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Biomaterials for bone defect repair: Types, mechanisms and effects. 用于骨缺损修复的生物材料:类型、机制和效果。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-02 DOI: 10.1177/03913988231218884
Jiaming Wang, Mingchong Liu, Chensong Yang, Yutao Pan, Shengchao Ji, Ning Han, Guixin Sun

Bone defects or bone discontinuities caused by trauma, infection, tumours and other diseases have led to an increasing demand for bone grafts and biomaterials. Autologous bone grafts, bone grafts with vascular tips, anastomosed vascular bone grafts and autologous bone marrow components are all commonly used in clinical practice, while oversized bone defects require the use of bone tissue engineering-related biomaterials to repair bone defects and promote bone regeneration. Currently, inorganic components such as polysaccharides and bioceramics, as well as a variety of bioactive proteins, metal ions and stem cells can be loaded into hydrogels or 3D printed scaffold materials to achieve better therapeutic results. In this review, we provide an overview of the types of materials, applications, potential mechanisms and current developments in the repair of bone defects.

由于创伤、感染、肿瘤和其他疾病造成的骨缺损或骨不连续性,导致对骨移植物和生物材料的需求不断增加。自体骨移植物、带血管蒂的骨移植物、吻合血管骨移植物和自体骨髓成分都是临床上常用的骨移植材料,而过大的骨缺损则需要使用骨组织工程相关的生物材料来修复骨缺损,促进骨再生。目前,多糖、生物陶瓷等无机成分以及各种生物活性蛋白、金属离子和干细胞都可以被载入水凝胶或三维打印支架材料中,以达到更好的治疗效果。在本综述中,我们将概述骨缺损修复材料的类型、应用、潜在机制和当前的发展情况。
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引用次数: 0
Osteogenic organoid for bone regeneration: Healing of bone defect in congenital pseudoarthrosis of the tibia. 用于骨再生的成骨有机体:胫骨先天性假关节的骨缺损愈合。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-05 DOI: 10.1177/03913988231220844
Jose E Cardier, Dylana Diaz-Solano, Olga Wittig, Giuseppe Sierra, Jose Pulido, Rita Moreno, Soraima Fuentes, Fredy Leal

Background: Congenital pseudoarthrosis of the tibia (CPT) is an uncommon disease associated with failure to achieve bone union and recurrent fractures. There is evidence showing that CPT is associated with decreased osteogenesis. Based on the capacity of mesenchymal stromal cells (MSCs) to induce osteogenesis, we develop an osteogenic organoid (OstO) constituted by these cells, and other components of the bone niche, for inducing bone formation in a child diagnosed with CPT.

Aim: To evaluate the capacity of an OstO to induce bone formation in a patient with CPT.

Methods: The OstO was fabricated with allogeneic bone marrow MSCs from a healthy donor, collagen microbeads (CM) and PRP clot. The CM and PRP function as extracellular matrix and scaffolds for MSC. The OstO was placed at the site of non-union. Internal and external fixation was placed in the tibia. Radiological evaluation was performed after MSCs transplantation.

Results: After 4 months of MSCs transplantation, radiographic imaging showed evidence of osteogenesis at the site of CPT lesion. The tibia showed bone consolidation and complete healing of the non-union CPT lesion after 6 months. Functional improvement was observed after 1 year of MSC transplantation.

Conclusions: The OstO is a bone-like niche which promote osteogenesis in patients with failure in bone formation, such as CPT. To our knowledge, these results provide the first evidence showing CPT healing induced by an OstO constituted by allogeneic MSCs. Future studies incorporating a larger number of patients may confirm these results.

背景:先天性胫骨假关节(CPT)是一种不常见的疾病,与无法实现骨结合和复发性骨折有关。有证据表明,先天性假性胫骨关节病与成骨能力下降有关。基于间充质基质细胞(MSCs)诱导骨生成的能力,我们开发了一种由这些细胞和其他骨龛成分构成的骨生成类器官(OstO),用于诱导一名被诊断为CPT的儿童的骨形成:方法:用来自健康供体的异体骨髓间充质干细胞、胶原微珠(CM)和PRP凝块制作OstO。CM和PRP具有细胞外基质和间充质干细胞支架的功能。OstO 被放置在骨不连的部位。对胫骨进行内外固定。间充质干细胞移植后进行了放射学评估:结果:间充质干细胞移植 4 个月后,放射影像学显示 CPT 病变部位有骨生成的迹象。6 个月后,胫骨显示骨质巩固,未愈合的 CPT 病灶完全愈合。间充质干细胞移植一年后,功能得到改善:结论:OstO是一种骨样龛,可促进骨形成失败(如CPT)患者的骨生成。据我们所知,这些结果首次提供了由异体间充质干细胞构成的 OstO 诱导 CPT 愈合的证据。未来纳入更多患者的研究可能会证实这些结果。
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引用次数: 0
Clinical effect of pulmonary rehabilitation in patients with mechanical ventilation: A meta-analysis. 机械通气患者的肺康复临床效果:荟萃分析
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-07 DOI: 10.1177/03913988231218116
Yang Yang, Rong-Ju Zhang, Xi-Na Yuan, Yue-Qin Gu, Yong-Nan Li, Shu-Ping Wu, Yan-Shuang Cheng

Objective: To systematically evaluate the clinical efficacy of pulmonary rehabilitation in patients with mechanical ventilation in an intensive care unit (ICU).

Methods: Relevant studies were identified in the PubMed, Web of Science, National Library of Medicine, China National Knowledge Infrastructure and Wanfang databases. A meta-analysis was performed after screening based on the inclusion and exclusion criteria, data extraction and literature quality evaluation.

Results: In total, 19 studies involving 2181 participants were included. The results of the meta-analysis revealed that compared with patients with conventional rehabilitation measures, patients with pulmonary rehabilitation measures had a higher offline success rate (relative risk (RR) = 1.16; 95% confidence interval (CI): 1.09, 1.24; p < 0.00001) and higher arterial oxygen partial pressure levels (mean difference (MD) = 8.96; 95%CI: 5.98, 11.94; p < 0.0001) and these measures significantly shortened the duration of mechanical ventilation (standardised MD (SMD) = -1.08; 95%CI: -1.58, -0.59; p < 0.0001) and ICU stay (SMD = -1.41; 95%CI: -1.94, -0.88; p < 0.0001). Aspiration significantly reduced the incidence of ventilator-associated pneumonia (RR = 0.35; 95%CI: 0.24, 0.51; p < 0.00001) and deep vein thrombosis (RR = 0.32; 95%CI: 0.13, 0.76; p = 0.01) in ICU patients with mechanical ventilation.

Conclusion: Pulmonary rehabilitation measures can improve the success rate of weaning from mechanical ventilation in ICU patients, shorten the time of mechanical ventilation and ICU hospitalisation and reduce the incidence of related adverse reactions, but the impact on mortality requires further study.

目的:系统评估重症监护病房机械通气患者肺康复治疗的临床疗效:系统评估肺康复治疗在重症监护病房(ICU)机械通气患者中的临床疗效:在 PubMed、Web of Science、美国国家医学图书馆、中国国家知识基础设施和万方数据库中查找相关研究。根据纳入和排除标准进行筛选、数据提取和文献质量评估后,进行荟萃分析:结果:共纳入 19 项研究,涉及 2181 名参与者。荟萃分析结果显示,与采用常规康复措施的患者相比,采用肺康复措施的 ICU 患者机械通气的脱机成功率更高(相对风险(RR)= 1.16;95% 置信区间(CI):1.09,1.24;P P P P = 0.01):肺康复措施可提高 ICU 患者机械通气断流的成功率,缩短机械通气和 ICU 住院时间,降低相关不良反应的发生率,但对死亡率的影响还需进一步研究。
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引用次数: 0
The alterations of cardiac function during venovenous artificial placenta support in fetal goats. 胎儿山羊静脉人工胎盘支持过程中心脏功能的改变。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-12-19 DOI: 10.1177/03913988231215905
Guanhua Li, Mingliang Li, Yun Teng, Li Zhang, Chengcheng Pang, Jianfeng Tan, Jimei Chen, Jian Zhuang, Chengbin Zhou

Introduction: Venovenous artificial placenta (VVAP) may mimic the intrauterine environment for maintaining fetal circulation. However, changes in ventricular function in fetal goats undergoing VVAP support remain unclear.

Methods: Pump-assisted VVAPs were established in five fetal goats for 9 h. The myocardial performance index (Tei index), cardiac output (CO), and blood biochemical parameters were measured during VVAP support.

Results: An increasing trend of the right ventricular (RV) Tei index was seen during VVAP support (p for trend < 0.01). The right ventricular cardiac output (RVCO) increased after the initiation of VVAP, while a significant trend of reduction was observed after 3 h (p for trend = 0.03). During VVAP support, we observed remarkable elevations of plasma cTnI and arterial lactic acid, which were positively correlated with the RV Tei index, but not the left ventricular (LV) Tei index, LVCO, and RVCO.

Conclusions: The RVCO increases initially while a tendency of decrease could be observed during VVAP support. Special attention should be paid to right ventricular dysfunction during VVAP support.

导言:静脉人工胎盘(VVAP)可模拟宫内环境以维持胎儿循环。然而,接受 VVAP 支持的胎儿山羊心室功能的变化仍不清楚:在 VVAP 支持期间测量了心肌性能指数(Tei 指数)、心输出量(CO)和血液生化指标:结果:在 VVAP 支持期间,右心室 Tei 指数呈上升趋势(p for trend p for trend = 0.03)。在 VVAP 支持期间,我们观察到血浆 cTnI 和动脉乳酸显著升高,这与 RV Tei 指数呈正相关,但与左心室 Tei 指数、LVCO 和 RVCO 无关:结论:在 VVAP 支持期间,RVCO 最初会增加,但随后会呈下降趋势。结论:在 VVAP 支持过程中,RVCO 最初会增加,但随后会呈下降趋势。在 VVAP 支持过程中,应特别注意右心室功能障碍。
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引用次数: 0
The use of CytoSorb in acute oral mercuric chloride poisoning at a potentially lethal dose. 在可能致死剂量的急性口服氯化汞中毒中使用 CytoSorb。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-12-23 DOI: 10.1177/03913988231215631
Anna Krakowiak, Beata Janasik, Łukasz Sadowski, Katarzyna Szwabe, Tomasz Wiśniewski, Małgorzata Anna Rak, Waldemar Machała

Introduction: The study aims to present a case of acute mercuric chloride poisoning treated successfully with continuous renal replacement therapy using the CytoSorb filter.

Case description: A 21-year-old female patient after a suicide attempt by intentional ingestion of mercuric chloride, was admitted to the hospital with features of multiple organ damage for specific treatment. The performed laboratory tests confirmed high levels of mercury in the blood (1051 μg/L) and urine (22,960 μg/L). Due to acute renal failure, continuous renal replacement therapy (CRRT) CVVHD Ci-Ca was initiated; the procedure was then converted to CVVHDF Ci-Ca with ultrafiltration to optimise therapy, and CytoSorb was added to the artificial kidney system on day 3. Specific antidote therapy (DMPS) was administered concurrently. The ongoing treatment resulted in a reduction in subjective complaints, a decrease in blood mercury levels to 580 μg/L, and an improvement in parenchymal organ function.

Conclusion: In the event of poisoning with inorganic mercury compounds (mercuric chloride), continuous renal replacement therapy using the CytoSorb filter as an extracorporeal blood purification method may be considered.

简介本研究旨在介绍一例使用 CytoSorb 过滤器进行持续肾脏替代治疗并获得成功的急性氯化汞中毒病例:一名 21 岁的女性患者因故意摄入氯化汞自杀未遂,入院接受特殊治疗时出现多器官损伤。实验室检测证实,患者血液(1051 微克/升)和尿液(22960 微克/升)中汞含量较高。由于急性肾功能衰竭,患者开始接受连续肾脏替代疗法(CRRT)CVVHD Ci-Ca;随后转为超滤CVVHDF Ci-Ca,以优化治疗,并在第3天将CytoSorb添加到人工肾脏系统中。同时还进行了特定的解毒治疗(DMPS)。通过持续治疗,主观症状有所减轻,血汞水平降至 580 μg/L,实质器官功能有所改善:结论:在无机汞化合物(氯化汞)中毒的情况下,可以考虑使用 CytoSorb 过滤器作为体外血液净化方法进行持续的肾脏替代治疗。
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引用次数: 0
Comparison of different 3D printers in terms of dimensional stability by image data of a dry human mandible obtained from CBCT and CT. 不同3D打印机尺寸稳定性的比较,由CBCT和CT获得的干人下颌骨图像数据。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-11-19 DOI: 10.1177/03913988231212405
Hilal Peker Ozturk, Simel Ayyıldız

Objectives: To manage the mandibular traumas, for the expression of the complex anatomy or pathology in education of health sciences related branches, a model of the traumatized mandible is indispensable. For these, different 3D-print-technologies can be used. The aim of this study is, to measure how close these 3D-printed-models are to human-mandible (trueness) and the effectiveness of CT and CBCT at this point.

Study design: One-dry-human-mandible and 10-models manufactured by five different 3D-printers in four different-kinds of additive-manufacturing technology (Fused-Deposition-Modeling (FDM), Stereolithography (SLA), Binder-jetting (BJ), Polyjet (PJ)) were used, five-anatomic-landmarks and eight-distances were measured and evaluated. Mandible's data were constructed based on DICOM-3.0 data from CBCT and CT scans. Images were opened in MIMICS (software-program).

Results: Study compared the devices that produced models with the same dry human-mandible. It was seen that the model with the highest margin of error (132.5 mm) was manufactured by Fused-deposition-modeling device using CT-data. In terms of distance to real-data, the model with the lowest error was generated by Binder-Jetting (ZCorp) with CBCT-data. Models produced with CBCT-data are closer to dry-human-mandible than models with CT-data.

Conclusion: The current study shows that CBCT generates significantly better data than CT in producing mandibular models. The first choice for manufacturing of human mandible is BJ and the second choice is the technology of SLA.

目的:在健康科学相关学科的教学中,为了表达复杂的解剖或病理,创伤下颌骨模型是必不可少的。对于这些,可以使用不同的3d打印技术。本研究的目的是测量这些3d打印模型与人类下颌骨的接近程度(真实性)以及CT和CBCT在这一点上的有效性。研究设计:使用5台不同的3d打印机以4种不同的增材制造技术(熔融沉积建模(FDM)、立体光刻(SLA)、粘结剂喷射(BJ)、Polyjet (PJ))制造的1个干式人体下颌骨和10个模型,测量和评估5个解剖标志和8个距离。下颌骨数据基于CBCT和CT扫描的DICOM-3.0数据构建。在MIMICS(软件程序)中打开图像。结果:研究比较了同种干燥人体下颌骨的模型。结果表明,利用ct数据,采用熔融沉积建模装置制造出误差最大的模型(132.5 mm)。在与实际数据的距离方面,使用cbct数据的Binder-Jetting (ZCorp)生成的模型误差最小。用cbct数据制作的模型比用ct数据制作的模型更接近于干人下颌骨。结论:目前的研究表明,CBCT在制作下颌骨模型方面的数据明显优于CT。制造人类下颌骨的首选技术是BJ,其次是SLA技术。
{"title":"Comparison of different 3D printers in terms of dimensional stability by image data of a dry human mandible obtained from CBCT and CT.","authors":"Hilal Peker Ozturk, Simel Ayyıldız","doi":"10.1177/03913988231212405","DOIUrl":"10.1177/03913988231212405","url":null,"abstract":"<p><strong>Objectives: </strong>To manage the mandibular traumas, for the expression of the complex anatomy or pathology in education of health sciences related branches, a model of the traumatized mandible is indispensable. For these, different 3D-print-technologies can be used. The aim of this study is, to measure how close these 3D-printed-models are to human-mandible (trueness) and the effectiveness of CT and CBCT at this point.</p><p><strong>Study design: </strong>One-dry-human-mandible and 10-models manufactured by five different 3D-printers in four different-kinds of additive-manufacturing technology (Fused-Deposition-Modeling (FDM), Stereolithography (SLA), Binder-jetting (BJ), Polyjet (PJ)) were used, five-anatomic-landmarks and eight-distances were measured and evaluated. Mandible's data were constructed based on DICOM-3.0 data from CBCT and CT scans. Images were opened in MIMICS (software-program).</p><p><strong>Results: </strong>Study compared the devices that produced models with the same dry human-mandible. It was seen that the model with the highest margin of error (132.5 mm) was manufactured by Fused-deposition-modeling device using CT-data. In terms of distance to real-data, the model with the lowest error was generated by Binder-Jetting (ZCorp) with CBCT-data. Models produced with CBCT-data are closer to dry-human-mandible than models with CT-data.</p><p><strong>Conclusion: </strong>The current study shows that CBCT generates significantly better data than CT in producing mandibular models. The first choice for manufacturing of human mandible is BJ and the second choice is the technology of SLA.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138046871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5. 心源性休克的病因和退出策略影响使用 Impella 5.5 的患者的存活率。
IF 1.4 4区 医学 Q4 ENGINEERING, BIOMEDICAL Pub Date : 2024-01-01 Epub Date: 2023-12-05 DOI: 10.1177/03913988231214180
McKenzie Sicke, Shan Modi, Yeahwa Hong, Michael Bashline, Wyatt Klass, Ed Horn, Barinder S Hansra, Raj Ramanan, Jeffrey Fowler, Nikita Sumzin, Ryan M Rivosecchi, Rahul Chaudhary, Luke A Ziegler, Nicholas R Hess, Nishant Agrawal, David J Kaczorowski, Gavin W Hickey

Background: Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5.

Objectives: This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center.

Methods: A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted.

Results: Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups.

Conclusions: ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.

背景:尽管不同病因导致的心源性休克(CS)结果存在历史差异,但对于使用 Impella 5.5 临时机械循环支持(MCS)的患者而言,不同病因导致的 CS 结果尚未得到描述:本研究旨在确定在一个高容量、三级移植中心接受急性心肌梗死(AMI)和急性失代偿性心力衰竭(ADHF)支持治疗的这些患者在存活率和支持后去向方面的差异:对 2020 年 11 月至 2022 年 6 月期间在本中心接受 Impella 5.5 的患者进行了回顾性回顾:67名患者因CS接受了Impella 5.5植入手术;23名(34%)患者因AMI接受植入手术,44名(66%)患者因ADHF接受植入手术。急性心肌梗死患者的 SCAI 分期、植入前乳酸水平和之前使用 MCS 装置的比例较高,从入院到植入的天数较少。AMI患者在30天、90天和出院时的存活率较低。在排除接受移植的患者后,全因死亡时间没有差异。两组患者的并发症发生率无明显差异:结论:使用 Impella 5.5 支持的 ADHF-CS 患者的存活率明显高于 AMI-CS 患者。与 AMI 患者相比,ADHF 患者更多地被成功转入心脏移植,从而提高了存活率。
{"title":"Cardiogenic shock etiology and exit strategy impact survival in patients with Impella 5.5.","authors":"McKenzie Sicke, Shan Modi, Yeahwa Hong, Michael Bashline, Wyatt Klass, Ed Horn, Barinder S Hansra, Raj Ramanan, Jeffrey Fowler, Nikita Sumzin, Ryan M Rivosecchi, Rahul Chaudhary, Luke A Ziegler, Nicholas R Hess, Nishant Agrawal, David J Kaczorowski, Gavin W Hickey","doi":"10.1177/03913988231214180","DOIUrl":"10.1177/03913988231214180","url":null,"abstract":"<p><strong>Background: </strong>Despite historical differences in cardiogenic shock (CS) outcomes by etiology, outcomes by CS etiology have yet to be described in patients supported by temporary mechanical circulatory support (MCS) with Impella 5.5.</p><p><strong>Objectives: </strong>This study aims to identify differences in survival and post-support destination for these patients in acute myocardial infarction (AMI) and acute decompensated heart failure (ADHF) CS at a high-volume, tertiary, transplant center.</p><p><strong>Methods: </strong>A retrospective review of patients who received Impella 5.5 at our center from November 2020 to June 2022 was conducted.</p><p><strong>Results: </strong>Sixty-seven patients underwent Impella 5.5 implantation for CS; 23 (34%) for AMI and 44 (66%) for ADHF. AMI patients presented with higher SCAI stage, pre-implant lactate, and rate of prior MCS devices, and fewer days from admission to implantation. Survival was lower for AMI patients at 30 days, 90 days, and discharge. No difference in time to all-cause mortality was found when excluding patients receiving transplant. There was no significant difference in complication rates between groups.</p><p><strong>Conclusions: </strong>ADHF-CS patients with Impella 5.5 support have a significantly higher rate of survival than patients with AMI-CS. ADHF patients were successfully bridged to heart transplant more often than AMI patients, contributing to increased survival.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10824236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138487439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Kinetics of C-reactive protein during extracorporeal membrane oxygenation. 体外膜氧化过程中c反应蛋白的动力学。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-11-29 DOI: 10.1177/03913988231213511
Yael Lichter, Amir Gal Oz, Uri Carmi, Nimrod Adi, Asaph Nini, Yoel Angel, Andrey Nevo, Daniel Aviram, Itay Moshkovits, Noam Goder, Dekel Stavi

Background: The exposure of blood to the artificial circuit during extracorporeal membrane oxygenation (ECMO) can induce an inflammatory response. C-reactive protein (CRP) is a commonly used biomarker of systemic inflammation.

Methods: In this retrospective observational study, we analyzed results of daily plasma CRP measurements in 110 critically ill patients, treated with ECMO. We compared CRP levels during the first 5 days of ECMO operation, between different groups of patients according to ECMO configurations, Coronavirus disease 2019 (COVID-19) status, and mechanical ventilation parameters.

Results: There was a statistically significant decrease in CRP levels during the first 5 days of veno-venous (VV) ECMO (173 ± 111 mg/L, 154 ± 107 mg/L, 127 ± 97 mg/L, 114 ± 100 mg/L and 118 ± 90 mg/L for days 1-5 respectively, p < 0.001). Simultaneously, there was a significant reduction in ventilatory parameters, as represented by the mechanical power (MP) calculation, from 24.02 ± 14.53 J/min to 6.18 ± 4.22 J/min within 3 h of VV ECMO initiation (p < 0.001). There was non-significant trend of increase in CRP level during the first 5 days of veno arterial (VA) ECMO (123 ± 80 mg/L, 179 ± 91 mg/L, 203 ± 90 mg/L, 179 ± 95 mg/L and 198 ± 93 for days 1-5 respectively, p = 0.126) and no significant change in calculated MP (from 14.28 ± 8.56 J/min to 10.81 ± 8.09 J/min within 3 h if ECMO initiation, p = 0.071).

Conclusions: We observed a significant decrease in CRP levels during the first 5 days of VV ECMO support, and suggest that the concomitant reduction in ventilatory MP may have mitigated the degree of alveolar stress and strain that could have contributed to a decrease in the systemic inflammatory process.

背景:体外膜氧合(ECMO)过程中,血液暴露于人工回路可诱导炎症反应。c反应蛋白(CRP)是一种常用的全身性炎症的生物标志物。方法:在这项回顾性观察性研究中,我们分析了110例经ECMO治疗的危重患者的每日血浆CRP测量结果。我们根据ECMO配置、2019冠状病毒病(COVID-19)状态和机械通气参数,比较不同组患者在ECMO手术前5天的CRP水平。结果:静脉-静脉(VV) ECMO前5天CRP水平下降有统计学意义(1-5天分别为173±111 mg/L、154±107 mg/L、127±97 mg/L、114±100 mg/L和118±90 mg/L, p p p = 0.126),计算MP变化无统计学意义(ECMO启动后3 h内从14.28±8.56 J/min降至10.81±8.09 J/min, p = 0.071)。结论:我们观察到在VV ECMO支持的前5天CRP水平显著下降,并提示伴随的通气MP降低可能减轻了肺泡应激和应变的程度,这可能有助于减少全身炎症过程。
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引用次数: 0
Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation. 心肌梗死术后静脉-动脉体外膜肺氧合术后疗效的机构间分析。
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-12-05 DOI: 10.1177/03913988231214934
Fausto Biancari, Timo Mäkikallio, Antonio Loforte, Alexander Kaserer, Vito G Ruggieri, Sung-Min Cho, Jin Kook Kang, Magnus Dalén, Henryk Welp, Kristján Jónsson, Sigurdur Ragnarsson, Francisco J Hernández Pérez, Giuseppe Gatti, Khalid Alkhamees, Antonio Fiore, Andrea Lechiancole, Stefano Rosato, Cristiano Spadaccio, Matteo Pettinari, Andrea Perrotti, Sebastian D Sahli, Camilla L'Acqua, Amr A Arafat, Monirah A Albabtain, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Ihor Krasivskyi, Robertas Samalavicius, Agne Jankuviene, Marta Alonso-Fernandez-Gatta, Markus J Wilhelm, Tatu Juvonen, Giovanni Mariscalco

Introduction: Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO.

Methods: Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching.

Results: Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients' risk profile.

Conclusions: In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.

简介需要进行心肌切开术后静脉-动脉体外膜氧合(V-A-ECMO)的患者早期死亡的风险很高。在这项分析中,我们评估了心肌切开术后 V-A-ECMO 的结果是否存在机构间差异:方法:通过对患者个体数据(IPD)荟萃分析的系统性回顾,确定了有关心肌切开术后 V-A-ECMO 的研究。采用直接标准化、估计观察/预期院内死亡率和倾向评分匹配等方法对机构间结果进行分析:结果:对文献进行系统回顾后得出了 31 项研究结果。本分析可获得 10 项研究的数据,这些数据涉及 25 家医院治疗的 1269 名患者。院内死亡率为 66.7%。六家医院的院内死亡率相对风险明显更高。观察到的院内死亡率与预期的院内死亡率之比显示,有四家医院属于异常值,死亡率明显升高,一家医院的院内死亡率明显降低。如果参与医院的观察/预期院内死亡率分别高于或低于 1.0,则将其分为表现不佳医院和表现不佳医院。在 395 对倾向得分匹配的医院中,表现优异的医院的院内死亡率(60.3% vs 71.4%,p = 0.001)明显低于表现不佳的医院。只有在对患者的风险状况进行调整后,心肌梗死术后V-A-ECMO的年手术量低才有可能预测不良预后:结论:参与研究的医院之间在心肌梗死术后V-A-ECMO的院内死亡率方面存在显著差异。这些研究结果表明,在许多中心,开胸术后V-A-ECMO的效果还有待提高。
{"title":"Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation.","authors":"Fausto Biancari, Timo Mäkikallio, Antonio Loforte, Alexander Kaserer, Vito G Ruggieri, Sung-Min Cho, Jin Kook Kang, Magnus Dalén, Henryk Welp, Kristján Jónsson, Sigurdur Ragnarsson, Francisco J Hernández Pérez, Giuseppe Gatti, Khalid Alkhamees, Antonio Fiore, Andrea Lechiancole, Stefano Rosato, Cristiano Spadaccio, Matteo Pettinari, Andrea Perrotti, Sebastian D Sahli, Camilla L'Acqua, Amr A Arafat, Monirah A Albabtain, Mohammed M AlBarak, Mohamed Laimoud, Ilija Djordjevic, Ihor Krasivskyi, Robertas Samalavicius, Agne Jankuviene, Marta Alonso-Fernandez-Gatta, Markus J Wilhelm, Tatu Juvonen, Giovanni Mariscalco","doi":"10.1177/03913988231214934","DOIUrl":"10.1177/03913988231214934","url":null,"abstract":"<p><strong>Introduction: </strong>Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO.</p><p><strong>Methods: </strong>Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching.</p><p><strong>Results: </strong>Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, <i>p</i> = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients' risk profile.</p><p><strong>Conclusions: </strong>In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138487441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options? 地震灾民中与挤压综合征相关的急性肾损伤,是时候考虑新的治疗方案了吗?
IF 1.7 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-08-17 DOI: 10.1177/03913988231191954
Gonzalo Ramírez-Guerrero, Thiago Reis, Matteo Marcello, Massimo de Cal, Claudio Ronco
{"title":"Crush syndrome-related acute kidney injury in earthquake victims, time to consider new therapeutical options?","authors":"Gonzalo Ramírez-Guerrero, Thiago Reis, Matteo Marcello, Massimo de Cal, Claudio Ronco","doi":"10.1177/03913988231191954","DOIUrl":"10.1177/03913988231191954","url":null,"abstract":"","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10005516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
International Journal of Artificial Organs
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