1
|
Hao S, Wang H, Li S, Zhang H, Xie X, Liu J, Yang C, Zhou W, Wang H. Carbon monoxide polyhemoglobin improves the therapeutic effect and relieves inflammation in the colon tissue of haemorrhagic shock/resuscitation rats. ARTIFICIAL CELLS, NANOMEDICINE, AND BIOTECHNOLOGY 2024; 52:370-383. [PMID: 39017642 DOI: 10.1080/21691401.2024.2367444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/03/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE The objective of this study was to test the therapeutic effect of carbon monoxide polyhemoglobin (polyCOHb) in haemorrhagic shock/resuscitation and its underlying mechanisms. METHODS 48 rats were divided into two experimental parts, and 36 rats in the first experiment and 12 rats in the second experiment. In the first experimental part, 36 animals were randomly assigned to the following groups: hydroxyethyl starch group (HES group, n = 12), polyhemoglobin group (polyHb group, n = 12), and carbon monoxide polyhemoglobin group (polyCOHb group, n = 12). In the second experimental part, 12 animals were randomly assigned to the following groups: polyHb group (n = 6), and polyCOHb group (n = 6). Then the anaesthetised rats were haemorrhaged by withdrawing 50% of the animal's blood volume (BV), and resuscitated to the same volume of the animal's withdrawing BV with HES, polyHb, polyCOHb. In the first experimental part, the 72h survival rates of each groups animals were measured. In the second experimental part, the rats' mean arterial pressure (MAP), heart rate (HR), blood gas levels and other indicators were dynamically monitored in baseline, haemorrhagic shock (HS), at 0point resuscitation (RS 0h) and after 1 h resuscitation (RS 1h). The concentrations of malondialdehyde (MDA), superoxide dismutase (SOD), tumour necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were measured by ELISA kits in both groups of rats at RS 1h. Changes in pathological sections were examined by haematoxylin-eosin (HE) staining. Nuclear factor erythroid 2-related factor 2 (Nrf2) and haem oxygenase-1 (HO-1) levels were detected by immunohistochemical analysis, while myeloperoxidase (MPO) levels were detected by immunofluorescence. DHE staining was used to determine reactive oxygen species (ROS) levels. RESULTS The 72h survival rates of the polyHb and polyCOHb groups were 50.00% (6/12) and 58.33% (7/12) respectively, which were significantly higher than that of the 8.33% (1/12) in the HES group (p < 0.05). At RS 0h and RS 1h, the HbCO content of rats in the polyCOHb group (1.90 ± 0.21, 0.80 ± 0.21) g/L were higher than those in the polyHb group (0.40 ± 0.09, 0.50 ± 0.12)g/L (p < 0.05); At RS 1h, the MDA (41.47 ± 3.89 vs 34.17 ± 3.87 nmol/ml) in the plasma, Nrf2 and HO-1 content in the colon of rats in the polyCOHb group were lower than the polyHb group. And the SOD in the plasma (605.01 ± 24.46 vs 678.64 ± 36.37) U/mg and colon (115.72 ± 21.17 vs 156.70 ± 21.34) U/mg and the MPO content in the colon in the polyCOHb group were higher than the polyHb group (p < 0.05). CONCLUSIONS In these haemorrhagic shock/resuscitation models, both polyCOHb and polyHb show similar therapeutic effects, and polyCOHb has more effective effects in maintaining MAP, correcting acidosis, reducing inflammatory responses than that in polyHb.
Collapse
Affiliation(s)
- Shasha Hao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Huan Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Shen Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Honghui Zhang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xintong Xie
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jiaxin Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Chengmin Yang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Wentao Zhou
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Hong Wang
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| |
Collapse
|
2
|
Zhou W, Wang N, Dong S, Huan Z, Sui L, Ge X. PRG4 mitigates hemorrhagic shock-induced cardiac injury by inhibiting mitochondrial dysregulation, oxidative stress and NLRP3-mediated pyroptosis. Int Immunopharmacol 2024; 137:112507. [PMID: 38897120 DOI: 10.1016/j.intimp.2024.112507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024]
Abstract
Hemorrhagic shock (HS) is one of the main causes of morbidity and death in patients with trauma or major surgery. Cardiac dysfunction is a well-known complication of HS. PRG4, also known as lubricin, is a mucin-like glycoprotein that plays anti-inflammatory and anti-apoptotic roles in a variety of diseases. In this study, we aimed to explore the cardioprotective efficacy of PRG4 in HS-induced cardiac injury. Employing the HS model and RNA-seq, we found that PRG4 was increased in the myocardial tissue of rats after HS. In vivo studies suggested that HS led to abnormal hemodynamic parameters and increased cTnI levels, and PRG4 overexpression effectively reversed these changes. PRG4 also suppressed HS-induced mitochondrial disorders, as reflected by increased mitochondrial membrane potential (MMP), ATP and mitochondria cytochrome c, COXIV and TOM20, as well as decreased BNIP3L and cytoplasmic cytochrome c. Furthermore, HS led to enhanced oxidative stress, as evidenced by upregulated ROS and MDA contents, and downregulated SOD and CAT activities, and these alterations were negated by PRG4 overexpression. Notably, PRG4 repressed the NLRP3-mediated pyroptosis pathway, as illustrated by decreased NLRP3 levels, caspase-1 activity and GSDMD-NT levels. In summary, these observations indicate that PRG4 overexpression protects against HS-induced cardiac dysfunction by inhibiting mitochondrial dysregulation, oxidative stress and NLRP3-mediated pyroptosis.
Collapse
Affiliation(s)
- Wuming Zhou
- Department of Critical Care Medicine, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China
| | - Nan Wang
- Department of Critical Care Medicine, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China
| | - Sheng Dong
- Department of Emergency, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China
| | - Zhirong Huan
- Department of Critical Care Medicine, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China
| | - Lijun Sui
- Department of Cardiology, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China.
| | - Xin Ge
- Department of Critical Care Medicine, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China; Department of Emergency, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China; Orthopedic Institution of Wuxi City, Wuxi, Jiangsu 214000, People's Republic of China.
| |
Collapse
|
3
|
Rao T, Yang W, Ma X, Jiang X, Jiang S, Xu S. Bergapten attenuates hemorrhagic shock induced multi-organ injury by inhibiting NLRP3 inflammasome activation and pyroptosis. Int Immunopharmacol 2024; 140:112839. [PMID: 39126737 DOI: 10.1016/j.intimp.2024.112839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/20/2024] [Accepted: 07/28/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES Treatment of hemorrhagic shock (HS) induced multi-organ injury remains a challenge. Bergapten (BeG) is a bioactive coumarin-derived compound, and previous articles have suggested that BeG may serve as a prospective therapeutic modality for HS. This study was designed to investigate the efficacy of BeG in the treatment of HS and its underlying mechanisms. METHODS In this research, we established a rat model of HS, following which we assessed the protective effects of BeG on HS induced multi-organ injury. Subsequently, we scrutinized the activation of NLRP3 inflammasomes and pyroptosis in damaged organs. Additionally, we conducted examinations of AMPK and the downstream mitophagy pathway in damaged organs. Finally, we established a hypoxia/reoxygenation (H/R) model in HK-2 cells to simulate the in vitro HS process. Following AMPK inhibition with compound C, we evaluated the levels of mitophagy and cellular pyroptosis in BeG-treated HK-2 cells subjected to H/R. RESULTS BeG treatment alleviated HS induced multi-organ injury. Subsequent analyses indicated that the therapeutic effects of BeG were related to the attenuation of NLRP3 inflammasome activation and pyroptosis. Additionally, we found BeG treatment stimulated the phosphorylation of AMPK, thereby enhancing mitophagy. Lastly, we found that the inhibition of AMPK in vitro attenuates BeG's enhancement of mitophagy and its suppression of pyroptosis. CONCLUSION Our research indicates that BeG has the potential to alleviate multi-organ injury induced by HS. The protective effect of BeG is likely associated with its promotion of mitophagy through AMPK activation, thereby inhibiting NLRP3 inflammasome-mediated pyroptosis.
Collapse
Affiliation(s)
- Taiwen Rao
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Wei Yang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Ximei Ma
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Xiangkang Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China
| | - Shouyin Jiang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China.
| | - Shanxiang Xu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Zhejiang Provincial Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, China.
| |
Collapse
|
4
|
Miao S, Yang L, Xu T, Liu Z, Zhang Y, Ding L, Ding W, Ao X, Wang J. A novel circPIK3C2A/miR‐31‐5p/TFRC axis drives ferroptosis and accelerates myocardial injury. MedComm (Beijing) 2024; 5:e571. [PMID: 38840772 PMCID: PMC11151151 DOI: 10.1002/mco2.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/08/2024] [Accepted: 03/16/2024] [Indexed: 06/07/2024] Open
Abstract
Iron overload is common in cardiovascular disease, it is also the factor that drives ferroptosis. Noncoding RNAs play an important role in heart disease; however, their regulatory role in iron overload-mediated ferroptosis remains much unknown. In our study, the iron overload model in mice was constructed through a high-iron diet, and ammonium iron citrate treatment was used to mimic iron overload in vitro. We found iron overload induced ferroptosis in cardiomyocytes, which was dependent on the high expression of transferrin receptor (TFRC). MiR-31-5p was downregulated during iron overload; it inhibited cardiomyocyte ferroptosis by targeting TFRC. CircPIK3C2A, a highly expressed circRNA in the heart, was upregulated when iron was overloaded. CircPIK3C2A enhanced the expression of TFRC by sponging miR-31-5p and promoted ferroptosis during iron overload. Our results reveal a novel mechanistic insight into noncoding RNA-based ferroptosis and identify the circPIK3C2A/miR-31-5p/TFRC axis as a promising therapeutic target for myocardial damage.
Collapse
Affiliation(s)
- Shuo Miao
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Lanting Yang
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Tao Xu
- Central LaboratoryQingdao Agricultural UniversityQingdaoChina
| | - Zhantao Liu
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Yixiao Zhang
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Lin Ding
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Wei Ding
- Department of Comprehensive Internal MedicineAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xiang Ao
- School of Basic MedicineQingdao UniversityQingdaoChina
| | - Jianxun Wang
- School of Basic MedicineQingdao UniversityQingdaoChina
| |
Collapse
|
5
|
Li Q, Yang Q, Tian C, Guo Y, Liu H, Cheng Y, Bi SZ, Chen JH. Effects of different types of Ringer's solution on patients with traumatic haemorrhagic shock: a prospective cohort study. Eur J Med Res 2024; 29:215. [PMID: 38566152 PMCID: PMC10988935 DOI: 10.1186/s40001-024-01664-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/11/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To compare the fluid resuscitation effect of sodium acetate Ringer's solution and sodium bicarbonate Ringer's solution on patients with traumatic haemorrhagic shock. METHOD We conducted a prospective cohort study in our emergency department on a total of 71 patients with traumatic haemorrhagic shock admitted between 1 December 2020 and 28 February 2022. Based on the time of admission, patients were randomly divided into a sodium bicarbonate Ringer's solution group and sodium acetate Ringer's solution group, and a limited rehydration resuscitation strategy was adopted in both groups. General data were collected separately, and the patients' vital signs (body temperature, respiration, blood pressure and mean arterial pressure (MAP)), blood gas indices (pH, calculated bicarbonate (cHCO3-), partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (pCO2) and clearance of lactate (CLac)), shock indices, peripheral platelet counts, prothrombin times and plasma fibrinogen levels were measured and compared before and 1 h after resuscitation. RESULTS The post-resuscitation heart rate of the sodium bicarbonate Ringer's solution group was significantly lower than that of the sodium acetate Ringer's solution group (p < 0.05), and the MAP was also significantly lower (p < 0.05). The patients in the sodium bicarbonate Ringer's solution group had significantly higher pH, cHCO3- and PaO2 values and lower pCO2 and CLac values (p < 0.05) than those in the sodium acetate Ringer's solution group, and the post-resuscitation peripheral platelet counts and fibrinogen levels were significantly higher, with shorter plasma prothrombin times and smaller shock indices (p < 0.001). CONCLUSION Sodium bicarbonate Ringer's solution is beneficial for maintaining MAP at a low level after resuscitation. The use of sodium bicarbonate Ringer's solution in limited fluid resuscitation has positive results and is of high clinical value.
Collapse
Affiliation(s)
- Qing Li
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China.
| | - Qiang Yang
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Chao Tian
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Yao Guo
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Hui Liu
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Yadong Cheng
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Shu-Zhen Bi
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| | - Jin-Hua Chen
- Department of Emergency, Changzhi People's Hospital, No. 502 of Changxing Street, Luzhou District, Changzhi, 046000, China
| |
Collapse
|
6
|
Jin H, Huan Z, Wu Y, Yao H, Zhang L, Ge X. Lilrb4 ameliorates ileal injury in rats with hemorrhagic shock and suppresses the activation of NF-κB signaling pathway. Biochim Biophys Acta Mol Basis Dis 2024; 1870:167082. [PMID: 38367899 DOI: 10.1016/j.bbadis.2024.167082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
Hemorrhagic shock (HS) leads to intestinal damage and subsequent multiple organ dysfunction syndrome. Intestinal barrier dysfunction is the main cause of multiple organ failure associated with HS. Leukocyte immunoglobulin-like receptor B4 (Lilrb4) belongs to the Ig superfamily and is a vital natural immunomodulatory receptor. The purpose of this study was to identify the role and molecular mechanism of Lilrb4 in HS-induced ileal injury. In this work, HS was established by femoral artery cannula and 90 min of HS (blood pressure, 35-40 mmHg), followed by resuscitation. RNA sequencing analysis showed that Lilrb4 was highly expressed in the ileum of HS rats. As observed, HS rats exhibited severe ileal injury, characterized by enlarged subepithelial space, edema, exfoliation and extensive loss of villi. Whereas, lentivirus system-mediated Lilrb4 overexpression considerably mitigated these alterations. HS led to increased release of markers associated with intestinal injury, which was effectively reversed by Lilrb4 overexpression. In addition, after resuscitation, Lilrb4 overexpression inhibited HS-triggered inflammatory response, as evidenced by decreased levels of proinflammatory cytokines. Lilrb4 also inhibited the activation of NF-κB signal induced by HS. Notably, Lilrb4 modulated the balance of regulatory T (Treg)-T helper 17 (Th17) cells in the mesenteric lymph node (MLN), which may also contribute to its protective role in HS progression. In aggregate, these findings confirmed that Lilrb4 overexpression protected against ileal injury caused by HS, indicating that Lilrb4 may be a potential candidate for the treatment of HS.
Collapse
Affiliation(s)
- Hongdou Jin
- Department of General Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China
| | - Zhirong Huan
- Department of Critical Care Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China
| | - Yifeng Wu
- Department of General Surgery, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China
| | - Hao Yao
- Department of Critical Care Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China
| | - Leyao Zhang
- Department of Gastroenterology, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China.
| | - Xin Ge
- Department of Critical Care Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu 214000, People's Republic of China; Orthopedic Institution of Wuxi City, Wuxi, Jiangsu 214000, People's Republic of China.
| |
Collapse
|
7
|
Saviano A, Perotti C, Zanza C, Longhitano Y, Ojetti V, Franceschi F, Bellou A, Piccioni A, Jannelli E, Ceresa IF, Savioli G. Blood Transfusion for Major Trauma in Emergency Department. Diagnostics (Basel) 2024; 14:708. [PMID: 38611621 PMCID: PMC11011783 DOI: 10.3390/diagnostics14070708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Severe bleeding is the leading cause of death in patients with major trauma admitted to the emergency department. It is estimated that about 50% of deaths happen within a few minutes of the traumatic event due to massive hemorrhage; 30% of deaths are related to neurological dysfunction and typically happen within two days of trauma; and approximately 20% of patients died of multiorgan failure and sepsis within days to weeks of the traumatic event. Over the past ten years, there has been an increased understanding of the underlying mechanisms and pathophysiology associated with traumatic bleeding leading to improved management measures. Traumatic events cause significant tissue damage, with the potential for severe blood loss and the release of cytokines and hormones. They are responsible for systemic inflammation, activation of fibrinolysis pathways, and consumption of coagulation factors. As the final results of this (more complex in real life) cascade, patients can develop tissue hypoxia, acidosis, hypothermia, and severe coagulopathy, resulting in a rapid deterioration of general conditions with a high risk of mortality. Prompt and appropriate management of massive bleeding and coagulopathy in patients with trauma remains a significant challenge for emergency physicians in their daily clinical practice. Our review aims to explore literature studies providing evidence on the treatment of hemorrhage with blood support in patients with trauma admitted to the Emergency Department with a high risk of death. Advances in blood transfusion protocols, along with improvements in other resuscitation strategies, have become one of the most important issues to face and a key topic of recent clinical research in this field.
Collapse
Affiliation(s)
- Angela Saviano
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (A.S.); (F.F.)
| | - Cesare Perotti
- Division of Immunohaematology and Transfusion, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Christian Zanza
- Geriatric Medicine Residency Program, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Yaroslava Longhitano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA;
- Department of Emergency Medicine-Emergency Medicine Residency Program, Humanitas University-Research Hospital, 20089 Rozzano, Italy
| | | | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy; (A.S.); (F.F.)
- Università Cattolica, 00168 Roma, Italy; (V.O.); (A.P.)
| | - Abdelouahab Bellou
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA;
- Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | | | - Eugenio Jannelli
- Department of Orthopedics and Traumatology, Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | | | - Gabriele Savioli
- Department of Emergency Medicine, Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| |
Collapse
|
8
|
Liu Z, Zhou W, Liu Q, Huan Z, Wang Q, Ge X. Pachymic Acid Prevents Hemorrhagic Shock-Induced Cardiac Injury by Suppressing M1 Macrophage Polarization and NF-[Formula: see text]B Signaling Pathway. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2023; 51:2157-2173. [PMID: 37865871 DOI: 10.1142/s0192415x23500921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Hemorrhagic shock (HS) is the leading cause of death in trauma patients. Inflammation following HS can lead to cardiac damage. Pachymic acid (PA), a triterpenoid extracted from Poria cocos, has been found to possess various biological activities, including anti-inflammatory and anti-apoptotic properties. Our research aims to investigate the protective effects of PA against HS-induced heart damage and the underlying mechanisms involved. Male Sprague-Dawley rats were intraperitoneally injected with PA (7.5 or 15[Formula: see text]mg/kg) daily for three days. Subsequently, we created a rat model of HS by drawing blood through a catheter inserted into the femoral artery followed by resuscitation. The results revealed that HS led to abnormalities in hemodynamics, serum cardiac enzyme levels, and cardiac structure, as well as induced cardiac apoptosis. However, pretreatment with PA effectively alleviated these effects. PA-pretreatment also suppressed mRNA and protein levels of interleukin (IL)-1[Formula: see text], IL-6, and tumor necrosis factor [Formula: see text] (TNF-[Formula: see text]) in the heart tissues of HS rats. Additionally, PA-pretreatment reduced inflammatory cell infiltration and M1 macrophage polarization while exaggerating M2 polarization in HS rat hearts. The study observed a decreased proportion of the expression of of M1 macrophages (CD86[Formula: see text]) and their marker (iNOS), along with an increased proportion of the expression of M2 macrophages (CD206[Formula: see text]) and their marker (Arg-1). Notably, PA-pretreatment suppressed NF-[Formula: see text]B pathway activation via inhibiting NF-[Formula: see text]B p65 phosphorylation and its nuclear translocation. In conclusion, PA-pretreatment ameliorates HS-induced cardiac injury, potentially through its inhibition of the NF-[Formula: see text]B pathway. Therefore, PA treatment holds promise as a strategy for mitigating cardiac damage in HS.
Collapse
Affiliation(s)
- Zhenfeng Liu
- Department of Traditional Chinese Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University Wuxi, Jiangsu 214000, P. R. China
| | - Wuming Zhou
- Department of Critical Care Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University Wuxi, Jiangsu 214000, P. R. China
| | - Qingyang Liu
- Department of Clinical Laboratory, Wuxi 9th People's Hospital Affiliated to Soochow University Wuxi, Jiangsu 214000, P. R. China
| | - Zhirong Huan
- Department of Critical Care Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University Wuxi, Jiangsu 214000, P. R. China
| | - Qiubo Wang
- Department of Clinical Laboratory, Wuxi 9th People's Hospital Affiliated to Soochow University Wuxi, Jiangsu 214000, P. R. China
| | - Xin Ge
- Department of Critical Care Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University Wuxi, Jiangsu 214000, P. R. China
- Orthopedic Institution of Wuxi City, Wuxi, Jiangsu 214000, P. R. China
| |
Collapse
|
9
|
Vega Suarez L, Epstein SE, Martin LG, Davidow EB, Hoehne SN. Prevalence and factors associated with initial and subsequent shockable cardiac arrest rhythms and their association with patient outcomes in dogs and cats undergoing cardiopulmonary resuscitation: A RECOVER registry study. J Vet Emerg Crit Care (San Antonio) 2023; 33:520-533. [PMID: 37573256 DOI: 10.1111/vec.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/17/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To report the prevalence of initial shockable cardiac arrest rhythms (I-SHKR), incidence of subsequent shockable cardiac arrest rhythms (S-SHKR), and factors associated with I-SHKRs and S-SHKRs and explore their association with return of spontaneous circulation (ROSC) rates in dogs and cats undergoing CPR. DESIGN Multi-institutional prospective case series from 2016 to 2021, retrospectively analyzed. SETTING Eight university and eight private practice veterinary hospitals. ANIMALS A total of 457 dogs and 170 cats with recorded cardiac arrest rhythm and event outcome reported in the Reassessment Campaign on Veterinary Resuscitation CPR registry. MEASUREMENTS AND MAIN RESULTS Logistic regression was used to evaluate association of animal, hospital, and arrest variables with I-SHKRs and S-SHKRs and with patient outcomes. Odds ratios (ORs) were generated, and significance was set at P < 0.05. Of 627 animals included, 28 (4%) had I-SHKRs. Odds for I-SHKRs were significantly higher in animals with a metabolic cause of arrest (OR 7.61) and that received lidocaine (OR 17.50) or amiodarone (OR 21.22) and significantly lower in animals experiencing arrest during daytime hours (OR 0.22), in the ICU (OR 0.27), in the emergency room (OR 0.13), and out of hospital (OR 0.18) and that received epinephrine (OR 0.19). Of 599 initial nonshockable rhythms, 74 (12%) developed S-SHKRs. Odds for S-SHKRs were significantly higher in animals with higher body weight (OR 1.03), hemorrhage (OR 2.85), or intracranial cause of arrest (OR 3.73) and that received epinephrine (OR 11.36) or lidocaine (OR 18.72) and significantly decreased in those arresting in ICU (OR 0.27), emergency room (OR 0.29), and out of hospital (OR 0.38). Overall, 171 (27%) animals achieved ROSC, 81 (13%) achieved sustained ROSC, and 15 (2%) survived. Neither I-SHKRs nor S-SHKRs were significantly associated with ROSC. CONCLUSIONS I-SHKRs and S-SHKRs occur infrequently in dogs and cats undergoing CPR and are not associated with increased ROSC rates.
Collapse
Affiliation(s)
- Laura Vega Suarez
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Steven E Epstein
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Linda G Martin
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Elizabeth B Davidow
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Sabrina N Hoehne
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| |
Collapse
|
10
|
Du Z, Wang T. A bibliometric analysis of publications on trauma-related hemorrhagic shock from 2012 to 2022: Research landscape and future trends. Medicine (Baltimore) 2023; 102:e33814. [PMID: 37335729 DOI: 10.1097/md.0000000000033814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Trauma-related hemorrhagic shock is a global problem. This study aimed to analyze the knowledge domain and frontiers of trauma-related hemorrhagic shock research through a bibliometric analysis. Articles on trauma-related hemorrhagic shock published between 2012 and 2022 were retrieved from the Web of Science Core Collection, and a bibliometric analysis was conducted using CiteSpace and VOSviewer. A total of 3116 articles and reviews were analyzed. These publications primarily came from 441 institutions in 80 countries, with the USA having the highest number of publications, followed by China. Among the publications, Ernest E. Moore published the most papers, whereas John B. Holcomb had the most co-citations. The most productive institution was the University of Pittsburgh in the USA. The keyword burst and reference clustering analysis indicated that "reboa," "whole blood," "exsome," "glycocalyx," "endotheliopathy," and "predictor" are new trends and developing areas of interest. With the help of CiteSpace and VOSviewer, this study provides a deeper understanding of the research landscape, frontier hotspots, and future trends in trauma-related hemorrhagic shock over the last decade. "Whole blood" instead of "component therapy" shows potential advantage while "REBOA" is increasingly discussed in rapid hemostasis. This study provides important clues for researchers to understand the knowledge domain and frontiers of this study field.
Collapse
Affiliation(s)
- Zhe Du
- Trauma Center, Peking University People's Hospital, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration (Ministry of Education), Beijing, China
| | | |
Collapse
|
11
|
Marrone M, Bellantuono L, Stellacci A, Misceo F, Silvestre M, Zotti F, Dell’Erba A, Bellotti R. Haemorrhage and Survival Times: Medical-Legal Evaluation of the Time of Death and Relative Evidence. Diagnostics (Basel) 2023; 13:diagnostics13040732. [PMID: 36832220 PMCID: PMC9955172 DOI: 10.3390/diagnostics13040732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Haemorrhage is the name used to describe the loss of blood from damaged blood vessels (arteries, veins, capillaries). Identifying the time of haemorrhage remains a clinical challenge, knowing that blood perfusion of systemic tissues is poorly correlated with the perfusion of specific tissues. In forensic science, one of the most discussed elements is the time of death. This study aims to provide the forensic scientist with a valid model to establish a precise time-of-death interval in cases of exsanguination following trauma with vascular injury, which can be useful as a technical aid in the investigation of criminal cases. To calculate the calibre and resistance of the vessels, we used an extensive literature review of distributed one-dimensional models of the systemic arterial tree as a reference. We then arrived at a formula that allows us to estimate, based on a subject's total blood volume and the calibre of the injured vessel, a time interval within which a subject's death from haemorrhage from vascular injury falls. We applied the formula to four cases in which death had been caused by the injury of a single arterial vessel and obtained comforting results. The study model we have offered is only a good prospect for future work. In fact, we intend to improve the study by expanding the case and statistical analysis with particular regard to the interference factors to confirm its actual usability in practical cases; in this way, useful corrective factors can be identified.
Collapse
Affiliation(s)
- Maricla Marrone
- Dipartimento Interdisciplinare di Medicina, Legal Medicine Section, Università degli Studi di Bari Aldo Moro, I-70124 Bari, Italy
| | - Loredana Bellantuono
- Dipartimento di Biomedicina Traslazionale e Neuroscienze (DiBraiN), Università degli Studi di Bari Aldo Moro, I-70124 Bari, Italy
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70125 Bari, Italy
- Correspondence:
| | - Alessandra Stellacci
- Dipartimento Interdisciplinare di Medicina, Legal Medicine Section, Università degli Studi di Bari Aldo Moro, I-70124 Bari, Italy
| | - Federica Misceo
- Dipartimento Interdisciplinare di Medicina, Legal Medicine Section, Università degli Studi di Bari Aldo Moro, I-70124 Bari, Italy
| | - Maria Silvestre
- Dipartimento Interdisciplinare di Medicina, Legal Medicine Section, Università degli Studi di Bari Aldo Moro, I-70124 Bari, Italy
| | - Fiorenza Zotti
- Dipartimento Interdisciplinare di Medicina, Legal Medicine Section, Università degli Studi di Bari Aldo Moro, I-70124 Bari, Italy
| | - Alessandro Dell’Erba
- Dipartimento Interdisciplinare di Medicina, Legal Medicine Section, Università degli Studi di Bari Aldo Moro, I-70124 Bari, Italy
| | - Roberto Bellotti
- Istituto Nazionale di Fisica Nucleare, Sezione di Bari, I-70125 Bari, Italy
- Dipartimento Interateneo di Fisica, Università degli Studi di Bari Aldo Moro, I-70126 Bari, Italy
| |
Collapse
|
12
|
Construction of Standard Fast Medical Procedures for Traumatic Shock and Its Application Effects. Emerg Med Int 2022; 2022:2055925. [PMID: 36267142 PMCID: PMC9578901 DOI: 10.1155/2022/2055925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To explore the construction of standard fast medical procedures for traumatic shock and its application effects. Methods 84 patients with traumatic shock were admitted to emergency department of the hospital between January 2018 and January 2020. Using random number table method, the patients were divided into the control group (was given emergency treatment by routine emergency rescue procedures) and the study group (was given emergency treatment by standard fast medical procedures) with 42 patients in each group. The treatment time (rescue time, consultation time in each department, and examination time), shock index (SI), blood pressure fluctuation range, urine output, serum lactate (LAC) level, activated partial thromboplastin time (APTT), and international normalized ratio (INR) were recorded. The incidences of complications in the two groups within 3 days were counted. Results The rescue time, consultation time, and examination time of the study group were shorter than those of the control group (P < 0.05). After 18 h of treatment, the SI, blood pressure fluctuation range, LAC, and APTT in the study group were lower or shorter than those in the control group (P < 0.05), while urine volume and INR were higher than those in the control group (P < 0.05). Within 3 days of treatment, the incidence of complications in the study group was 5.41% lower than that in the control group which was 24.14% (P < 0.05). Conclusion Standard fast medical procedures can effectively shorten the time of each stage of emergency treatment for traumatic shock, which allows patients to receive effective treatment in the shortest time while improving shock symptoms and reducing related complications.
Collapse
|
13
|
Effects of Different Types of Early Restrictive Fluid Resuscitation on Immune Function and Multiorgan Damage on Hemorrhagic Shock Rat Model in a Hypothermic Environment. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4982047. [PMID: 35844441 PMCID: PMC9279086 DOI: 10.1155/2022/4982047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/25/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022]
Abstract
Objective This study was aimed at investigating the effects of different types of fluid restriction fluid resuscitation on the immune dysfunction and organ injury of hemorrhagic shock rats under a hypothermic environment. Methods SD rats were divided into sham operation group (SHAM), hemorrhagic shock model group (HS), crystal liquid limited resuscitation group (CRLLR), colloidal liquid limited resuscitation group (COLLR), and nonlimited resuscitation group (NLR); rats in each group were placed in a low-temperature environment of 0-5°C for 30 min, and then, a hemorrhagic shock rat model was prepared. Sodium lactate Ringer's restricted resuscitation solution, hydroxyethyl starch restricted resuscitation solution, and hydroxyethyl starch were used for resuscitation, and hemodynamic examination was performed. The mortality rate, inflammatory factors, oxidative stress factors, and immune function were detected by ELISA. The dysfunction and injury of the intestinal, lung, liver, and kidney were examined by histological methods. Results Hemorrhagic shock resulted in decreased immune function and activation of inflammation. Unrestricted fluid infusion further activated the inflammatory response. The crystalloid-restricted fluid infusion performed effectively to regulate inflammatory response, promote antioxidative activity, and reduce the immunosuppressive reaction. Rehydration could regulate the coagulation. The hydroxyethyl starch reduced the expression of platelet glycoproteins Ib and IIb/IIIa and blocked the binding of fibrinogen to activated platelets, thereby inhibiting intrinsic coagulation and platelet adhesion and aggregation. Rats in the CRLLR group showed to relieve the injury of the lung, liver, kidney, and intestine from hemorrhagic shock in low-temperature environment. Conclusion The early application of restrictive crystalloid resuscitation in hemorrhagic shock rats in hypothermic environment showed the best therapy results. Early LR-restrictive fluid replacement promotes the balance of inflammatory response and the recovery of immunosuppressive state, resists oxidative stress, stabilizes the balance of coagulation and fibrinolysis, improves coagulation function, and relieves organ injury.
Collapse
|