Prevention and treatment of gastrointestinal dysfunction following severe burns: A summary of recent 30-year clinical experience

AIM: To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients, and propose practicable guidelines for the prevention and treatment of gastrointestinal (GI) dysfunction. METHODS: From 1980 to 2007, a total of 219 patients with large area and extraordinarily large area burns (LAB) were admitted, who were classified into three stages according the therapeutic protocols used at the time: Stage 1 from 1980 to 1989, stage 2 from 1990 to 1995, and stage 3 from 1996 to 2007. The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed. RESULTS: The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1, which was significantly lower than that in stage 1 (P < 0.05). No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3. The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%, 21.4% and 28.5%, respectively, which were significantly lower than those in stage 1 patients(P < 0.05 or P < 0.01), and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients (P < 0.05). CONCLUSION: Comprehensive fluid resuscitation, early excision of necrotic tissue, staged food ingestion, and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients.

Potentially fatal electrolyte imbalance caused by severe hydrofluoric acid burns combined with inhalation injury: A case report

BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small area of the skin.Published cases of HF burns have mostly reported small HF burn areas.Few cases of HF inhalation injury have been reported to date.CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60%of the total body surface area(TBSA),including deep second degree burns on 47%and third degree burns on 13%of the TBSA,after he fell into a pickling pool containing 15%HF.Comprehensive treatments were carried out after the patient was admitted.Ventricular fibrillation occurred 9 times within the first 2 h,and the lowest serum Ca2+concentration was 0.192 mmol/L.A dose of calcium gluconate(37 g)was intravenously supplied during the first 24 h,and the total amount of calcium gluconate supplementation was 343 g.Extracorporeal membrane oxygenation(ECMO)was applied for 8 d to handle the acute respiratory distress syndrome(ARDS)induced by the HF inhalation injury.The patient was discharged after 99 d of comprehensive treatment,including skin grafting.CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS.Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.

Single-cell transcriptome profiling of sepsis identifies HLA-DR^(low)S100A^(high)monocytes with immunosuppressive function

Background Sustained yet intractable immunosuppression is commonly observed in septic patients,resulting in aggravated clinical outcomes.However,due to the substantial heterogeneity within septic patients,precise indicators in deciphering clinical trajectories and immunological alterations for septic patients remain largely lacking.Methods We adopted cross-species,single-cell RNA sequencing(scRNA-seq)analysis based on two published datasets containing circulating immune cell profile of septic patients as well as immune cell atlas of murine model of sepsis.Flow cytometry,laser scanning confocal microscopy(LSCM)imaging and Western blotting were applied to identify the presence of S100A9^(+)monocytes at protein level.To interrogate the immunosuppressive function of this subset,splenic monocytes isolated from septic wild-type or S100a9^(–/–)mice were co-cultured with naive CD4^(+)T cells,followed by proliferative assay.Pharmacological inhibition of S100A9 was implemented using Paquinimod via oral gavage.Results scRNA-seq analysis of human sepsis revealed substantial heterogeneity in monocyte compartments following the onset of sepsis,for which distinct monocyte subsets were enriched in disparate subclusters of septic patients.We identified a unique monocyte subset characterized by high expression of S100A family genes and low expression of human leukocyte antigen DR(HLA-DR),which were prominently enriched in septic patients and might exert immunosuppressive function.By combining single-cell transcriptomics of murine model of sepsis with in vivo experiments,we uncovered a similar subtype of monocyte significantly associated with late sepsis and immunocompromised status of septic mice,corresponding to HLA-DR^(low)S100A^(high)monocytes in human sepsis.Moreover,we found that S100A9^(+)monocytes exhibited profound immunosuppressive function on CD4^(+)T cell immune response and blockade of S100A9 using Paquinimod could partially reverse sepsis-induced immunosuppression.Conclusions This study identifies HLA-DR^(low)S100A^(high)monocytes correlated with immunosuppressive state upon septic challenge,inhibition of which can markedly mitigate sepsis-induced immune depression,thereby providing a novel therapeutic strategy for the management of sepsis.

Gastrointestinal dysfunction is associated with mortality in severe burn patients:a 10-year retrospective observational study from South China

Background:Data on severe and extensive burns in China are limited,as is data on the prevalence of a range of related gastrointestinal(GI)disorders[such as stress ulcers,delayed defecation,opioid-related bowel immotility,and abdominal compartment syndrome(ACS)].We present a multicentre analysis of coincident GI dysfunction and its effect on burn-related mortality.Methods:This retrospective analysis was conducted on patients with severe[≥20%total burn surface area(TBSA)]and extensive(>50%TBSA or>25%full-thickness TBSA)burns admitted to three university teaching institutions in China between January 1,2011 and December 31,2020.Both 30-and 90-day mortality were assessed by collating demographic data,burn causes,admission TBSA,%full-thickness TBSA,Baux score,Abbreviated Burn Severity Index(ABSI)score,and Sequential Organ Failure Assessment(SOFA)score,shock at admission and the presence of an inhalation injury.GI dysfunction included abdominal distension,nausea/vomiting,diarrhoea/constipation,GI ulcer/haemorrhage,paralytic ileus,feeding intolerance and ACS.Surgeries,length of intensive care unit(ICU)stay,pain control[in morphine milligram equivalents(MME)]and overall length of hospital stay(LOHS)were recorded.Results:We analyzed 328 patients[75.6%male,mean age:(41.6±13.6)years]with a median TBSA of 62.0%(41.0%–80.0%);256(78.0%)patients presented with extensive burns.The 90-day mortality was 23.2%(76/328),with 64(84.2%)of these deaths occurring within 30 d and 25(32.9%)occurring within 7 d.GI dysfunction was experienced by 45.4%of patients and had a significant effect on 90-day mortality[odds ratio(OR)=14.070,95%confidence interval(CI)5.886–38.290,P<0.001].Multivariate analysis showed that GI dysfunction was associated with admission SOFA score and%full-thickness TBSA.Overall,88.2%(67/76)of deceased patients had GI dysfunction[hazard ratio(HR)for death of GI dysfunction=5.951],with a survival advantage for functional disorders(diarrhoea,constipation,or nausea/vomiting)over GI ulcer/haemorrhage(P<0.001).Conclusion:Patients with severe burns have an unfavourable prognosis,as nearly one-fifth died within 90 d.Half of our patients had comorbidities related to GI dysfunction,among which GI ulcers and haemorrhages were independently correlated with 90-day mortality.More attention should be given to severe burn patients with GI dysfunction.

Current Status of ADSCs-Enriched Fat Grafts in Plastic Surgery

Autologous fat grafting is an increasingly popular technique in plastic surgery for volume augmentation and rejuvenation.However,the unpredictability of long-term volume retention limits its clinical application.Various animal studies have documented the positive effects of adipose tissue-derived stem cells(ADSCs)on the acceleration of lipofilling.However,the results have been inconsistent,and there is an insufficient number of high-quality clinical studies to formulate evidence-based recommendations for ADSC-enriched fat grafts.Moreover,related technical standards,such as the final count of harvested ADSCs and the enrichment ratio,have not yet been established.This systematic review included all clinical trials on ADSC-enriched fat grafts in plastic surgery from PubMed in the past 10 years,as well as all registered clinical trials on ClinicalTrials.Gov.To examine the current landscape of ADSCs harvest,we summarize the current applications of ADSCs in the field of plastic surgery and discuss the current barriers to universal clinical use.

Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed.Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire.Then,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions.This consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good consistency.After summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were produced.Finally,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this consensus.In summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

Appendicitis combined with Meckel’s diverticulum obstruction, perforation, and inflammation in children: Three case reports

BACKGROUND Meckel’s diverticulum is a common congenital malformation of the small intestine,with the three most common complications being obstruction,per-foration,and inflammation.To date,only a few cases have been reported world-wide.In children,the clinical symptoms are similar to appendicitis.As most of the imaging features are nonspecific,the preoperative diagnosis is not precise.In addition,the clinical characteristics are highly similar to pediatric acute appendicitis,thus special attention is necessary to distinguish Meckel’s diver-ticulum from pediatric appendicitis.Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications,including intestinal necrosis,intestinal perforation and gastrointestinal bleeding.CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction,which was caused by fibrous bands(ligaments)arising from the top part of Meckel's diverticulum,diverticular perforation,and diver-ticular inflammation.All three patients,aged 11-12 years,had acute appendicitis as their initial clinical presentation.All were treated by laparoscopic surgery with a favorable outcome.A complete dataset including clinical presentation,dia-gnostic imaging,surgical information,and histopathologic findings was also provided.CONCLUSION Preoperative diagnosis of Meckel’s diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children.Laparoscopy combined with laparotomy is useful for diagnosis and treatment.

Effect of nonpeptide NK1 receptor antagonist L-703,606 on the edema formation in rats at early stage after deep partial-thickness skin scalding

Objective:To investigate the effect and the relevant potential mechanism of nonpeptide neurokinin 1(NK1) receptor antagonist L-703,606 in the edema formation after burn injury. Method:1.-703,606 treatment was performed in Sprague-Dawley(SD) rats at early stage after deep partial-thickness skin scalding.One hundred and fifty two adult male SI) rats were used in the study and randomly divided into sham scald(SS,n=8),scald control(SC,n=48),and L-703,606 treatment(IT,n=48) groups.The rats in SC and LT groups were subjected to 20%total body surface area(TBSA) deep partial-thickness skin scalding.Modified Evans blue extravasation, tracing electron microscopy by lanthanum nitrate and mean water content assay were employed to observe and detect the changes of vascular permeability,ultrastructure and edema formation in adjacent tissue to the wounds and in the jejuna of rats at early stage(72 h) after scald.Results: The pathological increase of vascular permeability in the periwound tissue and jejunum of rats in LT group were significantly lower than that in SC group(P【0.01),and recuperated earlier. Meanwhile,the changes of water contents of corresponding tissues in LT group were lighter than those in SC group(P【0.01).The ultrastructural changes of the microvessels in the peri-wound tissue of LT group showed that the junctions between microvascular endothelium cells were more narrow than those of SC group,moreover,and the number of opening and the engorgement and cavitation of the vascular endothelium cells decreased,the areosis and edema in perivascular tissue lightened,and the precipitation of the high eletron density lanthanum tracing agent in the interspace of the tissue decreased significantly in LT group.Conclusions:It is concluded that nonpeptide NK1-receptor antagonist L-703,606 could lighten the vascular permeability and edema formation in the periwound tissue and jejunum,and accelerate the normalization process of pathological changes in the tissues of rats after scald.

Treatment of invasive fungal disease: A case report

BACKGROUND In recent years,the incidence of fungal infection has been increasing,often invading one or more systems of the body.However,it is rare for lymph nodes to be invaded without the involvement of other organs.CASE SUMMARY A 21-year-old man was admitted to hospital for repeated cough for 2 mo and abdominal pain for 1 mo.Physical examination revealed multiple lymph nodes enlargement,especially those in the left neck and groin.CT scan showed multiple lymph nodes enlargement in the chest,especially left lung,abdominal cavity,and retroperitoneum.The first lymph node biopsy revealed granulomatous lesions of lymph nodes,so intravenous infusion of Cefoperazone tazobactam combined with anti-tuberculosis drugs were given.Because fever and respiratory failure occurred 4 d after admission,mechanical ventilation was given,and Caspofungin and Voriconazole were used successively.However,the disease still could not be controlled.On the 11th day of admission,the body temperature reached 40° C.After mycosis of lymph nodes was confirmed by the second lymph node biopsy,Amphotericin B was given,and the patient recovered and was discharged from the hospital.CONCLUSION No fixed target organ was identified in this case,and only lymph node involvement was found.Caspofungin,a new antifungal drug,and the conventional first choice drug,Voriconazole,were ineffective,while Amphotericin B was effective.

Electrospinning of a sandwich-structured membrane with sustained release capability and long-term anti-inflammatory effects for dental pulp regeneration

Current electro spun membranes used for pulp capping still lack the sustained-release capability and long-term anti-inflammatory effects that are favorable for dental pulp regeneration.In this work,a single-layered poly(lac tic acid)(PLA)electro spun membrane loaded with amorphous calcium phosphate(ACP)and aspirin(PLA/ACP/Aspirin membrane,i.e.,PA A membrane)is sandwiched between two poly(lactic-co-glycolic acid)(PLGA)electro spun membranes as a novel sandwich-structured PLGA and PA A composite electro spun membrane(PLGA-PAA membrane)to resolve the need for sustained-release design and anti-inflammatory effects.Contact angle measurements indicate that the PLGA-PAA membrane is more hydrophilic than the PAA membrane.An in vitro release study reveals that PLGA membranes coated on PAA membrane could slightly slow down ion release,while signiificantly prolonging aspirin release.We also co-cultured membranes with dental pulp stem cells(DPSCs)and human monocytic THP-1 cells to evaluate their osteogenic ability and anti-inflammatory effects,respectively.Compared with the PAA membrane,the PLGA-PAA membrane promotes cell adhesion,proliferation,and osteogenic differentiation.A prolonged anti-inflammatory effect of up to 18 days is also observed in the PLGA-PAA group.The results suggest a promising strategy for fabricating an electro spun membrane system with controlled release capabilities and long-term anti-inflammatory effects for use as pulp-capping material for regeneration of the dentin-pulp complex.

Advances in regenerative medicine applications of tetrahedral framework nucleic acid-based nanomaterials: an expert consensus recommendation

With the emergence of DNA nanotechnology in the 1980s, self-assembled DNA nanostructures have attracted considerable attention worldwide due to their inherent biocompatibility, unsurpassed programmability, and versatile functions. Especially promising nanostructures are tetrahedral framework nucleic acids(t FNAs), first proposed by Turberfield with the use of a one-step annealing approach. Benefiting from their various merits, such as simple synthesis, high reproducibility, structural stability, cellular internalization, tissue permeability, and editable functionality, t FNAs have been widely applied in the biomedical field as threedimensional DNA nanomaterials. Surprisingly, t FNAs exhibit positive effects on cellular biological behaviors and tissue regeneration,which may be used to treat inflammatory and degenerative diseases. According to their intended application and carrying capacity,t FNAs could carry functional nucleic acids or therapeutic molecules through extended sequences, sticky-end hybridization,intercalation, and encapsulation based on the Watson and Crick principle. Additionally, dynamic t FNAs also have potential applications in controlled and targeted therapies. This review summarized the latest progress in pure/modified/dynamic t FNAs and demonstrated their regenerative medicine applications. These applications include promoting the regeneration of the bone,cartilage, nerve, skin, vasculature, or muscle and treating diseases such as bone defects, neurological disorders, joint-related inflammatory diseases, periodontitis, and immune diseases.

Research progress of stem cell-derived exosomes in injury repair

After organ and tissue injury,the proliferation and differentiation of stem cells themselves play only a small role in the repair of injury,and their repair role is mainly played through the paracrine function of stem cells.Exosomes are nano-scale vesicles that are secreted into the extracellular space in an exocytic manner,and its own function will be regulated after the target cells absorb the exosomes.Stem cell-derived exosomes communicate between cells by transmitting proteins,lipids and micro-RNAs(miRNAs).The targeting and biological properties of stem cell-derived exosomes are determined by the level of miRNAs that they carry.After the exosomes reach the target cells and undergo fusion,the gene expression of the target cells is changed by degradation and expression.In addition,the RNA and protein of stem cell-derived exosomes can also limit the development of injury through cell homing.This article will review the mechanism of stem cell-derived exosomes in wound healing,joint injury,fracture healing and cardiac injury.

Efficacy and safety of clarithromycin for patients with sepsis or septic shock:a systematic review and meta-analysis

Background:Clarithromycin exerts an immunomodulatory role in several human diseases.However,whether this effect improves the prognosis in patients with sepsis remains controversial,and higher levels of clinical evidence are urgently needed.To the best of our knowledge,no meta-analysis to date has reported the clinical efficacy and safety of clarithromycin in sepsis.Methods:A comprehensive literature search of PubMed,EMBASE,and the Cochrane Library was conducted up to December 31,2022.Only randomized controlled trials comparing the clinical efficacy and safety of clarithromycin with controls among patients with sepsis or septic shock were included.Data were pooled by applying a fixed-effects model and a relative risk(RR)estimate with 95%confidence intervals(CIs)using Review Manager(version 5.3;Cochrane Collaboration,Copenhagen,Denmark).Results:Three randomized controlled trials involving a total of 910 patients were included.The pooled results confirmed that clarithromycin had no beneficial effect on progression to multiple organ dysfunction syndrome(RR:1.51;95%CI:1.02-2.25;P=0.04;I^(2)=0%),28-day mortality(RR:1.09;95%CI:0.87-1.36;P=0.46;I^(2)=0%),and 90-day mortality(RR:0.86;95%CI:0.71-1.03;P=0.10;I^(2)=81%)in patients with sepsis or septic shock.Moreover,there was no difference in other serious adverse events between patients who received clarithromycin and those in the control group(RR:1.02;95%CI:0.87-1.19;P=0.83;I^(2)=18%).Conclusion:Our meta-analysis did not reveal an improvement to short-term outcomes in patients with sepsis treated with clarithromycin.However,administration of clarithromycin did not increase the risk of adverse events.

Randomized controlled trial of the absorbency of four dressings and their effects on the evaporation of burn wounds

Background Wound dressings are divided into traditional and new types. The new dressings are thought to accelerate wound healing. The purpose of this study was to supplement the scanty data on the absorbency of the new dressings and their effects on evaporation from the burn surface.Methods The water absorption rate of four dressings （carbon fiber dressing, hydrogel dressing, silver nanoparticle dressing, and vaseline gauze） were measured by the immersion-weight gain method. A total of 120 inpatients with 10% superficial partial-thickness burn wounds were randomly assigned to four groups, each with 30 participants. Carbon fiber dressing, hydrogel dressing, and silver nanoparticle dressing were used in groups A, B, and C as the primary dressing, and traditional vaseline gauze was used in group D as the control. Multi-spot evaporation from normal skin and naked wound, and from wounds covered with each of the four dressings was measured post-burn on days 1, 3, 5, and 7 by an EP-I evaporimeter under conditions of 21℃ -22℃ ambient temperature and 74%-78% humidity.Results The absorption rates of the four dressings were 988% with carbon fiber dressing, 96% with silver nanoparticle, 41% with vaseline gauze, and 6% with hydrogel. Evaporation from the naked burn wounds was about 1/3 higher than from normal skin （P〈0.01）. Compared with wounds without applied dressing, evaporation from dressed wounds decreased and was time-dependent （P〈0.01）. The evaporation of wounds with carbon fiber dressing was the lowest （（13.40 ± 2.82） ml·h^-1·m^-2, P〈0.01） on day 1 post-burn, compared with the other groups. Conclusion All four dressings have water retention capacity while carbon fiber dressing has the highest absorption rate and shows the best containment and evaporation from the burn wound.

CircRNA_Maml2 promotes the proliferation and migration of intestinal epithelial cells after severe burns by regulating the miR-93-3p/FZD7/Wnt/β-catenin pathway

Background:Circular RNA(circRNA)plays key regulatory roles in the development of many diseases.However the biological functions and potential molecular mechanisms of circRNA in the injury and repair of intestinal mucosa in mice after severe burns are yet to be elucidated.Methods:Cell counting kit-8(CCK-8),5-ethynyl-2-deoxyuridine(EdU),wound healing and transwell assays were used to detect cell proliferation and migration ability.Real-time quantitative PCR was used to identify the expression of circRNA,microRNA and messenger RNA.Nuclear and cytoplas-mic separation experiments were employed to perceive the location of circRNA_Maml2.Finally,in vitro and in vivo experiments were conducted to study the repairing effect of circRNA_Maml2 on the intestinal mucosa of mice after severe burns.Results:When compared with the control group,the expression of circRNA_Maml2 was sig-nificantly reduced in the severe burn group.Furthermore,overexpression of circRNA_Maml2 promoted the proliferation and migration of CT26.wt cells in vivo and the repair of damaged intestinal mucosa in vitro.CircRNA_Maml2 acted as a sponge adsorption molecule for miR-93-3p to enhance the expression of frizzled class receptor 7 and activate the downstream Wnt/β-catenin pathway,thereby promoting the repair of the intestinal mucosa.Conclusions:Our findings demonstrate that circRNA_Maml2 regulates the miR-93-3p/FZD7/Wnt/β-catenin pathway and promotes the repair of damaged intestinal mucosa.Hence,circRNA_Maml2 is a potential therapeutic target to promote intestinal mucosal repair.

Dimethyl sulfoxide inhibits zymosan-induced intestinal inflammation and barrier dysfunction

AIM: To investigate whether dimethyl sulfoxide(DMSO) inhibits gut inflammation and barrier dysfunction following zymosan-induced systemic inflammatoryresponse syndrome and multiple organ dysfunction syndrome.METHODS: Sprague-Dawley rats were randomly divided into four groups: sham with administration of normal saline(SS group); sham with administration of DMSO(SD group); zymosan with administration of normal saline(ZS group); and zymosan with administration of DMSO(ZD group). Each group contained three subgroups according to 4 h,8 h,and 24 h after surgery. At 4 h,8 h,and 24 h after intraperitoneal injection of zymosan(750 mg/kg),the levels of intestinal inflammatory cytokines [tumor necrosis factor-alpha(TNF-α) and interleukin(IL)-10] and oxides(myeloperoxidase,malonaldehyde,and superoxide dismutase) were examined. The levels of diamine oxidase(DAO) in plasma and intestinal mucosal blood flow(IMBF) were determined. Intestinal injury was also evaluated using an intestinal histological score and apoptosis of intestinal epithelial cells was determined by deoxynucleotidyl transferase d UTP nick end labeling(TUNEL) assay. The intestinal epithelial tight junction protein,ZO-1,was observed by immunofluorescence.RESULTS: DMSO decreased TNF-α and increased IL-10 levels in the intestine compared with the ZS group at the corresponding time points. The activity of intestinal myeloperoxidase in the ZS group was higher than that in the ZD group 24 h after zymosan administration(P < 0.05). DMSO decreased the content of malondialdehyde(MDA) and increased the activity of superoxide dehydrogenase(SOD) 24 h after zymosan administration. The IMBF was lowest at 24 h and was 49.34% and 58.26% in the ZS group and ZD group,respectively(P < 0.05). DMSO alleviated injury in intestinal villi,and the gut injury score was significantly lower than the ZS group(3.6 ± 0.2 vs 4.2 ± 0.3,P < 0.05). DMSO decreased the level of DAO in plasma compared with the ZS group(65.1 ± 4.7 U/L vs 81.1 ± 5.0 U/L,P < 0.05). DMSO significantly preserved ZO-1 protein expression and localization 24 h after zymosan administration. The TUNEL analysis indicated that the number of apoptotic intestinal cells in the ZS group was much higher than the ZD group(P < 0.05).CONCLUSION: DMSO inhibited intestinal cytokines and protected against zymosan-induced gut barrier dysfunction.

Predictors of functional independence, quality of life, and return to work in patients with burn injuries in China's Mainland

Background:Burn injury may be associated with long-term rehabilitation and disability,while research studies on the functional performance after injuries,quality of life(QOL),and abilities to return to work of burn patients are limited.These outcomes are related not just to the degree and nature of injuries,but also to the socio-economical background of the society.This study aimed to identify the factors which might affect burn patients’abilities to reintegrate back to the society based on a sample in China's Mainland.Methods:A retrospective study was conducted to collect data of demographic characteristics,medical data about burn injuries,physical and psychological status,and self-perceived QOL at the initial phase and upon discharge from a rehabilitation hospital,timing of rehabilitation,and duration of rehabilitation intervention.Four hundred fifteen patients with burn injuries were recruited in the study.Multiple linear regression and logistic regression were used to obtain a model to predict the functional abilities and the perceived QOL at discharge and their changes during rehabilitation,as well as the post-injury work status within 6 months after discharge.Results:The functional performance at discharge and its change were significantly predicted by the functional abilities and QOL at the admission,duration of treatment,timing of rehabilitation,payer source,and total body surface area burned.The perceived QOL at discharge and its change were significantly predicted by the baseline QOL at admission and duration of treatment.The significant predictors of work status within 6 months post-discharge included age,education,payer source,total body surface area burned,perceived QOL,and bodily pain at admission.Conclusions:The present study identified a number of factors affecting the rehabilitation outcomes of people with burn injuries.Identification of these predictors may help clinicians assess the rehabilitation potential of burn survivors and assist in resource allocation.Policy makers should ensure that resources are adequate to improve the outcomes based on these factors.

Artificial intelligence in small intestinal diseases:Application and prospects

The small intestine is located in the middle of the gastrointestinal tract,so small intestinal diseases are more difficult to diagnose than other gastrointestinal diseases.However,with the extensive application of artificial intelligence in the field of small intestinal diseases,with its efficient learning capacities and computational power,artificial intelligence plays an important role in the auxiliary diagnosis and prognosis prediction based on the capsule endoscopy and other examination methods,which improves the accuracy of diagnosis and prediction and reduces the workload of doctors.In this review,a comprehensive retrieval was performed on articles published up to October 2020 from PubMed and other databases.Thereby the application status of artificial intelligence in small intestinal diseases was systematically introduced,and the challenges and prospects in this field were also analyzed.

Is oxygen therapy beneficial for normoxemic patients with acute heart failure?A propensity score matched study

Background:The clinical efficiency of routine oxygen therapy is uncertain in patients with acute heart failure(AHF)who do not have hypoxemia.The aim of this study was to investigate the association between oxygen therapy and clinical outcomes in normoxemic patients hospitalized with AHF using real-world data.Methods:Normoxemic patients diagnosed with AHF on intensive care unit(ICU)admission from the electronic ICU(eICU)Collaborative Research Database were included in the current study,in which the study population was divided into the oxygen therapy group and the ambient air group.Propensity score matching(PSM)was applied to create a balanced covariate distribution between patients receiving supplemental oxygen and those exposed to ambient air.Linear regression and logistic regression models were performed to assess the associations between oxygen therapy and length of stay(LOS),and all-cause in-hospital as well as ICU mortality rates,respectively.A series of sensitivity and subgroup analyses were conducted to further validate the robustness of our findings.Results:A total of 2922 normoxemic patients with AHF were finally included in the analysis.Overall,42.1%(1230/2922)patients were exposed to oxygen therapy,and 57.9%(1692/2922)patients did not receive oxygen therapy(defined as the ambient air group).After PSM analysis,1122 pairs of patients were matched:each patient receiving oxygen therapy was matched with a patient without receiving supplemental oxygen.The multivariable logistic model showed that there was no significant interaction between the ambient air and oxygen therapy for all-cause in-hospital mortality[odds ratio(OR)=1.30;95%confidence interval(CI)0.92–1.82;P=0.138]or ICU mortality(OR=1.39;95%CI 0.83–2.32;P=0.206)in the post-PSM cohorts.In addition,linear regression analysis revealed that oxygen therapy was associated with prolonged ICU LOS(OR=1.11;95%CI 1.06–1.15;P<0.001)and hospital LOS(OR=1.06;95%CI 1.01–1.10;P=0.009)after PSM.Furthermore,the absence of an effect of supplemental oxygen on mortality was consistent in all subgroups.Conclusions:Routine use of supplemental oxygen in AHF patients without hypoxemia was not found to reduce all cause in-hospital mortality or ICU mortality.