Aggressive hydration with lactated ringer solution in prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review and meta-analysis.

BACKGROUND: Acute pancreatitis is the most common complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). There was no conclusion on the prevention of Post-ERCP Pancreatitis (PEP) by Lactated Ringer Solution. AIM: The purpose of this meta analyses is to determine whether aggressive hydration with Lactated Ringer Solution reduced the incidence of PEP. METHODS: We retrieved randomized clinical trials comparing the preventive effects of aggressive hydration with Lactated Ringer Solution and standard hydration on PEP from PubMed, the Cochrane Library, Embase, the Web of Science, Clinical Trial.gov, Scopus database, CNKI, CQVIP and WanFang Data. Primary outcome was incidence of PEP. Secondary outcomes included incidence of hyperamylasemia, abdominal pain and adverse events. RESULTS: Ten randomized controlled trials with 2200 patients were included in this meta-analysis. Meta-analysis showed that compared with standard hydration, aggressive hydration reduced the incidence of PEP (odds ratio [OR], 0.40; 95% confidence intervals [CI], 0.26-0.63; P < .0001). Compared with standard hydration, aggressive hydration also reduced the incidence of hyperamylasemia after ERCP (OR, 0.48; 95% CI, 0.38-0.60; P < .0001). There was significant difference between aggressive hydration and standard hydration in the incidence of abdominal pain (OR, 0.29; 95% CI, 0.11-0.73; P = .008). There was no difference in adverse events between aggressive hydration and standard hydration (OR, 0.93; 95% CI, 0.21-4.13; P = .93). Sensitivity analyses showed that neither alternative effect measures nor statistical models regarding heterogeneity affected the conclusions of this meta-analysis. CONCLUSION: Aggressive hydration with Lactated Ringer Solution during perioperative period of ERCP can prevent PEP.

Is restrictive fluid resuscitation beneficial not only for hemorrhagic shock but also for septic shock?: A meta-analysis.

BACKGROUND: Whether to use limited fluid resuscitation (LFR) in patients with hemorrhagic shock or septic shock remains controversial. This research was aimed to assess the pros and cons of utilizing LFR in hemorrhagic shock or septic shock patients. METHODS: PubMed, Cochrane Library, Embase, Web of science, CNKI, VIP, and Wan Fang database searches included for articles published before December 15, 2020. Randomized controlled trials of LFR or adequate fluid resuscitation in hemorrhagic shock or septic shock patients were selected. RESULT: This meta-analysis including 28 randomized controlled trials (RCTs) and registered 3288 patients. The 7 of 27 RCTs were the patients with septic shock. Others were traumatic hemorrhagic shock patients. Comparing LFR or adequate fluid resuscitation in hemorrhagic shock or septic shock patients, the summary odds ratio (OR) was 0.50 (95% confidence interval [CI] 0.42-0.60, P < .00001) for mortality, 0.46 (95% CI 0.31-0.70, P = .0002) for multiple organ dysfunction syndrome (MODS), 0.35 (95% CI 0.25-0.47) for acute respiratory distress syndrome (ARDS), and 0.33 (95% CI 0.20-0.56) for disseminated intravascular coagulation (DIC). CONCLUSION: Limited fluid resuscitation is the benefit of both traumatic hemorrhagic shock patients and septic shock patients.

Characteristics of Gastric Microbiota in GK Rats with Spontaneous Diabetes: A Comparative Study.

BACKGROUND: The Goto-Kakizaki (GK) rat, developed from repeated inbreeding of glucose-intolerant Wistar rats, has been widely used to explore the development of spontaneous type-2 diabetes mellitus (T2DM). However, the gastric microbiota of GK and Wistar rats are still unclear. This study aimed to understand the gastric microbiota characteristics of GK rats by comparing it with non-diabetic Wistar rats. MATERIALS AND METHODS: Male Wistar rats and GK rats were housed in specific pathogen-free (SPF) environment for 12 weeks with free access to sterilized food and water. Body weight and random blood glucose (BG) levels were determined. At the end of the experiment, the gastric contents of the rats were collected for the identification of gastric microbiota using 16S rRNA gene sequencing. RESULTS: The richness of gastric microbiota in GK rats was similar to that of Wistar rats (P > 0.05). The results of Shannon, Simpson, beta diversity indices, and ANOSIM analysis showed that alpha and beta diversity of gastric microbiota in GK rats were significantly lower than that of Wistar rats (P < 0.01). Firmicutes (96.0%), Proteobacteria (1.9%) and Cyanobacteria (0.8%) were the dominant gastric microbiota in GK rats accounting for 72.9%, 14.7% and 10.9%, respectively. Linear discriminant analysis effect size (LEfSe) revealed that phylum Firmicutes and four genera (Anaerovibrio, Collinsella, Prevotellaceae_UCG_001, and Lactobacillus) were significantly abundant in the stomachs of GK rats. In contrast, seven genera (unidentified_Chloroplast, Porphyromonas, Neisseria, Rubrobacter, Veillonella, Lachnospiraceae_UCG_005, and unidentified_Erysipelotrichaceae) were significantly abundant in the stomachs of Wistar rats. Blood glucose was positively correlated with Anaerobibrio and Lactobacillus, and negatively correlated with four genera (Porphyromonas, Rubrobacter, Lachnospiraceae_UCG_005, and unidentified_Erysipelotrichaceae). In addition, chemoheterotrophy and fermentation were the most important functions of gastric microbiota. CONCLUSION: The gastric microbiota of GK rats with spontaneous T2DM showed the typical characteristics of low diversity and significant enrichment of Firmicutes phylum and four genera (Anaerovibrio, Collinsella, Prevotellaceae_UCG_001, and Lactobacillus) compared with gastric microbiota of Wistar rats.

Open-chest cardiopulmonary resuscitation versus closed-chest cardiopulmonary resuscitation in patients with cardiac arrest: a systematic review and meta-analysis.

BACKGROUND: Cardiopulmonary resuscitation is the most urgent and critical step in the rescue of patients with cardiac arrest. However, only about 10% of patients with out-of-hospital cardiac arrest survive to discharge. Surprisingly, there is growing evidence that open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation. Meanwhile, The Western Trauma Association and The European Resuscitation Council encouraged thoracotomy in certain circumstances for trauma patients. But whether open-chest cardiopulmonary resuscitation is superior to closed-chest cardiopulmonary resuscitation remains undetermined. Therefore, the aim of this study was to summarize current studies on open-chest cardiopulmonary resuscitation in a systematic review, comparing it to closed-chest cardiopulmonary resuscitation, in a meta-analysis. METHODS: In this systematic review and meta-analysis, we searched the PubMed, EmBase, Web of Science, and Cochrane Library databases from inception to May 2019 investigating the effect of open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in patients with cardiac arrest, without language restrictions. Statistical analysis was performed using Stata 12.0 software. The primary outcome was return of spontaneous circulation. The secondary outcome was survival to discharge. RESULTS: Seven observational studies were eligible for inclusion in this meta-analysis involving 8548 patients. No comparative randomized clinical trial was reported in the literature. There was no significant difference in return of spontaneous circulation and survival to discharge between open-chest cardiopulmonary resuscitation and closed-chest cardiopulmonary resuscitation in cardiac arrest patients. The odds ratio (OR) were 0.92 (95%CI 0.36-2.31, P > 0.05) and 0.54 (95%CI 0.17-1.78, P > 0.05) for return of spontaneous circulation and survival to discharge, respectively. Subgroup analysis of cardiac arrest patients with trauma showed that closed-chest cardiopulmonary resuscitation was associated with higher return of spontaneous circulation compared with open-chest cardiopulmonary resuscitation (OR = 0.59 95%CI 0.37-0.94, P < 0.05). And subgroup analysis of cardiac arrest patients with non-trauma showed that open-chest cardiopulmonary resuscitation was associated with higher ROSC compared with closed-chest cardiopulmonary resuscitation (OR = 3.12 95%CI 1.23-7.91, P < 0.05). CONCLUSIONS: In conclusion, for patients with cardiac arrest, we should implement closed-chest cardiopulmonary resuscitation as soon as possible. However, for cardiac arrest patients with chest trauma who cannot perform closed-chest cardiopulmonary resuscitation, open-chest cardiopulmonary resuscitation should be implemented as soon as possible.

Enteral nutrition provided within 48 hours after admission in severe acute pancreatitis: A systematic review and meta-analysis.

BACKGROUND: Whether to conduct enteral nutrition in patients with severe acute pancreatitis (SAP) during the active phase of intestinal stress or to feed during remission remains controversial. This study was aimed to evaluate the efficacy and safety of enteral nutrition within 48 hours after admission in the patients with SAP or predicted severe acute pancreatitis (pSAP). METHODS: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library before December 2017. Randomized controlled trials of early enteral nutrition (starting within 48 hours after admission) versus late enteral nutrition or total parental nutrition in severe acute pancreatitis or predicted severe acute pancreatitis were selected. RESULTS: Ten randomized controlled trials containing 1051 patients were included. Comparing early enteral nutrition to late enteral nutrition or total parental nutrition in SAP or pSAP, the pooled risk ratios were 0.53 (95% confidence interval [CI] 0.35-0.81, P = .003) for mortality, 0.58 (95% CI 0.43-0.77, P = .0002) for multiple organ failure (MOF), 0.50 (95% CI 0.33-0.75, P = .0008) for operative intervention, 0.75 (95% CI 0.61-0.93, P = .009) for systemic infection, 0.42 (95% CI 0.26-0.69, P = .0005) for local septic complications, 0.84 (95% CI 0.74-0.96, P = .01) for gastrointestinal symptoms. 0.87 (95% CI 0.74-1.02, P = .08) for systemic inflammatory response syndrome (SIRS), and 1.24 (95% CI 0.66-2.31, P = .50) for other local complications. CONCLUSIONS: Enteral nutrition within 48 hours after admission is efficient and safe for the patients with SAP or pSAP.

Absorption mechanisms of lead in aqueous solutions with hydrous manganese dioxide.

Hydrous manganese dioxide (HMO) has been synthesized through a facile method. It is found that HMO has an excellent Pb(II) adsorption performance, and an equilibrium adsorption capacity of 127 mg g-1 is expected under room conditions. The sorption capacity is strongly dependent on pH when pH < 7.0, but is not affected by ionic strength, suggesting a mechanism of inner-sphere surface complexation confirmed by X-ray photoelectron analyses (XPS) and Fourier transform infrared spectroscopy (FTIR). The adsorption capacity of Pb(II) in the presence of coexisting negative ions is higher than positive ions. The best fitting of adsorption kinetics and isotherm data are simulated by pseudo-second order equation and Langmuir model, respectively. An endothermic and spontaneous nature in the adsorption process of Pb(II) can be deduced from the obtained thermodynamic data (ΔG < 0, ΔH > 0, ΔS > 0).

Cost optimization of a real-time GIS-based management system for hazardous waste transportation.

In this paper, the design and cost analysis of a real-time, geographical information system (GIS) based management system for hazardous waste transportation are described. The implementation of such a system can effectively prevent illegal dumping and perform emergency responses during the transportation of hazardous wastes. A case study was conducted in Guangzhou, China to build a small-scale, real-time management system for waste transportation. Two alternatives were evaluated in terms of system capability and cost structure. Alternative I was the building of a complete real-time monitoring and management system in a governing agency; whereas alternative II was the combination of the existing management framework with a commercial Telematics service to achieve the desired level of monitoring and management. The technological framework under consideration included locating transportation vehicles using a global positioning system (GPS), exchanging vehicle location data via the Internet and Intranet, managing hazardous waste transportation using a government management system and responding to emergencies during transportation. Analysis of the cost structure showed that alternative II lowered the capital and operation cost by 38 and 56% in comparison with alternative I. It is demonstrated that efficient management can be achieved through integration of the existing technological components with additional cost benefits being achieved by streamlined software interfacing.