to validate the relationship between ferroptosis and intestinal I/R injury. MS treatment was applied to assess its impact on intestinal epithelial cell damage, intestinal barrier disruption, and ferroptosis. RESULTS MS treatment led to a reduction in I/R-induced intestinal epithelial cell damage and intestinal barrier disruption. Moreover, similar to treatment with ferroptosis inhibitors, MS treatment reduced ferroptosis in I/R, as indicated by a decrease in the levels of intracellular pro-ferroptosis factors, an increase in the levels of anti-ferroptosis factors, and alleviation of mitochondrial damage. Additionally, the expression of Nrf2/HO-1 was significantly increased after MS treatment. However, the intestinal protective and ferroptosis inhibitory effects of MS were diminished after the use of M385 to inhibit Nrf2 in mice or si-Nrf2 in Caco-2 cells. DISCUSSION We proved that intestinal I/R injury was mitigated by MS and that the underlying mechanism involved modulating the Nrf2/HO-1 signaling pathway to decrease ferroptosis. MS could be a promising treatment for intestinal I/R injury.
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Affiliation(s)
- Qingrui Fan
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
- Xi’an Medical University, Xi’an, People’s Republic of China
| | - Hulin Chang
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
- Department of Hepatobiliary Surgery, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - Lifei Tian
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - Ruiting Liu
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
| | - Zeyu Li
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China
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8
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Castro R, Born P, Roessler E, Labra C, McNab P, Bravo S, Soto D, Kattan E, Hernández G, Bakker J. Preload responsiveness-guided fluid removal in mechanically ventilated patients with fluid overload: A comprehensive clinical-physiological study. J Crit Care 2024; 84:154901. [PMID: 39197236 DOI: 10.1016/j.jcrc.2024.154901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/07/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024]
Abstract
This study investigated fluid removal strategies for critically ill patients with fluid overload on mechanical ventilation. Traditionally, a negative fluid balance (FB) is aimed for. However, this approach can have drawbacks. Here, we compared a new approach, namely removing fluids until patients become fluid responsive (FR) to the traditional empiric negative balance approach. Twelve patients were placed in each group (n = 24). FR assessment was performed using passive leg raising (PLR). Both groups maintained stable blood pressure and heart function during fluid management. Notably, the FR group weaned from the ventilator significantly faster than negative FB group (both for a spontaneous breathing trial (14 h vs. 36 h, p = 0.031) and extubation (26 h vs. 57 h, p = 0.007); the difference in total ventilator time wasn't statistically significant (49 h vs. 62 h, p = 0.065). Additionally, FR group avoided metabolic problems like secondary alkalosis and potential hypokalemia seen in the negative FB group. FR-guided fluid-removal in fluid overloaded mechanically ventilated patients was a feasible, safe, and maybe superior strategy in facilitating weaning and disconnection from mechanical ventilation than negative FB-driven fluid removal. FR is a safe endpoint for optimizing cardiac function and preventing adverse consequences during fluid removal.
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Affiliation(s)
- Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile; Hospital Clínico UC-CHRISTUS, Pontificia Universidad Católica de Chile. Santiago, Chile.
| | - Pablo Born
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile.
| | - Eric Roessler
- Departamento de Nefrología, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile; Hospital Clínico UC-CHRISTUS, Pontificia Universidad Católica de Chile. Santiago, Chile.
| | - Christian Labra
- Hospital Clínico UC-CHRISTUS, Pontificia Universidad Católica de Chile. Santiago, Chile.
| | - Paul McNab
- Departamento de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile; Hospital Clínico UC-CHRISTUS, Pontificia Universidad Católica de Chile. Santiago, Chile.
| | - Sebastián Bravo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile; Hospital Clínico UC-CHRISTUS, Pontificia Universidad Católica de Chile. Santiago, Chile.
| | - Dagoberto Soto
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile.
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile; Hospital Clínico UC-CHRISTUS, Pontificia Universidad Católica de Chile. Santiago, Chile.
| | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile; Hospital Clínico UC-CHRISTUS, Pontificia Universidad Católica de Chile. Santiago, Chile
| | - Jan Bakker
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile. Santiago Centro, Chile; Department of Intensive Care, Erasmus MC University Medical Center. Rotterdam, the Netherlands.
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Renz M, Siegert P, Paul R, Lepadatu A, Leukel P, Frauenknecht K, Urmann A, Hain J, Mohnke K, Ziebart A, Harder A, Ruemmler R. Hypoxic-ischemic brain injury in pig after cardiac arrest - A new histopathological scoring system for non-specialists. Resusc Plus 2024; 20:100779. [PMID: 39328899 PMCID: PMC11424782 DOI: 10.1016/j.resplu.2024.100779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/05/2024] [Accepted: 09/08/2024] [Indexed: 09/28/2024] Open
Abstract
Introduction After cardiac arrest and successful resuscitation patients often present with hypoxic-ischemic brain injury, which is a major cause of death due to poor neurological outcome. The development of a robust histopathological scoring system for the reliable and easy identification and quantification of hypoxic-ischemic brain injury could lead to a standardization in the evaluation of brain damage. We wanted to establish an easy-to-use neuropathological scoring system to identify and quantify hypoxic-ischemic brain injury. Methods The criteria for regular neurons, hypoxic-ischemic brain injury neurons and neurons with ischemic neuronal change (ischemic change neurons) were established in collaboration with specialized neuropathologists. Nine non-specialist examiners performed cell counting using the mentioned criteria in brain tissue samples from a porcine cardiac arrest model. The statistical analyses were performed using the interclass correlation coefficient for counting data and reliability testing. Results The inter-rater reliability for regular neurons (ICC 0.68 (0.42 - 0.84; p < 0.001) and hypoxic-ischemic brain injury neurons (ICC 0.87 (0.81 - 0.92; p < 0.001) showed moderate to excellent correlation while ischemic change neurons showed poor reliability. Excellent results were seen for intra-rater reliability for regular neurons (ICC 0.9 (0.68 - 0.97; p < 0.001) and hypoxic-ischemic brain injury neurons (ICC 0.99 (0.83 - 1; p < 0.001). Conclusion The scoring system provides a reliable method for the discrimination between regular neurons and neurons affected by hypoxic/ischemic injury. This scoring system allows an easy and reliable identification and quantification of hypoxic-ischemic brain injury for non-specialists and offers a standardization to evaluate hypoxic-ischemic brain injury after cardiac arrest.
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Affiliation(s)
- Miriam Renz
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Pascal Siegert
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Roman Paul
- Institute for Medical Biometry, Epidemiology and Information Technology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Adina Lepadatu
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Petra Leukel
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Katrin Frauenknecht
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
- Luxembourg Center of Neuropathology (LCNP) & Department of Cancer Research (DoCR), Luxembourg Institute of Health (LIH), 1210 Luxembourg, Luxembourg
| | - Andrea Urmann
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Johanna Hain
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Katja Mohnke
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alexander Ziebart
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Anja Harder
- Institute of Neuropathology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
- Research Center for Immunotherapy (FZI), University Medical Center of the Johannes Gutenberg University Mainz, Germany
- Institute of Neuropathology, University Hospital Muenster, 48149 Muenster, Germany
- Cure NF Research Group, Medical Faculty, Martin Luther University Halle-Wittenberg, 06108 Halle, Saale, Germany
| | - Robert Ruemmler
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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10
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Yang X, Zhu L, Pan H, Yang Y. Cardiopulmonary bypass associated acute kidney injury: better understanding and better prevention. Ren Fail 2024; 46:2331062. [PMID: 38515271 PMCID: PMC10962309 DOI: 10.1080/0886022x.2024.2331062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
Cardiopulmonary bypass (CPB) is a common technique in cardiac surgery but is associated with acute kidney injury (AKI), which carries considerable morbidity and mortality. In this review, we explore the range and definition of CPB-associated AKI and discuss the possible impact of different disease recognition methods on research outcomes. Furthermore, we introduce the specialized equipment and procedural intricacies associated with CPB surgeries. Based on recent research, we discuss the potential pathogenesis of AKI that may result from CPB, including compromised perfusion and oxygenation, inflammatory activation, oxidative stress, coagulopathy, hemolysis, and endothelial damage. Finally, we explore current interventions aimed at preventing and attenuating renal impairment related to CPB, and presenting these measures from three perspectives: (1) avoiding CPB to eliminate the fundamental impact on renal function; (2) optimizing CPB by adjusting equipment parameters, optimizing surgical procedures, or using improved materials to mitigate kidney damage; (3) employing pharmacological or interventional measures targeting pathogenic factors.
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Affiliation(s)
- Xutao Yang
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Li Zhu
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
- The Jinhua Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Hong Pan
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Yi Yang
- The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
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11
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Monares-Zepeda E, Barrera-Hoffmann C, Cueto-Robledo G, Navarro-Vergara DI. Mechanical power in cardiogenic shock. Int J Cardiol 2024; 416:132499. [PMID: 39214469 DOI: 10.1016/j.ijcard.2024.132499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Enrique Monares-Zepeda
- Critical Medicine, Obstetrics Intensive Care Unit, Hospital General de México "Dr. Eduardo Liceaga", 06720 México City, Mexico.
| | - Christopher Barrera-Hoffmann
- Critical Medicine, Hospital General de Zona No. 1 "Lic. Benito Coquet Lagunes", 91930, Veracruz, Veracruz, Mexico
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico
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12
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Li X, Xu X, Zhang J, Wang X, Zhao C, Liu Q, Fan K. Review of the therapeutic effects of traditional Chinese medicine in sepsis-associated encephalopathy. JOURNAL OF ETHNOPHARMACOLOGY 2024; 334:118588. [PMID: 39029543 DOI: 10.1016/j.jep.2024.118588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/21/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Sepsis-associated encephalopathy (SAE) is a common and serious complication during the acute phase of and after recovery from sepsis that seriously affects the quality of life of patients. Traditional Chinese medicine (TCM) has been widely used in modern medicine for neurological anomalies and has become a therapeutic tool for the treatment of SAE due to its multitargeting effects and low toxicity and side effects. AIMS OF THE STUDY This review provides insights into the pathogenesis and treatments of SAE, focusing on the clinical and experimental impacts of TCM formulations and their single components. METHODS Several known databases such as PubMed, Web of Science, Google Scholar, China National Knowledge Infrastructure (CNKI), and others were extensively explored with keywords and phrases such as "sepsis-associated encephalopathy", "traditional Chinese medicine", "herbs", "SAE", "sepsis", "cerebral" or other relevant terms to obtain literature between 2018 and 2024. RESULTS Extensive evidence indicated that TCM could decrease mortality and normalize neurological function in patients with sepsis; these effects might be associated with factors such as reduced oxidative stress and downregulated expression of inflammatory factors. CONCLUSIONS TCM shows notable efficacy in treating SAE, warranting deeper mechanistic studies to optimize its clinical application.
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Affiliation(s)
- Xingyao Li
- College of Veterinary Medicine, China Agricultural University, Beijing, 100193, China.
| | - Xiaolong Xu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
| | - Jun Zhang
- Intensive Care Unit, Wuhan Hospital of Traditional Chinese Medicine, Wu Han, 430014, China.
| | - Xuerui Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
| | - Chunming Zhao
- Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Qingquan Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
| | - Kai Fan
- College of Veterinary Medicine, China Agricultural University, Beijing, 100193, China.
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13
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Svigelj R, de Marco A. Biological and technical factors affecting the point-of-care diagnostics in not-oncological chronic diseases. Biosens Bioelectron 2024; 264:116669. [PMID: 39146770 DOI: 10.1016/j.bios.2024.116669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024]
Abstract
Inexpensive point-of-care (POC) analytical solutions have the potential to allow the implementation of large-scale screening campaigns aimed at identifying the initial stages of pathologies in the population, reducing morbidity, mortality and, indirectly, also the costs for the healthcare system. At global level, the most common preventive screening schemes address some cancer pathologies or are used to monitor the spread of some infective diseases. However, systematic testing might become decisive to improve the care response even in the case of chronic pathologies and, in this review, we analyzed the state-of-the-art of the POC diagnostics for Chronic Kidney Disease, Chronic Obstructive Pulmonary Disease and Multiple Sclerosis. The different technological options used to manufacture the biosensors and evaluate the produced data have been described and this information has been integrated with the present knowledge relatively to the biomarkers that have been proposed to monitor such diseases, namely their availability and reliability. Finally, the nature of the macromolecules used to capture the biomarkers has been discussed in relation to the biomarker nature.
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Affiliation(s)
- Rossella Svigelj
- Department of Agrifood, Environmental and Animal Sciences, University of Udine, Via Cotonificio 108, 33100, Udine, Italy
| | - Ario de Marco
- Lab of Environmental and Life Sciences, University of Nova Gorica, Vipavska Cesta 13, 5000, Nova Gorica, Slovenia.
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Fleischmann-Struzek C, Born S, Kesselmeier M, Ely EW, Töpfer K, Romeike H, Bauer M, Bercker S, Bodechtel U, Fiedler S, Groesdonk HV, Petros S, Platzer S, Rüddel H, Schreiber T, Reinhart K, Scherag A. Functional dependence following intensive care unit-treated sepsis: three-year follow-up results from the prospective Mid-German Sepsis Cohort (MSC). THE LANCET REGIONAL HEALTH. EUROPE 2024; 46:101066. [PMID: 39308983 PMCID: PMC11415812 DOI: 10.1016/j.lanepe.2024.101066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024]
Abstract
Background Surviving sepsis can lead to chronic physical, psychological and cognitive impairments, which affect millions of patients worldwide, including survivors after COVID-19 viral sepsis. We aimed to characterize the magnitude and trajectory of functional dependence and new impairments post-sepsis. Methods We conducted a prospective cohort study including sepsis survivors who had been discharged from five German intensive care units (ICUs), until 36 months post-discharge. Primary outcome was functional dependence, defined as ≥1 impaired activity of daily living (ADL; 10-item ADL score <100), self-reported nursing care dependence or nursing care level. Secondary outcome was post-sepsis morbidity in the physical, psychological or cognitive domain. We used a multistate, competing risk model to address competing events in the course of dependence, and conducted multiple linear regression analyses to identify predictors associated with the ADL score. Findings Of 3210 sepsis patients screened, 1968 survived the ICU treatment (61.3%). A total of 753 were included in the follow-up assessments of the Mid-German Sepsis cohort. Patients had a median age of 65 (Q1-Q3 56-74) years, 64.8% (488/753) were male and 76.1% (573/753) had a septic shock. Considering competing risk modelling, the probability of still being functional dependent was about 25%, while about 30% regained functional independence and 45% died within the three years post-sepsis. Patients reported a high burden of new and often overlapping impairments until three years post-sepsis. In the subgroup of three-year survivors (n = 330), new physical impairments affected 91.2% (n = 301) while new cognitive and psychological impairments were reported by 57.9% (n = 191) and 40.9% (n = 135), respectively. Patients with pre-existing functional limitations and higher age were at risk for low ADL scores three years after sepsis. Interpretation Sepsis survivorship was associated with a broad range of new impairments and led to functional dependence in around one quarter of patients. Targeted measures are needed to mitigate the burden of this Post-Sepsis-Syndrome and increase the proportion of patients that achieve functional improvements. Funding This work was supported by the Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC) at the Jena University Hospital funded by the German Ministry of Education and Research and by the Rudolf Presl GmbH & Co, Kreischa, Germany.
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Affiliation(s)
- Carolin Fleischmann-Struzek
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Integrated Research and Treatment Center, Centre for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Sebastian Born
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Integrated Research and Treatment Center, Centre for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Miriam Kesselmeier
- Institute of Medical Statistics, Computer and Data Sciences (IMSID), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - E. Wesley Ely
- Veteran's Affairs Tennessee Valley Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Critical Illness, Brain Dysfunction, Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristin Töpfer
- Integrated Research and Treatment Center, Centre for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences (IMSID), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | | | - Michael Bauer
- Integrated Research and Treatment Center, Centre for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Sven Bercker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Ulf Bodechtel
- Department of Interdisciplinary Intensive Care Medicine and Rehabilitation, Klinik Bavaria Kreischa, Kreischa, Germany
| | - Sandra Fiedler
- Center for Clinical Studies (ZKS Jena), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Heinrich V. Groesdonk
- Department of Interdisciplinary Intensive Care Medicine and Intermediate Care, Helios Clinic Erfurt, Health and Medical University Erfurt, Erfurt, Germany
| | - Sirak Petros
- Medical ICU, University Hospital Leipzig, Leipzig, Germany
| | - Stefanie Platzer
- Integrated Research and Treatment Center, Centre for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Center for Clinical Studies (ZKS Jena), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | - Hendrik Rüddel
- Integrated Research and Treatment Center, Centre for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
| | | | - Konrad Reinhart
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany
| | - André Scherag
- Integrated Research and Treatment Center, Centre for Sepsis Control and Care (CSCC), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
- Institute of Medical Statistics, Computer and Data Sciences (IMSID), Jena University Hospital/Friedrich-Schiller-University Jena, Jena, Germany
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15
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Varga A, Matrai AA, Fazekas LA, Al-Khafaji MQM, Vanyolos E, Deak A, Szentkereszty Z, Peto K, Nemeth N. Changes in microcirculation of small intestine end-to-end anastomoses in an experimental model. Microvasc Res 2024; 156:104731. [PMID: 39134118 DOI: 10.1016/j.mvr.2024.104731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/02/2024] [Accepted: 08/09/2024] [Indexed: 08/25/2024]
Abstract
INTRODUCTION Sufficient perfusion is essential for a safe intestinal anastomosis. Impaired microcirculation may lead to increased bacterial translocation and anastomosis insufficiency. Thus, it is important to estimate well the optimal distance of the anastomosis line from the last mesenterial vessel. However, it is still empiric. In this experiment the aim was to investigate the intestinal microcirculation at various distances from the anastomosis in a pig model. MATERIALS AND METHODS On 8 anesthetized pigs paramedian laparotomy and end-to-end jejuno-jejunostomy were performed. Using Cytocam-IDF camera, microcirculatory recordings were taken before surgery at the planned suture line, and 1 to 3 mesenterial vessel mural trunk distance from it, and at the same sites 15 and 120 min after anastomosis completion. After the microcirculation monitoring, anastomosed and intact bowel segments were removed to test tensile strength. RESULTS The proportion and the density of the perfused vessels decreased significantly after anastomosis completion. The perfusion rate increased gradually distal from the anastomosis, and after 120 min these values seemed to be normalized. Anastomosed bowels had significantly lower maximal tensile strength and higher slope of tensile strength curves than intact controls. CONCLUSION Alterations in microcirculation and tensile strength were observed. After completing the anastomosis, the improvement in perfusion increased gradually away from the wound edge. The IDF device was useful to monitor intestinal microcirculation providing data to estimate better the optimal distance of the anastomosis from the last order mesenteric vessel.
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Affiliation(s)
- Adam Varga
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Adam Attila Matrai
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Laszlo Adam Fazekas
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Erzsebet Vanyolos
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Adam Deak
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Szentkereszty
- Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Peto
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Norbert Nemeth
- Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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16
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Bear DE, Summers MJ, Chapple LAS. Dietary protein in the ICU in relation to health outcomes. Curr Opin Clin Nutr Metab Care 2024; 27:479-485. [PMID: 39150402 DOI: 10.1097/mco.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Critical care nutrition guidelines recommend provision of higher protein doses than recommended in health. These recommendations have been predominately based on lower quality evidence and physiological rationale that greater protein doses may attenuate the significant muscle loss observed in critically ill patients. This review discusses the mechanistic action of protein in the critically ill, details results from recent trials on health outcomes, discusses considerations for interpretation of trial results, and provides an overview of future directions. RECENT FINDINGS Two recent large clinical trials have investigated different protein doses and the effect on clinical outcome. Important findings revealed potential harm in certain sub-groups of patients. This harm must be balanced with the potential for beneficial effects on muscle mass and physical function given that two recent systematic reviews with meta-analyses demonstrated attenuation of muscle loss with higher protein doses. Utilizing biological markers such as urea: creatinine ratio or urea levels may prove useful in monitoring harm from higher protein doses. SUMMARY Future research should focus on prospectively investigating biological signatures of harm as well as taking into the consideration elements that will likely enhance the effectiveness of protein dose.
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Affiliation(s)
- Danielle E Bear
- Department of Nutrition and Dietetics
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust
- Department of Nutritional Sciences, King's College London, London, UK
| | - Matthew J Summers
- Intensive Care Research, Royal Adelaide Hospital
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Lee-Anne S Chapple
- Intensive Care Research, Royal Adelaide Hospital
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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17
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Li F, Han X, Wu C, He J, Liu H, Li S, Li L, Long X, Sun H. Evaluation of immune and pyroptosis status in a model of sepsis-induced secondary pneumonia. Int Immunopharmacol 2024; 140:112835. [PMID: 39088917 DOI: 10.1016/j.intimp.2024.112835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/03/2024]
Abstract
In recent years, researchers have focused on studying the mechanism of sepsis-induced immunosuppression, but there is still a lack of suitable animal models that accurately reflect the process of sepsis-induced immunosuppression. The aim of this study was to evaluate the immune status at various stages in a model of sepsis-induced secondary pneumonia and to demonstrate whether pyroptosis is one of the modes of immune cell death in sepsis. Firstly, we established a sepsis model in C57BL/6J mice using cecal ligation and puncture (CLP). The surviving mice were treated with a 40 μL suspension of P.aeruginosa (Pa) under anesthesia on day 4 post-CLP to establish a sepsis-induced secondary pneumonia model. Secondly, routine blood tests, serum ALT and PCT levels, gross lung specimens, and H&E staining of the lung and liver tissues were used to assess the successful establishment of this model. Serum levels of TNF-α and IL-6, the CD4+/CD8+ratio in blood, H&E staining of the spleen, and immunohistochemistry of CD4 and CD8 in the spleen were detected to evaluate the immune status of the model mice. Finally, the expression levels of pyroptosis-related proteins in the spleen were detected by Western blot. The expression of GSDMD was assessed using immunohistochemistry, and pyroptosis was directly observed through transmission electron microscopy. The experimental results above confirmed the successful construction of the model for sepsis-induced secondary pneumonia, demonstrating its ability to reflect sepsis-induced immunosuppression. Moreover, the expression of pyroptosis-related proteins, immunohistochemical GSDMD, and transmission electron microscopy of the spleen showed that pyroptosis was one of the modes of immune cell death in sepsis.
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Affiliation(s)
- Fei Li
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China; Department of Infectious Diseases,The People's Hospital of Jiulongpo District, Chongqing,China
| | - Xinjing Han
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Chuanxin Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Jiahui He
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Huang Liu
- Department of Respiratory and Critical Care Medicine, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Shuhua Li
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Li Li
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Xianli Long
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Hang Sun
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, PR China.
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Zhang W, Kong M, Jiang Y, Gan Q, Wei J, Zhang Q, Wang J, Shen J, Wu S. Ambient air pollutants exposure during gestation and incidence risk of hypertensive disorders of pregnancy or preeclampsia in China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 359:124722. [PMID: 39147229 DOI: 10.1016/j.envpol.2024.124722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/27/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024]
Abstract
The relationships between the exposure to ambient air pollutants during gestation and the incidence of hypertensive disorders in pregnancy (HDPs) or preeclampsia are contradictory. This prospective cohort study enrolled the participants between January 2020 and December 2021 from the Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology. The exposure to ambient air pollutants and daily temperatures were obtained from the ChinaHighAirPollutants dataset and the Big Earth Data Platform for Three Poles, respectively. Logistic regression models were used as single- and two-pollutant models. Restricted cubic splines were applied to each ambient air pollutant exposure to further evaluate the exposure-response relationships. Quantile G-computation approaches were employed to evaluate the cumulative impact of mixed ambient air pollutants on the incidence risk HDPs and preeclampsia. Among 19,325 participants (median age: 30.2 years), 1669 (8.64%) were diagnosed with HDPs and 180 (0.94%) with preeclampsia. While mostly null risk estimates were observed, exposure to PM1, PM2.5, PM10, and NO2 correlated with a decreased incidence risk for HDPs and preeclampsia during most gestational periods. Additionally, our multi-pollutant model presented that an increase by one quartile in the cumulative effect of ambient air pollutants was associated with a significantly decreased incidence risk for HDPs in the trimester before gestation and in the third trimester during gestation, as well as for preeclampsia in the third trimester during gestation. These findings warrant further investigation into the mechanisms underlying these associations.
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Affiliation(s)
- Wenkai Zhang
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minghao Kong
- Tongji University School of Medicine, Shanghai, China
| | - Yuan Jiang
- Tongji University School of Medicine, Shanghai, China
| | - Quan Gan
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wei
- Department of Atmospheric and Oceanic Science, Earth System Science Interdisciplinary Center, University of Maryland, College Park, USA
| | - Qing Zhang
- Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Wang
- School of Atmospheric Sciences, Nanjing University, Nanjing, China
| | - Jun Shen
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shijie Wu
- Tongji University School of Medicine, Shanghai, China.
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19
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Phipps AJ. Bleeding disorder in a Holstein calf comparable to bovine neonatal pancytopenia. Aust Vet J 2024. [PMID: 39365055 DOI: 10.1111/avj.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 09/05/2024] [Accepted: 09/17/2024] [Indexed: 10/05/2024]
Abstract
The clinical findings associated with a bleeding disorder, suspected to be an immune mediated pathogenesis comparable to bovine neonatal pancytopenia (BNP), in a 14-day-old Holstein calf are summarised. The clinical examination, clinical laboratory findings, treatment, postmortem findings and referral laboratory diagnostics are reported and discussed in relation to existing knowledge of bleeding disorders in cattle. Veterinary attention was required for a twin 14-day-old Holstein calf that was lethargic, weak and had pale mucous membranes. On clinical examination the calf was tachycardic had pale mucous membranes with petechial and ecchymotic haemorrhages on the ventral surface of the tongue, petechial haemorrhages on the vulval membranes and scleral haemorrhage. The calf received 1.1 L of whole blood from a donor cow to which the calf initially responded. The calf's health appeared to wax and wane over the following 19 days and despite further intervention, the calf died. A postmortem was carried out and samples were submitted to the state laboratory for cytological, histopathological, parasitological and serological examination. Although no exact aetiology was found, there is evidence to suggest that the bleeding disorder was immune-mediated, with a pathogenesis comparable to BNP. To the author's knowledge, this case report is the first peer-reviewed manuscript to describe the clinical presentation similar to BNP in an Australian Holstein calf.
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Affiliation(s)
- A J Phipps
- Rochester Veterinary Practice, Rochester, Victoria, Australia
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20
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Marrero-García R, Cruz-Tabares Y, Gonzalez-Cava JM, Méndez-Pérez JA, Reboso-Morales JA. Evaluation of a low-cost portable NIRS device for monitoring muscle ischemia. J Clin Monit Comput 2024:10.1007/s10877-024-01226-2. [PMID: 39356374 DOI: 10.1007/s10877-024-01226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 09/13/2024] [Indexed: 10/03/2024]
Abstract
The main objective of this study is to evaluate the low-cost, open-source HEGduino device as a tissue oximetry monitor to advance the research of somatic NIRS monitoring. Specifically, this study analyzes the use of this portable functional NIRS system for detecting the cessation of blood flow due to vascular occlusion in an upper limb. 19 healthy patients aged between 25 and 50 were recruited and monitored using HEGduino device. Participants underwent a vascular occlusion test on one forearm. Raw values collected by HEGduino as well as the processed variables derived from the measurements were registered. Additional variables to characterize the signal noise during the tests were also recorded. The results of the data distribution curves for all the subjects in the study accurately detected the physiological events associated with transient tissue ischemia. The statistical analysis of the recorded data showed that the difference between the baseline values recorded by the red led (RED) and its normalized minimum variable was always different from zero (p < 0.014). Furthermore, the difference between the normalized baseline values recorded by the infrared led (IR) and the corresponding normalized minimum value was also different from zero (p < 0.001). The R-squared coefficient of determination for the noise variables considered in this study on the normalized RED and IR values was 0.08 and 0.105, respectively. The study confirms the potential of HEGduino system to detect an interruption of the blood flow by means of variations in regional tissue oxygen saturation. This study demonstrates the potential of the HEGduino device as a monitoring alternative to advance the study of the applicability of NIRS in muscle tissue oximetry.
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Affiliation(s)
| | - Yaiza Cruz-Tabares
- Anesthesia, Resuscitation and Pain Unit, Cruces Hospital, 48903, Baracaldo, Spain
| | - Jose M Gonzalez-Cava
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Camino San Francisco de Paula, 19, La Laguna, 38200, Canary Islands, Spain
| | - Juan Albino Méndez-Pérez
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, Camino San Francisco de Paula, 19, La Laguna, 38200, Canary Islands, Spain
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21
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Silva WJ, Cruz A, Duque G. MicroRNAs and their Modulatory Effect on the Hallmarks of Osteosarcopenia. Curr Osteoporos Rep 2024; 22:458-470. [PMID: 39162945 DOI: 10.1007/s11914-024-00880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE OF THE REVIEW Osteosarcopenia is a geriatric syndrome associated with disability and mortality. This review summarizes the key microRNAs that regulate the hallmarks of sarcopenia and osteoporosis. Our objective was to identify components similarly regulated in the pathology and have therapeutic potential by influencing crucial cellular processes in both bone and skeletal muscle. RECENT FINDINGS The simultaneous decline in bone and muscle in osteosarcopenia involves a complex crosstalk between these tissues. Recent studies have uncovered several key mechanisms underlying this condition, including the disruption of cellular signaling pathways that regulate bone remodeling and muscle function and regeneration. Accordingly, emerging evidence reveals that dysregulation of microRNAs plays a significant role in the development of each of these hallmarks of osteosarcopenia. Although the recent recognition of osteosarcopenia as a single diagnosis of bone and muscle deterioration has provided new insights into the mechanisms of these underlying age-related diseases, several knowledge gaps have emerged, and a deeper understanding of the role of common microRNAs is still required. In this study, we summarize current evidence on the roles of microRNAs in the pathogenesis of osteosarcopenia and identify potential microRNA targets for treating this condition. Among these, microRNAs-29b and -128 are upregulated in the disease and exert adverse effects by inhibiting IGF-1 and SIRT1, making them potential targets for developing inhibitors of their activity. MicroRNA-21 is closely associated with the occurrence of muscle and bone loss. Conversely, microRNA-199b is downregulated in the disease, and its reduced activity may be related to increased myostatin and GSK3β activity, presenting it as a target for developing analogues that restore its function. Finally, microRNA-672 stands out for its ability to protect skeletal muscle and bone when expressed in the disease, highlighting its potential as a possible therapy for osteosarcopenia.
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Affiliation(s)
- William J Silva
- Department of Research and Development, Mirscience Therapeutics, São Paulo, Brazil
| | - André Cruz
- Department of Research and Development, Mirscience Therapeutics, São Paulo, Brazil
| | - Gustavo Duque
- Bone, Muscle & Geroscience Group. Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
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22
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Kasim AH, Mohammad SA, Habib LA, Saleh GA, Salah SH. Utility of doppler ultrasound in early-onset neonatal sepsis: A case-control study. J Neonatal Perinatal Med 2024:NPM240028. [PMID: 39365328 DOI: 10.3233/npm-240028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
BACKGROUND Early-onset sepsis is one of the leading causes of neonatal morbidity and mortality worldwide and timely diagnosis is, therefore, of paramount importance. As there is a lack of literature regarding early alteration of the cerebral blood flow (CBF) in neonatal sepsis, our study aimed to appraise changes in the CBF velocities and Doppler indices in neonates with early-onset neonatal sepsis (EONS) and to assess its diagnostic accuracy. METHODS A total of 99 neonates were recruited in the study; 56 neonates with EONS, and the age-matched 43 neonates without any manifestations of sepsis. A Transcranial Doppler examination and cerebral hemodynamics were assessed in neonates during the first seventy-two hours of life. Doppler indices and CBFV were measured in the anterior cerebral artery (ACA), and middle cerebral artery (MCA), of either side. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. RESULTS A significantly lower resistance in Resistivity (RI) and Pulsatility (PI) indices, a significant high end-diastolic velocity (EDV), and relatively higher peak systolic velocity (PSV) in both ACA and MCA have been documented within 72 hours of birth in neonates with EONS compared to the control group of neonates without sepsis. CONCLUSION Our Study revealed that assessment of CBF at early hours of birth by Transcranial Doppler examination showed alteration in cerebral hemodynamics in neonates with EONS with an increase in the CBF and a decrease in the resistance. It can be adopted as a bedside, noninvasive tool with immediate diagnostic value.
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Affiliation(s)
- A H Kasim
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Radiology Department Mansheyet El Bakry Hospital, Heliopolis, Cairo, Egypt
| | - S A Mohammad
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - L A Habib
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - G A Saleh
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - S H Salah
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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23
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Shakir J, Pedicini M, Bullock BC, Hoen PW, Macias LK, Freiman J, Pletnikov MV, Tamashiro KLK, Cordner ZA. Effects of psilocybin on body weight, body composition, and metabolites in male and female mice. Physiol Behav 2024; 284:114627. [PMID: 38964565 PMCID: PMC11323168 DOI: 10.1016/j.physbeh.2024.114627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 06/14/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
There is growing interest in the therapeutic potential of psilocybin for the treatment of a wide variety of medical problems, and even for the promotion of wellbeing among healthy individuals. Interestingly, among the many proposed indications, both obesity and anorexia nervosa (AN) have been discussed. However, the effect of psilocybin on appetitive behavior and metabolism is not well known. Here, we report the effects of psilocybin on body weight, intake and output, body composition, and metabolic function among lean male and female wild-type mice. In the days immediately following treatment, both male and female mice receiving a single intraperitoneal dose of psilocybin were consistently heavier than saline controls, with no effect of psilocybin on intake or output. Co-administration of the 5-HT2A/2C receptor antagonist ketanserin had no effect on this outcome. Body composition analysis revealed that psilocybin significantly increased lean and water mass among males, with a similar trend among females. A metabolic panel revealed increased creatine kinase (CK), aspartate aminotransferase (AST), and chloride among male and female psilocybin treated mice. Together, these findings begin to investigate the potential mechanisms of psilocybin's effects on body weight and metabolic measures. Such understanding will be critical for the safe, efficacious, and well-informed use of psilocybin in clinical and non-clinical settings.
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Affiliation(s)
- Jasmine Shakir
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Megan Pedicini
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Brianna C Bullock
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Penn W Hoen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Lindsey K Macias
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Jackson Freiman
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Mikhail V Pletnikov
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA; Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, 14203, USA
| | - Kellie L K Tamashiro
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Zachary A Cordner
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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24
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Lumpuy-Castillo J, Amador-Martínez I, Díaz-Rojas M, Lorenzo O, Pedraza-Chaverri J, Sánchez-Lozada LG, Aparicio-Trejo OE. Role of mitochondria in reno-cardiac diseases: A study of bioenergetics, biogenesis, and GSH signaling in disease transition. Redox Biol 2024; 76:103340. [PMID: 39250857 PMCID: PMC11407069 DOI: 10.1016/j.redox.2024.103340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 09/01/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024] Open
Abstract
Acute kidney injury (AKI) and chronic kidney disease (CKD) are global health burdens with rising prevalence. Their bidirectional relationship with cardiovascular dysfunction, manifesting as cardio-renal syndromes (CRS) types 3 and 4, underscores the interconnectedness and interdependence of these vital organ systems. Both the kidney and the heart are critically reliant on mitochondrial function. This organelle is currently recognized as a hub in signaling pathways, with emphasis on the redox regulation mediated by glutathione (GSH). Mitochondrial dysfunction, including impaired bioenergetics, redox, and biogenesis pathways, are central to the progression of AKI to CKD and the development of CRS type 3 and 4. This review delves into the metabolic reprogramming and mitochondrial redox signaling and biogenesis alterations in AKI, CKD, and CRS. We examine the pathophysiological mechanisms involving GSH redox signaling and the AMP-activated protein kinase (AMPK)-sirtuin (SIRT)1/3-peroxisome proliferator-activated receptor-gamma coactivator (PGC-1α) axis in these conditions. Additionally, we explore the therapeutic potential of GSH synthesis inducers in mitigating these mitochondrial dysfunctions, as well as their effects on inflammation and the progression of CKD and CRS types 3 and 4.
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Affiliation(s)
- Jairo Lumpuy-Castillo
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz-Ciberdem, Medicine Department, Autonomous University, 28040, Madrid, Spain.
| | - Isabel Amador-Martínez
- Department of Cardio-Renal Physiopathology, National Institute of Cardiology Ignacio Chávez, 14080, Mexico City, Mexico; Department of Biology, Faculty of Chemistry, National Autonomous University of Mexico, 04510, Mexico City, Mexico.
| | - Miriam Díaz-Rojas
- Division of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, The Ohio State University, 43210, Columbus, Ohio, USA.
| | - Oscar Lorenzo
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz-Ciberdem, Medicine Department, Autonomous University, 28040, Madrid, Spain.
| | - José Pedraza-Chaverri
- Department of Biology, Faculty of Chemistry, National Autonomous University of Mexico, 04510, Mexico City, Mexico.
| | - Laura Gabriela Sánchez-Lozada
- Department of Cardio-Renal Physiopathology, National Institute of Cardiology Ignacio Chávez, 14080, Mexico City, Mexico.
| | - Omar Emiliano Aparicio-Trejo
- Department of Cardio-Renal Physiopathology, National Institute of Cardiology Ignacio Chávez, 14080, Mexico City, Mexico.
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25
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Xiang H, Wu Y, Zhang Y, Hong Y, Xu Y. Obtusifolin inhibits podocyte apoptosis by inactivating NF-κB signaling in acute kidney injury. Cytotechnology 2024; 76:559-569. [PMID: 39188647 PMCID: PMC11344750 DOI: 10.1007/s10616-024-00638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 06/18/2024] [Indexed: 08/28/2024] Open
Abstract
Acute kidney injury (AKI) is a common clinical condition and is associated with unacceptable morbidity and mortality. Obtusifolin is an anthraquinone extracted from the seeds of Cassia obtusifolia with anti-inflammatory properties. This study focused on the role and mechanism of obtusifolin in AKI. The mouse podocyte cell line MPC5 was exposed to lipopolysaccharide (LPS) to establish a cell model of AKI. The viability of MPC5 cells treated with obtusifolin and/or LPS was detected by 3-(4, 5-Dimethylthiazol-2-yl)-2,5diphenyltetrazolium bromide assay. Cell apoptosis was analyzed by flow cytometry. The levels of podocyte injury- and apoptosis-related proteins as well as the nuclear factor-kappaB (NF-κB) signaling pathway was examined using western blotting analysis. The renal protective effects of obtusifolin were determined using an LPS-induced mouse model of AKI. Serum creatinine and blood urea nitrogen levels were measured. Hematoxylin-eosin staining of kidney sections was performed to evaluate renal histology. We found that MPC5 cells treated with LPS showed suppressed cell viability (p < 0.01) and increased cell apoptosis (p < 0.001). LPS reduced the protein expression of Bcl-2, nephrin, and synaptopodin as well as increased the protein levels of Bax and Cleaved Caspase-3 in podocytes in a concentration-dependent manner (p < 0.01). In addition, 10 μg/ml LPS-repressed cell viability was rescued by obtusifolin in a concentration-dependent manner (p < 0.01). Moreover, LPS-induced increase in MPC5 cell apoptosis was reversed by obtusifolin treatment (p < 0.01). Obtusifolin administration ameliorated LPS-induced kidney injury and reduced blood urea nitrogen and serum creatinine levels in mice (p < 0.001). Additionally, obtusifolin inhibited LPS-induced activation of NF-κB signaling in vitro and in vivo (p < 0.01). Overall, obtusifolin was effective in protecting renal function against LPS-induced AKI via inactivation of NF-κB signaling, which suggested that obtusifolin may act as a valuable agent for AKI therapy.
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Affiliation(s)
- Haiyan Xiang
- Department of Nephrology, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, No.168, Jiang ’an District, Wuhan, Hubei China
| | - Yan Wu
- Department of Nephrology, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, No.168, Jiang ’an District, Wuhan, Hubei China
| | - Yun Zhang
- Department of Nephrology, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, No.168, Jiang ’an District, Wuhan, Hubei China
| | - Yuanhao Hong
- Department of Nephrology, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, No.168, Jiang ’an District, Wuhan, Hubei China
| | - Yaling Xu
- Department of Nephrology, Wuhan Sixth Hospital, Affiliated Hospital of Jianghan University, No.168, Jiang ’an District, Wuhan, Hubei China
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26
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Ma Y, Zhao Y, Zhang X. Factors affecting neutrophil functions during sepsis: human microbiome and epigenetics. J Leukoc Biol 2024; 116:672-688. [PMID: 38734968 DOI: 10.1093/jleuko/qiae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
Sepsis is a severe disease that occurs when the body's immune system reacts excessively to infection. The body's response, which includes an intense antibacterial reaction, can damage its tissues and organs. Neutrophils are the major components of white blood cells in circulation, play a vital role in innate immunity while fighting against infections, and are considered a feature determining sepsis classification. There is a plethora of basic research detailing neutrophil functioning, among which, the study of neutrophil extracellular traps is providing novel insights into mechanisms and treatments of sepsis. This review explores their functions, dysfunctions, and influences in the context of sepsis. The interplay between neutrophils and the human microbiome and the impact of DNA methylation on neutrophil function in sepsis are crucial areas of study. The interaction between neutrophils and the human microbiome is complex, particularly in the context of sepsis, where dysbiosis may occur. We highlight the importance of deciphering neutrophils' functional alterations and their epigenetic features in sepsis because it is critical for defining sepsis endotypes and opening up the possibility for novel diagnostic methods and therapy. Specifically, epigenetic signatures are pivotal since they will provide a novel implication for a sepsis diagnostic method when used in combination with the cell-free DNA. Research is exploring how specific patterns of DNA methylation in neutrophils, detectable in cell-free DNA, could serve as biomarkers for the early detection of sepsis.
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Affiliation(s)
- Yina Ma
- Department of Urology Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing 100043, China
| | - Yu Zhao
- Department of Urology Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing 100043, China
| | - Xin Zhang
- Department of Urology Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing 100043, China
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27
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Han Z, Quan Z, Zeng S, Wen L, Wang H. Utilizing omics technologies in the investigation of sepsis-induced cardiomyopathy. IJC HEART & VASCULATURE 2024; 54:101477. [PMID: 39171080 PMCID: PMC11334652 DOI: 10.1016/j.ijcha.2024.101477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024]
Abstract
Sepsis-induced cardiomyopathy (SIC) is a common and high-mortality complication among critically ill patients. Uncertainties persist regarding the pathogenesis, pathophysiology, and diagnosis of SIC, underscoring the necessity to investigate potential biological mechanisms. With the rise of omics technologies, leveraging their high throughput and big data advantages, a systems biology perspective is employed to study the biological processes of SIC. This approach aids in gaining a better understanding of the disease's onset, progression, and outcomes, ultimately providing improved guidance for clinical practices. This review summarizes the currently applied omics technologies, omics studies related to SIC, and relevant omics databases.
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Affiliation(s)
- Zheng Han
- Harbin Medical University Graduate School, Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Zhen Quan
- Harbin Medical University Graduate School, Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Siyao Zeng
- Harbin Medical University Graduate School, Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Lianghe Wen
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Hongliang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
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28
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Kovacevic P, Milakovic D, Kovacevic T, Barisic V, Dragic S, Zlojutro B, Miljkovic B, Vucicevic K, Rizwan Z. Thrombocytopenia risks in ARDS COVID-19 patients treated with high-dose linezolid during vvECMO therapy: an observational study. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:7747-7756. [PMID: 38713258 DOI: 10.1007/s00210-024-03136-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
Patients treated with ECMO are at great risk of nosocomial infections, and around 10% of isolates are gram-positive pathogens. Linezolid (LZD) is effective in the treatment of these infections but appropriate dosing is challenging. The aim was to evaluate the occurrence of thrombocytopenia during ECMO when treated with LZD. An LZD trough concentration of 8 mg/L was set as the cutoff value for thrombocytopenia occurrence among critically ill patients who received parenteral LZD therapy at a dose of 600 mg every 8 h during ECMO. Eleven patients were included in this prospective observational study. Median LZD trough concentrations were 7.85 (interquartile range (IQR), 1.95-11) mg/L. Thrombocytopenia was found in 81.8% of patients. Based on the median LZD trough concentrations cutoff value, patients were divided into two groups, 1.95 (IQR, 0.91-3.6) and 10.3 (IQR, 9.7-11.7) mg/L, respectively. Median platelet values differed significantly between groups on admission, ECMO day 0, ECMO day 1, and LZD sampling day [194 and 152.5, (p < 0.05)], [113 and 214, (p < 0.05)], [76 and 147.5, (p < 0.01)], and [26 and 96.5, (p < 0.01)], respectively. Duration of LZD therapy was similar between the groups. Significant platelet reduction was observed in both groups, emphasizing the need for closer monitoring to prevent LZD-associated thrombocytopenia.
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Affiliation(s)
- Pedja Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina.
| | - Dragana Milakovic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tijana Kovacevic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Vedrana Barisic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Sasa Dragic
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest Beba Bb, 78000, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000, Banja Luka, Bosnia and Herzegovina
| | - Branislava Miljkovic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade Faculty of Pharmacy, Vojvode Stepe 40, 11221, Belgrade, Republic of Serbia
| | - Katarina Vucicevic
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade Faculty of Pharmacy, Vojvode Stepe 40, 11221, Belgrade, Republic of Serbia
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29
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Gross A, Colombier S, Arlettaz L, Delay D. Systemic Mastocytosis Successfully Managed using Cytosorb ® During Cardiopulmonary Bypass for Aortic Valve Replacement. Ann Card Anaesth 2024; 27:364-367. [PMID: 39206776 DOI: 10.4103/aca.aca_16_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/20/2024] [Indexed: 09/04/2024] Open
Abstract
ABSTRACT We describe the case of a 72-year-old male with a history of systemic mastocytosis scheduled for on-pump aortic valve replacement for severe aortic insufficiency. Anesthesia and peri-operative management included avoidance of histamine-releasing drugs, methylprednisolone and clemastin prophylaxis. Furthermore, a CytoSorb ® cartridge has been added to the bypass circuit and hemoadsorption was performed throughout the entire cardiopulmonary bypass (CPB) duration. CytoSorb ® is a hemoadsorption device designed to remove various cytokines and drugs from the blood. The use of CytoSorb ® during CPB in our case was not associated with adverse events, and the patient did not present any allergic or anaphylactic reaction.
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Affiliation(s)
- Adrien Gross
- Department of Anaesthesia, ICH, Valais Hospital, Sion, Switzerland
| | | | - Lionel Arlettaz
- Department of Service of Immunology and Allergology, ICH, Valais Hospital, Sion, Switzerland
| | - Dominique Delay
- Department of Cardiac Surgery, ICH, Valais Hospital, Sion, Switzerland
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Ang CYS, Chiew YS, Wang X, Ooi EH, Cove ME, Chen Y, Zhou C, Chase JG. Patient-ventilator asynchrony classification in mechanically ventilated patients: Model-based or machine learning method? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108323. [PMID: 39029417 DOI: 10.1016/j.cmpb.2024.108323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND AND OBJECTIVE Patient-ventilator asynchrony (PVA) is associated with poor clinical outcomes and remains under-monitored. Automated PVA detection would enable complete monitoring standard observational methods do not allow. While model-based and machine learning PVA approaches exist, they have variable performance and can miss specific PVA events. This study compares a model and rule-based algorithm with a machine learning PVA method by retrospectively validating both methods using an independent patient cohort. METHODS Hysteresis loop analysis (HLA) which is a rule-based method (RBM) and a tri-input convolutional neural network (TCNN) machine learning model are used to classify 7 different types of PVA, including: 1) flow asynchrony; 2) reverse triggering; 3) premature cycling; 4) double triggering; 5) delayed cycling; 6) ineffective efforts; and 7) auto triggering. Class activation mapping (CAM) heatmaps visualise sections of respiratory waveforms the TCNN model uses for decision making, improving result interpretability. Both PVA classification methods were used to classify incidence in an independent retrospective clinical cohort of 11 mechanically ventilated patients for validation and performance comparison. RESULTS Self-validation with the training dataset shows overall better HLA performance (accuracy, sensitivity, specificity: 97.5 %, 96.6 %, 98.1 %) compared to the TCNN model (accuracy, sensitivity, specificity: 89.5 %, 98.3 %, 83.9 %). In this study, the TCNN model demonstrates higher sensitivity in detecting PVA, but HLA was better at identifying non-PVA breathing cycles due to its rule-based nature. While the overall AI identified by both classification methods are very similar, the intra-patient distribution of each PVA type varies between HLA and TCNN. CONCLUSION The collective findings underscore the efficacy of both HLA and TCNN in PVA detection, indicating the potential for real-time continuous monitoring of PVA. While ML methods such as TCNN demonstrate good PVA identification performance, it is essential to ensure optimal model architecture and diversity in training data before widespread uptake as standard care. Moving forward, further validation and adoption of RBM methods, such as HLA, offers an effective approach to PVA detection while providing clear distinction into the underlying patterns of PVA, better aligning with clinical needs for transparency, explicability, adaptability and reliability of these emerging tools for clinical care.
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Affiliation(s)
| | - Yeong Shiong Chiew
- School of Engineering, Monash University Malaysia, Selangor, Malaysia; Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
| | - Xin Wang
- School of Engineering, Monash University Malaysia, Selangor, Malaysia
| | - Ean Hin Ooi
- School of Engineering, Monash University Malaysia, Selangor, Malaysia
| | - Matthew E Cove
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Health System, Singapore
| | - Yuhong Chen
- Intensive Care Unit, the Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Cong Zhou
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - J Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
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31
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Turunen A, Kuuliala K, Kuuliala A, Puolakkainen P, Kylänpää L, Hästbacka J, Lindström O. Syndecan-1 Levels and Early Positive Fluid Balance Are Associated With Disease Severity in Acute Pancreatitis. Pancreas 2024; 53:e739-e747. [PMID: 38696459 DOI: 10.1097/mpa.0000000000002366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
OBJECTIVE The aim of the study is to study fluid balance and endothelial glycocalyx degradation, reflected by syndecan-1, and heparan sulfate (HS) levels, in early stages of acute pancreatitis (AP). MATERIALS AND METHODS This study comprised of 210 AP patients (104 mild, 53 moderately severe, 17 severe). Blood was sampled within 72 hours from the onset of symptoms, and plasma syndecan-1 and HS levels were determined using ELISA. Fluid balance up to sampling and up to 4 days was determined retrospectively from medical records. RESULTS Syndecan-1 levels predicted severe AP (SAP) in receiver operating characteristic analysis [area under curve 0.699, 95% confidence interval (CI) 0.546 to 0.851, P = 0.021]. Increasing AP severity was associated with higher intravenous fluid intake and lower urine output. In multivariate binary logistic regression analysis, positive fluid balance up to sampling [odds ratio (OR) 1.05 per 100 ml, 95% CI 1.02 to 1.11, P = 0.010] and higher Acute Physiology and Chronic Health Evaluation II score at sampling (OR 1.48, 95% CI 1.20 to 1.83, P < 0.001) were independently associated with severe AP, while syndecan-1 level was not. CONCLUSIONS SAP is associated with high positive fluid balance in the early stages of treatment. Although increased in SAP, syndecan-1 was not independently associated with SAP when controlling for fluid balance and Acute Physiology and Chronic Health Evaluation II score.
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Affiliation(s)
- Antti Turunen
- From the Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki
| | - Krista Kuuliala
- Department of Bacteriology and Immunology, Helsinki University Hospital and University of Helsinki
| | - Antti Kuuliala
- Department of Bacteriology and Immunology, Helsinki University Hospital and University of Helsinki
| | - Pauli Puolakkainen
- From the Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki
| | - Leena Kylänpää
- From the Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki
| | | | - Outi Lindström
- From the Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki
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32
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Kartal A, Robba C, Helmy A, Wolf S, Aries MJH. How to Define and Meet Blood Pressure Targets After Traumatic Brain Injury: A Narrative Review. Neurocrit Care 2024; 41:369-385. [PMID: 38982005 PMCID: PMC11377672 DOI: 10.1007/s12028-024-02048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) poses a significant challenge to healthcare providers, necessitating meticulous management of hemodynamic parameters to optimize patient outcomes. This article delves into the critical task of defining and meeting continuous arterial blood pressure (ABP) and cerebral perfusion pressure (CPP) targets in the context of severe TBI in neurocritical care settings. METHODS We narratively reviewed existing literature, clinical guidelines, and emerging technologies to propose a comprehensive approach that integrates real-time monitoring, individualized cerebral perfusion target setting, and dynamic interventions. RESULTS Our findings emphasize the need for personalized hemodynamic management, considering the heterogeneity of patients with TBI and the evolving nature of their condition. We describe the latest advancements in monitoring technologies, such as autoregulation-guided ABP/CPP treatment, which enable a more nuanced understanding of cerebral perfusion dynamics. By incorporating these tools into a proactive monitoring strategy, clinicians can tailor interventions to optimize ABP/CPP and mitigate secondary brain injury. DISCUSSION Challenges in this field include the lack of standardized protocols for interpreting multimodal neuromonitoring data, potential variability in clinical decision-making, understanding the role of cardiac output, and the need for specialized expertise and customized software to have individualized ABP/CPP targets regularly available. The patient outcome benefit of monitoring-guided ABP/CPP target definitions still needs to be proven in patients with TBI. CONCLUSIONS We recommend that the TBI community take proactive steps to translate the potential benefits of personalized ABP/CPP targets, which have been implemented in certain centers, into a standardized and clinically validated reality through randomized controlled trials.
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Affiliation(s)
- Ahmet Kartal
- University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany.
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Sciences, University of Genoa, Genoa, Italy
| | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Stefan Wolf
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcel J H Aries
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
- Institute of Mental Health and Neurosciences, University Maastricht, Maastricht, The Netherlands
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Zawadka M, Santonocito C, Dezio V, Amelio P, Messina S, Cardia L, Franchi F, Messina A, Robba C, Noto A, Sanfilippo F. Inferior vena cava distensibility during pressure support ventilation: a prospective study evaluating interchangeability of subcostal and trans‑hepatic views, with both M‑mode and automatic border tracing. J Clin Monit Comput 2024; 38:981-990. [PMID: 38819726 PMCID: PMC11427491 DOI: 10.1007/s10877-024-01177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/10/2024] [Indexed: 06/01/2024]
Abstract
The Inferior Vena Cava (IVC) is commonly utilized to evaluate fluid status in the Intensive Care Unit (ICU),with more recent emphasis on the study of venous congestion. It is predominantly measured via subcostal approach (SC) or trans-hepatic (TH) views, and automated border tracking (ABT) software has been introduced to facilitate its assessment. Prospective observational study on patients ventilated in pressure support ventilation (PSV) with 2 × 2 factorial design. Primary outcome was to evaluate interchangeability of measurements of the IVC and the distensibility index (DI) obtained using both M-mode and ABT, across both SC and TH. Statistical analyses comprised Bland-Altman assessments for mean bias, limits of agreement (LoA), and the Spearman correlation coefficients. IVC visualization was 100% successful via SC, while TH view was unattainable in 17.4% of cases. As compared to the M-mode, the IVC-DI obtained through ABT approach showed divergences in both SC (mean bias 5.9%, LoA -18.4% to 30.2%, ICC = 0.52) and TH window (mean bias 6.2%, LoA -8.0% to 20.4%, ICC = 0.67). When comparing the IVC-DI measures obtained in the two anatomical sites, accuracy improved with a mean bias of 1.9% (M-mode) and 1.1% (ABT), but LoA remained wide (M-mode: -13.7% to 17.5%; AI: -19.6% to 21.9%). Correlation was generally suboptimal (r = 0.43 to 0.60). In PSV ventilated patients, we found that IVC-DI calculated with M-mode is not interchangeable with ABT measurements. Moreover, the IVC-DI gathered from SC or TH view produces not comparable results, mainly in terms of precision.
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Affiliation(s)
- Mateusz Zawadka
- 2nd Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland.
| | - Cristina Santonocito
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Via S. Sofia N 78, 95123, Catania, Italy
| | - Veronica Dezio
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Via S. Sofia N 78, 95123, Catania, Italy
| | - Paolo Amelio
- School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Simone Messina
- School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Luigi Cardia
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Federico Franchi
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Department of Medical Science, Surgery and Neurosciences, University Hospital of Siena, 53100, Siena, Italy
| | - Antonio Messina
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Chiara Robba
- Department of Surgical Science and Diagnostic Integrated, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alberto Noto
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
- Division of Anesthesia and Intensive Care, Policlinico "G. Martino", Messina, Italy
| | - Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. Policlinico-San Marco, Via S. Sofia N 78, 95123, Catania, Italy.
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
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Marcy F, Goettfried K, Enghard P, Piper SK, Kunz JV, Schroeder T. Impact of AKI on metabolic compensation for respiratory acidosis in ICU patients with AECOPD. J Crit Care 2024; 83:154846. [PMID: 38936337 DOI: 10.1016/j.jcrc.2024.154846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can result in severe respiratory acidosis. Metabolic compensation is primarily achieved by renal retention of bicarbonate. The extent to which acute kidney injury (AKI) impairs the kidney's capacity to compensate for respiratory acidosis remains unclear. MATERIALS AND METHODS This retrospective analysis covers clinical data between January 2009 and December 2021 for 498 ICU patients with AECOPD and need for respiratory support. RESULTS 278 patients (55.8%) presented with or developed AKI. Patients with AKI exhibited higher 30-day-mortality rates (14.5% vs. 4.5% p = 0.001), longer duration of mechanical ventilation (median 90 h vs. 14 h; p = 0.001) and more severe hypercapnic acidosis (pH 7.23 vs. 7.28; pCO2 68.5 mmHg vs. 61.8 mmHg). Patients with higher AKI stages exhibited lower HCO3-/pCO2 ratios and did not reach expected HCO3- levels. In a mixed model analysis with random intercept per patient we analyzed the association of pCO2 (independent) and HCO3- (dependent variable). Lower estimates for averaged change in HCO3- were observed in patients with more severe AKI. CONCLUSION AKI leads to poor outcomes and compromises metabolic compensation of respiratory acidosis in ICU patients with AECOPD. While buffering agents may aid compensation for severe AKI, their use should be approached with caution.
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Affiliation(s)
- Florian Marcy
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany.
| | - Katharina Goettfried
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Philipp Enghard
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Sophie K Piper
- Charité - Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Strasse 2, 10178 Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Medical Informatics Berlin, Germany
| | - Julius Valentin Kunz
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
| | - Tim Schroeder
- Charité - Universitätsmedizin Berlin, Department of Nephrology and Medical Intensive Care Medicine, Berlin, Germany
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35
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Li Y, Xi Y, Wang H, Sun A, Deng X, Chen Z, Fan Y. The Impact of Rotor Axial Displacement Variation on Simulation Accuracy of Fully Magnetic Levitation Centrifugal Blood Pump. ASAIO J 2024; 70:868-875. [PMID: 38569187 DOI: 10.1097/mat.0000000000002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
The rotor axial displacement of the full magnetic levitation blood pump varies with the operating conditions. The effect of rotor axial displacement on simulation results is unclear. This study aimed to evaluate the effect of rotor axial displacement on the predicted blood pump flow field, hydraulic performance, and hemocompatibility through simulation. This study used the CentriMag blood pump as a model, and conducted computational fluid dynamics simulations to assess the impact of rotor displacement. Considering rotor axial displacement leads to opposite results regarding predicted residence time and thrombotic risk compared with not considering rotor axial displacement. Not considering rotor axial displacement leads to deviations in the predicted values, where the effects on the flow field within the blood pump, ratio of secondary flow, and amount of shear stress >150 Pa are significant. The variation in the back clearance of the blood pump caused by the ideal and actual rotor displacements is the main cause of the above phenomena. Given that the rotor axial displacement significantly impacts the simulation accuracy, the effect of rotor axial displacement must be considered in the simulation.
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Affiliation(s)
- Yuan Li
- From the Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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36
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Bernard A, Koeppen M. [Extracorporeal procedures in sepsis]. DIE ANAESTHESIOLOGIE 2024; 73:713-720. [PMID: 39331071 DOI: 10.1007/s00101-024-01464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Sepsis and septic shock are frequent and severe clinical pictures in intensive care medicine that result from a dysregulated immune response to an infection and cause a high mortality rate. This article provides an overview of the various extracorporeal procedures used to treat sepsis. Various procedures are used to treat sepsis and septic shock. These include high-volume hemofiltration (HVHF), very high-volume hemofiltration (VHVHF), high cut-off filter (HCO), polymyxin B hemoperfusion and cytokine adsorption filters. The HVHF and VHVHF remove inflammatory mediators but show no significant benefit in terms of stabilization and survival in sepsis patients. The HCO filters effectively eliminate cytokines but so far there is no evidence of a survival benefit. Polymyxin B hemoperfusion shows promising results in initial studies in certain patient groups, while evidence for cytokine adsorption filters is limited. Combined plasma filtration and adsorption (CPFA) and therapeutic plasma exchange (TPE) have so far shown promising results in small studies. Although CPFA shows no survival benefit, TPE may have protective effects on the vascular glycocalyx. Extracorporeal procedures carry risks such as thrombosis and loss of proteins and clotting factors. The therapeutic benefit of these procedures in the treatment of sepsis remains unclear and further prospective randomized multicenter studies are needed to evaluate their efficacy and safety. There are currently no guideline recommendations for the routine use of these procedures in sepsis.
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Affiliation(s)
| | - Michael Koeppen
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland.
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37
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Nikravangolsefid N, Suppadungsuk S, Singh W, Palevsky PM, Murugan R, Kashani KB. Behind the scenes: Key lessons learned from the RELIEVE-AKI clinical trial. J Crit Care 2024; 83:154845. [PMID: 38879964 PMCID: PMC11297665 DOI: 10.1016/j.jcrc.2024.154845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
Continuous kidney replacement therapy (CKRT) is commonly used to manage critically ill patients with severe acute kidney injury. While recent trials focused on the correct dosing and timing of CKRT, our understanding regarding the optimum dose of net ultrafiltration is limited to retrospective data. The Restrictive versus Liberal Rate of Extracorporeal Volume Removal Evaluation in Acute Kidney Injury (RELIEVE-AKI) trial has been conducted to assess the feasibility of a prospective randomized trial in determining the optimum net ultrafiltration rate. This paper outlines the relevant challenges and solutions in implementing this complex ICU-based trial. Several difficulties were encountered, starting with clinical issues related to conducting a trial on patients with rapidly changing hemodynamics, low patient recruitment rates, increased nursing workload, and the enormous volume of data generated by patients undergoing prolonged CKRT. Following several brainstorming sessions, several points were highlighted to be considered, including the need to streamline the intervention, add more flexibility in the trial protocols, ensure comprehensive a priori planning, particularly regarding nursing roles and their compensation, and enhance data management systems. These insights are critical for guiding future ICU-based dynamically titrated intervention trials, leading to more efficient trial management, improved data quality, and enhanced patient safety.
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Affiliation(s)
- Nasrin Nikravangolsefid
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | - Waryaam Singh
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul M Palevsky
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Kidney Medicine Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Raghavan Murugan
- The Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; The Center for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA), Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Mizenko RR, Feaver M, Bozkurt BT, Lowe N, Nguyen B, Huang K, Wang A, Carney RP. A critical systematic review of extracellular vesicle clinical trials. J Extracell Vesicles 2024; 13:e12510. [PMID: 39330928 PMCID: PMC11428870 DOI: 10.1002/jev2.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 08/06/2024] [Accepted: 09/06/2024] [Indexed: 09/28/2024] Open
Abstract
This systematic review examines the landscape of extracellular vesicle (EV)-related clinical trials to elucidate the field's trends in clinical applications and EV-related methodologies, with an additional focus on the acknowledgement of EV subpopulations. By analysing data from public reporting repositories, we catalogued 471 EV-related clinical trials to date, with indications for over 200 diseases. Diagnostics and companion diagnostics represented the bulk of EV-related clinical trials with cancer being the most frequent application. EV-related therapeutics trials mainly utilized mesenchymal stromal cell (MSC) EVs and were most frequently used for treatment of respiratory illnesses. Ultracentrifugation and RNA-sequencing were the most common isolation and characterization techniques; however, methodology for each was not frequently reported in study records. Most of the reported characterization relied on bulk characterization of EV isolates, with only 11% utilizing EV subpopulations in their experimental design. While this may be connected to a lack of available techniques suitable for clinical implementation, it also highlights the opportunity for use of EV subpopulations to improve translational efforts. As academic research identifies more chemically distinct subpopulations and technologies for their enrichment, we forecast to more refined EV trials in the near future. This review emphasizes the need for meticulous methodological reporting and consideration of EV subpopulations to enhance the translational success of EV-based interventions, pointing towards a paradigm shift in personalized medicine.
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Affiliation(s)
- Rachel R. Mizenko
- Department of Biomedical EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Madison Feaver
- Department of Biomedical EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Batuhan T. Bozkurt
- Department of Biomedical EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Neona Lowe
- Department of Biomedical EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Bryan Nguyen
- Department of Biomedical EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Kuan‐Wei Huang
- Department of Biomedical EngineeringUniversity of CaliforniaDavisCaliforniaUSA
| | - Aijun Wang
- Department of Biomedical EngineeringUniversity of CaliforniaDavisCaliforniaUSA
- Department of SurgeryUniversity of CaliforniaDavisCaliforniaUSA
| | - Randy P. Carney
- Department of Biomedical EngineeringUniversity of CaliforniaDavisCaliforniaUSA
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Roden-Foreman JS, Foreman ML, Monday K, Lingle K, Blough B, Safa MM, Schwartz G. Body mass index is not associated with time on veno-venous extracorporeal membrane oxygenation or in-hospital mortality. Perfusion 2024; 39:1356-1362. [PMID: 37501258 DOI: 10.1177/02676591231193269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Morbid obesity, as characterized by BMI, is often utilized as an exclusion criterion for VV-ECMO because of presumed poor prognosis and technically complex cannulation. However, the "obesity paradox" suggests obesity may be protective during critical illness, and BMI does not capture variations in body type, adiposity, or fluid balance. This study examines relationships between BMI and patient outcomes. Adult VV-ECMO patients with BMI ≥ 35 kg/m2 admitted January 2012 to June 2021 were identified from an institutional registry. BMI and outcomes were analyzed with Mann-Whitney U tests and Pearson correlations with Bayesian post-hoc analyses. 116 of 960 ECMO patients met inclusion criteria. Median (Q1, Q3) BMI was 42.3 (37.3, 50.8) and min, max of 35.0, 87.8 with 9.0 (5.0, 15.5) ECMO days. BMI was not significantly correlated with ECMO days (r = -0.102; p = .279). Bayesian analyses showed moderate evidence against BMI correlating with ECMO days. In-hospital mortality (27%) was significantly associated with ECMO days (p = .014) but not BMI (p = .485). In this cohort of high-BMI patients, BMI was not associated with survival or time on ECMO. BMI itself should not be used as an exclusion criterion for VV-ECMO.
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Affiliation(s)
- Jordin S Roden-Foreman
- Baylor University Medical Center at Dallas, Dallas, TX, USA
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | - Kara Monday
- Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Kaitlyn Lingle
- Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Britton Blough
- Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Mohamad M Safa
- Baylor University Medical Center at Dallas, Dallas, TX, USA
| | - Gary Schwartz
- Baylor University Medical Center at Dallas, Dallas, TX, USA
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40
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Kalantari L, Hajjafari A, Goleij P, Rezaee A, Amirlou P, Farsad S, Foroozand H, Arefnezhad R, Rezaei-Tazangi F, Jahani S, Yazdani T, Nazari A. Umbilical cord mesenchymal stem cells: A powerful fighter against colon cancer? Tissue Cell 2024; 90:102523. [PMID: 39154502 DOI: 10.1016/j.tice.2024.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/20/2024]
Abstract
Colon cancer (CC) stands as one of the most common malignancies related to the gastrointestinal system, whose increasing incidence and death rates have been reported all over the world. Standard treatments for fighting cancers like CC comprise surgical approaches, chemotherapy, and radiotherapy, which are suggested by clinicians according to patients' conditions and disease stages. However, patients who utilize these modalities may suffer from serious side effects and adverse outcomes, for example, toxicity and tumor recurrence, as well as a low 5-year survival rate. The present shreds of evidence showed that mesenchymal stem cells (MSCs) can have a suitable capacity for treating different health problems, especially neoplasms. These multipotent stem cells can be isolated from several sources, such as the umbilical cord, bone marrow, adipose tissue, and placenta. Among these mesenchymal sources, umbilical cord-MSCs have gathered much attention in scientific societies due to their advantages (e.g., low immunogenicity, lack of ethical problems, and easy collection). These days, the efficacy of umbilical cord-MSCs and umbilical cord-MSCs-based strategies, such as conditioned medium, extracellular vesicles, and exosomes, on CC have been explored, and promising findings have been stated. Therefore, in this review, we aimed to summarize and debate evidence regarding the effects of UC-MSCs and their related products on CC with a focus on molecular and cellular mechanisms involved in its treatment and pathogenesis of this malignant tumor.
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Affiliation(s)
- Leila Kalantari
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran; School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Ashkan Hajjafari
- Department of Pathobiology, Faculty of Veterinary Medicine Science, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Pouya Goleij
- Department of Genetics, Sana Institute of Higher Education, Sari, Iran; USERN Office, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aryan Rezaee
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parsa Amirlou
- Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Farsad
- Faculty of Basic Science, Islamic Azad University, Qom, Iran
| | - Hassan Foroozand
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Arefnezhad
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Coenzyme R Research Institute, Tehran, Iran
| | - Fatemeh Rezaei-Tazangi
- Department of Anatomy, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Saleheh Jahani
- Pathology department, University of California, SanDiego, United States
| | - Taha Yazdani
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Nazari
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Siebers NW, Steiner LA. Anesthesia for traumatic brain injury. Curr Opin Anaesthesiol 2024; 37:486-492. [PMID: 39011685 DOI: 10.1097/aco.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) presents complex clinical challenges, requiring a nuanced understanding of its pathophysiology and current management principles to improve patient outcomes. Anesthetists play a critical role in care and need to stay updated with recent evidence and trends to ensure high-quality treatment. The Brain Trauma Foundation Guidelines, last updated in 2016, have shown moderate adherence, and much of the current management relies on expert opinions. This literature review synthesizes the current evidence and provides insights into the role of anesthetists in TBI management. RECENT FINDINGS Recent literature has emphasized the importance of tailored anesthetic management principles in treating TBI, focusing on minimizing secondary brain injury during neurosurgical interventions or extracranial surgery. Emerging trends include individualized intracranial pressure approaches and multimodal neuromonitoring for comprehensive assessment of cerebral physiology. SUMMARY Anesthesia for TBI patients requires a comprehensive approach that balances anesthetic goals with the unique pathophysiological factors of brain injury. Despite recent research expanding our understanding, challenges remain in standardizing protocols and addressing individual patient response variability. Adherence to established management principles, personalized approaches, and ongoing research is crucial for improving the outcomes.
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Affiliation(s)
- Nys Willem Siebers
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
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Svedung Wettervik T, Hånell A, Lewén A, Enblad P. Should Patients with Traumatic Brain Injury with Significant Contusions be Treated with Different Neurointensive Care Targets? Neurocrit Care 2024; 41:511-522. [PMID: 38506969 PMCID: PMC11377649 DOI: 10.1007/s12028-024-01954-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/01/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Patients with traumatic brain injury (TBI) with large contusions make up a specific TBI subtype. Because of the risk of brain edema worsening, elevated cerebral perfusion pressure (CPP) may be particularly dangerous. The pressure reactivity index (PRx) and optimal cerebral perfusion pressure (CPPopt) are new promising perfusion targets based on cerebral autoregulation, but they reflect the global brain state and may be less valid in patients with predominant focal lesions. In this study, we aimed to investigate if patients with TBI with significant contusions exhibited a different association between PRx, CPP, and CPPopt in relation to functional outcome compared to those with small/no contusions. METHODS This observational study included 385 patients with moderate to severe TBI treated at a neurointensive care unit in Uppsala, Sweden. The patients were classified into two groups: (1) significant contusions (> 10 mL) and (2) small/no contusions (but with extra-axial or diffuse injuries). The percentage of good monitoring time (%GMT) with intracranial pressure > 20 mm Hg; PRx > 0.30; CPP < 60 mm Hg, within 60-70 mm Hg, or > 70 mm Hg; and ΔCPPopt less than - 5 mm Hg, ± 5 mm Hg, or > 5 mm Hg was calculated. Outcome (Glasgow Outcome Scale-Extended) was assessed after 6 months. RESULTS Among the 120 (31%) patients with significant contusions, a lower %GMT with CPP between 60 and 70 mm Hg was independently associated with unfavorable outcome. The %GMTs with PRx and ΔCPPopt ± 5 mm Hg were not independently associated with outcome. Among the 265 (69%) patients with small/no contusions, a higher %GMT of PRx > 0.30 and a lower %GMT of ΔCPPopt ± 5 mm Hg were independently associated with unfavorable outcome. CONCLUSIONS In patients with TBI with significant contusions, CPP within 60-70 mm Hg may improve outcome. PRx and CPPopt, which reflect global cerebral pressure autoregulation, may be useful in patients with TBI without significant focal brain lesions but seem less valid for those with large contusions. However, this was an observational, hypothesis-generating study; our findings need to be validated in prospective studies before translating them into clinical practice.
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Affiliation(s)
- Teodor Svedung Wettervik
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden.
| | - Anders Hånell
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden
| | - Anders Lewén
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden
| | - Per Enblad
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, 751 85, Uppsala, Sweden
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Girardis M, David S, Ferrer R, Helms J, Juffermans NP, Martin-Loeches I, Povoa P, Russell L, Shankar-Hari M, Iba T, Coloretti I, Parchim N, Nielsen ND. Understanding, assessing and treating immune, endothelial and haemostasis dysfunctions in bacterial sepsis. Intensive Care Med 2024; 50:1580-1592. [PMID: 39222142 DOI: 10.1007/s00134-024-07586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024]
Abstract
The interplay between the immune system, coagulation, and endothelium is critical in regulating the host response to infection. However, in sepsis and other critical illnesses, a dysregulated immune response can lead to excessive alterations in these mechanisms, resulting in coagulopathy, endothelial dysfunction, and multi-organ dysfunction. This review aims to provide a comprehensive analysis of the pathophysiological mechanisms that govern the complex interplay between immune dysfunction, endothelial dysfunction, and coagulation in sepsis. It emphasises clinical significance, evaluation methods, and potential therapeutic interventions. Understanding these mechanisms is essential for developing effective treatments that can modulate the immune response, mitigate thrombosis, restore endothelial function, and ultimately improve patient survival.
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Affiliation(s)
- Massimo Girardis
- Anaesthesiology and Intensive Care Department, University Hospital of Modena, University of Modena, Reggio Emilia, Italy.
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julie Helms
- Université de Strasbourg (UNISTRA), Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France
| | - Nicole P Juffermans
- Department of Intensive Care and Translational Laboratory of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James' Hospital, Dublin, D08 NHY1, Ireland
- Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, 08180, Barcelona, Spain
| | - Pedro Povoa
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
- Department of Intensive Care, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Lene Russell
- Copenhagen University Hospital Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Manu Shankar-Hari
- Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh, UK
- Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Toshiaki Iba
- Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Irene Coloretti
- Anaesthesiology and Intensive Care Department, University Hospital of Modena, University of Modena, Reggio Emilia, Italy
| | - Nicholas Parchim
- Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, New Mexico, Mexico
| | - Nathan D Nielsen
- Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, New Mexico, Mexico
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Liao XY, Chen YT, Liu MJ, Liao QX, Lin JD, Lin HR, Huang YH, Zhou Y. COMPARISON OF OXIRIS AND CONVENTIONAL CONTINUOUS RENAL REPLACEMENT THERAPY IN MANAGING SEVERE ABDOMINAL INFECTIONS: IMPACT ON SEPTIC SHOCK MORTALITY. Shock 2024; 62:529-538. [PMID: 39158926 DOI: 10.1097/shk.0000000000002437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
ABSTRACT Objective: The objective of this study is to assess and compare the efficacy of oXiris with conventional continuous renal replacement therapy (CRRT) in managing severe abdominal infections. Methods: A retrospective analysis encompassing cases from 2017 to 2023 was conducted at the Department of Critical Care Medicine within the First Affiliated Hospital of Fujian Medical University. Parameters including heart rate (HR), mean arterial pressure (MAP), oxygenation index, lactate (Lac), platelet count, neutrophil ratio, procalcitonin, C-reactive protein (CRP), interleukin 6 (IL-6), norepinephrine dosage, Acute Physiology and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA) were recorded prior to treatment initiation, at 24 h, and 72 h after treatment for both the oXiris and conventional CRRT groups. In addition, the duration of respiratory support, CRRT treatment, length of stay in the intensive care unit (ICU), total hospitalization period, and mortality rates at 14 and 28 days for both groups were recorded. Results: 1) Within the conventional CRRT group, notable enhancement was observed solely in Lac levels at 24 h after treatment compared with pretreatment levels. In addition, at 72 h after treatment, improvements were evident in HR, Lac, CRP, and IL-6 levels. 2) Conversely, the oXiris group exhibited improvements in HR, MAP, Lac, oxygenation index, neutrophil ratio, and IL-6 at 24 h after treatment when compared with baseline values. In addition, reductions were observed in APACHE II and SOFA scores. At 72 h after treatment, all parameters demonstrated enhancement except for platelet count. 3) Analysis of the changes in the indexes (Δ) between the two groups at 24 h after treatment revealed variances in HR, MAP, Lac, norepinephrine dosage, CRP levels, IL-6 levels, APACHE II scores, and SOFA scores. 4) The Δ indexes at 72 h after treatment indicated more significant improvements following oXiris treatment for both groups, except for procalcitonin. 5) The 14-day mortality rate (24.4%) exhibited a significant reduction in the oXiris group when compared with the conventional group (43.6%). However, no significant difference was observed in the 28-day mortality rate between the two groups. 6) Subsequent to multifactorial logistic regression analysis, the results indicated that oXiris treatment correlated with a noteworthy decrease in the 14-day and 28-day mortality rates associated with severe abdominal infections, by 71.3% and 67.6%, respectively. Conclusion: oXiris demonstrates clear advantages over conventional CRRT in the management of severe abdominal infections. Notably, it reduces the fatality rates, thereby establishing itself as a promising and potent therapeutic option.
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Affiliation(s)
- Xiu-Yu Liao
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Yu-Ting Chen
- Department of Gastroenterology, Fuzhou NO.1 Hospital, Fuzhou, Fujian Province, China
| | - Ming-Jun Liu
- Department of Infection, People's Hospital of YangJiang, YangJiang, Guangdong Province, China
| | - Qiu-Xia Liao
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jian-Dong Lin
- Department of Intensive Care Unit, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Hai-Rong Lin
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ying-Hong Huang
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ye Zhou
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
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Siew LY, Lee ZY, Yunos NM, Atan R, Cove ME, Lumlertgul N, Srisawat N, Hasan MS. Outcomes of extracorporeal blood purification with oXiris® membrane in critically ill patients: A systematic review and meta-analysis. J Crit Care 2024; 83:154844. [PMID: 38901069 DOI: 10.1016/j.jcrc.2024.154844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/26/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To evaluate the efficacy of the novel oXiris® membrane in critically ill adult patients. METHODS We systematically searched MEDLINE, EMBASE, and CENTRAL from inception to 01/06/2023 for relevant randomised controlled trials (RCTs) and non-randomised studies of intervention (NRSI). The primary outcome was overall mortality. Random effect meta-analyses were conducted in RevMan 5.4.1. Study quality was evaluated using Cochrane's risk of bias tool. (PROSPERO: CRD42023389198). RESULTS Ten studies (2 RCTs and 8 NRSIs) with 481 patients were included. None had low risk of bias. Treatment using oXiris® was associated with reduced overall mortality (RR 0.78, 95%CI 0.62-0.98; p = 0.03; 6 NRSI). One RCT reported 28-day mortality, finding no significant difference between groups. Besides, pooled NRSIs results showed significant reductions in SOFA scores, norepinephrine dosage, and several inflammatory biomarkers (C-reactive protein [CRP], lactate, and interleukin-6 [IL-6]) post oXiris® treatment. However, other clinical outcomes (ICU and hospital length of stay, mechanical ventilation duration) were similar between groups. CONCLUSION In critically ill patients, the use of oXiris® membrane was associated with reduced overall mortality, norepinephrine dosage, CRP, IL-6, lactate levels, along with improved organ function. However, the certainty of evidence was very low, necessitating high-quality RCTs to further evaluate its efficacy in this population.
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Affiliation(s)
- Li Ying Siew
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zheng-Yii Lee
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Cardiac Anesthesiology & Intensive Care Medicine, Charité Berlin, Germany
| | - Nor'azim Mohd Yunos
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Anaesthesiology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rafidah Atan
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Anaesthesiology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Matthew Edward Cove
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Nuttha Lumlertgul
- Division of Nephrology, Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Faculty of Medicine, Centre of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Faculty of Medicine, Centre of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - M Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Anaesthesiology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Scaramuzzo G, Karbing DS, Ball L, Vigolo F, Frizziero M, Scomparin F, Ragazzi R, Verri M, Rees SE, Volta CA, Spadaro S. Intraoperative Ventilation/Perfusion Mismatch and Postoperative Pulmonary Complications after Major Noncardiac Surgery: A Prospective Cohort Study. Anesthesiology 2024; 141:693-706. [PMID: 38768389 PMCID: PMC11389881 DOI: 10.1097/aln.0000000000005080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Postoperative pulmonary complications can increase hospital length of stay, postoperative morbidity, and mortality. Although many factors can increase the risk of postoperative pulmonary complications, it is not known whether intraoperative ventilation/perfusion (V/Q) mismatch can be associated with an increased risk of postoperative pulmonary complications after major noncardiac surgery. METHODS This study enrolled patients undergoing general anesthesia for noncardiac surgery and evaluated intraoperative V/Q distribution using the automatic lung parameter estimator technique. The assessment was done after anesthesia induction, after 1 h from surgery start, and at the end of surgery. Demographic and procedural information were collected, and intraoperative ventilatory and hemodynamic parameters were measured at each timepoint. Patients were followed up for 7 days after surgery and assessed daily for postoperative pulmonary complication occurrence. RESULTS The study enrolled 101 patients with a median age of 71 [62 to 77] years, a body mass index of 25 [22.4 to 27.9] kg/m2, and a preoperative Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score of 41 [34 to 47]. Of these patients, 29 (29%) developed postoperative pulmonary complications, mainly acute respiratory failure (23%) and pleural effusion (11%). Patients with and without postoperative pulmonary complications did not differ in levels of shunt at T1 (postoperative pulmonary complications: 22.4% [10.4 to 35.9%] vs. no postoperative pulmonary complications:19.3% [9.4 to 24.1%]; P = 0.18) or during the protocol, whereas significantly different levels of high V/Q ratio were found during surgery (postoperative pulmonary complications: 13 [11 to 15] mmHg vs. no postoperative pulmonary complications: 10 [8 to 13.5] mmHg; P = 0.007) and before extubation (postoperative pulmonary complications: 13 [11 to 14] mmHg vs. no postoperative pulmonary complications: 10 [8 to 12] mmHg; P = 0.006). After adjusting for age, ARISCAT, body mass index, smoking, fluid balance, anesthesia type, laparoscopic procedure and surgery duration, high V/Q ratio before extubation was independently associated with the development of postoperative pulmonary complications (odds ratio, 1.147; 95% CI, 1.021 to 1.289; P = 0.02). The sensitivity analysis showed an E-value of 1.35 (CI, 1.11). CONCLUSIONS In patients with intermediate or high risk of postoperative pulmonary complications undergoing major noncardiac surgery, intraoperative V/Q mismatch is associated with the development of postoperative pulmonary complications. Increased high V/Q ratio before extubation is independently associated with the occurrence of postoperative pulmonary complications in the first 7 days after surgery. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Gaetano Scaramuzzo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; and Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy
| | - Dan Stieper Karbing
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Federico Vigolo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Martina Frizziero
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Riccardo Ragazzi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; and Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy
| | - Marco Verri
- Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy
| | - Stephen Edward Rees
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Carlo Alberto Volta
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; and Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy
| | - Savino Spadaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; and Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy
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Gutierrez G. A non-invasive method to monitor respiratory muscle effort during mechanical ventilation. J Clin Monit Comput 2024; 38:1125-1134. [PMID: 38733504 DOI: 10.1007/s10877-024-01164-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE This study introduces a method to non-invasively and automatically quantify respiratory muscle effort (Pmus) during mechanical ventilation (MV). The methodology hinges on numerically solving the respiratory system's equation of motion, utilizing measurements of airway pressure (Paw) and airflow (Faw). To evaluate the technique's effectiveness, Pmus was correlated with expected physiological responses. In volume-control (VC) mode, where tidal volume (VT) is pre-determined, Pmus is expected to be linked to Paw fluctuations. In contrast, during pressure-control (PC) mode, where Paw is held constant, Pmus should correlate with VT variations. METHODS The study utilized data from 250 patients on invasive MV. The data included detailed recordings of Paw and Faw, sampled at 31.25 Hz and saved in 131.1-second epochs, each covering 34 to 41 breaths. The algorithm identified 51,268 epochs containing breaths on either VC or PC mode exclusively. In these epochs, Pmus and its pressure-time product (PmusPTP) were computed and correlated with Paw's pressure-time product (PawPTP) and VT, respectively. RESULTS There was a strong correlation of PmusPTP with PawPTP in VC mode (R² = 0.91 [0.76, 0.96]; n = 17,648 epochs) and with VT in PC mode (R² = 0.88 [0.74, 0.94]; n = 33,620 epochs), confirming the hypothesis. As expected, negligible correlations were observed between PmusPTP and VT in VC mode (R² = 0.03) and between PmusPTP and PawPTP in PC mode (R² = 0.06). CONCLUSION The study supports the feasibility of assessing respiratory effort during MV non-invasively through airway signal analysis. Further research is warranted to validate this method and investigate its clinical applications.
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Affiliation(s)
- Guillermo Gutierrez
- Professor Emeritus Medicine, Anesthesiology and Engineering, The George Washington University, 700 New Hampshire Ave, NW Suite 510, Washington, DC, 20037, USA.
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Delfrate G, Albino LB, Assreuy J, Fernandes D. CECAL SLURRY AS AN ALTERNATIVE MODEL TO CECAL LIGATION AND PUNCTURE FOR THE STUDY OF SEPSIS-INDUCED CARDIOVASCULAR DYSFUNCTION. Shock 2024; 62:547-555. [PMID: 38888572 DOI: 10.1097/shk.0000000000002412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
ABSTRACT Sepsis is a life-threatening condition widely studied by animal models. Cecal ligation and puncture (CLP) is still regarded as the gold standard model for sepsis. However, CLP has limitations due to its invasiveness and variability. Cecal slurry (CS) model is a nonsurgical and thus less invasive alternative. However, the lack of standardization of the CS model in the literature limits its practical application. Additionally, it is not well studied whether CS model reproduces septic cardiovascular dysfunction in rats, which is a crucial issue in septic patients. Thus, this study aimed to standardize the CS model in Wistar rats and evaluate sepsis-induced cardiovascular dysfunction compared to CLP. Our results showed that CS model induced important features of sepsis cardiovascular dysfunction 24 h after its onset, such as hypotension, tachycardia, and decreased contractile response to vasoconstrictors both in vivo and ex vivo as well changes in renal blood flow. Increases in blood lactate, AST, ALT, creatinine, and urea indicated organ dysfunction. CS model also induced increased production of nitric oxide metabolites and bacterial spread to tissues. CS model causes less animal suffering, it is a nonsurgical model, and, more importantly, it replicates the cardiovascular dysfunction induced by sepsis with better homogeneity than CLP. Therefore, CS model serves as an alternative and possibly as a better model for sepsis research.
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Affiliation(s)
- Gabrielle Delfrate
- Department of Pharmacology, Universidade Federal de Santa Catarina, Florianópolis, Brazil
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Serafini SC, Hemmes SNT, Serpa Neto A, Schultz MJ, Tschernko E, Gama de Abreu M, Mazzinari G, Ball L. Risk factors for PPCs in laparoscopic non-robotic vs. laparoscopic robotic abdominal surgery (LapRas): rationale and protocol for a patient-level analysis of LAS VEGAS and AVATaR. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:592-600. [PMID: 38987020 DOI: 10.1016/j.redare.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Postoperative pulmonary complications (PPCs) vary amongst different surgical techniques. We aim to compare the incidence of PPCs after laparoscopic non-robotic versus laparoscopic robotic abdominal surgery. METHODS AND ANALYSIS LapRas (Risk Factors for PPCs in Laparoscopic Non-robotic vs Laparoscopic robotic abdominal surgery) incorporates harmonized data from 2 observational studies on abdominal surgery patients and PPCs: 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS), and 'Assessment of Ventilation during general AnesThesia for Robotic surgery' (AVATaR). The primary endpoint is the occurrence of one or more PPCs in the first five postoperative days. Secondary endpoints include the occurrence of each individual PPC, hospital length of stay and in-hospital mortality. Logistic regression models will be used to identify risk factors for PPCs in laparoscopic non-robotic versus laparoscopic robotic abdominal surgery. We will investigate whether differences in the occurrence of PPCs between the two groups are driven by differences in duration of anesthesia and/or the intensity of mechanical ventilation. ETHICS AND DISSEMINATION This analysis will address a clinically relevant research question comparing laparoscopic and robotic assisted surgery. No additional ethical committee approval is required for this metanalysis. Data will be shared with the scientific community by abstracts and original articles submitted to peer-reviewed journals. REGISTRATION The registration of this post-hoc analysis is pending; individual studies that were merged into the used database were registered at clinicaltrials.gov: LAS VEGAS with identifier NCT01601223, AVATaR with identifier NCT02989415.
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Affiliation(s)
- S C Serafini
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy; Department of Intensive Care, Amsterdam UMC, Amsterdam, Netherlands.
| | - S N T Hemmes
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, Netherlands; Department of Anesthesiology, Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - A Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia; Department of Critical Care, Data Analytics Research and Evaluation Centre, University of Melbourne, Melbourne, Victoria, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - M J Schultz
- Department of Intensive Care, Amsterdam UMC, Amsterdam, Netherlands
| | - E Tschernko
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Viena, Austria
| | - M Gama de Abreu
- Division of Intensive Care and Resuscitation, Division of Cardiothoracic Anesthesia, and Outcomes Research Consortium, Department of Anesthesiology, Integrated Hospital Care Institute, Cleveland Clinic, Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, United States
| | - G Mazzinari
- Research Group in Perioperative Medicine, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Department of Statistics and Operational Research, Universidad de Valencia, Valencia, Spain
| | - L Ball
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy; Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l'Oncologia e le Neuroscience, Genoa, Italy.
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He Q, Wei Y, Qian Y, Zhong M. Pathophysiological dynamics in the contact, coagulation, and complement systems during sepsis: Potential targets for nafamostat mesilate. JOURNAL OF INTENSIVE MEDICINE 2024; 4:453-467. [PMID: 39310056 PMCID: PMC11411436 DOI: 10.1016/j.jointm.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 09/25/2024]
Abstract
Sepsis is a life-threatening syndrome resulting from a dysregulated host response to infection. It is the primary cause of death in the intensive care unit, posing a substantial challenge to human health and medical resource allocation. The pathogenesis and pathophysiology of sepsis are complex. During its onset, pro-inflammatory and anti-inflammatory mechanisms engage in intricate interactions, possibly leading to hyperinflammation, immunosuppression, and long-term immune disease. Of all critical outcomes, hyperinflammation is the main cause of early death among patients with sepsis. Therefore, early suppression of hyperinflammation may improve the prognosis of these patients. Nafamostat mesilate is a serine protease inhibitor, which can inhibit the activation of the complement system, coagulation system, and contact system. In this review, we discuss the pathophysiological changes occurring in these systems during sepsis, and describe the possible targets of the serine protease inhibitor nafamostat mesilate in the treatment of this condition.
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Affiliation(s)
- Qiaolan He
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yilin Wei
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiqi Qian
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ming Zhong
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, School of Public Health, Fudan University, Shanghai, China
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