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Kwok JL, Ventimiglia E, De Coninck V, Sierra A, Panthier F, Corrales M, Barghouthy Y, Gauhar V, Kranzbühler B, Schmid FA, Poyet C, Eberli D, Traxer O, Keller EX. Illumination matters Part III: Impact of light obstruction on illuminance from flexible ureteroscopes - a comparative PEARLS analysis. World J Urol 2024; 42:188. [PMID: 38520528 PMCID: PMC10960769 DOI: 10.1007/s00345-024-04910-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024] Open
Abstract
PURPOSE Artifacts from poor ureteroscopes' light design with shadowing and dark areas in the field of view have been reported. The aim was to quantify effects of light obstruction in a kidney calyx model. METHODS We evaluated a series of contemporary flexible ureteroscopes including the Storz Flex-Xc and Flex-X2s, Olympus V3 and P7, Pusen 7.5F and 9.2F, as well as OTU Wiscope using an enclosed 3D-printed pink in vitro kidney calyx model submerged in saline, where the field of light was intentionally partially obstructed alternatively at 12, 3, 6, and 9 o'clock. A color spectrometer was used for illuminance measurements at a 45° opening position in the background of the model. RESULTS Overall and mean background illuminance for each obstructive situation were significantly different between scopes for both 50% and 100% brightness settings (ANOVA p < 0.001). At 50% brightness setting, almost all scopes had their highest and lowest background illuminance with the 6 o'clock and 3 o'clock obstructive situation, respectively. At 100% brightness setting, these became 6 o'clock and 12 o'clock obstructive situations. Considering each obstructive situation individually, the Flex-Xc was consistently the scope with highest background illuminance and the Pusen 7.5F the lowest. Background illuminance for each obstructive situation varied significantly for each scope individually, with the greatest range of variability for Pusen 7.5F and V3. CONCLUSIONS Illuminance performance of ureteroscopes within an obstructed calyx model differ significantly for various obstructive situations. Urologists should be aware of this to help guide their choice of ureteroscope.
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Affiliation(s)
- Jia-Lun Kwok
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Department of Urology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Eugenio Ventimiglia
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology and Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vincent De Coninck
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology and Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Alba Sierra
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology and Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- Urology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Frédéric Panthier
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC no 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, Hôpital Tenon, 75020, Paris, France
| | - Mariela Corrales
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Endourology and Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands
- GRC no 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, Hôpital Tenon, 75020, Paris, France
| | - Yazeed Barghouthy
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Vineet Gauhar
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Benedikt Kranzbühler
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Florian Alexander Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Olivier Traxer
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France
- GRC no 20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Sorbonne Université, Hôpital Tenon, 75020, Paris, France
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
- Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France.
- Endourology and Urolithiasis Working Group, Young Academic Urologists (YAU), Arnhem, The Netherlands.
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Liu K, Feng YJ, Guo JX, Wang GL, Shan LL, Gao SW, Liu Q, Sun HN, Li XY, Sun XR, Bian JY, Kwon T. Argon non-thermal plasma treatment promotes the development of rice (Oryza sativa L.) in saline alkali environments. Protoplasma 2024:10.1007/s00709-024-01946-x. [PMID: 38519772 DOI: 10.1007/s00709-024-01946-x] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/16/2024] [Indexed: 03/25/2024]
Abstract
Soil salinization leads to a reduction in arable land area, which seriously endangers food security. Developing saline-alkali land has become a key measure to address the contradiction between population growth and limited arable land. Rice is the most important global food crop, feeding half of the world's population and making it a suitable choice for planting on saline-alkali lands. The traditional salt-alkali improvement method has several drawbacks. Currently, non-thermal plasma (NTP) technology is being increasingly applied in agriculture. However, there are few reports on the cultivation of salt/alkali-tolerant rice. Under alkaline stress, argon NTP treatment significantly increased the germination rate of Longdao 5 (LD5) rice seeds. In addition, at 15 kV and 120 s, NTP treatment significantly increased the activity of antioxidant enzymes such as catalase and SOD. NTP treatment induced changes in genes related to salt-alkali stress in rice seedlings, such as chitinase and xylanase inhibitor proteins, which increased the tolerance of the seeds to salt-alkali stress. This experiment has expanded the application scope of NTP in agriculture, providing a more cost-effective, less harmful, and faster method for developing salt-alkali-tolerant rice and laying a theoretical foundation for cultivating NTP-enhanced salt-alkali-tolerant rice.
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Affiliation(s)
- Kai Liu
- Heilongjiang Academy of Agricultural Sciences, Harbin, 150086, Heilongjiang, China
- Northeast Branch of National Center of Technology Innovation for Saline-Alkali Tolerant Rice, Harbin, 150086, Heilongjiang, China
| | - Yan-Jiang Feng
- Rice Research Institute of Heilongjiang Academy of Agricultural Sciences, Jiamusi, 154026, Heilongjiang, China
| | - Jun-Xiang Guo
- Rice Research Institute of Heilongjiang Academy of Agricultural Sciences, Jiamusi, 154026, Heilongjiang, China
| | - Gui-Ling Wang
- Rice Research Institute of Heilongjiang Academy of Agricultural Sciences, Jiamusi, 154026, Heilongjiang, China
| | - Li-Li Shan
- Rice Research Institute of Heilongjiang Academy of Agricultural Sciences, Jiamusi, 154026, Heilongjiang, China
| | - Shi-Wei Gao
- Suihua Branch of Heilongjiang Academy of Agricultural Sciences, Suihua, 152000, Heilongjiang, China
| | - Qing Liu
- Suihua Branch of Heilongjiang Academy of Agricultural Sciences, Suihua, 152000, Heilongjiang, China
| | - Hu-Nan Sun
- College of Life Science & Biotechnology, Heilongjiang Bayi Agricultural University, Daqing, 163319, Heilongjiang, China
| | - Xi-Yu Li
- College of Agriculture, Heilongjiang Bayi Agricultural University, Daqing, 163319, Heilongjiang, China
| | - Xing-Rong Sun
- Daqing Branch of Heilongjiang Academy of Agricultural Sciences, Daqing, 163319, Heilongjiang, China
| | - Jing-Yang Bian
- Daqing Branch of Heilongjiang Academy of Agricultural Sciences, Daqing, 163319, Heilongjiang, China.
| | - Taeho Kwon
- Primate Resources Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), 351-33 Neongme-Gil, Ibam-Myeon, , Jeongeup-Si, Jeonbuk, 56216, Republic of Korea.
- Department of Applied Biological Engineering, KRIBB School of Biotechnology, Korea National University of Science and Technology (UST), Daejeon, 34113, Republic of Korea.
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Zhou X, Chen Z, Cho P. A snap-shot of orthokeratology lens rinsing habits: An online survey in a major eye hospital in Shanghai. Cont Lens Anterior Eye 2023; 46:102049. [PMID: 37633754 DOI: 10.1016/j.clae.2023.102049] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE A hospital-based survey to explore lens rinsing habits of orthokeratology (ortho-k) patients, including the solution used for rinsing. METHODS An anonymous survey, via an online questionnaire, was administered to ortho-k lens wearers or their parents when they attended Fudan University Eye and ENT Hospital for routine follow-up visits. Three major issues were investigated: basic demographics, lens rinsing solution used, and specific rinsing habits. Relationships between demographics and rinsing solution used and rinsing behaviours were explored. RESULTS Of the total of 541 online questionnaires delivered, 296 were completed and returned. The respondents were the person responsible for lens care, either the ortho-k users themselves, or their parents. The median age of the lens wearers was 12.0 years (range: 8-22 years), and the median period of ortho-k lens wear was 18.0 months (range: 1-109 months). The most common rinsing solutions reported were a particular brand of multidose preserved saline (28.4%), cooled boiled water (23.3%), and non-preserved multidose saline (16.2%). Overall, the main reason for choice of rinsing solution was recommendation of eye care practitioners (90.2%). The respondents with a longer lens wear history tended to use commercially available bottled water, drinking water, or cooled boiled water rather than non-preserved saline (unidose or multidose) (p ≤ 0.009) and were more likely to use the rinsing solution to soak their lenses (p = 0.009). Lens wearers who rinsed the lenses themselves tended to use tap water compared to those whose lenses were handled by parents (p = 0.040). CONCLUSION Inappropriate choice and usage of rinsing solution appeared to be a common issue among ortho-k lens wearers in Shanghai, China. The problem was more pronounced in long-term wearers and in those who performed rinsing themselves.
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Affiliation(s)
- Xueyi Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Research Center of Ophthalmology and Optometry, Shanghai 200031, China; Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai 200031, China
| | - Zhi Chen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 200031, China; Research Center of Ophthalmology and Optometry, Shanghai 200031, China; Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai 200031, China.
| | - Pauline Cho
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
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Solomon R. Hydration to Prevent Contrast-Associated Acute Kidney Injury in Patients Undergoing Cardiac Angiography. Interv Cardiol Clin 2023; 12:515-524. [PMID: 37673495 DOI: 10.1016/j.iccl.2023.06.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Administration of fluid (oral and intravenous) is the cornerstone of prevention of contrast-associated acute kidney injury in the cardiac environment. Intravenous saline is the preferred fluid. The amount, timing, and duration of therapy are discussed. A key determinant of the benefit may be the rate of urine output stimulated by the therapy. Approaches using hemodynamic-guided rates of fluid administration and novel techniques to generate large urine outputs while maintaining fluid balance are highlighted.
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Affiliation(s)
- Richard Solomon
- Larner College of Medicine, University of Vermont, Burlington, VT 05401, USA.
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Tantuway V, Thomas W, Parikh MB, Sharma R, Jeyaraman N, Jeyaraman M. Clinical Outcome of Minimally Manipulated, Mechanically Isolated Autologous Adipose Tissue-Derived Stromal Vascular Fraction (Sahaj Therapy®) in Knee Osteoarthritis-Randomized Controlled Trial. Indian J Orthop 2023; 57:1646-1658. [PMID: 37766954 PMCID: PMC10519910 DOI: 10.1007/s43465-023-00981-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Introduction Regenerative therapy has shown promising results in the treatment of osteoarthritis (OA) knee with Kellgren-Lawrence (KL) Grades I-III. We compared the safety, efficacy, functional, and clinical outcomes of intra-articular implantation of autologous adipose tissue-derived stromal vascular fraction (SVF) isolated using direct ultrasonic cavitation (Sahaj therapy-Cell Innovation Patented Technology) and saline injection in knee osteoarthritis. Materials and Methods The present prospective observational study was conducted over 3 years. We enrolled 120 patients in our study, where four patients got excluded as they did not meet the inclusion criteria. The remaining 116 patients were randomized into two groups, one with autologous adipose tissue-derived SVF and the other group with saline injection. A comparison of mean KOOS and VAS scores at different follow-ups was done using Paired 't' test. A p value of < 0.05 was considered significant. Results The results show that the SVF group had significantly higher KOOS scores (78.49 ± 6.54 in the SVF group vs 59.19 ± 5.14 in the saline group), respectively (p < 0.001). Similarly, the SVF group had significantly lesser VAS scores (3.17 ± 0.94 in the SVF group vs 3.89 ± 1.04 in the saline group), respectively (p < 0.001). Conclusions Autologous adipose tissue-derived SVF is a better choice for treating knee osteoarthritis. For individuals with degenerative osteoarthritis, autologous SVF grafting in the same surgical procedure is an innovative and promising treatment modality. Even after 3 years of follow-up, the study participants with OA knee have shown a good clinical and functional outcome.
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Affiliation(s)
- Vinay Tantuway
- Department of Orthopaedics & Traumatology, Index Medical College Hospital and Research Centre, Indore, Madhya Pradesh India
| | - Wayne Thomas
- Department of Tumor Immunology, The University of Newcastle, Callaghan, Australia
| | - Mittal B. Parikh
- Department of Orthopaedics, Navjivan Hospital, Ahmedabad, Gujarat India
| | - Raj Sharma
- Sahaj Regenerative Cell Therapeutics, Indore, Madhya Pradesh India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu India
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Iram K, Ashraf MA, Ibrahim SM, Rasheed R, Ali S. Coumarin regulated redox homeostasis to facilitate phytoremediation of saline and alkaline soils by bitter gourd (Momordica charantia L.). Environ Sci Pollut Res Int 2023; 30:99584-99604. [PMID: 37620696 DOI: 10.1007/s11356-023-29360-5] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023]
Abstract
The use of coumarin (COU) to alleviate the phytotoxic effects of salinity has great potential in improving the phytoremediation of saline and alkaline soils. 30-day bitter gourd plants were exposed to 15 dS m‒1 salinity of neutral (NaCl and Na2SO4) and alkaline (Na2CO3 and NaHCO3) salts. 60-day plants were harvested to record different growth, physiological and biochemical attributes. Salinity significantly subsided plant growth, chlorophyll, photosynthesis, and nutrient acquisition. Salinity induced notable oxidative damage in plants that displayed higher relative membrane permeability (RMP), accumulated elevated ROS (H2O2 and O2•‒) and MDA levels alongside intensified lipoxygenase (LOX) activity. The production of cytotoxic methylglyoxal was also significantly higher in plants under salinity. COU seed priming (50, 100 and 150 mg L‒1) promoted plant growth by circumventing oxidative injury and intensifying oxidative defense. Further, COU maintained the intricate balance between reduced (GSH) and oxidized (GSSG) glutathione to diminish ion excess toxicity, thereby facilitating the phytoremediation of saline soils. The lower doses of COU promoted methylglyoxal and ROS detoxification systems that, in turn, lessened the phytotoxic effects of salinity. COU restored ions homeostasis by augmenting osmotic adjustment in plants under salinity.
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Affiliation(s)
- Kamila Iram
- Department of Botany, Government College University Faisalabad, Faisalabad, 38000, Pakistan
| | - Muhammad Arslan Ashraf
- Department of Botany, Government College University Faisalabad, Faisalabad, 38000, Pakistan.
| | - Sobhy M Ibrahim
- Department of Biochemistry, College of Science, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Rizwan Rasheed
- Department of Botany, Government College University Faisalabad, Faisalabad, 38000, Pakistan
| | - Shafaqat Ali
- Department of Environmental Sciences, Government College University Faisalabad, Faisalabad, 38000, Pakistan
- Department of Biological Sciences and Technology, China Medical University, Taichung, 40402, Taiwan
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Botu RK, Rachuri P, Martha S, Raparla M, Matilda S, Yemparla S. Comparative Evaluation of the Efficacy of Chlorhexidine, Diode Laser, and Saline in Reducing the Microbial Count in Primary Teeth Root Canals: An In Vivo Study. Int J Clin Pediatr Dent 2023; 16:459-463. [PMID: 37496951 PMCID: PMC10367290 DOI: 10.5005/jp-journals-10005-2596] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Context Different irrigation materials in pediatric endodontics. Aims To evaluate the efficacy of chlorhexidine (CHX), diode laser, and saline in primary teeth root canals. Settings and design This manuscript is designed to know the effectiveness of the different root canal irrigants and laser irradiation technology in primary teeth root canals. Materials and methods A total of 60 primary teeth from 60 children were selected and divided into three groups of 20 each. Group I (CHX), group II (diode laser), and group III (saline). Pulp tissue was extirpated from the root canals of primary teeth, and samples were collected using sterile paper points. After cleaning and shaping, the root canals of the teeth in each group were disinfected using CHX and saline or irradiated with a diode laser. The samples were collected again and sent for microbiological examination. Statistical analysis used Statistical analyzes were performed using the Wilcoxon signed-rank test, Mann-Whitney U test, and Kruskal-Wallis one-way analysis of variance. All analyzes were conducted using the Statistical Package for the Social Sciences version 23.0. Results The colony-forming unit (CFU) of the predisinfection sample served as a baseline for comparisons throughout the study. The mean microbial counts of all the postdisinfected samples were reduced after disinfection. Intergroup comparisons showed significant results between groups I and III (CHX and saline) and groups II and III (diode laser and saline) (p < 0.01), whereas groups I and II (CHX and diode laser) showed nonsignificant results (p < 0.092). Conclusion Diode laser irradiation succeeded in reducing root canal infection when compared with 2% CHX. Diode laser irradiation can also be used for disinfecting the root canal in primary teeth. How to cite this article Botu RK, Rachuri P, Martha S, et al. Comparative Evaluation of the Efficacy of Chlorhexidine, Diode Laser, and Saline in Reducing the Microbial Count in Primary Teeth Root Canals: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(3):459-463.
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Affiliation(s)
- Raj K Botu
- Department of Pedodontics and Preventive Dentistry, KLR's Lenora Institute of Dental Sciences, Rajamahendravaram, Andhra Pradesh, India
| | - Punithavathy Rachuri
- Department of Pedodontics and Preventive Dentistry, KLR's Lenora Institute of Dental Sciences, Rajamahendravaram, Andhra Pradesh, India
| | - Satyam Martha
- Department of Pedodontics and Preventive Dentistry, KLR's Lenora Institute of Dental Sciences, Rajamahendravaram, Andhra Pradesh, India
| | - Mythraiye Raparla
- Department of Pedodontics and Preventive Dentistry, KLR's Lenora Institute of Dental Sciences, Rajamahendravaram, Andhra Pradesh, India
| | - Swathi Matilda
- Department of Pedodontics and Preventive Dentistry, KLR's Lenora Institute of Dental Sciences, Rajamahendravaram, Andhra Pradesh, India
| | - Seshaiah Yemparla
- Department of Pedodontics and Preventive Dentistry, KLR's Lenora Institute of Dental Sciences, Rajamahendravaram, Andhra Pradesh, India
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Gajendran A, Saravanam PK, Jayagandhi S. Efficacy of Triamcinolone Nasal Packing on Post-Operative Outcome in Endoscopic Sinus Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:957-961. [PMID: 37206842 PMCID: PMC10188726 DOI: 10.1007/s12070-023-03496-9] [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] [Received: 11/09/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
Introduction: Endoscopic sinus surgery is a frequently performed surgery for sinonasal polyposis. This includes various complications such as Crusting and synechiae formation etc. which can be reduced or minimised by regular nasal douching and nasal toileting in immediate post operative period. Methods: This study was conducted to assess the quality of life using SNOT 22 score and the efficacy of Triamcinolone Acetate impregnated anterior nasal packing based on the Peri-Operative Sinus Endoscopic (POSE) score and Lund Kennedy score on short and midterm post operative outcomes in patients undergoing Endoscopic Sinus Surgery for sinonasalpolyposis. This study was a prospective observational study comprising of 80 patients diagnosed with sinonasal polyposis. Patients were divided into two groups with 40 patients in group A (non absorbable Triamcinolone Acetate impregnated nasal packing) and 40 patients in group B(non absorbable Saline impregnated nasal packing). Study setting: This study was conducted at a tertiary care centre in South India from July 2017 to July 2019 after EthicsCommitteeapproval. Results of this study showed Improvement in quality of life index in the postoperative period in both Group A (Triamcinolone Acetate) and Group B (saline). Lund Kennedy and Peri operative sinus endoscopy score (POSE) showed statistically significant results with better and early healing among Group A (Triamcinolone Acetate) patients. Conclusion: This shows Triamcinolone Acetate nasal packing in intaoperative period helps to reduce early post operative complications such as edema,crusting and synechiae formation. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03496-9.
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Almuqbel MM, Palmer NJ, Jenkins A, Keenan RJ, Melzer TR. Magnetic resonance imaging of breast implants: Optimizing tissue contrast. J Med Imaging Radiat Sci 2023; 54:9-15. [PMID: 36646549 DOI: 10.1016/j.jmir.2022.12.001] [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] [Received: 08/11/2022] [Revised: 11/24/2022] [Accepted: 12/05/2022] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Patients with breast implants need to undergo regular screening MRI procedures. One of the key requirements of this screening scan is the ability to suppress one or more tissues (water, fat, or silicone) simultaneously. However, the presence of "foreign" implants within the breast biological space affects the MRI scanner's normal operating mode. Often, this requires operator's supervision to make sure the correct image contrast is achieved. METHODS We built a phantom that represents the commonly encountered tissues (water, fat, and silicone) in breast implant imaging. The phantom was used to optimise imaging parameters and highlight common challenges encountered while imaging breast implants. We scanned the phantom on seven different MRI scanners (including 1.5T and 3T) and produced vendor-specific cheat-sheets on how to image breast implants. Ethical approval was not required for this article type. CONCLUSION Performing a breast MRI procedure with implants in-situ can be challenging. Employing a purpose-built phantom, we provide easy-to-use cheat sheets, with examples, outlining steps that can be taken to ensure appropriate tissue suppression and image contrast in breast implant MRI. We hope these cheat-sheets will help MRI practitioners to confidently and efficiently achieve accurate image contrasts across a number of implant scenarios which will aid in improving diagnostic accuracy, treatment plans, and thus prognosis for the patient.
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Affiliation(s)
- Mustafa M Almuqbel
- Pacific Radiology Group, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand.
| | | | | | - Ross J Keenan
- Pacific Radiology Group, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - Tracy R Melzer
- New Zealand Brain Research Institute, Christchurch, New Zealand; Department of Medicine, University of Otago, Christchurch, New Zealand; School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Chu J, Duan W, Yu Z, Tao T, Xu J, Ma Q, Zhao L, Guo JJ. Intra-articular injections of platelet-rich plasma decrease pain and improve functional outcomes than sham saline in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:4063-71. [PMID: 35124707 DOI: 10.1007/s00167-022-06887-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare the long-term clinical efficacy provided by intra-articular injections of either Pure Platelet-rich Plasma (P-PRP) or sham saline to treat knee osteoarthritis (KOA). METHODS This prospective, parallel-group, double-blind, multi-center, sham-controlled randomized clinical trial recruited participants with KOA from orthopedic departments at nine public hospitals (five tertiary medical centers, four secondary medical units) starting January 1, 2014, with follow-up completed on February 28, 2021. Participants were randomly allocated to interventions in a 1:1 ratio. Data were analyzed from March 1, 2021, to July 15, 2021. Three sessions (1 every week) of P-PRP or sham saline injected by physicians. The primary outcome was the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 3, 6, 12, 24, 60 months of follow-up. Secondary outcomes included the International Knee Documentation Committee (IKDC) subjective score, visual analogue scale (VAS) score, intra-articular biochemical marker concentrations, cartilage volume, and adverse events. Laboratory of each hospital analyzed the content and quality of P-PRP. RESULTS 610 participants (59% women) with KOA who received three sessions of P-PRP (n = 308, mean age 53.91 years) or sham saline (n = 302, mean age 54.51 years) injections completed the trial. The mean platelet concentration in PRP is 4.3-fold (95% confidence interval 3.6-4.5) greater than that of whole blood. Both groups showed significant improvements in IKDC, WOMAC, and VAS scores at 1 month of follow-up. However, only the P-PRP group showed a sustained improvement in clinical outcome measurements at month 24 (P < 0.001). There were statistically significant differences between the P-PRP and sham saline groups in all clinical outcome measurements at each follow-up time point (P < 0.001). The benefit of P-PRP was clinically better in terms of WOMAC-pain, WOMAC-physical function and WOMAC-total at 6, 12, 24, and 60 months of follow-up. No clinically significant differences between treatments were documented in terms of WOMAC-stiffness at any follow-up. A clinically significant difference favoring P-PRP group against saline in terms of IKDC and VAS scores was documented at 6, 12, 24 and 60 months of follow-up. At 6 months after injection, TNF-α and IL-1β levels in synovial fluid were lower in the P-PRP group (P < 0.001). Tibiofemoral cartilage volume decreased by a mean value of 1171 mm3 in the P-PRP group and 2311 mm3 in the saline group over 60 months and the difference between the group was statistically significant (intergroup difference, 1140 mm3, 95% CI - 79 to 1320 mm3; P < 0.001). CONCLUSIONS In this randomized clinical trial of patients with KOA, P-PRP was superior to sham saline in treating KOA. P-PRP was effective for achieving at least 24 months of symptom relief and slowing the progress of KOA, with both P-PRP and saline being comparable in safety profiles.
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Peña-Martínez VM, Acosta-Olivo C, Tamez-Mata Y, Simental-Mendía LE, Blázquez-Saldaña J, Vilchez-Cavazos F, Simental-Mendía M. Normal saline injection produces a therapeutic effect in patients with plantar fasciitis: A systematic review and meta-analysis of randomized controlled trials. Foot Ankle Surg 2022; 28:1129-1138. [PMID: 35637108 DOI: 10.1016/j.fas.2022.04.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/15/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Injectable therapies have been increasingly investigated to treat plantar fasciitis in randomized controlled trials (RCT) where normal saline injections are frequently used as placebo. The purpose was to quantify the effect of saline injections and compared against available minimal clinically important difference (MCID) criteria specific for plantar fasciitis to assess if changes were clinically meaningful. METHODS RCT including a placebo group (normal saline) and reporting changes in pain and functional outcomes in plantar fasciitis were identified through a search in MEDLINE, Embase, Web of Science, and Scopus to February 2022. PRISMA guidelines and a registered protocol (PROSPERO: CRD42020214035) were followed to conduct the study. RESULTS Pooled analysis of 13 RCT (379 subjects) included for analysis revealed a significant improvement on pain (P < .00001) and functional scores (P < .00001) after normal saline injections. These changes exceeded the established MCID criteria. CONCLUSIONS Normal saline injections in plantar fasciitis showed a therapeutic effect with statistically and clinically meaningful improvement when administered in the setting of an RCT for up to 12 months. The control of potential confounders influencing the effect of saline injections is required for future research.
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Affiliation(s)
- Víctor Manuel Peña-Martínez
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Carlos Acosta-Olivo
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Yadira Tamez-Mata
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Luis E Simental-Mendía
- Instituto Mexicano del Seguro Social, Biomedical Research Unit, Delegación Durango, Durango, Mexico
| | - Jaime Blázquez-Saldaña
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Félix Vilchez-Cavazos
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Mario Simental-Mendía
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico.
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12
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Refahee SM, Mahrous AI, Shabaan AA. Clinical efficacy of magnesium sulfate injection in the treatment of masseter muscle trigger points: a randomized clinical study. BMC Oral Health 2022; 22:408. [PMID: 36123724 PMCID: PMC9484239 DOI: 10.1186/s12903-022-02452-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Myofascial pain syndrome with trigger points is the most common cause of nonodontogenic pain. Although injection of the trigger points is the most effective pain reduction treatment, many patients exhibit recurrence after a short period. Therefore, the aim of the current study was to evaluate the clinical efficacy of magnesium sulfate injections in the treatment of the masseter muscle trigger points when compared to saline injections.
Material and method This study randomly (1:1) assigned 180 patients to one of two treatment groups based on whether their trigger points were injected with 2 ml of saline or magnesium sulfate. Pain scores, maximum mouth opening (MMO), and quality of life were measured at the pre-injection and 1, 3, and 6 months post-injection.
Results The pain scores were significantly higher in the saline group during all follow-up assessments, whereas the MMO was significantly higher in the magnesium sulfate group up to 3 months of follow-up (p < 0.001). However, the difference in MMO ceased to be statistically significant after 6 months of follow-up (p = 0.121). Additionally, the patient’s quality of life score was significantly higher in the magnesium sulfate group compared to the saline group (p < 0.001). Conclusion Injection of magnesium sulfate is an effective treatment measure for myofascial trigger points. However, further studies with a proper design addressing the limitations of the current study are necessary. ClinicalTrials: org (ID: NCT04742140) 5/2/2021.
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Affiliation(s)
- Shaimaa Mohsen Refahee
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Fayoum University, Fayoum, Egypt.
| | - Aliaa Ibrahim Mahrous
- Fixed Prosthodontic Department, Faculty of Dentistry, Fayoum University, Fayoum, Egypt
| | - Alshaimaa Ahmed Shabaan
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Fayoum University, Fayoum, Egypt
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13
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Li F, Wang B, Kong B, Xia X, Bao Y. Impact of Ultrasound-assisted Saline Thawing on the Technological Properties of mirror carp (Cyprinus carpio L.). Ultrason Sonochem 2022; 86:106014. [PMID: 35504137 PMCID: PMC9079082 DOI: 10.1016/j.ultsonch.2022.106014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/23/2022] [Accepted: 04/21/2022] [Indexed: 05/06/2023]
Abstract
The aim of the study was to evaluate the positive effect of ultrasound-assisted saline thawing (UST) on the technological properties (water mobility, water holding capacity, colour, pH, shear force, TVB-N, oxidation reaction and microstructure) of mirror carp (Cyprinus carpio L.). The results present in the study showed that different thawing methods had negative impacts on the quality of mirror carp to varying degrees. Among them, UST samples had significant lower thawing loss, centrifugal loss and cooking loss than ultrasound thawing (UT) and air thawing (AT) samples (P < 0.05). The analysis result of low-field nuclear magnetic resonance illustrated that UST inhibited the mobility and distribution of water effectively. Decrease in shear force and TVBN values were observed in all thawing samples, and the UST samples maintained the significant better texture property and freshness than UT and AT samples did (P < 0.05). In addition, the treatment of UST obtained 1% salt concentration inhibited the oxidation reactions effectively. Investigation of the microstructure of samples demonstrated that the treatment of UST kept the relatively complete structure of tissue than other thawing methods. Therefore, UST can be an alternative strategy to the traditional thawing of meat.
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Affiliation(s)
- Fangfei Li
- College of Forestry, Northeast Forestry University, Harbin, Heilongjiang 150040, China
| | - Bo Wang
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, China
| | - Baohua Kong
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, China
| | - Xiufang Xia
- College of Food Science, Northeast Agricultural University, Harbin, Heilongjiang 150030, China.
| | - Yihong Bao
- College of Forestry, Northeast Forestry University, Harbin, Heilongjiang 150040, China.
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14
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Tabuchi M, Morozumi K, Maki Y, Toyoda D, Kotake Y. Hyperchloremic metabolic acidosis due to saline absorption during laser enucleation of the prostate: a case report. JA Clin Rep 2022; 8:20. [PMID: 35267114 PMCID: PMC8913822 DOI: 10.1186/s40981-022-00499-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/26/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recent technological advancements have enabled the use of electrolyte solutions such as saline or buffered electrolyte solution during transurethral resection or laser enucleation of the prostate. However, saline absorption may cause hyperchloremic metabolic acidosis. Case presentation A male in his late seventies underwent holmium laser enucleation of the prostate under a combination of subarachnoid block and general anesthesia. Intraoperatively, abdominal distension prompted the attending anesthesiologist to consider the possibility of SGA malposition, and the trachea was intubated. Oropharyngeal and neck edema was observed, and laboratory examination revealed considerable acidosis with hyperchloremia. Further evaluation confirmed the absorption of a large amount of saline into the circulation via the perforated bladder. Application of the simplified Stewart approach clearly suggested that hyperchloremia was the principal cause of metabolic acidosis. The dilution of albumin attenuated acidosis. Conclusions Absorption of normal saline during laser enucleation of prostate caused hyperchloremic metabolic acidosis and airway edema.
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Affiliation(s)
- Makiko Tabuchi
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro, Tokyo, 153-8515, Japan.
| | - Kohei Morozumi
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro, Tokyo, 153-8515, Japan
| | - Yuichi Maki
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro, Tokyo, 153-8515, Japan
| | - Daisuke Toyoda
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro, Tokyo, 153-8515, Japan
| | - Yoshifumi Kotake
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro, Tokyo, 153-8515, Japan
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15
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Vanishree BK, Gangadharaiah C, Kajjari S, Sundararajan BV, Kansar N. Comparative Evaluation of the Effect of Alum and Herbal Mouthrinses on Plaque Inhibition in Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2021; 14:610-615. [PMID: 34934270 PMCID: PMC8645625 DOI: 10.5005/jp-journals-10005-2036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Gram-positive and gram-negative bacteria that compose oral biofilms produce many metabolites that induce the formation of dental plaque. Dental plaque is the main factor for the initiation and progression of oral diseases. Plaque preventive measures like mechanical or chemical approaches can be used in combination with this. Aims and objectives A study was done to compare and evaluate the effects of 0.02 M alum mouthrinse, herbal mouthrinse, and saline on plaque inhibition in children. Materials and methods Sixty healthy children of age-group 9-12 years were included in the study and divided into 3 groups of 20 each: group I: alum containing mouthwash (0.02 M), group II: saline, and group III: herbal mouthwash, rinsing two times daily for 30 days. Plaque index scores were recorded from each individual on the 1st, 15th, and 30th day. Results Alum group (group I) showed a highly significant reduction of plaque at 1st, 15th, and 30th day when comparison to herbal group (group III) and saline group (group II). Conclusion Ingredients in the alum group (group I) were effective in plaque inhibition, it may serve as an alternative antimicrobial mouthwash. Further long-term study with a large population group is recommended to determine the efficacy of alum-containing mouthwash and herbal (Hi-ora) mouthwash in improving oral health status. How to cite this article Vanishree BK, Gangadharaiah C, Kajjari S, et al. Comparative Evaluation of the Effect of Alum and Herbal Mouthrinses on Plaque Inhibition in Children: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(5):610-615.
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Affiliation(s)
- B K Vanishree
- Department of Pediatric Dentistry, MAR Dental College, Pune, Maharashtra, India
| | | | - Shweta Kajjari
- Department of Pediatric and Preventive Dentistry, KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India
| | - Bharath V Sundararajan
- Department of Pediatric and Preventive Dentistry, Oxford Dental College, Bengaluru, Karnataka, India
| | - Nisarga Kansar
- Department of Pediatric and Preventive Dentistry, Subbaiah Institute of Dental Sciences and Hospital, Shivamogga, Karnataka, India
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16
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Weiss SL, Balamuth F, Long E, Thompson GC, Hayes KL, Katcoff H, Cook M, Tsemberis E, Hickey CP, Williams A, Williamson-Urquhart S, Borland ML, Dalziel SR, Gelbart B, Freedman SB, Babl FE, Huang J, Kuppermann N. PRagMatic Pediatric Trial of Balanced vs nOrmaL Saline FlUid in Sepsis: study protocol for the PRoMPT BOLUS randomized interventional trial. Trials 2021; 22:776. [PMID: 34742327 PMCID: PMC8572061 DOI: 10.1186/s13063-021-05717-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background/aims Despite evidence that preferential use of balanced/buffered fluids may improve outcomes compared with chloride-rich 0.9% saline, saline remains the most commonly used fluid for children with septic shock. We aim to determine if resuscitation with balanced/buffered fluids as part of usual care will improve outcomes, in part through reduced kidney injury and without an increase in adverse effects, compared to 0.9% saline for children with septic shock. Methods The Pragmatic Pediatric Trial of Balanced versus Normal Saline Fluid in Sepsis (PRoMPT BOLUS) study is an international, open-label pragmatic interventional trial being conducted at > 40 sites in the USA, Canada, and Australia/New Zealand starting on August 25, 2020, and continuing for 5 years. Children > 6 months to < 18 years treated for suspected septic shock with abnormal perfusion in an emergency department will be randomized to receive either balanced/buffered crystalloids (intervention) or 0.9% saline (control) for initial resuscitation and maintenance fluids for up to 48 h. Eligible patients are enrolled and randomized using serially numbered, opaque envelopes concurrent with clinical care. Given the life-threatening nature of septic shock and narrow therapeutic window to start fluid resuscitation, patients may be enrolled under “exception from informed consent” in the USA or “deferred consent” in Canada and Australia/New Zealand. Other than fluid type, all decisions about timing, volume, and rate of fluid administration remain at the discretion of the treating clinicians. For pragmatic reasons, clinicians will not be blinded to study fluid type. Anticipated enrollment is 8800 patients. The primary outcome will be major adverse kidney events within 30 days (MAKE30), a composite of death, renal replacement therapy, and persistent kidney dysfunction. Additional effectiveness, safety, and biologic outcomes will also be analyzed. Discussion PRoMPT BOLUS will provide high-quality evidence for the comparative effectiveness of buffered/balanced crystalloids versus 0.9% saline for the initial fluid management of children with suspected septic shock in emergency settings. Trial registration PRoMPT BOLUS was first registered at ClinicalTrials.gov (NCT04102371) on September 25, 2019. Enrollment started on August 25, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05717-4.
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Affiliation(s)
- Scott L Weiss
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,The Children's Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia, PA, USA.
| | - Fran Balamuth
- The Children's Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia, PA, USA.,Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elliot Long
- Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Departments of Pediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Graham C Thompson
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katie L Hayes
- The Children's Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia, PA, USA
| | - Hannah Katcoff
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marlena Cook
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elena Tsemberis
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher P Hickey
- The Children's Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia, PA, USA
| | - Amanda Williams
- Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sarah Williamson-Urquhart
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meredith L Borland
- Divisions of Emergency Medicine and Pediatrics, Perth Children's Hospital, School of Medicine at the University of Western Australia, Crawley, Australia
| | - Stuart R Dalziel
- Departments of Surgery and Pediatrics: Child and Youth Health, Starship Children's Hospital, University of Auckland, Auckland, New Zealand
| | - Ben Gelbart
- Departments of Pediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Australian and New Zealand Intensive Care Society Paediatric Study Group, Camberwell, Australia.,Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Franz E Babl
- Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Victoria, Australia.,Departments of Pediatrics and Critical Care, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jing Huang
- Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine and Pediatrics, UC Davis School of medicine and UC Davis Health, Sacramento, CA, USA
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17
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Huijghebaert S, Hoste L, Vanham G. Essentials in saline pharmacology for nasal or respiratory hygiene in times of COVID-19. Eur J Clin Pharmacol 2021; 77:1275-1293. [PMID: 33772626 PMCID: PMC7998085 DOI: 10.1007/s00228-021-03102-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Nasal irrigation or nebulizing aerosol of isotonic or hypertonic saline is a traditional method for respiratory or nasal care. A recent small study in outpatients with COVID-19 without acute respiratory distress syndrome suggests substantial symptom resolution. We therefore analyzed pharmacological/pharmacodynamic effects of isotonic or hypertonic saline, relevant to SARS-CoV-2 infection and respiratory care. METHODS Mixed search method. RESULTS Due to its wetting properties, saline achieves an improved spreading of alveolar lining fluid and has been shown to reduce bio-aerosols and viral load. Saline provides moisture to respiratory epithelia and gels mucus, promotes ciliary beating, and improves mucociliary clearance. Coronaviruses and SARS-CoV-2 damage ciliated epithelium in the nose and airways. Saline inhibits SARS-CoV-2 replication in Vero cells; possible interactions involve the viral ACE2-entry mechanism (chloride-dependent ACE2 configuration), furin and 3CLpro (inhibition by NaCl), and the sodium channel ENaC. Saline shifts myeloperoxidase activity in epithelial or phagocytic cells to produce hypochlorous acid. Clinically, nasal or respiratory airway care with saline reduces symptoms of seasonal coronaviruses and other common cold viruses. Its use as aerosol reduces hospitalization rates for bronchiolitis in children. Preliminary data suggest symptom reduction in symptomatic COVID-19 patients if saline is initiated within 48 h of symptom onset. CONCLUSIONS Saline interacts at various levels relevant to nasal or respiratory hygiene (nasal irrigation, gargling or aerosol). If used from the onset of common cold symptoms, it may represent a useful add-on to first-line interventions for COVID-19. Formal evaluation in mild COVID-19 is desirable as to establish efficacy and optimal treatment regimens.
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Affiliation(s)
| | - Levi Hoste
- Pediatric Pulmonology, Infectious Diseases and Immunology, Ghent University Hospital, Ghent, Belgium
- Primary Immunodeficiency Research Lab, Center for Primary Immunodeficiency Ghent, Jeffrey Modell Diagnosis and Research Center, Ghent University Hospital, Ghent, Belgium
| | - Guido Vanham
- Department of Biomedical Sciences, Institute of Tropical Medicine and University of Antwerp, Antwerp, Belgium
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18
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Chang GH, Lin YS, Hsu KH, Cheng YC, Yang PR, Tsai MS, Tsai YT, Hsu CM, Chang PJ, Shi CS, Yang YH, Wu CY. Nasal irrigation with Glycyrrhiza glabra extract for treatment of allergic rhinitis - A study of in vitro, in vivo and clinical trial. J Ethnopharmacol 2021; 275:114116. [PMID: 33857594 DOI: 10.1016/j.jep.2021.114116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Glycyrrhiza glabra, a family of licorice and a traditional Chinese medicine with sweet taste and favorable smell, has anti-inflammatory, anti-allergic and immunomodulatory functions. AIM OF THE STUDY We developed a licorice extract (LE) by using glycyrrhiza glabra and administered it through nasal irrigation to treat allergic rhinitis (AR). MATERIALS AND METHODS LE was prepared into extract powder, and the anti-inflammatory effect of the LE was evaluated by calcium ionophore-induced activated mast cell model (in vitro). Then, local passive anaphylaxis assays were applied to investigate the anti-IgE-mediated allergic reaction of the LE in mice (in vivo). A developed LE was administered through nasal irrigation to treat AR in clinic settings. A total of 60 participants diagnosed with AR were included in this clinical trial; they were randomly assigned to three interventions: licorice nasal irrigation (LNI), corticosteroid nasal irrigation (CNI), and saline nasal irrigation (SNI). They performed nasal irrigation once a day for 1 month. Both subjective questionnaires (22-item Sino-Nasal Outcome Test [SNOT-22] and visual analog scale [VAS]) and objective examinations (acoustic rhinometry and nasal endoscopy) were used for effectiveness assessments. RESULTS All three interventions could improve SNOT-22 scores, but the effects of LNI and CNI were more significant. According to VAS scores for nasal blockage, rhinorrhea, sneezing, nasal pruritus, postnasal discharge, and olfactory disturbance, the effect of LNI was superior to those of CNI and SNI. The results of rhinometry revealed that LNI significantly improved nasal resistance. Endoscopic analysis showed that both LNI and CNI, but not SNI, could significantly improve turbinate hypertrophy. Moreover, the best procedural comfort was found for LNI, which had no side effects or complications during the trial. CONCLUSIONS LNI is a natural, safe, and innovative therapy that can effectively treat AR. Its effect is superior to those of CNI and SNI, and it has greatly improved procedural comfort.
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Affiliation(s)
- Geng-He Chang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chia-Yi 61363, Taiwan; Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yu-Shih Lin
- Department of Pharmacy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Ke-Hsin Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Yu-Ching Cheng
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Pei-Rung Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ming-Shao Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chia-Yi 61363, Taiwan; Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yao-Te Tsai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Cheng-Ming Hsu
- Department of Otolaryngology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan.
| | - Chung-Sheng Shi
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan.
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chia-Yi 61363, Taiwan; Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-Yuan Wu
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Gulabivala K, Azam I, Mahdavi-Izadi S, Palmer G, Georgiou G, Knowles JC, Y-L N. Effect of root canal irrigant (sodium hypochlorite & saline) delivery at different temperatures and durations on pre-load and cyclic-loading surface-strain of anatomically different premolars. J Mech Behav Biomed Mater 2021; 121:104640. [PMID: 34126506 DOI: 10.1016/j.jmbbm.2021.104640] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/02/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
AIM To evaluate the effect of NaOCl (5%) and saline (control) irrigant delivery at different temperatures and durations on pre-load and cyclic-loading tooth-surface-strain (TSS) on anatomically different premolars. METHODOLOGY Single-rooted premolars (n = 36), root-canal-prepared in standard manner, were randomly allocated to six irrigation groups: (A1) NaOCl-21 °C; (A2) NaOCl-60 °C; (A3) saline-21 °C then NaOCl-21 °C; (A4) saline-60 °C then NaOCl-21 °C; (A5) saline-21 °C then NaOCl-60 °C; (A6) saline-60 °C then NaOCl-60 °C. A1-2 received nine 10-min irrigation periods (IP) with NaOCl; A3-6 received nine 10-min IP with saline, followed by 9 IP with NaOCl at different temperature combinations. Premolars (n = 56) with single, fused or double roots prepared by standard protocol, were stratified and randomly allocated to: (B1) saline-21 °C; (B2) saline-80 °C; (B3) NaOCl-21 °C; (B4) NaOCl-80 °C. TSS (μє) was recorded pre-irrigation, post-irrigation and pre-load for each IP and during cyclic loading 2 min after each IP, over 30-274 min, using strain-gauges. Generalised linear mixed models were used for analysis. RESULTS Baseline TSS in double-rooted premolars was significantly (p=0.001) lower than in single/fused-rooted-premolars; and affected by mesial-wall-thickness (p=0.005). There was significant increase in loading-TSS (μє) after NaOCl-21 °C irrigation (p=0.01) but decrease after NaOCl-60 °C irrigation (p=0.001). TSS also increased significantly (p = 0.005) after Saline-80 °C irrigation. Pre-load "strain-shift" was noted only upon first saline delivery but every-time with NaOCl. Strain-shift negatively influenced loading-TSS after saline or NaOCl irrigation (A3-6) but was only significant for saline-21 °C. CONCLUSIONS Tooth anatomy significantly affected its strain characteristics, exhibiting limits within which strain changes occurred. Intra-canal introduction of saline or NaOCl caused non-random strain shifts without loading. Irrigation with NaOCl-21 °C increased loading tooth strain, as did saline-80 °C or NaOCl-80 °C but NaOCl-60 °C decreased it. A "chain-link" model was proposed to explain the findings and tooth biomechanics.
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Affiliation(s)
- K Gulabivala
- Unit of Endodontology, Division of Restorative Dental Science, UK.
| | - I Azam
- Unit of Endodontology, Division of Restorative Dental Science, UK
| | - S Mahdavi-Izadi
- Unit of Endodontology, Division of Restorative Dental Science, UK
| | - G Palmer
- Division of Biomaterials & Tissue Engineering; UCL Eastman Dental Institute, UK
| | - G Georgiou
- Division of Biomaterials & Tissue Engineering; UCL Eastman Dental Institute, UK
| | - J C Knowles
- Division of Biomaterials & Tissue Engineering; UCL Eastman Dental Institute, UK; The Discoveries Centre for Regenerative and Precision Medicine, UCL Campus, London, UK; Department of Nanobiomedical Science and BK21 Plus NBM, Global Research Center for Regenerative Medicine, Dankook University, 518-10, Anseo-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, Republic of Korea
| | - Ng Y-L
- Unit of Endodontology, Division of Restorative Dental Science, UK
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Brems JH, Casey JD, Wang L, Self WH, Rice TW, Semler MW. Balanced crystalloids versus saline in critically ill adults with low plasma bicarbonate: A secondary analysis of a clinical trial. J Crit Care 2021; 63:250-253. [PMID: 33500146 PMCID: PMC9084443 DOI: 10.1016/j.jcrc.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE We aimed to determine if balanced crystalloids compared with saline improve outcomes in critically ill adults admitted with low plasma bicarbonate. MATERIALS AND METHODS We performed a secondary analysis of the Isotonic Solutions and Major Adverse Renal Events Trial (SMART). We included patients who presented to the Emergency Department with a first measured plasma bicarbonate less than 20 mmol/L. Among these patients, we compared the effect of balanced crystalloid versus saline on the primary outcome of major adverse kidney events within 30 days (MAKE30), defined as a composite of death, new renal-replacement therapy, or persistent renal dysfunction (final inpatient creatinine ≥200% baseline). Secondary outcomes included 30 day in-hospital mortality, receipt of new RRT, persistent renal dysfunction, incident AKI, and vasopressor-free days. RESULTS Among the 2029 patients with an initial plasma bicarbonate concentration < 20 mmol/L, there was no difference in the incidence of MAKE30 between those assigned to balanced crystalloid versus saline (21.8% vs 21.3%; P = 0.93). Secondary outcomes were similar between the balanced crystalloid and saline groups. CONCLUSIONS Among critically ill adults presenting to the Emergency Department, initial plasma bicarbonate concentration does not appear to be a useful marker to guide the selection of balanced crystalloid versus saline.
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Affiliation(s)
- J Henry Brems
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Jonathan D Casey
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Todd W Rice
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Matthew W Semler
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
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Takamiya S, Yamazaki K, Tokairin K, Osanai T, Shindo T, Seki T, Fujimura M. Intraoperative Identification of the Shunt Point of Spinal Arteriovenous Malformations by a Selective Arterial Injection of Saline to Subtract Signals of Indocyanine Green: Technical Note. World Neurosurg 2021; 151:132-137. [PMID: 34004358 DOI: 10.1016/j.wneu.2021.05.019] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND It is crucial to identify a shunt point for spinal arteriovenous malformation (AVM) treatment. For this purpose, some intraoperative supports have been reported-intravenous injection of indocyanine green (ICG), selective arterial injection of ICG, and selective arterial injection of saline with a high frame rate digital camera. However, there are difficulties in accurately identifying the shunt point, especially if the lesion has multiple feeders. The aim of this technical note was to report a novel method, selective arterial injection of saline to subtract signals of ICG, to precisely identify perimedullary arteriovenous fistula shunt points having multiple feeding arteries. METHODS After exposing the lesion, a 4-F catheter was cannulated into the origins of the segmental artery. ICG was injected intravenously as a first step, and then heparinized saline solution was flushed from the catheter. RESULTS Compared with other methods, this method could identify the exact shunt point and was effective for certain shunt point obliterations. CONCLUSIONS Despite having similar invasiveness, selective arterial injection of saline to subtract signals of ICG is superior to previously described techniques, such as selective arterial injection of ICG. Therefore, it will be useful in spinal arteriovenous malformation surgical treatment.
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Affiliation(s)
- Soichiro Takamiya
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Kazuyoshi Yamazaki
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kikutaro Tokairin
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiya Osanai
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashi Shindo
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshitaka Seki
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Li YQ, Chai YH, Wang XS, Huang LY, Luo XM, Qiu C, Liu QH, Guan XY. Bacterial community in saline farmland soil on the Tibetan plateau: responding to salinization while resisting extreme environments. BMC Microbiol 2021; 21:119. [PMID: 33874905 PMCID: PMC8056723 DOI: 10.1186/s12866-021-02190-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Salinization damages the health of soil systems and reduces crop yields. Responses of microbial communities to salinized soils and their functional maintenance under high salt stress are valuable scientific problems. Meanwhile, the microbial community of the salinized soil in the plateau environment is less understood. Here, we applied metagenomics technology to reveal the structure and function of microorganisms in salinized soil of the Tibetan Plateau. Results The diversity of composition and function of microbial community in saline soil have changed significantly. The abundances of chemoautotrophic and acidophilic bacteria comprising Rhodanobacter, Acidobacterium, Candidatus Nitrosotalea, and Candidatus Koribacter were significantly higher in saline soil. The potential degradation of organic carbon in the saline soil, as well as the production of NO and N2O via denitrification, and the production of sulfate by sulfur oxidation were significantly higher than the non-saline soil. Both types of soils were rich in genes encoding resistance to environmental stresses (i.e., cold, ultraviolet light, and hypoxia in Tibetan Plateau). The resistance of the soil microbial communities to the saline environment is based on the absorption of K+ as the main mechanism, with cross-protection proteins and absorption buffer molecules as auxiliary mechanisms in our study area. Network analysis showed that functional group comprising chemoautotrophic and acidophilic bacteria had significant positive correlations with electrical conductivity and total sulfur, and significant negative correlations with the total organic carbon, pH, and available nitrogen. The soil moisture, pH, and electrical conductivity are likely to affect the bacterial carbon, nitrogen, and sulfur cycles. Conclusions These results indicate that the specific environment of the Tibetan Plateau and salinization jointly shape the structure and function of the soil bacterial community, and that the bacterial communities respond to complex and harsh living conditions. In addition, environmental feedback probably exacerbates greenhouse gas emissions and accelerates the reduction in the soil pH. This study will provide insights into the microbial responses to soil salinization and the potential ecological risks in the special plateau environment. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-021-02190-6.
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Affiliation(s)
- Yi Qiang Li
- School of Ocean Sciences, China University of Geosciences (Beijing), Beijing, 100083, China
| | - Ying Hui Chai
- School of Ocean Sciences, China University of Geosciences (Beijing), Beijing, 100083, China.,Laboratory division, Eighth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, 100000, People's Republic of China
| | - Xu Sheng Wang
- School of Ocean Sciences, China University of Geosciences (Beijing), Beijing, 100083, China
| | - Li Ying Huang
- Institute of Agricultural Quality Standards and Testing, Tibet Academy of Agriculture and Animal Husbandry Sciences, Lhasa, 850000, China
| | - Xi Ming Luo
- School of Ocean Sciences, China University of Geosciences (Beijing), Beijing, 100083, China.,Beijing Key Laboratory of Water Resources and Environmental Engineering, China University of Geosciences (Beijing), Beijing, 100083, China
| | - Cheng Qiu
- Institute of Agricultural Quality Standards and Testing, Tibet Academy of Agriculture and Animal Husbandry Sciences, Lhasa, 850000, China
| | - Qing Hai Liu
- Institute of Agricultural Quality Standards and Testing, Tibet Academy of Agriculture and Animal Husbandry Sciences, Lhasa, 850000, China
| | - Xiang Yu Guan
- School of Ocean Sciences, China University of Geosciences (Beijing), Beijing, 100083, China. .,Beijing Key Laboratory of Water Resources and Environmental Engineering, China University of Geosciences (Beijing), Beijing, 100083, China.
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Bolaji TA, Oti MN, Onyekonwu MO, Bamidele T, Osuagwu M, Chiejina L, Elendu P. Preliminary geochemical characterization of saline formation water from Miocene reservoirs, offshore Niger Delta. Heliyon 2021; 7:e06281. [PMID: 33665441 PMCID: PMC7900698 DOI: 10.1016/j.heliyon.2021.e06281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/18/2019] [Accepted: 02/10/2021] [Indexed: 11/15/2022] Open
Abstract
The Niger Delta is one of the most prolific hydrocarbon provinces in the world, but information on basinal hydrogeology is scanty. Oilfield brines from nine producer wells in the Miocene reservoirs (2,472.25–3,532.48 m.b.s.l.), offshore Niger Delta, have been investigated along with two seawater samples to understand their hydrogeochemical characteristics in relation to the host rock mineralogy. Chemical analysis revealed that the waters are slightly alkaline and can be generally classified as saline water of the Na–Cl type based on their total dissolved solids (TDS). On the basis of bicarbonate, chloride, and sulphate ions, they are shown to be of connate origin. Relative abundance of major ions is in the following order: Na > Ca > Mg > K and Cl > HCO3 > SO4. Saturation indices (SI) of selected mineral phases calculated using PHREEQC indicate that the dissolution of iron oxide and carbonate minerals may contribute major ions in the formation water. The preponderance of alkali elements suggests the presence of feldspars, which could have resulted from sediments through which the water flows. An inverse relationship is observed between the resistivity of formation water and its TDS, which could be used to calculate resistivity values of formation waters in the area if the TDS contributions are known. Chemical data suggest that the formation waters were derived from seawater, dominantly altered by reverse ion-exchange processes and subsequently by water-rock interactions. Multivariate statistical analyses (correlation and factor analysis) indicate multiple sources of enrichment of ions in the formation waters.
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Affiliation(s)
- Taiwo A Bolaji
- World Bank African Centre for Excellence in Oilfield Chemicals Research, Institute of Petroleum Studies, University of Port Harcourt, Nigeria.,Department of Geology, Federal University Oye-Ekiti, Nigeria
| | - Michael N Oti
- Department of Geology, University of Port Harcourt, Nigeria
| | - Mike O Onyekonwu
- Department of Petroleum Engineering, University of Port Harcourt, Nigeria
| | - Taiwo Bamidele
- Shell Petroleum Development Company of Nigeria, Port Harcourt, Nigeria
| | - Michael Osuagwu
- Shell Petroleum Development Company of Nigeria, Port Harcourt, Nigeria
| | - Leo Chiejina
- Shell Nigeria Exploration and Production Company, Lagos, Nigeria
| | - Precious Elendu
- Shell Petroleum Development Company of Nigeria, Port Harcourt, Nigeria
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Moritz ML, Ayus JC. 0.9% saline and balance crystalloids in acute ill patients: Trading one problem for another. J Crit Care 2021; 63:254-256. [PMID: 33608168 DOI: 10.1016/j.jcrc.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Michael L Moritz
- UPMC Children's Hospital of Pittsburgh, USA; Division of Nephrology, Department of Pediatrics, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Juan C Ayus
- University of California, Irvine, Department of Nephrology, Orange, CA, USA
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25
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Liu F, Zhang J, Zhu Y, Su L, Li Y, He L, Yu L, Peng Z. Acetate Ringer's solution versus 0.9% saline for septic patients: study protocol for a multi-center parallel controlled trial. Trials 2021; 22:89. [PMID: 33494795 PMCID: PMC7830046 DOI: 10.1186/s13063-020-05007-5] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 12/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background Previous study drew different conclusions on significant differences between saline and balanced crystalloid solution infused in critical illness but both showed a statistical difference in the sepsis subgroup. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on renal outcomes are related to the underline acute kidney injury (AKI) severity and total volumes of infusion. Methods/design The investigators designed a pragmatic, multi-center parallel controlled trial recruiting 312 patients who are diagnosed with sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer’s solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrolment are excluded. Enrolled patients will be regarded as with mild, moderate, or severe sepsis on the basis of the severity of their illness and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events within 28 days (MAKE28), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28-day mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT, and ICU and hospital length of stay. Results and conclusions To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration. Trial registration ClinicalTrials.gov NCT03685214. Registered on August 15, 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-020-05007-5.
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Affiliation(s)
- Fang Liu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Jing Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Yuan Zhu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Lianjiu Su
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Yiming Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Li He
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China
| | - Li Yu
- Department of Critical Care Medicine, Wuhan Central Hospital, Huazhong University of Science & Technology, Tongji Medical School, Wuhan, 430030, Hubei, China
| | - Zhiyong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, 430071, Hubei, China.
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De Silva PM, Stevenson H, Smith PP, Justin Clark T. A Systematic Review of the Effect of Type, Pressure, and Temperature of the Distension Medium on Pain During Office Hysteroscopy. J Minim Invasive Gynecol 2021; 28:1148-1159.e2. [PMID: 33444792 DOI: 10.1016/j.jmig.2021.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/18/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify the optimal distension medium type, pressure, and temperature to minimize pain during office hysteroscopy. DATA SOURCES MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to January 29, 2020. METHODS OF STUDY SELECTION We included randomized controlled trials in which women undergoing office hysteroscopy were randomized to either a distension medium type, pressure, or temperature against a suitable control, where pain was an outcome. Data regarding feasibility, visualization, complications, and satisfaction were also collected. TABULATION, INTEGRATION, AND RESULTS The literature search returned 847 studies, of which 18 were included for systematic review and 17 for meta-analysis. There was no significant difference in intraprocedural pain when comparing the use of normal saline against carbon dioxide (standardized mean difference [SMD], -0.12; 95% confidence interval [CI], -0.36 to 0.13). Subgroup analysis of high-quality studies revealed a statistically significant reduction in postprocedural pain with normal saline (SMD, -0.65; 95% CI, -1.14 to -0.16). Side effects were less frequent (Peto odds ratio, 0.29; 95% CI, 0.20-0.40) and patient satisfaction was higher (SMD, 1.39; 95% CI, 0.51-2.28) with normal saline compared with carbon dioxide. Pressures of ≤40 mm Hg reduced intraprocedural pain (SMD, -0.67; 95% CI, -1.09 to -0.26) at the expense of a higher proportion of unsatisfactory views (81%-89% at ≤40 mm Hg vs 95%-99% at ≥50 mm Hg). Postprocedural pain was reduced with lower filling pressures. Warming saline did not reduce intraprocedural pain (SMD, 0.59; 95% CI, -0.14 to 1.33). CONCLUSION Normal saline, instilled at the lowest pressure to acquire a satisfactory view, should be used for uterine distension during office hysteroscopy to minimize pain.
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Doshi N, Rutherford K, Najjar A. Dissolution of Polysorbate 20 Degradation Related Free Fatty Acid Particles in Intravenous Bag Solutions. J Pharm Sci 2020; 110:687-692. [PMID: 33039438 DOI: 10.1016/j.xphs.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 11/15/2022]
Abstract
Degradation of Polysorbate 20 (PS20), a commonly used surfactant in drug product (DP) formulations, is a phenomenon of increasing concern to the biopharmaceutical industry. One of the most prevalent modes of PS20 degradation is enzymatic hydrolysis resulting from co-purified hydrolases that make their way into biologic DP formulations at trace levels. Enzymatic PS20 degradation results in generation of free fatty acids (FFAs) that have limited solubility in aqueous formulations and can form visible and/or sub-visible particles which is undesirable for parenteral DP stability and administration. Many therapeutic monoclonal antibodies are administered intravenously after first diluting the DP into an infusion solution (e.g., 0.9% normal saline, 0.45% half normal saline or 5% dextrose). The purpose of this work is to understand if FFA particles in the DP dissolve in intravenous solutions prior to administration. Our assessment indicates that visible and/or sub-visible particles that contain high levels of lauric, myristic and palmitic acids dissolve immediately upon dilution (at or exceeding two fold) regardless of the intravenous bag or solution type. Therefore, the risk is low of visible and/or sub-visible particles, comprised of FFAs in biopharmaceutical DPs, being intravenously administered to a patient.
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Affiliation(s)
- Nidhi Doshi
- Pharmaceutical Development, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| | - Karen Rutherford
- Pharmaceutical Development, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Asil Najjar
- Pharmaceutical Development, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
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Aoyagi Y, Yoshida T, Uchino S, Takinami M, Uezono S. Saline versus 5% dextrose in water as a drug diluent for critically ill patients: a retrospective cohort study. J Intensive Care 2020; 8:69. [PMID: 32944250 PMCID: PMC7488509 DOI: 10.1186/s40560-020-00489-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background The choice of intravenous infusion products for critically ill patients has been studied extensively because it can affect prognosis. However, there has been little research on drug diluents in this context. The purpose of this study is to evaluate the impact of diluent choice (saline or 5% dextrose in water [D5W]) on electrolyte abnormalities, blood glucose control, incidence of acute kidney injury (AKI), and mortality. Methods This before-after, two-group comparative, retrospective study enrolled adult patients who stayed for more than 48 h in a general intensive care unit from July 2015 to December 2018. We changed the default diluent for intermittent drug sets in our electronic ordering system from D5W to saline at the end of 2016. Results We included 844 patients: 365 in the D5W period and 479 in the saline period. Drug diluents accounted for 21.4% of the total infusion volume. The incidences of hypernatremia and hyperchloremia were significantly greater in the saline group compared to the D5W group (hypernatremia 27.3% vs. 14.6%, p < 0.001; hyperchloremia 36.9 % vs. 20.4%, p < 0.001). Multivariate analyses confirmed the similar effects (hypernatremia adjusted odds ratio (OR), 2.43; 95% confidence interval (CI), 1.54–3.82; hyperchloremia adjusted OR, 2.09; 95% CI, 1.31–3.34). There was no significant difference in the incidences of hyperglycemia, AKI, and mortality between the two groups. Conclusions Changing the diluent default from D5W to saline had no effect on blood glucose control and increased the incidences of hypernatremia and hyperchloremia.
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Affiliation(s)
- Yukari Aoyagi
- Intensive Care Unit, Department of Anesthesiology, The Jikei University Hospital, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, 105-8471 Japan
| | - Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, The Jikei University Hospital, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, 105-8471 Japan
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, The Jikei University Hospital, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, 105-8471 Japan
| | - Masanori Takinami
- Intensive Care Unit, Department of Anesthesiology, The Jikei University Hospital, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, 105-8471 Japan
| | - Shoichi Uezono
- Intensive Care Unit, Department of Anesthesiology, The Jikei University Hospital, 3-19-18, Nishi-Shinbashi Minato-ku, Tokyo, 105-8471 Japan
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Liu S, Shan XG, Zhang XJ. The place of hydration using intravenous fluid in patients at risk of developing contrast-associated nephropathy. Br J Hosp Med (Lond) 2020; 81:1-7. [PMID: 32990074 DOI: 10.12968/hmed.2020.0394] [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: 11/11/2022]
Abstract
There has been a significant rise in the incidence of contrast-associated nephropathy caused by administration of contrast media during cardiac interventions. This is one of the major complications of percutaneous coronary interventions, which may proceed to acute renal failure. Risk factors, including pre-existing renal dysfunction, older age and use of high osmolar contrast media, predispose patients to the development of contrast-associated nephropathy. Different risk-reduction strategies have been used to prevent contrast-associated nephropathy, including use of low osmolar contrast media, N-acetylcysteine, alkalisation of tubular fluid with intravenous sodium bicarbonate, and oral and intravenous hydration with isotonic solution. Hydration using intravenous saline is one of the main treatments used to prevent the development of nephropathy in patients receiving contrast media during cardiac interventions. Prehydration, before administering contrast media, seems to be crucial. The results of studies of the relative efficacy of sodium bicarbonate and/or N-acetylcysteine in reducing the development of contrast-associated nephropathy are not consistent and any beneficial effects may depend on the pre-existing state of the kidney. This review discusses hydration of patients who are at risk of developing contrast-associated nephropathy using intravenous fluid.
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Affiliation(s)
- Shuang Liu
- Department of Nursing Management, The First Hospital of Jilin University-The Eastern Division, Changchun, China
| | - Xin-Gang Shan
- Administrative Office, The First Hospital of Jilin University-The Eastern Division, Changchun, China
| | - Xiao-Jie Zhang
- Department of Nursing Management, The First Hospital of Jilin University-The Eastern Division, Changchun, China
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Abstract
With the advent of parenteral, intravenous infusion for various purposes like chemotherapy, parenteral nutrition, radiocontrast intravenous injection for imaging studies, extravasation injuries are emerging as a serious problem with often disastrous complications, if not recognized early. Fortunately, if treated early, the affected extremities can be salvaged and hence the role of plastic surgeons cannot be over-emphasized, especially when it comes to the reconstruction of necrotic and ischemic wounds as a result of these injuries. Proper monitoring and immediate intervention will go a long way in minimizing the morbidity associated with these injuries. However, if there is a delay in recognition and treatment, it can lead to complications like skin necrosis, gangrene, extensive soft tissue defects and contractures. Treatment in these circumstances needs an individualized approach and entails wound debridement followed by skin grafts and flap cover. Documentation and prompt intervention can avoid medicolegal issues for the physician and the hospital.
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Affiliation(s)
- Leon Alexander
- Sheikh Khalifa Medical City, Division of Plastic Surgery, Department of Surgery, Abu Dhabi, UAE
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Mahesh NK, Gupta A, Barward P, Vijayvergiya R, Sharma P, Mahesh A. Study of saline optical coherence tomography-guided percutaneous coronary intervention (SOCT-PCI Study). Indian Heart J 2020; 72:239-243. [PMID: 32861376 PMCID: PMC7474129 DOI: 10.1016/j.ihj.2020.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/01/2020] [Accepted: 03/28/2020] [Indexed: 11/29/2022] Open
Abstract
AIM The aim of this study was to evaluate the feasibility of heparinised saline as flushing media for frequency-domain optical coherence tomography (FD-OCT) image acquisition during percutaneous coronary intervention (PCI) optimisation. METHODS AND RESULTS Twenty-seven patients undergoing FD-OCT-guided PCI were enrolled. Heparinised saline was injected into the coronary during FD-OCT image acquisition. A total of 118 runs were analysed for image quality and diagnostic value. FD-OCT runs were categorised as follows: good runs (GRs), clinically usable runs (CURs) and clinically not usable runs (NURs); GRs and CURs were combined as clinically effective runs (ERs). Saline FD-OCT enabled visualisation of all possible coronary lesions. Of the 118 runs analysed, 61%, 27.1%, 11.9% and 88.1% were GRs, CURs, NURs and ERs, respectively. Sixty-one percent of total runs were left coronary system (LCS) and 39% were right coronary system (RCS) runs. Among LCS runs, 55.6%, 30.6%, 13.8% and 86.2% were GRs, CURs, NURs and ERs, respectively. Among RCS runs, 69.6%, 21.7%, 8.7% and 91.3% were GRs, CURs, NURs and ERs, respectively. CONCLUSION This is the first study to demonstrate the technical feasibility of isolated saline FD-OCT for PCI optimisation.
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Affiliation(s)
- Nalin K Mahesh
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
| | - Ankush Gupta
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India.
| | | | | | - Prafull Sharma
- Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India
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Chua TH, Loh WJ. Osmotic demyelination syndrome in a patient with Noonan syndrome and anterior hypopituitarism. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200039. [PMID: 32820141 PMCID: PMC7487176 DOI: 10.1530/edm-20-0039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/29/2020] [Indexed: 12/03/2022] Open
Abstract
SUMMARY Severe hyponatremia and osmotic demyelination syndrome (ODS) are opposite ends of a spectrum of emergency disorders related to sodium concentrations. Management of severe hyponatremia is challenging because of the difficulty in balancing the risk of overcorrection leading to ODS as well as under-correction causing cerebral oedema, particularly in a patient with chronic hypocortisolism and hypothyroidism. We report a case of a patient with Noonan syndrome and untreated anterior hypopituitarism who presented with symptomatic hyponatremia and developed transient ODS. LEARNING POINTS Patients with severe anterior hypopituitarism with severe hyponatremia are susceptible to the rapid rise of sodium level with a small amount of fluid and hydrocortisone. These patients with chronic anterior hypopituitarism are at high risk of developing ODS and therefore, care should be taken to avoid a rise of more than 4-6 mmol/L per day. Early recognition and rescue desmopressin and i.v. dextrose 5% fluids to reduce serum sodium concentration may be helpful in treating acute ODS.
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Affiliation(s)
- Tzy Harn Chua
- Department of Endocrinology, Changi General Hospital, Singapore
| | - Wann Jia Loh
- Department of Endocrinology, Changi General Hospital, Singapore
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Edwards D, Hickey A, Batycky R, Griel L, Lipp M, Dehaan W, Clarke R, Hava D, Perry J, Laurenzi B, Curran AK, Beddingfield BJ, Roy CJ, Devlin T, Langer R. A New Natural Defense Against Airborne Pathogens. QRB Discov 2020; 1:e5. [PMID: 34192261 DOI: 10.1017/qrd.2020.9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 01/05/2023] Open
Abstract
We propose the nasal administration of calcium-enriched physiological salts as a new hygienic intervention with possible therapeutic application as a response to the rapid and tenacious spread of COVID-19. We test the effectiveness of these salts against viral and bacterial pathogens in animals and humans. We find that aerosol administration of these salts to the airways diminishes the exhalation of the small particles that face masks fail to filter and, in the case of an influenza swine model, completely block airborne transmission of disease. In a study of 10 human volunteers (5 less than 65 years and 5 older than 65 years), we show that delivery of a nasal saline comprising calcium and sodium salts quickly (within 15 min) and durably (up to at least 6 h) diminishes exhaled particles from the human airways. Being predominantly smaller than 1 μm, these particles are below the size effectively filtered by conventional masks. The suppression of exhaled droplets by the nasal delivery of calcium-rich saline with aerosol droplet size of around 10 μm suggests the upper airways as a primary source of bioaerosol generation. The suppression effect is especially pronounced (99%) among those who exhale large numbers of particles. In our study, we found this high-particle exhalation group to correlate with advanced age. We argue for a new hygienic practice of nasal cleansing by a calcium-rich saline aerosol, to complement the washing of hands with ordinary soap, use of a face mask, and social distancing.
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Becerra-Bayona SM, Solarte-David VA, Sossa CL, Mateus LC, Villamil M, Pereira J, Arango-Rodríguez ML. Mesenchymal stem cells derivatives as a novel and potential therapeutic approach to treat diabetic foot ulcers. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM19-0164. [PMID: 32698128 PMCID: PMC7354732 DOI: 10.1530/edm-19-0164] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/26/2020] [Indexed: 12/19/2022] Open
Abstract
SUMMARY Diabetic foot ulcer morbidity and mortality are dramatically increasing worldwide, reinforcing the urgency to propose more effective interventions to treat such a devastating condition. Previously, using a diabetic mouse model, we demonstrated that administration of bone marrow mesenchymal stem cells derivatives is more effective than the use of bone marrow mesenchymal stem cells alone. Here, we used the aforementioned treatments on three patients with grade 2 diabetic foot ulcers and assessed their beneficial effects, relative to the conventional approach. In the present study, two doses of cell derivatives, one dose of mesenchymal stem cells or one dose of vehicle (saline solution with 5% of human albumin), were intradermally injected around wounds. Wound healing process and changes on re-epithelialization were macroscopically evaluated until complete closure of the ulcers. All ulcers were simultaneously treated with conventional treatment (PolyMen® dressing). Patients treated with either cell derivatives or mesenchymal stem cells achieved higher percentages of wound closure in shorter times, relative to the patient treated with the conventional treatment. The cell derivative and mesenchymal stem cells approaches resulted in complete wound closure and enhanced skin regeneration at some point between days 35 and 42, although no differences between these two treatments were observed. Moreover, wounds treated with the conventional treatment healed after 161 days. Intradermal administration of cell derivatives improved wound healing to a similar extent as mesenchymal stem cells. Thus, our results suggest that mesenchymal stem cell derivatives may serve as a novel and potential therapeutic approach to treat diabetic foot ulcers. LEARNING POINTS In diabetic mouse models, the administration of mesenchymal stem cells derivatives have been demonstrated to be more effective than the use of marrow mesenchymal stem cells alone. Mesenchymal stem cells have been explored as an attractive therapeutic option to treat non-healing ulcers. Mesenchymal stem cells derivatives accelerate the re-epithelialization on diabetic foot ulcers.
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Affiliation(s)
- Silvia M Becerra-Bayona
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga – UNAB, Bucaramanga, Colombia
| | | | - Claudia L Sossa
- Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga – UNAB, Bucaramanga, Colombia
- Banco Multitejidos y Centro de Terapias Avanzadas, Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia
| | - Ligia C Mateus
- Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia
| | - Martha Villamil
- Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia
| | - Jorge Pereira
- Banco Multitejidos y Centro de Terapias Avanzadas, Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia
| | - Martha L Arango-Rodríguez
- Banco Multitejidos y Centro de Terapias Avanzadas, Fundación Oftalmológica de Santander, Clínica Carlos Ardila Lulle – FOSCAL, Floridablanca, Colombia
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Aytekin K, Duman A, Aytekin FY, Cinar I, Akdeniz E, Takir S, Esenyel CZ. Evaluation of Necrotic, Edematous and Inflammatory Changes in Bone Marrow and Soft Tissue After Irrigation with Different Concentrations of NaOCl Solution: An Experimental Study in Rat Tibia. Eurasian J Med 2020; 52:243-248. [PMID: 33209075 DOI: 10.5152/eurasianjmed.2020.19216] [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] [Received: 07/05/2019] [Accepted: 01/23/2020] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to investigate effects of different concentrations (0.5-5%) of Sodium Hypochlorite (NaOCl) solution on healthy tissues, and determine the optimal concentration that does not harm to tissue. Materials and Methods 30 tibias of 15 male Wistar albino rats were used. The tibias were randomly divided into 5 groups (Salin, 0.5%, 1%, 2.5%, and 5% NaOCl). Tibias were reamed intramedullary, and irrigated with 20 ml of saline or increasing concentrations of (0.5-5%) NaOCl. The tibias were embedded in paraffin and the sections were stained with hematoxylin-eosin. All sections were assessed for edema, acute inflammation, or necrosis according to their density, in bone marrow and soft tissues. Results Pairwise comparisons revealed that irrigation of tibia with saline or 0.5% NaOCl solutions was not statistically significant in terms of necrosis in the bone marrows (p=0.320). However, irrigation of rat tibia with saline caused less necrosis in the bone marrows compared to high concentrations (1%, 2.5%, and 5%) of NaOCl (saline and 1% NaOCl, p=0.017; saline and 2.5% NaOCl, p=0.0007; saline and 5% NaOCl, p=0.001). Conclusion As an irrigation solution, the effects of 0.5% NaOCl are similar to those of saline in terms of edema, inflammation, and necrosis. There is a need for evaluation of necrosis for extended periods such as one week or one month by immunohistochemical methods and flow cytometry.
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Affiliation(s)
- Kursad Aytekin
- Department of Orthopaedics and Traumatology, Giresun University School of Medicine, Giresun, Turkey
| | - Aslihan Duman
- Department of Pathology, Giresun University School of Medicine, Giresun, Turkey
| | - Feyza Yildiz Aytekin
- Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Giresun University Prof. Dr. A. Ilhan Ozdemir Training and Research Hospital, Giresun, Turkey
| | - Ilkay Cinar
- Department of Pathology, Ministry of Health Giresun University Prof. Dr. A. Ilhan Ozdemir Training and Research Hospital, Giresun, Turkey
| | - Esra Akdeniz
- Department of Biostatistics, Marmara University School of Medicine, Istanbul, Turkey
| | - Selcuk Takir
- Department of Pharmacology, Giresun University School of Medicine, Giresun, Turkey
| | - Cem Zeki Esenyel
- Department of Orthopaedics and Traumatology, Giresun University School of Medicine, Giresun, Turkey
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Abstract
PURPOSE OF REVIEW Pediatric and adult chronic rhinosinusitis (CRS) have some similarities but a number of differences. This article reviews the similarities and differences between pediatric and adult CRS. RECENT FINDINGS Rhinosinusitis is an inflammatory disease of the nose and the paranasal sinuses. In adults, inflammation in CRS without polyps (CRSsNP) mainly manifests with T-helper 1 lymphocytes while in CRS with polyps (CRSwNP) manifests with T-helper 2 lymphocytes and eosinophilic inflammation. In children, CRS inflammation manifests with neutrophils, macrophages, and lymphocytes. The associations between the ostiomeatal complex occlusion and CRS are revealed in adults but are not so evident in children. Although the relationship between the CRS and allergic rhinitis is still controversial, recent findings have shown an association between allergen sensitization and a specific group of adults with rhinosinusitis. Intranasal corticosteroids and saline constitute the first-line of medical treatment for both pediatric and adult rhinosinusitis. Low-dose macrolides are used for immunomodulatory activities and beneficial effects to adult patients with CRSsNP were demonstrated by recent meta-analyses. For surgical treatment, adenoidectomy is a key strategy to eradicate mature biofilms in pediatric CRS and effective in treating children with CRS regardless of the adenoid size. Although endoscopic sinus surgery has been proven to improve quality of life outcomes in adult CRS, it should be only considered in the pediatric CRS after failure of adenoidectomy. Pediatric and adult CRS are different in many aspects, including immunopathogenesis and management. Investigations should be considered in specific cases. After failure of medical treatments, endoscopic sinus surgery is recommended for adults, while adenoidectomy is primarily considered for children.
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Affiliation(s)
- Kornkiat Snidvongs
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | | | - Orapan Poachanukoon
- Center of Excellence for Allergy, Asthma and Pulmonary Diseases, Thammasat University Hospital, Bangkok, Thailand.,Department of Pediatrics, Faculty of Medicine, Thammasat University, Bangkok, Thailand
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Volcko KL, Brakey DJ, Przybysz JT, Daniels D. Exclusively drinking sucrose or saline early in life alters adult drinking behavior by laboratory rats. Appetite 2020; 149:104616. [PMID: 32006660 DOI: 10.1016/j.appet.2020.104616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/22/2022]
Abstract
Proper fluid balance is critical for life. Learning plays an important role in shaping the appetitive behaviors required for drinking. Children often forego drinking plain water and instead consume beverages such as milk or juice. What effect this may have on adult thirst responses remains an open question. To model aspects of the human condition, we bred Sprague-Dawley rats and prevented the pups from obtaining fluid other than from nursing. Pups were weaned onto either tap water, 5% sucrose, or 0.45% saline, and given access to only that fluid for at least 7 weeks. We then measured intake of water or sucrose/saline in one-bottle tests after mild hypertonic saline (HS) injection, or overnight fluid deprivation, and in two-bottle tests after HS injection while rats were maintained on their respective fluids, and after all subjects had only water to drink for a week. We found that sucrose- and saline-maintained rats drank less water than did controls after the HS challenge. After overnight fluid deprivation, rats maintained on saline drank less water and more saline, but there was no difference in intake between water-maintained and sucrose-maintained rats. Differences in licking patterns, including more licks/burst for sucrose by sucrose-maintained rats were detected, even in cases when total intake was not different. These data provide evidence that adult rat water intake can be reduced by exclusively drinking sucrose or saline early in life.
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Abstract
Background During drilling of bone, which is common in clinical surgeries, heat generation increases local temperature in the drilling site. Transmission of excessive heat to the surrounding bone tissue can cause thermal osteonecrosis. Consequently, it may lead to failure of implants and fixation screws or delay in healing process. Using cooling is a method for limiting temperature elevation. Materials and methods In this study, through comparing three conditions of drilling without cooling, external cooling with normal saline, and external cooling with OpSite spray, the efficiency of OpSite as coolant is studied. In this regard, 2 drill bit diameters, 3 drilling speeds, and 3 drilling feed-rates are considered as drilling variables in the experiments. Results For the whole experiments, while cooling with normal saline resulted in lower maximum temperatures than without cooling condition, OpSite had even better results and limited the temperature elevation during drilling of bone efficiently. Conclusion OpSite spray, which has lower infection risks than normal saline on one hand and lower maximum temperature rise with all combinations of drilling parameters on the other hand, can be considered in clinical surgeries for cooling applications.
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Affiliation(s)
| | - Nima Jamshidi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran.
| | - Alireza Mosavar
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
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Kusuki K, Suzuki S, Mizuno Y. Pembrolizumab-induced fulminant type 1 diabetes with C-peptide persistence at first referral. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190152. [PMID: 32478673 PMCID: PMC7219158 DOI: 10.1530/edm-19-0152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022] Open
Abstract
SUMMARY A 72-year-old man with no history of diabetes was referred to our department due to hyperglycemia during pembrolizumab treatment for non-small-cell lung carcinoma. His blood glucose level was 209 mg/dL, but he was not in a state of ketosis or ketoacidosis. Serum C-peptide levels persisted at first, but gradually decreased, and 18 days later, he was admitted to our hospital with diabetic ketoacidosis (DKA). The patient was diagnosed with fulminant type 1 diabetes (FT1D) induced by pembrolizumab. According to the literature, the insulin secretion capacity of a patient with type 1 diabetes (T1D) induced by anti-programmed cell death-1 (anti-PD-1) antibody is depleted in approximately 2 to 3 weeks, which is longer than that of typical FT1D. Patients with hyperglycemia and C-peptide persistence should be considered for hospitalization or frequent outpatient visits with insulin treatment because these could indicate the onset of life-threatening FT1D induced by anti-PD-1 antibodies. Based on the clinical course of this patient and the literature, we suggest monitoring anti-PD-1 antibody-related T1D. LEARNING POINTS Immune checkpoint inhibitors, such as anti-PD-1 antibodies, are increasingly used as anticancer drugs. Anti-PD-1 antibodies can cause immune-related adverse events, including T1D. FT1D, a novel subtype of T1D, is characterized by the abrupt onset of hyperglycemia with ketoacidosis, a relatively low glycated hemoglobin level and depletion of C-peptide level at onset. In patients being treated with anti-PD-1 antibody, hyperglycemia with C-peptide level persistence should be monitored through regular blood tests. Because of C-peptide persistence and mild hyperglycemia, it is possible to miss a diagnosis of life-threatening FT1D induced by anti-PD-1 antibody. In particular, in patients who have no history of diabetes, hyperglycemia without DKA is likely to be the very beginning of anti-PD-1 antibody-induced T1D. Therefore, such patients must be considered for either hospitalization or frequent outpatient visits with insulin injections and self-monitoring of blood glucose.
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Affiliation(s)
- Kazuhisa Kusuki
- Department of Diabetes and Endocrinology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Tokyo, Japan
| | - Saya Suzuki
- Department of Diabetes and Endocrinology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Tokyo, Japan
| | - Yuzo Mizuno
- Department of Diabetes and Endocrinology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Setagaya-ku, Tokyo, Japan
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Singer AD, Rosenthal J, Umpierrez M, Guo Y, Gonzalez F, Wagner E. A comparison of saline and gadolinium shoulder MR arthrography to arthroscopy. Skeletal Radiol 2020; 49:625-633. [PMID: 31773187 DOI: 10.1007/s00256-019-03338-2] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/11/2019] [Accepted: 10/30/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Compare the diagnostic performance of saline and gadolinium shoulder magnetic resonance arthrograms (MRA) in the detection of labral and rotator cuff injury compared to arthroscopy. MATERIALS AND METHODS Consecutive patients who underwent a gadolinium or saline MRA followed by arthroscopy were retrospectively reviewed. The reports were reviewed for injuries. A chi square or Fisher's exact test was performed to compare the MRA and surgery. Kappa values were calculated to correlate diagnosis of tear between MRA and arthroscopy. RESULTS There were a total of 58 patients included, including 34 gadolinium arthrograms and 24 saline arthrograms. The accuracy of saline MRA was similar compared to gadolinium MRA in the diagnosis of tears of the supraspinatus (accuracy 0.88 vs 0.74, respectively) and infraspinatus (accuracy 0.88 vs 0.65, respectively) tendons and tears of the anterior/anterior inferior, posterior, and superior labrum, (accuracy 0.79 vs 0.76, 0.71 vs 0.62, and 0.58 vs 0.56), and saline vs gadolinium, respectively. Although there was a trend toward overall better saline MRA performance, a statistically significant difference in the accuracy to detect tears was only noted for the infraspinatus tendon. Interobserver agreement for rotator cuff tears was higher for saline than gadolinium MRA. CONCLUSION Saline MRA was accurate, with no significant differences compared gadolinium arthrograms in the diagnosis of labral and rotator cuff pathology. Given expense, and the potential additional information provided by fluid sensitive sequences over T1 fat-suppressed sequences, consideration should be given to using saline for shoulder MRAs. LEVEL OF EVIDENCE Level III, Retrospective Cohort Study.
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Affiliation(s)
- Adam D Singer
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
| | - Jeffrey Rosenthal
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Yi Guo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Felix Gonzalez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Eric Wagner
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, Georgia
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Abstract
As the understanding of the primary cause of chronic rhinosinusitis has shifted away from infection toward inflammation, topical corticosteroid sprays and saline irrigations have become mainstays of treatment. Topical corticosteroid irrigations are recommended particularly in the postoperative setting, but further research on their effect and possible hypothalamic-pituitary-adrenal axis suppression is needed. The popularity of topical antibiotics has subsequently waned with their use reserved for recalcitrant cases. Further research is needed on the effect of topical antifungals in allergic fungal rhinosinusitis. Topical alternative therapies that target biofilms have gained increasing recognition, and investigations on topical probiotics are on the horizon.
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Affiliation(s)
- Victoria S Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, 1855 West Taylor Street, MC 648, Room 3.87, Chicago, IL 60611, USA.
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Williams V, Jayashree M, Nallasamy K, Dayal D, Rawat A. 0.9% saline versus Plasma-Lyte as initial fluid in children with diabetic ketoacidosis (SPinK trial): a double-blind randomized controlled trial. Crit Care 2020; 24:1. [PMID: 31898531 PMCID: PMC6939333 DOI: 10.1186/s13054-019-2683-3] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/22/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is an important complication encountered during the course of diabetic ketoacidosis (DKA). Plasma-Lyte with lower chloride concentration than saline has been shown to be associated with reduced incidence of AKI in adults with septic shock. No study has compared this in DKA. METHODS This double-blind, parallel-arm, investigator-initiated, randomized controlled trial compared 0.9% saline with Plasma-Lyte-A as initial fluid in pediatric DKA. The study was done in a tertiary care, teaching, and referral hospital in India in children (> 1 month-12 years) with DKA as defined by ISPAD. Children with cerebral edema or known chronic kidney/liver disease or who had received pre-referral fluids and/or insulin were excluded. Sixty-six children were randomized to receive either Plasma-Lyte (n = 34) or 0.9% saline (n = 32). MAIN OUTCOMES Primary outcome was incidence of new or progressive AKI, defined as a composite outcome of change in creatinine (defined by KDIGO), estimated creatinine clearance (defined by p-RIFLE), and NGAL levels. The secondary outcomes were resolution of AKI, time to resolution of DKA (pH > 7.3, bicarbonate> 15 mEq/L & normal sensorium), change in chloride, pH and bicarbonate levels, proportion of in-hospital all-cause mortality, need for renal replacement therapy (RRT), and length of ICU and hospital stay. RESULTS Baseline characteristics were similar in both groups. The incidence of new or progressive AKI was similar in both [Plasma-Lyte 13 (38.2%) versus 0.9% saline 15 (46.9%); adjusted OR 1.22; 95% CI 0.43-3.43, p = 0.70]. The median (IQR) time to resolution of DKA in Plasma-Lyte-A and 0.9% saline were 14.5 (12 to 20) and 16 (8 to 20) h respectively. Time to resolution of AKI was similar in both [Plasma-Lyte 22.1 versus 0.9% saline 18.8 h (adjusted HR 1.72; 95% CI 0.83-3.57; p = 0.14)]. Length of hospital stay was also similar in both [Plasma-Lyte 9 (8 to 12) versus 0.9% saline 10 (8.25 to 11) days; p = 0.39]. CONCLUSIONS The incidence of new or progressive AKI and resolution of AKI were similar in both groups. Plasma-Lyte-A was similar to 0.9% Saline in time to resolution of DKA, need for RRT, mortality, and lengths of PICU and hospital stay. TRIAL REGISTRATION Clinical trial registry of India, CTRI/2018/05/014042 (ctri.nic.in) (Retrospectively registered).
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Affiliation(s)
- Vijai Williams
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Devi Dayal
- Division of Pediatric Endocrinology, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Amit Rawat
- Division of Pediatric Allergy & Immunology, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Vintimilla DR, Chambers L, Mauffrey C, Parry JA. Just add water? Chlorhexidine's antimicrobial properties are minimally affected by dilution in saline compared to water. Eur J Orthop Surg Traumatol 2019; 30:613-615. [PMID: 31863271 DOI: 10.1007/s00590-019-02609-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/13/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dilute chlorhexidine gluconate (CHG) in sterile water is an antiseptic solution approved for intraoperative wound irrigation by the United States Food and Drug Administration. In practice, however, CHG is commonly diluted with normal saline, which can result in its precipitation potentially reducing the antimicrobial effect. The purpose of this study was to determine if the antimicrobial properties of CHG are reduced after dilution with normal saline compared to sterile water. MATERIALS AND METHODS Sterile paper disks were placed into undiluted 4% CHG (positive control), 0.05% CHG in sterile water, 0.05% CHG in normal saline, or normal saline alone (negative control) and then placed in triplicate onto the agar plates inoculated with Staphylococcus aureus. After incubating at 37 °C for 24 h, the diameter of the zone of inhibition around each disk was measured. RESULTS The mean zone of inhibition for 4% CHG, 0.05% CHG in sterile water, 0.05% CHG in normal saline, and normal saline alone was 24 ± 0.6 mm, 16 ± 0.9 mm, 14 ± 0.5 mm, and 0 ± 0 mm, respectively (p < 0.01). The zone of inhibition for dilute CHG in normal saline was on average 2.5 mm less (95% CI 1.7-3.2 mm) than that of CHG in sterile water. CONCLUSIONS Dilute CHG in normal saline, versus sterile water, retained its antimicrobial activity with a small reduction in the zone of inhibition. Surgeons and scientists should be aware of the interaction between normal saline and CHG. Future scientific studies need to control for what solution is used for dilution.
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Affiliation(s)
- David Rojas Vintimilla
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA
| | - Lori Chambers
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA.
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Arnez L, Lawrence V. Complex management decisions in a woman with concurrent primary hyperparathyroidism and metastatic papillary thyroid carcinoma, both presenting during pregnancy. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190110. [PMID: 31829974 PMCID: PMC6935714 DOI: 10.1530/edm-19-0110] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/22/2019] [Indexed: 11/08/2022] Open
Abstract
SUMMARY A 40-year-old woman was hospitalised at 25-week gestation following a diagnosis of severe symptomatic hypercalcaemia (adjusted serum calcium 3.02 mmol/L). A diagnosis of primary hyperparathyroidism (PHP) was made on the basis of elevated parathyroid hormone (PTH) 11.2 pmol/L (reference range 1.5-6.9) and exclusion of familial hypocalciuric hypercalcaemia. Ultrasound examination of the neck did not convincingly demonstrate an abnormal or enlarged parathyroid gland and parathyroid scintigraphy was not performed due to maternal choice relating to perceived radiation risk to the foetus. At neck exploration during the 28th week of pregnancy a right lower pole parathyroid lesion was excised together with two abnormal lymph nodes (largest 1.6 cm). Histology confirmed a parathyroid adenoma and also papillary thyroid carcinoma deposits in the two resected lymph nodes. Post-operatively, levels of adjusted serum calcium normalised and pregnancy progressed uneventfully to term. Total thyroidectomy was performed 2 weeks after delivery revealing two small foci of papillary micro-carcinoma (largest 2.3 mm, one in each thyroid lobe) with no evidence of further metastatic tumour in lymph nodes removed during functional neck dissection. Radioiodine remnant ablation (RRA) was performed 2 months post thyroidectomy to allow for breast involution. The patient remains in full clinical and biochemical remission 9 years later. We present and review the difficult management decisions faced in relation to the investigation and treatment of PHP in pregnancy, further complicated by incidentally discovered locally metastatic pT1aN1aM0 papillary thyroid carcinoma. LEARNING POINTS PHP may have serious consequences during pregnancy and usually requires surgical management during pregnancy to reduce the risk of maternal and foetal complications. The indications for and optimal timing of surgical management are discussed. Localisation by parathyroid scintigraphy is controversial during pregnancy: modified dose regimes may be considered in preference as an alternative to unguided neck exploration. Breastfeeding is contraindicated for 6-8 weeks before radioactive-iodine remnant ablation (RRA) to prevent increased breast uptake. Breastfeeding is further contra-indicated until after a subsequent pregnancy. Incidentally discovered differentiated thyroid carcinoma (DTC) in cervical lymph nodes in some cases may be managed expectantly because in one quarter of thyroidectomies the primary tumour remains occult.
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Affiliation(s)
- Lorena Arnez
- St Mary’s Hospital, Isle of Wight NHS Trust, Newport, UK
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Arnold N, O’Toole V, Huynh T, Smith HC, Luxford C, Clifton-Bligh R, Eastman CJ. Intractable hypercalcaemia during pregnancy and the postpartum secondary to pathogenic variants in CYP24A1. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM190114. [PMID: 31751313 PMCID: PMC6893306 DOI: 10.1530/edm-19-0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/29/2019] [Indexed: 01/09/2023] Open
Abstract
SUMMARY Parathyroid-independent hypercalcaemia of pregnancy, due to biallelic loss of function of the P450 enzyme CYP24A1, the principal inactivator of 1,25(OH)2D results in hypervitaminosis D, hypercalcaemia and hypercalciuria. We report two cases of this disorder, with intractable hypercalcaemia, one occurring during gestation and into the postpartum, and the other in the postpartum period. Case 1, a 47-year-old woman with a twin pregnancy conceived by embryo transfer, presented with hypercalcaemia at 23 weeks gestation with subnormal serum parathyroid hormone (PTH) and normal serum 25-OH D levels. She was admitted to hospital at 31 weeks gestation with pregnancy-induced hypertension, gestational diabetes and increasing hypercalcaemia. Caesarean section at 34 weeks gestation delivered two healthy females weighing 2.13 kg and 2.51 kg. At delivery, the patient's serum calcium level was 2.90 mmol/L. Postpartum severe hypercalcaemia was treated successfully with Denosumab 60 mg SCI, given on two occasions. CYP24A1 testing revealed she was compound heterozygous for pathogenic variants c.427_429delGAA, (p.Glu143del) and c.1186C>T, (p.Arg396Trp). Case 2, a 36-year-old woman presented 4 days after the delivery of healthy twins with dyspnoea, bradycardia, severe headaches, hypertension and generalized tonic-clonic seizures after an uneventful pregnancy. She was hypercalcaemic with a suppressed PTH, normal 25(OH)D, and elevated 1,25(OH)2D levels. Her symptoms partially responded to i.v. saline and corticosteroids in the short term but bisphosphonates such as Pamidronate and Zoledronic acid did not result in sustained improvement. Denosumab 120 mg SCI successfully treated the hypercalcaemia which resolved completely 2 months post-partum. CYP24A1 testing revealed she was homozygous for the pathogenic variant c.427_429delGAA, (p.Glu143del). LEARNING POINTS Hypercalcaemia in pregnancy can be associated with considerable morbidity with few options available for management. In non-PTH-related hypercalcaemia the diagnosis of CYP24A1 deficiency should be considered. Making a definitive diagnosis of CYP24A1 deficiency by genetic testing delays the diagnosis, while the availability of serum 24,25-dihydroxyvitamin D (24,25(OH)2D) will expedite a diagnosis. In pregnant women with CYP24A1 deficiency hypercalcaemia can worsen in the post-partum period and is more likely to occur with twin pregnancies but generally resolves within 2-3 months. Therapeutic alternatives are limited in pregnancy and their effectiveness is short-lived and mostly ineffective. Denosumab used in both our patients after delivery was the most effective agent normalizing calcium and may have benefit as a long-term therapeutic agent in preventing complications in patients with CYP24A1 deficiency.
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Affiliation(s)
- Nirusha Arnold
- Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
| | - Victor O’Toole
- Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
| | - Tien Huynh
- Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
| | - Howard C Smith
- Westmead Teaching Hospital, Royal North Shore Teaching Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Luxford
- Kolling Institute of Medical Research, Royal North Shore Teaching Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Roderick Clifton-Bligh
- Kolling Institute of Medical Research, Royal North Shore Teaching Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Creswell J Eastman
- Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
- Westmead Teaching Hospital, Royal North Shore Teaching Hospital, The University of Sydney, Sydney, New South Wales, Australia
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Magai DN, Mwaniki M, Abubakar A, Mohammed S, Gordon AL, Kalu R, Mwangi P, Koot HM, Newton CR. A randomized control trial of phototherapy and 20% albumin versus phototherapy and saline in Kilifi, Kenya. BMC Res Notes 2019; 12:617. [PMID: 31547861 PMCID: PMC6757356 DOI: 10.1186/s13104-019-4632-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 04/24/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022] Open
Abstract
Objective The study evaluated the efficacy of phototherapy and 20% albumin infusion to reduce total serum bilirubin (TSB) in neonates with severe hyperbilirubinemia. The primary outcome was a reduction of TSB at the end of treatment. The secondary outcomes were the need for exchange transfusion, inpatient mortality, neurological outcomes at discharge, and development outcomes at 12-months follow-up. Results One hundred and eighteen neonates were randomly assigned to phototherapy and 20% albumin (n = 59) and phototherapy and saline (n = 69). The median age at admission was 5 (interquartile range (IQR) 3–6) days, and the median gestation was 36 (IQR 36–38) weeks. No significant differences were found in the change in TSB (Mann–Whitney U =609, p = 0.98) and rate of change in TSB per hour after treatment (Mann–Whitney U = 540, p = 0.39) between the two groups. There were no significant differences between the two groups in the proportion of participants who required exchange transfusion (χ2 (2) = 0.36, p = 0.546); repeat phototherapy (χ2 (2) = 2.37, p = 0.123); and those who died (χ2 (2) = 0.92, p = 0.337). Trial registration The trial was registered in the International Standardized Randomized Controlled Trial Number (ISRCTN); trial registration number ISRCTN89732754.
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Affiliation(s)
- Dorcas N Magai
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Wellcome Trust Research Programme, PO Box 230-8010, Kilifi, Kenya. .,Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Michael Mwaniki
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Wellcome Trust Research Programme, PO Box 230-8010, Kilifi, Kenya.,Afya Research Africa, Nairobi, 00202, Kenya
| | - Amina Abubakar
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Wellcome Trust Research Programme, PO Box 230-8010, Kilifi, Kenya.,Department of Public Health, Pwani University, P.O. Box 195-80108, Kilifi, Kenya.,Institute for Human Development, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
| | - Shebe Mohammed
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Wellcome Trust Research Programme, PO Box 230-8010, Kilifi, Kenya
| | - Anne L Gordon
- Faculty of Life Sciences and Medicine, King's College London, Strand, London, WC2R2LS, England, UK
| | - Raphael Kalu
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Wellcome Trust Research Programme, PO Box 230-8010, Kilifi, Kenya
| | - Paul Mwangi
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Wellcome Trust Research Programme, PO Box 230-8010, Kilifi, Kenya
| | - Hans M Koot
- Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Charles R Newton
- Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute, Wellcome Trust Research Programme, PO Box 230-8010, Kilifi, Kenya.,Department of Public Health, Pwani University, P.O. Box 195-80108, Kilifi, Kenya.,Institute for Human Development, Aga Khan University, P.O. Box 30270-00100, Nairobi, Kenya.,Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK
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Hülsen T, Hsieh K, Batstone DJ. Saline wastewater treatment with purple phototrophic bacteria. Water Res 2019; 160:259-267. [PMID: 31154123 DOI: 10.1016/j.watres.2019.05.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 04/17/2019] [Accepted: 05/18/2019] [Indexed: 06/09/2023]
Abstract
Biological removal of organics, nitrogen and from saline wastewaters is adversely impacted by high salinity, which can be a major concern for treatment of industrial or domestic saline wastewater. In anaerobic treatment systems, sulfidogensis, especially when treating sulfate-rich saline wastewaters (e.g. seawater has 930 mgSO4-S L-1, or 2800 mg L-1 as SO42-) can cause additional biological, operational, and safety issues, due to H2S toxicity. Here, the use of anaerobic purple phototrophic bacteria (PPB) is tested as mediator to treat high salinity domestic wastewater (NaCl), and marine wastewater (Red Sea Salt - high sulfate, potassium, etc.) in a continuous anaerobic infra-red photo bioreactor, operated over 372d. Saline adapted PPB simultaneously removed COD, nitrogen and phosphorus with biomass yields of 0.8 gCOD gCOD-1. Batch activity tests found a broad optimum peak for saline adapted PPB between 30 and 70 mS cm-1, and 50% reduced activity at 140 mS cm-1 (3.5x seawater). For marine wastewater, high sulfate influent concentrations (770 mgSO4-S L-1) did not result in substantial H2S production (<1.6 mgS L-1) over 80 d. When irradiation was removed, sulfide rapidly rose to >90 mgS L-1 and the process failed. The results indicate rapid adaptation to high-salt conditions (both NaCl and marine), and the capacity for PPB to form a combined wastewater treatment/resource recovery process, particularly for salty industrial wastewater.
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Affiliation(s)
- Tim Hülsen
- Advanced Water Management Centre, Gehrmann Building, The University of Queensland, Brisbane, Queensland, 4072, Australia.
| | - Kent Hsieh
- Advanced Water Management Centre, Gehrmann Building, The University of Queensland, Brisbane, Queensland, 4072, Australia
| | - Damien J Batstone
- Advanced Water Management Centre, Gehrmann Building, The University of Queensland, Brisbane, Queensland, 4072, Australia
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48
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Rock EM, Limebeer CL, Aliasi-Sinai L, Parker LA. The ventral pallidum as a critical region for fatty acid amide hydrolase inhibition of nausea-induced conditioned gaping in male Sprague-Dawley rats. Neuropharmacology 2019; 155:142-149. [PMID: 31145905 DOI: 10.1016/j.neuropharm.2019.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/29/2019] [Revised: 05/15/2019] [Accepted: 05/23/2019] [Indexed: 12/21/2022]
Abstract
Here we investigate the involvement of the ventral pallidum (VP) in the anti-nausea effect of fatty acid amide hydrolase (FAAH) inhibition with PF-3845, and examine the pharmacological mechanism of such an effect. We explored the potential of intra-VP PF-3845 to reduce the establishment of lithium chloride (LiCl)-induced conditioned gaping (a model of acute nausea) in male Sprague-Dawley rats. As well, the role of the cannabinoid 1 (CB1) receptors and the peroxisome proliferator-activated receptors-α (PPARα) in the anti-nausea effect of PF-3845 was examined. Finally, the potential of intra-VP GW7647, a PPARα agonist, to reduce acute nausea was also evaluated. Intra-VP PF-3845 dose-dependently reduced acute nausea by a PPARα mechanism (and not a CB1 receptor mechanism). Intra-VP administration of GW7647, similarly attenuated acute nausea. These findings suggest that the anti-nausea action of FAAH inhibition may occur in the VP, and may involve activation of PPARα to suppress acute nausea.
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Affiliation(s)
- Erin M Rock
- Department of Psychology and Neuroscience Graduate Program, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Cheryl L Limebeer
- Department of Psychology and Neuroscience Graduate Program, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Lital Aliasi-Sinai
- Department of Psychology and Neuroscience Graduate Program, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada
| | - Linda A Parker
- Department of Psychology and Neuroscience Graduate Program, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada.
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Novodvorsky P, Hussein Z, Arshad MF, Iqbal A, Fernando M, Munir A, Balasubramanian SP. Two cases of spontaneous remission of primary hyperparathyroidism due to auto-infarction: different management and their outcomes. Endocrinol Diabetes Metab Case Rep 2019; 2019:EDM180136. [PMID: 31063971 PMCID: PMC6510711 DOI: 10.1530/edm-18-0136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/12/2019] [Indexed: 12/18/2022] Open
Abstract
Spontaneous remission of primary hyperparathyroidism (PHPT) due to necrosis and haemorrhage of parathyroid adenoma, the so-called 'parathyroid auto-infarction' is a very rare, but previously described phenomenon. Patients usually undergo parathyroidectomy or remain under close clinical and biochemical surveillance. We report two cases of parathyroid auto-infarction diagnosed in the same tertiary centre; one managed surgically and the other conservatively up to the present time. Case #1 was a 51-year old man with PHPT (adjusted (adj.) calcium: 3.11 mmol/L (reference range (RR): 2.20-2.60 mmol/L), parathyroid hormone (PTH) 26.9 pmol/L (RR: 1.6-6.9 pmol/L) and urine calcium excretion consistent with PHPT) referred for parathyroidectomy. Repeat biochemistry 4 weeks later at the surgical clinic showed normal adj. calcium (2.43 mmol/L) and reduced PTH. Serial ultrasound imaging demonstrated reduction in size of the parathyroid lesion from 33 to 17 mm. Twenty months later, following recurrence of hypercalcaemia, he underwent neck exploration and resection of an enlarged right inferior parathyroid gland. Histology revealed increased fibrosis and haemosiderin deposits in the parathyroid lesion in keeping with auto-infarction. Case #2 was a 54-year-old lady admitted with severe hypercalcaemia (adj. calcium: 4.58 mmol/L, PTH 51.6 pmol/L (RR: 1.6-6.9 pmol/L)) and severe vitamin D deficiency. She was treated with intravenous fluids and pamidronate and 8 days later developed symptomatic hypocalcaemia (1.88 mmol/L) with dramatic decrease of PTH (17.6 pmol/L). MRI of the neck showed a 44 mm large cystic parathyroid lesion. To date, (18 months later), she has remained normocalcaemic. Learning points: Primary hyperparathyroidism (PHPT) is characterised by excess parathyroid hormone (PTH) secretion arising mostly from one or more autonomously functioning parathyroid adenomas (up to 85%), diffuse parathyroid hyperplasia (<15%) and in 1-2% of cases from parathyroid carcinoma. PHPT and hypercalcaemia of malignancy, account for the majority of clinical presentations of hypercalcaemia. Spontaneous remission of PHPT due to necrosis, haemorrhage and infarction of parathyroid adenoma, the so-called 'parathyroid auto-infarction', 'auto-parathyroidectomy' or 'parathyroid apoplexy' is a very rare in clinical practice but has been previously reported in the literature. In most cases, patients with parathyroid auto-infarction undergo parathyroidectomy. Those who are managed conservatively need to remain under close clinical and biochemical surveillance long-term as in most cases PHPT recurs, sometimes several years after auto-infarction.
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Affiliation(s)
- Peter Novodvorsky
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ziad Hussein
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Muhammad Fahad Arshad
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ahmed Iqbal
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Malee Fernando
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alia Munir
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Sabapathy P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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50
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Fróes SDP, Souza ABFD, Matos NAD, Philips NE, Costa GDP, Talvani A, Cangussú SD, Bezerra FS. Intranasal instillation of distilled water, hypertonic saline and sodium bicarbonate promotes redox imbalance and acute lung inflammation in adult mice. Respir Physiol Neurobiol 2019; 266:27-32. [PMID: 31028848 DOI: 10.1016/j.resp.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/08/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
Abstract
Bronchial obstruction, caused by retained secretions, is often treated by the administration of mucoactive agents including distilled water, saline, hypertonic saline, and sodium bicarbonate. However, the inflammatory effect of these solutions on the lungs remains unclear. This study evaluated the instillation effects of different solutions on oxidative stress and lung inflammatory response in C57BL/6 mice. Fifty C57BL/6 mice were divided into 5 groups: control (CG); distilled water (DWG), hypertonic saline (HSG), saline (SG) and sodium bicarbonate (SBG). CG was exposed to ambient air while DWG, HSG, SG and SBG had 50 μl of respective solutions administered intranasally for 5 consecutive days. Twenty-four hours after the last intranasal instillation, all animals were euthanized for subsequent analysis. All solutions promoted increased recruitment of inflammatory cells to the lung compared to controls. Superoxide dismutase activity was lower in HSG compared to all other groups; catalase activity was reduced in SG, while it increased in SBG and DWG compared to CG. Finally, there was an increase in the inflammatory markers TNF-α, CCL2 and IFN-γ in DWG compared to CG, SG and HSG. In conclusions, the intranasal instillation of different solutions promotes redox imbalance and inflammation on lungs of adult mice.
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Affiliation(s)
- Sophia Dias Pozzolini Fróes
- Laboratory of Experimental Pathophysiology (LAFEx), Department of Biological Sciences (DECBI), Center of Research in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Ana Beatriz Farias de Souza
- Laboratory of Experimental Pathophysiology (LAFEx), Department of Biological Sciences (DECBI), Center of Research in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Natália Alves de Matos
- Laboratory of Experimental Pathophysiology (LAFEx), Department of Biological Sciences (DECBI), Center of Research in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Nicole Elizabeth Philips
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael´s Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Guilherme de Paula Costa
- Laboratory of Immunobiology of Inflammation (LABIIN), Department of Biological Sciences (DECBI), Center of Research in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - André Talvani
- Laboratory of Immunobiology of Inflammation (LABIIN), Department of Biological Sciences (DECBI), Center of Research in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Sílvia Dantas Cangussú
- Laboratory of Experimental Pathophysiology (LAFEx), Department of Biological Sciences (DECBI), Center of Research in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil
| | - Frank Silva Bezerra
- Laboratory of Experimental Pathophysiology (LAFEx), Department of Biological Sciences (DECBI), Center of Research in Biological Sciences (NUPEB), Federal University of Ouro Preto (UFOP), Brazil; Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael´s Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
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