BACKGROUND:The complications of systemic inflammatory response syndrome(SIRS)include acute lung injury,acute kidney injury,shock,and multiple organ dysfunction syndrome(MODS).In recent years,how to clear inflammatory ...BACKGROUND:The complications of systemic inflammatory response syndrome(SIRS)include acute lung injury,acute kidney injury,shock,and multiple organ dysfunction syndrome(MODS).In recent years,how to clear inflammatory mediators has become a hot topic in critical care medicine.Researchers hypothesize that continuous blood purification(CBP) can effectively eliminate a variety of inflammatory mediators which participate in the occurrence of MODS and adjust the immune imbalance.This study aimed to observe the effects of CBP in MODS patients.METHODS:In this retrospective clinical study,a total of 38 MODS patients,18 males and 20 females,were enrolled.After conventional therapy,all the patients received CBP.Biochemistry,blood gas analysis,oxygenation index,mean arterial blood pressure(MAP),acute physiology and chronic health evaluation(APACHE) II scores were monitored.RESULTS:After CBP,the vital signs of patients were rapidly stable,and electrolyte disorders and acid-base imbalance were corrected.Renal function,blood gas,oxygenation index were all improved.MAP was increased,and APACHE II score was significantly decreased.All patients had good tolerance,stable hemodynamics,and no obvious adverse reaction on CBP compared with pre-CBP.CONCLUSION:CBP can effectively clean toxins,correct electrolyte acid-base balance,and improve systemic inflammatory response syndrome and the organ function of MODS patients.展开更多
Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi (O. tsutsugamushi) in which humans are accidental hosts. Acute arrest of hemopoiesis (AAH) always manifests in pancytopenia and with supportive treat...Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi (O. tsutsugamushi) in which humans are accidental hosts. Acute arrest of hemopoiesis (AAH) always manifests in pancytopenia and with supportive treatment or inducement removal, the AAH patients would show significant improvement in blood routine for about a week. As a rapidly progressive and potentially life-threatening organ function disorder syndrome, multiple organ dysfunction syndrome (MODS) is often induced by many factors including infection, illness and injury. We received a rare case of scrub typhus rapidly presenting with AAH and MODS 2 weeks ago. The clinical data of a 32-year-old female with O. tsutsugamushi-induced AAH and MODS was summarized retrospectively and analyzed with a literature review. In this case, we selected tigecycline and moxifloxacin as treatment regimens for scrub typhus. When the potential infection was controlled, her pancytopenia and hepatic function rapidly improved in a few days.展开更多
BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsor...BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsorption combined CWH(HP+CWH) has higher ability of mediator clearance,and can improve clinical outcomes in theory.This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration(HP+CWH) on plasm cytokines like TNF-α,IL-1β,IL-6,cellular immunity and prognosis in patients with multiple organ dysfunction syndrome(MODS).METHODS:This was a prospective,randomized clinical trial.A total of 30 patients who had been diagnosed with MODS were enrolled in this study.Patients were randomly allocated to routine treatment+HP+CWH group(treatment group) and routine treatment+only CWH group(control group).In the treatment group,patients received blood hemoperfusion with resin adsorption for 2hours,and then received CWH for 10 hours every day.In the control group,patients received CWH for 12 hours only every day.The patients in the two groups received blood purification therapy for three days.The plasma of patients in the treatment group was obtained at 0,2,12,24,26,36,48,50,60 hours,5th day,7th day and 10 th day,respectively.The plasma of patients in the control group was obtained at 0,12,24,36,48,60 hours,5th day,7th day and 10 th day,respectively.APACHE Ⅱscore,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,breathing rate,and oxygenation index were observed.RESULTS:Plasma cytokines like TNF-α,IL-1β,IL-6 decreased markedly after HP(P<0.01);T-lymphocytes subpopulations CD3+,CD4+,CD8+,CD4+/CD8+ increased after HP+CWH or only CWH.The plasma concentrations of TNF-α,IL-1β and IL-6 in the two groups were not markedly different at 12,36,and 50 hours.But on the 5th day,the plasma concentrations of TNF-α,IL-1β and IL-6 in the treatment group were lower than those in the control group(P<0.05).On the 28 th day,5patients died in the treatment group,and 6 patients in the control group.CONCLUSIONS:Both HP+CWH and CWH can clean plasma cytokines like TNF-α,IL-1β,and IL-6,and improve cellular immunity and clinical symptoms and signs of patients.Compared with only CWH,the plasma concentrations of TNF-α,IL-1β and IL-6 were lower on the 5th day,and patients have an increased survival rate on the 28 day in the HP+CWH group.展开更多
BACKGROUND Mitochondrial myopathy is a rare genetic disease with maternal inheritance that may involve multiple organ systems.Due to the lack of typical characteristics,its clinical diagnosis is difficult,and it is of...BACKGROUND Mitochondrial myopathy is a rare genetic disease with maternal inheritance that may involve multiple organ systems.Due to the lack of typical characteristics,its clinical diagnosis is difficult,and it is often misdiagnosed or even missed.CASE SUMMARY The patient was a young college student.When he presented at the hospital,he had severe lactic acidosis,respiratory failure,and shock with multiple organ dysfunction syndrome(MODS).He was treated by mechanical ventilation,venoarterial extracorporeal membrane oxygenation,and other organ support.However,his condition continued to worsen.After a thorough and detailed medical and family history was taken,a mitochondrial crisis was suspected.A muscle biopsy was taken.Further genetic testing confirmed a mitochondrial gene mutation(TRNL13243A>G).The final diagnosis of mitochondrial myopathy was made.Although there is no known specific treatment,intravenous methylprednisone and intravenous immunoglobulin were started.The patient’s shock eventually improved.The further course was complicated by severe infection in multiple sites,severe muscle weakness,and recurrent MODS.After 2 mo of multidisciplinary management and intensive rehabilitation,the patient could walk with assistance 4 mo after admission and walk independently 6 mo after admission.CONCLUSION More attention should be paid to mitochondrial myopathy to avoid missed diagnosis and misdiagnosis.展开更多
Multiple organ dysfunction syndrome is the presence of altered organ function of two or more organ systems in acute ill patients with severe trauma,burn,shock and infection.In this case,the patient with burn area amou...Multiple organ dysfunction syndrome is the presence of altered organ function of two or more organ systems in acute ill patients with severe trauma,burn,shock and infection.In this case,the patient with burn area amounted to 95%and the third-degree burn was up to 90%.He underwent gastrointestinal tract,blood clotting,lung,brain,heart,liver dysfunction,and cardiac arrest for 30 minutes during the courses of treatment,and was discharged from the hospital after 108 days on the basis of comprehensive treatment and repeated skin grafting.展开更多
The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, la...The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO<sub>2</sub>, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus<sup>®</sup>) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.展开更多
Pathogenic Escherichia coli is of great concern in the clinical setting.But few reports have demonstrated the variation in disease course.We present a severe case of multiple organ dysfunction syndrome caused by E.col...Pathogenic Escherichia coli is of great concern in the clinical setting.But few reports have demonstrated the variation in disease course.We present a severe case of multiple organ dysfunction syndrome caused by E.coli infection.Pathogens isolated from blood and urine samples harboured many virulence factors.Whole‐genome sequencing and conventional analyses showed that the isolates experienced beneficial variations,both genetically and phenotypically,during the disease course.These findings showed that E.coli can cause sys-temic symptoms and informed us of the importance of assessing the reasons for such variations in pathogens occurring in vivo.展开更多
BACKGROUND Seminal vesicle abscess(SVA)is the manifestation of a relatively rare urinary system infection.In response to urinary system inflammation,an abscess forms in special locations.However,acute diffuse peritoni...BACKGROUND Seminal vesicle abscess(SVA)is the manifestation of a relatively rare urinary system infection.In response to urinary system inflammation,an abscess forms in special locations.However,acute diffuse peritonitis(ADP)induced by SVA is unusual.CASE SUMMARY We report a case of a left SVA in a male patient complicated with pelvic abscess,ADP,multiple organ dysfunction syndrome,infectious shock,bacteremia,and acute appendiceal extraserous suppurative inflammation as a result of a long-term indwelling urinary catheter.The patient received a course of morinidazole+cefminol antibiotics but showed no obvious relief,so the perineal SVA underwent puncture drainage and abdominal abscess drainage+appendectomy was performed.The operations were successful.After the operation,anti-infection,anti-shock,and nutritional support treatments were continued and various laboratory indicators were regularly reviewed.The patient was discharged from the hospital after recovery.This disease is a challenge for the clinician because of the unusual spreading path of the abscess.Moreover,appropriate intervention and adequate drainage of abdominal and pelvic lesions are necessary,especially when the primary focus cannot be determined.CONCLUSION The etiology of ADP varies,but acute peritonitis secondary to SVA is very rare.In this patient,the left SVA not only affected the adjacent prostate and bladder but also spread retrogradely through the vas deferens,forming a pelvic abscess in the loose tissues of the extraperitoneal fascia layer.Inflammation involving the peritoneal layer led to ascites and pus accumulation in the abdominal cavity,and appendix involvement led to extraserous suppurative inflammation.In clinical practice,surgeons need to consider the results of various laboratory tests and imaging examinations to make comprehensive judgments involving the diagnosis and treatment plan.展开更多
Objective:To study epidemiology,clinical manifestations,and laboratory parameters of scrub typhus in Hadoti region of Rajasthan,India.Methods:A cross-sectional study was conducted on 50 patients with scrub typhus betw...Objective:To study epidemiology,clinical manifestations,and laboratory parameters of scrub typhus in Hadoti region of Rajasthan,India.Methods:A cross-sectional study was conducted on 50 patients with scrub typhus between August 2022 and November 2022.Scrub typhus was diagnosed by ELISA IgM scrub typhus antibody.The data about demography,vital parameters,and lab investigations were collected and analyzed.Results:Ninety-two percent of the patients were from a rural background(92%),86% were farmers and the majority were females.Most patients were 40-60 years old.The major complaints were fever(100%),myalgia(100%),headache(82%),and body swelling(80%).Major complications were pneumonia(68%),multiple organ dysfunction syndrome(62%),hepatitis(44%),and acute kidney injury(42%).Triglyceride levels were>200 mg/dL in 80% of patients,albumin<3.5 g/dL in 98% and eschar mark was present in 24%of patients.Conclusions:Scrub typhus is a serious acute febrile illness that can lead to multi-organ dysfunction and is associated with significant mortality.Increasing awareness regarding disease in endemic regions,early screening of patients,and treatment as early as possible could help prevent the patient from severe life-threatening complications.展开更多
A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department.With o...A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department.With organ function supportive treatment,the etiology was finally identified to be a bone spur located at the inner border of the left costa due to repeated friction between the implanted steel bar and the rib,which damaged the heart repeatedly and induced the consequent acute cardiac tamponade.After operation,the patient was successfully managed and discharged.Follow-ups till three years indicated a good recovery.展开更多
Objective: To investigate the level of acute phase proteins (APP)-synthesized in hepatocytes in pathogenic process of multiple organ dysfunction syndrome (MODS) and the effect of Dachengqi Decoction (DCQD) on it. Meth...Objective: To investigate the level of acute phase proteins (APP)-synthesized in hepatocytes in pathogenic process of multiple organ dysfunction syndrome (MODS) and the effect of Dachengqi Decoction (DCQD) on it. Methods: The levels of C-reactive protein (CRP),α1-acid glycoprotein (AAG), α1-antitrypsin total (α1AT), α2-macroglobulin (α2-MG), ceruloplasmine (CP), hepatoglobin (HP) and transferrin (TF) synthesis were determined in 32 cases of MODS patients and rat models of MODS induced by acute infective peritonitis and mesenterial artery ischemia-reperfusion.Results: The serum APP level in MODS patients was increased and higher than that in the control group (P < 0. 01 ). After 3 days of DCQD treatment it reduced significantly (P <0. 05). Serum APP level in MODS model was also increased significantly, and after 3 days of DCQD treatment, it reduced significantly (P < 0. 05). The APP secreting level of rat hepatocytes cultured in vitro raised after stimulated and activated by lipopolysacchride, which was reduced after cultured with rabbits serum containing different concentration of effective ingredients of DCQD. The APP inhibiting effect of DCQD was dose dependent. Conclusion: Purgation therapy with DCQD could reduce the stimulation of pathogenic factors on hepatocytes, protect tissues and organs from damage caused by excessive inflammatory reaction.Original article on CJIM(Chin) 1998; 18(8):展开更多
BACKGROUND:Urokinase-type plasminogen activator(uPA) and urokinase-type plasminogen activator receptor(uPAR) are known as important factors,which mediate a variety of functions in terms of vascular homeostasis,inflamm...BACKGROUND:Urokinase-type plasminogen activator(uPA) and urokinase-type plasminogen activator receptor(uPAR) are known as important factors,which mediate a variety of functions in terms of vascular homeostasis,inflammation and tissue repair.However,their role in systemic inflammatory response syndrome(SIRS) has been less well studied.This study aimed to test the hypothesis that the abnormalities of fibrinolysis and degradation of extracellular matrix mediated by uPA and uPAR are directly related to the patients with SIRS.We therefore analyzed their role and clinicopathological significance in patients with SIRS.METHODS:A case-control study was conducted with 85 patients who were divided into two groups according to the diagnostic criteria of SIRS:SIRS group(n=50) and non-SIRS group(/7=35).The SIRS group was divided into MODS group(n=26) and non-MODS group(n=24) by their severity,and survival group(n=35) and non-survival group(n=15) by their prognosis.Another 30 healthy adults served as normal controls.uPA and uPAR in plasma were detected by commercial enzyme-linked immunosorbent assay(ELISA) kits.RESULTS:The plasma level of uPA was lower in the SIRS group than in the non-SIRS group and controls(P<0.001 and P<0.001).It was lower in sepsis patients and the MODS group than in the non-sepsis patients and the non-MODS patients(all P<0.05).However,there was no difference in uPA level between survivors and non-survivors(P>0.05).The plasma level of uPAR increased in the SIRS group compared with the non-SIRS group and controls(P<0.001 and P<0.001).There was a significant elevation of uPAR in sepsis patients,MODS patients and non-survivors as compared with non-sepsis patients,non-MODS patients and survivors respectively(all P<0.05).Plasma uPAR levels were positively correlated with APACHE Ⅱ score(r=0.575,P<0.001) and SOFA score(r=0.349,P=0.013).AUCs for the prediction of SIRS mortality were 0.67 and 0.51,respectively,for uPA and uPAR.CONCLUSION:uPAR could be a predictor of poor outcome in patients with SIRS.展开更多
In modern warfare,therapy for combat injury is a critical issue to improve personnel survival and battle effectiveness.Be limited to the severe circumstance in the distant battlefield,quick and effective treatment can...In modern warfare,therapy for combat injury is a critical issue to improve personnel survival and battle effectiveness.Be limited to the severe circumstance in the distant battlefield,quick and effective treatment cannot be supplied that leads infections,sepsis,multiple organ dysfunction syndrome(MODS)and high mortality.To get a better therapy for combat injury,we summarized several reports that associated with the mechanisms of sepsis and MODS,those published on MMR recently.Chaudry and colleagues reported gender difference in the outcomes of trauma,shock and sepsis.The advantageous outcome in female is due to their hormone milieu.Their accumulating reports indicated estrogen as a beneficial factor for multiple system and organs,including the central nervous system,the cardiopulmonary system,the liver,the kidneys,the immune system,and leads to better survival from sepsis.Thompson et al.reviewed the underlying mechanisms in trauma induced sepsis,which can be concluded as an imbalance of immune response triggered by damage-associated molecular patterns(DAMPs)and other immune modifying agents.They also emphasize immunomodulation as a better therapeutic strategy that might be a potential benefit in regulating the host immune response.Fan et al.have revealed a crucial mechanism underlying lung epithelial and macrophage crosstalk,which involves IL-25 as a mediator.After the injury,lung epithelial secreted IL-25 promotes TNF-αproduction in macrophage leading to acute lung injury(ALI).In addition to a mountain of cytokines,mitochondrial dysfunction in immune cell is another critical risk factor for immune dysfunction during sepsis.Both morphology and function alterations in mitochondria are closely associated with inadequate ATP production,insufficient metabolism process and overloaded ROS production,which lead harm to immune cells and other tissues by triggering oxidative stress.All the above reports discussed mechanisms of sepsis induction after trauma and provided evidence to improve better therapy strategies targeting diverse risk factors.展开更多
BACKGROUND The outbreak of coronavirus disease 2019(COVID-19)has rapidly evolved into a global pandemic.COVID-19 is clinically categorized into mild,moderate,severe,and critical illness.Acute kidney injury is an indep...BACKGROUND The outbreak of coronavirus disease 2019(COVID-19)has rapidly evolved into a global pandemic.COVID-19 is clinically categorized into mild,moderate,severe,and critical illness.Acute kidney injury is an independent risk factor for poor prognosis in patients with.Serum cystatin C(s Cys C)is considered a more sensitive biomarker for early renal insufficiency than conventional indicators of renal function.Early detection of risk factors that affect the prognosis of severe and critically ill patients while using active and effective treatment measures is very important and can effectively reduce the potential mortality rate.AIM To determine the predictive value of s Cys C for the prognosis of patients with COVID-19.METHODS The clinical data of 101 severe and critically ill patients with COVID-19 at a designated hospital in Wuhan,Hubei Province,China were analyzed retrospectively.According to the clinical outcome,the patients were divided into a discharge group(64 cases)and a death group(37 cases).The general information,underlying diseases,and laboratory examination indexes of the two groups were compared.Multivariate Cox regression was used to explore the relationship between s Cys C and prognosis.The receiver operating characteristic(ROC)curve was used to demonstrate the sensitivity and specificity of s Cys C and its optimal cut-off value for predicting death.RESULTS There were significant differences in age,s Cys C,creatinine,C-reactive protein,serum albumin,creatine kinase-MB,alkaline phosphatase,lactate dehydrogenase,neutrophil count,and lymphocyte count between the two groups(P<0.001).Multivariate logistic regression analysis showed that s Cys C was an independent risk factor for death in patients with COVID-19(Odds ratio=1.812,95%confidence interval[CI]:1.300-2.527,P<0.001).The area under the ROC curve was 0.755(95%CI:1.300-2.527),the cut-off value was 0.80,the specificity was 0.562,and the sensitivity was 0.865.CONCLUSION s Cys C is an independent risk factor for death in patients with COVID-19.Patients with a s Cys C level of 0.80 mg/L or greater are at a high risk of death.展开更多
Based on clinical and experimental work two new types of volumetric overload shocks are reported: volumetric overload shock type one and type two depending on the type of fluid causing their induction. Volumetric over...Based on clinical and experimental work two new types of volumetric overload shocks are reported: volumetric overload shock type one and type two depending on the type of fluid causing their induction. Volumetric overload shock type one is induced by sodium-free fluids such as glycine, glucose, mannitol and sorbitol and is characterized with acute dilutional hyponatraemia. Volumetric overload shock type 2 is induced with sodium-based fluids normal saline and plasma substitutes used for resuscitation of the critically ill and has no serological marker. It presents with the multiple vital organs dysfunction or failure syndrome or the adult respiratory distress syndrome. Hypertonic sodium is an effective treatment when given early adequately. The underlying pathophysiology is discussed. An alternative to Starling’s law for the capillary interstitial fluid transfer is given. Hydrodynamic of a porous orifice tube akin to capillary with a surrounding Chamber akin to the interstitial fluid space demonstrated a rapid dynamic magnetic field-like fluid circulation between the surrounding chamber and the lumen of the G tube that represent an adequate replacement for Starling’s law.展开更多
This review attempts to unveil the possible mechanisms underlying how gut lymph affects lung and further gives rise to acute respiratory distress syndrome,as well as potential interventional targets under the conditio...This review attempts to unveil the possible mechanisms underlying how gut lymph affects lung and further gives rise to acute respiratory distress syndrome,as well as potential interventional targets under the condition of ischemia-reperfusion injury.We searched electronic databases including PubMed,MEDLINE,Cochrane Central Register of Controlled Trials,Google Scholar,Web of Science,and Embase to identify relevant literatures published up to December 2019.We enrolled the literatures including the Mesh Terms of"gut lymph or intestinal lymph and acute lung injury or acute respiratory distress syndrome."Gut is considered to be the origin of systemic inflammation and the engine of multiple organ distress syndrome in the field of critical care medicine,whereas gut lymph plays a pivotal role in initiation of ischemia-reperfusion injury-induced acute respiratory distress syndrome.In fact,in the having been established pathologic model of sepsis leading to multiple organ dysfunction named by Gut Lymph theory,a variety of literatures showed the position and role of changes in gut lymph components in the initiation of systemic inflammatory response,which allows us to screen out potential intervention targets to pave the way for future clinic and basic research.展开更多
Burn is an under-appreciated trauma that is associated with unacceptably high morbidity and mortality.Although the survival rate after devastating burn injuries has continued to increase in previous decades due to med...Burn is an under-appreciated trauma that is associated with unacceptably high morbidity and mortality.Although the survival rate after devastating burn injuries has continued to increase in previous decades due to medical advances in burn wound care,nutritional and fluid resuscitation and improved infection control practices,there are still large numbers of patients at a high risk of death.One of the most common complications of burn is sepsis,which is defined as“severe organ dysfunction attributed to host’s disordered response to infection”and is the primary cause of death in burn patients.Indeed,burn injuries are accompanied by a series of events that lead to sepsis and multiple organ dysfunction syndrome,such as a hypovolaemic state,immune and inflammatory responses and metabolic changes.Therefore,clear diagnostic criteria and predictive biomarkers are especially important in the prevention and treatment of sepsis and septic shock.In this review,we focus on the pathogenesis of burn wound infection and the post-burn events leading to sepsis.Moreover,the clinical and promising biomarkers of burn sepsis will also be summarized.展开更多
Background:India is an integral component of“tsutsugamushi triangle”which depicts a part of the globe endemic to scrub typhus.Owing to frequent outbreaks witnessed in different parts of the country in the recent pas...Background:India is an integral component of“tsutsugamushi triangle”which depicts a part of the globe endemic to scrub typhus.Owing to frequent outbreaks witnessed in different parts of the country in the recent past,scrub typhus is described as a re-emerging infectious disease in India.The present study aimed to study the clinical and paraclinical profile,complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012.Methods:A longitudinal study was conducted in a hospital of Meghalaya,India between Sept 2011 and Aug 2012.Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi(solid phase immunochromatographic assay)rapid diagnostic test for antibodies(IgM,IgG or IgA).Descriptive analyses of age,gender,geographic area,symptoms and signs,treatment,laboratory findings,complications,and outcome were conducted.Relative risk(RR)with 95%confidence interval(CI)was computed for Multiple Organ Dysfunction Syndrome(MODS)and mortality.Binary logistic regression was applied to the significant correlates(P<0.05)on univariate analysis to identify the predictors of MODS and mortality in scrub typhus.Results:As many as 662 clinically suspected scrub typhus patients were tested and 90(13.6%)were diagnosed to have scrub typhus.Out of 90 patients,52.2%(n=47)were males and their mean(SD)age was 36.29(13.38)years.Fever of<7 days(n=75,83.3%),myalgia(n=56,62.2%),pain abdomen(n=24,26.7%),headache(n=24,26.7%),nausea/vomiting(n=21,23.3%),dry cough(n=21,23.3%),hepatomegaly(n=24,26.7%),splenomegaly(n=22,24.4%),and lymphadenopathy(n=20,22.2%)were the predominant clinical features.Eschar was seen in 10 patients(11.1%).One third(n=30)of the patients developed at least one systemic complication.Acute hepatitis(n=15,16.7%),pneumonitis(n=14,15.6%),and acute kidney injury(n=11,12.2%)were the common complications.MODS was seen in 14.4%(n=13)and 38.5%(n=5)of the patients with MODS died.Overall,case fatality rate was 5.15%(n=5).On univariate analysis,platelets<100000/mm3,serum creatinine>1.5 mg/dl,and transaminase(AST,ALT or both)>500 U/L were associated with MODS(P<0.001)and mortality(P<0.05).In addition,serum bilirubin>3 mg/dl was also associated with MODS(P<0.001).On applying binary logistic regression,serum creatinine>1.5 mg/dl was a predictor of MODS(OR:76.1,95%CI:4.9–1175.6)and mortality(OR:18.03,95%CI:1.38–235.1).Conclusion:In this study setting,approximately one-seventh(13.6%)of the acute undifferentiated febrile illness were due to scrub typhus.Systemic complications were common(33.3%).Serum creatinine>1.5 mg/dl was a predictor of MODS and mortality.展开更多
Severe burns often cause various systemic complications and multiple organ dysfunction syndrome,which is the main cause of death.The lungs and kidneys are vulnerable organs in patients with multiple organ dysfunction ...Severe burns often cause various systemic complications and multiple organ dysfunction syndrome,which is the main cause of death.The lungs and kidneys are vulnerable organs in patients with multiple organ dysfunction syndrome after burns.Extracorporeal membrane oxygenation(ECMO)and continuous renal replacement therapy(CRRT)have been gradually applied in clinical practice and are beneficial for severe burn patients with refractory respiratory failure or renal dysfunction.However,the literature on ECMO combined with CRRT for the treatment of severe burns is limited.Here,we focus on the current status of ECMO combined with CRRT for the treatment of severe burns and the associated challenges,including the timing of treatment,nutrition support,heparinization and wound management,catheter-related infection and drug dosing in CRRT.With the advancement of medical technology,ECMO combined with CRRT will be further optimized to improve the outcomes of patients with severe burns.展开更多
Mortality remains one of the most important end-point quality control parameters to evaluate a burn care system. We retrospectively reviewed the characteristics and multiple organ dysfunction syndrome (MODS) patterns ...Mortality remains one of the most important end-point quality control parameters to evaluate a burn care system. We retrospectively reviewed the characteristics and multiple organ dysfunction syndrome (MODS) patterns of burn deaths in our center from January 2003 to December 2009. The mortality rate during this time period was 2.3%. Fifty-six patients died, including 49 males and 7 females. The mean survival time was 28.45 ± 24.60 days. The burn percentage was (76.70 ± 26.86) % total burn surface area (TBSA), with (27.74 ± 24.95) % deep-partial thickness burns and (46.88 ± 33.84) % full-thickness burns. Inhalation injury was diagnosed in 36 (64.29%) patients. Patients who had undergone an operation, particularly in the first week post-burn, had a significantly longer survival time. An average of 5.50 ± 1.35 malfunctioning organs per patient and a mean sequential organ failure assessment (SOFA) score of 13.91 ± 3.65 were observed. The most frequently malfunctioning organs were involved in the respiratory, hematologic, circulatory, and central nervous systems. Most of the organ damage occurred during the first week post-burn, followed by 4 weeks later, with relatively less organ damage observed in the third week. Among patients with a TBSA over 50%, non-survivors had larger burn sizes (particularly larger full-thickness burns) and a higher incidence of inhalation injury compared with survivors;nonsurvivors were also more likely to have microorganism-positive blood and sputum cultures. In conclusion, burn deaths are related to a higher burn percentage, inhalation injury, MODS, and infection. Early operation may help improve survival duration.展开更多
文摘BACKGROUND:The complications of systemic inflammatory response syndrome(SIRS)include acute lung injury,acute kidney injury,shock,and multiple organ dysfunction syndrome(MODS).In recent years,how to clear inflammatory mediators has become a hot topic in critical care medicine.Researchers hypothesize that continuous blood purification(CBP) can effectively eliminate a variety of inflammatory mediators which participate in the occurrence of MODS and adjust the immune imbalance.This study aimed to observe the effects of CBP in MODS patients.METHODS:In this retrospective clinical study,a total of 38 MODS patients,18 males and 20 females,were enrolled.After conventional therapy,all the patients received CBP.Biochemistry,blood gas analysis,oxygenation index,mean arterial blood pressure(MAP),acute physiology and chronic health evaluation(APACHE) II scores were monitored.RESULTS:After CBP,the vital signs of patients were rapidly stable,and electrolyte disorders and acid-base imbalance were corrected.Renal function,blood gas,oxygenation index were all improved.MAP was increased,and APACHE II score was significantly decreased.All patients had good tolerance,stable hemodynamics,and no obvious adverse reaction on CBP compared with pre-CBP.CONCLUSION:CBP can effectively clean toxins,correct electrolyte acid-base balance,and improve systemic inflammatory response syndrome and the organ function of MODS patients.
文摘Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi (O. tsutsugamushi) in which humans are accidental hosts. Acute arrest of hemopoiesis (AAH) always manifests in pancytopenia and with supportive treatment or inducement removal, the AAH patients would show significant improvement in blood routine for about a week. As a rapidly progressive and potentially life-threatening organ function disorder syndrome, multiple organ dysfunction syndrome (MODS) is often induced by many factors including infection, illness and injury. We received a rare case of scrub typhus rapidly presenting with AAH and MODS 2 weeks ago. The clinical data of a 32-year-old female with O. tsutsugamushi-induced AAH and MODS was summarized retrospectively and analyzed with a literature review. In this case, we selected tigecycline and moxifloxacin as treatment regimens for scrub typhus. When the potential infection was controlled, her pancytopenia and hepatic function rapidly improved in a few days.
文摘BACKGROUND:Blood hemoperfusion with resin adsorption can clean larger molecules that exceed the molecular weight cutoff of combined continuous veno-venous hemofiltration(CWH).Hence blood hemoperfusion with resin adsorption combined CWH(HP+CWH) has higher ability of mediator clearance,and can improve clinical outcomes in theory.This study aimed to investigate the effect of blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration(HP+CWH) on plasm cytokines like TNF-α,IL-1β,IL-6,cellular immunity and prognosis in patients with multiple organ dysfunction syndrome(MODS).METHODS:This was a prospective,randomized clinical trial.A total of 30 patients who had been diagnosed with MODS were enrolled in this study.Patients were randomly allocated to routine treatment+HP+CWH group(treatment group) and routine treatment+only CWH group(control group).In the treatment group,patients received blood hemoperfusion with resin adsorption for 2hours,and then received CWH for 10 hours every day.In the control group,patients received CWH for 12 hours only every day.The patients in the two groups received blood purification therapy for three days.The plasma of patients in the treatment group was obtained at 0,2,12,24,26,36,48,50,60 hours,5th day,7th day and 10 th day,respectively.The plasma of patients in the control group was obtained at 0,12,24,36,48,60 hours,5th day,7th day and 10 th day,respectively.APACHE Ⅱscore,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,breathing rate,and oxygenation index were observed.RESULTS:Plasma cytokines like TNF-α,IL-1β,IL-6 decreased markedly after HP(P<0.01);T-lymphocytes subpopulations CD3+,CD4+,CD8+,CD4+/CD8+ increased after HP+CWH or only CWH.The plasma concentrations of TNF-α,IL-1β and IL-6 in the two groups were not markedly different at 12,36,and 50 hours.But on the 5th day,the plasma concentrations of TNF-α,IL-1β and IL-6 in the treatment group were lower than those in the control group(P<0.05).On the 28 th day,5patients died in the treatment group,and 6 patients in the control group.CONCLUSIONS:Both HP+CWH and CWH can clean plasma cytokines like TNF-α,IL-1β,and IL-6,and improve cellular immunity and clinical symptoms and signs of patients.Compared with only CWH,the plasma concentrations of TNF-α,IL-1β and IL-6 were lower on the 5th day,and patients have an increased survival rate on the 28 day in the HP+CWH group.
基金The Science and Technology Department of Gansu Province,No.20JR5RA355 and No.22JR10KA009Talent Innovation and Entrepreneurship Project of Science and Technology Bureau of Chengguan District,Lanzhou,No.2020RCCX0030+1 种基金Lanzhou Science and Technology Development Guiding Plan Project,No.2019-ZD-37Fund of The First Hospital of Lanzhou University,No.Ldyyyn2020-79.
文摘BACKGROUND Mitochondrial myopathy is a rare genetic disease with maternal inheritance that may involve multiple organ systems.Due to the lack of typical characteristics,its clinical diagnosis is difficult,and it is often misdiagnosed or even missed.CASE SUMMARY The patient was a young college student.When he presented at the hospital,he had severe lactic acidosis,respiratory failure,and shock with multiple organ dysfunction syndrome(MODS).He was treated by mechanical ventilation,venoarterial extracorporeal membrane oxygenation,and other organ support.However,his condition continued to worsen.After a thorough and detailed medical and family history was taken,a mitochondrial crisis was suspected.A muscle biopsy was taken.Further genetic testing confirmed a mitochondrial gene mutation(TRNL13243A>G).The final diagnosis of mitochondrial myopathy was made.Although there is no known specific treatment,intravenous methylprednisone and intravenous immunoglobulin were started.The patient’s shock eventually improved.The further course was complicated by severe infection in multiple sites,severe muscle weakness,and recurrent MODS.After 2 mo of multidisciplinary management and intensive rehabilitation,the patient could walk with assistance 4 mo after admission and walk independently 6 mo after admission.CONCLUSION More attention should be paid to mitochondrial myopathy to avoid missed diagnosis and misdiagnosis.
文摘Multiple organ dysfunction syndrome is the presence of altered organ function of two or more organ systems in acute ill patients with severe trauma,burn,shock and infection.In this case,the patient with burn area amounted to 95%and the third-degree burn was up to 90%.He underwent gastrointestinal tract,blood clotting,lung,brain,heart,liver dysfunction,and cardiac arrest for 30 minutes during the courses of treatment,and was discharged from the hospital after 108 days on the basis of comprehensive treatment and repeated skin grafting.
文摘The critically ill patient is capable of presenting a multiple organ dysfunction syndrome (MODS) caused by different diseases, which can be infectious (sepsis, septic shock) as well as non-infectious (pancreatitis, large surgeries, traumatic injuries, burn patients and brain injuries), this syndrome is characterized by global hemodynamic and organ perfusion alterations accompanied by an uncontrolled and marked inflammatory response unresponsive to pharmacological treatment due to which extracorporeal organ support can be a viable option. Acute renal lesion can occur in up to 60% of patients receiving intensive care, and close to 10% - 20% require renal replacement therapy (RRT) globally this can be provided as peritoneal dialysis (PD) or intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), hybrid therapies known as sustained slow efficiency dialysis (SLED), which combines the benefits IHD and CRRT, slow continuous ultrafiltration (SCUF). Extracorporeal membrane oxygenation (ECMO) and extracorporeal elimination of CO<sub>2</sub>, have been used more frequently lately, these are temporal artificial support used for respiratory and/or cardiac insufficiency that is refractory to conventional treatment. Acute liver failure in adults has a mortality rate close to 50% furthermore one-third of patients hospitalized for cirrhosis are likely to progress to acute liver failure which will drastically increase its mortality. Based on concepts of albumin dialysis, one of its most known is the following: Molecular Adsorbent Recirculating System (MARS), Fractionated Plasma Separation and Absorption—FPSA (Prometheus<sup>®</sup>) and also, hemoperfusion with different cartridges used in different extracorporeal therapies, used in liver failure, rhabdomyolysis, cytokine release syndrome and more in the context of the pandemic covid19. The objective of this review is to know the different extracorporeal therapies and the therapeutic utility in critical patients.
基金National Natural Science Foundation of China,Grant/Award Number:81902112。
文摘Pathogenic Escherichia coli is of great concern in the clinical setting.But few reports have demonstrated the variation in disease course.We present a severe case of multiple organ dysfunction syndrome caused by E.coli infection.Pathogens isolated from blood and urine samples harboured many virulence factors.Whole‐genome sequencing and conventional analyses showed that the isolates experienced beneficial variations,both genetically and phenotypically,during the disease course.These findings showed that E.coli can cause sys-temic symptoms and informed us of the importance of assessing the reasons for such variations in pathogens occurring in vivo.
文摘BACKGROUND Seminal vesicle abscess(SVA)is the manifestation of a relatively rare urinary system infection.In response to urinary system inflammation,an abscess forms in special locations.However,acute diffuse peritonitis(ADP)induced by SVA is unusual.CASE SUMMARY We report a case of a left SVA in a male patient complicated with pelvic abscess,ADP,multiple organ dysfunction syndrome,infectious shock,bacteremia,and acute appendiceal extraserous suppurative inflammation as a result of a long-term indwelling urinary catheter.The patient received a course of morinidazole+cefminol antibiotics but showed no obvious relief,so the perineal SVA underwent puncture drainage and abdominal abscess drainage+appendectomy was performed.The operations were successful.After the operation,anti-infection,anti-shock,and nutritional support treatments were continued and various laboratory indicators were regularly reviewed.The patient was discharged from the hospital after recovery.This disease is a challenge for the clinician because of the unusual spreading path of the abscess.Moreover,appropriate intervention and adequate drainage of abdominal and pelvic lesions are necessary,especially when the primary focus cannot be determined.CONCLUSION The etiology of ADP varies,but acute peritonitis secondary to SVA is very rare.In this patient,the left SVA not only affected the adjacent prostate and bladder but also spread retrogradely through the vas deferens,forming a pelvic abscess in the loose tissues of the extraperitoneal fascia layer.Inflammation involving the peritoneal layer led to ascites and pus accumulation in the abdominal cavity,and appendix involvement led to extraserous suppurative inflammation.In clinical practice,surgeons need to consider the results of various laboratory tests and imaging examinations to make comprehensive judgments involving the diagnosis and treatment plan.
文摘Objective:To study epidemiology,clinical manifestations,and laboratory parameters of scrub typhus in Hadoti region of Rajasthan,India.Methods:A cross-sectional study was conducted on 50 patients with scrub typhus between August 2022 and November 2022.Scrub typhus was diagnosed by ELISA IgM scrub typhus antibody.The data about demography,vital parameters,and lab investigations were collected and analyzed.Results:Ninety-two percent of the patients were from a rural background(92%),86% were farmers and the majority were females.Most patients were 40-60 years old.The major complaints were fever(100%),myalgia(100%),headache(82%),and body swelling(80%).Major complications were pneumonia(68%),multiple organ dysfunction syndrome(62%),hepatitis(44%),and acute kidney injury(42%).Triglyceride levels were>200 mg/dL in 80% of patients,albumin<3.5 g/dL in 98% and eschar mark was present in 24%of patients.Conclusions:Scrub typhus is a serious acute febrile illness that can lead to multi-organ dysfunction and is associated with significant mortality.Increasing awareness regarding disease in endemic regions,early screening of patients,and treatment as early as possible could help prevent the patient from severe life-threatening complications.
文摘A 19-year-old male patient who suffered from sudden and repeated multiple organ dysfunction syndrome one month after the bar removal procedure of Nuss surgery for pectus excavatum was admitted to our department.With organ function supportive treatment,the etiology was finally identified to be a bone spur located at the inner border of the left costa due to repeated friction between the implanted steel bar and the rib,which damaged the heart repeatedly and induced the consequent acute cardiac tamponade.After operation,the patient was successfully managed and discharged.Follow-ups till three years indicated a good recovery.
文摘Objective: To investigate the level of acute phase proteins (APP)-synthesized in hepatocytes in pathogenic process of multiple organ dysfunction syndrome (MODS) and the effect of Dachengqi Decoction (DCQD) on it. Methods: The levels of C-reactive protein (CRP),α1-acid glycoprotein (AAG), α1-antitrypsin total (α1AT), α2-macroglobulin (α2-MG), ceruloplasmine (CP), hepatoglobin (HP) and transferrin (TF) synthesis were determined in 32 cases of MODS patients and rat models of MODS induced by acute infective peritonitis and mesenterial artery ischemia-reperfusion.Results: The serum APP level in MODS patients was increased and higher than that in the control group (P < 0. 01 ). After 3 days of DCQD treatment it reduced significantly (P <0. 05). Serum APP level in MODS model was also increased significantly, and after 3 days of DCQD treatment, it reduced significantly (P < 0. 05). The APP secreting level of rat hepatocytes cultured in vitro raised after stimulated and activated by lipopolysacchride, which was reduced after cultured with rabbits serum containing different concentration of effective ingredients of DCQD. The APP inhibiting effect of DCQD was dose dependent. Conclusion: Purgation therapy with DCQD could reduce the stimulation of pathogenic factors on hepatocytes, protect tissues and organs from damage caused by excessive inflammatory reaction.Original article on CJIM(Chin) 1998; 18(8):
文摘BACKGROUND:Urokinase-type plasminogen activator(uPA) and urokinase-type plasminogen activator receptor(uPAR) are known as important factors,which mediate a variety of functions in terms of vascular homeostasis,inflammation and tissue repair.However,their role in systemic inflammatory response syndrome(SIRS) has been less well studied.This study aimed to test the hypothesis that the abnormalities of fibrinolysis and degradation of extracellular matrix mediated by uPA and uPAR are directly related to the patients with SIRS.We therefore analyzed their role and clinicopathological significance in patients with SIRS.METHODS:A case-control study was conducted with 85 patients who were divided into two groups according to the diagnostic criteria of SIRS:SIRS group(n=50) and non-SIRS group(/7=35).The SIRS group was divided into MODS group(n=26) and non-MODS group(n=24) by their severity,and survival group(n=35) and non-survival group(n=15) by their prognosis.Another 30 healthy adults served as normal controls.uPA and uPAR in plasma were detected by commercial enzyme-linked immunosorbent assay(ELISA) kits.RESULTS:The plasma level of uPA was lower in the SIRS group than in the non-SIRS group and controls(P<0.001 and P<0.001).It was lower in sepsis patients and the MODS group than in the non-sepsis patients and the non-MODS patients(all P<0.05).However,there was no difference in uPA level between survivors and non-survivors(P>0.05).The plasma level of uPAR increased in the SIRS group compared with the non-SIRS group and controls(P<0.001 and P<0.001).There was a significant elevation of uPAR in sepsis patients,MODS patients and non-survivors as compared with non-sepsis patients,non-MODS patients and survivors respectively(all P<0.05).Plasma uPAR levels were positively correlated with APACHE Ⅱ score(r=0.575,P<0.001) and SOFA score(r=0.349,P=0.013).AUCs for the prediction of SIRS mortality were 0.67 and 0.51,respectively,for uPA and uPAR.CONCLUSION:uPAR could be a predictor of poor outcome in patients with SIRS.
文摘In modern warfare,therapy for combat injury is a critical issue to improve personnel survival and battle effectiveness.Be limited to the severe circumstance in the distant battlefield,quick and effective treatment cannot be supplied that leads infections,sepsis,multiple organ dysfunction syndrome(MODS)and high mortality.To get a better therapy for combat injury,we summarized several reports that associated with the mechanisms of sepsis and MODS,those published on MMR recently.Chaudry and colleagues reported gender difference in the outcomes of trauma,shock and sepsis.The advantageous outcome in female is due to their hormone milieu.Their accumulating reports indicated estrogen as a beneficial factor for multiple system and organs,including the central nervous system,the cardiopulmonary system,the liver,the kidneys,the immune system,and leads to better survival from sepsis.Thompson et al.reviewed the underlying mechanisms in trauma induced sepsis,which can be concluded as an imbalance of immune response triggered by damage-associated molecular patterns(DAMPs)and other immune modifying agents.They also emphasize immunomodulation as a better therapeutic strategy that might be a potential benefit in regulating the host immune response.Fan et al.have revealed a crucial mechanism underlying lung epithelial and macrophage crosstalk,which involves IL-25 as a mediator.After the injury,lung epithelial secreted IL-25 promotes TNF-αproduction in macrophage leading to acute lung injury(ALI).In addition to a mountain of cytokines,mitochondrial dysfunction in immune cell is another critical risk factor for immune dysfunction during sepsis.Both morphology and function alterations in mitochondria are closely associated with inadequate ATP production,insufficient metabolism process and overloaded ROS production,which lead harm to immune cells and other tissues by triggering oxidative stress.All the above reports discussed mechanisms of sepsis induction after trauma and provided evidence to improve better therapy strategies targeting diverse risk factors.
文摘BACKGROUND The outbreak of coronavirus disease 2019(COVID-19)has rapidly evolved into a global pandemic.COVID-19 is clinically categorized into mild,moderate,severe,and critical illness.Acute kidney injury is an independent risk factor for poor prognosis in patients with.Serum cystatin C(s Cys C)is considered a more sensitive biomarker for early renal insufficiency than conventional indicators of renal function.Early detection of risk factors that affect the prognosis of severe and critically ill patients while using active and effective treatment measures is very important and can effectively reduce the potential mortality rate.AIM To determine the predictive value of s Cys C for the prognosis of patients with COVID-19.METHODS The clinical data of 101 severe and critically ill patients with COVID-19 at a designated hospital in Wuhan,Hubei Province,China were analyzed retrospectively.According to the clinical outcome,the patients were divided into a discharge group(64 cases)and a death group(37 cases).The general information,underlying diseases,and laboratory examination indexes of the two groups were compared.Multivariate Cox regression was used to explore the relationship between s Cys C and prognosis.The receiver operating characteristic(ROC)curve was used to demonstrate the sensitivity and specificity of s Cys C and its optimal cut-off value for predicting death.RESULTS There were significant differences in age,s Cys C,creatinine,C-reactive protein,serum albumin,creatine kinase-MB,alkaline phosphatase,lactate dehydrogenase,neutrophil count,and lymphocyte count between the two groups(P<0.001).Multivariate logistic regression analysis showed that s Cys C was an independent risk factor for death in patients with COVID-19(Odds ratio=1.812,95%confidence interval[CI]:1.300-2.527,P<0.001).The area under the ROC curve was 0.755(95%CI:1.300-2.527),the cut-off value was 0.80,the specificity was 0.562,and the sensitivity was 0.865.CONCLUSION s Cys C is an independent risk factor for death in patients with COVID-19.Patients with a s Cys C level of 0.80 mg/L or greater are at a high risk of death.
文摘Based on clinical and experimental work two new types of volumetric overload shocks are reported: volumetric overload shock type one and type two depending on the type of fluid causing their induction. Volumetric overload shock type one is induced by sodium-free fluids such as glycine, glucose, mannitol and sorbitol and is characterized with acute dilutional hyponatraemia. Volumetric overload shock type 2 is induced with sodium-based fluids normal saline and plasma substitutes used for resuscitation of the critically ill and has no serological marker. It presents with the multiple vital organs dysfunction or failure syndrome or the adult respiratory distress syndrome. Hypertonic sodium is an effective treatment when given early adequately. The underlying pathophysiology is discussed. An alternative to Starling’s law for the capillary interstitial fluid transfer is given. Hydrodynamic of a porous orifice tube akin to capillary with a surrounding Chamber akin to the interstitial fluid space demonstrated a rapid dynamic magnetic field-like fluid circulation between the surrounding chamber and the lumen of the G tube that represent an adequate replacement for Starling’s law.
基金funded by the Zunyi Medical College 2017 Academic New Seedling Cultivation and Innovative Exploration Fund(Qian Ke He Talents Platform[2017]5733-019)Science and Technology Support Plan of Guizhou Province in 2019(Qian Ke He Support[2019]2834)。
文摘This review attempts to unveil the possible mechanisms underlying how gut lymph affects lung and further gives rise to acute respiratory distress syndrome,as well as potential interventional targets under the condition of ischemia-reperfusion injury.We searched electronic databases including PubMed,MEDLINE,Cochrane Central Register of Controlled Trials,Google Scholar,Web of Science,and Embase to identify relevant literatures published up to December 2019.We enrolled the literatures including the Mesh Terms of"gut lymph or intestinal lymph and acute lung injury or acute respiratory distress syndrome."Gut is considered to be the origin of systemic inflammation and the engine of multiple organ distress syndrome in the field of critical care medicine,whereas gut lymph plays a pivotal role in initiation of ischemia-reperfusion injury-induced acute respiratory distress syndrome.In fact,in the having been established pathologic model of sepsis leading to multiple organ dysfunction named by Gut Lymph theory,a variety of literatures showed the position and role of changes in gut lymph components in the initiation of systemic inflammatory response,which allows us to screen out potential intervention targets to pave the way for future clinic and basic research.
基金supported by grants from the National Natural Science Foundation of China(81821002,81790251,81672381)the Guangdong Basic and Applied Basic Research Foundation(2019B030302012)+1 种基金the Science and Technology Department of Sichuan Province(2018RZ0133)the Chengdu Science and Technology Program(2019-YF05-00715-SN).
文摘Burn is an under-appreciated trauma that is associated with unacceptably high morbidity and mortality.Although the survival rate after devastating burn injuries has continued to increase in previous decades due to medical advances in burn wound care,nutritional and fluid resuscitation and improved infection control practices,there are still large numbers of patients at a high risk of death.One of the most common complications of burn is sepsis,which is defined as“severe organ dysfunction attributed to host’s disordered response to infection”and is the primary cause of death in burn patients.Indeed,burn injuries are accompanied by a series of events that lead to sepsis and multiple organ dysfunction syndrome,such as a hypovolaemic state,immune and inflammatory responses and metabolic changes.Therefore,clear diagnostic criteria and predictive biomarkers are especially important in the prevention and treatment of sepsis and septic shock.In this review,we focus on the pathogenesis of burn wound infection and the post-burn events leading to sepsis.Moreover,the clinical and promising biomarkers of burn sepsis will also be summarized.
文摘Background:India is an integral component of“tsutsugamushi triangle”which depicts a part of the globe endemic to scrub typhus.Owing to frequent outbreaks witnessed in different parts of the country in the recent past,scrub typhus is described as a re-emerging infectious disease in India.The present study aimed to study the clinical and paraclinical profile,complications and predictors of outcome among 90 cases of scrub typhus diagnosed in a hospital of north-eastern India from Sept 2011 to Aug 2012.Methods:A longitudinal study was conducted in a hospital of Meghalaya,India between Sept 2011 and Aug 2012.Diagnosis of scrub typhus was arrived by SD BIOLINE tsutsugamushi(solid phase immunochromatographic assay)rapid diagnostic test for antibodies(IgM,IgG or IgA).Descriptive analyses of age,gender,geographic area,symptoms and signs,treatment,laboratory findings,complications,and outcome were conducted.Relative risk(RR)with 95%confidence interval(CI)was computed for Multiple Organ Dysfunction Syndrome(MODS)and mortality.Binary logistic regression was applied to the significant correlates(P<0.05)on univariate analysis to identify the predictors of MODS and mortality in scrub typhus.Results:As many as 662 clinically suspected scrub typhus patients were tested and 90(13.6%)were diagnosed to have scrub typhus.Out of 90 patients,52.2%(n=47)were males and their mean(SD)age was 36.29(13.38)years.Fever of<7 days(n=75,83.3%),myalgia(n=56,62.2%),pain abdomen(n=24,26.7%),headache(n=24,26.7%),nausea/vomiting(n=21,23.3%),dry cough(n=21,23.3%),hepatomegaly(n=24,26.7%),splenomegaly(n=22,24.4%),and lymphadenopathy(n=20,22.2%)were the predominant clinical features.Eschar was seen in 10 patients(11.1%).One third(n=30)of the patients developed at least one systemic complication.Acute hepatitis(n=15,16.7%),pneumonitis(n=14,15.6%),and acute kidney injury(n=11,12.2%)were the common complications.MODS was seen in 14.4%(n=13)and 38.5%(n=5)of the patients with MODS died.Overall,case fatality rate was 5.15%(n=5).On univariate analysis,platelets<100000/mm3,serum creatinine>1.5 mg/dl,and transaminase(AST,ALT or both)>500 U/L were associated with MODS(P<0.001)and mortality(P<0.05).In addition,serum bilirubin>3 mg/dl was also associated with MODS(P<0.001).On applying binary logistic regression,serum creatinine>1.5 mg/dl was a predictor of MODS(OR:76.1,95%CI:4.9–1175.6)and mortality(OR:18.03,95%CI:1.38–235.1).Conclusion:In this study setting,approximately one-seventh(13.6%)of the acute undifferentiated febrile illness were due to scrub typhus.Systemic complications were common(33.3%).Serum creatinine>1.5 mg/dl was a predictor of MODS and mortality.
基金supported by the Foundation of Chongqing Science and Technology Commission(cstc2018jscx-msybX0-112).
文摘Severe burns often cause various systemic complications and multiple organ dysfunction syndrome,which is the main cause of death.The lungs and kidneys are vulnerable organs in patients with multiple organ dysfunction syndrome after burns.Extracorporeal membrane oxygenation(ECMO)and continuous renal replacement therapy(CRRT)have been gradually applied in clinical practice and are beneficial for severe burn patients with refractory respiratory failure or renal dysfunction.However,the literature on ECMO combined with CRRT for the treatment of severe burns is limited.Here,we focus on the current status of ECMO combined with CRRT for the treatment of severe burns and the associated challenges,including the timing of treatment,nutrition support,heparinization and wound management,catheter-related infection and drug dosing in CRRT.With the advancement of medical technology,ECMO combined with CRRT will be further optimized to improve the outcomes of patients with severe burns.
文摘Mortality remains one of the most important end-point quality control parameters to evaluate a burn care system. We retrospectively reviewed the characteristics and multiple organ dysfunction syndrome (MODS) patterns of burn deaths in our center from January 2003 to December 2009. The mortality rate during this time period was 2.3%. Fifty-six patients died, including 49 males and 7 females. The mean survival time was 28.45 ± 24.60 days. The burn percentage was (76.70 ± 26.86) % total burn surface area (TBSA), with (27.74 ± 24.95) % deep-partial thickness burns and (46.88 ± 33.84) % full-thickness burns. Inhalation injury was diagnosed in 36 (64.29%) patients. Patients who had undergone an operation, particularly in the first week post-burn, had a significantly longer survival time. An average of 5.50 ± 1.35 malfunctioning organs per patient and a mean sequential organ failure assessment (SOFA) score of 13.91 ± 3.65 were observed. The most frequently malfunctioning organs were involved in the respiratory, hematologic, circulatory, and central nervous systems. Most of the organ damage occurred during the first week post-burn, followed by 4 weeks later, with relatively less organ damage observed in the third week. Among patients with a TBSA over 50%, non-survivors had larger burn sizes (particularly larger full-thickness burns) and a higher incidence of inhalation injury compared with survivors;nonsurvivors were also more likely to have microorganism-positive blood and sputum cultures. In conclusion, burn deaths are related to a higher burn percentage, inhalation injury, MODS, and infection. Early operation may help improve survival duration.
