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Topic Review
Serotonin
Serotonin (5-hydroxytryptamine, 5-HT) plays two important roles in humans—one central and the other peripheral—depending on the location of the 5-HT pools of on either side of the blood-brain barrier. In the central nervous system it acts as a neurotransmitter, controlling such brain functions as autonomic neural activity, stress response, body temperature, sleep, mood and appetite. This role is very important in intensive care, as in critically ill patients multiple serotoninergic agents like opioids, antiemetics and antidepressants are frequently used. High serotonin levels lead to altered mental status, deliria, rigidity and myoclonus, together recognized as serotonin syndrome. In its role as a peripheral hormone, serotonin is unique in controlling the functions of several organs. In the gastrointestinal tract it is important for regulating motor and secretory functions. Apart from intestinal motility, energy metabolism is regulated by both central and peripheral serotonin signaling. It also has fundamental effects on hemostasis, vascular tone, heart rate, respiratory drive, cell growth and immunity. Serotonin regulates almost all immune cells in response to inflammation, following the activation of platelets. 
  • 4.1K
  • 18 May 2021
Topic Review
Cannabis Sativa Revisited
Critically ill patients with sepsis require a multidisciplinary approach, as this situation implies multiorgan distress, with most of the bodily biochemical and cellular systems being affected by the condition. Moreover, sepsis is characterized by a multitude of biochemical interactions and by dynamic changes of the immune system. At the moment, there is a gap in our understanding of the cellular, genetic, and molecular mechanisms involved in sepsis. One of the systems intensely studied in recent years is the endocannabinoid signaling pathway, as light was shed over a series of important interactions of cannabinoid receptors with biochemical pathways, specifically for sepsis. Furthermore, a series of important implications on inflammation and the immune system that are induced by the activity of cannabinoid receptors stimulated by the delta-9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) have been noticed. One of the most important is their ability to reduce the biosynthesis of pro-inflammatory mediators and the modulation of immune mechanisms. Different studies have reported that cannabinoids can reduce oxidative stress at mitochondrial and cellular levels. In detail, the entry shows the important mechanisms modulated by the endocannabinoid signaling pathway, as well as of the molecular and cellular links it has with sepsis. At the same time, the possible implications of cannabinoids in the most important biological pathways involved in sepsis, such as inflammation, redox activity, immune system, and epigenetic expression will be presented.
  • 1.5K
  • 04 Jul 2022
Topic Review
Free Flaps in Burn Care
Microsurgical free flap reconstruction in acute burn care offers the option of reconstructing even challenging defects in a single stage procedure. Due to altered rheological and hemodynamic conditions in severely burned patients, it bears the risk of a higher complication rate compared to microsurgical reconstruction in other patients. To avoid failure, appropriate indications for free flap reconstruction should be reviewed thoroughly. Several aspects concerning timing of the procedure, individual flap choice, selection and preparation of the recipient vessels, and perioperative measures must be considered.
  • 1.5K
  • 28 Jul 2021
Topic Review
Severe TBI: Second and Third Tier Therapies
Intracranial hypertension is a common finding in severe traumatic brain injury, and requires treatment in the intensive care unit with intracranial pressure monitoring and, when possible, the application of multimodal neuromonitoring. A three-tier approach is suggested in current rec-ommendations, with higher tier therapies having more significant side effects. Researchers explain the rationale for this approach, they analyze the benefits and risks of each therapeutic mo-dality, and they discuss how to adapt the therapy to the resources available, based on the most recent recommendations.
  • 1.5K
  • 08 Oct 2022
Topic Review
HDL in Familial Hypercholesterolemia
HDL are the first defensive barrier against the burden of high LDL cholesterol levels owing to their contribution to reverse cholesterol transport as well as their antioxidant and anti-inflammatory properties, among others. 
  • 1.1K
  • 28 Jul 2021
Topic Review
Antiviral Drugs against COVID-19
Several FDA-approved available antiviral drugs, alone or in combination, have been screened clinically for their extended use since the early phase of the current pandemic to find a safe and effective treatment option against COVID-19, and many clinical trials of these antiviral drugs are still ongoing. However, an in-depth understanding is required from current clinical literature reports to execute integrated approaches between computational and experimental methods to guarantee high success rates of repositioned drugs. Moreover, multiple challenges associated with repurposed drugs have been identified, including dose adjustments, route of administration, acute/chronic toxicity, appropriate delivery systems, etc..
  • 1.1K
  • 27 Sep 2021
Topic Review
Plant-Derived Bioactive Compounds as Anti-Cancerous Agents
Cancer is one of the major deadly diseases globally. The alarming rise in the mortality rate due to this disease attracks attention towards discovering potent anticancer agents to overcome its mortality rate. Based on their particular activity, a number of other plant-derived bioactive compounds are in the clinical development phase against cancer, such as gimatecan, elomotecan, etc. Additionally, the conjugation of natural compounds with anti-cancerous drugs, or some polymeric carriers particularly targeted to epitopes on the site of interest to tumors, can generate effective targeted treatment therapies. 
  • 1.0K
  • 27 Dec 2022
Topic Review
Microfluidics
Microfluidics is the advanced microtechnology of fluid manipulation in channels with at least one dimension in the range of 1–100 microns. Microfluidic technology offers a growing number of tools for manipulating small volumes of fluid to control chemical, biological, and physical processes relevant to separation, analysis, and detection.
  • 1.0K
  • 05 Mar 2024
Topic Review
Angiotensin Converting Enzyme II
Angiotensin converting enzyme II (ACE2), a type I transmembrane mono-carboxypeptidase of renin angiotensin system (RAS), in involved in conversion of angiotensin I (Ang I) and angiotensin II (Ang II) to angiotensin (1-9) and angiotensin (1-7), respectively. This enzyme, as the receptor of SARS-CoV-2, plays a crucial role in the virus entrance into the host cells. The docking of the S protein to this receptor, eventually leads to the fusion of the virus membrane with the host cell plasma membrane to release the viral genome into the cell cytoplasm.
  • 1.0K
  • 16 May 2023
Topic Review
Ventilation-Perfusion Mismatch in the Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) is a heterogenous condition that is characterized by the development of inflammatory pulmonary edema and life-threatening hypoxemia, and it accounts for nearly 25% of patients who require mechanical ventilation. Acute respiratory distress syndrome (ARDS) remains an important clinical challenge with a mortality rate of 35–45%. It is being increasingly demonstrated that the improvement of outcomes requires a tailored, individualized approach to therapy, guided by a detailed understanding of each patient’s pathophysiology. In patients with ARDS, disturbances in the physiological matching of alveolar ventilation (V) and pulmonary perfusion (Q) (V/Q mismatch) are a hallmark derangement. The perfusion of collapsed or consolidated lung units gives rise to intrapulmonary shunting and arterial hypoxemia, whereas the ventilation of non-perfused lung zones increases physiological dead-space, which potentially necessitates increased ventilation to avoid hypercapnia.
  • 1.0K
  • 12 Jan 2023
Topic Review
Hyperoncotic Human Albumin Solution in Traumatic Brain Injury
Fluid resuscitation with human albumin solution (HAS) corrects low serum albumin levels and aids in preserving euvolemia in non-brain-injured intensive care units and in perioperative patients. Ischemia, hypotension, hypoxia, and energy dysfunction are important determinants of the outcomes following a severe traumatic brain injury (TBI). Cerebral edema and increased intracranial pressure (ICP) are frequently observed after TBI, leading to cerebral ischemia.
  • 939
  • 17 May 2022
Topic Review
Changes of Endothelial Glycocalyx in Cardiac Surgery
Cardiac surgery is one of the highest-risk procedures, usually involving cardiopulmonary bypass and commonly inducing endothelial injury that contributes to the development of perioperative and postoperative organ dysfunction. Substantial scientific efforts are being made to unravel the complex interaction of biomolecules involved in endothelial dysfunction to find new therapeutic targets and biomarkers and to develop therapeutic strategies to protect and restore the endothelium. 
  • 903
  • 17 May 2023
Topic Review
Intensive Care Unit-Acquired Weakness and Sarcopenia
Intensive care unit-acquired weakness (ICUAW) brings about skeletal muscle wasting due to critical illness and has important clinical implications, significantly impacting rehabilitation, and increasing both morbidity and mortality. ICUAW is sometimes referred to as critical illness polyneuromyopathy—being called critical illness polyneuropathy (CIP) when nerve involvement predominates, or critical illness myopathy (CIM) where muscle involvement is crucial. It manifests as muscle weakness that develops rapidly, prior to any detectable muscle wasting. 
  • 845
  • 10 Aug 2022
Topic Review
Endocrine Challenges with Continuous-Flow LVADs
Heart failure (HF) remains a leading cause of morbidity, hospitalization, and mortality worldwide. Advancement of mechanical circulatory support technology has led to the use of continuous-flow left ventricular assist devices (LVADs), reducing hospitalizations, and improving quality of life and outcomes in advanced HF. Recent studies have highlighted how metabolic and endocrine dysfunction may be a consequence of, or associated with, HF, and may represent a novel (still neglected) therapeutic target in the treatment of HF. On the other hand, it is not clear whether LVAD support, may impact the outcome by also improving organ perfusion as well as improving the neuro-hormonal state of the patients, reducing the endocrine dysfunction. Moreover, endocrine function is likely a major determinant of human homeostasis, and is a key issue in the recovery from critical illness. Care of the endocrine function may contribute to improving cardiac contractility, immune function, as well as infection control, and rehabilitation during and after a LVAD placement.
  • 784
  • 02 Jul 2021
Topic Review
Cardiothoracic Surgical Critical Care Medicine
Cardiothoracic surgical critical care medicine (CT-CCM) is a medical discipline centered on the perioperative care of diverse groups of patients. With an aging demographic and an increase in burden of chronic diseases the utilization of cardiothoracic surgical critical care units is likely to escalate. Given these projections, it is important to assess the state of cardiothoracic surgical intensive care, to develop goals and objectives for the future, and to identify knowledge gaps in need of scientific inquiry.
  • 769
  • 09 Jan 2023
Topic Review
Prone Positioning and COVID-19-Related Acute Respiratory Distress
The prone position is a non-invasive technique resulting from the mobilization of the patient, where the person is lying horizontally face down. This technique has been used since the 1970s, but it has gained great relevance in the last year owing to the COVID-19 pandemic with the use of invasive mechanical ventilation.
  • 763
  • 15 Nov 2021
Topic Review
Extracorporeal Cytokine Removal
Cytokine removal can attenuate dysregulated immune response caused vasoplegia, leading to quicker hemodynamic stabilization and shock reversal. The most frequently used criteria to define shock reversal include normalization of serum lactate (<2.2 mmol/L) coupled with a significant (≥90%) reduction in norepinephrine dose requirements. The current paper has summarized the available data, which indicate the important contribution of early hemoadsorption in achieving rapid hemodynamic stabilization in patients with refractory vasoplegic shock.
  • 758
  • 07 Jul 2021
Topic Review
Iron Deficiency and Anemia Diagnostics
Anemia, iron deficiency and other hematinic deficiencies are a major cause of perioperative transfusion needs and are associated with increased morbidity and mortality. Anemia can be caused either by decreased production of hemoglobin or red blood cells or by increased consumption and blood loss. Decreased production can involve anything from erythropoietin or vitamin B12 insufficiency to absolute or functional lack of iron. 
  • 740
  • 14 Oct 2021
Topic Review
Cardiogenic Shock Complicating Acute Myocardial Infarction
Cardiogenic shock complicating acute myocardial infarction is a complex clinical condition associated with dismal prognosis. Routine early target vessel revascularization remains the most effective treatment to substantially improve outcomes, but mortality remains high. Temporary circulatory support devices have emerged with the aim to enhance cardiac unloading and improve end-organ perfusion.
  • 729
  • 21 Sep 2022
Topic Review
Emergency Airway Management
Emergency airway management (EAM) is a commonly performed procedure in the critical care setting. Despite clinical advances that help practitioners identify patients at risk for having a difficult airway, improved airway management tools, and algorithms that guide clinical decision-making, there remains significant morbidity and mortality associated with EAM.
  • 720
  • 10 Nov 2022
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