101
|
Zhao WC, Zhang B, Liao MJ, Zhang WX, He WY, Wang HB, Yang CX. Curcumin ameliorated diabetic neuropathy partially by inhibition of NADPH oxidase mediating oxidative stress in the spinal cord. Neurosci Lett 2013; 560:81-5. [PMID: 24370596 DOI: 10.1016/j.neulet.2013.12.019] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/16/2013] [Accepted: 12/10/2013] [Indexed: 11/28/2022]
Abstract
Nicotinamide adenine dinucleotide phosphate (NADPH) oxidases are the main enzymes that produce oxidative stress, which plays an important role in painful diabetic neuropathy. Curcumin has been reported to exert an antinociceptive effect in a rat model of diabetic neuropathy by suppressing oxidative stress in the spinal cord. However, it remains unknown whether the mechanism by which curcumin ameliorates diabetic neuropathy can be attributed to spinal NADPH oxidases. This study was designed to determine the effect of curcumin on diabetic neuropathy and to investigate its precise mechanism in relation to NADPH oxidase-mediating oxidative stress in the spinal cord. Diabetic neuropathy was induced in Sprague-Dawley rats by intraperitoneal injection with 1% streptozotocin (STZ; 60 mg/kg). After the onset of diabetic neuropathy, a subset of the diabetic rats received daily intragastric administrations of curcumin (200mg/kg) or intraperitoneal injections of apocynin (2.5mg/kg) for 14 consecutive days, whereas other diabetic rats received equivalent volumes of normal saline (NS). STZ resulted in diabetic neuropathy with hyperglycemia and a lower paw withdrawal threshold (PWT), accompanied by elevations in the expression of the NADPH oxidase subunits p47(phox) and gp91(phox) and in the levels of hydrogen peroxide (H2O2) and malondialdehyde (MDA) and a reduction in superoxide dismutase (SOD) activity (P<0.05) in the spinal cord. Both curcumin and apocynin ameliorated diabetic neuropathy. In conclusion, curcumin attenuated neuropathic pain in diabetic rats, at least partly by inhibiting NADPH oxidase-mediating oxidative stress in the spinal cord.
Collapse
Affiliation(s)
- Wei-Cheng Zhao
- Department of Anesthesiology, The First People's Hospital of Foshan, 81# North of Rinlan Road, Foshan 528000, China
| | - Bin Zhang
- Department of Anesthesiology, The First People's Hospital of Foshan, 81# North of Rinlan Road, Foshan 528000, China
| | - Mei-Juan Liao
- Department of Anesthesiology, The First People's Hospital of Foshan, 81# North of Rinlan Road, Foshan 528000, China
| | - Wen-Xuan Zhang
- Department of Anesthesiology, The First People's Hospital of Foshan, 81# North of Rinlan Road, Foshan 528000, China
| | - Wan-You He
- Department of Anesthesiology, The First People's Hospital of Foshan, 81# North of Rinlan Road, Foshan 528000, China
| | - Han-Bing Wang
- Department of Anesthesiology, The First People's Hospital of Foshan, 81# North of Rinlan Road, Foshan 528000, China
| | - Cheng-Xiang Yang
- Department of Anesthesiology, The First People's Hospital of Foshan, 81# North of Rinlan Road, Foshan 528000, China.
| |
Collapse
|
102
|
Jacques AC, Lougheed C, Macdonald E, Karovitch A, Giguère P. Effectiveness of Unfractionated Heparin in Normal Saline versus Dextrose for Achieving and Maintaining Therapeutic Anti-Factor Xa Levels in Patients with Non-ST-Elevation Acute Coronary Syndrome. Can J Hosp Pharm 2013; 66:347-54. [PMID: 24357866 DOI: 10.4212/cjhp.v66i6.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Unfractionated heparin (UFH) administered by IV infusion is effective in preventing myocardial infarction and death after non-ST-elevation acute coronary syndrome. At the authors' centre, preparations of UFH in 0.9% sodium chloride (normal saline; UFH-NS) were used during a shortage of commercially available UFH in dextrose 5% in water (UFH-D5W), the usual preparation. Anecdotal observations raised concerns about the effectiveness of the saline-based preparation in achieving minimally therapeutic anticoagulation. OBJECTIVE To compare the effectiveness of UFH-NS and UFH-D5W for achieving and maintaining therapeutic anti-factor Xa levels in patients with non-ST-elevation acute coronary syndrome. METHODS A retrospective cohort study was conducted with 2 groups of 100 consecutive patients who received either UFH-NS or UFH-D5W for a minimum of 24 h after non-ST-elevation acute coronary syndrome in accordance with a weight-based dosing nomogram. RESULTS A minimally therapeutic level of anti-Xa (≥ 0.31 IU/mL) was achieved within 24 h for 92% of the patients receiving UFH-D5W and 67% of those receiving UFH-NS (absolute risk difference 25%, 95% confidence interval [CI] 13.4%-36.6%; p < 0.001). Infusion of UFH-NS was associated with lower probability of achieving minimally therapeutic anticoagulation (hazard ratio [HR] 2.30, 95% CI 1.68-3.15; p < 0.001) and maintaining therapeutic anticoagulation (HR 2.31, 95% CI 1.69-3.17; p < 0.001) relative to UFH-D5W. Significant differences in the numbers of patients with subtherapeutic and therapeutic anticoagulation, favouring UFH-D5W, were observed at each of the first, second, and third anti-Xa measurements (p < 0.05). Patients receiving UFH-NS required a greater median number of adjustments to the infusion rate during the first 48 h (1.0 v. 0.5 adjustment per day, p < 0.001). There was no difference between groups in terms of major reductions in hemoglobin. CONCLUSIONS Infusion of UFH-NS was inferior to UFH-D5W for achieving and maintaining therapeutic anticoagulation in patients with non-ST-elevation acute coronary syndrome. Until further study, saline-based heparin infusions should be used with caution, and patients should be monitored closely to ensure timely achievement and maintenance of therapeutic anticoagulation.
Collapse
Affiliation(s)
- Amanda C Jacques
- , BScPharm, ACPR, is a Pharmacist with The Ottawa Hospital, General Campus, Ottawa, Ontario
| | - Colleen Lougheed
- , BScPhm, ACPR, was, at the time of this study, a Pharmacist with The Ottawa Hospital, General Campus, Ottawa, Ontario. She is now with London Health Sciences Centre, University Hospital, London, Ontario
| | - Erika Macdonald
- , BScPharm, ACPR, is a Pharmacist with The Ottawa Hospital, General Campus, Ottawa, Ontario
| | - Alan Karovitch
- , MD, FRCPC, MEd, is Head and Chair of the Division of General Internal Medicine, Departments of Medicine and of Obstetrics and Gynecology, as well as a staff physician, The Ottawa Hospital and University of Ottawa, General Campus, Ottawa, Ontario
| | - Pierre Giguère
- , BPharm, MSc, is a Clinical Pharmacy Specialist, The Ottawa Hospital and Ottawa Hospital Research Institute, General Campus, Ottawa, Ontario
| |
Collapse
|
103
|
Rong Z, Pan R, Xu Y, Zhang C, Cao Y, Liu D. Hesperidin pretreatment protects hypoxia-ischemic brain injury in neonatal rat. Neuroscience 2013; 255:292-9. [PMID: 24076349 DOI: 10.1016/j.neuroscience.2013.09.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/15/2013] [Accepted: 09/16/2013] [Indexed: 02/01/2023]
Abstract
Neonatal hypoxia-ischemic encephalopathy (HIE) remains a major cause of brain damage, leading to high disability and mortality rates in neonates. In vitro studies have shown that hesperidin, a flavanone glycoside found abundantly in citrus fruits, acts as an antioxidant. Although hesperidin has been considered as a potential treatment for HIE, its effects have not been fully evaluated. In this study, the protective effect of hesperidin pretreatment against hypoxia-ischemic (HI) brain injury and possible signal pathways were investigated using in vivo and in vitro models. In vivo HI model employed unilateral carotid ligation in postnatal day 7 rat with exposure to 8% hypoxia for 2.5h, whereas in vitro model employed primary cortical neurons of neonatal rats subjected to oxygen and glucose deprivation for 2.5h. Hesperidin pretreatment significantly reduced HI-induced brain tissue loss and improved neurological outcomes as shown in 2,3,5-triphenyltetrazolium chloride monohydrate staining and foot-fault results. The neuroprotective effects of hesperidin are likely the results of preventing an increase in intracellular reactive oxygen species and lipid peroxide levels. Hesperidin treatment also activated a key survival signaling kinase, Akt, and suppressed the P-FoxO3 level. Hesperidin pretreatment protected neonatal HIE by reducing free radicals and activating phosphorylated Akt.
Collapse
Affiliation(s)
- Z Rong
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | | | | | | | | | | |
Collapse
|
104
|
Smorenberg A, Ince C, Groeneveld ABJ. Dose and type of crystalloid fluid therapy in adult hospitalized patients. Perioper Med (Lond) 2013; 2:17. [PMID: 24472418 PMCID: PMC3964340 DOI: 10.1186/2047-0525-2-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 07/04/2013] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE In this narrative review, an overview is given of the pros and cons of various crystalloid fluids used for infusion during initial resuscitation or maintenance phases in adult hospitalized patients. Special emphasis is given on dose, composition of fluids, presence of buffers (in balanced solutions) and electrolytes, according to recent literature. We also review the use of hypertonic solutions. METHODS We extracted relevant clinical literature in English specifically examining patient-oriented outcomes related to fluid volume and type. RESULTS A restrictive fluid therapy prevents complications seen with liberal, large-volume therapy, even though restrictive fluid loading with crystalloids may not demonstrate large hemodynamic effects in surgical or septic patients. Hypertonic solutions may serve the purpose of small volume resuscitation but carry the disadvantage of hypernatremia. Hypotonic solutions are contraindicated in (impending) cerebral edema, whereas hypertonic solutions are probably more helpful in ameliorating than in preventing this condition and improving outcome. Balanced solutions offer a better approach for plasma composition than unbalanced ones, and the evidence for benefits in patient morbidity and mortality is increasing, particularly by helping to prevent acute kidney injury. CONCLUSIONS Isotonic and hypertonic crystalloid fluids are the fluids of choice for resuscitation from hypovolemia and shock. The evidence that balanced solutions are superior to unbalanced ones is increasing. Hypertonic saline is effective in mannitol-refractory intracranial hypertension, whereas hypotonic solutions are contraindicated in this condition.
Collapse
Affiliation(s)
- Annemieke Smorenberg
- Department of Intensive Care, Erasmus Medical Centre, ‘s-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Can Ince
- Department of Intensive Care, Erasmus Medical Centre, ‘s-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - AB Johan Groeneveld
- Department of Intensive Care, Erasmus Medical Centre, ‘s-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| |
Collapse
|
105
|
Behçet AL, Kılıç H, Zengin S, Güler M, Taysi S, Yıldırım C, Sarı İ. Efficiency of Ankaferd Blood Stopper used in bleeding control on intraabdominal adhesions formed postoperatively. Clin Appl Thromb Hemost 2013; 20:524-9. [PMID: 23288869 DOI: 10.1177/1076029612471710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study is to investigate the hispathological, biochemical, and clinical efficiency of Ankaferd Blood Stopper (ABS) in preventing postoperative intraabdominal adhesions. METHOD A total of 40 Wistar albino species female rats were randomly separated into 4 groups. For the control group, 1 mL normal saline was administered; and for the second, third, and fourth groups 0.5, 1, and 2 mL, respectively, ABS was administered. Statistical analyses were evaluated with Tukey and analysis of variance test. FINDINGS Significant increase was observed in fibroblast and vascularization microscopically with increasing amount of ABS used. Degree of adhesion in the group administered with normal saline was lower compared to the other groups. Adhesion thickness and prevalence macroscopically increased with the increasing amount of ABS used in groups. CONCLUSION It was determined in our study that ABS is not efficient in preventing intraabdominal adhesions; on the contrary, adhesions were increased with the increased amount of ABS used.
Collapse
Affiliation(s)
- A L Behçet
- Emergency Department of Medicine Faculty, Gaziantep University, Gaziantep, Turkey
| | - Hasan Kılıç
- Emergency Department of Malatya State Hospital, Malatya, Turkey
| | - Suat Zengin
- Emergency Department of Medicine Faculty, Gaziantep University, Gaziantep, Turkey
| | - Mehmet Güler
- General Surgery Department of Medicine Faculty, Gaziantep University, Gaziantep, Turkey
| | - Seyithan Taysi
- Biochemistry Department of Medicine Faculty, Gaziantep University, Gaziantep, Turkey
| | - Cuma Yıldırım
- Emergency Department of Medicine Faculty, Gaziantep University, Gaziantep, Turkey
| | - İbrahim Sarı
- Pathology Department of Medicine Faculty, Gaziantep, Turkey
| |
Collapse
|
106
|
Al-Taie OH, Bauer Y, Dietrich CG, Fischbach W. Efficacy of submucosal injection of different solutions inclusive blood components on mucosa elevation for endoscopic resection. Clin Exp Gastroenterol 2012; 5:43-8. [PMID: 22573940 PMCID: PMC3345931 DOI: 10.2147/ceg.s29704] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Endoscopic resection has become the standard treatment for noninvasive gastrointestinal malignancies. In flat mucosal tumors, normal saline is frequently used for submucosal fluid injection in order to reduce the risk of complications during endoscopic resection. Recent studies have demonstrated longer-lasting mucosa elevation by injection of agents such as hyaluronic acid or glyceol, rather than normal saline. We investigated the efficacy of different blood components in comparison with other solutions for use as a submucosal fluid cushion. Methods Normal saline, sodium hyaluronate, glyceol, hydroxyethyl starch, serum, plasma, and whole blood were evaluated for their effectiveness in creating a submucosal cushion. One milliliter of each solution was injected into the submucosa of 5 × 5 cm specimens of resected porcine stomach. Mucosa elevation was measured before and up to 60 minutes after injection. Results The shortest duration of mucosa elevation was observed after injection of normal saline, glyceol, and 0.125% hyaluronic acid. A significantly longer duration was obtained after injection of hydroxyethyl starch, 0.25% and 0.5% hyaluronic acid, serum, and plasma. However, whole blood generated a longer-lasting mucosa elevation than all other agents. Conclusion The results of the current study suggest that whole blood is more effective in generating long-lasting mucosa elevation than any other commonly used solution. Because autologous blood is readily available at almost no cost, this seems to be an optimal agent for creating the mucosa elevation needed for endoscopic resection. Further in vivo studies in humans are needed to clarify the potential role of autologous blood for long-lasting endoscopic mucosa resection or endoscopic submucosal dissection.
Collapse
Affiliation(s)
- Oliver H Al-Taie
- Department of Internal Medicine, Sankt Elisabeth-Hospital, Gütersloh
| | | | | | | |
Collapse
|
107
|
Bhukal I, Srinivas N, Solanki SL, Yaddanapudi LN, Jain A. A randomized study to compare the efficacy of two intravenous fluid regimens of normal saline on the incidence of postoperative nausea and vomiting. Anesth Essays Res 2012; 6:21-4. [PMID: 25885496 PMCID: PMC4173421 DOI: 10.4103/0259-1162.103366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of two different volume of crystalloid given intraoperatively on postoperative nausea and vomiting (PONV). MATERIALS AND METHODS Eighty adult patients of either sex belonging to ASA I and II class undergoing elective surgeries under general anesthesia for 1-2 h were studied in this prospective, randomized double blinded study. First group (group L) (n=40) received normal saline 4 mL/kg and second group (group H) (n=40) received 10 mL/kg of normal saline. This was in excess of the fasting requirement of the patients. No propofol or antiemetic drugs were given. PONV was evaluated by verbal descriptive score (VDS) [0 = none, 1 = mild, 2 = moderate, 3 = severe, and 4 = unbearable]. Ondansetron (4 mg i.v.) was given if VDS score was 3 or more. RESULTS The median immediate PONV score was 2 and 1 in group L and H, respectively. The median 2 h PONV score in group L was 3 and in group H was 1. The median 6 h PONV score in group L was 3 and in group H was 1. The 24 h median postoperative PONV score was 1 and 0 in group L and H, respectively. In all these period of time the differences were statistically significant. The incidence of vomiting was more in group L [72.5% (29/40)] than in group H [30% (12/40)]. This was statistically significant (P=0.0003). CONCLUSION From the current study it was concluded that patients who received larger volume of crystalloid intraoperatively have lesser incidence of PONV.
Collapse
Affiliation(s)
- Ishwar Bhukal
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - N. Srinivas
- Department of Anesthesia, Alchemist Hospitals Ltd, Panchkula, Haryana, India
| | - Sohan Lal Solanki
- Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India (At the time of work, all authors were affiliated to Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India), India
- Corresponding author: Dr. Sohan Lal Solanki, Department of Anesthesiology, SGPGIMS, Rae-Bareilly Road, Lucknow, India. E-mail:
| | - L. N. Yaddanapudi
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Jain
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
108
|
Hasman H, Cinar O, Uzun A, Cevik E, Jay L, Comert B. A randomized clinical trial comparing the effect of rapidly infused crystalloids on acid-base status in dehydrated patients in the emergency department. Int J Med Sci 2012; 9:59-64. [PMID: 22211091 PMCID: PMC3245412 DOI: 10.7150/ijms.9.59] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 11/16/2011] [Indexed: 11/06/2022] Open
Abstract
STUDY OBJECTIVE To compare the effect of normal saline (NS), lactated Ringer's, and Plasmalyte on the acid-base status of dehydrated patients in the emergency department (ED). METHOD We conducted a prospective, double-blind, randomized trial of consecutive adult patients who presented to the emergency department with moderate-severe dehydration. Patients were randomly allocated to blindly receive normal saline (NS), lactated Ringer's or Plasmalyte at 20 ml/kg/h for 2 hours. Outcome measures of the study were pH and changes in electrolytes, including serum potassium, sodium, chloride and bicarbonate levels at 0, 60, and 120 minutes in venous blood gas samples. RESULTS Ninety patients participated in the study and were randomized to NS (30 patients), lactated Ringer's (30 patients) and Plasmalyte (30 patients) groups. Mean age was 48±20 years and 50% (n=45) of the patients were female. All pH values were in the physiological range (7.35-7.45) throughout the study period. In the NS group there was a significant tendency to lower pH values, with pH values of 7.40, 7.37, and 7.36 at 0, 1, and 2 hours respectively. Average bicarbonate levels fell in the NS group (23.1, 22.2, and 21.5 mM/L) and increased in the Plasmalyte group (23.4, 23.9, and 24.4 mM/L) at 0, 1, and 2 hours, respectively. There were no significant changes in potassium, sodium, or chloride levels. CONCLUSIONS NS, lactated Ringer's, and Plasmalyte have no significant effect on acid-base status and all can be used safely to treat dehydrated patients in the emergency department. However, NS can effect acidosis which might be significant in patients who have underlying metabolic disturbances; thus, its use should be weighed before fluid administration in the ED.
Collapse
Affiliation(s)
- Hakan Hasman
- Department of Emergency Medicine, Gulhane Military Medical Academy, GATA Acil Tip Anabilim Dali, Etlik, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|