BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for r...BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for refractory septic shock,assessing mortality,vasopressor use,intensive care unit(ICU)length of stay,and organ dysfunction.METHODS A systematic search was conducted in PubMed,EMBASE,Cochrane CENTRAL Library,and Web of Science for studies published between 2000 and 2024.Inclusion criteria encompassed randomized controlled trials(RCT)evaluating innovative therapies for refractory septic shock.Variables of interest:The primary outcome was allcause mortality among patients treated with novel interventions.Secondary outcomes included length of stay in the ICU,total hospital length of stay,and use of vasoactive drugs.Methodological rigor was assessed using the Cochrane Risk of Bias tool.RESULTS From 850 records,24 RCTs met the inclusion criteria,evaluating therapies such as methylene blue,vasopressin,terlipressin,and combinations of hydrocortisone,vitamin C,and thiamine.Mortality rates ranged from 28.6%to 56.8%.Methylene blue reduced vasopressor dependency in patients requiring high norepinephrine doses by 1.0 vasopressor-free day,and terlipressin improved renal perfusion by 13.1%.Combination therapies enhanced secondary outcomes,including reductions in Sequential Organ Failure Assessment score.However,no single intervention consistently demonstrated significant survival benefits.CONCLUSION Adjunctive therapies for refractory septic shock may improve hemodynamics and organ function,however,they have not been shown to consistently reduce mortality.Larger trials are needed to confirm these findings.Multimodal approaches targeting inflammation are critical.展开更多
BACKGROUND Perinatal depression affects 10%-20%of pregnant women and subsequently influences maternal health and fetal development.Concerns over the safety of antidepressants during pregnancy have prompted the explora...BACKGROUND Perinatal depression affects 10%-20%of pregnant women and subsequently influences maternal health and fetal development.Concerns over the safety of antidepressants during pregnancy have prompted the exploration of nutritional interventions as adjunct therapies.This study evaluated the impact of combining preconception and prenatal supplementation with myo-inositol,probiotics,and trace elements on mood,quality of life,and fetal development in depressed mothers.This retrospective cohort study included 314 pregnant women who were diag-nosed with mild to moderate depression,as determined by a Zung self-rating depression scale score of less than 69.The participants were divided into an intervention group(n=161)receiving myo-inositol,probiotics,and trace elements and a control group(n=153)without supplementation.Supplementation comm-enced 3 months before conception and continued through pregnancy.Psychiatric symptoms and quality of life were evaluated using the positive and negative affect schedule-now,state-trait anxiety inventory,Patient Health Ques-tionnaire-8,and World Health Organization Quality of life Assessment:Brief Version scales preconception and postpartum.Fetal development metrics were assessed via ultrasound,and neonatal outcomes were recorded.RESULTS The intervention group presented significant reductions in gestational diabetes mellitus(13.04%vs 23.53%,P=0.016)and gestational hypertension(3.73%vs 9.15%,P=0.049).Higher levels of inositol,iron,zinc,and probiotics were observed near term in the intervention group.Postpartum mood assessments indicated lower anxiety and depression scores for the intervention group,with significant improvements in the positive and negative affect schedule-now(P=0.002),trait anxiety(P=0.002),and Patient Health Questionnaire-8(P=0.018)scores.The World Health Organization Quality of life Assessment:Brief Version scores improved in the psychological(P=0.041)and environmental(P=0.009)domains postpartum.Fetal biparietal diameter and femoral length were greater in the intervention group alongside better neonatal body length and reduced neonatal unit admissions(2.48%vs 7.84%,P=0.031).CONCLUSION Combined supplementation with myo-inositol,probiotics,and trace elements from preconception through pregnancy may reduce pregnancy-related complications,enhance mood and quality of life,and improve fetal growth metrics.展开更多
Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanica...Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanical and chemical preparation methods remain inadequate,often leaving significant portions of the canal uncleaned and contributing to persistent infection.The advent of erbium laser-assisted chemical preparation has demonstrated significant potential in enhancing root canal disinfection through advanced fluid dynamics mechanisms,particularly cavitation and photoacoustic streaming.This review explores the fundamental principles governing fluid dynamics in erbium laser-assisted irrigation,with a focus on primary and secondary cavitation effects.The interaction between erbium laser energy and water generates vapor bubbles that induce dynamic fluid movement,enhancing the penetration and distribution of irrigants deep within the root canal system.Key factors influencing fluid dynamics intensity,including laser parameters,working tip design,and water medium confinement,are critically analyzed.Furthermore,recent advancements such as Photon-Initiated Photoacoustic Streaming(PIPS),Photoacoustic Synchronized Transients(PHAST),and Shock Wave Enhanced Emission Photoacoustic Streaming(SWEEPS)are reviewed in the context of their ability to improve fluid motion and irrigation efficacy.While these laser-assisted techniques offer promising improvements over traditional methods,challenges remain in optimizing energy parameters and mitigating the constraints imposed by confined root canal environments.Future research should focus on refining fluid dynamics models and conducting clinical studies to validate the efficacy of these innovations.This review aims to provide a comprehensive overview of current developments in fluid dynamics research related to erbium laser-assisted chemical preparation,offering insights into its potential as an advanced modality for root canal disinfection.展开更多
BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical ...BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures.AIM To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures.METHODS During May 2023,the PubMed,EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies.Data regarding study characteristics,patient demographics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.In addition,the level of evidence(LOE)and quality of evidence(QOE)for each individual study was also assessed.Thirteen studies were included in this review.RESULTS In total,363 patients(397 ankles and feet)received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8±9.2 months.The most common procedure performed was ankle arthrodesis in 94 patients(25.9%).Other procedures performed included hindfoot fusion,1st metatarsophalangeal joint arthrodesis,5th metatarsal intramedullary screw fixation,hallux valgus correction,osteochondral lesion of the talus repair and unicameral talar cyst resection.The osseous union rate in the ankle and hindfoot arthrodesis cohort,base of the 5th metatarsal cohort,and calcaneal fracture cohort was 85.6%,100%,and 100%,respectively.The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6±0.1 to a post-operative score of 0.4±0.1.The overall complication rate was 27.2%,the most common of which was non-union(8.8%).There were 43 failures(10.8%)all of which warranted a further surgical procedure.CONCLUSION This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates.Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM,with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot.However,the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.展开更多
[目的]考察来源于中国传统发酵制品中乳酸菌的抑真菌特性,研究其在酸奶贮藏中的抑制霉菌效果。[方法]高效液相色谱法(HPLC)检测7株具有抗真菌效果的乳杆菌发酵液中苯乳酸(PLA)含量,研究PLA与乳杆菌发酵液抗真菌活性的相关性。选取抑菌...[目的]考察来源于中国传统发酵制品中乳酸菌的抑真菌特性,研究其在酸奶贮藏中的抑制霉菌效果。[方法]高效液相色谱法(HPLC)检测7株具有抗真菌效果的乳杆菌发酵液中苯乳酸(PLA)含量,研究PLA与乳杆菌发酵液抗真菌活性的相关性。选取抑菌活性最强的菌株Lactobacillus casei AST18进行抑菌特性研究。Lactobacillus casei AST18分别以2%、4%、6%、8%接种量作为辅助发酵剂添加至酸奶发酵工艺中,成品酸奶贮藏期间,监测酸奶中霉菌生长状况,检测酸奶理化指标并进行感官评定。[结果]乳杆菌发酵液中苯乳酸含量与其抑真菌直径间相关关系不显著。Lactobacillus casei AST18发酵上清液经胃蛋白酶和胰蛋白酶处理后不影响其抑菌活性,而环境pH对其抑菌活性的影响显著,热处理可使其丧失抑菌活性。Lactobacillus caseiAST18以2%添加量作为辅助发酵剂应用在酸奶中可抑制霉菌菌丝生长和孢子生成,且对酸奶产品风味、感官品质无显著影响。[结论]Lactobacillus casei AST18具有较好的抑制霉菌生长能力,应用在酸奶中具有显著的防霉保鲜效果。展开更多
文摘BACKGROUND Refractory septic shock is a critical and multifaceted condition that continues to pose significant challenges in critical care.AIM To systematically review randomized trials on emerging interventions for refractory septic shock,assessing mortality,vasopressor use,intensive care unit(ICU)length of stay,and organ dysfunction.METHODS A systematic search was conducted in PubMed,EMBASE,Cochrane CENTRAL Library,and Web of Science for studies published between 2000 and 2024.Inclusion criteria encompassed randomized controlled trials(RCT)evaluating innovative therapies for refractory septic shock.Variables of interest:The primary outcome was allcause mortality among patients treated with novel interventions.Secondary outcomes included length of stay in the ICU,total hospital length of stay,and use of vasoactive drugs.Methodological rigor was assessed using the Cochrane Risk of Bias tool.RESULTS From 850 records,24 RCTs met the inclusion criteria,evaluating therapies such as methylene blue,vasopressin,terlipressin,and combinations of hydrocortisone,vitamin C,and thiamine.Mortality rates ranged from 28.6%to 56.8%.Methylene blue reduced vasopressor dependency in patients requiring high norepinephrine doses by 1.0 vasopressor-free day,and terlipressin improved renal perfusion by 13.1%.Combination therapies enhanced secondary outcomes,including reductions in Sequential Organ Failure Assessment score.However,no single intervention consistently demonstrated significant survival benefits.CONCLUSION Adjunctive therapies for refractory septic shock may improve hemodynamics and organ function,however,they have not been shown to consistently reduce mortality.Larger trials are needed to confirm these findings.Multimodal approaches targeting inflammation are critical.
文摘BACKGROUND Perinatal depression affects 10%-20%of pregnant women and subsequently influences maternal health and fetal development.Concerns over the safety of antidepressants during pregnancy have prompted the exploration of nutritional interventions as adjunct therapies.This study evaluated the impact of combining preconception and prenatal supplementation with myo-inositol,probiotics,and trace elements on mood,quality of life,and fetal development in depressed mothers.This retrospective cohort study included 314 pregnant women who were diag-nosed with mild to moderate depression,as determined by a Zung self-rating depression scale score of less than 69.The participants were divided into an intervention group(n=161)receiving myo-inositol,probiotics,and trace elements and a control group(n=153)without supplementation.Supplementation comm-enced 3 months before conception and continued through pregnancy.Psychiatric symptoms and quality of life were evaluated using the positive and negative affect schedule-now,state-trait anxiety inventory,Patient Health Ques-tionnaire-8,and World Health Organization Quality of life Assessment:Brief Version scales preconception and postpartum.Fetal development metrics were assessed via ultrasound,and neonatal outcomes were recorded.RESULTS The intervention group presented significant reductions in gestational diabetes mellitus(13.04%vs 23.53%,P=0.016)and gestational hypertension(3.73%vs 9.15%,P=0.049).Higher levels of inositol,iron,zinc,and probiotics were observed near term in the intervention group.Postpartum mood assessments indicated lower anxiety and depression scores for the intervention group,with significant improvements in the positive and negative affect schedule-now(P=0.002),trait anxiety(P=0.002),and Patient Health Questionnaire-8(P=0.018)scores.The World Health Organization Quality of life Assessment:Brief Version scores improved in the psychological(P=0.041)and environmental(P=0.009)domains postpartum.Fetal biparietal diameter and femoral length were greater in the intervention group alongside better neonatal body length and reduced neonatal unit admissions(2.48%vs 7.84%,P=0.031).CONCLUSION Combined supplementation with myo-inositol,probiotics,and trace elements from preconception through pregnancy may reduce pregnancy-related complications,enhance mood and quality of life,and improve fetal growth metrics.
文摘Microbial infection is a principal etiological factor in pulp and periapical diseases,necessitating effective root canal therapy(RCT)for thorough decontamination of the root canal system.However,conventional mechanical and chemical preparation methods remain inadequate,often leaving significant portions of the canal uncleaned and contributing to persistent infection.The advent of erbium laser-assisted chemical preparation has demonstrated significant potential in enhancing root canal disinfection through advanced fluid dynamics mechanisms,particularly cavitation and photoacoustic streaming.This review explores the fundamental principles governing fluid dynamics in erbium laser-assisted irrigation,with a focus on primary and secondary cavitation effects.The interaction between erbium laser energy and water generates vapor bubbles that induce dynamic fluid movement,enhancing the penetration and distribution of irrigants deep within the root canal system.Key factors influencing fluid dynamics intensity,including laser parameters,working tip design,and water medium confinement,are critically analyzed.Furthermore,recent advancements such as Photon-Initiated Photoacoustic Streaming(PIPS),Photoacoustic Synchronized Transients(PHAST),and Shock Wave Enhanced Emission Photoacoustic Streaming(SWEEPS)are reviewed in the context of their ability to improve fluid motion and irrigation efficacy.While these laser-assisted techniques offer promising improvements over traditional methods,challenges remain in optimizing energy parameters and mitigating the constraints imposed by confined root canal environments.Future research should focus on refining fluid dynamics models and conducting clinical studies to validate the efficacy of these innovations.This review aims to provide a comprehensive overview of current developments in fluid dynamics research related to erbium laser-assisted chemical preparation,offering insights into its potential as an advanced modality for root canal disinfection.
文摘BACKGROUND Demineralized bone matrix(DBM)is a commonly utilized allogenic bone graft substitute to promote osseous union.However,little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures.AIM To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures.METHODS During May 2023,the PubMed,EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies.Data regarding study characteristics,patient demographics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.In addition,the level of evidence(LOE)and quality of evidence(QOE)for each individual study was also assessed.Thirteen studies were included in this review.RESULTS In total,363 patients(397 ankles and feet)received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8±9.2 months.The most common procedure performed was ankle arthrodesis in 94 patients(25.9%).Other procedures performed included hindfoot fusion,1st metatarsophalangeal joint arthrodesis,5th metatarsal intramedullary screw fixation,hallux valgus correction,osteochondral lesion of the talus repair and unicameral talar cyst resection.The osseous union rate in the ankle and hindfoot arthrodesis cohort,base of the 5th metatarsal cohort,and calcaneal fracture cohort was 85.6%,100%,and 100%,respectively.The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6±0.1 to a post-operative score of 0.4±0.1.The overall complication rate was 27.2%,the most common of which was non-union(8.8%).There were 43 failures(10.8%)all of which warranted a further surgical procedure.CONCLUSION This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates.Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM,with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot.However,the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.
文摘[目的]考察来源于中国传统发酵制品中乳酸菌的抑真菌特性,研究其在酸奶贮藏中的抑制霉菌效果。[方法]高效液相色谱法(HPLC)检测7株具有抗真菌效果的乳杆菌发酵液中苯乳酸(PLA)含量,研究PLA与乳杆菌发酵液抗真菌活性的相关性。选取抑菌活性最强的菌株Lactobacillus casei AST18进行抑菌特性研究。Lactobacillus casei AST18分别以2%、4%、6%、8%接种量作为辅助发酵剂添加至酸奶发酵工艺中,成品酸奶贮藏期间,监测酸奶中霉菌生长状况,检测酸奶理化指标并进行感官评定。[结果]乳杆菌发酵液中苯乳酸含量与其抑真菌直径间相关关系不显著。Lactobacillus casei AST18发酵上清液经胃蛋白酶和胰蛋白酶处理后不影响其抑菌活性,而环境pH对其抑菌活性的影响显著,热处理可使其丧失抑菌活性。Lactobacillus caseiAST18以2%添加量作为辅助发酵剂应用在酸奶中可抑制霉菌菌丝生长和孢子生成,且对酸奶产品风味、感官品质无显著影响。[结论]Lactobacillus casei AST18具有较好的抑制霉菌生长能力,应用在酸奶中具有显著的防霉保鲜效果。
