The Journal of surgical research
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High mobility group box 1 (HMGB1) is a critical proinflammatory factor that is closely related to mortality in sepsis patients. Dexmedetomidine has been proven to reduce the mortality rate from endotoxin shock and attenuate endotoxin-induced acute lung injury. These effects result from reduced secretion of many proinflammatory mediators, although it is not clear whether dexmedetomidine affects the secretion of HMGB1. In this study, we explored the effect of dexmedetomidine on the expression and secretion of HMGB1 from lipopolysaccharide (LPS)-activated macrophages. ⋯ Our study demonstrates that dexmedetomidine inhibits the translocation of HMGB1 from the nucleus to the cytoplasm and the expression of HMGB1 mRNA at clinically relevant dosages. The mechanism responsible for these effects may be through the NF-κB signaling pathway and the α2-adrenergic receptors.
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Therapeutic hypothermia has been proposed to protect organs in some diseases. However, the effect of therapeutic hypothermia on liver injury in sepsis is unknown. The aim of this study was to evaluate the effects of therapeutic hypothermia on liver injury in sepsis. ⋯ Therapeutic hypothermia attenuated liver injury in a polymicrobial sepsis model of rats by enhancing the Akt signaling pathway and decreasing apoptosis.
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Mechanical ventilation is a life-saving therapy for acute respiratory distress syndrome (ARDS). However, unphysiological lung stress (transpulmonary pressure) and strain (the ratio between inflated volume and functional residual capacity) can induce lung injury. Unfortunately, both stress and strain are not measured directly because of technical limitations but predicted from airway plateau pressure (Pplat) and tidal volume (Vt). Recently, some literatures indicated that Pplat and Vt cannot be good surrogates without distinguishing pulmonary ARDS patients (ARDSp) from extrapulmonary ARDS patients. Analyzing them together might distort the truth. Thus, we established animal models of ARDSp to explore whether lung stress and strain can be surrogated precisely by Pplat and Vt. ⋯ Pplat is an adequate surrogate for lung stress, but Vt cannot represent lung strain sufficiently.
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This study tested the hypothesis that blockade of the pH-regulatory protein, Na+/H+ exchanger (NHE1) during prolonged hemorrhagic shock can protect against whole-body ischemia-reperfusion injury, resulting in improved neurological outcomes. ⋯ In this study, NHE1 inhibition with BIIB513 improved vital organ blood flow, prevented the development of metabolic acidosis during prolonged hypovolemia, and facilitated the hemodynamic response to fluid resuscitation, resulting in increased survival and normal neurological outcomes.
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We assessed the short-term outcomes and predictors of 30-d mortality in patients requiring temporary, peripheral extracorporeal membrane oxygenation (ECMO) for postcardiotomy cardiac failure. ⋯ ECMO therapy provides a valuable therapeutic strategy for postcardiotomy myocardial failure but is still limited by high complication rates with fewer than 30% of patients discharged from the hospital. Patient age appears to be an essential preoperative predictor for mortality, and the blood lactate level is a relevant marker for the assessment of efficient ECMO support.