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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Targeted regional optimization (TRO) describes partial resuscitative endovascular balloon occlusion of the aorta strategy that allows for controlled distal perfusion to balance hemostasis and tissue perfusion. This study characterized hemodynamics at specific targeted distal flow rates in a swine model of uncontrolled hemorrhage to determine if precise TRO by volume was possible. ⋯ This study demonstrated technical feasibility of TRO as a strategy to improve outcomes after prolonged periods of aortic occlusion and resuscitation in the setting of ongoing solid organ hemorrhage. A dose-dependent ischemic end-organ injury occurs beginning with partial aortic occlusion that progresses through the critical care phase, with exaggerated effect on renal function.
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We investigated the association between vitamin D deficiency and neurologic outcomes after cardiopulmonary resuscitation. ⋯ The prevalence of vitamin D deficiency in patients with cardiac arrest was 44% and was associated with poor neurological outcomes at 3 months.
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The pathophysiology of sepsis-associated acute kidney injury (S-AKI) is not well elucidated. Platelets have been reported to play a critical role in the pathogenesis of AKI, but the true mechanism remains unknown. Herein, we established a mouse model of S-AKI by cecal ligation and puncture (CLP). ⋯ The results indicated that platelet TTR can cause reactive oxygen species production and apoptosis in HK2 cells. Further research found that platelet TTR can also result in increased levels of mRNA and protein for protein kinase B (AKT), phosphatidylinositol 3-kinase (PI3K), and extracellular regulated protein kinase (ERK), as analyzed by real-time quantitative polymerase chain reaction (RT-qPCR) and western blotting. In conclusion, platelet-derived TTR may be one kind of DAMPs that plays an important role in the development of S-AKI.
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Septic acute kidney injury (AKI) is a common condition in ICU with poor outcomes. Septic AKI patients have a progressively decreased urine output and increased serum creatinine. However, urine volume and serum creatinine showed poor sensitivity to early diagnosis of septic AKI. Searching for potential biomarkers to early detect AKI is crucial in day-to-day clinical practice. Macrophage migration inhibitory factor (MIF), primarily released by renal tubular epithelial cells, vascular endothelial cells, and immune cells, was found to be closely associated with the inflammatory response in sepsis. MIF may be used as a biomarker of septic AKI indicating aggravation of systemic inflammatory response. ⋯ Serum MIF might be a biomarker for predicting the occurrence, development, and outcomes of septic AKI. This conclusion will need to be confirmed by more robust investigations in the future.
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Sepsis-associated encephalopathy (SAE) often manifests in severe diffuse cerebral dysfunction due to an aberrant systemic immune response to infection. The underlying pathophysiology of SAE is not entirely understood but is likely a multifactorial process that involves disruption in cell death mechanism. Ferroptosis is a novel form of programmed cell death characterized by iron accumulation and lipid peroxidation, leading to inflammatory cascade and glutamate release. ⋯ Combined with an observed reduction in calcium transporter PLCG and PLCB activation, these processes ultimately protected the integrities of synapses and neurons during SAE. Fer-1 treatment also rescued sepsis-induced nuclear autophagy and improved the behaviors of tail suspension test and novel object recognition test in septic mice. Conclusively, our results suggested that inhibition of ferroptosis could attenuate glutamate excitotoxicity and SAE outcomes.