Search Results (83)

Background: This study aimed to develop a predictive model to assess risk factors and prognoses in pediatric patients with dilated cardiomyopathy (DCM). Methods: A total of 233 pediatric patients with DCM who were hospitalized between January 2019 and June 2024 were enrolled. The children were followed up and categorized into two groups: the death/heart transplantation (D/HT) group and the non-D/HT group. Univariate and multivariate analyses identified risk factors. A nomogram model and a scoring system were developed. The performance of these models was evaluated using the H-L test, ROC analysis, and internal validation. Results: The results demonstrated that the age of onset, cardiac functional classification III–IV, moderate-to-severe mitral regurgitation, low voltage in limb leads on an ECG, and the need for vasoactive drugs are independent predictors of D/HT risk in children with DCM. A nomogram model was developed, achieving an AUC of 0.804 (95% CI: 0.734–0.874), a sensitivity of 80.3%, and a specificity of 66.7%. A scoring system was established: 1 point for age of onset, 10 points for cardiac functional classification III–IV, 2.5 points for moderate-to-severe mitral regurgitation, 4 points for low voltage in limb leads on an ECG, 3 points for the need for vasoactive drugs, or 0 points if none of these criteria were met. When the cumulative score was ≥ 13.25, the sensitivity and specificity increased to 68.9% and 73.9%, respectively. Conclusions: We developed both a nomogram and a scoring system model, which are capable of rapidly and accurately predicting the risk of D/HT in children with DCM. Full article

Background: Postoperative delirium is associated with an increased number of different complications, such as prolonged hospital stay, long-term cognitive impairment, and increased mortality. Therefore, early prediction of delirium after percutaneous coronary intervention (PCI) is necessary, but currently, there is still a lack of reliable and effective prediction models for such patients. Methods: All data used in this study were derived from the MIMIC-IV database. Multivariable Cox regression was employed to analyze the data, and the performance of the newly developed nomogram was evaluated based on the area under the receiver operating characteristic curve (AUC). The clinical value of the prediction model was tested using decision curve analysis (DCA). Results: A total of 313 PCI patients in the intensive care unit (ICU) were included in the analysis, comprising 219 in the training cohort and 94 in the testing cohort. Twenty variables were selected for model development. Multivariable Cox regression revealed that benzodiazepine use, vasoactive drug therapy, age, white blood cell count (WBC), and serum potassium were independent risk factors for predicting the occurrence of delirium after PCI. The AUC values for predicting delirium occurrence in the training and validation cohorts were 0.771 and 0.743, respectively. Conclusions: This study has identified several important demographic and laboratory parameters associated with the occurrence of delirium after PCI, and used them to establish a more accurate and convenient nomogram model to predict the occurrence of postoperative delirium in such patients. Full article

Background/Objectives: Red blood cell distribution width (RDW) and mean platelet volume (MPV) are well-established prognostic biomarkers across various medical conditions. However, their role in predicting mortality among critically ill pediatric patients remains unclear. This study investigates the association between RDW, MPV, and 28-day mortality in pediatric intensive care unit (PICU) patients. Methods: This retrospective cohort study analyzed data from children aged 1 month to 18 years who were admitted to the PICUs at Chiang Mai University Hospital for ≥24 h between January 2018 and December 2022. The primary outcome was 28-day PICU mortality. A log-binomial regression analysis was conducted to assess the association of RDW and MPV with 28-day PICU mortality, adjusting for age, sex, mechanical ventilation, vasoactive drug use, continuous renal replacement therapy, and multiorgan failure. Results: A total of 580 PICU patients were included, 55.3% male, with a median age of 5.9 (IQR: 4.7–10.4) months. The 28-day PICU mortality rate was 9.8% (57/580). Respiratory failure and acute respiratory distress syndrome were the most common admission diagnoses (72.1%). Elevated RDW (≥15%) and MPV (≥10 fL) were independently associated with increased 28-day PICU mortality (adjusted RR: 2.73, 95% CI: 1.45–5.13 and 2.38, and 95% CI: 1.43–3.93, respectively). Both markers demonstrated high negative predictive values (RDW: 96.0% and MPV: 94.6%). Conclusions: Elevated RDW (≥15%) and MPV (≥10 fL) were independently associated with increased 28-day PICU mortality. These findings highlight their potential utility as accessible and cost-effective biomarkers for early risk stratification in critically ill pediatric patients. Full article

Background/Objectives: The incidence, timing, and predictors of hemodynamic and respiratory deterioration in patients with high-risk or intermediate-high-risk pulmonary embolism (PE) undergoing pulmonary mechanical thrombectomy (PMT) remain poorly understood. This hemodynamic and respiratory instability can lead to modifications in the anesthetic management. This study investigates these key factors and quantifies the 30-day mortality following thrombectomy. Methods: A retrospective study was conducted on 98 patients aged ≥18 years who underwent PMT. Patients were categorized based on the occurrence of cardiac arrest (CA). Results: Of the 98 patients, 34 had high-risk PE, 62 intermediate/high-risk, and 2 low risk. There were 27 cases of CA, 17 pre- and 10 intra-PMT. An SBP < 90 mmHg increases the risk of CA by 33 (p < 0.001); men have an 8-fold higher risk than women (p = 0.004); SpO₂ <90% by 6 (p = 0.012); and pre-existing respiratory conditions increase the risk by 4 (p = 0.047)). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were 8206 ± 11660.86 and 2388.50 ± 5683.71 pg/mL (p = 0.035) in patients with and without CA, respectively. During PMT, 14% of patients required increased vasoactive drug use, and 38.77% were intubated, including 12 who required ECMO support. Sedation was administered in 64.3% of patients, while general anesthesia was used in 38.8%, with a preemptive indication in 23.5%. The survival rate of patients without CA before and/or during PMT was 96%. Conclusions: While PMT was successfully performed in all patients, hemodynamic and respiratory instability remained a significant concern. More than 10% of patients experienced severe hemodynamic instability, primarily during thrombus extraction, requiring conversion from sedation to general anesthesia. Male sex, pre-existing respiratory disease, SpO₂ < 90%, and SBP < 90 mmHg were associated with an increased risk of CA. Additionally, elevated NT-proBNP levels were linked to a higher incidence of CA. Full article

Background/Objectives: Surgical procedures in chronic obstructive pulmonary disease (COPD) patients carry a high risk of postoperative respiratory failure, often causing the need for mechanical ventilation and prolonged intensive care unit (ICU) stays. Accompanying COPD with heart failure further increases the risk of complications. This study aimed to identify predictors of mortality, prolonged ICU and hospital stays, the need for mechanical ventilation, and vasoactive drug usage in ICU patients with moderate to severe COPD undergoing elective non-cardiac surgery. Methods: This retrospective cohort study analyzed eICU-CRD data, including adult patients with moderate to severe COPD admitted to the ICU from the operating room following elective non-cardiac surgery. Spearman’s correlation analysis was performed to assess associations between intraoperative ventilation parameters and ICU/hospital length of stay, postoperative laboratory parameters, and their perioperative dynamics. Results: This study included 680 patients (21% with severe COPD). Hospital and ICU mortality were 8.6% and 4.4%, respectively. Median ICU and hospital stays were 1.9 and 6.6 days, respectively. Intraoperative tidal volume, expired minute ventilation, positive end-expiratory pressure, mean airway pressure, peak inspiratory pressure, and compliance had no statistically significant association with mortality, postoperative mechanical ventilation, its duration, or the use of vasopressors/inotropes. Tidal volume correlated positively with changes in monocyte count (R = 0.611; p = 0.016), postoperative lymphocytes (R = 0.327; p = 0.017), and neutrophil count (R = 0.332; p = 0.02). Plateau pressure showed a strong positive association with the neutrophil-to-lymphocyte ratio (R = 0.708; p = 0.001). Conclusions: Intraoperative ventilation modes and parameters in COPD patients appear to have no significant impact on the outcomes or laboratory markers, except possibly for the neutrophil-to-lymphocyte ratio, although its elevation cause remains unclear. Full article

Diabetic nephropathy (DN) is a progressive microvascular disorder of diabetes that contributes as a primary reason for end-stage renal disease worldwide. The pathological hallmarks of DN include diffuse mesangial expansion, thicker basement membrane of glomeruli, and arteriole hyalinosis. Hypertension and chronic hyperglycemia are the primary risk factors contributing to the occurrence of DN. The complex pathophysiology of DN involves the interplay amongst metabolic and hemodynamic pathways, growth factors and cytokines production, oxidative stress, and ultimately impaired kidney function. Hyperglycemia-induced vascular dysfunction is the main pathological mechanism that initiates DN. However, several other pathogenic mechanisms, such as oxidative stress, inflammatory cell infiltration, and fibrosis, contribute to disease progression. Different vasoactive hormone processes, including endothelin and renin–angiotensin, are activated as a part of the pathophysiology of DN, which also involves increased intraglomerular and systemic pressure. The pathophysiology of DN will continue to be better understood because of recent developments in genomics and molecular biology, but attempts to develop a comprehensive theory that explains all existing cellular and biochemical pathways have been thwarted by the disease’s multifactorial nature. This review extensively discusses the current understanding regarding the metabolic and hemodynamic pathological mechanisms, along with other signaling pathways and molecules responsible for the pathogenesis of DN. This work will encourage a greater in-depth understanding and investigation of the present status of the biochemical mechanistic processes underlying the pathogenesis of DN, which may assist in the determination of different biomarkers and help in the design and development of novel drug candidates in the near future. Full article

Objective: We sought to assess variations in pulse oximetry waveform amplitude (ΔP) and peak values (ΔS) separately during passive leg raising (PLR) and challenge plus maintenance crystalloid volume resuscitation over time in mechanically ventilated (MV) patients in shock. Methods: Variables were recorded and analayzed using previously described techniques. Findings were compared between the following: at baseline, during passive leg raising (PLR), with 0.9% normal saline administration (or removal), and applying tidal volume (Vt), peak, and mean airway pressure (Paw,peak and Paw,mean, respectively) and positive end-expiratory pressure (PEEP) as covariates in multifactorial logistic regression analysis. Results: Twenty patients with sepsis or septic shock were included in the analysis. Origins of sepsis varied. Their diagnoses upon admission to the intensive care unit included sepsis in nine (45%), septic shock (defined as the need for vasopressors) in nine (45%), and one (5%) rescuscitated from pulseless electrical activity following heroin overdose, all of whom were supported by volume control MV. Eleven patients required vasoactive drugs at the outset, of which seven were on norepinephrine. Three patients required surgical drainage or removal of necrotic tissue. Median ΔP and ΔS decreased, respectively, by 42% and 37% with PLR (p = 0.036 and p = 0.061, respectively). There were no significant changes in ΔP and ΔS between PLR and net fluid volume administered. Correction for body weight did not change these relationships. Application of Vt, Paw,peak, Paw,mean, and PEEP did not significantly influence these changes. Conclusions: Hemodynamic repsonse to slow fluid volume administration can be assessed by changes in the pulse oximetry waveform amplitude over time. The effects of mechanical ventilation are negligible. Full article

Lactiplantibacillus plantarun HFY11 (LP-HFY11) is a newly discovered microbial strain. This study was the first to investigate the preventive effect of LP-HFY11 on compound diphenoxylate induced constipation in mice by measuring intestinal contents, serum, and small intestinal tissue indexes. In mice suffering from constipation, LP-HFY11 could prevent the reduction in fecal weight, particle count, and water content. The constipated mice that ingested a high LP-HFY11 dose (LP-HFY11H) expelled the first black stool faster than the model group and the drug lactulose-treated group, but they were slower than the normal group. Furthermore, the small intestine in the LP-HFY11H group had a greater propulsion rate of activated charcoal than that in the model and lactulose groups, but the propulsion rate was still lower than that in the normal group. According to hematoxylin–eosin (H&E) staining, LP-HFY11H was more effective than lactulose at reducing intestinal villi breaking and constipation-induced harm to the small intestine. Simultaneously, compared with the model group, the LP-HFY11H group had markedly increased serum levels of motilin (MTL), endothelin-1 (ET-1), vasoactive intestinal peptide (VIP), and acetylcholinesterase (AchE). Transient receptor potential vanilloid 1 (TRPV1) expression was only higher than in the normal group, but the mRNA expression of c-Kit, stem cell factor (SCF), and glial cell line-derived neurotrophic factor (GDNF) was all higher in the small intestine in the LP-HFY11H group than in the model and lactulose groups, according to the results of quantitative polymerase chain reaction (qPCR) experiments. Analysis of microbial mRNA in the small intestinal contents of the constipated mice further validated the capacity of LP-HFY11 to decrease the abundance of Firmicutes and increase the abundance of Bacteroidetes, Bifidobacteria, and Lactobacillus. This revealed that LP-HFY11, which produced better results than the drug lactulose, can control the gut microbiota of constipated mice and successfully cure constipation. LP-HFY11 has the potential to be used as a probiotic in the treatment of constipation. It has good application prospects in the food industry and biopharma. Full article

Candidemia infection remains a critical challenge in intensive care units (ICUs), with high morbidity and mortality rates despite advances in therapeutic practices. This multicenter prospective surveillance study assessed the epidemiology, clinical management, and mortality predictors of candidemia in critically ill patients across two periods (2010–2012 and 2017–2018) in 11 tertiary hospitals in Brazil. Among 314 ICU patients with candidemia, the overall mortality rate was 60.2%, with no significant reduction over time (58.8% vs. 62.6%, p = 0.721). Candida albicans was the predominant pathogen (43.6%), followed by C. tropicalis (20%) and C. glabrata (13.7%). The use of echinocandins increased significantly in the second period (21.1% to 41.7%, p < 0.001); however, 70% of patients still did not receive these agents as first-line therapy. Catheter removal due to candidemia was performed in only 52.1% of cases but was associated with improved 30-day survival (p < 0.001). Multivariate analysis identified cancer, inadequate treatment, and vasoactive drug use as independent predictors of mortality. Our findings underscore persistent gaps in adherence to guidelines, particularly regarding timely echinocandin initiation and catheter removal. Strengthening therapeutic strategies focused on these key interventions is essential to improving outcomes for ICU patients with candidemia. Full article

The interaction between the neuroendocrine system and the immune system plays a key role in the onset and progression of various diseases. Neuropeptides, recognized as common biochemical mediators of communication between these systems, are receiving increasing attention because of their potential therapeutic applications in immune-related disorders. Additionally, many neuropeptides share significant similarities with antimicrobial peptides (AMPs), and evidence shows that these antimicrobial neuropeptides are directly involved in innate immunity. This review examines 10 antimicrobial neuropeptides, including pituitary adenylate cyclase-activating polypeptide (PACAP), vasoactive intestinal peptide (VIP), α-melanocyte stimulating hormone (α-MSH), ghrelin, adrenomedullin (AM), neuropeptide Y (NPY), urocortin II (UCN II), calcitonin gene-related peptide (CGRP), substance P (SP), and catestatin (CST). Their expression characteristics and the immunomodulatory mechanisms mediated by their specific receptors are summarized, along with potential drugs targeting these receptors. Future studies should focus on further investigating antimicrobial neuropeptides and advancing the development of related drugs in preclinical and/or clinical studies to improve the treatment of immune-related diseases. Full article

The complement system includes soluble and cell surface proteins and is an important arm of the innate immune system. Once activated, the complement system rapidly generates proteins with inflammatory and vasoactive activities. Although complement is crucial to host defense and homeostasis, its inappropriate or uncontrolled activation can also drive tissue injury. Glomerulopathy encompasses a spectrum of diseases with diverse etiologies, clinical presentations, and outcomes. Among the intricate web of factors contributing to glomerulopathies pathogenesis, the role of complement activation has emerged as a focal point of research interest and therapeutic intervention. The pioneer drug was eculizumab, which made it possible to drastically change the prognosis of atypical hemolytic uremic syndrome, an otherwise fatal disease. This comprehensive review aims to elucidate the multifaceted interplay between complement pathways and glomerulopathies, shedding light on potential pathways for targeted therapies and improved patient care. Full article

Background/Objectives: Enhanced recovery after surgery (ERAS) protocols aim to improve clinical outcomes, shorten hospital length of stay (LOS), and reduce costs through a multidisciplinary perioperative approach. Although introduced in colorectal surgery, they are less established in cardiac surgery, especially in combination with on-table extubation (OTE). This study evaluates the impact of a novel ERAS concept with OTE (RERACS) in elective aortic-valve-replacement and coronary bypass surgery. Methods: In a monocentric study, we compared a prospective RERACS-group (n = 114) to a retrospective control group (n = 119) (TRIAL Registration (DRKS00031402). The RERACS concept contained multiple perioperative treatment measures such as respiratory training, short fasting, and OTE. The control group received standard care. Results: Primary endpoint: postoperative LOS. Secondary measurements: length of postoperative vasoactive drug support, duration of mechanical ventilation, complication rate, and patient satisfaction on the second postoperative day. RERACS patients showed significantly shorter postoperative length of stay (ICU: 40 ± 34 h vs. 56 ± 51 h, p = 0.005; hospital: 9 ± 4 d vs. 11 ± 6 d, p = 0.028), lower nosocomial infection rates (24% vs. 40%), fewer cases of postoperative cognitive dysfunction ((subsyndromal) delirium 40% vs. 57%), reduced nausea and vomiting (14.9% vs. 32.8%), and faster weaning from catecholamines (22 ± 30 h vs. 42 ± 48 h, p < 0.001), as well as high patient satisfaction. Conclusions: Our study indicated that an ERAS concept with OTE is safe and associated with faster and improved recovery, including lower catecholamine requirements, reduced LOS, and high patient satisfaction in low-risk cardiac surgery. Full article

In the field of biomedical engineering, the issue of drug delivery constitutes a multifaceted and demanding endeavor for healthcare professionals. The intravenous administration of pharmacological agents to patients and the normalization of average arterial blood pressure (AABP) to desired thresholds represents a prevalent approach employed within clinical settings. The automated closed-loop infusion of vasoactive drugs for the purpose of modulating blood pressure (BP) in patients suffering from acute hypertension has been the focus of rigorous investigation in recent years. In previous works where model-based and fuzzy controllers are used to control AABP, model-based controllers rely on the precise mathematical model, while fuzzy controllers entail complexity due to rule sets. To overcome these challenges, this paper presents an adaptive closed-loop drug delivery system to control AABP by adjusting the infusion rate, as well as a communication time delay (CTD) for analyzing the wireless connectivity and interruption in transferring feedback data as a new insight. Firstly, a nonlinear backstepping controller (NBC) is developed to control AABP by continuously adjusting vasoactive drugs using real-time feedback. Secondly, a model-free deep reinforcement learning (MF-DRL) algorithm is integrated into the NBC to adjust dynamically the coefficients of the controller. Besides the various analyses such as normal condition (without CTD strategy), stability, and hybrid noise, a CTD analysis is implemented to illustrate the functionality of the system in a wireless manner and interruption in real-time feedback data. Full article

Post decompression syndrome (PDS) is a rare and life-threatening complication of pericardiocentesis, especially after rapid drainage of large amounts of pericardial fluid. We present the case of a 21-year-old man who presented with cardiac tamponade of unknown etiology. After preoperative optimization, surgical drainage of the pericardial effusion was performed and approximately 2500 mL of fluid was released over 30 min. The patient rapidly developed hemodynamic collapse with severe biventricular dysfunction, with a left ventricle ejection fraction of 15%. Vasopressor and inotropic support were initiated with Noradrenaline and Dobutamine, further escalated to Adrenaline and Levosimendan with no improvement in clinical and hemodynamic parameters. Considering the high doses of vasoactive drugs, rescue veno-arterial extracorporeal membrane oxygenation (V-A ECMO) was started within the first 24 h. After 10 days on V-A ECMO, the cardiac function slowly recovered, and the extracorporeal mechanical support was successfully weaned. The diagnosis of paraneoplastic PDS secondary to angiosarcoma was made and the patient was successfully discharged to the ward on the 24th day. In conclusion, far from being the last option in the management of PDS, V-A ECMO deserves early consideration for securing adequate myocardial and systemic perfusion, while the cardiac function recovers, but a risk-to-benefit assessment should be made by an experienced multidisciplinary team. Full article

Growing evidence suggests that neuroinflammation is not just a consequence of neurodegeneration in pathologies such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease or Amyotrophic lateral sclerosis, but it is rather a determinant factor, which plays a pivotal role in the onset and progression of these disorders. Neuroinflammation can affect cells and processes in the central nervous system (CNS) as well as immune cells, and might precede protein aggregation, which is a hallmark of the neurodegenerative process. Standard treatment methods are far from being able to counteract inflammation and delay neurodegeneration. Remarkably, phosphodiesterase 5 inhibitors (PDE5is), which represent potent vasoactive drugs used as a first-line treatment for erectile dysfunction (ED), display important anti-inflammatory effects through cyclic guanosine monophosphate (cGMP) level stabilization. Since PDE5 hydrolyzes cGMP, several studies positioned PDE5 as a therapeutic target, and more specifically, PDE5is as potential alternative strategies for the treatment of a variety of neurological disorders. Indeed, PDE5is can limit neuroinflammation and enhance synaptic plasticity, with beneficial effects on cognitive function and memory. The aim of this review is to provide an overview of some of the main processes underlying neuroinflammation and neurodegeneration which may be potential targets for PDE5is, focusing on sildenafil, the most extensively studied. Current strategies using PDEis for the treatment of neurodegenerative diseases will be summarized. Full article