The effect of French maritime pine bark extract supplementation on inflammation, nutritional and clinical status in critically ill patients with traumatic brain injury: A randomized controlled trial

The roles of vitamin C in infectious diseases: A comprehensive review

Vitamin C is a versatile nutrient with essential antioxidant properties and roles in amino acid metabolism, collagen promotion, and hormone synthesis. It has long been regarded as benefitting infectious disease management, although its specific roles remain uncertain. The dominant view is that this efficacy not only stems from its redox regulation in the body but also from its profound impact on the immune system. This review provides a comprehensive overview of Vitamin C's effects on redox regulation and shows how the vitamin influences various immune cells and cell-intrinsic innate immunity signaling pathways, thereby updating and expanding our previous perspectives. Clinically, though some studies and case series have suggested potential benefits of Vitamin C in preventing and (or) treating respiratory tract infections and sepsis and septic shock, the evidence remains controversial. The current data is insufficient to support the routine clinical use of Vitamin C in managing these diseases and requires further rigorous evaluation to establish definitive efficacy and safety profiles. This review thoroughly examines current clinical research progress on Vitamin C, summarizes the primary controversies and their underlying causes, and proposes directions for future clinical research. Furthermore, preclinical evidence shows potential roles for Vitamin C in the supplementary treatment of the "Big Three" infectious diseases: acquired immunodeficiency syndrome (AIDS), tuberculosis, and malaria; however, systematic clinical studies in these areas are lacking. We examine related in vitro and animal studies, as well as clinical trials, and discuss potential roles for Vitamin C as a treatment and (or) adjuvant therapy.

An updated systematic review and meta-analysis of pomegranate consumption on lipid profile

Pomegranate, rich in bioactive compounds such as polyphenols and flavonoids, has been studied for its potential lipid-modulating effects, yet evidence remains inconsistent. This systematic review and meta-analysis aimed to evaluate the impact of pomegranate consumption on plasma lipid profiles by synthesizing data from randomized controlled trials (RCTs). Following PRISMA guidelines, 37 RCTs (n = 2695 participants) were included after searching Scopus and MEDLINE databases. Studies assessed pomegranate products (juice, extract, seed oil) administered orally for ≥ 7 days, with lipid parameters, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) as outcomes. Data were pooled using RevMan 5.3 with random-effects models. Results indicated that pomegranate intake significantly increased HDL-C levels (mean difference: 2.50 mg/dL, 95 % CI: 1.00-4.00, p < 0.05), while no significant changes were observed in TC, LDL-C, or TG. Subgroup analyses revealed pronounced HDL-C elevation in non-alcoholic fatty liver disease (NAFLD) patients, health participants and interventions lasting ≥ 8 weeks. Heterogeneity across studies was attributed to variations in intervention duration, dosage forms, and participant characteristics. Publication bias was nonsignificant (Egger's test, p > 0.05). These findings suggest that pomegranate supplementation may improve HDL-C, potentially through modulation of HDL-associated enzymes like paraoxonase. However, further large-scale, long-term RCTs are warranted to confirm these effects and explore synergistic benefits with standard lipid-lowering therapies.

Prognostic Values of Routine Clinical Tests in Adult Patients with Traumatic Brain Injury

OBJECTIVE

To determine the prognostic impacts of the characteristics in routine plasma and blood tests for patients with traumatic brain injury (TBI).

METHODS

A total of 136 consecutive adult patients with TBI were recruited. Blood and plasma routine tests were performed within 24 hours from admission. All patients were briefly followed up at the third month after discharge. We analyzed the prognostic factors with univariate and multifactor logistic regression models in the patients receiving surgical and conservative treatments, respectively.

RESULTS

We found different prognostic factors in the patients receiving diverse treatments. In the patients receiving surgical treatment, infection is the only influencing factor, while in the patients receiving conservative treatment, age (P = 0.004), white blood cell count (WBC) (P = 0.008), and albumin (P = 0.040) were the independent factors of prognosis. In the receiver operator characteristic analysis, the values of area under the curve of these factors were 0.788 for age, 0.695 for WBC, and 0.709 for albumin, respectively. The combined area under the curve of the 3 factors was 0.898.

CONCLUSIONS

TBI patients receiving diverse treatments might have different pathophysiologic conditions and different influencing factors of prognosis.

Efficacy, side effects, adherence, affordability, and procurement of dietary supplements for treating hypercholesterolemia: a narrative review

INTRODUCTION

Statins are effective in reducing high cholesterol levels; however, due to associated side effects, many patients actively seek alternative medications. This review evaluates the efficacy, side effects, patient adherence, cost-effectiveness, and accessibility of dietary supplements (DS) as a treatment option for hypercholesterolemia.

METHODS

This narrative review compares red yeast rice (RYR), flaxseed, artichokes, bergamot, Ayurvedic mixtures (with garlic as a prominent ingredient), and statins for treating hypercholesterolemia. We searched PubMed, Scopus, and Cochrane databases for studies published between 2012 and 2024 using "hypercholesterolemia" in combination with a dietary supplement (red yeast rice, flaxseed, artichokes, garlic, or bergamot). The selected articles were published until 28th January 2024 with no language restrictions.

RESULTS

Study results suggest that alternative treatments using dietary supplements such as flaxseed, bergamot, or red yeast rice may effectively reduce cholesterol levels, with the specific value varying based on the study.

CONCLUSION

The following natural ingredients - red yeast rice, artichoke extract, bergamot, garlic, and flaxseed - have been specifically selected for their cholesterol-lowering properties. Based on consistent usage, except for aged garlic extract, these ingredients appear to have a beneficial impact on cholesterol levels. (1) It is advisable to conduct a comprehensive cohort study to assess the efficacy of relevant dietary supplements, particularly red yeast rice, bergamot, and flaxseed, in treating hypercholesterolemia. This is important due to the varying effectiveness of alternative treatments. However, there are lingering concerns regarding the lack of supervision and quality control that require attention. (2) Further research into the specific molecular composition and the underlying mechanisms by which it reduces cholesterol levels is warranted.

Associations between dietary coenzyme Q10 intake and lipid profiles in adults: a national cross-sectional study

Objective

This study aimed to determine the average intake of CoQ10 from dietary sources and explore the dose-response relationships between the dietary-derived CoQ10 intake and lipid profiles.

Methods

We performed a cross-sectional study based on the China Health and Nutrition Survey, which included 7,938 adults. The dietary intake assessment used three consecutive 24-h recalls combined with a household inventory. Serum was used for lipid profiling.

Results

The average dietary-derived CoQ10 intake was 5.4 mg/day in Chinese adults. The dietary CoQ10 intake of the highest quartile (Q4 ≥ 6.96 mg/day) was negatively associated with total cholesterol (TC) [-0.12 (-0.19, -0.06) mmol/L], low-density lipoprotein cholesterol (LDL-C) [-0.17 (-0.23, -0.10) mmol/L], and non-high-density lipoprotein cholesterol (non-HDL-C) [-0.12 (-0.18, -0.05) mmol/L], while positively associated with apolipoprotein A-1 (ApoA1) [0.10 (0.08, 0.13) g/L] and triglycerides (TG) [0.14 (0.05, 0.23) mmol/L], compared to the lowest quartile (Q1 < 1.88 mg/day). Besides, dietary CoQ10 intake showed nonlinear dose-response associations with the above lipid variables (all P nonlinear < 0.05).

Conclusion

Dietary-derived CoQ10 intake may be associated with some lipid profiles, such as TG, ApoA1, TC, LDL-C, and non-HDL-C. However, CoQ10 from dietary sources may not be a good choice for individuals who need to CoQ10 supplement.

Efficacy of taurine-enhanced enteral nutrition in improving the outcomes of critically ill patients: A systematic review and meta-analysis

BACKGROUND

Taurine is considered an immunomodulatory agent. From current reports on clinical studies, we conducted a systematic review and meta-analysis to investigate the effects of taurine-enhanced enteral nutrition (EN) on the outcomes of critically ill patients to resolve conflicting evidence in literature.

METHODS

Literature from PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, SINOMED, and WanFang databases were retrieved, and randomized controlled trials (RCTs) were identified. The time range spanned from January 1, 2000, to January 31, 2024. The Cochrane Collaboration Tool was used to evaluate the risk of bias. We used the GRADE approach to rate the quality of evidence and the I2 test to assess the statistical heterogeneity of the results. Risk ratio (RR), mean difference (MD), and 95% confidence interval (95% CI) were used to analyze measurement data.

RESULTS

Four trials involving 236 patients were finally included. The meta-analysis results indicated that taurine-enhanced EN did not reduce mortality (RR = 0.70, p = 0.45, 95% CI [0.28, 1.80], two trials, 176 participants, low quality). There was also no significant difference in length of stay in the intensive care unit (ICU) between the taurine-enhanced EN and control groups. Taurine-enhanced EN may reduce pro-inflammatory factor interleukin-6 (IL-6) levels in critically ill patients（the result about IL-6 cannot be pooled）. However, taurine-enhanced EN had no significant impact on high-sensitivity-C-reactive protein levels (MD = -0.41, p = 0.40, 95% CI [-1.35, 0.54], two trials, 60 participants, low quality).

DISCUSSION

Taurine-enhanced EN may reduce IL-6 levels and is not associated with improved clinical outcomes in critically ill patients, which may have potential immunoregulatory effects in critically ill patients. Given that published studies have small samples, the above conclusions need to be verified by more rigorously designed large-sample clinical trials.

Impact of a multidisciplinary collaborative nutritional treatment model in patients who are critically ill with neurological disorders: A randomized controlled trial

BACKGROUND

Malnutrition is a widespread problem in critically ill patients with neurological disorders.

OBJECTIVE

The purpose of this study is to investigate the effect of a multidisciplinary collaborative nutritional treatment mode based on a standardized unit for nutritional support on the outcome metrics in patients with neurological disorders who are critically ill.

METHODS

We enrolled 84 participants who were hospitalized in the intensive care unit (ICU) of Yancheng No. 1 People's Hospital for neurological disorders between June 2018 and December 2021. The participants were randomly assigned to the control group and the test group. The control group received traditional nutritional support, while the test group was treated with a multidisciplinary collaborative nutritional treatment mode based on a standardized unit for nutritional support. We collected the general information, feeding tolerance (FT), nutritional risk score, and laboratory indicators before intervention, after intervention for one week, and after intervention for 2 weeks, and other data of the participants.

RESULTS

After the intervention, the test group scored significantly lower than the control group in the incidence of gastroparesis and diarrhea, as well as the NUTRIC score, with statistically significant differences (P< 0.001). The prealbumin levels in the test group increased progressively prior to intervention, after intervention for one week, and after intervention for two weeks. Compared to the control group, the test group had higher prealbumin levels prior to intervention, after intervention for one week, and after intervention for two weeks, with statistically significant differences (P< 0.001).

CONCLUSION

We developed a multidisciplinary collaborative nutritional treatment model based on a standard unit for nutritional support. This model can improve neural function, FT, and pertinent outcome indicators and is generally applicable.

The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction

BACKGROUND

Malnutrition is common in patients with acute myocardial infarction (AMI) and is associated with a poor prognosis. The prognostic value of the prognostic nutritional index (PNI) in patients with AMI remains controversial. We aimed to explore the relationship between PNI and all-cause mortality in critically ill patients with AMI and evaluate the incremental prognostic value of PNI to commonly used prognostic assessment tools.

METHODS

The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was used to conduct a retrospective cohort analysis on 1180 critically ill patients with AMI. The primary endpoints were defined as 6-month and 1-year all-cause mortality. Cox regression analysis was used to investigate the relationship between admission PNI and all-cause mortality. The effect of adding PNI to sequential organ failure assessment (SOFA) score, or charlson comorbidity index (CCI) on its discriminative ability was assessed using C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

RESULTS

Multivariate cox regression analysis demonstrated that the low PNI was regarded as an independent predictor of 1-year all-cause mortality in AMI patients admitted to ICU (adjusted Hazard Ratio: 95% CI = 1.75 (1.22-2.49)). The ROC test showed that admission PNI had a moderate predictive ability to predict all-cause mortality of critically ill patients with AMI. Furthermore, the net reclassification and integrated discrimination of the CCI alone model improved significantly with PNI. [C-statistic increased from 0.669 to 0.752, p < 0.001; NRI = 0.698, p < 0.001; IDI = 0.073, p < 0.001]. When PNI was added to the SOFA score, the C-statistic significantly improved from 0.770 to 0.805 (p < 0.001), and the NRI and IDI were estimated at 0.573 (p < 0.001) and 0.041 (p < 0.001), respectively.

CONCLUSION

PNI could be a novel predictor for identifying patients at high risk of 1-year all-cause mortality in critically ill patients with AMI. The addition of PNI to the SOFA score or CCI may be useful for very early risk stratification.

Effects of Probiotics Supplementation on CRP, IL-6, and Length of ICU Stay in Traumatic Brain Injuries and Multiple Trauma Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

METHOD

This meta-analysis aims to evaluate the effectiveness of probiotics in reducing inflammatory biomarkers and the length of intensive care unit (ICU) stays. PubMed-Medline, SCOPUS, Embase, and Google Scholar databases up to July 2021 were searched. The meta-analysis was carried out using random-effect analysis. To determine the sources of heterogeneity, subgroup analyses were performed. In case of the presence of publication bias, trim and fill analysis was carried out. The Cochrane Collaboration tool was used for checking the quality assessment. We hypothesized that probiotics would improve inflammatory markers (CRP and IL-6) and the length of ICU stay in traumatic brain injury and multiple trauma patients.

RESULTS

The present meta-analysis, which includes a total of seven studies, showed that there were no significant effects of probiotics supplementation on interleukin (IL)-6 (Hedges's g = -2.46 pg/ml; 95% CI: -12.16, 7.25; P=0.39), C-reactive protein (CRP) (Hedges's g = -1.10 mg/L; 95% CI: -2.27, 0.06; P=0.06), and the length of staying in ICU. The overall number of RCTs included in the analysis and the total sample size were insufficient to make firm conclusions.

CONCLUSION

As a result, more carefully designed RCTs are needed to investigate the effect of probiotics on inflammatory biomarkers and the length of ICU stay in traumatic brain injuries and multiple trauma patients in greater detail.

The combination of arterial lactate level with GCS-pupils score to evaluate short term prognosis in traumatic brain injury: a retrospective study

Background

The aim of the study was to determine whether the combination of Glasgow Coma Scale (GCS) and Pupil responses score (GCSP) with arterial lactate level would be an index to predict the short term prognosis in patients with traumatic brain injury (TBI).

Methods

A retrospective study was performed enrolling all TBI patients admitted to intensive care unit (ICU) from 2019 to 2020. The demographics, clinical characteristics, and arterial lactate concentration were recorded. The GCSP and arterial blood analysis (ABG) with lactate was tested as soon as the patient was admitted to ICU. The Glasgow Outcome Scale (GOS) after discharge was regarded as the clinical outcome. A new index named GCSP-L was the combination of GCSP and lactate concentration. GCSP-L was the GCSP score (range 1-15) plus the lactate score (range 0-2). The lactate score was defined based on different lactate concentrations. If lactate was below 2 mmol/L, lactate score was 0, which above 5 mmol/L was 2 and between 2 and 5 mmol/L, the score was 1. As the range of GCSP was 1-15, the range of the GCSP-L was 1 to 17. The area under receiver operating characteristic curve (AUC) was calculated to evaluate the predictive ability of GCSP, lactate and GCSP-L. Statistical significance was set when p value < 0.05.

Results

A total of 192 TBI patients were included in the study. Based on GCSP, mild, moderate, and severe TBI were 13.02, 14.06 and 72.92%, respectively. There were 103 (53.65%) patients with the lactate concentration below 2 mmol/L (1.23 ± 0.37 mmol/l), 63 (32.81%) of the range from 2 to 5 (3.04 ± 2.43 mmol/l) and 26 (13.54%) were above 5 mmol/l (7.70 ± 2.43 mmol/l). The AUC was 0.866 (95% CI 0.827-0.904) for GCSP-L, 0.812 (95% CI 0.765-0.858) for GCSP and 0.629 (95% CI 0.570—0.0.688) for lactate. The AUC of GCSP-L was higher than the other two, GCSP and lactate alone.

Conclusions

The combination of GCSP and lactate concentration can be used to predict the short term prognosis in TBI patients.

Therapeutic Efficacy of Flavonoids in Allergies: A Systematic Review of Randomized Controlled Trials

Objective

To assess the clinical efficacy of flavonoid supplements on allergic diseases.

Design

Systematic review. Data Sources. MEDLINE/PubMed, Scopus, Web of Science, and Embase databases were searched from inception to September 2021. Eligibility Criteria for Selecting Studies. Eligible study designs were randomized controlled trials that investigated the effect of flavonoids applied to allergic diseases.

Results

This review included 15 randomized controlled trials, including allergic rhinitis/cedar pollinosis (n = 10), asthma (n = 3), and atopic dermatitis (n = 2). A total of 990 participants aged 6 to 69 years were included in these studies. Globally, 12 studies (80%) revealed some benefits of flavonoids (isolate or combined with other compounds) in allergic patients, while three studies (20%) reported no statistically significant impact on symptom scores and/or lung function. No severe adverse events related to treatment were reported. According to the GRADE system, the outcomes evaluated were of low to moderate quality of evidence.

Conclusions

Overall, this review suggests that the administration of flavonoids may provide a viable strategy for mitigating allergic symptoms. Future trials with high methodological quality are needed to establish definitive conclusions. This trial is registered with PROSPERO registration no. CRD42021237403.