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Frontiers in Psychiatry 2021Sudden cardiac arrest (SCA) is a leading cause of mortality and morbidity in affluent societies, which underscores the need to identify persons at risk. The etiology of... (Review)
Review
Sudden cardiac arrest (SCA) is a leading cause of mortality and morbidity in affluent societies, which underscores the need to identify persons at risk. The etiology of SCA is however complex, with predisposing and precipitating factors interacting. Although anxiety and mental stress have been linked to SCA for decades, their precise role and impact remain unclear and the biological underpinnings are insufficiently understood. In this paper, we systematically reviewed various types of observational studies (total = 20) examining the association between anxiety or mental stress and SCA. Multiple methodological considerations challenged the summarizing and interpretation of the findings. For anxiety, the overall picture suggests that it predisposes for SCA in physically healthy populations (unadjusted OR = 2.44; 95% CI: 1.06-5.59; = 3). However, in populations at risk for SCA ( = 4), associations were heterogeneous but not significant. Anxiety may partly predispose to SCA by contributing to other risk factors such as cardiovascular disease and diabetes mellitus via mechanisms such as unhealthy lifestyle and metabolic abnormalities. Mental stress appears to precipitate SCA, presumably by more directly impacting on the cardiac ion channels that control the heart's electrical properties. This may lead to ventricular fibrillation, the arrhythmia that underlies SCA. To advance this field of research, experimental studies that unravel the underlying biological mechanisms are deemed important, and most easily designed for mental stress as a precipitating factor because of the short timeframe. These proof-of-concept studies should examine the whole pathway from the brain to the autonomic nervous system, and eventually to cardiac ion channels. Ultimately, such studies may facilitate the identification of persons at risk and the development of novel preventive strategies.
PubMed: 35185641
DOI: 10.3389/fpsyt.2021.813518 -
Biomedicines Jun 2023Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute and severe decompensation of chronic liver disease (CLD) correlated with multiple organ... (Review)
Review
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute and severe decompensation of chronic liver disease (CLD) correlated with multiple organ failure, poor prognosis, and increased mortality. In 40-50% of ACLF cases, the trigger is not recognized; for many of these patients, bacterial translocation associated with systemic inflammation is thought to be the determining factor; in the other 50% of patients, sepsis, alcohol consumption, and reactivation of chronic viral hepatitis are the most frequently described trigger factors. Other conditions considered precipitating factors are less common, including acute alcoholic hepatitis, major surgery, TIPS insertion, or inadequate paracentesis without albumin substitution. Host response is likely the primary factor predicting ACLF severity and prognosis, the host immune response having a particular significance in this syndrome, together with the inflammatory cascade. The management of ACLF includes both the prevention of the precipitating factors that lead to acute liver decompensation and the support of vital functions, the prevention and management of complications, the estimation of prognosis, and the opportunity for liver transplantation.
PubMed: 37509478
DOI: 10.3390/biomedicines11071840 -
Frontiers in Immunology 2023Tumor-infiltrating T lymphocytes in the tumor microenvironment are critical factors influencing the prognosis and chemotherapy outcomes. As a Chinese herbal medicine,...
INTRODUCTION
Tumor-infiltrating T lymphocytes in the tumor microenvironment are critical factors influencing the prognosis and chemotherapy outcomes. As a Chinese herbal medicine, Marsdenia tenacissima extract (MTE) has been widely used to treat cancer in China. Its immunoregulatory effects on tumor-associated macrophages is well known, but whether it regulates tumor-infiltrating T-cell functions remains unclear.
METHOD
We collected 17 tumor samples from MTE-administered colorectal cancer patients, 13 of which showed upregulation of CD3+/CD8+ tumor-infiltrating T cells. Further and experiments were performed to investigate the regulatory effects of MTE on tumor-infiltrating T cells and immune escape of tumors.
RESULTS
Under single and co-culture conditions, MTE inhibited TGF-β1 and PD-L1 expression in the colorectal cancer (CRC) cell lines HCT116 and LoVo. In Jurkat cells, MTE inhibited FOXP3 and IL-10 expression, increased IL-2 expression, but had no effect on PD-1 expression. These findings were confirmed using subcutaneous and colitis-associated CRC mouse models. MTE also increased the density of CD3+/CD8+ tumor-infiltrating T cells and exhibited considerable tumor-suppressive effects in these two tumor mouse models.
CONCLUSIONS
Our findings suggested that MTE inhibits the immune escape of cancer cells, a precipitating factor increasing the immune response of T lymphocytes.
Topics: Animals; Mice; Marsdenia; CD8-Positive T-Lymphocytes; Cell Line; Colitis-Associated Neoplasms; Immunity; Tumor Microenvironment
PubMed: 37649480
DOI: 10.3389/fimmu.2023.1238694 -
Acta Clinica Croatica Apr 2023The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender...
The aim of the study was to determine the most common precipitating factors and symptoms of diabetic ketoacidosis and the possible difference according to age, gender and severity of diabetic ketoacidosis. Medical records from January 1, 2017 until December 31, 2019 were reviewed and patients diagnosed with diabetic ketoacidosis were selected. The study included 52 patients, median age 34 (interquartile range 21-56) years. There was no statistically significant difference between male and female gender. The severity of diabetic ketoacidosis was moderate in the majority of cases (65.4%; p=0.005). The most common precipitating factor was infection (61.7%). In patients with moderate diabetic ketoacidosis, respiratory infections were more common, while gastrointestinal infections were more common in severe diabetic ketoacidosis (33% and 25%, respectively; p=0.03). Nausea (median age 32 years; p=0.004) and vomiting (median age 31 years; p=0.01) were more common in younger age groups, while altered mental status was more common in the older age group (median age 61 years; p=0.001). Infection was the most common precipitating factor. The most common symptoms in younger age groups were nausea and vomiting, and altered mental status in the older age group.
Topics: Humans; Male; Female; Aged; Young Adult; Adult; Middle Aged; Diabetic Ketoacidosis; Diabetes Mellitus, Type 1; Precipitating Factors; Vomiting; Nausea
PubMed: 38304369
DOI: 10.20471/acc.2023.62.01.08 -
Seminars in Liver Disease May 2016Acute-on-chronic liver failure (ACLF) is a complex syndrome that develops in patients with cirrhosis at any stage during the natural history of the disease. In most... (Review)
Review
Acute-on-chronic liver failure (ACLF) is a complex syndrome that develops in patients with cirrhosis at any stage during the natural history of the disease. In most cases, the development of ACLF is associated with an identifiable precipitating factor. Overall, the most common precipitating events are bacterial infections. Although data suggest that any type of infection may trigger ACLF, spontaneous bacterial peritonitis, secondary peritonitis, and pneumonia appear to be the most common types of infection leading to ACLF. Nevertheless, frequency and characteristics of precipitating factors differ among geographical areas. Although in the West the most common precipitating factors are bacterial infections followed by active alcoholism, in the East the most common triggering events are exacerbation of hepatitis B virus followed by bacterial infections. Although precipitating events may be crucial in the development of ACLF, mortality appears to be independent of the type of precipitating factor. Finally, it should be noted that in up to 20 to 40% of patients with ACLF no precipitating factor can be identified. It is suggested that in these patients, bacterial products derived from bacterial translocation or damage-associated molecular patterns resulting from injured liver tissue cells may act as triggering factors.
Topics: Acute-On-Chronic Liver Failure; Alcoholism; Bacterial Infections; Hepatitis B; Humans; Liver Cirrhosis; Precipitating Factors; Severity of Illness Index; Syndrome
PubMed: 27172352
DOI: 10.1055/s-0036-1583204 -
British Journal of Anaesthesia Sep 2016Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is... (Review)
Review
Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration. Trials specifically examining bleeding management in vascular surgery are lacking, and much of the literature and guidelines are derived from studies on patients with trauma. In general, it is recommended to adopt permissive hypotension with a restrictive fluid strategy, using a combination of crystalloid and colloid solutions up to one litre during the initial resuscitation, after which blood products should be administered. A restrictive transfusion trigger for red cells remains the mainstay of treatment except for the high-risk patients, where the trigger should be individualized. Transfusion of blood components should be initiated by clinical evidence of coagulopathy such as diffuse microvascular bleeding, and then guided by either laboratory or point-of-care coagulation testing. Prophylactic antifibrinolytic use is recommended for all surgery where excessive bleeding is anticipated. Fibrinogen and prothrombin complex concentrates administration are recommended during massive transfusion, whereas rFVIIa should be reserved until all means have failed. While debates over the ideal resuscitative strategy continue, the approach to vascular haemostasis should be scientific, rational, and structured. As far as possible, therapy should be monitored and goal directed.
Topics: Anticoagulants; Blood Coagulation Factors; Blood Transfusion; Factor VIIa; Fibrinogen; Fluid Therapy; Hemorrhage; Humans; Plasma; Platelet Aggregation Inhibitors; Point-of-Care Systems; Recombinant Proteins; Vascular Surgical Procedures; Vitamin K
PubMed: 27566811
DOI: 10.1093/bja/aew270 -
The American Journal of Cardiology Dec 2018Inability to predict short-term cardiovascular (CV) events and take immediate preemptive actions has long been the Achilles heel of cardiology. However, certain triggers... (Review)
Review
Inability to predict short-term cardiovascular (CV) events and take immediate preemptive actions has long been the Achilles heel of cardiology. However, certain triggers of these events have come to light. Although these triggers are nonspecific and are part of normal life, studying their temporal relationship with the onset of CV events provides an opportunity to alert high-risk atherosclerotic patients who may be most vulnerable to such triggers, the "vulnerable patient". Herein, we review the literature and shed light on the epidemiology and underlying pathophysiology of different triggers. We describe that certain adrenergic triggers can precipitate a CV event within minutes or hours; whereas triggers that elicit an immune or inflammatory response such as infections may tip an asymptomatic "vulnerable patient" to become symptomatic days and weeks later. In conclusion, healthcare providers should counsel high-risk CV patients (e.g., in secondary prevention clinics or those with coronary artery Calcium >75th percentile) on the topic, advise them to avoid such triggers, take protective measures once exposed, and seek emergency care immediately after becoming symptomatic after such triggers. Furthermore, clinical trials targeting triggers (prevention or intervention) are needed.
Topics: Acute Disease; Cardiovascular Diseases; Humans; Physical Exertion; Precipitating Factors; Risk Factors; Stress, Psychological
PubMed: 30309628
DOI: 10.1016/j.amjcard.2018.08.049 -
The Journal of the Association of... Jan 2023Hepatorenal syndrome (HRS) is a functional renal failure due to intense renal vasoconstriction that frequently develops in patients with cirrhosis. Past studies reported...
INTRODUCTION
Hepatorenal syndrome (HRS) is a functional renal failure due to intense renal vasoconstriction that frequently develops in patients with cirrhosis. Past studies reported that in almost half of the cases of HRS, one or more precipitating factors can be identified. We conducted a study to determine the Precipitating factors and outcome of hepatorenal Syndrome in liver cirrhosis.
MATERIALS
This cross-sectional analytical study was conducted in tertiary care centre. A total of 62 consecutive patients admitted with HRS were included in this study. All adult patients admitted with diagnosis chronic liver disease with hepatorenal syndrome after applying exclusion criteria. The precipitants of HRS were correlated with the type of HRS; length of hospital stay and mortality.
RESULT
Among the 62 subjects, 52% were alcoholics who were predominantly male and they had alcoholic cirrhosis. 21% and 16% were affected by hepatitis B and C respectively. Remaining 11% of them had non-alcoholic fatty liver disease. Bacterial infection and Large volume paracentesis had the longest duration of stay 16 ± 2 days and 12 deaths, GI bleed was around 12 ± 1 days and 4 deaths, ug induced HRS had 8 ± 2 days and 2 deaths, unknown factors were 5 ± 2 days.
CONCLUSION
Patients presenting with two or more precipitating factors and advanced grade of HE had a prolonged hospital stay and increased mortality rate. Spontaneous bacterial infection was the most common precipitating factor at our centre. References Ginès A, Escorsell A, Ginès P, et al. Incidence, predictive factors, and prognosis of the hepatorenal syndrome in cirrhosis with ascites. Gastroenterology 1993;105(1):229-236. Arroyo V, Ginès P, Alexander L, et al. Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club. Hepatology 1996;23(1):164- 176.
Topics: Adult; Humans; Male; Female; Precipitating Factors; Hepatorenal Syndrome; Ascites; Cross-Sectional Studies; Liver Cirrhosis
PubMed: 37116041
DOI: No ID Found -
Liver International : Official Journal... Jun 2021Acute-on-chronic liver failure (ACLF) is defined by the rapid development of organ(s) failure(s) associated with high rates of early (28-day) mortality in patients with...
Acute-on-chronic liver failure (ACLF) is defined by the rapid development of organ(s) failure(s) associated with high rates of early (28-day) mortality in patients with cirrhosis. ACLF has been categorized into three grades of increasing severity according to the nature and number of organ failures. In patients with grade 3 ACLF, 28-day mortality is >70%. While the definition of ACLF has been endorsed by European scientific societies, North American and Asian Pacific associations have proposed alternative definitions. A prognostic score called the CLIF-C ACLF score provides a more precise assessment of the prognosis of patients with ACLF. Although bacterial infections and variceal bleeding are common precipitating factors, no precipitating factor can be identified in almost 60% of patients with ACLF. There is increasing evidence that cirrhosis is a condition characterized by a systemic inflammatory state and occult infections or translocation of bacteria or bacterial products from the lumen of the GUT to the systemic circulation which could play a role in the development of ACLF. Simple and readily available variables to predict the occurrence of ACLF in patients with cirrhosis have been identified and high-risk patients need careful management. Whether prolonged administration of statins, rifaximin or albumin can prevent ACLF requires further study. Patients with organ(s) failure(s) may needed to be admitted to the ICU and there should be no hesitation in admitting patients with cirrhosis to the ICU. No benefit to survival was observed with albumin dialysis and rescue transplantation is the best option in the most severe patients. One-year post-transplant survival rates exceeding 70%-75% have been reported, including in patients with grade 3 ACLF but these patients were highly selected. Criteria have been proposed to define futile transplantation (too ill to be transplanted), but these criteria need to be refined to include age, comorbidities and frailty in addition to markers of disease severity.
Topics: Acute-On-Chronic Liver Failure; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Prognosis
PubMed: 34155793
DOI: 10.1111/liv.14855 -
BioMed Research International 2019Coronary artery spasm (CAS) is one of the mechanisms of angina pectoris. Unlike the diagnosis of acute myocardial infarction which is based on the elevation of cardiac... (Review)
Review
Coronary artery spasm (CAS) is one of the mechanisms of angina pectoris. Unlike the diagnosis of acute myocardial infarction which is based on the elevation of cardiac markers, the diagnosis of CAS is difficult and sometimes requires sophisticated and risky provocative test which is not widely accepted in China. There is no well-established biomarker for the diagnosis or prediction of CAS. However, there are some biomarkers proven to be associated with the occurrence of CAS. For example, inflammatory factors including C-reactive protein and cytokines, lipoprotein (a), and cystatin-C might be precipitating factor for CAS. Rho-kinase as a mediator involved in multiple mechanisms of CAS, serotonin, and endothelin-1 as powerful vasoconstrictors leading to vasospasm were all observed being elevated in patients with CAS. Thioredoxin and nitrotyrosine reflected the oxidative status and could be observed to be elevated after the occurrence of CAS. In some cases doubted to be CAS without the evidence of provocative test, the blood test for the biomarkers mentioned above could be useful for the diagnosis of CAS.
Topics: Acetylcholine; Angina Pectoris; Biomarkers; C-Reactive Protein; China; Coronary Vasospasm; Coronary Vessels; Cystatin C; Cytokines; Humans; Lipoprotein(a); Myocardial Infarction
PubMed: 31637257
DOI: 10.1155/2019/4834202