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[PMID]:29465593
[Au] Autor:Lou X; Lu G; Zhao M; Jin P
[Ad] Endereço:Emergency Department.
[Ti] Título:Preoperative fluid management in traumatic shock: A retrospective study for identifying optimal therapy of fluid resuscitation for aged patients.
[So] Source:Medicine (Baltimore);97(8):e9966, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Fluid resuscitation was used on aged patients with traumatic shock in their early postoperative recovery. The present study aimed to assess whether different fluid resuscitation strategies had an influence on aged patients with traumatic shock.A total of 219 patients with traumatic shock were recruited retrospectively. Lactated Ringer and hydroxyethyl starch solution were transfused for fluid resuscitation before definite hemorrhagic surgery. Subjects were divided into 3 groups: group A: 72 patients were given aggressive fluid infusion at 20 to 30 mL/min to restore normal mean arterial pressure (MAP) of 65 to 75 mm Hg. Group B: 72 patients were slowly given restrictive hypotensive fluid infusion at 4 to 5 mL/min to maintain MAP of 50 to 65 mm Hg. Group C: 75 patients were given personalized infusion to achieve MAP of 75 to 85 mm Hg. Preoperative infusion volume, preoperative MAP, optimal initial points for surgery, postoperative shock time and mortality rates at 6 and 24 hours after surgery were determined.No significant difference in clinical characteristics was found among the 3 groups. Amount of preoperative infusion was considerably lower in the restrictive group (P < .01, compared with group A). A significant difference in preoperative infusion volume was found between the personalized and other 2 groups (P < .01, compared with groups A and B). Patients in the personalized resuscitation group achieved a higher preoperative MAP (P < .01 compared with Group B; P < .05, compared with group A) and required less prepared time for surgery (P < .01 compared with groups A and B). In addition, a lower mortality rate at 6 and 24 hours after operation was observed in the subjects with personalized therapy (P < .05, compared with group B).Personalized management of fluid resuscitation in traumatized aged patients with appropriate volume and speed of fluid transfusion, suggesting increased survival rate and less prepared time for surgery.
[Mh] Termos MeSH primário: Hidratação/métodos
Cuidados Pré-Operatórios/métodos
Ressuscitação/métodos
Choque Traumático/terapia
[Mh] Termos MeSH secundário: Idoso
Pressão Arterial
Feminino
Seres Humanos
Derivados de Hidroxietil Amido/administração & dosagem
Soluções Isotônicas/administração & dosagem
Masculino
Período Pré-Operatório
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hydroxyethyl Starch Derivatives); 0 (Isotonic Solutions); 8022-63-7 (Ringer's lactate)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009966


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[PMID]:28930961
[Au] Autor:Black GE; Sokol KK; Moe DM; Simmons JD; Muscat D; Pastukh V; Capley G; Gorodnya O; Ruchko M; Roth MB; Gillespie M; Martin MJ
[Ad] Endereço:From the Department of Surgery (G.E.B., K.K.S., D.M.M., M.J.M.), Madigan Army Medical Center, Joint Base Lewis-McChord, Washington; Department of Surgery (J.S.), University of South Alabama, Mobile, Alabama; Department of Pharmacology (D.M., V.P., G.C., O.G., M.R., M.G.), University of South Alabama, Mobile, Alabama; Basic Sciences Division (M.B.R.), Fred Hutchinson Cancer Research Center, Seattle, Washington; and Trauma and Acute Care Surgery Service (M.J.M.), Legacy Emanuel Medical Center, Portland, Oregon.
[Ti] Título:Impact of a novel phosphoinositol-3 kinase inhibitor in preventing mitochondrial DNA damage and damage-associated molecular pattern accumulation: Results from the Biochronicity Project.
[So] Source:J Trauma Acute Care Surg;83(4):683-689, 2017 Oct.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Despite improvements in the management of severely injured patients, development of multiple organ dysfunction syndrome (MODS) remains a morbid complication of traumatic shock. One of the key attributes of MODS is a profound bioenergetics crisis, for which the mediators and mechanisms are poorly understood. We hypothesized that metabolic uncoupling using an experimental phosphoinositol-3 kinase (PI3-K) inhibitor, LY294002 (LY), may prevent mitochondrial abnormalities that lead to the generation of mitochondrial DNA (mtDNA) damage and the release of mtDNA damage-associated molecular patterns (DAMPs). METHODS: Sixteen swine were studied using LY, a nonselective PI3-K inhibitor. Animals were assigned to trauma only (TO, n = 3), LY drug only (LYO, n = 3), and experimental (n = 10), trauma + drug (LY + T) groups. Both trauma groups underwent laparotomy, 35% hemorrhage, severe ischemia-reperfusion injury, and protocolized resuscitation. A battery of hemodynamic, laboratory, histological, and bioenergetics parameters were monitored. Mitochondrial DNA damage was determined in lung, liver, and kidney using Southern blot analyses, whereas plasma mtDNA DAMP analysis used polymerase chain reaction amplification of a 200-bp sequence of the mtDNA D-loop region. RESULTS: Relative to control animals, H + I/R (hemorrhage and ischemia/reperfusion) produced severe, time-dependent decrements in hepatic, renal, cardiovascular, and pulmonary function accompanied by severe acidosis and lactate accumulation indicative of bioenergetics insufficiency. The H-I/R animals displayed prominent oxidative mtDNA damage in all organs studied, with the most prominent damage in the liver. Mitochondrial DNA damage was accompanied by accumulation of mtDNA DAMPs in plasma. Pretreatment of H + I/R animals with LY resulted in profound metabolic suppression, with approximately 50% decreases in O2 consumption and CO2 production. In addition, it prevented organ and bioenergetics dysfunction and was associated with a significant decrease in plasma mtDNA DAMPs to the levels of control animals. CONCLUSIONS: These findings show that H + I/R injury in anesthetized swine is accompanied by MODS and by significant mitochondrial bioenergetics dysfunction, including oxidative mtDNA damage and accumulation in plasma of mtDNA DAMPs. Suppression of these changes with the PI3-K inhibitor LY indicates that pharmacologically induced metabolic uncoupling may comprise a new pharmacologic strategy to prevent mtDNA damage and DAMP release and prevent or treat trauma-related MODS. LEVEL OF EVIDENCE: Therapeutic study, level III.
[Mh] Termos MeSH primário: Cromonas/uso terapêutico
Dano ao DNA
DNA Mitocondrial
Inibidores Enzimáticos/uso terapêutico
Morfolinas/uso terapêutico
Insuficiência de Múltiplos Órgãos/prevenção & controle
Choque Traumático/terapia
[Mh] Termos MeSH secundário: Animais
Modelos Animais de Doenças
Metabolismo Energético
Insuficiência de Múltiplos Órgãos/etiologia
Choque Traumático/complicações
Suínos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Chromones); 0 (DNA, Mitochondrial); 0 (Enzyme Inhibitors); 0 (Morpholines); 31M2U1DVID (2-(4-morpholinyl)-8-phenyl-4H-1-benzopyran-4-one)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170921
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001593


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[PMID]:28930955
[Au] Autor:Johnson MC; Alarhayem A; Convertino V; Carter R; Chung K; Stewart R; Myers J; Dent D; Liao L; Cestero R; Nicholson S; Muir M; Schwaca M; Wampler D; DeRosa M; Eastridge BJ
[Ad] Endereço:From the University of Texas Health Science Center at San Antonio (M.J., A.A., R.S., J.M., D.D., L.L., R.C., S.N., M.M., M.S., D.W., M.D., B.E.); and US Army Institute of Surgical Research (V.C., R.C., K.C.), San Antonio, Texas.
[Ti] Título:Comparison of compensatory reserve and arterial lactate as markers of shock and resuscitation.
[So] Source:J Trauma Acute Care Surg;83(4):603-608, 2017 Oct.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: During traumatic hemorrhage, the ability to identify shock and intervene before decompensation is paramount to survival. Lactate is extremely sensitive to shock, and its clearance has been demonstrated a useful gauge of shock and resuscitation status. Though lactate can be measured in the field, logistical constraints render it impractical in certain environments. The compensatory reserve represents a new clinical measurement reflecting the remaining capacity to compensate for hypoperfusion. We hypothesized the compensatory reserve index (CRI) would be an effective surrogate marker of shock and resuscitation compared to lactate. METHODS: The CRI device was placed on consecutive patients meeting trauma center activation criteria and remained on the patient until discharge, admission, or transport to operating suite. All subjects had a lactate level measured as part of their routine admission metabolic analysis. Time-corresponding CRI and lactate values were matched in regards to initial and subsequent lactate levels. Mean time from lactate sample collection to data availability in the electronic medical record was calculated. Predictive capacity of CRI and lactate in predicting hemorrhage was determined by receiver-operator characteristic curve analysis. Correlation analysis was performed to determine if any association existed between changing CRI and lactate values. RESULTS: Receiver-operator characteristic (ROC) curves were generated and area under the curve was 0.8052 and 0.8246 for CRI and lactate, respectively. There was no significant difference in each parameter's ability to predict hemorrhage (p = 0.8015). The mean duration from lactate sample collection to clinical availability was 44 minutes whereas CRI values were available immediately. Analysis of the concomitant change in serial CRI and lactate levels revealed a Spearman's correlation coefficient of -0.73 (p < 0.01). CONCLUSION: CRI performed with equivalent predictive capacity to lactate with respect to identifying initial perfusion status associated with hemorrhage and subsequent resuscitation. LEVEL OF EVIDENCE: Diagnostic, Level II.
[Mh] Termos MeSH primário: Ácido Láctico/sangue
Ressuscitação
Choque Traumático/sangue
Choque Traumático/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Biomarcadores/sangue
Volume Sanguíneo
Feminino
Seres Humanos
Masculino
Valor Preditivo dos Testes
Estudos Prospectivos
Curva ROC
Choque Traumático/terapia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Biomarkers); 33X04XA5AT (Lactic Acid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170921
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001595


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[PMID]:28601315
[Au] Autor:Hwabejire JO; Nembhard CE; Oyetunji TA; Seyoum T; Abiodun MP; Siram SM; Cornwell EE; Greene WR
[Ad] Endereço:Department of Surgery, Howard University College of Medicine and Howard University Hospital, Washington, District of Columbia.
[Ti] Título:Age-related mortality in blunt traumatic hemorrhagic shock: the killers and the life savers.
[So] Source:J Surg Res;213:199-206, 2017 Jun 01.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There are sparse data on the association between age and mortality in hemorrhagic shock (HS). We examined this association in this study. MATERIALS AND METHODS: The Glue Grant database was analyzed. Patients aged ≥16 y with blunt traumatic HS were stratified into eight age groups (16-24, 25-34, 35-44, 45-54, 55-64, 65-74, 75-84, and ≥85 y) to identify the mortality inflection point. Subsequently, patients were restratified into young age (16-44 y), middle age (45-64 y), and elderly (≥65 y). Multivariate analysis was used to determine predictors of mortality by group. RESULTS: A total of 1976 patients were included, with mortality of 16%. Mortality by initial age group is as follows: 16-24 (13.0%), 25-34 (11.9%), 35-44 (11.9%), 45-54 (15.6%), 55-64 (15.7%), 65-74 (20.3%), 75-84 (38.2%), and ≥85 y (51.6%), delineating 65 y as the mortality inflection point. Overall, 55% were young, 30% middle age, and 15% elderly. Predictors of mortality in the young include multiple-organ dysfunction score (MODS; odds ratio [OR]: 1.93, confidence interval [CI]: 1.62-2.30), emergency room lactate (OR: 1.14, CI: 1.02-1.27), injury severity score (OR: 1.06, CI: 1.03-1.09), and cardiac arrest (OR: 10.60, CI: 3.05-36.86). Predictors of mortality in the middle age include MODS (OR: 1.38, CI: 1.24-1.53), cardiac arrest (OR: 12.24, CI: 5.38-27.81), craniotomy (OR: 5.62, CI: 1.93-16.37), and thoracotomy (OR: 2.76, CI: 1.28-5.98). In the elderly, predictors of mortality were age (OR: 1.07, CI: 1.02-1.13), MODS (OR: 1.47, CI: 1.26-1.72), laparotomy (OR: 2.04, CI: 1.02-4.08), and cardiac arrest (OR: 11.61, CI: 4.35-30.98). Open fixation of nonfemoral fractures was protective against mortality in all age groups. CONCLUSIONS: In blunt HS, mortality parallels increasing age, with the inflection point at 65 y. MODS and cardiac arrest uniformly predict mortality across all age groups. Craniotomy and thoracotomy are associated with mortality in the middle age, whereas laparotomy is associated with mortality in the elderly.
[Mh] Termos MeSH primário: Choque Hemorrágico/mortalidade
Choque Traumático/mortalidade
Ferimentos não Penetrantes/mortalidade
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Feminino
Indicadores Básicos de Saúde
Seres Humanos
Masculino
Meia-Idade
Análise Multivariada
Prognóstico
Estudos Retrospectivos
Fatores de Risco
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170612
[St] Status:MEDLINE


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[PMID]:28253806
[Au] Autor:Neuhaus V; Simmen HP
[Ad] Endereço:1 Klinik für Unfallchirurgie, Universitätsspital Zürich.
[Ti] Título:Vom Schockraum-Management bis zur definitiven Versorgung in der Unfallchirurgie..
[So] Source:Praxis (Bern 1994);106(5):249-253, 2017.
[Is] ISSN:1661-8157
[Cp] País de publicação:Switzerland
[La] Idioma:ger
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência
Traumatismo Múltiplo/diagnóstico
Traumatismo Múltiplo/fisiopatologia
Choque Traumático/fisiopatologia
[Mh] Termos MeSH secundário: Algoritmos
Serviços Médicos de Emergência/organização & administração
Seres Humanos
Comunicação Interdisciplinar
Colaboração Intersetorial
Traumatismo Múltiplo/mortalidade
Traumatismo Múltiplo/terapia
Procedimentos Ortopédicos
Choque Traumático/diagnóstico
Choque Traumático/mortalidade
Choque Traumático/terapia
Taxa de Sobrevida
Suíça
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170629
[Lr] Data última revisão:
170629
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170304
[St] Status:MEDLINE
[do] DOI:10.1024/1661-8157/a002611


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[PMID]:27805993
[Au] Autor:Sokol KK; Black GE; Willey SB; Kniery K; Marko ST; Eckert MJ; Martin MJ
[Ad] Endereço:From the Department of Surgery (K.K.S., G.E.B., S.B.W., K.K., S.T.M., M.J.E., M.J.M.), Madigan Army Medical Center, Tacoma, Washington; and Trauma and Acute Care Surgery Service (M.J.M.), Legacy Emanuel Medical Center, Portland, Oregon.
[Ti] Título:There's an app for that: A handheld smartphone-based infrared imaging device to assess adequacy and level of aortic occlusion during REBOA.
[So] Source:J Trauma Acute Care Surg;82(1):102-108, 2017 Jan.
[Is] ISSN:2163-0763
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Advances in thermal imaging devices have made them an appealing noninvasive point-of-care imaging adjunct in the trauma setting. We sought to assess whether a smartphone-based infrared imaging device (SBIR) could determine presence and location of aortic occlusion in a swine model. We hypothesized that various levels of aortic occlusion would transmit significantly different heat signatures at various anatomical points. METHODS: Six swine (35-50 kg) underwent sequential zone 1 (Z1) aortic cross clamping as well as zone 3 (Z3) aortic balloon occlusion (resuscitative endovascular balloon occlusion of the aorta [REBOA]). SBIR images and readings (FLIR One) were taken at five anatomic points (axilla [A], subcostal [S], umbilical [U], inguinal [I], medial malleolar [M]) and were used to determine significant thermal trends 5 minutes to 10 minutes after Z1 and Z3 occlusion. Significant (p ≤ 0.05) thermal ratio patterns were identified and compared among groups, and images were reviewed for obvious qualitative differences at the various levels of occlusion. RESULTS: Body temperatures were similar during control (CON), Z1 occlusion, and Z3 occlusion, ranging from 94.0 °F to 100.9 °F (p = 0.126). No significant temperature differences were found among A, S, U, I, M points prior to and after aortic occlusions. Among the anatomical 2-point ratios evaluated, A/M and S/M ratios were the best predictors of aortic occlusion, whether at Z1 (8.2 °F, p < 0.01; 10.9 °F, p < 0.01) or Z3 (7.3 °F, p < 0.01; 8.4 °F, p < 0.01), respectively. The best predictor of Z1 versus Z3 level of occlusion was the S/I ratio (5.2 °F, p < 0.05 vs. 3.4 °F, p = 0.27). SBIR generated qualitatively different thermal signatures among groups. CONCLUSION: SBIR was capable of detecting thermal trends during Z1 and Z3 aortic occlusion by using an anatomical 2-point thermal ratio. There were also easily recognized qualitative differences between control and occlusion images that would allow immediate determination of adequate occlusion of the aorta. SBIR represents a potential inexpensive and accurate tool for assessing perfusion, adequate REBOA placement, and even the aortic level of occlusion.
[Mh] Termos MeSH primário: Aorta
Oclusão com Balão/métodos
Diagnóstico por Imagem/instrumentação
Procedimentos Endovasculares/métodos
Aplicativos Móveis
Sistemas Automatizados de Assistência Junto ao Leito
Ressuscitação/métodos
Choque Hemorrágico/terapia
Choque Traumático/terapia
Smartphone
[Mh] Termos MeSH secundário: Animais
Raios Infravermelhos
Suínos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170707
[Lr] Data última revisão:
170707
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161103
[St] Status:MEDLINE
[do] DOI:10.1097/TA.0000000000001264


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[PMID]:27717564
[Au] Autor:Linnaus ME; Notrica DM; Langlais CS; St Peter SD; Leys CM; Ostlie DJ; Maxson RT; Ponsky T; Tuggle DW; Eubanks JW; Bhatia A; Alder AC; Greenwell C; Garcia NM; Lawson KA; Motghare P; Letton RW
[Ad] Endereço:Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA.
[Ti] Título:Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study.
[So] Source:J Pediatr Surg;52(2):340-344, 2017 Feb.
[Is] ISSN:1531-5037
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity. METHODS: A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1.22, >1.0, and >0.9 in the emergency department were used for 4-6, 7-12 and 13-16year-olds, respectively. Patients with ISS ≤15 were excluded to conform to the original paper. Discrimination outcomes were compared between SIPA and shock index (SI). RESULTS: Of 1008 patients, 386 met inclusion. SI was elevated in 321, and SIPA elevated in 282. The percentage of patients with elevated index (SI or SIPA) and blood transfusion within 24 hours (30% vs 34%), BLSI grade ≥3 requiring transfusion (28% vs 32%), operative intervention (14% vs 16%) and ICU admission (64% vs 67%) was higher in the SIPA group. CONCLUSION: SIPA was validated in this multi-institutional prospective study and identified a higher percentage of children requiring additional resources than SI in BLSI patients. SIPA may be useful for determining necessary resources for injured patients with BLSI. LEVEL OF EVIDENCE: Level II prognosis.
[Mh] Termos MeSH primário: Indicadores Básicos de Saúde
Fígado/lesões
Choque Traumático/diagnóstico
Baço/lesões
Ferimentos não Penetrantes/complicações
[Mh] Termos MeSH secundário: Adolescente
Transfusão de Sangue
Criança
Pré-Escolar
Serviço Hospitalar de Emergência
Feminino
Hospitalização
Seres Humanos
Escala de Gravidade do Ferimento
Masculino
Prognóstico
Estudos Prospectivos
Estudos Retrospectivos
Choque Traumático/etiologia
Choque Traumático/terapia
Ferimentos não Penetrantes/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY; VALIDATION STUDIES
[Em] Mês de entrada:1702
[Cu] Atualização por classe:170202
[Lr] Data última revisão:
170202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161009
[St] Status:MEDLINE


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[PMID]:27712876
[Au] Autor:Zhang Y; Zhang J; Xu T; Wu W; Huang FF; Yu WQ; Zhang SY; Liang TB
[Ad] Endereço:Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, Zhejiang, China.
[Ti] Título:Allicin ameliorates intraintestinal bacterial translocation after trauma/hemorrhagic shock in rats: The role of mesenteric lymph node dendritic cell.
[So] Source:Surgery;161(2):546-555, 2017 Feb.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Intestinal dendritic cells play important roles in regulating the function of the intestinal immune barrier and the intestinal bacterial translocation. In this study, we aim to investigate the effects of allicin on the function of mesenteric lymph node-dendritic cells after trauma/hemorrhagic shock. METHODS: One hundred and eight-four Sprague-Dawley rats were randomly assigned into a sham group (n = 46), sham + allicin group (n = 46), trauma/hemorrhagic shock group (n = 46), and trauma/hemorrhagic shock + allicin group (n = 46). Studies were performed on an in vivo model of spontaneously breathing rats with induced trauma/hemorrhagic shock. Allicin was diluted in resuscitation fluid and was administered through the right jugular vein. Flow cytometry was used to determine the expression of CD80, CD86, and major histocompatibility complex II (MHC II) on the surface of mesenteric lymph node-dendritic cells, as well as apoptosis. Intraintestinal bacterial translocation was monitored by using bioluminescent citrobacter. Intestinal permeability tests were conducted by using both FITC-Dextran and Ussing-Chember assay. RESULT: CD80 and MHC-II expression levels were downregulated in the trauma/hemorrhagic shock group compared with the sham and sham + allicin groups; however, the expression was upregulated after allicin treatment. Also, allicin could ameliorate the trauma/hemorrhagic shock-induced increase in early apoptosis of mesenteric lymph node-dendritic cells. A significant increase was observed in the permeability of the intestinal barrier after severe traumatic shock, along with an obvious intraintestinal bacterial translocation to mesenteric lymph node. No difference was noticed in the bacterial translocation in mesenteric lymph node in the trauma/hemorrhagic shock group compared with trauma/hemorrhagic shock + allicin group (P = .589), which indicated allicin could not block bacterial translocation into mesenteric lymph node after trauma/hemorrhagic shock. However, it may increase the capacity of mesenteric lymph node to block intraintestinal bacterial translocation to extraintestinal organs as a statistical difference was noticed in the bacterial translocation in liver, blood, and spleen between trauma/hemorrhagic shock and trauma/hemorrhagic shock + allicin groups (P < .05). CONCLUSION: Trauma/hemorrhagic shock resulted in a decrease of mature mesenteric lymph node-dendritic cells. Allicin treatment could block intraintestinal bacterial translocation through increasing the immunologic barrier function of mesenteric lymph node by modulating dendritic cells maturation.
[Mh] Termos MeSH primário: Apoptose/efeitos dos fármacos
Translocação Bacteriana/efeitos dos fármacos
Células Dendríticas/efeitos dos fármacos
Choque Hemorrágico/tratamento farmacológico
Choque Traumático/tratamento farmacológico
Ácidos Sulfínicos/farmacologia
[Mh] Termos MeSH secundário: Animais
Western Blotting
Células Dendríticas/citologia
Modelos Animais de Doenças
Linfonodos/efeitos dos fármacos
Masculino
Distribuição Aleatória
Ratos
Ratos Sprague-Dawley
Valores de Referência
Sensibilidade e Especificidade
Choque Hemorrágico/diagnóstico
Choque Hemorrágico/mortalidade
Choque Traumático/diagnóstico
Choque Traumático/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Sulfinic Acids); 3C39BY17Y6 (allicin)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161008
[St] Status:MEDLINE


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[PMID]:27999410
[Au] Autor:Chamorro V; Pandolfi R; Moreno L; Barreira B; Martínez-Ramas A; Morales-Cano D; Ruiz-Cabello J; Lorente JA; Duarte J; Cogolludo Á; Alvarez-Sala JL; Perez-Vizcaino F
[Ad] Endereço:Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid 28040, Spain. vchamo26@hotmail.com.
[Ti] Título:Effects of Quercetin in a Rat Model of Hemorrhagic Traumatic Shock and Reperfusion.
[So] Source:Molecules;21(12), 2016 Dec 20.
[Is] ISSN:1420-3049
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We hypothesized that treatment with quercetin could result in improved hemodynamics, lung inflammatory parameters and mortality in a rat model of hemorrhagic shock. METHODS: Rats were anesthetized (80 mg/kg ketamine plus 8 mg/kg xylazine i.p.). The protocol included laparotomy for 15 min (trauma), hemorrhagic shock (blood withdrawal to reduce the mean arterial pressure to 35 mmHg) for 75 min and resuscitation by re-infusion of all the shed blood plus lactate Ringer for 90 min. Intravenous quercetin (50 mg/kg) or vehicle were administered during resuscitation. RESULTS: There was a trend for increased survival 84.6% (11/13) in the treated group vs. the shock group 68.4% (13/19, > 0.05 Kaplan-Meier). Quercetin fully prevented the development of lung edema. The activity of aSMase was increased in the shock group compared to the sham group and the quercetin prevented this effect. However, other inflammatory markers such as myeloperoxidase activity, interleukin-6 in plasma or bronchoalveolar fluid were similar in the sham and shock groups. We found no bacterial DNA in plasma in these animals. CONCLUSIONS: Quercetin partially prevented the changes in blood pressure and lung injury in shock associated to hemorrhage and reperfusion.
[Mh] Termos MeSH primário: Quercetina/uso terapêutico
Choque Hemorrágico/tratamento farmacológico
Choque Traumático/tratamento farmacológico
[Mh] Termos MeSH secundário: Animais
Pressão Arterial/efeitos dos fármacos
Biomarcadores/sangue
Edema/prevenção & controle
Hemodinâmica
Inflamação/complicações
Inflamação/tratamento farmacológico
Interleucina-6/química
Soluções Isotônicas/uso terapêutico
Masculino
Peroxidase/química
Edema Pulmonar/complicações
Edema Pulmonar/tratamento farmacológico
Ratos
Ratos Wistar
Reperfusão
Ressuscitação
Choque Hemorrágico/complicações
Choque Traumático/complicações
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Interleukin-6); 0 (Isotonic Solutions); 8022-63-7 (Ringer's lactate); 9IKM0I5T1E (Quercetin); EC 1.11.1.7 (Peroxidase)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170309
[Lr] Data última revisão:
170309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161222
[St] Status:MEDLINE


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[PMID]:27977787
[Au] Autor:Langness S; Costantini TW; Morishita K; Eliceiri BP; Coimbra R
[Ad] Endereço:Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, University of California, San Diego Health Sciences, San Diego, California, United States of America.
[Ti] Título:Modulating the Biologic Activity of Mesenteric Lymph after Traumatic Shock Decreases Systemic Inflammation and End Organ Injury.
[So] Source:PLoS One;11(12):e0168322, 2016.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Trauma/hemorrhagic shock (T/HS) causes the release of pro-inflammatory mediators into the mesenteric lymph (ML), triggering a systemic inflammatory response and acute lung injury (ALI). Direct and pharmacologic vagal nerve stimulation prevents gut barrier failure and alters the biologic activity of ML after injury. We hypothesize that treatment with a pharmacologic vagal agonist after T/HS would attenuate the biologic activity of ML and prevent ALI. METHODS: ML was collected from male Sprague-Dawley rats after T/HS, trauma-sham shock (T/SS) or T/HS with administration of the pharmacologic vagal agonist CPSI-121. ML samples from each experimental group were injected into naïve mice to assess biologic activity. Blood samples were analyzed for changes in STAT3 phosphorylation (pSTAT3). Lung injury was characterized by histology, permeability and immune cell recruitment. RESULTS: T/HS lymph injected in naïve mice caused a systemic inflammatory response characterized by hypotension and increased circulating monocyte pSTAT3 activity. Injection of T/HS lymph also resulted in ALI, confirmed by histology, lung permeability and increased recruitment of pulmonary macrophages and neutrophils to lung parenchyma. CPSI-121 attenuated T/HS lymph-induced systemic inflammatory response and ALI with stable hemodynamics and similar monocyte pSTAT3 levels, lung histology, lung permeability and lung immune cell recruitment compared to animals injected with lymph from T/SS. CONCLUSION: Treatment with CPSI-121 after T/HS attenuated the biologic activity of the ML and decreased ALI. Given the superior clinical feasibility of utilizing a pharmacologic approach to vagal nerve stimulation, CPSI-121 is a potential treatment strategy to limit end organ dysfunction after injury.
[Mh] Termos MeSH primário: Lesão Pulmonar Aguda/prevenção & controle
Hidrazonas/uso terapêutico
Inflamação/prevenção & controle
Linfa/efeitos dos fármacos
Mesentério/efeitos dos fármacos
Choque Hemorrágico/tratamento farmacológico
Choque Traumático/tratamento farmacológico
[Mh] Termos MeSH secundário: Lesão Pulmonar Aguda/metabolismo
Lesão Pulmonar Aguda/patologia
Animais
Modelos Animais de Doenças
Inflamação/metabolismo
Inflamação/patologia
Mediadores da Inflamação/metabolismo
Linfa/imunologia
Linfa/metabolismo
Vasos Linfáticos/efeitos dos fármacos
Vasos Linfáticos/metabolismo
Masculino
Mesentério/imunologia
Mesentério/metabolismo
Mesentério/patologia
Camundongos
Camundongos Endogâmicos C57BL
Ratos
Ratos Sprague-Dawley
Choque Hemorrágico/complicações
Choque Hemorrágico/imunologia
Choque Hemorrágico/metabolismo
Choque Traumático/complicações
Choque Traumático/imunologia
Choque Traumático/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (CPSI-121); 0 (Hydrazones); 0 (Inflammation Mediators)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170705
[Lr] Data última revisão:
170705
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0168322



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