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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Sepsis is a life-threatening condition with high mortality rates. Early detection and treatment are critical to improving outcomes. Our primary objective was to develop artificial intelligence capable of predicting sepsis earlier using a minimal set of streaming physiological data in real time. ⋯ This study demonstrates that salient physiomarkers derived from continuous bedside monitoring are temporally and differentially expressed in septic patients. Using this information, minimalistic artificial intelligence models can be developed to predict sepsis earlier in critically ill patients.
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Hematopoietic stem/progenitor cells (HSPC) have both unique and common responses following hemorrhage, injury, and sepsis. HSPCs from different lineages have a distinctive response to these "stress" signals. ⋯ In this review, we summarize the pathophysiology of emergency myelopoiesis and the role of myeloid-derived suppressor cells, impaired erythropoiesis, as well as the mobilization of HSPCs from the bone marrow. Finally, we discuss potential therapeutic options to optimize HSPC function after severe trauma or infection.
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Review
Calpain Activation and Organ Failure in Sepsis: Molecular Insights and Therapeutic Perspectives.
Sepsis is a severe systemic response to infection; its ensuing organ failure commonly portends an unfavorable prognosis. Despite the fact that sepsis has been studied for decades, the molecular mechanisms underlying sepsis-induced organ dysfunction remain elusive and more complex than previously thought, and effective therapies are extremely limited. Calpain is a type of calcium-dependent cysteine protease that includes dozens of isoforms. ⋯ Further, there is an accumulating body of evidence supporting the beneficial effect of calpain inhibition or regulation on multiple organ failure in sepsis. Better understanding of the underlying molecular mechanisms is helpful in the development of calpain/calpastatin-targeted therapeutic strategies to protect against sepsis-induced organ injury. The aim of this review is to summarize the recent literature and evidence surrounding the role of the calpain/calpastatin system in the process of organ dysfunction caused by sepsis-including regulation of cell death, modulation of inflammatory response, and disruption of critical proteins-to provide guidance for future research and therapy development.
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Physical trauma is one of the leading causes of mortality worldwide. Early post-traumatic upregulation of the pro-inflammatory immune response to traumatic injury is paralleled by an anti-inflammatory reaction. A prevalence of each has been associated with the development of secondary complications, including nosocomial infections, acute lung injury, acute respiratory distress syndrome, sepsis, and death after trauma. ⋯ Altered antigen presentation on neutrophils has been shown to possess biomarker features predicting both outcome and vulnerability to infectious complications in severely injured patients. Dysregulated activation of neutrophils following trauma affects their functions including phagocytizing capacity, production of reactive oxygen species, formation of neutrophil extracellular traps, which all together have been associated with the development of secondary complications. Thus, we highlight neutrophils and their functions as potential future targets for optimizing post-traumatic treatment strategies, which potentially may improve patient outcomes.
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Multicenter Study
Predicting the Need for Vasopressors in the Intensive Care Unit Using an Attention Based Deep Learning Model.
Previous models on prediction of shock mostly focused on septic shock and often required laboratory results in their models. The purpose of this study was to use deep learning approaches to predict vasopressor requirement for critically ill patients within 24 h of intensive care unit (ICU) admission using only vital signs. ⋯ We used Bi-LSTM to develop a model to predict the need for vasopressor for critically ill patients for the first 24 h of ICU admission. With attention mechanism, respiratory rate, mean arterial pressure, and heart rate were identified as key sequential determinants of vasopressor requirements.