Diagnostic value of urine sCD163 levels for sepsis and relevant acute kidney injury: a prospective study

BACKGROUND: Sepsis is a common syndrome in critically ill patients and easily leads to the occurrence of acute kidney injury (AKI), with high mortality rates. This study aimed to investigate the diagnostic value of urine soluble CD163 (sCD163) for identification of sepsis, severity of sepsis, and for secondary AKI, and to assess the patients’ prognosis. METHODS: We enrolled 20 cases with systemic inflammatory response syndrome (SIRS), 40 cases with sepsis (further divided into 17 sepsis cases and 23 severe sepsis cases) admitted to the intensive care unit (ICU), and 20 control cases. Results for urine sCD163 were recorded on the day of admission to the ICU, and AKI occurrence was noted. RESULTS: On the day of ICU admission, the sepsis group exhibited higher levels of urine sCD163 (74.8 ng/ml; range: 47.9-148.3 ng/ml) compared with those in the SIRS group (31.9 ng/ml; 16.8-48.0, P < 0.001). The area under the curve (AUC) was 0.83 (95% confidence interval [CI]: 0.72-0.94, P < 0.001) the sensitivity was 0.83, and the specificity was 0.75 (based on a cut-off point of 43.0 ng/ml). Moreover, the severe sepsis group appeared to have a higher level of sCD163 compared with that in the sepsis group (76.2; 47.2-167.5 ng/ml vs. 74.2; 46.2-131.6 ng/ml), but this was not significant. For 15 patients with AKI, urine sCD163 levels at AKI diagnosis were significantly higher than those of the remaining 35 sepsis patients upon ICU admission (121.0; 74.6-299.1 ng/ml vs. 61.8; 42.8-128.3 ng/ml, P = 0.049). The AUC for urine sCD163 was 0.688 (95% CI: 0.51-0.87, P = 0.049). Sepsis patients with a poor prognosis showed a higher urine sCD163 level at ICU admission (98.6; 50.3-275.6 ng/ml vs. 68.0; 44.8-114.5 ng/ml), but this was not significant. Patients with AKI with a poor prognosis had higher sCD163 levels than those in patients with a better prognosis (205.9; 38.6-766.0 ng/ml vs. 80.9; 74.9-141.0 ng/ml), but this was not significant. CONCLUSIONS: This study shows, for the first time, the potential value of urine sCD163 levels for identifying sepsis and diagnosing AKI, as well as for assessment of patients’ prognosis. TRIAL REGISTRATION: ChiCTR-ONC-1000081

Incorporating electrical impedance tomography to transpulmonary pressure-guided PEEP in severe ARDS with pneumothorax and multiple cavitations: a case report

Pneumothorax is a potentially fatal complication in patients with acute respiratory distress syndrome (ARDS), presenting challenges in determining the optimal positive end-expiratory pressure (PEEP) level to prevent atelectasis without exacerbating the pneumothorax. This case report describes the successful application of transpulmonary pressure and electrical impedance tomography (EIT) at the bedside to guide PEEP selection in a patient with ARDS complicated by pneumothorax due to methicillin-resistant Staphylococcus aureus infection. By using minimal PEEP to maintain positive end-expiratory transpulmonary pressure and visualizing lung reopening with EIT, the optimal PEEP level was reaffirmed, even if traditionally considered high. The patient’s condition improved, and successful weaning from the ventilator was achieved, leading to a transfer out of the intensive care unit.Clinical trial registration: https://clinicaltrials.gov/show/NCT04081142, identifier NCT04081142

Editorial: Coronavirus disease (COVID-19): pathophysiology, epidemiology, clinical management and public health response

During a pandemic, there are multiple concurrent clinical and scientific priorities, including the need to understand the pathophysiology of the disease, the different modes of transmission, how patient care can be optimized, as well as the need to develop mathematical models that can now cast and forecast the progression of infections within given populations and/or geographical regions. When the current SARS-CoV2 pandemic was declared a Public Health Emergency of International Concern by the World Health Organization, a formal declaration of its gravity, it became evident that there was an acute need to understand all of the above aspects. In doing so, by 11th February 2020, a special topic, entitled “Coronavirus Disease (COVID-19): Pathophysiology, Epidemiology, Clinical Management and Public Health Response,” was initiated with a dedicated team of handling editors to facilitate the timely peer-review and publication of relevant manuscripts (1). Frontiers, as the publisher of this special topic, took the bold step of waiving any article processing charges so that financial constraints would not be a barrier to communicating crucial information about the pandemic to a broad audience. Furthermore, this was the most extensive special topic to date in the Frontiers portfolio, in terms of the numbers of participating Frontiers journals, disciplines, and sections. This reflected the acute need for the scientific community to understand the many aspects of the pandemic. This special Research Topic captured the entire first wave in the northern hemisphere, from February to May 2020, and the intensity of the associated editorial work is evident by the reported numbers. Within 4 months, 194 abstracts were received; in total 851 manuscripts were submitted, of which 453 were rejected while 398 were published. From the scientific community perspective, by June 2020 the special topic achieved over 2 million views, by December 2020 over 4 million views, and by August 2021 over 8 million views. As an example of the breadth of subjects covered, manuscripts included the attempt by Larsen et al. to model the onset of symptoms of COVID-19; the observed gender differences on COVID-19 patients’ severity and mortality by Jin et al., the correlation between poverty levels and rates of COVID-19 incidence and death in the United States by Finch and Finch, as well as the careful review of the cytokine storm in COVID-19 (Tang et al.

Parathyroid Hormone versus Bisphosphonate Treatment on Bone Mineral Density in Osteoporosis Therapy: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Bisphosphonates and parathyroid hormone (PTH) represent the antiresorptive and anabolic classes of drugs for osteoporosis treatment. Bone mineral density (BMD) is an essential parameter for the evaluation of anti-osteoporotic drugs. The aim of this study was to evaluate the effects of PTH versus bisphosphonates on BMD for the treatment of osteoporosis. METHODS/PRINCIPAL FINDINGS: We performed a literature search to identify studies that investigated the effects of PTH versus bisphosphonates treatment on BMD. A total of 7 articles were included in this study, representing data on 944 subjects. The pooled data showed that the percent change of increased BMD in the spine is higher with PTH compared to bisphosphonates (WMD = 5.90, 95% CI: 3.69-8.10, p<0.01,). In the hip, high dose (40 µg) PTH (1-34) showed significantly higher increments of BMD compared to alendronate (femoral neck: WMD = 5.67, 95% CI: 3.47-7.87, p<0.01; total hip: WMD = 2.40, 95%CI: 0.49-4.31, p<0.05). PTH treatment has yielded significantly higher increments than bisphosphonates with a duration of over 12 months (femoral neck: WMD = 5.67, 95% CI: 3.47-7.86, p<0.01; total hip: WMD = 2.40, 95% CI: 0.49-4.31, P<0.05) and significantly lower increments at 12 months (femoral neck: WMD = -1.05, 95% CI: -2.26-0.16, p<0.01; total hip: WMD: -1.69, 95% CI: -3.05-0.34, p<0.05). In the distal radius, a reduction in BMD was significant between PTH and alendronate treatment. (WMD = -3.68, 95% CI: -5.57-1.79, p<0.01). DISCUSSION: Our results demonstrated that PTH significantly increased lumbar spine BMD as compared to treatment with bisphosphonates and PTH treatment induced duration- and dose-dependent increases in hip BMD as compared to bisphosphonates treatment. This study has also disclosed that for the distal radius, BMD was significantly lower from PTH treatment than alendronate treatment

Demonstration of laser-produced neutron diagnostic by radiative capture gamma-rays

We report a new scenario of time-of-flight (TOF) technique in which fast neutrons and delayed gamma-ray signals were both recorded in a millisecond time window in harsh environments induced by high-intensity lasers. The delayed gamma signals, arriving far later than the original fast neutron and often being ignored previously, were identified to be the results of radiative captures of thermalized neutrons. The linear correlation between gamma photon number and the fast neutron yield shows that these delayed gamma events can be employed for neutron diagnosis. This method can reduce the detecting efficiency dropping problem caused by prompt high-flux gamma radiation, and provides a new way for neutron diagnosing in high-intensity laser-target interaction experiments

Editorial: Clinical Application of Artificial Intelligence in Emergency and Critical Care Medicine, Volume I

10.3389/fmed.2021.809478Frontiers in Medicine880947