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Nah S, Choi S, Lee SU, Kim GW, Lee YH, Han S. Effects of smoking on delayed neuropsychiatric sequelae in acute carbon monoxide poisoning: A prospective observational study. Medicine (Baltimore) 2021; 100:e26032. [PMID: 34011113 PMCID: PMC8137110 DOI: 10.1097/md.0000000000026032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/03/2021] [Indexed: 01/05/2023] Open
Abstract
Smoking is a well-known risk factor for cardio-cerebrovascular disease. However, several studies have reported the "smoker's paradox" whereby smokers have a better prognosis for cardio-cerebrovascular diseases. Similar to cardio-cerebrovascular diseases, hypoxia is one of the major mechanisms of injury in carbon monoxide (CO) poisoning. This study investigated the association between smoking and delayed neuropsychiatric sequelae (DNS) in acute CO poisoning.This study involved patients with CO poisoning treated at a university hospital in Bucheon, Korea between September 2017 and March 2020. The exclusion criteria were age <18 years, discharge against medical advice, loss to follow-up, persistent neurological symptoms at discharge, transfer from another hospital 24 hours after exposure, and transfer from another hospital after hyperbaric oxygen therapy. Logistic regression analysis was performed to find factors associated with DNS.Two hundred sixty three patients visited the hospital due to CO poisoning and of these, 54 were excluded. DNS was evaluated up to 3 months after discharge, and until this time, DNS occurred in 35 (16.8%) patients. And the incidence rate of DNS was lower in smokers than non-smokers (15, 12% vs 20, 23.8%, P = .040). Multivariable logistic regression analysis revealed that CO exposure time (odds ratio [OR] 1.003; confidence interval [CI] 1.001-1.005; P = .003), the Glasgow coma scale (GCS) (OR 0.862; CI 0.778-0.956; P = .005), and pack-years (OR 0.947; CI 0.903-0.993; P = .023) were statistically significant for DNS development.These results indicate that more pack-years smoked were associated with reduced risk of the development of DNS in acute CO poisoning, and that CO exposure time and GCS is a predictive factor for DNS occurrence.
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Affiliation(s)
- Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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202
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Gentile D, Adams R, Klatka M, Bradberry S, Gray L, Thanacoody R, Jackson G, Sandilands EA. Carbon monoxide exposures reported to the UK National Poisons Information Service: a 4-year study. J Public Health (Oxf) 2021; 44:565-574. [PMID: 33993287 DOI: 10.1093/pubmed/fdab132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/23/2021] [Accepted: 04/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Unintentional carbon monoxide (CO) poisoning poses a public health challenge. The UK National Poisons Information Service (NPIS) provides advice to healthcare professionals via the online database, TOXBASE®, and a 24-hour telephone line. Our aim was to analyse all CO-related enquiries to the NPIS. METHODS We analysed enquiries regarding unintentional CO exposure (1st July 2015-30th June 2019). Information on patient demographics, CO source and location, clinical features and poisoning severity was collected from telephone enquiries and TOXBASE accesses. RESULTS 2970 unintentional non-fire-related CO exposures were reported. Exposures occurred commonly in the home (60%) with faulty boilers frequently implicated (27.4%). Although five fatalities were reported, 68.7% of patients experienced no or minor symptoms only (headache most frequently reported). Despite being the gold standard measurement, blood carboxyhaemoglobin concentration was only recorded in 25.6% patients, with no statistically significant correlation with severity. CONCLUSIONS Unintentional CO exposures in the UK commonly occur in domestic settings and although are generally of low severity, fatalities continue to occur. Carboxyhaemoglobin measurement is important to confirm exposure but further work is required to assess its validity as a prognostic indicator in CO exposure. Public health policy should continue to focus on raising awareness of the dangers of CO.
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Affiliation(s)
- Daniela Gentile
- National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Richard Adams
- National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Michal Klatka
- National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Sally Bradberry
- National Poisons Information Service (Birmingham Unit), City Hospital, Birmingham B18 7QH, UK
| | - Laurence Gray
- National Poisons Information Service (Cardiff Unit), University Hospital Llandough, Penarth CF64 2XX, UK
| | - Ruben Thanacoody
- National Poisons Information Service (Newcastle Unit), Regional Drug and Therapeutics Centre, Newcastle upon Tyne NE2 4AB, UK
| | - Gillian Jackson
- National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Euan A Sandilands
- National Poisons Information Service (Edinburgh Unit), Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
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203
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Yang X, Xie M, Tan L, Li T, Tang X. Case report of new-onset obstructive sleep apnea after carbon monoxide poisoning. J Int Med Res 2021; 49:300060521992228. [PMID: 33616419 PMCID: PMC7903828 DOI: 10.1177/0300060521992228] [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: 02/05/2023] Open
Abstract
Obstructive sleep apnea (OSA) is characterized by repetitive intermittent oxygen desaturation during sleep. Carbon monoxide poisoning (COP) is the second most common cause of death among non-medicinal poisonings, and oxygen therapy is the current standard of treatment for COP. We herein report a case of a 50-year-old woman diagnosed with severe OSA associated with COP. Both the OSA and COP gradually resolved by automatic continuous positive airway pressure (CPAP) therapy. New OSA symptoms appeared following the development of delayed encephalopathy after acute COP (DEACMP) 3 weeks later. Severe OSA was diagnosed 76 days after COP with an apnea–hypopnea index of 66 events/hour, and CPAP therapy was immediately administered. The patient’s DEACMP symptoms and OSA both improved with CPAP therapy (her apnea–hypopnea index decreased to 32.4 and 16.5 events/hour at 161 and 204 days after COP, respectively). To our knowledge, this is the first case report of OSA caused by COP based on the occurrence and disappearance of OSA symptoms and laboratory findings associated with the emergence and improvement of DEACMP.
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Affiliation(s)
- Xiaorong Yang
- Outpatient Department, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Min Xie
- Sleep Medicine Center, Laboratory of Anaesthesia & Critical Care Medicine, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Tan
- Sleep Medicine Center, Laboratory of Anaesthesia & Critical Care Medicine, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Taomei Li
- Sleep Medicine Center, Laboratory of Anaesthesia & Critical Care Medicine, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangdong Tang
- Sleep Medicine Center, Laboratory of Anaesthesia & Critical Care Medicine, Department of Respiratory and Critical Care Medicine, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
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204
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Liu CC, Hsu CS, He HC, Cheng YY, Chang ST. Effects of intravascular laser phototherapy on delayed neurological sequelae after carbon monoxide intoxication as evaluated by brain perfusion imaging: A case report and review of the literature. World J Clin Cases 2021; 9:3048-3055. [PMID: 33969090 PMCID: PMC8080739 DOI: 10.12998/wjcc.v9.i13.3048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Delayed neurological sequelae (DNS) caused by carbon monoxide (CO) intoxication poses considerable treatment challenges for clinical practitioners. In this report, we used nuclear medicine imaging and the Mini-Mental State Examination (MMSE) to evaluate the effectiveness of intravascular laser irradiation of blood (ILIB) therapy for the management of DNS.
CASE SUMMARY A 51-year-old woman presented to our medical center experiencing progressive bradykinesia, rigidity of limbs, gait disturbance, and cognitive impairment. Based on her neurological deficits, laboratory tests and imaging findings, the patient was diagnosed with delayed neurological sequelae of CO intoxication. She received intensive rehabilitation and ILIB therapy during 30 sessions over 2 mo after diagnosis. Brain single-photon emission computed tomography was performed both prior to and after ILIB therapy. The original hypoperfusion area in bilateral striata, bilateral frontal lobe, right parietal lobe, and bilateral cerebellum showed considerable improvement after completion of therapy. The patient’s MMSE score also increased markedly from 6/30 to 25/30. Symptoms of DNS became barely detectable, and the woman was able to carry out her daily living activities independently.
CONCLUSION ILIB therapy could facilitate recovery from delayed neurological sequelae in patients with CO intoxication, as demonstrated by improved cerebral blood flow and functional outcomes in our patient.
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Affiliation(s)
- Chuan-Ching Liu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chun-Sheng Hsu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
| | - Hsin-Chen He
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Shin-Tsu Chang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
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205
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Simonsen C, Magnusdottir SO, Andreasen JJ, Wimmer R, Rasmussen BS, Kjaergaard B, Maltesen RG. Metabolic changes during carbon monoxide poisoning: An experimental study. J Cell Mol Med 2021; 25:5191-5201. [PMID: 33949122 PMCID: PMC8178256 DOI: 10.1111/jcmm.16522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/26/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022] Open
Abstract
Carbon monoxide (CO) is the leading cause of death by poisoning worldwide. The aim was to explore the effects of mild and severe poisoning on blood gas parameters and metabolites. Eleven pigs were exposed to CO intoxication and had blood collected before and during poisoning. Mild CO poisoning (carboxyhaemoglobin, COHb 35.2 ± 7.9%) was achieved at 32 ± 13 minutes, and severe poisoning (69.3 ± 10.2% COHb) at 64 ± 23 minutes from baseline (2.9 ± 0.5% COHb). Blood gas parameters and metabolites were measured on a blood gas analyser and nuclear magnetic resonance spectrometer, respectively. Unsupervised principal component, analysis of variance and Pearson's correlation tests were applied. A P-value ≤ .05 was considered statistically significant. Mild poisoning resulted in a 28.4% drop in oxyhaemoglobin (OHb) and 12-fold increase in COHb, while severe poisoning in a 65% drop in OHb and 24-fold increase in COHb. Among others, metabolites implicated in regulation of metabolic acidosis (lactate, P < .0001), energy balance (pyruvate, P < .0001; 3-hydroxybutyrc acid, P = .01), respiration (citrate, P = .007; succinate, P = .0003; fumarate, P < .0001), lipid metabolism (glycerol, P = .002; choline, P = .0002) and antioxidant-oxidant balance (glutathione, P = .03; hypoxanthine, P < .0001) were altered, especially during severe poisoning. Our study adds new insights into the deranged metabolism of CO poisoning and leads the way for further investigation.
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Affiliation(s)
- Carsten Simonsen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sigriður Olga Magnusdottir
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Biomedical Research Laboratory, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Jesper Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Reinhard Wimmer
- Department of Chemistry and Bioscience, Aalborg University, Aalborg, Denmark
| | - Bodil Steen Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Anaesthesiology and Intensive Care, Pulmonary Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Benedict Kjaergaard
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Biomedical Research Laboratory, Aalborg University Hospital, Aalborg, Denmark
| | - Raluca Georgiana Maltesen
- Department of Anaesthesiology and Intensive Care, Pulmonary Research Center, Aalborg University Hospital, Aalborg, Denmark
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206
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Lee H, Kang H, Ko BS, Oh J, Lim TH, Cho Y. Initial creatine kinase level as predictor for delayed neuropsychiatric sequelae associated with acute carbon monoxide poisoning. Am J Emerg Med 2021; 43:195-199. [DOI: 10.1016/j.ajem.2020.02.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022] Open
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Sorkin A, Nadler R, Sommer A, Tsur AM, Chen J, Bader T, Benov A. Medical Challenges in Underground Warfare. Mil Med 2021; 186:839-844. [PMID: 33499517 DOI: 10.1093/milmed/usaa447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/25/2020] [Accepted: 10/30/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Throughout history, underground systems have served military purposes in both offensive and defensive tactical settings. With the advance of underground mining, combat tactics, and weapon systems, providing medical support in the subterranean battlefield is a constantly growing challenge. This retrospective cohort study describes the Israeli Defense Force (IDF) Medical Corps experience with treating casualties from underground warfare, as recorded in the IDF Trauma Registry. METHODS A retrospective cohort study of all casualties engaged in underground warfare, between the years 2004-2018. Medical data were extracted from the IDF Trauma Registry and tactical data were obtained from operational reports. An expert committee characterized the most prevalent challenges. Recommendations were based on a literature review and the lessons learned by the IDF experience. RESULTS During the study period, 26 casualties were injured in the underground terrain. Of casualties, 12 (46%) due to blast injuries, 9 (35%) were due to smoke inhalation, and 5 (19%) due to crushing injuries. All were males, and the average age was 21.6 years. Ten (38%) were killed in action (died before reaching a medical facility). All 16 casualties reaching the hospital survived (Table I). The expert committee divided the most common challenges into three categories-tactical, environmental, and medical. An overview of medical response planning, common injuries, and designated combat casualty care are discussed below. As in all combat casualty care, the focus should be on safety, bleeding control, and rapid evacuation. CONCLUSION To plan and provide medical support, a thorough understanding of operational planning is essential. This manuscript presents the evolution of underground warfare, tactical and medical implications, environmental hazards, and common casualty care challenges.
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Affiliation(s)
- Alex Sorkin
- Israel Defense Forces, Medical Corps, Surgeon General's Headquarters, Headquarters of the Surgeon General, Ramat Gan, Israel
| | - Roy Nadler
- Israel Defense Forces, Medical Corps, Surgeon General's Headquarters, Headquarters of the Surgeon General, Ramat Gan, Israel
| | - Adir Sommer
- Israel Defense Forces, Medical Corps, Surgeon General's Headquarters, Headquarters of the Surgeon General, Ramat Gan, Israel
| | - Avishai M Tsur
- Israel Defense Forces, Medical Corps, Surgeon General's Headquarters, Headquarters of the Surgeon General, Ramat Gan, Israel
| | - Jacob Chen
- Israel Defense Forces, Medical Corps, Surgeon General's Headquarters, Headquarters of the Surgeon General, Ramat Gan, Israel
| | - Tarif Bader
- Israel Defense Forces, Medical Corps, Surgeon General's Headquarters, Headquarters of the Surgeon General, Ramat Gan, Israel
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Surgeon General's Headquarters, Headquarters of the Surgeon General, Ramat Gan, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Sefad, Israel
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208
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Huang CC, Chen TH, Ho CH, Chen YC, Hsu CC, Lin HJ, Wang JJ, Chang CP, Guo HR. Increased Risk of Congestive Heart Failure Following Carbon Monoxide Poisoning. Circ Heart Fail 2021; 14:e007267. [PMID: 33866825 DOI: 10.1161/circheartfailure.120.007267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Carbon monoxide poisoning (COP) is an important public health issue around the world. It may increase the risk of myocardial injury, but the association between COP and congestive heart failure (CHF) remains unclear. We conducted a study incorporating data from epidemiological and animal studies to clarify this issue. METHODS Using the National Health Insurance Database of Taiwan, we identified patients with COP diagnosed between 1999 and 2012 and compared them with patients without COP (non-COP cohort) matched by age and the index date at a 1:3 ratio. The comparison for the risk of CHF between the COP and non-COP cohorts was made using Cox proportional hazards regression. We also established a rat model to evaluate cardiac function using echocardiography and studied the pathological changes following COP. RESULTS The 20 942 patients in the COP cohort had a higher risk for CHF than the 62 826 members in the non-COP cohort after adjusting for sex and underlying comorbidities (adjusted hazard ratio, 2.01 [95% CI, 1.74-2.32]). The increased risk of CHF persisted even after 2 years of follow-up (adjusted hazard ratio, 1.85 [95% CI, 1.55-2.21]). In the animal model, COP led to a decreased left ventricular ejection fraction on echocardiography and damage to cardiac cells with remarkable fibrotic changes. CONCLUSIONS Our epidemiological data showed an increased risk of CHF was associated with COP, which was supported by the animal study. We suggest close follow-up of cardiac function for patients with COP to facilitate early intervention and further studies to identify other long-term effects that have not been reported in the literature.
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Affiliation(s)
- Chien-Cheng Huang
- Department of Emergency Medicine (C.-C. Huang, C.-C. Hsu, H.-J.L.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-C. Huang, T.-H.C., H.-R.G.).,Department of Senior Services (C.-C. Huang), Southern Taiwan University of Science and Technology, Tainan
| | - Tzu-Hao Chen
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-C. Huang, T.-H.C., H.-R.G.)
| | - Chung-Han Ho
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan (C.-H.H.)
| | - Yi-Chen Chen
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine (C.-C. Huang, C.-C. Hsu, H.-J.L.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology (C.-C. Hsu), Southern Taiwan University of Science and Technology, Tainan
| | - Hung-Jung Lin
- Department of Emergency Medicine (C.-C. Huang, C.-C. Hsu, H.-J.L.), Chi Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan (H.-J.L.)
| | - Jhi-Joung Wang
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan.,Allied AI Biomed Center (J.-J.W.), Southern Taiwan University of Science and Technology, Tainan
| | - Ching-Ping Chang
- Department of Medical Research (T.-H.C., C.-H.H., Y.-C.C., J.-J.W., C.-P.C.), Chi Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-C. Huang, T.-H.C., H.-R.G.).,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan (H.-R.G.).,Occupational Safety, Health and Medicine Research Center, National Cheng Kung University, Tainan Taiwan (H.-R.G.)
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Bo-Htay C, Shwe T, Jaiwongkam T, Kerdphoo S, Pratchayasakul W, Pattarasakulchai T, Shinlapawittayatorn K, Chattipakorn SC, Chattipakorn N. Hyperbaric oxygen therapy effectively alleviates D-galactose-induced-age-related cardiac dysfunction via attenuating mitochondrial dysfunction in pre-diabetic rats. Aging (Albany NY) 2021; 13:10955-10972. [PMID: 33861726 PMCID: PMC8109141 DOI: 10.18632/aging.202970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/27/2021] [Indexed: 12/23/2022]
Abstract
Currently, the prevalence of obesity in aging populations is fast growing worldwide. Aging induced by D-galactose (D-gal) is proven to cause the worsening of cardiac dysfunction in pre-diabetic rats via deteriorating cardiac mitochondrial function. Hyperbaric oxygen therapy (HBOT) has been shown to attenuate D-gal-induced cognitive deterioration through decreased inflammation and apoptosis. We tested the hypothesis that HBOT alleviates D-gal induced cardiac dysfunction via improving mitochondrial function in pre-diabetic rats. Wistar rats (n=56) were fed normal diet or high-fat diet for 12 weeks. For subsequent 8 weeks, they were subcutaneously injected either vehicle (0.9% normal saline) or D-gal (150mg/kg/day). Rats were randomly subdivided into 7 groups at week 21: sham-treated (normal diet fed rats with vehicle (NDV), high-fat diet fed rats with vehicle (HFV), normal diet fed rats with D-gal (NDDg), high-fat diet fed rats with D-gal (HFDg)) and HBOT-treated (HFV, NDDg, HFDg). Sham rats received ambient pressure of oxygen while HBOT-treated ones received 100% oxygen given once daily for 60 minutes at 2 atmosphere absolute. HBOT reduced metabolic impairments, mitochondrial dysfunction and increased autophagy, resulting in an improvement of cardiac function in aged pre-diabetic rats.
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Affiliation(s)
- Cherry Bo-Htay
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thazin Shwe
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thidarat Jaiwongkam
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sasiwan Kerdphoo
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Wasana Pratchayasakul
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Thienchai Pattarasakulchai
- Hyperbaric Oxygen Therapy Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Krekwit Shinlapawittayatorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Siriporn C Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai 50200, Thailand
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210
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Choi YK, Kim YM. Regulation of Endothelial and Vascular Functions by Carbon Monoxide via Crosstalk With Nitric Oxide. Front Cardiovasc Med 2021; 8:649630. [PMID: 33912601 PMCID: PMC8071856 DOI: 10.3389/fcvm.2021.649630] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/16/2021] [Indexed: 12/21/2022] Open
Abstract
Carbon monoxide (CO), generated by heme oxygenase (HO), has been considered a signaling molecule in both the cardiovascular and central nervous systems. The biological function of the HO/CO axis is mostly related to other gaseous molecules, including nitric oxide (NO), which is synthesized by nitric oxide synthase (NOS). Healthy blood vessels are essential for the maintenance of tissue homeostasis and whole-body metabolism; however, decreased or impaired vascular function is a high-risk factor of cardiovascular and neuronal diseases. Accumulating evidence supports that the interplay between CO and NO plays a crucial role in vascular homeostasis and regeneration by improving endothelial function. Moreover, endothelial cells communicate with neighboring cells, such as, smooth muscle cells, immune cells, pericytes, and astrocytes in the periphery and neuronal vascular systems. Endogenous CO could mediate the cell-cell communication and improve the physiological functions of the cardiovascular and neurovascular systems via crosstalk with NO. Thus, a forward, positive feedback circuit between HO/CO and NOS/NO pathways can maintain cardiovascular and neurovascular homeostasis and prevent various human diseases. We discussed the crucial role of CO-NO crosstalk in the cardiovascular and neurovascular systems.
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Affiliation(s)
- Yoon Kyung Choi
- Department of Bioscience and Biotechnology, Konkuk University, Seoul, South Korea
| | - Young-Myeong Kim
- Department of Molecular and Cellular Biochemistry, School of Medicine, Kangwon National University, Chuncheon, South Korea
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Sert ET, Kokulu K, Mutlu H. Clinical predictors of delayed neurological sequelae in charcoal-burning carbon monoxide poisoning. Am J Emerg Med 2021; 48:12-17. [PMID: 33838469 DOI: 10.1016/j.ajem.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The main objective of the treatment of acute carbon monoxide (CO) poisoning is to prevent delayed neurological sequelae (DNS). However, today there is still no objective screening tool to identify patients at high risk of developing DNS. The aim of this study was to identify clinical factors that could predict DNS after acute charcoal-burning CO poisoning. METHODS This prospective observational study was conducted from September 1, 2019 to August 31, 2020 in a single academic medical center. Patients older than 18 years of age suffering from charcoal-burning CO poisoning were included in the study. After acute recovery, patients were followed up for six weeks to investigate for DNS development. The clinical predictors of DNS were determined using a multivariate logistic regression model. RESULTS Of the 217 patients-113 males (52.1%), median age 37.0 (27.5-51.5) years-included, 49 (22.6%) developed DNS. The multivariate logistic regression analysis revealed the independent predictors of DNS as a lower initial Glasgow Coma Scale (GCS) score (adjusted odds ratio (AOR): 0.73, 95% confidence interval (CI): 0.62-0.87), a longer duration of CO exposure (AOR: 2.18, 95% CI: 1.65-2.88), and the presence of acute brain lesions with high signal intensity on diffusion-weighted imaging (AOR: 5.22, 95% CI: 1.50-18.08). The created multivariate regression model predicted DNS development with high accuracy (area under the curve: 0.93, 95% CI: 0.89-0.97). CONCLUSION A low initial GCS score, longer exposure to CO and abnormal findings on diffusion-weighted magnetic resonance imaging can assist in the early identification of patients at high risk of DNS development.
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Affiliation(s)
- Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray University Medical School, Aksaray, Turkey
| | - Kamil Kokulu
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray University Medical School, Aksaray, Turkey.
| | - Hüseyin Mutlu
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray University Medical School, Aksaray, Turkey
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212
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Preadmission Exposure to Air Pollution and 90-Day Mortality in Critically ill Patients: A Retrospective Study. J Occup Environ Med 2021; 62:93-97. [PMID: 31651597 DOI: 10.1097/jom.0000000000001743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated the association between preadmission exposure to air pollutants and 90-day mortality in critically ill patients. METHODS This retrospective cohort study analyzed the medical records of adult patients (more than or equal to 18 years) admitted to the intensive care unit of a tertiary academic hospital from 2015 to 2016. RESULTS Four air pollutants were not significantly associated with 90-day mortality and pulmonary disease-related 90-day mortality (P > 0.05). In patients with preadmission chronic obstructive lung disease (COPD), a 1 ppm increase in ozone (O3) and carbon monoxide (CO) was associated with a 1.04-fold and 5.99-fold increase in pulmonary disease-related 90-day mortality, respectively. CONCLUSIONS Preadmission exposure to air pollution was not associated with 90-day mortality in critically ill patients. However, a higher concentration of CO and O3 was associated with an increase in pulmonary disease-related 90-day mortality in patients with preadmission COPD.
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213
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Mao Q, Kawaguchi AT, Mizobata S, Motterlini R, Foresti R, Kitagishi H. Sensitive quantification of carbon monoxide in vivo reveals a protective role of circulating hemoglobin in CO intoxication. Commun Biol 2021; 4:425. [PMID: 33782534 PMCID: PMC8007703 DOI: 10.1038/s42003-021-01880-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
Carbon monoxide (CO) is a gaseous molecule known as the silent killer. It is widely believed that an increase in blood carboxyhemoglobin (CO-Hb) is the best biomarker to define CO intoxication, while the fact that CO accumulation in tissues is the most likely direct cause of mortality is less investigated. There is no reliable method other than gas chromatography to accurately determine CO content in tissues. Here we report the properties and usage of hemoCD1, a synthetic supramolecular compound composed of an iron(II)porphyrin and a cyclodextrin dimer, as an accessible reagent for a simple colorimetric assay to quantify CO in biological samples. The assay was validated in various organ tissues collected from rats under normal conditions and after exposure to CO. The kinetic profile of CO in blood and tissues after CO treatment suggested that CO accumulation in tissues is prevented by circulating Hb, revealing a protective role of Hb in CO intoxication. Furthermore, hemoCD1 was used in vivo as a CO removal agent, showing that it acts as an effective adjuvant to O2 ventilation to eliminate residual CO accumulated in organs, including the brain. These findings open new therapeutic perspectives to counteract the toxicity associated with CO poisoning. Mao et al. report highly sensitive quantification of carbon monoxide with a simple colorimetric assay, exploiting a synthetic supramolecular compound, hemoCD1. It can reveal distribution of CO in organs including the brain and can also serve as a CO scavenger for residual CO accumulated in organs. Finally, the authors showed circulating hemoglobin plays a protective role in CO intoxication.
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Affiliation(s)
- Qiyue Mao
- Department of Molecular Chemistry and Biochemistry, Faculty of Science and Engineering, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Akira T Kawaguchi
- Cell Transplantation and Regenerative Medicine, Tokai University, Isehara, Kanagawa, Japan
| | - Shun Mizobata
- Department of Molecular Chemistry and Biochemistry, Faculty of Science and Engineering, Doshisha University, Kyotanabe, Kyoto, Japan
| | | | - Roberta Foresti
- University Paris Est Creteil, INSERM, IMRB, Creteil, France.
| | - Hiroaki Kitagishi
- Department of Molecular Chemistry and Biochemistry, Faculty of Science and Engineering, Doshisha University, Kyotanabe, Kyoto, Japan.
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214
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Trotman-Lucas M, Gibson CL. A review of experimental models of focal cerebral ischemia focusing on the middle cerebral artery occlusion model. F1000Res 2021; 10:242. [PMID: 34046164 PMCID: PMC8127011 DOI: 10.12688/f1000research.51752.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
Cerebral ischemic stroke is a leading cause of death and disability, but current pharmacological therapies are limited in their utility and effectiveness.
In vitro and
in vivo models of ischemic stroke have been developed which allow us to further elucidate the pathophysiological mechanisms of injury and investigate potential drug targets.
In vitro models permit mechanistic investigation of the biochemical and molecular mechanisms of injury but are reductionist and do not mimic the complexity of clinical stroke.
In vivo models of ischemic stroke directly replicate the reduction in blood flow and the resulting impact on nervous tissue. The most frequently used
in vivo model of ischemic stroke is the intraluminal suture middle cerebral artery occlusion (iMCAO) model, which has been fundamental in revealing various aspects of stroke pathology. However, the iMCAO model produces lesion volumes with large standard deviations even though rigid surgical and data collection protocols are followed. There is a need to refine the MCAO model to reduce variability in the standard outcome measure of lesion volume. The typical approach to produce vessel occlusion is to induce an obstruction at the origin of the middle cerebral artery and reperfusion is reliant on the Circle of Willis (CoW). However, in rodents the CoW is anatomically highly variable which could account for variations in lesion volume. Thus, we developed a refined approach whereby reliance on the CoW for reperfusion was removed. This approach improved reperfusion to the ischemic hemisphere, reduced variability in lesion volume by 30%, and reduced group sizes required to determine an effective treatment response by almost 40%. This refinement involves a methodological adaptation of the original surgical approach which we have shared with the scientific community via publication of a visualised methods article and providing hands-on training to other experimental stroke researchers.
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Affiliation(s)
| | - Claire L Gibson
- School of Psychology, University of Nottingham, Nottingham, NG7 2UH, UK
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215
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Ochi S, Sekiya K, Abe N, Funahashi Y, Kumon H, Yoshino Y, Nishihara T, Boku S, Iga JI, Ueno SI. Neural precursor cells are decreased in the hippocampus of the delayed carbon monoxide encephalopathy rat model. Sci Rep 2021; 11:6244. [PMID: 33737717 PMCID: PMC7973557 DOI: 10.1038/s41598-021-85860-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 03/08/2021] [Indexed: 11/25/2022] Open
Abstract
The pathophysiology of delayed carbon monoxide (CO) encephalopathy remains unclear. In this study, the effects of CO exposure on the dentate gyrus (DG) were investigated in a Wistar rat model by histochemical and molecular methods. Model rats showed significant cognitive impairment in the passive-avoidance test beginning 7 days after CO exposure. Immunohistochemistry showed that compared to the control, the cell number of SRY (sex-determining region Y)-box 2 (SOX2)+/brain lipid binding protein (BLBP)+/glial fibrillary acidic protein (GFAP)+ cells in the DG was significantly less, but the number of SOX2+/GFAP− cells was not, reflecting a decreased number of type 1 and type 2a neural precursor cells. Compared to the control, the numbers of CD11b+ cells and neuron glial antigen 2+ cells were significantly less, but the number of SOX2−/GFAP+ cells was not. Flow cytometry showed that the percent of live microglial cells isolated from the hippocampus in this CO rat model was significantly lower than in controls. Furthermore, mRNA expression of fibroblast growth factor 2 and glial cell-derived neurotrophic factor, which are neurogenic factors, was significantly decreased in that area. We conclude that, in this rat model, there is an association between delayed cognitive impairment with dysregulated adult hippocampal neurogenesis and glial changes in delayed CO encephalopathy.
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Affiliation(s)
- Shinichiro Ochi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Keisuke Sekiya
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoki Abe
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yu Funahashi
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hiroshi Kumon
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yuta Yoshino
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tasuku Nishihara
- Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shuken Boku
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Jun-Ichi Iga
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Shu-Ichi Ueno
- Department of Neuropsychiatry, Molecules and Function, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Cruz-Martínez H, Rojas-Chávez H, Montejo-Alvaro F, Peña-Castañeda YA, Matadamas-Ortiz PT, Medina DI. Recent Developments in Graphene-Based Toxic Gas Sensors: A Theoretical Overview. SENSORS (BASEL, SWITZERLAND) 2021; 21:1992. [PMID: 33799914 PMCID: PMC8001952 DOI: 10.3390/s21061992] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022]
Abstract
Detecting and monitoring air-polluting gases such as carbon monoxide (CO), nitrogen oxides (NOx), and sulfur oxides (SOx) are critical, as these gases are toxic and harm the ecosystem and the human health. Therefore, it is necessary to design high-performance gas sensors for toxic gas detection. In this sense, graphene-based materials are promising for use as toxic gas sensors. In addition to experimental investigations, first-principle methods have enabled graphene-based sensor design to progress by leaps and bounds. This review presents a detailed analysis of graphene-based toxic gas sensors by using first-principle methods. The modifications made to graphene, such as decorated, defective, and doped to improve the detection of NOx, SOx, and CO toxic gases are revised and analyzed. In general, graphene decorated with transition metals, defective graphene, and doped graphene have a higher sensibility toward the toxic gases than pristine graphene. This review shows the relevance of using first-principle studies for the design of novel and efficient toxic gas sensors. The theoretical results obtained to date can greatly help experimental groups to design novel and efficient graphene-based toxic gas sensors.
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Affiliation(s)
- Heriberto Cruz-Martínez
- Tecnológico Nacional de México, Instituto Tecnológico del Valle de Etla, Abasolo S/N, Barrio del Agua Buena, Santiago Suchilquitongo, Oaxaca 68230, Mexico; (H.C.-M.); (F.M.-A.)
| | - Hugo Rojas-Chávez
- Tecnológico Nacional de México, Instituto Tecnológico de Tláhuac II, Camino Real 625, Tláhuac, Ciudad de México 13508, Mexico;
| | - Fernando Montejo-Alvaro
- Tecnológico Nacional de México, Instituto Tecnológico del Valle de Etla, Abasolo S/N, Barrio del Agua Buena, Santiago Suchilquitongo, Oaxaca 68230, Mexico; (H.C.-M.); (F.M.-A.)
| | - Yesica A. Peña-Castañeda
- Colegio de Ciencia y Tecnología, Universidad Autónoma de la Ciudad de México, Av. Fray Servando Teresa de Mier 92, Cuauhtémoc, Ciudad de México 06080, Mexico;
| | - Pastor T. Matadamas-Ortiz
- Instituto Politécnico Nacional, CIIDIR-OAXACA, Hornos No. 1003, Noche Buena, Santa Cruz Xoxocotlán 71230, Mexico
| | - Dora I. Medina
- Tecnologico de Monterrey, School of Engineering and Sciences, Atizapan de Zaragoza, Estado de México 52926, Mexico
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217
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Ruan HL, Deng WS, Wang Y, Chen JB, Hong WL, Ye SS, Hu ZJ. Carbon monoxide poisoning: a prediction model using meteorological factors and air pollutant. BMC Proc 2021; 15:1. [PMID: 33648509 PMCID: PMC7923450 DOI: 10.1186/s12919-021-00206-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background While the influence of meteorology on carbon monoxide (CO) poisoning has been reported, few data are available on the association between air pollutants and the prediction of CO poisoning. Our objective is to explore meteorological and pollutant patterns associated with CO poisoning and to establish a predictive model. Results CO poisoning was found to be significantly associated with meteorological and pollutant patterns: low temperatures, low wind speeds, low air concentrations of sulfur dioxide (SO2) and ozone (O38h), and high daily temperature changes and ambient CO (r absolute value range: 0.079 to 0.232, all P values < 0.01). Based on the above factors, a predictive model was established: “logitPj = aj - 0.193 * temperature - 0.228 * wind speed + 0.221 * 24 h temperature change + 1.25 * CO - 0.0176 * SO2 + 0.0008 *O38h; j = 1, 2, 3, 4; a1 = -4.12, a2 = -2.93, a3 = -1.98, a4 = -0.92.” The proposed prediction model based on combined factors showed better predictive capacity than a model using only meteorological factors as a predictor. Conclusion Low temperatures, wind speed, and SO2 and high daily temperature changes, O38h, and CO are related to CO poisoning. Using both meteorological and pollutant factors as predictors could help facilitate the prevention of CO poisoning. Supplementary Information The online version contains supplementary material available at 10.1186/s12919-021-00206-7.
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Affiliation(s)
- Hai-Lin Ruan
- Department of Emergency, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, 545005, PR China
| | - Wang-Shen Deng
- Department of Emergency, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, 545005, PR China
| | - Yao Wang
- Department of Emergency, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, 545005, PR China
| | - Jian-Bing Chen
- Guangxi Liuzhou Meteorological Bureau, Liuzhou, Guangxi, 545001, PR China
| | - Wei-Liang Hong
- Guangxi Liuzhou Environmental Protection Bureau, Liuzhou, Guangxi, 545006, PR China
| | - Shan-Shan Ye
- Department of Emergency, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, 545005, PR China
| | - Zhuo-Jun Hu
- Department of Respiration, Liuzhou Worker's Hospital, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi, 545005, PR China.
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218
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Underner M, Perriot J, Peiffer G, Dewitte J, Jaafari N. Republication de : Intoxication au monoxyde de carbone chez les fumeurs actifs ou passifs de chicha. JOURNAL EUROPÉEN DES URGENCES ET DE RÉANIMATION 2021. [DOI: 10.1016/j.jeurea.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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219
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Cho Y, Lim TH, Ko BS, Kang H, Oh J, Lee H. Risk factors for venous thromboembolism after carbon monoxide poisoning: A nationwide population-based study. HONG KONG J EMERG ME 2021. [DOI: 10.1177/1024907921994426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The risk of venous thromboembolism increases after acute carbon monoxide poisoning. However, studies on the characteristics of patients who develop venous thromboembolism after carbon monoxide poisoning are rare. The aim of this study was to identify the risk factors for venous thromboembolism within 3 months after carbon monoxide poisoning. Methods: This is a population-based study that employed nationwide claims data from South Korea. Among the carbon monoxide poisoning patients (⩾18 years), the characteristics of the groups with and without venous thromboembolism (pulmonary embolism or deep vein thrombosis) were identified. All the significant variables in the univariable analysis were included in the multivariable logistic regression to determine the risk factors for venous thromboembolism occurrence. Results: Among the 24,232 carbon monoxide poisoning patients, 130 subjects developed venous thromboembolism within 90 days of their carbon monoxide poisoning diagnosis. The significant risk factors for venous thromboembolism in the multivariable analysis were age (adjusted odds ratio (aOR) = 1.01; 95% confidence interval (CI) = 1.003–1.03), intensive care unit admission (aOR = 3.80; 95% CI = 2.34–6.12), length of stay (aOR = 1.02; 95% CI = 1.0001–1.04), congestive heart failure (aOR = 2.17; 95% CI = 1.36–3.42), and cancer (aOR = 1.94; 95% CI = 1.10–3.22). The adjusted odds ratios for intensive care unit admission for patients with pulmonary embolism and deep vein thrombosis were 3.05 (95% CI = 1.61–5.61) and 5.60 (95% CI = 2.89–10.90), respectively. Conclusion: Patients with older age, intensive care unit admission, a longer length of stay, congestive heart failure, or cancer are at greater risk of developing venous thromboembolism after carbon monoxide poisoning. In particular, intensive care unit admission was the strongest risk factor for venous thromboembolism, pulmonary embolism, and deep vein thrombosis. Monitoring and administering prophylactic treatments to prevent venous thromboembolism would be helpful in high-risk in carbon monoxide poisoning patients.
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Affiliation(s)
- Yongil Cho
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Heekyung Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
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220
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Fan G, Wang X, Tu X, Xu H, Wang Q, Chu X. Density functional theory study of Cu-doped BNNT as highly sensitive and selective gas sensor for carbon monoxide. NANOTECHNOLOGY 2021; 32:075502. [PMID: 33113514 DOI: 10.1088/1361-6528/abc57a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The adsorption of CO, CO2, CH4, H2, N2 and N2O on armchair (5,5) boron nitride nanotube (BNNT) with and without the doping of transition metals (TM), i.e. Sc, Ti, V, Cr, Mn, Fe, Co, Ni, Cu or Zn, was investigated using the density functional theory calculation. The results indicate all the considered gases are physically adsorbed by weak interaction on the pure BNNT, revealing that pure BNNT has poor sensing performance for these gases. TM are then doped in the B or N vacancy of BNNT to improve the sensitivity and selectivity. As a result, it was found that the gas adsorption performance of BNNT is obviously enhanced due to the introduction of TM dopant atom. In particularly, according to the results of adsorption energy, Cu doped BNNT (Cu-BNNT) system shows a high selectivity toward CO molecule compared with other metal doped systems. This is further confirmed by the density of state, energy gap and charge transfer analyses. Furthermore, based on the sensor performance analysis, it was found that Cu-BNNT also has favorable desorption characteristics for CO. Therefore, this study concluded that Cu-BNNT can be used as a superior sensor material with high sensitivity, selectivity and favorable recycle time for CO gas.
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Affiliation(s)
- Guohong Fan
- School of Chemistry and Chemical Engineering, Anhui University of Technology, Maanshan, Anhui 243002, People's Republic of China
| | - Xiaohua Wang
- School of Chemistry and Chemical Engineering, Anhui University of Technology, Maanshan, Anhui 243002, People's Republic of China
| | - Xianxian Tu
- School of Chemistry and Chemical Engineering, Anhui University of Technology, Maanshan, Anhui 243002, People's Republic of China
| | - Hong Xu
- School of Chemistry and Chemical Engineering, Anhui University of Technology, Maanshan, Anhui 243002, People's Republic of China
| | - Qi Wang
- School of Chemistry and Chemical Engineering, Anhui University of Technology, Maanshan, Anhui 243002, People's Republic of China
| | - Xiangfeng Chu
- School of Chemistry and Chemical Engineering, Anhui University of Technology, Maanshan, Anhui 243002, People's Republic of China
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221
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Chen RJ, Lee YH, Chen TH, Chen YY, Yeh YL, Chang CP, Huang CC, Guo HR, Wang YJ. Carbon monoxide-triggered health effects: the important role of the inflammasome and its possible crosstalk with autophagy and exosomes. Arch Toxicol 2021; 95:1141-1159. [PMID: 33554280 DOI: 10.1007/s00204-021-02976-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022]
Abstract
Carbon monoxide (CO) has long been known as a "silent killer" because of its ability to bind hemoglobin (Hb), leading to reduced oxygen carrying capacity of Hb, which is the main cause of CO poisoning (COP) in humans. Emerging studies suggest that mitochondria is a key target of CO action that can impact key biological processes, including apoptosis, cellular proliferation, inflammation, and autophagy. Despite its toxicity at high concentrations, CO also exhibits cyto- and tissue-protective effects at low concentrations in animal models of organ injury and disease. Specifically, CO modulates the production of pro- or anti-inflammatory cytokines and mediators by regulating the NLRP3 inflammasome. Given that human diseases are strongly associated with inflammation, a deep understanding of the exact mechanism is helpful for treatment. Autophagic factors and inflammasomes interact in various situations, including inflammatory disease, and exosomes might function as the bridge between the inflammasome and autophagy activation. Thus, the interplay among autophagy, mitochondrial dysfunction, exosomes, and the inflammasome may play pivotal roles in the health effects of CO. In this review, we summarize the latest research on the beneficial and toxic effects of CO and their underlying mechanisms, focusing on the important role of the inflammasome and its possible crosstalk with autophagy and exosomes. This knowledge may lead to the development of new therapies for inflammation-related diseases and is essential for the development of new therapeutic strategies and biomarkers of COP.
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Affiliation(s)
- Rong-Jane Chen
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Hsuan Lee
- Department of Cosmeceutics, China Medical University, Taichung, Taiwan
| | - Tzu-Hao Chen
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan.,Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Ying Chen
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ya-Ling Yeh
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - Ching-Ping Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan.,Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.,Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, 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.
| | - Ying-Jan Wang
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 70428, Taiwan. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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222
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Kandari R, Kumar A. COVID-19 pandemic lockdown: effects on the air quality of South Asia. ENVIRONMENTAL SUSTAINABILITY (SINGAPORE) 2021; 4:543-549. [PMID: 38624635 PMCID: PMC7859897 DOI: 10.1007/s42398-020-00154-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 05/11/2023]
Abstract
The world is facing an unexpected, like never before, situation due to COVID-19. The measures to contain the COVID-19 pandemic are to incorporate lockdown, social distancing, disconnection, and home isolation. Lockdown was enforced by the various governments of the South Asian countries, which include non-working of all the businesses and assembling units, with limited access to the outer world pertaining to essential commodities. However, During the COVID-19 pandemic, an uncommon positive impact is noteworthy for worldwide abatement in air-contamination levels. Principally, specialists have estimated significant improvement in air quality and a remarkable decrease in concentration levels of various harmful gases like sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3). In this article, there is an analysis made on the impact of Covid-19 lockdown on the air quality of the South Asian region i.e. (that is) the various environmental parameters along with others namely aerosol, temperature, and particulate matter (PM2.5, PM10). The work includes the refining and analysis of crude information of this present (2020) and the past year of different toxic gases and parameters of air pollutants. These have been obtained from pollution control boards of respective South Asian nations alongside information and satellite pictures from the UN Environment Program and Space Administration for correlation of various parameters. It has been observed that there is a sharp dip in the pollutant concentration in South Asia. This examination altogether will be valuable data to environmentalists and experts to make the future policies for improving air quality and the environment.
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Affiliation(s)
- Ritu Kandari
- Indira Gandhi Delhi Technical University for Women, Kashmere Gate, New Delhi, India
| | - Ashwani Kumar
- University School of Basic and Applied Sciences, Guru Gobind Singh Indraprastha University, Sec 16 C Dwarka, New Delhi, India
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223
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Jang DH, Piel S, Greenwood JC, Kelly M, Mazandi VM, Ranganathan A, Lin Y, Starr J, Hallowell T, Shofer FS, Baker WB, Lafontant A, Andersen K, Ehinger JK, Kilbaugh TJ. Alterations in cerebral and cardiac mitochondrial function in a porcine model of acute carbon monoxide poisoning. Clin Toxicol (Phila) 2021; 59:801-809. [PMID: 33529085 DOI: 10.1080/15563650.2020.1870691] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The purpose of this study is the development of a porcine model of carbon monoxide (CO) poisoning to investigate alterations in brain and heart mitochondrial function. DESIGN Two group large animal model of CO poisoning. SETTING Laboratory. SUBJECTS Ten swine were divided into two groups: Control (n = 4) and CO (n = 6). INTERVENTIONS Administration of a low dose of CO at 200 ppm to the CO group over 90 min followed by 30 min of re-oxygenation at room air. The Control group received room air for 120 min. MEASUREMENTS Non-invasive optical monitoring was used to measure cerebral blood flow and oxygenation. Cerebral microdialysis was performed to obtain semi real time measurements of cerebral metabolic status. At the end of the exposure, both fresh brain (cortical and hippocampal tissue) and heart (apical tissue) were immediately harvested to measure mitochondrial respiration and reactive oxygen species (ROS) generation and blood was collected to assess plasma cytokine concentrations. MAIN RESULTS Animals in the CO group showed significantly decreased Complex IV-linked mitochondrial respiration in hippocampal and apical heart tissue but not cortical tissue. There also was a significant increase in mitochondrial ROS generation across all measured tissue types. The CO group showed a significantly higher cerebral lactate-to-pyruvate ratio. Both IL-8 and TNFα were significantly increased in the CO group compared with the Control group obtained from plasma. While not significant there was a trend to an increase in optically measured cerebral blood flow and hemoglobin concentration in the CO group. CONCLUSIONS Low-dose CO poisoning is associated with early mitochondrial disruption prior to an observable phenotype highlighting the important role of mitochondrial function in the pathology of CO poisoning. This may represent an important intervenable pathway for therapy and intervention.
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Affiliation(s)
- David H Jang
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Sarah Piel
- Resuscitation Science Center, Philadelphia, PA, USA
| | - John C Greenwood
- Department of Anesthesiology and Critical Care Medicine, Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Matthew Kelly
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Yuxi Lin
- Resuscitation Science Center, Philadelphia, PA, USA
| | | | | | - Frances S Shofer
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Wesley B Baker
- Department of Pediatric Neurology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Alec Lafontant
- Department of Pediatric Neurology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Kristen Andersen
- Department of Pediatric Neurology, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA, USA
| | - Johannes K Ehinger
- Mitochondrial Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund University, Malmo, Sweden
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224
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Xie W, You J, Zhi C, Li L. The toxicity of ambient fine particulate matter (PM2.5) to vascular endothelial cells. J Appl Toxicol 2021; 41:713-723. [DOI: 10.1002/jat.4138] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Wei Xie
- Clinical Anatomy & Reproductive Medicine Application Institute University of South China Hengyang China
| | - Jia You
- Clinical Anatomy & Reproductive Medicine Application Institute University of South China Hengyang China
| | - Chenxi Zhi
- Clinical Anatomy & Reproductive Medicine Application Institute University of South China Hengyang China
| | - Liang Li
- Hunan Province Key Laboratory of Typical Environmental Pollution and Health Hazards University of South China Hengyang China
- Institute of Cardiovascular Research, Key Laboratory for Atherosclerology of Hunan Province, Medical Research Center, Hunan Province Cooperative Innovation Center for Molecular Target New Drug Study University of South China Hengyang China
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225
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Tamura T, Sugihara G, Takahashi H. Memory Impairment and Hippocampal Volume after Carbon Monoxide Poisoning. Arch Clin Neuropsychol 2021; 36:145-148. [PMID: 32770218 DOI: 10.1093/arclin/acaa050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE We report longitudinal changes in neuroimaging and neuropsychological measurements in a case of carbon monoxide (CO) poisoning showing reversible changes in hippocampal volume, which was closely linked to the degree of memory impairment. METHODS The current study presents a female in her early 20s, with a high school level of education. She became aware of headaches and drowsiness while working in a restaurant that operated charcoal braziers, and she was urgently transported to our hospital. Her high blood carboxyhemoglobin concentration led to a diagnosis of CO poisoning, but no obvious abnormalities were found by brain magnetic resonance imaging (MRI) and physical examinations. She underwent a series of hyperbaric oxygen therapies. One year after CO poisoning, she consulted a psychiatrist due to her own awareness of gradually worsening memory function. She was assessed by brain MRI and standard neuropsychological tests every 6 months for 1 year. RESULTS Her neuropsychological profile showed the impairment of memory function according to a low score of Delayed Recall Index of Wechsler Memory Scale-Revised. At 320 days after CO poisoning, her hippocampal volume had decreased by 3%. Her memory function was found to have improved at 530 days after CO poisoning. Of note, during this period, her hippocampal volume had increased by approximately 7%. CONCLUSIONS This report suggests that a clinician should conduct careful neuropsychological examinations to avoid overlooking mild sequelae of CO poisoning, even if a general assessment of brain MRI is normal.
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Affiliation(s)
- Takehiro Tamura
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Genichi Sugihara
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry and Behavioral Neurosciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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226
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Air Pollution Is Associated with Poor Cognitive Function in Taiwanese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010316. [PMID: 33406674 PMCID: PMC7795645 DOI: 10.3390/ijerph18010316] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/31/2022]
Abstract
The issue of air pollution is gaining increasing attention worldwide, and mounting evidence has shown an association between air pollution and cognitive decline. The aim of this study was to investigate the relationships between air pollutants and cognitive impairment using the Mini-Mental State Exam (MMSE) and its sub-domains. In this study, we used data from the Taiwan Biobank combined with detailed daily data on air pollution. Cognitive function was assessed using the MMSE and its five subgroups of cognitive functioning. After multivariable linear regression analysis, a high level of particulate matter with an aerodynamic diameter of ≤2.5 μm (PM2.5), low ozone (O3), high carbon monoxide (CO), high sulfur dioxide (SO2), high nitric oxide (NO), high nitrogen dioxide (NO2), and high nitrogen oxide (NOx) were significantly associated with low total MMSE scores. Further, high SO2 and low O3 were significantly associated with low MMSE G1 scores. Low O3, high CO, high SO2, high NO2, and high NOx were significantly associated with low MMSE G4 scores, and high PM2.5, high particulate matter with an aerodynamic diameter of ≤10 μm (PM10), high SO2, high NO2, and high NOx were significantly associated with low MMSE G5 scores. Our results showed that exposure to different air pollutants may lead to general cognitive decline and impairment of specific domains of cognitive functioning, and O3 may be a protective factor. These findings may be helpful in the development of policies regarding the regulation of air pollution.
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227
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Li N, Gao X, Wang W, Wang P, Zhu B. Protective effects of recombinant human brain natriuretic peptide on the myocardial injury induced by acute carbon monoxide poisoning. Cardiovasc Diagn Ther 2021; 10:1785-1794. [PMID: 33381423 DOI: 10.21037/cdt-20-591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the protective effect of recombinant human brain natriuretic peptide (rhBNP) on myocardial injury after acute carbon monoxide poisoning (ACOP). Methods We retrospectively reviewed medical records of patients with ACOP and high risk of cardiac events admitted to our hospital, and grouped them into rhBNP group and control group according treatments they received. Patients in control group received conventional treatment while those in rhBNP group were treated with rhBNP intravenously for 72 hours on the basis of conventional treatment. Levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), serum creatine kinase MB fraction (CK-MB), aldosterone (ALD), angiotensin II (AT II), and endothelin-1 (ET-1) prior to and after treatment of rhBNP or conventional treatment were collected. Corrected QT dispersion (QTcd) results were calculated based on the electrocardiography data. The left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVS), left ventricular ejection fraction (LVEF), and stroke output (SV) were measured using color Doppler echocardiography. Major adverse cardiovascular events (MACEs) that occurred within 1 month after treatment were recorded. Results A total of 135 patients in the rhBNP group and 136 patients in the control group were enrolled. Baseline characteristics between the two groups were similar at admission. Levels of cTnI, CK-MB, and ET-1 in the rhBNP group were significantly lower than those in the control group at day 1, 2 and 3 after treatment (P<0.05). Compared with the control group, levels of QTcd, ALD and AT II in the rhBNP group were significantly lower at day 3 after treatment (P<0.05). After 7 days of treatment, the reduction of NT-proBNP in the rhBNP group was significantly greater than that in the control group at each day (P<0.05), and LVEF, SV and LVEDD in the rhBNP group were all greater than those in the control group. After 1 month of treatment, the incidence of MACEs in the rhBNP group was significantly lower than that in the control group. Conclusions For patients with ACOP and high risk of cardiac events, early treatment of rhBNP can protect injured cardiomyocytes, prevent the injury of carbon monoxide on heart, and reduce the incidence of MACE.
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Affiliation(s)
- Na Li
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Xun Gao
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
| | - Weizhan Wang
- 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
| | - Baoyue Zhu
- Department of Emergency, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui, China
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228
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Bearblock E, Aiken CE, Burton GJ. Air pollution and pre-eclampsia; associations and potential mechanisms. Placenta 2020; 104:188-194. [PMID: 33360680 DOI: 10.1016/j.placenta.2020.12.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/11/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Air pollution has significant negative health impacts, particularly on the cardiovascular system. The aims of this narrative review were to identify whether there is an association between air pollution and the incidence of pre-eclampsia, and the potential mechanisms by which any effects may be mediated. METHODS We undertook a literature search using Google Scholar, PubMed, the Cochrane Library and NICE Evidence. The primary eligibility criterion was articles correlating exposure to air pollution with incidence of pre-eclampsia. RESULTS Meta-analyses currently show a positive association between pre-eclampsia and exposure to both particulate matter PM2.5 and nitrogen dioxide, but no significant associations with ambient ozone or carbon monoxide exposure. No meta-analysis has been performed for exposure to sulfur dioxide. Variability in terms of quantification of exposure, the exposure period and co-founders among the studies makes comparisons complex. Adverse effects on trophoblast invasion and placental vascularisation, and increases in oxidative stress and anti-angiogenic factors, such as sFlt-1, in response to air pollution provide pathways by which exposure may contribute to the pathophysiology of pre-eclampsia. So far, studies have not discriminated between the early- and late-onset forms of the syndrome. DISCUSSION Future prospective studies using personal air pollution monitors and blood biomarkers of pre-eclampsia would strengthen the associations. Interactions between pollutants are poorly documented, and at present there is minimal informed advice available to women on the need to avoid exposure to air pollutants during pregnancy.
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Affiliation(s)
- Elizabeth Bearblock
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Catherine E Aiken
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, UK; Centre for Trophoblast Research, University of Cambridge, Cambridge, UK
| | - Graham J Burton
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK; Centre for Trophoblast Research, University of Cambridge, Cambridge, UK.
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229
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Han S, Nah S, Choi S, Lee YH, Kim GW, Cho YS. Hyperbaric Oxygen Therapy Did Not Prevent Delayed Neuropsychiatric Sequelae in a Prospective Observational Study With Propensity Score Matching in 224 Patients With Acute Carbon Monoxide Toxicity. J Emerg Med 2020; 60:498-505. [PMID: 33298359 DOI: 10.1016/j.jemermed.2020.10.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is important to prevent the development of delayed neuropsychiatric sequelae (DNS) in acute carbon monoxide (CO) intoxication, but no effective treatment has been clearly identified. Hyperbaric oxygen (HBO) therapy is one of the treatment options in acute CO poisoning; however, whether it can prevent the development of DNS is controversial. OBJECTIVES The purpose of this study is to compare the effectiveness of normobaric oxygen (NBO) and HBO in preventing DNS. METHODS This prospective observational study was conducted on all patients with CO poisoning admitted to the emergency department of a tertiary hospital from 2016 to 2019. We followed-up patients to determine whether symptoms of DNS occurred at ≤6 months. We matched the propensity score to an equivalent distribution of potential covariates. RESULTS A total of 224 patients with CO poisoning were enrolled in this study. NBO was used for 26 patients and HBO for 198 patients. DNS occurred in 40 patients. There were significant differences between the NBO and HBO groups in terms of carboxyhemoglobin, loss of consciousness, dizziness, chest pain, hospitalization, and length of hospital stay. The incidence of DNS was 19.2% in the HBO group, which was higher than the 7.7% observed in the NBO group, but the difference was not significant (p = 0.18). After propensity score matching, the incidence of DNS did not differ between the NBO and HBO groups (8.3% vs. 10.4%, p > 0.99). CONCLUSION There was no difference in the incidence of DNS between groups receiving HBO and NBO in acute CO intoxication.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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Lin YH, Wang CF, Chiu H, Lai BC, Tu HP, Wu PY, Huang JC, Chen SC. Air Pollutants Interaction and Gender Difference on Bone Mineral Density T-Score in Taiwanese Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9165. [PMID: 33302461 PMCID: PMC7764089 DOI: 10.3390/ijerph17249165] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 12/18/2022]
Abstract
Osteoporosis is defined as a systemic skeletal disease characterized by a reduction in bone mass and microarchitectural deterioration of bone tissue. Previous studies have reported associations between air pollution and lower bone mineral density; however, few studies have investigated the association between air pollution and osteoporosis. In this study, we combined two databases, the first including 5000 individuals registered in the Taiwan Biobank, and the second containing detailed daily data on air pollution. After multivariable adjustments, ozone (O3) (unstandardized coefficient β, 0.015; p = 0.008) was significantly positively associated with T-score, whereas carbon monoxide (CO) (unstandardized coefficient β, -0.809; p < 0.001), sulfur dioxide (SO2) (unstandardized coefficient β, -0.050; p = 0.005), nitric oxide (NO) (unstandardized coefficient β, -0.040; p < 0.001), nitrogen dioxide (NO2) (unstandardized coefficient β, -0.023; p < 0.001), and nitrogen oxide (NOx) (unstandardized coefficient β, -0.017; p < 0.001) were significantly negatively associated with T-score. The interactions between CO and NOx (p = 0.001) and SO2 and NO2 (p = 0.004) on T-score were statistically significant. An increase in exposure to CO, NO and NOx was associated with a faster decline in T-score in the female participants compared to the male participants. In addition, an increase in O3 was associated with a faster increase in T-score in the female participants compared to the male participants. In conclusion, the air pollutants CO, SO2, NO, NO2, and NOx were associated with osteoporosis. In addition, there were interaction and synergetic effects between CO and NOx and SO2 and NO2 on T-score. We also observed differences in the associations between air pollutants and T-score between the female and male participants.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Chen-Feng Wang
- Institute of Electronics, National Chiao Tung University, Hsinchu 300, Taiwan
| | - Hsuan Chiu
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Bo-Cheng Lai
- Institute of Electronics, National Chiao Tung University, Hsinchu 300, Taiwan
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Szu-Chia Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Adsorption studies on small toxic gases using silicane nanosheet as a chemi-resistive sensor – DFT method. COMPUT THEOR CHEM 2020. [DOI: 10.1016/j.comptc.2020.113046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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232
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Lee GY, Zeb A, Kim EH, Suh B, Shin YJ, Kim D, Kim KW, Choe YH, Choi HI, Lee CH, Qureshi OS, Han IB, Chang SY, Bae ON, Kim JK. CORM-2-entrapped ultradeformable liposomes ameliorate acute skin inflammation in an ear edema model via effective CO delivery. Acta Pharm Sin B 2020; 10:2362-2373. [PMID: 33354507 PMCID: PMC7745126 DOI: 10.1016/j.apsb.2020.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/16/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022] Open
Abstract
The short release half-life of carbon monoxide (CO) is a major obstacle to the effective therapeutic use of carbon monoxide-releasing molecule-2 (CORM-2). The potential of CORM-2-entrapped ultradeformable liposomes (CORM-2-UDLs) to enhance the release half-life of CO and alleviate skin inflammation was investigated in the present study. CORM-2-UDLs were prepared by using soy phosphatidylcholine to form lipid bilayers and Tween 80 as an edge activator. The deformability of CORM-2-UDLs was measured and compared with that of conventional liposomes by passing formulations through a filter device at a constant pressure. The release profile of CO from CORM-2-UDLs was evaluated by myoglobin assay. In vitro and in vivo anti-inflammatory effects of CORM-2-UDLs were assessed in lipopolysaccharide-stimulated macrophages and TPA-induced ear edema model, respectively. The deformability of the optimized CORM-2-UDLs was 2.3 times higher than conventional liposomes. CORM-2-UDLs significantly prolonged the release half-life of CO from 30 s in a CORM-2 solution to 21.6 min. CORM-2-UDLs demonstrated in vitro anti-inflammatory activity by decreasing nitrite production and pro-inflammatory cytokine levels. Furthermore, CORM-2-UDLs successfully ameliorated skin inflammation by reducing ear edema, pathological scores, neutrophil accumulation, and inflammatory cytokines expression. The results demonstrate that CORM-2-UDLs could be used as promising therapeutics against acute skin inflammation.
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233
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Casey JA, Fukurai M, Hernández D, Balsari S, Kiang MV. Power Outages and Community Health: a Narrative Review. Curr Environ Health Rep 2020; 7:371-383. [PMID: 33179170 PMCID: PMC7749027 DOI: 10.1007/s40572-020-00295-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Power outages, a common and underappreciated consequence of natural disasters, are increasing in number and severity due to climate change and aging electricity grids. This narrative review synthesizes the literature on power outages and health in communities. RECENT FINDINGS We searched Google Scholar and PubMed for English language studies with titles or abstracts containing "power outage" or "blackout." We limited papers to those that explicitly mentioned power outages or blackouts as the exposure of interest for health outcomes among individuals living in the community. We also used the reference list of these studies to identify additional studies. The final sample included 50 articles published between 2004 and 2020, with 17 (34%) appearing between 2016 and 2020. Exposure assessment remains basic and inconsistent, with 43 (86%) of studies evaluating single, large-scale power outages. Few studies used spatial and temporal control groups to assess changes in health outcomes attributable to power outages. Recent research linked data from electricity providers on power outages in space and time and included factors such as number of customers affected and duration to estimate exposure. The existing literature suggests that power outages have important health consequences ranging from carbon monoxide poisoning, temperature-related illness, gastrointestinal illness, and mortality to all-cause, cardiovascular, respiratory, and renal disease hospitalizations, especially for individuals relying on electricity-dependent medical equipment. Nonetheless the studies are limited, and more work is needed to better define and capture the relevant exposures and outcomes. Studies should consider modifying factors such as socioeconomic and other vulnerabilities as well as how community resiliency can minimize the adverse impacts of widespread major power outages.
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Affiliation(s)
- Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Mihoka Fukurai
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Diana Hernández
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Satchit Balsari
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Mathew V Kiang
- FXB Center for Health and Human Rights, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Han S, Choi S, Nah S, Lee SU, Cho YS, Kim GW, Lee YH. Cox regression model of prognostic factors for delayed neuropsychiatric sequelae in patients with acute carbon monoxide poisoning: A prospective observational study. Neurotoxicology 2020; 82:63-68. [PMID: 33232744 DOI: 10.1016/j.neuro.2020.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A major challenge for physicians is to identify patients with acute carbon monoxide (CO) poisoning who are likely to develop delayed neuropsychiatric sequelae (DNS). DNS is defined as neuropsychological sequelae that develops after 2-40 days of lucid interval after CO intoxication. Currently, there is no consensus on factors that predict the prognosis of CO poisoning. Thus, the purpose of this study was to identify factors predicting the development of DNS using a Cox regression model. METHODS This prospective observational study included 310 CO-poisoned patients admitted to an emergency department in South Korea from July 2017 to February 2020. Demographic, clinical, and laboratory data were analyzed. Kaplan-Meier curves were constructed to estimate the cumulative incidence of DNS. A multivariate Cox regression model was used to identify the main predictors of the development of DNS. RESULTS The incidence of DNS was 18.8 %, and the median onset time was 23.7 days (interquartile range, 14-30 days). The Kaplan-Meier survival curve showed that a serum creatine kinase (CK) level > 175.5 U/L and initial Glasgow Coma Scale (GCS) score ≤ 9 were associated with a higher cumulative incidence of DNS (log-rank test; p < 0.01 and p = 0.02, respectively). Cox regression analysis showed that a serum CK level > 175.5 U/L (hazard ratio [HR]: 2.862, 95 % confidence interval [CI]: 1.491-5.496; p < 0.01) and an initial GCS ≤ 9 (HR: 2.081, 95 % CI: 1.048-4.131; p = 0.04) were significant prognostic factors. CONCLUSION In acute CO poisoning, an initial GCS score ≤ 9 and serum CK level > 175.5 U/L are significant predictors of DNS development.
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Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sungwoo Choi
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sangun Nah
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, Seoul, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Gi Woon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
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235
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Gigengack RK, Cleffken BI, Loer SA. Advances in airway management and mechanical ventilation in inhalation injury. Curr Opin Anaesthesiol 2020; 33:774-780. [PMID: 33060384 DOI: 10.1097/aco.0000000000000929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Airway management, mechanical ventilation, and treatment of systemic poisoning in burn patients with inhalation injury remains challenging. This review summarizes new concepts as well as open questions. RECENT FINDINGS Several life-threatening complications, such as airway patency impairment and respiratory insufficiency, can arise in burn patients and require adequate and timely airway management. However, unnecessary endotracheal intubation should be avoided. Direct visual inspection via nasolaryngoscopy can guide appropriate airway management decisions. In cases of lower airway injury, bronchoscopy is recommended to remove casts and estimate the extent of the injury in intubated patients. Several mechanical ventilation strategies have been studied. An interesting modality might be high-frequency percussive ventilation. However, to date, there is no sound evidence that patients with inhalation injury should be ventilated with modes other than those applied to non-burn patients. In all burn patients exposed to enclosed fire, carbon monoxide as well as cyanide poisoning should be suspected. Carbon monoxide poisoning should be treated with an inspiratory oxygen fraction of 100%, whereas cyanide poisoning should be treated with hydroxocobalamin. SUMMARY Burn patients need specialized care that requires specific knowledge about airway management, mechanical ventilation, and carbon monoxide and cyanide poisoning.
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Affiliation(s)
- Rolf Kristian Gigengack
- Department of Anesthesiology, Amsterdam UMC, VU Medical Center, Amsterdam.,Departments of Intensive Care and Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Berry Igor Cleffken
- Departments of Intensive Care and Trauma and Burn Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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236
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Li CZ, Li CC, Lin MC, Tseng WS. Sudden hearing loss following acute carbon monoxide poisoning: A case report and literature review. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920969306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Acute carbon monoxide (CO) poisoning could lead to headache, dizziness, myocardial injury, neurological sequela, and death. Sudden hearing loss is a rare symptom of acute CO poisoning. Case Presentation: Here, we report a case of a 42-year-old woman who suffered from acute hearing loss after exposure to a suicidal environment of high concentration of CO. Partial recovery of hearing was demonstrated after a combination of corticosteroid and hyperbaric oxygen therapy was given. Discussion: The mechanism of sudden hearing loss caused by acute CO poisoning is not well-established. It is believed to be related with the hypoxic damage to the cochlea. The characteristic of sudden hearing loss caused by acute CO poisoning is that it often affects in high frequency bilaterally. Conclusion: This report would prompt the clinician in early recognition of this sudden hearing loss of uncommon etiology.
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Affiliation(s)
- Chiao-Zhu Li
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan, ROC
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei city, Taiwan, ROC
| | - Chiao-Ching Li
- Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan, ROC
| | - Meng-Chi Lin
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei city, Taiwan, ROC
- Department of Surgery, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan, ROC
| | - Wei-Shih Tseng
- Department of Diving and Hyperbaric Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan, ROC
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei city, Taiwan, ROC
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237
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Abstract
The differential diagnosis for the comatose patient is includes structural abnormality, seizure, encephalitis, metabolic derangements, and toxicologic etiologies. Identifying and treating the underlying pathology in a timely manner is critical for the patient's outcome. We provide a structured approach to taking a history and performing a physical examination for this patient population. We discuss diagnostic testing and treatment methodologies for each of the common causes of coma. Our current understanding of the mechanisms of coma is insufficient to accurately predict the patient's clinical trajectory and more work needs to be done to investigate potential treatments for this often fatal disorder.
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Affiliation(s)
- Anna Karpenko
- Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Joshua Keegan
- Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
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239
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Ekpenyong EE, Louis H, Anyama CA, Ogar JO, Utsu PM, Ayi AA. Experimental and density functional theory studies on the adsorption behavior of selected gas molecules on Mg(II) coordination polymer constructed with 1,3,5-benzenetricarboxylates. J Mol Struct 2020. [DOI: 10.1016/j.molstruc.2020.128641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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240
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Abstract
OBJECTIVES This study aimed to describe the epidemiology and clinical burden of unintended carbon monoxide (CO) poisoning among children in the Negev region of southern Israel. METHODS This was a cross-sectional retrospective study of CO poisoning patients admitted to Soroka University Medical Center in 2011 through 2015. RESULTS Overall, 43 cases of CO poisoning were recorded among children younger than 18 years. Five patients died, all upon admission. Poisoning due to smoke "per se" and due to CO emitted from heating devices were responsible for 28 (65.1%) and 14 (32.6%) cases, respectively. Eight (18.6%) patients suffered from convulsions, and 13 (43.3%) of 30 evaluable patients complained of headaches. Twenty-two (51.2%) were found unconscious in the field, and 7 (16.3%) were unconscious at examination at the emergency department. The average carboxyhemoglobin level on admission was 10.5% ± 10.4% (level ranging from 0.1% to 46.2%). Treatment included oxygen in 34 patients (79%) and hyperbaric oxygen therapy in 8 patients (19%). No differences were found between Bedouin and Jewish children in sex, age, residence area, source of CO poisoning, symptoms severity, and need for hyperbaric oxygen therapy. More patients with exposure to water heating devices were older than 4 years, lived in villages, and were diagnosed as having loss of consciousness in the field compared with those exposed to smoke inhalation. CONCLUSIONS Carbon monoxide poisoning in children is frequent in southern Israel. Education about prevention, implementation of safer standards for home heating systems, and government supervision are required management strategies to decrease the CO poisoning incidence in southern Israel.
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241
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Stucki D, Stahl W. Carbon monoxide – beyond toxicity? Toxicol Lett 2020; 333:251-260. [DOI: 10.1016/j.toxlet.2020.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022]
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242
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Affiliation(s)
- Kanika Jain
- Yale Cardiovascular Research Center, Section of
Cardiovascular Medicine, Department of Internal Medicine, Yale School of
Medicine. 300 George St New Haven CT 06511
| | - Tarun Tyagi
- Yale Cardiovascular Research Center, Section of
Cardiovascular Medicine, Department of Internal Medicine, Yale School of
Medicine. 300 George St New Haven CT 06511
| | - John Hwa
- Yale Cardiovascular Research Center, Section of
Cardiovascular Medicine, Department of Internal Medicine, Yale School of
Medicine. 300 George St New Haven CT 06511
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243
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Abstract
BACKGROUND Carbon monoxide poisoning affects approximately 5000 children per year and can be challenging to diagnose and treat (Pediatr Emerg Med Pract. 2016;13:1-24). It is in the differential diagnosis of a patient presented with altered consciousness. Patients may look quite "pink" and well perfused, but are often in serious distress. We present the first case in the literature of carbon monoxide poisoning treated with the use of veno-veno extracorporeal membrane oxygenation (ECMO). CASE We report the case of a 10-year-old patient who had carbon monoxide poisoning (carboxyhemoglobin of 18%). She was treated with hydroxocobalamin at 70 mg/kg and was being prepared to transfer to a facility that offered hyperbaric therapy when she suffered a cardiac arrest requiring cardiopulmonary resuscitation. After 11 minutes of resuscitation, she had return of spontaneous circulation and an echocardiogram showed reasonable cardiac function. She was judged too unstable for ambulance transport and the ECMO team was called. Veno-veno ECMO was placed via a single right internal jugular dual-lumen catheter with fluoroscopy in the cardiac catheterization laboratory. There was a rapid improvement in carboxyhemoglobin level, and the ECMO therapy was weaned the next day. The patient eventually made a full recovery. CONCLUSIONS This is the first time that veno-veno ECMO has been reported for the emergent treatment of carbon monoxide intoxication. If emergency physicians are treating such a patient and cannot administer hyperbaric oxygen therapy, ECMO represents a valuable alternative that is not commonly thought of in this situation before.
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244
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Park JH, Heo R, Kang H, Oh J, Lim TH, Ko BS. Diagnostic performance and optimal cut-off values of cardiac biomarkers for predicting cardiac injury in carbon monoxide poisoning. Clin Exp Emerg Med 2020; 7:183-189. [PMID: 33028061 PMCID: PMC7550812 DOI: 10.15441/ceem.19.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/11/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study aimed to compare the diagnostic performance of cardiac biomarkers and to evaluate the optimal cut-off values for echocardiographic cardiac injury prediction in patients with carbon monoxide (CO) poisoning. METHODS This retrospective observational cohort study included adult patients with acute CO poisoning. Patients who did not undergo transthoracic echocardiography, which was used to define patients with cardiac injury (ejection fraction <55%), were excluded. The area under the curve was used to evaluate diagnostic performance for cardiac injury prediction. Mann-Whitney U, chi-square, and Fisher exact tests were used to analyze data. RESULTS After excluding the 27 patients who did not undergo echocardiography, 114 patients were included in the study. Fifteen (13.2%) patients had cardiac injury. The area under the curve values for the B-type natriuretic peptide, creatine kinase-myocardial band, and troponin I were 0.711 (95% confidence interval [CI], 0.527-0.895; P=0.011), 0.766 (95% CI, 0.607-0.926; P=0.001), and 0.801 (95% CI, 0.647-0.955; P<0.001), respectively, with optimal cut-off values of 330 pg/mL, 10.1 ng/mL, and 0.455 ng/mL, respectively. The sensitivity, specificity, and positive and negative predictive values of troponin I were 67%, 91%, 53%, and 95%, respectively. CONCLUSION Troponin I showed the best diagnostic performance for predicting cardiac injury in patients with CO poisoning. A cut-off value of 0.455 ng/mL appeared optimal for cardiac injury prediction. However, further studies on cardiac biomarkers and other diagnostic tools in CO poisoning are needed given the low sensitivity of troponin I.
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Affiliation(s)
- Jun Hwan Park
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ran Heo
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
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245
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Myocardial Repolarization Parameters and Neutrophil-to-Lymphocyte Ratio are Associated with Cardiotoxicity in Carbon Monoxide Poisoning. Cardiovasc Toxicol 2020; 20:190-196. [PMID: 31863276 DOI: 10.1007/s12012-019-09560-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The present study aims to examine the clinical values of complete blood count (CBC) bioindicators and corrected QT (QTc), Tpeak - Tend interval (Tp-e), Tpeak dispersion (Tp disp), and Tp-e/QT ratio that are the parameters of myocardial repolarization (M-rep) for cardiotoxicity, which develops due to acute carbon monoxide (CO) intoxication in patients admitted to the emergency service. This retrospective, cross-sectional, observational, and single-center study was conducted between April and June 2019. Statistical analysis was performed using the SPSS 23.0 software. Data of 234 participants were analyzed. Of these, 54.9% (n = 129) were female. Neutrophil-to-lymphocyte ratio (NLR), QTc, Tp-e values were significantly high in the CO intoxication group (p < 0.001, p < 0.001, and p < 0.001, respectively), whereas Tp-e/QTc ratio was significantly lower in the CO intoxication group than that in the control group (p < 0.001). NLR, Tp-e, Tp disp values were significantly high in the myocardial injury (M-inj) group (p < 0.001, p = 0.003, and p = 0.018, respectively). Furthermore, Tp-e/QTc ratio was significantly low in the M-inj group (p = 0.002). M-rep parameters and NLR are associated with CO intoxication and the development of M-inj. Moreover, these bioindicators and can provide clinicians an early indication of M-inj.
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246
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Yesiloglu O, Gulen M, Satar S, Avci A, Acehan S, Akoglu H. Treatment of carbon monoxide poisoning: high-flow nasal cannula versus non-rebreather face mask. Clin Toxicol (Phila) 2020; 59:386-391. [PMID: 32959716 DOI: 10.1080/15563650.2020.1817477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE In this study, the aim was to compare the rate of decrease in carboxyhemoglobin (COHb) values at consecutive time points and calculate the half-life of COHb (COHb t½) in patients admitted to the emergency department (ED) with carbon monoxide (CO) poisoning and treated with either high flow nasal cannula oxygen therapy (HFNC) or non-rebreather face mask (NRFM). METHODS This retrospective, cohort study with historical controls was performed over a 2-year period and included adult patients with CO poisoning, whose COHb values were checked. The HFNC group consisted of patients admitted to the ED with CO poisoning when HFNC was available in the hospital, while the NRFM group consisted of patients who presented to the ED with CO poisoning before the availability of HFNC. The primary outcome of the study was to detect the COHb t½. RESULTS A total of 71 patients were enrolled in the study. While 35 patients received oxygen with NRFM, 36 patients received HFNC. The mean COHb t½ in the HFNC group was 41.1 min (95% CI: 31.0-58.4) and 64.0 min (95% CI: 43.5-114.4) in the NRFM group. We did not find a significant difference in the COHb t½ between the HFNC group and NRFM group (p = 0.099). COHb levels between treatment arms at serial time points showed a statistically significant difference at 60 min (p = 0.048). We compared the decay constant and half-life of COHb between groups according to gender. In both genders, COHb t½ was significantly different between groups, and COHb t½ was lower in the patients treated with HFNC. CONCLUSION HFNC was effective in reducing the half-life of COHb values in patients with carbon monoxide poisoning. Prospective studies to be conducted in larger groups are needed to fully understand the effect of HFNC on carbon monoxide poisoning.
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Affiliation(s)
- Onder Yesiloglu
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Muge Gulen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Akkan Avci
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Selen Acehan
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Haldun Akoglu
- Department of Emergency Medicine, Marmara University, Istanbul, Turkey
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247
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Zhang Y. The authors respond: Evaluating and analyzing outcomes accurately. Am J Emerg Med 2020; 38:2225. [PMID: 32800680 DOI: 10.1016/j.ajem.2020.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Yongxue Zhang
- Department of Surgery, Handan Medical Center of Bethune International Peace Hospital, 3 Nanhuan Road, 054000 Handan, China.
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248
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Demirtaş E, Korkmaz İ, Tekin YK, Demirtaş E, Çaltekin İ. Assessment of serum glucose/potassium ratio as a predictor for delayed neuropsychiatric syndrome of carbon monoxide poisoning. Hum Exp Toxicol 2020; 40:207-213. [PMID: 32783475 DOI: 10.1177/0960327120945773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Carbon monoxide (CO) poisoning is a crucial cause of delayed neuropsychiatric syndrome (DNS). However, most biomarkers are not satisfactory for the prediction of DNS caused by CO poisoning. Thus, we evaluated the adequacy of the serum glucose/potassium (GLU/K) ratio, which may be an easy, quick, and readily available parameter that can be used in the emergency department for predicting DNS. METHODS We evaluated 281 patients who were admitted to our emergency department between January 2012 and December 2018. The patients were divided into two groups: DNS (+) and DNS (-). The GLU/K was compared for the groups. RESULTS Glucose, blood urea nitrogen, carboxyhemoglobin, and GLU/K ratios of patients in the DNS (+) group were statistically significantly higher than those patients in DNS (-) group (140 ± 34 vs. 110 ± 24, p < 0.001; 17.58 ± 6.14 vs. 14.27 ± 5.08, p = 0.003; 29 ± 5.1 vs. 18.9 ± 7.6, p < 0.001; and 38.35 ± 10.11 vs. 28.65 ± 6.53, p < 0.001, respectively). The area under the curve for GLU/K to predict DNS was measured as 0.791, and 35.9 as a cut-off value had 63.6% sensitivity and 89.6% specificity. CONCLUSIONS DNS development in CO poisoning is a serious and feared complication. We suggest that the GLU/K ratio has a high potential as a rapid, easy preliminary marker for the exclusion of patients who will not subsequently develop DNS.
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Affiliation(s)
- E Demirtaş
- Department of Emergency Medicine, 63986Faculty of Medicine, University of Sivas Cumhuriyet, Sivas, Turkey
| | - İ Korkmaz
- Department of Emergency Medicine, 63986Faculty of Medicine, University of Sivas Cumhuriyet, Sivas, Turkey
| | - Y K Tekin
- Department of Emergency Medicine, 63986Faculty of Medicine, University of Sivas Cumhuriyet, Sivas, Turkey
| | - Es Demirtaş
- Department of Family Medicine, 63986Faculty of Medicine, University of Sivas Cumhuriyet, Sivas, Turkey
| | - İ Çaltekin
- Department of Emergency Medicine, 485513Faculty of Medicine, University of Bozok, Yozgat, Turkey
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249
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Taguchi K, Maruyama T, Otagiri M. Use of Hemoglobin for Delivering Exogenous Carbon Monoxide in Medicinal Applications. Curr Med Chem 2020; 27:2949-2963. [PMID: 30421669 DOI: 10.2174/0929867325666181113122340] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 09/25/2018] [Accepted: 11/09/2018] [Indexed: 01/02/2023]
Abstract
Carbon Monoxide (CO), at low concentrations, can have a variety of positive effects on the body including anti-apoptosis, anti-inflammatory, anti-oxidative and anti-proliferative effects. Although CO has great potential for use as a potent medical bioactive gas, for it to exist in the body in stable form, it must be associated with a carrier. Hemoglobin (Hb) represents a promising material for use as a CO carrier because most of the total CO in the body is stored associated with Hb in red blood cells (RBC). Attempts have been made to develop an Hb-based CO carrying system using RBC and Hb-based artificial oxygen carriers. Some of these have been reported to be safe and to have therapeutic value as a CO donor in preclinical and clinical studies. In the present review, we overview the potential of RBC and Hb-based artificial oxygen carriers as CO carriers based on the currently available literature evidence for their use in pharmaceutical therapy against intractable disorders.
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Affiliation(s)
- Kazuaki Taguchi
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, Kumamoto, Japan.,DDS Research Institute, Sojo University, Kumamoto, Japan
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250
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Kim YM, Shin HJ, Choi DW, Kim JM, Lee SW, Jeong SH, Kim H. Comparison of high-flow nasal cannula oxygen therapy and conventional reserve-bag oxygen therapy in carbon monoxide intoxication: A pilot study. Am J Emerg Med 2020; 38:1621-1626. [DOI: 10.1016/j.ajem.2019.158451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/11/2019] [Accepted: 09/14/2019] [Indexed: 01/11/2023] Open
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