Neutrophil Extracellular Trap Formation and Syndecan-1 Shedding Are Increased After Trauma
Background:
Damage-associated molecular patterns (DAMPs) stimulate endothelial syndecan-1 shedding and neutrophil extracellular traps (NET) formation. The role of NETs in trauma and trauma-induced hypercoagulability is unknown. We hypothesized that trauma patients with accelerated thrombin generation would have increased NETosis and syndecan-1 levels.
Methods:
In this pilot study, we analyzed 50 citrated plasma samples from 30 trauma patients at 0 h (n = 22) and 6 h (n = 28) from time of injury (TOI) and 21 samples from healthy volunteers, for a total of 71 samples included in analysis. Thrombin gene...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Does Chloride Intake at the Early Phase of Septic Shock Resuscitation Impact on Renal Outcome?
Introduction:
Fluid administration is one of the first lines of treatment for hemodynamic management of sepsis and septic shock. Studies investigating the effects of chloride-rich fluids including normal saline on renal function report controversial findings.
Methods:
This is a prospective, observational, multicenter study. Patients with septic shock, defined according to Sepsis-2 definition, were eligible. A “high-dose” of chloride was defined as a chloride intake greater than 18 g administrated within the first 48 h of septic shock management. The purpose of this study was to investigate the impact of ...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Carotid Ultrasound in Assessing Fluid Responsiveness in Patients with Hypotension and Suspected Sepsis
Purpose:
We sought to assess whether ultrasound (US) measurements of carotid flow time (CFTc) and carotid blood flow (CBF) predict fluid responsiveness in patients with suspected sepsis.
Methods:
This was a prospective observational study of hypotensive (systolic blood pressure (Source: Shock)
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Serum Mitochondrial Quality Control Related Biomarker Levels are Associated with Organ Dysfunction in Septic Patients
Background:
To investigate the feasibility and the value of using mitochondrial quality control (MQC)-related proteins as biomarkers in septic patients.
Methods:
The enrolled subjects were divided into four groups: healthy control group (n = 30), intensive care unit (ICU) control group (n = 62), septic nonshock group (n = 40), and septic shock group (n = 94). Serum levels of peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α), fission protein 1 (Fis1), mitofusin2 (Mfn2), and Parkin were measured by enzyme-linked immunosorbent assay at the time of enrollment for all groups. Cli...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Prognostic Value of Angiopoietin-like 4 in Patients with Acute Respiratory Distress Syndrome
Background:
Angiopoietin-like 4 (ANGPTL4) is a secreted glycoprotein that plays an important role in endothelial injury and the inflammatory response. Experimental models have implicated ANGPTL4 in acute respiratory distress syndrome (ARDS), but its impact on the progression of ARDS is unclear.
Methods:
Paired bronchoalveolar lavage fluid (BALF) and serum samples were obtained from patients with ARDS (n = 56) within 24 h of diagnosis and from control subjects (n = 32). ANGPTL4, angiopoietin-2, interleukin (IL)-6, and TNF-α levels were measured by magnetic Luminex assay. BALF albumin (BA) and serum alb...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Clinical Significance of Pro-inflammatory Cytokines and Their Correlation with Disease Severity and Blood Coagulation in Septic Patients with Bacterial Co-infection
Purpose:
To evaluate the clinical significance of pro-inflammatory cytokines for disease severity and coagulation in septic patients with bacterial co-infection.
Methods:
A total of 92 patients with sepsis admitted to intensive care unit (ICU) from January 2017 to August 2020 were enrolled and their clinical data were retrospectively analyzed. Forty-seven patients (51.1%) had a single infection by Klebsiella pneumoniae or Acinetobacter baumannii (single-infection group), and 45 patients (48.9%) were infected by both species (co-infection group). We compared the clinical characteristics and disease severity among...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Brief High Oxygen Concentration Induces Oxidative Stress in Leukocytes and Platelets: A Randomized Cross-over Pilot Study in Healthy Male Volunteers
Conclusion:
Clinically relevant oxygen exposure induces oxidative stress in leukocytes and platelets, which may influence the immune and clotting functions of these cells. (Source: Shock)
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Recombinant Human Thrombomodulin Has Additive Effects in Septic Patients Undergoing Continuous Hemodiafiltration Due to Intestinal Perforation
Conclusion:
Additive effects of rhTM treatment were observed in septic patients undergoing CHDF. (Source: Shock)
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Prognostic Accuracy of VqSOFA for Predicting 28-day Mortality in Patients with Suspected Sepsis in the Emergency Department
Conclusions:
VqSOFA was more predictive of 28-day mortality and vasopressor and mechanical ventilator use than the qSOFA and SOFA scores. (Source: Shock)
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Rhabdomyolysis is Associated with In-Hospital Mortality in Patients with COVID-19
Purpose:
Rhabdomyolysis (RM) has been associated with many viral infectious diseases, and associated with poor outcomes. We aim to evaluate the clinical features and outcomes of RM in patients with coronavirus disease 2019 (COVID-19).
Method:
This was a single-center, retrospective, cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan Hospital in Wuhan, China, between February 17 and April 12, 2020.
Results:
The overall incidence of RM was 2.2%. Compared with patients without RM, those with RM tended to have a higher risk of deterioration. Patients with RM als...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Vasopressor Responsiveness Beyond Arterial Pressure: A Conceptual Systematic Review Using Venous Return Physiology
We performed a systematic review to investigate the effects of vasopressor-induced hemodynamic changes in adults with shock. We applied a physiological approach using the interacting domains of intravascular volume, heart pump performance, and vascular resistance to structure the interpretation of responses to vasopressors. We hypothesized that incorporating changes in determinants of cardiac output and vascular resistance better reflect the vasopressor responsiveness beyond mean arterial pressure alone.
We identified 28 studies including 678 subjects in Pubmed, EMBASE, and CENTRAL databases.
All studies demonstrated...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Review Articles Source Type: research
Immunopathological Roles of Neutrophils in Virus Infection and COVID-19
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been spread around the world and is currently affecting global public health. Clinical evidence indicates that the elevated number of peripheral neutrophils and higher ratio of neutrophils-to-lymphocytes are correlated with severe outcomes in COVID-19 patients, suggesting the possible immunopathological role of neutrophils during SARS-CoV-2 infection. As an abundant innate immune cell type, neutrophils are well known for their contributions to antimicrobial defense. However, their dysfunction is also ass...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Review Articles Source Type: research
Gut Microbial Changes and their Contribution to Post-Burn Pathology
Burn injuries are a common form of traumatic injury that leads to significant morbidity and mortality worldwide. Burn injuries are characterized by inflammatory processes and alterations in numerous organ systems and functions. Recently, it has become apparent that the gastrointestinal bacterial microbiome is a key component of regulating the immune response and recovery from burn and can also contribute to significant detrimental sequelae after injury, such as sepsis and multiple organ failure. Microbial dysbiosis has been linked to multiple disease states; however, its role in exacerbating acute traumatic injuries, such ...
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Review Articles Source Type: research
What's New in Shock, September 2021?
No abstract available (Source: Shock)
Source: Shock - August 26, 2021 Category: Emergency Medicine Tags: Commentary Source Type: research
A Novel Human Glucocorticoid Receptor Variant, G459V, is Hyperactive in Response to Steroids
A potential cause of the variable response to injury and sepsis is the variability of a patient's human glucocorticoid receptor (hGR) profile. To identify hGR variants, blood samples were collected on admission and biweekly thereafter from hospitalized patients who sustained at least a 20% total body surface area burn injury. A hyperactive G1376T single-nucleotide polymorphism (SNP) isoform was identified. This SNP led to a single amino acid change of glutamine to valine at site 459, “G459V,” in the DNA-binding domain. The isoform's activity was tested in a reporter assay after treatment with steroids, the hGR antagoni...
Source: Shock - July 22, 2021 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
