Cirp Induces Neutrophil Reverse Transendothelial Migration in Sepsis: Erratum
No abstract available (Source: Shock)
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Erratum Source Type: research

Remote Ischemic Conditioning in a Model of Severe Renal Ischemia–Reperfusion Injury
Ischemia–reperfusion (I/R) injury is a leading cause of acute renal dysfunction. Remote ischemic conditioning (rIC) is known to protect organs exposed to I/R. We sought to investigate whether rIC would influence renal function recovery in a severe renal I/R injury rat model. Rats were randomly assigned to four experimental groups following median laparotomy and right nephrectomy: Sham (n = 6); 30-min left renal ischemia (RI) only (n = 20); RI + rIC (n = 20) (four 5-min cycles of limb ischemia interspersed with 5-min limb reperfusion during RI); and RI + erythropoietin pretreatment (EPO) (n = 20). Rena...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Deficiency of the Transcription Factor NR4A1 Enhances Bacterial Clearance and Prevents Lung Injury During Escherichia Coli Pneumonia
This study aims to explore the role of NR4A1 in Escherichia coli (E. coli) pneumonia. Methods: Alveolar macrophages (AMs) were isolated from wild-type (WT) and NR4A1 knock out (Nr4a1−/−) mice, and the NR4A1 expression and phagocytic capacity against E. coli were measured in vitro. WT and Nr4a1−/− mice were subjected to E. coli or sham pneumonia. Bacterial load, lung injury severity, inflammatory cell infiltration, and cytokines were assessed at 0, 4, and 18 h after surgery. Survival rates within 48 h were evaluated in WT and Nr4a1−/− mice. In addition, NR4A1 antagonist (DIM-C-pPhC...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Dysfunction of Iron Metabolism and Iron-Regulatory Proteins in the Rat Hippocampus After Heat Stroke
Heat stroke, the most serious type of heat illness, refers to the presence of hyperthermia (core temperature>40°C), accompanied by central nervous system dysfunction. The hippocampus is a particularly vulnerable region in the early stage of heat stroke. Increasing evidence suggests that dysregulation of brain iron metabolism is involved in many neurodegenerative diseases. However, whether heat stroke causes dysfunction of iron metabolism, as well as iron-regulatory proteins, in the hippocampus remains unknown. The present study was conducted to explore the effects on spatial learning and memory, as well as iron cont...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Systematic Identification and Analysis of Expression Profiles of mRNAs and Incrnas in Macrophage Inflammatory Response
In this study, we performed high-throughput sequencing to identify the profiles of mRNA and lncRNA transcriptomes in response to lipopolysaccharide (LPS) stimulation, followed by a comprehensive bioinformatics analysis. We found a total of 325 lncRNAs and 1,187 mRNAs to be significantly dysregulated in RAW264.7 cells stimulated with LPS (fold change>4.0 or (Source: Shock)
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Partial Deletion of Tie2 Affects Microvascular Endothelial Responses to Critical Illness in A Vascular Bed and Organ-Specific Way
Tyrosine kinase receptor (Tie2) is mainly expressed by endothelial cells. In animal models mimicking critical illness, Tie2 levels in organs are temporarily reduced. Functional consequences of these reduced Tie2 levels on microvascular endothelial behavior are unknown. We investigated the effect of partial deletion of Tie2 on the inflammatory status of endothelial cells in different organs. Newly generated heterozygous Tie2 knockout mice (exon 9 deletion, ΔE9/Tie2+/−) exhibiting 50% reduction in Tie2 mRNA and protein, and wild-type littermate controls (Tie2+/+), were subjected to hemorrhagic shock and resuscita...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Total Salvianolic Acid Injection Prevents Ischemia/Reperfusion-Induced Myocardial Injury Via Antioxidant Mechanism Involving Mitochondrial Respiratory Chain Through the Upregulation of Sirtuin1 and Sirtuin3
Sirtuin1 (Sirt1) and Sirtuin3 (Sirt3) are known to participate in regulating mitochondrial function. However, whether Total Salvianolic Acid Injection (TSI) protects against myocardial ischemia/reperfusion (I/R) injury through regulating Sirt1, Sirt3, and mitochondrial respiratory chain complexes is unclear. The aim of this study was to explore the effects of TSI on I/R-induced myocardial injury and the underlying mechanism. Male Sprague–Dawley rats were subjected to 30 min occlusion of the left anterior descending coronary artery followed by 90 min reperfusion with or without TSI treatment (8 mg/kg/h). The res...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Fibrinogen Protects Against Barrier Dysfunction Through Maintaining Cell Surface Syndecan-1 In Vitro
Conclusion: These data suggest that in vitro, fibrinogen associated with cell surface syndecan-1 and enhanced endothelial barrier integrity. (Source: Shock)
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Murine Pancreatic Cancer Alters T Cell Activation and Apoptosis and Worsens Survival After Cecal Ligation and Puncture
Patients with cancer who develop sepsis have a markedly higher mortality than patients who were healthy prior to the onset of sepsis. Potential mechanisms underlying this difference have previously been examined in two preclinical models of cancer followed by sepsis. Both pancreatic cancer/pneumonia and lung cancer/cecal ligation and puncture (CLP) increase murine mortality, associated with alterations in lymphocyte apoptosis and intestinal integrity. However, pancreatic cancer/pneumonia decreases lymphocyte apoptosis and increases gut apoptosis while lung cancer/CLP increases lymphocyte apoptosis and decreases intestinal ...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Effects of Psychosocial Stress on Subsequent Hemorrhagic Shock and Resuscitation in Male Mice
Conclusions: Chronic psychosocial stress during adulthood is not sufficient to promote hemodynamic complications, organ dysfunction, metabolic disturbances and did not increase the risk of MOF after subsequent hemorrhage and resuscitation. Intravenous norepinephrine to keep target hemodynamics might have led to a certain level of oxidative stress in both groups and, therefore, disguised potential effects of chronic psychosocial stress on organ function after hemorrhagic shock in the present murine trauma model. (Source: Shock)
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Inverse Correlation Between Plasma Sphingosine-1-Phosphate and Ceramide Concentrations in Septic Patients and Their Utility in Predicting Mortality
Introduction: The aim of this study was to investigate the correlation between plasma sphingosine-1-phosphate (S1P) and ceramide concentrations in sepsis, and the possible mechanisms for altered expression. Methods: Plasma S1P and ceramide concentrations were measured by HPLC-ESI-MS/MS. HLA-DR (human leukocyte antigen-DR) expression on peripheral blood mononuclear cells was examined by flow cytometry. Platelet sphingosine kinases 1/2 (SphK1/2) mRNA expression, protein content, and enzyme activities were determined by qRT-PCR, western blot, and commercial enzyme assay kits, respectively. Results: Compared with healt...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Anticoagulation Therapy Using rh-Thrombomodulin and/or Antithrombin III Agent is Associated With Reduction in in-Hospital Mortality in Septic Disseminated Intravascular Coagulation: A Nationwide Registry Study
We analyzed the Nationwide Registry database on sepsis to examine the effects of an anticoagulation therapy, especially with rh-thrombomodulin (rh-TM) and/or antithrombin (AT) III agent, in septic disseminated intravascular coagulation (DIC) patients. In 3,193 patients enrolled after the exclusion, we investigated the association with in-hospital mortality using Cox proportional hazards models. DIC was diagnosed using the Japanese Association of Acute Medicine (JAAM) and the International Society of Thrombosis and Hemostasis (ISTH) criteria. To analyze the separate treatment effects of rh-TM and/or AT III, we excluded the ...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Prognostic Value of Tissue Oxygen Saturation Using a Vascular Occlusion Test in Patients in the Early Phase of Multiorgan Dysfunction Syndrome
Conclusions: Impaired values of the VOT-parameters OS and RS are associated with an increased 28-day mortality in patients in the early phase of MODS. (Source: Shock)
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Plasma Adenylate Levels are Elevated in Cardiopulmonary Arrest Patients and May Predict Mortality
Cerebral and cardiac dysfunction cause morbidity and mortality in postcardiac arrest syndrome (PCAS) patients. Predicting clinical outcome is necessary to provide the optimal level of life support for these patients. In this pilot study, we examined whether plasma ATP and adenylate levels have value in predicting clinical outcome in PCAS patients. In total, 15 patients who experienced cardiac arrest outside the hospital setting and who could be reanimated were enrolled in this study. Healthy volunteers (n = 8) served as controls. Of the 15 PCAS patients, 8 died within 4 days after resuscitation. Of the 7 survivors, 2 l...
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Predictors of Successful Weaning From Veno-Arterial Extracorporeal Membrane Oxygenation After Coronary Revascularization for Acute Myocardial Infarction Complicated by Cardiac Arrest: A Retrospective Multicenter Study
Conclusions: Successful weaning from VA-ECMO was predicted by post-PCI TIMI flow grade, MAP at 4 h, and serum lactate at 24 h after VA-ECMO initiation in patients of AMI complicated by CA. Furthermore, in patients who failed to wean from ECMO, LVEF did not recover within 48 h. In such patients, adjunctive use of other circulatory mechanical devices must be considered. (Source: Shock)
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Long-Term Effects of Experimental Human Endotoxemia on Immune Cell Function: Similarities and Differences With Sepsis
In conclusion, despite considerable differences, experimental endotoxemia captures several long-term aspects of sepsis immunology, specifically the behavior of CD8+ T cells, which may eventually aid the development of new therapies for sepsis patients. (Source: Shock)
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

What's New in Shock, June 2019?
No abstract available (Source: Shock)
Source: Shock - May 15, 2019 Category: Emergency Medicine Tags: Commentary Source Type: research

The Effects of Pharmacological Hypothermia Induced by Neurotensin Receptor Agonist ABS 201 on Outcomes of CPR
Neurotensin is an endogenous tridecapeptide that binds to neurotensin receptors in the brain, which induce hypothermia. The aim of this study was to investigate whether the receptor agonist ABS 201 could induce therapeutic hypothermia and improve postresuscitation outcomes in a ventricular fibrillation cardiac arrest (VFCA) rat model. VF was electrically induced in 12 rats. Defibrillation was achieved after 6 min of cardiopulmonary resuscitation. After successful resuscitation, animals were randomized to receive ABS 201 (8 mg/kg/h) or placebo. Postresuscitation myocardial function and neurological deficit scores (NDS) ...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Endovascular Perfusion Augmentation for Critical Care: Partial Aortic Occlusion for Treatment of Severe Ischemia–Reperfusion Shock
Background: The resuscitation of patients in shock is materially intensive and many patients are refractory to maximal therapy. We hypothesized that partial inflation of an intra-aortic balloon, termed Endovascular Perfusion Augmentation for Critical Care (EPACC), would minimize material requirements while improving physiologic metrics. Methods: Swine underwent a 25% controlled bleed and 45 min of complete aortic occlusion to create a severe ischemia–reperfusion shock state. Animals received either standardized critical care (SCC) composed of IV fluids and norepinephrine delivered through an algorithmically cont...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

The Effects of Vasoconstriction And Volume Expansion on Veno-Arterial ECMO Flow
Conclusions: In a circulation completely dependent on ECMO support, maximum achievable flow directly depended on the vascular factors governing venous return—i.e., closing conditions, stressed vascular volume and the elastance and resistive properties of the vasculature. Both treatments increased maximum achievable ECMO flow at stable DO2, via increases in stressed volume by different mechanisms. Vascular resistance and pump afterload decreased with Volume Expansion. (Source: Shock)
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Blood–Brain Barrier Dysfunction After Smoke Inhalation Injury, With and Without Skin Burn
In this study, we characterize acute pathophysiological changes in the brain of sheep exposed to smoke inhalation, with- and without third-degree skin burn that models the injuries sustained by human victims of fire accidents. Blood–brain barrier integrity and hemorrhage were analyzed throughout the brain using specific histological stains: Hematoxylin & Eosin, Luxol fast blue, Periodic acid–Schiff (PAS), and Martius, Scarlet and Blue (MSB). Our data show that, following smoke inhalation injury, alone and in combination with third-degree skin burn, there was a significant increase in the number of congested...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Effects of Multiday Ethanol Intoxication on Postburn Inflammation, Lung Function, and Alveolar Macrophage Phenotype
Burn patients who consumed alcohol before injury have worse clinical outcomes, including longer hospital stays, increased ventilator days, and more respiratory infections. Most alcohol consumers are binge drinkers and not chronic alcoholics, and binge drinking patterns fluctuate over the week, with consecutive days of drinking over the weekend followed by relative abstinence during the week. We used a murine model simulating this drinking pattern in the context of burn injury. Mice were given ethanol for 3 days, rested for 4 days, given ethanol for 3 more days, followed by a sham or 15% total body surface area full-thickne...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Epidemiology of Emergency Department Sepsis: A National Cohort Study Between 2001 and 2012
The aim of this study is to examine the incidence trend of sepsis over 11 years and compared mortality outcomes among Taiwanese patients with sepsis admitted from emergency department (ED) and non-ED routes. We used a nationwide health insurance database from Taiwan, which comprise of 23 million beneficiaries. Patients with sepsis were identified by ICD-9 CM codes for infection and organ dysfunction from 2001 to 2012. We performed propensity score matching and compared mortality rates between ED-admitted and non ED-admitted patients. During the 11-year study period, we identified 1,256,684 patients with sepsis. 493,397 (2...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Current Practices in Central Venous Catheter Position Confirmation by Point of Care Ultrasound: A Survey of Early Adopters
Conclusions: Though data support its utility and advantages for POCUS as a sole modality for CVC position confirmation and PTX evaluation, POCUS is rarely used for this indication. We identified several perceived barriers toward widespread utilization suggesting areas for dissemination and implementation strategy development that will benefit patient care practices. (Source: Shock)
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Increase of Perfusion Index During Vascular Occlusion Test is Paradoxically Associated With Higher Mortality in Septic Shock After Fluid Resuscitation: A Prospective Study
In conclusion, high values of PI during VOT indicate higher mortality in septic shock and are associated with adrenergic stimulus. Additionally, the assessment of PI-VOT appears to improve the predictive value of arterial lactate. (Source: Shock)
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

A Comparison of Outcomes of Trauma Patients With Ventilator-Associated Events by Diagnostic Criteria Set
Background: The Centers for Disease Control and Prevention replaced the definition for ventilator-associated pneumonia with an algorithm comprised of three categories: ventilator-associated condition (VAC), infection-related ventilator associated complication (IVAC), and possible ventilator-associated pneumonia (PVAP). We sought to compare the outcome of trauma patients with VAEs to those with no VAEs. Methods: Patients admitted from 2013 to 2017 were identified from trauma registry. Logistic regression was performed for the association between VAEs and mortality. Results: Two thousand six hundred eighty patients w...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Early Hyperoxia in The Intensive Care Unit is Significantly Associated With Unfavorable Neurological Outcomes in Patients With Mild-to-Moderate Aneurysmal Subarachnoid Hemorrhage
Conclusions: Early hyperoxia was not associated with unfavorable neurological outcomes in overall SAH patients, but it was associated with unfavorable neurological outcomes in those with H&K grades I to III. (Source: Shock)
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Variations of Cutaneous Capnometry and Perfusion Index During a Heating Challenge is Early Impaired in Septic Shock and Related to Prognostic in Non-Septic Shock
This study aimed to develop a noninvasive approach, the heating challenge (HC), to monitor the microvascular reactivity of patients with shock and to evaluate the potential relationship with outcome. Methods: After ethics committee agreement was obtained, 59 shock patients, including 37 septic shock, 22 non-septic shock (14 cardiogenic and eight hemorrhagic), 10 intensive care unit (ICU)-controls and 12 healthy volunteers, were included in this study. The HC consisted of heating the ear lobe PcCO2 sensor from 37° to 45° over 5 min and recording PcCO2 and PI variations (ΔPcCO2 and PImax/min). HC was perfo...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Alterations in Mitochondrial Function in Blood Cells Obtained From Patients With Sepsis Presenting to an Emergency Department
Conclusions: Bedside measurement of mitochondrial respiration can be minimally invasive and performed in a timely manner. Mitochondrial dysfunction, detected by decreased oxygen consumption utilized for energy production and depleted cellular bioenergetics reserve. (Source: Shock)
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Burn-Induced Microglia Activation is Associated With Motor Neuron Degeneration and Muscle Wasting in Mice
Introduction: Burn injury (BI) leads to both systemic and neuro-inflammation and is associated with muscle wasting and weakness, which increase morbidity and mortality. Disuse atrophy is concomitantly present in BI patients. Most studies have focused on muscle with little attention to role of central nervous system (CNS) in the neuromuscular changes. We tested the hypothesis that BI-induced muscle wasting stems from CNS microglia activation and cytokines and chemokine release, which is associated with spinal ventral horn motor neuron degeneration. Methods: Body surface (35%) BI, immobilization alone (Immob), BI with i...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: 2018 New Investigator Award Competition Source Type: research

Surfactant Protein D Dampens Lung Injury by Suppressing NLRP3 Inflammasome Activation and NF-κB Signaling in Acute Pancreatitis
Conclusion: SP-D exerts protective effects against ALI via suppressing NLRP3 inflammasome and NF-κB activation in experimental SAP. (Source: Shock)
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: 2018 New Investigator Award Competition Source Type: research

CIRP Induces Neutrophil Reverse Transendothelial Migration in Sepsis
Extracellular cold-inducible RNA-binding protein (CIRP) exaggerates inflammation in sepsis. Neutrophil reverse transendothelial migration (rTEM) allows neutrophils to migrate from tissues into the circulation. The phenotype of neutrophils after reverse migration is CD54hiCXCR1lo. We hypothesize that CIRP induces neutrophil rTEM in sepsis. Sepsis was induced in male C57BL/6 mice by cecal ligation and puncture (CLP), and at 5, 10, or 20 h after CLP the frequencies of reversely migrated (RM) neutrophils were assessed in the blood by flow cytometry. As 20 h of CLP showed highest increase in the frequency of RM neutrophils,...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: 2018 New Investigator Award Competition Source Type: research

Protein Kinase C-Delta (PKCδ) Tyrosine Phosphorylation is a Critical Regulator of Neutrophil-Endothelial Cell Interaction in Inflammation
Conclusions: PKCδ tyrosine 155 is a key phosphorylation site controlling proinflammatory signaling and neutrophil–endothelial cell interactions. These studies provide mechanistic insights into PKCδ regulation during inflammation. (Source: Shock)
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: 2018 New Investigator Award Competition Source Type: research

What's New in Shock, May 2019?
No abstract available (Source: Shock)
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Commentary Source Type: research

Dietary Cellulose Supplementation Modulates the Immune Response in a Murine Endotoxemia Model
The role of dietary fiber in chronic inflammatory disorders has been explored, but very little is known about its benefits in acute inflammation. Previously, we have demonstrated that dietary cellulose supplementation confers protection in a murine model of sepsis by promoting the growth of the gut microbiota that are linked to metabolic health. The survival benefit is associated with a decrease in serum concentration of proinflammatory cytokines, reduced neutrophil infiltration in the lungs, and diminished hepatic inflammation. Here, we aim to understand if the benefit of manipulating the gut microbiome exerts a broader &...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Effects of End-Tidal Carbon Dioxide-Guided Fluid Resuscitation on Outcomes in a Cecal Ligation and Puncture Induced Rat Model of Sepsis
Cecal ligation and puncture (CLP) was used to cause severe sepsis in male Sprague–Dawley rats. There are four groups in this study: sham (n = 5), CLP (n = 10), end-tidal carbon dioxide (ETCO2) (n = 10), and mean arterial pressure (MAP) (n = 10). In ETCO2 group, fluid resuscitation (FR) began when ETCO2 at most 25 mmHg. In MAP group, FR began when MAP at most 100 mmHg. Electrocardiogram, aortic pressure, core temperature, and ETCO2 values were recorded at baseline, 2, 4, 6, 8, 10, and 12 h post-CLP. Lactate level, cardiac output (CO), perfused small vessel density (PSVD), and microvascular flow index...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Endoplasmic Reticulum Stress-Induced NLRP1 Inflammasome Activation Contributes to Myocardial Ischemia/Reperfusion Injury
In conclusion, NLRP1 inflammasome activation promotes myocardial I/R injury. ER stress can activate NLRP1 inflammasome via activating the NF-κB signaling pathway. (Source: Shock)
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Reduction in Blood Glutamate Levels Combined With the Genetic Inactivation of A2AR Significantly Alleviate Traumatic Brain Injury-Induced Acute Lung Injury
Traumatic brain injury-induced acute lung injury (TBI-ALI) is a serious complication of traumatic brain injury (TBI). Our previous clinical study found that high levels of blood glutamate after TBI were closely related to the occurrence and severity of TBI-ALI, while it remains unknown whether a high concentration of blood glutamate directly causes or aggravates TBI-ALI. We found that inhibition of the adenosine A2A receptor (A2AR) after brain injury alleviated the TBI-ALI; however, it is unknown whether lowering blood glutamate levels in combination with inhibiting the A2AR would lead to better effects. Using mouse models...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Hypertonic Saline Solution Reduces Microcirculatory Dysfunction and Inflammation in a Rat Model of Brain Death
This study investigated the effects of 7.5% hypertonic saline solution (HSS) on mesenteric microcirculatory dysfunction and inflammation in a rat model of BD. Methods: Male Wistar rats were anesthetized and mechanically ventilated. BD was induced by rapidly inflating an intracranial balloon catheter. The rats were randomly divided into: SH, sham-operated rats subjected to trepanation; NS, rats treated with NaCl 0.9%, 4 mL/kg immediately after BD; T1, rats treated with HSS (NaCl 7.5%, 4 mL/kg) immediately or 60 min after BD, T60. All groups were analyzed 180 min after the start of the experiment. Results: Rats i...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Herpes Virus Entry Mediator (HVEM) Expression Promotes Inflammation/ Organ Injury in Response to Experimental Indirect-Acute Lung Injury
Therapeutic interventions to treat acute lung injury (ALI) remain largely limited to lung-protective strategies, as a real molecular pathophysiologically driven therapeutic intervention has yet to become available. While we have previously documented the expression of herpes virus entry mediator (HVEM) on leukocytes of septic mice and critically ill patients, its functional role in shock/sepsis-induced ALI has not yet been studied. Inasmuch, a murine model of indirect ALI (iALI) was induced by hemorrhagic shock (HEM) followed by cecal ligation and puncture (CLP), septic challenge and HVEM-siRNA or phosphate buffered saline...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Monitoring of Conjunctival Microcirculation Reflects Sublingual Microcirculation in Ovine Septic and Hemorrhagic Shock
Introduction: The conjunctival region may serve as an alternative site for microcirculatory measurements. The present study was performed to investigate the correlation of sublingual and conjunctival microcirculation in ovine models of septic and hemorrhagic shock. Methods: Septic shock was induced in 10 sheep by inoculation of feces into the peritoneal cavity until mean arterial pressure (MAP) was (Source: Shock)
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

The Effects of Genetic 3-Mercaptopyruvate Sulfurtransferase Deficiency in Murine Traumatic-Hemorrhagic Shock
Conclusions: In summary, in a resuscitated murine model of traumatic-hemorrhagic shock, 3-MST deficiency had no physiologically relevant impact on hemodynamics and metabolism, which ultimately lead to unchanged mortality regardless of an additional blunt chest trauma. (Source: Shock)
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Phagocytosis by Fibrocytes as a Mechanism to Decrease Bacterial Burden and Increase Survival in Sepsis
Fibrocytes are unique cells with innate and adaptive immune functions, but these mechanisms have not been fully explored. The aim of this study was to explain the mechanism by which adoptive transfer of exogenous fibrocytes improved bacterial clearance and increased sepsis survival. Initial flow cytometry-based, in vitro assays demonstrated phagocytosis by fibrocytes and intracellular bacterial killing was confirmed by direct plating of cell lysates after exposure to live bacteria. Intravenous adoptive transfer of fibrocytes at the time of cecal ligation and puncture (CLP) or 2 h after CLP in mice increased survivability. ...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Chronic Alcohol Ingestion Worsens Survival and Alters Gut Epithelial Apoptosis and CD8+ T Cell Function After Pseudomonas Aeruginosa Pneumonia-Induced Sepsis
Mortality is higher in septic patients with a history of alcohol use disorder than in septic patients without a history of chronic alcohol usage. We have previously described a model of chronic alcohol ingestion followed by sepsis from cecal ligation and puncture in which alcohol-fed septic mice have higher mortality than water-fed septic mice, associated with altered gut integrity and increased production of TNF and IFNγ by splenic CD4+ T cells without alterations in CD8+ T cell function. The purpose of this study was to determine whether this represents a common host response to the combination of alcohol and sepsi...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Use of qSOFA Score in Predicting the Outcomes of Patients With Glyphosate Surfactant Herbicide Poisoning Immediately Upon Arrival at the Emergency Department
This study aimed to identify whether quick sequential organ failure assessment (qSOFA) performed immediately upon arrival can predict the outcome of patients with glyphosate surfactant herbicide (GlySH) poisoning. Methods: Adult patients with GlySH poisoning between January 2006 and April 2017 were included in this retrospective observational study. The qSOFA score (respiratory rate ≥22 breaths per minute, systolic blood pressure (Source: Shock)
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

A Rise in Neutrophil Cell Size Precedes Organ Dysfunction After Trauma
This study investigated the chronologic relation between neutrophil characteristics and organ dysfunction in trauma patients with a femoral fracture. Methods: Patients with a femoral fracture presenting at the University Medical Center Utrecht between 2007 and 2013 were included. Data of neutrophil characteristics from standard hematological analyzers were recorded on a daily basis until the 28th day of hospital stay or until discharge. Generalized Estimating Equations were used to compare outcome groups. Results: In total 157 patients were analyzed, of whom 81 had polytrauma and 76 monotrauma. Overall mortality with...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Distinct Dynamics of Stem and Progenitor Cells in Blood of Polytraumatized Patients
Endogenously mobilized stem and progenitor cells (SPCs) or exogenously provided SPCs are thought to be beneficial for trauma therapy. However, still little is known about the synchronized dynamics of the number of SPCs in blood after severe injury and parameters like cytokine profiles that correlate with these numbers. We determined the number of hematopoietic stem cells, common myeloid progenitors, granulocyte-macrophage progenitors, and mesenchymal stem/stromal cells in peripheral blood (PB) 0 to 3, 8, 24, 48, and 120 h after polytrauma in individual patients (injury severity score ≥ 21). We found that the number of...
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Circulating Monocyte Counts and its Impact on Outcomes in Patients With Severe Sepsis Including Septic Shock
This study was performed to evaluate the association of monocyte counts with mortality, the rate of bacteremia, and organ dysfunction and to evaluate whether the change in monocyte counts from the premorbid state to sepsis would differ between survivors and non-survivors in patients with severe sepsis including septic shock. A retrospective analysis of patients with severe sepsis including septic shock was performed. Monocyte counts were categorized into  (Source: Shock)
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Heart Rate Variability, Clinical and Laboratory Measures to Predict Future Deterioration in Patients Presenting With Sepsis
Conclusions: A model that combines HRV and laboratory values may help ED physicians evaluate risk of deterioration in patients with sepsis and merits validation and further evaluation. (Source: Shock)
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research

Intestinal Fatty Acid Binding Protein is Associated With Mortality in Patients With Acute Heart Failure or Cardiogenic Shock
Conclusion: Circulating levels of iFABP at admission predict mortality. This suggests that early inadequate perfusion of the small intestine may be associated with a dramatically decreased survival in patients with cardiogenic shock or severe acute heart failure. (Source: Shock)
Source: Shock - March 14, 2019 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research