Association between intravenous fluid administration and endothelial glycocalyx shedding in humans: a systematic review

INTRODUCTION

Several studies have demonstrated associations between greater rate/volume of intravenous (IV) fluid administration and poorer clinical outcomes. One postulated mechanism for harm from exogenous fluids is shedding of the endothelial glycocalyx (EG).

METHODS

A systematic review using relevant search terms was performed using Medline, EMBASE and Cochrane databases from inception to October 2023. Included studies involved humans where the exposure was rate or volume of IV fluid administration and the outcome was EG shedding. The protocol was prospectively registered on PROSPERO: CRD42021275133.

RESULTS

The search yielded 450 articles, with 20 articles encompassing 1960 participants included in the review. Eight studies were randomized controlled clinical trials. Half of studies examined patients with sepsis and critical illness; the remainder examined perioperative patients or healthy subjects. Almost all reported blood measurements of soluble EG components; one study used in vivo video-microscopy to estimate EG thickness. Four of 10 sepsis studies, and 9 of 11 non-sepsis studies, found a positive relationship between IV fluid rate/volume and measures of EG shedding.

CONCLUSIONS

A trend toward an association between IV fluid rate/volume and EG shedding was found in studies of stable patients, but was not consistently observed among studies of septic and critically ill patients.

Enhancing Risk Stratification on Coronary Computed Tomography Angiography: The Role of Artificial Intelligence

PURPOSE

To describe and outline the role of artificial intelligence (AI) in assisting coronary computed tomography angiography (CCTA) in enhancing risk stratification.

METHODS

A comprehensive review of the literature was performed to identify published work investigating the utility of applying AI to CCTA.

FINDINGS

CCTA is an excellent diagnostic tool for the detection of atherosclerotic cardiovascular disease. The noninvasive nature and high diagnostic accuracy have made CCTA a viable alternative to invasive coronary angiography to detect luminal stenosis. However, it is now understood that stenosis is just one factor that predicts cardiac risk and other factors need to be considered. CCTA-derived plaque biomarkers have since emerged as established predictors of cardiac events to improve risk stratification. Despite awareness of these biomarkers, they are still yet to be incorporated into routine clinical practice. The major barriers to implementation include the specialized skills required for image evaluation and the time intensive nature of analysis. With the many recent advancements in the technology, AI presents itself as a promising solution. AI is attractive because it has the potential to rapidly automate technically challenging tasks with exceptional accuracy.

IMPLICATIONS

Developments in the field of AI are occurring at a rapid rate. There is already increasing evidence of the potential AI has to greatly improve the utility of CCTA by improving analysis time and extracting additional prognostic data from new plaque biomarkers. There are, however, technical and ethical challenges that need to be considered before implementing such technology into routine clinical practice.

The relationship between midlife dyslipidemia and lifetime incidence of dementia: A systematic review and meta-analysis of cohort studies

Introduction

We conducted a systematic review and meta-analysis to review the relationship between midlife dyslipidemia and lifetime incident dementia.

Methods

The databases Medline, Embase, Scopus, Web of Science, and Cochrane were searched from inception to February 20, 2022. Longitudinal studies examining the relationship between midlife lipid levels on dementia, dementia subtypes, and/or cognitive impairment were pooled using inverse-variance weighted random-effects meta-analysis.

Results

Seventeen studies (1.2 million participants) were included. Midlife hypercholesterolemia was associated with increased incidence of mild cognitive impairment (effect size [ES] = 2.01; 95% confidence interval [CI] 1.19 to 2.84; I² = 0.0%) and all-cause dementia (ES = 1.14; 95% CI: 1.07 to 1.21; I² = 0.0%). Each 1 mmol/L increase in low-density lipoprotein was associated with an 8% increase (ES = 1.08, 95% CI: 1.03 to 1.14; I² = 0.3%) in incidence of all-cause dementia.

Discussion

Midlife dyslipidemia is associated with an increased risk of cognitive impairment in later life.