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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The ultrasonographic evaluation of inferior vena cava (IVC) parameters, particularly the collapsibility index (CI), has been widely used in the assessment of the fluid responsiveness of critically ill patients, but the results are conflicting. In this study, we aimed to investigate the early change in CI after increased intravascular volume (IVV) induced by passive leg raising (PLR). A total of 145 healthy volunteers over 18 years old were enrolled between September and December in 2015. ⋯ In conclusion, IVC-CI measured by ultrasound is useful for the detection of early IVV change induced by 2 min PLR. However, its ability to detect the increased IVV value is influenced by age, BMI, and baseline CI. Moreover, only 50.3% of the subjects had an IVC-CI reduction of more than 10%, making IVC-CI of little value for clinical applications, due to its poor sensitivity.
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The incidence of multiple organ dysfunction syndrome (MODS) has decreased in the last decade by improvement in trauma care. However, it still remains a major cause of morbidity and mortality. This study investigated the current incidence and mortality of MODS in polytrauma patients. ⋯ In this polytrauma population mortality was predominantly caused by brain injury. Even though MODS was still present in severely injured polytrauma patients, its presentation was only early onset, less severe during a shorter time period, and accompanied by lower mortality.
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Autophagy has been found to be involved in myocardial ischemia/reperfusion injury. However, the underlying mechanism and significance of autophagy in reperfusion injury remain unclear. Herein, we evaluated the effects of exogenous calreticulin (CRT) on autophagy in hypoxia/reoxygenation (H/R)-treated human microvascular endothelial cells (MECs). ⋯ Exogenous CRT attenuated H/R-induced human MEC injury by inhibiting autophagy.
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Animal models of endotoxemia are frequently used to understand the pathophysiology of sepsis and test new therapies. However, important differences exist between commonly used experimental models of endotoxemia and clinical sepsis. Animal models of endotoxemia frequently produce hypodynamic shock in contrast to clinical hyperdynamic shock. This difference may exaggerate the importance of hypoperfusion as a causative factor in organ dysfunction. This study sought to develop an ovine model of hyperdynamic endotoxemia and assess if there is evidence of impaired oxidative metabolism in the vital organs. ⋯ An escalating dose endotoxin infusion was successful in producing hyperdynamic shock. There was evidence of impaired oxidative metabolism in the liver suggesting impaired splanchnic perfusion. This may be a modifiable factor in the progression to multiple organ dysfunction and death.
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An overwhelming immune response, particularly from macrophages, plays a critical role in survival and organ damage in sepsis patients. Toll-like receptors (TLRs) are important receptors to recognize the conserved motifs expressed by invading bacteria. The TLRs except TLR3 signal via a MyD88-dependent pathway. ⋯ Moreover, MyD88 KO, but not TRIF KO mice, showed a decreased CD14 expression in the tissue of septic mice, which was associated with a strongly attenuated inflammatory response and increased survival rate. These data suggest that a MyD88-dependent and TRIF-independent pathway of TLR is activated in upregulating CD14 expression under septic conditions. This study deciphers a critical cross-talk between TLRs and CD14.