Effects of nursing team communication and collaboration on treatment outcomes in intensive care unit patients with severe pneumonia

BACKGROUND Severe pneumonia is a common severe respiratory infection worldwide,and its treatment is challenging,especially for patients in the intensive care unit(ICU).AIM To explore the effect of communication and collaboration between nursing teams on the treatment outcomes of patients with severe pneumonia in ICU.METHODS We retrospectively analyzed 60 patients with severe pneumonia who were treated at the ICU of the hospital between January 1,2021 and December 31,2023.We compared and analyzed the respiratory mechanical indexes[airway resistance(Raw),mean airway pressure(mPaw),peak pressure(PIP)],blood gas analysis indexes(arterial oxygen saturation,arterial oxygen partial pressure,and oxygenation index),and serum inflammatory factor levels[C-reactive protein(CRP),procalcitonin(PCT),cortisol(COR),and high mobility group protein B1(HMGB1)]of all patients before and after treatment.RESULTS Before treatment,there was no significant difference in respiratory mechanics index and blood gas analysis index between 2 groups(P>0.05).However,after treatment,the respiratory mechanical indexes of patients in both groups were significantly improved,and the improvement of Raw,mPaw,plateau pressure,PIP and other indexes in the combined group after communication and collaboration with the nursing team was significantly better than that in the single care group(P<0.05).The serum CRP and PCT levels of patients were significantly decreased,and the difference was statistically significant compared with that of nursing group alone(P<0.05).The levels of serum COR and HMGB1 before and after treatment were also significantly decreased between the two groups.CONCLUSION The communication and collaboration of the nursing team have a significant positive impact on respiratory mechanics indicators,blood gas analysis indicators and serum inflammatory factor levels in the treatment of severe pneumonia patients in ICU.

Reabsorption of intervertebral disc prolapse after conservative treatment with traditional Chinese medicine:A case report

BACKGROUND Conservative treatments have been reported to diminish or resolve clinical symptoms of lumbar intervertebral disc herniation(LIDH)within a few weeks.CASE SUMMARY Computed tomography and magnetic resonance imaging(MRI)of the lumbar region of a 25-yearold male diagnosed with LIDH showed prolapse of the L5/S2 disc.The disc extended 1.0 cm beyond the vertebral edge and hung along the posterior vertebral edge.The patient elected a conservative treatment regimen that included traditional Chinese medicine(TCM),acupuncture,and massage.During a follow-up period of more than 12 mo,good improvement in pain was reported without complications.MRI of the lumbar region after 12 mo showed obvious reabsorption of the herniation.CONCLUSION A conservative treatment regimen of TCM,acupuncture,and massage promoted reabsorption of a prolapsed disc.

Allocation of patients with liver cirrhosis and organ failure to intensive care: Systematic review and a proposal for clinical practice

AIM: To propose an allocation system of patients with liver cirrhosis to intensive care unit(ICU), and developed a decision tool for clinical practice. METHODS: A systematic review of the literature was performed in Pub Med, MEDLINE and EMBASE databases. The search includes studies on hospitalized patients with cirrhosis and organ failure, or acute on chronic liver failure and/or intensive care therapy. RESULTS: The initial search identified 660 potentially relevant articles. Ultimately, five articles were selected; two cohort studies and three reviews were found eligible. The literature on this topic is scarce and no studies specifically address allocation of patients with liver cirrhosis to ICU. Throughout the literature, there is consensus that selection criteria for ICU admission should be developed and validated for this group of patients and multidisciplinary approach is mandatory. Based on current available data we developed an algorithm, to determine if a patient is candidate to intensive care if needed, based on three scoring systems: premorbid Child-Pugh Score, Model of End stage Liver Disease score and the liver specific Sequential Organ Failure Assessment score.CONCLUSION: There are no established systems for allocation of patients with liver cirrhosis to the ICU and no evidence-based recommendations can be made.

Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria

BACKGROUND Multidrug-resistant Gram-negative bacteria,exacerbated by excessive use of antimicrobials and immunosuppressants,are a major health threat.AIM To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia,and to provide theoretical reference for clinical diagnosis and treatment.METHODS This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June 2022.After bacteriological culture,the patients'airway secretions were collected to confirm the presence of Gram-negative bacilli.The patients were divided into the experimental and control groups according to the medication used.The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous,nebulization,or intravenous combined with nebulization,with a daily dosage of 1.5–3.0 million units.The control group consisted of 26 patients who received standard dosages of other antibiotics(including sulbactam sodium for injection,cefoperazone sodium sulbactam for injection,tigecycline,meropenem,or vaborbactam).RESULTS Of the 28 patients included in the research group,26 patients showed improvement,treatment was ineffective for two patients,and one patient died,with the treatment efficacy rate of 92.82%.Of the 26 patients in the control group,18 patients improved,treatment was ineffective for eight patients,and two patients died,with the treatment efficacy rate of 54.9%;significant difference was observed between the two groups(P<0.05).The levels of white blood cell(WBC),procalcitonin(PCT),and C-reactive protein(CRP)in both groups were significantly lower after treatment than before treatment(P<0.05),and the levels of WBC,PCT,and CRP in the research group were significantly lower than those in the control group(P<0.05).Compared with before treatment,there were no significant changes in aspartate aminotransferase,creatinine,and glomerular filtration rate in both groups,while total bilirubin and alanine aminotransferase decreased after treatment(P<0.05)with no difference between the groups.In patients with good clinical outcomes,the sequential organ failure assessment(SOFA)score was low when treated with inhaled polymyxin sulfate,and specific antibiotic treatment did not improve the outcome.Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes.CONCLUSION Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable.Moreover,the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions,providing new ideas for clinical administration.

Study on the impact of comprehensive geriatric assessment on anxiety and depression in chronic obstructive pulmonary disease patients

BACKGROUND Psychological factors such as anxiety and depression will not only aggravate the symptoms of chronic obstructive pulmonary disease(COPD)patients and reduce the quality of life of patients,but also affect the treatment effect and long-term prognosis.Therefore,it is of great significance to explore the clinical application of senile comprehensive assessment in the treatment of COPD and its influence on psychological factors such as anxiety and depression.AIM To explore the clinical application of comprehensive geriatric assessment in COPD care and its impact on anxiety and depression in elderly patents.METHODS In this retrospective study,60 patients with COPD who were hospitalized in our hospital from 2019 to 2020 were randomly divided into two groups with 30 patients in each group.The control group was given routine nursing,and the observation group was given comprehensive assessment.Clinical symptoms,quality of life[COPD assessment test(CAT)score],anxiety and depression Hamilton Anxiety Rating Scale(HAMA)and Hamilton Depression Rating Scale(HAMD)were compared between the two groups.RESULTS CAT scores in the observation group decreased from an average of 24.5 points at admission to an average of 18.3 points at discharge,and in the control group from an average of 24.7 points at admission to an average of 18.3 points at discharge.The average score was 22.1(P<0.05).In the observation group,HAMA scores decreased from 14.2 points at admission to 8.6 points at discharge,and HAMD scores decreased from 13.8 points at admission to 7.4 points at discharge.The mean HAMD scores in the control group decreased from an average of 14.5 at admission to an average of 12.3 at discharge,and from an average of 14.1 at admission to an average of 11.8 at discharge.CONCLUSION The application of comprehensive geriatric assessment in COPD care has a significant effect on improving patients'clinical symptoms and quality of life,and can effectively reduce patients'anxiety and depression.

Protective eff ect and mechanism of nanoantimicrobial peptide ND-C14 against Streptococcus pneumoniae infection

BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae infections.Nanodefensin with a 14-carbon saturated fatty acid(ND-C14)is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of humanα-defensin 5(HD5)via an amide bond.However,it is unclear whether ND-C14 is effective against lung infections caused by S.pneumoniae.METHODS:In vitro,three groups were established,including the control group,and the HD5 and ND-C14 treatment groups.A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S.pneumoniae.The morphological changes of S.pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy.In vivo,mice were divided into sham,vehicle,and ND-C14 treatment groups.Mice in the sham group were treated with 25μL of phosphate-buffered saline(PBS).Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25μL of bacterial suspension with 2×108 CFU/mL(total bacterial count:5×10^(6) CFU),and then the mice were given 25μL PBS or intratracheally injected with 25μL of ND-C14(including 20μg or 50μg),respectively.Survival rates were evaluated in the vehicle and ND-C14 treatment groups.Bacterial burden in the blood and bronchoalveolar lavage fluid were counted.The lung histology of the mice was assessed.A propidium iodide uptake assay was used to clarify the destructive eff ect of ND-C14 against S.pneumoniae.RESULTS:Compared with HD5,ND-C14 had a better bactericidal eff ect against S.pneumoniae because of its stronger ability to destroy the membrane structure of S.pneumoniae in vitro.In vivo,ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S.pneumoniae.ND-C14 reduced bacterial burden and lung tissue injury.Moreover,ND-C14 had a membrane permeation eff ect on S.pneumoniae,and its destructive ability increased with increasing ND-C14 concentration.CONCLUSION:The ND-C14 may improve bactericidal eff ects on S.pneumoniae both in vitro and in vivo.

Relationship between the incidence of non-hepatic hyperammonemia and the prognosis of patients in the intensive care unit

BACKGROUND Ammonia is a normal constituent of body fluids and is found mainly through the formation of urea in the liver.Blood levels of ammonia must remain low as even slightly elevated concentrations(hyperammonemia)are toxic to the central nervous system.AIM To examine the relationship between the incidence of non-hepatic hyperammonemia(NHH)and the prognosis of patients who were admitted to the intensive care unit(ICU).METHODS This is a prospective,observational and single-center study.A total of 364 patients who were admitted to the ICU from November 2019 to February 2020 were initially enrolled.Changes in the levels of blood ammonia at the time of ICU admission and after ICU admission were continuously monitored.In addition,factors influencing the prognosis of NHH patients were analyzed.RESULTS A total of 204 patients who met the inclusion criteria were enrolled in this study,including 155 NHH patients and 44 severe-NHH patients.The incidence of NHH and severe-NHH was 75.98% and 21.57%,respectively.Patients with severe-NHH exhibited longer length of ICU stay and higher Acute Physiologic Assessment and Chronic Health Evaluation and Sequential Organ Failure Assessment scores compared to those with mild-NHH and non-NHH.Glasgow Coma Scale scores of patients with severe-NHH were than those of non-NHH patients.In addition,the mean and initial levels of ammonia in the blood might be helpful in predicting the prognosis of NHH.CONCLUSION High blood ammonia level is frequent among NHH patients admitted to the ICU,which is related to the clinical characteristics of patients.Furthermore,the level of blood ammonia may be helpful for prognosis prediction.

Volatility in High-Frequency Intensive Care Mortality Time Series: Application of Univariate and Multivariate GARCH Models

Mortality time series display time-varying volatility. The utility of statistical estimators from the financial time-series paradigm, which account for this characteristic, has not been addressed for high-frequency mortality series. Using daily mean-mortality series of an exemplar intensive care unit (ICU) from the Australian and New Zealand Intensive Care Society adult patient database, joint estimation of a mean and conditional variance (volatility) model for a stationary series was undertaken via univariate autoregressive moving average (ARMA, lags (p, q)), GARCH (Generalised Autoregressive Conditional Heteroscedasticity, lags (p, q)). The temporal dynamics of the conditional variance and correlations of multiple provider series, from rural/ regional, metropolitan, tertiary and private ICUs, were estimated utilising multivariate GARCH models. For the stationary first differenced series, an asymmetric power GARCH model (lags (1, 1)) with t distribution (degrees-of- freedom, 11.6) and ARMA (7,0) for the mean-model, was the best-fitting. The four multivariate component series demonstrated varying trend mortality decline and persistent autocorrelation. Within each MGARCH series no model specification dominated. The conditional correlations were surprisingly low (<0.1) between tertiary series and substantial (0.4 - 0.6) between rural-regional and private series. The conditional-variances of both the univariate and multivariate series demonstrated a slow rate of time decline from periods of early volatility and volatility spikes.

Advancing understanding and management of invasive fungal diseases in the intensive care unit:Insights from FUNDICU consensus definitions

Invasive fungal diseases(IFDs)are increasingly relevant in critical care medicine.[1]Due to the population being admitted to an intensive care unit(ICU),the type of patient has significantly changed over the last two decades.[2]More often,patients affected by comorbid conditions are candidates for being admitted to an ICU.There are mainly two sources of patients.

Prediction of Th17/Treg cell balance on length of stay in intensive care units of patients with sepsis

Background Prolonged length of stay(LOS)of sepsis can drain a hospital's material and human resources.This study investigated the correlations between T helper type 17(Th17)and regulatory T(Treg)balance with LOS in sepsis.Methods A prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai,China,from January to October 2020.The patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines,procalcitonin,subtypes,and biomarkers of T cells in the peripheral blood were detected.We analyzed the correlation between these and LOS.Results Sixty septic patients were classified into two groups according to whether their intensive care unit(ICU)stay exceeded 14 days.The patients with LOS≥14 days were older([72.6±7.5]years vs.[63.3±10.4]years,P=0.015)and had higher Sequential Organ Failure Assessment(SOFA)(median[interquartile range]:6.5[5.0–11.0]vs.4.0[3.0–6.0],P=0.001)and higher Acute Physiology and Chronic Health Evaluation(APACHE)II scores(16.0[13.0–21.0]vs.8.5[7.0–14.0],P=0.001).There was no difference in other demographic characteristics and cytokines,interleukin-6,tumor necrosis factor-α,and interleukin-10 between the two groups.The Th17/Treg ratio of sepsis with LOS<14 days was considerably lower(0.48[0.38–0.56]vs.0.69[0.51–0.98],P=0.001).For patients with LOS≥14 days,the area under the receiver operating characteristic curve for the Th17/Treg ratio was 0.766.It improved to 0.840 and 0.850 when combined with the SOFA and APACHE II scores,respectively.Conclusions The Th17/Treg ratio was proportional to septic severity and can be used as a potential predictor of ICU stay in sepsis,presenting a new option for ICU practitioners to better care for patients with sepsis.

High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross- sectional survey

Background The coronavirus disease 2019(COVID-19)pandemic has had a profound and prolonged impact on healthcare services and healthcare workers.Aims The Australian COVID-19 Frontline Healthcare Workers Study aimed to investigate the severity and prevalence of mental health issues,as well as the social,workplace and financial disruptions experienced by Australian healthcare workers during the COVID-19 pandemic.Methods A nationwide,voluntary,anonymous,single timepoint,online survey was conducted between 27 August and 23 October 2020.Individuals self-identifying as frontline healthcare workers in secondary or primary care were invited to participate.Participants were recruited through health organisations,professional associations or colleges,universities,government contacts and national media.Demographics,home and work situation,health and psychological well-being data were collected.Results A total of 9518 survey responses were received;of the 9518 participants,7846(82.4%)participants reported complete data.With regard to age,4110(52.4%)participants were younger than 40 years;6344(80.9%)participants were women.Participants were nurses(n=3088,39.4%),doctors(n=2436,31.1%),allied health staff(n=1314,16.7%)or in other roles(n=523,6.7%).In addition,1250(15.9%)participants worked in primary care.Objectively measured mental health symptoms were common:mild to severe anxiety(n=4694,59.8%),moderate to severe burnout(n=5458,70.9%)and mild to severe depression(n=4495,57.3%).Participants were highly resilient(mean(SD)=3.2(0.66)).Predictors for worse outcomes on all scales included female gender;younger age;pre-existing psychiatric condition;experiencing relationship problems;nursing,allied health or other roles;frontline area;being worried about being blamed by colleagues and working with patients with COVID-19.Conclusions The COVID-19 pandemic is associated with significant mental health symptoms in frontline healthcare workers.Crisis preparedness together with policies and practices addressing psychological well-being are needed.

Clinical study of NFNC in the treatment of acute exacerbation chronic obstructive pulmonary disease patients with respiratory failure

BACKGROUND Most patients with acute exacerbation chronic obstructive pulmonary disease(AECOPD)have respiratory failure that necessitates active correction and the improvement of oxygenation is particularly important during treatment.High flow nasal cannula(HFNC)oxygen therapy is a non-invasive respiratory aid that is widely used in the clinic that improves oxygenation state,reduces dead space ventilation and breathing effort,protects the loss of cilia in the airways,and improves patient comfort.AIM To compare HFNC and non-invasive positive pressure ventilation in the treatment of patients with AECOPD.METHODS Eighty AECOPD patients were included in the study.The patients were in the intensive care department of our hospital from October 2019 to October 2021.The patients were divided into the control and treatment groups according to the different treatment methods with 40 patients in each group.Differences in patient comfort,blood gas analysis and infection indices were analyzed between the two groups.RESULTS After treatment,symptoms including nasal,throat and chest discomfort were significantly lower in the treatment group compared to the control group on the 3rd and 5th days(P<0.05).Before treatment,the PaO_(2),PaO_(2)/FiO_(2),PaCO_(2),and SaO_(2)in the two groups of patients were not significantly different(P>0.05).After treatment,the same indicators were significantly improved in both patient groups but had improved more in the treatment group compared to the control group(P<0.05).After treatment,the white blood cell count,and the levels of C-reactive protein and calcitonin in patients in the treatment group were significantly higher compared to patients in the control group(P<0.05).CONCLUSION HFNC treatment can improve the ventilation of AECOPD patients whilst also improving patient comfort,and reducing complications.HFNC is a clinically valuable technique for the treatment of AECOPD.

Analysis and Literature Review of Deep Vein Thrombosis Related Phlegmasia Cerulea Dolens Diagnosis in Critically Patients

Goal: The purpose of this research is to analyze the clinical characteristics, diagnosis, treatment, and prognosis of critical care patients with phlegmasia cerulea dolens (PCD) caused by deep vein thrombosis. Our goal is to improve both awareness and early diagnosis and treatment of rare clinical diseases. Furthermore, we aim to examine advancements in the diagnosis and treatment of deep vein thrombosis. Method: The clinical information of patients with PCD received in 2022 was subject to retrospective analysis. The author conducted a search of 191 publications with a focus on PCD, from January 2010 to July 2022, from databases such as the China National Knowledge Infrastructure (CNKI), Wanfang Data, PubMed, etc. The results were used to summarize the examinations, diagnostic criteria, and treatment progress of PCD patients. Additionally, the author conducted another search using keywords such as “Venous thromboembolism” and “Anticoagulant drugs” to summarize research progress in anticoagulant drugs and the treatment of VTE. The search was limited to relevant. Outcome: Six months prior to admission, the patient, a 68-year-old female, developed sunken edema and cyanosis in both her lower extremities and was diagnosed with lower extremity deep vein thrombosis complicated by PCD, lower extremity ischemic necrosis, and septicemia. This diagnosis was made using a combination of CT and lower extremity vascular ultrasound-related examinations, as well as a significantly elevated D-dimer value. Despite active treatment and aggressive measures, such as anti-infection, organ function maintenance, anticoagulation, and improvement of microcirculatory disorders, the patient’s family declined corresponding surgical treatment and interventional surgery for the lower extremity due to objective factors, and the patient ultimately succumbed to her illness. The clinical characteristics of this patient were similar to those of the 14 cases of PCD reported by Xie Fei et al. in 2022. Conclusion: For patients with malignancy, it is crucial to start anticoagulation and physical prevention of DVT early on. Patients with DVT complicated by PCD have a variety of surgical options available to them, including surgical embolization or PMT (percutaneous mechanical thrombus ablation), CDT (catheter contact thrombolysis), and fascial ventriculotomy decompression [1]. Additionally, it may be necessary to place an inferior venous filter. Although the incidence of this disease is low accounting for approximately 5% of all patients with iliofemoral deep vein thrombosis [2], the prognosis is poor, as the mortality rate can reach up to 40% - 60% due to venous gangrene, with an overall mortality rate of 20% - 40% [3]. To increase the survival rate, it is important to diagnose and treat this disease as early as possible.

Vascular endothelium,a promising target for effectively treating fulminant diquat intoxication?

Following the withdrawal of paraquat,diquat(DQ)has emerged as the predominant herbicide.When people come into contact with or ingest DQ,may lead to poisoning and potentially fatal outcomes.Reports suggest that the mortality of DQ poisoning can be as high as 50%.DQ poisoning can be categorized as mild,moderate to severe or fulminant.In cases of fulminant poisoning,victims often succumb to multiple organ failure within 48 h.This presents a significant challenge in the clinical management.Scholars have discovered that oxidative stress,inflammatory injury,and cell apoptosis play crucial roles in the DQ poisoning.However,the underlying connection of the extensive organ damage remains unknown.The abnormal function and activity of endothelial cells(EC)should play a crucial role in tissue damage caused by DQ due to rich microcirculation and high sensitivity to perfusion in the vulnerable organs.However,reports on DQ-induced EC injury is rare.We made a preliminary discovery-the presence of severe vascular endothelial damage in the kidneys and lungs affected by DQ.Therefore,we hypothesize that DQ poisoning may be attributed to EC damage,ultimately resulting in multiple organ failure.

Acquired factor XIII deficiency presenting with multiple intracranial hemorrhages and right hip hematoma:A case report

BACKGROUND Factor XIII(FXIII)deficiency is a rare yet profound coagulopathy.FXIII plays a pivotal role in hemostasis,and deficiencies in this factor can precipitate unchecked or spontaneous hemorrhaging.Immunological assays for detecting FXIII inhibitors are indispensable for diagnosing acquired FXIII deficiency;however,the availability of suitable testing facilities is limited,resulting in prolonged turnaround times for these assays.CASE SUMMARY In this case study,a 53-year-old male devoid of significant medical history presented with recurrent intracranial hemorrhages and a hematoma in the right hip.Subsequent genetic analysis revealed a homozygous mutation in the ACE gene,confirming the diagnosis of acquired FXIII deficiency.CONCLUSION This case underscores the significance of considering acquired deficiencies in clotting factors when evaluating patients with unexplained bleeding episodes.

Immunology demystified: A guide for transplant hepatologists

Liver transplantation has become standard practice for treating end-stage liver disease.The success of the procedure relies on effective immunosuppressive medications to control the host's immune response.Despite the liver's inherent capacity to foster tolerance,the early post-transplant period is marked by significant immune reactivity.To ensure favorable outcomes,it is imperative to identify and manage various rejection types,encompassing T-cell-mediated,antibody-mediated,and chronic rejection.However,the approach to prescribing immunosuppressants relies heavily on clinical judgment rather than evidencebased criteria.Given that the majority of patients will require lifelong immunosuppression as the mechanisms underlying operational tolerance are still being investigated,healthcare providers must possess an understanding of immune responses,rejection mechanisms,and the pathways targeted by immunosuppressive drugs.This knowledge enables customization of treatments and improved patient care,even though a consensus on an optimal immunosuppressive regimen remains elusive.

Genitourinary tumors and liver transplantation: A comprehensive review

Liver transplantation is as a crucial therapeutic option for patients with end-stage liver disease,but the persistent organ shortage emphasizes a need to explore unconventional donor sources,including individuals with a history of malignan-cies.This review investigates the viability of liver donation from individuals with current or past genitourinary malignancies,focusing on renal,prostate and urinary bladder cancers.The rising incidence of urogenital malignancies among potential donors is thought to result from increasing donor age.Analysis of transmission risks reveals low rates of donor-derived cancer transmission,partic-ularly for early-stage renal and prostate cancers.Recipients with a history of genitourinary malignancy pose complex challenges regarding post-transplant immunosuppression and cancer recurrence.Nonetheless,the evidence suggests acceptable outcomes can be achieved with careful patient selection and tailored management strategies.Recommendations for pre-transplant evaluation and post-transplant surveillance are discussed,highlighting the need for individualized approaches in this patient population.Further prospective studies are warranted to refine guidelines and optimize outcomes in liver transplantation for patients with genitourinary malignancies.

Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage

Acute variceal hemorrhage,a life-threatening condition that requires a multidisciplinary approach for effective therapy,is defined as visible bleeding from an esophageal or gastric varix at the time of endoscopy,the presence of large esophageal varices with recent stigmata of bleeding,or fresh blood visible in the stomach with no other source of bleeding identified.Transfusion of blood products,pharmacological treatments and early endoscopic therapy are often effective;however,if primary hemostasis cannot be obtained or if uncontrollable early rebleeding occurs,transjugular intrahepatic portosystemic shunt(TIPS)is recommended as rescue treatment.The TIPS represents a major advance in the treatment of complications of portal hypertension.Acute variceal hemorrhage that is poorly controlled with endoscopic therapy is generally well controlled with TIPS,which has a 90%to 100%success rate.However,TIPS is associated with a mortality of 30%to 50%in such a setting.Emergency TIPS should be considered early in patients with refractory variceal bleeding once medical treatment and endoscopic sclerotherapy failure,before the clinical condition worsens.Furthermore,admission to specialized centers is mandatory in such a setting and regional protocols are essential to be organized effectively.This review article discusses initial management and then focuses on the specific role of TIPS as a primary therapy to control acute variceal hemorrhage,particularly as a rescue therapy following failure of endoscopic approaches.

Effect of liver cirrhosis on long-term outcomes after acute respiratory failure: A population-based study

AIM To assessed the effect of liver cirrhosis(LC) on the poorly understood long-term mortality risk after firstever mechanical ventilation(1-MV) for acute respiratory failure.METHODS All patients in Taiwan given a 1-MV between 1997 and 2013 were identified in Taiwan's Longitudinal Health Insurance Database 2000. Each patient with LC was individually matched, using a propensity-score method, to two patients without LC. The primary outcome was death after a 1-MV.RESULTS A total of 16653 patients were enrolled: 5551 LC-positive (LC^([Pos])) patients, including 1732 with cryptogenic LCs and 11102 LC-negative(LC^([Pos])) controls. LC^([Pos]) patients had more organ failures and were more likely to be admitted to medical department than were LC^([Pos]) controls. LC^([Pos]) patients had a significantly lower survival rate(AHR = 1.38, 95%CI: 1.32-1.44). Moreover, the mortality risk was significantly higher for patients with non-cryptogenic LC than for patients with cryptogenic LC(AHR = 1.43, 95%CI: 1.32-1.54) and patients without LC(AHR = 1.56, 95%CI: 1.32-1.54). However, there was no significant difference between patients with cryptogenic and without LC(HR = 1.05, 95%CI: 0.98-1.12).CONCLUSION LC, especially non-cryptogenic LC, significantly increases the risk of death after a 1-MV.

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Acute mesenteric ischemia(AMI)is a severe condition associated with poor prognosis,ultimately leading to death due to multiorgan failure.Several mechanisms may lead to AMI,and non-occlusive mesenteric ischemia(NOMI)represents a particular form of AMI.NOMI is prevalent in intensive care units in critically ill patients.In NOMI management,promptness and accuracy of diagnosis are paramount to achieve decisive treatment,but the last decades have been marked by failure to improve NOMI prognosis,due to lack of tools to detect this condition.While real-life diagnostic management relies on a combination of physical examination,several biomarkers,imaging,and endoscopy to detect the possibility of several grades of NOMI,research studies only focus on a few elements at a time.In the era of artificial intelligence(AI),which can aggregate thousands of variables in complex longitudinal models,the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought.In the following work,we bring you a state-of-the-art literature review regarding NOMI,its presentation,its mechanics,and the pitfalls of routine work-up diagnostic exams including biomarkers,imaging,and endoscopy,we raise the perspectives of new biomarker exams,and finally we discuss what AI may add to the field,after summarizing what this technique encompasses.