Early prediction and prevention of infected pancreatic necrosis

Approximately 20%-30%of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis(IPN),a highly morbid and potentially lethal complication.Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes.In the past two decades,several markers and predictive tools have been proposed and evaluated for this purpose.Conventional biomarkers like C-reactive protein,procalcitonin,lymphocyte count,interleukin-6,and interleukin-8,and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN.On the other hand,scoring systems like the Acute Physiology and Chronic Health Evaluation II and Pancreatitis Activity Scoring System have also been tested,and the results showed that they may provide better accuracy.For early prevention of IPN,several new therapies were tested,including early enteral nutrition,anti-biotics,probiotics,immune enhancement,etc.,but the results varied.Taken together,several evidence-supported predictive markers and scoring systems are readily available for predicting IPN.However,effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition.In this editorial,we summarize evidence concerning early prediction and prevention of IPN,providing insights into future practice and study design.A more homo-geneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN,thereby achieving individualized treatment.

Medium-chain fatty acids and monoglycerides as feed additives for pig production:towards gut health improvement and feed pathogen mitigation

Ongoing challenges in the swine industry,such as reduced access to antibiotics and virus outbreaks(e.g.,porcine epidemic diarrhea virus,African swine fever virus),have prompted calls for innovative feed additives to support pig production.Medium-chain fatty acids(MCFAs)and monoglycerides have emerged as a potential option due to key molecular features and versatile functions,including inhibitory activity against viral and bacterial pathogens.In this review,we summarize recent studies examining the potential of MCFAs and monoglycerides as feed additives to improve pig gut health and to mitigate feed pathogens.The molecular properties and biological functions of MCFAs and monoglycerides are first introduced along with an overview of intervention needs at different stages of pig production.The latest progress in testing MCFAs and monoglycerides as feed additives in pig diets is then presented,and their effects on a wide range of production issues,such as growth performance,pathogenic infections,and gut health,are covered.The utilization of MCFAs and monoglycerides together with other feed additives such as organic acids and probiotics is also described,along with advances in molecular encapsulation and delivery strategies.Finally,we discuss how MCFAs and monoglycerides demonstrate potential for feed pathogen mitigation to curb disease transmission.Looking forward,we envision that MCFAs and monoglycerides may become an important class of feed additives in pig production for gut health improvement and feed pathogen mitigation.

Nature and mechanism of immune boosting by Ayurvedic medicine: A systematic review of randomized controlled trials

BACKGROUND Many Ayurvedic preparations are claimed to have immune-boosting properties,as suggested in various published randomized clinical trials(RCTs)AIM To compile evidence on the nature and mechanism of immune system enhancement by Ayurvedic preparations in healthy and sick individuals.METHODS After prospectively registering study protocol with PROSPERO,we searched PubMed,DOAJ,Google Scholar,three dedicated Ayurveda research portals,two specialty Ayurveda journals,and reference lists for relevant records published until February 6,2021 using appropriate search strategies.Baseline features and data pertaining to the nature and mechanism of immune system function were extracted from all eligible records.Methodological quality was assessed using the Cochrane RoB-2 tool.RESULTS Of 12554 articles screened,19 studies reporting 20 RCTs(17 parallel group design,three crossover design)with 1661 unique patients were included;11/19 studies had Indian first authors.Healthy population was included in nine studies,of which one study included pregnant women and two included pediatric population;remaining studies included patients with different health conditions,including one study with coronavirus disease 2019 patients.A total of 21 Ayurvedic interventions were studied,out of which five were composite mixtures.The predominant route of administration was oral;dose and frequency of administration of the intervention varied across the studies.The results reported with five RCTs exploring five Ayurvedic interventions were incomplete,ambiguous,or confusing.Of the remaining 16 interventions,indirect evidence of immune enhancement was reported with four interventions,while lack of the same was reported with two interventions.Enhancement of T helper cells and natural killer cells was reported with three and four interventions,respectively,while the pooled results did not clearly point toward enhancement of other components of the immune system,including cytotoxic T cells,B lymphocytes,immunoglobulins,cytokines,complement components,leucocyte counts,and other components.Nine of the 20 RCTs had a high risk of bias,and the remaining 11 RCTs had some concerns according to RoB-2.CONCLUSION Various Ayurvedic preparations appear to enhance the immune system,particularly via enhancements in natural killer cells and T helper cells.

Perioperative nutrition optimization:a review of the current literature

Objective:This article aims to elaborate the recent research status of perioperative nutrition optimization,in order to help clinical practice.Methods:This study employed a comprehensive and systematic method to search prominent databases,including PubMed and Web of Science,using carefully selected keywords.Following meticulous screening,the inclusion of high-quality studies was prioritized,and a thorough review of the references was conducted to comprehensively analyze the latest evidence on perioperative nutrition optimization.Results:The main contents include preoperative nutritional risk screening and assessment,nutritional support pathway,immune enhancing nutrition,preoperative and postoperative nutritional management,as well as personalized nutrition optimization strategies for specific populations(such as children,bariatric surgery patients,and cancer patients).Conclusions:In clinical practice,the importance of perioperative nutrition should be emphasized,and personalized nutrition management plans should be developed based on the characteristics and needs of patients.Further research and promotion of perioperative nutrition optimization strategies will help improve the overall prognosis and quality of life of surgical patients.

Implantable sandwich PHBHHx film for burst-free controlled delivery of thymopentin peptide

Sustained release and non-parental formulations of peptides and protein drugs are highly desirable because of enhanced therapeutic effects as well as improved patient compliance. This is especially true for small peptides such as thymopentin(TP5). To this end, implantable sandwich poly(hydroxybutyrate-co-hydroxyhexanoate)(PHBHHx) films were designed to prolong release time and to inhibit burst release phenomenon of TP5 by a simple volatilization method. In vitro release studies revealed that sandwich films had nearly no burst release. In vivo release time of sandwich films was prolonged to 42 days. Pharmacodynamic evaluation demonstrated that TP5 sandwich films significantly increased survival rates in a rat immunosuppressive model and normalized CD4^+/CD8^+ values. These results suggest that TP5 released from sandwich films can attenuate cyclophosphamide's immunosuppressive activity, and possibly achieve results comparable to daily TP5 injection therapy. Thus, sandwich PHBHHx films show excellent potential as a sustained, burst-free release system for small molecular weight, hydrophilic peptide drugs.

Dendritic cells maturation facilitated by group-adjustable lipopolysaccharide analogues synthesized via RAFT polymerization

Transforming immature DCs into mature state to activate cellular immunity is a critical step in initiating immunoprophylaxis and immunotherapy.Lipopolysaccharides(LPS)can promote DCs maturation by binding receptor on DCs surface,but their clinical application is limited due to biological toxicity.Although many LPS analogues have been developed,complex synthesis and purification hinder their practical application.Here,we propose a novel and simple strategy to synthesize LPS analogues with adjustable structural units.Using monomer units similar to the key functional groups of LPS,we synthesize LPS analogues with different group ratios by RAFT polymerization.The obtained analogues have little negative effect on cell viability.Compared with LPS,the analogues show greater promoting effect on DCs maturation.And the analogues can be applied to different scenarios since the degrees of promoting DCs maturation by LPS analogues with different group ratios are different.This strategy provides a new direction for synthesizing LPS analogues,and it has the potential to produce LPS analogues on a large scale with tunable promoting DCs maturation effect.