Loading…

Plasma levels of microRNA are altered with the development of shock in human sepsis: an observational study

Endothelial dysfunction plays a critical role in the development of sepsis-related organ failure; however, the mechanisms that govern its development are not fully understood. Endothelial progenitor cells (EPCs) reduce vascular leak and organ failure in experimental sepsis while modulating plasma ex...

Full description

Saved in:
Bibliographic Details
Published in:Critical care (London, England) England), 2015-12, Vol.19 (440), p.440-440, Article 440
Main Authors: Goodwin, Andrew J, Guo, Changrun, Cook, James A, Wolf, Bethany, Halushka, Perry V, Fan, Hongkuan
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c494t-de593cbbab51abace5d513c1581467dcd24da81f519a29cf2093ca9a3ffbb1983
cites cdi_FETCH-LOGICAL-c494t-de593cbbab51abace5d513c1581467dcd24da81f519a29cf2093ca9a3ffbb1983
container_end_page 440
container_issue 440
container_start_page 440
container_title Critical care (London, England)
container_volume 19
creator Goodwin, Andrew J
Guo, Changrun
Cook, James A
Wolf, Bethany
Halushka, Perry V
Fan, Hongkuan
description Endothelial dysfunction plays a critical role in the development of sepsis-related organ failure; however, the mechanisms that govern its development are not fully understood. Endothelial progenitor cells (EPCs) reduce vascular leak and organ failure in experimental sepsis while modulating plasma expression of microRNA (miRNA). MicroRNAs are small, noncoding segments of RNA that regulate gene expression and are known to modulate endothelial cell function and inflammatory signaling pathways. We hypothesized that miRNA may play an etiologic role in the endothelial dysfunction of sepsis and that their extracellular expression levels would be altered in those with shock. Thirteen miRNAs were identified by literature search and analysis of the contents of human EPC-derived exosomes using real-time PCR. Plasma samples were obtained from patients within 24 hours of their admission to ICUs with severe sepsis (n = 62) and from healthy controls (n = 32) and real-time PCR was used to measure the expression of the candidate miRNAs. The Wilcoxon rank sum test was used to compare expression levels of the 13 candidate miRNAs in septic patients with (n = 29) and without (n = 33) shock while logistic regression was used to determine the area under the curve for associations between miRNA expression and shock. Bioinformatic analyses using miRNA databases were performed to identify pathways and gene targets of differentially expressed miRNA with potential relevance to sepsis-related shock. MiRNA-34a expression was significantly increased in the group who developed shock (p = 0.03) while miR-15a and miR-27a expressions were significantly decreased in this group (p = 0.006 and 0.03, respectively). The combined expression of these three miRNAs predicted shock with an area under the curve of 0.78 (95 % CI 0.66-0.90). In silico analyses predict that these three miRNAs regulate genes involved in endothelial cell cycle, apoptosis, VEGF signaling, LPS-stimulated MAPK signaling, and nuclear factor kappa B signaling. The plasma levels of miRNA are altered in patients with severe sepsis complicated by shock and may offer prognostic value as well as insights into the mechanisms of endothelial dysfunction in sepsis.
doi_str_mv 10.1186/s13054-015-1162-8
format article
fullrecord <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4699334</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A451670074</galeid><sourcerecordid>A451670074</sourcerecordid><originalsourceid>FETCH-LOGICAL-c494t-de593cbbab51abace5d513c1581467dcd24da81f519a29cf2093ca9a3ffbb1983</originalsourceid><addsrcrecordid>eNptUk1v1DAQjRCIlsIP4IIsceGSkoljJ-aAtKr4kipACCRu1sSedN068WIni_rvcbSlUIR88Mh-82bezCuKp1CdAnTyZQJeiaasQJQAsi67e8UxNFKWslLf7-eYy6bsBBdHxaOULqsK2k7yh8VRLWXH60odF1efPaYRmac9-cTCwEZnYvjyccMwEkM_UyTLfrp5y-YtMbviwm6kaV7BaRvMFXMT2y4jTizRLrn0iuUw9IniHmcXJvQszYu9flw8GNAnenJznxTf3r75eva-PP_07sPZ5rw0jWrm0pJQ3PQ99gKwR0PCCuAGRJe1tdbYurHYwSBAYa3MkHVwgwr5MPQ9qI6fFK8PvLulH8ma3GtEr3fRjRivdUCn7_5Mbqsvwl43UinOm0zw4oYghh8LpVmPLhnyHicKS9LQCgCVu1QZ-vwf6GVYYpacUUrknttOiD-oC_Sk3TSEXNespHrTCJBtVbVr2dP_oPKxlJcSJhpcfr-TAIeEvLGUIg23GqHSq0P0wSE6O0SvDtHrcJ79PZzbjN-W4L8Ae0K3jQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1951587855</pqid></control><display><type>article</type><title>Plasma levels of microRNA are altered with the development of shock in human sepsis: an observational study</title><source>Open Access: PubMed Central</source><source>ProQuest - Publicly Available Content Database</source><creator>Goodwin, Andrew J ; Guo, Changrun ; Cook, James A ; Wolf, Bethany ; Halushka, Perry V ; Fan, Hongkuan</creator><creatorcontrib>Goodwin, Andrew J ; Guo, Changrun ; Cook, James A ; Wolf, Bethany ; Halushka, Perry V ; Fan, Hongkuan</creatorcontrib><description>Endothelial dysfunction plays a critical role in the development of sepsis-related organ failure; however, the mechanisms that govern its development are not fully understood. Endothelial progenitor cells (EPCs) reduce vascular leak and organ failure in experimental sepsis while modulating plasma expression of microRNA (miRNA). MicroRNAs are small, noncoding segments of RNA that regulate gene expression and are known to modulate endothelial cell function and inflammatory signaling pathways. We hypothesized that miRNA may play an etiologic role in the endothelial dysfunction of sepsis and that their extracellular expression levels would be altered in those with shock. Thirteen miRNAs were identified by literature search and analysis of the contents of human EPC-derived exosomes using real-time PCR. Plasma samples were obtained from patients within 24 hours of their admission to ICUs with severe sepsis (n = 62) and from healthy controls (n = 32) and real-time PCR was used to measure the expression of the candidate miRNAs. The Wilcoxon rank sum test was used to compare expression levels of the 13 candidate miRNAs in septic patients with (n = 29) and without (n = 33) shock while logistic regression was used to determine the area under the curve for associations between miRNA expression and shock. Bioinformatic analyses using miRNA databases were performed to identify pathways and gene targets of differentially expressed miRNA with potential relevance to sepsis-related shock. MiRNA-34a expression was significantly increased in the group who developed shock (p = 0.03) while miR-15a and miR-27a expressions were significantly decreased in this group (p = 0.006 and 0.03, respectively). The combined expression of these three miRNAs predicted shock with an area under the curve of 0.78 (95 % CI 0.66-0.90). In silico analyses predict that these three miRNAs regulate genes involved in endothelial cell cycle, apoptosis, VEGF signaling, LPS-stimulated MAPK signaling, and nuclear factor kappa B signaling. The plasma levels of miRNA are altered in patients with severe sepsis complicated by shock and may offer prognostic value as well as insights into the mechanisms of endothelial dysfunction in sepsis.</description><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1364-8535</identifier><identifier>EISSN: 1366-609X</identifier><identifier>DOI: 10.1186/s13054-015-1162-8</identifier><identifier>PMID: 26683209</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Analysis ; Apoptosis ; Blood ; Cancer ; Care and treatment ; Cell cycle ; Complications and side effects ; Critical care ; Endothelial Cells - metabolism ; Female ; Gene expression ; Homeostasis ; Humans ; Influence ; Kidneys ; Kinases ; Male ; MicroRNA ; MicroRNAs ; MicroRNAs - analysis ; MicroRNAs - blood ; Middle Aged ; Observational studies ; Pathogenesis ; Permeability ; Plasma ; Plasma - metabolism ; Prognosis ; Sepsis ; Shock, Septic - complications ; Shock, Septic - etiology ; Shock, Septic - metabolism ; Shock, Septic - pathology ; Vascular endothelial growth factor</subject><ispartof>Critical care (London, England), 2015-12, Vol.19 (440), p.440-440, Article 440</ispartof><rights>COPYRIGHT 2015 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2015</rights><rights>Goodwin et al. 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-de593cbbab51abace5d513c1581467dcd24da81f519a29cf2093ca9a3ffbb1983</citedby><cites>FETCH-LOGICAL-c494t-de593cbbab51abace5d513c1581467dcd24da81f519a29cf2093ca9a3ffbb1983</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699334/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1951587855?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,315,733,786,790,891,25783,27957,27958,37047,37048,44625,53827,53829</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26683209$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Goodwin, Andrew J</creatorcontrib><creatorcontrib>Guo, Changrun</creatorcontrib><creatorcontrib>Cook, James A</creatorcontrib><creatorcontrib>Wolf, Bethany</creatorcontrib><creatorcontrib>Halushka, Perry V</creatorcontrib><creatorcontrib>Fan, Hongkuan</creatorcontrib><title>Plasma levels of microRNA are altered with the development of shock in human sepsis: an observational study</title><title>Critical care (London, England)</title><addtitle>Crit Care</addtitle><description>Endothelial dysfunction plays a critical role in the development of sepsis-related organ failure; however, the mechanisms that govern its development are not fully understood. Endothelial progenitor cells (EPCs) reduce vascular leak and organ failure in experimental sepsis while modulating plasma expression of microRNA (miRNA). MicroRNAs are small, noncoding segments of RNA that regulate gene expression and are known to modulate endothelial cell function and inflammatory signaling pathways. We hypothesized that miRNA may play an etiologic role in the endothelial dysfunction of sepsis and that their extracellular expression levels would be altered in those with shock. Thirteen miRNAs were identified by literature search and analysis of the contents of human EPC-derived exosomes using real-time PCR. Plasma samples were obtained from patients within 24 hours of their admission to ICUs with severe sepsis (n = 62) and from healthy controls (n = 32) and real-time PCR was used to measure the expression of the candidate miRNAs. The Wilcoxon rank sum test was used to compare expression levels of the 13 candidate miRNAs in septic patients with (n = 29) and without (n = 33) shock while logistic regression was used to determine the area under the curve for associations between miRNA expression and shock. Bioinformatic analyses using miRNA databases were performed to identify pathways and gene targets of differentially expressed miRNA with potential relevance to sepsis-related shock. MiRNA-34a expression was significantly increased in the group who developed shock (p = 0.03) while miR-15a and miR-27a expressions were significantly decreased in this group (p = 0.006 and 0.03, respectively). The combined expression of these three miRNAs predicted shock with an area under the curve of 0.78 (95 % CI 0.66-0.90). In silico analyses predict that these three miRNAs regulate genes involved in endothelial cell cycle, apoptosis, VEGF signaling, LPS-stimulated MAPK signaling, and nuclear factor kappa B signaling. The plasma levels of miRNA are altered in patients with severe sepsis complicated by shock and may offer prognostic value as well as insights into the mechanisms of endothelial dysfunction in sepsis.</description><subject>Adult</subject><subject>Analysis</subject><subject>Apoptosis</subject><subject>Blood</subject><subject>Cancer</subject><subject>Care and treatment</subject><subject>Cell cycle</subject><subject>Complications and side effects</subject><subject>Critical care</subject><subject>Endothelial Cells - metabolism</subject><subject>Female</subject><subject>Gene expression</subject><subject>Homeostasis</subject><subject>Humans</subject><subject>Influence</subject><subject>Kidneys</subject><subject>Kinases</subject><subject>Male</subject><subject>MicroRNA</subject><subject>MicroRNAs</subject><subject>MicroRNAs - analysis</subject><subject>MicroRNAs - blood</subject><subject>Middle Aged</subject><subject>Observational studies</subject><subject>Pathogenesis</subject><subject>Permeability</subject><subject>Plasma</subject><subject>Plasma - metabolism</subject><subject>Prognosis</subject><subject>Sepsis</subject><subject>Shock, Septic - complications</subject><subject>Shock, Septic - etiology</subject><subject>Shock, Septic - metabolism</subject><subject>Shock, Septic - pathology</subject><subject>Vascular endothelial growth factor</subject><issn>1364-8535</issn><issn>1466-609X</issn><issn>1364-8535</issn><issn>1366-609X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNptUk1v1DAQjRCIlsIP4IIsceGSkoljJ-aAtKr4kipACCRu1sSedN068WIni_rvcbSlUIR88Mh-82bezCuKp1CdAnTyZQJeiaasQJQAsi67e8UxNFKWslLf7-eYy6bsBBdHxaOULqsK2k7yh8VRLWXH60odF1efPaYRmac9-cTCwEZnYvjyccMwEkM_UyTLfrp5y-YtMbviwm6kaV7BaRvMFXMT2y4jTizRLrn0iuUw9IniHmcXJvQszYu9flw8GNAnenJznxTf3r75eva-PP_07sPZ5rw0jWrm0pJQ3PQ99gKwR0PCCuAGRJe1tdbYurHYwSBAYa3MkHVwgwr5MPQ9qI6fFK8PvLulH8ma3GtEr3fRjRivdUCn7_5Mbqsvwl43UinOm0zw4oYghh8LpVmPLhnyHicKS9LQCgCVu1QZ-vwf6GVYYpacUUrknttOiD-oC_Sk3TSEXNespHrTCJBtVbVr2dP_oPKxlJcSJhpcfr-TAIeEvLGUIg23GqHSq0P0wSE6O0SvDtHrcJ79PZzbjN-W4L8Ae0K3jQ</recordid><startdate>20151218</startdate><enddate>20151218</enddate><creator>Goodwin, Andrew J</creator><creator>Guo, Changrun</creator><creator>Cook, James A</creator><creator>Wolf, Bethany</creator><creator>Halushka, Perry V</creator><creator>Fan, Hongkuan</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20151218</creationdate><title>Plasma levels of microRNA are altered with the development of shock in human sepsis: an observational study</title><author>Goodwin, Andrew J ; Guo, Changrun ; Cook, James A ; Wolf, Bethany ; Halushka, Perry V ; Fan, Hongkuan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-de593cbbab51abace5d513c1581467dcd24da81f519a29cf2093ca9a3ffbb1983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Analysis</topic><topic>Apoptosis</topic><topic>Blood</topic><topic>Cancer</topic><topic>Care and treatment</topic><topic>Cell cycle</topic><topic>Complications and side effects</topic><topic>Critical care</topic><topic>Endothelial Cells - metabolism</topic><topic>Female</topic><topic>Gene expression</topic><topic>Homeostasis</topic><topic>Humans</topic><topic>Influence</topic><topic>Kidneys</topic><topic>Kinases</topic><topic>Male</topic><topic>MicroRNA</topic><topic>MicroRNAs</topic><topic>MicroRNAs - analysis</topic><topic>MicroRNAs - blood</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Pathogenesis</topic><topic>Permeability</topic><topic>Plasma</topic><topic>Plasma - metabolism</topic><topic>Prognosis</topic><topic>Sepsis</topic><topic>Shock, Septic - complications</topic><topic>Shock, Septic - etiology</topic><topic>Shock, Septic - metabolism</topic><topic>Shock, Septic - pathology</topic><topic>Vascular endothelial growth factor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Goodwin, Andrew J</creatorcontrib><creatorcontrib>Guo, Changrun</creatorcontrib><creatorcontrib>Cook, James A</creatorcontrib><creatorcontrib>Wolf, Bethany</creatorcontrib><creatorcontrib>Halushka, Perry V</creatorcontrib><creatorcontrib>Fan, Hongkuan</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest - Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Goodwin, Andrew J</au><au>Guo, Changrun</au><au>Cook, James A</au><au>Wolf, Bethany</au><au>Halushka, Perry V</au><au>Fan, Hongkuan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plasma levels of microRNA are altered with the development of shock in human sepsis: an observational study</atitle><jtitle>Critical care (London, England)</jtitle><addtitle>Crit Care</addtitle><date>2015-12-18</date><risdate>2015</risdate><volume>19</volume><issue>440</issue><spage>440</spage><epage>440</epage><pages>440-440</pages><artnum>440</artnum><issn>1364-8535</issn><eissn>1466-609X</eissn><eissn>1364-8535</eissn><eissn>1366-609X</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Undefined-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><abstract>Endothelial dysfunction plays a critical role in the development of sepsis-related organ failure; however, the mechanisms that govern its development are not fully understood. Endothelial progenitor cells (EPCs) reduce vascular leak and organ failure in experimental sepsis while modulating plasma expression of microRNA (miRNA). MicroRNAs are small, noncoding segments of RNA that regulate gene expression and are known to modulate endothelial cell function and inflammatory signaling pathways. We hypothesized that miRNA may play an etiologic role in the endothelial dysfunction of sepsis and that their extracellular expression levels would be altered in those with shock. Thirteen miRNAs were identified by literature search and analysis of the contents of human EPC-derived exosomes using real-time PCR. Plasma samples were obtained from patients within 24 hours of their admission to ICUs with severe sepsis (n = 62) and from healthy controls (n = 32) and real-time PCR was used to measure the expression of the candidate miRNAs. The Wilcoxon rank sum test was used to compare expression levels of the 13 candidate miRNAs in septic patients with (n = 29) and without (n = 33) shock while logistic regression was used to determine the area under the curve for associations between miRNA expression and shock. Bioinformatic analyses using miRNA databases were performed to identify pathways and gene targets of differentially expressed miRNA with potential relevance to sepsis-related shock. MiRNA-34a expression was significantly increased in the group who developed shock (p = 0.03) while miR-15a and miR-27a expressions were significantly decreased in this group (p = 0.006 and 0.03, respectively). The combined expression of these three miRNAs predicted shock with an area under the curve of 0.78 (95 % CI 0.66-0.90). In silico analyses predict that these three miRNAs regulate genes involved in endothelial cell cycle, apoptosis, VEGF signaling, LPS-stimulated MAPK signaling, and nuclear factor kappa B signaling. The plasma levels of miRNA are altered in patients with severe sepsis complicated by shock and may offer prognostic value as well as insights into the mechanisms of endothelial dysfunction in sepsis.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>26683209</pmid><doi>10.1186/s13054-015-1162-8</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1364-8535
ispartof Critical care (London, England), 2015-12, Vol.19 (440), p.440-440, Article 440
issn 1364-8535
1466-609X
1364-8535
1366-609X
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4699334
source Open Access: PubMed Central; ProQuest - Publicly Available Content Database
subjects Adult
Analysis
Apoptosis
Blood
Cancer
Care and treatment
Cell cycle
Complications and side effects
Critical care
Endothelial Cells - metabolism
Female
Gene expression
Homeostasis
Humans
Influence
Kidneys
Kinases
Male
MicroRNA
MicroRNAs
MicroRNAs - analysis
MicroRNAs - blood
Middle Aged
Observational studies
Pathogenesis
Permeability
Plasma
Plasma - metabolism
Prognosis
Sepsis
Shock, Septic - complications
Shock, Septic - etiology
Shock, Septic - metabolism
Shock, Septic - pathology
Vascular endothelial growth factor
title Plasma levels of microRNA are altered with the development of shock in human sepsis: an observational study
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-09-22T01%3A49%3A25IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Plasma%20levels%20of%20microRNA%20are%20altered%20with%20the%20development%20of%20shock%20in%20human%20sepsis:%20an%20observational%20study&rft.jtitle=Critical%20care%20(London,%20England)&rft.au=Goodwin,%20Andrew%20J&rft.date=2015-12-18&rft.volume=19&rft.issue=440&rft.spage=440&rft.epage=440&rft.pages=440-440&rft.artnum=440&rft.issn=1364-8535&rft.eissn=1466-609X&rft_id=info:doi/10.1186/s13054-015-1162-8&rft_dat=%3Cgale_pubme%3EA451670074%3C/gale_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c494t-de593cbbab51abace5d513c1581467dcd24da81f519a29cf2093ca9a3ffbb1983%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1951587855&rft_id=info:pmid/26683209&rft_galeid=A451670074&rfr_iscdi=true