Paraquat Poisoning: A Retrospective Study of 55 Patients From a Tertiary Care Center in Southern India

Background

In India the data on paraquat (PQ) poisoning are limited to case reports and small case series. Hence, this study was carried out to understand the clinical features and outcomes of PQ poisoning. We also briefly report the relevant Indian studies on PQ poisoning.

Materials and methods

This was a retrospective case record-based study of PQ poisoning victims admitted over a period of 5 years.

Results

Of the 55 patients included in this study, the in-hospital mortality rate was 72.7%. Acute kidney injury was the most common manifestation. The use of cyclophosphamide did not affect the clinical outcome. Hemoperfusion (HP) was not done for any patient. Pulmonary edema and acute tubular necrosis were the most common histopathological findings.

Conclusion

In India, this is one of the most comprehensive studies of PQ toxicity. Hence, we hope that this information would be of use to clinicians who deal with PQ poisoning.

How to cite this article

Ravichandran R, Amalnath D, Shaha KK, Srinivas BH. Paraquat Poisoning: A Retrospective Study of 55 Patients from a Tertiary Care Center in Southern India. Indian J Crit Care Med 2020;24(3):155–159.

Vitamin K1 prevents diabetic cataract by inhibiting lens aldose reductase 2 (ALR2) activity

This study investigated the potential of vitamin K1 as a novel lens aldose reductase inhibitor in a streptozotocin-induced diabetic cataract model. A single, intraperitoneal injection of streptozotocin (STZ) (35 mg/kg) resulted in hyperglycemia, activation of lens aldose reductase 2 (ALR2) and accumulation of sorbitol in eye lens which could have contributed to diabetic cataract formation. However, when diabetic rats were treated with vitamin K1 (5 mg/kg, sc, twice a week) it resulted in lowering of blood glucose and inhibition of lens aldose reductase activity because of which there was a corresponding decrease in lens sorbitol accumulation. These results suggest that vitamin K1 is a potent inhibitor of lens aldose reductase enzyme and we made an attempt to understand the nature of this inhibition using crude lens homogenate as well as recombinant human aldose reductase enzyme. Our results from protein docking and spectrofluorimetric analyses clearly show that vitamin K1 is a potent inhibitor of ALR2 and this inhibition is primarily mediated by the blockage of DL-glyceraldehyde binding to ALR2. At the same time docking also suggests that vitamin K1 overlaps at the NADPH binding site of ALR2, which probably shows that vitamin K1 could possibly bind both these sites in the enzyme. Another deduction that we can derive from the experiments performed with pure protein is that ALR2 has three levels of affinity, first for NADPH, second for vitamin K1 and third for the substrate DL-glyceraldehyde. This was evident based on the dose-dependency experiments performed with both NADPH and DL-glyceraldehyde. Overall, our study shows the potential of vitamin K1 as an ALR2 inhibitor which primarily blocks enzyme activity by inhibiting substrate interaction of the enzyme. Further structural studies are needed to fully comprehend the exact nature of binding and inhibition of ALR2 by vitamin K1 that could open up possibilities of its therapeutic application.

The role of donor-derived exosomes in lung allograft rejection

Lung transplant recipients (LTxRs) with acute or chronic rejection release circulating exosomes that mostly originate from donor lung tissue and express mismatched human leucocyte antigens (HLA) and lung-associated self-antigens (SAgs), Collagen-V and K alpha 1 Tubulin. During lung transplant (LTx), donor lungs often undergo injuries that increase the antigenicity of the transplanted organ. 30% of LTxRs also have pre-transplant antibodies (Abs) to HLA and lung SAgs, which may induce conditions that increase the risk of chronic lung allograft dysfunction (CLAD). Post-transplant, some recipients experience de novo development of Abs to mismatched donor HLA (donor-specific antibody [DSA]) and Abs to lung SAgs, which have been implicated in CLAD pathogenesis. Because most LTxRs who develop DSA also develop Abs to SAgs, some have suggested a synergistic relationship between alloimmunity and autoimmunity in CLAD immunopathogenesis. These processes likely occur from stress-induced exosome release. Exosomes carry allo-antigens, lung SAgs, several micro RNAs, proteasome, co-stimulatory molecules, and pro-inflammatory transcription factors-resulting in efficient antigen presentation by direct, semidirect, and indirect pathways, leading to immune responses to both allo-antigens and lung-associated SAgs. This review summarizes recent findings on the role of exosomes, and processes triggering immune responses to allo-antigens and lung SAgs that ultimately culminate in CLAD.

Tissue-associated self-antigens containing exosomes: Role in allograft rejection

Exosomes are extracellular vesicles that express self-antigens (SAgs) and donor human leukocyte antigens. Tissue-specific exosomes can be detected in the circulation following lung, heart, kidney and islet cell transplantations. We collected serum samples from patients who had undergone lung (n = 30), heart (n = 8), or kidney (n = 15) transplantations to isolate circulating exosomes. Exosome purity was analyzed by Western blot, using CD9 exosome-specific markers. Tissue-associated lung SAgs, collagen V (Col-V) and K-alpha 1 tubulin (Kα1T), heart SAgs, myosin and vimentin, and kidney SAgs, fibronectin and collagen IV (Col-IV), were identified using western blot. Lung transplant recipients diagnosed with bronchiolitis obliterans syndrome had exosomes with higher expression of Col-V (4.2-fold) and Kα1T (37.1-fold) than stable. Exosomes isolated from heart transplant recipients diagnosed with coronary artery vasculopathy had a 3.9-fold increase in myosin and a 4.7-fold increase in vimentin compared with stable. Further, Kidney transplant recipients diagnosed with transplant glomerulopathy had circulating exosomes with a 2-fold increased expression of fibronectin and 2.5-fold increase in Col-IV compared with stable. We conclude that circulating exosomes with tissue associated SAgs have the potential to be a noninvasive biomarker for allograft rejection.

Type I Collagen-Derived Injectable Conductive Hydrogel Scaffolds as Glucose Sensors

The advent of home blood glucose monitoring revolutionized diabetes management, and the recent introduction of both wearable devices and closed-loop continuous systems has enormously impacted the lives of people with diabetes. We describe the first fully injectable soft electrochemical glucose sensor for in situ monitoring. Collagen, the main component of a native extracellular matrix in humans and animals, was used to fabricate an in situ gellable self-supporting electroconductive hydrogel that can be injected onto an electrode surface or into porcine meat to detect glucose amperometrically. The study provides a proof-of-principle of an injectable electrochemical sensor suitable for monitoring tissue glucose levels that may, with further development, prove clinically useful in the future.

Role of exosomes in rejection following human lung transplantation – an in vitro analysis using human airway epithelial cells

Studies have demonstrated that exosomes expressing donor human leukocyte antigen (HLA) and lung self-antigens (SAg), Collagen V (Col-V) and Kα1 Tubulin (Kα1T), can be detected in the circulation of human lung transplant recipients (LTxR) who developed antibodies (Ab) to donor HLA and diagnosed with rejection However, the mechanisms by which Ab mediate induction of exosomes into the circulation from airway epithelial cells (AEC) remains unclear. Ab ligation to HLA could enhance PERK-mediated pathways involved in endoplasmic reticular (ER) stress-dependent exosome release. The goal of this study is to determine the mechanism by which Ab induce exosomes from AEC. Towards this we employed human AEC, ligated antigens by Ab specific to HLA (HiPRA) and lung SAg (rabbit anti-Col-V or Kα1T) and the role of ER stress signaling molecule in exosomes release were determined. Effect of exosome inhibition by GW4869 was also analyzed. AEC were incubated with HiPRA or Ab to SAg for 24hr in both normoxia and hypoxia (0.1% O2) conditions. AEC incubated with HiPRA or Ab to SAg demonstrated induction of exosomes containing lung SAg, Col-V and Kα1T. Incubation with HiPRA and Ab (20μg/ml) to SAg also demonstrated induction of exosomes containing lung SAg, MHC class II, CD80, CD86. Treatment with GW4869, exosome inhibitor (20μM) reduced the exosomes and SAg. Effect of HiPRA and Ab to SAg on stress kinase in both normoxic and hypoxic conditions and influence of GW4869 in these pathways will be delineated. Identification of stress kinase and exosome inhibition will provide novel results for Ab mediated upregulation of stress leading to exosome release from the transplanted organ resulting in immune responses thus increasing the risk for chronic rejection following LTx.

Evaluation of positional accuracy in multiple implants using four different splinting materials: An in vitro study

Background:

Prosthesis misfit plays an important role in complications such as occlusal and abutment screw loosening and fracture in implant restorations. Reproducing the intraoral relationship of implants through impression procedures is the first step in achieving an accurate, passively fitting prosthesis to ensure maximum accuracy. Hence, splinting of multiple implants with most accurate material may be a valid option.

Context:

The results of splinting multiple implants are always inconsistent, and there is limited literature available to compare the accuracy of impression techniques as well as materials. In such situation, more and more studies have to be done to prove the efficacy and accuracy of each splinting materials.

Aim:

The aim of the study was to evaluate the positional accuracy in multiple implants using acrylic resin, pattern resin, flowable composite, and bite registration paste.

Subjects and Methods:

An acrylic resin model was fabricated into which four implant analogs placed. The copings attached were splinted with dental floss onto which acrylic resin was added, which was sectioned and rewelded (Group A). Similarly, pattern resin, flowable composite, and bite registration material were added which were considered as Group B, C, and D, respectively. Impressions were made in vinyl polysiloxane and analogs were attached. The casts retrieved from each group were analysed for the positional accuracy of implants.

Statistical Analysis:

One-way ANOVA was done to analyze the significant difference between the four implant analogs of each group with the master model. The confidence interval was also calculated to assess the accuracy.

Results:

It was observed that all materials are equally effective for the accurate reproduction of implant positions. There was no significant difference between the centroids of implant analogues of master model and the mean of interimplant distance 1 and 2, 1 and 4, 3 and 4 and 2 and 4 in each group. The P-values were >0.05. The accuracy of splinting materials were analysed and it showed that splinting with flowable composite (Group C) as well as bite registration paste were in par with the conventionally used materials like pattern resin and acrylic resin.

Conclusions:

Results showed that flowable composite as well as bite registration material can be recommended as splinting material of choice for multiple implant cases, as these exhibited similar results like other groups (pattern resin and acrylic resin) which are conventionally used.

Prosthetic rehabilitation in neurosurgical cranioplasty

The defects of the skull cause mechanical vulnerability of the brain, esthetic disfigurement, and transmission of vibrations and pulsation of the brain. Subsequent cranioplasty may be required to compensate for the defect and to alleviate various signs and symptoms. When long-term outcome of biomaterial use in pediatric cases is limited, alloplastic cranioplasty in adults are supported by several large case series. This case report narrates cranioplasty using titanium alloplastic implant material.

Correction: Functionalised type-I collagen as a hydrogel building block for bio-orthogonal tissue engineering applications

Correction for 'Functionalised type-I collagen as a hydrogel building block for bio-orthogonal tissue engineering applications' by R. Ravichandran et al., J. Mater. Chem. B, 2016, 4, 318-326.

MAGE-TRIM28 complex promotes the Warburg effect and hepatocellular carcinoma progression by targeting FBP1 for degradation

Hepatocellular carcinoma (HCC) is one of the leading cause of cancer death in the world. Fructose-1,6-biphosphatase (FBP1), a rate-limiting enzyme in gluconeogenesis, has been identified recently as a tumor suppressor in HCC and other cancer types. In this study, we demonstrated that the tripartite motif-containing protein 28 (TRIM28) binds directly to and promotes FBP1 for ubiquitination and degradation. MAGE-A3 and MAGE-C2, which are known to be overexpressed in HCC, can enhance TRIM28-dependent degradation of FBP1 by forming ubiquitin ligase complexes with TRIM28. We further showed that expression of TRIM28 increased glucose consumption and lactate production by promoting FBP1 degradation in HCC cells and that FBP1 is a key mediator of TRIM28-induced HCC growth in culture and in mice. Moreover, we demonstrated that FBP1 and TRIM28 protein levels inversely correlated in HCC patient specimens. Finally, we showed that the proteasome inhibitor bortezomib mitigated the Warburg effect by inhibiting FBP1 degradation in HCC. Collectively, our findings not only identify oncogenic MAGE-TRIM28 complex-mediated proteasome degradation of FBP1 as a key mechanism underlying downregulation of FBP1 proteins in HCC, but also reveal that MAGE-TRIM28-regulated reprogramming of cancer cell metabolism and HCC tumorigenesis is mediated, at least in part, through FBP1 degradation.

Intelligent ECM mimetic injectable scaffolds based on functional collagen building blocks for tissue engineering and biomedical applications

A one-pot approach to fabricate in situ-gellable, thermo- and pH-responsive, hydrogels based on covalently crosslinked networks of collagen-I and thermo-responsive polymer.

A comparative evaluation of the marginal adaptation of a thermoplastic resin, a light cured wax and an inlay casting wax on stone dies: An in vitro study

Background:

Different pattern materials do not produce copings with satisfactory, marginal accuracy when used on stone dies at varying time intervals.

Purpose:

The purpose of this study was to evaluate and compare the vertical marginal accuracy of patterns formed from three materials, namely, thermoplastic resin, light cured wax and inlay casting wax at three-time intervals of 1, 12, and 24 h.

Methodology:

A master die (zirconia abutment mimicking a prepared permanent maxillary central incisor) and metal sleeve (direct metal laser sintering crown #11) were fabricated. A total of 30 stone dies were obtained from the master die. Ten patterns were made each from the three materials and stored off the die at room temperature. The vertical marginal gaps were measured using digital microscope at 1, 12, and 24 h after reseating with gentle finger pressure.

Results:

The results revealed a significant statistical difference in the marginal adaptation of three materials at all the three-time intervals. Light cured wax was found to be most accurate at all time intervals, followed by thermoplastic resin and inlay casting wax. Furthermore, there was a significant difference between all pairs of materials. The change in vertical marginal gap from 1 to 24 h between thermoplastic resin and light cured wax was not statistically significant.

Conclusion:

The marginal adaptation of all the three materials used, was well within the acceptable range of 25–70 μm. The resin pattern materials studied revealed significantly less dimensional change than inlay casting wax on storage at 1, 12, and 24 h time intervals. They may be employed in situations where high precision and delayed investing is expected.

Coloured cornea replacements with anti-infective properties: expanding the safe use of silver nanoparticles in regenerative medicine

Despite the broad anti-microbial and anti-inflammatory properties of silver nanoparticles (AgNPs), their use in bioengineered corneal replacements or bandage contact lenses has been hindered due to their intense yellow coloration. In this communication, we report the development of a new strategy to pre-stabilize and incorporate AgNPs with different colours into collagen matrices for fabrication of corneal implants and lenses, and assessed their in vitro and in vivo activity.

New Insights into Peptide-Silver Nanoparticle Interaction: Deciphering the Role of Cysteine and Lysine in the Peptide Sequence

We studied the interaction of four new pentapeptides with spherical silver nanoparticles. Our findings indicate that the combination of the thiol in Cys and amines in Lys/Arg residues is critical to providing stable protection for the silver surface. Molecular simulation reveals the atomic scale interactions that underlie the observed stabilizing effect of these peptides, while yielding qualitative agreement with experiment for ranking the affinity of the four pentapeptides for the silver surface.

Self-assembled collagen-like-peptide implants as alternatives to human donor corneal transplantation

PEG-conjugated collagen-like peptides promote corneal regeneration in a pig cornea.

Functionalised type-I collagen as a hydrogel building block for bio-orthogonal tissue engineering applications

Modulating the hydrogel properties from injectable to implantable scaffolds using the bio-orthogonal thiol-Michael addition click reaction.

Modified technique of continuous ambulatory peritoneal dialysis catheter insertion in the pediatric population

OBJECTIVES

To assess whether placement of a superficial cuff deeper to the external oblique aponeurosis reduces cuff extrusion and exit site infection in peritoneal catheter insertion in children.

MATERIAL AND METHODS

In 2013, a total of fourteen children underwent open continuous ambulatory peritoneal dialysis catheter insertion using Tenckhoff double cuffed catheters. The initial eight patients underwent a conventional technique and developed exit site infection and cuff extrusion. In six other patients, the technique was modified by placing the superficial cuff deeper to the external oblique aponeurosis.

RESULTS

In the former group, three patients developed cuff extrusion, whilst none developed it in the latter, modified group.

CONCLUSION

Continuous ambulatory peritoneal dialysis catheter insertion in children is associated with superficial cuff extrusion as a complication. It can be prevented by placing the cuff deeper to the external oblique aponeurosis instead of placing it in the conventional subcutaneous plane. In early experiences with this innovative technique, results have been promising. Randomized controlled trials can thus be undertaken to strengthen this finding.

Applications of self-assembling peptide scaffolds in regenerative medicine: the way to the clinic

Peptides that self-assemble into well-defined nanofibrous networks provide a prominent alternative to traditional biomaterials for fabricating scaffolds for use in regenerative medicine and other biomedical applications. Such scaffolds can be generated by decorating a peptide backbone with other bioactives such as cell specific adhesion peptides, growth factors and enzyme cleavable sequences. They can be designed to mimic the three-dimensional (3D) structural features of native ECM and can therefore also provide insight into the ECM-cell interactions needed for development of scaffolds that can serve as regeneration templates for specific target tissues or organs. This review highlights the potential application of self-assembling peptides in regenerative medicine.