简介：AbstractImportance:Acute necrotizing encephalopathy (ANE) is a rare disease with high mortality. Plasma exchange (PLEX) has recently been reported to treat ANE of childhood (ANEC), but its efficacy is uncertain.Objective:This study aimed to investigate the effectiveness of PLEX on ANEC.Methods:A retrospective study was conducted in four pediatric intensive care units from December 2014 to December 2020. All patients who were diagnosed with ANEC were included; however, these patients were excluded if their length of stay was less than 24 h. Participants were classified into PLEX and non-PLEX groups.Results:Twenty-nine patients with ANEC were identified, 10 in the PLEX group and 19 in the non-PLEX group. In the PLEX group, C-reactive protein, procalcitonin, alanine aminotransferase, and aspartate aminotransaminase levels were significantly lower after 3 days of treatment than before treatment (13.1 vs. 8.0, P = 0.043; 9.8 vs. 1.5, P = 0.028; 133.4 vs. 31.9, P = 0.028; 282.4 vs. 50.5, P = 0.046, respectively). Nine patients (31.0%, 9/29) died at discharge, and a significantly difference was found between the PLEX group and non-PLEX group [0 vs. 47.4% (9/19), P = 0.011]. The median follow-up period was 27 months, and three patients were lost to follow-up. Thirteen patients (50.0%, 13/26) died at the last follow-up, comprising three (33.3%, 3/9) in the PLEX group and ten (58.8%, 10/17) in the non-PLEX group, but there was no significant difference between the two groups (P = 0.411). Three patients (10.3%, 3/29) fully recovered.Interpretation:PLEX may reduce serum C-reactive protein and procalcitonin levels and improve liver function in the short term. PLEX may improve the prognosis of ANEC, and further studies are needed.

简介：瞄准：在试验性的老鼠在生物化学、组织病理学说的变化，氧化压力，和细菌的易位(BT)上调查allopurinol和高比重的氧(HBO)治疗的单个、联合的效果尖锐胰腺炎(AP)。方法：85只Sprague-Dawley老鼠在学习被包括。85只老鼠中的十五个被用作控制(假冒，组我)。AP在留下经由管内牛磺胆酸盐注入被导致七十只老鼠。幸存到尖锐引起坏死胰腺炎的正式就职的老鼠被使随机化进四个组。组II独自收到了saline，组IIIallopurinol，加HBO的组IVallopurinol和组VHBO。浆液淀粉酶层次，氧化压力参数，BT和组织病理学说的分数是坚定的。结果：浆液淀粉酶层次在与组II相比的组III，IV和V是更低的(974+/-110，384+/-40，851+/-56，和1664+/-234U/L，分别地P<0.05，为所有)。联合揭示的二种处理选择显著地降低median[25-75百分位数]组织病理学说的分数什么时候与单个政府相比(13[12.5-15]在allopurinol组，9.5[7-11.75]在HBO组，并且6[4.5-7.5]在联合的组，P<0.01)。氧化压力标记在与控制相比的所有处理组显著地更好。进胰和mes伤寒淋巴结的细菌的易位在与组II相比的组III，IV和V是更低的(54%，23%，50%对为到胰的易位的100%，并且62%，46%，58%对为到mes伤寒淋巴节点的易位的100%，分别地P<0.05为所有)。结论：当在试验性的老鼠AP独立管理了时，现在的学习证实HBO和allopurinol处理的利益。这些处理选择的联合看起来更有效地阻止胰腺的损害参数的前进。

简介：瞄准：与尖锐引起坏死胰腺炎在老鼠调查浆液IL-2，IL-10，IL-2/IL-10和sFas的动态变化。与尖锐引起坏死胰腺炎(ANP)在老鼠的肠粘膜探索船边交货的表示。方法：64只Sprague-Dawley(SD)老鼠的一个总数随机被划分成二个组：正常控制组(C组)，ANP组(P组)。一个ANP模特儿被50g/L牛磺胆酸钠的注射在胰腺的膜下面劝诱。正常控制用一样的方法组织9g/L生理盐水答案的收到的isovolumetric注射。在每个组的老鼠的血样品经由优异mes伤寒静脉被获得测量IL-2的层次，IL-10，sFas并且计算IL-2/IL-10的价值。IL-2，IL-10和sFas的层次被ELISA决定。肠的粘膜损害的严厉被病理学的分数评估。在肠的粘膜织物的船边交货的表示被染色的免疫组织化学决定。结果：浆液IL-2的层次比C组的那些在P组是显著地更高的(2.79+/-0.51对3.53+/-0.62，2.93+/-0.89对4.35+/-1.11，4.81+/-1.23对6.94+/-1.55和3.41+/-0.72对4.80+/-1.10，分别地P<0.01，为所有)并且它在6h的到达山峰。浆液IL-10的层次比在6h和12h的C组的那些在P组是显著地更高的(54.61+/-15.81对47.34+/-14.62，141.15+/-40.21对156.12+/-43.10，89.18+/-32.52对494.98+/-11.23和77.15+/-22.60对93.28+/-25.81，分别地P<0.01，为所有)。IL-2/IL-10的价值比在0.5h和2h的C组的那些在P组显著地是更高的(0.05+/-0.01对0.07+/-0.02和0.02+/-0.01对0.03+/-0.01，分别地P<0.01，为所有)，并且它是比在6h的C组的那些显著地低的(0.05+/-0.02对0.01+/-0.01，P<0.01)并且在12h回到了控制水平(0.04+/-0.01对0.05+/-0.02，P>0.05)。在sFas试金，在P组和C组之间没有有效差量(3.16+/-0.75对3.31+/-0.80，4.05+/-1.08对4.32+/-1.11，5.93+/-1.52对5.41+/-1.47和4.62+/-1.23对4.44+/-

简介：Necrotizingpancreatitisisanuncommonyetseriouscomplicationofacutepancreatitiswithmortalityratesreportedupto15%thatreach30%incaseofinfection.Traditionallyopensurgicaldebridementwastheonlytoolinourdisposaltomanagethisseriousclinicalentity.Thisapproachishoweverassociatedwithpooroutcomes.Managementhasnowshiftedawayfromopensurgicaldebridementtoamoreconservativemanagementandminimallyinvasiveapproaches.Contemporaryapproachtopatientswithnecrotizingpancreatitisand/orinfectiouspancreatitisissummarizedinthe3Ds:Delay,DrainandDebride.Patientscanbemanagedintheintensivecareunitandanyinterventionshouldbedelayed.Percutaneousdrainagecanbeutilizedfirstandearlyinthecourseofthedisease,followedbyendoscopicdrainageorvideoassistedretroperitoneoscopicdrainageifnecrosectomyisdeemednecessary.Opensurgeryisnowlessfrequentlyperformedandshouldbereservedforcasesrefractorytoanyotherapproach.Themanagementofnecrotizingpancreatitisthereforerequiresamultidisciplinarydynamicmodelofapproachratherthanbeingasurgicaldisease.

简介：摘要BackgroundDelayed encephalopathy (DE) is the most severe complication after acute carbon monoxide (CO) poisoning, which seriously affects the outcome of patients and leads to a high disability rate. Prior studies have shown that hyperbaric oxygen (HBO2) therapy is therapeutic for DE due to reducing immune-mediated neuropathology and thus improving cognitive performance.MethodsIn our present perspective study, five DE patients were treated regularly with HBO2 therapy. The mini-mental state examination (MMSE) and Barthel index (BI) were intermittently collected during their hospitalization for mental and physical status evaluation, the peripheral bloods were serially sampled to determine the concentration changes of circulating stem cells, as well as corresponding BDNF and neural markers.ResultsMMSE and BI showed series of improvements after multiple HBO2 therapies. The CD34+/CD90+ and CD34+/CD133+ dual positive cells, which were categorized as circulating stem cells, were observed an overall up-regulation since the beginning of the DE onset upon the application of HBO2 therapy. Characteristic neurotrophin BDNF, neural markers such as nestin and synaptophysin (SYP) were also up-regulated after exposure of HBO2. Conclusion The application of HBO2 therapy is of significance in improving the cognition of DE patients, along with mobilized circulating stem cells.ConclusionWe primarily infer that the CD34+/CD90+ and CD34+/CD133+ cells were mobilized by HBO2 exposure and have played a positive role in cognition improvement on DE patients by up-regulation of BDNF, nestin and SYP. The altering amount of circulating stem cells mobilized in peripheral blood could be a potential marker on predicting the outcome of DE.

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简介：Hepaticencephalopathy(HE)isasevereneuropsychiatricsyndromethatmostcommonlyoccursindecompensatedlivercirrhosisandincorporatesaspectrumofmanifestationsthatrangesfrommildcognitiveimpairmenttocoma.AlthoughtheetiologyofHEisnotcompletelyunderstood,itisbelievedthatmultipleunderlyingmechanismsareinvolvedinthepathogenesisofHE,andoneofthemainfactorsisthoughttobeammonia;however,theammoniahypothesisinthepathogenesisofHEisincomplete.Recently,ithasbeenincreasinglydemonstratedthatinflammation,includingsystemicinflammation,neuroinflammationandendotoxemia,actsinconcertwithammoniainthepathogenesisofHEincirrhoticpatients.Meanwhile,agoodnumberofstudieshavefoundthatcurrenttherapiesforHE,suchaslactulose,rifaximin,probioticsandthemolecularadsorbentrecirculatingsystem,couldinhibitdifferenttypesofinflammation,therebyimprovingtheneuropsychiatricmanifestationsandpreventingtheprogressionofHEincirrhoticpatients.TheantiinflammatoryeffectsofthesecurrenttherapiesprovideanoveltherapeuticapproachforcirrhoticpatientswithHE.ThepurposeofthisreviewistodescribetheinflammatorymechanismsbehindtheetiologyofHEincirrhosisanddiscussthecurrenttherapiesthattargettheinflammatorypathogenesisofHE.

简介：AcuterheumaticfeverisinitiatedbygroupAstreptococcalphar-yngitis.Thisisfollowedbyalatentperiodof2-6weeks,afterwhichtheclinicalsyndromeofacuterheumaticfeverevolves,characterizedbypolyarthritis,carditis,chorea,erythemamarginatumandsubcutaneousnodules.Thesefeaturesmayoccursinglyorinanycombination.

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简介：AbstractObjective:Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP.Methods:We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens.Results:The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P <.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < .001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4-5.3, P <.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04-1.1, P <.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4-7.4, P <.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6-14.1, P <.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74-0.81, P <.001).Conclusion:VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes; however, AP without necrosis does not increase upper and lower extremity VTE risk.

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简介：AbstractPurpose:Malnutrition is a common problem among hospitalized patients, especially among traumatic brain injury (TBI) patients. It is developed from hypermetabolism and the condition may worsen under the circumstance of underfeeding or incompatible dietary management. However, the data of nutrient intake especially calorie and protein among TBI patients were scarce. Hence, this study aimed to determine the calorie and protein intake among acute and sub-acute TBI patients receiving medical nutrition therapy in hospital Sultanah Nur Zahirah, Terengganu.Methods:This observational study involved 50 patients recruited from the neurosurgical ward. Method of 24 h dietary recall was utilized and combined with self-administered food diaries for 2-8 days. Food consumptions including calorie intake and protein intake were analyzed using Nutritionist PRO™ (Woodinville, USA) and manual calculation based on the Malaysian food composition database (2015).Results:Patients consisted of 56% males and 44% females with the median age of 28.0 (IQR = 22.8-36.5) years, of which 92% were diagnosed as mild TBI and the remaining (8%) as moderate TBI. The Glasgow coma scale (GCS) was adopted to classify TBI severity with the score 13-15 being mild and 9-12 being moderate. The median length of hospital stay was 2 (IQR = 2.0-3.3) days. Calorie and protein intake improved significantly from day 1 to discharge day. However, the intake during discharge day was still considered as suboptimal, i.e. 75% of calorie requirement, whilst the median protein intake was only 61.3% relative to protein requirement. Moreover, the average percentages of calorie and protein intakes throughout hospitalization were remarkably lower, i.e. 52.2% and 41.0%, respectively.Conclusion:Although the calorie and protein intakes had increased from baseline, hospitalized TBI patients were still at a risk to develop malnutrition as the average intakes were considerably low as compared to their requirements. Optimum nutrient intakes especially calorie and protein are crucial to ensure optimum recovery process as well as to minimize risks of infection and complications.

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简介：AbstractAcute pancreatitis (AP) is a common and potentially life-threatening pancreatic inflammatory disease. Although it is usually self-limiting, up to 20% of patients will develop into severe AP. It may lead to systemic inflammatory response syndrome and multiple organ dysfunction, affecting the lungs, kidneys, liver, heart, etc. Surviving patients usually have sequelae of varying degrees, such as chronic hyperglycemia after AP (CHAP), pancreatic exocrine insufficiency, and chronic pancreatitis. Lacking specific target treatments is the main reason for high mortality and morbidity, which means that more research on the pathogenesis of AP is needed. Ferroptosis is a newly discovered regulated cell death (RCD), originally described in cancer cells, involving the accumulation of iron and the depletion of plasma membrane polyunsaturated fatty acids, and a caspase-independent RCD. It is closely related to neurological diseases, myocardial infarction, ischemia/reperfusion injury, cancer, etc. Research in the past years has also found the effects of ferroptosis in AP, pancreatic cancer, and AP complications, such as acute lung injury and acute kidney injury. This article reviews the research progress of ferroptosis and its association with the pathophysiological mechanisms of AP, trying to provide new insight into the pathogenesis and treatment of AP, facilitating the development of better-targeted drugs.

简介：Acutepancreatitisduringpregnancyisarareevent,andcanbeassociatedwithhighmaternalmortalityandfetalloss.Gallstonediseaseisthoughttobethemostcommoncausativefactorofacutepancreatitis,but,inmanycases,thecauseremainsunclear.Wereportacaseofa36-year-oldwomanat35wkofgestation,whopresentedwithseverepainconfinedtotheupperabdomenandradiatingtotheback.Thepatientwasdiagnosedwithacuteidiopathicpancreatitis,whichwasmanagedconservatively;sherecoveredwithinseveraldaysandthendeliveredahealthybaby.Thereforeitisimportanttoconsideracutepancreatitiswhenapregnantwomanpresentswithupperabdominalpain,nauseaandvomitinginordertoimprovefetalandmaternaloutcomesforpatientswithacutepancreatitis.