Predicting mortality of elderly patients undergoing open heart surgery with delirium using sequential organ failure assessment (SOFA), multi-organ dysfunction (MODS), and logistic organ dysfunction system (LODS) scores.

PURPOSE: This study aims to assess the predictive accuracy of SOFA, MODS, and LODS scores in determining the mortality of elderly undergoing open heart surgery with delirium. METHODS: A prospective study involved 111 elderly patients who met the inclusion criteria. Data were collected using scoring systems: SOFA, MODS, and LODS. RESULTS: Upon final follow-up, 86.5 % of the patients had recovered, 13.5 % had died. Sensitivity, specificity, negative, and positive predictive values for predicting mortality in elderly patients were calculated for the SOFA score as 99 %, 73 %, 98 %, and 76 %, respectively. For the MODS score, these values were 95 %, 60 %, 95 %, and 67 %; for the LODS score, they were 92 %, 73 %, 92 %, and 75 %, respectively. The overall accuracy of the three scores-SOFA, MODS, and LODS-was 84 %, 76 %, and 82 %, respectively. CONCLUSION: The results indicated that the SOFA score exhibited the highest sensitivity and specificity in predicting mortality among elderly individuals.

Life-Threatening Transfusion Reaction in Postoperative Total Knee Arthroplasty: A Unique Case and Comprehensive Insights.

Introduction: Blood transfusions are essential for managing blood loss in surgical patients but can lead to life-threatening reactions. This report presents a severe transfusion reaction in a postoperative total knee arthroplasty (TKA) patient, emphasizing the need for vigilant monitoring and timely intervention. Case Report: A 70-year-old male with a history of bilateral knee pain underwent right-sided TKA. Preoperative evaluations were normal. Post-surgery, significant blood loss led to a one-pint packed red blood cell transfusion. The patient developed fever, chills, palpitations, and rapid breathing, indicating a transfusion reaction. Despite immediate treatment, the patient's condition deteriorated, requiring ICU admission. Complications included acute kidney injury (AKI), metabolic acidosis, thrombocytopenia, pleural effusion, and aspiration pneumonitis. Multiple organ dysfunction syndrome (MODS) developed, necessitating hemodialysis. Despite comprehensive care, the patient passed away. Conclusion: This case highlights the critical need for rigorous pre-transfusion screening, vigilant monitoring, and immediate intervention in managing severe transfusion reactions in postoperative TKA patients. Comprehensive patient care strategies are essential to mitigate the multifocal complications associated with transfusion reactions. Additional research is needed to understand and prevent such life-threatening reactions.

Acute Pericarditis as a Complication of Hiatal Hernia Perforation.

Acute pericarditis is a serious and potentially fatal disease in which a diagnostic workup is not always straightforward. Hiatal hernia, on the other hand, is often asymptomatic and can be easily diagnosed if symptomatic. In advanced forms of hiatal hernia, oppression of intrathoracic organs and heart failure can occur. In uncommon cases, the large intestine can also be translocated into the chest cavity, and very rarely, it can be perforated with the development of mediastinitis and/or pericarditis. We report the case of a 74-year-old female with a 1.5-month history of chest pain with elevated inflammatory markers. This patient was empirically treated with antibiotics for suspected pneumonia. After a few weeks, due to a worsening of the patient's condition, an echocardiogram and then a CT of the chest were performed, showing a large hiatal hernia and a very probable purulent pericarditis, necessitating a surgical exploration. A cardiac surgeon found stercoral contents in the pericardium, with a fistula at the apex of the heart. The operation continued with an exploration of the abdominal cavity; the general surgeon returned the massive hiatal hernia to the abdomen, the contents of which were the stomach and transverse colon. An extensive perforation in the transverse colon was found. Lavage, drainage, and resection of the affected part of the intestine were performed, and a permanent (terminal) colostomy was constructed. The patient was in severe septic shock with multiorgan failure and died 10 hours after surgery despite maximal therapy. This case highlights the importance of interdisciplinary cooperation and the importance of considering the possible fistula in the co-occurrence of hiatal hernia and pericarditis.

Mechanical support for the treatment of fulminant myocarditis combined with cardiac arrest and MODS in children: A case report and review.

A 13 years and 1 month old child was admitted to the hospital with fulminant myocarditis. After admission, the child's condition deteriorated rapidly, with a rapid drop in blood pressure, alternating malignant arrhythmias, such as ventricular tachycardia and ventricular fibrillation, and then developed rapid cardiac arrest, which lasted for 62 min. Moreover, the child developed multiple organ failure (heart, kidney, brain, lungs, liver, gastrointestinal tract, and inflammatory system) with internal environmental disturbances, indicating critical conditions. After emergency extracorporeal membrane oxygenation (ECMO) and an intra-aortic balloon pump (IABP), continuous renal replacement therapy (CRRT) was administered to dehydrate and maintain homeostasis of the internal environment. The treatment plan was adjusted in a timely manner by performing standardized and detailed comprehensive respiratory, circulatory, anti-infection, volume, anticoagulation, skin, and physical rehabilitation treatments. The patient was transferred to the ICU 15 days later. The patient was successfully discharged from the hospital and resumed normal studies and life without any neurological sequelae. This case is the first study of ECMO combined with IABP and CRRT for the treatment of fulminant myocarditis combined with cardiac arrest and multiple organ failure in children, which has not yet been reported in the literature. The duration of the cardiac arrest in this case was extremely long (62 min), and the patient had a good prognosis for the resumption of normal life and growth. This case suggests the need for early recognition of fulminant myocarditis and early initiation of devices for circulatory function support, such as ECMO and IABP. Additionally, early initiation of CRRT can assist in precise volume management, reduce cerebral edema, stabilize the internal environment, and reduce organ functional damage, which is a strong guarantee of treatment.

Organ crosstalk and dysfunction in sepsis.

Sepsis is a dysregulated immune response to an infection that leads to organ dysfunction. Sepsis-associated organ dysfunction involves multiple inflammatory mechanisms and complex metabolic reprogramming of cellular function. These mechanisms cooperate through multiple organs and systems according to a complex set of long-distance communications mediated by cellular pathways, solutes, and neurohormonal actions. In sepsis, the concept of organ crosstalk involves the dysregulation of one system, which triggers compensatory mechanisms in other systems that can induce further damage. Despite the abundance of studies published on ​​organ crosstalk in the last decade, there is a need to formulate a more comprehensive framework involving all organs to create a more detailed picture of sepsis. In this paper, we review the literature published on organ crosstalk in the last 10 years and explore how these relationships affect the progression of organ failure in patients with septic shock. We explored these relationships in terms of the heart-kidney-lung, gut-microbiome-liver-brain, and adipose tissue-muscle-bone crosstalk in sepsis patients. A deep connection exists among these organs based on crosstalk. We also review how multiple therapeutic interventions administered in intensive care units, such as mechanical ventilation, antibiotics, anesthesia, nutrition, and proton pump inhibitors, affect these systems and must be carefully considered when managing septic patients. The progression to multiple organ dysfunction syndrome in sepsis patients is still one of the most frequent causes of death in critically ill patients. A better understanding and monitoring of the mechanics of organ crosstalk will enable the anticipation of organ damage and the development of individualized therapeutic strategies.

The Role of Systemic Inflammation in the Pathogenesis of Spontaneous Intracranial Hemorrhage in the Presence or Absence of Effective Cerebral Blood Flow.

Background: Spontaneous intracerebral hemorrhage (ICH) is one of the leading causes of mortality in intensive care units. The role of systemic hyperintense inflammation (SHI) in the pathogenesis of critical complications of ICH remains a poorly understood problem. There is a specific variant of severe ICH associated with increased intracranial pressure and occlusion of intracranial vessels, defined as ineffective cerebral blood flow (IECBF). Methods: To evaluate the role of SHI in the pathogenesis of severe (comatose) ICH in a dynamic comparison of patients with IECBF (n-26) and without IECBF (n-52). The SHI integral score criterion (SI scale) was used, including certain values of plasma concentrations of IL-6, IL-8, IL-10; TNF-α, PCT, cortisol, myoglobin, troponin I, D-dimer, and, additionally, SOFA scale values. Blood levels of ACTH and neuron-specific enolase (NSE) were also assessed. Results: Twenty-eight-day mortality in severe ICH reached 84.6% (without IECBF) and 96.2% (with IECBF). Clear signs of SHI were detected in 61.5%/87.8% (without IECBF) and 0.0%/8.7% (with IECBF) within 1-3/5-8 days from the onset of ICH manifestation. The lower probability of developing SHI in the IECBF group was associated with low blood NSE concentrations. Conclusions: The development of SHI in ICH is pathogenetically related to the permeability of the blood-brain barrier for tissue breakdown products and other neuroinflammatory factors.

The evaluation of cytokines in predicting the organ injury of critically pediatric patients: a retrospective study.

Background: The current early warning model for organ damage in critically ill patients has certain limitations. Based on the pathological mechanism, the establishment of an early warning system for organ damage in critically ill children using cytokines profile has not been explored. The aim of this study is to explore the predicting value of cytokines in critically ill patients. Methods: There were 200 critically pediatric patients and 49 general patients between August 22, 2018 and April 28, 2023 from Children's Hospital of Soochow University enrolled in this study. The clinical information was retrospectively collected and analyzed. The cytokine profiles of these patients were detected by flow cytometry. Receiver operating characteristic (ROC) curves were plotted to determine the association between the cytokines and organ injury. Results: There were no statistically significant differences in gender, age and underlying disease between critically ill patients and general patients. The interleukin (IL)-6 (P<0.001), IL-10 (P<0.001), IL-17A (P=0.001), tumor necrosis factor-α (TNF-α) (P=0.02) and interferon-γ (IFN-γ) (P=0.02) level in the critically patients were significantly higher than those in the general patients. The results showed that the incidence of acute gastrointestinal injury (AGI) and acute kidney injury (AKI) in critically ill patients was 39% and 23.5%, respectively. Moreover, there were 4% and 3.5% patients with the occurrence of cardiac arrest and acute live injury. The IFN-γ level was increased in these patients with acute liver injury compared to those without these organ injuries, but reduced in the patients with AGI compared to those without. The patients with AKI showed a significant increase in IL-10 in contrast to those without. The IL-2, IL-4, IL-6, IL-10 and IL-17A were higher in patients with acute liver failure (ALF), but TNF-α was reduced, compared to those without. The IL-2, IL-4, IL-6 and IL-10 were significantly increased in the patients with cardiac arrest compared to those without. When IL-10 was higher than 279.45 pg/mL, the sensitivity and specificity for predicting cardiac arrest were 0.875 and 0.927, respectively. While the sensitivity and specificity of IL-6 (more than 1,425.6 pg/mL) were 0.625 and 0.844, respectively. However, no synergistic effect of IL-6 and IL-10 was observed for predicting cardiac arrest. Additionally, the IL-17A (more than 21.6 pg/mL) was a good predictor for the incidence of ALF (sensitivity =0.714, specificity =0.876). Conclusions: The cytokines profile was different between critically ill patients with organ injury and those without organ injury. The IL-6 and IL-10 levels were good predictors for cardiac arrest in critically ill patients. Additionally, higher IL-17A predicted the incidence of ALF of the critically ill patients.

Validity of different scoring systems in prediction of intensive care unit admission and mortality in acute organophosphate poisoning.

Background: Organophosphate compounds (OPCs) pose significant health risks, especially in developing countries with limited resources. Predicting outcomes in OPCs poisoning is crucial for guiding clinical management and reducing mortality rates. The aim of this study to evaluate the validity of different scoring systems Rapid Emergency Medicine Score, Multiple Organ Dysfunction Score, Acute Physiology and Chronic Health Evaluation Score, and Poison Severity Score in prediction of intensive care unit (ICU) admission and mortality of acute OPCs poisoning patients. Methods: A cross-sectional study was conducted on 103 patients admitted to Xx Poison Control Center between May 2022 and June 2023. Scoring systems were applied at admission, and their performance in predicting the need for ICU admission and mortality was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Most patients survived (92.2%). Only 13.6% of the patients required ICU admission. Significant differences in median scores were observed between survivors and non-survivors and between patients requiring ICU admission and those who did not. Multiple Organ Dysfunction Score exhibited the highest discriminatory power for predicting both ICU admission (AUC = 0.983) and mortality (AUC = 0.999). Conclusion: The findings highlight the importance of utilizing scoring systems, particularly Multiple organ dysfunction score, for prediction of poor outcomes of acute OPCs poisoning.

Pioglitazone ameliorates sepsis-associated encephalopathy through SIRT1 signaling pathway.

Sepsis is a severe immune response to an infection. It is associated with multiple organ dysfunction syndrome (MODs) along with systemic and neuronal inflammatory response. This study focused on the acute neurologic dysfunction associated with sepsis by exploring the role of PPARγ/SIRT1 pathway against sepsis. We studied the role of this axis in ameliorating sepsis-associated encephalopathy (SAE) and its linked neurobehavioral disorders by using pioglitazone (PIO). This PPARγ agonist showed neuroprotective actions in neuroinflammatory disorders. Sepsis was induced in mice by LPS (10 mg/kg). Survival rate and MODs were assessed. Furthermore, behavioral deficits, cerebral oxidative, inflammatory, and apoptotic markers, and the cerebral expression level of SIRT1 were determined. In this study, we observed that PIO attenuated sepsis-induced cerebral injury. PIO significantly enhanced survival rate, attenuated MODs, and systemic inflammatory response in septic mice. PIO also promoted cerebral SIRT1 expression and reduced cerebral activation of microglia, oxidative stress, HMGB, iNOS, NLRP3 and caspase-3 along with an obvious improvement in behavioral deficits and cerebral pathological damage induced by LPS. Most of the neuroprotective effects of PIO were abolished by EX-527, a SIRT1 inhibitor. These results highlight that the neuroprotective effect of PIO in SAE is mainly SIRT1-dependent.

Unilateral lateral rectus palsy following dengue: a case report.

Introduction and importance: Dengue fever is a mosquito-borne viral infection presenting with high-grade fever and other constitutional symptoms. Case presentation: This case report details a rare occurrence of lateral rectus palsy in an 18-year-old male subsequent to dengue infection. The patient initially presented with fever, a generalized tonic-clonic seizure (GTCS), and symptomatic hypoglycemia, leading to multiple organ dysfunction syndrome (MODS) necessitating intensive care. Remarkably, no haemorrhagic manifestations were observed. The MODS gradually resolved by the 12th day of admission, coinciding with the emergence of complaints about uniocular diplopia and right esotropia. Systemic examination, including a normal computed tomography (CT) head scan, did not reveal any abnormalities. Additionally, potential causes contributing to esotropia and diplopia were ruled out. The patient was subsequently managed expectantly for lateral rectus palsy following severe dengue. Follow-up assessments indicated a gradual improvement in esotropia and diplopia, and the patient was advised to continue the prescribed medications. Conclusion: This is the first documented case report of paralytic squint post-severe dengue in Nepal, emphasizing the importance of considering it as a differential diagnosis in tropical regions with endemic dengue infections. The case report advocates early identification and treatment of ophthalmic issues, notably with prednisolone, to achieve favourable outcomes, as evidenced by improvements in visual acuity, esotropia, and diplopia during follow-ups. Further research is essential to determine optimal treatment strategies for such neurological complications associated with dengue fever.

A Rare Case of Acute Pancreatitis as an Initial Presentation of Acute Myeloid Leukemia.

Acute pancreatitis is a rare manifestation of acute myeloid leukemia which can be a presentation at the initial diagnosis or during or after the onset of the disease. Acute myeloid leukemia occurs due to the abnormal proliferation of undifferentiated hematopoietic stem cells in the bone marrow which alter the normal hematopoiesis. We report the case of a 32-year-old male admitted with a one-month history of fever and backache, followed by 15 days of blackish stool discoloration and two days of abdominal pain and reduced urine output. On clinical examination, he was hypoxic with respiratory distress with epigastric tenderness. Blood investigations and imaging were consistent with acute pancreatitis. A complete blood count with peripheral smear showed severe normocytic normochromic anemia and an increased myeloid series containing 50% myeloblasts and 30% monoblasts. Additionally, some cells displayed cytoplasmic vacuolations, with a reticulocyte count of 2%. These findings were suggestive of acute myeloid leukemia M5. Due to the poor Glasgow Coma Scale (GCS), he was intubated and placed on mechanical ventilation. Unfortunately, he did not improve despite treatment and succumbed to the illness.

The role and therapeutic potential of SIRTs in sepsis.

Sepsis is a life-threatening organ dysfunction caused by the host's dysfunctional response to infection. Abnormal activation of the immune system and disturbance of energy metabolism play a key role in the development of sepsis. In recent years, the Sirtuins (SIRTs) family has been found to play an important role in the pathogenesis of sepsis. SIRTs, as a class of histone deacetylases (HDACs), are widely involved in cellular inflammation regulation, energy metabolism and oxidative stress. The effects of SIRTs on immune cells are mainly reflected in the regulation of inflammatory pathways. This regulation helps balance the inflammatory response and may lessen cell damage and organ dysfunction in sepsis. In terms of energy metabolism, SIRTs can play a role in immunophenotypic transformation by regulating cell metabolism, improve mitochondrial function, increase energy production, and maintain cell energy balance. SIRTs also regulate the production of reactive oxygen species (ROS), protecting cells from oxidative stress damage by activating antioxidant defense pathways and maintaining a balance between oxidants and reducing agents. Current studies have shown that several potential drugs, such as Resveratrol and melatonin, can enhance the activity of SIRT. It can help to reduce inflammatory response, improve energy metabolism and reduce oxidative stress, showing potential clinical application prospects for the treatment of sepsis. This review focuses on the regulation of SIRT on inflammatory response, energy metabolism and oxidative stress of immune cells, as well as its important influence on multiple organ dysfunction in sepsis, and discusses and summarizes the effects of related drugs and compounds on reducing multiple organ damage in sepsis through the pathway involving SIRTs. SIRTs may become a new target for the treatment of sepsis and its resulting organ dysfunction, providing new ideas and possibilities for the treatment of this life-threatening disease.

Ivabradine in Septic Shock: A Narrative Review.

In patients with septic shock, compensatory tachycardia initially serves to maintain adequate cardiac output and tissue oxygenation but may persist despite appropriate fluid and vasopressor resuscitation. This sustained elevation in heart rate and altered heart rate variability, indicative of autonomic dysfunction, is a well-established independent predictor of adverse outcomes in critical illness. Elevated heart rate exacerbates myocardial oxygen demand, reduces ventricular filling time, compromises coronary perfusion during diastole, and impairs the isovolumetric relaxation phase of the cardiac cycle, contributing to ventricular-arterial decoupling. This also leads to increased ventricular and atrial filling pressures, with a heightened risk of arrhythmias. Ivabradine, a highly selective inhibitor of the sinoatrial node's pacemaker current (If or "funny" current), mitigates heart rate by modulating diastolic depolarization slope without affecting contractility. By exerting a selective chronotropic effect devoid of negative inotropic properties, ivabradine shows potential for improving hemodynamics in septic shock patients with cardiac dysfunction. This review evaluates the plausible mechanisms and existing evidence regarding the utility of ivabradine in managing patients with septic shock.

Nitrogen Loss and Migration in Rice Fields under Different Water and Fertilizer Modes.

Irrigating aquaculture wastewater in appropriate irrigation and drainage modes in paddy fields could reduce water and fertilizer loss. However, the precise mechanisms involved in the degradation and movement of nitrogen in various water and fertilizer modes are still not fully understood. This study involves conducting a controlled experiment using barrels to examine the effects of various water quality, irrigation and drainage methods, and fertilization levels. The aim is to analyze the patterns of nitrogen degradation, loss, migration, and absorption in surface water, underground drainage, and soil leakage at different depths. The results showed the following: (1) The paddy field has a significant purification effect on aquaculture wastewater after one day of irrigation, reached at 78.55-96.06%. (2) Aquaculture wastewater irrigation increased nitrogen concentration in the plough layer, which helps rice roots absorb nitrogen and boosts plant TN. (3) In special dry years, underground seepage is the predominant method of nitrogen loss, and underground drainage nitrogen concentration peaks 2-6 days after fertilization. (4) Under aquaculture wastewater irrigation, the TN loss load of II decreased by 27.65-42.45% than FSI. Compared with IA-80, the TN degradation rate of IA in surface water increased by 18.51%, TN loss load decreased by 5.48%, TN absorption rate significantly increased by 14.61%, and yield increased by 31.14% significantly. IA is recommended in special dry years, which can improve the TN absorption rate and ensure high yield while significantly reducing the loss load of nitrogen. The findings can provide a basis for the purification of aquaculture wastewater through paddy field ecosystems in response to fertilizer supply levels.

Early selective enteral feeding in treatment of acute pancreatitis: A case report.

BACKGROUND: Early initiation of enteral feeding is recognized to play a crucial role in improving the outcomes of treatment of acute pancreatitis. However, the method of administration of enteral nutrition remains debatable. We present the experience of treating a patient with moderate-severe acute pancreatitis, at high risk of progressing to a severe or fatal condition, using a novel method of selective feeding with duodenal isolation. CASE SUMMARY: A 27-year-old female patient presented to the emergency unit of the hospital with a typical manifestation of acute pancreatitis. Despite a conventional treatment, the patient's condition deteriorated by day 2 of hospitalization. Using an endoscopic approach, a novel catheter PandiCath® was placed to the duodenum of the patient, isolating its segment between the duodenal bulb and the ligament of Treitz. In the isolated area created, a negative pressure was applied, followed by introduction of early selective enteral feeding. The patient's condition subsequently improved in a rapid manner, and no complications often associated with moderate-to-severe acute pancreatitis developed. CONCLUSION: Within 48 h of starting treatment with the novel method, it can prevent the development of multiple organ failure and, when combined with minimally invasive drainage methods, help prevent infection.

The Prognostic Value of a Liver Function Test Using Indocyanine Green (ICG) Clearance in Patients with Multiple Organ Dysfunction Syndrome (MODS).

BACKGROUND: Multiple organ dysfunction syndrome (MODS) is common in intensive care units (ICUs) and is associated with high mortality. Although there have been multiple investigations into a multitude of organ dysfunctions, little is known about the role of liver dysfunction. In addition, clinical and laboratory findings of liver dysfunction may occur with a significant delay. Therefore, the aim of this study was to investigate whether a liver function test, based on indocyanine green (ICG)-clearance, contains prognostic information for patients in the early phase of MODS. METHODS: The data of this analysis were based on the MODIFY study, which included 70 critically ill patients of a tertiary medical ICU in the early phase of MODS (≤24 h after diagnosis by an APACHE II score ≥ 20 and a sinus rhythm ≥ 90 beats per minute, with the following subgroups: cardiogenic (cMODS) and septic MODS (sMODS)) over a period of 18 months. ICG clearance was characterized by plasma disappearance rate = PDR (%/min); it was measured non-invasively by using the LiMON system (PULSION Medical Systems, Feldkirchen, Germany). The PDR was determined on the day of study inclusion (baseline) and after 96 h. The primary endpoint of this analysis was 28-day mortality. RESULTS: ICG clearance was measured in 44 patients of the MODIFY trial cohort, of which 9 patients had cMODS (20%) and 35 patients had sMODS (80%). Mean age: 59.7 ± 16.5 years; 31 patients were men; mean APACHE II score: 33.6 ± 6.3; 28-day mortality was 47.7%. Liver function was reduced in the total cohort as measured by a PDR of 13.4 ± 6.3%/min At baseline, there were no relevant differences between survivors and non-survivors regarding ICG clearance (PDR: 14.6 ± 6.1%/min vs. 12.1 ± 6.5%/min; p = 0.21). However, survivors showed better liver function than non-survivors after 96 h (PDR: 21.9 ± 6.3%/min vs. 9.2 ± 6.3%/min, p < 0.05). Consistent with these findings, survivors but not non-survivors show a significant improvement in the PDR (7.3 ± 6.3%/min vs. -2.9 ± 2.6%/min; p < 0.01) within 96 h. In accordance, receiver-operating characteristic curves (ROCs) at 96 h but not at baseline show a link between the PDR and 28-day mortality (PDR at 96 h: AUC: 0.87, 95% CI: 0.76-0.98; p < 0.01. CONCLUSIONS: In our study, we found that ICG clearance at baseline did not provide prognostic information in patients in the early stages of MODS despite being reduced in the total cohort. However, improvement of ICG clearance 96 h after ICU admission is associated with reduced 28-day mortality.

Analysis of risk factors for acute kidney injury in children with severe wasp stings.

BACKGROUND: Acute kidney injury (AKI) is common in children with sepsis, chronic kidney disease, poisoning or other conditions. Wasp stings are recognized as an important etiology. Several retrospective studies have investigated AKI after wasp stings in adults, but research on children remains limited. METHODS: The study included 48 children with multiple organ dysfunction syndrome after wasp stings. Demographic data, clinical manifestations, laboratory findings, management and clinical outcomes were collected, and analyzed to identify early indicators or risk factors for AKI. RESULTS: 20 children (41.7%) developed AKI, and 28 (58.3%) did not. Serum creatine levels elevated mostly within 24 h from stings in children with AKI (16/20, 80%). Compared with non-AKI group, AKI group exhibited more cases with cola-colored urine, jaundice, and had higher sting numbers/body surface area (BSA) and higher revised sequential organ failure assessment scores (rSOFA) as well as higher levels of C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), lactate dehydrogenase (LDH), troponin (cTnI), creatine kinase (CK), and longer prothrombin time (PT). Both univariable and multivariable logistic regression analysis identified cola-colored urine as a potential early risk factor for AKI. CONCLUSIONS: The AKI group exhibited higher sting numbers/BSA, higher levels of CRP, ALT, AST, TBIL, LDH, cTnI, and CK, as well as longer PT (p < 0.05). Our findings also suggest that cola-colored urine may serve as an early indicator or potential risk factor for AKI after wasp stings in children, which is very easy to identify for first aiders or pediatricians.

Prevention of lipid droplet accumulation by DGAT1 inhibition ameliorates sepsis-induced liver injury and inflammation.

Background & Aims: Lipid droplet (LD) accumulation in cells and tissues is understood to be an evolutionarily conserved tissue tolerance mechanism to prevent lipotoxicity caused by excess lipids; however, the presence of excess LDs has been associated with numerous diseases. Sepsis triggers the reprogramming of lipid metabolism and LD accumulation in cells and tissues, including the liver. The functions and consequences of sepsis-triggered liver LD accumulation are not well known. Methods: Experimental sepsis was induced by CLP (caecal ligation and puncture) in mice. Markers of hepatic steatosis, liver injury, hepatic oxidative stress, and inflammation were analysed using a combination of functional, imaging, lipidomic, protein expression and immune-enzymatic assays. To prevent LD formation, mice were treated orally with A922500, a pharmacological inhibitor of DGAT1. Results: We identified that liver LD overload correlates with liver injury and sepsis severity. Moreover, the progression of steatosis from 24 h to 48 h post-CLP occurs in parallel with increased cytokine expression, inflammatory cell recruitment and oxidative stress. Lipidomic analysis of purified LDs demonstrated that sepsis leads LDs to harbour increased amounts of unsaturated fatty acids, mostly 18:1 and 18:2. An increased content of lipoperoxides within LDs was also observed. Conversely, the impairment of LD formation by inhibition of the DGAT1 enzyme reduces levels of hepatic inflammation and lipid peroxidation markers and ameliorates sepsis-induced liver injury. Conclusions: Our results indicate that sepsis triggers lipid metabolism alterations that culminate in increased liver LD accumulation. Increased LDs are associated with disease severity and liver injury. Moreover, inhibition of LD accumulation decreased the production of inflammatory mediators and lipid peroxidation while improving tissue function, suggesting that LDs contribute to the pathogenesis of liver injury triggered by sepsis. Impact and Implications: Sepsis is a complex life-threatening syndrome caused by dysregulated inflammatory and metabolic host responses to infection. The observation that lipid droplets may contribute to sepsis-associated organ injury by amplifying lipid peroxidation and inflammation provides a rationale for therapeutically targeting lipid droplets and lipid metabolism in sepsis.

Treatment of patients with multiple organ dysfunction syndrome (MODS) with an electromagnetic field coupled to biorhythmically defined impulse configuration: the MicrocircMODS study.

BACKGROUND: To potentially improve impaired vasomotion of patients with multiple organ dysfunction syndrome (MODS), we tested whether an electromagnetic field of low flux density coupled with a biorhythmically defined impulse configuration (Physical Vascular Therapy BEMER®, PVT), in addition to standard care, is safe and feasible and might improve disturbed microcirculatory blood flow and thereby improve global haemodynamics. METHODS: In a prospective, monocentric, one-arm pilot study, 10 MODS patients (APACHE II score 20-35) were included. Patients were treated, in addition to standard care, for 4 days with PVT (3 treatment periods of 8 min each day; day 1: field intensity 10.5 µT; day 2:14 µT, day 3:17.5 µT; day 4:21.0 µT). Primary endpoint was the effect of PVT on sublingual microcirculatory perfusion, documented by microvascular flow index (MFI). Patient safety, adverse events, and outcomes were documented. RESULTS: An increase in MFI by approximately 25% paralleled 4-day PVT, with the increase starting immediately after the first PVT and lasting over the total 4-day treatment period. Concerning global haemodynamics (secondary endpoints), halving vasopressor use within 24 h, and haemodynamic stabilisation paralleled 4-day PVT with an increase in cardiac index, stroke volume index, and cardiac power index by 30%-50%. No adverse events (AEs) or serious adverse events (SAEs) were classified as causally related to the medical product (PVT) or study. Three patients died within 28 days and one patient between 28 and 180 days. CONCLUSION: PVT treatment was feasible and safe and could be performed without obstruction of standard patient care. An increase in microcirculatory blood flow, a rapid reduction in vasopressor use, and an improvement in global haemodynamics paralleled PVT treatment. Findings of this pilot study allowed forming a concept for a randomized trial for further proof.