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 Phoenix sepsis criteria define sepsis in children with suspected or confirmed infection who have ≥2 in the Phoenix Sepsis Score. The adoption of the Phoenix sepsis criteria eliminated the Systemic Inflammatory Response Syndrome criteria from the definition of pediatric sepsis. The objective of this study is to derive and validate machine learning models predicting in-hospital mortality for children with suspected or confirmed infection or who met the Phoenix sepsis criteria for sepsis and septic shock. ⋯ For children with Phoenix sepsis and Phoenix septic shock, the multivariable logistic regression, light gradient boosting machine, random forest, eXtreme Gradient Boosting, support vector machine, multilayer perceptron, and decision tree models predicting in-hospital mortality had AUPRCs of 0.48-0.65 (95% CI range: 0.42-0.66), 0.50-0.70 (95% CI range: 0.44-0.70), 0.52-0.70 (95% CI range: 0.47-0.71), 0.50-0.70 (95% CI range: 0.44-0.70), 0.49-0.67 (95% CI range: 0.43-0.68), 0.49-0.66 (95% CI range: 0.45-0.67), and 0.30-0.38 (95% CI range: 0.28-0.40) and AUROCs of 0.82-0.88 (95% CI range: 0.82-0.90), 0.84-0.88 (95% CI range: 0.84-0.90), 0.81-0.88 (95% CI range: 0.81-0.90), 0.84-0.88 (95% CI range: 0.83-0.90), 0.82-0.87 (95% CI range: 0.82-0.90), 0.80-0.86 (95% CI range: 0.79-0.89), and 0.76-0.82 (95% CI range: 0.75-0.85), respectively. Conclusion: Among children with Phoenix sepsis admitted to a PICU, the random forest model had the best AUPRC for in-hospital mortality compared to the light gradient boosting machine, eXtreme Gradient Boosting, logistic regression, multilayer perceptron, support vector machine, and decision tree models or a Phoenix Sepsis Score ≥ 2. These findings suggest that machine learning methods to predict in-hospital mortality in children with suspected infection predict mortality in a PICU setting with more accuracy than application of the Phoenix sepsis criteria.
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Background : New strategies are needed to mitigate further tissue injury during traumatic limb ischemia in cases requiring damage control resuscitation (DCR). Little is known about the pathophysiology and injury course in acute limb ischemia (ALI) with DCR in polytraumatized casualties. We therefore investigated the effects of therapeutic limb hypothermia in a swine model of ALI and DCR. ⋯ Mean nerve histology scores did not differ between the 5°C and paired control limbs, or between the mean muscle and nerve histology scores of the 15°C and paired control limbs. Conclusion : Cooling to 15°C significantly reduced local tissue metabolites compared to paired controls, while producing no significant increase in histologic damage, whereas cooling to 5°C increased histologic muscle damage. These results suggest an approach to prevention of ischemic injury through local hypothermia but warrant further functional testing.
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Mice used in biomedical research are typically housed at ambient temperatures (22°C-24°C) below thermoneutrality (26°C-31°C). This chronic cold stress triggers a hypermetabolic response that may limit the utility of mice in modeling hypermetabolism in response to burns. To evaluate the effect of housing temperature on burn-induced hypermetabolism, mice were randomly assigned to receive sham, small, or large scald burns. ⋯ Locomotion was significantly reduced in mice with large burns compared to sham and small burn groups, irrespective of sex or housing temperature ( P < 0.05). Housing at 30°C revealed sexual dimorphism in terms of the impact of burns on body mass and composition, where males with large burns displayed marked cachexia, whereas females did not. Collectively, this study demonstrates a sex-dependent role for housing temperature in influencing energetics and body composition in a rodent model of burn trauma.
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In natural disasters such as earthquakes and landslides, the main problem that wounded survivors are confronted with is crush syndrome (CS). The aim of this study was to explore more convenient and effective early treatment measures for it. In the present study, we investigated the protective effect of fasciotomy combined with different concentration of hypertonic saline flushing with CS rats. ⋯ Among them, alternating flushing with 3%-0.45% saline had the best therapeutic effect on CS. Finally, it can be found that 3%-0.45% saline treatment regimen dramatically raised the survival rate of CS rats. All in all, this study suggests that fasciotomy combined with hypertonic saline flushing is a good therapeutic approach for CS.
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Sepsis results from a dysregulated host immune response to infection and is responsible for ~11 million deaths each year. In the laboratory, many aspects of sepsis can be replicated using a cecal ligation and puncture model, which is considered the most clinically relevant rodent model of sepsis. ⋯ Treatment of mice with 10 μg of a synthetic 68-amino acid peptide derived from an immunomodulatory molecule secreted by a parasitic worm of humans and livestock, F. hepatica , termed F. hepatica helminth defense molecule, potently suppressed the systemic inflammatory profile, protected mice against acute kidney injury, and improved survival between 48 and 72 h after procedure. These results suggest that the anti-inflammatory parasite-derived F. hepatica helminth defense molecule peptide has potential as a biotherapeutic treatment for sepsis.