BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology imp...BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.展开更多
Dear editor,Paraquat(PQ)can cause acute lung injury and irreversible pulmonary fibrosis,without specific antidotes.Respiratory failure is the main cause of death among patients with PQ poisoning.Currently,the treatmen...Dear editor,Paraquat(PQ)can cause acute lung injury and irreversible pulmonary fibrosis,without specific antidotes.Respiratory failure is the main cause of death among patients with PQ poisoning.Currently,the treatment involves the use of adsorbents,intensive hemoperfusion,antioxidants,immunosuppressive therapy,respiratory support by mechanical ventilation,and other symptomatic and supportive treatments.[1-3]The mortality of patients with severe PQ poisoning remains high.More eff ective and safer therapies remain to be explored.Few studies reported performing extracorporeal membrane oxygenation(ECMO)and subsequent lung transplantation with either successful or poor clinical outcome in extremely critical patients with PQ poisoning.[4,5]This study aims to summarize the clinical experience and refl ect on the therapeutic prospect of ECMO in respiratory failure or cardiopulmonary failure caused by fatal PQ poisoning.展开更多
Foreign bodies’ingestion is a common phenomenon,and most of the ingested foreign bodies pass through the gut uneventfully.In clinical practice,less than 1%of these patients develop complications such as gut wall pene...Foreign bodies’ingestion is a common phenomenon,and most of the ingested foreign bodies pass through the gut uneventfully.In clinical practice,less than 1%of these patients develop complications such as gut wall penetration or perforation[1–3].We present a rare complication of hepatic abscess secondary to the toothpick piercing the gastric wall into the liver.The abscess was successfully treated by endoscopic retrieval of the foreign body and empirical antibiotic therapy,without drainage or laparotomy.展开更多
Drug-induced liver injury(DILI),which refers to liver damage caused by a drug or its metabolites,has emerged as an important cause of acute liver failure(ALF)in recent years.Chemically-induced ALF in animal models mim...Drug-induced liver injury(DILI),which refers to liver damage caused by a drug or its metabolites,has emerged as an important cause of acute liver failure(ALF)in recent years.Chemically-induced ALF in animal models mimics the pathology of DILI in humans;thus,these models are used to study the mechanism of potentially effective treatment strategies.Mesenchymal stromal cells(MSCs)possess immunomodulatory properties,and they alleviate acute liver injury and decrease the mortality of animals with chemically-induced ALF.Here,we summarize some of the existing research on the interaction between MSCs and immune cells,and discuss the possible mechanisms underlying the immunomodulatory activity of MSCs in chemically-induced ALF.We conclude that MSCs can impact the phenotype and function of macrophages,as well as the differentiation and maturation of dendritic cells,and inhibit the proliferation and activation of T lymphocytes or B lymphocytes.MSCs also have immunomodulatory effects on the production of cytokines,such as prostaglandin E2 and tumor necrosis factor-alpha-stimulated gene 6,in animal models.Thus,MSCs have significant benefits in the treatment of chemically-induced ALF by interacting with immune cells and they may be applied to DILI in humans in the near future.展开更多
Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a dise...Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic cancer.Methods:Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were collected.Patients were divided into two groups depending on how their disease was detected.Group A(n=85):Patients were diagnosed with pancreatic cancer in clinic visits.Group B(n=72):Patients were diagnosed with pancreatic cancer in routine check-ups.We compared their prognosis.Results:The tumor stage in group B was earlier than that in group A.The 1-year survival rate in group B was significantly higher than that in group A(74.6%vs.42.4%,P<0.001),while the 3-and 5-year survival rates of the two groups showed no significant difference(P>0.05).The difference of overall survival time between the two groups was not significant(22.0 vs.9.0 months,P=0.078).Conclusions:The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore,the intervention was earlier which improved short-term survival rate.However,early intervention did not improve overall survival in the long-term.展开更多
Poisoning is often characterized by the acute onset,rapid progress,or specific manifestations of pathological symptoms,such as pulmonary fibrosis due to paraquat poisoning or high mortality arising from dinitrophenol ...Poisoning is often characterized by the acute onset,rapid progress,or specific manifestations of pathological symptoms,such as pulmonary fibrosis due to paraquat poisoning or high mortality arising from dinitrophenol intoxication (Jiang et al.,2016;Wang et al.,2017;Feng et al.,2018;Lu,2018;Xu and Lu,2019).Unlike general poisoning,however,the manifestation of n-hexane intoxication is subacute,and its clinical symptoms are dormant,and thus the provision of a timely and correct diagnosis is often difficult.展开更多
Background and Aims:Timely and effective assessment scoring systems for predicting the mortality of patients with hepatitis E virus-related acute liver failure(HEV-ALF)are urgently needed.The present study aimed to es...Background and Aims:Timely and effective assessment scoring systems for predicting the mortality of patients with hepatitis E virus-related acute liver failure(HEV-ALF)are urgently needed.The present study aimed to establish an effective nomogram for predicting the mortality of HEV-ALF patients.Methods:The nomogram was based on a cross-sectional set of 404 HEV-ALF patients who were identified and enrolled from a cohort of 650 patients with liver failure.To compare the performance with that of the model for end-stage liver disease(MELD)scoring and CLIF-Consortiumacute-on-chronic liver failure score(CLIF-C-ACLFs)models,we assessed the predictive accuracy of the nomogram using the concordance index(C-index),and its discriminative ability using time-dependent receiver operating characteristics(td-ROC)analysis,respectively.Results:Multivariate logistic regression analysis of the development set carried out to predict mortality revealed that γ-glutamyl transpeptidase,albumin,total bilirubin,urea nitrogen,creatinine,international normalized ratio,and neutrophil-to-lymphocyte ratio were independent factors,all of which were incorporated into the new nomogram to predict the mortality of HEV-ALF patients.The area under the curve of this nomogram for mortality prediction was 0.671(95%confidence interval:0.602-0.740),which was higher than that of the MELD and CLIF-C-ACLFs models.Moreover,the td-ROC and decision curves analysis showed that both discriminative ability and threshold probabilities of the nomogram were superior to those of the MELD and CLIF-C-ACLFs models.A similar trend was observed in the validation set.Conclusions:The novel nomogram is an accurate and efficient mortality prediction method for HEV-ALF patients.展开更多
Emergency departments often encounter many severe illnesses.[1-3] Sepsis,a major cause of death in the emergency room,is a syndrome involving physiologic,pathologic,and biochemical abnormalities,induced by a life-thre...Emergency departments often encounter many severe illnesses.[1-3] Sepsis,a major cause of death in the emergency room,is a syndrome involving physiologic,pathologic,and biochemical abnormalities,induced by a life-threatening infection.[4] Sepsis directly or indirectly impairs the function of virtually all types of immune cells,[5,6] and initiates a complex immune response that varies over time,which results in profound immunosuppression,including metabolic failure,epigenetic reprogramming,and myeloidderived suppressor cells.展开更多
Due to the low specificity and sensitivity of biomarkers in sepsis diagnostics,the prognosis of sepsis patient outcomes still relies on the assessment of clinical symptoms.Inflammatory response is crucial to sepsis on...Due to the low specificity and sensitivity of biomarkers in sepsis diagnostics,the prognosis of sepsis patient outcomes still relies on the assessment of clinical symptoms.Inflammatory response is crucial to sepsis onset and progression;however,the significance of inflammatory response-related genes(IRRGs)in sepsis prognosis is uncertain.This study developed an IRRG-based signature for sepsis prognosis and immunological function.The Gene Expression Omnibus(GEO)database was retrieved for two sepsis microarray datasets,GSE64457 and GSE69528,followed by gene set enrichment analysis(GSEA)comparing sepsis and healthy samples.A predictive signature for IRRGs was created using least absolute shrinkage and selection operator(LASSO).To confirm the efficacy and reliability of the new prognostic signature,Cox regression,Kaplan-Meier(K-M)survival,and receiver operating characteristic(ROC)curve analyses were performed.Subsequently,we employed the GSE95233 dataset to independently validate the prognostic signature.A single-sample GSEA(ssGSEA)was conducted to quantify the immune cell enrichment score and immune-related pathway activity.We found that more gene sets were enriched in the inflammatory response in sepsis patient samples than in healthy patient samples,as determined by GSEA.The signature of nine IRRGs permitted the patients to be classified into two risk categories.Patients in the low-risk group showed significantly better 28-d survival than those in the high-risk group.ROC curve analysis corroborated the predictive capacity of the signature,with the area under the curve(AUC)for 28-d survival reaching 0.866.Meanwhile,the ss GSEA showed that the two risk groups had different immune states.The validation set and external dataset showed that the signature was clinically predictive.In conclusion,a signature consisting of nine IRRGs can be utilized to predict prognosis and influence the immunological status of sepsis patients.Thus,intervention based on these IRRGs may become a therapeutic option in the future.展开更多
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine (2017-XK-A36)the Key Research and Development Program of Zhejiang Province (2019C03076).
文摘BACKGROUND:Fatal aortic rupture caused by esophageal foreign body(EFB),is associated with a high mortality,but can be prevented by thoracic endovascular aorta repair(TEVAR)that performed increasingly as technology improves.This study aims to investigate the cause,management and prognosis of suspected penetrating aortoesophageal foreign body injury.METHODS:Twelve cases who met the criteria were enrolled in this study.The demographic and clinical data were reviewed for evaluating the characteristics of EFB.RESULTS:Among 12 cases enrolled,7 were males and 5 were females,with an age 27–86 years.The distance of EFB from aorta(DFA)of 7 cases were less than or equal to 0 mm,5 cases were 0–2 mm.Eleven cases were managed with TEVAR,only one case was with open surgery standby but finally treated by flexible endoscopy(FE)successfully,without TEVAR.In group with TEVAR,EFB of 7 cases were successfully removed by rigid endoscopy(RE),and one of them was failed at the first RE treatment.EFB of 2 cases were successfully removed by open surgery with TEVAR,and other 9 cases were managed by endoscopies with TEVAR.The mean length of stay of hospitalization(LOS)and length of ICU stay of patients treated by open surgery with TEVAR(18.50±2.12 days and 5.50±0.71 days)was significantly longer than those of patients treated by endoscopy with TEVAR(7.00±2.74 days and 1.33±1.12 days,P<0.001 and P=0.001,respectively).Five cases had severe complications.CONCLUSION:Rational application of TEVAR can be a life-saving management for aortoesophageal foreign body injury,and jointed with endoscopy is safe and effective with a shorter length of ICU or total hospital stay.
基金the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(2017-XK-A36)the Medical and Health Science Foundation of Zhejiang Province(2019327552).
文摘Dear editor,Paraquat(PQ)can cause acute lung injury and irreversible pulmonary fibrosis,without specific antidotes.Respiratory failure is the main cause of death among patients with PQ poisoning.Currently,the treatment involves the use of adsorbents,intensive hemoperfusion,antioxidants,immunosuppressive therapy,respiratory support by mechanical ventilation,and other symptomatic and supportive treatments.[1-3]The mortality of patients with severe PQ poisoning remains high.More eff ective and safer therapies remain to be explored.Few studies reported performing extracorporeal membrane oxygenation(ECMO)and subsequent lung transplantation with either successful or poor clinical outcome in extremely critical patients with PQ poisoning.[4,5]This study aims to summarize the clinical experience and refl ect on the therapeutic prospect of ECMO in respiratory failure or cardiopulmonary failure caused by fatal PQ poisoning.
基金This study was supported by a grant from the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(2017-XK-A36).
文摘Foreign bodies’ingestion is a common phenomenon,and most of the ingested foreign bodies pass through the gut uneventfully.In clinical practice,less than 1%of these patients develop complications such as gut wall penetration or perforation[1–3].We present a rare complication of hepatic abscess secondary to the toothpick piercing the gastric wall into the liver.The abscess was successfully treated by endoscopic retrieval of the foreign body and empirical antibiotic therapy,without drainage or laparotomy.
基金National Natural Science Foundation of China,No.81971756and Stem Cell and Translational Research from National Key Research and Development Program of China,No.2016YFA0101001.
文摘Drug-induced liver injury(DILI),which refers to liver damage caused by a drug or its metabolites,has emerged as an important cause of acute liver failure(ALF)in recent years.Chemically-induced ALF in animal models mimics the pathology of DILI in humans;thus,these models are used to study the mechanism of potentially effective treatment strategies.Mesenchymal stromal cells(MSCs)possess immunomodulatory properties,and they alleviate acute liver injury and decrease the mortality of animals with chemically-induced ALF.Here,we summarize some of the existing research on the interaction between MSCs and immune cells,and discuss the possible mechanisms underlying the immunomodulatory activity of MSCs in chemically-induced ALF.We conclude that MSCs can impact the phenotype and function of macrophages,as well as the differentiation and maturation of dendritic cells,and inhibit the proliferation and activation of T lymphocytes or B lymphocytes.MSCs also have immunomodulatory effects on the production of cytokines,such as prostaglandin E2 and tumor necrosis factor-alpha-stimulated gene 6,in animal models.Thus,MSCs have significant benefits in the treatment of chemically-induced ALF by interacting with immune cells and they may be applied to DILI in humans in the near future.
基金the National Natural Science Foundation of China(81272075 and 81801572)the Medical and Health Science Foundation of Zhejiang Province(2019327552)+1 种基金the Foundation of Key Research Project of Zhejiang Province for Traditional Chinese Medicine(2019ZZ014)the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(2017-XKA36).
文摘Background:The high coverage of annual routine health check-up in China is a unique phenomenon throughout the world.However,its clinical value is controversial.In this cohort study,we chose pancreatic cancer as a disease model to explore the role of routine check-up in the prognosis of patients with pancreatic cancer.Methods:Data from 157 patients who were diagnosed with pancreatic cancer between January 2010 and April 2014 were collected.Patients were divided into two groups depending on how their disease was detected.Group A(n=85):Patients were diagnosed with pancreatic cancer in clinic visits.Group B(n=72):Patients were diagnosed with pancreatic cancer in routine check-ups.We compared their prognosis.Results:The tumor stage in group B was earlier than that in group A.The 1-year survival rate in group B was significantly higher than that in group A(74.6%vs.42.4%,P<0.001),while the 3-and 5-year survival rates of the two groups showed no significant difference(P>0.05).The difference of overall survival time between the two groups was not significant(22.0 vs.9.0 months,P=0.078).Conclusions:The stage of pancreatic cancer diagnosed in routine check-ups was earlier and therefore,the intervention was earlier which improved short-term survival rate.However,early intervention did not improve overall survival in the long-term.
基金supported by the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(No.2017-XK-A36),China。
文摘Poisoning is often characterized by the acute onset,rapid progress,or specific manifestations of pathological symptoms,such as pulmonary fibrosis due to paraquat poisoning or high mortality arising from dinitrophenol intoxication (Jiang et al.,2016;Wang et al.,2017;Feng et al.,2018;Lu,2018;Xu and Lu,2019).Unlike general poisoning,however,the manifestation of n-hexane intoxication is subacute,and its clinical symptoms are dormant,and thus the provision of a timely and correct diagnosis is often difficult.
基金Project supported by the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(No.2017XKA36)the Medical and Health Science Foundation of Zhejiang Province(No.2019327552)+1 种基金the Foundation of Key Research Project of Zhejiang Province for Traditional Chinese Medicine(No.2019ZZ014)the Foundation of Science and Technology Department of Zhejiang Province for Beneficial Technology Research of Social Development(No.2015C33146),China。
基金the National Science and Technology Major Project for Infectious Diseases(2012ZX10002004).
文摘Background and Aims:Timely and effective assessment scoring systems for predicting the mortality of patients with hepatitis E virus-related acute liver failure(HEV-ALF)are urgently needed.The present study aimed to establish an effective nomogram for predicting the mortality of HEV-ALF patients.Methods:The nomogram was based on a cross-sectional set of 404 HEV-ALF patients who were identified and enrolled from a cohort of 650 patients with liver failure.To compare the performance with that of the model for end-stage liver disease(MELD)scoring and CLIF-Consortiumacute-on-chronic liver failure score(CLIF-C-ACLFs)models,we assessed the predictive accuracy of the nomogram using the concordance index(C-index),and its discriminative ability using time-dependent receiver operating characteristics(td-ROC)analysis,respectively.Results:Multivariate logistic regression analysis of the development set carried out to predict mortality revealed that γ-glutamyl transpeptidase,albumin,total bilirubin,urea nitrogen,creatinine,international normalized ratio,and neutrophil-to-lymphocyte ratio were independent factors,all of which were incorporated into the new nomogram to predict the mortality of HEV-ALF patients.The area under the curve of this nomogram for mortality prediction was 0.671(95%confidence interval:0.602-0.740),which was higher than that of the MELD and CLIF-C-ACLFs models.Moreover,the td-ROC and decision curves analysis showed that both discriminative ability and threshold probabilities of the nomogram were superior to those of the MELD and CLIF-C-ACLFs models.A similar trend was observed in the validation set.Conclusions:The novel nomogram is an accurate and efficient mortality prediction method for HEV-ALF patients.
文摘Emergency departments often encounter many severe illnesses.[1-3] Sepsis,a major cause of death in the emergency room,is a syndrome involving physiologic,pathologic,and biochemical abnormalities,induced by a life-threatening infection.[4] Sepsis directly or indirectly impairs the function of virtually all types of immune cells,[5,6] and initiates a complex immune response that varies over time,which results in profound immunosuppression,including metabolic failure,epigenetic reprogramming,and myeloidderived suppressor cells.
基金Project supported by the National Natural Science Foundation of China(Nos.81801572 and 81272075)the Foundation of Key Discipline Construction of Zhejiang Province for Traditional Chinese Medicine(No.2017-XKA36)+5 种基金the Foundation of Key Research Project of Zhejiang Province for Traditional Chinese Medicine(No.2019ZZ014)the Medical and Health Science Foundation of Zhejiang Province(No.2019327552)the Key Research and Development Program of Zhejiang Province(No.2019C03076)the General Research Program of Zhejiang Provincial Department of Medical and Health(No.2013KYA066)the Opening Foundation of State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases(Nos.2018KF02 and 2019KF06)the Program of Education Department of Zhejiang Province(No.Y201738150),China。
基金supported by theKey Research and Development Program of Zhejiang Province(No.2019C03076)the Opening Foundation of the State Key Laboratory for Diagnosis and Treatment of Infectious Diseases(No.2018KF02),China.
文摘Due to the low specificity and sensitivity of biomarkers in sepsis diagnostics,the prognosis of sepsis patient outcomes still relies on the assessment of clinical symptoms.Inflammatory response is crucial to sepsis onset and progression;however,the significance of inflammatory response-related genes(IRRGs)in sepsis prognosis is uncertain.This study developed an IRRG-based signature for sepsis prognosis and immunological function.The Gene Expression Omnibus(GEO)database was retrieved for two sepsis microarray datasets,GSE64457 and GSE69528,followed by gene set enrichment analysis(GSEA)comparing sepsis and healthy samples.A predictive signature for IRRGs was created using least absolute shrinkage and selection operator(LASSO).To confirm the efficacy and reliability of the new prognostic signature,Cox regression,Kaplan-Meier(K-M)survival,and receiver operating characteristic(ROC)curve analyses were performed.Subsequently,we employed the GSE95233 dataset to independently validate the prognostic signature.A single-sample GSEA(ssGSEA)was conducted to quantify the immune cell enrichment score and immune-related pathway activity.We found that more gene sets were enriched in the inflammatory response in sepsis patient samples than in healthy patient samples,as determined by GSEA.The signature of nine IRRGs permitted the patients to be classified into two risk categories.Patients in the low-risk group showed significantly better 28-d survival than those in the high-risk group.ROC curve analysis corroborated the predictive capacity of the signature,with the area under the curve(AUC)for 28-d survival reaching 0.866.Meanwhile,the ss GSEA showed that the two risk groups had different immune states.The validation set and external dataset showed that the signature was clinically predictive.In conclusion,a signature consisting of nine IRRGs can be utilized to predict prognosis and influence the immunological status of sepsis patients.Thus,intervention based on these IRRGs may become a therapeutic option in the future.
