Background Hepatic encephalopathy(HE)is highly prevalent in patients with liver diseases.The pathophysiology of HE is centered on the synergic role of hyperammonemia and systemic inflammation.However,some data suggest...Background Hepatic encephalopathy(HE)is highly prevalent in patients with liver diseases.The pathophysiology of HE is centered on the synergic role of hyperammonemia and systemic inflammation.However,some data suggest altered functioning of the blood–brain barrier(BBB).Assessing BBB function is challenging in clinical practice and at the bedside.Protein-S-100 Beta(PS100-Beta)could be a useful peripheral marker of BBB permeability in HE.This study aimed to assess plasmatic PS100-Beta levels in a prospective cohort of patients admitted to the intensive care unit(ICU)with decompensated cirrhosis with and without overt HE.Methods We retrospectively evaluated a prospective cohort of cirrhotic patients admitted to the ICU from October 2013 to September 2015 that had an available plasmatic PS100-Beta measurement.Patients with previous neurological impairment or limitation of intensive or resuscitative measures were excluded.Overt HE was defined as West-Haven grades 2 to 4.The patients were compared to a control cohort of outpatient clinic cirrhotic and non-cirrhotic patients explored for isolated elevation of liver enzymes.After ICU discharge,the patients were followed for at least 3 months for the occurrence of overt HE.Adverse outcomes(liver transplantation or death)were collected.The ability of PS100-Beta–in combination with other factors–to predict overt HE was evaluated in a multivariate analysis using logistic regression.Likelihood ratios were used to determine the effects and calculate odds ratios(OR).Survival analysis was performed by using the Kaplan–Meier method and survival between groups was compared using a Log-rank test.Results A total of 194 ICU patients and 207 outpatients were included in the study.Increased levels of plasmatic PS100-Beta were detected in the ICU decompensated cirrhotic patients compared with the outpatients([0.15±0.01]mg/L vs.[0.08±0]mg/L,P<0.001).ICU patients with overt HE had higher levels of PS100-Beta([0.19±0.03]mg/L)compared with the ICU patients without overt HE([0.13±0.01]mg/L)(P=0.003).PS100-Beta levels did not differ in outpatients with F 0–3 compared to F 4 fibrosis(P=0.670).PS100-Beta values were correlated with Child-Pugh score(P<0.001),Model for End-Stage Liver Disease(MELD)score(P=0.004),C-reactive protein(P<0.001),ammonemia(P<0.001),and chronic liver failure consortium(CLIF-C)organ failure(P<0.001)and CLIF-C acute-on-chronic(P=0.038)scores,but not with leukocytes(P=0.053),procalcitonin(PCT)(P=0.107),or the lymphocyte-to-neutrophil ratio in ICU patients(P=0.522).In a multivariate model including age,ammonemia,PS100-Beta,PCT,MELD,presence of transjugular portosystemic shunt,and sodium level,the diagnostic performance was 0.765 for the diagnosis of overt HE.Patients with a PS100-Beta level<0.12 mg/L had a better overall survival(P=0.019)and a better survival without liver transplantation(P=0.013).Conclusions Serum levels of PS100-Beta are elevated in ICU patients with decompensated cirrhosis,and even more so in those displaying overt HE,and the levels are correlated with outcome.This suggests an increase in the permeability of the BBB in these patients.展开更多
We deployed four geo-electric monitoring stations in Sichuan and Yunnan provinces from 2004, using the new generation of equipment (PS-100) and technologies to capture the HRT wave earthquake precursor. Before the Wen...We deployed four geo-electric monitoring stations in Sichuan and Yunnan provinces from 2004, using the new generation of equipment (PS-100) and technologies to capture the HRT wave earthquake precursor. Before the Wenchuan Ms8.0 earthquake, we recorded the HRT wave precursor at the only operating station in Hongge (HG, Δ=465 km) and found that significant impending signal had been recorded at the station in the early morning ( 0―5 am) of 12th of May, 2008. The precursor for this earthquake is consistent with precursors recorded for other strong earthquakes. The measured physical properties (geo-resistivity and telluric-current) show tidal wave period oscillations from several days to several months before the earthquakes and the amplitude of such HT oscillation increases significantly towards the occurrence of an earthquake. These HT and RT waves from the epicenter have a causal relationship with the earthquakes that happened several days later. The arrival time of two RT waves is proportional to the distance from the station to the epicenter. The estimated natural decay of the amplitude is correlated with the natural period (T0) of the earthquake fault, which is proportional to the fault length. From this relationship, we can predict the earthquake magnitude. For magnitude 6―9 earthquakes, the natural period is about 1―6 hours. Such oscillation comes from the epicenter area and they can propagate several thousand kilometers in the Earth's crust. Before a strong earthquake in the shallow crust, the conductive pore fluid will experience major changes before the fault rapture. Such fluid change will emit an oscillation in the pore fluid pressure. This is the mechanism for the HRT wave generation. Since the China Earthquake Administration funded the HRT wave short-term earth-quake prediction project in 2003, the first record of HRT precursor wave has been recorded from the 2004-12-26 Sumatra Mw9.0 earthquake with the largest epicentre distance Δ=2900 km. Thereafter, we have captured HRT waves from more than twenty strong earthquakes, which are well-matched and show repeatability, consistency and regularity. All our observation with the HRT waves demonstrate that HRT wave precursors to earthquakes indeed exist. Strong earthquakes can be predicted and short-term and impending earthquake prediction is achievable in the very near future. From all the observations, including the ones at HG station from Wenchuan Ms8.0 earthquake, we conclude that using HRT wave to predict earthquakes is feasible.展开更多
基金supported by the Fondation pour le Recherche Médicale(grant number:EQU202003010517).
文摘Background Hepatic encephalopathy(HE)is highly prevalent in patients with liver diseases.The pathophysiology of HE is centered on the synergic role of hyperammonemia and systemic inflammation.However,some data suggest altered functioning of the blood–brain barrier(BBB).Assessing BBB function is challenging in clinical practice and at the bedside.Protein-S-100 Beta(PS100-Beta)could be a useful peripheral marker of BBB permeability in HE.This study aimed to assess plasmatic PS100-Beta levels in a prospective cohort of patients admitted to the intensive care unit(ICU)with decompensated cirrhosis with and without overt HE.Methods We retrospectively evaluated a prospective cohort of cirrhotic patients admitted to the ICU from October 2013 to September 2015 that had an available plasmatic PS100-Beta measurement.Patients with previous neurological impairment or limitation of intensive or resuscitative measures were excluded.Overt HE was defined as West-Haven grades 2 to 4.The patients were compared to a control cohort of outpatient clinic cirrhotic and non-cirrhotic patients explored for isolated elevation of liver enzymes.After ICU discharge,the patients were followed for at least 3 months for the occurrence of overt HE.Adverse outcomes(liver transplantation or death)were collected.The ability of PS100-Beta–in combination with other factors–to predict overt HE was evaluated in a multivariate analysis using logistic regression.Likelihood ratios were used to determine the effects and calculate odds ratios(OR).Survival analysis was performed by using the Kaplan–Meier method and survival between groups was compared using a Log-rank test.Results A total of 194 ICU patients and 207 outpatients were included in the study.Increased levels of plasmatic PS100-Beta were detected in the ICU decompensated cirrhotic patients compared with the outpatients([0.15±0.01]mg/L vs.[0.08±0]mg/L,P<0.001).ICU patients with overt HE had higher levels of PS100-Beta([0.19±0.03]mg/L)compared with the ICU patients without overt HE([0.13±0.01]mg/L)(P=0.003).PS100-Beta levels did not differ in outpatients with F 0–3 compared to F 4 fibrosis(P=0.670).PS100-Beta values were correlated with Child-Pugh score(P<0.001),Model for End-Stage Liver Disease(MELD)score(P=0.004),C-reactive protein(P<0.001),ammonemia(P<0.001),and chronic liver failure consortium(CLIF-C)organ failure(P<0.001)and CLIF-C acute-on-chronic(P=0.038)scores,but not with leukocytes(P=0.053),procalcitonin(PCT)(P=0.107),or the lymphocyte-to-neutrophil ratio in ICU patients(P=0.522).In a multivariate model including age,ammonemia,PS100-Beta,PCT,MELD,presence of transjugular portosystemic shunt,and sodium level,the diagnostic performance was 0.765 for the diagnosis of overt HE.Patients with a PS100-Beta level<0.12 mg/L had a better overall survival(P=0.019)and a better survival without liver transplantation(P=0.013).Conclusions Serum levels of PS100-Beta are elevated in ICU patients with decompensated cirrhosis,and even more so in those displaying overt HE,and the levels are correlated with outcome.This suggests an increase in the permeability of the BBB in these patients.
文摘We deployed four geo-electric monitoring stations in Sichuan and Yunnan provinces from 2004, using the new generation of equipment (PS-100) and technologies to capture the HRT wave earthquake precursor. Before the Wenchuan Ms8.0 earthquake, we recorded the HRT wave precursor at the only operating station in Hongge (HG, Δ=465 km) and found that significant impending signal had been recorded at the station in the early morning ( 0―5 am) of 12th of May, 2008. The precursor for this earthquake is consistent with precursors recorded for other strong earthquakes. The measured physical properties (geo-resistivity and telluric-current) show tidal wave period oscillations from several days to several months before the earthquakes and the amplitude of such HT oscillation increases significantly towards the occurrence of an earthquake. These HT and RT waves from the epicenter have a causal relationship with the earthquakes that happened several days later. The arrival time of two RT waves is proportional to the distance from the station to the epicenter. The estimated natural decay of the amplitude is correlated with the natural period (T0) of the earthquake fault, which is proportional to the fault length. From this relationship, we can predict the earthquake magnitude. For magnitude 6―9 earthquakes, the natural period is about 1―6 hours. Such oscillation comes from the epicenter area and they can propagate several thousand kilometers in the Earth's crust. Before a strong earthquake in the shallow crust, the conductive pore fluid will experience major changes before the fault rapture. Such fluid change will emit an oscillation in the pore fluid pressure. This is the mechanism for the HRT wave generation. Since the China Earthquake Administration funded the HRT wave short-term earth-quake prediction project in 2003, the first record of HRT precursor wave has been recorded from the 2004-12-26 Sumatra Mw9.0 earthquake with the largest epicentre distance Δ=2900 km. Thereafter, we have captured HRT waves from more than twenty strong earthquakes, which are well-matched and show repeatability, consistency and regularity. All our observation with the HRT waves demonstrate that HRT wave precursors to earthquakes indeed exist. Strong earthquakes can be predicted and short-term and impending earthquake prediction is achievable in the very near future. From all the observations, including the ones at HG station from Wenchuan Ms8.0 earthquake, we conclude that using HRT wave to predict earthquakes is feasible.
