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Su J, Wang P, Zhou W, Peydayesh M, Zhou J, Jin T, Donat F, Jin C, Xia L, Wang K, Ren F, Van der Meeren P, García de Arquer FP, Mezzenga R. Single-site iron-anchored amyloid hydrogels as catalytic platforms for alcohol detoxification. NATURE NANOTECHNOLOGY 2024; 19:1168-1177. [PMID: 38740933 PMCID: PMC11329373 DOI: 10.1038/s41565-024-01657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/21/2024] [Indexed: 05/16/2024]
Abstract
Constructing effective antidotes to reduce global health impacts induced by alcohol prevalence is a challenging topic. Despite the positive effects observed with intravenous applications of natural enzyme complexes, their insufficient activities and complicated usage often result in the accumulation of toxic acetaldehyde, which raises important clinical concerns, highlighting the pressing need for stable oral strategies. Here we present an effective solution for alcohol detoxification by employing a biomimetic-nanozyme amyloid hydrogel as an orally administered catalytic platform. We exploit amyloid fibrils derived from β-lactoglobulin, a readily accessible milk protein that is rich in coordinable nitrogen atoms, as a nanocarrier to stabilize atomically dispersed iron (ferrous-dominated). By emulating the coordination structure of the horseradish peroxidase enzyme, the single-site iron nanozyme demonstrates the capability to selectively catalyse alcohol oxidation into acetic acid, as opposed to the more toxic acetaldehyde. Administering the gelatinous nanozyme to mice suffering from alcohol intoxication significantly reduced their blood-alcohol levels (decreased by 55.8% 300 min post-alcohol intake) without causing additional acetaldehyde build-up. Our hydrogel further demonstrates a protective effect on the liver, while simultaneously mitigating intestinal damage and dysbiosis associated with chronic alcohol consumption, introducing a promising strategy in effective alcohol detoxification.
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Affiliation(s)
- Jiaqi Su
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
- Particle and Interfacial Technology Group, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
| | - Pengjie Wang
- Department of Nutrition and Health, Beijing Higher Institution Engineering Research Center of Animal Products, China Agricultural University, Beijing, China
| | - Wei Zhou
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Mohammad Peydayesh
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Jiangtao Zhou
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Tonghui Jin
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Felix Donat
- Institute of Energy and Process Engineering, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Cuiyuan Jin
- Institute of Translational Medicine, Zhejiang Shuren University, Zhejiang, China
| | - Lu Xia
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Kaiwen Wang
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Fazheng Ren
- Department of Nutrition and Health, Beijing Higher Institution Engineering Research Center of Animal Products, China Agricultural University, Beijing, China
| | - Paul Van der Meeren
- Particle and Interfacial Technology Group, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - F Pelayo García de Arquer
- ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Raffaele Mezzenga
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
- Department of Materials, ETH Zurich, Zurich, Switzerland.
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Alvear TF, Farias-Pasten A, Vergara SA, Prieto-Villalobos J, Silva-Contreras A, Fuenzalida FA, Quintanilla RA, Orellana JA. Hemichannels contribute to mitochondrial Ca 2+ and morphology alterations evoked by ethanol in astrocytes. Front Cell Dev Biol 2024; 12:1434381. [PMID: 39129788 PMCID: PMC11310047 DOI: 10.3389/fcell.2024.1434381] [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: 05/17/2024] [Accepted: 07/03/2024] [Indexed: 08/13/2024] Open
Abstract
Alcohol, a toxic and psychoactive substance with addictive properties, severely impacts life quality, leading to significant health, societal, and economic consequences. Its rapid passage across the blood-brain barrier directly affects different brain cells, including astrocytes. Our recent findings revealed the involvement of pannexin-1 (Panx1) and connexin-43 (Cx43) hemichannels in ethanol-induced astrocyte dysfunction and death. However, whether ethanol influences mitochondrial function and morphology in astrocytes, and the potential role of hemichannels in this process remains poorly understood. Here, we found that ethanol reduced basal mitochondrial Ca2+ but exacerbated thapsigargin-induced mitochondrial Ca2+ dynamics in a concentration-dependent manner, as evidenced by Rhod-2 time-lapse recordings. Similarly, ethanol-treated astrocytes displayed increased mitochondrial superoxide production, as indicated by MitoSox labeling. These effects coincided with reduced mitochondrial membrane potential and increased mitochondrial fragmentation, as determined by MitoRed CMXRos and MitoGreen quantification, respectively. Crucially, inhibiting both Cx43 and Panx1 hemichannels effectively prevented all ethanol-induced mitochondrial abnormalities in astrocytes. We speculate that exacerbated hemichannel activity evoked by ethanol may impair intracellular Ca2+ homeostasis, stressing mitochondrial Ca2+ with potentially damaging consequences for mitochondrial fusion and fission dynamics and astroglial bioenergetics.
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Affiliation(s)
- Tanhia F. Alvear
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arantza Farias-Pasten
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio A. Vergara
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Prieto-Villalobos
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Silva-Contreras
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando A. Fuenzalida
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo A. Quintanilla
- Laboratory of Neurodegenerative Diseases, Facultad de Ciencias de La Salud, Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Juan A. Orellana
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Gómez GI, García-Rodríguez C, Marillán JE, Vergara SA, Alvear TF, Farias-Pasten A, Sáez JC, Retamal MA, Rovegno M, Ortiz FC, Orellana JA. Acute activation of hemichannels by ethanol leads to Ca 2+-dependent gliotransmitter release in astrocytes. Front Cell Dev Biol 2024; 12:1422978. [PMID: 38974144 PMCID: PMC11224458 DOI: 10.3389/fcell.2024.1422978] [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: 04/25/2024] [Accepted: 05/30/2024] [Indexed: 07/09/2024] Open
Abstract
Multiple studies have demonstrated that acute ethanol consumption alters brain function and cognition. Nevertheless, the mechanisms underlying this phenomenon remain poorly understood. Astrocyte-mediated gliotransmission is crucial for hippocampal plasticity, and recently, the opening of hemichannels has been found to play a relevant role in this process. Hemichannels are plasma membrane channels composed of six connexins or seven pannexins, respectively, that oligomerize around a central pore. They serve as ionic and molecular exchange conduits between the cytoplasm and extracellular milieu, allowing the release of various paracrine substances, such as ATP, D-serine, and glutamate, and the entry of ions and other substances, such as Ca2+ and glucose. The persistent and exacerbated opening of hemichannels has been associated with the pathogenesis and progression of several brain diseases for at least three mechanisms. The uncontrolled activity of these channels could favor the collapse of ionic gradients and osmotic balance, the release of toxic levels of ATP or glutamate, cell swelling and plasma membrane breakdown and intracellular Ca2+ overload. Here, we evaluated whether acute ethanol exposure affects the activity of astrocyte hemichannels and the possible repercussions of this phenomenon on cytoplasmatic Ca2+ signaling and gliotransmitter release. Acute ethanol exposure triggered the rapid activation of connexin43 and pannexin1 hemichannels in astrocytes, as measured by time-lapse recordings of ethidium uptake. This heightened activity derived from a rapid rise in [Ca2+]i linked to extracellular Ca2+ influx and IP3-evoked Ca2+ release from intracellular Ca2+ stores. Relevantly, the acute ethanol-induced activation of hemichannels contributed to a persistent secondary increase in [Ca2+]i. The [Ca2+]i-dependent activation of hemichannels elicited by ethanol caused the increased release of ATP and glutamate in astroglial cultures and brain slices. Our findings offer fresh perspectives on the potential mechanisms behind acute alcohol-induced brain abnormalities and propose targeting connexin43 and pannexin1 hemichannels in astrocytes as a promising avenue to prevent deleterious consequences of alcohol consumption.
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Affiliation(s)
- Gonzalo I. Gómez
- Faculty of Health Sciences, Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - Claudia García-Rodríguez
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Instituto de Neurociencia, Universidad de Valparaíso, Valparaíso, Chile
| | - Jesús E. Marillán
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio A. Vergara
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tanhia F. Alvear
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arantza Farias-Pasten
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan C. Sáez
- Centro Interdisciplinario de Neurociencia de Valparaíso, Facultad de Ciencias, Instituto de Neurociencia, Universidad de Valparaíso, Valparaíso, Chile
| | - Mauricio A. Retamal
- Programa de Comunicación Celular en Cancer, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Maximiliano Rovegno
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando C. Ortiz
- Mechanisms of Myelin Formation and Repair Laboratory, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago, Chile
| | - Juan A. Orellana
- Departamento de Neurología, Escuela de Medicina and Centro Interdisciplinario de Neurociencias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Lapish CC. Understanding How Acute Alcohol Impacts Neural Encoding in the Rodent Brain. Curr Top Behav Neurosci 2024. [PMID: 38858298 DOI: 10.1007/7854_2024_479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Alcohol impacts neural circuitry throughout the brain and has wide-ranging effects on the biophysical properties of neurons in these circuits. Articulating how these wide-ranging effects might eventually result in altered computational properties has the potential to provide a tractable working model of how alcohol alters neural encoding. This chapter reviews what is currently known about how acute alcohol influences neural activity in cortical, hippocampal, and dopaminergic circuits as these have been the primary focus of understanding how alcohol alters neural computation. While other neural systems have been the focus of exhaustive work on this topic, these brain regions are the ones where in vivo neural recordings are available, thus optimally suited to make the link between changes in neural activity and behavior. Rodent models have been key in developing an understanding of how alcohol impacts the function of these circuits, and this chapter therefore focuses on work from mice and rats. While progress has been made, it is critical to understand the challenges and caveats associated with experimental procedures, especially when performed in vivo, which are designed to answer this question and if/how to translate these data to humans. The hypothesis is discussed that alcohol impairs the ability of neural circuits to acquire states of neural activity that are transiently elevated and characterized by increased complexity. It is hypothesized that these changes are distinct from the traditional view of alcohol being a depressant of neural activity in the forebrain.
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Affiliation(s)
- Christopher C Lapish
- Department of Anatomy, Cell Biology, and Physiology, Stark Neuroscience Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
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Richards VL, Glenn SD, Turrisi RJ, Mallett KA, Ackerman S, Russell MA. Transdermal alcohol concentration features predict alcohol-induced blackouts in college students. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:880-888. [PMID: 38639884 PMCID: PMC11114374 DOI: 10.1111/acer.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Alcohol-induced blackouts (AIBs) are common in college students. Individuals with AIBs also experience acute and chronic alcohol-related consequences. Research suggests that how students drink is an important predictor of AIBs. We used transdermal alcohol concentration (TAC) sensors to measure biomarkers of increasing alcohol intoxication (rise rate, peak, and rise duration) in a sample of college students. We hypothesized that the TAC biomarkers would be positively associated with AIBs. METHODS Students were eligible to participate if they were aged 18-22 years, in their second or third year of college, reported drinking 4+ drinks on a typical Friday or Saturday, experienced ≥1 AIB in the past semester, owned an iPhone, and were willing to wear a sensor for 3 days each weekend. Students (N = 79, 55.7% female, 86.1% White, Mage = 20.1) wore TAC sensors and completed daily diaries over four consecutive weekends (89.9% completion rate). AIBs were assessed using the Alcohol-Induced Blackout Measure-2. Logistic multilevel models were conducted to test for main effects. RESULTS Days with faster TAC rise rates (OR = 2.69, 95% CI: 1.56, 5.90), higher peak TACs (OR = 2.93, 95% CI: 1.64, 7.11), and longer rise TAC durations (OR = 4.16, 95% CI: 2.08, 10.62) were associated with greater odds of experiencing an AIB. CONCLUSIONS In a sample of "risky" drinking college students, three TAC drinking features identified as being related to rising intoxication independently predicted the risk for daily AIBs. Our findings suggest that considering how an individual drinks (assessed using TAC biomarkers), rather than quantity alone, is important for assessing risk and has implications for efforts to reduce risk. Not only is speed of intoxication important for predicting AIBs, but the height of the peak intoxication and the time spent reaching the peak are important predictors, each with different implications for prevention.
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Affiliation(s)
- Veronica L. Richards
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Shannon D. Glenn
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Robert J. Turrisi
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kimberly A. Mallett
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sarah Ackerman
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Michael A. Russell
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
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Hancock DG, Berry L, Scott NM, Mincham KT, Ditcham W, Larcombe AN, Clements B. Treatment with inhaled aerosolised ethanol reduces viral load and potentiates macrophage responses in an established influenza mouse model. Exp Lung Res 2024; 50:118-126. [PMID: 38683138 DOI: 10.1080/01902148.2024.2346320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
AIM Treatment options for viral lung infections are currently limited. We aimed to explore the safety and efficacy of inhaled ethanol in an influenza-infection mouse model. MATERIALS AND METHODS In a safety and tolerability experiment, 80 healthy female BALB/c mice (20 per group) were exposed to nebulized saline (control) or three concentrations of ethanol (40/60/80% ethanol v/v in water) for 3x30-minute periods, with a two-hour break between exposures. In a separate subsequent experiment, 40 Female BALB/c mice were nasally inoculated with 104.5 plaque-forming units of immediate virulence "Mem71" influenza. Infection was established for 48-h before commencing treatment in 4 groups of 10 mice with either nebulized saline (control) or one of 3 different concentrations of ethanol (40/60/80% ethanol v/v in water) for 3x30-minute periods daily over three consecutive days. In both experiments, mouse behavior, clinical scores, weight change, bronchoalveolar lavage cell viability, cellular composition, and cytokine levels, were assessed 24-h following the final exposure, with viral load also assessed after the second experiment. RESULTS In uninfected BALB/c mice, 3x30-minute exposures to nebulized 40%, 60%, and 80% ethanol resulted in no significant differences in mouse weights, cell counts/viability, cytokines, or morphometry measures. In Mem71-influenza infected mice, we observed a dose-dependent reduction in viral load in the 80%-treated group and potentiation of macrophage numbers in the 60%- and 80%-treated groups, with no safety concerns. CONCLUSIONS Our data provides support for inhaled ethanol as a candidate treatment for respiratory infections.
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Affiliation(s)
- David G Hancock
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Luke Berry
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
| | - Naomi M Scott
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
| | - Kyle T Mincham
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
- National Heart and Lung Institute, Imperial College London, London, UK
| | - William Ditcham
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Alexander N Larcombe
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
- Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, WA, Australia
| | - Barry Clements
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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Oi I, Ito I, Tanabe N, Konishi S, Ibi Y, Hidaka Y, Hamao N, Shirata M, Nishioka K, Imai S, Yasutomo Y, Kadowaki S, Hirai T. Investigation of predictors for in-hospital death or long-term hospitalization in community-acquired pneumonia with risk factors for aspiration. Eur Clin Respir J 2024; 11:2335721. [PMID: 38586609 PMCID: PMC10997353 DOI: 10.1080/20018525.2024.2335721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024] Open
Abstract
Background It is known that the mortality of pneumonia in patients with risk factors for aspiration is worse than that in those without these risk factors. However, it is still unknown which risk factors for aspiration predict prognosis. Therefore, we aimed to determine which risk factors for aspiration are associated with death or prolonged hospitalization. Methods We prospectively followed patients with community-acquired pneumonia at a single hospital providing acute to chronic care in Japan until they died or were discharged. Patients at any risk of aspiration were included. The associations between pneumonia severity, individual risk factors for aspiration, and in-hospital death or prolonged hospitalization were investigated. Overall survival was estimated by the Kaplan - Meier method, and the factors associated with in-hospital death or prolonged hospitalization were investigated by multivariate analysis using factors selected by a stepwise method. Results In total, 765 patients with pneumonia and risk factors for aspiration were recruited. One hundred and ten patients deceased, and 259 patients were hospitalized over 27 days. In-hospital death increased as the number of risk factors for aspiration increased. In the multivariate analysis, male, impaired consciousness, acidemia, elevated blood urea nitrogen, and bedridden status before the onset of pneumonia were associated with in-hospital death (odds ratio [OR]: 2.5, 2.5, 3.6, 3.1, and 2.6; 95% confidence interval [CI]: 1.6-4.1, 1.4-4.2, 1.6-8.0, 1.9-5.0, and 1.6-4.2 respectively). In the Cox regression analysis, these factors were also associated with in-hospital death. None of the vital signs at admission were associated. Tachycardia, elevated blood urea nitrogen, hyponatremia, and bedridden status were associated with hospitalization for >27 days (OR: 4.1, 2.3, 4.3, and 2.9; 95% CI: 1.3-12.9, 1.5-3.4, 2.0-9.4, and 2.0-4.0, respectively). Conclusions Blood sampling findings and bedridden status are useful for predicting in-hospital mortality and long-term hospitalization in patients with pneumonia and any risk factor for aspiration.
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Affiliation(s)
- Issei Oi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Isao Ito
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Satoshi Konishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Yumiko Ibi
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Yu Hidaka
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Nobuyoshi Hamao
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Masahiro Shirata
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Kensuke Nishioka
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Seiichiro Imai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Yoshiro Yasutomo
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Seizo Kadowaki
- Department of Internal Medicine, Ono Municipal Hospital, Ono, Hyogo, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
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8
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Miquel L, Liotta J, Pivano A, Gnisci A, Netter A, Courbiere B, Agostini A. Ethanol endometrioma sclerotherapy: safety through 8 years of experience. Hum Reprod 2024; 39:733-741. [PMID: 38327007 DOI: 10.1093/humrep/deae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 01/06/2024] [Indexed: 02/09/2024] Open
Abstract
STUDY QUESTION What are the complications of transvaginal ethanol sclerotherapy for the treatment of endometriomas? SUMMARY ANSWER Sclerotherapy is a reliable, minimally invasive method applicable in outpatient procedures but with specific and potential life-threatening complications that need to be identified and prevented. WHAT IS KNOWN ALREADY There are currently few data on the use of transvaginal ethanol sclerotherapy, and we mainly note septic complications. STUDY DESIGN, SIZE, DURATION A retrospective observational cohort study was carried out. The study was conducted at an academic hospital and included 126 women aged 31.9 ± 5.5 years (mean ± SD), between November 2013 and June 2021. We analyzed a total of 157 ethanol sclerotherapy treatment (EST), treated by 131 EST procedures, in 126 women. PARTICIPANTS/MATERIALS, SETTING, METHODS The study included women with an indication for transvaginal ethanol sclerotherapy. Indications were women with at least one endometrioma over 10 mm, isolated or associated with other endometriosis locations, requiring treatment for pain or infertility before assisted reproductive treatment. We followed a standardized transvaginal ethanol sclerotherapy procedure consisting of an ultrasound-guided transvaginal puncture of one or more endometriomas under general anesthesia. The cyst content was completely removed and flushed with saline solution. Ethanol (96%) was injected at 60% of the initial volume of the endometrioma, remained in the cyst for 10 min and was then completely removed. Ethanol loss was defined as a loss of 5 ml or more than 10% of the initial volume of the injected ethanol. Failure was defined by the contraindication of endometrioma puncture because of interposition of the digestive tract, ethanol loss in the previous endometrioma treated (in case of multiple ESTs), failure to aspirate the endometriotic fluid, contraindication to start ethanol injection owing to saline solution leakage, or contraindication to continue ethanol injection owing to suspicions of ethanol leakage at sonography. Intraoperative complications were defined by ethanol loss, positive blood alcohol level, and ethanol intoxication. Postoperative complications were defined by fever, biological inflammatory syndrome, and ovarian abscess. Complications were classified according to the Clavien and Dindo surgical classification, which is a system for classifying postoperative complications in five grades of increasing severity. MAIN RESULTS AND THE ROLE OF CHANCE We reported a total of 17/157 (10.8%) transvaginal ethanol sclerotherapy failures during 14/131 (10.7%) transvaginal ethanol sclerotherapy procedures in 13/126 (10.3%) women. In the same sets of data, complication was reported for 15/157 (9.5%) transvaginal ethanol sclerotherapy in 13/131 (9.9%) transvaginal ethanol sclerotherapy procedures in 13/126 (10.3%) women. Nine of 126 women (7.1%) had a grade I complication, one (0.8%) had a grade II complication (medical treatment for suspicion of pelvic infection), two (1.6%) had a grade III complication (ovarian abscess) and one (0.8%) had a grade IV complication (ethanol intoxication). We did not observe any grade V complications. LIMITATIONS, REASONS FOR CAUTION This was a retrospective study and pain assessment not considered. The benefit-risk balance of endometrioma transvaginal ethanol sclerotherapy was not evaluated. WIDER IMPLICATIONS OF THE FINDINGS Our study is the first to evaluate the complications of transvaginal ethanol sclerotherapy with such a large cohort of women in a standardized protocol. Transvaginal ethanol sclerotherapy seems to be an effective alternative to laparoscopic surgery in the management of endometriomas and limits the alteration of ovarian reserve. Transvaginal ethanol sclerotherapy is a reliable, minimally invasive method applicable on an outpatient basis. The majority of complications are Clavien-Dindo ≤IV, for which preventative measures, or at least early diagnosis and treatment, can be easily performed. The risk of ethanol intoxication is rare, but it is a life-threatening risk that must be avoided by appropriate implementation and promotion of the sclerotherapy procedures. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER Aix Marseille University's ethics committee registration number 2021-06-03-01.
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Affiliation(s)
- L Miquel
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
| | - J Liotta
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
| | - A Pivano
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
| | - A Gnisci
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
| | - A Netter
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
- Department of Mediterranean Institute of marine and terrestrial Biodiversity and Ecology, Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, Marseille, France
| | - B Courbiere
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
- Department of Mediterranean Institute of marine and terrestrial Biodiversity and Ecology, Aix Marseille Univ, Avignon Université, CNRS, IRD, IMBE, Marseille, France
| | - A Agostini
- Department of Obstetrics Gynecology and Reproductive Medicine, Pôle femmes parents enfants, La Conception University Hospital, Marseille, France
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9
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Palmese F, Bonavita ME, Pompili E, Reggidori N, Migliano MT, Di Stefano C, Grieco M, Colazzo S, Baldassarre M, Caraceni P, Foschi FG, Giostra F, Farina G, Del Toro R, Bedogni G, Domenicali M. Development and internal validation of a multivariable model for the prediction of the probability of 1-year readmission to the emergency department for acute alcohol intoxication. Intern Emerg Med 2024; 19:823-829. [PMID: 38095747 DOI: 10.1007/s11739-023-03490-7] [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: 06/19/2023] [Accepted: 11/17/2023] [Indexed: 04/24/2024]
Abstract
To develop and internally validate a multivariable logistic regression model (LRM) for the prediction of the probability of 1-year readmission to the emergency department (ED) in patients with acute alcohol intoxication (AAI). We developed and internally validated the LRM on a previously analyzed retrospective cohort of 3304 patients with AAI admitted to the ED of the Sant'Orsola-Malpighi Hospital (Bologna, Italy). The benchmark LRM employed readmission to the same ED for AAI within 1 year as the binary outcome, age as a continuous predictor, and sex, alcohol use disorder, substance use disorder, at least one previous admission for trauma, mental or behavioral disease, and homelessness as the binary predictors. Optimism correction was performed using the bootstrap on 1000 samples without replacement. The benchmark LRM was gradually simplified to get the most parsimonious LRM with similar optimism-corrected overall fit, discrimination and calibration. The 1-year readmission rate was 15.7% (95% CI 14.4-16.9%). A reduced LRM based on sex, age, at least one previous admission for trauma, mental or behavioral disease, and homelessness, performed nearly as well as the benchmark LRM. The reduced LRM had the following optimism-corrected metrics: scaled Brier score 17.0%, C-statistic 0.799 (95% CI 0.778 to 0.821), calibration in the large 0.000 (95% CI - 0.099 to 0.099), calibration slope 0.985 (95% CI 0.893 to 1.088), and an acceptably accurate calibration plot. An LRM based on sex, age, at least one previous admission for trauma, mental or behavioral disease, and homelessness can be used to estimate the probability of 1-year readmission to ED for AAI. To begin proving its clinical utility, this LRM should be validated in external cohorts.
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Affiliation(s)
- Francesco Palmese
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy.
| | - Maria Elena Bonavita
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Enrico Pompili
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Nicola Reggidori
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Maria Teresa Migliano
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Cecilia Di Stefano
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Marta Grieco
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Stefano Colazzo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Center for Applied Biomedical Research-CRBA, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | | | - Fabrizio Giostra
- Emergency Department-Pronto Soccorso, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Gabriele Farina
- Emergency Department-Pronto Soccorso, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Rossella Del Toro
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
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10
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Joyce LR, Crossin R, Jin S, Young W, Mulder R. Presence of alcohol and other drug use within youth mental health presentations to the emergency department: A single-site retrospective observational study. Emerg Med Australas 2024; 36:213-220. [PMID: 37899072 DOI: 10.1111/1742-6723.14333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Youth mental health is a growing issue, which can be worsened by alcohol and other drug (AOD) use. The present study aimed to characterise the association of AOD use in youth presenting to an ED with a mental health crisis. METHODS A retrospective observational study of paediatric patients presenting with mental health concerns to a tertiary ED in New Zealand in 2019-2020, with an examination of use of alcohol or other drugs before presentation. RESULTS There were 842 ED presentations, made up of 491 unique individuals, examined from the 2-year period. Overdose (63.1%) was the most common reason for presentation, with 39.9% of overdoses involving prescription-only medications, 36.7% over-the-counter, and 20.0% a combination. Seventy-four (8.8%) presentations had documented use of alcohol or other drugs (excluding those taken in overdose) before arrival, with alcohol (51 presentations), followed by cannabis (19 presentations), being the most commonly recorded drugs used. Concurrent AOD use was not associated with any significant difference in triage, length of stay or admission status. CONCLUSION In New Zealand, it is not legal to sell alcohol to persons under 18 years; however, this was the most commonly identified drug impacting on youth mental health presentations. There is a known association between alcohol use and adverse mental health symptoms; therefore, efforts to decrease access to alcohol in this age group must continue, and harm reduction interventions to reduce clinically significant overdoses recommended.
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Affiliation(s)
- Laura R Joyce
- Department of Surgery and Critical Care, University of Otago, Christchurch, New Zealand
- Emergency Department, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Rose Crossin
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Sangjun Jin
- Resident Medical Officer Unit, Te Whatu Ora, Waikato, New Zealand
| | - William Young
- Specialist Mental Health Services, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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11
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Niiya M, Shimato Y, Ohno T, Makino T. Effects of Hovenia dulcis fruit and peduncle extract on alcohol metabolism. JOURNAL OF ETHNOPHARMACOLOGY 2024; 321:117541. [PMID: 38052412 DOI: 10.1016/j.jep.2023.117541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The dried fruit and peduncle of Hovenia dulcis Thunberg (Rhamnaceae) (HD) has been used as a folk medicine to treat liver disease, detoxify alcoholism, and prevent and cure hangovers. AIM OF THE STUDY We investigated the pharmacology of HD on the kinetics of EtOH and on the enzymes related to alcohol metabolism to seek the scientific evidence of HD to prevent hangover, the effectiveness as a folk medicine. MATERIALS AND METHODS EtOH was orally administered 30 min after oral administration of HD boiling water extract in rats. Then, the profiles of blood EtOH concentrations were measured. Mice were reared with food containing powdered HD for 7 days, and the activities of alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH) in liver were measured. Hepa1c1c7 cells were cultured with the medium containing HD extract, and the activities of ADH and ALDH were measured. RESULTS HD extract reduced the blood EtOH concentrations in rats and induced the activities of ADH and ALDH and mRNA and protein expressions of ADH1B, ALDH1A1, and ALDH2 in the liver of mice and Hepa1c1c7 cells. Dihydromyricetin, one of the ingredients of HD, significantly induced the activities of ADH and ALDH in Hepa1c1c7 cells, however, the fractions containing hydrophilic organic compounds with small molecular weight contributed the most of the activities of HD extract. CONCLUSIONS We clarified the experimental pharmacological evidences of HD as a folk medicine to detoxify alcoholism and prevent hangovers.
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Affiliation(s)
- Madoka Niiya
- Department of Pharmacognosy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-Dori, Mizuho-ku, Nagoya, 467-8603, Japan.
| | - Yota Shimato
- Matsuura Yakugyo Co., Ltd., 24-21 Enjo-cho, Showa-ku, Nagoya, 466-0054, Japan.
| | - Takamasa Ohno
- Matsuura Yakugyo Co., Ltd., 24-21 Enjo-cho, Showa-ku, Nagoya, 466-0054, Japan.
| | - Toshiaki Makino
- Department of Pharmacognosy, Graduate School of Pharmaceutical Sciences, Nagoya City University, 3-1 Tanabe-Dori, Mizuho-ku, Nagoya, 467-8603, Japan
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12
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Xuan NTT, Le DV, Thanh MT, Son LD, Doanh NV, Thu DM, Tuan NT, Duy TK, Thang TD, Nien LV. A comparison between the enzymatic oxidation method and headspace gas chromatography with a flame ionization detector in the determination of postmortem blood ethanol. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00791-x. [PMID: 38376759 DOI: 10.1007/s12024-024-00791-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Abstract
Ethanol is the most commonly encountered substance in forensic toxicology. Determining blood alcohol concentration (BAC) in autopsies accounts for the majority of work in forensic diagnosis. The most common method to assess BAC is the enzymatic oxidation method because of its low cost, easy operation, and high throughput. Still, the elevated lactate and lactate dehydrogenase (LDH) levels in postmortem blood may affect accuracy. This study uses headspace gas chromatography with a flame ionization detector (HS-GC/FID) to assess the interference of lactate and LDH levels on BAC in 110 autopsied blood samples determined by the enzymatic oxidation method. The results showed that lactate and LDH levels in postmortem blood were higher than in normal blood. There was a weak correlation between the lactate levels and BAC difference (r = 0.23, p < 0.05) and a strong correlation between LDH levels and BAC difference (r = 0.67, p < 0.001). The differentiation of BAC between the enzymatic oxidation method and HS-GC/FID was significant (p < 0.001), confirming the interference significantly. All postmortem blood samples with lactate and LDH levels higher than regular lead to a positive error in determining BAC by enzymatic oxidation method. The study results suggest that the HS-GC/FID method should be used to determine BAC in postmortem blood samples instead of the enzymatic oxidation method to avoid mistakes in forensic diagnosis.
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Affiliation(s)
| | - Dinh Vu Le
- Faculty of Chemical Engineering, Industrial University of Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam.
| | - Mai Thi Thanh
- Forensic Medicine Center of Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Le Dinh Son
- Forensic Medicine Center of Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Nguyen Viet Doanh
- Forensic Medicine Center of Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Dang Minh Thu
- Forensic Medicine Center of Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Nguyen Trong Tuan
- Forensic Medicine Center of Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Trang Khanh Duy
- Forensic Medicine Center of Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
| | - Tran Dinh Thang
- Institute of Biotechnology and Food Technology, Industrial University of Ho Chi Minh City, Ho Chi Minh, 700000, Vietnam
| | - Lam Vinh Nien
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000, Vietnam
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13
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Park YS, Yun I, Jang SY, Park EC, Jang SI. Association between nurse staffing level in intensive care settings and hospital-acquired pneumonia among surgery patients: result from the Korea National Health Insurance cohort. Epidemiol Infect 2024; 152:e62. [PMID: 38326273 PMCID: PMC11062778 DOI: 10.1017/s0950268824000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
This study examined the association between the number of nursing staff in intensive care units (ICUs) and hospital-acquired pneumonia (HAP) among surgical patients in South Korea. Data were obtained between 2008 and 2019 from the Korean National Health Insurance Service Cohort Database; 37,706 surgical patients who received critical care services were included in the analysis. Patients with a history of pneumonia 1 year prior to surgery or those who had undergone lung-related surgery were excluded. The ICU nursing management fee is an admission fee that varies based on the grading determined by nurse-to-bed ratio. Using this grading system, we classified four groups from the highest to the lowest level based on the proportion of beds to nurses (high, high-mid, mid-low, and low group). HAP was defined by the International Classification of Disease, 10th revision (ICD-10) code. Multilevel logistic regression was used to investigate the relationship between the level of ICU nurse staffing and pneumonia, controlling for variables at the individual and hospital levels. Lower levels of nurse staffing were associated with a greater incidence of HAP than higher levels of nurse staffing (mid-high, OR: 1.33, 95% CI: 1.12-1.57; mid-low, OR: 1.61, 95% CI: 1.27-2.04; low, OR: 2.13, 95% CI: 1.67-2.71). The intraclass correlation coefficient value was 0.177, and 17.7% of the variability in HAP was accounted for by the hospital. Higher ICU nursing management fee grades (grade 5 and above) in general and hospital settings were significantly associated with an increased risk of HAP compared to grade 1 admissions. Similarly, in tertiary hospitals, grade 2 and higher ICU nursing management fees were significantly associated with an increased risk of HAP compared to grade 1 admissions. Especially, a lower level of nurse staffing was associated with bacterial pneumonia but not pneumonia due to aspiration. In conclusion, this study found an association between the level of ICU nurse staffing and HAP among surgical patients. A lower level of nurse staffing in the ICU was associated with increased rates of HAP among surgical patients. This indicates that having fewer beds assigned to nurses in the ICU setting is a significant factor in preventing HAP, regardless of the size of the hospital.
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Affiliation(s)
- Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Il Yun
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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14
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Davidson TL, Stevenson RJ. Vulnerability of the Hippocampus to Insults: Links to Blood-Brain Barrier Dysfunction. Int J Mol Sci 2024; 25:1991. [PMID: 38396670 PMCID: PMC10888241 DOI: 10.3390/ijms25041991] [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: 01/03/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
The hippocampus is a critical brain substrate for learning and memory; events that harm the hippocampus can seriously impair mental and behavioral functioning. Hippocampal pathophysiologies have been identified as potential causes and effects of a remarkably diverse array of medical diseases, psychological disorders, and environmental sources of damage. It may be that the hippocampus is more vulnerable than other brain areas to insults that are related to these conditions. One purpose of this review is to assess the vulnerability of the hippocampus to the most prevalent types of insults in multiple biomedical domains (i.e., neuroactive pathogens, neurotoxins, neurological conditions, trauma, aging, neurodegenerative disease, acquired brain injury, mental health conditions, endocrine disorders, developmental disabilities, nutrition) and to evaluate whether these insults affect the hippocampus first and more prominently compared to other brain loci. A second purpose is to consider the role of hippocampal blood-brain barrier (BBB) breakdown in either causing or worsening the harmful effects of each insult. Recent research suggests that the hippocampal BBB is more fragile compared to other brain areas and may also be more prone to the disruption of the transport mechanisms that act to maintain the internal milieu. Moreover, a compromised BBB could be a factor that is common to many different types of insults. Our analysis indicates that the hippocampus is more vulnerable to insults compared to other parts of the brain, and that developing interventions that protect the hippocampal BBB may help to prevent or ameliorate the harmful effects of many insults on memory and cognition.
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Affiliation(s)
- Terry L. Davidson
- Department of Neuroscience, Center for Neuroscience and Behavior, American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
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15
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D'Elia F, Simonit F, Desinan L. A case of complex asphyxia sheds light on problems in the classification of asphyxias. Leg Med (Tokyo) 2024; 66:102368. [PMID: 38039659 DOI: 10.1016/j.legalmed.2023.102368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Death from positional asphyxia is often an accidental event occurring when the victim's body assumes a position which can compromise an effective respiration. Its diagnosis is usually not simple, because it needs to know the exact circumstance in which the body was found and the original positioning of all the body segments. In this case, a 41-year-old man with a history of opioid drugs abuse was found dead in a knee-chest position; the head was down on the floor with the face resting on a plastic bag. Pictures of the scene of death was taken while the body was still in its original position. At first, the main suspicion was that of a fatal overdose. Following the autopsy examination, completed by histological and toxicological examinations, the cause of death was determined as postural asphyxia secondary to intoxication by methadone, in the presence of ischemic heart disease. Some features, moreover, were typical of the death in head down position, and the prolonged knee-chest position was also associated with the obstruction of mouth and nose by the plastic bag, which may have contributed to the asphyxiation. These cases of "combined" asphyxia represent a challenge for the current classifications of asphyxia, which are very variable and not standardized, as we observe from a brief review of the literature. The elaboration of new systems of classification for asphyxias, which must be clear, simple and shareable, is necessary to avoid confusion in categorizing cases that present overlapping between several types of asphyxiation modalities.
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Affiliation(s)
- Francesco D'Elia
- University of Trieste, Clinical Department of Medical Surgical and Health Sciences, School of Legal Medicine, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy.
| | - Francesco Simonit
- Department of Medicine, Legal Medicine, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD, Italy.
| | - Lorenzo Desinan
- Department of Medicine, Legal Medicine, University of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, UD, Italy.
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16
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Uslin V, Hällberg V, Lukkarinen T, Niskanen M, Koivistoinen T, Palomäki A. A four-way patient search method for the retrospective identification of poisoning patients. Sci Rep 2024; 14:1801. [PMID: 38245593 PMCID: PMC10799932 DOI: 10.1038/s41598-024-52358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
When studying emergency department (ED) visits, electronic health record systems of hospitals provide a good basis for retrospective studies. However, many intoxication patients presenting to the ED, may not be identified retrospectively if only a single search method is applied. In this study, a new four-way combined patient search method was used to retrospectively identify intoxication patients presenting to the ED. The search included reason for admission to the ED, laboratory results related to intoxication diagnostics, ICD-10 codes, and a novel free word search (FWS) of patient records. After the automated search, the researcher read the medical records of potential substance abuse patients to form comprehensive profiles and remove irrelevant cases. The addition of a free word search identified 36% more substance abuse patients than the combination of the other three methods mentioned above. Patients identified by the FWS search alone were generally admitted to the ED for trauma or mental health problems and were often found to be heavily under the influence of alcohol and/or drugs. The main intoxicants were ethanol and benzodiazepines. The free word search was highly complementary to traditional patient search methods, highlighting the importance of the combined patient search method in retrospective data collection.
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Affiliation(s)
- Veronika Uslin
- Department of Medicine and Surgery, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
- Emergency Department, Kanta-Häme Central Hospital, 13530, Hämeenlinna, Finland.
| | - Ville Hällberg
- Emergency Department, Kanta-Häme Central Hospital, 13530, Hämeenlinna, Finland
| | - Timo Lukkarinen
- City of Helsinki, Social Services, Health Care and Rescue Services Division, 00100, Helsinki, Finland
| | | | - Teemu Koivistoinen
- Emergency Department, Kanta-Häme Central Hospital, 13530, Hämeenlinna, Finland
| | - Ari Palomäki
- Emergency Department, Kanta-Häme Central Hospital, 13530, Hämeenlinna, Finland
- Faculty of Medicine and Health Technology, Tampere University, 33520, Tampere, Finland
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17
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Li Q, Lu Y, Shang J, Song Q, Jiao J, Bi L, Jiang T, Liu X. Ganshuang granule plays a pharmacological role in anti-alcoholic and anti-hangover via regulating alcohol metabolism and affecting neurotransmitters. Int J Neurosci 2024:1-13. [PMID: 38197183 DOI: 10.1080/00207454.2023.2300734] [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: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND To explore the effect of Ganshuang granule on anti-alcoholic and anti-hangover and its potential mechanism. METHODS SPF SD rats' drunken model and SPF Kunming mice's hangover model were used as models. RESULTS Ganshuang granule could significantly reduce sleep time, the time to climb in mice, and significantly prolong the tolerance time and shorten sleep time in rats (p < 0.05). The blood ethanol concentration of rats in each administration group was lower than that in the model group at each time point (p < 0.05). Compared with the control group, the activities of ADH and ALDH in the liver of the model group were significantly decreased (p < 0.05); the content of DA and 5-HT in the striatum of the model group was significantly increased (p < 0.05); and the activity of AchE in the hippocampus was significantly decreased (p < 0.05). The above processes could be improved and regulated in the drug administration group. Compared with the control group, there was no significant difference between ADH and ALDH in the serum of the model group (p > 0.05). However, the activities of ADH and ALDH in the liver of drunk rats could be upregulated by Ganshuang granule (p < 0.05). CONCLUSION Ganshuang granule has the pharmacological effects of anti-alcoholic and anti-hangover, which is related to regulating the activities of ADH and ALDH in the liver, the contents of DA and 5-HT in striatum, and the activity of AchE in the hippocampus.
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Affiliation(s)
- Qiannan Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yinghui Lu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Jinfeng Shang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Song
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Jiakang Jiao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Lei Bi
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Tingyue Jiang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Xin Liu
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
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18
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Sun T, Lv J, Zhao X, Li W, Zhang Z, Nie L. In vivo liver function reserve assessments in alcoholic liver disease by scalable photoacoustic imaging. PHOTOACOUSTICS 2023; 34:100569. [PMID: 38046637 PMCID: PMC10690638 DOI: 10.1016/j.pacs.2023.100569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/09/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023]
Abstract
We present a rapid and high-resolution photoacoustic imaging method for evaluating the liver function reserve (LFR). To validate its accuracy, we establish alcoholic liver disease (ALD) models and employ dual-wavelength spectral unmixing to assess oxygen metabolism. An empirical mathematical model fits the photoacoustic signals, obtaining liver metabolism curve and LFR parameters. Liver oxygen metabolism significantly drops in ALD with the emergence of abnormal hepatic lobular structure. ICG half-life remarkably extends from 241 to 568 s in ALD. A significant decline in LFR occurs in terminal region compared to central region, indicated by a 106.9 s delay in ICG half-life, likely due to hepatic artery and vein damage causing hypoxia and inadequate nutrition. Reduced glutathione repairs LFR with a 43% improvement by reducing alcohol-induced oxidative damage. Scalable photoacoustic imaging shows immense potential for assessing LFR in alcoholic-related diseases, providing assistance to early detection and management of liver disease.
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Affiliation(s)
- Tong Sun
- Medical Research Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, South China Normal University, Guangzhou 510631, China
| | - Jing Lv
- Guangdong Cardiovascular Institute, Guangzhou 510080, China
- Medical Research Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
| | - Xingyang Zhao
- Medical Research Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
| | - Wenya Li
- Medical Research Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
| | - Zhenhui Zhang
- MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, South China Normal University, Guangzhou 510631, China
| | - Liming Nie
- Medical Research Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou 510080, China
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19
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Munshi S, Albrechet-Souza L, Dos-Santos RC, Stelly CE, Secci ME, Gilpin NW, Tasker JG. Acute Ethanol Modulates Synaptic Inhibition in the Basolateral Amygdala via Rapid NLRP3 Inflammasome Activation and Regulates Anxiety-Like Behavior in Rats. J Neurosci 2023; 43:7902-7912. [PMID: 37739795 PMCID: PMC10669756 DOI: 10.1523/jneurosci.1744-22.2023] [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: 09/13/2022] [Revised: 08/22/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
Chronic alcohol exposure leads to a neuroinflammatory response involving activation of the nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome and proinflammatory cytokine production. Acute ethanol (EtOH) exposure activates GABAergic synapses in the central and basolateral amygdala (BLA) ex vivo, but whether this rapid modulation of synaptic inhibition is because of an acute inflammatory response and alters anxiety-like behavior in male and female animals is not known. Here, we tested the hypotheses that acute EtOH facilitates inhibitory synaptic transmission in the BLA by activating the NLRP3 inflammasome-dependent acute inflammatory response, that the alcohol-induced increase in inhibition is cell type and sex dependent, and that acute EtOH in the BLA reduces anxiety-like behavior. Acute EtOH application at a binge-like concentration (22-44 mm) stimulated synaptic GABA release from putative parvalbumin (PV) interneurons onto BLA principal neurons in ex vivo brain slices from male, but not female, rats. The EtOH facilitation of synaptic inhibition was blocked by antagonists of the Toll-like receptor 4 (TLR4), the NLRP3 inflammasome, and interleukin-1 receptors, suggesting it was mediated by a rapid local neuroinflammatory response in the BLA. In vivo, bilateral injection of EtOH directly into the BLA produced an acute concentration-dependent reduction in anxiety-like behavior in male but not female rats. These findings demonstrate that acute EtOH in the BLA regulates anxiety-like behavior in a sex-dependent manner and suggest that this effect is associated with presynaptic facilitation of parvalbumin-expressing interneuron inputs to BLA principal neurons via a local NLRP3 inflammasome-dependent neuroimmune response.SIGNIFICANCE STATEMENT Chronic alcohol exposure produces a neuroinflammatory response, which contributes to alcohol-associated pathologies. Acute alcohol administration increases inhibitory synaptic signaling in the brain, but the mechanism for the rapid alcohol facilitation of inhibitory circuits is unknown. We found that acute ethanol at binge-like concentrations in the basolateral amygdala (BLA) facilitates GABA release from parvalbumin-expressing (PV) interneuron synapses onto principal neurons in ex vivo brain slices from male rats and that intra-BLA ethanol reduces anxiety-like behavior in vivo in male rats, but not female rats. The ethanol (EtOH) facilitation of inhibition in the BLA is mediated by Toll-like receptor 4 (TLR4) and nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome activation and proinflammatory IL-1β signaling, which suggests a rapid NLRP3 inflammasome-dependent neuroimmune cascade that plays a critical role in acute alcohol intoxication.
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Affiliation(s)
- Soumyabrata Munshi
- Department of Cell and Molecular Biology, Tulane University, New Orleans, Louisiana 70118
| | - Lucas Albrechet-Souza
- Department of Cell Biology and Anatomy, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
- Alcohol and Drug Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
| | | | - Claire E Stelly
- Department of Cell and Molecular Biology, Tulane University, New Orleans, Louisiana 70118
| | - Maria E Secci
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
- Alcohol and Drug Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
- Southeast Louisiana Veterans Affairs Healthcare System (SLVHCS), New Orleans, Louisiana 70119
| | - Nicholas W Gilpin
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
- Alcohol and Drug Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
- Neuroscience Center of Excellence, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112
- Southeast Louisiana Veterans Affairs Healthcare System (SLVHCS), New Orleans, Louisiana 70119
| | - Jeffrey G Tasker
- Department of Cell and Molecular Biology, Tulane University, New Orleans, Louisiana 70118
- Tulane Brain Institute, Tulane University, New Orleans, Louisiana 70118
- Southeast Louisiana Veterans Affairs Healthcare System (SLVHCS), New Orleans, Louisiana 70119
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20
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Bujaroska Perkovikj M, Anastasova L, Stankov A, Zhivikj Z, Poposka V, Petrusevska-Tozi L. The role of alcohol and patterns of alcohol-related deaths in Republic of North Macedonia within the period 2007-2020. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00748-6. [PMID: 37946096 DOI: 10.1007/s12024-023-00748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Excessive alcohol consumption is one of the most important factors in a substantial number of violent deaths. The aim of our study was to investigate alcohol-related deaths in the Republic of North Macedonia in the period from 2007 to 2020, in order to study the influence of elevated blood alcohol levels in violent deaths. Five hundred sixty-four post-mortem blood samples from alcohol-related death cases-natural deaths and violent deaths (suicides, accidents, and homicides)-were analyzed, and the results were evaluated according to sex, age, and cause of death. Among 564 cases, traffic accidents were the leading cause of violent death (54.3% of the cases) followed by suicides (19.9% of the cases). In the examined post-mortem samples, BAC values ranged from 0.15-6.20 g/L. The average age was 45 ± 16 years for the male and 49 ± 19 years for the female group. The biggest proportion of high BAC values was found in the group of accidents specifically road traffic accidents and accidental intoxication as well as in the group of bolus deaths. The analysis of BAC in the cases of violent deaths in the Republic of North Macedonia confirmed that consumption of alcohol is strongly related to violent deaths. The data obtained from this study could raise caution and give aid in a national strategy for the prevention of alcohol-related violent deaths.
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Affiliation(s)
- Marija Bujaroska Perkovikj
- Institute of Forensic Medicine, Criminology and Medical Deontology, Medical Faculty, Ss. Cyril and Methodius University in Skopje, Mother Theresa 19, 1000, Skopje, Republic of North Macedonia.
| | - Liljana Anastasova
- Institute of Applied Chemistry and Pharmaceutical Analysis, Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000, Skopje, Republic of North Macedonia
| | - Aleksandar Stankov
- Institute of Forensic Medicine, Criminology and Medical Deontology, Medical Faculty, Ss. Cyril and Methodius University in Skopje, Mother Theresa 19, 1000, Skopje, Republic of North Macedonia
| | - Zoran Zhivikj
- Institute of Applied Biochemistry, Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000, Skopje, Republic of North Macedonia
| | - Verica Poposka
- Institute of Forensic Medicine, Criminology and Medical Deontology, Medical Faculty, Ss. Cyril and Methodius University in Skopje, Mother Theresa 19, 1000, Skopje, Republic of North Macedonia
| | - Lidija Petrusevska-Tozi
- Institute of Applied Biochemistry, Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Mother Theresa 47, 1000, Skopje, Republic of North Macedonia
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21
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Kim H, Suh HJ, Hong KB, Jung EJ, Ahn Y. Combination of Cysteine and Glutathione Prevents Ethanol-Induced Hangover and Liver Damage by Modulation of Nrf2 Signaling in HepG2 Cells and Mice. Antioxidants (Basel) 2023; 12:1885. [PMID: 37891964 PMCID: PMC10604027 DOI: 10.3390/antiox12101885] [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: 09/22/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Excessive alcohol consumption increases oxidative stress, leading to alcoholic liver disease. In this study, the protective effects of a mixture of cysteine and glutathione against ethanol-induced hangover and liver damage were evaluated in mice and HepG2 cells. Ethanol (2 mL/kg) was orally administered to the mice 30 min before receiving the test compounds (200 mg/kg), and the behavioral and oxidative stress-related biochemical parameters altered by ethanol were analyzed. Acute ethanol administration increased anxiety behavior and decreased balance coordination in mice (p < 0.001); however, a mixture of cysteine and glutathione (MIX) in a 3:1 ratio improved alcohol-induced behavior more effectively than the individual compounds (p < 0.001). The MIX group showed higher ethanol-metabolizing enzyme activity than the control group (p < 0.001) and significantly suppressed the elevation of serum alcohol (p < 0.01) and acetaldehyde (p < 0.001) levels after 1 h of ethanol administration. In HepG2 cells, 2.5 mM MIX accelerated ethanol metabolism and reduced cytochrome P450 2E1 mRNA expression (p < 0.001). MIX also increased the expression of antioxidant enzymes through the upregulation of nuclear erythroid 2-related factor 2 (Nrf2) signaling and consequently suppressed the overproduction of reactive oxygen species and malondialdehyde (p < 0.001). Collectively, MIX alleviates the hangover symptoms and attenuates the alcohol-induced oxidative stress by regulating the Nrf2 pathway.
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Affiliation(s)
- Hyeongyeong Kim
- Department of Integrated Biomedical and Life Science, Graduate School, Korea University, Seoul 02841, Republic of Korea; (H.K.); (H.J.S.)
- Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul 02841, Republic of Korea
| | - Hyung Joo Suh
- Department of Integrated Biomedical and Life Science, Graduate School, Korea University, Seoul 02841, Republic of Korea; (H.K.); (H.J.S.)
- Transdisciplinary Major in Learning Health Systems, Department of Healthcare Sciences, Graduate School, Korea University, Seoul 02841, Republic of Korea
| | - Ki-Bae Hong
- Department of Food Science and Nutrition, Jeju National University, Jeju 63243, Republic of Korea;
| | - Eun-Jin Jung
- Department of Food and Biotechnology, Korea University, Sejong 30019, Republic of Korea;
| | - Yejin Ahn
- Research Group of Functional Food Materials, Korea Food Research Institute, Wanju-gun 55365, Republic of Korea
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22
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Won YW, Kang JH, Kwon JH, Koo DH, Kang JH, Maeng CH, Ahn HK, Oh SY, Lee DW, Sohn J, Oh SY, Lee KH, Koh SJ, Lee KS, Kim CK, Kim JY, Ji JH, Kim SB, Ha JY, Kim HY. A Multicenter, Prospective, Observational Study to Evaluate Ethanol-Induced Symptoms in Patients Receiving Docetaxel Chemotherapy. Cancer Res Treat 2023; 55:1096-1103. [PMID: 37054719 PMCID: PMC10582550 DOI: 10.4143/crt.2022.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/03/2023] [Indexed: 04/15/2023] Open
Abstract
PURPOSE Several previous studies and case reports have reported ethanol-induced symptoms in patients receiving anticancer drugs containing ethanol. Most docetaxel formulations contain ethanol as a solvent. However, there are insufficient data on ethanol-induced symptoms when docetaxel-containing ethanol is administered. The primary purpose of this study was to investigate the frequency and pattern of ethanol-induced symptoms during and after docetaxel administration. The secondary purpose was to explore the risk factors for ethanol-induced symptoms. MATERIALS AND METHODS This was a prospective, multicenter, observational study. The participants filled out ethanol-induced symptom questionnaire on the day of chemotherapy and the following day. RESULTS Data from 451 patients were analyzed. The overall occurrence rate of ethanol-induced symptoms was 44.3% (200/451 patients). The occurrence rate of facial flushing was highest at 19.7% (89/451 patients), followed by nausea in 18.2% (82/451 patients), and dizziness in 17.5% (79/451 patients). Although infrequent, unsteady walking and impaired balance occurred in 4.2% and 3.3% of patients, respectively. Female sex, presence of underlying disease, younger age, docetaxel dose, and docetaxel-containing ethanol amount were significantly associated with the occurrence of ethanol-induced symptoms. CONCLUSION The occurrence of ethanol-induced symptoms was not low in patients receiving docetaxel-containing ethanol. Physicians need to pay more attention to the occurrence of ethanol-induced symptoms and prescribe ethanol-free or low-ethanol-containing formulations to high-risk patients.
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Affiliation(s)
- Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri,
Korea
| | - Jin-Hyoung Kang
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jung Hye Kwon
- Division of Hematology and Oncology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong,
Korea
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jung Hun Kang
- Division of Hematology and Oncology, Department of Internal Medicine, Gyeongsang National University College of Medicine, Jinju,
Korea
| | - Chi Hoon Maeng
- Division of Oncology and Hematology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul,
Korea
| | - Hee Kyung Ahn
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Sung Yong Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan,
Korea
| | - Dae-Won Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Joohyuk Sohn
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,
Korea
| | - So Yeon Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan University College of Medicine, Yangsan,
Korea
| | - Kyung Hee Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu,
Korea
| | - Su-Jin Koh
- Division of Hematology and Oncology, Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan,
Korea
| | - Keun Seok Lee
- Center for Breast Cancer, Research Institute, National Cancer Center, Goyang,
Korea
| | - Chan-Kyu Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon,
Korea
| | - Ji-Yeon Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Jun Ho Ji
- Division of Hematology and Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon,
Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Joo Young Ha
- Division of Hematology and Oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - Ho Young Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
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23
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Wargh N, Piltti J, Hedberg P. The performance of saliva test strips for determining ethanol levels, as compared to gas chromatography and breathalyser methods. Scand J Clin Lab Invest 2023; 83:432-438. [PMID: 37694716 DOI: 10.1080/00365513.2023.2255970] [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: 04/26/2023] [Revised: 08/18/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
We set out to determine the performance of the Testi Technologies enzymatic assay saliva ethanol test strips of three different detection levels: 0 g/L, 0.2 g/L and 0.5 g/L, using as the reference method a gas chromatography analyser (GC). Alcohol levels were measured in 104 volunteers at up to three points in time, using up to three test strips per measurement, while gathering blood samples and breathalyser readings in parallel. The plasma alcohol concentrations (PAC) were determined from the plasma samples using GC. The qualitative results of the test strips were compared to the quantitative results from the reference method, as well as the breathalyser readings, and the amount of true and false positive and true and false negative results were classified using predetermined cut-off levels. The best performing test strips were the 0 g/L and the 0.2 g/L strips. The 0 g/L strips had a sensitivity and specificity of 1.00, as false negatives and false positives were not detected. The 0.2 g/L strips had a sensitivity and specificity [95% confidence interval (CI)] of 0.98 (0.96 - 1.00) and 0.83 (0.62 - 1.00) respectively, an accuracy of 0.97 (0.95 - 0.99), and a diagnostic odds ratio of 205.00 (35.33 - 1189.66). The test strips perform their intended purpose of screening for alcohol consumption well, with their great sensitivity as a defining property compared to other testing methods. For them to be able to be implemented in a clinical setting however, further refinement of the tests' characteristics would be required.
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Affiliation(s)
- Niklas Wargh
- NordLab Wellbeing Services, Oulu University Hospital, Oulu, Finland
| | - Juha Piltti
- NordLab Wellbeing Services, Oulu University Hospital, Oulu, Finland
| | - Pirjo Hedberg
- NordLab Wellbeing Services, Oulu University Hospital, Oulu, Finland
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24
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Dong J, Wang S, Mao J, Wang Z, Zhao S, Ren Q, Kang J, Ye J, Xu X, Zhu Y, Zhang Q. Preparation of Dihydromyricetin-Loaded Self-Emulsifying Drug Delivery System and Its Anti-Alcoholism Effect. Pharmaceutics 2023; 15:2296. [PMID: 37765265 PMCID: PMC10535266 DOI: 10.3390/pharmaceutics15092296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
Intraperitoneal injection of dihydromyricetin (DMY) has shown promising potential in the treatment of alcoholism. However, its therapeutic effect is limited due to its low solubility, poor stability, and high gut-liver first-pass metabolism, resulting in very low oral bioavailability. In this study, we developed a DMY-loaded self-emulsifying drug delivery system (DMY-SEDDS) to enhance the oral bioavailability and anti-alcoholism effect of DMY. DMY-SEDDS improved the oral absorption of DMY by facilitating lymphatic transport. The area under the concentration-time curve (AUC) of DMY in the DMY-SEDDS group was 4.13-fold higher than in the DMY suspension group. Furthermore, treatment with DMY-SEDDS significantly enhanced the activities of alcohol dehydrogenase (ADH) and acetaldehyde dehydrogenase (ALDH) in the liver of mice (p < 0.05). Interestingly, DMY-SEDDS also increased ADH activity in the stomach of mice with alcoholism (p < 0.01), thereby enhancing ethanol metabolism in the gastrointestinal tract and reducing ethanol absorption into the bloodstream. As a result, the blood alcohol concentration of mice with alcoholism was significantly decreased after DMY-SEDDS treatment (p < 0.01). In the acute alcoholism mice model, compared to saline treatment, DMY-SEDDS prolonged the onset of LORR (loss of righting reflex) (p < 0.05) and significantly shortened the duration of LORR (p < 0.01). Additionally, DMY-SEDDS treatment significantly reduced gastric injury in acute alcoholism mice. Collectively, these findings demonstrate the potential of DMY-SEDDS as a treatment in the treatment of alcoholism.
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Affiliation(s)
- Jianxia Dong
- Department of Medicinal Natural Products, West China School of Pharmacy, Sichuan University, Chengdu 610041, China; (J.D.); (S.W.)
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.W.); (J.K.)
| | - Shu Wang
- Department of Medicinal Natural Products, West China School of Pharmacy, Sichuan University, Chengdu 610041, China; (J.D.); (S.W.)
| | - Jiamin Mao
- Institute of Materia Medica, Structure-Specific Small Molecule Drugs Key Laboratory of Sichuan Provincial Universities, School of Pharmacy, Chengdu Medical College, Chengdu 610500, China; (S.Z.); (Q.R.); (J.Y.); (X.X.); (Y.Z.)
| | - Zhidan Wang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.W.); (J.K.)
| | - Shiying Zhao
- Institute of Materia Medica, Structure-Specific Small Molecule Drugs Key Laboratory of Sichuan Provincial Universities, School of Pharmacy, Chengdu Medical College, Chengdu 610500, China; (S.Z.); (Q.R.); (J.Y.); (X.X.); (Y.Z.)
| | - Qiao Ren
- Institute of Materia Medica, Structure-Specific Small Molecule Drugs Key Laboratory of Sichuan Provincial Universities, School of Pharmacy, Chengdu Medical College, Chengdu 610500, China; (S.Z.); (Q.R.); (J.Y.); (X.X.); (Y.Z.)
| | - Jialing Kang
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China; (Z.W.); (J.K.)
| | - Jing Ye
- Institute of Materia Medica, Structure-Specific Small Molecule Drugs Key Laboratory of Sichuan Provincial Universities, School of Pharmacy, Chengdu Medical College, Chengdu 610500, China; (S.Z.); (Q.R.); (J.Y.); (X.X.); (Y.Z.)
| | - Xiaohong Xu
- Institute of Materia Medica, Structure-Specific Small Molecule Drugs Key Laboratory of Sichuan Provincial Universities, School of Pharmacy, Chengdu Medical College, Chengdu 610500, China; (S.Z.); (Q.R.); (J.Y.); (X.X.); (Y.Z.)
| | - Yujin Zhu
- Institute of Materia Medica, Structure-Specific Small Molecule Drugs Key Laboratory of Sichuan Provincial Universities, School of Pharmacy, Chengdu Medical College, Chengdu 610500, China; (S.Z.); (Q.R.); (J.Y.); (X.X.); (Y.Z.)
| | - Quan Zhang
- Institute of Materia Medica, Structure-Specific Small Molecule Drugs Key Laboratory of Sichuan Provincial Universities, School of Pharmacy, Chengdu Medical College, Chengdu 610500, China; (S.Z.); (Q.R.); (J.Y.); (X.X.); (Y.Z.)
- Development and Regeneration Key Lab of Sichuan Province, Department of Pathology, Department of Anatomy and Histology and Embryology, Chengdu Medical College, Chengdu 610500, China
- Chengdu Nature’s Grace Biological Technology Co., Ltd., Chengdu 610213, China
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25
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Cinquetti A, Terranova C, Aprile A, Favretto D. Driving license regranting: Hair EtG, serum CDT, and the role of sociodemographic and medicolegal variables. Drug Test Anal 2023; 15:953-961. [PMID: 36525282 DOI: 10.1002/dta.3426] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
Driving under the influence (DUI) of alcohol is a road safety problem. Driving license regranting is based on the evaluation of medicolegal and toxicological variables that may include serum carbohydrate-deficient transferrin (CDT) and hair ethyl glucuronide (hEtG). The aim of the study was to compare the diagnostic performance of CDT and hEtG in a population of DUI offenders. Other factors potentially associated with heavy alcohol use were explored. The population included DUI offenders examined during the period of January 1, 2019, through June 30, 2022. Sociodemographic, medicolegal, and toxicological variables were collected. CDT in serum and EtG in head hair were determined in all subjects. Excessive alcohol intake (hEtG ≥30 pg/mg) was considered cause for unfitness to drive. Cohen's kappa coefficient was calculated. Descriptive analyses were performed using chi-square and Mann-Whitney tests. Variables significantly different between the groups were included in a multivariate binary logistic regression model. The sample encompassed 838 subjects (case group: 179, comparison group: 689). CDT exhibited poor agreement (κ = 0.053) with hEtG as the reference test. Lower education, age at DUI, heavy smoking, and GGT levels associated with heavy alcohol consumption differentiated the two groups. For DUI offenders, the use of CDT to assess heavy alcohol consumption is limited, possibly due to the time-window assessed, the time required for normalization, and the different amount of ethanol needed to reach higher CDT levels, in comparison to hEtG; thus, hEtG assessment is strongly recommended for this population. Heavy smoking, GGT, education, and age could be related to heavy alcohol consumption and higher risk of DUI.
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Affiliation(s)
- Alessandro Cinquetti
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Claudio Terranova
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Anna Aprile
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Donata Favretto
- Legal Medicine and Toxicology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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26
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Wang Y, Chen Q, Wu S, Sun X, Yin R, Ouyang Z, Yin H, Wei Y. Amelioration of ethanol-induced oxidative stress and alcoholic liver disease by in vivo RNAi targeting Cyp2e1. Acta Pharm Sin B 2023; 13:3906-3918. [PMID: 37719371 PMCID: PMC10502278 DOI: 10.1016/j.apsb.2023.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/16/2022] [Accepted: 12/10/2022] [Indexed: 09/19/2023] Open
Abstract
Alcoholic liver disease (ALD) results from continuous and heavy alcohol consumption. The current treatment strategy for ALD is based on alcohol withdrawal coupled with antioxidant drug intervention, which is a long process with poor efficacy and low patient compliance. Alcohol-induced CYP2E1 upregulation has been demonstrated as a key regulator of ALD, but CYP2E1 knockdown in humans was impractical, and pharmacological inhibition of CYP2E1 by a clinically relevant approach for treating ALD was not shown. In this study, we developed a RNAi therapeutics delivered by lipid nanoparticle, and treated mice fed on Lieber-DeCarli ethanol liquid diet weekly for up to 12 weeks. This RNAi-based inhibition of Cyp2e1 expression reduced reactive oxygen species and oxidative stress in mouse livers, and contributed to improved ALD symptoms in mice. The liver fat accumulation, hepatocyte inflammation, and fibrosis were reduced in ALD models. Therefore, this study suggested the feasibility of RNAi targeting to CYP2E1 as a potential therapeutic tool to the development of ALD.
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Affiliation(s)
- Yalan Wang
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, China
| | - Qiubing Chen
- Department of Urology, Frontier Science Centre for Immunology and Metabolism, Medical Research Institute, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
- Department of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Shuang Wu
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, China
| | - Xinyu Sun
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, China
| | - Runting Yin
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, China
| | - Zhen Ouyang
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, China
| | - Hao Yin
- Department of Urology, Frontier Science Centre for Immunology and Metabolism, Medical Research Institute, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
- Department of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- RNA Institute, Wuhan University, Wuhan 430072, China
- Wuhan Research Centre for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan 430010, China
| | - Yuan Wei
- School of Pharmacy, Jiangsu University, Zhenjiang 212013, China
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van Roozendaal H, Verhulst S, Glazemakers I, De Meulder F, Vander Auwera A, Bael A, Van Damme E, Vlemincx I, De Dooy J, van der Lely N, Van Hal G. Characteristics of Adolescents Admitted with Acute Alcohol Intoxication: A Retrospective Multicentre Study in Antwerp, Belgium, in the Period 2015-2021. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1378. [PMID: 37628377 PMCID: PMC10453587 DOI: 10.3390/children10081378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
Binge drinking among adolescents is common in Belgium, posing a risk of serious health consequences. Until today, only estimations of the prevalence of acute alcohol intoxication (AAI) in adolescents have been made. Research into potential risk factors has not yet been conducted in Belgium. Therefore, this study aims to gain more insight into the prevalence, medical characteristics and potential risk factors of AAI among adolescents. A retrospective multicentre chart study was performed on adolescents aged 10-17 years with AAI in Antwerp, Belgium (2015-2021). Patient's demographics, medical characteristics and information regarding the context of the AAI were collected from medical charts. Over the study period, a total of 1016 patients were admitted with AAI in Antwerp, having a median age of 16.6 years old, a median blood alcohol concentration of 1.95 g/L and combined drug use in 10% of cases. These findings did not significantly change over the study period. Multiple linear regression analysis indicated that after correcting for covariates, higher age, no combined drug use and decreased consciousness at admission were associated with more severe AAI cases (higher blood alcohol concentration). This study shows that AAI is prevalent among Belgian adolescents, and better targeted preventive measures and policies are needed. Our findings could be taken into account when developing preventive measures. However, data addressing the demographics and context of AAI were mostly missing. Therefore, prospective research is required to further investigate potential risk factors associated with AAI.
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Affiliation(s)
- Hanna van Roozendaal
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
| | - Stijn Verhulst
- Department of Paediatrics, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Inge Glazemakers
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
- University Centre for Child and Adolescent Psychiatry (ZNA-UKJA), 2020 Antwerp, Belgium
| | - Frederic De Meulder
- Department of Paediatrics, GasthuisZusters Antwerpen (GZA), 2018 Antwerp, Belgium; (F.D.M.); (A.V.A.)
| | - Ann Vander Auwera
- Department of Paediatrics, GasthuisZusters Antwerpen (GZA), 2018 Antwerp, Belgium; (F.D.M.); (A.V.A.)
| | - Anna Bael
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
- Department of Paediatrics, Hospital Network Antwerp (ZNA), 2020 Antwerp, Belgium;
| | - Emmi Van Damme
- Department of Paediatrics, Hospital Network Antwerp (ZNA), 2020 Antwerp, Belgium;
| | - Ilse Vlemincx
- Department of Paediatrics, General Hospital (AZ) Monica, 2100 Antwerp, Belgium;
| | - Jozef De Dooy
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
- Department of Paediatrics, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Nico van der Lely
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
- Department of Paediatrics, Reinier de Graaf Hospital, 2625 AD Delft, The Netherlands
| | - Guido Van Hal
- Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (I.G.); (A.B.); (J.D.D.); (N.v.d.L.); (G.V.H.)
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Wolfe M, Menon A, Oto M, Fullerton NE, Leach JP. Alcohol and the central nervous system. Pract Neurol 2023:pn-2023-003817. [PMID: 37328277 DOI: 10.1136/pn-2023-003817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/18/2023]
Abstract
Ethanol use is common to most cultures but with varying doses and to varying extents. While research has focused on the effects on the liver, alcohol exerts a range of actions on the function and structure of the nervous system. In the central nervous system (CNS) it can provoke or exacerbate neurological and psychiatric disease; its effects on the peripheral nervous system are not included in this review. Sustained alcohol intake can predispose to acute neurochemical changes which, with continued ingestion and incomplete treatment, can lead to chronic structural changes in the CNS: these include generalised cortical and cerebellar atrophy, amnesic syndromes such as Korsakoff's syndrome, and specific white matter disorders such as central pontine myelinolysis and Marchiafava-Bignami syndrome. Alcohol in pregnancy commonly and significantly affects fetal health, though this receives less medical and political attention than other causes of fetal harm. This review looks at the range of disorders that can follow acute or chronic alcohol use, and how these should be managed, and we provide a practical overview on how neurologists might diagnose and manage alcohol addiction.
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Affiliation(s)
- Maytal Wolfe
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Arun Menon
- University of Glasgow, Glasgow, UK
- Gartnavel Royal Hospital, Glasgow, UK
| | - Maria Oto
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Natasha E Fullerton
- University of Glasgow, Glasgow, UK
- Queen Elizabeth University Hospital, Glasgow, UK
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Gao H, Li Z, Liu Y, Zhao YK, Cheng C, Qiu F, Gao Y, Lu YW, Song XH, Wang JB, Ma ZT. A clinical experience-based Chinese herbal formula improves ethanol-induced drunken behavior and hepatic steatohepatitis in mice models. Chin Med 2023; 18:47. [PMID: 37127639 PMCID: PMC10150545 DOI: 10.1186/s13020-023-00753-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Bao-Gan-Xing-Jiu-Wan (BGXJW) is a clinical experience-based Chinese herbal formula. Its efficacy, pharmacological safety, targeted function, process quality, and other aspects have met the evaluation standards and the latest requirements of preparations. It could prevent and alleviate the symptoms of drunkenness and alcoholic liver injury clinically. The present work aims to elucidate whether BGXJW could protect against drunkenness and alcoholic liver disease in mice and explore the associated mechanism. MATERIAL AND METHODS We used acute-on-chronic (NIAAA) mice model to induce alcoholic steatosis, and alcohol binge-drinking model to reappear the drunk condition. BGXJW at indicated doses were administered by oral gavage respectively to analyze its effects on alcoholic liver injury and the associated molecular mechanisms. RESULTS BGXJW had no cardiac, hepatic, renal, or intestinal toxicity in mice. Alcoholic liver injury and steatosis in the NIAAA mode were effectively prevented by BGXJW treatment. BGXJW increased the expression of alcohol metabolizing enzymes ADH, CYP2E1, and ALDH2 to enhance alcohol metabolism, inhibited steatosis through regulating lipid metabolism, counteracted alcohol-induced upregulation of lipid synthesis related proteins SREBP1, FASN, and SCD1, meanwhile it enhanced fatty acids β-oxidation related proteins PPAR-α and CPT1A. Alcohol taken enhanced pro-inflammatory TNF-α, IL-6 and down-regulated the anti-inflammatory IL-10 expression in the liver, which were also reversed by BGXJW administration. Moreover, BGXJW significantly decreased the blood ethanol concentration and alleviated drunkenness in the alcohol binge-drinking mice model. CONCLUSIONS BGXJW could effectively relieve drunkenness and prevent alcoholic liver disease by regulating lipid metabolism, inflammatory response, and alcohol metabolism.
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Affiliation(s)
- Han Gao
- College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- Department of Hepatology, Fifth Medical Center of Chinese, PLA General Hospital, Beijing, 100039, China
| | - Zhen Li
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- College of Pharmacy, Henan University of Traditional Chinese Medicine, Henan, 450046, Zhengzhou, China
| | - Yao Liu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- Department of Infectious Disease, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Yong-Kang Zhao
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Cheng Cheng
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
- Department of Pharmacy, Jincheng General Hospital, Jincheng, 048006, Shanxi, China
| | - Feng Qiu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Yuan Gao
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Ya-Wen Lu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Xin-Hua Song
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China
| | - Jia-Bo Wang
- College of Pharmacy, Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, Fujian, China.
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China.
| | - Zhi-Tao Ma
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China.
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Zwolinski NM, Patel KS, Vadivelu N, Kodumudi G, Kaye AD. ERAS Protocol Options for Perioperative Pain Management of Substance Use Disorder in the Ambulatory Surgical Setting. Curr Pain Headache Rep 2023; 27:65-79. [PMID: 37079258 PMCID: PMC10116112 DOI: 10.1007/s11916-023-01108-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/21/2023]
Abstract
Even prior to the COVID-19 pandemic, rates of ambulatory surgeries and ambulatory patients presenting with substance use disorder were increasing, and the end of lockdown has further catalyzed the increasing rates of ambulatory patients presenting for surgery with substance use disorder (SUD). Certain subspecialty groups of ambulatory procedures have already established protocols to optimize early recovery after surgery (ERAS), and these groups have subsequently enjoyed improved efficiency and reduced adverse outcomes as a result. In this present investigation, we review the literature as it relates to substance use disorder patients, with a particular focus on pharmacokinetic and pharmacodynamic profiles, and their resulting impact on the acute- or chronic user ambulatory patient. The systematic literature review findings are organized and summarized. We conclude by identifying areas of opportunity for further study, specifically with the aim of developing a dedicated ERAS protocol for substance use disorder patients in the ambulatory surgery setting. - Healthcare in the USA has seen an increase in rates of both substance use disorder patients and separately in ambulatory surgery cases. - Specific perioperative protocols to optimize outcomes for patients who suffer from substance use disorder have been described in recent years. - Agents of interest like opioids, cannabis, and amphetamines are the top three most abused substances in North America. - A protocol and recommend further work should be done to integrate with concrete clinical data, in which strategies should be employed to confer benefits to patient outcomes and hospital quality metrics like those enjoyed by ERAS protocol in other settings.
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Affiliation(s)
- Nicholas M Zwolinski
- Department of Anesthesiology, Yale University School of Medicine, 333, Cedar Street, New Haven, CT, 06520, USA
| | - Kaiwal S Patel
- Department of Anesthesiology, Yale University School of Medicine, 333, Cedar Street, New Haven, CT, 06520, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University School of Medicine, 333, Cedar Street, New Haven, CT, 06520, USA
| | - Gopal Kodumudi
- Department of Anesthesiology, LSU School of Medicine, 1542 Tulane Avenue Room 659, New Orleans, LA, 70112, USA
| | - Alan David Kaye
- Department of Anesthesiology, LSU School of Medicine, 1542 Tulane Avenue Room 659, New Orleans, LA, 70112, USA.
- Department of Anesthesiology, Louisiana State University Health Sciences Center, 1501 Kings Hwy, Shreveport, LA, 71103, USA.
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Schwegler E, Bachmann M, Kube F, Eriksson U. Gender-specific differences in comorbidities, in-hospital complications and outcomes in emergency patients with ethanol intoxication with and without multisubstance use. Swiss Med Wkly 2023; 153:40061. [PMID: 37155832 DOI: 10.57187/smw.2023.40061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
AIMS OF THE STUDY To analyse gender-specific differences in comorbidities, multisubstance abuse, in-hospital complications, intensive care unit transfers and referrals to psychiatric wards of emergency department patients with ethanol intoxication. Several lines of evidence suggest an influence of gender differences on diagnostic and therapeutic approaches to various diseases. METHODS Over a period of 7 years, all patients with signs or symptoms of ethanol intoxication and a positive blood ethanol test admitted for the first time to the emergency department of a Swiss regional tertiary referral hospital were prospectively enrolled. Patients were categorised into two subgroups: patients without additional drug use were considered ethanol-only cases, whereas patients who had also ingested other substances (as determined from bystanders, physicians and urine drug screening) were considered multisubstance cases. A retrospective analysis of this database evaluated gender-specific differences in comorbidities, multisubstance abuse, in-hospital complications, intensive care unit transfers and referrals to psychiatric wards within these two subgroups. Statistical analysis included Fisher's exact test for categorical data and Wilcoxon rank sum test for continuous data. RESULTS Of 409 enrolled patients, 236 cases were ethanol-only and 173 were multisubstance cases. The three most common comorbidities in multisubstance patients showed significant gender differences: psychiatric disorders (43% males vs 61% females; p = 0.022), chronic ethanol abuse (55% males vs 32% females; p = 0.002) and drug addiction (44% males vs 17% females; p = 0.001). Gender differences were also found for the most frequently co-ingested substances: benzodiazepines (35% males vs 43% females; p = 0.014), cannabis (45% males vs 24% females; p = 0.006) and cocaine (24% males vs 6% females; p = 0.001). Male and female ethanol-only patients were transferred to the intensive care unit in 8% of cases. In multisubstance cases, 32% of male and 43% of female patients were transferred to the intensive care unit (no significant gender difference). The psychiatric ward referral rate in male (30%) and female (48%) patients with multisubstance abuse was significantly different (p = 0.028). No significant gender difference in psychiatric ward referral rates was observed for ethanol-only patients (12% males, 17% females). CONCLUSION Among emergency department patients admitted with ethanol intoxication, gender differences in comorbidities, substance use and psychiatric ward referrals were highly significant among patients who presented with multisubstance abuse. Rates of intensive care unit transfer for patients with ethanol intoxication are substantial for both genders, reflecting relevant disease burden and resource demand, as well as the need for further preventive efforts.
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Affiliation(s)
- Eric Schwegler
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
| | - Marta Bachmann
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
| | - Frank Kube
- Emergency Department, GZO Regional Health Center, Wetzikon, Switzerland
| | - Urs Eriksson
- Department of Medicine, GZO Regional Health Center, Wetzikon, Switzerland
- University of Zurich, Zürich, Switzerland
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32
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Perpiñá-Clérigues C, Mellado S, Català-Senent JF, Ibáñez F, Costa P, Marcos M, Guerri C, García-García F, Pascual M. Lipidomic landscape of circulating extracellular vesicles isolated from adolescents exposed to ethanol intoxication: a sex difference study. Biol Sex Differ 2023; 14:22. [PMID: 37085905 PMCID: PMC10120207 DOI: 10.1186/s13293-023-00502-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/03/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Lipids represent essential components of extracellular vesicles (EVs), playing structural and regulatory functions during EV biogenesis, release, targeting, and cell uptake. Importantly, lipidic dysregulation has been linked to several disorders, including metabolic syndrome, inflammation, and neurological dysfunction. Our recent results demonstrated the involvement of plasma EV microRNAs as possible amplifiers and biomarkers of neuroinflammation and brain damage induced by ethanol intoxication during adolescence. Considering the possible role of plasma EV lipids as regulatory molecules and biomarkers, we evaluated how acute ethanol intoxication differentially affected the lipid composition of plasma EVs in male and female adolescents and explored the participation of the immune response. METHODS Plasma EVs were extracted from humans and wild-type (WT) and Toll-like receptor 4 deficient (TLR4-KO) mice. Preprocessing and exploratory analyses were conducted after the extraction of EV lipids and data acquisition by mass spectrometry. Comparisons between ethanol-intoxicated and control human female and male individuals and ethanol-treated and untreated WT and TLR4-KO female and male mice were used to analyze the differential abundance of lipids. Annotation of lipids into their corresponding classes and a lipid set enrichment analysis were carried out to evaluate biological functions. RESULTS We demonstrated, for the first time, that acute ethanol intoxication induced a higher enrichment of distinct plasma EV lipid species in human female adolescents than in males. We observed a higher content of the PA, LPC, unsaturated FA, and FAHFA lipid classes in females, whereas males showed enrichment in PI. These lipid classes participate in the formation, release, and uptake of EVs and the activation of the immune response. Moreover, we observed changes in EV lipid composition between ethanol-treated WT and TLR4-KO mice (e.g., enrichment of glycerophosphoinositols in ethanol-treated WT males), and the sex-based differences in lipid abundance are more notable in WT mice than in TLR4-KO mice. All data and results generated have been made openly available on a web-based platform ( http://bioinfo.cipf.es/sal ). CONCLUSIONS Our results suggest that binge ethanol drinking in human female adolescents leads to a higher content of plasma EV lipid species associated with EV biogenesis and the propagation of neuroinflammatory responses than in males. In addition, we discovered greater differences in lipid abundance between sexes in WT mice compared to TLR4-KO mice. Our findings also support the potential use of EV-enriched lipids as biomarkers of ethanol-induced neuroinflammation during adolescence.
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Affiliation(s)
- Carla Perpiñá-Clérigues
- Bioinformatics and Biostatistics Unit, Príncipe Felipe Research Center, C/ Eduardo Primo Yúfera, 3, 46012, Valencia, Spain
- Department of Physiology, School of Medicine and Dentistry, University of Valencia, Avda. Blasco Ibáñez, 15, 46010, Valencia, Spain
| | - Susana Mellado
- Department of Physiology, School of Medicine and Dentistry, University of Valencia, Avda. Blasco Ibáñez, 15, 46010, Valencia, Spain
- Department of Molecular and Cellular Pathology of Alcohol, Príncipe Felipe Research Center, 46012, Valencia, Spain
| | - José F Català-Senent
- Bioinformatics and Biostatistics Unit, Príncipe Felipe Research Center, C/ Eduardo Primo Yúfera, 3, 46012, Valencia, Spain
| | - Francesc Ibáñez
- Department of Molecular and Cellular Pathology of Alcohol, Príncipe Felipe Research Center, 46012, Valencia, Spain
| | - Pilar Costa
- Emergency Department, University Hospital of Salamanca-IBSAL, University of Salamanca, 37007, Salamanca, Spain
| | - Miguel Marcos
- Department of Internal Medicine, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, 37007, Salamanca, Spain
| | - Consuelo Guerri
- Department of Molecular and Cellular Pathology of Alcohol, Príncipe Felipe Research Center, 46012, Valencia, Spain
| | - Francisco García-García
- Bioinformatics and Biostatistics Unit, Príncipe Felipe Research Center, C/ Eduardo Primo Yúfera, 3, 46012, Valencia, Spain.
| | - María Pascual
- Department of Physiology, School of Medicine and Dentistry, University of Valencia, Avda. Blasco Ibáñez, 15, 46010, Valencia, Spain.
- Department of Molecular and Cellular Pathology of Alcohol, Príncipe Felipe Research Center, 46012, Valencia, Spain.
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Chapp AD, Collins AR, Driscoll KM, Behnke JE, Shan Z, Zhang L, Chen QH. Ethanol Metabolite, Acetate, Increases Excitability of the Central Nucleus of Amygdala Neurons through Activation of NMDA Receptors. ACS Chem Neurosci 2023; 14:1278-1290. [PMID: 36957993 PMCID: PMC11163875 DOI: 10.1021/acschemneuro.2c00784] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
The central nucleus of the amygdala (CeA) is a key brain region involved in emotional and stressor responses due to its many projections to autonomic regulatory centers. It is also a primary site of action from ethanol consumption. However, the influence of active metabolites of ethanol such as acetate on the CeA neural circuitry has yet to be elucidated. Here, we investigated the effect of acetate on CeA neurons with the axon projecting to the rostral ventrolateral medulla (CeA-RVLM), as well as quantified cytosolic calcium responses in primary neuronal cultures. Whole-cell patch-clamp recordings in brain slices containing autonomic CeA-RVLM neurons revealed a dose-dependent increase in neuronal excitability in response to acetate. N-Methyl-d-aspartate receptor (NMDAR) antagonists suppressed the acetate-induced increase in CeA-RVLM neuronal excitability and memantine suppressed the direct activation of NMDAR-dependent inward currents by acetate in brain slices. We observed that acetate increased cytosolic Ca2+ in a time-dependent manner in primary neuronal cell cultures. The acetate enhancement of calcium signaling was abolished by memantine. Computational modeling of acetic acid at NMDAR/NR1 glutamatergic and glycinergic sites suggests potential active site interactions. These findings suggest that within the CeA, acetate is excitatory at least partially through activation of NMDAR, which may underlie the impact of ethanol consumption on autonomic circuitry.
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Affiliation(s)
- Andrew D Chapp
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, SDC, 1400 Townsend Drive, Houghton, Michigan 49931, United States
- Department of Biological Sciences, Michigan Technological University, Houghton, Michigan 49931, United States
- Department of Neuroscience, University of Minnesota, Twin Cities, 321 Church Street SE, Minneapolis, Minnesota 55455, United States
| | - Andréa R Collins
- Department of Psychiatry, University of California, San Francisco, Fresno, California 93701, United States
| | - Kyle M Driscoll
- Department of Biological Sciences, Michigan Technological University, Houghton, Michigan 49931, United States
| | - Jessica E Behnke
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, SDC, 1400 Townsend Drive, Houghton, Michigan 49931, United States
- Department of Biological Sciences, Michigan Technological University, Houghton, Michigan 49931, United States
| | - Zhiying Shan
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, SDC, 1400 Townsend Drive, Houghton, Michigan 49931, United States
- Department of Biological Sciences, Michigan Technological University, Houghton, Michigan 49931, United States
| | - Li Zhang
- Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland 20852, United States
| | - Qing-Hui Chen
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, SDC, 1400 Townsend Drive, Houghton, Michigan 49931, United States
- Department of Biological Sciences, Michigan Technological University, Houghton, Michigan 49931, United States
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Zhai Z, Yamauchi T, Shangraw S, Hou V, Matsumoto A, Fujita M. Ethanol Metabolism and Melanoma. Cancers (Basel) 2023; 15:1258. [PMID: 36831600 PMCID: PMC9954650 DOI: 10.3390/cancers15041258] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Malignant melanoma is the deadliest form of skin cancer. Despite significant efforts in sun protection education, melanoma incidence is still rising globally, drawing attention to other socioenvironmental risk factors for melanoma. Ethanol and acetaldehyde (AcAH) are ubiquitous in our diets, medicines, alcoholic beverages, and the environment. In the liver, ethanol is primarily oxidized to AcAH, a toxic intermediate capable of inducing tumors by forming adducts with proteins and DNA. Once in the blood, ethanol and AcAH can reach the skin. Although, like the liver, the skin has metabolic mechanisms to detoxify ethanol and AcAH, the risk of ethanol/AcAH-associated skin diseases increases when the metabolic enzymes become dysfunctional in the skin. This review highlights the evidence linking cutaneous ethanol metabolism and melanoma. We summarize various sources of skin ethanol and AcAH and describe how the reduced activity of each alcohol metabolizing enzyme affects the sensitivity threshold to ethanol/AcAH toxicity. Data from the Gene Expression Omnibus database also show that three ethanol metabolizing enzymes (alcohol dehydrogenase 1B, P450 2E1, and catalase) and an AcAH metabolizing enzyme (aldehyde dehydrogenase 2) are significantly reduced in melanoma tissues.
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Affiliation(s)
- Zili Zhai
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Takeshi Yamauchi
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sarah Shangraw
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Vincent Hou
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Akiko Matsumoto
- Department of Social Medicine, School of Medicine, Saga University, Saga 849-8501, Japan
| | - Mayumi Fujita
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Veterans Affairs Medical Center, VA Eastern Colorado Health Care System, Aurora, CO 80045, USA
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Mirijello A, Sestito L, Antonelli M, Gasbarrini A, Addolorato G. Identification and management of acute alcohol intoxication. Eur J Intern Med 2023; 108:1-8. [PMID: 35985955 DOI: 10.1016/j.ejim.2022.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/03/2022] [Accepted: 08/11/2022] [Indexed: 02/07/2023]
Abstract
Acute alcohol intoxication (AAI) is a harmful clinical condition, potentially life-threatening, secondary to the intake of large amounts of alcohol. Clinical manifestations of AAI are characterized by behavioural and neurological symptoms, even if its effects involve several organs and apparatus. Moreover, severe alcohol intoxication can produce a global neurological impairment leading to autonomic dysfunction, respiratory depression, coma and cardiac arrest. The evaluation of blood alcohol concentrations (BAC) is useful to confirm the suspicion of intoxication, both for clinical and legal reasons. Most of patients with AAI are referred to Emergency Departments due to behavioural, social, traumatic or clinical complications. Patient's stabilization is the first step in the management of AAI, in order to support vital functions and to prevent complications. Metadoxine represents a useful drug to increase ethanol metabolism and elimination. Given that AAI could represent a sentinel event of chronic alcohol abuse, patients presenting with acute intoxication should be screened for the presence of an underlying alcohol use disorder and referred to and an alcohol addiction unit to start a multidisciplinary treatment to achieve long term alcohol abstinence. The present review will focus on clinical features, diagnostic criteria and treatment strategies of AAI.
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Affiliation(s)
- Antonio Mirijello
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luisa Sestito
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Mariangela Antonelli
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Antonio Gasbarrini
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Giovanni Addolorato
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy.
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36
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Petrolini VM, Locatelli CA. Pharmacological treatment of acute alcohol intoxication: More doubts than certainties. Eur J Intern Med 2023; 108:25-27. [PMID: 36693776 DOI: 10.1016/j.ejim.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 01/23/2023]
Affiliation(s)
- Valeria M Petrolini
- Toxicology Unit, Pavia Poison Centre and National Toxicology Information Centre, Laboratories of Clinical and Experimental Toxicology, IRCCS Hospital of Pavia, Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Carlo A Locatelli
- Toxicology Unit, Pavia Poison Centre and National Toxicology Information Centre, Laboratories of Clinical and Experimental Toxicology, IRCCS Hospital of Pavia, Istituti Clinici Scientifici Maugeri, Pavia, Italy.
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Yang Z, Gao Y, Wu W, Mu H, Liu R, Fang X, Gao H, Chen H. The mitigative effect of lotus root ( Nelumbo nucifera Gaertn) extract on acute alcoholism through activation of alcohol catabolic enzyme, reduction of oxidative stress, and protection of liver function. Front Nutr 2023; 9:1111283. [PMID: 36712522 PMCID: PMC9875029 DOI: 10.3389/fnut.2022.1111283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Lotus root (Nelumbo nucifera Gaertn) is a common medicinal-food dual-use vegetable. In this study, the effects of lotus root extract on acute alcoholism were investigated. Methods The Walle-Hoch method was used to determine the ADH activity of lotus root extracts in vitro. Lotus root methanol extract were identified by UPLC-QTOF-MS/MS based metabolomics analysis. Then 109 active ingredients with achievable oral doses and drug-like properties were explored using the TCMSP platform. SwissTargetPrediction Database to predict lotus root treatment targets for acute alcoholismSTRING database (https://www.string-db.org/) was used to construct protein-protein interaction network graphs. Gene ontology (GO) functional, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of genes common to lotus root and alcoholism by Metascap database. Molecular docking simulations were performed using AutoDock 1.5.6 software. Animal experiments verified the relieving effect of lotus root extract on acute alcoholism after intervention. Results Results indicated the methanol extract of lotus root showed the highest activation rate of ethanol dehydrogenase in vitro (18.87%). The 433 compounds of lotus root methanol extract were identified by UPLC-QTOF-MS/MS based metabolomics analysis. Bioinformatics analysis indicate that there were 224 intersectioning targets between lotus root extract and acute alcoholism. KEGG enrichment analysised shows that lotus root extract may play a role in treating acute alcoholism by intervening with the neuroactive ligand-receptor interaction pathway. The protein-protein interaction network (PPI) analysis found that HSP90AA1, MAPK1 and STAT3 played a key role in lotus root extract-modulated PPI networks. Molecular docking showed that (7R, 8S)-dihydrodihydrodipine cypressol had the best binding ability with MAPK1. Experiments in mice indicate that lotus root extract improved the activity of liver alcohol dehydrogenase (ADH), acetaldehyde dehydrogenase (ALDH), catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX), increase glutathione (GSH) and reduce malondialdehyde (MDA) levels, decrease glutamate transaminase (AST), alanine transaminase (ALT) and alkaline phosphatase (AKP) in the serum of mice with acute alcoholism, and accelerate the metabolic rate of alcohol after drinking. This study reveals the mechanism of lotus root to alleviate acute alcoholism, which provides a basis for further research on functional foods using lotus root and offers new possibilities for the treatment of acute alcoholism. Conclusions The results of the current study showed that the methanolic extract of lotus root had the highest activation rate of ethanol dehydrogenase. Network pharmacology results suggest that lotus root extract may play a role in the treatment of alcoholism by regulating signaling pathways, such as neuroactive ligand-receptor interactions, as well as biological processes, such as regulation of secretion, regulation of ion transport, response to lipopolysaccharides, and response to alcohol. Animal experiments confirmed the therapeutic effect of lotus root on acute alcoholism mechanistically through activation of alcohol catabolic enzyme, reduction of oxidative stress and protection of liver function.
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Affiliation(s)
- Zihan Yang
- Food Science Institute, Zhejiang Academy of Agricultural Sciences, Hangzhou, China,Key Laboratory of Postharvest Handling of Fruits, Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Vegetables (Co-Construction by Ministry and Province), Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Fruits and Vegetables Postharvest and Processing Technology Research of Zhejiang Province, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Fruits and Vegetables, China National Light Industry, Hangzhou, China
| | - Yuan Gao
- Food Science Institute, Zhejiang Academy of Agricultural Sciences, Hangzhou, China,Key Laboratory of Postharvest Handling of Fruits, Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Vegetables (Co-Construction by Ministry and Province), Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Fruits and Vegetables Postharvest and Processing Technology Research of Zhejiang Province, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Fruits and Vegetables, China National Light Industry, Hangzhou, China
| | - Weijie Wu
- Food Science Institute, Zhejiang Academy of Agricultural Sciences, Hangzhou, China,Key Laboratory of Postharvest Handling of Fruits, Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Vegetables (Co-Construction by Ministry and Province), Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Fruits and Vegetables Postharvest and Processing Technology Research of Zhejiang Province, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Fruits and Vegetables, China National Light Industry, Hangzhou, China
| | - Honglei Mu
- Food Science Institute, Zhejiang Academy of Agricultural Sciences, Hangzhou, China,Key Laboratory of Postharvest Handling of Fruits, Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Vegetables (Co-Construction by Ministry and Province), Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Fruits and Vegetables Postharvest and Processing Technology Research of Zhejiang Province, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Fruits and Vegetables, China National Light Industry, Hangzhou, China
| | - Ruiling Liu
- Food Science Institute, Zhejiang Academy of Agricultural Sciences, Hangzhou, China,Key Laboratory of Postharvest Handling of Fruits, Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Vegetables (Co-Construction by Ministry and Province), Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Fruits and Vegetables Postharvest and Processing Technology Research of Zhejiang Province, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Fruits and Vegetables, China National Light Industry, Hangzhou, China
| | - Xiangjun Fang
- Food Science Institute, Zhejiang Academy of Agricultural Sciences, Hangzhou, China,Key Laboratory of Postharvest Handling of Fruits, Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Vegetables (Co-Construction by Ministry and Province), Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Fruits and Vegetables Postharvest and Processing Technology Research of Zhejiang Province, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Fruits and Vegetables, China National Light Industry, Hangzhou, China
| | - Haiyan Gao
- Food Science Institute, Zhejiang Academy of Agricultural Sciences, Hangzhou, China,Key Laboratory of Postharvest Handling of Fruits, Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Vegetables (Co-Construction by Ministry and Province), Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Fruits and Vegetables Postharvest and Processing Technology Research of Zhejiang Province, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Fruits and Vegetables, China National Light Industry, Hangzhou, China,*Correspondence: Haiyan Gao ✉
| | - Hangjun Chen
- Food Science Institute, Zhejiang Academy of Agricultural Sciences, Hangzhou, China,Key Laboratory of Postharvest Handling of Fruits, Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Vegetables (Co-Construction by Ministry and Province), Ministry of Agriculture and Rural Affairs, Hangzhou, China,Key Laboratory of Fruits and Vegetables Postharvest and Processing Technology Research of Zhejiang Province, Hangzhou, China,Key Laboratory of Postharvest Preservation and Processing of Fruits and Vegetables, China National Light Industry, Hangzhou, China,Hangjun Chen ✉
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Shi Z, Long X, Li Y, Jin J, Li J, Yuan C, Jin R. Protective Effect of Tea Saponins on Alcohol-Induced Gastric Mucosal Injury in Mice. ACS OMEGA 2023; 8:673-681. [PMID: 36643417 PMCID: PMC9835626 DOI: 10.1021/acsomega.2c05880] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Excessive alcohol consumption harms the human body, particularly the digestive system, by causing damage to the gastric mucosa. Tea saponin is a natural active substance extracted from tea tree seeds that has gastroprotective potential against alcohol-induced mucosal damage. However, the protective mechanism of tea saponins is not fully understood. The current study aimed to explore the protective mechanism of tea saponins against alcohol-induced gastric mucosal injury in mice. Histopathological changes, immunohistochemistry, immunoblotting, and gastric mucosa-related cytokine levels were analyzed in three groups of male mice: model, control, and tea saponin-treated. Compared to the model group, the tea saponin group prominently ameliorated alcohol-induced gastric mucosal injury by improving cell necrosis, inflammatory cell infiltration, and edema. Downregulation of inflammation-related factors cluster of differentiation 68 (CD68), myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β) was also found in the tea saponin group. These results suggest that tea saponins have a protective effect against alcohol-induced gastric mucosal damage in mice. Therefore, tea saponin may serve as a food additive for gastric mucosal protection.
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Affiliation(s)
- Zhaojuan Shi
- School
of Food and Biological Engineering, Hefei
University of Technology, Hefei 230009, P. R. China
- Engineering
Research Center of Agricultural Product Biochemicals, Ministry of
Education, Hefei 230009, P. R. China
| | - Xue Long
- School
of Food and Biological Engineering, Hefei
University of Technology, Hefei 230009, P. R. China
- Engineering
Research Center of Agricultural Product Biochemicals, Ministry of
Education, Hefei 230009, P. R. China
| | - Yan Li
- School
of Food and Biological Engineering, Hefei
University of Technology, Hefei 230009, P. R. China
- Engineering
Research Center of Agricultural Product Biochemicals, Ministry of
Education, Hefei 230009, P. R. China
| | - Jing Jin
- School
of Food and Biological Engineering, Hefei
University of Technology, Hefei 230009, P. R. China
- Engineering
Research Center of Agricultural Product Biochemicals, Ministry of
Education, Hefei 230009, P. R. China
| | - Jianfang Li
- School
of Food and Biological Engineering, Hefei
University of Technology, Hefei 230009, P. R. China
- Engineering
Research Center of Agricultural Product Biochemicals, Ministry of
Education, Hefei 230009, P. R. China
| | - Chuanxun Yuan
- School
of Food and Biological Engineering, Hefei
University of Technology, Hefei 230009, P. R. China
- Engineering
Research Center of Agricultural Product Biochemicals, Ministry of
Education, Hefei 230009, P. R. China
| | - Risheng Jin
- School
of Food and Biological Engineering, Hefei
University of Technology, Hefei 230009, P. R. China
- Engineering
Research Center of Agricultural Product Biochemicals, Ministry of
Education, Hefei 230009, P. R. China
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Terayama T, Sasa R, Nakatani Y, Tanaka F, Terashige S, Higashiyama D, Sugiura T, Hatanaka K, Nishiyama T, Takeshima S. Effect of intravenous fluid therapy for acute alcohol intoxication on length of time from arrival at the emergency department until awakening: A prospective observational cohort study. Acute Med Surg 2023; 10:e841. [PMID: 37153868 PMCID: PMC10156605 DOI: 10.1002/ams2.841] [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: 12/16/2022] [Accepted: 04/02/2023] [Indexed: 05/10/2023] Open
Abstract
Aim To evaluate the association of intravenous fluid (IVF) therapy on the length of time from arrival at the emergency department (ED) until awakening in cases of acute alcohol intoxication. Methods This single-center, prospective, observational study was conducted in the ED of the Self-Defense Forces Central Hospital during October 1, 2018 to July 31, 2019. Patients with 1,000 mL bolus of lactated Ringer's solution and those without bolus were compared. The primary outcome was the length of time until awakening. Secondary outcomes were the length of stay in the ED and occurrence of conditions requiring extra care. Predictors of the occurrence of any event requiring extra care were identified. Results We included 201 patients, of whom 109 received IVF and 92 did not. No significant difference existed in the baseline characteristics between the groups. The median length of time until awakening did not significantly differ between the groups (P = 0.77). Multivariable regression analysis adjusted by age, sex, hemoglobin, blood alcohol concentration, and initial Glasgow Coma Scale (GCS) score demonstrated that the regression coefficient of IVF for length of time until awakening was -9.55 (95% confidence interval [CI], -36.2 to 17.2). Hemoglobin (regression coefficient, 10.1; 95% CI, 0.38-19.9) and initial GCS score (regression coefficient, -7.51; 95% CI, -10.8 to -4.21) were significantly associated with length of time. Conclusion IVF therapy was not associated with the length of time until awakening in patients with acute alcohol intoxication in the ED. Routine IVF administration was unnecessary.
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Affiliation(s)
- Takero Terayama
- Department of EmergencySelf‐Defense Forces Central HospitalTokyoJapan
- Department of Psychiatry, School of MedicineNational Defense Medical CollegeSaitamaJapan
| | - Ruka Sasa
- Department of EmergencySelf‐Defense Forces Central HospitalTokyoJapan
| | - Yuka Nakatani
- Department of Health InformaticsKyoto University School of Public HealthKyotoJapan
| | - Fumika Tanaka
- Department of EmergencySelf‐Defense Forces Central HospitalTokyoJapan
| | - Sho Terashige
- Department of EmergencySelf‐Defense Forces Central HospitalTokyoJapan
| | | | - Takao Sugiura
- Department of EmergencySelf‐Defense Forces Central HospitalTokyoJapan
| | - Kosuke Hatanaka
- Department of EmergencySelf‐Defense Forces Central HospitalTokyoJapan
| | - Takashi Nishiyama
- Department of EmergencySelf‐Defense Forces Central HospitalTokyoJapan
| | - Shigeto Takeshima
- Department of EmergencySelf‐Defense Forces Central HospitalTokyoJapan
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40
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Horiguchi A, Numazawa S. Development of a risk assessment method for the detailed consideration of the effects of liquid toxic substance leakage incidents on the human body: ethanol as a model substance. J Toxicol Sci 2023; 49:37-47. [PMID: 38191200 DOI: 10.2131/jts.49.37] [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]
Abstract
To ensure safety in chemical plants handling a wide variety of liquid and gaseous hazardous substances, it is necessary to carry out highly accurate risk assessments and take appropriate measures. In this study, a risk assessment method was developed for the problem of the leakage of liquid hazardous substances. The risk assessment of toxic liquid leaks must consider the exposure of workers to the liquid and toxic gases produced by vaporization. The absorption and subsequent metabolism of hazardous substances in the body via multiple pathways after exposure to liquids and gases was calculated using a pharmacokinetic model. Estimation of exposure concentrations of toxic gases volatilized from leaked liquids was reproduced by computational fluid dynamics simulation. In this study, ethanol was selected as the hazardous substance and the risk of hazardous liquid leakage was assessed. The results of the analysis, which considered liquid and gas exposure under the conditions of the assumed scenario, showed that the maximum blood concentration of ethanol was 1640 µmol/L, which is sufficiently low compared to the concentration of 10,900 µmol/L at which acute toxic effects become apparent. These results suggest that work can be carried out safely under the conditions of the assumed scenario. The risk assessment methodology for liquid spills in this study confirms that risk assessment is possible under multiple scenarios, including individual differences, activity conditions, and the use of protective equipment.
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Affiliation(s)
- Akio Horiguchi
- Department of Toxicology, Showa University Graduate School of Pharmacy
- Science Innovation Center, Mitsubishi Chemical Corporation
| | - Satoshi Numazawa
- Department of Toxicology, Showa University Graduate School of Pharmacy
- Showa University Pharmacological Research Center
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Palmese F, Bonavita ME, Pompili E, Migliano MT, Reggidori N, Di Stefano C, Grieco M, Colazzo S, Tufoni M, Baldassarre M, Caraceni P, Foschi FG, Giostra F, Farina G, Del Toro R, Bedogni G, Domenicali M. Mortality and its association with chronic alcohol-related diseases in patients admitted to the emergency department for acute alcoholic intoxication: retrospective cohort study. Intern Emerg Med 2023; 18:257-263. [PMID: 36199001 PMCID: PMC9883355 DOI: 10.1007/s11739-022-03114-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/25/2022] [Indexed: 02/01/2023]
Abstract
We assessed long-term mortality and its association with chronic alcohol-related diseases in patients admitted to the emergency department (ED) because of acute alcoholic intoxication (AAI). A retrospective cohort study was performed at the ED of Sant'Orsola-Malpighi Hospital, Bologna, Italy. 3304 patients, corresponding to 6415 admissions for AAI, who accessed the ED from January 1, 2005, to December 31, 2017, were studied. The ED electronic registry system was used to assess living status on 08 May 2020 and to obtain the prespecified potential predictors, i.e., age at first admission, sex, alcohol use disorder (AUD), substance use disorder (SUD), more than 1 admission to ED for trauma, mental and behavioral disorders, neurological disorders, and cardiovascular disease. The median follow-up time was 9.3 years and the time on risk was 30,053 person years (PY) with a death rate corresponding to 4.42 (95% CI 3.74-5.26) per 1000 PY (n = 133 deaths). The death rate was higher in patients with AUD (17.30) than in those without AUD (1.98) and in those with SUD (13.58) than in those without SUD (3.80). Lastly, there was a clearly higher death rate among AUD+ SUD+ (20.89) compared to AUD-SUD-patients (1.74). At multivariable Cox regression, AUD, SUD, and liver cirrhosis were strong and independent predictors of time-to-death. Using standardized mortality ratios, a clear excess of mortality was evident for all the age bands from (40-45] to (60-65] years. Mortality is higher in AAI than in the general population and chronic alcohol-related diseases are strongly associated with it.
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Affiliation(s)
- Francesco Palmese
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy.
| | - Maria Elena Bonavita
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Enrico Pompili
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Maria Teresa Migliano
- Department of Internal Medicine, "Degli Infermi" Hospital, AUSL Romagna, Faenza, Italy
| | - Nicola Reggidori
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Cecilia Di Stefano
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Marta Grieco
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Stefano Colazzo
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Manuel Tufoni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Maurizio Baldassarre
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Center for Applied Biomedical Research-CRBA, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-Related Diseases, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | | | - Fabrizio Giostra
- Emergency Department-Pronto Soccorso, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Gabriele Farina
- Emergency Department-Pronto Soccorso, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Rossella Del Toro
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Giorgio Bedogni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
| | - Marco Domenicali
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Department of Primary Health Care, Internal Medicine Unit Addressed to Frailty and Aging, "S. Maria Delle Croci" Hospital, AUSL Romagna, Ravenna, Italy
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Sharif AF, Kasemy ZA, Alshabibi RA, Almufleh SJ, Abousamak FW, Alfrayan AA, Alshehri M, Alemies RA, Almuhsen AS, AlNasser SN, Al-Mulhim KA. Prognostic factors in acute poisoning with central nervous system xenobiotics: development of a nomogram predicting risk of intensive care unit admission. Toxicol Res (Camb) 2022; 12:62-75. [PMID: 36866212 PMCID: PMC9972822 DOI: 10.1093/toxres/tfac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 12/27/2022] Open
Abstract
Background Acute intoxication with central nervous system (CNS) xenobiotics is an increasing global problem. Predicting the prognosis of acute toxic exposure among patients can significantly alter the morbidity and mortality. The present study outlined the early risk predictors among patients diagnosed with acute exposure to CNS xenobiotics and endorsed bedside nomograms for identifying patients requiring intensive care unit (ICU) admission and those at risk of poor prognosis or death. Methods This study is a 6-year retrospective cohort study conducted among patients presented with acute exposure to CNS xenobiotics. Results A total of 143 patients' records were included, where (36.4%) were admitted to the ICU, and a significant proportion of which was due to exposure to alcohols, sedative hypnotics, psychotropic, and antidepressants (P = 0.021). ICU admission was associated with significantly lower blood pressure, pH, and HCO3 levels and higher random blood glucose (RBG), serum urea, and creatinine levels (P < 0.05). The study findings indicate that the decision of ICU admission could be determined using a nomogram combining the initial HCO3 level, blood pH, modified PSS, and GCS. HCO3 level < 17.1 mEq/L, pH < 7.2, moderate-to-severe PSS, and GCS < 11 significantly predicted ICU admission. Moreover, high PSS and low HCO3 levels significantly predicted poor prognosis and mortality. Hyperglycemia was another significant predictor of mortality. Combining initial GCS, RBG level, and HCO3 is substantially helpful in predicting the need for ICU admission in acute alcohol intoxication. Conclusion The proposed nomograms yielded significant straightforward and reliable prognostic outcomes predictors in acute exposure to CNS xenobiotics.
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Affiliation(s)
- Asmaa F Sharif
- Corresponding author: Clinical Medical Sciences Department, College of Medicine, Dar AlUloom University, Riyadh, Al-Falah, 13314, Saudi Arabia.
| | - Zeinab A Kasemy
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt
| | | | - Salem J Almufleh
- College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | | | | | - Muath Alshehri
- College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Rakan A Alemies
- College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Assim S Almuhsen
- College of Medicine, Dar Al-Uloom University, Riyadh, Saudi Arabia
| | - Shahd N AlNasser
- Poison Control Department, Emergency Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid A Al-Mulhim
- Emergency Medicine Department, King Fahad Medical City, Riyadh, 1125, Saudi Arabia
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Wan MX, Huang XJ, Li X, Suan J, Xu L. Integrating network pharmacology and experimental verification to explore the mechanism of puerarin against oliguria in acute alcoholism. Front Pharmacol 2022; 13:1006660. [DOI: 10.3389/fphar.2022.1006660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study was designed to evaluate the pharmacological mechanisms of puerarin against oliguria in acute alcoholism via network pharmacology analysis combined with experimental verification.Methods: First, this study established an acute alcoholism rat model, compared the changes in urine volume in each group, and observed the therapeutic effect of puerarin by H&E staining, biochemical, RT-qPCR, and immunohistochemical analyses. Second, puerarin-related targets were searched in TCMS, PubChem, CNKI, Wanfang, PubMed, and GeenMedical Academic databases. Also, potential disease targets were obtained from the GeneCards, MalaCards, and NCBI-gene databases and genes with puerarin target gene intersections were screened out. The interaction network for co-predicted targets was obtained using the STRING database, and the core targets were imported into Cytoscape for visualization using DAVID Bioinformatics Resources 6.8. The essential genes were subjected to the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) pathway enrichment analyses to predict related biological processes and significant signaling pathways. Finally, molecular docking was used to examine the interaction of puerarin with key targets, and the core targets were validated further by RT-qPCR and Western blotting.Results: Compared to the model group, the urine volume of the rats was significantly increased after puerarin treatment, and the levels of anti-diuretic hormone (ADH) and aquaporin 2 (AQP2) expression were decreased. Searching the intersection of puerarin and acute alcoholism targets yielded 214 potential targets, 837 biological processes, and 185 signaling pathways involved. The molecular docking results indicated a good affinity between puerarin and key targets (cyclic adenosine monophosphate (cAMP), protein kinase A (PKA), cAMP-response element-binding protein (CREB), and c-Fos). RT-qPCR and Western blotting further verified that puerarin could down-regulate the expression of cAMP/PKA/CREB/c-Fos.Conclusion: This study identified the potential targets of puerarin against oliguria in rats with acute alcoholism using network pharmacology and animal experiments. The mechanism may be closely related to the cAMP signaling pathway.
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Raza ZA, Shahzad Q, Rehman A, Taqi M, Ayub A. Biosurfactants in the sustainable eradication of SARS COV-2 from the environmental surfaces. 3 Biotech 2022; 12:273. [PMID: 36101547 PMCID: PMC9464425 DOI: 10.1007/s13205-022-03320-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/19/2022] [Indexed: 11/03/2022] Open
Abstract
The COVID-19 outbreak has brought the world, at least, to one consensus that cleanliness is unavoidable under all circumstances. Hands are the main body part to interact with the environment and thus are prone to receive, initiate and propagate the chain of infection. Hand hygiene has, therefore, been most emphasized by experts to interrupt the spread of infection. Various harsh chemicals like synthetic surfactants and alcoholic preparations have been in practice to eradicate and disinfect the germs. This choice may be unsafe and cause a subsequent chain of adversities. Thereby, biosurfactants have been proposed as sustainable, non-toxic and safe surface cleaners cum disinfectants under a wide range of physiological and environmental conditions. The amphiphilic micellar behavior of biosurfactants makes them promising candidates as hygienic surface cleaners and therapeutic carriers. We overview the possibilities of using biosurfactants in different ways against microbial pathogens, in general, and the SARS COV-2, in specific.
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Paprocki S, Qassem M, Kyriacou PA. Review of Ethanol Intoxication Sensing Technologies and Techniques. SENSORS (BASEL, SWITZERLAND) 2022; 22:6819. [PMID: 36146167 PMCID: PMC9501510 DOI: 10.3390/s22186819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
The field of alcohol intoxication sensing is over 100 years old, spanning the fields of medicine, chemistry, and computer science, aiming to produce the most effective and accurate methods of quantifying intoxication levels. This review presents the development and the current state of alcohol intoxication quantifying devices and techniques, separated into six major categories: estimates, breath alcohol devices, bodily fluid testing, transdermal sensors, mathematical algorithms, and optical techniques. Each of these categories was researched by analyzing their respective performances and drawbacks. We found that the major developments in monitoring ethanol intoxication levels aim at noninvasive transdermal/optical methods for personal monitoring. Many of the "categories" of ethanol intoxication systems overlap with each other with to a varying extent, hence the division of categories is based only on the principal operation of the techniques described in this review. In summary, the gold-standard method for measuring blood ethanol levels is through gas chromatography. Early estimation methods based on mathematical equations are largely popular in forensic fields. Breath alcohol devices are the most common type of alcohol sensors on the market and are generally implemented in law enforcement. Transdermal sensors vary largely in their sensing methodologies, but they mostly follow the principle of electrical sensing or enzymatic reaction rate. Optical devices and methodologies perform well, with some cases outperforming breath alcohol devices in terms of the precision of measurement. Other estimation algorithms consider multimodal approaches and should not be considered alcohol sensing devices, but rather as prospective measurement of the intoxication influence. This review found 38 unique technologies and techniques for measuring alcohol intoxication, which is testament to the acute interest in the innovation of noninvasive technologies for assessing intoxication.
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Plis SS, Veselkina OV, Klevno VA, Vlassov VV. Mortality in Cases of Acute Alcohol Intoxication in Children: A 10-Year Retrospective Study of the Moscow Region, Russia. Am J Forensic Med Pathol 2022; 43:231-235. [PMID: 35679160 DOI: 10.1097/paf.0000000000000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Russia suffers from high alcohol-related mortality. Most forensic autopsies in Russia include blood alcohol tests, but a systematic analysis of these data has never been conducted for children's deaths. METHODS We performed an analysis of juvenile mortality using autopsy reports from the Moscow Region Bureau of Forensic Medical Examination from January 1, 2009, to December 31, 2018. RESULTS Despite a decrease in incidence ( Rs = -0.661), the number of cases of alcohol intoxication in minors was still high. The mean age of children in our study was 14.77 years (95% confidence interval [CI], 14.31-15.23). Death was predominantly among boys (72%) and those with higher blood alcohol concentrations (mean difference [MD], 0.295; 95% CI MD , 0.012-0.58). The number of cases of unnatural death increased with age ( Rs = 0.746, P = 0.001). Accidents were the most predominant cause of death, followed by suicide, homicide, and natural causes. Fatal alcohol intoxication was observed at an average blood alcohol concentration of 3.58 g/L (95% CI, 1.46-5.7), without any specific signs on autopsy. Even a strong smell of alcohol is an unreliable sign in the clinic. CONCLUSION A systematic study of alcohol in forensic autopsy shows that the number of children who die with alcohol intoxication is high. Teenagers are the predominant age group experiencing alcohol intoxication. In our opinion, an alcohol blood test should be performed in all suspicious cases, especially in teenagers.
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Affiliation(s)
- Semyon S Plis
- From the Department of Forensic Medicine, Moscow Regional Research and Clinical Institute ("MONIKI")
| | | | - Vladimir A Klevno
- From the Department of Forensic Medicine, Moscow Regional Research and Clinical Institute ("MONIKI")
| | - Vasiliy V Vlassov
- Department of Health Care Management and Economics, National Research University Higher School of Economics, Moscow, Russia
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Han L, Zhou J, Hu Z, Fu C, Li X, Liu J, Zhao W, Wu T, Li C, Kang J, Li J, Chen X. Lamivudine remedies alcoholism by activating acetaldehyde dehydrogenase. Biochem Pharmacol 2022; 203:115199. [DOI: 10.1016/j.bcp.2022.115199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022]
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Lai X, Wang X, Wen S, Sun L, Chen R, Zhang Z, Li Q, Cao J, Lai Z, Li Z, Sun S, Liu X. Six Types of Tea Reduce Acute Alcoholism in Mice by Enhancing Ethanol Metabolism, Suppressing Oxidative Stress and Inflammation. Front Nutr 2022; 9:848918. [PMID: 35677547 PMCID: PMC9169692 DOI: 10.3389/fnut.2022.848918] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/02/2022] [Indexed: 12/12/2022] Open
Abstract
Acute alcoholic intoxication (AAI) is a pathological process of multiple system damage caused by a large amount of alcohol, especially in the liver. Although tea extracts alleviate AAI and alcohol-induced liver damage, the mechanisms underlying the protective actions of different types of Chinese tea are unclear. In this study, the AAI mice model was used to explore the functions and mechanisms of six types of tea extract (WEATs) in alleviating AAI. The losing righting reflexes of mice were evaluated to assess the effects of the WEATs on AAI. The levels of the ethanol metabolism enzymes (ADH, ALDH2, CYP2E1), the oxidative stress-related indicators (NRF-2, HO-1, SOD, GSH, CAT, and TG) and the inflammatory factors (TNF-α, iNOS, IL-6, and IL-10) were determined. Black tea and dark tea significantly shortened the sleep time (duration of the loss of righting reflex) and had a good sobering effect. Green tea and oolong tea had the dual effect of prolonging tolerance time (time of losing righting reflex) and shortening sleep time. While white tea had the most significant effect on prolonging tolerance time but with no obvious sobering effect. Black tea, dark tea, and oolong tea significantly up-regulated ADH and ALDH2, and down-regulated CYP2E1. Green tea and white tea significantly increased the levels of Nrf2, GSH, and CAT. Black tea, dark tea and oolong tea markedly increased the levels of HO-1, IL-10, and inhibited TG. Therefore, it is possible that black tea, dark tea and oolong tea reduced AAI by increasing ethanol metabolism, suppressing oxidative stress and inflammation. While green tea was mainly by regulating oxidative stress. White tea may prolong the tolerance time by increasing ethanol metabolism and reducing oxidative stress. Different types of tea have specific chemical compositions and can alleviate AAI. In conclusion, despite variations in the composition and mechanism of action, tea is a potent natural product to alleviate a hangover and protect the liver.
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Affiliation(s)
- Xingfei Lai
- College of Tea Science, Yunnan Agricultural University, Kunming, China
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Xinrong Wang
- College of Tea Science, Yunnan Agricultural University, Kunming, China
| | - Shuai Wen
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Lingli Sun
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Ruohong Chen
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Zhenbiao Zhang
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Qiuhua Li
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Junxi Cao
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Zhaoxiang Lai
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Zhigang Li
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Shili Sun
- Guangdong Provincial Key Laboratory of Tea Plant Resources Innovation and Utilization, Tea Research Institute, Guangdong Academy of Agricultural Sciences, Guangzhou, China
- *Correspondence: Shili Sun,
| | - Xiaohui Liu
- College of Tea Science, Yunnan Agricultural University, Kunming, China
- Xiaohui Liu,
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Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Prevalence of alcohol and other drug use in patients presenting to hospital for fall-related injuries: a systematic review. Inj Prev 2022; 28:381-393. [PMID: 35508365 DOI: 10.1136/injuryprev-2021-044513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Alcohol and other drug (AOD) use is a key preventable risk factor for serious injuries. Prevention strategies to date have largely focused on transport injuries, despite AOD use being a significant risk factor for other injury causes, including falls. This systematic review aimed to report the prevalence of AOD use in patients presenting to hospital for fall-related injuries. METHODS This systematic review includes studies published in English after the year 2010 that objectively measured the prevalence of AOD use in patients presenting to hospital for a fall-related injury. Screening, data extraction and risk of bias assessments were completed by two independent reviewers. Data were presented using narrative synthesis and, where appropriate, meta-analyses. RESULTS A total of 12 707 records were screened. Full texts were retrieved for 2042 records, of which 29 were included. Four studies reported the combined prevalence of any alcohol and/or drug use, generating a pooled prevalence estimate of 37% (95% CI 25% to 49%). Twenty-two records reported on the prevalence of acute alcohol use alone and nine reported specifically on the prevalence of drugs other than alcohol, with prevalence ranging from 2% to 57% and 7% to 46%, respectively. The variation in prevalence estimates likely resulted from differences in toxicology testing methods across studies. CONCLUSIONS AOD exposure was common in hospitalised fall-related injuries. However, research addressing prevalence across different types of falls and the use of drugs other than alcohol was limited. Future research should address these areas to improve our understanding of which populations should be targeted in AOD and injury prevention strategies . PROSPERO REGISTRATION NUMBER CRD42020188746.
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Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jia Ying Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Health Data Research UK, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Behaviours and Health Risks Program, Burnet Institute, Melbourne, Victoria, Australia.,National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
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Clinical effect of ethanol co-use in patients with acute drug toxicity involving the use of central nervous system depressant recreational drugs. Eur J Emerg Med 2022; 29:291-300. [PMID: 35404314 DOI: 10.1097/mej.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE Patients who use recreational drugs frequently co-ingest ethanol, which is considered a central nervous system (CNS) depressant. The clinical relevance of this in acute toxicity involving other CNS depressants is not well described. OBJECTIVE To assess the clinical impact of ethanol co-use in patients presenting to the emergency department (ED) with acute toxicity involving the use of CNS depressant drugs. DESIGN, SETTINGS AND PARTICIPANTS A retrospective multicentre study using data from the Euro-DEN Plus database from January 2014 to December 2019. OUTCOMES MEASURE AND ANALYSIS Comparison of epidemiologic and clinical characteristics, ED and hospital management of patients with CNS depressant intoxication with or without ethanol co-use. MAIN RESULTS Although 7644 (17.5%) of the 43 633 presentations were included, ethanol was co-ingested in 3811 (49.9%). In total 53.3% required medical treatment, 14 patients died. Patients with ethanol co-use more frequently presented with a Glasgow Coma Scale (GCS) ≤8 (34.1% vs. 22.4%; P < 0.001), vomiting (8.1% vs. 4.6%; P < 0.001), anxiety (12 % vs. 6.4%; P < 0.001), agitation/aggression (22% vs. 14.7%; P < 0.001), seizures (3.8% vs. 2.4%; P < 0.001) and hypotension (7.5% vs. 4.6%; P < 0.001). They more often required ambulance transport (85.5% vs. 76.5%; P < 0.001), medical treatment (57.3% vs. 48.0%; P < 0.001), hospitalization (27.7% vs. 18.9%; P < 0.001), and admission to intensive care (12.2% vs. 4.0%; P < 0.001). Subgroup analysis showed that GCS ≤8 was particularly common in patients who combined ethanol with opioids or gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL). CONCLUSION Co-use of ethanol with CNS-depressant drugs appears to increase the risk of adverse effects and is associated with a higher need for medical treatment, especially when ethanol is combined with opioids or GHB/GBL.
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