Extracorporeal organ support for critically ill patients:Overcoming the past,achieving the maximum at present,and redefining the future

Extracorporeal organ support(ECOS)has made remarkable progress over the last few years.Renal replacement therapy,introduced a few decades ago,was the first available application of ECOS.The subsequent evolution of ECOS enabled the enhanced support to many other organs,including the heart[veno-arterial extracorporeal membrane oxygenation(ECMO),slow continuous ultrafiltration],the lungs(veno-venous ECMO,extracorporeal carbon dioxide removal),and the liver(blood purification techniques for the detoxification of liver toxins).Moreover,additional indications of these methods,including the suppression of excessive inflammatory response occurring in severe disorders such as sepsis,coronavirus disease 2019,pancreatitis,and trauma(blood purification techniques for the removal of exotoxins,endotoxins,or cytokines),have arisen.Multiple organ support therapy is crucial since a vast majority of critically ill patients present not with a single but with multiple organ failure(MOF),whereas,traditional therapeutic approaches(mechanical ventilation for acute respiratory failure,antibiotics for sepsis,and inotropes for cardiac dysfunction)have reached the maximum efficacy and cannot be improved further.However,several issues remain to be clarified,such as the complexity and cost of ECOS systems,standardization of indications,therapeutic protocols and initiation time,choice of the patients who will benefit most from these interventions,while evidence from randomized controlled trials supporting their use is still limited.Nevertheless,these methods are currently a part of routine clinical practice in intensive care units.This editorial presents the past,present,and future considerations,as well as perspectives regarding these therapies.Our better understanding of these methods,the pathophysiology of MOF,the crosstalk between native organs resulting in MOF,and the crosstalk between native organs and artificial organ support systems when applied sequentially or simultaneously,will lead to the multiplication of their effects and the minimization of complications arising from their use.

21st century critical care medicine:An overview

Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units(ICUs).This abstract provides a concise summary of the latest developments in critical care,highlighting key areas of innovation.Recent advancements in critical care include Precision Medicine:Tailoring treatments based on individual patient characteristics,genomics,and biomarkers to enhance the effectiveness of therapies.The objective is to describe the recent advancements in Critical Care Medicine.Telemedicine:The integration of telehealth technologies for remote patient monitoring and consultation,facilitating timely interventions.Artificial intelligence(AI):AI-driven tools for early disease detection,predictive analytics,and treatment optimization,enhancing clinical decision-making.Organ Support:Advanced life support systems,such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support.Infection Control:Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections.Ventilation Strategies:Precision ventilation modes and lung-protective strategies to minimize ventilatorinduced lung injury.Sepsis Management:Early recognition and aggressive management of sepsis with tailored interventions.Patient-Centered Care:A shift towards patient-centered care focusing on psychological and emotional wellbeing in addition to medical needs.We conducted a thorough literature search on PubMed,EMBASE,and Scopus using our tailored strategy,incorporating keywords such as critical care,telemedicine,and sepsis management.A total of 125 articles meeting our criteria were included for qualitative synthesis.To ensure reliability,we focused only on articles published in the English language within the last two decades,excluding animal studies,in vitro/molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.These advancements reflect a dynamic landscape in critical care medicine,where technology,research,and patient-centered approaches converge to improve the quality of care and save lives in ICUs.The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.

Method for designing organization decision support system framework

The concept of organization decision support system （ODSS） is defined according to practical applications and novel understanding. And a framework for ODSS is designed. The framework has three components： infrastructure, decision-making process and decision execution process. Infrastructure is responsible to transfer data and information. Decision-making process is the ODSS＇s soul to support decision-making. Decision execution process is to evaluate and execute decision results derived from decision-making process. The framework presents a kind of logic architecture. An example is given to verify and analyze the framework. The analysis shows that the framework has practical values, and has also reference values for understanding ODSS and for theoretical studies.

Prediction of Henry Constants and Adsorption Mechanism of Volatile Organic Compounds on Multi-Walled Carbon Nanotubes by Using Support Vector Regression

Support vector regression （SVR） combined with particle swarm optimization for its parameter optimization is employed to establish a model for predicting the Henry constants of multi-walled carbon nanotubes （MWNTs） for adsorption of volatile organic compounds （VOCs）. The prediction performance of SVR is compared with those of the model of theoretical linear salvation energy relationship （TLSER）. By using leave-one-out cross validation of SVR test Henry constants for adsorption of 35 VOCs on MWNTs, the root mean square error is 0.080, the mean absolute percentage error is only 1.19~, and the correlation coefficient （R2） is as high as 0.997. Compared with the results of the TLSER model, it is shown that the estimated errors by SVR are ali smaller than those achieved by TLSER. It reveals that the generalization ability of SVR is superior to that of the TLSER model Meanwhile, multifactor analysis is adopted for investigation of the influences of each molecular structure descriptor on the Henry constants. According to the TLSER model, the adsorption mechanism of adsorption of carbon nanotubes of VOCs is mainly a result of van der Waals and interactions of hydrogen bonds. These can provide the theoretical support for the application of carbon nanotube adsorption of VOCs and can make up for the lack of experimental data.

Chiral BINAP-based hierarchical porous polymers as platforms for efficient heterogeneous asymmetric catalysis

Two vinyl‐functionalized chiral2,2'‐bis(diphenylphosphino)‐1,1'‐binaphthyl(BINAP)ligands,(S)‐4,4'‐divinyl‐BINAP and(S)‐5,5'‐divinyl‐BINAP,were successfully synthesized.Chiral BINAP‐based porous organic polymers(POPs),denoted as4‐BINAP@POPs and5‐BINAP@POPs,were efficiently prepared via the copolymerization of vinyl‐functionalized BINAP with divinyl benzene under solvothermal conditions.Thorough characterization using nuclear magnetic resonance spectroscopy,thermogravimetric analysis,extended X‐ray absorption fine structure analysis,and high‐angle annular dark‐field scanning transmission electron microscopy,we confirmed that chiral BINAP groups were successfully incorporated into the structure of the materials considered to contain hierarchical pores.Ru was introduced as a catalytic species into the POPs using different synthetic routes.Systematic investigation of the resultant chiral Ru/POP catalysts for heterogeneous asymmetric hydrogenation ofβ‐keto esters revealed their excellent chiral inducibility as well as high activity and stability.Our work thereby paves a path towards the use of advanced hierarchical porous polymers as solid chiral platforms for heterogeneous asymmetric catalysis.

The intensity of organ support: Restrictive or aggressive therapy for critically ill patients

The intensity of organ support has received attention in recent years. To make better clinical decisions, we should understand the mechanisms and benefits, and disadvantages of the different intensities of organ support in critically ill patients. Therapeutic strategies such as supplemental oxygen therapy, mechanical ventilation, respiratory stimulant, vasoactive agents, transfusion, albumin infusion, fluid management, renal placement, and nutrition support, if they are implemented in accordance with an aggressive strategy, could result in side effects and/or complications, resulting in iatrogenic harm in critically ill patients. It is found that the intensity of organ support is not a determining factor in prognosis. A normal rather than supernormal physiological target is recommended for support therapy.

Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific： A Retrospective Analysis of Extracorporeal Life Support Organization Registry

Background： Recent advances in extracorporeal membrane oxygenation （ECMO） have led to increasing interest in its use during cardiopuhnonary resuscitation （CPR）. However, decisions regarding extracorporeal CPR （ECPR） in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization （ELSO） registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality. Methods： The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups （Group 1 1999-2007 and Group 2： 2008-2016） to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality. Results： A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 （43.1% vs. 52.5%,χ^2= 1.67, P - 0.196）, the median age （1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = 2.93, P = 0.003） and weight （3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = -3.14, P 0.002） of children increased over time, while the proportion of congenital heart disease （75.9% for Group 1 vs. 57.8% for Group 2, χ^2=6.52, P 0.011 ） and cardiogenic shock （36.2% for Group 1 vs. 7.2% for Group 2, χ^2=36.59, P 〈 0.001 ） decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regress!on analysis of ECMO complications showed that disseminated intravascular coagulation （DIC）, myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality. Conclusions： The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.

Organ function support in patients with coronavirus disease 2019:Tongji experience

Coronavirus disease 2019(COVID-19)is a highly contagious disease and a serious threat to human health.COVID-19 can cause multiple organ dysfunction,such as respiratory and circulatory failure,liver and kidney injury,disseminated intravascular coagulation,and thromboembolism,and even death.The World Health Organization reports that the mortality rate of severe-type COVID-19 is over 50%.Currently,the number of severe cases worldwide has increased rapidly,but the experience in the treatment of infected patients is still limited.Given the lack of specific antiviral drugs,multi-organ function support treatment is important for patients with COVID-19.To improve the cure rate and reduce the mortality of patients with severe-and critical-type COVID-19,this paper summarizes the experience of organ function support in patients with severe-and criticaltype COVID-19 in Optical Valley Branch of Tongji Hospital,Wuhan,China.This paper systematically summarizes the procedures of functional support therapies for multiple organs and systems,including respiratory,circulatory,renal,hepatic,and hematological systems,among patients with severe-and critical-type COVID-19.This paper provides a clinical reference and a new strategy for the optimal treatment of COVID-19 worldwide.

Reimagining critical care:Trends and shifts in 21st century medicine

primarily driven by advancements in technology,changes in healthcare delivery,and a deeper understanding of disease processes.Advancements in technology have revolutionized patient monitoring,diagnosis,and treatment in the critical care setting.From minimally invasive procedures to advances imaging techniques,clinicians now have access to a wide array of tools to assess and manage critically ill patients more effectively.In this editorial we comment on the review article published by Padte S et al wherein they concisely describe the latest developments in critical care medicine.