查看更多>>摘要：The burden of respiratory syncytial virus(RSV)disease is widely recognized.Main risk factors for severe disease,such as extreme ages,chronic cardiopulmonary conditions,and immunosuppression,typically coincide with poorer outcomes.While the majority of RSV hospitalizations involve healthy children,a higher proportion of hospitalized adults with underlying conditions need intensive care.Presently,treatment primarily consists of supportive measures.RSV-induced wheezing should be distinguished from respiratory tract thickening,without response to bronchodilators.Obstructive RSV disease frequently overlaps with viral pneumonia.Non-invasive mechanical ventilation and high-flow oxygen therapy represented significant advancements in the management of severe RSV disease in children and may also hold considerable importance in specific phenotypes of RSV disease in adults.Most severe infections manifest with refractory hypoxemia necessitating more advanced ventilatory support and/or extracorporeal membrane oxygenation therapy.Although bacterial co-infection rates are low,they have been associated with worse outcomes.Antibiotic prescription rates are high.Accurately diagnosing bacterial co-infections remains a challenge.Current evidence and antibiotic stewardship policies advise against indiscriminate antibiotic usage,even in severe cases.The role of currently developing antiviral therapies in severe RSV disease will be elucidated in the coming years,contingent upon the success of new vaccines and immune passive strategies involving nirsevimab.
查看更多>>摘要：Acute respiratory distress syndrome(ARDS),a fatal critical disease,is induced by various insults.ARDS rep-resents a major global public health burden,and the management of ARDS continues to challenge healthcare systems globally,especially during the pandemic of the coronavirus disease 2019(COV1D-19).There remains no confirmed specific pharmacotherapy for ARDS,despite advances in understanding its pathophysiology.Debate continues about the potential role of glucocorticoids(GCs)as a promising ARDS clinical therapy.Questions re-garding GC agent,dose,and duration in patients with ARDS need to be answered,because of substantial variations in GC administration regimens across studies.ARDS heterogeneity likely affects the therapeutic actions of exoge-nous GCs.This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS,especially during the COVID-19 pandemic.
查看更多>>摘要：Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60％of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.
查看更多>>摘要：The nervous and immune systems are crucial in fighting infections and inflammation and in maintaining immune homeostasis.The immune and nervous systems are independent,yet tightly integrated and coordinated organi-zations.Numerous molecules and receptors play key roles in enabling communication between the two systems.Transient receptor potential vanilloid subfamily member 1(TRPV1)is a non-selective cation channel,recently shown to be widely expressed in the neuroimmune axis and implicated in neuropathic pain,autoimmune disor-ders,and immune cell function.TRPV1 is a key bridge in neuroimmune interactions,allowing for smooth and convenient communication between the two systems.Here,we discuss the coordinated cross-talking between the immune and nervous systems and the functional role and the functioning manner of the TRPV1 involved.We suggest that TRPV1 provides new insights into the collaborative relationship between the nervous and im-mune systems,highlighting exciting opportunities for advanced therapeutic approaches to treating neurogenic inflammation and immune-mediated diseases.
查看更多>>摘要：Sepsis is a life-threatening syndrome resulting from a dysregulated host response to infection.It is the primary cause of death in the intensive care unit,posing a substantial challenge to human health and medical resource allocation.The pathogenesis and pathophysiology of sepsis are complex.During its onset,pro-inflammatory and anti-inflammatory mechanisms engage in intricate interactions,possibly leading to hyperinflammation,immuno-suppression,and long-term immune disease.Of all critical outcomes,hyperinflammation is the main cause of early death among patients with sepsis.Therefore,early suppression of hyperinflammation may improve the progno-sis of these patients.Nafamostat mesilate is a serine protease inhibitor,which can inhibit the activation of the complement system,coagulation system,and contact system.In this review,we discuss the pathophysiological changes occurring in these systems during sepsis,and describe the possible targets of the serine protease inhibitor nafamostat mesilate in the treatment of this condition.
查看更多>>摘要：This study investigates the use of computational frameworks for sepsis.We consider two dimensions for investi-gation-early diagnosis of sepsis(EDS)and mortality prediction rate for sepsis patients(MPS).We concentrate on the clinical parameters on which sepsis diagnosis and prognosis are currently done,including customized treatment plans based on historical data of the patient.We identify the most notable literature that uses com-putational models to address EDS and MPS based on those clinical parameters.In addition to the review of the computational models built upon the clinical parameters,we also provide details regarding the popular publicly available data sources.We provide brief reviews for each model in terms of prior art and present an analysis of their results,as claimed by the respective authors.With respect to the use of machine learning models,we have provided avenues for model analysis in terms of model selection,model validation,model interpretation,and model comparison.We further present the challenges and limitations of the use of computational models,providing future research directions.This study intends to serve as a benchmark for first-hand impressions on the use of computational models for EDS and MPS of sepsis,along with the details regarding which model has been the most promising to date.We have provided details regarding all the ML models that have been used to date for EDS and MPS of sepsis.
查看更多>>摘要：Background:To evaluate the effectiveness and safety of the Shenfu injection(SFI)combined with standard bundle treatment in septic patients with hypoperfusion.Method:This study was a multi-center,randomized,open-label,controlled trial conducted in four teaching hos-pitals in China.The septic patients with hypoperfusion and traditional Chinese medicine(TCM)syndrome with Yang-Qi deficiency were enrolled from January 2019,through September 2020.Eligible patients were randomly allocated in a 1∶1 ratio to either receive 60 mL of SFI infusion per day plus standard treatment(SFI group)or stan-dard bundle treatment alone(control group).The primary outcome was 28-day all-cause mortality.Secondary outcomes were 90-day all-cause mortality time to weaning from mechanical ventilation,time to weaning from vasopressors,time to discharge from the ICU and hospital,and laboratory results after randomization.Results:A total of 188 patients completed the trail.This study revealed that the results of the SFI group and the control groups were not statistically significant in 28-day all-cause mortality(10.6％vs.20.2％,respectively;P=0.106).The infusion of SFI was associated with a significant reduction in the duration of vasopressor use(median=4.0 days,interquartile range[IQR]:2.0 days-6.0 days vs.median=5.0 days,IQR:3.0 days-8.0 days,respectively;P=0.043).Patients in the SFI group had statistically greater reductions in plasma lactate levels compared with those in the control group at the first 12 h(median=1.1 mmol/L,IQR:0.3-2.0 mmol/L vs.median=0.0 mmol/L,IQR:-0.2 to 0.8 mmol/L,respectively;P＜0.001)and 24 h(median=1.4 mmol/L,IQR:0.3-2.2 mmol/L vs.median=0.4 mmol/L,IQR:-0.4 to 1.6 mmol/L,respectively;P=0.001).Conclusion:SFI plus standard therapy did not significantly decrease 28-day all-cause mortality for septic patients with hypoperfusion and TCM syndrome with Yang-Qi deficiency.
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