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Bansal S, Liu D, Mao Q, Bauer N, Wang B. Carbon Monoxide as a Potential Therapeutic Agent: A Molecular Analysis of Its Safety Profiles. J Med Chem 2024; 67:9789-9815. [PMID: 38864348 PMCID: PMC11215727 DOI: 10.1021/acs.jmedchem.4c00823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 06/13/2024]
Abstract
Carbon monoxide (CO) is endogenously produced in mammals, with blood concentrations in the high micromolar range in the hemoglobin-bound form. Further, CO has shown therapeutic effects in various animal models. Despite its reputation as a poisonous gas at high concentrations, we show that CO should have a wide enough safety margin for therapeutic applications. The analysis considers a large number of factors including levels of endogenous CO, its safety margin in comparison to commonly encountered biomolecules or drugs, anticipated enhanced safety profiles when delivered via a noninhalation mode, and the large amount of safety data from human clinical trials. It should be emphasized that having a wide enough safety margin for therapeutic use does not mean that it is benign or safe to the general public, even at low doses. We defer the latter to public health experts. Importantly, this Perspective is written for drug discovery professionals and not the general public.
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Affiliation(s)
| | | | | | - Nicola Bauer
- Department of Chemistry and
the Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
| | - Binghe Wang
- Department of Chemistry and
the Center for Diagnostics and Therapeutics, Georgia State University, Atlanta, Georgia 30303, United States
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Stoleriu MG, Gerckens M, Zimmermann J, Schön J, Damirov F, Samm N, Kovács J, Stacher-Priehse E, Kellerer C, Jörres RA, Kauke T, Ketscher C, Grützner U, Hatz R. Preoperative risk factors predict perioperative allogenic blood transfusion in patients undergoing primary lung cancer resections: a retrospective cohort study from a high-volume thoracic surgery center. BMC Surg 2023; 23:44. [PMID: 36849951 PMCID: PMC9972742 DOI: 10.1186/s12893-023-01924-9] [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: 01/05/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Our study aimed to identify preoperative predictors for perioperative allogenic blood transfusion (ABT) in patients undergoing major lung cancer resections in order to improve the perioperative management of patients at risk for ABT. METHODS Patients admitted between 2014 and 2016 in a high-volume thoracic surgery clinic were retrospectively evaluated in a cohort study based on a control group without ABT and the ABT group requiring packed red blood cell units within 15 days postoperatively until discharge. The association of ABT with clinically established parameters (sex, preoperative anemia, liver and coagulation function, blood groups, multilobar resections) was analyzed by contingency tables, receiver operating characteristics (ROC) and logistic regression analysis, taking into account potential covariates. RESULTS 60 out of 529 patients (11.3%) required ABT. N1 and non-T1 tumors, thoracotomy approach, multilobar resections, thoracic wall resections and Rhesus negativity were more frequent in the ABT group. In multivariable analyses, female sex, preoperative anemia, multilobar resections, as well as serum alanine-aminotransferase levels, thrombocyte counts and Rhesus negativity were identified as independent predictors of ABT, being associated with OR (95% Confidence interval, p-value) of 2.44 (1.23-4.88, p = 0.0112), 18.16 (8.73-37.78, p < 0.0001), 5.79 (2.50-13.38, p < 0.0001), 3.98 (1.73-9.16, p = 0.0012), 2.04 (1.04-4.02, p = 0.0390) and 2.84 (1.23-6.59, p = 0.0150), respectively. CONCLUSIONS In patients undergoing major lung cancer resections, multiple independent risk factors for perioperative ABT apart from preoperative anemia and multilobar resections were identified. Assessment of these predictors might help to identify high risk patients preoperatively and to improve the strategies that reduce perioperative ABT.
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Affiliation(s)
- Mircea Gabriel Stoleriu
- Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany. .,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131, Gauting, Germany. .,Comprehensive Pneumology Center (CPC), Member of the German Lung Research Center, Helmholtz Zentrum Muenchen, Institute for Lung Biology and Disease, 81377, Munich, Germany. .,Asklepios Lung Clinic Munich-GautingDivision of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU) and Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131, Gauting, Germany.
| | - Michael Gerckens
- grid.4567.00000 0004 0483 2525Comprehensive Pneumology Center (CPC), Member of the German Lung Research Center, Helmholtz Zentrum Muenchen, Institute for Lung Biology and Disease, 81377 Munich, Germany ,grid.5252.00000 0004 1936 973XDepartment of Internal Medicine V, Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Julia Zimmermann
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Johannes Schön
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Fuad Damirov
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Nicole Samm
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Julia Kovács
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Elvira Stacher-Priehse
- Department of Pathology, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Christina Kellerer
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Ziemssenstraße 1, 80336 Munich, Germany ,grid.6936.a0000000123222966School of Medicine, Institute of General Practice and Health Services Research, Technical University of Munich, Orleansstr. 47, 81667 Munich, Germany
| | - Rudolf A. Jörres
- grid.411095.80000 0004 0477 2585Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of Ludwig-Maximilians-University Munich (LMU), Ziemssenstraße 1, 80336 Munich, Germany
| | - Teresa Kauke
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany
| | - Christian Ketscher
- Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Uwe Grützner
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
| | - Rudolf Hatz
- grid.411095.80000 0004 0477 2585Division of Thoracic Surgery Munich, Hospital of Ludwig-Maximilians-University Munich (LMU), Marchioninistr. 15, 81377 Munich, Germany ,Department of Thoracic Surgery, Asklepios Pulmonary Hospital, Robert-Koch-Allee 2, 82131 Gauting, Germany
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Carabineanu A, Zaharia C, Blidisel A, Ilina R, Miclaus C, Ardelean O, Preda M, Mazilu O. Risk of More Advanced Lesions at Hysterectomy after Initial Diagnosis of Non-Atypical Endometrial Hyperplasia in Patients with Postmenopausal Bleeding and Oral Anticoagulant Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57101003. [PMID: 34684040 PMCID: PMC8539967 DOI: 10.3390/medicina57101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/19/2022]
Abstract
Background and Objectives: Endometrial hyperplasia (EH) is a precursor lesion to endometrial cancer (EC), and when cellular atypia is present, in 40% of cases, they are diagnosed with EC on hysterectomy. Usually, EH is clinically manifested by uterine bleeding. In patients with oral anticoagulant therapy (OAT), the uterus is the second most common source of bleeding. The aim of the study was to show that uterine bleeding in postmenopausal patients undergoing OAT may reveal precancerous endometrial lesions with atypia, or neoplastic lesions in patients with an initial diagnosis of endometrial hyperplasia without atypia (non-atypical endometrial hyperplasia, NAEH) on dilation and curettage (D&C). We will be able to estimate the risk of a postmenopausal female patient with uterine bleeding during an OAT to have a precancerous endometrial lesion. Materials and Methods: The subjects of the study were 173 female patients with uterine bleeding, who have had total hysterectomy with bilateral salpingoovarectomy, of whom 99 underwent an OAT. There were 101 female patients initially diagnosed with NAEH, of which 60 did not have anticoagulant treatment (mean age 57.36 ± 6.51) and 41 had anticoagulant treatment (mean age 60.39 ± 7.35) (p = 0.006). From the pathology diagnosis moment, the surgery was performed at 42.09 ± 14.54 days in patients without OAT and after 35.39 ± 11.29 days in those who received such treatment (p = 0.724). Results: Initial diagnosis of NAEH established at D&C was changed at the final diagnosis after hysterectomy in EH with cellular atypia (atypical endometrial hyperplasia AEH) or EC in 18.18% of patients without OAT, and in 40.54% of patients who received this treatment. Conclusions: Based on a logistic regression model, it is estimated that female patients with an initial histopathological diagnosis of NAEH and who underwent OAT have, on average, 4.85 times greater odds (OR = 4.85, 95% CI 1.79–14.06) than the others of being identified postoperatively with more advanced lesions.
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Affiliation(s)
- Adrian Carabineanu
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Claudia Zaharia
- Department of Mathematics, Faculty of Mathematics and Computer Science, West University of Timisoara, 300223 Timisoara, Romania;
| | - Alexandru Blidisel
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
- Correspondence:
| | - Razvan Ilina
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Codruta Miclaus
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Ovidiu Ardelean
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Marius Preda
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
| | - Octavian Mazilu
- First Department of Surgery, Second Discipline of Surgical Semiology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (A.C.); (R.I.); (C.M.); (O.A.); (M.P.); (O.M.)
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