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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Objective: The aim of this study was to evaluate the reliability and feasibility of pulse Doppler measurements of peak velocity respiratory variability of mitral and tricuspid valve rings during systole as new dynamic indicators of fluid responsiveness in patients with septic shock. Methods: Transthoracic echocardiography (TTE) was performed to measure the respiratory variability of aortic velocity-time integral (∆VTI), respiratory variability of tricuspid annulus systolic peak velocity (∆RVS), respiratory variability of mitral annulus systolic peak velocity (∆LVS), and other related indicators. Fluid responsiveness was defined as a 10% increase in cardiac output after fluid expansion, assessed by TTE. ⋯ The sensitivity (Se) values were 1.00, 0.73, 0.81, and 0.83, whereas the specificity (Sp) values were 0.84, 0.91, 0.76, and 0.67, respectively. The optimal thresholds were 0.128, 0.129, 0.130, and 13.9 mm, respectively. Conclusion: Tissue Doppler ultrasound evaluation of respiratory variability of mitral and tricuspid annular peak systolic velocity could be a feasible and reliable method for the simple assessment of fluid responsiveness in patients with septic shock.
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Sepsis after a major hepatectomy is a critical problem. In septic shock, the inflammatory mediator, nitric oxide (NO), is overproduced in hepatocytes and macrophages. The natural antisense (AS) transcripts, non-coding RNAs, are transcribed from a gene that encodes inducible nitric oxide synthase (iNOS). iNOS AS transcripts interact with and stabilize iNOS mRNAs. ⋯ The combined treatment decreased mRNA expression of the inflammatory and pro-apoptotic genes while increasing that of the anti-apoptotic gene. Furthermore, the combined treatment reduced the number of myeloperoxidase-positive cells. These results suggested that the combination of SO1 and rTM has therapeutic potential for sepsis.
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Background : Accurate prediction of fluid responsiveness is important for postoperative critically ill elderly patients. The objective of this study was to evaluate the predictive values of peak velocity variation (ΔVpeak) and passive leg raising (PLR)-induced changes in ΔVpeak (ΔVpeak PLR ) of the left ventricular outflow tract to predict fluid responsiveness in postoperative critically ill elderly patients. Method : Seventy-two postoperative elderly patients with acute circulatory failure who were mechanically ventilated with sinus rhythm were enrolled in our study. ⋯ Results : Thirty-two patients were fluid responders. The area under the receiver operating characteristic curves (AUC) for baseline PPV and ΔVpeak to predict fluid responsiveness was 0.768 (95% confidence interval [CI], 0.653-0.859; P < 0.001) and 0.899 (95% CI, 0.805-0.958; P < 0.001) with gray zones of 7.63% to 12.66% that included 41 patients (56.9%) and 9.92% to 13.46% that included 28 patients (38.9%). ΔPPV PLR predicted fluid responsiveness with an AUC of 0.909 (95% CI, 0.818-0.964; P < 0.001), and the gray zone was 1.49% to 2.93% and included 20 patients (27.8%). ΔVpeak PLR predicted fluid responsiveness with an AUC of 0.944 (95% CI, 0.863-0.984; P < 0.001), and the gray zone was 1.48% to 2.46% and included six patients (8.3%). Conclusions : Passive leg raising-induced changes in peak velocity variation of blood flow in the left ventricular outflow tract accurately predicted fluid responsiveness with a small gray zone in postoperative critically ill elderly patients.
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Multicenter Study
Clinical Characteristics and Predictors of Mortality Differ Between Pulmonary and Abdominal Sepsis.
Background: Pulmonary sepsis and abdominal sepsis have pathophysiologically distinct phenotypes. This study aimed to compare their clinical characteristics and predictors of mortality. Methods: In this multicenter retrospective trial, 1,359 adult patients who fulfilled the Sepsis-3 criteria were enrolled and classified into the pulmonary sepsis or abdominal sepsis groups. ⋯ Conclusions: Patients with pulmonary sepsis had higher 28-day mortality than patients with abdominal sepsis. The study identified sepsis subgroup-specific mortality predictors. Shock had a larger effect on mortality in patients with abdominal sepsis than in those with pulmonary sepsis.
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Background: Considerable data have shown that circular RNAs (circRNAs) mediate the pathogenesis of chronic obstructive pulmonary disease (COPD). The study aims to analyze the function and mechanism of circ_0026466 in COPD. Methods: Human bronchial epithelial cells (16HBE) were treated with cigarette smoke extract (CSE) to establish a COPD cell model. ⋯ Additionally, TRAF6, a target gene of miR-153-3p, regulated CSE-induced 16HBE cell injury by combining with miR-153-3p. Importantly, circ_0026466 activated NF-κB pathway by targeting the miR-153-3p/TRAF6 axis. Conclusion: Circ_0026466 absence protected against CSE-triggered 16HBE cell injury by activating the miR-153-3p/TRAF6/NF-κB pathway, providing a potential therapeutic target for COPD.