Cameroon Climate Predictions Using the SARIMA-LSTM Machine Learning Model: Adjustment of a Climate Model for the Sudano-Sahelian Zone of Cameroon

It is acknowledged today within the scientific community that two types of actions must be considered to limit global warming: mitigation actions by reducing GHG emissions, to contain the rate of global warming, and adaptation actions to adapt societies to Climate Change, to limit losses and damages [1] [2]. As far as adaptation actions are concerned, numerical simulation, due to its results, its costs which require less investment than tests carried out on complex mechanical structures, and its implementation facilities, appears to be a major step in the design and prediction of complex mechanical systems. However, despite the quality of the results obtained, biases and inaccuracies related to the structure of the models do exist. Therefore, there is a need to validate the results of this SARIMA-LSTM-digital learning model adjusted by a matching approach, “calculating-test”, in order to assess the quality of the results and the performance of the model. The methodology consists of exploiting two climatic databases (temperature and precipitation), one of which is in-situ and the other spatial, all derived from grid points. Data from the dot grids are processed and stored in specific formats and, through machine learning approaches, complex mathematical equations are worked out and interconnections within the climate system established. Through this mathematical approach, it is possible to predict the future climate of the Sudano-Sahelian zone of Cameroon and to propose adaptation strategies.

Evaluating pediatric ureteropelvic junction obstruction:Dynamic magnetic resonance urography vs renal scintigraphy 99mtechnetium mercaptoacetyltriglycine

BACKGROUND Ureteropelvic junction obstruction(UPJO)is a common congenital urinary tract disorder in children.It can be diagnosed as early as in utero due to the presence of hydronephrosis or later in life due to symptomatic occurrence.AIM To evaluate the discrepancy between dynamic contrast-enhanced magnetic resonance urography(dMRU)and scintigraphy 99m-technetium mercaptoacetyltriglycine(MAG-3)for the functional evaluation of UPJO.METHODS Between 2016 and 2020,126 patients with UPJO underwent surgery at Robert DebréHospital.Of these,83 received a prenatal diagnosis,and 43 were diagnosed during childhood.Four of the 126 patients underwent surgery based on the clinical situation and postnatal ultrasound findings without undergoing functional imaging evaluation.Split renal function was evaluated preoperatively using scintigraphy MAG-3(n=28),dMRU(n=53),or both(n=40).In this study,we included patients who underwent surgery for UPJO and scintigraphy MAG-3+dMRU but excluded those who underwent only scintigraphy MAG-3 or dMRU.The patients were divided into groups A(<10%discrepancy)and B(>10%discrepancy).We examined the discrepancy in split renal function between the two modalities and investigated the possible risk factors.RESULTS The split renal function between the two kidneys was compared in 40 patients(28 boys and 12 girls)using scintigraphy MAG-3 and dMRU.Differential renal function,as determined using both modalities,showed a difference of<10%in 31 children and>10%in 9 children.Calculation of the relative renal function using dMRU revealed an excellent correlation coefficient with renal scintigraphy MAG-3 for both kidneys.CONCLUSION Our findings demonstrated that dMRU is equivalent to scintigraphy MAG-3 for evaluating split renal function in patients with UPJO.

Vanadium-dependent activation of glucose transport in adipocytes by catecholamines is not mediated via adrenoceptor stimulation or monoamine oxidase activity

BACKGROUND Benzylamine and methylamine activate glucose uptake in adipocytes.For tyramine,this effect has even been extended to cardiomyocytes.AIM To investigate the effects of catecholamines and other amines on glucose uptake.METHODS A screening compared 25 biogenic amines on 2-deoxyglucose(2-DG)uptake activation in rat adipocytes.Pharmacological approaches and transgenic mouse models were then used to decipher the mode of action of several hits.RESULTS In rat adipocytes,insulin stimulation of 2-DG uptake was reproduced with catecholamines.100μmol/L or 1 mmol/L adrenaline,noradrenaline,dopamine and deoxyepinephrine,maximally activated hexose transport only when sodium orthovanadate was added at 100μmol/L.Such activation was similar to that already reported for benzylamine,methylamine and tyramine,well-recognized substrates of semicarbazide-sensitive amine oxidase(SSAO)and monoamine oxidase(MAO).Several,but not all,tested agonists ofβ-adrenoreceptors(β-ARs)also activated glucose transport whileα-AR agonists were inactive.Lack of blockade byα-andβ-AR antagonists indicated that catecholamine-induced 2-DG uptake was not mediated by AR stimulation.Adipocytes from mice lackingβ1-,β2-andβ3-ARs(triple KO)also responded to millimolar doses of adrenaline or noradrenaline by activating hexose transport in the presence of 100μmol/L vanadate.The MAO blocker pargyline,and SSAO inhibitors did not block the effects of adrenaline or noradrenaline plus vanadate,which were blunted by antioxidants.CONCLUSION Catecholamines exert unexpected insulin-like actions in adipocytes when combined with vanadium.For limiting insulin resistance by activating glucose consumption at least in fat stores,we propose that catecholamine derivatives combined with vanadium can generate novel complexes that may have low toxicity and promising anti-diabetic properties.

Characterization of two rat models of cystic fibrosis—KO and F508del CFTR—Generated by Crispr-Cas9

Background: Genetically engineered animals are essential for gaining a proper understanding of the disease mechanisms of cystic fibrosis(CF). The rat is a relevant laboratory model for CF because of its zootechnical capacity, size, and airway characteristics, including the presence of submucosal glands.Methods: We describe the generation of a CF rat model(F508 del) homozygous for the p.Phe508 del mutation in the transmembrane conductance regulator(Cftr) gene. This model was compared to new Cftr-/-rats(CFTR KO). Target organs in CF were examined by histological staining of tissue sections and tooth enamel was quantified by micro-computed tomography. The activity of CFTR was evaluated by nasal potential difference(NPD) and short-circuit current measurements. The effect of VX-809 and VX-770 was analyzed on nasal epithelial primary cell cultures from F508 del rats.Results: Both newborn F508 del and Knock out(KO) animals developed intestinal obstruction that could be partly compensated by special diet combined with an osmotic laxative. The two rat models exhibited CF phenotypic anomalies such as vas deferens agenesis and tooth enamel defects. Histology of the intestine, pancreas, liver, and lungs was normal. Absence of CFTR function in KO rats was confirmed ex vivo by short-circuit current measurements on colon mucosae and in vivo by NPD, whereas residual CFTR activity was observed in F508 del rats. Exposure of F508 del CFTR nasal primary cultures to a combination of VX-809 and VX-770 improved CFTR-mediated Cl-transport.Conclusions: The F508 del rats reproduce the phenotypes observed in CFTR KO animals and represent a novel resource to advance the development of CF therapeutics.

Theobroma cacao improves bone growth by modulating defective ciliogenesis in a mouse model of achondroplasia

A gain-of-function mutation in the fibroblast growth factor receptor 3 gene(FGFR3)results in achondroplasia(ACH),the most frequent form of dwarfism.Constitutive activation of FGFR3 impairs bone formation and elongation and many signal transduction pathways.Identification of new and relevant compounds targeting the FGFR3 signaling pathway is of broad importance for the treatment of ACH,and natural plant compounds are prime drug candidate sources.Here,we found that the phenolic compound(-)-epicatechin,isolated from Theobroma cacao,effectively inhibited FGFR3’s downstream signaling pathways.Transcriptomic analysis in an Fgfr3 mouse model showed that ciliary mRNA expression was modified and influenced significantly by the Indian hedgehog and PKA pathways.(-)-Epicatechin is able to rescue mRNA expression impairments that control both the structural organization of the primary cilium and ciliogenesis-related genes.In femurs isolated from a mouse model(Fgfr3^(Y367C/+))of ACH,we showed that(-)-epicatechin eliminated bone growth impairment during 6 days of ex vivo culture.In vivo,we confirmed that daily subcutaneous injections of(-)-epicatechin to Fgfr3^(Y367C/+) mice increased bone elongation and rescued the primary cilium defects observed in chondrocytes.This modification to the primary cilia promoted the typical columnar arrangement of flat proliferative chondrocytes and thus enhanced bone elongation.The results of the present proof-of-principle study support(-)-epicatechin as a potential drug for the treatment of ACH.

Locoregional therapies and their effects on the tumoral microenvironment of pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma(PDAC) is expected to become the second leading cause of death from cancer by 2030. Despite intensive research in the field of therapeutics, the 5-year overall survival is approximately 8%, with only 20% of patients eligible for surgery at the time of diagnosis. The tumoral microenvironment(TME) of the PDAC is one of the main causes for resistance to antitumoral treatments due to the presence of tumor vasculature, stroma, and a modified immune response. The TME of PDAC is characterized by high stiffness due to fibrosis, with hypo microvascular perfusion, along with an immunosuppressive environment that constitutes a barrier to effective antitumoral treatment. While systemic therapies often produce severe side effects that can alter patients’ quality of life, locoregional therapies have gained attention since their action is localized to the pancreas and can thus alleviate some of the barriers to effective antitumoral treatment due to their physical effects. Local hyperthermia using radiofrequency ablation and radiation therapy-most commonly using a local high single dose-are the two main modalities holding promise for clinical efficacy. Recently, irreversible electroporation and focused ultrasound-derived cavitation have gained increasing attention. To date, most of the data are limited to preclinical studies, but ongoing clinical trials may help better define the role of these locoregional therapies in the management of PDAC patients.

High doses of catecholamines activate glucose transport in human adipocytes independently from adrenoceptor stimulation or vanadium addition

BACKGROUND When combined with vanadium salts,catecholamines strongly activate glucose uptake in rat and mouse adipocytes.AIM To test whether catecholamines activate glucose transport in human adipocytes.METHODS The uptake of 2-deoxyglucose(2-DG)was measured in adipocytes isolated from pieces of abdominal subcutaneous tissue removed from women undergoing reconstructive surgery.Pharmacological approaches with amine oxidase inhibitors,adrenoreceptor agonists and antioxidants were performed to unravel the mechanisms of action of noradrenaline or adrenaline(also named epinephrine).RESULTS In human adipocytes,45-min incubation with 100μmol/L adrenaline or noradrenaline activated 2-DG uptake up to more than one-third of the maximal response to insulin.This stimulation was not reproduced with millimolar doses of dopamine or serotonin and was not enhanced by addition of vanadate to the incubation medium.Among various natural amines and adrenergic agonists tested,no other molecule was more efficient than adrenaline and noradrenaline in stimulating 2-DG uptake.The effect of the catecholamines was not impaired by pargyline and semicarbazide,contrarily to that of benzylamine or methylamine,which are recognized substrates of semicarbazide-sensitive amine oxidase.Hydrogen peroxide at 1 mmol/L activated hexose uptake but not pyrocatechol or benzoquinone,and only the former was potentiated by vanadate.Catalase and the phosphoinositide 3-kinase inhibitor wortmannin inhibited adrenaline-induced activation of 2-DG uptake.CONCLUSION High doses of catecholamines exert insulin-like actions on glucose transport in human adipocytes.At submillimolar doses,vanadium did not enhance this catecholamine activation of glucose transport.Consequently,this dismantles our previous suggestion to combine the metal ion with catecholamines to improve the benefit/risk ratio of vanadium-based antidiabetic approaches.

Dental pulp stem cells as a promising model to study imprinting diseases

Parental imprinting is an epigenetic process leading to monoallelic expression of certain genes depending on their parental origin.Imprinting diseases are characterized by growth and metabolic issues starting from birth to adulthood.They are mainly due to methylation defects in imprinting control region that drive the abnormal expression of imprinted genes.We currently lack relevant animal or cellular models to unravel the pathophysiology of growth failure in these diseases.We aimed to characterize the methylation of imprinting regions in dental pulp stem cells and during their differentiation in osteogenic cells(involved in growth regulation)to assess the interest of this cells in modeling imprinting diseases.We collected dental pulp stem cells from five controls and four patients(three with Silver-Russell syndrome and one with Beckwith-Wiedemann syndrome).Methylation analysis of imprinting control regions involved in these syndromes showed a normal profile in controls and the imprinting defect in patients.These results were maintained in dental pulp stem cells cultured under osteogenic conditions.Furthermore,we confirmed the same pattern in six other loci involved in imprinting diseases in humans.We also confirmed monoallelic expression of H19(an imprinted gene)in controls and its biallelic expression in one patient.Extensive imprinting control regions methylation analysis shows the strong potential of dental pulp stem cells in modeling imprinting diseases,in which imprinting regions are preserved in culture and during osteogenic differentiation.This will allow to perform in vitro functional and therapeutic tests in cells derived from dental pulp stem cells and generate other cell-types.

Comment on “Locating the source field lines of Jovian decametric radio emissions” by YuMing Wang et al.

In this comment on the article“Locating the source field lines of Jovian decametric radio emissions”by Wang YM et al.,2020,we discuss the assumptions used by the authors to compute the beaming angle of Jupiter’s decametric emissions induced by the moon Io.Their method,relying on multi-point radio observations,was applied to a single event observed on 14th March 2014 by Wind and both STEREO A/B spacecraft from~5 to~16 MHz.They have erroneously identified the emission as a northern(Io-B type)instead of a southern one(Io-D type).We encourage the authors to update their results with the correct hemisphere of origin and to test their method on a larger sample of Jupiter-Io emissions.

Adult human liver slice cultures:Modelling of liver fibrosis and evaluation of new anti-fibrotic drugs

BACKGROUND Liver fibrosis can result in end-stage liver failure and death.AIM To examine human liver fibrogenesis and anti-fibrotic therapies,we evaluated the three dimensional ex vivo liver slice(LS)model.METHODS Fibrotic liver samples(F0 to F4 fibrosis stage according to the METAVIR score)were collected from patients after liver resection.Human liver slices(HLS)were cultivated for up to 21 days.Hepatitis C virus(HCV)infection,alcohol(ethanol stimulation)and steatosis(palmitate stimulation)were examined in fibrotic(F2 to F4)liver slices infected(or not)with HCV.F0-F1 HLS were used as controls.At day 0,either ursodeoxycholic acid(choleretic and hepatoprotective properties)and/or α-tocopherol(antioxidant properties)were added to standard of care on HLS and fibrotic liver slices,infected(or not)with HCV.Expression of the biomarkers of fibrosis and the triglyceride production were checked by quantitative reverse transcription polymerase chain reaction and/or enzymelinked immunosorbent assay.RESULTS The cultures were viable in vitro for 21 days allowing to study fibrosis inducers and to estimate the effect of anti-fibrotic drugs.Expression of the biomarkers of fibrosis and the progression to steatosis(estimated by triglycerides production)was increased with the addition of HCV and/or ethanol or palmitate.From day 15 of the follow-up studies,a significant decrease of both transforming growth factorβ-1 and Procol1A1 expression and triglycerides production was observed when a combined anti-fibrotic treatment was applied on HCV infected F2-F4 LS cultures.CONCLUSION These results show that the human three dimensional ex vivo model effectively reflects the in vivo processes in damaged human liver(viral,alcoholic,nonalcoholic steatohepatitis liver diseases)and provides the proof of concept that the LS examined model permits a rapid evaluation of new anti-fibrotic therapies when used alone or in combination.

Deep inside molecules-digital twins at the nanoscale

Background Digital twins offer rich potential for exploration in virtual reality(VR).Using interactive molecular simulation approaches,they enable a human operator to access the physical properties of molecular objects and to build,manipulate,and study their assemblies.Integrative modeling and drug design are important applications of this technology.Methods In this study,head-mounted virtual reality displays connected to mole-cular simulation engines were used to create interactive and immersive digital twins.They were used to perform tasks relevant to specific use cases.Results Three areas were investigated,including model building,rational design,and tangible models.Here,we report several membrane-embedded systems of ion channels,viral com-ponents,and artificial water channels.We were able to improve and create molecular designs based on digital twins.Conclusions The molecular application domain offers great opportunities,and most of the technical and tech-nological aspects have been solved.Wider adoption is expected once the onboarding of VR is simplified and the technology gains wider acceptance.

Unraveling one billion years of geological evolution of the southeastern Amazonia Craton from detrital zircon analyses

Despite representing one of the largest cratons on Earth,the early geological evolution of the Amazonia Craton remains poorly known due to relatively poor exposure and because younger metamorphic and tectonic events have obscured initial information.In this study,we investigated the sedimentary archives of the Carajás Basin to unravel the early geological evolution of the southeastern Amazonia Craton.The Carajás Basin contains sedimentary rocks that were deposited throughout a long period spanning more than one billion years from the Mesoarchean to the Paleoproterozoic.The oldest archives preserved in this basin consist of a few ca.3.6 Ga detrital zircon grains showing that the geological roots of the Amazonia Craton were already formed by the Eoarchean.During the Paleoarchean or the early Mesoarchean(<3.1 Ga),the Carajás Basin was large and rigid enough to sustain the formation and preservation of the Rio Novo Group greenstone belt.Later,during the Neoarchean,at ca.2.7 Ga,the southeastern Amazonia Craton witnessed the emplacement of the Parauapebas Large Igneous Province(LIP)that probably covered a large part of the craton and was associated with the deposition of some of the world largest iron formations.The emplacement of this LIP immediately preceded a period of continental extension that formed a rift infilled first by iron formations followed by terrigenous sediments.This major change of sedimentary regime might have been controlled by the regional tectonic evolution of the Amazonia Craton and its emergence above sea-level.During the Paleoproterozoic,at ca.2.1 Ga,the Rio Fresco Group,consisting of terrigenous sediments from the interior of the Amazonia Craton,was deposited in the Carajás Basin.At that time,the Amazonian lithosphere could have either underwent thermal subsidence forming a large intracratonic basin or could have been deformed by long wavelength flexures that induced the formation of basins and swells throughout the craton under the influence of the growing Transamazonian mountain belt.

French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic

Since the outbreak of coronavirus disease 2019(COVID-19)in December 2019 in China,various measures have been adopted in order to attenuate the impact of the virus on the population.With regard to spine surgery,French physicians are devoted to take place in the national plan against COVID-19,the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients.A three levels stratification was elaborated with Level I:Urgent surgical indications,Level II:Surgical indications associated to a potential loss of chance for the patient and Level III:Non-urgent surgical indications.We also report French experience in a COVID-19 cluster region illustrated by two clinical cases.We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.

Learning models for colorectal cancer signature reconstruction and classification in patients with chronic inflammatory bowel disease

BACKGROUND In their everyday life,clinicians face an overabundance of biological indicators potentially helpful during a disease therapy.In this context,to be able to reliably identify a reduced number of those markers showing the ability of optimising the classification of treatment outcomes becomes a factor of vital importance to medical prognosis.In this work,we focus our interest in inflammatory bowel disease(IBD),a long-life threaten with a continuous increasing prevalence worldwide.In particular,IBD can be described as a set of autoimmune conditions affecting the gastrointestinal tract whose two main types are Crohn’s disease and ulcerative colitis.AIM To identify the minimal signature of microRNA(miRNA)associated with colorectal cancer(CRC)in patients with one chronic IBD.METHODS We provide a framework of well-established statistical and computational learning methods wisely adapted to reconstructing a CRC network leveraged to stratify these patients.RESULTS Our strategy resulted in an adjusted signature of 5 miRNAs out of approximately 2600 in Crohn’s Disease(resp.8 in Ulcerative Colitis)with a percentage of success in patient classification of 82%(resp.81%).CONCLUSION Importantly,these two signatures optimally balance the proportion between the number of significant miRNAs and their percentage of success in patients’stratification.

Exercise sustains the hallmarks of health

Exercise has long been known for its active role in improving physical fitness and sustaining health.Regular moderate-intensity exercise improves all aspects of human health and is widely accepted as a preventative and therapeutic strategy for various diseases.It is well-documented that exercise maintains and restores homeostasis at the organismal,tissue,cellular,and molecular levels to stimulate positive physiological adaptations that consequently protect against various pathological conditions.Here we mainly summarize how moderate-intensity exercise affects the major hallmarks of health,including the integrity of barriers,containment of local perturbations,recycling and turnover,integration of circuitries,rhythmic oscillations,homeostatic resilience,hormetic regulation,as well as repair and regeneration.Furthermore,we summarize the current understanding of the mechanisms responsible for beneficial adaptations in response to exercise.This review aimed at providing a comprehensive summary of the vital biological mechanisms through which moderate-intensity exercise maintains health and opens a window for its application in other health interventions.We hope that continuing investigation in this field will further increase our understanding of the processes involved in the positive role of moderate-intensity exercise and thus get us closer to the identification of new therapeutics that improve quality of life.

Potential impacts of climate and anthropogenic-induced changes on DOM dynamics among the major Chinese rivers

Dissolved organic matter (DOM) is closely linked to human activities in drainage basins and plays a crucial role in maintaining ecosystem functioning and reflecting environmental quality. However, the impacts of climate and anthropogenic-induced changes on DOM in riverine systems under increasingly warming conditions still need to be better understood, particularly at large regional scales. To address this knowledge gap, we analyzed a dataset containing 386 published measurements for nine major Chinese river systems, examining dissolved organic carbon (DOC) concentrations and optical properties of chromophoric DOM (CDOM) under diverse envi- ronmental conditions, including mean air temperature, precipitation, surface solar radiation, population density, and land use. Our findings indicate that riverine DOC concentrations are significantly higher in northern China (at ∼46.8%) than in the south. This disparity is primarily due to the high input of soil erosion-induced DOM from drying-affected lands (57.0%), farmland (49.1%), and forests in the north. The high temperate and strong hydrological conditions would lead to DOM degradation easily in the riverine system in the south of China. Our study highlights that various climatic and anthropogenic factors, such as agriculture, vegetation coverage, soil erosion, surface solar radiation, and precipitation, individually or in combination, can affect DOM dynamics in river systems. Therefore, considering alterations in DOM dynamics resulting from climate and environmental changes is crucial for carbon-neutral policies and sustainable river ecosystem assessments.

The germline genetics of mild-to-moderate penetrance:An intriguing role of PRAME in multiple carcinogenesis

Germline genetics of high penetrance such as BRCA genes,mutations might be sufficient for carcinogenesis,but this only explains fewer than 10%of cancers.We assume that most cancers are the result of germline mutations of low to moderate penetrance,combined with acquired mutations due to external carcinogenic stressors.With their accumulation over time,aging is associated with an increased risk of multiple cancer development in a given individual.For decades,germline genetics have been based on familial linkage studies enabling most high-penetrance genes to be identified.More recently,population-wide studies have led to the identification of considerable numbers of polymorphisms associated with cancer risk.However,most of them are of unknown functional value,thus limiting their translational application.

Severe asthma exacerbation:Changes in patient characteristics,management,and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area

Background Despite advances in asthma treatments,severe asthma exacerbation(SAE)remains a life-threatening condition in adults,and there is a lack of data derived from adult patients admitted to intensive care units(ICUs)for SAE.The current study investigated changes in adult patient characteristics,management,and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area.Methods In this retrospective observational study,admissions to 40 ICUs in the greater Paris area for SAE from January 1,1997,to December 31,2016 were analyzed.The primary outcome was the proportion of ICU admissions for SAE during 5-year periods.Secondary outcomes were ICU and hospital mortality,and the use of mechanical ventilation and catecholamine.Multivariate analysis was performed to assess factors associated with ICU mortality.Results A total of 7049 admissions for SAE were recorded.For each 5-year period,the proportion decreased over time,with SAE accounting for 2.84%of total ICU admissions(n=2841)between 1997 and 2001,1.76%(n=1717)between 2002 and 2006,1.05%(n=965)between 2007 and 2011,and 1.05%(n=1526)between 2012 and 2016.The median age was 46 years(interquartile range[IQR]:32–59 years),55.41%were female,the median Simplified Acute Physiology Score II was 20(IQR:13–28),and 19.76%had mechanical ventilation.The use of mechanical ventilation remained infrequent throughout the 20-year period,whereas the use of catecholamine decreased.ICU and hospital mortality rates decreased.Factors associated with ICU mortality were renal replacement therapy,catecholamine,cardiac arrest,pneumothorax,acute respiratory distress syndrome,sepsis,and invasive mechanical ventilation(IMV).Non-survivors were older,had more severe symptoms,and were more likely to have received IMV.Conclusion ICU admission for SAE remains uncommon,and the proportion of cases decreased over time.Despite a slight increase in symptom severity during a 20-year period,ICU and hospital mortality decreased.Patients requiring IMV had a higher mortality rate.

Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal infection.This study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and mortality.Methods:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal infection.Only patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the ICU.Relationships with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and non-survivors.Conclusions:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term outcome.In this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse peritonitis,and severity of disease expression,were not associated with an increased mortality risk.