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Cao C, Zhang L, Shen J. Phosgene-Induced acute lung injury: Approaches for mechanism-based treatment strategies. Front Immunol 2022; 13:917395. [PMID: 35983054 PMCID: PMC9378823 DOI: 10.3389/fimmu.2022.917395] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Phosgene (COCl2) gas is a chemical intermediate of high-volume production with numerous industrial applications worldwide. Due to its high toxicity, accidental exposure to phosgene leads to various chemical injuries, primarily resulting in chemical-induced lung injury due to inhalation. Initially, the illness is mild and presents as coughing, chest tightness, and wheezing; however, within a few hours, symptoms progress to chronic respiratory depression, refractory pulmonary edema, dyspnea, and hypoxemia, which may contribute to acute respiratory distress syndrome or even death in severe cases. Despite rapid advances in medicine, effective treatments for phosgene-inhaled poisoning are lacking. Elucidating the pathophysiology and pathogenesis of acute inhalation toxicity caused by phosgene is necessary for the development of appropriate therapeutics. In this review, we discuss extant literature on relevant mechanisms and therapeutic strategies to highlight novel ideas for the treatment of phosgene-induced acute lung injury.
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Affiliation(s)
- Chao Cao
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, China
- Center of Emergency and Critical Medicine, Jinshan Hospital of Fudan University, Shanghai, China
- Training Center of Acute Poisoning Treatment Technology of Fudan University Shanghai Medical College, Shanghai, China
| | - Lin Zhang
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, China
- Center of Emergency and Critical Medicine, Jinshan Hospital of Fudan University, Shanghai, China
| | - Jie Shen
- Research Center for Chemical Injury, Emergency and Critical Medicine of Fudan University, Shanghai, China
- Key Laboratory of Chemical Injury, Emergency and Critical Medicine of Shanghai Municipal Health Commission, Shanghai, China
- Center of Emergency and Critical Medicine, Jinshan Hospital of Fudan University, Shanghai, China
- Training Center of Acute Poisoning Treatment Technology of Fudan University Shanghai Medical College, Shanghai, China
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Fan Y, Wang J, Feng Z, Cao K, Liu J, Xu H. Hydrogen-rich and hyperoxygenate saline inhibits lipopolysaccharide-induced lung injury through mediating NF-κB/NLRP3 signaling pathway in C57BL/6 mice. ENVIRONMENTAL TOXICOLOGY 2022; 37:1575-1586. [PMID: 35278280 DOI: 10.1002/tox.23507] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/21/2022] [Accepted: 02/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Background: Acute lung injury (ALI) is one kind of frequently occurred emergency in Intensive Care Unite with a high mortality. The underlying causes are uncontrolled inflammatory reactions and intractable hypoxemia, which are difficult to control and improve. In the past 10 years, gas medical studies have found that both hydrogen molecules and oxygen molecules have protective effects on acute lung injury by improving inflammatory reactions and hypoxia, respectively. Oxygen is an oxidant and hydrogen is an antioxidant. In this study, we investigated the combined effect of above two-gas molecular on lipopolysaccharide (LPS) -induced acute lung injury. METHODS To clarify whether the combination of hydrogen and oxygen could increase or cancel out the protective effect, an ALI mice model induced by intraperitoneal injection of LPS was established, and the degree of lung tissue and mitochondria damage was evaluated based on the pathological sections, inflammatory factors, wet-dry ratio, bronchoalveolar lavage fluid (BALF). Immunohistochemistry, electron microscopy, western blotting and other detection methods also used to evaluate the therapeutic effect on acute lung injury model. RESULTS We observed that the combined protective effect of hydrogen and oxygen was superior to their respective protective effects, and the specific molecular mechanisms of the two therapies might be different. CONCLUSION Hydrogen plays a more important role in the inflammatory and anti-apoptosis mechanisms, while oxygen improves hypoxia of the body, and thus, its molecular mechanism may be closely associated to the hypoxia pathways.
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Affiliation(s)
- Yingying Fan
- Center for Mitochondrial Biology and Medicine and Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Jian Wang
- Department of Ear-nose-throat, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, China
| | - Zhihui Feng
- Center for Mitochondrial Biology and Medicine and Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Ke Cao
- Center for Mitochondrial Biology and Medicine and Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Jiankang Liu
- Center for Mitochondrial Biology and Medicine and Key Laboratory of Biomedical Information Engineering of the Ministry of Education, School of Life Science and Technology, and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Hao Xu
- Institution of Basic Medical Science, Xi'an Medical University, Xi'an, China
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Wang J, Tuo Z, Zhang J, Guo P, Song B. Hyperoxygenated solution improves tissue viability in an avulsion injury flap model. J Plast Reconstr Aesthet Surg 2019; 73:975-982. [PMID: 31899115 DOI: 10.1016/j.bjps.2019.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/18/2019] [Accepted: 11/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Management of avulsion injuries remains a challenge due to necrosis. The aim of the present study is to create an experimental model reproducing an avulsion injury and investigate the effects of hyperoxygenated solution (HOS), a method of oxygen delivery that has been widely used in the therapy of ischaemia-hypoxia diseases, on avulsion injury flap survival in rats. METHODS Forty male rats were divided into four groups (n = 10 each). Dorsal random pattern flaps measuring 3 × 9 cm, including the panniculus carnosus, were elevated and run over by the skin avulsion model machine, and the flaps were then sutured into their original places. The sham+HOS and avulsion+HOS groups received intravenous HOS (20 ml/kg) each day for 7 days after the operation. The sham+saline and avulsion+saline groups received intravenous saline solution (20 ml/kg) each day for 7 days after the operation. Percutaneous O2 pressure (TcpO2) measurement, serial examinations of skin flap blood perfusion, skin flap survival evaluation and histopathology were performed to assess the efficacy of HOS on avulsion injury. RESULTS Compared to the avulsion+saline groups, TcpO2 was significantly higher in the avulsion+HOS groups at 15, 30 and 60 min after infusion (P < 0.05). The blood perfusion of flaps in the avulsion+HOS group was higher than in the avulsion+saline group (P < 0.05). The survival rate was higher in the avulsion+HOS group than in the avulsion+saline group (P < 0.05), and the histopathology assays supported the data. CONCLUSION We succeeded in developing an avulsion injury model and demonstrated that HOS could improve the survival of the avulsion injury flaps in rats by effectively increasing the local oxygen content and blood perfusion and ameliorating inflammatory damage.
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Affiliation(s)
- Jianzhang Wang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No.127 Changle West Road, Xi'an, Shanxi Province 710032, People's Republic of China
| | - Zhangqiang Tuo
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No.127 Changle West Road, Xi'an, Shanxi Province 710032, People's Republic of China
| | - Juan Zhang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No.127 Changle West Road, Xi'an, Shanxi Province 710032, People's Republic of China
| | - Peng Guo
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No.127 Changle West Road, Xi'an, Shanxi Province 710032, People's Republic of China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, No.127 Changle West Road, Xi'an, Shanxi Province 710032, People's Republic of China.
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Meng X, Xu H, Dang Y, Fan Y, Lv M, Sang H, Xu L. Hyperoxygenated Hydrogen-Rich Solution Suppresses Lung Injury Induced by Hemorrhagic Shock in Rats. J Surg Res 2019; 239:103-114. [PMID: 30825755 DOI: 10.1016/j.jss.2019.01.050] [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: 06/11/2018] [Revised: 12/06/2018] [Accepted: 01/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hemorrhagic shock could induce acute lung injury (ALI), which is associated with cell hypoxia, lung tissue inflammation, free radical damage, and excessive cell apoptosis. Our previous studies demonstrated that hyperoxygenated solution could alleviate cell hypoxia. Furthermore, hydrogen-rich solution (HS) could relieve lung tissue inflammation, free radical damage and excessive cell apoptosis. Therefore we hypothesize that Hyperoxygenated Hydrogen-rich solution (HOHS) can protect the lung against ALI. MATERIALS AND METHODS SD rats were randomly divided into five groups (n = 6 at each time point in each group) and were exposed to Hemorrhagic shock induced ALI, and then treated with lactated Ringer's solution (LRS), hyperoxygenated solution, HS, and HOHS, respectively. The protective effects of these solutions were assessed using methods as follows: arterial blood samples were collected for blood gas analysis; Bronchoalveolar lavage fluid was collected for cell count and protein quantification; lung tissue samples were collected to measure wet/dry ratio, as well as levels of T-SOD, MDA, TNF-α, and IL-6; Caspase-3 and TUNEL-positive cells, and pathological changes were observed under light microscope; ALI was scored using the Smith scoring method; ultrastructural changes of lung tissues were further observed with transmission electron microscopy. RESULTS The results indicated that PaO2, PaCO2, and T-SOD increased in the three treatment groups (P < 0.05), most significantly in the HOHS group (P < 0.01) compared with the LRS group; and conversely that the levels of lactate, MDA, TNF-α and IL-6, cell count, protein content, caspase-3 and TUNEL-positive cells as well as ALI score decreased in the three treatment groups (P < 0.05), most significantly in the HOHS group (P < 0.01) compared with the LRS group. Morphological observation with optical microscope and electron microscopy showed that compared with the LRS group, cell damage in the three treatment groups improved to a varying extent, especially evident in the HOHS group. CONCLUSIONS These findings demonstrate that HOHS can protect the lung against ALI induced by hemorrhagic shock.
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Affiliation(s)
- Xiangzhong Meng
- Department of Anesthesiology, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, School of Stomatology, Air Force Medical University, Xi'an, Shaanxi, China
| | - Hao Xu
- Institution of Basic Medical Science, Xi'an Medical University, Xi'an, China
| | - Yangjie Dang
- The Department of Anesthesiology, Children Hospital of Xi'an, Xi'an, Shaanxi, China
| | - Yingying Fan
- Center for Mitochondrial Biology and Medicine and Key Laboratory of Biochemical Information Engineering of the Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Miaomiao Lv
- Department of Anesthesiology, No. 323 Hospital of PLA, Xi'an, China
| | - Hanfei Sang
- Department of Anesthesiology, Xiang'an Hospital of Xiamen Uiversity, Xiamen, Fujian Province, P.R., China
| | - Lixian Xu
- Department of Anesthesiology, State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Engineering Research Center for Dental Materials and Advanced Manufacture, School of Stomatology, Air Force Medical University, Xi'an, Shaanxi, China.
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Abstract
The transport of specific molecules across lipid membranes is an essential function of all living organisms. The processes are usually mediated by specific transporters. One of the largest transporter families is the ATP-binding cassette (ABC) family. More than 40 ABC transporters have been identified in human, which are divided into 7 subfamilies (ABCA to ABCG) based on their gene structure, amino acid sequence, domain organization, and phylogenetic analysis. Of them, at least 11 ABC transporters including P-glycoprotein (P-GP/ABCB1), multidrug resistance-associated proteins (MRPs/ABCCs), and breast cancer resistance protein (BCRP/ABCG2) are involved in multidrug resistance (MDR) development. These ABC transporters are expressed in various tissues such as the liver, intestine, kidney, and brain, playing important roles in absorption, distribution, and excretion of drugs. Some ABC transporters are also involved in diverse cellular processes such as maintenance of osmotic homeostasis, antigen processing, cell division, immunity, cholesterol, and lipid trafficking. Several human diseases such as cystic fibrosis, sitosterolemia, Tangier disease, intrahepatic cholestasis, and retinal degeneration are associated with mutations in corresponding transporters. This chapter will describe function and expression of several ABC transporters (such as P-GP, BCRP, and MRPs), their substrates and inhibitors, as well as their clinical significance.
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Affiliation(s)
- Xiaodong Liu
- China Pharmaceutical University, Nanjing, China.
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Tange Y, Yoshitake S. Data on a simple method for producing a solution that contains a high partial pressure of oxygen and a low partial pressure of carbon dioxide. Data Brief 2018; 18:176-179. [PMID: 29896508 PMCID: PMC5996131 DOI: 10.1016/j.dib.2018.02.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/27/2018] [Indexed: 11/28/2022] Open
Abstract
The data presented here shows a simple method for producing a solution that contains a high partial pressure of oxygen (pO2) and a low partial pressure of carbon dioxide (pCO2). This novel solution was created by simply injecting oxygen gas into conventional supplemental bicarbonate fluid for renal replacement therapy. We compared the gas profiles of the novel solution and the conventional fluid in vitro. There was a significant increase in pO2 and pH, and a significant decrease in pCO2 in the experimental solution, in each of which an additional volume of oxygen was injected. The method shown here is capable of facilitating an increase of pO2 and decrease of pCO2 by using a closed fluid bag without any special devices.
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Gehlbach JA, Rehder KJ, Gentile MA, Turner DA, Grady DJ, Cheifetz IM. Intravenous oxygen: a novel method of oxygen delivery in hypoxemic respiratory failure? Expert Rev Respir Med 2016; 11:73-80. [PMID: 27910706 DOI: 10.1080/17476348.2017.1267568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Hypoxemic respiratory failure is a common problem in critical care. Current management strategies, including mechanical ventilation and extracorporeal membranous oxygenation, can be efficacious but these therapies put patients at risk for toxicities associated with invasive forms of support. Areas covered: In this manuscript, we discuss intravenous oxygen (IVO2), a novel method to improve oxygen delivery that involves intravenous administration of a physiologic solution containing dissolved oxygen at hyperbaric concentrations. After a brief review of the physiology behind supersaturated fluids, we summarize the current evidence surrounding IVO2. Expert commentary: Although not yet at the stage of clinical testing in the United States and Europe, IVO2 has been used safely in Asia. Furthermore, preliminary laboratory data have been encouraging, suggesting that IVO2 may play a role in the management of patients with hypoxemic respiratory failure in years to come. However, significantly more work needs to be done, including definitive evidence that such a therapy is safe, before it can be included in an intensivist's arsenal for hypoxemic respiratory failure.
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Affiliation(s)
- Jonathan A Gehlbach
- a Department of Pediatrics, Division of Pediatric Critical Care Medicine , Duke Children's Hospital , Durham , NC , USA
| | - Kyle J Rehder
- a Department of Pediatrics, Division of Pediatric Critical Care Medicine , Duke Children's Hospital , Durham , NC , USA
| | - Michael A Gentile
- a Department of Pediatrics, Division of Pediatric Critical Care Medicine , Duke Children's Hospital , Durham , NC , USA
| | - David A Turner
- a Department of Pediatrics, Division of Pediatric Critical Care Medicine , Duke Children's Hospital , Durham , NC , USA
| | | | - Ira M Cheifetz
- a Department of Pediatrics, Division of Pediatric Critical Care Medicine , Duke Children's Hospital , Durham , NC , USA
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Grady DJ, Gentile MA, Riggs JH, Cheifetz IM. Improved arterial blood oxygenation following intravenous infusion of cold supersaturated dissolved oxygen solution. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2014; 8:11-6. [PMID: 25249764 PMCID: PMC4167317 DOI: 10.4137/ccrpm.s16760] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND One of the primary goals of critical care medicine is to support adequate gas exchange without iatrogenic sequelae. An emerging method of delivering supplemental oxygen is intravenously rather than via the traditional inhalation route. The objective of this study was to evaluate the gas-exchange effects of infusing cold intravenous (IV) fluids containing very high partial pressures of dissolved oxygen (>760 mm Hg) in a porcine model. METHODS Juvenile swines were anesthetized and mechanically ventilated. Each animal received an infusion of cold (13 °C) Ringer’s lactate solution (30 mL/kg/hour), which had been supersaturated with dissolved oxygen gas (39.7 mg/L dissolved oxygen, 992 mm Hg, 30.5 mL/L). Arterial blood gases and physiologic measurements were repeated at 15-minute intervals during a 60-minute IV infusion of the supersaturated dissolved oxygen solution. Each animal served as its own control. RESULTS Five swines (12.9 ± 0.9 kg) were studied. Following the 60-minute infusion, there were significant increases in PaO2 and SaO2 (P < 0.05) and a significant decrease in PaCO2 (P < 0.05), with a corresponding normalization in arterial blood pH. Additionally, there was a significant decrease in core body temperature (P < 0.05) when compared to the baseline preinfusion state. CONCLUSIONS A cold, supersaturated dissolved oxygen solution may be intravenously administered to improve arterial blood oxygenation and ventilation parameters and induce a mild therapeutic hypothermia in a porcine model.
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Affiliation(s)
| | - Michael A Gentile
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, NC
| | | | - Ira M Cheifetz
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, NC
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Xu H, Li Y, Gao W, Zhang H, Xu LX. Hyperoxygenated solutions in clinical practice: preventing or reducing hypoxic injury. J Int Med Res 2012; 39:1589-606. [PMID: 22117960 DOI: 10.1177/147323001103900502] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In cases of hypoxia, oxygen can be supplied via a number of methods including face masks, nasal cannulae, hyperoxygenated oxygen chambers and mechanical ventilation. Administering oxygen via the respiratory tract is, however, limited in respiratory diseases such as pulmonary fibrosis, pneumoconiosis and severe acute respiratory syndrome, or following the inhalation of asphyxiating poisons. This has led to research into new methods of supplying oxygen that bypass the lungs. Research has investigated the efficacy of intravenous hyperoxygenated solutions (HOS) as auxiliary oxygen supplies in several hypoxic states including cardiopulmonary resuscitation, respiratory failure, cerebrovascular disease, myocardial ischaemia, severe acute respiratory syndrome, poisoning, neonatal hypoxia, altitude sickness, large burns and traumatic haemorrhagic shock. Much of the research has taken place in China and more than 3.5 million hypoxic patients have received HOS, with good therapeutic effects. This review summarizes the literature supporting the use of this novel treatment.
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Affiliation(s)
- H Xu
- Department of Anaesthesiology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
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