Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Observational Study
CT-proAVP is Not a Good Predictor of Vasopressor Need in Septic Shock.
Septic shock features a high hospital mortality. Improving our ability to risk stratify these patients at admission may help better define management strategies and design studies. The primary objective of this study was to determine if patients dead or with sustained vasopressor need at day 7 had a relative arginine vasopressin (AVP) deficiency as compared with vasopressor-free patients at day 7. Another objective was to explore if plasma CT-proAVP (C terminal part of preprovasopressin) measured within 24 h of sepsis onset could predict patient severity. ⋯ Patients with septic shock and sustained need of vasopressors do not seem to present a relative AVP deficiency. In sepsis, the subgroup of patients that may benefit from AVP supplementation still needs to be identified. Our study further confirms previous data on the ability of the CT-proAVP to predict patient severity in severe sepsis and septic shock.
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We sought to examine the association between the clinical outcomes and the early, dynamic, systemic acute inflammatory response in the setting of major bone/soft tissue injury. ⋯ Our results suggest that severe extremity/soft tissue injury can drive a differential inflammation program including multiple chemokines that affect systemic IL-6 and IL-10, in a manner associated with worse clinical outcomes as compared to mild/moderate soft tissue injury.
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Systemic inflammation is associated with an excessive production of nitric oxide (NO), which interferes with a number of metabolic pathways, including mitochondrial ATP synthesis. ⋯ Supported by EU-ESF and NSRF-THALES.
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Persistent lymphopenia several days after admission is associated with increased mortality in septic and severely injured patients. We hypothesised that severe abnormalities of the lymphocyte count in the early stages of critical illness are associated with poor outcome in emergency general surgical (EGS) patients. ⋯ : Early profound lymphopenia is a marker of illness severity in critically unwell EGS patients and is associated with increased mortality. Further investigation of early lymphocyte dysfunction in critically ill patients may lead to novel therapeutic interventions.
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Low-level light therapy (LLLT) is clinically used to attenuate inflammation and improve tissue repair processes. We aimed to evaluate the effects of red LED light on inflammatory response in a whole blood in vitro model as well as in isolated granulocytes. ⋯ Our data suggest that the beneficial effects do not depend on the direct impact on leukocytes and their secretion of pro-inflammatory mediators. Also, our data disprove the hypothesis that LLLT can render some pro-inflammatory mediators harmless. Thus, more research studies are needed to understand the molecular mechanisms of LLLT and to standardize the clinical dosing and delivery protocols for light therapy to ensure the maximum efficacy and safety of photo-biomodulation.