RESUMEN
The prompt initiation of empirical anti-infective therapy is crucial in patients presenting with unexplained pulmonary infection. Although imaging acquisition is relatively straightforward in clinical practice, its lack of specificity often necessitates additional time-consuming tests such as sputum culture, bronchoalveolar-lavage fluid culture, or genetic sequencing to identify the underlying etiology of the disease accurately. Moreover, the limited efficacy of empirical anti-infective treatment may contribute to antibiotic misuse. Recent advancements in interpreting microbial background on rapid on-site evaluation (ROSE) slides have enabled clinicians to promptly obtain samples through bronchoscopy (e.g., alveolar lavage, mucosal brushing, tissue clamp), facilitating bedside staining and interpretation that provides essential microbial background information. Consequently, this establishes a foundation for developing targeted anti-infection treatment and individualized drug therapy plans. With a better understanding of which pathogens are causing infections in real-time, physicians can avoid unnecessary broad-spectrum antibiotics contributing to antibiotic resistance. Establishing a rapid and standardized M-ROSE workflow within respiratory medicine departments or intensive care units will greatly assist physicians in formulating accurate treatment strategies for patients, which holds significant clinical implications.
Asunto(s)
Antiinfecciosos , Enfermedades Transmisibles , Humanos , Lavado Broncoalveolar/métodos , Evaluación in Situ Rápida , Líquido del Lavado Bronquioalveolar , Enfermedades Transmisibles/tratamiento farmacológico , Antibacterianos/farmacología , Antibacterianos/uso terapéuticoRESUMEN
BACKGROUND: Parkinson's disease is the second major neurodegenerative diseases secondarily to Alzheimer's disease. Rapamycin is a fermentation product, which derived from Streptomyces hygroscopius. The aim of this study is to investigate the effect of rapamycin and its potential mechanisms on the acute attack of 1-methyl-4-phenyl-1,2,3,6-four hydrogen pyridine (MPTP) induced Parkinson's disease (PD) in mice. METHODS: PD model was established by intraperitoneal injection of MPTP for 5 days. The effect of intraperitoneal injection of rapamycin for treating the symptoms caused by PD was evaluated by behavior observation and HE pathological section. In order to understand the possible mechanism, immunofluorescence and immune precipitation mainly analyzes were used to measure the expression of critical protein p-4ebp1 in mammalian target of rapamycin (mTOR) signaling pathways in the striatum and substantia nigra. RESULTS: Rapamycin can effectively alleviate symptoms of PD. The levels of key protein p-4EBP1 in the striatum and substantia nigra were both significantly higher in PD group compared with control group (P<0.01), while being pretreated with rapamycin, the expression of p-4EBP1 in the striatum and substantia nigra were both decreased obviously (P<0.01). CONCLUSIONS: p-4EBP1 protein may be involved in the pathogenesis of PD via mTOR signaling pathway. Inhibited mTOR-4EBP1 pathways could make a certain protective effect for the acute attack of PD induced by MPTP.
Asunto(s)
Enfermedad de Parkinson , 1-Metil-4-fenil-1,2,3,6-Tetrahidropiridina , Animales , Ratones , Ratones Endogámicos C57BL , Enfermedad de Parkinson/tratamiento farmacológico , Sirolimus/uso terapéutico , Sustancia NegraRESUMEN
BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as an early biomarker for prediction of acute kidney injury (AKI). However, the utility of NGAL to predict the occurrence of AKI in septic patients remains controversial. We performed a systematic review and meta-analysis to evaluate the evidence on diagnosis of sepsis AKI and the prediction of other clinical outcomes. METHOD: The MEDLINE, EMBASE, Cochrane Library, Wanfang, and CNKI databases were systematically searched up to August 19, 2015. Quality assessment was applied by using the Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tool. The diagnostic performance of NGAL for the prediction of AKI in sepsis was evaluated using pooled estimates of sensitivity, specificity, likelihood ratio, and diagnostic odds ratio (DOR), as well as summary receiver operating characteristic curves (SROC). RESULTS: Fifteen studies with a total of 1,478 patients were included in the meta-analysis. For plasma NGAL, the pooled sensitivity and specificity with corresponding 95% confidence intervals (CI) were 0.83 (95% CI: 0.77 - 0.88) and 0.57 (95% CI: 0.54 - 0.61), respectively. The pooled positive likelihood ratio (PLR) was 3.10 (95% CI: 1.57 - 6.11) and the pooled negative likelihood ratio (NLR) was 0.24 (95% CI: 0.13 - 0.43). The pooled DOR was 14.72 (95% CI: 6.55 - 33.10) using a random effects model. The area under the curve (AUC) for SROC to summarize diagnostic accuracy was 0.86. For urine NGAL, the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC values were 0.80 (95% CI: 0.77 - 0.83), 0.80 (95% CI: 0.77 - 0.83), 4.42 (95% CI: 2.84 - 6.89), 0.21 (95% CI: 0.13 - 0.35), 24.20 (95% CI: 9.92 - 59.05) and 0.90, respectively. Significant heterogeneity was explored as a potential source. There was no notable publication bias observed across the eligible studies. NGAL for prediction of renal replacement therapy (RRT) and mortality associated with AKI in septic patients were also evaluated. CONCLUSION: To a certain extent, NGAL is not only an effective predictive factor for AKI in the process of sepsis, but also shows potential predictive value for RRT and mortality. However, future trials are needed to clarify this controversial issue.
Asunto(s)
Lesión Renal Aguda/diagnóstico , Proteínas de Fase Aguda/metabolismo , Biomarcadores/sangre , Lipocalinas/metabolismo , Proteínas Proto-Oncogénicas/metabolismo , Sepsis/mortalidad , Lesión Renal Aguda/metabolismo , Lesión Renal Aguda/mortalidad , Humanos , Lipocalina 2 , Valor Predictivo de las Pruebas , Pronóstico , Sepsis/metabolismoRESUMEN
The aim of this study is to evaluate the feasibility of Laser Doppler imaging (LDI) for noninvasive and dynamic assessment of hemorrhagic shock in a rabbit model. A rabbit model of hemorrhagic shock was generated and LDI of the microcirculation in the rabbit ears was performed before and at 0, 30, 60, and 90 min after hemorrhage. The CCD (Charge Coupled Device) image of the ears, the mean arterial pressure (MAP) and the heart rate (HR) were monitored. The mean LDI flux was calculated. The HR of rabbits was significantly (p < 0.05) elevated and the MAP was decreased after hemorrhage, compared to the pre-hemorrhage level. Within the initial 30 min after hemorrhage, the perfusion flux lineally dropped down. In contrast, the MAP values did not differ significantly between the time points of 0 and 30 after hemorrhage (p > 0.05). Both the flux numbers and the red-to-blue color changes on LDI imaging showed the reduction of the microcirculation. LDI imaging is a noninvasive and non-contact approach to evaluate the microcirculation and may offer benefits in the diagnosis and treatment of hemorrhage shock. Further studies are needed to confirm its effectiveness in clinical practice.
Asunto(s)
Flujometría por Láser-Doppler , Microcirculación , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/fisiopatología , Animales , Presión Sanguínea , Modelos Animales de Enfermedad , Oído/irrigación sanguínea , Conejos , Factores de TiempoRESUMEN
A special "small to big" temperature-responsive phase-transformation strategy based on the "acoustic droplet vaporization (ADV)" mechanism is developed for efficient targeted ultrasonography and synergistic high intensity focused ultrasound (HIFU) cancer surgery by engineering targeted nanoemulsions, which is systematically evaluated and successfully demonstrated in vitro, ex vivo, and in vivo.