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Zhong J, Wang D, Xie S, Li M, Yin Y, Yu J, Ma C, Yu S, Qiu L. Pre-analytical stability and physiological fluctuations affect plasma steroid hormone outcomes: A real-world study. J Steroid Biochem Mol Biol 2024; 244:106596. [PMID: 39089343 DOI: 10.1016/j.jsbmb.2024.106596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/03/2024]
Abstract
Since steroids are crucial for diagnosing endocrine disorders, the lack of research on factors that affect hormone levels makes interpreting the results difficult. Our study aims to assess the stability of the pre-analytical procedure and the impact of hormonal physiological fluctuations using real-world data. The datasets were created using 12,418 records from individuals whose steroid hormone measurements were taken in our laboratory between September 2019 and March 2024. 22 steroid hormones in plasma by a well-validated liquid chromatography tandem mass spectrometry method were measured. After normalization transformation, outlier removal, and z-score normalization, generalized additive models were constructed to evaluate preanalytic stability and age, sex, and sample time-dependent hormonal fluctuations. Most hormones exhibit significant variability with age, particularly steroid hormone precursors, sex hormones, and certain corticosteroids such as aldosterone. 18-hydroxycortisol, 18-oxocortisol. Sex hormones varied between males and females. Levels of certain hormones, including cortisol, cortisone, 11-deoxycortisol, 18-hydroxycortisol, 18-oxocortisol, corticosterone, aldosterone, estrone, testosterone, dihydrotestosterone, dehydroepiandrosterone sulfate, 11-ketotestosterone, and 11-hydroxytestosterone, fluctuated with sampling time. Moreover, levels of pregnenolone and progesterone decreased within 1 hour of sampling, with pregnenolone becoming unstable with storage time at 4 degrees after centrifugation, while other hormone levels remained relatively stable for a short period of time without or after centrifugation of the sample. This is the first instance real-world data has been used to assess the pre-analytic stability of plasma hormones and to evaluate the impact of physiological factors on steroid hormones.
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Affiliation(s)
- Jian Zhong
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Danchen Wang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shaowei Xie
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yicong Yin
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jialei Yu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
| | - SongLin Yu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China.
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2
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Xia C, Dai W, Carreno J, Rogando A, Wu X, Simmons D, Astraea N, Dalleska NF, Fonteh AN, Vasudevan A, Arakaki X, Kloner RA. Higher sodium in older individuals or after stroke/reperfusion, but not in migraine or Alzheimer's disease - a study in different preclinical models. Sci Rep 2024; 14:21636. [PMID: 39284837 PMCID: PMC11405707 DOI: 10.1038/s41598-024-72280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024] Open
Abstract
Sodium serves as one of the primary cations in the central nervous system, playing a crucial role in maintaining normal brain function. In this study, we investigated alterations in sodium concentrations in the brain and/or cerebrospinal fluid across multiple models, including an aging model, a stroke model, a nitroglycerin (NTG)-induced rat migraine model, a familial hemiplegic migraine type 2 (FHM2) mouse model, and a transgenic mouse model of Alzheimer's disease (AD). Our results reveal that older rats exhibited higher sodium concentrations in cerebrospinal fluid (CSF), plasma, and various brain regions compared to their younger counterparts. Additionally, findings from the stroke model demonstrated a significant increase in sodium in the ischemic/reperfused region, accompanied by a decrease in potassium and an elevated sodium/potassium ratio. However, we did not detect significant changes in sodium in the NTG-induced rat migraine model or the FHM2 mouse model. Furthermore, AD transgenic mice showed no significant differences in sodium levels compared to wild-type mice in CSF, plasma, or the hippocampus. These results underscore the nuanced regulation of sodium homeostasis in various neurological conditions and aging, providing valuable insights into potential mechanisms underlying these alterations.
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Affiliation(s)
- Chenchen Xia
- Cognition and Brain Integration Laboratory, Neurosciences Department, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Wangde Dai
- Cardiovascular Department, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Juan Carreno
- Cardiovascular Department, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Andrea Rogando
- Cognition and Brain Integration Laboratory, Neurosciences Department, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Xiaomeng Wu
- Analytical Biochemistry Core, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Darren Simmons
- Analytical Biochemistry Core, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Natalie Astraea
- Analytical Biochemistry Core, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Nathan F Dalleska
- Water and Environment Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - Alfred N Fonteh
- Biomarker and Neuro-Disease Mechanism Laboratory, Neurosciences Department, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Anju Vasudevan
- Angiogenesis and Brain Development Laboratory, Department of Neurosciences, Huntington Medical Research Institutes, Pasadena, CA, USA
| | - Xianghong Arakaki
- Cognition and Brain Integration Laboratory, Neurosciences Department, Huntington Medical Research Institutes, Pasadena, CA, USA.
| | - Robert A Kloner
- Cardiovascular Department, Huntington Medical Research Institutes, Pasadena, CA, USA
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Koch CA, Mooradian AD. Screening Tool For Dehydration Risk. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:411. [PMID: 39087336 DOI: 10.3238/arztebl.m2023.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
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4
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Refardt J, Atila C, Christ-Crain M. New insights on diagnosis and treatment of AVP deficiency. Rev Endocr Metab Disord 2024; 25:639-649. [PMID: 38087160 PMCID: PMC11162367 DOI: 10.1007/s11154-023-09862-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 06/09/2024]
Abstract
Arginine vasopressin deficiency (AVP-D) is one of the main entities of the polyuria-polydipsia syndrome. Its correct diagnosis and differentiation from the other two causes - AVP resistance and primary polydipsia - is crucial as this determines the further management of these patients.Over the last years, several new diagnostic tests using copeptin, the stable surrogate marker of AVP, have been introduced. Among them, hypertonic saline stimulated copeptin was confirmed to reliably and safely improve the diagnostic accuracy to diagnose AVP-D. Due to its simplicity, arginine stimulated copeptin was put forward as alternative test procedure. Glucagon-stimulated copeptin also showed promising results, while the oral growth hormone secretagogue Macimorelin failed to provide a sufficient stimulus. Interestingly, an approach using machine learning techniques also showed promising results concerning diagnostic accuracy.Once AVP-D is diagnosed, further workup is needed to evaluate its etiology. This will partly define the further treatment and management. In general, treatment of AVP-D focuses on desmopressin substitution, with oral formulations currently showing the best tolerance and safety profile. However, in addition to desmopressin substitution, recent data also showed that psychopathological factors play an important role in managing AVP-D patients.
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Affiliation(s)
- Julie Refardt
- Departments of Endocrinology, Diabetology and Metabolism University Hospital Basel, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
- Department of Internal Medicine, Section of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Cihan Atila
- Departments of Endocrinology, Diabetology and Metabolism University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Departments of Endocrinology, Diabetology and Metabolism University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Yang X, Xue C, Chen K, Gao D, Wang H, Tang C. Characteristics of elderly diabetes patients: focus on clinical manifestation, pathogenic mechanism, and the role of traditional Chinese medicine. Front Pharmacol 2024; 14:1339744. [PMID: 38273819 PMCID: PMC10808572 DOI: 10.3389/fphar.2023.1339744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Diabetes mellitus has become a major public health issue globally, putting an enormous burden on global health systems and people. Among all diseased groups, a considerable part of patients are elderly, while their clinical features, pathogenic processes, and medication regimens are different from patients of other ages. Despite the availability of multiple therapies and techniques, there are still numerous elderly diabetes patients suffering from poor blood glucose control, severe complications, and drug adverse effects, which negatively affect the quality of life in their golden years. Traditional Chinese Medicine (TCM) has been widely used in the treatment of diabetes for several decades, and its relevant clinical practice has confirmed that it has a satisfactory effect on alleviating clinical symptoms and mitigating the progression of complications. Chinese herbal medicine and its active components were used widely with obvious clinical advantages by multiple targets and signaling pathways. However, due to the particular features of elderly diabetes, few studies were conducted to explore Traditional Chinese Medicine intervention on elderly diabetic patients. This study reviews the research on clinical features, pathogenic processes, treatment principles, and TCM treatments, hoping to provide fresh perspectives on the prevention and management strategies for elderly diabetes.
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Affiliation(s)
- Xiaofei Yang
- Beijing University of Chinese Medicine, Beijing, China
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chongxiang Xue
- Beijing University of Chinese Medicine, Beijing, China
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Keyu Chen
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dongyang Gao
- Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Han Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Cheng Tang
- Beijing University of Chinese Medicine, Beijing, China
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Tudor RM, Sherlock M, Thompson C. Recurrent severe hypernatraemia in a young patient: a disconnect between osmoreceptor function and drinking behaviour. BMJ Case Rep 2024; 17:e255377. [PMID: 38191224 PMCID: PMC10806951 DOI: 10.1136/bcr-2023-255377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
Chronic hypernatraemia is a rare clinical entity. In the younger population, hypernatraemia is often a consequence of failure to generate thirst in response to osmotic stimuli.We report the case of a male patient admitted with severe hypernatraemia (plasma sodium 175 mmol/L) on return from holidays. His urine was maximally concentrated at 894 mOsm/kg-suggestive of normal vasopressin reserve. MRI of the brain showed a large extra-axial cyst, with preservation of the posterior pituitary bright spot. Formal osmoregulatory studies demonstrated normal osmoregulated vasopressin secretion and normal thirst, but no appropriate drinking behaviour.This patient illustrates a unique pathophysiological disconnect between thirst appreciation and the central drive to drink, in the context of normal osmoregulatory function. It is likely that this disconnect is related to the patient's large intracranial cyst.The management challenge is to maintain appropriate fluid intake in order to prevent recurrent severe hypernatraemia.
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Affiliation(s)
- Roxana Maria Tudor
- Academic Department of Endocrinology and Diabetes, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark Sherlock
- Academic Department of Endocrinology and Diabetes, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chris Thompson
- Academic Department of Endocrinology and Diabetes, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Schein CH. Distinguishing Curable from Progressive Dementias for Defining Cancer Care Options. Cancers (Basel) 2023; 15:cancers15041055. [PMID: 36831398 PMCID: PMC9954275 DOI: 10.3390/cancers15041055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/06/2023] [Accepted: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
The likelihood of a diagnosis of dementia increases with a person's age, as is also the case for many cancers, including melanoma and multiple myeloma, where the median age of diagnosis is above 60 years. However, patients diagnosed with dementia are less likely to be offered invasive curative therapies for cancer. Together with analysis of diet and medication history, advanced imaging methods and genetic profiling can now indicate more about syndromes causing the neurological symptoms. Cachexia, malnutrition, dehydration, alcohol consumption, and even loneliness can all accentuate or cause the "3Ds" of dementia, delirium and depression. Many common drugs, especially in the context of polypharmacy, can cause cognitive difficulties resembling neurodegenerative disease. These syndromes may be reversed by diet, social and caregiver changes, and stopping potentially inappropriate medications (PIMs). More insidious are immune reactions to many different autoantigens, some of which are related to cancers and tumors. These can induce movement and cognitive difficulties that mimic Alzheimer's and Parkinson's diseases and other ataxias associated with aging. Paraneoplastic neurological syndromes may be reversed by directed immunotherapies if detected in their early stages but are best treated by removal of the causative tumor. A full genetic workup should be done for all individuals as soon as possible after diagnosis, to guide less invasive treatments suitable for frail individuals. While surgical interventions may be contraindicated, genetic profile guided immunotherapies, oral treatments, and radiation may be equally curative in a significant number of cancers.
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Affiliation(s)
- Catherine H Schein
- Department of Biochemistry and Molecular Biology, Institute for Human Infections and Immunity, University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
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8
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Yun G, Baek SH, Kim S. Evaluation and management of hypernatremia in adults: clinical perspectives. Korean J Intern Med 2022; 38:290-302. [PMID: 36578134 PMCID: PMC10175862 DOI: 10.3904/kjim.2022.346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/30/2022] Open
Abstract
Hypernatremia is an occasionally encountered electrolyte disorder, which may lead to fatal consequences under improper management. Hypernatremia is a disorder of the homeostatic status regarding body water and sodium contents. This imbalance is the basis for the diagnostic approach to hypernatremia. We summarize the eight diagnostic steps of the traditional approach and introduce new biomarkers: exclude pseudohypernatremia, confirm glucose-corrected sodium concentrations, determine the extracellular volume status, measure urine sodium levels, measure urine volume and osmolality, check ongoing urinary electrolyte free water clearance, determine arginine vasopressin/copeptin levels, and assess other electrolyte disorders. Moreover, we suggest six steps to manage hypernatremia by replacing water deficits, ongoing water losses, and insensible water losses: identify underlying causes, distinguish between acute and chronic hypernatremia, determine the amount and rate of water administration, select the type of replacement solution, adjust the treatment schedule, and consider additional therapy for diabetes insipidus. Physicians may apply some of these steps to all patients with hypernatremia, and can also adapt the regimens for specific causes or situations.
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Affiliation(s)
- Giae Yun
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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9
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Atjo NM, Soraya GV, Natzir R, Kasyim H, Rasyid H, Chana G, Erlichster M, Skafidas E, Hardjo M. Point-of-Care Saliva Osmolarity Testing for the Screening of Hydration in Older Adults With Hypertension. J Am Med Dir Assoc 2022; 23:1984.e9-1984.e14. [PMID: 36174654 DOI: 10.1016/j.jamda.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 08/14/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Older adults have an elevated risk of dehydration, a state with proven detrimental cognitive and physical effects. Furthermore, the use of diuretics by hypertensive patients further compounds this risk. This prospective study investigated the diagnostic accuracy of point-of-care (POC) salivary osmolarity (SOSM) measurement for the detection of dehydration in hypertensive adults with and without diuretic pharmacotherapy. DESIGN Prospective diagnostic accuracy study. SETTING Home visits to patients recruited from 4 community health centers in West Sulawesi, Indonesia. PARTICIPANTS A total of 148 hypertensive older adults (57 men, 91 women). The mean ages of male and female patients were 69.4 ± 11.4 and 68.1 ± 7.8 years, respectively. METHODS Hypertensive adults were divided into 2 groups based on the presence of diuretics in their pharmacotherapeutic regimen. First-morning mid-stream urine samples were used to perform urine specific gravity (USG) testing. Same-day SOSM measurements were obtained using a POC saliva testing system. RESULTS Both USG (P = .0002) and SOSM (P < .0001) were significantly elevated in hypertensive patients with diuretic pharmacotherapy. At a USG threshold of ≥1.030, 86% of diuretic users were classified as dehydrated compared with 55% of non-using participants. A strong correlation was observed between USG and SOSM measurements (r = 0.78, P < .0001). Using a USG threshold of ≥1.030 as a hydration classifier, an SOSM threshold of ≥93 mOsm had a sensitivity of 78.6% and a specificity of 91.1% for detecting dehydration. CONCLUSIONS AND IMPLICATIONS Hypertensive patients on diuretics have significantly higher first-morning USG and SOSM values, indicating a higher likelihood of dehydration relative to those on other classes of antihypertensive medication. POC SOSM assessment correlates strongly with first-morning USG assessment, and represents a rapid and noninvasive alternative to urinary hydration assessment that may be applicable for routine use in populations with elevated risk of dehydration.
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Affiliation(s)
- Neng Mira Atjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Nursing, Faculty of Health Sciences, University of West Sulawesi, Majene, Indonesia
| | - Gita Vita Soraya
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Rosdiana Natzir
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Hasyim Kasyim
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Haerani Rasyid
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Clinical Nutrition, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Gursharan Chana
- MX3 Diagnostics Inc., VIC, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, VIC, Australia
| | | | - Efstratios Skafidas
- MX3 Diagnostics Inc., VIC, Australia; Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, VIC, Australia
| | - Marhaen Hardjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia
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Sharma R, Geranpayehvaghei M, Ejeian F, Razmjou A, Asadnia M. Recent advances in polymeric nanostructured ion selective membranes for biomedical applications. Talanta 2021; 235:122815. [PMID: 34517671 DOI: 10.1016/j.talanta.2021.122815] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/13/2021] [Accepted: 08/18/2021] [Indexed: 12/30/2022]
Abstract
Nano structured ion-selective membranes (ISMs) are very attractive materials for a wide range of sensing and ion separation applications. The present review focuses on the design principles of various ISMs; nanostructured and ionophore/ion acceptor doped ISMs, and their use in biomedical engineering. Applications of ISMs in the biomedical field have been well-known for more than half a century in potentiometric analysis of biological fluids and pharmaceutical products. However, the emergence of nanotechnology and sophisticated sensing methods assisted in miniaturising ion-selective electrodes to needle-like sensors that can be designed in the form of implantable or wearable devices (smartwatch, tattoo, sweatband, fabric patch) for health monitoring. This article provides a critical review of recent advances in miniaturization, sensing and construction of new devices over last decade (2011-2021). The designing of tunable ISM with biomimetic artificial ion channels offered intensive opportunities and innovative clinical analysis applications, including precise biosensing, controlled drug delivery and early disease diagnosis. This paper will also address the future perspective on potential applications and challenges in the widespread use of ISM for clinical use. Finally, this review details some recommendations and future directions to improve the accuracy and robustness of ISMs for biomedical applications.
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Affiliation(s)
- Rajni Sharma
- School of Engineering, Macquarie University, Sydney, NSW, 2109, Australia
| | - Marzieh Geranpayehvaghei
- School of Engineering, Macquarie University, Sydney, NSW, 2109, Australia; Department of Nanobiotechnology, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, 14115-175, Iran
| | - Fatemeh Ejeian
- Department of Animal Biotechnology, Cell Science Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran; Department of Biotechnology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, 73441-81746, Iran
| | - Amir Razmjou
- School of Engineering, Macquarie University, Sydney, NSW, 2109, Australia; Department of Biotechnology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, 73441-81746, Iran; Centre for Technology in Water and Wastewater, University of Technology Sydney, New South Wales, Australia; UNESCO Center for Membrane Technology, School of Chemical Engineering, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Mohsen Asadnia
- School of Engineering, Macquarie University, Sydney, NSW, 2109, Australia.
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Campana P, Palaia ME, Conte M, Cante T, Petraglia L, Femminella GD, Parisi V, Leosco D. The elderly at risk: aldosterone as modulator of the immune response to SARS-CoV-2 infection. GeroScience 2021; 44:567-572. [PMID: 34741250 PMCID: PMC8570771 DOI: 10.1007/s11357-021-00481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/25/2021] [Indexed: 12/12/2022] Open
Abstract
The elderly population is the most susceptible to SARS-CoV-2 infection and develops the worst clinical phenotype with severe pneumonia and cardiac complications. Older COVID-19 patients are also at higher risk of sudden death, mainly attributable to electrolyte disorders and to an uncontrolled inflammatory response. After the identification of ACE 2 as the receptor of SARS-CoV-2 in human cells, several research studies have focused on the role of the activation of Renin Angiotensin System in COVID-19 clinical course. In the present opinion paper, we discuss the role of hyperaldosteronism in the increasing risk of cardiac complications in COVID-19 older patients. In particular, we focus on the immunoregulatory activity of aldosterone, as the last mediator of the Renin Angiotensin System cascade, in activating the innate and adaptive immune response related to SARS-CoV-2 infection in the elderly. Aldosterone may stimulate dendritic cells and the recruitment of monocytes/macrophages in the endothelium of coronary vessels, favoring the production of pro-inflammatory mediators and T-cells response. Higher basal levels of aldosterone together with SARS-CoV-2-induced production may explain the unfavorable course of COVID-19 in the elderly.
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Affiliation(s)
- Pasquale Campana
- Department of Translational Medical Sciences, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Maria Emiliana Palaia
- Department of Translational Medical Sciences, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maddalena Conte
- Department of Translational Medical Sciences, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.,Casa di Cura San Michele, Maddaloni, Italy
| | - Teresa Cante
- Department of Translational Medical Sciences, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.,Casa di Cura San Michele, Maddaloni, Italy
| | - Dario Leosco
- Department of Translational Medical Sciences, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.,Casa di Cura San Michele, Maddaloni, Italy
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12
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Negishi A, Oshima S, Horii N, Mutoh M, Inoue N, Numajiri S, Ohshima S, Kobayashi D. Categorisation of Pharmaceutical Adverse Events Using the Japanese Adverse Drug Event Report Database: Characteristic Adverse Drug Events of the Elderly Treated with Polypharmacy. Drugs Real World Outcomes 2020; 8:49-61. [PMID: 33367976 PMCID: PMC7984209 DOI: 10.1007/s40801-020-00221-8] [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] [Accepted: 11/20/2020] [Indexed: 12/02/2022] Open
Abstract
Background Pharmacokinetics and pharmacodynamics of drugs in elderly individuals differ from those in younger adults; thus, adverse drug events (ADEs) are common in older patients with polypharmacy because co-existing comorbidities elevate the risk of ADEs occurring. However, ADEs have not yet been characterised based on the elderly patients of Japanese origin and polypharmacy. Objective The 100 most commonly reported ADEs were grouped into four classes (Class 1–Class 4) based on elderly patients with polypharmacy. Patients and Methods In this study, logistic regression analysis was performed using cases recorded in the Japanese Adverse Drug Event Report (JADER) database. Results ADEs in elderly patients treated with polypharmacy—in whom the risk of electrolyte abnormalities, renal and respiratory disorders, and coagulopathy was high—were categorised as ‘Class 1 [E(+), P(+)]’, while ADEs in elderly patients not treated with polypharmacy—in whom the risk of delirium and fall was high—were categorised as ‘Class 2 [E(+), P(−)]’. When there was no association with being elderly, ADEs associated with polypharmacy that carried a high risk of myelosuppression and infection were categorised as ‘Class 3 [E(−), P(+)]’, and allergic ADEs that were not affected by being elderly or polypharmacy, were categorised as ‘Class 4 [E(−), P(−)]’. Class 1 events as well as Class 3 ADEs occurred more frequently in females than in males, whereas Class 3 ADEs (deep vein thrombosis and pulmonary embolism) occurred more frequently in males. Conclusions Class 1 and Class 2 ADEs should be investigated in analyses that focus on individual drugs. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-020-00221-8.
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Affiliation(s)
- Akio Negishi
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan
| | - Shinji Oshima
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan.
| | - Norimitsu Horii
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan.,Josai University Pharmacy, Saitama, Japan
| | - Mizue Mutoh
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Naoko Inoue
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan.,Josai University Pharmacy, Saitama, Japan
| | - Sachihiko Numajiri
- Student Learning Assistance Centre, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Shigeru Ohshima
- Laboratory of Pharmacy Management, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, Saitama, Japan.,Josai University Pharmacy, Saitama, Japan
| | - Daisuke Kobayashi
- Laboratory of Analytical Pharmaceutics and Informatics, Faculty of Pharmacy and Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado, Saitama, 350-0295, Japan.,Josai University Pharmacy, Saitama, Japan
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13
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Fenrich M, Habjanovic K, Kajan J, Heffer M. The circle of Willis revisited: Forebrain dehydration sensing facilitated by the anterior communicating artery: How hemodynamic properties facilitate more efficient dehydration sensing in amniotes. Bioessays 2020; 43:e2000115. [PMID: 33191609 DOI: 10.1002/bies.202000115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
We hypothesize that threat of dehydration provided selection pressure for the evolutionary emergence and persistence of the anterior communicating artery (ACoA - the inter-arterial connection that completes the Circle of Willis) in early amniotes. The ACoA is a hemodynamically insignificant artery, but, as we argue in this paper, its privileged position outside the blood-brain barrier gives it a crucial sensing function for the osmolarity of the blood against the background of the rest of the brain, which efficiently protects itself from dehydration. Till now, the questions of why the ACoA evolved, and what its physiological function is, have remained unsatisfactorily answered. The traditional view-that the ACoA serves as a collateral source of vascularization in case of arterial stenosis-is anthropocentric, and not in accordance with principles of natural selection that apply more generally. Diseases underlying arterial stenosis are associated with aging and the human lifestyle, so this cannot explain why the ACoA formed hundreds of millions of years ago and persisted in amniotes to this day. The peculiar hemodynamic properties of the ACoA could be selected traits that allowed for more efficient forebrain detection of dehydration and complex behavioral responses to water loss, a major advantage in the survival of early amniotes. This hypothesis also explains insufficient hydration often seen in elderly humans.
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Affiliation(s)
- Matija Fenrich
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Karlo Habjanovic
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Josip Kajan
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Marija Heffer
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
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14
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Chapman CL, Johnson BD, Parker MD, Hostler D, Pryor RR, Schlader Z. Kidney physiology and pathophysiology during heat stress and the modification by exercise, dehydration, heat acclimation and aging. Temperature (Austin) 2020; 8:108-159. [PMID: 33997113 PMCID: PMC8098077 DOI: 10.1080/23328940.2020.1826841] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
The kidneys' integrative responses to heat stress aid thermoregulation, cardiovascular control, and water and electrolyte regulation. Recent evidence suggests the kidneys are at increased risk of pathological events during heat stress, namely acute kidney injury (AKI), and that this risk is compounded by dehydration and exercise. This heat stress related AKI is believed to contribute to the epidemic of chronic kidney disease (CKD) occurring in occupational settings. It is estimated that AKI and CKD affect upwards of 45 million individuals in the global workforce. Water and electrolyte disturbances and AKI, both of which are representative of kidney-related pathology, are the two leading causes of hospitalizations during heat waves in older adults. Structural and physiological alterations in aging kidneys likely contribute to this increased risk. With this background, this comprehensive narrative review will provide the first aggregation of research into the integrative physiological response of the kidneys to heat stress. While the focus of this review is on the human kidneys, we will utilize both human and animal data to describe these responses to passive and exercise heat stress, and how they are altered with heat acclimation. Additionally, we will discuss recent studies that indicate an increased risk of AKI due to exercise in the heat. Lastly, we will introduce the emerging public health crisis of older adults during extreme heat events and how the aging kidneys may be more susceptible to injury during heat stress.
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Affiliation(s)
- Christopher L. Chapman
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | - Blair D. Johnson
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Mark D. Parker
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - David Hostler
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA
| | - Riana R. Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY, USA
| | - Zachary Schlader
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA
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15
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Bruno RR, Masyuk M, Muessig JM, Binneboessel S, Bernhard M, Bäz L, Franz M, Kelm M, Jung C. Sublingual microcirculation detects impaired perfusion in dehydrated older patients. Clin Hemorheol Microcirc 2020; 75:475-487. [DOI: 10.3233/ch-200859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Dehydration occurs frequently in older patients and constitutes a significant clinical problem. OBJECTIVE: This proof-of-concept study examines whether 1) sublingual measurement in dehydrated old patients is feasible, 2) frailty and incompliance in old, awake patients affects video-quality, 3) dehydration impacts microcirculation METHODS: This prospective observational study included clinically dehydrated patients aged ≥65 years immediately after admission. Dehydration was assessed clinically. A sidestream dark field camera (SDF) was used for measurement. Video-quality was evaluated with MIQS (microcirculation image quality score). Both AVA 4.3C- and AVA POEM-software analyzed the videos. Seventeen patients ≥65 years not showing dehydration served as control. RESULTS: Thirteen patients (8 female) were included. The average age was 83±8 years. The mini-mental test was 17±15 points, the Clinical Frailty Scale 4±3, the Barthel-Index 59±39. None of these parameters correlated with MIQS (3.4±4.2 SD (“acceptable”)). Dehydrated patients had a slightly impaired microcirculation, with a significantly lower percentage of perfused small vessels compared to control (83.1±7.7% versus 88.0±6.0%, P < 0.05). After rehydration, there was acute improvement in the microcirculation. CONCLUSIONS: Sublingual microcirculatory SDF-measurement is both, safe and valid for dehydrated old patients - regardless of frailty, age or cognitive performance. Dehydration leads to an impaired microcirculation.
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Affiliation(s)
- Raphael Romano Bruno
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maryna Masyuk
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Johanna M. Muessig
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Binneboessel
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Laura Bäz
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, University Hospital Jena, Jena, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonary Diseases, and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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16
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Wilms JN, Leal LN, Martín-Tereso J. Short communication: Hypernatremia in diarrheic calves associated with oral electrolyte administration in water and milk replacer in absence of access to water. J Dairy Sci 2020; 103:5495-5500. [PMID: 32307155 DOI: 10.3168/jds.2019-17371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/07/2020] [Indexed: 11/19/2022]
Abstract
A major goal in treatment of calves with diarrhea is to restore hydration and to correct metabolic acidosis. This can be achieved by the administration of oral electrolyte solutions (OES). However, the composition of OES products and the administration protocols in practice vary widely, which can potentially compromise the efficacy and safety of these treatments. In particular, administration of OES in milk replacer (MR) and the absence of water supply in young calves are not unusual and these conditions could compromise calf health. In this light, the objective of this study was to evaluate the efficacy and safety of OES administered in MR and in water without access to water. Forty-five male Holstein calves (16.6 ± 1.6 d of age and 45.4 ± 2.2 kg at arrival) were purchased from a collection center located in the Netherlands. After arrival, calves went through an adaptation period of 4 d. Calves that developed diarrhea within 6 d after the end of the adaptation period were enrolled in the study, and the remaining calves were sold after being weaned. Upon morning detection of abnormal fecal scores (d 1 starting point), calves were blocked based on initial BW. Within each block, calves were randomly assigned to 1 of 2 treatments, including a control consisting of a small dose of whey (CON; n = 12) and an OES treatment (OES; n = 14). Treatments were blinded to the farm staff by randomly assigning a letter to each treatment. Treatments were simultaneously administered for 4 d in MR (2.5 L at 0800 and 1730 h) and in water (3 L at 1300 and 2200 h). Calves had no supplemental access to plain water. Blood samples were taken at 0600 h for 4 d, and fecal scores (0 = normal; 1 = watery feces) were assessed daily at 0900 h for 15 consecutive days. Additionally, skin turgor and degree of enophthalmos were assessed at 1000 h from d 1 to 4 using a 3-level scoring system. Calves fed OES had a higher prevalence of diarrhea on d 3, 4, and 5 as well as higher prevalence of delayed skin turgor and increased degree of enophthalmos over the 4 monitoring days. Diarrhea duration was longer in calves receiving OES than in calves receiving CON (4.2 d vs. 2.1 d, respectively). The OES treatment resulted in hypernatremia (serum Na+ >145 mmol/L) within 48 h after the first OES administration. Hypernatremia was linked with higher serum Cl- and urea concentrations and thus higher serum osmolarity in OES calves compared with CON calves. Administered under these conditions, OES resulted in various degrees of hypernatremia and a delayed recovery from diarrhea, thus defeating the purpose of OES administration.
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Affiliation(s)
- Juliette N Wilms
- Trouw Nutrition R&D, PO Box 299, 3800 AG, Amersfoort, the Netherlands.
| | - Leonel N Leal
- Trouw Nutrition R&D, PO Box 299, 3800 AG, Amersfoort, the Netherlands
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17
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Sugizaki CSDA, Braga CC, Freitas ATVDS, Peixoto MDRG. Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis. J Bras Nefrol 2020; 42:153-162. [PMID: 32187260 PMCID: PMC7427644 DOI: 10.1590/2175-8239-jbn-2019-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/18/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD). METHODS The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC). RESULTS The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001). CONCLUSION Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.
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Affiliation(s)
| | - Clarice Carneiro Braga
- Universidade Federal de Goiás, Faculdade de Nutrição, Programa
de Pós-Graduação em Nutrição e Saúde, Goiânia, GO, Brasil
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18
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Impending Low Intake Dehydration at Admission to A Geriatric Ward- Prevalence and Correlates in a Cross-Sectional Study. Nutrients 2020; 12:nu12020398. [PMID: 32024303 PMCID: PMC7071250 DOI: 10.3390/nu12020398] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/22/2020] [Accepted: 01/30/2020] [Indexed: 12/22/2022] Open
Abstract
Dehydration risk increases with frailty and functional dependency, but a limited number of studies have evaluated this association in hospitalized geriatric patients. This cross-sectional study aimed to assess the prevalence and determinants of dehydration in patients admitted to the geriatric ward. Dehydration was diagnosed when calculated osmolarity was above 295 mMol/L. Logistic regression analyses (direct and stepwise backward) were used to assess determinants of impending dehydration. 358 of 416 hospitalized patients (86.1%) were included: 274 (76.5%) women, and 309 (86.4%) 75+ year-old. Dehydration was diagnosed in 209 (58.4%) cases. Significantly higher odds for impending dehydration were observed only for chronic kidney disease with trends for diabetes and procognitive medication when controlling for several health, biochemical, and nutritional parameters and medications. After adjusting for “dementia” the negative effect of “taking procognitive medications” became a significant one. Chronic kidney disease, diabetes, taking procognitive medications and hypertension were the main variables for the outcome prediction according to the stepwise backward regression analysis. This may indicate an additional benefit of reducing the risk of dehydration when using procognitive drugs in older patients with dementia.
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19
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Fülöp T, Zsom L, Rodríguez RD, Chabrier-Rosello JO, Hamrahian M, Koch CA. Therapeutic hypernatremia management during continuous renal replacement therapy with elevated intracranial pressures and respiratory failure. Rev Endocr Metab Disord 2019; 20:65-75. [PMID: 30848433 DOI: 10.1007/s11154-019-09483-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cerebral edema and elevated intracranial pressure (ICP) are common complications of acute brain injury. Hypertonic solutions are routinely used in acute brain injury as effective osmotic agents to lower ICP by increasing the extracellular fluid tonicity. Acute kidney injury in a patient with traumatic brain injury and elevated ICP requiring renal replacement therapy represents a significant therapeutic challenge due to an increased risk of cerebral edema associated with intermittent conventional hemodialysis. Therefore, continuous renal replacement therapy (CRRT) has emerged as the preferred modality of therapy in this patient population. We present our current treatment approach, with demonstrative case vignette illustrations, utilizing hypertonic saline protocols (3% sodium-chloride or, with coexisting severe combined metabolic and respiratory acidosis, with 4.2% sodium-bicarbonate) in conjunction with the CRRT platform, to induce controlled hypernatremia of approximately 155 mEq/L in hemodynamically unstable patients with acute kidney injury and elevated ICP due to acute brain injury. Rationale, mechanism of activation, benefits and potential pitfalls of the therapy are reviewed. The impact of hypertonic citrate solution during regional citrate anticoagulation is specifically discussed. Maintaining plasma hypertonicity in the setting of increased ICP and acute kidney injury could prevent the worsening of ICP during renal replacement therapy by minimizing the osmotic gradient across the blood-brain barrier and maximizing cardiovascular stability.
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Affiliation(s)
- Tibor Fülöp
- Department of Medicine - Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA.
- Medical Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
| | - Lajos Zsom
- Fresenius Medical Care Hungary Kft, Cegléd, Hungary
| | - Rafael D Rodríguez
- Department of Medicine - Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Jorge O Chabrier-Rosello
- Department of Medicine - Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Mehrdad Hamrahian
- Department of Medicine - Division of Nephrology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christian A Koch
- Medicover GmbH, Berlin, Germany.
- Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
- Technical University of Dresden, Dresden, Germany.
- University of Tennessee Health Science Center, Memphis, TN, USA.
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20
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Birder LA, Wolf-Johnston AS, Jackson EK, Wein AJ, Dmochowski R. Aging increases the expression of vasopressin receptors in both the kidney and urinary bladder. Neurourol Urodyn 2019; 38:393-397. [PMID: 30311671 PMCID: PMC9839378 DOI: 10.1002/nau.23830] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/17/2023]
Abstract
AIMS The goal of this study was to determine whether aging effects the expression of V1a and V2 vasopressin receptors in the urinary bladder mucosa (UBM) and kidney. METHODS UBM and kidneys were obtained from young (3 months-of-age) and old (25-30 months-of-age) female Fisher 344 rats. Tissue samples were analyzed by western blotting for V1a and V2 receptor expression, and rat plasma levels of vasopressin levels were measured by ELISA. RESULTS V1a and V2 receptors were detected in both the UBM and kidneys. Aging significantly (P < 0.05) increased the expression of V2 receptors by 2.80 ± 0.52 and 6.52 ± 1.24-fold in the UBM and kidneys, respectively. Aging also increased V1a receptor expression in the kidneys (5.52 ± 1.05 fold; P < 0.05), but not in the UBM. To the best of our knowledge, because this is the first detection of V2 receptors in the mammalian bladder mucosa, we also probed human UBM for V2 receptors and observed high expression in human UBM. Unlike V1a and V2 receptors, aging had only a minor effect on plasma vasopressin levels (8% increase). CONCLUSIONS V2 receptors are substantially increased in the aging UBM. The role of these receptors in UBM is as yet undefined, but given their presence and action in the kidneys, the possible effect of these receptors in free water regulation should be considered. The large age-related increase in the expression of V2 receptors in both the UBM and kidney may contribute to the effectiveness of desmopressin in age-related nocturia.
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Affiliation(s)
- Lori A Birder
- University of Pittsburgh School of Medicine, Department of Medicine, Pittsburgh, Pennsylvania
- University of Pittsburgh School of Medicine, Department of Pharmacology and Chemical Biology, Pittsburgh, Pennsylvania
| | - Amanda S Wolf-Johnston
- University of Pittsburgh School of Medicine, Department of Medicine, Pittsburgh, Pennsylvania
| | - Edwin K Jackson
- University of Pittsburgh School of Medicine, Department of Pharmacology and Chemical Biology, Pittsburgh, Pennsylvania
| | - Alan J Wein
- University of Pennsylvania Perelman School of Medicine, Division of Urology, Philadelphia, Pennsylvania
| | - Roger Dmochowski
- Vanderbilt University Medical Center, Department of Urology, Nashville, Tennessee
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21
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Koch CA, Fülöp T. Case reports: old-timers and evergreens. J Med Case Rep 2018; 12:355. [PMID: 30477565 PMCID: PMC6257958 DOI: 10.1186/s13256-018-1889-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- C A Koch
- Medicover GmbH, Berlin, Germany. .,Carl von Ossietzky University of Oldenburg, Oldenburg, Germany. .,Technical University of Dresden, Dresden, Germany. .,University of Louisville, Louisville, KY, USA.
| | - T Fülöp
- Medical University of South Carolina, Charleston, USA
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22
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Kurt G, Woodworth HL, Fowler S, Bugescu R, Leinninger GM. Activation of lateral hypothalamic area neurotensin-expressing neurons promotes drinking. Neuropharmacology 2018; 154:13-21. [PMID: 30266601 DOI: 10.1016/j.neuropharm.2018.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/04/2018] [Accepted: 09/24/2018] [Indexed: 12/18/2022]
Abstract
Animals must ingest water via drinking to maintain fluid homeostasis, yet the neurons that specifically promote drinking behavior are incompletely characterized. The lateral hypothalamic area (LHA) as a whole is essential for drinking behavior but most LHA neurons indiscriminately promote drinking and feeding. By contrast, activating neurotensin (Nts)-expressing LHA neurons (termed LHA Nts neurons) causes mice to immediately drink water with a delayed suppression of feeding. We therefore hypothesized that LHA Nts neurons are sufficient to induce drinking behavior and that these neurons specifically bias for fluid intake over food intake. To test this hypothesis we used designer receptors exclusively activated by designer drugs (DREADDs) to selectively activate LHA Nts neurons and studied the impact on fluid intake, fluid preference and feeding. Activation of LHA Nts neurons stimulated drinking in water-replete and dehydrated mice, indicating that these neurons are sufficient to promote water intake regardless of homeostatic need. Interestingly, mice with activated LHA Nts neurons drank any fluid that was provided regardless of its palatability, but if given a choice they preferred water or palatable solutions over unpalatable (quinine) or dehydrating (hypertonic saline) solutions. Notably, acute activation of LHA Nts neurons robustly promoted fluid but not food intake. Overall, our study confirms that activation of LHA Nts neurons is sufficient to induce drinking behavior and biases for fluid intake. Hence, LHA Nts neurons may be important targets for orchestrating the appropriate ingestive behavior necessary to maintain fluid homeostasis. This article is part of the Special Issue entitled 'Hypothalamic Control of Homeostasis'.
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Affiliation(s)
- Gizem Kurt
- Department of Physiology, Michigan State University, East Lansing, MI, 48114, USA
| | - Hillary L Woodworth
- Department of Physiology, Michigan State University, East Lansing, MI, 48114, USA
| | - Sabrina Fowler
- Department of Physiology, Michigan State University, East Lansing, MI, 48114, USA
| | - Raluca Bugescu
- Department of Physiology, Michigan State University, East Lansing, MI, 48114, USA
| | - Gina M Leinninger
- Department of Physiology, Michigan State University, East Lansing, MI, 48114, USA.
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23
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Lõhmus M. Possible Biological Mechanisms Linking Mental Health and Heat-A Contemplative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071515. [PMID: 30021956 PMCID: PMC6068666 DOI: 10.3390/ijerph15071515] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/09/2018] [Accepted: 07/17/2018] [Indexed: 12/15/2022]
Abstract
This review provides examples of possible biological mechanisms that could, at least partly, explain the existing epidemiological evidence of heatwave-related exacerbation of mental disease morbidity. The author reviews the complicated central processes involved in the challenge of maintaining a stable body temperature in hot environments, and the maladaptive effects of certain psychiatric medicines on thermoregulation. In addition, the author discusses some alternative mechanisms, such as interrupted functional brain connectivity and the effect of disrupted sleep, which may further increase the vulnerability of mental health patients during heatwaves.
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Affiliation(s)
- Mare Lõhmus
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Solnavägen 4, 113 65 Stockholm, Sweden.
- Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 13, 17177 Solna, Sweden.
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24
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Hewer W, Tomandl B, Marburger C. [Medical complications in patients with neurocognitive disorders]. MMW Fortschr Med 2018; 160:45-48. [PMID: 29556997 DOI: 10.1007/s15006-018-0290-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- W Hewer
- Klinikum Christophsbad, Faurndauer Str. 6-28, D-73035, Göppingen, Deutschland.
| | - Bernd Tomandl
- Klinik für Radiologie und Neuroradiologie, Dysphagiezentrum, Klinikum Christophsbad, Göppingen, Deutschland
| | - Christian Marburger
- Klinik für Geriatrische Rehabilitation, Dysphagiezentrum, Klinikum Christophsbad, Göppingen, Deutschland
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Song SH, Sim GA, Baek SH, Seo JW, Shim JW, Koo JR. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) Associated with Mediastinal Schwannoma. Electrolyte Blood Press 2018; 15:42-46. [PMID: 29399023 PMCID: PMC5788814 DOI: 10.5049/ebp.2017.15.2.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/28/2017] [Indexed: 11/24/2022] Open
Abstract
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of euvolemic hypo-osmotic hyponatremia. There are several etiologies of SIADH including neuroendocrine tumor, pulmonary disease, infection, trauma, and medications. Here, we report a case of SIADH associated with a schwannoma involving the mediastinum in a 75-year-old woman who presented with nausea, vomiting, and general weakness. Laboratory testing showed hypo-osmolar hyponatremia, with a serum sodium level of 102mmol/L, serum osmolality of 221mOsm/kg, urine osmolality of 382mOsm/kg, urine sodium of 55 mmol/L, and plasma antidiuretic hormone (ADH) of 4.40 pg/mL. Chest computed tomography identified a 1.5-cm-sized solid enhancing nodule in the right lower paratracheal area. A biopsy specimen was obtained by video-assisted thoracoscopic surgery, which was diagnosed on pathology as a schwannoma. The hyponatremia was completely resolved after schwannoma resection and plasma ADH level decreased from 4.40 pg/mL to 0.86 pg/mL. This case highlights the importance of suspecting and identifying the underlying cause of SIADH when faced with refractory or recurrent hyponatremia, and that on possibility is mediastinal schwannoma
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Affiliation(s)
- Shin Han Song
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Gyeong Ah Sim
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jang Won Seo
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Jung Weon Shim
- Department of Pathology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Ja Ryong Koo
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Picetti D, Foster S, Pangle AK, Schrader A, George M, Wei JY, Azhar G. Hydration health literacy in the elderly. NUTRITION AND HEALTHY AGING 2017; 4:227-237. [PMID: 29276792 PMCID: PMC5734130 DOI: 10.3233/nha-170026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Inadequate hydration in the elderly is associated with increased morbidity and mortality. However, few studies have addressed the knowledge of elderly individuals regarding hydration in health and disease. Gaps in health literacy have been identified as a critical component in health maintenance, and promoting health literacy should improve outcomes related to hydration associated illnesses in the elderly. METHODS We administered an anonymous survey to community-dwelling elderly (n = 170) to gauge their hydration knowledge. RESULTS About 56% of respondents reported consuming >6 glasses of fluid/day, whereas 9% reported drinking ≤3 glasses. About 60% of respondents overestimated the amount of fluid loss at which moderately severe dehydration symptoms occur, and 60% did not know fever can cause dehydration. Roughly 1/3 were not aware that fluid overload occurs in heart failure (35%) or kidney failure (32%). A majority of respondents were not aware that improper hydration or changes in hydration status can result in confusion, seizures, or death. CONCLUSIONS Overall, our study demonstrated that there were significant deficiencies in hydration health literacy among elderly. Appropriate education and attention to hydration may improve quality of life, reduce hospitalizations and the economic burden related to hydration-associated morbidity and mortality.
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Affiliation(s)
- Dominic Picetti
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stephen Foster
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amanda K. Pangle
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amy Schrader
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Masil George
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanne Y. Wei
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gohar Azhar
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Abstract
Water intake is one of the most basic physiological responses and is essential to sustain life. The perception of thirst has a critical role in controlling body fluid homeostasis and if neglected or dysregulated can lead to life-threatening pathologies. Clear evidence suggests that the perception of thirst occurs in higher-order centres, such as the anterior cingulate cortex (ACC) and insular cortex (IC), which receive information from midline thalamic relay nuclei. Multiple brain regions, notably circumventricular organs such as the organum vasculosum lamina terminalis (OVLT) and subfornical organ (SFO), monitor changes in blood osmolality, solute load and hormone circulation and are thought to orchestrate appropriate responses to maintain extracellular fluid near ideal set points by engaging the medial thalamic-ACC/IC network. Thirst has long been thought of as a negative homeostatic feedback response to increases in blood solute concentration or decreases in blood volume. However, emerging evidence suggests a clear role for thirst as a feedforward adaptive anticipatory response that precedes physiological challenges. These anticipatory responses are promoted by rises in core body temperature, food intake (prandial) and signals from the circadian clock. Feedforward signals are also important mediators of satiety, inhibiting thirst well before the physiological state is restored by fluid ingestion. In this Review, we discuss the importance of thirst for body fluid balance and outline our current understanding of the neural mechanisms that underlie the various types of homeostatic and anticipatory thirst.
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Affiliation(s)
- Claire Gizowski
- Centre for Research in Neuroscience, Research Institute of the McGill University Health Centre and Montreal General Hospital, 1650 Cedar Avenue, Montreal H3G1A4, Canada
| | - Charles W Bourque
- Centre for Research in Neuroscience, Research Institute of the McGill University Health Centre and Montreal General Hospital, 1650 Cedar Avenue, Montreal H3G1A4, Canada
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Affiliation(s)
- Edgar V Lerma
- Section of Nephrology, University of Illinois at Chicago College of Medicine/Advocate Christ Medical Center, Oak Lawn, IL, USA.
| | - Christian A Koch
- Division of Endocrinology, Diabetes, Metabolism, University of Mississippi Medical Center, Jackson, MS, USA
- G.V. (Sonny) Montgomery VA Medical Center, Jackson, MS, USA
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
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