Liver function reserve in surgical treatment of patients with portal hypertension: report of 146 cases

Objective: To evaluate the significance of intraopera- tive reassessment of liver function reserve in the se- lection of surgical procedures to optimize therapeutic results in the treatment of portal hypertension. Methods: The data of 146 patients with portal hyper- tension treated in the past 10 years were retrospec- tively reviewed. Posthepatitis cirrhosis was found in 118 patients, schistosomial cirrhosis in 6, alcoholic cirrhosis in 1, mixed cirrhosis in 5, and other disea- ses in 16. According to Child's criteria, 45 patients were classified into class A, 92 class B, and 9 class C. At operation, 33 patients were reclassified into class A, 78 class B, and 35 class C. Disconnection procedure was performed in 89 patients (61. 0%) and shunt procedure in 57 (39. 0 %). These opera- tions included prophylactic operations in 27 patients (18. 5 %) and emergency disconnection operations in 2 (1. 4%). Results: One patient (0. 7 %) died of upper gastroin- testinal bleeding during operation. Early rebleeding following operation occurred in 9 patients (6. 1%) (disconnection in 5 patients and shunt in 4). Early encephalopathy after operation occurred in 2 patients (1. 4 %) (disconnection in 1 patient and shunt in 1). A total of 98 patients (67. 6%) (disconnection in 61 patients and shunt in 37) were followed up (6 months to 9 years). Bleeding occurred again in 12 patients (12. 2 %) (disconnection in 9 patients and shunt in 3) 17 months after operation (4 to 41 months). Late encephalopathy occurred in 6 shunt patients at 19 months (3-40 months). The late re- bleeding rates of shunt patients and disconnection pa- tients were 8.1% (3/37 patients) and 14. 9 % (9/ 61) (P>0. 05) respectively. The late encephalopathy rates of shunt patients and disconnection patients were 16. 2% (6/37) and 0% (0/61) respectively (P <0. 01). Eight patients (5. 5 %) died of upper gas- trointestinal bleeding (2), hepatic failure (3), liver cancer (2), and rectal cancer (1) in the period of follow-up. Conclusions: The success and effectiveness of surgical procedures for portal hypertension are closely related to the status of patient's liver function reserve. In- tra-operative reassessment of hepatic function reserve is crucial. Selection of procedures based on patient's hepatic function reserve, local anatomical conditions and surgeon's experience would optimize therapeutic results.

Data science in the intensive care unit

In this editorial,we comment on the current development and deployment of data science in intensive care units(ICUs).Data in ICUs can be classified into qualitative and quantitative data with different technologies needed to translate and interpret them.Data science,in the form of artificial intelligence(AI),should find the right interaction between physicians,data and algorithm.For individual patients and physicians,sepsis and mechanical ventilation have been two important aspects where AI has been extensively studied.However,major risks of bias,lack of generalizability and poor clinical values remain.AI deployment in the ICUs should be emphasized more to facilitate AI development.For ICU management,AI has a huge potential in transforming resource allocation.The coronavirus disease 2019 pandemic has given opportunities to establish such systems which should be investigated further.Ethical concerns must be addressed when designing such AI.

Expert consensus on the use of human serum albumin in adult cardiac surgery

Introduction Albumin,which is a 65-kDa liver-synthesized protein,accounts for nearly 50%of total plasma protein and contributes to approximately 80%of intravascular oncotic pressure.Albumin helps maintain microvascular integrity,functions as an antioxidant,and transports hormones,fatty acid,bile salts,bilirubin,electrolytes(e.g.,calcium,magnesium,copper,zinc,et al.),and drugs.[1–3]Human serum albumin(HSA)is a sterile,liquid albumin product derived from large pools of human plasma by fractionation and pasteurization.The medical use of HAS could date back to approximately the time of World War II.

Positive sputum culture of Candida spp.as a risk factor for 30-day mortality in patients with hospital-acquired pneumonia:A propensity-score matched retrospective clinical study

Background:Candida species(Candida spp.)are commonly isolated microorganisms from lower respiratory tract(LRT)specimens of patients with hospital-acquired pneumonia(HAP);however,the clinical significance remains controversial.This study aimed to investigate the correlation between Candida spp.in the LRT and the clinical features and prognosis of HAP.Methods:This retrospective analysis included eligible patients with HAP from the database of a prospective study carried out between 2018 and 2019 in nine Chinese hospitals.Data on demographics,clinical characteristics,and prognosis were collected and analyzed.Propensity score matching(PSM)was used to balance the baseline characteristics.Results:A total of 187 HAP patients were enrolled.After PSM of severity score,27 cases with positive sputum culture of Candida spp.were compared with the control group at a ratio of 1:1.The Candida-positive group had more bacterial isolates in blood culture than the Candida-negative group(39.1%[9/23]vs.7.7%[2/26],χ^(2)=6.928,effect size[ES]=0.38,95%CI:0.12-0.61,P=0.008).The proportion of patients with chronic lung diseases was significantly higher in the Candida-positive group(55.6%[15/27]vs.22.2%[6/27],χ^(2)=6.312,ES=0.34,95%CI:0.07-0.59,P=0.012).The 30-day prognosis of HAP was significantly different between the two groups(80.8%[21/26]vs.38.5%[10/26],χ^(2)=9.665,ES=0.43,95%CI:0.19-0.66,P=0.002).Univariable logistic regression analysis showed that LRT Candida spp.colonization was a risk factor for 30-day mortality of HAP(OR=6.720,95%CI:1.915-23.577,P=0.003).Conclusions:Candida spp.in the LRT was associated with 30-day mortality of HAP.Patients with chronic under-lying lung diseases tend to have Candida spp.colonization.

Early Kinetics of Procalcitonin in Predicting Surgical Outcomes in Type A Aortic Dissection Patients

Background： In cardiac surgery, elevation of procalcitonin （PCT） could be observed postoperatively in the absence of any evidence of infection and also seems to be a prognostic marker. PCT levels measured in patients undergoing Type A aortic dissection （TAAD） were used to determine prognostic values for complications and surgical outcomes. Methods： Measurements of PCT, C-reactive protein （CRP）, and leukocyte count were observed in TAAD surgery patients （n = 251 ; average age： 49.02 ± 12.83 years; 78.5% male） at presurgery （TO） and 24 h （T1）, 48 h （T2）, and 7 days （T3） postsurgery. PCT clearance （PCTc） oll days 2 and 7 was calculated： （PCTd - PCTd,±,, d,,v）/PCTdx 100%. Endotracheal intubation duration, length of stay （LOS） in the Intensive Care Unit （1CU）/hospital, and complications were recorded± Results： PCT peaked 24 h postsurgery （median 2.73 ng/ml） before decreasing, Correlation existed between PCT levels at T1 and duration of cardiopulmonary bypass （P = 0.001, r = 0.278）. Serum PCT concentrations were significantly higher in nonsurvivor and multiple organ dysfunction syndrome groups on all postoperative days. PCT levels at T1 correlated with length of time of ventilation support and ICU/hospital LOS. Comparing PCT values of survivors versus nonsurvivors, a PCT cutoff level of 5.86 ng/ml at T2 had high sensitivity （70.6%） and specificity （74.3%） in predicting in-hospital death. PCTc-day 2 and 7 were significantly higher in survivor compared with nonsurvivor patients （38% vs. 8%, P = 0.012, 83% vs. -39%, P 〈 0.001）. A PCTc-day 7 cutoff point of 48.7% predicted survival with high sensitivity （77.8%） and specificity （81.8%）. Conclusions： PCT level and PCTc after TAAD surgery might serve as early prognostic markers to predict postoperative outcome. PCT measurement may help identify high-risk patients.

Basal-plane stacking-fault energies of Mg alloys: A first-principles study of metallic alloying effects

Generalized stacking-fault energies （GSFEs） of basal-plane stacking faults 11 and 12 in Mg alloys have been studied based on first-principles calculations, where 43 alloying elements were considered. It is found that the most contributing features of alloying elements to GSFEs are bulk modulus, equilibrium volume, binding energy, atomic radius and ionization energy. Both bulk modulus and ionization energy exhibit positive relationships with GSFEs, and the others show opposite relationships. Multiple regressions have been performed to offer a quantitative prediction for basal-plane GSFEs in Mg-X systems. GSFEs, alloying effects of elements and the prediction model established within this work may provide guidelines for new Mg alloys design with better ductility.

Ginsenoside Rb1 Reduces D-GalN/LPS-induced Acute Liver Injury by Regulating TLR4/NF-κB Signaling and NLRP3 Inflammasome

Background and Aims:The effect of ginsenoside Rb1 on D-galactosamine(D-GalN)/lipopolysaccharide(LPS)-induced acute liver injury(ALI)is unknown.The aim of this study was to evaluate the effect of ginsenoside Rb1 on ALI and its underlying mechanisms.Methods:Mice were pretreated with ginsenoside Rb1 by intraperitoneal injection for 3 days before D-GalN/LPS treatment,to induce ALI.The survival rate was monitored every hour for 24 h,and serum biochemical parameters,hepatic index and histopathological analysis were evaluated to measure the degree of liver injury.ELISA was used to detect oxidative stress and inflammatory cytokines in hepatic tissue and serum.Immunohistochemistry staining,RT-PCR and western blotting were performed to evaluate the expression of toll-like receptor 4(TLR4),nuclear factorkappa B(NF-κB),and NLR family,pyrin domain-containing 3 protein(NLRP3)in liver tissue and Kupffer cells(KCs).Results:Ginsenoside Rb1 improved survival with D-GalN/LPS-induced ALI by up to 80%,significantly ameliorated the increased alanine and aspartate transaminase,restored the hepatic pathological changes and reduced the levels of oxidative stress and inflammatory cytokines altered by D-GalN/LPS.Compared to the control group,the KCs were increased in the D-GalN/LPS groups but did not increase significantly with Rb1 pretreatment.D-GalN/LPS could upregulate while Rb1 pretreatment could downregulate the expression of interleukin(IL)-1β,IL-18,NLRP3,apoptosis associated specklike protein containing CARD(ASC)and caspase-1 in isolated KCs.Furthermore,ginsenoside Rb1 inhibited activation of the TLR4/NF-κB signaling pathway and NLRP3 inflammasome induced by D-GalN/LPS administration.Conclusions:Ginsenoside Rb1 protects mice against D-GalN/LPS-induced ALI by attenuating oxidative stress and the inflammatory response through the TLR4/NF-κB signaling pathway and NLRP3 inflammasome activation.

Effects of soil spatial variability on structural reliability assessment in excavations

In this study,the effects of soil spatial variability in braced excavations are investigated by focusing on three structural responses:wall bending moments,wall shear forces,and strut forces.The soil spatial variability is modeled using random field theory,and the generated soil parameters are mapped onto a finite element model.A procedure for automating the Monte Carlo simulation,which is used for probabilistic analysis,is described.A case study demonstrates that the soil spatial variability has a considerable effect on the excavation-induced structural responses.Furthermore,a reliability analysis is performed to estimate the failure probability for three structural failure modes.The results demonstrate the importance of considering soil spatial variability in the structural assessment of braced excavati ons.