The rationale of albumin use lies in its potential to increase oncotic pressure and optimize tissue perfusion. Randomized trials have not demonstrated a survival benefit, and the effects of albumin on volemia remain unclear. This study investigates, in healthy pigs, the effects of a 48-h albumin infusion on intravascular fluid volume, albumin kinetics, and its impact on respiratory function. Thirty-nine healthy female pigs ventilated for 48h were grouped according to mechanical power (high ~ 18J/min vs. low ~ 6J/min) and type of fluid (5% albumin solution vs. crystalloid), generating four experimental groups: MPLOW-Crystalloid; MPLOW-Albumin; MPHIGH-Crystalloid; and MPHIGH-Albumin. Intravascular fluid volume was similar across groups (MPLOW-Crystalloid: 1.92 (± 0.38)L; MPHIGH-Crystalloid: 1.72 (± 0.40)L; MPLOW-Albumin: 1.86 (± 0.37)L; MPHIGH-Albumin: 2.10 (± 0.58)L; p 0.389). For the same mechanical power, the fraction of albumin lost from the plasma was higher in the albumin compared to the crystalloid groups (MPLOW-Albumin: 62 (± 13)% vs. MPLOW-Crystalloid: -16 (± 66)%; and MPHIGH-Albumin: 58 (± 24)% vs. MPHIGH-Crystalloid: 29 (± 14)%; p < 0.001). Albumin groups showed greater ascites (MPLOW-Crystalloid: 261 (± 380)mL; MPHIGH-Crystalloid: 144 (± 148)mL; MPLOW-Albumin: 710 (± 664)mL; MPHIGH-Albumin: 685 (± 651)mL; p 0.034), and worse end-expiratory lung gas volume and elastance, despite comparable histological damage. In our cohort, prolonged albumin infusion did not lead to a difference in intravascular fluid volume, but it resulted in the loss of ~ 60% of the infused albumin and ascites development. Ascites was associated with lower end-expiratory lung gas volume and higher elastance, despite similar histological lung damage across the groups.

Current cancer therapies for solid tumors are significantly hampered by the dense tumor extracellular matrix (ECM), which restricts antitumor drug penetration and accumulation. Hence, there is a critical need for controllable drug delivery systems capable of spatiotemporally controlling the sequential action of ECM-modulating agents and cytotoxic drugs. However, conventional carriers often suffer from "non-selective synchronous release", failing to achieve such spatiotemporal control. Herein, we propose a spatiotemporal antitumor regimen (STAR) based on a size-gated DNA supramolecular hydrogel (DSH) drug delivery system. In this system, a small-molecule drug Losartan (Los) and a larger indocyanine green-loaded platelet-mimetic particle (ICG/PLT) are co-encapsulated within the DSH. The programmable size-selectivity of DSH allows for the rapid diffusion of Los to first remodel tumor ECM by reducing matrix density and enhancing tissue perfusion; meanwhile, the larger ICG/PLT particles are retained within the hydrogel structure and released later along with hydrogel degradation. Notably, this size-gated sequential release strategy significantly enhances the accumulation of ICG/PLT at the tumor site, resulting in superior light-activated photodynamic therapeutic outcomes against tumors. Taken together, this study establishes a novel STAR paradigm based on size-gated DSH, holding promise to advance the therapeutic strategy for solid tumors with dense ECM.

BACKGROUND: Our previous studies demonstrated that administration of Cordyceps militaris (L.) Fr. biomass and culture fluid extracts resulted in significant changes in blood pressure and heart rate in rats. However, the effect of these fungal biotechnological products on microcirculation processes has not been studied. BACKGROUND: Our previous studies demonstrated that administration of Cordyceps militaris (L.) Fr. biomass and culture fluid extracts resulted in significant changes in blood pressure and heart rate in rats. However, the effect of these fungal biotechnological products on microcirculation processes has not been studied. AIM: To determine changes in microcirculation parameters in rats exposed to Cordyceps militaris (L.) Fr. mushroom extracts. METHODS: Group 1 served as a control group, Group 2 (ECG) received 0.5 ml of C. militaris culture fluid extract, and Group 3 (EBM) received 0.5 ml of Cordyceps militaris (L.) Fr. biomass extract. Microcirculation was studied using laser Doppler flowmetry using a Lazma-MC laser blood flow analyzer (version 2, manufactured by Lazma Research and Production Enterprise, Russia). Both non-oscillatory and oscillatory parameters of tissue microhemodynamics were recorded. RESULTS: Intraperitoneal administration of an extract of the in vitro-obtained mycelial biomass (EBM) of Cordyceps militaris (L.) Fr. resulted in a 30.3% increase in tissue perfusion (p=0.0026) due to increased endothelial metabolic activity, decreased sympathetic adrenergic pressor effects, and decreased precapillary sphincter and precapillary metarteriole tone due to the development of Ca2+-dependent muscle relaxation. This was evidenced by significant increases in all oscillatory and non-oscillatory parameters of microcirculation. With the administration of ECG Cordyceps militaris (L.) Fr., perfusion increased by 32.6% (p=0.0016), Ae - by 55% (p=0.0072), An - by 77.9% (p=0.0121), Am by - 82.1% (p=0.0099), and Ad - by 45.5% (p=0.0370) compared to those in the control group of animals, indicating the development of vasodilation. CONCLUSIONS: Thus, as analysis of the study results showed, the administration of C. militaris ECF and EBM to animals has a beneficial effect. led to an increase in endothelium-dependent vasodilation, a decrease in peripheral resistance, an increase in blood flow into the nutritional microvascular bed, and an improvement in venous outflow.

REBOA is a recognized rescue strategy in exsanguinating shock. Nevertheless, effects of partial- versus total-REBOA inflation on both macrocirculatory and microcirculatory splanchnic flows are not fully understood. Controlled hemorrhagic shock was induced in 18 landrace pigs. After 30 minutes of shock, animals were randomly allocated to receiving partial-REBOA (n = 6), total-REBOA (n = 6), or no-REBOA (n = 6). Resuscitation with whole blood was initiated 25 minutes after balloon inflation (in both REBOA groups) or attaining shock (in no-REBOA group). Thereafter, the balloon was progressively deflated according to hemodynamic tolerance. Aortic root, femoral, and end-diastolic left ventricular pressures were monitored throughout the experiment. Simultaneous carotid, supra-celiac abdominal aorta and superior mesenteric artery flows were recorded, while microvascular flows at jejunal-serosa and mucosa were assessed by laser Doppler flowmetry (LDF) and sidestream dark-field video-microscopy. Mesenteric-venous blood samples were drawn to measure blood gases and lactate levels. All macrohemodynamic and microhemodynamic parameters were followed up to 4 hours of completing REBOA deflation (or its equivalent-time in no-REBOA group). Total-REBOA group showed the highest increase in aortic-root and coronary perfusion pressures during inflation, but these decreased significantly during reperfusion period, compared with partial- and no-REBOA (p < 0.001). Partial- and total-REBOA groups showed significant decreases in superior mesenteric artery flow during reperfusion period compared with no-REBOA (p < 0.001). However, partial-REBOA allowed some flow during inflation while enabling significantly better jejunal-microvascular flow assessed by LDF during reperfusion period, when compared with total-REBOA (p = 0.048). The proportion of jejunal-villi with predominant continuous flow was significantly higher in partial- than total- or no-REBOA groups (p < 0.01). The total-REBOA group had higher arterial and mesenteric-venous lactate levels both during occlusion and reperfusion periods (p = <0.001; p = <0.001, respectively) when compared with partial-REBOA and no-REBOA groups. Partial-REBOA preserved regional-mesenteric and intestinal microcirculatory blood flow during both balloon occlusion and the early reperfusion period compared with total-REBOA. Partial-REBOA was also related with more favorable mesenteric venous pH and lactate values during balloon occlusion and reperfusion phases. Animal experiment; Level III.

AimsPeriprosthetic joint infection (PJI) represents one of the most severe complications following joint arthroplasty, often associated with a high recurrence rate despite appropriate therapeutic interventions. The underlying mechanisms contributing to this persistent risk remain incompletely understood. We hypothesize that alterations in joint capsule vascularization and fibrotic remodelling contribute to the pathophysiology of PJI and its recurrence.MethodsA total of 69 patients undergoing joint arthroplasty surgery were included in the study (21 controls: primary total knee arthroplasty (TKA), 22 PJI revision: explantation, and 26 PJI revision: prosthesis reimplantation after temporary arthrodesis). Each knee joint capsule specimen was analyzed using haematoxylin and eosin (HE) staining, Masson’s trichrome, Sirius red staining, immunofluorescence staining, and real-time quantitative polymerase chain reaction (RT-qPCR).ResultsMean vessel area, diameter, and perimeter were reduced in PJI specimens, despite an overall increase in the number of blood vessels. A significant reduction in smooth muscle cell (SMC) and pericyte layer thickness, along with decreased pericyte coverage of vessel walls, was observed following both explantation and reimplantation. Fibrotic remodelling, indicated by increased collagen deposition, was markedly elevated in PJI samples at both stages. Gene expression analysis revealed upregulation of PDGFB, MIG, MMP-9, and COL1A1 at explantation or reimplantation, while PDGFA and FN1 were downregulated at explantation and significantly upregulated at reimplantation. VEGFA and FGF-2 expression remained consistently suppressed.ConclusionPJI is associated with profound vascular remodelling and fibrotic transformation of the joint capsule, marked by aberrant angiogenesis, disrupted vessel architecture, and distinct gene expression profiles. These alterations may impair tissue perfusion, compromise immune surveillance, and hinder antibiotic delivery, thereby contributing to recurrent infection. Targeting soft-tissue vascularization and fibrosis may represent a novel therapeutic strategy to reduce PJI recurrence and enhance surgical outcomes.Cite this article: Bone Joint Res 2026;15(2):121–134.

To compare retinal vessel oxygen saturations and diameters before, 1 and 3 months after trabeculectomy. Retinal oxygen saturations and vessel diameters were obtained using retinal oximetry. The effect of the postoperative intraocular pressure (IOP) decrease on the arteriovenous difference (AV-difference) was evaluated, adjusting for mean defect (MD). The impact of trabeculectomy on AV-difference was compared between lowest (Q1) and highest (Q4) MD quartiles. Paired t-test, linear regression and Welch's t-test were applied. Of 72 enrolled participants, 64 eyes of 64 participants were included. Arteriolar oxygen saturations were unchanged (97.4 ± 4.9% preoperatively, 98.1 ± 6.0% 1 month [p = 0.053], 98.2 ± 6.8% 3 months postoperatively [p = 0.154]). Venular saturations were also unchanged (62.0 ± 9.5% preoperatively, 61.7 ± 8.0% 1 month [p = 0.505], 61.3 ± 10.6% 3 months postoperatively [p = 0.685]). No significant difference in AV-difference occurred. Arteriolar diameters were unchanged 1 month postoperatively (109.7 μm ± 16.2 vs. 110.9 μm ± 19.3 [p = 0.80]) but decreased to 106.0 μm ± 15.7 3 months postoperatively (p = 0.012). Venular diameters increased 1 month postoperatively (152.8 μm ± 21.3 vs. 147.7 μm ± 20.0 [p = 0.034]) but not 3 months postoperatively (148.6 μm ± 24.8; p = 0.893). No association between postoperative IOP decrease and postoperative MD-adjusted AV-difference was found (p = 0.380). No significant change in AV-difference between Q1 and Q4 (p = 0.18) was found. Retinal oxygen saturations remained stable, whereas vessel diameter changes occurred after trabeculectomy, probably reflecting alterations in IOP and perfusion pressure.

Insights from comparing blood perfusion metrics and Vancouver Scar Scale in keloid assessment.

Influence of pressure on mandibular angiosomes: What implications for decellularization?

Impaired placental vascular remodeling and persistent uNK cells in the RUPP model: A time-dependent perspective.

Deep learning approach for DCE-MRI parameter estimation: Evaluating signal intensity and concentration-time curve-based convolution-neural-networks.

Efficient delivery of mRNA to the bone marrow is crucial for maintaining immune homeostasis and understanding the pathogenesis of numerous disorders. However, achieving effective delivery remains challenging due to the low blood perfusion of bone tissue and the restrictive blood-bone marrow barrier. Conventional strategies for developing and screening bone-targeting carriers mainly rely on in vitro bone-binding assays and lack robust in situ evaluation tools. Here, we report a BODIPY-doped nanocarrier engineering (BONE) strategy that leverages NIR-II bioimaging for guided development and screening of mRNA delivery systems targeting the bone marrow. A library of NIR-II-emissive BODIPY dyes with intrinsic bone marrow tropism was doped onto lipid nanoparticles (LNPs) to construct BONE LNPs. Using NIR-II imaging, we achieve in situ, noninvasive, and real-time visualization of the bone-targeting capability of these LNPs prior to performing in vivo mRNA transfection studies. Among the formulations, BONE-2 LNPs demonstrate the highest bone accumulation at 24 h postinjection. Flow cytometry of bone marrow cells further reveal that BONE-2 LNPs preferentially localize to myeloid populations─including monocytes, macrophages, and dendritic cells─resulting in a 3.3-fold improvement in bone marrow mRNA transfection compared with a commercial LNP formulation. Together, this work establishes that integrating NIR-II BODIPY dyes into LNPs provides not only an effective strategy for targeted mRNA delivery to the bone marrow but also a generalizable framework for NIR-II imaging-guided screening of nanocarriers tailored to specific tissues.

The optimal target of mean arterial pressure (MAP) remains controversial in sepsis management. Critical closing pressure (Pcc), the arterial pressure at which blood flow ceases, is the key determinant of vascular waterfall phenomenon. Tissue perfusion pressure (TPP), the difference between MAP and Pcc, represents the driving pressure for arterial blood flow. This study evaluated the prognostic value of Pcc and TPP for improving risk stratification in sepsis. This retrospective cohort study included adult patients with sepsis in 18 hospitals between August 2013 to October 2022 from two independent data sets (the Study on the Epidemiology, Diagnosis and Treatment of Sepsis [SEPSIS-EDT] registry and the critical care database of Peking Union Medical College Hospital, Beijing, China). Pcc was estimated via linear regression of hourly MAP against product of heart rate and pulse pressure, while TPP was calculated as MAP minus Pcc. Patients were categorized into four groups based on the optimal thresholds for mean Pcc and TPP within 24 h of sepsis diagnosis: low TPP-low Pcc, low TPP-high Pcc, high TPP-low Pcc, and high TPP-high Pcc. Clinical outcomes included mortality rates and development of acute kidney injury within 2 and 7 days of sepsis diagnosis. External validation was performed using the Medical Information Mart for Intensive Care IV (MIMIC-IV) cohort. A total of 6,769 patients (mean age, 61 yr; 61.0% men) were included. Intensive care unit mortality was highest in the low TPP-low Pcc group and lowest in the high TPP-high Pcc group (35.1% vs . 20.1%; risk difference, 15.0%; 95% CI, 10.2 to 19.8%). Similar patterns were observed for other outcomes. After adjustment for MAP, increased Pcc with concomitant reduced TPP showed a significant U-shaped association with both mortality and acute kidney injury development ( P < 0.001). The findings were consistent in the MIMIC-IV cohort. While MAP remains central to sepsis management, Pcc and TPP provide complementary prognostic information. Incorporating these parameters into clinical assessment may improve risk stratification and optimize blood pressure management.

Generalized periodontitis (GP) is recognized as a significant risk factor for the development of coronary artery disease (CAD). Chronic infectious foci within the periodontal tissues contribute to systemic inflammation, accelerate atherogenesis, and promote the progression of atherosclerotic vascular lesions. Conversely, circulatory disorders characteristic of CAD impair tissue perfusion and oxygenation in the periodontium, leading to hypoxia and reduced regenerative capacity. Given the bidirectional aggravating relationship between GP and CAD, it is essential to investigate the clinical features of GP in the context of cardiac pathology and to account for local risk factors associated with periodontal disease. Such an approach is crucial for developing effective strategies to improve periodontal health in patients with CAD. Aim. To perform a comprehensive index-based assessment of periodontal tissue condition and individual oral hygiene in patients with CAD, followed by analysis of their clinical significance. Materials and Methods. Dental examinations were conducted in 114 patients with GP and CAD (main group). The comparison group included 35 patients with GP without CAD. Periodontal tissue status was evaluated using the following indices: PMA (Papillary-Marginal-Alveolar Index, M. Massler, modified by S. Parma, 1960) and the Gingival Bleeding Index (PBI, Mühlemann &amp; Saxer, 1977). Treatment needs were determined using the PSR screening test (Periodontal Screening and Recording, AAP and ADA, 1992). Oral hygiene status was assessed using the OHI-S (Oral Hygiene Index-Simplified, J.C. Green &amp; J.R. Vermillion, 1964). Results. Patients with GP and CAD demonstrated significantly higher PMA, PBI, and PSR scores compared with those with GP alone. The mean PMA value in the GP + CAD group was 63.27 ± 1.92%, indicating severe inflammation. In the comparison group, the PMA index reflected a moderate degree of gingival inflammation (43.32 ± 2.18%), which was significantly lower (p &lt; 0.001). The mean PBI score in patients with GP and CAD was 2.06 ± 0.08, significantly higher than in patients with GP without CAD (1.20 ± 0.08; p&lt;0.001). A more pronounced degree of periodontal tissue damage was also evident in the PSR index, which reached 3.30 ± 0.06 in the main group versus 3.01 ± 0.09 in the comparison group (p &lt; 0.01). No significant differences in oral hygiene status (OHI-S) were observed between groups (p &gt; 0.05). However, most CAD patients demonstrated “unsatisfactory” (27.19 ± 4.17%) or “poor” (53.50 ± 14.67%) oral hygiene. In the GP+CAD group, no significant gender differences were found in PMA and PSR scores (p &gt; 0.05). However, gingival bleeding measured by PBI was higher in men than in women (p &lt; 0.05), while individual oral hygiene was significantly better in women (p &lt; 0.01). Conclusion. The findings indicate that, against the background of poor oral hygiene, inflammatory changes in periodontal tissues are particularly pronounced in patients with GP when accompanied by atherosclerotic processes such as CAD.

Preeclampsia, a life-threatening hypertensive disorder of pregnancy, has been linked to iron dysregulation, though mechanistic insights remain limited. We integrated clinical data, a reduced uterine perfusion pressure mouse model, in vitro trophoblast cell experiments, and placental organoids derived from patients with preeclampsia. Iron metabolism was assessed via mass spectrometry, quantitative polymerase chain reaction, Peris' Prussian blue staining and immunohistochemistry. Ferroptosis markers and iron transporters were analyzed. Interventions included the iron chelator deferoxamine, antioxidant MitoQ, ferroptosis inhibitor Fer-1 (ferrostatin-1), and the apoptosis inhibitor Z-VAD. Patients with preeclampsia exhibited elevated hemoglobin, ferritin, and serum iron levels from the second trimester, alongside placental iron overload. Single-cell/nucleus RNA sequencing revealed dysregulated iron transporters (TFRC↑, DMT1↑, FPN↓) in preeclampsia trophoblasts. Iron overload induced ferroptosis and apoptosis in trophoblasts, evidenced by increased lipid peroxidation (4HNE↑, Gpx4↓), ROS, Tunnel staining positive and cell death, while suppressing PlGF and progesterone secretion. Both deferoxamine and MitoQ rescued these effects in vitro (similar to Ferr-1) and in preeclampsia-derived organoids. The reduced uterine perfusion pressure model confirmed the preservation of iron dyshomeostasis and ferroptosis in preeclamptic placentas, while oral administration of MitoQ was found to reduce 4-hydroxynonenal and malondialdehyde expression in placenta. Our findings reveal that iron overload and subsequent ferroptosis contribute to placental damage in preeclampsia, suggesting that iron metabolism dysregulation is a critical feature of the disease. This highlights the need to reevaluate iron supplementation protocols in high-risk pregnancies and to consider individualized iron management strategies that balance maternal-fetal iron requirements while minimizing oxidative stress.

To evaluate whether intra-arrest diastolic blood pressure (DBP) and coronary perfusion pressure (CPP) are associated with improved return of spontaneous circulation (ROSC) in cardiac arrest. A systematic search (PROSPERO registration: CRD420251042344) was conducted in English on EMBASE, MEDLINE, CINAHL and the Cochrane Library from inception to 1 May 2025. Grey literature sources (trial registries, conference abstracts, Google Scholar) were searched. Key resuscitation experts were contacted to identify unpublished or ongoing studies. The search strategy was peer-reviewed using the Peer Review of Electronic Search Strategies checklist. Eligible studies included randomised controlled trials (RCTs) contributing cohort data, observational studies and case series (≥10 patients) monitoring intra-arrest DBP or CPP in adult patients with cardiac arrest managed in prehospital or emergency department settings. Study selection involved two reviewers independently screening titles and abstracts, and full-text articles. Risk of bias was assessed using the Risk of Bias 2 and Risk of Bias in Non-randomised Studies of Interventions tools. This research received no funding. 15 studies (n=970 patients) across seven countries were included: 3 RCT-based prospective cohort studies and 12 observational studies. Meta-analysis was not performed due to heterogeneity in study designs. Aziz et al identified a DBP threshold of 35 mm Hg associated with ROSC (p<0.001), reporting a 5% increase in ROSC odds for every 1 mm Hg rise in DBP. This finding was supported by other observational studies reporting significantly higher maximum DBP values in patients with ROSC (34-56.5 mm Hg) compared with those without ROSC. Interventional studies aimed at augmenting DBP or CPP-including resuscitative endovascular balloon occlusion of the aorta-generally reported increases in ROSC, though studies were underpowered and at high risk of bias. This review demonstrates an association between intra-arrest DBP and CPP and ROSC. DBP may provide a feasible clinical target, but definitive thresholds and their impact on survival to hospital discharge remain undefined. CRD420251042344.

Research Objectives: To present the broadest available evidence regarding the safety and efficacy of ketamine in traumatic brain injury (TBI) and explain the evolution of clinical guidelines. This review aims to verify historical contraindications against current knowledge and demonstrate how ketamine's role has evolved from a contraindicated drug to a potentially beneficial therapeutic option in prehospital settings. Methods: Systematic analysis of clinical studies and systematic reviews examining ketamine's effects on cerebral hemodynamics, intracranial pressure (ICP), and cerebral perfusion pressure (CPP). Evaluation of ketamine's utility as an analgesic-sedative drug in prehospital TBI care, including assessment of safety profiles and clinical outcomes across civilian and military settings. Conclusions: Ketamine's effect on cerebral hemodynamics is at least neutral and often beneficial, contrary to historical concerns about increased ICP. The drug demonstrates high utility as a prehospital analgesic-sedative agent, providing effective pain control and sedation without compromising patient safety. Historical contraindications must be regularly re-verified in light of current evidence. Clinical guidelines have evolved significantly, reflecting growing recognition that proper ventilation control and hemodynamic monitoring eliminate previous safety concerns. Current evidence supports ketamine as a safe and potentially advantageous therapeutic option in prehospital TBI management, particularly for achieving rapid sequence intubation, maintaining hemodynamic stability, and preventing secondary brain injury in emergency settings.

Intraocular pressure (IOP) exhibits significant fluctuations in response to changes in body posture. Postural modification may serve as a potential adjunctive strategy for IOP management in glaucoma patients. A total of 144 patients with glaucoma were enrolled in this study. IOP was measured and compared between the high-pillow position (head elevated by 20-35° using two pillows) and the supine position. Additionally, changes in jugular venous lumen in response to postural variation were evaluated via ultrasonography in 20 healthy volunteers. Compared with the supine position, the high-pillow position was associated with significantly elevated IOP, increased 24-hour IOP fluctuation and reduced ocular perfusion pressure (OPP) (all p<0.001). Greater postural IOP fluctuation (ΔIOP) was observed in younger individuals (p=0.027) and patients with primary open-angle glaucoma (POAG) (p<0.001). Multiple regression analysis identified thicker central corneal thickness and the presence of POAG (vs normal-tension glaucoma) as positive predictors of larger ΔIOP changes (both p<0.05). Ultrasonography in healthy volunteers revealed significant constriction of both internal and external jugular venous lumen in the high-pillow position (all p<0.001), accompanied by an increase in maximum blood flow velocity of the internal jugular vein (p=0.013). Compared with the supine position, the high-pillow position is associated with increased IOP and decreased OPP in patients with glaucoma, which may be linked to jugular venous compression. Patients with glaucoma may benefit from avoiding sleeping postures that induce jugular venous compression to mitigate postural IOP elevation, though further studies are needed to validate these preliminary associations.

Background: Shock is a life-threatening paediatric emergency marked by inadequate tissue perfusion and rapid progression to organ failure if untreated. Mortality remains high in low- and middle-income countries, where delayed recognition and limited resources hinder optimal care. Septic and hypovolaemic shock predominate in sub-Saharan Africa, often driven by infectious diseases and malnutrition. Understanding local patterns is essential for improving early detection and treatment. Therefore, the study aimed to describe the clinical features, management practices and factors associated with mortality among children admitted with shock to the Children’s Emergency Ward of Federal Medical Centre, Yenagoa. Methods: A retrospective review of children admitted with shock between January 2018 and December 2022 was conducted. Case notes were examined for demographic data, presenting features, laboratory findings, type of shock, interventions and outcomes. Data were analysed using SPSS version 26. Associations were assessed using Chi-square or Fisher’s exact test. Results: Fifty-four cases were identified among 4,453 admissions. Septic shock was the most common type. Severe malnutrition, hypoglycaemia, anaemia, electrolyte derangements, leukocytosis and low oxygen saturation were significantly associated with mortality. Use of intraosseous access and inotropes was linked with poor outcomes, while fluid-only resuscitation had the best survival. All deaths occurred within 48 hours. Conclusions: Septic shock remains the dominant and most fatal form of paediatric shock in this setting. Early recognition, prompt resuscitation and strengthened emergency care systems are critical to improving outcomes.

BACKGROUNDSeptic shock disrupts systemic and organ-specific microcirculation, leading to poor tissue perfusion and impaired healing. While mesenteric hemodynamics have been studied, the impact of sepsis on intestinal microcirculation and anastomotic healing remains unclear.AIMTo assess the short-term effects of septic shock on microcirculation in the small intestine and colon, with a focus on hand-sewn and stapled anastomoses, using laser speckle contrast imaging (LSCI).METHODSTen pigs underwent midline laparotomy with the creation of four anastomoses: One hand-sewn and one stapled anastomosis in both the small intestine and colon. LSCI measurements were taken before anastomosis formation (TB), immediately after (TA), and after one hour of rest (T0). Septic shock was induced via intravenous Escherichia coli infusion, with subsequent LSCI measurements at 30-minute intervals (T30-T150). Results were expressed as relative changes compared to TB.RESULTSSeptic shock significantly reduced microcirculation in both untouched intestine and anastomoses. Hand-sewn anastomoses consistently exhibited higher perfusion than stapled anastomoses. At T150, perfusion in hand-sewn anastomoses remained significantly higher than in stapled anastomoses (51% vs 34% of TB, P = 0.002).CONCLUSIONThis study shows that septic shock significantly impairs intestinal microcirculation indicating a risk of intestinal ischemia if bacteriaemia and subsequent septic shock is untreated. Due to diminish blood flow following septic shock, the anastomotic healing may be compromised leading to increased risk of anastomotic leakage. Conclusively, this study provides a foundation for optimizing surgical strategies and improving patient outcomes in this high-risk population.

Perfusion imaging is extensively utilized to assess hemodynamic status and tissue perfusion in various organs. Computed tomography perfusion (CTP) imaging plays a key role in the early assessment and planning of stroke treatment. While CTP provides essential perfusion parameters to identify abnormal blood flow in the brain, the use of contrast agents in CTP can lead to allergic reactions and adverse side effects, along with costing USD 4.9 billion worldwide in 2022. To address these challenges, we propose a novel deep learning framework called Multitask Automated Generation of Intermodal CT perfusion maps (MAGIC). This framework combines generative artificial intelligence and physiological information to map non-contrast computed tomography (CT) imaging to multiple contrast-free CTP imaging maps. We demonstrate enhanced image fidelity by incorporating physiological characteristics into the loss terms. Our network was trained and validated using CT image data from patients referred for stroke at UF Health and demonstrated robustness to abnormalities in brain perfusion activity. A double-blinded study was conducted involving seven experienced neuroradiologists and vascular neurologists. This study validated MAGIC's visual quality and diagnostic accuracy showing favorable performance compared to clinical perfusion imaging with intravenous contrast injection. Overall, MAGIC holds great promise in revolutionizing healthcare by offering contrast-free, cost-effective, and rapid perfusion imaging.