Acute diseases:An epidemiologic perspective

Many underdeveloped countries still struggle with the public health issue of acute illnesses,especially with the emergence of injuries as a major category of acute diseases.Control of the acute disease is challenging particularly when it occurs as an outbreak,either in isolation or as part of a wider epidemic.This narrative review summarizes the definition,epidemiologic transition,pattern and modes of spread,classification,epidemiologic measures,community burden,prevention,control,and future challenges of acute disease.This review is to provide a reference for epidemiologists,clinicians,researchers,and policymakers.

Expert consensus guidelines on clinical use of Xiyanping injection for acute infectious diseases

Xiyanping injection,a traditional Chinese medicine injection made of andrographolide sulfonate,consisting of well-defined ingredients with antiviral,antibacterial,anti-inflammatory and antipyretic efficacy,has been widely used for treating infectious diseases of respiratory and digestive systems.However,its wide applications may easily lead to unreasonable clinical medication.In order to guide the precise clinical application and rational use of Xiyanping injection,experts in related fields conducted systematically literature review,evaluated and deliberated the application of Xiyanping injection in treating acute infectious diseases using evidence-based medicine method,and jointly drafted the consensus to summarize types of acute infectious diseases in children and adults that can be treated with Xiyanping injection,and recommend the intervention time,usage and dosage,course of treatment and combined medication of the injection.Besides,the consensus elucidates the safety,precautions and contraindications of the injection,so as to provide guidance for clinical use.

Research Progress and Analysis of Moxibustion in Prevention and Treatment of Acute Infectious Diseases

To introduce and evaluate current research progress of moxibustion in the prevention and treatment of acute infectious diseases,related literature in CNKI,Wanfang Data,and SinoMed was retrieved and analyzed by the present study.Results showed abundant studies on the mechanism of action of moxibustion in the prevention and treatment of acute infectious diseases with remarkable clinical efficacy.The present study also summarizes the commonly-occurring problems and found out the deficiencies in existing studies in hope of providing more reference for further research.

Research Progress and Analysis of Moxibustion in Prevention and Treatment of Acute Infectious Diseases

To introduce and evaluate current research progress of moxibustion in the prevention and treatment of acute infectious diseases,related literature in CNKI,Wanfang Data,and SinoMed was retrieved and analyzed by the present study.Results showed abundant studies on the mechanism of action of moxibustion in the prevention and treatment of acute infectious diseases with remarkable clinical efficacy.The present study also summarizes the commonly-occurring problems and found out the deficiencies in existing studies in hope of providing more reference for further research.

Predictive value of diaphragm ultrasound for mechanical ventilation outcome in patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is often combined with respiratory failure,which increases the patient's morbidity and mortality.Diaphragm ultrasound(DUS)has developed rapidly in the field of critical care in recent years.Studies with DUS monitoring diaphragm-related rapid shallow breathing index have demonstrated important results in guiding intensive care unit patients out of the ventilator.Early prediction of the indications for withdrawal of non-invasive ventilator and early evaluation of patients to avoid or reduce disease progression are very important.AIM To explore the predictive value of DUS indexes for non-invasive ventilation outcome in patients with AECOPD.METHODS Ninety-four patients with AECOPD who received mechanical ventilation in our hospital from January 2022 to December 2023 were retrospectively analyzed,and they were divided into a successful ventilation group(68 cases)and a failed ventilation group(26 cases)according to the outcome of ventilation.The clinical data of patients with successful and failed noninvasive ventilation were compared,and the independent predictors of noninvasive ventilation outcomes in AECOPD patients were identified by multivariate logistic regression analysis.RESULTS There were no significant differences in gender,age,body mass index,complications,systolic pressure,heart rate,mean arterial pressure,respiratory rate,oxygen saturation,partial pressure of oxygen,oxygenation index,or time of inspiration between patients with successful and failed mechanical ventilation(P>0.05).The patients with successful noninvasive ventilation had shorter hospital stays and lower partial pressure of carbon dioxide(PaCO_(2))than those with failed treatment,while potential of hydrogen(pH),diaphragm thickening fraction(DTF),diaphragm activity,and diaphragm movement time were significantly higher than those with failed treatment(P<0.05).pH[odds ratio(OR)=0.005,P<0.05],PaCO_(2)(OR=0.430,P<0.05),and DTF(OR=0.570,P<0.05)were identified to be independent factors influencing the outcome of mechanical ventilation in AECOPD patients.CONCLUSION The DUS index DTF can better predict the outcome of non-invasive ventilation in AECOPD patients.

Effects of Wuwei Xiaodu Decoction on Uterine Energy Metabolism and Serum Inflammatory Factors in Rats with Acute Pelvic Inflammatory Disease

[Objectives]To observe the effects of Wuwei Xiaodu Decoction on uterine energy metabolism and serum inflammatory factors in the acute pelvic inflammatory disease(APID)model.[Methods]75 Wistar rats(females)were randomly divided into control group,model group and Wuwei Xiaodu Decoction low,medium and high dose groups(n=15).Except for the control group,the rat APID model was established by right uterine inoculation.On the fifth day after inoculation,the low,medium and high dose groups of Wuwei Xiaodu Decoction were administered at 4,8 and 16 g/kg,and the control group and model group received normal saline.Rats were killed 12 h after nondose administration,blood was collected from the abdominal aorta and measured by ELISA for serum interleukin-6(interleukin-6,IL-6),IL-8,and C-reactive proteins(CRP);the right uterus of rats was tested for high-energy phosphate adenosine phosphate(AMP),adenosine diphosphate(ADP),adenosine triphosphate(ATP)and total adenine nucleotides(TAN)level to evaluate the uterine energy metabolism.[Results]AMP,ADP,ATP and TAN were significantly higher in the Wuwei Xiaodu Decoction of low,medium and high dose than the model group,while the serum IL-6,IL-8 and CRP were significantly lower than the model group,and the difference between the low,medium and high doses(P<0.05).[Conclusions]The Wuwei Xiaodu Decoction can dose-dependent promote uterine energy metabolism and inhibit inflammatory response in APID model rats.

Acute hepatitis induced by an Aloe vera preparation: A case report

AIM: Aloe vera, plant extracts of Aloe barbadensis miller,is widely used in phytomedicine. The first case of acute hepatitis due to this compound was described.METHODS: Description of a clinical case.RESULTS: Hepatitis in a 57-year old female could be linked to the ingestion of Aloe barbadensis miller compounds. The patient's hepatitis resolved completely after discontinuing this medication.CONCLUSION: The case emphasizes the importance of considering phytopharmaceutical over-the-counter drugs as causative agents of hepatitis.

Heparin improves organ microcirculatory disturbances in caerulein-induced acute pancreatitis in rats

AIM:Microcirculatory disturbances are important early pathophysiological events in various organs during acute pancreatitis.The aim of the study was to evaluate changes in microperfusion of the pancreas,liver,kidney,stomach, colon,skeletal muscle,and to investigate the influence of heparin on the organ microcirculation in caerulein-induced experimental acute pancreatitis. METHODS:Acute pancreatitis was induced by 4 intraperitoneal injections of caerulein(Cn)(15 μg/kg).The organ microcirculation was measured by laser Doppler flowmetry.Serum interleukin 6 and hematocrit levels were analysed. RESULTS:Acute pancreatitis resulted in a significant drop of microperfusion in all examined organs.Heparin administration(2×2.5 mg/kg)improved the microcirculation in pancreas(36.9±4% vs 75.9±10%),liver(56.6±6% vs 75.2±16%),kidney (45.1±6% vs 79.3±5%),stomach (65.2±8% vs 78.1±19%),colon(69.8±6% vs 102.5±19%), and skeletal muscle (59.2±6% vs 77.9±13%).Heparin treatment lowered IL-6(359.0±66 U/mL vs 288.5±58 U/mL) and hematocrit level(53±4% vs 46±3%). CONCLUSION:Heparin administration has a positive influence on organ microcirculatory disturbances accompanying experimental Cn-induced acute pancreatitis.

Nuclear factor kB activity in patients with acute severe cholangitis

AIM: To determine the NF-kB activity in peripheral blood mononuclear cells (PBMC) in patients with acute cholangitis of severe type (ACST) and correlate the degree of NF-kB activation with severity of biliary tract infection and clinical outcome. METHODS: Twenty patients with ACST were divided into survivor group (13 cases) and nonsurvivor group (7 cases). Other ten patients undergoing elective gastrectomy or inguinal hernia repair were selected as control group. Peripheral blood samples were taken 24 hours postoperatively. PBMC were separated by density gradient centrifugation, then nuclear proteins were isolated from PBMC, and Electrophoretic Mobility Shift Assay (EMSA) used determined. The results were quantified by scanning densitometer of a Bio-Image Analysis System and expressed as relative optical density (ROD). The levels of TNF-alpha, IL-6, and IL-10 in the plasma of patients with ACST and healthy control subjects were determined by using an enzyme-linked immunoassay (ELISA). RESULTS: The NF-kB activity was 5.02 +/- 1.03 in nonsurvivor group, 2.98 +/- 0.51 in survivor group and 1.06 +/- 0.34 in control group. There were statistical differences in three groups (P【0.05). The levels of TNF-alpha and IL-6 in plasma were (498 +/- 53)ng.L(-1)and (587 +/- 64)ng.L(-1)in nonsurvivor group, (284 +/- 32)ng.L(-1) and (318 +/- 49)ng.L(-1)in survivor group and (89 +/- 11)ng.L(-1) and (102 +/-13)ng.L(-1)in control group. All patients with ACST had increased levels of TNF-alpha and IL-6, which were many-fold greater than those of control group, and there was an evidence of significantly higher levels in those of nonsurvivor group than that in survivor group (P【0.05). The levels of IL-10 in plasma were (378+/-32)ng.L(-1), (384+/-37)ng.L(-1) and (68+/-11)ng.L(-1) in three groups, respectively. All patients had also increased levels of IL-10 when compared with control group (P【0.05), but the IL-10 levels were not significantly higher in nonsurvivors than in survivors (P】0.05). CONCLUSION: NF-kB activity in PBMC in patients with ACST increases markedly and the degree of NF-kB activation is correlated with severity of biliary tract infection and clinical outcome.

Presence and density of common bile duct microlithiasis in acute biliary pancreatitis

AIM:Common bile duct microlithiasis(CBDM)is found in majority of patients with acute biliary pancreatitis(ABP)and no CBD stones in fluoroscopy during urgent ERCP.It is unclear,however,weather CBDM is a cause or the result of the disease.This prospective study was done to investigate the presence and density of CBDM in patients with ABP,when endoscopic retrograde cholangiopancreatography(ERCP) done in different periods from the onset of the disease. METHODS:One hundred fifty one consecutive patients with ABP and no CBDS on ERCP,performed as an urgent(<24 h of admission)procedure,(101-with gallbladder stones, 50 post-cholecystectomy patients),treated during last 4 years were prospectively included to the study.The presence and density of CBDM(cholesterol monohydrate crystals-CMCs and calcium bilirubinate granules-CBGs)in bile collected directly from common bile duct during ERCP was prospectively calculated according to Juniper and Burson criteria.High density of crystals was considered,when we found >10 CMCs and/or >25 clusters of CBGs on 1 slide. RESULTS:CBD microlithiasis was present in given number of patients:on d 1-30/34(88.2%,),on d2 41/49(83.7%), on d 3-23/33(69.5%,),on d4-7-24/35(58.6%)[ P for trend =0.018 ].In patients with CBD microlithiasis the high density of crystals was observed in given number of patients:on d 1-27/30(90%),on d 2-34/41(82.9%),on d3-18/23 (78.3%),on d4-7-16/24(66.7%)[P for trend=0.039]. CONCLUSION:In patients with ABP and no CBDS on ERCP, CBD microlithiasis is observed in the majority of patients, especially during the first day of the disease.Density of CBD microlithiasis is the highest in the first day of the disease.This suggests that CBD microlithiasis can be the cause and not the result of ABP.

Role of oxygen free radicals in patients with acute pancreatitis

AIM:The generation of oxygen free radicals has been implicated in the pathogenesis of experimental pancreatitis. The aim of this study was to determine the role of oxygen free radicals in patients with acute pancreatitis. METHODS:The plasma levels of C-reactive protein(CRP), lipid peroxide(LPO),myeloperoxidase(MPO)and superoxide dismutase(SOD)were measured in 13 patients with acute pancreatitis and 14 healthy volunteers. RESULTS:Among the patients with acute pancreatitis,there were higher plasma levels of LPO and MPO and lower SOD activity in patients with severe pancreatitis than in those with mild pancreatitis.However,there was no significant difference in the serum marker of oxidative stress no matter what the etiology was.The LPO level was especially correlated with the concentration of serum CRP and CT severity index. CONCLUSION:The oxygen free radicals may be closely associated with inflammatory process and the severity of acute pancreatitis.Especially,the concentration of plasma LPO is a meaningful index for determining the severity of the disease.

Stress kinase inhibition modulates acute experimental pancreatitis

AIM: To examine the role of p38 during acute experimental cerulein pancreatitis. METHODS: Rats were treated with cerulein with or without a specific JNK inhibitor (CEP1347) and/or a specific p38 inhibitor (SB203580) and pancreatic stress kinase activity was determined. Parameters to assess pancreatitis included trypsin, amylase, lipase, pancreatic weight and histology. RESULTS: JNK inhibition with CEP1347 ameliorated pancreatitis, reducing pancreatic edema. In contrast, p38 inhibition with SB203580 aggravated pancreatitis with higher trypsin levels and, with induction of acinar necrosis not normally found after cerulein hyperstimulation. Simultaneous treatment with both CEP1347 and SB203580 mutually abolished the effects of either compound on cerulein pancreatitis. CONCLUSION: Stress kinases modulate pancreatitis differentially. JNK seems to promote pancreatitis development, possibly by supporting inflammatory reactions such as edema formation while its inhibition ameliorates pancreatitis. In contrast, p38 may help reduce organ destruction while inhibition of p38 during induction of cerulein pancreatitis leads to the occurrence of acinar necrosis.

TECA hybrid artificial liver support system in treatment of acute liver failure

AIM: To assess the efficacy and safety of TECA type hybrid artificial liver support system (TECA-HALSS) in providing liver function of detoxification, metabolism and physiology by treating the patients with acute liver failure (ALF). METHODS: The porcine liver cells (1-2) x 10(10) were separated from the Chinese small swine and cultured in the bioreactor of TECA-BALSS at 37.0 degrees C and circulated through the outer space of the hollow fiber tubes in BALSS. The six liver failure patients with various degree of hepatic coma were treated by TECA-HALSS and with conventional medicines. The venous plasma of the patients was separated by a plasma separator and treated by charcoal adsorbent or plasma exchange. The plasma circulated through the inner space of the hollow fiber tubes of BALSS and mixed with the patients' blood cells and flew back to their blood circulation. Some small molecular weight substances were exchanged between the plasma and porcine liver cells. Each treatment lasted 6.0-7.0 h. Physiological and biochemical parameters were measured before,during and after the treatment. RESULTS: The average of porcine liver cells was (1.0-3.0) x 10(10) obtained from each swine liver using our modified enzymatic digestion method. The survival rate of the cells was 85%-93% by trypan blue stain and AO/PI fluorescent stain. After cultured in TECA-BALSS bioreactor for 6 h, the survival rate of cells still remained 70%-85%. At the end of TECA-HALSS treatment, the levels of plasma NH(3), ALT, TB and DB were significantly decreased. The patients who were in the state of drowsiness or coma before the treatment improved their appetite significantly and regained consciousness, some patients resumed light physical work on a short period after the treatment.One to two days after the treatment, the ratio of PTA increased warkedly. During the treatment, the heart rates, blood pressure, respiration condition and serum electrolytes (K(+), Na(+) and Cl(-)) were stable without thrombosis and bleeding in all the six patients. CONCLUSION: TECA-HALSS treatment could be a rapid, safe and efficacious method to provide temporary liver support for patients with ALF.

Diagnostic evaluation of acute pancreatitis in two patients with hypertriglyceridemia

We present two diagnostically challenging cases of acute pancreatitis with hypertriglyceridemia accompanied with chylomicronemia caused with a deficiency of lipoprotein lipase and with the presence of type Ⅴ hyperlipidemia. Both cases suffered from acute abdomen following the ingestion of fatty food and revealed the increase in parameters of inflammation without significant elevation of serum amylase levels.The imaging examination of ultrasonography could not detect significant findings of acute pancreatitis and a computer tomography scan eventually confirmed the findings of acute pancreatitis.Both cases responded to a low fat diet and administration of a cholecystokinin receptor antagonist,exhibiting a relief of abdominal symptoms.As in the present cases with acute abdomen following the ingestion of fatty food,the identification of serum hypertriglyceridemia and an abdominal computer tomography scan might be useful in establishing the diagnosis of acute pancreatitis and in developing the therapeutic regimen,when hypertriglyceridemia interferes with the evaluation of pancreatic enzyme activities and ultrasound examination provides poor pancreatic visualization.

Enteral nutrition and acute pancreatitis

INTRODUCTIONAcute pancreatitis (AP) is a common severe illness of the digestive tract with variable involvement of other regional tissues and / or remote organ sysems[1-3],Mild disease is associated with minimal organ dysfunction and rapid recovery ,while severe disease is associated with multiple organ system failure and local complications such as necrosis , abscess , fistulas and pseudocyst formation [4-6].

Can ultrasound predict the severity of acute pancreatitis early by observing acute fluid collection?

INTRODUCTIONThe spectrum of acute pancreatitis (AP) ranges from a mild spontaneously resolved disorder to severe disease with mortality up to 20%-48.4%[1-3]. sAP is defined as the AP with organ failure and /or local complications which developed form acute fluid collection (AFC) including necrosis ,abscess , pseudocyst formation into or around the pancreas [4].

Point-of-care continuous ^(13)C-methacetin breath test improves decision making in acute liver disease: Results of a pilot clinical trial

AIM: To assess the role of the 13C-methacetin breath test (MBT) in patients with acute liver disease. METHODS: Fifteen patients with severe acute liver disease from diverse etiologies were followed-up with 13C-MBT during the acute phase of their illnesses (range 3-116 d after treatment). Patients fasted for 8 h and ingested 75 mg of methacetin prior to the MBT. We compared results from standard clinical assessment, serum liver enzymes, synthetic function, and breath test scores. RESULTS: Thirteen patients recovered and two patients died. In patients that recovered, MBT parameters improved in parallel with improvements in lab results. Evidence of consistent improvement began on day 3 for MBT parameters and between days 7 and 9 for blood tests. Later convergence to normality occurred at an average of 9 d for MBT parameters and from 13 to 28 d for blood tests. In both patients that died, MBT parameters remained low despite fluctuating laboratory values. CONCLUSION: The 13C-MBT provides a rapid, noninvasive assessment of liver function in acute severe liver disease of diverse etiologies. The results of this pilot clinical trial suggest that the MBT may offer greater sensitivity than standard clinical tests for managing patients with severe acute liver disease.

Intestinal expressions of eNOSmRNA and iNOSmRNA in rats with acute liver failure

AIM: To observe the gene expression change of eNOSmRNA and iNOSmRNA in the small and large intestines with acute liver failure (ALF), and to reveal the biological function of NO on the pathogenesis of ALF and multiple organs dysfunction at the molecular level. METHODS: Sixty male Wistar rats were selected, weighing from 250g to 350g, and divided into 5 groups randomly: SO, ALF (6h, 12h), L-Arg, L-NAME, L-Arg and L-NAME, each group with 10 rats. The dose of L-Arg was 300mg.kg(-1), and L-NAME was 30mg.kg(-1), the reagents diluted by normal saline were injected through tail vein 30 minutes pre and post operation. The rats in the ALF group were respectively sacrificed postoperatively at 6h, 12h, and the rats in the other groups were sacrificed postoperatively at 6h. The tissues of small and large intestines were harvested in 4% paraforaldehyde containing the reagent of DEPC and fixed at 6h, embedded in paraffin, and 4 microm section was cut. The expression of eNOSmRNA and iNOSmRNA in these tissues was determined with in situ hybridization, and analyzed with the imaging analysis system of CMM-3 and SPSS statistical software. RESULTS: The expression of eNOSmRNA in the large intestine and iNOSmRNA in the small and large intestines increased significantly at 6h after ALF, but the expression of iNOSmRNA in the small and large intestines reduced notably at 12h after ALF (P【0.05); the expression of eNOSmRNA in the large intestine and iNOSmRNA in the small and large intestines decreased significantly with the reagents of L-Arg at 6h ALF, but the expression of eNOSmRNA and iNOSmRNA in the small and large intestines decreased totally with the reagents of L-NAME or association with L-Arg 6h ALF. CONCLUSION: The expression of eNOSmRNA in the large intestine increased notably at the early stage of ALF, NO induced by the enzyme of eNOS from the transplantation of eNOSmRNA can protect the function of the large intestine, the high expression of iNOSmRNA is involved in the damaged function of the small and large intestines. NO precursor can reduce the expression of iNOSmRNA in the small and large intestines and the damage to intestines; NOS inhibitor or association with NO pre-cursor can totally lower the expression of eNOSmRNA and iNOSmRNA in the small and large intestines, it cannot notably influence the NOS inhibitor in the gene expression of eNOSmRNA and iNOSmRNA to supply the additional NO precursor.

Seasonal variation in the onset of acute pancreatitis

AIM:A drcannual variation in the onset of several acute diseases, mostly dealing with cardiovascular system,has been reported. The present study was to verify the possible existence of a seasonal variability in the onset of acute pancreatitis. METHODS:All patients consecutively admitted to the Hospital of Ferrara,Italy,between January 1998 to December 2002, whose discharge diagnosis was acute pancreatitis,were considered.According to the time of admission,cases were categorized into twelve 1-mo intervals and in four periods by season.x^2 test for goodness of fit and partial Fourier series were used for statistical analysis. RESULTS:During the study period,549 cases of acute pancreatitis were observed.A significant peak of higher incidence was found in March-May,both for total population, males and subgroups with and without cholelithiasis or alcoholism.Fourier analysis showed the existence of a circannual rhythmic pattern with its main peak in March(95% CL.:February-April,P=0.005),and a secondary one in September.Death occurred more frequently in December- February,compared to the other periods(P=0.029),and chronobiologic analysis yielded a seasonal peak in November- December(P<0.001). CONCLUSION:This study shows the existence of a circannual variation in the onset of acute pancreatitis,with a significantly higher frequency of events in the spring,especially for patients with cholelithiasis or alcoholism.Moreover,events occurring during the colder months seem to be characterized by a higher mortality rate.

Hepato-splenic lymphoma:a rare entity mimicking acute hepatitis:A case report

We reported a case of non-Hodgkin's lymphoma where liver involvement was the predominant clinical manifestation.A 27-year old man presented wiht markedly elevated serum aspartate aminotrasferase,alanine aminotransferase and lactate dehydrogenase,reduced prothrombin activity,thrombocytopenic purpura and hepato-splenomegaly without adenopathy.Viral,toxic, autoimmune and metabolic liver diseases were excluded. Bone marrow biopsy showed an intracapillary infiltration of T-lymphocytes with no evidence of lipid storage disease. Because of a progressive spleen enlargement,splenectomy was performed.Histological examination showed lymphomatous intrasinuses invasion of the spleen. Immunohistochemical investigation revealed the T phenotype of the neoplastic cells:CD45+,CD45RO+, CD3+,CD4-,CD8-,TIAl-.About 50 % of the lymphoid cells expressed CD56 antigen.The diagnosis of hepatosplenic T cell lymphoma was done.The patient was treated with chemotherapy,which induced a complete remission.Eighteen months later,he had a first relapse with increased aspartate aminotransferase,alanine aminotransferase,lactate dehydrogenase, thrombocytopenic purpura and blast in the peripheral blood. In spite of autologous bone marrow transplantation,he died twenty months after the diagnosis.Even in the absence of a mass lesion or lymphoadenopathy,hepatosplenic T- cell lymphoma should be considered in the differential diagnosis of a patient whose clinical course is atypical for acute hepatic dysfunction.