Time from hospital admission to onset of septic shock is associated with higher in-hospital mortality
Conclusion: In-hospital mortality continued to rise as admission-shock-onset-time increased in patients with septic shock. No clear dichotomization between early and late septic shock could be ascertained, and this categorization may limit our understanding of the temporal relationship of shock onset to mortality. (Source: Shock)
Source: Shock - September 1, 2022 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Hospital characteristics are associated with clinical outcomes in patients with cardiogenic shock
This study aims to assess whether receiving hospital characteristics such as the availability of 24-hour coronary angiography, on-site cardiac surgery, and annual treated CS volume influence outcomes in patients transferred by emergency medical services (EMS) to hospital with CS. Methods: This population-based cohort study included consecutive adult patients with CS who were transferred to hospital by EMS between January 1, 2015 and June 30, 2019 in Victoria, Australia. Data were obtained from individually linked ambulance, hospital, and state death index data sets. The primary outcome assessed was 30-day mortality stratif...
Source: Shock - September 1, 2022 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Effects of shenfu injection on sublingual microcirculation in septic shock patients: a randomized controlled trial
Conclusions: Shenfu injection provided apparent effects in improving sublingual microcirculatory perfusion in patients with septic shock, and this protection may be related with the inhibition of endothelial dysfunction and vasodilatory effects. (Source: Shock)
Source: Shock - September 1, 2022 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Goodnight, sleep tight, don’t let the microbes bite: a review of sleep and its effects on sepsis and inflammation
Sleep is a restorative biological process that is crucial for health and homeostasis. However, patient sleep is frequently interrupted in the hospital environment, particularly within the intensive care unit. Suboptimal sleep may alter the immune response and make patients more vulnerable to infection and sepsis. In addition, hospitalized patients with sepsis experience altered sleep relative to patients without infectious disease, suggesting a bidirectional interplay. Preclinical studies have generated complementary findings, and together, these studies have expanded our mechanistic understanding. This review article summ...
Source: Shock - September 1, 2022 Category: Emergency Medicine Tags: Review Article Source Type: research
Activation of the mitochondrial antiviral signaling protein (mavs) following liver ischemia/reperfusion and its effect on inflammation and injury
Resuscitation of trauma patients after hemorrhagic shock causes global I/R, which may contribute to organ dysfunction. Oxidative stress resulting from I/R is known to induce signaling pathways leading to the production of inflammatory molecules culminating in organ dysfunction/injury. Our recent work demonstrated that oxidative stress was able to induce activation of the mitochondrial antiviral signaling protein (MAVS), a protein known to be involved in antiviral immunity, in an in vitro model. We therefore hypothesized that the MAVS pathway might be involved in I/R-induced inflammation and injury. The present studies show...
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
The wnk4/spak pathway stimulates alveolar fluid clearance by upregulation of epithelial sodium channel in mice with lipopolysaccharide-induced acute respiratory distress syndrome
With-No lysine Kinases (WNKs) have been newly implicated in alveolar fluid clearance (AFC). Epithelial sodium channels (ENaCs) serve a vital role in AFC. The potential protective effect of WNK4 in acute respiratory distress syndrome (ARDS), mediated by ENaC-associated AFC was investigated in the study. A model of lipopolysaccharide (LPS)-induced ARDS was established in C57BL/6 mice. WNK4, Sterile 20-related proline-alanine-rich kinase (SPAK), small interfering RNA (siRNA)-WNK4 or siRNA-SPAK were transfected into mouse lung or primary alveolar epithelial type II (ATII) cells. AFC, bronchoalveolar lavage fluid and lung histo...
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Mechanism of mir-25-3p carried by extracellular vesicles derived from platelet-rich plasma in il-1β–induced nucleus pulposus cell degeneration via the sox4/cxcr7 axis
Conclusion: miR-25-3p carried by PRP-EVs into NP cells elevated intracellular miR-25-3p expression, which suppressed SOX4 expression and further limited CXCR7 transcription, thus alleviating IL-1β–induced NP cell degeneration. Extracellular vesicles derived from PRP containing miR-25-3p may be a new method for IVD treatment. (Source: Shock)
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Acute and sustained alterations to the bone marrow immune microenvironment following polymicrobial infection
This study will serve as a valuable resource for future work investigating acute and/or long-term sepsis-associated immune cell derangements. (Source: Shock)
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Trauma-derived extracellular vesicles are sufficient to induce endothelial dysfunction and coagulopathy
ABSTRACT—Introduction
Although a number of studies have demonstrated increased release of extracellular vesicles (EVs) and changes in their origin differentials after trauma, the biologic significance of EVs is not well understood. We hypothesized that EVs released after trauma/hemorrhagic shock (HS) contribute to endotheliopathy and coagulopathy. To test this hypothesis, adoptive transfer experiments were performed to determine whether EVs derived from severely injured patients in shock were sufficient to induce endothelial dysfunction and coagulopathy. Methods: Total EVs were enriched from plasma of severely injure...
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research
Longitudinal analysis of transcriptomic subtypes in trauma patients
Conclusions: This study provides a proof of concept that immune status can worsen after admission and highlights the benefit of longitudinally monitoring SG subtypes in trauma patients. (Source: Shock)
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Value of corrected flow time in common carotid artery in predicting volume responsiveness under mechanical ventilation
Objective: The present study aimed to investigate whether corrected flow time (FTc) in common carotid artery could predict volume responsiveness under mechanical ventilation and to further explore whether the sensitivity and specificity would be influenced by positive end-expiratory pressure (PEEP). Methods: The first stage of this study included 80 patients from the general surgery department undergoing laparotomy. After induction of general anesthesia, FTc in the common carotid artery was measured when hemodynamic indicators, such as blood pressure, heart rate, and cardiac output (CO), were stabilized. Then, 7 mg/kg (ide...
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Early differentiation between sepsis and sterile inflammation via urinary gene signatures of metabolic dysregulation
Conclusions: Whole-genome transcriptomic profiling of urinary cells revealed focused probe panels that can function as an early diagnostic tool for differentiating sepsis from sterile SIRS. Functional analysis of differentially expressed genes demonstrated a distinct metabolic dysregulation signature in sepsis. (Source: Shock)
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Subclinical kidney injury is caused by a moderate single inflammatory event
Background: Current means of diagnosis of acute kidney injury (AKI) based on serum creatinine have poor sensitivity and may miss possible therapeutic windows in subclinical kidney injury, especially in septic AKI. Kidney injury molecule-1 (KIM-1) may be a valuable biomarker to improve diagnostic algorithms for AKI. The understanding of septic AKI is still insufficient, and knowledge about KIM-1 kinetics in inflammation is scarce. The aim of this study was to investigate the possible effect of lipopolysaccharide (LPS) on KIM-1 as a marker of structural kidney injury in healthy volunteers. Methods: A single-blinded, placebo-...
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Platelet function in trauma: is current technology in function testing missing the mark in injured patients?
Platelets are subcellular anucleate components of blood primarily responsible for initiating and maintaining hemostasis. After injury to a blood vessel, platelets can be activated via several pathways, resulting in changed shape, adherence to the injury site, aggregation to form a plug, degranulation to initiate activation in other nearby platelets, and acceleration of thrombin formation to convert fibrinogen to fibrin before contracting to strengthen the clot. Platelet function assays use agonists to induce and measure one or more of these processes to identify alterations in platelet function that increase the likelihood...
Source: Shock - July 1, 2022 Category: Emergency Medicine Tags: Review Article Source Type: research
Modulation of LTCC Pathways by a Melusin Mimetic Increases Ventricular Contractility During LPS-Induced Cardiomyopathy
Conclusions:
This study identifies AKT/Melusin as a key pathway for preserving cardiac function following LPS challenge. The cell-permeable mimetic peptide (R7W-MP) represents a putative therapeutic for sepsis-induced cardiomyopathy. (Source: Shock)
Source: Shock - June 1, 2022 Category: Emergency Medicine Tags: Basic Science Aspects (Animal Subjects) Source Type: research
