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Background: Early evaluation of the severity of acute pancreatitis (AP) requires measurement of many variables within 48 h after admission. Septic complications (SC) are frequent, and preliminary studies have highlighted the value of prophylactic antibiotherapy; however, single and reliable predictive markers of sepsis are not yet available. The aim of this study was to assess the value of determining early blood Th-1 cytokines and their natural antagonists (interleukin-6 (IL-6), IL-1, IL-1ra, and the soluble form of tumor necrosis factor (sTNF) receptors RI and RII) to predict the severity and SC during AP. Methods: Thirty-seven patients with AP were prospectively included; 25 of them had severe AP, including 8 with SC. Serum cytokines were measured 48 h and 72 h after the onset of AP with an enzyme-linked immunosorbent assay. The optimal severity or SC diagnostic thresholds was determined using receiver operative curves. Results: Severe AP in accordance with the Atlanta criteria were better predicted by C-reactive protein and IL-6 serum determination, albeit these levels could not predict absolutely the death of two patients. In severe AP cases (n = 25) the IL-1 to IL-1-ra ratio was lower in cases further complicated by sepsis ((6 ± 4) 10 versus (34 ± 13) 10, P < 0.05); moreover, sTNF RI (2497 ± 270 pg/ml versus 2133 ± 611 pg/ml, P < 0.05) and RII (3751 ± 400 pg/ml versus 3045 ± 509 pg/ml, P < 0.05) were higher in AP characterized by further SC. The IL-1 to IL-1-ra ratio and IL-1 concentration were dramatically decreased within the first 48 h ((0.4 ± 0.4) 10 versus (30 ± 11) 10, P < 0.05, and 0.3 ± 0.3 versus 15 ± 3 ng/l, P < 0.05) in patients with further infection of the pancreatic necrosis (n = 3). The SC diag-nosis was better anticipated by an IL-1 to IL-1-ra ratio lower than 5 × 10 or by an sTNF RI higher than 1750 pg/ml and sTNF RII higher than 2750 pg/ml, and the infection of the pancreatic necrosis by an IL-1 concentration <2 ng/l or an IL-1 to IL-1-ra ratio <2 × 10. Conclusion: Besides severity markers, IL-1, IL-1-ra, and sTNF RI and RII should be considered in base-line AP assays and, if confirmed by larger studies, could help to screen patients at risk for SC and candidates for prophylactic antibiotherapy with a good negative predictive value. [ABSTRACT FROM AUTHOR]

Importance: SARS-CoV-2 is a new virus responsible for the Covid-19 pandemic. Although SARS-CoV-2 primarily affects the lungs, other organs are infected. Alterations of testosteronemia and spermatozoa motility in infected men have raised questions about testicular infection, along with high level in the testis of ACE2, the main receptor used by SARS-CoV-2 to enter host cells. Using an organotypic culture of human testis, we found that SARS-CoV-2 replicated with slow kinetics in the testis. The virus first targeted testosterone-producing Leydig cells and then germ-cell nursing Sertoli cells. After a peak followed by the upregulation of antiviral effectors, viral replication in the testis decreased and did not induce any major damage to the tissue. Altogether, our data show that SARS-CoV-2 replicates in the human testis to a limited extent and suggest that testicular damages in infected patients are more likely to result from systemic infection and inflammation than from viral replication in the testis., Competing Interests: The authors declare no conflict of interest.

Purpose: A new semi-continuous thermodilution cardiac output (CCO) system has been developed recently (Opti-Q and Q-vue Abbott critical care system). The aim of this study was to compare the accuracy and reproducibility of this new device with conventional ice-bolus thermodilution cardiac output (BCO)., Methods: Fifteen critically ill patients who needed pulmonary artery catheterization were prospectively investigated. Eighty seven paired data using BCO and CCO methods were compared. Reproducibility was assessed from 90 BCO and 87 CCO determinations by calculation of the mean standard error (SEM) and according to Bland and Altman methodology., Results: The BCO and CCO ranged from 2.46 to 11.20 L.min-1 and from 1.75 to 10.05 L.min-1 respectively. Bias (mean difference between BCO and CCO) was null (0.002 L.min-1, P = 0.98), precision (SD of the bias) was 0.74 L.min-1 and the limits of agreement (mean difference +/- 1.96 SD) ranged from -1.45 to 1.45 L.min-1. The threshold to consider two cardiac outputs as different (3 x SEM) was equivalent for BCO and CCO (0.54 and 0.465 L.min-1 respectively). According to the Bland and Altman method, reproducibility of CCO was greater than that of BCO; bias of repeated measurements of BCO and CCO were 0.15 L.min-1 (P < 0.05) and 0.047 L.min-1 (NS), respectively., Conclusion: Compared with BCO, this new device was accurate but cannot be considered as interchangeable regarding the limits of agreement. Reproducibility of CCO was superior to BCO.