Yale Journal of Biology and Medicine最新文献

Goal-directed fluid therapy (GDFT) is usually recommended in patients undergoing major surgery and is essential in enhanced recovery after surgery (ERAS) protocols. This fluid regimen is usually guided by dynamic hemodynamic parameters and aims to optimize patients' cardiac output to maximize oxygen delivery to their vital organs. While many studies have shown that GDFT benefits patients perioperatively and can decrease postoperative complications, there is no consensus on which dynamic hemodynamic parameters to guide GDFT with. Furthermore, there are many commercialized hemodynamic monitoring systems to measure these dynamic hemodynamic parameters, and each has its pros and cons. This review will discuss and review the commonly used GDFT dynamic hemodynamic parameters and hemodynamic monitoring systems.

Introduction: Many commercially available foods and beverages contain color additives to which patients may develop allergic hypersensitivity. Several color additives currently approved for commercial sale in the United States have raised health concerns to a varying degree as testing and evidence of carcinogenicity, genotoxicity, and hypersensitivity has thus far been inadequate. Common uses for color additives include baked goods (eg, cakes, pastries, candy), flavored dairy products such as yogurt, sports-themed drinks (eg, Gatorade® Fruit Punch), and red-dyed Slurpee® beverages. Methods: We present the case of a patient who experienced color additive-related allergic hypersensitivity reactions after consumption of Slurpee® beverages, which may place her at risk when consuming other commercially available beverages and food products containing color additives. Percutaneous skin testing and an oral challenge were administered using three different red color additives (two color additives for skin testing and one color additive for the oral challenge). Results: The specific color additive precipitating her symptoms was not conclusively identified. Review of the literature acknowledges the idea that further research into color additive-related allergy should be conducted as there are many commercially available color additives that can elicit hypersensitivity reactions after consumption. Conclusion: Current research shows that of the red color additives available, Citrus Red, Red No. 3, and Red No. 40 are recognized to elicit such reactions. In order to lessen the burden of color additive-related hypersensitivity in the general population, public education, increased research, and subsequent regulations should be implemented.

The incidence of arrhythmia after myocardial infarction has declined since the introduction of reperfusion techniques. Nevertheless, ischemic arrhythmias are often associated with increased morbidity and mortality particularly in the first 48 hours after hospital admission. This paper presents a comprehensive review of the epidemiology, characteristics, and management of ischemic tachy- and brady-arrhythmias focusing on the period shortly after myocardial infarction (MI) in patients with both ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI).

Background: Aiming at understanding whether there are cases of near-tolerance among long-term surviving kidney transplant recipients in our center, or even operant tolerance can be attempted based on their immune status, we analyzed changes of immune cell subsets and cytokines in various groups, and evaluated immune status of long-term survival recipients. Methods: A real-world, observational, retrospective cohort study was conducted in our hospital. Twenty-eight long-term recipients were selected as study subjects, 15 recent postoperative stable recipients, and 15 healthy subjects as controls. T and B lymphocyte subsets, MDSCs, and cytokines were detected and analyzed. Results: Treg/CD4 T cells, total B and B10 cells in long-term and recent renal recipients were lower than healthy controls (HC). The level of IFN-γ and IL-17A in long-term survival patients was obviously higher than that in recent postoperative stable recipients and HC, while TGF-β1 level was significantly lower in long-term survival group than in short-term postoperative group and HC. Notably, compared with short-term recipients, it has been found that the IL-6 level in both positive and negative HLA groups were obviously lower (all P<0.05). In the long-term survival group, 43% of recipients were positive for urinary protein and 50% were positive for HLA antibody. Conclusion: This "real-world" study validates the findings of real status of long-term survival recipients observed in clinical trials. Contrary to a state of proper tolerance as expected, the group recipients in long-term survival were accompanied by the increased indicators of immune response, while those related to immune tolerance were not significantly increased. Long-term survival recipients with stable renal function may be in an immune equilibrium state where immunosuppression and rejection coexist under the action of low-intensity immune agents. If immunosuppressive agents are reduced or even removed, rejection may occur.

Natriuretic peptides (NPs) encompass a family of structurally related hormone/paracrine factors acting through the natriuretic peptide system regulating cell proliferation, vessel tone, inflammatory processes, neurohumoral pathways, fluids, and electrolyte balance. The three most studied peptides are atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-Type natriuretic peptide (CNP). ANP and BNP are the most relevant NPs as biomarkers for the diagnosis and prognosis of heart failure and underlying cardiovascular diseases, such as cardiac valvular dysfunction, hypertension, coronary artery disease, myocardial infarction, persistent arrhythmias, and cardiomyopathies. Cardiac dysfunctions related to cardiomyocytes stretching in the atria and ventricles are primary elicitors of ANP and BNP release, respectively. ANP and BNP would serve as biomarkers for differentiating cardiac versus noncardiac causes of dyspnea and as a tool for measuring the prognosis of patients with heart failure; nevertheless, BNP has been shown with the highest predictive value, particularly related to pulmonary disorders. Plasma BNP has been reported to help differentiate cardiac from pulmonary etiologies of dyspnea in adults and neonates. Studies have shown that COVID-19 infection also increases serum levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) and BNP. This narrative review assesses aspects of ANP and BNP on their physiology, and predictive values as biomarkers. We present an overview of the NPs' synthesis, structure, storage, and release, as well as receptors and physiological roles. Following, considerations focus on ANP versus BNP, comparing their relevance in settings and diseases associated with respiratory dysfunctions. Finally, we compiled data from guidelines for using BNP as a biomarker in dyspneic patients with cardiac dysfunction, including its considerations in COVID-19.

Sickle cell disease (SCD) is an inherited monogenic disease which is characterized by distorted red blood cells (RBCs) that cause vaso-occlusion and vasculopathy. In the pathogenesis of SCD, polymerized hemoglobin turn RBCs into fragile, less deformable cells, and are subsequently more susceptible to endothelial adhesion after deoxygenation. Presently, electrophoresis and genotyping are used as routine tests for diagnosis of SCD. These techniques are expensive and require specialized laboratories. Lab-on-a-chip technology is a low-cost microfluidics-based diagnostic tool which holds significant promise for rapid screening of RBC deformability. To explore the sickle RBC mechanics for screening purposes, we present a mathematical model for the flow of single RBC with altered rheological properties and slip effect on capillary wall in microcirculation. We consider single-file flow of cells through the axis symmetrical cylindrical duct, applying lubrication theory as plasma trapped between successive red blood cells. The rheological parameters used from published literature for normal RBC and corresponding variation has been taken for the purpose of this simulation to present the condition of the disease. An analytical solution has been found for realistic boundary conditions and results are simulated using MATLAB. We found that the height of plasma film in the capillary increases with increase in cell deformability and compliance which affects the forward flow velocity in the capillary. Rigid RBCs with increased adhesion between cell and capillary wall shows reduction in velocity and occurrence of vaso-occlusion events in extreme conditions. These rheological properties of the cells coupled with microfluidics mechanics can mimic the physiological condition and provides unique insights with novel possibilities for the design of microfluidics base diagnostic kit towards effective therapeutic intervention of SCD.

During the metastasis of cancer cells, circulating tumor cells (CTCs) are released from the primary tumor, reach the bloodstream, and colonize new organs. A potential reduction of metastasis may be accomplished through the use of nanoparticles in micromixers in order to capture the CTCs that circulates in blood. In the present study, the effective mixing of nanoparticles and the blood that carries the CTCs are investigated. The mixing procedure was studied under various inlet velocity ratios and several T-shaped micromixer geometries with rectangular cavities by using computational fluid dynamics techniques. The Navier-Stokes equations were solved for the blood flow; the discrete motion of particles is evaluated by a Lagrangian method while the diffusion of blood substances is studied by using a scalar transport equation. Results showed that as the velocity ratio between the inlet streams increases, the mixing rate of nanoparticles with the blood flow is increased. Moreover, nanoparticles are uniformly distributed across the mixing channel while their concentration is decreased along the channel. Furthermore, the evolution in time of the blood substances in the mixing channel increases with the increase of the velocity ratio between the two streams. On the other hand, the concentration of both the blood substances and the nanoparticles is decreased in the mixing channel as the velocity ratio increases. Finally, the differences in the dimensions of the rectangular cavities seems to have an insignificant effect both in the evolution in time of the blood substances and the concentration of nanoparticles in the mixing channel.

Despite being a reliable first-hand source of data on neuronal pathology, cerebrospinal fluid (CSF) analysis remains an often-overlooked evaluation method in first-episode psychosis (FEP). In this paper, we begin by discussing the current role of CSF testing during FEP evaluation in clinical practice. Given that anti-N-methyl-D-aspartate receptor encephalitis presents with a clinical picture indistinguishable from FEP in >85% of cases, we debate the importance of testing for CSF neuronal antibodies in at least a subset of patients. Then, we continue by reviewing the most important recent studies which sought to identify potential CSF biomarkers in FEP caused by a primary psychiatric disorder. By circumventing traditional psychiatric classifications, characteristic biomarker profiles have the potential to become integral components of early diagnosis, disease stratification, treatment choice, and outcome prediction. Along these lines, we aim to provide an updated perspective on the importance of CSF investigation in FEP.

Background: Antibiotic resistance in cystic fibrosis (CF) is a well-known phenomenon. However, the comprehensive epidemiological impact of antibiotic resistance in CF is not clearly documented. So, this meta-analysis evaluated the proportion rates of carbapenem resistance (imipenem, meropenem, and doripenem) in CF based on publication date (1979-2000, 2001-2010, and 2011-2021), continents, pathogens, and antimicrobial susceptibility testing (AST). Methods: We searched studies in PubMed, Scopus, and Web of Science (until April 2021). Statistical analyses were conducted using STATA software (version 14.0). Results: The 110 studies included in the analysis were performed in 25 countries and investigated 13,324 pathogens associated with CF. The overall proportion of imipenem, meropenem, and doripenem resistance in CF were 43% (95% CI 36-49), 48% (95% CI 40-57), 28% (95% CI 23-33), and 45% (95% CI 32-59), respectively. Our meta-analysis showed that trends of imipenem, meropenem, and doripenem-resistance had gradual decreases over time (1979-2021). This could be due to the limited clinical effectiveness of these antibiotics to treat CF cases over time. Among the opportunistic pathogens associated with CF, the highest carbapenem resistance rates were shown in Stenotrophomonas maltophilia, Burkholderia spp., Pseudomonas aeruginosa, and Staphylococcus aureus. The highest and lowest carbapenem resistance rates among P. aeruginosa in CF patients were shown against meropenem (23%) and doripenem (39%). Conclusions: We showed that trends of carbapenem resistance had decreased over time (1979-2021). This could be due to the limited clinical effectiveness of these antibiotics to treat CF cases over time. Plans should be directed to fight biofilm-associated infections and prevent the emergence of mutational resistance. Systematic surveillance for carbapenemase-producing pathogens in CF by molecular surveillance is necessitated.