SHOCK最新文献

{"title":"INHIBITING ALOX15 PREVENTS MYOCARDIAL INJURY INDUCED BY EXERTIONAL HEAT STROKE.","authors":"Yonggang Zhao, Wei Tuo, Xiaomin Wu, Ruoyu Gou, Ling Hou, Juan Liu, Guanghua Li","doi":"10.1097/SHK.0000000000002625","DOIUrl":"10.1097/SHK.0000000000002625","url":null,"abstract":"<p><strong>Abstract: </strong>As the frequency of global heat waves keeps rising, exertional heat stroke (EHS) is becoming an increasingly prevalent health concern, which causes myocardial injury. However, the mechanisms underlying myocardial injury following EHS are still unclear. In this study, we established an EHS mouse model in which mice were exercised by running on a treadmill in a high-humidity and high-temperature environment and investigated the time points of myocardial injury within 24 h after EHS. We found that mice had cardiac dysfunction and myocardial injury after EHS and that the damage was the most serious at 6 h of recovery. Next, changes in cardiac ferroptosis and lipid peroxidation levels after EHS were evaluated, and ferroptosis was found to be the main form of myocardial cell death, and inhibition of ferroptosis by liproxstatin-1 ameliorated EHS-induced myocardial injury. In addition, we found that arachidonic acid 15-lipoxygenase-1 (Alox15) is a critical molecule of ferroptosis in cardiomyocytes through targeted metabolomics experiments. Based on in vivo and in vitro studies, inhibiting Alox15 conspicuously ameliorates EHS-induced cardiac dysfunction and myocardial injury. Mechanistically, EHS-induced excessive activation of transcription factor p53 upregulated Alox15 expression via inducing SAT1 (spermidine/spermine N1-acetyltransferase 1) expression and reduced the expression of Gpx4 (glutathione peroxidase 4) to initiate ferroptosis. This study reveals the key role of ferroptosis in EHS-induced myocardial injury and confirms that Alox15-mediated ferroptosis of cardiomyocytes is the core pathological mechanism. This finding provides a new molecular target and theoretical basis for the prevention and treatment strategies of EHS-related myocardial injury.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"272-282"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144161582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE S-SHAPED ASSOCIATION BETWEEN MNUTRIC SCORE AND DELIRIUM IN SEPTIC PATIENTS IN THE INTENSIVE CARE UNIT: A RETROSPECTIVE COHORT STUDY USING THE MIMIC-IV DATABASE.","authors":"Jianmin Qu, Congcong Lv, Xue Zhang, Xiaoxu Ren, Yingying Li, Chunya Wu","doi":"10.1097/SHK.0000000000002609","DOIUrl":"10.1097/SHK.0000000000002609","url":null,"abstract":"<p><strong>Abstract: </strong>Background: The association between the modified Nutrition Risk in the Critically Ill (mNUTRIC) score and delirium in septic patients during their intensive care unit stay has not been studied. Hence, the objective of this study was to explore the correlation between the mNUTRIC score and the incidence of delirium events in these patients. Methods: We performed a retrospective analysis on critically ill patients diagnosed with sepsis using the MIMIC-IV 2.2 database. The mNUTRIC score was obtained within the initial 24 h of admission to the intensive care unit (ICU). The relationship between the mNUTRIC score and delirium occurring during ICU admission was examined using restricted cubic splines (RCS) and multivariable logistic regression. Additionally, propensity score matching, interaction analysis, and subgroup analysis were conducted to ensure the consistency of these study results. Results: A total of 8,438 participants were included, with mean age of 66.9 years, among them, 4,901 (58.1%) were male. The incidence of delirium was 24.6% (2,073/8,438). Compared to the low-risk group (mNUTRIC score <5), the incidence of delirium was markedly elevated in the high-risk group (mNUTRIC score ≥5), at 33.8% (95% CI, 32.1%-35.5%, P < 0.001). Specifically, the incidence of delirium in the low-risk group was 19.8% (95% CI, 18.4%-20.5%). In the multivariable regression model, after controlling for all covariates, for each unit increase in mNUTRIC score, the incidence of delirium increased by 19% (adjusted OR = 1.19, 95% CI, 1.10-1.28, P < 0.001). Our analysis revealed an S-shaped association between mNUTRIC score and delirium incidence, suggesting a complex relationship between nutritional risk and delirium, with the rate of increase in delirium incidence slowing at very high mNUTRIC scores. Compared to the low-risk group, the incidence of delirium was elevated in the high-risk group (adjusted OR = 1.42, 95% CI, 1.22-1.66, P < 0.001). Subgroup analysis and propensity score matching consistently indicated a notable correlation between mNUTRIC score and the incidence of ICU delirium. Conclusions: Among ICU patients with sepsis, higher mNUTRIC score are associated with an increased risk of delirium incidence.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"161-168"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995859","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":"EFFECT OF CHEST COMPRESSION RELEASE VELOCITY ON CEREBRAL PERFUSION PRESSURE IN PORCINE CARDIAC ARREST MODEL.","authors":"Sang Hun Kim, Ki Hong Kim, Yoonjic Kim, Yoon Ha Joo, Hyun Jeong Kang, Chae Yeong An, Young Sun Ro, Ki Jeong Hong, Kyoung Jun Song, Sang Do Shin","doi":"10.1097/SHK.0000000000002604","DOIUrl":"10.1097/SHK.0000000000002604","url":null,"abstract":"<p><strong>Abstract: </strong>Objective: High-quality cardiopulmonary resuscitation is crucial for the survival of patients experiencing cardiac arrest, but the effect of the chest compression release velocity (CCRV) has not been well studied. The aim of this study was to evaluate the effect of the CCRV on cerebral perfusion pressure (CePP) in an experimental study of porcine cardiac arrest. Methods: A ventricular fibrillation (VF)-induced experimental model of cardiac arrest was established in 16 pigs. The study subjects were randomized into a high-CCRV (400 mm/s) group and a low-CCRV (300 mm/s) group. Six minutes after VF induction, all the study subjects underwent 4 min of chest compression followed by 20 min of advanced cardiovascular life support, including the i.v. administration of epinephrine. Defibrillation was provided after 24 minutes of resuscitation. The primary outcome was CePP, which was calculated as the difference between the MAP and intracranial pressure. The Wilcoxon rank sum test was used to compare two groups in each resuscitation phase, and a linear mixed model was used to analyze the interaction effect of group and resuscitation phase. Results: Each of the eight subjects in the high-CCRV group and low-CCRV group were finally analyzed. The CEPP was highest at 10 to 12 min after VF in the low-CCRV group, with a mean (95% confidence interval) of 14.9 (0.2-29.7) mm Hg, and at 12 to 14 min after VF in the high-CCRV group, with a mean (95% confidence interval) of 18.2 (3.8-32.6) mm Hg. Compared with the low-CCRV group, the high-CCRV group had a greater CePP throughout the entire resuscitation phase, but there was no significant difference in the linear mixed model. Conclusion: In the porcine model of VF-induced cardiac arrest, there was a significant difference in CePP between the low-CCRV and high-CCRV groups. Further investigations should be performed to develop the resuscitation protocol to optimize brain perfusion.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"213-217"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046763","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":"LOW-VOLUME RESUSCITATION WITH VS -101, A NEXT-GENERATION PEGYLATED HEMOGLOBIN-BASED OXYGEN CARRIER, IMPROVES SURVIVAL AFTER SEVERE HEMORRHAGIC SHOCK IN RATS.","authors":"William H Nugent, Kim D Vandegriff, Ashok Malavalli, Forest R Sheppard, Bjorn K Song","doi":"10.1097/SHK.0000000000002570","DOIUrl":"10.1097/SHK.0000000000002570","url":null,"abstract":"<p><strong>Abstract: </strong>Over 30% of trauma-related deaths are from massive hemorrhage with 90% of potentially preventable battlefield deaths occurring prehospital. Immediate resuscitation with whole blood is ideal but often limited to hospital and medical treatment facilities. Shelf-stable hemoglobin-based oxygen carriers (HBOCs) are designed to relieve the hypoperfusion and hypoxia of shock during the critical pre-hospital period. A new PEGylated human HBOC product, VS -101, with high oxygen affinity and hyperoncotic pressure, has been designed for hypovolemic resuscitation protocols at the point of injury. Thirty-six Sprague-Dawley rats underwent a severe, pressure-guided 45% total blood volume (T BV ) hemorrhage. Shocked animals were randomly assigned to receive 20% T BV Lactated Ringers' (LRS), plasma, blood, or VS -101. Cardiovascular parameters, arterial blood gases, 8-h survival, arteriolar diameters, and oxygenation of the spinotrapezius microvasculature were measured. Even compared with whole blood, VS -101 was the only group with survivors (67%) at the end of the 8-h observation period. Mean survival times were 49, 95, 197, and 426 min for LRS, plasma, blood, and VS -101 ( P < 0.05 vs all), respectively. VS -101 produced the highest spinotrapezius interstitial oxygenation and recovery of MAP with no evidence of hypertension or arteriolar vasoconstriction. Hypovolemic resuscitation with VS -101 was effective in stabilizing hemorrhagic shock in a simulated prehospital setting, which was associated with its combination of high oncotic pressure and oxygen carrying constituent. The lack of arteriolar vasoconstriction and hypertension suggests VS -101 is poised to pass critical safety and efficacy checkpoints for treatment of severe hemorrhage.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"198-204"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A DELPHI CONSENSUS ALGORITHM FOR MODERN REBOA PROGRAMS: EMPLOYING A TITRATABLE CATHETER AND PARTIAL AORTIC OCCLUSION TO ADVANCE THE PROCEDURE.","authors":"Jonathan Nguyen, M Chance Spalding, Courtney H Meyer, Andrew Beckett, Alison Smith, Rishi Kundi, Shariq S Raza, Michal Radomski, Brad Dennis, K Mukherjee, Eric Akrish, Jessica Raley, Chuck Fox, Ernest E Moore","doi":"10.1097/SHK.0000000000002622","DOIUrl":"10.1097/SHK.0000000000002622","url":null,"abstract":"<p><strong>Background: </strong>Technical advances in REBOA catheters have made partial aortic occlusion a more common hemorrhage mitigation strategy in trauma resuscitation. This technique balances hemorrhage control and distal ischemic concerns; however, there are limited data to guide best practices. We aim to provide a pragmatic guideline, based on expert consensus, on the use of pREBOA and partial aortic occlusion for modern REBOA programs.</p><p><strong>Methods: </strong>A Delphi study was conducted based on 12 experts experienced in pREBOA and partial aortic occlusion. An initial questionnaire was distributed and results anonymously collated into consensus statements. These statements were then anonymously distributed and refined to reach 80% consensus.</p><p><strong>Results: </strong>After the initial questionnaire and two rounds of polling, a total of 15 consensus statements were developed, all reaching >80% agreement. These statements focused around REBOA program development, early common femoral arterial access, REBOA placement, management, and occlusion/reperfusion strategies.</p><p><strong>Conclusion: </strong>This Delphi study provides guidance on how to leverage pREBOA and partial aortic occlusion as a resuscitative adjunct. It addresses thresholds for common femoral arterial access, triggers for occlusion, complete versus partial aortic occlusion, computed tomography imaging, pREBOA with thoracic injuries, proximal and distal blood pressure goals, updated ischemia times, strategies for reperfusion, and sheath management. This algorithm provides a framework for the development of REBOA programs that encompasses new REBOA technologies with partial aortic occlusion and guides the user from patient presentation to sheath removal in a modern era.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"176-186"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044966","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":"N-ACETYLCYSTEINE REDUCES VON WILLEBRAND FACTOR MULTIMER SIZE AND IMPROVES RENAL MICROVASCULAR BLOOD FLOW IN RATS AFTER SEVERE TRAUMA.","authors":"Alexander St John, Xu Wang, Junmei Chen, Jennie Le, Kristyn Ringgold, Jenna Klug, Nathan White, Susan Stern, Dominic Chung, Jonathan R Lindner, José López","doi":"10.1097/SHK.0000000000002611","DOIUrl":"10.1097/SHK.0000000000002611","url":null,"abstract":"<p><strong>Abstract: </strong>Background: Severe injury induces systemic microvascular impairment that reduces microvascular blood flow (MBF), even after resuscitation to normal blood pressure. These changes are associated with organ dysfunction and death, but the underlying causes and potential therapeutic approaches to address them remain unclear. Two possible contributors are hyperadhesive von Willebrand factor (VWF) secretion from an activated endothelium and oxidative modification of hemostatic proteins. N-acetylcysteine has been shown to address both of these processes and increase MBF in other disease states with similar features. Methods: Anesthetized, male Sprague-Dawley rats were subjected to a standardized polytrauma and pressure-targeted catheter hemorrhage. They then received either no treatment (control) or a single bolus of N-acetylcysteince (NAC), followed by autologous whole blood transfusion. Renal MBF was measured using contrast-enhanced ultrasound at prespecified time points. VWF multimer gels and other laboratory studies were performed. Histologic analysis of vascular thrombi was also performed on uninjured tissue from rats undergoing either this trauma protocol or a sham procedure. Results: NAC increased MBF at 3 h after resuscitation. This was accompanied by a decrease in VWF multimer size that was not seen in the control group. Histologic data showed an overall increase in systemic thrombus burden associated with trauma. Conclusions: NAC improves renal MBF, possibly by reducing VWF multimer size and reducing microthrombus burden. This is significant both mechanistically and therapeutically. It sheds light on the possible pathways involved in causing microvascular obstruction after trauma and identifies possible treatment approaches that could be developed further. Ultimately, targeting these pathways could move us closer to resuscitation strategies that optimize vital organ MBF.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":"236-244"},"PeriodicalIF":2.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut-Liver Axis Metabolites and Sepsis: Insights From Mendelian Randomization.","authors":"Hao Pan, Jijie Qi, Xinyi Li, Yongpeng Xie, Xiaomin Li, Yanli Wang","doi":"10.1097/SHK.0000000000002667","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002667","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis is a life-threatening syndrome characterized by a dysregulated host response to infection. Alterations in gut-liver axis metabolites, particularly bile acids, are commonly observed in sepsis. However, the associations between bile acids and sepsis risk or outcomes remain unclear. This study aimed to investigate the potential associations between genetically predicted levels of gut-liver axis metabolites-primarily bile acids-and sepsis risk and prognosis using bidirectional two-sample Mendelian randomization (MR), multivariable MR, and two-step mediation MR analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Genetic instruments for circulating bile acids were obtained from genome-wide association studies (GWAS) curated in the OpenGWAS database. Summary-level data for sepsis and 28-day mortality were derived from the UK Biobank. We conducted bidirectional two-sample MR to assess the associations between nine bile acids and both sepsis incidence and short-term prognosis. In addition, two-step mediation MR was performed to evaluate whether the associations between specific bile acids and sepsis risk might be mediated through intermediate traits, such as liver function markers. The statistical significance of mediation effects was further tested using both the Sobel test and bootstrap resampling methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Univariable MR analyses suggested that higher genetically predicted levels of taurodeoxycholate acid (TDCA) were associated with a lower risk of sepsis (OR = 0.797, 95%CI: 0.668-0.952, p = 0.012). In contrast, glycocholate acid (GCA) (OR = 1.964, 95%CI: 1.220-3.164, p = 0.005) and taurochenodeoxycholate acid (TCDCA) (OR = 1.998, 95%CI: 1.085-3.678, p = 0.026) were positively associated with an increased 28-day mortality risk among sepsis patients. Results from the two-step mediation MR analysis indicated that alanine aminotransferase (ALT) may act as a mediator in the association between ursodeoxycholate acid (UDCA) and sepsis risk. The statistical significance of this mediation effect was further supported by both the Sobel test and bootstrap resampling analysis, suggesting that UDCA may be associated with a reduced risk of sepsis, at least in part, through its influence on circulating ALT levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This MR study provides genetic evidence consistent with potential relationships between specific bile acids and sepsis risk and prognosis. Taurodeoxycholate acid (TDCA) may be associated with a reduced risk of sepsis, whereas glycocholate acid (GCA) and taurochenodeoxycholate acid (TCDCA) might relate to worse outcomes. Moreover, among these liver enzymes, ALT exhibited the most significant mediation effect, suggesting that it may play a crucial role in the process by which UDCA influences the occurrence of sepsis. These findings suggest a possible role of bile acids in the pathophysiology of sepsis and may inform future mechanistic studies or therapeutic consid","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732956","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":"Serum Myoglobin after Cardiac Surgery Predicts Postoperative Cardiogenic Shock Requiring Mechanical Circulatory Support within 14 Days.","authors":"Xiao-Jun Liu, Jia-Sheng Liu, Yu-Peng Jian, Chen Wang, Jian Ma, Yue-Ming Peng, Zhuo-Shan He, Yan Li, Zhi-Jun Ou, Jing-Song Ou","doi":"10.1097/SHK.0000000000002675","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002675","url":null,"abstract":"<p><strong>Background: </strong>Cardiogenic shock requiring mechanical circulatory support is a life-threatening complication of cardiac surgery with cardiopulmonary bypass (CPB). This study aimed to determine the role of myoglobin in predicting the occurrence of postoperative cardiogenic shock requiring mechanical circulatory support within 14 days.</p><p><strong>Methods: </strong>A total of 4610 patients undergoing cardiac surgery with CPB were included and analyzed. Mechanical circulatory support included the form of intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO). Cox regression with a natural cubic spline was used to assess the relationship between postoperative myoglobin levels and the 14-day risk of mechanical circulatory support for cardiogenic shock.</p><p><strong>Results: </strong>Of 4610 patients, 279 (6.1%) required mechanical circulatory support within 14 days after surgery. The 14-day risk of using mechanical circulatory support increased with the postoperative peak myoglobin levels. Among the patients who underwent aortic surgery, the threshold myoglobin level measured within 1 day after surgery, associated with an adjusted hazard ratio greater than 1.00 for using mechanical circulatory support within 14 days, was 1568 ng/mL (95% CI, 195 - 6040). Among the patients who underwent non-aortic surgery, the corresponding threshold myoglobin level was 419 ng/mL (95% CI, 180 - 452).</p><p><strong>Conclusions: </strong>Postoperative myoglobin levels are closely related to the 14-day risk of using mechanical circulatory support after cardiac surgery. When postoperative myoglobin exceeds certain thresholds, the 14-day risk of using mechanical circulatory support after surgery starts to increase with the myoglobin level. Myoglobin has potential value in predicting postoperative cardiogenic shock requiring mechanical circulatory support within 14 days after cardiac surgery.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144744622","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":"Continuous antithrombin III infusion in a clinically relevant sepsis model.","authors":"Naoki Hayase, Rohit R Chari, Alef A C Dos Santos, Yoshitaka Naito, Xuzhen Hu, Peter S T Yuen, Robert A Star","doi":"10.1097/SHK.0000000000002648","DOIUrl":"10.1097/SHK.0000000000002648","url":null,"abstract":"<p><strong>Background: </strong>Bolus antithrombin-III (AT) improved sepsis/organ dysfunction and survival in lipopolysaccharide/monomicrobial infusion pretreatment animal models; however, AT failed in clinical trials. Because insults and drug administration schedules differed between pre-clinical and clinical settings, we re-examined AT using a clinically relevant polymicrobial insult (cecal ligation and puncture, CLP) and a new method to continuously infuse AT after animals became ill.</p><p><strong>Methods: </strong>Mice were catheterized with saline-filled osmotic minipumps. During CLP surgery we inserted AT- or saline-containing minipumps. We created and validated a ~ 6 h delay between sepsis induction and treatment. We compared delayed, continuous AT infusion with a conventional bolus AT injection using survival studies and 48 h studies.</p><p><strong>Results: </strong>6 h delayed, continuous AT infusion significantly improved 7d survival vs saline infusion (65% vs 29%, n = 21, p = 0.018) and vs a single injection of AT (65% vs. 19%, n = 21, p = 0.003). Delayed, continuous AT attenuated liver but not kidney or lung injury. Vascular leakage and inflammatory cytokines were suppressed only in liver. The highest accumulation of bacteria and thrombin at 48 h was in liver. AT did not change organ bacterial counts.</p><p><strong>Conclusions: </strong>Delayed, continuous AT infusion improved 7d survival after CLP compared to single bolus AT injection or continuous vehicle. Liver may be critical in abdominal sepsis because of bacterial accumulation and subsequent thrombin generation. AT may be protective due to attenuation of thrombin-induced vascular leakage, inflammation, and liver injury during CLP sepsis. Because other organs were unprotected, AT may be combined with drugs protecting different organs.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643351","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":"Risk Factors for Postoperative Lower Extremity Deep Venous Thrombosis Following Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis.","authors":"Min-Ling Mo, Ya-Juan Zhang, Da-Hong Zhai, Xiao-Shan Li, Ying Zhu, Gu-Qing Zeng","doi":"10.1097/SHK.0000000000002676","DOIUrl":"https://doi.org/10.1097/SHK.0000000000002676","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to systematically evaluate the risk factors associated with the development of postoperative lower extremity deep venous thrombosis (LEDVT) in patients with severe traumatic brain injury (sTBI).</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comprehensive searches of Chinese and English databases, including PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang, were conducted from inception to December 12, 2024. Two researchers independently screened articles and extracted relevant data. Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality criteria. Meta-analyses were performed using RevMan 5.3, applying a random-effects model to combine effect sizes, with subsequent sensitivity analyses and assessments for publication bias. The review was registered in PROSPERO (CRD42024629624).</p><p><strong>Results: </strong>A total of 13 studies (n = 777,327) were included, comprising 8 case-control studies, 2 cohort studies, and 3 cross-sectional studies. Eleven significant risk factors for postoperative LEDVT were identified: advanced age (odds ratio [OR] = 1.12, 95% confidence interval [CI]: 1.10-1.14), use of dehydrant (OR = 2.04, 95% CI: 1.38-3.04), mechanical ventilation (OR = 1.01, 95% CI: 1.01-1.02), elevated D-dimer level (OR = 1.19, 95% CI: 1.11-1.27), polytrauma (OR = 1.63, 95% CI: 1.29-2.03), hypertension (OR = 1.11, 95% CI: 1.07-1.15), surgical duration (OR = 1.60, 95% CI: 1.06-2.42), elevated body mass index (OR = 1.30, 95% CI: 1.16-1.45), deep venous catheterization (OR = 1.36, 95% CI: 1.15-1.60), length of hospital stay (OR = 1.36, 95% CI: 1.18-1.56), and blood transfusion (OR = 3.56, 95% CI: 1.91-6.63), with all p values <0.05. No statistically significant associations were observed for Glasgow Coma Scale score (OR = 1.12, 95% CI: 0.98-1.28) or diabetes mellitus (OR = 1.02, 95% CI: 0.97-1.07).</p><p><strong>Conclusions: </strong>Eleven variables were identified as significant risk factors for postoperative LEDVT among patients with sTBI. These findings underscore the importance of implementing individualized preventive strategies for patients identified as high risk.</p>","PeriodicalId":21667,"journal":{"name":"SHOCK","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144744621","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}