Development Of Sepsis Research Articles

GENETIC PREDICTION OF CAUSAL RELATIONSHIPS BETWEEN OSTEOPOROSIS AND SEPSIS: EVIDENCE FROM MENDELIAN RANDOMIZATION WITH TWO-SAMPLE DESIGNS.

Background: Recent observational studies have suggested that osteoporosis may be a risk factor for sepsis. To mitigate confounding factors and establish the causal relationship between sepsis and osteoporosis, we conducted a two-sample Mendelian randomization analysis using publicly available summary statistics. Methods: Utilizing summary data from FinnGen Biobank, we employed a two-sample Mendelian randomization (MR) analysis to predict the causal relationship between osteoporosis and sepsis. The MR analysis primarily utilized the inverse variance weighted (IVW) method, supplemented by MR-Egger, weighted median, weighted mode, and simple mode analyses, with Bayesian weighted MR (BWMR) analysis employed for result validation. Sensitivity analyses included MR-PRESSO, "leave-one-out" analysis, MR-Egger regression, and Cochran Q test. Results: In the European population, an increase of one standard deviation in osteoporosis was associated with an 11% increased risk of sepsis, with an odds ratio (OR) of 1.11 (95% CI, 1.06-1.16; P = 3.75E-06). BWMR yielded an OR of 1.11 (95% CI, 1.06-1.67; P = 1.21E-05), suggesting osteoporosis as a risk factor for sepsis. Conversely, an increase of one standard deviation in sepsis was associated with a 26% increased risk of osteoporosis, with an OR of 1.26 (95% CI, 1.11-1.16; P = 0.45E-03). BWMR yielded an OR of 1.26 (95% CI, 1.09-1.45; P = 1.45E-03), supporting sepsis as a risk factor for osteoporosis. Conclusion: There is an association between osteoporosis and sepsis, with osteoporosis serving as a risk factor for the development of sepsis, while sepsis may also promote the progression of osteoporosis.

Risk Factors for Sepsis in Postoperative Patients

Sepsis is a severe acute infection that can lead to organ failure and mortality in 30-50% of patients. It ranks among the top 10 causes of mortality in the United States and has increased significantly since the 1970s. Postoperative sepsis, the primary type of sepsis, accounts for almost one-third of all sepsis cases. Postoperative sepsis is a major cause of illness and death for hospitalized patients, often leading to multiple organ failure and mortality. A study found that patients aged 18 years or older who have undergone surgical interventions and have been hospitalized for at least 4 days after the operation have a higher likelihood of developing sepsis. The most prevalent complication after radical gastrectomy for stomach cancer is postoperative infection, which occurs through leukocyte depletion in transfusion patient. Being male or over 65 significantly increased the likelihood of having postoperative sepsis. Sex hormones significantly influence the body's response to sepsis, and elderly individuals may be more susceptible due to deterioration of immune system function and age-related immunosenescence. Chronic renal illness, diabetes, and chronic heart failure have the highest risks of developing postoperative sepsis, ranked first, second, and third, respectively. Dysfunctions in the cardiovascular and hematological systems also have the highest probability of leading to the development of postoperative sepsis. These findings suggest potential areas for future research to decrease the impact of the disease.

Ulinastatitis in Complex Treatment of Acute Pancreatitis (Literature Review)

The purpose of this literature review is to assess the completeness and significance of recent research on the treatment of a destructive form of pancreatitis for public health and scientific achievements, highlighting areas that require further detailed study. A review of foreign literature on the use of the protease inhibitor ulinastatin in the complex conservative treatment and prevention of acute pancreatitis is made. The clinical and laboratory effectiveness of the drug in preventing the transition of uninfected pancreatic necrosis into a complicated purulent-necrotic form with the development of abdominal sepsis, as well as the effect on treatment results and mortality, has been demonstrated. Existing schemes and modes of application are given. In recent years, significant scientific achievements have been presented in the field of treatment of acute pancreatitis, especially in the context of its destructive forms. The results of numerous studies have made it possible to formulate recommendations aimed at optimizing treatment approaches and improving the prognosis of this condition. Studies have identified key factors affecting the prognosis and outcome of treatment of acute pancreatitis, including the degree of destruction of the pancreas, clinical and laboratory characteristics of patients, as well as complications associated with various treatment methods. These data will allow surgeons to develop individual treatment strategies, taking into account the specifics of each case. Ulinastatin is not only a protease inhibitor, but also has anti-inflammatory and immunomodulatory properties. Based on the results of numerous foreign studies, the high clinical and laboratory effectiveness of ulinastainin the complex drug therapy of acute pancreatitis has been proven. And also, to prevent it and/or hyperfermentemia during ERCP and extended operations on the organs of the pancreato-duodenal zone. Ulinastatin is most effective in the edematous form of AP and aseptic pancreatic necrosis. In case of infected pacreonecrosis with severe organ-systemic failure or the formation of purulent-necrotic foci in the retroperitoneum (abdominal sepsis), the drug is not effective.

Rethinking Human-AI Collaboration in Complex Medical Decision Making: A Case Study in Sepsis Diagnosis.

Today's AI systems for medical decision support often succeed on benchmark datasets in research papers but fail in real-world deployment. This work focuses on the decision making of sepsis, an acute life-threatening systematic infection that requires an early diagnosis with high uncertainty from the clinician. Our aim is to explore the design requirements for AI systems that can support clinical experts in making better decisions for the early diagnosis of sepsis. The study begins with a formative study investigating why clinical experts abandon an existing AI-powered Sepsis predictive module in their electrical health record (EHR) system. We argue that a human-centered AI system needs to support human experts in the intermediate stages of a medical decision-making process (e.g., generating hypotheses or gathering data), instead of focusing only on the final decision. Therefore, we build SepsisLab based on a state-of-the-art AI algorithm and extend it to predict the future projection of sepsis development, visualize the prediction uncertainty, and propose actionable suggestions (i.e., which additional laboratory tests can be collected) to reduce such uncertainty. Through heuristic evaluation with six clinicians using our prototype system, we demonstrate that SepsisLab enables a promising human-AI collaboration paradigm for the future of AI-assisted sepsis diagnosis and other high-stakes medical decision making.

Exploring the relationship between HCMV serostatus and outcomes in COVID-19 sepsis.

Sepsis, a life-threatening condition caused by the dysregulated host response to infection, is a major global health concern. Understanding the impact of viral or bacterial pathogens in sepsis is crucial for improving patient outcomes. This study aimed to investigate the human cytomegalovirus (HCMV) seropositivity as a risk factor for development of sepsis in patients with COVID-19. A multicenter observational study enrolled 95 intensive care patients with COVID-19-induced sepsis and 80 post-surgery individuals as controls. HCMV serostatus was determined using an ELISA test. Comprehensive clinical data, including demographics, comorbidities, and 30-day mortality, were collected. Statistical analyses evaluated the association between HCMV seropositivity and COVID-19 induced sepsis. The prevalence of HCMV seropositivity did not significantly differ between COVID-19-induced sepsis patients (78%) and controls (71%, p = 0.382) in the entire cohort. However, among patients aged ≤60 years, HCMV seropositivity was significantly higher in COVID-19 sepsis patients compared to controls (86% vs 61%, respectively; p = 0.030). Nevertheless, HCMV serostatus did not affect 30-day survival. These findings confirm the association between HCMV seropositivity and COVID-19 sepsis in non-geriatric patients. However, the lack of an independent effect on 30-day survival can be explained by the cross-reactivity of HCMV specific CD8+ T-cells towards SARS-CoV-2 peptides, which might confer some protection to HCMV seropositive patients. The inclusion of a post-surgery control group strengthens the generalizability of the findings. Further research is needed to elucidate the underlying mechanisms of this association, explore different patient populations, and identify interventions for optimizing patient management. This study validates the association between HCMV seropositivity and severe COVID-19-induced sepsis in non-geriatric patients, contributing to the growing body of evidence on viral pathogens in sepsis. Although HCMV serostatus did not independently influence 30-day survival, future investigations should focus on unraveling the intricate interplay between HCMV, immune responses, and COVID-19. These insights will aid in risk stratification and the development of targeted interventions for viral sepsis.

STUDY ON “SURGICAL MANAGEMENT IN DYNAMIC SMALL BOWEL OBSTRUCTION IN ADULT”

Objectives: This study undergoes cases of dynamic small bowel obstruction in the adult population, requiring surgical intervention based on cause, anatomical and pathological nature, age-related factors, mode of presentation, investigation modalities, surgical procedure done, outcome after surgery, and complications. Methods: The study was conducted on 100 small bowel obstructions from 2020 to 2022. 50 patients in each group requiring surgical intervention based on cause, anatomical, and pathological nature, age-related factors, mode of presentation, investigation modalities, surgical procedure done, and outcome after surgery and complications were analyzed. Results: In the present study, the most common cause was adhesions and bands followed by hernia. In this study, 56% of the cases belonged to 31–50- year age group; there are 25 males and 25 females. On abdominal examination, diffuse tenderness was present in all 50 cases, followed by (muscle hold) guarding in 35, rigidity in eight, with mass abdomen including seven cases. Conclusion: Intestinal obstruction is an important surgical emergency, demand vigorous correction of fluid, and electrolyte. Adhesions and bands are the common cause to produce intestinal obstruction. Patients with intestinal obstruction due to adhesions and bands are more likely to develop post-operative complications. Early operation is mandatory to avoid the development of peritonitis and systemic sepsis associated with multi-system organ failure.

Machine learning reveals ferroptosis features and a novel ferroptosis classifier in patients with sepsis.

Sepsis is an organ malfunction disease that may become fatal and is commonly accompanied by severe complications such as multiorgan dysfunction. Patients who are already hospitalized have a high risk of death due to sepsis. Even though early diagnosis is very important, the technology and clinical approaches that are now available are inadequate. Hence, there is an immediate necessity to investigate biological markers that are sensitive, specific, and reliable for the prompt detection of sepsis to reduce mortality and improve patient prognosis. Mounting research data indicate that ferroptosis contributes to the occurrence, development, and prevention of sepsis. However, the specific regulatory mechanism of ferroptosis remains to be elucidated. This research evaluated the expression profiles of ferroptosis-related genes (FRGs) and the diagnostic significance of the ferroptosis-related classifiers in sepsis. We collected three peripheral blood data sets from septic patients, integrated the clinical examination data and mRNA expression profile of these patients, and identified 13 FRGs in sepsis through a co-expression network and differential analysis. Then, an optimal classifier tool for sepsis was constructed by integrating a variety of machine learning algorithms. Two key genes, ATG16L1 and SRC, were shown to be shared between the algorithms, and thus were identified as the FRG signature of classifier. The tool exhibited satisfactory diagnostic efficiency in the training data set (AUC = 0.711) and two external verification data sets (AUC = 0.961; AUC = 0.913). In the rat cecal ligation puncture sepsis model, in vivo experiments verified the involvement of ATG16L1 and SRC in the early sepsis process. These findings confirm that FRGs may participate in the development of sepsis, the ferroptosis related classifiers can provide a basis for the development of new strategies for the early diagnosis of sepsis and the discovery of new potential therapeutic targets for life-threatening infections.

Traditional Japanese herbal medicine Hochuekkito protects development of sepsis after nasal colonization in mice

IntroductionStreptococcus pneumoniae, a commensal in the nasopharynx, can cause invasive pneumococcal diseases (IPDs). To prevent the aggravation of IPDs, it is important to enhance host immune defense against S. pneumoniae. Hochuekkito (HET) is expected to have an immunostimulatory effect against infections. MethodsHET was administrated by gavage to adult BALB/cA mice before and after intranasal inoculation of S. pneumoniae. We evaluated the effect of HET on pneumococcal nasal colonization and subsequent development of lethal pneumococcal infections. ResultsNo effect on nasal colonization was observed, but HET significantly reduced bacterial count in the blood, decreased the incidence of bacteremia, and improved survival. HET also reduced nasal tissue damage 3 days after intranasal infection. Neutrophils from HET-treated mice showed significantly higher bactericidal activity against S. pneumoniae in the presence of the serum from the HET group compared with from the control group. ConclusionsThe non-specific immunostimulatory effect of HET is suggested by this study to be effective in preventing the progression in IPDs and provided insights into novel strategy in the post-pneumococcal vaccine era.

Sepsis and Septic Shock in Patients Undergoing Thyroidectomy: Incidence, Risk Factors, and Outcomes

IntroductionPostoperative sepsis represents a rare complication following thyroidectomy. We aimed to explore the incidence, risk factors, sources, and outcomes of postoperative sepsis and septic shock among adult patients undergoing thyroidectomy. MethodsData from the American College of Surgeons National Surgical Quality Improvement Program were used in this retrospective cohort study. Patients aged ≥18 y who underwent elective thyroidectomy between 2005 and 2019 were included. Multivariable binary logistic regression models were computed to explore risk factors and outcomes of 30-d sepsis and septic shock. ResultsAmong the 180,373 included patients, 0.1% developed sepsis or septic shock. Male gender, low body mass index, American Society of Anesthesiologists classes 3-5, functional dependence, smoking, diabetes mellitus, pulmonary disease, inpatient surgery, malignant indication, clean-contaminated wound classification, and operation time ≥150 min were significant risk factors for development of sepsis or septic shock. Common infectious sources of sepsis included surgical site infections (29.6%), pneumonia (18.6%), urinary tract infections (16.2%), and multiple infections (6.9%). Patients with postoperative sepsis or septic shock were significantly more likely to develop complications, including wound disruption, stroke, cardiac and renal complications, thromboembolism, prolonged length of stay, unplanned reoperation, and mortality. ConclusionsSepsis is rare following thyroidectomy. Our study provides insight into risk factors and procedural characteristics which may contribute to the development of postoperative sepsis or septic shock in this population.

Predictive performance of NEWS and qSOFA in immunocompromised sepsis patients at the emergency department

PurposeSepsis has a high incidence and a poor prognosis. Early recognition is important to facilitate timely initiation of adequate care. Sepsis screening tools, such as the (quick) Sequential Organ Failure Assessment ((q)SOFA) and National Early Warning Score (NEWS), could help recognize sepsis. These tools have been validated in a general immunocompetent population, while their performance in immunocompromised patients, who are particularly at risk of sepsis development, remains unknown.MethodsThis study is a post hoc analysis of a prospective observational study performed at the emergency department. Inclusion criteria were age ≥ 18 years with a suspected infection, while ≥ two qSOFA and/or SOFA criteria were used to classify patients as having suspected sepsis. The primary outcome was in-hospital mortality.Results1516 patients, of which 40.5% used one or more immunosuppressives, were included. NEWS had a higher prognostic accuracy as compared to qSOFA for predicting poor outcome among immunocompromised sepsis patients. Of all tested immunosuppressives, high-dose glucocorticoid therapy was associated with a threefold increased risk of both in-hospital and 28-day mortality.ConclusionIn contrast to NEWS, qSOFA underestimates the risk of adverse outcome in patients using high-dose glucocorticoids. As a clinical consequence, to adequately assess the severity of illness among immunocompromised patients, health care professionals should best use the NEWS.

Inflammatory liver diseases and susceptibility to sepsis.

Patients with inflammatory liver diseases, particularly alcohol-associated liver disease and metabolic dysfunction-associated fatty liver disease (MAFLD), have higher incidence of infections and mortality rate due to sepsis. The current focus in the development of drugs for MAFLD is the resolution of non-alcoholic steatohepatitis and prevention of progression to cirrhosis. In patients with cirrhosis or alcoholic hepatitis, sepsis is a major cause of death. As the metabolic center and a key immune tissue, liver is the guardian, modifier, and target of sepsis. Septic patients with liver dysfunction have the highest mortality rate compared with other organ dysfunctions. In addition to maintaining metabolic homeostasis, the liver produces and secretes hepatokines and acute phase proteins (APPs) essential in tissue protection, immunomodulation, and coagulation. Inflammatory liver diseases cause profound metabolic disorder and impairment of energy metabolism, liver regeneration, and production/secretion of APPs and hepatokines. Herein, the author reviews the roles of (1) disorders in the metabolism of glucose, fatty acids, ketone bodies, and amino acids as well as the clearance of ammonia and lactate in the pathogenesis of inflammatory liver diseases and sepsis; (2) cytokines/chemokines in inflammatory liver diseases and sepsis; (3) APPs and hepatokines in the protection against tissue injury and infections; and (4) major nuclear receptors/signaling pathways underlying the metabolic disorders and tissue injuries as well as the major drug targets for inflammatory liver diseases and sepsis. Approaches that focus on the liver dysfunction and regeneration will not only treat inflammatory liver diseases but also prevent the development of severe infections and sepsis.

Procalcitonin and C-Reactive Protein in Critically Ill Patients with Sepsis and Septic Shock Admitted in an ICU of a Tertiary Care Hospital in Bangladesh

Background: Early intervention and predicting outcome has become a cornerstone in the treatment of sepsis as this may ensure the difference between survival and mortality. Both C-reactive protein and Procalcitonin have long been identified as good diagnostic markers of sepsis but their prognostic value is still a matter of debate. This study aims to find this particular point out. Objectives: Objective of this current study is to see the relationship of Procalcitonin and C-reactive protein respectively with the outcome of the patients with sepsis and septic shock and to compare their usefulness as predictors of outcome. Methods: This study was carried out in Intensive Care Unit of BIRDEM General Hospital, Shahbag, Dhaka for a period of one year. All consecutive patients with sepsis and septic shock were enrolled as study subjects during this period according to selection criteria. At the time of diagnosis that is at zero hour of development of sepsis or septic shock both C-reactive protein and Procalcitonin were measured and it was repeated at 24 hours. Data were collected in preformed data collection sheet and analyzed by the SPSS. Results: In this study, total 170 patients were enrolled as a case of sepsis or septic shock. The mean age was 59.5 ± 15.8 with a range between 20-96 years. Fifty seven (34%) patients had septic shock either during admission or during the first 24 hour of ICU stay and 46 (27.1%) patients did not survive their illness. The mean SOFA score was 6.30±2.18, mean duration of ICU stay 5.5.±2.98 days and mean MAP was 83.73±24.49 mmHg and 98 patients (57.65%) patients were ventilated during their admission. Diabetes mellitus had majority among co-morbidities with 147 (86.4%) patients having diabetes mellitus. Finally after calculating the cut off values from Youden’s index C-reactive protein was found to be more sensitive and Procalcitonin more specific as predictors of outcome. Conclusion: This study concludes that both Procalcitonin and C-reactive protein can individually predict outcome in sepsis and septic shock and one is not inferiorto the other.The dynamic changes of both these biomarkers over first 24 hours were also strongly associated with outcome. It was noted that while C-reactive protein was more sensitive, Procalcitonin was more specific. Bangladesh Crit Care J March 2024; 12 (1): 4-10

The effects of antioxidant supplementation on short-term mortality in sepsis patients

BackgroundThe occurrence and development of sepsis are related to the excessive production of oxygen free radicals and the weakened natural clearance mechanism. Further dependable evidence is required to clarify the effectiveness of antioxidant therapy, especially its impact on short-term mortality. ObjectivesThe purpose of this systematic review and meta-analysis was to evaluate the effect of common antioxidant therapy on short-term mortality in patients with sepsis. MethodsAccording to PRISMA guidelines, a systematic literature search on antioxidants in adults sepsis patients was performed on PubMed/Medline, Embase, and the Cochrane Library from the establishment of the database to November 2023. Antioxidant supplements can be a single-drug or multi-drug combination: HAT (hydrocortisone, ascorbic acid, and thiamine), ascorbic acid, thiamine, N-acetylcysteine and selenium. The primary outcome was the effect of antioxidant treatment on short-term mortality, which included 28-day mortality, in-hospital mortality, intensive care unit mortality, and 30-day mortality. Subgroup analyses of short-term mortality were used to reduce statistical heterogeneity and publication bias. ResultsSixty studies of 130,986 sepsis patients fulfilled the predefined criteria and were quantified and meta-analyzed. Antioxidant therapy reduces the risk of short-term death in sepsis patients by multivariate meta-analysis of current data, including a reduction of in-hospital mortality (OR = 0.81, 95% CI 0.67 to 0.99; P = 0.040) and 28-day mortality (OR = 0.81, 95% CI 0.69 to 0.95]; P = 0.008). Particularly in subgroup analyses, ascorbic acid treatment can reduce in-hospital mortality (OR = 0.66, 95% CI 0.90 to 0.98; P = 0.006) and 28-day mortality (OR = 0.43, 95% CI 0.24 to 0.75; P = 0.003). However, the meta-analysis of RCTs found that antioxidant therapy drugs, especially ascorbic acid, did substantially reduce short-term mortality(OR = 0.78, 95% CI 0.62 to 0.98; P = 0.030; OR = 0.57, 95% CI 0.36 to 0.91; P = 0.020). ConclusionsAccording to current data of RCTs, antioxidant therapy, especially ascorbic acid, has a trend of improving short-term mortality in patients with sepsis, but the evidence remains to be further demonstrated.

Integrated Analysis Identified TGFBI as a Biomarker of Disease Severity and Prognosis Correlated with Immune Infiltrates in Patients with Sepsis.

Sepsis is a major contributor to morbidity and mortality among hospitalized patients. This study aims to identify markers associated with the severity and prognosis of sepsis, providing new approaches for its management and treatment. Data were mined from the Gene Expression Omnibus (GEO) databases and were analyzed by multiple statistical methods like the Spearman correlation coefficient, Kaplan-Meier analysis, Cox regression analysis, and functional enrichment analysis. Candidate indicator' associations with immune infiltration and roles in sepsis development were evaluated. Additionally, we employed techniques such as flow cytometry and neutral red staining to evaluate its impact on macrophage functions like polarization and phagocytosis. Twenty-eight genes were identified as being closely linked to the severity of sepsis, among which transforming growth factor beta induced (TGFBI) emerged as a distinct marker for predicting clinical outcomes. Notably, reductions in TGFBI expression during sepsis correlate with poor prognosis and rapid disease progression. Elevated expression of TGFBI has been observed to mitigate abnormalities in sepsis-related immune cell infiltration that are critical to the pathogenesis and prognosis of the disease, including but not limited to type 17 T helper cells and activated CD8 T cells. Moreover, the protein-protein interaction network revealed the top ten genes that interact with TGFBI, showing significant involvement in the regulation of the actin cytoskeleton, extracellular matrix-receptor interactions, and phagosomes. These are pivotal elements in the formation of phagocytic cups by macrophages, squaring the findings of the Human Protein Atlas. Additionally, we discovered that TGFBI expression was significantly higher in M2-like macrophages, and its upregulation was found to inhibit lipopolysaccharide-induced polarization and phagocytosis in M1-like macrophages, thereby playing a role in preventing the onset of inflammation. TGFBI warrants additional exploration as a promising biomarker for assessing illness severity and prognosis in patients with sepsis, considering its significant association with immunological and inflammatory responses in this condition.

Clostridium Cadaveris Bacteremia in an Immunocompromised Host

Clostridial bacteremia is an exceedingly rare clinical entity that can cause significant morbidity and mortality. Immunocompromised patients with insult to the gastrointestinal mucosa are especially prone to the development of clostridial sepsis based on limited existing literature. Here we report a case of a 65-year-old male nursing home resident with incompletely treated colorectal adenocarcinoma who was admitted for sepsis. He was found to have polymicrobial bacteremia with Escherichia coli and Clostridium cadaveris. He was successfully treated with intravenous piperacillin/tazobactam followed by an oral regimen of amoxicillin/clavulanic acid.

Cuproptosis-Related Biomarkers and Characterization of Immune Infiltration in Sepsis.

Sepsis is a worldwide epidemic, with high morbidity and mortality.Cuproptosis is a form of cell death that is associated with a wide range of diseases. This study aimedto explore genes associated withcuproptosisin sepsis, construct predictive modelsandscreen for potential targets. The LASSO algorithm and SVM-RFE model has been analysedthe expression ofcuproptosis-related genes in sepsis and immune infiltration characteristics and identified the marker genes under a diagnostic model. Gene-drug networks, mRNA-miRNA networksandPPI networks were constructed to screen for potential biological targets. The expression of marker genes was validated based on the GSE57065 dataset. Consensus clustering method was used to classify sepsis samples. We found 381 genes associated with the development of sepsis anddiscovered significantly differentially expressedcuproptosis-related genes of 16 cell types in sepsis and immune infiltration with CD8/CD4 T cells being lower.NFE2L2, NLRP3, SLC31A1, DLD, DLAT, PDHB, MTF1, CDKN2A andDLST were identified as marker genes by the LASSO algorithm and the SVM-RFE model. AUC > 0.9 was constructed for PDHB and MTF1 alone respectively. The validation group data for PDHB (P=0.00099) and MTF1 (P=7.2e-14) were statistically significant. Consistent clustering analysis confirmed two subtypes.The C1 subtype may be more relevant to cellular metabolism and the C2 subtype has some relevance to immune molecules.The results of animal experiments showed that the gene expression was consistent with the bioinformatics analysis. Our study systematically explored the relationship between sepsis andcuproptosisand constructed a diagnostic model. And, severalcuproptosis-related genes may interfere with the progression of sepsis through immune cell infiltration.

Comparison of Preoperative and Postoperative Neutrophil/Lymphocyte Ratio in Predicting Mortality in Neonates with Intestinal Atresia

Abstract Objective Congenital intestinal atresia is one of the most common surgical pathologies in the neonatal period. This study aimed to compare the efficacy of preoperative neutrophil/lymphocyte ratio (NLR) and postoperative NLR in predicting early mortality in neonates with intestinal atresia. Methods The data of 38 newborns with intestinal atresia operated on in our hospital between January 2016 and March 2023 were retrospectively analyzed. Patients' gestational age, gender, birth weight, other congenital anomalies, operative findings, length of hospital stay, sepsis, and mortality rates were recorded. NLR was calculated by analyzing preoperative and postoperative day 1 complete blood tests. Results Of the patients included in the study, 60.5% were male and 39.5% were female. The median birth weight was 2,468 g (600–3,800 g), and the median gestational age was 36 weeks (28–40 weeks). Gender, number of areas of atresia in the gut, and development of sepsis were not associated with mortality. Mortality was observed at a lower rate in duodenal atresia when compared with the other types of atresia (p < 0.05). The mortality was higher in patients with prematurity, low birth weight, long duration of mechanical ventilation, and severe congenital anomalies (p < 0.05). Preoperative lymphocyte and neutrophil counts were not found to be predictive of mortality. The mortality rate increased as the postoperative lymphocyte count decreased and as the neutrophil count increased (p < 0.05). The preoperative and postoperative NLR was not useful in predicting mortality, the development of sepsis, or the need for reoperation. Conclusion It is possible to predict early mortality in newborns with intestinal atresia who underwent surgery with neutrophil and lymphocyte counts on the first day after surgery. However, early NLR is not useful in predicting prognosis after surgery in newborns.

An improved mouse model of sepsis based on intraperitoneal injections of the enriched culture of cecum slurry

AimSepsis is a life-threatening clinical syndrome comprising multiorgan dysfunctions caused by a disproportionate body immune response. There are several animal sepsis models which are based on cecum ligation, cecal puncture, and cecum slurry injection. The major limitation of all current sepsis models is the high variability owing to the variable degree of ligation, puncture and inconsistent microbial composition used for sepsis initiation. The primary objective of this work is to demonstrate the feasibility of a standardized method for sepsis development. Materials and methodsThe cecal slurry bacterial culture was developed and preserved in glycerol stocks. Antibiotics aztreonam and vancomycin were used for generating several defined, enriched cecal slurry bacterial cultures. Mice survival was assessed until 48 hrs post injection, and the tissue samples were collected after 10 hrs from sepsis initiation. Key findingsThe results indicate that increasing polymicrobial load resulted in lower survival rates and was associated with the higher number of infiltrating immune cells and necrosis. H&E (haematoxylin & eosin) staining & serum markers revealed that septic mice exhibited increased inflammation and significant damage to the liver and kidneys. The defined Gram-negative and Gram-positive specific cecal slurry bacterial cultures were developed and their efficiency in inducing sepsis was characterized. SignificanceEnriched cecal slurry bacterial cultures can be stored in glycerol stocks at −80 °C. This has an ethical advantage of avoiding unnecessary animal euthanasia for each experiment and provides a standardization capability of sepsis development.

Causal association between thyroid dysfunction and sepsis: a two-sample mendelian randomization study.

The causal association between thyroid dysfunction (including hyperthyroidism and hypothyroidism) and sepsis is controversial in previous studies. Therefore, we used Mendelian randomization (MR) to explore the causal association between hyperthyroidism or hypothyroidism and the susceptibility to four distinct subtypes of sepsis (streptococcal sepsis, puerperal sepsis, asthma-associated pneumonia or sepsis, and other sepsis). In our research, we conducted two-sample Mendelian randomization (MR) analyses utilizing publicly available genome-wide association studies (GWAS) data from Sakaue etal. and the Finnish database to investigate the potential causal associations between hyperthyroidism, hypothyroidism, and each of the four distinct subtypes of sepsis, in addition to reverse MR analyses of the positive results to examine the existence of reverse causality. Genetic hypothyroidism was causally related to the development of asthma-associated pneumonia or sepsis (ORIVW: 1.097, 95% CI: 1.024 to 1.174, P = 0.008); hypothyroidism was significantly associated with the development of other sepsis (ORIVW: 1.070, 95% CI: 1.028 to 1.115, P < 0.001). In addition, sensitivity analysis substantiated the robustness of these two MR findings, with no evidence of horizontal pleiotropy observed (P > 0.05). MR Egger regression analysis demonstrated no heterogeneity between instrumental variables (IVs). Inverse MR results confirmed no reverse causality between hypothyroidism and asthma-associated pneumonia or sepsis, or between hypothyroidism and other sepsis. The findings of this study also unveiled that there is no evidence of a causal link between hypothyroidism and the development of streptococcal sepsis or puerperal sepsis. Additionally, the research provided evidence indicating the absence of a causal relationship between hyperthyroidism and streptococcal sepsis, puerperal sepsis, asthma-associated pneumonia or sepsis, and other sepsis. This study identified a causal link between hypothyroidism and the occurrence of asthma-associated pneumonia or sepsis, and other sepsis, but not with the development of streptococcal sepsis and puerperal sepsis. Moreover, our findings did not reveal any causal association between hyperthyroidism and streptococcal sepsis, puerperal sepsis, asthma-associated pneumonia or sepsis, and other sepsis.

Risk-Benefit Comparison Between Endoloop and Endostapler Devices for the Closure of Appendiceal Stumps in Laparoscopic Appendectomy.

Introduction Acute appendicitis is a common cause of acute abdomen and the most frequent surgical emergency in the world. Since the nineteenth century, surgical resolution has been the most accepted treatment worldwide, and laparoscopic appendectomy is currently preferred as the treatment of choice because it has several benefits. The closure of the appendiceal stump is the most crucial step during appendectomy since its inadequate management can cause post-surgical complications. Throughout recent years, several methods have been proposed to perform this closure. This study was performed to compare the post-surgical outcomes of the use of endoloop and endostapler devices. Methods This is a retrospective study of 290 patients aged 18 to 83 who underwent laparoscopic appendectomy between 2016 and 2020. Demographic data, clinical history, tomographic findings, and laboratory data were collected, as well as appendicular base management technique, severity degree of appendicitis at hospital admission, postoperative complications at 30 days, hospital readmission, and in-hospital stay. Statistical tests and binary logistic regression analyses were used to identify risk factors, with a significance level of p<0.05. Results Demographic data and clinical history did not show statistically significant differences. The presence of a pre-surgical abscess with tomography was 1.58 times higher in the endostapler group. Post-surgical results showed that the use of endostapler devices represented a 2.7 times higher risk of post-surgical abscess. The endostapler group was also found to have 1.87 times the risk of post-surgical sepsis. Conclusion Our study shows that the use of an endoloop reduces the risk of postoperative abscess by 16.5% and protects against the development of post-surgical sepsis by 30%.