Pub Date : 2022-02-21DOI: 10.1097/EC9.0000000000000032
Shouming Li, D. Wei, Zhenhua Wang, Han Song, Shaopeng Cheng, Xin Zhao
Abstract Background: This study aimed to identify whether the interval from onset of symptoms to surgery affects the outcomes of surgery in patients with acute type A aortic dissection (AAAD). Methods: This study retrospectively examined 249 patients with AAAD who underwent Sun's procedure. All patients were divided into 2 groups, hyperacute and acute, according to the interval from onset of symptoms to surgery. The primary endpoint was all-cause early mortality, and the secondary endpoint was early reoperation. Results: The surgery time, cardiopulmonary bypass time, clamp time, and selective cerebral perfusion time were not significantly different between the 2 groups. The intensive care unit length of stay and duration of mechanical ventilation of the 2 groups were 185.50 hours versus 185.00 hours (P = 0.970) and 41.50 hours versus 44.00 hours (P = 0.678), respectively. There were 52 early deaths: 29 in the hyperacute group and 23 in the acute group (21.6% vs. 20.0%, P = 0.751). The incidence of reoperation was 0.7% and 0.9% (P > 0.999), respectively. The incidence rates of postoperative acute heart failure (AHF), acute respiratory failure (ARF), nervous dysfunction, and acute kidney injury were 37.3% versus 25.2% (P = 0.041), 51.5% versus 51.3% (P = 0.976), 13.4% versus 7.0% (P = 0.096), and 37.3% versus 37.4% (P = 0.990), respectively. Multivariable analysis indicated that surgery in the hyperacute phase might be an independent risk factor for AHF (OR: 1.765; 95% CI: 1.021–3.052; P = 0.042). Conclusion: Surgery in the hyperacute phase of AAAD was associated with postoperative AHF. Therefore, early medical management or interventional therapy for complications before surgery performed by experienced surgeons is recommended, especially in the hyperacute phase.
背景:本研究旨在探讨急性A型主动脉夹层(AAAD)患者从症状出现到手术的时间间隔是否会影响手术结果。方法:本研究回顾性分析249例行孙氏手术的AAAD患者。根据症状出现至手术时间的长短，将所有患者分为超急性组和急性组。主要终点是全因早期死亡率，次要终点是早期再手术。结果:两组患者手术时间、体外循环时间、钳夹时间、选择性脑灌注时间差异无统计学意义。两组患者重症监护病房住院时间和机械通气时间分别为185.50 h比185.00 h (P = 0.970)和41.50 h比44.00 h (P = 0.678)。早期死亡52例:超急性组29例，急性组23例(21.6% vs. 20.0%， P = 0.751)。再手术发生率分别为0.7%和0.9% (P < 0.05 0.999)。术后急性心力衰竭(AHF)、急性呼吸衰竭(ARF)、神经功能障碍、急性肾损伤的发生率分别为37.3%比25.2% (P = 0.041)、51.5%比51.3% (P = 0.976)、13.4%比7.0% (P = 0.096)、37.3%比37.4% (P = 0.990)。多变量分析显示，超急性期手术可能是AHF的独立危险因素(OR: 1.765;95% ci: 1.021-3.052;p = 0.042)。结论:AAAD超急性期手术与术后AHF相关。因此，建议在手术前由经验丰富的外科医生对并发症进行早期医疗管理或介入治疗，特别是在超急性期。
{"title":"Effect on surgery outcomes owing to the interval between onset of symptoms and surgery of patients with acute type A aortic dissection","authors":"Shouming Li, D. Wei, Zhenhua Wang, Han Song, Shaopeng Cheng, Xin Zhao","doi":"10.1097/EC9.0000000000000032","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000032","url":null,"abstract":"Abstract Background: This study aimed to identify whether the interval from onset of symptoms to surgery affects the outcomes of surgery in patients with acute type A aortic dissection (AAAD). Methods: This study retrospectively examined 249 patients with AAAD who underwent Sun's procedure. All patients were divided into 2 groups, hyperacute and acute, according to the interval from onset of symptoms to surgery. The primary endpoint was all-cause early mortality, and the secondary endpoint was early reoperation. Results: The surgery time, cardiopulmonary bypass time, clamp time, and selective cerebral perfusion time were not significantly different between the 2 groups. The intensive care unit length of stay and duration of mechanical ventilation of the 2 groups were 185.50 hours versus 185.00 hours (P = 0.970) and 41.50 hours versus 44.00 hours (P = 0.678), respectively. There were 52 early deaths: 29 in the hyperacute group and 23 in the acute group (21.6% vs. 20.0%, P = 0.751). The incidence of reoperation was 0.7% and 0.9% (P > 0.999), respectively. The incidence rates of postoperative acute heart failure (AHF), acute respiratory failure (ARF), nervous dysfunction, and acute kidney injury were 37.3% versus 25.2% (P = 0.041), 51.5% versus 51.3% (P = 0.976), 13.4% versus 7.0% (P = 0.096), and 37.3% versus 37.4% (P = 0.990), respectively. Multivariable analysis indicated that surgery in the hyperacute phase might be an independent risk factor for AHF (OR: 1.765; 95% CI: 1.021–3.052; P = 0.042). Conclusion: Surgery in the hyperacute phase of AAAD was associated with postoperative AHF. Therefore, early medical management or interventional therapy for complications before surgery performed by experienced surgeons is recommended, especially in the hyperacute phase.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44169799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-09DOI: 10.1097/EC9.0000000000000027
Ahmet Butun, F. Lynn, J. McGaughey, K. McLaughlin, M. Linden
Abstract Background: Overcrowding in Emergency Departments (EDs) is a significant global concern with negative consequences for patients, healthcare staff, and healthcare systems. The use of EDs by parents of children with non-urgent conditions is associated with overcrowding, higher healthcare costs, lower quality of care, and longer waiting times. Research in this area has largely been conducted in high-income countries, with a dearth of work originating in middle and low-income regions. The aim of this study was to explore the reasons for parents attending EDs with their child for non-urgent conditions in Turkey. Method: Semi-structured interviews were conducted with 13 parents, 15 ED staff, and 10 General Practitioners (GPs) in 2 regions of Turkey between March and May 2017. Data were analyzed using the principles of grounded theory. Results: The findings were classified into 5 core categories: (1) parents’ feelings, knowledge, and perceived inability to provide self-care; (2) perceived limitations of healthcare services, system, and staff; (3) parents’ preferences for hospital and ED services; (4) adverse impact on ED services; and (5) perceived needs for care. Conclusion: This is the first study conducted in a middle-income country regarding parental reasons for using the ED for nonurgent conditions. Greater efforts must be made to reduce unnecessary visits to the ED to better meet service user needs and to increase the satisfaction of both parents and healthcare staff. The findings of this study may inform healthcare providers, policymakers, healthcare staff, and researchers to design interventions in order to mitigate overcrowding in the ED.
{"title":"Exploring attendance at emergency departments for children with non-urgent conditions in Turkey: a qualitative study of parents and healthcare staff perspectives","authors":"Ahmet Butun, F. Lynn, J. McGaughey, K. McLaughlin, M. Linden","doi":"10.1097/EC9.0000000000000027","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000027","url":null,"abstract":"Abstract Background: Overcrowding in Emergency Departments (EDs) is a significant global concern with negative consequences for patients, healthcare staff, and healthcare systems. The use of EDs by parents of children with non-urgent conditions is associated with overcrowding, higher healthcare costs, lower quality of care, and longer waiting times. Research in this area has largely been conducted in high-income countries, with a dearth of work originating in middle and low-income regions. The aim of this study was to explore the reasons for parents attending EDs with their child for non-urgent conditions in Turkey. Method: Semi-structured interviews were conducted with 13 parents, 15 ED staff, and 10 General Practitioners (GPs) in 2 regions of Turkey between March and May 2017. Data were analyzed using the principles of grounded theory. Results: The findings were classified into 5 core categories: (1) parents’ feelings, knowledge, and perceived inability to provide self-care; (2) perceived limitations of healthcare services, system, and staff; (3) parents’ preferences for hospital and ED services; (4) adverse impact on ED services; and (5) perceived needs for care. Conclusion: This is the first study conducted in a middle-income country regarding parental reasons for using the ED for nonurgent conditions. Greater efforts must be made to reduce unnecessary visits to the ED to better meet service user needs and to increase the satisfaction of both parents and healthcare staff. The findings of this study may inform healthcare providers, policymakers, healthcare staff, and researchers to design interventions in order to mitigate overcrowding in the ED.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41772952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-28DOI: 10.1097/EC9.0000000000000030
Junkang Wang, Jing Wang, Hongliang Zhang, Chengyu Guo, Yanbiao Wang, Bing Lu, C. Feng, F. Pan, Tanshi Li
Abstract Background High-quality real war trauma data are important, but they are still lacking. Using the database to realize the networked, systematic, standardized, and dynamic management of war injury animal experimental data can provide a real and reliable supplement for the research of war injury treatment. Methods Through demand analysis, module design, architecture design, compilation and debugging, and other processes, JAVA language development tools were used to develop a time-effect assessment database for experiments on war-traumatized animals, where the browser/server architecture (B/S architecture) is used as the technical architecture and SQL Server as the database management system. Results A time-effect assessment database for experiments on war-traumatized animals that features reasonable structural design, rich data resources, and convenient use has been established, in which case efficient collection, storage, display, retrieval, and management of animal experimental data have been achieved. At present, the database is running well and has good data quality.
{"title":"Construction and application of time-effect assessment database for experiments on war-traumatized animals","authors":"Junkang Wang, Jing Wang, Hongliang Zhang, Chengyu Guo, Yanbiao Wang, Bing Lu, C. Feng, F. Pan, Tanshi Li","doi":"10.1097/EC9.0000000000000030","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000030","url":null,"abstract":"Abstract Background High-quality real war trauma data are important, but they are still lacking. Using the database to realize the networked, systematic, standardized, and dynamic management of war injury animal experimental data can provide a real and reliable supplement for the research of war injury treatment. Methods Through demand analysis, module design, architecture design, compilation and debugging, and other processes, JAVA language development tools were used to develop a time-effect assessment database for experiments on war-traumatized animals, where the browser/server architecture (B/S architecture) is used as the technical architecture and SQL Server as the database management system. Results A time-effect assessment database for experiments on war-traumatized animals that features reasonable structural design, rich data resources, and convenient use has been established, in which case efficient collection, storage, display, retrieval, and management of animal experimental data have been achieved. At present, the database is running well and has good data quality.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46888116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-27DOI: 10.1097/ec9.0000000000000031
Zhangbo Shi, Yuanliang Jiang, J. Weir-McCall, Ximing Wang, Z. Teng
{"title":"COVID-19 and atherosclerosis","authors":"Zhangbo Shi, Yuanliang Jiang, J. Weir-McCall, Ximing Wang, Z. Teng","doi":"10.1097/ec9.0000000000000031","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000031","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61678429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-27DOI: 10.1097/ec9.0000000000000028
Matthew M Wilson, J. Mathan
{"title":"Corneal foreign body and rust ring removal in a remote setting","authors":"Matthew M Wilson, J. Mathan","doi":"10.1097/ec9.0000000000000028","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000028","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44391306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-12DOI: 10.1097/EC9.0000000000000025
C. Feng, Li-li Wang, Jingyang Peng, Xiang Cui, Xuan Zhou
Abstract Objectives: To observe the protective effect of cathepsin B inhibition against apoptosis of acinar cells in the early management of pancreatic contusion and laceration in rats, which would provide evidence of a potential early therapeutic for pancreatic contusion and laceration. Methods: Twenty-four rats were assigned to 2 groups: 1) Model (n = 12) with an induced pancreatic injury of severity I–II and 2) CA074-V (n = 12): an induced pancreatic injury, severity I–II treated with the cathepsin B inhibitor CA074-me (0.01 mg/g) by intravenous administration through the caudal vein at 5 minutes post model establishment. The mice in these two groups were further randomly divided into 4 subgroups containing 3 rats each that were sacrificed for quantitation of apoptosis, immunohistochemistry of cathepsin B, and serum amylase and lipase measurements at different time points after model establishment (0, 3, 6, and 12 hours). Results: The percentage of apoptotic pancreatic acinar cells collected from the injured tissues were much lower in the CA074-V group than the Model group at 3 hours [9.25 ± 3.94% vs. 64.76 ± 26.47%, P < 0.10] and 6 hours [14.71 ± 8.22% vs. 66.60 ± 13.54%, P < 0.10] post model establishment. The percentage of cathepsin B-positive pancreatic acinar cells were much lower in the CA074-V group than in the Model group at 3 hours [31.07 ± 12.02% vs. 69.16 ± 5.71%, P < 0.10], 6 hours [24.84 ± 0.93% vs. 47.06 ± 0.91%, P < 0.10], and 12 hours [28.33 ± 9.14% vs. 52.72 ± 1.25%, P < 0.10] post model establishment. Conclusions: Early cathepsin B inhibition effectively blocked acinar cell apoptosis in an experimental rat model of pancreatic contusion and laceration.
{"title":"Inhibition of cathepsin B protects pancreatic acinar cells against apoptosis in early pancreatic trauma in rats","authors":"C. Feng, Li-li Wang, Jingyang Peng, Xiang Cui, Xuan Zhou","doi":"10.1097/EC9.0000000000000025","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000025","url":null,"abstract":"Abstract Objectives: To observe the protective effect of cathepsin B inhibition against apoptosis of acinar cells in the early management of pancreatic contusion and laceration in rats, which would provide evidence of a potential early therapeutic for pancreatic contusion and laceration. Methods: Twenty-four rats were assigned to 2 groups: 1) Model (n = 12) with an induced pancreatic injury of severity I–II and 2) CA074-V (n = 12): an induced pancreatic injury, severity I–II treated with the cathepsin B inhibitor CA074-me (0.01 mg/g) by intravenous administration through the caudal vein at 5 minutes post model establishment. The mice in these two groups were further randomly divided into 4 subgroups containing 3 rats each that were sacrificed for quantitation of apoptosis, immunohistochemistry of cathepsin B, and serum amylase and lipase measurements at different time points after model establishment (0, 3, 6, and 12 hours). Results: The percentage of apoptotic pancreatic acinar cells collected from the injured tissues were much lower in the CA074-V group than the Model group at 3 hours [9.25 ± 3.94% vs. 64.76 ± 26.47%, P < 0.10] and 6 hours [14.71 ± 8.22% vs. 66.60 ± 13.54%, P < 0.10] post model establishment. The percentage of cathepsin B-positive pancreatic acinar cells were much lower in the CA074-V group than in the Model group at 3 hours [31.07 ± 12.02% vs. 69.16 ± 5.71%, P < 0.10], 6 hours [24.84 ± 0.93% vs. 47.06 ± 0.91%, P < 0.10], and 12 hours [28.33 ± 9.14% vs. 52.72 ± 1.25%, P < 0.10] post model establishment. Conclusions: Early cathepsin B inhibition effectively blocked acinar cell apoptosis in an experimental rat model of pancreatic contusion and laceration.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49551964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-11DOI: 10.1097/EC9.0000000000000024
Chuanbao Li, Huiruo Liu, F. Xu, Yuguo Chen
Abstract Fatty acids are the primary fuel for cardiac muscle. The physiological equilibrium of lipid uptake and oxidation may aid in the prevention of excessive lipid accumulation. Several pathological states, such as myocardial ischemia, obesity, and insulin resistance, are routinely associated with disorders of lipid metabolism. There is growing evidence that certain types of lipids trigger cardiac lipotoxicity and ultimately heart failure. This review focuses on recent advances in the pathogenesis of lipotoxic cardiomyopathy and the treatment prospects for the repair of cardiac damage caused by lipotoxicity.
{"title":"The role of lipotoxicity in cardiovascular disease","authors":"Chuanbao Li, Huiruo Liu, F. Xu, Yuguo Chen","doi":"10.1097/EC9.0000000000000024","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000024","url":null,"abstract":"Abstract Fatty acids are the primary fuel for cardiac muscle. The physiological equilibrium of lipid uptake and oxidation may aid in the prevention of excessive lipid accumulation. Several pathological states, such as myocardial ischemia, obesity, and insulin resistance, are routinely associated with disorders of lipid metabolism. There is growing evidence that certain types of lipids trigger cardiac lipotoxicity and ultimately heart failure. This review focuses on recent advances in the pathogenesis of lipotoxic cardiomyopathy and the treatment prospects for the repair of cardiac damage caused by lipotoxicity.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42059013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background It is imperative to identify potential biomarkers for early diagnosis and intervention of severe sepsis. This study investigated the relationship between melatonin secretion and outcome of sepsis after 28-day admission. Methods Patients with sepsis were randomly divided into an eye mask group and a control group. Blood and urine samples were collected from day 0 to 4. Relevant clinical data and 28-day survival data were obtained. Serum melatonin and urine 6-hydroxy sulfate melatonin (6-SMT) levels were measured. Results The outcome of sepsis did not differ between the eye mask and control groups. Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were significantly higher and monocyte human leukocyte antigen-DR (mHLA-DR), serum melatonin, nocturnal urine 6-SMT, and 24-hour urine 6-SMT levels were significantly lower in the nonsurvivors than in the survivors. The outcome at day 28 after admission was significantly associated with APACHE II and SOFA scores and mHLA-DR, nocturnal urine 6-SMT, and 24-hour urine 6-SMT levels. The areas under the receiver operating characteristic curve were 0.785, 0.740, 0.774, and 0.858 for APACHE II score, SOFA score, mHLA-DR expression, and nocturnal urine 6-SMT amount, respectively. The optimal thresholds for mHLA-DR and nocturnal urine 6-SMT were 30.13% and 43.60%, respectively. Nocturnal urine 6-SMT level was significantly and positively correlated with mHLA-DR expression. Conclusion Nocturnal urine 6-SMT level may be a feasible biomarker to predict the outcome of patients with sepsis. The use of a night-time eye mask has no significant effect on the outcome of sepsis. Clinical trials This study was registered at clinicaltrials.gov (NCT02304224).
{"title":"Nocturnal urine 6-hydroxy sulfate melatonin is associated with the outcome of subjects with sepsis","authors":"Wenjie Li, Jiameng Chen, Shuming Pan, Chengjin Gao","doi":"10.1097/EC9.0000000000000007","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000007","url":null,"abstract":"Abstract Background It is imperative to identify potential biomarkers for early diagnosis and intervention of severe sepsis. This study investigated the relationship between melatonin secretion and outcome of sepsis after 28-day admission. Methods Patients with sepsis were randomly divided into an eye mask group and a control group. Blood and urine samples were collected from day 0 to 4. Relevant clinical data and 28-day survival data were obtained. Serum melatonin and urine 6-hydroxy sulfate melatonin (6-SMT) levels were measured. Results The outcome of sepsis did not differ between the eye mask and control groups. Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were significantly higher and monocyte human leukocyte antigen-DR (mHLA-DR), serum melatonin, nocturnal urine 6-SMT, and 24-hour urine 6-SMT levels were significantly lower in the nonsurvivors than in the survivors. The outcome at day 28 after admission was significantly associated with APACHE II and SOFA scores and mHLA-DR, nocturnal urine 6-SMT, and 24-hour urine 6-SMT levels. The areas under the receiver operating characteristic curve were 0.785, 0.740, 0.774, and 0.858 for APACHE II score, SOFA score, mHLA-DR expression, and nocturnal urine 6-SMT amount, respectively. The optimal thresholds for mHLA-DR and nocturnal urine 6-SMT were 30.13% and 43.60%, respectively. Nocturnal urine 6-SMT level was significantly and positively correlated with mHLA-DR expression. Conclusion Nocturnal urine 6-SMT level may be a feasible biomarker to predict the outcome of patients with sepsis. The use of a night-time eye mask has no significant effect on the outcome of sepsis. Clinical trials This study was registered at clinicaltrials.gov (NCT02304224).","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44096227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-10DOI: 10.1097/EC9.0000000000000016
Z. Gluvić, R. Tomasevic, Ksenija Bojović, M. Obradović, E. Isenovic
Abstract Non-alcoholic fatty liver disease (NAFLD) is among the most frequently encountered chronic liver diseases in everyday clinical practice. It is considered the hepatic manifestation of metabolic syndrome. Today, liver biopsy is still the gold standard for NAFLD confirmation and assessing NAFLD's possible progression to non-alcoholic steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Because of the high prevalence of NAFLD and potential associated risks of invasive diagnostic procedures, it is of great interest to recruit the patients for liver biopsy. However, as the presence of liver fibrosis determines the further clinical course, liver biopsy is expectedly reserved for those with increased fibrosis risk. The quality of liver biopsy recruitment and patient monitoring could be significantly improved by using non-invasive tools to assess liver fibrosis presence and interactive collaboration between general practitioners, gastroenterologists, and endocrinologists. As a result, the quality of liver biopsy recruitment and patients monitoring could be significantly improved. Here, we proposed clinical practice guidelines that could be implemented for everyday clinical practice in NAFLD patients.
{"title":"Non-alcoholic fatty liver disease: a multidisciplinary clinical practice approach—the institutional adaptation to existing Clinical Practice Guidelines","authors":"Z. Gluvić, R. Tomasevic, Ksenija Bojović, M. Obradović, E. Isenovic","doi":"10.1097/EC9.0000000000000016","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000016","url":null,"abstract":"Abstract Non-alcoholic fatty liver disease (NAFLD) is among the most frequently encountered chronic liver diseases in everyday clinical practice. It is considered the hepatic manifestation of metabolic syndrome. Today, liver biopsy is still the gold standard for NAFLD confirmation and assessing NAFLD's possible progression to non-alcoholic steatohepatitis, fibrosis, cirrhosis, and hepatocellular carcinoma. Because of the high prevalence of NAFLD and potential associated risks of invasive diagnostic procedures, it is of great interest to recruit the patients for liver biopsy. However, as the presence of liver fibrosis determines the further clinical course, liver biopsy is expectedly reserved for those with increased fibrosis risk. The quality of liver biopsy recruitment and patient monitoring could be significantly improved by using non-invasive tools to assess liver fibrosis presence and interactive collaboration between general practitioners, gastroenterologists, and endocrinologists. As a result, the quality of liver biopsy recruitment and patients monitoring could be significantly improved. Here, we proposed clinical practice guidelines that could be implemented for everyday clinical practice in NAFLD patients.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44550886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-07DOI: 10.1097/EC9.0000000000000021
Rachel Parise, Manoj Govindarajulu, S. Ramesh, Tonya L Thomas, Timothy Moore, M. Dhanasekaran
Abstract Background: Kidney injuries caused by several viral diseases have been reported worldwide among all age groups, races, and genders. Of particular importance is coronavirus disease 2019 (COVID-19), and its prevalence in communities infecting all patient populations with symptoms ranging from asymptomatic to severe, including complications and mortality. Methods: Data were acquired from PubMed, Scopus, Google Scholar, Centers for Disease Prevention and Control (CDC), and Lexi-Comp using the following search terms: “COVID-19 and renal pathology,” “COVID-19 induced kidney disease,” “Viral infection induced kidney disease,” and “Viral infection induced renal damage.” Titles and abstracts were manually analyzed as per the exclusion and inclusion criteria of relevant articles; relevance of articles included studies on the pathology of a specific viral infection and the impact of the virus on the adult renal system. Results: The mechanisms for renal disease due to COVID-19 include direct renal tubular injury, cytokine storm, inflammation, thrombosis vs. acute tubular necrosis, thrombotic events, and direct renal injury. Although some mechanisms behind renal dysfunction among the studied viral infections are similar, the prevalence rates of kidney injury or damage differ. This might be described by recommended prophylactic and therapeutic approaches that can alter the viral infection characteristics and possibly the impact a particular organ system. Conclusion: The patient population at risk was old in age and had a high body mass index. The mechanisms associated with renal dysfunction are similar, including direct renal injury through angiotensin converting enzyme 2 (ACE2) entry, inflammation, and thrombosis. The renal pathology of coronaviruses that differs from that of other prevalent viral infections is the activation of cytokine storm, which causes elevations of a greater number and different kinds of cytokines than other viral infections.
{"title":"COVID-19 induced renal injury differs from that in other viral-infections","authors":"Rachel Parise, Manoj Govindarajulu, S. Ramesh, Tonya L Thomas, Timothy Moore, M. Dhanasekaran","doi":"10.1097/EC9.0000000000000021","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000021","url":null,"abstract":"Abstract Background: Kidney injuries caused by several viral diseases have been reported worldwide among all age groups, races, and genders. Of particular importance is coronavirus disease 2019 (COVID-19), and its prevalence in communities infecting all patient populations with symptoms ranging from asymptomatic to severe, including complications and mortality. Methods: Data were acquired from PubMed, Scopus, Google Scholar, Centers for Disease Prevention and Control (CDC), and Lexi-Comp using the following search terms: “COVID-19 and renal pathology,” “COVID-19 induced kidney disease,” “Viral infection induced kidney disease,” and “Viral infection induced renal damage.” Titles and abstracts were manually analyzed as per the exclusion and inclusion criteria of relevant articles; relevance of articles included studies on the pathology of a specific viral infection and the impact of the virus on the adult renal system. Results: The mechanisms for renal disease due to COVID-19 include direct renal tubular injury, cytokine storm, inflammation, thrombosis vs. acute tubular necrosis, thrombotic events, and direct renal injury. Although some mechanisms behind renal dysfunction among the studied viral infections are similar, the prevalence rates of kidney injury or damage differ. This might be described by recommended prophylactic and therapeutic approaches that can alter the viral infection characteristics and possibly the impact a particular organ system. Conclusion: The patient population at risk was old in age and had a high body mass index. The mechanisms associated with renal dysfunction are similar, including direct renal injury through angiotensin converting enzyme 2 (ACE2) entry, inflammation, and thrombosis. The renal pathology of coronaviruses that differs from that of other prevalent viral infections is the activation of cytokine storm, which causes elevations of a greater number and different kinds of cytokines than other viral infections.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43981559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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