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https://www.readbyqxmd.com/read/29163354/diabetes-and-sepsis-risk-recurrence-and-ruination
#1
REVIEW
Lynn M Frydrych, Fatemeh Fattahi, Katherine He, Peter A Ward, Matthew J Delano
Sepsis develops when an infection surpasses local tissue containment. A series of dysregulated physiological responses are generated, leading to organ dysfunction and a 10% mortality risk. When patients with sepsis demonstrate elevated serum lactates and require vasopressor therapy to maintain adequate blood pressure in the absence of hypovolemia, they are in septic shock with an in-hospital mortality rate >40%. With improvements in intensive care treatment strategies, overall sepsis mortality has diminished to ~20% at 30 days; however, mortality continues to steadily climb after recovery from the acute event...
2017: Frontiers in Endocrinology
https://www.readbyqxmd.com/read/29160643/antithrombotic-treatment-in-neonates-and-children
#2
Cornelia H van Ommen
Despite the increasing incidence of venous thromboembolic disease in pediatric patients, it remains a rare complication in childhood. Particularly neonates and adolescents are at risk for development of venous thrombosis. Spontaneous thrombotic events are sporadic, the majority of children have multiple co-existing risk factors, including central venous catheter, asphyxia, congenital heart disease, infection, malignancy, surgery and hypovolemia. Most thrombi are diagnosed by ultrasonography. Recommendations for management of pediatric thrombosis are typically extrapolated from adult studies, despite many differences between adults and children, including developmental hemostasis...
November 21, 2017: Minerva Pediatrica
https://www.readbyqxmd.com/read/29159457/ertugliflozin-in-patients-with-stage-3-chronic-kidney-disease-and-type-2-diabetes-mellitus-the-vertis-renal-randomized-study
#3
George Grunberger, Sarah Camp, Jeremy Johnson, Susan Huyck, Steven G Terra, James P Mancuso, Zhi Wei Jiang, Gregory Golm, Samuel S Engel, Brett Lauring
INTRODUCTION: Ertugliflozin is a sodium-glucose cotransporter 2 inhibitor in development for type 2 diabetes mellitus (T2DM). The safety and efficacy of ertugliflozin were evaluated over 52 weeks in patients with chronic kidney disease (CKD). METHODS: In this double-blind randomized study (NCT01986855), patients with glycated hemoglobin (A1C) 7.0-10.5% and stage 3 CKD [estimated glomerular filtration rate (eGFR) ≥ 30 to < 60 mL/min/1.73 m(2)] who were undergoing treatment with standard diabetes therapy (or therapies) including insulin and/or sulfonylureas were randomized to once-daily ertugliflozin 5 mg, 15 mg, or placebo...
November 20, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/29157947/vascular-endothelial-specific-il-4r%C3%AE-abl1-kinase-signaling-axis-regulates-severity-of-ige-mediated-anaphylactic-reactions
#4
Amnah Yamani, David Wu, Lisa Waggoner, Taeko Noah, Anthony J Koleske, Fred Finkelman, Simon P Hogan
BACKGROUND: Severe IgE-mediated, food-induced anaphylactic reactions are characterized by pulmonary venous vasodilatation and fluid extravasation, which is thought to lead to the life-threatening anaphylactic phenotype. The underlying immunological and cellular processes involved in driving fluid extravasation and the severe anaphylactic phenotype are not fully elucidated. OBJECTIVE: To define the interaction and requirement of IL-4 and vascular endothelial (VE) IL-4Rα chain signaling in histamine-ABL1-mediated VE dysfunction and fluid extravasation in the severity of IgE-mediated anaphylactic reactions in mice...
November 17, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29154687/pyruvate-enhancement-of-cardiac-performance-cellular-mechanisms-and-clinical-application
#5
Robert T Mallet, Albert H Olivencia-Yurvati, Rolf Bünger
Cardiac contractile function is adenosine-5'-triphosphate (ATP)-intensive, and the myocardium's high demand for oxygen and energy substrates leaves it acutely vulnerable to interruptions in its blood supply. The myriad cardioprotective properties of the natural intermediary metabolite pyruvate make it a potentially powerful intervention against the complex injury cascade ignited by myocardial ischemia-reperfusion. A readily oxidized metabolic substrate, pyruvate augments myocardial free energy of ATP hydrolysis to a greater extent than the physiological fuels glucose, lactate and fatty acids, particularly when it is provided at supra-physiological plasma concentrations...
January 1, 2017: Experimental Biology and Medicine
https://www.readbyqxmd.com/read/29149941/pathophysiology-of-septic-shock
#6
REVIEW
James A Russell, Barret Rush, John Boyd
Fundamental features of septic shock are vasodilation, increased permeability, hypovolemia, and ventricular dysfunction. Vasodilation owing to increased nitric oxide and prostaglandins is treated with vasopressors (norepinephrine first). Increased permeability relates to several pathways (Slit/Robo4, vascular endothelial growth factor, angiopoietin 1 and 2/Tie2 pathway, sphingosine-1-phosphate, and heparin-binding protein), some of which are targets for therapies. Hypovolemia is common and crystalloid is recommended for fluid resuscitation...
January 2018: Critical Care Clinics
https://www.readbyqxmd.com/read/29145824/observations-on-significant-hemodynamic-changes-caused-by-a-high-concentration-of-epidurally-administered-ropivacaine-correlation-and-prediction-study-of-stroke-volume-variation-and-central-venous-pressure-in-thoracic-epidural-anesthesia
#7
Jeong-Min Hong, Hyeon Jeong Lee, Young-Jae Oh, Ah Rhem Cho, Hyae Jin Kim, Do-Won Lee, Wang-Seok Do, Jae-Young Kwon, Haekyu Kim
BACKGROUND: Thoracic epidural anesthesia (TEA) exacerbates hypotension due to peripheral vasodilator effects following the use of general anesthetics. This study aimed to compare the hemodynamic changes caused by three different concentrations of epidural ropivacaine and to evaluate the performance of the stroke-volume variation (SVV) and central venous pressure (CVP) during TEA with general anesthesia. METHODS: A total of 120 patients were administered 8 mL of ropivacaine solution via epidural injection, following randomization into one of three groups based on the concentration of ropivacaine in the study solution: 0...
November 16, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/29141498/incidence-and-natural-progression-of-neurogenic-shock-following-traumatic-spinal-cord-injury
#8
Ian A Ruiz, Jordan W Squair, Aaron A Phillips, Christine D Lukac, Dayan Huang, Patrick Oxciano, Dong Yan, Andrei V Krassioukov
Neurogenic shock, a distributive type of circulatory shock following spinal cord injury (SCI), results in profound hypotension. The consequent hemodynamic instability complicates clinical management, delays surgical intervention, and impacts neurological outcome. Moreover, the reported incidence of this condition varies significantly. Here, we establish the true incidence of neurogenic shock by comparing the most common clinical definitions used to diagnose the condition. Further, we characterize the acute progression and recovery of neurogenic shock...
November 15, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29135598/cardiac-arrest-in-the-operating-room-resuscitation-and-management-for-the-anesthesiologist-part-1
#9
Vivek K Moitra, Sharon Einav, Karl-Christian Thies, Mark E Nunnally, Andrea Gabrielli, Gerald A Maccioli, Guy Weinberg, Arna Banerjee, Kurt Ruetzler, Gregory Dobson, Matthew McEvoy, Michael F O'Connor
Cardiac arrest in the operating room and procedural areas has a different spectrum of causes (ie, hypovolemia, gas embolism, and hyperkalemia), and rapid and appropriate evaluation and management of these causes require modification of traditional cardiac arrest algorithms. There is a small but growing body of literature describing the incidence, causes, treatments, and outcomes of circulatory crisis and perioperative cardiac arrest. These events are almost always witnessed, frequently known, and involve rescuer providers with knowledge of the patient and their procedure...
November 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29132523/pancreatitis-and-pancreatic-cancer
#10
REVIEW
Anne Walling, Robert Freelove
Most cases of acute pancreatitis are related to gallstones. More than 80% resolve within a few days. The diagnosis is based on upper abdominal pain, elevated lipase and/or amylase, and transabdominal ultrasound findings. Management requires early aggressive hydration, pain control, nutritional support, and monitoring for progression. Patients who develop hypovolemia, systemic inflammatory response, pancreatic necrosis, and organ failure have high mortality, risk of recurrence, and progression to chronic pancreatitis (CP)...
December 2017: Primary Care
https://www.readbyqxmd.com/read/29132515/acute-kidney-injury-in-the-critically-ill
#11
REVIEW
Robert A Maxwell, Christopher Michael Bell
Acute kidney injury (AKI) occurs frequently in the surgical intensive care unit and results in significant morbidity and mortality. AKI needs to be identified early and underlying causes treated or eliminated. Sepsis, major surgery such as coronary artery bypass, and hypovolemia are the most common causes and patients with underlying comorbidities have increased susceptibility. Treatment should begin by ensuring that patients are adequately resuscitated and all contributing causes are replaced or eliminated...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29129646/extracellular-volume-depletion-and-resultant-hypotonic-hyponatremia-a-novel-translational-approach
#12
Philip J G M Voets, Roderick P P W M Maas
Although several methods currently exist to determine that a person is hypovolemic, it often remains very challenging to accurately estimate the effective circulating volume or amount of intravascular volume depletion in a non-controlled setting. This depletion of intravascular volume can have many causes and is frequently accompanied by hypotonic hyponatremia as a result of hypovolemia-induced release of arginine vasopressin (AVP) from the posterior pituitary gland. Here, we derive a novel, comprehensible equation that provides a theoretical insight into the complex interrelationship between the degree of isotonic volume depletion and the resultant change in plasma sodium concentration...
November 10, 2017: Mathematical Biosciences
https://www.readbyqxmd.com/read/29123436/development-and-retrospective-clinical-assessment-of-a-patient-specific-closed-form-integro-differential-equation-model-of-plasma-dilution
#13
Glen Atlas, John K-J Li, Shawn Amin, Robert G Hahn
A closed-form integro-differential equation (IDE) model of plasma dilution (PD) has been derived which represents both the intravenous (IV) infusion of crystalloid and the postinfusion period. Specifically, PD is mathematically represented using a combination of constant ratio, differential, and integral components. Furthermore, this model has successfully been applied to preexisting data, from a prior human study, in which crystalloid was infused for a period of 30 minutes at the beginning of thyroid surgery...
2017: Biomedical Engineering and Computational Biology
https://www.readbyqxmd.com/read/29117996/effect-of-isolated-ultrafiltration-and-isovolemic-dialysis-on-myocardial-perfusion-and-left-ventricular-function-assessed-with-13n-nh3-pet-and-echocardiography
#14
Solmaz Assa, Hannie Kuipers, Esmee Ettema, Carlo A Gaillard, Wim P Krijnen, Yoran M Hummel, Adriaan A Voors, Joost P van Melle, Ralf Westerhuis, Antoon Willemsen, Riemer H J A Slart, Casper Fm Franssen
Hemodialysis is associated with a fall in myocardial perfusion and may induce regional left ventricular (LV) systolic dysfunction. The pathophysiology of this entity is incompletely understood and the contribution of ultrafiltration and diffusive dialysis has not been studied. We investigated the effect of isolated ultrafiltration and isovolemic dialysis on myocardial perfusion and LV function. Eight patients (7 male, age 55±18 years) underwent 60 min of isolated ultrafiltration and 60 min of isovolemic dialysis in randomized order...
November 8, 2017: American Journal of Physiology. Renal Physiology
https://www.readbyqxmd.com/read/29114227/non-linear-heart-rate-and-blood-pressure-interaction-in-response-to-lower-body-negative-pressure
#15
Ajay K Verma, Da Xu, Amanmeet Garg, Anita T Cote, Nandu Goswami, Andrew P Blaber, Kouhyar Tavakolian
Early detection of hemorrhage remains an open problem. In this regard, blood pressure has been an ineffective measure of blood loss due to numerous compensatory mechanisms sustaining arterial blood pressure homeostasis. Here, we investigate the feasibility of causality detection in the heart rate and blood pressure interaction, a closed-loop control system, for early detection of hemorrhage. The hemorrhage was simulated via graded lower-body negative pressure (LBNP) from 0 to -40 mmHg. The research hypothesis was that a significant elevation of causal control in the direction of blood pressure to heart rate (i...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/29099424/colloids-and-the-microcirculation
#16
Huaiwu He, Dawei Liu, Can Ince
Colloid solutions have been advocated for use in treating hypovolemia due to their expected effect on improving intravascular retention compared with crystalloid solutions. Because the ultimate desired effect of fluid resuscitation is the improvement of microcirculatory perfusion and tissue oxygenation, it is of interest to study the effects of colloids and crystalloids at the level of microcirculation under conditions of shock and fluid resuscitation, and to explore the potential benefits of using colloids in terms of recruiting the microcirculation under conditions of hypovolemia...
November 1, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29090256/pulseless-electrical-activity-during-general-anesthesia-induction-in-patients-with-amyotrophic-lateral-sclerosis
#17
Tae Min You, Seungoh Kim
Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and lack of palpable pulse in the presence of organized cardiac electrical activity and is caused by a profound cardiovascular insult (e.g., severe prolonged hypoxia or acidosis, extreme hypovolemia, or flow-restricting pulmonary embolus). Amyotrophic lateral sclerosis (ALS) is a disease that is characterized by progressive degeneration of all levels of the motor nervous system. Damage to the respiratory system and weakness of the muscles may increase the likelihood of an emergency situation occurring in patients with ALS while under general anesthesia...
September 2017: J Dent Anesth Pain Med
https://www.readbyqxmd.com/read/29089345/loss-of-female-sex-hormones-exacerbates-cerebrovascular-and-cognitive-dysfunction-in-aortic-banded-miniswine-through-a-neuropeptide-y-ca-2-activated-potassium-channel-nitric-oxide-mediated-mechanism
#18
T Dylan Olver, Jessica A Hiemstra, Jenna C Edwards, Todd R Schachtman, Cheryl M Heesch, Paul J Fadel, M Harold Laughlin, Craig A Emter
BACKGROUND: Postmenopausal women represent the largest cohort of patients with heart failure with preserved ejection fraction, and vascular dementia represents the most common form of dementia in patients with heart failure with preserved ejection fraction. Therefore, we tested the hypotheses that the combination of cardiac pressure overload (aortic banding [AB]) and the loss of female sex hormones (ovariectomy [OVX]) impairs cerebrovascular control and spatial memory. METHODS AND RESULTS: Female Yucatan miniswine were separated into 4 groups (n=7 per group): (1) control, (2) AB, (3) OVX, and (4) AB-OVX...
October 31, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29084268/early-structural-changes-of-the-heart-after-experimental-polytrauma-and-hemorrhagic-shock
#19
Christian K Braun, Miriam Kalbitz, Rebecca Halbgebauer, Philipp Eisele, David A C Messerer, Sebastian Weckbach, Anke Schultze, Sonja Braumüller, Florian Gebhard, Markus S Huber-Lang
Evidence is emerging that systemic inflammation after trauma drives structural and functional impairment of cardiomyocytes and leads to cardiac dysfunction, thus worsening the outcome of polytrauma patients. This study investigates the structural and molecular changes in heart tissue 4 h after multiple injuries with additional hemorrhagic shock using a clinically relevant rodent model of polytrauma. We determined mediators of systemic inflammation (keratinocyte chemoattractant, macrophage chemotactic protein 1), activated complement component C3a and cardiac troponin I in plasma and assessed histological specimen of the mouse heart via standard histomorphology and immunohistochemistry for cellular and subcellular damage and ongoing apoptosis...
2017: PloS One
https://www.readbyqxmd.com/read/29076664/routine-preoperative-blood-group-and-save-testing-is-unnecessary-for-elective-laparoscopic-cholecystectomy
#20
Ashutosh Tandon, Kashif Shahzad, Quentin Nunes, Milind Shrotri, Raimundas Lunevicius
Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted...
July 2017: Journal of Ayub Medical College, Abbottabad: JAMC
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