RESUMEN
PURPOSE: One of the most common causes of intensive care unit admission in the immunocompromised population is acute respiratory failure. This population has many unique characteristics that render their respiratory failure risk factors, etiologies, and management different from the general nonimmunocompromised population. While mortality rates have improved in the setting of invasive mechanical ventilation, it remains higher than the general population, making prevention of intubation a key area of interest. RECENT FINDINGS: Acute respiratory failure in immunocompromised patients is common, complex, and associated with a high case-fatality rate. Ventilatory strategies should be tailored to the clinical context and to the prognosis of the underlying condition. In eligible patients, early ICU admission, a thorough work up to identify the etiology and invasive mechanical ventilation should not be delayed once criteria for intubation are met, despite attempts at noninvasive oxygenation. Future research should aim move beyond a binary definition of immunosuppression and account for its complexities to identify sub-phenotypes most likely to benefit from specific therapeutic strategies, thereby advancing the personalization of care. SUMMARY: This review explores the literature on noninvasive respiratory support, invasive mechanical ventilation, and extracorporeal life support and the unique considerations in the immunocompromised population.
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Cuidados Críticos , Oxigenación por Membrana Extracorpórea , Huésped Inmunocomprometido , Respiración Artificial , Síndrome de Dificultad Respiratoria , Insuficiencia Respiratoria , Humanos , Respiración Artificial/métodos , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/inmunología , Unidades de Cuidados Intensivos , Oxigenación por Membrana Extracorpórea/métodos , Cuidados Críticos/métodos , Factores de Riesgo , Enfermedad Aguda , Ventilación no Invasiva/métodos , Síndrome de Dificultad Respiratoria/terapiaRESUMEN
OBJECTIVE: Benign prostatic hyperplasia (BPH) is a common urinary disease in elderly men, with acute urinary retention (AUR) severely impacting quality of life. Urodynamic abnormalities and prostate-specific antigen (PSA) levels reflect urinary obstruction and prostate enlargement/inflammation. This study was to correlate the two factors with AUR in BPH patients. METHODS: A total of 120 BPH patients were divided into AUR group and non-AUR group, with 60 cases in each group. Clinical, laboratory, and urodynamic data were collected. Independent variables with significant differences in univariate analysis were included in multifactorial logistic regression analysis. The diagnostic value of urodynamic parameters and PSA for AUR in BPH patients was assessed. A spline regression model was established to analyze the relationship between AUR and PSA. RESULTS: Elevated levels of urodynamic parameters volume at first desire to void (FDV), bladder compliance (BC), total PSA (tPSA), and free PSA (fPSA) were independent risk factors for AUR in BPH patients. FDV and tPSA showed high predictive efficacy, while BC and fPSA relatively weaker. tPSA was positively correlated with both FDV and BC. fPSA was positively correlated only with FDV. CONCLUSION: FDV and BC with tPSA and fPSA are significantly elevated in BPH patients with AUR and show a strong association.
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Antígeno Prostático Específico , Hiperplasia Prostática , Retención Urinaria , Urodinámica , Humanos , Masculino , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/sangre , Hiperplasia Prostática/fisiopatología , Retención Urinaria/etiología , Retención Urinaria/fisiopatología , Retención Urinaria/sangre , Antígeno Prostático Específico/sangre , Urodinámica/fisiología , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Enfermedad Aguda , Factores de RiesgoRESUMEN
Acute eosinophilic pneumonia (AEP) is a rare, rapidly progressive respiratory disease characterized by diffuse pulmonary eosinophilia. Its etiology, clinical course, and prognosis in children remain incompletely understood. We conducted a retrospective cohort study at Yuying Children's Hospital, enrolling children diagnosed with AEP between January 2014 and December 2024. Demographic, clinical, laboratory, radiological, treatment, and outcome data were analyzed. Among 31 patients with pediatric AEP, the highest proportion occurred in autumn (38.7%). Respiratory infections were identified in 26 (83.9%) patients, most commonly Mycoplasma pneumoniae (n = 12) and human bocavirus (n = 4). Passive smoke exposure was identified in five patients (16.1%). Children with allergic comorbidities (10/31, 32.3%) demonstrated significantly elevated total immunoglobulin E levels (median, 742.0 vs. 317.5 IU/mL, P = 0.012), but otherwise comparable clinical laboratory profiles. Fifteen patients (48.4%) who presented with respiratory failure demonstrated significantly elevated procalcitonin (PCT, 0.39 vs. 0.07 µg/L, P = 0.002) and D-dimer levels (1.10 vs. 0.55 µg/mL, P = 0.015), longer hospital stays (7.0 vs. 5.0 days, P = 0.028), and a higher prevalence of pleural effusion (53.3% vs. 18.8%, P = 0.044) compared with the non-respiratory failure group. Twenty-two patients (71.0%) received systemic corticosteroids. Most achieved full recovery, though asthma (n = 5) was observed during follow-up. CONCLUSION: Pediatric AEP is primarily infection-driven, with a probable autumn seasonality and passive smoke exposure as a potential co-trigger. Elevated PCT and D-dimer levels are associated with the development of respiratory failure. The overall prognosis is generally favorable, but long-term follow-up is essential to monitor sequelae. WHAT IS KNOWN: ⢠AEP is a rare, acute hypoxemic disease characterized by eosinophil-mediated inflammation triggered by infection, inhalational exposures, or medications. ⢠It responds rapidly to corticosteroid therapy; pediatric-specific guidelines are lacking, and existing evidence is largely limited to case reports. WHAT IS NEW: ⢠Pediatric AEP appears to be primarily infection-driven, with autumn clustering and a potential contribution from passive smoke exposure, while generally maintaining a favorable prognosis. ⢠Elevated PCT and D-dimer levels are associated with the development of respiratory failure in pediatric AEP.
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Eosinofilia Pulmonar , Humanos , Estudios Retrospectivos , Masculino , Femenino , Niño , Pronóstico , Preescolar , Enfermedad Aguda , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/epidemiología , Eosinofilia Pulmonar/tratamiento farmacológico , Eosinofilia Pulmonar/complicaciones , Lactante , Adolescente , Estaciones del AñoRESUMEN
Acute gastroenteritis (AGE) is a significant cause of morbidity and mortality among children under five years where viral agents are major contributors to AGE. Limited data exist on molecular epidemiology of viral gastroenteritis in northeastern India. The present study aimed to determine the prevalence and molecular diversity of major viral agents causing AGE in children under five years in Assam, India. A hospital-based prospective study was conducted from January 2022 to December 2023. Stool samples (n = 110) from children with AGE were screened for rotavirus A (RVA), adenovirus (HAdV), norovirus (NoV), astrovirus (HAstV) and sapovirus (SaV) using multiplex real-time Polymerase Chain Reaction, followed by genotyping and sequencing of selected isolates. Phylogenetic analysis was conducted to identify specific circulating strains. Enteric viruses were detected in 44.5 % (49/110) of samples. HAdV (16.36 %) was the most prevalent, followed by RVA (11.81 %), NoV GII (7.27 %), SaV (0.9 %) and HAstV (0.9 %). Mixed infections occurred in 14.55 %, mainly HAdV-NoV GII. Phylogenetic analysis identified HAdV species F (serotypes 40 and 41), NoV genotypes GII.4 and GII.2, RVA genotype G3P[8] and HAstV-1. HAdV-41 was the predominant adenovirus type, closely related to global strains. No correlation was found between mixed infections and disease severity. The predominance of HAdV-41 and exclusive detection of RVA G3P[8] reflect evolving viral epidemiology in the post-rotavirus vaccine era. Continuous molecular surveillance and strengthened WASH (water, sanitation and hygiene) interventions are essential to guide vaccine strategies and reduce the burden of viral gastroenteritis in young children in northeast India.
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Gastroenteritis , Virosis , Virus , Humanos , Gastroenteritis/virología , Gastroenteritis/epidemiología , India/epidemiología , Preescolar , Lactante , Estudios Prospectivos , Filogenia , Heces/virología , Masculino , Femenino , Genotipo , Prevalencia , Epidemiología Molecular , Enfermedad Aguda/epidemiología , Virus/genética , Virus/clasificación , Virus/aislamiento & purificación , Rotavirus/genética , Rotavirus/aislamiento & purificación , Norovirus/genética , Norovirus/aislamiento & purificación , Virosis/epidemiología , Virosis/virologíaRESUMEN
BACKGROUND: Several aspects of acute type A aortic dissection (ATAAD) management remain debated. The strategies for arterial cannulation, cerebral protection, temperature management and extent of aortic resection are all contested. We aimed to explore and describe variations in the current management of patients with ATAAD in the Nordic countries, which form a limited geographic region with similar healthcare systems. METHODS: A 32-item questionnaire regarding the organizational and periprocedural aspects of care for patients with ATAAD was sent to 17 Nordic cardiac surgery units, prospective collaborators in the Nordic Consortium for Acute type A Aortic Dissection. Results were summarized using descriptive statistics. RESULTS: The response rate was 12/17 (71%). Fifty-eight per cent of centres used femoral artery cannulation, of which two centres (17%) used femoral artery cannulation in addition to another method. Nine centres (75%) used cerebral perfusion in most of surgical repairs requiring HCA, and among those using cerebral perfusion, 92% opted for antegrade cerebral perfusion. Five centres (42%) stated that total arch replacements were never performed. Valve sparing root replacements were performed by seven centres (58%). Regarding postoperative surveillance, all centres reported that CT-scans were performed at 6-12 months intervals. CONCLUSION: Although strategies for pre-, peri-, and postoperative management of patients with ATAAD could be expected to be reasonably similar, we found several differences in almost all aspects of management. The current survey may help identify relevant research questions that can be explored in the NORCAAD2 database, ultimately contributing to the development of consensus documents and guidelines.
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Aneurisma de la Aorta , Disección Aórtica , Implantación de Prótesis Vascular , Disparidades en Atención de Salud , Pautas de la Práctica en Medicina , Procedimientos Quirúrgicos Vasculares , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/fisiopatología , Países Escandinavos y Nórdicos/epidemiología , Pautas de la Práctica en Medicina/tendencias , Enfermedad Aguda , Resultado del Tratamiento , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Encuestas de Atención de la Salud , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/tendencias , Disparidades en Atención de Salud/tendencias , Cateterismo Periférico/tendencias , Cateterismo Periférico/efectos adversos , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/tendencias , Factores de Tiempo , Circulación Cerebrovascular , Hipotermia Inducida/tendencias , Hipotermia Inducida/efectos adversosRESUMEN
A 41-year-old woman presented to the emergency department with a widespread pruritic, erythematous eruption following 6 weeks of kava consumption for anxiety and insomnia. The eruption began on the abdomen and progressively involved the chest, upper back and face. Laboratory investigations revealed mild derangement of liver function test results. Skin biopsy results demonstrated folliculocentric inflammation and necrosis of sebaceous glands, consistent with acute kava dermopathy. Kava, a traditional anxiolytic herbal preparation, has been implicated in both chronic and acute cutaneous reactions, including ichthyosiform and sebotropic eruptions. Its active compounds, kavalactones, are hypothesised to provoke a cytotoxic T-cell-mediated response targeting sebaceous glands. This case is notable as it occurred in an Australian woman with no travel history to the Pacific Islands-a region where kava use is prevalent. Moreover, the distinct histopathological findings, rarely documented in the literature, provide valuable diagnostic insight and serve as a visual reference for clinicians encountering this condition.
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Erupciones por Medicamentos , Kava , Humanos , Femenino , Adulto , Kava/efectos adversos , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Erupciones por Medicamentos/diagnóstico , Enfermedad AgudaRESUMEN
BACKGROUND: Radiodermatitis is one of the most common radiotherapy-related side effects, which can influence patients' quality of life and affect therapeutic efficacy. Photobiomodulation therapy (PBMT) appears as a low-cost technology, with significant results in the tissue repair process. METHODS: It is a triple blind randomized controlled trial. A total of 96 patients undergoing radiotherapy for breast cancer are estimated for the sample, which will be randomly assigned to a control group to receive a placebo and the institution's standard protocol (n = 48) or to an intervention group to receive PBMT, in addition to standard therapy (n = 48). The intervention consists of applying Laser Therapy EC (DMC™, São Carlos-SP, Brazil), with power of 100mW, continuous emission mode, red wavelength (660 ± 20 nm), fluence of 10.16 J/cm2, and energy of 1 J per point, three times a week since day one, right before the radiotherapy session. Blinding will be applied to patients, evaluators, and the statistician. Skin reactions will be assessed weekly using the Acute Radiation Morbidity Scoring Criteria developed by the Radiation Therapy Oncology Group and thermal images of the irradiated area that will be captured. In addition, the impact of radiodermatitis on the quality of life will be assessed through the application of the Cancer Quality of Life Questionnaire (EORTC QLQ-30) and the Breast Cancer Quality of Life Questionnaire (EORTC QLQ -BR23) at the beginning and in the end of treatment. Data will be processed and analyzed by the statistical package R using descriptive and inferential statistics. DISCUSSION: Photobiomodulation stands out for being a non-invasive and low-cost therapy that has not been associated with adverse events. It used to stimulate wound healing by promoting tissue repair, by reducing inflammation, by stimulating collagen synthesis, and relieving pain. Cientific literature have been highlighted PBMT as an effective tool in preventing or reducing the severity of radiodermatitis and its associated symptoms, which expected to be demonstrated with this ongoing study. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC - Registro Brasileiro de Ensaios Clínicos) - Id. RBR-7gkw3d4; Universal Trial Number (UTN) - Id. U1111-1279-1686; Plataforma Brasil/Research Ethics Committee - Id. 5.788.390, registered on 24 August 2022. https://ensaiosclinicos.gov.br/rg/RBR-7gkw3d4 .
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Neoplasias de la Mama , Terapia por Luz de Baja Intensidad , Radiodermatitis , Femenino , Humanos , Enfermedad Aguda , Brasil , Neoplasias de la Mama/radioterapia , Terapia por Luz de Baja Intensidad/efectos adversos , Terapia por Luz de Baja Intensidad/métodos , Calidad de Vida , Radiodermatitis/etiología , Radiodermatitis/radioterapia , Radiodermatitis/diagnóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Acute anal fissure is a common cause of severe pain in the anorectal region. The standard treatment is the topical application of a calcium channel blocker or glyceryl trinitrate. Despite acute anal fissure being a common proctologic condition, data on the healing rates and long-term outcomes remain scarce. This study aimed to evaluate data from our centre, with a special focus on long-term follow-up and recurrent disease. METHODS: All consecutive patients who presented with acute anal fissure between January 2016 and December 2016 were retrospectively identified. Patients were included if their clinical symptoms lasted for less than 6 weeks, secondary changes to fissure morphology were absent, and data from follow-up examinations were available. Clinical features, symptoms, therapy and long-term outcomes were evaluated. RESULTS: A total of 623 patients with a median age of 45 years were included; 342/623 patients were female (54.9%). The median follow-up period was 41 months (range 6 weeks-89 months), and 39.5% of the patients had a follow-up duration exceeding 5 years. Most fissures occurred in the 6 o'clock lithotomy position (63.7%), in the 12 o'clock position (21.0%), or in both (4.5%). In 67/623 patients, the fissure was in an atypical region (10.8%). In 439/623 patients, the fissure healed completely (70.5%). A total of 8.7% of the patients underwent fissurectomy, and 180/623 patients experienced recurrence (28.9%). CONCLUSIONS: The management of acute anal fissure can be challenging because recurrence is common. Conservative management is successful in the majority of cases. Surgery is necessary only for a minority of patients.
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Bloqueadores de los Canales de Calcio , Fisura Anal , Nitroglicerina , Humanos , Fisura Anal/terapia , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Recurrencia , Enfermedad Aguda , Estudios de Seguimiento , Nitroglicerina/uso terapéutico , Nitroglicerina/administración & dosificación , Adulto Joven , Anciano , Factores de Tiempo , Adolescente , Bloqueadores de los Canales de Calcio/uso terapéutico , Bloqueadores de los Canales de Calcio/administración & dosificación , Cicatrización de HeridasRESUMEN
RATIONALE: Colonoscopy is a widely used diagnostic and therapeutic procedure with a low risk of serious adverse events. Acute bilateral lower-limb paralysis following colonoscopy is extremely rare. Acute limb ischemia due to thromboembolism from abdominal aortic aneurysm (AAA) is a vascular emergency that requires prompt diagnosis and intervention. This is the report of a unique case of acute limb ischemia due to thromboembolism associated with infrarenal AAA following colonoscopy. This case report aims to raise clinical awareness of the potential risk of thromboembolic complications after colonoscopy. Further, this case suggests a potential mechanism in which hemodynamic alterations or periprocedural factors, such as dehydration associated with bowel preparation, may have contributed to thrombus dislodgement and subsequent embolization. PATIENT CONCERNS: A 67-year-old man with acute paraplegia was referred to our emergency department following colonoscopy. DIAGNOSES: The patient was diagnosed with acute thromboembolism associated with an infrarenal AAA, resulting in paraplegia following colonoscopy, as confirmed by computed tomography angiography. INTERVENTIONS: The patient underwent emergent aorto-bifemoral bypass, bilateral lower extremity thrombectomy, and left femoral artery-to-distal superficial femoral artery bypass surgery. OUTCOMES: Although revascularization was technically successful, the patient died of massive reperfusion injury. LESSONS: Acute paraplegia caused by thromboembolism from an infrarenal AAA following colonoscopy is extremely rare but potentially fatal. Awareness of this potential adverse event after colonoscopy is critical to avoid severe outcomes and improve patient prognoses.
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Aneurisma de la Aorta Abdominal , Colonoscopía , Paraplejía , Tromboembolia , Humanos , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/cirugía , Masculino , Anciano , Colonoscopía/efectos adversos , Paraplejía/etiología , Tromboembolia/etiología , Tromboembolia/complicaciones , Tromboembolia/cirugía , Resultado Fatal , Enfermedad AgudaRESUMEN
BACKGROUND: Acute pancreatitis (AP) or abdominal pain does not always precede chronic pancreatitis (CP), but prevalence estimates from prior studies utilized variable definitions of CP. We aimed to examine the clinical characteristics of CP patients presenting with and without AP or abdominal pain. METHODS: The records of consecutive patients with definite CP per the M-ANNHEIM criteria between 2010 and 2023 were reviewed. AP was defined as per the revised Atlanta classification. AP preceding or concurrent with CP was defined as a diagnosis of CP >1 or ≤1 year after an index episode of AP, respectively. Painful CP was defined as a presentation with abdominal pain but without a history of AP. Primary painless CP was defined as having no history of abdominal pain or AP. RESULTS: Among a total of 548 CP patients, 306 (55.8%) had AP preceding CP, 96 (17.5%) had AP concurrent with CP, 100 (18.2%) had painful CP, and 46 (8.4%) had primary painless CP. The median time from index AP and onset of abdominal pain to a CP diagnosis was 4.67 [1.45, 7.89] years and 5.0 [1, 16.5] months, respectively. Smoking-only etiology of CP was 3 times more prevalent in AP concurrent with CP compared with AP preceding CP (20.8% vs. 7.5%, P<0.001). AP preceding or concurrent with CP compared with the painful and primary painless CP was more prevalent in those with an alcohol etiology (38%, 28% vs. 20%, P=0.01) and in younger patients (49.4±15.4, 57.5±13.4 vs. 70.0±10.1 y, P<0.001). Primary painless CP was found more frequently in patients with advanced age (70.0±10.1 y), male gender (66.7%), and an idiopathic etiology (50.0%) compared with all of the other groups (P<0.05). CONCLUSION: Preceding or concurrent AP is found in nearly 75% of patients with definite CP by the M-ANNHEIM classification. Pain-only presentations are seen in 20% of patients with definite CP. Age of disease onset and etiology have a significant impact on the clinical presentation of CP patients.
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Dolor Abdominal , Pancreatitis Crónica , Pancreatitis , Humanos , Dolor Abdominal/diagnóstico , Dolor Abdominal/epidemiología , Dolor Abdominal/etiología , Masculino , Femenino , Pancreatitis Crónica/diagnóstico , Pancreatitis Crónica/epidemiología , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/etiología , Persona de Mediana Edad , Adulto , Pancreatitis/diagnóstico , Pancreatitis/epidemiología , Pancreatitis/etiología , Anciano , Enfermedad Aguda , Estudios Retrospectivos , PrevalenciaRESUMEN
Rhinosinusitis is a spectrum of diseases with varied causes, presentations, and diagnostic approaches-from viral and bacterial acute rhinosinusitis to chronic inflammatory or fungal etiologies. This article reviews the diagnosis of acute, chronic, recurrent, and fungal rhinosinusitis, highlighting key clinical, endoscopic, and radiologic features that distinguish these entities. It provides practical guidance on differentiating viral from bacterial causes, assessing chronic inflammation with and without polyps, and recognizing rare but serious fungal infections. It also explores emerging diagnostic tools such as biomarkers and artificial intelligence that are reshaping personalized care in sinusitis.
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Micosis , Pólipos Nasales , Rinitis , Sinusitis , Humanos , Sinusitis/diagnóstico , Sinusitis/microbiología , Sinusitis/etiología , Pólipos Nasales/diagnóstico , Enfermedad Crónica , Micosis/diagnóstico , Micosis/microbiología , Enfermedad Aguda , Rinitis/diagnóstico , Rinitis/etiología , Rinitis/microbiología , Diagnóstico Diferencial , Biomarcadores , EndoscopíaRESUMEN
BACKGROUND: Adoptive transfer of regulatory T-cells (Tregs) has shown promising therapeutic efficacy in ameliorating graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation. However, the underlying mechanisms have not been thoroughly studied. OBJECTIVE: In this study, we investigated the potential application of adoptive transfer of IL-33-cultured Tregs to prevent acute graft-versus-host disease (aGVHD) and its underlying mechanism. STUDY DESIGN: Tregs were magnetically isolated from the spleen of C57BL/6 mice and subsequently cultured with IL-2 (TregIL-2) or IL-2 + IL-33 (TregIL-33) for 7d. BALB/c mice received 6 Gy of total body irradiation 24 h prior to transplantation. After irradiation, ex vivo cultured TregIL-2 or TregIL-33 cells were co-adoptively transferred with splenocytes and T cell-depleted bone marrow cells from C57BL/6 donors. On day 8 post transplantation, splenocytes and liver cells were collected and analyzed by flow cytometry for M1/M2 macrophage populations and T cell subsets. For in vitro experiments, bone marrow derived macrophages (BMDM) were cultured with TregIL-33 cells for 48 h. The M1/M2 macrophage population was detected at both mRNA and protein levels. For TregIL-33 cells, hydroxyprostaglandin dehydrogenase (HPGD) expression and prostaglandin E2 (PGE2) production were examined. To demonstrate that the regulation of macrophage polarization was mediated through the HPGD/PGE2 axis, the HPGD inhibitor SW033291 and an anti-PGE2 antibody were used in a co-culture setting. RESULTS: Adoptive transfer of TregIL-33 cells was more effective in preventing aGVHD than adoptive transfer of TregIL-2. In addition, recipients receiving TregIL-33 cells showed increased Tregs, especially ST2+Tregs frequencies in the spleen and liver, while frequencies of IFN-γ and IL-17 producing conventional T cells were decreased. Meanwhile, the expression of CD86+ type I macrophages was downregulated and that of CD206+ type II macrophages was upregulated in mice co-transferred with TregIL-33 cells. In in vitro study, TregIL-33 cells promoted M2 polarization and inhibited the M1 transition of BMDM compared with BMDM cultured with TregIL-2. Mechanistically, IL-33 induced ST2 expression on Tregs, increased HPGD synthesis, and accelerated PGE2 degradation. Using the HPGD inhibitor SW033291, and an anti-PGE2 antibody, we demonstrated that TregIL-33 cells regulated M1/M2 macrophage polarization via the HPGD/PGE2 axis. Furthermore, blocking HPGD activity with SW033291 abolished the efficacy of TregIL-33 cells in protecting against aGVHD in vivo. CONCLUSION: Our data demonstrate that adoptive transfer of TregIL-33 cells could ameliorate aGVHD by regulating the HPGD/PGE2 axis, thus regulating M1/M2 paradigm.
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Traslado Adoptivo , Dinoprostona , Enfermedad Injerto contra Huésped , Interleucina-33 , Linfocitos T Reguladores , Animales , Enfermedad Injerto contra Huésped/inmunología , Enfermedad Injerto contra Huésped/prevención & control , Enfermedad Injerto contra Huésped/terapia , Linfocitos T Reguladores/inmunología , Linfocitos T Reguladores/trasplante , Interleucina-33/metabolismo , Interleucina-33/inmunología , Dinoprostona/metabolismo , Ratones Endogámicos C57BL , Ratones Endogámicos BALB C , Ratones , Transducción de Señal , Macrófagos/inmunología , Células Cultivadas , Enfermedad AgudaRESUMEN
BACKGROUND: The purpose of this study was to evaluate the safety, effectiveness, and feasibility of thrombus removal using the peroneal vein (PeV) approach in acute iliofemoral deep vein thrombosis (IFDVT). METHODS: From May 2019 to July 2020, the acute IFDVT patients who had undergone AngioJet pharmacomechanical thrombectomy and/or manual aspiration thrombectomy through PeV access were analyzed retrospectively. Clinical characteristics, operative and postoperative therapy details, and PeV access-related data were investigated. Outcome measures included thrombus removal grade, venous patency rate, and the incidence of postthrombotic syndrome (PTS). All patients were followed up for a minimum of 1 year. RESULTS: A total of 42 patients were reviewed. The thrombus involved the popliteal vein in 85.7% (n = 36) of cases. The PeV access was successfully achieved in all patients through 4 puncture methods. Therein, blind puncture under fluoroscopy was used in 52.4% of patients. Postoperatively, the mean thrombolysis time was 4.8 ± 1.9 days, and the average dose of urokinase was 2.7 ± 1.0 million units. All the patients had successfully thrombus lysis, including 9.5% of grade II lysis and 90.5% of grade III lysis. Three complications occurred during the thrombolysis treatment, including 2 puncture site minor bleeding and 1 minor gingival bleeding. During the 1-year follow-up, the venous patency rate and the PTS incidence rate were 97.6% and 9.5%, respectively. CONCLUSION: Thrombus removal of acute IFDVT through PeV access is safe, effective, and feasible, while large cohort studies are needed to confirm the superiority of PeV access.
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Cateterismo Periférico , Vena Femoral , Vena Ilíaca , Trombectomía , Trombosis de la Vena , Humanos , Estudios Retrospectivos , Masculino , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/fisiopatología , Trombosis de la Vena/terapia , Femenino , Trombectomía/efectos adversos , Trombectomía/métodos , Persona de Mediana Edad , Resultado del Tratamiento , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Vena Femoral/diagnóstico por imagen , Vena Femoral/fisiopatología , Factores de Tiempo , Grado de Desobstrucción Vascular , Adulto , Anciano , Enfermedad Aguda , Síndrome Postrombótico/etiología , Estudios de Factibilidad , Punciones , Terapia Trombolítica/efectos adversos , Cateterismo Periférico/efectos adversosRESUMEN
BACKGROUND: The relationship between isolated iliac aneurysms (IIAs) and acute aortic dissection (AAD) is uncertain. We aimed to determine the prevalence of IIAs in patients with AAD and evaluate the independent risk factors for the presence of IIAs in them. METHODS: Seven patients were confirmed to have AAD with IIAs (AAD + IIA group) who had undergone computed tomography angiography (CTA). The control group comprised 597 patients were confirmed with AAD without IIAs (AAD group). Demographic data or baseline characteristics of patients included in this study were completely obtained. Two readers reviewed all CTA scans independently to assess the data of the IIAs. Baseline characteristics were compared between the aortic dissection group and the control group using propensity score matching, and logistic regression analysis was performed to determine the independent risk factors for the presence of IIAs. RESULTS: The average age was 67.57 ± 10.13 years in the AAD + IIA group and 52.09 ± 12.06 years in the AAD group (P = 0.002). The proportion of smokers was respectively 39.6% and 85.7% in the AAD group and AAD + IIA group (P = 0.037). In the control group, no difference in age was observed between the dissections from the aorta to the iliac artery (n = 251 [42%]; 51.08 ± 11.35 years) and those limited to the aortic region (n = 346 [58%]; 52.82 ± 12.51 years) (P = 0.055). Multivariate analysis revealed age as an independent risk factor for the presence of IIAs (odds ratio, 1.144; 95% confidence interval, 1.059-1.235; P = 0.001). Similarly, smoking was an independent risk factor for the presence of IIAs (odds ratio, 14.601; 95% confidence interval, 1.652-129.073; P = 0.016). CONCLUSION: The prevalence of IIA in AAD was 1.2%. Age and smoking can increase the prevalence of IIAs in patients with AAD. Our results can represent a valid aid in selecting patients to be screened, which would improve the treatment outcome. Further prospective studies are warranted to demonstrate the substantial prevalence of IIAs in the AAD population.
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Aneurisma de la Aorta , Disección Aórtica , Aneurisma Ilíaco , Humanos , Aneurisma Ilíaco/epidemiología , Aneurisma Ilíaco/diagnóstico por imagen , Masculino , Prevalencia , Factores de Riesgo , Femenino , Persona de Mediana Edad , Disección Aórtica/epidemiología , Disección Aórtica/diagnóstico por imagen , Anciano , Angiografía por Tomografía Computarizada , Estudios Retrospectivos , Aneurisma de la Aorta/epidemiología , Aneurisma de la Aorta/diagnóstico por imagen , Enfermedad Aguda , Modelos Logísticos , Aortografía/métodos , Fumar/epidemiología , Fumar/efectos adversos , Oportunidad Relativa , Puntaje de Propensión , AdultoRESUMEN
BACKGROUND: The aim of this study is using interpretable machine learning (ML) methods to construct models by combing routine laboratory examination biomarkers and clinical characteristics to identify acute aortic dissection (AAD) patients from other sudden chest pain patients referring to acute myocardial infarction (AMI), acute pulmonary embolism, and abdominal aortic aneurysm. METHODS: The research encompassed a cohort of 832 individuals, with 515 of them diagnosed as AAD patients. Patients were randomly assigned to training and test groups for model development and evaluation, with data collected from medical records and validated by study physicians. Logistic Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for variable selection in the study, which utilized 9 ML algorithms for model development. The DeLong test compared area under the curve (AUC) values among models. Optimal parameters were found through grid search on the training set with 5-fold cross validation. The SHapley Additive exPlanation (SHAP) method ranks input feature importance and explains model outcomes to address model opacity. RESULTS: Utilizing the LASSO regression technique, 8 variables were pinpointed for their nonlinear significance. Evaluation of these models using test set data yielded AUC values between 0.72 and 0.77, suggesting promising utility in differential diagnosis. The Random Forest method demonstrated noteworthy sensitivity, specificity, and F1 Score. The internal validation set consistently yielded results with an AUC ranging from 0.71 to 0.77. The SHAP method was utilized to assess the influence of features on the model, identifying neutrophil (N.L) and age as the most significant variables. CONCLUSION: In this prognostic study, a ML model was created to assist in differentiating patients with aortic dissection from those presenting with chest pain. The use of interpretable ML techniques allows for the prioritization of key features, showcasing significant potential for application in supporting the prompt diagnosis and treatment of aortic dissection differentials.
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Aneurisma de la Aorta , Disección Aórtica , Dolor en el Pecho , Técnicas de Apoyo para la Decisión , Aprendizaje Automático , Humanos , Disección Aórtica/diagnóstico , Disección Aórtica/complicaciones , Disección Aórtica/sangre , Disección Aórtica/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Dolor en el Pecho/etiología , Dolor en el Pecho/diagnóstico , Valor Predictivo de las Pruebas , Anciano , Reproducibilidad de los Resultados , Diagnóstico Diferencial , Enfermedad Aguda , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/sangre , Factores de Riesgo , Estudios Retrospectivos , Medición de RiesgoRESUMEN
PURPOSE OF REVIEW: Currently, no universally accepted definition or management strategy for chronic rhinosinusitis (CRS) and its acute exacerbations (AECRS) exists. This review aims to provide an overview of the current research in this field and to present recent advances in diagnosis and management. RECENT FINDINGS: A variant in the CDHR3 gene has been identified as a risk factor for AECRS, associated with increased viral replication, type-2 cytokine upregulation, and downregulation of Toll-like receptor mediated responses. Microbiome studies show that patients with AECRS are more likely to harbor rare microbial taxa, and most strains isolated during exacerbations form biofilms. Biologic therapies targeting type-2 inflammation have reduced exacerbation rates and decreased the need for antibiotics and systemic corticosteroids. Culture-directed antibiotics may improve longer-term endoscopic outcomes, though short-term symptom and quality-of-life benefits remain unclear. Cost-effectiveness modeling suggests observation is usually the most efficient initial strategy, unless the probability of bacterial etiology exceeds ~49%. In addition, a new patient-informed definition of AECRS has been proposed, although further validation is needed. SUMMARY: Advances in genetics, microbiome analysis, and biologic therapy offer promising avenues, yet definitions and outcome measures remain inconsistent. Robust, long-term studies are still needed to harmonize definitions and standardize management.
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Rinitis , Sinusitis , Humanos , Sinusitis/terapia , Sinusitis/diagnóstico , Sinusitis/microbiología , Enfermedad Crónica , Rinitis/terapia , Rinitis/diagnóstico , Rinitis/microbiología , Enfermedad Aguda , Progresión de la Enfermedad , Antibacterianos/uso terapéutico , RinosinusitisRESUMEN
OBJECTIVE: The under-representation of female patients in key trials results in a lack of sex-based guidelines regarding appropriate evaluation, diagnosis, and management of the female vascular patient. As a result, recent literature has found a difference in the amputation and mortality rates in female patients after treatment for acute limb ischemia (ALI). However, the reasons for outcome variability are unknown. The objectives of this study were to identify sex specific predictors of major amputation and mortality after intervention for ALI and sex-specific differences in the presentation, management, and outcome of patients who undergo revascularization for ALI. METHODS: We included all adults who underwent revascularization for ALI at a multihospital health care system (2016-2023), excluding those who presented secondary to trauma, dissection, iatrogenic injury, popliteal aneurysms, or COVID. The terms male and female were used to delineate patient's sex assignment at birth, were obtained from electronic health records, and were assumed to be congruent with gender references. Survival and amputation were evaluated using Kaplan-Meier and multivariable Cox regression with a priori and empirically selected covariates. Comprehensive subgroup analyses were conducted to assess risk of mortality and amputation. RESULTS: We identified 548 patients, of whom 252 (46%) were female. Male patients were younger (64.4 ± 11.5 years vs 67.0 ± 15.3 years; P = .023), more likely to have coronary artery disease (P = .014), a smoking history (P < .001), and a history of prior revascularization (P < .001). Female patients were more likely to be hypercoagulable (P = .001) and less likely to present with acute-on-chronic disease (P < .001). Female patients were less frequently on a preoperative statin (P < .001) or antiplatelet agent (P = .004). Although there was no sex-based difference in Rutherford ALI classification upon presentation, female patients were more likely to go to the operating room within 24 hours (P = .024). There were no differences in the initial surgical approach (endovascular vs open). Female patients had an increased rate of death on univariable (P = .009) and multivariable (adjusted hazard ratio, 1.6; 95% confidence interval, 1.07-2.33) analyses. On subgroup analyses, female patients who were optimized medically on presentation achieved mortality rates similar to male patients. Although there was no difference in overall amputation rates, female patients who underwent an endovascular first approach were twice as likely to undergo amputation in comparison with males (odds ratio, 2.6; Pinteraction = .01). CONCLUSIONS: Female patients who presented with ALI had higher mortality after revascularization, except for those who were medically optimized. They also had notably higher amputation rates after endovascular intervention. Further exploration of these disparities may allow for tailored intervention strategies by sex.
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Procedimientos Endovasculares , Disparidades en el Estado de Salud , Isquemia , Enfermedad Arterial Periférica , Procedimientos Quirúrgicos Vasculares , Humanos , Femenino , Masculino , Persona de Mediana Edad , Amputación Quirúrgica , Isquemia/mortalidad , Isquemia/cirugía , Isquemia/diagnóstico , Isquemia/terapia , Anciano , Factores de Riesgo , Factores Sexuales , Medición de Riesgo , Enfermedad Aguda , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Recuperación del Miembro , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/cirugía , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Anciano de 80 o más AñosRESUMEN
OBJECTIVES: Endovascular therapy (EVT) is vital for the treatment of acute nonvariceal gastrointestinal bleeding (NVGIB). In this study, the factors influencing EVT efficacy were analyzed to guide treatment optimization. MATERIALS AND METHODS: A retrospective analysis of 172 NVGIB patients who underwent EVT was conducted at our hospital (January 2013-August 2023). Univariate analysis was used to evaluate the associations between clinical variables and four endpoints: positive angiographic findings, successful hemostasis, 30-day rebleeding, and 30-day mortality. Significant factors were analyzed using multivariable logistic regression for these four outcomes. RESULTS: Among the patients, the outcomes were positive angiographic findings (40.1 %, 69/172), successful hemostasis (64.5 %, 111/172), 30-day rebleeding (15.3 %, 17/111), 30-day mortality (24.4 %, 42/172), and complications (2.9 %, 5/172). The shock index (SI) and preoperative contrast-enhanced CT (PECT) were independent predictors of positive angiographic findings (P < 0.05), the fibrinogen concentration (Fib) and transarterial embolization (TAE) were independent predictors of successful hemostasis (P < 0.05), intraoperative use of vasopressors (IOV) were independent predictors of 30-day rebleeding (P < 0.05), and tumor-associated bleeding (TAB) and successful hemostasis were independent predictors of 30-day mortality (P < 0.05). CONCLUSION: EVT serves as a critical therapeutic modality for the management of NVGIB, offering both high technical success rates and favorable clinical outcomes. A comprehensive understanding of the factors influencing prognosis following EVT in patients with acute NVGIB is essential for optimizing treatment efficacy and enhancing risk stratification.
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Procedimientos Endovasculares , Hemorragia Gastrointestinal , Humanos , Masculino , Femenino , Estudios Retrospectivos , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/mortalidad , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/cirugía , Procedimientos Endovasculares/métodos , Anciano , Persona de Mediana Edad , Embolización Terapéutica/métodos , Resultado del Tratamiento , Enfermedad Aguda , Anciano de 80 o más Años , Recurrencia , AngiografíaRESUMEN
Acute graft-vs-host disease (aGVHD) is a serious and potentially life-threatening complication that can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). It is characterized by the activation of innate immune cells during a cytokine storm, often triggered by tissue injury. aGVHD typically impacts the skin, liver, and gastrointestinal tract, resulting in a range of clinical manifestations that can hinder post-transplant recovery, increase risk of infection, and significantly affect patient survival. This review article integrates current knowledge on the prevalence, risk factors, pathophysiology, clinical presentation, and grading of aGVHD. Additionally, we explore existing strategies for prevention and treatment, including the use of immunosuppressive therapies and novel pharmacological agents. By synthesizing recent research findings and clinical insights, we aim to deepen the understanding of aGVHD and promote advancements in its management, ultimately enhancing the quality of life and survival outcomes for patients undergoing allo-HSCT.
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Enfermedad Injerto contra Huésped , Humanos , Enfermedad Injerto contra Huésped/prevención & control , Enfermedad Injerto contra Huésped/fisiopatología , Enfermedad Injerto contra Huésped/terapia , Enfermedad Aguda , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Factores de RiesgoRESUMEN
Patients with cancer-associated thrombosis (CAT) are commonly treated with low-molecular-weight heparin (LMWH), but whether dose capping is needed in patients over 90 kg is unclear. We conducted the WAVe study, a multicenter prospective cohort study in adult patients (≥ 18 years) with acute CAT and a weight of over 90 kg starting anticoagulation. Patients received weight-adjusted dalteparin at 200 IU/kg per day (up to 33 000 IU) for 30 (± 4) days, after which anticoagulation was continued per clinician discretion and followed for 6 months. The primary outcome was major bleeding (MB) at 30 days. Secondary outcomes included objectively confirmed recurrent venous thromboembolism (VTE) at 30 days and trough anti-Xa levels. The cumulative incidences of outcomes were estimated by time-to-event analysis, with death as a competing risk. The study stopped early due to recruitment challenges after 91 patients. Median weight and daily dose of dalteparin were 107.5 kg and 22 500 IU, respectively. Three patients had a MB episode for a cumulative incidence of 5.3% (95% CI 1.1%-14.8%) at 30 days. One patient had recurrent VTE for a cumulative incidence of 1.2% (95% CI 0.1%-5.7%) at 30 days. No significant bioaccumulation noted up to Day 30 based on trough anti-Xa levels. The median Day 7 trough anti-Xa levels were higher in those with bleeding events within 30 days compared to those without (0.6 vs. 0.2 IU/mL, p = 0.01). Our results suggest that weight-adjusted dosing of dalteparin in patients over 90 kg is associated with acceptable rates of bleeding and thrombosis. Trial Registration: NCT03297359.