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Srichawla BS, Garcia-Dominguez MA. Spectrum of delayed post-hypoxic leukoencephalopathy syndrome: A systematic review. World J Clin Cases 2024; 12:6285-6301. [DOI: 10.12998/wjcc.v12.i29.6285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/31/2024] [Accepted: 08/14/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Delayed post hypoxic leukoencephalopathy syndrome (DPHLS), also known as Grinker’s myelinopathy, is a rare but significant neurological condition that manifests days to weeks after a hypoxic event. Characterized by delayed onset of neurological and cognitive deficits, DPHLS presents substantial diagnostic and therapeutic challenges.
AIM To consolidate current knowledge on pathophysiology, clinical features, diagnostic approaches, and management strategies for DPHLS, providing a comprehensive overview and highlighting gaps for future research.
METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines, we systematically searched PubMed, ScienceDirect and Hinari databases using terms related to delayed post-hypoxic leukoencephalopathy. Inclusion criteria were original research articles, case reports, and case series involving human subjects with detailed clinical, neuroimaging, or pathological data on DPHLS. Data were extracted on study characteristics, participant demographics, clinical features, neuroimaging findings, pathological findings, treatment, and outcomes. The quality assessment was performed using the Joanna Briggs Institute critical appraisal checklist.
RESULTS A total of 73 cases were reviewed. Common comorbidities included schizoaffective disorder, bipolar disorder, hypertension, and substance use disorder. The primary causes of hypoxia were benzodiazepine overdose, opioid overdose, polysubstance overdose, and carbon monoxide (CO) poisoning. Symptoms frequently include decreased level of consciousness, psychomotor agitation, cognitive decline, parkinsonism, and encephalopathy. Neuroimaging commonly revealed diffuse T2 hyperintensities in cerebral white matter, sometimes involving the basal ganglia and the globus pallidus. Magnetic resonance spectroscopy often showed decreased N-acetylaspartate, elevated choline, choline-to-creatinine ratio, and normal or elevated lactate. Treatment is often supportive, including amantadine, an antioxidant cocktail, and steroids. Hyperbaric oxygen therapy may be beneficial in those with CO poisoning. Parkinsonism was often treated with levodopa. Most of the patients had substantial recovery over the course of months and many cases had some residual neurocognitive deficits.
CONCLUSION DPHLS remains a complex and multifaceted condition with various etiologies and clinical manifestations. Early recognition and appropriate management are crucial to improving patient outcomes. Future research should focus on standardizing diagnostic criteria, using advanced imaging techniques, and exploring therapeutic interventions to improve understanding and treatment of DPHLS. Conducting prospective cohort studies and developing biomarkers for early diagnosis and monitoring will be essential to advance patient care.
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Affiliation(s)
- Bahadar S Srichawla
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
| | - Maria A Garcia-Dominguez
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, United States
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Shahraki J, Tabrizian K, Rezaee R, Tashakori B, Dadrezaei S, Ghorani V, Bagheri G, Jahantigh H, Hashemzaei M. Hesperidin neuroprotective effects against carbon monoxide-induced toxicity in male rats. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:7673-7681. [PMID: 38700797 DOI: 10.1007/s00210-024-03132-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/29/2024] [Indexed: 08/04/2024]
Abstract
Carbon monoxide (CO) is produced via incomplete combustion of fossil fuels and it may cause long-term neurological sequel upon exposure. Hesperidin (HES), a flavanone glycoside found in citrus plants, exerts diverse beneficial health effects. The present study mechanistically examined the neuroprotective effects of HES in CO-poisoned rats. Thirty male Wistar rats (five groups of six animals) were exposed to 3000 ppm CO for 1 h. Immediately after the exposure and on the next 4 consecutive days (totally five doses), rats intraperitoneally received either normal saline (the control group) or different doses of HES (25, 50, and 100 mg/kg). A sham group that was not exposed to CO was also considered. After evaluation of spatial learning and memory using a Morris water maze (MWM), animals were sacrificed and oxidative stress status in blood samples, and Akt, Bax, Bcl2, and brain-derived neurotrophic factor (BDNF) expression in brain samples were assessed. Western blot analysis indicated increased Akt but decreased Bax/Bcl2 levels in the HES 100 mg/kg, and induced BDNF levels in all HES-treated groups. MWM results showed that HES significantly decreased memory loss. The current findings indicate that HES could alleviate neurological impairments induced by CO in rats.
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Affiliation(s)
- Jafar Shahraki
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Kaveh Tabrizian
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Ramin Rezaee
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Behnam Tashakori
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Seyedehzahra Dadrezaei
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran
| | - Vahideh Ghorani
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hosseinali Jahantigh
- Department of Pathology, Amiralmomenin Hospital, Zabol University of Medical Sciences, Zabol, Iran
| | - Mahmoud Hashemzaei
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Zabol University of Medical Sciences, Zabol, Iran.
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Wu Q, Ding Y, Ding B, Zhu H, Wu Z, Wu H. Association of ambient air pollution and Air Quality Index with risk of sudden sensorineural hearing loss: a cross-sectional study. BMJ Open 2024; 14:e085884. [PMID: 39343450 PMCID: PMC11440207 DOI: 10.1136/bmjopen-2024-085884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES To explore the associations of air pollutants and Air Quality Index (AQI) with risk of sudden sensorineural hearing loss (SSNHL) DESIGN: Cross-sectional study SETTING: Medical record data and local population data collected between 2014 and 2022 in Changshu, China were retrospectively reviewed. PARTICIPANTS Adults aged 18 years and above who were diagnosed with SSNHL in Changshu No. 1 People's Hospital or Changshu No. 2 People's Hospital from the spring of 2014 to the fall of 2022 were included in the study. OUTCOME MEASURE SSNHL was diagnosed by clinicians using the Chinese diagnostic criteria for SSNHL. RESULTS Compared with those exposed to the lowest tertile of carbon monoxide (CO), the prevalence ratio for those exposed to middle and high tertiles of CO were 1.113 (95% CI 1.022 to 1.213) and 1.230 (95% CI 1.105 to 1.369), respectively. The risk of SSNHL was increased by 30.6% (95% CI 9.9% to 55.4%) per doubling increment of CO. No categorical association was found between ozone (O3) exposure and risk of SSNHL, however, an increased risk of 22.2% (0.8%-48.2%) was identified for each doubling of O3. No association was identified between other pollutants and AQI and risk of SSNHL. CONCLUSIONS In this study, CO and O3 were associated with an increased risk of SSNHL in Changshu, China. Further studies are warranted to confirm our findings.
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Affiliation(s)
- Qiong Wu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yuancheng Ding
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Bixiao Ding
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Hao Zhu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Zhen Wu
- Changshu No 2 People's Hospital, Changshu, Jiangsu, China
| | - Hao Wu
- Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Ahn GJ, Lee S, Heo YW, Cha YS. Mortality Risks and Causes in Previous Carbon Monoxide Poisoning: A Nationwide Population-Based Cohort Study. Crit Care Med 2024:00003246-990000000-00378. [PMID: 39298511 DOI: 10.1097/ccm.0000000000006414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2024]
Abstract
OBJECTIVES Carbon monoxide (CO) poisoning can cause brain, heart, and kidney injuries. We aimed to determine the association of risks of all-cause and cause-specific mortality in patients with previous CO poisoning. DESIGN, SETTING, AND PATIENTS This population-based cohort study used data from the National Health Insurance Service database and the National Death Registry of Korea. Adult patients diagnosed with CO poisoning and controls between 2002 and 2020 were included. Patients were matched with controls on a 1:1 ratio, considering age, sex, insurance type, income level, residential location, smoking status, alcohol consumption, obesity status, medical and psychiatric illness history, and Charlson Comorbidity Index at the index date. The cohort was monitored from 2002 to 2022 or until death or emigration in terms of all-cause and cause-specific mortality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 48,600 patients with CO poisoning and matched controls were included. The cohort included 41.30% females, and the mean age was 48.05 years. Patients with CO poisoning exhibited a substantially elevated risk of all-cause mortality compared with those in the control group, with an adjusted hazard ratio (aHR) of 15.67 (95% CI, 12.58-19.51). The mortality associated with infectious (aHR, 6.71; 95% CI, 1.51-29.72), neoplasm/oncologic (aHR, 5.20; 95% CI, 3.39-7.99), endocrine (aHR, 13.44; 95% CI, 1.76-102.70), neurologic (aHR, 7.42; 95% CI, 2.91-18.90), cardiovascular (aHR, 8.97; 95% CI, 5.05-15.93), respiratory (aHR, 17.54; 95% CI, 5.48-56.17), and gastrointestinal (aHR, 24.72; 95% CI, 3.34-182.69) disorders was significantly greater in the former. Deaths due to external causes, including suicide, were significantly higher in the CO poisoning group (aHR, 50.07; 95% CI, 30.98-80.90). CONCLUSIONS Patients with CO poisoning exhibited a heightened risk of all-cause mortality compared with the matched controls. Additionally, the cause-specific mortality risk differed between the groups.
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Affiliation(s)
- Gyo J Ahn
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yeon-Woo Heo
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong S Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Research Institute of Hyperbaric Medicine and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Ogbodo JO, Egba SI, Ogbodo CG, Onwurah IE, Njoku OU. Effects of exposure to volatile organic compounds (VOCs) content from paint on automobile paint workers in Nsukka, South Eastern Nigeria. Heliyon 2024; 10:e37015. [PMID: 39286128 PMCID: PMC11402925 DOI: 10.1016/j.heliyon.2024.e37015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/01/2024] [Accepted: 08/26/2024] [Indexed: 09/19/2024] Open
Abstract
Background Volatile organic compounds (VOCs) fume in the workplace can act as an inducing agent to many health disorders. Objectives This work investigated the effects of exposure to VOCs content from paint on the automobile paint workers in South Eastern Nigeria. Methods A total of fifty (50) respondent participated in the study. Following the completion of informed consent form and well-structured questionnaire, blood samples were drawn and used for biochemical analysis. Results The results of the haematological analysis showed a significant (p < 0.05) increase in white blood cell (WBC) cluster of differentiation 4 (CD4), and platelet (PLT), and a significant (p < 0.05) decrease in packed cell volume (PCV), hemoglobin (HB), lymphocytes (LYM) and eosinophil (EOS) of the exposed automobile paint workers compared to the control (unexposed workers). Results also showed significant (p < 0.05) increase in liver marker indices; alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TB) and albumin (ALB) as well as significant (p < 0.05) decrease in Alkaline phosphatase (ALP), total protein (TP), direct bilirubin (DB). There was significant (p < 0.05) increase in urea, creatinine, potassium (K+), uric acid and nitric oxide concentrations and decrease in sodium (Na+) and bicarbonate (HCO3-) Again, results showed significant increase in Glutathione (GSH), and Glutathione peroxidase (GPx) and significant (p < 0.05) decrease in Superoxide dismutase (SOD) and Catalase (CAT). The Malondialdehyde MDA concentration showed varied significant (p < 0.05) difference based on ages. There was significant (p < 0.05) increase in luteinizing hormone (LH) and Follicle stimulating hormone (FSH), and significant (p < 0.05) decrease in the Testosterone (TET) concentrations of the exposed automobile paint workers compared to the unexposed workers. Conclusions Result of this study suggests a toxic outcome due to exposure to VOCs in spray paint workers.
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Affiliation(s)
| | - Simeon Ikechukwu Egba
- Department of Biochemistry, Research and Extension, Kampala International University, Uganda
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Huang CC, Chen TH, Ho CH, Chen YC, Chang WT, Hsu CC, Lin HJ, Chang CP, Guo HR. Hypothyroidism following carbon monoxide poisoning: An epidemiological study supported by animal experiments. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 283:116772. [PMID: 39053183 DOI: 10.1016/j.ecoenv.2024.116772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 07/27/2024]
Abstract
Previous studies have suggested a possible association between carbon monoxide poisoning (COP) and hypothyroidism, but the evidence is limited. Therefore, the aim of this study was to further investigate this relationship. Using data from the Taiwan National Health Research Database, we identified 32,162 COP patients and matched with 96,486 non-COP patients by age and index date for an epidemiological study. The risk of hypothyroidism was compared between the two cohorts until 2018. Independent predictors of hypothyroidism were analyzed using competing risk analysis. An animal study was also conducted to support the findings. COP patients had an increased risk of hypothyroidism compared to non-COP patients in the overall analysis (adjusted hazard ratio [AHR]= 3.88; 95 % confidence interval [CI]: 3.27-4.60) and in stratified analyses by age, sex, and comorbidities. The increase in the overall risk persisted even after more than six years of follow-up (AHR= 4.19; 95 % CI: 3.18-5.53). Independent predictors of hypothyroidism, in addition to COP, included age ≥65 years, female sex, hyperlipidemia, and mental disorder. The animal study showed damages in the hypothalamus, pituitary gland, and thyroid, as well as altered hormone levels 28 days after COP exposure. The epidemiological results showed an increased risk of hypothyroidism in COP patients, which was further supported by the animal study. These findings suggest the need for close monitoring of thyroid function in COP patients, especially in those who are age ≥65 years, female, and have hyperlipidemia or mental disorder.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Emergency Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Tzu-Hao Chen
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Ting Chang
- School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen university, Kaohsiung, Taiwan; Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Ping Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Occupational Safety, Health and Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan.
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Zhang Y, Liu J, Rong C, Wang D, Li W, Gao Z, Chen Y. Current Advances of CO Sensing Based on Low Dimensional Materials. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2024; 40:18821-18836. [PMID: 39196291 DOI: 10.1021/acs.langmuir.4c01861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Carbon monoxide (CO) is a harmful gas with significant impacts on human health and the environment. Its timely detection, especially in the event of thermal runaway in automotive lithium batteries, is crucial to prevent casualties. This paper reviews the progress in the development of efficient, sensitive, and reliable CO sensors, focusing on electrochemical, optical, and resistive sensing materials. Low-dimensional materials have a large specific surface area, providing an abundant number of active sites, which has drawn extensive attention from researchers. According to the different sensor signals, we categorized these sensors into electrical and optical signal sensors. We hope that by systematically introducing the sensing mechanism and sensing performance of these two kinds of sensors, appropriate CO sensors can be developed in different application scenarios so as to realize early warning and monitoring to the maximum extent, reduce industrial losses, and ensure the life and health of personnel.
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Affiliation(s)
- Yundi Zhang
- College of Automotive Engineering, Jilin University, Changchun 130025, China
| | - Jie Liu
- College of Automotive Engineering, Jilin University, Changchun 130025, China
| | - Changru Rong
- General Research and Development Institute, China FAW Corporation Limited, Changchun 130013, China
| | - Deping Wang
- General Research and Development Institute, China FAW Corporation Limited, Changchun 130013, China
| | - Weifeng Li
- National Key Laboratory of Automotive Chassis Integration and Bionics, Jilin University, Changchun 130025, China
| | - Zhenhai Gao
- College of Automotive Engineering, Jilin University, Changchun 130025, China
| | - Yupeng Chen
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology, Beijing 100190, China
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Setia K, Newsom M, Hashimi H, Collins J, Senthil-Kumar P, Feldman MJ. Carbon Monoxide-Related Vision Loss in an Acute Burn Patient. J Burn Care Res 2024; 45:1331-1332. [PMID: 38833305 DOI: 10.1093/jbcr/irae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Indexed: 06/06/2024]
Abstract
Carbon monoxide poisoning can occur as part of smoke exposure in the burn population. Here we report the case of a 32-year-old, previously healthy male, with carbon monoxide-related blindness after smoke exposure in an apartment fire. Cerebral hypoperfusion was diagnosed using magnetic resonance imaging of the brain, and the patient was diagnosed with cortical visual impairment. He was treated with hyperbaric oxygen therapy following which he had partial recovery of his vision. There is a paucity of information regarding this phenomenon and its treatment.
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Affiliation(s)
- Karishma Setia
- Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA 23223, USA
| | - Megan Newsom
- Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA 23223, USA
| | - Habiba Hashimi
- Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA 23223, USA
- Department of Surgery, Evan Haynes Burn Center, Virginia Commonwealth University, Richmond, VA 23223, USA
| | - Jay Collins
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Prabhu Senthil-Kumar
- Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA 23223, USA
- Department of Surgery, Evan Haynes Burn Center, Virginia Commonwealth University, Richmond, VA 23223, USA
| | - Michael J Feldman
- Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University, Richmond, VA 23223, USA
- Department of Surgery, Evan Haynes Burn Center, Virginia Commonwealth University, Richmond, VA 23223, USA
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Vigh Z, Johnson P, Thomovsky EJ, Brooks AC. Smoke Inhalation in Veterinary Patients: Pathophysiology, Diagnosis, and Management. J Am Anim Hosp Assoc 2024; 60:169-178. [PMID: 39235782 DOI: 10.5326/jaaha-ms-7431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 09/06/2024]
Abstract
Smoke contains a mixture of harmful gases, chemicals, and superheated particles. Inhalation of smoke causes generalized hypoxia and airway inflammation due to impaired oxygen transport and utilization, as well as thermal and chemical injury in the airways. Generally, treatment is supportive with oxygen therapy and airway management, including chest physiotherapy, bronchodilators, and nebulization. Immediate oxygen therapy is mandatory for all suspected smoke inhalation patients and should not be delayed pending diagnostic test results or due to "normal" oxygen saturation readings that can be falsely elevated in carbon monoxide intoxication. Smoke inhalation patients with mild clinical signs who respond well to initial stabilization generally have a favorable prognosis. However, patients with severe signs or progression despite initial stabilization may require more advanced or intensive care.
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Affiliation(s)
- Zsofia Vigh
- From the Department of Veterinary Clinical Sciences, Small Animal Emergency and Critical Care, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Paula Johnson
- From the Department of Veterinary Clinical Sciences, Small Animal Emergency and Critical Care, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Elizabeth J Thomovsky
- From the Department of Veterinary Clinical Sciences, Small Animal Emergency and Critical Care, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | - Aimee C Brooks
- From the Department of Veterinary Clinical Sciences, Small Animal Emergency and Critical Care, School of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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Vural A, Dolanbay T. Early and late adverse clinical outcomes of severe carbon monoxide intoxication: A cross-sectional retrospective study. PLoS One 2024; 19:e0301399. [PMID: 39213322 PMCID: PMC11364238 DOI: 10.1371/journal.pone.0301399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Carbon monoxide (CO) results from incomplete combustion of carbon-based materials, causing symptoms such as headaches, dizziness, nausea, chest pain, confusion, and, in severe cases, unconsciousness. Normobaric oxygen therapy (NBOT) is the standard therapy, whereas hyperbaric oxygen therapy (HBOT) is recommended in severe cases of organ damage. This study examined the early and late adverse outcomes in patients with severe CO poisoning. MATERIALS AND METHODS This study analyzed severe cases of CO poisoning among patients admitted to the emergency department between January 2020 and May 2022. The demographic, clinical, and laboratory data of symptomatic individuals and those requiring HBOT were examined. The study recorded early outcomes, such as intubation and in-hospital mortality, and late outcomes, such as delayed neurological sequelae and 1-year mortality. Chi-square tests, Spearman's rho correlation tests, and logistic regression analyses were performed to identify factors affecting these outcomes. RESULTS Patients who received HBOT showed a significant difference in delayed neurological sequelae (DNS) compared to those who received NBOT (p = 0.037). Significant differences were observed in the need for intubation, in-hospital mortality, and 1-year mortality between patients based on COHb levels, but no significant differences were found in DNS. The 1-year mortality probability was significantly influenced by COHb level (odds ratio = 1.159, 95% CI [1.056-1.273]). Patients receiving NBOT had a higher odds ratio for DNS risk than those receiving HBOT (odds ratio = 8.464, 95% [1.755-40.817], p = 0.008). CONCLUSION The study showed no differences in intubation, in-hospital mortality, and 1-year mortality rates between the HBOT and NBOT groups. However, significant differences in DNS suggest that treatment modalities have different effects on neurological outcomes. High COHb levels are associated with an increased risk of intubation, and mortality underscores the significance of monitoring COHb levels in clinical evaluations.
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Affiliation(s)
- Abdussamed Vural
- Department of Emergency Medicine, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey
| | - Turgut Dolanbay
- Department of Emergency Medicine, Nigde Omer Halisdemir University School of Medicine, Nigde, Turkey
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Albin CSW, Cunha CB, Glaser TP, Schachter M, Snow JW, Oto B. The Approach to Altered Mental Status in the Intensive Care Unit. Semin Neurol 2024. [PMID: 39137901 DOI: 10.1055/s-0044-1788894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Altered mental status (AMS) is a syndrome posing substantial burden to patients in the intensive care unit (ICU) in both prevalence and intensity. Unfortunately, ICU patients are often diagnosed merely with syndromic labels, particularly the duo of toxic-metabolic encephalopathy (TME) and delirium. Before applying a nonspecific diagnostic label, every patient with AMS should be evaluated for specific, treatable diseases affecting the central nervous system. This review offers a structured approach to increase the probability of identifying specific causal etiologies of AMS in the critically ill. We provide tips for bedside assessment in the challenging ICU environment and review the role and yield of common neurodiagnostic procedures, including specialized bedside modalities of diagnostic utility in unstable patients. We briefly review two common etiologies of TME (uremic and septic encephalopathies), and then review a selection of high-yield toxicologic, neurologic, and infectious causes of AMS in the ICU, with an emphasis on those that require deliberate consideration as they elude routine screening. The final section lays out an approach to the various etiologies of AMS in the critically ill.
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Affiliation(s)
| | - Cheston B Cunha
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Timlin P Glaser
- University of Arizona College of Medicine, Phoenix, Arizona
- Banner University Medical Center, Phoenix, Arizona
| | | | - Jerry W Snow
- University of Arizona College of Medicine, Phoenix, Arizona
- Banner University Medical Center, Phoenix, Arizona
| | - Brandon Oto
- sBridgeport Hospital, Yale New Haven Health, Bridgeport, Connecticut
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12
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Cho DH, Thom SR, Son JW, Ko SM, Cha YS. Practical Recommendations for the Evaluation and Management of Cardiac Injury Due to Carbon Monoxide Poisoning. JACC. HEART FAILURE 2024; 12:1343-1352. [PMID: 38385937 DOI: 10.1016/j.jchf.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 02/23/2024]
Abstract
Carbon monoxide (CO) is a relatively frequent cause of poisoning evaluated in emergency departments. The risk of neurologic injuries, such as cognitive, psychological, vestibular, and motor deficits, is 25% to 50%. However, the risk of cardiac injuries should also be considered. Among patients with CO poisoning, the mortality in patients with myocardial injury is approximately 3 times greater than that in patients without myocardial injury. In large-scale studies, up to 69.2% of patients with acute CO poisoning exhibiting elevated troponin I levels and no underlying cardiovascular illnesses had late gadolinium enhancement on cardiac magnetic resonance, suggesting covert CO-induced myocardial fibrosis. Myocardial damage can be evaluated using electrocardiography, echocardiography, computed tomography, and cardiac magnetic resonance. This paper offers recommendations for cardiac evaluations based on our collective experience of managing >2,000 cases of acute CO poisoning with supporting information taken from peer-reviewed published reports on CO poisoning.
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Affiliation(s)
- Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jung-Woo Son
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Min Ko
- Department of Radiology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea; Research Institute of Hyperbaric Medicine and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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13
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Popiolek C, Vithayaveroj PP, Jones CL, Ebeling-Koning NE, DelBianco JD, Beauchamp GA, Yaeger SK, Amaducci AM, Katz KD. Mass Carbon Monoxide Poisoning at a Daycare: A Public Health Lesson. Cureus 2024; 16:e66717. [PMID: 39262515 PMCID: PMC11390160 DOI: 10.7759/cureus.66717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/12/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Carbon monoxide (CO) poisoning is a leading cause of preventable toxicity-related deaths in the United States. We describe a case series of 16 individuals who were exposed to CO due to a malfunctioning furnace at a Pennsylvania daycare, a state which did not mandate CO detectors in daycares. METHODS An institutional review board-approved retrospective analysis was performed, and de-identified patient records were examined. Collected data included age, sex, race, ethnicity, CO concentrations, arrival time, time to hyperbaric oxygen center contact, and time to transfer and discharge. RESULTS Emergency medical services transported 16 patients to a tertiary care emergency department (ED) with both adult and pediatric departments. Fourteen patients were 10 years of age or younger. Fifteen patients arrived within one hour. Sixty-two percent (N=10) were male, and 94% (N=15) identified as Hispanic. Emergency physicians, medical toxicologists, clinicians, interpreters, and volunteers from across the hospital system were mobilized to the ED to assist with management. CONCLUSION This large-scale daycare CO poisoning represents a potentially avoidable mass casualty incident among children and daycare staff and necessitated significant coordination of care. CO detectors in Pennsylvania daycares would provide early warning for staff, prevent or minimize toxicity, inform first responders, and better prepare EDs to handle similar situations.
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Affiliation(s)
- Christopher Popiolek
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Putt P Vithayaveroj
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Chase L Jones
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Natalie E Ebeling-Koning
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - John D DelBianco
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Gillian A Beauchamp
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Susan K Yaeger
- Department of Emergency and Hospital Medicine, Division of Pediatric Emergency Medicine, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Alexandra M Amaducci
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
| | - Kenneth D Katz
- Department of Emergency and Hospital Medicine, Division of Medical Toxicology, Lehigh Valley Health Network/University of South Florida (USF) Morsani College of Medicine, Allentown, USA
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14
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Zeng S, Li Y, Yao Z, Li Y, Cao Y, Wen L, Li M, Zheng J, Wang H. Edaravone combined with hyperbaric oxygen therapy in delayed encephalopathy after acute carbon monoxide poisoning: A meta-analysis. J Clin Neurosci 2024; 126:270-283. [PMID: 38986338 DOI: 10.1016/j.jocn.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/21/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The use of both edaravone (EDA) and hyperbaric oxygen therapy (HBOT) is increasingly prevalent in the treatment of delayed encephalopathy after carbon monoxide poisoning (DEACMP). This meta-analysis aims to evaluate the efficacy of using EDA and HBOT in combination with HBOT alone in the treatment of DEACMP. METHODS We searched and included all randomized controlled trials (RCTs) published before November 6, 2023, from 12 Chinese and English databases and clinical trial centers in China and the United States. The main outcome indicator was the total effective rate. The secondary outcome indicators included the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Hasegawa Dementia Scale (HDS), Fugl-Meyer Assessment (FMA), Superoxide Dismutase (SOD), and Malondialdehyde (MDA). Statistical measures utilized include risk ratios (RR), weighted mean difference (WMD), and 95 % confidence intervals (95 % CI). RESULTS Thirty studies involving a combined total of 2075 participants were ultimately incorporated. It was observed that the combination of EDA with HBOT for the treatment of DEACMP demonstrated an improvement in the total effective rate (RR: 1.25; 95 % CI: 1.20-1.31; P < 0.01), MMSE (WMD: 3.67; 95 % CI: 2.59-4.76; P < 0.01), MoCA (WMD: 4.38; 95 % CI: 4.00-4.76; P < 0.01), BI (WMD: 10.94; 95 % CI: 5.23-16.66; P < 0.01), HDS (WMD: 6.80; 95 % CI: 4.05-9.55; P < 0.01), FMA (WMD: 8.91; 95 % CI: 7.22-10.60; P < 0.01), SOD (WMD: 18.45; 95 % CI: 16.93-19.98; P < 0.01); and a reduction in NIHSS (WMD: -4.12; 95 % CI: -4.93 to -3.30; P < 0.01) and MDA (WMD: -3.05; 95 % CI: -3.43 to -2.68; P < 0.01). CONCLUSION Low-quality evidence suggests that for DEACMP, compared to using HBOT alone, the combined use of EDA and HBOT may be associated with better cognition and activity of daily living. In the future, conducting more meticulously designed multicenter and large-sample RCTs to substantiate our conclusions is essential.
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Affiliation(s)
- Siyao Zeng
- Harbin Medical University Graduate School, Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Yue Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Zhipeng Yao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Yunlong Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Yang Cao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Lianghe Wen
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Ming Li
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China
| | - Junbo Zheng
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China.
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Heilongjiang Province, Harbin 150086, China.
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15
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Du W, Tian Z, Lv B, Wang P, Wang H, Ding S, Tian Z, Zhou J, Jiao W, Zhang X, Gao H. Association of carbon monoxide poisoning with cardiovascular disease risk: A systematic review and meta-analysis. Heliyon 2024; 10:e34062. [PMID: 39113966 PMCID: PMC11305204 DOI: 10.1016/j.heliyon.2024.e34062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/17/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024] Open
Abstract
Objective This study aims to provide an updated overview of the relationship between carbon monoxide poisoning (COP) and cardiovascular disease. Methods A systematic literature search was conducted in PubMed, Embase, Cochrane, and Web of Science databases up to September 2023. The association between COP patients and cardiovascular adverse events was examined and summarized. The outcomes included arrhythmia, coronary heart disease, heart failure, myocardial infarction, major adverse cardiovascular events (MACE), carboxyhaemoglobin percent (COHB%), Pondus Hydrogenii (PH) electrocardiography (ECG) parameters. Results Eight eligible articles, involving a total of 251,971 patients, were included for evidence synthesis. The analysis revealed a heightened incidence of MACE in patients with COP. Additionally, COP exhibited an impact on specific ECG parameters. The incidence of MACE after COP was found to be similar in Korean and Chinese populations, and there was no significant effect of gender or underlying diseases on MACE incidence following COP. The incidence of MACE after COP did not differ significantly in individuals aged 50 years and older. Conclusions Considering the observed heterogeneity and potential biases in the selected studies, emergency physicians should be aware of the increased likelihood of cardiovascular events in patients diagnosed with COP.
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Affiliation(s)
- Wenxia Du
- The Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050061, China
| | - Zhesen Tian
- The Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050061, China
| | - Baopu Lv
- The Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050061, China
| | - Peng Wang
- The Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050061, China
| | - Hong Wang
- The Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050061, China
| | - Senyang Ding
- The Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050061, China
| | - Zhexing Tian
- The Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050061, China
| | - Jie Zhou
- Shijiazhuang People's Hospital, Shijiazhuang Hebei, 050011, China
| | - Weiliang Jiao
- Shijiazhuang People's Hospital, Shijiazhuang Hebei, 050011, China
| | - Xu Zhang
- Shijiazhuang People's Hospital, Shijiazhuang Hebei, 050011, China
| | - Hengbo Gao
- The Second Hospital of Hebei Medical University, Shijiazhuang Hebei, 050061, China
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16
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Northrop AJ, Do V, Flores NM, Wilner LB, Sheffield PE, Casey JA. Power Outages: An Underappreciated Risk Factor for Children's Carbon Monoxide Poisoning. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.20.24310120. [PMID: 39072047 PMCID: PMC11275657 DOI: 10.1101/2024.07.20.24310120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Children's risk of exposure to carbon monoxide (CO) increases after disasters, likely due to improper generator use during power outages. Here, we evaluate the impact of outages on children's CO-related emergency department (ED) visits in New York State (NYS). We leveraged power outage data spanning 2017-2020 from the NYS Department of Public Service for 1,865 power operating localities (i.e., communities) and defined all-size and large-scale power outage hours. All-size outage hours affected ≥1% of customers, and large-scale outage hours affected ≥20%. We identified CO poisoning using diagnostic codes among those aged <18 between 2017 and 2020 using the Statewide Planning and Research Cooperative System (SPARCS), an all-payer reporting system in NYS. We linked community power outage exposure to patients using the population-weighted centroid of their block group of residence. We estimated the impact of power outages on CO poisoning using a time-stratified case-crossover study design with conditional logistic regression, controlling for daily relative humidity, mean temperature, and total precipitation. Analyses were stratified by urban and rural communities. From 2017-2020, there were 917 pediatric CO poisoning ED visits in NYS. Most cases (83%) occurred in urban region of the state. We observed an association statewide between all-size and large-scale outages and CO ED visits on the index day and the following two days before a return to baseline on lag day 3. Four hours without power increased the odds of a pediatric CO poisoning ED visit by ≥50% for small-scale and ≥150% for large-scale outages, and associations were stronger in urban versus rural areas. While CO poisoning is a relatively rare cause of pediatric ED visits in NYS, it can be deadly and is also preventable. Expanded analyses of the health impacts of outages and advocacy for reliable energy access are needed to support children's health in a changing climate.
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Affiliation(s)
- Alexander J. Northrop
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York City, NY
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Vivian Do
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Nina M. Flores
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Lauren Blair Wilner
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Perry E. Sheffield
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York City, NY
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Joan A. Casey
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA
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17
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Ning X, Zhu X, Wang Y, Yang J. Recent advances in carbon monoxide-releasing nanomaterials. Bioact Mater 2024; 37:30-50. [PMID: 38515608 PMCID: PMC10955104 DOI: 10.1016/j.bioactmat.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
As an endogenous signaling molecule, carbon monoxide (CO) has emerged as an increasingly promising option regarding as gas therapy due to its positive pharmacological effects in various diseases. Owing to the gaseous nature and potential toxicity, it is particularly important to modulate the CO release dosages and targeted locations to elucidate the biological mechanisms of CO and facilitate its clinical applications. Based on these, diverse CO-releasing molecules (CORMs) have been developed for controlled release of CO in biological systems. However, practical applications of these CORMs are limited by several disadvantages including low stability, poor solubility, weak releasing controllability, random diffusion, and potential toxicity. In light of rapid developments and diverse advantages of nanomedicine, abundant nanomaterials releasing CO in controlled ways have been developed for therapeutic purposes across various diseases. Due to their nanoscale sizes, diversified compositions and modified surfaces, vast CO-releasing nanomaterials (CORNMs) have been constructed and exhibited controlled CO release in specific locations under various stimuli with better pharmacokinetics and pharmacodynamics. In this review, we present the recent progress in CORNMs according to their compositions. Following a concise introduction to CO therapy, CORMs and CORNMs, the representative research progress of CORNMs constructed from organic nanostructures, hybrid nanomaterials, inorganic nanomaterials, and nanocomposites is elaborated. The basic properties of these CORNMs, such as active components, CO releasing mechanisms, detection methods, and therapeutic applications, are discussed in detail and listed in a table. Finally, we explore and discuss the prospects and challenges associated with utilizing nanomaterials for biological CO release.
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Affiliation(s)
- Xiaomei Ning
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
- School of Resources, Environment and Materials, Guangxi University, Nanning, 530004, China
| | - Xinyuan Zhu
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Youfu Wang
- School of Chemistry and Chemical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Jinghui Yang
- Department of Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
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18
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Lee SJ, Lee S, Kim YH, Cha YS. Risk of lung diseases in patients with previous carbon monoxide poisoning: a nationwide population-based cohort study in the Republic of Korea. Clin Toxicol (Phila) 2024; 62:425-431. [PMID: 38946481 DOI: 10.1080/15563650.2024.2371020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Carbon monoxide poisoning is associated with severe damage to various organs. In this study, we aimed to determine if previous carbon monoxide poisoning was associated with an increased risk of lung diseases. METHODS The study population was derived from the National Health Insurance Service database of Korea between 1 January 2002 and 31 December 2021. Adults with carbon monoxide poisoning, with at least one visit to medical facilities between 2002 and 2021, were included. For comparison, an equal number of matched controls with the same index date were selected from the database. RESULTS A total of 28,618 patients with carbon monoxide poisoning and 28,618 matched controls were included in this study. Approximately 42.8 per cent of the patient and control groups were female, with a mean age of 51.3 years. In patients with carbon monoxide poisoning, there was a significant increase in the risk of lung cancer (adjusted hazard ratio, 1.84; 95 per cent confidence interval, 1.42-2.39; P < 0.001), chronic obstructive pulmonary disease (adjusted hazard ratio, 1.60; 95 per cent confidence interval, 1.36-1.89; P < 0.001), pulmonary tuberculosis (adjusted hazard ratio, 1.46; 95 per cent confidence interval, 1.13-1.88; P = 0.003), and non-tuberculous mycobacterial infection (adjusted hazard ratio, 1.54; 95 per cent confidence interval, 1.01-2.36; P = 0.047). DISCUSSION In this retrospective cohort study, previous carbon monoxide poisoning was associated with an increased risk of lung cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, and non-tuberculous mycobacterial infection. Further studies are needed to confirm such an association in other populations and the risk of lung diseases due to the toxic effect of carbon monoxide from different sources. CONCLUSIONS Previous carbon monoxide poisoning was associated with an increased risk of lung diseases, but the relative importance of the causes and sources of exposure was not known. The long-term management of survivors of acute carbon monoxide poisoning should include monitoring for lung cancer, chronic obstructive pulmonary disease, pulmonary tuberculosis, and non-tuberculous mycobacterial infection.
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Affiliation(s)
- Seok Jeong Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - You Hyun Kim
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Research Institute of Hyperbaric Medicine and Science, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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19
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El-Sarnagawy GN, Elgazzar FM, Ghonem MM. Development of a risk prediction nomogram for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning. Inhal Toxicol 2024; 36:406-419. [PMID: 38984500 DOI: 10.1080/08958378.2024.2374394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVES Delayed neuropsychiatric sequelae (DNS) are critical complications following acute carbon monoxide (CO) poisoning that can substantially affect the patient's life. Identifying high-risk patients for developing DNS may improve the quality of follow-up care. To date, the predictive DNS determinants are still controversial. Consequently, this study aimed to construct a practical nomogram for predicting DNS in acute CO-poisoned patients. METHODS This retrospective study was conducted on patients with acute CO poisoning admitted to the Tanta University Poison Control Center (TUPCC) from December 2018 to December 2022. Demographic, toxicological, and initial clinical characteristics data, as well as laboratory investigation results, were recorded for the included patients. After acute recovery, patients were followed up for six months and categorized into patients with and without DNS. RESULTS Out of 174 enrolled patients, 38 (21.8%) developed DNS. The initial Glasgow Coma Scale (GCS), carboxyhemoglobin (COHb) level, CO exposure duration, oxygen saturation, PaCO2, and pulse rate were significantly associated with DNS development by univariate analysis. However, the constructed nomogram based on the multivariable regression analysis included three parameters: duration of CO exposure, COHb level, and GCS with adjusted odd ratios of 1.453 (95% CI: 1.116-1.892), 1.262 (95% CI: 1.126-1.415), and 0.619 (95% CI: 0.486-0.787), respectively. The internal validation of the nomogram exhibited excellent discrimination (area under the curve [AUC] = 0.962), good calibration, and satisfactory decision curve analysis for predicting the DNS probability. CONCLUSIONS The proposed nomogram could be considered a simple, precise, and applicable tool to predict DNS development in acute CO-poisoned patients.
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Affiliation(s)
- Ghada N El-Sarnagawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Fatma M Elgazzar
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mona M Ghonem
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
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20
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Li J, Qi HN, Gong P, Wang YY, Xiao QM, Wang P, Wang WZ. Prognostic value of systemic immune-inflammation index and monocyte-to-HDL-cholesterol ratio in early cardio-cerebral complications in elderly patients with acute severe carbon monoxide poisoning. Drug Chem Toxicol 2024; 47:381-385. [PMID: 38213233 DOI: 10.1080/01480545.2024.2301938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
To investigate how effectively systemic immune-inflammation index (SII) and Monocyte-to-HDL-cholesterol ratio (MHR) predict the development of early cardio-cerebral complications in elderly patients who have experienced acute severe carbon monoxide poisoning (ASCMP). A retrospective analysis was conducted on 77 elderly patients with ASCMP admitted to the emergency department of Harrison International Peace Hospital from November 2020 to March 2022. The prevalence of early-onset complications among the 77 individuals was 38.96%. Binary Logistics regression analysis showed that SII and MHR were independent influencing factors of early cardio-cerebral complications in elderly patients with ASCMP. The complication group had a longer length of stay, a greater mortality rate, and a higher incidence of delayed encephalopathy after acute carbon monoxide poisoning (p < .05) than the non-complication group. The area under the curve (AUC) of SII and MHR in predicting early cardio-cerebral complications in elderly patients with ASCMP were 0.724 and 0.796, respectively, with 80.0% and 63.3% sensitivity, and 61.7% and 87.2% specificity. The incidence of early cardio-cerebral complications in elderly patients who had ASCMP is high and the prognosis is poor. SII and MHR can be utilized as independent predictors of early cardio-cerebral complications in elderly patients with ASCMP, allowing doctors to diagnose and treat cardio-cerebral complications earlier and improve prognosis.
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Affiliation(s)
- Jia Li
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Hong-Na Qi
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Ping Gong
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Yuan-Yuan Wang
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Qing-Mian Xiao
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Pu Wang
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Wei-Zhan Wang
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
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21
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Bansal S, Liu D, Mao Q, Bauer N, Wang B. Carbon Monoxide as a Potential Therapeutic Agent: A Molecular Analysis of Its Safety Profiles. J Med Chem 2024; 67:9789-9815. [PMID: 38864348 PMCID: PMC11215727 DOI: 10.1021/acs.jmedchem.4c00823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
Carbon monoxide (CO) is endogenously produced in mammals, with blood concentrations in the high micromolar range in the hemoglobin-bound form. Further, CO has shown therapeutic effects in various animal models. Despite its reputation as a poisonous gas at high concentrations, we show that CO should have a wide enough safety margin for therapeutic applications. The analysis considers a large number of factors including levels of endogenous CO, its safety margin in comparison to commonly encountered biomolecules or drugs, anticipated enhanced safety profiles when delivered via a noninhalation mode, and the large amount of safety data from human clinical trials. It should be emphasized that having a wide enough safety margin for therapeutic use does not mean that it is benign or safe to the general public, even at low doses. We defer the latter to public health experts. Importantly, this Perspective is written for drug discovery professionals and not the general public.
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Affiliation(s)
| | | | | | - Nicola Bauer
- Department of Chemistry and
the Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Binghe Wang
- Department of Chemistry and
the Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
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22
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Liu ZB, Wang LC, Lian JJ, Li S, Zhao L, Li HL. Analysis of factors associated with the development of delayed encephalopathy following acute carbon monoxide poisoning. Sci Rep 2024; 14:14630. [PMID: 38918432 PMCID: PMC11199494 DOI: 10.1038/s41598-024-64424-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/09/2024] [Indexed: 06/27/2024] Open
Abstract
In this study, we analyzed the factors influencing the development of delayed encephalopathy in patients with acute carbon monoxide poisoning (ACOP) (DEACMP) following conventional treatment such as hyperbaric oxygen therapy (HBOT). Between January 2012 and January 2022, we retrospectively analyzed 775 patients with ACOP, who were admitted to the Second Department of Rehabilitation Medicine and received HBOT in the Second Hospital of Hebei Medical University. These patients were divided into the non-DEACMP and DEACMP groups based on their follow-up; we then compared the general data, clinical characteristics, admission examination, and treatment between the two groups to identify risk factors for the development of DEACMP. The DEACMP group comprised of 168 cases, while the non-DEACMP group consisted of 607 cases. Univariate analysis showed that there were 20 possible prognostic factors in the non-DEACMP and DEACMP groups. The results of multivariable regression analyses suggested that the occurrence of DEACMP was significantly correlated with advanced age, the combination of multiple medical histories, the duration of CO exposure, the duration of coma, poisoning degree, the Interval between ACOP and the first HBOT, the total number of HBOTs, and the combination with rehabilitation treatment. DEACMP patients who are older, have more comorbidities, prolonged CO exposure, prolonged coma, severe intoxication, long intervals between ACOP and the first HBOT, fewer HBOT treatments, and who are not treated with a combination of rehabilitative therapies have a poor prognosis.
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Affiliation(s)
- Zi-Bo Liu
- Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, People's Republic of China
| | - Li-Chun Wang
- Rehabilitation Department, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou, 061001, Hebei, People's Republic of China
| | - Jia-Jia Lian
- Department of Rehabilitation, The Second Hospital of Hebei Medical University, No215 of Hepingxi Road, Xinhua District, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Sha Li
- Department of Rehabilitation, The Second Hospital of Hebei Medical University, No215 of Hepingxi Road, Xinhua District, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Long Zhao
- Department of Rehabilitation, The Second Hospital of Hebei Medical University, No215 of Hepingxi Road, Xinhua District, Shijiazhuang, 050000, Hebei, People's Republic of China
| | - Hong-Ling Li
- Department of Rehabilitation, The Second Hospital of Hebei Medical University, No215 of Hepingxi Road, Xinhua District, Shijiazhuang, 050000, Hebei, People's Republic of China.
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23
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Oliverio S, Ferger MC, Yegles M. Postmortem concentrations for total blood carbon monoxide (TBCO) as a novel biomarker for carbon monoxide (CO) poisonings. J Anal Toxicol 2024; 48:289-298. [PMID: 38662395 DOI: 10.1093/jat/bkae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/25/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
Total blood carbon monoxide (TBCO) showed promising results in improving accuracy of CO determinations in blood and presenting better stability to different storage conditions. Therefore, it was proposed as an alternative biomarker to carboxyhemoglobin (COHb) for CO poisoning diagnosis. However, given that current interpretation reference values exist for COHb only, it is difficult to implement TBCO analysis in routine. Therefore, we aimed at determining TBCO reference values for postmortem CO poisoning cases. A previously validated method for TBCO analysis via gas chromatography-mass spectrometry was applied to cardiac, peripheral, cranial and spleen blood samples collected from 92 autopsies. Autopsy cases included 21 non-CO-related and 71 CO-related cases with varying postmortem intervals (PMIs). Statistical analyses were performed using statistical software R Studio. When comparing lower to higher PMIs for non-CO-related cases, no significant differences were found, which suggests that CO formation or degradation at low PMIs does not occur. Spleen blood showed potential as an alternative matrix to CO determinations in cases with sample availability issues but needs to be evaluated for CO-positive cases. Results for cardiac blood in CO-related autopsies showed a positive correlation between COHb and TBCO values (R = 0.78). This value is lower than what is found in the literature, suggesting that even though COHb and TBCO are correlated, a potential underestimation of the true CO exposure might occur if only COHb values are taken into consideration. Samples were divided into CO exposure groups based on COHb concentrations, and with the data obtained, classification into the following TBCO concentration groups is proposed: no significant CO exposure case <6 µmol/mL, medium CO exposure case 6-20 µmol/mL and high CO exposure case >20 µmol/mL. Even if a higher number of samples in each group would enable to increase the confidence, these results are very promising and highlight the importance of TBCO measurement.
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Affiliation(s)
- Stefania Oliverio
- Department of Forensic Medicine, Laboratoire National de Santé, 1 Rue Louis Rech, Dudelange 3555, Luxemburg
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine Lausanne-Geneva, Chemin de la Vuillette 4, Lausanne 1000 Switzerland
| | - Marie-Caroline Ferger
- Department of Forensic Medicine, Laboratoire National de Santé, 1 Rue Louis Rech, Dudelange 3555, Luxemburg
| | - Michel Yegles
- Department of Forensic Medicine, Laboratoire National de Santé, 1 Rue Louis Rech, Dudelange 3555, Luxemburg
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Wang Y, Chu T, Jin T, Xu S, Zheng C, Huang J, Li S, Wu L, Shen J, Cai X, Deng H. Cascade Reactions Catalyzed by Gold Hybrid Nanoparticles Generate CO Gas Against Periodontitis in Diabetes. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308587. [PMID: 38647388 PMCID: PMC11199988 DOI: 10.1002/advs.202308587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/25/2024] [Indexed: 04/25/2024]
Abstract
The treatment of diabetic periodontitis poses a significant challenge due to the presence of local inflammation characterized by excessive glucose concentration, bacterial infection, and high oxidative stress. Herein, mesoporous silica nanoparticles (MSN) are embellished with gold nanoparticles (Au NPs) and loaded with manganese carbonyl to prepare a carbon monoxide (CO) enhanced multienzyme cooperative hybrid nanoplatform (MSN-Au@CO). The Glucose-like oxidase activity of Au NPs catalyzes the oxidation of glucose to hydrogen peroxide (H2O2) and gluconic acid,and then converts H2O2 to hydroxyl radicals (•OH) by peroxidase-like activity to destroy bacteria. Moreover, CO production in response to H2O2, together with Au NPs exhibited a synergistic anti-inflammatory effect in macrophages challenged by lipopolysaccharides. The underlying mechanism can be the induction of nuclear factor erythroid 2-related factor 2 to reduce reactive oxygen species, and inhibition of nuclear factor kappa-B signaling to diminish inflammatory response. Importantly, the antibacterial and anti-inflammation effects of MSN-Au@CO are validated in diabetic rats with ligature-induced periodontitis by showing decreased periodontal bone loss with good biocompatibility. To summarize, MSN-Au@CO is fabricate to utilize glucose-activated cascade reaction to eliminate bacteria, and synergize with gas therapy to regulate the immune microenvironment, offering a potential direction for the treatment of diabetic periodontitis.
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Affiliation(s)
- Yi Wang
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Tengda Chu
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Ting Jin
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Shengming Xu
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Cheng Zheng
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Jianmin Huang
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Sisi Li
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Lixia Wu
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Jianliang Shen
- Wenzhou InstituteUniversity of Chinese Academy of SciencesState Key Laboratory of OphthalmologyOptometry and Vision ScienceSchool of Ophthalmology & OptometrySchool of Biomedical EngineeringWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Xiaojun Cai
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
| | - Hui Deng
- School and Hospital of StomatologyWenzhou Medical UniversityWenzhouZhejiang325024P. R. China
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Delvau N, Elens L, Penaloza A, Liistro G, Thys F, Roy P, Gianello P, Hantson P. Carboxyhemoglobin half-life toxicokinetic profiles during and after normobaric oxygen therapy: On a swine model. Toxicol Rep 2024; 12:271-279. [PMID: 38433766 PMCID: PMC10907397 DOI: 10.1016/j.toxrep.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Investigations on acute carbon monoxide (CO) poisoning struggle to highlight a relevant discriminant criterion related to CO poisoning severity for predicting complications, such as delayed neurological syndromes. In this context, it remains difficult to demonstrate the superiority of one method of oxygen (O2) administration over others or to identify the optimal duration of normobaric 100% oxygen (NBO) treatment. Myoglobin, as hemoglobin, are a potential binding site for CO, which could be a source of extravascular CO storage that impacts the severity of CO poisoning. It is not possible in routine clinical practice to estimate this potential extravascular CO storage. Indirect means of doing so that are available in the first few hours of poisoning could include, for example, the carboxyhemoglobin half-life (COHbt1/2), which seems to be influenced itself by the level and duration of CO exposure affecting this store of CO within the body. However, before the elimination of CO can be assessed, the COHbt1/2 toxicokinetic model must be confirmed: research still debates whether this model mono- or bi-compartmental. The second indirect mean could be the assessment of a potential COHb rebound after COHb has returned to 5% and NBO treatment has stopped. Moreover, a COHb rebound could be considered to justify the duration of NBO treatment. On an experimental swine model exposed to moderate CO poisoning (940 ppm for ±118 min until COHb reached 30%), we first confirm that the COHb half-life follows a bi-compartmental model. Secondly, we observe for the first time a slight COHb rebound when COHb returns to 5% and oxygen therapy is stopped. On the basis of these two toxicokinetic characteristics in favor of extravascular CO storage, we recommend that COHbt1/2 is considered using the bi-compartmental model in future clinical studies that compare treatment effectiveness as a potential severity criterion to homogenize cohorts of the same severity. Moreover, from a general toxicokinetic point of view, we confirm that a treatment lasting less than 6 hours appears to be insufficient for treating moderate CO poisoning.
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Affiliation(s)
- N. Delvau
- Department of Emergency Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium
| | - L. Elens
- Integrated Pharmacometrics, Pharmacogenomics and PharmacoKinetics (PMGK) Research group, Louvain Drug Research Institute (LDRI), Université Catholique de Louvain, Brussels 1200, Belgium
- Louvain Center for Toxicology and Applied Pharmacology (LTAP), Université Catholique de Louvain, Brussels 1200 , Belgium
| | - A. Penaloza
- Department of Emergency Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium
| | - G. Liistro
- Department of Pneumology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium
| | - F. Thys
- Emergency Department, GHDC: Grand Hôpital de Charleroi, Charleroi 6000, Belgium
| | - P.M. Roy
- Emergency Department, CHU Angers: Centre Hospitalier Universitaire d’Angers, Angers Cedex 01, Angers 49033, France
| | - P. Gianello
- Department of Health Sciences, Institute for Experimental and Clinical, Experimental Surgery and Transplantation (CHEX), Université Catholique de Louvain, Brussels 1200, Belgium
| | - P. Hantson
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels 1200, Belgium
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Piegari G, d'Aquino I, Salanti GV, Russo V, De Biase D, Caccia G, Carfora A, Campobasso CP, Paciello O. Pathological alterations and COHb evaluations as tools for investigating fire-related deaths in veterinary forensic pathology. Front Vet Sci 2024; 11:1396540. [PMID: 38835893 PMCID: PMC11148361 DOI: 10.3389/fvets.2024.1396540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
Fire-related deaths are usually a consequence of carbon monoxide (CO) poisoning or shock from thermal injuries. In humans, high levels of carboxyhemoglobin (COHb) concentrations in the blood can support a diagnosis of CO poisoning. In veterinary medicine, few studies investigated the pathological changes and blood COHb% in fire victims, and no data are available on post-mortem changes in blood gas composition due to fire. This study aims to investigate the pathological changes and COHb levels in both animal victims of fire and cadavers experimentally exposed to fire. For this purpose, dogs were selected and subdivided into three groups. Group A comprised 9 adult dogs, and Group B comprised 7 puppies that died under fire-related conditions. Group C was represented by 4 dog cadavers experimentally exposed to heat and smoke. A complete macroscopic, histological, and COHb evaluation were performed on each animal. Animals in Groups A and B showed cherry-red discoloration, thermal-injuries and soot deposits along the respiratory tract. Animals in Group C showed thermal injuries and soot deposits limited to the upper respiratory tract. The mean COHb% values in cadavers in Group C were lower than those observed in the other groups but higher compared to the values detected before the heat and smoke treatment. These findings suggest that both pathological changes and COHb analysis are valid tools for investigating fire-related deaths in dogs. However, the increase of COHb levels in cadavers exposed post-mortem to heat and smoke highlights how the COHb analysis should always be evaluated together with macroscopical and microscopical findings to avoid significant misjudgments in investigating fire-related fatalities in veterinary forensic practice.
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Affiliation(s)
- Giuseppe Piegari
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Ilaria d'Aquino
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Giovanni Valerio Salanti
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Valeria Russo
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Davide De Biase
- Department of Pharmacy, University of Salerno, Fisciano, Salerno, Italy
| | - Giulia Caccia
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Carfora
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Orlando Paciello
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
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27
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Greenwood JC, Morgan RW, Abella BS, Shofer FS, Baker WB, Lewis A, Ko TS, Forti RM, Yodh AG, Kao SH, Shin SS, Kilbaugh TJ, Jang DH. Carbon monoxide as a cellular protective agent in a swine model of cardiac arrest protocol. PLoS One 2024; 19:e0302653. [PMID: 38748750 PMCID: PMC11095756 DOI: 10.1371/journal.pone.0302653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/08/2024] [Indexed: 05/19/2024] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) affects over 360,000 adults in the United States each year with a 50-80% mortality prior to reaching medical care. Despite aggressive supportive care and targeted temperature management (TTM), half of adults do not live to hospital discharge and nearly one-third of survivors have significant neurologic injury. The current treatment approach following cardiac arrest resuscitation consists primarily of supportive care and possible TTM. While these current treatments are commonly used, mortality remains high, and survivors often develop lasting neurologic and cardiac sequela well after resuscitation. Hence, there is a critical need for further therapeutic development of adjunctive therapies. While select therapeutics have been experimentally investigated, one promising agent that has shown benefit is CO. While CO has traditionally been thought of as a cellular poison, there is both experimental and clinical evidence that demonstrate benefit and safety in ischemia with lower doses related to improved cardiac/neurologic outcomes. While CO is well known for its poisonous effects, CO is a generated physiologically in cells through the breakdown of heme oxygenase (HO) enzymes and has potent antioxidant and anti-inflammatory activities. While CO has been studied in myocardial infarction itself, the role of CO in cardiac arrest and post-arrest care as a therapeutic is less defined. Currently, the standard of care for post-arrest patients consists primarily of supportive care and TTM. Despite current standard of care, the neurological prognosis following cardiac arrest and return of spontaneous circulation (ROSC) remains poor with patients often left with severe disability due to brain injury primarily affecting the cortex and hippocampus. Thus, investigations of novel therapies to mitigate post-arrest injury are clearly warranted. The primary objective of this proposed study is to combine our expertise in swine models of CO and cardiac arrest for future investigations on the cellular protective effects of low dose CO. We will combine our innovative multi-modal diagnostic platform to assess cerebral metabolism and changes in mitochondrial function in swine that undergo cardiac arrest with therapeutic application of CO.
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Affiliation(s)
- John C. Greenwood
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Ryan W. Morgan
- Resuscitation Science Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Benjamin S. Abella
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Frances S. Shofer
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Wesley B. Baker
- Resuscitation Science Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Alistair Lewis
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Chemistry, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Tiffany S. Ko
- Resuscitation Science Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Rodrigo M. Forti
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Arjun G. Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Shih-Han Kao
- Resuscitation Science Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Samuel S. Shin
- Department of Pharmacology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Todd J. Kilbaugh
- Resuscitation Science Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - David H. Jang
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Resuscitation Science Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States of America
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28
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Zhao Y, Wang X, He M, Zeng G, Xu Z, Zhang L, Kang Y, Xue P. Vacancy-Rich Bismuth-Based Nanosheets for Mitochondrial Destruction via CO Poisoning, Ca 2+ Dyshomeostasis, and Oxidative Damage. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2307404. [PMID: 38054772 DOI: 10.1002/smll.202307404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/02/2023] [Indexed: 12/07/2023]
Abstract
Mitochondria are core regulators of tumor cell homeostasis, and their damage has become an arresting therapeutic modality against cancer. Despite the development of many mitochondrial-targeted pharmaceutical agents, the exploration of more powerful and multifunctional medications is still underway. Herein, oxygen vacancy-rich BiO2-x wrapped with CaCO3 (named BiO2-x@CaCO3/PEG, BCP) is developed for full-fledged attack on mitochondrial function. After endocytosis of BCP by tumor cells, the CaCO3 shell can be decomposed in the acidic lysosomal compartment, leading to immediate Ca2+ release and CO2 production in the cytoplasm. Near-infrared irradiation enhances the adsorption of CO2 onto BiO2-x defects, which enables highly efficient photocatalysis of CO2-to-CO. Meanwhile, such BiO2-x nanosheets possess catalase-, peroxidase- and oxidase-like catalytic activities under acidic pH conditions, allowing hypoxia relief and the accumulation of diverse reactive oxygen species (ROS) in the tumor microenvironment. Ca2+ overload-induced ion dyshomeostasis, CO-mediated respiratory chain poisoning, ROS-triggered oxidative stress aggravation, and cytosolic hyperoxia can cause severe mitochondrial disorders, which further lead to type I cell death in carcinoma. Not only does BCP cause irreversible apoptosis, but immunogenic cell death is simultaneously triggered to activate antitumor immunity for metastasis inhibition. Collectively, this platform promises high benefits in malignant tumor therapy and may expand the medical applications of bismuth-based nanoagents.
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Affiliation(s)
- Yinmin Zhao
- School of Materials and Energy, Southwest University, Chongqing, 400715, China
| | - Xiaoqin Wang
- School of Materials and Energy, Southwest University, Chongqing, 400715, China
| | - Mengting He
- School of Materials and Energy, Southwest University, Chongqing, 400715, China
| | - Guicheng Zeng
- School of Materials and Energy, Southwest University, Chongqing, 400715, China
| | - Zhigang Xu
- School of Materials and Energy, Southwest University, Chongqing, 400715, China
| | - Lei Zhang
- State Key Laboratory of Resource Insects, Southwest University, Chongqing, 400715, China
| | - Yuejun Kang
- School of Materials and Energy, Southwest University, Chongqing, 400715, China
- Yibin Academy of Southwest University, Yibin, 644000, China
| | - Peng Xue
- School of Materials and Energy, Southwest University, Chongqing, 400715, China
- Yibin Academy of Southwest University, Yibin, 644000, China
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29
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Truicu FN, Damian RO, Butoi MA, Belghiru VI, Rotaru LT, Puticiu M, Văruț RM. How to Personalize General Anesthesia-A Prospective Theoretical Approach to Conformational Changes of Halogenated Anesthetics in Fire Smoke Poisoning. Int J Mol Sci 2024; 25:4701. [PMID: 38731919 PMCID: PMC11083261 DOI: 10.3390/ijms25094701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Smoke intoxication is a central event in mass burn incidents, and toxic smoke acts at different levels of the body, blocking breathing and oxygenation. The majority of these patients require early induction of anesthesia to preserve vital functions. We studied the influence of hemoglobin (HMG) and myoglobin (MGB) blockade by hydrochloric acid (HCl) in an interaction model with gaseous anesthetics using molecular docking techniques. In the next part of the study, molecular dynamics (MD) simulations were performed on the top-scoring ligand-receptor complexes to investigate the stability of the ligand-receptor complexes and the interactions between ligands and receptors in more detail. Through docking analysis, we observed that hemoglobin creates more stable complexes with anesthetic gases than myoglobin. Intoxication with gaseous hydrochloric acid produces conformational and binding energy changes of anesthetic gases to the substrate (both the pathway and the binding site), the most significant being recorded in the case of desflurane and sevoflurane, while for halothane and isoflurane, they remain unchanged. According to our theoretical model, the selection of anesthetic agents for patients affected by fire smoke containing hydrochloric acid is critical to ensure optimal anesthetic effects. In this regard, our model suggests that halothane and isoflurane are the most suitable choices for predicting the anesthetic effects in such patients when compared to sevoflurane and desflurane.
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Affiliation(s)
- Flavius Nicușor Truicu
- Emergency Medicine and First Aid Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.N.T.); (R.O.D.); (M.A.B.); (V.I.B.)
| | - Roni Octavian Damian
- Emergency Medicine and First Aid Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.N.T.); (R.O.D.); (M.A.B.); (V.I.B.)
| | - Mihai Alexandru Butoi
- Emergency Medicine and First Aid Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.N.T.); (R.O.D.); (M.A.B.); (V.I.B.)
| | - Vlad Ionuț Belghiru
- Emergency Medicine and First Aid Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.N.T.); (R.O.D.); (M.A.B.); (V.I.B.)
| | - Luciana Teodora Rotaru
- Emergency Medicine and First Aid Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.N.T.); (R.O.D.); (M.A.B.); (V.I.B.)
| | - Monica Puticiu
- Emergency Medicine and First Aid Department, Faculty of Medicine, University of Medicine and Pharmacy “Vasile Goldiș” Arad, 310025 Arad, Romania
| | - Renata Maria Văruț
- Research Methodology Department, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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30
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Li A, Wu S, Li Q, Wang Q, Chen Y. Elucidating the Molecular Pathways and Therapeutic Interventions of Gaseous Mediators in the Context of Fibrosis. Antioxidants (Basel) 2024; 13:515. [PMID: 38790620 PMCID: PMC11117599 DOI: 10.3390/antiox13050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Fibrosis, a pathological alteration of the repair response, involves continuous organ damage, scar formation, and eventual functional failure in various chronic inflammatory disorders. Unfortunately, clinical practice offers limited treatment strategies, leading to high mortality rates in chronic diseases. As part of investigations into gaseous mediators, or gasotransmitters, including nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H2S), numerous studies have confirmed their beneficial roles in attenuating fibrosis. Their therapeutic mechanisms, which involve inhibiting oxidative stress, inflammation, apoptosis, and proliferation, have been increasingly elucidated. Additionally, novel gasotransmitters like hydrogen (H2) and sulfur dioxide (SO2) have emerged as promising options for fibrosis treatment. In this review, we primarily demonstrate and summarize the protective and therapeutic effects of gaseous mediators in the process of fibrosis, with a focus on elucidating the underlying molecular mechanisms involved in combating fibrosis.
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Affiliation(s)
- Aohan Li
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
| | - Siyuan Wu
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
| | - Qian Li
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
| | - Qianqian Wang
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
- Engineering Technology Research Center for The Utilization of Functional Components of Organic Natural Products, Dalian University, Dalian 116622, China
| | - Yingqing Chen
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
- Engineering Technology Research Center for The Utilization of Functional Components of Organic Natural Products, Dalian University, Dalian 116622, China
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Erlebach R, Buhlmann A, Andermatt R, Seeliger B, Stahl K, Bode C, Schuepbach R, Wendel-Garcia PD, David S. Carboxyhemoglobin predicts oxygenator performance and imminent oxygenator change in extracorporeal membrane oxygenation. Intensive Care Med Exp 2024; 12:41. [PMID: 38656714 PMCID: PMC11043307 DOI: 10.1186/s40635-024-00626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The continuous exposure of blood to a non-biological surface during extracorporeal membrane oxygenation (ECMO) may lead to progressive thrombus formation in the oxygenator, hemolysis and consequently impaired gas exchange. In most centers oxygenator performance is monitored only on a once daily basis. Carboxyhemoglobin (COHb) is generated upon red cell lysis and is routinely measured with any co-oximetry performed to surveille gas exchange and acid-base homeostasis every couple of hours. This retrospective cohort study aims to evaluate COHb in the arterial blood gas as a novel marker of oxygenator dysfunction and its predictive value for imminent oxygenator change. RESULTS Out of the 484 screened patients on ECMO 89, cumulatively requiring 116 oxygenator changes within 1833 patient days, including 19,692 arterial COHb measurements were analyzed. Higher COHb levels were associated with lower post-oxygenator pO2 (estimate for log(COHb): - 2.176 [95% CI - 2.927, - 1.427], p < 0.0001) and with a shorter time to oxygenator change (estimate for log(COHb): - 67.895 [95% CI - 74.209, - 61.542] hours, p < 0.0001). COHb was predictive of oxygenator change within 6 h (estimate for log(COHb): 5.027 [95% CI 1.670, 15.126], p = 0.004). CONCLUSION COHb correlates with oxygenator performance and can be predictive of imminent oxygenator change. Therefore, longitudinal measurements of COHb in clinical routine might be a cheap and more granular candidate for ECMO surveillance that should be further analyzed in a controlled prospective trial design.
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Affiliation(s)
- Rolf Erlebach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Alix Buhlmann
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Rea Andermatt
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Benjamin Seeliger
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Klaus Stahl
- Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Christian Bode
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Reto Schuepbach
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
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Vlcek P, Monkova I, Nerandzic Z, Lippert-Grüner M. Delayed encephalopathy after acute carbon monoxide poisoning: a case study. Brain Inj 2024; 38:331-336. [PMID: 38308510 DOI: 10.1080/02699052.2024.2311339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) is a relatively rare inflammatory-associated neurometabolic complication. In this article, we present a case report of a 50-year-old male patient with a history of carbon monoxide poisoning. This acute poisoning, although successfully controlled during a stay in the intensive care unit of a local hospital, later led to persistent neurological symptoms. The patient was then treated in the inpatient unit of the rehabilitation clinic, where cognitive deterioration began to develop 20 days after admission. Subsequent examination using EEG and magnetic resonance imaging confirmed severe encephalopathy later complicated by SARS-CoV-2 infection with fatal consequences due to bronchopneumonia. Because currently there are no approved guidelines for the management of DEACMP, we briefly discuss the existing challenges for future studies, especially the application of rational immunosuppressive therapy already in the acute treatment phase of CO poisoning, which could prevent the development of a severe form of DEACMP.
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Affiliation(s)
- Premysl Vlcek
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ivana Monkova
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zoran Nerandzic
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marcela Lippert-Grüner
- Department of Rehabilitation, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Zhang Y, Wang T, Wang S, Zhuang X, Li J, Guo S, Lei J. Gray matter atrophy and white matter lesions burden in delayed cognitive decline following carbon monoxide poisoning. Hum Brain Mapp 2024; 45:e26656. [PMID: 38530116 DOI: 10.1002/hbm.26656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/21/2024] [Accepted: 02/25/2024] [Indexed: 03/27/2024] Open
Abstract
Gray matter (GM) atrophy and white matter (WM) lesions may contribute to cognitive decline in patients with delayed neurological sequelae (DNS) after carbon monoxide (CO) poisoning. However, there is currently a lack of evidence supporting this relationship. This study aimed to investigate the volume of GM, cortical thickness, and burden of WM lesions in 33 DNS patients with dementia, 24 DNS patients with mild cognitive impairment, and 51 healthy controls. Various methods, including voxel-based, deformation-based, surface-based, and atlas-based analyses, were used to examine GM structures. Furthermore, we explored the connection between GM volume changes, WM lesions burden, and cognitive decline. Compared to the healthy controls, both patient groups exhibited widespread GM atrophy in the cerebral cortices (for volume and cortical thickness), subcortical nuclei (for volume), and cerebellum (for volume) (p < .05 corrected for false discovery rate [FDR]). The total volume of GM atrophy in 31 subregions, which included the default mode network (DMN), visual network (VN), and cerebellar network (CN) (p < .05, FDR-corrected), independently contributed to the severity of cognitive impairment (p < .05). Additionally, WM lesions impacted cognitive decline through both direct and indirect effects, with the latter mediated by volume reduction in 16 subregions of cognitive networks (p < .05). These preliminary findings suggested that both GM atrophy and WM lesions were involved in cognitive decline in DNS patients following CO poisoning. Moreover, the reduction in the volume of DMN, VN, and posterior CN nodes mediated the WM lesions-induced cognitive decline.
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Affiliation(s)
- Yanli Zhang
- Deparment of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China
- The Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, China
| | - Tianhong Wang
- Department of Neurology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Shuaiwen Wang
- Deparment of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China
- The Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, China
| | - Xin Zhuang
- Deparment of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China
- The Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, China
| | - Jianlin Li
- Deparment of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China
- The Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, China
| | - Shunlin Guo
- Deparment of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China
- The Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, China
| | - Junqiang Lei
- Deparment of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- Radiological Clinical Medicine Research Center of Gansu Province, Lanzhou, Gansu, China
- The Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, China
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Zhang M, Jiesisibieke ZL, Wei HS, Chen PE, Chien CW, Tao P, Tung TH. Increased Long-Term Risk of Dementia in Patients With Carbon Monoxide Poisoning: A Systematic Review and Meta-Analysis of Cohort Studies. Psychiatry Investig 2024; 21:321-328. [PMID: 38695039 PMCID: PMC11065530 DOI: 10.30773/pi.2021.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/29/2023] [Accepted: 10/05/2023] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE To assess whether carbon monoxide (CO) poisoning increases the incidence of dementia. METHODS We searched the Cochrane Library, PubMed, and EMBASE from inception to 14 August 2022. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreement was resolved by discussion with a third author. Only cohort study with an enough follow-up period was included for systematic reviews and meta-analysis. RESULTS Thirty-three full texts were initially searched, but only three studies met our inclusion criteria, and they were comprised of 134,563 participants who were initially free of dementia. The follow-up period ranged from 9 to 12 years. We found that CO poisoning increased the risk of dementia incidence (adjusted hazard ratio 2.61, 95% confidence interval 1.56 to 4.36, p=0.0003). Subgroup analysis showed that the increased dementia risk was significant in males but not in females, and the highest risk was in young age group, followed by in middle age group, but not in the old one. CONCLUSION Overall the evidence from prospective cohort studies supported a link between CO exposure and an increased dementia risk, although all the included studies were limited to Taiwanese population.
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Affiliation(s)
- Meixian Zhang
- Enze Medical Research Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Zhu Liduzi Jiesisibieke
- Enze Medical Research Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Ho-Shan Wei
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-En Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
- Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
| | - Ping Tao
- Department of Medical Affairs and Planning, Section of Medical Fees Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
| | - Tao-Hsin Tung
- Enze Medical Research Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
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Akkan S, Uyanik Ö. Comparing high-flow nasal oxygen therapy and normobaric oxygen therapy on the treatment of carbon monoxide poisoning. Med Klin Intensivmed Notfmed 2024; 119:214-219. [PMID: 37530814 DOI: 10.1007/s00063-023-01044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/09/2023] [Accepted: 06/25/2023] [Indexed: 08/03/2023]
Abstract
AIM We aimed to investigate whether there is a difference in the rate of decrease in carboxyhemoglobin (COHB) values between high-flow nasal oxygen (HFNO) and normobaric oxygen (NBO) therapy. MATERIAL AND METHOD This retrospective observational study included patients with carbon monoxide poisoning who were treated with HFNO or NBO (control group). All patients were started on NBO therapy with a non-rebreather face mask at a rate of 15 L/min. In the NBO group, NBO treatment was continued until the COHB value fell below 10%. In the HFNO group, as soon as the preparation of the HFNO device was completed, NBO treatment was terminated and HFNO treatment was started and continued until the COHB value fell below 10%. The primary outcome of the study was the difference between HFNO and NBO in terms of COHB half-life rates. RESULTS A total of 81 patients were included in the study, 44 in the HFNO group and 37 in the NBO group. The median of COHB t1/2 values between HFNO and the NBO treatment groups were 47.3 (IQR: 25-75%: 31.5-65.4) and 46 (IQR: 25-75%: 32.3-56.2), respectively, but this difference was not statistically significant (p = 0.81). CONCLUSION The results of this study suggest that HFNO treatment does not have a significant advantage over NBO treatment in the carbon monoxide elimination rate within the first 60 min of treatment.
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Affiliation(s)
- Sedat Akkan
- Elbistan State Hospital, Department of Emergency Medicine, Kahramanmaraş, Turkey.
| | - Ömür Uyanik
- Elbistan State Hospital, Department of Emergency Medicine, Kahramanmaraş, Turkey
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36
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Wong ZK, Teo CK, Kwek JW, Kim SJ, See HG. Hyperbaric oxygen for the treatment of carbon monoxide-induced delayed neurological sequelae: a case report and review of the literature. Diving Hyperb Med 2024; 54:65-68. [PMID: 38507912 PMCID: PMC11227963 DOI: 10.28920/dhm54.1.65-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/03/2024] [Indexed: 03/22/2024]
Abstract
Introduction Hyperbaric oxygen treatment (HBOT) remains a recognised treatment for acute carbon monoxide (CO) poisoning, but the utility of HBOT in treating CO-induced delayed neurological sequelae (DNS) is not yet established. Case description A 26-year old woman presented with reduced consciousness secondary to CO exposure from burning charcoal. She underwent a single session of HBOT with US Navy Treatment Table 5 within six hours of presentation, with full neurological recovery. Eight weeks later, she represented with progressive, debilitating neurological symptoms mimicking Parkinsonism. Magnetic resonance imaging of her brain demonstrated changes consistent with hypoxic ischaemic encephalopathy. The patient underwent 20 sessions of HBOT at 203 kPa (2 atmospheres absolute) for 115 minutes, and received intravenous methylprednisolone 1 g per day for three days. The patient's neurological symptoms completely resolved, and she returned to full-time professional work with no further recurrence. Discussion Delayed neurological sequelae is a well-described complication of CO poisoning. In this case, the patient's debilitating neurocognitive symptoms resolved following HBOT. Existing literature on treatment of CO-induced DNS with HBOT consists mainly of small-scale studies and case reports, many of which similarly suggest that HBOT is effective in treating this complication. However, a large, randomised trial is required to adequately determine the effectiveness of HBOT in the treatment of CO-induced DNS, and an optimal treatment protocol.
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Affiliation(s)
- Zebedee Kr Wong
- Navy Medical Service, Republic of Singapore Navy, Singapore
- Corresponding author: Dr Zebedee KR Wong, Navy Medical Service, Republic of Singapore Navy, Singapore,
| | - Colin Ka Teo
- Navy Medical Service, Republic of Singapore Navy, Singapore
| | - James Wm Kwek
- Navy Medical Service, Republic of Singapore Navy, Singapore
| | - Soo Joang Kim
- Hyperbaric and Diving Medicine Centre, Singapore General Hospital, Singapore
| | - Hooi Geok See
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore
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37
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An T, Liu C, Yuan W, Qin X, Yin Z. Divergent synthesis of carbamates and N-methyl carbamates from dimethyl carbonate and nitroarenes with Mo(CO) 6 as a multiple promoter. Chem Commun (Camb) 2024; 60:3389-3392. [PMID: 38344856 DOI: 10.1039/d3cc06257k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Dialkyl carbonates are green and versatile reagents that can be used in alkylation and alkoxycarbonylation reactions. Herein, we disclosed a reductive methoxycarbonylation of aromatic nitro compounds with dimethyl carbonate for the construction of diverse carbamates and N-methyl carbamates. Using Mo(CO)6 as a multiple promoter, different nitroarenes were smoothly transformed into the corresponding carbamates in yields between 27 and 94% using DMC as both solvent and reagent. It is worth noting that the choice of different bases allowed the desired products to be controlled: K3PO4 favoured the formation of carbamates as the primary product, whereas DBU facilitated the formation of N-methyl carbamates as the main product.
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Affiliation(s)
- Tongshun An
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, P. R. China.
| | - Chenwei Liu
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, P. R. China.
| | - Weiheng Yuan
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, P. R. China.
| | - Xiaowen Qin
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, P. R. China.
| | - Zhiping Yin
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, P. R. China.
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38
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Matias FR, Groves I, Durrans J, Herigstad M. Carbon monoxide affects early cardiac development in an avian model. Birth Defects Res 2024; 116:e2330. [PMID: 38488476 DOI: 10.1002/bdr2.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Carbon monoxide (CO) is a toxic gas that can be lethal in large doses and may also cause physiological damage in lower doses. Epidemiological studies suggest that CO in lower doses over time may impact on embryo development, in particular cardiac development, however other studies have not observed this association. METHODS Here, we exposed chick embryos in ovo to CO at three different concentrations (3, 9, 18 ppm) plus air control (4 protocols in total) for the first 9 days of development, at which point we assessed egg and embryo weight, ankle length, developmental stage, heart weight, ventricular wall thickness, ventricular-septal thickness and atrial wall thickness. RESULTS We found that heart weight was reduced for the low and moderate exposures compared to air, that atrial wall and ventricular wall thickness was increased for the moderate and high exposures compared to air and that ventricular septal thickness was increased for low, moderate and high exposures compared to air. Ventricular wall thickness was also significantly positively correlated with absolute CO exposures across all protocols. CONCLUSIONS This intervention study thus suggests that CO even at very low levels may have a significant impact on cardiac development.
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Affiliation(s)
- Filipa Rombo Matias
- Lisbon School of Health Technology, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Ian Groves
- School of Mathematics and Statistics, The University of Sheffield, Sheffield, UK
- School of Biosciences, The University of Sheffield, Sheffield, UK
| | - Joshua Durrans
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Mari Herigstad
- Biomolecular Sciences Research Centre, Sheffield Hallam University, Sheffield, UK
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Alharthy N, Alanazi A, Almoqaytib A, Alharbi B, Alshaibani R, Albuniyan J, Alshibani A. Demographics and clinical characteristics of carbon monoxide poisoning for patients attending in the emergency department at a tertiary hospital in Riyadh, Saudi Arabia. Int J Emerg Med 2024; 17:25. [PMID: 38408885 PMCID: PMC10895805 DOI: 10.1186/s12245-024-00600-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Carbon Monoxide (CO) is one of the most common environmental causes of acute intoxication globally. It can lead to the development of Delayed Neuropsychiatric Sequelae (DNS) which may develop in 2-40 days after remission of acute CO poisoning. DNS is defined by recurrent-transient neurological, cognitive, or psychological manifestations. This study was intended to describe the demographics and characteristics of CO poisoning patients attending at the Emergency Department (ED) and assess the association between CO intoxication and the development of DNS in a tertiary hospital, Riyadh, Saudi Arabia. METHODS A retrospective descriptive cross-sectional study was conducted in subjects who were diagnosed with CO poisoning and attended to the ED at King Abdulaziz Medical City (KAMC) and King Abdullah Specialist Children's Hospital (KASCH) in Riyadh during the period from January 2016 to December 2021. Patient demographics, vitals, diagnostic tests, and oxygen therapy at initial presentation were documented. Patient medical records were reviewed at 2-40 days following CO poisoning for development of DNS. Ethical approval was obtained from King Abdullah International Medical Research Center (KAIMRC). RESULTS A total of 85 patients were diagnosed with CO poisoning and met the study inclusion criteria. Of those, 76% were adults with an average age of 32.36 (SD ± 15.20) and 51% were male adults. Five (6%) of the 85 patients developed DNS. Common symptoms included dizziness, nausea, and decreased visual acuity in 40% of the cases. The development of DNS manifestations was most likely (80%) to occur at 2 to 10 days after the initial incident. Inferential statistics showed that BMI (p-value = 0.021) and age group (p-value = 0.029) were significantly associated with COHb level, which was not the case for gender and the presence of clinical manifestation. Furthermore, Gender was significantly associated with the development of DNS (20% male vs. 80% female, p = 0.050). CONCLUSIONS The findings of this study are consistent with previous published studies showing low proportions of patients who were exposed to CO poisoning at risk of developing DNS. Further larger-scale multicenter studies are needed to assess the factors associated with the development of DNS for patients with CO poisoning.
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Affiliation(s)
- Nesrin Alharthy
- Pediatrics Emergency Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Aljohara Alanazi
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alreem Almoqaytib
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bedour Alharbi
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rakad Alshaibani
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Jawaher Albuniyan
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Alshibani
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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40
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Gao X, Wei W, Yang GD. Clinical factors for delayed neuropsychiatric sequelae from acute carbon monoxide poisoning: a retrospective study. Front Med (Lausanne) 2024; 11:1333197. [PMID: 38371510 PMCID: PMC10869438 DOI: 10.3389/fmed.2024.1333197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Background Delayed neuropsychiatric sequelae (DNS), which seriously affect the daily lives of patients, are the most common complications of carbon monoxide (CO) poisoning. No uniform screening tool is available for identifying high-risk groups. Therefore, in this study, we aimed to explore whether conventional laboratory indicators and imaging data from primary hospitals could predict the occurrence of DNS. Methods This retrospective observational study was conducted in a single-center primary hospital from January 1, 2021 to May 31, 2023. Participants included patients aged >18 years with acute CO poisoning. Patients with complete recovery in the acute phase were followed up by telephone and outpatient visits, and the presence of DNS was determined according to the occurrence of new neurological symptoms within 6 weeks after discharge. We obtained demographic, laboratory, and imaging data from the medical records and performed a univariate analysis. A multivariate logistic regression model was used to identify independent clinical predictors of DNS. Results A total of 73 patients were included in the study, of whom 25 (34.2%) developed DNS. Multivariate logistic regression analysis revealed that a longer duration of CO exposure (adjusted odds ratio (AOR): 1.262, 95% confidence interval (CI): 1.069-1.490) and the presence of acute brain lesions on diffusion-weighted imaging (DWI) (AOR: 5.117, 95% CI: 1.430-18.315) were independent risk factors for DNS. Receiver operating characteristic analyses of the duration of CO exposure were performed (area under the curve (AUC): 0.825; 95% CI: 0.731-0.918) with a cut-off value of 5.5 h, and DNS was predicted with a sensitivity of 96% and a specificity of 66.7%. Conclusion High cranial DWI signal within 24 h and duration of poisoning longer than 5.5 h are independent predictors of DNS. The predictive effects of conventional laboratory indicators require further standardized and large-sample studies.
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Affiliation(s)
| | | | - Guo-Dong Yang
- Department of Neurology, Jiu Jiang No. 1 People’s Hospital, Jiujiang, China
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41
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Tekin YK. Optic nerve sheath diameter measurements to predict delayed neurological sequelae after carbon monoxide poisoning. Clin Toxicol (Phila) 2024; 62:88-93. [PMID: 38466623 DOI: 10.1080/15563650.2024.2323092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES Delayed neurological sequelae are a major complication of carbon monoxide poisoning. However, today there is still no objective screening tool for predicting delayed neurological sequelae in patients with carbon monoxide poisoning. The present study aimed to assess the usefulness of optic nerve sheath diameter measurements in predicting delayed neurological sequelae after carbon monoxide poisoning. METHODS In this retrospective study, patients with a diagnosis of carbon monoxide poisoning in the emergency department from 2010 to 2021 were included in the study. Right and left optic nerve sheath diameters were calculated based on cranial computed tomography scans, and the presence of delayed neurological sequelae was evaluated. RESULTS The mean (± standard deviation) optic nerve sheath diameter in patients who developed delayed neurological sequelae was statistically significantly greater on both the right and left compared to patients who did not develop delayed neurological sequelae (right; 5.02 ± 0.06 mm versus 4.89 ± 0.07 mm, P < 0.001; left; 5.03 ± 0.09 mm versus 4.85 ± 0.10 mm, P < 0.001). A multivariate linear regression analysis revealed that carboxyhemoglobin and both right and left optic nerve sheath diameter were the factors associated with the delayed neurological sequelae. DISCUSSION The present study revealed that optic nerve sheath diameter measurements may be a useful screening tool to predict delayed neurological sequelae after carbon monoxide poisoning. The ability to predict a poor neurological prognosis in carbon monoxide poisoning is important for initiating early rehabilitation interventions and make help future trials. Limitations of this study include that normal optic nerve sheath diameters are not well established, and that not every patient underwent computed tomography. CONCLUSIONS Optic nerve sheath diameters measurements may be a helpful screening tool for predicting delayed neurological sequelae after carbon monoxide poisoning.
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Affiliation(s)
- Yusuf Kenan Tekin
- Department of Emergency Medicine, Sivas Cumhuriyet University, Sivas, Turkey
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Wang S, Xiong B, Tian Y, Hu Q, Jiang X, Zhang J, Chen L, Wang R, Li M, Zhou X, Zhang T, Ge H, Yu A. Targeting Ferroptosis Promotes Functional Recovery by Mitigating White Matter Injury Following Acute Carbon Monoxide Poisoning. Mol Neurobiol 2024; 61:1157-1174. [PMID: 37697220 DOI: 10.1007/s12035-023-03603-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
Survivors experiencing acute carbon monoxide poisoning (ACMP) tend to develop white matter injury (WMI). The mechanism of ACMP-induced WMI remains unclear. Considering the role of ferroptosis in initiating oligodendrocyte damage to deteriorate WMI, exploring therapeutic options to attenuate ferroptosis is a feasible approach to alleviating WMI. Our results indicated that ACMP induced accumulation of iron and reactive oxygen species (ROS) eventually leading to WMI and motor impairment after ACMP. Furthermore, ferrostatin-1 reduced iron and ROS deposition to alleviate ferroptosis, thereafter reducing WMI to promote the recovery of motor function. The nuclear factor erythroid-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway was found to be involved in alleviating ferroptosis as seen with the administration of ferrostatin-1. The present study rationalizes that targeting ferroptosis to alleviate WMI is a feasible therapeutic strategy for managing ACMP.
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Affiliation(s)
- Shuhong Wang
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Binyuan Xiong
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Yin Tian
- Department of Cardiology, The First People's Hospital of Zunyi, Zunyi, Guizhou, 133012, China
| | - Quan Hu
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Xuheng Jiang
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Ji Zhang
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Lin Chen
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Ruilie Wang
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Mo Li
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Xin Zhou
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China
| | - Tianxi Zhang
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
| | - Hongfei Ge
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
| | - Anyong Yu
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, 563000, China.
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Sagheer U, Al-Kindi S, Abohashem S, Phillips CT, Rana JS, Bhatnagar A, Gulati M, Rajagopalan S, Kalra DK. Environmental Pollution and Cardiovascular Disease: Part 1 of 2: Air Pollution. JACC. ADVANCES 2024; 3:100805. [PMID: 38939391 PMCID: PMC11198409 DOI: 10.1016/j.jacadv.2023.100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/13/2023] [Accepted: 11/21/2023] [Indexed: 06/29/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Over the past 50 years, there has been a substantial decline in the incidence of CVD and related mortality in high-income countries, largely due to the mitigation of modifiable risk factors such as smoking, hypertension, and diabetes. However, a significant burden of CVD remains in low- to middle-income countries, despite their lower prevalence of traditional risk factors; other environmental factors, particularly pollution, play a significant role in this attributable risk. Mounting evidence underscores a strong association between pollution and adverse health effects, including CVD. This article is part 1 of a 2-part state-of-the-art review and discusses air pollution and its adverse effects on CVD, highlighting pathophysiological mechanisms and methods to reduce air pollution and exposure to these pollutants.
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Affiliation(s)
- Usman Sagheer
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Sadeer Al-Kindi
- Division of Cardiology, Department of Medicine, University Hospitals, Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shady Abohashem
- Divison of Cardiovascular Imaging, Radiology Department, Massachusetts General Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Colin T. Phillips
- Department of Cardiology, Maine Medical Center, Portland, Maine, USA
| | - Jamal S. Rana
- The Permanente Medical Group, Department of Cardiology, Oakland Medical Center, Oakland, California, USA
| | - Aruni Bhatnagar
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sanjay Rajagopalan
- Division of Cardiology, Department of Medicine, University Hospitals, Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dinesh K. Kalra
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, Kentucky, USA
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Parker AL, Johnstone TC. Carbon monoxide poisoning: A problem uniquely suited to a medicinal inorganic chemistry solution. J Inorg Biochem 2024; 251:112453. [PMID: 38100903 DOI: 10.1016/j.jinorgbio.2023.112453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
Carbon monoxide poisoning is one of the most common forms of poisoning in the world. Although the primary mode of treatment, oxygen therapy, is highly effective in many cases, there are instances in which it is inadequate or inappropriate. Whereas oxygen therapy relies on high levels of a low-affinity ligand (O2) to displace a high-affinity ligand (CO) from metalloproteins, an antidote strategy relies on introducing a molecule with a higher affinity for CO than native proteins (Kantidote,CO > Kprotein,CO). Based on the fundamental chemistry of CO, such an antidote is most likely required to be an inorganic compound featuring an electron-rich transition metal. A review is provided of the protein-, supramolecular complex-, and small molecule-based CO poisoning antidote platforms that are currently under investigation.
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Affiliation(s)
- A Leila Parker
- Department of Chemistry and Biochemistry, University of California Santa Cruz, Santa Cruz, California 95064, United States
| | - Timothy C Johnstone
- Department of Chemistry and Biochemistry, University of California Santa Cruz, Santa Cruz, California 95064, United States..
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Yu J, Lee J, Cho Y, Oh J, Kang H, Lim TH, Ko BS. Correlation between Carboxyhemoglobin Levels Measured by Blood Gas Analysis and by Multiwave Pulse Oximetry. J Pers Med 2024; 14:168. [PMID: 38392600 PMCID: PMC10890311 DOI: 10.3390/jpm14020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Carbon monoxide (CO) poisoning is difficult to diagnose owing to its nonspecific symptoms. Multiwave pulse oximetry can be used to quickly screen patients for CO poisoning. However, few studies have analyzed patients with CO poisoning who presented to the emergency department (ED). The primary aim of our study was to determine the correlation between COHb levels measured in blood gas analysis and COHb levels measured in multiwave pulse oximetry. Secondary aims were the sensitivity and specificity of the COHb level cutoff value using multiwave pulse oximetry to predict a 25% COHb level in blood gas analysis. This single-center retrospective observational study included patients with CO poisoning who visited the ED of a university-affiliated hospital in Seoul, Korea between July 2021 and June 2023. COHb poisoning was determined using blood gas analysis and multiwave pulse oximetry. The correlation of COHb levels between the two tests was evaluated using correlation analysis. The area under the receiver operating characteristic curve (AUC) of multiwave pulse oximetry was calculated to predict COHb levels from the blood gas analysis. The optimal cutoff values, sensitivity, and specificity of COHb were determined. A total of 224 patients who had COHb levels measured using both multiwave pulse oximetry and blood gas analysis were included in the analysis. In the correlation analysis, COHb showed a high positive correlation with COHb measured using blood gas analysis (Spearman correlation coefficient = 0.86, p < 0.001). The AUC of COHb measured by multiwave pulse oximetry to predict 25% of the COHb level (which can be an indication of hyperbaric oxygen treatment) measured by blood gas analysis was 0.916. When the COHb levels measured with multiwave pulse oximetry were 20% the sensitivity was 81% and the specificity was 83%, and when the COHb levels were 25% the sensitivity was 50% and the specificity was 95%. The COHb value measured using multiwave pulse oximetry blood gas analysis showed a high correlation. However, additional research using large-scale studies is required for validation.
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Affiliation(s)
- Jisu Yu
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Juncheol Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
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Dent MR, Rose JJ, Tejero J, Gladwin MT. Carbon Monoxide Poisoning: From Microbes to Therapeutics. Annu Rev Med 2024; 75:337-351. [PMID: 37582490 PMCID: PMC11160397 DOI: 10.1146/annurev-med-052422-020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Carbon monoxide (CO) poisoning leads to 50,000-100,000 emergency room visits and 1,500-2,000 deaths each year in the United States alone. Even with treatment, survivors often suffer from long-term cardiac and neurocognitive deficits, highlighting a clear unmet medical need for novel therapeutic strategies that reduce morbidity and mortality associated with CO poisoning. This review examines the prevalence and impact of CO poisoning and pathophysiology in humans and highlights recent advances in therapeutic strategies that accelerate CO clearance and mitigate toxicity. We focus on recent developments of high-affinity molecules that take advantage of the uniquely strong interaction between CO and heme to selectively bind and sequester CO in preclinical models. These scavengers, which employ heme-binding scaffolds ranging from organic small molecules to hemoproteins derived from humans and potentially even microorganisms, show promise as field-deployable antidotes that may rapidly accelerate CO clearance and improve outcomes for survivors of acute CO poisoning.
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Affiliation(s)
- Matthew R Dent
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; ,
| | - Jason J Rose
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA; ,
| | - Jesús Tejero
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; ,
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark T Gladwin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA; ,
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Sun H, Wan Y, Pan X, You W, Shen J, Lu J, Zheng G, Li X, Xing X, Zhang Y. Long-term air pollution and adverse meteorological factors might elevate the osteoporosis risk among adult Chinese. Front Public Health 2024; 12:1361911. [PMID: 38347931 PMCID: PMC10859497 DOI: 10.3389/fpubh.2024.1361911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
Objective This study aims to investigate the relationship between exposure to air pollution and adverse meteorological factors, and the risk of osteoporosis. Methods We diagnosed osteoporosis by assessing bone mineral density through Dual-Energy X-ray absorptiometry in 2,361 participants from Jiangsu, China. Additionally, we conducted physical examinations, blood tests, and questionnaires. We evaluated pollution exposure levels using grid data, considering various lag periods (ranging from one to five years) based on participants' addresses. We utilized logistic regression analysis, adjusted for temperature, humidity, and individual factors, to examine the connections between osteoporosis and seven air pollutants: PM₁, PM₂.₅, PM₁₀, SO₂, NO₂, CO, and O₃. We assessed the robustness of our study through two-pollutant models and distributed lag non-linear models (DLNM) and explored susceptibility using stratified analyses. Results In Jiangsu, China, the prevalence of osteoporosis among individuals aged 40 and above was found to be 15.1%. A consistent association was observed between osteoporosis and the five-year average exposure to most pollutants, including PM₂.₅, PM₁₀, CO, and O₃. The effects of PM₁₀ and CO remained stable even after adjusting for the presence of a second pollutant. However, the levels of PM₁ and PM₂.₅ were significantly influenced by O₃ levels. Individuals aged 60 and above, those with a BMI of 25 or higher, and males were found to be more susceptible to the effects of air pollution. Interestingly, males showed a significantly higher susceptibility to PM₁ and PM₂.₅ compared to females. This study provides valuable insights into the long-term effects of air pollution on osteoporosis risk among the adult population in China. Conclusion This study indicates a potential association between air pollutants and osteoporosis, particularly with long-term exposure. The risk of osteoporosis induced by air pollution is found to be higher in individuals aged 60 and above, those with a BMI greater than 25, and males. These findings underscore the need for further research and public health interventions to mitigate the impact of air pollution on bone health.
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Affiliation(s)
- Hong Sun
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yanan Wan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Xiaoqun Pan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Wanxi You
- Luhe District Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Jianxin Shen
- Wujiang District Center for Disease Control and Prevention, Suzhou, Jiangsu, China
| | - Junhua Lu
- Chongchuan District Center for Disease Control and Prevention, Nantong, Jiangsu, China
| | - Gangfeng Zheng
- Jingjiang Center for Disease Control and Prevention, Taizhou, Jiangsu, China
| | - Xinlin Li
- Nantong Center for Disease Control and Prevention, Nantong, Jiangsu, China
| | - Xiaoxi Xing
- Quanshan District Center for Disease Control and Prevention, Xuzhou, Jiangsu, China
| | - Yongqing Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
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Yan Z, Liu Z, Zhang H, Guan X, Xu H, Zhang J, Zhao Q, Wang S. Current trends in gas-synergized phototherapy for improved antitumor theranostics. Acta Biomater 2024; 174:1-25. [PMID: 38092250 DOI: 10.1016/j.actbio.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/14/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Phototherapy, such as photothermal therapy (PTT) and photodynamic therapy (PDT), has been considered an elegant solution to eradicate tumors due to its minimal invasiveness and low systemic toxicity. Nevertheless, it is still challenging for phototherapy to achieve ideal outcomes and clinical translation due to its inherent drawbacks. Owing to the unique biological functions, diverse gases have attracted growing attention in combining with phototherapy to achieve super-additive therapeutic effects. Specifically, gases such as nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H2S) have been proven to kill tumor cells by inducing mitochondrial damage in synergy with phototherapy. Additionally, several gases not only enhance the thermal damage in PTT and the reactive oxygen species (ROS) production in PDT but also improve the tumor accumulation of photoactive agents. The inflammatory responses triggered by hyperthermia in PTT are also suppressed by the combination of gases. Herein, we comprehensively review the latest studies on gas-synergized phototherapy for cancer therapy, including (1) synergistic mechanisms of combining gases with phototherapy; (2) design of nanoplatforms for gas-synergized phototherapy; (3) multimodal therapy based on gas-synergized phototherapy; (4) imaging-guided gas-synergized phototherapy. Finally, the current challenges and future opportunities of gas-synergized phototherapy for tumor treatment are discussed. STATEMENT OF SIGNIFICANCE: 1. The novelty and significance of the work with respect to the existing literature. (1) Strategies to design nanoplatforms for gas-synergized anti-tumor phototherapy have been summarized for the first time. Meanwhile, the integration of various imaging technologies and therapy modalities which endow these nanoplatforms with advanced theranostic capabilities has been summarized. (2) The mechanisms by which gases synergize with phototherapy to eradicate tumors are innovatively and comprehensively summarized. 2. The scientific impact and interest. This review elaborates current trends in gas-synergized anti-tumor phototherapy, with special emphases on synergistic anti-tumor mechanisms and rational design of therapeutic nanoplatforms to achieve this synergistic therapy. It aims to provide valuable guidance for researchers in this field.
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Affiliation(s)
- Ziwei Yan
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Zhu Liu
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Haotian Zhang
- Department of Pharmacology, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Xinyao Guan
- Experimental Teaching Center, Faculty of Functional Food and Wine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Hongwei Xu
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Jinghai Zhang
- Department of Biomedical Engineering, School of Medical Devices, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Qinfu Zhao
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China.
| | - Siling Wang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China.
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49
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Wankhade BS, Shaikh WS, Alrais ZF, ElKhouly AE, Salman AA. Neurological Sequelae After Acute Carbon Monoxide Poisoning. Cureus 2024; 16:e52840. [PMID: 38406153 PMCID: PMC10884778 DOI: 10.7759/cureus.52840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Carbon monoxide poisoning (COP) is a common cause of death due to poisoning. After COP, a significant number of patients may develop a distinct type of neurological dysfunction called delayed neurological sequel (DNS). Recently, we came across a disaster of COP cases after a fire in a shared accommodation. The hostel was overcrowded and had a faulty air-conditioning/exhaust system. A total of five patients with loss of consciousness and shock were brought to us. They were diagnosed with acute COP based on their history of exposure to carbon monoxide (CO) and elevated carboxyhemoglobin levels in blood gas measurements. All patients were intubated and mechanically ventilated. Standard intensive care management was given to them, which included oxygenation, sedation, fluid resuscitation, and vasopressors. Their carboxyhemoglobin was rapidly reversed with normobaric oxygen therapy (NBO2). Three patients showed good response and neurological recovery after NBO2. Unfortunately, two patients developed DNS. DNS is a neuropsychological condition that may have cognitive, psychiatric, vestibulocochlear, motor, sensory, or diffuse demyelinating effects after COP. DNS is diagnosed in patients with a typical history of exposure to CO and a constellation of signs and symptoms. Neuroimaging, specifically magnetic resonance imaging of the brain with gadolinium contrast, is the method of choice for diagnosis. Treatment of DNS after COP begins with anticipation. All patients should receive appropriate oxygen therapy to bring down carboxyhemoglobin as soon as possible. Hyperbaric oxygen therapy (HBO2) for the treatment of COP and prevention of DNS is still debatable. In the available medical literature, there are conflicting recommendations regarding the use of HBO2 in COP/DNS. Moreover, apart from a lack of consensus, there is also a lack of clarity about optimum timing, duration, atmospheric pressure, and number of sessions of HBO2 in preventing DNS after COP. The development of DNS after COP is not directly responsible for mortality, but recovery sometimes takes a long time, which can contribute to increased morbidity and costs of treatment.
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Affiliation(s)
| | - Wasim Shabbir Shaikh
- Critical Care Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Zeyad Faoor Alrais
- Critical Care Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Adel Elsaid ElKhouly
- Critical Care Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE
| | - Ammar Ali Salman
- Critical Care Medicine, Rashid Hospital, Dubai Academic Health Corporation, Dubai, ARE
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50
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Mavroudis CD, Lewis A, Greenwood JC, Kelly M, Ko TS, Forti RM, Shin SS, Shofer FS, Ehinger JK, Baker WB, Kilbaugh TJ, Jang DH. Investigation of Cerebral Mitochondrial Injury in a Porcine Survivor Model of Carbon Monoxide Poisoning. J Med Toxicol 2024; 20:39-48. [PMID: 37847352 PMCID: PMC10774472 DOI: 10.1007/s13181-023-00971-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Carbon monoxide (CO) is a colorless and odorless gas that is a leading cause of environmental poisoning in the USA with substantial mortality and morbidity. The mechanism of CO poisoning is complex and includes hypoxia, inflammation, and leukocyte sequestration in brain microvessel segments leading to increased reactive oxygen species. Another important pathway is the effects of CO on the mitochondria, specifically at cytochrome c oxidase, also known as Complex IV (CIV). One of the glaring gaps is the lack of rigorous experimental models that may recapitulate survivors of acute CO poisoning in the early phase. The primary objective of this preliminary study is to use our advanced swine platform of acute CO poisoning to develop a clinically relevant survivor model to perform behavioral assessment and MRI imaging that will allow future development of biomarkers and therapeutics. METHODS Four swine (10 kg) were divided into two groups: control (n = 2) and CO (n = 2). The CO group received CO at 2000 ppm for over 120 min followed by 30 min of re-oxygenation at room air for one swine and 150 min followed by 30 min of re-oxygenation for another swine. The two swine in the sham group received room air for 150 min. Cerebral microdialysis was performed to obtain semi real-time measurements of cerebral metabolic status. Following exposures, all surviving animals were observed for a 24-h period with neurobehavioral assessment and imaging. At the end of the 24-h period, fresh brain tissue (cortical and hippocampal) was immediately harvested to measure mitochondrial respiration. RESULTS While a preliminary ongoing study, animals in the CO group showed alterations in cerebral metabolism and cellular function in the acute exposure phase with possible sustained mitochondrial changes 24 h after the CO exposure ended. CONCLUSIONS This preliminary research further establishes a large animal swine model investigating survivors of CO poisoning to measure translational metrics relevant to clinical medicine that includes a basic neurobehavioral assessment and post exposure cellular measures.
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Affiliation(s)
- Constantine D Mavroudis
- Divisions of Cardiothoracic Surgery, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, 19104, USA
| | - Alistair Lewis
- Divisions of Cardiothoracic Surgery, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Anesthesia and Critical Care Medicine Mitochondrial Unit (ACMU), The Children's Hospital of Philadelphia (CHOP), Lab 6200, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - John C Greenwood
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Matthew Kelly
- Divisions of Cardiothoracic Surgery, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, 19104, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Anesthesia and Critical Care Medicine Mitochondrial Unit (ACMU), The Children's Hospital of Philadelphia (CHOP), Lab 6200, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Emergency Medicine, University of Alabama, Birmingham, AL, USA
| | - Tiffany S Ko
- Anesthesia and Critical Care Medicine Mitochondrial Unit (ACMU), The Children's Hospital of Philadelphia (CHOP), Lab 6200, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rodrigo M Forti
- Anesthesia and Critical Care Medicine Mitochondrial Unit (ACMU), The Children's Hospital of Philadelphia (CHOP), Lab 6200, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Samuel S Shin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Frances S Shofer
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Johannes K Ehinger
- Otorhinolaryngology, Head and Neck Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Wesley B Baker
- Anesthesia and Critical Care Medicine Mitochondrial Unit (ACMU), The Children's Hospital of Philadelphia (CHOP), Lab 6200, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Todd J Kilbaugh
- Anesthesia and Critical Care Medicine Mitochondrial Unit (ACMU), The Children's Hospital of Philadelphia (CHOP), Lab 6200, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - David H Jang
- Anesthesia and Critical Care Medicine Mitochondrial Unit (ACMU), The Children's Hospital of Philadelphia (CHOP), Lab 6200, Colket Translational Research Building, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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