Infectious pancreatic necrosis (IPN) is associated with the prognosis of acute pancreatitis (AP). The correlation between microbial diversity in the peripancreatic region and AP severity remains unclear. This study investigates whether pathogen profiles in peripancreatic necrosis differ between IPN patients with and without organ failure (OF), using 16 S ribosomal RNA (16 S rRNA) and internal transcribed spacer (ITS) sequencing. Patients with acute pancreatitis meeting clinical diagnostic criteria for IPN were prospectively enrolled. These patients were subsequently divided into an OF group and a non-OF group. Peripancreatic necrotic fluid samples were collected via percutaneous drainage and subjected to 16 S rRNA and ITS sequencing. A total of 28 patients with suspected infected pancreatic necrosis (IPN) were included, with 14 patients in the OF group and 14 in the non-OF group. No significant difference was observed in bacterial alpha diversity between the OF and non-OF groups. However, beta diversity showed significant differences according to Welch’s t test (P < 0.001), Adonis analysis (P = 0.037) and Anosim analysis (P = 0.032). The relative abundance of Klebsiella significantly differed between the two groups (2.79

Background Infectious pancreatic necrosis (IPN) is associated with the prognosis of acute pancreatitis (AP). The correlation between the microbial diversity in the peripancreatic region and the severity of AP remains unclear. The objectives of this study were to analyse the microbial composition of peripancreatic necrosis in IPN patients by 16S ribosomal RNA (16S rRNA) and internal transcribed spacer (ITS) sequencing. Methods Patients with acute pancreatitis who met the clinical diagnostic criteria for IPN were prospectively included. These patients were subsequently divided into a sepsis group and a non-sepsis group. Samples of peripancreatic necrotic fluid were collected by percutaneous puncture drainage, followed by 16S rRNA sequencing and internal transcribed spacer (ITS) sequencing. Results There was no significant difference between the sepsis and non-sepsis groups in terms of bacterial alpha diversity, and there was a significant difference in beta diversity according to the Welch's t test (P < 0.001), Adonis analysis (P = 0.037) and Anosim analysis (P = 0.032). The relative abundance of Klebsiella differed significantly between the two groups (2.79% vs. 34.14%, P = 0.0093) and correlated with the length of hospital stay (r = 0.422, P = 0.025). Conclusion The peripancreatic microbiota is associated with the severity of acute pancreatitis, with Klebsiella being the dominant microflora in patients with IPN combined with sepsis.

Contrast-induced nephropathy (CIN) is a complication of patients undergoing percutaneous coronary intervention (PCI). Promising biomarkers for the early prediction of CIN can significantly improve outcomes of these patients. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies. Trials reporting an area under the curve (AUC) for the utility of novel biomarkers in the early prediction of CIN in adults after PCI were included. In total, 42 studies comprising 11,984 adult patients undergoing PCI met the criteria. Four urinary biomarkers and four blood biomarkers were included. For urine biomarkers, the pooled AUCs for neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver-type fatty acid-binding protein (L-FABP), and kidney injury molecule-1 (KIM-1) were 0.91 (95% CI 0.89–0.94), 0.79 (0.75–0.82), 0.78 (0.74–0.82), and 0.79 (0.76–0.83), respectively. The blood biomarkers NGAL, cystatin C, brain natriuretic peptide (BNP), and C-reactive protein (CRP) had pooled AUCs of 0.93 (0.91–0.95), 0.92 (0.89–0.94), 0.78 (0.74–0.81), and 0.75 (0.71–0.79), respectively. Subgroup analysis showed that blood NGAL in early CIN predictive time (<6 h) was more effective in predicting CIN. The efficiency of cystatin C in predicting CIN was reduced, whereas that of L-FABP was increased among chronic kidney disease (CKD) patients.

Contrast-induced nephropathy (CIN) is a complication of patients undergoing percutaneous coronary intervention (PCI). Promising biomarkers for the early prediction of CIN can significantly improve outcomes of these patients. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies. Trials reporting an area under the curve (AUC) for the utility of novel biomarkers in the early prediction of CIN in adults after PCI were included. In total, 42 studies comprising 11,984 adult patients undergoing PCI met the criteria. Four urinary biomarkers and four blood biomarkers were included. For urine biomarkers, the pooled AUCs for neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), liver-type fatty acid-binding protein (L-FABP), and kidney injury molecule-1 (KIM-1) were 0.91 (95% CI 0.89-0.94), 0.79 (0.75-0.82), 0.78 (0.74-0.82), and 0.79 (0.76-0.83), respectively. The blood biomarkers NGAL, cystatin C, brain natriuretic peptide (BNP), and C-reactive protein (CRP) had pooled AUCs of 0.93 (0.91-0.95), 0.92 (0.89-0.94), 0.78 (0.74-0.81), and 0.75 (0.71-0.79), respectively. Subgroup analysis showed that blood NGAL in early CIN predictive time (<6 h) was more effective in predicting CIN. The efficiency of cystatin C in predicting CIN was reduced, whereas that of L-FABP was increased among chronic kidney disease (CKD) patients.

Objective:To systematically assess the effect of electrical impedance tomography (EIT) guided positive end-expiratory pressure (PEEP) titration on patients with acute respiratory distress syndrome (ARDS) / acute respiratory failure (ARF).Methods:Systematic searches were performed in the PubMed, Embase, Web of science, Cochrane library, CNKI, VIP and Wanfang databases for articles published up to March 10, 2020 about effects of EIT guided PEEP titration on ARDS / ARF patients. Two reviewers independently screened articles, extracted data and evaluated the quality of included studies. Then meta-analysis was conducted using RevMan 5.3 software.Results:Seven articles with 147 patients were enrolled in this study. Meta-analysis showed that compared with traditional PEEP setting methods (ARDS network, pressure / volume curve, flow rate / volume curve), the PEEP [mean difference (MD) = 2.35, 95% confidence interval (CI) (0.38, 4.32), Z = 2.34, P = 0.02] and oxygenation index [MD = 26.63, 95%CI (7.89, 45.38), Z = 2.78, P = 0.005] were higher, and the lung compliance [MD = 5.06, 95%CI (2.49, 7.62), Z = 3.86, P = 0.000 1] was better in ARDS / ARF patients with EIT guided PEEP titration. However, there was no significant difference in the mean arterial pressure [MD = -0.97, 95%CI (-6.31, 4.36), Z = 0.36, P = 0.72] and in-hospital mortality [odds ratio = 0.40, 95%CI (0.14, 1.12), Z = 1.74, P = 0.08] between the EIT guided PEEP titration and traditional PEEP setting methods.Conclusion:Compared with traditional PEEP setting methods, EIT guided PEEP titration can improve the PEEP, oxygenation index and lung compliance, but has no significant effect on the mean arterial pressure and in-hospital mortality of ARDS / ARF patients.

We aimed to determine whether the average mean arterial pressure (aMAP) in the first 24 hours of hospital admission is useful in predicting short-term outcomes of patients with intermediate- and high-risk pulmonary embolism (PE). We conducted a single-center retrospective study. From May 2012 to April 2019, 122 patients with intermediate- and high-risk PE were included. The primary outcome was in-hospital mortality. The secondary outcome was adverse events. Receiver operating characteristic (ROC) curves and cutoff values for aMAP predicting in-hospital death were computed. According to cutoff values, we categorized 5 groups defined as follows: group 1: aMAP < 70 mm Hg; group 2: 70 mm Hg ≤ aMAP < 80 mm Hg; group 3: 80 mm Hg ≤ aMAP < 90 mm Hg; group 4: 90 mm Hg ≤ aMAP <100 mm Hg; and group 5: aMAP ≥ 100 mm Hg. Cox regression models were calculated to investigate associations between aMAP and in-hospital death. In the study group of 122 patients, 15 (12.30%) patients died in the hospital due to PE. The ROC analysis for MAP predicting in-hospital death revealed an area under the curve of 0.729 with a cutoff value of 79.4 mm Hg. Cox regression models showed a significant association between in-hospital death and aMAP group 1 (ref), aMAP group 2 (odds ratio [OR] = 1.680, 95% CI: 0.020-140.335), aMAP group 3 (OR = 0.003, 95% CI: 0.0001-0.343), aMAP group 4 (OR = 0.006, 95% CI: 0.0001-1.671), and aMAP group 5 (OR = 0.003, 95% CI: 0.0001-9.744). In particular, those with an aMAP of 80 to 90 mm Hg had minimum adverse events. The optimal range of MAP for patients with intermediate- and high-risk PE may be 80 to 90 mm Hg.

Objective: Pulmonary embolism is a terrible cardiovascular condition with considerable morbidity and mortality. Previous studies have investigated systolic blood pressure (systolic BP) and diastolic blood pressure (diastolic BP) as being related to 30-day and in-hospital mortality. We aimed to determine whether the average mean arterial pressure (aMAP) in the first 24 hours of hospital admission is useful in predicting short-term outcomes of intermediate-risk and high-risk PE patients. Method: We conducted a single-center retrospective study. From May 2012 to April 2019, 122 intermediate-risk and high-risk PE patients were included. The primary outcome was in-hospital mortality. The secondary outcome was adverse events. ROC curves and cut-off values for aMAP predicting in-hospital death were computed. According to cut-off values, we categorized five groups defined as follows: group 1: aMAP<70 mmHg; group 2: 70 mmHg≤aMAP<80 mmHg; group 3: 80 mmHg≤aMAP<90 mmHg; group 4: 90 mmHg≤aMAP<100 mmHg; and group 5: aMAP≥100 mmHg. Cox regression models were calculated to investigate associations between aMAP and in-hospital death. Results: In the study group of 122 patients, 15 patients (12.30%) died in the hospital due to PE. ROC analysis for MAP predicting in-hospital death revealed an AUC of 0.729 with a cut-off value of 79.4 mmHg. Cox regression models showed a significant association between in-hospital death and aMAP group 1 (ref), aMAP group 2 (OR 1.680, 95% CI 0.020-140.335), aMAP group 3 (OR 0.003, 95% CI 0.0001-0.343), aMAP group 4 (OR 0.006, 95% CI 0.0001-1.671), and aMAP group 5 (OR 0.003, 95% CI 0.0001-9.744). In particular, those with an aMAP of 80-90 mmHg suffer from minimum adverse events. Conclusion: The prognostic role of MAP during the first 24 hours of hospital admission should be emphasized in patients with PE. The optimal range of MAP for intermediate-risk and high-risk PE patients may be 80 to 90 mmHg.