Adv Exp Med Biol
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As a classical form of programmed cell death, autophagy is widely involved in cellular metabolism and vital for the maintenance of homeostasis in physiological and pathological states. With multiple levels of regulation and signaling integrated in, autography presents complicated relevance with various diseases, such as cancer and neurological diseases. The emerging subject, systems biology, along with multi-omics approaches, offers a new strategy to investigate these interactive processes from a holistic perspective. ⋯ The critical step of systematic study is to explore interplay between biological molecules based on massive biological data, which requires construction of networks in different biological levels, modification, and identification of key pathways and targets via optimized algorithm and experimental verification. Guided by systems biology research, drug design can thus be strengthened by efficient screening and accurate evaluation. Overall, systems biology promises to act as a powerful tool which both helps to clarify the profound mechanism and to develop efficacious medicine.
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Immunoglobulins are key effector molecules in the humoral immune response. Intravenous polyspecific immunoglobulin (IVIG) is a preparation of polyclonal serum immunoglobulins, typically IgG, from thousands of donors. It has been used as adjunctive therapy in critically ill patients with severe infections, i.e. sepsis, septic shock, and necrotizing soft tissue infections. ⋯ A blinded, placebo-controlled clinical trial (INSTINCT) assessed the effect of IVIG in 100 intensive care unit patients with necrotizing soft tissue infections, including all bacterial etiologies. The study did not demonstrate any effect on self-reported physical functioning at 6 months. In this chapter, we review the mechanisms of action of IVIG and the clinical studies that are available for necrotizing soft tissue infections as well as severe group A streptococcal infections.
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The growing success of immune checkpoint inhibitors (ICIs) has led to effectively treating several types of cancers. Even though their use has been associated with the development of cardiac adverse effects, which may decrease the overall survival in cancer patients. ⋯ Although cardiotoxicities related to immunotherapy are reportedly rare, they can be severe and associated with life-threatening conditions such as fulminant myocarditis, hemodynamic instability, and cardiac arrest. We will review the most commonly reported cardiovascular toxicities associated with ICIs and their management.
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Regional anaesthesia involves targeting specific peripheral nerves with local anaesthetic. It facilitates the delivery of anaesthesia and analgesia to an increasingly complex, elderly and co-morbid patient population. Regional anaesthesia practice has been transformed by the use of ultrasound, which confers advantages such as accuracy of needle placement, visualisation of local anaesthetic spread, avoidance of intraneural injection and the ability to accommodate for anatomical variation. ⋯ Much research has been done, and is ongoing, with the aim of improving needle visualisation; this is also reviewed. Image interpretation requires the application of anatomical knowledge and understanding of the typical sonographic appearance of different tissues (as well as the needle). Years of practice are required to attain expertise, although it is hoped that continuing advances in nerve and needle visualisation, as described in this chapter, will expedite that process.
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Case Reports Multicenter Study
Necrotizing Soft Tissue Infections: Case Reports, from the Clinician's Perspectives.
Necrotizing soft tissue infections (NSTI) are rapidly spreading and life-threatening infections of skin and soft tissue. Essentially there are two types of NSTI, based on the invasive microorganisms. The speed of development and associated clinical features differ markedly depending on the bacterial etiology. ⋯ In this chapter, we present three cases from the INFECT-study population. This study was an international, multicenter, prospective cohort study of adult patients with NSTI. We describe the clinical presentations, pre-, peri-, and postoperative clinical findings, microbiology, and treatment in cases of monobacillary Streptococcus pyogenes necrotizing soft tissue infections NSTI, polymicrobial infection, and an unusual presentation of pelvic monobacillary S. pyogenes infection in an immunocompromised patient.