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https://www.readbyqxmd.com/read/28938253/guidelines-for-the-diagnosis-and-management-of-critical-illness-related-corticosteroid-insufficiency-circi-in-critically-ill-patients-part-i-society-of-critical-care-medicine-sccm-and-european-society-of-intensive-care-medicine-esicm-2017
#1
Djillali Annane, Stephen M Pastores, Bram Rochwerg, Wiebke Arlt, Robert A Balk, Albertus Beishuizen, Josef Briegel, Joseph Carcillo, Mirjam Christ-Crain, Mark S Cooper, Paul E Marik, Gianfranco Umberto Meduri, Keith M Olsen, Sophia C Rodgers, James A Russell, Greet Van den Berghe
OBJECTIVE: To update the 2008 consensus statements for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in adult and pediatric patients. PARTICIPANTS: A multispecialty task force of 16 international experts in critical care medicine, endocrinology, and guideline methods, all of them members of the Society of Critical Care Medicine and/or the European Society of Intensive Care Medicine. DESIGN/METHODS: The recommendations were based on the summarized evidence from the 2008 document in addition to more recent findings from an updated systematic review of relevant studies from 2008 to 2017 and were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28937407/time-course-of-septic-shock-in-immunocompromised-and-nonimmunocompromised-patients
#2
Matthieu Jamme, Fabrice Daviaud, Julien Charpentier, Nathalie Marin, Michaël Thy, Yannick Hourmant, Jean-Paul Mira, Frédéric Pène
OBJECTIVES: To address the impact of underlying immune conditions on the course of septic shock with respect to both mortality and the development of acute infectious and noninfectious complications. DESIGN: An 8-year (2008-2015) monocenter retrospective study. SETTING: A medical ICU in a tertiary care center. PATIENTS: Patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients were classified in four subgroups with respect to their immune status: nonimmunocompromised and immunocompromised distributed into hematologic or solid malignancies and nonmalignant immunosuppression...
September 20, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28936740/therapeutic-effects-of-mesenchymal-stem-cell-derived-exosomes-in-cardiovascular-disease
#3
Etsu Suzuki, Daishi Fujita, Masao Takahashi, Shigeyoshi Oba, Hiroaki Nishimatsu
Mesenchymal stem cells (MSCs) are multipotent stem cells that reside in various organs. They have the capacity to differentiate into various cell types, including cardiomyocytes, vascular endothelial cells, and vascular smooth muscle cells. Among the various MSCs, bone marrow-derived MSCs (BMMSCs) have been widely used for treating acute myocardial infarction (AMI) and ischemic heart failure (IHF) in preclinical and clinical studies. Although the beneficial effects of BMMSCs in treating AMI and IHF were originally attributed to their capacity to differentiate into cardiac cell types, recent evidence suggests that the differentiation capacity of BMMSCs appears to be minimal and that BMMSCs exert cardioprotective effects by secreting paracrine factors...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28936735/dual-behavior-of-exosomes-in-septic-cardiomyopathy
#4
Valter Vinícius Silva Monteiro, Jordano Ferreira Reis, Rafaelli de Souza Gomes, Kely Campos Navegantes, Marta Chagas Monteiro
Sepsis is one of the main causes of ICU hospitalization worldwide, with a high mortality rate, and is associated with a large number of comorbidities. One of the main comorbidities associated with sepsis is septic cardiomyopathy. This process occurs mainly due to mechanisms of damage in the cardiovascular system that will lead to changes in cardiovascular physiology, such as decreased Ca(2+) response, mitochondrial dysfunction and decreased β-adrenergic receptor response. Within this process the exosomes play an important role in the pathophysiology of this disease, in which the exosomal content is related to mechanisms that will trigger its development...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28935598/infection-dynamics-of-a-v-splendidus-strain-pathogenic-to-mytilus-edulis-in-vivo-and-in-vitro-interactions-with-hemocytes
#5
Yosra Ben Cheikh, Marie-Agnès Travers, Frank Le Foll
The pathogenic strain V. splendidus 10/068 1T1 has previously been reported for its virulence to the blue mussel and for its capacity to alter immune responses. In this study, we expanded the knowledge on hemocyte-pathogen interactions by using in vitro and in vivo assays. V. splendidus 10/068 1T1 severely inhibited cell adhesion and acidic vacuole formation unlike the innocuous phylogenetically related V. splendidus 12/056 M24T1 which had no effect on these cell functions. Furthermore, the virulent bacteria decreased hemocyte viability (59% of viability after 24 h)...
September 18, 2017: Fish & Shellfish Immunology
https://www.readbyqxmd.com/read/28934717/expression-of-c-ebp%C3%AE-in-myeloid-progenitors-during-sepsis-promotes-immunosuppression
#6
Jun Dai, Ajinkya Kumbhare, Dima Youssef, Zhi Q Yao, Charles E McCall, Mohamed El Gazzar
Sepsis-induced myeloid-derived suppressor cells (MDSCs) contribute to immunosuppression associated with sepsis. We reported that the CCAAT enhancer-binding protein C/EBPβ activates microRNA (miR)-21 and miR-181b expressions, which induce transcription factor NFI-A to support the generation and expansion of MDSCs in the bone marrow and spleens of septic mice. Here, using a conditional knockout mouse model lacking C/EBPβ in the myeloid lineage, we find that without C/EBPβ, myeloid progenitor cells could not express miR-21 or miR-181b, and ectopic expression of C/EBPβ in the C/EBPβ-deficient myeloid progenitors activated the expression of the two miRNAs...
September 18, 2017: Molecular Immunology
https://www.readbyqxmd.com/read/28934705/vitamin-c-the-next-step-in-sepsis-management
#7
REVIEW
J Teng, A Pourmand, M Mazer-Amirshahi
Sepsis is a life-threatening medical condition, affecting approximately 26 million people worldwide every year. The disease is a continuum, marked by dysregulated inflammation and hemodynamic instability leading to shock, multi-system organ dysfunction, and death. Over the past decades, there has been a focus on the early identification and treatment of sepsis primarily with bundled and goal directed therapy. Despite these advances, morbidity and mortality has remained high, prompting investigation into novel therapies...
September 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28933807/recognizing-and-managing-adrenal-disorders-in-the-emergency-department-digest
#8
Amy Cutright, Stephen Ducey, Claudia L Barthold, Jeremy Kim
Primary and secondary adrenal insufficiency are underrecognized conditions among emergency department patients, affecting an estimated 10% to 20% of critically ill patients. The signs and symptoms of cortisol deficit can be nonspecific and wide-ranging, and identification and swift treatment with stress-dosing of hydrocortisone is vital to avoid life-threatening adrenal crisis. Laboratory evaluation focuses on identification of electrolyte abnormalities typical of adrenal insufficiency, and while additional testing may depend on the type and severity of symptoms, it should not delay corticosteroid replacement...
September 22, 2017: Emergency Medicine Practice
https://www.readbyqxmd.com/read/28933172/-development-of-views-on-pathophysiology-of-sepsis
#9
Jiří Beneš
Sepsis was understood as a disease caused by an invasive bacterial infection associated with deluging of organism with bacterial toxins (blood poisoning). Schottmüllers definition emphasized the existence of a focus as the source of invading bacteria. Further research led to the discovery of the cytokine cascade and to the recognition that sepsis is induced by our own endogenous mediators. The dysfunction or failure of various organs in sepsis can be explained both by hemodynamic disorders which originate in the altered microcapillars but also by a complex transformation of metabolism...
2017: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28932731/extracorporeal-membrane-oxygenation-support-for-refractory-septic-shock-in-liver-transplantation-recipients
#10
Kyo Won Lee, Chan Woo Cho, Nuri Lee, Gyu-Seong Choi, Yang Hyun Cho, Jong Man Kim, Choon Hyuck David Kwon, Jae-Won Joh
PURPOSE: This study was designed to assess the outcome of the extracorporeal membrane oxygenation (ECMO) in liver transplantation (LT) recipients with refractory septic shock and predict the prognosis of those cases. METHODS: From February 2005 to October 2012, ECMO was used in 8 cases of refractory septic shock. Laboratory values including lactate and total bilirubin level just before starting ECMO were obtained and sepsis-related organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACH) II score and simplified acute physiology score (SAPS) 3 were calculated...
September 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28932285/comparison-of-the-hospital-costs-for-two-stage-reimplantation-for-deep-infection-single-stage-revision-and-primary-total-elbow-arthroplasty
#11
Eric R Wagner, Jeanine E Ransom, Hilal Maradit Kremers, Mark Morrey, Joaquin Sanchez-Sotelo
BACKGROUND: The purpose of the present study was to determine the cost of two-stage reimplantation for the treatment of deep infection after total elbow arthroplasty (TEA) and compare this with primary and aseptic revision TEA. METHODS: Three hundred and seventy-one primary TEA and 286 revision TEAs (including 47 elbows requiring two-stage reimplantation) were performed. Total direct medical costs during each hospitalization were obtained from our institutional research database and compared for three groups: primary TEA, revision for nonseptic reasons and two-stage reimplantation for deep infection...
October 2017: Shoulder & Elbow
https://www.readbyqxmd.com/read/28931916/salidroside-ameliorates-sepsis-induced-acute-lung-injury-and-mortality-via-downregulating-nf-%C3%AE%C2%BAb-and-hmgb1-pathways-through-the-upregulation-of-sirt1
#12
Kuo-Cheng Lan, Sung-Chuan Chao, Hsiao-Yi Wu, Chia-Lien Chiang, Ching-Chia Wang, Shing-Hwa Liu, Te-I Weng
Sepsis is a life-threatening medical condition. Salidroside, a substance isolated from Rhodiola rosea, possesses antioxidant and anti-inflammatory properties. The effect and mechanism of salidroside on sepsis-induced acute lung injury still remains to be well clarified. Here, we investigated the effect and mechanism of salidroside on septic mouse models and explored the role of salidroside-upregulated SIRT1. Salidroside inhibited the inflammatory responses and HMGB1 productions in bacterial lipopolysaccharide (LPS)-treated macrophages and mice...
September 20, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28931420/presence-of-periaortic-gas-in-clostridium-septicum-infected-aortic-aneurysm-aids-in-early-diagnosis-a-case-report-and-systematic-review-of-the-literature
#13
Fumihito Ito, Ryota Inokuchi, Akinori Matsumoto, Yoshibumi Kumada, Hideyuki Yokoyama, Tokiya Ishida, Katsuhiko Hashimoto, Masashi Narita, Kazuaki Shinohara
BACKGROUND: Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. CASE PRESENTATION: A 58-year-old Japanese man with an unremarkable medical history presented with a 3-day history of mild weakness in both legs, and experienced paraplegia and paresthesia a day before admission. Upon recognition of signs of an abdominal aortic aneurysm and paraplegia, we suspected an occluded Adamkiewicz artery and performed a contrast-enhanced computed tomography scan, which revealed an aortic aneurysm with periaortic gas extending from his chest to his abdomen and both kidneys...
September 21, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28931367/changes-in-radial-artery-pulse-pressure-during-a-fluid-challenge-cannot-assess-fluid-responsiveness-in-patients-with-septic-shock
#14
Victor De la Puente-Diaz de Leon, Valente de Jesus Jaramillo-Rocha, Jean-Louis Teboul, Sofia Garcia-Miranda, Bernardo A Martinez-Guerra, Guillermo Dominguez-Cherit
BACKGROUND: Arterial blood pressure is the most common variable used to assess the response to a fluid challenge in routine clinical practice. The aim of this study was to evaluate the accuracy of the change in the radial artery pulse pressure (rPP) to detect the change in cardiac output after a fluid challenge in patients with septic shock. METHODS: Prospective observational study including 35 patients with septic shock in which rPP and cardiac output were measured before and after a fluid challenge with 400 mL of crystalloid solution...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28931365/predictive-value-of-matrix-metalloproteinases-and-their-inhibitors-for-mortality-in-septic-patients-a-cohort-study
#15
Sergio Serrano-Gomez, Gabriel Burgos-Angulo, Daniela Camila Niño-Vargas, María Eugenia Niño, María Eugenia Cárdenas, Estephania Chacón-Valenzuela, Diana Margarita McCosham, Juan Sebastián Peinado-Acevedo, M Marcos Lopez, Fernando Cunha, Antonio Pazin-Filho, Ramses Ilarraza, Richard Schulz, Diego Torres-Dueñas
PURPOSE: Over 170 biomarkers are being investigated regarding their prognostic and diagnostic accuracy in sepsis in order to find new tools to reduce morbidity and mortality. Matrix metalloproteinases (MMPs) and their inhibitors have been recently studied as promising new prognostic biomarkers in patients with sepsis. This study is aimed at determining the utility of several cutoff points of these biomarkers to predict mortality in patients with sepsis. MATERIALS AND METHODS: A multicenter, prospective, analytic cohort study was performed in the metropolitan area of Bucaramanga, Colombia...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28930916/peripheral-muscle-near-infrared-spectroscopy-nirs-variables-are-altered-early-in-septic-shock
#16
Diego Orbegozo, Fuhong Su, Keliang Xie, Lokmane Rahmania, Fabio Silvio Taccone, Daniel De Backer, Jean-Louis Vincent, Jacques Creteur
BACKGROUND: Non-invasive evaluation of muscle perfusion using near infrared spectroscopy (NIRS) coupled with a vascular occlusion test (VOT) may provide an early and simple marker of altered perfusion and microcirculatory function in sepsis. OBJECTIVE: To compare the time-course of NIRS-derived variables with systemic measures of perfusion in an experimental model of peritonitis. METHODS: Peritonitis was induced in eight anesthetized, mechanically ventilated, adult sheep (24-34 Kg), by injecting autologous feces into the peritoneal cavity...
September 19, 2017: Shock
https://www.readbyqxmd.com/read/28929031/procalcitonin-a-powerful-rescuer-on-surgical-floors
#17
EDITORIAL
Ahsan Zil-E-Ali, Syeda Naqvi, Mariam Tariq
Necrotizing fasciitis (NF) is a rare but life-threatening medical and surgical emergency. It is characterized by necrosis of the soft tissue leaving the overlying tissue unaffected, which delays the diagnosis and treatment. Delay in recognition of the severity of necrotizing fasciitis might lead to serious morbidity and mortality. Diagnosis of NF relies on strong clinical judgment, predictable by severe pain, erythema, and a presence of air under the skin, but all of them are not always present. Management of NF is prompt surgical intervention and antimicrobial therapy...
July 8, 2017: Curēus
https://www.readbyqxmd.com/read/28928953/treatment-of-femoral-shaft-fractures-with-monoaxial-external-fixation-in-polytrauma-patients
#18
Gianluca Testa, Domenico Aloj, Alessandro Ghirri, Eraclite Petruccelli, Vito Pavone, Alessandro Massé
Background: Femoral shaft fractures, typical in younger people, are often associated with polytrauma followed by traumatic shock. In these situations, despite intramedullary nailing being the treatment of choice, external fixation could be used as the definitive treatment. The aim of this study is to report evidence regarding definitive treatment of femoral shaft fractures with monoaxial external fixation. Methods: Between January 2006 and December 2015, 83 patients with 87 fractures were treated at the Department of Orthopaedics and Traumatology CTO of Turin, with a monoaxial external fixation device...
2017: F1000Research
https://www.readbyqxmd.com/read/28927832/impact-of-weekend-admission-on-mortality-and-other-outcomes-among-patients-with-burn-injury-a-nationwide-analysis
#19
Heather Peluso, Marwan S Abougergi, Julie Caffrey
OBJECTIVE: To study the relationship between day of admission and important outcomes among patients with burn injuries. METHODS: The 2014 National Inpatient Sample database was used. Inclusion criterion was a principal diagnosis of burn injury. Exclusion criteria were age <18years, superficial burn, and non-urgent admission. The primary outcome was in-hospital mortality. Secondary outcomes were morbidity (septic shock and prolonged mechanical ventilation), treatment metrics (time to surgery and parenteral or enteral nutrition (P/E-nutrition)) and resource utilization (length of stay (LOS) and total hospitalization charges and costs)...
September 16, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28927770/-pyomyositis-in-children-two-cases-of-staphylococcus-aureus-infection
#20
F Gravot, J Hébert, A Robert-Dehault, R Bouttier, F Le Gall, G Blondin, P Vic
Pyomyositis is a term used to denote primary pyogenic infection of a skeletal muscle. It is a rare disease that was first described in immunodeficient patients living in tropical climates. Lately, however, cases involving healthy children have been described in temperate climates. The origin of primary pyomyositis remains unclear, although it is thought to be caused by seeding from transient bacteremia. Onset of disease is insidious, therefore necessitating rapid diagnosis to successfully select appropriate antibiotic therapy and avoid complications...
September 15, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
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