Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection and is associated with high morbidity and mortality. Circulating histones (CHs), a group of damage-associated molecular pattern molecules mainly derived from neutrophil extracellular traps, play a crucial role in sepsis by mediating inflammation response, organ injury and death through Toll-like receptors or inflammasome pathways. Herein, we first elucidate the molecular mechanisms of histone-induced inflammation amplification, endothelium injury and cascade coagulation activation, and discuss the close correlation between elevated level of CHs and disease severity as well as mortality in patients with sepsis. Furthermore, current state-of-the-art on anti-histone therapy with antibodies, histone-binding proteins (namely recombinant thrombomodulin and activated protein C), and heparin is summarized to propose promising approaches for sepsis treatment.

Background Heart failure (HF) is a common clinical syndrome associated with substantial morbidity, a heavy economic burden, and high risk of readmission. eHealth self-management interventions may be an effective way to improve HF clinical outcomes. Objective The aim of this study was to systematically review the evidence for the effectiveness of eHealth self-management in patients with HF. Methods This study included only randomized controlled trials (RCTs) that compared the effects of eHealth interventions with usual care in adult patients with HF using searches of the EMBASE, PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and CINAHL databases from January 1, 2011, to July 12, 2022. The Cochrane Risk of Bias tool (RoB 2) was used to assess the risk of bias for each study. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria were used to rate the certainty of the evidence for each outcome of interest. Meta-analyses were performed using Review Manager (RevMan v.5.4) and R (v.4.1.0 x64) software. Results In total, 24 RCTs with 9634 participants met the inclusion criteria. Compared with the usual-care group, eHealth self-management interventions could significantly reduce all-cause mortality (odds ratio [OR] 0.83, 95% CI 0.71-0.98, P=.03; GRADE: low quality) and cardiovascular mortality (OR 0.74, 95% CI 0.59-0.92, P=.008; GRADE: moderate quality), as well as all-cause readmissions (OR 0.82, 95% CI 0.73-0.93, P=.002; GRADE: low quality) and HF-related readmissions (OR 0.77, 95% CI 0.66-0.90, P<.001; GRADE: moderate quality). The meta-analyses also showed that eHealth interventions could increase patients’ knowledge of HF and improve their quality of life, but there were no statistically significant effects. However, eHealth interventions could significantly increase medication adherence (OR 1.82, 95% CI 1.42-2.34, P<.001; GRADE: low quality) and improve self-care behaviors (standardized mean difference –1.34, 95% CI –2.46 to –0.22, P=.02; GRADE: very low quality). A subgroup analysis of primary outcomes regarding the enrolled population setting found that eHealth interventions were more effective in patients with HF after discharge compared with those in the ambulatory clinic setting. Conclusions eHealth self-management interventions could benefit the health of patients with HF in various ways. However, the clinical effects of eHealth interventions in patients with HF are affected by multiple aspects, and more high-quality studies are needed to demonstrate effectiveness.

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Purpose To explore the prognostic value of albumin corrected anion gap (ACAG) within 24 hours of admission to the intensive care unit (ICU) for acute pancreatitis (AP). Patients and Methods This was a retrospective cohort study. Adult AP patients admitted to ICU from June 2016 to December 2019 were included in the study, who were divided into three groups according to initial serum ACAG within 24 hours upon ICU admission: ACAG ≤ 14.87 mmol/L, 14.87 < ACAG ≤ 19.03 mmol/L, and ACAG > 19.03 mmol/L. The primary study outcome indicator was in-hospital mortality. Age, sex, Glasgow Coma Scale score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were matched through propensity score matching (PSM) method to balance the baseline between the survivors and non-survivors. Multivariate Cox regression was used to determine the relationship between ACAG and in-hospital mortality. Results A total of 344 patients (of them 81 non-survivors) were analyzed in this study. Patients with higher ACAG intended to present significantly higher in-hospital mortality, APACHE II score, creatine, lower albumin, and bicarbonate. Multivariate Cox regression analysis after matching demonstrated that white blood cell count, platelet count, and higher ACAG were independently associated with higher in-hospital mortality (ACAG ≤ 14.87 as a reference, 14.87 < ACAG ≤ 19.03 mmol/L with HR of 2.34 and 95% CI of 1.15–4.76, ACAG >19.03 with HR of 3.46 and 95% CI of 1.75–6.84). Conclusion Higher ACAG was independently associated with higher in-hospital mortality in patients with AP after matching the baseline between the survivors and non-survivors.

Background Infection has long been the major cause for death after liver transplantation. Diagnosing this deadly disease in time can be of great help to support the patients in intensive care units. However, tests like blood culture would take too much time to generate an outcome. Procalcitonin seems to be a promising biomarker in such clinical settings these days. To evaluate its diagnostic value as a biomarker in identifying and differentiating infectious complications in liver transplant recipients. Methods PUBMED, Scopus, Web of Science, Cochrane Library were searched for articles published from January 1990 to September 2019 without language limitation. Cohort or case-control study investigating the value of PCT in distinguishing postoperative infectious complications among liver transplant recipients were included, followed by measurement using QUADAS-2 tool to estimate the risk of bias of each study. Bivariate approach and random-effects model were performed to generate the pooled outcomes. Results 8 studies (studying 560 liver transplant recipients) from 6 populations were reviewed and included, one of which is later excluded due to huge heterogeneity it caused. No significant threshold effect was found, suggesting that heterogeneity returned by the I 2 was not due the various cutoff values. The pooled DOR was 18.65 (95%CI 9.85-35.31) and the area under HSROC was 0.857 ( θ =-0.024; β =-0.203). The positive likelihood ratio and negative likelihood ratio are 3.472 (95% 2.352-5.127) and 0.289 (95% 0.192-0.434). Conclusion Current articles suggest a reasonable diagnostic value for the procalcitonin test in identifying infectious complications among patients undergoing liver transplantation. However, the reason why no threshold effect was found remained explored.

Background Cerebral fat embolism (CFE) is a subtype of fat embolism syndrome which tends to cause ischemic cerebral infarction. Fat embolism in the cerebral venous system have not been reported. We hereby present a rare case of fat embolus formed in the cerebral venous system 10 days after cosmetic surgery, and describe our management of this patient. Case presentation A 26-year-old woman with the disturbance of consciousness and recurrent convulsions of the right upper extremity over a 21-h period was admitted to our hospital. The patient was initially diagnosed with haemorrhagic infarction, and cerebral venous thrombosis (CVT) was suspected based on computed tomography (CT). A diagnosis of CFE was confirmed based on surgical findings. Breast and hip augmentation performed 10 days ago was considered the underlying cause. Drug-induced hypothermia, low molecular weight heparin, atorvastatin, dexamethasone, piperacillin/tazobactam, valproic acid, and mannitol were applied. On hospital day 30, she was discharged with a Montreal Cognitive Assessment score of 25. Conclusions Fat embolism can occur in the cerebral venous system, and may mimic CVT symptoms rather than CFE symptoms. Early identification of the nature of the embolus is essential. The use of heparin may prevent secondary thrombus formation, and accelerate fat embolus decomposition.

BackgroundThe Controlling Nutritional Status (CONUT) score was designed to assess the immune-nutritional status in patients. This study aimed to investigate the role of the CONUT score in the short-term prognosis of severe acute pancreatitis.MethodsThis was a retrospective cohort study. 488 patients with severe acute pancreatitis at the Department of Critical Care Medicine of the West China Hospital of Sichuan University (Chengdu, China) were enrolled in the study. Baseline data were collected from the West China Hospital of Sichuan University database. The primary outcome during follow-up was all-cause mortality. The secondary outcomes were 28 day mortality, renal insufficiency, length of stay (LOS) in the ICU, and length of stay (LOS) in the hospital. Patients were divided into two groups based on a median CONUT score of 7, and baseline differences between the two groups were eliminated by propensity matching. Univariate Cox regression analyses were performed to estimate the association between CONUT score and outcomes. The Kaplan–Meier method was used to estimate the survival rate of patients.ResultsCONUT score was an independent predictor of all-cause mortality (hazard ratio [HR]:2.093; 95%CI: 1.342–3.263; p &lt; 0.001) and 28 day mortality (hazard ratio [HR]:1.813; 95%CI: 1.135–2.896; p &lt; 0.013). CONUT score was not statistically significant in predicting the incidence of renal insufficiency. The high CONUT group had significantly higher all-cause mortality (p &lt; 0.001), and 28 day mortality (p &lt; 0.011) than the low CONUT group.ConclusionThe CONUT score is an independent predictor of short-term prognosis in patients with severe acute pancreatitis, and timely nutritional support is required to reduce mortality in patients with severe acute pancreatitis.