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| 1 | Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock显示文摘Objective: Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation (Macro). This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulatory shock. Data sources: We retrieved information from the PubMed database up to January 2018 using various search terms or/and their combinations, including resuscitation, circulatory shock, septic shock, tissue perfusion, hemodynamic coherence, and microcirculation (Micro). Study selection: The data from peer-reviewed journals printed in English on the relationships of tissue perfusion, shock, and resuscitation were included. Results: A binary (coherence/incoherence, coupled/uncoupled, or associated/disassociated) mode is used to describe resuscitation coherence. The phenomenon of resuscitation incoherence (RI) has gained great attention. However, the RI concept requires a more practical, systematic, and comprehensive framework for use in clinical practice. Moreover, we introduce a conceptual framework of RI to evaluate the interrelationship of the Macro, Micro, and cell. The RI is divided into four types (Type 1: Macro-Micro incoherence + impaired cell;Type 2: Macro-Micro incoherence + normal cell;Type 3: Micro-Cell incoherence + normal Micro;and Type 4: both Macro-Micro and Micro-cell incoherence). Furthermore, we propose the concept of dynamic circulation-perfusion coupling to evaluate the relationship of circulation and tissue perfusion during circulatory shock. Conclusions: The concept of RI and dynamic circulation-perfusion coupling should be considered in the management of circulatory shock. Moreover, these concepts require further studies in clinical practice. | Huai-Wu He Yun Long Da-Wei Liu Can Ince | 2019 | Chinese Medical Journal2019，，10： | 5 |
| 2 | NONRESUSCITATED ENDOTOXEMIA INDUCES MICROCIRCULATORY HYPOXIC AREAS IN THE RENAL CORTEX IN THE RAT显示文摘 | Tanja Johannes Egbert G. Mik Can Ince | 2009 | Shock2009，，1： | 1 |
| 3 | The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients显示文摘 | Alexandre Lima Tim C. Jansen Jasper van Bommel Can Ince Jan Bakker | 2009 | Critical Care Medicine2009，，3： | 1 |
| 4 | The Effect of Interleukin-10 on Acute Pancreatitis Induced by Cerulein in a Rat Experimental Model显示文摘 | Mustafa Keceli Can Kucuk Erdogan Sozuer Mustafa Kerek Ozhan Ince Makbule Arar | 2005 | Investigative Surgery2005，，1： | 1 |
| 5 | TEMPOL has limited protective effects on renal oxygenation and hemodynamics but reduces kidney damage and inflammation in a rat model of renal ischemia/reperfusion by aortic clamping显示文摘Background:Renal ischemia-reperfusion(I/R)is a common clinical complication in critically ill patients that is associated with considerable morbidity and mortality.Renal I/R is a major cause of acute kidney injury(AKI)resulting from I/R-induced oxidative stress,sterile inflammation,and microcirculatory perfusion defects,which can be ameliorated with the superoxide scavenger TEMPOL.The most common cause of AKI in the clinical setting is aortic surgery with suprarenal aortic clamping.The protective effect of TEMPOL in aortic clamping-induced renal I/R has not been studied before.Aim:To evaluate the protective effects of TEMPOL on oxidative stress,inflammation,tissue injury,and renal hemodynamics and oxygenation in a clinically representative rat model of I/R using aortic crossclamping.Methods:Animals(N=24)were either sham-operated or subjected to ischemia(30 min)and 90-min reperfusion,with or without TEMPOL treatment(15 min before ischemia and during entire reperfusion phase,200μmol/kg/h).Systemic and renal hemodynamics,renal oxygenation,and blood gas values were determined at 15 min and 90 min of reperfusion.At 90-min reperfusion,iNOS,inflammation(IL-6,MPO),oxidative stress(MDA),and tissue damage(NGAL,L-FABP)were determined in tissue biopsies.Results:TEMPOL administration at a cumulative dose of 400μmol/kg conferred a protective effect on AKI in terms of reducing renal damage,inflammation,and iNOS activation.With respect to renal hemodynamics and oxygenation,TEMPOL only reduced renal vascular resistance to near-baseline levels at both reperfusion time points and partially ameliorated the I/R-induced drop microvascular partial tension of oxygen at 90 min reperfusion.Also,TEMPOL alleviated the I/R-induced metabolic acidosis.However,TEMPOL exerted no restorative effect in terms of the severely reduced mean arterial pressure,renal blood flow,and renal oxygen delivery and consumption.The renal oxygen extraction ratio remained unchanged during the 90-min reperfusion phase.Kidneys in all groups were anuric throughout the experiment.Conclusions:This clinically representative renal I/R model,which entails both renal I/R and hind limb I/R as opposed to the standardly used renal I/R model that employs renal artery clamping,resulted in relatively moderate direct AKI.The damage was exacerbated by the perturbed systemic hemodynamics and metabolic acidosis as a result of the hind limb I/R.TEMPOL partially intervened in the factors that led to AKI as well as renal microvascular partial tension of oxygen and metabolic acidosis.However,more effective interventions should be devised for the mean arterial pressure drop(i.e.,anuria)associated with aortic clamping and for restoring other critical renal hemodynamic and oxygenation parameters in order to improve post-I/R renal function.Relevance for patients:TEMPOL is a promising compound that has been shown to protect kidneys from I/R damage,which is relevant in kidney transplantation,pancreas transplantation,and aortic aneurysm repair in kidney transplant patients.This study suggests that intervening with TEMPOL is not sufficient to ensure optimal clinical outcome in patients that have undergone aortic clamping and that more effective interventions should be investigated. | Bulent Ergin Rick Bezemer Asli Kandil Cihan Demirci-Tansel Can Ince | 2015 | Journal of Clinical & Translational Research2015，1，2： | 1 |
| 6 | The Heterogeneity of the Microcirculation in Critical Illness显示文摘 | Eva Klijn C.A. Den Uil Jan Bakker Can Ince | 2008 | Clinics in Chest Medicine2008，，4： | 1 |
| 7 | A rare complication of Brucella infection myocarditis and heart failure 显示文摘 | Efe C Can T Ince M | 2009 | Intern Med2009，48，19： | 1 |
| 8 | Systemic and microcirculatory responses to progressive hemorrhage显示文摘 | Arnaldo Dubin Mario Omar Pozo Gonzalo Ferrara Gastón Murias Enrique Martins Carlos Canullán Héctor Saul Canales Vanina Siham Kanoore Edul Elisa Estenssoro Can Ince | 2009 | Intensive Care Medicine2009，，3： | 1 |
| 9 | The acute effects of acetate-balanced colloid and crystalloid resuscitation on renal oxygenation in a rat model of hemorrhagic shock显示文摘 | Emre Almac Ugur Aksu Rick Bezemer Willeke Jong Asli Kandil Koray Yuruk Cihan Demirci-Tansel Can Ince | 2012 | Resuscitation2012，，9： | 1 |
| 10 | Association between serosal intestinal microcirculation and blood pressure during major abdominal surgery显示文摘Background:In clinical practice,blood pressure is used as a resuscitation goal on a daily basis,with the aim of maintaining adequate perfusion and oxygen delivery to target organs.Compromised perfusion is often indicated as a key factor in the pathophysiology of anastomotic leakage.This study was aimed at assessing the extent to which the microcirculation of the bowel coheres with blood pressure during abdominal surgery.Methods:We performed a prospective and observational cohort study.In patients undergoing abdominal surgery,the serosal microcirculation of either the small intestine or the colon was visualized using handheld vital mi-croscopy(HVM).From the acquired HVM image sequences,red blood cell velocity(RBCv)and total vessel density(TVD)were calculated using MicroTools and AVA software,respectively.The association between microcircula-tory parameters and blood pressure was assessed using Pearson’s correlation analysis.We considered a two-sided P-value of<0.050 to be significant.Results:In 28 patients undergoing abdominal surgery,a total of 76 HVM images were analyzed.The RBCv was 335±96μm/s and the TVD was 13.7±3.4 mm/mm ^(2).Mean arterial pressure(MAP)was 71±12 mm Hg during microcirculatory imaging.MAP was not correlated with RBCv(Pearson’s r=−0.049,P=0.800)or TVD(Pearson’s r=0.310,P=0.110).Conclusion:In 28 patients undergoing abdominal surgery,we found no association between serosal intestinal microcirculatory parameters and blood pressure. | Arthur LM Tavy Anton FJ de Bruin E Christiaan Boerma Can Ince Matthias P Hilty Peter G Noordzij Djamila Boerma Mat van Iterson | 2021 | Journal of Intensive Medicine2021，1，1： | 1 |
| 11 | Abnormal mierocireulation in brain tumours during surgery显示文摘 | Keshen R Mathura Gerrit J Bouma Can Ince | 2001 | RE- SEARCH LETFERS2001，358，17： | 1 |
| 12 | Direct Observation of the Human Microcirculation During Cardiopulmonary Bypass: Effects of Pulsatile Perfusion显示文摘 | Paul W.G. Elbers Jeroen Wijbenga Frank Solinger Aladdin Yilmaz Mat van Iterson Eric P.A. van Dongen Can Ince | 2011 | Journal of Cardiothoracic and Vascular Anesthesia2011，，2： | 1 |
| 13 | Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients显示文摘Background:Accurate risk stratification of critically ill patients with coronavirus disease 2019(COVID-19)is essential for optimizing resource allocation,delivering targeted interventions,and maximizing patient survival probability.Machine learning(ML)techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care.Methods:We retrieved data on patients with COVID-19 admitted to an intensive care unit(ICU)between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit(RISC-19-ICU)registry.We applied the Extreme Gradient Boosting(XGBoost)algorithm to the data to predict as a binary out-come the increase or decrease in patients’Sequential Organ Failure Assessment(SOFA)score on day 5 after ICU admission.The model was iteratively cross-validated in different subsets of the study cohort.Results:The final study population consisted of 675 patients.The XGBoost model correctly predicted a decrease in SOFA score in 320/385(83%)critically ill COVID-19 patients,and an increase in the score in 210/290(72%)patients.The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model(0.86 vs.0.69,P<0.01[paired t-test with 95%confidence interval]).Conclusions:The XGBoost model predicted the change in SOFA score in critically ill COVID-19 patients admitted to the ICU and can guide clinical decision support systems(CDSSs)aimed at optimizing available resources. | Jonathan Montomoli Luca Romeo Sara Moccia Michele Bernardini Lucia Migliorelli Daniele Berardini Abele Donati Andrea Carsetti Maria Grazia Bocci Pedro David Wendel Garcia Thierry Fumeaux Philippe Guerci Reto Andreas Schüpbach Can Ince Emanuele Frontoni Matthias Peter Hilty RISC-19-ICU Investigators | 2021 | Journal of Intensive Medicine2021，1，2： | 0 |
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