SHOCK最新文献

{"title":"Lung Ultrasound Evaluation of the Impact of Inspired Oxygen Fraction on Atelectasis During Induction of General Anesthesia in Pediatric Patients: A Randomized Controlled Trial.","authors":"Yin-Qi Tian, Wei Wei, Yu-Qiong Liu, Ying-Ying Xiao, Kai-Jing Liu, Jian-Hui Li, Xue-Mei Peng","doi":"10.1097/SHK.0000000000002793","DOIUrl":"10.1097/SHK.0000000000002793","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the impact of different inspired oxygen fractions (FiO 2 ) on the development of anesthesia-induced atelectasis in pediatric patients aged 1-7 years, utilizing lung ultrasound (LUS) for assessment.</p><p><strong>Methods: </strong>In this prospective, randomized controlled trial, 114 pediatric patients with American Society of Anesthesiologists physical status I-II were randomized to receive either 100% FiO 2 (n = 57) or 50% FiO 2 (n = 57) during anesthesia induction. In the 100% FiO 2 group, the inspired oxygen fraction was reduced to 50% after 10 minutes of mechanical ventilation. LUS assessments were conducted at six time points by evaluators blinded to group allocation. The primary outcome was the incidence of clinically significant atelectasis, defined as one or more lung regions exhibiting an LUS score of 2 or higher.</p><p><strong>Results: </strong>Atelectasis incidence peaked 10 minutes after the initiation of mechanical ventilation and was significantly higher in the 100% FiO 2 group (67%) compared with the 50% FiO 2 group (33%; P < 0.001), representing a 51% relative risk reduction. The highest recorded global LUS score was 34% greater in the 100% FiO 2 group (12.4 ± 3.1 vs. 8.2 ± 2.6; P < 0.001). Atelectasis affecting gravity-dependent lung regions was also significantly more pronounced in the 100% FiO 2 group ( P < 0.05). No hypoxemic events were observed in either group.</p><p><strong>Conclusions: </strong>Administration of 50% FiO 2 during anesthesia induction in pediatric patients significantly decreased the incidence and severity of atelectasis without compromising oxygenation or safety. These findings support the use of a lower inspired oxygen concentration as a potentially optimal strategy for minimizing anesthesia-related pulmonary complications in this population.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1099-1106"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Profiling of Angiogenic, Metabolic, and Immune Checkpoint Biomarkers Predicts Chronic Critical Illness and Long-term Outcomes in Abdominal Sepsis.","authors":"Tianwei Xu, Chao Lin, Haoyang Huang, Yihan Xu, Jingnan Chen, Siyang Han, Yefei Rong, Tiantao Kuang, Dansong Wang","doi":"10.1097/SHK.0000000000002829","DOIUrl":"10.1097/SHK.0000000000002829","url":null,"abstract":"<p><strong>Background: </strong>Many patients who survive abdominal sepsis develop Chronic Critical Illness (CCI), characterized by prolonged intensive care unit stay, ongoing organ dysfunction, and poor 1-year outcomes. Current severity scoring systems, such as Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II, are not effective in identifying patients at high risk for this trajectory, limiting the opportunities for early intervention.</p><p><strong>Methods: </strong>We conducted a prospective longitudinal study of adults diagnosed with abdominal sepsis at a tertiary acute care center. The serum levels of 13 biomarkers were measured on days 1, 4, 7, and 14 after diagnosis. Patients were grouped into two categories: Rapid Recovery (RAP) and CCI. Predictive models were developed by combining clinical data based on the Predisposition, Insult, Response, and Organ dysfunction framework with biomarker trends to assess the evolving host response.</p><p><strong>Results: </strong>Patients with CCI showed poorer clinical outcomes than those with RAP. Among the 252 patients included in the analysis, dynamic profiling revealed significant differences between the RAP and CCI groups. Patients who developed CCI exhibited persistently elevated levels of immunosuppressive biomarkers (soluble programmed death-ligand 1, arginase-1, and transforming growth factor-beta) and inflammatory markers (induced protein-10), along with dysregulation of the angiogenic and metabolic pathways. Multivariate models incorporating Predisposition, Insult, Response, and Organ dysfunction variables showed strong performance in predicting CCI by day 4 (area under the curve [AUC] = 0.899) and poor 1-year outcomes (Zubrod 4/5) by day 7 (AUC = 0.851). The addition of key biomarkers significantly enhanced the predictive accuracy for both CCI (AUC = 0.926) and functional outcomes (AUC = 0.910).</p><p><strong>Conclusions: </strong>Our findings suggest that Persistent Inflammation, Immunosuppression, and Catabolism Syndrome, a maladaptive pathophysiological state, plays a central role in the development of CCI after abdominal sepsis. The combination of serial biomarker data and clinical variables enables earlier and more accurate risk stratification. This approach may support timely and targeted interventions to improve patient survival and long-term recovery.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1114-1126"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147521570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying GADD45A as a Potential R-Loop Regulator in Sepsis Via Machine-Learning and Multi-Omics Analysis.","authors":"Min Chen, Jie-Xiang Kang, Shi-Ling He, Hui-Rong Hu, Hai-Jun Weng, Xiao-Qi Zhang, Pei-Qing Weng","doi":"10.1097/SHK.0000000000002902","DOIUrl":"10.1097/SHK.0000000000002902","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is a life-threatening syndrome characterized by dysregulated immune responses, while the molecular basis of immune dysfunction remains unclear. Increasing evidence suggests that R-loop accumulation and DNA damage may contribute to immune disorders, but their roles in sepsis have not been systematically investigated.</p><p><strong>Methods: </strong>Four Gene Expression Omnibus microarray datasets were integrated after batch-effect correction and normalization. Differential expression analysis and weighted gene co-expression network analysis were performed to identify sepsis-related genes. Overlapping R-loop-related genes (RLRGs) were obtained by intersecting differentially expressed genes, key module genes, and curated RLRGs. Machine learning was then applied to prioritize hub genes and construct an optimal diagnostic model, which was validated in external cohorts. A nomogram, single-cell RNA sequencing analysis, survival analysis, and in vivo / in vitro experiments were further used for validation.</p><p><strong>Results: </strong>Five overlapping RLRGs ( EXOSC4, GADD45A, HMGB2, LDHA , and PRKDC ) were identified, and all were consistently retained by top-performing machine learning models, supporting their robustness. The five-gene nomogram showed good calibration and clinical utility. Single-cell analysis revealed cell-type-specific expression across neutrophils, monocytes, and T cells. Among the five genes, only GADD45A was significantly associated with poor survival. Experimental validation showed that GADD45A was upregulated in a cecal ligation and puncture-induced sepsis mouse model. In HL-60 cells, GADD45A silencing reduced lipopolysaccharide-induced inflammatory cytokine expression, R-loop accumulation, and DNA damage.</p><p><strong>Conclusions: </strong>GADD45A is a promising biomarker for the diagnosis and prognosis of sepsis and may promote disease progression by enhancing R-loop accumulation and DNA damage.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1162-1178"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"miR-340-5P Acts as a Lung-Protective Factor in Sepsis-Induced Acute Lung Injury by Inhibiting Rock1.","authors":"Yuan Zhang, Fangning Liu","doi":"10.1097/SHK.0000000000002911","DOIUrl":"10.1097/SHK.0000000000002911","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to explore the role of miR-340-5p in sepsis-related acute lung injury.</p><p><strong>Methods: </strong>Firstly, receiver operating characteristic curve and binary logistic regression were employed to assess the correlation between the level of miR-340-5p in patients with sepsis and the risk of acute respiratory distress syndrome (ARDS). Acute lung injury was induced in mice through cecal ligation and puncture, and then the number of neutrophils, inflammatory factors, and pulmonary edema were observed. Furthermore, the effects of miR-340-5p on the cell viability, apoptosis, and inflammatory factors of lung epithelial cells induced by lipopolysaccharide were observed through Cell Counting Kit-8, flow cytometry, and ELISA. Moreover, the binding relationship between miR-340-5p and ROCK1 was verified through dual-luciferase reporter assay.</p><p><strong>Results: </strong>miR-340-5p is an important risk factor affecting ARDS. After overexpression of miR-340-5p, the lung injury in cecal ligation and puncture mice was significantly alleviated, as evidenced by the inhibition of inflammatory factors and pulmonary edema. miR-340-5p also has a significant protective effect on lung epithelial cells, manifested as reduced cell apoptosis and decreased inflammatory factors. Moreover, overexpression of ROCK1 weakened the protective effect of miR-340-5p on alveolar epithelial cells.</p><p><strong>Conclusion: </strong>Patients with sepsis who have low expression of miR-340-5p are associated with a higher risk of developing ARDS. During acute lung injury, miR-340-5p exerts a protective effect by inhibiting ROCK1.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1139-1149"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Temperature Modeling Predicts Mortality in Murine Sepsis.","authors":"Zengli Xiao, Luhao Wang, Sandra L Carpenter, Melissa B Gutierrez, Yosuke Hayashi, Priji Prasad Jalaja, Evan Straub, Vanessa K Lee, Zhe Liang, Mandy L Ford, Eileen D Burd, John D Lyons, Sivasubramanium V Bhavani, Craig M Coopersmith","doi":"10.1097/SHK.0000000000002901","DOIUrl":"10.1097/SHK.0000000000002901","url":null,"abstract":"<p><p>Body temperature generally correlates with mortality in mouse sepsis. However, single temperature measurements fail to accurately discriminate whether mice will subsequently live or die following a septic insult, limiting their usefulness as an endpoint in preclinical sepsis studies. Temperature trajectories using serial measurements have been demonstrated to have predictive capacity in septic patients. The purpose of this study was to determine if temperature trajectories could predict subsequent mortality in septic mice. A cohort of 511 C57Bl/6 mice from three different laboratories undergoing survival experiments had serial body temperature measured every 12 hours from baseline to 7 days following the onset of sepsis. To optimize generalizability, the cohort was intentionally heterogeneous, including 6-31-week-old mice with an equal number of females and males undergoing three different models of sepsis with different comorbidities before sepsis, and different genetic variants. A training cohort comprised the first 80% (n = 417) and a validation cohort comprised the final 20% (n = 94). To quantitatively predict mortality risk following sepsis, a Bayesian joint model was developed incorporating longitudinal temperature measurements using data collected at baseline and 12 and 24 hours after the onset of sepsis to predict the probability of death in the subsequent 12-72 hours. Predictive accuracy improved progressively with longer horizons, with area under the curve increasing from 0.864 at 12 hours (predicting 24-36 hour mortality) to 0.932 at 72 hours (predicting 24-96 hour mortality) in the training cohort. Model performance was not improved by incorporating type of sepsis model, age, or sex as covariates. While specificity was >0.92 at all timepoints in the training cohort, it was only 0.796 at both 24 and 36 hours in the validation cohort. Since a specificity <1 means that some mice predicted to die would instead survive, leading to errors in the survival curve, an additional prespecified analysis was independently evaluated to identify irreversible terminal states where no mouse ended up surviving. At 24, 36, and 48 hours, temperature thresholds of 27.0°C, 28.2°C, and 30.2°C identified mice that would subsequently die with a specificity of 1. Temperature trajectories identifying longitudinal hypothermia, therefore, represent a powerful predictor of mortality in a large heterogeneous population of murine sepsis. Whereas a single temperature measurement has limitations in prediction of subsequent mortality except at extreme hypothermia, dynamic Bayesian modeling enables individualized mortality risk estimation as criteria that may be used for humane endpoint determination.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1179-1187"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the Metabolic Profiles and Identifying Early Diagnostic Biomarkers For Sepsis-Associated Acute Kidney Injury Based on Untargeted Metabolomics.","authors":"Dandan Li, Yi Gou, Nazila Haireti, Wenting Jia, Ailikuti Aikepaer, Ziyu Xia, Jianzhong Yang","doi":"10.1097/SHK.0000000000002879","DOIUrl":"10.1097/SHK.0000000000002879","url":null,"abstract":"<p><strong>Background: </strong>Sepsis-associated acute kidney injury (SA-AKI) is a critical condition associated with high morbidity and mortality rates. Elucidating metabolic alterations and identifying early diagnostic biomarkers is essential for timely intervention and precise treatment. The study aimed to characterize the metabolic features of SA-AKI and identify specific biomarkers for its early diagnosis.</p><p><strong>Methods: </strong>Using existing plasma metabolomics data from 20 healthy controls (HC group), 22 sepsis patients with acute kidney injury (AKI, AKI group), and 31 sepsis patients without AKI (N-AKI group), we performed three comparative analyses (N-AKI vs. HC, AKI vs. HC, and AKI vs. N-AKI). This approach identified the core perturbed metabolic pathways and a set of shared differentially expressed metabolites (DEMs). Correlation analysis was performed between the shared DEMs and serum creatinine levels, and those demonstrating a strong correlation (∣ r ∣ > 0.6) were selected as final diagnostic biomarkers.</p><p><strong>Results: </strong>Three pairwise comparative analyses (N-AKI vs. HC, AKI vs. HC, and AKI vs. N-AKI) revealed three core metabolic pathways: ascorbate and aldarate metabolism, glycerophospholipid metabolism, and sphingolipid metabolism. We identified 161 DEMs that were common to all comparison groups. From this shared pool, five DEMs demonstrated a strong correlation with serum creatinine levels (∣ r ∣ > 0.6) and were selected as early diagnostic biomarkers: 3h-indole-3-propanoic acid, α-amino- (3I3PAα), lysophosphatidylcholine (LysoPC) (18:1/0:0), lysophosphatidylcholine (LPC) 18:2, N -methylethanolaminium phosphate, and pseudouridine.</p><p><strong>Conclusions: </strong>By analyzing three distinct clinical groups, this untargeted metabolomics study identified three core metabolic pathways and five potential early diagnostic biomarkers for SA-AKI. These findings provide crucial insights that could facilitate the development of early diagnoses and precise interventions for this condition.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1127-1138"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Machine Learning Models For Sepsis Prediction: An Appraise-Ai Approach.","authors":"Tingrui Wang, Qinqin Li, Zhangyi Wang, Chen Yu, Li Yao, Zihan Zhou, Jiajia Yin, Yan Liu, Yuhan Chen, Xinglin Wei, Zhigang Zhang, Lihua Xia, Jiangyun Ru, Wei Hong","doi":"10.1097/SHK.0000000000002850","DOIUrl":"10.1097/SHK.0000000000002850","url":null,"abstract":"<p><strong>Background: </strong>Sepsis, a leading cause of intensive care unit mortality and high healthcare costs, results from a systemic inflammatory response to infection. Early detection is crucial but challenging. Machine learning (ML) models present a promising solution by analyzing diverse data for real-time predictions.</p><p><strong>Purpose: </strong>To evaluate the impact of ML models on sepsis prediction, assess the methodological and reporting quality of existing research, and report on model accuracy, sensitivity, specificity, and clinical applicability.</p><p><strong>Methods: </strong>The included studies were randomized controlled trials, cohort studies, or nested case-control studies using ML for sepsis prediction. Independent reviewers used the APPRAISE-AI tool to extract and assess data across six domains: clinical relevance, data quality, methodological conduct, result robustness, reporting quality, and reproducibility.</p><p><strong>Results: </strong>The review included 53 papers, mainly retrospective cohort studies from 2020 to 2024. Evaluated with the APPRAISE-artificial intelligence (AI) tool, most studies were of moderate quality. Model area under the curve values ranged from 0.64 to 0.98, with LightGBM and multilayer perceptron models performing best at 0.98. AI models generally outperformed non-AI methods in predicting sepsis.</p><p><strong>Conclusion: </strong>ML models hold promise for accurately predicting sepsis; however, study quality varies, with notable flaws in methodology, robustness, and reproducibility. Future research should enhance data quality, advance algorithms, and perform multicenter prospective studies for validation.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1076-1084"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elucidating the Pathophysiology and Diagnostic Biomarkers of Sepsis-Associated Encephalopathy: A Multiomics Approach.","authors":"Yuechen Zhang, Yun Xie, Zhouxing Zhang, Fuli Gu, Shaosong Xi","doi":"10.1097/SHK.0000000000002899","DOIUrl":"10.1097/SHK.0000000000002899","url":null,"abstract":"<p><p>Sepsis-associated encephalopathy (SAE) is a diffuse neurological injury that results from severe sepsis, and its underlying pathophysiological mechanisms remain largely unknown. This study aimed to elucidate the pathological basis of SAE and identify potential diagnostic biomarkers by integrating analyses of the intestinal microbiome, plasma metabolomics, and circulating microRNAs. We analyzed data from 50 patients, who were divided into SAE or non-SAE groups. The results revealed significant differences in microbial composition between these groups, with a marked decrease in Bacteroides abundance and an increase in Enterococcus abundance in SAE patients. Compared with non-SAE patients, SAE patients presented notable alterations in LysoPC 18:3, linoleic acid, and microRNA PC-3p-535_63045 levels. Multiomics association analysis revealed positive correlations between Enterococcus and LysoPC 18:3, whereas Bacteroides and PC-3p-535_63045 were negatively correlated with linoleic acid. Gene prediction analysis indicated that PC-3p-535_63045 was enriched in PIK3R1, and a Kyoto Encyclopedia of Genes and Genomes pathway analysis underscored the role of the PI3K-Akt signaling pathway. PC-3p-535_63045 exhibited strong diagnostic performance, with an area under the curve of 0.850 (specificity of 0.867, sensitivity of 0.800). Comparative ROC analysis revealed no significant difference between PC-3p-535_63045 alone and the multiomics model. The integrated results from multiomics least absolute shrinkage and selection operator (LASSO) regression and random forest analyses suggest that PC-3p-535_63045 is a promising biomarker for the diagnosis of SAE. In conclusion, our multiomics analysis revealed a significant association among Bacteroides , PC-3p-535_63045, and linoleic acid, which suggests that the PI3K-Akt signaling pathway may play an important role in SAE progression. These findings deepen our understanding of the pathophysiological mechanisms underlying SAE and may ultimately enhance diagnostic and predictive capabilities for this condition.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1085-1098"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148332395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Meta-Analytic Perspective on Echocardiographic Signs of Long-Term Cardiac Dysfunction After Burns, Sepsis, and Trauma.","authors":"Tobias Niederegger, Emre Karakas, Thomas Schaschinger, Jule Brandt, Leonard Knoedler, Bhagvat Maheta, Anya Ramsamooj, Christoph Kauf, Patrick Most, Julia Ritterhoff, Adriana C Panayi, Gabriel Hundeshagen","doi":"10.1097/SHK.0000000000002857","DOIUrl":"10.1097/SHK.0000000000002857","url":null,"abstract":"<p><p>Severe burns, major trauma, and sepsis cause systemic inflammation and metabolic stress, often leading to acute cardiac dysfunction. How myocardial sequelae evolve over time remains unclear. This meta-analysis evaluated whether consistent echocardiographic patterns of long-term dysfunction exist across these conditions and whether current data permit longitudinal comparison. A systematic search of PubMed, EMBASE, Web of Science, Cochrane, and Google Scholar (inception to July 2025) followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies reported echocardiographic outcomes ≥72 h after injury or sepsis onset. Data on demographics, illness severity, and echocardiographic parameters were extracted. Subgroup and meta-analyses compared conditions and follow-up periods. In this meta-analysis of 47 studies (n = 3,117; trauma: 282, sepsis: 959, burns: 1,876) left ventricular ejection fraction (LVEF), heart rate (HR), and E/A ratio were the most common echocardiographic parameters. LVEF was reported in n = 35 (73%) studies: n = 9 (19%) trauma, n = 17 (35%) sepsis, and n = 9 (19%) burn studies, limited by substantial heterogeneity in patient severity and follow-up timing. The same applies to HR, reported in n = 11 (23%) studies [n = 3 (6.3%) trauma, n = 5 (10%) sepsis, and n = 3 (6.3%) burn studies], and E/A ratio reported in n = 14 (29%) studies [n = 4 (8.3%) trauma, n = 6 (13%) sepsis, and n = 4 (8.3%) burn studies]. Marked heterogeneity in study design, patient selection, and echocardiographic assessment limited direct comparability across conditions. Despite signals of long-term alteration, analysis was restricted by short follow-up durations (median 9 days for sepsis, 10 for trauma, and 447 for burns) and scarce longitudinal data, particularly in trauma and sepsis cohorts. This meta-analysis identifies long-term myocardial dysfunction after burns, sepsis, and trauma, most pronounced in burn survivors. Marked heterogeneity and limited longitudinal data hinder trajectory assessment. Prospective studies with standardized echocardiography are needed to define postcritical illness cardiac phenotypes.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1057-1075"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disruption of Mitochondria-Associated Er Membranes: A Novel Mechanism for High-Salt Diet-Exacerbated Hemorrhagic Shock-Induced Lymphatic Dysfunction.","authors":"Hong-Li Han, Yang Liu, Yu-Yao Hao, Hai-Ning Zheng, Li-Min Zhang, Hui-Bo Du, Xiao-Qi Yue, Min Gao, Run Li, Yu-Ping Zhang, Chun-Yu Niu, Zi-Gang Zhao","doi":"10.1097/SHK.0000000000002913","DOIUrl":"10.1097/SHK.0000000000002913","url":null,"abstract":"<p><strong>Background: </strong>Although a high-salt diet (HSD) impairs cardiovascular function, its impact on the prognosis of hemorrhagic shock (HS) has not been elucidated. Impaired mesenteric lymphatic contractility post-HS contributes to an unfavorable prognosis. Since mitochondria-associated endoplasmic reticulum membranes (MAMs) regulate calcium-dependent contraction, we hypothesized that HSD exacerbates HS-induced lymphatic dysfunction by damaging MAM integrity in lymphatic smooth muscle cells (LSMCs).</p><p><strong>Methods: </strong>Male Wistar rats were fed either a normal diet (ND) or HSD containing 8% NaCl for 8 weeks. A conscious rat model of fixed-pressure HS (40 mmHg for 90 minutes) with resuscitation was established. The rats were divided into four groups: ND + sham shock, ND + HS, HSD + sham shock, and HSD + HS. Additional HS groups were treated with either the inositol 1,4,5-trisphosphate receptor type 1 (IP3R1) inhibitor 2-aminoethyl diphenylborinate (2-APB) (HSD + HS + 2-APB) or the IP3R1 activator cadmium chloride (CdCl 2 ) (ND + HS + CdCl 2 ). Survival time and in vivo and ex vivo mesenteric lymphatic contractility were assessed. The ultrastructure and protein expression of MAM were analyzed.</p><p><strong>Results: </strong>HSD significantly increased blood pressure but not body weight and markedly reduced survival time after HS. HSD alone impaired mesenteric lymphatic contractility and exacerbated HS-induced contractile and reactive dysfunction. HS and HSD independently shortened the contact distance and increased the contact coefficient of MAM in LSMCs, with combined exposure producing the most severe disruption. These structural alterations were accompanied by increased protein expression of IP3R1 and voltage‑dependent anion channel 1. Importantly, therapeutic inhibition of MAM with 2-APB in HSD + HS rats improved survival, restored lymphatic contractility, and normalized MAM structure and protein expression. Conversely, pharmacological aggravation of MAM with CdCl 2 in ND + HS rats worsened survival and lymphatic function, paralleling MAM disruption.</p><p><strong>Conclusion: </strong>Chronic HSD is a risk factor for poor outcomes after HS, worsening both survival and mesenteric lymphatic function by disrupting MAM integrity in LSMCs. Targeting MAM, exemplified by IP3R1 inhibition, represents a novel therapeutic strategy for mitigating shock-induced lymphatic dysfunction, particularly in salt-sensitive populations.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"1150-1161"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}