Weiping Xia

Rationale: Cardiac arrest (CA) is an acute emergency with high mortality and is closely associated with the risk of brain damage or systemic ischemia–reperfusion injury, post-traumatic stress symptoms. Patient concerns: Targeted temperature management in the intensive care unit can improve the neurological outcomes of patients who are comatose after resuscitation from CA. However, there is often a lack of specific evaluation methods for optimal target temperature settings. Diagnoses: From November 2021 to October 2022, 9 CA patients received prompt cardiopulmonary resuscitation and return of spontaneous circulation after approximately 10 to 30 minutes of cardiopulmonary resuscitation in Xiangya Hospital, Central South University. Interventions: We retrospectively reviewed 9 CA patients’ medical data, including demographic characteristics, hemodynamic change, clinically relevant score, imageological examination, transcranial Doppler ultrasonography, electroencephalogram (EEG), somatosensory-evoked potential, and laboratory data. Outcomes: According to the result of each patient’s transcranial Doppler ultrasonography, somatosensory-evoked potential, and EEG to formulate an individualized target temperature. Contrary to the internationally recommended target of hypothermia, we found that not all patients require hypothermia therapy to maintain normal cerebrovascular autonomic regulation function. And neuron-specific enolase and S100β in patients showed a downward trend after hypothermia therapy. Compared with before hypothermia treatment, clinically relevant scores were reduced in patients with good prognosis. Intracranial congestion or ischemia was improved and intracranial pressure was reduced in all patients during hypothermia treatment. For patients with good EEG response, the ratio of gray matter in the brain increased and the neurological prognosis was significantly improved. Finally, after 6 months of follow-up, we found 3 patients died and 1 patient had a long-term vegetative state, the other patients had a good prognosis. Lessons: Individualized targeted temperature management under the guidance of multimodal brain monitoring plays an important role in brain protection of patients with CA.

Background: Gut microbiota have been previously reported to be related to a variety of immune diseases. However, the causal connection between Sjögren’s syndrome (SS) and gut microbiota has yet to be clarified. Methods: We employed a two-sample Mendelian randomization (MR) analysis to evaluate the causal connection between gut microbiota and SS, utilizing summary statistics from genome-wide association studies (GWASs) obtained from the MiBioGen and FinnGen consortia. The inverse variance weighted (IVW) approach represents the primary method of Mendelian randomization (MR) analysis. Sensitivity analysis was used to eliminate instrumental variables heterogeneity and horizontal pleiotropy. In addition, we performed an analysis using independent GWAS summary statistics for SS from the European Bioinformatics Institute (EBI) dataset for further verify our results. Results: IVW results demonstrated that the phylum Lentisphaerae (OR = 0.79, 95% CI: 0.63–0.99, p = 0.037), class Deltaproteobacteria (OR = 0.67, 95% CI: 0.47–0.96, p = 0.030), family Porphyromonadaceae (OR = 0.60, 95% CI: 0.38–0.94, p = 0.026), genus Eubacterium coprostanoligenes group (OR = 0.61, 95% CI: 0.4–0.93, p = 0.021), genus Blautia (OR = 0.62, 95% CI: 0.43–0.90, p = 0.012), genus Butyricicoccus (OR = 0.61, 95% CI: 0.42–0.90, p = 0.012), genus Escherichia.Shigella (OR = 0.7, 95% CI: 0.49–0.99, p = 0.045) and genus Subdoligranulum (OR = 0.61, 95% CI: 0.44–0.86, p = 0.005) exhibited protective effects on SS. Relevant heterogeneity of horizontal pleiotropy or instrumental variables was not detected. Furthermore, repeating our results with an independent cohort provided by the EBI dataset, only the genus Eubacterium coprostanoligenes group remained significantly associated with the protective effect on SS (OR = 0.41, 95% CI: 0.18–0.91, p = 0.029). Two-step MR analysis further revealed that genus Eubacterium coprostanoligenes group exerts its protective effect by reducing CXCL6 levels in SS (OR, 0.87; 95% CI = 0.76–0.99, p = 0.033). Conclusions: Our study using two-sample MR analysis identified a causal association between multiple genera and SS. A two-step MR result calculated that genus Eubacterium coprostanoligenes group mediated its protective effect by reducing CXCL6 levels in SS. However, the datasets available from the MiBioGen and FinnGen consortia do not provide sufficient information or comprehensive demographic data for subgroup analyses. Additional validation using various omics technologies is necessary to comprehend the development of SS in the intricate interplay between genes and the environment over a period of time.

Background: Chyluria is a rare disease in which chylous is excreted in the urine. Currently, management of chyluria includes conservative treatments and surgical measures. This study aimed to report our experience in treating non-parasitic chyluria with retroperitoneal laparoscopic ligation of the renal lymphatic vessels. Methods: Data from 52 patients who underwent retroperitoneoscopic ligation of the renal lymphatic vessels for non-parasitic chyluria between December 2009 and May 2022 were reviewed. After general anesthesia, the patients were passively placed in the healthy lateral decubitus position and underwent three-port retroperitoneal laparoscopy. Detailed medical data, including demographic characteristics, intraoperative outcomes, postoperative data, and complications, were reviewed. Results: Fifty-two patients received surgery treatment at our institution. The mean disease course was 89.3 months. The mean age was 58.8 years, with females accounting for 57.7% (30/52); the majority of patients (33/52) had the laterality of chyluria on the left and 9 (17.3%) had a history of previous thoracic or abdominal surgery. Compared with the urine and blood data before the operation and on the first day after the operation, urinary protein, urinary tract infection, urinary red blood cells, hemoglobin, albumin, and serum total protein significantly improved 3 months after the operation. However, there were no significant differences in blood creatinine and blood urea nitrogen levels among the three groups. The mean surgery time was about 110.0 minutes, and the estimated total blood loss was 81.2 mL. The postoperative drainage volume was 229.9 mL. The average time to start a liquid diet and to be out of bed were 1.5 and 1.9 days, respectively. Transient postoperative gross hematuria occurred in eight patients, and complications occurred in five patients after surgery. The mean length of hospitalization was 6.6 days. The follow-up duration ranged from 3 to 152 months, and except for three patients who did not respond to treatment, the remaining patients had no recurrence and did not require reoperation. Conclusions: Our long-term follow-up results showed that renal pedicle lymphatic ligation via retroperitoneal laparoscopic surgery is an effective, safe, and reliable surgical option for patients with non-parasitic chyluria.

The gut microbiota is a large symbiotic community of anaerobic and facultative aerobic bacteria inhabiting the human intestinal tract, and its activities significantly affect human health. Increasing evidence has suggested that the gut microbiome plays an important role in tumor-related immune regulation. In the tumor microenvironment (TME), the gut microbiome and its metabolites affect the differentiation and function of immune cells regulating the immune evasion of tumors. The gut microbiome can indirectly influence individual responses to various classical tumor immunotherapies, including immune checkpoint inhibitor therapy and adoptive immunotherapy. Microbial regulation through antibiotics, prebiotics, and fecal microbiota transplantation (FMT) optimize the composition of the gut microbiome, improving the efficacy of immunotherapy and bringing a new perspective and hope for tumor treatment.