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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Editorial
Perfluorocarbon Gas Transport: an Overview of Medical History With Yet Unrealized Potentials.
Perfluorocarbon (PFCs) compounds have been a hereto fore under realized pharmaceutical class of intravenous emulsions and respiratory adjuvants researched extensively since the late 1970. This review represents an introduction for a series of more detailed lectures/manuscripts that were part of a combined United States collaborative Federal agency meeting in early February, 2017 at Ft Detrick, MD, focused upon potential technologies in development to fulfill a perceived need: "When blood transfusion is not available." As such, PFCs represent a distinctly different class of pharmaceutical artificial oxygen (and other gas) transporters than are hemoglobin-based oxygen carriers (HBOCs). ⋯ The PFCs should be viewed as pharmaceuticals possessing unique gas solubility and diffusion characteristics such that they may relieve ischemia of tissues with low/flow-no flow states therefore they can enhance tissue salvage while other definitive treatments are being sought. PFCs as short-term enhanced tissue oxygen (and other gas enhancements) delivery vehicles should have varied and potentially game-changing medical potentials.
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Rapid induction of hypothermia early after resuscitation can be an effective strategy against post-cardiac arrest syndrome (PCAS). Preliminary data suggested that continuous renal replacement therapy (CRRT) might be an efficient method to rapidly induce hypothermia. In this study, we investigated the efficacy of cooling induced by CRRT and its effects on the outcomes of PCAS in a porcine model. ⋯ Post-resuscitation myocardial dysfunction, brain injury, and systemic inflammation were significantly improved in the 2 hypothermic groups compared to the normothermia group. However, the improvement was significantly greater in the CRRT group than in the SC group. In conclusion, fast hypothermia was successfully induced by CRRT and significantly alleviated the severity of PCAS in a porcine model.
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The aim of the study was to investigate the role of dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin (DC-SIGN) in intestinal epithelial cells (IECs) in regulating sepsis-induced acute intestinal injury and systemic inflammatory response. ⋯ Sepsis-induced DC-SIGN expression in IECs plays a significant role in regulating acute intestinal injury and systemic inflammatory response. The inhibition of DC-SIGN exhibited protective effects on sepsis-associated organ injury and systemic inflammation.
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Approximately 10 years ago, the development of hemoglobin-based oxygen carriers (HBOCs) was largely stalled after two large phase 3 clinical trials failed to achieve licensure primarily because the safety profile was viewed as unsatisfactory when HBOCs were compared with red cells. Concerns were also raised that HBOCs, as a class, had inherent toxicities. ⋯ Yet, logistical constraints still limit use of blood products in the prehospital setting. As the urgent need for oxygen-carrying capacity for trauma patients for whom red cells are not available is becoming much more apparent, it is imperative that we reexamine the possibility of using HBOCs when red blood cell transfusion is not an option.
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Perfluorocarbon emulsions (PFC) are a class of lipid-coated micelle slurries wherein the active center of the micelle is a completely halogen/fluorine-substituted hydrocarbon capable of dissolving very large quantities of nonpolar gases. Due to their unique enhanced solubility for oxygen (O2) and nitrogen (N2), PFCs have been used in research as enhanced gas transport media for situations wherein the microcirculation is dysfunctional. In the early 1990s a PFC emulsion was approved for human use during coronary artery angioplasty and one is presently in use in Russia as well as other countries. ⋯ Although thrombocytopenia has been reported in response to PFC emulsion formulations, it is not ubiquitous and seems to be less associated with some formulations. As well, in some recent animal studies there is no evidence of platelet white cell adverse interactions. The mechanism for the reported thrombocytopenia is as yet not fully understood, and risk-benefit profiles will have to be carefully studied as contemporary human trials move forward.